A few weeks ago, my wife Susan received a letter from her longtime primary care physician. Concerned that her large practice made it difficult for her to give patients the attention and care they deserve, this doctor proudly announced that she was converting to a smaller but more personalized practice, and invited Susan to apply. If Susan acts now, and is among the first 600 patients to scrape together the new $1,500 annual membership fee, she can enjoy continued access to her beloved doctor; otherwise, she'll have to find a new one.
Welcome to the new Club Med.
Susan's doctor has chosen to affiliate with MDVIP, a company in the growing field of "concierge medicine" or "boutique medicine". In the MDVIP business model, each doctor limits the practice to a 600-patient maximum, each of whom pays $1,500 per year. Of that $900,000 annual "dues" coming in to the doctor, MDVIP keeps a third for help with administration, marketing, and research, leaving the doctor with a guaranteed annual income of $600,000 and no cumbersome insurance paperwork. For the patient, that $1,500/year has to come out of pocket - your insurance doesn't pay for it - although MDVIP says you can use your pre-tax Flexible Spending Account, if your employer lets you set one up.
MDVIP is experiencing a growth spurt. In 2006 they had about 100 doctors; the number now is 350. While Susan's doctor is one of only 5 MDVIP franchisees in Pennsylvania, neighboring New Jersey has 9, New York has 13, and California has 51. This growth may accelerate even more now that consumer products company Procter & Gamble has completed its buyout of MDVIP. No word yet on whether this corporate partnership means your MDVIP doctor will be advising you on the health benefits of P&G products such as Prilosec.
There are other concierge medicine "clubs" with even higher annual fees than MDVIP. MD2 charges over $10,000/year for the privilege of being one of only 50 families in your doctor's practice. Concierge Medicine/LA has a sliding scale fee based on age, from $1,750/year to $10,000/year, in return for the type of annual physical they say the U.S. President receives.
This gets to the core of what should be the starting point for any national debate on health care: what do we, as a nation, believe about the type of healthcare people should receive? Is health care a right, where all people deserve the type of comprehensive exams and easy access that the U.S. President or a corporate CEO receives? Or is health care a privilege, where such boutique-level services are rationed according to one's ability to pay?
Susan will be looking for another doctor, since this $1,500/year Club Med fee doesn't fit within our family budget. Meanwhile, our oldest daughter is only able to remain on my employer-provided health insurance as long as she's a full-time student. Once Kate finishes college, she'll have to find her own insurance, provided she doesn't get denied because her asthma is deemed to be a pre-existing condition. Welcome to the world of those priced out of these concierge clubs - the world of steerage medicine.
Sunday, February 28, 2010
Sunday, February 21, 2010
The Antidemocratic Democratic Majority
In his 1966 soul hit, Wilson Pickett told his lover that "Ninety-Nine and a Half Won't Do"; he needed all 100% of her love. Today, Senate Majority "Leader" Harry Reid seems to believe that fifty-nine and a half won't do; unless he has 60% of the Senate aligned on an issue, he won't bring a bill to the floor for a vote.
Funny, but I thought that anything over 50% was how democracy worked.
The latest policy issue to hit this anti-democratic brick wall is the healthcare "public option". Polls consistently show that a majority of the U.S. supports such a government-sponsored, non-profit public health insurance plan to provide some much-needed competition to the for-profit health insurance industry. A majority of U.S. Senators have expressed support for it. Yet the public option was stripped out of the Senate health reform bill as part of the Democrats' quixotic quest to win over enough conservative Democrats and/or "moderate Republicans" to reach the 60% supermajority needed to avoid a filibuster. That didn't happen, yet the public option remains out of the bill.
Senator Michael Bennet (D-CO) is circulating a letter to Reid asking that the public option be brought to a vote under the reconciliation process, which only requires a simple majority (51 Senators, or even just 50 if Vice-President Biden can then cast the tie-breaking vote). The Progressive Change Campaign Committee is asking us to call our Democratic Senators and ask them to sign the letter; 20 have signed it so far, including progressives Bernie Sanders (I-VT), Sherrod Brown (D-OH), and Barbara Boxer (D-CA). Even one of my own Senators, the "born-again Democrat" Arlen Specter (?-PA), signed on Friday, no doubt as a result of my call to his office earlier that day.
Isn't it sad that, having elected a Democratic majority to the House and Senate, as well as a Democratic President, we now have to call and beg our members of Congress to actually use that majority to pass a bill?
Barack Obama was elected President in 2008 with 53% of the popular vote. Why should he now be required to muster a 60% supermajority in the U.S. Senate to get any new laws?
Let's see how this rule would have affected a famous vote from our past. On June 4, 1919, after several failed attempts, the Senate finally passed a bill guaranteeing the right of women to vote. After being ratified by the required number of states, this bill became the 19th Amendment to the U.S. Constitution in 1920.
That bill passed the Senate with 56 out of 96 votes (we only had 48 states at the time), or 58.3% of the full Senate.
Harry Reid would have waited until he had a 60% supermajority, or 58 votes out of 96. With his brand of leadership, we might still be waiting for women to have the vote.
Some Senators, such as Tom Harkin (D-IA), are trying to change these rules (see his interview with the WaPo's Ezra Klein back in December for some interesting perspective). This 60% rule is anti-democratic in the way it's being used to thwart the will of the majority. It's got to go.
Funny, but I thought that anything over 50% was how democracy worked.
The latest policy issue to hit this anti-democratic brick wall is the healthcare "public option". Polls consistently show that a majority of the U.S. supports such a government-sponsored, non-profit public health insurance plan to provide some much-needed competition to the for-profit health insurance industry. A majority of U.S. Senators have expressed support for it. Yet the public option was stripped out of the Senate health reform bill as part of the Democrats' quixotic quest to win over enough conservative Democrats and/or "moderate Republicans" to reach the 60% supermajority needed to avoid a filibuster. That didn't happen, yet the public option remains out of the bill.
Senator Michael Bennet (D-CO) is circulating a letter to Reid asking that the public option be brought to a vote under the reconciliation process, which only requires a simple majority (51 Senators, or even just 50 if Vice-President Biden can then cast the tie-breaking vote). The Progressive Change Campaign Committee is asking us to call our Democratic Senators and ask them to sign the letter; 20 have signed it so far, including progressives Bernie Sanders (I-VT), Sherrod Brown (D-OH), and Barbara Boxer (D-CA). Even one of my own Senators, the "born-again Democrat" Arlen Specter (?-PA), signed on Friday, no doubt as a result of my call to his office earlier that day.
Isn't it sad that, having elected a Democratic majority to the House and Senate, as well as a Democratic President, we now have to call and beg our members of Congress to actually use that majority to pass a bill?
Barack Obama was elected President in 2008 with 53% of the popular vote. Why should he now be required to muster a 60% supermajority in the U.S. Senate to get any new laws?
Let's see how this rule would have affected a famous vote from our past. On June 4, 1919, after several failed attempts, the Senate finally passed a bill guaranteeing the right of women to vote. After being ratified by the required number of states, this bill became the 19th Amendment to the U.S. Constitution in 1920.
That bill passed the Senate with 56 out of 96 votes (we only had 48 states at the time), or 58.3% of the full Senate.
Harry Reid would have waited until he had a 60% supermajority, or 58 votes out of 96. With his brand of leadership, we might still be waiting for women to have the vote.
Some Senators, such as Tom Harkin (D-IA), are trying to change these rules (see his interview with the WaPo's Ezra Klein back in December for some interesting perspective). This 60% rule is anti-democratic in the way it's being used to thwart the will of the majority. It's got to go.
Saturday, February 13, 2010
Joan Baez Not Afraid To Change Subject At Civil Rights Celebration
During the February 11 PBS broadcast of "In Performance at the White House: A Celebration of Music from the Civil Rights Movement", artists including Smokey Robinson, Natalie Cole, and Bob Dylan sang some of the songs that had accompanied activists as they challenged racial prejudice. Joan Baez, as usual pushing the envelope of discussion, attempted to remind the audience of the connections between fighting injustice and violence at home and fighting our government's efforts to wage war in other countries.
After singing two verses of "We Shall Overcome", the anthem she memorably sang at the 1963 March on Washington, Baez recalled Martin Luther King, Jr.'s decision to speak out against the Vietnam War. She said they had sung the words "We are not afraid" to this tune, to help King overcome his fear of taking on such a controversial topic, then led the audience in singing that verse.
If the members of that audience, which included the Obama family along with members of Congress and the Cabinet, are curious about what King ended up saying, they should read the speech he gave on April 4, 1967 at Riverside Church in New York City. Titled "Beyond Vietnam: A Time to Break Silence", it still has relevance today.
In answer to questions about why he was speaking out against the war, King said that "America would never invest the necessary funds or energies in rehabilitation of its poor so long as adventures like Vietnam continue to draw men and skills and money like some demonic destructive suction tube." Substitute "Afghanistan" for "Vietnam", and contrast the vast sums of money we continue to spend on that war with the apparent lack of money available for domestic programs, and you'll see how little has changed.
King did not just focus on our government's war in Vietnam, however. He asked us to "look at our alliance with the landed gentry of Latin America", and pointed to the U.S. military presence in Venezuela, Guatemala, Columbia, and Peru. Today our military is still active in Columbia, supporting the business-friendly Uribe government while workers are murdered for organizing unions. The Obama administration's refusal to strongly oppose last June's coup in Honduras seems to once again confirm that, as King said, "we are on the side of the wealthy and the secure while we create hell for the poor." As President Obama continues to push Congress for approval of so-called Free Trade Agreements with Columbia and South Korea, he should instead heed Dr. King's admonition to not let "the need to maintain social stability for our investments" drive our foreign policy.
One can only guess how King would have reacted to the recent Citizens United v. FEC Supreme Court ruling that corporations have the same free speech rights as persons; but he seems to have foreseen such a distorted set of values in 1967 by warning that "when machines and computers, profit motives and property rights are considered more important than people, the giant triplets of racism, materialism, and militarism are incapable of being conquered."
During his January 27 State of the Union address, President Obama called for a spending freeze on most government programs, but exempted the Department of Defense budget, for which he's actually proposing a spending increase. Forty-three years earlier, in his Riverside Church speech, Dr. King told us that "a nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death."
President Obama should take this hint from Joan Baez, read King's 1967 speech, and consider what his administration's policies say about our nation's values. Otherwise, the election of an African-American President who merely perpetuates the policies of his white predecessors, while ignoring the need for what King called a "revolution of values", will be a hollow victory.
After singing two verses of "We Shall Overcome", the anthem she memorably sang at the 1963 March on Washington, Baez recalled Martin Luther King, Jr.'s decision to speak out against the Vietnam War. She said they had sung the words "We are not afraid" to this tune, to help King overcome his fear of taking on such a controversial topic, then led the audience in singing that verse.
If the members of that audience, which included the Obama family along with members of Congress and the Cabinet, are curious about what King ended up saying, they should read the speech he gave on April 4, 1967 at Riverside Church in New York City. Titled "Beyond Vietnam: A Time to Break Silence", it still has relevance today.
In answer to questions about why he was speaking out against the war, King said that "America would never invest the necessary funds or energies in rehabilitation of its poor so long as adventures like Vietnam continue to draw men and skills and money like some demonic destructive suction tube." Substitute "Afghanistan" for "Vietnam", and contrast the vast sums of money we continue to spend on that war with the apparent lack of money available for domestic programs, and you'll see how little has changed.
King did not just focus on our government's war in Vietnam, however. He asked us to "look at our alliance with the landed gentry of Latin America", and pointed to the U.S. military presence in Venezuela, Guatemala, Columbia, and Peru. Today our military is still active in Columbia, supporting the business-friendly Uribe government while workers are murdered for organizing unions. The Obama administration's refusal to strongly oppose last June's coup in Honduras seems to once again confirm that, as King said, "we are on the side of the wealthy and the secure while we create hell for the poor." As President Obama continues to push Congress for approval of so-called Free Trade Agreements with Columbia and South Korea, he should instead heed Dr. King's admonition to not let "the need to maintain social stability for our investments" drive our foreign policy.
One can only guess how King would have reacted to the recent Citizens United v. FEC Supreme Court ruling that corporations have the same free speech rights as persons; but he seems to have foreseen such a distorted set of values in 1967 by warning that "when machines and computers, profit motives and property rights are considered more important than people, the giant triplets of racism, materialism, and militarism are incapable of being conquered."
During his January 27 State of the Union address, President Obama called for a spending freeze on most government programs, but exempted the Department of Defense budget, for which he's actually proposing a spending increase. Forty-three years earlier, in his Riverside Church speech, Dr. King told us that "a nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death."
President Obama should take this hint from Joan Baez, read King's 1967 speech, and consider what his administration's policies say about our nation's values. Otherwise, the election of an African-American President who merely perpetuates the policies of his white predecessors, while ignoring the need for what King called a "revolution of values", will be a hollow victory.
Saturday, February 6, 2010
The Colorblind Soul of Stax
Fifty years ago, on February 1, 1960, four black college students walked into the Woolworth's store in Greensboro, North Carolina, and sat at the "whites only" section of the lunch counter to buy something to eat. This sparked a wave of similar sit-ins across the southern U.S. to challenge the long-standing "Jim Crow" laws of separate facilities for "white" and "colored".
Around that same time, though, blacks and whites were working together in the Southern city of Memphis, Tennessee to create incredible soul music that still sounds sweet today. At the Stax Records building on McLemore Avenue, there were no separate sections for "white" and "colored".
Brother and sister Jim Stewart and Estelle Axton, two white businesspeople in Memphis, used the first two letters of their last names (STewart/AXton) to come up with the name of their record label and studio in 1961. Over the next several years they produced crossover hits on both the R&B and pop charts by artists including Sam & Dave ("Soul Man", "Hold On, I'm Coming"), Eddie Floyd ("Knock On Wood"), Carla Thomas ("B-A-B-Y"), Wilson Pickett ("In The Midnight Hour"), and Otis Redding ("Respect", "Try A Little Tenderness", "(Sittin' On) The Dock Of The Bay").
Part of what wove these songs by different artists into a cohesive Stax sound was the label's house band, the core of which also recorded instrumental hits as Booker T. & the MGs ("Green Onions", "Time Is Tight"). This integrated band of two black guys (Booker T. Jones on keyboards, Al Jackson on drums) and two white guys (Steve Cropper on guitar, Lewie Steinberg and later Donald "Duck" Dunn on bass) often surprised audiences at concerts and TV viewers who expected to see an all-black band. The image of blacks and whites working side-by-side, bound together by their love of the music they were co-creating, helped smash the assumptions behind the segregation laws just as surely as the images of blacks and whites trying to drink coffee together.
In a 2005 interview for Philadelphia's WXPN radio station, Cropper reflected on this colorblind atmosphere: "As far as I know the whole time I was at Stax Records there was absolutely zero color. Everybody came in there equal through those doors." Isaac Hayes, who cowrote many Sam & Dave hits with David Porter before starting his solo career, confirmed this in his own WXPN interview in 2003: "We were all mixed there. We were a family. And that's a testament of the power of artistry, because it has no boundaries. Music has no boundaries. It's a human process and that's what brought us together."
Cropper and Dunn helped revive interest in this music in the late 1970s by playing in The Blues Brothers band. Despite their name, a nod to the electric Chicago blues of Chess Records, many of this comedy/musical act's songs came right out of the Stax catalog: frontmen John Belushi and Dan Aykroyd would run out on stage while the band played Redding's "I Can't Turn You Loose"; they had a hit single with a remake of Sam & Dave's "Soul Man"; and their third album featured remakes of The Bar-Kay's "Soul Finger" and the MGs' "Green Onions". Belushi and Aykroyd were the first to admit that their versions were at best pale imitations of the originals, and they urged fans to revisit those original recordings. During a scene in their 1980 movie when Aykroyd pushes an 8-track tape cartridge into his car's player, the camera lingers on the "Best Of Sam & Dave" label as the music plays, as if to say, "buy this album!".
Yes, by all means, buy this incredible music, and celebrate the example of these artists for whom the important question was not whether you were "white" or "colored", but only if you had soul.
Around that same time, though, blacks and whites were working together in the Southern city of Memphis, Tennessee to create incredible soul music that still sounds sweet today. At the Stax Records building on McLemore Avenue, there were no separate sections for "white" and "colored".
Brother and sister Jim Stewart and Estelle Axton, two white businesspeople in Memphis, used the first two letters of their last names (STewart/AXton) to come up with the name of their record label and studio in 1961. Over the next several years they produced crossover hits on both the R&B and pop charts by artists including Sam & Dave ("Soul Man", "Hold On, I'm Coming"), Eddie Floyd ("Knock On Wood"), Carla Thomas ("B-A-B-Y"), Wilson Pickett ("In The Midnight Hour"), and Otis Redding ("Respect", "Try A Little Tenderness", "(Sittin' On) The Dock Of The Bay").
Part of what wove these songs by different artists into a cohesive Stax sound was the label's house band, the core of which also recorded instrumental hits as Booker T. & the MGs ("Green Onions", "Time Is Tight"). This integrated band of two black guys (Booker T. Jones on keyboards, Al Jackson on drums) and two white guys (Steve Cropper on guitar, Lewie Steinberg and later Donald "Duck" Dunn on bass) often surprised audiences at concerts and TV viewers who expected to see an all-black band. The image of blacks and whites working side-by-side, bound together by their love of the music they were co-creating, helped smash the assumptions behind the segregation laws just as surely as the images of blacks and whites trying to drink coffee together.
In a 2005 interview for Philadelphia's WXPN radio station, Cropper reflected on this colorblind atmosphere: "As far as I know the whole time I was at Stax Records there was absolutely zero color. Everybody came in there equal through those doors." Isaac Hayes, who cowrote many Sam & Dave hits with David Porter before starting his solo career, confirmed this in his own WXPN interview in 2003: "We were all mixed there. We were a family. And that's a testament of the power of artistry, because it has no boundaries. Music has no boundaries. It's a human process and that's what brought us together."
Cropper and Dunn helped revive interest in this music in the late 1970s by playing in The Blues Brothers band. Despite their name, a nod to the electric Chicago blues of Chess Records, many of this comedy/musical act's songs came right out of the Stax catalog: frontmen John Belushi and Dan Aykroyd would run out on stage while the band played Redding's "I Can't Turn You Loose"; they had a hit single with a remake of Sam & Dave's "Soul Man"; and their third album featured remakes of The Bar-Kay's "Soul Finger" and the MGs' "Green Onions". Belushi and Aykroyd were the first to admit that their versions were at best pale imitations of the originals, and they urged fans to revisit those original recordings. During a scene in their 1980 movie when Aykroyd pushes an 8-track tape cartridge into his car's player, the camera lingers on the "Best Of Sam & Dave" label as the music plays, as if to say, "buy this album!".
Yes, by all means, buy this incredible music, and celebrate the example of these artists for whom the important question was not whether you were "white" or "colored", but only if you had soul.
Subscribe to:
Posts (Atom)