Noam Chomsky on How the United States Developed Such a Scandalous Health System

http://www.truth-out.org/opinion/item/41488-noam-chomsky-on-how-the-united-states-developed-such-a-scandalous-health-system

In a new book of Truthout interviews, Noam Chomsky discusses capitalism, US imperialism, Black Lives Matter, the refugee crisis and cracks in the European Union, the dysfunctional US electoral system, the climate crisis and more. Order Optimism Over Despair: Noam Chomsky On Capitalism, Empire, and Social Change today with a donation to Truthout!

In the following excerpt, originally published at Truthout in January 2017, shortly before Donald Trump’s inauguration, Chomsky discusses the historical and political factors that have created and maintained such a shamefully profit-driven health system in the United States.

C.J. Polychroniou: Article 25 of the UN Universal Declaration on Human Rights (UDHR) states that the right to health care is indeed a human right. Yet, it is estimated that close to 30 million Americans remain uninsured even with the 2010 Patient Protection and Affordable Care Act (ACA) in place. What are some of the key cultural, economic and political factors that make the US an outlier in the provision of free health care?

Noam Chomsky: First, it is important to remember that the US does not accept the Universal Declaration of Human Rights — though in fact the UDHR was largely the initiative of Eleanor Roosevelt, who chaired the commission that drafted its articles, with quite broad international participation.

The UDHR has three components, which are of equal status: civil-political, socioeconomic and cultural rights. The US formally accepts the first of the three, though it has often violated its provisions. The US pretty much disregards the third. And to the point here, the US has officially and strongly condemned the second component, socioeconomic rights, including Article 25.

Opposition to Article 25 was particularly vehement in the Reagan and Bush I years. Paula Dobriansky, deputy assistant secretary of state for human rights and humanitarian affairs in these administrations, dismissed the “myth” that “‘economic and social rights constitute human rights,” as the UDHR declares. She was following the lead of Reagan’s UN Ambassador Jeane Kirkpatrick, who ridiculed the myth as “little more than an empty vessel into which vague hopes and inchoate expectations can be poured.” Kirkpatrick thus joined Soviet Ambassador Andrei Vyshinsky, who agreed that it was a mere “collection of pious phrases.” The concepts of Article 25 are “preposterous” and even a “dangerous incitement,” according to ambassador Morris Abram, the distinguished civil rights attorney who was US Representative to the UN Commission on Human Rights under Bush I, casting the sole veto of the UN Right to Development, which closely paraphrased Article 25 of the UDHR. The Bush II administration maintained the tradition by voting alone to reject a UN resolution on the right to food and the right to the highest attainable standard of physical and mental health (the resolution passed 52-1).

Rejection of Article 25, then, is a matter of principle. And also a matter of practice. In the OECD ranking of social justice, the US is in twenty-seventh place out of thirty-one, right above Greece, Chile, Mexico and Turkey. This is happening in the richest country in world history, with incomparable advantages. It was quite possibly already the richest region in the world in the eighteenth century.

In extenuation of the Reagan-Bush-Vyshinsky alliance on this matter, we should recognize that formal support for the UDHR is all too often divorced from practice.

US dismissal of the UDHR in principle and practice extends to other areas. Take labor rights. The US has failed to ratify the first principle of the International Labour Organization Convention, which endorses “Freedom of Association and Protection of the Right to Organise.” An editorial comment in the American Journal of International Law refers to this provision of the International Labour Organization Convention as “the untouchable treaty in American politics.” US rejection is guarded with such fervor, the report continues, that there has never even been any debate about the matter. The rejection of International Labour Organization Conventions contrasts dramatically with the fervor of Washington’s dedication to the highly protectionist elements of the misnamed “free trade agreements,” designed to guarantee monopoly pricing rights for corporations (“intellectual property rights”), on spurious grounds. In general, it would be more accurate to call these “investor rights agreements.”

Comparison of the attitude toward elementary rights of labor and extraordinary rights of private power tells us a good deal about the nature of American society.

Furthermore, US labor history is unusually violent. Hundreds of US workers were being killed by private and state security forces in strike actions, practices unknown in similar countries. In her history of American labor, Patricia Sexton — noting that there are no serious studies — reports an estimate of seven hundred strikers killed and thousands injured from 1877 to 1968, a figure which, she concludes, may “grossly understate the total casualties.” In comparison, one British striker was killed since 1911.

As struggles for freedom gained victories and violent means became less available, business turned to softer measures, such as the “scientific methods of strike breaking” that have become a leading industry. In much the same way, the overthrow of reformist governments by violence, once routine, has been displaced by “soft coups” such as the recent coup in Brazil, though the former options are still pursued when possible, as in Obama’s support for the Honduran military coup in 2009, in near isolation. Labor remains relatively weak in the US in comparison to similar societies. It is constantly battling even for survival as a significant organized force in the society, under particularly harsh attack since the Reagan years.

All of this is part of the background for the US departure in health care from the norm of the OECD, and even less privileged societies. But there are deeper reasons why the US is an “outlier” in health care and social justice generally. These trace back to unusual features of American history. Unlike other developed state capitalist industrial democracies, the political economy and social structure of the United States developed in a kind of tabula rasa. The expulsion or mass killing of Indigenous nations cleared the ground for the invading settlers, who had enormous resources and ample fertile lands at their disposal, and extraordinary security for reasons of geography and power. That led to the rise of a society of individual farmers, and also, thanks to slavery, substantial control of the product that fueled the industrial revolution: cotton, the foundation of manufacturing, banking, commerce, retail for both the United States and Britain, and less directly, other European societies. Also relevant is the fact that the country has actually been at war for 500 years with little respite, a history that has created “the richest, most powerful and ultimately most militarized nation in world history,” as scholar Walter Hixson has documented.

For similar reasons, American society lacked the traditional social stratification and autocratic political structure of Europe, and the various measures of social support that developed unevenly and erratically. There has been ample state intervention in the economy from the outset — dramatically in recent years — but without general support systems.

As a result, US society is, to an unusual extent, business-run, with a highly class-conscious business community dedicated to “the everlasting battle for the minds of men.” The business community is also set on containing or demolishing the “political power of the masses,” which it deems as a serious “hazard to industrialists” (to sample some of the rhetoric of the business press during the New Deal years, when the threat to the overwhelming dominance of business power seemed real).

Here is yet another anomaly about US health care: According to data by the Organization for Economic Cooperation and Development (OECD), the US spends far more on health care than most other advanced nations, yet Americans have poor health outcomes and are plagued by chronic illnesses at higher rates than the citizens of other advanced nations. Why is that?

US health care costs are estimated to be about twice the OECD average, with rather poor outcomes by comparative standards. Infant mortality, for example, is higher in the United States than in Cuba, Greece and the EU generally, according to CIA figures.

As for reasons, we can return to the more general question of social justice comparisons, but there are special reasons in the health care domain. To an unusual extent, the US health care system is privatized and unregulated. Insurance companies are in the business of making money, not providing health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs are far greater in the private component of the health care system than in Medicare, which itself suffers by having to work through the private system.

Comparisons with other countries reveal much more bureaucracy and higher administrative costs in the US privatized system than elsewhere. One study of the United States and Canada a decade ago, by medical researcher Steffie Woolhandler and associates, found enormous disparities, and concluded that “Reducing U.S. administrative costs to Canadian levels would save at least $209 billion annually, enough to fund universal coverage.” Another anomalous feature of the US system is the law banning the government from negotiating drug prices, which leads to highly inflated prices in the United States as compared with other countries. That effect is magnified considerably by the extreme patent rights accorded to the pharmaceutical industry in “trade agreements,” enabling monopoly profits. In a profit-driven system, there are also incentives for expensive treatments rather than preventive care, as strikingly in Cuba, with remarkably efficient and effective health care.

Why aren’t Americans demanding — not simply expressing a preference for in survey polls — access to a universal health care system?

They are indeed expressing a preference, over a long period. Just to give one telling illustration, in the late Reagan years 70 percent of the adult population thought that health care should be a constitutional guarantee, and 40 percent thought it already was in the Constitution since it is such an obviously legitimate right. Poll results depend on wording and nuance, but they have quite consistently, over the years, shown strong and often large majority support for universal health care — often called “Canadian-style,” not because Canada necessarily has the best system, but because it is close by and observable. The early ACA proposals called for a “public option.” It was supported by almost two-thirds of the population, but was dropped without serious consideration, presumably as part of a compact with financial institutions. The legislative bar to government negotiation of drug prices was opposed by 85 percent, also disregarded — again, presumably, to prevent opposition by the pharmaceutical giants. The preference for universal health care is particularly remarkable in light of the fact that there is almost no support or advocacy in sources that reach the general public and virtually no discussion in the public domain.

The facts about public support for universal health care receive occasional comment, in an interesting way. When running for president in 2004, Democrat John Kerry, the New York Times reported, “took pains… to say that his plan for expanding access to health insurance would not create a new government program,” because “there is so little political support for government intervention in the health care market in the United States.” At the same time, polls in the Wall Street Journal, Businessweek, the Washington Post and other media found overwhelming public support for government guarantees to everyone of “the best and most advanced health care that technology can supply.”

But that is only public support. The press reported correctly that there was little “political support” and that what the public wants is “politically impossible” — a polite way of saying that the financial and pharmaceutical industries will not tolerate it, and in American democracy, that’s what counts.

Returning to your question, it raises a crucial question about American democracy: Why isn’t the population “demanding” what it strongly prefers? Why is it allowing concentrated private capital to undermine necessities of life in the interests of profit and power? The “demands” are hardly utopian. They are commonly satisfied elsewhere, even in sectors of the US system. Furthermore, the demands could readily be implemented even without significant legislative breakthroughs. For example, by steadily reducing the age for entry to Medicare.

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The question directs our attention to a profound democratic deficit in an atomized society, lacking the kind of popular associations and organizations that enable the public to participate in a meaningful way in determining the course of political, social and economic affairs. These would crucially include a strong and participatory labor movement and actual political parties growing from public deliberation and participation instead of the elite-run candidate-producing groups that pass for political parties. What remains is a depoliticized society in which a majority of voters (barely half the population even in the super-hyped presidential elections, much less in others) are literally disenfranchised, in that their representatives disregard their preferences while effective decision-making lies largely in the hands of tiny concentrations of wealth and corporate power, as study after study reveals.

The prevailing situation reminds us of the words of America’s leading twentieth-century social philosopher, John Dewey, much of whose work focused on democracy and its failures and promise. Dewey deplored the domination by “business for private profit through private control of banking, land, industry, reinforced by command of the press, press agents and other means of publicity and propaganda” and recognized that “Power today resides in control of the means of production, exchange, publicity, transportation and communication. Whoever owns them rules the life of the country,” even if democratic forms remain. Until those institutions are in the hands of the public, he continued, politics will remain “the shadow cast on society by big business.”

This was not a voice from the marginalized far left, but from the mainstream of liberal thought.

Turning finally to your question again, a rather general answer, which applies in its specific way to contemporary western democracies, was provided by David Hume over 250 years ago, in his classic study Of the First Principles of Government. Hume found

nothing more surprising than to see the easiness with which the many are governed by the few; and to observe the implicit submission with which men resign their own sentiments and passions to those of their rulers. When we enquire by what means this wonder is brought about, we shall find, that as Force is always on the side of the governed, the governors have nothing to support them but opinion. ‘Tis therefore, on opinion only that government is founded; and this maxim extends to the most despotic and most military governments, as well as to the most free and most popular.
Implicit submission is not imposed by laws of nature or political theory. It is a choice, at least in societies such as ours, which enjoys the legacy provided by the struggles of those who came before us. Here power is indeed “on the side of the governed,” if they organize and act to gain and exercise it. That holds for health care and for much else.

Note: The Rams signed Germany earlier in the spring for a try out.

…

His college highlights:

http://www.hudl.com/video/3/1519530/5834ab875b3cd925e8886dad

Rams’ Lamarcus Joyner happy with move to safety, not experiencing any ‘Hard Knocks’

RICH HAMMOND

link: http://www.ocregister.com/2017/08/03/rams-lamarcus-joyner-happy-with-move-to-safety-not-experiencing-any-hard-knocks/?utm_source=dlvr.it&utm_medium=twitter

This year, there are no omnipresent cameras on hand to capture all of the Rams’ training-camp drama, and unlike 2016, defensive back Lamarcus Joyner is calm, cool and knows his role.

That job has changed, again, but Joyner has no complaints. The former cornerback seems settled as the Rams’ starting free safety and, through the first five days of camp, he has looked confident at the position he played in high school and during part of his college career at Florida State.

“It’s going well so far,” Joyner said this week. “I have a lot to learn and a lot to get done, but I’m taking it all in. The coaches, they all make it easy to adjust and transition, so I think I’ll be ready.”

That’s important for the Rams, who need a strong secondary to make defensive coordinator Wade Phillips’ system work. Joyner, listed at 5-foot-8, 190 pounds, certainly isn’t the biggest safety around, but he and Maurice Alexander have helped make the Rams’ secondary look strong thus far in camp.

Moreover, Joyner is settled and relaxed, which is more than the Rams could say of him a year ago.

During 2016 training camp, cameras for the “Hard Knocks” show captured a series of scenes in which Joyner missed a walk-through practice (without excuse), then had a meeting with Coach Jeff Fisher in which he expressed consternation with his role and said he “can go work at Walmart.”

The matter quickly got settled and Joyner settled into his role as the Rams’ nickel cornerback and thrived. He missed two games because of injury but still finished third on the team with 66 total tackles.

Coach Sean McVay and Phillips took over in January, and in April they signed cornerback Nickell Robey-Coleman, a nickel specialist. What would that mean for Joyner? The coaches had a plan, to move Alexander to strong safety (to replace T.J. McDonald) and move Joyner to free safety.

This time, no sit-down, talk-it-out meetings were needed. Joyner immediately embraced the new role.

“I mean, I was calm last year,” Joyner said. “I had a few misunderstandings, but since this new coaching staff has come, they’ve given me the opportunity to prove myself and let my light shine. It feel like a dream come true, and I’m motivated and hungry to show what I can do for this organization.”

Joyner indicated that he isn’t alone. A second-round pick in 2014, Joyner has been part of Rams teams that have a combined record of 17-31. He came from a Florida State team that won the national championship in 2013, so the adjustment to losing has been difficult, but Joyner said he is optimistic.

“I would say the culture is changing around here,” Joyner said. “You’re hearing guys talk about, ‘win, win, win’ more, versus, ‘All-Pro,’ or, ‘I want to be a Pro Bowler,’ or I want to do this or that. Now you hear guys on the field saying, ‘We need to win.’ When a team has success, you have individual success. So the culture has definitely changed and we’re looking forward to winning some football games.”

Training Camp Report: Everything You Need To Know From Day 5

By Kristen Lago

http://www.therams.com/news-and-events/article-1/Training-Camp-Report-Everything-You-Need-To-Know-From-Day-5/7e354138-9f76-4c10-b68b-37b42e9f1a4f

The Rams finished up their second day in pads on a cloudy Wednesday afternoon before the team gets ready to take a much-needed break Thursday. Wednesday marked the team’s second practice in full pads with no “live” tackling and featured a series of high-spirited drills and standout players.

Check out the top field-level observations from Rams Camp Day 5:

TOP TAKEAWAYS

1. A “next man up” mentality

Earlier today we reported that defensive lineman Dominique Easley would be out indefinitely after suffering a knee injury in yesterday’s practice. Easley was expected to start for the Rams defensive line alongside nose tackle Michael Brockers and left tackle Aaron Donald.

With Donald’s absence from camp and Easley’s season-ending injury, the team has been forced to reevaluate their depth at the position. Head coach Sean McVay will look within to fill these voids, pushing forth a “next-man up” mentality.

“We’ll find different ways to continue to develop that depth and being mindful of some of the things moving forward,” McVay said in regards to Easley’s injury. “But that certainly is a big loss for us. With the injuries, you have to be ready to move on and adjust to that adversity like we’ve talked about, so that is something that we will do.”

In today’s practice defensive tackles Ethan Westbrooks, Tanzel Smart and Louis Trinca-Pasat alternated reps with the first-team defense. Smart and Trinca-Pasat both spoke after practice about their new, increased roles during training camp.

“We’re competing out here every day and I’ve got to come out here and show them why they drafted me,” Smart said. “They took a chance on me and I’ve got to do good for them. Whatever my role is on the team, whatever they want me to do, I’m going to do it.”

“Nothing is given,” Trinca-Pasat added on. “Everybody has got to earn their spot, I’ve got to earn my spot. There’s guys competing for the same position so I am just going out there and trying to get as good as I can and improve every day.”

2. Injury Updates

There were three players noticeably absent from Wednesday’s practice: wideout Tavon Austin, rookie linebacker Samson Ebukam and outside linebacker Robert Quinn.

Though there is no need to worry about any injury on Quinn’s part, as he was pre-excused from Day 5 of camp, McVay was able to shed some light on Austin and Ebukam’s injuries.

“He’s [Austin] got a minor hamstring and that is something that we’re going to be monitoring day-to-day. You always want to be really careful, especially with guys that are explosive and those fast twitch guys like Tavon.”

“Samson had a hamstring tweak in our special teams drill and it might be a little bit different than Tavon in terms of how careful you are,” McVay went on. “But I think in terms of the severity, they are minor issues that we’ll monitor day-to-day. I expect those guys to do a good job with the rehab and we’ll kind of have updates as we go.”

With Austin out, wideouts Robert Woods and Cooper Kupp have stepped up over the last two practices, making for a pair of reliable receivers on the first-team offense. Both had several completions from quarterback Jared Goff in today’s practice and seem to be improving in their timing on various routes.

3. A glimpse at situational drills

Rather than working on one-on-ones or 7-on-7 drills, McVay chose to dedicate more time in this afternoon’s practice to red zone and situational drills. The new portions of practice gave Goff a chance to work on fresh routes from the playbook and build confidence in leading the offense through a variety of situations.

“We did some different things at the end of practice, where you emphasize some two-minute situations at the end of the first half and I think those are situations that are different from what he was doing at Cal,” McVay said. “But, similar in terms of the up-tempo, if you will, of what that two-minute offense dictates and he’s comfortable in those settings. I thought our guys did a good job communicating both sides of the football. I thought it was a good way to end practice for us.”

These drills also gave the defense a chance to showcase their physical attacking skills in the red zone.

“I think it gives our offense a great look,” he said. “We’ve got a bunch of great players on defense and Wade [Phillips] runs a system where guys can play fast and be confident and knowing what to do and how to do it and then being able to execute their assignment and that’s why I think he’s a great coach.”

FIELD-LEVEL OBSERVATIONS

Practice ended about 20 minutes early. The team will receive the day off from practice Thursday before returning to camp on Friday.
During the 11-on-11 portion, cornerbacks Trumaine Johnson and Lamarcus Joyner teamed up on a would-be interception off of Woods hands.
Cornerback Kevin Peterson had a near pick-six against the third team offense during team drills. Though he prevented the completion, the corner did pushups on the sidelines after missing the interception.
Goff impressed with several successful completions during red zone drills but struggled a bit with timing on a few routes downfield.
Wideout Pharoh Cooper had an impressive catch from quarterback Sean Mannion, eluding coverage for a would-be touchdown play.
Tight End Gerald Everett showcased his strength as a blocker on offense making way for running back Todd Gurley on several plays throughout the day.
Practice wrapped up with field goal drills putting kicker Greg “The Leg” Zuerlein on display. Much to no one’s surprise, Zuerlein made all but one of his attempts.
PLAY OF THE DAY

Today’s play of the day once again came from the defense – this time starring Johnson.

During the 11-on-11 portion of practice the veteran corner had an impressive pass break-up on a second down play from Goff to Kupp. Though the receiver had the ball in his hands after a perfect pass from Goff, Johnson stripped the ball right out, eliciting a round of applause from a few excited fans.

PRESS POINTS

After practice Brockers spoke to the media about the impact of losing Easley for the season. Catch up on his best points from Day 5.

MICHAEL BROCKERS:

On how tough it was for him to see Easley go down: “It’s tough. You know I mean we work so hard, we push each other every day and you start missing a guy like that who drives you and drives that competitiveness in you and brings it out of you and you hate to lose that. That’s what we’ll miss about him. You kind of miss those guys’ character and the atmosphere that they bring, but the biggest thing for me is just pick up the guys behind them, influence them and encourage them to do the right things. ”

..

Ramlock

Gurley, Kupp, Spruce and Rogers stayed after practice catching fades from Goff, Mannion and Orlovsky

Good to see

The TE’s worked on blocking drills

Britt Hager was practicing long snaps!

I thought Mannion looked good on his reps in practice, fitting balls in tight spots.

Goff was very good….liked the Roll outs

They went about 3 Periods before a ball hit the ground

Wade moved Barwin all over

Whole defense looked ahead of offense

The secondary, the whole defense looked fast and very competitive.

Did anyone get the sense that ol’ Wade wasn’t holding back anything?
Plenty of pressure and the DB’s were pressed up on the pass catchers

This just in, Johnny Hekker is a good punter!

Greg the leg missed one from 47, hit the rest

OCRamRef68 camp report summary Days 1-5

I live in the OC, so I’m going to try and make as many practices as possible. I went to 10 last year. Bummed I won’t be there this weekend, I have a mini vacation planned. I will be back for Monday’s practice and Wednesday’s Scrimmage. Here are a few random observations:

Practices have a much different pace. Players hustle in and out of drills. Very little wasted time. They are shorter than last years as well.

Goff looks better. More confident. He’s been a little inconsistent. He’s missed some throws, but made his fair share of plays as well. Good today in the Hurry up. They put .50 seconds on the clock to simulate an end of half/game scenario. He was 4-4 and hit R. Woods for about 20 yards on the last play which would’ve put them in FG range. I like what I see. Still a work in progress.

Tight ends will defintely be a big part of the offense. Plenty of 12 personnel. As reported, Goff developing a rapport with both of them. Everett is really athletic. Looks like they are going to try and get him the ball in space and let him make plays.

Austin was participating in Running Back drills yesterday taking handoffs and pitches from the QB’s. Could he be used as a RB in certain situations, especially with Dunbar’s injury status? Thought that was interesting. I think they’re going to find different ways to get him the ball.

Defense is way ahead of the offense at this point. The secondary has been really impressive!! I agree with Wade about our secondary being better than most people think. Tru has been great, Joyner is totally prospering from his new role, Webster looks to be solid, and Robey-Coleman has been all over the field making plays.

Ebukam has a burst. Can’t wait to see him in game action.

Gurley’s going to be used in the passing game. Caught a long pass yesterday and caught a TD from Goff today in a red zone drill. I like what I see from him. As reported, he’s in great shape and looks to have that explosiveness back.

Kupp is the real deal. Great route runner with great hands. Doesn’t have 4.4 speed but makes up for it with his precise routes. He’s going to be a dependable target for Goff.

Whitworth may be the largest man I’ve seen in person.

Hard to Judge the offensive line. Only 2 padded practices, not a lot of one on one drills in pads.

Haven’t seen a lot from Josh Reynolds. I had to ask my son after we got home if he practiced today.

Spruce and P. Cooper getting plenty of reps bouncing back and forth between the 1’s and 2’s

Don’t tell Eric Dickerson, but Mannion’s been very average. Strong arm but hasn’t been very accurate.

Josh Forrest could have a tough time making this team. Consistently running with the 3rd team.

Hager stayed after practice and was working as a long snapper.

Troy Hill has had a good camp so far IMO.

M. Thomas was in shorts running sprints on his own today. Not sure what the deal with him is. I asked JB Long about it and he said he was “injured”.

That’s all I can remember for now.

Daniel Jeremiah‏ @MoveTheSticks

Quick Rams nuggets– Goff has good chemistry with both young TEs. Trumaine Johnson had good day (nice pbu vs Kupp). Wade Phillips is a stud.

Anxious to see how Rams use Tavon Austin this fall (didn’t practice today). Kupp and Woods are both capable of playing inside/outside.