Tagged: poor

Declining US doctor visits: A product of social decay and the assault on health care


4 October 2012

The US Census Bureau reported this week that between 2001 and 2010, the average number of doctor visits by individuals aged 18 to 64 fell by nearly 20 percent, from 4.8 visits to 3.9 visits. The report is the latest evidence of a sharp decline in access to health care for millions of Americans.

The economic situation is a major factor in this decline. Millions of people have lost their jobs over the past decade, particularly since the onset of the global crisis in 2008. In the United States, losing one’s job generally means losing one’s health insurance, and uninsured people are much less likely to visit a doctor.

At the same time, insurance companies have been raising premiums and co-payments, making doctor visits a major expense even for those who have insurance. “It’s a widespread decline in the use of medical services,” commented the chief of the Census Bureau’s health and disability statistics branch.

These figures confirm earlier reports of falling doctor visits, fewer prescriptions and stagnant health care spending—a trend that accelerated in 2011 and 2012, years not covered by the Census report. The IMS Institute for Healthcare Informatics reported earlier this year that doctor visits fell 4.7 percent in 2011 compared to 2010, and the number of prescriptions issued fell by 1.1 percent.

The decline in access to health care for millions of people has a predictable consequence: reduced life expectancy. A study released last month in the journal Health Affairs found that life expectancy for the poorest sections of the working class fell sharply between 1990 and 2008. For white women with less than a high school education, life expectancy fell from 78 to 74 years, and for men in this category from 70.5 to 67.5.

This shocking decline is a product not simply of abstract economic forces, but a deliberate policy carried out by the corporations and both big business parties. The aim is to establish a class-based health care system in which the vast majority of the population receives bare-bones care, while the rich have access to the best coverage money can buy.

The decline in health care spending and doctor visits will be welcome news to the Obama administration, which has been working for precisely such an outcome. Behind the administration’s health care “reform” is a bipartisan effort to reduce costs for corporations and the government by restricting medical tests, procedures and drugs, and rationing care—with the inevitable consequence of eroding the health and lifespan of large parts of the population.

One of the aims of Obama’s health care overhaul is to allow corporations to scrap their employee health care programs and force workers to purchase private insurance on the market. As many as 20 million people may lose employer-sponsored coverage by 2019, according to estimates. Individuals forced to buy private insurance will either pay more or receive less coverage, and they will likely be more vulnerable to rising co-payments and cuts in services.

The New York Times,which generally tracks the positions of the Obama administration and the Democratic Party, has spearheaded the media promotion of health care rationing. The Times regularly decries supposedly unnecessary tests and procedures—from mammograms and prostate screenings to stents. The newspaper argues that “excess” health care is positively harmful.

Last April, the Times published an article on health care costs under the headline “In Hopeful Sign, Health Spending is Flattening Out.” This “hopeful” trend was a result of the fact that “millions of Americans lost insurance coverage along with their jobs.” The article continued: “Worried about job security, others may have feared taking time off work for doctor’s visits or surgical procedures, or skipped non-urgent care when money was tight.”

The Census figures released this week cover individuals aged 18-64. They do not include the elderly. Older Americans, because they are covered by the federal Medicare program, have been less affected by the economic imperatives to forego health care.

Within US ruling circles, this is considered a serious problem. As far as the financial oligarchs are concerned, billions are being wasted keeping alive people who can no longer be exploited for profit.

While they have disagreements over the best means of accomplishing the job, a principal aim of both the Democrats and the Republicans is to find ways of imposing huge cuts in Medicare spending.

Steven Rattner—a multi-millionaire financier and former Obama administration “car czar”—spelled out the basic strategy in an opinion piece entitled “Beyond Obamacare” that appeared in the Times last month. Rattner was indicted on charges of corruption and insider-dealing while head of the private equity firm Quadrangle. As the leader of Obama’s Auto Task Force he oversaw the restructuring of the auto industry based on halving the pay of newly hired workers and imposing deep cuts in health care and pension benefits.

“We need death panels,” Rattner’s column began. “Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently—rationing, by its proper name—the exploding cost of Medicare will swamp the federal budget. But in the pantheon of toxic issues—the famous ‘third rails’ of American politics— none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.”

Rattner went on to criticize both Obama and Republican vice presidential candidate Paul Ryan—who has proposed privatizing Medicare and turning it into a voucher program—for avoiding stating the main issue: the need to deny medical treatment to some retirees.

“Medicare needs to take a cue from Willie Sutton, who reportedly said he robbed banks because that’s where the money was,” Rattner wrote. “The big money in Medicare is not to be found in Mr. Ryan’s competition or Mr. Obama’s innovation, but in reducing the cost of treating people in the last year of life, which consumes more than a quarter of the program’s budget.”

While Rattner presents his comments as a criticism, they point to what is, in fact, the aim of both the Democrats’ and Republicans’ proposals: reduce health care for the working class, and particularly the elderly. Obama’s proposal centers on government panels to recommend reduced coverage, while Ryan has advocated outsourcing this responsibility to private insurers.

The presidential elections are part of a general conspiracy against the American population, in which the real plans of the ruling class are concealed. Regardless of who wins the election, Obama or Romney, the financial aristocracy—which is responsible for the worst economic crisis since the Great Depression—is planning on vastly escalating its social assault on the American people.

Joseph Kishore

http://www.wsws.org/articles/2012/oct2012/pers-o04.shtml

Self-Financing that Works for the Poor


Arely Domínguez, right, and other members of El Guapo at the inauguration of the bankomunales exhibit. Credit: Estrella Gutiérrez/IPSArely Domínguez, right, and other members of El Guapo at the inauguration of the bankomunales exhibit. Credit: Estrella Gutiérrez/IPS

CARACAS, Oct 2 2012 (IPS) – “We were used to losing, so a group of us said to ourselves: let’s lose something here,” said Carmen Caravallo, describing the start of a “bankomunal”, a self-managed microfinance fund based on investment, in her rural community in eastern Venezuela.

Ten years later, Caravallo and the other members of the bankomunal in Llanada de Puerto Santo, in the state of Sucre, “are getting used to winning,” she told IPS. “Now we are a family, and we have learned to be responsible; we have improved our lives with money that belongs to us, and strange as it may seem, we feel we are very much in charge,” she added.

Bankomunales, present in 14 countries on four continents, are the brainchild of Venezuelan social entrepreneur Salomón Raydán, who demonstrated that the poor can be self-financed, after Muhammad Yunus of Bangladesh, the father of microcredit, had shown that they could be financed.

The 54-year-old Caravallo, who is in mourning after the recent death of one of her three children, said the road has been “slow, hard and paved with mistrust.” But after three years “people began to make a profit, and saw that we were reliable and responsible.”

In her community of 1,000 people, in one of the poorest states in the country, she is treasurer of the local bankomunal, which began with 20 members and now has 107 as well as “a long waiting list to join.”

Similar experiences have been repeated in 180 bankomunales throughout Venezuela, which have a combined total of 25,465 members who contributed a minimum of 2.30 dollars to become both investors and clients.

Raydán, a philosopher and sociologist by training, told IPS the idea was born 15 years ago, out of his experiences as an adviser for small farmer financial assistance programmes and from what he learned about the way of life of poor rural communities.

Poverty is defined by the irregularity of income, more than the lack of it, he said. “Insecure and fluctuating resources do not allow the poor to face spending that is needed for survival, and so poverty takes root,” said Raydán, the head of the Foundation for Rural Finance (FUNDEFIR).

“Eighty percent of poor people in the world have access to credit through informal systems,” mostly self-managed in their communities, he said.

“But these sources are insecure and they do not add value for their users. They need to be adapted to offer more transparency, training, security and efficiency, so they become more formal, although that doesn’t mean they need to be regulated according to the rules of the state that has excluded them,” said Raydán.

These mutual credit associations began to operate in 1997, granting multiple and variable loans, in contrast with traditional systems that make rotating loans of fixed amounts, which are widespread in poor areas of the developing South.

Furthermore, “their members are not just savers, but investors; they are active, not passive,” he emphasised.

“Only 2.5 percent of the poor population of the world has access to banking services, and microcredit systems serve 105 million people, while the demand for microfinance is two billion people,” he said.

Venezuelan microinvestors acquire a certificate of assets worth 2.30 dollars. No one can acquire more than 15 percent of the total assets, members of different bankomunales who have arrived in Caracas for a photo exhibit about the system tell IPS enthusiastically.

Members are the leading lights of the show launched in September in a gallery in the capital city, where powerful images are shown of open-air meetings or gatherings in borrowed spaces – meetings of credit committees and activities involving the granting or payment of loans.

There are also images of members on cultivated land in both rural and urban areas, grocery stores set up in homes, other small shops, home renovations, sewing or repair workshops, and minifactories producing different products. Other members are depicted next to children wearing new school uniforms, or holding up new kitchen utensils.

Credits are granted for “any legal purpose,” in general to be repaid in three to 18 months, with interest decided by each organisation. Loan amounts vary: a new association may only lend up to 100 dollars, while a more established one may have a ceiling of 2,000 dollars.

All decisions are made at well-attended meetings, and the credit committee gives its decision on each request within 24 hours. “We know each other and we know everyone’s payment capacity; we work on trust,” said Arely Domínguez, head of the bankomunal in El Guapo, a village that was reborn from tragedy.

In December 1999 a flood burst the dam near the village, located 125 kilometres from Caracas, in the north-central state of Miranda. The low-lying land in El Guapo, home to some 3,000 people, was flooded.

FUNDEFIR was one of the organisations to come to their aid, and a year later Domínguez and 34 others founded their bankomunal, which now has 117 members and makes an average of 10 loans a week, totalling 6,000 dollars.

First of all, like everyone else involved in the initiative, they received training and advice from FUNDEFIR. “We learned how to balance our accounts, write budgets, do audits, assess risks and use computers,” said Domínguez, a 49-year-old schoolteacher with two daughters.

Up to August, bankomunales had granted 275,631 credits to 84,884 people, for a total 3.6 million dollars at the official exchange rate.

In El Guapo, the bankomunal operates in the building of a cultural association, but most of the associations meet in members’ houses. Officers are elected at general meetings and work on an honorary basis.

The vast majority of members are women, but the number of men is increasing. One-third of loans are requested for consumption, one-third for enterprises and one-third for emergencies, especially health problems.

Every loan is backed up to at least 40 percent by certificates of assets of the member and his or her sponsors, “to be in the safe zone,” a mantra repeated by the members. “There are hardly ever any problems, but on the second default, they are out,” Caravallo said.

Profits are calculated monthly and distributed to the members annually. “One of the principles of bankomunales is distribution rather than accumulation,” said Raydán. “The profits have little economic importance, but a great deal of educational importance.”

It is “a financial education programme, not a microfinance programme, and the profits help generate a sense of entrepreneurship,” he said.

The model has spread to Bolivia, Brazil, Chile, Colombia, Dominican Republic, Haiti, Peru, Germany, Spain, Hungary, Portugal, Senegal and Indonesia.

The Spanish version, Comunidades Autofinanciadas, won the 2009 prize for the best microfinance programme in Europe, while FUNDEFIR’s system was voted in 2010 one of the 25 social projects in the world most likely to be globalised, by Ashoka Globaliser, an international foundation that promotes social enterprise.

FUNDEFIR has financial support from Total Oil and Gas Venezuela, a subsidiary of the transnational French oil corporation Total, which works in the east of the country.

Diana Vilera, the sustainable development manager, told IPS the company “seeks to promote projects that are a tool for people to be lifted out of poverty.”

“Oil companies take a lot out of the planet and the environment, and we have a duty to contribute whatever we can, beyond the business angle,” she said.

http://www.ipsnews.net/2012/10/self-financing-that-works-for-the-poor/