Posts Tagged 'Politics'

The real invasion of Africa is not news and a licence to lie is Hollywood’s gift

Dandelion Salad, February 3, 2012

The real invasion of Africa is not news and a licence to lie is Hollywood’s gift
by John Pilger

Global Research

http://johnpilger.com

January 30, 2013

A full-scale invasion of Africa is under way. The United States is deploying troops in 35 African countries, beginning with Libya, Sudan, Algeria and Niger. Reported by Associated Press on Christmas Day, this was missing from most Anglo-American media.

The invasion has almost nothing to do with “Islamism”, and almost everything to do with the acquisition of resources, notably minerals, and an accelerating rivalry with China. Unlike China, the US and its allies are prepared to use a degree of violence demonstrated in Iraq, Afghanistan, Pakistan, Yemen and Palestine. As in the cold war, a division of labour requires that western journalism and popular culture provide the cover of a holy war against a “menacing arc” of Islamic extremism, no different from the bogus “red menace” of a worldwide communist conspiracy.

Reminiscent of the Scramble for Africa in the late 19th century, the US African Command (Africom) has built a network of supplicants among collaborative African regimes eager for American bribes and armaments. Last year, Africom staged Operation African Endeavor, with the armed forces of 34 African nations taking part, commanded by the US military. Africom’s “soldier to soldier” doctrine embeds US officers at every level of command from general to warrant officer. Only pith helmets are missing.

It is as if Africa’s proud history of liberation, from Patrice Lumumba to Nelson Mandela, is consigned to oblivion by a new master’s black colonial elite whose “historic mission”, warned Frantz Fanon half a century ago, is the promotion of “a capitalism rampant though camouflaged”.

A striking example is the eastern Congo, a treasure trove of strategic minerals, controlled by an atrocious rebel group known as the M23, which in turn is run by Uganda and Rwanda, the proxies of Washington.

Long planned as a “mission” for Nato, not to mention the ever-zealous French, whose colonial lost causes remain on permanent standby, the war on Africa became urgent in 2011 when the Arab world appeared to be liberating itself from the Mubaraks and other clients of Washington and Europe. The hysteria this caused in imperial capitals cannot be exaggerated. Nato bombers were dispatched not to Tunis or Cairo but Libya, where Muammar Gaddafi ruled over Africa’s largest oil reserves. With the Libyan city of Sirte reduced to rubble, the British SAS directed the “rebel” militias in what has since been exposed as a racist bloodbath.

The indigenous people of the Sahara, the Tuareg, whose Berber fighters Gaddafi had protected, fled home across Algeria to Mali, where the Tuareg have been claiming a separate state since the 1960s. As the ever watchful Patrick Cockburn points out, it is this local dispute, not al-Qaida, that the West fears most in northwest Africa… “poor though the Tuareg may be, they are often living on top of great reserves of oil, gas, uranium and other valuable minerals”.

Almost certainly the consequence of a French/US attack on Mali on 13 January, a siege at a gas complex in Algeria ended bloodily, inspiring a 9/11 moment in David Cameron. The former Carlton TV PR man raged about a “global threat” requiring “decades” of western violence. He meant implantation of the west’s business plan for Africa, together with the rape of multi-ethnic Syria and the conquest of independent Iran.

Cameron has now ordered British troops to Mali, and sent an RAF drone, while his verbose military chief, General Sir David Richards, has addressed “a very clear message to jihadists worldwide: don’t dangle and tangle with us. We will deal with it robustly” – exactly what jihadists want to hear. The trail of blood of British army terror victims, all Muslims, their “systemic” torture cases currently heading to court, add necessary irony to the general’s words. I once experienced Sir David’s “robust” ways when I asked him if he had read the courageous Afghan feminist Malalai Joya’s description of the barbaric behaviour of westerners and their clients in her country. “You are an apologist for the Taliban” was his reply. (He later apologised).

These bleak comedians are straight out of Evelyn Waugh and allow us to feel the bracing breeze of history and hypocrisy. The “Islamic terrorism” that is their excuse for the enduring theft of Africa’s riches was all but invented by them. There is no longer any excuse to swallow the BBC/CNN line and not know the truth. Read Mark Curtis’s Secret Affairs: Britain’s Collusion with Radical Islam (Serpent’s Tail) or John Cooley’s Unholy Wars: Afghanistan, America and International Terrorism (Pluto Press) or The Grand Chessboard by Zbigniew Brzezinski (HarperCollins) who was midwife to the birth of modern fundamentalist terror. In effect, the mujahedin of al-Qaida and the Taliban were created by the CIA, its Pakistani equivalent, the Inter-Services Intelligence, and Britain’s MI6.

Brzezinski, President Jimmy Carter’s National Security Adviser, describes a secret presidential directive in 1979 that began what became the current “war on terror”. For 17 years, the US deliberately cultivated, bank-rolled, armed and brainwashed jihadi extremists that “steeped a generation in violence”. Code-named Operation Cyclone, this was the “great game” to bring down the Soviet Union but brought down the Twin Towers.

Since then, the news that intelligent, educated people both dispense and ingest has become a kind of Disney journalism, fortified, as ever, by Hollywood’s licence to lie, and lie. There is the coming Dreamworks movie on WikiLeaks, a fabrication inspired by a book of perfidious title-tattle by two enriched Guardian journalists; and there is Zero Dark Thirty, which promotes torture and murder, directed by the Oscar-winning Kathryn Bigelow, the Leni Riefenstahl of our time, promoting her master’s voice as did the Fuhrer’s pet film-maker. Such is the one-way mirror through which we barely glimpse what power does in our name.

Copyright © John Pilger, JohnPilger.com, 2013

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Spaniards Protest Health Care Reforms: privatization, closures of public facilities

Spaniards Protest Health Care Reforms

By HAROLD HECKLE
Associated Press

Protestors march as they carry a banner reading, “Public health care” and “24 hours strike” during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

MADRID — Thousands of people marched in Madrid on Sunday to protest plans to privatize parts of their public health care system, with some questioning the motives behind the government’s actions.

The march by employees and users of the system is the year’s second large “white tide” demonstration, named after the color of the medical scrubs many protesters wear. Several similar marches took place last year.

Demonstrators thronged main boulevards in the center of the Spanish capital, carrying banners saying, “Public health care should be defended, not sold off.”

The Madrid region has proposed selling the management of six of 20 large public hospitals in its jurisdiction and 10 percent of its 268 public health centers. It says these reforms are needed to secure health services during Spain’s economic crisis.

A protestor carries a banner reading, “Spanish Prime Minister Mariano Rajoy, serial fraudster” during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

But protesters were skeptical.

“This measure is politically inspired and not financial,” said mechanical engineer Mario Sola, 47. “If public hospitals were unsustainably loss-making as we’re being told, private enterprise wouldn’t be interested.”

Health care and education are administered by Spain’s 17 semi-autonomous regions rather than by the central government.

Many regions are struggling financially as Spain’s economy has shrunk due to a double-dip recession following the 2008 implosion of the once-prosperous real estate and construction sectors.

Some regions overspent during boom years, but are now excluded from borrowing on the financial markets to repay their accumulated debts, forcing them to seek savings and even request rescue aid from the central government.

Regional health councilor Javier Fernandez-Lasquetty called the protests irresponsible and said that “everyone has their point of view, but we are all fighting to defend the same thing.”

Jose Gabriel Gonzalez Martin, president of Spain’s Independent Civil Service Trade Union Center, said many people’s suspicions were aroused when former government health officials acquired jobs with private companies lining up to take over medical analysis functions.

“It might be purely coincidental, but some coincidences are surprising,” Gonzalez said.

Protestors shout slogans during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

 

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Can We Please Stop Pretending Obama is “Capitulating” on Social Security?

Firedoglake, Wednesday, December 19, 2010

Can We Please Stop Pretending Obama is “Capitulating” on Social Security?

By: Jane Hamsher

Everywhere you look, the media narrative is that President Obama is “capitulating” to Republicans by agreeing to cuts in Social Security benefits.

And I have to ask, where is this collective political amnesia coming from?

Obama has made a deliberate and concerted effort to cut Social Security benefits since the time he took office.  FDL reported on February 12, 2009 that the White House was meeting behind closed doors to consider ways to cut Social Security benefits, and that the framework they were using was the Diamond-Orszag plan, which was co-authored by OMB Director Peter Orszag when he was at the Brookings Institute.

The birth of the now-ubiquitous “catfood” meme came on February 18, 2009 with this FDL headline:

“Hedge Fund Billionaire Pete Peterson Key Speaker At Obama “Fiscal Responsibility Summit,” Will Tell Us All Why Little Old Ladies Must Eat Cat Food”

As I wrote in August of 2010, Peterson’s keynote spot was the worst kept secret in town; I knew about it because I had been on a conference call with about 40 representatives of various DC interest groups, many of whom had received written notice from the White House that Peterson was scheduled to headline the event. But nobody wanted to go on the record for fear of jeopardizing their relationship with the administration in its early days.

After FDL broke the news, Peterson was “disinvited” from the summit. Both he and the White House denied everything, but Robert Kuttner subsequently confirmed in the Washington Post that Peterson had, in fact, been scheduled as the keynote speaker that day.

The administration backed off its immediate plans for reforming Social Security. The New York Times reported that they were “running into opposition from his party’s left” who are “vehement in opposing any reductions in scheduled benefits for future retirees.” But NYT columnist David Brooks reported that shortly after the summit, “four senior members of the administration” called him to say that Obama “is extremely committed to entitlement reform and is plotting politically feasible ways to reduce Social Security.”

Undeterred, the White House began telling journalists off the record that they were interested in “establishing an independent commission (outside the congressional committee structure) to look at creating a specific reform plan.”

In January of 2010, a bill sponsored by committed Social Security slashers Judd Gregg and Kent Conrad which would have created an official commission to make recommendations about the nation’s deficit was defeated by the Senate on a bipartisan vote — 22 Democrats and 24 Republicans voted no.

After the Senate defeat, on February 18, President Obama issued an executive order creating what subsequently became known as the “Catfood Commission” anyway.

Unlike Bill Clinton’s Danforth Commission, which ended in deadlock, Obama set this commission up in such a way that it was stacked with deficit hawks who largely agreed on what needed to be done: 12 of the 18 members were to be appointed by Senate and House leaders in each party, and 6 would be appointed by the President. This virtually guaranteed that Social Security privatization fetishist Paul Ryan would be on the commission, as would Gregg and Conrad.

Among the President’s six appointments:

  • As Bowles’ Republican Co-Chair, the President appointed loose cannon Alan Simpson, the former rich kid GOP Senator from Wyoming once famously said that those who were complaining that Social Security needed protection were “people who live in gated communities and drive their Lexus to the Perkins restaurant to get the AARP discount.”
  •  David M. Cote, the Republican CEO of defense contractor Honeywell

The composition of the Commission was conveniently stacked with 14 of the 18 members committed deficit hawks looking to start balancing the federal budget on the backs of old people.

And who supplied the staff to the commission? Why, Pete Peterson.

Are we to believe that the President was blissfully ignorant of the agendas of the people he appointed to this commission, created with the goal of bypassing Congressional process?

With the exception of a few public dog and pony shows, the Commission conducted its deliberations in secret.  But on June 16 of 2010, Alex Lawson of Social Security Works blew a hole in that secrecy on the front page of FDL when he caught Alan Simpson on live streaming video as he was exiting a meeting of the Catfood Commission.   In real time, Alex got Alan Simpson to say what everyone in the room was thinking but wouldn’t say publicly. Simpson told Alex that the commission was “really working on solvency”:

“We’re trying to take care of the lesser people in society and do that in a way without getting into all the flash words you love dig up, like cutting Social Security, which is bullshit. We’re not cutting anything, we’re trying to make it solvent.”

The Catfood Commission ultimately failed it is mission, due in no small part to the work of people like Alex, Nancy Altman and Eric Kingson of Social Security Works who have consistently been out there informing and uniting interest groups and educating the public to the fact that, yes, the White House has an agenda of cutting Social Security benefits.

I don’t know why Obama wants to cut Social Security benefits. I do know that Obama has been honest about it from the start. In January of 2009, even before he took office, he told the Washington Post that he believed Social Security was a broken system and that “entitlement reform” was something he wanted to achieve during his tenure in office:

“Obama said that he has made clear to his advisers that some of the difficult choices–particularly in regards to entitlement programs like Social Security and Medicare – should be made on his watch. “We’ve kicked this can down the road and now we are at the end of the road,” he said.”

Perhaps Obama wants to do what Bill Clinton couldn’t do.  It’s clear the oligarch class has decided that this is what must happen, and that in order to be considered a “serious” person, this is what a President must do.  Perhaps Obama simply wants to be considered a “serious person” by those in the ruling class.

But it’s clear that he did not arrive at the decision to “reform” Social Security and cut benefits because he is a poor negotiator, or because of Republican arm twisting.  It defies all logic and reason to look at his actions over the years and think that the President is now “capitulating” on Social Security.

The President has been very forthcoming about the fact that cutting Social Security benefits is something he wants to do.  When he said during the debate that he didn’t differ from Mitt Romney on entitlement reform, he meant it.   It’s time for people to remove the rose-colored glasses and stop projecting their own feelings on to the man.  It’s time to take him at his word.

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Here’s Real History in the Making: Fighting to Save SF City College

Here’s Real “History in the Making”:
The People Fight Back to Save City College
Friday, January 11, 9–10:30 AM
SF City College, Ocean Campus
Between Diego Rivera Theater & Visual Arts Bldg.
MUNI # 9X, 9AX, 9BX, 29, 36, 43, 49, 54, and K
Balboa Park BART 3 blocks away on Geneva
See map of campus: http://tinyurl.com/aoq7yp6

Contact:
Allan Fisher, afisher800@gmail.com
Wendy Kaufmyn ,(510) 714-8687, kaufmyn@aol.com

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Students cross Phelan Avenue at the main campus of S.F. City College, which is under fire by the accrediting commission. Photo: Megan Farmer, The Chronicle / SF

City College of San Francisco students, staff, teachers and department chairs will picket and boycott the interim chancellor’s welcome address which traditionally kicks off the new semester. Instead of listening to Dr. Thelma Scott-Skillman’s speech, “History in the Making”, City College’s community will make its own history by conducting a press conference and rally addressing the people of San Francisco.

The people of San Francisco overwhelmingly showed a vote of confidence in CCSF by passing Proposition A, a parcel tax specifically dedicated to offset budget cuts, prevent worker layoffs, maintain essential classes, programs and student support services. However, the district is intending to use the funds for other purposes, namely paying high-priced consultants and bolstering reserves.

During this event people will be asked to sign a Pledge of Resistance stating their intention to take drastic action if the district doesn’t spend Proposition A funds (or reserves) as intended.

“San Francisco voters sent a clear message of affirmation for City College’s mission to serve the whole community,” said Leslie Simon, instructor in Women’s Studies and former department chair. “We denounce the district’s downsizing our mission, downsizing our college and limiting student accessibility.”

Allan Fisher, ESL instructor, insisted that, “The administration has failed to promote student enrollment, thereby creating a ‘budget crisis’. Meanwhile they are spending excessive amounts on administrative salaries, high paid consultants and lucrative interim administrative positions.”

Wendy Kaufmyn, Engineering instructor of 29 years, said, “ We need to remain steadfast in our commitment to the California Master Plan and its vision of free education for all and to AB1725, legislation which encourages an administrative role by department chairs elected by their peers.”

We accept the accreditation commission’s legitimate suggestions, we will not accept the Accrediting Commission for Community and Junior Colleges undermining of mission of our community college. We demand a commitment to the California Master Plan and its vision of free education for all, and to AB1725, encouraging an administrative role by peer-elected department chairs.

Speakers at the action will denounce:

* how Proposition A funds are not being used as the voters intended for classes, programs, and student services, and to prevent layoffs

* the limiting of student accessibility through the downsizing of CCSF

* the narrowing of CCSF’s mission to serve the whole community

* the failure of the administration to effectively promote student enrollment, thereby creating a “budget crisis”

* the administration efforts to limit democratic culture and institute an authoritarian, top-down business model for CCSF

* the dismantling of the Department Chair structure, and the negative impact on the “diversity departments”

* the excessive spending on administrative salaries and high paid consultants

* the unilateral take-backs (an additional 9% salary cut from employees on top 2.85%) after six years of employee pay freezes and concessions

* the district proposals to limit or terminate health benefits and pro-rata pay for part-time employees

* the use of CCSF funds for lucrative interim administrative hiring positions

* the mantra of productivity expressed by the administration under the name “enrollment management” that negatively impacts educational quality

* the chronic misrepresentation of CCSF in the media

* the taking away of power from the elected local Board of Trustees

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Fight Foreclosures and Evictions: Take Your Money Out of Wells Fargo

Indybay Media, December 18, 2012

Take Your Money Out of Wells Fargo

by Patricia Jackson

Gray Panthers leaving WF Bank after closing account

On Tuesday, December 18, two senior organizations took their money out of Wells Fargo and joined a protest rally outside at Grant and Market in San Francisco. James Chionsini of Senior Disability Action and Michael Lyon of Gray Panthers addressed the rally after they had closed their organizations’ accounts and called on other organizations to also take their money out of predatory banks. Prior to the rally and while members of Gray Panthers and Senior and Disability Action were inside closing their accounts, a Wells “undercover spy” approached several protesters and took our pictures. He then tried to pass himself off as “one of us.” All morning Wells Fargo customers had to show ID and Wells ATM cards before guards would allow them into the bank. Protesters engaged in conversations with customers and passersby to talk about alternative ways of banking, local credit unions. Speakers educated them about Wells Fargo’s foreclosures.

Senior & Disability Action is welcomed by WF Bank undercover men

Setting up for the protest

Tony Robles, a member of Senior and Disability Action and a 4th generation San Franciscan, started the rally citing case after case of folks who are in foreclosure, forced out of homes they have lived in for decades. Like Larry Fox being thrown out of his home he has lived since as a child when his father took him watch as it was being built.And Robert Moses, 92. year old WWII Veteran, refinanced his nearly paid-off loan with Deutsche Bank to bring his home up to city code. Deutsche raised his interest rate and payment to $3,400 a month. Many seniors living on Social Security and/or fortunate enough to have a pension usually average far less that that amount a month to live on.

Foreclosure Fighters speaking out

Another Foreclosure Fighter

Wells Fargo has been fraudulently processing mortgage documents with a practice called robo-signing for years. Placing quotas on employees and forcing them to sign a certain number of foreclosure files each day. While other documents required for homeowners to avoid foreclosure were ignored, left sitting on unattended fax machines. Wells Fargo has double the number of foreclosures of other banks- a despicable record of evicting record numbers of seniors, disabled and people of color with a $4.8 billion profit. Protesters call for them to negotiate with the 27 families who are in foreclosures.

Archbishop Franzo King, of St. John Coltrane African Orthodox Church and NAACP told us that Wells Fargo made money off trading slaves and now it is foreclosing on the African American decedents of slaves. These banksters have no morality if they continue to put seniors and poor people out of their homes and on to the streets!

Tommi Avicolli Mecca told us to come to a rally Wednesday, December 19th, at 8th & Castro to protest the evictions caused by the Ellis Act- currently 25 buildings in the Mission are being “Ellised”, throwing out people with AIDS, parents and children.

Henne Kelly of California Alliance of Retired Americans (CARA) warned us about the ads Wells Fargo is running in the SF Chronicle offering $20,000 loans, which would not have to be paid back if people stay in a home for 5 years. “Do we trust Wells Fargo?” We roared back, “No!” Chants followed- “Wells Fargo’s impunity Destroys Community!”

It feels good to fight back!

Speaking out against the Grinch that stole our homes.

All groups should take their money out of Wells Fargo!

John Stumpf, Wells Fargo CEO

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Senior and Disability Groups Protest Wells Fargo Evictions, Shutter Accounts

Fog City Journal, December 18, 2012

Senior and Disability Groups Protest Wells Fargo Evictions, Shutter Accounts

By Christopher D. Cook

A fiery crowd of as many as 50 seniors and their supporters including green-clad, Doctor Seuss-styled grinches, rallied this afternoon in front of Wells Fargo Bank at the intersection of Market and Grant streets, calling on the national bank to halt its evictions of struggling homeowners and to change its foreclosure practices.

“Wells Fargo, I had a home but you took it back and sold it—you’re a grinch!” activists from the San Francisco Grey Panthers and Senior & Disability Action yelled under crisp clear winter skies. “I’m a kid who had a warm house to live in but you took that away from me—you’re a Grinch!”

An hour earlier, representatives from the two groups entered the bank and closed their Wells Fargo accounts to protest home foreclosures that have “disproportionately shuttered the homes of seniors, people with disabilities, and people of color,” the groups stated.

“Too many families have lost their homes due to predatory lending, dual tracking, and simple greed,” the groups said in a media release. Dual tracking involves the selling of a house even while the current homeowners are negotiating a new loan to try to keep their home. “Wells Fargo is at the center of the foreclosure crisis in San Francisco.  They have more foreclosures in their name than any of the other banks.”

Grinch-clad protesters.

Evelyn Luluquisen, Executive Director of Manilatown Heritage Foundation, admonishes Wells Fargo over its foreclosure and eviction practices.

According to their research, Wells Fargo has held 92 auctions on foreclosed homes in San Francisco—more than double the combined total of JP Morgan Chase and Bank of America.

The groups demand “immediate action to stop the holiday foreclosures and evictions,” listing 27 San Francisco families who are at risk of eviction over the holidays.

“We’re encouraging all other organizations” to close their Wells Fargo Accounts, said James Chionsini, director of healthcare advocacy for Senior & Disability Action (SDA). “We can’t in good conscience support an organization that’s displacing our members, it’s just unethical.”

The rally was supported by an array of local labor and social justice groups including Occupy Bernal, Causa Justa: Just Cause, Housing Rights Committee, California Alliance for Retired Americans, Jobs with Justice, the Coalition on Homelessness, OPEIU Local 3, Poor Magazine/Prensa Pobre, Occupy Action Council of SF, Alliance of Californians for Community Empowerment and the Manilatown Heritage Foundation.

The groups are joining forces for a “Happy Holidays, Now Get the Hell Out!” press conference and rally tomorrow at noon at 18th and Castro to share their stories about people facing evictions during the holidays. Learn more at http://www.ellishurtsseniors.org.

Christopher D. Cook is a San Francisco author and journalist who has written for Harper’s, The Economist, The Nation, Mother Jones, the Los Angeles Times and elsewhere. He is the author of Diet for a Dead Planet: Big Business and the Coming Food Crisis. You can find more of his work at www.christopherdcook.com.

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Healthcare Crisis: Not Enough Specialists For The Poor, but Calif to Cut Medi-Cal Spending

Healthcare Crisis: Not Enough Specialists For The Poor

LA Times, December 15, 2012

With months-long waits for Medi-Cal patients to see specialists, some turn to emergency rooms — exactly what healthcare reform is banking on avoiding.

By Anna Gorman, Los Angeles Times

The blurry vision began early last year. Roy Lawrence ignored it as long as he could. But after falling off a ladder at his construction job, he knew he had to see a doctor.

He went to a community health clinic in South Los Angeles, where doctors determined he had diabetes and cataracts. The clinic could manage his illness but referred him early this year to the county health system for eye surgery.

Nearly a year later, Lawrence, a Jamaican immigrant without insurance, still is waiting for the operation. His vision has deteriorated so much he is considered legally blind.

PHOTOS: Waiting in vain to be seen

“I want to see again,” he said. “I’ve been waiting a long time.”

Lawrence, 49, and patients like him are posing a critical challenge for the planned overhaul of the nation’s healthcare system. Federal officials are investing billions in community health centers like the To Help Everyone (T.H.E.) Clinic, where Lawrence’s problem was diagnosed, with the hope that they can keep more patients out of high-cost emergency rooms.

But a dearth of specialists available to low-income patients presents one of the bigger hurdles facing the country as it tries to bring spiraling healthcare costs under control. Doctors say meeting new government mandates to keep patients healthy and out of hospitals — a linchpin in reducing medical spending — will be virtually impossible without the ability to make timely patient appointments with specialists.

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

“Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. “We’re really disappointed and concerned what it’s going to do for patient access.”

The healthcare overhaul includes initiatives aimed at reducing shortages of general medicine professionals but does little to increase the availability of specialists.

In Los Angeles County, the sheer volume of poor or uninsured patients needing specialist services has long overwhelmed the public health system, creating costly inefficiencies and appointment delays that can stretch as long as a year and half.

Patients’ conditions often must be dire for them to see a neurologist, cardiologist or other specialist quickly. Community clinics try to bypass the backed-up formal government referral system by pleading, cajoling and negotiating to get less critically ill patients like Lawrence moved up on waiting lists.

“Where needs are absolutely critical, we are able to work out special arrangements,” said Rise Phillips, chief executive of T.H.E. Clinic. “That is not the norm. That is, rather, the exception.”

At times, clinic staff members are forced to work against one of their key missions by sending patients to emergency rooms to increase the odds of their seeing a specialist more quickly.

The challenge can be seen in Belinda De Leon’s cubicle in a small, windowless back corner of T.H.E. Clinic. A referral specialist, De Leon spends her days trying to speed up appointments for the center’s clients — and fielding calls from patients wanting to know how much longer they have to wait. At any given time, she’s juggling more than 1,000 pending referrals.

One involves uninsured housekeeper Juana Barrera. Barrera, 45, has been waiting since April 2011 to see a gastroenterologist and get a colonoscopy. She has had bleeding off and on and recently started having pain in her stomach.

On a recent visit, she told De Leon she is scared to wait any longer. But she can’t afford to pay for the test out of pocket. “I’m hoping it’s not anything like cancer,” she said.

De Leon promised to update Barrera’s referral paperwork to indicate she is experiencing pain. “Hopefully that will help,” she said.

Waits for specialist appointments vary dramatically, depending on the type of specialist needed. Patients willing and able to travel across L.A. County to specialty clinics may be able to see a doctor within a month or two. Others who lack transportation and must go to a nearby facility can wait up to a year for a dermatologist or neurologist and up to 18 months for a cardiologist or ophthalmologist.

The county is trying to make the system more efficient, reduce wait times and ensure that those who don’t need more advanced care don’t overburden the system, said Mitch Katz, head of the L.A. County Department of Health Services. County officials risk losing newly insured patients, along with government funding, if they can’t find ways to reduce the bottleneck.

One focus is using technology to improve communication and better screen patients. A pilot program, for example, is allowing primary care doctors at community and public clinics to quickly transmit patients’ medical information via computer to a public health specialist for a consultation.

The electronic consults are streamlining referrals and helping clinic doctors make better treatment choices, said Louise McCarthy, executive director of the Community Clinic Assn. of Los Angeles County.

During an August visit to T.H.E. Clinic, Lawrence saw nurse practitioner Sandeep Lehil for the first time. He told her he was controlling his diabetes with medication and a modified diet. But his vision wasn’t getting any better.

“My eyes are really bad,” he told Lehil. “I can barely see.”

Lawrence’s medical record showed that he wouldn’t be seeing an ophthalmologist for many months.

“That’s a long time to live with blurry vision,” Lehil said.

“By that time, I’ll be blind maybe,” Lawrence responded.

Lawrence, who has a soft voice, an accent and a lanky frame, arrived in the U.S. nearly 20 years ago to pick apples, and overstayed his visa. He can’t work or drive, and he relies on others to cook meals to avoid burning himself. His immigration status prevents him from getting health insurance or unemployment benefits. He lives with a friend, spending most days listening to a television he can barely see. When the phone rings, he lifts it almost to his nose to see who is calling.

In mid-October, Lawrence was back at the clinic and saw a different, fill-in doctor who knew nothing about his situation, nor when his surgery would be scheduled. “You haven’t received any notice?” asked physician David Hwang. “No, not yet,” Lawrence answered, adding that he checks his mailbox every day.

De Leon, the referral clerk, later gave Lawrence unwelcome news: The wait to see an ophthalmologist at the county’s Harbor-UCLA Medical Center was still about a year. She said she was trying to get him an appointment elsewhere sooner.

Weeks later, Lawrence took matters into his own hands. With the help of a friend, he took three buses to reach the emergency room at Los Angeles County/USC Medical Center northeast of downtown. He waited several hours but finally saw an emergency room physician, who managed to get him an appointment the next day with an eye doctor.

“You have to do what you have to do,” Lawrence said.

At the medical center’s specialty clinic, ophthalmologist Simon Bababeygy told Lawrence his cataracts probably were caused by his diabetes, high blood pressure and high cholesterol.

He described the surgery he would perform, on one eye at a time. And he spoke the words Lawrence had been waiting for: He should be seeing much more clearly by the end of the year.

Preparing for the surgery, doctors got an abnormal result on a heart test. Now, Lawrence has to wait to see a county cardiologist before going back to Bababeygy to schedule the eye operation. He has no idea how long that could take.

“Every time, it’s something else,” he said. “My eyes are getting worse. And now it’s my heart.”

anna.gorman@latimes.com

Times staff writer Anna Gorman reported aspects of this story while participating in the California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism.

Copyright © 2012, Los Angeles Times

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LA Times, December 13, 2012

Court Ruling Could Cut California Spending On Medi-Cal

A 9th Circuit appeals panel decides California can reduce its Medi-Cal reimbursements to doctors, pharmacies and others. Providers say the doctor shortage will worsen.

By Maura Dolan and Chris Megerian, Los Angeles Times

SAN FRANCISCO — In a potential windfall for the state, a federal appeals court decided unanimously Thursday that California may cut reimbursements to doctors, pharmacies and others who serve the poor under Medi-Cal.

A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned injunctions blocking the state from implementing a 2011 law that slashed Medi-Cal reimbursements by 10%. Medi-Cal, a version of Medicaid, serves low-income Californians.

The ruling could make it harder to find doctors for as many as 2 million new patients who could become eligible for Medi-Cal under President Obama’s healthcare law — a possible 25% expansion of the program. California already provides one of the lowest rates of reimbursement in the nation for medical services to the poor, and there is a shortage of doctors to serve those patients.

Lynn S. Carman, an attorney for a group of pharmacies, said the decision would be costly for providers, worsen the doctor shortage and would be appealed.

“If this decision stands it will not only destroy the Medicaid program in California, but it will destroy the Obamacare program for millions of Americans who are now being shoved into the Medicaid program under the Affordable Care Act,” Carman said.

“They will not be able to obtain quality healthcare or access to services because providers cannot provide services at less than what it costs to furnish them,” Carman said.

The ruling could make it considerably easier for the state to close its budget gap.

The state is facing a $1.9-billion deficit next year, although Proposition 30’s temporary tax hike and an improving economy are projected to shift the state back into surpluses in the near future.

Medical providers said Thursday that the cutback should be lifted now that the state’s fiscal outlook has improved. The ruling can be applied retroactively to June 1, 2011.

“Now that the state has money, it would be like Scrooge for Gov. Brown not to pass a bill to eliminate at least the retroactivity part of it,” Carman said.

For the governor, Medi-Cal cuts could serve one policy aim at the expense of another.

Balancing the budget has been Brown’s first priority since taking office, and cutting healthcare — the state’s second-biggest cost after education — has been key to his fiscal goal.

But at the same time, he has wanted California to be out front in healthcare reform, and lead the country in efforts to put the federal law into place.

A spokesman for Gov. Brown released a statement Thursday that implied that Brown was inclined to put his budget priorities first, and was not likely to rescind the cuts.

“Today’s decision allows California to continue providing quality care for people on Medi-Cal while saving the state millions of dollars in unnecessary costs,” the spokesman wrote.

In a ruling written by Judge Stephen S. Trott, appointed by President Reagan, the panel said the lower court injunctions were unwarranted because the federal government had approved the cuts.

“Neither the State nor the federal government ‘promised, explicitly or implicitly,’ that provider reimbursement rates would never change,” Trott wrote.

California has estimated that the 10% cut to medical providers and pharmacies would save the state $50 million a month.

Medi-Cal typically covers families and disabled Californians. The federal law will extend its coverage to single, childless adults beginning in 2014.

The California Medical Assn., which joined dentists, pharmacists, medical suppliers and medical response companies in trying to block the cutbacks, urged Brown to repeal them.

Dr. Paul R. Phinney, president of the doctors’ association, said the cuts shrink the number of providers who could afford to serve both existing Medi-Cal patients and the new ones who could become eligible for coverage in 2014.

“We need to ensure that health insurance isn’t just an empty promise for these patients,” Phinney said.

According to the California HealthCare Foundation, Medi-Cal patients already have difficulty finding doctors.

A foundation study published in July 2010 said 25% of physicians provided care to 80% of Medi-Cal patients.

Although 90% of physicians told the foundation they were accepting new patients, only 57% said they were taking on new Medi-Cal patients.

Dr. Ted Mazer, a San Diego ear, nose and throat surgeon, said he had to stop taking fee-for-service Medi-Cal patients several years ago because the reimbursements didn’t cover his costs and Medi-Cal patients were inundating his practice.

“So few doctors will see Medi-Cal patients that I was seeing them from the Mexican border to Riverside County to Orange County,” said Mazer, an officer of the California Medical Assn. “The reimbursement costs are so poor they don’t even cover costs, let alone pay for the administrative hassle. I can only see so many until I go under.”

Chris Perrone, deputy director of the foundation, said Thursday’s ruling will make it harder to block rate cuts in the future.

“The hurdles for people who want to block these rate cuts are little higher,” said Perrone.

maura.dolan@latimes.com

chris.megerian@latimes.com

Dolan reported from San Francisco and Megerian from Sacramento.

Times staff writer Anna Gorman contributed to this report.

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