Debunking Canadian Health Care Myths

Debunking Canadian Health Care Myths by Rhonda Hackett
As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I'll avoid answering, regardless of the questioner's nationality. To choose one or the other system usually translates into a heated discussion of each one's merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America's health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada's government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks - unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.

There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn't the big bad "socialist" bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty - who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care - will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Dick Cheney's Tower of Lies

When Will Dick Cheney's Tower of Lies Finally Come Tumbling Down on Him?

Dick Cheney's statement to Greta van Susteren that "On the question of whether or not Iraq was involved in 9/11, there was never any evidence to prove that" is being widely portrayed as an admission.

But it's less an admission than a PR move. Cheney has spent the better part of the last seven years doing everything in his power to convince the American people of the very connection he now says there was "never any evidence" of.

In 2004, even after the 9/11 commission found "no credible evidence" of Iraqi involvement in 9/11, Cheney was still claiming the evidence that al Qaeda had a relationship with Saddam Hussein's regime in Iraq was "overwhelming."

When he was asked in '04 if Iraq was involved in 9/11, he said, "We don't know." Three years after the attack -- and he still didn't know? Even after they had tried every trick in the black book -- including torture -- to find a link?

And while Cheney's gotten more careful with his words over the years, he's never really stopped insinuating that there was a connection between 9/11 and the war in Iraq.

Indeed, as recently as two weeks ago in his big speech at the America Enterprise Institute, Cheney was still banging the drum about Saddam's "known ties to Mideast terrorists" as part of his rationale for invading Iraq and using torture.

Cheney's ongoing Forget Everything I Ever Told You Tour is historical revisionism at its most despicable.

And we are clearly watching a master manipulator at work. I've always felt that his best -- and by that I mean worst -- work was going on "Meet the Press" in 2002 to tell us about those ominous aluminum tubes and the "number of contacts over the years" between Al Qaeda and Iraq... or his repeated designed-to-terrify-voters warnings about nuclear attacks on US soil. But this ranks right up there.

In his interview with van Susteren, Cheney also backed away from his claim that the documents he wants the CIA to declassify would prove that torture was effective -- saying instead that they would offer a good summary of "what we learned" not just from waterboarding but the detainee interrogation program as a whole.

So, he gets all the media value and spin by originally making the claim that the intel documents would prove the value of torture - if only Obama would let the truth come out. Then he backs away from the claim, using weasel-words to give him sufficient wiggle room to say that what he really meant was that the overall interrogation program provided useful information -- not that waterboarding or other enhanced interrogation techniques did.

Perhaps it suddenly dawned on the former VP that he doesn't have the power to keep those documents classified any more -- and that he could be proven to be a liar (yet again) with the stroke of President Obama's pen. Hence the verbal tap-dancing.

But eventually the pile of lies may get so high that it will tumble down on him. For instance, it's not a very smart idea to go around saying that Richard Clarke missed the warning signs on bin Laden and 9/11 when there is email after email after email from the spring and summer of 2001 showing that it was actually Cheney and Bush who ignored the warning signs on bin Laden.

You know what they say about people living in glass houses? Well, people with a paper trail that proves they ignored the looming threat of al-Qaeda, sanctioned torture, and used lies and manipulated intelligence to get us into a war, shouldn't be so fast to throw stones either.

GM Re-organization Hurting American Labor

Governing GM

President Obama, announcing the nationalization of General Motors--one of the more dizzying recent developments in American capitalism--sought to soothe startled free-market sensibilities by promising to "get GM back on its feet, take a hands-off approach and get out quickly." This was not enough to appease his rabid critics on the right, such as Republican National Committee chair Michael Steele, who condemned the move as "another government grab of a private company" and a "handout to the union cronies who helped bankroll his presidential campaign." The alternative course Republicans apparently prefer is the liquidation of the company, a position galling in its indifference to this country's economic and human needs.



At the same time, however, Obama's message, coming only nine weeks after his administration demanded that GM "slim down" in order to qualify for federal help, must have been hard to hear for GM workers, 21,000 of whom are slated to lose their jobs as the firm closes US plants and shifts production to low-wage countries. As Robert Reich observed of the government's stick-'em-up stance toward the auto companies, "Having General Motors or Chrysler cut tens of thousands of jobs in order to be eligible for a government bailout reminds me of 'saving' Vietnam by bombing it to smithereens."

It is more than clear by now that the goal of this intervention is not to help the workers who are suffering the effects of this devastating downturn. It is not even about saving Detroit: when pressed on whether the "new GM" would move its headquarters, the president reportedly responded that it would be a "commercial decision" and he "wouldn't get involved." Nor is this part of a bold new industrial strategy, let alone a step toward a more ecologically sustainable economy. It is a company bailout. As such, it is not only a letdown for American workers but a missed opportunity for the Obama administration to live up to its transformational rhetoric.

Some believe that the $50 billion taxpayer investment in GM is merely buying time--that the once-mighty auto giant is bound for the scrapheap, taking its remaining 60,000 jobs with it. They might be right. To be sure, the half-million-plus middle-class jobs GM used to provide as the bedrock of the economy are unlikely to return. And after the economic meltdown of the past year, we are facing a national unemployment crisis. By the administration's own estimate, the stimulus will create or save 3.6 million jobs over the next two years. But 28.5 million workers are already effectively unemployed, and 3 million more are likely to lose their jobs over the next twelve to eighteen months. Because the government has responded to this crisis by addressing the needs of companies first and foremost rather than those of workers and communities, we appear to be headed for a jobless recovery.

A smarter government policy on manufacturing could be the starting point for a long-term solution to the jobs crisis--and protect the planet at the same time. There is little question that the auto industry needs retooling. In the past decade, Americans bought more than 17 million new cars a year, many financed through home-equity loans and easy consumer credit. That economy is gone; even the rosiest of estimates puts new sales at less than 10 million a year through 2010. And even if consumer lending ultimately bounces back to pre-crash rates, the combined effect of the recession and the climate crisis may be to jolt Americans into breaking their addiction to the car culture.

Greater fuel efficiency and a transition to new green technologies are clearly in order. This doesn't just mean building smaller cars or even electric ones. Detroit could be manufacturing city buses, wind turbines, light rail, high-speed trains and solar panels. Such a shift would require an infusion of resources and ingenuity--and abandoning the free-market fanaticism that is still pervasive--but it is not unprecedented. In the 1940s, thanks in large part to the leadership of President Roosevelt and the United Auto Workers' Walter Reuther, idle car factories began building fighter planes for World War II, thereby simultaneously aiding the fight against fascism and helping to pull the country out of the Great Depression.

But today, for a variety of reasons, such leadership is lacking. The Obama administration certainly isn't providing it. And the voice of the UAW has become difficult to distinguish from that of industry management. Part of the problem is simply that the union has been hemorrhaging members as US manufacturing jobs evaporate. The fact that the union has swallowed concession after concession and still seen jobs disappear has led to profound demoralization among the rank and file. Today the union's membership is less than a third of what it was just thirty years ago, and its future is more uncertain than ever. As GM and Chrysler shed workers and plants, the nonunion firms and auto parts suppliers that largely dictate labor standards in the industry will wield even greater influence. And the Obama administration's plan for the industry, exacting painful concessions from the union on jobs and pay, only reinforces this downward-trending logic.

The challenge facing the UAW is to look beyond the financial health of the GM and Chrysler brands and steer an innovative course toward preserving well-paid manufacturing jobs and promoting environmental sustainability. But even if it crafts such a visionary message, in order to get a hearing for it the union must regain the leverage it has lost by organizing the unorganized, much as it did at its birth in the 1930s. Back then, the UAW's model of social movement unionism put it at the vanguard of progressive politics, and it used its clout in Detroit and Washington to pull up wages for workers in all industries, building a broad middle class. It won't be easy to get to that place again. Yet today there are fleets of nonunion workers--in newer Toyota and Honda plants in states like Kentucky and Alabama; at small independent parts makers that dot the industrial Midwest; and even in thousands of car dealerships in towns and cities across the country--who could be the key to the union's resurgence.

GOP fantasies aside, the Obama administration is not conducting its auto industry policy with the interests of organized labor in mind. The Wall Street brain trust that ran the president's auto task force spent months deliberating over the fate of the automakers in near isolation from workers, Congress and the people, and arrived at a solution notable for its timidity and callousness in the face of economic calamity. The lesson, for the UAW and for progressives, is clear. If there is to be another course for the domestic auto industry--and there must--it will have to be charted outside the Beltway by concerned citizens and emboldened workers ready to say, "What's good for us is what's good for GM," and not the other way around.

Medical bills underlie 60 percent of U.S. bankruptcies

Medical bills underlie 60 percent of U.S. bankruptcies

Medical bills are behind more than 60 percent of U.S. personal bankruptcies, U.S. researchers reported Thursday in a report they said demonstrates that healthcare reform is on the wrong track.

More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.

"Unless you're Warren Buffett, your family is just one serious illness away from bankruptcy," Harvard's Dr. David Himmelstein, an advocate for a single-payer health insurance program for the United States, said in a statement.

"For middle-class Americans, health insurance offers little protection," he added.

The United States is embarking on an overhaul of its healthcare system, now a patchwork of public programs such as Medicare for the elderly and disabled and employer-sponsored health insurance that leaves 15 percent of the population with no coverage.

The researchers and some consumer advocates said the study showed the proposals under the most serious consideration are unlikely to help many Americans. They are pressing for a so-called single payer plan, in which one agency, usually the government, coordinates health coverage.

"Expanding private insurance and calling it health reform will fail to prevent financial catastrophe for hundreds of thousands of Americans every year," Dr. Sidney Wolfe of the Health Research Group at Public Citizen said in a statement.

About 170 million people get health insurance through an employer but President Barack Obama says soaring healthcare costs hurt the economy and force businesses to drop medical insurance for their workers.

CANCELED COVERAGE

"Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year," the report reads.

Obama told Congress Wednesday he was open to making mandatory health insurance part of the overhaul.

Neither Congress nor Obama are considering the kind of single-payer plan advocated by Public Citizen, Himmelstein and his colleague Dr. Steffie Woolhandler.

"We need to rethink health reform," Woolhandler said. "Covering the uninsured isn't enough.

"Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy."

The researchers studied 2,134 random families who filed for bankruptcy between January and April in 2007, before the current recession began.

They used public bankruptcy court records and surveyed 1,032 people by telephone.

"Using a conservative definition, 62.1 percent of all bankruptcies in 2007 were medical; 92 percent of these medical debtors had medical debts over $5,000, or 10 percent of pretax family income," the researchers wrote.

"Most medical debtors were well-educated, owned homes and had middle-class occupations."

The researchers, funded by the Robert Wood Johnson Foundation, said the share of bankruptcies that could be blamed on medical problems rose by 50 percent from 2001 to 2007.

Patients with multiple sclerosis paid a mean of $34,167 out of pocket in 2007, diabetics paid $26,971, and those with injuries paid $25,096, the researchers found.

Fox News again distorts Obama's Strasbourg remarks, promotes "another apology tour"

Fox News again distorts Obama's Strasbourg remarks, promotes "another apology tour"
SUMMARY: Fox News' Jon Scott asked if "the president's upcoming trip [to Europe and the Middle East will] be what conservatives might call another apology tour," and both Scott and co-host Jane Skinner aired cropped clips of President Obama's remarks from an April 3 speech in France to falsely suggest that Obama only criticized the United States.


During a June 2 segment on Fox News' Happening Now in which co-host Jon Scott asked if "the president's upcoming trip [to Europe and the Middle East will] be what conservatives might call another apology tour," both Scott and co-host Jane Skinner aired cropped clips of President Obama's remarks from an April 3 speech in Strasbourg, France, to falsely suggest that Obama only criticized the United States. In fact, during his speech, he also praised it and criticized European anti-Americanism. As Media Matters for America has documented, several Fox hosts and guests, as well as the Fox Nation website, have cropped or misrepresented Obama's Strasbourg remarks to falsely suggest, in the words of host Sean Hannity, that Obama was "blam[ing] America first" and, more broadly, that Obama's earlier overseas trip constituted an "apology tour."

Teasing Scott's segment, Skinner said: "President Obama is getting ready for a big trip overseas, a major policy speech in Egypt," and aired a cropped quote from Obama's Strasbourg speech:

OBAMA: There is plenty of blame to go around for what has happened. The United States certainly shares its, shares blame for what has happened.

She then asserted: "Sharing blame -- some are asking if the president's trip this week will be an apology tour." On-screen text during Skinner's remarks advanced the "apology tour" smear:

Minutes later, Scott similarly noted Obama's upcoming overseas trip, and aired a different cropped quote from his Strasbourg speech:

OBAMA: In America there is a failure to appreciate Europe's leading role in the world. Instead of celebrating your dynamic union and seeking to partner with you to meet common challenges, there have been times where America has shown arrogance and been dismissive, even derisive.

Scott then asked guest Heather Hurlburt, former speechwriter for Secretaries of State Madeleine Albright and Warren Christopher: "[W]hen the president speaks about American arrogance, that might play well overseas, but how does it play in this country?" Scott also asked Hurlburt, "[Y]ou think that that kind of talk is a positive?" During the interview, on-screen text again advanced the "apology tour" smear:

Another on-screen graphic, dubbed a "FOXfact," highlighted Obama's "arrogance" remark:

However, at no point did either Scott or Skinner note that Obama also criticized Europe and praised America during his Strasbourg remarks. Indeed, immediately after the part of the speech Scott aired, Obama criticized anti-Americanism in Europe as well as Europeans who "choose to blame America for much of what's bad" and referred to "the good that America so often does in the world."

From Obama's April 3 speech in Strasbourg:

Now, there's plenty of blame to go around for what has happened, and the United States certainly shares its -- shares blame for what has happened. But every nation bears responsibility for what lies ahead, especially now, for whether it's the recession or climate change, or terrorism, or drug trafficking, poverty, or the proliferation of nuclear weapons, we have learned that without a doubt there's no quarter of the globe that can wall itself off from the threats of the 21st century.

[...]

Such an effort is never easy. It's always harder to forge true partnerships and sturdy alliances than to act alone, or to wait for the action of somebody else. It's more difficult to break down walls of division than to simply allow our differences to build and our resentments to fester. So we must be honest with ourselves. In recent years we've allowed our Alliance to drift. I know that there have been honest disagreements over policy, but we also know that there's something more that has crept into our relationship. In America, there's a failure to appreciate Europe's leading role in the world. Instead of celebrating your dynamic union and seeking to partner with you to meet common challenges, there have been times where America has shown arrogance and been dismissive, even derisive.

But in Europe, there is an anti-Americanism that is at once casual but can also be insidious. Instead of recognizing the good that America so often does in the world, there have been times where Europeans choose to blame America for much of what's bad.

On both sides of the Atlantic, these attitudes have become all too common. They are not wise. They do not represent the truth. They threaten to widen the divide across the Atlantic and leave us both more isolated. They fail to acknowledge the fundamental truth that America cannot confront the challenges of this century alone, but that Europe cannot confront them without America.

So I've come to Europe this week to renew our partnership, one in which America listens and learns from our friends and allies, but where our friends and allies bear their share of the burden. Together, we must forge common solutions to our common problems.

So let me say this as clearly as I can: America is changing, but it cannot be America alone that changes. We are confronting the greatest economic crisis since World War II. The only way to confront this unprecedented crisis is through unprecedented coordination.

Cheney admits there was never any evidence tying Iraq 9/11

Cheney admits there was never any evidence tying Iraq 9/11
Oops.

Former Vice President Dick Cheney wants a do-over. After being party to an administration that repeatedly sought to tie the Sept. 11, 2001 terrorist attacks with Saddam Hussein, he’s ready to let that assertion go.

In an interview with Fox News’ Greta van Susteren Monday, Cheney said there was no evidence tying Iraq and 9/11 — and that there never was.

“On the question of whether or not Iraq was involved in 9-11, there was never any evidence to prove that,” he told the Fox host. “There was “some reporting early on … but that was never borne out… [President] George [Bush] … did say and did testify that there was an ongoing relationship between al-Qaeda and Iraq, but no proof that Iraq was involved in 9-11.”

Cheney’s comments are a marked shift from those he made in 2003. Pressed to disavow assertions that Iraq was in any way involved with the attacks, the then-VP claimed the administration was learning “more and more” about al Qaeda-Iraq ties.

Now, after 4,308 US servicemembers have lost their lives in Iraq, and no longer in office, the vociferous GOP hawk has appears to have changed his mind.

As GM Files Bankruptcy, Conservatives Again Claiming That Bondholders Were Treated Unfairly

As GM Files Bankruptcy, Conservatives Again Claiming That Bondholders Were Treated Unfairly

General Motor’s long awaited trip into bankruptcy is official as of this morning. Of course, conservatives have been decrying the plight of the company’s creditors, who are receiving a ten percent stake in the company, while a 17.5 percent stake will go to the United Auto Workers’ health trust. First, the Wall Street Journal’s editorial board:

Every decision the feds have made since December suggests that nonpolitical management will be impossible…Treasury bludgeoned the bond holders in both Chrysler and GM to take pennies on the dollar, which will not make creditors eager to lend to the companies in the future.

And conservative members of the House:

“The proposal seems to favor the rights and claims of the UAW, a political ally of the current administration and a powerful lobbying force in Washington, over the rights and claims of the company’s diverse group of bondholders,” according to a letter from 20 House members, led by Rep. Jeb Hensarling (R-Tex.), to Treasury Secretary Timothy F. Geithner. “Contractual rights of investors are being trampled by the government under the rationale of ‘extraordinary circumstances.’ ”

We went through the same song and dance with Chrysler’s bankruptcy filing earlier this month, and the concerns don’t hold any more weight now. As the Washington Post noted today, “there are a number of precedents for retiree health funds getting preferential treatment during bankruptcies, particularly in the steel industry in recent years when Bethlehem Steel and others were sold off”:

“We felt that we needed the strong support of the union going forward,” said Wilbur Ross, who ran the private-equity firm that acquired Bethlehem after its 2001 bankruptcy filing. “It’s one thing to compromise a union contract. It’s another thing to get them working with good morale.”

“The only difference here is that you have the government playing the role of the vulture investor,” Ross added. “They are the only ones willing to make this investment, so they’re calling the shots.”

It’s also likely that the GM bondholders would get no more in liquidation than they are getting under the current deal, which may be why a majority of bondholders (54 percent) have jumped on board. Plus, as Harold Meyerson put it, “shareholders and bondholders knew they were taking risks when they invested in the company, but workers were flatly promised pensions and health benefits in retirement, payments for which were deducted from their paychecks.”

GM workers have already given up a lot in wage and benefit cuts, and they’re going to see their ranks thinned by some 21,000. In light of this, refusing to gut their health trust seems like the right decision.

- courtesy ThinkProgress