Gray Matters: Health Insurance Companies

Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. His Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, appears here at Time Goes By twice each month.

Now that we’ve heard all the horror stories of coverage denials and soaring profits, I propose that we stop beating up on the health insurance companies and consider a more fundamental issue: Do we need health insurance companies at all?

This is a rhetorical question, of course, to which you can guess my reply, but bear with me.

The United States is unique in that we have a for-profit health insurance industry which has not done very well in providing health care. In France and Switzerland, such insurance companies are non-profit and tightly regulated. But almost everywhere else where there is a form of national health insurance, there are no such things as companies that make profits based on a person’s health – and no one is without access to health care.

I am not opposed to profit-making insurance. But the insurance we take for granted suggests what’s wrong with health insurance. Homeowners’ insurance works well because people tend to take care of their homes and the risk for the insurer is reasonable. But some companies won’t cover a house a few miles from the shore because of hurricane possibilities. They won’t insure homes that really need protection.

Similarly, most states mandate auto insurance coverage and even subsidize it with “no fault” coverage for people who can’t pay. But the prices of policies generally reflect risk factors that protect most careful drivers as well as the companies from excessive losses.

Life insurance may no longer be a good investment, but the companies' actuaries are pretty good at figuring life spans and take a modest risk that not every policy holder will die at the same time.

Here is my point: Life span is generally predictable; cars and homes may be replaced, and not everyone is in an accident or suffers a home fire or burglary. But everyone one gets sick, many seriously, even catastrophically. And our health and that of our families is unpredictable, out of anyone’s control, and may be a matter of life or death.

But health insurers can stay in business (without the present government subsidies) only if

1. we don’t get sick, or


2. if we do, they can avoid and minimize coverage, or


3. we die quickly

Perhaps that’s harsh. But health insurance is an absurd conflict of interests, the patient’s versus the insurance company’s bottom line; this is a market system, after all. This essential problem with private health insurance was first pointed out to me by one of my heroes in the health reform battles – Dr. Marcia Angell, a pathologist who ten years ago became the first woman editor-in-chief of the prestigious New England Journal of Medicine.

In that position, she guided the journal towards critically examining the American health care system along with its papers and studies on medical advances. She analyzed the inherent conflicts in employer-based health insurance in which one’s health coverage is dependent on the employer’s financial health. And she was among the first to suggest gradually opening Medicare to persons of all ages – a belief she still holds.

In 2003, after she became a senior lecturer at Harvard’s medical school, Angell co-authored a paper which was a breakthrough for the staid and conservative Journal of the American Medical Association. The paper, endorsed by 7,800 doctors and medical students, was entitled a “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance.” The other writers were Drs. Steffie Woolhandler and David Himmelstein, both of Harvard’s Cambridge Hospital, and Dr. Quentin Young, a founder of Physicians for a National Health Program.

Critics of the current health reform proposals say health care is best left to the market system, but that’s where it has been for decades. Here’s how Angell characterized private health insurance:

“The United States alone treats health care as a commodity distributed according to ability to pay, rather than as a social service to be distributed according to medical need. In this market driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or other payers.

“This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar.”

Each of these satellite businesses, with their telephone answering bureaucrats to explain health coverage denials, add not one pill to a patient’s well-being. And by the very nature of our market system, insurance companies, which pay their executives multi-million dollar salaries, are beholden less to patients than to shareholders and Wall Street analysts who demand higher profits for each quarter. (Humana just reported a 65 percent rise in profits in the third quarter of this year on top of a 37 percent increase in the second quarter.)

Angell said on another occasion,

“We are the only nation in the world with a health care system based on dodging sick people. These practices add greatly to overhead costs because they require a mountain of paperwork...Private insurers regularly skim off the top a substantial fraction of the premium – from 10 to 25 percent – for their administrative costs, marketing and profits.

The remainder is then passed along a veritable gauntlet of satellite businesses that feed off the health industry, including brokers...disease management companies, drug-management companies, legal services, marketing companies, billing agencies...”

Congressional analysts estimate the five largest health insurers spend 73 to 84 percent of premiums on health care claims. The rest, as Angell says, goes to marketing, administration and profits.

According to The New York Times, a Commonwealth Fund survey found, not surprisingly, that

“73 percent of adults who tried to buy insurance on the open market over three-year period never bought a plan because they could not afford it, could not find a plan that met their needs, or were turned down.”

Angell was asked recently in a New York Times interview what would happen to the insurance companies and their employees and satellites if a single-payer, Medicare-for-All program was adopted. She was frank:

“It would lead to job losses in this sector, which constitutes 17 percent of the economy,” she said. “But what about the other 83 percent of the economy? They’re being bled to death.”

She is skeptical of the current health reform proposals because they depend on private health insurance and drug companies which, she maintains, will not change their behavior.

“These are investor-owned companies. Their fiduciary responsibility is to maximize profits...If you keep health coverage in the hands of for-profit companies, you can do one or the other – increase coverage by putting more money into the system or control costs by decreasing coverage. You cannot do both unless you change the basic structure of the system.”

That’s not about to happen. Lawmakers are still fighting about costs and how many Americans can be covered and when. The conflicts of interest will go on. But Marcia Angell is worth listening to and one day we’ll turn to her rather straightforward solution – Medicare for Everyone.

Write to saulfriedmanATcomcastDOTnet

How Well Do You Sleep?

As I have undoubtedly mentioned here from time to time, I don't sleep worth a damn. If it's not that I need to pee, it's waking at ungodly early hours - like 2:30AM - without a chance of going back to sleep. On nights when that doesn't happen, the cat's circadian rhythm has him poking me by 4AM or 4:30AM with breakfast in mind. He is the personification of persistence.

In just the past two weeks, however, I've regularly been sleeping for seven or eight hours without interruption. Even the cat has slept past 4:30AM on a few occasions. I can't say what changed, but I'm grateful for it.

Even so, since there is no telling how long my new-found full-night's sleep will last, I was eager when I was invited by the International Longevity Center to take part in a teleconference earlier this week with four of the authors - all medical doctors and all experts in sleep and aging - of new report published this year in The Journal of the American Geriatrics Society (paid subscription required) outlining new recommendations for treating sleep disorders.

Many people believe that sleep disturbances are a normal part of getting old. Not so, say the authors. Nevertheless, 30 to 50 percent of elders report problems with insomnia – that is, difficulty falling asleep and/or staying asleep. Other sleep disorders that effect smaller numbers of people include

• sleep apnea
• restless leg syndrome
• circadian rhythm disorders
• parasomnias
• hypersomnias
• disorders associated with nursing homes

Lack of a good night's sleep has a strong impact on elders' quality of life contributing to balance difficulties leading to falls, an inability to concentrate, frailty and decreased cognitive function. The causes are many – among them, hypertension, stress, depression, some illnesses, any medications that affect neurotransmitters, use of nicotine, alcohol, caffeine, some herbal and over-the-counter medicines.

Certain changes in our bodies as we get older also affect sleep. Circadian rhythms appear to change so that old people tend to fall asleep earlier and wake earlier than when they were younger. The amount of light sleep increases and the amount of deep sleep decreases.

I asked about the effect of the last item. It is known, the doctors told us, that growth hormone which is needed for a body to repair itself, is secreted primarily during deep sleep. It is not yet known what causes the decrease or its effect on old people.

As Dr. Robert N. Butler, the president and CEO of the International Longevity Center, noted during the teleconference, sleep is a profound piece of the human condition. It deserves more attention than we or our physicians often give it. Few doctors ask about sleep problems; I know I have never, when young or old, been asked how I sleep.

Elders need to be more pro-active and let our physicians know if we have trouble sleeping and discuss possible treatments. Be wary of hypnotic drugs such as Ambien and Lunestra which, say the researchers, are often prescribed because it is easiest thing to do rather than search out causes.

Depending on the type of sleep disorder, treatment can include changing medications, light therapy and cognitive behavioral therapy, among others.

Here are the researchers' tips for a better night's sleep. We all sort of know these things, but don't necessarily follow them. I often read and watch television in bed.

• Go to bed and wake up at the same time every day
• Develop a sleep ritual
• If you cannot fall asleep in 20 minutes, get up and do something relaxing until you feel sleepy
• Avoid exercising within two hours of bedtime
• If you must nap during the day, limit it to 30 minutes and try to nap before 3:00PM
• Use the bedroom only for sleep and sex; do not watch television or work in bed
• Get regular exercise and exposure to outdoor light

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The PBS series, Life (Part 2) continues. This week's episode deals with what makes us happy. Here is a short clip of a whole lot of people answering that question.

You can watch the whole episode here.

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At The Elder Storytelling Place today, Clarence Bowles: A Pet Peeve

The Cult of Manhattan Tower

Two or three times over the life of this blog, I have written about a 1945 recording titled Manhattan Tower. I was a little girl of no more than five or six when my parents obtained it when it was first released, and I adopted it as my own. I played those two 78s hundreds of times and I am convinced it is what began my love affair with New York City – nothing else explains my yearning to live there from earliest childhood.

The album is a love story to New York City, a suite composed and conducted by Gordon Jenkins with the lead performances sung by Eliot Lewis and Beverly Mahr. Never heard of them? Me neither – except on this album.

For the longest time, decades, I believed Manhattan Tower was a private obsession. But ever since I blogged about it in 2005, people regularly stop by having, I assume, googled the title. Some leave comments about how happy they are to rediscover an old favorite, and many others turn up in the blog stats having visited the page, but not left a comment. There is, apparently, a cult surrounding Manhattan Tower.

Having long lost the album, I found it a few years ago on a CD of old, old New York songs, some much older than these. A check yesterday at Amazon turned up a newer CD titled Manhattan Tower, but because it references the 1956 release, I can't tell if it is the version made in that decade with a different cast, or the original 1945 release. The one I bought is still available at Amazon, but only from outside vendors at a horrendously high price: $63.66 and $39.69.

Jenkins' arrangement is, by today's standards, overblown, grandiose and almost-but-not-quite sticky sweet. But that doesn't matter to me and other members of the Manhattan Tower cult. And the story, in a way, matches my own New York story, a city a still miss every day.

Now that audio is possible on this blog, I've posted the entire suite below. There are four movements, each about four minutes long. For those of you who don't find it too treacly – enjoy.

Magical Tower

Party

New York's My Home

Love in a Tower

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At The Elder Storytelling Place today, Dani Ferguson: What's Up, Doc?

The Secret War on Social Security and Medicare

Certainly you recall that back in 2004 and 2005, then-President Bush put all the substantial muscle of his office into Social Security “reform.” He and his surrogates spent more than year flitting about the nation spreading lies that Social Security was in “crisis,” that it was “broke.”

The solution to this non-problem, he said, was to privatize Social Security. Younger workers would be allowed to divert a portion of their Social Security contribution into private accounts and invest it as they chose.

Ignoring Wall Street history that includes a decade-long, ruinous Depression and several painful recessions, the president blithely suggested that everyone would be millionaires by the time they retired.

Sensibly, the people of the United States overwhelmingly rejected President Bush's privatization scheme, and if anyone had any doubts about its dangers, they were washed away in the crash of October 2008.

That should have been the end of attacks on the most successful social program in the history of the world. But no.

There is a growing drumbeat, mostly under the media radar, to cut not just Social Security benefits, but Medicare and Medicaid too. Several previous attempts at what is being called “entitlement reform” have faded away, but the pressure for it continues and is increasing.

Now, there is a proposal from Senate Budget Committee Chairman Kent Conrad (Dem. N.D.) and Republican Senator Judd Gregg of New Hampshire to create an “entitlement commission” and to do it soon.

The idea this time, as in similar past efforts, is to force major changes to Social Security, Medicare and Medicaid (read: benefit cuts) by tasking the commission of appointed members to create legislation to cut costs and then force an up or down vote in Congress without scheduling time for debate or an allowance for amendments.

Last week, the Senate Budget Committee heard testimony on the Conrad/Gregg commission proposal. All ten witnesses support the creation of this commission; none who oppose it were invited. Among the supporters who spoke was David M. Walker, president and CEO of the Peter G. Peterson Foundation who, like most proponents of the commission, seeks to conflate the current recession with the cost of entitlement programs:

“...we must recognize the reality that key factors that contributed to the recent mortgage-related sub-prime crisis also exist in connection with the federal government's own finances,” said Walker. “These factors are: first, a disconnect between the parties who benefit from prevailing policies and practices and those who will pay the price and and bear the burden for today's fiscal irresponsibility.”

Barbara B. Kennelly, president and CEO of the National Committee to Preserve Social Security and Medicare, translated that (intentionally?) murky testimony into English in a letter to Congress [pdf]:

“[W]e are surprised to see the federal deficit and the federal debt cited as the reason a commission needs to be established to make cuts in Social Security.”

That the head of the Peter G. Peterson Foundation testified in favor of the commission should raise a bright red warning flag to all of us. For years, Peterson has used his influence and his money – he endowed the Foundation with $1 billion from his personal fortune – to crusade for the dismantling of Social Security and Medicare. Earlier this year, William Greider further deconstructed Peterson's message:

“It is a frightful message,” wrote Greider. “Peterson describes a '$53 trillion hole' in America's fiscal condition - but the claim assumes numerous artful fallacies. His most blatant distortion is lumping Social Security, which is self-funded and sound, with other entitlements like Medicare and Medicaid.

“Those programs do face financial crisis - not because the elderly and poor are greedily gaming the system but because the medical-industrial complex has the profit incentive to drive healthcare costs higher and higher. Healthcare reform can solve the financing problem only if it imposes cost controls on private players like the insurance and pharmaceutical industries.”

So what we have is a well-connected, billionaire activist who has no need for Social Security and Medicare using his fortune and influence (he was Secretary of Commerce under President Nixon, founder of the Blackstone Group and former chairman of the Council on Foreign Relations) to set up a 15-person commission within Congress that would remove control from and the responsibility of ALL of Congress to make decisions about Social Security, Medicare and much of the entire tax system.

A substantial number of Congress members appear to believe this is a good idea, and it is more dangerous than President Bush's privatization scheme because it is moving forward without attention from major media. If the plan succeeds, decisions about Social Security, Medicare, Medicaid and other social programs will be made by a cabal of legislators and unelected appointees behind closed doors rather than in open Congress.

Not only would Congress at large have no say beyond a yes/no vote on commission-created legislation, there would be no opportunity for we the people to let our representatives know where we stand. I won't stand for that and neither should you.

There are, of course, more details than there is room to explain here. If you are as interested and alarmed as I am, here are some links – in addition to the ones above - to help you understand what's going on.

Passing the Buck to an Entitlement Commission
17 November 2009

Lawmakers, White House Consider Bipartisan Route To Bend Health 'Cost Curve'
13 November 2009

Senators Discuss Creation of Panel to Control Health Costs
11 November 2009

Fast-tracking Cuts to Social Security and Medicare
10 November 2009

Senator Gregg's Comments in Congress [pdf]
13 May 2009

Checking America's Balance Sheets
12 February 2009

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At The Elder Storytelling Place today, Ellen Younkins: The Scullery Maid

Social Media Jabberwocky

There is hardly a moment in Crabby Old Lady's online life when she is not being exhorted to tweet, Digg, Facebook, Yahoo Buzz, etc. everything she reads, hears, eats, believes and thinks.

It's not just blogs anymore, it's newspapers big and small, political sites, health sites, commercial sites - pretty much any website: They all post a bunch of little links at the bottom of their stories begging people to spread the word of their brilliant prose or to “follow me on Twitter.”

Crabby joined Facebook and Twitter a couple of years ago to see what they are and how they work. She wasn't impressed then and still is not impressed. As to Twitter, there isn't much that can be conveyed in 140 characters and there is not a person on earth about whose moment-to-moment lunch and travel arrangements or emotional temperature Crabby cares to know.

Mavens of social media extol the virtues of Twitter and boast that when news happens, it's reported on Twitter first. The obvious problem for Crabby is that short of a missile pointed at her neighborhood, there isn't any news she needs to know immediately. Among her 25 daily news alerts and two or three dozen email subscriptions from varied news sources, RSS subscriptions and her paper subscriptions, she manages to keep up despite the fact that social media denizens think she is hopelessly behind the times.

Businesses, they tell us, can no longer succeed without Twitter so every corporation in the U.S. is now tweeting. Crabby doesn't care what Ajax cleanser workers have to say, nor Sony or FedEx, etc. She just wants their products to work properly and if she needs to know more, they all have websites that are likely to answer her question, especially when that answer requires more than 140 characters, which most do.

As soon as Crabby had determined that Facebook held no interest for her – it took about 30 minutes - people started “friending” her. She still doesn't know what that is supposed to mean to her life but because it seems churlish to not accept a friend invitation, she says yes to everyone - about of third of whom she has never heard of.

On the theory that some of those 100-plus “friends” Crabby as accepted use only Facebook, a few weeks ago, Crabby set up this blog to publish automatically to Facebook. Typepad makes it easy – about two clicks – so it's no skin off Crabby's nose, but there is no way to know whether or not it benefits anyone.

There is more to social media than Twitter and Facebook. For example, The New York Times, in one of the many kinds of attempts traditional newspapers are making to join the social media bandwagon, started a online “Conversation” on health care. There are 20-odd subtopics each with comments numbering in the hundreds, and one with more than 1700 comments.

That's not news or even social media and it is certainly not “conversation.” It's jabberwocky. Who is going read 1700 comments from people they never heard of who may or may not write anything worth knowing? Crabby believes it is a newspaper's job to edit the news. If they're not going to do that, Crabby may as well read the unfiltered wire services herself.

In addition to their journalistic responsibilities, the Times now forces their reporters to write blogs, as does CNN. Paul Krugman, for example, writes two well-thought out, op-ed columns a week. Given the intricacies of economics and the current state of the world's economies, that should be more than enough to earn his salary. But no. Now the poor man also writes blog posts two or three or more times a day.

Wolf Blitzer, of CNN, hosts three hours of live television a day, sometimes more. For years, Crabby produced daily, live television back in the days when individual stories lasted five to eight minutes. It was hard work keeping up then and nowadays, when stories rarely last more than two to three minutes, there is that much more to know. Say what you will about Blitzer, his job is not easy. But now CNN requires him to tweet all day and record podcasts too.

With all this output, the quality of all of it suffers.

The people who count such things say that use of social media is growing and while email is still growing, the rate has slowed. That may have something to do with the fact that 299 million Americans already use email, which pretty much accounts for everyone but infants (and makes the figure questionable).

Those same people say that social media is used mostly by young people, up to about age 44, and they imply that old people are somehow deficient in knowledge of technology or slow to adopt new trends. Crabby Old Lady doesn't think so.

Crabby thinks elders are long accustomed to thinking and writing in complete sentences and paragraphs and are able to carry on conversations for longer than 140 characters. That's an advantage when discussing anything more complex than the lunch menu or responding with the ubiquitous, “What she said.”

But most of all, keeping up Twitter, Facebook, Digg, StumbleUpon, etc. accounts is way too much like work, too time-consuming and anyway, Crabby doesn't have that much to say. She can turn out a blog post and wrangle the 150-200 emails that arrive each day, but that's her limit. And anyway, all that social media is mostly just noise.

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At The Elder Storytelling Place today, Johna Ferguson: TAHW?

Medicare Sign Up Starts Now, and More on Elderblogs

MEDICARE SIGN UP
The annual enrollment in Medicare Part B (Medigap, also called supplemental) and Part D (prescription drug) is open now and until 31 December.

As noted in a post here a month ago, almost all premiums are increasing and some policies are increasing or adding co-pays. Others are adding deductibles and some coverage is being discontinued. So it behooves us all to check our current coverage, see what else is available and decide if we want to make changes.

The Part D Prescription Drug Plan Finder is here, and the Part B Medigap Finder is here. If you missed it on Saturday, Saul Friedman's Gray Matters column has a lot more information about Medicare sign up.

And, serendipitously, Mage Bailey's story at The Elder Storytelling Place today is also about signing up for Medicare (link is at the bottom of this post).

With all the above, you should be well prepared to make your annual decisions about Medicare. You have six weeks to fit this chore into the busy-ness the holidays.

ELDERBLOGS LIST
Following Friday's post about the update to the Elderbloggers List, several people suggested their blogs or mentioned disappointment that they were not included. How right the latter are. I had planned to add each of them and I can't say what happened. Perhaps some of my notes got lost during my hard drive failure three weeks ago.

I am most chagrined to have omitted them, so they have now been added along with a couple of the new ones. Also, I forgot to mention in the list of criteria (is this memory thing of mine getting serious, do you think?) that the topic of an elderblog is not a consideration. All are welcome – stamps, cooking, movies, grandchildren, politics, health, bicycling, knitting – anything at all, including no specific topic. And finally, blogs are added at my discretion.

My apologies for the omissions. Here are the newly added elderblogs:

Family Finance

Letters For George

Mature Landscaping

Photoblogging in Paris

Privilege

Retirement Daze

Self-Sufficient Steward

If other readers want their blogs included on the list or wish to suggest other elderblogs, email me (use the Contact link in the upper left corner of this page). If they meet the criteria, I will include them on the next update sometime early next year.

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At The Elder Storytelling Place today, Mage Bailey: Naivety

ELDER MUSIC: Some Early Blues Women

You never know who you're going to meet on the internet and I came to know Peter Tibbles (bio here) via email over the past couple of years. His extensive knowledge of most genres of music and his excellent taste became apparent only gradually (Peter's not one to toot his horn) but once I understood, I knew he needed his own column at Time Goes By - or, better, that TGB needed his column - which appears here each Sunday. You can find previous Elder Music columns here.

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Norma’s Choice: These tracks were chosen by the A.M. (The Assistant Musicologist).

I think of Rosetta Tharpe as a gospel singer rather than a blues singer, however, she was versatile and quite willing to swing either way, so to speak, and perform in concert halls and nightclubs. She toured extensively both in the gospel circuit and on blues tours. Rosetta suffered a stroke in 1970 and lost the use of her legs. She died in 1973.

She has been acknowledged as a major influence by such performers as Elvis, Jerry Lee Lewis (I’m surprised he acknowledges anyone), Little Richard, Aretha Franklin and Isaac Hayes.

She was a strong guitarist, but on her secular tunes she was usually accompanied by a band and later in her career, backed by what would now be called a rock 'n' roll band.

On this track, I Want a Tall Skinny Papa, the backing is more in the big band, jump blues mould.

Tharpe - I Want A Tall Skinny Papa

Although born in Mississippi, Lil Green moved to Chicago early in her life and recorded and performed there predominantly. She was notable for her excellent timing and a sinuous voice. Lil regularly performed with Big Bill Broonzy.

Unfortunately, she was often in poor health and died of pneumonia, at the age of 34.

The song Why Don’t You Do Right? has been covered by a number of artists, most notably by Peggy Lee (who did a couple of versions of it) but also Ella Fitzgerald, Julie London, Mark Murphy, Johnny Otis, Mel Torme and Kiri Te Kanawa (Kiri?). It was also featured in the film Who Framed Roger Rabbit? by the character Jessica Rabbit sung by Amy Irving. After seeing Amy in Honeysuckle Rose, I didn’t realise she was a singer.

This is Lil Green performing the song backed on guitar by Bill Broonzy.

Lil Green - Why Don't You Do Right

Ada Brown was a singer and an actor and her early career was spent primarily on stage in musical theatre and vaudeville. She was a founding member of the Negro Actors Guild of America in 1936, and worked at the London Palladium and on Broadway in the late 1930s.

Ada appeared with Fats Waller in the film Stormy Weather in 1943, and here sings with Fats, That Ain’t Right.

Ada Brown, Fats Waller - That Ain't Right

Memphis Minnie has often been cited as the best blues singer of them all [but Bessie still gets my vote – A.M.]. She was born in Louisiana and learned to play guitar as a child. She ran away from home at 13 to perform on the streets and in nightclubs in Memphis and after that, joined Ringling Brothers Circus. She started recording in 1929 and recorded for the next 40 years.

In the forties Minnie formed a touring vaudeville company. It is generally considered that her best work is from this period. She pioneered the use of electric guitar and she took country blues into electric urban blues, paving the way for Muddy Waters and others.

This song is In My Girlish Days from the forties.

In the last few years, there have been a couple of excellent cover versions of this song by Mollie O’Brien and Maria Muldaur, but we’re going with Minnie’s version.

Memphis Minnie - In My Girlish Days

Bessie Smith was born in Chattanooga and her father died when she was very young. Her mother followed when Bessie was nine. To earn money for their family, Bessie and her brother Andrew began busking on the streets of Chattanooga as a duo: she singing and dancing, he accompanying her on guitar.

Her oldest brother joined a traveling troupe of musicians. Some years later, he returned and Bessie joined him as a dancer rather than a singer. This soon changed. By the twenties, Bessie was acting and singing on Broadway and became the biggest draw (and highest paid) black entertainer of her day.

A combination of the Depression and the advent of talking pictures pretty much spelled the end of vaudeville, Bessie’s natural stomping ground.

She was rediscovered in the thirties by John Hammond and he recorded her and these records are the ones that survive today.

Bessie was killed in a car accident in 1937. After her death, a popular story emerged that she died as a result of having been refused admission to a "Whites Only" hospital in Clarksdale. This has now been discredited.

The song is I Ain’t Gonna Play No Second Fiddle.

I Ain't Gonna Play No Second Fiddle