The Afternoon Sound Alternative 10-17-2014 with DJ Segue        
Playlist:

Lord Newborn and the Magic Skulls- Astro Blue - Lord Newborn and the Magic Skulls
Sorry Bamba- Porry - World Psychedelic Classics 3 Loves a Real Thing The Funky Fuzzy Sounds of West Africa
Flying Lotus- Fat Boy Face - Tracks
The Gaslamp Killer- Spectre Arkham FRK020 Chris Harwood Wooden Ships FKR005 Susan Christie Paint A Lady FKR007 JeanJacques Dexter Be Quite FKR020 - All Killer Finders Keepers Records 120
Super Hi Fi- Single Payer Victor Rice Remix - For Whom The Cowbell Tolls
- 13 A DAY IN THE LIFE WAR -
DJ Sun- Ten feat Jessica Zweback - One Hundred
Os Magrelos- Luz Negra - For Whom The Cowbell Tolls
toKio le deux- Me The Devil NYC Orchestral version vs Original reedit by Gil Scott Heron - Gil Scott Heron mashup
Coultrain- Streams Rivers - Jungle Mumbo Jumbo
The Electric Peanut Butter Company- El Prudence - TransAtlantic Psych Classics Vol2
- 10 RETURN FROM ASHES JOHN DANKWORTH -
Beats Antique- The Approach - A Thousand Faces Act I
DJ Shadow Cut Chemist- Dennis Coffey A whole lot of love - Product Placement Breaks
Purple Penguin- Western Interlude - Question
Scientist- Rootical Dubber - All Hail The Dub Head
- 18 Blackish White -
The Cyril X Diaz His Orchestra- Tabu 1958 - Looking Back The Jamaican Chart Hits Of 1958 1959
Cymande- Genevieve - The Message CD1 Second Time Around 1973
VA- I Been Watching You - Ultimate Breaks And Beats Vol 25 LP
VA- Handclapping Song - Ultimate Breaks And Beats Vol 13 LP
- 07 SUPER SNATCH FLASH FEARLESS -
Sub Obskuru- Track 35 - DITC rare breaks 2 original
LOrange- The Mourning - Old Soul
Taku- Clap for Me - Bricks Mortar
UHT- Uht Jazz Club - Electro Swing Fever
Sub- Charlie - Webdigga WB 35 Rare groove and beats vol35
Cook Classics- Shades - Cook Classics Vs NowAgain
dbruit- Mezd - i Srpriz EP
Flako- Inside - Beatnicks Vol2
Dan The Automator- Fists Of Curry - Bombay The Hard Way Guns Cars Sitars
Jon Kennedy- Flux - 14 WEB
Lil Hardin Armstrong and Her Orchestra- Oriental Swing - White Mink Black Cotton Vol 3 Electro Swing vs Speakeasy Jazz
ManJah- La Cumbia De Los Cielos - Cumbiadelica EP
LOrange- Broken Clocks inst - After The Flowers EP
Chinese Man- Once Upon a Time Hugo Kant Remix - Once Upon a Time
DOC Mastermind- Emc Go Yama Reedit - 1985
Ernest Gonzales- Aquarius - Chasing the Sun
KenoSobi- mos def - Fela BeatTape KenoSobi X Ranmecca
The Budos Band- Crimson Skies - The Budos Band III
- 03 Signify 3 -
- 06 Track 06 -
- 7 Audio Track -
Bas Lexter Ensample- No Te Meta - Tres Greatful Amigos
Kalbata Mixmonster- Out a Road Instrumental Version - Congo Beat the Drum
UBQTS- The Beat Tape -
Sjob Movement- You Only Live Once -
Skills Instrumentalz- Together Just Me You - Blues Soul Samples Edition Pt1
The Duals- Stick Shift - The London American Story 1961 Disc2
Tobin Amon- Defocus - Bricolage
- Track 10 - Music to Watch Girls Cry
Adrian Younge Presents the Delfonics- Stop and Look - Adrian Younge Presents the Delfonics
Fusioon- Tocata Y Fug - Absolute Belter
Karl Hector and The Malcouns- Girmas Lament - Unstraight Ahead
Brown Sabbath feat David Jimenez- Planet Caravan - Brownout Presents Brown Sabbath
Kill Emil- Fridays Child - Lights Shadows
Lord Newborn The Magic Skulls- Astro Blue - Lord Newborn The Magic Skulls
- Porry - World Psychedelic Classics 3 Loves A Real Thing The Funky Fuzzy Sounds Of West Africa
Beats Antique- The Approach - A Thousand Faces Act 1
Brownout Presents Brown Sabbath- Planet Caravan feat David Jimenez - Brownout Presents Brown Sabbath


playlist URL: http://www.afterfm.com/index.cfm/fuseaction/playlist.listing/showInstanceID/65/playlistDate/2014-10-17
          When ‘Single Payer’ Won’t Pay        
Medicaid used to be the program providing health care and medical services to the poor. Before Obamacare, Medicaid covered primarily poor retirees, children in poor families, and the disabled living in poverty — the “truly needy.”
          Open thread for night owls: Who really owns U.S. farmland? Increasingly, it's not American farmers        

Katy Keiffer at The New Food Economy writes—Who Really Owns American Farmland? The answer, increasingly, is not American farmers:

We’re used to thinking of escalating rents as an urban problem, something suffered mostly by the citizens of booming cities. So when city people look out over a farm—whether they see corn stalks, or long rows of fruit bushes, or cattle herds roving across wild grasses—the price of real estate is probably the last thing that’s going to come to mind. But the soil under farmers’ feet has become much more valuable in the past decade. While urban commercial real estate has skyrocketed in places like New York, San Francisco, and Washington, D.C., powerful investors have also sought to turn a profit by investing in the most valuable rural real estate: farmland. It’s a trend that’s driving up costs up for the people who grow our food, and—slowly—it’s started to change the economics of American agriculture.

Ghost_Owl_2.jpg

Think of it this way: If you wanted to buy Iowa farmland in 1970, the average going price was $419 per acre, according to the Iowa State University Farmland Value Survey. By 2016, the price per acre was $7,183—a drop from the 2013 peak of $8,716, but still a colossal increase of 1,600 percent. For comparison, in the same period, the Dow Jones Industrial Average rose less than half as fast, from $2,633 to $21,476. Farmland, the Economist announced in 2014, had outperformed most asset classes for the previous 20 years, delivering average U.S. returns of 12 percent a year with low volatility.

That boom has resulted in more people and companies bidding on American farmland. And not just farmers. Financial investors, too. Institutional investors have long balanced their portfolios by putting part of their money in natural resources—goldmines and coal fields and forests. But farmland, which was largely held by small property owners and difficult for the financial industry to access, was largely off the table. That changed around 2007. In the wake of the stock market collapse, institutional investors were eager to find new places to park money that might prove more robust than the complex financial instruments that collapsed when the housing bubble burst. What they found was a market ready for change. The owners of farms were aging, and many were looking for a way to get cash out of the enterprises they’d built.

And so the real estate investment trusts, pension funds, and investment banks made their move. Today, the United States Department of Agriculture (USDA) estimates that at least 30 percent of American farmland is owned by non-operators who lease it out to farmers. And with a median age for the American farmer of about 55, it is anticipated that in the next five years, some 92,000,000 acres will change hands, with much of it passing to investors rather than traditional farmers. [...]

TOP COMMENTS • HIGH IMPACT STORIES

QUOTATION

“For the true measure of agriculture is not the sophistication of its equipment the size of its income or even the statistics of its productivity but the good health of the land.” 
                  
 ~Wendell Berry, The Unsettling of America: Culture and Agriculture (1977)

TWEET OF THE DAY

x

BLAST FROM THE PAST

At Daily Kos on this date in 2005—Condi: Still out of touch:

Our Secretary of State says:

Rice told TIME she believes the insurgents are "losing steam" as a political force, even though their ability to kill and maim at will appears undiminished. When Rice points to "rather quiet political progress" while the country remains embroiled in chaos, even some of her backers cringe. Says a Republican elder statesman: "I don't have any sense of where she thinks she's going on Iraq."
Insurgents are losing steam? They've never been more lethal. They've never been more organized. They've never been more effective. Yet the best the administration can do is keep talking about turning corners, last throes, and lost steam? We can't afford to continue with this current crop of incompetents.

On today’s Kagro in the Morning show, Greg Dworkin keeps things on an even keel, revisiting the need for policy groundwork on any movement toward single payer. Trump, meanwhile, threatens nuclear war. Which presumably makes his twice-daily “good news” folder, while Manafort does not.

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          Politics - USA        
Rosebuddy wrote:

A plan she has abandoned in favour of supporting the watered-down ACA, while rejecting a single-payer system because Republicans and the insurance industry oppose it. Clinton doesn't want to fight for anyone. She just wants to win and will adapt her positions accordingly.


Single payer wouldn't work in the US, there are far too many legal barriers in place. But, regardless, it is pretty difficult to push for legislation if you can't get elected.

Rosebuddy wrote:

This is why there is so much venom against Sanders supporters recently.


No, the venom is largely the result of Sanders supporters being salty losers who actively push ridiculous conspiracy theories to explain why Sanders is losing.

Rosebuddy wrote:

She has taken longer to take out Sanders than Trump took to win over all the GOP nominees.


That's only because Sanders refuses to bow out like Cruz did.

Rosebuddy wrote:

That kind of thing really tarnishes the narrative of her has the undisputed, rightful heir to the presidency.


A narrative that was largely pushed by Republicans and Sanders supporters looking to juxtapose their "outsider" status with Hillary's "establishment" status.
          Friday Scattershots: Beto's 2, Abbott's 34, and the special session        
Normally I leave the fundraising reporting to those that groove on it.  But occasionally it's newsworthy, and this is one of those times.


-- Beto O'Rourke out-raised Ted Cruz, and he did it without PAC money, or big donors, or out-of-staters, like that Blue Dog loser Jon Ossoff.  He merits kudos from The Intercept for his Bernie Sanders-style fundraising, also his (finally) unqualified support for single payer.  Let's pick out just a little of Ryan Grim's piece for consideration.

He is far from the centrist mold that power brokers in Washington might recruit to run for Senate in Texas, but then again, power brokers in Washington don’t spend much time thinking about running for Senate in Texas.

But the way O’Rourke is raising money changes the game. The El Paso congressman does not have much in the way of a national fundraising network, has refused corporate PAC money, and is known among his colleagues to be a less-than-enthusiastic fundraiser. That’s the kind of lawmaker who often had little future in Washington — but exactly the kind many grassroots Democrats would like to see rise. The type of person who is good at spending hours a day with doctors, bankers, lawyers and other professionals who can write four and five-figure checks is a) probably not hard-wired to be a conviction politician and b) vulnerable to have their politics diluted just by virtue of the conversations they’re having day in and day out.

Former Rep. Tom Perriello, D-Va., said that spending so much time on the phone fundraising winds up creating “an enormous anti-populist element, particularly for Dems, who are most likely to be hearing from people who can write at least a $500 check. They may be liberal, quite liberal in fact, but are also more likely to consider the deficit a bigger crisis than the lack of jobs.”

On the other end of the spectrum, Greg Abbott announces for re-election today with gobs of money in the bank and no challengers.

His lips are ready to smooch the backsides of the big check-writers.

Despite criticism, Abbott remains a popular figure among Republicans statewide and has a campaign kitty that will be daunting to any potential challengers. He had more than $34 million in his campaign account in January, and that number is expected to grow when new fundraising totals are announced shortly.

Let's just go ahead and acknowledge that we're not going to be rid of Helen Wheels until he decides to run for president.  And since he can do so and remain governor after losing a White House bid, perhaps not even then.

If the special session does not go his way, will it damage him politically?  I think the opposite, candidly.  First, note that Texas is already losing commerce to other states for the first time in over a decade (that's at least two oil slumps ago, not counting the current one) and if he and Dan Patrick ram through the bathroom bill, that will hurt the state's reputation for a welcoming bidness climate even further.  But it is the capitalist titans inside and outside Texas that are going to have to make him pay the price for his governmental intrusion and over-reach into our private lives: in corporate or branch relocations reconsidered, in conventions and events like the Final Four canceled, and in their reduced, or embargoed, or eliminated campaign contributions to him.

To the GOP base, though, he'll be martyred on a toilet in a transgender-friendly restroom.  He'll have fended off the primary challenge from Lite Guv Goeb, and he'll have the Christian Soldiers marching onward as to war for him.  He wins by losing (if he loses, and Joe Straus has to be feeling pretty lonely these days).

-- Did the Russians try to hack Harris County's elections website?  Stan Stanart's IT guy isn't saying yes, isn't saying no.

Despite widespread alarm over the breadth of Russian cyber attacks on state and local election systems last year, including revelations of Dallas County being targeted, Harris County officials are refusing to say whether hackers similarly took aim at the nation's third-largest county.

Releasing information on whether Harris County election systems saw attacks from Russian hackers would threaten the county's cyber security by emboldening hackers to further target local systems, county officials said this week.

The county's argument was dismissed by experts, who said the secrecy is unnecessary, and could actually downplay the seriousness of the threat and the resources needed to combat it.

So ... 'don't ask, don't tell, maybe it will go away' seems to be the strategy.  This strikes me as pluperfect Stanart.  Did you know that a number of voters greater than one out of every four say they are considering not voting because of fears of the elections being hacked?

More than a quarter of recently polled registered voters say they will consider not casting ballots in future U.S. elections because of hacking concerns, with 27 percent saying they may stay home from the polls when the 2018 midterm elections roll around.

That number could mark a challenge during the midterms, with the possibility of as many as 58.8 million of the more than 200 million eligible voters choosing to stay home, according cybersecurity firm Carbon Black. The June survey of 5,000 people found a lower level of confidence in the overall voting process compared to data collected prior to most recent presidential election.

This is what Democratic paranoia hath wrought.  So in a perverse way, maybe Stanart's office is on to something.  We certainly don't need any more vote suppression efforts, especially not those borne out of Clinton Democrats' fever dreams.

There has been a lot of Moscow-on-the-Potomac to digest this week.  Maha has a good summary, including that McClatchy piece that Gadfly has already skewered.  But her lede is slightly buried.

To those who are certain the Trump/Russians stole the 2016 election, I would like to point out that if the Clinton campaign hadn’t been so brain dead, there would have been fewer vulnerabilities to exploit. Ultimately, it was Clinton’s election to lose, and she lost it. She might very well have lost it had the Russians done nothing at all. Historians will probably be arguing the point for the rest of eternity. But this is about something bigger than who won the election.

Yes it is.  More on that later.

-- I also have some thoughts coming on the dispute between Caitlyn Johnstone and Yoav Litvin (and some who have responded ahead of me) over the potential direction and alliances of the Green Party, specifically David Cobb's role in said, in the middle of it all.  BTW, the Greens' national meeting is happening right now in Newark, NJ.

          Re: Take the Generic Drug, Patients Are Told - Unless Insurers Say No        
Down with for-profit insurance. Single payer now.
Posted by GorillaMindthet
          Breaking News from Our Neighbors to the North        
CanuckCare© continues to auger in:"“Free” Canadian healthcare is not free, according to a report released Tuesday ... a “typical Canadian family of four will pay $12,057 for health care in 2017—an increase of nearly 70 percent over the last 20 years.”So how's that Single Payer system working out?Still, that $12 large may be a bargain since it buys great care, right?Turns out, not so much:"[T]here is still a long waiting list for a host of operations, both routine and urgent."And over 60,000 Canadians sought actual care outside the country last year.But "free" (or, you know, not).[Hat Tip: FoIB Holly R]Original content copyright © InsureBlog
          Single Payer Now.        
This is close to home. People are literally going to the black market to get insulin because their insurance won’t cover it. Fourth grader Gabriella Corley is trapped. She has type-1 diabetes and is allergic to the kind of insulin … Continue reading
          Single Payer...Education?        
Baaaaaaaaaaaaaaahhhhhnnnnnnnnn [sound of buzzer]

Wrong answer.

And here's why:

Everyone will want to go to the best school, and the best school can't hold everyone, so the kids who are poor, or can't bribe their way in, or can't drive an hour to the best school because they can't afford their own car because they are not in the upper-middle class or higher, or the kids whose parents don't know how to game the system, or the kids who are "bad," or "bored," or god-forbid-acting-like-boys....the kids who need good schools the MOST....

...will be stuck exactly where they are.

So, we're back to the original point--we need to improve all schools. I have no problem with shutting down a bad school, retooling it, and reopening it. But do we let people CHOOSE THEIR FIRE DEPARTMENT?? There is NOTHING more critical to a functioning society than a group, an organization, that keeps crap from burning down.

Therefore, we demand, expect and I hope, pay for every fire department to function at some generally accepted minimum level of competence.

Why can't we ask the same for schools?

Please let's get real.

http://www.huffingtonpost.com/arianna-huffington/so-we-cant-have-single-pa_b_276644.html

http://iwf.org/inkwell/show/21991.html
          A Year Ago        
It's not terribly popular in my circles to admit you were a Bernie supporter. In hindsight all female Bernie support seems like a betrayal of gender. Let me assure you that gender had nothing to do with my enthusiasm for Bernie Sanders. I thought his message had value.


Spare and I went to a Bernie rally in the spring of 2016. We stood in line all day at Temple University. This was as close as we ever bonded, I think ... and life kind of went downhill for both of us after this event.

The Democratic National Convention was held in Philadelphia in July of 2016. There were many well-attended pro-Bernie rallies and marches as a part of that convention. Since I wasn't blogging then, I'm going to walk down memory lane and show a few photos of the marching that came before the real marching.

Of course all the pro-Bernie rallies were organized over Facebook, and that's where I saw the message from the woman named Michelle. She left a comment: "I wish I could be there with you. I'm a single mother of a disabled son. I need single payer and a decent minimum wage. Please, someone, march for me."

So I did. Then I posted all the photos with her name tagged. Below, Exhibit A, is the "establishing shot" with City Hall in the background, so Michelle would know I was for real. I was wearing my Bernie hat and my Phillies shirt with no sleeves that I use on paint crew.


It was about 95 degrees that day with very little shade. The rally began at Thomas Paine Plaza.


It seemed like a huge crowd at the time, but now ... after the ensuing events ... it was little more than a congenial gathering.


I wasn't the only Baby Boomer in that crowd. Seemed like it skewed to older people.


Michelle wanted to feel like she was there, so I asked lots of people to hold my "Hi Michelle" sign.


To be absolutely honest, this was one of the few people in attendance that actually was a Bernie bro. He came in from Akron, Ohio.


Guess I wasn't alone in being a traitor to my gender.


Proof that not all middle-aged white men voted for Trump.


I talked to people from all over the place. Some of them weren't prepared for Philly weather.


Kinda wanted to flirt with this one, but didn't.


This is a sentiment I did not share, even at this rally. I was going to vote Democrat even if they nominated Bill Maher.


... INEVITABLE


More female voters who were seduced by the good looks and shallow charm of Bernie Sanders.


Philadelphia is a big city. It has real, live socialists. They hand out leaflets and everything. Here is someone who probably really didn't vote for Hillary Clinton.


Someone made a Bernie quilt.


Hi Michelle, we need to OVERTHROW this system! Someone? Anyone? Can I get a harrumph?


Again in hindsight, this one seems a little bit prescient. When it comes to voter fraud, I have my suspicions. And they rest squarely upon bullying, intimidation, and sketchy machinery.


Some of these folks, I just wonder. Did they really sit out the election? Or did they, like me, scurry to the polls to vote for Secretary Clinton, who -- I'll be the first to admit -- had every quality a leader of the free world would ever need?


These jackasses were scattered all over the city. There were 52 of them, one for each state, one for Puerto Rico, and one for the District of Columbia. Each one was painted differently. This one was Iowa.

So, on that hot day a year ago, we rallied at Thomas Paine Plaza and then set off on a march down Broad Street, exactly the same route the Mummers take on New Year's Day. It was so unbearably hot that I bagged the march at the corner of Broad and Pine, doubled back and took the El train home to Snobville.

On the way to the train, I got accosted by a young woman with an island accent (couldn't place it, might have been Jamaican or Haitian). She took me to task about Bernie in a way that led me to believe she had lived in Philly long enough to pick up its behavior patterns. How the hell, she wanted to know, could I support Bernie when a menace like Donald Trump loomed? How could I feel right about splitting the ticket? Didn't I know what danger Donald Trump posed to immigrants?

I assured her I did, and I promised that I would vote for Hillary (and I did), and with an airy wave at the throng of protesters, I said, "They all will too. Don't worry about a thing."


Never ask me to handicap a race. This last photo was shot on November 9, 2016. To this day I wonder where that island lady is, and how she is faring. Oh my bored gods, what burdens we bear.

Late addendum: Yes, Michelle saw the photos, and she loved them. She was very grateful and kind of amazed that I went to so much trouble for a stranger. I hope she has her health care and a decent wage.
          Socialist can't explain why socialist states are unable to pass socialist health care        
In this revealing segment from Jake Tapper’s show today, he asks Bernie Sanders to explain why socialist states like California can’t figure out how to pass single payer health care. He yells a lot of random words but can’t really explain why:  
          California Democrat Drops Nuclear BOMB On New Universal Health Care Bill        
California’s new universal health care passed the Senate in a Thursday vote, and drew criticism from the unlikeliest of places: Democrats. One in particular dropped this bomb, “We are not debating single payer today because we are not debating a funding source.” Democratic Sen. Ben Hueso told the Sacramento Bee. “We are not debating delivery of service. We are not debating where the health savings will come from. None of that is in the bill. This is the Senate kicking the can down the road to the Assembly and asking the Assembly to fill in all the rest of the blanks.” Hueso’s...
          By: jawnbc        
<i>Growing up in Canada, I often heard that profiting from illness was just wrong. Canada’s public health system generally banned private medicine. Whenever anybody pointed to systems like New Zealand’s, which provided better services by combining public and private provision, they would be shouted down.</i> Either he left Canada 20 years ago or came from the far north or he’s a fibber. If he wanted to “go private” there are doctors in every major Canadian city with whom he could do this. AND…he’s got the whole US to choose from, which for most Canadians is less than a 90 minute drive away. Edit: he’s from Manitoba and left 20 years ago for the States before coming here a decade ago. Canada doesn’t have a public health system. It has mixed delivery (public, private and non-profit) and multiple single payer health insurance schemes: one for each province, plus additional ones for the territories, military and folks living on Aboriginal reserves. All doctors are private business; most either opt into the public scheme or opt out. They still make excellent money. Testing and assays? Almost entirely private. Hospitals? About 50/50 public and non-profit, often run by religious groups. Allied health professionals? Mostly private except for in hospitals. There is no “gap” or co-payment to see doctors. There is no equivalent of Pharmac, so the cost of prescriptions is means tested based on your previous year’s income. Seniors get everything for free—and most people have supplemental insurance that covers prescriptions 80-100% These plans also include dental insurance that covers 100% of basic care and 50-80% of more advance procedures. I have found hospital care in NZ to be the same standard as Canada. I find GP care—and referrals to specialists—woeful compared to Canada. Never waited more than 4 weeks to see a specialist; never waited more than 8 weeks for “elective” surgery. Never paid a penny out of pocket for any of it. Health care here is better than the US, in terms of access/opportunity costs. But that’s a low bar. Health care here sucks compared to Canada.
          Single payer declared as Supremes nix mandate        
On the heels of the Supreme Court decision on June 15, 2012, invalidating the individual mandate provisions of the health care reform law, the President and Congress took swift action to implement a...

Health reform: positions for progressives. Taking action today to build for tomorrow. See http://ellenshaffer.blogspot.com/ for more.

          Single payer can't happen in California. At least, not right away - Los Angeles Times        

Los Angeles Times

Single payer can't happen in California. At least, not right away
Los Angeles Times
Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is ...
Single Payer, Meet All Payer: The Surprising State That Is Quietly Revolutionizing Health CareThe Intercept
Public support for 'single payer' health coverage grows, driven by DemocratsPew Research Center
Medicare for All - Bernie SandersBernie Sanders

all 171 news articles »

          Bernie Sanders: Lots of Dreams, No Reality        


After watching the New Hampshire Democratic Town Hall last night I have come to one inescapable conclusion: Bernie Sanders is well-intentioned but has no actual plan to govern.

When asked how he would usher in the passage of his ambitious agenda (single payer healthcare system, free college, etc.) by moderator Anderson Cooper, the Vermont senator went on a long tirade about the bottom-up political revolution. Specifically, he thinks young people’s involvement with this presidential race will somehow inspire what may likely remain a republican-dominated house and senate to enact sweeping leftist policies.

We’ve heard this answer from him many times before. However, Sanders did not touch on even a hint of strategy for actually working with the congress. By the way, it is very likely that even democrats will not support the bulk of his goals.

Moreover, Sanders seems ignorant of the unfortunate truth of how politics work in this country. Lots of people gets very fired up about a presidential race. It happens once every four years and legitimately inspires people with the prospect of new leadership and a better direction. But then the election ends and people go back to the challenges of their day-to-day lives. To say that they become entirely uninvolved diminishes our citizens, but it’s been demonstrated time and again that people pay less attention during midterms and so on.

In 2008, Barack Obama was the candidate that was going to change Washington. It ended up changing him more than he it. In 2016, Bernie Sanders is taking up the change mantle, though his word is revolution. He was wonderful ideas—I find myself inspired by them—but he has no firm strategies to turn them into tangible achievements.

It’s time for President Clinton.

          Supreme Court and partisan politics        

Until June, we will not know what the Supreme Court has probably already decided about the Affordable Care Act, but pundits from both sides of the political spectrum are forecasting and dissecting the three days of testimony that occurred in early March.

Will it be yet another 5-4 decision?

Will they decide that the individual mandate is unconstitutional?

Will they keep parts of the law intact or throw out the whole thing?

Only they know.

But what we do know, from the transcripts, is bit unnerving.

When you walk up the steps to the main entrance of the Supreme Court Building, these are the words you see, “Equal Justice Under The Law”. This court is the highest tribunal in the nation for all cases and controversies arising under he Constitution or the laws of the United States. As such, it has the responsibility to remain apart from partisan politics. But that is not what seems to be happening in recent years. The trust we have always placed in this court is being undermined by decisions that seem more influenced by special interests than interpretation of law. At least from a layman’s perspective.

After the universally disliked decision of Citizen’s United, I wonder how many people have any faith left in the current Supreme Court. And after hearing some of the questions asked during those three days, it is difficult to know what is really going on. I wonder if one of the justices got his questions from Fox News, or just repeated a Republican talking point about broccoli. Then this justice seemed appalled that he might be expected to actually read the law about which he had to make a very important decision — one that will affect the health of many Americans.

It seems to me that if one is a justice on the highest court of the land, and collects a salary and health benefits for himself, then, yes, he should read the law. That is his job, and his responsibility.

Other justices asked questions that were more substantial, and of course, one justice never asked anything. But then he never does. And yet, strangely enough, his decision is pretty much known by any court watcher.

It just seemed like a sad state of affairs in most respects.

Looking at a very recent decision by the Supreme Court, another of the 5-4 decisions, makes it even more difficult to have faith in this court.

This was the decision that allows for a strip- search of any citizen, for any offense, no matter how small, or even if one didn’t commit a crime at all. It came to the court because of a man in New Jersey who was “arrested” because he didn’t pay a fine. But that was a mistake — he had paid the fine. He was then subjected to a strip search, a clear violation of personal liberty. But the five justices think that is lawful.

As long as we have these partisan 5-4 decisions, I think we have a big problem.

And it is one of many, many reasons I think we need to re-elect President Obama, and hope he gets to appoint one or two Supreme Court Justices during his next term. Also, if the court decides against the Affordable Care Act, we may have a chance for single payer health insurance, from which the whole country would benefit.

But none of us benefit if the Supreme Court sticks to partisan politics. That is the lesson of the past 12 years.

Columnist Barbara Kelly can be reached at bkellyshaw.kelly@gmail.com.

Content Watch Publication ID: 
11093274

          America's Healthcare: What's Next?        
Deck: 
Lower Cape Indivisible - First Parish Brewster, August 15th
Towns: 
Topic: 
Hub Category: 
Main Image: 
Main Image Credit: 
Healthcare forum sponsored by Lower Cape Indivisible
Thumbnail Image: 
Body: 

America’s Healthcare: What’s Next?

August 15, 7-9pm

First Parish Brewster, 1969 Main St. Brewster

Hosted by Lower Cape Indivisible and Harvard Medical Indivisible

As our government debates the issue, we find ourselves as a nation in a very scary and precarious period of time. This forum is an opportunity to hear from healthcare experts where we are regarding this very important issue as a nation, and as a state, Lower Cape Indivisible is joining with Harvard Medical Indivisible in hosting this forum to find out - where do we go from here?

Medical experts and citizens alike are rightfully concerned. Areas of discussion at this forum will include:

The fear that millions will lose coverage

Losing Medicaid for our seniors in nursing homes.

Not knowing if the ACA (Affordable Care Act) will survive or what might replace it.

And, what if we could look at a different model: Healthcare as a human right and a universal plan for Single Payer Healthcare.

Speaking will be:

Celia Wcislo: She has long served as Assistant Division Director of 1199 SEIU, United Healthcare Workers East, a union of over 300,000 healthcare workers. As a board member of the Massachusetts Connector Board, she has extensive experience with Massachusetts healthcare and the Affordable Care Act. 2.

Dr. Alan Meyers, Emeritus Professor of Pediatrics at Boston University, a founding member of Physicians for a National Health Program.  

Professor William Hsiao, Ph.D, Professor of Economics at Harvard TH Chan School of Public Health, Department of Global Health and Population. His work focuses on healthcare financing and social insurance.

The forum will be moderated by Carol Seibert, MD. Dr. Seibert served for nearly three decades as an anesthesiologist in the Harvard hospital system.  She also has deep ties to the Cape community having lived in Truro and serving as Medical Director at Hospice and Palliative Care of Cape Cod.  Now retired, she is actively engaged with Harvard Medicine Indivisible

Dr. Seibert is available for interviews if you would like to do an advance piece on this important event. Her email is cpseibert@gmail.com. Her number is 617-694-6687

Please bring your questions and concerns, and participate in this lively discussion. This event is free and open to the public. Light refreshments will be served.


          Why So Many Senior Academics Favor Single-Paying Medicine        
by Richard KostelanetzIt would create a two tier system where the privileged class could get different, reputably better doctors who would accept higher payments.Where "higher payments" made illegal, because, say, "un American," as indeed a two tier system would be, the result would be a medical black market. Think?Senior academics are accustomed to a two tier system where those tenured tower above the hoi polloi.Why is it that advocates of single payer American medicine never mention the likely social result?Incidentally, long a beneficiary on Medicare, I favor single paying, but dislike dishonesty which I fear anti Trump fanatics have made epidemic.Lies from those who are self righteous are no more acceptable than lies from crooks.My being anti anti Trump now no more makes me a Trumpster than my being anti anti Communist made me a Communist a few decades ago. People failing to recognize this distinction are either stupid or, yes, dishonest....
          Comment on Resolution No. 1: Studying Single Payer in Ohio by Joseph Jeu, MD, FAAFP        
It is prudent for the OAFP to explore all possible answers for our current health care dilemma. Business as usual does not seem to be working and it is doubtful it will correct itself anytime soon. We need new possibilities and answers. Still happy to be a Family Physician, Joseph Jeu, MD
          Response to Nation Article on Single Payer: Improved Medicare for All is the Solution        
By Margaret Flowers | Health Over Profit for Everyone | August 7, 2017 On August 2, 2017, The Nation published an article by Joshua Holland, “Medicare for All isn’t the Solution for Universal Health Care,” chastising Improved Medicare for All supporters because, in his view, the single payer movement has “failed to grapple with the […]
          Universal Health Care Can Work: But the Case Must Be Made for How to Pay and How Money Will Be Saved        
There's an opening in Congress with the GOP's health failures and tax reform looming.

Progressives are riled up with renewed seize-the-day determination to turn Congress’ failure to gut Obamacare and Medicaid into a push for nationwide universal health care.

“JOIN THE MOVEMENT,” shouted a typical email blast Monday from the Progressive Turnout Project, quoting Bernie Sanders and Elizabeth Warren, and, of course, asking for donations.

"I need your ideas re: Medicare-for-all," Sanders said via an email blast from BernieSanders.com.

There were suggestions on where to start transforming the system to create inroads leading to universal coverage, such as a Salon piece by Amanda Marcotte calling for a Medicaid buy-in for those over 50. Others, like Ann Jones writing for the Nation Institute, suggested expanding Medicare to create a Norway-like single-payer system in Maryland. Economists and policy experts writing on off-the-record listservs suggested lowering Medicare’s eligibility age and allowing consumers to buy into it, as its doctors and hospitals have a better record of getting paid than under state-run Medicaid.

Meanwhile, center-left voices like the Urban Institute posted pieces saying insurance markets for individuals can be stabilized by bipartisan cooperation, echoing remarks made in the Senate last week by Maryland Democrat Ben Cardin. There were like-minded editorials, such as in USA Today, urging bipartisan action. (On Tuesday, the Senate health committee announced early September hearings “to stabilize and strengthen the individual health insurance market.”)

Amid these frothy expectations, there were a handful of ex-Obama administration officials who were still keeping their eye on the prize—ensuring Obamacare is safe from President Trump's sabotage. He has threatened not to pay subsidies for 58 percent of individuals who bought policies via government exchanges. Trump is expected to announce the first of these attacks this week, although hospitals and doctors are protesting they would bear the brunt as it would drive up uncompensated care.

This tumult may end up temporarily sidelining the push for single-payer—whether by more chaos caused by Trump or the prospect of centrist legislation in Congress. But the push for universal health care will not go away nor will the strong arguments in favor of it. Americans across the political spectrum have learned their health care is vulnerable to swings of the political pendulum in Washington. 

Yet those pushing for universal coverage need to step up their sales game and do better than offering the same talking points Bernie Sanders made 25 years ago and last week. (Exhibit A: Everybody knows other Western democracies do better than we do.)

Few Americans need to be reminded of the frustrations in the current insurance-based system. Yet few on the progressive end of the spectrum are talking about how funds can be raised to supplement what all government programs spend so the result is no person or business has to pay premiums, deductibles and co-pays.

That was where the conversation led by the California Nurses Association was heading, but it got blocked in deep-blue California, when the state assembly’s Democratic leader buried their bill in June. The nurses put forth a progressive financing plan, but Democrats in charge allowed a Senate fiscal committee to derail a progressive taxation debate by issuing a scaremonger report saying such coverage meant business and employee payroll taxes would double to pay for it. That was not the only revenue choice for single payer, even with the large sums involved. (The nurses said California has to generate another $150 billion a year on top of all government health spending in the state. In New York, where a single-payer bill has remained a few votes shy of passage for several years, that figure is roughly $90 billion.)

What we didn't hear was any discussion about how California could do it. Yet the state's economy is the size of Italy’s and its population equals Canada's—two countries that have universal coverage. The nurses suggested a 2.3 percent increase in the sales tax and 2.3 percent increase in the gross business receipts tax after the first $2 million, to exempt small businesses. It also include a broad range of exemptions including housing, utilities and service expenditures. Nobody got to hear how that revenue-raising strategy would save businesses tons of money and paperwork, save people from unexpectedly emptying their pockets and create unheralded health security for every Californian.

The other key missing ingredient in the California legislature’s discussion was how a transition to a single-payer system would unfold. There were no wide press disclosures of who was making the biggest health care profits—the specific industry sectors, and how they would have to adapt. And there was little discussion of who should never have to pay for health care, like children and fixed-income seniors. The frames, analysis and funding didn’t change; therefore the politics didn’t change.

These are all topics that the public will want to know about and will likely welcome; a prerequisite to embracing a new system.

“The California and D.C. fights are identical,” said Michael Lighty, legislative director for the California Nurses Association, in an email to AlterNet. “On policy, the Urban Institute is wrong about the cost of improved Medicare-for-all, just as in California where the corporate Democrats and their protectors are creating a false narrative overlooking the savings, which are substantial driven by the elimination of the insurance company premiums, deductibles and co-pays.”

Lighty said that getting health care right would send numerous positive ripples through the economy, just as Trump’s threats and the GOP’s plans to go after Obamacare and Medicaid have done the opposite, creating chaos—threatening people and businesses with higher premiums, and many current Obamacare and Medicaid recipients with the loss of health care, and all that implies.

“Politically, single-payer public financing can drive a broader progressive program first because money spent improving health care and lowering costs reduces inequality, and the savings frees up money for wages, pensions, investments and growth,” Lighty said. “It is a reverse of the GOP program to take away health care to lower taxes on the wealthy. No, let’s equitably finance health care through single-payer to improve workers’ wages and living standards. We can achieve real health security.”

There’s another reason it’s important to talk about the financing. The White House and the GOP-led Congress want to take up tax reform as soon as they can. While it is anyone’s guess whether that will happen, progressive taxation is the key to paying for nationwide universal coverage. While that’s not the tax discussions the GOP has in mind in, it's an open invitation to return to one of the biggest benefits progressive tax reform could bring.

Stepping Stones to Universal Care?

Moreover, should a bipartisan health care bill emerge in Congress this fall, progressives need to be mindful of what may or may not be stepping stones to universal coverage. When the Supreme Court preserved Obamacare’s subsidies in 2015, that ruling was a gift to insurers. That same ruling also said states don’t have to expand Medicaid programs to add in their uninsured, another gift to the industry by undermining competition and a pillar of what could evolve toward a universal system.

Tuesday’s brief statement by Senate Health Education Labor Pensions Committee Chairman Lamar Alexander, R-TN, said their agenda was fortifying the industry and policyholders. “This committee will hold hearings beginning the week of September 4 on the actions Congress should take to stabilize and strengthen the individual health insurance market so that Americans will be able to buy insurance at affordable prices in the year 2018,” he said.

Beyond the Obamacare fixes sought by insurers, the conversation on listservs by some of the nation’s leading economists and safety net experts was filled with suggestions about what could concretely turn American health care toward a system that was not held captive by capitalists until Americans reach age 65—the age they become eligible for Medicare.

One prevalent idea was to slowly lower the age people can access Medicare, including allowing anyone over age 50 to buy into it. While that could take a bite out of what’s spent by the insurers on care (because many chronic diseases tend to appear around age 60), it also could grow government-directed health care toward more universal coverage.

This discussion was driven by the value of not allowing the good to interfere with the perfect. But there were telling remarks that underscored how even stabilizing Obamacare and expanding Medicare doesn’t address the problems with the market-based system. Namely, today’s co-pays and deductibles can still drive households into unmanageable debt, if not bankruptcy.

Patching Obamacare for insurers alone by having the government chip in toward premiums, co-pays and deductibles, isn’t providing health security. It’s a constant reminder that too many households are one paycheck away from not affording health care when costs are driven by the capitalist desire to maximize profits.

Another formidable hurdle to the Medicare-for-all solution is overcoming the Hyde Amendment, which prevents the government from paying for most abortion-related services. That victimizes women and prevents them from accessing other reproductive health and breast cancer screening. It is yet another obstacle to universal care.

While incremental progress might be acceptable to centrists, it patches up a status quo that is rejected by progressives.

“Incremental reforms that ‘stabilize’ the insurance markets or provide individual purchase options fail to address high costs due to drug company prices, and insurance company inefficiency, profits and executive salaries,” Lighty said. “Rather than bail out the insurance companies by taking their costliest patients (via public option or Medicare buy-in), or subsidizing the purchase of private insurance, we need to guarantee health care as a human right, therefore a public good.”

“We’ve tried every other health policy that’s part of the U.S. ‘system’ (really a health care industry driven by revenue and profit) except improving and expanding Medicare-for-all,” Lighty continued in an email. “We’ve finally broken through on political feasibility thanks to the Bernie campaign and sadly the attack on the Affordable Care Act. This is a story of the people vs. the establishment, nationally and in California; the successful district-based actions to get House Democrats to co-sponsor HR 676, now a majority [of Dems] have and growing; the national grassroots organizing to promote single-payer at town halls; and the success of the [California] SB 562 campaign, including passing the state senate.”

“Medicare-for-all is on the national political table despite the bipartisan political establishment opposition to it,” he concluded. “Yet, many of the endorsements, resolutions and sponsors of single payer are symbolic. So what needs to happen is those who support single-payer, need to enact it.”

That’s more easily said than done. But as Trump lashes out anew and the Congress decides what to do next, there’s an opening.

Anyone who has followed the issue knows universal coverage isn’t going to be enacted or taken seriously by centrists in either party without a grassroots push and making the case in compelling new ways. This year's town hall testimonials by people who would be badly hurt by repealing Obamacare were an example of adding new voices and new urgency—and it worked.  

As the California Nurses' effort verged on showing, there’s new detail and discussion awaiting—paying for it via progressive taxes; selling those savings to businesses, employees and the self-employed; and describing how a transition would unfold.

The status quo’s defenders have been out there for years reading from the same scripts, but these new arguments have not. The arguments for universal coverage will get stronger under Trump’s bullying, and if bipartisan fixes only stabilize revenues for the health care industry, but not the public.

    

Related Stories

 

          Re: The Senate Is Finalizing a Health Care Bill But You’re Not Allowed to See It        

We do not want any form of “Single Payer/Socialized Medicine”. Your doctor may not be signed up as a participant. Besides basically this would still be run by the Government. Keep the Government out of Medicine!!!


          By: Abby        
I thought that this was going to go in an entirely different direction. A couple of months ago Brad DeLong posted on whether rich people deserved their money in a moral sense. High prices, he posited, for certain services were a signalling mechanism to encourage people to enter those fields (never mind the cartels like lawyers and doctors). They don't retroactively deposit moral desert on the winner. I am increasingly less convinced by the value of meritocracy. It's efficient in a lot of areas, but there's also a value to knowing that you may not fully deserve what you have, an aspect of humility. And I am starting to thinnk that everyone deserves a certain level of healthcare (what the rich get will always be somewhat better) but that basic, competent medical care shouldn't depend on how succesful you are. I know it's a slippery socialist step. Still, I don't knwo why more entrepreneurs don't support some sort of universal coverage--either a single payer or opening up the FEHB (which employs community rating) to everyone with subsidies for those on lower incomes. It means a healthier workforce and the entrepreneurs can concentrate on their business and won't have to worry about picking a health insurance plan.
          Single Payer        
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          Vermont passes health insurance exchange, pushes forward on single payer        
Vermont Governor Peter Shumlin has signed a new health care bill into law that will create a health insurance exchange and continue the state’s push...
          Buffett Should Stick To What He Knows        
Any person, and Buffett should pay close attention here, who thinks single payer government run insurance is good should look closely at the Veteran's Administration. [Comments welcome. There are many ways to sign up to be notified of new items].
          The Desperate Democrats Fight Dirty on Health Care Bill        
You know the healthcare fight is getting desperate on the left when they start going after the wife of the independent they see standing in their way. Oh boy.


Washington (CNN) - Sen. Joe Lieberman whose opposition to a public insurance option has drawn outrage from liberal groups for months is used to finding himself in progressive crosshairs.

Now it's his wife's turn.

Activists are setting their sights on Hadassah Lieberman, launching a celebrity-studded petition drive to convince the nation's largest breast cancer non-profit to end the Connecticut senator's wife role as a spokeswoman.

The move to pressure the Susan G. Komen for the Cure foundation came the same day Lieberman's husband angered Democrats by announcing that he would not support an expansion of Medicare to cover individuals under the age of 55. Organizers did not point to that decision, instead citing Hadassah Lieberman's own ties to the health care industry.

Wow. This is hardball. Lieberman refuses to vote for the healthcare bill in it's present form, and they go after his wife.

Add to that this the video and audio of Obama speaking about how to get to a single payer healthcare system, that just so happens to beReid's exact new plan, and you have Democrats scrambling. They had hoped that this kind of thing wouldn't be exposed. Clearly it is a government run plan that they want. This game we are playing right now is just a means to an end. The end being a single payer system. We don't even have to speculate or accuse. They have said it themselves. They (especially Obama) don't want you to remember past statements. And if the MSM have anything to do with it, you won't.

A new CNN poll shows 61% of Americans opposed to a dramatic new health care system, and this "new" proposal by Reid about a Medicare buy-in doesn't seem to be going anywhere even with some in his own party. On CBS's "Face The Nation" this Sunday, Sen. Nelson called the buy-in proposal "the forerunner of single-payer, the ultimate single-payer plan, maybe even more directly than the public option."

If I were Nelson, I'd make sure his wife is watching her back.
          No Surprise        


This shows video and audio of Obama speaking about about how to get to a single payer system in healthcare. It just so happens it's Reid's exact new plan.

via HotAir
          Liberals Strike Back... Against Single Payer        
Ironically, healthcare reform efforts have sought to "improve and expand" every element of the present system, except the program that works best: Medicare. The Clintons tried to expand HMOs, Obama expanded private health insurance and Medicaid, the GOP tried to expand "individual purchase. Medicare—if improved and expanded to all—could confront the industry, contain prices and restore the values of caring and community to our healthcare system.

With the explosive growth of the movement for single payer healthcare, it should not be a surprise to see the Empire Strike Back.

With the explosive growth of the movement for single payer healthcare, it should not be a surprise to see the Empire Strike Back.

In the name of political reality, some liberal pundits, politicians and policy wonks are scolding progressives to give up on Medicare for All. There are many ways to achieve "universal coverage," we're told. "Overhauling" the entire system is too hard, healthcare is too big a part of the economy, and politicians will not take out the health insurance companies.

Yet, the alternative approaches to reform pose the same political problems: the insurance industry is likely to fight the elimination of their profits (Dutch and German health insurers, for example, are non-profit), and the severe reductions in executive compensation, elimination of shareholder dividends, and rate setting, all of which go away under European-style health insurance.  The benefits and rates are government mandated, the companies are essentially payment administrators. 

Either this regulated system of private health plans lowers prices through government—by setting rates and negotiations—or it fails to do so and costs shift to individuals.  But it is still the government role as rate setter/price negotiator that matters. Wouldn't it be more straightforward and simpler to improve and expand Medicare?

Still, the pundits say it's best to search for incremental reform of the insurance-based system, and live (or not!) with the results. In other words, the best health reform we can do is a version of what we have. Worse, it props up and reinforces a profit-focused system that is antithetical to the very concept of healing. Advocates of Medicare for all, and other non-reformist reforms, are looking to solve problems immediately, not accommodating the status quo.

Progressives are badly served by shallow political advice from the likes of Paul Krugman. It obscures the reality working people actually face and undermines the fight for our values and program.

Our health is not a commodity—it doesn't belong in the "market"—it is a human right. Those who advise us to settle for models of national health systems in other countries are missing the fundamental difference from the broken U.S. scheme. What Australia, the Netherlands and Switzerland all have in common is they do not conflate "coverage" with healthcare. Those countries guarantee healthcare.

Having health insurance in America doesn't prevent medical bankruptcy or denied care. In the U.S., employer based healthcare creates great uncertainty for workers, as premiums and out of pocket costs increase, reflecting costs shifted from the company to workers to fund the profits of the insurance companies.

Only 55 percent of employers offer coverage. Why would we try to buttress a system that is failing workers, hurting business, and shrinking? From 60 to 70 percent of healthcare spending comes from taxes. We're just not getting our monies worth. We are wasting 20 cents on the dollar when we pay for private health insurance, wasting huge resources that could go to higher wages, child care, and pensions.

Alternatively, single payer is the reform that establishes health security and enables greater equality and freedom—values worth fighting for.

Ironically, healthcare reform efforts have sought to "improve and expand" every element of the present system, except the program that is popular and works best: Medicare. The Clintons tried to expand HMOs, Obama expanded private health insurance and Medicaid, the GOP tried to expand "individual purchase," so we'd all be on our own when dealing with insurance companies, drug companies and hospital corporations.

It is precisely profit-focused healthcare industry that has caused the problems of escalating costs and restricted access. Rising premiums pay for rising prescription drug costs, which hospital corporations pass on to patients and drive up their own rates as they leverage their market share. As a result, each sector's revenues and profits increase. The industry imperative of revenue and profits has replaced caregiving as the basis of healthcare in the US (see Elizabeth Rosenthal’s book, "American Sickness.")

We are not "starting from scratch," as Krugman contends (which he did not in 2005) but instead there exists a model in the U.S. for how single-payer financing could work: Medicare—which if improved and expanded to all—could confront the industry, contain prices and restore the values of caring, compassion and community to our healthcare system.

Alternative approaches to universal coverage (though even with the Affordable Care Act, 28 million people remain uninsured) depend on using huge tax subsidies to enable individuals and businesses to buy insurance coverage. Without those subsidies—in California alone they amount to over $100 billion—health insurance is a failed business model. Taxpayers prop up the insurers profits for the honor of paying $2000 in deductibles and potentially under the ACA over 9.5 percent of our income in out of pocket costs. In California, this means 15 million people are uninsured or underinsured.

Truly controlling costs requires eliminating the waste and inefficiency of the private payers – Medicare administrations are cost 4-5 percent compared to up to 12 percent for insurance companies (before profits). The inherently wasteful insurance company bureaucracy doesn't go away when everybody has to buy one of their health plans.

Ultimately, what we must face is an issue of power. Can we collectively organize a healthcare system without the imperatives of revenue and profit? Only if we build a movement for health justice that demands guaranteed healthcare for all as a human right. Only collectively through government do we as a society have the resources and standing to secure that right. Only through an Improved Medicare for All can we achieve health security, not subject to the market power of healthcare corporations.

Michael Lighty is the Director of Public Policy for National Nurses United, where he has worked since its founding in 2009, and for the California Nurses Association since 1994. Follow him on Twitter: @mlighty60


          Push for Single Payer Plan as Lives Are on the Line        
Last week, the Senate blocked a proposal by Republicans to repeal much of the the Affordable Care Act, but many people in the U.S. worry Republicans in Congress remain determined to take away health care. A recent study shows a majority of Americans say it is the federal government's responsibility to make sure all Americans have health care coverage; a growing number now supports a single payer plan. On Saturday, July 29, demonstrators called the win in the Senate a "temporary victory." and said they are not waiting for the next Republican attack.
          Comment on The ‘Party of Ideas?’ by beltwayjim        
It's 3:00 EDT and I am late to the party. My suggestion is to change the conversation around the ACA. We should be talking about a took kit, not a one size can't fit everybody approach. I have started a list of tools for the tool kit. Add you tools and suggest subtracting the ones that don't work. Tools in the kit. Payroll plans. This is the big one at the present time. Single payer or single reinsurer. This is for pools that only have one insurance company bidding. It is better than monopoly pricing. Local Hospital consortium plans in rural areas only served by one hospital. In or out of the reinsurance pool. It will work both ways. Open market high deductible plans limited to those who make over 1000 times the annual expected deductible. This is for the rich, think Republicans. Medicare for any one who wants to apply. That should be enough ideas to start a tool kit. Please add yours.
          Comment on The ‘Party of Ideas?’ by Linda        
I also have no time for Michael Moore. I consider myself an old fashioned liberal. I think single payer or even Medicare for all risk becoming slogans with the same fate as repeal and replace. Health care is a heap of details and will not be fixed by slogans. I am in favor of fixing the ACA, lowering the age for Medicare eligibility and stabilizing the individual markets. Single payer or some version of it may make the most sense in a pure approach to providing universal coverage. It isn't so clear that taking the 80% of Americans off their employer plans would do anything but create chaos and resentments. The details of that transition would overwhelm the system. It's okay for me that there are different strands of thought in the Democratic Party as long as when the talking is done and the elections start the purists don't take their energy and turn into a left version of the tea party. Compromise is not a dirty word for me.
          Comment on The ‘Party of Ideas?’ by winterbanyan        
Deliver me from Michael Moore and the Jill Steins of the world. And the Bernies, too. They seem totally focused on slashing whatever unity might exist in this country. Sweeping ideas are a great thing, as long as they are not just slogans. Slogans are easy to sell, but the devil will always be in the details. Repeal and Replace was a popular slogan that worked well for Republicans until they had to do something about it. The bankruptcy of their "ideas" lit a fire under the electorate of all persuasions. At least around here, town halls are still getting mobbed by people who are upset about healthcare, and most of them simply want to see Obamacare improved or to see single payer. The repeal and replace advocates are steadily becoming a thing of the past. So, yes, there's going to be a lot of arguing over the next few years. The Democrats are swinging further left, but if we don't discuss and debate the details, we'll be responsible for another empty bunch of slogans. "Single Payer" is a great rallying cry. Now tell me how we're supposed to accomplish that and how much it's going to cost each American, and what the program will cover. We need to know that if we're to make wise decisions.
          Why I Am A Liberal        
Well, friends, I am starting to string some sentences together to start working on my next book, which will be called "Now, What's Left?"

The first thing I have to do is put together a book proposal, which is kind of a big job, but - the good news is that when it's done, you've really done the hardest part of writing the book.

So, in preparation for the proposal, I'm sort of synopsizing everything that's been rattling around in my head that I want to be a part of this book, and one of the things I ended up doing was making a list of the reasons I am a liberal.

I'm sure I'll think of more, but... here goes!




This is what being a liberal means to me:
·      I believe that freedom means freedom for everyone, not just me and mine;
·      I believe in not only personal responsibility but shared responsibility towards the group of which I am a part;
·      I believe that leadership does not equal dominance
·      I believe that every person is entitled to dignity and respect, not because of what they have but because of who they are – human. I do not believe that someone who has more than I do is more worthy than I am, and I do not believe that someone who has less than I do is less worthy.
·      I believe that each individual’s religious belief (or non-belief) should be respected, but it should not infringe upon others’ belief, non-belief, or personal freedom and that religion and government should be separate – for the good of both.
·      I believe that the qualities of tolerance and empathy are not the same as ‘moral relativity’ (whatever that actually means), but are expressions of the Golden Rule and moral values to which I am proud to aspire.
·      When people disparage ‘diversity’ (always said with the little eye-roll), I assume they prefer inbreeding.
·      I believe that there are some things that government is better equipped to deal with than private enterprise; that there is room for both. I do not believe government should be run like a business, and I do not believe that private enterprise should be run like the government.
·      I believe that the areas that include shared life-and-death resources (clean air, fresh water, safe food, transportation infrastructure, judicial and legal infrastructure, essential [not elective] medical care, military defense), and education for all, should be administered, overseen, and protected without a profit motive by a body that is accountable to the people – that is, government.
·      I respect tradition, but not for tradition’s sake only; I embrace change, but not change for change’s sake. For each I ask myself, “Is it necessary?”
·      If I claim freedom for myself, I need to extend it to others in return. Civil rights are rights conferred upon citizens, and civil marriage is one of those rights. No one should be guaranteed a religious marriage; that is up to the tenets of that particular religion and not the business of government. But civil marriage recognized by the state grants rights, benefits and responsibilities to married couples that all citizens who wish to marry the person they love should be able to benefit from – and be responsible for.
·      I believe basic health care is a right, and not only that, but a benefit to society that saves money to all Americans in the long run. I believe that national single payer health care, administered (but not provided) by the government, is the most cost-effective and fair way to ensure that no person is denied care because they can’t afford it, or goes bankrupt because of an illness or accident.
The argument that health care should not be called a ‘right’ because no doctor shoud be forced to care for an ill person against their will makes no sense. Emergency rooms are already mandated to care for anyone who comes in regardless of their ability to pay; the cost is astronomical and borne by the taxpayers anyway.
No one should die because they can’t afford care, and if the costs of medical care are shared in a large enough pool that includes healthy people as well as sick people, then medical costs will be more affordale all round. This is nothing more than insurance, taken to its logical conclusion – but without the profit motive that takes precious dollars away from health care. No other industrialized nation allows insurance for profit; even private insurance is non-profit. It is immoral to me to enrich myself at the cost of human health and life. Not only that but it is a drain and an expense that society must pay for in terms of lost productivity, lost wages, families thrown into poverty (and the public dole) – so it is actually cheaper and more efficient on many, many levels for society to manage health care.
If I wish to have a 5-star hotel-room hospital experience, or get elective plastic surgery to indulge my vanity – by all means, let the market take care of that! If you want it and can afford it and an insurer wants to make a profit from that, go for it.
Private, for-profit insurance for things like cars, houses, travel, flood, hurricane, fire and other things that you choose to have in your life that cost a lot to replace is perfectly useful as far as I’m concerned, but in matters of a human life it is unconscionable.
·      I believe that government is US – We the People – and, as flawed as it can be, it is answerable to us. Private enterprise in charge of public needs is NOT answerable to us (See California’s disastrous power deregulation and susequent grotesque theft from the people of CA for a good example of what the lure of the profit motive can lead to with public utilities.) Privatization is not the answer to what’s wrong with government.
·      I do not believe that the Invisible Hand of the Free Market will make everything hunky-dory with the economy. I think that is a willful misinterpretation from Adam Smith that Republicans accept as fact because it favors the interests of Big Business to do so. I do not believe that ‘free markets’ are free if all the power is on one side of the equation.
·      I do not believe that tax cuts for the wealthy create jobs. All they do is add to the deficit and give Republicans an excuse to cut social programs in the name of ‘deficit reduction’.
·      I do not believe you can ‘cut’ your way out of a depression (pardon me – a recession.) by belt-tightening. Just ask Hoover – or go visit a Hooverville. I hear they’re quite the ‘coming thing’.
·      I believe that workers have the right to organize and negotiate with the companies they work for. Otherwise, it becomes a race to the bottom for the cheapest labor – leading to the demise of American jobs, massive outsourcing and the demand for, not just immigrant labor, but illegal immigrant labor (basically slave labor) – as a business model! Union wages keep non-union wages high as well, leading to a strong economy where there are consumers who can afford to buy things that cost a little more. It’s a race to the top instead of the bottom.
·      I also believe in reasonable regulation. If we had had reasonable regulation in place over the last 15 years, we would not be in an economic collapse only rivalled in the last century by the Great Depression. There is a middle ground between micro-managing and reasonable regulation, but the corporate powers-that-be treat any attempt to oversee financial matters as the grossest of meddling, nit-picking, and job-killing. That, of course, is their strategy. It’s called ‘working the refs’ and it has worked like a charm for them. For us? Not so much. Even a football game has rules.
·      I believe that justice and the rule of law should not be for sale to the highest bidder.
·      I DO NOT BELIEVE THAT CORPORATIONS SHOULD BE  LEGAL PEOPLE.
·      I believe that elections should be financed by the public to ensure that politicians are not purchased by corporations and that the important work of our nation is not disrupted by 24/7 fundraising once a candidate is elected. I don’t believe a congressperson should be under the thumb of corporate money, and subject to the pressure of having an opponent financed by a corporation if that congressperson doesn’t ‘play ball’. I also do not believe that there should be a revolving door between Congress and K Street once that Congressperson leaves office.
·      I believe we overlook conflicts of interest at our peril.
·      I do not believe that military dominance of the world is the way to keep America safe.
·      I do not believe that we should ever pre-emptively attack another nation, and that war should be the last of last resorts in self-defense. Real last resort, not pretend, made-up ‘last resort’ that was actually the first resort. I wish there was no reason for war at all, but if we do go into combat, we should take care of our soldiers both in and out of the service, for as long as they need it. It is the least we can do for the men and women of whom we have asked the unspeakable. David Swanson is right; war is a crime. I wish I were smart enough to figure out how to keep our governments from engaging in them.


Well, it's a start...
          235: Interview Prep: What is Happening in Our Healthcare System?        

Session 235

Jen Briney is host of the Congressional Dish podcast and joins me today to talk about our current healthcare system and where it may be headed.

Enter to win a free copy of my new book The Premed Playbook: Guide to the Medical School Interview. Text BOOKGIVEAWAY to 44222. Promo runs until June 4, 2017.

Today's guest is very interesting as it's someone who wouldn't normally be here on the podcast but with the changing landscape of our U.S. healthcare system, I thought of bringing an expert in this field. Jen Briney's Congressional Dish podcast is devoted to talking about bills that go through Congress. She has read the Affordable Care Act (ACA), Current TBAC, the new AHCA, and has discussed what's in there or not. She comes on the podcast today to talk about these things so you can come prepared for your medical school interviews. This is going to be a good primer for our healthcare system even if you listen to this in 2018 or 2019, assuming there are no dramatic changes.

[03:15] The Congressional Dish Podcast

Being a Congress-watcher, Jen watches Congressional hearing and reads bills and laws being created so that taxpayers, like her, would know what's going with their money. What led her to become so familiar with healthcare was the government shutdown in 2013 when the Republicans were trying to repeal the Affordable Care Act (ACA). She did not like the system as a whole because it's an insurance system, not a healthcare system. But Jen believes it's better than we had before because rules have been put in on the insurance industry. Currently, the Republicans have control of all of government. They're trying to repeal the Affordable Care Act but instead of repealing it, they're putting together bills very quickly with no hearings and no overall plan.

What Jen does now is she's reading all the different versions. She has read the first one that failed. But now the house just passed another version of the American Health Care Act, which she's reading for her next episode.

[05:22] An Insurance Policy, Not a Healthcare Policy

Jen explains there are different ways you can give people healthcare. A lot of other countries do "single payer" where you pay taxes and the government pays for healthcare. It's one of those essential government functions.

Conversely, the United States buys health insurance which is supposed to cover the big catastrophes. Before the ACA, these are for profit companies so what they would do is only cover healthy people because it would cost them the least. What health insurance does is you give them $100 a month and as long as you're healthy, they just put that in their pockets. That's profit. But as soon as you get sick, that's when they have to start to pay for stuff and they really don't like this part.

In order to have this system that still had private insurance at the center of it, the Affordable Care Act put rules in place. Before the ACA, there would be lifetime limits. You'd sign up for a plan. You get cancer and then you look in the fine print of your insurance and they would say, "Once we hit $1 million, we're not paying for anything for you ever again." And you would go bankrupt.

Another common practice with health insurance where once someone would get sick, they would just drop their plan. They would no longer cover you because they don't have to. Basically, they were doing all kinds of shady things to make money.

Why Jen thinks the ACA is better is because there are certain rules. For instance, there are now 10 essential health benefits that if you buy health insurance, they have to cover it such as preventive care. Jen shares her experience that when she went to get a physical exam and all the little bills came in, it cost her over $400. Now, that's illegal. Thanks to the Affordable Care Act. They also have to cover things like ambulances, hospital stays, maternity, prescription drugs, etc. There are things now that when you buy insurance, you know you're going to get. It's better than it was was before but it's still based on private insurance.

What you see now is these insurance companies liked the old days where they could profit by making up all the rules. Now the people in Congress working on behalf of the insurance industry are trying to make those rules go away. These are the people writing legislation designed to help the insurance industry to be more profitable. They're eliminating these rules so these essential health benefits are going to be flexible in certain states, if states wanted to, so they won't have to cover those essential health benefits anymore. This is not something that's good for the people, but it's good for the businesses.

[08:50] Congress Working for Businesses, Not for the People

Jen mentions the website OpenSecrets.org where you can look and see these people who are voting for this elimination of rules and you can see where they're getting their campaign funding from and in almost every case, you can see the health insurance industry and health professionals. Then you can see these companies get invited to help write these bills to repeal the Affordable Care Act. In fact, these insurance companies were in the room to write the Affordable Care Act, as well as the pharmaceutical companies.  These health insurance companies want to exist so they use their lobbying power to stay in existence and that is the basis of the Affordable Care Act. Jen says a lot of people call it the "poison pill" and no one right now in Congress is talking about the "single payer" system, the tax-funded system that works in so many other countries.

Jen explains why she says these people are working for businesses and not for us is because when you look at what they're doing, that's who benefits. Jen always looks at who benefits financially. With the American Health Care Act of 2017 (AHCA), it's the businesses that benefit from it.

[10:21] The Affordable Care Act (Obamacare)

In Episode 48 of the Congressional Dish podcast, Jen read the Obamacare and shares some big takeaways.

First, it puts rules on the private insurance industry. It allows the private insurance industry to remain the main way that people get their healthcare in the United States. As opposed to now, if you wanted to get a government plan, you have to get Medicaid, a program for poor people that gives them their health insurance. The federal government picks up all of the Medicaid funding for the states that accepted it. It basically expanded the program beyond what it used to be. So it allows poor people to get government-funded health insurance. Medicare, on the other hand, is for people over the age of 65 and for the most part, they also get government-sponsored healthcare. Everybody else is in the middle. If you make more than 133% of the poverty line or under the age of 65, you have to get health insurance in order to get healthcare for the most part.

This is the basis of the Affordable Care Act. It's a very complicated system that tries to put rules in the private insurance companies so that they will not go bankrupt but still have to cover people with pre-existing conditions. This is expensive because these as your healthcare provider, these insurance companies would have to pay for those benefits for your entire life and they don't want to do that. Hence, ACA forces them to cover you and it forces healthy people to get health insurance to outweigh those costs. Jen thinks it's a very delicate system with a lot of moving parts that have to work together in order to make this private insurance system work.

However, this is currently being actively dismantled. Jen admits she doesn't know what to study when it comes to ACA because we really don't know how much of this is going to survive.

[13:15] Different Ways to Get Health Insurance

One way to get health insurance today is the individual market which didn't exist before. For instance, Jen as a podcaster doesn't have a big corporation paying for her health insurance so if she were single and needed health insurance, she would have to go to each individual company and try to figure out what they cover which can be very confusing. Jen basically ended up with a $400 physical since she had no idea what she was buying.

One of the basics of the ACA is that it has created this individual insurance market where people could go on a website and pick a plan from a selection of companies offering it and compare them based on the premium, coverage, percentages - all of which are being explained, which didn't exist before.

Through the ACA, it separated your healthcare from your employer so you could quit your job and still have health insurance. Apparently, there are so many people in this country that are clinging onto jobs they don't like because of their health insurance.

Other ways of getting health insurance include the small group market and the large employers, where most people in the country are still getting their insurance from. Moreover, the ACA also requires that employers buy plans that cover those ten essential benefits and have minimum of what needs to be provided in return for premiums.

Jen ultimately stresses that the Affordable Care Act keeps the private insurance company at the center of our healthcare and try to make it so they can be profitable and yet we get coverage with fewer medical bankruptcies. Jen adds that this did not eliminate medical bankruptcies in the U.S. nor did it cover everybody but it is better than it was before. Basically, it's a stepping stone.

[15:25] Medical Bankruptcy and Hospitals Covering healthcare

Even if you don't have insurance, you're going to get care anyway, right? You show up to a hospital and you're going to get the care you need. Is this how it works?

Jen thinks it's anecdotal but that's not how it works. Before the ACA, Jen's friend got cancer at 15 years old. She went into remission. They had one awesome summer and then the cancer came back. She was told she was going to need a bone marrow transplant. That's what was submitted to her health insurance company but someone behind the desk decided it was too expensive and said no. Because her parents were not millionaires, she died.

So you can't really separate medical bankruptcy from getting care. If you got hit by a car and you get brought to a hospital, you're going to get the basics so you can get out of there. But what about the follow-up care? What about cancer treatments? You can't get that in emergency rooms.

Jen firmly says this is inaccurate to say that hospitals have to cover you. They do cover the minimums like emergency care but the maintenance and the preventive stuff, that's what keeps you alive long term and that is not covered in the emergency room, especially not on a systemic level when there 325 million people in the U.S.

[17:14] Democrats versus Republicans

Jen has observed that there is so much corporate influence in our Congress right now on both sides. You have the Republican party that wants the insurance industry to write the rules. So they get to call the shots and they decide who gets covered and who doesn't because they believe in an economic theory. They believe in it so strongly that Jen is convinced they're not really looking at it from the people's perspective. They want people to have access to healthcare but access is different from "actually" having healthcare. So the Republicans are really working on behalf of businesses in a way that I think clouds their judgment.

As with the Democrats, they're also corporate in a certain way so they're the ones who created the Affordable Care Act. Instead of nationalizing the healthcare industry like it is in so many other countries, they are also creating the system and doing the middle of the road thing. They can keep the private health insurance in control as long as there are rules. But the people who just want to get healthcare as part of being American citizens are vastly outnumbered in our Congress right now.

[19:00] Healthcare as a Business

Unfortunately, there is no side that is saying that access to doctors and getting healthcare is just an essential that everybody needs. Jen thinks there is an ideological battle happening and it seems to her that government should be covering the things that we all need but we don't know when.

The problem with treating healthcare like any other business is you can't opt out of it. It's not a restaurant, you can't choose to not go there and cook at home. You need the doctors when you need them. And the Republican party, specifically, sees healthcare as a business.

Jen adds it's not necessarily a left versus right thing. Instead, is this a business and should it be for profit or should be a part of the government? This is the real battle going on right now and business is winning big time.

Let's say, you got bitten by a dog and you're bleeding. Are you supposed to go to Yelp for doctors and figure out which one is the cheapest? And then go to the cheapest one questioning where this doctor actually got their degree. Jen doesn't think this makes sense on so many levels. When you're sick the only thing you're thinking of is how do you get better. You're afraid for you actual life.

This is why health insurance companies are an amazing profitable business because it's something we all need and will pay anything for. We don't question our doctors and for most of us, doctors are gods.

Again, it's not a business; at least, it's not supposed to be a business. It's not like buying a shirt and choose from different stores. But it matters when it's your health because you only have one body and if you screw it up, game over.

[23:45] It’s Going to Get More Expensive!

Jen bluntly admits that she is horrified with what the current administration is trying to do by making it all for profit again. It's not a normal business and so a lot of people are going to get hurt by this. With the new American Health Care Act, if it becomes a law, people with pre-existing conditions still have to be covered technically but there are so many loopholes that they've now written into the system.

The The MacArthur Amendment got passed in the house. It's basically a waiver that lets states waive the essential health benefits and states can create the essential health benefits, state by state. This implies that not only will states be able to define the categories of benefits but they also get to decide what's in those categories. For example, a state may decide to only cover three prescription drugs instead of a lot of them which were supposed to be covered or a state may decide they won't cover ambulances anymore.

Moreover, when you get sick, the ACA puts a limit that you only have to pay a certain amount out-of-pocket. Those are all tied tied to the essential health benefits. With the MacArthur Amendment, each state is allowed to determine what essential health benefits mean and it's also going to determine your lifetime and annual limits and what your out-of-pocket expenses are.

Jen thinks this is just going to be much more expensive for customers on so many different levels that people are going to skip care because they can't afford it. Additionally, they say it's designed to reduce premiums. By eliminating the rules on the insurance companies, it's true that premiums might go down because the plans do not cover anything. Jen had one of those. She got her plan for $80 a month but when she went to get a physical, it was $400. Imagine if she actually got sick! That's what they're going back to.

Jen says they promise this is only the first step. The main goal is to allow the private insurance companies to do what they will. This is Jen's biggest concern (and ours too!) because they exist not to provide the best healthcare but to make as much money as they can and divvy it up to their shareholders. This is what for profit corporations do. Jen explains it's not necessarily evil but it is when you do it with healthcare. Again, you're talking about desperate people that will pay anything for their own health. So she doesn't see anything good about it.

[27:35] The Car Insurance Analogy

To better understand what Jen has just discussed, it's like car insurance. When you're looking for a car insurance from a premium standpoint, you're typically looking for the cheapest thing possible and you're not digging around aspects like towing service, accident coverage, or parts replacement. All you want is the cheapest premium because you're a poor college student.

Allowing patients to choose the cheapest premium without understanding that back-end of what they're actually buying. They're basically betting on the American population to not be smart. Jen thinks it's not even smart because what they do is deceptive and put it in the fine prints. Those are tricky things insurance companies do so you're not aware. They don't want you to be aware because they want to get out of covering you when you actually do get sick.

Jen got a cheaper plan for her car and when her battery died and called her insurance asking for roadside assistance, she found out she's not covered for it anymore. She ended up asking for help from someone. Good thing it wasn't a big deal, but what if it was?

However, the problem with comparing health insurance and car insurance, is that you actually don't need a car. So if you don't want to pay premiums, you may choose not to have a car. But you don't have the option to not have a body. You basically don't have any choice. So even if you compare it to other insurances, it doesn't make sense because you don't have to own a car or a home and even life insurance.

[30:40] Where to Read and Understand the Bills

For those who want to know more about these policies, Jen recommends you go straight to the bill. It can be super painful to read legislation but Jen has seen so many conflicting information from sources written by other people. Hence, the best way to truly understand it is to go to Congressional sources and read what they're reading. Jen says it's not that intimidating. She's outlining the stuff on Congressional Dish and she links to all the individual provisions.

Jen uses GovTrack.us to look at the status of bills as well as those that have already been enacted. Jen considers reading the Affordable Care Act was the most miserable experience for her and found it so difficult. It has ten sections. She actually ready the first nine and found out that the tenth edits the first nine. But if you truly want to understand what the system is, you have to go to the bills and the U.S. code and read it. The codes can be confusing to read because of all the numbers or codes written but the laws are written in plain English. So you can go to the sections of the law itself and just read it to understand. It's not as hard as reading bills because you don't have to jump back and forth.

[33:20] What Happens to AHCA Now?

AHCA has passed the House and now it's in the Senate. Jen explains that what happens from here is that it may be changed because the Senators are not happy with it as it is. The people on the committees don't give Jen hope that it's going to be changed in a way that protects people more. There are certain Republican senators that are uncomfortable with people losing their insurance and having it be more expensive. But there's also a group that are ideologically opposed to the idea that the government puts any kind of restraints on private business and they see healthcare as a business. Two of these people, Ted Cruz and Rand Paul, are going to be involved in the shaping of the Senate's version and jen says they just don't believe in government.

The best we can hope for in this Congress is that the whole thing just stops. Jen hopes we can make enough noise that the Senate doesn't vote on it or it fails in the Senate. Timing-wise. Jen heard they want to have this vote in the Senate done by August. This means we have a couple of months to make a fuss in the Senate particularly. The House's rule is done for now (May 2017). So you have to focus from now until August of 2017 unless it's passed sooner.

[35:40] Jen's Message to Doctors

Jen wants to emphasize to doctors that private insurance is based on a lot of paperwork. There are a lot of receptionists hired to fight with the private insurance industry and a lot of times, the doctors care more about the patient. Jen says what happens to many doctors is they end up having to be insurance experts to help their patients get better and not go bankrupt. So doctors are involved in this and if you like to minimize your cost, minimizing the role of insurance would be good. Insurance companies don't want to pay because that's their business model and you want to get paid. So it's important for doctors to really pay attention to what's going on right now. Having read the bill, Jen encourages doctors in all of their interest to fight it as she thinks there is no good going on here.

Jen's friend has Crohn's disease and she's working on moving to New Zealand so that if this becomes a law, she's out. Jen stresses this is how serious this is for your patients. It sounds extreme but it is extreme! This is what keeps Jen awake at night and she thinks this should keep us awake at night too.

[39:05] Not a Carefully Crafted Bill

Lastly, Jen mentions how fast this is being crafted. It's not something the Republican have been working on for the last eight years since the Affordable Care Act. This bill they passed in the House was not available to read the night before the vote. It was not on the internet. The Congressional Budget Office does the really in-depth analysis of the financials but they were not done with this until the week of May 22, which is in the future of when this bill was actually passed. They simply just wanted to get something passed and so they passed it. Jen thinks this is so reckless. It's not a carefully crafted bill but something that has been thrown together last minute and the effects be damned.

This is the same as a doctor not evaluating a patient, giving them some antibiotics and if something doesn't work, another doctor will fix them.

[40:30] Be Informed

Jen outlined the Affordable Care Act on the Congressional Dish podcast episode 048 and linked them to specific provisions. Episode 151 is Jen's next episode where she will be linking to all these provisions she's talking about when she outlines the American Health Care Act. You may also get a free app so you can get the show notes on your phone as you listen.

Links:

Enter to win a free copy of my new book The Premed Playbook: Guide to the Medical School Interview. Text BOOKGIVEAWAY to 44222.

Congressional Dish podcast

Congressional Dish Podcast Episode 048: The Affordable Care Act (Obamacare)

OpenSecrets.org

Affordable Care Act

American Health Care Act of 2017 (AHCA)

Medicaid

Medicare

The MacArthur Amendment

GovTrack.us


          Comment on All Quiet in the Western Conference by SurfCity        
Yes, and I certainly didn't mean to imply it only happens with journalists. It is indeed everywhere. That's one of the reasons I'm in favor of single payer healthcare such as Medicare for All being provided by the government. Too many people are having to struggle working all sorts of freelance or part-time jobs and don't receive even minimal benefits let alone proper benefits.
          FDR3629 How To Save Health Care: A Memo to Donald Trump        
With the failure of Republicans to pass the Ryancare legislation as the alternative to Obamacare, the critical state of the United States health care industry is once again in the headlines. What can be done to fix the failing healthcare system in the United States of America? Some of the solutions – and problems may surprise you!

Stefan Molyneux discussed the importance of price transparency, lifestyle related health issues, the problems with single payer healthcare, the ability to refuse treatment, the perverted nature of insurance, the “friendly societies” of the past, how medical organizations reduce the supply of doctors to artificially raise prices, defensive medicine, the importance of tort reform, prescription drug challenges, specialization, end of life healthcare service, expensive not-for-profits and much more!

The Truth About Obamacare
https://www.youtube.com/watch?v=E9r93OxpE8g

Sources: http://www.fdrurl.com/how-to-save-health-care

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          A lot of well-meaning people don’t understand single-payer healthcare        
I see a lot of sentiment from American liberals and lefties that the United States needs single-payer healthcare, e.g.: 16/ Among the three remaining choices — GOP-Care, Obamacare, and Single Payer Universal Healthcare — the last is the winner. — Adam W Gaffney (@awgaffney) December 22, 2016 Now, I understand being frustrated with the American […]
          Comment on Court’s handling of health care makes me queasy by bobfromsanluis        
Wow, Joe, well said. The comparison to Social Security and Medicare are more to the point than ever. Part of the conservative argument against the Affordable Care Act is the part about "mandating" the purchase of a product (or service) from a private entity, such as an insurance company. Okay, let's change that; instead of mandating that we purchase private insurance, how about we just pool <i>all</i> of us together into a single payer system. We don't even have to reinvent the wheel since we already have a single payer system in place, even though it has lots of flaws and warts, it can certainly be improved. I'm talking about Medicare, of course, which could be expanded to include all Americans, not just those over 64 years of age. Doing this would eliminate the distasteful "mandate" about having to buy from private enterprise, and those in the insurance field would be free to offer "premium" upgrade policies. The flaws and warts I spoke of, mostly the fraud perpetrated by some of the providers and doctors in the Medicare system currently, that definitely needs to be addressed. All of the claims about the system going broke can be firmly refuted by the sheer numbers of participants if we open it up to all Americans, and the "problem" of having doctors refusing to participate is pretty much eliminated since most all Americans will be in the program. Alright then, let the conservatives unload on both of us now.
          By: ohwilleke        
Medicare Part D was necessary because of a design problem in Medicare before then. Medicare was created when drugs were a far smaller share of the health care pie than they are now. Making drugs available to old people who can't afford them, old people whom the U.S. government already has an obligation to provide otherwise comprehensive health care for on a single payer basis, is hardly an obviously bad idea. We funded Medicare pay as you go from general revenues, as a non-means tested welfare program, rather than with an ear marked trust fund revenue source. As a result, the problem in the original post number is really in the accounting and not the program. Reporting as an unfunded liability an entitlement program whose benefits are subject to change at any time, and whose future costs are wildly unpredictable (due to issues like demographic bubbles, the reduction of existing drugs prices as they become generic, and great uncertainty regarding new drug technologies and new drug prices) is silly. The Medicare Part D budget projections also fail to reflect the lack of independence of this line item from others. For example, a very expensive new cancer or diabetes drug could dramatically reduce total Medicare costs by reducing doctor and hospital care expenses in other parts of Medicare. Medicare Part D also has the potential, if exercised, to be used to give the U.S. the power to negotiate price reductions from pharma (in addition Congress can reduce their profits by changing patent laws if they want). Social Security and Medicare non-part D are actually overfunded. The general fund budget of the United States is underfunded. But, blaming that on Medicare Part D overstates the issue. Increased unfunded defense spending and failure to increase taxes to pay for our current spending are more at fault than the contribution of Medicare Part D.
          Jobs are No Reason to Quit the Paris Climate Agreement        
Donald Trump cited “jobs” no fewer than eighteen times in announcing his plans to withdraw from the Paris climate agreement. Nonsense. Jobs are not a good reason—in fact, they are no reason at all—for that decision.

Let’s start with the fact that the US economy doesn’t really need more jobs. We are already awash in jobs. At the macro level, there is no sign that the Paris accord, in place for over a year now, has hurt the steady growth of employment. Neither has it slowed the decline of unemployment, which reached a 16-year low in May. Take a look at the charts. Do you see a sharp break over the last year, since the agreement was signed? I don’t.

To be sure, the Paris agreement is not yet fully in effect, but markets are forward looking. If employers expected the agreement to put the brakes on growth, they would have been holding off on hiring already. What would be the use of taking on workers you are just going to have to lay off as soon as those onerous regulations come into play? If the charts tell us anything about Paris and the job market, it is not how great the employers expect the effects to be, but how small.

But that’s just the macroeconomic perspective. What about low rates of labor force participation and declining labor mobility? Those are real problems, but they have been around, and growing more serious, since long before the Paris agreement was even in the planning stages. Getting out of Paris will not fix them.


Critics are justified in pointing out that although the economy has been creating lots of jobs, the quality of those jobs is not uniformly high. Yet there is little evidence that jobs in coal and other fossil fuel industries, which Trump aims to preserve, are in any way better than those in green energy that are increasingly replacing them. Trump’s problem is not one of keeping or breaking promises, but of making the wrong promises. With a small pivot, instead of promising to put people back to work in the mines, he could help them find new and better work in the energy economy of the future.

Addressing just that point, an article in the Harvard Business Review compares jobs in coal with those in solar power industries. According to an underlying study that the article summarizes, more people already work in solar power than in coal. The solar industry alone—leaving aside wind, biofuels, energy efficiency jobs and the rest—could absorb all workers released by coal as the industry gradually shrinks.

The article makes a job-by-job comparison of skills and wages in the two industries. Yes, some retraining would be required to turn a coal industry operations engineer into a solar manufacturing technician, but many of the basic skills are similar, and the new job would pay 10 percent more. The same goes for lower-skill jobs. Even a janitor in a coal facility would get a 7 percent pay boost if retrained as a low-skill assembly worker in solar.

Unfortunately, moving from job to job and from state to state in search of a job is not always as easy as it should be. However, the barriers to labor mobility are not the fault of the Paris agreement. As I have written at length elsewhere, the fluidity of the labor market is suffering a death of a thousand cuts. A broken social safety net, a stumbling healthcare system, excessive occupational licensing, housing policy, and employer bias against ex-offenders all play their role. Those are the policy areas the administration and Congress should focus on—not the illusory quick fix of leaving the climate agreement.

Take health care, for example. Job-lock caused by employer-sponsored health insurance is one of the most serious barriers to labor mobility. Unless you are perfectly healthy, and sure you are going to stay that way, leaving an employer-sponsored health plan to look for a new job or start your own business is fraught with risks, both medical and financial. Yet the American Health Care Act passed by House Republicans, endorsed by the administration, and pending in the Senate, does nothing to combat job-lock. It leaves the dysfunctional system of employer-linked healthcare coverage virtually untouched. We need to end the $250 billion per year tax subsidy to employer-sponsored plans and put the money into something more flexible and portable.

Eurostyle single payer healthcare? That would work well, if you go by international surveys of the efficiency and effectiveness of national healthcare systems. If single-payer offends your ideology, you might prefer an idea with an impeccable conservative pedigree: universal catastrophic coverage, supplemented by market-friendly health savings accounts.

Disincentives built into our social safety net are another source of barriers to labor mobility. Research by MIT’s David Autor and colleagues has shown that workers displaced by trade and technology shocks often end up receiving social benefits in one form or another. Once they are on food stamps, Medicaid, housing assistance, or other programs, they face a trap. If they get new jobs, the government takes their benefits away. The effective tax rate of benefit reductions can be shockingly high, up to 50 or even 100 percent, with workers close to and just above the poverty line facing the stiffest penalties. In the case of disability benefits, disincentives can be so strong as to turn temporarily displaced workers into permanent labor force dropouts. 

What could be done about the work disincentives of the social safety net? A universal basic income would be one possible solution, but that would be a big step politically. In the meanwhile, Democrats have introduced bills to implement a less radical but quicker fix, through expansion of the Earned Income Tax Credit. But why just Democrats? In the past, Republicans like Paul Ryan and Marco Rubio have also backed the idea. They should renew their support now. An expanded EITC would do a lot more to help displaced coal workers than withdrawal from the Paris climate accord.

I could go on, but you get the point. The “jobs” mantra just doesn’t make sense as a justification for abandoning our commitment to combatting climate change. Not when unemployment is already approaching historic lows. Not when there are better policy responses to jobs lost in a dying coal industry—responses that make it easier for displaced workers to find new and better employment rather than preserving jobs that are no longer economically or environmentally viable. 

Donald Trump needs to wake up and listen to his own words. Speaking on Thursday in the Rose Garden, he said, “My job as president is to do everything within my power . . . to create the economic, regulatory and tax structures that make America the most prosperous and productive country on earth.” Amen. But let’s start with healthcare reform, labor market reforms, and reform of the social safety net, not by abandoning American global leadership on climate change.

A version of this post appeared previously on Milken Institute Review

          Universal Healthare Access is Coming to the US. Stop Fighting It. Make it Work.        
Many observers are describing the dramatic failure of the American Health Care Act (AHCA) as a debacle, but perhaps it will prove to be a step forward. As everyone knows by now, the United States is alone among advanced economies in not having universal access to health care, but it is already much closer to such a system than most people realize. The defeat of the ACHA may be a tipping point in which the forces trying to figure out how to make universal access health care work gain the upper hand over those that are fighting it.

The true scope of government in our healthcare system

The term “single payer” is often used to describe the healthcare systems of other high-income countries. Although that is a convenient term, it is not entirely accurate. As the following chart of healthcare spending in OECD countries shows, all countries use a mix of private and public payments. Furthermore, even in many countries where the government share of spending is high, the actual administration of payments is split among several funds, trusts, or regional agencies. There are no countries where all health-related services, including optical and dental services, drugs, and long-term care, are entirely free to patients without co-pays or deductibles.  Healthcare systems of OECD countries also differ widely in such aspects as whether facilities are publically or privately owned, whether doctors are public employees or independent practitioners, and whether private provision of healthcare, in competition with public services, is encouraged or discouraged.


In the United States, as elsewhere, even the public healthcare sector is not a true single-payer system. The federal government already operates three large systems: Medicare, Medicaid, and the Veterans Administration. Each of the first two is comparable in size to the entire healthcare systems of most European countries. If we categorize healthcare expenditures by the type of primary payer, the three big federal programs accounted for roughly a third of all spending in 2015, according to data from the Centers for Medicare and Medicaid Services.


However, this perspective understates the extent of the government role in U.S. healthcare. If we categorize expenditures by the source of the funds (instead of the type of payer) the government share of spending is much larger. This is partly because state and local governments account for 17 percent of all healthcare spending, which is not fully reflected in the chart above. Also, that chart hides the extent to which federal tax expenditures finance much of our ostensibly private health insurance. According to data from the Tax Policy Center, deductions and exclusions of health insurance premiums and related tax breaks cost the federal government some $250 billion in revenue in 2015 — a substantial burden on the federal budget.

Deductibility of employer healthcare expenditures accounts for about three-fifths of total tax expenditures. Others include exclusions of Medicaid benefits from declared income, deductibility of insurance for self-employed individuals, tax breaks for some types of out-of-pocket costs, and other items. If we categorize healthcare expenditures according to the ultimate source of funds rather than the primary payer, we find that government budgets account for over half of all spending, as this chart shows:

 

Our faltering private insurance system

Both the Affordable Care Act (ACA or “Obamacare”) and the AHCA tried to salvage what is left of private healthcare finance. Yet its two pillars, employer-sponsored insurance and individual insurance plans, are beyond saving.

The individual insurance market is failing because too large a share of health care risks is inherently uninsurable. Two conditions must hold for a real insurance market to work. First, the risks in question must be fortuitous; that is, predictable statistically but not predictable for any particular individual. Second, premiums must be high enough to cover claims and administrative expenses, yet still affordable to the customer.

Neither condition holds for individual health insurance. The principal reason is that a tiny share of the population accounts for the great bulk of all healthcare spending. The next chart, based on data from the Kaiser Family Foundation, shows that the top 10 percent of households account for two-thirds of all personal healthcare spending, and the top 5 percent for half of all spending. The majority of these high spenders have one or more chronic conditions that keep their spending high year after year.


The skewed pattern of spending poses a dilemma for policymakers: If they allow insurance companies to refuse to issue policies to people with pre-existing conditions, the people most in need of medical care will not be able to buy policies. If they insist on guaranteed issue, then the presence of high spenders in the risk pool pushes up premiums for everyone. As that happens, relatively healthy people drop out of the pool, pushing claims and premiums higher still for those who remain. As losses mount, insurers begin to drop out, too, until the system collapses.

Both the ACA and the ACHA opted for guaranteed issue. That sounds good politically, since many of us know a neighbor or relative with a pre-existing condition even if we don’t have one ourselves. Ultimately, though, guaranteed issue is an unsustainable policy that threatens the whole individual insurance market with a “death spiral.” The ACA is already showing early signs of such a spiral, and, as I explained in this earlier post, the ACHA seemed designed to make things worse rather than better.

Meanwhile, employer-sponsored health insurance has problems of its own. First, it works much better for large corporations than for small businesses. Most small firms simply do not have enough employees to constitute an affordably insurable risk pool. Second, economists believe that over time, employees end up bearing the cost of healthcare benefits through lower pay. Rising employer healthcare costs are thus a major contributor to the stagnation of wages. Third, the fear of losing insurance coverage makes people reluctant to give up jobs that are otherwise unsuitable—reluctant to try something new or start a business of their own. This “job lock,” in turn, reduces labor mobility and makes the economy less able to respond to shocks from new technologies and changing patterns of trade.

For these reasons, job-linked health insurance has been gradually dying for some time now. According to another report from the Kaiser Family Foundation, from 1999 to 2014, the share of the nonelderly population covered by employer-sponsored insurance fell from 67 percent to 56 percent. If the ACHA had passed, its repeal of the ACA’s employer mandate would have locked in the downward trend.  The Congressional Budget Office estimated that over ten years, 7 million employees would have lost employer-sponsored insurance as a result of the AHCA.

What lies ahead?
 
Despite the best of intentions, the ACA has been unable to save private-sector health insurance in either its individual or employer-sponsored form. The AHCA, the only alternative Republicans could offer, would only have accelerated the decline. That leaves two possibilities. Either the share of the population without effective access to the healthcare system will begin to rise again, or the government share of the national healthcare budget will continue to grow.

Decreased access may be the outcome in the short run. Republicans may make another attempt at reform that saves money through reduced coverage, but even if they abandon that legislative path and leave the ACA as the law of the land, its prospects are not good. Even with the greatest administrative energy behind it, it would be hard to make the ACA’s private insurance market work well, and it is more likely that current administrators will work to undermine than to support its operation.

In the long run, however, collapse of the ACA is unlikely to prove politically acceptable, once it actually starts to hit home. Looking at CBO projection of decreased coverage is one thing; waking up in the morning to find that Aunt Sally can’t get her chemo or Uncle John can’t get his bypass surgery is another thing altogether. At that point, some form of universal healthcare access, whether we call it single payer or something else, will be the only option left.

And really, it is not such a bad alternative. A revealing report from the Commonwealth Fund ranks U.S. healthcare eleventh out of eleven against those of ten high-income countries, all with systems that offer universal access. U.S. healthcare is at the top in terms of cost, and at the bottom in terms of efficiency and equity. And no, contrary to the scare stories, other countries do not use death panels or endless waiting periods to ration care. The United States ranks in the middle of the pack on measures of timeliness of care, although it is the worst of the eleven in terms of cost-related limitations on access.

So get used to it. We, too, could free up a good chunk of our national income now spent on healthcare, reduce medical insecurity, and cut the high administrative costs of our fragmented and overlapping healthcare systems. Universal healthcare access is coming. Stop fighting it and start figuring out how to make it work here, as it does elsewhere.

This post includes material first published on the website Fabius Maximus.
          To Succeed, Healthcare Reform Must Include Action on Prices        
 Republican reformers have repeatedly promised affordable healthcare for all Americans — doubly affordable, in fact. They promise to put premiums and out-of-pocket costs within reach of low- and middle-income consumers, and at the same time, that the plan will be affordable to the federal budget, even given the constraints their most conservative members would like to impose on federal revenues.

Unfortunately, the American Health Care Act (AHCA) now before Congress will make healthcare affordable in the budgetary sense only while making it less affordable in the individual sense. According to analysis by the Congressional Budget Office, the AHCA will reduce the budget deficit by $337 billion over a ten-year period, but only at the expense of reducing the number of insured by 14 million in the near term and by 24 million after the full effects of the bill come into force. As the CBO points out, even many people who retain coverage will find it more expensive because the ACHA tax credits will be less than the subsidies available through exchanges under the current Affordable Care Act (ACA or "Obamacare"). For others, the only option that will become more “affordable” is that of going without insurance, due to the ACHA’s elimination of the ACA’s individual mandate.

Under the ACHA or ACA, one uncomfortable fact remains unavoidable: There is no way to make healthcare affordable for either the budget or individuals without strong action to control prices for drugs, medical devices, hospitals, and doctors’ fees that are higher than in any other country. The current draft of the ACHA does nothing to deal with that critical problem.
 
The elephant in the room

Princeton economist Uwe Reinhardt calls high healthcare prices the “elephant in the room.” Yes, he says, there is waste at every level of the U.S. healthcare system. Yes, U.S. doctors and hospitals probably do overuse some procedures (C-sections) and tests (MRIs). Still, Reinhardt argues that by and large, it is the high price of care, not an excessive amount of care, that makes our healthcare so much more costly than that of any other advanced country. We don’t have more hospital beds per capita, or more doctors, or more births. We just pay more for each unit of service.
 

Reinhardt cites data from the International Federation of Healthcare Plans to back up his claim. For example, in 2012, the average cost of an appendectomy in the United States was $13,851, compared to $5,467 in Australia, the country with the next highest price. For a normal delivery, the U.S. price was $9,775 compared to $6,846 in Australia. The range of prices charged within the United States was even more astonishing than the average. At the twenty-fifth price percentile, an appendectomy in the United States cost $8,156 — higher than Australia’s average. At the ninety-fifth percentile, the U.S. price was an astounding $29,426. A normal delivery in the United States raged from $7,282 to $16,653.

What causes high prices and what can we do about them? Here is a list of some of the most common ideas. (Warning: Each of the following paragraphs would have to be expanded to its own long post — or even to a doctoral dissertation — for a complete treatment.)

Lack of transparency

A lack of transparency helps keep prices high by discouraging consumers from shopping around for the best deal, even when their problem is not so acute that they have no time to shop. As Reinhardt puts it, “Fees in the private [healthcare] sector have been jealously guarded trade secrets among insurers and providers of health care.”

Some reformers hope to encourage consumers to be smart comparison shoppers by imposing higher deductibles and copays and softening the blow with health savings accounts, which consumers can draw on to pay their out-of-pocket costs. However, those devices are useless if consumers cannot get price information in the first place.

Some insurers are trying to combat the lack of transparency by providing comparative price information, but what they give is not always easy to understand, and many patients do not look at it. A 2015 poll by the Kaiser Family Foundation found that only 6 percent of patients had seen price information on hospitals and doctors, and only 2 to 3 percent had made use of it.

There are plenty of ideas around to make price information more accessible and easier to use. For example, Jeffrey Kullgren, writing for the New England Journal of Medicine Catalyst, recommends bundling price quotes to show the sum of all fees that a consumer would face for a procedure, rather than separate fees for use of facilities, doctors’ services, supplies, and medications. He also recommends that providers have dedicated staff to provide price information to patients and explain what it means. Providers should also be willing to tell patients what services might not benefit them. For example, a $100 blood test might be essential for one patient but provide no useful information to another.

Structural incentives

Even when price information is available to consumers, the structure of their insurance plan may not encourage them to use it. For example, if a plan covers whatever the provider charges, once a deductible has been satisfied, the consumer has no incentive to look for the best value for major procedures. In another article, Reinhardt  recommends “reference pricing,” a scheme under which an insurer pays only the price charged by a low-price provider in the area, leaving consumers to pay the balance if they choose a higher cost provider.

Narrow network policies are a step in that direction of reference pricing, but they can meet resistance when patients have established relations with certain doctors and hospitals. Also, some consumers, to their sorrow, find that narrow networks can fail, leaving them with surprise bills from radiologists or anesthesiologists who are not network members, even though the hospitals where they work are.

Individual consumers are not always the ones to blame for a failure to respond to incentives. Reinhardt notes that employers are also notoriously bad shoppers for low priced care. One reason may be that they think they can pass higher healthcare costs along to workers through lower wages — a hypothesis that many labor economists agree with.

At a minimum, it is fair to say that a well-structured healthcare system should include some checkpoint in the chain between provider and patient where some party has an incentive to ask whether the product or procedure in question has a medical value that is commensurate with its cost. There is room for discussion as to who this should be or what standards should apply. The problem with the current U.S. system is that often no one at all has an incentive to address this question.

Fragmentation

Insurance coverage in the United States is highly fragmented. In the private insurance market, there are many carriers. Small carriers, especially, have weak bargaining power compared to large hospital groups and drug companies. On the government side, coverage is divided among Medicaid, Medicare, and VA systems that have differing authority to negotiate for low prices — and sometimes none at all.

In the private sector, insurers could be given the power to negotiate jointly with providers in their area. Government providers could also have a way to negotiate jointly for advantageous prices.

The ultimate in bargaining power would be to have a single payer for all healthcare services. The bargaining power inherent in single-payer systems is one of the main reasons other advanced countries have lower healthcare costs and still manage to produce superior quality of care compared with the United States, where doctors remain in individual practices and hospitals are privately owned.

Drug prices

The issue of pricing has nowhere received more attention than in the case of drug prices. Some observers think the advent of a million dollar pill is not far off. A recent commentary by Scott Alexander provides a good summary of the complexity of the issues involved.

The central problem is that of balancing the high costs of research and testing against the relatively low costs of producing drugs, once they are in use. The current regime handles this by giving drug companies temporary monopoly rights through patents. During the patent period, producers can charge whatever prices they deem appropriate. After patents expire, competition from manufacturers of generics usually brings the price down toward production costs.

This regime can have good outcomes or bad. The new generation of drugs to fight hepatitis C, which are very expensive but also very effective, appear to represent the good end of the spectrum. Research that, at vast expense, only fiddles with a molecule or two to produce a drug that prolongs a patent with no added medical benefit is the bad end.

Price discrimination also contributes to high U.S. drug prices. A 2015 report from Bloomberg found that the prices of seven out of eight common medications cost more abroad than in the United States, even after taking into account the discounts negotiated behind closed doors with some insurers. The cholesterol lowering pill Crestor cost five times more in the United States than in the next-most-expensive country at list price, and more than twice as much even after discounts. The leukemia drug Gleevec cost four times more in the United States, and no discount was available.

Economists do not universally condemn price discrimination. No one objects when theaters or theme parks charge reduced prices for children. Airlines use price discrimination to keep their airplanes filled — a practice that lowers average prices in the long run and increases the number of fights passengers can choose from. However, there are ways to keep price discrimination from getting out of control without undermining its usefulness in markets where fixed costs are high.

High barriers to resale across markets are one factor that facilitates price discrimination. For that reason, many reformers suggest allowing consumers to purchase drugs online from retailers in Canada, Mexico, and other countries where prices are lower. Since the United States is the high-price consumer in most cases, moves to reduce price discrimination would probably lower prices here. However, the net gains would be less than suggested by the current cross-border price differential, since curbing price discrimination would probably raise drug prices abroad at the same time it lowered them in the United States.

Mergers, monopolies, and entry barriers

Numerous studies (this one, for example) have found that mergers among hospitals tend to raise prices in the affected areas. Mergers between hospitals and physician groups can have a similar effect. During the Obama administration, the Federal Trade Commission began to push back against the wave of mergers. It is not yet clear whether such actions will continue under the Trump administration.

Entry barriers are another factor that contributes to a lack of competition and higher prices. A recent study from the Mercatus Center notes that thirty-six states do not allow the entry of new hospitals without a certificate of need issued by a government agency. The ostensible purpose is to improve the quality of care by preventing excessive competition. The Mercatus study casts doubt on that claim, showing that by some measures, the quality of medical service is actually lower in states with certificate of need laws.

Economists have also long argued that limits on admission to medical schools help to keep doctors’ salaries higher than in other equally wealthy countries. Observers on both the left and the right of the political spectrum complain that the American Medical Association acts as a cartel in resisting the expansion of medical schools even as the number of applicants rises.

Administrative costs

The fragmented nature of U.S. healthcare produces higher administrative costs than other countries. Those costs ultimately work their way into the prices of hospital care, physician services, drugs, and every other area of care. A study from the Commonwealth Fund found that in 2014, administrative costs accounted for 25 percent of all hospital expenses—higher than any of eight other countries studied, and double the level of Canada. An earlier study from the Office of Technology Assessment found similar results for total administrative costs in the healthcare system.

Single payer systems are inherently more efficient in terms of administrative costs. International experience shows that many savings can be realized within a unitary administrative framework without requiring that hospitals be owned and operated by the government or that all physicians become government employees.

No simple answer but a need for action

It should be clear from these examples that there is no single explanation for high U.S. healthcare prices, and no simple solution. Action is needed, but it needs to come across many fronts at once — against mergers, entry barriers, drug prices, lack of transparency, administrative fragmentation, and other problems. If each of these areas could eliminate a single percentage point of the gap between U.S. prices and those that prevail in our high-income peers, we could save billions of dollars a year.

If the current draft of the AHCA is not revised to address the problem of excessive healthcare prices, it is likely to do little to improve affordability. Any savings it brings can come only from reducing the quantity or quality of care provided, not by reducing costs per unit of service.

Paul Ryan, the most vocal backer of the bill, insists that this is only the first step. We have to understand, he says, that the AHCA is tailored to meet the arcane requirements of the Congressional reconciliation process, which limits changes to matters directly affecting taxes and spending. He promises a three step approach, of which the ACHA is only the first. The second step (administrative action) and third (further legislation, not subject to reconciliation constraints) are supposed to address cost controls and issues of efficiency.

There is a huge danger in this approach, however: Every dollar saved in healthcare costs means a dollar less of revenue for some healthcare provider. Any proposals to cut drug prices, increase competition among hospitals, or squeeze out administrative costs in the insurance industry will face tooth-and-nail opposition from an army of lobbyists.

The AHCA, if passed in its current form, will satisfy the potent symbolism of repealing Obamacare. Any Republican Senator or Congressman who votes against it will have broken an explicit campaign promise and will face a primary fight in the next election. But once a repeal bill passes — any bill — the political heat will be off. The motivation to tighten the screws on big pharma or the insurance industry, against the will of the lobbyists, will evaporate.

At the same time, Democrats will dig in their heels against anything that might make the AHCA work better. At least a few Democratic votes will be needed for any further reforms that can’t squeeze through the eye of the reconciliation needle. But where is the political motivation to cooperate? Many Democrats may well prefer to see a half-baked GOP reform collapse in a death spiral, (as I predicted in an earlier post that it will do), and hope to pick up the pieces after the 2020 elections.

By the time you read this, the ACHA may have reached a legislative dead end. If so, let's hope the next attempt includes realistic action on the pricing issue.

A version of this post appeared earlier on the "Poverty Matters" blog from the Niskanen Center. Reposted with permission.
          CNN’s Sanders-Cruz Healthcare Debate: A Scorecard        


CNN, Senator Sanders, and Senator Cruz deserve congratulations for a great town hall. Real focus, real exchange of views, even real agreement now and then on some important ideas. Worth viewing, or if you missed it, worth reading the transcript.

Still, articulate and well prepared though the participants were, there were things they should have said that they didn’t say. I often had the feeling that Cruz was changing the subject when he didn’t have answers and glossing over some key points that needed closer examination. At the same time, I think Sanders missed some chances to hold him to account. Here is my scorecard, organized by topic.

Pre-existing conditions


The ACA (or Obamacare) has many detractors, and it has flaws that Sanders himself admits, but some parts are popular. None is more popular than the mandate that insurance companies must cover people regardless of pre-existing conditions. Probably fewer than one in ten Americans falls into that category, but almost everyone has a parent or child or spouse or friend who is in the ten percent. Together that ten percent of patients account for about two-thirdsof all personal healthcare spending. Even if you are healthy, your biggest fear is that you might develop cancer, or diabetes, or have a bad auto accident, and end up in the ten percent without adequate healthcare coverage.


The pre-existing conditions mandate was, appropriately, the subject of the very first question from the audience. 


AUDIENCE MEMBER NEOSHO PONDER (A breast cancer patient): “Senator Cruz, what can you do to protect people like me who are alive because of Obamacare?”


Cruz gave several versions of his response:


CRUZ: All of [the GOP proposals] prohibit insurance companies from canceling someone because they got sick. They prohibit insurance companies from jacking up the insurance rates because they got sick or injured.


CRUZ: [a] proposal that is consistent in virtually every one of the pieces of Republican legislation that's been filed is a prohibition on insurance companies canceling people because they got sick.


CRUZ: all of the Republican legislation that has been filed that the Democrats have opposed maintains a continuity of coverage so that insurance companies can't cancel policies.


Sanders tried to press him:


SANDERS: What you just said is "cancel your insurance." "Cancel your insurance," OK? That's good. But what happens if tomorrow you wake up and you go to the doctor and you discover that you have cancer? All right? You just discovered it. And the insurance companies say, hey, you're not a good deal for us, we can't make money off of you, you will not get that health insurance.


Unfortunately, Sanders didn’t quite drive home the key point that the Republic plans only protect people with pre-existing conditions if they maintain continuity of coverage. Continuity of coverage is a proviso in several GOP proposals. It forbids insurance companies to cancel coverage or raise rates for people who were already insured before they got sick and have been continuously covered since. They are not required to cover, or are allowed to charge higher rates, if people develop their cancer or diabetes or whatever during a period when they are uninsured. Even if they were insured when they were first diagnosed, if they have had a gap in their coverage after they develop their condition, neither their former insurer or a new one has to take them on.

Sanders should have made it crystal-clear that continuity of coverage is not enough. There are lots of reasons people might not meet the continuity of coverage requirement. One reason is that young people might not get coverage in the first place. They might not have parents with a plan they can stay on until they are 26. Under GOP plans, they would not have the spur of an ACA-type fine for not having coverage. Or they might just think they are immortal, like most normal young people do. Then, at age 27, they might crash their car or wake up one morning with a scary lump and suddenly want insurance for the first time. Under a system that requires continuity of coverage, they would be out of luck.


Another other big problem comes if your coverage is linked to your job. What if you lose your job? Will you have COBRAcoverage (the main continuity mechanism before the ACA) or something similar? Can you afford it during the interval of financial stress while you are looking for a new job? Will your new employer even offer insurance? Under GOP plans, not necessarily.


In practice, then, loss of job, not to mention death of a covered spouse, divorce, and other events, carry considerable risk of losing continuity of coverage. Under some GOP plans, even a brief loss of coverage could turn into a virtual death sentence for a person with a pre-existing condition. 

For this segment, I give Cruz a C- for obfuscation when he tries to pass off continuity of coverage as being an adequate solution to the problem of pre-existing conditions. I give a B to Sanders for not driving home the point as effectively as he might have. 

Rationing



More than once, Sanders brought up the fact that the US spends more on healthcare than any other advanced country, even though they have universal coverage and we don’t. Each time Cruz blamed this on rationing. For example:

CRUZ: [Sanders] often points to Canada, the United Kingdom. He says why do we pay more?

Well, there's a reason we pay more than those countries. We get a lot more and a lot better health care.

Let me give you some basic facts. As I noticed in all the Democratic primary debates, there was no discussion of the facts on the other side. The United States, population controlled, delivers three times as many mammograms as Europe, two-and-a-half times the number of MRI scans, and 31 percent more C sections. We provide more health care.

Not only that, in the United Kingdom, for example, wait times, in 2013, you waited 72 days for cataract surgery, you waited 89 days for hip replacement, 95 days for knee replacement. There are 3.7 million people in the United Kingdom right now on a waiting list, waiting for health care.

Whenever you put government in charge of health care, what it means is they ration.

 Sanders replies that the US rations too, but rations by price rather and gaps in coverage rather than by waiting periods:


SANDERS: We have enormous rationing in this country. When you have 28 million people who have no health insurance, that's rationing. When you have people who can't afford to go to the doctor or can't afford to buy prescription drugs, one out of five Americans can't afford the prescription drugs their doctors prescribe, that's called rationing. Except there's no rule on that; there's no law on that. It's just people don't have the money to buy what they need in terms of health care.


True enough, but if Sanders had really been on his toes, he would have challenged Cruz’s assertion that waits for care are longer in other countries. Cruz had a notebook full of useful data. Sanders should have had one too. Among other things, his notebook should have included data from a widely-cited study of healthcare in eleven wealthy countries from the Commonwealth Fund. Key findings of the study:

  •  Far from offering “a lot more and a lot better health care” than other advanced countries, the US ranked 11th out of 11 overall, 5th on quality of care, 9th on access, and 11thon efficiency.
  • On timeliness, the US ranked 5thoverall, 7th on waiting for emergency care, and 8th on evening and weekend access. 
  • The US scored better, but still not the very best, on waits to see a specialist (3rd) and waits for treatment after diagnosis (2nd).

·         Cruz was off-base to cite UK as inferior to the US in terms of timeliness of care. In the Commonwealth survey, the UK scored 3rdvs. 5th for the US on overall timeliness. Cruz should have stuck to Canada, the one country that does make the US look good. Canada is dead last on timeliness of care.


Sanders also could have challenged Cruz’s assertion that more C-sections, more MRI’s, and more mammograms mean more and better care. More is notalways better. Complaints that US doctors perform too many C-Sections and too many MRIs are common.


I’ll give Cruz a C- on this one; he didn’t have his facts right despite his notebook. Sanders gets a B- for not having  a better rebuttal.


Bernie’s big fumble


Sanders’ biggest fumble came in answer to a question by LaRonda Hunter, an audience member from Texas. Hunter owns a string of hair salons and is afraid to expand or hire more people because doing so would take her over the fifty employee limit, beyond which the ACA would require her to provide health care. She said she couldn’t afford to do so without cutting wages or raising prices. In fact, she said she can’t even afford health insurance for herself. Here is how Sanders answered:


SANDERS: [L] me give you an answer you will not be happy with . . . if you have more than 50 people, you know what, I think—I'm afraid to tell you—I think you will have to provide health insurance.  . .  If you have more than 50 people, yes, you should be providing health insurance.


I don’t know what he was thinking. Sanders own healthcare plan, Medicare for all, completely eliminates employer-provided care. His answer  to Hunter’s question should have been, simply, that employer provided health care is not a good idea for any business, large or small. 


Later, Sanders seemed to remember that and tried to backtrack, but it was too late. I give him a D for this episode. Cruz gets an A for being smart enough to stand aside and let his opponent twist in the wind.


Promises, promises


Cruz repeatedly hammered away at “broken promises of Obamacare.” We all know the litany. The ACA did not let everyone who liked their doctor keep their doctor—instead it steered many of them into narrow networks with limited choices. It did not let everyone who liked their plan keep their plan—some plans that people liked were canceled because they didn’t meet ACA standards or because companies withdrew from the marketplace. Premiums and out-of-pocket costs went up, not down, at least for many people. 


Fair enough. It is hard to deny that the early rhetoric of ACA supporters overpromised and under delivered. But what about the promises Cruz and other GOP reformers are now making? Here is a sample from Cruz’s closing statement:


CRUZ: We can do better. I believe we are going to honor the promises we made to the American people and we are going to repeal what Bill Clinton called Obamacare—the craziest law in the world. Instead, we're going to give you choice, let you buy insurance across state lines, expand health savings accounts, make insurance portable, block grant Medicaid to the states so you can have experimentation, health savings accounts so we can meet your need, put you in charge of your health care with your doctor, not government.

What is missing here is any actual mechanism by which the GOP plan can maintain coverage at least as broad as the ACA, and cut premiums, and increase choice, andcut the cost of healthcare to the federal budget. You can’t get all that by just waving a magic wand and repeating “market, market.”


Ideas like buying insurance across state lines are just tweaks. They might help, but they address just a little piece of the problem. Ditto for shopping overseas for drugs (a suggestion Cruz made earlier in the debate).  Medical savings accounts are a good idea for people who are relatively healthy and just need a way to manage deductibles and co-pays, but they are little help for people who have serious chronic conditions. For the top 5 percent of healthcare users, who account for half percent of all spending, yearly costs average $40,000. Anyone with expenses like that would quicly exhaust a medical savings account. 


Medicaid block grants are primarily a way to reduce aid to poor patients, not a way to improve their coverage. Their whole purpose is to cut the federal budget by capping the federal contribution to healthcare spending. They would stick states with the hard choices of how to ration care for the poor. Longer waits? Harder to qualify? Fewer choices of doctors or drugs? Not our problem, says Congress, call your governor.


Sanders, on the other hand, actually has a plan. His Medicare for all—that would establish a single payer system similar to the ones that are already up and running in other advanced countries. Sanders plan is not perfect (read my detailed critique here) but does touches all the bases. The Republicans don’t have any detailed plan at all. There is no real way even to debate them until they put something specific on the table.


On promises, I’ll give an A- to Sanders for being smart enough not to defend the ACA’s obvious flaws and for actually having a complete, if imperfect, alternative. Cruz gets a C- for carping about the ACA without offering more than jam-tomorrow promises as an alternative.


The bottom line


I found the debate as a whole to be refreshing. It was so much better than any debate or town hall during the campaign. On the whole, I thought Sanders had more passion, and secondarily because he did bring a compete plan to the table. Cruz, however, is a very skilled debater. He had facts and figures at his fingertips, and took advantage of Sanders’ inability to refute them in the same detail. Most of all, he was frightening successful at covering up the fact that the GOP really does not know what to do with the healthcare system over which it now has so much power.



          Labor Organizer on Single Payer        
Michael Lighty ,August 8, 2017 Common Dreams Ironically, healthcare reform efforts have sought to “improve and expand” every element of the present system, except the program that works best: Medicare. The Clintons tried to expand HMOs, Obama expanded private health insurance and Medicaid, the GOP tried to expand “individual purchase. Medicare—if improved and expanded to […]
          qotd: Ask Minnesota if the individual insurance market is stable        
StarTribune
September 30, 2016
Individual health plan premiums to jump at least 50 percent in Minn.
By Christopher Snowbeck

Health insurers are hiking premiums and limiting enrollment in Minnesota's individual market next year, with regulators saying the emergency measures were needed to avert a market collapse.

The moves are a clear sign that the market for some 250,000 people who buy coverage for themselves is dysfunctional and needs reform, said Commerce Commissioner Mike Rothman during a Friday news conference.

While rate increases of more than 50 percent aren't fair to consumers, Rothman said, things could have been worse. He described a period this summer when all health insurers in the state seemed prepared to abandon that segment of the market.

The premium jumps and enrollment caps are confined to the individual market, where about 5 percent of state residents buy coverage. The market includes the MNsure exchange and has undergone significant changes with the federal Affordable Care Act.

Premiums will jump by an average of 50 percent to 67 percent, depending on the insurer. Regulators also are taking the unusual step of letting most health plans limit the number of enrollees they'll cover.

The caps will pressure consumers to shop early during the coming open enrollment period, since some plan options could disappear once insurers hit their limits. And regulators say the policies being sold for next year will feature tighter controls on the doctors and hospitals that enrollees can use.

The premium hikes and enrollment caps amount to a "finger in the dike" that's meant to buy time while the state figures out what to do, said Jim Schowalter, chief executive of the Minnesota Council of Health Plans, a trade group for insurers.

"What I think no one really appreciated until today was the trouble that the insurance market is in," Schowalter said. "This announcement is another sign that how people are getting their own insurance isn't working."

"These rising insurance rates are unsustainable and unfair," Rothman said. "Middle-class Minnesotans, in particular, are being crushed by the heavy burden of shouldering these costs."


===


Comment by Don McCanne

We keep hearing that ACA is working as intended, that all we need to do is enroll more younger, healthier individuals in the plans and all will be well. Ask the people in Minnesota how it is going. And they certainly are not the only state with problems.

Our politicians on the one hand tell us that all we need is a couple of patches, and on the other hand tell us that we should dump the system and let the markets work. Well, the system is not amenable to patches - we need comprehensive reform of the financing infrastructure - and the market cannot possibly work when prices far exceed the discretionary income of most of those who need health care.

The current patches in Minnesota include large premium hikes, and allowing the insurers to put limits on the total number of enrollees. Those patches might help the insurers, but for patients they make insurance less affordable and less accessible. Wasn't reform supposed to take care of patients?

Regular readers know what would work - a well designed single payer national health program. Everyone would be covered by a system that would be affordable for each one of us. Minnesota should be leading the way on this.


          qotd: How would a Medicare buy-in and a public option be designed?        
Urban Institute
September 2016
Designing a Medicare Buy-In and a Public Plan Marketplace Option
By Linda J. Blumberg and John Holahan

Medicare is an attractive basis for developing an insurance alternative (either a direct buy-in or a public option based in some way on Medicare rates) because the program generally has lower provider payment rates and lower administrative costs than private insurers. However, Medicare's structure and cost-sharing requirements are different from private insurers' as well. A Medicare-related proposal could provide more plan choice for those eligible, which would have a significant effect where few or even only one insurer offers coverage in the nongroup insurance market. Depending upon how the proposal is structured, it could reduce costs for younger adults in the private insurance market as older adults leave the risk pool. However, designing such programs raises myriad issues, each with specific implications for costs and benefits to different age groups.

Medicare Buy-In for 55- to 64-Year-Olds

We assume that a Medicare buy-in option would offer enrollees the same covered benefits and cost-sharing structures offered to current Medicare beneficiaries. Even so, a buy-in directly into the existing Medicare options would lead to questions necessitating policy decisions:

*  Would potential enrollees have the choice of traditional Medicare, Medicare Advantage, or both?
 
*  Would eligibles be able to choose between a Medicare option and Marketplace-qualified health plans for which they are currently eligible, or would Medicare be their only option outside of employer-sponsored insurance?

*  Would enrollees be allowed to make separate purchase decisions for Medicare Parts A, B, and D, or would they have to purchase all if they purchase any? How will consumers respond to offers of coverage that, unlike private insurance options, have no out-of-pocket maximum? Would Medigap or some other supplemental plans be available to the 55- to 64-year-olds?

*  How would the unsubsidized cost of coverage be determined? For example, what premium would be charged to individuals with high incomes? Would 55- to 64-year-olds be charged the same premiums as those age 65 and older, even though the premiums would not reflect the cost of coverage for those enrolled? Or would actuaries set premiums based on the benefits provided and cost-sharing requirements for each component? Would the high income surcharges in the current Medicare program apply to the buy-in population?

*  Assuming that 55- to 64-year-old enrollees would not pay the same premiums as current-law Medicare enrollees, would premiums reflect the health care costs of only the 55- to 64-year- olds enrolling? Or would premiums be set to reflect enrollees' health care costs being shared by others? For example, their costs could be shared with other nongroup market enrollees or perhaps with current-law Medicare enrollees, but that would require the development of a mechanism for achieving it.

*  Would the 55- to 64-year-olds buying in to Medicare be eligible for financial assistance similar to that for Medicare beneficiaries today (e.g., 75 percent of Medicare Part B costs for all but the high-income beneficiaries? Would they be eligible for ACA-like financial assistance, advanced premium tax credits and cost-sharing reductions? Or would no financial assistance be offered at all? If subsidies are provided, how would they be structured? Would actuarial differences between Medicare and Marketplace silver coverage be taken into account, affecting both advanced premium tax credits and cost-sharing reductions?

*  Would 55 to 64 year olds with access to an affordable employer insurance plan be permitted to enroll in a Medicare buy-in option?

A Public Option for All Age Groups

A public option is a qualified health plan that would be sold through the ACA's government-created Marketplaces (either federal or state). The public option would bear health insurance risk like other insurers, complying with the ACA's insurance reforms (e.g., modified community rating, guaranteed issue, and essential health benefits) and offering coverage in the same actuarial value tiers.

A public option avoids complexities associated with a Medicare buy-in for 55- to 64-year-olds. Because the option would be structured and operated in much the same way as any other Marketplace-qualified health plan, it would not have different actuarial values, cost-sharing structures, or premium structures than other Marketplace options. The appropriateness of applying a Marketplace subsidy structure to a Medicare product would not be an issue, and risk-sharing questions across different age groups would not arise. Yet several design decisions would remain:

*  How would provider payment rates be set? Would they be set consistent with Medicare rates, set consistent with Medicare rates plus some percentage, or based on some other fee schedule? Many states have self-insured plans for their employees; this is another potential platform for creating a public option offered in a state Marketplace.

*  If rates are set at the Medicare level (or at some other level that falls below those paid by private insurers), what leverage would the plan have to ensure sufficient provider participation? How does a state's leverage compare with that of the federal government in this respect?

*  Should public options be set up in all geographic areas or only those with high premiums, high premium growth, or otherwise weak insurer or provider competition? If the latter, who will judge appropriate locales, and by what metric will an area's appropriateness be assessed?

From the Summary

Regardless of the approach taken, providers are likely to resist new insurance options that may move more patients into plans paying lower rates. While this is to be expected, it highlights the perpetual quandary of health care cost containment. Health care spending and its growth cannot be reduced without either paying less, on average, per unit of service rendered or reducing the quantity of services provided. No matter the strategy for containing costs, achieving that goal will take money out of the pockets of providers. To protect providers financially means abdicating cost-containment efforts of any type.


===


Comment by Don McCanne

There is considerable enthusiasm for expanding on the advances of the Affordable Care Act by adding a Medicare buy-in for those 55 to 64, and by adding a public option - an insurance program run by the government competing with private health plans. What is lacking in this discussion is a precise description of either proposal considering that there are a multitude of policy options that must be decided on in order to construct these programs.

In this Urban Institute paper, Linda Blumberg and John Holahan discuss some of the design options, and there are many more. Each option has its own advantages and disadvantages, so it is inevitable that the eventual design would forge a compromise between benefits and deficiencies. Building these two programs on top of our highly fragmented financing infrastructure inevitably perpetuates inefficiencies.

Each program would require an act of Congress. We need only to look at the insurance industry influence in the legislative process that developed the designs for the private insurance exchanges under ACA, for the Part D Medicare drug program, for the private Medicare Advantage plans, for the privatization  of the Medicaid programs, for the previous public option proposals that never got off the ground, and for the co-op model that is failing in the marketplaces, and it will be obvious that the Medicare buy-in and public option will be designed to maximize the leverage of the private insurance industry at a cost to potential enrollees and taxpayers. The insurers will introduce features that are designed to make public programs noncompetitive or even cause them to fail.

When you hear people advocate for a Medicare buy-in or for the public option - and those people are everywhere - demand that they show you their model that was distilled from the multitude of policy options. (Be sure to read the Blumberg and Holahan paper so that you understand at least some of the issues.) Without such a model, the design will default to the private insurers.

Once advocates present their definitive model then analyze it to see how well it meets our reform goals. Will it ensure that everyone is covered? (No) Will it slow the increase in health care costs? (No) Will it ensure that everyone has free choice of health care professionals and institutions? (No) Will it remove financial barriers to care? (No) Will it fill in all of the gaps in coverage of our traditional Medicare program? (No)

Efforts to enact a single payer national health program are rejected because the program supposedly is not politically feasible. Does anyone really believe that a Medicare buy-in and a public option would be politically feasible in a Congress dominated by conservatives and neoliberals? It's not the goal of a single payer model that needs to be changed; it's the politics. That takes work. A lot of it.


          qotd: Gerald Kominski discusses the politicians' proposals and the future of U.S. health care        
The UCLA Center for Health Policy Research
The Center's Health Policy Seminar Series
September 27, 2016
"The Presidential Candidates: Their Health Plans"
By Dr. Gerald Kominski, Director, UCLA Center for Health Policy Research
 and Professor, UCLA Fielding School of Public Health


Excerpt at 0:52:24 of the video:

Question: Will the U.S. move to universal health care in the next ten years or so.

Gerald Kominski:  Wow! I've spent my entire career talking about the history of the effort to get universal health care in the United States. And, again, I'm looking at Mark Peterson whose written about this extensively as well and knows the history. Our history is that we have been trying to do this now for 120 years in the United States. We've made progress, but the progress is glacial. Having said that, we never stop fighting for that. First of all, that's why we're in Public Health. It's why this center - The Center for Health Policy Research - does what it does, and it's why thousands of people across the country, across the state… millions of people are working towards this goal. But the next ten years are very difficult… we are so divided politically right now, it is very, very difficult to imagine the scenarios that lead us to true universal access through, say, a single payer system in the next ten years. But I'm an optimist, and I believe that there are people in this room who will one day see a single payer system in this country. Now I may not be around, but some of you will be. And we're getting there. It just takes a long time.

Video, with PowerPoint:

===


Comment by Don McCanne

In this seminar Gerald Kominski discusses the health care proposals of presidential candidates Democrat Hillary Clinton and Republican Donald Trump plus those of Libertarian Gary Johnson and Green Party candidate Jill Stein.

Health policy wonks and others certainly understand the complexity of the proposals of the two leading candidates and even that of Libertarian Gary Johnson, as described by Professor Kominski. But he was able to describe Jill Stein's proposal in full in one brief, elegant sentence. Here is his full description of her plan (at 0:41:12 of the video): 

"Jill Stein, the Green Party candidate, is for a Medicare for All plan, basically a single payer plan with no copayments, no deductibles, basically free health care for all Americans."

That's it! 

Wow!


Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.

          qotd: Employee health deteriorated under award-winning wellness program        
STAT
September 27, 2016
Top wellness award goes to workplace where many health measures got worse
By Sharon Begley

When Idaho's Boise School District receives the workplace wellness industry's highest award Wednesday at a celebration in Atlanta, it is expected to be applauded for helping its 3,000-plus employees and their families improve their health and reduce their risk of illness.

It is "an exemplary program," said Dr. James Fries, an emeritus professor of medicine at Stanford University and member of The Health Project, an industry-sponsored group that makes the annual award. Program participants, he said in an announcement this month, "showed improvements in health behavior," helping Boise save money on medical costs.

Data collected by the company that sold Boise the wellness program and trumpeted the "Koop Award," however, cast doubt on that claim. More key measures of health deteriorated than improved. Self-reported quality of health got worse. And health care costs jumped around in a way that suggests any changes were due at least in part to random fluctuations and possibly employee turnover, not any benefits of the wellness program.

This would not be the first time the Koop Award, named for the late US Surgeon General Dr. C. Everett Koop, stirred controversy. Employees in the wellness program that won in 2015, for instance, collectively achieved a lower reduction in smoking than the national average. More gained weight than lost, more raised their total cholesterol level than lowered it, and more had higher blood glucose levels after participating in the wellness program than before.

Such cases reinforce a growing recognition among experts that wellness programs — which constitute an $8 billion a year industry — "don't lead to any visible results," Stanford's Emma Seppala recently wrote in Harvard Business Review. "At best, these initiatives are nothing more than lip service or PR. But at worst, they actually cause more stress."


===


Comment by Don McCanne

We still hear that employers are adopting wellness programs in order to reduce the future costs of their health benefit programs by making their employees healthier. There could be no better evidence that these programs do not work than the fact that the top award for a workplace wellness program went to an employer whose employees' health deteriorated.

If employers really want to do something about controlling health care costs, they should get on the single payer bandwagon. Not only would that eliminate the hassle and expense of administering their health benefit programs, all of their employees would have health care automatically, and future increases in health care costs would be reduced to sustainable levels.

Any employers reading this who are not yet convinced about single payer would benefit by watching a movie developed by and for the business community, "FIX IT - Healthcare at The Tipping Point":



          qotd: What should the candidates tell us about controlling costs?        
Modern Healthcare
September 24, 2016
Editorial: Thank you for that question, Lester
By Merrill Goozner

(Question for candidates, proposed by the New York Times): "Health insurance premiums and out-of-pocket costs are rising rapidly. What would you do to control them?"

If I were advising a candidate on how to respond to that question, here's what I'd recommend he or she say:

(Excerpts)

"Thank you for that question, Lester. I understand why many Americans think their insurance premiums are rising rapidly. There's been a lot of attention paid to next year's increases for the individual policies sold on the Obamacare insurance exchanges, which will rise about 9% on average, according to the latest Kaiser Family Foundation survey."

"Employers are forcing individuals to pick up more of the cost of their plans."

"The employer portion of your health insurance is going up just 4% next year on average. That means the family share has to go up more than 5.5% to make up the difference."

"Employers are doing that by putting more of us in high-deductible plans. They're asking more of us to pay higher co-pays and deductibles. They are raising our portion of the premiums."

"So what can we do about it? First, we have to recognize this is a big experiment that has been endorsed by economists associated with both political parties. They say by forcing patients and consumers to have more skin in the game, they will become wiser healthcare shoppers."

"I say, to make that work, we have to have total transparency — in healthcare prices, in insurance prices, in which doctors and hospitals are in health plan networks, in quality ratings, and with good, easy-to-understand information about what constitutes the most effective and cost-effective care. I pledge to work night and day to give consumers the information they need to make smarter choices in the healthcare marketplace."

"And if some people simply can't afford to put money into the health savings accounts accompanying these plans, let's remove some of the tax subsidies given high-income people for their health insurance so we can finance a generous federal match for what lower-income people contribute."

"Let me now turn to what can we do about those rising individual rates for plans sold on the exchanges. The bottom line is we need more people to sign up. The No. 1 reason why rates are rising is that not enough healthy uninsured people signed up for coverage."

"We need everyone who is uninsured to jump into the individual insurance pool."


===


Comment by Don McCanne

Merrill Goozner certainly understands the political realities about health policy. To a question on health costs that could be part of tonight's presidential debate, he suggests an answer for the candidates that aligns with the current financing system under the Affordable Care Act. Unfortunately, because of the restrictions he apparently placed on himself, it's a terribly deficient answer.

For the problem of high-deductibles he suggests making patients better shoppers through greater transparency in prices, in network composition and in quality ratings. But that would have almost no impact on making the deductibles and other cost sharing more affordable.

He accepts the dubious concept that health savings accounts should accompany these high-deductible plans, and further suggests that the accounts for lower-income individuals be subsidized. Health savings accounts are strictly an administrative tool that increases the complexity and waste in health care financing. When the accounts are depleted, beneficial health care services are forgone - not a desirable outcome. If you are going to have first dollar coverage built into the HSAs, why not instead save administrative hassles and expenses by building first dollar coverage into the insurance program itself?

For the high premiums of the exchange plans, he suggests enrolling more of the healthy to dilute the risk pool. But the low-lying fruit has been picked. The policy community is beside itself in trying to figure out how to bring more into the exchange plans, while having only negligible success in doing so.

Goozner is certainly highly respected by me and others, but we wish that he and others like him would move beyond feeble patchwork solutions and support a program that would make health care accessible and permanently affordable for all. Of course that would be a single payer national health program - an improved Medicare for all. Goozner understands that we won't hear that from either candidate tonight, but that doesn't mean that we shouldn't be asking for that response.


          qotd: Doubling down by insuring against losses from insurance gaps        
Kaiser Health News
September 21, 2016
Would You Like Some Insurance With Your Insurance?
By Bram Sable-Smith

Gap plans, used to cover out-of-pocket expenses like high deductibles, are becoming increasingly popular among consumers and businesses.

Gap insurance is in a category of insurance known as "limited benefit." No matter how bad a person's situation, the plan will pay out only a certain amount of money.

Now, there's renewed interest in gap plans. With monthly premiums on health insurance going up, more people are choosing cheaper, high-deductible options. In 2016, more than 90 percent of people buying insurance under the ACA chose plans with an average deductible of $3,000 or higher.

"The cost of health insurance is going up, and businesses have been forced to deal with that by raising their deductibles or increasing out-of-pocket costs for their employees," said (Alex Forrest, an insurance broker in South Carolina).

With a gap plan, he said, companies can offer a package of health benefits that keeps out-of-pocket-expenses for employees down.

"That's actually just insurance for my insurance," said freelance designer Susannah Lohr.

Health economist Deborah Chollet of Mathematica Policy Research, an independent research firm, said the insurance reforms in the ACA were designed "basically to drive these kinds of creative insurance arrangements out of the market."

Because gap plans aren't major medical insurance, Chollet explained, they're not regulated by the health care law and can avoid complying with consumer protections built into the law. So the companies providing gap insurance, she said, "can ask you about your health status, they can deny you coverage, they can do all of the kinds of things that the Affordable Care Act prohibits."


===

Patient Protection and Affordable Care Act

Sec. 3210. Development of New Standards for Certain Medigap Plans

(a) (1) IN GENERAL.—The Secretary shall request the National Association of Insurance Commissioners to review and revise the standards for benefit packages described in paragraph (2) under subsection (p)(1), to otherwise update standards to include requirements for nominal cost sharing to encourage the use of appropriate physicians' services under part B. Such revisions shall be based on evidence published in peer-reviewed journals or current examples used by integrated delivery systems and made consistent with the rules applicable under subsection (p)(1)(E) with the reference to the '1991 NAIC Model Regulation'… To the extent practicable, such revision shall provide for the implementation of revised standards for benefit packages as of January 1, 2015.


===

National Association of Insurance Commissioners (NAIC)
Letter Re: PPACA Sec. 3210
December 19, 2012

Dear Secretary Sebelius,

Pursuant to section 3210 of the Patient Protection and Affordable Care Act (ACA) you have requested the National Association of Insurance Commissioners (NAIC) to review and revise the NAIC Medicare supplement insurance (Medigap) model regulation to include nominal cost sharing in Medigap Plans C and F to encourage the use of appropriate physicians' services under Medicare Part B. Section 3210 directs the NAIC to base these revisions on evidence published in peer-reviewed journals or current examples used by integrated delivery systems.

Consistent with the process established by the Social Security Act for changes to Medigap standards, the NAIC appointed the Medigap PPACA (B) Subgroup (Subgroup) comprised of state insurance regulators, representatives from the Centers for Medicare and Medicaid Services (CMS), insurers and trade associations, consumer advocates, and other experts in the areas of Medicare and Medigap.

The NAIC has performed its requested review of the standards for Plans C and F under Section 3210 of the ACA. We were unable to find evidence in peer-reviewed studies or managed care practices that would be the basis of nominal cost sharing designed to encourage the use of appropriate physicians' services. Therefore, our recommendation is that no nominal cost sharing be introduced to Plans C and F. We hope that you will agree with this determination.

Medigap is a product that has served our country's Medicare eligible consumers well for many years, offering them security and financial predictability with regard to their Medicare costs. Medigap's protections are now inappropriately being held responsible for encouraging the overuse of covered services and increasing costs in the Medicare program.

We do not agree with the assertion being made by some parties that Medigap is the driver of unnecessary medical care by Medicare beneficiaries. As you are aware, Medigap plans pay benefits only after Medicare has determined that the services are medically necessary and has paid benefits. Medigap cannot alter Medicare's coverage determination and the assertion that Medigap coverage causes overuse of Medicare services fails to recognize that Medigap coverage is secondary and that only Medicare determines the necessity and appropriateness of medical care utilization and services.

The statute requires the NAIC to base nominal cost sharing revisions on "peer-reviewed journals or current examples of integrated delivery systems". However, the Subgroup discovered that there is a limited amount of relevant peer-reviewed material on this topic. None of the studies provided a basis for the design of nominal cost sharing that would encourage the use of appropriate physicians' services. Many of the studies caution that added cost sharing would result in delayed treatments that could increase Medicare program costs later (e.g., increased expenditures for emergency room visits and hospitalizations) and result in adverse health outcomes for vulnerable populations (i.e., elderly, chronically ill and low-income). Most of the studies do not consider the same population of health insurance beneficiaries as those that purchase Medigap products.


===

Kaiser Family Foundation
January 13, 2014
Medigap Reform: Setting the Context for Understanding Recent Proposals

This issue brief contextualizes recent proposals to change Medigap plans in order to understand how they may affect Medicare beneficiaries, using recently available data.

Many proposals and recommendations would prohibit Medigap plans from providing first-dollar coverage by requiring plans to include deductibles for Part A and Part B services.  Such proposals are designed to discourage utilization (and reduce spending) by exposing beneficiaries to greater costs when they seek medical care.

Table 1 at this link lists proposals:

===


Comment by Don McCanne

It is really a sad commentary on the dysfunctional state of our health care financing system when insurance deductibles - supposedly designed to make patients better health care shoppers - have caused such great financial burdens that a market of plans has been generated to insure against deductibles and other cost-sharing losses that frequently are no longer affordable.

Let's take a closer look at gap plans that are designed to fill in the deficiencies in traditional coverage.

It is the high deductibles that have brought this issue into the forefront. There are two primary reasons for the growth in the prevalence and in the dollar amount of the deductibles. One is that health insurance premiums have continued to become less and less affordable. Both individuals and employers who purchase plans are looking for relief, and high-deductible plans do have lower premiums.

The other reason is that the policy community is dominated by a partnership of right-wing ideologues who insist that patients must feel financial pain when they access health care services, and centrist policymakers who worry more about premiums, figuring that public insurance subsidies (ACA) and public welfare programs (Medicaid) will protect those who are less able to afford care, while accepting, with regret, the increasing burden placed on middle-income Americans.

So is gap insurance designed to help pay deductibles a reasonable solution? If the gap policy is adequate to increase the actuarial value of the combined coverage of gap plus high-deductible plans to the levels of more traditional health plans then the combined premiums must be higher since the administrative costs of two insurers would be greater than those of one comprehensive insurer alone. Besides, under the gap plans patients could face other coverage problems since the plans do not have to comply with the regulatory and benefit requirements of qualified health plans as defined by the Affordable Care Act.

Let's turn to a gap program with which we have considerable experience - the Medigap plans that cover some of the coverage gaps in the traditional Medicare program.

The stand-alone traditional Medicare program leaves individuals vulnerable to high out-of-pocket costs if they have significant medical problems. Many are protected with additional coverage such as retiree health benefit plans, VA health benefits, Medicare Advantage plans, or dual coverage with Medicaid. Most individuals not eligible for these plans purchase Medigap plans to avoid losses from significant gaps in the Medicare coverage. But, once again, being covered with multiple plans increases administrative costs and complexity. It would be much more efficient and less costly to have an improved Medicare program for everyone that did not necessitate additional coverage. Medigap, particularly, is a wasteful intrusion that should be eliminated by folding the Plan F Medigap benefits into the traditional Medicare program (while making other improvements in Medicare while we're at it).

Yet the right-wing ideologues and the wimpy moderate policy wonks that follow them have been insisting that we need to reduce the benefits of the Medigap plans. Specifically they would mandate deductibles under their consumer-directed ideology - making patients more thrifty health care shoppers. Innumerable studies have show that deductibles cause patients to forgo beneficial health care services - not a policy position we should be supporting.

How pervasive this concept is was demonstrated by Sec. 3210 of the Affordable Care Act. That section required the National Association of Insurance Commissioners (NAIC) to come up with a recommendation based on evidence published in peer-reviewed journals or current examples used by integrated delivery systems to support requiring cost-sharing to be included in the Medigap plans, in order to make patients better health care shoppers, and that the recommendations would be implemented by January 1, 2015.

Why didn't this happen? NAIC reported that they were "unable to find evidence in peer-reviewed studies or managed care practices that would be the basis of nominal cost sharing designed to encourage the use of appropriate physicians' services. Therefore, our recommendation is that no nominal cost sharing be introduced to Plans C and F."

Further, "None of the studies provided a basis for the design of nominal cost sharing that would encourage the use of appropriate physicians' services. Many of the studies caution that added cost sharing would result in delayed treatments that could increase Medicare program costs later (e.g., increased expenditures for emergency room visits and hospitalizations) and result in adverse health outcomes for vulnerable populations (i.e., elderly, chronically ill and low-income)."

Unfortunately, their take-home message has been ignored by the policy community who continue to clamor for more cost sharing. Specifically, NAIC stated, "We do not agree with the assertion being made by some parties that Medigap is the driver of unnecessary medical care by Medicare beneficiaries. As you are aware, Medigap plans pay benefits only after Medicare has determined that the services are medically necessary and has paid benefits. Medigap cannot alter Medicare's coverage determination and the assertion that Medigap coverage causes overuse of Medicare services fails to recognize that Medigap coverage is secondary and that only Medicare determines the necessity and appropriateness of medical care utilization and services."

Yet the Kaiser Family Foundation report on Medigap reform includes a table with a dozen different proposals from across the political spectrum calling for controlling Medicare costs by increasing the financial burden placed on Medicare beneficiaries with Medigp plans.

We don't need insurance to insure our insurance. We need a national health program that would ensure that everyone has affordable access to all essential health care services. That will never happen with our current system; ACA patches cannot possibly accomplish that. Single payer Medicare for all, without gaps, is what we need.


          qotd: The public option is back        
U.S. Senate
Committee on Health, Education, Labor & Pensions
September 15, 2016
Senators Introduce Resolution Calling for Health Care Public Option

Today, Oregon's Senator Jeff Merkley and Senators Charles E. Schumer (D-NY), Patty Murray (D-WA), Dick Durbin (D-IL) and Bernie Sanders (I-VT), along with 22 of their colleagues, introduced a Senate resolution calling for a public option in the health insurance market.

Senate Resolution

Supporting efforts to increase competition and accountability in the health insurance marketplace, and extend accessible, quality, affordable health care coverage to every American through the choice of a public insurance plan.

After nine whereases:

Resolved, that the Senate supports efforts—

 to build on the Affordable Care Act by ensuring that, in addition to the coverage options provided by private insurers, every American has access to a public health insurance option which, when established, will strengthen competition, improve affordability for families by reducing premiums and increasing choices, and save American taxpayers billions of dollars.


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Comment by Don McCanne

This week an intensive campaign is being initiated in support of a "public option" - offering the choice of a public, nonprofit insurance plan which competes with private health plans. Our enthusiasm should be tempered.

Following are a couple of points to keep in mind, especially when you hear promises that the public option is a giant step towards single payer:

*  A public option will be only one more player in our costly, fragmented system of funding health care. It alone will bring us none of the important features of a single payer system such as efficiency, equity, systemic cost savings, and universality. The profoundly wasteful administrative complexity will remain.

*  Previous efforts by Congress, heavily influenced by the insurance industry, to design a public option led to a highly flawed model that would prevent the "unfair" competitive advantage that a government program would otherwise have over the private insurance industry. This same insurance industry influence is precisely why the co-op models authorized by ACA are now failing. And there is absolutely no reason to believe that the insurance industry might change its tune now.

*  The public option has been characterized as a Medicare buy-in. But Medicare is an equitably funded social insurance program covering everyone who is eligible, whereas the public option would be just another individual plan in a market of private plans, likely with higher premiums because of adverse selection.

*  If a public option were to be enacted some believe that it would be only a matter of time before everyone would want in once it demonstrates its superiority, and then we would have a de facto single payer system. You need look only at the experience with the conspiracy between Congress and the private insurance industry in the establishment of the private Medicare Advantage plans that compete with traditional Medicare. Congress has given the private plans an unfair advantage so Medicare beneficiaries are moving from the public program to the private plans in ever greater numbers - the exact opposite of what the public option supporters visualize.

*  The Affordable Care Act drew support of much of the progressive community as it seemed to them to be the only politically feasible approach at the time. Thus the clamor for comprehensive reform died down. We are hearing again that single payer is not feasible, but the public option is. When the public option is enacted, it will be mislabeled as single payer, and then it will be exposed for the miserable failure that it will be because it was designed by the private insurance industry to fail (like the co-ops). The single payer concept will have been tarnished, and it could be decades before our nation would recover and be ready for reform that really works. In the meantime, millions would have gone broke, suffered, and died merely because we didn't think single payer was feasible.

Many look to Jacob Hacker for inspiration on enacting and implementing a public option. But he has identified the greatest barrier to moving forward. In a recent Vox article, he wrote, "Private plans lobbied aggressively against the public option in 2009 on the grounds that it would amount to unfair competition. But insurers don't want a level playing field; they want the field tilted in their favor."

Now see if you can find a Congress that doesn't tilt the field in favor of the private insurers. Not even on the horizon.


          qotd: Out-of-pocket expenses drag 11 million people into poverty        
United Census Bureau
September 2016
The Supplemental Poverty Measure: 2015
By Trudi Renwick and Liana Fox

This is the sixth report describing the Supplemental Poverty Measure (SPM) released by the U.S. Census Bureau, with support from the Bureau of Labor Statistics (BLS). The SPM extends the official poverty measure by taking account of many of the government programs designed to assist low-income families and individuals that are not included in the current official poverty measure.

In 2015, 45.7 million people were poor using the SPM definition of poverty, more than the 43.5 million using the official definition of poverty with the adjusted universe.

The SPM and the Effect of Cash and Noncash Transfers, Taxes, and Other Nondiscretionary Expenses

(Excerpt):  Without subtracting MOOP (Medical Out-of-Pocket) expenses from income, the SPM rate would have been 3.5 percentage points lower. In numbers, 11.2 million fewer people would have been classified as poor.


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Modern Healthcare
September 13, 2016
Uninsured rate drops, but medical expenses still drag millions into poverty
By Bob Herman

However, separate census data showed that medical out-of-pocket expenses dragged 11.2 million people into poverty in 2015, a potential symptom of the shift of moving employees and individuals into health plans that have higher deductibles, copays and coinsurance rates.


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Comment by Don McCanne

We read repeatedly about how out-of-pocket health care spending is exposing patients to financial hardship. Yet our policymakers are continuing to expand that exposure under the screwball concept that spending out of pocket makes patients better health care shoppers, which we know is not true. It only makes them forgo beneficial care. Today's number should be an awakening call: in 2015, out-of-pocket health care expenses shoved 11 million individuals into poverty!

At a time when we need to improve our anti-poverty programs, we are pushing more people into poverty through policies inherent in our dysfunctional health care financing system. With a well-designed single payer system, nobody would be forced into poverty because of medical bills.

Or should we continue with policies that prevent people from getting the care they should have, while forcing millions into poverty? How could anyone think that we really have a choice here?


          qotd: Deductibles soar in employer health plans        
Kaiser Health News
September 14, 2016
Studies: Employer Costs Slow As Consumers Use Less Care, Deductibles Soar
By Jay Hancock and Shefali Luthra 

Employer health insurance expenses continued to rise by relatively low amounts this year, aided by moderate increases in total medical spending but also by workers taking a greater share of the costs, new research shows.

Average premiums for employer-sponsored family coverage rose 3.4 percent for 2016, down from annual increases of nearly twice that much before 2011.

But 3.4 percent is still faster than recent economic growth, which determines the country's long-run ability to afford health care.

And the tame premium increases obscure out-of-pocket costs that are being loaded on employees in the form of higher deductibles and copayments. Another new study suggests those shifts have prompted workers and their families to use substantially fewer medical services.

Since 2011, the average deductible for single coverage has soared 63 percent, according to the survey, while workers' earnings have gone up by only 11 percent.

Change from 2011 to 2016 (from graph available at KHN link below):

6%   Overall inflation
11%  Workers earnings
19%  Single coverage premiums
63%  Single coverage deductibles, all workers

Members of high-deductible plans paid nearly a fourth of their total medical costs out of pocket versus only 14 percent for members of conventional plans.

Average annual 2016 premiums for single coverage were $6,435 for single coverage and $18,142 for family coverage, according to the Kaiser report.


KFF 2016 Employer Health Benefits Survey:

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Comment by Don McCanne

Although most media attention has been directed toward health plans offered by the ACA exchanges, most individuals actually obtain their insurance through their employment, so it is important to observe what is happening there, and the news is not so good.

In the past five years, inflation has remained low and wage increases have almost doubled the rate of inflation, and that's the good news. Medical costs have continued to increase at a rate greater than inflation, and that has contributed to the tripling of insurance premiums. But what is really disturbing is that the rate of increase in plan deductibles is ten times the rate of inflation. Ten times!

Many enrollees in the ACA exchange plans receive government subsidies to help pay for their premiums and deductibles, but those those subsidies are not available for the majority who receive their coverage from their employer (though higher-income employees unfairly benefit from tax expenditures that help pay their premiums).

Fortunately, the majority of workers and their families are quite healthy and have little need for health care. It is those families that have greater medical needs that are now facing these high deductibles. Precisely those individuals who need help paying their medical bills are the ones being punished with financial penalties for being sick (the financial penalties being high deductibles and other cost sharing).

Our geniuses in the policy community came up with the concept of incentivizing enrollment in low actuarial value plans in the ACA exchanges - the ones that require high deductibles to reduce the pressure to increase premiums. Employers have quickly latched onto that concept and are now increasing the deductibles in their plans to levels that will cause financial hardship for too many families.

Did you catch that line above? The one that says that we are assessing financial penalties against those unfortunate enough to have significant medical needs. Isn't just suffering from medical problems enough punishment for the unfortunate? Or maybe we don't even want them to be punished. Maybe we would prefer to help them, as other civilized societies do.

Let's fix this system. A single payer national health program with first dollar coverage would be a great start.


          qotd: Health insurance gains fall short of what we could have had        
United States Census Bureau
September 2016

Health Insurance Coverage in the United States: 2015
By Jessica C. Barnett and Marina Vornovitsky

Highlights (excerpts)

*  The uninsured rate decreased between 2014 and 2015 by 1.3 percentage points as measured by the CPS ASEC. In 2015, the percentage of people without health insurance coverage for the entire calendar year was 9.1 percent, or 29.0 million, lower than the rate and number of uninsured in 2014 (10.4 percent or 33.0 million).

*  The percentage of people with health insurance coverage for all or part of 2015 was 90.9 percent, higher than the rate in 2014 (89.6 percent).

*  In 2015, private health insurance coverage continued to be more prevalent than public coverage, at 67.2 percent and 37.1 percent, respectively. Of the subtypes of health insurance, employer-based insurance covered 55.7 percent of the population for some or all of the calendar year, followed by Medicaid (19.6 percent), Medicare (16.3 percent), direct-purchase (16.3 percent), and military cover- age (4.7 percent).

*  In 2015, the percentage of uninsured children under age 19 was 5.3 percent. This was a decrease from 6.2 percent in 2014.

*  In 2015, the uninsured rate for children under age 19 in poverty, 7.5 percent, was higher than the uninsured rate for children not in poverty, 4.8 percent.

*  In 2015, non-Hispanic Whites had the lowest uninsured rate among race and Hispanic origin groups, at 6.7 percent. The uninsured rates for Blacks and Asians were higher than for non-Hispanic Whites, at 11.1 percent and 7.5 percent, respectively. Hispanics had the highest uninsured rate in 2015, at 16.2 percent.


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Income and Poverty in the United States: 2015
By Bernadette D. Proctor, Jessica L. Semega, and Melissa A. Kollar

Highlights (excerpts)

*  Median household income was $56,516 in 2015, an increase in real terms of 5.2 percent from the 2014 median of $53,718.

*  The 2015 real median earnings of men ($51,212) and women ($40,742) who worked full time, year round increased 1.5 percent and 2.7 percent, respectively, between 2014 and 2015.

*  In 2015 there were 43.1 million people in poverty, 3.5 million less than in 2014.

*  The 2015 poverty rate was 1.0 percentage point higher than in 2007, the year before the most recent recession.

*  The income deficit for families in poverty (the difference in dollars between a family's income and its poverty threshold) averaged $10,118 in 2015, which was not statistically different from the inflation-adjusted 2014 estimate.

Income Inequality

Since 1993, the earliest year available for comparable measures of income inequality, the Gini index was up 5.5 percent. Comparing changes in household income at selected percentiles shows that income inequality has increased from 1999 (the year that household income peaked before the 2001 recession) to 2015 (Table A-2). Incomes at the 50th and 10th percentiles declined 2.4 percent and 9.9 percent, respectively, while income at the 90th percentile increased 5.7 percent between 1999 and 2015. Since 1999, the 90th to 10th percentile income ratio (10.42 in 1999 and 12.23 in 2015) has increased 17.4 percent.


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PNHP release on Census health insurance report:


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Comment by Don McCanne

The good news is that more people than ever now have health insurance. The bad news is that 29 million people remain uninsured with little hope that this number will decrease significantly because of our flawed model of health care financing. The other bad news, which does not appear in this report, is that costs are up, out-of-pocket spending is less affordable, and patients are losing choice of their health care professionals.

Great news is that median household income is up, and there are 3.5 million fewer people living in poverty. The terrible news is that we still have 43 million people in poverty. Further, the increase in median income was not enough to reverse the trend in income inequality which has prevented low- and middle-income workers from getting ahead.

It must be disappointing for many of those with income gains to have the additional funds consumed by higher insurance premiums, larger deductibles, and costs of unavoidable out-of-network care. It is particularly a shame when we know that we can improve health care equity by simply changing to a single payer national health program.

Providing the 29 million uninsured with health care should be the easy step. Then we can intensify our efforts in addressing the more difficult problem of improving the living standards for the 43 million still living in poverty. But charity alone won't do it. We need efficacious public policies and a government that will enact and implement them.


          qotd: Dartmouth devises ACO concept, but then abandons its own        
The New York Times
September 10, 2016
Dropout by Dartmouth Raises Questions on Health Law Cost-Savings Effort
By Robert Pear

In its quest to remake the nation's health care system, the Obama administration has urged doctors and hospitals to band together to improve care and cut costs, using a model devised by researchers at Dartmouth College.

But Dartmouth itself, facing mounting financial losses in the federal program, has dropped out, raising questions about the future of the new entities known as accountable care organizations, created under the Affordable Care Act.

The entities are in the vanguard of efforts under the health law to move Medicare away from a disjointed fee-for-service system to a new model that rewards doctors who collaborate and coordinate care.

"There's little in the way of analysis or data about how A.C.O.s did in 2015," said Dr. Ashish K. Jha, a professor at the Harvard School of Public Health. "The results have not been a home run."

In addition, he said, "there is little reason to think that A.C.O.s will bend the cost curve in a meaningful way" unless they bear more financial risk, sharing losses as well as savings with the government.

An evaluation for the federal government found that Dartmouth's accountable care organization had reduced Medicare spending on hospital stays, medical procedures, imaging and tests. And it achieved goals for the quality of care. But it was still subject to financial penalties because it did not meet money-saving benchmarks set by federal officials.

"We were cutting costs and saving money and then paying a penalty on top of that," said Dr. Robert A. Greene, an executive vice president of the Dartmouth-Hitchcock health system. "We would have loved to stay in the federal program, but it was just not sustainable."

Dr. Elliott S. Fisher, the director of the Dartmouth Institute for Health Policy and Clinical Practice, said: "It's hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with. I helped design the model of accountable care organizations. So it's sad that we could not make it work here."

Dartmouth-Hitchcock is the main teaching hospital for Dartmouth's medical school, of which the Dartmouth Institute is part.


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Health Affairs
January 2007 (online December 2006)
Creating Accountable Care Organizations: The Extended Hospital Medical Staff
By Elliott S. Fisher, Douglas O. Staiger, Julie P.W. Bynum and Daniel J. Gottlieb

Abstract

Many current policies and approaches to performance measurement and payment reform focus on individual providers; they risk reinforcing the fragmented care and lack of coordination experienced by patients with serious illness. In this paper we show that Medicare beneficiaries receive most of their care from relatively coherent local delivery systems comprising physicians and the hospitals where they work or admit their patients. Efforts to create accountable care organizations at this level — the extended hospital medical staff — deserve consideration as a potential means of improving the quality and lowering the cost of care.


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Quote of the Day
October 28, 2010
How does the Affordable Care Act define ACOs?
Comment by Don McCanne

Excerpt

So how do ACOs achieve higher quality and lower cost?

The ACOs are not rewarded monetarily for meeting the quality standards. Their motivation to comply is to avoid being suspended from the program.

Costs are reduced by the shared savings program. A benchmark is established for each ACO "using the most recent available 3 years of per-beneficiary expenditures for parts A and B services for Medicare fee-for-service beneficiaries assigned to the ACO." If the ACO can provide care for costs below the benchmark, the ACO then shares those savings with HHS. The benchmark is reset at the beginning of each 3 year agreement.

If the costs are above the benchmark, then the fees are still paid as usual, with no adjustments.

Think about this. The incentives continue to promote greater volume. There is no penalty for running the charges up. Is the reward for reducing the volume and intensity of services enough? Since fixed costs for the ACO are relatively unchanged, the reductions in marginal overhead expenses due to reduced volume must be greater than the amount of savings that HHS shares with the ACO in order to come out ahead. Since this is the opposite of "making it up in volume," it is more likely that net income will be reduced. Further, since the benchmarks are reset every 3 years based on lower utilization, it is very unlikely that that the ACO could continue to ratchet down services to qualify for shared savings.

(A later iteration included penalties for failure to meet savings targets.)


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Quote of the Day
March 28, 2011
Elliott Fisher questions whether ACOs will work
Comment by Don McCanne

Excerpt

Accountable care organizations (ACOs) began as an abstract concept of integrating health care providers into a not-yet-defined entity that would be rewarded for improving quality and reducing costs. Without knowing what they were, Congress included them in the Affordable Care Act (ACA). Dartmouth's Elliott Fisher, who was one of the first to promote the concept, now says that "there are some really important questions about whether this will work."


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Comment by Don McCanne

Elliott Fisher and his colleagues at the Dartmouth Institute are generally credited with introducing in 2006 the concept of the accountable care organization (ACO) - coordinated organizations of hospitals and their extended medical staffs that would improve quality and lower costs (HMO 2.0?). The concept was incorporated into the Affordable Care Act. But by 2011, we should have been concerned when Elliott Fisher said, "there are some really important questions about whether this will work."

Many doubts have been expressed about this model, and after a decade of fooling around with it, the record can be summed up by Ashish Jha's understatement, "The results have not been a home run."

Well it did not work for Dartmouth-Hitchcock in spite of Elliott Fisher's presence. They dropped out of the program a year ago (though Robert Pear's article provides much needed transparency on the ACO concept). Fisher said that he helped design the model so it is sad that they couldn't make it work there. He said that it was hard for Dartmouth-Hitchcock to achieve savings since they were already "a low cost provider."

But it should not have been a surprise. In a Quote of the Day in 2010 (excerpt above) we explained why, in a "think about this" comment, that the basic concept was fundamentally flawed - the reward for participation being that you would have to give a major portion of your savings to Medicare instead of keeping them as profits (Medicare shared savings).

It's too bad that Congress didn't listen to those of us expressing concerns when they included the concept in the Affordable Care Act. Yet acting CMS administrator Andrew Slavitt is moving forward, saying that the current iteration is "like the iPhone 2." If you read the thousands of pages of rules that CMS is generating, it is clear that this will be a godsend - for those profiting from administrative services, that is.

Abstractions of higher quality and lower costs sound great, but you need proven policy to carry them out. The single payer experiments have already been done, and they work! Even Gail Wilensky says, "Enough demonstrations, already."


          qotd: Is it true that 85% do not have to worry about premium increases?        
ACASignups.net
September 6, 2016
Steve Davis & Robert Laszewski confirm what I've been saying all along: Appx. 40% of ACA indy market is OFF EXCHANGE.
By Charles Gaba

For 2 1/2 years, dating back to around February 2014, I've been trying to hammer home the importance of the OFF-exchange individual market. Time and time again I've been stunned at the seeming blind spot that people who should know better (such as Avik Roy) have regarding the millions of people who are enrolled in fully ACA-compliant policies, but are doing so directly through the carriers themselves. There are a few reasons why people buying individual/family policies would do this, but the most obvious one is simple: If you earn more than 400% of the Federal Poverty Level (around 97,000/year for a family of 4), there's no reason to jump through the extra hoops of enrolling through HealthCare.Gov or the other various ACA exchanges...because you don't qualify for federal financial assistance anyway. For whatever reason, however, numerous reporters, pundits and even the HHS Dept. itself keep acting as though this market doesn't exist.

How many people are we talking about here? Well, back in 2014 I estimated that roughly 8 million people had signed up as of mid-April...almost exactly the same as the 8.02 million who selected QHPs on the ACA exchanges, or about 50% of the total. That 8 million included several million transitional and grandfathered policy enrollees, however, though I wasn't sure what the breakout was.

By this year, the exchange-based number had grown to around 11.1 million as of March 2016, of course...but the off-exchange number has been tougher to estimate. I've generally estimated the total off-exchange indy market at around 8-9 million, with roughly 7-8 million of that consisting of people enrolling in ACA-compliant plans at full price, and another 1-2 million or so enrolled in ACA-noncompliant "grandfathered" or "transitional" policies.

This estimate has been strongly supported by Mark Farrah Associates, which pegs the total individual market in 2016 at around 20.5 million.

Well, today, Robert Laszewski stumbled upon an excellent piece of data diving by a reporter named Steve Davis, in which Davis dug up the broken-out enrollment numbers for a whole mess of Blue Cross carriers nationwide.

The overall picture is quite clear: Roughly 48% (2.3 million) of all individual policies sold by these carriers (Blue Cross only) are subsidized, while another 48% are ACA-compliant but unsubsidized (8% on exchange, 40% off exchange). The remaining 4% or so are grandfathered/transitional enrollees.

It's important to note that in the states where there's no Grandfathered/Transitional (GR/TR) numbers listed, some chunk of the "Off Exchange Unsubsidized" tally likely belongs in the GR/TR column. Even so, the above hard data is remarkably close to my own assumptions:

9.4 million on-exchange subsidized (47%)
1.7 million on-exchange unsubsidized (8%)
7.1 million off-exchange unsubsidized (ACA-compliant) (35%)
2.0 million off-exchange unsubsidized (NON-ACA compliant) (10%)
= 20.2 million total


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Comment by Don McCanne

More numbers. Moving directly to the point, HHS and others keep assuring us that the anticipated greater increase in ACA insurance premiums will not be a problem for the 85 percent of individuals who receive premium subsidies through the ACA exchanges. Well it is a problem not only for the 15 percent of individuals in the exchanges who do not receive subsidies but also for those who buy their individual plans outside of the exchanges.

Charles Gaba makes the point that the individual plans sold by the insurers both within and outside of the exchanges share a common risk pool.

So roughly 47 percent of plans sold by insurers servicing the exchanges are subsidized, but another 53 percent (10 percent of total are not ACA compliant) sold on and off the exchanges are not subsidized so the insured individual bears the full premium increase. So it is not 85 percent who do not have to worry, but rather it is closer to half of those with ACA compliant plans.

Middle-income individuals not only bear the brunt of the premium increases, but they also pay taxes that will be used to provide the subsidies for the higher premiums in the exchanges. This is one more example of why middle-income individuals have fared poorly under ACA.

Single payer would have been simpler, more equitable, and would have had better control of increases in health care spending that are contributing to higher premiums. We can still make the change.


          qotd: Fewer are uninsured, but…        
National Center for Health Statistics
September 2016
Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2016
By Robin A. Cohen, Ph.D., Michael E. Martinez, M.P.H., M.H.S.A., and Emily P. Zammitti, M.P.H.

This report provides health insurance estimates from the first quarter of the 2016 National Health Interview Survey.

*  In the first 3 months of 2016, 27.3 million (8.6%) persons of all ages were uninsured at the time of interview — 1.3 million fewer persons than in 2015 and 21.3 million fewer persons than in 2010.

*  The percentage of persons under age 65 with private insurance enrolled in a high-deductible health plan (HDHP) increased, from 25.3% in 2010 and 36.7% in 2015 to 40.0% in the first 3 months of 2016.

*  In the first 3 months of 2016, among adults aged 18–64, 11.9% were uninsured at the time of interview, 19.5% had public coverage, and 70.2% had private health insurance coverage.

*  Among adults aged 18–64, the 12-month increase in the percentage with private coverage through the Health Insurance Marketplace or state-based exchanges — from 4.4% (8.6 million) in the first quarter of 2015 to 4.7% (9.2 million) in the first quarter of 2016 — was not statistically significant.

*  In the first 3 months of 2016, among adults aged 18–64, 24.7% of those who were poor, 23.6% of near poor, and 6.5% of not poor lacked health insurance coverage at the time of interview.

*  In the first 3 months of 2016, 24.5% of Hispanic, 13.0% of non-Hispanic black, 8.4% of non-Hispanic white, and 6.7% of non-Hispanic Asian adults aged 18–64 lacked health insurance coverage at the time of interview.


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Comment by Don McCanne

Six years after the enactment of the Affordable Care Act, we have achieved less than half of the goal of covering all of the uninsured - a decline from 48.6 million in 2010 to 27.3 million earlier this year. Many are celebrating this as a great success, but others do not out of concern for the 27 million who remain uninsured. Besides, there are many other observations in this report that should concern advocates of health care justice for all.

Although 21.3 million uninsured gained coverage since 2010, the further reduction in the uninsured in the past year - 1.3 million - was not statistically significant. This suggests that we are close to the flat of the curve. The feasible patches to ACA are very unlikely to have much more than a negligible impact in further reducing the numbers of uninsured. We need a system that is designed to cover absolutely everyone, such as a single payer national health program.

For adults under 65, 70 percent are privately insured, predominantly through employer sponsored plans. Only 4.7% are insured through the exchanges. Those who dreamed that the nation would swarm to the exchanges because of their superior competitive markets of private plans (HHS even changed the name from exchange to marketplace) had better go back to their drawing boards, and think "improved Medicare for all".

Perhaps the most alarming trend is the increase in enrollment in high deductible health plans (HDHP). For those under age 65, the percentage has increased from 25.3% in 2010 to 40.0% earlier this year. This has been responsible for much of the financial hardship caused by medical bills for those who are insured. The system is not working well for them, and it is getting worse.

Some say that the answer to high deductible plans is to include health savings accounts (HSA), making them consumer-directed health plans (CDHP). But three-fifths of those with HDHPs do not even have an HSA, and for many of the other two-fifths, the HSAs are inadequately funded. Pretending that deductibles can be paid with empty or nonexistent savings accounts is not sound health policy.

Another concern is that the uninsured rates are higher amongst the poor, Hispanics, and non-Hispanic blacks. Although much still needs to be done to reduce inequities in health care, the task remains much more difficult without adopting an equitable health care financing system (single payer).

So when you see headlines this week stating that the number of uninsured is at an all time low, don't think, "a job well done." It wasn't.


          qotd: Labor Day message        
The Orange County Register
August 21, 2016
Letter
Clovis' teachers benefit from union gains

Re: "On teacher freedom, Clovis sets an example for California" [Opinion, Aug. 18]:

Kudos to the school teachers and administrators in Clovis. However, I disagree that the unions have played no role in their success.

People need to be compensated financially for their work and level of expertise. The teachers union has been key in obtaining adequate pay for its members. If Clovis paid salaries less than surrounding unionized communities, they would not be able to recruit qualified teachers.

Thus, the Clovis teachers reap the benefits without contributing their fair share financially to the process.

-Sandra McCanne, San Juan Capistrano


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Economic Policy Institute
August 30, 2016
Union decline lowers wages of nonunion workers
The overlooked reason why wages are stuck and inequality is growing
By Jake Rosenfeld, Patrick Denice, and Jennifer Laird

Pay for private-sector workers has barely budged over the past three and a half decades. In fact, for men in the private sector who lack a college degree and do not belong to a labor union, real wages today are substantially lower than they were in the late 1970s.

Unions, especially in industries and regions where they are strong, help boost the wages of all workers by establishing pay and benefit standards that many nonunion firms adopt. But this union boost to nonunion pay has weakened as the share of private-sector workers in a union has fallen from 1 in 3 in the 1950s to about 1 in 20 today.

The impact of the erosion of unions on the wages of both union and nonunion workers is likely the largest single factor underlying wage stagnation and wage inequality.


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The Nation
September 4, 2016
Donald Trump Is the Anti–Labor Day Candidate: Running Against Fair Wages, Worker Rights, and Unions
By John Nichols

Donald Trump, the billionaire candidate who has argued that "having a low minimum wage is not a bad thing for this country" and complained in a 2015 GOP debate that wages are "too high," is running for president this fall on the most virulently anti-worker and anti-union platform in the history of his Republican Party.

Trump's decision to make fiercely anti-union Indiana Governor Mike Pence his running mate should be read as another signal that the Republican presidential nominee is prepared to steer federal policy making toward the disastrous approaches of dogmatic governors such as Pence and Wisconsin's Walker.

Trump and the anti-labor partisans who nominated him for the presidency have rejected the legacy of a Grand Old Party that once cheered when Abraham Lincoln declared: "Labor is prior to and independent of capital. Capital is only the fruit of labor, and could never have existed if labor had not first existed. Labor is the superior of capital, and deserves much the higher consideration."

Dwight Eisenhower warned, as a Republican president, about politicians "who hold some foolish dream of spinning the clock back to days when unorganized labor was a huddled, almost helpless mass."

"Only a handful of unreconstructed reactionaries harbor the ugly thought of breaking unions," Eisenhower argued in the prosperous 1950s.


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Comment by Don McCanne

Labor Day seems to be an opportune time to step back and take a look at how today's labor force is faring.

Wages are stagnant. The income and wealth inequality gap has increased in recent decades. Financial hardship is rampant. This has coincided with the suppression of unions and their bargaining power.

In the past, workers who were not members of unions have benefited from the higher standards for all workers that union negotiation had achieved. The study by the Economic Policy Institute demonstrates that the decline in unions coincides with a negative impact on the wages of all workers, union or not.

Unions have also fought for health benefits for their members, and that led to employer sponsored plans covering more Americans, union or not, than any other public or private health program. But that still left many out. With the decline in union power, the nation has turned to the Affordable Care Act to try to fill the void, but that has fallen short as well.

Unfortunately, the problem is political, but it need not be so. The Republican party has traditionally supported America's workers, and they can do so again, although they seem to be missing the opportunity in this election year.

Just as union support for living wages improves incomes for all workers, their support for health care would do the same. But they do need to redirect their support away from the current fragmented system that leaves so many uninsured and underinsured, and move towards a system that would work for everyone: a single payer national health program - an improved Medicare for all.

(A personal note:  I'm especially proud of Sandy, my bride of 56 years who, without my prompting, wrote the above letter to the libertarian Orange County Register, letting them know that celebrating free riders stains the concept of freedom.)

Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any political party or candidate for public office.


          qotd: AJPH editors define the two sides of the health care reform debate        
American Journal of Public Health
August, 2016

Editors on the Campaign Trail: Why Bernie Sanders Is Wrong on Health Care (and Hillary Clinton Is Right)
By Roy Grant, MA, Associate Editor, AJPH

The two candidates to the 2016 Democratic Presidential primary, former Secretary of State Hillary Clinton and Senator Bernie Sanders (I-VT), both attempt to implement the principle that health care is a basic right, but Sen. Sanders' advocacy for single-payer health care has dominated the discussion.

On the Republican side, health care has not received much attention, besides attempts to repeal the Affordable Care Act of 2010 (ACA). Donald Trump, the presumptive 2016 Republican nominee, proposes increasing competition, block granting Medicaid, and expanding health savings accounts, all Republican boilerplate proposals. In the absence of greater specificity, there is no health care plan to discuss.

Hillary Clinton Is Right on Health Care

Sec. Clinton maintains that attempting to implement single-payer would disrupt our current health care system, repeal the ACA, and plunge the nation back into contentious debate. The ACA expands insurance coverage as it currently exists in the United States, with 66% privately insured (mostly employer-provided) and 34% government insured. A single-payer system would cover the 11% uninsured but replace coverage and potentially disrupt health care for the nearly 90% of insured Americans and effectively repeal much of the ACA.

Sec. Clinton correctly recognizes the success of the ACA. Between October 2013 and early 2016, 20 million previously uninsured adults gained coverage, reducing the uninsured rate from 20.3% to 11.5%. African-Americans, Hispanics, and women made the greatest gains. The first group to benefit from expanded coverage — young adults — now has fewer emergency room visits, which contributes to lower overall health care costs.

Conclusions

The Sanders single-payer program would fulfill the progressive goal of universal health care as a right, if passed by Congress and successfully implemented. The evidence shows insufficient political support to pass single-payer and implementation barriers including tax policy and devolution of health policy to the states. Evidence supports Sec. Clinton's position that building on the ACA would move us toward universal coverage but maintain progress made by the law. This approach is consistent with the politics of divided government and more likely to succeed.

The difference between the two positions may be viewed as ideology versus realism. Ideology may be more inspirational but is less likely to produce change.


===

Brown Responds: Why Hillary Clinton Is Wrong and Bernie Sanders Is Right
By Theodore M. Brown, PhD, Associate Editor, AJPH

Refuting "Clinton Is Right: ACA Represents True Progress"

I agree that the ACA has had certain positive results: 20 million previously uninsured adults have achieved coverage; African-Americans, Hispanics, and women have made considerable gains; and young adults now have expanded coverage on their parents' policies. Several other positive improvements could be added to this list. However, the ACA fails to establish a right to uniformly high-quality health care, crystallizes unequal levels of access for those who get care, leaves out 30 million people altogether, and adds to the excessively complex and costly administrative features of our health system. The ACA also strengthens the role of the commercial insurance industry by sanctioning its inefficient multiplicity of profit-maximizing companies and their high overhead costs, by allowing exorbitant premium charges, deductibles, and out-of-pocket expenditures (especially in policies bought through the health exchanges), and by condoning tough restrictions in the choice of providers (also especially in policies bought through the exchanges). The ACA, in fact, guarantees the commercial insurance industry substantial new business facilitated by government subsidies and exercises very limited control over the rapidly escalating cost of insurance. Moreover, the ACA fails to limit the huge, often unconscionable prices and profits of the pharmaceutical industry.

Refuting "Single-Payer Would Disrupt Health Care Delivery"

Grant doesn't say so directly, but he seems to endorse Hillary Clinton's scare tactic scenario. However, I see no plausibility to the projected cascade of negative events. In fact, it was the ACA that had a disastrous rollout, whereas the implementation of "radical" single-payer Medicare in the 60s was remarkably smooth and efficient.5 Moreover, the supposed fear and opposition of the "protected public" (the 90% of Americans who are currently insured) may be minimal or nonexistent. After all, that public has been frustrated and angered by regular increases in premium costs, deepening deductibles, copayments and out-of-pocket costs generally, runaway and often obscene drug prices, the general threat of medical bankruptcy, and a widespread sense of powerlessness. The American public, in fact, does not feel "protected," and according to a recent tracking poll has clearly indicated strong willingness to opt for single-payer over yet another attempt at the status quo or its incremental extension.6 We can also add to the widespread sense of dissatisfaction with our current system the realization by employees that they would be freed by a universal single-payer system from job lock and by employers that they would have less obligation to underwrite the health care costs of their workers. Who exactly would feel frightening disruption, other than the profit-maximizers of our current system?

Refuting "Building on ACA Is the Only Pragmatic Way"

Here I strongly disagree because attempting to build incrementally on the ACA will simply consolidate and concretize its fundamental flaws and even deepen some. The essential mistake is to believe that incrementalism is the only true path of American political progress. But this belief is belied by the facts of our political history. That's not how we got Social Security or civil rights legislation.

Health care is a right, and single-payer is the fairest and most cost-effective way to achieve it in practice.


===


Comment by Don McCanne

Although more people than ever now have health insurance, there remain intolerable deficiencies in our health care financing system that clearly demand remedy. Two associate editors of the American Journal of Public Health debate the two approaches to reforming health care: Hillary Clinton's expansion of ACA, and Bernie Sanders" single payer reform.

The thrust of today's message is that these are the two legitimate approaches. Some in the media still seem to think that the only two approaches are Clinton's expansion of ACA and Trump's repeal and replacement of Obamacare. But as stated above, in the absence of greater specificity, the Republicans have "no health care plan to discuss." Most of their boilerplate proposals would move us backwards - diminishing access and affordability.

So the real choice is, do we live with the dysfunctional system we have, merely tweaking it with measures such as adding yet one more (public) option to our fragmented system, or do we actually fix it by making health care affordable and accessible for all through single payer?

In arguing for ACA expansion Roy Grant indicates that single payer is inspirational but not pragmatic, whereas Theodore Brown points out that pragmatic incrementalism is not how we got Social Security or civil rights legislation. How can we let the nebulous notion of pragmatic inertia obstruct the inspirational, dynamic reform that we need?


          qotd: California’s answer to surprise, out-of-network medical bills        
California Legislative Information
AB-72  Health care coverage: out-of-network coverage.

Summary (as amended):

Establishes a payment rate, which is the greater of the average of a health care service plan (health plan) or health insurer's contracted rate, as specified, or 125% of the amount Medicare reimburses for the same or similar services; and an independent dispute resolution process (IDRP) for claims and claim disputes related to covered services provided at a contracted health facility by a noncontracting individual health care professional for health plan contracts and health policies issued, amended, or renewed on or after July 1, 2017. Limits enrollee and insured cost sharing for these covered services to no more than the cost sharing required had the services been provided by a contracting health professional.

Votes:

8/29/16 - Senate:  Passed 35 to 1

8/31/16 - Assembly:  Passed 79 to 0

To Gov. Jerry Brown


===


Comment by Don McCanne

Under private insurance, a person who is admitted to an in-network hospital may unavoidably or inadvertently receive care from a professional, such as an anesthetist, who is not in the insurer's network, and thus the patient may be responsible for the entire bill rather than the insurer's normal contracted amount. This legislation corrects that injustice by making the patient responsible only for cost sharing that is no greater than it would have been had the provider been in the network.

So what are the other implications of this legislation?

The out-of-network provider is no longer able to demand payment for the full fee but has to accept either the same payment that in-network providers receive or 125% of the Medicare rate, whichever is higher. If the out-of-network provider demands more, a dispute resolution process with the insurer is established, but in no circumstances does the patient pay more than the contracted in-network cost sharing.

Think about that. One of the ways that insurers are attempting to control spending is through the use of provider networks, the narrower, the better. If the insurer has a contract with the hospital, then why bother with contracting with the specialists who might be called in since they will have to accept the contracted rate even though no contract has been established with these providers, just as Medicare can establish rates for those who have not signed Medicare contracts. Also, since the insurers do not need as many physicians in their ultra-narrow networks, they can hold out for even lower contracted rates with those who do agree to sign contracts - rates which will also apply to the physicians who remain out-of-network.

Think some more about that. This places the private insurer in the position of being able to dictate price controls within the private health care delivery system. It has long been acknowledged that the government can establish rates through programs such as Medicare and Medicaid. Even though Medicare rates do tend to be fairly low, most physicians continue to see Medicare patients, even if they prefer the higher rates often paid by private insurers. However, the private Medicare Advantage plans are now paying less than traditional Medicare rates. It does not take much to imagine that the private insurers will now try to push the rates for their commercial plans below the traditional Medicare rates as well.

This legislation is important because it recognizes that we must take care of patients first. Also this legislation recognizes that the providers must be paid, but not at extravagant fees that they might set themselves. But what about the private insurers? Why do we need them at all?

Under a single payer Medicare-for-all system, the fees would be set, but at a level that would ensure adequacy of the health care delivery system. The waste of the private insurers and the burden they place on the delivery system would be recovered so that it could be spent on patient care instead. The patients would certainly benefit, and the hospitals, physicians and other professionals would do just fine as well under a public financing system.


          qotd: Government pays for 71 percent of health care in California        
UCLA Center for Health Policy Research
Health Policy Brief
August 2016
Public Funds Account for Over 70 Percent of Health Care Spending in California
By Andrea Sorensen, Narissa J. Nonzee, and Gerald F. Kominski

Summary 

In California, personal health care expenditures are estimated to total more than $367 billion in 2016. Approximately 71 percent of these expenditures will be paid for with public funds (i.e., taxpayer dollars). This estimated contribution of public funds to health care expenditures is much higher than estimates that include only major health insurance programs such as Medicare and Medicaid. Several additional public funding sources also contribute to health care expenditures in the state, including government spending for public employee health benefits, tax subsidies for employer-sponsored insurance and the Affordable Care Act (ACA) insurance exchange, and county health care expenditures. As health care reform continues to take effect, it will be important to monitor the public versus private contributions to state health care expenditures to ensure that funds are being distributed both efficiently and equitably.

Health Care Expenditures in California

In California, health care expenditures in 2016 are estimated to total more than $367 billion; our estimates suggest that 71 percent of these expenditures will be paid for with public funds. Medi-Cal/Healthy Families will comprise the largest proportion of total spending (27 percent), followed by Medicare (20 percent). Tax subsidies for ESI (12 percent); government spending for public employee insurance (4 percent); county health expenditures (3 percent); other government programs—Veterans Affairs (VA) health care, Indian Health Services, and Maternal and Child Health (3 percent altogether); and ACA marketplace exchange subsidies (2 percent) will account for the remainder of total expenditures. Private expenditures for covered benefits will comprise approximately 29 percent of total health care spending in California in 2016. These expenditures include employer share of premiums (16 percent), employee share of premiums (6 percent), out-of-pocket expenditures for covered benefits (4 percent), and premium contributions for individually purchased insurance (3 percent).

Conclusion and Recommendations

Public funds in California contribute to approximately 71 percent of total state health care expenditures. As an increasing number of individuals gain health insurance coverage under the ACA, as health care expenditure growth rates continue to increase, and as policy debates continue to mount around introducing a public insurance option, it is important that public funding for health care expenditures be monitored. Comparable to national-level analyses, these findings run contrary to the assumption that U.S. health care expenditures are funded primarily by private payers. If public funds continue to comprise the majority of total health care expenditures, it will be increasingly important for policymakers to consider whether these public funds are being distributed efficiently and effectively, and whether alternatives such as a state single-payer system would be a more effective use of public and private health spending.


===

UCLA Center for Health Policy Research
Newsroom
August 31, 2016
Public money accounts for more than two-thirds of health care spending in California
By Gwendolyn Driscoll

Contrary to the notion that the country's health care is primarily a privately funded system, 71 percent of health care expenditures in California are paid for with public funds, according to a new analysis by the UCLA Center for Health Policy Research.

In California, public funds will pay for 71 percent ($260.9 billion) of a projected $367.5 billion spent on health care in 2016, according to the study.

"The public sector is the primary player in health care spending," said Gerald Kominski, director of the UCLA Center for Health Policy Research who led the study. "But monies are disbursed in a fragmented way through numerous different entities, each of which has their own system and way of doing things. The question for policy makers is, 'does this fragmented approach make sense?'"

"For a majority of Californians, a public-run system is already the reality," said Andrea Sorensen, a graduate student at the UCLA Fielding School of Public Health, who co-authored the study. "A single-payer system could unite all these various programs and expand them to the entire population, resulting in a more streamlined and cost-effective approach to health care spending."


David Himmelstein and Steffie Woolhandler on the national taxpayer share of health costs:

===


Comment by Don McCanne

Over two-thirds of health care in California - 71 percent -  is paid for by the government, using our taxes. That is even greater than the national taxpayer share of health care - 64 percent (increasing to 67 percent in 2024) - as demonstrated by Himmelstein and Woolhandler.

As Himmelstein and Woolhandler have stated previously, U.S. taxpayers are already paying for a national health program, but not getting it. And that is even more true for Californians.

California has previously made efforts to adopt a single payer program, but they have failed - in the election booth, in the state legislature, and on the governor's desk. As we continue to shift more of health care costs to the government, we have brought along our terribly wasteful, fragmented health care financing system. The California taxpayers are getting a bad deal, and a very expensive one at that ($261 billion for 2016 in public spending alone).

Without enabling federal legislation, states are limited in how close they can come to a much more efficient single payer system, but that does not mean that we should not proceed with whatever is possible now.

California, and every other state for that matter, should do two things simultaneously: 1) Advocate vigorously for a national single payer program - an improved Medicare for all, and 2) Move forward on a state level with improving the health care financing system so that eventual transition to a national program will be that much simpler, not to mention providing some limited interim relief.


          Easy healthcare fixes        
Congress has once again failed to fix the problem of healthcare—a problem exacerbated (but not created) by Obamacare. Arguably, the main reason for this failure is the fact that trying to manage the healthcare industry by government fiat is impossible. It's manifestly impossible for any collection of politicians and bureaucrats, no matter how smart or how well-intentioned, to design a healthcare system that covers pre-existing conditions, expands access, improves services and lowers costs. The best and most efficient healthcare system can only be achieved by a freely-functioning market that is not burdened by government meddling, subsidies, regulations, or mandates.

The best way to "fix" healthcare is to get the government out of the business of "fixing" healthcare. Steve Horwitz has a few simple suggestions that would go a long way to improving  the healthcare industry. (Big HT to Mark Perry!)

If you want to really reform health care and make it cheaper and provide easier access, you can start with the following, after you end the ACA:
1. End the tax-favored treatment of employer-provided insurance
2. End the limits on interstate competition in the insurance market
3. End the community standards legislation
4. Tort reform
5. Deregulate the supply side of the market by loosening or ending licensing provisions and the AMA's monopoly on the supply of physicians.
6. Encourage the development of more walk-in clinics and other ways of avoiding third-party payment.
7. Encourage health insurance to be actual insurance for major medical problems, not third-party payment for health maintenance
8. Expand the use of pre-tax dollars in health savings accounts
There are surely more. But all of these have been on the table as alternatives for years. They would work from both the supply and demand side to accomplish the goals of lower cost and higher quality care.

It would not guarantee universal coverage, but the cost of covering everyone is that you give up on lowering cost and will eventually have to ration supply. You cannot have lower costs, expanding supply, and universal coverage. At best, pick two.

While this would help a great deal, it doesn't address the problem of the poor, the unfortunate, and those with pre-existing conditions. Fortunately, there are ways to solve this problem, as I discussed in this post—as John Cochrane has proposed, we should raise taxes to directly support charity care and subsidies, instead of using the system of cross-subsidies that so greatly distorts things today.

I posted the chart below a long time ago, and it bears repeating:


Since the consumers of healthcare are for the most part not the ones who pay the bill, there is no price discovery, there is no transparency, and there is no way for competition to work effectively to reduce prices and improve services. We must get rid of the third party payer problem if we want to have any chance of improving the healthcare industry. That can be accomplished very easily by changing the tax code: for example, let everyone deduct the cost of healthcare insurance. Since WW II, the government has allowed only employers to deduct the cost of healthcare insurance. This created a powerful incentive for everyone to get as much healthcare insurance as possible (insurance that covers not just major expenses but also very minor expenses) from their employer. And it's now the case that almost 90% of all money spent on healthcare is spent by someone other than the person receiving healthcare services.

Suppose we did the same thing for food. Suppose we said as a society that food was a universal right; that it would be inhuman to not provide quality food for everyone. Suppose we made food a single payer commodity—let everyone have access to food and have the government pay for it all. What incentive would there be for producers to supply all the things people want and in the right quantities? Why would anyone buy what are now the cheap cuts of beef? Think of the amount of food that would go to waste in people's refrigerators. Soon there would be shortages of food, and the inevitable result would be the rationing of food. Single payer for anything can never be a good solution. History is littered with failed experiments in single payer, aka socialism.

It is immoral to declare a "right" to healthcare, because by doing so we make anyone who works in the healthcare field a slave of everyone else. No one should have the right to the services of someone else—to argue otherwise is to condone slavery, and ultimately to empower the government at the expense of the liberty of all.

Fixing healthcare isn't really all that difficult. What's difficult is accepting the reality that government can't fix healthcare except by drastically reducing its influence on the healthcare market. We don't need a government healthcare fix; we need to restore market forces to the healthcare industry.



          Obamacare Has a Glaring Coverage Gap        
The idea behind Obamacare is great: get everyone in the United States affordable health insurance. It could have been done better, such as with a single payer system, or even providing a public option, but what was put together was pretty good. There’s a problem though: if your family is below the poverty line, and [...]
          SEIU 1021 Nato Green Doing Damage Control For SEIU? Opposes Single Payer In CA        
Comedian and SEIU 1021 consultant has written an op ed opposing pushing for single payer in California. He says that instead people should push for the national bill 562. The California SEIU taking their cue from the bosses at Kaiser are opposing single payer in California. The corporate unionists that Nato works for are in bed with the bosses at Kaiser and many of their own members such as home care workers cannot even get healthcare. Nato should know better but maybe his job is more important that telling the truth about the need in CA for single payer.
          We Must Fill the Void Ourselves        
Like millions of my fellow citizens, I am reflecting after the death of Ted Kennedy. Death is an egocentric experience for the survivors. Indeed, rituals such as funerals, wakes or in the Jewish religion “sitting Shiva,” is really about nurturing the souls of those left behind. That is also true when it is a public figure or celebrity that has died. We may never have met them or knew them yet they touched us nonetheless. The Kennedy family understands this better than anyone and is well practiced in rituals that not only honor the dead but comfort the living.

President John Kennedy and Robert Kennedy were assassinated before I was born. They touched my parents, but to me they were legendary martyrs and almost mythical. In 1980 however, their very real brother delivered the first political speech that ever captured my attention at the Democratic convention. I was only a kid but inspired by Kennedy’s defiant idealism following defeat. As I grew older, I appreciated Kennedy’s quest to stand up for the voiceless as predatory conservatism systematically destroyed the hopes and dreams of society’s most vulnerable. Remarkably, Kennedy always managed to fight the good fight with a smile even as he remained true to his principles.

Kennedy’s civility and statesmanship was rightly extolled among his colleagues as ideologically diverse as Chris Dodd and Orin Hatch. And certainly there is virtue with respect to how Kennedy never looked upon his adversaries as “enemies.” Hence, Kennedy forged a record and legacy as America’s most accomplished liberal legislator. More children have health insurance because of his legislative partnership with Orin Hatch. More Americans were empowered to vote because of his crossing party lines to collaborate with Bob Dole. In 1982, Kennedy joined forces with a young conservative Senator from Indiana named Dan Quayle so more citizens would receive job training.

Kennedy’s generosity of spirit as so many conservative voices demonized him and his family is an inspiration we can all learn from. True Kennedy was a flawed man and his dishonorable and irresponsible conduct resulted in the death of Mary Jo Kopechne. If I were a member of her family I likely could never forgive. Yet I find it ironic how so many conservative critics who champion Christian values could find so little virtue in Kennedy’s personal quest for redemption. Kennedy was a flawed man with his heart in the right place who tried to do well. Alas, too many politicians are intolerant of the imperfections of others and pursue policies that cause more harm than good.

Yet as members of the establishment political class honor Kennedy’s “bipartisanship” we should never forget that his political leverage stemmed from authenticity and conviction. When other Democrats preferred triangulation Kennedy unapologetically carried the liberal banner. In 2002 and 2003, while too many Democrats cowered as the Bush administration pursued a reckless war of choice with Iraq, Kennedy unequivocally and forcefully opposed it. Ultimately, Kennedy’s strength and compassion, enhanced the stature of those who entered into principled compromises with him. With all due respect to Orin Hatch, without Ted Kennedy he was just another callous conservative.

In comparison, one’s stature simply cannot be enhanced by compromising with tools of the medical industrial complex such as senators Max Baucus and Evan Bayh. How can anyone with an ounce of common sense or deductive reasoning have any faith in any compromise forged by plastic figures like those two agents of corporatism? To be sure, many Democrats, in the House especially are unwavering in their support of the public option. Sadly though, President Obama has sent mixed signals about how staunchly he supports it and key Democrats on the Senate Finance Committee such as Max Baucus are more beholden to the insurance companies than their constituents.

Kennedy's absence from the debate has left a void that is being filled with feckless Democrats, corporate shills and homicidal right wing ideologues. It’s an enormous void that will take many figures and years to fill. Presently, I don’t see anyone on the scene, including I regret to say, President Obama, who has the political intuition and will to fill it. Kennedy understood that politics was intensely personal. As a figure who suffered great personal loss he tapped into raw emotions on behalf of the voiceless better than any Democrat since his brother Robert Kennedy.

Today, as I mourn Senator Kennedy, I am also thinking about my best friend from high school. My friend prefers to remain anonymous so I’ll refer to him as John Doe or JD. JD and I re-established contact after almost no communication for the preceding twenty plus years through online social networking. Isn’t it strange how life works that way? JD and I talked nearly every day for four years but after graduating we went our separate ways.

Anyway, I learned that three years ago, JD sustained a brain injury following a car accident and is currently disabled. Previously, JD was professionally successful and thriving. He also married and has a six year old daughter. The fates were not kind to my friend and the accident has turned his life upside down. Today, JD is desperately motivated to rehabilitate, recover and resume an active life. Sadly, the medical industrial complex is an obstacle to his getting better. Here is how JD described his most recent encounters with insurance bureaucrats:
“I should send my story to a town hall meeting to explain why health care needs to be a single payer. I went to an orthopedic for the first time today as my back is killing me. After 3 years of shots to numb the pain and non-stop pain killers I feel it is time to try and find the cause and not just numb it, which does not work.
I gave the orthopedist rep at the front desk my no fault information and expected stupidly that it would just go through without a problem. Of course that did not happen. She called No Fault and was told that my account was closed on 7/5/09 and that I was not entitled to any further payment for my injuries.
I knew this was BS as they just agreed to pay for a different doctor last week and even if this was true you would think that would have notified me.”
Already, JD’s experience is sadly familiar for too many citizens. Yet his frustration would only get worse:
“This day was the first time I was told that I was denied going to a orthopedic doctor in 2006 as I was told then I did not need it. I told the supervisor on the phone that I found this strange considering that today was the FIRST time I had even gone to an orthopedist so how could I be refused something that I have never gone to before to see if I could even get any help from them. I then said that it makes no sense because they continue to pay for my pain management doctor, which basically just gives me shots in my back and medication for pain. In other words I said to the supervisor, you will pay for me to get drugs and be numb but you won't pay to fix the problem?”
JD’s experience grew even more absurd:
“This idiot then said that if I want to challenge this ruling that I would have to send them further information proving that I have these problems in my back and neck that would warrant this care. I have gone thru that before and I could tell you stories about that. But I said, OK I could do that as I had all of that paper work in the orthopedics office now and I could fax it immediately.
He THEN said something beyond stupid. That because the IME was in 2006 there was a chance that the doctor would not be found to review the addendum to change his mind. Yet, the doctor that said I was fine would have to get the new information and than have to admit that he was wrong, which isn’t happening. To further piss me off, the supervisor tells me that even if I send in the information that if the doctor could not be found that even the new information would not change anything, they could not contact another doctor to review it and that their original opinion would stand. So I said to the guy, you are saying that if I show you proof that I have these problems you STILL may not pay for this? He said yes. I said that is BS. I then ranted on him how could I be denied seeing an orthopedic before I even TRIED to go to one before. The guy was an idiot so I said that I wanted to speak to HIS supervisor. The guy said that I can but he will say the same thing. I said I still want to talk to him. He took my number and said he did not know when he would get back to me.
I went to the doctor anyway as I was there for 2 hours, stressed out of my gord, and having the doctor submit it to No Fault, have them deny it and then go thru my medical.”
I felt helpless and angry as I read this closing paragraph from my friend:
“This is yet another stupid war I have had with these people over the last 3 years. They expect me to give up by giving me the run around and I refuse to until they give in. They push and push as most people would just give up. THIS is why we need a single payer Medicare for all so this shit won't happen. I just want to get better and these idiots are making it harder for me to do so.”
Ted Kennedy who knew tragedy and loss was on the side of people like my friend. It was often a lonely fight as he went up against the institutional strength and money of the medical industrial complex. Making the fight even harder is that too many of Kennedy’s colleagues in both parties have served as enablers of the parasitic insurance industry. Indeed, the struggle for economic and social justice must have often felt to Kennedy like he was climbing a greased hill in bare feet. Even so he continued to put every scrap of prestige and talent at his disposal in pursuit of a more prosperous and just society. The “cause” endured for him far longer than his personal ambitions. Alas, too many figures today care more about being big than doing good.

There is no single figure anymore that possesses the combination of gravitas and will to stand up for people like my friend as Ted Kennedy did throughout his career. It is therefore incumbent upon all of us to fill the void Kennedy left behind. As JD confided to me recently, until his accident he didn’t have much interest in politics. Today JD understands just how high the stakes of political discourse are. On any given day, any one of us could have their lives turned upside down just like my old friend from high school.

Ted Kennedy, who had his life turned upside down numerous times understood that better than anyone.
          Obama's Legacy, debating single payer, and Obamacare's jobs impact        
Matt, Sarah, and Ezra reflect on Obama's successes and failures, take a look at Hillary Clinton's new attack on Bernie Sanders, and consider some research on the new health law's surprising lack of impact on the labor market.This episode is brought to you by Squarespace. Start building your website today atSquarespace.com. Enter offer code WEEDS at checkout to get 10% off. Squarespace—Build it Beautiful.
          Would single payer health care work in America?        
In the second episode of the Weeds, Ezra, Sarah, and Matt debate whether nationalized health care could work in America, what solutions are really needed to solve the country's mass shooting issue — and introduce an exciting new, regular segment: white paper of the week! 
          Remember Medicare for All in the healthcare reform debate        
I would encourage we post this call to action widely.

We are getting nothing from this jerk Obama and these Democrats. I am so glad I voted for Cynthia McKinney.

Rita



http://thehill.com/blogs/congress-blog/healthcare/66053-remember-medicare-for-all-in-the-healthcare-reform-debate





Remember Medicare for All in the healthcare reform debate


By Kay Tillow, Coordinator, All Unions Committee For Single Payer Health Care--HR 676, Nurses Professional Organization - 11/03/09


We are in danger of losing the opportunity to bring Improved Medicare for All, a single payer plan, before the Congress. Last July Congressman Anthony Weiner and six of his colleagues on the Energy and Commerce Committee attempted to substitute the real public option—HR 676, a single payer plan—for the healthcare reform in the House. Speaker Nancy Pelosi assured them that if they withdrew the amendment in committee they would have an opportunity to bring it to the House floor for a debate and vote. Now Pelosi is threatening to keep the Weiner Single Payer Amendment from seeing the light of day.

If we were able to get this plan really on the table and before the nation in a meaningful way, we could win this hands down. Even Blue Dog Mike Ross, in an unguarded moment, asked why not just have Medicare for All. HR 676, the national single payer legislation introduced by Congressman John Conyers, would cover everyone for all medically necessary care through an Expanded and Improved Medicare for All. The bill and its advocates have been blocked, excluded, and beaten back in the current national healthcare reform debate.

Yet Medicare for All continues to raise its head. When single payer advocates were excluded from the White House kick off meeting for health care reform, doctors’ opened the door to two single payer advocates with a plan to protest at the White House gate. When Senate Finance Chair Baucus ruled single payer off the table, thirteen doctors, nurses, and others rose to protest. Baucus had them arrested. Those gutsy advocates pried open another door and won a round of publicity for single payer. But still not a place at the table.

Yet support for single payer continues to grow. Its simplicity, humanity, and economic efficiency win more supporters each day. The Kentucky House of Representatives, four other state legislative bodies, scores of cities and counties, a half dozen giant religious denominations, NOW, the NAACP, and the National Conference of Mayors have called for passage of HR 676. For unions, it’s the plan of choice. At each contract deadline the double digit rise in health care costs gobbles up the lion’s share of bargaining power. For that reason, 578 unions including 39 state AFL-CIO’s and 134 central labor councils have endorsed HR 676. In September the national AFL-CIO Convention declared unanimous support for single payer as the social insurance plan necessary to achieve social justice.

When Physicians for a National Health Program founder Quentin Young, testified before a House committee last June, Representative Weiner listened and was impressed. Weiner turned HR 676 into an amendment that would transform the House bill into a single payer plan. He popularized it as Medicare for All and catapulted the discussion into the national media with his feisty good humor and popular style.

Now Pelosi wants to renege on her promise to Weiner. We have sent an action alert to over 19,000 unionists asking them to contact Pelosi, and Waxman (who relayed Pelosi’s commitment publicly) and Slaughter (who heads the rules committee) to assure that they allow the Weiner amendment to come to the floor.

The “public option” that remains in both the Senate and the House bills is pitiful and powerless--totally incapable of providing cost control. Those bills, with their forced mandates and fines, their massive transfer of public funds to the insurance industry, and their ban on bulk buying power to rein in the pharmaceutical companies, will fail woefully to cover our people and to make that care affordable.

Pelosi should stick to her promise. We’ll keep up the effort to make her do so. Either now or later Medicare for All will have to come to the table. We’ll keep building the movement to make that happen.

Source:
http://thehill.com/blogs/congress-blog/healthcare/66053-remember-medicare-for-all-in-the-healthcare-reform-debate
The contents of this site are © 2009 Capitol Hill Publishing Corp., a subsisiary of News Communications, Inc.
          Comment on 20,000 Regulations To Control You and Your HealthCare Provider by dscott        
facts: SOCIALIZED MEDICINE KILLS http://www.frontpagemag.com/fpm/267432/socialized-medicine-kills-daniel-greenfield <i>ObamaCare insurers are losing billions. Aetna pulled out after $700 million in losses. United Health jumped after losing $720 million. The single-payer that Bernie wants to propose will be even worse. <b>Vermont’s single payer experiment cost $4.3 billion out of a $4.9 billion state budget. The California Senate passed single-payer with no way to cover the $400 billion cost in a $183 billion budget.</b> Democrats who wouldn’t vote for it faced death threats and accusations that they were “murderers”.</i> Bolds mine.
          Comment on 20,000 Regulations To Control You and Your HealthCare Provider by dscott        
Important points to consider: California wanted to institute single payer but even Governor Moonbeam Brown said no because it is unsustainable financially. IF California can't make it work financially, then it certainly can't for the whole country. Why won't ObamaCare and Single Payer ever work? They both make promises they can't pay for. You can't have your cake and eat it too. Which brings us to point 3, children want everything without paying for it. Adults recognize that you can only have what you can pay for either in pay as you go OR borrowing until you can't anymore. Liberals have sold people on what they want, but reality demands you have to pay for it. The failure of the GOP Senate is their failure to recognize unsustainability for what it is and their failure to expose what is obvious. It's time to grow up. The other major fallacy of ObamaCare and Single payer is the all or nothing fallacy. Healthcare is a series of issues whose solutions are individual and NOT all inclusive. If you are concerned about pre-existing conditions, create a fund to cover it for those few who are in that situation, etc.
          Single payer won’t work        
In response to a recent letter to the editor from a writer endorsing the single-payer approach to health care, there are many reasons why this will not work. First, who is going to pay for it? Currently about 50 percent of Americans pay no income tax, which means the other 50 percent will be stuck with paying for the program. ...
          Health care (again)        
Tomorrow (Sunday) night, Moveon.org is hosting a Ready to Resist conference call about health care. (see more below)

In addition, on Monday, July 24, there will be a March for Medicare for All in Washington, DC (and related marches across the country (closest to La Crosse is in Rockford, IL). You can view the DC event at their website.

And, a recent article, Message to Democrats: Get on Board with Medicare for All, or Go Home, talks about a House bill introduced earlier this year (HR 676) by Rep. John Conyers and how pressure is mounting on those Democrats (guess who?) who haven't yet signed on,

So, maybe on Monday everyone in the Third CD could do a PHONE March for Medicare for All by pledging to call Rep. Ron Kind's office (DC: (202) 225-5506 or La Crosse: (608) 782-2558) in solidarity with the real marches and tell him to join the 115 co-sponsors of HR 676 (including fellow Dem reps Mark Pocan, Gwen Moore, and Keith Ellison, among 112 others) ASAP because that's what most people want and need. See below for talking points.

FIRST: Sunday's conference call:

Ready to Resist mass movement call, this Sunday, July 23 at 7 p.m. Central Time for some #RealTalk on Trumpcare—including our successes in stopping it so far and how the next few days may unfold—and to prepare for the upcoming August congressional recess.
Click here to RSVP! 



We know we face real challenges—still with health care, and with the Muslim Ban, relentless attacks on immigrants and undocumented youth, the constitutionality of this president, and much more. And yet, our movement is growing strong. Even Republican senators are admitting that "the health care resistance is working."1

This Sunday's speakers and trainers will do what they do best, breaking down the state of play and the actions each of us can take to continue to have the kind of collective impact that is already changing history:
  • Ben Wikler, Washington director for MoveOn, will join us for the third installment of his lively updates on the health care fight from the nation's capitol as we head into a crucial, possibly make-or-break week.
  • Rusty Williams is a fourth-generation, lifelong resident of West Virginia and a leader with West Virginia Citizen Action. When he was diagnosed with cancer in 2012 and left without insurance, Rusty became active in advocating for patients' rights. Trump is headed to West Virginia Monday in a last-ditch effort to persuade Senator Shelley Moore Capito to support his disastrous health care plan, which would cripple the Medicaid program that 30% of West Virginians count on for health care. Rusty will share the story of how West Virginians have effectively organized to stop Sen. Capito from taking away their health care.
  • Mari Cordes, Marcia Dinkins, and Biola Jeje will lead a short training on how to hold members of Congress accountable for their votes during the upcoming monthlong August congressional recess. Mari Cordes has been a registered nurse for 30 years and is the former local union president of Vermont Federation of Nurses and Health Professionals and a founding board member of Rights and Democracy Vermont. Marcia Dinkins is the executive director of the Mahoning Valley Organizing Collaborative in Youngstown, Ohio. Biola Jeje is National Organizer with Resist Here, a project of the Working Families Organization.
  • Jennifer Epps-Addison, President and Co-Executive Director of the Center for Popular Democracy, will host the conversation.
Because we've continually raised our voices together, 181 days into the Trump administration, we've protected our health care and changed the conversation to continue pressing for Medicare for All.
Click here to RSVP for the call, and we'll dial you in this Sunday at 7 p.m. CT.

You can also listen to Sunday’s call here via live online streaming: moveon.org/readytoresist
==========  
The job of single-payer proponents now, Dr. Paris emphasized, is to make it politically damaging for Democrats who refuse to listen to their constituents and instead remain committed to a failed for-profit system, under which millions remain uninsured.
"We're not going to wait around for our members of Congress to say, 'Now it's politically feasible.' If we wait for that, we're going to be waiting for the rest of my life, your life, and many more lives," Paris said. (from Message to Democrats: Get on Board with Medicare for All or Go Home)

Talking points for your Monday call to Rep. Ron Kind telling him to co-sponsor HR 676
  • There is no Republican plan that won't result in millions of people - from children to veterans - in losing health care coverage.
  • HR 676 is the only plan that would actually cover everyone and would save money
  • HR 676  is the only fiscally responsible way to cover everyone and would bring health care costs down by reducing administrative expenses and profits
  • Polls show that a majority of Americans favor a single payer Medicare for All health care program
For more general talking points about why a single payer health plan is better than other options, visit the Physicians for a National Health Program FAQ page. 





          Call in the Economists!        
The health care debate has so far produced remarkably little in the way of cost-saving strategies.  Instead, there has been a kind of placeholder claim that “single payer” will do the job.  Certainly, it is not hard to see how “single payer” will cut prices for some people.  After all, when hospitals treat the uninsured ... Continue reading »
                  

Who is the Ruling Class? They Exposed Themselves Last Night

Let me start by saying that I have a deep reverence for John McCain as an American hero of the last century. In his currently stricken state, it might seem that he is a poor choice of starting point for this particular argument. I would argue that exactly the opposite is true. For more on the other side of Senator McCain, here is a good primer.

Last night he and two other Republicans drove a stake through the heart of the attempt to stop the nationalization of health care. He left the care of his own doctors and flew to Washington for that express purpose. This is the very pinnacle of ruling class hubris. Whilst engaged in a battle for his own life and taking advantage of a level health care that most Americans can only dream of, he flew across the continent to cast a vote against the tide of failed government interference in the market for medical care that has succeeded only in breaking the system to the point that we are on the brink of an irresistible movement to take freedom out of health care altogether and institute “single payer” government control.

Leaving aside the illogic of increasing the control of the government in order to “fix” what the government broke in the first place, I want to focus on the people whose ”leadership” keeps us digging while it becomes more and more improbable that we could ever climb out of this hole into which we have all, leaders and constituents, dug ourselves.

The most privileged people in our country are arrogant and self-important. But they are still dependent on the votes and confidence of the public. To convince the voting public, themselves and each other that they are magnanimous and trustworthy, they make public shows of “compassion”. They crusade to expand insurance coverage for “the uninsured”. They open our borders without discrimination both to those who will enrich our culture and those who will impoverish it. They grant subsidies for all manner of anti-social and counter-productive behavior: low interest financing and tax benefits for useless degrees at schools that offer not much more than “party campuses” and breeding grounds for political unrest, welfare benefits that encourage families without fathers and multi-generational dependance the list is endless. The bottom line is that The United States of America is turning into a modernized reproduction of the Ancient Regimes of pre World War I.

Instead of “The Church”, The Royal Families and the Landed Aristocrats, we now have Politicians, Academics, Journalists and Money Manipulators as our “betters” but the result is very similar. If I had the artistic talent, I would do an updated version of the Heinrich Kley drawing showing the new worthies loading up the backs of our working people and entrepreneurs with illegal immigrants, affirmative action, alternative energy, relaxed mortgage requirements for people designed to encourage minority home ownership, single payer health care and all the other vanity projects of our ruling class.

John McCain is sick and he is fighting, once again, for his life but let’s get this straight because it is life and death for the rest of us. He had the opportunity to get treatment and his operation at the VA. He is entitled and deserving of that for his service. As a grateful nation, we should ensure that the VA gives the best care possible to our veterans. He, however, chose not to get that treatment but to go to The Mayo Clinic. I cannot fault that decision personally but politically, it is very telling.

 More and more our “public servants” send their children to private schools, use government paid transportation, live behind security walls with armed guards, ignore laws and ethical practices the rest of us are held to, avoid taxes with impunity, amass private wealth at the public trough and, in general, live lives that are entirely unlike ours.

They keep pushing the idea that they are compassionate, not by living compassionate lives or even by helping the poor achieve better lives, but by posing as compassionate people. It is an illusion! The programs they create do nothing but continually decrease the difference between those who work and those who don’t work. They take our tax money and create federal fiefdoms (EPA, HUD, BLM, Education, etc…,) that create and exacerbate more problems than they solve.

Most corrosive of all, they tell the undocumented aliens and the entrenched poor they have taken into their plantation that they are their benefactors. then the go home, with a wink to their fellow elitists, to their gated communities. This is where we are headed as a nation unless we can get the right leadership in place. We now have a president who gets it but the McCain, Collins, Alexander, Moore-Capito, Heller, Murkowski, and Portman votes of last evening just added more burden for us all, This virtue posing and false compassion is killing us. We need it to stop.

SOURCE

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The Staircase to Government Corruptocracy

In Toronto, common sense is severely lacking. A resident spent a relatively paltry $550 — provided through the benevolence of him and his community — to erect a park staircase on a dangerous slope. Apparently, government officials were upset over the initiative shown by the resident, who had serious and legitimate qualms with the city’s project estimate of at least $65,000 (and possibly as high as $150,000). Under the guise of safety requirements, the city considered destroying the stairway to install what it deems is a regulatory-compliant structure. Fortunately, new indications are that demolition is probably off the table and refinements will be pursued.

Update: The city moved forward with destroying the structure and a new one will be assembled for roughly $10,000. Which begs the question: Where in the world did the original estimate come from?
According to Mayor John Tory, “We just can’t have people decide to go out to Home Depot and build a staircase in a park because that’s what they would like to have.” The question is: Why not? To be fair, the mayor did also call his government’s price tag “completely out of whack with reality.” But that’s not stopping him from venting frustration. We’re literally talking about eight steps. Park-goers were getting injured. And for $550 residents solved two issues: unnecessary government expenditure and a dangerous situation that wasn’t being sufficiently remediated. It may not be the most well-built structure, but it’s better than government either doing nothing or wasting tax dollars. It would be easy to mock Canada for this uncanny situation, but it’s hardly a Canadian specialty. Taxpayers here in the U.S. know just how pitiful the government is when it comes to frugality.

John Stossel chronicles a similarly obnoxious case of government waste in his most recent column. He writes, “Did you see the $2 million dollar bathroom? That’s what New York City government spent to build a ‘comfort station’ in a park. I went to look at it. There were no gold-plated fixtures. It’s just a little building with four toilets and four sinks.” He adds, “No park bathroom needs to cost $2 million. An entire six-bedroom house nearby was for sale for $539,000.” But no matter: “Everything costs more when government builds it.” For the record, another bathroom located at nearby Bryant Park was constructed for a far more reasonable $300,000 — because, Stossel says, it’s privately managed. He notes, “Since government spends other people’s money, they don’t care that much about cost and they certainly don’t care much about speed.”

The fact is, government is just about the worst money manager there is. Take Barack Obama’s “stimulus,” for example. According to The Washington Free Beacon, some of the waste that occurred from the American Recovery and Reinvestment Act included funding for studies analyzing duck penises, erectile dysfunction and obesity, alcoholic effects on mice, as well as funding for puppet shows vilifying free enterprise and, least but not least, the infamous Solyndra debacle.

Even Obama conceded that “shovel-ready was not as shovel-ready as we expected.” And no wonder — a good deal of it was spent on frivolous and unnecessary things. This underscores too the importance of making frugal decisions when it comes to infrastructure repairs. As Tony Caporale and Marc Poitras write at Real Clear Policy, “Infrastructure Spending Must Justify Itself.” And the private sector has to play a critical role. Otherwise, you risk outlandish outcomes. Like $2 million bathrooms, multi-thousand-dollar staircases and even research on duck private parts.

SOURCE

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Leftists Suddenly Worry About Politicizing Boy Scouts

What could be less controversial than the president of the United States addressing the Boy Scouts of America jamboree in West Virginia? Of all the public addresses given by President Donald Trump in the first seven months of his presidency, surely this one would keep Democrats and their media attack dogs from going into hysterics.

Think again. Leftists managed to characterize the speech with their typical vitriol, exaggeration and animosity. Some even compared the event to a Hitler Youth rally. But it doesn't take long to figure out that much of the criticism has less to do with Trump talking politics at the jamboree than it does with Trump talking about the "wrong" politics.

Case in point: New York Magazine's headline reads, "The 14 Most Inappropriate Moments From Trump's Speech at the Boy Scout Jamboree." The headline suggests that Trump invited the Scouts to join him for beer and poker after the event. Yet many of the 14 points are based on Trump criticizing Barack Obama, Hillary Clinton and the press. Trump's speech was indeed political, and we could have done without his reference to a party in New York, but it was hardly inappropriate.

Opining in The Washington Post, Stephen Stromberg took issue with the ideological content and erratic nature of Trump's address. He remarked, "Sure, scout membership skews right. But those of us who did not fit that stereotype know that the organization is and should be open to all. I spent middle and high school in a small troop that met in a Mormon church but contained Jews, agnostics, a Seventh-day Adventist and various others." But Trump didn't say anything about religion. Talk about erratic.

Scroll down a few paragraphs and the real reason for the outrage over Trump's remarks comes to the surface. Stromberg adds: "When one of our fellow scouts came out of the closet, he left the troop. But the BSA has since revised its membership policies to better reflect its mission of offering guidance to all young men."

There you go. Stromberg and other leftists aren't as upset over Trump's partisan remarks as they are about his failure to touch on the issues that Democrats want the boys to hear. We doubt Trump would have been criticized had he stated that the Scouts need to be more diverse and inclusive. Had he called for more transgender Scouts, Democrats would be lauding his remarks.

Some of the criticism of Trump's speech is understandable. He should have focused more on the Scouts' history and core principles, or on American patriotism and civics more generally. But the most critical remarks have come from Democrats and Republicans who already have issues with the president.

While the content of Trump's address has been the focus, far less reporting has been done on the fact that the Scouts cheered just about everything he had to say, despite the fact that the president of the Scouts discouraged them from showing partisan support for Trump. But they couldn't resist. Despite his flaws, the Scouts know that Trump will defend and fight for their values.

Apparently, however, the organization's leadership wasn't pleased. On Thursday, Chief Scout Executive Michael Surbaugh stated, "I want to extend my sincere apologies to those in our Scouting family who were offended by the political rhetoric that was inserted into the jamboree."

But Surbaugh didn't mind getting political when transgender Scouts were admitted earlier this year. At the time, Surbaugh exclaimed, "Communities and state laws are now interpreting gender identity differently than society did in the past. And these new laws vary widely from state to state." It was no different when they accepted homosexual Scouts four years ago and homosexual leaders two years ago. In other words, some in the BSA are perfectly willing to change according to the shifting political winds, as long as those winds are blowing in a certain direction.

Surbaugh's apology seems hypocritical and one-sided. After all, where were the apologies to the Scouts offended by the Left's political and cultural ideology over the past generation? And did anyone apologize when delegates to the 2000 Democrat National Convention actually booed Boy Scouts when they walked on the stage?

There were no apologies then, just political attacks against the Scouts. Philip Wegmann writes in the Washington Examiner, "The Boy Scouts have come under fire in the last two decades because of their membership standards concerning gay boys and leaders. They were regularly attacked as bigots in the editorial pages of the New York Times. They were mocked by the likes of Madonna (the elderly Queen of Pop creepily proclaimed she knew 'how to scout for boys.') And they were assaulted in the courts again and again and again."

As for the media, it's beyond hypocritical that they're suddenly worried about the Boy Scouts of America. The Left has successfully forced the BSA to change core principles and beliefs for many years, but suddenly media types are worried that Donald Trump criticizing Barack Obama is somehow going to tarnish a century's worth of Boy Scout values. All this damage had been done long before Trump took the stage at this year's jamboree.

The Rules and Regulations of the Boy Scouts of America state that the organization "must not, through its governing body or through any of its officers, chartered councils, Scouters, or members, involve Scouting in political matters." The handbook should have been revised years ago, because the BSA is very much a political organization these days. All President Trump did was provide a different political view. And that's the real reason why his speech has been condemned.

SOURCE

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated),  a Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here (Pictorial) or  here  (Personal)

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          Scott Adams: How To Crowdsource A Popular Health Plan For The Populist President To Sell (And Trigger A New Golden Age) #PeoplesPlanHealth         
On Monday morning's edition of his regular 'Coffee With Scott Adams' Periscope broadcast, the startup expert and creator of the 'Dilbert' cartoon brainstormed ways to help President Trump find out-of-the-box ideas to lower health care costs. "It could be that [such a plan] gets modified down the road by Congress, but as a starting place, why don't we give our populist president something to sell? We hired a salesman and gave him no product to sell... We sent him into battle unarmed," he explained. New hashtag for health care plan ideas from the public: #PeoplesPlanHealth (Let's give @realDonaldTrump something to sell to Congress.)— Scott Adams (@ScottAdamsSays) August 7, 2017 He wrote a simple elevator pitch in his blog later that day: We the People of the United States elected a populist president to go to Washington DC and make the changes the people want. Sounds good on paper. Unless the people don't know what they want. That's the situation with health care. The public doesn't have any majority opinion on what a comprehensive plan should look like. The topic is too complicated and the public is too uninformed. We sent President Trump into battle unarmed. If We the People find a way to tell our president what we want, I have confidence he can help us get it. But if we don't know what we want, our populist president has nothing to sell. That's our situation today. We elected the world's greatest salesman and gave him no product to sell to Congress. Don't say 'repeal Obamacare.' That's not a health care plan. That's just a step. What we need is a 'people's plan' for health care that does not originate from congress or lobbyists or the healthcare industry. We need 1-3 sensible plans created by the public, and presented to our populist president for selling to Congress. No other path is likely to succeed. To get the ball rolling, I created the hashtag #PeoplesPlanHealth to capture the various ideas coming from the public. If any of those plans emerge as popular (based on retweets, likes, etc.) I have offered to help turn what is likely to be a complicated idea into something simple and persuasive. Once we have a plan with popular support, and persuasive packaging, I will make sure it gets to the right people in the White House. One way or another. Scott Adams is the author of the upcoming book, Win Bigly: Persuasion in a World Where Facts Don't Matter, where he will reveal why he calls President Trump a "Master Persuader" and what clues led him to be one of the first to predict that Trump would win the 2016 election. But before he explains the health care idea, he makes a prediction that sounds as bold as the one he made about President Trump's election: If the president gets health care (and a few other things) right, the United States could be on the brink of a Golden Age. He lists potential wins: "If you get health care, something with taxes, ISIS is beaten back, and you have North Korea starting to look good, that is the Golden Age, my friends. Economy is already good, optimism would be sky high, even the VA is looking better." "If we don't get health care, we can't say we ever had a Golden Age, even if other stuff goes well. But if we get health care, and it comes from the people, and it looks like a success, we will start to see a pattern of success that is unparalleled-- something we've never seen before," he explained. "Half the country is thinking we're on the verge of complete civil war, breakdown, country falls apart," he also said. "At the same time, I'm telling you a story in which the country is one good idea away from a Golden Age." Scott's call for help finding a plan for the president to sell: "How does some individual who just knows a lot about insurance get their plan in front of the public? And that's what I'm offering to help today. Chances are that whoever is smart enough in the public to put together a health care plan that helps everybody, if such a person exists, it is unlikely that they also possess good packaging, branding, persuasion skills. So that is what I am here to offer." Full transcript: SCOTT ADAMS: I promised that I was going to solve the biggest problems in the world. And I'm going to lay out a path for doing that. Here's my starting supposition: I believe that if President Trump's administration starts getting some momentum, and they get on a roll, all kinds of good things could begin to happen, and we could be entering a Golden Age. By Golden Age, I mean a period where things are relatviely peaceful, the economy is good, people are figuring stuff out, health care is good. But in order to get momentum, first you have to accomplish a few things that both sides say is good. So far, the president has accomplished things that one side, his own side, says are good, but the other side says are bad or unneccesary. I'm thinking about the executive orders, here. But suppose he were to get a few things done that were unambiguously good for everyone. That could create a momentum which could be quite important. You've seen already that President Trump has some momentum on North Korea, by cleverly reframing the situation from the old way of "North Korea vs. the United States," a spunky little wannabe country that is taking on the big monster devil U.S., into: You may have noticed just in the last few days, the frame was completely changed --and I've never seen this done before, so I think it is not a coincidence-- that you get someone with President Trump's persuasion skills in office and suddenly the frame changes. You notice the new frame from the U.N. security council? They voted unanimously, which means that China and Russia were on our side on this, to sanction the hell out of North Korea, to put pressure on them. So you have seen for the first time [since World War Two] a military alliance that includes China, Russia, and the U.S. on the same side. It is one of the biggest events in human history, but it has been reported as just 'security council is saying something.' Think about it: What just happened this week is that Russia, China, and the U.S. declared war, essentially not just on North Korea, but on several Chinese companies who do business with North Korea. The government of China probably did not have as much control over their corporations as you would like, because of nepotism and connectivity and corruption, so even the government couldn't control their companies. So what did the government of China do? It formed a military alliance with Russia and the U.S. against its own corporations, because that is the only way the corporations are going to do what the government of China tells them to do, which is to stop trading [with North Korea], otherwise they keep doing it. So that is amazing, but that wasn't even the point I was going to talk about today... I'm going to tell you a story in which you could imagine President Trump having two big wins -- one, North Korea, which hasn't happened yet, but looks like its going in a good direction. And the other: health care. Listen to this next part, because this is key to understanding where we're going on health care: I had this realizaton yesterday. See if this realization matches with your view of things? The reason that President Trump is the president is because he is a populist, and he essentially magnifies the will of the people. So if you say we want better security, he brands that as 'The Wall' and he amplifies it. If the country wants to fight ISIS better, he tells Gen. Mattis to go nuts, gives him more freedom to go fight ISIS and it happens. So when you have a populist president, what he or she does is amplify what the public wants. Now look at health care. Do you know what the problem was? Why President Trump couldn't get health care for the people? Because there was nothing to amplify. Because the people --you and I-- we didn't have a plan. We had no plan for him to sell. We hired him to sell what we want to the world, the government, the Congress in particular. What was the plan we asked our president to sell? We elected him to sell our stuff, right? We put him in office to do what we want to do, and we have no plan, he's just flailing on our behalf. What was the best he could do in that situation? He said whatever Congress produces, my pen is ready, I'll sign it. The populist president went into battle unarmed. We sent President Trump into the health care battle completely unarmed, because we didn't have a plan, we didn't know what we wanted. We just wanted better --get rid of Obamacare-- which isn't really a plan. It is just one part of a larger thing. Next, Scott offers his services to popularize a good plan, if we can find one. SCOTT ADAMS: So here's the deal, it seems like there are people somewhere in America who understand the health care situation, and are free of the control of the lobbyists and the insurance companies, etc. Probably there is someone who understands it well enough that they can put together a plan, and we could call it the public plan, perhaps we would discuss it... But there is probably someone who has the public interest in mind, who understands the space, is not biased, and could put together a plan. Where is the problem if such a person does that? If someone does this, they know no one will sell their plan right? How does some individual who just knows a lot about insurance get their plan in front of the public? And that's what I'm offering to help with today. Chances are that whoever is smart enough in the public to put together a health care plan that helps everybody, if such a person exists, it is unlikely that they also possess good packaging, branding, persuasion skills. So that is what I am here to offer, if you can, collectively, find me that person that has the information, the knowledge, and is sufficiently free of bias from lobbyists, that their plan could be a starting place. It could be that it gets modified down the road by Congress, but as a starting place, why don't we give our populist president something to sell? We hired a salesman and gave him no product to sell... I will help package it, and then collectively we can pitch it to our populist president and if he likes it, he would for the first time have something to sell! He has nothing to sell, it is a complete waste of talent. I'm going to say a political statement that no one here will argue with: Congress is the wrong tool for the job... of coming up with ideas. Congress is not the right tool for this job. The idea has to come from the public, because it is what we want, not what the pharmaceutical or insurance companies want. I actually trust that President Trump could sell the hell out of anything that was actually sellable. If you put together a plan that has a few key points --and that is where I'll help. I'll trim down your complicated plan to its three bullet points to sell it. So that is what I'm asking of you. I don't want to look at a link or talk to a guy, but if there is someone who has that plan, they've already done it, or they're working on it, once it is fully packaged, I'll clean it up and I will guarantee it will get to the right people, and by the time it gets to them it will be very persuasive. It could be that we need three plans -- because people like choices. We could have a market based one, a single payer one, and before you say you hate single payer, just assume there are probably a million variations on that and they can't all be bad. There are more than one way to do things... So that's my offer, let me pull this all together. People see that two points make a line, if two good things happen people start being irrational about it and say if two good things happened it might be a trend. So North Korea is poised to be a big win, it could take some time, but it looks like it is heading in the right direction with the Chinese pressure on North Korea. If health care could be also a win-- And this would require somebody to come up with a plan, and somebody to help package it, so our president can sell it to Congress. He's not selling to the people, he is selling to the Congress. If we could get a health care plan that is better than what is talked about so far, progress in North Korea, and some improvements in tax rates --smaller changes not big ones-- he'll have a tax success, health care success, and North Korea success, and probably ISIS will be in mop-up territory, with a strong economy and good jobs. That's what we're looking at. To me, the whole key to the Golden Age is health care. If we don't get health care, we can't say we ever had a Golden Age, even if other stuff goes well. But if we get health care, and it comes from the people, and it looks like a success, we will start to see a pattern of success that is unparalleled-- something we've never seen before. Hold this thought in mind: There are so many situations in life where it can look like you are on the verge of complete failure, this is how half the country looks at the Trump presidency: "We're on the edge of Civil War, and society is breaking down, falling apart." Half the country is thinking we're on the verge of complete civil war, breakdown, country falls apart. At the same time, I'm telling you a story which is one good idea away from a Golden Age. All we need is from the public --the president doesn't even need to do it-- the public needs to just put forward a plan, and it will put him in the heart of the greatest winning streak this country has ever had. If you get health care, something with taxes, ISIS is beaten back, and you have North Korea starting to look good, that is the Golden Age, my friends. Economy is already good, optimism would be sky high, even the VA is looking better. Next, he talks to people in the comments and brainstorms a hashtag: #PeoplesPlanHealth
          One Small Step        

If anyone here reads Andrew Sullivan's blog, runs across this post, and finds anything familiar in the writing, there could be a reason... Anonymity doesn't do much for blog traffic, but any way to spread the word...

The word, of course, is the extent to which health care reform is aimed at doing things that will be helpful. Even -- especially! -- for those very people who yell and weep and carry guns to meetings, spouting verbatim the insane ravings of Glenn Beck and Sarah Palin while having not the slightest idea what they're really talking about. "Keep government out of Medicare," they say. "Socialism."

The "socialism" trope may be the most laughable (were it actually funny): all of the proposals on the table fall over themselves to maintain the death-grip insurance companies have on us. (Talk about "death panels!" What is it when insurers deny coverage?) None talks about nationalizing the health care delivery system. Not even Medicare is socialism. Single payer -- which in my mind is the only option that makes sense, and which, like Medicare is NOT socialism -- is, clearly, off the table.

There's no possible health care reform package that will satisfy everyone; nor, given the way Congress works, one that will be free of pork-fat, undue complexity, or unexpected consequences that will need to be addressed. Still, what the various iterations seem to have in common are regulations to prevent rescission, to create portability, to remove limits on lifetime coverage, to banish denial for pre-existing conditions. Is it really possible that any of the screamers are against those reforms?

Cost is most certainly an issue, and there is a multitude of ways to address it. Starting, from the doctors' part, with the sort of thing mentioned in that Andrew Sullivan post. Only the surface has been scratched there. And, long after I'm dead, assuming the country still exists, I predict single payer will have come to pass, and people will be glad for it. Even the gun-totin' America lovers.

Signs at the meetings -- ignoring the ones showing Obama as Hitler, a completely ludicrous meme hatched and promoted at Fox "News" (sic) and ingested without chewing by its self-pitying listeners -- point out that Medicare is "bankrupt." While not yet true, it's a point worth considering. To the extent that it hasn't enough money, it's not the fault of Medicare, which spends far less on non-medical expenses than any private insurer. It's because of funding. It's because of the holdover idea from the Reaganomics that you can have what you want without paying taxes.

So, what if everyone were covered by a Medicare-like program, and no one paid premiums; or if there were the sorts of premiums and co-pays associated with Medicare? Currently I pay $14K/year in premiums for me and my wife. Would I be happy to have taxes raised in another area, even, say, by $10K/year? Who wouldn't take that trade? By getting rid of the 30% skim by insurers, that math works right away. And by taking seriously -- instead of demagoging as "death panels" -- the idea of finding cost savings in more efficient care, much more than that will be saved.

And yet, they rave and froth. Getting crazier and scarier. Arguing, in effect, for maintaining a system in which their premiums have likely more than doubled in the last ten years, which covers them sparingly, cutting them off when they need it most: sick, out of work. And they are ready to draw weapons over a plan to pay for help writing the very instructions that will keep them in charge of their care when they're unable to make decisions for themselves.

Who'd have thought people so in need of health care reform could be whipped into a froth by people who lie so freely and make easily refutable claims? I remain unable to understand. And bereft of hope.
          The .01% Don’t Want More Money to Create Jobs or Buy More Frivolous Shit, They Want More Money Simply So You Don’t Have It        

Hey, did you know that the proposed single payer health care bill in California is already dead? Did you know that it was a Democrat that killed it? Neither did I, but...

The post The .01% Don’t Want More Money to Create Jobs or Buy More Frivolous Shit, They Want More Money Simply So You Don’t Have It appeared first on disinformation.


          California passes single payer health plan, without a way to pay for it        
Running out of other people’s money: The state senate of California today passed a single payer health plan, essentially proposing to take over the health industry in that state. It is estimated that the proposal will cost California $400 billion per year, which is twice more than three times that state’s annual budget. A Massachusetts study claims the government health
          People in the USA Demand ...        
SINGLE PAYER, MEDICARE FOR ALL





          The Dems' Rookie Mistake: Achieving Their Goal        

You have to wonder whether Congressional Dems, facing the 2010 midterms, realize they've in effect made the rookie Washington lobbyists' mistake of getting their big bill passed in  one year when they could have taken two or three. After February, if all goes according to expectations, they'll more or less have done a lot of the job they were elected to do.** After that, who needs them? ***

Look at the way various groups can be expected to react to the health care victory:

A-- Will old people be happy? No, they're kind of pissed off.

B-- Will young people be happy? Well, they're getting targeted by the mandate to buy insurance and milked by community rating to make the system solvent. So maybe not.

C-- Will opponents of the bill like it? Obviously not. They will turn out.

D-- Will supporters of the bill like it? Two subgroups here: i) Those who wanted more (like a public option or single payer) are disappointed and maybe angry and demoralized. But at least they have a good reason to show up at the polls (to elect liberals who will help them achieve what they want). ii) Those who didn't necesarily want more-- who are happy with the Pelosi/Reid product-- have far less incentive to show up . For them, the deed is done. Unless, that is, Dems can somehow bait the Republicans into making repeal of Reid/Pelosi a hard-core pledge. ****...

I still  expect the Democrats will hold the House and Senate , simply because (in part thanks to the Feiler Faster principle ) the entire health care issue will seem like less of a big deal by November. But when you think about it in this category-by-category way, the outlook is kind of grim for the Dems, no? ....

P.S.--BREAKING! Wait, a nice, constructive debate over amnesty for illegal immigrants will save them. ....

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**--There is the pattern: Once Democrats have established key, long-demanded institutions--Social Security, Unemployment Compensation, Medicare--voters are then quite happy to elect Republicans--Eisenhower, Nixon, Reagan--to run the resulting, larger government. They're especially happy to do it once it's clear the Republicans won't tamper with the basic structure. (A semi-exception is AFDC-welfare, where voters never demanded, and in fact hated, the basic structure--giving no-strings cash to single parents who could work.)

***--If they'd gone the Medicare buy-in route, by way of contrast, the Dems could have lowered the entry age by two years or so every session--all the while pledging to lower it another two years or ten years if they were returned to power. Cover and cover, expand and expand, elect and elect. ...

****--I suppose that, in the welfare reform debate of 1996, pro-reformers should have worried that Newt Gingrich's Republicans would wake up and realize that once they'd ended the AFDC entitlement, they'd have lost their main argument against the "failed liberal welfare state"--and the main reason for voters to reelect them .  Luckily the Gingrichian combination of principle and hubris was sufficient to preclude this realization. ... Also welfare reform was a) way more popular than the Dems' current health care reform (in other words, group D above was something like 70% of the electorate) and b) completed much closer to the election--thereby maximizing any tendency of "D (ii)" voters to sentimentally and somewhat irrationally reward those who'd achieved it after the fact. ... Also c) it wasn't immediately clear that the Dems wouldn't unreform welfare if they got their Congressional majorities back. (They still might, of course. But the threat at least appears to have receded.) ... 10:10 P.M.

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          @kausfiles Prosthetic Twitter Feed        

Selected and artificially augmented entries from the kausmickey Twitter feed:   

Time' s Tumulty says H. Reid quietly emasculated Obama's pet cost-cutting "Fed for Med" panel by fiddling with trigger. http://tiny.cc/0hod7 Heh!   ... The idea that Congress would give up power over Medicare (think mammograms) to a panel of experts was always an Orszagian fantasy . Nor should we want it to. ... (If you believe Orszag will bend the cost curve you maybe also believe that Uri Geller bends spoons.) ...  less than 20 seconds ago from web

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Could be key: An Ipsos pollster says big chunk of those who "oppose" health care reform do it b/c it doesn't go far enough. http://tiny.cc/vHIUv      about 1 hour ago   from web   ... Update: MereRhetoric notes that "doesn't go far enough" could mean doesn't go far enough in a right -wing direction. In fact, 20% of conservatives in the poll said the reform "doesn't go far enough"--that probably doesn't mean they were really for single payer. ... But Mystery Pollster cites a CNN poll discovering that 10% opposed the plan as "not liberal enough."  And that's not 10% of opponents. It's 10% of all those asked. Add that 10 to the 39 percent who support reform in the Pollster.com poll of polls and you have ... well, 49%. Almost a majority! ... P.S.: A big question is whether the ranks of these liberal dissenters has been growing more rapidly recently, as the bill is watered down. If so, that would give the Pollster.com graphic less of a  menacing "jaws" aspect, at least to wavering pols ...

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Noah buries lede? http://tiny.cc/j13SA Did Fed panel undercut Gawande's claim of large variation in Medicare spending? http://tiny.cc/iyKQz about 4 hours ago from web ... See J. Cohn response . ...

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Black Caucus vs. Obama: Some juicy speculation in this Dick Morris piece http://tiny.cc/m3yaS 1) Why flay Desiree? 2) Take care of Pierre! 12:03 PM Dec 4th from web

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CNN missing Lou Dobbs? http://tinyurl.com/ygbn54w Lou Dobbs is missing Lou Dobbs http://tinyurl.com/yjxs2wg 1:39 PM Dec 3rd from web  

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New Infiniti M http://tinyurl.com/ykh4blz Can't *anybody* design a good-looking rich person's car anymore? #aspire2Baspirational 12:55 PM Dec 2nd from web

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Facebook Post of the Day. http://tinyurl.com/ycgy9j2 This is great for GM. Makes public what happened in an unspinnable way. Clears the air. Now the onus is completely on Whitacre to make it work, Buck unpassable.Transparency! Accountability. ... If that was a GM PR team impersonating Henderson's daughter, they couldn't have done a better job. ... 12:19 AM Dec 2nd from web

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Now they've gone too far! ACORN pushes speed bumps. http://tinyurl.com/ylks24g 11:30 PM Nov 30th from web

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If the hed on this item doesn't bring the hits I give up! http://tinyurl.com/y8rryee 6:51 PM Nov 30th from web   Update: Hits!

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25:13 of Pain--Lou Dobbs on Telemundo http://tiny.cc/2DTIy Worse than "The Road"! 12:05 AM Nov 30th from web

1:02 A.M.

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          Why Does the "Public Option" Have to Lower Costs?        

The Curve Has To Want to Bend: Like Steven Pearlstein , Robert Samuelson more or less assumes the purpose of a "public option" is to control costs  (as opposed to providing the security of a guaranteed fall-back plan). In an Un-Samuelsonesque fashion, he also assumes that there is some solution that will control costs in a manner agreeable to patients.

It's not insurers that cause high health costs; they're simply the middlemen. It's the fragmented delivery system and open-ended reimbursement. Would strict regulation of doctors, hospitals and patients under a single-payer system provide control? Or would genuine competition among health plans over price and quality work better?

That's the debate we need, but in truth, doctors, hospitals and patients don't want to be limited, whether by government or markets. Congress reflects public opinion. Fearing a real debate, we fake it.

a) Maybe none of these options--single payer, competition among health plans--will significantly lower costs, and we'll simply have to pay the increasing bill. Just a thought.  b) If, as Samuelson says, "doctors, hospitals and patients don't want to be limited," it sounds like the debate over our system of "open-ended reimbursement" isn't a "debate we need." It's a debate we've had. Samuelson's side lost. Nobody wants to bend the curve.

Maybe it won't be bent.  8:38 P.M.

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Give Him a Fifth Chance! After completely misreading the zeitgeist and-- in a series of self-servingly ostentatious steps ("storytelling," emo)-- leading his network into a ditch , is CNN's Jon Klein really going to keep his job? He doesn't seem even to be "embattled." ...   8:34 P.M.

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The Federalist Capers: A federalism compromise on the "public option" always seemed more promising  to me than a "trigger" based compromise. But I'd been viewing the issue through a welfare-reform prism, in which states would either be in or out as discrete statewide units. Josh Marshall points out that the virtue of Harry Reid's plan is it allows states to join a single nationwide federal plan rather than set up their own plans . That lets you create a big--or big enough--pool of insured. It's like letting states opt out of (or in to) Medicare. ... That said, the federalist approach still offers a giant menu of possible compromises, from 1 to 50. You can have opt-out, opt-in, opt-in with a numerical limit, opt-out with incentives not to opt-out, opt-in with incentives to opt-in if regional distribution isn't achieved, even opt-out with a trigger that offers the incentives only if too few states stay "in." ... Update: Sam Stein has more . ...  

P.S.: Note also that the federalist solution means at least one "juice" vote in every state legislature , as health insurance lobbyists seek to use campaign contributions to bribe gain access and thereby influence the "opt out" or "opt in" vote. Another source of federalism's appeal! And bipartisan appeal at that. ... 8:34 P.M.

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          Bob Wright's New Electric God        

The "man in charge of the [Chevy] Volt’s battery development and integration" is bailing out of General Motors "in the middle of [the Volt's] frenzied gestation." TTAC thinks it's a perverse side-effect of government intervention --with all the new federal electric car money sloshing around, and pay caps looming, it's more lucrative to be an independent "consultant." ... 5:35 P.M.

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Ben Sheffner says Gawker is "running a very risky business." Why? No libel insurance . ...  12:30 P.M.

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Bob Wright thinks the Web is the new God , in a particular sense. .... 1:37  A.M.

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Charles Lane argues that unions are now a "significant" impediment to "sensible health care reform" because of their tooth-and-nail fight against taxing "Cadillac" health plans. ... Even if you think (as I do) that the unions have a point when they argue they gave up wage increases in order to get lavish health benefits, isn't the answer to give them five years (or until their next contract negotiation) to rebalance the mix to what it would be in a world in which employer health benefits didn't go untaxed? ... If the problem for powerful unions is they no longer have quite the clout they used to have to extract wage increases in exchange for giving up "luxury" health benefits ... well, that's their problem. ...

P.S.: Lane also criticizes unions who support single payer but want to preserve their right to bargain for "supplemental" coverage.

Probably the only thing less likely to pass Congress than single-payer is single-payer with a layer of extra benefits for unions only.

Hmm. Why shouldn't unions, or anyone, be free to bargain for supplemental benefits**-- at least for more treatments or services--on top of what's available in a single payer plan (as long as those benefits are taxed)? Lane seems to imply that the idea of single payer is that the government plan would have near-monopoly status--you take what it offers, and that's it. No adding on to the system for, say, cancer drugs the government's decided not to pay for.** If that's Lane's version of single-payer, I know a woman named Betsy who'd like to talk to him. ...  1:50  A.M.

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Whatever you think of the Polanski case, this is a good hed :

Free Roman Polanski! Demand Harvey Weinstein and Woody Allen

1:51  A.M.

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          Two Statements about Health Care Reform        
In the debate over health care, there are two statements that I feel reflect the dilemma.

Rich people should get higher quality health care if they are willing and able to pay for it.
Poor people should get lower quality health care since they can't afford it.

Of course, these statements say the exact same thing. People who favor a single payer system would likely disagree with these statements. People who favor a more market-based approach would likely agree with these statements. But many people would agree with the first statement and disagree with the second statement. Psychologists know that phrasing is very important in poll questions and that is why it is often difficult to gauge public opinion.
Our current system stinks and I know that. Our idea of universal health care is the Emergency Room, but if you have insurance you can see a doctor, get an MRI, and call in a prescription pretty easily. At the other extreme you have a single payer system where health care is free, but you have to wait six months to see a doctor.
In my mind, the real question in the health care debate is determining what level of health care people have a "right" to. I'm basically OK with preventative medicine, periodic check-ups, vaccinations, and other treatments which will lead to full recovery for the patient. I'm generally opposed to expensive procedures that simply prolong death. I think a lot of people might even agree with me on these points (or maybe not), but someone would have to draw the line between what level of health care is a right and what level is a privilege. Can you say Death Panel?
          Three Big Interviews before Iowa: Clinton, Sanders and Trump        
Breaking News: Iran Sanctions Lifted Freed Americans have left Iran Kerry hails U.S. deal with Iran Interview: Hillary Clinton Iran releases Americans in prisoner swap Former Iran prisoner slams Hillary Clinton Clinton ally calls on Sanders to release medical records Democrats face off in debate tonight Clinton addresses single payer healthcare Sanders, Clinton wrangle over healthcare Democrats's criticize Chelsea Clinton's attack Should Barack Obama have listened to Hillary Clinton on arming Syrian rebels? Interview: Bernie Sanders Clinton ally asking for medical records Sanders disappointed by comments made by Chelsea Clinton Healthcare is a priority for Sanders Sanders: "Healthcare is a right for all people" How will Sanders pay for healthcare plan? Sanders reverses stance on gun liability Interview: Donald Trump Trump vs. Cruz heats up in Iowa Trump: "I have a great relationship with God" Trump: "I try to lead a good life" Cruz rejects Trumps deportation plan Trump stands by "deportation force" intentions Bush ad calls Trump "jerk" for mocking disabled Trump: "I would never" mock a disability Would Trump self-finance national run? Trump hasn't decided about public funding Trump: Cruz controlled by Goldman-Sachs Trump supports campaign finance reform Trump attacked by Barack Obama and GOP in SOTU speeches Trump: "Great Honor" to be attacked by both parties Trump: "There's an anger that we should have"
          Recently diagnosed HIV+ and going to study in The Netherlands        
Q: Hello, I have mixed feelings right now. On one hand, I am excited because I am going to study in The Netherlands (NL) very soon, and on the other hand, I am still in shock because I have just been diagnosed HIV+ two weeks ago - thanks God, by now I am calm.I haven't started any treatment yet because I am waiting for my first CD4 and viral load results (actually, I don't know how convenient would be to start any treatment here if I will be flying in almost a month from now, and possibly this trea...

A: I can answer the insurance portion of your question, but you should ask a doctor on this panel the medical issue. The Netherlands has an excellent single payer health system, that you may be able to join. If you are working part time while there, you will be eligible for it. I am attaching more information based on where you are coming from.If you are not eligible for their national insurance, you will be able to purchase private coverage. I have done some work with HIV+ people in The Netherland...

Read More

          America's nightmarish political situation: two illustrative graphs        

Harvard University's Theda Skocpol just put out a serious look at the fight for a cap and trade bill in 2009-10 with an effort to draw lessons for environmental organizations (and others) for future action. As with essentially everything that Skocpol has ever published, there is much to be learned and think about from "Naming the Problem: What It Will Take to Counter Extremism and Engage Americans in the Fight Against Global Warming." (pdf) -- no matter how much agreement one has with Skocpol's conclusions. Skocpol's work help crystallize, for me, something long 'realized' (by many) but not truly absorbed into our national political discussion: that the entire nature of American politics is being skewed by a radicalized 'just say no' minority of the Republican Party and that 'institutional' failures to recognize this are compounding the problem.
Two graphics illuminate the issue.
Congressional GOP hates environment
The first, to the right, contrasts Congressional perspectives (based on League of Conservation Voter ratings) with the public's perspective (based on public opinion polling) on environmental issues. While a deep divide existed between Republican and Democratic Party members of Congress, this divide has become a chasm over the past 20 years. Notably, "GOP views" (as an entirety) tracked more closely with the Democratic Party than GOP politicians until Ronald Reagan and the era of 'trees cause pollution'. Even so, "GOP views" remained closer to Democratic Party perspectives (both party members and members of Congress) than with the GOP members of Congress.
As Skocpol put it:

two realities are worth emphasis.
Partisan differences in public opinion remained very small compared to steadily growing partisan splits in Congressional voting about environmental policies; and
Public views evolved in closer relationship to the pro- environmental positions taken by Democrats in Congress than to the increasingly all-out oppositional voting of Congressional Republicans.

The GOP Congressional caucus has -- for the past 30 years or so -- become far more representative of a radical, fossil-foolish (funded) minority perspective than the overall viewpoint of those stating allegiance to the Republican Party. The wall of (in)difference between GOP Congressional perspectives and the general voter has been morphing into an ever more impressive Great Wall of Denial on climate science, pollution, and other environmental issues with each passing primary. Even as the Republican Party entered the 1980s with President Ronald Reagan showed the dominance of GOP's polluter wing ('polluting trees), a meaningful portion of the Party would count -- today -- as environmentalists with representation and voice in people like Senator Charles "Mac" Mathias, R-MD - and Mathias didn't stand alone (Hatfield, Weicker, Javits, ...). Mathias would almost seem a radical environmentalist today (noting that Mathias has an environmental medal named after him). In 2013, there is not a single Republican in Congress with even a shadow of Mathias (and his cohort's) understanding and consideration of environmental issues. In Mathias' day there would have been a good share of the GOP 'caucus' who would have been in line with the "Dem views" and "GOP views" somewhat balancing those Republicans (and, well, Democratic politicians as well) who were in bad with polluting industries. Those 'balancers' have been driven out of the GOP political elite by a radicalized minority whipped to a froth via Koch Brothers and other funded astroturfing.
Now, as to whipping to a froth' Fox Reporting and Climate Denialism, let us take a moment to consider the impact of Faux News. As Rupert Murdoch's News Corp machine (including, of course, the Wall Street Journal) propagates deceptive, partial, and outright false information on climate science and climate mitigation, there follow (at least a portion of the) GOP (primary) voters.
If we combine these two graphs, take the lesson that polluters take:

Investing in astroturf political movements whipped to a froth by deceptive (and false) reporting drives primary election results that provide veto power over Republican Party political action.

Professor Skocpol eloquently captures the basic Congressional Republican strategy and how it has been driven by the "Grassroots":

Grassroots conservatives were not about to let their party’s Congressional leaders repeat old mistakes by cooperating with Obama’s initiatives in any area – and certainly not with his proposals for stimulus spending, the expansion of health insurance coverage, or regulations to limit greenhouse gas emissions. Strategic considerations and popular pressures alike make it understandable that GOP Congressional leaders chose a “just say hell no” approach to the new Obama administration.

Now, putting the quite serious issue of how "grassroots" are often petroleum Koch-Brothers Astroturf, "just say hell no" has been the impolite Republican extension of Nancy Reagan's approach to drugs ("Just Say No!"). (To be clear, Skocpol and Vanessa Williamson's The Tea Party and the Remaking of Republican Conservatism provides a strong window on how real 'grassroots', impassioned Americans are being influenced (and deceived) by astroturf organizations and false reporting from Fox News and elsewhere.) And, as per the graphics above, what seems not to have been incorporated in Democratic Party leadership thinking and "The Village" conception is that this minority tail wagging the GOP dog(s) is so out-of-touch not just with "mainstream" American thinking but even mainstream Republicans.
And, the most important: this is not an environmental (climate change) issue that somehow sits in 'pet issue' for those softies cuddling polar bears and concerned amount the 10,000s of Americans killed by fossil-fuel pollution every year (year in, year out ...) but is fundamental to the entire political dynamic.
Name any major issue of American politics today (fiscal, environmental, social, ...) and the radical Republican Party elite is 'out of touch' with mainstream Americans.

  • Choice: The majority of Americans (including a good share of "GOP") align with Bill Clinton's concept of abortion: "Legal, safe, and as rare as possible." The radical Republicans in Congress call for extreme anti-choice, even thinking that rape (even "forcible rape") victims and women whose babies would suffer horrible pain en route a death shortly after birth should face criminal charges if they seek an abortion.
  • Government spending: While Americans might see concern about spending (frothed up by "Fiscal Cliff" mania and fed even by President Obama's over-discussion of it), Americans want investment and expenditures to help create employment and foster a real end to the recession. The radical Republicans in Congress want to starve the government and many are gleeful at the prospects of a government shutdown over a debt ceiling fight.
  • Taxes: The vast majority of Americans support a more equitable tax code, seeing that the richest Americans can actually afford to pay somewhat more and 'sacrifice' just a bit to help pay for wars & the strengthening of society. The radical Republicans in Congress never met a billionaire tax-subsidy path that they didn't love.
  • Health Care: Americans saw value to 'single payer' approaches, certainly favored having a 'government option', and see many values from ACA like being able to cover children through age 26 and the elimination of pre-existing condition constraints (although this support has been skewed by false reporting and mediocre Administration messaging). The radical Republicans in Congress want to wipe away the ACA and, in fact, reduce Americans' access to affordable health care coverage to beneath the pitiful state it was before the health care legislation.
  • Gun Control: Americans -- especially in face of the devastating Sandy Hook Elementary School attack -- support reasoned gun control measures by significant majorities. As an example of funded machines on specific issues, the NRA has become devoted to Nancy Reagan with 'just say no' to any rational discussion of gun control.) The radical Republicans in Congress seem to want to emulate Somalia's libertarian paradise (must see video) with a submachine gun under every pillow and a crew-served weapon in every (three-car) garage.

On issue after issue, there is a funded effort to distort reality.
On issue after issue, we have a impassioned GOP base which might best be described as delusional. Birthers, Sandy Hook conspirators, Obama as Socialist / Muslim / etc, Global Warming deniers .. Tin-foil hat wearing conspiracy theorists being mis-informed, manipulated, and whipped to a froth to an end ...
On issue after issue, not just in pet 'green' worlds, this is a mobilized (and frothed up) a reality-denying 'base' in the primaries.
On issue after issue, we face a maniacal base that creates an environment where a Republican politician willing to work toward 'compromise', keep their feet firmly in reality-based decision-making, and figure out real solutions to the nation's real problems faces an incredible uphill battle (and is as close to impossible Sisyphean nightmare in most parts of the United States).
Climate Change denial (and, more broadly, Anti-Science Syndrome Hatred Of a Livable Economic System) is part and parcel of a generalized pattern of extreme radical right misrepresentation, truthiness, falsehoods, and outright delusion. This is not some 'pet issue' to be dragged out in an oh-by-the-way manner but is (a) key to every other issue and (b) is part-and-parcel of the effort to undermine American Democracy and undermine our future prospects via the leveraging of this extreme radicals to push American society away from reality-based policy making.
Unless (and until) the Democratic Party leadership truly incorporates this 21st century reality, policy issue after policy issue will crash against the jagged shores of radicalized Republican reality denial that specializes in "just saying no".
And, incorporating this reality and making this a centerpiece of political discourse creates the potential cracking of the radical right's control over the Republican Party while increasing the chances for reality-based politicians to win electoral contests.
And, embracing reality will heighten the chance for meaningful action forward on taxes, health care, education, social issues, gun control, ... and climate change.
Recognizing that Republican anti-science is one of the core issues that will foster a Populist Wave in 2014 will heighten the chance for political change that will enable meaningful action forward on taxes, health care, education, social issues, gun control, ... and climate change.
Sadly, the climate silence through the 2012 Presidential election campaign and stoic refusal to pound the table as to how climate disruption helped drive Sandy does not show an understanding of the necessity to confront -- directly -- the falsehoods being fostered on the American public that are driving the radical Republicans in Congress toward policies so damaging to the nation's future.

Here are some worthwhile discussions of the Skocpol paper:

A following thought ...
Now, while I have many 'nit pick' issues with Skocpol's paper (for example, the World Resources Institute (one of the most respected environmental think tanks in the world) is called the "World Resources Council"), a more significant issue is what one might call the 'giving the pass to President Obama and the Obama team'. In short, Professor Skocpol basically states that the Obama Administration really could not have done more related to the American Clean Energy and Security (ACES) Act (Waxman-Markey). While fully addressing this merits another (set of) posts, consider President Obama's continued appeals for "bipartisan" action and bipartisan consensus in light of the graphics above.
Here is President Obama at his first inauguration:

“On this day, we gather because we have chosen hope over fear, unity of purpose over conflict and discord,” the president said in his inaugural address. “On this day, we come to proclaim an end to the petty grievances and false promises, the recriminations and worn-out dogmas that for far too long have strangled our politics.”

With this sort of rhetoric, do environmental organizations merit singling out as erroneous in fighting to create a bipartisan legislative approach to tackle climate change?
After all the efforts for otherwise, the Affordable Car Act ("Obamacare") passed on a purely partisan vote.
While Professor Skocpol lays out -- with some degree of legitimacy -- 'professional' environmental organizations' failures to adapt to the new political environment, President Obama (and the rest of the Democratic Party 'machine') failed to realize that the situation was even worse when it came to climate mitigation action because there were (are) strong political reasons why -- unlike with health care -- winning Democratic unity for anything meaningful was an illusionary concept. There were not going to be meaningful numbers of Republicans joining Democratic votes for action (as seen, those Republicans who did face funded astroturf heavy Tea-hadist assaults in primaries) and there were going to be Democratic "no" votes no matter what. Thus, a 'key' failure in 2009 was the decision (or set of decisions) not to figure out how critical measures could pass in a fiscal measure that would not require 60 votes for Senate passage with less controversial 'complementary' measures (such as tax credits for energy efficiency, energy research and development tax credits, etc ...) that could garner (some) bipartisan support left outside the tighter package.
That decision -- to let climate legislation fester in a path requiring 60 votes and thus nearly assuring non-passage -- doomed any realistic chance that climate legislation would pass the Senate without the sort of forceful Presidential engagement that, in any event, Skocpol basically suggests is essentially irrelevant to the legislative process with the exception of a limited arm twisting for that last required vote or two. Would not Presidential (Administration) realization -- not just on climate change -- of the barriers to 'bipartisan action' have created an environment for more aggressive Administrative actions along with a more serious search for what could be done without bastardizing action to the radical Republican anti-reality demands?
As to how anti-science attitudes play in the efforts to radicalize the Republican party, while the examples could be myriad as to these issues interactions, see James Downie How gun control is another front in the far right's war on science.

Regardless of where one stands on gun control, or on any of these other issues, the far right’s attempts to restrict scientific research should concern everyone. Consider the “gun in the house” study mentioned in the Times article cited earlier, conducted by Art Kellerman: Gun control advocates continue to cite the study’s finding that “a gun kept in the home was 43 times more likely to be involved in the death of a member of the household than to be used in self-defense.” But the study has had a number of critics and the data is now more than 20 years old. Unfortunately, more recent national studies are few and far between, and, as one paper says, “many of the studies conducted to date have been based on small samples and were limited to specific population groups such as adolescents or older adults.” Taken together, the studies still back Kellerman’s findings, but regardless of where one stands, the data are not exactly ideal for policymaking. If our country is to make smart decisions, surely suppressing science is the wrong way to go, yet the far right continues to insist on doing just that. President Obama’s call for gun violence research is an important stand against this war on science.

A question to ask oneself: How many other issues could similar statements be drafted?

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          Why So Many Senior Academics Favor Single-Paying Medicine        
by Richard KostelanetzIt would create a two tier system where the privileged class could get different, reputably better doctors who would accept higher payments.Where "higher payments" made illegal, because, say, "un American," as indeed a two tier system would be, the result would be a medical black market. Think?Senior academics are accustomed to a two tier system where those tenured tower above the hoi polloi.Why is it that advocates of single payer American medicine never mention the likely social result?Incidentally, long a beneficiary on Medicare, I favor single paying, but dislike dishonesty which I fear anti Trump fanatics have made epidemic.Lies from those who are self righteous are no more acceptable than lies from crooks.My being anti anti Trump now no more makes me a Trumpster than my being anti anti Communist made me a Communist a few decades ago. People failing to recognize this distinction are either stupid or, yes, dishonest....
          The death of the death of #Obamacare? (newly updated)        
The Turtle loses a round
A week ago, that seemed to be the case.

The House, after one failure, narrowly passed its version of Trumpcare late this spring.

Then, on to the Senate.

Majority Leader Mitch McConnell figured he could use reconciliation rules to get a simple majority to pass something.

Wrong.

Hardcore faux libertarian Rand Paul and moderate (for the GOP, it's still relative) Susan Collins both said they couldn't vote for the Turtle's soup. Pretty soon others, like Rob Portman, Shelley Moore Capito and even Mike Lee of Utah and Jerry Moran of Kansas, along with Lisa Murkowski of Alaska, started raising more stinks.

So the Turtle did a crab crawl.

He then came out with the Turtle Two-Step of "repeal now, replace later."

But that is also now dead.

Selected members of the aforementioned specifically said they refused to buy a pig, or a turtle, in a poke. Surely others felt the same way.

Meanwhile, Donald Duck, the Trumpcare original snake-oil peddler, pulled the floor out from under the Turtle with a "let Obamacare fail" tack.

But, that still didn't stop the Turtle.

And the Turtle still wants to do something. He scheduled ANOTHER vote this week, even though people as high ranking as Senate No. 2 John Cornyn claim they still don't know what they're going to vote on. Per John Thune at the last link, it sounds like that's deliberate. Basically, it sounds like the Senate will be asked to give the Turtle a blank check.

And the Turtle is peddling a blank check because there's cheating like hell on Senate reconciliation rules on his omnibus pig in a poke. Parts of the cheat the Senate parliamentarian ruled out of bounds included an attempt to defund Planned Parenthood and an attempt to let insurers peddle Ted Cruz-style junk policies.

Collins and Murkowski were the only two GOPers to refuse to buy the first half of the pig-in-a-poke; the Senate voted 50-50 to approve a motion to debate the actual, still-unidentified, pig-in-a-poke, with Vice President Mike Pence then breaking the tie.

That said, Capito and others "rallied" to help put a marker on the Turtle's actual bill. The vote to override the parliamentarian and let Mitch go full-speed with selling the pig-in-a-poke died 43-57.

And, July 26, the new attempt at "repeal now, replace later" also failed. That also was by 43-57; per the NYT live vote tracker, "partial repeal and replace" failed 45-55.

But, knowing the zombie-like antics of McConnell, who, like John Randolph of Roanoke's description of President Martin Van Buren, "rows to his object with muffled oars," I still wouldn't call Trumpcare dead.

Indeed, the live vote tracker says an allegedly, and I don't think that word can be stressed enough, final vote, is scheduled for later this week.

It's like McConnell is trying half a dozen options, seeing which loses by the smallest margin, with plans of then trying to force that one option down recalcitrant senators' throats.

The latest version of that is what John Cornyn et al started calling "skinny repeal" on July 27. It would keep Dear Leader's surtaxes in place, while still calling on wingers to defy the parliamentarian and defund Planned Parenthood. That seemingly reflects what I said just above, per Politico. The Turtle has essentially been running trial balloon votes to see just what might have a chance of passage.

Of course, this itself is hypocrisy. This is ultimately just an attempt to have something to run through the reconciliation process (perhaps parliamentarian be damned) and send it back to the House. Politico appears to confirm this is the skinny of skinny repeal.

You know, kind of like how Obamacare itself was passed after Ted Kennedy died.

And, surprisingly, the Schmuck Talk express joined Murkowski and Collins in killing this. Heller, Capito et al went AWOL on any alleged principles and joined the Turtle. McCain voted no because he wanted a fatter repeal, while lying about Obamacare's alleged "collapse."

==

Of course, half the "fun" of this, in the earlier fails especially, was real fun — watching the GOP fallout. Until the latest news.

(The other half isn't so fun — it means being stuck with a semi-crappy Obamacare rather than the somewhat better option of a truly improved O-care, let alone single payer. Anyway, I digress.)

First up, sotto voce but getting louder, will be intra-Senate sniping. I'm sure that will only increase after the July 25 fail.

House-Senate GOP friendly fire will come next, with strongly conservative, but not quite Tea Party, House GOPers, not appreciative of being hung out to dry.

After that, since we're only halfway through 2017, will come threats or actualities of tea partiers primarying senators.

However, there's just one problem for the tea sippers.

None of the above senators is up for re-election in 2018.

But, most of them ARE hypocrites, given their 2015 vote for a repeal now, replace later bill. Collins is the one exception.

And, even if THIS does fail?

Don't declare Obamacare magically resurrected.

Moran still wants to replace it.

That said, he wants an actually open Senate process. And it seems clear that he wants nothing to do with Havana Ted Cruz's junk-bonds level insurance offerings as part of that.

There is little way, though, that a truly improved Obamacare would come out of that. Senate Dems wouldn't play ball without further wheelings, and while the Turtle isn't that much of an ideologue, he might not play ball.

Also, in all of this, do NOT believe that insurers like Blue Cross / Blue Shield are your friend. They're not. They're still bloodsucking vampires, just with more money for their hypocrisy under Obamacare.
          When Premium Prices Sore on ACA Marketplace, you can thank Trump....        
Insurance companies quaked with uncertainty and will probably raise premiums to cover their butts after this irresponsible Trump tweet:

Which prompted this reaction from Bernie Sanders, which by the way, should be everyone's reaction:
Sen. Bernie Sanders, I-Vt., accused President Trump of wanting to “sabotage” the Affordable Care Act. 
“You know, I really think it’s incomprehensible that we have a president of the United States who wants to sabotage health care in America, make life more difficult for millions of people who are struggling now to get the health insurance they need and to pay for that health insurance.”
Not to mention increasing costs substantially for Americans on the exchange and in the individual market.

Sadly, Sanders still hasn't fine tuned the message around single payer; it's virtually impossible to create little independent single payer islands in the U.S.. He should have known better. It has to be all or nothing, maybe a system that utilizes insurance companies to administer the system like Medicare and Medicare Advantage. 

Attempts have failed in the past because the costs are too high when a state is working alone, and prices for care can't be standardized lower using the power of the entire U.S. population. And that's the big difference, which is why Jake Tapper didn't get it either and asked the following question:
Sanders said he planned to introduce single-payer health care legislation now that Republicans efforts at health care reform failed. However when pressed by “State of the Union” host Jake Tapper on how single-payer could be passed nationally after failed attempts in California and his home state of Vermont, Sanders admitted, “Politically, this is difficult.”
“Look, taking on the insurance companies and the drug companies, taking on Wall Street, taking on a lot of very powerful forces that make billions of dollars a year from the current health care system is not going to be easy. And it’s not going to take place until millions of people get involved in this struggle and appreciate the fact that whether you’re rich or whether you are poor, health care is a right.”

          Our Dysfunctional Health Care System part 2: Single Payer & the Ted Cruz Con.         
To start, here's what I've been saying for some time:
All payer, single payer, Medicare for all, universal health care is simple: All doctors are your doctors, all hospitals are your hospitals. No bills, co-pays or deductibles. We could cut costs by a third to half of of what we're paying now. We won't. Are we insane?
And yet, as this reaction to a recent story about Medicare Advantage demonstrates, many people don't seem to understand our health care system...at all:

MSNBC's Ali Velshi gave us the best presentation yet showing us how backward and downright bizarre the Republicans free market idea of health care is; we're the only country doing it. He followed that up with the effect cut backs on Medicaid would have on dementia and Alzheimer's seniors on Medicare:


My favorite candidate running against Paul Ryan recently tweeted this simple truth:

Another great look at the myth of health care greatness before the ACA was discussed belwo on WPR's On Point. I edited the discussion to hit on the main points, especially the "free market" control wielded by insurance companies, which is anything but:



The Ted Cruz ACA "Poison Pill" Con: The Senate's BCRA is going to get passed, even if 22 million people will lose their health care insurance.

The Ted Cruz plan will please his GOP base; by purposely making ObamaCare's plans collapse. When they do, Cruz can say, "I told you so:"
Sen. Mike Lee (R-UT) conditioned his support (of the BCRA) on an amendment proposed by his colleague Cruz. The gist is this: Health insurers could sell non-Obamacare plans as long as they also sold Obamacare-compliant insurance. The proposal does (eventually) erode Obamacare's protections for people with preexisting medical conditions, because it would likely segment the insurance market into healthy and sick pools. Healthy people would buy non-Obamacare plans, while sick people would buy the more robust Obamacare coverage. That would drive up premiums for the ACA marketplace.
Clever. It would also make people appreciate their stripped down high deductible junk insurance policies.

Not Letting the Free Marketplace Work: For a party touting the wonders of the free marketplace, they sure know how to mess with it. While complaining about some insurers leaving the ObamaCare marketplaces, they never waited around to see other insurers take their place. That's what markets do:
Centene fills Missouri's empty counties. You might have missed it in the rancor over the health care debate in Washington, but health plans have been stepping in to fill Obamacare's bare-shelf markets. Missouri is now the latest state to benefit, after Centene announced it would sell plans there next year.
 That's right, the latest state.



Republican "Health Care" Tax Cut Plan and Stock Market Payoff: If you're going to make insurers lots of money, buy their stock:

Health industry stocks, including insurance giants like UnitedHealth, have surged as Republicans have moved forward with their repeal effort, which rolls back broad taxes on healthcare firms while loosening consumer regulations.

Republican Sen. James Inhofe of Oklahoma purchased between $50,000 to $100,000 in UnitedHealth stock ... Rep. Mike Conaway, a Texas Republican and member of Speaker Paul Ryan’s leadership team, added a health insurance company to his portfolio ... An account owned by Conaway’s wife made two purchases of UnitedHealth stock, worth as much as $30,000, on March 24th, the day the legislation advanced in the House. 

As we’ve reported, the House of Representatives has actively fought efforts to enforce the law after the Securities and Exchange Commission attempted to investigate one congressional staffer accused of passing healthcare information to a set of hedge funds.
Here's one former Republican making an amazing admission:



          Our Dysfunctional Health Care System part 1 Medicare Advantage!         
Most of the world's industrialized nations have already done their research, and found: private health care isn't safe, cost effective, or moral. Yet the Republican Party keeps pushing their deadly free market plan.

All payer, single payer, Medicare for all, universal health care is simple: All doctors are your doctors, all hospitals are your hospitals. No bills, co-pays or deductibles. We could cut costs by a third to half of of what we're paying now. We won't. Are we insane?

More horror stories about health insurers. It's stuff like this that distracts us from having the real debate, one that the Democrats are once again missing; All payer or free market, that's the choice, not tweaks or nibbling around the edges. 
Medicare Advantage: A recent report by the Government Accountability Office, the auditing arm of Congress, adds new weight to criticisms that some health plans may leave sicker patients worse off … reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to "preferred doctors and hospitals" or other medical care, as the leading reasons for leaving. "People who are sicker are much more likely to leave (Medicare Advantage plans) than people who are healthier," James Cosgrove, director of the GAO’s health care analysis, said in explaining the research.

David Lipschutz, an attorney at the Center for Medicare Advocacy, says the GAO findings were alarming and should prompt tighter government oversight.
Private Insurers, Profit Driven Health Care: So let’s talk about the Republicans free market health care dream. Here’s what you get, whether on a small or large scale…doesn’t matter:
In the first two months of this year the federal Centers for Medicare & Medicaid Services (CMS) fined 10 Medicare Advantage health plans a total of more than $4.1 million for alleged misconduct that “delayed or denied access” to covered benefits, mostly prescription drugs … health plans charged patients too much for drugs or failed to advise them of their right to appeal denials of medical services.

Last month, CMS officials ended a 16-month ban on enrollment in Cigna Corp.’s Medicare Advantage plans … Cigna (had) “widespread and systematic failures” … a “serious threat to enrollee health and safety.”

A flurry of whistleblower lawsuits … Freedom Health, a Florida Medicare Advantage insurer, agreed to pay nearly $32 million to settle allegations that it exaggerated how sick some patients were to boost profits, while getting rid of others who cost a lot to treat. Freedom Health allegedly kept a list of some “unprofitable” patients that it discouraged from staying in the health plan, while encouraging healthier, “more profitable” members to remain, according to the whistleblower suit. Federal regulations prohibit health plans from discriminating based on a person’s health.

          Update: Rubio Submits Legislation to Stop Bailout - The ObamaCare Bailout Mr. O Neglected to Tell Us About        

Last week I was discussing my thoughts on ObamaCare with a friend.  I mentioned about how I think everything that is happening has been planned in order to usher in single-payer, government controlled health care.  I said I even thought that Mr. Obama didn't really care about the internet mess up or how it affected his polls, just as long as the desired outcome is achieved. My friend said that my beliefs are a conspiracy theory. 

I read this article today.  It only reassures me that the "conspiracy theory" is reality.

We are now finding out that our tax dollars will be bailing out the insurance companies.  Another little tidbit Mr. Obama neglected to share with the taxpayers.

Via:  The Weekly Standard
Bailing Out Health Insurers and Helping Obamacare
BY JEFFREY H. ANDERSON
Robert Laszewski—a prominent consultant to health insurance companies—recently wrote in a remarkably candid blog post that, while Obamacare is almost certain to cause insurance costs to skyrocket even higher than it already has, “insurers won’t be losing a lot of sleep over it.”  How can this be?  Because insurance companies won’t bear the cost of their own losses—at least not more than about a quarter of them.  The other three-quarters will be borne by American taxpayers.
But that’s exactly what it will do—unless Republicans take action.  As Laszewski explains, Obamacare contains a “Reinsurance Program that caps big claim costs for insurers (individual plans only).”  He writes that “in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government [read: by taxpayers], for example.” For some reason, President Obama hasn’t talked about this particular feature of his signature legislation.  Indeed, it’s bad enough that Obamacare is projected by the Congressional Budget Office to funnel $1,071,000,000,000.00 (that’s $1.071 trillion) over the next decade (2014 to 2023) from American taxpayers,through Washington, to health insurance companies.  It’s even worse that Obamacare is trying to coerce Americans into buying those same insurers’ product (although there are escape routes).  It’s almost unbelievable that it will also subsidize those same insurers’ losses. 
In other words, insurance purchased through Obamacare’s government-run exchanges isn’t even full-fledged private insurance; rather, it’s a sort of private-public hybrid.  Private insurance companies pay for costs below $45,000, then taxpayers generously pick up the tab—a tab that their president hasn’t ever bothered to tell them he has opened up on their behalf—for four-fifths of the next $200,000-plus worth of costs.  In this way, and so many others, Obamacare takes a major step toward the government monopoly over American medicine (“single payer”) that liberals drool about in their sleep.
Read more...

UPDATE 1/13/14:

Senator Marco Rubio (R-FL) has submitted legislation to prevent the bailout of the insurance companies.  Read Rubio's article:

Sebelius, Congress should take ObamaCare bailout off the table 

Excerpt:
"...By law, health insurers are leveling with their shareholders about how ObamaCare will hurt their bottom line. Now President Obama, Secretary Sebelius and ObamaCare’s supporters should level with American taxpayers about the law’s true costs and eliminate any chance for a bailout.
Unfortunately, we can’t just take the administration’s word that it won’t happen. Congress has to act, and it should approve legislation I’ve introduced to repeal ObamaCare’s risk corridor provision and stop any bailout.  At just a page long, my bill is simple but would instantly wipe away the taxpayer's exposure to millions – and potentially billions – of dollars' worth of a bailout for insurance companies.
If the only way ObamaCare works is with a taxpayer-funded bailout of insurers, it’s yet another clear sign that the law can’t survive and isn’t worth saving.
 While in office, I have worked with others to protect Americans from ObamaCare's damage – as patients, taxpayers, consumers and workers. While some immediate relief is possible, it's become clear that all of ObamaCare's damage can't be prevented forever, unless the law is repealed and replaced with market-based reforms that will make health care more affordable and accessible for all Americans..."




          Obamacare As Superstatute        
               I am have always been a partial skeptic about Eskridge and Ferejohn’s “superstatute” theory--their groundbreaking argument that certain statutes are special because they transform and entrench norms beyond the rights embodied in the statute itself. Some of my resistance stems from how hard it has been for scholars to identify and reach consensus on which statutes, apart from Eskridge and Ferejohn's paradigm example of the Civil Rights Act (which beautifully fits the theory) fit the bill. (The other part of my resistance comes from dissatisfaction with the doctrinal implications of their theory.)

               But since last October, Eskridge and Ferejohn have been paramount in my mind and I may need to eat some crow. It has been impossible to watch the past eight months of debate and drama over the Affordable Care Act without thinking of superstatute theory. I have nearly finished an article making that case, but given this week’s events, I could not resist putting the idea out there sooner.

              The ACA seems to clearly satisfy the threshold criteria of superstatute theory. It has survived (several) election cycles, including a change in  Administration.  It has survived more political contestation than any statute in modern memory, including not only the 50 times Congress tried to repeal it under Obama and the four other, more serious, attempts that  we just saw; but also four years' worth of sabotage by Congress to starve to death with lack of funding. It also has survived not one, but two, high profile showdowns in the U.S. Supreme Court that had the potential to take the entire statute down (NFIB and King), and other important challenges  to discrete aspects of the law (e.g., Hobby Lobby).

            But what is most interesting to me about the ACA’s recent story for purposes of superstatute theory is the normativetransformation that the statute seems to have wrought. That will be Obama’s biggest legacy on health care, regardless of what happens to the ACA itself; whether it gets amended, partially amended, repealed, or just tweaked and given a different name. That stuff is politics. I’m talking about our fundamental and “gut” understanding of what a health care system should be and what the government's role in it should look like.


           As I have detailed before and further detail in the article, our society has never been willing to directly confront the question of what exactly a health care system is supposed to be. Our regulatory structure of health care reflects a purposeful  ambivalence between the norms of solidarity and individual responsibility (should we all be assured some basic level of health care or do we only deserve the health care we each can earn?). We can explain a lot of the fragmentation and regulatory design we currently have in health care by our collective desire to straddle and avoid resolving that tension.

          What the ACA did was more forcefully push the needle toward solidarity than ever before.  During the election, it was Trump himself who said that “we are going to cover everyone,” that no one’s health care would be taken away.  We saw a remarkable number of Republicans in the House and Senate over the past seven months defending Medicaid and blanching at the idea of throwing people off the rolls.   Even more shocking, the threat of killing the ACA entirely led more Democrats to talk publicly than ever before about single payer health reform--Medicare for all, what was viewed just 8 months ago as political impossibility, pie in the sky, when Sanders and only a few other idealistic souls were touting it. The ACA changed the political discourse, the political imagination and also the political possibilities. In Jack Balkin’s terms, it seems to have  moved some ideas from “off the wall” to “on the wall,” or at least put them on that path.

         The ACA also transformed our legalunderstandings of the healthcare system. The most important transformation was ACA's facilitation of the federal government’s direct and heavy-handed involvement in the insurance industry.  As I detail in a different new piece with Nichole Huberfeld, the federal government’s intervention in health care is certainly not new.  But the ACA brought the federal government into the insurance system like never before--a private industry previously regulated most directly by the states--and it effectively forced the industry to change the basic way it does business.  None of the repeal bills, notably, would have changed that.  That’s a strikingly widespread acceptance of a new regulatory model.

         There is a difference between the political difficulty of taking away social welfare benefits once they are awarded and the entrenchment of new norms that are likely to endure. The ACA was certainly structured--by rolling out its most popular benefits early--with an eye toward the former, and some might argue that the recent debates over Medicaid simply show that benefits once given are hard to take away. But the conversation and the durability of the statute over the past seven crazy months seem to illustrate that we are also in the realm of the second: transformative norm entrenchment that goes beyond the four corners of the statute itself. That's a pretty big deal.

                More to come when the article is posted on SSRN.



          Comment on A lot of well-meaning people don’t understand single-payer healthcare by Lurker        
As a Finn, I'd like to digress about the single-payer system we're supposed to have. It is really not a single payer system when you get in the thick of it. On the front, it looks like a single-payer system: we have a system of public clinics, and public hospitals. However, there exists also a private, government-supported system of healthcare. For example, most large employers offer their employees "workplace" healthcare, which essentially means that you go to see a general practicioner on your employer's dime. This is actually effective for both the employer and the employee: the queus at the private clinic are much shorter, so the employee is back on job much faster. If the case is more difficult, the private GP can have the patient admitted to the public system already on the specialist level, thus bypassing the municipal public clinic. Similarly, all university students are covered by a GP level medical care that is specific for university students, and naturally, the military has its own system of health care for conscripts with its own GP level facilities and agreements with civilian public hospitals for more specialised care. There also exist private insurances that are actually mandatory. For example, if you get hurt on the job, or in the traffic, the insurance company of your employer (or of the gulity party in traffic) will cover your care, and they will probably pay for it in a private hospital, unless you require ultra-specialised or extremely intensive care, which are only provided by the public system. This is because the insurance company can probably get a better price in a private hospital than at a governmental one. The private hospital can, if the patient experiences a crisis, admit the patient to more intensive care in a public hospital without cost, so they can have lighter infrastructure as they don't need heavy intensive care facilities. The public hospital system is definitely not single-payer. It requires copays, which are limited by your income so that regardless of actual cost, you should end up with 90 euros per month in hand, if you stay in the care for the whole month. As the actual cost is extremely high, even an upper-middle-class person will spend their whole monthly income in the prolonged hospital stay. This is a feature of the system, not a bug. (However, the payment does not take into account your property, so your funds are not depleted, you only lose your income.) Similarly, the prescripitions are not fully covered: you pay always the firs 50 euros per year, and from there on 60 % up to 605 euros per year, after which the state covers the cost almost fully. (Cancer medicines, intravascular diabetes medication and a few other expensive medicine classes are covered 100 % from the start, though.) Third, because there exists a private system, it is possible to buy care in the private sector. This can be done either out-of-pocket or by private health insurance, and the government actually supports this by reimbursing a portion of the cost.
          Liberals Strike Back… Against Single Payer        

In the name of political reality, some liberal pundits, politicians and policy wonks are scolding progressives to give up on Medicare for All. They are dead wrong.

With the explosive growth of the movement for single payer healthcare, it should not be a surprise to see the Empire Strike Back.

In the name of political reality, some liberal pundits, politicians and policy wonks are scolding progressives to give up on Medicare for All. There are many ways to achieve "universal coverage," we're told. "Overhauling" the entire system is too hard, healthcare is too big a part of the economy, and politicians will not take out the health insurance companies.

Yet, the alternative approaches to reform pose the same political problems: the insurance industry is likely to fight the elimination of their profits (Dutch and German health insurers, for example, are non-profit), and the severe reductions in executive compensation, elimination of shareholder dividends, and rate setting, all of which go away under European-style health insurance.  The benefits and rates are government mandated, the companies are essentially payment administrators. 

Either this regulated system of private health plans lowers prices through government—by setting rates and negotiations—or it fails to do so and costs shift to individuals.  But it is still the government role as rate setter/price negotiator that matters. Wouldn't it be more straightforward and simpler to improve and expand Medicare?

Still, the pundits say it's best to search for incremental reform of the insurance-based system, and live (or not!) with the results. In other words, the best health reform we can do is a version of what we have. Worse, it props up and reinforces a profit-focused system that is antithetical to the very concept of healing. Advocates of Medicare for all, and other non-reformist reforms, are looking to solve problems immediately, not accommodating the status quo.

Progressives are badly served by shallow political advice from the likes of Paul Krugman. It obscures the reality working people actually face and undermines the fight for our values and program.

Our health is not a commodity—it doesn't belong in the "market"—it is a human right. Those who advise us to settle for models of national health systems in other countries are missing the fundamental difference from the broken U.S. scheme. What Australia, the Netherlands and Switzerland all have in common is they do not conflate "coverage" with healthcare. Those countries guarantee healthcare.

Having health insurance in America doesn't prevent medical bankruptcy or denied care. In the U.S., employer based healthcare creates great uncertainty for workers, as premiums and out of pocket costs increase, reflecting costs shifted from the company to workers to fund the profits of the insurance companies.

Only 55 percent of employers offer coverage. Why would we try to buttress a system that is failing workers, hurting business, and shrinking? From 60 to 70 percent of healthcare spending comes from taxes. We're just not getting our monies worth. We are wasting 20 cents on the dollar when we pay for private health insurance, wasting huge resources that could go to higher wages, child care, and pensions.

Alternatively, single payer is the reform that establishes health security and enables greater equality and freedom—values worth fighting for.

Ironically, healthcare reform efforts have sought to "improve and expand" every element of the present system, except the program that is popular and works best: Medicare. The Clintons tried to expand HMOs, Obama expanded private health insurance and Medicaid, the GOP tried to expand "individual purchase," so we'd all be on our own when dealing with insurance companies, drug companies and hospital corporations.

It is precisely profit-focused healthcare industry that has caused the problems of escalating costs and restricted access. Rising premiums pay for rising prescription drug costs, which hospital corporations pass on to patients and drive up their own rates as they leverage their market share. As a result, each sector's revenues and profits increase. The industry imperative of revenue and profits has replaced caregiving as the basis of healthcare in the US (see Elizabeth Rosenthal’s book, "American Sickness.")

We are not "starting from scratch," as Krugman contends (which he did not in 2005) but instead there exists a model in the U.S. for how single-payer financing could work: Medicare—which if improved and expanded to all—could confront the industry, contain prices and restore the values of caring, compassion and community to our healthcare system.

Alternative approaches to universal coverage (though even with the Affordable Care Act, 28 million people remain uninsured) depend on using huge tax subsidies to enable individuals and businesses to buy insurance coverage. Without those subsidies—in California alone they amount to over $100 billion—health insurance is a failed business model. Taxpayers prop up the insurers profits for the honor of paying $2000 in deductibles and potentially under the ACA over 9.5 percent of our income in out of pocket costs. In California, this means 15 million people are uninsured or underinsured.

Truly controlling costs requires eliminating the waste and inefficiency of the private payers – Medicare administrations are cost 4-5 percent compared to up to 12 percent for insurance companies (before profits). The inherently wasteful insurance company bureaucracy doesn't go away when everybody has to buy one of their health plans.

Ultimately, what we must face is an issue of power. Can we collectively organize a healthcare system without the imperatives of revenue and profit? Only if we build a movement for health justice that demands guaranteed healthcare for all as a human right. Only collectively through government do we as a society have the resources and standing to secure that right. Only through an Improved Medicare for All can we achieve health security, not subject to the market power of healthcare corporations.

 


          Caring Fiercely: Nurses Tell Dems Why They Won’t Sit Down, Be Quiet in Fight for Single Payer        

As California’s single payer bill, S.B. 562, continues to occupy its parking space in the California Assembly — courtesy of Speaker Anthony Rendon’s decision last month to table the bill — nurses in California have noticed a familiar trend. The more we continue to stand up and speak out, holding elected officials accountable for doing their job of legislating on this lifesaving legislation, the more our advocacy is painted as too loud, too strong, too soon.

Much like the suffragists, who were jailed and even beaten for what was seen at the time as an audacious, unladylike stand for women’s right to vote, the collective voice of nurses, as we stand for healthcare as a human right, has even been chastised as threatening. This attempt to paint a public health movement as a “threat” would be surreal if history hadn’t given us previous examples, but when the status quo faces changing against its will, as we have seen in recent weeks, it will lash out against the intentions even of professional healers.

The California Nurses Association comprises nearly 100,000 registered nurse members, a great majority of which are women. We have dedicated our lives to helping and healing the people of California. Every day, we nurse until our muscles ache. We nurse until our hearts ache — all while we personally face the highest rates of workplace violence out of any other industry.


We will never quietly go away. Not until our patients have guaranteed access to healthcare.

Registered nurses do this physically and emotionally demanding work because, through the process of becoming RNs, we have taken an oath to protect our patients.

Let’s illuminate what that protection looks like in action: It looks like hundreds of nurses coming together in recent weeks, as the California Assembly has continued to press snooze on single payer, volunteering their time off work to show up in the capital and in assembly districts to say, “Healthcare is a human right!” and “Guaranteed healthcare now!”

Those who call for temperance in the passion of our patient advocacy, who conflate registered nurses with Internet trolls and call our activism “militant,” misunderstand something critical. Love, in the face of danger (and all nurses know that without guaranteed healthcare, their patients’ lives are at stake), becomes fierce. But it never stops being love.

California Nurses Association has been called “the union that roars.”

Those who take issue with the fierceness of our commitment to the health and safety of our patients require an expanded vision of how care is best expressed.


"If we don't get no healthcare, you don't get no peace."

When lives are at stake, nurses know better than anyone that care is not quiet and passive. It does not wait. There is no better time to care — or a softer register in which to express care. For patients without access to affordable treatment, for families facing crushing medical debt, the time is now, and nurses have the tenacity to stand up and speak up, to march, canvass and say, “You must do better!” to elected officials for inaction on single payer.

This is not “hardball.” It is not militant, a “tactic,” or any of the other rhetoric that attempts to shift focus from the nurses’ lifesaving message to the volume of our voices when conveying that message.

This is love.

Hundreds of healers and our allies showing up en masse to advocate for the health and safety of Californians is what it looks like to care. Simple as that.

This is what it looks like to care.


This is not “hardball.” It’s patient advocacy.

There is still time for Speaker Rendon to prove he also cares by moving S.B. 562 forward, given that the legislative session does not end until mid September. While he may believe inaction will cause nurses to grow weary and return to the bedside, shamed for our “inappropriate” behavior, and leave our poor elected officials alone, that is an underestimation of nurses’ strength and heart.

The California Nurses Association has been fighting for single payer for decades and, in this moment where it feels more possible than ever to achieve, the nurses will not go quietly away. Not today. Not ever, until our patients have guaranteed access to healthcare. In fact, if nurses can shoulder 12-hour shifts, day after day, saving people’s lives, with hardly enough time even take a meal break or sit down, we have a message for California Democrats:

Nurses do not give up.


We don’t give up; we show up. In the capital if that’s what it takes.

We will never be shamed into silence when our message is advocacy on behalf of all the vulnerable lives we’ve vowed to protect. At our full height, at the full volume of our voices, CNA nurses will continue expressing the great depth of our care for the people of California by standing up for single payer. We ask Speaker Rendon and members of the Assembly to actively stand with nurses in that movement by freeing S.B. 562 and doing the hard, critical work to move it forward. We CAN do this. Our patients deserve no less.

HAVE A HEALTHCARE HORROR STORY? TELL US WHERE IT HURTS

As nurses continue to stand up for our patients, by standing up for single payer, we want to bring YOUR healthcare stories to our legislators’ attention. Please share your patient stories, and we will work to ensure that elected officials cannot ignore the voice of the people in this movement for healthcare as a human right.


Bonnie CastilloDirector of Health & Safety at @NationalNurses, Director of RN Response Network; I’m an RN & healthcare champion who believes healthcare is a human right!


          The Public Option – Doomed From the Start        

There's a significant danger that a public option would not only fail to improve the ACA, it could undermine the movement for Medicare for All

With the collapse of the dismal Republican healthcare bill, some Democrats are reviving talk of a public option as the cure for the holes in the Affordable Care Act that opened the door for the GOP attack.

Some even project the public option as the path to real transformative reform, an improved and expanded Medicare for all. It's not. The public option bears more in common with fool's gold. It may look shiny, but it will still leave you broke.

And there's a significant danger that a public option would not only fail to improve the ACA, it could undermine the movement for single payer, discrediting a fully publicly financed system that is not a feeble adjunct to the private insurance market.

Granted, the ACA did enact some important course corrections, especially the expansion of Medicaid, to a profit-focused healthcare system that had plummeted to 37th in World Health Organization rankings.

But ignoring the highly successful and popular model of a proven system, Medicare, the ACA architects instead opted for an alternative that left 28 million Americans uninsured and failed to reign in the price gouging practices of the private market.

The inevitable result was millions of newly insured people paying premiums for insurance they increasingly could not use because of ever-rising deductibles, co-pays and other out of pocket costs.

Enter the proposal for a public option, now again in vogue as the solution for driving down costs by offering competition for the private insurers. The public option, the argument goes, can offer less expensive coverage because it doesn't have to divert massive sums for administrative costs, mainly profits, lush executive pay packages, claims denial paperwork, and marketing.

But in practice, the outcome would be far different. Medicare works in large part by including all the people it covers in one large risk pool so that healthier patients balance out sicker patients in costs that must be reimbursed to providers. But the public option would not have that protection. One of two scenarios is likely:

A. To actually compete, the public option has to employ the same cutthroat tactics private insurers employ to limit their costs.

Insurance companies reap profits by collecting premiums and restricting payments for care. They accomplish that goal by denying claims—data from California and Connecticut have shown insurers deny from one-fifth to one-fourth of all claims—or excluding patients likely to be sicker and in need of more costly care.

The ACA barred insurers from refusing to sell plans to people they used to summarily reject with even minor pre-existing conditions. But the insurers have decades of experience in gaming the system, such as the use of restrictive provider networks and drug formularies.

As Adam Gaffney and Danny McCormick wrote in The Lancet in April, in the massive New York market only one insurer, a consumer cooperative that ultimately collapsed financially, covered care at the city’s top cancer center. Another popular scam is charging their enrollees more for essential drugs for AIDS, cancer or other serious illnesses.

So the public option can engage in the same skullduggery to exclude sicker, more costly patients, or

B. The public option becomes the ACA escape valve by welcoming in the sickest people selected out by the private insurers, in effect another bailout for a failed private insurance market.

Noble, but fatal. Thus the public option has far higher operating costs than the private plans. To effectively compete, it must either greatly jack up its rates, eliminating it as a less expensive alternative, or endure the bankrupted fate of that consumer coop in New York.

To top it all off, the Congressional Budget Office in 2013 concluded that adding a public option would not even slice the number of uninsured, and could even encourage employers to dump workers they now cover into the ACA exchanges.

With millions still either uninsured or paying exorbitant costs for care, imagine promoting a publicly financed Medicare for all to a public that sees a public option that is just as unethical as the notorious private insurers, or a financial wreck that just went belly up.

In 1957, the Ford Motor Co. had the hot idea of a glitzy new car that would capture new market share. It was called the Edsel, which soon become a synonym for a flop. Nurses have a message to the public option purveyors. Stop trying to sell us an Edsel.

Original Post: https://www.commondreams.org/views/2017/07/20/public-option-doomed-start


          Since When Is It Not Okay to Play Hardball With the Democrats?        

The real issue in the fight for single-payer health care in California is not cost—it is political will and political priorities.

“We have not made a single gain in civil rights without determined legal and nonviolent pressure.… It is an historical fact that privileged groups seldom give up their privileges voluntarily.”
—Dr. Martin Luther King Jr., “Letter From a Birmingham Jail”

Despite efforts by the political establishment to shut it down, the quest for a state-based, Medicare-for-all type system in California, based on patient need, not corporate profits, rolls on.

After SB 562 passed the California Senate in early June, California Assembly Speaker Anthony Rendon unilaterally blocked the bill from advancing before a single hearing could be held or a single amendment could be considered.

Nurses, the lead sponsors of the bill, and thousands of health-care and community activists who have organized and mobilized in support of SB 562, responded with multiple protests at the state Capitol, canvassing and hosting a town-hall meeting in Rendon’s Los Angeles area district, and flooding social media in protest.

They are far from done. Activists will work to hold every member of the California Assembly accountable, insisting all sign on as co-sponsors of the bill and declare whether they agree that insurance companies should be the determinants of our health. They are also reminding Rendon that there is still time to move the bill in a legislative session that does not end until mid-September.

With Rendon claiming he acted because the bill is “woefully inadequate,” many have wondered what is the job of elected representatives if not to hold hearings and make amendments to legislation they think needs changes.

Corporate-media critics have been quick to inflate the projected cost of a system to guarantee health care for all Californians, with real patient choice, and no premiums, deductibles or co-pays that reinforce an inequitable system based on ability to pay.

But economist Robert Pollin, lead author of a study on the potential costs, recently wrote that the bill “could deliver decent health care to all 39 million California residents while also lowering overall costs of health care by about 8 percent relative to the existing system.” Under Pollin’s recommended approach, virtually every California household and business would spend less on health care than they do today.

The real issue is not cost—it is political will and political priorities. Will state legislators be accountable to the 40 percent of the state’s population who remain without any coverage or with out-of-pocket costs so high they face financial stress or ruin if they seek to get care?

Or will they continue to protect their corporate donors who hold as much sway in Sacramento, even with its two-thirds Democratic majority, as they do in Trump’s Washington? As Lydia O’Neil and David Sirota have noted, “donors from the health services sector and major health insurers gave more than $16 million to Democratic candidates and the California Democratic Party in the 2014 election cycle.”

The seminal fight for SB 562 also reflects a national struggle for the movement for social change in the United States. In an decade in which Democrats have lost 1,000 national and state elections under the umbrella of a status-quo leadership that remains more responsive to Wall Street, K Street, and Silicon Valley than to its grassroots base, the battle for single payer/Medicare-for all-takes on added significance.

A recent national poll shows that 60 percent of Americans believe “it is the federal government’s responsibility to make sure all Americans have health coverage.” The question remains: Will those who control the Democratic Party believe that “resistance” to Trump is enough to win lost voters, or do they need to actively promote real populist reforms, like Medicare for all?

Opponents of SB 562, from the inner circle of the Democratic Party to their allies in the mainstream, and even some in the liberal or supposed progressive media, have cited the pretexts that we must wait while fighting the threat of repeal of Obamacare, falsely characterized some components of the bill even as amendments are blocked by Speaker Rendon, or denounced assertive tactics of the campaign by supporters to pass the bill.

We can draw lessons of the words of Dr. King, during the great civil-rights movement, written from solitary confinement in a dismal Birmingham jail cell in 1963.

Dr. King chastised the “white moderates” who with their criticism of direct nonviolent action and greater devotion to “order” than to justice often posed a greater “stumbling block” to the “stride toward freedom” than the most virulent opponents in their path.

And he had stern words for those who always advised African Americans “to wait for a ‘more convenient season.’”

“For years now,” wrote Dr. King, “I have heard the word ‘Wait!’… This ‘Wait’ has almost always meant ‘Never.’ We must come to see…that ‘justice too long delayed is justice denied.’”

Original Post: https://www.thenation.com/article/since-when-is-it-not-okay-to-play-hardball-with-the-democrats


          Nurses Scolded: Not OKAY to Play Hardball with Democrats        

The seminal fight for single-payer healthcare in California reflects a national struggle for the movement for social change. So, no, organized nurses and our allies will not wait. And we will not back down.

"We have not made a single gain in civil rights without determined legal and nonviolent pressure… It is a historical fact that privileged groups seldom give up their privileges voluntarily." –Dr. Martin Luther King, Jr., Letter From a Birmingham Jail

Despite efforts by the political establishment to shut it down, the quest for a state based, Medicare for all type system in California, based on patient need, not corporate profits, rolls on.

After SB 562 passed the California Senate in early June, California Assembly Speaker Anthony Rendon unilaterally blocked the bill from advancing before a single hearing could be held or a single amendment could be considered.

Nurses, the lead sponsors of the bill, and thousands of healthcare and community activists who have organized and mobilized in support of SB 562, responded with multiple protests at the state Capitol, canvassing and hosting a town hall meeting in Rendon’s Los Angeles area district, and flooding social media in protest.

They are far from done. Activists will work to hold every member of the California Assembly accountable, insisting all sign on as co-sponsors of the bill and declare whether they agree that insurance companies should be the determinants of our health. They are also reminding Rendon that there is still time to move the bill in a legislative session that does not end until mid-September.

With Rendon claiming he acted because the bill is "woefully inadequate," many have wondered what is the job of elected representatives if not to hold hearings and make amendments to legislation they think needs changes.

Corporate media critics have been quick to inflate the projected cost of a system to guarantee healthcare for all Californians, with real patient choice, and no premiums, deductibles and co-pays that reinforce an inequitable system based on ability to pay.

But economist Robert Pollin, lead author of a study on the potential costs, recently wrotethat the bill "could deliver decent health care to all 39 million California residents while also lowering overall costs of health care by about 8 percent relative to the existing system." Under Pollin’s recommended approach virtually every California household and business would spend less on health care than they do today.

The real issue is not cost – it is political will and political priorities. Will state legislators be accountable to the 40 percent of the state's population who remain without any coverage or out of pocket costs so high they face financial stress or ruin if they seek to get care?

Or will they continue to protect their corporate donors who hold as much sway in Sacramento, even with its two-thirds Democratic majority, as they do in Trump’s Washington? As Lydia O’Neil and David Sirota have noted, "donors from the health services sector and major health insurers gave more than $16 million to Democratic candidates and the California Democratic Party in the 2014 election cycle."

The seminal fight for SB 562 also reflects a national struggle for the movement for social change in the U.S. In a decade in which Democrats have lost 1,000 national and state elections under the umbrella of a status quo leadership that remains more responsive to Wall Street, K Street, and Silicon Valley than to its grassroots base, the battle for single payer/Medicare for All takes on added significance.

A recent national poll shows 60 percent of Americans believe "it is the federal government’s responsibility to make sure all Americans have health coverage." The question remains, will those who control the Democratic Party believe that "resistance" to Trump is enough to win lost voters or do they need to actively promote real populist reforms, like Medicare for All.

Opponents of SB 562, from the inner circle of the Democratic Party to their allies in the mainstream and even some in the liberal or supposed progressive media have cited the pretexts that we must wait while fighting the threat of repeal of Obamacare, falsely characterized some components of the bill even as amendments are blocked by Speaker Rendon, or denounced assertive tactics of the campaign by supporters to pass the bill.

We can draw lessons of the words of Dr. King, during the great civil rights movement, written from solitary confinement in a dismal Birmingham jail cell in 1963.

King chastised the "white moderates" who with their criticism of direct non-violent action and greater devotion to "order" than justice often posed a greater "stumbling block" to the "stride toward freedom" than the most virulent opponents in their path.

And he had stern words for those who always advised African-Americans "to wait for a 'more convenient season.'"

"For years now," wrote King, "I have heard the word 'wait'… This 'wait' has almost always meant 'never.' We must come to see that 'justice too long delayed is justice denied.'"


          Nurses Join Movement to End Illinois Budget Crisis By Taking to the Streets        

This Memorial Day weekend, Illinois members of National Nurses United (NNU), including RN Martese Chism, will lace up their walking shoes and prove that “going the extra mile” to stand up for their patients is a promise they take literally.

Chism will be joining the entire final May 26–30 stretch of the “March to Springfield,” a protest led by Fair Economy Illinois, numerous groups and organizations so fed up with a nearly two-year delay on Democratic state assembly members and Republican governor Bruce Rauner passing a budget — that they decided to stand up and move on the budget themselves.

“My great-grandmother marched from Selma, Alabama to Montgomery, Alabama with Dr. Martin Luther King Jr. and Congressman John Lewis,” said Chism. “Ten months later, she was murdered by the Klan for registering blacks to vote. I was five years old. This weekend, I am going to march to Springfield, Illinois to pay homage to my great-grandmother and her activism by fighting for a budget that provides good jobs, support for our communities and protection for the environment.”


Chism speaks at the May 15 Chicago kickoff rally for the March to Springfield.

A 200-mile journey to Illinois’ capital, launched in Chicago on May 15, the March to Springfield is meant to draw attention to the impact of the budget crisis on everyday people’s lives. Marchers, who are stopping in cities along the way for “listening sessions” with local residents, are championing a “People and Planet First Budget” that invests in single payer/Medicare for all healthcare, good jobs, world class public education, free public higher education, safe infrastructure, and green energy. Funding, say the marchers, can come from closing corporate tax loopholes, raising taxes on higher income earners, and enacting a financial transaction tax (“LaSalle Tax”) on Chicago’s commodities exchange.

Too many people are suffering in the state of Illinois. Poverty, and the lack of opportunities have taken their toll,” said Chism. “Last year, more than several hundred people died from gun violence. Two of those lost were my [family members]. That’s why I march.”

“I worked for 8 years in the dialysis unit at [John H. Stroger Hospital of Cook County],” Chism continued. “Many dialysis patients end up in kidney failure because they don’t have access to the basic healthcare they need; that’s why I’m marching, to create universal, single payer healthcare in Illinois. I want to come together with everyone across the state to win a people and planet first budget. “

“This is not a political game. This is a crisis,” agreed Chicago-area RN JoAnn Lingle, who did around 10 miles of the March to Springfield earlier in the month, inspired by the need for single payer healthcare. “Lives are at stake.”


RNs Lingle (L) and Chism with a photo of Chism’s great-grandmother, a civil rights activist killed by the Klan for registering blacks to vote. Chism carries on a family tradition of activism and marches in honor of her great-grandmother.

Standing up for public health is a vow on which they will always take action, say nurses, everywhere they go.

“We’re going to keep fighting for what we need, what will make our communities more healthy,” said Lingle. “I believe change has to be from the grassroots up, nothing happens from top down. So we will keep on marching.”

Marchers will arrive in Springfield, May 30 at 10:30 a.m., to march the last half mile from the old state capital building to the capital, where hundreds will rally, lobby and hold a People’s General Assembly to do what the General Assembly hasn’t done in two years: pass a People and Planet First Budget. For more information about the march and how to get involved, visit marchtospringfield.org


          Nurses, Activists Converge in Sacramento to Transform Democratic Party, Press Case for Single Payer        

More than 1,000 registered nurses and grassroots activists from across California converged on the state capital Friday for three days of action to challenge the status quo trend of the Democratic Party nationally and in California, and to press the call for the CNA-sponsored single-payer bill, the Healthy California Act, S.B. 562.
 
For many of the nurses and the hundreds of activists — dubbed “Berniecrats” who, inspired by the campaign of Bernie Sanders, won election as delegates to the California Democratic Party (CDP) convention — it was their first time as delegates.
 
After a day of RN visits to nearly every California state senator and Assembly office Friday urging their support of S.B. 562, the day culminated with an enthusiastic rally in front of the Capitol, followed by a vocal march to the Sacramento Convention Center where the state convention was getting underway.


Nurse power! RNs lobby senators and assembly members, urging support for S.B. 562.

The nurses and Berniecrats’ influence on the proceedings was apparent throughout the three days.
 
In her address to the full convention hall, CNA and NNU Executive Director RoseAnn DeMoro passionately argued that the path to uniting the party in California is to embrace a different set of priorities. After talk about how the “elephant in the room” was President Trump, DeMoro added that it is also “Republican ideology.” 
 
“You know we have our share of blame as Democrats for what’s happened in this nation,” said DeMoro, citing the loss of 1,000 elected seats across the nation in the last eight years. “I know we can all unify in hating the despicable policies of Washington, D.C., but the truth of the matter is we have to find the things that absolutely unify us and set us on the right path.”
 
“The Democratic Party desperately needs to enfranchise disillusioned Americans with vision, courage, and a sense of purpose. The status quo doesn’t work for Democrats, and don’t tell us we have to be more conservative in more conservative areas.”
 
“Consensus for consensus’ sake is over,” she warned. “If the Democrats dismiss progressive values and reenforce the status quo, don’t assume the activists in California and around the country are going to stay with the Democratic Party.”


NNU‘s ’RoseAnn Demoro: “Dems need to enfranchise disillusioned Americans. Consensus for consensus’ sake is over.”

The way to start to “bring this party together, to set the nation on the right track as leaders in this country, is to establish a model of progressive leadership, and for the Democrats to unite on supporting S.B. 562,” DeMoro said. It’s not enough to say you support universal healthcare while failing to support the bill to achieve it, S.B. 562, she pointedly added.
 
After DeMoro spoke, a number of those who followed her to the podium specifically cited support for S.B. 562, including Secretary of State Alex Padilla and Insurance Commissioner Dave Jones.
 
DeMoro’s challenge was also expressed by former Ohio State Senator Nina Turner, a board member of Our Revolution, who spoke at the Friday rally, to a large delegation of Berniecrats Friday night, and on the floor of the convention with Berniecrat nominee for CDP chair Kimberly Ellis.
 
“There is something wrong, not just in the great state of California but throughout this nation, when we have to beg elected officials to do the right thing. So we are not going to keep begging, we are demanding, and if they don’t come through we will vote them the hell out of office,” Turner said at the rally.


Nina Turner fires up the crowd by challenging California democrats to lead on progressive issues, support S.B. 562.

She invoked the counsel of former South African President Nelson Mandela that, “It always seems impossible until it is done.” Turner continued, “So I want you all, nurses and non-nurses, because that’s how we’re measuring folks now, nurses and non-nurses, people who believe in humanity to keep on pushing, keep on demanding. You in the great state of California will lead the nation and remember you have supporters all over this country.”

At the rally, CNA Co-presidents, RNs Malinda Markowitz and Zenei Cortez, also talked about how to win S.B. 562 and other progressive changes through concerted grassroots organizing. They highlighted the need to hold Democrats, who control the Legislature and the governor’s office, accountable to the voters, not the powerful health insurance and pharmaceutical industries.
 
On the floor of the convention, the push for change came down to the hotly contested election for new CDP chair between Ellis, supported by CNA and the Berniecrats, and CDP vice chair Eric Bauman, the anointed candidate of the establishment wing of the party who has campaigned for the job for months.


Kimberly Ellis, surrounded by her supporters, who packed the convention hall.

Ultimately, Bauman was proclaimed the winner by a razor-thin margin of 62 votes out of nearly 3,000 votes recorded, with at least a third of the votes being handed to appointees of party officials and legislators who are anxious to hold their grip on the reins. These appointed delegates are the state equivalent of national Democratic Party “superdelegates.”
 
While Ellis and her supporters continue to raise questions about the vote count, DeMoro afterwards praised activists for taking on the establishment reflected in the extremely narrow vote.
 
The final result “has very little to do with what we do out as an organization out in the field,” DeMoro said. “So let’s talk about this, where do you go from here? You don’t give up. You double down.”
 
“For you to come, and us to come, this close is pretty amazing,” DeMoro said. “Don’t feel discouraged. You showed tremendous power and strength. These votes mean that you can take out just about any Democrat in the state if you continue to organize.”
 
As Los Angeles Times reporter Cathleen Decker afterwards wrote, the reign of the old guard in the CDP “effectively ended at this weekend’s state party convention, part of a shift both generational and ideological that is altering power across the country and in the nation’s biggest Democratic state.”


Nurses will not give up until California democrats stand up for S.B. 562. RNs know healthcare is a human right.


          Global Nurses United Organizes Global Week of Action in Honor of International Nurses’ Week        

Global Nurses United, the international federation of nurses’ unions in 21 countries on six continents, organized a global week of action in honor of International Nurses’ Week.  Around the world, nurses took action to protect patients, improve their health care systems, ensure that all patients have access to health care services and medicines, and address health care inequity and social justice concerns.  Here’s a sample of the nurses in action around the globe.

Australia

The New South Wales Nurses and Midwives’ Association (NSWNMA) urged the government to provide strong funding for the health sector.  “Nurses and midwives have been lobbying for the resources necessary to deliver safe patient care across our public health system for many years with little reprieve,” said NSWNMA General Secretary Brett Holmes.  Union members demonstrated on May 4 in Gunnedah demanding better nurse-to-patient ratios.

Members of the Australian Nursing & Midwifery Federation (ANMF) also celebrated International Midwives’ Day across the country this week.  Activities in New South Wales included: morning and afternoon tea parties, ‘walk with midwives’ marches, midwifery conferences, and the packaging of birth kits for women in developing countries.  Holmes highlighted the increasing demand being placed on registered midwives, with ongoing workforce shortage issues occurring throughout the state.

“The New South Wales Government needs to deliver a sustainable midwifery workforce and ensure measures are in place to support our midwifery profession into the future,” Holmes said. “Midwifery isn’t a nine to five, Monday to Friday job, it demands highly skilled professionals to be responsive under a whole raft of evolving circumstances. Maternity wards must have the correct skill mix to ensure midwives are supported across every shift, of every day.”

Queensland Nurses and Midwives' Union secretary Beth Mohle said the importance of midwives should never be underestimated as they help expectant mothers safely navigate one of life's major milestones. "Increasingly more women are choosing to have a known midwife to provide care throughout pregnancy and birth in Queensland," she said.

The ANMF called on the Australian government to increase funding for the health care sector.  “On International Nurses Day, we are disappointed the Government can deliver up to $50 billion in corporate tax cuts to big businesses, but can hurt hard-working aged care nurses and Australia’s next generation of nurses,” said Federal Secretary Lee Thomas.

Read more about the Australian events here:

Western Advocate
Coffs Coast Advocate
The Bellingen Shire Courier-Sun
The Paramatta Holroyd Sun

Brazil

Members of the Federação Nacional dos Enfermeiros have been active throughout the week in honoring International Nurses Day by fighting to prevent dangerous changes to the nation’s labor and social security system.  In the states, they had several events in commemoration, as well.

Canada

Canadian Federation of Nurses Unions President Linda Silas has a video message to the nearly 200,000 members across Canada on their Facebook page

Canadian nurses helped lead the Canadian Labour Federation march for a fair future with thousands of fellow labor activists. They marched for “decent work, a $15 minimum wage and the right to join a union, but it also means challenging racism, Islamophobia and xenophobia, while championing equity, social justice, and a green economy.”

Dominican Republic

The nurses’ union SINATRAE engaged in a day of protest at the Ricardo Limardo Hospital in Puerto Plata on May 11, demanding that the hospital be supplied with medications and other supplies and repair its physical plant. Nurses and other workers were met with repression from the police, including the use of pepper spray. "Despite the harassment of the National Police against the protest in front of the Ricardo Limardo hospital, dozens of nurses, pharmaceutical bio-analysts, support workers and doctors also joined in. The health workers are firm, to the point that they paralyzed traffic for several minutes on the avenue since this fight does not stop," said Miguelina Alejandro Martínez, an official of the union.

Honduras

In Honduras, the auxiliary nurses’ union ANEEAH, demanded last Friday that the Honduran government pay 90 million lempiras (US$3.8 million) to the health authorities to pay for back nurses’ wages.

Ireland

The Irish Nurses and Midwives’ Organisation held their annual National Occupational Health Nurses Section Conference on Wednesday, May 10 in Cork. The theme of the conference was “Occupational Health: Wellbeing Strategies that Work” and nurses heard from a host of excellent speakers on how to improve occupational health standards.

The week before, the INMO held its annual conference in Wexford. INMO President Martina Harkin-Kelly told delegates that the conditions nurses work in are “unsustainable, unacceptable and dangerous, and something will be done.” Harkin-Kelly threatened industrial “Armageddon” if nurses aren’t given a significant pay rise and improved working conditions.

Kenya

In Kenya, more than 1,000 striking nurses, members of the Kenyan National Union of Nurses, held demonstrations to protest at delayed promotions, under-staffing, and poor working conditions.

New Zealand

The New Zealand Nurses Organisation (NZNO) has been very active throughout the week, including presenting to the leader of the opposition its vision for delivery of primary health care, celebrating indigenous nurses and calling for more government attention to recruiting Māori nurses, holding picnics at various regions, and launching a new poetry book Listening with my Heart’ – the poetry of Aotearoa New Zealand nurses. NZNO organisers and member are also gaining signatures for the petition for more healthcare funding at the Northland (Tai Tokerau) Regional Convention and at the Auckland Nurses’ Picnic.

NZNO Manager of Nursing and Professional Services Jane MacGeorge says, “Nurses are the largest profession in the health system and without them the health outcomes for people receiving care and treatment in the health system would not be improving as they are.  I often reflect that nurses hold the world together. We are in every community, culture and society the world over.”

Check out the NZNO Facebook page for more info.

Philippines

The Filipino Nurses United (FNU) this week paid a special tribute to Filipino nurses all over the world and stood proudly as part of the global community pursuing improvements in the socio-economic conditions of nurses alongside the promotion of people’s right to health. FNU was proud to join together with Global Nurses United members all over the to take action against attacks on nurses’ rights, and against government health budget cuts and privatization of public health.

The Filipino Nurses United stood proudly for health care as a right and for a fully funded national health care system responsive to the needs of the people.  This week FNU spoke out about the inequitable distribution of nurses and health care.  At the same time, it also spoke out against the continued low wages and poor working conditions of Filipino nurses, including incredibly unsafe staffing of as many as 60-80 patients at a time.  Nurses suffer from extended, often unpaid duty hours due to severe understaffing, aggravated by very low pay, inadequate benefits and even shortage or lack of medicines, supplies and equipment to carry out our nursing tasks. With inadequate or lack of nursing job opportunities, nurses become more vulnerable victims of exploitation.

“We are marching to Malacanang to reiterate our extreme disappointment with the abuse and exploitation happening within our ranks while the government remains unresponsive and indifferent to our plight. People’s health and our legitimate demands remain least priority while the government aggressively pursue neoliberal policies such as privatization of public health, free trade agreements such as ASEAN integration and labor export policy.” Ms. Nolasco, FNU president declared.

South Africa

The Democratic Nursing Organisation of South Africa (DENOSA) Limpopo, in collaboration with the provincial Department of Health, will lead thousands of nurses in the province in commemorating International Nurses Day (IND) on Friday 12 May to reflect on both successes and challenges that nursing is faced with, and commit to supporting sustainable development and health around the world.  DENOSA is proud that in South Africa, nurses are committed to achieving the sustainable development. 

Spain

SATSE launched competitions for nurses to promote the work they do online with the hashtag #DiaDeLaEnfermeria which is highlighted on the union’s Twitter campaign sites @soyenfermera and https://twitter.com/Sindicato_SATSEThe union also is organizing events at hospitals and health centers in Huelva and Asturias and elsewhere around the country, celebrating the contribution of nurses in those communities.


United States of America

In the United States, more than 100 members of National Nurses United (NNU), the nation’s largest union of registered nurses, visited the U.S. Capitol in Washington, DC and took action on Wednesday.  Nurses met with members of Congress to urge them to support expanded and improved Medicare for all, mandatory nurse-to-patient ratio legislation, and other bills to lower prescription drug costs, and fund health care, free college tuition and other social needs.

"Health care is a human right, and the way to make that right a reality for everyone in this country is through an expanded and improved Medicare for all system,” said NNU Co-President Jean Ross, RN.

"Nurses are speaking powerfully to our elected officials of both parties to tell them what Americans need and that’s a fair, just and equitable healthcare system for all,” said NNU Executive Director RoseAnn DeMoro.

The nurses also marched on the office of Senate Finance Committee chair Sen. Orrin Hatch to urge him to reject the American Health Care Act (AHCA), a Republican bill passed by the House of Representatives that would take away health insurance for more than 24 million people and instead support real reform, an improved and expanded Medicare for all.

NNU members, led by co-presidents RNs Deborah Burger and Jean Ross delivered a letter for Sen. Hatch to one of his aides, a health adviser, which called the AHCA “a mortal threat to the health and well-being of our patients, and to the health security of our country” that would result in the loss of existing health coverage for tens of millions of people without any restraints on healthcare industry pricing practices.

NNU members also paid visits to numerous other Congress members urging them to oppose the AHCA, and support Medicare for all.  The RNs also called on legislators to support legislation introduced last week that would set specific safety limits on the numbers of patients each RN can care for in hospitals throughout the U.S.

“It is a travesty that 49 out of 50 states in the U.S. impose no legal limit on how many patients can be assigned to a nurse at one time in acute care hospitals,” said Burger.

The Minnesota Nurses Association/NNU worked with legislators to introduce the Quality Patient Care Act in the Minnesota Legislature to require hospitals to maintain a minimum number of trained nursing personnel at all times to take care of the number of patients at that facility.  Hospital staffing plans would follow nationally accepted, evidence-based standards that indicate the proper nurse-to-patient ratio for each department.  “Nurses continue to say we are taking care of too many patients at one time,” said Mary Turner, president of the Minnesota Nurses Association. “Short staffing is unacceptable in Minnesota.  Patients suffer when they don't receive the care they deserve.  Their medications are late.  Their assessments don't happen.  Their discharge instructions are rushed through.  That means some patients have to come back to the hospital with infections or complications.”

The Maine State Nurses Association/NNU participated in a health fair and helped lead a rally in support of a Medicare for all system in Maine, on Saturday, May 6th.  Maine State legislators joined nurses and allies for a rally and a press conference, and released a report details the state of the healthcare crisis in Maine and calls for statewide, universal, publicly funded care.

“The new report reflects the healthcare crisis that RNs witness first hand," said Cokie Giles, RN and MSNA president. "As long as health care is controlled by the insurance industry, nurses will not be able to provide the single standard of safe and effective care that our patients deserve. We are inspired by the campaign to create a single payer insurance plan in California and efforts in Congress to move towards single payer nationally. Now is the time for Maine to move forward too."

And registered nurses and other healthcare workers at Hospice of Southern Maine Wednesday voted to join the Maine State Nurses Association, resisting an intense anti-union campaign by their employer.

Registered nurses in Ohio are organizing to pass legislation in their state to prevent the dangerous and common practice of mandatory overtime and to make nurse-to-patient ratios the law of the state.

Global Nurses United was created in 2013 to address the issues all nurses around the world dedicated to social justice have in common. Members of GNU work to protect their patients on many fronts, from bedside care to the environment. GNU was born from the idea that we are one planet, one people, dedicated to caring for each other.


          Support for S.B. 562 grows. A conversation with CNA/NNU Legislative Advocate Stephanie Roberson.        

If you haven't heard about the Healthy California Act (S.B. 562) you need to listen to this podcast. Nurse Talk visits with CNA/NNU Legislative Advocate Stephanie Roberson about this SINGLE PAYER legislation that if passed could guarantee all California residents affordable comprehensive healthcare. We need your help to pass this California! Visit www.healthyca.org for full details of the bill and how you can support it.


          Over 1000 Supporters Converge on Capital to Rally and March for SB 562 the Healthy California Act        

Bill Clears First Hurdle with Senate Health Committee Approval!

Registered nurses and other healthcare advocates are celebrating the California Senate Health Committee's passage this week of SB 562, the Healthy California Act, a bill to establish an improved Medicare for all type system in California. Full details of the bill may be viewed here http://bit.ly/2ng5hUg

Prior to the hearing, over a thousand supporters, including members of the California Nurses Association/National Nurses United, held a spirited rally at the Sacramento Convention Center followed by a colorful march to the State Capitol for the Senate Health Committee hearing.

“The most important thing today was the breadth and depth of support by the dozens of people lining up to back the bill, representing 250 organizations across the state. These are organizers who are going to be with us to make the Healthy California Act the law of the land in California,” said RoseAnn DeMoro, executive director of CNA/NNU, the primary organizational sponsor of SB 562.

The rally kicked off with comments from CNA/NNU leadership, followed by Dr. Paul Song, co-chair of the Healthy California Campaign, Mahul Thakker, of the Business Alliance for a Healthy California and bill co-authors, Senators Ricardo Lara and Toni Atkins.

"Why is this fight important for me," asked Zenei Cortez RN and CNA/NNU Co-President. "As an RN for almost 40 years I find it very difficult to see patients who come in for surgery but when they register they find out they have a $5000 copay and they cancel the much needed surgery because they can’t afford it. That breaks my heart.  So this fight is important to me as it is for all of you. The people that came in on the bus with me came from the community – I thank you for joining with the nurses, traveling here to Sacramento to win this fight with us. The time is now."

“From our perspective as nurses, for many years it felt like we were in this fight alone, but look at us today. We have people here from all walks of life. We have a coalition that is so awesome and we have the people of California that want single payer,” said Malinda Markowitz RN and Co-President of CNA/NNU.  

“In the run up to this day we’ve been meeting with thousands of Californians all across the state in meetings, rallies and town halls," said Bonnie Castillo RN, CNA/NNU Associate Executive Director. "The combination of nurses working with all of you community organizers is a winning combination. We are demonstrating to our elected officials what Californians need and that’s a fair, just and equitable healthcare system for all.

“Nurses understand that we are in a healthcare crisis that is only going to get worse for our families and communities. Nurses know it is a moral imperative to put an end to this market-driven system,” said Castillo.

“There are still 2.9 million people who don’t have healthcare in our great state. We are not going to rest till every single Californian has access to comprehensive healthcare," said bill co-author Sen. Ricardo Lara. "We know that those who don’t have access to healthcare have significantly worse outcomes and are disproportionately people of color and families from low-income communities. Americans continue to pay more than any other industrialized nation and get less. How does this make sense? That we as the richest country on the globe pay more for healthcare and get less? That is not right and we have to change that. 

"Join us in this revolution to insure that everyone has the access to care, we don’t care if you are undocumented, if you are a low-income worker. We want to insure that everyone has care, because this is who we are as a society. One election is not going to determine who we are as Americans, and who we are as Californians. California leads. California has the courage to say it’s time finally to remove the insurance companies from the decision-making on how we get care in this country," said Sen. Lara.

 “It’s unbelievable that we could live in the richest state, in the richest nation in the world and yet people don’t have access to healthcare. That is wrong,” said bill co-author, Senator Toni Atkins. “California will not go back. We are not standing still. We are going forward.”

As marchers headed to the Capitol building through the streets of downtown Sacramento they chanted: “When the system fails us, what do we do? Pass S-B-5-6-2,” and “California here we come, 562, let’s get it done!”

Once marchers arrived at the Capitol, the Senate Health Committee hearing room quickly became packed with enthusiastic supporters of the bill - the crowd spilling out of the chamber and filling the hallways.

 

 

Senators Lara and Atkins, introduced the bill followed by Michael Lighty, CNA/NNU Public Policy Director’s opening statement. “Registered nurse are on the front line of patient care as you know and I’m proud to represent the 100,000 RN members of the California Nurses Association/National Nurses United, the primary sponsors of this bill to provide universal coverage for all Californians,” said Lighty.

Many supporters with a wide arrange of affiliations from throughout the state, took turns at the microphone to urge passage of the bill during the public comment period. These included California Labor Federation, Latino Coalition for a Healthy California, California Alliance of Retired Americans, California Teachers Association with 325,000 members, California Federation of Teachers with over 100,000 members, and California School Employee Association with over 240,000 members. A representative of the California chapter of Physicians for a National Health Program (PNHP-CA), stated, “our 3000 members are in strong support of this bill because it will allow us to practice much better medicine than we are able to in the current system.”   

After more than two hours of debate and discussion the Senators took a vote and pased the bill by a vote of 5-2.  

To see photos of the march and rally click here.

For resources and information about the Healthy California Campaign, click here.


          Progressive Democrats Of America’s Donna Smith, “YES WE CAN”!        

The time is here for single payer and there is a groundswell of support. The single payer healthcare movement—more specifically California’s Healthy California Act or SB 562 and on a National level HR 676 a Single Payer Bill introduced by John Conyers. Both bills are garnering much attention. Executive Director of Progressive Democrats of America, Donna Smith joins Nurse Talk Radio.


          One part of the Constitution the establishment loves        
Sam Smith Some media made a big thing of a conservative judge joining the appeals court decision upholding Obamacare’s individual mandate. In fact, Obamacare is a highly conservative measure – when compared to Medicare or single payer – and the individual mandate amounts to a huge earmark subsidizing the health insurance industry. Bear in mind, … Continue reading One part of the Constitution the establishment loves
          Re: Solutions to health care issues are non-political, not D.C.-based        

Politicians cannot figure out how to save the obscene profits of the healthcare insurance corporations, HMOs and big pharmaceutical corporations with single payer.............

Single payer aka Medicare for ALL...............including Craig Hall........


          Re: My experience says we don’t have a health care problem        

What a fuggin idiot.................you need to get outside your bubble and see the real world.
Single payer aka Medicare for ALL..............not just you and your dad.


          Comment on Pelosi Promises Policy by Wayde Delafield        
If the Democrat bill passes the House of Representatives then everybody that is employed in the Health Insurance industry will ultimately lose their jobs. Speaker of the House Nancy Pelosi and the liberals have already begun the process of demonizing the insurance industry as the source of all of our problems. President Obama clearly wants the single payer option, which is demonstrated by the Senate bills incentives for employers to offload their employees onto the government rolls. Clearly, this is not about providing insurance for Americans, rather it is a socialistic game changer where bloated bureaucrats get to control all aspects of our lives under the guise of cost containment. When has the government ever lowered the cost of anything? Why was the cost of Medicare nine times more expensive than projected? Trusting this liberal government to do accomplish anything is simply a fools errand!
          Early Headlines: Asia Stocks And Oil Up, Dollar Down, Gold Flat, Trump Letter Screw-Up, Single Payer Gains Support, India Turns On Fuel Burner, Abe Scandal Bites, Few N. Korea Options, And More         

Written by Econintersect

Early Bird Headlines 01 August 2017

Econintersect: Here are some of the headlines we found to help you start your day. For more headlines see our afternoon feature for GEI members, What We Read Today, which has many more headlines and a number of article discussions to keep you abreast of what we have found interesting.

early-bird-301-180

Read more ...


          Comment on Political Reality Bites and So Does Bernie Sanders by Caroline        
If you are going to push Medicare for all you've got to be honest about it and so far Bernie has not been. You've got to tell people exactly what is going to be covered, what is not and how much it is going to cost everybody in taxes. One of the things that these advocates don't admit is that the way we do medicine in this country is expensive and Medicare for all does nothing to change that. So hence the extremely high cost for a single payer plan in this country. Bernie's own plan failed in his own home state and then it went down 80/20 in Colorado. The thing that needs to be advocated for is universal health care. There are a lot of ways to get there and unless the Hyde Amendment is gotten rid of single payer will cut a lot of women out of access to health care. Also do we want Mike Pence making our decisions for us?
          Improved Medicare for All is the Answer        
On August 2, 2017, The Nation published an article by Joshua Holland, “Medicare for All isn’t the Solution for Universal Health Care,” chastising Improved Medicare for All supporters because, in his view, the single payer movement has “failed to grapple with the difficulties of transitioning to a single-payer system.” The article, which doesn’t quote anyone More
          1648 - Joshua Holland: Time To Sweat The Details Of Single Payer        

Why The Trump Administration is pushing a new white supremacy based anti immigrant package.

Journalist Jushua Holland, explains the recent Democratic pivot toward Medicare For All. Is Single Payer healthcare the wrong litmus test? The transition to universal healthcare. The basic challenges of insuring every American. Loss aversion and the best way to achieve  full coverage. Why the ACA was sold in the wrong way. Is there a distinct importance to having a universal coverage? And why no matter what the specifics are we should call the program Medicare For All.

On The Fun Half: Seb Gorka says Trump can dictate North Korea policy through Twitter. Stephen Miller attacks Jim Acosta. Mark Steyn, can get out of our country. Tucker Carelson still complaining about Al Gore. Dave Rubin hosts British tabloid bigot and your calls IMs.

Become a member of the Majority Report today! https://majority.fans.fm/memberships/new


          1640 - Ben Mankiewicz: Goodbye Spicer, Hello Scaramucci         

Ben Mankiewicz (@BenMank77) on TCM and TYT joins us today. What's the significance of Chuck Schumer saying "single payer" is "on the table" on ABC's This Week? Remembering Sean Spicer, meeting Anthony Scaramucci. Jared Kushner talks to the Senate about Russia.

On the fun half - The Dems new slogan, are we a free country if Mueller is fired?, Obama sons Anthony Scaramucci in 2010, and your calls and IMs!


          Fight for Single Payer        
Editor: With the struggle about healthcare continuing, the strengths of a single-payer system are visibly impressive.…
          Single Payer Now        
Editor: Senate Bill 562, the single payer health care bill that was passed by the California Senate, has been shelved for the year by Assembly Speaker Anthony Rendon ("My Selfish Lens," June 22).…
          Bringing a single payer healthcare system to DC        
I have retired from PR and have decided to work full time to bring a single payer healthcare system to DC. Under Obama's Affordable Care Act states, including DC, can create their own single payer systems. Such a system would save DC taxpayers millions or dollars in addition to guaranteeing healthcare to every DC resident. It is cheaper for the entire city to self insure itself that pay millions of dollars to private health insurance companies in addition to contracting with providers. It would save residents of DC millions of dollars to pay a reasonable healthcare tax, such as Canadians do, rather than extortionate health insurance premiums. Follow my work at Alice Marshall on Medium. Contact me at marshall@prestovivace.biz if you would like to help.
          Affordable Health Care? Facts, Opinions, and a Solution!        

Disclaimer: I am not a financial wizard, or a financial analyst. I sold health insurance for six months or so but that was 35 years ago. I do work for a company in the
business of health care but we distribute supplies so we get paid no matter how this goes. Finally, these thoughts are mine and mine alone. I’m just a concerned citizen who scratches his head at the folly of our legislature debating Health Care and various acts they want to repeal or pass.

Let’s begin with the Facts:

Prior to 1973, it was illegal for healthcare to be conducted on a “for profit” basis. The Health Maintenance Organization Act was passed by Congress and signed into law by President Nixon on December 29, 1973 to encourage and promote HMOs as a way to reduce the cost of health care on a trial basis. The intention of this act was that entities could eventually begin to use profits to offset costs, thus driving down overall costs. (Or make a buck out of healthcare, however it worked out. Turned out to be the latter.)

All Americans are guaranteed to receive some form of health care should they show up at an Emergency Room at a hospital even if they have no way to pay for it. (This is as a result of the Emergency Medical Treatment and Labor Act passed by Congress in 1986 and signed into law by President Reagan. It’s an unfunded mandate that all hospitals appear to heed; more on this later.) The fact that this legislation was passed leads me to believe that, We the People, believe that everyone is entitled and has a right to basic healthcare.

The annual cost of healthcare in the US is $8608 per capita (that’s as of 2015; current estimate is $10,068 per capita) which is the highest in the world. Despite this, the US does not have the “best health care in the world” as many believe. The following paragraph comes from Wikipedia.

The United States life expectancy of 79.8 years at birth, up from 75.2 years in 1990, ranks it 42nd among 224 nations, and 22nd out of the 35 industrialized OECD countries, down from 20th in 1990.[6][7] Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of obesity, car accidents, infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, and homicides. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country, though notably Americans aged 75 live longer than those who reach that age in other developed nations.[8] A 2014 survey of the healthcare systems of 11 developed countries found the US healthcare system to be the most expensive and worst-performing in terms of health access, efficiency, and equity.[9] 

(We must be very proud!)

There is no such thing as “free health care.” Even the indigent, who may get health care they can’t pay for, aren’t getting it for free. It may be free to them but the rest of us are paying for it.

How? Hospitals, bound by the law mentioned above, record the cost of that care on their books as “un-reimbursed expenses” which is above the profit line. That means, it is accounted for as an expense or “cost of doing business” and is simply deducted from their potential profits. In other words, all of those who pay the hospital money (insurance companies, your employer, you in the form of copay or deductibles) pay for it.

That means WE pay for all the health care in the country. Medicare, Medicaid, private insurance, and our employers may send a check to pay parts of our healthcare bill but they get the money to do so from We The People in the form of taxes paid, health insurance premiums, copays, and deductibles. We pay. They 
administrate.

About 18.5% of all the money in our economy is taken up by the cost of health care. How much is that?

Current In round numbers, it’s $3,400,000,000,000. That’s over three trillion dollars and it continues to go up every year. This is the reason that the Affordable
Current Law
Care Act
and it’s repeal / replacement / adjustment / tweaking are so important to our Congress. And it should be very important to all of us because, in the end, they’re discussing the distribution of almost 20% of our money, each year.

Do you trust them? (And by them, I’m talking about Congress since they’re the ones deciding how this will be done.)

Now, here are my Opinions (along with some additional facts):

Consumerism????

I find it ridiculous that healthcare isn’t treated like nearly every other business in this country. What do I mean? Well, we have all kinds of consumer protection laws in place to ensure we don’t get the shaft from just about every type of business but nothing like that exists in healthcare!

When I worked in retail consumer electronics, we were required to have on display
Prices?
and available for sale in every store, any item that was advertised in our newspaper circular. Failure to do so, could result in a $10,000 fine per location. On any given Sunday, that meant we were on the hook for up to $7 million in fines due to being out of stock and this was enforced by the Federal Trade Commission. (The law came about as the result of bait and switch tactics practiced by some retailers.)
In the world of healthcare, pricing is a kind of smoky unreality that no one really wants to talk about with the patients. (The only place where pricing is upfront is typically in the case of Urgent Care Clinics. These places spell out their prices for visits when you check in. In other words, they act like a retailer. How refreshing!)

Example – an acquaintance of mine was diagnosed with a form of sleep apnea and was prescribed a CPAP device; these blow air in your nose and keep your airway open so you can actually sleep. When they went to the equipment provider, they were unable to tell how much the unit cost and how much the private insurer would cover. This person called the insurance provider and they were unable to explain how much coverage would be provided so that the insured could budget for the purchase. In other words, no one was willing to own up to actual cost for the patient! (In the end, it amounted to over $1200 and this person was able to cover that but most people in this country could not afford that expense; in fact, most Americans couldn’t afford it if it was as little at $400.)

High Costs – because, waste

On a different plane, why is the cost of healthcare itself so high? Particularly when the US clearly isn’t getting much in return? (See rankings above.)


For one thing, there is a great deal of waste involved in our current system. The person with the CPAP machine that I just mentioned received a total of 11 different bills (delivered thru US mail) for the device, despite having gone to only one provider for the unit!

This is an example of waste that occurs on a daily basis in every aspect of health care. In this case there is at least 10 bills too many, all with postage that adds up to around $5 of wasted postage cost. But it’s far more than that. Each of those bills and invoices had to go through various departments/people for processing before being printed and mailed to the insured. A quick Google search tells me that it costs anywhere from $7 to $37 dollars for each invoice produced. If we take the halfway point, that’s $22 per invoice or $220 worth of waste for this one transaction. Bear in mind, that the waste noted here is only on the patient side. If the same number of invoices have to be produced for the private insurers, it doubles. That’s $400 of waste on one transaction (that cost the patient $1200) and we’ve only looked at the billing!

More waste occurs in another way, over-testing. Currently, physicians are reimbursed for procedures / tests that they perform, a methodology known as pay for procedure. The downside to this is that it incents them to perform more tests than may be needed for a given presentation by a patient. Is there justification for this? Maybe. Doctors claim that it helps to keep the cost of malpractice insurance down but I haven’t done any research on that. (I do know that my personal physician sold his practice about 8 years ago and moved into another role in health care because his malpractice insurance had risen to $12,000 per month and he’d never had a claim! That cost was more than he could overcome.)

It’s estimated that a third of health care costs are caused by waste in the system. That seems like a reasonable number to me, especially when you consider that 64% of all healthcare is paid or administered through some form of government program: Medicaid, Medicare, Veteran’s Administration, for example. If that estimate is correct, that is $1 trillion that is being paid for, needlessly, by all of us every year! (That’s 1/12 of the economy.)

Higher Costs – because, profit!

Another cause for the high cost of health care stems from the costs of pharmaceuticals. Manufacturers invest a great deal of money in coming up with new drugs to fix all of the things that ail humankind and I recognize that. But do you know how much they spend on advertising? In 2016, it was $5.2 billion!
WTF with 2 tubs????

Direct to consumer drug advertising began in 1982 but didn’t really get going until 1997 when the law was loosened up and TV advertising began in earnest. It’s gotten really bad the last few years as more and more manufacturers expand their advertising and, coincidentally, their prices. According to a report by CBS News, 20 brand-name, high use, prescription drugs have quadrupled their prices since 2014. In 3 years, that equates to a compound annual increase of 48%! I’m not aware of any current business that is driving it’s pricing in such a way while still remaining in business.

So, “Ask your doctor if continuing to get screwed by high drug prices is right for you!”

Solutions – are there any?

The Affordable Care Act, known colloquially as Obamacare, was enacted in 2010 and signed into law by President Obama. It was designed to reduce the overall cost of healthcare by providing insurance coverage for those who can least afford it and, generally speaking, cost the most.

Remember the law guaranteeing health care for poor people in the ER? That’s where many would go for anything health related. As a result, they’d be going to the most expensive provider for the least expensive need (flu, cold, general maladies) and getting no well care to help keep chronic disease (diabetes, hypertension, high cholesterol) held at bay. Result – increase in health care cost.

The ACA provided millions more people with health insurance, and coincidentally slightly better health care, thus bending the cost curve down. (That’s not really a reduction in expense, it’s a reduction in the amount of increase. It’s better but not dramatically so.)

American Health Care Act
Turn your head and cough!

Now that the GOP is in charge of the House, Senate, and White House, they are bound and determined to fix healthcare once and for all. They intend to do this by repealing and replacing the ACA and replacing it with something better. (Thus, saving us from “the complete failure of Obamacare.” I wish everyone would speak less dramatically about all of this. Obamacare has actually bent the curve down slightly as to the overall cost. I hope whatever the GOP comes up with fails at least that good!)

The House plan calls for reducing the amount of money spent on Medicaid (that’s the one that covers the poorest people in the country) a defunding of Planned Parenthood, along with a loosening of insurance laws that would allow them to sell across state lines (that’s not yet clear on details) and it would leave in place some of the features from the ACA around pre-existing conditions and allowing dependent children coverage until age 26.

This plan would also remove a tax on the wealthiest members of society which was in place to pay for the ACA. (Thank goodness! I was worried about them.)

According to the Congressional Budget Office, this would cause 23 million people currently insured to lose their coverage.

According to the House majority, this would turn loose the power of the open market to reduce prices for insurance thanks to competition and free market forces. It would also allow people to purchase the insurance they want, instead of having it forced up on them. (Except of course poor people who, according to one legislator could just “get a job to pay for it.” Or pay for their living expenses, like food or something.)

The Senate, as of this writing, is still working on their own version of the repeal and replace bill. Things that have been floated out from the caucus that is working on it, don’t sound much different from the House version

My Solution – Hey guys, you’re fixing the wrong things!

I believe that every citizen of the US is entitled to basic healthcare, just like every other developed nation on the planet. I further believe that rich people should be free to purchase even better health care if they wish because, hey, they can!

I don’t believe that the government should be in the administration of health care but I do believe they need to be involved in setting parameters for the business. (Why? It’s 1/6 of our economy. If it’s not regulated we end up with the Great Medical Recession of 2030 or something like it. Don’t think it needs to be? See banking and Great Recession on Google.)

I believe that the only way to do this is by using a system that I call Modified Single Payer. (I fully recognize this is way oversimplified but we have to start somewhere and I'm not against something completely different!)

I propose that insurance companies are designated for every locale in the country. It could be state, region, county, GMA, or something else. Every area has at least 2 companies to insure competition. These are for-profit entities and are required to cover all the citizens in their markets. (Note that non-citizens are not covered by this.)

Providers (that’s the medical people) can sign up with whichever insurer they want or both or none if they prefer. (My back doctor refuses to take insurance and he is doing just fine without it. I don’t want to force any provider on this.)

All of the money (less 30%) that is currently being paid out for healthcare is dumped into a pool to be divided among the payers and it’s their job to pay for the health care being handled by the providers.

The pool of money made up of that 30% is held back for bonuses. As waste is identified and quantified, the bonus money is provided in some form to compensate the group that discovers it, at a maximum of 1/3 of the bonus pool. This could be providers, insurers, even patients! If no waste is discovered, no bonus is paid. 

All of the money left over at the end of a period (2/3 or 20% of the total spent) is refunded back to the citizens who paid it into the fund. (If someone didn’t pay any in, they don’t get any back.)

I submit that this would improve out healthcare AND our health while improving our economy ($680 billion back in the hands of Americans that isn’t going to health care? New TVs for everybody!!!!). And we might even have a health system that rivals other countries.


What a concept!

          Comment on SEAL sniper killed—not exactly an eulogy by Patrice Greanville        
THANKS EVERYONE FOR YOUR COMMENTS. Much appreciated. THESE LINES ARE CHIEFLY IN REPLY TO KURT B., who responded to this article on <a href="http://www.opednews.com/articles/SEAL-sniper-killed-not-ex-by-Patrice-Greanville-130204-518.html#startcomments" rel="nofollow">OpedNews</a>. He says: <blockquote><em><strong>KurtB</strong> <strong>The true enemy</strong> We have no business executing resistors in the Middle East whether it is done with Chris Kyle's sniper rifle or Barrack Obama's drones. To those appalled at the thought of shooting a mother holding a baby, were you equally appalled when an agent of your government did the same thing to Vickie Weaver at Ruby Ridge as she held her infant daughter but no grenade? It's time to stop the demonization of "Right-wingers' and see the true enemy: those who control the apparatus of government both Left and right.</em><em> </blockquote> <strong>Kurt, I understand your feelings and sense of rage. What happened to Vicky Weaver should not have happened, other methods should have been employed to reach a civilized settlement to that standoff.</strong> But, let's face the facts. The US is now a mess. And there is no way to get out of this stalemate in policy because the country is deeply split between irreconcilable factions. There are three distinct factions:The right, which, however it wants to see itself, or be seen, always manages to side with the corporate powers that be, in other words, the owning class, the superrich. Then there's what passes in America for the Left, that is "the liberals.". (More on that below). The right and the pseudo left are about matched in social power and numbers. And then there's the real left, which is next to invisible, tiny in numbers, its powerlessness inflicted by the establishment's total victory in the media.propaganda wars. The establishment, much noise to the contrary, comprises both the right and the liberals. Keep that in mind. The right and ultra-right, with a very upside down view of history and reality, are bathed in the mental rot of religion, and wholly supportive of "American exceptionalism"—that is imperialist approaches to foreign policy (and authoritarian measures at home, too). These people, who constitute at least half of the population of America specialize in shooting themselves in the foot when it comes to defending their own interest or that of America at large. (Check out, What's Wrong with Kansas?). Knee-jerk "patriots" —mostly middle and lower middle class with little property to their names invariably support tough-talking rightwing politicians like George Bush, Cheney and total scum like Oklahoma Senator Jim Inhofe, and their ilk who govern the country on behalf of the plutocracy. They care little and understand less about environmental problems, now reaching catastrophic proportions around the world. This crowd ends up giving their time, muscle and money to the plutocracy (government of the rich, by the rich and for the rich) that is really the problem we all face. These people gladly support big government when it comes to throwing obscene amounts of money into the bottomless corrupt military-industrial well, but —in the misguided and heavily propagandized notion of "proud self-sufficiency" and strong rugged individualism, oppose any policies that would support aid to the weak, the poor, the unemployed—in other words "the losers" in this lottery type of society we call capitalism ("free enterprise"). Libertarians to the marrow, they also oppose (as did the Obama liberals) any policies that would make this nation more egalitarian and civilized, like having a single payer healthcare system. This obviously hurts them, in many cases ruins them, but no matter. They support whatever nonsense they hear from Fox News and other precincts of rightwing propaganda denouncing "commie" approaches top social organization. This leaves us, among other things, in the hands of the worst possible vultures, the pharmaceutical and health insurance rackets, the petroleum bandits, and the rest of the criminal Wall Street-led corporatocracy. But no matter, to these folks it's better to eat mud than to elect a "pinko" politician that will cuddle gays or tolerate abortion—two of their stupid busybody obsessions. Note, please, that while the rank and file of the right follows and embraces such notions, THOSE WHO EXPLOIT SUCH OBSESSIONS, the politicians, the toxic media buffoons (Hannity, Limbaugh, etc.), the superrich, and the religious charlatans who pull the strings, laugh all the way to their big fat bank accounts and multiple palatial residences around the world. Incidentally, for people who shout so much about freedom, it is the Right that has supported most vehemently the passage of the Patriot Act and other ugly police state laws that keep reducing American freedoms and dismantling Constitutional guarantees. You may also want to ask why we need this super-armed and invasive police system in America now. To protect us from "terrorists"? Ha ha ha ha—let me have a good belly laugh. Terrorists, such as they are, have been almost entirely spawned by the powers that be, and by bipartisan accord. They issue as a response from a stinking, criminal, smug and exploitative foreign policy that makes us the object of hatred and derision around the world. And those engaged in just revenge against The American invaders and so on are the "legitimate" ones, people who, if you and the rest of the Rightwing crowd, could see more clearly, would doubtless identify under normal circumstances as patriots resisting colonialist invaders armed to the nuclear teeth. But there's another category of "terrorist" in the world. Much more sordid. These are the completely manufactured terrorists, those created and controlled by the American state and its accomplices around the world. People who engage in false flag operations to maintain a climate of world tension to justify the present insane situation, and to keep scaring Americans into surrendering their freedom for the sake of "security." So much for the right and what it purports to be. Next we have the big mass of centrist-rightist liberals. The Clintons, the Obamas, the Pelosis, the Max Baucuses, and so on. These folks are seen (wrongly) by right-wingers as "the left.". This crowd would like to have it both ways: a national system that is more "humane", democratic, and egalitarian (you do believe in equality, don't you?) but without seriously overhauling the capitalist system from the root up. Unfortunately, it is capitalism that causes inequality all the time, it is capitalism and its logic that seeds the soil for war, and which opposes democracy in all its forms. Thus, since they (liberals) won't touch the beast in its lair, their policies satisfy no one; they are terrifically inadequate and hypocritical. They give reform a bad name because all reform should be seen only as a way station on the road to complete eradication of the ills that cause a particular social problem, not the perpetuation of mild sedatives in place of radical cures. Thus, at the end of the day, both right-wingers and liberals support the empire's illegal wars around the world, they both support the rotten status quo, and whatever differences exist are in method, pragmatic questions of approach and not principle. The morality or immorality of such actions is never discussed. Yes, liberals are worthless, and despicable in many ways, but they are not the left. Finally we come to the left. The left sees things for what they are. They tend to reject capitalism because it is a predatory and immoral system whose time is way past. There is no way to reform capitalism because its very core dynamic is about exploitation and constant expansion in a finite planet—thereby a constant threat to the survival of all life. (This does not seem to bother a vocal segment of the right, the "Christian fundamentalists" who believe in the deranged notion of the "Rapture."). So the core of capitalism is rotten and the RIGHT, OPENLY AND VOCIFEROUSLY, SUPPORTS IT, WHILE THE TREACHEROUS LIBERALS DO, TOO, BUT IN A MORE EQUIVOCAL WAY. Leftists see a world in which we respect each other and support each other as generous people should. They care and insist on protecting the Earth, for our well being and that of future generations, not like the corporadoes and their unwitting idiotic supporters who live in the here and now, in the world of short-term gain and to hell with what may come a few years from now. They support honorable peace. And they support democracy, non-meddling in other nation's affairs (which includes not sending our huge military machine to destroy their countries in the name of "freedom" and "democracy" but really only to the benefit of the ultra rich around the world). For them it's imbecilic to shout, "My country right or wrong!" as this is the signature of anyone who has put worshiping a tribal identity over morality itself. How many crimes have been committed and ARE being committed by those who think this way? In sum, there's no need to DEMONIZE the right or the mainstream liberals. They both stink. To describe accurately what they are and do, to tear down their rationalizations, evasions and hypocrisy, to make a dent in the thick wall of self-inflicted ignorance, more than suffices to take away their legitimacy. Just like a simple description of what the SS Nazi troopers did in Russia, for example, suffices to condemn these people as war criminals of the worst kind, "misguided patriots", in the service of a rotten philosophy. A world run by "leftist" ideas would be a better world (please save yourself the effort to point out the crimes of Stalin, and Mao, and the rest of that thick propaganda muck about "totalitarian communism" , as the history of the world, Soviet Union included, and the truth about the US system of government (carefully kept from view) are far too complex to be debated through propaganda slogans). But the real left in the US and much of the developed world is miniscule. This is not accidental. The right with its minions in all the levers of power and owning the media outright (all media are rightist or centrist-rightist) has kept it that way. The left represents the truth more than any other political position. All I can say is that if you ever understood clearly what the right represents, and what the left represents, you'd probably choose the latter. But I'm not counting on it because I know how tough it is to step out of the Bubble. People do not yield to facts unless something truly horrendous forces them to reevaluate their beliefs. For the most part our political positions (whenever we are enmeshed in incomplete information) are built on temperamental choices, and the latter cannot be changed so easily. That's why the right continues to have a hold on America and the world, and why liberals also prosper. Upholding terribly wrong interpretations of reality, grounding themselves in selfishness, they mirror a world still largely mired in superstition, ignorance and mediocrity. One final point. I agree with you in the sense that the current government of the US does not speak for me and my interests, those of the ordinary citizen. This is proved just about every day in words and deeds big and small. From the shameful neglect of Katrina and more recently Sandy's victims, to the continuation of economic and war policies patently immoral and inimical to the vast majority of the American population and the world. In that sense, 'it's not my government." But, friend, "government is not the problem" because government is merely a tool. We make it what we want it to be. Right now it's in the hands of an usurping Wall Street cabal, a class that will not alter its criminal ways until they confront the focused anger of the great majority of Americans. But for that we need unity. That will not happen as long as the rightist mob continues cynically posturing as friends of the people, while "liberals" implement rightwing policies behind the label of progressivism and "security." —P. Greanville Editor, <a href="http://www.greanvillepost.com/" rel="nofollow">The Greanville Post</a>
          Gina Bauman vs Barb Goodwin on the Issues - Health Care        
Issue: Health Care
Health care costs continue to rise at a much higher pace than general inflation. If nothing is done the situation will only worsen, especially with the looming imposition of Obamacare and the associated tax increases and mandates that will inevitably lead to rationing and a sharp decline in the quality of care.
Gina Bauman
Barb Goodwin

Recognizes that we have the best health care in the world and that the problem is one of insurance and finance rather than availability. A primary reason that health care costs have increased at a far higher rate than general inflation is government interference in the free market and provisions in the tax code that discourage privatized portable coverage.

Supports market oriented means of lowering health care costs by cutting the excessive regulation of health insurers and health care providers that are primarily driven by social engineering and have driven competitive pricing out of the health care marketplace.

Opposes Governor Dayton’s attempt to establish an Obamacare health care exchange without the consent of the legislature and opposes the forced imposition of Obamacare on Minnesotans.

Has publicly stated that health care in the United States is not as good as many other places in the world. Supports Governor Dayton’s attempt to establish an Obamacare health care exchange without the consent of the legislature and favors the forced imposition of Obamacare on Minnesotans.

Stated at a New Brighton candidate’s forum that society should be working toward a government mandated, single payer universal health care system.



This is a critical issue on several levels. If Barb Goodwin achieves her stated goal of a government run single payer health care system (which realistically is also the ultimate goal of Obamacare) not only will the availability and quality of care decline - our privacy, personal liberty, and economic well being will also be very negatively impacted.
There are extremely few, if any, things government does that is done as well or as efficiently as the private sector. Do we really want the government in control of our health care? As far as I'm concerned Goodwin's stand on this issue alone is more than enough to disqualify her from consideration.
          GreenTech and BackBone Present “Now is the Time”        
Backbone Campaign presents a documentary and community discussion about Single Payer Health Care on Tuesday, August 8th, 6 pm at the Theatre.  “Now Is the Time: Healthcare for Everybody” delves into the problems of US healthcare, what single payer health … Continue reading
          Larwyn's Linx: The Violent Left And The Anti-Democratic Nature Of Antifa        
Send us tips! Bloggers: install a Larwyn's Linx widget. Get real-time news, 24/7, at BadBlue.

Nation

The Violent Left And The Anti-Democratic Nature Of Antifa: John Sexton
The Treachery of Murkowski, Collins and McCain: Bruce Bialosky
We’re Witnessing A Slow-Rolling Coup: Derek Hunter

Video: AG Office Reining In A Mueller Fishing Expedition?: Jazz Shaw
Deputy AG: Mueller needs to ask to go outside scope of Russia probe: Daniel Chaitin
Sunday Talks: Rod Rosenstein -vs- Chris Wallace: CTH

Kayleigh McEnany Recapping a Week of Real News: CTH
A Glimpse Inside a Violent Gang: Tony Mecia
Pence Slams ‘Disgraceful And Offensive’ NYT: RWN

Where Does Maxine Waters Get Her Money?: LidBlog
Illinois has 63,000 government workers making over $100K: IllinoisPolicy
Planned Parenthood Wants Preschoolers to Learn How to be Transgender: RWN

Economy

Optimism of Small-Business Owners at Highest Level Seen in Decade: Ali Meyer
The Top 20% of Households Pay 88% of Federal Income Taxes: ATR
LA made $1.3B in illegal immigrant welfare payouts in just 2 years: Tori Richards

Scandal Central

Dershowitz: Mueller Chose D.C. For His Grand Jury Knowing Jurors Are Likely To Be Anti-Trump: Hot Air
LA County Admits Number Of Registered Voters At 144% Of Resident Citizens Of Voting Age: ZH
Illinois’ bubbling soda tax rebellion: John Ruberry

Media

The Top Three Reasons Why Liberals Hate Conservatives: Christopher Cook (2014)
CNN’s Zakaria: Democrats ‘Out of Touch’ With Voters on Immigration: Nicholas Fondacaro
Dana Milbank gets utterly destroyed over claim ‘there’s no such thing as a Trump Democrat’: Twitchy

Egregious Media Dishonesty Overshadows Important Economic Observation: Dan Mitchell
Trump’s Immigration Bill Makes CNN’s Acosta Squeal Like A Pig: John Derbyshire
Google Acosta in English: Pacific

Unlike "Dunkirk," Nobody Went to See "Detroit": Steve Sailer
Director Of “Death Wish” Movie Being Called “Alt-Right” Responds To Criticism: Chicks on the Right
Israel Set To Boot Out Al Jazeera: Israelly Cool

World

The ghost of Chavez returns to Venezuela: Babalu
Guess who is blocking building a desalinization plant in Gaza?: Elder of Ziyon
Man Arrested at Eiffel Tower in Apparent Terror Incident; 7th Terror Event in France This Year: Patrick Poole

The Vicissitudes Of A “Regulated” Person: Babalu
US killed Shabaab commander in recent strike: Bill Roggio
ISIS Posting Syrian Children Outside of Car Bomb Factories to Prevent U.S. Airstrikes: Natalie Johnson

Sci-Tech (courtesy BadBlue Tech News)

The Real War on Science: John Tierney
Waves of Destruction: The Z Man
Spacex and Boeing are both on track for 2018 manned flights: Brian Wang

Cornucopia

2 Arrested After Airplane Passenger Witnesses Texts About Child Sexual Exploitation: Breaking911
'Excessive corrosion' caused the deadly Ohio State Fair accident: Circa
Malia Obama thrashes on the ground at Lollapalooza: Breaking911

Sponsored by: My Beer Fund

QOTD:


          Larwyn's Linx: Paul Ryan and “Big Club” Begin Positioning Comprehensive Immigration Narrative        
Send us tips! Bloggers: install a Larwyn's Linx widget. Get real-time news, 24/7, at BadBlue.

Nation

Paul Ryan, “Big Club” Begin Positioning Comprehensive Immigration Narrative: Treehouse
McConnell Criticized For Pelosi-Like Tactics On Health Bill: David Thornton
DHS Bypasses Environmental Regs to Start Border Wall Construction: Breitbart

The Liberal Elite Wants to Manage Our Lives. They Must Be Stopped.: Mark Levin
Attkisson v. DOJ: The Computer Intrusion Lawsuit against the Federal Govt.: Attkisson
Whistleblower gets job in new accountability office at Trumps' VA: Exam

Audio Reveals Seymour Hersh Alleging Seth Rich Was Wikileaks Source: Disobedient
Ethics Watchdog Files Complaint Against Wasserman Schultz: Peter Hasson
NASA job posting: Protect the planets on a six-figure salary!: KHOU

Levin Mocks Sanders on Single Payer: ‘Cut the Crap … This Is about Us’: CNS
Cook County Continues to Tax Itself Into Oblivion: Dave Blount
Overwhelming Vote Confirms America’s New FBI Director: RWN

Economy

Chicago Public Schools to pay $850 million in interest on $500 million loan: IL Policy
DHS: Pres. Obama Granted 2.3 Million Work Permits to Foreign Workers in 2016: NUSA
Florida Economy Under Gov. Rick Scott Far Surpassed Campaign Promises: PPD

Scandal Central

The dots between Imran Awan, Debbie Wasserman Schultz and Seth Rich begin to connect: TheDuran
Hina Alvi: 5 Fast Facts You Need to Know: Heavy
Congressional Investigation Into Wasserman Schultz IT Scandal Moves Forward: Adam Kredo

Former Obama Aide Ben Rhodes now a person of interest in unmasking investigation: Sara Carter
Have You Seen The Nutty Statement Imran Awan’s Lawyer Released Yesterday?: HayRide
Awan Brothers Worked for Several California Democrats: Breitbart

Climate, Energy & Regulations

Scientific Integrity Committee Clears Pruitt Against Sierra Club’s ‘Climate Denier’ Charge: WFB

Media

With Repeal Off The Table, Media Suddenly 'Discover' That ObamaCare Is In Deep Trouble: IBD
Bozell: Media Must Report the Facts About 'Imposter' Jeff Flake: NB
Corey Lewandowski: Trump Is ‘Greatest Communicator We Have Ever Seen’: Joe Bilello

World

'Ironclad': In Nearly Hour-Long Phone Call, Japan's Abe Stands with Trump on North Korea: Breitbart
South Korea Is Preparing A "Surgical Strike" Against The North: Report: ZH
China formally opens first overseas military base in Djibouti: Reuters

Westernity Matters: Brutalist
Venezuela opposition leaders 'taken from their homes', family members say: Independent
Foreign workers being used to build auto plants in U.S.: CBS News

Sci-Tech (courtesy BadBlue Tech News)

Assumptions: Nathan Kontny
Scientists in Finland made high-tech food using electricity to solve world hunger : QZ
How a coffee machine brewed up ransomware, and other startling findings: Tom Sullivan

Cornucopia

Man Marries Laptop, Makes Demands: RWN
Gee Dad, it's a Wurlitzer: C&S
The World’s Most Expensive Sex Doll That’s Sweeping the Internet: RWN

Sponsored by: My Beer Fund

QOTD: "Former Obama White House National Security Adviser Ben Rhodes is now an emerging as a person of interest in the House Intelligence Committee’s unmasking investigation, according to a letter sent Tuesday by the committee to the National Security Agency (NSA). This adds Rhodes to the growing list of top Obama government officials who may have improperly unmasked Americans in communications intercepted overseas by the NSA, Circa has confirmed.

The House Intelligence Committee Chairman Devin Nunes, R-CA, sent the letter to the National Security Agency requesting the number of unmaskings made by Rhodes from Jan. 1, 2016 to Jan. 20, 2017, according to congressional sources..." --Sara A. Carter

          The Truth About Health Care's Waste, Fraud and Abuse        
Health care systems and single payer (Photo credit: Wikipedia) Waste, fraud and abuse estimates of at least 30% in the existingMedicare and Medicaid systemwas one of the factors that informed Obamacare on affordability of the new program. Really? The expression itself makes my teeth hurt (similar to "game changer" and "new paradigm") [...]
          Catastrophic*        
Four days before the election, I said, even as a liberal, I'd be angry after a Hillary Clinton victory and Democratic gains in the House and Senate because of the way Clinton and the Democrats campaigned. So after what happened you can imagine how I feel. Shocked, saddened and furious would be an understatement. It was supposed to be the Republicans who were left in shambles after the election, not the Democrats.

There are a few aspects to the election and I'm going to take each one separately.

What the hell happened?

Hillary Clinton had everything going for her. She had the money and the organization so she could have beaten Donald Trump through the air or on the ground. She had a number of endorsements from Republicans and a 500-26 advantage in newspaper and magazine endorsements. Athletes, celebrities and even the late-night comics were on her side. How could she possible lose?

Donald Trump meanwhile spent half of what Clinton did, didn't run many TV ads, didn't have much of an organization at the state and county levels, and the country's demographics were clearly against him. If that wasn't enough, Republicans were denouncing him and neo-Nazis were praising him. How can he possibly win?

Much has been made of the working-class, rural white voter who has been angry at establishment politicians for turning their backs on them in a post-NAFTA world. (February insert: Had Vice President Joe Biden run, and got the Democratic nomination, he would have won the election in a landslide and this wouldn't have been an issue at all.) The Intercept's Glenn Greenwald makes a good case for that and compares it to the United Kingdom's Brexit vote.

Not to dismiss this reasoning entirely, but Republicans have historically been against unions and labor. Heck, Wisconsin Republican governor Scott Walker, who tried to destroy unions, won re-election and a recall election. So why do these blue-collar voters in Ohio, Michigan and Wisconsin keep electing and re-electing Republican governors and legislatures? What have Republicans done for workers that was so special for them to keep giving them power? And why does Trump, who manufacturers his clothing line in a dozen countries, reap the rewards of this anti-trade anger?

Also, why didn't these anti-establishment voters show up in the polls? Why was Clinton consistently and clearly ahead in the polls, nationally and in these states, all year? And why did she extended her lead after the Access Hollywood bus video came out on October 7?

The polls indicated a big Clinton victory until the final week or two of the campaign when it tightened up. What could possibly have changed the voter's minds so suddenly?

Well, there was the Wikileaks release of Clinton campaign chairman John Podesta's emails, hacked apparently by Russia (it's quite possible that Russia was involved in this election in more ways than one. Then again, maybe not.).

Then there's FBI Director Jim Comey's letter to Congress, 11 days before the election, announcing that the Bureau would be renewing their investigation into Clinton's email server. And according to the exit polls, that just might have made the difference.

And all this brings to the media. There's plenty of examples of the media hyping the wrong stories and not hyping the right stories. It was obvious that the media didn't treat Clinton fairly during this campaign. For instance, they obsessed over her emails and the Clinton Foundation "scandals," when there weren't any real scandals there. And they ignored her policies. Meanwhile, the media gave Trump $5 billion in free advertising and a free pass on the issues, his lies, his conflicts of interests and his own scandals.

Sher Watts Spooner of Daily Kos:

We waded through nonstop screaming coverage of Hillary Clinton's emails on every channel and every inch of print. Yet there was so little coverage of Donald Trump's coming conflicts of interest, his fraudulent practices at Trump University, and his pay-to-play dealings with the Trump Foundation that the average voter would react with a shrug and a big, "Huh? Never heard of it."

If there's a "liberal media," I'd like to know where it was.

One of the specific problems I had with the media, was that even as far back as the GOP primaries, I was wondering how Trump would benefit personally from his trade policies as president. It never became as big of a story as Hillary's emails (probably out of fear of being blasted by the right for being on "Clinton's side." The right's done one heck of a job of "working the refs" over the years.).

Actually, give Trump credit in that he brought trade, NAFTA and the TPP to the forefront of this campaign. And I was expecting the media to explain both sides of this complex issue in a non-partisan manner. But they never did (then again, the media never explains anything).

But regardless of how poor of a job the media did, you didn't have to be a genius to filter fact from fiction insanity in this campaign and determine who the better candidate was. So you can't blame the media if tens of millions of Americans didn't get the message or got the wrong message. But it shouldn't come as surprise because, as this blog has proven, the Republican Party and entire right-wing movement is a massive cult. And the followers are taught, programmed, and even conned brainwashed into not "getting it." Via their massive propaganda machine, Republicans tell their members what to think and what to believe. And they do, no questions asked.

For example, the right believes that climate change is a hoax, believes that Iraq had WMDs, still believes that Obama is not an American citizen and that cutting taxes increases revenue. They have to because if they don't, then the evil, Commie, pinko liberals would be right. And they can never, ever admit that, out of spite, even if it makes them look incredibly foolish. But it's also because the GOP has redefined "Democrats," "liberal" and "government" as incompetent, lacking in all credibility, and always, always wrong (when it's Republicans who aren't just always wrong, but can't be more wrong!). And the media can't do anything about it because the lies and propaganda fit into the follower's warped sense of reality conspiracy theories. Obama was born in Africa? Of course he was. Obama's Clinton's going to take my guns away? Of course he did she will. Obama increased the deficit? Of course he did. An FBI agent assigned to investigating Clinton's emails killed his wife and committed suicide? Of course he did. It all fits into the cynical, conspiracy-laden narrative they've been fed all these years. So what is the media supposed to do about that? "Correcting the record" can only do so much when half the country has been trained not to believe the "liberal media." (And the media can't do much about the deliberately placed fake news stories either because there's so much of it out there.)

So coming into this election, conservative voters never believed negative news on Republicans. They were always immune to it. And Trump was no different. Everything he said during the campaign was reported - the hate, the lies, the insanity - but it didn't matter because it came from the "liberal media."

But Trump has turned the media into an even bigger enemy on the right by literally pointing at the reporters at the back of his rallies and attacking them directly. Naturally, his supporters did the same, including a direct threat of lynching.

It's alarming when Trump discredits reporters and journalists and gets the public to turn on them with such vitriol. Because then, he can get away with anything he wants because he knows that if the media reports his lies, extreme policies or blatant conflicts of interest, it won't be believed, and therefore, won't matter. If anything, the report would further enrage his supporters and empower and embolden his stature even more for standing up to the "dishonest" media. And that's dangerous because a free press is what stands between a democracy and tyranny.

If that's not enough, in the Trump Lunacy World, there's "no such thing of facts anymore." And whatever he does is legal because he's president. So Trump can do anything he wants and can say anything he wants because he will be believed and not the media:

A 56 percent majority of Trump voters say that if a national media outlet reported that Trump said something untrue, they would be more inclined to believe him than the news outlet. Just 2 percent say they’d believe the media, with another 38 percent saying it depends on what the story is.

But wait, there's more (unfortunately).

As far as Trump voters and undeniable facts are concerned, 67 percent believe unemployment has risen while Obama has been office when it's gone down from 7.8 percent to 4.6 percent; 39 percent believe the stock market has gone down when it almost tripled; 40 percent believe Trump won the popular vote when he didn't; 53 percent believe California should not be included in the popular vote; 60 percent believe "millions" voted illegally for Clinton which is obviously a lie; and 73 percent believe Democratic financier George Soros is paying people to protest Trump, but he's not. (Here.)

That's unsettling to say the least because that shows mass hysteria, paranoia and brainwashing on a national scale. Surely, those Trump voters need serious help. But again, they have to believe these things in order to conform to their non-reality reality world where "liberals," "Democrats" and the "liberal media" are always wrong, and Republicans and Donald Trump are always right.

Mark Sumner of Daily Kos:

There's no need to work that hard. There's no need to ground "alt right" arguments in any reality. The audience is already so convinced of their inherent superiority that you can feed them anything, so long as it agrees with their pre-existing hatred.

This has been going on for decades on the right. The Republican Party and their massive propaganda machine have dumbed down America to the point where truth, facts and logic do not matter. All that matters is God, guns, gays, abortion, tax cuts, deregulation, "liberal media" and whoever the right's "enemy of the week" happens to be. And if reality gets in the way, they make stuff up. So it's a cult of extreme ignorance and conspiracy theories, void of creativity and individuality, where the members are kept in a perpetual state of fear and rage (to prevent them from wising up and leaving this cult). (MSNBC's Ari Melber had a very good segment on conspiracy "news" and how it's given credibility by Republicans.) (Dec. 28 insert: Proof that the right has turned real news into fake news and fake news into real news is here.) (Dec. 30 insert: It's only fair to point out that the left believes in fake news too.)

When you've removed the ability of your followers to think for themselves and spew inflammatory rhetoric, paranoia and conspiracies, and instill nothing but rage and fear of Democrats, liberals, Muslims, immigrants and the media, they'll believe you, no questions asked. And then follow through with deadly threats and homicidal acts. That's what cults are!

Sanctimonious conservative/Republican voters have always had this arrogant know-it-all attitude. They're smart and savvy enough to know that Democrats and liberals are evil, incompetent, destructive and wrong. And yet, too dumb to realize that the Republican Party is a political terrorist organization. They're smart and savvy enough to know that Hillary Clinton is "crooked," but too dumb to know that Donald Trump is a total fraud and con man. Or they do and don't care.

Trump voters held Clinton's email server against her because she put the country "at risk" for having a handful of "top secret" emails pass through a private server that she shouldn't have had. But they'll give complete control of our military and nuclear codes to a pathological liar and huckster who doesn't have a clue about history, foreign policy, the military or even current events, nor a fundamental understanding of our nuclear arsenal; and on a personal level, is incoherent, petty, vindictive, spiteful, impulsive, extremely sensitive to criticism and holds grudges. Gee, I feel safer already.

Lies. Fear. Hypocrisy. Conspiracies. Incessant attacks. Double standards. That's is how the leaders of this cult, and their followers and voters, justify everything they do. How else could anyone justify voting Republican? For anything? I'm serious. Therefore, you have to be, well, brainwashed into doing so, even if it means voting against your own self-interests, like your health care or the future of your union, when the rest of the electorate is selfish and votes in their own self-interests. But that's what cults get you to do!

So yes, the media did a horrible job covering this campaign. But it's not entirely their fault that Clinton lost when cynical, paranoid and brainwashed Republican voters believed what they want had to believe. And Jim Comey's letter and the hacked emails shouldn't have made a difference in the election either, assuming of course we truly had a smart and savvy electorate that wasn't so easily conned and fooled. That said, I better not hear a Trump voter say, "I had no idea he'd..." Yes, they did. And if not, then they're as mindless and gullible as Trump and the Republican Party - and possibly Vladimir Putin - needed them to be. Hey, that's what's what cults are!

There's two other things that were key to this election, and both have gone vastly underreported.

First, this was the first Presidential election with voting restrictions in place without full protection of the Voting Rights act. That forced Americans in a number of states to show a photo ID before voting even though not everyone has one. There were also millions of voters that were purged off the voting rolls, long lines at the precincts, and the usual Republican tricks where they played hide-and-go-seek with the polling locations, naturally in poor, non-white areas.

Voter suppression shouldn't be shrugged off. Republicans have strategically, systematically and deliberately blocked Americans from voting, mostly minorities who vote Democratic. And they admit that's their intention.

And you can be sure with Trump's delusions that "millions" of votes were cast illegally for Clinton (even though it was Trump voters that were caught voting illegally), red state Republicans will continue to make it harder and harder for Americans Democratic-leaning voters to vote. And that will tighten the GOP's grip, not only on power, but the power to re-draw congressional and state legislative district lines in 2021. So, in effect, Republicans have rigged the system with voter suppression, and also extreme racial gerrymandering, to ensure that they re-draw the district lines that will determine who will govern in the 2020's (one way to remove the GOP's election-rigging monopoly, would be for Democrats to pick off Republican governors in 2018).

(Samantha Bee had a segment that proves that Voter ID isn't about "voter fraud" at all and is really about suppressing Democratic turnout. You can begin at the 2:15 mark.) (February insert: Yes, voter ID laws do suppress minority voter turnout.)

Second, Republicans kept their eye on the prize: the Supreme Court. It was no secret the the next president was going to reshape the court for a generation. This was not lost on the NRA.

They made it clear to their members that guns were on the ballot in this election, specifically in the rural areas of Wisconsin, Michigan and Pennsylvania where Trump out-performed and Clinton under-performed. Those voters may not have liked Trump, but because of their selfish and sick infatuation with guns, and the NRA-manufactured fear of having their guns taken away, the NRA made sure they got that message paranoia out to their members and to vote for Trump.

As I've brought up many times in this blog, gun control is a not an issue at all on the left. Democrats avoid it because it's become a political loser for them and it's not an important issue among Democratic voters. But on the other side, it's not the issue, it's war. Heck, the NRA and gun owners are a massive cult in and of itself (within the massive right-wing cult). So gun owners naturally believe what their leader tells them. And they vote accordingly.

(Earlier I said that conservatives vote against their own self-interests, but here, gun owners are voting in their self-interests. But guns will never be banned or taken away. So gun owners are selfish to their paranoia instead of being selfish to their union, health care, public schools, the environment, etc.)

And you can also add right-wing Evangelical voters - another cult within the massive right-wing cult - who want a future Supreme Court to overturn Roe vs Wade.

Even though exit polling does not suggest the Supreme Court had an effect, I think it might have in the key states.

All that said, Clinton beat Trump by more than 2.8 million votes (2.1 percent). But it came down to about 80,000 votes in Wisconsin, Michigan and Pennsylvania because Democrats didn't come out for Clinton the way they did for Obama in 2012. Did voter suppression have an effect?

Over the years, two decades in fact, Hillary Clinton paid her dues, and then some; enough for five white male presidential candidates. She worked hard for the Democratic nomination and, her personal and political failings aside, didn't deserve this devastating defeat. She was the better candidate. But even though she was treated unfairly by the media and Jim Comey, which was entirely out her control, she was the candidate and it was her campaign.

As I pointed out in my last post, she didn't mention the Republicans and their political terrorism at all during the campaign, and also allowed Trump to get away with a lot at the debates by failing to stand up for herself, the facts and President Obama.

And you'd think she'd embrace Obama's deficit-cutting, job-creating economic record that has seen the stock market almost triple while he's been president. But she didn't. Just like Al Gore who ran away from President Clinton's economic record when he was campaigning in 2000, Clinton ignored Obama's record. And by always setting up what she had to say by talking about income inequality, "bringing jobs back," or "the wealthy paying their fair share in taxes," she made it sound like Obama did a bad job, didn't try and address those issues, and accomplished nothing, economically. I never understood why she distanced herself from Obama and failed to give him any credit (if I was Obama, I'd be ticked off for getting dissed like that).

Clinton wasn't an inspiring candidate either. She went into the "prevent defense" after the convention by running a strict "stay on message" campaign, void of creativity, leadership, independence and ground-breaking policy initiatives. In other words, she was the a typical politician running against someone who wasn't.

Granted, the media wouldn't have covered a bold policy initiative because they were fixated on her emails, even more so than Trump. But she was the candidate. It was her campaign. And she has to take some of the blame.

Donald Trump wins

Even though Trump's a fraud, racist, narcissist and pathological liar, it did not matter. Even though he bragged about assaulting women in 2005, it did not matter. Even though he was accused of assaulting women, it did not matter. Even though he's never held elected office and has no experience whatsoever in government, it did not matter. Even though he's totally unfit for the office of President of the United States, it did not matter. He won the White House on what he said and how he said it. But what happens when he doesn't come close to following through with his promises? How will his voters feel about him then? For instance:

Mexico is not paying for a wall and it will not be built. And eleven million undocumented aliens will not be deported because it would be a logistical nightmare and cost hundreds of billions of dollars.

Muslims will not be barred from entering the county (assuming they'd still want to come here) because it's unconstitutional (besides, how can you tell if someone's a Muslim or not?).

Outsourced and manufacturing jobs that moved overseas are not coming back. And mines will not suddenly need more miners because it's the "free market" (and fracking) that has dramatically cut the demand for coal.

Trump does not know more about ISIS than the generals, and bombing the "s--t" out of them is very revealing. It's exactly the sort of "strategy" you'd expect from an ignorant bully who's incapable of deep any thought whatsoever.

ISIS won't go away because of anything Trump does. In fact, his policies, and maybe even more so, his tone, could very well empower and embolden ISIS by increasing recruitment.

Tearing up trade agreements and the Iran deal is unlikely, and turning our backs on our NATO and our allies isn't happening either. (Trump voters will say, "Great, I didn't believe him when he said those things anyway!" But if Clinton won and back-tracked from her campaign promises...)

Trump and the Republicans will not repeal Obamacare in its entirety because there's nothing to "replace" it with except single payer. And repealing parts of it would lead to the collapse of the entire system. Republicans are like the dog that catches up to the car on this one (if it wasn't so serious, it would be comical to watch).

Trump already said he won't prosecute Clinton, so "lock her up" was just something to rile up his supporters who were stupid enough to believe it and chant it.

And then there's all the conflicts of interests he'll have.

So when he doesn't follow through with any of his impractical and controversial insane campaign promises, and makes decisions based on his own financial interests and not the country's, then what? How will his "mad as hell" anti-establishment constituency that put him into office to shake up the system react when he acts like, well, an establishment politician...an establishment politician who enriches himself like an African or Mid-East dictator? Will they say, "I had no idea he'd...?"

My guess is that Trump and his White House will bumble through the first six months or so. And then things will get steadily worse. And worse. And worse. And worse. And worse. And worse. And worse. And then maybe, at some point, some his voters will have buyers remorse.

Now what?

Laurence Lewis of Daily Kos:

Clinton had a lot working against her, including not yet fully investigated Russian hacking of the election, an unprecedented politicization of the FBI by its director, James Comey, and a media that was incompetent if not outright hostile. She also was trying to break through a glass ceiling that, with all else working against her, proved just too tough to shatter. But don't let anyone say she was a failed candidate. Don't let anyone say she or her political agenda were rejected. The rules are the rules, but if this were a democracy, she would be the president-elect...

Over 1.5 (2.8) million more voters embraced Hillary Clinton's candidacy than Donald Trump's. Over 1.5 (2.8) million more voters embraced Hillary Clinton's agenda than Donald Trump's. By the arcane, undemocratic rules, Trump gets to claim the presidency, but he does not get to claim a mandate, and he does not get to claim an embrace of his extremist agenda. Republicans who claim otherwise are hypocrites. President Obama won two legitimate mandate elections, receiving more votes than any candidate in history while gaining seats in both houses of Congress, yet from day one Republicans fought him every step of the way. After a historically close election, they don't get to claim that Democrats must comply with agendas the voters did not validate.

As already stated, a shift of 80,000 votes out of over 135 million cast would have made Hillary Clinton president. And then we wouldn't be complaining about Russia, Wikileaks, Jim Comey or angry, blue-collar workers. Instead, Republicans would be complaining about appealing more to blacks and Hispanics a GOP primary system that nominated a lunatic for president.

What a difference a handful of votes makes. Anyway, maybe a shift in those votes and a larger Democratic turnout would have brought in a few more Democrats. They were poised to pick up the four seats they needed in the Senate to take control. But they only got two and were lucky to get the second one. They were expected to at least clear 200 House seats but came away with about five or 10 less then that. And after Republicans picked up 900 state legislative seats since Obama took office, Democrats had to start getting some of them back. But they actually lost 46 seats. So Congress and the state capitals are a sea of red (granted, it's because of extreme racial gerrymandering, but still...)

Democrats were destroyed in 2010 and 2014 and decimated in 2016. I'm getting sick and tired of this. Recklessness, irresponsibility, scorched-Earth strategies, bare-knuckles partisan politics, outright sabotage and political terrorism by Republicans have once again been rewarded because Democrats allow them to be.

During the 2008 campaign, Barack Obama never attacked Republicans, per say. He went after George Bush. His reasoning was that he didn't want to insult Republican voters or Congressional Republicans because he wanted to have a good working relationship with them had he won. That's ludicrous! Do Republicans campaign that way? Do they care about Democratic voters? Are Republicans worried that if they attack Democrats they wouldn't be able to work with them? My God, literally the night Obama was inaugurated, Republican leaders were already plotting his demise! And days later, despite the Democrats gaining big majorities in the House and Senate in that election, Obama extended his hand to Republicans!

Juan Cole:

... are (Democrats) worried about being called socialists or about public opinion turning against them (if Obama did not name Republicans to his cabinet)? But W. and Trump weren't worried about those things when they appointed loony tunes Neoconservatives who told us Iraqis would drape garlands around the necks of invading Western infidel troops in gratitude for being occupied. Half of Trump's proposed appointees could probably be committed to insane asylums if their relatives cared enough about them to get them help. And the Dems are worried about reputational damage from appointing people who are merely left of center?

I can remember when Scott Brown won a senate seat from Massachusetts, and Obama said he didn’t want to push through Obamacare in Brown’s absence. What is this, a game of lawn croquet? What did President Obama get from being gentlemanly? Not a single Republican senator voted for the ACA, despite demands that it be reshaped in ways that hurt ordinary people, and now they will destroy it and toss 30 million people out of health care.

And when Republicans lose an election, such the governor's election in North Carolina last month, they change the rules stage a coup to strip the Democrat of power:

Republican lawmakers quickly proposed sweeping changes to state government, including proposals that would diminish the governor’s authority to make appointments.

Lawmakers want to hobble the incoming Democratic governor, Roy Cooper, before he takes office Jan. 1 by making his Cabinet appointments subject to approval by the state Senate and cutting his ability to appoint members to UNC schools' boards of trustees and the state Board of Education.

Another proposal in the mix would equally divide election boards between the two major political parties, ending control by the governor's party.

Yet another provision would cut the number of employees who serve at the governor's pleasure from 1,500 to 300, reversing an expansion approved for Republican Gov. Pat McCrory at the start of his term...

A Senate bill would shift power from the N.C. Supreme Court that will be controlled by Democrats to the 15-member state Court of Appeals that will have a Republican majority.

(More details here.)

This is what Republicans (and Fascists) do. But see the difference between the parties? Whether in power or out, Republicans attack, attack and attack again. It's double standards. It's hypocrisy. It's extreme partisanship. It's pigheaded obstinance. It's bare knuckles, attack politics, 24/7. Republicans can't govern responsibly - they don't want to govern responsibly at all - so they attack, they lie, they cheat, they spin, they blame, they sabotage, they obstruct, they obfuscate, they ridicule, they filibuster. They re-write history. They bully and intimidate. They rig the system. They game the system. They change the system. They blow up the system. They control the system. They create villains, confrontations and gridlock. They manufacture hate, fear, paranoia and conspiracies. And then it's on to the next attack, the next lie, the next obstruction, the next conspiracy and the next villain. Meanwhile, Democrats never responded to it, never fought back, beg Republicans to work with them and play Charlie Brown to Lucy's football. This has been going on for years, decades.

As I wrote six years ago:

Democrats are like a child that is constantly beaten by his father. To avoid these beatings, the child not only tries to appease his father to keep him from blowing his stack, but runs up to him for affection, as if that too will prevent the beatings.

What Republicans have also done for the last two decades, is constantly demagogue the words "liberal," "Democrat" and "government" and turned them into dirty words that mean bad and incompetent. When you say "liberals, bad" "government, incompetent" all the time without Democrats challenging it, and in fact feed into it, people begi

          When government usurps the rights of parents        
When government usurps 
the rights of parents

Michael Hoffman’s comment: In any society where the Bible, its statutes, judgments and morality, are not esteemed and held in authority, the government will usurp the rights of the parents and before long, the power of life and death itself. Many white liberals, who pride themselves on rescuing cats and dogs from animal shelters, are persuaded that the “population explosion” is, after “climate change,” the chief threat facing the planet. When these people obtain judicial or medical power, the value of human life in their eyes is highly problematic, and more often than not, disposable. 

For the Love of Charlie Gard

When it comes to the life of a child, should parental devotion be disqualifying?

By William McGurn
Wall Street Journal | July 18, 2017 p. A13
https://www.wsj.com

So Charlie Gard’s fate now comes down to this: whether an American doctor can persuade a British judge that little Charlie’s life is worth living.

The child cannot see, cannot hear, and suffers from a genetic disorder for which there is no cure—yet he has exposed the great fault line between the post-Christian West and its past. For most of history, men and women have regarded suffering as part of life. But as medicine tames once-deadly afflictions and the idea of some larger meaning to the cosmos wanes, suffering comes to appear less a part of the natural order than an intolerable anomaly.

Follow this logic to the end and you will arrive at London’s Great Ormond Street Hospital for Children. The hospital dates to 1852, when it was founded by a doctor hoping to relieve “the shockingly high level of infant mortality.” How curious that this same hospital now argues for infant mortality, or at least for the mortality of one particular infant.

Hospital experts say it’s in Charlie’s “best interests” that he be denied the experimental treatments because he “has no quality of life.” Better for him to die, they say, than risk suffering. Never mind the judge’s original admission that “no one can be certain whether or not Charlie feels pain.”

Let us stipulate a distinction between removing someone from life support, as the hospital proposes, and taking active measures to induce death. Put another way, if Connie Yates and Chris Gard —Charlie’s parents—decided to remove their son from his ventilator and allow nature to take its course, it would be a difficult but eminently defensible position.

But the claim asserted by the representatives of Britain’s state-run health care system is more sweeping and insidious: This is our call, they say. Such is the Great Ormond Street Hospital’s sense of dominion, says Ms. Yates, that it refused to allow Charlie to come home to die, wrapped in the loving arms of his mom and dad.

In the Book of Exodus the Israelites are warned that theirs is a “jealous God,” but there is no god more jealous than single-payer health care. For at the heart of single payer is single authority. Isn’t it striking how resentful the legal and health care authorities are that Charlie’s family has raised $1.7 million, thus taking money off the table as an excuse to deny him the offered treatments?

Against the emotional outbursts of the parents, the official pronouncements all aim to convey a sense of reasonableness, with soothing references to the law, the selflessness and expertise of those pushing to overrule Charlie’s parents, and, of course, the complexity of the situation.

Still, the deck has been stacked from the beginning. The giveaway is the appointment of a guardian to represent Charlie’s interests, even as the court rulings concede it would be difficult to find a more devoted mother and father. Now we learn the lawyer who represents Charlie in court runs a charity with connections—surprise!—to a sister organization that promotes assisted suicide and until 2006 called itself the Voluntary Euthanasia Society.

The Great Ormond Street Hospital even wants the last word on love: “In one respect, Charlie is immensely fortunate” to have such loving parents. Because in this context “in one respect” really means, “not in the sense that has to do with decisions about their son’s life.” In other words, the parents’ love disqualifies them. In choosing a guardian to represent Charlie against his parents, the courts sided with the doctor who characterized Charlie’s mom and dad as a “spanner in the works.”

It wasn’t long ago that people worried about the cheapening of human life were predicting practices such as legal abortion would lead to the acceptance of things once thought unthinkable. Euthanasia, for example, or the weeding out of children deemed not perfect enough. These people were dismissed as Cassandras. They now look like prophets.

Charlie Gard’s story comes after a case in the Netherlands where an elderly women suffering from dementia woke up and resisted as she was about to be euthanized—only to have the doctor order her family to hold her down for the fatal injection...

The essence of civilization is that the strong protect the weak. But Charlie Gard shows that the barbarian no longer comes wielding a club and grunting in some undecipherable tongue. These days the barbarian comes as an expert, possessed of all the requisite certification—and an unquestioned faith in his absolute right to impose final judgments about the “quality of life” of other people’s loved ones.

[Emphasis supplied]

Read more: https://www.wsj.com/articles/for-the-love-of-charlie-gard-1500326103

____________________________



          Nurses: Paul Krugman Offers 'Shallow Political Advice' When It Comes to Health Care        
Only with Medicare-for-all can we achieve health security.

With the explosive growth of the movement for single payer healthcare, it should not be a surprise to see the Empire Strikes Back.

In the name of political reality, some liberal pundits, politicians and policy wonks are scolding progressives to give up on Medicare-for-all. There are many ways to achieve “universal coverage,” we’re told. “Overhauling” the entire system is too hard, healthcare is too big a part of the economy, and politicians will not take out the health insurance companies.

Yet, the alternative approaches to reform pose the same political problems: the insurance industry is likely to fight the elimination of their profits (Dutch and German health insurers, for example, are non-profit), and the severe reductions in executive compensation, elimination of shareholder dividends, and rate setting, all of which go away under European-style health insurance. The benefits and rates are government mandated, the companies are essentially payment administrators. 

Either this regulated system of private health plans lowers prices through government –set rates and negotiations, or it fails to do so and costs shift to individuals.  But it is still the government role as rate setter/price negotiator that matters. Wouldn’t it be more straightforward and simpler to improve and expand Medicare?

Still, the pundits say it’s best to search for incremental reform of the insurance-based system, and live (or not!) with the results. In other words, the best health reform we can do is a version of what we have. Worse, it props up and reinforces a profit-focused system that is antithetical to the very concept of healing. Advocates of Medicare-for-all, and other non-reformist reforms, are looking to solve problems immediately, not accommodating the status quo.

Progressives are badly served by shallow political advice from the likes of Paul Krugman. It obscures the reality working people actually face and undermines the fight for our values and program.

Our health is not a commodity, it doesn't belong in the "market," it is a human right. Those who advise us to settle for models of national health systems in other countries are missing the fundamental difference from the broken U.S. scheme. What Australia, the Netherlands and Switzerland all have in common is they do not conflate "coverage" with healthcare. Those countries guarantee healthcare.

Having health insurance in America doesn't prevent medical bankruptcy or denied care. In the U.S., employer based healthcare creates great uncertainty for workers, as premiums and out of pocket costs increase, reflecting costs shifted from the company to workers to fund the profits of the insurance companies. 

Only 55 percent of employers offer coverage. Why would we try to buttress a system that is failing workers, hurting business, and shrinking? From 60 to 70 percent of healthcare spending comes from taxes. We're just not getting our money's worth. We are wasting 20 cents on the dollar when we pay for private health insurance, wasting huge resources that could go to higher wages, child care and pensions.

Alternatively, single payer is the reform that establishes health security, and enables greater equality and freedom, values worth fighting for.

Ironically, healthcare reform efforts have sought to “improve and expand” every element of the present system, except the program that is popular and works best: Medicare. The Clintons tried to expand HMOs, Obama expanded private health insurance and Medicaid, the GOP tried to expand “individual purchase,” so we’d all be on our own when dealing with insurance companies, drug companies and hospital corporations.

It is precisely profit-focused healthcare industry that has caused the problems of escalating costs and restricted access. Rising premiums pay for rising prescription drug costs, which hospital corporations pass on to patients and drive up their own rates as they leverage their market share. As a result, each sector’s revenues and profits increase. The industry imperative of revenue and profits has replaced caregiving as the basis of healthcare in the US (see Elizabeth Rosenthal’s book “American Sickness.”)

We are not “starting from scratch,” as Krugman contends (which he did not in 2005) but instead there exists a model in the U.S. for how single-payer financing could work – Medicare, which if improved and expanded to all, could confront the industry, contain prices and restore the values of caring, compassion and community to our healthcare system. 

Alternative approaches to universal coverage (though even with the Affordable Care Act, 28 million people remain uninsured) depend on using huge tax subsidies to enable individuals and businesses to buy insurance coverage. Without those subsidies – in California alone they amount to over $100 billion – health insurance is a failed business model. Taxpayers prop up the insurers profits for the honor of paying $2000 in deductibles and potentially under the ACA over 9.5 percent of our income in out of pocket costs.  In California, this means 15 million people are uninsured or underinsured.

Truly controlling costs requires eliminating the waste and inefficiency of the private payers – Medicare administration cost 4-5 percent compared to up to 12 percent for insurance companies (before profits). The inherently wasteful insurance company bureaucracy doesn’t go away when everybody has to buy one of their health plans.

Ultimately, what we must face is an issue of power. Can we collectively organize a health care system without the imperatives of revenue and profit? Only if we build a movement for health justice that demands guaranteed healthcare for all as a human right. Only collectively through government do we as a society have the resources and standing to secure that right. Only through an improved Medicare-for-all can we achieve health security, not subject to the market power of health care corporations.

 

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          Insurance coverage: advocating for CGMS in a system that leaves many people out        
Today I received an email from JDRF about their campaign to get continuous glucose monitoring (CGMS) covered by insurance companies. I want my insurance to cover CGMS so that I could use it. I don't think they have any business denying people coverage to this device that is helpful to our health and probably lifesaving for people with hypoglycemia unawareness. But I also don't think health insurance companies or our health care system in general as any business denying anyone coverage. It pisssed me off that this is JDRFs focus when there are more pressing issues for many people.

I wrote back:

I want CGM covered, but MUCH MUCH more than that, I want a single payer health care system that covers everyone in this country.

Please fight for things that will help ALL diabetics and that are much more necessary than CGM. I test 10 times a day, and sometimes wish I had CGM (for example, tonight, I am up late because I worry that my blood sugar is dropping). The diabetics that come to the free clinic I volunteer at are all uninsured, and cannot afford test strips. If they come to the clinic, wait on the waiting list for the diabetes education class, and then attend all the classes, they receive enough strips to test once a day. Though they are type 2s, this includes many people on insulin. People taking insulin that can test their blood sugar once or less a day. As for yearly dilated exams (more often if retinopathy is already present)? The waiting time to see an opthalmologist is 22 months

The millions of diabetics that are uninsured or underinsured and can't even access the basic necessities of diabetes care deserve much more help and I think it's abominable that this is your priority.

Sincerely,
me


We need healthcare for EVERYONE that leaves nobody out. We need a universal single-payer system (expanded & improved Medicare for all) now.
          What They've Wanted To Repeal For Seven Years (Michael Maiello)        

Ever since the Affordable Care Act became law, Republicans have sought to repeal it. In the most recent failed attempt, I've seen numerous references to the difficulty of repealing an "entitlement" once people have grown used to having it and the use of that word mostly reminds me of just what a paltry entitlement the ACA is for most people.

Now, I'm not saying the ACA is insignificant. It greatly reduced the uninsured population and that means the ACA is a good thing. The no-cost annual physical, requirement that insurers cover pre-existing conditions and the elimination of lifetime expense caps were also great improvements.

But, at its core, the ACA is no entitlement. The ACA obligates all citizens to buy health insurance from a private insurer, whether it is provided as part of employment compensation or purchased over a publicly run exchange. The ACA, for all the good it does, is no entitlement.  It's really a law that cements the role of private health insurers in healthcare, in exchange for a few (good) concessions.

It's not health insurers trying to repeal this thing.  Though they have their complaints and would love to win concessions here or there, they mostly support the ACA. Oddly enough, the ACA really gets the government out of our healthcare. Private insurers rule the industry and just have to obey some rules in order to do so forever. The Republican vitriol against this incredibly business friendly regime is the real answer to why we can't have nice things.

There really should be a public option, open to everybody, whether or not they are offered health insurance as employment compensation. Even that would have been a compromise with the right.  The left wants single payer medical coverage for everyone from cradle to grave. A public option would have been a far cry from that and is only the modest suggestion that if people would rather have health coverage from their government than from a private corporation, they should get to choose.

That's how compromised the ACA really is... we started out asking for single payer and came up with something where there isn't even the option of using a public program. Yet its opponents have still spent 7 years trying to get rid of it and the media covering this guffaws that, "you can't take away an entitlement!"

The ACA is good and worth defending but it is amazing to me how we have spent 7 years battling for something that is really not a big deal. It's a requirement that people either get health insurance through work or buy it. That's what it is. It's effective but it's not radical, not socialism, and is in many ways a subsidy to for-profit businesses.

But they've spent seven years fighting it and I am under no illusion that they're done.  The ACA really should have been an entitlement. There should have been some sort of high priced give-away to everyone.  Then it really would have been something Republicans wouldn't dream of tearing down. In the end, the ACA may be vulnerable because it doesn't give enough so that people will support it.

Whenever Democrats get into power and want to do something nice for people, they need to go big or risk having their deeds undone. Forget a "better deal," we need a "bigger deal."


          Cruising the Web        
I'm traveling with my daughters in New England. On the way driving up, we visited Grounds for Sculpture in Hamilton, NJ. This was the coolest place - hundreds and hundreds of sculptures, mostly modern, in beautifully landscaped gardens. Our favorites were the lifesize sculptures by Seward Johnson of famous impressionist paintings such as this based on Manet's "Luncheon on the Grass."


Seward Johnson was the founder of these sculpture gardens and it turned out to be a marvelous place to spend the afternoon. If you're anywhere nearby, I heartily recommend it. Then, for us, it was on to tackling the drive around NYC and into Connecticut. As always when I'm traveling to D.C. or NYC, I can't imagine how people live with such traffic and the horrendous commutes and I'm grateful for living in a medium-sized city where I rarely have to worry about parking and my commute to work, when traffic is bad, is 20 minutes instead of 18 minutes.

We went to Hartford to see Mark Twain's house where he lived for 17 years and wrote some of his greatest works. His family had such a marvelous house in the style of Gingerbread Gothic with the interiors done by the Tiffany firm with handpainted walls and all sorts of neat touches throughout. They have it recreated to really give you a feel of what it looked like when he lived there with his three daughters. I hadn't realized that two of the daughters had died tragically so young and then he'd lost his wife.

After Hartford, we have come to Newport, RI to visit the Touro Synagogue, the oldest synagogue in the U.S. Then we went to the National Museum of Illustration, which is located in one of the Gilded Age mansions. It was like delving into all these great picture books seeing all these illustrations. It was a lot of fun and we've enjoyed walking around and peeking in at the mansions and walking along the Cliff Walk and in the touristy sections. Now, we're onto Boston to visit the historical sites there. I don't know how much time I'll get to blog there since the internet in the hotels can be iffy and you know, it's rather a relief to not pay much attention to national news for a bit. I'd rather tour neat places and, when I have time to go online, read about NBA free agency and all the changes throughout the league. It's almost as if the league is more fun when we're anticipating what these changes will mean rather than watching the actual games.

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One of the stories that has transfixed the political world over the past week is Trump tweeting stupid and nasty things about the media. While it might be amusing that "Morning Joe," which gave Trump a platform all during the primaries, to suddenly decide that Trump is a tasteless and vicious boor who it is dangerous to have in politics or to read liberals, who denied that the guy who shot up the GOP Congressional baseball team was influenced by what he watched in the liberal media, claim that a tweet of Trump bodyslamming CNN might incite violence, Trump's tweets are still classless and stupid. They are not some master plan to neutralize media criticism; they are just puerile and tasteless. Kevin Williamson captures the true motivation for Trump's tweets and ongoing feud with the media.
Some people simply cannot handle the fact that Donald Trump was elected president.

One of those people is Donald Trump.

Trump has shown himself intellectually and emotionally incapable of making the transition from minor entertainment figure to major political figure. He is in the strange position of being a B-list celebrity who is also the most famous man in the world. His recent Twitter attack on Mika Brzezinski of MSNBC’s Morning Joe exemplifies that as much as it does the president’s other by-now-familiar pathologies, notably his strange psychological need to verbally abuse women in physical terms.

Trump may have his problems with women, but it is his unrequited love of the media that is undoing him....

He needs them the way a junkie needs his junk.

Donald Trump cares more about how he is perceived in the media than he cares about anything else in the world, including money. Trump is a true disciple of Bishop Berkeley, professing the creed of the social-media age: Esse est percipi— “To be is to be seen.” Trump is incapable of enjoying anything — money, success, sex — without being perceived enjoying it.

Consider: Even though he has in fact been on the cover of Time magazine, it was discovered this week that he had had his people produce some fake Time magazine covers lauding the success of his television show, The Apprentice. He had these fake Time covers displayed at Trump properties around the world. Why? Because Trump, for all his professed contempt for the media, believes that success is not success until it is certified by Time magazine or (avert thine eyes, Hannity!) the New York Times.

Donald Trump is a man who invented an imaginary friend, John Barron, to call up members of the New York press and lie to them about his business success and his sex life. (He claimed, among other things, to be dating Carla Bruni.) A man who “does not need” the media does not do that....

As president and president-elect, Trump spent a great deal of time tweeting about his ratings as host of The Apprentice and those of his successor, about the ratings of various news programs covering him, about the viewerships and readerships of various media outlets, generally theorizing that those critical of him must by moral necessity be in decline. On the other hand, he plainly does not know that there are tax provisions in the health-care bill Republicans are trying to drag out of Congress: He was perplexed when they came up at a White House meeting with Republican senators, saying that he was planning on taking on tax reform at a later date, oblivious to the content of the bill he purports to be negotiating. He doesn’t understand what’s going on between Saudi Arabia and Qatar, but has taken to Twitter to argue — surprise — that, whatever it is, it’s all about him.

What do you think he reads first in the morning: His national-security briefing or Page Six?

I’d wager that Trump could list at least three times as many cable-news commentators as world leaders. He is much better versed in CNN’s lineup than in NATO’s.

Doesn’t need the media? He is the media, a former contract employee at NBC with a sideline in casinos. He was born to conduct Twitter feuds with second-tier cable-television hosts. Figuring out health-care policy?

Nobody watches that.

Seth Lipsky looks at how the Roberts Court has racked up an admirable record of preserving religious liberty. There was last week's decision in the Trinity Lutheran case that struck a blow at state constitutions barring government aid to schools with religious affiliations.
The trend began to emerge in 2012, when the court blocked federal authorities from trying to apply equal-employment law to the hiring of church ministers. That case, known as Hosanna-Tabor v. Equal Employment Opportunity Commission, was unanimous.

Several key cases followed. In one, the court ruled that the upstate town of Greece was within its rights to permit volunteer chaplains to open town meetings with a prayer. The New York Times editorial board nearly fainted.

Then came the Hobby Lobby case. That’s where the court exempted the religious owners of a closely held retail chain of craft stores from the contraceptive mandate that was put into effect by the Department of Health and Human Services after ObamaCare’s passage.

That puzzler divided the court five to four — and infuriated the godless left. That’s because it seemed to suggest that a capitalistic corporation could have religious views, as if the family owners didn’t matter.

The court’s secularist wing buckled, though, before the Little Sisters of the Poor. The doughty nuns who care for the elderly poor finally won their right not to be entangled in the birth-control mandate in a unanimous ruling by the nine.

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The Wsj argues why Republicans shouldn't be so hesitant to reform Medicaid. As they explain that most of the increase of coverage under Obamacare from extending Medicaid coverage to able-bodied adults instead of the poor and disabled the program was originally meant to cover.
The federal-state program has become the world’s single largest insurer by enrollment, covering more people than Medicare or the British National Health Service. Total spending grew 18% in 2015 and 17% in 2016 in the 29 states that expanded.
This is what needs to be reformed and the Senate bill is trying to do that.
The Senate bill attempts to arrest this unsustainable surge by moving to per capita spending caps from an open-ended entitlement. When states spend more now, they generate an automatic payment from the feds. The goal is to contain costs and give Governors the incentive and flexibility to manage their programs.

Meanwhile, four long years from now, the bill would start to phase-down the state payment formula for old and new Medicaid beneficiaries to equal rates. Governors ought to prioritize the most urgent needs.

This would be the largest entitlement reform ever while still protecting the most vulnerable. The bill is carefully designed to avoid overreach and would save taxpayers $772 billion compared with what Medicaid would otherwise spend under current law, according to the Congressional Budget Office. This does not “cut” spending; it merely slows the rate of increase.
But some of the Republican senators are balking at such reform. They should think instead about why it is so necessary to reform this new expansion of Medicaid under Obamacare or the results down the road are going to be dire.
Some 65% of the federal budget is mandatory spending, meaning Social Security and the health-care entitlements. Interest on the debt is 6% and more than half of the discretionary budget flows to defense. The GOP can’t meaningfully reform government or increase defense spending without fixing Medicaid and replacing ObamaCare.

The alternative will be much higher levels of taxation across society, reaching deep into the middle class, or a debt crisis. “To avoid fiscal and economic calamity,” as one GOP Senator wrote in a 2014 op-ed on these pages, Washington must “reform Social Security and health entitlements. The CBO estimates that a deal saving $4 trillion over the decade would put the budget on a path to sustainability. . . . The longer we wait to enact reforms, the more abrupt and painful they will be. It is time for everyone to come together and start to erase the red ink.”

That Senator was Mr. Portman, a former White House budget director and member of the “super committee” of 2011 that tried to negotiate entitlement reform with Barack Obama. The Senate bill doesn’t save close to $4 trillion but you’ve got to start somewhere.

Someone should also ask the Governors like John Kasich who are predicting doom a substantive policy question or two. Some 43% of the Ohio all-funds budget goes to Medicaid compared to a mere 14% for K-12 education. The average state all-funds Medicaid share is 28%. Does Mr. Kasich think this is the correct fiscal priority for America’s future—skimp on educating the next generation to finance free health care for able-bodied adults?

If Republicans fail to pass a bill or weaken the Senate bill so much that it won’t make a difference, the result will be a calamity of a different kind. GOP Governors who declined to join ObamaCare’s new Medicaid will conclude that the expansion is permanent and the political pressure will rise to take the federal bribe. Medicaid costs will soar, and national Republicans will show that they’re incapable of doing what voters sent them to Washington to do.

Democrats will conclude that Medicaid is politically untouchable and thus a wedge for single payer. They’ll enlarge eligibility to ever-higher income levels and gradually crowd out private insurance. Republicans won’t have a plausible argument against the idea if they can’t reform Medicaid now.
James Capretta also makes the argument that reform of Medicaid is absolutely necessary.
There’s nothing in the Senate bill that would force states to drop coverage of low-income elderly and disabled persons, or poor women and children, as so many of the misleading attacks on the plan have implied.

Even with the changes to Medicaid contained in the Senate bill, which would be phased in very slowly, the program would remain a large and growing part of the federal budget. The Congressional Budget Office (CBO) projects that, under current law, the federal government will spend nearly $5.2 trillion over the next ten years on Medicaid. If the emerging GOP plan cuts federal funding by $0.9 trillion over a decade, which is possible, that will still mean the federal government will spend $4.3 trillion on the program over ten years. CBO estimates enrollment in Medicaid in 2026 would be about 71 million people under the House-passed Medicaid provisions (which are similar to those in the Senate bill), or 4 million more than were enrolled in the program in 2011.

Moreover, the Senate bill provides a new, refundable tax credit to anyone who has a low income or is poor and is not eligible for Medicaid. Under this provision, households with incomes below the federal poverty line (FPL) are guaranteed that they can enroll in an insurance plan with a premium that does not exceed 2 percent of their annual income. For a person with an income at the poverty level, this means his maximum premium for health coverage would be about $20 per month.
Unfortunately, no one is out there making these arguments in public. Sometimes I wish for a Ross Perot-like figure who could get up there with some simple charts contrasting what will happen if we continue on the path that Obamacare set us on with what the Republicans are proposing. The proposed bill isn't ideal and can be tweaked. But the real argument shouldn't be the contrast between their bill and some Platonic ideal of health care reform. It's between Obamacare and whatever reform they can come up with.

Chris Christie seems determined
to rack up the lowest poll ratings of any modern politician.
People hoping to visit Island Beach State Park this holiday weekend were not allowed in because of the state government shutdown Gov. Chris Christie ordered amid the state budget standoff in Trenton.

But there was one family there: Christie's. They are using the summer beach house provided by the state for a weekend down the Shore....

Christie was asked if he got any sun Sunday.

"I didn't," he said. "I didn't get any sun today."

When later told of the photo, Brian Murray, the governor's spokesman, said: "Yes, the governor was on the beach briefly today talking to his wife and family before heading into the office."

"He did not get any sun," Murray added. "He had a baseball hat on."
Sign that guy up for the Trump communications office.

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Enjoy the Fourth of July! We're going to be in Boston for the Fourth - a highly appropriate place to celebrate our nation's founding. May you have fun celebrating the holiday with your friends and family and may you stop a minute to appreciate the people who launched this country with no real assurance that they would win independence.

          We Were Had        
(By American Zen's Mike Flannigan, on loan from Ari.)
     ObamaCare, to put it simply, is a snake venom that nonetheless somewhat succeeds in counteracting an even more pernicious malady. It's the red-hot piece of metal that cauterizes a bleeding wound.
     It was never, ever intended to be anything more than that.
     It is a position, often a lonely and adversarial one, that had been consistently taken by yours truly in this very byline since the mislabeled Affordable Care Act was first being debated by no less than five Congressional committees starting in the spring of 2009. Yet, conservatives and truly enlightened liberals such as me cannot and should not succumb to the siren lure of schadenfreude in light of the strangely delayed revelations regarding Jonathan Gruber.
     Beginning in March of 2010, a week before Congress finally ratified the ACA and put it on Mr. Obama's desk to sign into law, Gruber had openly, brazenly and, seemingly without impunity until now, was crowing about how "lack of transparency and the stupidity of the American voter, whatever" was responsible for the bill's success. Yesterday brought a fifth video (and, no doubt, counting) of a now-infamous testy and condescending exchange between Gruber and a Vermont voter concerned about the ACA's ramifications.
     Predictably, wingnuts on Twitchy, Hot Air, Breitbart and other right wing convection ovens have been crowing about ObamaCare's inherent dishonesty, of which most us were already aware. But now they have in Gruber their smoking gun. Five, in fact. And among their talking points is how liberal elitists lied to the American public about the health care bill. But liberals had absolutely nothing whatsoever to do with the bill's crafting, creation or ratification.
     ObamaCare was passed in first the House, then the Senate then put on the president's desk to be signed into law as with countless other bills. It was not put on a national referendum and not one American voted for it. None of us little people had any say as to what it would contain or not.
     And now, "leaders" such as Nancy Pelosi are playing the predictably scummy, craven political game of distancing herself from someone she'd quoted and mentioned countless times five years ago who has now been exposed as the Most Hated Man in America. Democrats are running from Gruber as if he has Ebola, Obama and everyone associated with the bill who's still on the Hill are in full spin mode and right wingers who were told to hate the ACA by the Koch Brothers and Dick Armey's Freedomwerx now have their health care Willie Horton.

The Triple Whammy

     They say celebrities die in threes and regarding the Affordable Care Act, this is the third whammy that may have finally sunk ObamaCare. First was the clusterfuck of a rollout. The government literally had several years to set up a workable website with adequate server space. State-run partners, through their own exchanges, had the same amount of time. But ObamaCare's website immediately crashed like a soggy house of cards because the Obama administration, hardly to the surprise of yours truly, decided to outsource its set-up and implementation to a private corporation.
     Secondly, there was Obama's palpable lie of, "If you like your present health care plan, you can keep it," which proved to be as honest and prescient as closing Guantanamo Bay.
     Thirdly, there's Gruber's arrogant, condescending and, frankly, out of touch comments about the American people and his pride in the lack of transparency of the government that had paid him so handsomely to mislead the American public
     And while conservatives jeered, liberals struggled to put on a happy face and bombed Twitter and Facebook with memes about how Bush killed hundreds of thousands (a place they seriously do not want to go) while Obama had a slow website. Now it's almost entertaining watching these liberals who think that everything Obama does is in some way miraculous on a Biblical level struggling even more mightily to keep on their O faces after ample evidence has been avalancheing down at warp speed 10 out of the past that its architect called them "stupid."
     It's impossible to estimate the embarrassment this has visited on the Obama administration, which paid this man over $400,000 to craft a bill that was mislabeled as almost all about health care (hence the inevitably sarcastic name of the bill). It ought to be embarrassing to the mainstream media (especially ABC, which is still ignoring it) for letting these explosive revelations languish for better than four and a half years. And it should be embarrassing to any Democrat still in Congress who'd voted for such a steaming pile of horse shit.
     Most of all, it should be embarrassing to so-called liberals such as Esquire's Charles Pierce (who seemed to love it simply because it helped his ailing wife) who thought the tepid reforms and it being just a giant gateway to the free market was the greatest thing since Medicare (which in 1965  LBJ signed into law without him or Congress having to mislead the American public). In short, anyone who hated the bill or opposed it with such virulence should be stripped of their voting rights and undergo a mandatory psychological evaluation since it seems no one save for Gruber, the President and several people on the five committees that had refined and crafted it knew exactly what it was all about.

The Three Blind Chinese Men and the Republican Mascot
   
       I'm sure we all know the story of the three blind Chinese men and the elephant. One blind man felt the tail and thought it was a rope. Another at the other end felt the trunk and thought it was a snake. The third in the middle thought the stomach was a wall. The parable only shows that, without the proper context, individual parties can be completely wrong about what they think they perceive.
     This perfectly describes the second-hand experience of the American voter who had no say in the bill's crafting and had foisted off on them like a pile of flaming dog shit on Cabbage Night. It was a testament, albeit a sad one, of the persistent cheerfulness and glass-half-full optimism of your typical Obama voter.
     But the fact remains that out of all the bills signed into law by the nearly six year-old Obama administration. the ACA is easily the most misunderstood one of all. And that's not completely their fault. The administration's and Democratic Congress's explanations of it were largely incoherent, almost as much as the Teabaggers' screaming oppositions to it during Town Halls in the summer of 2009. And Gruber did, after all, lie to not just us but the nonpartisan CBO over how the ACA should be packaged and sold (90% cost control and 10% mandatory health care instead of the opposite). Yet it wasn't as if there was a complete media blackout of the bill's contents.
     However, liberals chose to ignore the back room deal struck by Rahm Immanuel (whose very name ought to be, if it already isn't, synonymous with arrogant, Democratic elitism) and Big Pharma to cap drug reimbursements at $80,000,000,000. La de la de dah, dig hole in sand, insert head. Repeat as necessary.
     Liberals also stuck their fingers in their ears when Max Baucus, then chairman of the Senate Finance Committee, refused to hear testimony from universal single-payer advocates and even made a joke about arrested protesters to Republican Chuck Grassley about running out of cops. Liberals were also nonplussed that the ACA was never, ever intended (despite Obama's immediately-broken campaign promises) to be anything more or less than a gateway to the very same health insurance companies that have been bilking the American taxpayer, and government, for decades, turning our health care system into the rest of the world's punchline.
     And Gruber's abominable and infuriating comments about the "stupidity" of the American people that he nonetheless willfully mislead and even lied to show just how much of an out-of-touch elitist he truly is. His comments back on March 10, 2010, when the bill was still being hashed out, that Americans care much more about health care costs and far less about insuring the uninsured are so wrongheaded and ignorant it's beyond laughter.

One Shade of Grayson

 
     I guess he forgot all about Alan Grayson constantly hammering home the fact on the floor of the House that 48,000,000 Americans were uninsured and that 45,000 Americans die each year because of lack of health coverage. I suppose Gruber also forgot about liberals (the real ones) screaming about universal single payer and not allowing red states to opt out of Medicare expansion out of a misguided and futile attempt to respect "states' rights" (a sop thrown to the GOP that got exactly two Republican votes in the Senate and has not done a thing to keep Republicans from voting no less than 52 consecutive times to repeal ObamaCare).
     Limousine liberals and the Obama administration (as I'd said here several times) made the colossal mistake of investing so much political capital on one piece of domestic legislation so early in its history. With the Iraq War, Afghanistan, terrorism, Gitmo, immigration, environmental issues, gay rights and too many others to name, the Obama administration should've dispersed its political capital more evenly instead of putting all its eggs in one basket.
     And so-called liberals, happily following that disastrous meme, acted as if the success of the rest of the Obama administration rested with ratification of the ACA, a bloated and more unwieldy version of the equally disastrous RomneyCare here in Massachusetts.
     Liberals had it only half right as were spittle-flecked teabaggers who didn't, couldn't or wouldn't understand it any better than we: ObamaCare has undoubtedly saved lives and over 10,000 fewer Americans are dying every year through lack of coverage. It has driven down premiums, deductibles and co-pays as well as abolishing the prejudice against those with preexisting conditions. And your child can remain on your health care plan until they're 26.
     But it was, at best, a vastly flawed work in progress and in desperate need of improvement. Liberals made the mistake of seeing it, hairy warts and all, with the peculiar beer goggles with which lonely horny men see the last barfly at last call. If it was to be so popular, then why enforce "compliance" through two bylaws in the federal tax code? Conservatives hoarsely screamed as they were told to that it was a Commie takeover of 1/6 of our national economy while Sarah Palin sneeringly claimed to see death panels from her house.
     It was neither. It was a single, staggering step in the right direction, with muddy bootprints. But with Gruber's astoundingly stupid confessions these past four to five years, this may be the monkey wrench the newly-empowered Republicans have been looking for to finally repeal the ACA and put us right back to the Dark Ages we were in prior to the bill's passage. Liberals and conservatives ought to stop pointing the finger at each other and at elitist assholes such as Gruber and Obama. We were all had.



          The Visible Vote        
I'm going to live-blog the Visible Vote forum that LOGO and HRC are hosting. All of the Democratic candidates - excepting Biden and Dodd - will be appearing to discuss issues of concern to lesbian, gay, bisexual and transgender people and their allies. I've also submitted some questions, mainly at the intersection of health policy and LGBT rights. But my guess is they're a bit on the wonkish side for a general debate.

The hosts: Journalist Jonathan Capehart, singer Melissa Etheridge, and HRC President Joe Solmonese. You can stream the debate live here.

Obama is up first.

9:06 PM - Obama draws an analogy between the outsider status he has often confronted due to his racial and ethnic heritage and the marginality faced by LGBT people. He argues strongly from anti-discrimination/civil rights framework for civil unions that are legally equivalent to marriage. He wants to leave marriage up to individual religious denominations. One of the panelists presses this - what about civil marriage?

9:08 PM - Obama just concern trolled the gays. He said they should choose their battles, and maybe the lack of access to civil marriage isn't the one they should focus on. He also said that whether or not civil marriage was available to same-sex couples was mostly a semantic issue. That does not sit well here. He actually comes of as dismissive and patronizing.

9:15 PM- One of the hosts, Mr. Capehart, raises the issue of homophobia in the black community. Barack responds that he has previously addressed to black audiences the impediment that homophobia has raised in adequately responding to the crisis of AIDS amongst black Americans. He also laments the use of homophobia to fragment progressive alliances between blacks and LGBT people. He is very good on this issue. His answer is very thoughtful and considered. I believe him when he says he will advocate for LGBT people not solely when he's on the burner before America's wealthiest gay rights group.

9:22 PM - Edwards steps up to the plate. I've previously blogged (quite unfavorably) on his discursive representation of LGBT people in public debates. Let's see how he does tonight.

9:24 PM - Melissa Etheridge has a great moment where she touches on the solidarity she feels with Elizabeth Edwards in their mutual struggle with cancer. She pivots from there to the incredible privilege she and Edwards share in being able to afford their expensive treatments. She asks if Edwards understands that the health care crisis hits LGBT people especially hard given that they cannot depend on employers and spouses to provide health care for them like most Americans.

Edwards answer is okay, but not impressive. He plugs his universal health care plan. Then he discusses his empathy for the large portion of LGBT people who are homeless as a result of discrimination. He does touch on an actual answer - between his stances on civil unions and his universal health care plan he'd see the problem addressed. He doesn't seem to have much to say about LGBT health at all, and is instead trying to soundbite on as many issues as possible.

9:29 PM - Edwards states, albeit equivocally, that he would support education about sexuality in public schools that emphasizes the naturalness of homosexuality and the need for tolerance. He comes across as empathetic, but admits he hasn't thought through the specific policy issues involved. It shows.

9:31 PM - Why, oh why, has Edwards spent the past three minutes talking about Anne Coulter?

9:33 PM - Edwards takes the first transgender specific question of the night - how would he react to the knowledge that one of his staffer was trans-identified and planning to transition? Edwards replies that he would be tolerant and as supportive as he could be (fair enough), and expresses his support for a transgender inclusive federal ENDA. This is his strongest answer yet.

9:35 PM - Edwards is finally taking on the marraige question. He says that he cannot impose religious views, that he believes in equality to his core and that he can understand why anything short of full equality before the law will be seen as a sleight to the LGBT community. But he doesn't give a direct justification for his policy. So he is asked for one, in a question that strongly indicts his "I'm on a journey" crap. His answer... is that Don't Ask Don't Tell ought to be repealed. Very disappointing.

9:41 PM - Kucinich takes the stage to the warmest welcome of the night. Right away Capehart points out that Kucinich seems to stand with the LGBT community on every issue. He then asks Kucinich why he stands in such a minority amongst candidates in his support for same-sex marriage. His response, simply, is that he stands for true equality. Capehart takes this and runs - is Kucinich saying that Obama and Edwards, who speak for equality as well, have jettisonned the LGBT community for political reasons. Kucinich takes the high-road and doesn't endorse Capehart's theory, but he gives a great answer on the role the federal government can play as an agent for social change.

9:47 PM - Kucinich is still getting a lot of flattery. The moderator calls him "evolved." Kucinich accepts the compliment. He says his role is to help all Americans "evolve" with him. He also emphasizes that his path is easy - he just has to listen to LGBT people and then act. They are the ones who have to struggle courageously with discrimination. How can he not help them? Kucinich understands solidarity, I'll say that.

9:49 PM - Are you serious? I guess this can't be a cakewalk the whole time, so Etheridge (after endorsing Kucinich's candidacy to his face) throws him a question on medicinal marijuana, citing the pain caused by AIDS and cancer in the gay and lesbian communities. Kucinich says - yes. He does not waffle. Just, yes - as a matter of compassion our approach to marijuana should be informed primarily by health policy not criminal justice. He also plugs his health care plan: the only universal single payer health care plan proposed by a candidate, the only one that is not-for -profit. Nice, but he sure swallowed a heck of a soundbite on the pot question.

9:52 PM - The panelists seem to concede that Kucinich can't win this as much as they'd like him to. They ask if he is electable. Kucinich is giving a terrific answer. He replies that middle America does believe in tolerance and equality. He'd like to lead that America, but at the same time his candidacy is not just about representation - it's also about transformation. He is trying to transform and persuade even as he positions himself for the White House.

9:54 PM - Now Kucinich gets the wonkiest question of the night: will he make HIV/AIDS prevention funding part of Ryan White? For those not in the know, Ryan White Care Act is the source of most federal funding to care for people living with HIV/AIDS but does not cover preventative care. Kucinich says he would advocate for that. Succinct, but he doesn't seem prepared to talk in detail about Ryan White, so he just talks about health care generally for awhile. Not a stellar answer.

9:59 PM - Kucinich's closing remarks are very eloquent. He talks about love and his wife, transformation and equality. I'd like to point out that Kucinich is the candidate who has talked least about "tolerance." He never uses the word. He talks about equality a lot, love almost as much and occasionally uses the word justice. But he is not talking about tolerance. It does not seem rehearsed, he just seems to be past that point. I'm consistently impressed by this man, and tonight is no exception.

10:05 PM - Now Gravel is on. He gets a question about how, as a member of his generation, he talks about his support for LGBT rights generally and same-sex marriage specifically. He answers that most of his generation is wrong, and in time the issue will not be one.
Gravel blames demagogues for dividing America on marriage equality. He thinks most Americans, if they followed their sense of fairness, would support marriage.

10:08 PM - Interesting and ballsy: Gravel calls out LGBT voters for supporting people like Clinton and Obama when candidates like himself and Kucinich are doing the hard work on LGBT issues. Point taken, sir.

10:10 PM - Capehart turns the blade at Gravel: Why aren't you as popular as Clinton and Obama with LGBT voters? Gravel seems to backtrack and acknowledge that there is a political liability that he does take on by supporting LGBT equality. And he says he does not want the support of Democrats who are not willing to take on that liability as a show of solidarity.

10:13 PM - Gravel has talked a lot about politics and public opinion. This is working against him because he isn't getting to talk much about the range of issues that Edwards and Obama did. He comes off as committed, but not particularly informed.

10:14 PM - Gravel is talking about nuclear testing in the Pacific? He's also kind of being a dick to Joe Solmonese, but that's probably okay since no LGBT activist worth their rainbow stripes actually likes the HRC.

10:17 PM - So now Gravel is giving a great schpeel on the prison system, the war on drugs and de-criminalization. It's decent enough... but unfortunately the question was about HIV/AIDS in the inner cities. Not particularly convincing.

10:19 PM - Now it's Richardson's turn.

10:22 PM - Richardson's "concern troll" is a lot more convincing than Obama's. He talks about using winnable battles against hate crimes, against No Child Left Behind (which he points out hurts good sexuality education and anti-bullying work). But he emphasizes using these battles to build the community of allies concerned with LGBT support and to transform public consciousness. He sounds like a realist, where Obama and Edwards just sounded evasive.

10:25 PM - Richardson apologizes the "miracon" gaffe, and minimizes. He wants to talk about his record, which is impressive (pioneering support for transgender rights, working against hate crimes, and moving aggressively for domestic partnerships and against DOMA). He is tremendously focused on talking about (1) what political goals are achievable for LGBT issues, (2) what his political record is and (3) how the community can move forward.

10:28 PM - Now Richardson takes a hypothetical: if you could sign a marriage act into law, would you? This is a great question because it challenges Richardson's position, which is the "achievable" bit keeping his own stances out of the picture. He dodges a lot, before finally saying that he isn't "there yet." Saw that coming. I think Richardson still comes off great. He admits that he isn't there, but neither are most Americans. And he seems to have really thought about how he will transform American politics for LGBT people. He has a plan.

10:31 PM - Interesting. Richardson says at first that homosexuality is a choice. Then he waffles. But his answer, that he continues forward with, is that categories don't matter. LGBT people are people, and whether they have chosen, been acculturated, or been born a certain way then they should not give up their rights. I agree. But I also agree with Etheridge's answer that it is alienating for LGBT people to be told that they have chosen their identity when their personal narrative reads otherwise. When pressed, Richardson makes it clear that he is about politics, not identity. He can't say what homosexuality is like, or what being transgender is like - but he can offer political protection. This is actually where I stand as well. There is no need to define identity to make a political coalition. I respect a man who demures from doing so, especially when he has the humility not to define the identities of others.

10:36 PM - And here comes Clinton, closing out the show.

10:38 PM - Mr. Solmonese asks why Clinton has never introduced legislation against Don't Ask Don't Tell, being a vocal advocate against it for so long and given her place on the Senate committee working on military issues. She basically answers that the political climate is wrong and we need an executive branch that will accommodate the change (or at least not veto the bill).

10:42 PM - Clinton isn't against same-sex marriage, she's just really for civil unions. Ick. She says equality matters, and civil unions can provide full equality. She wants states to make decisions. But she is personally against same-sex marriage. Her position is much like Edwards and Obama's: she doesn't have a plan to provide justice for LGBT people, but she sees the country moving in that direction and will not obstruct that movement. But she is herself unwilling to take the position (and political risk herself).

10:45 PM - Clinton says the states are better battlegrounds for LGBT people than the federal governments. I'd agree if so many states hadn't explicitly repudiated that hypothesis with bblatantly discriminatory statutes last November.

10:47 PM - Next to Kucinich, Hilary is doing the best job of answering the questions she is asked. But her discussions is kind of wonky, she talks a lot about the powers that be - not the powers the she will use and the moves she'd like to make for LGBT people. She also isn't talking much about her record, other than emphasizing her record with HRC (oh boy). She is coming off as a political advisor and something of a political historian even. In apologizing for the conditions facing LGBT people now she gives phenomenally informed answers on why their legal position is the way it is. But she seems lacking on vision, on a gameplan, and on a record. She understands the political waters, but doesn't know where she wants to swim.

10:50 PM - Clinton says she wants to reverse the "mean-spirited assault" political assault on LGBT people. Other than that, she doesn't seem to have much to offer.

Commentary: I loved the format. Very intimate, like a conversation. Questioners could follow-up easily, and answers were lengthier. The answers were even more substantive, where the candidates wanted them to be. I applaud the planners for that. I really feel like I know where each candidate stands.

Kucinich was clearly the star of the evening. Richardson would be my second - he isn't on my page on all the issues, but I know exactly what he'd do for me as a gay citizen were he to sit in the White House. Obama performed well when talking about race, AIDS and progressive coalitions. But his answers on marriage were nearly offensive. Gravel was alternatively solid and way off topic. Clinton just didn't seem to have much to say other than that she wanted to support LGBT people but needed to change the political climate to do that effectively. Edwards was awful.

There's an exit poll on the LOGO site seeing how people felt. I'd expect to see it swing a bit now that the debate has ended. But here's the breakdown:

Question: Who's your candidate?

1. Barack Obama (37%) - My 2nd choice candidate, 3rd best performance tonight
2. Dennis Kucinich (24%) - My 1st choice candidate, 1st best performance tonight
3. Hilary Clinton (19%) - My 4th choice candidate, 5th best performance tonight
4. John Edwards (9%) - My 5th choice candidate, worst performance tonight
5. Bill Richardson (5%) - My 3rd choice candidate, 2nd best performance tonight
6. Mike Gravel (4%) - My 6th choice candidate, 4th best performance tonight

Question: What's your issue:

1. LGBT Rights (40%) - my 2nd choice out of the poll
2. Health Care (31%) - my 1st choice out of the poll (and 1st overall in this election)
3. Gay Marriage (29%) - my 3rd choice out of the poll (and important overall, though I'd be hard pressed to rank it precisely)
          SHOCK & AWE: NAZI TREX EJACULATES TWICE COSTING US TAXPAYERS BILLIONS & CORPORATE TAX WELFARE BUT NO CHANGED OWNERSHIP!        

Bona Fide NAZI lineage ROCKEFELLER CITIGROUP/EXXON/MORGAN MOST CURRENT FILTHY, CARNIVOROUS, TREX TRUMP Administration demonstrates his/their military hardware, prowess, twice in one week at ENORMOUS US TAXPAYER cost!

Anyway, the boys with the toys are asses.

HERE very few people give a damn about North Korea which the US attacked in the 1950s and South Korea in which the US installed a BRUTAL CIA DICTATORSHIP!

All of it being OBVIOUS SHAM, SABER RATTLING, FAKE NEWS, like CHINA, which has become one large toxic parking lot and garbage dump with TONS of slave labor transporting THEIR GARBAGE products across the seas into places like Amazon and Walmart.

People here are too busy, preoccupied, SURVIVING, or, trying to survive multiple economic tsunamis created by THOSE above to worry about North Korea.

We have unemployed, underemployed, homeless, poverty stricken, declasse, impoverished, exploited, overworked, underpaid, working class, POVERTY TERRORISM, debt burdened students, credit card debt, national debt, medical debt, you name it, an intentionally INVISIBLE ARMY.

As a minor aside, reminder, whatever happened NOT to Baby Jane BUT Hillary Clinton's e-mails which snake oil salesman, two bit fleabag hustler, Trump trumpeted so much during his campaign??

Along with all else, Clinton's emails disappeared in CURRENT NAZI ROCKEFELLER CITIGROUP/EXXON/MORGAN T-REX ADMINISTRATIVE SWIRLING BLACK HOLE VORTEX.

Now, as for latest PRIVATE CORPORATE TAX WELFARE proposal by our MOST CURRENT ANAL RETENTIVE, IN YOUR FACE, REPULSIVE, REPTILIAN, PARASITICAL, PIRANHA, RECIDIVIST CRIMES AGAINST HUMANITY, TREX TRUMP ADMINISTRATION, 
I make the following counter offer, proposal, SOLUTION, like Single Payer Health Care, OFF THE TABLE:

NO corporate tax, instead, PUBLIC-PRIVATE PARTNERSHIP WITH MINIMUM 51% STATE OWNERSHIP, INCOME REVENUE SHARING, STATE AND LABOR DECISION MAKING, INCLUDING ALLOCATION OF RESOURCES, CIVIL SERVICE JOBS, AND, more.

How's that for DEAL MAKING??
Put it in your peace pipe and smoke it.

It SHOULD be 100% state owned, prosecution, liquidation, appropriation of assets, CHARGES of GRAND LARCENY, THEFT of BIBLICAL MAGNITUDE, RECIDIVIST HIGH CRIMES AND MISDEMEANORS AGAINST HUMANITY.

I am more than very, very, generous proposing ANY partnership at all!

But, of course, HERE, in the world's GREATEST STUPID, IDIOT, SUCKER, BRAINWASHED, DUMB, NATION, they, our NAZI PARTNERED AFL-CIA/SEIU, demand NOTHING, NOTHING AT ALL, instead, told to grovel and be happy the ILL GOTTEN GAINS OF PRIVATE CAPITAL to be repatriated HERE!!??

That's THEIR idea of DEAL MAKING??

By the way, as another reminder, anyone remember former VP Dick Cheney of oil giant HALLIBURTON fame and ALL government cash flowing into THEIR pockets and OTHERS, LIKE, THEIR IRAN SURROGATES IN IRAQ??

Forget tax.

OWNERSHIP THE ONLY ANSWER! 

Too big to fail MUST be prosecuted, LIQUIDATED, their ASSETS SEIZED!

NO TAX SUBSIDIES FOR PRIVATE CAPITAL IN ANY WAY, FORM, SHAPE, REPRESENTING CORPORATE WELFARE, ENTITLEMENTS, STIMULUS, QE, SOCIALIZED DEBT, PRIVATIZED PROFIT, in another form!

NADA, ZERO, ZIP!

Collectively, here and abroad, WE pay MANY TIMES OVER for PRIVATE CAPITAL assets THEY seized from the US and abroad thru MURDER, WAR, LABOR EXPLOITATION, coups, assassinations, etc.

NO ADDED VALUE CREATED MERELY SUPPLYING MONEY.
ONLY those who LABOR create ADDED USE VALUE.
Without them, nothing happens.

This most certainly extends to industries like the internet, COMPUTERS, SOFTWARE, HARDWARE, CREATED BY PUBLIC, taxpayer, FUNDS NEVER intended for vast CRAPPY COMMERCIAL APPLICATION, USURPED BY PRIVATE CORPORATIONS LIKE NAZI IBM, MICROSOFT, PRIVATE DELIVERY SYSTEMS, PARIAHS, BEHEMOTHS, MONOPOLIES, PHONE AND CABLE COMPANIES VERIZON, COMCAST offering absolutely NO security but the illusion of it and a burgeoning NATIONAL INSECURITY STATE industrial apparatus!!

Meanwhile, garbage ghost ships crisscross oceans dumping CHINA TRASH products on US shores, and, as well, TRASH exists on the internet, TV, phones, a vast electronic media, a totally TRASHED, intellectually, physically, polluted, toxic, environment, including schools, education, food, you name it.

Human life has NO value HERE, despite meaningless, cynical, hypocritical, empty, rhetoric, shibboleths.

NO YOUNG PIONEERS EXIST TODAY, certainly NOT HERE, or, anywhere else in the world NOW!









          DROWNING IN PRIVATE HEALTH CARE; ENERGY; HENRY HUB; NATURAL GAS, RRs & MORE        
The US is BANKRUPT THANKS TO A NAZI/FASCIST PRIVATE CAPITAL SYSTEM, a large PART of it having to do with a KAFKAESQUE, ORWELLIAN, BYZANTINE, BIZARRE, PATCHWORK QUILT OF PRIVATE HEALTH CARE INSURANCE NETWORKS SUBSIDIZED BY UNITED SUCKERS AND ASSHOLES TAXPAYERS, JUST AS IS EVERY OTHER PRIVATE INDUSTRY IN THE US!

Tax subsidies HERE euphemistically called public-private partnerships!

US, Dis-united Suckers and Assholes, GOVERNMENT, TAXPAYERS, ALWAYS become payers of last, or, first, resort, rescuing PRIVATE CAPITAL from THEIR/ITS SYSTEMIC disastrous consequences which THEY themselves create, cyclical boom and bust, financial, real estate, energy, speculative asset bubbles, inflation, perpetual, endless, WARS, coups, interventions abroad, MASS Murder, Inc., RECIDIVIST EMPIRES OF CRIME, SOCIALIZED DEBT BUT PRIVATIZED PROFIT!

Taxpayers, serfs, peons, slaves, pay thru their ringed noses to keep THEIR system afloat, while benefiting NOTHING, losing everything, including TOTALLY WASTED MILITARY EXPENDITURES, HARDWARE, a boon to another PRIVATELY OWNED INDUSTRIAL COMPLEX marketing death and destruction abroad peddling their hardware as part of THEIR protection racketeering, extortion, blackmail.

In NATURAL DISASTER, of which TOO MANY exist, whether or not MAN MADE and/or natural climate change, combined, like earthquakes, volcanoes, floods of biblical proportions, hurricanes, fire, tsunamis, tornadoes, drought, asteroids, solar/electrical storms, pandemics, epidemics, you name it, the government issues DISASTER funds INSURING PRIVATE FIRMS DO NOT GO BANKRUPT!

Well, what the hell are we/you paying PRIVATE insurers when you can just give THAT SAME money to a NON PROFIT GOVERNMENT DISASTER RELIEF AGENCY??

Why have PRIVATE INSURANCE MIDDLE MEN at all collecting fees and profits??

Not to mention investment policies fueled by LOCAL GOVERNMENT TAX ABATEMENT, FREE PRIVATELY OWNED FEDERAL RESERVE STIMULUS monies, UNBRIDLED PRIVATE CAPITAL INVESTMENT for LUXURY PRIVATE AND COMMERCIAL REAL ESTATE SPECULATION, SPRAWL, DEVELOPMENT, EXPANSION, CONTRIBUTING to and multiplying dire outcomes, consequences, of natural disasters of all sorts and dimensions, creating ever more poverty, displaced peoples, homelessness, welfare, impoverishment, marginalized urban and rural blight, despair, desperation!

Now, we have, in addition, a healthcare debacle of biblical proportions DROWNING most everyone in a dysfunctional PRIVATE health care INDUSTRY!

Both, twin, NAZI PARTIES support THEIR SICK PRIVATE health care system, MOST OF ALL, THEIR ENABLING, PARTNERED, COLLABORATIVE, BUSINESS AFL-CIA/SEIU, MAFIA LABOR UNIONS with PENSION systems equally bankrupt thanks to PRIVATE investments, BUT, guaranteed by TAXPAYER monies IF they happen to be "public" servants!

OUR UNIONS, AFL-CIA/SEIU, are culpable!

THEY will, shall  and MUST be targeted, PAY, and, cease to exist until and unless THESE policies CHANGE!

THEY are the MAIN reason NO PRINCIPLED, MILITANT, ORGANIZED, opposition exists AGAINST AN ONGOING NIGHTMARE.

For those READING this HERE DECIMATED by supposed Obooma-does-not-care astronomical health care costs, ORGANIZE,
demonstrate, boycott, OCCUPY, MAKE NOISE, get your professional, business, community, organizations, IF you have any, to DO SOMETHING!
BE MILITANT--PROACTIVE not reactive!

ONLY ONE ANSWER exists to THEIR MANUFACTURED health care dilemma:

EXPAND AN ALREADY EXISTING, NATIONAL, GOVERNMENT SPONSORED, NOT FOR PROFIT, SINGLE PAYER HEALTH CARE SYSTEM, known as MEDICARE FOR ALL to encompass long term life care, nursing homes, assisted living, medicine, NO deductibles, NO income capped contributions and no MORE BANKRUPTCIES, IMPOVERISHMENT, ANXIETY, DUE TO EVER RISING HEALTH CARE COSTS!

OBOOMA DOES NOT CARE PUBLIC-PRIVATE HEALTH INSURANCE MUST GO--NOT TO BE REPLACED BY ANY FOR PROFIT RACE TO THE BOTTOM PRIVATE HEALTH CARE ALTERNATIVE which exactly is what is GOING TO HAPPEN AS OBOOMACARE EXPLODES, IMPLODES, ALREADY FINANCIALLY STRANGLING MUCH OF THE COUNTRY!

Now, as for blowhard, liar, snake oil, Trump, just ONE out of MANY examples of HIS stupidity, double standard, cynicism, FAKE NATIONALISM, represented in a local report, links, below.

SEPTA, a major Northeast PUBLIC TRANSIT SYSTEM located in southern Penna serving Phila and surrounding suburbs, plans purchasing MORE passenger RR cars, previously having done so FIRST from a South Korean firm which FAILED them, NOW, instead, from a mysterious so-called "state-private" (like our public-private partnerships) CHINESE FIRM about which we know nothing except for the fact that China exports GARBAGE to the US and everywhere else and SOMEONE negotiated this monstrous deal!

Well, STOP THIS DEAD IN ITS TRACKS!

Where are all our presumed "nationalists?"
Nowhere to be found!:

http://www.philly.com/philly/business/transportation/Mass-based-company-with-Chinese-backing-beats-out-local-group-for-SEPTA-car-contract.html

AND:
http://www.philly.com/philly/business/transportation/SEPTA-approves-contract-for-new-rail-cars.html

Most, more, important, why does NO US STATE OWNED RR PASSENGER PRODUCTION, NOT TO MENTION ENERGY, STEEL, AND/OR, OTHER BASIC INDUSTRY EXIST??

Why are we IMPORTING MANUFACTURED ITEMS like RR cars from everywhere else on the globe while NOT producing our own, but, manufacturing MORE MILITARY HARDWARE than ANYONE ELSE ON THE GLOBE, INSTEAD??

Why can't OUR COMMERCIAL RR COMPANIES MANUFACTURE AT NOT FOR PROFIT, AT COST, PASSENGER RR CARS??

Further questions arise around a necessity for these NEW cars, considering one BASIC, FUNDAMENTAL, amenity does NOT even exist, namely, BATHROOMS, TOILETS, LAVATORIES!
WIFI much more important, apparently!
Or, are they mutually exclusive categories??

On a somewhat tangential rumination regarding above subject matter, is it not possible to RETROFIT some sort of lavatory system, and, POSSIBLY, wifi, into existing RR cars.
I can think of LOTS of possibilities to do the above COMPARATIVELY inexpensive, relatively much more simple and easier.
NOT a BIG deal!

Further, PUBLIC TRANSIT FARES by RR, BUS, WHERE IT DOES EXIST, LIMITED MOSTLY to LARGE urban centers like Boston, NY, D.C., Phila, Chicago, ARE EXORBITANTLY EXPENSIVE, DISCOURAGING many people from using it MORE.
This includes AMTRAK.

Between 2 factors, exorbitant fares and/or LIMITED availability, MOST people HAVE cars BECAUSE NO PUBLIC OPTION EXISTS, BY DESIGN, or, lack thereof!

Public transportation, RRs, Bus, cars, compete with one another with PUBLIC TRANSIT as a POOR stepchild, BY strategic DESIGN on the part of BOTH OIL AND AUTO INDUSTRIES post WWII.

NO PUBLIC TRANSIT SYSTEM EXISTS IN MANY, MANY, RURAL, SUBURBAN, SMALLER, METRO AREAS OF THE US, except for a possibility of SOME sort of AMTRAK service!

As for ANY "nominally," Chinese investment HERE, whatsoever, slap a HUGE tariff ON ALL CHEAP, JUNK, GARBAGE, SLAVE LABOR, products emanating from China which FILL the coffers of AMAZON AND WALMART along with others, build domestic alternatives and/or import from OTHER areas when needed and where ABOVE factors do NOT APPLY.

For those elsewhere on the globe, don't worry.
Return favor in kind by SLAPPING A HUGE, GIANT, IMPORT FEE/TAX/TARIFF ON ALL IMPORTED OIL/GAS/COAL/ENERGY AND MILITARY HARDWARE EMANATING FROM THE US AND/OR OTHER PLACES ON THE GLOBE!

More regarding GAS, COAL, OIL, ENERGY, ELECTRICAL PRODUCTION and DELIVERY SYSTEMS, AND TAXPAYER SUBSIDIZED INFRASTRUCTURE, i.e., ANOTHER GREAT US ENERGY GIVEAWAY, STIMULUS PACKAGE, SUCKER, swindle!

First, an entity named Henry Hub exists here as a central distribution point, hub, regarding GAS pipelines thruout the country.

Below are a couple of basic info links, snippets, regarding Henry Hub, as its called.

Also, in one link, below, AT THE BOTTOM, END, to be found a map of ALL existing US pipelines AS WELL AS OTHER PLACES ON THE GLOBE.

The US, as a nation, has the MOST pipelines in the world!
OODLES, MILES, OF THEM!
Take a look at the following link/chart and scroll down alphabetically to US to SEE HOW MUCH exists in comparison to ELSEWHERE on the globe!
ASTRONOMICAL!:

https://en.wikipedia.org/wiki/List_of_countries_by_total_length_of_pipelines

The idea we NEED more is another dark, cruel, JOKE, hoax!

EVERY SINGLE PIECE OF OUR ENERGY SYSTEM, from gas, coal, oil, land, pipes, delivery system, RR, ELECTRICAL PRODUCTION AND DELIVERY, BEING PRIVATELY OWNED, INCLUDING, OF COURSE, THAT ON SUPPOSED FEDERAL LAND OR WATER, LIKE US GULF OF MEXICO, A SEA OF PRIVATE CORPORATIONS!

Once again, a proposed "public-private" gas pipeline and a SHELL petrochemical EXPORT project in THE MOST STUPID State of Penna sponsored by Trump AND OTHERS, including unions, Democrats, represents one, big, giant, enormous rip-off, REWARD, for ALL PRIVATE interests, investors, SUBCONTRACTORS (foreign and domestic), PARTIES combined, benefiting NO ONE HERE whatsoever but those PRIVATE CAPITAL giants with TAX ABATEMENT, exemptions, along with infrastructure subsidies!

Indeed, Trump was correct--the US is THE MOST STUPID COUNTRY ON THE GLOBE!

FIRST, THEY REPETITIVELY STEAL YOUR COLLECTIVE, PUBLIC, ASSETS, NOT TO MENTION FINANCIAL INSTITUTIONS AS WELL, then, ADDING INSULT TO INJURY TELL YOU NEXT TO SPONSOR THEIR PROGRAMS WITH TAX RELIEF AND INFRASTRUCTURE, and, then you are supposed to kiss ass, bow down, and, be grateful!

Questions, debates, about TAX issues exist ONLY BECAUSE COLLECTIVELY WE OWN NOTHING, APPROPRIATING IT ALL FOR THEMSELVES!

NO tax question, "stimulus," public/private partnership, to exist IF, collectively, WE OWNED and thus CONTROLLED OUR OWN NATURAL RESOURCES AND INDUSTRIES, LAND, WATER, PIPELINES, RR.

So, THIS PROJECT ALSO MUST BE STOPPED DEAD IN ITS TRACKS by ALL and everyone concerned HERE AND ABROAD, BY ANY AND ALL MEANS NECESSARY.

I ask a rhetorical question never answered over and over--why is it OUR terrorists, HERE, NEVER, EVER, NOT ONCE, target, as, for example, they DO in IRAQ, STRATEGIC INTERESTS??

Then, of course, in contrast, comparison, those people here predominantly in rural areas thinking they NEED to protect their rifles, guns, well, fine, but, WHAT HAVE THEY ACCOMPLISHED WITH ALL THEIR AMMUNITION IN THE WAY OF PROTECTING THEIR/OUR JOBS, INDUSTRY, FINANCE??
Answer THAT??
What good has ALL your ammunition done for you except to shoot a deer??

IF they or we think they/we NEED, WANT, ANOTHER PIPELINE AND/OR PETROCHEMICAL processing plant, THEN, IT MUST BE STATE OWNED, NOT FOR PRIVATE CAPITAL INVESTMENT, EXPORT PURPOSES, SPECULATION, MORE ASSET STRIPPING, EXPLOITATION, bubble, adding insult to insult both to US and thruout the globe, OVER AND OVER AGAIN, WITH NO PROSECUTION, NO PENALTIES, NO LIQUIDATION, NO ACCOUNTABILITY, NO NEGATIVE REPERCUSSIONS, ZERO, NADA, ZIP!!

So, some information links:

https://en.wikipedia.org/wiki/Henry_Hub

And:

https://www.energyandcapital.com/articles/who-is-henry-hub/2040

And:

https://stateimpact.npr.org/pennsylvania/tag/pipelines/

And, for pipeline MAPS: 

https://images.search.yahoo.com/search/images;_ylt=A0LEVzXFCdBYyRQAEJFXNyoA;_ylu=X3oDMTEyMzB2dHU1BGNvbG8DYmYxBHBvcwMxBHZ0aWQDQjM2MjZfMQRzZWMDc2M-p=natural+gas+pipeline+map&fr=yfp-t-s

Below, one image of our latest snake oil Trump/TRex Administration:





          ALBRIGHT, MUSLIMS, DEBT & OTHER NOTES        

Well, link below about Albright pretty much sums up the unconscionable bi-partisan NAZI hypocrisy and artificial bifurcation sponsoring most, much, of recent anti-Trump events, along with Trump's OWN gratuitous THEATRICS!

Remember Albright??

Another of our NUMEROUS East European NAZI imports, "refugees!"

Albright, NOT real name, did tell TRUTH when she commented AT THAT TIME about US NON-involvement in one of many, this time, Rwanda, massacres, saying:
THE US HAS NO FRIENDS, JUST INTERESTS!

That being a TRUE AND ACCURATE STATEMENT.
A big uproar THEN ensued.

WARNING: 
VIEWER DISCRETION ADVISED:
PROFANE LANGUAGE, DARK HUMOR, COMEDY, SATIRE!:

https://www.yahoo.com/news/why-madeleine-albright-says-she-ready-register-muslim-210535975.html

AND, in case you do not remember, here is NAZI Albright's "consulting" scum, I mean, firm:

http://www.albrightstonebridge.com/


Next, a word about the hoopla one MAY hear about defunding Federal "sanctuary" cities, like Philadelphia, where most recent US NAZI Trump trash appeared along with alternate sponsored demonstrations.

Sanctuary cities really translates to LOCAL LOSS OF FEDERAL CASH, DOLLARS, INCOME.

Since our previous, former, AND, of course, CURRENT Administration, BANKRUPT LOCAL, FEDERAL, STATE, budgets thanks to THEIR PRIVATE, LUXURY, REAL ESTATE and INDUSTRIAL DEVELOPMENT, SPECULATION, CHARTER SCHOOLS, FINANCIAL, YOU NAME IT, WAR, subsidies, STIMULUS, QE, tax giveaways, handouts, loss of ANY further Federal income to local government coffers becomes catastrophic.

THAT being the MAIN reason for all hoopla about Sanctuary Cities.

Remember, YAWL, YOU ALL, MERELY REPRESENT DISPOSABLE, DISPENSABLE, PAWNS, "votes," to be moved about ON THEIR GRAND PRIVATE CHESSBOARD SINCE YOU OWN AND CONTROL NOTHING--NOTHING WHATSOEVER, A LA BORN AGAIN SOCIALIST SANDERS--
'WE DON'T DO THAT HERE," meaning FORBIDDEN N WORD, NATIONALIZATION!

Anytime one hears Democracy uttered run quickly, as rapidly as possible, away from and in another direction, because, it translates to PRIVATIZATION, BARBARISM, ASSET STRIPPING, RAPE, PLUNDER, EXPLOITATION, MURDER, INC., NOT a new phenomena.

On a perpetual theme of MANUFACTURED US DEBT, SAME old, same old, debate looms on the near horizon, AGAIN, namely, RAISING US FEDERAL DEBT CEILING, LIMIT.

THIS excuse by ALL parties concerned utilized to CONTRACT government while NEVER, EVER, NOT ONCE, touching THOSE BENEFITING MOST FROM CONSTRUED DEBT, including those HIRING illegal immigrants, often, small, independent, PRIVATE contractors, many in our criminal building trades.

A PERPETUAL NAZI EMPIRE OF RECIDIVIST CRIMES AGAINST HUMANITY CONTINUES ITS MACABRE, SORDID, DEATH MARCH!

NO LIQUIDATION, PROSECUTIONS, EXECUTIONS, PRISON, NATIONALIZATION, ACCOUNTABILITY, NO NOTHING!

Sometimes, very occasionally, one or more of them, does get a slap on the wrist, a slight reprimand.

Just MORE OF SAME so they can continue plundering, plying their dirty, filthy, trade here and abroad.

Global untouchables which WE, as a whole, SUBSIDIZE, a profoundly morbid, moribund, sick, PARASITICAL, ECONOMIC SYSTEM continues on LIFE SUPPORT, namely, YOUR LIVES, labor, work, money!:

http://bipartisanpolicy.org/press-release/debt-limit-returns-in-2017/

The debt issue ALSO on a STATE, local, not just Federal, agenda.
But, Federal "trickles down" to others, of course.

Obooma Does-Not-Care PRIVATE HEALTH INSURANCE SUBSIDIES VIA STATE MEDICAID, (not to be confused with Medicare), helps BANKRUPT State and Federal governments.

Single Payer, EXPANDED (to include LONG TERM, ASSISTED LIVING, CARE) GOVERNMENT MEDICARE FOR ALL, being OFF THE TABLE, not for discussion, a priori, NOT SUPPORTED BY OUR FASCIST PARTNERED AND INVESTED, MAFIA, CRIMINAL, LABOR UNIONS, AFL-CIA/SEIU.

THEY SUPPORT SINKING, STINKING, OBOOMACARE, instead.

I might note, add, Trump DID tell ONE truth about Obooma Does-Not-Care, namely, HE/THEY, Republic-rats, ARE DOING DEMOC-RATS A FAVOR REPEALING OBOOMACARE BEFORE MIDTERM S-ELECTION so Dems will NOT take the heat for it's economic collapse, implosion, demise!

Next State, City, local, government employee pensions vastly UNDERFUNDED BECAUSE they INVEST IN PRIVATE FINANCIAL INSTRUMENTS, SPECULATIVE STOCK MARKET tools, etc., and, of course, local tax abatement, give backs, etc., loss of local income, to PRECEDING private interests.
Well, too bad folks!

OUR UNIONS, of course, do and did NOTHING, absolutely nothing, to CHANGE THEIR system.
And, NOBODY, inside or outside, CHALLENGES IT/THEM, apparently.

So, national and local Federal, City, State debt, once again, will be excuse to CUT FURTHER government expenditures, programs.

ALL neglect mentioning policies above, for what, whose, which purposes went PREVIOUS, PRESENT AND FUTURE TAX ABATEMENT, STIMULUS MONIES, QE, MILITARY, WAR, PRIVATE CHARTER SCHOOLS, FINANCIAL INSTITUTIONS, MANUFACTURED GOVERNMENT DEBT, IN TURN, MUCH OF WHICH OWNED BY SAME FINANCIAL INSTITUTIONS here and abroad profiting from stimulus, QE, all sorts of government largesse in a REAL, NOT VIRTUAL, money-go-round.

The NAZI DEMOCRATS DO, CAN, AND, WILL NOT OBJECT BECAUSE, ALONG WITH THEIR UNIONS, THEY OFFER ABSOLUTELY NO ALTERNATIVE PROGRAM, ANSWERS.

There will be NO economic recovery in this country, despite what P.T. Barnum Trump 3 ring circus promises, except, of course, continued, ongoing, stimulus, SUBSIDIES, for PRIVATE interests.

Trump is full of SHIT pouring out of all his orifices.

The US is DEAD, FINISHED, KAPUT, DITTO for the rest of the globe because their cancerous economic SYSTEM metastasized abroad.
It's a race to the bottom under guise of nationalistic jingoism, empty jargon, sloganeering.

Mexico WAS BETTER off than the US BEFORE those like NAZI ROCKEFELLER CITIGROUP/SLIM, et.al, got their dirty, filthy hands on it/them. 
Mexico had more State involvement, assets, NATIONALIZED ENERGY.

But, combined together, they threw people OFF their land for PRIVATE multinational agricultural business, EXPANDED INVESTMENT, INDUSTRIAL PRODUCTION, real estate speculation, CHEAP LABOR, DE-REGULATION, TAXES, etc.

So, many fled here, including from Central American which, again, ABOVE helped destroy.

Then, DEMOCRATS sponsor and cry cynical, hypocritical, crocodile tears, humanitarian gestures, and so on.
VICTIMS of THEIR processes INTERNATIONALLY being twice victimized as political footballs.
PRIVATE interests NEVER TOUCHED!

Our ENTIRE COMMERCIAL media, POLITICIANS, SYSTEM, ESTABLISHMENT, ALL PARTIES concerned, sponsored front groups, engage in TABLOID, YELLOW, SENSATIONAL, JOURNALISM, PROPAGANDA, SPIN, TO DISTRACT AWAY FROM REAL, UNDERLYING, ECONOMIC AND HUMANITARIAN ISSUES, REALITIES AS EXPRESSED ABOVE with DIVIDE AND CONQUER TACTICS, domestic and international FOCUS, ATTENTION, DIVERTED!

IF, a very dubious proposition, a great wall of Trump/Mexico to become reality, I think they/he should put on it a great big, huge, flashing, NEON sign with following WARNING:

STAY OUT: STUPID PEOPLE LIVE HERE: CONTAGIOUS MENTAL DISEASE!

Additionally, he/they might put up a HUGE, GIANT FLOAT, DIRIGIBLE, OR, EARTH ORBITING SATELLITE WITH SIMILAR MESSAGE, sending it around the globe for EVERYONE to see when they look up AT A NIGHT SKY towards the Heavens!


          DEMOCRAT SPONSORED MADE FOR TV LOVE FEST, MIDTERM VOTE         

Forget all this ridiculous nonsense, garbage, made for TV, Love Me I'm Liberal, DEMOCRAT SPONSORED, so-called womens event, march, orgy, adolescent feel good get together, happening.

They busily are counting numbers to see how many votes they can muster in another Mid-term s-election process.

IT'S ALL THEATRE!

The hypocrisy of it all truly is overwhelming, along with MONEY WASTED.

It is understatement to call it/them an insult, slap in the face, to ALL in a greater Mideast BRUTALLY victimized by OUR/THEIR MANUFACTURED, SPONSORED, SUPPORTED, PSEUDO ISLAMIC BARBARIC, MEDIEVAL, NAZI TORTURE REGIMES, OCCUPATIONS, WARS, with IRAN, IRAQ, SYRIA, LIBYA, front and center, along with Turkey, Egypt's MB, and OTHERS.

It, they, are OBSCENE for above and below reasons.
They should go home, shut up and HIDE!
The audacity and arrogance of hope being boundless, isn't it?

CONSPICUOUSLY ABSENT, MISSING, DURING THE LAST 8 and LONGER YEARS, HERE, NOT ONE MAJOR PROTEST, DEMONSTRATION, MILITANT ACTION, STRIKE, AGAINST ANY PRECEDING APPEASEMENT, INVESTMENT, COLLABORATION, POLICIES.

NOT ONE PEEP OUT OF THEIR COMBINED, COLLECTIVE, MOUTHS!

NOT ONE SUCH ORGANIZED EVENT SUPPORTING NATIONAL SINGLE PAYER HEALTH CARE, EXPANDING MEDICARE FOR ALL, OPPOSING OBOOMA DOES NOT CARE!

Likewise, MORE SIGNIFICANTLY, our unions, partnered in crime, of course.

No, these folks help BLOCK preceding, not to mention its underlying economic motives, PRIVATIZATION VERSUS NATIONALIZATION!

They function like a sports team BLOCKING ANY POSSIBLE WINNING PASS, STRATEGY, TACTIC, GOALS with a UNITED FRONT AGAINST FASCISM, CHANGED OWNERSHIP, EXPANDED NATIONALIZATION!


Democrat Pavlov rings his bell and their vicious attack dogs, lemmings, come flying out from their kennels, extras on a movie set, Kabuki Theatre.

I listened VERY BRIEFLY, which is ALL I can tolerate, on TV to one or two of THEIR CIA SPONSORED FRONT WHORES, individuals, groups, organizers of this extravaganza--like Gloria Steinem, EXPOSED over and over again for CIA funding, backing, but, still, standing there, given legitimacy by all concerned, saying glowing words about Obooma, Hillary, et.al.

No point in beating a DEAD HORSE.

They shot themselves AND ALL OF US in the foot and continue doing so repeating the same sophomoric refrain over and over again, thus, alienating themselves from EVERYONE ELSE!

And, just for the record, since THEY love employing identity politics helping to DIVIDE AND CONQUER, this event PREDOMINANTLY was a SEA OF WHITE FACES, AND, MOST LIKELY, MIDDLE TO UPPER MIDDLE INCOME, parasitical, redundant, "management, professionals," along with kids.

NOT REPRESENTED our industrial or agricultural working class, base, unemployed, underemployed, poverty stricken, urban homeless, rural, marginal, people.

Just see it for what it is, a Democrat get out the vote rally for upcoming Mid-term s-elections.
And, then dismiss it.
They are totally irrelevant, meaningless. 
STUPID!

Trump is correct, WE/THEY ARE THE MOST STUPID PEOPLE, thanks to them, AND, of course, charlatans, opportunists, like Trump, himself!

Together, TWO ARTIFICIALLY BIFURCATED NAZI PARTIES EQUAL ONE TRAPPED NAZI DICTATORSHIP and THE MOST STUPID, BACKWARD, REACTIONARY, COUNTRY ON THE PLANET!
          Comment on Media Coverage of American Healthcare by WhitemoonG        
Yes, I've been to other countries. Once on a tour of Italy, Greece, Egypt, Syria, Jordan, Israel, Turkey. Much of this was visiting major historical points, biblical archaeology sites, but did involve some impromptu hiking and mxing with the local populations, including providing some on the spot "Baksheesh" to desperately poor young Arab children in Cairo, as one example. In addition, I spent two entire summers in South America, first on a long, winding bus trip from the Pacific in Lima, Peru up throught the Andes to a volunteer constjuction project way up in the Andes in remote Bolivia, the second time in Brazil along the Amazon to another volunteer construction project in the very remote, rural Northeastern Brazilian highlands. On both occasions, long periods of time were spent alongside wonderful, yet poverty bound local peoples. It was quite an experience for me, and needless to say, we did not observe any fellow Americans on some long trek to get some routine dental or medical care there. Our team leader at one point nearly died of high altitude pulmonary edema in rural Boliva at 13,500 feet, and was brought in the back of a jeep to the hospital in Cochabamba, where he survived. To be sure, we were grateful for the doctor and limited facilities doing what they could, But don't delude yourself about comparisons with state of the art high level intensive care medicine in the USA. I have seen countless examples of extremely ill people survive critical illnesses and injuries thanks to very sophisticated (and always available, regardless of questionable :"ability to pay" ) care, that wouldn't have lasted an hour in Cochabamba, Bolivia, regardless of how hard they tried with limited facilities. Ever make a list of landmark medical diagnostic and therapeutic equipment and devices, life prolonging/life enhancing medications originating from countries without any evil corporations and capitalists such as completely government controlled collectivist people's paradises like Cuba or North Korea? It's a list with a big ZERO. With their government control and efficiency, I wonder why that is? I know many dedicated specialists who have lost countless hours of sleep and self sanity, dropping everything on a moment's notice to work all night to save critically ill patients, without having any idea whether they'd eventually get paid or not. Often not, with each one having rendered hundreds of thousands or more of care never paid for, written off the books. Many people had large bills on paper, often never paid even if the patient wished they could do so. But stuck with a large bill on paper after the fact or not, they GOT THE CARE THEY NEEDED. Wouldn't happen in many other countries, they'd either be dead or on a long waitng list, with no accountability and no private interests to sue or threaten to sue, as is the case in the USA. Of course, said Docs would, on one level, be more than happy to be paid something, even if severely discounted, by some universal single payer system, as opposed to getting nothing. However, most docs I know are well aware that government single payer comes with an enormous burden of strings attached, not the least of which would be the Supremely empowered, and legally unaccountable 14 member "effectiveness council" that is one of the key portions of Obamacare if fully implemented. The all powerful government medical politburo will be able to completely dictate to doctors and hospitals how each condition is cared for,in a top down, cookbook manner, as opposed to physician experience and learning determining the individualized care plan for each citizen. Namely, the 14 member supremely empowered "effectiveness council" will do the actual practicing of medicine, through :"government approved" medical providers as conduits, being told what is and is not allowed in caring for patients. Many doctors are preparing to retire early if they can afford to, rather than submit to government control and review of everything done for their paients, while being paid less and less and less for the same amount of work. Result? Seemingly wonderful comprehensive medical care legislation courtesy of left leaning eggheads, with fewer and fewer qualified medical "providers" around to do the care. Result? Increasingly long lines and unavailibility of actual medical care, despite being :"free." Like everyone having a constitutional "right" to a free season pass to the amusment park, only minor problem being said amusement park is usually closed. If your doctor tells you, tomorrow, you've got a heart murmur, which could be a toally benign thing, or could be evidence of a developing serious structural heart problem, he will usually order an echocardiogram, which gives much more precise clarification and answers immediately. If here in my town, the test will be ordered and done within a day or two. In Canada or the UK, enjoy the several weeks or months wait! Sure, Seniors often try to get their medications from Canada or Mexico at half or less the cost than in the USA. Why the disparity? A Wall Street Journal analysis published over 10 years ago answers the question as to why it costs twice as much in America for the same medicine in one word, LAWYERS. But aside from disparate costs for medicines, people from Canada or the UK who cannot wait months and months for tests or treaments, will end up getting the tests or treatments in the USA if they can manage it. There are examples on record of high risk pregnancies in trouble from mid or northern Alberta, airlifted urgently for high level obstetric care in Northern Idaho or Montana. Why might that be, if Canada has the wonderfully socialized system we are supposed to emulate? Why have many Canadian analysts stated concerns that if Obamacare is fully implemented here, they won't have us to send all the urgent cases in need of care NOW? Also, please re-read and carefully consider what the statistics you cite really mean, as opposed to the seeming impression they might leave. Saying a big insurer's profits are up 25% sounds big and greedy, right? But the real questions is, 25% of WHAT? If 25% of an already big 40% profit margin, as an example,, then that would be a big difference, more in line with the evil, money grubbing impression that leftists like to leave. But, the average profit margin of private insurers is 3%. So, a 25% increase of 3% would be an increase to 3.75%. A 25% increase of nothing much still amounts to nothing much. Sure, large sums of money are involved with millions of premium dollars collected, yet 85-90% typically is immediately paid right back out in claims covered,and after the additional necessary amounts needed to cover the overhead and management, the actual profit margin for the industry is a small 3%, much lower than many other industries. As another comparison example, I assume you share the often articulated mantra about "big oil" and Exxon, as one example, raking in "unconscionable profits" and the like. With each gallon of gasoline Exxon sells at the pump, that you and I buy, how much of that is profit to Exxon? $ 2 of each gallon sold? A dollar and 50 cents? Well, of each gallon of gas you and I pay for at the pump, the federal government takes in 50 cents, states take in from 8 cents to 25 cents, and Exxon itself makes the huge, unconscionable figure of 4 CENTS profit from each gallon sold. Wow, pay $3.50 to $4 for each gallon, and Exxon gets to keep 4 whopping cents! Aside from federal,state and local taxes taking a large chunk from each gallon sold, the rest goes to the Huge amounts of money in expenses needed to be able to go find the oil and dig it out of the ground,and refine and deliver it for us to use, with a whopping 4 cents left after all of that for Exxon itself. Maybe you and I should go dig it up ourselves, or start our own oil company. We'd find out right away, that contrary to lazy leftist myth, the oil industry is ALREADY HIGHLY REGULATED. And, what some see as a desirable GOVERNMENT OIL COMPANY would do a far worse job, less efficiently, at far more expense than private entities, that have to be effective and efficient or go under. Unlike anything government, that tries to do the same less efficiently and at far more cost, with no worry about bottom lines, just drain the private sector with increasingly larger tax burdens to forever try to cover all the growing governmental innefficiencies and expenses, until the private sector is bled dry, when we all finally lose. Ditto Medicare, which for better or worse,is long established as the promised answer to years of private citizens. If you think it can manage large ticket items more efficiently and economically than private interests, dream on. By the way, why does HCFA, in charge of admiinistering medicare, contract out management to large PRIVATE interests such as CIGNA for one? If all private interests are squeezed out of existence by major government takeover such as is pending with full implementation of Obamacare, how will the completely government run and managed (and unaccountable) system fare any differently than the forever near insolvent postal system?
          Paul Krugman loses his way on the incremental path to reform        
Perhaps the greatest fraud in health policy today is being perpetrated by the politicians - Republicans who say health care will be more affordable and accessible by taking away coverage, and Democrats who say that incremental additions to the Affordable Care Act are almost as good as enacting single payer - an improved Medicare for all.
          Medicare Value-Based Payment Program penalizes more dedicated physicians        
Rather than being smart and actually improving our health care system by enacting a single payer program, the bureaucrats and policy community have fixated on magical solutions that supposedly would improve quality and reduce costs by paying for value instead of volume.
          Single payer vs. universal public coverage through managed competition        
The authors support public universal health coverage while rejecting single payer on the left and private insurance markets on the right as “two seemingly irreconcilable extremes, coverage versus budget control,” yet they advocate for competing integrated delivery systems - Alain Enthoven’s dream of “managed competition.”
          Some Dems Now Running on Single Payer Healthcare...Do They Have a Shot?        
Some Dems Now Running on Single Payer Healthcare...Do They Have a Shot?
          Government healthcare - No!        
Dems want "Single Payer" which doesn't work well in other countries.
          Planned Parenthood protests Trumpcare near US Capitol as total ACA repeal fails         
On the 26th of June, Planned Parenthood held a protest against "Trumpcare" with hundreds of supporters, many dressed in Pink at Upper Senate Park. Speakers noted that once again, all of the proposed bills boot millions off insurance, bring back pre-existing conditions exclusions-and all defend Planned Parenthood. They also pointed out that all this is to fund tax cuts for the rich. Since the "Individual Mandate" is already unenforceable, the so-called "skinny repeal" is nothing but a scam to get big tax cuts for the rich funded by Medicaid rollbacks back on the table. Shortly after this protest, a duplicate of the 2015 ACA repeal bill was voted down, getting only 43 votes and 7 GOP Senators voting NO. Oh well-if Trump sabotages the markets until all the health insurance companies pull out, he will end up being responsible for a forced transition to single payer, opposite what he
          'Single Payer' Healthcare Has Failed The U.S. Indian Health Service -- So Why Does The Left Keep Advocating It?        
The federal government's Indian Health Service illustrates the problems with "single payer" health care.
          The Death of Aid-in-Dying in DC        

by Craig Klugman, Ph.D.

I recently gave a talk to a local chapter of a national physicians’ health care group where I was talking about what end of life could look like under a single payer health care system. Several of the attendees were advocates of aid-in-dying and were hoping I was going to talk about that issue as well. I did not as there was so much else to talk about regarding proposals for health care plans to replace the ACA and comparing death and dying in the US with countries that have a single-payer system (In short, no one is great at it; we aren’t doing so badly in comparison, and having a single payer system does not correlate with having good end of life).…


          Re: Policy Wonk Nicole Mace Lands in a Swirling Political Storm        
Being a Democrat does not make one automatically support everything a union supports. And the NEA should not automatically support Democratic candidates. When that happens blindly, neither does what is best for their constituents. Yet, I've seen the NEA only support Democrats, even ones who support teachers and unions less than their rival.

Now that the Dems are pushing single payer, state and federal level insurance, why not let teachers pilot that? I support my union (NEA member!) but lockstep always never makes good policy.
Posted by Tom Triumph
          Ryan Kelly spotted on crutches        
Ryan opted for the single payer system, so he has to wait 2-3 weeks for the MRI. #kidding
          Women and American Politics. First Monday        

There will be four posts in this series, though I cheat and use old material.

This post is about the question whether "identity politics," including such issues as women's reproductive rights, were what the Democratic Party needs to dispense with if it ever wants to win any elections again.  My take on that topic can be found here

The article I respond to in that post was the first of many, so it's useful to stress that I want* the Democratic Party to have a much stronger economic platform, to focus much more on reducing income inequality and on making sure that this country actually offers fair economic opportunities for all.

But that should be doable without dropping general fairness concerns, unless it turns out that Democrats can't both walk and chew gum.  Which would be pretty disappointing.

--------
* And have written about that many times.  I want single payer health care, for instance, and actually not for only ideological reasons, but because it's the least horrible of all horrible systems that humans have created for financing health care.  I also want a stronger defense of progressive taxes, a better and more egalitarian school system and better benefits for workers, including proper summer vacations. 
          Healthcare provision in the United States        
The American Federation of Teachers – with which my union, the GEO, is affiliated – has voted to endorse a bill to provide Universal Healthcare in the United States: HR 676 would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident. HR 676 would cover […]
          Goody Procurement Department        
Over the last year I've had to find different sources for my fabric habit. While Fabric of Vision has had some awesome little pop up sales of some special and unusual fabrics, they are not the bread and butter of my sewing.

Coral leather and some very special gauzy linen
 Cotton and linen remain the mainstay, with some wools thrown in when needed. Natural fibers. I ran into a FOV alumni last week in the grocery store. She didn't really like the fabric stores she found online and wanted to know where I had been buying my fabrics. Etsy! I have plumbed Etsy and found some wonderful sellers. She was going to go home and give it all whirl. I hope she did!

For those reading, here is a list of my go to sellers.

Spindle and Rose. Alexa is a lovely seller to deal with, and who doesn't appreciate a beautiful thank you card with their sweetly wrapped order.

FABRIKSHOP. Not the largest collection but some really fun Japanese fabrics. I got my lovely flannel raccoon fabric here. It's been a favorite tunic this winter season.

Fabric Supply. Mostly, if not all Japanese fabrics. I like her index too. I've bought a fair amount of fabric here through the year.

Pink Door Fabrics. This is one of my newer discoveries. She sells new fabric coming out on pre-sale and I like that. Some pretty cute quilt patterns I might add and some good sale fabrics too!

JAQS Fabrics. They carry a huge inventory and offer free shipping over $50.00

For linen I have one source and it is Fabrics-Store.Com  I have used just about every weight and color of linen offered. Their IL019 line of mid-weight linen is the staple pant/jacket weight for me. Their finally woven IC64 makes the best tunics and the heavier 4C22 line makes great towels and bedding along with heavier garments. I've ordered a lot of yardage from them and have never been disappointed.

So there you have it, you have been enabled!
And here is some eye candy of recently curated fabrics.

The foxes are a linen cotton blend and the moths, a cotton lawn.

Check out those raccoons. The fabric is called "Snacks"!
And let's whiplash into ...

Did That Just Happen?
Rep King, I think you have America all wrong or maybe you are what is wrong with America.

For the life of me, I can't understand why we wouldn't want everyone covered under a single payer system, but barring that, why not just fix the ACA instead of this?

I wonder just how we will explain how we turned our backs on this in the coming years.

And little tempest Stella gets her own perfect storm. My Northeast friends, stay warm and safe.

Parting shot: Happiness is....


          The First Priority for the Resurgent U.S. Socialist Movement? Single-Payer Healthcare        

“Are y’all ready to crush the private health insurance industry? Are you ready to make healthcare a human right in America?”

These questions from Ari Marcantonio, a single-payer organizer for the East Bay chapter of the Democratic Socialists of America (DSA), were met with raucous cheers at the organization’s national convention in Chicago this weekend.

DSA members affirmed their commitment to making single-payer organizing a national priority with a majority vote by the convention’s more than 700 delegates. Billed as the largest gathering of U.S. socialists since World War II, the convention took place on the heels of DSA reaching more than 25,000 dues-paying members—an all-time high (this author is a member of the group).

The organization’s growth has been dramatic: In May 2016, DSA had just 6,500 members, meaning the group has nearly quadrupled in size in just over a year.

Delegates to the convention also voted for resolutions backing the ‘Fight for $15,’ supporting the boycott, divestment and sanctions campaign against Israel and endorsing Black Youth Project 100’s Agenda to Build Black Futures, among many others. 

Where recent years’ DSA conventions have been much smaller affairs, at times attended by fewer than 200 members, this year saw more than 1,000 democratic socialists assemble, practicing the sometimes messy process of self-governance—and grabbing national media attention along the way. Many of the attendees were young and new to the organization, inspired in large part by Bernie Sanders’ 2016 run for president as an open democratic socialist. 

Sanders made the demand for a universal, single-payer healthcare system a centerpiece of his campaign, and has continued to rally support for such a program throughout the recent healthcare debate in Congress over the GOP’s efforts to repeal and replace Obamacare.

Polls show that more and more Americans are turning on to the idea of single payer, with 53 percent now in support of getting health insurance from a single government plan. Prominent Democrats are beginning to speak out in favor of such a program, and John Conyers’ (D-Mich.) single-payer bill in the House, which he’s introduced every year since 2003, now has record support. 

This newfound appeal of single payer has created an opportunity that DSA members hope to seize. Throughout the convention, the energy around organizing for Medicare for All was palpable.

Jen James, a member of the socialist-feminist working group in the New York City chapter, told attendees that “Medicare for All can be a truly transformational reform and give power back to the working class.”

James explained how fighting for universal healthcare benefits the most vulnerable members of society while bridging key issues—from opposing the prison industrial complex to challenging wealth and income inequality. “Studies show that wealth is the greatest predictor of good healthcare outcomes,” said James. By fighting for universal healthcare, we can “focus our efforts on those who have the most to gain: single mothers, women of color and the working poor.”

In New York, where James organizes, members are advocating for the New York Health Act, a bill that would provide a universal, publicly-financed healthcare system. And in the East Bay chapter, Marcantonio and hundreds of other volunteers are knocking on doors to build support for the Healthy California Act, which would also institute single payer statewide.

These efforts on the state level show how organizing around single payer offers key opportunities for political mobilization.

“I think single payer will be an issue that people across the entire organization take up, but it may look different in different states,” says Joseph Schwartz, newly re-elected member of DSA’s national political committee. “In places like Minnesota, New York and California, it is a real question of whether it can be passed and implemented. But I do think in red states there will have to be a focus on defending against cuts to Medicaid.” 

That doesn’t mean organizing for universal healthcare is being confined to states with Democratic majorities, however. Amy Zachmeyer is a DSA member and single-payer organizer in Texas, one of the reddest states in the nation and home to the country’s highest uninsured rate. She says her experience has shown that people are open to considering radical ideas when they are presented as a genuine break with the political establishment.

“Fox News has inoculated their viewers against the Democrats,” Zachmeyer says, so openly identifying as a socialist and inviting people to join the fight for Medicare for All “is not an alienating ask.”     

To build national support for the demand, Philadelphia DSA member Dustin Guastella advocates organizing for a federal Medicare for All system that would cover every American regardless of what state they live in.

“The federalized nature of the U.S. healthcare system creates barriers for state-wide wins,” Guastella told convention attendees. “We need to raise the profile of this demand and force politicians to listen to a durable political coalition built at the national level.”

As universal healthcare continues to grow in popularity nationwide, many in DSA see the potential of using the issue to recruit droves of new members to the socialist organization.

“We should be the organizational home for the millions of people who believe in single payer: health advocates, workers, Sandersistas and socialists,” says Guastella.

DSA national director Maria Svart tells In These Times, “Single payer is obviously an issue that resonates and has real traction right now. It’s both good in and of itself and it’s a good organizing issue.”

Coming out of the convention, DSA leaders and membership will now turn to the task of how best to advance their priorities, including single payer—and how to build socialist politics in the process.

One immediate area where the group can show their influence is the upcoming 2018 elections, where healthcare is sure to come up as a prominent issue. By demanding that candidates support taking insurance out of the private market and making it universal, DSA members can have a direct impact on this debate, shifting its terms toward a truly radical reform: the decommodification of healthcare in the United States. 

If this year’s convention is any guide, the excitement behind single payer has the potential to lead to a new wave of organizing behind a goal that just a few short years ago seemed a near impossibility.

After the Medicare for All resolution passed, the chair announced that “the DSA supports socialized medicine in America.” And another round of cheers erupted through the convention hall.


          An Inside Account of How Direct Action Helped Kill the GOP Healthcare Bill        

Welcome to Interviews for Resistance. Since election night 2016, the streets of the United States have rung with resistance. People all over the country have woken up with the conviction that they must do something to fight inequality in all its forms. But many are wondering what it is they can do. In this series, we'll be talking with experienced organizers, troublemakers and thinkers. They'll be sharing their insights on what works, what doesn't, and what has changed, and what’s still the same.

Mari Cordes: My name is Mari Cordes. I am a registered nurse of thirty years, all in Vermont. I am a founding board member of Rights and Democracy.

Sarah Jaffe: You were in Washington, D.C., on Thursday when the vote went down for healthcare reform, right?

MC: I have been here since Thursday as a candidate. I am running for the Vermont House of Representatives again in 2018 and I am here for the Progressive Change Campaign Committee’s national candidate training. I was selected as one of 300 candidates to attend this amazing training which coincided with more actions by the Center for Popular Democracy and Housing Works in the Senate offices, in the Capitol and at Senators’ offices. I was part of the protest and the rally outside of the Capitol building the night the vote came down.

SJ: Tell us a little bit about what that was like, while you were waiting to hear about the vote.

MC: It was an amazing experience to hear, once again, many stories of how everyone would have been impacted by the repeal of the Affordable Care Act, and already how we are already impacted by our elected leaders intentionally doing something that equates to attacking the American people.

We heard so many incredible, painful and heartbreaking stories about friends, people that we know, people that we don’t know who would have died and families that would have lost their homes or gone bankrupt. All this in the name of an obsession with an ideology, an obsession with a hatred that a black man was president of the United States and was successful in creating policy that was definitely not perfect, but did help millions of people. It was very powerful to be in that circle and hold a vigil for our country whatever the outcome is going to be.

There was a moment we thought “We are going to lose”—that feeling of hopelessness and despair. Then, a pause and a quiet moment. Ben Wikler delivered the news beautifully. He became really somber. I thought it meant that we had lost, but it created this silent space for us to hear the statement that the vote was “No.” I don’t think I have ever experienced anything so powerful in my life. It was incredible.

SJ: That vote was “No,” but you are not stopping. We are talking on Saturday evening and you are about to head to another rally for healthcare. Tell us about that and tell us about why the fight is still going.

MC: We got to bed at 4:30 that morning. We did rest a little bit, but with the awareness that the American people are still under attack on many fronts, not just healthcare, but the freedom and liberation of many individuals in this country is at risk. So we can’t stop. In fact, there is no better time to increase the pressure and increase our activism than after a win like this, because especially those who were at risk of losing so much and especially those who have been working so hard in this fight. We have that lived experience of collective power of movement building, the organizing work. We cannot stop. We have to take this momentum and move forward.

SJ: You went to D.C. a few times. You were involved in a lot of organizing, even though Vermont, obviously, didn’t have a Senator that was going to vote “Yes” on this thing. But, what are some of the important lessons that you learned from the seven months of fighting to try to stave off cuts to healthcare?

MC: I think the most important lesson is to never give up. In a fight like this, never give up. I have been very active working in Vermont towards a universal publicly funded healthcare system that gets rid of the highly profitable insurance companies and creates a real system. We have had our successes, like when Act 48 (single payer) in Vermont passed. And we have lost in Vermont when Governor Shumlin pulled the plug on that. We are still working hard in the state to move towards a universal publicly funded system. I would say that is the most important thing. We have to keep going. It is okay to rest for a little bit and take care of each other and ourselves, but we have to keep moving forward.

SJ: Was there a particular moment or a particular tactic around Trumpcare that you thought was particularly successful? Some moment that maybe you saw somebody’s mind change?

MC: I think there were many moments that were successful. I was in the first group of people of 150 or more and 40 of us were arrested, I was in the second group, I don’t remember how many were in there, but 80 of us were arrested. Then, the third time, I was a legal support for ADAPT. Hundreds were arrested, I believe, in that action.

I think it was a cumulative effect, in addition to all of the actions and emails and calls from people across the country that created enough pressure on senators. All of these actions, and the media that they generated, including all of the social media. I could see on my own personal social media sites people getting engaged that might not have gotten engaged before and taking actions. It is a cumulative thing. That is the thing about collective power and movement building, it is generative. It is obvious now that people are rising up and that more people realize that organizing does work.

SJ: As you said, you are a nurse, you have been a union leader, and you have been working on healthcare for your entire adult life. Why is this such a powerful issue to get people organized around?

MC: Healthcare is a very powerful issue to get people organized around because it impacts every single person personally, often in potentially devastating ways. As I mentioned earlier, many people that I have met though doing these actions and then all the patients that I work with every day; I hear, I see how critically important having access to healthcare is for them and their families.

I work in a busy cardiology unit at the University of Vermont Medical Center and every day I am at work, when I have three or four patients, I look at each one of them and wonder “What if they didn’t have access to healthcare, if they didn’t have insurance? If they couldn’t get healthcare when they needed it, would they be alive right now?” The huge majority of the time, the answer is “No.”

Then, it is personal for me, too. I have health issues, like most of us do. I would say, more than anything, it is such a huge area of injustice in our country and the fact that in 2017 we are having to fight to stay alive is beyond ludicrous.

SJ: You were involved in a fight to end insurance discrimination against transgender people. Of course, this week while the healthcare fight was going on, Trump came out and said he was going to ban trans people from the military because their healthcare was too expensive. I wonder if you could talk a little bit about that particular fight that you were in and what we can learn from that.

MC: My friends and I were just at the rally at the White House today around Trump tweeting military policy changes. I was involved in some major change work in Vermont, in co-leading a coalition of organizations and people, including physicians that provide medical care for transgender individuals. The organizations we worked with have been working on transgender justice issues for a long time. Vermont, at the time, I think it was 2011 or 2012, did have a law that said it was illegal for health insurance companies not to provide insurance for transgender individuals, but that was a pretty broad statement and, of course, what the health insurance companies did was refuse to cover medically necessary care for transgender people.

I became aware of that when an amazing nurse friend who is also transgender came to me and told me that he needed to have surgery and it was not covered by our hospital insurance. The University of Vermont Medical Center self-insures, so they get to decide what their policy looks like. This person and I and the other leaders of these organizations worked together on a campaign that eventually led the commissioner of the Department of Financial Regulation, which oversees insured companies in Vermont, to issue a clarifying bulletin that made Vermont, at the time, the fourth state in the nation to have clear language that denying medically necessary care for transgender individuals was against the law.

SJ: I am wondering if there is something about this happening in the midst of the healthcare fight, your experience on both these issues, that you think we can learn from going forward, as Trump is clearly going to keep doubling down on attacking marginalized groups, especially as he is losing?

MC: Because of all the attacks against marginalized groups, more than ever we need to be unified. I do see that happening. I do see people in organizations working towards being as unified as possible. I believe it is the only way that we are not only going to survive, but thrive.

SJ: Let’s go back to the single-payer struggle in Vermont. Vermont was the first state to vote for a universal publicly funded healthcare system, but had trouble getting it implemented. I wonder if you could tell people a little bit about that process, the organizing that got the bill passed, and then the struggles you have been in in trying to continue to move forward with it.

MC: We began around 2008—“we” meaning the Vermont Workers Center—started the Healthcare is a Human Right campaign, which was an amazing grassroots mobilization and education project all across the state that got thousands of people involved in the education of people in the community about how our healthcare system, or lack of it, is broken and what we can do to fix it.

We did things like holding peoples’ forums across the state where the people led the forums with legislators present. It was a chance for people to ask legislators questions: Do you and will you actively work to support publicly funded universal healthcare? The Workers Center organized annual rallies. I think before the Women’s March, it was one of the Healthcare is a Human Right rallies on May Day that was the largest rally in Vermont’s history. Eventually, working with other organizations like Vermont for Single Payer Now led to us win by putting pressure on legislators and supporting those who were doing the policy and taking the political risks. We did win Act 48, which has embedded in it, the five universal human rights principles.

I was appointed as a commissioner to two, at the time, of Governor Shumlin’s workgroups: The Consumer Workgroup for Healthcare to try to move towards this new system and another commission. We did a fair amount of good work there, but in retrospect it seemed like a farce. What was really being planned was not happening in those groups with members of the public and healthcare professionals. It was happening at the governor’s office. That meant that eventually Governor Shumlin and some of the legislators decided that they didn’t have the political capital to pull this off, so they pulled the plug on it.

SJ: Where are things now? You have a different governor now. So what are things like on the ground in Vermont, working on healthcare on the state level?

MC: We are organizing. Always organizing. Actively. The main organizations that are working towards a universal publicly funded healthcare system are now working together to figure out what that looks like going forward. We are back on the ground organizing in communities, setting up town halls, talking with legislators.

The one possible step that actually was in the state house as a bill last year is universal primary care which would do just what it says: provide access to healthcare for everyone in Vermont as primary care. Primary care is often one of the obstacles that people face when they are sick or have something going on and they can’t afford it or access it. So, they don’t go and then they get sicker and end up in the ER with a worse condition. There is a patient that I remember, a young man who had a simple infection and waited too long and it turned into a devastating full system infection that killed him. It was something pretty simple that could have been fixed had he been able to access primary care. That is what we are working on now.

SJ: You mentioned at the beginning that you are running for office. Tell us what your platform is. I presume that universal healthcare will be part of it.

MC: Yes, it is. My main platform items are working towards an economy that works for us all. That includes having a healthcare system and working towards progressive tax reform that insures corporations and the wealthy pay their fair share, further developing and safeguarding the public services that are the foundation of strong communities. Also, that Vermont must lead on climate change. I am also a board member of 350Vermont.

And quality education—we have had some major changes in how school governance is run in Vermont with the passage of Act 46, which is very controversial and in many ways took the local direct engagement away from small towns. The intent, or the stated intent of Act 46, one of them, is to help reduce property tax burdens. I am not sure how effective that is going to be. There are some one-time savings that we will see, but the real issue is that the biggest line item in a school district’s budget is health insurance for educators and staff. So until we get control over that, it is still going to be a major issue.

Then, I will continue to work very hard in organizing representing my district to develop a healthcare system that is financed and administered publicly with strong and transparent government regulations and ample public engagement.

SJ: How can people keep up with you and your campaign and your healthcare organizing?

MC: A couple of different ways, they can go to www.maricordes.org. There are Facebook and Twitter links on my website. You can also find me on my personal Facebook page: Mari Cordes. I am working with Rights and Democracy a lot, so I would encourage people to follow Rights and Democracy Vermont and New Hampshire.

Interviews for Resistance is a project of Sarah Jaffe, with assistance from Laura Feuillebois and support from the Nation Institute. It is also available as a podcast on iTunes. Not to be reprinted without permission. 


          The Democrats’ New Agenda Is Everything That’s Wrong With the Party        

The story of the Democratic Party in 2017 has been one of timidity and stubborn resistance to real change.

In the immediate aftermath of the party’s preferred candidate facing a humiliating defeat in last year’s presidential election, questions swirled over what direction the party would take to respond to the new political reality. With Democrats at their weakest position in decades, having lost over 1,000 seats in states and Congress over the previous eight years, it appeared that a drastic shift in how the party operated was in store.

And the party was offered an early opportunity to embark on such a shift, with the campaign by Keith Ellison for Democratic National Committee chair. Ellison sported a resume as a bold progressive with popular support from rank-and-file Democrats and party activists alike. And he presented a clear break with the Democratic Party’s traditional establishment.

But rather than embrace the new direction presented by Ellison’s bid, party insiders conspired to instead elect Tom Perez, a candidate with much stronger connections to the party’s establishment wing. The result came as a dispiriting blow to many in the party’s base who hoped for a clear break in Democratic leadership.

In the ensuing months, the Democrats have turned to neoliberal architects such as Rahm Emanuel for advice, invested a historic amount of funding in centrist Jon Ossoff’s failed congressional campaign in Georgia and returned to the strategy of recruiting moderate “Blue Dogs” to run in the upcoming 2018 midterm elections.

And this week, the Democratic Party announced its new slogan and platform: “A Better Deal: Better Jobs, Better Wages, Better Future.” Besides its possible plagiarism from Papa John’s tagline, the plan includes a repackaging of a number of longtime Democratic ideas, with some potential progressive offerings sprinkled in. But much like a pizza from Papa John’s, “A Better Deal” mostly amounts to an uninspired, stale and cheesy agglomeration stuffed neatly into a box.

Lack of imagination

One of the main policies included in “A Better Deal,” lauded by both Chuck Schumer and Nancy Pelosi in their respective op-eds announcing the agenda, is a tax credit for companies to train workers in new skills. On its face, this initiative may come across as smart and sound policy aimed at retraining workers and incentivizing businesses at the same time. Except their plan has one problem: It doesn’t work.

As has been documented time and again, simply handing money to the private sector is an ineffective way to make sure that workers become retrained with new skills. In fact, as Corey Robin notes, when such programs have been instituted in the past, data and research over decades has shown that overall they’ve performed poorly.

In an In These Times article published in 1994, John B. Judis explained why job retraining, then touted by the Bill Clinton administration, failed to lead to wage increases for workers or growth in employment. To prove his case, Judis cited the Labor Department’s own studies.

What didn’t work in 1994 and in the intervening decades is not any more likely to work in 2017. And yet the plan sits as one of the centerpieces of the Democrats’ new strategy. Why?

This goes back to the issue of timidity. Schumer has called the plan “a strong, bold economic agenda.” In reality, promising more cash to companies is not bold at all: It is the plan least likely to offend or challenge the profit-maximizing model of corporate America.    

The same holds true regarding the issue of jobs. “A Better Deal” sets a goal of creating jobs for 10 million more Americans over the next five years. This is a good start, but why stop there? Rather than setting its sights on a simple, round number of jobs, the Democratic Party could take an actual bold step and announce a goal of full employment across the country, with everyone who wants a job being offered one.

This isn’t some pie-in-the-sky fantasy. A federal job guarantee has been part of the national conversation going back to at least 1934 when Louisiana’s populist governor Huey Long called for it in his “Share the Wealth” plan. Franklin Roosevelt included a federal job guarantee in his famous second bill of rights. Martin Luther King Jr. spoke out in favor of such a plan. George McGovern ran on it in 1972, and some form of full employment was featured in the Democratic Party platform from 1944 up until 1992, the year Bill Clinton won the presidency.

And today, it’s not just socialists and far-left economists calling for a jobs guarantee: Even the Center for American progress is pushing the proposal. What’s more, it’s popular. And as scholars such as Darrick Hamilton, Mark Paul and William Darity Jr. have pointed out, such a plan could help stem the tide of income inequality, as well as the racial wealth gap, while increasing the power of workers to organize and win fairer wages and conditions on the job.

If the Democrats want to prove they’re fighting for working people and offering dynamic leadership on jobs and the economy, a jobs guarantee for everyone is a much clearer position to stake out than a promise of 10 million more over five years.

Populist echoes?

The area where “A Better Deal” breaks the most with recent Democratic policymaking is the call for real action on enforcing and bolstering anti-trust laws to help peel back corporate control over the economy.

Consolidation of major businesses in recent decades has led to massive mergers and corporate monopolies which wield incredible power over economic activity in the United States. In 2015, global activity in mergers and acquisitions exceeded $5 trillion. Nearly half of this activity took place in the United States, making it the highest amount ever in a single year.

With merger activity at an all-time high, the economy is being left with fewer, larger firms and far less competition. Just look at the current bid by Amazon to purchase Whole Foods for $13.7 billion. If this acquisition goes through, consumers will have even less choice in their ability to purchase groceries and other goods, and Amazon will tighten its firm grip over the commodity market.

Since the 1970s, Democrats have largely stood on the sidelines as these types of mergers have taken place. As Matt Stoller explained in The Atlantic last year, this has largely been due to the party moving away from its populist roots toward a more friendly relationship with powerful corporations, which in return make hefty contributions to Democratic campaigns.

If Democrats are now committing to reversing this trend and taking an aggressive stand against corporate power, with the potential to break up large institutions such as banks and other conglomerates, this would indeed signal a stark shift for the party.

However, when such a plan is being sold by the likes of Chuck Schumer, who has benefited enormously from his cozy relationship to Wall Street throughout his career, there is every reason to demand more details—and action—before celebrating this populist invocation.     

Missing out

There are some other glimmers of progressive hope in the plan, including calls for a $15 minimum wage and paid family and sick leave for workers. 

But “A Better Deal” is also notable for what it leaves out, especially when it comes to healthcare.

At a time when Republicans are attempting to jam their barbarous Obamacare repeal bill through Congress, potentially stripping coverage from tens of millions of Americans, the lack of a healthcare plank in this new plan is striking.  

This is especially true when you consider the growing popularity of a clear alternative among the party’s base: Medicare for All, single-payer healthcare.

A new poll from Kaiser shows public support for a single-payer system now at 53 percent—an all-time high. Among Democrats, support has grown by 19 points over the past three years.

In recent weeks, a number of Democratic senators have joined Bernie Sanders in speaking out in favor of single payer, from Elizabeth Warren to Jeff Merkley to Kirsten Gillibrand. Even party up-and-comers Kamala Harris and Cory Booker have offered tepid support for such a program.

John Conyers’ Medicare-for-all bill in the House of Representatives now has the support of over half the Democratic caucus—the most since he began introducing it in 2003.     

If there was ever a time for Democrats to get behind a bold plan on healthcare, this is it. Even if Republicans are unable to successfully repeal and replace Obamacare with their vicious counter offer, the ACA’s many problems are sure to increase in the coming years.

Rather than simply defending a status quo that millions of Americans are already frustrated with, Democrats can draw a clear line in the sand by stating that they believe healthcare should be guaranteed as a right to all Americans.

The same holds true on the issue of climate change: Now is the perfect moment to demand bold action as part of a broader strategy to achieve economic justice.

The Trump administration has proven time and again its intention to dig for—and burn through—as much fossil fuels as possible during its time in office, with zero concern for the destructive effects this will have on the climate.

At the same time, the costs of renewable energy sources are dropping at a precipitous rate, encouraging demand for technologies such as solar and wind. Democrats could take advantage of this dire moment in history to commit to a massive investment in renewables, both to stave off environmental destruction and provide employment and a better standard of living for all Americans.

This list of areas where “A Better Deal” comes up short goes on. The platform is bereft of plans to improve housing and education, tackle institutional racism and sexism or build up a beleaguered labor movement—historically a core constituency of the Democratic Party.

A better agenda

There’s no shortage of ambitious programs waiting for the Democrats to embrace. The party could pledge to break up big banks, offer free public college, tax the wealthy and financial transactions, provide a universal basic income and fight for universal collective bargaining rights. Add these ideas to single-payer healthcare, a federal jobs guarantee and sweeping climate action and you have the makings of the kind of bold economic agenda that Schumer claims is key to the party reclaiming its mantel as an unabashed advocate for the working class.

Such an agenda would require the Democrats to shed their timidity and prove that they are not beholden to corporate interests. And it would certainly mean providing more than a shiny, poll-tested new messaging campaign.

If Democrats are worried about the efficacy of adopting a broad-left platform in 2017, all they need to do is peer across the pond. Labour was able to score stunning advances in Britain’s June election running on the most left-wing platform the party had put forward in more than three decades. The manifesto that leaked before the election called for nationalizing utilities such as water, rail and electricity, eliminating tuition fees, instituting free childcare, expanding public housing, taxing the wealthy and corporations and transitioning to 60 percent low-carbon fuels by 2030.

Rather than sabotaging the party’s chances, the manifesto was hugely popular and was credited in boosting Labour’s late rise in the polls, leading to the shock outcome with Jeremy Corbyn and the party making huge gains and threatening Theresa May’s Conservative government.    

The rhetoric used by Schumer is his New York Times op-ed announcing “A Better Deal” echoes that of Bernie Sanders, castigating the power of corporations over our economy and fighting for the rights of working people. “Americans believe they’re getting a raw deal from both the economic and political systems in our country,” he writes. “And they are right.”

It’s important for the party to become comfortable naming the enemy and openly calling for a realignment of economic power to break the stranglehold of neoliberal capitalism over the poor and working class.    

But rhetoric on its own will never solve our country’s economic problems or change the Democrats’ fortunes. To accomplish this, the party must prove its willingness to stand up to entrenched corporate power through its actions. In this regard, the recent track record of the Democratic Party has been abysmal. This is their chance to offer not more drab layers of paint, but real, fundamental change.


          School Scope: Health Care - Educating People Honestly is First Step to Reform By Norm Scott        

The WAVE - www.rockawave.com -- Aug. 4, 2017

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School Scope: Health Care - Educating People Honestly is First Step to Reform
By Norm Scott

If you are looking for commentary on education let me remind you this is summer vacation for most ed news, other than to say that the de Blasio/Farina operation of the schools is not as different from BloomKlein. One of the big stories this week was the Susan Edelman expose in the NY Post of the scandals in the principal training Leadership Academy, which spawned our very own Marcella Sills. http://nypost.com/2017/07/29/doe-lost-track-of-101m-given-to-leadership-coaches-audit.

I compare the NYC Leadership Academy training to the Nazi SS - where there are stories that they would give a new recruit a dog when they arrived, allow them to bond, and then order them to kill the dog to complete their training. All too many Lead Acad grads act like they’ve emerged from that type of trauma and feel free to engage in vicious, sadistic behavior.

But let’s get back to an equally vicious and sadistic topic. Health care as a follow-up to last week’s column (School Scope: Why Not Medicare for All?) where I talked about single payer around the world with an emphasis on how health stats in Rwanda may one day, if Republicans remain ascendant, may soon surpass ours.

There has been increasing serious media attention (as opposed to mocking commentary) related to Bernie Sanders bringing up a single payer bill, an idea he was ridiculed for a year ago. It is clear there are problems with Obama Care, many of them exaggerated by eight years of Republican attempts to go back to the pre-Obamacare good old days of death panels. The criticisms of Obamacare from both left and right go deep but come at the issue from two entirely different directions.

One of the attacks on Obama was based on his false promise that people could keep their plans. Seven years ago I was tossed out of my UFT plan and into Medicare by law as I joined everyone who turns 65 . I didn’t cry, as Medicare just happens to be one of the most popular government run programs.

I keep repeating that my wife who worked in billing for a major hospital and dealt with every insurance company maintained that Medicare, staffed with career professionals (as opposed to the often revolving door employees in private insurance) was also the most efficient and well-run. I would say this was one of the biggest issues in former Obama voters moving to Trump.  Goodness, is it possible that the big, bad government which comes under attack by so many can out perform privately run operations?

Boys and girls there is a solution, even if a temporary one to stabilize the market while we work to expand Medicare down to younger people. (Bernie suggests we move people who are 55 into Medicare as a first step.)

Obama abandoned the offer of a public option very quickly to appease the insurance companies who didn’t want to compete with the government. (He also ignored please control drug costs to keep big pharm on board). With so many insurance companies abandoning the market at this time, the biggest immediate fix to Obamacare would be to add a government option in every area that is left with few options or none. I find it funny how all the people who believe in competition don’t want the government to compete with private insurance plans.

Now I want to be clear. In a single payer system everyone would be tossed out of their plan and into the same plan. This would be huuuuge and of course disrupting as even employer based plans would end. Some argue that industry offers these plans as a way to lure workers. And many workers make job choices based on health care. By taking the burden of health care off the table, as would happen in single payer, there would be a major bump in earnings for boss and worker – think of taking the money spent on health care and giving raises.

We also should be clear that single payer would wipe out most of the insurance industry with its overhead and high executive salaries – and all those lobbying costs. How can that be a bad thing?

Let me end with a reference to some correspondence I’ve been having with  a WAVE reader who doesn’t agree with my take but does admire the variation of single payer system in Singapore, which forces everyone to pay something whenever they use a health service. (Google Singapore health care if interested in learning more.) I am open to negotiations on means payments and co-payments. My recent foray into health care related to a urinary tract infection taught me a few things. I had to have a picc line installed in my arm to receive antibiotics and it was done at NYU-Langone where two nurses and a doctor did the job (who knew that the line went  directly from my arm into my heart – ugh). They billed for over $15,000. Medicare paid about $600. It was clear before I went in – there would be no cost to me and they knew what they were going to get. Thus an advantage of single payer even with all the waste and fraud ( and over testing) – there is one place to go to get paid and someone makes a value judgment.

Even under single payer, which would replace everyone’s health care costs with a  --- dare I  say the word – tax, people would come out ahead.

If you want to read a medical horror story, check out the recent NY Times exposure (The Company Behind Many Surprise Emergency Room Bills) of scams where emergency rooms have been privatized by EmCare, a rapacious company. https://www.nytimes.com/2017/07/24/upshot/the-company-behind-many-surprise-emergency-room-bills.html.

Norm blogs about whatever drivel comes into his head at ednotesonline.com.

          School Scope: Why Not Medicare for All?        
My column in The Wave, Rockaway's local paper. Published July 29, 2017

School Scope: Why Not Medicare for All?
By Norm Scott

I write this on the morning before the Senate Republicans are about to vote on their version of death panels. And I’m thinking…..

Imagine a medical care system where you can get your health taken care of without worrying about finances. I’ve been in the midst of dealing with some not too serious (so far) medical issues and as a Medicare (with GHI supplement) patient I haven’t paid a dime, despite lots of visits to more than one doctor. And every doctor I use accepts Medicare – apparently they can manage to live on what they pay.

Should I feel guilty about costing our economy money I might not have been willing or able to spend otherwise? Not when we see that if I lived in just about every other advanced nation, not only people over 65 but everyone would have the same system I have. The major difference is that in these foreign systems the costs to the system and for drugs are significantly lower.

I'm amazed at how the so-called liberal press lets the Democrats off the hook. Eduardo Porter had a good piece in the NY Times about single payer health care around the world in a letter to Republicans (https://tinyurl.com/yb27jcyb). He might as well have included most of our Democratic Party leaders. This article should be read out aloud in every hall of legislature and also to convince the public -- instead we hear all about Russia all the time. This would be the best way to fight Trump and the Republicans but the Dems spin their wheels. Their “better deal” will not turn out to be that much better as long as they are bought by big pharm and other corporations.

In a single payer system, there is a big bump in taxes, but no one has to buy health care and there are no insurance companies to take a profit. And big pharm has to come into line on costs. Pretty much a win-win for almost everyone. So why not here? Ask our own local politicians, weather Republican or Democrat why they aren’t doing more to educate their constituents on this issue to counter the propaganda from big pharm, insurance companies and the politicians who are bought by them?

What country is Porter talking about? Rwanda. Can you imagine the day post Republican health care when we flock to Rwanda to get better care?

Teachers to Eric Ulrich on supporting Bo Dietl - Say It Ain’t So
Teacher's union has hijacked our classrooms. When I'm mayor, teachers will pass drug tests and performance evaluations. I'm not for sale… Bo Dietl tweet.

Last week I posted an Eric Ulrich tweet supporting Bo Dietl for mayor. Dietl has made it a specialty to attack teachers and the teacher union. I think Ulrich owes the teachers in his district an explanation.

Arthur Goldstein had some comments about Dietl at his blog, NYC Educator (http://nyceducator.com/2017/07/here-come-mayoral-candidates.html).

Circus clown/ Arby's pitchman/ mayoral hopeful Bo Dietl is on Twitter making statements about what things will be like when he's mayor. There's some teacher at John Adams accused of allowing a student to sit on his lap, and Bo is outraged. Bo…says teachers caught having sex with students shouldn't be paid. The only problem is that this teacher has not been caught having sex with a student, and no one is saying otherwise. Inconvenient for Bo, though, is that allegations have to be proven here. You know, there's that whole innocent until proven guilty thing in the United States. Bo has had it with all that mollycoddling, evidently, and just wants to declare people guilty of whatever. As for drug tests for teachers, I don't support them, but Bo has got another thing wrong here: Performance evaluations? Teachers already have performance evaluations.

For proof that Dietl is blowing smoke up his ass on teacher evaluation: http://schools.nyc.gov/Offices/advance/About+Advance/Overview/default.htm.

Norm blows smoke wherever every day at ednotesonline.com


          Jacobin: Message to the Left - Stop the Damn Marching and Organize        
I've been posting stuff on the moral bancruptsy of the Democratic Party. Some people on the progressive wing think the party can be salvaged but I don't think so -- it will destroy itself I believe and out of the cinders something else will rise -- maybe a social-democratic type party with real chops. Though the left will often savage itself over sectarian politics -- so hope in that end is also bleak.

So read the article below in that light.

If you look at the Ed Notes masthead you'll see Educate, Organize, Mobilize -- in that order. Don't skip the educating and organizing and skip to Mobilizing without passing GO, something the drooling left seems wont to do all too often.

I've seen a lot of that in MORE activists who will race to any rally that touches on social justice but when you want to talk about the crappy policies on bulletin boards -- ho, hum.

Some of us in MORE (and I hear in the Chicago Teachers Union too) have been pushing back against what we see as endless campaigns that often go nowhere instead of focusing on their own schools and localities.

So the leftist Jacobin mag has an article telling people in the left to quit the marching and focus on organizing which according to people who follow these things has caused some people on the left who believe that mobilizing alone can get people active to get very agitated over this article.

If you are someone who delves into these issues arising on the left jump into this one.

If you don't know about DSA -- Democratic Socialists of America -- this is an interesting piece written for activists.

Don’t March, Organize for Power

The socialist left needs more organizing and less mobilizing.

--- Jacobin
https://jacobinmag.com/2017/07/march-single-payer-medicare-health-care-democratic-socialists-of-america-unions




With the sudden and unexpected expansion of socialist organizations like Democratic Socialists of America (DSA) in the wake of the 2016 elections, socialists finally have the opportunity to debate basic strategy. A nationwide socialist movement with tens of thousands of members and supporters has emerged. Considering what we should do now is a vitally important question.

It’s also a difficult one. Despite its recent growth, organized socialists remain marginal, with no real mass base. To change the direction of American politics and challenge capitalist hegemony, we will need to reach out not only to self-identified progressives but also to a broader layer of politically disillusioned workers.

We will need to choose battles where we can genuinely affect outcomes despite limited resources. We will need to find ways to engage in coalition politics while carving out space to the left of the Democratic Party’s newly invigorated progressive wing. We will need to win measurable victories that grow our constituency, develop class consciousness, and build toward a broader fight.
We should use these criteria to judge Dustin Guastella’s recent Jacobin article, which called on socialists to spend the next year organizing a “Medicare for All March on Washington.”

We should praise Guastella for starting a conversation on strategy. But his proposal itself leaves something to be desired. Why should socialists spend months planning a national march? What do we hope to achieve?
It should go without saying that single payer will not be enacted under the Trump administration. Republicans oppose it, and neither the socialist left nor the much-larger progressive left can change their minds.

One could argue that a march would put single payer on the Democratic Party’s 2020 agenda, but the issue is already playing a central role in that organization’s internal life. More than half of the Democratic congressional delegation and several leading presidential contenders, including Kirsten Gillibrand, already support it. It will almost certainly take center stage in the 2018 and 2020 election cycles.

A small organization like DSA has little chance of exerting meaningful pressure on the federal government to pass major legislation; if single-payer does go into effect after 2020, it will be thanks to groups like Our Revolution and National Nurses United (NNU).
The socialist left needs to focus on local organizing, not national mobilizations.


Why March?

If DSA decides to pursue single payer, we should consider how a march would help advance the cause. Washington, D.C. has seen thirteen such events already this year, and three more are planned.

Each has required a major investment of time and resources on the part of its organizers, and some, like the Women’s March and the Climate March, have attracted hundreds of thousands of people — far more than DSA could hope to mobilize. While some have shaped the national mood, none has significantly altered the political landscape. Most have made headlines for a day or two and then vanished without a trace. Why would the Medicare March be any different?
As Guastella himself acknowledges, marches only work when they demonstrate the power of an organized mass movement, proving that a mass base has unified around a particular demand. Put differently, organizing work must precede any successful march, and that work takes years, not months.

Today’s left, however, often goes in reverse, organizing a march in the hopes that it will spark a mass movement. Guastella appears properly skeptical of this strategy, but he nonetheless proposes it.

Socialists do not yet have an organized a base in the United States. A march on Washington without a supporting movement amounts to a meaningless publicity stunt. Politicians and the ruling class will have no reason to listen to its demands. Democratic operatives may stop by for a photo op, but we are unlikely to meaningfully influence their political calculus.

At best, a march will attract a few thousand people and garner a day’s worth of media attention. It will not advance its central demand, and it will quickly fade from memory. But achieving even this level of success would require a substantial investment of time and resources from an organization that enjoys little funding outside member dues. It is hard to imagine how demobilizing and dispiriting this project will be for the activists involved, many of whom are new to politics. In fact, a failed Medicare March may do more to depoliticize young socialists than to inspire them.


Why Health Care?

But these arguments miss Guastella’s point. He’s less interested in winning the fight for single payer and more interested in associating DSA, and socialism more broadly, with the ongoing struggle. As he writes:
Medicare for All is the only demand that meets the needs of most workers and has received a warm reception among voters across the political spectrum. The prospect of free health care at the point of access is more popular than ever … Simply, a march would give socialists the opportunity to vocally and aggressively lead on a major working-class demand.
Guastella argues that socialists should identify with single payer because people like single payer. If they identify us as “leading” on that issue, perhaps they will like us, too.
It’s an understandable impulse. The socialist movement remains small and weak despite its recent growth. The movement for single payer, and the progressive Democrats who have taken it as their signature issue, appears large and strong. If socialists go all-in on single payer, perhaps some of that strength will rub off on us. A march may not win single payer, but it could help the DSA’s brand.
As seductive as that idea is, it suffers from a number of basic problems.

For one, the fact that single payer is popular among the working class does not mean that an ineffective march will inspire workers to join the DSA. Working-class people already know that they need health care; they just don’t know how to get it. Spending months organizing an action that won’t move people closer to a universal-health-care system won’t make them sympathize with the DSA, it will simply show them that the organization can’t help.

The national march proposal sharply contrasts with the strategy of serious single-payer advocates like National Nurses United. The nurses’ union has focused on California where passing single-payer legislation seems possible. Further, it has used health-care activism to drive a wedge between the Democratic Party’s conservative and progressive wings and committed to an electoral strategy that can build on those gains by primarying the Democrats who oppose single payer. These tactics have attracted a large and effective activist base, including local DSA chapters.

Pursuing the same goal with less effective tactics will not attract new people to socialism. Rather, serious activists will join the serious organizations doing real work for single payer, not a socialist movement more interested in jumping on bandwagons than winning fights.

Which brings us to a broader point: for the socialist movement to succeed and grow, it must distinguish itself from the Democratic Party.

In one sense, we can easily accomplish this task: many socialists live in large cities controlled by progressive Democrats — Chicago, Los Angeles, New York, Oakland, and San Francisco — that are nevertheless still riven by inequality, segregation, mass incarceration, and a seemingly endless housing crisis. The DSA is perfectly positioned to show how poorly these Democrats serve their working-class constituencies. The party can build an oppositional base around the demands progressive Democrats have no time for.

Of course, from another perspective, it’s immensely difficult to build a movement around issues that have been beyond the pale of mainstream political thinking for fifty years. Far easier to follow Guastella’s suggestion and identify ourselves with the progressive Democrats, adopting their chief demand and providing organizational support for their campaigns. Progressive Democrats have grown in popularity since making single payer their central policy plank.

If the DSA adopts the progressive Democrats’ platform, however, the organization risks being dissolved into the Democratic Party. The mainstream liberals are more likely to coopt segments of the emerging socialist movement than to allow it to share in the Democrats’ success.

This is not to say that we should avoid collaborating with progressives on shared objectives; coalition work creates useful alliances and leads to real gains. For example, the DSA’s work on the New York and California single-payer campaigns has helped grow the organization.

But the socialist movement must articulate the necessity of anticapitalist politics. Choosing an issue that makes the socialists indistinguishable from the Democrats’ welfare capitalism leads away from that goal.


Why Not Organize?

In her book No Shortcuts, Jane McAlevey distinguishes between organizing and mobilizing.

Leftist organizing — the work it takes to build a labor or tenants’ union — addresses itself to the apolitical, the disillusioned, or those actively hostile to the Left and attempts to persuade them to join organizations and take collective action for their own betterment. Mobilizing, in contrast, seeks out those who already agree and asks them to make their support visible.

Organizing brings new constituencies into the Left, while mobilizing demonstrates existing support. The characteristic culmination of organizing is something like a strike — an action that requires majority support within a specific constituency. The protest is the characteristic culmination of mobilizing, and it draws a self-selecting minority of activists to show up and demonstrate support.
Both forms of activity have their uses, but, as McAlevey points out, mobilizing comes with sharp limits: in the US today, there are not enough leftists or progressives to win the necessary fights. The Left must bring in new people, which means organizing.

Organizing, however, is hard, resource-intensive work that takes years to accomplish, so leftists will always be tempted to take the “shortcut” and mobilize existing supporters. But, the same historical conditions that make marches so seductive — the Left’s lack of local organizations with ties to a larger base as well as its inexperience in building effective campaigns for power — are the very conditions that make mobilization the wrong strategy.

They also happen to be the very conditions that the DSA is meant to — and must — change.

Guastella’s proposal focuses exclusively on mobilization. A futile march on Washington will not interest anyone except the tiny minority of Americans who already support single payer, who already engage in left-wing activism, and who can travel across the country for a protest.


Think Local

A serious DSA organizing campaign would push socialists to build alliances with their local working-class bases. It would engage in the small but real battles on which movements thrive while building mass support for the bigger confrontations ahead. It would be national in scale but local in focus since socialists are not yet powerful enough to push federal legislation.

For example, socialists could lead a national campaign around housing rights. In big cities, that would mean fighting rent increases, advocating for tenants’ rights, and demanding government action to address housing shortages. Elsewhere, campaigns could focus on mortgage debt and housing quality.

In every locality, a housing campaign would directly address an issue every working-class person faces, would challenge the property regime that leaves basic needs to the whims of the market, and would produce tangible wins. Most importantly, it would entail organizing local communities for rent strikes and anti-gentrification work rather than drawing energy toward Washington.

This kind of nationally coordinated, locally focused organizing isn’t limited to housing. In health care, too, we can do important work around specific, winnable issues that supports our understanding of health care as a human right.
Socialists can bring the fight for adequate and just health to the local level. In cities, access to care often follows the lines of racial segregation. We can push municipalities to provide better mental health care and addiction treatment for workers, states to guarantee care to undocumented immigrants, and schools to ensure young women have access to reproductive care. Working on these issues will help build solidarity and bring new people into the movement. Just as importantly, they will lend real substance to our commitment to universal and decommodified health care by winning battles that make an immediate difference in people’s lives.

We need to pick campaigns that bridge the gap between our long-term socialist goals and the realities of working people’s daily lives as well as between national coordination and local organizing.

A march on Washington in support of federal legislation does not meet these criteria. It squanders time, money, and energy. Even worse, it sets up members for defeat and disappointment. Guastella’s proposal actually works against the goal of building a powerful movement that can fight for socialist goals.

At the height of its power in the 1930s, the American socialist movement was deeply involved in organizing the working class into unions. The labor movement recognized socialists and communists as among the most dedicated, astute, and effective organizers, and the millions-strong, racially integrated, rank-and-file-oriented, ideologically progressive unions they built produced gains for their members and the broader working class that we still enjoy.

About the Author

Michael Kinnucan is a Democratic Socialists of America member in New York City. He writes for Current Affairs.

          Single Payer! Rep. Alan Grayson Files “Medicare You Can Buy Into Act        
[subscribers] [/subscribers] Free Preview Clip Repeating a move that cost him his seat in 2010, progressive Rep. Alan Grayson (D-FL) … Continue reading Single Payer! Rep. Alan Grayson Files “Medicare You Can Buy Into Act
          Comment on Expanding Medicaid is important; keeping an eye on Managed Care corporations is more so by shortwhitecoatinc        
Oh - I meant to mention. Speaking of state-based initiatives, Vermont has a form of single payer that will take place in 2017 when the ACA allows for state innovation waivers. Though their method is imperfect, I think they will be the model that other states will follow when the exchanges inevitably fail to contain costs and improve quality.
          If California Can’t Pass Single Payer, the Democrats Will Never Really Win        
Most of the attention these days on Congress (the opposite of progress) has centred on the Senate’s inability to pass a replacement for the misnamed Affordable Care Act.  Let me make my first stipulation: the “repeal and replace” business is pure political theatre, has been from the start, and in a sense Donald Trump has … Continue reading If California Can’t Pass Single Payer, the Democrats Will Never Really Win
          NOW THERE’S LIKELY AT LEAST A THREE-YEAR WAIT FOR SINGLE-PAYER        
SOUTHERN CALIFORNIA FOCUS
FOR RELEASE: FRIDAY, JULY 14, 2017, OR THEREAFTER


BY THOMAS D. ELIAS
     “NOW THERE’S LIKELY AT LEAST A THREE-YEAR WAIT FOR SINGLE-PAYER”


Single-payer health insurance that would cover every Californian has stalled, at least for now. Because Democratic Speaker Anthony Rendon shelved state Assembly consideration of the Senate-passed insurance outline at least until next year, a popular vote on the well-publicized, often criticized single-payer health insurance plan is probably at least three years away, and probably more.


Chances are the idea won’t reach voters before June 2020, if then.


The many Californians who wanted this quickly as a potential defense against whatever changes President Trump and the Republican-dominated Congress might bring to ex-President Barack Obama’s Affordable Care Act will just have to wait. It’s the third time in the last 12 years this idea has been stymied in California despite getting considerable legislative support.


          Twice former Democratic state Sen. Sheila Kuehl, now a Los Angeles county supervisor, got a single-payer plan through the Legislature in this century’s first decade, only to see it vetoed by then-Gov. Arnold Schwarzenegger. Her idea – like this year’s plan – was to use existing health insurance premiums as the main funding source. Coverage of the previously uninsured would be paid with the approximately 15 percent of premiums now going to insurance executives and corporate profits.


          As before, this year saw a lot of lip service to single payer, sponsored now by Democratic state Sen. Ricardo Lara of Bell Gardens, also a candidate for state insurance commissioner.


Single payer is sometimes called “Medicare for all” because, like federal Medicare insurance covering all those over 65 who want it, the latest plan would have a central clearing house for claims. Payroll taxes would help fund it, also like Medicare.


As was Schwarzenegger, current Gov. Jerry Brown has been skeptical, mostly because of costs. But if this proposal gets no action until after next year’s election, now very likely, Brown’s views will no longer matter much. Current gubernatorial possibilities like Lt. Gov. Gavin Newsom, former Los Angeles Mayor Antonio Villaraigosa or state Treasurer John Chiang might be more favorable, if elected.