Mr Reich, Improved Medicare for All is the Solution

By ellenView Comments

Paul Ryan is off the wall on Medicare.  Robert Reich is lots better.  But off just enough. 

The following widely followed column describes every problem in our health care system, problems Medicare shares and perpetuates.

What’s great about Medicare:  everyone’s in it and the government runs it.

What’s wrong with Medicare:  Fee-for-service payments, no incentives for quality like more primary care and electronic medical records.  All improvements that are included in the Affordable Care Act.

Specifically:

Medicare for All Is the Solution
By Robert Reich, Robert Reich’s Blog – 13 April 2011
Mr. President: Why Medicare Isn’t the Problem, It’s the Solution hope when he tells America how he aims to tame future budget deficits the President doesn’t accept conventional Washington wisdom that the biggest problem in the federal budget is Medicare (and its poor cousin Medicaid).
Medicare isn’t the problem. It’s the solution.
The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.
Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.
Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs are soaring because our health-care system is totally screwed up.

YES IN MANY WAYS; FINANCING AND DELIVERY SYSTEMS

Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS. 

You have lower back pain? Almost 95% of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There’s not much money in physical therapy.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS. 

Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you’re back there within a month. You wouldn’t be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don’t nurses do home visits to Americans with acute conditions? Hospitals aren’t paid for it.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS. 

America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.

ALSO TRUE IN MEDICARE. THE ACA FUNDS AND IMPLEMENTS WIDESPREAD USE OF ELECTRONIC MEDICAL RECORDS.

Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.
A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.
Trying to slow the rise in Medicare costs doesn’t deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors – whose clout will grow as boomers are added to the ranks – demand the limits be increased. (If you thought the demagoguery over “death panels” was bad, you ain’t seen nothin’ yet.)
Paul Ryan’s plan – to give seniors vouchers they can cash in with private for-profit insurers — would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.
So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.
In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.
Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced. Let me say it again: Medicare isn’t the problem. It’s the solution.

ONLY IF WE UNDERSTAND HOW TO FIX IT.

Uncategorized

Budget – Obama – Strategy?

By ellenView Comments

 

Unfortunately for Obama, the Republicans have him trapped against the wall. First, Republicans have a foolish wing that believes that a government shutdown would be good for the nation and would force immediate savings. Second, the nation has an enormous budget deficit and the debt ceiling that needs to be extended now. As a result, unless Obama was willing to make some painful cuts, the Republicans pull out the trump card and threaten a government shutdown or default on America’s debt. I resent playing this game of chicken on our country. My prediction is that the Republicans like this and will extend the debt ceiling by maybe $500 billion and keep using it as a hammer every year. Obama needs to say some really radical stuff tomorrow when he addresses the nation- like single payer national health insurance or get us out of the wars that we have to stop pretending we can afford. That is where we are now, but I doubt he is willing to say that. So the choice in Nov. 2012 will be between the lesser of two depressing visions of which Obama will probably be preferable. My only hope is that once he is a lame duck, he will be wiling to lead.

Walter

HiI hear you all loud and clear. (Catherine, I did not know about how Obama
was handling the Bradley Manning case, and I’m very disappointed to hear
this. I travel so much in developing countries, and I miss some news
events. I was very disturbed about how many handled that, including Amazon,
Visa, etc.)So, what are we are our alternatives to re-electing Obama? What are we going
to do? This morning NPR said that the big stumbling block for Mitt Romney
to get the republican nomination was that he had created something in Mass
that was considered the equivalent of ObamaCare, so republicans are
skeptical of him. Who/what should we be supporting now: Mitt Romney as a
republican president?I have become very disenchanted with black-white or “winner takes all”
aspect of American politics, where there seems to be no middle ground (which
at least Obama is looking for). The speeches and Op Ed pieces that
criticize what is happening offer no practical solutions in a political
environment where market economics is viewed with a religious fervor by
many, where social solidarity is not an underlying value in this society,
and where no one seems willing to give up anything to repair a declining
economy, which will ultimately undermine everything else. I’ve watched
health care statistics improve tremendously in developing countries that
were really “developing” because the population is better off and can afford
better food, education, sanitation, etc. (e.g. Cambodia, despite entrenched
corruption). And I’ve seen the entire socio-economic structure collapse
along with economic decline (e.g. Jamaica). My Canadian dollars were worth
around $0.70 US a couple of years ago; now they are worth more than an
American dollar. If action is not taken to repair the American economy, all
of the social services (including public education) will continue to
decline, and the worst of the damage will not be evident for a generation.I am on a number of lists that would be described as left-wing, and I don’t
see any strategy emerging from those, anything where we are also making
informed decisions (that are very difficult to make) about what concessions
can be made. Not that I am any better: I clicked the buttons that “Move On”
and others sent to me to lobby for NPR funding, but then I know that I’m
asking other tax payers to fund a service that they may not use and that is
not an essential when I lobby for NPR.Maggie 

Krugman bemoans the absence of President Obama’s willingness to take a stand,
Professor Greenwood (http://dissentmagazine.org/atw.php?id=429) tells us what
price we pay and where Obama ought to lead.

Peace,

Aaron

Though the arrows were aimed at Obama, Paul Krugman’s column was mainly
about Ryan’s budget proposal. Let’s see how President Obama responds to
that proposal Wednesday night.


Paul Johnston
I hate to get into these kinds of discussions, BUT I will on this one.
And this is my personal opinion.It’s a caution about putting our energies into disappointments with
Obama. You might want to think about the basic politics of counting
votes. I was at the White House when Obama kicked off the healthcare
debate. He was right on target and said all the right things. Then
various folks in Congress (many on the D side of the aisle) turned it
into a much less robust piece of progress. But that is where the VOTES
WERE! Anyone remember Max Baucus? What he did? If Obama didn’t have
the votes for single payer or public option, then his championing of it
would have gone where?It’s easy to be disappointed. I don’t see the leadership or risk-taking
either. But that’s an easy way out for all of us. The fact is that we
thought we could take a shortcut to a progressive agenda by electing a
President we thought was progressive. We forgot that there still has to
be an actual base that believes in a progressive vision and is
emotionally enough attached to that vision to fight for it. We forgot
that we needed a Congress that understood they would be voted out if
they defied the progressive desires of their constituents. Until we
build that, the Obama’s of the world will come and go and we will grouse
and complain. It’s a good thing that we have Krugman to point out the
lack of leadership. But it’s a mistake to spin our wheels there. Lets
talk about how to go out and capture the imagination of the American
people with a vision and organization that can confront regressive
forces and rebuild the nation. The good thing about a politician that
has no basic moorings is that when we get the wind blowing our way,
he’ll float that direction too….________________________________From: equal-list@googlegroups.com [mailto:equal-list@googlegroups.com]
On Behalf Of John Troidl
Sent: Monday, April 11, 2011 6:13 PM
To: Maggie Huff-Rousselle
Cc: Karl Keener; equal-list@googlegroups.com
Subject: Re: [EQUAL] Paul Krugman is looking for President ObamaMaggie,I think it “comes with the territory”. He needs to come up with better
approaches that are wise enough to bring people together or have the
guts to fight for what he believes in. Maybe he’s too young…..JohnOn Mon, Apr 11, 2011 at 2:41 PM, Maggie Huff-Rousselle
<mhuffrousselle@ssds.net> wrote:It is easy to get up on a soap box and criticize Obama with some punchy
prose in an Op Ed, and not so easy to do his difficult job. I don’t
think by publicly undermining Obama that those of us with shared
concerns about health care (and other social issues) are accomplishing
anything. We should be mobilizing to educate baby boomers who will
gradually retire to lobby against undermining Medicare, etc. etc.MaggieFrom: equal-list@googlegroups.com [mailto:equal-list@googlegroups.com]
On Behalf Of Karl Keener
Sent: Monday, April 11, 2011 11:27 AM
To: equal-list@googlegroups.com
Subject: [EQUAL] Paul Krugman is looking for President ObamaIn today’s NY Times is an excellent op-ed by Krugman. It truly is a
shame the guy we campaigned for and elected in 2008 is MIA.Karlwww.nytimes.com/2011/04/11/opinion/11krugman.html

Uncategorized

Funding health care reform

By ellenView Comments

from Jonathan Starr:
The article “Funding for health care law next  big battle” by Prof. Robert
Reich (San Francisco Chronicle, 1/23/11)  makes the case that funding
universal health-insurance through taxes is likely  to be better accepted than
funding it through mandating individual policy  purchases.  But it does not
make the case that using FICA-style payroll  taxes (i.e. like Social Security
and Medicare taxes) would be preferable to  using progressive income taxes to
fund single-payer health  insurance.  And there are many reasons why the
latter would be much  better.

For entitlement programs like Social  Security and Medicare, there may be
some psychological advantage in  designating a specific tax that appears
separately on paycheck stubs and W-2  statements.  This is because people,
during their working years, tend to  see these as programs for which they pay now
in order to receive specific  benefits in the future.  Making the mental
connection across time between  the payments now for benefits later may be
enhanced by having a designated  associated tax, visible in writing.

But this would not be necessary for universal  single-payer health
insurance.  Upon implementation, universal health  insurance coverage would be part
of the panoply of government services and  benefits that everyone would
receive at all times.  As such, there  would be no need for some written
artifice to calm the public psyche.

After all, no one now needs to see on their  paystub what portion of their
income taxes goes to fire and police  protection, water quality, food
inspection, national defense, etc.  That is  because people can see every day that
they are deriving the same benefits  as everyone else; they do not need
written proof that they are entitled to  them.  The same would be true of
universal single-payer health  insurance.  It would be another such benefit to
which citizens would  know they have access every day, without anything about
it needing to appear on  their tax-related documents.

Meanwhile, progressive income taxes, scaled by  ability to pay, would be a
far more fair and equitable way to fund  single-payer health insurance than
FICA-style payroll taxes.  That is  why countries with single-payer systems
now, like Canada, have chosen to fund  them with progressive income taxes.

The Social Security payroll tax in particular is  very regressive, since it
applies only to earned income (i.e. wages and  salaries), and only up to a
certain cap level.  Unearned income (e.g.  capital gains, dividends,
interest), which accrues overwhelmingly to wealthy  people, is entirely exempt from
both Social Security and Medicare taxes.

And the employer portion of FICA payroll taxes  is very inequitably
distributed as well, and in a way that discourages hiring  and employment, and even
threatens business viability.  In accordance with  the principle of taxing
by ability to pay, business taxes should be based on  level of profits.  But
instead, employer FICA taxes are applied by number  of employees,
regardless of the level of profitability of the business.   So, for example, a
barely-surviving company that employs many people will pay  much higher FICA
payroll taxes than a highly profitable business with few  employees.
Essentially, these are substantial taxes on hiring,  strongly encouraging businesses to
make do with as few employees as possible,  and making it much harder for
labor-intensive businesses to survive at  all.

In FDR’s famous “Four Freedoms” speech, he said  “the principle of tax
payments in accordance with ability to pay should be  constantly before our eyes
to guide our legislation”.  Progressive income  taxes, scaled by ability to
pay, comply with FDR’s principle, while regressive  and inequitable
FICA-style payroll taxes do not.  The implementation of  universal single-payer
health insurance, available to everyone immediately and  at all times, would
eliminate the perceived need to document eligibility for  benefits later based
on payments made now.  As such, equitably applied  progressive income taxes
are the better way to fund single-payer health  insurance.

– Jonathan Starr
The New Great Society
Santa Clara,  CA

Uncategorized

Can rate control help?

By ellenView Comments
I am going to initiate a discussion here.  I’ve posted it here on the EQUAL discussion blog in case some people want to hash it out – we’ll report back to the list once everyone declares unity or a truce:
 
A single payer system would certainly be a vast improvement, and probably ultimately our only salvation.  But I’m not sure Don’s excellent statement exactly nails the case.  Even if true, I want to suggest that it is possible to wring out savings as we progress towards that solution.
 
Blue Shield claims that rising health care costs account for their need to raise rates.  Insurance Commissioner Dave Jones disputed that claim in our interview today.
 
Could the insurance industry do better?  How?
 
If their rates were regulated, they would start to figure it out.  They don’t have to spend 20% of our premium on administration; they just do, because they can.  One MD who is a listserve member regularly sends me piles of useless and misdirected memos from one of his insurers, spewing out useless advice about coordinating care and medications for people who aren’t his patients or who aren’t taking the meds the company is suggesting they shouldn’t take. ( One reason the medical loss ratio should be better adjusted!) Nor do they have to pay exorbitant executive compensation.
 
A single payer system would certainly bring drug companies, hospitals, doctors and others to the negotiating table with governments to lower prices.  However: a. That will be a bloody battle when it happens.  b. Again, not only don’t insurance companies have the leverage in many cases to negotiate – they have no incentive to do so. (It’s not easy.) Regulated rates would give them that incentive.  Ultimately they’ll backtrack because (although many of them probably are very nice people) private plans will likely be less accountable and more driven to show a surplus of funds than are government-run programs.
 
Subsidized premiums proposed under the ACA are in fact affordable for the vast majority of the presently uninsured who earn less than 400% of poverty, who generally are entirely priced out of insurance now (the Blue Shield plan at issue now proposed to raise monthly premiums for one individual from $271 to $431):
 
•150% of FPL($16,245): $68/month
•200% of FPL ($21,660): $113/ month
•250% of FPL ($27,075): $191/month
•300% of FPL ($32,490): $257/month
•Hardship exemption: will be available to individuals whose lowest cost plan option exceeds 8% of an individual’s income

Out of pocket expenses can drive up these costs. And for people over 400% of poverty (who would not get subsidies – a minority of the uninsured), premium costs can also be a deterrent.  So affordability in the ACA is a problem; it’s just not prohibitive in all cases, and for a lot of people it is ok.

How to provide higher quality care, while controlling costs:  the ACA proposes some “best practices” models; somewhat more primary care (through community health centers, the National Health Service Corps, and payment reforms); and other measures a single payer system would have to at least explore.
 
A single payer system would (or at least could) effectively negotiate prices for drugs and health care goods and services vastly better than the fragmented insurance industry; we the public would be far better able to hold it accountable to control costs, and administrative inflation would be much better controlled (no need to evaluate enrollees for eligibility e.g.).  
 
Regulating insurance company rates, meanwhile, would help make premiums more affordable, while we’re figuring out how to replace the industry with a more humane public system, and to actually deliver high quality, affordable, publicly accountable health care. Meanwhile we should not let Blue Shield off the hook. – Ellen Shaffer 

On Fri, Jan 7, 2011 at 2:47 PM, aaron roland <doctoraaron@pacbell.net> wrote:

Many of you have probably already seen these comments by Dr. Don McCanne about these rate hike proposals but I think they are important for all to read so I have copied them below.  Only true reform through a single payer gives us any chance of controlling costs with while providing reasonable quality care for all:
Last year California’s for-profit Anthem Blue Cross, a division of WellPoint, enraged everyone when they attempted to raise premiums as much as 39 percent. In contrast, Blue Shield of California is a non-profit insurer attempting to compete in a market in which the rules are established by investor-owned insurers, yet they are now calling for premium increases as high as 59 percent. As a provider or a patient, it is difficult to tell the California Blues apart.
That said, the brief statement released by Blue Shield of California explains the reasons for the increases: higher provider prices, increased utilization, and a decline in enrollment in a bad economy resulting in spiraling premiums due to adverse selection. In spite of these premium increases, Blue Shield expects to lose tens of millions of dollars on its individual health plans.
These premium increases are intolerable, but is Blue Shield really to blame? Keep in mind that the average working family of four now uses over $18,000 worth of medical care (Milliman Medical Index), and Blue Shield is trying to sell a product that covers those costs plus its own administrative expenses. With insurer administrative costs at 20 percent for the individual market, that’s about $22,500 that the premium would have to be. To lower the premium, costs are shifted directly to the family through deductibles, co-payments, coinsurance, and paring of benefits, but how much in direct costs can the family bear when median household income is about $50,000?
Blue Shield is facing an impossible situation. They cannot create a product that has both affordable premiums and adequate protection against out-of-pocket medical expenses.
That is why the Patient Protection and Affordable Care Act provides income-indexed subsidies for both premiums and cost sharing, but applying simple math to these subsidies will demonstrate that they are inadequate for the majority of low- and moderate-income families who have health care needs.
If we were to increase the subsidies to a level where they would be adequate, then you would be paying more than an improved Medicare for all would cost since the subsidies would have to pay not only for health care but for all of the administrative excesses of our fragmented system composed of a multitude of private and public plans. If taxpayers are going to pay the bill, we might as well pay the one that is a bargain.
The administrative team at Blue Shield of California is composed of fine people. We should thank them for their dedicated service and offer them job retraining to serve in our expanded and improved Medicare program. For the investors and administrative team at Anthem Blue Cross, we should show them the door.
 
Peace,
 
 
Aaron
Uncategorized

On taxes in HR 676

By ellenView Comments

Harvey Fernbach, Jonathan Starr and others commented on the proposed reliance on the payroll tax to finance health care in the proposed re-daft of HR 676, a single-payer proposal.  While the Affordable Care Act imposes a progressive tax on the wealthy through a 3,8% tax on “unearned income,” the single payer advocates who have contributed to date in re-drafting H.R. 676 have not adopted this provision. Harvey has called this to the attention of the Congressional staff to Mr. Conyers.

The comments by Jonathan Starr follow. – Ellen Shaffer

 I am a long-time supporter of single-payer  national health-insurance.
But some of the largest of the  proposed changes to HR-676 are so bad that I
would cease to support that  bill as the mechanism for single-payer if they
were added.
The objectionable proposals are to financially support the  single-payer
system with:
1) Per-employee payroll taxes, 6% for employees and 8% for employers.
2) Financial transactions taxes, incorporating the provisions of Rep.
DeFazio’s proposed HR-1068.

Payroll taxes such as those proposed are inherently  regressive.  They
apply only to earned income (wages and  salaries), and exempt unearned income
(interest, capital gains, dividends) which  accrues overwhelmingly to wealthy
people.  And unlike income taxes, for  which there are progressively defined
tax-rate brackets as well as deductions  and exemptions, payroll taxes
apply in full from the first wage-dollar  earned.

Regressive payroll taxes already account for more than 40% of all federal
tax-revenue.  (A similar portion of federal tax-revenue comes from
individual income-taxes, which are very progressive; the net effect is an  overall
tax-system that is moderately progressive.)  The changes to HR-676  being
proposed would double the amount of federal revenue coming from payroll  taxes,
making the overall tax-system far more regressive, a thoroughly
undesirable outcome.
One of the big potential advantages of single-payer is that it could make
American companies more competitive with those from countries that already
have  single-payer, by eliminating the per-employee financial burden of
providing  health-insurance.  This also could make it more attractive to hire
more  employees.

But the new system proposed for HR-676 would constitute a per-employee tax
on hiring, doubling the already large per-employee tax for Social Security
and  Medicare.  This would discourage hiring of additional employees, and
would be inherently unfair.  Why should a labor-intensive business bear  more
of the financial burden for a society-wide program than a less
labor-intensive one?  For example, why should a home-health-care agency  with many
employees pay more for the single-payer program than a similarly  profitable
construction-equipment rental company with few employees?   Profits are the
proper measure of ability to pay (and of the degree to which an  entity, human
or corporate, benefits from the existence of the American  system).  As
such, profitability, not number of employees, should be the  determinant of
tax-levels paid by a business.

By hurting the international competitiveness of American  businesses,
discouraging hiring, and penalizing labor-intensive companies,  the proposed
changes to HR-676 would turn a potential advantage of  single-payer into a
disadvantage.

Completely absurd is the proposal to add the content of HR-1068 to  HR-676.
 The DeFazio bill was designed to require financial-services  companies to
pay for their federal bailouts over time.  That at least had  some internal
consistency.  But, obviously, its provisions have no  intrinsic relationship
to health care or to health insurance.

Just grabbing at some arbitrary and unrelated source of revenue is morally
and politically unsupportable and improper.  There is no reason why any
particular area of business activity should bear a special burden for
supporting a fully national program of single-payer health insurance.

Not only would this be obvious to the public, but it would also bring upon
HR-676 the understandable wrath and political opposition of the financial
services industry.  As everyone knows, this is one of the most
politically-powerful and heaviest-lobbying industries in the country.   (That is partly
why HR-1068, even in its present, more creditable form, has  garnered barely
a dozen co-sponsors, a tiny number.)   Antagonizing such a strong entity
unnecessarily, and completely  without justification, would be idiotic and
probably suicidal for the  bill.
Single-payer national health insurance should be supported by progressive
individual and corporate income taxes.  Ability to pay is the most
reasonable and equitable basis for taxation, the financial support for the  general
societal system that benefits us all.  This is what should be  embodied in
HR-676.

We should not add provisions to HR-676 which would make the tax-system much
 more regressive, would discourage hiring, would hurt American business
competitiveness, would arbitrarily target completely unrelated commerce, and
would inevitably and unnecessarily provoke powerful political  opposition.
These proposed revisions to HR-676 are counter-productive  and unfair, as
well as politically damaging to the overall prospects for  single-payer.  They
should be rejected.

– Jonathan Starr
The New Great Society
Santa Clara, CA

Jsincalif@aol.com

Uncategorized

Don’t Ask Don’t Tell Ended; No on DREAM Act

By ellenView Comments
I’d rather no one were in the military.
I’d rather no one had to be married to enjoy full benefits of social and political life.
I hope today’s vote removes another barrier to social inclusion. It was a hard fight; this is a milestone.
Next year we’ll fight for immigrants to claim recognition, to trust women with decisions about their bodies, and for equitable, quality, universal affordable health care.
From Politico:  
By SCOTT WONG | 12/18/10 11:57 AM EST Updated: 12/18/10 3:52 PM EST

The Senate voted Saturday afternoon to repeal the ban on gays in the military, marking a major victory for gay rights and an end to the 17-year old “don’t ask, don’t tell” policy. 

The bill now heads to President Barack Obama, who plans to sign it into law, overturning what repeal advocates believed was a discriminatory policy that unfairly ended the careers of thousands of gay members of the military over the years.

The 65-31 Senate vote marked a historic – and emotional – moment for the gay-rights movement and handed Obama a surprising political victory in the closing days of the 111th Congress. The legislation had been left for dead as recently as last week after Republicans in the Senate blocked efforts to advance it, yet on final passage, the bill won surprising support from eight Republicans.

The repeal, which would not take effect immediately, ushers in a major cultural shift for a military that has operated under the “don’t ask, don’t tell” policy since the first year of Bill Clinton’s presidency.

The Senate vote capped months of uncertainty about whether Congress or the federal courts, where gay-rights advocates are fighting the ban, would act first to repeal the policy.

The real drama had already come a few hours earlier when the repeal bill cleared a crucial procedural hurdle. The 63-33 cloture vote was three more than needed to beat back a Republican filibuster.

With support from all but one member of the Democratic caucus and help from seven Republicans, the bill overcame the 60-vote threshold required to move forward.

The Republican senators voting “yes” with the Democrats were Richard Burr of North Carolina, Mark Kirk of Illinois, John Ensign of Nevada, Scott Brown of Massachusetts, George Voinovich of Ohio, Lisa Murkowski of Alaska – and Olympia Snowe and Susan Collins, both of Maine. Burr, Ensign and Kirk were late surprises, bucking their party on the historic vote.

West Virginia Sen. Joe Manchin, who previously stated he opposes repeal, was the only Democrat to miss the vote, apparently because of a family “holiday gathering,” his spokeswoman said.

President Barack Obama called the procedural vote an “historic step” toward ending a discriminatory policy that weakens America’s national security and violates the ideals troops risk their lives to defend.

“By ending ‘Don’t Ask, Don’t Tell,’ no longer will our nation be denied the service of thousands of patriotic Americans forced to leave the military, despite years of exemplary performance, because they happen to be gay,” Obama said in a statement. “And no longer will many thousands more be asked to live a lie in order to serve the country they love.”

The repeal measure, passed by the Senate Saturday, already cleared the Democratic-controlled House this week along a mostly party-line 250-175 vote. It now goes directly to the president for his promised signature.

The repeal, however, wouldn’t take effect immediately. Obama, Gates and Mullen would have to certify to Congress that they have reviewed the Pentagon report on the impacts of repeal, that the Defense Department is prepared to implement repeal and that doing so would not harm military readiness, troop morale, and recruiting and retention.

The policy would be repealed 60 days after the president submits the document.
Read more: http://www.politico.com/news/stories/1210/46576.html#ixzz18V2i4ifj

Uncategorized

Fight the Budget Deal

By ellenView Comments

Numerous campaigns have sprung up to oppose the deal to extend tax breaks for the rich in  exchange for extending unemployment benefits.  I’ll post excerpts on this page and invite comments. – Ellen Shaffer, EQUAL Health Network.

from: campaigns@dailykos.com

 A “deal” has been announced to extend all of the Bush tax cuts–including those for millionaires. Some deal.
But the fight isn’t over. Sign the petition at:

http://kos.salsalabs.com/dia/track.jsp?v=2&c=j7rO3OGWrTHDYmJL9YE2ZQ%3D%3D–oppose

to oppose the deal.
In the Senate, Bernie Sanders has promised to filibuster, and Dick Durbin has said “there is a group [of progressives] that may walk.”
In the House, several members of the Congressional Progressive Caucus, led by Rep. Peter Welch, have already stated their opposition. The White House is so worried about support for the deal that it is sending Vice President Joe Biden to Capitol Hill to try and sell it.
The bottom line is that this is not a done deal. With the Daily Kos community voting 3-1 in opposition to the deal, we need to show our support for the progressive members of Congress who are not caving. Give them that support now by signing our petition, and sending words of encouragement. We’ll deliver your signatures at the end of the week.
Keep fighting,
Chris Bowers
Campaign Director, Daily Kos

Huff Post’s Ryan Grim…

Mary Landrieu: ‘Obama-McConnell’ Plan Is ‘Almost Morally Corrupt’
WASHINGTON — Sen. Mary Landrieu, a conservative Democratic from Louisiana, lashed out Tuesday at President Obama’s deal with congressional Republicans that allows tax cuts for the wealthy to be extended for two years.
Extending the tax cuts for those making more than a million dollars a year is borderline immoral, Landrieu charged. “I’m going to argue forcefully for the nonsensicalness and the almost, you know, moral corruptness of that particular policy,” said Landrieu, walking into a meeting with Vice President Joe Biden and Senate Democrats. “This is beyond politics. This is about justice and doing what’s right.”
Landrieu was fuming about the deal. On her way into the meeting, she slammed the tax-cut extension as a needless giveaway, adding, “That’s all I have to say.” But it wasn’t. She emerged from the meeting a few moments later to continue prosecuting her case to reporters.
“It’s what I’m calling the Obama-McConnell plan. We’re going to borrow $46 billion from the poor, from the middle class, from businesses of all sizes basically to give a tax cut to families in America today, that despite the recession, are making over a million dollars. I mean, this is unprecedented. Unprecedented. I want to repeat that,” she said. Landrieu added, however, that she had yet to make a decision on the final package and was speaking strictly about the extension of tax cuts for the wealthy.
Landrieu put the tax cuts in the context of the poverty and joblessness facing African Americans across the country. “The median net worth of African-American families — net worth, not income — in this country today, according to our census, is $5,000. You want me to repeat that? $5,000. So we are borrowing money from constituencies, and large segments of the population like this,” said Landrieu. “I want you all to get your heads around this.”
Obama had allies in the Senate who would have fought the extension of the tax cuts, Landrieu said, if only he had relied on them. “Why the president didn’t think there were forty or fifty or sixty of us to defend him on this principle, I don’t know, but he basically didn’t think anybody of us cared much about it. Well, I want him to know I do care.”

On Tue, Dec 7, 2010 at 2:04 PM, Adam Green <adam@boldprogressives.org> wrote:

Two big updates from the Hill.

1) In the House, as thousands of calls from PCCC and other groups pour into offices, 15 Representatives have already signed onto Rep. Peter Welch’s letter saying no to the Obama deal. More momentum to come. List below.

2) Today’s MVP: (Never thought I’d say this): MARY LANDRIEU!!! Via Politico:
“I still seemed puzzled with the president’s enthusiasm and the Republicans giving an income tax break for people that make over a $1 million,” said Louisiana Sen. Mary Landrieu… Landrieu added: “But why the president thought he had to give in on this? Why he didn’t have the confidence in a Democratic Caucus to hold the line? I don’t know.”  Linda McMahon would be pleased. In WWF wrestling parlance, that’s called “an elbow from the sky!” Go Landrieu.

Welch signers:

John    Conyers    D    MI    14
William D.    Delahunt    D    MA    10
James L.    Oberstar    D    MN    8
Fortney Pete    Stark    D    CA    13
Peter A.    DeFazio    D    OR    4
Raul M.    Grijalva    D    AZ    7
Chellie    Pingree    D    ME    1
John W.    Olver    D    MA    1
Bob    Filner    D    CA    51
Judy    Chu    D    CA    32
David E.    Price    D    NC    4
Donna    Edwards    D    MD    4
Paul    Tonko    D    NY    21
Jim    McDermott    D    WA    7
Keith M.    Ellison    D    MN    5

PCCC email to grassroots activists today:
———- Forwarded message ———-
From: Stephanie Taylor, BoldProgressives.org <info@boldprogressives.org>
Date: Tue, Dec 7, 2010 at 1:35 PM
Subject: No deal!

 
Last night, President Obama cut a deal with Republicans to extend tax cuts for the richest 2% — by borrowing billions from the next generation.
But for any deal to go through, Congress has to pass it. That’s where Rep. Peter Welch, Democrat from Vermont, comes in.
Rep. Welch wrote a letter last night saying NO to this deal and asking his fellow Representatives in the House to stand with him. Within minutes, many other Representatives added their name.
Can you call your Representative, Gabrielle Giffords, and ask her to sign the Welch letter and fight against this deal to give tax cuts to the rich? Click here for a number and a script.
I know we’ve been asking you to call Congress a lot recently, but your calls work — and this is a moment when many Representatives are deciding what to do. If Obama won’t fight, it’s up to us to make sure Congress acts.
Thanks for being a bold progressive,
Stephanie Taylor, Adam Green, Jason Rosenbaum, and the PCCC team
 
# # #Congressman Peter Welch
United States House of Representatives
 
 
FOR IMMEDIATE RELEASE
Monday, December 6, 2010
 
CONTACT:
Paul Heintz
202.226.8346 (o)
202.577.7970 (c)
 
Welch to White House: “Don’t Back Down”
       
As Obama announces deal, Welch calls it “fiscally irresponsible” and “grossly unfair”
 
WASHINGTON, DC – As President Obama took to the airwaves Monday night to announce a deal to extend the Bush tax cuts, Rep. Peter Welch (D-Vt.) called the plan “fiscally irresponsible” and “grossly unfair.”
 
In a letter to Speaker Pelosi that Welch circulated to his House colleagues Monday night, Welch wrote, “We support extending tax cuts in full to 98 percent of American taxpayers, as the President initially proposed. He should not back down. Nor should we.”
 
Welch will send the letter to Speaker Pelosi after gathering signatures from his colleagues on Tuesday. The full text of the letter is copied below.
       
 
Dear Madam Speaker,
 
We oppose acceding to Republican demands to extend the Bush tax cuts to millionaires and billionaires for two reasons.
 
First, it is fiscally irresponsible. Adding $700 billion to our national debt, as this proposal would do, handcuffs our ability to offer a balanced plan to achieve fiscal stability without a punishing effect on our current commitments, including Social Security and Medicare. 
 
Second, it is grossly unfair. This proposal will hurt, not help, the majority of Americans in the middle class and those working hard to get there. Even as Republicans seek to add $700 billion to our national debt, they oppose extending unemployment benefits to workers and resist COLA increases to seniors.
 
Without a doubt, the very same people who support this addition to our debt will oppose raising the debt ceiling to pay for it.
 
We support extending tax cuts in full to 98 percent of American taxpayers, as the President initially proposed. He should not back down. Nor should we.
 
Sincerely,
 
PETER WELCH
Member of Congress

Dear MoveOn member,

Last night, President Obama announced that he’s giving in to the GOP and extending the Bush tax breaks for the rich.1

The “deal” he’s proposing is an “absolute disaster,” as Senator Bernie Sanders said.2

But it’s not a done deal. Leading Democrat Chris Van Hollen said yesterday that “House Democrats have not signed off on any deal,” and last night Senator Sanders vowed to “do whatever I can to see that 60 votes are not acquired to pass this piece of legislation.”3

Senator Sanders and other progressives in the Senate are our best hope to stop this terrible deal. But Bernie can’t do it alone.

The clock’s ticking. Can you sign a petition today to leading progressives in the Senate—Sens. Feingold, Franken, Brown (OH), Boxer, Merkley, Whitehouse, Durbin, Harkin, and Schumer—urging them to stand up and use the filibuster to block this awful “deal”?

http://pol.moveon.org/no_bailout/?id=25405-524561-D7NcpSx&t=3

The petition says: “Sens. Feingold, Franken, Brown, Boxer, Merkley, Whitehouse, Durbin, Harkin, and Schumer: You are our progressive heroes and we need you now. Please join Sen. Bernie Sanders and do everything you can to block the ‘deal’ to extend the Bush tax bailout for millionaires.”

The deal President Obama agreed to with Republicans would extend the Bush tax breaks for the top 2% of earners for two years, extend unemployment insurance for 13 months, and cut the payroll tax for one year, among other things.4

Tomorrow, we’ll deliver your petition signatures to the Senate along with a visual message the Senate and news media can’t miss: a supply of cots and copies of the U.S. Constitution—the tried and true provisions of any good filibuster.

Congress and the White House need to see the incredible lack of support for this deal. And that lack of support is very real: an overnight survey of a random sample of MoveOn members found 4:1 in opposition, while a poll of Obama campaign donors found that a whopping 74% are opposed to President Obama’s deal.5

Strong opposition is no surprise, given what the deal really means: a tax break of an incredible $83,347 for the top 1% of earners in the U.S.—far more than most working Americans make in a year.6 And as Nobel Prize-winning economist Paul Krugman explains, a two-year millionaire bailout—the cornerstone of the deal—is just bad policy:

“First, temporary tax breaks for the rich are stunningly bad economic policy…[and a two-year extension] would still be much more expensive than measures like aid to the unemployed and to small businesses that would do far more for the economy, yet spent months held up in Congress because of alleged concerns about the deficit.”7

We can’t capitulate to the GOP on this terrible deal, and it’s up to progressive leaders in the Senate to stop it. Can you sign the petition right away?

http://pol.moveon.org/no_bailout/?id=25405-524561-D7NcpSx&t=4

Thanks for all you do.

–Nita, Amy, Wes, Kat, and the rest of the team

Sources:

1. “Liberals find Obama’s tax cut deal positively revolting,” The Sacramento Bee, December 6, 2010
http://www.moveon.org/r?r=205411&id=25405-524561-D7NcpSx&t=5

“Republicans achieve top goal in Obama tax-cut plan,” The Associated Press, December 7, 2010
http://www.moveon.org/r?r=205417&id=25405-524561-D7NcpSx&t=6

2. “Obama-GOP Tax Deal ‘an Absolute Disaster,’ Says Bernie Sanders, as Filibuster Talk Stirs,” The Nation, December 7, 2010
http://www.moveon.org/r?r=205413&id=25405-524561-D7NcpSx&t=7

3. “Liberals find Obama’s tax cut deal positively revolting,” The Sacramento Bee, December 6, 2010
http://www.moveon.org/r?r=205411&id=25405-524561-D7NcpSx&t=8

“Obama-GOP tax deal agitates Democrats,” The Seattle Times, December 7, 2010
http://www.moveon.org/r?r=205412&id=25405-524561-D7NcpSx&t=9

“Sen. Sanders Threatens To Filibuster Obama Tax Deal,” YouTube, December 6, 2010
http://www.youtube.com/watch?v=rAboE_ahSa4

4. “Deal Struck on Tax Package,” The Wall Street Journal, December 7, 2010
http://www.moveon.org/r?r=205416&id=25405-524561-D7NcpSx&t=10

5. “Poll: Obama supporters strongly opposed to deal extending Bush tax cuts,” The Washington Post, December 7, 2010
http://www.moveon.org/r?r=205414&id=25405-524561-D7NcpSx&t=11

6. “Richest Americans could buy a $83,000 Mercedes every year if Bush tax cuts extended, or light 800 pricey cigars with $100 bills,” The Raw Story, November 19, 2010
http://www.moveon.org/r?r=205415&id=25405-524561-D7NcpSx&t=12

7. “Tax cuts for the rich? No.” The New York Times, September 17, 2010
http://www.moveon.org/r?r=205214&id=25405-524561-D7NcpSx&t=13

_______________________________________________________________________________________________________

From Organizing for Amereica:Yesterday, the President announced the framework of a bipartisan agreement to extend a set of tax cuts that were set to expire, restore unemployment benefits for millions of Americans, and pass additional measures to help middle-class families and create jobs.Now, he’s recorded a video to speak directly to OFA supporters about the deal. Watch it here — and leave a note with your thoughts.

Watch the message from President Obama

This agreement, while not perfect, is vital to millions of Americans who are out of work through no fault of their own — as well as millions of middle-class families, students, parents, and small businesses.

Take a minute to watch his message — and then let us know what you think:
Thanks,
Mitch

Mitch Stewart
Director
Organizing for America

P.S. — The President will be talking with OFA supporters live tomorrow at 6:00 p.m. Eastern Time — sign up here for a reminder and instructions on how to listen in to the call.

Paid for by Organizing for America, a project of the Democratic National Committee — 430 South Capitol Street SE, Washington, D.C. 20003. This communication is not authorized by any candidate or candidate’s committee.

 

What some might call it a “deal” or “compromise” I would call capitulation to the Republicans.

Just as we do not negotiate with international terrorists, we must stand up to the political terrorism of the Republicans in the United States Senate.

At some point, the American people have to know what kind of people these Republicans are. They may never find out if the Republicans can force their view point on the Administration, splitting the Democratic Party.

The Republicans rant against the deficit, but they give billions, approaching trillions, of tax cuts to millionaires and billionaires.

Click here to contact Senate Majority Leader Harry Reid and Speaker Nancy Pelosi to thank them for speaking out against this issue and having the Democratic Party stand for something.

You can also call their offices:

Harry Reid
Senate Majority Leader
Washington DC: (202) 224-3542
Nevada: (702) 388-5020

Nancy Pelosi
Speaker of the House
Washington DC: (202) 225-0100
San Francisco: (415) 556-4862

Peace and friendship,

John Burton
Chair
California Democratic Party

Obama’s Hostage Deal

By PAUL KRUGMAN
Published: December 9, 2010

  

past couple of days trying to make my peace with the Obama-McConnell tax-cut deal. President Obama did, after all, extract more concessions than most of us expected.

Yet I remain deeply uneasy — not because I’m one of those “purists” Mr. Obama denounced on Tuesday but because this isn’t the end of the story. Specifically: Mr. Obama has bought the release of some hostages only by providing the G.O.P. with new hostages.

About the deal: Republicans got what they wanted — an extension of all the Bush tax cuts, including those for the wealthy. This part of the deal was bad all around. Yes, some of those tax cuts would be spent, boosting the economy to some extent. But a large part of the tax cuts, especially those for the wealthy, would not be spent, so the tax-cut extension increases the budget deficit a lot while doing little to reduce unemployment.

And by stringing things along, the extension increases the chances that the Bush tax cuts will be made permanent, with devastating effects on the budget and the long-term prospects for Social Security and Medicare.

In return for this bad stuff, Mr. Obama got a significant amount of short-term stimulus. Unemployment benefits were extended; there was a temporary cut in the payroll tax; and there were tax breaks for investment. Incidentally: how, exactly, did we get to the point where Democrats must plead with Republicans to accept lower corporate taxes?

Unemployment benefits aside, all of this is very much second-best policy: consumers would probably spend only part of the payroll tax break, and it’s unclear whether the business break would do much to spur investment given the excess capacity in the economy. Still, it would be a noticeable net positive for the economy next year.

But here’s the thing: while the bad stuff in the deal lasts for two years, the not-so-bad stuff expires at the end of 2011. This means that we’re talking about a boost to growth next year — but growth in 2012 that would actually be slower than in the absence of the deal.

This has big political implications. Political scientists tell us that voting is much more strongly affected by the economy’s direction in the year or less preceding an election than by how well the nation is doing in some absolute sense.

When Ronald Reagan ran for re-election in 1984, the unemployment rate was almost exactly the same as it had been just before the 1980 election — but because the economic trend in 1980 was down while the trend in 1984 was up, an unemployment rate that spelled defeat for Jimmy Carter translated into landslide victory for Reagan.

This political reality makes the tax deal a bad bargain for Democrats. Think of it this way: The deal essentially sets up 2011-2012 to be a repeat of 2009-2010. Once again, there would be initial benefits from the stimulus, and decent growth a year before the election. But as the stimulus faded, growth would tend to stall — and this stall would, once again, come in the months leading up to the election, with seriously negative consequences for Mr. Obama and his party.

You may say that economic policy shouldn’t be affected by partisan considerations. But even if you believe that — how’s the weather on your planet? — you have to consider the situation likely to prevail a year from now, as the good parts of the Obama-McConnell deal are about to expire. Wouldn’t there be pressure on Democrats to offer Republicans something, anything, to improve economic prospects for 2012? And wouldn’t that be a recipe for another bad deal?

Surely the answer to both questions is yes. And that means that Mr. Obama is, as I said, paying for the release of some hostages — getting an extension of unemployment benefits and some more stimulus — by giving Republicans new hostages, which they may well use to make new, destructive demands a year from now.

One big concern: Republicans may try using the prospect of a rise in the payroll tax to undermine Social Security finances.

Which brings me back to Mr. Obama’s press conference, where — showing much more passion than he seems able to muster against Republicans — he denounced purists on the left, who supposedly refuse to accept compromises in the national interest.

Well, concerns about the tax deal reflect realism, not purism: Mr. Obama is setting up another hostage situation a year down the road. And given that fact, the last thing we need is the kind of self-indulgent behavior he showed by lashing out at progressives who he feels aren’t giving him enough credit.

The point is that by seeming angrier at worried supporters than he is at the hostage-takers, Mr. Obama is already signaling weakness, giving Republicans every reason to believe that they can extract another ransom.

And they can be counted on to act accordingly.

A version of this op-ed appeared in print on December 10, 2010, on page A35 of the New York edition.

RE: [equal] Re: equal digest: December 14, 2010
From “Brian Stompe” <bkstompe@verizon.net>

Re the Estate Tax, why would anyone that’s dead object to being taxed?

We don’t want huge estates being passed down to create a wealthy class of

people.

Pass some on, but let’s create a class of “working people”.

Best,  Brian Stompe

Uncategorized

EQUAL Health Network: CALL FOR DIRECTION IN 2011

By ellenView Comments

At a gathering on November 21, 2010, a number of community partners who have been active with the EQUAL Health Network expressed our deep concerns regarding the future of health care reform and the political direction of the country more generally.  Our concerns included:

1. Misguided policies have widened social and economic inequality, eroding the middle class in the U.S. and shredding the financial security of millions.  A decade of the virtual abandonment of government oversight and accountability contributed significantly to the collapse of the financial sector, persistent high unemployment, record rates of home foreclosures and bankruptcies, and uncontrolled health care costs. Corporate-sponsored campaigns and corporate-dominated media attempt to falsely attribute responsibility for the economic crash to an overly intrusive government. This stands reality on its head and must be challenged.

2. Progress requires a political program that recognizes the central role of the government in generating an economic recovery.  Further tax breaks to wealthy individuals will not create jobs. Banks are now sitting on billions that they refuse to invest, while pursuing relentless and questionably legal home foreclosures. Substantial deficit spending is critical to regenerate demand and innovation. Demand will flow from employment in the public sector as well as programs such as extended unemployment benefits that provide cash to lower-income people who will spend it.  Public investment in education, health care and housing will help to renew innovation. It is vital to protect Medicare and Social Security from arbitrary cuts, both to protect people’s financial security and to reorient policy towards a more productive course.

3. The Obama Administration, elected on a wave of voter mobilization, has succeeded in enacting an historic health care reform law, as well as numerous other achievements. But it has yet to generate the momentum for an economic recovery, or the civic engagement that can achieve a political one.

We propose to organize our activities for the near future as follows:

1. We call for leadership at every level- among elected officials. community leaders, and advocacy organizations – to reinvigorate our vision of social justice and to reconnect with and mobilize the American public in our own self-interest, for financial security and the opportunity to improve our lives and communities.

2. We will aim to act as catalysts for the change we believe is necessary, and seek to create alliances with organizations and individuals who ascribe to similar beliefs and goals.

3. In the realm of health care reform, we commit to the following. 

a. Oppose and resist calls to repeal, delay and otherwise undermine the implementation of the Affordable Care Act.

b. Educate the public about the substantial benefits ensuing from the ACA, particularly the expansion of publicly-financed coverage, greater controls over administrative waste and excessive costs, protection from insurance company abuses, and improvements in the quality of care.

c. Implement the law to the benefit of the public, through campaigns on regulations and state laws.

d. Address and improve the shortcomings of the law, most significantly:

  • Cover abortion care and contraception the same as any other medical event.  Defuse the controversy over this issue and destigmatize the conversation.

 

  • Cover undocumented residents and all individuals for the costs of health care, as a matter of human rights, reciprocal fairness for the treatment of Americans abroad, and good public health practice.

 

  • Improve the affordability of health care.

 

  • Recognize and aim to replicate the success of all other economically developed nations and many developing nations at controlling health care costs by invoking the authority of the government to negotiate prices with powerful health care industries including drug companies, hospitals and health care  professionals.  This includes expanding the role of local initiatives to provide publicly-financed and publicly-provided health care services, as well as broader initiatives to create state-based single payer systems.

The EQUAL Health Network’s listserve will continue to disseminate news and opinion consistent with these views, and provide a discussion blog for debate on how best to achieve them.

Uncategorized

Moving Forward on Health Reform: Invitation to a Discussion

By ellenView Comments

Many are mad as hell this election season, including some progressives. Absent the funding of the madly rich and insanely right-wing Koch brothers, what are we to do?

For one thing, take a sober look at the policy and politics associated with the Affordable Care Act.

This is not the single payer system many staunch health care reform advocates – including me – preferred, but lacked the power to enact. As we continue the campaign for a single payer, it is essential to recognize, vigorously defend and advance the victories we achieved in the Affordable Care Act, in order to preserve the gains for people in need and also to shore up the valuable activists, and activism, we will need for what is going to be a long haul ahead.

Here’s what the ACA accomplishes, what single payer systems do, why we’re absolutely right to continue to advocate for them, and how we can shape policy to get there from here.

What does the ACA accomplish? The U.S. health care system will do a better job of treating illness and improving health at an affordable cost. The Medicare Trust Fund will be solvent for an additional 12 years, through 2029. There are substantial improvements for lower and middle income people, and immediate benefits for women, younger people, seniors and small businesses. Importantly, the ACA creates policy space to continue efforts to cover everyone while controlling costs, goals that are popular with the public. It accomplishes these objectives in part by imposing new progressive taxes and fees on the wealthiest 2% of the population and on employers.

Politically, the ACA opens opportunities to challenge corporate power at the national level, in the formation of extensive regulations. It throws some leverage to the states, which progressives can use to advance our goals of equitable, quality, universal, affordable health care.

The law includes compromises that call out for revision, particularly on affordability, and on coverage for immigrants and for reproductive health care. And the political process that got us here will be grist for analysis for decades to come.

But it is just not true, as some have characterized it, that the law is primarily a victory for business as usual by the insurance industry. Furthermore, the fight to undermine and defeat the law unquestionably empowers and invigorates the most predatory anti-government political and financial interests in the country. Since the facts don’t serve their agenda – to profit by destabilizing our social and financial security, including dismantling Medicare – they rely on hyperbole and distortion to mobilize the public’s complicity in opposing our own real best interests. In contrast, we can and must remain critical while carefully examining sweeping generalizations that don’t fit.

Single Payer: Getting There from Here

Single payer systems funnel all payments for health care to one collection point – usually a state or national government. This single payer then pays all the health care providers: doctors, hospitals, drug companies. There is overwhelming evidence that single payer systems are more cost-efficient and affordable, along with their many benefits for equity and quality of care.

This is different from our current system in at least two ways that are key to controlling health care costs.

• First, it is administratively efficient. It eliminates the middleman: the proliferation of private insurance companies that take a bite out of every health care dollar for the administrative service of paying the bills. These insurance companies, both for-profit and non-profit, now rake off about 30% or more of our insurance premiums, using ploys that at the same time restrict access to necessary health care and inflict great suffering on ailing humanity. They also add to the administrative burdens of doctors and hospitals.

• Secondly, it moderates prices. It gives a powerful negotiator – the government – the authority to negotiate prices with the health care industry: hospitals, doctors, medical supply companies, drug companies.

Largely for these reasons, single payer proposals are fiercely attacked, maligned and misrepresented and in all manner just blocked in the halls of power by the industry, which profits nicely from this mess.

The state and federal governments are now writing the rules for implementing the Affordable Care Act. Advocates can help to shape these rules to get us closer to administrative efficiency, and to expand the public sector’s purview over prices. Some examples:

• In 2014, new insurance Exchanges will standardize health insurance plans. People who buy insurance now as individuals or in small groups will be grouped into much larger pools, sharply reducing cost-shifting. Advocates have the opportunity to craft and support state laws implementing the exchanges that can push limits on standardizing health plans and require financial transparency.

• The law sharply expands the number of people covered by public sector health plans. For the first time Medicaid will cover everyone under 133% of the federal poverty level, regardless of health status. State governments already do negotiate drug prices under Medicaid, in which enrollment will grow by almost half by 2014. State laws to adopt a public option would further expand the number of people who receive health care either paid for or provided directly by the public sector.

• There are numerous opportunities to regulate, review and otherwise limit premiums, depending on the rules adopted by HHS, and state implementation laws. The current policy debate on how to define and enforce the Medical Loss Ratio is an important example.

• The law also draws on the public’s control over Medicare to address some of the underlying drivers of increasing health costs through new measures such as comparative effectiveness research and payment reforms to encourage more cost-effective delivery systems. It also expands primary care and public health.

• Finally, as soon as 2017 – maybe sooner – there is a defined process for states to prepare for and enact alternative systems, including single payer.

The corporate media surround us with messages – and messengers – that exhort us to succumb to cynicism (nothing will ever work, they’ll always sell us out). Voluntarily taking ourselves out of the real health care fights of the day is tantamount to capitulation. Effective strategies for building the power we need will require and emerge from engagement as well as resistance. Advocates can rebuild public awareness and momentum for single payer systems, and at the same time support legislation and regulations that maximize the progressive aspects of the ACA. If done well, our work on the ACA will build the pathways we need to a single payer system.

Uncategorized

from John Iversen on Pacifica/WBAI

By ellenView Comments

A response to FB friend Kirsten Thomas of KPFA who asked for my opinion:  AIDS-denialism is part of a larger plot to destroy the Pacifica Network in my humble, shade of gray opinion:
ellen i’m on a mac, hopefully you can translate this to PC so every fourth word is not an asterick or something:)
Kirsten, here are my comments after listening: feel free to disseminate, but correct any typos, I am not perfect!
this is John Iversen, an activist for 40 years who has recieved over 20 community awards including East Bay Express Activist of the year, Bay Guardian Local Hero-1993, first Olympic torch relay carrier with AIDS, social worker of the year , Bsoton 1979, some award from the Episcopal Chruch  Madison WI, member of Minnesota Chippewa Tribe/Bos Forte at Nett Lake, only person to receive a lifetime achievemnet award for AIDS work from Alameda County, Wounded Knee veteran 1973 (inside for 7 weeks) co-founde Berkeley Needle Excahnge, ACT UP East Bay, HealthNet AIDS patients union,Black Panther Party Defense Committee after the murders of Fred Hampton/Mark Clark.  I never earned over $25 K per year.  My Berkeley jobs were Dir of YMCA New Light Senior Center and a PT aide to Maudelle Shirek, former member of SEIU  535, 505, 209 (maybe 219) and Steelworkers 5296.  Recieved a college scolarship from Local 5296 in Silver Bay, Minn. My brother is on the Duluith Labor Council, a former Two Harbors City Councilmember for 20 years and one of Paul Wellstone’s 5 rank n file labor advisors. My brother campaigneed for Wellstone and Wellstone returned the favor. My parents were both active in unions, cooperatives, community health centers–Mom was on the Board of the first community clinic in the country-Two Harbors, Minn (NY times article in 1947)  She was recently honored at age 90 by our tribe-google Alice Iversen, Bois Forte a a page and one-third in our Band’s monthly paper. One opf my grandfathers was in the IWW and even in their marching band in Kellogg Idaho, my other grandfather was a potato farmer from French-Canadian Prince Edward Island who moved to Duluth and became an ironworker.  My indigenous grandmother had six kids and stayed at home in Duluth.  My Norwegian grandmother and my father came to the Duluth when they were 25 and 3 repectivley.
My IWW grandfather died in a plague in 1920. My grandmother supported herself and my dad by going out in a boat by herself with nets, noirth of the Arctic Circle.  Duluth must have seemed like Miami to them.  So my working class roots are deep, part of me has been in Northamerica forever and other parts recently arrived. I also come from a reigiously mixed family, dad a Lutheran, mom a Catholic-almost unheard of in the 50s in my hometown.
I think there ar few who’ve done more on the left on a volunteer basis as I have.  And I was not doing it to pad my resume, like many HIV negative people who now have jobs with AIDS Inc.  If you can top me on voluteering for the left and wanna talk, I am willing to listen, but actions do speak louder than words. I fully support SAVEKPFA.  so replacements (not the great Minneapolis band): Walter Tuner, Davey D, Sasha Lily (sp), bringing back Chris n Philip, Mitch Jesserich (sp), Glenn Reeder, Bonnie Simmons, Eric Larsen from KALW.  Arlene = Surely Mean. silence = Death. kpfa under attack, what do we do? ACT UP Fight Back! and by the way, i’ve only touched on a few of my left actions.  I am an internationally known AIDS actiivst and former board member of HealthGap.
Also it is no coincidence that days after Brian n Aimee were fired, Doug Henwood’s hours were cut at WBAI, and WBAI gave it’s weekday noon to 1 slot to aids denialist and vitamin entreprenuer, Gary Null, who has rich friends who are donating  $$ to cash-strapped WBAI.  As a musician , Pay to Play is an old concept, much hated, now it has come to the air of Pacifica.  Something’s happening here and you don’t know what it is, do you Mr. Jones (btw born in the same hospital, maybe delivered by the same doctor as the man i just quoted.  Arlene if you have the power toi fire Brian and Aimee, you have the pwer to fire ro stop the half-truths of Gary Null at WBAI. I think I’ve made my point!  Kirsten, Mitch and all–DON’T GIVE UP THE SHIP! and everyone else, I urge you to follow Mitch and Kirsten on Facebook because they are the truth tellers and not in it for themselves or to grind a particular political axe. That said, maybe Kirsten and Mitch for morning show hosts, but Brian’s seniority rights seem to have been violated by Arlene who makes $90,000/ year.  I think only real criticism of paid staff can come from those earning their average salary of $24-25K per year.  To have a retired doctor refer to good people like Mitch, Kirsten, Chris and Philip as “exclusivists” is childish nonsense and classist!  My humble opinion that I hope is worth two cents–John Iversen

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