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If the Supreme Court Goes Rogue April 1, 2012

Posted by rogerhollander in Constitution, Health.
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ROGER’S COMMENT: HOW IRONIC!  NOW IT COMES FROM THE LIBERAL LEFT, ACCUSING THE JUDICIARY OF LEGISLATING.  THIS HAS BEEN THE PROVINCE OF THE RIGHT, MOST NOTABLY IS THE WARREN COURT’S DESEGREGATION  DECISION, BROWN VS. THE BOARD OF EDUCATION OF TOPEKA, KANSAS.  WHAT THE AUTHOR OF THE POSTED ARTICLE FAILS TO RECOGNIZE IS THAT CONSTITUTIONS AND SUPREME COURT DECISIONS ASIDE, LAWS ARE MADE AND INTERPRETED BY HUMAN BEINGS AND THERE IS NO FAIL SAFE APART FROM GENUINE DEMOCRACY, WHICH IS IMPOSSIBLE IN A CAPITALIST WORLD.  I ONCE HEARD A TALK GIVEN BY LEGENDARY CIVIL RIGHTS LAWYER, WILLIAM KUNTSLER, WHO POINTED OUT THAT ALL MAJOR STATE CRIMES IN HISTORY, FROM THE DEATHS OF SOCRATES AND JESUS TO THE NAZI HOLOCAUST, WERE CARRIED OUT “LEGALLY.”  FOR MORE ON THIS SEE MY ESSAY: THE CONSTITUTION IS UNCONSTITUTIONAL (http://rogerhollander.wordpress.com/category/rogers-archived-writing/political-essays-roger/the-constitution-is-unconstitutional/)
AN ADDITIONAL IRONY: SINCE THE OBAMA HEALTH CARE PLAN IS ESSENTIALLY A REPUBLICAN ORIENTED PROJECT IN THAT IT IS A HUGE GIFT TO THE PRIVATE HEALTH CARE INDUSTRY, THE SUPREME COURT REPUBLICANS NEEDS TO DECIDE IF IT IS MORE IMPORTANT TO GIVE OBAMA A HUGE POLITICAL DEFEAT RATHER THAN SUSTAIN WHAT THEY IDEOLOGICALLY WOULD OTHERWISE NORMALLY ACCEPT.
Published on Sunday, April 1, 2012 by Consortium News

by  Sam Parry

What happens to a Republic under a written Constitution if a majority of the Supreme Court, which is empowered to interpret that Constitution, goes rogue? What if the court’s majority simply ignores the wording of the founding document and makes up the law to serve some partisan end? Does that, in effect, turn the country into a lawless state where raw power can muscle aside the democratic process?

Chief Justice John Roberts

Something very much like that could be happening if the Supreme Court’s five Republicans continue on their apparent path to strike down the individual mandate at the heart of the Affordable Care Act. In doing so, they will be rewriting the Constitution’s key Commerce Clause and thus reshaping America’s system of government by fiat, rather than by the prescribed method of making such changes through the amendment process.

And the word “regulate” means today what it meant then, as was noted in a Nov. 8, 2011, ruling written by Judge Laurence Silberman, a senior judge on the U.S. Court of Appeals for the District of Columbia Circuit, a conservative appointee of President Ronald Reagan.The plain text of the Commerce Clause – Article 1, Section 8, Clause 3 – is so straightforward that a middle-school child should be able to understand it. Here it is: “Congress shall have Power… to regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.”

In upholding the individual mandate as constitutional, Silberman wrote: “At the time the Constitution was fashioned, to ‘regulate’ meant, as it does now, ‘[t]o adjust by rule or method,’ as well as ‘[t]o direct.’ To ‘direct,’ in turn, included ‘[t]o prescribe certain measure[s]; to mark out a certain course,’ and ‘[t]o order; to command.’ In other words, to ‘regulate’ can mean to require action.”

So, for the individual mandate to clear the Commerce Clause hurdle it must be a regulation of commerce among the states. Everyone agrees that health care and health insurance are interstate markets. Check. Everyone also agrees that health care and health insurance are commerce. Check. There’s also no dispute that the individual mandate is a form of regulation. Check.

Judge Silberman went through the same check list and concluded that there was “no textual support” in the Constitution for striking down the individual mandate because the word “regulate” has always included the power to compel people to act.

But the law’s opponents insist that the individual mandate is a unique and improper form of regulation because it forces an American to do something that the person might not want to do it, i.e. go into the private market and buy health insurance.

Yet, in other enumerated powers, this idea of Congress having the power to compel people to act is widely accepted. Take, for example, the draft. While there is not currently a draft, there has been at many points in U.S. history and even now every male citizen, when he turns 18, is required to register for selective service. And, should the draft come back and should you get drafted, you would be legally compelled to serve.

If compelling individuals to risk their lives in war is an accepted use of congressional authority, it is hard to see the logic in striking down the power of Congress to compel individuals to get health insurance.

Washington and Madison

And, despite what the Affordable Care Act’s critics have said repeatedly, this is not the first time the federal government has ordered Americans to buy a private product.

Indeed, just four years after the Constitution’s ratification, the second U.S. Congress passed the Militia Acts of 1792, which were signed into law by President George Washington. The militia law ordered white men of fighting age to arm themselves with a musket, bayonet and belt, two spare flints, a cartridge box with 24 bullets and a knapsack so they could participate in militias.

If one wants to gauge whether a mandate to buy a private product violates the original intent of the Framers, one probably can’t do better than applying the thinking of George Washington, who presided at the Constitutional Convention in 1787, and James Madison, the Constitution’s architect who served in the Second Congress and argued for the militia law. [For more, see Consortiumnews.com’s “Madison: Father of the Commerce Clause.”]

So, it would seem to be a rather clear-cut constitutional case. Whether one likes the Affordable Care Act or not, it appears to fall well within the Constitution and historical precedents. By the way, that’s also the view of Ronald Reagan’s Solicitor General Charles Fried who said this in a March 28 interview:

“Now, is it within the power of Congress? Well, the power of Congress is to regulate interstate commerce. Is health care commerce among the states? Nobody except maybe Clarence Thomas doubts that. So health care is interstate commerce. Is this a regulation of it? Yes. End of story.”

However, if Chief Justice John Roberts and the Court’s four other Republicans go in the direction they signaled during oral arguments and strike down the individual mandate, they will not merely be making minor clarifications to the noun “commerce” and the adjective “interstate” — as the Court has done previously — but they will be revising the definition of the verb “regulate” and thus substantially editing the Constitution.

Amendment Process

When it comes to editing the Constitution, there is a detailed process spelled out for how you do that. It’s in Article 5 of the Constitution and it’s called the amendment process – something in which the Judicial Branch plays absolutely no role. The process for revising the founding document requires votes by two-thirds of both the House and the Senate and the approval of three-quarters of the states.

Besides representing an affront to the nation’s constitutional system, an end-run by a narrow majority of the Supreme Court taking upon itself to rewrite an important section of the Constitution would drastically alter the balance among the three branches of government.

Such an action would fly in the face of the longstanding principle in constitutional cases that the Supreme Court should give deference to legislation passed by the government’s Legislative Branch and signed into law by the President as chief of the Executive Branch. Under that tradition, the Judicial Branch starts with the assumption that the other two branches have acted constitutionally.

The burden of proof, therefore, should not be on the government to prove that the Constitution permits a law – but rather on the plaintiffs to demonstrate how a law is unconstitutional.

Yet, during oral arguments this week, Republican justices pressed the government to prove that the Affordable Care Act was constitutional and even demanded that Solicitor General Donald B. Verrilli Jr. put forward a limiting principle to the Commerce Clause – to speculate about what couldn’t be done under that power.

Justice Anthony Kennedy several times raised the point that the individual mandate changes the relationship between citizens and the federal government in, as he put it, “fundamental ways” and thus the government needed to offer a powerful justification. In his questions, however, it was not entirely clear why Kennedy thought this, given the fact that Congress has previously enacted many mandates, including requirements to contribute money to Social Security and Medicare.

In the March 28 interview, former Solicitor General Fried took issue with Kennedy’s question about this “fundamental” change, calling the line “an appalling piece of phony rhetoric” and dismissing it as “Kennedy’s Tea Party-like argument.”

Fried noted that Social Security in the 1930s and Medicare in the 1960s indeed were major changes in the relationship between the government and the citizenry, “but this? This is simply a rounding out in a particular area of a relation between the citizen and the government that’s been around for 70 years.”

On policy substance as well as on constitutional principle, Fried was baffled by the Republican justices’ opposition to the law, saying: “I’ve never understood why regulating by making people go buy something is somehow more intrusive than regulating by making them pay taxes and then giving it to them. I don’t get it.”

A Noble Rationale

But Kennedy seemed to be fishing for some noble-sounding rationale for striking down the individual mandate. He was backed up by Justice Antonin Scalia who proffered the peculiar argument that if Congress could mandate the purchase of health care, why couldn’t it require people to buy broccoli – as if any outlandish hypothetical regarding congressional use of the Commerce Clause disqualifies all uses of the Commerce Clause.

This line of reasoning by the Republican justices also ignored the point that the Court’s role is not to conjure up reasons to strike down a law, but rather to make a straightforward assessment of whether the individual mandate represents a regulation of interstate commerce and is thus constitutional.

In searching for a rationale to strike down the law, the Court’s Republicans also ignored the true limiting principle of any act of Congress – the ballot box. If any congressional majority were crazy enough to mandate the purchase of broccoli, the voters could throw that bunch out and vote in representatives who could then reverse the law.

In the case of the Affordable Care Act, Democrats won Election 2008, in part, because they promised the voters to tackle the crisis in U.S. health care. If the voters don’t like what was done, they can vote the Democrats out of office in November. The pendulum of democracy can always undo or modify any law through legislative action.

However, what the Republican majority on the Supreme Court seems to be angling toward is a radical change in the longstanding principles behind the Constitution’s checks and balances. The five justices would bestow upon themselves the power to not only undo legislation, which has been lawfully enacted by Congress and signed by the President, but to rewrite the founding document itself.

© 2012 Consortium News

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Sam Parry

Sam Parry is co-author of Neck Deep: The Disastrous Presidency of George W. Bush. He has worked in the environmental movement, including as a grassroots organizer, communications associate, and on the Sierra Club’s and Amnesty International’s joint Human Rights and the Environment campaign. He currently works for Environmental Defense Fund.

Sleazy California Democratd on Health Reform February 6, 2012

Posted by rogerhollander in California, Democracy, Health.
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Roger’s note: this is an excerpt from an email I received from activist.thepen@gmail.com.  It describes the machinations of the California Democratic Party in appearing to support a single payer health insurance plan while at the same time behind the scenes doing everything it can to ensure that it DOESN’T come to pass.  In the seven years I spend on the Toronto municipal council, I saw this kind of hypocrisy in action time and time again.  What they did in California is a classical example of this tactic, and the pen activists captured it perfectly and are to be congratulated for the exposé.  And one more example of why electoral politics (as opposed to taking to the streets) is for the most part futile.

As you know, if you have been a participant of this distribution list for a while, we have been valiantly advocating for a single payer health care system for many years. Such a bill (SB 840) was passed by both chambers of the CA state legislature in 2006, but the bill was vetoed by Governor Maid Molester (Schwarzenegger).
At the time we TRIED to get the Democratic nominee Phil Angelides (who had previously claimed to support single payer) to do an action to demand that Arnold sign the bill. It would have been a great campaign issue for him, but he was too chicken hearted or corrupt himself (your choice) to do it, and he lost by 30 points or something like that.

The same bill passed in 2008 and was vetoed again.

Now fast forward the clock to last week, when single payer
(renumbered SB 810) was again in front of the CA Senate, but now with a Democratic governor, Jerry Brown, who would be expected to sign the bill. All of a sudden four Democratic senators refused to even vote at all. That’s right, folks, they ABSTAINED, which is being in the room for the vote and refusing to cast a vote one way or another. At least three of these abstainers had voted “Yes” for single payer the last time.
So we cranked out a targeted action aimed only at these turncoat abstainers and have good information they got LOTS of phone calls for them to reconsider. But reconsideration never happened. So what’s really going on here? Here’s what the sponsor of the bill, Mark Leno, said on the Thom Hartmann show when gently challenged on why previous supporters were now abstaining.
“Arnold Schwartzeneggar was always going to veto the bill, so if one
had an interest in not ruffling the feathers of the insurance industry, the possibility is to vote for it with the wink of the eye that it’s not going anywhere anyway.”
In Greek mythology, Tantalus as his eternal punishment was cursed to stand in a pool of water underneath a fruit tree with low hanging branches always just out of reach, with the water always receding before he could take a drink. THAT is the very image of what the
Democratic party has become for the interests of the people who consider themselves constituents. It’s all a scam, folks, just one great, big, giant, honking scam.
This is essentially the same thing that happened in 2010 with that phony baloney health care bill, with a bottom line of nothing but pig grease for the medical insurance corporations. After lulling people
along for almost a year with the promise of a “public option”, itself a feeble impersonation of single payer, they refused to even allow a vote on it. In the end, having been forced to pass the bill using a reconciliation gimmick requiring only 51 votes, and 51 Democratic senators on record as supporting the so-called public option, they simply REFUSED to bring it up for a vote, even though they had the votes to do.
And the worst thing about it is that even the so-called good guys are in on it. Mark Leno, the sponsor of SB 810, KNOWS it will never pass, that the vote will always be manipulated so it falls just short in some way. The only reason for him to bring the bill up at all is to CON his own constituents into thinking he’s on their side, otherwise he would be vociferously calling out these abstainer traitors, not accidentally spilling the beans as he did. It’s nothing but a cynical PR stunt, and they are ALL in on it. No matter how many Democrats we vote for, till the end of all eternity, they will always find some way to fail to pass single payer health care.

One Montana County’s Medicare-for-All Coverage June 28, 2011

Posted by rogerhollander in Health, Montana.
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Published on Tuesday, June 28, 2011 by OtherWords

As the Ryan Republicans try to destroy Medicare, here’s a prescription to clean up the whole mess.

  by  Kay Tillow

Back when he presided over the Senate’s health care reform debate, Max Baucus, chairman of the all-powerful Senate Finance Committee, had said everything was on the table — except for single-payer universal health care. When doctors, nurses, and others rose in his hearing to insist that single payer be included in the debate, the Montana Democrat had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”

Yet when Baucus needed a solution to a catastrophic health disaster in Libby, Montana and surrounding Lincoln County, he turned to the nation’s single-payer healthcare system, Medicare, to solve the problem.

You see, a vermiculite mine had spread deadly airborne asbestos that killed hundreds and sickened thousands in Libby and northwest Montana. W.R. Grace & Co., which owned the mine, denied its connection to the outbreaks of mesothelioma and asbestosis and dodged responsibility for this disaster. The federal government got stuck with most of the tab for the cleanup costs, and the EPA has issued a first-of-its-kind order declaring Lincoln County a public health disaster.

When all lawsuits and legal avenues failed, Baucus turned to Medicare.

The single-payer plan that Baucus kept off the table in 2009 is now very much on the table in Libby. It turns out that Baucus quietly inserted a section into the Affordable Care Act that covers the suffering people of Libby, Montana. Medicare covers the whole community, not just the former miners.

Residents of Libby don’t have to be 65 years old or more. They don’t have to wait until 2014 for the state exchanges. There’s no 10-year roll out for them — it’s immediate. They don’t have to purchase a plan — this isn’t a buy-in to Medicare. It’s free. They don’t have to be disabled for two years before they apply. They don’t have to go without care for three years until Medicaid expands. They don’t have to meet income tests. They don’t have to apply for a subsidy or pay a fine for failure to buy insurance. They don’t have to hope that the market will make a plan affordable or hide their pre-existing conditions. They don’t have to find a job that provides coverage.

Baucus simply inserted a clause into the health care reform law to make special arrangements for them in Medicare.

No one should begrudge the people of Lincoln County, where toxic mine waste was used as soil additives, home insulation, and even spread on the running tracks at local schools. Miners brought carcinogens home on their clothes.

“The people of Libby have been poisoned and have been dying for more than a decade,” Baucus explained in a New York Times interview. “New residents continue to get sick all the time. Public health tragedies like this could happen in any town in America. We need this type of mechanism to help people when they need it most.”

But health tragedies are happening in every American town. Over 51 million have no insurance. and over 45,000 uninsured people die needlessly each year. Employers are cutting coverage and dropping plans. States in economic crisis are slashing both Medicaid and their employees’ plans.

Nothing in Obama’s health care law will mitigate the skyrocketing costs. More than half of us, including tens of millions of insured Americans, now go without necessary care. As Baucus said of Medicare, “We need this mechanism to help people when they need it most.” We all need it now.

So as the Ryan Republicans try to destroy Medicare and far too many Democrats use the deficit excuse to suggest other ways to tear the social safety net apart, Libby offers a prescription to clean up the whole mess. Only single-payer universal health care — improved Medicare for all — can save and protect Medicare, rein in skyrocketing health care costs, and give us universal coverage.

Medicare was implemented within less than a year of its 1965 passage. When Congress passes a national single-payer bill, we can all be enrolled in the twinkling of an eye.

A longer version of this commentary first appeared on Firedoglake.

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Kay Tillow

Kay Tillow is the coordinator of the All Unions Committee for Single Payer Health Care, which builds union support for H.R. 676. She lives in Louisville, Kentucky. www.unionsforsinglepayer.org

James Verone Robs Bank For Jail Health Care June 21, 2011

Posted by rogerhollander in Health.
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James Verone said he walked up to a teller at a Gastonia, N.C. bank and handed her a note.

It said “This is a bank robbery, please only give me one dollar.” Verone then told the teller he’d be sitting in a nearby chair, waiting for the police.

The 59-year-old said he did everything he could to get caught so he could receive free health care in jail.

Verone has a growth on his chest, two ruptured disks and a problem with his left foot. With no job, Verone thought his desperate plan was the best way to provide for himself.

Verone was charged with larceny.

Courtney Boyd Myers at The Next Web notes Verone’s plot provides clear evidence of a flawed medical system.

“As his fellow American, I have to say, our national health care is in a very sad state,” Myers writes.

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Though Verone said he’s receiving good care in jail, Slate previously reported that health care in prison is at best as good as a low-income health plan and at worst, almost nonexistent.

From Slate:

The majority of ailments are treated on-site, but inmates who are gravely ill can be taken to the nearest hospital. Sick prisoners must make a nominal co-payment for each visit to the jailhouse doctor—usually $5 or so, taken from an hourly wage that typically runs between 19 cents and 40 cents an hour. Costs above that are covered by the state.

It’s been more then a year since President Obama signed landmark health care reform legislation. The bill was designed to provide health insurance to millions of Americans who currently lack it. But one year later, the number of uninsured remains roughly the same. That’s largely because most of the bill’s major elements aren’t due to be implemented for another three years.

This month, Republican governors fought against federal rules requiring states to maintain current levels of health-care coverage for the poor and disabled.

There is also an effort, spearheaded by Rep. Paul Ryan (R-Wisconsin) to change Medicare from a government run program to a voucher system. Critics of the plan said it would mean seniors would have to pay more out of pocket for care.

Late last week, AARP, a powerful lobbying group for older Americans, said it was open to cuts in Social Security benefits.

Verone’s plan was to go to jail for three years, then be released in time to start collecting Social Security.

Vt. Senate gives final nod to universal health care bill in 21-9 vote April 30, 2011

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Roger’s note:  I confess that I don’t understand the ins and outs of Obama’s Byzantine insurance industry dominated health care legislation, or how a Vermont single payer universal coverage plan can occur in that context.  As a Canadian, however, I cannot but think of Tommy Douglas.  Tommy Douglas was a clergyman and an unrepentant socialist who happened to be the Premier of the Canadian Province of Saskatchewan in the 1950s.  Against massive resistance and fears of economic collapse, he introduced universal health care into the province, which became the catalyst for its adoption by the entire country.  The domino theory at work.  Do Canadians value their system of single payer universal health insurance?   Would they support going back to private health care?  In 2004 the CBC polled Canadians on who what the greatest Canadian of all time.  Tommy Douglas won hands down.  We can only hope that what the governor and senate have now accomplished in Vermont will be more than symbolic, that it will introduce genuine universal coverage where no one is left unprotected and health care costs come under control through the limitation of windfall profits by private insurers.  Americans will then see what they are missing and demand single payer universal health care on a national basis.  I love what Dr. Richter said: You go for what you want, not for what you think you might get – that’s what the bill does.  Would that that great advocate of change you can believe in, Barack Obama, had had the courage to do just that instead of compromising the principled position of universal care from the very beginning of the congressional process.

by Anne Galloway | April 27, 2011

In a historic vote on Tuesday, the Vermont Legislature created the enabling legislation for a first-in-the-nation universal health care system. The state Senate approved the visionary plan for a single-payer system in a 21-9 vote after four hours of debate. The split was largely along party lines.

Gov. Peter Shumlin, a Democrat, campaigned on a promise to create a single-payer system in Vermont that would contain health care costs and give all of the state’s residents universal access to medical care. On Tuesday, Shumlin made good on the first step toward fulfilling that promise, and just five hours after the Senate vote, he marked the legislative victory in an appearance on MSNBC’s “The Rachel Maddow Show.”

Shumlin said in a statement to the Vermont press: “Today the Legislature took a huge step toward making Vermont the first state in the first in the nation to control skyrocketing health care costs and remove the burden of providing health care coverage from small business owners. This bill is good for Vermonters and Vermont businesses.

Many Vermont businesses, however, believe otherwise. Though small employers have said they will benefit, some larger employers actively lobbied against the bill. Opponents of H.202 argued that the legislation would leave businesses in the lurch during the transition period between 2013 and 2014 when the state is required under federal law to participate in insurance exchanges. The opposition was led by insurance brokers (the Fleischer Jacobs Group, Business Resource Specialists), business associations (Vermont Chamber of Commerce, Vermont Grocers’ Association and Vermont Retailers Association), large employers (Dealer.com, Biotek, Rhino Foods and IBM). The Senate debate on Monday and Tuesday centered on changes to the legislation that would have made it more palatable to these groups.

Sen. Vince Illuzzi, R/D-Essex Orleans, who proposed two amendments that would have made the bill more business friendly, said companies are afraid “we will end up with a plan most won’t be able to afford.”

The legislation sets the state’s health care system on a new trajectory. Instead of continuing to use an insurance model for covering the cost of care, the bill moves the state toward an integrated payment system that would be controlled by a quasi judicial board and administered by a third party entity. The system would be funded through a broad-based tax.

The universal health care system would be implemented in 2014, if it clears 10 very high hurdles, including the receipt of a federal waiver. Otherwise it wouldn’t kick in until 2017.

Longtime single-payer advocate Dr. Deb Richter was ecstatic about the Senate passage of the bill.

“I’m absolutely thrilled,” Richter said. “It’s one of the best days of my life. I’ve given 400 speeches over the last 10 years and it feels like the work was worth it. We have a ways to go, but this is a step in the right direction.”

A universal health care system is the only way to cover everyone and contain costs, Richter said.

The passage of H.202 marks the first time any state in the country has attempted to provide universal care and a cost containment system that addresses administrative costs, hospital budgeting and uniform payments to doctors, Richter said.

Whether the federal government will give Vermont a waiver to adopt a universal health care system in 2014 is an open question. Richter said the state has a 50-50 chance of getting the exemption from the Affordable Care Act. Even so, she believes Vermont’s attempt to create a single-payer system is worthwhile.

“You go for what you want, not for what you think you might get – that’s what the bill does,” Richter said.

The Senate debate focused on the state’s implementation of the insurance exchanges that are required under federal law. The Affordable Care Act has mandated that states provide an actuarial value for insurance products (the insurance equivalent of a per unit price mechanism that allows consumers to compare the cost of on the shelf grocery items). The federal government has set up very general guidelines for the actuarial levels for insurance products insurers must provide under the exchange. The idea is to create an easy system for comparison between health insurance benefit plans that offer a dizzying array of deductibles, co-insurance, co-pays and premiums. The products, under the federal requirements, range from bronze (60 percent actuarial value) to silver (70 percent), gold (80 percent) and platinum (90 percent). It also puts minimum requirements on the “qualifying plans.” Many of these mandates are already in Vermont law. Insurers, for example, are not allowed to “cherry pick” consumers who are healthy and create pools without a cross-section of the sick and healthy populations.

Read this summary of the ACA requirements from Kaiser Foundation.

The Affordable Care Act requires individuals without insurance to buy into the exchange or face a $695 fine. Families of four with incomes of less than $88,700 qualify for tax credits. Businesses with more than 50 employees that do not buy insurance face a penalty of $2,000 per worker.

The fight between employers and proponents of H.202 was about the potential for mandatory inclusion of businesses that have between 50 and 100 workers in the exchange. Sens. Hinda Miller, D-Chittenden, and Illuzzi argued that requiring companies of that size to participate in the exchange could jeopardize their economic viability. Employers in that range tend not to self-insure and so are not protected under the Employee Retirement Income Security Act.

The federal law allows states some flexibility. States can decide what benefit plan levels can be offered, for example. They can also determine the size of the businesses that must be included in the exchange. The Shumlin administration pushed for intent language in the bill that could have led to the inclusion of businesses with 50 to 100 employees into the exchange. Proponents of H.202 have said it’s important to include these 28,000 workers in the state’s insurance exchange in order to build toward a single-payer system.

An amendment proposed by Sen. Diane Snelling, R-Chittenden, and approved by the Senate struck the intent language. The Green Mountain Care board, which will oversee the health care reform effort including the exchanges, is charged with producing a report that would outline the impact of excluding the 50-100 employee group on the exchange, which the Shumlin administration wants to use as a stepping stone toward the single-payer system.

Illuzzi proposed two amendments that would have forced the state to include a broader array of insurance carriers in the exchange, would have specifically allowed health savings accounts and high deductible plans under the exchange and would have allowed “nonqualified” plans outside the exchange. H.202 allows for two carriers.

“Let’s not kid ourselves it will be more than one carrier,” Illuzzi said on the Senate floor. “It will likely be Blue Cross Blue Shield. It will be two carriers in name only. Both will be required to offer same (plans). It will be a change without a difference.”

Anya Rader Wallack, Shumlin’s special assistant on health care, said she was impressed by the Legislature.

“A lot of people worked very hard educating themselves in a short period of time,” Wallack said. “This isn’t simple stuff. I was impressed with the amount of effort both bodies have put into this.”

The Shumlin administration was heavily involved in drafting the bill, H.202. By the time the legislation reached final passage it had changed somewhat from its original incarnation, which was based in part on recommendations from Professor William Hsiao, the renowned Harvard economist who created a single payer system for Taiwan.

Sen. Claire Ayer talks with Anya Rader Wallack and Robin Lunge before Monday's session. VTD/Josh LarkinSen. Claire Ayer talks with Anya Rader Wallack and Robin Lunge before Monday’s session. VTD/Josh Larkin

Over the next year, the Shumlin administration will hire a director of health care reform and the chair of a quasi-judicial board. The board would be in place by January 2012 and would begin the arduous task of sorting through the maze of federal laws, waivers, benefits, provider reimbursements, system financing and cost containment options.

H.202 will be read in the House Health Care Committee on Wednesday morning. Rep. Mark Larson, D-Burlington, said he expects the bill will go to conference committee in several days. He expects to have no major beefs with the Senate version.

“The core composition of the bill remains identical to what passed in the House,” Larson said. “There are differences between the two bills but they are things we can work out.”

Larson said those details include a change in the dynamic of the board. “We want to make sure it’s an independent board.”

He also referred to the so-called “Mullin” amendment, which set conditions for implementation of Green Mountain Care, the single-payer style system that would be created under H.202. Larson said he thinks the new criteria for the implementation standards need to be more clearly defined.

“It has to be clear what hurdle has to be overcome,” Larson said.

Vermont House Passes Single-Payer Health Care Bill March 27, 2011

Posted by rogerhollander in Canada, Health.
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(Roger’s note: Vermont’s state legislature taking this bold step brings to mind Canada’s revered Tommy Douglas, when his leadership led to the passing of a single payer plan in the Province of Saskatchewan in 1962.  This turned out to be the domino that that began the overwhelming popular drive for Canadian national health care, and which led to the passing of Canada’s single payer universal coverage national health plan.  But that was then and this is now.  Today in the United States the giant blood-sucking private health insurance and pharmaceutical industries virtually own a gutless president and the majority of legislators in both pathetic political parties.  This was evidenced in the debate that led to the passing of the Obama health legislation last year, a debate in which a public plan or single payer plan was off the table from the beginning; and where the Democratic members of the House who were considered the most progressive and principled caved in the end and supported legislation that enshrines the power of the health insurance industry.  Nevertheless, the Vermont action can very well be a first step towards setting an example for a health care plan that is single payer, universal and economic; which in turn can generate public opinion to put on the pressure in other jurisdictions.  That is, if the gigantic insurance and pharmaceutical industries don’t find a way to snuff the breath out of the Vermont initiative before it has a chance to come to life.)

Published on Friday, March 25, 2011 by the Brattleboro Reformer (Vt.)

by Chris Garofolo

MONTPELIER — The Vermont House of Representatives passed a bill calling for a single-payer system Thursday afternoon, putting the state on a path to become the first in the nation to adopt universal access to health care.

Lawmakers voted 92 to 49 after nearly two days of debate, including discussion on the floor until the early morning hours on Thursday.

Advocates hail the measure as the solution to control costs by reducing administrative overhead. However, critics said it leaves too much financial uncertainty and could hurt the economic growth in Vermont.

The legislation proposes to develop a unified health system where all Vermonters are eligible for benefits under a universal coverage program called Green Mountain Care. Democratic leaders are optimistic the single-payer plan will contain the skyrocketing costs of health care and put the state on a more sustainable fiscal path.

“I think that we all know, and there was universal agreement on the House floor, that the current system will bankrupt us. Costs of health care in Vermont are going up $1 million a day. They are $2 billion more than they were 10 years ago. We have a problem, we need to solve it,” said House Speaker Shap Smith, D-Morrisville. “This is just the first step in the process. This will be a long road ahead, and we have much work left to do. But we have taken a bold step forward today.”

The measure also designs a four-year timeframe to establish a publicly funded system, beginning with the creation of the Green Mountain Care Board on July 1 with a budget of $1.2 million. The five-member board will design a more sensible payment plan for health care providers, control the overall cost to align it closer to Vermonters’ ability to pay and recommend a benefit package for every resident.

However, the bill does not require the governor to propose a payment plan for the single-payer system until 2013, which sparked outcry from House Republicans. Paying for the reform is the most controversial portion of the bill and it will not be addressed until Gov. Peter Shumlin campaigns for his second term next year.

Shumlin, the first-term Democrat who made health care reform a cornerstone of his gubernatorial campaign last year, said the House has moved Vermont in a historic direction toward fixing a broken system.

“This is a really important step for Vermont. If we want to create jobs, if we want to be the state that makes the difference in controlling health care costs so that we can grow jobs and economic opportunities … this is an extraordinary moment,” he said.

Thursday’s otherwise civil debate turned into a political war of words after Rep. Thomas Burditt, R-West Rutland, said promoting universal coverage is the “keystone in the arch of socialism,” drawing criticism from Democrats and independents supporting the measure.

“I take offense at the remarks … that we’re socialists, that we’re communists,” said Rep. Paul Poirier, I-Barre. “I ask all members to respect other people’s points of view.”

Cooler heads prevailed as lawmakers wrapped up the roll call vote shortly after 3 p.m. The legislation heads to the Senate, where it is expected to pass with some possible changes.

Republican critics called on Senate members to “correct the errors” on the bill, particularly the cost burdens on state government.

Opponents said it is not feasible to implement a single-payer system as a stand-alone, suggesting instead an amendment to protect self-insured employers in the state. GOP lawmakers pressured their Democratic counterparts to listen to the hundreds of small businessowners voicing concerns over self-insurance.

“Risk and uncertainty are two barriers to economic growth and this promise would help alleviate these concerns,” said Rep. Oliver Olsen, R-Jamaica. “Self-insured businesses represent nearly 20 percent of all employers in Vermont, which is a large portion of our economy, and they are worried about how this bill will affect their ability to do business in Vermont.”

The amendment, proposed by Stowe Republican Heidi Scheuerman, was soundly defeated.

Rep. Michael Hebert, R-Vernon, spoke from the floor about his issues with the uncertain cost of such a health care network.

“I have a tremendous number of questions. And I’m not in opposition to health care finance reform, I’m just in opposition of us going down a road where we don’t know what it costs,” he said. “There are just so many unanswered questions and I’m really concerned with this five-member board. They’re going to have the authority to rule on every aspect of our health care in the state of Vermont.”

Meanwhile, Democrats hailed the swift-moving bill as a vote for hope and not fear. Supporters hugged outside the House chamber following the passage, a sense of pride on their faces as they praised the landmark health care measure.

“Today, Vermont’s House of Representatives showed America our small state has both the courage and conviction to lead the way nationwide on the creation of a unified single-payer health care system,” said Rep. Valerie Stuart, D-Brattleboro. “I thank the members of the [House Health Care] committee that created this piece of legislation with all my heart.”

The benefits under Green Mountain Care would not take effect until after Vermont receives a federal waiver under the Patient Protection and Affordable Care Act of 2010. By 2014, the bill established a health care exchange as required by federal law.

Do Not Resuscitate the ‘Public Option’ February 23, 2010

Posted by rogerhollander in Health.
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(Roger’s note: I have been inundated of late with passionate e-mail pleas from liberal and progressive Democratic Party web sites, urging me to join the bandwagon pushing for the so-called “public option.”  Senators who signed on to a petition to add the public option are being hailed as heroes, and we are being urged to contribute to the campaigns of those who are facing opposition because of their stand.  While it is pathetic that so many are willing to consider a few crumbs falling off the table as a political victory, it has further been argued forcefully that the current health form legislation, as it has been passed by both houses of congress, constitutes a disaster for genuine reform with our without the token public option that is being proposed.  I am convinced that in order to support genuine health care reform [i.e. some form of single-payer universal coverage], the current legislation in whatever form the appeaser Obama and the bought-and-paid-for Congress come up with should be opposed, and it should fail.  The reason for this is that this legislation will further entrench the blood-sucking health insurance industry under the guise of reform.  It will set back the cause of single-payer health care for decades or longer.  When will we learn that the kind of pragmatism practiced by Obama under the influence of Rahm Emanuel is self defeating and only feeds in the long run into the agenda of the neo-fascist right?)

Published on Tuesday, February 23, 2010 by CommonDreams.org

by Andy Coates

Like initiating CPR on a patient who was dead in the field and remained dead on arrival, the effort to resuscitate the “public option” is mistaken and futile.

Once upon a time, proponents of the “public plan option” sought a “Medicare-like” program that might enroll every other person in the nation and thus run private insurers out of business.

“A roadblock to reform” cried the insurance companies. In turn, nothing in the bills passed by the House and the Senate would erect a public insurer that could possibly influence the insurance market.

The House bill included a feeble government plan, to start in 2013, that would enroll perhaps 2 percent of the nation by 2019. The Senate bill simply nixed the idea altogether. Now the President, in his latest proposal, has also abandoned the “public option.”

In reality the “public option” was never much more than a K-street phrase, a shadow-puppet, a political posture. All along proponents of adding a new government-sponsored insurer boasted “talking points” but never offered workable health reform.

But the insurance companies oppose the “public option” and that proves its virtue, its supporters exclaim.

Hello? Of course the insurers oppose it.

Why would the insurers want to yield even 2 percent of the market to a public plan (House bill) when they’ve been given the “option” (Senate bill) of keeping 100 percent of the market? Why would the insurance companies not fight for the whole pie when the White House let slip that it saw the “public option” as simply a bargaining chip in private dealmaking?

But there is something else here.

With its reliance on the magic of the marketplace, the “public option” is simply not a proposal for reform. In fact, it has already been tried, and failed: in Maine, a “public option” insurer known as DirigoChoice, was established in 2003. It has failed to enroll but a tiny percent of the uninsured, did nothing to reduce the costs of insurance or health care, nor did it reduced overall health spending, nor did disparities in care improve – and in the last year DirigoChoice has fatally tanked.

In the United States a corporate oligopoly of huge insurers, with near-monopoly control in most locales, dominate the market. A government insurer of any size would simply add yet another bureaucracy to the present byzantine insurance mess.

Does it really make any sense to think that a government plan could give the private insurance companies a run for their money – within the contemporary corporate marketplace – without draconian regulation upon the industry? Even with regulation, as former Cigna executive Wendell Potter explained at the PNHP annual meeting this year, insurance companies simply “flaunt regulations.”

The insurance market cannot be tricked into reforming itself. The health insurance company that wins at the marketplace avoids and jettisons sick and poor patients and enrolls the healthy and the wealthy – and a “public option” will not change this fact. The market that serves the private interests – profiteering at the expense of the sick – would continue to do so.

The proper name for this kind of “market magic” is the race to the bottom. Adding a public plan into the private mix can not and will not change the character of this cruel game.

Any successful “public option” insurance plan would wind up covering the sick and the poor. It would be designed to lose, not win, the market competition. It would not prove affordable or comprehensive. Worst of all, a highly successful “public plan option” could put our nation on a fast-track to permanent two-tiered health services, exacerbating deplorable disparities that plague us.

Regrettably, that the “public option” has been given attention at all is but a measure of how deeply our culture has surrendered to neoliberal ideology, the ideas popularized by Ronald Reagan. It is a lie that the market will always provide, most especially when it comes to health care. So why would some of our friends still seek to revive the false promise of the “public option”?

Marie Gottschalk, University of Pennsylvania Professor of Political Science, identified the psychology at work. In a remarkably prescient essay written in late 2009, she compared health reformers in the United States to victims of the Stockholm Syndrome, in which hostages identify with – and even defend – the hostage-takers.

We ought to reach out with sympathy to our friends who have fallen captive to Ronald Reagan ideology and say: Do not resuscitate the “public option.” It is time to let it go.

All along, adding a feeble public insurance plan to the insurance market has been but a very poor excuse to support “insurance reform” that will criminalize the uninsured, divert billions of tax dollars to subsidize unaffordable private insurance premiums and protect pharmaceutical industry super-profits.

Another world is still possible. It is called Medicare-for-all, expanded and improved.

Andrew D. Coates, MD is a leader of Physicians for a National Health Program and the grassroots coalition Single Payer New York. (An earlier version of this essay appeared at The Progressive Media Project in December.)

A Patient’s View of the Senate Christmas Healthcare Gift December 24, 2009

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Published on Thursday, December 24, 2009 by CommonDreams.orgby Donna Smith

So, all the great fanfare and all the king’s horses.  The great and almighty U.S. Senate has spoken.  I will have to buy private health insurance — forever, amen.  The defective product that has left me wanting for real healthcare for all of my adult life is now a step closer to being the law of the land.

A lump of Christmas coal all polished up with sparkling rhetoric. 

Here’s what the Chicago Tribune said this week, and I agree: 

On Sunday, the Chicago Tribune published an exhaustive front-page analysis by Northwestern University‘s Medill News Service and the Center for Responsive Politics of how it was done. The main culprit: “a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in health care legislation.”

The study found that 13 former congressmen and 166 congressional staffers were actively engaged in lobbying their former colleagues on the bill. The companies they were working for — some 338 of them — spent $635 million on lobbying. It was money extremely well spent — delivering a bill that, by forcing people to buy a shoddy product in a market with no real competition, enshrines into law the public subsidy of private profit.

As we approach the end of Obama’s first year in office, this public subsidizing of private profit is becoming something of a habit. It is, after all, exactly what the White House did with the banks. Just as he did with insurance companies, Obama talked tough to the bankers in public, but, when push came to shove, he ended up shoving public money onto their privately held balance sheets.

This is not just bad policy, it’s bad politics.

Now, back to my own thoughts as a patient:

I went broke while carrying health insurance, a disability insurance policy and a small healthcare savings account.  And if I get sick under this mess of a plan, it will happen to me again.  Little has changed except that millions more of my fellow citizens will join my ranks.

How does it happen to insured people under this plan?  Easy.  Step-by-torturous-step.  Slowly.  Like water-torture. 

1.       Buy health insurance at work or on the new exchange;

2.       Avoid using insurance due to co-pays, deductibles and out-of-pocket maximum exposures — not to mention lost work time and the worry about losing one’s job in a tough economy;

3.       If symptoms are noticed, treat by internet medical site suggestions and over-the-counter drugs until no other option but going to a doctor are available;

4.       Attempt to make appointment with doctor but first find one who accepts both new patients and your insurance;

5.       Go to doctor and pay co-pay up front before ever speaking to anyone about medical problem;

6.       Sit in outer waiting room for as long as required, missing work and worrying;

7.       Sit in exam room waiting for doctor for as long as required;

8.       See doctor for five or six minutes, if lucky, during which time you will either be prescribed some expensive drug to fix a problem the doctor isn’t sure you have, referred to another doctor who may have a month or two wait for appointments, be directed to get some tests done you aren’t sure your insurance will allow or pay for, and do it all sitting in your underwear or less;

9.       Leave medical office owing more than what you thought your insurance and co-pay advertised (and never get an explanation for how that is possible)  and never sure if this experience was much different than being to a used car lot where the sales folks have assessed your financing mechanism before showing you anything at all and then only show you what fits the financing not what you need or want;

10.   In the alternative, if you collapse or wait until symptoms get so severe that going for an office appointment is impossible, go to an emergency room — repeat steps five through eight — and either be admitted to the hospital if your insurance is adequate and you have any available sick-time from work (if not, beg for drugs and to be released) or go to number nine.

11.    Need a dentist?  Too bad.  Have dental insurance?  Still too bad.  You might get a cleaning and some x-rays, but getting the care you may or may not need will be again totally related to your ability to pay whatever portion of the dental work is not covered (and amazingly, every penny of what dental insurance will cover will be eaten up by whatever problem you may or may not have) — in the alternative, avoid dentists or just pull teeth as they go bad;

12.   When the bills roll in, try to pay some after trying to find out how you can possible owe hundreds if not thousands more than the insurance policy you have indicates is possible;

13.   When the collectors call to collect all of the balances due, try to negotiate payments but endure threats of lawsuit, garnishment and worse as the collectors report back to the doctors you saw for a few moments in number eight;

14.   Try to get your meds — if too costly, go without;

15.   Try to get well — if you cannot, go back to work;

16.   Try to act like this is all wonderful and you are grateful to have any insurance at all;

17.   Get sued by a collection agency for a doctor bill or hospital bill you cannot cover;

18.   Sell your house and use whatever proceeds you have to try to pay some of the debts;

19.   Collectors for the doctors and hospitals are not happy if you don’t pay it all in full and up-front most of the time;

20.   Feel stress, fear, anguish — but don’t gripe and don’t show it at work — buck it up, chump;

21.   Sell keepsakes and anything valuable to try to stay afloat;

22.   Stress, more stress.  Fear to answer the phone.  Friends and family fall away as they don’t want you to ask to borrow money;

23.   Keep working — sick or not, keep working or you’ll lose that damn insurance if you cannot pay the premium — or you’ll be back out on the exchange trying to buy another policy that is cheaper and even worse;

24.   Watch your elected officials claim victory and history as they work to make sure your kids and grandkids must suffer the same fate if they need healthcare in America;

25.   Have a Merry Christmas, so says your U.S. Senate.

Don’t think this can happen to you because it hasn’t yet?  Count your blessings this Christmas. 

I’d really like the gift of healthcare. Medicare for all, single-payer healthcare would remove so much of this awful process. That would be a gift.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

Pro-Single-Payer Physicians Call for Defeat of Senate Health Bill December 22, 2009

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Published on Tuesday, December 22, 2009 by CommonDreams.orgby Physicians for National Health Program

WASHINGTON – A national organization of 17,000 physicians who favor a single-payer health care system called on the U.S. Senate today to defeat the health care legislation presently before it and to immediately consider the adoption of an expanded and improved Medicare-for-All program.While noting that the Senate bill includes some “salutary provisions” like an expansion of Medicaid, increased funding for community clinics and the curbing of some of the worst practices of the private insurance industry, the group says the negatives in the bill outweigh the positives.

[While noting that the Senate bill includes some “salutary provisions” like an expansion of Medicaid, increased funding for community clinics and the curbing of some of the worst practices of the private insurance industry, the group says the negatives in the bill outweigh the positives.]
While noting that the Senate bill includes some “salutary provisions” like an expansion of Medicaid, increased funding for community clinics and the curbing of some of the worst practices of the private insurance industry, the group says the negatives in the bill outweigh the positives.

The negatives, the group says, include the individual mandate requiring that people buy private insurance policies, large government subsidies to private insurers, new restrictions on abortion, the unfair taxing of high-cost health plans, and cuts of $43 billion in Medicare payments to safety-net hospitals. Moreover, at least 23 million people will remain uninsured when the plan finally takes effect, they said. 

“We have concluded that the Senate bill’s passage would bring more harm than good,” the group said in a statement signed by its president, Dr. Oliver Fein, and two co-founders, Drs. David Himmelstein and Steffie Woolhandler.

Addressing the Senate in an open letter, they write: “We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.”

The full statement appears below.

To the Members of the U.S. Senate:

It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken health care financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill’s passage would bring more harm than good.

We are fully cognizant of the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers’ most egregious practices. Yet these are outweighed by its central provisions – particularly the individual mandate – that would reinforce private insurers’ stranglehold on care. Those who dislike their current employer-sponsored coverage would be forced to keep it. Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness would bankrupt them. And the $476 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.

Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources – including funds diverted from Medicare – into the very private insurers who caused today’s health care crisis. Social Security’s first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!

While the fortification of private insurers is the most malignant aspect of the bill, several other provisions threaten harm to vulnerable patients, including:

  • The bill’s anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.
  • The new 40 percent tax on high-cost health plans – deceptively labeled a “Cadillac tax” – would hit many middle-income families. The costs of group insurance are driven largely by regional health costs and the demography of the covered group. Hence, the tax targets workers in firms that employ more women (whose costs of care are higher than men’s), and older and sicker employees, particularly those in high-cost regions such as Maine and New York.
  • The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned. These threatened hospitals are also a key resource for emergency care, mental health care and other services that are unprofitable for hospitals under current payment regimes. In many communities, severely ill patients will be left with no place to go – a human rights abuse.
  • The bill would leave hundreds of millions of Americans with inadequate insurance – an “actuarial value” as low as 60 percent of actual health costs. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care. Such coverage is more akin to a hospital gown than to a warm winter coat.

Congress’ capitulation to insurers – along with concessions to the pharmaceutical industry – fatally undermines the economic viability of reform. The bill would inflate the already crushing burden of insurance-related paperwork that currently siphons $400 billion from care annually. According to CMS’ own projections, the bill will cause U.S. health costs to increase even more rapidly than presently, and budget neutrality is to be achieved by draining funds from Medicare and an accounting trick – front-loading the new revenues while delaying most new coverage until 2014. As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.

We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.

Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program

The Underlying Divisions in the Health Care Debate December 18, 2009

Posted by rogerhollander in Barack Obama, Democracy, Health, Political Commentary.
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(Roger’s note: Hmm, “the merger of government power and corporate interests.”  Now, where have I heard that before?  Yes, now I remember, it was called National Socialism and occurred in post-Weimar Germany in the 1930s.  The article below discusses the corporatist phenomenon but stops short of calling a spade a spade.  Corporatism = Capitalism.  Plain and simple.  The inner logic of capitalism, whether it occurs in a political democracy or in a Communist dictatorship in the form of state capitalism, is accumulate, accumulate, accumulate.  The big keeps getting bigger, the rich richer, the poor poorer.  With greater economic concentration comes the ability to hijack the political process, which is exactly what we are seeing in the United States.  Big Corporate America owns Congress, the Presidency, and via the Presidency the Supreme Court.  “We the People” are the ones left out.  Permanent war, billions upon billions spent upon nuclear and non-nuclear armaments; permanent economic crisis; continuing deterioration of the social safety net; continuing environmental degradation: these are the by-products of worldwide capitalism.  Nothing short of revolutionary changes can save the planet [or do you think the heads of state meeting at Copenhagen -- the heads of state of the industrial nations fronting for oil and coal, the heads of state of the poor nations bludgeoned by the likes of Hillary Clinton and Rahm Emanuel into submission -- do you think they can or will do it?])
 
Published on Friday, December 18, 2009 by Salon.comby Glenn Greenwald
Ed Kilgore has a very perceptive analysis in The New Republic about the underlying (and largely unexamined) ideological and strategic differences among progressives that are at least partially driving the rift over the health care bill.  He argues — correctly — that the current debate “displays a couple of pretty important potential fault lines within the American center-left” that have manifested in other disputes as well.  That was the principal point of this much-maligned Daily Kos post observing that many (but not all) of the progressive bloggers most vehemently demanding passage of the health care bill also supported the Iraq War.  As the author of that post (Jake McIntyre) explicitly said, his intent wasn’t to suggest that those individuals shouldn’t be listened to because of their Iraq position six years ago (that would be an invalid and unfair claim), but simply that — as Kilgore says — there are underlying and significant differences in strategic and ideological outlook driving the health care debate that have been present for some time but are typically ignored.Shared contempt for the Bush administration (at least once Bush and the Iraq War became discredited) largely obscured these differences when Bush was in office.  The desire to undermine the Bush GOP and dislodge that movement from power subsumed all other objectives and united people with vastly different political outlooks and agendas.  There is still a shared revulsion towards the Palin/Limbaugh Right, but that faction is too marginalized and impotent to serve the same function.  With the unifying force of Bush/Cheney gone, the divisions Kilgore describes are now vibrant and increasingly potent.  In addition to health care and Iraq, roughly the same progressive fault lines are seen over the bank bailout, escalation in Afghanistan, Obama’s economic team, tolerance for Obama’s embrace of Bush/Cheney civil liberties polices, and even the reaction to Matt Taibbi’s recent Rolling Stone article on Obama’s subservience to Wall Street. 

There are many reasons for the progressive division on the health care bill.  There are differences over the narrow question of health care policy, with some believing the bill does more harm than good just on that ground alone.  Some of it has to do with broader questions of political power:  if progressives always announce that they are willing to accept whatever miniscule benefits are tossed at them (on the ground that it’s better than nothing) and unfailingly support Democratic initiatives (on the ground that the GOP is worse), then they will (and should) always be ignored when it comes time to negotiate; nobody takes seriously the demands of those who announce they’ll go along with whatever the final outcome is.  But the most significant underlying division identified by Kilgore is the divergent views over the rapidly growing corporatism that defines our political system.

Kilgore doesn’t call it “corporatism” — the virtually complete dominance of government by large corporations, even a merger between the two — but that’s what he’s talking about.  He puts it in slightly more palatable terms:

To put it simply, and perhaps over-simply, on a variety of fronts (most notably financial restructuring and health care reform, but arguably on climate change as well), the Obama administration has chosen the strategy of deploying regulated and subsidized private sector entities to achieve progressive policy results. This approach was a hallmark of the so-called Clintonian, “New Democrat” movement, and the broader international movement sometimes referred to as “the Third Way,” which often defended the use of private means for public ends.

As I’ve written for quite some time, I’ve honestly never understood how anyone could think that Obama was going to bring about some sort of “new” political approach or governing method when, as Kilgore notes, what he practices — politically and substantively — is the Third Way, DLC, triangulating corporatism of the Clinton era, just re-packaged with some sleeker and more updated marketing.  At its core, it seeks to use government power not to regulate, but to benefit and even merge with, large corporate interests, both for political power (those corporate interests, in return, then fund the Party and its campaigns) and for policy ends.  It’s devoted to empowering large corporations, letting them always get what they want from government, and extracting, at best, some very modest concessions in return.  This is the same point Taibbi made about the Democratic Party in the context of economic policy:

The significance of all of these appointments isn’t that the Wall Street types are now in a position to provide direct favors to their former employers. It’s that, with one or two exceptions, they collectively offer a microcosm of what the Democratic Party has come to stand for in the 21st century. Virtually all of the Rubinites brought in to manage the economy under Obama share the same fundamental political philosophy carefully articulated for years by the Hamilton Project: Expand the safety net to protect the poor, but let Wall Street do whatever it wants.

One finds this in far more than just economic policy, and it’s about more than just letting corporations do what they want.  It’s about affirmatively harnessing government power in order to benefit and strengthen those corporate interests and even merging government and the private sector.  In the intelligence and surveillance realms, for instance, the line between government agencies and private corporations barely exists.  Military policy is carried out almost as much by private contractors as by our state’s armed forces.  Corporate executives and lobbyists can shuffle between the public and private sectors so seamlessly because the divisions have been so eroded.  Our laws are written not by elected representatives but, literally, by the largest and richest corporations.  At the level of the most concentrated power, large corporate interests and government actions are basically inseparable.

The health care bill is one of the most flagrant advancements of this corporatism yet, as it bizarrely forces millions of people to buy extremely inadequate products from the private health insurance industry — regardless of whether they want it or, worse, whether they can afford it (even with some subsidies).   In other words, it uses the power of government, the force of law, to give the greatest gift imaginable to this industry — tens of millions of coerced customers, many of whom will be truly burdened by having to turn their money over to these corporations — and is thus a truly extreme advancement of this corporatist model.  It’s undeniably true that the bill will also do some genuine good, as it will help many people who can’t get coverage now to get it (though it will also severely burden many people with compelled, uncontrolled premiums and will potentially weaken coverage for millions as well).  If one judges the bill purely from the narrow perspective of coverage, a rational and reasonable (though by no means conclusive) case can be made in its favor.  But if one finds this creeping corporatism to be a truly disturbing and nefarious trend, then the bill will seem far less benign.

As I’ve noted before, this growing opposition to corporatism — to the virtually absolute domination of our political process by large corporations — is one of the many issues that transcend the trite left/right drama endlessly used as a distraction.  The anger among both the left and right towards the bank bailout, and towards lobbyist influence in general, illustrates that.  Kilgore says that anger among the left and right over corporatism is irreconcilable, and this is the point I think he has mostly wrong:

To put it more bluntly, on a widening range of issues, Obama’s critics to the right say he’s engineering a government takeover of the private sector, while his critics to the left accuse him of promoting a corporate takeover of the public sector. They can’t both be right, of course, and these critics would take the country in completely different directions if given a chance.  But the tactical convergence is there if they choose to pursue it.

This supposedly irreconcilable difference Kilgore identifies is more semantics than substance.  It’s certainly true that health care opponents on the left want more a expansive plan while opponents on the right want the opposite.  But the objections over the mandate are largely identical — it’s a coerced gift to the private health insurance industry that underwrites the Democratic Party.  The same was true over opposition to the bailout, objections to lobbying influence over Washington, and most of all, the growing anger that Washington serves the interests of financial elites at the expense of the working class.  

Whether you call it “a government takeover of the private sector” or a “private sector takeover of government,” it’s the same thing:  a merger of government power and corporate interests which benefits both of the merged entities (the party in power and the corporations) at everyone else’s expense.  Growing anger over that is rooted far more in an insider/outsider dichotomy over who controls Washington than it is in the standard conservative/liberal ideological splits from the 1990s.  It’s true that the people who are angry enough to attend tea parties are being exploited and misled by GOP operatives and right-wing polemicists, but many of their grievences about how Washington is ignoring their interests are valid, and the Democratic Party has no answers for them because it’s dependent upon and supportive of that corporatist model.  That’s why they turn to Glenn Beck and Rush Limbaugh; what could a Democratic Party dependent upon corporate funding and subservient to its interests possibly have to say to populist anger?

Even if one grants the arguments made by proponents of the health care bill about increased coverage, what the bill does is reinforces and bolsters a radically corrupt and flawed insurance model and and an even more corrupt and destructive model of “governing.”  It is a major step forward for the corporatist model, even a new innovation in propping it up.  How one weighs those benefits and costs — both in the health care debate and with regard to many of Obama’s other policies — depends largely upon how devoted one is to undermining and weakening this corporatist framework (as opposed to exploiting it for political gain and some policy aims).  That’s one of the primary underlying divisions Kilgore identifies, and he’s right to call for greater examination and debate over the role it is playing.

Copyright ©2009 Salon Media Group, Inc.

Glenn Greenwald was previously a constitutional law and civil rights litigator in New York. He is the author of the New York Times Bestselling book “How Would a Patriot Act?,” a critique of the Bush administration’s use of executive power, released in May 2006. His second book, “A Tragic Legacy“, examines the Bush legacy.

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