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21 Ways the Canadian Health Care System is Better than Obamacare and Vermont Goes Universal November 22, 2013

Posted by rogerhollander in Canada, Health.
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Roger’s note: this posting gives you two articles on health care, including Ralph Nader’s on the Canadian system.  Having lived most of my life in Canada, and with the early detection of my daughter’s meningitis that saved her life at age two, I know first hand the benefits of no one excluded single payer.  Like the system in Great Britain (which is more like socialized medicine than Canada’s universal insurance), Canada’s health care is deteriorating, not because of flaws in the system, but rather neoliberal under funding.  It is not quite the Utopia that Nader pictures, but it is a thousand percent better than what Americans have.

 

 

Dear America:

Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.

In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!

Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.

Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.

Love, Canada

Number 21:
In Canada, everyone is covered automatically at birth – everybody in, nobody out.

In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.

Number 20:
In Canada, the health system is designed to put people, not profits, first.

In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.

Number 19:
In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.

In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.

Number 18:
In Canada, health care coverage stays with you for your entire life.

In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.

Number 17:
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.”

In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking – thus restricting freedom of choice – and if you want to go out of network, you pay for it.

Number 16:
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.

In the United States, under Obamacare, for thousands of Americans, it’s pay or die – if you can’t pay, you die. That’s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.

Number 15:
In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill.

In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.

Number 14:
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.

In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn’t cover tens of millions of people.

Number 13:
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.

In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.

Number 12:
In Canada, simplicity leads to major savings in administrative costs and overhead.

In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.

Number 11:
In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?”

In the United States, the first thing they ask you is: “What kind of insurance do you have?”

Number 10:
In Canada, the government negotiates drug prices so they are more affordable.

In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.

Number 9:
In Canada, the government health care funds are not profitably diverted to the top one percent.

In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.

Number 8:
In Canada, there are no necessary co-pays or deductibles.

In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.

Number 7:
In Canada, the health care system contributes to social solidarity and national pride.

In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.

Number 6:
In Canada, delays in health care are not due to the cost of insurance.

In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.

Number 5:
In Canada, nobody dies due to lack of health insurance.

In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.

Number 4:
In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.

In the United States, a majority – many for different reasons – oppose Obamacare.

Number 3:
In Canada, the tax payments to fund the health care system are progressive – the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.

In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.

Number 2:
In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.

In the United States, Obamacare’s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage “we have to pass the bill so that you can find out what is in it.”

Number 1:
In Canada, the majority of citizens love their health care system.

In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system – single-payer, free choice of doctor and hospital , everybody in, nobody out.

For more information see Single Payer Action.

Ralph Nader

Ralph Nader is a consumer advocate, lawyer, and author. His latest book is The Seventeen Solutions: Bold Ideas for Our American Future. Other recent books include, The Seventeen Traditions: Lessons from an American Childhood, Getting Steamed to Overcome Corporatism: Build It Together to Win, and “Only The Super-Rich Can Save Us” (a novel).

 

Vermont Approves Single-Payer Health Care: ‘Everybody in, nobody out’

posted by Salvatore Aversa November 20, 2013, http://www.occupydemocrats.com

The Affordable Care Act continues to plow ahead, despite Republican attempts to fight it at every turn.  What is unfolding in front of us is nothing short of spectacular.  The problems with healthcare.gov are slowly being resolved which is helping more and more people sign up for affordable healthcare, many for the first time in their life.  The law provides so much more than that, including standards for even the lowest level plans, protections for young adults 26 and younger, and the elimination of pre-existing plans.  Of course, you will not hear the success stories on the news, because those stories are not nearly as sexy as the “Obama Lied” slogan they are so fond of.

The biggest downside of the ACA is the reliance on the private insurance industry.  It does not have to be this way, however.  There is yet another provision in the Affordable Care Act that can open the door for states to institute their own single-payer healthcare system.  Other states have a public option, especially for those below a certain income level, but no state had instituted a true single-payer system.  All of this has changed thanks to President Obama and the Affordable Care Act.

Vermont—Home of Ben and Jerry’s, Maple Syrup, Bernie Sanders and the first state to pass marriage equality.  Now, Vermont will be known for something that will impact every resident in the state.

The ACA provided states with federal funds to institute a Medicaid expansion.  The states chose to expand the program also were able to set up their own state exchanges, which were relatively free from the problems the federal site had.  Vermont decided to take it a step further by setting up their very own single payer system.

The slogan of the program: Everybody in, nobody out.

The program will be fully operational by 2017, and will be funded through Medicare, Medicaid, federal money for the ACA given to Vermont, and a slight increase in taxes.  In exchange, there will be no more premiums, deductibles, copay’s, hospital bills or anything else aimed at making insurance companies a profit.  Further, all hospitals and healthcare providers will now be nonprofit.

This system will provide an instant boost the state economy.  On the one side, you have workers that no longer have to worry about paying medical costs or a monthly premium and are able to use that money for other things.  On the other side, you have the burden of paying insurance taken off of the employers side, who will be able to use the saved money to provide a better wage and/or reinvest in their company through updated infrastructure and added jobs.  It is a win-win solution.

To make sure that it is done right the first time, Vermont brought in a specialist who knows a thing or two about setting up a single-payer system.

Dr. William Hsaio, the Harvard health care economist who helped craft health systems in seven countries, was Vermont’s adviser. He estimates that Vermont will save 25 percent per capita over the current system in administrative costs and other savings.

Many like to say that the United States has the best healthcare system in the world.  The problem is we don’t.  Not even close.  In fact, the only way you can get the best healthcare in the world, is if you are willing and able to pay for it.  The United States can and must do better for its people.

Costs have to be held down — there is no reason why the U.S. has to pay twice the amount per capita as the next most costly system in the world (Norway’s), and still not cover millions of its citizens. A Harvard Medical School study states that 45,000 Americans die each year from treatable diseases because they cannot afford to get treatment.

45,000 Americans die every single year because they cannot afford treatment, are you ready for that?  That is 15 times the amount of people that died during the September 11, 2001, attacks, or perhaps for you Righty’s out there you would rather see it put this way, 11,250 times the amount of people that died in the Benghazi attack.  That equals 5 Americans that die every hour, of every day, of every year because of a preventable illness that was not taken care of due to lack of access and means.

Even once the Affordable Care Act wrinkles are ironed out, which they will be, and every America is covered, which will happen, that will not change the fact that all of this is being driven by a for-profit system by companies that only care about their bottom line.  Despite rules in the ACA which prevent insurance companies from absolutely gouging their customers, insurance companies are not exactly know for their ethical behavior.

A single-payer system would all but eliminate anybody dying unnecessarily due to lack of access to healthcare.  Our Declaration of Independence states, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”  How can somebody have life and happiness, without their health?  Despite the glaring hypocrisy of rich, white males who owned slaves stating all men are created equal, we have come a long way from 1776.  Yet when it comes to the very basic need, we are left to the whim of a business.  Single-payer is inevitable, and the ACA is a giant step in that direction.  We need must hold our officials to a higher standard which will get us there faster.  40,000 people a year is absolutely unacceptable.  Vermont saw the writings on the wall.  Will the rest of us?

Video

Bernie Sanders on MSNBC discussing his state’s new single-payer system.

 

 

With Rise of American Fascism, Shutdown Politics ‘Predictable’ October 7, 2013

Posted by rogerhollander in Democracy, Economic Crisis, Imperialism.
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Can new progressive era rise from ashes of ‘era of obstructionism’ or is the descent of US democracy just beginning?

 

- Jon Queally, staff writer

Republican senator from Texas, Ted Cruz. (Photo: AP)

“All of this was predictable.”

In the midst of the ongoing government shutdown—with the GOP still trying their darndest to kill Obamacare and the global financial markets now truly jittery over the quite real possibility of a US default—those five words, found in Paul Krugman’s Monday New York Times column, don’t say it all, but they begin to tell a story long in the making.

If the current situation in Washington is a consternation to many observers, why so predictable to progressives and others like Krugman? He writes:

It has been obvious for years that the modern Republican Party is no longer capable of thinking seriously about policy. Whether the issue is climate change or inflation, party members believe what they want to believe, and any contrary evidence is dismissed as a hoax, the product of vast liberal conspiracies.

For a while the party was able to compartmentalize, to remain savvy and realistic about politics even as it rejected objectivity everywhere else. But this wasn’t sustainable. Sooner or later, the party’s attitude toward policy — we listen only to people who tell us what we want to hear, and attack the bearers of uncomfortable news — was bound to infect political strategy, too.

In short, when an individual—or a political party—commits to a world view fundamentally insulated from reality, it is only a matter of time before the wheels will come off the rails. Like a pathological liar, the truth finally catches up. For a gambling addict, the house will ultimately call the game.

Over the weekend, the takeaway news was that Speaker of the House Rep. John Boehner (R-OH) was either “lying” or “incompetent” when he claimed on a Sunday talk show that he didn’t have the votes to pass a “clean CR” (continuing resolution) that would end the shutdown by funding the government without GOP riders or demands. The problem, of course—as many reporters and observers documented—was that it just wasn’t factually true.

As The Hill reports:

Democrats have repeatedly called on Boehner to allow a vote on a so-called “clean” Senate bill that would reopen the government for a short period of time, but not include Republican demands to delay or defund ObamaCare.

A whip count by The Washington Post found that 20 Republican representatives supported a so-called clean continuing resolution (CR), with another four counted as “leaning yes.” If all 200 Democrats voted for the legislation, they would need just 17 Republicans to vote with them.

Boehner made the comment during an interview on ABC’s “This Week,” after host George Stephanopoulos asked him if he was “prepared to schedule a clean bill on government funding.”

When Stephanopoulos pressed Boehner on whether it was true that the votes did not exist, the Speaker said that the American people expected leaders in Washington to “sit down and have a conversation.”

So what’s at stake? According to Bloomberg on Monday, a voluntary default by the U.S. on its debt obligations would be “catastrophic” and lead to worse consequences than when the collapse of Lehman Brothers helped facilitate the financial crisis that swept the globe in 2008. The business paper reports:

Failure by the world’s largest borrower to pay its debt — unprecedented in modern history — will devastate stock markets from Brazil to Zurich, halt a $5 trillion lending mechanism for investors who rely on Treasuries, blow up borrowing costs for billions of people and companies, ravage the dollar and throw the U.S. and world economies into a recession that probably would become a depression. Among the dozens of money managers, economists, bankers, traders and former government officials interviewed for this story, few view a U.S. default as anything but a financial apocalypse.

The $12 trillion of outstanding government debt is 23 times the $517 billion Lehman owed when it filed for bankruptcy on Sept. 15, 2008. As politicians butt heads over raising the debt ceiling, executives from Berkshire Hathaway Inc.’s Warren Buffett to Goldman Sachs Group Inc.’s Lloyd C. Blankfein have warned that going over the edge would be catastrophic.

If nothing else, that’s a view of how the global capitalists see the situation. But what it also reveals is confirmation of the argument presented by many that the modern day Republican Party has become hostage to its most radical and destructive elements. Once beholden to serve the leaders of global capitalism, the new Republican Party, dominated by the branding and rhetoric of the Tea Party, has seemingly lost its ability to even know what that is.

Chris Hedges, a freelance journalist and author of the American Fascists: The Christian Right and the War on America, writes on Monday, the rise in prominence of Sen. Ted Cruz of Texas is the best example of how the ‘Christian right’ and its “anti-Enlightenment” word view has taken over the party and in its lust for power, sabotaged the country’s ability to govern itself. On the ideology of Cruz and his followers, which he terms ‘American fascism,’ Hedges writes:

They live in a binary world of black and white. They feel they are victims, surrounded by sinister groups bent on their destruction. They have anointed themselves as agents of God who alone know God’s will. They sanctify their rage. This rage lies at the center of the ideology. It leaves them sputtering inanities about Barack Obama, his corporate-sponsored health care reform bill, his alleged mandated suicide counseling or “death panels” for seniors under the bill, his supposed secret alliance with radical Muslims, and “creeping socialism.” They see the government bureaucracy as being controlled by “secular humanists” who want to destroy the family and make war against the purity of their belief system. They seek total cultural and political domination.

All ideological, theological and political debates with the radical Christian right are useless. It cares nothing for rational thought and discussion. Its adherents are using the space within the open society to destroy the open society itself. Our naive attempts to placate a movement bent on our destruction, to prove to it that we too have “values,” only strengthen its supposed legitimacy and increase our own weakness.

It is a mixture of this religious politics, combined with the financial self-interest of billionaires and ideologues—like “the Koch brothers, the political arm of the Heritage Foundation and others” described by Krugman—that fuels the current crisis. And though many step back and call the whole thing “political theater,” the final act has yet to begin.

What was “predictable,” according to Krugman, was that the GOP would ultimately end up in such a position where their aversion to facts would make them victims of reality. What is not yet clear—though predictions abound—is how the current impasse ends and what impact it will have on U.S politics leading into the 2014 election season and beyond.

With the Democratic Party also guilty in propping up a political system that fails to deliver the transformative change demanded by a world awash in war, economic inequality, and on the precipice of runaway climate change, the prospects for a new progressive era originating in Washington, DC are not only dim, but non-existent.

As Charles P. Pierce writes at Esquire on Monday morning, both parties—despite all warnings by social activists, progressives and Keynesian economists—have already agreed on austerity as a cure for the ongoing recession.

“For all the talk about how Republican extremism is finally catching up with the party,” writes Pierce, “one can argue just as well that Wall Street-friendly, deficit-hawk, DLC-onomics is finally catching up with the Democratic party.” He continues:

After all, if the shutdown ended tomorrow, the sequester would still be in place. Austerity still would be the tacitly agreed upon program for both parties, and Paul Krugman likely still would be drinking before noon. The administration’s brilliant eleventy-dimensional chess in 2010 looks more and more like a case of being too smart by half. It created a new reality in which both sides decided that what a country barely out of a devastating recession really needed was some belt-tightening and some fiscal discipline.

And Richard Eskow, from Campaign for America’s Future, writes, “The Democrats have already made too many concessions.” What’s needed, he says, is “for the people to take their government back from the extremists, before their empire collapses and takes us all down with it.”

And Eskow gets no quarrel from Hedges, who writes:

The rise of Christian fascism is aided by our complacency. The longer we fail to openly denounce and defy bankrupt liberalism, the longer we permit corporate power to plunder the nation and destroy the ecosystem, the longer we stand slack-jawed before the open gates of the city waiting meekly for the barbarians, the more we ensure their arrival.

For the moment, however, how this “impasse” ends—and what rises in its ugly wake—continues to be a guess.

_________________________________________

The Real Health Care Debate April 9, 2012

Posted by rogerhollander in Health.
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Published on Monday, April 9, 2012 by Truthdig

  by  Chris Hedges

The debate surrounding the Patient Protection and Affordable Care Act illustrates the impoverishment of our political life. Here is a law that had its origin in the right-wing Heritage Foundation, was first put into practice in 2006 in Massachusetts by then-Gov. Mitt Romney and was solidified into federal law after corporate lobbyists wrote legislation with more than 2,000 pages. It is a law that forces American citizens to buy a deeply defective product from private insurance companies. It is a law that is the equivalent of the bank bailout bill—some $447 billion in subsidies for insurance interests alone—for the pharmaceutical and insurance industries. It is a law that is unconstitutional. And it is a law by which President Barack Obama, and his corporate backers, extinguished the possibilities of both the public option and Medicare for all Americans. There is no substantial difference between Obamacare and Romneycare. There is no substantial difference between Obama and Romney. They are abject servants of the corporate state. And if you vote for one you vote for the other.

 

But you would never know this by listening to the Democratic Party and the advocacy groups that purport to support universal health care but seem more intent on re-electing Obama. It is the very sad legacy of the liberal class that it proves in election cycle after election cycle that it espouses moral and political positions it will not pay a price to defend. And since we have no fight in us, since we will not punish politicians like Obama who betray our core beliefs, the corporate juggernaut rolls forward with its inexorable pace to cement into place our global neofeudalism.

Protesting outside the Supreme Court recently as it heard arguments on the constitutionality of the Affordable Care Act were both conservatives from Americans for Prosperity who denounced the president as a socialist and demonstrators from Democratic front groups such as the SEIU and the Families USA health care consumer group who chanted “Protect the law!” Lost between these two factions were a few stalwarts who hold quite different views, including public health care advocates Dr. Margaret Flowers, Dr. Carol Paris and attorneys Oliver Hall, Kevin Zeese and Russell Mokhiber. They displayed a banner that read: “Single Payer Now! Strike Down the Obama Mandate!” They, at least, have not relinquished the demand for single payer health care for all Americans. And I throw my lot in with these renegades, dismissed, no doubt, as cranks or dreamers or impractical by those who flee into the embrace of empty political theater and junk politics. These single payer advocates, joined by 50 doctors, filed a brief to the court that challenges, in the name of universal health care, the individual mandate.

“We have the solution, we have the resources and we have the money to provide lifelong, comprehensive, high-quality health care to every person,” Dr. Flowers said when we spoke a few days ago in Washington, D.C. Many Americans have not accepted the single payer approach “because people get confused by the politics,” she said. “People accept the Democratic argument that this [Obamacare] is all we can have or this is something we can build on.”

“If you are trying to meet the goal of universal health coverage and the only way to meet that goal is to force people to purchase private insurance, then you might consider that it is constitutional,” Flowers said. “Our argument is that the individual mandate does not meet the goal of universality. When you attempt to use the individual mandate and expansion of Medicaid for coverage, only about half of the uninsured gain coverage. This is what we have seen in Massachusetts. We do, however, have systems in the United States that could meet the goal of universality. That would be either a Veterans Administration type system, which is a socialized system run by the government, or a Medicare type system, a single payer, publicly financed health care system. If the U.S. Congress had considered an evidence-based approach to health reform instead of writing a bill that funnels more wealth to insurance companies that deny and restrict care, it would have been a no-brainer to adopt a single payer health system much like our own Medicare. We are already spending enough on health care in this country to provide high-quality, universal, comprehensive, lifelong health care. All the data point to a single payer system as the only way to accomplish this and control health care costs.”

Obamacare will, according to figures compiled by Physicians for a National Health Plan (PNHP), leave at least 23 million people without insurance, a figure that translates into an estimated 23,000 unnecessary deaths a year among people who cannot afford care. Costs will continue to climb. There are no caps on premiums, including for people with “pre-existing conditions.” The elderly can be charged three times the rates provided to the young. Companies with predominantly female workforces can be charged higher gender-based rates. Most of us will soon be paying about 10 percent of our annual incomes to buy commercial health insurance, although this coverage will pay for only about 70 percent of our medical expenses. And those of us who become seriously ill, lose our incomes and cannot pay the skyrocketing premiums are likely to be denied coverage. The dizzying array of loopholes in the law—written in by insurance and pharmaceutical lobbyists—means, in essence, that the healthy will receive insurance while the sick and chronically ill will be priced out of the market.

Medical bills already lead to 62 percent of personal bankruptcies, and nearly 80 percent of those declaring personal bankruptcy because of medical costs had insurance. The U.S. spends twice as much per capita on health care as other industrialized nations, $8,160. Private insurance bureaucracy and paperwork consume 31 percent of every health care dollar. Streamlining payment through a single, nonprofit payer would save more than $400 billion per year, enough, the PNHP estimates, to provide comprehensive, high-quality coverage for all Americans.

But as long as corporations determine policy, as long as they can use their money to determine who gets elected and what legislation gets passed, we remain hostages. It matters little in our corporate state that nearly two-thirds of the public wants single payer and that it is backed by 59 percent of doctors. Public debates on the Obama health care reform, controlled by corporate dollars, ruthlessly silence those who support single payer. The Senate Finance Committee, chaired by Max Baucus, a politician who gets more than 80 percent of his campaign contributions from outside his home state of Montana, locked out of the Affordable Care Act hearing a number of public health care advocates including Dr. Flowers and Dr. Paris; the two physicians and six other activists were arrested and taken away. Baucus had invited 41 people to testify. None backed single payer. Those who testified included contributors who had given a total of more than $3 million to committee members for their political campaigns.

“It is not necessary to force Americans to buy private health insurance to achieve universal coverage,” said Russell Mokhiber of Single Payer Action. “There is a proven alternative that Congress didn’t seriously consider, and that alternative is a single payer national health insurance system. Congress could have taken seriously evidence presented by these single payer medical doctors that a single payer system is the only way to both control costs and cover everyone.”

© 2012 Truthdig.com

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Chris Hedges

Chris Hedges writes a regular column for Truthdig.com. Hedges graduated from Harvard Divinity School and was for nearly two decades a foreign correspondent for The New York Times. He is the author of many books, including: War Is A Force That Gives Us Meaning, What Every Person Should Know About War, and American Fascists: The Christian Right and the War on America.  His most recent book is Empire of Illusion: The End of Literacy and the Triumph of Spectacle.

REVEALED: The Democrats’ devious plan to compromise with the Republicans April 3, 2012

Posted by rogerhollander in Health.
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–>, www.opednews.com, April 2, 2012

In Monday’s New York Times, Ross Douthat explains the devious reasoning behind the Democrats’ adoption of the individual mandate: “It protected the Democratic bill on two fronts at once: buying off some of the most influential interest groups even as it hid the true cost of universal coverage.”

Clever! But I can’t help feeling like Ross is forgetting something. There was some other reason Democrats adopted this policy. I’m almost sure of it. If you give me a second, I’m sure it’ll come to me.

Ah, right! Because Chuck Grassley, the ranking Republican on the Senate Finance Committee, was saying things like “I believe that there is a bipartisan consensus to have individual mandates,” and “individual mandates are more apt to be accepted by a majority of the people in Congress than an employer mandate.”

And it wasn’t just Grassley. A New York Times columnist by the name of Ross Douthat praised Utah Sen. Bob Bennett for “his willingness to co-sponsor a centrist (in a good way!) health care reform bill with the Oregon Democrat Ron Wyden.” That health-care reform bill was the Healthy Americans Act which included, yes, an individual mandate. But while Douthat did later say that the Healthy Americans Act wasn’t his “preferred health care reform,” at no point did he accuse Bennett of “buying off some of the most influential interest groups” even as he “hid the true cost of universal coverage.”

The Healthy Americans Act, meanwhile, had been cosponsored by a bevy of heavy-hitting Senate Republicans, including Lamar Alexander, Mike Crapo, Bob Corker, Judd Gregg, Norm Coleman and Trent Lott. And it’s not like they were off the reservation in some significant way: In 2007, both Sen. Jim DeMint and the National Review endorsed Mitt Romney, who had passed an individual mandate into law in Massachusetts. In their endorsements, both icons of conservatism specifically mentioned his health-care plan as a reason for their endorsement. DeMint, for instance, praised Romney’s health-care plan as “something that I think we should do for the whole country.”

Avik Roy points out that many liberals — including candidate Barack Obama — were historically skeptical of the individual mandate. And that’s true! There was a robust debate inside the party as to whether Democrats should move from proposing a government-centric health-care model to one Republicans had developed in order to preserve the centrality of “personal responsibility” and private health insurers. Many liberals opposed such a shift. But they lost to the factions in the party that wanted health-care reform to be a bipartisan endeavor.

Roy tries to use this to draw some equivalence between the two parties. Both Democrats and Republicans changed their mind on the individual mandate, he argues. But there’s a key difference: The Democrats changed their mind in order to secure a bipartisan compromise on health-care reform. Republicans changed their mind in order to prevent one.

And so what did Democrats get for their troubles? Well, the individual mandate is the least popular element of the health-care law. The entire Republican Party decided the individual mandate was an unconstitutional assault on freedom. And today, even relatively moderate Republicans like Douthat present the mandate as some kind of underhanded trick.

That’s politics, I guess. But ask yourself: If Obamacare is overturned, and Obama is defeated, who will win the Democratic Party’s next fight over health care? Probably not the folks counseling compromise. Too many Democrats have seen how that goes. How much easier to propose a bill that expands Medicaid eligibility to 300 percent of the poverty line, covers every child through the Children’s Health Insurance Program, and makes Medicare availability to every American over age 50. Add in some high-risk pools, pay for the bill by slapping a surtax on rich Americans — indisputably constitutional, as even Randy Barnett will tell you — and you’ve covered most of the country’s uninsured. Oh, and you can pass the whole thing through the budget reconciliation process.

I don’t think that’s a particularly good future for the health-care system. And I doubt that bill will pass anytime soon. But, if Obamacare goes down, something like it will eventually be passed. And what will Republicans have to say about it? That no, this time, they really would have worked with the Democrats to reform America’s health-care system? Who will believe them?

All U.S. Constituencies Oppose Obama’s “Individual Mandate” for Health Care April 3, 2012

Posted by rogerhollander in Barack Obama, Health, Race.
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Black Agenda Radio commentary by Glen Ford

President Obama’s mandate to buy private insurance was born in the rightwing Heritage Foundation, and has not found a home among any actual constituency of the public – white, non-white, Republican, Democrat, college-educated or not. A new poll confirms that “Obama has based his plan on a scheme that nobody likes – even his most loyal supporters.”

 

All U.S. Groups Oppose Obama’s “Individual Mandate” for Health Care

A Black Agenda Radio commentary by Glen Ford

The new poll shows that no significant constituency supports Obama’s individual mandate.”

When one takes a cursory look at where various groups in the nation stand on President Obama’s health care legislation – now under review by the U.S. Supreme Court – it appears the country is split along party and race lines. A new poll conducted by Princeton Research Associates shows 75 percent of Democrats support the Obama position, and 86 percent of Republicans oppose it, with so-called independents evenly split. The racial divide is similar. Sixty-eight percent of non-whites “strongly favor” or “somewhat favor” the overall health care law, with only 18 percent opposed. Whites are far more divided, with 33 percent favoring Obama’s law, and 47 percent opposed.

These numbers are, however, heavily influenced by what people think is in the law, and what side they think they should be on, based on their larger loyalties. It is doubtful that majorities on either side of the issue actually understand most of the law’s many provisions, some of which do not go into effect for several years. Therefore, many of the respondents are using the poll to register their broader preference for or against the incumbent president and his party. It is no surprise that majorities of whites and super-majorities of Republicans oppose ObamaCare, as Republicans call it, and more than two thirds of non-whites and three-quarters of Democrats support Health Care Reform, as Obama calls it.

However, most people do understand the central element of the law, the “individual mandate” that forces nearly everyone to buy health insurance from private companies, or face a fine. The new poll shows that no significant constituency supports Obama’s individual mandate, with only 28 percent of the overall public favorable to the scheme. Even non-whites, two-thirds of whom claim to support Obama on health care in general, balk at mandatory purchase of insurance from private companies. Fifty-three percent of non-whites give thumbs down to the individual health insurance mandate, as do 71 percent of whites. More Democrats are opposed to Obama’s individual mandate than favor it: 48 to 44 percent. And Republicans are off the scale in opposition, at 15 to 1.

Fifty-three percent of non-whites give thumbs down to the individual health insurance mandate.”

So, if the core of the Obama health care plan is the individual mandate, as both the administration and the Republicans contend in their arguments before the Supreme Court, then Obama has based his plan on a scheme that nobody likes – even his most loyal supporters.

There’s another interesting aspect to the new poll. It shows that only a hard core of one in four people want to tamper with Medicare as the Republicans do, with around two-thirds of all racial groups opting to keep the program the way it is, with the government paying doctors and hospitals directly for the service they provide to seniors.” Taken together, the poll indicates strong support for the core elements of the U.S. healthcare safety net, and rejection of private schemes, including Obama’s mandatory purchase of insurance from private companies. It appears that most Americans would rather have the option of dependable, direct health care paid for by the government – which was the case at the beginning of 2009, before Obama unveiled his health care scheme, when 60 percent and more of the American people favored single-payer health care. But Obama maneuvered them into a something they hadn’t asked for, and which, three years later, nobody wants. For Black Agenda Radio, I’m Glen Ford. On the web, go to BlackAgendaReport.com.

 

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.

Freedom Rider: Obama Usurps the GOP March 2, 2012

Posted by rogerhollander in 2012 Election, Barack Obama, Political Commentary.
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Roger’s note: I generally stay away from posting articles analyzing the 2012 election, not because it is irrelevant, but because the election “debate” has little to do with the real world and the dangers therein, it is rather an exercise in surrealistic entertainment that would be funny if it weren’t tragically and menacingly insane.  The Black Agenda Review web site has consistently told it like it is about the Obama presidency, and this article while not necessarily brilliant, does put things in their proper perspective. 

by BAR editor and senior columnist Margaret Kimberley, www.blackagendareport.com, February 29, 2012

Republicans don’t know how to run against Obama because he has governed as one of them from the start.”

It seems strange that the issues of abortion and contraception have taken up such a large proportion of Republican campaign rhetoric. Every Republican presidential debate features candidates outdoing one another in declaring their opposition to a woman’s right to choose abortion.

I’m against abortion,” one will say, only to be silenced by another candidate declaring that he has been opposed to abortion longer, or with more vehemence, or even in cases of rape. Bizarre statements about contraception are the order of the day, and former senator Rick Santorum uses his home schooled children as a rallying point, unless of course he is telling Americans not to enjoy sex, because it is only for making babies. Liberals, who love nothing more than feeling superior to conservatives, are mystified by the campaign, which looks more like a trip in a time machine back to the 1950s.

Why would the Republicans use campaign issues which appeal to such a small group of their electorate? It is true that religious conservatives make up a large portion of their base of support, but there is something else going on, too.

The prominence of these outlier issues are a direct result of Barack Obama having taken over every other Republican talking point. Before he even took office Obama showed whose side he was on when he made it clear that he would continue the bailouts to the banks that George W. Bush began. He has expanded America’s defense budget and the wars that inevitably result. His “grand bargain” with conservatives has resulted in cuts to government programs and an agreement on austerity measures which are the exact opposite of what should be done to improve the economy and prospects for unemployed people.

Bizarre statements about contraception are the order of the day.”

Republicans don’t know how to run against Obama because he has governed as one of them from the start. They may mutter about “Obamacare” but his health care plan is a bailout of the health insurance industry and Big Pharma. They can’t call him weak on defense issues when he sends drones to kill people in Afghanistan or Pakistan or when he makes good on his threat to kill Muammar Gaddafi. Even American citizens like Anwar al-Awlaki are not safe when the president decides to literally take them out.

What is a conservative to do? Conservative pundit Bill Kristol called Obama a born again neo-con and Republican commentator Ben Stein said that Obama was the perfect Republican candidate. There is nowhere for the Republican faithful to go except to rail against the birth control mandate in the health care plan and call Obama an enemy of the Catholic church.

It isn’t difficult to amuse oneself when Rick Santorum says he throws up thinking about John F. Kennedy’s promise to the American public to keep religion out of government. It is all seemingly harmless theater, but the economic elite, the 1% if you will, win no matter who is in office.

It is indeed appalling when state legislatures across the country take on extreme positions in order to attack abortion. But make no mistake about it, there is never any opposition to thievery at the top because both parties kiss the rings of the rulers. The divide and conquer strategy is at work once again. While it is necessary to point out the dangerous Republican positions regarding women’s reproductive rights, it is also necessary to remember who runs the country and how they and their corporate media spokespersons never allow us to truly debate the most fundamental issues of the day.

Conservative pundit Bill Kristol called Obama a born again neo-con and Republican commentator Ben Stein said that Obama was the perfect Republican candidate.”

The media do not point out the inherent dangers of a billion dollar presidential campaign. If they did so, they would have to reveal how they manufacture public opinion and create phony outrage regarding a number of topics. Despite all the campaign rhetoric to the contrary, Mitt Romney, Rick Santorum, Newt Gingrich and Barack Obama are all conservatives. Gingrich may call Obama the food stamp president now, but neither man had any problems with the other when they joined forces to conduct a jeremiad against public education. Gingrich was welcomed to the White House, and he joined Obama mininion Al Sharpton in pushing for privatization of the schools and promoting a panoply of deadly corporate school “reform” measures.

We are fed a steady diet of manufactured opinion, pure propaganda which diverts our attention from the one constant in American politics. Money rules, and it will rule in January 2013 on inauguration day. Barack Obama will be that person because he plays the game better than anyone else. He has moved as far to the right as Ronald Reagan but Democrats still see him as their savior, the facts be damned. While the media have succeeded in creating smoke screens around contraception or the debate over the role of religion and government, the bailouts continue.

On Election Day in November 2012, we the people will lose, no matter who is giving a concession speech. All the outrage will have been misplaced and another defender of corporate control will rule over the rest of us. The divide and conquer strategy still wins the day.

Margaret Kimberley’s Freedom Rider column appears weekly in BAR, and is widely reprinted elsewhere. She maintains a frequently updated blog as well as at http://freedomrider.blogspot.com.Ms. Kimberley lives in New York City, and can be reached via e-Mail at Margaret.Kimberley(at)BlackAgendaReport.com.

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.

Single Payer Advocates Starting to Break Against Obama November 8, 2009

Posted by rogerhollander in Health.
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11.07.09 – 3:39 PM


“At the highest level this bill will enshrine in law the monopolistic powers of the private health insurance industry,” Massa said yesterday in a telephone press conference. “There’s no other way to look at it.”

 

by Russell Mokhiber

Single payer activists are starting to break against President Obama on health care reform.

On Thursday, Physicians for a National Health Program, in an e-mail message to its members, endorsed the view that “no bill is better than a bad bill.”

“Even the public option in the House is a sham,” the group said on Thursday.

PNHP’s John Geyman called on the House to shelve Obamacare.

“The negatives far outweigh the positives,” Geyman wrote.

Yesterday, Congressman Eric Massa (D-NY), a lead single payer advocate in the House, said he would vote against Obamacare.

And it wouldn’t matter what kind of pressure the White House or President Obama put on him to change his mind.

“I have respect for the chief executive, but I don’t work for him,” Massa said. “I work for people of the 29th Congressional District.”

“At the highest level this bill will enshrine in law the monopolistic powers of the private health insurance industry,” Massa said yesterday in a telephone press conference. “There’s no other way to look at it.”

The Rochester Democrat and Chronicle reported that Massa spent the last week studying 1,990-page H.R. 3962.

Massa said that the bill “fails to address the fundamental question before the American people, and that is, how do you control the costs of health care?”

Massa is the only solid no vote who turned on Obama because it gave too much to the insurance industry.

There are two other single payer advocates – Marcy Kaptur (D-Ohio) and Dennis Kucinich (D-Ohio) – who are undecided and may join Massa in the “no” camp when the House votes comes down – possibly as early as tonight.

In late July 2009, virtually the entire Congressional Progressive Caucus wrote a letter saying that anything less than a public option tied to Medicare rates was “unacceptable.”

But most have reneged on that position – including such progressives as Donna Edwards (D-Maryland) and Raul Grajalva (D-Arizona) – under pressure from Obama and the White House.

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