Thursday, January 28, 2010

An Open Letter to President Obama on Health Care Reform, By Margaret Flowers, M.D.

There is still time for real reform, listen to the American people

January 28, 2010

President Barack Obama|
1600 Pennsylvania Avenue
Washington, D.C. 20500

Dear President Obama,

I was overjoyed to hear you say in your State of the Union address last night:

"But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know."

My colleagues, fellow health advocates and I have been trying to meet with you for over a year now because we have an approach which will meet all of your goals and more.

I am a pediatrician who, like many of my primary care colleagues, left practice because it is nearly impossible to deliver high quality health care in this environment. I have been volunteering for Physicians for a National Health Program ever since. For over a year now, I have been working with the Leadership Conference for Guaranteed Health Care/ National Single Payer Alliance. This alliance represents over 20 million people nationwide from doctors to nurses to labor, faith and community groups who advocate on behalf of the majority of Americans, including doctors, who favor a national Medicare-for-All health system.

I felt very optimistic when Congress took up health care reform last January because I remember when you spoke to the Illinois AFL-CIO in June, 2003 and said:

"I happen to be a proponent of a single-payer universal health care program." [applause] "I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that's what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. And that's what I'd like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House."

And that is why I was so surprised when the voices of those who support a national single-payer plan/Medicare for All were excluded in place of the voices of the very health insurance and pharmaceutical industries which profit off the current health care situation.

There was an opportunity this past year to create universal and financially sustainable health care reform rather than expensive health insurance reform. As you well know, the United States spends the most per capita on health care in the world yet leaves millions of people out and receives poor return on those health care dollars in terms of health outcomes and efficiency. This poor value for our health care dollar is due to the waste of having so many insurance companies. At least a third of our health care dollars go towards activities that have nothing to do with health care such as marketing, administration and high executive salaries and bonuses. This represents over $400 billion per year which could be used to pay for health care for all of those Americans who are suffering and dying from preventable causes.

The good news is that it doesn't have to be this way. You said that you wanted to "keep what works" and that would be Medicare. Medicare is an American legacy of which we can feel proud. It has guaranteed health security to all who have it. Medicare has lifted senior citizens out of poverty. Health disparities, which are rising in this nation, begin to disappear as soon as patients reach 65 years of age. And patients and doctors prefer Medicare to private insurance. Why, our Medicare has even been used as a model by other nations which have developed and implemented universal health systems.

Mr. President, we wanted to meet with you because we have the solution to health care reform. The United States has enough money already and we have the resources, including esteemed experts in public health, health policy and health financing. Our very own Dr. William Hsiao at Harvard has designed health systems in five other countries.

I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system. We can implement it within a year of designing such a system.

What are the benefits of doing this?

* It will save tens of thousands (perhaps hundreds of thousands) of American lives each year, not to mention the prevention of unnecessary suffering.

* It will relieve families of medical debt, which is the number one cause of bankruptcy and foreclosure despite the fact that most of those who experienced bankruptcy had health insurance.

* It will relieve businesses of the growing burden of skyrocketing health insurance premiums so that they can invest in innovation, hiring, increased wages and other benefits and so they can compete in the global market.

* It will control health care costs in a rational way through global budgeting and negotiation for fair prices for pharmaceuticals and services.

* It will allow patients the freedom to choose wherever they want to go for health care and will allow patients and their caregivers to determine which care is best without denials by insurance administrators.

* It will restore the physician-patient relationship and bring satisfaction back to the practice of medicine so that more doctors will stay in or return to practice.

* It will allow our people in our nation to be healthy and productive and able to support themselves and their families.

* It will create a legacy for your administration that may someday elevate you to the same hero status as Tommy Douglas has in Canada.

Mr. President, there are more benefits, but I believe you get the point. I look forward to meeting with you and am so pleased that you are open to our ideas. The Medicare-for-All campaign is growing rapidly and is ready to support you as we move forward on health care reform that will provide America with one of the best health systems in the world. And that is something of which all Americans can be proud.

With great anticipation and deep respect,

Margaret Flowers, M.D.
Congressional Fellow, Physicians for a National Health Program

Tuesday, January 26, 2010

What Are Your Federal Budget Priorities?

U.S. Budget Priorities

This chart represents the U.S. discretionary budget - for last year. It does not include the bailout or the massive increase Congress voted overwhelmingly to give the Pentagon for this year.

The first limitation needs to be on defense spending; i.e. the stupid wars in Iraq, Afghanistan and marginally Pakistan.

There's something radically wrong when we're spending this proportion of our national budget for oversees military operations -  and we have the pressing economic/social catastrophe here at home.

Obama’s Credibility Gap

Published: January 25, 2010

Who is Barack Obama?

Americans are still looking for the answer, and if they don’t get it soon — or if they don’t like the answer — the president’s current political problems will look like a walk in the park.

Mr. Obama may be personally very appealing, but he has positioned himself all over the political map: the anti-Iraq war candidate who escalated the war in Afghanistan; the opponent of health insurance mandates who made a mandate to buy insurance the centerpiece of his plan; the president who stocked his administration with Wall Street insiders and went to the mat for the banks and big corporations, but who is now trying to present himself as a born-again populist.

Mr. Obama is in danger of being perceived as someone whose rhetoric, however skillful, cannot always be trusted. He is creating a credibility gap for himself, and if it widens much more he won’t be able to close it.

Mr. Obama’s campaign mantra was “change” and most of his supporters took that to mean that he would change the way business was done in Washington and that he would reverse the disastrous economic policies that favored mega-corporations and the very wealthy at the expense of the middle class and the poor.

“Tonight, more Americans are out of work, and more are working harder for less,” said Mr. Obama in his acceptance speech at the Democratic National Convention in August 2008. “More of you have lost your homes and even more are watching your home values plummet. More of you have cars you can’t afford to drive, credit card bills you can’t afford to pay, and tuition that’s beyond your reach.”

Voters watching the straight-arrow candidate delivering that speech, in the midst of the worst economic crisis since the Depression, would not logically have thought that an obsessive focus on health insurance would trump job creation as the top domestic priority of an Obama administration.

But that’s what happened. Moreover, questions were raised about Mr. Obama’s candor when he spoke about health care. In his acceptance speech, for example, candidate Obama took a verbal shot at John McCain, sharply criticizing him for offering “a health care plan that would actually tax people’s benefits.”

Now Mr. Obama favors a plan that would tax at least some people’s benefits. Mr. Obama also repeatedly said that policyholders who were pleased with their plans and happy with their doctors would be able to keep both under his reform proposals.

Well, that wasn’t necessarily so, as the president eventually acknowledged. There would undoubtedly be changes in some people’s coverage as a result of “reform,” and some of those changes would be substantial. At a forum sponsored by ABC News last summer, Mr. Obama backed off of his frequent promise that no changes would occur, saying only that “if you are happy with your plan, and if you are happy with your doctor, we don’t want you to have to change.”

These less-than-candid instances are emblematic of much bigger problems. Mr. Obama promised during the campaign that he would be a different kind of president, one who would preside over a more open, more high-minded administration that would be far more in touch with the economic needs of ordinary working Americans. But no sooner was he elected than he put together an economic team that would protect, above all, the interests of Wall Street, the pharmaceutical industry, the health insurance companies, and so on.

How can you look out for the interests of working people with Tim Geithner whispering in one ear and Larry Summers in the other?

Now with his poll numbers down and the Democrats’ filibuster-proof margin in the Senate about to vanish, Mr. Obama is trying again to position himself as a champion of the middle class. Suddenly, with the public appalled at the scandalous way the health care legislation was put together, and with Democrats facing a possible debacle in the fall, Mr. Obama is back in campaign mode. Every other utterance is about “fighting” for the middle class, “fighting” for jobs, “fighting” against the big bad banks.

The president who has been aloof and remote and a pushover for the health insurance and pharmaceutical industries, who has been locked in the troubling embrace of the Geithners and Summers and Ben Bernankes of the world, all of a sudden is a man of the people. But even as he is promising to fight for jobs, a very expensive proposition, he’s proposing a spending freeze that can only hurt job-creating efforts.

Mr. Obama will deliver his State of the Union address Wednesday night. The word is that he will offer some small bore assistance to the middle class. But more important than the content of this speech will be whether the president really means what he says. Americans want to know what he stands for, where his line in the sand is, what he’ll really fight for, and where he wants to lead this nation.

They want to know who their president really is.

Monday, January 25, 2010

If the administration sticks to its current trajectory, all bets are off for the political future of this president

Published: January 23, 2010

It was not a referendum on Barack Obama, who in every poll remains one of the most popular politicians in America. It was not a rejection of universal health care, which Massachusetts mandated (with Scott Brown’s State Senate vote) in 2006. It was not a harbinger of a resurgent G.O.P., whose numbers remain in the toilet. Brown had the good sense not to identify himself as a Republican in either his campaign advertising or his victory speech.

And yet Tuesday’s special election was a dire omen for this White House. If the administration sticks to this trajectory, all bets are off for the political future of a president who rode into office blessed with more high hopes, good will and serious promise than any in modern memory. It’s time for him to stop deluding himself. Yes, last week’s political obituaries were ludicrously premature. Obama’s 50-ish percent first-anniversary approval rating matches not just Carter’s but Reagan’s. (Bushes 41 and 43 both skyrocketed in Year One.) Still, minor adjustments can’t right what’s wrong.

Obama’s plight has been unchanged for months. Neither in action nor in message is he in front of the anger roiling a country where high unemployment remains unchecked and spiraling foreclosures are demolishing the bedrock American dream of home ownership. The president is no longer seen as a savior but as a captive of the interests who ginned up the mess and still profit, hugely, from it.

That’s no place for any politician of any party or ideology to be. There’s a reason why the otherwise antithetical Leno and Conan camps are united in their derision of NBC’s titans. A TV network has become a handy proxy for every mismanaged, greedy, disloyal and unaccountable corporation in our dysfunctional economy. It’s a business culture where the rich and well-connected get richer while the employees, shareholders and customers get the shaft. And the conviction that the game is fixed is nonpartisan. If the tea party right and populist left agree on anything, it’s that big bailed-out banks have and will get away with murder while we pay the bill on credit cards — with ever-rising fees.

Politically, no other issue counts. In last weekend’s Washington Post/ABC News poll, 42 percent of Americans chose the economy as the country’s most pressing concern. Only 5 percent picked terrorism, and 2 percent Afghanistan. Obama’s highest approval ratings are now on foreign policy and national security issues — despite the relentless hammering from the Cheney right — but voters don’t care.

Does health care matter? Not as much as you’d think after this yearlong crusade. In the Post/ABC poll, the issue was second-tier — at 24 percent. Obama has blundered, not by positioning himself too far to the left but by landing nowhere — frittering away his political capital by being too vague, too slow and too deferential to Congress. The smartest thing said as the Massachusetts returns came in Tuesday night was by Howard Fineman on MSNBC: “Obama took all his winnings and turned them over to Max Baucus.”

Worse, the master communicator in the White House has still not delivered a coherent message on his signature policy. He not only refused to signal his health care imperatives early on but even now he, like Congressional Democrats, has failed to explain clearly why and how reform relates to economic recovery — or, for that matter, what he wants the final bill to contain. Sure, a president needs political wiggle room as legislative sausage is made, but Scott Brown could and did drive his truck through the wide, wobbly parameters set by Obama.

Ask yourself this: All these months later, do you yet know what the health care plan means for your family’s bottom line, your taxes, your insurance? It’s this nebulousness, magnified by endless Senate versus House squabbling, that has allowed reform to be caricatured by its foes as an impenetrable Rube Goldberg monstrosity, a parody of deficit-ridden big government. Since most voters are understandably confused about what the bills contain, the opponents have been able to attribute any evil they want to Obamacare, from death panels to the death of Medicare, without fear of contradiction.

It’s too late to rewrite that history, but it may not be too late for White House decisiveness. Whatever happens now — good, bad or ugly — must happen fast. Each day Washington spends dickering over health care is another day lost while the election-year economy, stupid, remains intractable for Americans who are suffering.

On the economic front, Obama needs both stylistic and substantive makeovers. He has stepped up the populist rhetoric lately — and markedly after political disaster struck last week — but few find this serene Harvard-trained lawyer credible when slinging populist rhetoric at “fat-cat” bankers. His two principal economic policy makers are useless, if not counterproductive, surrogates. Timothy Geithner, the Treasury secretary, was probably fatally compromised from the moment his tax lapses surfaced; now he is stalked by the pileup of unanswered questions about the still-not-transparent machinations at the New York Fed when he was knee-deep in the A.I.G. bailout. Lawrence Summers, the top administration economic guru, is a symbol of the Clinton-era deregulatory orgy that helped fuel the bubble.

The White House clearly knows this duo is a political albatross. After the news broke that 85,000 more jobs had been lost in December despite some economists’ more optimistic predictions, Christina Romer, a more user-friendly (though still academic) economic hand, was dispatched to the Sunday shows. This is at best a makeshift solution.

Obama needs more independent economists like Paul Volcker, who was hastily retrieved from exile last week after the Massachusetts massacre prompted the White House to tardily embrace his strictures on big banks. Obama also needs economic spokesmen who are not economists and who can authentically speak to life on the ground. Obama must also reconnect. The former community organizer whose credit card was denied at the Hertz counter during the 2000 Democratic convention now spends too much time at the White House presiding over boardroom-table meetings and stiff initiative rollouts instead of engaging with Americans not dressed in business suits.

When it comes to economic substance, small symbolic gestures (the proposed new bank “fee”) won’t cut it. Nor will ineffectual presidential sound bites railing against Wall Street bonuses beyond the federal government’s purview. There’s no chance of a second stimulus. The White House will have to jawbone banks on foreclosures, credit card racketeering and the loosening of credit to small businesses. This means taking on bankers who were among the Obama campaign’s biggest backers and whose lobbyists have castrated regulatory reform by buying off congressmen of both parties. It means pressing for all constitutional remedies that might counter last week’s 5-to-4 Supreme Court decision allowing corporate campaign contributions to buy off even more.

It’s become so easy to pin financial elitism on Democrats that the morning after Brown’s victory the Republican Senatorial Campaign Committee had the gall to accuse them of being the “one party who bailed out the automakers and insurance companies.” Never mind that the Bush White House gave us the bank (and A.I.G.) bailouts, or that the G.O.P. is even more in hock than Democrats to corporate patrons. The Obama administration is so overstocked with Goldman Sachs-Robert Rubin alumni and so tainted by its back-room health care deals with pharmaceutical and insurance companies that conservative politicians, Brown included, can masquerade shamelessly as the populist alternative.

Last year the president pointedly studied J.F.K.’s decision-making process on Vietnam while seeking the way forward in Afghanistan. In the end, he didn’t emulate his predecessor and escalated the war. We’ll see how that turns out. Meanwhile, Obama might look at another pivotal moment in the Kennedy presidency — and this time heed the example.

The incident unfolded in April 1962 — some 15 months into the new president’s term — when J.F.K. was infuriated by the U.S. Steel chairman’s decision to break a White House-brokered labor-management contract agreement and raise the price of steel (but not wages). Kennedy was no radical. He hailed from the American elite — like Obama, a product of Harvard, but, unlike Obama, the patrician scion of a wealthy family. And yet he, like that other Harvard patrician, F.D.R., had no hang-ups about battling his own class.

Kennedy didn’t settle for the generic populist rhetoric of Obama’s latest threats to “fight” unspecified bankers some indeterminate day. He instead took the strong action of dressing down U.S. Steel by name. As Richard Reeves writes in his book “President Kennedy,” reporters were left “literally gasping.” The young president called out big steel for threatening “economic recovery and stability” while Americans risked their lives in Southeast Asia. J.F.K. threatened to sic his brother’s Justice Department on corporate records and then held firm as his opponents likened his flex of muscle to the power grabs of Hitler and Mussolini. (Sound familiar?) U.S. Steel capitulated in two days. The Times soon reported on its front page that Kennedy was at “a high point in popular support.”

Can anyone picture Obama exerting such take-no-prisoners leadership to challenge those who threaten our own economic recovery and stability at a time of deep recession and war? That we can’t is a powerful indicator of why what happened in Massachusetts will not stay in Massachusetts if this White House fails to reboot.

Friday, January 22, 2010

Will President Obama salvage his centerpiece? Four Choices for the Health Care Situation

ABC News
January 20, 2010
George Stephanopoulos' Exclusive Interview with President Obama

President Obama: I would advise that we try to move quickly to coalesce
around those elements of the package that people agree on. We know that we
need insurance reform, that the health insurance companies are taking
advantage of people. We know that we have to have some form of cost
containment because if we don't, then our budgets are going to blow up and
we know that small businesses are going to need help so that they can
provide health insurance to their families. Those are the core, some of the
core elements of, to this bill.


President Obama: If you ask the American people about health care, one of
the things that drives them crazy is insurance companies denying people
coverage because of preexisting conditions. Well, it turns out that if you
don't -- if you don't make sure that everybody has health insurance, then
you can't eliminate insurance companies -- you can't stop insurance
companies from discriminating against people because of preexisting
conditions. Well, if you're going to give everybody health insurance, you've
got to make sure it's affordable. So it turns out that a lot of these things
are interconnected.

Comment: It looks like there are four choices: 1) walk away and accept the
status quo, 2) use alternative political maneuvers to move the bill through
Congress, 3) attempt to salvage at least a portion of the less
controversial components of the current proposal, or 4) start over. Let's
look at these.

1) Walk away

Far too many individuals and businesses are no longer capable of paying the
very high costs of our health care system. The existing spending controls in
government and in the marketplace show no evidence of ameliorating the
excessive growth of our total national health expenditures. The status quo
is unacceptable. On this everyone agrees, so we cannot walk away.

2) Move the bill through Congress anyway

The strategy that has been advanced to pass the bill relatively intact would
be to have the House approve the Senate version, and then make corrections
in a budget reconciliation process. We can forget this approach since the
bill managers' head count in the House has come up far short of the votes
needed. Also, cramming the bill through before Sen. Kirk is replaced by
Scott Brown has been rejected by President Obama and other Democratic
leaders. But the overriding reason why this bill will not clear Congress
intact is that a majority of Americans are very displeased with it - that
includes all conservatives, most liberals, and a majority of moderates.
Sometimes we question the collective wisdom of Congress, but they're not
that dense.

3) Salvage a portion of the legislation

Crafting a health care financing system and integrating it with the health
care delivery system creates a dysfunctional system if it is done piecemeal.
That's what we've been doing over the past century, and it's obvious where
that has led. As President Obama said, "it turns out that a lot of these
things are interconnected."

President Obama and some members of Congress would still like to salvage the
centerpiece of this legislation - making health insurance markets work for
us. They would like to do that without including the policies that offended
so many in Massachusetts and throughout the nation - new taxes, and an
individual mandate to purchase private insurance. If there is no mandate
then there is less need for the taxes that would be required to pay for the
private insurance subsidies. Of course, without a mandate, many more will be
left uninsured, but that seems to be the price that many members of Congress
are willing to pay simply to pass something that looks like reform.

President Obama shows that he understands the greatest difficulty with
reforming the private insurance market as a stand-alone process. The insurer
abuses that he wants to eliminate were there for a reason. They are designed
to reduce the amount of health care that the insurers fund. Once the
insurers are required to cover all risks, insurance premiums increase. With
no mandate, many of the healthy will decide they cannot afford the higher
premiums and will remain uninsured. The adverse selection that would result
could send our entire private insurance industry into a death spiral of
skyrocketing premiums.

Obviously, as we've been saying all along, the centerpiece based on private
insurance plans is inherently a dysfunctional model that can never achieve
efficiency, equity, universality, and affordability for all of us.

That said, there are some measures in this legislation that could be
salvaged and enacted on an emergency basis until we finish the task of
delivering a just health care system for all. As prime examples, we should
move immediately to expand Community Health Centers and to reinforce our
primary care infrastructure. We should also recover the overpayments to the
Medicare Advantage plans that are wasted on excess administration and
investor profits. There are many other beneficial measures that could be
enacted without requiring that they be part of an omnibus bill.

4) Start over

The policy work has already been done. We know what we need - an improved
Medicare for all national health program. President Obama and most of the
Democrats in Congress know that as well.

Even the conservatives certainly understand that it would work for all of us
and that, once enacted, it would be in place forever because of its
popularity. Since they can't oppose it based on its sound policies, they
simply oppose it based on their ideological opposition to social solidarity.
That is perhaps the saddest reality in this whole debate

Don McCanne
Quote of the Day

Wednesday, January 20, 2010

Obama Finally Gets His Victory For Bipartisanship

Drew WestenPsychologist and neuroscientist; Emory University Professor
Posted: January 20, 2010 02:32 AM

You can blame a bad candidate, bad organization, bad timing of a vacation -- choose your rationalization. But the reality is that voters in Massachusetts were reacting to the same foul mist coming off Boston Harbor that New Jersey Voters smelled coming off the Hudson and Virginia voters off the Chesapeake.

What they all understood was that the source lay on the shores of the Potomac.

It is a truly remarkable feat, in just one year's time, to turn the fear and anger voters felt in 2006 and 2008 at a Republican Party that had destroyed the economy, redistributed massive amounts of wealth from the middle class to the richest of the rich and the biggest of big businesses, and waged a trillion-dollar war in the wrong country, into populist rage at whatever Democrat voters can cast their ballot against.

All of this was completely predictable. And it was predicted. I wrote about it for the first time here on the sixth day of Obama's presidency, and many of us have written about it in the intervening year.

The President's steadfast refusal to acknowledge that we have a two-party system, his insistence on making destructive concessions to the same party voters he had sent packing twice in a row in the name of "bipartisanship," and his refusal ever to utter the words "I am a Democrat" and to articulate what that means, are not among his virtues. We have competing ideas in a democracy -- and hence competing parties -- for a reason. To paper them over and pretend they do not exist, particularly when the ideology of one of the parties has proven so devastating to the lives of everyday Americans, is not a virtue. It is an abdication of responsibility.

What happens if you refuse to lay the blame for the destruction of our economy on anyone -- particularly the party, leaders, and ideology that were in power for the last 8 years and were responsible for it? What happens if you fail to "brand" what has happened as the Bush Depression or the Republican Depression or the natural result of the ideology of unregulated greed, the way FDR branded the Great Depression as Hoover's Depression and created a Democratic majority for 50 years and a new vision of what effective government can do? What happens when you fail to offer and continually reinforce a narrative about what has happened, who caused it, and how you're going to fix it that Americans understand, that makes them angry, that makes them hopeful, and that makes them committed to you and your policies during the tough times that will inevitably lie ahead?

The answer was obvious a year ago, and it is even more obvious today: Voters will come to blame you for not having solved a problem you didn't create, and you will allow the other side to create an alternative narrative for what's happened (government spending, deficits, big government, socialism) that will stick. And it will particularly stick if you make no efforts to prevent it from starting or sticking.

Were Massachusetts voters reacting in part to the health care debate turned debacle? Sure. In a misguided effort to avoid the mistakes of 1993, the President decided that leadership on health care wasn't in his job description and encouraged the Democrats to make their sausage in public, after making his own deals with the same people who brought us pre-existing conditions and $150 prescriptions (and that's with insurance). He promised transparency, and he gave the country a huge dose of it. Unfortunately, what was transparent turned people's stomachs.

The White House allowed the health care narrative to be all about process, and the process the American people saw wasn't pretty. It scared seniors, who worried what would happen to their Medicare. It scared workers, who worried about what would happen to the plans their unions had negotiated so hard for in lieu of salaries. It scared middle class Americans with good health insurance plans, who had -- and have -- no idea whether their plans will be deemed -- if not today, in three or four years -- Cadillacs, which will first be taxed and then discontinued, leaving them with exactly what Frank Luntz told them it would leave them with: a bureaucrat between them and their doctor. And worst of all, it seemed to most Americans that the reason they were being asked to make such potentially big sacrifices was so that health insurance companies, pharmaceutical companies, and millionaires wouldn't have to. It seemed not only risky but unfair.

So in that sense, the story of health insurance played right into the story that lies behind the looming tsunami that swept away Ted Kennedy's Senate seat and will sweep away so many more Democratic seats if the Democrats draw the wrong conclusions from this election. The White House just couldn't seem to "get" that the American people could see that they were constantly coming down on the side of the same bankers who were foreclosing people's homes and shutting off the credit to small business owners, when they should have been helping the people whose homes were being foreclosed and the small businesses that were trying to stay afloat because of the recklessness of banks that were now starving them. Americans were tired of hearing Obama "exhort" bankers and speculators to play nice as they collected their record bonuses for a heckuva job in 2009. It took him a year to float the idea of making them pay for a fraction of the damage they had done, and at this point, few Americans have any faith that a tax on big banks will ever become law or that the costs won't just be passed on to them in new fees.

The White House has squandered the greatest opportunity to change both the country and the political landscape since Ronald Reagan. It should have started with a non-watered-down stimulus package big enough to stop the bleeding in the job market -- and a smack-down of any Republican who dared to utter the word "deficit" after 8 years of reckless, unpaid Republican spending. It should have followed with stringent regulations on Wall Street and protection of homeowners and small businesses instead of with a jobs creation program inside the administration for failed bankers and failed regulators. A stimulus -- including a jobs program -- strong enough to prevent the hemorrhaging of 700,000 jobs a month and a muscular approach to the bad actors who had crashed the economy would have gotten the public firmly behind the President and the Democrats, demonstrating to the average voter that they have a choice between one party that's on their side and another that's not. Instead, the White House just blurred the lines between the parties so the average American couldn't tell the difference.

With all its efforts to tack to the center, the White House missed the point. The issue isn't about right or left. It's about whose side you're on. In Massachusetts, the voters believe they know. It's now up to the President and his party to convince the American people otherwise.
Move Your Money

As President Obama took office last year, many of us watched with dismay and disgust as Washington handed out billions of dollars - with no strings attached - to bailout the banks and financial institutions - the very individuals who were in the driver's seat when the economy tanked. But "too-big-to-fail" means "we must bail," or so were told.

Despite carting taxpayer dollars into Wall Street coffers, homeowners continued to foreclose on their homes and cash-strapped businesses were rapidly being forced to close their doors. All the while, the bailed-out banks have continued to pay out millions in executive bonuses, raise credit card rates for consumers, and have failed to free up credit for small businesses. To top it all off, Congress has failed to pass financial reforms in the 16 months since the economic crash to prevent another crisis like this one from happening again.

Well, it's time to take action and put our money where our mouth is! This New Year's, Arianna Huffington challenged us to Move Our Money into community banks and credit unions that did not receive money from the bailouts and are more likely to invest in local communities. Read more about it here.

Find out how you can move your money by finding a community bank or credit union near you.

As President Obama took office last year, many of us watched with dismay and disgust as Washington handed out billions of dollars - with no strings attached - to bailout the banks and financial institutions - the very individuals who were in the driver's seat when the economy tanked. But "too-big-to-fail" means "we must bail," or so were told.

Despite carting taxpayer dollars into Wall Street coffers, homeowners continued to foreclose on their homes and cash-strapped businesses were rapidly being forced to close their doors. All the while, the bailed-out banks have continued to pay out millions in executive bonuses, raise credit card rates for consumers, and have failed to free up credit for small businesses. To top it all off, Congress has failed to pass financial reforms in the 16 months since the economic crash to prevent another crisis like this one from happening again.

Well, it's time to take action and put our money where our mouth is! This New Year's, Arianna Huffington challenged us to Move Our Money into community banks and credit unions that did not receive money from the bailouts and are more likely to invest in local communities. Read more about it here.

Find out how you can move your money by finding a community bank or credit union near you.

The Only Recognizable Feature of Hope is Action; Listen Carefully Mr. President


Dear Mr. President,

Your administration and your party are in trouble. That is clear from the elections in Massachusetts and Virginia, from the drop in your approval rating, from the rise of conservative opposition groups.

This is a time when progressive forces in this country need to mobilize to prevent a backlash that will take this country further to the right. But progressives are disappointed and demoralized. Look at me.

In 2008, I was one of millions united for hope and change. As 2010 dawns, change looks to me like more of the same. Instead of peace, we got more war. Instead of healthcare reform, we have an industry win that requires Americans to buy health insurance without any real cost controls. On the environment, one of your top priorities, you came back from Copenhagen with yet another non-binding resolution and more clean coal, to boot. Instead of helping struggling homeowners and small businesses during the financial crisis, bank executives were rewarded and we have yet to see reform. Wall Street firms ended 2009 with record bonus and profits while unemployment remains in double digits.

Obama, I am losing hope. This is not the change I believe in. The change I believe in puts people and our planet before industry, it promotes peace, international law and human rights instead of militarism. As you are asking Congress to approve the largest Pentagon budget in history, plus another $33 billion to pay for your Afghan surge, the prophetic works of Dr. Martin Luther King sound a clarion call: A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.

Obama, we need renewed leadership, we need you to show us—not in words but in deeds—that you can stand up to corporate interests that are blocking us from real healthcare, environmental and financial reform. We need you to show us—not in words but in deeds—that you will stand up for the Constitution, for due process, for the rule of law. We need you to show us—not in words but in deeds—that you lead this country out of endless war to a nation that lives in peace with its neighbors.

In the meantime, I pledge to keep pushing your administration and Congress, and mobilizing others--not for partisan politics but for policies of social and environmental uplift.

May 2010 be a year of renewed commitment and movement toward the change we so desperately need.

Monday, January 18, 2010

Disarray, disgust and despair among healthcare reformers. Let's Talk w/TeaBaggers


It has long been apparent that there was no consensus among 'progressives' on the best way to achieve universal health care. From the very beginning, MoveOn and the labor movement gave lip service (sometimes) to single payer ideas but put their money behind whatever the President proposed. As we now know, what the President proposed changed daily, shifting each time one or another well-heeled lobbying group demanded a 'compromise.' Eventually there was no legislation that addressed health CARE, only legislation addressing health INSURANCE. The Administration shifted its labeling from 'health reform' to 'health insurance reform.' After that, the supporters of the President's plan began to talk about jumping ship, but never got up the courage to actually do so.

Instead, despair at ever achieving universal equitable health care led to disgust with the blatant purchase of Congressional votes and then disarray among those who voted and worked for Obama's election.

The result is a Democratic Senatorial candidate intended to replace Teddy Kennedy but who will likely lose to a Republican whom no one has ever heard of. The next result is a dramatic loss of the Democratic majority in the Senate and probably in the House during the mid-term elections. The final result will be the likely emergence of a challenger to Obama from within the Democratic Party and, ultimately, the election of a Sarah Palin lookalike (if not Palin herself) as the next President in 2012.

What a horror show!

At this point, despair, disgust and disarray may be all that will save us from driving over a cliff with the Palinistas. How so?

If a Republican is elected in Massachusetts, say goodbye to any health legislation that can be styled as reform. Even without a new Republican senator, health reform may never be enacted. No matter how much ObamaRahma pushes at Congress, the disarray among progressives guarantees that no one on the left will like what is proposed for passage. Even those who say "something is better than nothing" only say so out of a forlorn loyalty to the idea that a defeat for Obama's health legislation is a defeat for Obama.

I think not. The best thing that could happen to Obama (and America) is for the Congress to FAIL at passing any health legislation. (Boy, is that statement going to raise some more rude and hypercritical email responses -- like these from the last 'Dumbocrats' letter.) That would give Obama the chance to do now what he should (and could) have done at the beginning. That will give everyone the chance to say 'OK, we now know that the system is beyond any rational attempt to repair it. We are starting from scratch.' That will give Democrats, Republicans, progressives and TeaPartiers the chance to talk about health CARE rather than health INSURANCE. That will give citizens the chance to reconsider, regroup and perhaps even join together to promote the one plan that could conceivably gain the approval of most Americans, whatever their ideology - Medicare For All.

Don't laugh at the idea of a progressive sitting down at a TeaParty. The opportunity is there -- we have to change the dialogue from health INSURANCE to health CARE. And then we have to show the TeaPartiers that they are better off when they enjoy the same type of health CARE that everyone else (rich and poor) also enjoys. Because very few of them (or of us, or of anyone) can be sure of equitable and reliable health CARE now, regardless of what kind of health INSURANCE anyone has. That is, very few of us except those already getting Medicare. So it is time to show the TeaPartiers that we progressives can reject despair, disarray and disgust. It is time to show them and ourselves that health CARE is what we should have been talking about all along. The argument is NOT ABOUT MONEY. The argument is about whether we should all get health CARE - you, me, the guy next door, everybody.

Sunday, January 10, 2010

How the World Balances Health Care Risk

The New York Times
January 8, 2010
By Uwe E. Reinhardt

In last week’s post I used a stylized illustration to throw into sharp
relief the economic and ethical dimensions of community-rated premiums for
health insurance.

I am gratified by the many comments that post drew, and even more so by
their quality. (In fact, I have shared these comments with my students in a
course on health policy.) The comments show that there is no consensus on
the merits of community rating in this country.

Remarkably, in virtually all other industrialized nations, this issue is
hardly ever raised. Community rating there has long been widely accepted and
is unlikely to be abandoned in the foreseeable future.

The health systems of Switzerland, the Netherlands and Germany are
frequently cited as potential models for a reformed American health system.
All three countries offer their citizens a wide choice of health insurers “
none of which is a government-run health plan. Yet in all three countries
full community rating is de rigueur.

Swiss citizens, for example, are required to purchase insurance coverage for
a comprehensive health-benefit package from a large menu of private health
insurance companies that compete for customers on the basis of the premium
they charge for that coverage.

Profits cannot be earned on insurance for the basic package. Premiums do
vary among competing insurers, but for a given insurer they can vary only by
the deductible and coinsurance rates of the different policies. Neither the
individual’s health status nor age affects the premium charged the
individual by a given insurer. Health insurers ending up with an older or
sicker enrolled risk pool then receive compensation from a risk-equalization

Similarly, Dutch citizens are mandated to purchase insurance coverage for a
comprehensive benefit package from a menu of private for-profit or
not-for-profit insurers.

Roughly half of the cost of this coverage is financed by a payroll tax “
that is, it is based roughly on ability to pay. The other half comes from
competitively set premiums collected directly from those enrolled.

The payroll taxes are paid into a national risk-equalization fund that then
pays a risk-adjusted amount to the insurance carrier chosen by a particular
individual. Among health services researchers, this risk-adjustment
mechanism has long been viewed as one of the most sophisticated in the

The part of the premium collected by Dutch insurers directly from
individuals is fully community-rated. Although these premiums vary among
insurers, a given insurer must charge all comers, healthy or not, young or
old, the same premium, which is community-rated over that insurer’s pool of
those insured.

Germany’s statutory health insurance system, covering about 90 percent of
the population, also has a national risk-equalization fund, which is fed by
a flat payroll tax on gross income of about 14 percent paid by all employees
insured by that system.

The risk-equalization fund makes a risk-adjusted payment to the health
insurer (which is a nonprofit “sickness fund”) of the individual’s choice.
That payment from the risk-equalization fund, of course, does reflect the
individual’s health status and age. But the individual’s payroll-tax payment
into the risk-equalization fund is completely independent of the
individual’s age and health status. It is based strictly on ability to pay.

I could continue to describe the health insurance systems of other European
countries, or Canada, Taiwan, Japan, Korea, Australia or New Zealand. We
would find that in none of these health systems does the individual’s or
family’s contribution to health insurance reflect that individual’s age or
health status.

Community rating is so acceptable in these countries because citizens there
view it not only as part of a larger social contract, but also as a vehicle
for life-cycle economic planning.

The vast majority of citizens in these countries view health care as a
so-called “social good” that is to be shared on the basis of need by all on
roughly equal terms and is to be financed largely on the basis of ability to

By contrast, Americans have never agreed on a shared social ethic that
should govern their health system, as the current debate over health reform
has made visibly and audibly clear.

Furthermore, younger and healthier people in these countries realize that,
but for the grace of God, they might become chronically ill only a few years
hence and that, in any event, one day they, too, will be older and sicker.
By paying more than their actuarially expected cost for health insurance,
young and healthy people in these countries join a club, so to speak, that
offers them a valuable call option. That call option allows them to procure
at age 55; health insurance at a premium much below their actuarially
expected cost.

By contrast, Americans have been taught that health insurance is largely a
private consumption item purchased year to year and customized to the
individual’s circumstances. Indeed, the private health insurance industry in
this country has never been able to offer individual Americans the kind of
life-cycle health insurance citizens in virtually all other industrialized
nations take for granted. With the exception of Medicare, all health
insurance in the United States is basically temporary.

Curiously, however, although Americans often flatter themselves with the
image of being self-reliant, rugged individualists, they actually tend to
rely more than citizens in many other countries on government-run health
insurance and pensions in their old age, or when they fall on hard times. It
is what makes the creature called “American” so perplexing in the eyes of

Furthermore, many Americans who oppose community-rated insurance in the
current health-reform plan are themselves beneficiaries of community rating.
I shall have something more to say about this oddity in my next post to this

Monday, January 04, 2010

Why Democrats Are Trying to Commit Electoral Suicide

by: Ian Welsh
Mon Jan 04, 2010 at 00:01

Forty-five percent of the Democratic base now says they aren't going to vote in 2010 or are thinking of not voting. This is a direct result of Democrats in Congress and the Presidency doing things the base disagrees with or not doing things the base wants to see done. It appears politically stupid to act as they have, and yet, they did. So why?
Elected Democrats at the Federal level are members of the national elite. If they weren't a member when they were elected, they are quickly brought into the fold. They are surrounded by lobbyists, other members and staffers who were lobbyists, as a rule. They learn they need to raise immense amounts of money in the off years when normal people aren't giving, and that the only way to raise that money is for corporate interests and rich people to write the checks. They also receive the benefits of elite status, very quickly. It's not an accident that the every Senator except Bernie Sanders is wealthy.

Whatever Americans think, whether they support a public option or single payer; whether they're for or against Iraq or Afghanistan; whether they agree with bailing out banks or not, elite consensus is much much narrower than American public opinion. It starts at the center right and heads over to reactionary (repeal the entire progressive movement and the New Deal, taking America back to the 1890s).

The elites are convinced they know what has to be done. Not necessarily what's "best", but what is possible given the constraints they believe America operates under and the pressures which elected officials work with. So Obama can say, and mean, that if he were creating a medical system from scratch, he'd go with single payer. But he "knows" that's impossible, not just for political reasons, but because there are huge monied interests who would be horribly damaged or even destroyed by moving to single payer. On top of that, he looks at the amount of actual change required to shift all that money away from insurance companies and to reduce pharma profits, and to change which providers get paid what, and he sees it as immensely disruptive to the economy. In theory, it might lead to a better place, but to Obama, the disruption on the way there is unthinkable.

The same thing is true of the financial crisis. The banks may be technically insolvent, but the idea of nationalizing them all, or shutting them down and shifting the lending to other entities would mean that the most profitable (in theory, not in reality) sector of the economy would largely be wiped out. Add to that the fact that Obama was the largest recipient of Wall Street cash of the major candidates for the Presidency, and the immense influence the banks wield through their alumni who are placed throughout the Federal Reserve, the Treasury and other departments, and the idea of actually radically reforming the banking system becomes unthinkable. Virtually every technocrat giving Obama, or most Senators advice, will be against it.

Moreover they understand that with a few exceptions, the financial economy is the American economy. It's what the US sold to the rest of the world: pieces of paper in exchange for real money which could be used to import real goods, so Americans could live beyond their means.

Shut that down and what's going to replace it? How are you going to avoid an immediate meltdown of the US standard of living? How are you going to avoid a large part of the elite being wiped out? You or I may have answers to that, except to wiping out a large chunk of the elite, which is something which needs to be done, but those who grew up under the system, who believe in the system, and who ran the system don't. What they've done all their lives is what they understand. And more to the point the system has been good to them. The last 35 years may have been a bad time to be an ordinary American, but the elite has seen their wealth and income soar to levels even greater than the gilded age. The rich, in America, have never, ever, been as rich as they are now.

And if you're a member of the elite, your friends, your family, your colleagues—everyone you really care about, is a member of the elite or attached to it as a valued and very well paid retainer. For you, for everyone you care about, the system has worked. Perhaps, intellectually, you know it hasn't worked for ordinary people, but you aren't one of them, you aren't friends with them, and however much you care in theory about them, it's a bloodless intellectual empathy, not one born of shared experience, sacrifice and the bonds of friendship or love.

So when a big crisis comes, all of your instincts scream to protect your friends, your family, and the system which you grew up under, prospered under and which has been good to you. Moreover, you understand that system, or you think you do, and you believe that with a twiddle here and an adjustment there, it's a system you can make work again. Doing something radical, like single payer or nationalizing the banks or letting the banks fail and doing lending direct through the Fed and through credit unions: that's just crazy talk. Who knows how it would work, or if it would work? Why take a chance?

And so, until disaster turns into absolute catastrophe, the elites will fiddle with the dials, rather than engaging in radical change. When the time comes when it becomes clear even to them that radical change is required, they are far more likely to go with their preconceived notions of what's wrong with the US, which are very reactionary, than to go with liberal or progressive solutions.

So you're far more likely to see Medicare and Social Security gutted, than you are to see the military budget cut in a third or Medicare-for-all enacted. You're far more likely to see a movement to a flat tax (supported by idiot right wing populists) than you are to see a return to high marginal taxation.

To the elites, ordinary Americans are pretty much parasites. It's not the bankers, with their multi-trillion dollar bailouts who are the problem, it's old people with their Social Security and Medicare. The elites made it. They are rich and powerful. They believe that their success is due entirely to themselves (even if they inherited the money or position). If you didn't, then that means you don't deserve it.

Democratic party elected leaders, as a group, are members of this elite, or are henchmen (and some women) of this elite. They believe what the elites believe, and they live within a world whose boundaries are formed by those beliefs.

They have no intention of engaging in radical change which threatens elite, which is to say, their, prosperity and power. The financial industry must be saved, the medical industry must be saved. Social Security and Medicare, which they don't need and don't benefit from, not so much. The military, which funnels huge amounts of money to them, must continue to expand (in real terms military spending is now twice what it was in 2000.)

As long as elected Democrats at the Federal level are members of this elite, or identify with the elite they are not going to make fundamental changes against the interests of that elite.

And so, no, there is no "change" you can believe in from this class of Democrats. There is no "hope" of an America which is better for ordinary people.

That doesn't mean things are hopeless, but it does mean there's little hope for anything radical from this Congress or President.

As Adam Smith pointed out, there's a lot of ruin in a nation. America's going to have to endure a lot more of it before things actually change.