Sunday, December 20, 2009

Friday, December 11, 2009

"Would you commit murder?": Copenhagen Time

Note for the 1(hi baby!)-1000 readers of Arob's View: My posts have been few and far between lately. I just became gainfully employed as a semi-permanent teacher's assistant sub in 6th grade special ed class (might lead to some interesting posts on the state of public education in poor urban areas, we'll see) and I'm applying to law school at the same time. Once the application process is over, hopefully by Christmas pending one more letter of recommendation, regular blogging will resume, probably more than normal. Between Copenhagen obstruction and the Afghanistan escalation I have a lot to comment on (and obviously critique)!

It's Copenhagen time, folks. What goes down in the next couple days or so will go a long way toward deciding how devastating global warming will be, and how much rich countries will help out the poor ones (especially in Africa and the small island states) that will bear the worst impacts.

It's ridiculous how little the American media is covering Copenhagen. Only the fate of millions of people and the capability of our planet to support life is at risk! Even the liberal blogosphere has been pretty mum on the subject.

Fortunately a few outlets have stepped up. The Nation magazine (a fine magazine by the way) has a couple journalists there posting updates on their Copenhagen blog here, including the great Naomi Klein. The Nation is cooperating with the Grist online environmental magazine, Mother Jones, and several other outlets in the Copenhagen News Feed, which you can see on the right side of The Nation's page.

Also the left-oriented Democracy Now! radio and TV show is broadcasting live from Copenhagen this week and last week. It's a great show hosted by Amy Goodman that runs on public television and radio across the country. She's getting some exclusive scoops from inside the conference, particularly from the climate justice perspective. So far I've enjoyed interviews with: Nmimo Bassey, the legendary head of Environmental Rights Action in Nigeria (affiliated with Friends of the Earth International), the new leader of Greenpeace International, Kumi Naidoo (known for anti-apartheid activism in his home country of South Africa), Gw'ichin representative Sarah James from Alaska, and even Archbishop Desmond Tutu of South Africa. It's clear how the climate fights is more and more about JUSTICE for the Global South, and I think the presence of so many anti-apartheid activists fighting in Copenhagen like Naidoo, the Archbishop, and even Nelson Mandela is illustrative of that phenomenon.

However awesome those interviews were, I most enjoyed Amy's interview of the 15 year-old youth representative from the Maldives (a Pacific island state), Mohamed Axam Maumoon, which I included at the top of this post. It's easy to be pessimistic about the climate talks. Especially coming from the Maldives, which will probably be under water before we realize how bad we've fucked with the global climate. He points out, as I quote in the title of this post, that allowing the climate tragedy to happen with at least partial knowledge amounts to murder of the people and cultures that will die as a result. Still, this young lad's spirits are high. He's so pumped about the youth summit and pleading his case to even the PM of Denmark. We in the US need to duplicate his resolve and match it with his realistic view of how drastically we need to change our energy productions systems to stave off disaster.

Let me give you the Cliff's Notes of Copenhagen from a US perspective for those who haven't been following: despite a new president, the US is still obstructing the talks. Not only are our emissions reductions goals for 2020 pathetically low, but our offer for climate aid to the Global South is ridiculously scanty. Let me be clear: the Obama administration does not get climate. They don't get how huge a problem is and they still won't acknowledge the massive climate debt we owe to the most impacted countries. 2008 Obama supporters need to wake up and realize that better than Bush is not sufficient on climate! (It's not sufficient on a plethora of issues, but I'll save that for another day).

Fortunately, the poor countries are fighting back as an organized bloc. We in the developed world, especially in our country, need to support them. I encourage you to get on the list of, Friends of the Earth US, and Friends of the Earth International and pepper the hell out of the administration with emails and calls on the climate talks. The message is clear: less emissions, more aid for developing countries!

Sunday, November 29, 2009

The Freedom To Know That Charles Is Not In Charge

If you've ever seen the Chapelle Show, you probably know who Paul Mooney is, but you might not know his background. A brilliant standup comic on his own, he also wrote material for Richard Pryor and a number of tv shows, as well as shepherding several other standup comedians to fame. He is notorious for pulling no punches.

As I was driving back from New York last weekend I caught Paul Mooney's appearance on the Tavis Smiley Show (yeah public radio!) discussing his life and his new book, Black Is The New White, which according to Paul "white people are going to buy to burn in their fireplace." He touches on Pryor, Cosby, deciding to become a comedian, being notorious, race, and what it means to be free. Tavis includes great clips from both Pryor and Mooney. Check out the segment here. Let me give you some choice quotes to entice you to listen.

Paul on white appropriation of black entertainers:
"They caught on because our race caught on...If we go to like something, they study us. That's why they bring things into the ghetto to find what's going on. Cause we're the most cleverest people in the world. We survived slavery. We're still here."
Mooney on freedom:
"The freedom to not be afraid. The freedom to know that Charles is not in charge. The freedom to know that as a black male that I come from the land of kings and queens. And the freedom to know that Queen Elizabeth is not all that."
Near the end, he makes a great note about slavery. He reminds us, as Marx does, that capital owned by white people today is built on capital accumulated in the past, including in the time of slavery in our nation.

Tuesday, November 24, 2009

Bagram=Obama's Gitmo

"If I deserve imprisonment, then imprison me. If not, let me go free." -Abdul Raqeeb in above video

This is a great interview. Note not only the extreme abuse of their human rights, but also the impact it has on the perception of the occupation. No wonder so many Afghans want us out!

Theoretically speaking, could the occupation take a more benevolent form without unjustified home invasions and indefinite detention without habeas corpus? Yes but you'd have to be naive as hell to think that would happen (remember when Rummy talked about winning hearts and minds?). This attitude toward the occupied people is part-and-parcel of American counterinsurgency efforts there. Given Obama's record so far on war and civil liberties, I think we can expect more of the same.

Glenn Greenwald notes in yet another great post that Bagram is also home to rendered terror suspects from other countries. It is clear now that the closing of Guantanamo is a big deal symbolically, but doesn't represent a huge change in policy. Bagram performs the same function that Gitmo did except with less scrutiny because it's way off in Afghanistan and exists under a president who is supposed to be a big civil liberties supporter.

Here's Glenn's summary of recent events:
"So, to recap: we have indefinite detention, military commissions, Blackwater assassination squads, escalation in Afghanistan, extreme secrecy to shield executive lawbreaking from judicial review, renditions, and denials of habeas corpus. These are not policies Obama has failed yet to uproot; they are policies he has explicitly advocated and affirmatively embraced as his own."
We're closing in on a year of Obama's presidency. He is now responsible for these assaults on the rule of law, transparency, and human rights as much as Bush was. We need to join Glenn and others in criticizing these policies with the same vehemence we excorciated Bush's.

Thursday, November 19, 2009

The Khalid Sheikh Mohammed Show Trial

If you thought the Obama administration deserves credit for trying Khalid Sheikh Mohammed and 5 other terrorist in a NYC civilian court, think again. Glenn Greenwald savages Attorney General Eric Holder and President Obama for the hypocrisy of trying 5 people in civilian court while deciding to try others in military commissions and detain others indefinitely (75 of them to be exact) (read the whole piece). He also points out that their refusal to put all the detainees into the civilian justice system handicaps their argument against conservatives who want KSM tried before a military comission (which of course would be a kangaroo court).
Once you endorse the notion that the Government has the right to imprison people not captured on any battlefield without giving them trials -- as the Obama administration is doing explicitly and implicitly -- what convincing rationale can anyone offer to justify giving Mohammed and other 9/11 defendants a real trial in New York? If you're taking the position that military commissions and even indefinite detention are perfectly legitimate tools to imprison people -- as Holder has done -- then what is the answer to the Right's objections that Mohammed himself belongs in a military commission? If the administration believes Omar Khadr belongs in a military commission, and if they believe others can be held indefinitely without any charges, why isn't that true of Khalid Sheikh Mohammed? By denying jury trials to a large number of detainees, Obama officials have completely gutted their own case for why they did the right thing in giving Mohammed a trial in New York.
Basically the system is rigged so that the Justice Department can choose the venue in which to try terrorism suspects by where they're most likely to win.
Does that remotely sound like a "justice system"? If you're accused of being a Terrorist, there's not one set procedure used to determine your guilt; instead, the Government has a roving bazaar of various processes which it, in its sole discretion, picks for you based on ensuring that it will win.
That's not fair, nor will it convince anyone in other Western countries or the Muslim world that we're really respecting human rights and civil liberties. (Glenn has another great recent post on how respecting civil liberties pulls the rug out from under terrorist recruitment in the Middle East.)

On top of that inconsistency, Holder told Congress that even if the terrorists are acquitted, the government reserves the right to continue to detain them indefinitely. That sounds like a show trial to me.

Here's Glenn's conclusion that I agree wholeheartedly with:
It's just another case of the administration wanting to bask in the rhetorical glory of "the rule of law" while simultaneously trampling on it for petty political convenience.
The President has outlawed torture and begun closing Guantanamo Bay, but rendition, restricted habeas corpus, indefinite detention, and military commissions go on. Even the staunchest defenders of Obama would have to agree that this former constitutional lawyer has fallen well short of expectations as well as campaign promises in this arena. Outside of torture, which granted is a big deal, what his treatment of terrorism suspects isn't that different from Bush's.

Footnote: Check out Glenn's blog every couple days, always something good there. He, Jeremy Scahill ( and The Nation), and my man Bill Moyers are the cream of the crop in independent journalism on the Left right now. Glenn is one of the foremost civil liberties defenders out there. He also does great work on drug reform, working for a less imperialistic American foreign policy, and criticizing the mainstream media. Unlike some liberals, he's holding Obama to the fire for doing the same things that Bush did.

Saturday, November 14, 2009

Conn Hallinan: "Why the Afghan Surge Will Fail"

Lately we've been hearing a lot in the news about the war in Afghanistan, but very little about how that war is fought on the ground. Oh yes, we've seen the reports of the "surge" troops "clearing and holding" towns, "protecting the population," and other bullshit catchphrases that the media takes directly from the military PR staff without commentary. Up until now, I haven't read or seen much about how the American military is specifically taking on the Taliban as it "clears and holds." Conn Hallinan paints that picture in a great article for Foreign Policy in Focus, and it ain't pretty.

He describes a Marine unit's incursion in the 2,000-person town of Zananeh in the southern Helmand province. They enter the town and are soon attacked by the Taliban, who were tipped off by the villagers. The opposing forces battle for a few days after which the Taliban sneaks back out of town. The Marines end up with a "cleared" and shot-up village with 12 dead insurgents, who as Hallinan points out probably weren't all insurgents.

What's really striking is our military's detachment from reality. To begin with, they think the town is crucial even though it's one of thousands of similar sized villages across the countryside. They think they've interfered with Taliban operations, when in fact the Taliban are very comfortable retreating to the countryside, which has been their modus operandi since the Soviet invasion and even farther back.

In short, the insurgency is adjusting. "To many of the Americans, it appeared as if the insurgents had attended something akin to the U.S. Army's Ranger school, which teaches soldiers how to fight in small groups in austere environments," writesKaren DeYoung in The Washington Post.

Actually, the Afghans have been doing that for some time, as Greeks, Mongols, British, and Russians discovered.

One Pentagon officer told the Post that the Taliban has been using the Korengal Valley that borders Pakistan as a training ground. It's "a perfect lab to vet fighters and study U.S. tactics," he said, and to learn how to gauge the response time for U.S. artillery, air strikes, and helicopter assaults. "They know exactly how long it takes before...they have to break contact and pull back."

I usually argue against the war on 1) the strategic basis that it won't protect us from terrorism and could likely cause more terrorism 2) the economic basis that we desperately need the funds for job programs at home and c) moral basis that we're killing and maiming tens of thousands of innocent Afghans as well as our own men and women. But I think the argument that the war is unlikely to be won is a powerful one, especially for those who don't agree with the above 3 points.

Here's some questions the Obama administration (who has already added 20,000 troops plus replaced 13,000 supply soldiers with combat soldiers through outsourcing) and the pro-escalation crowd should answer but likely won't except with catchprases from "counterinsurgency doctrine" and references to the 2007 surge in Iraq:

1) Callinan writes that the military's counterinsurgency manual advises a ratio of 20 troops for every 1,000 civilians. By their own logic, we would need 600,000 soldiers. How do they intend to win without enough troops? (see the part of Callinan's article on problems with building up Afghan forces)
2) How does protecting the cities make sense when only 10% of Afghans live in cities? How does it make sense when the Taliban seems to prefer the countryside to urban battlefields?
3) What does "protecting the populace" mean when that populace often informs the Taliban about our troop movements and the intended act of protection leads to ambush?
4) How can we rout the Taliban when they can slip easily into the forests and mountains where our troops rarely go?
5) What does it mean to defeat the Taliban? What quantitative and qualitative benchmarks are there to show that we are gaining the upper hand with them? What does gaining the upper hand even mean in asymmetrical warfare?
6) Finally can our military wage counterinsurgency war when it seems so ill-suited for it? This runs the gamut from vehicles to personal equipment to soldier training to the strategic abilities of our generals.

I urge you to read Hallinan's article in its entirety; he breaks things down very well. Our politicians who are for the escalation and even those who think keeping current troop levels is a good idea need to think critically: can we defeat the Taliban in some meaningful way? If so, how? Whether yay or nay, the burden is on them to do so.

Friday, November 13, 2009

Autechre: Nine

China Getting Serious About Carbon While US Dithers

In a Financial Times piece yesterday, Gordon Conway summarizes the findings of the task force working on the energy-related aspects of China's next 5 year plan:
The report is to be presented to CCICED in Beijing on Thursday and to Premier Wen Jiabao on Friday. The proposals are partly based on a set of energy demand scenarios produced by the Chinese Energy Research Institute. One adopts a continuation of current trends that will result in the production of nearly 13bn tonnes of CO2 per year by 2050. A second, produced as a “low-carbon scenario”, reduces emissions to nearly 9bn tonnes. A third, more radical “enhanced low-carbon” scenario would produce peak emissions around 2025, reducing to 5bn tonnes by 2050.
It looks like China is moving toward a very serious approach of "decoupling" economic growth from carbon emissions, led by the public rather than the private sector. It has broader carbon goals, like reducing carbon emissions per unit GDP 20-23% over 2010-2015, but also the specific goals of how to go there through energy efficiency and low-carbon energy sources:
The Chinese plan is to reduce energy consumption per unit of GDP by 75-85 per cent by 2050. It will be achieved through industrial restructuring and efficiency gains in every economic sector, including new low-carbon cities that avoid suburban sprawl and prioritise public transport.
The energy mix will progressively change. In the medium term there will be an increase in renewable energy and nuclear power, with 50 per cent of generating capacity coming from low-carbon sources by 2030. By 2050 all new power sources will be low carbon.
Of course it's still not clear which approach Premier Jiabao will take, and there's a big difference between 13 billion tons, almost twice their current emissions, and 5 billion tons, significantly below current US and Chinese emissions. Still, some snippets in the article from Conway, who worked on the report, suggest that they are leaning towards more ambitious approaches because they understand the economic value of decarbonization.

He says that China worries about being locked into outmoded industrial structures in a low-carbon world (perhaps also about being hit by carbon tariffs from developed countries). Furthermore, they recognize that clean energy technologies will drive growth in the first half of the 21st century, as Tom Friedman writes over and over and over albeit correctly. China's government is obsessed with growth because that's what maintains stability under their authoritarian regime, and they may favor a crash investment in decarbonization as a means of creating growth.

What significance does this have for the US? It bodes very well for international climate negotiations, yet it puts pressure on us to stop holding back. We can't point the finger at the growing developing nations any more, as the Obama administration continues to do. Even though China is not responsible for the historical emissions causing current warming, they're taking aggressive steps to slow their emissions growth because they are worried about climate change and understand the economic potential of clean energy. The burden is on the US to speed up our emissions reductions and get more ambitious as the EU has. If Copenhagen fails, it will now be because of the US, not China.

Secondly, it shows that a government-planned and government-led program on carbon emissions may be the best approach to tackle such an urgent problem as climate change. We'll have to wait and see if their plan works. But, as our mobilization for World War II demonstrated, a Keynesian and/or socialist approach of public investment and public ownership of parts of the energy sector can create the leverage to exert fast transformations in an economy.

That's not to say that market approaches to pollution don't work. Cap-and-trade worked in the 90's in reducing acid rain-causing SO2 emissions. The ETS, or European Trading System, has helped the EU be on track to hit its Kyoto targets (see Joe Romm's Climate Progress post here). However, market approaches can easily be filled with loopholes that limit their effect, as the Waxman-Markey bill that passed out of the House this summer shows. A direct investment approach such as China's seems better suited to rapid transformation.

The planet needs a more aggressive approach from the United States government, and so does our moribund economy.

Tuesday, November 10, 2009

The Berlin Wall and the Palestine Wall

Yesterday was the 20th anniversary of the fall of the Berlin Wall. The Berlin Wall divided a nation. It was a tangible manifestation of the global split between capitalism and communism that nearly led to a nuclear war. We should celebrate its fall along with the Germans, and be thankful that our foolishness as well as that of the Soviet Union didn't kill us all.

Francis Fukuyama said the fall of Communism marked the "end of history." He was wrong. Violent symbols of conflict like the Berlin Wall still exist, in tangible as well as symbolic form.

Israel has built a similar wall through the West Bank. Along with settlements, it is part of Israel's colonial project to annex parts of the West Bank. As Robert Naiman notes in a great post on the Just Foreign Policy blog, 85% of the wall lies within the West Bank and outside the internationally accepted borders of Israel. It cuts off 9.5% of the West Bank and 35,000 Palestinians from the rest of their territory. The wall has been condemned by the World Court and even Israel's High Court.

Friends of Freedom and Justice Binin, a Palestinian activist group in the town of Bilin along the wall, excellently documents the confiscation and repression that the wall engenders on their website. Yesterday a number of Biliners marked the anniversary of the fall of the Berlin Wall by protesting at the Israeli wall and actually ripping down a part of it as Berliners did to theirs. Check out the video below. As you can see near the end, the Israelis respond rather violently.

Definitely read the whole of Naiman's post. He notes that the US and EU have done nothing to stop the wall as we provide massive foreign aid to Israel. Commendable calls on Israel to stop building new settlements on Palestinian territory have not been backed up with action. Naiman notes:
We've reached this point in large measure because of the unwillingness of the Obama Administration to put real pressure on the Israeli government to implement past agreements - in particular, to implement a freeze on the expansion of Israeli settlements in the West Bank. When the first President Bush demanded a settlement freeze, he backed up his demand with real pressure - holding up loan guarantees to Israel. The Obama Administration never indicated that there was any "or else" associated with its demand for a settlement freeze, leading the Netanyahu government to conclude that it could just wait the Obama Administration out - a conclusion that appears to have been borne out by events.
In other news on Obama's failure to back up rhetoric with real change in our foreign policy: the New York Times reports that the Mahmoud Abbas is threatening to resign as head of the Palestinian Authority. He believes, I think correctly, that the peace process is completely untenable in the wake of the Obama administration "backpedaling" on its call on Israel to halt new settlement construction in Palestinian territory. Doesn't sound like change to me, Mr. Obama.

Note: Just Foreign Policy does some great work on pushing our government for a more peaceful foreign policy that is fairer to the people of the Global South. Check out their website and sign up for their action list. For subscribers they send out a daily compilation of pertinent news stories on American foreign policy; it's a great way to stay in the loop.

Thursday, November 5, 2009

Obama and the Mayoral Race in NYC

If you haven't heard, the mayoral race in NYC ended up being extremely close with independent incumbent Michael Bloomberg, the billionaire, defeating Democrat William C. Thompson Jr. by just 51-46. The mainstream media reported widely on how this was a surprise, because Bloomberg had a good approval rating and spent $90 million on the campaign. Most reported on how that absurdly high level of campaign spending and his repeal of the term limits law to stay in power pushed a lot of voters over to Thompson. Very few, however, reported on how the national Democratic party failed to get behind Thompson. That refusal to get their hands dirty in the NYC race demonstrates a lot about the centrist and even right economic beliefs of Obama and the national Democratic leadership.

Glenn Greenwald wrote a great post on his blog (btw, great blog if you're into civil liberties, antiwar, and media issues) the other day on the tiff between Rep. Anthony Weiner and the administration on this matter. Weiner publicly criticized the President for spending resources to support Gov. Corzine in NJ but not doing the same for Thompson. The Politico reporter allowed a White House aide to respond anonymously, childishly taunting Weiner for deciding not to run for mayor himself.

Glenn focused on so many mainstream media outlets allow Obama aides to comment anonymously. Frequently they use that anonymity to bash those on the left in his own party who criticize him for being such a centrist. He also notes the irony of American media criticizing left-wing leaders in Latin America who change term limits laws to extend their terms and failing to do so in the case of right-winger Uribe in Colombia and Bloomberg.

I think it also says a lot about the Obama administration's stance on political economy. The refusal to campaign for Thompson suggests some level of comfort with Bloomberg on the part of Obama. Bloomberg is a social liberal and is great on environmental issues. However, on economic issues, which a mayor has much more control over than social issues, he is quite conservative. As this Nation article states, Bloomberg opposes a living wage ordinance, favors regressive taxes like the sales tax instead over the progressive income tax, and consistenly favors big developers and big finance. He presides over a higher than average unemployment level while manufacturing has sunk to just 2% of the city's economy. The Nation article predicted a Thompson loss because of his failure to present an alternative economic vision for the city, which I think is right.

The Working Families party, which does have that vision, endorsed Thompson, which suggests that he would be far better on these issues, even if he didn't make them the centerpiece of his campaign. What if Obama had come to NYC and campaigned briefly for Thompson every time he was in the area to do so for Corzine? New Yorkers love Obama; he might have allowed Thompson to close the gap.

The fact that he didn't suggests that Bloomberg's economic policies are just fine with him. It reinforces that Obama is a centrist, not a progressive. He espouses a mostly Keynesian view of debt-funded public investment during recessions with some programs to protect the poor and middle classes and the environment (typically weak ones), but has no intention of reducing the massive socio-economic gap in our country between the super-rich and everyone else.

Bloomberg is a symbol of American finance, as that's where he made his fortune. The Democrats' comfort with him is a symptom of their closeness to Wall Street. Let's not forget that the mildly liberal Corzine, whom Obama backed strongly, is a Goldman Sachs alum. Those of us who want a fair economy need to stop supporting the Democrats without strings attached, because it's not getting us very far.

Wednesday, November 4, 2009

LTJ Bukem

I've never blogged about music before, but I love music, ergo I will henceforth. Recently I've been really getting into drum'n'bass music. If you haven't heard of it, it's a form of electronic music with super fast and heavy beats and pretty spare bass and keyboards. I love dem BPMs! Ha my girlfriend hates when I play it because it makes her anxious, but I love the energy in this music.

LTJ Bukem is a great producer from the UK who's huge in d'n'b. To the speedy beats and heavy bass he adds some great 70's jazz fusionish electric keyboards. Lots of BPMs, but really spacey at the same time. Check the song out below, it's one of his early tunes from the early 90's.

Monday, November 2, 2009

Krugman: We need more stimulus!

In the 3rd quarter of this year, our economy grew at an annualized rate of 3.5%. Good news?: yes. Is everything all better?: definitely not. A lot of economists are predicting a so-called "jobless recovery." On top of that, it's entirely possible that reduced demand from unemployment and a continuing credit crunch might drag our economy back down. Our government has a lot more work to do to fix the economy.

Nobel laureate Paul Krugman has been calling for more and more effective (ie. less tax cuts, more direct spending) stimulus in his NY Times column for a long time. His column today continues that motif and lays out an excellent case for more economic stimulus.

He writes that the growth numbers show that the stimulus is working. That spending will continue to go out over the next year and a half. However, the rate at which it is going out, and thus its effect on growth, is currently peaking, meaning that the stimulus won't continue to increase growth. If that rate of growth is going to continue, private spending will need to increase as the stimulus tapers off by the end of 2010. Krugman doesn't see that happening.

On top of that, even if growth continues, it will take an unacceptably long time to put a dent in unemployment. Krugman points out that our 3.5% annualized GDP growth rate in the 3rd quarter is roughly the same as annual growth during the Clinton administration, very interesting. If job creation proceeds as it did at that growth rate in the 90's, it would take a decade to get to "something like full employment."

So it's clear that we need more stimulus, despite the huge deficit resulting from Bush-era tax cuts for the wealthy, the creation of Medicare Part D, and immoral and unnecessary wars. The deficit hawks on the right and left worry that our debt-fueled stimulus will present a big debt burden in the form of higher taxes to the next generation of Americans. As Krugman writes, that generation, my generation, is feeling unemployment the most (yes I am one of them). Krugman's colleague Bob Herbert at the Times had a great column on that subject on Saturday. High unemployment will be a huge drag on our generation for an extended period of time, not just directly through unemployment but also through unemployment hampering growth.

That argument alone trumps the deficit hawks' weak arguments. However, he adds something I hadn't thought of:
Even the claim that we’ll have to pay for stimulus spending now with higher taxes later is mostly wrong. Spending more on recovery will lead to a stronger economy, both now and in the future — and a stronger economy means more government revenue. Stimulus spending probably doesn’t pay for itself, but its true cost, even in a narrow fiscal sense, is only a fraction of the headline number.
It almost echoes the supply-side argument of the Reganites except in reverse. And except that it actually makes sense.

So will the Obama administration and the Democrats in Congress push for more deficit spending to fuel stronger re-growth in our economy? Right now they're patting themselves on the back for how the stimulus worked, and they should. However, they need to move forward on job creation, and currently it doesn't look they will.

In the meantime, they seem perfectly willing to borrow money to continue a war in Afghanistan. Sounds like they got their priorities straight, huh?

Friday, October 2, 2009

Paying for health care reform: Why it matters big time

As Bill Moyers said, health care reform is a means to social justice. Getting almost universal coverage and bringing down costs for working families is crucial not just because health care is a human right, but also because the middle class livelihood is becoming untenable for more and more families in America. The gap between the wealthy and everyone else has grown by leaps and bounds since the Reagan years. Reducing what working families pay for health care makes the middle class accessible to more people and makes it more secure for those already there.

Back in August, I laid out the three fundamental goals of health care reform that we need to keep our eye on. But there's also principles for going about health care reform that are important as well. Unlike the goals, these are more subjective and vary a lot from person to person. An example of a health reform principle: a lot of pundits from the center-left and the right have been crowing about increasing competition, a panacea for these free marketeers. Competition doesn't necessarily reduce costs or expand coverage (it actually expands them, but that's not my point here), so it doesn't have anything to do with the goals of reform, but it's how these people want to go about reform. The principles of reform are different from the goals in that they mostly deal with how to reach those goals.

One important principle for those of us who see health care as a means to social justice is paying for expanding health care coverage in a progressive way. This means that the funding for health care reform ensures that reform overall transfers wealth downward. Expanding coverage and lowering cost will benefit working families, but if we pay for that by taxing working families then it might not benefit them overall economically.

The mandate-and-subsidies approach that the Congressional Democrats have taken to health care reform won't reduce health costs very much as I've written earlier. Nothing will change for workers who get coverage from their employers, and the un-insured will have to pay more than they did before because of the individual mandate. As such, if Congress chooses to pay for the subsidies by taxing the middle class, it may actually increase overall costs for working class families. Given that the idea behind goal #2 of reform is to make health care less of a cost burden on working families, the principle of paying for reform progressively becomes elevated to a goal and a must under the mandate-and-subsidies approach.

House Democrats proposed to pay for their bill, HR 3200, by creating a surtax on the wealthy. This is the preferred approach. The wealthy have benefited so much from the Bush tax cut and our general economic policy of the last 30 years, so it's only just that they pay to cover the un-insured. The House has also discussed taxing sugary drinks as well. Although this is a regressive tax, I would find it acceptable if paired with a surtax on the wealthy because it would improve our nation's health and lower health care costs overall.

President Obama proposed to pay for reform by limiting tax deductions for the wealthy. This would also be a satisfactory approach because it would rely on funding coming from the rich, although it seems unlikely to be included in the final health care bill.

In the Senate only the Finance Committee has the jurisdiction over taxes. The bill currently in that committee, proposed by its chairman Max Baucus, would fund the subsidies by taxing so-called "Cadillac" health care benefits over a certain amount at 35%. The NY Times ran a great article today that this tax would hit middle class union workers who negotiated for better health benefits instead of higher wages, small businesses that typically have more expensive plans, and people who live in areas with high health care costs like California and Massachusetts, despite being designed to tax the benefits of the wealthy. The threshold is indexed to inflation, so over time most employer-based coverage would be hit by the tax. The Baucus bill would also place $88 billion in taxes on insurance companies, drug companies, labs, and device makers. As Maggie Mahar writes on her excellent blog, most people think these taxes will simply be passed on to consumers in higher premiums. On top of those taxes on working families, the bill would limit tax deductions for medical expenses. The committee amended that approach because it would hit the elderly very hard, but it still remains in the bill for everyone else, and it will mostly hit the middle class as well.

Unfortunately the Baucus bill seems to be the most likely to win over the conservative and moderate Democrats needed to pass any bill. So there's a decent chance that health care reform will be funded in large part on the backs of the working families that it's supposed to help.

Because Congress's approach does little to reduce overall health care costs, it has to be funded by taxes on the wealthy to truly benefit most Americans. Our progressive members of Congress need to stand firm against the Baucus bill and any other plan that would tax the middle class to pay for itself, especially if like the Baucus bill it does not contain a public option to hold down costs. It would be better to put off reform than make the middle class pay even more.

Note: How to pay for reform would be important in a single-payer bill as well, but it would be a principle instead of a goal. That's because single-payer would save so much in health care costs that even if we taxed everybody at a flat rate to pay for it, all working class families would be better off than they are now. Obviously those of us who want a more just society would want the tax to fund single-payer to be progressive, but it wouldn't be as necessary as with the mandate-and-subsidies approach.

HR 676 would pay for itself partially through flat payroll taxes on employees, but also a payroll tax on employers, a 1/3 of 1% stock transaction tax, a surtax on the wealthy, and closing corporate tax loopholes. It satisfies my principle and all 3 health reform goals, which is why Congressional leaders should push it instead any mandate-and-subsidies bill.

Monday, September 21, 2009

Sekoff v. Simmons on the Ed Show last night

The fight over the public option has forced the Democrats to show their true colors. It has become easy to distinguish principled progressives fighting for a fairer economy from corporate Democrats eager for more campaign contributions from corporations and the wealthy. This has been true not only for Democrats in Congress and the President (we know where he and Rahm stand), but also for liberal advocacy groups and media figures. The Ed Show last night demonstrated this difference so clearly in a transition between two segments.

In the first, Ed spoke with Roy Sekoff from Huffington Post. Sekoff criticized the President for caving on the public option and favoring the Baucus bill. He urged Obama to forget about the Republicans and "bring out the brass knuckles" on conservatives in his own party, pointing out that the President sure wasn't afraid to tell Gov. Paterson to go. Finally he raised the excellent point that if we pass weak reform that is ineffectual and costly it will only make more people think that government can't solve problems. As I wrote here, a bill that takes the mandates-and-subsidies approach without a public option won't cover everyone, won't bring down costs, and thus won't be sustainable long-term, leading to Sekoff's scenario.

The segment that followed was a discussion by 3 media figures on a couple issues (see transcript here). One of the figures was Jamal Simmons, a "Democratic consultant." Ed asks Simmons if a public option trigger would be acceptable, and Simmons gives an unequivocal yes. Simmons says, "It's competition. It's affordability." Isn't that what the public option brings? Simmons thinks we should "give the private market a chance." Wait, this guy is a Democratic consultant? Last I heard the private insurance market led to health care costs twice as high as other industrialized countries and left tens of millions without coverage. It's enough of a compromise that the Democrats are allowing the insurance companies to continue to exist.

Simmons is deeply concerned about Democratic seats in red states. He thinks a failure to pass health care reform will cause those Dems, many of them Blue Dogs, to lose their seats. However, polls in a couple of these states show that a plurality of swing staters favor the public option, as a plurality of Americans do. The right-wingers are going to call health care reform a government take-over, public option or no, so they'll lambast conservative Dems who vote for legislation either way. Why not push the Blue Dogs to play ball and get a decent bill instead of a shite one that is a handout to insurance industry?

Simmons is one of these tepid liberals who thinks that the Democrats need to pass something, anything to avoid the debacle of 1994 in which the Republicans gained a stranglehold on Congress after the failure of health care reform. Phoenix Woman points out at Firedoglake that the losses of 1994 had as much to do with the demoralization of the Democratic base after NAFTA as failure on health care reform. Progressives aren't excited to get out and vote for Democrats if the Democrats fail to pass meaningful reforms. If Democrats can't pass health care reform this time because conservative Democrats oppose the public option, they can blame it on the Republicans and do just fine in 2010 because their base will still be with them. I wouldn't be too concerned if some of the Blue Dogs lost their primaries along the way.

It's become clear that the 1994 argument is code-speak for concern that progressive reforms will stem the flow of corporate campaign contributions to Democratic coffers. The reason why Blue Dogs and members of the Democratic Leadership Council are so coveted by Democratic party leaders is because they are the most successful at raking in contributions from the insurance companies, coal companies, and the like. But the problem is more than the Blue Dogs. It pervades the party's power structure. We continue to have these DLCers and moderates running the show: Clinton, Obama, Reid, Hoyer, Emanuel, etc. etc. The face of the Democratic party is consultants like Simmons instead of the middle class Americans that supply most of the votes.

I look at the differences between Democrats and Republicans, and wish that the Democrats' base acted more like the Republicans' base. The right wing demands that Republicans pay homage to them and be uncompromising with the left. Obviously this has hurt their party lately as the Republicans associate themselves more and more with the birthers, bigots, and anti-science crowd. However, I don't think the same would happen for the Democrats because progressives aren't so nutty. If the Democrats had a strong base that forced the Democrats to the left, what would the opposition say? That the Democrats are moving us to socialism. Only the Republicans' base will buy that crap, especially as the country's demographics change. In addition, a more progressive Democratic party would pass stronger reform legislation that could show more Americans that government can do things well, and that it should.

I'm tired of listening to "consultants" say why the Democrats should cave to monied interest again and again. I'm tired of liberal advocacy groups saying that we need to "support the President." What's the point in electing Democrats if they never pass real reform? Down with the consultants, up with the base!

Friday, September 18, 2009

Public Option or Bust!!!!!

I outlined HR 3200 the other day. The bill has some serious deficiencies in several different areas, but it has turned out to be far better than the Sen. Baucus's bill that the Senate Finance Committee is poised to take up. The biggest difference between the two bills is that HR 3200 has a public option and the Baucus bill does not. Let's take a look at why the public option is so important, and is an absolute necessity for this approach to health reform.

It doesn't take a rocket scientist to see that single-payer is the most efficient approach to universal coverage. HR 3200's biggest deficiency is simply that isn't single-payer: it doesn't get rid of the private insurance companies that take a piece of the action for their Wall Street investors on every transaction. Instead it uses mandates, an expansion of a Medicaid, and subsidies to get us to universal coverage.

The bill will only leave 3% of Americans without insurance, which wouldn't happen under single-payer, but it's way better than 20%. So it does pretty well in terms of goal 1 and thus goal 3 of health care reform. However, it doesn't do too well in goal 2. Outside of important reforms in Medicare, the bill does very little to drive down costs except with the public option. With private insurance companies still covering most Americans, the plan doesn't get rid of their incentives that drive up costs so much, profits and competition.

The consumer reforms in the bill to prevent under-insurance are great. They would put a big dent in the incidence of medical bankruptcy. But they probably won't save money overall. They will force insurers to pay for their sick clients' coverage, but those costs could easily be passed on to everyone in higher premiums.

Expanding insurance coverage increases health care costs simply because more people are getting health care. Proponents of the mandates-and-subsidies approach claim that prevention of illness by expanding coverage will bring down costs because people will be healthier. However, most studies indicate that preventive care, although it is crucial for having a healthier society, does not reduce costs and probably increases them (see this PNHP blog post).

The bill uses an "exchange" where individual and small businesses can go to shop for insurance plans. This actually does bring down costs a bit because insurance companies don't have to spend as much on marketing, but the savings are small compared to the cost of expanding coverage. Giving people subsidies to buy insurance on the exchange is great in terms of affordability for low and middle-income families, but it encourages private insurance companies to keep premiums high with the bill going to taxpayers. Not very efficient, except one provision in the bill that reins in these bad incentives.

The public option! It's another plan consumers can buy on the exchange, run by the government as a non-profit entity, but otherwise similar to any other insurance plan. With lower administrative costs and the ability to charge Medicare rates to providers, it will be able to offer low premiums. The CBO estimates that the bill will cover 10 to 11 million Americans, so it will bring down costs in that way alone. On top of that, it will force private plans on the exchange to offer lower premiums if they want to compete.

A public plan with 10 million Americans is disappointingly small, but it could still save a lot of money. The Commonwealth Fund found that having a public plan paying at Medicare rates on the exchange would save $265 billion in administrative costs over ten years, whereas expanding coverage with just an exchange would increase costs by $32 billion. While $265 billion over ten years is less than the $400 billion in administrative costs single-payer would save in one year, it's not chump change.

Requiring individuals to buy insurance without a public option is a big handout to insurance companies: it gives them tens of millions more customers with consumers and taxpayers together paying $297 billion more over 10 years than they would otherwise! If the subsidies aren't high enough, people won't be able to afford coverage. It would be highly unsustainable over time and lead policymakers to a difficult choice: pay ever-higher subsidies that would pad the profits of insurance companies, or force working families to pay more and leave some unable to afford insurance. The mandate-and-subsidize approach is inherently inefficient, and it needs a public option for it to work for consumers and taxpayers in the long run.

If the Democrats drop the public option because moderates don't like it, progressives should vote against the bill because it would be so inefficient that it would basically amount to corporate welfare for the insurance companies. Conservative Democrats have been threatening to vote against health care reform because they don't like the public option and the cost of the bill (HA I guess they don't see the inconsistency there!). If progressives stand strong for the public option, it forces the Congressional leadership and the White House to play hardball with the centrists if they want the votes for health care reform.

According to polls, 77% of Americans support the public option, so the Democrats don't have any excuse as the majority party in both chambers of Congress, whether they come from a blue state or a red state. Last I heard this was a democracy. Is it too much to ask for Democrats to do what 77% of Americans want?!!!!!

Wednesday, September 16, 2009

Ppm, shmeepm: clearer language in global warming advocacy

During the August recess, the Center for Biological Diversity and Friends of the Earth organized a coalition of more than 300 groups that signed on to a letter to Sen. Barbara Boxer and the US Senate as a whole. The letter urges the Senate to pass global warming legislation stronger than the American Clean Energy and Security Act that passed out of the House this summer. The effort has garnered a respectable amount of press coverage, and fills a crucial vacuum. ACES was a terribly compromised bill that won't reduce our greenhouse gas emissions by very much and is riddled with loopholes and corporate giveaways. A lot of the mainstream environmental groups either let the compromising happen without a peep or actively encouraged it. It's nice to see some groups with a back bone!

I think what CBD and FOE are doing is excellent, from an organizing perspective. Their coalition is big, and it comprises more than just environmentally focused groups. Through their press attention, they are starting to create the notion that environmentalists are disappointed in the efforts of Congressional Democrats and to a lesser extent President Obama on global warming. We need to push back hard against moderate Dems who are in the pocket of the coal and oil industries! However, I think the vague manner in which they refer to climate science makes their efforts less effective than they could be, specifically in how they invoke the 350 ppm target of Dr. James Hansen.

The most important thing to improve in climate legislation is emissions targets, and the letter rightly starts there. It says, "The Senate bill must set an economy wide cap on greenhouse emissions that is consistent with the best available science." The problem is that the letter doesn't define what that means except in terms of the level of carbon dioxide in our atmosphere globally. Instead of providing a specific minimum acceptable target for emissions reductions by 2020 or 2050, it launches into a discussion of whether we should aim for 350 ppm or 450 ppm (if you're confused, don't worry, your Senator probably is too). Although conceding that ACES won't get us even to 450 ppm, it concludes that 350 ppm should be the goal without saying how we should get there. Not very clear, and thus probably not very effective.

Okay let's take a step back for a moment. You may be asking, what the hell does 350 or 450 ppm mean? ppm means parts per million, the concentration of carbon dioxide in the atmosphere. Climate scientists have used models to find the level of carbon dioxide in the atmosphere past which the effects of global warming would be dangerous. Of course dangerous is a pretty subjective term. But still, the scientists of the Intergovernmental Panel on Climate Change agreed that anything more than a 2 degree C rise in average global temperature would be dangerous, and to prevent that from happening we would have to keep CO2 below 450 ppm in the atmosphere. We're currently getting close to 390 ppm, after we started before the Industrial Revolution at 275 ppm, so we don't have a lot of room to maneuver. (See this paper by Joe Romm of Climate Progress)

So what's the deal with 350?, as the name would suggest, has an excellent summary of why 350 is an important number. Dr. James Hansen of NASA, a climate hero who has been sounding the alarm since the 80's, wrote a paper recently stating that we must reduce the level of CO2 below 350 ppm "if humanity wishes to preserve a planet similar to that on which civilization developed and to which life on Earth is adapted." Pretty scary stuff considering we're well past 350. The paper found that the planet is warming faster than scientists previously believed and that the impacts will be worse, making the 450 ppm target too conservative. So this coalition has told the Senate to shoot for 350 ppm. Clearly Congress can't decree our way to 350 ppm, especially because we're not the only polluter (though we are by far the biggest per capita). They would have to figure out how much we need to cut our pollution to do our part. Does the letter provide any specifics on that? No. For their call to have any concrete meaning, these groups need to provide a target for emissions cuts and they don't.

To figure out how to push the envelope on global warming legislation, we need to keep in mind where things are now. ACES would cut our emissions 17% below 2005 levels by 2020. Where does that compare with what the IPCC said we need to do? The IPCC found that developed countries need to cut their emissions 25-40% below 1990 levels by 2020. Considering that as of 2007 our emissions were 16% higher than in 1990, ACES falls well short of what we need to do to get to 450 ppm. Furthermore, as Joe Romm notes in the paper cited above, the IPCC didn't include carbon-cycle feedback in its predictions. These are effects of global warming that release more carbon and make warming worse, such as the methane and CO2 release from the melting of the Arctic permafrost. So even 25% below 1990 levels by 2020 might not hack it.

Unless the EU beefs up its efforts and China makes big changes in the next couple years, ACES won't stop us from surpassing 450 ppm. If that's the case, would clamoring for 350 ppm to be the target have much of an impact? I highly doubt it, especially considering that nobody has determined how much developed countries would have to cut their emissions to get to 350 ppm as far as I know (let me know if I'm wrong). It currently is not part of our discourse on climate policy so it can't have a lot of relevance around legislation. It should be a part of that discourse, and these groups should work on that, but not in a letter to the Senate about the nitty gritty of climate legislation.

Instead they should demand that Congress hit a target for emissions reductions that is specific and practically meaningful. 25% below 1990 levels by 2020 is the minimum acceptable according to the IPCC for 450 ppm, and that would equate to a bit more than 35% below today's levels. So if we doubled the emissions reductions in ACES we would get there. It's very meaningful and easy to grasp that ACES fails in that it reduces our emissions only half as much as it should.

Now I doubt the Senate would get all the way to a 25% below 1990 levels by 2020 reduction, especially considering the filibuster and the disproportionate representation from coal states there. But a specific campaign to double the reductions of ACES might get them to make at least slightly deeper cuts. The recent science suggests that even if the developed world cut its emissions 25% below 1990 levels by 2020 we might not avoid disastrous impacts. But activists around the world need to work for as much cuts as we can within our various political systems to minimize the effects of global warming (that we're already seeing now!), and we have to think pragmatically about how to do it. As such, bringing 350 ppm into the discussion around details of climate legislation doesn't make a lot of sense.

So write your Senator. We must do better than the American Clean Energy and Security Act! Double those emissions reductions! (Tell them to get rid of the offsets too, but I don't have time to write about that now). This would be a more effective approach to climate advocacy then talking about 350 ppm in a vague way.

PS That's not to say, Bill McKibben, and Dr. Hansen should stop talking about 350. They're doing a tremendous job of getting the word out about what dire straits we're in and describing the huge gap between our miniscule efforts on global warming and the gravity of the problem. I just think bringing 350 into the discussion around the specifics of climate legislation isn't very effective.

Monday, September 14, 2009

Take the Fight to Glenn Beck!

If you haven't heard, Glenn Beck sucks. He successfully carried out a false smear campaign against Van Jones that forced Van to resign (the President helped by not standing up for Van). That campaign was based on racist attitudes towards African-Americans. He attacked Jones's past as a community organizer in California, equating black people organizing themselves with extremism and hating America (!). In a scary reversion to the days of McCarthy, Beck used red-baiting strategies, accusing Van and by extension Obama of being a communist (although anyone on the left will tell you that Obama is, if anything, a centrist). Anyone that has read about the persecution and witch trials of the 1950's should be concerned by this development.

We live in a free society. Glenn has the right to say what he will. However, from his position at Fox News he has a privileged position to have his speech heard. As a member of our news media, he has a responsibility to all of us to remain within a civilized discourse, refraining from racism and fear-mongering. His rhetoric damages our democracy by reducing the ability of people to speak across ideology. As consumers of the news, we have the right to assert our free speech rights and challenge his position of privilege.

Let's take the fight to Glenn! Click here and sign a Color of Change petition to companies to stop advertising during his show. More than 200,000 people have signed, and in response 62 companies have stopped advertising during the Glenn Beck show. Haha, let's get him to shed some tears, as the above picture demonstrates he is wont to do.

Sunday, September 13, 2009

What's really in these health care reform bills?

The Radical Right is fond of saying that the Democrats favor a "government takeover" of health care. Even if the Democrats were proposing a single-payer system, the Radical Right would be full of shit. A single-payer insurance system isn't a takeover of the health care system as a whole, just the insurance part of it. As far as I know, no one is proposing a British-style system where the government runs health care delivery as well as insuring all its citizens.

But the biggest inaccuracy in that statement is that the Democrats' main reform proposals do not come close to a single-payer system. These plans won't get rid of useless insurance companies that just take a piece of the action for their Wall Street investors on every health care transaction. Instead they would preserve the structure of the insurance system mostly as it is. Let's take a critical look at what is really in the Democrats' health care plans.

I'm going to base this mostly on the House bill, but the Senate bill that passed out of the HELP committee (that's Sen. Kennedy's committee) is pretty similar. These bills are huge and bring a lot of different changes in health care policy under one umbrella. Open Congress has a summary of HR 3200 here, the New York Times has a graphic comparing the various proposals here in regards to expanding insurance coverage here, and Ezra Klein has a good summary of the House bill here.

Note: The House bill has passed out of three committees in slightly varied form, but the basic outline is the same. The Senate will have another bill from the Finance Committee, headed by Sen. Max Baucus, that will be different than the HELP bill, and probably way less progressive because Baucus is negotiating with Republicans who probably won't vote for the final bill anyways. More on the Baucus bill later.

1) Covering the Un-Insured with Subsidies and Mandates

The plan uses mandates to get close to universal coverage. Under the employer mandate, also called the "pay or play" provision, employers must offer a group plan to their workers and pay the majority of its cost or else pay a tax, either on their payroll or per employee. Under the individual mandate, everyone who doesn't have employer-based coverage has to buy an insurance plan or else pay a penalty.

Another way the bill seeks to cover the un-insured is by expanding Medicaid. Medicaid pays for health care for families below the poverty line. It would increase the maximum income to qualify up to 133% of the poverty level, which would help a lot of the poor un-insured.

For the un-insured and small businesses that don't qualify for Medicaid or can't afford insurance, the plan creates a national "exchange" where they can shop for plans. All the plans have to offer a minimum of benefits, and can only make consumers pay a certain amount in deductibles and co-payments, preventing people from being under-insured in the exchange. The idea is that it forces insurance companies to compete and should lower their administrative costs because they don't need to market the plans as much. Even then people wouldn't be able to afford the plans (that's why most of the un-insured don't have coverage!), so subsidies are available for people with incomes up to 400% of the poverty level to buy insurance.

The House bill currently includes the "public option." This would be a government-run, non-profit insurance plan that people would pay their premiums to just like any other insurance plan. It should have lower premiums because of lower administrative costs and power to bargain with hospitals and pharmaceutical companies.

Anyone who gets coverage through their employer cannot leave that plan and buy insurance on the exchange. So a very limited amount of people could buy into the public option. Also, the public option wouldn't get special taxpayer subsidies. People buying insurance on the exchange would get the same subsidy whether they buy one of the private plans or the public plan.

2) Consumer Protections: Reduce Under-Insurance

The bill has consumer protections, mostly aimed at reducing under-insurance, which occurs when people have insurance but still get stuck with a large chunk of the bill (a majority of those who experience medical bankruptcy actually had insurance). It bans the insurance company practice of dropping people when they get sick because of a pre-existing condition that those people didn't inform them about. It also bans companies from not covering someone to begin with because they have a pre-existing condition. The bill prevents companies from discriminating in its premiums based on anything except age, geography, or family enrollment. Finally, it caps what families and individuals have to pay out-of-pocket under an insurance plan, which will greatly help reduce medical bankruptcy.

3) Medicare Reforms

This part of the bill could be another bill on its own (I wrote about how conservatives like David Brooks are falsely characterizing this section here). It expands coverage for most seniors in that it makes preventive care free and provides greater assistance for buying prescription drugs by closing the so-called "donut hole." It also staves off a reduction in payments to doctors that was planned earlier so that doctors won't stop taking Medicare patients.

Despite those increased benefits, the bill still extends the projected solvency of the Medicare trust fund from 2017 to 2022. The best things that it does is cut overpayments to private plans that cover elderly people through Medicare Part C, the Medicare Advantage plans. It also cuts the growth in payments to hospitals, and creates incentives for hospitals to ensure when they discharge a patient, the patient doesn't have to return soon thereafter, which costs Medicare a lot more.

4) Other

The bill funds the creation of an institute to do "comparative effectiveness" research. Basically it would seek to find which treatments for a given condition get the best outcomes for the least cost. These findings could be used eventually to cut costs in Medicare (or when we move to a single-payer system some day!).

Like with Medicare, it increases coverage for preventive care under Medicaid.


So let's recap what's in the bill: consumer protections; mandates, an exchange, subsidies, and (hopefully) a public option to expand coverage; and Medicare reforms with some smaller items as well. The big question is: does it meet the goals of health care reform?

Does it get us to universal coverage? Pretty darn close but not quite. The Congressional Budget Office found that 3% of Americans will still go without coverage. 3% of Americans is still a lot of people. The consumer protections should do a lot to combat the problem of under-insurance, and the high rate of medical bankruptcy that it causes.

Does it cut costs? If so, not by much. The cost savings in Medicare are great, because treatment for the elderly is a big chunk of our health care system. But does it do anything to cut the costs that a private insurance market creates for us all? I'll get into that later, but the short answer is, nope. Near-universal coverage ideally should cut insurance premiums for everyone. Hospitals won't have to charge insurance companies as much to compensate for treating the un-insured. However given the profit motive, it's likely that insurance companies and perhaps hospitals will simply pocket the savings. The employer mandate and subsidies should bring down premiums for working families, but won't really cut overall costs, just transfer them to businesses and/or taxpayers.

Does it improve care? Yes, by expanding insurance coverage and improving coverage for preventive care under private plans, Medicare, and Medicaid, the lack of which was formerly a big reason why our health care outcomes are not as good as those of other countries.

One last question: Does it come anywhere close to reform on the level of single-payer? Not even close!
In the coming days, I'm going to keep blogging on parts of the plan that need to be improved and/or retained for it to be worth supporting, as well as on what parts single-payer advocates should be concerned about.

Saturday, September 12, 2009

Why Single-Payer Insurance Is the Best Solution for Our Health Care Woes

As I've documented earlier, the US has by far the most expensive health care system in the world, and we're basically the only developed country that does not guarantee access to health care. A big part of that is because of our terrible insurance system. Most Americans buy health insurance, either individually or as part of their employer's plan, from a number of private insurance companies. Although we are not the only developed country with a partially private health insurance sector, we have the system with the least public sector involvement and the least regulation, and the result is high economic and human costs.

The idea for years has been that competition forces companies to offer their products at lower prices. That's often true in some areas of our economy. Health insurance, however, is one sector in which the "invisible hand" of competition actually drives up costs. You don't have to be a socialist to see that, and to understand that we have to replace private insurance companies with a government-run "single-payer" plan to cut costs.

Under our current system, we pay premiums to health insurance companies, and in return they pay when we have to go to the doctor or to a hospital. In a single-payer system, the government acts as the sole payer for treatment, as the name implies. In return for citizens paying their taxes, the government guarantees health care access for everyone. It's way more efficient than a fragmented system of private insurers, and no one has to forego treatment because they don't have insurance.

Here's a couple reasons why single-payer insurance system would accomplish the three goals of health care reform I outlined back in August: universal coverage, lower health care costs, and improved health care outcomes.

1) Overhead and Profits

Private insurance companies have far higher administrative costs than single-payer systems, basically higher overhead. They need sales departments to add to their customer base, and huge marketing departments to bolster their image and attract more customers. Whereas single-payer systems get their premiums automatically through taxes, private plans have to have a billing department to make sure people pay. Because of the profit motive, they spend money to deny claims so they have to pay for less treatment, and they spend money to deny coverage to people who might cost them more to begin with ie. people with "pre-existing conditions." Finally, they pay massive salaries to their executives, which obviously doesn't happen in government agencies.

On average, overhead in the private industry ranges from 12-14%. In the small group market it's 25-27% and higher than 40% on the individual market (see here)! Meanwhile, the overhead for Medicare is somewhere below 3%, and the Canadian system has attained overhead below 1.5%.

Studies of insurance industry overhead generally don't include profits that go to shareholders, and they don't always include their spending on political contributions and lobbying. Jacob Hacker cites a study of profits of Medicare Advantage plans, a privatized portion of Medicare in which Medicare pays a private insurance company to cover a person. Those private plans spent 6.6% of premiums on profits! On the Bill Moyers Journal, former industry executive Wendell Potter explains how companies compete for Wall Street investment by paying the least amount of premium dollars on actual treatment that they can (here).

So between the motivation of profits and competition, private plans are far more inefficient than government-administered insurance plans. As Congressman Anthony Weiner is fond of saying, insurance companies basically take a piece of the action on every health care transaction, so who needs them? I'm sick and tired of liberals as well as conservatives defending the need to have a private health insurance industry. If the government can provide the same service for far less cost, than it should do so.

2) Administrative Costs Outside of the Insurance Industry

Overhead and profits aren't the only part of the story. A key study by Dr. Steffi Woolhander and Dr. David Himmelstein from Physicians for a National Health Care Plan found that 31% of our health care expenditures in total go to administrative costs, about twice that in Canada. They document how a private insurance system not only creates costs in overhead and profits, but creates costs on the health care delivery side as well because of its fragmented nature.

Because they have to handle payments from a number of different entities, hospitals, clinics, nursing homes, and doctors have to hire more clerical staff to deal with all the paperwork. On top of that, they spend a significant amount of time dealing with that paperwork themselves, time better spent treating patients. Furthermore, large employers have to hire clerical staff to deal with their insurance plans as well. Dr. Himmelstein finds that hospitals would save $120 billion in overhead and doctors would save $95 billion under a single-payer plan, which is well more than the $131 billion that would be saved from less overhead (see his testimony to Congress this spring here).

Dr. Himmelstein finds that a single-payer plan would save nearly $400 billion per year over our current system in lower administrative costs alone! Keep in mind that the mainstream Dems are looking for ways to cut the $1 trillion price tag of their reform plan over ten years. A single-payer plan would save our economy more than the entire cost of that 10 year plan in 3 years!

3) Negotiating Lower Prices

Because they take a piece of the action on each transaction, insurance companies don't have the incentive to negotiate lower prices with health care providers and pharmaceutical companies, nor do they have enough customers to have a lot of bargaining leverage. A single-payer plan obviously has the incentive because taxpayer dollars are at stake. Because a single-plan would cover so many people, it would have way more bargaining power. As a result, we would reduce overpayments to hospitals, doctors, and drug companies.

Here's a case in point. The Veterans Health Administration negotiates drug prices with pharmaceutical companies, and Medicare Part D does not. Consequently, the VA pays 49% less for the same drugs!

These savings can't be calculated in as straightforward a fashion as administrative savings, but they would certainly be huge.

4) Guaranteeing Health Care for All!

These savings would allow the government to pay for everyone's health care without co-payments and deductibles, according to Dr. Himmelstein and others. Because the government is accountable to the people, unlike insurance companies, nobody would be denied care or stuck with huge medical bills. Thus a single-payer plan would eliminate the problem of the un-insured and under-insured in one fell swoop.

Although single-payer is the only way to dramatically cut costs from our private insurance sector, it's not the only way to cover the un-insured and end under-insurance. For example, the Democrat's plan would cap what insurance companies can make consumers can pay out-of-pocket and require plans to have basic benefits to end under-insurance. It would ban denial based on pre-existing conditions and create subsidies to cover the un-insured.

However, the Congressional Budget Office found that 3% of Americans would still go without insurance under their best bill, HR 3200. 3% of Americans is no paltry sum. Single-payer is the only way to guarantee coverage for all. With universal coverage, we can save the lives of 18,000 Americans every year who otherwise would have died without insurance coverage.


So there you have it folks. As I said earlier, we have to keep in mind the basic goals of reform: universal coverage, lowering costs for families and businesses, and improving our health. Single-payer is the way to go because it achieves all three goals. Any "reform" plan that maintains a mostly private insurance system will not be able to cut costs nearly as much, and probably won't truly guarantee coverage for all.

A nice thing about single-payer is that you can still have a private health care delivery system. Doctors and hospitals would still be private entities (private hospitals, some hospitals are already public). The only difference would be that government would be the sole payer for your treatment. So single-payer is far from socialized medicine, it's just socialized health insurance.

Another thing to note is that we already have government-run insurance programs: Medicare, Medicaid, the VA, and several others. Primarily because older people need more health care and they're covered by Medicare, our government already pays for 47% of health care in the US! And as some of the examples I cite above demonstrate, it does so far more efficiently than private insurance companies. Some critics say that moving to single-payer would be too much of a disruption because it would be starting a system from scratch. But it would actually consist of building on government-run programs we already have. That's why a lot of single-payer advocates refer to the system as "Medicare-For-All."

I'll talk more about the politics of single-payer later on. For now let me say that currently single-payer doesn't have the votes to pass in Congress. John Conyers' single-payer bill in the House, HR 676, has 85 co-sponsors, which is great, but not enough to pass because of opposition from Democrats that favor the regulate-and-subsidize approach. No matter what passes or doesn't pass this fall, single-payer has to be the long-term goal of American progressives. It's the only way we can insure everyone and hold down costs that threaten to swamp our middle class and restrain our economy as a whole.