Thursday, August 27, 2009

Obama, Salazar, and the wolves

Last year, the Bush administration decided to remove the gray wolf from the endangered species list. Fortunately, they decided too late and that rule was not codified before a new President Obama halted all rules issued by the Bush administration but not finalized. Environmentalists were elated because they, and a number of scientists, believed that it was premature to delist the gray wolf. This celebration, as it turned out, was premature, as the Obama administration has gone forward with the Bush administration plan.

Between hunting, predator control, and habitat loss, the gray wolf was mostly extinct in the lower 48 states by the 1970's, except in northern Minnesota and Isle Royale in Michigan. This was a tragedy not only in that a species was nearly lost, but in the terrible effect it had on the ecosystems that wolves inhabited. The loss of wolves allowed populations of prey such as elk to skyrocket, threatening some plant species and other animal species that depend on those plants, like beavers. These effects rippled far--losing wolves can even cause greater stream bed erosion, hurting fish species! Coyote populations also skyrocket in the absence of the wolf, causing another ripple through the ecosystem (see more on the effects here, here, and especially here).

Fortunately the gray wolf went on the endangered species list way back in 1974, right after the Endangered Species Act passed (signed by Richard Nixon!).

In many ways the wolf is a success story of the ESA. Wolves were re-introduced to Yellowstone and the Northern Rockies in 1995, and now are once again an important part of the Northern Rockies ecosystem. There are now 1645 wolves between Wyoming, Idaho, and Montana.

In 1974, Fish and Wildlife Service biologists set the goal for the Northern Rockies gray wolf recovery to be 300 wolves, so they've well surpassed that goal. Now interest groups such as hunters, ranchers, and developers are calling not only for the wolf to be delisted, but that it be hunted and reduced.

President Obama's Secretary of the Interior, Ken Salazar, did their bidding and delisted the wolf this March. Because Wyoming didn't have an acceptable wolf management plan, the wolf remains endangered in that state, but is now unprotected in Idaho and Montana. As a result, Idaho has issued 70,000 wolf hunting permits and will allow 255 wolves to be killed, and Montana will allow 75 more to be killed.

Although the wolf population is sustainable according to the 1974 goal, more recent science suggests that the goal should be far higher--probably somewhere between 2000 and 2500 to prevent genetic loss. 225 scientists wrote a letter to Secretary Salazar protesting his decision.

Why did he do it? It's pretty straightforward--mostly the influence of special interest groups. Hunters just want to hunt the wolf, and they don't want the wolf to reduce the game populations that they hunt, even if that benefits the ecosystem as a whole. Some ranchers are still vehemently opposed to wolf recovery, despite the fact that wolves account for less than 1% of livestock deaths. (Coyotes are a far bigger problem than wolves, and as mentioned earlier, wolf recovery keeps coyote populations in check.). Developers want to be able to build homes in wolf habitat areas of the Northern Rockies wilderness.

In addition to the influence of special interests, fear and hostility toward wolves is part of our myth about the American West, as Verlyn Klinkenborg's NY Times op-ed describes here.

As Klinkenborg writes, the Interior department isn't as beholden to special interests as it was under Bush. Yet in the case of the wolves, we get the same bad decisions not based on the latest science. Is this what environmentalists expected when we part of the progressive coalition that did the grunt work to get Obama elected?

Environmental groups should have been far more critical of the choice of Salazar to be Secretary to begin with. The Center for Biological Diversity, one of the most effective and principled groups out there, were among the minority that did (here), and they proved to be prescient. As they document, Salazar consistently voted in the Senate in favor of drilling, in favor of livestock grazing on public lands, and against endangered species and wilderness protections, just not quite as often as the Republicans. In fact, he's a rancher himself with a vested interest in how we manage public lands.

It's time to take the kid gloves off with Salazar, and Obama for that matter. They may be better than Bush and his drilling, mining, and logging-loving Interior department, but that's not good enough. With the planet under siege by global warming and many other anthropogenic threats, we need more wilderness protection, less logging, mining, and drilling on public lands, and better endangered species protections, not just a return to slightly better Clinton-era standards.

You can help start to hold them accountable by joining in this Defenders of Wildlife (another aggressive and effective group) action alert here urging President Obama to reverse Salazar's decision to delist the wolf. And if you have the money (I unfortunately do not), contribute to their and the Center's efforts to fight this decision and court and stop the hunts, which unfortunately began yesterday. As I wrote earlier, the science tells us that not only is the wolf at risk, but the health of the entire Northern Rockies ecosystem.

Tuesday, August 25, 2009

Tell Grandma: Health care reform won't cut your benefits!

This past Friday I was watching the Jim Lehrer NewsHour with my girlfriend before we went to sleep (pretty thrilling Friday, eh?). As usual he had NY Times columnist David Brooks (pictured above), as well as Ruth Marcus from the Washington Post, on to discuss the news of the week. Not surprisingly they talked about all the furor around health care reform, and not surprisingly they spread some falsehoods about reform, in the process demonstrating some of the major flaws of the mainstream media.

Check out the transcript and streaming video here. Right as they begin discussing health care, both Brooks and Marcus cite proposed changes to Medicare under current legislation as motivation for the opposition to reform. Both of them explicitly say that the Democrats' bills will cut seniors' benefits under Medicare. Brooks mentions "Medicare cuts and taking benefits away from people." Marcus asserts, probably correctly, that seniors are the demographic most concerned with health care reform, but follows that up saying that "there are some serious changes in Medicare, needed changes in Medicare, but they will affect seniors, some of them, in terms of seniors' benefits.

Brooks and Marcus are incorrect. Although the House and Senate bills do reduce Medicare spending, these changes do not cut benefits for seniors. Rather, the Medicare savings in the bill are created mostly by achieving greater efficiency and cutting costs in the system.

The Medicare Rights Center, a non-profit consumer group that helps the elderly negotiate Medicare issues and advocates around Medicare policy issues, issued a fact sheet on the effects on Medicare of HR 3200, the bill that passed out of committee in the House. It's important to note that the Center is primarily concerned about the effects of legislation on the elderly and that reforming the entire health care system isn't part of their agenda, so they aren't inherently biased in favor of overall health care reform.

They write in bold letters: "There are no cuts to Medicare benefits in HR 3200." Well David Brooks, it seems that you're wrong.

The bill achieves a large amount of savings by cutting overpayments to private insurance plans that operate under Medicare Part C, the Medicare Advantage program (wikipedia explains). This Physicians for a National Health Plan blog post explains the nefarious history of Medicare Advantage. Under the MA program, Medicare pays insurance companies to provide coverage to people who enroll, and pays them significantly more than what it pays for traditional Medicare coverage.

Conservatives claimed that private company involvement would make Medicare more efficient, but the opposite turned out to be true. While traditional Medicare coverage has administrative costs of just 2%, MA plans have administrative costs of more than 11%, and one government study found those costs to be 16.7% when you include insurance company profits (see here). So basically our taxes are paying for these companies to be inefficient and reap big profits. As the PNHP blog post states, conservatives really wanted to drive up Medicare costs as an excuse to shrink or destroy Medicare, and enrich their insurance company cronies at the same time.

By cutting overpayments to MA plans, HR 3200 might cause insurance companies to stop their involvement in the program, meaning some people covered under their plans would switch to Original Medicare coverage. Some MA plans did formerly offer more benefits than Original Medicare, but HR 3200 expands benefits under Original Medicare to compensate. It eliminates copays and deductibles for preventive care under Original Medicare, which formerly was advantage of MA plans.

Between cutting overpayments to MA plans and cutting the growth in payments to hospitals and nursing homes, HR 3200 would make Medicare solvent until 2022 instead of just 2017 as it would be otherwise.

Overall the Center finds that HR 3200 not only improves the fiscal outlook for Medicare but improves affordability and quality of care for seniors. In addition to eliminating fees for preventive services, it expands assistance for low-income seniors to buy prescription drugs. It gives incentives to hospitals to give better care so that patients don't have to make return trips to the hospital. Finally, it makes sure that payments to doctors don't get cut as planned so that doctors don't stop treating seniors (aforementioned PNHP blog post has a lot on this and history of planned Medicare pay cut to doctors).

So tell your grandma and grandpa, the Democrats' reform plan is actually good for you! It will make preventative health care and prescription drugs more affordable, ensure that your doctor doesn't drop you, and make sure Medicare doesn't run out of money for at least 12 years.

It's ironic that Marcus mentions the "mischaracterizations" of legislation by opponents of health care reform just before she falsely claims that that legislation will cut benefits for seniors. Hey Ruth: seniors aren't magically concerned about health care reform--they're concerned because people like you are falsely telling them that their Medicare benefits will be cut.

These journalists have no self-awareness of their effect on the public discourse. To begin with, it's the fault of newspapers and television news channels that the worst mischaracterizations of reform are out there because they don't do their own research to contest those mischaracterizations. On top of that they assume that they report impartially without projecting their opinions, or that they project their opinions based on only the facts Brooks and Marcus are excellent testaments to the mainstream media's failure to report basic facts and figures of public policy, resulting in an uninformed American public.

Sunday, August 23, 2009

The Journal--That of Bill Moyers, not Wall Street

Check out this week's Bill Moyers Journal on PBS here. Normally the show is comprised of Bill Moyers interviewing a group or two of people along with the classic opinion essays scribed by him and Michael Winship. However, this week's episode is mostly a documentary film called Critical Condition by filmmaker Roger Weisberg. This touching film is a must-see for those who care about health care reform.

Weisberg follows three people who don't have health insurance and require crucial and expensive treatment for their ailments. All three either are currently working or worked up until recently, and those who no longer work have spouses who do. All three make too much money to qualify for Medicaid (the government program that pays for health care for the poor, funded half by states and half by the federal government). They can't afford insurance premiums and/or would be denied for a pre-existing condition. The health of all three suffers as a result.

This film succeeds in how moving it is, how it captures the emotions of these victims of our health care systems and their families. It conveys the basic fact that people get sicker and die when they don't have health insurance. Conservatives like to warn of the terrible specter of "rationing" that is assumed to accompany health care reform as if our current system doesn't ration care. They couldn't be more out of touch with reality. As one doctor puts it in the film, our system rations care based on ability to pay, and as a result people die (today's NY Times editorial on the uninsured cites a study finding that 18,000 Americans die each year from not having insurance).

For progressives, it's a great reminder of why we fight to cover the uninsured and reform health care. For moderates and even conservatives who are on the fence on health care reform, this movie can only tip them in favor of reform by their heartstrings. Don't just read this, watch it! Email it to your moderate and conservative friends as well!


Besides so movingly making the ethical case for covering the uninsured, the film touches on some interesting policy points. At the start of the film, none of the victims qualify for Medicaid because their incomes are too high. One qualifies for Medicaid two days before he dies, way too late. This suggest that despite having Medicaid as a safety net, many recently unemployed people fall through the cracks in our current system. They have to wait until their annual income is demonstrably lower as a result of unemployment.

The health care legislation in the House, HR 3200, would raise the income to be eligible for Medicaid, so perhaps some of the working families in the film would qualify after health care reform without losing their job. For those that wouldn't, they would qualify for subsidies to help purchase either regulated private insurance plans or a government-managed plan under the proposed insurance exchanges. Make no mistake, the House bill will reduce the uninsured and make things better for families like those in the film, improving health and reducing medically incurred debt.

However, the Congressional Budget Office found that HR 3200 would not cover every American, leaving 3% uninsured. Although HR 3200 will make things better for working class families, a better choice would be to create a single-payer health care system, like that of Canada. If only the Democratic leadership had moved forward with Rep. John Conyers's HR 676 (for more info, see here), which would create a single-payer health care system in which every American citizen is insured, like in Canada. It's the only way to guarantee that nobody goes without health care.


As always, Bill Moyers puts it best. Here's how he concludes this week's Journal:

And on the ground, those congressional town hall meetings have been hijacked by yelling, jeering, and belligerent shock troops of protest who have turned the media spotlight on themselves, away from the issue of how to get health care to the people who need but can't afford it.

When all the flash and fury have turned to ash, here's what remains: our present system treats medicine as a profit center instead of a human need and public service.

Side note on Bill Moyers: Bill Moyers is a great American progressive hero. Unlike most journalists, he actually investigates the issues instead of just reporting what the government, think tanks, and big corporations have to say. Over more than 30 years, he's been one of luminaries of the left in this country, making the case for a fairer economy and a stronger progressive people's movement. He is one of the most prominent supporters of the single payer health care solution.

His show appears weekly on PBS. Watch it! Next week's episode is another documentary, this time about the problems associated with our health care system being driven by profits. Every episode is posted online and available permanently in the archive. In particular, I recommend the May 22nd episode with an interview of single-payer advocates Dr. David Himmelstein and Dr. Sidney Wolfe, and the July 10th episode with Wendell Potter, a former health insurance company executive turned supporter of health care reform.

Sunday, August 16, 2009

Clarity in Health Care Debate: What are we aiming for?

As I'm currently unemployed (hopefully not for long), I have been following politics closely, particularly the debates over health care reform and global warming legislation. Much has been made of the inaccuracies of both politicians and the mainstream media when it comes to these issues. The corporate entities that benefit from the status quo and politicians who are either in their pocket or are ideological allies use their power to spread falsehoods about efforts at reform. They say, falsely, that clean energy legislation will destroy our economy and that health care reform will lead to socialism, or even, fascism! And they convince a lot of people that they're right.

But I think the problem goes deeper than distortions and falsehoods, and the health care debate is a great example. There is a terrible lack of clarity in our public discourse on the purpose of health care reform. Policies like exchanges, the public option, and cost-cutting measure have little meaning to people when they don't even know why we need reform! If we forget why we need to reform health care, then people can only become confused and stay out of the debate. I believe that is partly why ratings for the President's health care reform proposals are way below his personal approval ratings. Most people have been confused out of the debate, leaving only far right-wingers who will believe what they want to, dedicated progressive activists, and the Beltway crowd, dominated by corporate lobbyists.

It was clear well before 2009 that our mainstream media, especially on the television, is failing us in terms of getting the facts out to the people and focusing on what really matters. However, pro-reform politicians and to a lesser degree progressive organizations are also responsible for failing to ground their arguments in the flaws of our health care system.

Here's the goals of health care reform as I see it and as I think most people in favor of reform see it (correct me if I'm wrong). This isn't anything new, but I want to get it out to drive everything else that I write about health care. The deeper we dig into why we need reform, the clearer the policy details will be. Also, these goals aren't mutually exclusive (as the Blue Dogs and others seem to think).


1) Universal health care coverage

Basically this means making sure everyone has adequate health insurance. In 2007, 46 million Americans (15.3% of us) went part of the year without health insurance. An additional 25 million are under-insured, meaning that despite having insurance they paid more than 10% of their income in out-of-pocket health costs. With the proliferation of high-deductible and high co-pay insurance plans, the problem is growing, as the number of the under-insured increased by 60% between 2003 and 2007 (see above link). Health insurance companies are allowed to deny coverage to those with pre-existing conditions, and even drop coverage to people that get sick. The Center for American Progress finds that in this recession 14,000 Americans are losing their insurance every day!

First of all, lack of health care coverage threatens basic physical well-being, and can be a matter of life and death if it means foregoing important treatment. Ethically speaking, I agree with those like Amnesty International that regard health care as a human right that societies must provide. Functionally speaking, we rank a disappointing 37th globally in terms of health care performance according to WHO, and that probably has a lot to do with the huge amount of people who don't go get treatment.

Secondly, uninsurance and underinsurance puts low and middle-income American families at tremendous risk. If they get sick and have to pay out-of-pocket, they have a lot less money to pay for the mortgage, college loans, credit card bills, utility bills, and even food. One study found that over 60% of bankruptcies are related to medical costs. Lack of good insurance forces a lot of American families out of the middle class.

Our health system is inherently discriminatory. Working class people in this country cannot afford health care unless they are poor enough to qualify for Medicaid or they are covered by their employer. Sick people can't get health insurance because insurance companies are allowed to deny coverage to those with pre-existing conditions.

2) Lowering health care costs

The US has the most expensive health care system in the world. We spend 16% of our GDP on health care, $7290 per person. France spends the next highest percentage of GDP, and they merely spend 10.6% of GDP. Meanwhile the OECD average for health care spending is $2964 per capita, and only 8.9% of GDP. That's bad enough, but our health care costs are projected to grow by 6.2% per year over the coming years, much higher than inflation.

These costs come not only from the delivery of care but also the overhead cost of insurance administration and the cost to doctors and hospitals of managing insurance claims.

American families experience higher health care costs in higher insurance premiums. Those who get insurance on the individual market tend to have plans with higher deductibles and co-pays. These folks see not only rising premiums, but much higher payments when they get sick and have to get care, putting them at even greater risk of medical bankruptcy.

The majority of American get health care through their employer. As health care costs more, employers have to spend more money to pay their share of their employees' insurance premiums. That robs them of capital to improve and expand their operations, and discourages them from hiring more workers. Obviously this means less jobs and thus less demand in our economy. Furthermore, it puts us at a comparative disadvantage to countries who have less health care costs, encouraging companies to go elsewhere.

Workers with employer insurance feel the pain as well. More and more employers are dropping coverage completely. For workers who retain coverage, many find their employers paying a lesser share of their premiums, which reduces their paychecks. Because buying health insurance on the individual market is so risky and expensive, unions find themselves having to fight for benefits instead of getting their workers better wages.

Ultimately health care is an economic issue. The result of rising costs has been more outsourced jobs, stagnant wages, and reduced consumer demand in a time when our economy is struggling enough.

One more thing to note: the cost of health care to our economy is related to, but not synonymous with, the cost to our government. A lot of people are concerned about the effect of health care costs on our federal budget deficit. They are right to do so, but many of them oppose any additional role in health care by the government on account that it might increase the deficit. If bringing more of health care spending under the aegis of the government can reduce the overall cost to our economy, then it makes sense. Deficits can be cut through efficiency and taxes instead of just cutting spending, as deficit hawks rarely concede. The important thing is the total cost to our economy, not how much health care spending is done by the government.

3) Better Health Care Outcomes

I must admit, I'm not a doctor. But it's clear that we need to get better health out of our health care system that we spend so much on. As you can see here, we have lower life expectancy and a higher rate of infant mortality than those of other developed countries.

To some degree this is partially a matter outside of reforming insurance and health care delivery. A lot of our health problems have to do with our personal habits, such as smoking, dietary choices, etc. (not judging, I have some bad habits myself). I think some people have a point that there's only so much government policy can do to change those habits. Still, making America healthier has a lot to do with how our health care system works, and to the other two principles I elaborate upon above.

Increasing insurance coverage simply gives people access to the care that they need. They wouldn't have to wait until their conditions worsens so much they have to go to the emergency room. Also, some studies of Medicare have found that some hospitals and clinics with lower costs have just as good or even better outcomes as Atul Gawande writes in The New Yorker. Perhaps a focus on efficiency can also produce better care.

As I see it these are the fundamental goals of health care reform. These are the goals by which we should evaluate proposed efforts at reform (and the problems to demonstrate why those who favor the status quo are so wrong). The Obama administration and the Democratic leadership need to do a better job of conveying these goals to the American people because right now the American people are confused as all hell. I also think that if they if the Democrats remained grounded in these goals, they would have come up with better reform proposals, as I'll discuss later. The media needs to cover these problems more. Every minute they fail to cover why we need health care reform provides cover for the special interests that benefit from the status quo.

I mentioned earlier that these goals are not mutually exclusive. A policy aimed at reducing costs would free up more money to cover the uninsured, or it might even improve quality of care. If you read this blog later on, you'll come to see that I'm a proponent of single-payer health care, in which the government acts as the insurer for all people while health care delivery remains in the private sector, precisely because it meets all three goals.

I'll leave a detailed discussion of single-payer for another time. For now, check out the great website of Physicians for a National Health Plan. Stay tuned, and drop me a comment if you're so inclined.