October 30, 2005
Good gravy. We're not satisified with our own screwed-up health care system -- now we're actually exporting it:
...Experts questioned the priorities of Washington's $1-billion rebuilding plan, which has focused on construction instead of basic needs such as better training for doctors and public healthcare campaigns.
..."I saw enormous incompetence which was more costly than even Iraqi corruption," said Richard Garfield, a Columbia University health expert who worked with U.S. and international officials in Iraq last year. The U.S. "was pouring money down the drain."
Willard Quite Right on Drunk Driving
Massachusetts Democrats have a bad name as a back-scratching old boy's club that look the other way when it suits them. The new drunk driving bill passed last week by the Legislature is a case in point. Willard said the bill had loopholes "so large you could fly a 747 through" them, and sent it back with three amendments, according to the Associated Press.
Willard "asked lawmakers to restore language that would let prosecutors use certified court records as proof of prior convictions when sentencing alleged repeat drunken drivers, instead of having to rely on the testimony of eyewitnesses or the arresting officer as proof of those convictions. That can be a daunting challenge if the original arrest took place years earlier," the AP reported.
He also said he "wants to suspend the driver's licenses of repeat offenders who refuse to submit to a breath test for at least one year - instead of the current six months - and to increase the mandatory jail sentence for anyone found guilty of motor vehicle manslaughter from two and a half to five years," according to the news service.
"The House and Senate both initially approved the use of court records to establish prior convictions, but that provision was stricken by a legislative conference committee made up largely of lawyers that had represented drunken drivers," the AP said.
The Governor's proposals deserve our support. More to the point, the Legislature should not defend drunk drivers, and the Demoratic Party should not let Willard take the lead in protecting the citizens of the Commonwealth.
October 29, 2005
I get meta: Daily Kos as a public policy engine?
Below is a diary I posted on DailyKos. I'm amazed at how much energy goes into the posts, diaries and comments on that site, and yet I feel like it could all be harnessed to much greater actual effect on what our government actually does. See what you think:
While endless yards of analysis of the Rove/Libby/Plame affair were spun out this week; while we all hit "reload" a thousand times waiting to see what goodies we were going to get for Fitzmas; while we indulged in Schadenfreude that we haven't enjoyed since Gingrich and Livingston got taken down...
The Senate voted this week not to boost the Low-Income Energy Assistance Program by a few billion dollars. To put it in perspective, the Republicans have already given $14.5 billion in tax breaks to oil companies in the energy bill passed three months ago.
Look, I love DKos, I love the community and the energy, and yes, I love the Schadenfreude. But we can't actually do anything to make Fitzgerald indict Rove, or throw Libby into the slammer for 30 years, or hold Dick Cheney's head in the toilet. That's in the hands of Fitzgerald, the lawyers, the judge and jury.
But this stuff -- the food stamps issue and the heating oil issue -- who knows, we might have done something about it, if we had anywhere near the amount of diaries and action and attitude and energy directed towards issues that affect many many real people, maybe even people you know. Up here in the Northeast, there may well be people dying from not being able to afford heat. Did we do all that we could to prevent that from happening? I don't mean to be hypocritical -- I implicate myself in all these questions.
What's the next big thing coming down the pike that we'll ignore, or give insufficient attention to, because we're consumed with rage at BushCo?
The Republicans never, ever let up in their zeal to destroy protections for the middle class and poor. For them, everything is an opportunity to push their callous agenda, making life a little more rotten for thousands or millions of people. And so, maybe we can't allow ourselves to be distracted by beautiful shiny objects, or the prospect of a merry Fitzmas.
What do you think?
Let's get the nomenclature straight before we go any further with the "Scooter Goes to Jail" discussion. "I" Lewis Libby is not an imperial form of address ala "I, Claudius" (although that may have been where Scooter hoped he would wind up). The initial, as NPR revealed 10 days ago in a model of investigative journalism -- but which even Patrick Fitzgerald seems not to have discovered, since the indictment reads "I. Lewis Libby also known as Scooter Libby" -- stands for "Irve," a name that Libby evidently hates.
October 28, 2005
They get letters
A letter from former Massachusetts Medicaid commissioner James J. Callahan Jr., in yesterday's Globe:
AN INDIVIDUAL mandate for healthcare coverage is bad public policy because it assumes that the provision of healthcare is an individual, not a social, responsibility.
Sound familiar? Read the whole thing.
And in response to Robert Kuttner's column on GM's new health-benefit-cutting deal with UAW, here's another letter writer who wonders: "What is puzzling is why General Motors is not screaming for national health insurance."
Well... that's a good question, but the question wishfully assumes a false choice: That GM would prefer to insure its workers through a more efficient government-based system -- and therefore pay higher taxes -- than through the wasteful system they're paying for now. Sadly, there's a third option: Neither. And that seems to be where we're headed, unless and until the public gets sick of it and demands government action.
GM, Ford, Starbucks and other globally-threatened companies are not walking through that single-payer door, folks. They are captive to the same hit-the-numbers-this-quarter thinking as the rest of Wall Street, and they are not going to go to Washington to ask for their taxes to be raised -- even if it's in their long-term interests, even if it would keep their employees healthy and productive, even if it would take the burden of health care costs off of them. Right now, all they can think of is getting the monkey off their backs as soon as possible and showing Wall Street a nice shiny quarter.
October 27, 2005
Health Care: What's your bottom line?
So, with health care reform (or "reform") apparently barrelling down the pike, we always knew the devil was going to be in the details. And now, all stakeholders will find themselves challenged -- ethically, economically, strategically -- as to what they'll accept in the final bill. For some, a personal mandate is an absolute non-starter; for others (our Gov), no tax increase whatsoever; for some, slot machines as a revenue stream are out (I'm certainly not crazy about them); for some, an employer assessment is straight out, while some won't sign on to a bill without one.
Yup, it's a mess -- and it always is with health care policy. Just like health plans and the government playing hot potato with expensive cases (people), we're all now playing hot potato with who gets the mandate to cover: Is it government (ie. single payer, funded who knows how), is it the individual (Mitt's plan), or is it employers ("pay or play")?
I'd like to suggest that if our various leaders and stakeholders pick one of these three bases to cling to tenaciously at all costs, we will go nowhere, or to a place that no one is happy to be.
In his must-read article about the various paradigms of health care, Malcolm Gladwell makes a distinction between "actuarial" insurance -- by which individuals pay more or less depending on their risk level, or else they skip out entirely -- and "social" insurance, in which the protection provided by the insurance is considered a social good, a necessity extended to all members of society as a matter of civic morality.
The three-part hot-potato discussion that's happening in the State House right now is limiting because we have not come to the necessary moral conclusion: Making sure that folks can see a doctor if they have to is a social good, something a civilized culture does for its members.
Yes, that's regardless of socio-economic status, race, class or gender; regardless of good luck or bad; good genes or bad; regardless of smarts or lack of smarts; morality or immorality (and who among us is capable to sit in judgement of our neighbors?). There are all kinds of things in life that depend on moral virtue; access to health care simply should not be one of them.
I support the Health Access and Affordability Act and the MassACT ballot initiative, not because they're perfect, but because it seems to me that those bills have some sense of the shared sacrifice -- yes, sacrifice -- that will be necessary to do the right thing. But let's be clear: this is a three-legged table, and without each of the legs no reform will stand. Individuals, either as taxpayers or as insurance-consumers, will have to stand up. Employers, either as taxpayers or as providers of insurance, will have to stand up. And government will have to stand up and facilitate logistically and financially.*
Really, my bottom line is to protect the bodies of Massachusetts citizens, for moral and economic reasons. There are better and worse ways to do that, but let's keep our eyes on the prize, be ready to sacrifice in good faith, and demand that others be willing to do the same.
*Yes, you can say that taxpayers and government are the same, but government also receives revenue from non-tax sources like the lottery and tolls, and from taxes on things not used by everyone, like cigarettes. Think of smoke taxes as "usage fees".
Senator Barrios talks health care
Monday afternoon we were fortunate to have a conference call with State Senator Jarrett Barrios (D-Cambridge) about the ongoing health care debate, and the various ways the state might ensure health care coverage for the currently uninsured. David has posted his objection to a personal mandate ("Thou shalt have health insurance") as the way to get everyone covered.
The issue of mandates in any prospective health care bill is extremely dicey. A mandate on someone is frankly necessary, since all parties involved -- individuals, insurers, and government -- all have reason to skip out on insuring many people. Individuals may not be able to afford insurance, or choose not to buy it; insurers wish to avoid expensive cases; the government has finite resources (i.e. tax revenue) and raising revenues is almost always politically risky.
Sen. Barrios has an interesting perspective, which in a sense may show the general direction of the Senate as much as his own wishes for the legislation. Barrios is a self-described "progressive Democrat", who places the greatest emphasis on covering the greatest number of uninsured. To this end, he endorses what he calls a "progressive mandate"; that is, a mandate on individuals to buy their own insurance, subsidized by the state; combined with a mandate on employers to either cover their own workers or pay into a pool which subsidizes the above-mentioned individuals. (This arrangement would not apply to the self-employed or very small businesses, who would be allowed to purchase from a pool created by the state. They would be mandated to provide themselves coverage one way or another.) Perhaps unfortunately, Barrios calls this arrangement "pay or play", and it is apparently similar to the arrangement repealed in 1996. For Barrios, a personal mandate without "pay or play" is a non-starter.
In other words, Barrios suggests hitting two of the three bases of possible mandates: Individual and employer. The Senator feels that the state taking over more individual cases (i.e. by expanding MassHealth/Medicaid eligibility) without an employer mandate would improperly "subsidize" those businesses that do not offer coverage.
Barrios is also very skeptical of Romney's supposed $200/month insurance plan, for which the Blue Cross Blue Shield Foundation apparently provided a back-of-the-napkin sketch: He refers to that as "semi-insurance", which has limited value in preventing or ameliorating illnesses early on, therefore depriving individuals of health, and depriving the state economy the productivity of a healthy worker. In other words, it's an insufficient investment to be worthwhile. In addition, no insurer has come forth to offer such a plan.
The most controversial part of the individual mandate would be the enforcement mechanism: How do you make someone buy a product that they feel they can't afford or don't want? Barrios couldn't remember, and said he'd get back to us on that. It's our impression that this is the most politically radioactive part of the individual mandate approach. The legislature would have to consider this extremely carefully to avoid a nasty backlash.
We should mention that Senator Barrios was very frank, cordial, responsive, and generous with his time. We appreciate his talking with us. We'll have a lot more on this issue this week and going forward.
You tell 'em, Harry
Senate minority leader Harry Reid (D-Nev.) on this morning's withdrawal of Harriet Miers's nomination to the Supreme Court:
The radical right wing of the Republican Party killed the Harriet Miers nomination. Apparently, Ms. Miers did not satisfy those who want to pack the Supreme Court with rigid ideologues.
I had recommended that the President consider nominating Ms. Miers because I was impressed with her record of achievement as the managing partner of a major Texas law firm and the first woman president of the Texas Bar Association. In those roles she was a strong supporter of law firm diversity policies and a leader in promoting legal services for the poor. But these credentials are not good enough for the right wing: they want a nominee with a proven record of supporting their skewed goals.
In choosing a replacement for Ms. Miers, President Bush should not reward the bad behavior of his right wing base. He should reject the demands of a few extremists and choose a justice who will protect the constitutional rights of all Americans.
Right on, Harry. This will be most interesting - does Bush deliver a slap in the face to his so-called "base" that just delivered to him the greatest humiliation of his presidency by nominating another "moderate," such as Alberto Gonzales? Or does he capitulate, figuring that with the indictment of his closest advisor likely within the next 24 hours he cannot afford to further piss them off, however angry he may be at them? My guess: Bush is really mad, and won't give them what they want. So it'll be Gonzales.
October 26, 2005
Republican moral limbo: How low can you go?
So, a week after John Edwards begins his national tour for poverty awareness, House Republicans revealed their poverty program: Grind the middle class and poor into dust.
Republicans began targeting key programs for budget cuts yesterday, from student loans and health care to food stamps and foster care. But the tough measures immediately drew staunch opposition from anti-poverty groups, businesses and moderate Republicans.
..."I can't believe that some people in Washington think that, after a Category 5 hurricane, the solution is to unleash a Category 5 hurricane on working people," said Michele Baker, a custodian for the Orleans Parish School District, who weathered Katrina in her car, spent the aftermath in the Louisiana Superdome and now has no job.
How low can they go? How morally bankrupt? How about depriving children of medical care? Picking on the disabled? It's all in there. Back in the 90's, Newt Gingrich got hammered for proposing cutting school lunches. This makes that look like, well, child's play.
There is no lower that the Congressional Republicans can stoop -- they're already at the worm's eye view. Next up -- reintroducing workhouses, child labor, slavery, and sharecropping. Why not?
Reminder: Health Care rally at State House tomorrow
A reminder: you can make your voice heard for ambitious health care reform tomorrow at the State House at noon. This is in support of the MassACT initiative, which would increase access to health care and reduce premiums across the board.