Alexandria Ocasio-Cortez knows yesterday’s radicalism can become tomorrow’s common sense
by Jeff Sparrow - The Guardian - January 27, 2019
You might have seen the clip floating around social media.
It’s a panel discussion from the World Economic Forum at Davos, in
which Michael Dell, the billionaire CEO responds to a question about a
70% marginal tax rate on the wealthiest Americans, a proposal recently
floated by US representative Alexandria Ocasio-Cortez.
“No, I’m not supportive of that,” Dell says, to much laughter from the assembled plutocrats. “And I don’t think it will help the growth of the US economy. Name a country where that’s worked.”
At which point his co-panellist, MIT professor Erik Brynjolfsson, chimes in: “The United States.”
As Dell and others sputter incredulously, Brynjolfsson explains that America didn’t always allow the super-rich to pay a mere 37% in tax.
“From about the 1930s to the 1960s the tax rate [on the very rich] averaged about 70%,” he says. “At times it was up as high as 95%. And those were actually pretty good years for growth … There’s actually a lot of economics to suggest that it’s not actually going to hurt growth.”
The response – and, more so, the clip’s massive popularity – illustrates the success of a new style of American politics.
Almost as soon as Ocasio-Cortez, running as a democratic socialist, defeated Joe Crowley, some mainstream Democrats dismissed her as a “meteor” that would soon fizzle out. Earlier this month, Republican strategist and cable fulminator Ed Rollins described AOC as a “little girl” with a big mouth. When she cast her vote for Speaker, audible boos rang out from the Republicans in the house.
Yet the public approves of precisely those policies that most horrify Beltway insiders. A recent poll shows, for instance, 59% of voters liking AOC’s tax plan, including 57% of Southerners and even 45% of GOP supporters.
The magnates at the WEF might be so out of touch as to still think Bono relevant. But even in Davos questions about inequality now resonate – thanks, in part, to Ocasio-Cortez’s proposals.
Her success deserves consideration outside America, not least because it confounds much of the established political wisdom.
In the 2000s “framing” became an almost ubiquitous preoccupation for liberals, particularly in the wake of Don’t Think of an Elephant! the bestselling book by linguist George Lakoff.
Lakoff noted the political significance of certain metaphorical fames. Conservatives adopt the “strict father” metaphor in which politicians act to protect the public from a dangerous world. If liberals inadvertently use terminology associated with that metaphor they undercut their own message. Instead, the argument goes, they must reframe the debate with rhetoric that metaphorically legitimates their own values.
In practice, throughout the 2000s, the obsession with framing reinforced a longstanding reliance on spin doctors, focus groups and soundbites, with many progressives convinced that reaching the public depended, first and foremost, on perfectly crafted zingers.
Then, of course, came 2016 and a presidential election in which Donald Trump destroyed his well-rehearsed opponents, seemingly by blurting out whatever came into his head.
AOC embodies a quite different strategy. Yes, she’s articulate and charismatic, and she positively rules on social media. But the “reframing” she performs relies on message more than the metaphor, resetting the terms of debate not through spin but by politics.
Traditionally Democrats react to socialism like the devil to holy water. But AOC openly embraced the label and helped set a whole generation debating what socialism might mean.
Her statement on tax certainly “reframed” politics. It presented Trump’s billions as a signifier of inequality rather than, as Republicans would have it, proof of his competence and acumen. The proposal cut so deeply precisely because it wasn’t a zinger but a policy – a plan that would make a genuine difference in US society.
The ensuing debate has highlighted the grotesque wealth of almost everyone at the top echelons of American governance, including the media. When, for instance, Fox’s Sean Hannity denounced increased taxation on income over $10m, many noted that, over the last year Hannity, that supposed voice of the white working man, took home, um, $36m.
That’s why – irrespective of how AOC’s career plays out – her success to date offers an important lesson for progressives, in Australia as much as anywhere elsewhere.
Those who want to change the world can’t shape their ideas according to the conventional wisdom about what the public will accept, whether on refugees, climate change or anything else.
For too long, politicians have used the alleged backwardness of the voters to justify their own pusillanimity. But leadership – particularly progressive leadership – entails challenging, rather than simply reflecting, the status quo. It means being prepared to displease media moguls or political insiders; it means fighting to popularise ideas that might initially seem difficult or extreme.
As Danton, who knew something about changing the world, put it: “We need audacity, and yet more audacity, and always audacity!”
Never has that been more important than today, an era in which voters everywhere loathe the stale pieties of conventional politics and crave a strategy that might offer some hope. Under such conditions, yesterday’s radicalism can quickly become tomorrow’s common sense.
We’re told that Bernie Sanders will soon announce his nomination for the 2020 presidential race. If that’s so, a possibility emerges that both America and Britain might soon be led by self-described socialists. Whatever you think of Sanders and Corbyn, their rise represents a quite remarkable shift in the political zeitgeist. Progressives in Australia should take note.
“No, I’m not supportive of that,” Dell says, to much laughter from the assembled plutocrats. “And I don’t think it will help the growth of the US economy. Name a country where that’s worked.”
At which point his co-panellist, MIT professor Erik Brynjolfsson, chimes in: “The United States.”
As Dell and others sputter incredulously, Brynjolfsson explains that America didn’t always allow the super-rich to pay a mere 37% in tax.
“From about the 1930s to the 1960s the tax rate [on the very rich] averaged about 70%,” he says. “At times it was up as high as 95%. And those were actually pretty good years for growth … There’s actually a lot of economics to suggest that it’s not actually going to hurt growth.”
The response – and, more so, the clip’s massive popularity – illustrates the success of a new style of American politics.
Almost as soon as Ocasio-Cortez, running as a democratic socialist, defeated Joe Crowley, some mainstream Democrats dismissed her as a “meteor” that would soon fizzle out. Earlier this month, Republican strategist and cable fulminator Ed Rollins described AOC as a “little girl” with a big mouth. When she cast her vote for Speaker, audible boos rang out from the Republicans in the house.
Yet the public approves of precisely those policies that most horrify Beltway insiders. A recent poll shows, for instance, 59% of voters liking AOC’s tax plan, including 57% of Southerners and even 45% of GOP supporters.
The magnates at the WEF might be so out of touch as to still think Bono relevant. But even in Davos questions about inequality now resonate – thanks, in part, to Ocasio-Cortez’s proposals.
Her success deserves consideration outside America, not least because it confounds much of the established political wisdom.
In the 2000s “framing” became an almost ubiquitous preoccupation for liberals, particularly in the wake of Don’t Think of an Elephant! the bestselling book by linguist George Lakoff.
Lakoff noted the political significance of certain metaphorical fames. Conservatives adopt the “strict father” metaphor in which politicians act to protect the public from a dangerous world. If liberals inadvertently use terminology associated with that metaphor they undercut their own message. Instead, the argument goes, they must reframe the debate with rhetoric that metaphorically legitimates their own values.
In practice, throughout the 2000s, the obsession with framing reinforced a longstanding reliance on spin doctors, focus groups and soundbites, with many progressives convinced that reaching the public depended, first and foremost, on perfectly crafted zingers.
Then, of course, came 2016 and a presidential election in which Donald Trump destroyed his well-rehearsed opponents, seemingly by blurting out whatever came into his head.
AOC embodies a quite different strategy. Yes, she’s articulate and charismatic, and she positively rules on social media. But the “reframing” she performs relies on message more than the metaphor, resetting the terms of debate not through spin but by politics.
Traditionally Democrats react to socialism like the devil to holy water. But AOC openly embraced the label and helped set a whole generation debating what socialism might mean.
Her statement on tax certainly “reframed” politics. It presented Trump’s billions as a signifier of inequality rather than, as Republicans would have it, proof of his competence and acumen. The proposal cut so deeply precisely because it wasn’t a zinger but a policy – a plan that would make a genuine difference in US society.
The ensuing debate has highlighted the grotesque wealth of almost everyone at the top echelons of American governance, including the media. When, for instance, Fox’s Sean Hannity denounced increased taxation on income over $10m, many noted that, over the last year Hannity, that supposed voice of the white working man, took home, um, $36m.
That’s why – irrespective of how AOC’s career plays out – her success to date offers an important lesson for progressives, in Australia as much as anywhere elsewhere.
Those who want to change the world can’t shape their ideas according to the conventional wisdom about what the public will accept, whether on refugees, climate change or anything else.
For too long, politicians have used the alleged backwardness of the voters to justify their own pusillanimity. But leadership – particularly progressive leadership – entails challenging, rather than simply reflecting, the status quo. It means being prepared to displease media moguls or political insiders; it means fighting to popularise ideas that might initially seem difficult or extreme.
As Danton, who knew something about changing the world, put it: “We need audacity, and yet more audacity, and always audacity!”
Never has that been more important than today, an era in which voters everywhere loathe the stale pieties of conventional politics and crave a strategy that might offer some hope. Under such conditions, yesterday’s radicalism can quickly become tomorrow’s common sense.
We’re told that Bernie Sanders will soon announce his nomination for the 2020 presidential race. If that’s so, a possibility emerges that both America and Britain might soon be led by self-described socialists. Whatever you think of Sanders and Corbyn, their rise represents a quite remarkable shift in the political zeitgeist. Progressives in Australia should take note.
- Jeff Sparrow is a Guardian Australia columnist.
Trump’s war on socialism will fail
by E. J. Dionne - Washington Post - February 11, 2019
“We socialists are trying to save capitalism, and the damned capitalists won’t let us.”
Political
scientist Mason B. Williams cited this cheeky but accurate comment by
New Deal lawyer Jerome Frank to make a point easily lost in the new war
on socialism that President Trump has launched: Socialism goes back a
long way in the United States, and it has taken doses of it to keep the
market system alive.
Going back to the late 19th
century, Americans and Europeans, socialists and liberal reformers,
worked together to humanize the system’s workings and to find creative
ways to solve problems capitalism alone couldn’t. This has been well
documented in separate books written by historians Daniel T. Rodgers and James T. Kloppenberg. “The New Deal,” Rodgers wrote, “was a great, explosive release of the pent-up agenda of the progressive past.”
Think about this when pondering the Green New Deal put forward last week
by Sen. Edward J. Markey (D-Mass.) and Rep. Alexandria Ocasio-Cortez
(D-N.Y). It’s sweeping and adventurous. There is virtually no way it
will become law as long as Republicans control the Senate and Trump is
president. And if something like it eventually does get enacted, there
will be many compromises and rewrites.
But there
would be no social reform, ever, if those seeking change were too timid
to go big and allowed cries of “socialism” to intimidate them.
In his State of the Union address last week, Trump cast himself as Horatius at the bridge standing against the Red Menace: “We renew our resolve that America will never be a socialist country.”
Yet
in referring to “new calls to adopt socialism in our country,” he had a
point. Open advocacy of socialism is now a normal part of our political
discourse. Ocasio-Cortez is a member of the Democratic Socialists of America, and Sen. Bernie Sanders (I-Vt.) won more than 12 million votes in the 2016 Democratic presidential primaries running explicitly as a democratic socialist. Some recent polls even have Sanders running ahead of Trump in hypothetical 2020 matchups.
We
should be clear that Trump’s words are entirely about reelection
politics. He wants to tar all Democrats as “socialists” and then define
socialism as antithetical to American values. “America was founded on
liberty and independence, and not government coercion, domination and
control,” he declared. “We are born free, and we will stay free.” Cue Lee Greenwood.
But
attacking socialism isn’t the cakewalk it used to be. During the Cold
War, it was easy to frighten Americans with the s-word because the Union
of Soviet Socialist Republics offered a powerful example of the oppression that state control of all of the means of production could unleash.
The
Soviet Union, however, has been dead for nearly three decades. China is
communist on paper but a wildly unequal crony capitalist dictatorship
in practice. Young Americans especially are far more likely to associate
“socialism” with generous social insurance states than with jackboots
and gulags. Sweden, Norway and Denmark are anything but frightening
places.
The 2018 PRRI American Values Survey
offered respondents two definitions of socialism. One described it as
“a system of government that provides citizens with health insurance,
retirement support and access to free higher education,” essentially a
description of social democracy. The other was the full Soviet dose: “a
system where the government controls key parts of the economy, such as
utilities, transportation and communications industries.”
You
might say that socialism is winning the branding war:
Fifty-four percent said socialism was about those public benefits, while
just 43 percent picked the version that stressed government domination.
Americans ages 18 to 29, for whom Cold War memories are dim to
nonexistent, were even more inclined to define socialism as social
democracy: Fifty-eight percent of them picked the soft option, 38
percent the hard one.
Oh, yes, and on those tax increases that conservatives love to hate — and associate with socialism of the creeping kind — a Fox News poll last week found that 70 percent of Americans favored raising taxes on families with incomes of over $10 million.
Trump
will still probably get some traction with his attacks on socialism.
And progressives should remember that social democratic ideas associated
with fairness and expanding individual freedoms — to get health care or
go to college, for example — are more popular than those restricting
choice.
Nonetheless, Jerome Frank was right:
Those slurred as socialists really do have a good track record of making
capitalism work better and more justly. The s-word is not now, and, in
its democratic forms, never should have been, an obscenity.
https://www.washingtonpost.com/opinions/trumps-war-on-socialism-will-fail/2019/02/10/b6fe3a6a-2be4-11e9-b2fc-721718903bfc_story.html?utm_term=.6517b22d24ef
Members of Congress who support bringing everyone in America under one federally administered health insurance program are proposing Medicare for All. Members of Congress who support opening up Medicare to people as an additional insurance option are proposing a Medicare buy-in or Medicare for Some. Predictably, some members of Congress support both.
"It is true that Medicare for All will require you to switch to Medicare from the commercial insurance you currently have. Yes, you will have to give up the restricted choice of doctors and hospitals under your existing commercial plan. You will be required to give up paying premiums, deductibles and coinsurance. You no longer will be able to haggle with your insurer about authorizing your care and paying claims. And you will lose the privilege of being forced into a different commercial insurance plan whenever your employer decides to change insurers or you change jobs."
Medicare for All is the bill introduced by Sen. Bernie Sanders (I-VT) in the Senate and co-sponsored by several other current and potential 2020 candidates, including Sen. Elizabeth Warren (D-MA), Sen. Kamala Harris (D-CA), Sen. Kirsten Gillibrand (D-NY) and Sen. Cory Booker (D-NJ). In the House, Rep. Pramila Jayapal (D-WA) will introduce a similar bill soon. It is an improved and expanded version of Medicare, the federal insurance plan for people over 65 and people with disabilities that covers care from most doctors and hospitals anywhere in the country. As proposed, Medicare for All eliminates all of Medicare’s premiums, deductibles and coinsurance, adds new vision, hearing and dental benefits to Medicare, and offers better home- and community-based care.
Medicare for Some comes in many versions. But the concept would allow people to keep their commercial coverage or switch to Medicare. All versions of Medicare for Some keep the premiums, deductibles and coinsurance payments required under commercial insurance and the current Medicare program. Some versions maintain Medicare Advantage plans, a form of commercial insurance, in the Medicare program. One version opens Medicare to people 55 and older. No version of Medicare for Some guarantees affordable care for all Americans.
While Medicare for Some appeals to our instinctive craving for more “choices,” it does not address the unsustainable cost increases keeping our commercial health care system from being as fair and effective as Medicare itself or the health care systems in place in other developed countries.
Only Medicare for All will bring down national health spending and guarantee health care as a human right for every American. It does so by eliminating the profits, administrative waste and inefficiencies of commercial health insurance and using the collective bargaining leverage of all Americans to negotiate fair rates for doctors, hospitals and prescription drugs.
Medicare for All will reduce national health spending by $2 to $5 trillion over ten years when compared to our current fragmented health insurance system. At the same time, Medicare for All—and only Medicare for All—will provide all Americans their choice of doctors and hospitals anywhere in the United States. (We will no longer have to figure out whether services or providers are “in-network” or “out-of-network.”) And only Medicare for All does away with nearly all out-of-pocket health care costs for individuals.
By eliminating trillions of dollars in excess health care costs, Medicare for All can include all Americans, broaden benefits and reduce out-of-pocket medical expenses for the vast majority of Americans.
It is true that Medicare for All will require you to switch to Medicare from the commercial insurance you currently have. Yes, you will have to give up the restricted choice of doctors and hospitals under your existing commercial plan. You will be required to give up paying premiums, deductibles and coinsurance. You no longer will be able to haggle with your insurer about authorizing your care and paying claims. And you will lose the privilege of being forced into a different commercial insurance plan whenever your employer decides to change insurers or you change jobs.
What will Medicare for All give you in return? Medicare for All will ensure that you can see the doctors you want to see and get care in the hospitals your doctors recommend—irrespective of where you work. And you will never risk losing your health insurance again.
"Medicare for All will ensure that you can see the doctors you want to see and get care in the hospitals your doctors recommend—irrespective of where you work. And you will never risk losing your health insurance again."
No health insurance system is perfect. But commercial insurance has created unsustainable health care costs for the nation, with irrational and excessive doctor, hospital and prescription drug costs. As a nation, we pay twice what other countries pay for health care, for medical outcomes that are below average. As individuals, too many Americans lack access to the care they need, cannot afford rising deductibles and copayments, and are one medical crisis away from bankruptcy. And let’s face it. Does anyone really enjoy dealing with Aetna, Anthem, Humana or UnitedHealth?
Now that the facts are straight, the challenge is to overcome the misinformation campaign mounted by those who benefit from the current system. In that debate, the 70 percent of Americans who currently support Medicare for All have on their side the one (and only) point that really matters: Medicare for All is the winning policy solution to our nation’s health care crisis.
https://www.commondreams.org/views/2019/02/14/be-crystal-clear-medicare-all-does-not-mean-medicare-some?
To Be Crystal Clear: 'Medicare for All' Does Not Mean 'Medicare for Some'
by Diane Archer - Common Dreams - February 14, 2019
As the health care debate heats up, it’s time to be clear about what Medicare for All is and what it is not. Medicare for All does not mean giving people the option to “buy in” to Medicare under our current health insurance system—what might be called Medicare for Some.Members of Congress who support bringing everyone in America under one federally administered health insurance program are proposing Medicare for All. Members of Congress who support opening up Medicare to people as an additional insurance option are proposing a Medicare buy-in or Medicare for Some. Predictably, some members of Congress support both.
"It is true that Medicare for All will require you to switch to Medicare from the commercial insurance you currently have. Yes, you will have to give up the restricted choice of doctors and hospitals under your existing commercial plan. You will be required to give up paying premiums, deductibles and coinsurance. You no longer will be able to haggle with your insurer about authorizing your care and paying claims. And you will lose the privilege of being forced into a different commercial insurance plan whenever your employer decides to change insurers or you change jobs."
Medicare for All is the bill introduced by Sen. Bernie Sanders (I-VT) in the Senate and co-sponsored by several other current and potential 2020 candidates, including Sen. Elizabeth Warren (D-MA), Sen. Kamala Harris (D-CA), Sen. Kirsten Gillibrand (D-NY) and Sen. Cory Booker (D-NJ). In the House, Rep. Pramila Jayapal (D-WA) will introduce a similar bill soon. It is an improved and expanded version of Medicare, the federal insurance plan for people over 65 and people with disabilities that covers care from most doctors and hospitals anywhere in the country. As proposed, Medicare for All eliminates all of Medicare’s premiums, deductibles and coinsurance, adds new vision, hearing and dental benefits to Medicare, and offers better home- and community-based care.
Medicare for Some comes in many versions. But the concept would allow people to keep their commercial coverage or switch to Medicare. All versions of Medicare for Some keep the premiums, deductibles and coinsurance payments required under commercial insurance and the current Medicare program. Some versions maintain Medicare Advantage plans, a form of commercial insurance, in the Medicare program. One version opens Medicare to people 55 and older. No version of Medicare for Some guarantees affordable care for all Americans.
While Medicare for Some appeals to our instinctive craving for more “choices,” it does not address the unsustainable cost increases keeping our commercial health care system from being as fair and effective as Medicare itself or the health care systems in place in other developed countries.
Only Medicare for All will bring down national health spending and guarantee health care as a human right for every American. It does so by eliminating the profits, administrative waste and inefficiencies of commercial health insurance and using the collective bargaining leverage of all Americans to negotiate fair rates for doctors, hospitals and prescription drugs.
Medicare for All will reduce national health spending by $2 to $5 trillion over ten years when compared to our current fragmented health insurance system. At the same time, Medicare for All—and only Medicare for All—will provide all Americans their choice of doctors and hospitals anywhere in the United States. (We will no longer have to figure out whether services or providers are “in-network” or “out-of-network.”) And only Medicare for All does away with nearly all out-of-pocket health care costs for individuals.
By eliminating trillions of dollars in excess health care costs, Medicare for All can include all Americans, broaden benefits and reduce out-of-pocket medical expenses for the vast majority of Americans.
It is true that Medicare for All will require you to switch to Medicare from the commercial insurance you currently have. Yes, you will have to give up the restricted choice of doctors and hospitals under your existing commercial plan. You will be required to give up paying premiums, deductibles and coinsurance. You no longer will be able to haggle with your insurer about authorizing your care and paying claims. And you will lose the privilege of being forced into a different commercial insurance plan whenever your employer decides to change insurers or you change jobs.
What will Medicare for All give you in return? Medicare for All will ensure that you can see the doctors you want to see and get care in the hospitals your doctors recommend—irrespective of where you work. And you will never risk losing your health insurance again.
"Medicare for All will ensure that you can see the doctors you want to see and get care in the hospitals your doctors recommend—irrespective of where you work. And you will never risk losing your health insurance again."
No health insurance system is perfect. But commercial insurance has created unsustainable health care costs for the nation, with irrational and excessive doctor, hospital and prescription drug costs. As a nation, we pay twice what other countries pay for health care, for medical outcomes that are below average. As individuals, too many Americans lack access to the care they need, cannot afford rising deductibles and copayments, and are one medical crisis away from bankruptcy. And let’s face it. Does anyone really enjoy dealing with Aetna, Anthem, Humana or UnitedHealth?
Now that the facts are straight, the challenge is to overcome the misinformation campaign mounted by those who benefit from the current system. In that debate, the 70 percent of Americans who currently support Medicare for All have on their side the one (and only) point that really matters: Medicare for All is the winning policy solution to our nation’s health care crisis.
https://www.commondreams.org/views/2019/02/14/be-crystal-clear-medicare-all-does-not-mean-medicare-some?
We need equality in health care. Will Medicare for all deliver it?
by Tom Deegan - Bangor Daily News - February 11, 2019
Credit Vermont Sen. Bernie Sanders with the vision to see
universal health care as a public issue whose time has come, and for the
bumper sticker slogan, Medicare-for-All. As income inequality widens, equality in health care takes on a new urgency.
We have excellent technological breakthroughs in medicine.
In my 23 years as a registered nurse we have gone from X-rays with
leaded vests to non-invasive 3D Echo, an ultrasound imaging done at
bedside and producing three-dimensional pictures a grade schooler could
interpret. Laboratory diagnostic provide fast and amazing analyses of
blood, tissue and other fluids. With laser and laparoscopy surgery,
12-inch incisions and two-week recoveries are a thing of the past.
The problem we face is how to distribute this bounty fairly,
which is not so simple when good health itself is not equally
distributed, and individual perception of medical necessity covers a
wide spectrum. Working in the emergency room, we were always aware that,
in the far corner of the waiting room, beyond the sprained ankles and
stomach aches, there might be a stoic Scandinavian suffering with a
silent heart attack. Most busy ERs have built-in triage protocols to
pierce the veil of drama and appearances.
Back to Sanders and his bill S. 1804, co-sponsored, apparently without being read, by a slew of Democratic presidential candidates.
I say that only because one of them, Kamala Harris, the dynamo from
California, casually blew by an important provision in the small print
in the Sanders’ Medicare-for-All Bill that does away with Medicare
Advantage, Part D insurance, employer-sponsored cafeteria plans and any
other private transactions — think liposuction, dermatology, elective
knee replacements and other procedures not considered life-threatening.
The press piled on, and Harris walked it back.
The other candidates will now have to pour over the 96-page piece of
legislation and dress down their staff for lack of due diligence. On
Capitol Hill, letting your principal twist in the wind is a capital
offense, no pun intended.
S. 1804 is more akin to the National Health Service in Great
Britain than anything we have in America. (The exception would be the
Veterans Administration — a self-contained single-payer, single-provider
that includes eye, ear and dental care for 8 million veterans, a
hard-earned privilege exempted from S. 1804.)
Think of S. 1804 as a Rolls Royce, fully loaded: hospital
stays, surgeries, office visits, rehab, ambulance transport, unlimited
ER services, free prescription drugs and, best of all, no co-pays. Oh
yeah, and dental, eyeglasses and hearing aids included.
With a stiff upper lip, the Brits put up with long waiting
lines for procedures not considered life-threatening. They mutely abide
by decisions by a government panel ( The National Institute for Health and Care Excellence)
to decide on whether a requested a treatment is appropriate. Their
healthcare is free and the most popular social program in Britain, and
even Conservatives, when in office, treat any changes to it as stepping
on a third rail.
Generally speaking our Medicare is quite different. Think of it as a Buick.
Since 1965 — and thanks to Lyndon Johnson — Medicare covers more than 50 million
elders (and about 9 million disabled individuals). It comes in two
models: traditional and Medicare Advantage plans. About 20 million
Medicare beneficiaries have opted for Medicare Advantage. Many private insurers offer plans
that may include dental, eye care, home health and prescription drug
packages. The tradeoff is that for elective surgeries, tiresome
justification can be called for and the plan usually reserves the right
to refuse expensive non-essential surgeries. Nonetheless, many folks are
obviously pleased with the bargain. Traditional Medicare offers
hospital stays and surgeries based on a physician’s referral, rehab,
emergency room care, lab work and other diagnostics. You are on your own
to pay for prescription drugs unless you sign up for Medicare Part D insurance at added expense. In my 23 years of nursing practice I have rarely heard a complaint about Medicare.
Medicare costs the US government an average of about $11,000 per enrollee per year, according to the most recent statistics. By comparison, the Affordable Care Act comes in at an average cost of $6,300 per enrollee per year, with steep co-pays.
We still await the list price of the Rolls Royce.
How to spot the health insurance industry’s favorite Democrats
by Wendell Potter - Tarbell.org - February 11, 2019
Having spent many years equipping politicians with health care industry talking points, I can tell when one in high places has been recruited to use them.I spotted one yesterday on NBC’s Meet the Press.
My former colleagues undoubtedly where cheering when they heard Sen. Michael Bennet (D-Colo.) come to the defense of private health insurers and trash the idea of improving and expanding Medicare to cover all Americans, which several of the Democratic presidential contenders have endorsed.
Bennet, who says he, too, is considering a run for the 2020 nomination, told Chuck Todd that Medicare for All “seems like a bad opening offer.” He prefaced that by saying that, “what the (other) Democrats are saying is, ‘If you like your insurance, we’re going to take it away from you,’ from 180 million people that get their insurance from their employer and like it, where 20 million Americans who are on Medicare Advantage, and love it.”
I checked to see where Bennet has been getting his campaign cash over the years and wasn’t surprised to see that a lot of it has come from insurance companies and other entrenched special interests in health care, including big drug companies and hospitals and their political action committees. All of those contributors have good reason to protect the status quo: it’s very profitable for all of them.
Among Bennet’s major contributors over the past few years are pharmaceutical companies like Amgen, Pfizer and Gilead Services, the maker of the hugely expensive hepatitis C medications Solvaldi and Harvoni. Another big contributor is the drug companies’ powerful lobbying group, the Pharmaceutical Research and Manufacturers of America (PhRMA). Yet another big contributor is CVS, which recently completed its $69 billion acquisition of Aetna, the big health insurer.
It’s worth noting that, according to data compiled by the Center for Responsive Politics, the vast majority of Bennet’s campaign contributions have come from PACs and large individual donations. Relatively little has come from small donations.
One of the reasons Bennet is a favorite of health care moneyed interests is because he serves on the Senate Health, Education, Labor and Pensions (HELP) Committee, which has jurisdiction over legislation pertaining to the U.S. health care system.
Back to those talking points Bennet used on Meet the Press: they are straight out of the insurance industry’s PR and lobbying shops—and those shops are increasing in number as the debate on Medicare for All intensifies.
Drug companies, for-profit hospitals and insurance companies are so determined to keep Medicare for All from being enacted that they are pouring money into a new front group they call the Partnership for America’s Health Care Future, which is being run out of Blue Engine Message & Media, a PR shop in Washington with close ties to Democrats.
America’s Health Insurance Plans, the industry’s largest trade association and lobbying group, last year launched a big public relations campaign—called Coverage@Work—with the goal of keeping the U.S. employer-based health system intact. Medicare for All would replace that system, which has become increasingly expensive and unreliable but continues to be the primary source of most big insurers’ revenues and profits from the private sector.
That 180 million figure Bennet used is the same one AHIP uses in its campaign and in the Partnership’s recent video attacking Medicare for All.
It’s notable also that Bennet mentioned Medicare Advantage plans. It’s true that a lot of Medicare beneficiaries in recent years have enrolled in Medicare Advantage plans—which are operated by private insurance companies—but two out of three Americans have opted instead for the traditional, government-run Medicare program.
(Insurance companies spend millions of dollars every year to entice Medicare-eligible Americans to enroll in their MA plans for one big reason: they have become cash cows for insurers, at the expense of taxpayers. In fact, some of the biggest insurers are now getting a majority of their revenues from public programs like Medicare and Medicaid.)
The industry’s campaign to protect the employer-based system and the Medicare Advantage program obscure some important realities—realities the industry and their spokespeople and friends on Capitol Hill like Sen. Bennet do not want you to know about. In their quest for Wall Street-pleasing profit margins, insurers have surely but steadily made employer-based insurance and Medicare Advantage coverage increasingly less valuable for patients and increasingly more restrictive.
- Unlike Medicare, employer-based and MA plans have defined networks of doctors and hospitals. If you go out of network, you will be on the hook for most if not all of the cost of your care.
- Those networks are becoming increasingly “skinny” as insurers exclude more and more doctors and health care facilities from their provider lists, and they change their lists frequently. The doctor you’ve been seeing for years might be in your network today but not tomorrow.
- It gets even more tricky because many of the doctors who treat patients in in-network hospitals are not in insurers’ physician networks. As a consequence, thousands of people are getting bills from doctors they assumed were in network because they were treated by them in their in-network hospitals.
- Both employer-based and MA plans are notoriously unreliable. If you get your coverage through your employer, if you lose your job, you also lose your employer-subsidized coverage. Enrollees in MA plans can be—and often are—dumped and left scrambling as well. Insurers that operate MA plans frequently leave markets when they decide they are not profitable enough.
- In both private and MA plans, final decisions about whether you will get coverage for the treatment and medications your doctor recommends are often made not by your doctor, as in traditional Medicare, but by your insurance company.
- Similarly, insurers have discrete lists of drugs they will cover, and they change those lists frequently. You might get full coverage for a medication today and only partial or no coverage tomorrow.
And to say that most people in employer-sponsored plans are happy with their coverage ignores this growing problem: because insurers and employers are shifting more of the cost of care to their workers every year in the form of higher deductibles, millions more of us are winding up in the ranks of the under-insured. They have coverage but many can’t use it because of what they have to pay out of our own pockets before that coverage kicks in. The Commonwealth Fund just last week released a study that showed that 28 percent of people in employer-sponsored plans are now under-insured.
Are Americans really as content with the status quo as Sen. Bennet and the industry’s other allies want us to believe? I don’t think so. I’m betting that many if not most of those folks would prefer to have a system in place that gave them greater value and security—greater peace of mind—than what they have now.
https://www.tarbell.org/2019/02/how-to-spot-the-health-insurance-industrys-favorite-democrats/
Hospital Mergers Improve Health? Evidence Shows the Opposite
by Austin Frakt - NYT - February 11, 2019
Many things affect your health. Genetics. Lifestyle. Modern medicine. The environment in which you live and work.
But although we rarely consider it, the degree of competition among health care organizations does so as well.
Markets for both hospitals and physicians have become more concentrated in recent years. Although higher prices are the consequences most often discussed, such consolidation can also result in worse health care. Studies show that rates of mortality and of major health setbacks grow when competition falls.
This runs counter to claims some in the health care industry have made in favor of mergers. By harnessing economies of scale and scope, they’ve argued, larger organizations can offer better care at lower costs.
But although we rarely consider it, the degree of competition among health care organizations does so as well.
Markets for both hospitals and physicians have become more concentrated in recent years. Although higher prices are the consequences most often discussed, such consolidation can also result in worse health care. Studies show that rates of mortality and of major health setbacks grow when competition falls.
This runs counter to claims some in the health care industry have made in favor of mergers. By harnessing economies of scale and scope, they’ve argued, larger organizations can offer better care at lower costs.
In one recent example, two Texas health systems — Baylor Scott & White, and Memorial Hermann Health System — sought to merge,
forming a 68-hospital system. The systems have since abandoned the
plan, but not before Jim Hinton, Baylor Scott & White’s chief
executive, told The Wall Street Journal that “the end, the more important end, is to improve care.”
Yet Martin Gaynor, a Carnegie Mellon University economist who been an author of several reviews exploring the consequences of hospital consolidation, said that “evidence from three decades of hospital mergers does not support the claim that consolidation improves quality.” This is especially true when government constrains prices, as is the case for Medicare in the United States and Britain’s National Health Service.
“When prices are set by the government, hospitals don’t compete on price; they compete on quality,” Mr. Gaynor said. But this doesn’t happen in markets that are highly consolidated.
In 2006, the National Health Service introduced a policy that increased competition among hospitals. When recommending hospital care, it required general practitioners to provide patients with five options, as well as quality data for each. Because hospital payments are fixed by the government — whichever hospital a patient chooses gets the payment for care provided to that patient — hospitals ended up competing on quality.
Mr. Gaynor was an author of a study showing that consequences of this policy included shorter hospital stays and lower mortality. According to the study, for every decrease of 10 percentage points in hospital market concentration, 30-day mortality for heart attacks fell nearly 3 percent.
Yet Martin Gaynor, a Carnegie Mellon University economist who been an author of several reviews exploring the consequences of hospital consolidation, said that “evidence from three decades of hospital mergers does not support the claim that consolidation improves quality.” This is especially true when government constrains prices, as is the case for Medicare in the United States and Britain’s National Health Service.
“When prices are set by the government, hospitals don’t compete on price; they compete on quality,” Mr. Gaynor said. But this doesn’t happen in markets that are highly consolidated.
In 2006, the National Health Service introduced a policy that increased competition among hospitals. When recommending hospital care, it required general practitioners to provide patients with five options, as well as quality data for each. Because hospital payments are fixed by the government — whichever hospital a patient chooses gets the payment for care provided to that patient — hospitals ended up competing on quality.
Mr. Gaynor was an author of a study showing that consequences of this policy included shorter hospital stays and lower mortality. According to the study, for every decrease of 10 percentage points in hospital market concentration, 30-day mortality for heart attacks fell nearly 3 percent.
Another study found that hospital competition in the N.H.S. decreased heart attack mortality, and several studies of Medicare also found that hospital competition results in lower rates of mortality from heart attacks and pneumonia.
Another piece of evidence in the competition-quality connection comes from other types of health care providers, including doctors. Recently, investigators from the Federal Trade Commission examined what happens when cardiologists team up into larger groups. The study, published in Health Services Research, focused on the health care outcomes of about two million Medicare beneficiaries who had been treated for hypertension, for a cardiac ailment or for a heart attack from 2005 to 2012.
The study found that when cardiology markets are more concentrated, these kinds of patients are more likely to have heart attacks, visit the emergency department, be readmitted to the hospital or die. These effects of market concentration are large.
To illustrate, consider a cardiology market with five practices in which one becomes more dominant — going from just below a 40 percent market share to a 60 percent market share (with the rest of the market split equally across the other four practices). The study found that the chance of having a heart attack would go up 5 to 7 percent as the largest cardiology practice became more dominant. The chance of visiting the emergency department, being readmitted to the hospital or dying would go up similarly.
The study also found that greater market concentration led to higher spending. And a different study of family doctors in England found that quality and patient satisfaction increased with competition.
For many goods and services, Americans are comfortable with the idea that competition leads to lower prices and better quality. But we often think of health care as different — that it somehow shouldn’t be “market based.”
What the research shows, though, is that there are lots of ways markets can function, with more or less government involvement. Even when the government is highly involved, as is the case with the British National Health Service or American Medicare, competition is a valuable tool that can drive health care toward greater value.
https://www.nytimes.com/2019/02/11/upshot/hospital-mergers-hurt-health-care-quality.html
Dr. Vikas Saini, president of the Lown Institute and co-chairman of the Right Care Alliance both based in Brookline, said a handful of drug companies create an “iron triangle” with insurance companies and pharmacy benefit managers that has led to skyrocketing insulin prices.
“It’s a broken market. It’s really not working,” said Saini, “They clearly have been using this as a cash cow, while they say we need this to do research and innovation.”
Saini said that insulin prices have increased over 1,000 percent in the last 25 years due in part to rising list prices from manufacturers and a markup over the cost of production.
Saini said that although there have not been many new innovations in insulin in the last two decades, drug companies will slightly tweak insulin molecules to get new patents.
“There’s been a lot of mutual back scratching that goes on and a lot of gamesmanship,” said Saini.
He said the situation has reached a breaking point.
“It can’t go on, young people are dying it’s that bad,” Saini said. “We can’t allow this to go on.”
At Cambridge-based Sanofi, one of the nation’s producers of insulin, spokesman Nicolas Kressmann said some insulin drugs like Lantus actually have a lower net price today than in the past.
“It is our belief that growing rebates and declining net prices should result in lower out-of-pocket drug costs for patients. Unfortunately, under the current system, this is generally not the case and these savings are not consistently passed through to patients in the form of lower co-pays or coinsurance,” said Kressmann.
He advised patients to consider the Sanofi Patient Connection Program and the Valyou Savings Program, both aimed at helping patients struggling with drug costs.
Saini is looking toward lawmakers for regulatory relief, saying that bulk purchasing, negotiation and distribution on a state level could offer a viable solution. Patients and advocates are hopeful, with three new bills filed in Congress in the last month to regulate prices.
Warren Kaplan, assistant professor at the Boston University School of Public Health, is also seeking a political solution to rising insulin prices. He said international agreements between foreign countries would create more competition in the market and lower prices.
“Drug companies are not going to like it, you’ll get some push-back from the pharma industry about losing profits,” said Kaplan. He also pointed to a lack of transparency in the market, which lawmakers could also fix.
“Someone has to shine a light in this black hole,” said Kaplan.
Kaplan said insulin is expensive to produce, but much of the high costs are “getting tied up in marketing and advertising, not research.”
https://www.bostonherald.com/2019/02/11/rising-price-has-pushed-insulin-out-of-reach-for-some-people/
Another piece of evidence in the competition-quality connection comes from other types of health care providers, including doctors. Recently, investigators from the Federal Trade Commission examined what happens when cardiologists team up into larger groups. The study, published in Health Services Research, focused on the health care outcomes of about two million Medicare beneficiaries who had been treated for hypertension, for a cardiac ailment or for a heart attack from 2005 to 2012.
The study found that when cardiology markets are more concentrated, these kinds of patients are more likely to have heart attacks, visit the emergency department, be readmitted to the hospital or die. These effects of market concentration are large.
To illustrate, consider a cardiology market with five practices in which one becomes more dominant — going from just below a 40 percent market share to a 60 percent market share (with the rest of the market split equally across the other four practices). The study found that the chance of having a heart attack would go up 5 to 7 percent as the largest cardiology practice became more dominant. The chance of visiting the emergency department, being readmitted to the hospital or dying would go up similarly.
The study also found that greater market concentration led to higher spending. And a different study of family doctors in England found that quality and patient satisfaction increased with competition.
For many goods and services, Americans are comfortable with the idea that competition leads to lower prices and better quality. But we often think of health care as different — that it somehow shouldn’t be “market based.”
What the research shows, though, is that there are lots of ways markets can function, with more or less government involvement. Even when the government is highly involved, as is the case with the British National Health Service or American Medicare, competition is a valuable tool that can drive health care toward greater value.
https://www.nytimes.com/2019/02/11/upshot/hospital-mergers-hurt-health-care-quality.html
Rising price has pushed insulin out of reach…
by Alexi Cohan - Boston Herald - February 11, 2019
The cost of insulin has increased over 250 percent since 2007, according to the American Diabetes Association, and patients are looking to lawmakers for relief.Dr. Vikas Saini, president of the Lown Institute and co-chairman of the Right Care Alliance both based in Brookline, said a handful of drug companies create an “iron triangle” with insurance companies and pharmacy benefit managers that has led to skyrocketing insulin prices.
“It’s a broken market. It’s really not working,” said Saini, “They clearly have been using this as a cash cow, while they say we need this to do research and innovation.”
Saini said that insulin prices have increased over 1,000 percent in the last 25 years due in part to rising list prices from manufacturers and a markup over the cost of production.
Saini said that although there have not been many new innovations in insulin in the last two decades, drug companies will slightly tweak insulin molecules to get new patents.
“There’s been a lot of mutual back scratching that goes on and a lot of gamesmanship,” said Saini.
He said the situation has reached a breaking point.
“It can’t go on, young people are dying it’s that bad,” Saini said. “We can’t allow this to go on.”
At Cambridge-based Sanofi, one of the nation’s producers of insulin, spokesman Nicolas Kressmann said some insulin drugs like Lantus actually have a lower net price today than in the past.
“It is our belief that growing rebates and declining net prices should result in lower out-of-pocket drug costs for patients. Unfortunately, under the current system, this is generally not the case and these savings are not consistently passed through to patients in the form of lower co-pays or coinsurance,” said Kressmann.
He advised patients to consider the Sanofi Patient Connection Program and the Valyou Savings Program, both aimed at helping patients struggling with drug costs.
Saini is looking toward lawmakers for regulatory relief, saying that bulk purchasing, negotiation and distribution on a state level could offer a viable solution. Patients and advocates are hopeful, with three new bills filed in Congress in the last month to regulate prices.
Warren Kaplan, assistant professor at the Boston University School of Public Health, is also seeking a political solution to rising insulin prices. He said international agreements between foreign countries would create more competition in the market and lower prices.
“Drug companies are not going to like it, you’ll get some push-back from the pharma industry about losing profits,” said Kaplan. He also pointed to a lack of transparency in the market, which lawmakers could also fix.
“Someone has to shine a light in this black hole,” said Kaplan.
Kaplan said insulin is expensive to produce, but much of the high costs are “getting tied up in marketing and advertising, not research.”
https://www.bostonherald.com/2019/02/11/rising-price-has-pushed-insulin-out-of-reach-for-some-people/
McCarthy blames Republican loss of House majority on GOP health care bill
by Mike DeBonis - Washington Post - February 12, 2019
Speaking privately to his donors, House Minority
Leader Kevin McCarthy squarely blamed Republican losses in last year’s
midterm elections on the GOP push to roll back health insurance
protections for people with preexisting conditions — and in turn blamed
his party’s right flank.
McCarthy’s comments,
made in a Feb. 6 conference call from which The Washington Post obtained
partial recordings, represent a vindication of Democratic efforts to
elevate health care as an issue in last year’s campaign. And in singling
out the House Freedom Caucus, the remarks threaten to rekindle internal
resentments inside the House Republican Conference.
Looking
toward the 2020 elections, McCarthy (R-Calif.) noted that several
Freedom Caucus members lost and said that he was focused on recruiting
candidates who would “find a solution at the end of the day” — noting
that he was already wooing doctors, Navy SEALs and a former CIA agent to
run.
“You want to aim before you fire,” he
said. “Let’s find the very best people that can do this job that knows
the commitment of what they’re doing to make sure that they’re going to
find a solution at the end of the day.”
Matt
Sparks, a spokesman for McCarthy, said in response to the recordings
that the GOP leader “has been clear-eyed on what went wrong last cycle
and no one is more committed to doing everything necessary to win back
the House and execute an agenda that offers every American limitless
potential to get ahead.”
McCarthy’s remarks
about the Freedom Caucus threaten to renew an old rift between the top
House Republican and the Freedom Caucus — one that dates to 2015, when
the group blocked McCarthy from succeeding John A. Boehner (R-Ohio) as
House speaker. McCarthy has since moved aggressively to win over
conservatives by pursuing a harder line on immigration, spending and
other key policy issues.
Rep.
Mark Meadows (R-N.C.), the Freedom Caucus chairman, said McCarthy’s
remarks were “very troublesome” after a reporter described them. “I
hoped the us-versus-them mentality of the past was something that indeed
was in the past,” he said.
Elsewhere on the
call, McCarthy offered a selective account of the 2017 health-care
battles on Capitol Hill, where Republicans in the House toiled for
months to craft an alternative to the Affordable Care Act, narrowly passing a bill in May before watching the Senate abandon the effort three months later.
“When
we couldn’t pass the repeal of Obamacare the first way through, an
amendment came because the Freedom Caucus wouldn’t vote for” the
original House bill, McCarthy said. “That amendment put [the]
preexisting condition campaign against us, and so even people who are
running for the very first time got attacked on that. And that was the
defining issue and the most important issue in the race.”
McCarthy’s
account accurately describes the dynamics of passing the American
Health Care Act, the Republican ACA alternative, in 2017: After an
initial version of the bill was withdrawn due to opposition from both
the Freedom Caucus and GOP moderates, Meadows and Rep. Tom MacArthur
(R-N.J.) crafted an amendment that would give states the ability to
waive protections for people with preexisting conditions.
But
it sidesteps the Republican leadership’s role in backing what became
known as the MacArthur Amendment and ultimately forcing a vote on a bill
that faced uncertain prospects in the Senate and put scores of GOP
lawmakers on the political defensive.
After House passage, McCarthy and dozens of Republicans joined President Trump at a White House celebration.
MacArthur,
who captured a district Trump won by six percentage points in 2016, was
among the 40 House Republicans who lost their seat to a Democratic
challenger last year.
At
another point in the call, McCarthy again suggested the health-care
issue was decisive: “Republicans carried the economy overwhelmingly. We
carried even immigration. We even carried the social issues. But there
was one issue we lost overwhelmingly — it was health care by 66 points.
Had we lost health care just by 34 points, we’d still be in the
majority. We’d have those other 80,000 votes that we needed.”
Among
those who lost reelection bids last year were three Freedom Caucus
members: Rep. Mark Sanford (R-S.C.) lost a primary race in a heavily GOP
district to a challenger who in turn lost to a moderate Democrat, while
Reps. Rod Blum (R-Iowa) and Dave Brat (R-Va.) both lost to Democratic
challengers who highlighted their health-care positions.
“Some
of them lost seats that were very safe,” McCarthy said on the call.
“But it was kind of the policies that they wouldn’t let go through of
why they lost. And I think those seats are better for us to win, but
also the quality of the candidate will matter more.”
But
many more establishment Republicans, who backed the GOP health care
bills despite political warning signs, lost their seats. One donor on
the call, bringing up the health-care issue and the GOP’s profound
midterm reversal in states Trump won, urged McCarthy to “get off that
horse — it ain’t gonna happen,” adding, “If Obamacare’s that bad, it’s
going to fail on its own.”
“If you’ll notice,” McCarthy replied, “we haven’t done anything when it comes to repealing Obamacare this time.”
Editor's Note -
The preceding clipping demonstrates how powerful the issue of fairness is to Americans. The unpopularity of the exclusion from coverage of pre-existing conditions is a testament to that .
-SPC
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