Disparities and high costs fuel the health care crisis
by Jeffrey D. Sachs - Columbia University
AMERICA’S HEALTH CRISIS is really three crises rolled into one. The first is public health: America’s life expectancy is now several years below that of many other countries, and, for some parts of the population, life expectancy is falling. The second is health inequality: The gaps in public health according to race and class are shockingly large. The third is health care cost: America’s health care is by far the costliest in the world.
Obamacare certainly did not solve these crises. Its main positive contribution has been to expand health coverage. Americans without health insurance fell from around 15.5 percent of the population in 2010 to around 9.1 percent today, a significant decline. Yet health care premiums are once again soaring, and the deeper causes of poor health are not being properly addressed. Obamacare amounted to a limited patch on a flawed system.
The numbers tell the story of the three crises. First, US health outcomes are actually below the averages of other high-income countries in the Organization for Economic Co-operation and Development, or OECD. US life expectancy at birth in 2013 stood at 78.8 years, almost two years below the OECD average of 80.5 years. The United States also had higher-than-average infant mortality, a greater incidence of low-birth-weight babies, and a higher incidence of both breast cancer and prostate cancer.
Second, regarding the inequality of health care and health outcomes, US health insurance coverage as a share of the population is ranked 33rd among the OECD, with 86.7 percent (rising to 90.9 in 2015, because of Obamacare), ahead only of crisis-stricken Greece.
America’s health outcomes are starkly unequal by class and race. According to the Health Inequality Project, the richest 1 per cent of American men have a life expectancy of 87.3 years, a remarkable 15 years longer than the poorest 1 percent of American men, at 72.7 years. As for race, non-Hispanic white life expectancy in 2014 was 78.8 years, 3.6 years longer than for non-Hispanic blacks, at 75.2 years.
Third, regarding the costs of the health care system, America’s costs are out of sight, far above those of other countries. America spent a remarkable $8,713 per person on health care in 2013 (the most recent year of comparable OECD data), with the next most expensive country, Switzerland, spending just $6,325. As a share of national income, US health spending came to a whopping 16.4 percent of GDP, compared with 11.1 percent for Switzerland. Since then, US spending has increased to around 18 percent of GDP. The average health spending among all OECD countries was just $3,453, less than half of US health care costs, and constituted an average 8.9 percent of GDP in the OECD countries as of 2013.
SO THE HEALTH crisis is stark enough. But what are its causes, and, even more important, what are its solutions?
At the core of the crisis of health outcomes are the glaring economic, social, and political inequalities of the United States. The United States has the highest inequality of disposable income among high-income countries, and also the largest entrenched class of the poor and near-poor. All of America’s social-support systems — including health care, education, and the judicial system — are now clogged with human sorrows that would hardly exist in a more equal society: children who can’t read, young people without requisite job skills, households in legal woes unable to afford lawyers, and poor people in ill health bearing the disease burdens of poverty.
Low-income Americans are in bad health for two main reasons. First, their social circumstances lead to more stress, mental illness, substance abuse, obesity, environmental harms, and other poverty-related disease burdens, which in turn entrench their poverty. Second, by dint of their poverty, they eat less healthy diets; have weaker links with the health care system (for example, no family doctor); cannot afford medications; disproportionately have lives disrupted by prison terms; and enjoy less leisure time.
The sky-high costs of medicines and health services exacerbate the problem at every turn. The most authoritative recent study of America’s soaring health care costs is the 2012 report on Best Care at Lower Cost, by the federal government’s Institute of Medicine (now the National Academy of Medicine). That report found that the higher health care outlays in the United States — compared with Europe, Canada, Japan, and Australia — are due to the higher prices of health services, including drugs, hospital stays, outpatient visits, and medical procedures rather than to a greater use or higher quality of those services.
For example, the cost of a bypass operation in 2013 averaged $75,345 in the United States compared with $36,509 in Switzerland, and a CT scan averaged $896 in the United States compared with $432 in Switzerland. Inpatient drug prices (measured in 2010) were also far lower abroad than in the United States — roughly half in the UK, Canada, and Australia.
In other high-income countries, governments set the prices for health services in the course of negotiations with hospitals, doctors groups, and pharmaceutical companies. The government often covers the entire cost of health care out of tax revenues. Hospitals and doctors are usually reimbursed a fixed sum each year for each insured individual (called “capitation”) rather than on the basis of reimbursements for each procedure (“fee-for-service”). Capitation encourages the health system to focus on prevention as well as treatment, and to encourage health-promoting activities (like weight loss and exercise). And where other countries use fee-for-service, there is very often one price for a given service that applies for all providers and patients in a given region.
In the United States, the situation is different. America’s hospitals, provider groups, and pharmaceutical companies set their prices in a bewildering array of negotiations between the providers and health insurers, governments (federal, state, and city), and individual patients paying out of pocket. Most providers are remunerated by fee-for-service rather than capitation. The prices they charge vary widely by patient, even for the same procedures. There is no single price list. The providers charge what they can, depending on their market power. Some patients are covered by private health plans, and then prices are set between the providers and the health insurers. In other cases, the payer is government, and so the negotiations are with public agencies. In still other cases, the patient is uninsured. Often the health providers charge the most to the uninsured who pay out of pocket.
The health providers have considerable market power, deriving from four sources: patents on medicines and devices; few provider groups in any given geographical market; the unilateral disarmament of Medicare in negotiations; and limits on the supply of health care workers, including doctors and nondoctors.
CONSIDER DRUG PRICES and the role of patents. The US patent law grants an exclusive monopoly for 20 years, from date of filing, to the holder of a drug patent. This temporary monopoly enables the patent holder to raise retail prices far above production costs, ostensibly to give incentives for R&D. The problem is that the drug companies are using their monopoly pricing power to abusive extremes.
Gilead Sciences, for example, spent $11 billion in 2011 to purchase the patent for a wonder cure for hepatitis C from a small biotech company. Gilead paid the hefty sum of $11 billion, knowing that it would turn around and charge the outrageous price of $1,000 per pill, even though the medicine costs around $1 per pill to manufacture. Gilead is earning more than $11 billion in profits every single year, recouping its purchase price countless times over. Many Americans with hepatitis C, including our veterans, are sick and even dying because they can’t afford Gilead’s extortionate prices.
A second source of monopoly power over prices is that, in many regions, there are now only one or two major health care providers. The problem of monopoly power is getting worse as mergers and consolidations are reducing the number of major health providers in each region.
A third source of monopoly power is the fact that the 2003 federal law establishing Medicare Part D (covering prescription drugs) explicitly bars Medicare from negotiating with the drug companies. Gilead can set any price it wants without the federal government saying a word. This provision was stuck in the legislation literally in the middle of the night, by the pharmaceutical industry’s lobbyists, and reflects the fact that the health industry is one of the biggest funders of Congressional campaigns. In the 2016 election cycle, campaign contributions by individuals and companies in the health sector have totaled more than $200 million in support to candidates and PACs.
A fourth source of monopoly power results from various limits on the supply of health-sector personnel. In 2013, the United States graduated just 7.3 medical students per 100,000 people, compared with an OECD average of 11.5 per 100,000 and a high of 19.7 per 100,000 in Denmark. The United States has only 2.6 doctors per 1,000 people, compared with an OECD average of 3.3 per 1,000. The United States could also augment the health workforce by allowing properly trained and supervised nondoctors to take on an expanded range of roles at lower cost, a process known as “task shifting.”
Sky-high health care costs, combined with entrenched poverty and stagnant working-class incomes, are leading to devastating health outcomes. Recent research by Nobel laureate Angus Deaton and his coauthor, Ann Case, has shown that middle-aged working-class whites are now experiencing an unprecedented rise in mortality rates, not unlike the falling life expectancy that plagued middle-aged men in the Soviet Union in the years before its collapse. Rising death rates in the population signify a deep crisis in the social order, including the health system.
OBAMACARE INCREASED health care coverage but did not solve the crisis of sky-high prices, and may well have exacerbated it by adding government subsidies into a system marked by pervasive market power and lack of competition.
I therefore recommend the following policies to address America’s urgent health care crisis.
First, as I’ve suggested in previous articles in this series, America should adopt policies to reduce income inequalities, end the over-incarceration of the poor, empower workers, clean and green the environment, and raise the social status of working-class families. Over time, such measures would help to reverse the epidemics of drug abuse, mental illness, obesity, and other diseases exacerbated by poverty and low social status.
Second, America should move toward universal health care coverage through public financing, as in Canada and Europe, with health providers (both private and not-for-profit) supplying coverage on the basis of capitation rather than fee-for-service. Capitation would encourage and enable health providers to offer supportive services (nutrition counseling, social support, health advising) that help to prevent, treat, and manage chronic conditions such as cardiovascular disease and adult-onset diabetes.
Third, the government should move to a system of price ceilings for medicines under patent through rational guidelines that balance the incentives for R&D with drug affordability and access. Economists have long argued that today’s patent law does not do an adequate job of balancing the needed incentives for innovation with the assurance of access to affordable medicines. The situation became intolerable after the advent of Medicare Part D, with the government now spending vast sums for drugs and drug companies grossly abusing the system by setting outrageous markups on the cost of production.
None of this is a dream or a utopian vision. These reforms would simply put the United States on the path toward improved health care coverage, affordability, and outcomes already enjoyed by the citizens of Canada, Japan, and many countries in Europe.
Jeffrey D. Sachs is University Professor and Director of the Center for Sustainable Development at Columbia University, and author of “The Age of Sustainable Development.”
Why the U.S. Still Trails Many Wealthy Nations in Access to Care
by Aaron E. Carroll - NYT
Many are still unhappy with Obamacare.
The main intent of the Affordable Care Act was to expand the safety net (Medicaid), regulate the non-employer-based private insurance market (the insurance exchanges) and help people buy that insurance (subsidies) in order to reduce the number of Americans who are uninsured.
On those metrics, it appears to be succeeding.
First and foremost, Obamacare was about improving access to health care. While it did improve access to insurance, in many, many other ways the United States is falling short. Things are likely to get worse before they get better.
Even with Obamacare, the United States still ranks poorly among comparable countries in insurance coverage. Even in 2016, when the rate of insured is the best it has ever been in the United States, Americans still have a greater percent of the population uninsured than pretty much any other industrialized nation in the world.
Access is about more than insurance, though. Every few years, the Commonwealth Fund conducts an international survey of patients. The last time the fund fielded the survey was in 2013, and it sampled patients in 11 different countries, all of them on the high end of the worldwide socioeconomic spectrum.
When asked if patients could get a same-day or next-day appointment with their provider when they were sick or needed care, 52 percent of Americans said no. This placed the United States next to last among these countries. Only Canada (59 percent) was worse.
Yes, we beat Canada. There’s a reason that politicians always seem to reach into that bucket when they want to provide evidence of American health care exceptionalism. But comparing ourselves with only one country is cherry-picking. Many other countries outperform us.
When asked whether it was “somewhat” or “very easy” to get care after regular working hours, the United States placed eighth, beating France, Canada (again) and Sweden. Because of this, at least in part, Americans are more likely to use the emergency room for care. In this metric, the United States beat only Canada, with 39 percent of adults using the emergency room in the last two years.
Primary care physicians feel this pinch as well. When the Commonwealth Fund surveyed them in 10 countries, doctors in the United States ranked ninth (ahead of Canada) in being “well prepared” to manage the care of patients with complex needs. They ranked last in whether staff made home visits. They also ranked last, by far, in whether practices had arrangements so that patients could see a doctor or nurse after hours without going to the emergency department.
Why is this? One of the reasons is manpower. The United States, for all its spending, has fewer general practitioners per population than any of these other countries. In 2013, America had half as many primary care physicians per 1,000 people as the next-closest country (Sweden) and one-fifth the number in France or Germany.
There’s an element of supply and demand here. When you have too few primary care physicians, it won’t be as easy for patients to see them. When you give more people insurance, this problem will only get worse, when many new patients try to access the health care system.
None of this should be taken as an argument against reducing the number of uninsured. When we keep one group, a relatively poorer one, out of the system in order to improve everyone else’s access, we’re rationing — just by cost. Everyone in the United States seems to loathe rationing, so no one wants to admit that’s what’s going on.
The biggest access problem in the United States is the expense of obtaining care. More than one third of Americans said they did not fill a prescription they were given, did not visit the doctor they should have or did not get the tests that were ordered because of the cost.
The Commonwealth Fund used to break down this question by income. Then, it was even more compelling. In its 2010 study, it turned out that the richer half of America was more likely to forgo care because of cost than the poorer half of almost every other compared country. It’s important to remember that the richer half of America was likely to be insured.
Perhaps most telling, when adults were asked about their views of the health care system in 2013, 75 percent of Americans said that it needed fundamental change, or that it needed to be completely rebuilt. This percentage was higher than for any other country surveyed, Canada included. Primary care physicians feel similarly. Yet years after the Affordable Care Act was passed, Americans are still litigating whether to return to the previous system.
Access was a problem before. Access is a problem now. Americans can’t seem to have a discussion on how to make that better. Without that, it’s hard to see how things will improve.
Some Health Plan Costs to Increase by an Average of 25 Percent, U.S. Says
by Robert Pear - NYT - 10/24/2016
WASHINGTON — Premiums for midlevel health plans under the Affordable Care Act will increase by an average of 25 percent next year, while consumers in some states will find significantly fewer insurance companies offering coverage, the federal government said Monday.
But the Obama administration said three-fourths of consumers would still be able to find plans for less than $100 a month with the help of federal subsidies.
The open enrollment period under President Obama’s signature health law begins on Nov. 1, but consumers got their first look at their options on Monday. Consumers who go without insurance next year could face possible tax penalties of $700 a person or more.
In many parts of the country, the available options are sure to become part of the political conversation in the election season’s closing days. And the rising costs and shrinking options all but ensure that the next president will need to make significant adjustments to the health law, something both Hillary Clinton and Donald J. Trumphave promised.
The average increase of 25 percent in benchmark premiums on the federal exchange compares with increases of 2 percent in 2015 and 7 percent this year. Major insurers have pulled out of the public marketplace in many states, citing multimillion-dollar losses, and state officials have approved rate increases of 25 to 50 percent or more for some insurers that remain.
One in five consumers on the federal health insurance website HealthCare.gov will find only one insurer with offerings next year, the administration said.
For a 27-year-old consumer, in the prime age group sought by insurers, the average monthly premium for a benchmark plan would be $302 next year, up from $242 this year, according to a report from the Department of Health and Human Services.
“While the president’s allies in Washington will try to spin the numbers, families across the country will be forced to figure out how to pay for such unaffordable insurance,” said Senator Orrin G. Hatch, Republican of Utah, who is an opponent of the Affordable Care Act and the chairman of the Senate Finance Committee, which has jurisdiction over much of the law.
The administration minimized the marketplace’s troubles. Officials said people could lower their costs by seeking income-based subsidies in the form of tax credits and by switching to less expensive plans. While some markets will have few choices, consumers nationwide will see an average of 10 plans per insurer. Plans vary in cost and cover different doctors, hospitals and drugs.
The Obama administration said last week that it expected monthly enrollment in the Affordable Care Act marketplace to average 11.4 million next year, up from a monthly average of 10.5 million this year. But five million to seven million people who buy insurance on their own do not receive federal subsidies.
“The number of people eligible for tax credits will increase” as premiums rise next year, and the amount of assistance will also increase, Kevin Griffis, a spokesman for the Department of Health and Human Services, said.
Under the federal health law, insurance plans are classified in four levels: bronze, silver, gold and platinum, depending on the amount of coverage.
“If every returning consumer nationwide selected the lowest-cost plan within the same metal level they picked last year, average premiums — taking into account financial assistance — would fall by $28 per month, or 20 percent, compared with 2016,” Kathryn E. Martin, an acting assistant secretary of health and human services, said.
But in many places, the options have shrunk.
Laura M. Schlett, 44, of Brandon, Miss., a suburb of Jackson, said she was losing coverage because her insurer, UnitedHealth, was pulling out of the public marketplace there, as in many other states.
Ms. Schlett said that she received a subsidy of $110 a month and spent $240 a month for health insurance with a $3,000 deductible this year.
“I can’t afford to get sick after paying for the health insurance,” Ms. Schlett said.
In Phoenix, only one insurer, Health Net, a subsidiary of Centene, is listed on HealthCare.gov, and it is offering only four plans for 2017. A Phoenix family of four with income of $62,000 a year could obtain a premium tax credit of $1,079 a month next year, but would still owe $342 a month, or roughly $4,100 a year, and the policy has an annual deductible of $14,100 for the family, according to HealthCare.gov.
In Raleigh, N.C., 18 plans are available for 2017 from two insurers, but the premiums could be a substantial expense for some consumers. For a 53-year-old man with income of $53,000 a year, the cheapest midlevel silver plan will cost $714 a month, or $8,568 a year, according to the federal website, and no subsidy would be available.
But a man of the same age with income of $25,000 a year could get a subsidy of $639 a month, reducing his premium to $75 a month, or $900 a year.
In Eugene, Ore., the cheapest silver plan available to a 35-year-old man has a full, unsubsidized premium of $348 a month, or $4,176 a year, and an annual deductible of $3,000. A total of 14 plans are available from two insurers.
In Charleston, W.Va., consumers have a choice of 16 plans offered by two insurers. For a 40-year-old woman, the cheapest silver plan has a full, unsubsidized premium of $505 a month, or $6,060 a year, and an annual deductible of $6,150. If the woman has annual income of $30,000, she could get a subsidy of $326 a month, but would still owe premiums of $179 a month, or about $2,150 a year.
Stabilizing the insurance marketplace could be a major challenge for Mrs. Clinton, the Democratic candidate for president, if she wins, as opinion polls suggest she will.
The assurances by the Obama administration on Monday differed in tone from Mrs. Clinton’s remarks on the campaign trail. She has supported the Affordable Care Act, but denounced “skyrocketing out-of-pocket health costs” and said the federal government should have the power to block or modify unreasonable rate increases so coverage would be more affordable.
Why Bernie Was Right
by Luke Savage - The Jacobin
This past April, just days before the critical New York primary, the Bernie Sanders campaign released a new ad it hoped would help overcome its rival’s home-state advantage and take the Vermont senator over the top:
Wall Street banks shower Washington politicians with campaign contributions and speaking fees [an unseen narrator declares]. While Washington politicians are paid over $200,000 an hour for speeches, they oppose raising the living wage to $15 an hour. Two hundred thousand dollars an hour for them, but not even 15 bucks an hour for all Americans. Enough is enough.
The pointedly unsubtle attack hit upon the central theme of the Sanders campaign, and its critique of frontrunner (and eventual nominee) Hillary Clinton. Making note of Clinton’s lucrative speaking fees from Wall Street banks it also employed coded class rhetoric to charge her — and by extension the entire Washington political establishment — of enjoying an incestuous, transactional relationship with powerful private interests at the expense of average Americans.
This was the essence of the populist, social-democratic message upon which Sanders founded his presidential campaign. The “rigged economy” of which he spoke was not only one in which corporate greed conspired to create a deeply unequal and unfair society, but also one underpinned by a symbiotic, mutually enriching relationship between plutocrats and politicians in both major parties.
And few seemed more emblematic of that relationship than Hillary Clinton.
In her time between leaving the State Department in 2012 and launching her own presidential campaign, Clinton personally pocketed a whopping $22 million — nearly four hundred times the median household income in 2015 — from speeches given almost exclusively to interest groups that had recently lobbied the government. (Even this figure paled in comparison to the combined $153 million the Clintons made from paid speeches, many of them to banks, since Bill left office.)
While Clinton sometimes made populist gestures in public, they appeared to contrast sharply with her activities in private — especially when it came to her seemingly cozy relationship with Wall Street and the wider financial-corporate complex.
During the primaries the Clinton campaign and its sympathizers variously dismissed, punted, deflected, or minimized the issue of her speaking fees along with the wider charge that she was too close to corporate interests. Even superficially critical analyses, like the one offered by Vox’s Jeff Stein, sought to characterize Clinton’s paid speeches as an example of poor political judgment rather than outright corruption.
In any case, it somehow proved controversial to assign blame for national problems — from deep and abiding inequality and poverty to the interminable assembly line of corporate-friendly legislation coming out of Congress — to the very visible nexus linking politicians and the wealthy. Through a combination of meddling, obfuscation, and fear-mongering, Democratic National Committee elites and liberal media figures successfully performed damage control and eked out a Clinton win in the primaries.
With the Sanders insurgency and its populist message neutralized, many no doubt assumed the issue had been safely put to bed. But in recent weeks, a near continuous stream of documents published or sent to the press by Wikileaks (and several other sources) has, at the very least, rendered that assumption premature — and put the innards of the rigged economy into a much sharper view.
The Podesta Emails: A Sketch
The sheer volume of emails, transcripts, and internal campaign communiqués that have emerged, particularly over the past several weeks, is simply staggering. Taken together, they document the inner workings of the Clinton machine and offer a window into the incestuous, often transactional relationship between corporate America and many of its ostensible political masters.
Perhaps most strikingly, they lay bare the banal duplicity of Democratic politics and the contempt many senior Democrats have for their party’s base and its ambitions. Were it not for the apocalyptic prospect of a Donald Trump presidency, the leaks could well have sent Hillary Clinton’s campaign into an irreversible tailspin.
Wikileaks’ latest document dumps contain emails related to campaign chairman John Podesta — a longtime Clinton ally, lobbyist, and chair of the Democratic Party–friendly Center for American Progress (CAP). Because of Podesta’s central role in the campaign, a series of hacked email exchanges and accompanying attachments have finally given us, among other things, a look at Clinton’s secretive speeches and interactions with corporate and financial patrons.
Most eye-catching are remarks from a 2013 speech to the National Multi-Housing Council in which Clinton discusses the need to adopt different positions in public and in private:
I mean, politics is like sausage being made. It is unsavory, and it always has been that way, but we usually end up where we need to be. But if everybody’s watching, you know, all of the back room discussions and the deals, you know, then people get a little nervous, to say the least. So, you need both a public and a private position.
On their own, these words could almost be interpreted as innocuous — the remarks of a hard-nosed pragmatist adept at political brokerage. But a comparison of Clinton’s private statements and her public stances suggests that the former represent a sincere articulation of her political outlook.
Accepting the Democratic nomination last July, Clinton declared, “Wall Street can never, ever be allowed to wreck Main Street again.” But in a 2013 speech to Goldman Sachs, we find her doubting the idea that Wall Street wrecked anything to begin with:
That was one of the reasons that I started traveling in February of ’09, so people could, you know, literally yell at me for the United States and our banking system causing this everywhere. Now, that’s an oversimplification we know, but it was the conventional wisdom. And I think that there’s a lot that could have been avoided in terms of both misunderstanding and really politicizing what happened with greater transparency, with greater openness on all sides, you know, what happened, how did it happen, how do we prevent it from happening? You guys help us figure it out and let’s make sure that we do it right this time.
(Goldman Sachs, which in 2009 received a $10 billion bailout from the American public, recently admitted to massively defrauding investors in the housing market, though no individuals involved will be charged or even named. In addition to speaking fees, the firm has also donated almost $1 million to various Clinton campaigns over the years.)
To take another example, in 2015 Clinton declared her support for a Senate bill that took aim at the “revolving door” between Wall Street and financial regulatory agencies, writing in an op-ed: “If you’re working for the government, you’re working for the people — not for an oil company, drug company, or Wall Street bank or money manager.”
But speaking at Goldman Sachs’ Builders And Innovators Summit in 2013, she laid out precisely the opposite view, arguing that financial executives face too many regulatory obstacles in moving between the private sector and government:
You know, part of the problem with the political situation, too, is that there is such a bias against people who have led successful and/or complicated lives. You know, the divestment of assets, the stripping of all kinds of positions, the sale of stocks. It just becomes very onerous and unnecessary.
At the firm’s Alternative Investments Symposium that same year, Clinton told bankers that financial reform “really has to come from the industry itself . . . the people that know the industry better than anybody are the people who work in the industry.” Elsewhere, we see her apologizing to the firm for the Dodd-Frank financial reform bill and saying it “had to pass for political reasons.”
Just weeks before announcing her opposition to the Keystone XL pipeline, Clinton dismissed concerns about the project as the whimsical objections of “radical environmentalists” who supported her rival, declaring: “My view is I want to defend natural gas. I want to defend repairing and building the pipelines we need to fuel our economy. I want to defend fracking under the right circumstances . . . I want to defend this stuff.”
Yet Clinton, who has since received more money from the oil industry than Donald Trump, ran an ad ahead of the New York primary in which she promised to “stand firm with New Yorkers opposing fracking, giving communities the right to say ‘no.’”
In other paid speeches, Clinton praised Walmart (whose board she once sat on) for helping foster a “spirit of community that I think is absolutely essential to the maintenance of our democracy, our freedom, our strength.” (As Zaid Jilani and Naomi LaChance note, the vehemently anti-union firm has in fact devastated many local communities, displacing at least four hundred thousand jobs and allowing the Walton family — which has also made donations to Clinton — to amass a fortunethat surpasses the wealth of the bottom 40 percent of Americans.)
While the Democratic Party platform backs a $15 minimum wage, emails show that a senior Clinton aide not only advised against it but likened the Democratic base to the Red Army for favoring it. And even though Clinton’s campaign ostensibly supports an expansion of Social Security, emails reveal she praised the Simpson-Bowles deficit-reduction plan (which specifically called for cuts to the popular program) during remarks to Morgan Stanley in 2013.
A public position and a private position, as they say.
A Rigged Economy
In each of these cases, Clinton’s sympathy with, and affinity for, corporate America and the interests of some of its worst actors sits in plain view. But beyond the very obvious deceit, they also give us a glimpse of just how calculated and cynical her progressive gestures truly are.
The overwhelming impression gathered is that Clinton and her machine — increasingly indistinguishable from the Democratic Party itself — have adopted the populist stances favored by their party’s base only when circumstances left them no other choice; that she has little will or desire to see any of them through; and, perhaps most importantly, that her Straussian courtship of Wall Street is firmly rooted in ideological belief rather than pragmatic consideration.
To the average Sanders supporter, the Podesta emails contain nothing particularly new or revelatory save for a few interesting and amusing details. But to Democrats and liberals who’ve argued in earnest that there’s nothing especially wrong or compromising about their party’s relationship to corporate America, the private missives should be cause for serious self-examination.
Not only do they corroborate the Sanders critique of Clinton, the DNC, and Washington politics in general, but they vindicate the theory of progressive change his campaign championed. Its central premise — that the transactional relationship between moneyed interests, politicians, and party machines produces a rigged economy that serves and enriches a tiny, insular elite at the expense of everyone else — couldn’t find a more vivid depiction.
In contrast to Sanders’s more militant and populist approach, Clinton touted her own individual experience, administrative competence, and the notion that political progress can only be achieved through painstaking, centrist incrementalism.
Though her campaign and its sympathizers seemed to vacillate on whether this represented a total repudiation of Sanders or merely a much lengthier means to the same end, its subtext was clear: anyone who pursues sweeping, structural change — by fighting for single-payer health care, championing radical financial reform, or challenging corporate power more broadly — is engaging in an unrealistic and dangerously naive enterprise. There is simply no alternative to traditional elite brokerage punctuated by populist flirtations that are quickly doused in cold water once their purpose in an election cycle has run its course.
This attitude, representing more or less the prevailing orthodoxy among the liberal intelligentsia, media figures, and the DNC leadership, is typically packaged as the prudent embrace of reality rather than the symptom of a deeply conservative political outlook.
But the Podesta emails make the actual reality of Washington’s institutionalized shell game all too clear.
The system is rigged, and Bernie Sanders was right.
https://www.jacobinmag.com/2016/10/bernie-sanders-hillary-clinton-podesta-emails-wikileaks/
Sanders Champions Colorado Single Payer Effort as Model for Nation
by Lauren MacCauley - Common Dreams
"Millions of people are watching what you do," Sen. Bernie Sanders (I-Vt.) toldvoters in Boulder, Colorado on Monday.
The progressive firebrand and former presidential candidate had traveled to the Rocky Mountain foothills to campaign on behalf of a state ballot measure that would establish a state-run, single-payer health care system in Colorado—one that he said could be a model for the nation.
"The current American healthcare system is dysfunctional and it has to change," Sanders told the crowd of more than 2,000 at the University of Colorado Boulder's Farrand Field. "Colorado can send a shot that will be heard all over the country and all over the world."
Colorado's Amendment 69, a citizen-initiated measure, would eliminate private insurance and establish a statewide program to provide universal healthcare coverage, known as ColoradoCare, for all residents.
This is not the first time that Sanders has lent his power to the high-stakes fight, which has seen a corporate-funded opposition out-raise supporters nearly five-to-one with major donations from the insurance industry.
According to Boulder's Daily Camera, on Monday, Sanders did not shy away from calling out the industry-funded misinformation campaign being spread across the state.
"Lobbyists and special-interest groups will spend millions of dollars telling you why we shouldn't pass Amendment 69," Sanders said. "But what they won't tell you is that in Colorado people get sick and die because they don't go to the doctor because they don't have health insurance."
Recent polling has indicated that the opposition campaign may be taking hold, with only about 30 percent of surveyed voters voicing support for Amendment 69.
Sanders was joined on stage by state lawmakers and National Nurses United executive director Roseann DeMoro, who said that the Colorado ballot measure was a continuation of the Sanders campaign vision for political revolution, which included healthcare for all.
"Single payer was the cornerstone of Bernie Sanders' campaign, and Colorado has put it on the ballot," DeMoro told the crowd, adding that the "movement for Bernie is a movement for all of us. ColoradoCare continues that. His values are your values."
Indeed, Sanders urged his supporters, "Stand tall and vote yes on Amendment 69."
"In this moment in American history, in these difficult days," he continued, "the United States of America must join every other major country on Earth in guaranteeing health care."
The Boulder rally was held one day after Sanders spoke alongside Sen. Elizabeth Warren (D-Mass.) in Denver at a campaign event in support of Democratic presidential nominee Hillary Clinton.
Vermont Governor Proposes Limits on Painkiller Prescriptions
by Jonah Engel Bromwich - NYT
Gov. Peter Shumlin of Vermont on Wednesday announced proposed limits on the number of painkillers that could be prescribed, the latest measure his administration has taken to combat the opioid crisis that has ravaged the state in the last five years.
At a news conference outside the Vermont Department of Health in Burlington, Mr. Shumlin and Dr. Harry Chen, the state’s health commissioner, spoke for about half an hour about proposed regulations, which they said represented a cutting-edge approach to combating the crisis.
Under the proposal, the severity and duration of pain would be used to determine the specific limit for a prescription of opioids. For example, for a minor procedure producing moderate pain, a provider would be limited to prescribing nine to 12 opioid painkiller pills, depending on the medication. The limits would be higher for more complicated procedures, and there would be exceptions for the treatment of severe pain.
The limits are proposed amendments to an existing rule and would be official in December if approved after a period of public comment and review by a state legislative committee, said Scott Coriell, a spokesman for the governor. Mr. Shumlin proposed the rule in his State of the State address in January, and he set its passage as one of the chief priorities in his final year in office.
The governor, who announced last year that he would not seek a fourth term, spoke in a phone interview about Wednesday’s announcement in the larger context of his battle against the flood of opioids. He said that when he took office in 2011, he very quickly realized that “we had a full-blown health crisis on our hands.” Three years later, in his State of the State address, he pledged to fight that crisis.
He said that limiting the number of opioid pills that could be prescribed would be an effective way to cut down on addiction.
Asked whether he hoped his successor would continue the fight, Mr. Shumlin said, “This is not a hard problem to solve.”
“We didn’t have a heroin crisis in America before OxyContin was approved and started being handed out like candy,” he said. “If politicians would lead a more rational conversation about how we manage pain in America, we could fix the majority of this problem with a click of our fingers.”
Dr. Chen stressed that the rule announced Wednesday was designed to combat the prescription of opioids for cases of “acute pain.”
“These are people who don’t normally take opioids,” he said. “We want to reduce the variability in terms of what prescribers are prescribing.”
Some critics said Wednesday’s proposals might backfire. Liz Evans, the executive director of the New York Harm Reduction Educators, a group that works to promote access to safe equipment and health care for people who use drugs, said that although she was “sure that the governor is motivated by kindness,” she was worried that the proposed regulations might not have the intended effect.
“I think prohibiting access to pain medication can result in pushing people to using more illicit drugs in a more dangerous way without being paired with existing evidence-based public health strategies that are known to work,” she said.
Dr. Chen agreed that a public health approach was necessary and said it was something that Vermont aimed to employ.
“It’s a community problem,” he said. “It needs to be solved on a communitywide basis.”
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