Editor's Note:
This excerpt from FDR's 1944 State of the Union speech seems apropos as we recover from the 2018 midterm elections. If progressive politicians continue their lurch to the left, they may end up where FDR was in 1944.
-SPC
Excerpt from Franklin Roosevelt's 1944 State of the Union:
This Republic had its beginning, and grew to its present strength, under the protection of certain inalienable political rights—among them the right of free speech, free press, free worship, trial by jury, freedom from unreasonable searches and seizures. They were our rights to life and liberty.
As our Nation has grown in size and stature, however—as our industrial economy expanded—these political rights proved inadequate to assure us equality in the pursuit of happiness.
We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence. "Necessitous men are not free men." People who are hungry and out of a job are the stuff of which dictatorships are made.
In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all regardless of station, race, or creed.
Among these are:
The right to a useful and remunerative job in the industries or shops or farms or mines of the Nation;
The right to earn enough to provide adequate food and clothing and recreation;
The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;
The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;
The right of every family to a decent home;
The right to adequate medical care and the opportunity to achieve and enjoy good health;
The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;
The right to a good education.
All of these rights spell security. And after this war is won we must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being.
America's own rightful place in the world depends in large part upon how fully these and similar rights have been carried into practice for our citizens. For unless there is security here at home there cannot be lasting peace in the world.
One of the great American industrialists of our day—a man who has rendered yeoman service to his country in this crisis-recently emphasized the grave dangers of "rightist reaction" in this Nation. All clear-thinking businessmen share his concern. Indeed, if such reaction should develop—if history were to repeat itself and we were to return to the so-called "normalcy" of the 1920's—then it is certain that even though we shall have conquered our enemies on the battlefields abroad, we shall have yielded to the spirit of Fascism here at home.
Free dental care day seen as ‘a warning sign’ that Maine isn’t meeting need for coverage
by Joe Lawlor - Portland Press Herald - November 2, 2018
Mary Rena stepped into a spacious yet bustling room at the University of New England’s Portland campus Friday for a dental cleaning – alongside 39 other adults who showed up for free dental work.
Rena, 58, of Portland, said her new sales job doesn’t include health or dental benefits, so the free cleaning is appreciated.
The university is one of six sites in the state that offer free dental care one day per year, an event called “Dentists Who Care for ME.” About 120 Mainers got free dental work at UNE – including cleanings, fillings and extractions – and about 500 received care overall including the other five sites: South Portland, Skowhegan, Scarborough, Falmouth and Presque Isle. At UNE, third- and fourth-year dental students did the work under the supervision of volunteer dentists.
Maine is one of 13 states that has no adult dental benefit in Medicaid, except for emergency work. Four states have no dental benefits for adults under Medicaid, while the remaining 33 states plus the District of Columbia have at least limited dental benefits – such as free cleanings – or comprehensive dental benefits. Some workers who earn too much to qualify for Medicaid may have health care coverage through their jobs, but their employers don’t offer dental plans.
The lack of Medicaid benefits for adults, plus low reimbursement rates for children, creates significant coverage gaps in Maine, experts say.
Dr. Jonathan Shenkin, past president of the Maine Dental Association, said while the free day is helpful, it’s not a strategy to take care of Mainers’ dental needs.
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“Free days of dental care is a warning sign that the state is not providing the resources people need,” Shenkin said. “Charity is not a health care system.”
About 100,000 of the 260,000 Mainers who have Medicaid are non-elderly, non-disabled adults who would stand to gain from a dental benefit. An additional 70,000 Mainers would be eligible for Medicaid under expansion, which voters approved in 2017 but hasn’t been implemented yet because of a court fight between the LePage administration and expansion advocates.
Shenkin, a pediatric dentist in Augusta, said the state has “ignored everything” except for efforts to get more dentists practicing in Maine.
DENTIST SHORTAGE
Maine has traditionally had a shortage of dentists. The state’s rate was 50 dentists per 100,000 people in 2017 – well below the national average of 61 dentists per 100,000, according to America’s Health Rankings, a study conducted by a private foundation that compares states on a number of health issues.
Maine taxpayers helped get the UNE program off the ground by approving a $5 million bond issue in 2010 with $3.5 million of that going to help establish the dental school, which opened in 2013. Maine also has sought to address the dentist shortage by approving a bill in 2014 that created a new licensed position, a dental therapist. Dental therapists can do cleanings, fill cavities and perform other dental work, but major dental care still must be performed by dentists.
Shenkin said the underlying problem for access to care is the lack of an adult Medicaid dental benefit and low reimbursement rates for pediatric dental care. The reimbursement rate for pediatric dental work in Maine is 44.6 percent of what a commercial plan would pay for, compared to the national average of 49.4 percent.
Shenkin said even children who are covered under Medicaid sometimes have a difficult time getting appointments. The low reimbursement rates mean that dentists who accept Medicaid patients must limit the number of Medicaid patients they see to avoid losing money, he said.
Rena said paying out-of-pocket for dental care is expensive, usually between $150 and $200 just for a cleaning, so she has tried to save money by taking advantage of programs like the free dental care day and getting reduced-cost cleanings at the University of New England, which operates a reduced-cost clinic for uninsured Mainers.
PREVENTION PAYS OFF
UNE is working to ease the dentist shortage with its program, said Dr. Fields Farrior, associate dean at the dental school. Of the 63 students who graduated in 2018, 18 stayed in Maine, and the program also sends students on 12-week “externship” programs to help dentists in rural locations in Maine, Vermont and New Hampshire.
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“This (free day) program fits into our mission of bringing access to care to patients,” Farrior said.
Angela Cole Westhoff, executive director of the Maine Dental Association, said that every dollar spent on prevention will save $7 to the health care system down the road because problems that are ignored become emergencies and require more expensive procedures. A 2010 study by the University of Southern Maine cited dental pain as a major driver in preventable emergency room utilization in Maine. That study has not been updated, but Shenkin said the underlying shortcomings with the dental care system in Maine remain the same as in 2010.
‘A GREAT OPPORTUNITY’
Stephanie Beeckel, a third-year dental student at UNE who worked on Rena’s cleaning, said the free cleaning day and the reduced cost clinic help students like her gain the practical skills she’ll need when she enters the field. Beeckel, 25, of Augusta, said she plans to stay in Maine.
Rena said she wasn’t expecting to go to the dentist Friday, but learned of the program Thursday.
“This is a great opportunity to get really good care and help people like me who have a gap in their health insurance,” Rena said.
Editor's Note -
The following link will take you to a Facebook posting of a succinct statement about the need for "Improved Medicare for All" from Robert Reich of MoveOn.com.
-SPC
https://www.facebook.com/RBReich/videos/256155541721419/
Three Deep Red States Vote to Expand Medicaid
by Abby Goodnough - NYT - November 7, 2018
WASHINGTON — Voters in Idaho, Nebraska and Utah on Tuesday were on track to approve what their Republican-led legislatures repeatedly would not: free or low-cost health coverage for most poor adults through an expansion of their Medicaid programs. The three deep-red states are now poised to join 33 others that have already expanded Medicaid, an option under the Affordable Care Act since 2014.
In Montana, where the legislature expanded the program in 2015, but only for four years, voters appeared to reject a plan to sharply raise the cigarette tax to pay the state share of the cost. Expanded Medicaid will now end there, unless the legislature agrees on another funding source. The tobacco industry poured more than $17 million into ads opposing the tax hike.
The success of the citizen-driven initiatives in the three other states reaffirms the outsized role of Medicaid in expanding access to health care in the Obamacare era. In all, enrollment in the program has grown by at least 15.6 million, or 28 percent, since 2013, the year before the health law’s main provisions took effect. If lawmakers in Utah, Idaho and Nebraska don’t interfere — as happened in Maine, where Gov. Paul LePage has blocked an expansion of Medicaid ever since voters approved it last year — an estimated 325,000 people in the three states will be able to enroll in Medicaid starting next spring.
In Maine, where Mr. LePage is leaving office because of term limits, the Democratic candidate, Janet Mills, won. She wants to immediately move forward with expanding Medicaid to at least 70,000 low-income adults there.
Prospects for expanding Medicaid also improved in Kansas, where Laura Kelly, a Democrat who supports doing so, won the governor’s race Tuesday, and Wisconsin, where Tony Evers, the Democrat, defeated Gov. Scott Walker. The Republican-controlled state legislature in Kansas voted last year to expand the program, but former Gov. Sam Brownback vetoed the bill.
In Georgia, Stacey Abrams, the Democratic candidate for governor who made expanding Medicaid a top priority, trailed her Republican opponent but was hoping for a runoff. The governor’s race in another state with a large uninsured population, Florida, went to the Republican candidate, Russ DeSantis, making expansion unlikely there any time soon.
Opinion polls found broad support for Medicaid expansion in the three states where voters approved it Tuesday — as well as nationally suggesting its popularity now cuts across party lines. In all three states, governors and candidates for governor had said they will accept whatever outcome the voters decide.
The biggest reason Republican lawmakers have opposed Medicaid expansion is concern that it will eat up too much of the state budget. In a number of states that have already expanded the program, enrollment has far exceeded expectations, driving up costs. But under the terms of the health law, the federal government pays at least 90 percent of the costs for the newly eligible adult population.
In Nebraska and Idaho, the ballot initiatives did not include a way to pay the state share of expansion costs. That could potentially make them vulnerable to the type of stalling that’s happened in Maine, where Mr. LePage has grounded his resistance in the fact that the initiative did not include a funding mechanism.
In Utah, the measure increases the state sales tax rate on items other than food to 4.85 percent, from the current 4.7 percent, to pay the state share.
The largest donor overall to the Medicaid ballot initiatives was the Fairness Project, an advocacy group backed primarily by a California labor union. The group spent more than $5 million on signature-gathering efforts, advertising, field offices and other efforts.
“This election proves that politicians who fought to repeal the Affordable Care Act got it wrong,” said Jonathan Schleifer, executive director of The Fairness Project. “Expanding access to health care isn’t a blue state value or a red state value; it’s an American value.”
Quick: What’s The Difference Between Medicare-For-All and Single-Payer?
by Samantha Young - Kaiser Health News - November 5, 2018
MODESTO, Calif. — Betsy Foster and Doug Dillon are devotees of Josh Harder. The Democratic upstart is attempting to topple Republican House incumbent Jeff Denham in this conflicted, semi-rural district that is home to conservative agricultural interests, a growing Latino population and liberal San Francisco Bay Area refugees.
To Foster’s and Dillon’s delight, Harder supports a “Medicare-for-all” health care system that would cover all Americans.
Foster, a 54-year-old campaign volunteer from Berkeley, believes Medicare-for-all is similar to what’s offered in Canada, where the government provides health insurance to everybody.
Dillon, a 57-year-old almond farmer from Modesto, says Foster’s description sounds like a single-payer system.
“It all means many different things to many different people,” Foster said from behind a volunteer table inside the warehouse Harder uses as his campaign headquarters. “It’s all so complicated.”
Across the country, catchphrases such as “Medicare-for-all,” “single-payer,” “public option” and “universal health care” are sweeping state and federal political races as Democrats tap into voter anger about GOP efforts to kill the Affordable Care Act and erode protections for people with preexisting conditions.
Republicans, including President Donald Trump, describe such proposals as “socialist” schemes that will cost taxpayers too much. They say their party is committed to providing affordable and accessible health insurance, which includes coverage for preexisting conditions, but with less government involvement.
Voters have become casualties as candidates toss around these catchphrases — sometimes vaguely and inaccurately. The sound bites often come across as “quick answers without a lot of detail,” said Gerard Anderson, a professor of public health at the Johns Hopkins University Bloomberg School Public Health.
“It’s quite understandable people don’t understand the terms,” Anderson added.
For example, U.S. Sen. Bernie Sanders (I-Vt.) advocates a single-payer national health care program that he calls Medicare-for-all, an idea that caught fire during his 2016 presidential bid.
But Sanders’ labels are misleading, health experts agree, because Medicare isn’t actually a single-payer system. Medicare allows private insurance companies to manage care in the program, which means the government is not the only payer of claims.
What Sanders wants is a federally run program charged with providing health coverage to everyone. Private insurance companies wouldn’t participate.
In other words: single-payer, with the federal government at the helm.
Absent federal action, Democratic gubernatorial candidates Gavin Newsom in California, Jay Gonzales in Massachusetts and Andrew Gillum in Florida are pushing for state-run single-payer.
To complicate matters, some Democrats are simply calling for universal coverage, a vague philosophical idea subject to interpretation. Universal health care could mean a single-payer system, Medicare-for-all or building upon what exists today — a combination of public and private programs in which everyone has access to health care.
Others call for a “public option,” a government plan open to everyone, including Democratic House candidates Antonio Delgado in New York and Cindy Axne in Iowa. Delgado wants the public option to be Medicare, but Axne proposes Medicare or Medicaid.
Are you confused yet?
Sacramento-area voter Sarah Grace, who describes herself as politically independent, said the dialogue is over her head.
“I was a health care professional for so long, and I don’t even know,” said Grace, 42, who worked as a paramedic for 16 years and now owns a holistic healing business. “That’s telling.”
In fact, most voters approached for this article declined to be interviewed, saying they didn’t understand the issue. “I just don’t know enough,” Paul Her of Sacramento said candidly.
“You get all this conflicting information,” said Her, 32, a medical instrument technician who was touring the state Capitol with two uncles visiting from Thailand. “Half the time, I’m just confused.”
The confusion is all the more striking in a state where the expansion of coverage has dominated the political debate on and off for more than a decade. Although the issue clearly resonates with voters, the details of what might be done about it remain fuzzy.
A late-October poll by the Public Policy Institute of California shows the majority of Californians, nearly 60 percent, believe it is the responsibility of the federal government to make sure all Americans have health coverage. Other state and national surveys reveal that health care is one of the top concerns on voters’ minds this midterm election.
Democrats have seized on the issue, pounding GOP incumbents for voting last year to repeal the Affordable Care Act and attempting to water down protections for people with preexisting medical conditions in the process. A Texas lawsuit brought by 18 Republican state attorneys general and two GOP governors could decimate protections for preexisting conditions under the ACA — or kill the law itself.
Republicans say the current health care system is broken, and they have criticized the rising premiums that have hit many Americans under the ACA.
Whether the Democratic focus on health care translates into votes remains to be seen in the party’s drive to flip 23 seats to gain control of the House.
The Denham-Harder race is one of the most watched in the country, rated too close to call by most political analysts. Harder has aired blistering ads against Denham for his vote last year against the ACA, and he sought to distinguish himself from the incumbent by calling for Medicare-for-all — an issue he hopes will play well in a district where an estimated 146,000 people would lose coverage if the 2010 health law is overturned.
Yet Harder is not clinging to the Medicare-for-all label and said Democrats may need to talk more broadly about getting everyone health care coverage.
“I think there’s a spectrum of options that we can talk about,” Harder said. “I think the reality is we’ve got to keep all options open as we’re thinking towards what the next 50 years of American health care should look like.”
To some voters, what politicians call their plans is irrelevant. They just want reasonably priced coverage for everyone.
Sitting with his newspaper on the porch of a local coffee shop in Modesto, John Byron said he wants private health insurance companies out of the picture.
The 73-year-old retired grandfather said he has seen too many families struggle with their medical bills and believes a government-run system is the only way.
“I think it’s the most effective and affordable,” he said.
Linda Wahler of Santa Cruz, who drove to this Central Valley city to knock on doors for the Harder campaign, also thinks the government should play a larger role in providing coverage.
But unlike Byron, Wahler, 68, wants politicians to minimize confusion by better defining their health care pitches.
“I think we could use some more education in what it all means,” she said.
Obamacare Repeal in Congress Is Dead. Next, a Battle Over Medicare for All
by John Pozzi - Bloomberg News - November 7, 2018
Obamacare repeal is officially dead. On to the battle over Medicare for All.
Tuesday’s midterm victories by Democrats mean that Republicans no longer have a path to make major changes to the Affordable Care Act. It also sets up a debate between Democrats’ liberal and moderate wings over whether to embrace a broad expansion of insurance to all Americans as they prepare to challenge President Donald Trump for the presidency in 2020.
Once considered an outlier position, Medicare for All has gained substantial support among Democrats thanks to midterm primary victories by progressives who embraced it.
In its broadest terms, the proposal would expand benefits in Medicare -- which covers more than 50 million elderly or disabled Americans -- and offer it to working age people. It would be a radical change to U.S. health care, potentially dismantling much of an existing system where people get health benefits through work. It would also shift trillions of dollars that the country currently spends on private insurance.
“Medicare for All has really been a slogan that has not been well-defined, and it was weaponized by the Republican party as some kind of an attempt to socialize the medical system,” said Dan Mendelson, founder of the consulting group Avalere Health.
“It’s really going to be important for anyone running for president to define what they mean by Medicare for All,” he said.
A presidential primary may ratchet up pressure on candidates to move left on health care. In the Senate, 2020 hopefuls including senators Cory Booker, Kirsten Gillibrand, Kamala Harris, and Elizabeth Warren have all co-sponsored a Medicare for All bill from Senator Bernie Sanders. Another supporter of a public insurance option is Representative Beto O’Rourke, who lost a challenge Tuesday night to Republican Senator Ted Cruz in Texas, and who has emerged as one of the Democratic party’s young stars.
What individual politicians mean by Medicare for All may vary. Some early drafts of the Affordable Care Act included plans for a “public option” -- a government-financed competitor to private insurers. That proposal didn’t make it into Obamacare in 2010, but Democrats who want to expand coverage without disrupting employer-based health plans could revive it.
Target for GOP
As Democrats fight out their future position, health care is likely to remain a line of attack for Republicans as well. Medicare for All has become a top target for Trump and his surrogates, who seem eager to paint it as socialism and a threat to current benefits for seniors.
“I think the Republicans are all-in on spending the next two years saying that Medicare-for-All will break Medicare,” said Rodney Whitlock, a former health-care adviser to Republican Senator Chuck Grassley of Iowa, and now a consultant for ML Strategies.
An Oct. 10 op-ed in USA Today under Trump’s name warned that Democrats “want to outlaw private health care plans.” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, tweeted on Halloween that the scariest costume was a T-shirt that said “MEDICARE FOR ALL.”
Democrats will have to consider whether they want to embrace that proposal or advocate more moderate, incremental changes. “If this had been a blue wave, we wouldn’t be having the conversation,” Whitlock said.
Other results from Tuesday showed how the politics of health care may be shifting. Three states -- Idaho, Nebraska and Utah -- are projected to have approved Medicaid expansion by ballot initiative, which will expand coverage substantially in those states.
One Obamacare wild card is a federal lawsuit in Texas. A federal judge in Fort Worth could rule any day on whether to wipe out Obamacare, including a popular provision requiring insurers to cover pre-existing conditions. It’s likely that any decision by the judge would be stayed until a higher court can review it.
Republican politicians from Senate Majority Leader Mitch McConnell to the incoming Missouri Senator Josh Hawley have committed to protections for people with pre-existing conditions, one of the most popular elements of the Affordable Care Act.
The Trump administration remains responsible for running the law’s marketplaces. Executive actions Trump takes may strengthen those markets or, as the president once pledged, make them implode. A Democrat-controlled House is also likely to give scrutiny to any such actions by the administration.
Health Insurers Hit Record as Split Congress Removes Risk
by Tatiana Darie - Bloomberg News - November 7, 2018
A rally in managed-care stocks is propelling health care to the top spot in the S&P 500 as a divided Congress removes the risk of major changes to the U.S. health system.
The S&P 500 Managed Care Index rose as much as 4.5 percent to an all-time high, led by a rally in insurers focused on the Medicaid program. Centene, WellCare Health and Molina are among the providers that stand to benefit from the three states that have voted to expand Medicaid coverage.
“A relief rally is logical given that the other outcomes were leading to likely increased headline risk,” said Jefferies health strategist Jared Holz.
Republicans having little chance at repealing or making significant changes to the Affordable Care Act is good news for health insurers, particularly those that still have exposure to the health exchanges, according to Bloomberg Intelligence analyst Jason McGorman. While mid-term victories by Democrats clear lead to a bigger debate on Medicare for All, a single-payer system is still seen as “wishful thinking at best,” Holz noted.
Humana’s boost to its full-year earnings forecast after beating third-quarter estimates is adding to the momentum in the sector. The solid quarter, a good 2019 selling season so far, and a purple Congress set the insurer up well for outperformance into next year, Leerink analyst Ana Gupte wrote in a note after the report.
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