Editor's Note -
Here is a link to a Podcast of an interview with Finnish journalist Anu Partanen, author of the book "The Nordic Theory of Everything", and her husband Trevor Corsin. In it they describe their reactions to their move from New York to Helsinki, Anu's birthplace. They talk abut the many reasons they find that they find much more freedom in Finland than they did in the US, and the active role of government in bringing that about. They de-bunk many of the shibboleths we in the US hear constantly about universal healthcare and other government programs in Finland that make their lives easier, and why the many false arguments that the same approach in the US can't work are simply fear-mongering.
It's well worth the 45 minutes it takes to listen to.
https://pitchforkeconomics.com/episode/re-imagining-capitalism-with-anu-partanen-and-trevor-corson/
'The system is broken': Americans cast their vote for better healthcare
Ramae Hamrin was a high school math teacher in rural northern Minnesota, in a small town with a Paul Bunyan statue and snow on the ground by October.
Hamrin, 50, instructed low-income students in calculus. It was not an easy job, but it provided health insurance for her and her three children. When it came to voting, like many Americans, she was put off by the two-party system. She voted third-party and often libertarian.
Then, Hamrin slipped, fell and broke her hip. She went to hospital, doctors discovered a 9-centimetre (3.5-inch) lesion on her femur, and within weeks was diagnosed with cancer: multiple myeloma. Within two years, she was unable to work, permanently disabled by the ravages of cancer treatment.
“Before I got diagnosed, I would have never thought about healthcare or drug prices,” as a voting issue, said Hamrin. “Now, really that’s my only issue.”
This year, she said, she is voting one way: “strictly Democratic”.
With the US election just over a week away, Hamrin is one of millions of Americans who have been heading to the polls this fall with healthcare and drug prices as their top voting issue.
The United States’ massive, largely private and very expensive health industry has ranked as a top voter concern for years, and helped drive Democrats to victory in the midterm elections of 2018, when the party took control of the House of Representatives.
But over the last six months of the coronavirus pandemic, which has killed more than 220,000 Americans, Covid-19 eclipsed healthcare as the top issue of the election, though health voters like Hamrin argue the two are inseparable. Her daughter, an accomplished cross-country runner in college, was diagnosed with Covid-19 and now needs an inhaler.
“I do trust the Democrats more than I trust the Republicans to get anything done on this issue,” said Hamrin. Although, she added: “It’s hard to know who to trust these days.”
Although healthcare reform elicits concern across parties, it is one in which Democrats hold a huge advantage. Biden has a 20-point lead over Trump on issues ranging from how to lower Americans’ health costs and to how to protect people from loathed insurance industry practices.
“Covid has made us all healthcare voters,” said David Mitchell, founder of Patients for Affordable Drugs, one of a handful of advocacy groups which does not take money from pharmaceutical companies.
Mitchell is also a cancer patient. Without insurance, the drugs he depends on would cost $900,000 a year. Because Mitchell buys private insurance, he pays $15,000 a year.
“We track prescription drug pricing in campaigns, and whether it’s the Senate race in New Mexico or the Senate race in Iowa or the Senate race in North Carolina, Georgia, Maine and Michigan – drug prices are figuring in all those races,” Mitchell said. “They’re spending millions and millions and millions of dollars in ads.”
It’s not hard to find stories about why the issue resonates with voters.
“My wife is a diabetic with high blood pressure. We don’t know how to pay for her meds next month!” wrote Brett, a Florida resident who provided their story to Patients for Affordable Drugs.
A story submitted to the organization by a Wisconsin woman named Kelsey, said her insurance requires $650 in monthly cost-sharing to cover post-traumatic stress disorder, diabetes and allergies among others. The cost “leaves us virtually broke every month”.
“People are terrified, folks have lost their jobs, the economy isn’t doing well for folks who are having to make some stark decisions, so healthcare is something people need in this moment,” said Rosemary Enobakhare, the campaign director for Healthcare Voter.
The campaign helped galvanize voters in 2018, and win Democratic control of the US House, on the back of support for the 2009 Affordable Care Act, more commonly known as Obamacare – the largest overhaul of the US healthcare system in decades that extended health insurance coverage to millions of Americans who could not afford it.
The politics of healthcare has changed dramatically in four years of the Trump administration. Republicans have repeatedly failed to fulfill their vow to repeal and “replace” Obamacare.
“We thought we had done all the work we needed to do to protect the ACA, but we have Republicans still working very hard to take away people’s healthcare,” said Enobakhare.
A repeal bill sank after Trump antagonist and Republican former US Senator John McCain cast a thumbs-down no vote. But Republicans have also since found that protections brought in under Obamacare have become more popular.
“When you are dealing with people who are sick on the verge of death they will do whatever it takes to get better and to stay alive,” said Daniel Dawes, director of the Satcher Health Leadership Institute at Morehouse School of Medicine.
“You now have folks who have reached the breaking point,” said Dawes. “They recognize there is something unfair about this system.”
Democrats and insurgent progressives then rode the wave of GOP failure to office in 2018. Senator Bernie Sanders has meanwhile raised the prominence of the Medicare for All healthcare plan, an NHS-style single-payer system favored by progressives that would eliminate private health insurance.
This election year, Democrats are again making healthcare and insurance a top issue, though Democratic presidential candidate Joe Biden’s health policy does not support Medicare for All. Instead, Biden advocates for the expansion of Obamacare, a policy likely to appeal to more centrist voters who are not yet convinced by the promise of a full healthcare revolution.
Trump has repeatedly claimed a new Republican health plan is in the wings, though he has failed to unveil one, and touted executive orders he claims will bring down drug prices, though they lack detail and are unlikely to do so.
The Trump administration is also now backing a legal challenge that could leave 20 million people without health insurance in the middle of a pandemic. One week after election day on 3 November, the supreme court is scheduled to hear oral arguments on whether the ACA is constitutional, which could send shockwaves through the health system as the United States grapples with the Covid-19 pandemic.
A Trump supreme court nominee, Amy Coney Barrett, expected to be confirmed this week, could be the deciding vote.
For Hamrin, this is not an ideological debate. On 1 January, she loses her private insurance, and the cost of the medication keeping her alive soars to $15,000 a year, all but wiping out her disability checks.
“The whole system is broken,” said Hamrin. “I think government needs to interfere on this one,” she said, adding that she is voting Democrat because she believes government interference “follows their philosophy”.
Without government regulation, she said: “I’m just not sure we’re ever going to see a workable solution, and one in time to save the lives of people that need it.”
https://www.theguardian.com/us-news/2020/oct/25/us-election-voters-healthcare-drug-prices
Letter to the Editor: Trump – The Nadir of Disgrace
by Joe Lendvai - The Daily Bulldog - October 25, 2020
Why would any person with even a modicum of self respect still support a power-mad narcissist for president? One who calls our war dead losers and suckers? Ditto for our military service chiefs whom he dismissed as “a bunch of dopes and babies”? And brags about being a billionaire who paid $750 in taxes for 2016 an 2017, but paid nothing, zero, for a decade. Worse, he personally owes hundreds of millions to foreign banks; money he must pay within the next two to four years. I wonder how he’ll do that as an unemployed?
Let’s face it. The man is a failure as a business man. He has filed Chapter 11 bankruptcies for his companies six times. And the failures continued with Trump airlines, mortgage, stakes vodka, university, and on and on. More importantly, Trump has been a failure at the most basic level as a human being. Vulgar and vindictive, he has shown no common decency nor empathy toward others.
He has been destroying would be migrant families by separating and caging, literally, their children, as he deported their parents – some never to be be reunited due to lack of responsible record keeping by our government. The long term harm to these kids is a given. Only a heartless, callous and inhumane person would order such actions.
There is a psychological term, ‘projection’ – attributing one’s negative traits onto others – that fits Trump to a “T”. He never accepts responsibility for any wrong doing that he is guilty of; it’s always someone else’s fault. Just recently he repeatedly called former VP Biden a “criminal”; as well as a reporter, for not writing about this absurd charge. I guess it takes one to know one.
Why would any person vote for a guy who lies to the American people every day? Over 20,000 times, as documented by our great newspapers. The man is an unhinged, unfiltered rant-and-rave machine, willing to attack and insult friend and foe. One wonders if the unique and aggressive treatment he received for his own Covid-19 infection affected more than just the virus, because he is not behaving like a sane person.
His most recent target was Dr. Anthony Fauci, our nation’s top infectious disease expert, whom Trump called a “disaster”, and dismissed medical scientists as “these idiots.” All this, while the coronavirus pandemic is raging anew, particularly in Midwest, killing Americans by the hundreds every day. And instead of helping to mitigate the pandemic, he is the super spreader! Organizing large public events without basic preventive measures - no masks, no physical distancing while mocking those who do - it’s no surprise that his own family and his own staff are getting infected, along with thousands of his supporters. Joining his personality cult is dangerous to your health.
The hypocrisy of it all is that Trump gets “government healthcare.” The very best in the world. Free! Well, not exactly, because you and I pay for it. And he has been jealously criticizing Obamacare for years. In fact, he has a lawsuit before the Supreme Court to eliminate it altogether. Right now. If successful, it will kill access to affordable healthcare, including coverage for pre-existing conditions, for over 23 millions Americans.
It should be clear to most Americans that Trump is a corrupt narcissist who has been masquerading as president. He is unfit to serve. His ‘talent’, if we can call it that, is to corrupt others, much like a cult leader does. His enablers are many, including members of the Republican Senate who rewarded him with a “get out of jail” card during his impeachment. It was wrong.
All Americans of conscience and civility should reject this pathetic and damaged president, along with his partisan enablers, come Election Day. Enough. Time to return to decency.
If the ACA Falls, Protecting Preexisting Conditions Could Be Harder Than It Sounds
By Selena Simmons-Duffin - BBC World Service - October 27, 2020
President Trump has tried to get rid of the Affordable Care Act since the first day of his presidency, but there's one part of Obamacare that he wants to preserve.
"We will always protect patients with preexisting conditions — always," Trump told a campaign crowd on Sunday in Londonderry, N.H. — a message he's shared repeatedly in the final days and weeks before the presidential election.
He said it again in an interview with CBS' Lesley Stahl that aired Sunday on 60 minutes: "We won't do anything — and no plan — unless we have preexisting conditions covered."
A "preexisting condition" refers to any health issue someone has before they sign up for a health insurance policy — from high blood pressure to pregnancy to allergies. Before the Affordable Care Act, it was perfectly legal for health insurers to deny coverage to people with such conditions.
An estimate from the Kaiser Family Foundation suggests that around 54 million people have conditions that — without legal protections — could prompt health insurers to deny them policies. Polls show this is one of the most popular provisions of the law, across the political spectrum.
Although Republicans failed to repeal the ACA in 2017, Trump now has another chance to strike it down: his administration will argue that the law must "fall" at the Supreme Court on November 10, just one week after the election. The addition of Justice Amy Coney Barrett to the court could make this Supreme Court challenge more likely to succeed than two previous attempts.
If the law does fall, Congress and the administration would have to act fast to protect people with preexisting conditions. But actually making a law that does that is harder than it sounds. Here's why it's so tricky, and how Trump may look to address the problem if he's elected for a second term.
How things worked, pre-ACA
To understand this problem, you have to time travel to pre-ACA times, says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.
Before the ACA, "one of the essential business models for health insurance companies was to discourage risky people from buying into their plans and get as [many] healthy people as they could," she explains. That way, "they could get the premium revenue and not have to pay out as much in medical claims."
When you applied for a private private health plan as an individual — as opposed to getting insurance through your job or a public plan like Medicare — insurers would usually require you to fill out a questionnaire and ask for permission to look through your medical records.
If they found a health condition that concerned them, Corlette explains, there were three things they could do.
The first tool they could use was to "simply deny you a policy and just say, 'I'm sorry, we can't cover you.' " The second tool was to issue you a policy but to say, "'We won't cover any care related to your preexisting condition — we see that you have asthma, so we won't cover anything related to an upper respiratory condition.' "
"A third tool would be to simply say, 'We will cover you, but we're going to essentially charge you a higher premium because we think you're a riskier person — we normally charge people $100 a month, we're going to charge you $150 a month,' " Corlette explains.
The ACA fix
To stop insurance companies from doing this, the Affordable Care Act needed to come up with a way to keep enough healthy people in the market to balance out the cost of covering more expensive, sick people.
Think about fire insurance, says Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. "If you let people insure their house once it's already on fire, everyone's going to wait until their house is on fire to buy insurance. It's a similar problem in health care: If you tell people with preexisting conditions that they're guaranteed access to insurance, people who are healthy will tend to wait to buy insurance until they get sick."
If the insurance market is made up of sick people who need lots of medical care, "premiums skyrocket into what's known as a death spiral," he says.
So, the people who crafted the Affordable Care Act came up with incentives to get more healthy people into the insurance pool. "The ACA had a carrot and stick," says Levitt. "The carrot was subsidies provided to low- and middle-income people that made insurance a good value, and the stick was the individual mandate."
In 2017, Republicans in Congress changed the individual mandate's penalty to $0 as part of the tax bill. (The fact that the penalty is zero dollars is the basis for the legal challenge soon to be argued before the Supreme Court.)
Even without the threat of a fine for not having insurance, though, "the carrot of the subsidies is still in place and has been very effective at keeping premiums stable," Levitt says.
As President Trump pointed out during Thursday's debate, "premiums are down, everything's down." Enough healthy people are buying plans in the private market to keep premiums from skyrocketing, although critics still argue that high plan costs price people out of the market.
The challenges of alternate solutions
So without the ACA, how would President Trump and his allies prefer to approach the problem?
"We don't know where the president is on this," says Douglas Holtz-Eakin, president of the American Action Forum, a conservative think tank. Trump did sign an executive order related to preexisting conditions in September, but all it did, Holtz-Eakin says, "was to say very firmly that the [health] secretary is going to have to figure this out."
There are other ways to incentivize healthy people to pay for health insurance. For Republicans, "the leading alternative approach has been continuous coverage provisions," Holtz-Eakin says. This idea has been part of Republican ACA replacement bills before — people could be charged a fee and potentially be locked out of the market if they have a break in coverage, thus presumably motivating the young and healthy to stay consistently insured.
Holtz-Eakin says the promise of this model is that "an insurer has a stake in more than one year of your life — so there are now incentives to cover prevention more than there would be otherwise." Critics have argued that could actually disincentivize healthy people who don't have coverage from joining the market, and hurt low-income people who already have trouble finding and maintaining health insurance.
Another Republican idea is to go back to "high risk pools," which were common before the ACA. This divides the market into healthy people and sick people. That way, healthy people can pay lower premiums, but the pool for sick people gets expensive fast. Monthly premiums — even if they're very high — from the limited pool of sick people would not pay for all their care, meaning the government and insurance companies would have to step in to cover costs.
Of course, on the other side of the political spectrum, there's the idea of Medicare-for-all, where everyone is covered in a government-funded plan. That would ensure people with preexisting conditions can be covered, says Levitt, but that's an idea the Trump administration would never go for.
What could happen?
If the Affordable Care Act is fully struck down by the Supreme Court without a replacement, "the preexisting condition protections go away," Corlette says, along with the insurance marketplaces, Medicaid expansion, premium subsidies, and more. As a result, a recent Urban Institute analysis projected that 21.1 million could lose health coverage, a nearly 70% increase in the number of uninsured.
Another concern: COVID-19 might be considered a preexisting condition by insurance companies. That could mean millions more people affected by changes to these rules because of the pandemic.
There are a lot of outstanding questions. Would the Supreme Court justices give Congress a few months to come up with a fix to the ACA or pass a new law to prevent the coverage losses? Would the court make a narrow ruling that kept most of the law intact? Would it rule against the challengers, keeping the ACA as it is?
Without the ACA or another federal law requiring insurance companies to cover everyone regardless of their health, they would almost certainly "revert back to their business model of yore," says Corlette. "The incentives for them to start underwriting again and getting rid of high cost, high risk people are too strong."
As an example, if you're an insurance company in a city with two competing insurers, "and you're the only one that is still taking sick people and enrolling them, you will quickly find yourself with the highest premiums, the fewest enrollees, and and you'll be losing money compared to your competitors," she says.
This is not what insurance companies want. Insurance industry group America's Health Insurance Plans submitted an amicus brief to the Supreme Court arguing that the ACA should not be struck down.
Mainers benefit as region’s churches erase about $26 million in medical debt
United Church of Christ congregations across southern New England helped raise enough money to help almost 20,000 families nationally.
By Associated Press - Portland Press Herald - October 28, 2020
BOSTON — More than 100 United Church of Christ congregations across southern New England have helped raise enough money to erase a total of $26.2 million in medical debt for thousands of families across the Northeast and more than 12,000 first responders and medical workers nationwide.
The churches in Massachusetts, Connecticut and Rhode Island, along with four church associations and more than 100 households raised more than $200,000, the denomination announced Sunday.
That money went to the New-York based nonprofit RIP Medical Debt, which bought debt in August from collection agencies for pennies on the dollar. That debt will now be forgiven.
About $8.4 million in medical debt for 7,175 households in Connecticut, Massachusetts, Maine, New Hampshire, New York, Rhode Island and Vermont will be wiped out.
In addition, another $17.8 million in debt for 12,144 health care workers and first responders across the U.S. will be erased.
All will receive letters telling them that their medical debt has been forgiven.
“In the midst of a pandemic that is disproportionately impacting communities of color and with widespread unemployment causing people to lose their insurance just when they may need it most, eliminating medical debt for vulnerable individuals and families is a tangible way in which we are responding to our call to make God’s love and justice real,” the Rev. Jocelyn Gardner Spencer, senior pastor of the United Church on the Green in New Haven, Connecticut, said in a statement.
The families that had their debt forgiven make less than two times the federal poverty level, are financially burdened, and have out-of-pocket expenses that are 5 percent or more of their annual income or have debts worth more than their assets, according to the church.
The United Church of Christ has held similar debt-forgiveness efforts across the nation.
The Maine Idea: Doing it right: How referendums can work
As with most things, in politics there’s a right way and a wrong way, and – as jokesters often chortle – we usually choose the wrong way first. Though not always.
Here’s a current case study in Maine’s vexed initiative-and-referendum system, adopted back in 1909 by a progressive Republican Legislature, and first used, two years later, to create the June primary election system that replaced party caucuses.
There’s concern that this unusual form of direct democracy – in New England, only Maine and Massachusetts have it – is vulnerable to outside pressure, and it can be. We all thought the attempt to reject the CMP power line to Canada was of indigenous growth, but it turns out it was mostly a stalking horse for NextEra Energy – a huge rival of Hydro Quebec for New England’s lucrative renewable energy market.
That referendum proposal, though duly certified, was removed from the ballot by the Maine Supreme Judicial Court, for the embarrassingly simple reason that it proposed no change in state law, as required, but just ordered the Public Utilities Commission to reverse its approval.
Then there’s the peculiar attempt by the Maine Republican Party to get ranked-choice voting back on the ballot for the third time. To recap, voters approved ranked-choice voting in 2016, along with measures to legalize marijuana, raise the minimum wage, and increase income taxes on wealthy individuals.
The results were decidedly mixed. It took four years to get marijuana shops up and running – regular legislation would have been quicker; the income tax increase was summarily repealed by lawmakers; and the primary purpose of ranked choice voting, to avoid splits in the race for governor, was found unconstitutional. Yes, the minimum wage increase did work, with the final increment, to $12, taking effect last January.
Ranked-choice then had a second test; the Legislature tried to repeal it, amid more gridlock, in 2018, but voters approved a people’s veto by a wide margin, presumably settling the issue. Whatever its flaws, ranked choice seems well-understood, and has been used intelligently by voters.
Nonetheless, Republicans tried to “people’s veto” this year’s extension to presidential elections. Give them credit for persistence: Amidst a pandemic and statewide shutdowns, the GOP turned out the troops and gathered a huge number of signatures, necessarily involving person-to-person contact; better not ask exactly how they did it.
The hasty collections, however, resulted in numerous disqualifications, and, after a brief courtroom back and forth – a judge said petition-gatherers didn’t need to be registered voters, but the Supreme Court confirmed that they did – the ballot attempt failed.
Unlike 2016, when there were five, there are, thankfully, no initiated questions on this presidential-year ballot.
It makes one wonder whether there’s much purpose to these ballot fights, but there certainly can be. One example was the 2017 referendum that made Maine the 36th state to adopt the Affordable Care Act’s Medicaid expansion.
Among advocates there was disagreement; former Gov. Paul LePage had been blocking expansion for four years, yet some thought it better to wait until he left office, because Mainers clearly favored expansion.
Maine Equal Justice pushed ahead, got the measure qualified, and a resounding 60% voted yes. True, LePage dragged his feet for another year, but the initiated bill became Job One for the Mills administration when it took office in 2019.
Equally important, Maine’s success inspired ballot measures elsewhere, where legislatures or governors blocked expansion. In three “red states,” Missouri, Nebraska and Oklahoma, voters have approved Medicaid expansion; South Dakota is likely to vote in 2022.
Now, Maine health care advocates want to go beyond the Affordable Care Act, and put a universal, “Medicare for All” measure on the ballot, since the Legislature has declined to act. The ACA, as the pandemic has dramatized, falls woefully short of national needs, especially by preserving the health-care-for-profit system that so distorts access to care while making it ruinously expensive.
Unlike the state GOP, however, health advocates opted not to circulate petitions during a pandemic, and will wait; a question won’t likely appear before 2022. It could be time well spent.
Demonstrating public support for a wholesale change in the system – something supported, to date, by neither Democratic nor Republican nominees for president – could again be highly influential. No state has done this; Maine would be the first.
Battles over the U.S. Supreme Court, the U.S. Senate and the Electoral College – all institutions that can be, and recently have been, controlled by voting minorities, can lead to despair over whether democracy, as measured by majority voting, can prevail.
Maine has shown that it works. That’s reason to believe we can do it again.
https://www.pressherald.com/2020/10/26/the-maine-idea-doing-it-right-how-referendums-can-work/
A President Looks Back on His Toughest Fight
Obama is a better writer than he was a president, but this is no Dreams from My Father. Like most politicians’ memoirs, it is annoyingly self-serving. He bad mouths unions but could have benefited from understanding something every Union negotiator knows: don’t make any concessions until you know your adversary is prepared to reciprocate.
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