Category Archives: Public Policy and Governance

Medicare For All? Or For All Who Want It?

Elizabeth Warren and Bernie Sanders have made “Medicare for All” a centerpiece of their campaigns. Pete Buttigieg has offered “Medicare for All Who Want It.” Both proposals have generated criticism, and in my opinion, most criticism of both is misplaced, because the discussion fails to distinguish between two very separate issues: 1) what would a sensible system look like, and 2) how do we get there?

I was prompted to revisit the issue because my cousin–the cardiologist I often cite on this blog–has done his own analysis of the current state of healthcare in this country, and concluded that a single-payer system is both preferable and inevitable. (Those who want to get “into the weeds” of that analysis should follow the link.)

In my most recent book, I also make the case for single-payer–and point out that a fully-implemented single-payer system would be much less costly than our current patchwork, dysfunctional approach. Virtually every economist who has analyzed the situation agrees. That doesn’t necessarily mean that taxes wouldn’t go up, but any increase would be more than offset by savings on premiums, co-pays and other costs currently borne by individuals and employers.

At any rate–I’m in full agreement that a single-payer system is needed. I depart from the “vote for me and I’ll change the system” approach being taken by Warren and Sanders because there is an enormous mountain to climb between where we are and where we need to be, and the suggestion that all we have to do to get a single-payer system is elect a Democratic president (or perhaps a Democratic president and Senate) is ludicrous.

It isn’t simply that politically powerful insurance and pharmaceutical  companies would throw everything they have into that debate. Voters rebel when they are told they will be forced into a new system, no matter how demonstrably better off they would be. Just getting the Affordable Care Act through Congress took enormous political capital, and that was after numerous (unfortunate but necessary) concessions.

In a recent column for the New York Times, political scientist Jacob Hatcher writes that we shouldn’t lose sight of what Ms. Warren is trying to do.

She’s making an evidence-based case for shifting the debate away from the perilous place it’s now in. Rather than “Will taxes go up?” or “Will private insurance be eliminated?” she wants us to ask a more basic question: How can we move from a broken system — a system that bankrupts even families who have insurance and produces subpar health outcomes despite exorbitant prices — to one that covers everyone, restrains prices and improves results?

I actually don’t see Warren asking (or answering) that very important question–she seems to be making the case for an immediate change that would eliminate all private insurers, and if my impression is correct, it is a politically fraught case.

Nevertheless, “how” is the most important question. As Hacker writes,

Getting to affordable universal care has always been a problem of politics, not economics. Given that the United States spends much more for much less complete coverage than any other rich democracy, it’s easy to come up with a health care design that’s much better than what we have. The problem is figuring out how to overcome three big political hurdles: financing a new system, reducing disruptions as you displace the old system and overcoming the backlash from those the old system makes rich.

Yep. And that brings me to an interesting paragraph in my cousin’s post. Dismissing the “public option” (which is what “Medicare for All Who Want It” really is), he writes,

Even now, given our current healthcare pricing, a medicare type program, operating with lower administrative costs, would be far cheaper than those offered by their private counterparts. This would allow employers to willingly relinquish expensive private plans in favor of the cheaper public option that would reduce the cost burden of extra employee benefits. This means that the public option would likely supplant the present private plans completely in short order. (Emphasis mine.)

Yes. That’s the point.

“Medicare for All Who Want It ‘ isn’t the answer to the “what” question. It’s the answer to the “how” question.

Hacker

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Old McDonald Had A Subsidy

Like many of you, I get all sorts of newsletters, from a variety of sources. A recent report about farm incomes, from this issue of Axios Markets, made me take a deep breath, because I’m old enough to remember the Republican Party that no longer exists.

That iteration of the GOP would have screamed bloody murder had a President imposed tariffs; defense of free trade was (forgive the pun) a party trademark. Those Republicans would have pointed to all the readily-available evidence of the negative effects of tariffs, including but not limited to the fact that they are paid for by consumers in the nation that levies them.

That GOP was also a champion of genuine capitalism, and an (admittedly selective)  opponent of corporate welfare.

That GOP did scream bloody murder when President Barack Obama “bailed out” American auto companies. Never mind that we were just coming off the “Great Recession,” or that thousands of American jobs were at stake, or that the funds were structured as loans, not giveaways. They continued to criticize the decision even after it was clear that the intervention had worked, and even after the companies completely repaid the loans.

But I haven’t heard a peep from any of today’s Republicans about the mounting subsidies to farmers–subsidies meant to compensate them for losses entirely caused by Trump’s tariffs. Those subsidies are now larger than the amounts lent to automakers.

Here’s the information from Axios Markets that set me off:

What’s happening: U.S. farmers have been suffering this year. Chapter 12 bankruptcies have risen 24% over the previous year and farm debt is projected to hit a record high $416 billion.

While farm income is expected to reach its highest total since 2014, 40% of that income will come from trade assistance, disaster assistance, the farm bill and insurance indemnities, according to the American Farm Bureau Federation.

What we’re hearing: That’s “definitely not the normal,” Farm Bureau chief economist John Newton tells Axios. The $28 billion bailout package for farmers that President Trump signed earlier this year has “increased the percentage to a level we’ve not seen in a while.”

So let’s see.  The party that believes in capitalism and markets–the party that counsels poor folks to suck it up and avoid ” welfare dependency”–is perfectly fine with government dollars supplying 40% of farm income.

The party of free trade has no problem with disruptive tariffs that interrupted farmers’ existing markets (many of which are unlikely to come back once this episode is over–other countries grow soybeans) so that their “leader” could look like the “tough guy” he clearly isn’t, and they’re hunky-dory with using billions of taxpayer dollars to compensate the people their idiocy injured.

Chinese imports of U.S. agricultural products totaled $24 billion in 2017 and peaked at $29 billion in 2013, according to U.S. government data. Imports fell to $9 billion last year as a result of the trade war.

Trump insists that he’ll make a new deal under which China will buy “40 to 50 billion”  dollars of American farm products annually. As the Axios report notes, we’ve heard that song about an impending “great deal” before–and each time, Trump has had to pull back.  Peterson Institute senior fellow Jeffrey Schott has opined that, even  if a deal is signed, it’s unlikely that either side could deliver on its bloated promises to sharply increase US farm exports to China to $50 billion annually, “or anywhere near that total.”

Of course not.

Sentient Americans understand that virtually all of Trump’s pronouncements are untethered to reality–that they come straight from the fantasy universe he inhabits. What we don’t understand is where all those free-trade, fiscally-conservative, pro-market Republicans have gone.

I guess those policy preferences were less important than supporting a “leader” who promised them the continued dominance of straight white Christian males….

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Talk About Conflicts Of Interest….

A recent report issued by Citizens for Responsibility and Ethics in Washington (CREW) finds that President Trump has 2,300 conflicts of interest. (For some reason, I’m having trouble linking to the report, but it’s easily Googled.)

We see a number of vague accusations of this administration’s “corruption,” but that all-encompassing description doesn’t tell us what the improprieties are, or why the behaviors are unethical. As a result, we are in danger of normalizing them.

The most common definition of a conflict of interest is a situation in which a person is in a position to derive personal benefit from actions or decisions made in their official capacity. CREW puts meat on the bare bones of that definition. The report begins with an explanation of the importance of divestment and the reasons for it.

Prior to President Trump, every modern president divested their business interests before entering office. For decades, this norm of presidential conduct has served as an important signal for both Republican and Democratic administrations to show that, as the nation’s most powerful and prominent public servant, the president would not put personal financial interests before the interests of the country. Divestiture also served as an assurance to the public that the president would not open himself up to undue influence from special interests and foreign governments that might use his businesses as a way to curry favor with him and his administration.

And Trump?

The president has visited his properties 362 times at taxpayer expense during his administration, sometimes visiting multiple properties in a single day. The number of days he’s spent time at a Trump-branded property account for almost a third of the days he’s been president.

One-hundred eleven officials from 65 foreign governments have visited a Trump property.

CREW has recorded 630 visits to Trump properties from at least 250 Trump administration officials. Ivanka Trumpand Jared Kushner are the most frequent executive branch officials to visit Trump properties, other than the president himself. Jared has made 28 known visits, while Ivanka has made 23.

Members of Congress have flocked to President Trump’s properties: 90 members of Congress have made 188 visits to a Trump property.

President Trump has used the presidency to provide free publicity for his properties, which he still profits from as president. As president, Trump has tweeted about or mentioned one of his properties on 159 occasions, and White House officials have mentioned a Trump property 65 times, sometimes in the course of their official duties.

Political groups have spent $5.9 million at Trump properties since President Trump took office. In more than a decade prior to his run for president, Trump’s businesses never received more than $100,000 from political groups in a single year.

Foreign governments and foreign government-linked organizations have hosted 12 events at Trump properties since the president took office. These events have been attended by at least 19 administration officials.

There is much more.

Trump’s behavior has been a truly shocking departure from that of previous presidents, but in all fairness, the expectation that government officials will avoid both conflicts and the appearance of conflicts has been eroded over the years by practices in the Senate.

An article a few weeks ago in The Guardian focused on those practices.

As they set national policy on important issues such as climate change, tech monopolies, medical debt and income inequality, US senators have glaring conflicts of interest, an investigation by news website Sludge and the Guardian can reveal.

An analysis of personal financial disclosure data as of 16 August has found that 51 senators and their spouses have as much as $96m personally invested in corporate stocks in five key sectors: communications/electronics; defense; energy and natural resources; finance, insurance and real estate; and health.

The majority of these stocks come from public companies, and some are private.

Overall, the senators are invested in 338 companies – including tech firms such as Apple and Microsoft, oil and gas giants including ExxonMobil and Antero Midstream, telecom companies including Verizon, and major defense contractors such as Boeing – in the five sectors as categorized by Sludge.

As the article noted, this ownership is not illegal, but such investments raise real questions about lawmakers’ motivations.

We have a lot of work to do.

In 2020, Americans’ first priority must be delivery of an overwhelming, crushing defeat to Trump and the obsequious Republicans who continue to enable him.

Our second must be a wholesale “clean up” of government– reform of electoral systems and governmental structures that facilitate unethical behavior, from state-level gerrymandering and voter suppression, to Senate-level conflicts of interest.

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Doug Masson Quotes The Federalist

Doug Masson is a lawyer in Lafayette, Indiana, and one of the most thoughtful and erudite Indiana bloggers. He has a post on the Democratic primary that is well worth reading in its entirety–and with which I entirely agree–but I was particularly struck by this quotation from Federalist 68

Nothing was more to be desired than that every practicable obstacle should be opposed to cabal, intrigue, and corruption. These most deadly adversaries of republican government might naturally have been expected to make their approaches from more than one quarter, but chiefly from the desire in foreign powers to gain an improper ascendant in our councils. How could they better gratify this, than by raising a creature of their own to the chief magistracy of the Union?”

The “desire in foreign powers to gain an improper ascendant…by raising a creature of their own to the chief magistracy of the Union.”

Whatever propaganda Republicans employ to dismiss the findings of the Mueller Report or denigrate America’s Intelligence operations, the evidence is overwhelming that Russia raised a creature of its own during the 2016 election. That evidence was recently confirmed by a bipartisan report from the Senate Intelligence committee, about which I will report more fully in due course.

As Doug says, Trump is “emotionally fragile, intellectually bankrupt, and utterly corrupt”.

He believes that the office of the Presidency is there to serve him rather than the other way around. His trading on public resources to induce foreign powers to meddle in our elections was exactly the kind of thing the Founders were concerned about when they wrote the Constitution.

Most readers of this blog have already joined me in my determination to “Vote Blue No Matter Who,” (I would personally cast my ballot for a potted plant if it was the alternative to Trump) but that doesn’t mean that most of us don’t have favorites in–and opinions about– the Democratic Primary. At this point in the process, I find myself agreeing with Doug’s analysis.

For my part, I don’t mind Biden, but I like Mayor Pete and Elizabeth Warren. I don’t have strong feelings about Bernie himself, but his online supporters have been fairly off-putting in a way that doesn’t seem nearly so common for supporters of other candidates. In a perfect world, I should be comparing policies, but Presidential campaigns are won or lost on the basis of personalities. The electorate says they care about policy, but when it comes time to vote, they mostly don’t understand the policies and have shaped their understanding of the policies to conform with their personality preferences. I may have better than average understanding of some of these issues, but ultimately, I don’t know enough about the ins and outs of federal laws, rules, and regulations to truly assess the candidates’ plans beyond a pretty superficial level. Nevermind the fact that whatever they propose will have to navigate the legislative process. I’m going to have to trust that the person will do the best they can and will generally make sound decisions.

I have previously called Bernie and Biden analog candidates for a digital age. Either would be immensely preferable to Trump, but I would prefer to see both of them as honored elder statesmen. I love Elizabeth Warren, but I worry that she would make a fairly easy target. Plus I’d hate to see her leave the Senate, where she has been such an effective voice for fairness.

And I really love Mayor Pete.

I’m ready to turn this country over to a new generation–to the people who will have to live with the results of the economic and environmental decisions they make, who grew up with and understand the immense impact of technology on everyday life, and who have the intellect and energy that the Presidency requires and that the current President so clearly lacks.

The men who wrote The Federalist and crafted our Constitution were young. I Googled it, and it turns out that many of the Founding Fathers were not yet 40 years old in 1776. The average age of the signers of the Declaration of Independence was 44 (Ben Franklin undoubtedly raised the average!), but more than a dozen of them were 35 or younger.

The impressive Jacinda Ardern of New Zealand was born in 1980 and elected at age 37, and Emmanuel Macron of France just turned 41.

On the other end of the spectrum, I’m Bernie’s age, and most days, I need a nap.

All that said–whoever emerges will have my activism and my vote. Whoever it is won’t have Russia’s.

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Now It’s Coal Ash

The Trump administration has announced its intention to roll back an Obama-era regulation that limited the leaching of heavy metals like arsenic, lead and mercury into water supplies–heavy metals that are produced and leach into groundwater from the ash residue produced by coal-fired power plants.

I wrote about the dangers of coal ash back in 2015, quoting the Hoosier Environmental Council when they were bringing in a coal ash expert to speak at their annual “Greening the Statehouse” event.

Coal ash has special significance for Indiana, since the state leads the nation in the number of coal ash waste lagoons. There is arguably no person better in America to speak to this issue than Lisa Evans. As a coal ash expert with twenty-five years of experience in hazardous waste law, Lisa has testified before the U.S. Congress and the National Academies of Science about the risks of coal ash and federal & state policy solutions.

The Obama Administration addressed those very real risks by passing new regulations in 2015; now, a series of newer rules expected from  the Environmental Protection Agency (courtesy of the former lobbyists now running the agency) will substantially weaken  regulations meant to strengthen inspection and monitoring at coal plants, and requiring plants to install new technology to protect water supplies from contaminated coal ash.

The E.P.A. will even exempt a significant number of power plants from any of the remaining requirements, according to quotations from people familiar with the Trump administration plan.

According to one report, 

Coal ash, the residue from burning coal, is stored at more than 1,100 locations around the nation, with about 130 million tons being added each year. Unlike emissions of carbon dioxide, which many climate science deniers consider a good thing, nobody doubts the dangers of the chemicals in coal ash—including arsenic, lead, mercury, and selenium, among others. All are associated with birth defects and stunted brain growth in children. But the list of damages they can cause is far longer and includes cancer, heart damage, lung disease, respiratory distress, kidney disease, reproductive problems, gastrointestinal illness, and behavioral problems.

Hundreds of ash storage pits don’t even have a simple liner to help prevent toxins from leaching into waterways. According to a 2010 EPA assessment, people who live within a mile of unlined coal ash ponds have a 1 in 50 risk of cancer. That’s more than 2,000 times higher than what the EPA considers acceptable. Tainting of the water mostly happens in a trickle. But, occasionally, as in the 2008 Kingston Fossil Plant’s sudden release of 1.1 billion gallons of coal slurry in Tennessee, or the leakage of 82,000 tons of coal ash into North Carolina’s Dan River, the contamination comes in a catastrophic rush.

Environmental activists criticized the 2015 rule, arguing that it fell short of what is needed to effectively deal with coal ash, and failed to classify the ash as a hazardous waste, which it obviously is. It was a step forward, however.

For every forward step taken by the Obama Administration, however, Trump’s “best people” take two steps back.

Like so many efforts being made daily by the Trump Administration, this move prioritizes the bottom line of industry over the health and welfare of citizens. In this case, that preference is especially galling, because it is intended to help an industry that is dying–and dying  thanks to market forces, not excessive regulations. Nor should its death be lamented: coal is a contributor to climate change, and the relatively few remaining jobs in coal mining are unacceptably dangerous.

Once again we are reminded that nothing this administration does–nothing–advances the common good, or makes environmental or even business sense.

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