Monthly Archives: July 2009

Health Care Politics

Originally published at care2.com on June 23, 2009

Consistent with his free-market approach to all things economic (emergencies aside), President Barack Obama has given some suggestions on how he believes reforms can make health care more affordable and efficient.  Mr. Obama has endorsed the creation of a public insurance entity from which Americans could choose to buy their health insurance, and which would offer competition to private insurers.

This approach is par-for-the-course for a President who addressed the financial crisis with public-private solutions instead of wholesale nationalization, and who believes in helping all Americans obtain health insurance but rejects the Canadian and European approaches to socialized medicine.

Mr. Obama has also smartly pressed for putting medical records on line as a way to track care and results in order to find ways to reduce costs and provide superior care.  A much-talked-about article by New Yorker writer and M.D., Atul Gawande, has illustrated that high costs in health care sometimes serve private financial interests at the patient’s and public’s expense rather than primarily reflecting patient needs.  Reformers hope that a public insurer could seek to both lower costs and provide high-quality care, inducing private insurers to match better care for lower cost.

While Congressional Republicans, some Democrats and insurance companies are speaking out against the public plan, saying it will undermine private insurers, recent public-opinion polls show popular support for a public insurance entity. Seventy-two percent of respondents in a nationwide poll supported the idea, including one in four Republicans. The President is going on the offensive, going so far as to mock lobbyists and legislators for protecting the insurance industry from competition.

Congressional Democratic leaders Henry Waxman, Charles Rangel and George Miller have unveiled a house bill containing the outlines of a public plan and proposal to insure 95% of Americans.  Senate legislation, being spearheaded by Democrat Max Baucus and separately in the offices of Senator Kennedy and others, is still being developed.

Any reform of such a massive sector of the economy is bold.  But with health care costs eating up an ever-greater share of public and private resources, change is required.  It will take years for the new legislation to transform our health care system, but the mantra of “more for less” is a good guiding principle.  Our spending on health care is unsustainable, damaging to public sector budgets and private business competativeness.  If we don’t want to give up the excellent care a majority of us enjoy, we will have to innovate.  Looking to competition, even that created by the introduction of a public insurance entity, and trying to bring more people into an efficiently-managed program, makes sense.

It’s about time Mr. Obama and Democratic leaders on health care received some bipartisan support for their efforts.

Firefighters in the U.S. Supreme Court

Originally published at care2.com on July 1, 2009

The U.S. Supreme Court decision regarding Connecticut firefighters is interesting for two principle reasons: it overturns a decision in which current Supreme Court Nominee Judge Sonia Sotomayor participated, and it provides Supreme Court authority in the sensitive and controversial legal area of race-conscious decision-making by government authorities.  The heart of the issue is whether there was sufficient justification for the city of New Haven, in charge of promoting officers in its fire department, to reject results of a test that saw no black candidates reach promotion, despite many applicants.

The High Court was called upon to make a difficult decision, and the 5-4 breakdown of the court shows it was a close call.  The majority opinion and dissent, penned by Justices Anthony Kennedy and Ruth Bader Ginsberg, respectively, provide details of the city government’s and the high court’s analysis of the fairness of treatment of minority firefighters and the legal standards that govern one aspect of how race should be dealt with in the workplace.

Falling into the trap of football politics and simplistic analysis, early reports call the decision “a blow to diversity in the American workplace” and a win for the conservative approach to discrimination law (more responses). However, this case is not Plessy v. Ferguson (perpetuated race-based discriminiation) or Brown v. Board of Education, (rejected “separate but equal” treatment of minorities).  The distinctions in this case, if given honest, unbiased consideration, are so subtle and intertwined with legal policies that they require in-dept analysis and some speculation to figure out what they could mean and achieve in the workplace.

Justice Anthony Kennedy’s opinion rejected arguments that past discrimination at the fire department (where there has been only one African American of 21 fire captains), perceived unfairness in the exam (some concerns were voiced at a public forum when the results were announced while experts interviewed had mixed responses), and state agency concern over being sued for discrimination would justify the city’s throwing out the results — which promoted only white and Hispanic firefighters.

The facts before the Court showed that the city authorities made significant and costly efforts to create a fair, consciously race-neutral test.  Evidence from scholars and testing experts showed that the tests and results were in line with those for good tests given elsewhere and did not make a clear case of evidence of a bad test.

The city rejected the test results out of concern that they turned out to discriminate against African Americans and that they would result in lawsuits from African American firefighters.  It is possible, but not certain, that other tests would achieve more race-neutral results.

Crucially, the majority decision found that there was not enough evidence under the legal standard, which the city was expected to use, to throw out the test results and deny promotion to white and Hispanic firefighters with higher scores.

Local government officials in Connecticut worked hard to try not to descriminate unfairly.  This is commendable.  The Court said that they erred when they took the further step in throwing out the results of a test designed carefully to be fair, without more evidence that it was, in fact, unfair.

The dissent disagreed.  Four members of the Court felt that past discrimination, test results (black candates passed, but didn’t score high enough for promotion), and local government concern over being sued by black candidates was enough to throw out the test and start again with a new process in hopes of better eliminating unfair descrimination.

This situation may still indicate that unfair racial descrimination exists in testing procedures used by government agencies.  However, it also shows that significant efforts were made by officials acting in good faith to avoid prejudice and unfair assessment.  The majority’s decision says that under these circumstances, it is not fair to winning candidates to throw out the results of their exams.

The city government and both sides in this Supreme Court decision tried to remove unfairness from the process of promotion of fire officials.  That is what we pay them for.  If respect were accorded to effort and not results, we would recognize in the workings of our government and the behavior of its leadership nobility of purpose and integrity of character.  Next time, the results may be different, but let us hope that the effort by public authorities can rise to the level of that evidenced here.

Governmental authorities may also consider the New Haven testing program a failure and may go on to make even greater efforts to root out testing problems if and where they exist.  The Court makes no determination of what other efforts governmental agencies should make in order to achieve fairness for its citizens.

Nor does it stop African-Americans from filing suit where they believe that they were discriminated against by tests and processes.  They may have a case where outcomes differ by racial groupings.  The issue would be different than in the current case (Constitutional or Civil Rights Act claims of unfair or unequal treatment) and the outcome could be different.

I think I can say all this and still have deep compassion and concern for African-Americans that have not yet found a level playing field for competition in the American workplace.  The discussion and investigation of problems must continue aggressively.

We need to do the best we can because our nation has embraced merit and rejected prejudice as a defining principle.  Let’s continue on that path.  But anyone that labels the various decision-makers he

Immigration Enforcement

Originally published at care2.com on July 6, 2009

The U.S. Citizenship and Immigration Services reported that more than 500 U.S. military servicemembers would take the Oath of Allegiance to become U.S. citizens this July 4th.  Some participated in ceremonies in Iraq, others at military bases in the United States.   These new citizen soldiers make up only a small portion of the hundreds of thousands of recent immigrants given citizenship every year, but they are an apt symbol of how important immigrants are to this country.  Last year, breaking previous records, more than a million immigrants became citizens.

Meanwhile, the administration of Barack Obama is taking action to increase policing of employers who hire illegal workers.  The administration reported that its investigations recently targeted more than 600 businesses.  In fact, the New York Times reported that 650 businesses were notified on just one day of pending audits, up from 503 audits for the entire last year of the Bush administration. The enhanced enforcement is part of President Obama’s policy of emphasizing border enforcement and employer compliance rather than stepping up action against individual illegal immigrant workers.

The President has also called on lawmakers to write immigration legislation that further increases border enforcement and legal immigration, but also creates a path towards legalization for many illegal residents.  Democratic Senator Charles Schumer of New York, who chairs a subcommittee on immigration, will likely take the Senate lead.  He may not have an easy task.

The issue has aroused passionate debate in support of and opposition to the estimated 12 million illegal residents already in the United States.  Commentators, such as CNN’s Lou Dobbs, fan the flames of anti-immigrant anger by focusing on criminal activity and threats from abroad as though every immigrant was a member of a gang or terror cell.  Criticism of illegal immigration is fierce, and most opponents strongly object to proposals to solve the problem through reform legislation containing any form of legalization (often described as “amnesty”). Besides seeing illegal residents as breaking the law, opposition to legalization focusess on the competition for jobs, burden on public resources, and crime and security concerns.

Reform advocates, while still seeking legalization of the vast majority of those already in the country, are concentrating on border enforcement and workplace compliance in an effort to meet some of the concerns raised by illegal immigration.  However, a CNN commentary by Ruben Navarrettepoints out that there are disagreements among those seeking comprehensive legislation.  For example, pro-business Republicans are seeking a guest worker program, but working against employer sanctions.   Pro-labor Democrats are against guest worker plans but support a path to citizenship.

Navarrette warns everyone in search of a solution to avoid going to the extremes:  For legalization supporters, that is advocating open borders; and for those opposed to a path to citizenship, that is racism and ethnic prejudice, he says.

President Obama’s enforcement program and the economic downturn may have a significant effect on lowering illegal entry into the United States.  It is not yet known whether this could also significantly lower the vast number of illegal residents in the United States.  It is logical that as the labor market for low-wage workers weakens, some workers might return to their home countries, at least if there are prospects for work or a lower cost-of-living to be found there.

But could this adequately resolve the illegal resident issue?

Even if illegal residency decreases, there will likely remain a demand for low-cost labor.  For U.S. manufacters, exports will be an important aspect leading the U.S. out of the recession.  They will need low-cost labor to trade competatively in the global marketplace.  One reason jobs were exported from the United States in recent years was because of higher labor costs.  Moreover, countries with abundant labor supplies such as China and India have higher economic growth rates and are poised to economically overtake Western nations during the 21st century.

Organizations such as the Federation for American Immigration Reform (FAIR) work in the opposite direction, calling for a “time-out” or decrease in the number of legal immigrants coming to the United States. Most anti-immigrant or anti-illegal immigrant positions come from the perspective of protecting the public – from crime, from cultural change, unfair employment competition, etc.  But the concerns of organizations like FAIR would be better resolved by demanding government support tocommunities heavily burdened by an influx of legal and illegal immigrants.  Support could take the form of free English classes, greater federal funds to public schools, hospitals and clinics, and additional law-enforcement.  Other nations, such as Canada, provide substantial governmental support to ease the assimilation and immigration transition.

If new legislation eased the burden of immigration on American communities, the focus on illegal immigration might be decreased.  Then we could turn to increasing the number of legal immigrants permited to work in the United States to match the needs of the U.S. labor market. This would offer a path to prosperity for the nation that would serve established as well as new Americans. 

Those doubting that the nation’s economic needs are sufficient to increase the number of legal residents should remember that, before the recent recession, unemployment rates in the United States were remarkably low, despite the fact that a substantial percentage of twleve million undocumented immigrants were generally participating in the labor market.  Their work, which could not have been done by others in such a tight pre-recession labor market, created wealth for the nation, although this wealth was not spread evenly through society.

Rather than debating whether to remove or legalize illegal residents, we should be welcoming more immigrants and working to make their assimilation and transition as positive as possible for our national community.  Let’s share the costs and benefits of expanded legal immigration, removing some of the reasons for its opposition.

President Obama’s African Visit

1191379_370

Originally published at care2.com on July 12, 2009

President Obama chose to visit Ghana, a functioning democracy in West Africa, despite his personal ties to Kenya, his father’s homeland.  The President’s diplomatic tour put Ghana on the map purposely, a show of diplomatic respect. In his speech to the Ghanaian Parliament, which the U.S. embassy helped make available more widely, Mr. Obama recognized that, through democracy and honest government, Ghana had made progress for its people.

The President’s message was that all Africans should look to Ghana for examples of what works.  Recognizing endemic problems with development in Africa, Mr. Obama said, “No business wants to invest in a place where the government skims 20 percent off the top, or the head of the port authority is corrupt.”  “No person wants to live in a society where the rule of law gives way to the rule of brutality and bribery. That is not democracy, that is tyranny, and now is the time for it to end.”

In one of the most inspirational passages, the President noted that Martin Luther King traveled to Ghana in 1961 to watch Ghana’s rebirth as an independent nation.  Then to the future of Africa he said, “I am particularly speaking to the young people all accross Africa and right here in Ghana. . . . And here is what you must know.  The world will be what you make of it.  You have the power to hold your leaders accountable and build institutions that serve the people. . . . But only if you take responsibility for your future. . . . But I can promise you this, America will be with you every step of the way.”  Full transcript

The Ghanain President John Atta Mills responded, “This encourages us also to sustain the gains that we have made in our democratic processes.”  “I can say without any fear of contradiction that all Ghanaians want to see you. I wish it was possible for me to send you to every home in Ghana.” Public response;  NYTimes Images from Ghana

President Obama also sought to put U.S. foreign aid in a sober context saying that the United States was willing to give aid to support new development, but the burden should be on Africans to make their own progress sustainable. He urged self-reliance across the continent and offered help getting started. “Aid is not an end in itself,” he said. “The purpose of foreign assistance must be creating the conditions where it is no longer needed.”

Ghana is a bustling country with a large metropolitan coastal city, Accra, and vast natural resources, including rainforest.  It has substantial tourism and was host to the 2008 Africa Cup soccer tournament and is a center of trade in African arts and crafts.  It is also the site of Cape Coast, a major slave-trade port from which slaves were shipped to the Americas (pictured above).

A great humorous moment of the President’s visit was when he was introduced to the Parliament of Ghana by a trumpet flourish.  Laughing, and likely wondering how long it was going to go on, the President started his addresss at the pause with, “I think Congress needs one of those horns.”  See first link below.

(the rest of the speech)

Deficit Spending

1189424_370

Originally published at care2.com on July 9, 2009

California government struggles.

Forced to match public spending with revenue (some monkey-business excluded), leaders have only two good options:  Cut spending or raise taxes.  You would think that this would be easy enough.  But either option takes money from people who feel it should be theirs. The conflict is so fierce, the interests so entrenched, that leaders will walk dangerously close to default, to failing to meet obligations, rather than give up what they defend.

In the federal government, we have a different problem.

The Bush administration did away with Clinton-era commitments to pay for spending increases or tax cuts by finding sources of revenue.  Without even that modest amount of discipline, legislators, who get elected by pleasing their constituents, consistently spent their way into incumbancy.

I do not fault the Bush or Obama administrations for their emergency efforts to buy off an economic Depression (or substantial risk thereof)through massive deficit spending on short-term stimulus.  It was the best judgment of the experts, and it seems to have worked.  A Depression is far more costly than the money spent on stimulus.  But neither does this deal with the underlying problems in long-term public spending.  How do we reverse course and begin to bring the long-term spending equation in line with the revenue picture?

It may be that our political system is able to solve the problem.  The public is aware and concern over public spending is growing.  President Barrack Obama has called for a return to “pay as you go” legislation. This will make it far more difficult for Congress to add new deficit spending.  Even the roughly one-trillion dollars discussed as a budget for health care reform is being treated as “pay as you go” spending requiring an offsetting spending cut or tax increase to protect the overall national budget.

However, we have traveled so far down the path of deficit spending, that we will have to do more than maintain our course.  Bloomberg podcast — “Rivlin Says Fed More Concerned About Deflation Than Inflation”

The nation has already made commitments to spending on Medicare and Medicaid that will dig us deeper in debt over the next ten years.  We would have to legislate cuts in Medicare and Medicaid in order to get out of those commitments, if we wanted to.  Therefore, new efforts must be made to raise revenue or cut spending in order to just maintain the level of deficit we have now.  We need courageous leadership, willing to ask for sacrifice from all parts of our society, and we need disciplined leaders, willing to put their careers on the line in order to do what is right.

The recession will end and revenue will therefore increase, but that does not mean we will be out of the woods.  If Congress is not able to legislate long-range fiscal responsibility we will need new solutions.  One approach, discussed in the past, is across-the-board spending cuts.  Another would be to create a deficit Czar or independent commission with responsibility for recommending spending cuts and revenue increases that would lead to a reasonable deficit.

We should think of the deficit as a percentage of the national economy, not a dollar figure.  When the percentage begins moving down, towards historic norms, we will be on the right track.

It might be that a group of leaders we trust, who are not elected officials, could do a better job giving us tough medicine than the people we pay to give us only good news.  In any case, the sooner we take the medicine, the sooner we will begin the road to recovery.

Pre-existing Conditions and Health Care Reform

Originally published at Politicsunlocked.com on July 1, 2009

Neccessary reforms or free-market intrusions?

There are three different classes of people in the health care marketplace in the United States: those receiving employer provided-health insurance, those who individually acquire health plans and those who remain uninsured.

Each group has a different stake in the outcome of health care reform. While costs impact all three, some crucial issues only affect one segment of the health care population, and “exclusions” and “rescissions” are important issues for those who purchase health care individually.

So-called “exclusions” typically relate to pre-existing conditions. Thus, in buying a health care policy, the insured is typically unable to obtain coverage that will pay for medical care as it relates to a pre-existing condition. This is less frequently an issue for the younger segment of the individual insurance market, such as college graduates, who are young and, statistically speaking, not yet burdened with many illnesses. Although if you are 22 and have a medical condition, you will face the reality of not having insurance for that condition unless you are employed by a company that provides insurance. Employer-provided plans generally do not have any pre-existing illness exclusions, but such employment may not be available in all fields or areas of the country, and especially in the current economic climate, many young people are graduating from college without full-time employment prospects in the near term.

Older Americans, not yet eligible for Medicare, are in a very difficult situation when in comes to purchasing individual insurance. They seek insurance in order to protect them from high costs in case of catastrophic illness, but also to aid in the payment for care related to typical illnesses and conditions that afflict people as they age.

Insurance companies are private, for profit, businesses. They compete to obtain clients who are healthy and who will pay the most premiums while requiring the least care, doing this through marketing campaigns, but also through exclusion of pre-existing conditions. Customers do not have good options, and deciding to not purchase insurance and relying on public health facilities and emergency room care can be risky and inconvenient.

One of the goals of President Barack Obama’s reform proposals is to eliminate exclusions for pre-existing conditions in individual insurance plans. This will interfere in the free-market private decision making of insurance companies, but it will be a risk born by all equally. In fact, insurance company executives have at times spoken out in favor of elimination of exclusions so long as it was done in a way that affected all insurers equally.

“Rescission” relates to “exclusion” because it refers to the cancellation of insurance when the insurer determines that the insured was not accurate in the insurance application. This is typically done when the insurer discovers that the insured person seeks payments for conditions that were pre-existing but were not revealed in the application. However, insurers also cancel contracts when they find technicalities in the applications that do not relate to pre-existing illnesses. For example, if someone failed to mention that he/she had a knee condition in his/her application, but then submitted an insurance claim related to heart surgery that was otherwise covered, the insurance company might research the insured’s medical history in search of any inconsistencies which would allow them to cancel insurance and avoid payment on the costly heart surgery.

During testimony by insurance company executives last week, outraged congressmen demanded that insurance companies stop rescissions based on technicalities. However, all three executives at the hearing refused to make that commitment. This is another issue likely to be worked over by legislators as they craft reform packages.

Ghana Hosts U.S. President

Originally published at politicsunlocked.com on July 15, 2009

Obama highlights democratic gains in West African nation

President Barack Obama recently visited Ghana and delivered a speech to its parliament. The U.S. President focused on the achievements of Ghanaian democracy and called on all Africans to work for democratic institutions and accountable government. As with his speech to the Muslim world from Cairo, the President called upon the next generation to take responsibility and assert its authority to end decades of corruption, tyranny and war on the continent.

Not long after the President’s address in Cairo, the Iranian population burst into demonstrations for democratic rights and accountable governance. It is speculation to guess at how much, if any impact, the U.S. President had on the Iranian movement, and Obama himself has bent over backwards in efforts not to appear to interfere in Iranian political affairs. But as with the Cairo address, the administration made efforts to reach a wide audience, broadcasting the Ghana speech in coordination with African embassies.

The White House press secretary, Robert Gibbs said that Ghana was chosen because it boasts a functioning democracy and civil society. Ghana has a major trade in African arts and tourism and is developing operations in natural resources. While the President has personal ties to Kenya, his father’s homeland, Ghana stands as a model of the government that President Obama would like to see throughout Africa. By contrast, Kenya’s most recent election was disputed and violence ensued. A power-sharing agreement in Kenya has met with limited success.

The President also visited Cape Coast Castle, where black Africans were held before being shipped into slavery in the Americas.

Watch the President’s speech to the Ghanaian Parliament below:

Part One

Part Two

Part Three

Part Four