Sunday, November 29, 2009

More Advice from a General

Gen. Anthony Zinni, USMC, (Ret.) Remarks at CDI Board of Directors Dinner, May 12, 2004
And what I thought I would do tonight is go through the ten crucial mistakes to this point that we've made. Because I think it helps frame what, in fact, has happened over time ... and is going to be the first part of that history. And I will conclude with maybe some thoughts on the way ahead, at least from my point of view.
Gen Zinni was CentCom Commander prior to Tommy Franks and in this days of demanding that we listen to the Commanders no matter what, some wonder why nobody wanted to listen to Tony Zinni in real time. There is a lot of selective memory going on about the period between Sept 11, 2001 and March 20, 2003 and equally about the events in Iraq and Afghanistan prior to the Surge announced in January 2007. There has been a tendency towards triumphalism among war supporters along the lines of "The Surge Worked" which totally ignores that Army Chief of Staff Shinseki was effectively sacked in 2003 because he testified to Congress that more troops would be needed, and that Zinni's reaction was in point 8 of the linked speech:
The eighth problem was the insufficiency of military forces on the ground. There were a lot more troops in my military plan for operations in Iraq. I know when that plan was presented, the secretary of defense said it was "old and stale." It sounded pretty new and fresh to me, and looking back at it, now because there were a hell of a lot more troops. It was more the (Eric) Shinseki model that I think might have been a hell of a lot more effective to freeze the situation. Those extra divisions we had in there were not to defeat the Republican Guard, they were in there to freeze the security situation because we knew the chaos that would result once we uprooted an authoritarian regime like Saddam's.
If Rumsfeld had just listened to his Generals we might not have had to waste four plus years and thousands of Americans dead that were in large part the result of going in too light the first time. Bush/Rumsfeld apologists themselves have a lot to apologize for. You screwed up and trusted the Neo-Cons. Bad move.

War is a racket.

Smedley Butler on Interventionism

-- Excerpt from a speech delivered in 1933, by Major General Smedley Butler, USMC.

War is just a racket. A racket is best described, I believe, as something that is not what it seems to the majority of people. Only a small inside group knows what it is about. It is conducted for the benefit of the very few at the expense of the masses.

I believe in adequate defense at the coastline and nothing else. If a nation comes over here to fight, then we'll fight. The trouble with America is that when the dollar only earns 6 percent over here, then it gets restless and goes overseas to get 100 percent. Then the flag follows the dollar and the soldiers follow the flag.

I wouldn't go to war again as I have done to protect some lousy investment of the bankers. There are only two things we should fight for. One is the defense of our homes and the other is the Bill of Rights. War for any other reason is simply a racket.

There isn't a trick in the racketeering bag that the military gang is blind to. It has its "finger men" to point out enemies, its "muscle men" to destroy enemies, its "brain men" to plan war preparations, and a "Big Boss" Super-Nationalistic-Capitalism.

It may seem odd for me, a military man to adopt such a comparison. Truthfulness compels me to. I spent thirty- three years and four months in active military service as a member of this country's most agile military force, the Marine Corps. I served in all commissioned ranks from Second Lieutenant to Major-General. And during that period, I spent most of my time being a high class muscle- man for Big Business, for Wall Street and for the Bankers. In short, I was a racketeer, a gangster for capitalism.

I suspected I was just part of a racket at the time. Now I am sure of it. Like all the members of the military profession, I never had a thought of my own until I left the service. My mental faculties remained in suspended animation while I obeyed the orders of higher-ups. This is typical with everyone in the military service.

I helped make Mexico, especially Tampico, safe for American oil interests in 1914. I helped make Haiti and Cuba a decent place for the National City Bank boys to collect revenues in. I helped in the raping of half a dozen Central American republics for the benefits of Wall Street. The record of racketeering is long. I helped purify Nicaragua for the international banking house of Brown Brothers in 1909-1912 (where have I heard that name before?). I brought light to the Dominican Republic for American sugar interests in 1916. In China I helped to see to it that Standard Oil went its way unmolested.

During those years, I had, as the boys in the back room would say, a swell racket. Looking back on it, I feel that I could have given Al Capone a few hints. The best he could do was to operate his racket in three districts. I operated on three continents.

Sunday, November 22, 2009

The Peterson Conspiracy: Cross Posted from Open Left

As they say, even paranoids have real enemies. In the last couple of weeks there has been a renewed effort to push the parallel bills Conrad-Gregg and Cooper-Wolf each of which would establish a Bi-Partisan Commission to tackle the 'Entitlements Crisis' by sending a set of proposals to Congress that could only be voted up or down on a model set by BRAC (the Base Realignment and Closure Commission of the 1990s. The current push is to attach this to whatever legislation is used to raise the Public Debt Ceiling, something that has to be done in the next few weeks to avoid defaulting on some interest payments. The problem is that Conrad-Gregg and Cooper-Wolf did not come out of nowhere and 'bi-partisan' does not mean what it would normally mean. Instead these bills exist to realize the vision of one man, a man who has founded and lavishly funded a series of 'Bi-Partisan' Institutions and Working Groups whose goals are, at times perhaps unknown to many of the participants in them, explicitly to destroy the crown jewel of the New Deal, that is Social Security, while also doing as much collateral damage to Medicare and Medicaid as possible in the process.

The man and his goal were revealed to the wider world in this important piece by William Grieder in the Nation last March Looting Social Security and was in fact the cover piece which had the result of having Peter G Peterson's face staring at you from the cover. Who is PGP? Well the Grieder article gives you a start, but suffice it to say that you couldn't make him or his career up, it reads more like an over the top conspiracy thriller than anything (though with less special effects and explosions). For today's purposes let us just start with his role as founder and funder of the Concord Coalition. Like most of PGPs efforts it is cast as a bi-partisan group devoted to fiscal responsibility and typically has titular leaders drawn from both parties. For example if we go to About the Concord Coalition
The Concord Coalition is a nationwide, non-partisan, grassroots organization advocating generationally responsible fiscal policy. The Concord Coalition was founded in 1992 by the late former Senator Paul Tsongas (D-Mass.), former Senator Warren Rudman (R-N.H.), and former U.S. Secretary of Commerce Peter Peterson. Former Senator Bob Kerrey (D-Ne.) was named a co-chair of the Concord Coalition in January 2002. The Concord Coalition is dedicated to educating the public about the causes and consequences of federal budget deficits, the long-term challenges facing America's unsustainable entitlement programs, and how to build a sound economy for future generations.
Bolding mine. For PGP and his like-minded colleagues, followers and employees the problem mostly start and stop with 'entitlements', a word whose existence largely owes itself to Peterson to begin with. The current head of Concord is Robert Bixby and its current main instrument is its Fiscal Wake Up Tour in which Bixby and former Comptroller General David Walker go around the country essentially selling 'Entitlements Crisis'. Now while Walker is invariably described by his former title and so an a more or less neutral observer, he actually has a day job with a somewhat more revealing title: President and CEO of the Peter G Peterson Foundation, itself endowed by PGP with a cool billion (with a 'b') dollars to promote its mission. About the PGPF On this page you will see the smiling faces of PGP himself and Walker and among other things a link to I.O.U.S.A.: the Movie itself a documentary of the Fiscal Wake Up Tour, which the About page proudly reports:
The Foundation awarded the Concord Coalition $1.5 million to expand its highly acclaimed Fiscal Wake-Up Tour, an urgent, bipartisan call for changes to America's fiscal policies in the tradition of Paul Revere.
. So lesson one. Anytime you see the names Robert Bixby or David Walker know that you are talking full time employees of the PGP founded Concord Coalition or the Peter G Peterson Foundation. Lesson two. Almost every time you see the buzzwords 'fiscal responsibility', 'bi-partisan' anything, 'intergenerational equity' odds are you are only one or two degrees of separation from a PGP entity or employee. But what does this have to do with Cooper-Wolf SAFE Commission. Well if we follow the link on the PGPF About page announcing the grant we find the following:
Partners in the Fiscal Wake-Up Tour include The Concord Coalition, the Peter G. Peterson Foundation, the Brookings Institution and the Heritage Foundation. The Concord Coalition is a 501(c)3 organization focused on promoting federal fiscal responsibility.
What the hell is 'left-leaning' Brookings doing in this mix? Well there is a tale. Back in 2008 Brookings and Heritage announced the formation of their 'Fiscal Seminar' which in time produced the following report Facing Our Fiscal Future (PDF) itself signed by sixteen authors, seven from Brookings, three from similarly 'left leaning' the Urban Institute, and one from the Progressive Policy Institute. Certainly seems bi-partisan. Until you realize that PPI is the creation of signatory Will Marshall and was the prime vehicle for sending Clintonism down the DLC/New Democrat/Third Way which mostly adds up to 'Renouncing FDR and All His Works'. And that a bunch of the Brookings people are similarly Clinton-Rubinista Deficit Hawks like Alice Rivlin and that the Urban Institute people include similarly hawkish former CBO Director Robert Reischauer. Plus among the remaining signatories from the center to right we have Robert Bixby (again), Maya MacGuineas (an author of a draconian Social Security 'reform' plan known as Liebman-MacGuineas-Samwick or LMS), and Stuart Butler the author of a detailed plan from 1983 to undermine and kill Social Security under the charming name Social Security Reform: Achieving a "Leninist" Strategy (PDF) which has to be read to be believed. What do we find if we delve into Facing our Fiscal Future? Unsurprisingly we find a reprise of the central message of the Fiscal Wakeup Tour
The authors of this paper are longtime federal budget and policy experts who have been drawn together by a deep concern about the nation’s long-term fiscal outlook. Our group covers the ideological spectrum. We are affiliated with a diverse set of organizations. We have been meeting informally for over a year, under the auspices of The Brookings Institution and The Heritage Foundation, to define the dimensions and consequences of the looming federal budget problem, examine alternative solutions, and reach agreement on what should be done. Despite our diverse philosophies and political leanings, we have found solid common ground. We agree that: • Unsustainable deficits in the federal budget threaten the health and vigor of the American economy. • The first step toward establishing budget responsibility is to reform the budget decision process so that the major drivers of escalating deficits—Social Security, Medicare, and Medicaid—are no longer on autopilot.
Once again the "ideological spectrum" means from barely center-left to right, and the only problem that matters is not military spending or regressive taxation, nope everything is the fault of Social Security and Medicare. And what is there solution? One establish a system of triggers that would automatically slash Social Security and Medicare benefits (and so keep Congress's hands clean when and if) or
Alternatively, the trigger process could require that a commission make recommendations for closing the gap to the president and Congress on which an up or down vote must be held.
. I.e. some version of Cooper-Wolf. Pete G Peterson and associates want to kill Social Security under the guise of 'fiscal responsibility'. And PGP has spent decades founding organizations largely or wholly devoted to that end and committed a billion dollars of his own money to do so. In the days and weeks to come look for the key words, starting not least with 'bi-partisan', and names like Bixby and Walker. These people are paid professional agents of the open conspiracy to roll back the New Deal. And that ain't paranoia talking. Follow the links.

Thursday, November 19, 2009

Senate Health Care Bill & CBO Scoring

by Bruce Webb

The new Senate Health Care Bill (big PDF) and the CBO Score. The outlines were reported last night, an $894 billion bill offset with enough taxes and fees to produce a $127 billion ten year reduction in the projected deficit, plus another $650 reduction in the ten years after that. (Traditionally CBO limits itself to 10 year scores, but the Republicans asked for a longer time frame for the stimulus bill, goose and gander). Also widely reported, but not quite correctly was the news that the bill would extend coverage to 94% of all Americans, or alternately all American citizens. In fact once you include Medicare and exclude illegal immigrants the actual coverage for legal American residents rises to 98%.

Tuesday, November 17, 2009

Food Security in America: a comment on Hullabaloo

There is a lot of discussion in the blogosphere around this NYT article and the response to it from the right: Hunger in U.S. at a 14-Year High which includes this response from Robert Rectum, er Rector at Heritage
“Very few of these people are hungry,” said Robert Rector, an analyst at the conservative Heritage Foundation. “When they lose jobs, they constrain the kind of food they buy. That is regrettable, but it’s a far cry from a hunger crisis.”
Which prompted well deserved outrage. But I tried to frame it a little differently over at Digby with the following and thought I would share it here.

There is a big difference between being hungry and being mal-nourished. Many third world people would likely shake their heads at the idea that anyone can starve in America, after all even the most meagre food stamp allocation would allow a family to buy enough corn meal and cooking oil to sustain life with maybe some potatoes and other root crops thrown in. Or alternately you could buy a fifty pound bag of rice. Or a bushel of oatmeal and some bacon trimmings. Whatever your heritage chances are that you have ancestors that lived day in and day out on that or less.

But we are not 21st century Sudan, 20th century China, 19th century Ireland, 17th century Scotland, there is no reason why Americans should not have access to balanced nutritional meals anymore than there is reason to deny them a change of clothes or a daily bath just because after all your great-great grandfather didn't have indoor plumbing.

I bring this up because it is a common rhetorical move from the right to argue that poor people in America are not really poor because they are fat, or have a TV, or a cell-phone. Or because in the end if they have a heart attack they will be admitted to the ER: "You can't be poor, look at how big your kids got eating government cheese".

I don't quite know how to counteract this move, there is nothing in the Declaration of Independence that promises 'life, liberty and the pursuit of a pizza and a side salad' but kids have a sense of injustice that goes beyond simple hunger pangs.

I wrote about this last Christmas Eve with a post called 'Why Does Santa Hate Poor Kids'
Because most every year every kid in poverty learns a hard lesson, rich kids get lavish gifts from Santa and dollar bills from the Tooth Fairy and big Easter Baskets from the Easter Bunny, while poor kids get squat. Which is a pretty fine way to socialize kids into just accepting their proper role in society.

So I don't know how much actual biologic hunger there is in this country, but people and especially children deserve something better than simple subsistence, that you can live on rice and beans doesn't mean that you should when all around you are living in relative lavishness. Did Charlie of "Charlie and the Chocolate Factory" REALLY need that chocolate bar? Well yes he did and not just because his stomach was growling.

Saturday, November 14, 2009

Thoughts on trying Terrorists in NYC

Article III Section 2 - Trial by Jury, Original Jurisdiction, Jury Trials

"The Trial of all Crimes, except in Cases of Impeachment, shall be by Jury; and such Trial shall be held in the State where the said Crimes shall have been committed; but when not committed within any State, the Trial shall be at such Place or Places as the Congress may by Law have directed."

Of course we have it from the highest authority that the Constitution is just a god damn piece of paper and where it isn't that Article II Section 2 obviously rules over all other Articles and that pesky Bill of Rights.

Trial by jury? In New York? Where do these anti-American terrorist lovers come up with crazy shit like that?
How do mature societies deal with this?

"We are not afraid to ride public transportation.

We are not afraid to walk down a crowded street.

We are not afraid of each other.

We are not afraid to say that terrorism in any form is never the answer.

We’re not afraid is an outlet for the global community to speak out against the acts of terror that have struck London, Madrid, New York, Baghdad, Basra, Tikrit, Gaza, Tel-Aviv, Afghanistan, Bali, and against the atrocities occurring in cities around the world each and every day. It is a worldwide action for people not willing to be cowed by terrorism and fear mongering.

The historical response to these types of attacks has been a show of deadly force; we believe that there is a better way. We refuse to respond to aggression and hatred in kind. Instead, we who are not afraid will continue to live our lives the best way we know how. We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

We are not afraid."

Conservatives are fond of mocking people for adopting a "Pre-9/11 Mindset" as if not living in a state of constant fear and paranoia and xenophobia is somehow a bad thing. This doesn't mean not being vigilant, it means not dismissing written intelligence warnings titled "Bin Laden Determined to Strike Inside the United States".

Thursday, November 12, 2009

Read the Bill! Part 3; and a possible reading error

by Bruce Webb

On July 28th I put up a post on what I considered to be the most important provision of the Tri-Committee Bill as introduced. The post was called Sec 116: Golden Bullet or Smoking Gun

(a) IN GENERAL.—A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner. For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio.

(b) BUILDING ON INTERIM RULES.—In implementing subsection (a), the Commissioner shall build on the definition and methodology developed by the Secretary of Health and Human Services under the amendments made by section 161 for determining how to calculate the medical loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by QHBP offering entities, competition in the health insurance market in and out of the Health Insurance Exchange, and value for consumers so that their premiums are used for services.
A Qualified Health Benefit Plan or QHBP is one that meets all the requirements outlined in the bill to be qualified for the Health Insurance Exchange itself scheduled to start on Jan. 1, 2013. Among those requirements is compliance with the detailed Acceptable Benefits Package whose fine points are to be established by the Health Benefits Advisory Committee who will be appointed after enactment of the bill. Premiums of a QHBP will be governed by requirements to meet a set Medical Loss Ratio whose set point will be established in accordance with principles set out in Sec 161.

All of this is clearly forward looking, a procedure is being set out that will govern insurance plans once the Exchange is established and three years are given to get the Health Choices Commissioner and the HBAC in place, for the MLR methodology to be established, for the final benefits package to be defined, to get all of that through the pubulication process, and to go through contract negotiations with the various insurance companies in time to meet the Jan 1, 2013 deadline. Altogether a pretty ambitious schedule, but one necessary to govern the Exchange going FORWARD.

On October 29th, a new and somewhat re-organized bill was introduced which included a whole new Title I called Immediate Reforms which were to go into effect right away on enactment of the bill. This included some truly new proposals including a new high risk pool to cover current uninsured between now and the start of the Exchange, plus a provision that allows family plans to cover children up to the age of 26. plus it moved some other protections on pre-existing conditions and prohibition of recessions forward. But it also did something curious, and ultimately inexplicable, it also moved the provisions of Sec 116 forward. In the new bill the equivalent language to Sec 116 is found in new Sec 102

(a) Group Health Insurance Coverage- Title XXVII of the Public Health Service Act is amended by inserting after section 2713 the following new section:

`(a) In General- Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary (but not less than 85 percent), the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of the amount by which the issuer's medical loss ratio is less than the level so specified.
`(b) Implementation- The Secretary shall establish a uniform definition of medical loss ratio and methodology for determining how to calculate it based on the average medical loss ratio in a health insurance issuer's book of business for the small and large group market. Such methodology shall be designed to take into account the special circumstances of smaller plans, different types of plans, and newer plans. In determining the medical loss ratio, the Secretary shall exclude State taxes and licensing or regulatory fees. Such methodology shall be designed and exceptions shall be established to ensure adequate participation by health insurance issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.
`(c) Sunset- Subsections (a) and (b) shall not apply to health insurance coverage on and after the first date that health insurance coverage is offered through the Health Insurance Exchange.'.
(b) Individual Health Insurance Coverage- Such title is further amended by inserting after section 2753 the following new section:

`The provisions of section 2714 shall apply to health insurance coverage offered in the individual market in the same manner as such provisions apply to health insurance coverage offered in the small or large group market except to the extent the Secretary determines that the application of such section may destabilize the existing individual market.'.
(c) Immediate Implementation- The amendments made by this section shall apply in the group and individual market for plan years beginning on or after January 1, 2010, or as soon as practicable after such date.
Okay the language is a little more bureaucratic and comes in the form of inserting new language into an existing title the Public Health Service Act but otherwise it is all the same thing, just old wine in new bottles. Right? Oh, oh, maybe not.

Yesterday on the assumption that it was the same thing I put up a post at Angry Bear STILL the Most Important Sentence in the House HC Bill citing only the (a) section. Commenter Gerald Weinand who took my advice to closely read the bill added this
Subsection (c) reads:
‘(c) Sunset- Subsections (a) and (b) shall not apply to health insurance coverage on and after the first date that health insurance coverage is offered through the Health Insurance Exchange.’.

I read through Title III. A. Sec. 304 and didn't see any refernce there to MLR's at all. Is the 85% established for policies offered through the exchange?
Well I was thrown for a loop. Instead of the orderly process set out in Sec 116 to establish rules for an Exchange that would start three years out via a scheduled process overseen by people to be appointed we have new rules that are subject to "Immediate Implementation" and which SUNSET on the day the Exchange opens. Moreover you can search through the bill as Gerald did and as I belatedly did and not find any specific mechanism to govern profits AFTER establishment of the Exchange.

I am not sure what to say, I only had this pointed out to me late last night, but my current thinking is that someone, somehow just screwed up. In their zeal to get certain protections in place right away they swept Sec 116 which clearly is focused on a FUTURE Exchange and tried to enforce its requirements on the current market. Which leads to some curious problems of language. What does ''adequate participation' mean in reference to an existing market? What about ensuring 'competition'? This language which makes perfect sense in the context of a competitive future exchange is pretty odd when applied to a market that already exists. Plus how do you immediately implement a methodology that has yet to be developed? How do you apply a process that mandates rebates on plans that are already in place based on MLRs that are on average about four points under the minimum set out in the legislation? Does every company in America expected to rebate 5% of its current premiums?

Well I got more questions than answers. But one partial solution is to get everyone on one page. Up to now people have been forced to rely on the original Tri-Committee Bill as introduced, only after Oct 29th did we have access to the bill as brought to the floor of the House, which induced some people, okay me, to read it too quickly. Well we now have some breathing room to examine the House Bill as passed with Amendments, Previously I had been linking to and using PDF versions which were pretty clumsy to navigate. The following link is to the bill as passed and engrossed, and should I think be the starting point for future discussion. ttp://
If that link is unstable you can Google it or use this pdf version:

Sunday, November 08, 2009

Abortion Coverage and Health Care Reform: an e-mail exchange

The following is the last (for now) stage of an e-mail exchange with my reply leading off. I deleted names not because any of the views expressed are in any way embarrassing but because I didn't get permission. Hopefully none of them will get too mad at me. But I thought my reply addressed a larger issue and I wanted to save it.

Me to (Man 1) I think you are missing the larger point. The argument for including abortion as a covered service is not at basis an economic one but instead stems from two deeper philosophic disputes: the separation of Church and State and the nature of a patriarchal society. I mean where do you stop? There are religious arguments against circumcism. And Christian Scientists have a valid argument that they shouldn't have to pay for the medical health care of others, particularly as their own practices are excluded. That is to the degree that objections to abortion are authentically based on religion enforcing those beliefs is a violation of the establishment clause.

But I don't believe these objections are actually religiously based, or rather that those religious objections are ultimately not based on any devotion to the principle of sanctity of life. For example immediately after Moses delivered the Ten Commandments to the Chosen including "Thou shalt not kill" his Lieutenant and Successor Joshua led his people into the Promised Land and exterminated nearly all its inhabitants excepting the one city whose people they saved to be hewers of wood and drawers of water, i.e. slaves. (I strongly suspect that the original Hebrew carried the meaning 'murder' and not 'kill'-in ancient law as today two very different concepts) So if the fundamental objection is not religious as such, or if the religious objection itself derives from some source other than the sanctity of life then from where does it derive?

Well the answer is pretty clear, from the same motive that would have women wear burqas or have widows perform purdah (religious suicide after a husband's death) or condemning women to death for BEING raped or having eunuchs as harem guards or in milder form strictly imposing the principle of chaperonage. That is whether you look at this from the biological or anthropological or sociological or historical perspective it is blindingly obvious that men are fundamentally driven by a desire to control the sexuality of "their" women whether that be consort or dependent. Thus the danger of birth control and abortion is that one of "your" women may be having sex with someone else without your knowledge and perhaps worse enjoying it more, and that you will never know. That this cross-cultural imperative has ended up embedded into those cultures religious practices is perfectly natural but let us not fool ourselves into thinking that its origins are spiritually based in some concept of the sanctity of life. Scratch the surface of anyone of 'God's children' and you can see the jealous baboon hidden inside. These guys are just defending the pack against outsiders who want access to the females. Pandering to this desire is just government enforcement of the basest kind of patriarchy.

Sure we could and probably should set up an alternative form of financing for abortion but ultimately being only a little bit of a slave is like only being a little bit pregnant, the question is whether women should be autonomous or not. Me I am a sucker for freedom and equality.

On Nov 8, 2009, at 9:03 AM, Man 1 wrote:

i am hoping i understand this: without being robbed by the insurance companies, most women would have enough money to pay for their own abortion if they needed one. at least that's close to the point i am trying to make. i fail to understand how that would "hold another person and their right to freedom of choice captive to religious, moral, and political motivations." rather the opposite. it seems to me that (Man X) is the one trying to hold others captive to HIS religious, moral, and political motivations. It seems to be impossible to convince people who think they don't have religious views that that IS a religious view.

if you (he) are seriously saying that not only does a woman have a right to an abortion (i agree) but she has a right to a government paid abortion, i hope you can see why you drive "conservatives" crazy.

On Nov 8, 2009, at 4:40 AM, Woman 1 wrote:

I assume that within less than ten years, an abortion case will go to
the Supreme Court, challenging that portion of the law. As the
non-profit or reduced profit players in health care see their fat
profits dry up, the case might even be brought by, or supported by

Either way, general prosperity will expand when the punitive burden of
health coverage is lifted. There may not be money available for a
particular woman, but the numbers of women having the means will rise.

(Woman 1)~off to read the news this morning~

On Sat, Nov 7, 2009 at 9:42 PM, (Man 2) > wrote:
(Man 1):

Save how for an abortion? With a declining income that has been undermined
for the last 30 years with increased expenses, lower paying jobs, denial of
equality, and a lack of opportunity. I find it reprehensible a political
party would hold another person and their right to freedom of choice captive
to religious, moral, and political motivations.

We will fund healthcare for cancer caused by smoking, we will fund
healthcare for those who over eat and suffer from diabetes, we will fund
healthcare for those who choose to use their heads as a battering ram on the
highways of America from riding motorcycles, we will fund healthcare for
those who abuse themselves from over dosing on drugs and alcohol; but god
forbid, a teen or the lady driving Reagan's Pink Cadillac gets pregnant and
it is then we choose to become self-righteous

Sunday, November 01, 2009

HR676: Political Fool's Gold

In discussions around the blogosphere about HR3962, the House Health Care Bill, some individuals suggest that at 1990 pages it was simply bloated and used the 30 page HR676 (Single Payer) as a clean, easy, effective alternative. Which led me to wonder "How the Hell can you reform the entire U.S. Code as it relates to health care in 30 pages?" So I read the bill and found out that it is a mirage. HR676 is so far from a political starter as to be literally laughable. To see why I offer some language and interpretation.
One of the most fervent promoters of HR676 is Physicians for a National Health Program (PNHP) and who naturally have a web page with all kinds of resources for defenders, including of course a link to the full text of the bill. So as a public service I suggest people wanting to push back on my analysis start there:

What I propose is a section by section analysis of the bill in real terms at each point asking the question "How do you sell this?" I don't think you can, once you get beyond the aspiration of Universal Single Payer, one which I share fully, there really is nothing here. So---
(a) SHORTTITLE.—This Act may be cited as the ‘‘United States National Health Care Act or the Expanded and Improved Medicare for All Act’’.
(b) TABLEOFCONTENTS.—The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms
Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.
Subtitle A—Budgeting and Payments
Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and medically necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement levels.
Subtitle B—Funding
Sec. 211. Overview: funding the USNHC Program.
Sec. 212. Appropriations for existing programs.
Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced clerical workers.
Sec. 304. Confidential Electronic Patient Record System.
Sec. 305. National Board of Universal Quality and Access.
Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
Sec. 501. Effective date.

Sec. 101: "(a) IN GENERAL.—All individuals residing in the United States (including any territory of the United States) are covered under the USNHC Program entitling them to a universal, best quality standard of care."

"(c) PRESUMPTION.—Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States National Health Insurance Card and have payment made for such benefits."

Meaning that undocumented workers and people on student and work visas are covered fully. A further provision covers tourists and visitors but provides some vague language about reimbursement and payment by the home country.

(a) IN GENERAL.—The health care benefits under this Act cover all medically necessary services, including at least the following: (1) Primary care and prevention. (2) Inpatient care. (3) Outpatient care. (4) Emergency care. (5) Prescription drugs. (6) Durable medical equipment. (7) Long-term care. (8) Palliative care. (9) Mental health services. (10) The full scope of dental services (other than cosmetic dentistry). (11) Substance abuse treatment services. (12) Chiropractic services. (13) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes). (14) Hearing services, including coverage of hearing aids. (15) Podiatric care. (b) PORTABILITY.—Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits. (c) NO COST-SHARING.—No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits."

I particularly like the "at least". Want weekly chiropractic and acupuncture visits? Designer prescription sunglasses? Six-months at the Betty Ford Clinic? You got it, and at ZERO out-of-pocket expense. Great for that undocumented landscaper with a bad back or for hypochondriacs, but ya think this might get kind of expensive overall?

(1) IN GENERAL.—No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned."

Sorry Walgreens and Payless, goodbye Perle Vision, and oh yeah if you want to open a mental health clinic anywhere be sure to able to finance it on your own. And don't make a profit on selling any product or service. What about existing institutions? Not to worry-Uncle Sam will compensate you for "reasonable financial losses incurred as a result of the conversion from for-profit to non-profit status. "

(a) IN GENERAL.—It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act"

Subtitle A—Budgeting and Payments

The government pays for everything including construction of health facilities and all equipment.


All health care institutions get paid a single monthly payment. Physicians, dentists, pharmacists, optometrists, nurse practioners can either be salaried or get payment on a single set fee schedule. Which allows no variation because it will be established with the following criteria.

"(B) CONSIDERATIONS.—In establishing such schedule, the Director shall take into consideration the following:
(i) The need for a uniform national standard.
(ii) The goal of ensuring that physicians, clinicians, pharmacists, and other medical professionals be compensated at a rate which reflects their expertise and the value of their services, regardless of geographic region and past fee schedules."

"Subtitle B—Funding"

"(c) FUNDING.—
(1) IN GENERAL.—There are appropriated to the USNHC Trust Fund amounts sufficient to carry out this Act from the following sources:
(A) Existing sources of Federal Government revenues for health care.
(B) Increasing personal income taxes on the top 5 percent income earners.
(C) Instituting a modest and progressive excise tax on payroll and self-employment income.
(D) Instituting a small tax on stock and bond transactions. "

Okay we will tax the top 5 percent of income at some unknown rate plus payroll at some unknown but graduated rate plus a similar unknown transaction tax. Good luck to the CBO in scoring that. Because they'll need it.

Title III: Administration

Set up bureaucracy

Title IV: Other provisions


(a) VA HEALTH PROGRAMS.—This Act provides for health programs of the Department of Veterans’ Affairs to initially remain independent for the 10-year period that begins on the date of the establishment of the USNHC Program. After such 10-year period, the Congress shall reevaluate whether such programs shall remain independent or be integrated into the USNHC Program.
(b) INDIAN HEALTH SERVICE PROGRAMS.—This Act provides for health programs of the Indian Health Service to initially remain independent for the 5-year period that begins on the date of the establishment of the USNHC Program, after which such programs shall be integrated into the USNHC Program. "

Likely elimination of the VA system. Certain elimination of IHS.

Title V: Effective date

Except as otherwise specifically provided, this Act shall take effect on the first day of the first year that begins more than 1 year after the date of the enactment of this Act, and shall apply to items and services furnished on or after such date."

Oh yeah and we will get the conversion of the entire health care delivery system from for-profit to non-profit including all necessary buy-outs in a single year.

Sorry, this is not a serious policy proposal, this is an aspirational manifesto that would take the U.S. health system far beyond even the British NHS. Under this system only the ultra-rich could ever dream of having a private room or a private nurse, everyone else is reduced to the lowest common denominator. It is common to hear commenters saying "no one is contemplating a government take-over of the medical system" or "no one is proposing an NHS system". Well sorry this is exactly that. The only terms that describe a system that makes all for-profit delivery of all medical, dental, mental health, substance abuse, vision and long-term care ILLEGAL and further makes any private insurance supplements ILLEGAL would set off all kinds of rhetorical alarms.

Progressives come on! I don't care how much of a bleeding heart you may have but do you really want to go to the country on the platform of "We provided universal free coverage to all illegal immigrants while abolishing the VA hospital system, oh and the Pharmacy section at your supermarket. Vote for us!" This is not serious policy, this is just posturing for effect. This bill demagogues itself.