Month: July 2009

70 Cents An Hour

by dday

As the final phase from a bill passed back in 2007, today the federal minimum wage rises to $7.25 an hour from $6.55 for workers across the country. This brings the federal minimum wage, adjusted for inflation, back to where it was in the 1990s. It’s hard to determine how many minimum-wage employees there are out there, but the best guess is that five million people get a raise today. Here’s one of them.

While those workers include thousands of financially secure students still living with Mom and Dad, they also include thousands of the most impoverished and vulnerable members of the workforce – those who sink further into debt each month as ordinary expenses outweigh their meager paychecks.

April Greer, 36, is one of them.

Her troubles began in December, when her husband was sent to prison for a parole violation, leaving her the sole provider for her three teenage children who live with her.

In January, she was fired from her job at a cellular provider. She said she was late for work because her sister-in-law commandeered her car.

She spent early spring trawling East Dallas for a new job, but, like millions of Americans, she found none.

In early May, Greer’s electricity provider finally turned out the lights. A few days later, her landlord changed the locks. She and her children crowded into the South Dallas bungalow of her husband’s parents.

She finally caught a break two months ago, when a nonprofit agency helped her land a part-time, minimum-wage job at T.J. Maxx, taking home about $800 a month.

Two weeks ago, after she started having dizzy spells at work, she collapsed and spent two days in the hospital.

Doctors aren’t sure what’s wrong with her. Maybe diabetes. Maybe her heart. Maybe just stress.

Greer knows she can’t afford $434 a month for the medication her doctor says she needs. She can barely afford the $100 a week she’s been paying her in-laws to cover their ballooning utility bills.

She wants to find a second job, but doesn’t know if her body can take it.

“Since I’m the only one right now for my kids, I have to take care of my health,” she said.

Those with the lowest incomes are often those who have the most health issues. That comes from stress, overwork, the lack of a nutritious diet, living in low-income environments where more pollution exists, and a variety of other factors. In this most cruel of American landscapes, the poor and the sick often are the same person.

But what we’ll hear today is how adding 70 cents an hour will bankrupt businesses. In actuality it will act as a mini-stimulus, giving the poor about $28 more a week for necessities that will almost certainly get spent and cycled into the economy.

What we certainly won’t hear about is how the struggle of these minimum-wage workers fits into the health care debate. Many are probably already on Medicaid, but a provision in the bill would limit out-of-pocket costs for everyone, and expanding access would help make sure nobody who needs health coverage slips through the cracks. The air-blown press corps may have thought Obama’s press conference was bor-ring, but the issues discussed directly affect the lives of people like April Greer. It would be nice if they could take up the debate with some inkling of concern for her, rather than acting like theater critics critiquing how folsky or animated the President was during his press conference.

Republicans and fiscal scolds say we just cannot afford to help someone like April. She ought to just get a job with the government. But Krugman says something important today – contrary to conservative belief, access and cost control are complementary.

Why does meaningful action on medical costs go along with compassion? One answer is that compassion means not closing your eyes to the human consequences of rising costs. When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers — but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.

Beyond that, I’d suggest that would-be health reformers won’t have the moral authority to confront our system’s inefficiency unless they’re also prepared to end its cruelty. If President Bush had tried to rein in Medicare spending, he would have been accused, with considerable justice, of cutting benefits so that he could give the wealthy even more tax cuts. President Obama, by contrast, can link Medicare reform with the goal of protecting less fortunate Americans and making the middle class more secure.

As a practical, political matter, then, controlling health care costs and expanding health care access aren’t opposing alternatives — you have to do both, or neither.

April Greer probably just wants the peace of mind that she can get treatment when she needs it, without going deeply and overwhelmingly into debt in the process. Long-term budgetary constraints and bending cost curves matter less to her. But Krugman is right that the two are not in conflict, and must be packaged together.

I’m happy April is getting a small raise for her troubles today. I want her to get a health care system that honors her struggle and provides her security. But Senators need a three-week recess, so she’ll have to wait.

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What Krugman Said

by tristero

On last night’s press conference

The talking heads on cable TV panned President Obama’s Wednesday press conference. You see, he didn’t offer a lot of folksy anecdotes.

Shame on them. The health care system is in crisis. The fate of America’s middle class hangs in the balance. And there on our TVs was a president with an impressive command of the issues, who truly understands the stakes…

I don’t know how many people understand the significance of Mr. Obama’s proposal to give MedPAC, the expert advisory board to Medicare, real power. But it’s a major step toward reducing the useless spending — the proliferation of procedures with no medical benefits — that bloats American health care costs.

And both the Obama administration and Congressional Democrats have also been emphasizing the importance of “comparative effectiveness research” — seeing which medical procedures actually work.

So the Obama administration’s commitment to health care for all goes along with an unprecedented willingness to get serious about spending health care dollars wisely. And that’s part of a broader pattern.

Many health care experts believe that one main reason we spend far more on health than any other advanced nation, without better health outcomes, is the fee-for-service system in which hospitals and doctors are paid for procedures, not results. As the president said Wednesday, this creates an incentive for health providers to do more tests, more operations, and so on, whether or not these procedures actually help patients.

So where in America is there serious consideration of moving away from fee-for-service to a more comprehensive, integrated approach to health care? The answer is: Massachusetts — which introduced a health-care plan three years ago that was, in some respects, a dress rehearsal for national health reform, and is now looking for ways to help control costs…

When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers — but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.

Beyond that, I’d suggest that would-be health reformers won’t have the moral authority to confront our system’s inefficiency unless they’re also prepared to end its cruelty. If President Bush had tried to rein in Medicare spending, he would have been accused, with considerable justice, of cutting benefits so that he could give the wealthy even more tax cuts. President Obama, by contrast, can link Medicare reform with the goal of protecting less fortunate Americans and making the middle class more secure.

As a practical, political matter, then, controlling health care costs and expanding health care access aren’t opposing alternatives — you have to do both, or neither.

This has been another edition of What Krugman Said.

Cannot Tell A Lie

by dday

Time decided to do some reporting about the final days in the Bush bunker, particularly about Dick Cheney’s efforts to extract a pardon for his pal Scooter Libby. It’s clearly from Bush’s perspective, but nevertheless it’s a pretty fascinating article just for seeing how the Bush loyalists spin the tale.

Petitions for pardons are usually sent in writing to the White House counsel’s office or a specially designated attorney at the Department of Justice. In Libby’s case, Cheney simply carried the message directly to Bush, as he had with so many other issues in the past, pressing the President in one-on-one meetings or in larger settings. A White House veteran was struck by his “extraordinary level of attention” to the case. Cheney’s persistence became nearly as big an issue as the pardon itself. “Cheney really got in the President’s face,” says a longtime Bush-family source. “He just wouldn’t give it up.”

And there was a darker possibility. As a former Bush senior aide explains, “I’m sure the President and [chief of staff] Josh [Bolten] and Fred had a concern that somewhere, deep in there, there was a cover-up.” It had been an article of faith among Cheney’s critics that the Vice President wanted a pardon for Libby because Libby had taken the fall for him in the Fitzgerald probe. In his grand-jury testimony reviewed by TIME, Libby denied three times that Cheney had directed him to leak Plame’s CIA identity in mid-2003. Though his recollection of other events in the same time frame was lucid and detailed, on at least 20 occasions, Libby could not recall details of his talks with Cheney about Plame’s place of employment or questions the Vice President raised privately about Wilson’s credibility. Some Bush officials wondered whether Libby was covering up for Cheney’s involvement in the leak of Plame’s identity.

That makes it seem like Bush just wanted to separate himself from the Libby case altogether, despite the fact that Libby was a special adviser to the President, not the Vice President, and he was protecting both Bush and Cheney. It makes sense for Bush to compartmentalize the Libby leak, as if he were an innocent bystander, and refusing to pardon obviously helps him in that case. But it’s not true at all. Marcy Wheeler has a lot more on this.

But this just blew me away. After Cheney lays out the case for a pardon, repeatedly, incessantly, for weeks:

A few days later, about a week before they would become private citizens, Bush pulled Cheney aside after a morning meeting and told him there would be no pardon. Cheney looked stricken. Most officials respond to a presidential rebuff with a polite thanks for considering the request in the first place. But Cheney, an observer says, “expressed his disappointment and disagreement with the decision … He didn’t take it well.”

Two days after that, Libby, who hadn’t previously lobbied on his own behalf, telephoned Bolten’s office. He wanted an audience with Bush to argue his case in person. To Libby, a presidential pardon was a practical as well as symbolic prize: among other things, it would allow him to practice law again. Bolten once more kicked the matter to the lawyers, agreeing to arrange a meeting with Fielding. On Saturday, Jan. 17, with less than 72 hours left in the Bush presidency, Libby and Fielding and a deputy met for lunch at a seafood restaurant three blocks from the White House. Again Libby insisted on his innocence. No one’s memory is perfect, he argued; to convict me for not remembering something precisely was unfair. Fielding kept listening for signs of remorse. But none came. Fielding reported the conversation to Bush.

OK, is it normal for the subject of a possible Presidential pardon to personally lobby for it on his own behalf? Has that ever happened before? If it has, I don’t recall it.

The article is decent enough, but don’t start to drink a glass of water when you read this part, or you’re in for a surefire spit-take:

While packing boxes in the upstairs residence, according to his associates, Bush noted that he was again under pressure from Cheney to pardon Libby. He characterized Cheney as a friend and a good Vice President but said his pardon request had little internal support. If the presidential staff were polled, the result would be 100 to 1 against a pardon, Bush joked. Then he turned to Sharp. “What’s the bottom line here? Did this guy lie or not?”

The lawyer, who had followed the case very closely, replied affirmatively.

Bush indicated that he had already come to that conclusion too.

“O.K., that’s it,” Bush said.

Yes, that moral paragon, truth-teller extraordinaire, George W. Bush, Honest George I think they called him, comes down firmly on the side of truth in virtually every circumstance. History will judge him as the most forthright human who ever bestrode the earth. A colossus among men.

Incidentally, the man, Jim Sharp, that Bush is talking with here? It’s his own defense attorney.

… you have to love Cheney’s response to the story. I guess the Bush loyalists got under his skin.

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Political Katrina

by digby

Following up on dday’s post below, I see that Jon Cohn is also reading the tea leaves and seeing that Obama is blessing not only the MEDPac idea, (which actually comes from the white house) but also the repeal of the employer tax exclusion, which the CBO Chief hinted broadly would get his blessing if included in the plan (and which I said they should do if only for that reason.) He’s specifically saying that he is intrigued by what we are calling the “Kerry plan,” as previously reported, which, as I wrote yesterday, seems like a rather elegant solution to the political aspects of that problem.

This is good. No news yet on the rumor that they have decided to report out a plan without the public option. But if they do, I hope they realize that they are going to see a progressive shit storm of Katrina proportions.

The Public Plan is already a compromise position that the grassroots nonetheless rallied around as a concession to pragmatism (driven by a presidential campaign that left them little choice.) For better or worse, it’s the sugar that made this hybrid medicine go down on the progressive side. Throwing that away, even if somebody thinks they can restore it in conference, is a deliberately provocative act and they should be wary of the consequences.

Recall it isn’t just the little bloggers who are agitating for a public plan. It has been endorsed by dozens of health industry interests at some political risk to themselves as well as Obama’s own grassroots organization. It is not just another data point.

I don’t doubt they would love to do it. It would be a huge victory for the insurance companies who own the financial services committee and would appease the Big Money Boyz across the board to see that there is absolutely no issue over which which Democrats will fulfill their promises to their constituents if it means threatening the power and influence of those who hold the purse strings. But it will cause these same Democrats a gargantuan amount of grief from their left. Maybe they don’t care. But if they don’t report out the public plan at this point, we’ll certainly find out.

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Strangers

by digby

I’m looking at a “Situation Room” chyron right now that says:

“Strangers Could Decide Your Coverage — Controversial idea for health council.”

Is there anyone out there who personally knows the people who decide your coverage? Does the current system, whereby your employer picks the policy and the procedures are approved by faceless insurance company clerks give people a lot of personal say in that regard? I don’t think so.

As it turns out, this misleading chyron is actually referring to proposed changes in Medicare, which would remove the decisions about reimbursement rates from congress and give it to an independent health board. Wonks I trust seem to think this could be helpful in containing costs. I don’t have an opinion. But I do know that the idea that it’s the elderly people themselves who are deciding the medicare reimbursements and suddenly it’s going to be a bunch of strangers is patently absurd.

Right now decisions about reimbursements are being made by strangers known as “lobbyists” who are buying off your very good friend the congressman. I don’t think most people see that as medicine with a personal touch.

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Yet Another Reason

by digby

From the “whodda thunk” files:

In a first-of-its-kind study, the non-profit Rand Corp linked the rapid growth in U.S. health care costs to job losses and lower output. The study, published online by the journal Health Services Research, gives weight to President Barack Obama’s dire warnings about the impact of rising costs if Congress does not enact health care reform.

The Rand researchers examined the economic performance of 38 industries from 1987 through 2005, in an attempt to assess the economic impact of “excess” growth in health care costs on U.S. industries. Excess growth is defined as the increase in health care costs that exceeds the overall growth of the nation’s GDP—a yearly occurrence in the U.S. The team compared changes in employment, economic output and the value added to the GDP product for industries that provide health benefits to most workers to those where few workers have job-based health insurance.

After adjusting for other factors, industries that provide insurance had significantly less employment growth than industries where health benefits were not common. Industries with a larger percentage of workers receiving employer-sponsored health insurance also showed lower growth in their contribution to the GDP…

This study provides some of the first evidence that the rapid rise in health care costs has negative consequences for several U.S. industries,” said Neeraj Sood, the study’s lead author and a senior economist at RAND. “Industries where more workers receive employer-sponsored health insurance are hit the hardest by rising health care costs.

To rule out the possibility that the economic effects were caused by some other industry-wide factor, the researchers compared U.S. industries with their counterparts in Canada, which has publicly financed universal health care. They found no similar percent change in employment in the corresponding Canadian industries over the 19-year study period.

Sadly, I’m afraid that many people will feel that the only logical response to this is for fewer employers to offer health insurance.

Bring on the Cato Plan.

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Moral Turpitude

by digby

Amanda Marcotte has written a very interesting post about the nasty campaign against Dr Regina Benjamin for allegedly being too fat to serve as Surgeon General. Aside from the very dubious claims that a bigger woman can’t possibly be a good role model for good health (which Marcotte dispatches quite convincingly, I think) there is another issue brewing around all this that we should all be concerned about.

Nobody disputes that morbid obesity is dangerous to people’s health and that something very strange is happening in our culture with so many children and adults rather suddenly becoming much larger than in the past. Some of the early science suggests it has something to do with the processed nature of the fast food nation as well as the overabundance of available food and sedentary lifestyle, but nobody knows exactly what’s going on. Whatever it is, it’s startlingly quick in evolutionary terms and there are a lot of questions to be answered before we have any idea of the full cause of the phenomenon.

But naturally, society’s moral scolds are using this health crisis as yet another reason to use others’ “failure” as a sign of their own righteousness. They are, in other words, using this bizarre, sudden change in human physiology as an excuse to label others as morally inferior.

Everyone who is overweight should exercise more, eat smaller portions and healthy foods. Nobody disputes that. But the scope and speed of this change in weight, especially among young people is far less likely to be attributable to moral weakness or a wholesale change in human nature in just 20 years than the fact that the food supply and daily habits of Americans have changed radically. At the very least I think it’s logical to assume that it’s more complicated than vast numbers of people, including half the children, have turned lazy, gluttonous and morally deficient overnight.

Yet, as Marcotte points out, there is an increasing tendency to see all of this as yet another opportunity to marginalize and shame certain segments of society based upon appearance:

By saying this, I’m not making any health claims about weight. That discussion, while interesting, is beside the point of this post. It’s enough to know that most people strongly associate health and weight. So when disingenuous sexists start to bellyache about the dangers of letting fat women out in public, they get traction, because it’s becoming increasingly acceptable to suggest that not being perfectly healthy is a moral failing that should be punished with social disapproval, shaming, ostracism, and lowered access to society. Of course, we double down on fat people, and triple down on fat women, because of plain old prejudice, but this isn’t happening in a vacuum. Smokers, people who don’t eat right, and other people with poor health habits are also considered morally inadequate, if harder to judge because they’re harder to spot. The fetish for health management is, I suspect, a large reason that the anti-vaccination movement has taken hold. People who want an edge in the moral olympics of prevention are inventing counterintuitive (and anti-intellectual) shit to do in order to win as the bestest, most deserving of good health.

This is a tiring game in American life, going back to the Puritans, and it’s one which particularly chaps my western, MYOB sensibilities. In fact, everyone should be wary of this one. When it comes to bad health, let’s just say that equating it with bad morals is a very dangerous thing to do — unless you think it’s impossible that you might get cancer or have a heart attack, that is. Illness has a funny way of equalizing a whole lot of things in life and it pays to keep in mind that even the most moral among us are all going to die someday too.

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Transfer Of Power

by dday

The remaining House committee to finish work on the health care bill, the Energy and Commerce Committee, has repeatedly delayed their markup sessions this week, as Henry Waxman negotiated with the several Blue Dogs on the committee over changes to the bill. Talks seemed to reach a breakthrough when Waxman agreed to add expanded power for MedPAC, an independent board that could make recommendations on public medical spending and face an up or down vote in Congress. But despite that, there’s been delay.

And that’s because the Blue Dogs want to sequence the votes. They want the Senate to go first with whatever comes out of the Finance Committee over there rather than take a vote on something that won’t be part of the final bill. Nancy Pelosi said as much yesterday:

House Speaker Nancy Pelosi has been pretty adamant: She would prefer to pass a health care bill by early August, and would be willing to hold the House in session past a scheduled recess to get there. But she’s also unwilling to move unless the Senate does…something.

‘[I]f we’re done, and they’re not done and they’re gone, what is the point?” Pelosi said in a meeting with reporters yesterday. “It’s interesting to me that people are saying, ‘Don’t leave until it’s done.’ I don’t know how much more we can do if the Senate is not going to move.”

This reflects a general frustration with the holdup in the Finance Committee, particularly the secrecy of them and how long they have played out. As far back as February, Max Baucus talked about a markup session in June. And he consistently agreed to that throughout the next several months. Now he hasn’t only help up the process, but he doesn’t even plan to run it by the Democratic caucus once he introduces it:

However, the level of consultation with Democrats stands in contrast with how Republican negotiators are briefing their Members. Senators said Enzi, who is the ranking member on the Health, Education, Labor and Pensions Committee, briefs leaders every day on the talks. And all three of the GOP negotiators have agreed to brief the entire GOP Conference before they sign on to any deal with Baucus.

But Democrats said Baucus is unlikely to run any deal by his caucus before he shakes hands on an agreement with Republicans.

On the stimulus bill, we had Presidents Nelson and Collins dictating the size and scope of the bill. Now there’s been a transfer of power. Presidents Baucus and Grassley are large and in charge. And virtually nobody in the Democratic leadership has challenged this hijacking of the process, outside of off-the-record grumbles. In particular, nobody has mentioned that they’ve gone well outside the confines of their mandate:

I would have thought that the role of the Senate Finance Committee was to figure out how to finance necessary health care reforms in a responsible fashion. It wasn’t their job to make the major “policy” calls about what reform entails. That’s the job of the Senate Health, Education, Labor and Pensions Committtee, and the respective House Committees, and they’ve already defined what they want and are in basic agreement.

No, Finance’s job was to look at the range of financing options — some from Tax A, some from Tax B, a bit from Tax C, plus Savings X, Savings Y, etc. — and then choose. Put together a package that’s fair and that does the job. But apparently, the entire Congressional leadership is waiting for President Baucus and President Grassley to tell them what the substance of reform will be.

So, what have the two Co-Presidents produced so far? Zero. Nada. Zilch. Unless you count delay.

Did you know that last November, you all voted for Max Baucus and Charles Grassley to become Presidents of the United States of Health Care?

UPDATE: Jane reports that a deal is coming from the Finance Committee shortly, and that it’ll use John Kerry’s suggestion to tax insurance companies for their most expensive plans, and that it won’t have a public plan. As Scarecrow said, since when does the Finance Committee dictate policy provisions?

Jane believes that the Senate bill could come together quickly, and that when Harry Reid reconciles the Finance bill with the HELP Committee bill, that he will drop the public plan. I would say that, since it’s completely at Reid’s discretion, the pressure is on him to include that in the merged package or not. Either way there will be an amendment to either strip it or add it back in. If Reid includes it, that amendment may need a 60-vote threshold to strip it, and if he doesn’t, it may need 60 votes to put it back in. So Reid has every opportunity to advance the prospects of a public option. Jane also says:

Anyway, as was always going to be the case, the only hope for the public plan is coming out of the House. And the only hope of forcing the Senate’s hand is if there is a roadblock in the House that can’t pass a health care bill without one. It puts them in the position of tanking health care because they petulantly insist on refusing to give in on something that 76% of Americans want, and the public pressure becomes enormous.

So please tell members of the House to stick around and fight, because with 50 million people in this country uninsured, it isn’t All About Them.

The best way to stop the delay tactics from the Finance Committee is to refuse them an out by putting passage of a bill ahead of the August recess.

UPDATE II: And Harry Reid continues his bold leadership…

Senate Majority Leader Harry Reid said today that the Senate would not attempt to pass sweeping health care reform until after returning from the August recess.

“It’s better to get a product that’s based on quality and thoughtfulness than on trying to just get something through,” Reid told reporters.

Reid said the Senate would try to complete a package in the fall.

The article makes it sound like Republicans asked for a delay, and Reid AGREED to it.

Should we just let Mitch McConnell be Majority Leader at this point?

…I should mention that I haven’t seen reports of that Baucus/Finance Committee/public option deal anywhere else. Things are very fluid and I still feel that most stakeholders in the debate are resigned to something called “public option” in the final bill. Whether it’s good or not remains to be seen. But conceding the recess and allowing the Finance Committee to delay and dictate the terms is unconscionable.

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The Fetid Underbelly

by digby

The other night I posted a comment from some wingnut saying that health care reform was being formulated to put unhealthy, undeserving Blacks and Hispanics ahead of the more responsible Whites in the health care system. It illustrated some of the most long standing prejudices in America, going all the way back to the beginning, when racists first decided that any kind of public welfare would mean taking the money of white people to help undeserving blacks. Our racist element has been one of the fundamental reasons why we differ from other industrialized countries in this respect.

Here’s the more, shall we say, simple argument:

Via TPM:

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Jon Stewart On Point

by tristero

I’ve heard it said, with sorrow and shame, that when a comedian becomes the most trusted person in America, we’ve tumbled an incalculable distance from the Olympian heights of Cronkite and Murrow.

I grew up with Cronkite (even met him a few times). And while, Murrow was a little before my time, I’ve watched and listened to a substantial number of his broadcasts (well worth it). And yes, they were both brilliant, decent human beings who worked hard – and their enormously talented collaborators worked equally hard – to make sense of the complex, bewildering issues of the day. Their work was essential.

But neither was capable of this:

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