Is the Obamacare problem a public or a private problem?: My WSJ greets me on the front stoop this AM with the banner headline on the "Depth of Health Law Woes," based on the rise of "thin" markets with too few private insurers to generate cost-saving competition. ...
First, while the Journal article is surely informative, it violates my rule #1 in this space: when writing about private exchanges, declare up front that we're talking about 7 percent of the population. That's the share that get coverage through the ... the exchanges. ...
Those shares don't negate the thin market problem at all, but they do give it essential context. Most people still get their coverage through their employer (about 50 percent) and Medicare or Medicaid (34 percent).
But my question today is whether this spate of articles is accurately framing this problem. That is, diminished competition among insurers in various markets is invariably framed as an architectural flaw in Obamacare, and thus, a government failure. But it could just as easily be seen as market failure, or more specifically, a pricing-calibration problem. If so, the problem isn't too much government intervention; it's too little.
The theory of the case when the law was being crafted was, for both policy and political reasons—the latter being buy-in from private insurers, whose powerful lobby couldn't be ignored—that the exchanges would be populated by private insurers competing for customers in the (relatively small!) non-group market.
The insurers would get a bunch more customers, most of whom would come to the table with a tax credit to help pay the cost of their subsidy, a non-trivial deal sweetener for the private insurers (not to mention the mandate, further nudging customers into the exchanges). In return, they'd have to accept a set of rules designed to promote adequate coverage, like accepting applicants with pre-existing conditions and "community rating:" no price discrimination based on health status.
At the time, there was a robust argument about the wisdom of this path. While it was the least disruptive to a major industry, the long history of the uneasy relationship between health care and markets, along with the experience of other advanced economies, led many to worry that private insurers could not be depended on to meet the demands of a newly regulated individual market. They had an incentive, for example, to set their initial prices too low to get customers, which would mean actuarial losses and a big jump in premiums (one solution was to add a program to limit losses to such insurers: the so-called "risk corridors").
This was partially the motivation for adding a public option, but the politics blocked that option (some will argue that the administration, of which I was then a member, didn't push hard enough; I'd argue the votes just weren't there). The private folks didn't want to compete with anything like Medicare, which consistently posts lower price growth than the privates—it is non-profit, after all—and their message was thus, "we got this."
Well, it turns out they don't got this, though again, this is less a failure in the structure of the program than growing pains as insurers learn to price their products based on the health of those coming into the exchanges. If there's a structural flaw in Obamacare, it's that it doesn't include the public option. Those of us who pulled for it had it right in that we saw the need for just such a backstop.
To be fair, a public option is itself a tricky bit of work, and it's too easy to make it sound like a hand-wave, miracle solution (see Jacob Hacker's excellent discussion of these issues here). But you know what else is a big, old hand wave?: the miracle of competition, allegedly solving everything that ails the health care market.
Obamacare is a public/private hybrid, and this recent episode with the 2017 premiums should teach us that dialing back the public side is not the way forward. To the contrary, the private sector never has and never will provide the health care Americans want and need on its own.
Critics decried the incentives offered to the company in exchange for keeping workers in Indiana, but others called Mr. Trump's effort a new path to economic growth.
Blog: EPIC Radio Podcasts Post: The WV Opiate Epidemic -- on the Are You Crazy Show Link: http://podcasts.enlightenradio.org/2016/12/the-wv-opiate-epidemic-on-are-you-crazy.html
(This article is based on remarks delivered to a meeting of the National Committee of the Communist Party USA, Nov. 19 in Chicago.)
Everything has changed as of Nov. 8. With the takeover of the Republican Party by white supremacists, a new kind of right-wing and authoritarian danger has emerged, one that if unchecked threatens basic democracy.
Our multi-racial working class and people and all democratic movements are immediately on the defensive and our nation and Earth, already in a precarious state, will be in a far more dangerous place. Tens of thousands will die as a direct result of the cruel and ruthless Trump and GOP Congressional policies.
The broad democratic movements cannot allow this defeat or the fear of authoritarian rule to lead to paralysis. It is not the end of the road. As the Rev. William Barber III said, "We must remember how our ancestors responded to disappointment without allowing it to deter them on the march toward justice."
Trump's victory did not represent a mandate for his policies. By voting for Hillary Clinton, the majority rejected hate and attacks on democratic rights. Even though the U.S. is deeply polarized politically, majorities of people support taxing the rich, taking money out of politics, expanding Social Security and Medicare, labor unions, a path to citizenship for undocumented immigrants, abortion and reproductive rights, criminal justice reform, LGBTQ rights, and urgently addressing the climate crisis. These issues and their moral implications form the basis for broad unity against the Trump policies.
After past election defeats, people were demoralized for a time. Already thousands are taking to the streets, campuses, and online to show their opposition. It's an important first step in regaining voice, hope and determination to forge ahead.
"We cannot walk alone. And as we walk, we must make the pledge that we shall always march ahead. We cannot turn back," said Dr. King.
Many protests have been self-organized on social media, initiated by youth declaring, "We reject Trumpland and the dystopian future it has in store for us." Tens of thousands are wearing safety pins to declare their opposition to the Trump policies.
Defiance is taking place on a much larger scale, too. States, counties, and cities are assuring fearful residents, "We will oppose Trump. We stand for tolerance. We are a safe place for immigrants, Muslims, people of color, women and the LGBT community."
Several protests are being organized to coincide with the inauguration, including the Women's March on Washington on January 21. This protest grew out of Pantsuit Nation, a Facebook group that has grown to 3.7 million members.
No one will walk alone. And it will take tens of millions, the majority of Americans, to block the Trump agenda.
Broad all-people's unity: resistance, solidarity, and tolerance
This is a fight to defend democracy and humanity. Trump and everything he stands for must not be allowed to be seen in any way as normal or "just another GOP administration." This is a fight for the moral heart of the nation. Everything Trump and the GOP stand for is immoral and repugnant.
What is absolutely necessary now is building a united multi-class, multi-racial, multi-gender identity, multi-generational, interfaith movement of every organization, network, institution, and political persuasion in opposition to the Trump agenda, without condition.
Such a movement already starts with a mass base. Trump assumes office as the most reviled and deeply unpopular president in history. Over half the electorate voted against him.
Unity must be built with every conceivable ally – starting with the people's coalition led by labor, communities of color, the Civil Right Movement including #blacklivesmatter, climate justice, the immigrant rights movement, including the Dreamers, LGBTQ community, Muslims and Jewish Americans, women's equality organizations, and youth and students.
All these organizations, networks, and movements will have to work in alliance with the Democratic Party, including its corporate wing and all parts of what was the Hillary Clinton electoral coalition, including Hillary Clinton and Barack Obama, and those inspired by the Bernie Sanders campaign, particularly the millions of youth.
It will include those who sat on the sidelines during the elections or who voted for Green Party candidate Jill Stein and Libertarian candidate Gary Johnson.
At times and depending on the issue, it might include moderate Republicans and sections of the GOP establishment, former government officials, and independents. Because the GOP majority in the Senate has shrunk, some GOP senators may join with Democrats to oppose particular Trump policies.
It will embrace the interfaith religious community, including some currently influenced by right-wing fundamentalism. Catholic Bishops have already expressed their opposition to Trump's immigration policies.
It includes public schools, universities, and media – particularly independent media – who will be under attack. It is too early to tell if major corporate media will buckle under the Trump threats or the fear of losing access to the president and favorable regulatory decisions.
It includes artists, cultural performers, celebrities, and athletes. The weekend after the election, David Chappelle, a Tribe Called Quest and cast turned Saturday Night Live into a protest. And Jalen Rose said NBA players would likely boycott the White House as long as Trump is president, and many NBA teams have announced boycotts of Trump hotels.
It already includes governing entities and democratic institutions, entire states, counties, and municipalities. New York City, Los Angeles, Chicago, and San Francisco have reaffirmed their commitment as Sanctuary Cities and vowed not to cooperate with ICE, despite threats by Trump to cut funding.
They can become places of solidarity, tolerance, and resistance in defense of Muslims, immigrants, women, and unions while defending democracy and the path of sustainable development to reduce greenhouse gas emissions.
It will have to include millions who voted for Trump but who oppose Republican attacks on specific programs like Obamacare, Social Security, Medicare, Medicaid, reproductive rights, public school funding, and their unions and other mass organizations.
No one should be left standing on the sidelines. And assembling this powerful opposition will be the first step toward regrouping for the 2018 elections.
Grassroots action and initiative
Every organization and individual can play a vital role in building the movement to block Trump. Sectarian pressures to narrow the scope and scale of the movement must be resisted.
First, movements are arising spontaneously in response to Trump. Everyone can initiate or help build these grassroots responses on a neighborhood, city, and state level.
Secondly, help to build the labor-led people's coalition component of this united multi-class, multi-racial alliance. The multi-racial, multi-gender, multi-generational working class in alliance with communities of color, women, and youth should put their stamp on the broader united people's movement to defend democracy by pushing forward the issues and helping build its breadth and depth. We should assist in defending and building the labor movement, and all the democratic movements intersecting with it.
Thirdly, at the core of this is the fight for multi-racial, multi-gender unity, so deeply under assault by the white supremacists. Efforts should be redoubled to combat the racism, misogyny, xenophobia, homophobia, and Islamophobia that are aimed at splintering the working class and people.
Fourthly, the people's coalition led by labor should continue to advance a program of economic, democratic, and sustainable restructuring combined with addressing structural racial and gender inequity.
Fight and resist now!
Trump must be fought at every turn and in every arena. His agenda should be fought at every turn and in every arena: in the streets, the legislative, political, and electoral arenas and in the battle of ideas.
Without a broad and vigorous resistance from every conceivable sector on every conceivable front, descent further into authoritarianism or worse is possible. Without a fight, those who voted for Trump based on an appeal to white supremacy can be drawn into an organized and full blown white supremacist and fascist movement.
"When fascism comes to America, it will be wrapped in the flag and carrying a cross," goes a saying that is widely attributed to the first American to win the Nobel Prize for Literature, Sinclair Lewis. And we could add, its bearer will be a reality TV star.
We are guided by the words of the great Bulgarian Communist Georgi Dimitrov in his famous speech to the 7th World Congress of the Communist International in 1935:
"[B]efore the establishment of a fascist dictatorship, (capitalist) governments usually pass through a number of preliminary stages and adopt a number of reactionary measures which directly facilitate the accession to power of fascism. Whoever does not fight the reactionary measures of the (capitalists) and the growth of fascism at these preparatory stages is not in a position to prevent the victory of fascism, but, on the contrary, facilitates that victory."
Or as Dumbledore, the wise elderly headmaster of Hogwarts, warned, "It was important to fight, and fight again, and keep fighting, for only then could evil be kept at bay, though never quite eradicated."
Solidarity with targets and the most vulnerable
Students protesting Trump's election in Seattle on Nov. 19. | Elaine Thompson / AP
The Trump victory has emboldened the forces of bigotry and unleashed a wave of hate, harassment, and violence. There have already been over 900 reported incidents. This moment calls for an immediate and unambiguous response: not here, not now, not ever.
The scapegoating, discrimination, and violence against Muslims, immigrants, people of color, the LGBTQ community, women, unions, and other democratic organizations will only increase as the new administration seeks ways to divide the working class and people and ram through its reactionary policies.
It begins with extending solidarity to the immediate targets – beginning with Muslims and undocumented immigrants. An attack on one is an attack on all.
First they came for the Communists, and I did not speak out – Because I was not a Communist.
Then they came for the Trade Unionists, and I did not speak out – Because I was not a Trade Unionist.
Then they came for the Jews, and I did not speak out – Because I was not a Jew.
Then they came for me – and there was no one left to speak for me.
Muslims, immigrants, women, and the LGBTQ community are not the only ones at the point of attack. Mass organizations that form the bulwark against attacks on democratic rights – the entire organized labor movement and organizations like Planned Parenthood – are in the crosshairs.
Historic democratic gains including public education, the entire legislative and legal edifice of the New Deal, Great Society, Voting Rights, Civil Rights, Disability Rights, reproductive rights, and environmental rights are under assault. Basic constitutional rights are under assault along with violations of international law reauthorizing waterboarding and other forms of torture.
The ACLU stated of Trump's plans, "These proposals are not simply un-American and wrongheaded, they are unlawful and unconstitutional. They violate the First, Fourth, Fifth, Eighth, and Fourteenth Amendments."
Depending on how he separates himself from his business empire, Trump will enter office already violating the Emoluments Clause of the Constitution by accepting favors for his foreign investments and with foreign dignitaries staying at the opulent new Trump Hotel in Washington, D.C.
Defense of labor
The multi-racial, multi-gender identity, multi-generational, labor movement played a leading role in the electoral coalition backing Clinton. There is no doubt were it bigger she might have won. The labor movement was also the most effective organizer in the communities of white workers, dispelling lies and challenging the Trump demagogy.
But the labor movement has been crippled and in some cases decimated through plant closings, layoffs, and anti-labor legislation in key Midwest battleground states won by Trump, especially Michigan, Wisconsin, Ohio, and Pennsylvania.
A central and strategic aim of this administration will be the destruction of the labor movement. They will draw on Republican success at the state level to pass a national right-to-work law and attempt to destroy public sector unions.
Trump's proposed $1 trillion infrastructure bill may be used to split the labor movement and consolidate his support, while rewarding investors through privatization of projects. We join with labor to insist workers be paid prevailing wages, the work be done by union members, and affirmative action guidelines implemented. There should be no privatization of finished projects.
Engaging with Trump voters; exposing the GOP
Trump won among white voters across the board and these voters must be engaged in cities, suburbs, small cities, rural areas, "red states," and "red districts".
There is no avoiding engaging and winning these voters if Trump and the right wing are to be defeated and social progress achieved. They too will feel the lash.
This requires building movements and coalitions, including the electoral coalition that works in and with the Democratic Party, on the ground in such places to oppose the assault on Social Security, Medicare, healthcare, etc. – winning people on the basis of self-interest, common destiny, and morality.
It means ramping up engagement in the "battle of ideas" through expanding the reach of the People's Worldand independent progressive mass media to millions now getting their news and information from right-wing media sources.
Trump has brought the most extreme political forces from the political fringes into the mainstream and into the White House. GOP elected officials are normalizing the existence of these forces at the center of government as they stumble in line behind Trump. They are getting an assist from sections of the corporate mass media that are treating this like a normal conservative GOP administration.
Contrary to his claims though, Trump is no anti-establishment outsider. Right-wing billionaires, the Heritage Foundation, and corporate lobbyists back him. They will stock his cabinet and are providing policy blueprints and lists of names to stack departments and the judiciary at all levels.
The authoritarianism and corruption of this new regime will deepen the inherent crises and contradictions of capitalism, between society and nature, and the existential crisis the planet faces due to climate change.
Trump arose amidst the divisions within the GOP. As Dimitrov noted, "In reality, fascism usually comes to power in the course of a mutual, and at times severe, struggle against the old bourgeois parties, or a definite section of these parties."
Authoritarian regimes are historically unstable and characterized by infighting, jockeying for the leader's ear, corruption, enemies lists, and ruthless retribution. We are seeing that all play out in the Trump transition.
This administration will have features of both a kleptocracy (rule by thieves) and a kakistocracy (a form of government in which the worst and least qualified persons are in power). These forces now have full access to the state security apparatus, which they also utilized during the campaign by colluding with right-wing rogue elements in the FBI.
They will govern the way they campaigned – through division, fear, and intimidation. This is the meaning of the appointment of the white supremacist, anti-Semite, and former CEO of Breitbart News, Steve Bannon as White House chief strategist.
Breitbart News, the mouthpiece of the so-called alt-right, a white supremacist movement, will be a de facto state mass communication arm of the Trump presidency – its ministry of information, marshaling supporters and attacking opponents.
During the administration of Pres. George W. Bush, the neo-cons arrogantly declared, "We create our own reality." They were in for a rude awakening.
Trump will also confront new global and climate realities, economic integration, regional trade pacts, treaties, and alliances. In today's world, the U.S. is a descending power and China and other countries are ascending powers. In addition to the domestic resistance movement, these will all act as countervailing forces to his unfolding policies.
The American people face difficult and ugly days ahead. The ferocity of the attack and suffering will be enormous, but the fight against it will stir hearts too. With unity, solidarity, and steadfastness, the Trump menace can and will be defeated.
The second part of this report will be published in People's Worldsoon.
Blog: Eastern Panhandle Independent Community (EPIC) Radio Post: Labor Beat on EPIC Radio -- Dec 1, 2016 Link: http://www.enlightenradio.org/2016/12/labor-beat-on-epic-radio-dec-1-2016.html
