The prospects for single-payer health care — adored by many liberals, despised by private health insurers and looking better all the time to others — did not die in the Affordable Care Act. It was thrown a lifeline through a little-known provision tucked in the famously long legislation. Single-payer groups in several states are now lining up to make use of Section 1332.
Vermont is way ahead of the pack, but Hawaii, Oregon, New York, Washington, California, Colorado and Maryland have strong single-payer movements.
First, some definitions. Single-payer is a system where the government pays all medical bills. Canada has a single-payer system. By the way, Canada's system is not socialized medicine but socialized insurance (like Medicare). In Canada, the doctors work for themselves.
Under Section 1332, states may apply for "innovation waivers" starting in 2017. They would let states try paths to health care reform different from those mapped out by the Affordable Care Act — as long as they meet certain of its goals. States must cover as many people and offer coverage as comprehensive and affordable. And they can't increase the federal deficit. Qualifying states would receive the same federal funding that would have been available under Obamacare.
My conservative friends complain that the innovation waiver requirements would rule out everything but single-payer. No doubt they are diligently working on a more privatized alternative that would cover less, cost more and raise the federal deficit.
"Vermont is the only state where they're thinking very concretely about using (the waiver) as part of their plan," Judy Solomon, health care expert at the Center on Budget and Policy Priorities, told me.
Hawaii got close. Its Legislature passed a single-payer bill in 2009, which was vetoed by then-Gov. Linda Lingle, a Republican. Lawmakers overrode the veto, but Lingle refused to implement the law.
The quest remains rocky, Dr. Stephen Kemble, a single-payer advocate and past president of the Hawaii Medical Association, told me. "If Vermont can get things going, that would make things easier for others."
In Washington state, "our focus is to work on grass-roots support," says Dr. David McLanahan, Washington coordinator for Physicians for a National Health Program. "We're laying the groundwork" for legislation and a request for an innovation waiver.
Problems in the Obamacare rollout have energized fans of single-payer. Computer glitches aside, the troubles stem chiefly from the law's complexity. Single-payer is all about simplicity.
Under the Vermont plan, employers and individuals would no longer have to buy private health coverage. They would instead pay a tax. The state-run system would also cover more things, like dental. And oh, yes, Vermonters could choose their hospitals and doctors.
William Hsiao, an economist at the Harvard School of Public Health, has projected that Vermont's annual health care spending could fall 25 percent. The savings would more than pay for the new benefits.
How? Fewer dollars would go to advertising, executive windfalls and payouts to investors. Doctors dealing with one insurer would save on office staff. Fraud and abuse would shrink as a comprehensive database makes crooks easier to spot.
It's too bad that some liberals have turned single-payer into a religion and are whacking the Vermont plan for not being pure enough. Vermont is permitting continued private coverage for very practical reasons. Bear in mind that the most acclaimed health care systems — in Germany, in France and our Medicare — combine single-payer for basics with private coverage for the extras.
Vermont intends to use its state health insurance exchange as the structure on which to build its single-payer system. By 2017, the road to an innovation waiver should be clear. Go forth, Green Mountain State. Show us what you can do.
(A member of the Providence Journal editorial board, Froma Harrop writes a nationally syndicated column from that city. She has written for such diverse publications as The New York Times, Harper's Bazaar and Institutional Investor.)
Last Updated on Wednesday, 31 December 1969 07:00
In the wars she has fought, America has often allied with regimes that represented the antithesis of the cause for which we were fighting.
In our Revolutionary War for freedom and independence from the tyrant King of England, our indispensable ally was the King of France.
In World War I, Woodrow Wilson said we were fighting to "make the world safe for democracy." Yet our foremost allies were five avaricious empires: the British, French, Italian, Japanese and Russian.
In World War II, the ally who did most of the fighting against Hitler was Josef Stalin.
Enough said. In America's wars, cold and hot, the enemy of our enemy has often been our ally, if not our friend.
And that is the question of the hour in the Middle East. The region seems to be descending step by step into a war of all against all. And at its heart is the civil-sectarian war to overthrow the Syrian Alawite regime of Bashar Assad. Now that war has spilled over into Lebanon and Iraq. And in Syria and Iraq our principal enemies are the jihadists of the al-Nusra Front and ISIS, the Islamic State of Syria and the Levant.
Implacably anti-American, these Islamist fighters control enclaves in northern Syria and appear to have captured Fallujah and perhaps Ramadi, crucial cities of Iraq's Anbar province for which hundreds of Americans died. And who are the foremost fighting foes of the Nusra Front and ISIS? In Syria it is Bashar al Assad, whom Obama said two years ago must leave, and a Syrian army, which Obama was about to attack in August, until the American people rose up to tell him to stay out.
Who are Assad's allies against the al Nusra Front and ISIS? Vladimir Putin's Russia, Iran, and Hezbollah whose forces helped turn the tide back last year against the rebels.
In Iraq and Syria, al-Qaida jihadists and Sunni terrorists, our enemies, are also the enemies of Iran, Hezbollah and Assad. Indeed, Iran has offered to join us in sending military assistance to Baghdad in its fight against the al-Qaida-backed rebellion in Anbar.
Yet, there are other vantage points from which this widening war is being seen, and one is Riyadh. While Saudi Arabia has come to recognize the menace of ISIS and sent aid to rival rebel factions in Syria, the larger and longer-term threat Riyadh sees is Tehran. And understandably so. Saudi Arabia is the Sunni and Arab power in the Persian Gulf. But Shia and Persian Iran is almost twice as populous and at the heart of a Shia Crescent of Iran, Iraq, Syria and Hezbollah. Moreover, Riyadh in 2013 saw her superpower patron, America, back away from an attack on Syria, negotiate in secret with Iran, and begin talks with the Ayatollah's regime on limitations to its nuclear program — in return for a lifting of U.S. sanctions. To the Saudis, what appears to be an emerging detente between Tehran and Washington looms as a strategic disaster.
From Israel's vantage point, the overthrow of Assad would mean the isolation of Hezbollah, which would no longer receive weapons from a Syrian regime that Hezbollah had fought to keep out of power.
But what about America's point of view? "Sooner or later," The Washington Post writes, "the United States will have to face the threat to its vital interests emerging across the Levant." But, with due respect, there are no U.S. "vital interests" in the Levant. For the first 150 years of our existence as a nation, the Levant was ruled by Ottoman Turks, and then by the British and the French under the Sykes-Picot Agreement of 1916. What difference did it make to us who ruled Damascus or Beirut?
The vital interest America has in that region is to keep the oil flowing out of the Gulf, upon which the global economy depends.
While a victory for the rebels might fit well with the agendas of Riyadh and Tel Aviv, it might also mean a massacre of Alawites and a mass exodus of Christians. At best, it would bring about a regime along the lines of the Muslim Brotherhood government that lately ruled in Cairo. At worst, it could bring to power a regime dominated by Sunni jihadists.
The greatest threat to U.S. interests there is not autocrats, Sunni or Shia, interested in getting rich, but radicals with the mindset of suicide bombers taking over a state and spreading revolution down the Gulf.
War is the clear and present danger, and peace the necessary condition of securing those interests.
The defeat of ISIS in Anbar and Syria and peace in the region should be our primary goal. And if Iran is willing to assist Damascus and Baghdad in defeating al-Qaida, Iran should be treated as a temporary ally in a common cause. After all, FDR and Truman got on famously with "good old Joe" Stalin.
(Syndicated columnist Pat Buchanan has been a senior advisor to three presidents, twice a candidate for the Republican presidential nomination and the presidential nominee of the Reform Party in 2000. He won the New Hampshire Republican Primary in 1996.)
Last Updated on Monday, 13 January 2014 10:38
My wishfully thinking Democratic friends are hoping that Bridgegate will sink the presidential ambitions of "frontrunner" Chris Christie, the New Jersey governor whose independent streak and straight-talking authenticity have earned him the mostly meaningless crown three years out.
In case you've been under a rock, Bridgegate is the mean bit of New Jersey politics in which the Democratic mayor of the town of Fort Lee was "punished" for not endorsing the Republican governor for re-election with crippling traffic jams on the George Washington Bridge on the first day of school. The governor had denied any political motivation or any involvement at all in the closures. Turns out one of his top aides e-mailed one of his top allies to teach the mayor a lesson. Scandal No. 1 of campaign 2016.
Presidential politics looks easy until you try it.
Better now than in 2016.
Bridgegate is the sort of scandal that could kill you if it were timed right. Christie is a candidate whose strengths and weaknesses are opposite sides of a fine line. People like the fact that he is a down-to-earth tough guy who takes charge, which is just a short jump away from being a Jersey boss who has to control — and win — everything. Authentic is good. So Christie has a temper. That makes him real. Until it makes him mean.
Luckily for Christie, it's 2014, and so far, he's done everything right, according to the playbook for handling political scandals. He's apologized and fired the supposedly responsible party; he'll cooperate with the investigation; he is suitably shocked and chagrined. It might all just go away as long as there are no e-mails or text messages that suggest he knew what he claims he didn't know (in which case, his denial is a dangerous tack and not a smart one).
But the press will be looking for "more" like this. Expect to read more about that traffic stop during which he supposedly threw his weight around when he was a U.S. Attorney. It didn't work when his Democratic opponent Jon Corzine used it in an anti-Christie ad, but it surely will be part of the developing narrative of Christie as the arrogant and power-abusing New Jersey boss. Was he a bully in junior high? Trust me, we'll find out.
To be sure, Christie is no Herman Cain. Not as funny. Also, he's run twice in a big state. But the second time was a cakewalk, and the first time, his opponent was in an uphill fight, to say the least. Christie has never had a really tough race, and he's certainly never felt the hot lights of presidential scrutiny, much less the rigors of 24/7 coverage of your every move and mistake in an era in which anyone over 5-years-old knows how to make a video. Politics has never been harder. There are no freebies anymore.
So, for those of us watching, it should be interesting, if not fun. Christie is a smart guy, and presumably, so are those around him. But almost no one is as smart as they should be when it comes to e-mail and texting.
I sometimes do a presentation for my clients where I hold up an ancient piece of technology — a telephone — and commend its use. People say things in e-mails and texts that they would say around a water cooler, but there are no cameras and recorders at the water cooler. E-mail is forever. It has the potential to do to candidates what it has done to any number of white-collar defendants. The old days when you could deny a true story and it might go away are over.
So Christie's first scandal has a message and a warning: The lights are on. Be careful what you write — or wrote.
(Susan Estrich is a professor of Law and Political Science at the University of Southern California Law Center. A best-selling author, lawyer and politician, as well as a teacher, she first gained national prominence as national campaign manager for Dukakis for President in 1988.)
Last Updated on Wednesday, 31 December 1969 07:00
What a Christmas little Bastrop had! It's still a mystery how Santa Claus got it down the chimney, but Bastrop got a nifty present that most children could only dream about: a big honkin', steel-clad, war toy called MRAP.
But Bastrop is not a 6-year-old child, and an MRAP is not a toy. Bastrop is a Texas county of some 75,000 people, and MRAP stands for "Mine-Resistant Ambush Protected." It's a heavily armored military vehicle weighing about 15 tons — one of several versions of fighting machines that have become the hot, must-have playthings of police departments all across the country.
Are the good people of Bastrop facing some imminent terrorist threat that warrants military equipment? No, it's a very pleasant, laid-back place. And while the county is named for a 19th century land developer and accused embezzler, it's never been a haven for particularly dangerous criminals — indeed, the relatively few crimes in Bastrop today don't rise above the level of routine police work.
Even the sheriff's department, which is the proud owner of the MRAP tank, says it doesn't have a specific use for the machine, but "It's here if we need it." Well, yeah ... but that same feeble rational would apply if the county decided to get an atom bomb — you just never know when a big mushroom cloud might come in handy!
What we have here is the absurdly dangerous militarization of America's police departments. Our sprawling Department of Homeland Security and the Pentagon (which gave the MRAP to Bastrop) are haphazardly spreading war equipment, war techniques and a war mentality to what are supposed to be our communities' peacekeepers and crime solvers.
Having the technology and mindset for military actions, local authorities will find excuses to substitute them for honest police work, turning common citizens into "enemies." As a spokesman for the Bastrop sheriff's department said of the MRAP, "With today's society ... there's no way the thing won't be used." How comforting is that?
But now, let's turn from the battlefield to the gridiron.
In the ever-escalating competition to be the No. 1 big-time college football program in the nation, Ohio State University bulked up last fall with a monster recruit named Maxx. Actually, it's not the coaching staff that signed up this brute, but the OSU campus police department. And the recruit's full name is MaxxPro — not a player, but a 19-ton armored fighting vehicle built by a pentagon contractor to withstand "ballistic arms fire, mine fields, IEDs, and Nuclear, Biological and Chemical environments." Wow, college games really have gotten rough!
But the campus PD, which received the MaxxPro as a gift from the Pentagon (ie, us taxpayers), says it's not just playing games, but deploying Maxx for things like hostage scenarios, killers loose on campus, and extreme flooding of up to three feet. Well, have such things been a problem at OSU? Uh ... no. Would a huge, slow, gas-guzzling vehicle designed for warfare be effective if any of the above were actually to occur? No response.
Oh, by the way, operating these machines requires specially trained personnel — is anyone in the department qualified? Again, no answer. Also, the vehicles are subject to frequent rollovers, and they lack the ability to go off-road or to maneuver in confined areas. That doesn't sound ideal for a college campus. Not to worry, though, for the gendarmes said they were adjusting Maxx to fit their needs. How? Removing the top gun turret and repainting the vehicle.
OSU police finally admitted that Maxx would mostly be used to drive them around campus and provide a police "presence" on football game days. Great — police authorities now believe they need a show of military force to keep tailgaters in check.
(Jim Hightower has been called American's most popular populist. The radio commentator and former Texas Commissioner of Agriculture is author of seven books, including "There's Nothing In the Middle of Road but Yellow Stripes and Dead Armadillos" and his new work, "Swim Against the Current: Even Dead Fish Can Go With The Flow".)
Last Updated on Wednesday, 31 December 1969 07:00
From the time we were youngsters, we have heard the phrase, "Ring out the old, and ring in the new". But, as John Kerry might say, were that it were true. The reality of life is that we simply cannot dispose of our problems with one tick of the clock. If we had problems at 11:59 p.m. on December 31, 2013, it's a pretty safe bet those same problems were with us at 12:00 Midnight, on January 1, 2014. By the same token, the good things that we enjoy in life are generally on the same time schedule. But that doesn't mean we can't change and rid ourselves of some of those problems, or that we can't retain that which is good. It's not magic . . . it's attitude, that makes the difference.
As I've mentioned before, the essence of management is preventing things from happening that you don't want to happen. Determining those things that might possibly upset your plan(s), and taking steps to prevent them, can be the key to achieving the good things you want. To be sure, that's easier said than done. While we can all try to eat healthy, not overindulge, exercise, and do all that's recommended, that may not prevent us from coming down with some affliction. That shouldn't stop us from trying though, because having done the right things might help in avoiding or overcoming an illness. The key is to try and determine what we need to do to prevent the unwanted things from happening.
It doesn't matter if we're talking about our personal life, or a business, or our government. The same principles can be applied. For example, what follows are some of the things our elected leaders should be concerned about, because they are things that we don't want to happen. So, what kind of plans does our government have to ensure these type of things don't occur. What if . . .
— China decides to invade Taiwan. We have had a mutual defense treaty with Taiwan since they broke away from Communist China. Do we honor our treaty or do we not, thereby nullifying virtually all of our treaties.
— Iran thumbs its nose at our lifting of sanctions and continues to enrich plutonium and gets closer to building an atomic weapon. Do we take decisive action or do we sit idly by as Israel does what is necessary to protect itself? And, do we fully and forcefully support our ally, Israel?
— The unspoken of war between the Sunni and Shia Muslims becomes open warfare as the Saudis and Iranis take aim at each other. Do we intervene? If so, which side do we ally with? And, if so, do we know how the other Muslim countries that are in various stages of civil war are going to align themselves?
— If the above happens, who is going to protect and keep open the Suez Canal? What are the consequences of a virtual shutdown of the Middle-East's oil supply? It's impact on China? The U.S.? The middle east itself? And the environment?
— Russia has vast oil and gas reserves and is Europe's basic supplier. What if Russia uses the Mid-East wars to exert dominance over most of Europe by turning its fuel provisioning on and off at its whim, leaving Europe virtually frozen, with no place to turn?
— Canada, tires of our political gamesmanship concerning the Keystone pipeline extension, and decides to build their own pipeline westward to Vancouver and the Pacific Ocean so that they can sell their oil to China? What does that do to our neighborly relationship . . . and our lost jobs, and the commerce that goes with our being the depot for that oil?
— The IRS keeps targeting citizens or groups because of their political views? After over a year, do we know what steps have been or are being taken to ensure that never happens again? Do we even know if anything has changed?
— Cabinet level people continue to lie to Congressional oversight committees? To date, that has happened repeatedly with no apparent consequence to any of the perjurers. What steps have been or are being taken to ensure that the department charged with enforcing the laws, does so with honesty and integrity?
— The Federal Reserve pulls back on its "quantitative easing" (the pumping of $88 billion per month, or roughly $1 trillion per year of "free money" into banks and financial institutions), possibly causing the inflated stock market to tumble? Or, conversely, what if the Federal Reserve continues its program thereby causing the value of the dollar to continue shrinking? Does anyone know how much interest people have already lost on their bank CDs and IRAs because of the quantitative easing? That easing caused banks to pay their customers/savers little or no interest, essentially making we the people compete with the free money the banks have been receiving from the Federal Reserve.
How much confidence do you have that we have solid plans in place to address these and countless other things that we don't want to happen?
(Bob Meade is a Laconia resident.)
Last Updated on Wednesday, 31 December 1969 07:00