Death By a Thousand Tweaks

The New York Times headline "Biden Administration Restores Rights of Transgender Patients" is not only misleading, it deflects attention from the overarching reality that the richest country on earth still does not provide guaranteed, single-payer health care to every single one of its citizens, regardless of race, color, creed, gender or sexual orientation. Even in the middle of a deadly pandemic, tens of millions of Americans are still forgoing care because of costs, or getting sued for their inability to pay for it because they either have inadequate insurance or no insurance at all. 

Moreover, the Health and Human Services Department's reversal of a Trump-era rule which had given health care providers the option to deny care to transgender people without fear of losing federal funding for their businesses paradoxically continues to punish this population by making them prove to the government's satisfaction that any denial of care is based solely upon their existence as transgender people. Since no other group of people is similarly required to submit evidence regarding denial of medical care, the Biden administration's restoration of their rights to "access" is punitive in and of itself. It might be said to deprive these patients of their rights by forcing them to jump through hoops that no other population group is ever forced to jump through to prove that their rights were, in fact, violated.

Rather than issuing a warning salvo to care-denying providers, the Biden administration is initially placing the onus directly on victims, merely "encouraging" affected patients to file complaints. Prosecution of bad actors, such as insurance providers, under existing civil rights laws is not guaranteed. Medical or surgical treatment for transgender people is not guaranteed, nor is monetary relief.

The verbal and ostentatious bestowal of "access" rights upon transgender patients is just one more example of the government nibbling around the edges of a massive social problem rather than addressing the problem in its entirety. They may just as well have declared "We feel your pain" for all the lack of urgency and remedies that the announcement entails.

The rule reversal and possible amendments to the law are - whether wittingly or not -  guaranteed to further inflame and perpetuate the "culture wars" which have become the centerpieces of modern political campaigns and legislative battles whose lack of any concrete policy solutions is guaranteed to please nobody. Conservatives and religious groups will howl on and on about government overreach and tyranny, while liberals will self-righteously defend "science" and make the interests of the oppressed group du jour the be-all and end-all of their artificially narrow discourse. 

These cultural provocations are, in fact, built right into the pathologically bloated Patient Protection and Affordable Care Act, one arcane section of which presumes to address health care rights. But for all its heft, it does not address them specifically enough, because the Biden administration will now have to spend all of its precious health reform capital on further "tweaking" the unnecessarily convoluted law, and enraging religious zealots and Trump cultists in the process.  Perhaps most importantly, it's a nifty way to delay discussing Bernie Sanders's own watered-down drive to "expand Medicare." 

From the New York Times article on the verbal restoration of transgender health rights:

Biden administration officials said they were working to write more complete new regulations on the civil rights provision of the law, known as Section 1557, that will specify which health care institutions are subject to the rules and what sorts of services they will be required to provide.

"We do anticipate engaging in further rule-making," said Robinsue Froheoese, the acting director of the Office of Civil Rights. She said the administration did not have a timeline for when a formal regulatory change would be announced. A formal rule will require reconsideration of a number of legal questions, such as whether the provisions apply to health insurers as well as health care providers. The Obama administration and the Trump administration also disagreed about whether the law's sex discrimination  language encompassed the treatment of patients who had had abortions.

Of course, transgender people could avoid being scapegoated and co-opted in the latest iteration of the culture war method of governing if the language of the ACA were simpler. For example, when the National Health Service law was enacted in England and Wales in 1948, every citizen received the following succinct letter from the ministry of health:

It will provide you with all medical, dental and nursing care. Everyone - rich or poor, man, woman or child - can use any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a "charity." You are all paying for it. mainly as taxpayers, and it will relieve your money worries in times of illness.

Contrast that to the kludge of arcane minutiae and wishy-washiness that is the "Affordable" Care Act, which in its nearly one thousand pages (and tweakily counting) had already incorporated the word "waiver" 214  times in the original bill. This number does not include the various state waivers, many of which were implemented during the Trump years and which themselves will require further tweaking by Joe Biden. The law is a document of death by a thousand tweaks and a thousand deliberately manufactured potholes in the road to the single payer system supported by seven out of 10 Americans.

 It is also a massive blank check subsidizing private health insurers and other profiteers to the tune of billions and billions of dollars.

Can you imagine what would have happened to the 1935 Social Security Act if it had contained a thousand pages, rather than 37?

Rather than protecting transgender patients, the ACA itself is a loaded weapon which places them smack-dab in the middle of the culture wars crossfire.  Trans teens, already vulnerable and prone to self-harm and even suicide, are being targeted in ten states by reactionary legislatures which have directly barred providers from administering hormone therapy and other care.

If we had a single payer program that guaranteed care for everybody, trans people would not only be provided with necessary treatment, they would be saved from the additional trauma of politicians either demonizing them or deliberately delaying justice for them as they tweak their timelines, in the process merrily co-opting them as pawns in their identity politics game of thrones.

*******

*Update, 5/12: I'd like to make clear that in no way am I advocating any sort of therapy, including gender reassignment surgery. Those are medical issues that I am not qualified to discuss. The point of my post was to critique the "identity politicization" of this particular medical issue by the usual suspects in the Duopoly. The Biden administration seems to be trying to score more points with the liberal class, co-opting the trans population as a way to differentiate itself from the extreme right wing of the GOP, which is demonizing trans people from many different angles, including the bathroom controversy. I found the White House's self-congratulatory bestowal of medical rights on trans people to be just another smug way to both virtue-signal and dump on Trump. I also found it hypocritical in the extreme, given Biden's abandonment even of the public option in health insurance, thus breaking one of his campaign promises. He is only playing a progressive on TV; his statement that health care is a basic human right is a lie, and his co-optation of vulnerable people, many of whom are already traumatized enough, in order to score political points, is pretty damned gross. In my opinion, of course.

Hope that clears things up.

Corporatists Behaving Badly

Let me get this straight. House Speaker Nancy Pelosi and Trump Treasury Secretary Steve Mnuchin have miraculously just come to a silky-smooth bipartisan budget agreement that rips the feathers right off the deficit hawks and kills the Obama-era Sequester and fake debt ceiling crises all in one swoop.

The catch is that the debt ceiling truce is only for two years. So if a Democrat wins the White House and the GOP holds the Senate, it will be back to deficit hawkery as a bipartisan weapon to kill any possible resurgence of the New Deal.

Meanwhile, Trump is happy because the deal protects the war machine and "our veterans" and contains no poison pills that would nauseate rich people. The Democrats will not interfere with his border wall, and the Hyde Amendment prohibiting federal funding for abortions will remain. Pelosi is happy because the deal "will enhance our national security and invest in middle class priorities that advance the health, financial security and well-being of the American people."

But Trump being Trump, it is entirely possible that he'll ultimately refuse to sign it no matter how much he praises it today. And Pelosi being Pelosi, she utters not one single word about helping the tens of millions of people now living in abject poverty in the United States. Bare survival priorities, such as food and shelter, are not the same thing as middle class priorities, which might include such things as somewhat more affordable prescription drugs and protecting our right to purchase expensive health insurance on the predatory marketplace.

Before we celebrate, therefore, we need to read the fine print in this proposed budget deal. Because whenever politicians "reach across the aisle" in one of those rare bipartisan moments of good feeling, we ordinary people must steel ourselves for the blows that are sure to come. The very fact that the deal was reached so secretly and so hastily and that it must be voted on before the artificial deadline of the Congressional summer recess, is our first clue that bipartisanship is the exact opposite of social and economic justice. This deal must go through before anybody even has a chance to read it.

That's how many poison pills for struggling people and how many gifts to the oligarchs that this package undoubtedly contains.

Take the issue of the nation's community health centers, which deal or no deal, appeared to be very much on the bipartisan chopping block as recently as last week. These centers, which serve the poor, are therefore conveniently and cynically exempt from Pelosi's "middle class priorities."

The Democratic lawmakers proposing the cuts frame their cruelty in the usual way: in order to be kind and save the poor, they have no choice but to punish and sacrifice the poor, because otherwise the Republican hostage takers will beat the poor into a bloody dead pulp.

As reported by the Washington Post,

Rep. Frank Pallone Jr. (D-N.J.), chair of the House Energy and Commerce Committee, is pushing a bipartisan plan that would provide flat levels of federal funding for hundreds of community health centers nationwide, at about $4 billion for the next four years. A similar plan is advancing in the Senate with the support of Sen. Patty Murray (D-Wash.), the top Democrat on the Health, Education, Labor and Pensions committee.
Lawmakers face a September deadline for the community health centers, after which their funding would begin to expire, likely leading to steep cuts.Pallone said the plan would provide the security of the longest guaranteed funding commitment ever secured by the clinics, averting the September cliff. But flat funding would not keep pace with medical inflation, likely forcing the community health centers to serve about 4 million fewer people annually by 2023 than they do now, said Leighton Ku, professor of health policy at George Washington University’s Milken Institute School of Public Health.
That prospect has alarmed liberal lawmakers including Sen. Bernie Sanders (I-Vt.), Rep. Ro Khanna (D-Calif.), Rep. Alexandria Ocasio-Cortez (D-N.Y.), and Rep. Pramila Jayapal (D-Wash.), co-chair of the congressional Progressive Caucus. They argue Democrats should use their control of the House to approve increases in funding for the centers, and then hammer out an agreement with Senate Republicans.
“I was, quite honestly, stunned. It’s just absolutely disastrous, and moving in the wrong direction,” said Sanders, a 2020 presidential candidate, in an interview. “We should be substantially increasing funding. I was very, very disappointed by Democratic leadership … We will do everything we can to rectify this.”

We still don't know if the TrumPelosi Manifesto contains the bait and switch method of reducing health care for the poor, or whether it's a side-deal negotiated apart from the budget agreement.

It is also quite telling that Trump waited until right after the budget agreement was announced to reveal plans to kick three million people off their food stamp benefits. In so doing, he gives credence to Pelosi's limited boast of protecting the financial interests of the "middle class" -- or those living above the poverty levels necessary to qualify for government nutrition assistance.

And speaking of bait and switch, the fact that Bernie Sanders is still going strong, and is even finally getting more refreshingly blunt about such corporate tools as Joe Biden, has finally elicited the full-blown hysteria of New York Times pundit Paul Krugman, who'd so far this campaign season kept his storied anti-Bernie powder dry, mainly by studiously ignoring Bernie Sanders.

Not any more. In a transparently bad-faith "both sides do it" column, ironically subtitled "A Bad Faith Debate Over Health Care Coverage," Krugman hilariously equates Biden's mendacity with Bernie's exposure of his mendacity.

But right now, two of the major contenders for the Democratic presidential nomination, Joe Biden and Bernie Sanders, are having an ugly argument about health care that could hurt the party’s chances. There are real, important differences between the two men’s policy proposals, and it’s fine to point that out. What’s not fine is the name-calling and false assertions. Both men are behaving badly. And for their party’s sake, and their country’s, they need to stop it.

Notwithstanding that Krugman cannot point to one single example of Sanders calling Biden any bad names or lying (because he hasn't) the accusation is simply cover for his main point: he doesn't want Medicare For All to be a platform in the presidential campaign, even though he likes Single Payer "in theory". The column is all of a piece with the centrist, or corporate wing of the party, striving to please its deep-pocketed donors at the expense of everybody else. The message is this: you can get rid of Trump, or you can clamor for things that will make your lives better. But you cannot do both. Supporting Medicare For All is the same thing as giving Trump another term. Therefore, everybody please shut up about your damned health. And that includes the 70-80 percent of you in favor of Medicare For All. You're nothing but a distraction.

Also, now that Pelosi's attempted diminution of the "Squad's" championship of single payer health care has spectacularly backfired, the corporate party and its pundits need a new scapegoat with which to undermine Single Payer, even as they pretend to embrace the dark-hued female members as a means of combating Trump's racism.  Bernie Sanders, an old white guy, fits their bill perfectly. A Democratic legal pundit who hilariously calls herself a "moderate" can even go on MSNBC and complain that he "makes my skin crawl and I don't know why" with no consequence whatsoever.

Here's my published response to Krugman, in which I refused to take his slimy personality-politics bait, but instead tried to address the centrist groupthink propaganda that he so shamelessly parrots:

Whenever you hear universal coverage defined as everyone having "access" to "affordable" health care, beware of the bait and switch.

 Access to care is not the same thing as guaranteed care. Calling a trip to the doctor or emergency room "affordable" is glib to the point of cruelty, given that the majority of Americans don't even have $500 in savings.

The standard talking point that "folks" will never accept a Single Payer program because they are loath to give up their wonderful employer-based plans is also pretty cynical. Employers not only change plans regularly, they are increasingly passing the costs of overpriced plans with less coverage along to their workers.

If people are afraid of Medicare For All, it's mainly because our rulers and their corporate media stenographers, beholden to the insurance cartel and Big Pharma and their Wall Street investors, are making sure they stay very afraid of it. It's obviously not in their job descriptions to educate people and inform them that the taxes for Single Payer will be far, far lower than what they now pay to the predatory health care marketplace, with the continued risk that they can go bankrupt if they get hurt or sick.

 Once Single Payer is passed, and the profit motive goes out of health care, it will be repeal-proof. It will be as popular as Medicare For Some is right now. That's what has the wealthy donor class shaking in their custom-made shoes: the prospect of too many people becoming healthy and less stressed.

Profiles In Ruling Class Chutzpah

The media-political complex is all abuzz that multimillionaire heiress and Boeing director Caroline Kennedy has named multimillionaire House Speaker Nancy Pelosi the latest winner of the Camelot Dynasty's Profiles in Courage award. 

It's A Club & You Ain't In It

Pelosi is specifically being honored for ramming the Affordable Care Act through Congress in 2010 and tacitly being honored for boldly going against the wishes of 70 percent of the US population by actively thwarting a true universal, single payer health care bill to replace it.

Multimillionaire former President Barack Obama, 2017's Kennedy prize winner, traveled all the way to Germany over the weekend in order to scold what he called American health care "purists" who have the crazy nerve to challenge the status quo. He called the current battle between Congressional centrists, like Pelosi, and progressives like Alexandria Ocasio-Cortez and Pramila Jayapal a "circular firing squad."

Winners Take All

This is a deliberate mischaracterization on Obama's part, because the centrists are the ones with the giant guns and the big corporate money, and the progressives are the underdogs with the $27 individual donations and the verbal slingshots. These two intraparty factions are as unequal as society itself. Obama refused to admit that the Circular Firing Squad within the Democratic Party is, in fact, a microcosm of the eternal Class War of the rich against the poor and working class. He instead framed the health insurance debate as a bunch of reckless extremists who unfairly attack the good, the rich, the wise, and the powerful.

Both of our establishment political parties and the transnational oligarchs who own and control them are scared to death of the social democracy and working class revolts now on the ascendant, global movements which threaten to undo 50 years of punitive austerity for the masses and record riches for themselves.

Obama made his latest antisocial remarks in Germany during a fund-raising "town hall" to benefit his own philanthrocapitalist foundation, so as not to be seen as directly interfering with party politics within the confines of the contiguous United States. He had previously met behind closed doors with Congressional freshmen to warn them against Medicare for All and to confront them with the usual "how you gonna pay for it!" bullying tactics. With a reported net worth now in the $100 million range only two years after leaving office, he made it abundantly clear that he and other wealthy people do not want to be taxed one more penny for the greater public good.

Of course, he put it a bit more delicately than that at his Berlin town hall:

“One of the things I do worry about sometimes among progressives in the United States — maybe it’s true here as well — is a certain kind of rigidity where we say, ‘Oh, I’m sorry, this is how it’s going to be,’” Obama said. “And then we start sometimes creating what’s called a ‘circular firing squad’ where you start shooting at your allies because one of them is straying from purity on the issues.”
The former president said he believes this approach “weakens” movements, and that those that would like to see a progressive agenda “have to recognize that the way we’ve structured democracy requires you to take into account people who don’t agree with you.”

Notice how he cagily redefines "circular firing squad" as a one-sided attack by progressives against the neoliberal centrists, and how it is not the rich and the privileged side straying from our "structured democracy," but the poor and the indebted. The only weakening he fears is that of the corporate Democratic Party itself, which like any political party, exists mainly to win and adhere to power. In Obama's world, it is not Nancy Pelosi who's the shooter and the bully: it's the progressives representing the interests of the struggling majority.

Only an entitled plutocrat could call the widespread demand by the US citizenry for basic health care an issue of "ideological purity" rather than as a response to a capitalism-spawned public health crisis and threat to our very survival. In Obama's world, it is more important for the Have-Nots to respect the Haves, who very reasonably expect that tens of millions of people will have to get sick and die prematurely as a good-faith sign of their own co-equal reasonableness.

Obama ended his speech by advocating for patience and incremental change: “We have to be careful in balancing big dreams and bold ideas with also recognizing that typically change happens in steps. And if you want to skip steps, you can. Historically what’s ended up happening is sometimes if you skip too many steps you end up having bad outcomes.”

Obama gave no examples to back up his claim. Again - the only bad outcomes he has to fear are those which might require him and his ruling class cohort to cede power to the lower classes and pay higher taxes. He certainly couldn't point to any bad outcomes when Medicare passed in the 1960s, and millions of older people were suddenly yanked off their employers' insurance plans and forced into the new single payer system for retirees. He couldn't say that it was really stupid, in retrospect, for people to have become eligible as soon as they reached the age of 65 and not have to wait until 80, when the coverage could have been spread downward in pragmatic baby steps instead of skipping all those golden waiting years.

Obama dishonestly and effectively likens guaranteed universal health coverage to corporations like Boeing, which cuts corners and skips steps only to have have its airplanes crash, killing everybody on board. But he can't talk about Boeing, because for one thing, his benefactress Caroline Kennedy is now in charge of its oversight and auditing board, and the United States was the very last country in the world to, after much insane resistance, finally ground the faulty airplanes while shifting blame for the crashes to the pilots. 

Perhaps the latest Profiles in Courage winner, Nancy Pelosi, will now even have the courage not to haul Boeing executives before Congress to face any real consequences.

Even if they do get hauled before Congress, it will be for the purpose of individual congressional showboating and tongue-lashings and slaps on the wrist. For in the just the last year alone, Boeing spent more than $130 million lobbying, wining, dining, schmoozing and arm-twisting these same members of Congress. Its board, besides Caroline Kennedy, is a veritable who's who of the oligarchy, mainly tycoons from the extracting industries of Big Oil, Big Finance and Private Equity.

The trouble is that Barack Obama, designated celebrity ambassador of global neoliberalism, simply does not lie or dissemble well. Neither does Nancy Pelosi. Just before Caroline Kennedy tapped Pelosi as the latest plutocratic Profile in Chutzpah, Madam Speaker again lied through her teeth in an interview about single payer health insurance and why tens of millions of poor people will simply have to grit their failing or missing teeth and suffer pragmatically in service to their greedy overlords.

As Matt Breunig reports, the big lie that neoliberal centrists keep tellng is that "people" love their employment-based private insurance plans. It's a lie, because private predatory insurance "is a complete nightmare" for those trapped within the market-based, for-profit system.

Among those (in Michigan) who had employer-sponsored insurance in 2014, only 72 percent were continuously enrolled in that insurance for the next twelve months. This means that 28 percent of people on an employer plan were not on that same plan one year later. You like your employer health plan? You better cross your fingers because one in four people on employer plans will come off their plan in the next twelve months.
The situation is even worse for other kinds of insurance. One thing opponents of Medicare for All frequently say is that poor people in the US are already covered by free insurance in the form of Medicaid and that Medicare for All therefore offers them relatively little net benefit while potentially raising their taxes some. But what this argument misses, among other things, is that people on Medicaid churn off it frequently, with many churning into un-insurance.

And that churning is a feature and not a bug, because what is capitalism but constant, cutthroat competition? What are citizens but consumers of whatever the ruling class racketeers deign to dish out to us in the form of spectacle politics and cheap electronic gadgets to merge with our bodies as virtual biological appendages and tracking devices? 

Let's face it. The modern-day robber barons view the population as raw material and commodities which exist not for our own well-being and happiness, but for their voracious, relentless, inhumane profit.

More people than ever, especially younger people, are on to their con. The Profiles in Chutzpah are afraid.

And the best they can do is give each other glitzy prizes in televised galas which they sometimes allow us to gawk at in supposed admiration. 

GOP Stupidly Asks If We Want Socialized Healthcare

For some reason, the National Republican Campaign Committee sent me a "flash poll" the other day, asking "Do You Want a Government Takeover of Healthcare, Yes or No?" (They obviously don't read this blog.)

The first time I pressed Yes, all I got was one of those annoying error messages, the bland equivalent of a "Danger Danger, Will Robinson, Does Not Compute!" warning siren. Nevertheless, I persisted, and after a couple more tries, I finally got my "vote" counted. (I think.) I know, I know, it was nothing but a ham-fisted push poll to get more money and gin up more resentment by Have-Not white people against Have-Not brown and black people. But nasty person that I am, I just couldn't pass up the opportunity to mess even briefly with their race-baiting algorithms. It felt therapeutic for all of five minutes.

Naturally, they want to warn their base that the corporate Democratic Party has been completely taken over by Bernie Sanders in the dead of night, and that his Medicare for All bill has a fantastic chance of passing, and that the luxuriously appointed medical suites of the rich are about to turn into Siberian forced labor camps.

"The leftist dream is gaining more traction with the Democratic Party every day. Even Senate Minority Leader Chuck Schumer agrees it should be on the table. We need to let these extreme leftist Democrats like Schumer and Bernie know that Americans refuse to support a single payer health system," the email hilariously warned.

Just a few points:

-The Republicans need the Democrats as much as the Democrats need the Republicans. GOP hyperbole against such Wall Street extremists as Schumer saves the Democrats themselves the trouble of bashing the real left wing, which does not naturally reside within the Democratic Party.

-Something being "on the table" is politician-speak for an appetizer made out of such fake ingredients as thin air.

-The majority of Americans do, in fact, now support single payer government health coverage. Of course, the GOP's own twisted definition of "American" is the white, the whole white, and nothing but the white - or more specifically, the party's wealthy clients and donors. They're banking on the base being willing to starve or die for the plutocracy rather than see black and brown people score a trip to the doctor. "Let them eat resentment" just about sums up the Republican platform.

-Although Bernie Sanders has yet to release his long-promised Medicare for All legislation, the word is that it will be far less inclusive than John Conyers's HR 676, which now has the support ("on the table") of the majority of House Democrats. 

According to Dr. Margaret Flowers of Physicians for a National Health Plan, Sanders is instead going the Barack Obama sellout route by offering to compromise with the privateers and the profiteers as a totally unnecessary and weak starting point in reform negotiations. Sanders is walking the tenuous line between serving the citizens of this country and serving his Senate colleagues in the exclusive millionaires' club to which they all belong.

Flowers writes:

When it comes to the healthcare crisis, the smallest incremental step is National Improved Medicare for All. That will create the system and the cost savings needed to provide universal comprehensive coverage. Throughout history, every movement for social transformation has been told that it is asking for too much. When the single payer movement is told that it must compromise, that is no different. The movement is demanding a proven solution to the healthcare crisis, and anything less will not work.

You can write to Sanders here. With any luck and with any human decency, he will take your concerns and your pain a lot more seriously than the Republicans and the Wall Street Democrats currently do. And keep in mind, of course, that he is no populist savior; like all politicians, he is a mere instrument and a public servant. All the billionaire donations in the world do not translate into actual votes, as Hillary Clinton could very ruefully tell him.

With so many people now taking matters into their own hands and offering their own powerful helping hands in flood-ravaged Houston, what better time than now to build on this newfound solidarity? People of all ethnicities and skin colors and classes are proving that we're all in this together, that we can sink or we can swim together, and that class and race have always been mutually intertwined.

Before the catastrophic flooding, we'd already been taking the first important step: a widespread recognition, in the wake of Charlottesville, of the racist/oppressive/militaristic American past and how it has evolved seamlessly into the neo-feudal present of the most extreme wealth inequality in modern history.

We have a choice: we can use this crisis to become a more humane country, or we can allow the privateers and the profiteers to use it as just one more excuse to crush people into ever deeper levels of submission.

Carpe diem.

Krugman: You Can Have Single Payer Health Care When You're Dead

Despite the palpable spike in my blood pressure whenever I read something by Paul Krugman, nevertheless I persisted.  And the ensuing pounding sensation in my ears this morning did not disappoint.

In a piece ironically titled "What's Next For Progressives?" the star New York Times pundit suggests that we stop being so damned unicorny and fight for universal pre-K as a worthy substitute for the impossible dream of maintaining our lives and livelihoods when we get sick or hurt.

Not that he personally has anything against a single payer health insurance system, of course. It's just that such a program would be too hard to sell to anti-government Deplorables.  It's just that a public program would put all those private insurance executives and claims adjusters and rent-seeking lobbyists out on the street. Or should I say, out on The Street?

No, it's simply that the desperate people insanely clamoring for a single payer program are unreasonably forcing Democratic politicians to take a litmus test for purity. Making candidates promise Medicare for All would essentially be inviting them to lie, and goodness knows, they don't want to also be faced with a lie detector test should they have the amazing good luck to win any more elections on their feeble incremental platforms.

On behalf of the Clinton-Obama wing of the party, Krugman chides:

So it’s time for a little pushback. A commitment to universal health coverage — bringing in the people currently falling through Obamacare’s cracks — should definitely be a litmus test. But single-payer, while it has many virtues, isn’t the only way to get there; it would be much harder politically than its advocates acknowledge; and there are more important priorities.

What could possibly be more important than life and good health, you may ask?

Why, saving the predatory insurance cartel which helped save Obamacare by altruistically pushing back against Republican repeal, of course! Blue Cross/Blue Shield saved the day for Blue Cross/Blue Shield. Let's give three cheers for the oligarchy.

Also more important than the lives and well-being of 330 million American citizens is the convenience of those who currently obtain their insurance through their employers. No matter that a program like HR 676 would require no effort, automatically enrolling everybody, Krugman claims to be worried that transitioning from private to public would cause a massive outbreak of Post Traumatic Stress Disorder among the current beneficiaries of for-profit coverage.

Moving to single-payer would mean taking away this coverage and imposing new taxes; to make it fly politically you’d have to convince most of these people both that they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old.

This might in fact be true, but it would be one heck of a hard sell. Is this really where progressives want to spend their political capital?

As economist Robert Frank and others have demonstrated, this premiums vs. taxes argument doesn't hold water. But Krugman not only refuses outright to discuss the specifics, he dismisses them out of hand. He doesn't tell his readers that for one thing, administrative costs for a government run insurance program would only be two percent of the total budget, as opposed to the six percent costs of running a for-profit system. Further reducing costs would be the government's ability to negotiate lower prices for drugs and other services. And most important, a Medicare for All plan would be virtually repeal-proof. If everybody enjoyed the same benefits, the divide and conquer politics of resentment would be a thing of the past.

So Krugman pulls the old bait and switcheroo. If centrist Democrats (he calls them  "progressives" solely for purposes of propaganda) can't deliver on single payer health care, perhaps they'll get some political mileage from pretending to care about Our Children. Krugman has suddenly discovered that "we" neglect the nation's children. But rather than suggesting a living wage and/or guaranteed income for their parents, an increase in food assistance, a federal jobs program and subsidized housing, he tosses out the crumbs of pre-K and paid parental leave.

My published response:

Health care is either a basic human right, or it isn't.

Incremental improvements to, and more public funding of, our for-profit predatory health care delivery system are not going to cut it. A system in which some lucky people are insured and some are not is, in fact, the very antithesis of social and economic justice. It's health care apartheid.

Whatever happened to "justice delayed is justice denied?"

Krugman maintains that it would be "too hard" to educate people that paying premiums, via taxes, to a centralized government-run Medicare for All-type system is fairer and cheaper than paying premiums to private corporations whose CEOs make obscene salaries and whose wealthy investors suck profits from the pain of ordinary people.

Krugman is squandering an enormous opportunity from his popular perch in the op-ed pages to do some of this educating himself. Of course, his claim of "impossibility" is not true at all. According to most polls, between half and two-thirds of the American populace already support a single payer system.

So he should have titled this piece "What's Next For the Plutocrats Running the Place?" As established by Gilens and Page in their Princeton study, it's the rich donor class which despises the idea of true universal health care.

The only "progress" the billionaires care about is the progress of their own wealth and their own dynasties as the chasm between rich and poor grows wider by the day.

The rest of us can't wait. Single Payer or bust.

A Paine-ful Weekend At Bernie's

"These principles had not their origin in him, but in the original establishment, many centuries back; and they were become too deeply rooted to be removed, and the augean stable of parasites and plunderers too abominably filthy to be cleansed, by anything, short of a complete and universal revolution."

Thomas Paine

Thomas Paine could have been writing about why the "resistance" to Donald Trump is so ineffectual when what's really needed is a global revolution against the whole rotten global financial system. No matter that Paine was talking about Louis XVI of France, who actually was more a weakling than a despot in the mold of his Trump-like ancestor, Louis XIV.

In this interim between the 4th of July and Bastille Day, with Hamburg burning as the G-20 oligarchs party and plunder, what better time to renew our acquaintance with that great global radical, Thomas Paine? He helped foment revolution in the American colonies, and in France and (unsuccessfully) in his native England, where he was thoroughly despised by the aristocracy. His particular nemesis was the anti-revolutionary conservative Edmund Burke. Were he alive today, I can almost guarantee that Burke would be writing scolding opinion pieces for the New York Times. It's probably no accident that the newspaper's star conservative columnist is diehard Burke fan David Brooks.

Since Trump and his fellow plunderer-parasites both here and abroad are indeed too abominably filthy to be cleansed, nothing short of a complete revolution will do, as evidenced by the brave people facing water cannons, tear gas, rubber bullets and other military police hardware in Germany.

Take the health care crisis here at home. Despite the overwhelming clamor for universal, government-run medical insurance from the vast majority of the American populace, response from the higher-ups has ranged from horrified, to dismissive, to tepid.

Bernie Sanders's prescription was just suddenly downgraded to the same piecemeal "reform" of our for-profit, market based insurance system as originally suggested by the Obama White House. So compared to what Thomas Paine demanded in The Rights of Man, it's quite the cynical travesty.

Bernie: "Everyone knows that the Affordable Care Act is far from perfect. Our job now is to improve it, not destroy it. Further, instead of throwing 22 million Americans off of health care, we must move to join the rest of the industrialized world and guarantee healthcare to all people as a right not a privilege through a Medicare-​for-​​a​ll, single​-​payer system."

Tom: "When it becomes necessary to do a thing, the whole heart and soul should go into the measure, or not attempt it."

 Just as Barack Obama did before him, Sanders - now the most popular politician in America - is wasting the moment and submitting to the vested interests before he even gets started. He's putting off introduction of his long-promised Medicare for All legislation and instead meekly suggesting a Medicare buy-in option for 55-and-overs, as well as a public "option" so as not to unduly discompose the predatory plunderers of the private insurance cartel. 

  What about the times that try the souls of the tens of millions of citizens who either totally lack health insurance coverage, or can't afford the premiums and deductibles of what covers only a portion of their medical costs? They'll still have to die or go bankrupt if they get sick under the existing Obamacare law, which Democrats see as the be-all and end-all of the current debate.

As health care advocates Margaret Flowers and Kevin Zeese point out,

 We are already spending enough on health care in the US to provide comprehensive health care to everyone. We have a bill that lays out the framework for a National Improved Medicare for All healthcare system: HR 676. A majority of Democrats in the House have signed on to it as co-sponsors.
So, why are they trying to convince us to accept a public option or a Medicare buy-in? It’s because they are corrupted by money – campaign contributions that they receive from the corporations that profit from the current system. You may say, well Bernie doesn’t take corporate money, so why would he go along with this charade? It may be because he has greater allegiance to the Democratic Party than he has to the supporters of Medicare for All, his base. He may fear losing positions on committees or his new position of leadership within the party.

 We have to be clear and uncompromising in our demand for National Improved Medicare for All NOW! We can’t put this fight off any longer because those in power will always try to knock us off course. The people and their families who are suffering under the current healthcare (non)system can’t wait any longer.

 If Bernie Sanders really believes that health care is a human right, then why does he accept that millions of people are being denied this right today, right this very minute? Until such time as he deems it safe to "compromise" with the predatory plunderers who'd just as soon see us all dead, people will continue suffering and dying prematurely. The gradual granting of health care rights which he espouses is as if Lyndon Johnson's civil rights legislation had "pragmatically" given relief to only half the country's black people or if his Great Society had "realistically" given Medicare and Medicaid insurance to half the country's elderly and poor people.

Either health care is a right, or it isn't. Whatever happened to justice delayed is justice denied?

As Thomas Paine retorted to Edmond Burke's treatise against the French Revolution: "Does Mr. Burke mean to deny that man has any rights? If he does, then he must mean that there is no such thing as rights anywhere, and that he had none himself; for who is there in the world but man?"

The mass psychic revolution for universal health care in the United States is already a done deal. Bernie Sanders can either accept this fait accompli, or he might as well join the Democratic Party's latest bumper sticker campaign of "We Suck Less."

As it stands now, Bernie is nothing if not an adherent of what Paine called the "caterpillar principle." Since all courts and courtiers are alike, they all consume similar policies and narratives which have little or nothing to do with people and nations. "While they agree to quarrel, they agree to plunder. Nothing can be more terrible to a Court or a Courtier than the Revolution.They tremble at the approach of principles, and dread the precedent that threatens their overthrow."

Far from voicing any solidarity with the anti-capitalist demonstrators in Hamburg, Bernie Sanders acted every inchworm the caterpillar courier in tweeting to Trump and his fellow oligarchs what their three top priorities should be at the G-20 summit:

1) Growing global economic inequality. The G20 has a major role to play in making sure the benefits of growth benefit all humanity.

(This is boilerplate neoliberal tripe. Talk about, but don't question whether this "growth" is healthy or cancerous. All of humanity sounds so much vaguer and grander than, say, mentioning the refugees and victims of endless wars of American and transnational corporate aggression.)

  2) North Korea. Trump should use the G20 to develop a consensus. Real leadership is bringing parties together to de-escalate tensions.

(Bernie fails to mention the forbidden word: peace. In his prescription pad, real leaders need not actually stop arms production and sales and reduce military spending to help pay for health care, but rather tamp down the "tensions" a wee tad in order to keep the defense contractors in business without obliterating the entire planet in the process. He needs those F-35s to stay in Vermont. Perhaps he didn't feel the need to chide Trump on climate change amelioration given that the president is already a world pariah in that regard.)

3) Russia’s meddling in our election. When Trump meets with Putin he must make clear interference is unacceptable & must never happen again.

(He not only swallows the Democratic Party's specious RussiaGate claims whole, he eagerly disseminates the propaganda to his followers. He is part of the lie.)

 

 In effect, Bernie deflects attention from our health crisis at the same time he pays mild lip service to it in the form of "fighting back against" one president and only one side of our corrupt Duopoly. Meanwhile, the more hardcore naysayers desperately try to do their own parts. They insist that a swift transformation to a single payer system is impossible, because most sane people would object to a tax increase. But their "math" doesn't bear out their paranoia. As economist Robert H. Frank lays out in (of all places) the New York Times, a Medicare for All arrangement would actually save us all a ton of money:

By analogy, suppose that your state’s government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement.

But if roads would be as well maintained as before, would that be a reason to oppose the move? Clearly not, since the resulting cost savings would reduce your county taxes by more than your state taxes went up. Likewise, it makes no sense to oppose single-payer on the grounds that it would require additional tax revenue. In each case, the resulting gains in efficiency would leave you with greater effective purchasing power than before.

Since Single Payer covers everybody, the countries which now implement such systems have lower overall costs because most of the people covered are relatively healthy. Contrast that with the United States, where the government restricts public coverage to the most vulnerable and sickest groups: the elderly, the disabled, and veterans of our endless wars. We pay more and we get less. The have-nots are taught to resent the haves, entrenching the oligarchic plunderers even more securely in power. So if everybody enjoyed the same privileges, they'd have no reason to either resent one another or settle for lesser evil candidates.

And if everybody enjoyed the same benefits, it would become next to impossible for reactionary politicians, acting at the behest of corporations and oligarchs, to yank these benefits away from the whole population, united in solidarity to the tune of more than 320 million human bodies.

So let's all be realistic, and demand the impossible. Universal health care is not only a human right, it's plain common sense. Don't let the oligarchs get you down and keep you down. Vive le revolution!

Silver Lining of the Silver Streak Trainwreck

With nearly a trillion dollars worth of succulent tax cuts dangling just out of reach of ravening plutocratic jaws, is it really a coincidence that Republicans pulled their wealth care package just as the stock market was closing for the weekend?

I suspect the main reason that GOP leaders prolonged their charade for one more theatrical day was not to glean more votes, but to buy time to plot their next billionaire-saving move. Anything to avoid the public spectacle of a market dive, anything keep investors and health insurance predators from thrashing around in a greedy panic before the platoons of political lifeguards went on TV to reinflate the swim bladders of freedom.

Paul Ryan, who in a sane and just world would have resigned both his seat and his speakership by now, instead used his big moment of defeat to dog-whine to his overlords. Despite their failure to repeal Obamacare and rip millions of people away from life-saving Medicaid benefits, they have concocted plenty of toxic back-up snacks, designed to cull the population in a more stealthy and piecemeal fashion. If anybody can make the vulnerable population sink like lead, these miscreants can. They just got a bit ahead of their sadistic selves, is all.

Barry Grey of World Socialist Website has them absolutely pegged:

 Both Ryan and Trump hinted that the administration would use its executive powers to slash away at Obamacare restraints on the health care industry and restrict eligibility and benefits for recipients, particularly those who depend on Medicaid.
Ryan said ominously, “There are things the secretary of health and human services can do.” He was referring to Tom Price, a rabid opponent of both Medicaid and Medicare, the government health program for the elderly.
Trump repeatedly predicted with relish that Obamacare would implode. “It will have a very bad year,” he said, suggesting that he and Price would do their best to undermine the program.

So notwithstanding the victory dance creakily performed on Friday by senescent Democratic Party leaders Nancy Pelosi and Chuck Schumer, this is no time for hoi polloi rejoicing. The GOP legislation failed, and yet at least 20 million Americans remain as uninsured as ever, with tens of millions more finding their premiums, co-pays and deductibles to be increasingly onerous. It's actual people continuing to drown. Not that the tide of the global plutonomy ever raised any rickety lifeboats, of course, It just that, lately, it's loading them down with enough ballast to sink them as quickly as possible.

Donald Trump certainly had a point when he cynically observed on Friday that Obamacare is not sustainable. He acted almost relieved in the aftermath of the AHCA debacle.

So what better time for Bernie Sanders, whose political capital and national popularity have only soared with every passing day of the chaotic Trump administration, to formally introduce another Senate version of Medicare for All?

If Donald Trump had any political smarts, he would rush to triangulate with the progressive wing of the Democratic Party against both the corporate Ryan and the fanatical Freedom Caucus wings of the GOP, and espouse true single payer health care. He'd help punch some big old holes in each bloated swim-bladder. And who knows - there may even be a handful of "moderate" Republicans willing to join the cause in the interest of saving their own political lives.

As Brent Budowsky writes in The Hill,

The consistently high ratings for Sanders, and the consistently low ratings for Trump, show that the real majority in America is the genuinely progressive and genuinely populist view of Sanders, not the phony populism or warped conservatism represented by Trump.
Based on the historical pattern of midterm election voting, if the midterm election were held today with the president's unpopularity so high, the result would be a landslide victory for Democrats.

Let Hillary Clinton, who recently announced that she's "ready to come out the woods" just try to denounce cost-effective and humane and egalitarian health care coverage, and pissily admonish single payer advocates to "get real" as she echoes her campaign's specious talking points against universal guaranteed care. She'll deservedly sound every inch the demented Grimm Brothers character who lost her way and stumbled out of the woods into the sunlight by pure, moral compass-free, mistake

Since there is no longer even the fuzziest of lines between entertainment and politics, why not treat America to a madcap buddy film instead of the current box office dud called RussiaGate?

There will never be enough lifeboats on the Titanic to allow disasters to end well, so let's forget for a moment all those depressing drowning metaphors - and hop on board the Medicare For All Express!

In an imaginary remake of Silver Streak, for example, a couple of erstwhile antagonists named Donald and Bernie would lead an improbable team of health care reformers who join forces to throw a band of neoliberals off the runaway capitalistic train. They'd manage to decouple the locomotive from the cars right in the nick of time, saving the day for their fellow passengers seated left, right and center. It's a relatively easy script to imitate, given that two of the characters in the original movie were also named Hilly and Whiney.

The suspense will be in guessing who are the villains and who are the heroes. Who finally sees the light, and who still adamantly refuses to seek treatment for chronic tunnel vision and willful myopia?

Therefore, the audience is definitely urged to participate. Keep calling your congress critters. Keep inundating the White House with synopses of Single Payer health care proposals. Don't get derailed by the emerging schlock horror genre called Them Bad Russians.

Poet Allen Ginsberg poignantly sounded the alarm half a century ago. "America: This is serious."