Corporate and “Progressive” Democrats Threaten Medicare Itself
Sanders, Jayapal, and more…
By Charles Andrews | Dissident Voice | March 1, 2019
The Democratic Party won a majority in the House of Representatives in the November 2018 elections by making health care one of its top “messages.” Yet events from Bernie Sanders’ bill of 2017 to legislation that “progressive” Representative Pramila Jayapal introduced on February 27, 2019 show that the Party is on its way to destroy Medicare.
For decades activists identified the prize as “single payer health care.” The program would issue a Medicare card to everyone, like the one senior citizens get now. The card would be good at any doctor’s office, clinic, hospital, laboratory, and prescription pharmacy. These largely private businesses would be reimbursed from a public single-payer fund. The fund would receive broadly collected tax revenues; the patient would pay little or nothing at the reception desk, and no monthly premium. This is guaranteed, comprehensive health care.
In other words, single payer is Medicare for all, carried to completion by eliminating Part B premiums and by more comprehensive coverage including prescribed drugs.
Health care activists always agonized over the colorless name “single payer.” A few years ago many of them began to speak of Improved Medicare for All. Actually, it had been in the title of the benchmark bill, H.R. 676, when congressperson John Conyers introduced it in 2003. A few years later he shortened the title to The Expanded and Improved Medicare for All Act. The text remained stable, and although the bill went nowhere in Congressional committees, H.R. 676 became the centerpiece of organizing. It is readable, only thirty pages of double-spaced large type. Hundreds of trade union locals and councils endorsed this model legislation in a steady stream year after year.
The health care industry has enjoyed a long-term phase of expansion, like railroads in the latter half of the nineteenth century. Back then, the new way of moving heavy goods and people was amazing and useful; today, new biological and biochemical understanding makes possible longer life, survival from a heart attack, restored clarity of vision, and so on. In both situations, capital has had strong pricing power and taken fat profits. And just as anger at railroads swelled into a populist revolt against The Octopus (Frank Norris’ novel about the Southern Pacific railroad corporation), people today are angry at insurance corporations, pharmaceutical monopolies, and hospitals, whether or not they call themselves “non-profit.”1
Opinion polls measure growing support for single payer health care for all. Employers continue to raise the employee cost of coverage, or simply not provide a health benefit. Health insurance purchased individually on the so-called exchanges of the Affordable Care Act (“Obamacare”) turns out to be full of exceptions like a slice of Swiss cheese.
Sanders Promotes Health Care for All Then Undercuts Conyers
Popular support erupted into a political force when Bernie Sanders launched his presidential campaign at the end of April 2015. Record-breaking crowds filled his rallies around the country. The top three issues in a Sanders speech rotated – sometimes including inequality of wealth and income, sometimes climate change – but he always revved up on health care for all. It had been the cause of a few thousand health care activists. Now Improved Medicare for All became a challenge to the neoliberal establishment. For the first time in forty years, people were on the verge of a mass campaign for a major gain in their quality of life and their security.
It did not happen. Sanders did not win the Democratic presidential nomination. He returned to the Senate, making an implicit or private deal with the party: he would speak as a independent progressive, but he will act on all serious matters as an unannounced Democrat.
Doing something about health care for people largely fell out of public view. Health care activists carried on. Policy aficionados spun proposals. Sanders had used the issue in his campaign, but sustained mass organizing for it did not happen.
Then in September 2017, senator Sanders introduced his “Medicare for All Act.” S. 1804 is three times as long as H.R. 676, and the reader must unravel cross-references within the text. Sanders made no mention of Conyers’ H.R. 676 at his press conference. Since then, no one has asked him the obvious question: Why didn’t Sanders simply introduce the text of H.R. 676 in the Senate?
The “Buy-In” Trap
Sanders’ bill would actually undermine Medicare. It would set up a “Transitional Medicare Buy-in Option and Transitional Public Option.” Sanders portrayed it as a four-year period (longer if necessary) to bring people of age 55 or over into Medicare, then down to age 45, then down to age 35, then everyone. This scheme is the very opposite of guaranteed single-payer health care for all.
How is Medicare financed today? Most of the money comes from payroll and income tax revenues, not enrollees’ Part B premiums, by a ratio of 3½ to one.2 We all pay into Medicare. At the moment when someone needs care, she gets it, period – without financial worry. That is the single-payer principle, and Medicare implements it, although not entirely, since enrollees must keep up-to-date on their Part B monthly premiums, and there are some co-payments for services.
Expanded and Improved Medicare for All would eliminate premiums and co-pays. That is what H.R. 676 declared, but in Sanders’ S. 1804 people younger than 65 could “join” Medicare by paying fat monthly premiums (a “buy-in”). People who want to sign up this way would use the notorious Obamacare exchanges.
Trade union campaigners for genuine Medicare for all, H.R. 676, wrote in a December 11, 2018 letter:
Unlike HR 676, S 1804 inserts supposedly incremental steps of public options and Medicare buy-ins for four years prior to arriving at a real single payer plan. Because S 1804 expands care while maintaining the private insurance companies, costs will skyrocket before the savings of single payer kick in. The incremental steps will become a roadblock rather than a path to single payer. Perhaps the worst part of this inclusion of the public option and the Medicare buy-in is the reinforcement of the false notion that there should or must be transitional steps to single payer. Neither the public option nor the Medicare by-in are based on sound policy. To place them in the bill for even a short period of time endangers the single payer goal.
— All Unions Committee for Single Payer Health Care, HR 676, Kay Tillow, coordinator
It is a neat trick: under the guise of expanding Medicare, you make it more dependent on premiums. You change it from a public good, like the neighborhood fire station, into a commodity insurance product that individuals buy. You make health care dependent on the patient’s finances.
This perversion of Medicare is not only a fraud upon people of age 55, 45, or 35. It is a threat to Medicare itself. Whenever Medicare seems headed for a financial crunch, real or conjured, the pressure in Congress will be to shift more and more toward a premium- and co-pay-financed program rather than one supported by general and progressive tax revenues – and to take chunks of medicine out of Medicare.
An independent in name but a Democrat, in fact, senator Sanders at his press conference happily introduced several corporate Democrat co-sponsors of his bill. Behind closed doors he had let them write sections of S. 1804! The public option section was written by senator Kirsten Gillibrand of New York. “One part of the bill that I worked with my colleagues to put in was the ability for every American to buy into a nonprofit public option as part of a four-year transition…,” she said during the news conference introducing the bill.
A public option is a competition with insurance corporations rigged in their favor. They know how to repel potential enrollees who are likely to need expensive care. A government health plan cannot and, of course, should not play that game. It can either raise premiums, or it can turn the program into something like its poor cousin Medicaid. Either way, it cannot become improved Medicare for all.
Democratic Party: “Death to H.R. 676!”
Two important bills stood in contradiction to each other: one for Expanded and Improved Medicare for All (H.R. 676), the other a threat to Medicare itself (S. 1804). Conyers’ bill has been the acknowledged model legislation since 2003; Sanders introduced his in 2017.
But words do not move on their own. The corporate Democratic Party soon put H.R. 676 on the chopping block. Representative John Conyers was pushed out of Congress in a #MeToo incident, resigning from a hospital bed, denying the charges but not up to the rigor of a fair hearing if he could get one.
Somehow, sponsorship of H.R. 676 went to new congressperson Pramila Jayapal. 3 She immediately announced that she was in consultations to rewrite it. In the meantime, she surrendered the number 676 that had been reserved for Conyers’ bill since 2003. It was issued to military legislation on January 17, 2019.
After the Democrats won control of the House of Representatives in the November 2018 elections, it became more urgent for them to gut single payer health care for all. Otherwise, they might have to deliver. Representative Nancy Pelosi, during a post-election whirlwind of bargaining to make sure she became Speaker of the House, agreed to help advance the same scheme that senators Sanders and Gillibrand had put into S. 1804: a buy-in to a premium-based option for people age 50 to 64. Jayapal, who also praised Pelosi during her run for Speaker, spoke out of both sides of her mouth. “I would prefer to have a reduction of the age of Medicare so that more people could qualify but not a buy-in, because that continues the problems that we have right now.” She said lowering the eligibility age “would be an appropriate way to go where we’re taking a step forward towards a system that will ultimately cover everybody.”
The Buy-in Trick Again
Representative Jayapal introduced H.R. 1384, her replacement for the Conyers’ model, on February 27, 2019. The 119-page bill is a masterful card trick. On one hand, it maintains the ban on premiums and co-payments, and it specifies a broad list of covered medical services, including some never proposed before in such legislation.
On the other hand, Jayapal copied Sanders’ big step backward – an optional “buy-in” transition period with premiums, only shortened from his four years to two. (After the first year, minors up to age 18 and people 55 and older would move automatically into the new system.) H.R. 1384 states:
The Administrator shall determine the premium amount for enrolling in the Medicare Transition buy-in, which may vary according to family or individual coverage, age, and tobacco status,… (H.R. 1384, Title X, Subtitle A, Sec. 1002 (e)(A))
Since Conyers introduced H.R. 676 in 2003, his bill never had a premium-based buy-in. Why does Rep. Jayapal think a buy-in period is necessary?
With a buy-in transition, the first experience people would have with the new system would be yet another commodity insurance plan with monthly premiums. This is a recipe for political failure. During those two years the tentative new system would soon be under attack as financially unworkable and just not popular enough.
People could buy in if they wished as individuals through the notorious Affordable Care Act exchanges (“Obamacare”). Because of the extensive benefits, the plan would be one of the most costly choices. Unaffordable for most as an individual premium plan, trying to compete in an unreformed health care system with its bloated costs, the buy-in would attract few enrollees. Enemies of genuine universal health care will pounce on the result, demanding that genuine Medicare for All be postponed and turned into a supplement of one kind or another to corporate health insurance.
Only H.R. 676 delivers guaranteed healthcare for all, the equal care for all of which our advanced society is capable. Bernie Sanders and Pramila Jayapal, just like openly corporate yet arguably less devious Democrats, cower before insurance capital, pharmaceutical capital, hospital capital, etc. These parasites demand that healthcare be a set of commodities that some can afford and others cannot. The people or the dollar – that is the inescapable choice.
- A nominally “non-profit” hospital today is not the church-run charity that it might have been a hundred years ago. Non-profit simply means that the corporation is tax-exempt. It does not pay dividends to stockholders, but it still makes a profit. Banks share in the loot, and layers of executives are paid millions of dollars. Affiliated for-profit clinics and labs may suck profits out under cover. Examine the Sutter Health and Kaiser hospital chains in California, for example.
- Medicare trust fund trustees’ report, 2018, pp. 45 and 78.
- Jayapal went to elite Georgetown University, got an MBA after that, worked on Wall Street on leveraged buyouts, switched to executive positions in several nonprofits, sat a mere two years in the Washington state senate, and won election to the House in 2016.
Charles Andrews is the author of The Hollow Colossus.
How Amnesty International is reinforcing Trump’s regime-change propaganda against Venezuela
By Joe Emersberger | The Canary | February 26, 2019
Amnesty International‘s reports, by their nature, require readers to trust their honesty and impartiality. But there is ample reason not to trust them. Because Amnesty has ignored grave human rights abuses in plain sight in Venezuela while demonizing supporters of Venezuelan President Nicolás Maduro.
Shortly after meeting with Juan Guaidó (whom Donald Trump and a new Iraq-style Coalition of the Willing have anointed as Venezuela’s interim president), Amnesty put out a report that reads like a barely disguised attempt to reinforce, from a ‘human rights’ angle, the military threats against Venezuela from Trump and his henchmen.
Team Trump as Venezuela’s “Only hope”?
Erika Guevara-Rosas, Amnesty’s Americas director, said:
International justice is the only hope for victims of human rights violations in Venezuela. It is time to activate all available mechanisms to prevent further atrocities.
And the report stated that:
[C]ountries genuinely concerned about the human rights situation in Venezuela should explore the application of universal jurisdiction.
Amnesty’s allegations about Venezuela are serious and, if true, deserve condemnation. But there are numerous reasons to question the group’s honesty, impartiality, and public statements.
Somebody should ask Amnesty, for example, to list the countries which are “genuinely concerned”. How many Saudi–arming countries like the US, UK, Canada, and France are on that list?
As Amnesty released this report, the threat of a US military attack on Venezuela disguised a “humanitarian aid delivery” could not be more obvious. Never mind that Venezuela is, in fact, receiving foreign aid with authorization from the Maduro government. US National Security Advisor John Bolton and Senator Marco Rubio have repeatedly made Mafioso-like threats against Venezuela’s military and Maduro. Trump himself has been repeatedly threatening a military “option” since 2017 (the year he reportedly asked “Why are we not at war with Venezuela?”).
Amnesty ignorning Trump’s attack on right to health and food
At the same time, Amnesty has refused to denounce Trump’s financial sanctions which have been in place since August 2017 and whose impact on the entire economy has been crippling. By now, the sanctions have cost Venezuela’s government well over $6bn in revenues in an economy that imported $11.7bn in goods in 2018. Before the deep and sustained collapse in oil prices (and oil production, which nose-dived as the sanctions began), Venezuela’s economy had been importing about $2bn a year in medicines.
It is important to remember that, in Venezuela’s case, Amnesty has been very explicit in pointing to economic problems as human rights abuses. Last year, when they wrote to me refusing to denounce Trump’s sanctions, Amnesty said:
Amnesty International does not take a position on the current application of these sanctions but rather emphasizes the urgent need to address the serious crisis of the right to health and food which Venezuela is facing. In terms of human rights, it is the Venezuelan state’s responsibility to resolve this.
As I’ve noted at The Canary, Amnesty has now updated its position on Trump’s sanctions. It absurdly asks Trump to please be careful and “monitor” the impact of new sanctions that he imposed in January. The new sanctions directly cut off revenues that the Venezuelan government obtained from sales to the US. Amnesty’s continued refusal to acknowledge that a devastating attack on the Venezuelan “right to health and food” has been ongoing since August 2017 is appalling. And that alone is an excellent reason to doubt the honesty and impartiality of their work on Venezuela. Because any credible human rights group would demand an immediate end to all the economic sanctions Trump has imposed.
Violent crime in Venezuela
Amnesty also stated in its latest report that:
The more impoverished areas of Caracas and other parts of the country were particularly affected and stigmatized, registering the highest numbers of victims, who were later presented as ‘criminals’ killed in clashes with the authorities.
There’s no doubt that Venezuela’s security forces have committed crimes. The Maduro government has conceded as much. And Venezuelan police officers were arrested for crimes perpetrated during the violent protests of 2017. In June 2017, Defense Minster Vladimir Padrino López publicly warned security forces in remarks broadcast on state TV that he didn’t “want to see one more national guard perpetrate an atrocity”. Those protests were the fifth US-backed effort to oust the government by force since 2002. Trump is now leading the sixth.
It’s also important to remember that Venezuelan security forces have confronted a very high homicide rate (since long before the current government came to power) and police officer death rate. At the same time, the country has been plagued by violent US-backed protesters for years, who have done things like burn Afro-Venezuelans alive in the streets and murder police officers. And today, it faces the very grave threat of US invasion that would install the most violent opposition groups into power.
We can only imagine how security forces in a country like the UK would behave under the above conditions. Young men have been sent to prison in Britain, for example, simply for writing Facebook posts that advocate riots. I made some of these points last year in response to a similar UN report that was hyped by Reuters.
Venezuela’s very real homicide problem (and violent US-backed opposition problem) could indeed allow security forces to pass off extrajudicial executions as “fighting crime” or as self-defense. But it can also allow apparently partisan groups like Amnesty to distort the situation in support of Trump’s regime-change agenda.
Propaganda groundwork for dirty war on Maduro supporters?
Amnesty said in its report that:
There is a strong presence of pro-Nicolás Maduro armed groups (commonly known as “colectivos”) in these areas, where residents depend to a large extent on the currently limited state programs to distribute staple foods.
Again, the “limited state programs” would be the ones Trump has been viciously attacking through sanctions since 2017. Also notice how Amnesty casts as thugs the organized poor people distributing food to millions of people – up to 60% of households according to an opposition-aligned pollster (Datanálisis).
As George Ciccariello-Maher explained in We Created Chavez, the history of poor people organizing and arming themselves (quite understandably) for self-defense in Venezuela’s poorest neighborhoods goes back decades. It’s not new.
It is Maduro’s supporters in poor neighborhoods and in the countryside, however, who – armed or not – will be violently targeted if the US-backed opposition takes power; especially if they do so in a coup or through a US invasion. Amnesty appears to have little concern about “stigmatizing” them, though, and negligible concern about Trump’s attack on their “right to health and food”.
All of the reasons above make a powerful case for questioning the integrity and objectivity of Amnesty when it comes to Venezuela. And for the sake of peace and justice, we should hold Amnesty to much higher standards.
US Urges ‘Calm’ While Stoking India-Pakistan Conflict
Strategic Culture Foundation | 01.03.2019
International powers this week anxiously urged India and Pakistan to avoid further escalation of military confrontation. Given the two nations have gone to war on three occasions during the past seven decades and are both nuclear armed, the international concern is palpable.
The US has lately joined calls by Russia, China and Europe appealing for restraint, and for the Indian and Pakistani leaderships to negotiate a resolution to avert a catastrophic slide towards conflict.
American President Donald Trump, while in Vietnamese capital Hanoi for a summit with North Korean leader Kim Jong-Un, claimed that the US was mediating to defuse the crisis between India and Pakistan.
“We’ve been in the middle trying to help them both out,” said Trump.
Incongruously, however, the Trump administration has in fact acted in an opposite fashion, to inflame the recent tensions between New Delhi and Islamabad.
Trump’s national security advisor John Bolton and Secretary of State Mike Pompeo have both issued statements which “support India’s right to self-defense against terrorism”. The US officials have also laid the blame on Pakistan for sponsoring acts of terrorism by militant groups in Indian-controlled Kashmir. The northern territory of Kashmir has been the cause of bitter dispute between India and Pakistan ever since they gained independence from Britain in 1947.
The massacre of over 40 Indian troops earlier this month on February 14 in the Indian-side of Kashmir has sparked outrage among the wider Indian population demanding revenge. The suicide bomb attack was claimed by Kashmiri militant group Jaish e-Mohammed (JeM). India claimed that Pakistan had a hand in the atrocity through its support for JeM, which the Pakistani authorities denied.
The mounting of air strikes by India this week deep inside Pakistani territory on a militant training camp – purportedly in retaliation for the Kashmir massacre of its troops – represented a dramatic escalation. If India had limited its strikes to Pakistani-controlled Kashmir the retaliation could perhaps have been argued as being proportionate. But the violation of Pakistani territory – some 50 kms west of the historical Line of Control – was arguably an act of war. The last time Indian warplanes struck inside Pakistan was in 1971 during the two countries’ third and last war.
Not surprisingly, Pakistani fighter jets have subsequently launched strikes on Indian-controlled Kashmir. There were also further alleged incursions by Indian warplanes, two of which were reportedly shot down by the Pakistani side. Pakistan also lost one of its jets in a shoot-down but the aircraft apparently crashed inside its territory.
Tensions have boiled over further with the capture of an Indian pilot by the Pakistanis who released video footage of him apparently injured with a bloodied face. That led to outcry in New Delhi that Islamabad was in breach of the Geneva Convention concerning treatment of prisoners of war. Pakistan’s Prime Minister Imran Khan has vowed to return the Indian pilot as a gesture towards de-escalation.
Nevertheless, the tensions and danger of an all-out war continue to mount. There have been several reports of heavy artillery cross-border exchanges between Indian and Pakistani forces. While both governments say they don’t want a war, the dynamic could explode beyond their control.
The Kashmir dispute is certainly fraught with enormous historical difficulties bestowed by baleful British imperialist legacy of partitioning land and people with such contempt for indigenous rights and traditions, as well as from cynically playing partisan politics for imperial advantage. Washington’s contemporary meddling in Indian-Pakistan affairs has echoes of past British subterfuge.
Pakistan’s relations with Kashmiri militant groups whom India denounces as “terrorist” is only part of a complex equation. Another part of the equation is India’s intensive militarization of the province and its alleged abusive occupation of territory and people who aspire to be part of Pakistan. The region is predominantly Muslim.
If a peaceful resolution is to ever succeed there must be an earnest process of demilitarizing the entire Kashmir area. That onus is primarily on India.
One thing that is certainly not constructive is the simplistic and clumsy way that the United States has intervened recently by pointedly taking the Indian side of the narrative. For senior Trump administration officials to proclaim India’s “right to self-defense” against implied Pakistani-sponsored terrorism is in effect a green light for New Delhi to launch air strikes against its neighbor.
That reckless advocacy by Washington is predictably leading to a spiral of violence which ultimately could result in an all-out war between two nuclear states.
President Trump’s self-congratulatory tone about supposed mediation between India and Pakistan is far off the mark from reality. The Trump administration’s belated words appealing for “restraint” and “calm” are belied by the earlier words from Bolton and Pompeo giving India a license to commit acts of war.
Of course, what would one expect from the American side? The Trump administration is currently in the throes of violating the sovereignty of Venezuela with threats of military invasion against that South American nation. Washington has completely lost its compass on international law and norms of conduct.
There are indeed deeper reasons for why Washington would like to see a conflict between India and Pakistan blow up. Such a confrontation would cause major geopolitical problems for China, which is historically an ally of Pakistan but which has also recently endeavored to build a rapprochement with India. Stoking a confrontation in South Asia would serve Washington’s interest in destabilizing China and Russia’s strategic plans for economic integration of Eurasia.
India and Pakistan’s political leaderships must keep cool heads and think of the bigger global picture. Only recently, India’s Narendra Modi and Pakistan’s Imran Khan were expressing an aspiration for improving ties between the two South Asian states. They must resist playing politics for internal political gains, and they must resist being manipulated by external powers which seek to gain advantage at the expense of Asian divisions. The historical thorn of Kashmir can be resolved if India and Pakistan entered into a genuine and mutual compromise.
“UK Decision to Blacklist Hezbollah Indicates London’s Servile Obedience to US”
Al-Manar | March 1, 2019
Hezbollah on Friday lashed out at UK over its decision to blacklist the Lebanese resistance group, stressing that the move indicates London’s “servile obedience” to the US.
In a statement released by the group’s Media Relations Office, Hezbollah stressed that it is a resistance group against the Israeli occupation, and that “any state which embraces, fund and support terrorism has no right to accuse Hezbollah or any other resistance group of being terrorist.”
The decision indicates that the “UK government is not but a subordinate that serves the American master,” Hezbollah said, noting that London, through this decision, antagonizes the people of the region in a bid to please Washington.
“Terrorism accusations fabricated by the UK government won’t deceive the free people across the world,” the statement said.
Hezbollah also said that the free people in the UK “know very well who created terrorism in our region, and who funded, supported and covered crimes committed in Syria, Iraq and Yemen,” referring to the US and its “international and regional tools.”
The UK decision is an “insult to the feelings, sympathies and will of the Lebanese people that consider Hezbollah a major political and popular force represented in the Lebanese parliament and cabinet,” the statement added.
Hezbollah concluded the statement as stressing that nothing will prevent the Lebanese resistance group – who have confronted both Israeli aggression and the Takfiri terror- from going ahead with defending Lebanon, its freedom and independence.