Senate Health Bill is Milestone … In Rationing

I find this a pretty convincing argument that the Senate healthcare bill is about rationing, if you define rationing as Ewe Reinhardt did in a recent NY Times piece, meaning decisions by insurers about what will be covered, versus what has to be paid for out-of-pocket. As this article indcates, in the future these decisions by insurers are more likely to be made collectively in response to various pressures including taxes on high-cost plans, government guidelines on effective and cost-effective treatment such as the recent breast and cervical cancer screening recommendations, the bi-partisan Medicare cost-control Commission, and finally reimbursement reform including moving away from fee-for-service and toward payments for doctors and hospitals bundled together for particular medical care episodes akin to managed care.

As this and another recent NY Times piece explain, the Obama administration favors the Senate bill, as it incorporates its four cornerstones of healthcare reform: (1) a Medicare cost-containment Commission, (2) taxing high-cost private insurance, (3) reform of medical payment incentives, and (4) deficit reduction.

If the whole package costs roughly $900 billion over ten years, that roughly $90 billion per year. For comparison, sending 35,000 troops to Afghanistan, at $1 million/individual troop/year will cost roughly $35 billion.

The Atlantic, Nov 21 2009, 11:29 am by Ronald Brownstein

A Milestone in the Health Care Journey

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. “The bottom line,” Nichols says, “is the legislation is sending a signal that business as usual [in the medical system] is going to end.”

Both the Senate bill’s priority on controlling long-term health care costs, and its strategy for doing so, represents a validation for Senate Finance Committee chairman Max Baucus (D-MT). When Baucus released his health reform proposal last September, after finally terminating months of fruitless negotiations with committee Republicans, Democratic liberals excoriated his plan as a dead end. And on several important fronts–such as subsidies for the uninsured, the role of a public competitor to private insurance companies, and the contribution required from employers who don’t insure their workers–Reid moved his product away from Baucus toward approaches preferred by liberals.

But the Reid bill’s fiscal strategy, and its vision of how to “bend the curve,” almost completely follows Baucus’ path from September. Baucus’ bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that’s the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas’ for shifting the medical payment system away from today’s fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus’ most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that’s just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.) Most of the other big ideas for controlling costs (such as medical malpractice reform) tend to draw support primarily among Republicans. And since virtually, if not literally, none of them plan to support the final health care bill under any circumstances, the package isn’t likely to reflect much of their thinking.

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end “Cadillac” insurance plans; to pursue “aggressive” tests of payment reforms that will “provide incentives for physicians and hospitals to focus on quality” and provide “care that is better coordinated”; and establish an independent Medicare commission that can continuously develop and implement “new efforts to improve quality and contain costs.” Finally, they said the Congressional Budget Office “must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter.”

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests. The CBO projected that the bill would reduce the federal deficit by $130 billion over its first decade and by as much as $650 billion in its second. (Conservatives, of course, consider those projections unrealistic, but CBO is the only umpire in the game, and Republicans have been happy to trumpet its analyses critical of the Democratic plans.)  “Let’s use the metric of that letter,” said Orszag, who helped shape the health reform debate for years from his earlier posts at CBO and the Brookings Institution. “Deficit neutral; got that. Deficit-reducing second decade, got that. Excise tax: That was retained. Third is the Medicare commission: has that. Fourth is delivery system reforms, bundling payments, hospital acquired infections, readmission rates. It has that. If you go down the checklist of what they said was necessary for a fiscally responsible bill that will move us towards the health care system of the future, this passes the bar.”

McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag’s assessment of it. “It has got all four of those elements in it,” McClellan said in an interview. “They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go.”

Reid gave ground on one Baucus proposal that the economists identified as a priority-taxing high-end insurance plans. Like many health reformers, the economists who wrote Obama argue that such a tax “will help curtail the growth of private health insurance premiums by creating incentives to limit the costs of plans to a tax-free amount.” Amid intense opposition from unions, Reid raised the thresholds at which family plans would face that excise tax from $21,000 to $23,000. But given all the pressure from labor, the more striking thing may have been that Reid didn’t increase the thresholds even more; the CBO calculated the proposal, which the House excluded from its bill, would still raise $35 billion annually by 2019. “They held pretty strong,” said one administration health care expert. “It’s not like unions haven’t been making the case that it shouldn’t have been a much higher number.”

On delivery reform, Reid stayed even closer to the Baucus blueprint. The Finance bill laid out a series of measures to change the way providers are paid for delivering care to Medicare recipients; the hope was that once Medicare instituted these reforms, private insurers would also adopt many of them. “The goal here is that the things we do in Medicare will translate over into the private sector, and there is quite a bit of historical precedence for that,” said one Democratic aide involved in drafting the package.

The Baucus delivery reform ideas revolved around two central aims. One was to reward Medicare providers who deliver care more efficiently and penalize those that don’t. The Reid bill upholds the major proposals Baucus offered to advance that goal. For instance, hospitals under current law must report on their performance in treating patients for common conditions like heart problems and pneumonia; under the bill, their Medicare payments, for the first time, would be affected by their ranking on those reports. Hospitals would also be penalized if they readmit too many patients after surgery or allow too many to acquire infections while in the hospital itself. Another provision would begin the process of applying such “value-based purchasing” toward other providers like hospice providers and inpatient rehabilitation facilities.

With physicians, the Reid plan takes a step back from the Finance Committee bill but still a long step beyond current law. The Finance Bill proposed automatic reimbursement reductions for doctors who order up the most care for Medicare recipients with similar medical and demographic characteristics. That was meant to respond to the research showing big disparities in spending on medical services for similarly-situated patients in different communities. But, Democratic sources say, that proposal ran into charges that it would promote rationing-and even function as “a death panel by proxy”-by compelling doctors to arbitrarily reduce care. So the final bill takes a less direct route toward a similar end. It requires Medicare to begin studying the utilization patterns of doctors participating in the program. And then it establishes a “values based payment modifier” that would, in a budget-neutral manner, increase reimbursements for physicians found to deliver high-quality care at lower cost, and reduce them for physicians at the other end of that spectrum. “It will, we believe, have the same net effect [as the original proposal],” said the Democratic aide. “It should change behavior around that threshold.”

The other set of Baucus proposals were intended to promote more coordination among providers. These have survived almost verbatim into the final bill. The bill encourages groups of providers to establish doctor-led “accountable care organizations” to more comprehensively manage patients’ care by allowing them to share in any savings for Medicare they produce. It also establishes a voluntary national pilot of “bundled” payments that would encourage hospitals, doctors and other providers to work more closely together. Another pilot program would test coordinated home-based care for chronically ill seniors.

Finally, the Reid bill maintains the two powerful institutions the Finance legislation proposed to promote these reforms and develop new ones. The one that’s attracted the most attention is an independent “Medicare Advisory Board.” Under the Senate bill, that board would be required to offer cost-saving proposals when Medicare spending rises too fast; Congress could not reject its proposals without substituting equivalent savings. Since the board would be prohibited from offering changes that raise taxes or “ration care,” and since the legislation initially exempts hospitals from its recommendations, it could choose to promote the sort of payment reforms the bill establishes. (More prosaically it might also clear away some of the expensive coverage mandates that Congress imposes on Medicare under pressure from different elements of the medical industry). Given the limitations imposed on the commission, an equally important means to expand these reforms might be a second institution the legislation creates: a Center for Medicare and Medicaid Innovation in the Health and Human Services Department. Though this center has received much less attention than the Medicare Commission, it could have a comparable effect. It would receive $1 billion annually to test payment reforms; in a little known provision, the bill authorizes the HHS Secretary to implement nationwide, without any congressional action, any reform that department actuaries certify will reduce long-term spending. While the House bill omitted the Medicare Commission (a top priority for Obama) it included the innovation center.

No one can say for certain that these initiatives will improve efficiency enough to slow the growth in health care spending. Some are only pilots; others would affect only a small portion of providers’ revenue from Medicare. CBO typically evaluates them skeptically: it generally scores little or no savings from most of them. Former CBO director Robert Reischauer, who signed the November 17 letter, says that’s not surprising. “CBO is there to score savings for which we have a high degree of confidence that they will materialize,” says Reischauer, now president of the Urban Institute. “There are many promising approaches [in these reform ideas] but you…can’t deposit them in the bank.” In the long run, Reischauer says, it’s likely “that maybe half of them, or a third of them, will prove to be successful. But that would be very important.”

While generally supportive of Reid’s approach, McClellan, the former Medicare administrator under Bush, offered several specific ideas for strengthening it. He says the Senate should improve the capacity of HHS to more quickly evaluate whether the payment reforms are working, and also to provide data and technical assistance to new physician groups like the accountable care organizations that will be attempting to better coordinate care. “Ideally you’d both be able to tell the organizations involved and Congress what is working or not, and give the organizations the feedback and data they need to know whether they are doing a good job,” he says. McClellan also believes that the plan needs sharper sticks-tougher penalties on providers who don’t provide efficient and effective care. “There are a lot of carrots and not so many sticks,” he maintains. Of course, tougher penalties might provoke more opposition from provider groups like hospitals and physicians now tenuously supporting the legislation.

[[McClellan stands at the forefront of centrist Republican thinking on health. Even the more ideologically conservative health care thinkers to his right generally don't oppose long-term reform ideas like bundling payments (John McCain promoted that during his presidential campaign). But they tend to view them as insufficient or tangential to the real problem. Their view highlights a fundamental difference between the parties' on health care. To save costs, Democrats mostly want to change the incentives for providers. Republicans mostly want to change the incentives for patients by shifting toward a model where insurance covers only catastrophic expenses and people pay for more routine care from tax-favored health savings accounts. In essence, the Republican view is that the best way to hold down long-term costs is to directly expose patients to more of them. Few Democrats accept that logic though and it has little influence on either chamber's legislation.

Another Republican cost-containment priority missing from the bill is meaningful medical malpractice reform. (The bill only encourages states to think about it.) Nichols, of the centrist New America Foundation, would like to see that included as well. Its omission is one reason he says he gives the plan a “b” rather than an “a”; the other is he’d like to see mechanisms to more quickly diffuse into the private insurance system reforms that show promise in Medicare. Democratic sources say a group of centrist Democrats led by Virginia Senator Mark Warner is trying to devise a package designed to do just that, perhaps by expanding the role of the independent Medicare advisory commission.

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn’t able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. “One never knows whether we’re turning the corner or if this is just playing the same old game for another inning,” he says. “But I sense there’s something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve.” If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.

Gray Panthers sit in Pelosi’s office for Single Payer

Demonstration outside the sit-in for single-payer at Pelosi's office

About a dozen single payer activists, including three Gray Panthers, sat in at Rep. Nancy Pelosi’s SF office on November 3rd, demanding she honor her promises on single payer. Pelosi had promised that the House health reform bill, HR 3962, would include the Kucinich Amendment, allowing states the option for single payer and the Weiner Amendment, allowing a full House debate on substituting HR 676 (Conyers national single payer bill) for the entire House bill being proposed.

Our immediate demand was that staff reach Pelosi or her chief aide in Washington by phone, and that we talk with her. We said we would stay until this happened. Some three hours later, we were arrested for failing to follow directions to leave. The arrests were ordered by Pelosi aide Dan Bernal, whom we remember for calling the GP office several years ago demanding apology for our newsletter article attacking her votes for war funding.  Bernal was too chicken to make the formal complaint from Pelosi’s office, so he went scurrying around trying to find someone else to make a complaint. All this time, we and the crowd outside were dialing Pelosi’s Washington office, so the switchboard was jammed and calls were rolling over onto a fax line.

Pelosi’s position as House Speaker is largely based on her ability to raise huge sums for Democratic electoral campaigns, so she stands at the intersection between political power and big money including big money from insurers, drug companies, and hospital chains. It is particularly galling that she uses that power to stall implementation of single payer in California, which twice passed the legislature of the state she is supposed to represent.  This is what dictatorship looks like.

Free Lynne Stewart!

Protest the Jailing of Lynne Stewart.   One of the first victims of the Patriot Act, she was convicted of aiding and abetting terrorism in the course of her legal work. Based on her years of defending the most exploited, and government infringement of attorney-client confidentiality in the case, she was sentenced to only 28 months of detention, and was freed on appeal.  Now, at age 70 and battling breast cancer, she has been ordered to jail, and her sentence is being reviewed to be increased. Read more.

SF Gray Panther Newsletter, December, 2009
Lynne Stewart’s Appeal Denied

Lynne at the SF Gray Panthers

After a long career representing the poor, oppressed and unpopular, radical attorney Lynne Stewart has been sent to jail. On November 17, a federal appeals court upheld her 2005 conviction of conspiracy and providing material support to terrorists and ordered her bond revoked. It also faulted District Judge John G. Koeltl for failing to issue a finding on whether she had committed perjury, and ordered him to review the mitigating circumstances that led him to sentence her to 28 months rather than the 30 years requested by the government. .

In the many years since charges were brought against her, the Gray Panthers have participated in nation-wide support and fundraising efforts for Lynne. In a typical political analysis of the events, she said the decision’s timing, “coming as it does on the eve of the arrival of the tortured men from the offshore prison in Guantánamo,” carried a message. “If you’re going to lawyer for these people, you’d better toe very close to the line that the government has set out.”

To send Lynne a letter, write:

Lynne Stewart, #53504-054
MCC-NY
150 Park Row
New York, NY 10007

Read SF Gray Panthers page on Lynne Stewart

Jeff Mackler wrote:

Dear Friends of Lynne Stewart,

I just got off the phone with Lynne Stewart a few minutes ago, that is, late Wednesday (early Thursday, November 19, New York time).  She bravely told me that she has been ordered to report to U.S. Federal Marshals to be imprisoned at 5 pm, Thursday, November 19.  There will be a 4 pm NY rally of her supporters, who will escort her to the courthouse for imprisonment.

In San Francisco, we will rally on Monday, Nov. 23 to protest Lynne’s frame-up trial and imprisonment.  Be there!  (See above.)

Background:

Following the November 16 decision of the U.S. Court of Appeals, Second Circuit that rejected Lynne Stewart’s appeal of her 1995 frame-up conviction on five counts of aiding and abetting terrorism, Lynne’s legal team as well as the federal district court were in a quandary as to how to proceed.  (Lynne has been a leading civil and human rights attorney for 30-years.  She is a member of the National Lawyers Guild and a member of the Continuations Committee of the National Assembly to End the Iraq and Afghanistan Wars and Occupations.)

The Second Circuit made what amounted to an unprecedented decision to not only affirm her conviction and reject her appeal but to order that her bail be revoked and that she be remanded to prison.  But lacking clear orders as to who would carry out this decision and when it would happen, the last two days have seen Lynne appear, along with her supporters at two rallies in her defense and numerous press conferences and interviews while judges and lawyers tried to ascertain what to do.  That decision has been made and Lynne will begin serving a 28-month prison term.

However, the Second Circuit’s 2-1 decision also remanded the issue of the length of Lynne’s sentence back to Judge John Koeltl’s Federal District Court ordering Koeltl to reconsider the 28-month jail sentence that he originally imposed.  Obviously furious at the relatively short duration of the sentence, the Second Circuit accepted the prosecution’s assertion that Koeltl had not properly considered the question of whether or not Lynne has perjured herself during her trial.  If that were to be determined, according to the Second Circuit, the length of Lynne’s sentence could be extended.  The single dissenting judge went further — expressing his outrage at Lynne’s relatively short sentence and suggesting that a qualitatively longer sentence be imposed than the majority contemplated.  The government originally demanded a 30-year sentence!

Still fighting, Lynne’s attorneys will ask the Second Circuit for a delay in her incarceration based on Lynne’s scheduled December surgery.  Here too, Lynne guesses that this will be denied, with the court holding that prison facilities are adequate for any medical needs that Lynne, a diabetic with hypertension and recovering from breast cancer surgery, may have.

Meanwhile, a new sentencing hearing before Judge Koeltl is scheduled for December 2 at the Foley Square Courthouse.  Federal prosecutors are expected to ask for the maximum sentence possible.  Also appearing in court will be Mohamed Yousry, Lynne’s innocent co-defendant and translator.  Koeltl was also ordered to reconsider Yousry’s 20-month sentence.  The prison term of a third defendant in Lynne’s case, Ahmed Sattar, who was sentenced to 20-plus years, was not challenged.

At this point we can only speculate as to whether Judge Koeltl will stand by his original sentence or be pressured by the Second Circuit to extend Lynne and Mohammed’s sentences.  The judge is known to carefully consider his sentences.  Close observers believe that he is unlikely to bend and impose a longer sentence.

Should Koeltl refuse to add additional years to Lynne’s prison term, the government is expected to appeal to the U.S. Supreme Court.  Government prosecutors and obviously the Second Circuit are outraged that a “convicted terrorist” has been walking around the streets for the past five years, free to champion her own cause and those of all others who suffer political repression.  It was clear from Judge Koeltl’s short sentence and high praise of Lynne’s record as an attorney and human being, a “credit to her profession,” said Koeltl during the sentencing hearing, that he felt compelled to take his distance from the government’s desire to put Lynne, 70, in prison for what would amount to the rest of her life.

Lynne will appeal the Second Circuit’s ruling to the U.S. Supreme Court.  She has repeatedly stated that her prosecution and persecution are consciously orchestrated by the government to chill the defense bar, that is, to instill the fear of government prosecutions into any attorney who seeks to afford alleged terrorists or others who are victims of unjust government persecution a vigorous and dedicated defense.  Lynne points to the upcoming U.S. prosecution efforts of Guantanamo prisoners as a prime example.

For further information contact: Jeff Mackler, Coordinator, West Coast Lynne Stewart Defense Committee 510-268-9429, <jmackler@lmi.net>.  Mail tax-free contributions payable to National Lawyers Guild Foundation.  Write in memo box: “Lynne Stewart Defense.”  Mail to: Lynne Stewart Defense, P.O. Box 10328, Oakland, CA 94610.

Lynne Stewart is charged for her actions acting as attorney for blind Egyptian cleric named Sheikh Omar Abdul Rahman, who is accused for the basement bombing of the World Trade Center in 1993.  Further investigation of this bombing shows that operatives for Federal agencies were involved in setting up this action.  Read more here.

Flawed Health Reform Could Hurt Dems in 2010—Part I

Flawed Health Reform Could Hurt Dems in 2010—Part I – Working In These Times

Flawed Health Reform Could Hurt Dems in 2010—Part I
Working In These Times, Wednesday, November 25Senate Majority Leader Harry Reid (D-Nev.) (R) hugs Sen. Chris Dodd (D-Conn.) during a news conference after the Senate approved a motion to bring healthcare reform legislation to a full debate on the floor of the Senate on November 21, 2009. (Photo by Brendan Hoffman/Getty Images)

By Roger Bybee

Many progressives appear to know little about the latest proposed Senate health reform bill, other than that it’s not single-payer. This two-part piece will try to remedy that. Part I will address the most fundamental inadequacies of the bill currently being debated.

Democrats’ timid, defensive approach to healthcare, which began by ignoring a single-payer, “Medicare for all” plan, could result in a political train wreck for the Democrats in 2010, while doing little to address Americans’ health problems.

The party has generally failed to authoritatively frame the issue in clear moral terms, instead deploying cloudy policy-wonk phrases that are meaningless to the general public. Democrats have refused to vigorously push a “public option” that could possibly compete with private insurers and thus hold down premiums. Instead, regardless of what version eventually emerges from Congress, the power and profits of insurers will be immensely strengthened, making the task of structural reform far more difficult in the future.

WHY THE DELAY?

The Dems have delayed implementation of most features of reform, even though 45,000 Americans die annually due to lack of insurance, according to a recent Harvard Medical School study. The uninsured only receive belated treatment or vastly inferior care; a new study reported that those without insurance are “nearly twice as likely to die” after treatment as those who have insurance.

So why are Democrats waiting until 2013 or 2014 to apply some of the most important provisions of their (increasingly watered-down) health plan? Perhaps they are afraid of the potential for widespread public disappointment and disillusionment and want to delay that as long as possible.

But people will eventually realize the limitations of what’s called “reform” when the legislation’s essential features start to seep through the media. To wit:

MANDATORY PURCHASE OF UNRELIABLE PRIVATE INSURANCE

“Private health insurance is a defective product. We know from our studies of bankruptcy that the majority of Americans who face medical bankruptcy start their illness with private health insurance but are bankrupted anyway by gaps in coverage, like co-payments, deductibles and uncovered services,” argues Dr. Steffie Woolhandler of Harvard Medical School. No less than 62% of personal bankruptcies are caused by medical costs.

Thus Business Week accurately concluded back in August that “the insurers have already won.” As Dr. Woolhandler explains, expansion of coverage without effective cost controls is likely to be a short-lived victory:

What’s happened in the past when bills like this have passed in the states is that they run out of money very quickly, healthcare is simply unaffordable, and then you start to see the coverage expansions cut back. The subsidies shrink, the Medicaid shrinks, and then you’re back at square one, where you’ve spent a lot of money and not made any progress.

AFFORDABLE PREMIUMS?

Very little discussion has been devoted by the media to the all-important question of whether premium levels will be set at genuinely affordable levels. First, for-profit insurers will continue to have the power to arbitrarily jack up their rates for most Americans whenever they feel like it, whether it is in retribution for regulations they wish to undermine or a drop in their returns from the stock and bond markets (which account for more than 40% of their revenues.)

Second, under the Senate Finance Committee plan drafted in large measure by former Wellpoint insurance lobbyist Liz Fowler working hand-in-glove with Chairman Max Baucus, premiums for under a “silver”-level plan would be unaffordable to most families.

For example, the Washington Post reported that a family of four earning $54,000 would pay premiums of $5,300. But before the family would derive any benefits from those premiums, they would have to pay a $5,000 deductible. In other words, the family would be exposed to
$10,300 in annual health costs.

Third, even the more generous House bill, described in depth by Carol
Miller in at excellent piece at CommonDreams.Org on Nov. 16, would set a deductible limit of $1,500 (which is high, but far lower than the Senate Finance Bill) but would also allow a variety of cost-sharing schemes, with a staggering limit of $10,000 per family annually.

While we don’t yet know the details of the final Senate bill to be unveiled by Majority Leader Harry Reid, there is very good reason to worry about the bill’s content as the Senate heads into debate.

It may take a while to sort out the final bill Democrats hope to enact, but when the public finally has a chance to sift through all the details of the final health bill (the Senate bill still has to be reconciled with the House bill, now weighed down by the fanatically anti-abortion Stupak amendment), they will see that the insurers get tens of millions of new customers thanks to some $465 billion in public subsidies so that fellow Americans can buy insurance, and untold additional billions in revenues.

GIVEAWAYS TO BIG PHARMA

Despite Obama’s campaign-trail blasting of Republic concessions to the drug industry—no federal negotiation of soaring drug prices and a ban on reimportation of drugs from Canada—the White House conceded on these very points.

Dr. Woolhandler observes:

The pharmaceutical industry, frankly, is thrilled with this bill. And despite all their squawking, the health insurance industry is pretty happy, too. You know, Wall Street has rewarded them by driving up the value of their stocks. And I think any fair and honest reading of this bill would say that it’s a tremendous victory for the health insurance industry.

PATHETIC, PUNY PUBLIC OPTION

The option will not be open to all Americans like the “Medicare Plan E” concept proposed about a month back, but will enroll only an infinitesimal 6 million. Hence the public option will never be able to achieve its rationale for exerting positive pressures on the premiums and practices of private insurers.

The public option will have to compete with well-established
private, for-profit insurers (United HealthCare alone has 70 million
customers), and will likely have to negotiate rates with doctors and hospitals rather than a formula of Medicare rates plus 5%.

By now, it is increasingly apparent that the public option is likely to function as a dumping ground for older, sicker patients, and thus will have higher, not lower premiums than the for-profit firms so skilled in “cherry-picking healthy patients. And the Senate plan will permit reactionary states like Mississippi—precisely those states with the most appalling health conditions—to opt out of the plan.

FREEZING INEQUITIES INTO PLACE

The Democratic reform plans institutionalize different tiers of care for people based on their ability to pay. Apparently no longer feeling it necessary to hide America’s shameful secret, the Democratic plans openly create “basic,” “enhanced,” “premium,” and “premium-plus” levels of benefits.

These tiers of coverage fundamentally repudiate the notion that healthcare is a basic human right to which all Americans are equally entitled.

Please visit Working In These Times tomorrow (while taking a break from your Thanksgiving celebrations) for Part II, which will focus on health reform’s electoral implications for Democrats in 2010—based on the assumption that some band-aid version of reform will actually be signed into law, of course.
Posted by Roger Bybee

A New United Movement Stops Mexico for a Day

San Francisco Gray Panther Earl Gilman has been in Mexico for several weeks reporting on the massive strike of Mexico City workers in the municipal electrical power system which was recently privatized, leading to firing of the workers, who were in one of Mexico’s most militant unions.  The workers took over a power plant, and a massive police action was necessary to dislodge the, leading to nation-wide sympathy strikes.

Earl wrote:

In response to the Mexican government´s firing of 44,000 electric workers strikes and stoppages took place throughout Mexico n November 11th.  In the central square in Mexico City 200,000 electric workers, students, teachers gathered to denounce the government action, which appears to be geared to privatizing the industry and destroying an oposition union. (The government claims that there were 60,000 at the demonstration.)

The head of the union, Nartin Esparza, stated: “Power comes from the people and when this is affected, a peaceful social movement needs to rise up.”¨

In Oaxaca the local teachers union closed down classes in 13 thousand schools. Also in Oaxaca the Peoples Assembly (APPO) closed down access to all offices and substations of the power system.

The federal highways between Mexico City and Tuxpan as well the highway between Mexico City and Pachuca the toll booths were taken over and motorists were allowed to pass without paying,. On the highway between Mexico City and Queretaro the police shot at the demonstrators who were blocking the highway.

At the National University there was a 12 hour strike of professors and students.

Thousands of demonstrators rallied in front of the two major television stations that support the government.  The TV stations have accused demonstrators of attacking their reporters, but this seems the action of provocateurs.

The government has offered compensation equivalent to 2 and half years wages to electrical workers who accept by this weekend. The government is also offering re-training courses for work in sewing factories and gardening.  But it appears at least  half the workers have refused the government offer and want their jobs back. The movement that defends the electric workers faces the problem that the families of at least 22,000 workers will have no income.

The following story is from Upside Down World, which reports on Latin American activism and politics.

Upside Down World – A New United Movement Stops Mexico for a Day

A New United Movement Stops Mexico for a Day Print E-mail
Written by Tamara Pearson
Tuesday, 17 November 2009

In the many metro stations of giant Mexico city, amidst the ugly smell of Pizza Hut and the newspapers vendors yelling out, “Gráfico! 3 pesos!”, youth crowd around the hand written posters recruiting for the national police daily. At 12,000 pesos (US$1000) per month, and with increasing unemployment and harder prospects for the country’s youth, the offer is very tempting.Since the US-Mexico trade agreement, NAFTA, the number of Mexicans illegally crossing the border into the US seeking employment has risen to 500,000 a year. Add to this the financial crisis (Mexicans repeat to me “When the U.S sneezes Mexico gets pneumonia”) and Mexican president Calderon’s measures to handle the crisis, which consist in a “fiscal package” of an increased consumption tax including food and medicine, new communication taxes and decreased government spending. Then add the fact that the minimum wage in Mexico today buys a third of what it bought twenty years ago, and you can see how the government’s firing of 44,000 electricity workers, members of the county’s most combative and independent union, SME (Mexican Electrical Union), became catalyst for a movement of people deeply angry at both an unfair economic system, and towards a president who, most studies admit, used fraud to win the elections in 2006.The electricity workers were fired on October 10th. On October 16th, around 500,000 people marched in the capital in protest. One month after the firing the people’s anger still had not cooled, and on November 11th there were again massive marches, road blocks, full strikes and partial strikes all across the country.

The Assembly

The decision to strike was taken on November 5th, in a massive meeting of the newly formed National Assembly of Popular Resistance. This is a convergence made up of around 400 unions, student, rural workers, and indigenous movements, women and gay rights organizations and left and revolutionary political parties from across the country.

The meeting was meant to start at 5, but at quarter to, the hall was already full and the streets outside where loud speakers were setup were also starting to fill up and block traffic. The chair was already welcoming each group, “Comrades from the teachers union, welcome. Compañeros of the Socialist Front, welcome,” and so on. It took about 25 minutes to welcome everyone.

There was an atmosphere of excitement, support and solidarity. In fact “support” (“This support really is seen!”) was the chant of the day as speaker after speaker from various unions declared that their union would also march and strike on November 11th, and, for four hours running, each organization declared that they would contribute to the campaign, hold their own assemblies, print leaflets, rally and march in the lead up to the strike. After and during each speaker, the audience stood tirelessly, waving their fists in the air and chanting.

On the few occasions when unions declared their support in the march, but said they would but not strike, everyone stood up and demanded, “Strike! Strike! Strike!”

The speaker from the telephone union detailed the union’s donations of food to the fired workers, while the left parliamentary party, Party of the Democratic Revolution (PRD) spokeswoman, a legislator, said the PRD had agreed to support all the SME’s decisions and to promote any marches, and handed over a cheque for 154,000 pesos (US $11,700).

University students promised to organize a range of political-cultural events and an “information week” to counter all the misinformation in the mainstream media, while a rural worker said the SME demands were their demands, but that they would also add the demand for food sovereignty. Even the association of retired people had a detailed and ambitious schedule of action to prepare for the national strike.

Martin Esparza, general secretary of the SME, was the last speaker. He told the meeting, “With this movement we’re going to define what kind of country we want… we have to advance and organise the people of Mexico…We create the wealth, and they socialize the losses… we pay to import what the Gringos (U.S) don’t want.”

“They’re after our collective contracts and our unions,” he concluded, talking of inequality, the need for dignity and for organization.

With more chants of “It’s a struggle of all workers of this country”, “Here the workers’ movement is forming”, “Give me an S, M, E…what does it spell…SME! SME! SME!” and “Unions united will never be defeated!”, the meeting concluded with a vote to strike on November 11th and to allow the SME to form a temporary organizing committee of movement representatives to coordinate the strike plans and campaign.

The Campaign

It was an intense week of campaigning. The next morning, the National Autonomous University of Mexico (UNAM) students had already put large stickers for the strike all over the insides of the trains, and there were hand painted banners in most faculties of the university, calling for assemblies and covering the walls with virtual articles on what had really happened to the SME workers.

Many workplaces held their own assemblies and even high school and primary school students marched 10 kilometres on 8 November, placards such as ‘Don’t steal my future”. SME workers marched in the thousands in the centre of the capital on 9 and 10 November.

The March

The long anticipated November 11th march was due to leave at 4 PM, but when I arrived at 2.30, and already there were thousands of people. Many were taking a snooze on their banners, while others were sitting on curbs reading the news. One group was spray painting a huge SME logo on the road, joking about needing Whiteout to fix their mistakes, and chanting when they finished it.

The street vendors, which really make up an ever growing army of their own in Mexico as the unemployed look for alternative ways to stay alive, sold corn, chips, and nuts from carts with posters for the strike taped all over them. When the march left they pushed their carts along with it. One woman with an SME bandana and placard alternated between joining the chanting of the march and calling out, “Two gum packets for 5 pesos!”

one street vendor, Octavio Manzera, wasn’t working that day. “I’m supporting the movement; I think it’s a just struggle. The government is acting in an unconstitutional way, violating the laws and constitution of Mexico, for commercial reasons and in order to privatize,” Manzera said.

Bernando Mejia, a young worker, said “I’m here to support the Mexican people, I’m one of those who doesn’t support the government we have here.”

“I’m here to support the union,” said Ana Laura Flores, a self-described “wife of a worker.”

“I’m supporting the SME. I’m here for the solidarity more than anything,” said university student Omar Vazquez.

“I’m an SME worker, I’m an electrical engineer and I was unjustly fired. This government is a sham, it’s a government of thieves, they took our jobs unconstitutionally, violating our rights as workers and as humans,” said Omar Ruiz. Ruiz was eager to say much more, but the march had already started to leave.

Marchers chanted “If there’s no solution there’ll be revolution!” and “From north to south, east to west, we’ll take on this struggle, no matter what it costs!”, while others sang, and some stuck flags in the arms of the various metal statues that line the wide main avenue.

An hour later, we arrived at Mexico City’s huge Zócalo plaza, filling it, squashed together to the point where an interesting system of lines of humans with hands on shoulders formed in order for people to move through the crowd. Members of this march kept arriving for another two hours, while marches from six other locations also continued to arrive.

One of Many

Organizers estimated that 200,000 people participated in the march, while the newspaper La Jornada reported that police estimated 60,000. However, the march in Mexico City was just one of many, with large marches taking place across the country and in outer suburbs, and workers and movement members blocking roads from 6 in the morning.

University students closed off the roads leading to TV Azteca, one of the most right-wing TV stations in the country, and there was also a protest by “the Other Campaign” in front of the US embassy. Universities went on strike, and students and teachers joined the march after their own protest on campus. The telephone and judicial power unions also went on strike, and some shops had signs saying they were turning off their lights or electricity in solidarity, while many shops were simply closed. Miners sent a contingent to the main march and held other marches in seven of the main mining cities and towns, and the National Organisation of Administrative, Manual and Technical Workers of National Anthropology and History Institute organized partial blockades of museums and archaeological zones of the country.

La Jornada reports that 14 toll booth points were also taken over. At one road block, on a main road to Puebla, one of the closest cities to the capital, national police dispersed the blockade with tear gas. La Jornada reported four injured protestors and three police. Eleven protestors were arrested and, on Thursday, Esparza told the press that they had been detained incommunicado and some had been beaten.

The Zócalo

Standing, listening to the speakers in the Zócalo, with my feet at unnatural angles in the little ground space available, a man in a mask shared his mandarin with me, and everyone around me listened with good humour and concentration to the speakers. A group wedged their way in front of us with a large plastic SME banner tied to ladders.

“Lower the banner! We can’t see!” yelled out the crowd around and behind me. The banner holders did, and the crowd called out, “Thanks compañeros!”

Meanwhile, the students to my left were having a ball chanting vehemently, laughing and smiling and jumping up and down and sharing bags of apples.

By 7:30, it was dark and freezing, and I watched the end of the march arrive. In it came a group with drums, a dancer and a violinist. Someone in the plaza set off fireworks and the palace was lit up. The smell of roasted corn rose above the milling people as they drummed and sang, some with large paper mache masks of politicians. A group of chanters defied their audibly sore voices, and a truck with music arrived, then more drums.

Covered and Uncovered

The next day, Mexican mainstream media chose to highlight an incident involving tear gas, with headlines of “Violence” and “Chaos.” The Excelsior headlined with “Patience tested,” and its biggest photo was of the tear gas. It bemoaned “children left without classes” and naively stated: “We can’t see what Chiapas is protesting about; SME has nothing to do with them.”
What the media did not want to talk about was a new solidarity that has formed, and how the movement has gone well beyond a labour conflict, with much more youth participating than during the protests against the electoral fraud of 2006.

An SME leader (who prefers to be described as a member), Jose Hernandez, told me the mobilization was much bigger than any previous ones, but that it was less apparent as it was spread out in various places and times.

“Up until now,” Hernandez said, “we’ve heard of 16 marches in other states, and just in the state of Michoacan for example, 11,000 schools went on strike, as well all the higher education institutions.”

“It’s also necessary to consider the amount of disorganization and domination which the large part of the Mexican working class has found itself in. What happened today signifies, without any doubt, a ‘leap’ in the consciousness of the Mexican working class. We need to be patient, but it seems to me that we’re on the threshold of qualitative change.”

Earlier articles on the Electrical Workers’ strike in Upside Down World

Mexico’s Utility Union Bust Reveals Flaws in NAFTA

Electrical Workers of Mexico Take on Calderon Government

Red Alert: The Second Wave of The Financial Tsunami

Red Alert: The Second Wave of The Financial Tsunami

Red Alert: The Second Wave of The Financial Tsunami
The Wave Is gathering force & could hit between the first & second quarter of 2010By Matthias Chang

Global Research, November 22, 2009
Future Fast Forward

Many of my friends who have been receiving my e-mail alerts over the last two years have lamented that in recent weeks I have not commented on the state of the global economy. I appreciate their anxiety but they forget that I am not a stock market analyst who is paid to write articles to lure investors back into the market. My website is free and I do not sell a financial newsletter so there is no need for me to churn out daily forecasts or analysis.

However, when the data is compelling and supports an inevitable trend, it is time for another review. This Red Alert is to enable visitors to my website to take appropriate actions to safeguard their wealth and welfare of their families in the coming months.

Since the last quarter of 2008, unrelenting currency warfare has been waged by the key global economies and while this competition thus far has been non-antagonistic, it will soon be antagonistic because the inherent differences are irreconcilable. The consequences to the global economy will be devastating and for the ordinary people, massive unemployment and social unrest are assured.

The policy-makers of these countries faced with the total collapse of the international financial architecture have concluded that the solution, the only solution is quantitative easing (i.e. massive injection of liquidity) to salvage the “too big to fail” banks and reinflate their depressed economies. This is best reflected in Bernanke’s candid remark that, “the US government has a technology, called the printing press (or today, its electronic equivalent), that allows it to produce as many US dollars as it wishes at essentially no cost”.

This is the crux of the problem!

The Irreconcilable Differences

Some two decades ago, it was decided by the global financial elites that the framework for the global economy shall consist of:

1) A global derivative-based financial system, controlled by the US Federal Reserve Bank and its associate global banks in the developed countries.

2) The re-location from the West to the East in the production of goods, principally to China and India to “feed” the developed economies.

The entire system was built on a simple principle, that of a FED-controlled global reserve currency which will be the engine for growth for the global economy. It is essentially an imperialist economic principle.

Once we grasp this fundamental truth, Bernanke’s boast that the “US can produce as many US dollars as it wishes at no cost” takes on a different dimension.

I have talked to so many economists and when asked what is the crux of the present financial problem, they all respond in unison, “it is the global imbalances… the West consumes too much while the East saves too much and consumes not enough”. This is exemplified by the huge US trade deficits on the one part and China’s massive surpluses on the other.

Incredible wisdom and almost everyone echoes this mantra. The recent concluded APEC Summit was no different. This mantra was repeated as well as the call for freer trade between trading nations.

This is a grand hoax. All the current leaders on the world’s stage are corrupted to the rotten core and as such have no interest to call a spade a spade and expose the inherent contradictions within the existing financial system.

The call for a multi-polar world is meaningless when the entire global financial system is based on the unipolar US dollar reserve currency. This is the inherent contradiction within the present system and the problems associated with it cannot be resolved by another global reserve currency based on the IMF’s Special Drawing Rights as advocated by some countries. It was stillborn, the very moment it was conceived!

The leaders of China, Japan and the oil producing countries of the Middle East are all cursing and pissing about the current situation, but they don’t have the courage of their convictions to spell it out to their countrymen that they have been conned by the financial spin masters from the Fed acting on the instructions from Goldman Sachs.

Tell me which leader would dare admit that they have exchanged the nation’s wealth for toilet papers?

The toilet paper currency pantomime continues.

We have now reached a stalemate in the current currency war, not unlike the situation of the Cold War between the NATO pact countries and the Warsaw pact countries. Both sides were deterred by the MAD (Mutually Assured Destruction) doctrine of nuclear wars. The costs to both sides were horrendous and it was only when the Soviet Union could not continue with the pace and cost of maintaining a nuclear deterrent and was forced into bankruptcy that the balance tilted in favour of the NATO alliance.

But it was a pyrrhic victory for the US and it allies. What kept the ability of the US to maintain its military might and outspend the Soviet Union was the right to print toilet paper currency and the acceptance of the US dollar by her allies as the world’s reserve currency.

But why did the countries allied to the US during the Cold War accepted the status quo?

Simple! They were all conned into believing that without the protection of Big Brother and its military outreach, they would be swallowed up by the communist menace. They agreed to march to the tune of the US Pied-Piper.

The next big question – why did the so-called “liberated” former communist allies of the Soviet bloc jump on the bandwagon?

Simple! They all believed in the illusion that was fostered by the global banks, led by Goldman Sachs that trading and selling their goods and services for the toilet paper US reserve currency would ensure untold wealth and prosperity.

But the biggest game in town was the Asia gambit. Japan, after a decade of recession following the burst of her property bubble did not have the means and the capacity to bring the game to the next level as envisaged by the financial architects in Goldman Sachs.

And China was the biggest beneficiary. The senior management of Goldman Sachs brokered a secret pact with China’s leaders that in exchange for orchestrating the most massive injection of US dollar capital and wholesale re-location of manufacturing capacity in the history of the global economy, China would recycle their hard-earned US toilet paper reserve currency wealth into US treasuries and other US debt instruments.

This was the necessary condition precedent for the global financial casino to rise to the next level of play.

Why?

The New Game

The financial architects at Goldman Sachs had a master plan – to dominate the global financial system. The means to achieve this financial power was the Shadow Banking System, the lynchpin being the derivative market and the securitization of assets, real and synthetic. The stakes would be huge, in the hundreds of US$ trillions and the way to transform the market was through massive leverage at all levels of the financial game.

But there was an inherent weakness in the overall scheme – the threat of inflation, more precisely hyperinflation. Such huge amounts of liquidity in the system would invariably trigger the depreciation of the reserve currency and the confidence in the system.

Hence the need for a system to keep in check price inflation and the illusion that the purchasing power of the toilet paper reserve currency could be maintained.

This is where China came in. Once China became the world’s factory, the problem would be resolved. When a suit which previously cost US$600 could be had for less than US$100, and a pair of shoes for less than US$5, the scam masterminds concluded that there would be no foreseeable threat to the largest casino operation in history.

China agreed to the exchange as it has over a billion mouths to feed and jobs for hundreds of millions needed to be secured, without which the system could not be maintained. But China was pragmatic enough to have two “economic systems” – a Yuan based domestic economy and a US$ based export economy, in the hope that the profits and benefits of the export economy would enable China to transform and establish a viable and dynamic domestic market which in time would replace the export dependent economy. It was a deal made with the devil, but there were no viable alternative options at the material time, more so after the collapse of the Soviet Union.

The Next Level of the Game

The next level of the game was reached when the toilet paper reserve currency literally went virtual – through the simple operation of a click of the mouse in the computers of the global banks.

The big boys at Goldman Sachs and other global banks were more than content to leave Las Vegas for the mafia and their miserable billions in turnover. The profits were considered dimes when compared to the hundreds of trillions generated by the virtual casino. It was a financial conquest beyond their wildest dreams. They even called themselves, “Master of the Universe”. Creating massive debts was the new game, and the big boys could even leverage more than 40 times capital! Asset values soared with so much liquidity chasing so few good assets.

However, the financial wizards failed to appreciate and or underestimate the amount of financial products that were needed to keep the game in play. They resorted to financial engineering – the securitization of assets. And when real assets were insufficient for securitization, synthetic assets were created. Soon enough, toxic waste was even considered as legitimate instruments for the game so long as it could be unloaded to greedy suckers with no recourse to the originators of these so-called investments.

For a time, it looked as if the financial wizards have solved the problem of how to feed the global casino monster.

Unfortunately, the music stopped and the bubble burst! And as they say the rest is history.

The Goldman Sachs Remedy

When losses are in the US$ trillions and whatever assets / capital remaining are in the US$ billions, we have a huge problem – a financial black-hole.

The preferred remedy by the financial masterminds at Goldman Sachs was to create another hoax – that if the big global banks were to fail triggering a systemic collapse, there would be Armageddon. These “too big to fail” banks must be injected with massive amount of virtual monies to recapitalize and get rid of the toxic assets on their balance sheet. The major central banks in the developed countries in cahoots with Goldman Sachs sang the same tune. All sorts of schemes were conjured to legitimize this bailout.

In essence, what transpired was the mere transfer of monies from the left pocket to the right pocket, with the twist that the banks were in fact helping the Government to overcome the financial crisis.

The Fed and key central banks agreed to lend “virtual monies” to the “too big to fail” global banks at zero or near zero interest rate and these banks in turn would “deposit” these monies with the Fed and other central banks at agreed interest rates. These transactions are all mere book entries. Other “loans” from the Fed and central banks (again at zero or near zero interest rates) are used to purchase government debts, these debts being the stimulus monies needed to revive the real economy and create jobs for the growing unemployed. So in essence, these banks are given “free money” to lend to the government at prior agreed interest rates with no risks at all. It is a hoax!

These “monies” are not even the dollar bills, but mere book entries created out of thin air.

So when the Fed injects US$ trillions into the banking system, it merely credits the amount in the accounts of the “too big to fail” banks at the Fed.

When the system is applied to international trade, the same modus operandi is used to pay for the goods imported from China, Japan etc.

For the rest of world, when buying goods denominated in US$, these countries must produce goods and services, sell them for dollars in order to purchase goods needed in their country. Simply put, they have to earn an income to purchase whatever goods and services needed. In contrast, all that the US needs to do is to create monies out of thin air and use them to pay for their imports!

The US can get away with this scam because it has the military muscle to compel and enforce this hoax. As stated earlier, this status quo was accepted especially during the Cold War and with some reluctance post the collapse of the Soviet Union, but with a proviso – that the US agrees to be the consumer of last resort. This arrangement provided some comfort because countries which have sold their goods to the US, can now use the dollars to buy goods from other countries as more than 80 per cent of world trade is denominated in dollars especially crude oil, the lifeline of the global economy.

But with the US in full bankruptcy and its citizens (the largest consumers in the world) being unable to borrow further monies to buy fancy goods from China, Japan and the rest of the world, the demand for dollar has evaporated. The dollar status as a reserve currency and its usefulness is being questioned more vocally.

The End Game

The present fallout can be summarized in simple terms:

Should a bankrupt country (the US) be allowed to use money created out of thin air to pay for goods produced with the sweat and tears of hardworking citizens of exporting countries? Adding insult to injury, the same dollars are now purchasing a lot less than before. So what is the use of being paid in a currency that is losing rapidly its value?

On the other hand, the US is telling the whole world, especially the Chinese that if they are not happy with the status quo, there is nothing to stop them from selling to the other countries and accepting their currencies. But if they want to sell to the mighty USA, they must accept US toilet paper reserve currency and its right to create monies out of thin air!

This is the ultimate poker game and whosoever blinks first loses and will suffer irreparable financial consequences. But who has the winning hand?

The US does not have the winning hand. Neither has China the winning hand.

This state of affairs cannot continue for long, for whatever cards the US or China may be contemplating to throw at the table to gain strategic advantage, any short term gains will be pyrrhic, for it will not be able to address the underlying antagonistic contradictions.

When the survival of the system is dependent on the availability of credit (i.e. accumulating more debts) it is only a matter of time before both the debtor and creditor come to the inevitable conclusion that the debt will never be paid. And unless the creditor is willing to write off the debt, resorting to drastic means to collect the outstanding debt is inevitable.

It would be naïve to think that the US would quietly allow itself to be foreclosed! When we reach that stage, war will be inevitable. It will be the US-UK-Israel Axis against the rest of the world.

The Prelude to the End Game

The US economy will be spiraling out of control in the coming months and will reach critical point by the end of the 1st quarter 2010 and implode by the 2nd quarter.

The massive US$ trillions of dollars stimulus has failed to turn the economy around. The massive blood transfusion may have kept the patient alive, but there are numerous signs of multi-organ failure.

There will be another wave of foreclosures of residential and more importantly commercial properties by end December and early 2010. And the foreclosed properties in 2009 will lead to depressed prices once they come through the pipeline. Home and commercial property values will plunge. Banks’ balance sheets will turn ugly and whatever “record profits” in the last two quarters of 2009 will not cover the additional red ink.

Given the above situation, will the Fed continue to buy mortgage-backed securities to prop up the markets? The Fed has already spent trillions buying Fannie Mae and Freddie Mac mortgages with no potential substitute buyer in sight. Therefore, the Fed’s balance sheet is as toxic as the “too big to fail” banks that it rescued.

In the circumstances, it makes no sense for anyone to assert that the worst is over and that the global economy is on the road to recovery.

And the surest sign that all is not well with the big banks is the recent speech by the President of the Federal Reserve Bank of New York, William Dudley at Princeton, New Jersey when he said that the Fed would curtail the risk of future liquidity crisis by providing a “backstop” to solvent firms with sufficient collateral.

This warning and assurance deserves further consideration. Firstly, it is a contradiction to state that a solvent firm with sufficient collateral would in fact encounter a liquidity crisis to warrant the need for a fall back on the Fed. It is in fact an admission that banks are not sufficiently capitalized and when the second wave of the tsunami hits them again, confidence will be sorely lacking.

Dudley actually said that, “the central bank could commit to being the lender of last resort… [and this would reduce] the risk of panics sparked by uncertainty among lenders about what other creditors think”.

To put it bluntly what he is saying is that the Fed will endeavour to avoid the repeat of the collapse of Bear Stearns, Lehman Bros and AIG. It is also an indication that the remaining big banks are in trouble.

It is interesting to note that a Bloomberg report in early November revealed that Citigroup Inc and JP Morgan Chase have been hoarding cash. The former has almost doubled its cash holdings to US$244.2 billion. In the case of the latter, the cash hoard amounted to US$453.6 billion. Yet, given this hoarding by the leading banks, the New York Federal Reserve Bank had to reassure the financial community that it is ready to inject massive liquidity to prop up the system.

It should come as no surprise that the value of the dollar is heading south.

When currencies are being debased, volatility in the stock market increases. But the gains are not worth the risks and if anyone is still in the market, they will be wiped out by the 1st quarter of 2010. The S&P may have shot up since the beginning of the year by over 25 per cent but it has been out-performed by gold. The gains have also lagged behind the official US inflation rate. It has in fact delivered a total return after inflation of approximately minus 25 per cent. When Meredith Whitney remarked that, “I don’t know what’s going on in the market right now, because it makes no sense to me”, it is time to get out of the market fast.

In a report to its clients, Société Générale warned that public debt would be massive in the next two years – 105 per cent of GDP in the UK, 125 per cent in the US and in Europe and 270 per cent in Japan. Global debt would reach US$45 trillion.

At some point in time, all these debts must be repaid. How will these debts be repaid?

If we go by what Bernanke has been preaching and practising, it means more toilet paper currency will be created to repay the debts.

As a result, debasement of currencies will continue and this will further aggravate existing tensions between the competing economies. And when creditors have enough of this toilet paper scam, expect violent reactions!
Disclaimer: The views expressed in this article are the sole responsibility of the author and do not necessarily reflect those of the Centre for Research on Globalization. The contents of this article are of sole responsibility of the author(s). The Centre for Research on Globalization will not be responsible or liable for any inaccurate or incorrect statements contained in this article.

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15-fold increase of birth defects and childhood cancers in Falluja

Huge rise in birth defects in Falluja | World news | guardian.co.uk

* Martin Chulov in Falluja
* guardian.co.uk, Friday 13 November 2009 19.24 GMT

Doctors in Iraq’s war-ravaged enclave of Falluja are dealing with up to 15 times as many chronic deformities in infants and a spike in early life cancers that may be linked to toxic materials left over from the fighting.The extraordinary rise in birth defects has crystallised over recent months as specialists working in Falluja’s over-stretched health system have started compiling detailed clinical records of all babies born.Neurologists and obstetricians in the city interviewed by the Guardian say the rise in birth defects – which include a baby born with two heads, babies with multiple tumours, and others with nervous system problems – are unprecedented and at present unexplainable.

A group of Iraqi and British officials, including the former Iraqi minister for women’s affairs, Dr Nawal Majeed a-Sammarai, and the British doctors David Halpin and Chris Burns-Cox, have petitioned the UN general assembly to ask that an independent committee fully investigate the defects and help clean up toxic materials left over decades of war – including the six years since Saddam Hussein was ousted.

“We are seeing a very significant increase in central nervous system anomalies,” said Falluja general hospital’s director and senior specialist, Dr Ayman Qais. “Before 2003 [the start of the war] I was seeing sporadic numbers of deformities in babies. Now the frequency of deformities has increased dramatically.”

The rise in frequency is stark – from two admissions a fortnight a year ago to two a day now. “Most are in the head and spinal cord, but there are also many deficiencies in lower limbs,” he said. “There is also a very marked increase in the number of cases of less than two years [old] with brain tumours. This is now a focus area of multiple tumours.”

After several years of speculation and anecdotal evidence, a picture of a highly disturbing phenomenon in one of Iraq’s most battered areas has now taken shape. Previously all miscarried babies, including those with birth defects or infants who were not given ongoing care, were not listed as abnormal cases.

The Guardian asked a pediatricians Samira Abdul Ghani, to keep precise records over a three-week period. Her records reveal that 37 babies with anomalies, many of them neural tube defects, were born during that period at Falluja general hospital alone.

Dr Bassam Allah, the head of the hospital’s children’s ward, this week urged international experts to take soil samples across Falluja and for scientists to mount an investigation into the causes of so many ailments, most of which he said had been “acquired” by mothers before or during pregnancy.

Other health officials are also starting to focus on possible reasons, chief among them potential chemical or radiation poisonings. Abnormal clusters of infant tumours have also been repeatedly cited in Basra and Najaf – areas that have in the past also been intense battle zones where modern munitions have been heavily used.

Falluja’s frontline doctors are reluctant to draw a direct link with the fighting. They instead cite multiple factors that could be contributors.

“These include air pollution, radiation, chemicals, drug use during pregnancy, malnutrition, or the psychological status of the mother,” said Dr Qais. “We simply don’t have the answers yet.”

The anomalies are evident all through Falluja’s newly opened general hospital and in centres for disabled people across the city. On 2 November alone, there were four cases of neural-tube defects in the neo-natal ward and several more were in the intensive care ward and an outpatient clinic.

Falluja was the scene of the only two setpiece battles that followed the US-led invasion. Twice in 2004, US marines and infantry units were engaged in heavy fighting with Sunni militia groups who had aligned with former Ba’athists and Iraqi army elements.

The first battle was fought to find those responsible for the deaths of four Blackwater private security contractors working for the US. The city was bombarded heavily by American artillery and fighter jets. Controversial weaponry was used, including white phosphorus, which the US government admitted deploying.

Statistics on infant tumours are not considered as reliable as new data about nervous system anomalies, which are usually evident immediately after birth. Dr Abdul Wahid Salah, a neurosurgeon, said: “With neural-tube defects, their heads are often larger than normal, they can have deficiencies in hearts and eyes and their lower limbs are often listless. There has been no orderly registration here in the period after the war and we have suffered from that. But [in relation to the rise in tumours] I can say with certainty that we have noticed a sharp rise in malignancy of the blood and this is not a congenital anomaly – it is an acquired disease.”

Despite fully funding the construction of the new hospital, a well-equipped facility that opened in August, Iraq’s health ministry remains largely disfunctional and unable to co-ordinate a response to the city’s pressing needs.

The government’s lack of capacity has led Falluja officials, who have historically been wary of foreign intervention, to ask for help from the international community. “Even in the scientific field, there has been a reluctance to reach out to the exterior countries,” said Dr Salah. “But we have passed that point now. I am doing multiple surgeries every day. I have one assistant and I am obliged to do everything myself.”

Huge rise in birth defects in Falluja

Paying for Health Reform: Medicare Advantage overpayments shifted onto seniors, not eliminated

Counterpunch, November 23, 2009

Health Care Reform and the Skinning of Seniors

By MARY LYNN CRAMER

The endgame is over for low-income senior citizens, but the national hoax continues.  Seniors in the state where I live don’t have to wait for the finale of “what is expected to be a bruising, full-scale health care debate after Thanksgiving” (AP) to find out how their health care costs and benefits will be impacted. No, the low-income elderly in Massachusetts already got notices in the mail, weeks ago, from their Medicare Advantage insurance providers announcing big premium increases for 2010.

In anticipation of the long-promised cuts in government funding to Medicare Advantage plans under any new health insurance makeover bill, the Medicare Advantage providers have jumped the gun, and already passed their predicted losses in profits onto the backs of their fixed-income elderly “beneficiaries.”  In my case, monthly premiums will go up 52 per cent.  Services for which there previously were no charges — like physical therapy, for instance — will now require the same $20 co-pay paid to physicians.  The cost of drugs will also see huge increases in the revised “formulary” which sets out restrictions on which drugs can be prescribed.  Low-income elderly also got letters from “Prescription Advantage,” a program that helped them with the cost of drug coverage, that “Effective January 1, 2010, Prescription Advantage will no longer pay any portion of your Medicare Part D drug plan premium.” They suffered a $5.6 million loss in government federal funding for next year. (Personal phone communication with PA staff.)

No one in the mainstream media or in Congress has been willing to talk openly about this one element of any new health insurance legislation that Obama and his bi-partisan buddies agreed to months ago.  At least as far back as July 2009, media coverage often led with Obama’s exclamations of his intention to “eliminate waste and inefficiency in Medicare,” by cutting “more than $100 billion in ‘unwarranted’ insurance company subsidies to Medicare.” (UPI, July 22, ’09).  Every week The President seemed to identify more waste that could be cut from Medicare Advantage programs to help pay for his health reform. (AP/ Espo & Werner, July 29, ’09).

As that amount continues to increase by $100s of billions, recent reminders that the now estimated $500 billion in Medicare “cost savings” will be taken out of the hide of poor seniors have been relegated to the final lines of press reports. For example: “To finance the expanded coverage Reid [Senate Majority Leader Harry Reid, D-Nev.]  proposed higher taxes as well as cuts totaling hundreds of billions of dollars in projected Medicare payments.  Hardest hit would be the private insurance Medicare plans, although providers such as home health agencies would also receive significantly less in future years than now estimated.” (AP/Espo, November 21, ’09). And, “About half of the bill Reid unveiled Wednesday would be financed by curbs in projected Medicare spending. While providers such as home health care agencies would absorb some of that, the biggest blow would fall on private Medicare plans.”  (AP/Espo, November 19, ’09).

This issue inspires no drama, no colorful debate, no headlines.   Targeting low-income elderly for cost cutting has always been the one objective upon which the Obama administration and both “sides of the aisle” are in complete agreement.  (See my articles: The Myth of Medicare for All, www.counterpunch.org/cramer08052009.html; Progressives Abet Obama-Fraud, www.counterpunch.org/cramer08182009.html; Doublespeak on Health Care, www.counterpunch.org/cramer10072009.html; Seniors on the Chopping Block, www.counterpunch.org/cramer10012009.html.).

Today, NPR’s “in-depth” discussion of who will pay for healthcare reform did not once mention the enormous contribution poor, aging citizens are being forced to make (“On Point” November 23, ’09).   The Obama administration, Congress, and the American public pretend not to be aware of the planned consequences for senior citizens; and worse, they ignore the fact that those hurtful consequences agreed to in close-door meetings with Obama’s chosen few have already been realized.  Frankly, Granny, they don’t give a damn.

Those who have not yet entered the growing ranks of enrollees in some form of Medicare, may not know that low-income seniors paying monthly premiums to Medicare Advantage plans also pay, in addition, the standard monthly premium for the wholly inadequate Medicare Parts A& B (sometimes called “Original Medicare” and more recently “FFS Medicare.”).  FFS Medicare does not cover monthly physical exams, nor eye exams, glasses, hearing exams, drugs, and a whole list of other medical services one would think the elderly in particular would require as they age.  That’s why we enroll in Medicare Advantage—to get comprehensive, affordable coverage of the basic services we need.  Whenever challenged about the impact on the elderly of drastically reducing funding to Medicare Advantage plans, Obama has repeatedly insisted that that $500 billion in cuts will have no effect on the cost or quality of services to seniors!  He repeatedly insisted those hundreds of billions of dollars in “cost savings” would only come from fraudulent and wasteful practices of Medicare Advantage programs that, he said, cost the government 14 per cent more than similar services provided by the original FFS Medicare.

At a recent Town Meeting on Health Care, my Congressman put the same spin on the aforementioned cuts when I asked him how he planned to protect my Medicare Advantage health insurance benefits. He responded, “Medicare Advantage costs the government and US taxpayers 14 per cent more than the same services under FFS Medicare. The cuts will only be from wasteful spending and fraud.”  I pointed out to the Representative the obvious fact that paying 14 per cent more for 95 per cent more coverage of essential medical services was a real bargain. However, what was not discussed in much more important: This excuse for skinning seniors is not only “spin,” it is such a distortion of the facts as to qualify for out and out lying to the American public.  To justify looting some of the most vulnerable and poor in our society— in order to finance the forced purchase of private health insurance by the rest of the population — the President, Congress and the Free Press have joined forces in spreading the myth that Medicare Advantage overcharges by 14 per cent compared with FFS Medicare.

Most of the statistics on health care costs are designed to overwhelm the consumer, encouraging them to believe they should leave interpreting the data up to political and corporate experts who have their own interests — not the consumers’ welfare — in mind.  Therefore, I refer you to some clearly understandable information provided by the “Report to the Congress: Medicare Payment Policy,” March 2009:  Close to one-quarter (23 per cent ) of Medicare beneficiaries are enrolled in Medicare Advantage plans which receive 23 per cent  of total Medicare funding.  Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-For-Service (PFFS) plans, and Special Needs Plans (SNPs).  Enrollment in Medicare Advantage is growing rapidly, and the greatest growth is in the HMO plans.  Medicare Advantage HMO plans are more efficient, according to the “Report to Congress,” and their cost of providing the same services is less than the cost under FFS Medicare.

So, where does the ‘politically correct’ commentary about Medicare Advantage costing 14 per cent  more than regular FFS Medicare come from?  From the manipulation of statistics.  The Report states: “MA [Medicare Advantage] plans provide enhanced benefits to enrollees, but, except for HMOs (which finance a portion of those benefits through bids below FFS), the enhanced benefits are financed entirely by the Medicare program and by beneficiaries — and at a high cost.  For example each dollar’s worth of enhanced benefits in PFFS [Private Fee-For-Service] plans cost the Medicare program more tan $300.”

Low-income seniors in urban areas are unlikely to enroll in these more expensive PFFS that allow you to go to any physician or specialist your want.  Most urban elderly purchasing Medicare Advantage are enrolled in the much less expensive HMO’s, where choice is limited to particular “panels” of physician groups and hospitals that have agreed to conditions of capitated payment and coverage set by the HMO.  Not only do the Medicare Advantage HMOs provide services more cheaply than does the original FFS Medicare, the Report makes it clear that “Quality is not uniform among MA [Medicare Advantage] plans or plan types.  High–quality plans tend to be established HMOs.”  HMOs continue to enroll the most beneficiaries of all plan types and, “We estimate that HMO bids were on average 98 percent of FFS [regular Medicare].  This suggests that HMOs can provide Part A and Part B services for less than the cost of FFS [regular Medicare].” HMOs bid to provide the same services at a cost savings of 2 per cent  below the regular FFS Medicare spending. (My emphasis throughout).

But remember that Medicare Advantage covers many services, like annual physical exams, that FFS Medicare does not. These services beyond what FFS Medicare cover are called “Enhanced Benefits.”  With regard to these services, the Report states, “In the case of HMO’s…their bids for the Medicare benefit package are below Medicare FFS spending, the program subsidy is 97 cents for each $1.00 of enhanced benefits.  In the case of PFFS plans, on average, the program subsidy is $3.26 for each dollar of enhanced benefits.  In other words, HMOs are the only MA plan type that finances any part of enhanced benefits through plan efficiencies:  3 cents of every dollar. Enhanced benefits in other plan types are completely subsidized by Medicare.”

And, finally, the Report concludes “Our analysis finds that some plans are able to cover the same services as the traditional Medicare Part A and Part B benefit at a lower cost — namely, HMOs, which cover these services on average at 98 percent of Medicare FFS expenditures.”  The fact of Medicare Advantage HMOs lower cost and higher quality gets lost in the final analysis because the Report is “concerned with the “average” cost of all the services offered by all the various Medicare Plans — those of the very costly PPOs, PFFS, SNPs , together with the very efficient HMOs.  Thus, “in the aggregate” they paint all Medicare Advantage costs as 14 per cent  more than those of FFS Medicare, and de-emphasize the fact that Medicare Advantage HMOs are more efficient than the original FFS Medicare.

Why can’t politicians, journalists, and talk show experts read the “Report to Congress” on Medicare Advantage and figure this out for themselves.  Why do they walk in lock-step agreement with Obama that it is necessary to gut the higher quality, cheaper and more efficient HMO Medicare Advantage program to pay for a big hunk of the cost of privatizing nation-wide health insurance?  And why have the private providers of Medicare Advantage, and huge insurance lobbyists like AARP been on board with this deal from the very beginning?  Why are the providers of Medicare Advantage insurance plans not objecting to the cuts, but already passing their anticipated losses on to elderly subscribers in the form of outrageously higher premiums, co-pays, and drug costs?

Yes, why would AARP and other private health insurance companies go along with this scam? In his article “Cashing In, Selling Out: AARP’s Tradition of Betrayal,” Stephen Lendman exposes the myth that AARP is a nonprofit dedicated to improving the quality of its members’ lives. He quotes the Physicians for a National Health Program calling AARP “part of the problem, not part of the solution.”  AARP, he says, is “largely profit-driven, offering 17 types of insurance reaping hundreds of millions annually in royalties.  Millions more from selling drugs; other products and services including mutual funds; plus federal subsidies exceeding $80 million annually; and annual membership dues…[from] 40 million members.”  He adds that AARP is “also active on Capitol Hill with a 50-person staff and a 2008  $28 million lobbying budget, much like major corporations and for the same purpose – profits at the expense of member interest, unaware how they’re ill-served by an organization claiming to be their advocate.”

As you and I will never see the numbers, we can only imagine the trillions of dollars in new profits the private insurance companies and pharmaceutical industry plan to reap when every American is forced to purchase a private insurance plan on the “free market”.  The very idea of providing a consumer product—with no price regulation or cost controls attached– that every citizen in the nation is required by federal law to purchase must have those CEOs on quite a high.  In the closed-door horse-trading that went on, the decision to give up government funding of seniors’ Medicare Advantage, in return for a lucrative new national  “market,” should have been a relatively painless one. Not only did it cover Obama with the illusion of being hard on private insurance companies while watching out for the “American taxpayers,” all parties involved no doubt knew they could count on the passivity of aging, anxious and insecure Medicare Advantage enrollees to absorb any short-run losses in corporate income.  Making a killing in the short run is the first rule of American Capitalism.

The entire scheme is, of course, just one more bailout for large corporations experiencing declining rates of profits in recent years.  As AP’s Calvin Woodward points out, “The insurance ‘industry’ like other parts of the economy has been in trouble for sometime, in spite of their skyrocketing premiums.   Health insurers posted a 2.2 percent profit margin last year, placing them 35th on the Fortune 500 list of top industries.”  Woodward gives several examples, including “HealthSpring, the best performer in the health insurance industry, post[ing] 5.4 percent.   That’s a less profitable margin than was achieved by the makers of Tupperware, Clorox bleach and Molson and Coors beers.” (AP/Woodward, October 21, ’09)

The President is doing the job his big money backers nominated him to do.  It is the same job any other President faced with an economic crisis must do:  Facilitate the transfer of as much of our national wealth and resources as is possible over to large private industries, while cutting spending on public programs through policies that reduce the consumption of working people, the unemployed, children, the poor and elderly — without causing public unrest or revolt — and, thereby, hopefully increase capital accumulation and  profits enough to encourage investment in expanded production and recovery in the “real economy.”  With all the silly charges of health care  “socialism,” it may be necessary to remind ourselves that our economy continues to be a Capitalist economy.  Capitalism is based on production for profit.  No profit, no production. As I said in my article “Whose Consumption Drives the Economy?  The Multi-Trillion Dollar Question:”

“Government spending on public works programs detracts from capital that could be spent in private profit-making industries. Military production has become big business for many private, for-profit, contractors. The US is the largest producer and distributor of military weapons in the world…But the real problem here is that, under our economic system (Capitalism), public (nonprofit) spending on domestic programs that directly benefit you and me will not jumpstart capitalist (for profit) production. It never has.

“With all the romantic (and a relatively few actual) recollections of FDR’s limited public works programs, it was WWII that provided Roosevelt with the authority to significantly increase employment; retool, redirect and plan industrial production. The US government has not been able to withdraw entirely from its role of propping up and intervening in the private economy. While postwar Europe created programs providing all citizens with healthcare, education, retirement, lengthy vacation time and other government-guaranteed benefits, the US left provision of the larger part of those services to the private sector. In our current economic recession, there will again be only a minimal amount of spending on domestic programs that benefit the citizens rather than private corporations. And that limited public spending will depend on how much ‘public unrest’ is feared…. the US increases competitiveness in the Capitalist world by lowering real wages, eliminating pensions, cutting employer-provided healthcare, and making higher education so expensive even two-income ‘upper middleclass’ families struggle to pay tuition. With this in-your-face everyday reality, it is difficult to understand how so many continue to believe that ours is a “consumer-driven” economy. Working people’s consumption of everyday necessities is being cut, while billions of taxpayer dollars goes to “bail out” financial institutions who have no incentive to loan those funds to low income people (or to companies) now that most of the fraudulent transactions and speculative securities are supposedly under closer scrutiny.”  (See also: Greenspan’s Higher Power,, Their Assets; Our Debts ).

Well, the senior sell-out is now a done deal.  And the “debate” over whether employers, insurance companies, or upper-income couples will be taxed (not!) to help pay for the cost of Obama’s health insurance makeover, sets the stage for more dramatic acting-out.  Backroom bargaining with the loyal “opposition” will abound, similar to the deal Sen. Mary Landrieu of Louisiana bragged about making in return for her holdout vote: “‘I’ve decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done.’ She also touted the $100 million included in the legislation to help her state cover its costs under Medicaid, the state-federal health care program for the poor [sic; poor children and disabled].” (AP, Espo, November 21, ’09).  We can look forward to more circus theatrics around whether a DOA “Public Option” will be run by the government or privatized, opted-in or out.

Last week there was a meeting at my town Senior Center, intended to explain the new Medicare and Medicare Advantage options.  Most of the attendees had gotten the letters advising them of big increases in the costs of their Medicare Advantage insurance plans. None of us had expected to see these painfully predictable results before the ink was even dry on that diabolical insurance bill. (Apparently they wanted to make sure we had the holidays to prepare for more belt-tightening and budgeting in 2010.) Their was much discussion about joining the original Medicare plan that is cheaper but does not cover physical exams, or eye exams, glasses, hearing exams, drugs, etc.  I honestly hate to say, “I told you so!”  I hoped that if I wrote and talked and yelled enough, this would not happen.  Magical thinking aside, I predicted months ago that low-income elderly would be forced into the option all the “progressive” physicians and other liberal professionals have been begging for: “Medicare For All.”   The original FFS Medicare — the worst health insurance imaginable –  requires additional “supplemental plans,” or  ‘”free care” and “safety net” dollars (only available in Massachusetts for those poor enough to qualify), just to cover basic medical needs. This original Medicare plan is accepted by a shrinking number of physicians at federal and state subsidized hospitals and community clinics which are also experiencing huge cuts in Federal and State funding for low income patients.

No, Granny, they aren’t going to “pull the plug on you” without your permission; and there will be no “death panels” by that name. (Those fabricated threats were the kinds of distracting theatrics Obama and the “progressives” love to entertain rather than focus on the issues or details of real reform proposals.) The actual plan is more insidious and noxious.  Your “tin-plate” Medicare Advantage HMO policy will become as expensive as last year’s gold-plated option.  And you will, according to design, eventually have to enroll in the Original FFS Medicare—the most limited, inadequate health insurance available.  Maybe there is some consolation in realizing that with the deepening depression in our real economy, our aging population, and the declining “middle class,” many of those who don’t give a damn, will sooner or later also be forced to join the “beneficiaries” of the worst medical insurance plan in the economically developed world: Medicare For All!

Mary Lynn Cramer, MA, MSW, LICSW, a low-income senior enrolled in a Medicare Advantage HMO plan, has a background in the history of economic thought, and clinical social work.  She can be reached at mllynn2@yahoo.com

Social Security Agency To Investigate If California Is Illegally Denying Social Security Disability and SSI Claims

California Disability Action Community Network,  November 23, 2009

Social Security Agency To Investigate If California Is
Illegally Denying Social Security Disability and SSI Claims

Social Security Commissioner Says Furloughs of Federally Funded State Employees In Dept. of Social Services Who Help In Determining Eligibility May Be Cause of Possible Violations of Federal Social Security Laws – Investigation Comes After Charges Made by San Diego Congressman Who Charged That  Denials of Claims Are Coming At “Expense of Those In Greatest Need”

SACRAMENTO, CALIF (CDCAN) [Updated 11/23/09  07:20 AM  (Pacific Time)  -  The US Social Security Administration will investigate allegations by Rep. Robert Filner (Democrat - San Diego) made before the US House Way and Means Subcommittee on Social Security on November 19th that California is improperly denying social security and SSI (supplemental security income) program claims as a means to get around delays caused by mandatory furloughs of state workers in the Disability Determination Service division within the Department of Social Services, who play a critical role in determining eligibility for those two programs.  The investigation will also look at similar policies and problems in Hawaii which has instituted similar mandatory furloughs of its state employees.

There was no official statement by the Schwarzenegger Administration reacting to the Social Security Administration's investigation.

As a budget cutting measure, earlier this year Governor Arnold Schwarzenegger ordered mandatory furloughs of all state departments and agencies - including the Department of Social Services, which are closed on the first, second, and third Friday of each month until June 30, 2010.  The Department of Social Services' Community Care Licensing Division and the Disability Determination Service Division offices will remain open and operate on "self-directed furloughs".

Commissioner Michael J. Astrue who heads the federal agency, said on Friday (November 20) that in a memo to Patrick P. O'Carroll, Inspector General of the Social Security Administration, ordered the investigation writing that:

...Governor Schwarzenegger has insisted on furloughing California Disability Determination Service...employees, despite the fact that we fully fund both their salaries and overhead.  According to Congressman Robert Filner, the State is attempting to find ways to improperly circumvent the effects of the furlough at the expense of some of the State residents who are in the greatest need.

The action by the Social Security Administration, which has no immediate impact on the state, does add yet more uncertainty about various state budget reductions, with California facing yet another huge budget shortfall - now estimated to be $21 billion by the end of the 2009-2010 State budget year (June 30, 2010).  Advocates and policymakers alike expect more major spending cuts to be proposed in the coming months to close the growing shortfall.

Congressman Filner Makes Charges of Improper Denial of Claims

Congressman Filner testified last Thursday that the California's Disability Determination Service (known as "DDS" - same initials as the "Department of Developmental Services" which is a completely different state agency)  is denying the claims of disability applicants who fail to return a 25 page report within 20 days - a practice which has been adopted since the mandatory state furloughs were implemented earlier this year, reporting the following:

• One California Disability Determination Service field office, Filner claimed, had closed 30% of its cases due to an individual's failure to return the completed application form within 20 days.
• In addition, Filner said he believed that California Disability Determination Services (under the California Department of Social Services) may be manipulating its service numbers by assigning claims to fictional examiners or supervisors, which Filner says would allow the state to hide the fact that these cases are not actually being reviewed.

Commissioner Is Bush Appointee - Reports Directly to President Obama

Commissioner Astrue, appointed by President Bush on September 14, 2006 and confirmed by the US Senate on February 2, 2007, was sworn into office on February 12, 2007 for a 6 year term that expires January 19, 2013.

The commissioner, who oversees the independent federal agency with over 60,000 federal employees and 1,500 offices across the nation,  reports directly to President Obama.  The headquarters is in Baltimore, Maryland.

Impact on People With Disabilities, the Blind & Seniors

The issue has actual and potential impact on thousands of children and adults with disabilities, mental health needs and seniors, among others, who are applying for federal social security disability benefits or federally funded SSI grants.  In California the SSI recipients also include an additional state funded "SSP"  (Supplemental Security Payments) grants.

Any delays or outright denial of claims - especially those dealing with SSI/SSP - could have a ripple effect also on a person's immediate accessible and affordable housing, transportation and medical and other support needs.

The Department of Social Services estimated in May the SSI/SSP caseload by June 30, 2010, will total 1,290,473 persons:

• 376,163 who are seniors or 30% of the projected caseload
• 20,225 persons who are blind (or 2% of the projected caseload)
• 894,085 who are children and adults with disabilities (or 68% of the projected caseload)

Background of Disability Determination Service

• The federal Disability Insurance program, established under Title II of the federal Social Security Act, provides benefits to wage earners and their families in the event the wage earner becomes disabled.
• The Supplemental Security Income program, established under Title XVI of the federal Social Security Act, provides benefits to financially needy individuals who are aged, blind, or disabled.
• The federal Social Security Administration (SSA) is responsible for implementing policies of handling and determining eligibility of disability claims under the Disability Insurance and Supplemental Security Income programs.
• Persons apply for either social security disability or SSI at any Social Security office. If the person applying meets the non-medical criteria, their application would then be sent to the state's Disability Determination Service, who will then obtain the applicant's medical and other related records to determine severity of the disability or impairments and the impact on the ability to engage in work.
• In each of the 50 states (plus the District of Columbia and Puerto Rico), eligibility - or determinations under both Disability Insurance and Supplemental Security Income are performed by its own "Disability Determination Service" (known as "DDS" - same initials used for the Department of Developmental Services, which is a different state agency entirely, though the same person could have gone through Disability Determination Service for SSI eligibility - and then to the Department of Developmental Services for supports and services) in each state. In California, the Disability Determination Service is a division under the Department of Social Services. It has 11 branch field offices, including 3 in Los Angeles County.
• The federal Social Security Administration reimburses state Disability Determination Services for 100% of allowable expenditures up to its approved funding authorization.

Social Security Administration Previously Raised Concerns of State Furlough Impact on Social Security Disability and SSI Claims

In a related action by the Social Security Administration dealing with the impact of California's furloughs, on October 16th, the US Department of Justice, on behalf of the Social Security Administration,  filed a "Statement of Interest" in the state lawsuit "Union of American Physicians and Dentists v. Arnold Schwarzenegger, Governor of California" that seeks to stop the mandatory state furlough program.    The state lawsuit, filed in the Alameda County Superior Court, is still pending further action.  It is one of several lawsuits filed by different unions and agencies regarding the mandatory state furloughs.

The Union of American Physicians and Dentists includes state employees of the California Disability Determination Services Division under the Department of Social Services, who evaluate the medical or health part of a person's Social Security Disability or SSI (Supplemental Security Income) claims.  The federal government fully pays for the salaries and overhead costs for these state employees in all 50 states.

The "Statement of Interest" which indicates in this instance support of this specific lawsuit, notes that California's furloughs of these specific state employees are inconsistent with the state's obligations and responsibilities under the federal Social Security Act which requires a state, in carrying out disability determination functions, "to the best of its ability, facilitate the processing of disability claims by avoiding personnel freezes, restrictions against overtime work, or curtailment of facilities or activities."

Commissioner Astrue said in October:

...for many months we have been trying to convince California officials that furloughing [Disability Determination Service Division state] employees does not save the state a single penny, and actually costs the state money.  It also unnecessarily harms their citizens with disabilities and their civil servants. Unfortunately, our arguments have fallen on deaf ears.  We hope our Statement of Interest will awaken state officials to the irreparable damage their furlough policy is causing.

Asture said in October that California’s furlough of Disability Determination Service employees under the Department of Social Services costs the state $849,000 per furlough day in administrative funding and that  ”…each furlough day results in a delay costing California’s disabled citizens over $420,000 in much-needed Social Security benefits”.

The State, represented by the California Department of Justice, is denying those claims in the various lawsuits.

TEXT OF COMISSIONER ASTRUE’S MEMO ORDERING INVESTIGATION

The following is the memo to Social Security Administration Inspector General Patrick P. O’Carroll from Commissioner Astrue, dated November 20^th:

At yesterday’s [November 19^th] hearing before the House Ways and Means Subcommittee on Social Security, I testified about some disturbing practices the State of California has instituted that aggravate, rather than help, in response to its budgetary situation.  As you know, Gov. Schwarzenegger has insisted on furloughing California Disability Determination Service (DDS) employees, despite the fact that we fully fund both their salaries and overhead.  According to Congressman Robert Filner, the State is attempting to find ways to improperly circumvent the effects of the furlough at the expense of some of the State residents who are in the greatest need.

Congressman Filner indicated that since the furloughs began, the California DDS [CDCAN Note: same initials as Department of Developmental Services which is a different state agency] has begun denying the claims of those disability applicants who fail to return a 25-page report within 20 days.  This practice, if true, places applicants in an untenable position because the substantial amount of information required must often be gathered from third parties.  If an applicant fails to return complete information within the time set by the State, the DDS deems the applicant to have failed to cooperate and closes the file, thereby depriving that applicant of fair and full consideration.

I am also greatly concerned by Congressman Filner’s report that the California DDS may be manipulating its service numbers by “staging” claims, assigning them to fictional examiners or supervisors, rather than to actual examiners.  According to Congressman Filner, this practice would allow the DDS to claim that the cases have been assigned, rather than indicate that they are still in queue, thus minimizing the effects of the furlough.

If true, these practices are, of course, very disturbing.  Therefore, I am asking you to undertake a full review of the practices of the California DDS to determine the scope and breadth of any inappropriate practices.

I am also concerned about the State of Hawaii, which is furloughing its DDS employees for as many days as California, and which has made statements about new business efficiencies that closely track statements made by California officials.  Accordingly, I ask that you also review that agency to ensure they are fully adhering to all SSA rules and policies.

Thank you for your assistance.

NOTE: There may be updated information located on our homepage. Also, don’t forget to check out the post tags to narrow your search.

REMEMBERING THE LIVES OF EDWARD M. KENNEDY, EUNICE KENNEDY-SHRIVER, JOAN LEE, DONALD ROBERTS AND BILL YOUNG

Note from Marty Omoto:

I have decided to return to the work of advocacy for the lives that matter. Thanks to all the hundreds of email messages, phone messages from so many people across the state who reminded me what I often have reminded others of: that we are a part of all that we have met – and that we no choice but to continue and to survive, and to fight for what is right and to always remember the lives that mattered – and the lives that still – and will always matter. That is what we fight for. And that is what we cannot let the State or anyone forget.

And we will get through this.

Gandhi once wrote that we must be the change we want to see in the world. And so we will be that change together. Marty Omoto

Pregnant Latina forced to give birth in shackles by Arpaio deputy

Phoenix New Times, October 20, 2009

Pregnant Latina Says She Was Forced to Give Birth in Shackles
After One of Arpaio’s Deputies Racially Profiled Her

Forced to give birth in shackles

The bleeding kept her up all night, drenching her black-and-white-striped jail uniform.

Alma Chacón feared her baby would arrive early. Her nightmare had started with a traffic stop a day earlier. She’d been weeping since. “What if the baby is born here, in the jail?” she thought.

In the afternoon, she was shackled and transported to Maricopa County Medical Center, where she gave birth in a “forensic restraint.” She couldn’t hold her baby daughter or kiss her. She could only watch as hospital personnel carried the infant out the door. She wouldn’t see the baby for 72 days.

Her case raises questions about the use of racial profiling by Maricopa County sheriff’s deputies during traffic stops, but, most importantly, sheds light on the mistreatment of unconvicted immigrants inside county jails.

Chacón retells her story inside her trailer home in Queen Creek. Outside, her children play in the shell of a home under construction. It’s Chacón’s dream townhome, and she’s been building it a block at a time.

She looks younger than 35; her long, black hair rains straight to the small of her back. The immigrant from Durango, Mexico, has quiet tears. She came to America when she was 16 on a tourist visa and never looked back.

No one promised it would be easy. Tamale sales and housecleaning have barely enabled her to feed her children. The father of the first four of her kids died six years ago in a car accident.

Fear of deportation was always a normal part of Chacón’s life in Queen Creek. The town, with a population of 23,000 on the outskirts of Maricopa County, has a contract with the Sheriff’s Office for police services. Like many immigrants, she drives slowly so she doesn’t attract suspicion.

But that didn’t help the afternoon of October 12, 2008, when she came head to head with a sheriff’s deputy. It was a Sunday and she was on her way to cash a check at the grocery store. Giselle, her 8-year-old, was along for the ride.

“He looked at me, did a U-turn, and got behind the car,” she said of the sheriff’s deputy. “There wasn’t time to check my plates.”

When he came to the driver’s-side window, she handed him her Mexican consular card.

“When are you due?” the deputy asked in English.

“October 21,” she answered.

Minutes later, he put her in handcuffs. There were two warrants for her arrest.

Turns out Chacón owed more than $1,000 in fines for driving without a license and had a misdemeanor shoplifting charge. She said that because she isn’t allowed to get a driver’s license because of her undocumented status, she wasn’t able to earn money to pay the fines. She had to drive, she said, to work and support her children. She said even the shoplifting charge came because, after her husband died, she was desperate and stole food to keep her children alive.

“If someone doesn’t come and pick up your daughter in 30 minutes, I’ll call CPS [Child Protective Services],’ the deputy told her.

A neighbor picked up a sobbing Giselle.

“That’s when the nightmare inside the nightmare began,” she said.

She spent her first night at the Fourth Avenue Jail on a cold cement bench. The following day she was taken to the Estrella jail.

During her second night behind bars, the bleeding started. On the morning of October 14, she felt contractions. Her hands and feet shackled, she was in labor and ushered into a paramedic’s van by a detention officer who restrained her to the stretcher.

“That’s not necessary,” the paramedic told the officer.

“It’s my job,” the officer responded. The guard was a Latina.

She thought she would be released from the shackles once she arrived at the hospital, but she wasn’t.

The officer chained her ankle to one leg of the hospital bed.

A nurse requested that she be freed to get a urine sample. But the officer suggested instead that her bed be dragged over to the bathroom.

Later she was changed from her jail uniform into a hospital gown.

“The officer chained me by the feet and the hands to the bed,” she said. “And that’s how my daughter was born.”

Baby Jaqueline was delivered at 9:25 p.m. and weighed 6.28 pounds. Chacón stared at her daughter as nurses cleaned her. It was a precious eight minutes, she said. But they didn’t allow her to hold the baby.

When questioned later about the incident, Sheriff Joe Arpaio said, “I wasn’t the one who kept her from holding the baby. Ask the hospital.”

Sheriff’s Office policy states that jail inmates be restrained for “security reasons in an unsecured facility,” said Jack MacIntyre, an MCSO deputy chief. McIntyre said a 12-foot chain link was attached to Chacón’s leg.

“Let’s assume someone is faking labor — that’s a hypothetical — and she then chose to escape and hit or assault the hospital staff,” McIntyre said. “She could do that easily because it’s an unsecured area.”

Sentenced, pregnant state prison inmates are treated better than un-sentenced ones in Maricopa County jails. Arizona Department of Corrections policies state: “A pregnant woman will not be restrained in any manner while in labor, while giving birth, or during the postpartum recovery period.”

Hospital records mentioned that Chacón had a forensic restraint on her ankle. Doctors turned down a request from New Times to talk about her case, even after Chacón gave consent for the release of her medical files.

Over the following weeks, after she was back in the county lock-up, her breasts swelled and hurt. Jail guards wouldn’t give her a breast pump. Nor would they give her enough medication to make the pain stop. She got one dose of pain medication a day, no matter how extreme her discomfort.

She worried about her four children, who were left alone in the care of her 17-year-old son, William. She said the baby’s father, her boyfriend, had left her after he found out she was pregnant.

“I felt so sad to see her children alone,” said Chacón’s mother, Maria Gómez, who arrived from Durango, Mexico, with a visa four days after her daughter was arrested.

Gómez took care of Chacón’s new baby, who had been picked up at the hospital by a family friend.

On October 29, a judge let her go but told Chacón she’d be on probation for two years, during which time she must pay all her remaining fines.

She waited 14 extra days in jail to be picked up by U.S. Immigration and Customs Enforcement.

“[ICE officers] took me to the Florence Detention Center, where they treated me much better,” she said. “At least not like an animal.”

There, she refused to sign a document for her voluntary removal from the country.

The story of an immigrant mother’s struggle to care for her children was told repeatedly on Spanish-language radio. People in her community raised $3,000 needed to make the bond set by an immigration judge, and she was released from custody.

Chacón’s hopes are up these days. After almost 20 years in the country, she may have a strong case to stay with her five children — who are all U.S.-born and therefore American citizens. Her attorney filed a motion to cancel her deportation, and now she’s hoping to get a work permit.

It’s been a year since the arrest (baby Jacqueline just turned 1).

“I’m not afraid to come out with my story,” she said. “But I’m disappointed to see that not much has been done to stop [Joe Arpaio].”