Posts Tagged 'budget'

How the Imposed MUNI Contract Would Hurt Drivers And the Public

Collective Bargaining:  According to Prop G, if drivers reject a contract, it goes to binding arbitration.

  • Proposition G specifies the arbitrator must consider the good of the system but says nothing about the good of the drivers or the public.    For example, MUNI drivers rejected the recent contract by a 2-1 vote, yet within days the Arbitrator imposed the very same contract on the drivers.  This is negotiating with a gun at your back.
  • Prop G is San Francisco’s version of Wisconsin, effectively eliminating collective bargaining.  Prop G was paid for by the same business interests that cause MUNI’s ongoing financial crisis by avoiding paying taxes or fees to support MUNI operations.

 

Part Timers: 7.5% of MUNI’s 2,200 full-time drivers can be replaced with part-time drivers.

  • This would give MUNI the flexibility to cut 3,300 driving hours each week in mid-day, night, and weekend runs, while still supplying downtown business’s demand for peak-hour downtown corridor service. 80% of MUNI operations already serve downtown business’ interests, bringing in customers and workers.
  • The loss of mid-day, night and weekend service would affect seniors, people with disabilities, school kids, and low-wage service workers.  Many are minority and immigrant.   Seniors, people with disabilities, and kids need this service to shop, go to doctor appointments, go to senior centers, and visit family and friends.  Workers in hotels and restaurants typically start or end work early in the morning or late in the evening.  They cannot afford taxis.

Health and Safety:

  • Drivers would have no more say in how MUNI runs on health and safety issues.  Drivers would loose their right to protest overly stressful schedules on health and safety grounds, a right they had for 40 years.   This is in spite of years of world-recognized research by SF General doctors showing stress causes high blood pressure in MUNI drivers. Drivers could also no longer protest use of unsafe equipment.  This puts the public, especially seniors, in danger, particularly in cases of unreliable or grabby brakes, or malfunctioning chair lifts or fatigued drivers.  MUNI is trying to fire drivers who complain about unsafe equipment, showing MUNI’s determination to continue using it.
  • Drivers would no longer have input into investigation of accidents. Instead of fixing unsafe schedules or equipment, MUNI can just blame the driver, and go on as before.  The decision of the management-appointed “Transit Safety Professional” cannot be appealed or reviewed, and drivers can be fired after a second accident judged preventable.
  • Drivers could no longer take health or safety issues to an outside arbitrator.

Make Downtown Business Pay:

Despite MUNI’s decades-long financial crisis, downtown businesses pays nothing to MUNI for having their customers and workers brought to them.

  • They pay no annual tax or fee to help support MUNI.
  • Newly constructed commercial buildings are supposed to be charged a one-time Transit Impact Development Fee, but this fee is limited to downtown buildings, the fee has not been raised in years, it applies only to certain kinds of buildings, and there a frequent waivers.

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America Speaks: Pushback in Palo Alto, CA

It was truly amazing how America Speaks worked to force us into giving us the answers they wanted: cutting Social Security, Medicare, and Medicaid.  They presented us with a 25-page doomsday 2025 budget scenario, where Obama’s defense budget and Bush’s tax cuts to the rich had been continued indefinitely. Even after our policy wizards ended mass unemployment and  the Iraq-Afghanistan war,  they said,  rapidly-growing health costs and senior population would drag the nation down to a second-rate power status unless we came up with $1.2 trillion in cuts or revenue increases.   Then they whooped us up, to get us dancing in front of the cameras waving over-sized dollar bills,  while the giant screen flashed to other Town Halls in city after city, where people were also dancing with dollar bills, all of us in a simultaneous paroxysm of debt-smashing enthusiasm.  Then they smothered us in smarmy togetherness, and inclusiveness, and earnestness, about making “our” nation a better place for our children and grandchildren.  It was like all of us were extras in Jim Carrey’s “The Truman Show.”

Given all this, I was amazed at how much pushback there was. Our group started out talking about how loaded the war budget and tax break assumptions were that led to the $1.2 trillion figure. Most people felt and said it was kind of outrageous to have a eight minute perfunctory conversations about 30 million unemployed or under-employed with no solution being proposed, and then have us dust off our hands and imagine in 2025 we’d gained full employment and put the wars behind us. The person next to me said this was about class war.

When the discussion of health care cuts came up, people were so disgusted with having to choose 5%, 10% or 15% cuts without being able to specify how the cuts would be made, that they refused to make any cuts at all. Even the table moderator had to admit it was a stupid way to do it. At least half the people said they’d be glad to cut health expenses if we had single payer or negotiated drug prices.

When the subject of military spending came up, there a big discussion about whether the military and the wars were making us safer, whose interest the wars were being fought in, and whether the cuts would hurt ordinary soldiers. We ended up agreeing on the highest possible cut (15%) with some wanting much higher.

In the revenue portion, everyone was emphatic that rich people should be hit heavily, and the arguments that this might discourage saving, or investment, or it might slow the growth of jobs got no traction. Everybody agreed on raising the cap on payroll taxes to the original 90% of earned income, and some said the cap should be eliminated, though this was not an option, of course. There was some debate over whether to raise the rate of payroll tax.

What amazed me was that much of the same feelings seemed to be expressed nationally. They had to admit on the national simulcast that there was a huge sentiment for single payer, and that people didn’t like the options of cutting categories of services like healthcare without saying how it was done. It made a complete mockery of their blather about our “empowerment,” and “taking control.” I felt like when they brought out Commission member Alice Rivlin, she didn’t know how to respond to the pushback, and just blathered herself.

About 2/3 of the way through, we had reached about $800 billion, and it was getting difficult because people didn’t want to make additional cuts, but the table moderator kept saying we needed to make our target of $1.2 trillion. By this time, we had all gotten comfortable with each other and beginning to feel bonded, so I ventured to say that we were like a jury faced with a judge’s instruction we didn’t feel was fair because it was based on continued war spending and tax cuts to the rich. But juries do disobey judges, and we had the option of disobeying our instructions, too. This made some impression on people, but there was a strong impulse to meet our goal, and more cuts were made up to $1 trillion.

When we were asked what we would commit to do to continue working on these issues, I said I was in the  California Alliance for Retired Americans and the SF Gray Panthers and we had already had a town hall to defend Social Security, Medicare, and Medicaid. Another person said she was from Democracy for America and would continue to work to stop the war. Another said he was from the Coffee Party, and I think he said he said he wanted to work against economic inequality.

Our table did vote to raise the Social Security retirement age, which I was really disappointed about. I talked about my 35 year old son who’s done landscape work and shines shoes, and whose shoulders and back are already beginning to fall apart. He’s got a kid, and he’ll never earn enough to go to school for a career change, and he’s unlikely to get a job with a pension, and I don’t see how he’ll last to 65, let alone 69. It didn’t make a difference; they still voted for the age increase. I think off all the issues in the afternoon, this was the question that demanded the most identification with workers.

I’m sorry we didn’t get a chance to talk afterward very much, but in the little talking I did with other California Alliance for Retired Americans and Move-On people, it seemed like they had the same kind of experience at their tables, and as I said, the pushback seemed to be reflected even in the simulcast. Of course, the America Speaks organizers are going to massage their message to the Obama Commission next Wednesday; they actually started doing it during the Town Hall, forming phrases like “legislators, do your duty,” “make the hard decisions,” “remember the people are powerful,” all of which which encourage the Commission to carry out the Peterson agenda. Still, I think our resistance to being stampeded was a well-deserved slap in the face to Peterson (and Obama.)  Now begins the work of talking to as many people as possible about the threats of Social Security, Medicare, and Medicaid, and to plan actions for when the Obama Commission submits its recommendations to Congress in early December.

Here’s a link to a Huffington Post article, “In Deficit “Town Meetings,” People Reject America Speaks Stacked Deck”

Or Suburban Guerrilla’s “America Speaks, Will the Politicians Listen?”

A video clip form Bucks County PA

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SF Gray Panthers support MUNI drivers voting for no concessions

SF Gray Panthers support MUNI drivers voting for no concessions

On Friday, June 11, San Francisco MUNI drivers rejected the City’s demands for concessions for the second time. (See below.)  SF Gray Panthers made the following statement of support:

The SF Gray Panthers salutes the MUNI drivers who resisted the pressures of downtown business, the Mayor’s office, the Chronicle and Examiner, and some Supervisors, in rejecting the concessions the City is trying to force down their throats. MUNI’s service cuts, fare increases, and financial problems are not caused by drivers’ greed or the riders’ fare evasion; they are caused by downtown business refusing to pay for the service MUNI provides in bringing them their customers and workers.

We recognize that the same forces that attack MUNI drivers and riders are also attacking the City services we need to survive; health, human services, housing, and nutrition. Thoughtful City workers in other unions should support the drivers, because the drivers’ refusal to make concessions and their crucial position in the City’s economy could make the City think twice demanding even more concessions from other unions. This could save both jobs and services.

We demand: No service cuts or fare increases for SF’s poor, seniors, minorities, and immigrants. Make downtown business pay for the services they receive. Drivers and riders should unite to demand more public transit, not less.

(See this letter in June 15 SF Chronicle.)

###

San Francisco Chronicle, June 12, 2010

S.F. Muni operators reject proposed givebacks

(06-11) 21:02 PDT SAN FRANCISCO — Muni operators rejected a proposed package of labor concessions Friday that city officials said was needed to help San Francisco’s financially pinched transit agency partially roll back the deep service cuts imposed last month.

Members of Transport Workers Local 250-A, which represents about 2,000 Muni operators, voted 747 against and 538 in favor of the proposed pact, according to union official Walter Scott.

The reductions, which went into effect five weeks ago, amounted to 300,000 service hours a year, or about 10 percent. They have led to more crowded buses and streetcars, fewer transit options late at night and longer waits between runs.

Mayor Gavin Newsom called the rejection “a slap in the face to everyone who rides Muni and to every other public employee union member,” who already agreed to givebacks. “Once again, I call upon the membership of the TWU to reconsider and revote.”

The leadership of Transport Workers Union Local 250-A forged a tentative agreement with Muni management two weeks ago that city officials say would cut costs by about $19 million over two years.

Union membership has been split bitterly over the proposal.

Bucking union officials, the rank and file resoundingly rejected a different set of proposed givebacks in February.

The new proposal called for lifting the de facto prohibition on the use of part-time operators, tightening overtime rules and changing dependent health care coverage.

It also would have extended the operators’ contract for another year, through June 30, 2012. That would have given operators an extra year to benefit from a guarantee enshrined in the city charter that they are paid at least the second-highest wage among U.S. transit operators.

That operator-friendly provision could be in jeopardy. Two separate charter amendments proposed for the November election seek to undo the automatic pay guarantee, though neither has qualified for the ballot.

The proposed ballot measures seek to set operator salaries through collective bargaining with the aim of giving management more flexibility in getting rid of inefficient work rules.

Municipal Transportation Agency chief Nathaniel Ford said that a favorable ratification vote would have benefited riders by restoring half the service cuts by early September.

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Senate Democrats propose a Task Force or Commssion to massively cut Social Security and Medicare

Medicare benefits, like Social Security and Medicaid benefits, have some legal protection because the program’s funding is supposed to automatically increase as the number of recipients increases. Both Democratic and Republican lawmakers have been dead-set on overturning this protection for years, but overcoming the legal obstacle requires a high-power entity like a Commission.

New American Media, November 19, 2009

Bipartisan’ Purple Dogs Go Rogue with ‘Task Force’ on Social Security, Medicare

Progressive advocates for elders must be wondering, “With Democrats like that, who needs Republicans?”

Last week, the Senate Budget Committee held a hearing on the proposal by its chair Sen. Kent Conrad, D-N.D., and top GOP member, Sen. Judd Gregg, R-N.H., to create the Bipartisan Task Force for Responsible Fiscal Action. The Conrad-Gregg task force would have the power to “improve the long-term fiscal balance of the Federal Government, including the fiscal balance of Social Security and Medicare.”

Washington is littered with official commissions and their reports, but this one would be set on an unusually fast track. The 16 committee members would include key powers in Congress and the White House. Both houses of Congress would get the task force’s plan late in 2010 but only for an up-or-down vote—no debate or amendments allowed. Each house would have to pass the measure by a 60 percent supermajority.

The plot thickened last week, when four prominent Democrats, plus Sen. Joe (“I won’t wiggle on the health care filibuster”) Lieberman, threatened to halt approval of an unrelated but critical piece of legislation unless congress lets them have their way with the task force.

Progressive economist Dean Baker explained in a Nov. 16 blog on Huffington Post that Congress must pass legislation by the end of this year to raise the level of the national debt, a normal periodic process without which the U.S. economy would be in even more serious trouble. Accusing the senators of being “hostage takers,” Baker, who co-directs the Center for Economic and Policy Research, asserted, “This commission would be stacked with people who want to cut Social Security and Medicare.”

Conrad, Gregg and their purple cabal want to fast-track the task force’s recommendations, as Congress did with base closings, in order to force-feed unpopular choices through a presumably ineffectual national legislature. Proof, say some purple dogs, is in the failure of the health care reform to cobble together bills that would do anything to control medical costs. Therefore, we need extraordinary action to save the nation. From its representatives. Such as themselves. Those advocating for the normal democratic process in this case argue that Social Security and Medicare are not like local military bases that might never close otherwise because of tit-for-tat political horse trading over claims of lost jobs and so on.

One of the debt-limit bandits, California Sen. Dianne Feinstein and others have proffered differing commission proposals, but all focus on social insurance protections that provide health and income security to America’s aging masses – you know, the ones conservatives call Greedy Geezers when they want to cut benefits and the Greatest Generation when they pander to senior voters.

All claim to skewer the presumed sacred cows of Social Security and Medicare, while none actually involve “responsible fiscal action,” that is, placing all U.S. spending priorities on the table. Cases in point: Wasteful military spending (especially but not exclusively related to two wars) and tax loopholes for corporate America. Take the $33 billion giveaway in tax breaks to the building industry – please! – that was secreted inside the extension of unemployment benefits passed last week, exposed in Sunday’s New York Times by business columnist Gretchen Morgenson.

In the Daily Kos last Thursday (Nov. 12), Mcjoan wrote that Sen. Conrad and his “unsurprising bipartisan ‘gang”—13 senators, among them Democrats Evan Bayh, Ind., Dianne Feinstein, Calif., Mark Warner, Va., and kosher dog Lieberman—have “put new pressure on Speaker Nancy Pelosi to turn the power to trim entitlement benefits over to an independent commission.” Mcjoan urged, “Go for it, guys. Form your national suicide pact. Tell the country that you are demanding deep cuts in Social Security and Medicare, or else you will personally cause the United States debt to double.”

NYT reporter Jackie Calmes blogged (Nov. 10) that most members of Congress or budget analysts who now support the fast-track commission claim to be “reluctant converts . . . having concluded that Democrats and Republicans cannot reach the needed compromises on spending cuts and tax increases without some forcing mechanism.” Pelosi and Senate Majority Leader Harry Reid (Nevada) oppose sidestepping debate, but House majority leader Steny H. Hoyer of Maryland, issued a statement strongly supporting the task force idea.

Respected progressive blogger Digby, opining for Campaign for America’s Future, warned Nov. 12 that in Congress “talk of cutting Social Security right now would be hugely popular, so all the incumbent Democrats should be intensely interested in getting that issue on the agenda in an election year.”

She added, “Seriously, this is Shock Doctrine lunacy of the most obvious kind. Conrad and Bayh are out there saying it right up front. The government has poured trillions into the economy to save the banks and run useless wars in Iraq and Afghanistan and the old people and the poor are going to have to pay the price. That’s the way it works.”

The thin wonky line standing against the Senate elder abusers includes a group of eight veteran experts, who had prominent staff roles in the vaunted 1983 “Greenspan Commission,” credited with saving Social Security, sent a joint letter last to the Senate Budget committee, urging them not to pull an end-run around congressional debate.

“We all agree that social insurance programs have problems, especially Medicare,” said Nancy J. Altman, author of The Battle for Social Security (Wiley, 2005), who was a special assistant to Chairman Greenspan on the commission. However, Altman, serving as a “point person” for the distinguished group, emphasized that sidestepping the normal congressional process in the spirit of forcing “do-nothing” politicians to take necessary action could severely damage America’s already frayed safety net.

She noted that low-income elders, especially those of color, are particularly reliant on Social Security and Medicare. For instance, a recent report by the Hispanic Institute in Washington, D.C., notes that 50 percent of Latinas 65 or older in the U.S. rely on Social Security for 100 percent of their income, and 85 percent of them gain at least half of the income from Social Security. (Readers can see fact sheets on Social Securities demographic impact on different ethnic groups here.)

To justify suspending the normal legislative process, the quick-fixers point to a Government Accountability Office study showing that without change, the nation will hand the coming generations an “unsustainable” $63 trillion liability from federal entitlement programs by 2083. Others last week mentioned that amount as $37 trillion.

Reporters need to be wary about the scary numbers game. Not only are the figures suspect, but even the conservative think tanks (Heritage Foundation, Cato, etc.), which jiggered up the formula for these 2012 disaster-movie calculations, admit that most comes from projected Medicare costs. Medicare is absolutely in trouble – but because of overall rampant health inflation in the United States, not because too many baby boomers will have the temerity to grow old. (Note added: See Henry J. Aaron’s “There is No Entitlement Crisis; There Is a Health Care Funding Crisis”)

One might ask where or where to the purple dogs go so wrong. And who’s the mastermind behind this fiscal caper?

Altman observed that when Sens. Conrad and Gregg first introduced their bill in 2007, they included three letters of support from The Peter G. Peterson Foundation, the Concord Coalition and the Committee for a Responsible Federal Budget—all three them connected to and funded by Wall Street Pete Peterson.

The grandfatherly octogenarian Peterson, who was Richard Nixon’s Secretary of Commerce and went on to found the private equity giant, The Blackstone Group, endowed his Peterson Foundation three years ago with $1 billion. Cutting and partially privatizing entitlement programs for elders is one of three stated missions of the tax-exempt organization. Peterson promptly hired then U.S. Comptroller General David Walker to head the foundation.

“This is really the Peterson Commission,” said anti-task force committee of eight in a background release. Peterson has spent almost three decades militating against Social Security and other federal supports for elders, and last Tuesday one of the main speakers called on to testify at Conrad-Gregg hearing on the task force was Walker.

As Altman stressed that the bipartisan 1983 commission, chaired by and informally named for Greenspan, accomplished major reforms of Social Security – which was in far deeper trouble then than it is now – through normal congressional debate and floor votes.

How quaint. Democracy actually worked. Maybe our representatives should try a little constructive nation building right there under the Capitol dome.

—Paul Kleyman

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Senate Health Bill is a 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.

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 20th:

At yesterday’s [November 19th] 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

California Democratic Party to says to Obama, Get Out of Afghanistan

Common Dreams,  November 16, 2009

Biggest State Party to Obama: Get Out of Afghanistan

By Norman Soloman

This week begins with a significant new straw in the political wind for President Obama to consider. The California Democratic Party has just sent him a formal and clear message: Stop making war in Afghanistan.

Overwhelmingly approved on Sunday by the California Democratic Party’s 300-member statewide executive board, the resolution is titled “End the U.S. Occupation and Air War in Afghanistan.”

The resolution supports “a timetable for withdrawal of our military personnel” and calls for “an end to the use of mercenary contractors as well as an end to air strikes that cause heavy civilian casualties.” Advocating multiparty talks inside Afghanistan, the resolution also urges Obama “to oversee a redirection of our funding and resources to include an increase in humanitarian and developmental aid.”

While Obama weighs Afghanistan policy options, the California Democratic Party’s adoption of the resolution is the most tangible indicator yet that escalation of the U.S. war effort can only fuel opposition within the president’s own party — opposition that has already begun to erode his political base.

Participating in a long-haul struggle for progressive principles inside the party, I co-authored the resolution with savvy longtime activists Karen Bernal of Sacramento and Marcy Winograd of Los Angeles.

Bernal, the chair of the state party’s Progressive Caucus, said on Sunday night: “Today’s vote formalized and amplified what had been, up to now, an unspoken but profoundly understood reality — that there is no military solution in Afghanistan. What’s more, the vote signified an acceptance of what is sure to be a continued and growing culture of resistance to current administration policies on the matter within the party. This is absolutely huge. Now, there can be no disputing the fact that the overwhelming majority of California Democrats are not only saying no to escalation, but no to our continued military presence in Afghanistan, period. The California Democratic Party has spoken, and we want the rest of the country to know.”

Winograd, who is running hard as a grassroots candidate in a primary race against pro-war incumbent Rep. Jane Harman, had this to say: “We need progressives in every state Democratic Party to pass a similar resolution calling for an end to the U.S. occupation and air war in Afghanistan. Bring the veterans to the table, bring our young into the room, and demand an end to this occupation that only destabilizes the region. There is no military solution, only a diplomatic one that requires we cease our role as occupiers if we want our voices to be heard. Yes, this is about Afghanistan — but it’s also about our role in the world at large. Do we want to be global occupiers seizing scarce resources or global partners in shared prosperity? I would argue a partnership is not only the humane choice, but also the choice that grants us the greatest security.”

Speaking to the resolutions committee of the state party on Saturday, former Marine Corporal Rick Reyes movingly described his experiences as a warrior in Afghanistan that led him to question and then oppose what he now considers to be an illegitimate U.S. occupation of that country.

Another voice of disillusionment reached party delegates when Bernal distributed a copy of the recent resignation letter from senior U.S. diplomat Matthew Hoh, sent after five months of work on the ground in Afghanistan. “I find specious the reasons we ask for bloodshed and sacrifice from our young men and women in Afghanistan,” he wrote. “If honest, our stated strategy of securing Afghanistan to prevent al-Qaeda resurgence or regrouping would require us to additionally invade and occupy western Pakistan, Somalia, Sudan, Yemen, etc. Our presence in Afghanistan has only increased destabilization and insurgency in Pakistan where we rightly fear a toppled or weakened Pakistani government may lose control of its nuclear weapons.”

Hoh’s letter added that “I do not believe any military force has ever been tasked with such a complex, opaque and Sisyphean mission as the U.S. military has received in Afghanistan.” And he wrote: “Thousands of our men and women have returned home with physical and mental wounds, some that will never heal or will only worsen with time. The dead return only in bodily form to be received by families who must be reassured their dead have sacrificed for a purpose worthy of futures lost, love vanished, and promised dreams unkept. I have lost confidence such assurances can anymore be made.”

From their own vantage points, many of the California Democratic Party leaders who voted to approve the out-of-Afghanistan resolution on Nov. 15 have gone through a similar process. They’ve come to see the touted reasons for the U.S. war effort as specious, the mission as Sisyphean and the consequences as profoundly unacceptable.

Sometime in the next few days, President Obama is likely to learn that the California Democratic Party has approved an official resolution titled “End the U.S. Occupation and Air War in Afghanistan.” But will he really get the message?

Norman Solomon is a journalist, historian, and progressive activist. His book War Made Easy: How Presidents and Pundits Keep Spinning Us to Death has been adapted into a documentary film of the same name. His most recent book is “Made Love, Got War. ” He is a national co-chair of the Healthcare NOT Warfare campaign. In California, he is co-chair of the Commission on a Green New Deal for the North Bay; http://www.GreenNewDeal.info .


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