The Pennsylvania Progressive

"Wind, Not Windfalls"

This is the theme of the Sierra Club's new initiative to begin transferring federal tax subsidies from old technologies to new.  Concentrating on the current Pennsylvania primary they are attending campaign events with petitions and organizing an election day/Earth Day (they are the same this year) effort to work the polls and increase awareness.  Poll workers armed with Sierra Club petitions can volunteer at their website.

Last year, the country’s five largest oil companies made $123 billion in profits, while benefiting from billions of dollars in taxpayer subsidies.  Meanwhile, critical renewable energy tax incentives are set to expire at the end of this year.  The America Wind Energy Association estimates that up to 75,000 America jobs could be lost if these incentives are not renewed early this year.

“Right now, Pennsylvanians have choices to make.  We can either support subsidies for Big Oil, or support creating a new energy future for America, built on clean renewable energy’” said Rachel Martin, Sierra Club Regional Representative.  “Taxpayer subsidies for big oil companies have brought us nothing but soaring gas prices and inflation.  Shifting to renewable sources of energy like wind and solar, however, will help build our economy, create good, green jobs, and help solve global warming.”

 
Over the next two weeks, Sierra Club activists will be circulating petitions and raising awareness about this issue at candidate events and at polling places, and holding major events in Pittsburgh and Philadelphia.

“Soon, Senators McCain, Clinton, Obama, and Specter will have the opportunity to vote on redirecting subsidies from the oil companies to incentives for job-creating renewable energy, and to demonstrate whether they stand for PA’s working families, or for big oil companies,” said Martin. “It’s time for the Senators to move forward and vote for clean energy, not Big Oil. We are asking them to vote yes on HR 5351, the Renewable Energy and Energy Conservation Tax Act of 2008.”

Cathy Duvall, the Sierra Club's National Political Director, called on Congress "to put its money where its mouth is" and fund wind, solar and other renewable energy sources instead of continuing to subsidize the oil industry.  They are attempting to influence the many United States Senators in and campaigning through Pennsylvania this month.

It's difficult to argue that at $112/barrel the oil industry continues to need corporate welfare from taxpayers.  It is the renewable, clean energy industry which should be receiving these funds and the Sierra Club is pushing legislation in the Senate to do just that.  The bill currently in the Senate is not enough and long term tax subsidies are needed according to the organization.

Sierra Club volunteers and activists are seeking to do three things:  attend candidate events to circulate petitions and increase visibility on these issues, do media events at gas stations in Philadelphia and Pittsburgh to create awareness, and recruit volunteers to work the polls on Earth Day which coincides with the Pennsylvania primary election April 22nd.

Fair Trade

Fair trade has taken a central role in the presidential campaign as the season began coming through the Rust Belt states hardest hit by bad trade policy.  Fair trade isn't only about protecting jobs, industries, and the environment however.  It is also about preserving farms and farmer in other countries, especially third world nations in Central and South America devastated by American subsidies for agriculture.  It means we must be fair on both sides of the ball.

Federal welfare subsidies for agribusiness are driving family farmers off the land both here in America and in countless other countries.  Coffee growers and rice farmers are unable to compete with huge agricultural companies in America who are subsidized with tax money.  Fair trade has to be fair for everyone.  Unfair trade has resulted in a flood of illegal immigration as we have driven people off the land.  They are emigrating here in an attempt to survive.

Every time you buy a cup of  coffee ask if it is fair trade coffee if you really want to fight the battle against undocumented workers.  If these coffee growers hadn't been forced off their farms and into desperation they wouldn't be here taking your job at lower wages.

Unfettered free trade is bad for workers, the environment and is leading to unsafe products.  It drives wages down and profits up.  The only entities who benefit are global corporations and it is they who are pushing these deals.

John Edwards brought these issues to the campaign and they largely disappeared after his withdrawal until Wisconsin.  As the campaign has centered in Ohio and Pennsylvania these issues have come front and center.  The Pennsylvania Fair Trade Coalition sent questionaires to each of the remaining candidates about these issues.  It is part of the Citizens Trade Campaign.  As such they issued this press release in late February:

To Implement Domestic Campaign Policy Priorities on Health Care and
Global Warming, Future Presidents Must Alter Existing U.S. Trade
Commitments

New Public Citizen Report Identifies Changes to WTO, NAFTA Rules Needed
to Facilitate Candidates' Proposals on Health and Climate

WASHINGTON, D.C. - Public Citizen today identified changes needed to
World Trade Organization (WTO) rules and the investment provisions of
the North American Free Trade Agreement (NAFTA) to implement a dozen of
the presidential candidates' key health and climate policy proposals.

The changes were detailed in a report, "Presidential Candidates'
Key Proposals on Health Care and Climate Will Require WTO Modifications,
Overreach of WTO Highlighted by Potential Conflicts with Candidates'
Non-Trade Proposals," released today, available at
http://www.citizen.org/documents/PresidentialWTOreport.pdf

"Growing public ire about our current trade and globalization
policies' damage to Americans' economic prospects has played an
enormously important role in this election, with most candidates
committing to reform NAFTA," said Lori Wallach, director of Public
Citizen's Global Trade Watch division. "But candidates and voters
have little idea that some of the candidates' domestic policy
priorities on health care and climate change could be limited by the
overreach of so-called trade agreements like the World Trade
Organization. The need for a comprehensive overhaul of the WTO could not
be more urgent."

Although they have nothing to do with trade, key health care cost
containment proposals on the creation of health insurance risk pooling
mechanisms, reduction of pharmaceutical prices and electronic medical
record-keeping, a proposal to expand coverage by requiring large
employers to provide health insurance and a proposal to establish tax
credits for small employers as an incentive to provide health insurance
fall within WTO jurisdiction. In addition, proposals that address
climate policy, such as increasing CAFE (Corporate Average Fuel
Efficiency) standards, banning incandescent light bulbs, establishing
new regulation of coal-fired electric plants and establishing national
renewable portfolio standards (RPS), green procurement proposals and
gree
n industry subsidies come under the jurisdiction of existing U.S.
WTO commitments.

"Corporate lobbyists, previous U.S. presidents, and 'free market'
think tanks worked hand-in-hand to lock in corporate privileges on
health care, energy and other domestic policies and shield them from
small 'd' democratic reforms of the kinds proposed by Clinton,
McCain and Obama," said Todd Tucker, research director for Public
Citizen's Global Trade Watch division and an author of the report.
"Now is the moment presidential candidates must stand up for their
important domestic platform priorities and commit to renegotiate the WTO
and other flawed trade deals."

Moreover, the candidates haven't addressed the need to renegotiate
other provisions in trade deals like the WTO, NAFTA and other
NAFTA-style trade deals that severely limit future presidents' policy
space to enact legislation on non-trade issues.

"Trying to work within the tiny policy space permitted by existing
WTO rules would result in the challenges surrounding America's health
care debacle and the global climate crisis being defined so narrowly as
to ensure real redress is impossible," said Wallach. "The candidates
must reject corporate calls for watering down their proposals and
instead emphasize opening up the much-needed policy space to provide
real solutions to pressing domestic concerns."

Hillary Clinton responded to the Pennsylvania Fair Trade Coalition with this statement:

Hillary Clinton’s Trade Agenda

            

Making Trade Work for Working Families             

With the middle class squeezed and the economy slipping into recession,       American families need a President who will fight for their economic     interests from day one. Americans need a President who will fight  for fair, pro-American trade policies that will not trap them in a race to the bottom.   Low wages in other countries are costing America jobs and putting pressure on wages here at home.   With approximately one quarter of our gross domestic product linked to international trade, we need trade policies that better manage globalization.  As President, Hillary will make trade work for working families.   

            

Fixing NAFTA.  NAFTA was negotiated more than 14 years ago, and Hillary believes it has not lived up to its promises. Hillary is the only candidate with a detailed plan to fix NAFTA—one that addresses its shortcomings and brings the agreement up to date.   As President, she will work with our trade partners to:             

            

 

            

  1)   Dramatically strengthen NAFTA’s labor and environmental provisions. Strengthening these provisions will elevate labor and environmental standards around the world, protecting our workers from a race to the bottom. It will also make it harder for companies to move jobs to countries where workers have fewer protections than in America. NAFTA’s labor and environmental provisions are now in a side agreement rather than in the core text.  The requirements are weaker than those Hillary will demand in future trade agreements, and weaker than those the Democratic leadership recently crafted. As President, Hillary will bring NAFTA’s labor and environmental protections up to date. She will make the standards far tougher and absolutely binding, and she will place them in the core agreement so that we are working to raise living standards around the world.   

            

 

            

  2)  Change NAFTA’s  investment provisions that grant special rights to foreign companies. Under NAFTA, foreign companies can challenge American laws before special tribunals and outside of our court system. The laws that foreign companies can challenge include regulations intended to protect workers and protect the environment.  Hillary believes that trade agreements must elevate standards of living around the world, not empower corporations to hold them down.             

            

 

            

  3)  Strengthen NAFTA’s enforcement mechanisms. Stronger enforcement mechanisms will ensure strict compliance with the agreement and it will help remove trade barriers our companies may still encounter.  Hillary will apply the stronger enforcement mechanisms not only to NAFTA’s commercial provisions, but to its labor and environmental provisions as well.             

            

 

            

 4)  Review NAFTA regularly. Regular reviews will enable us to measure whether our workers and communities are reaping benefits, will ensure that labor and environmental standards are improving, and will allow us to assess whether the agreement requires additional  changes going forward. 

            

 

Strong Labor and Environmental Provisions in All Trade Agreements. Hillary will require that all future trade agreements contain strong and enforceable labor and environmental provisions in the core of the agreement. These provisions will elevate labor and environmental standards around the world, protecting our workers from a race to the bottom. These provisions will also make it harder for companies to ship jobs to countries where workers have less protection than they do in America.  Hillary opposed CAFTA in part because the labor and environmental provisions were inadequate.             

 

A Trade “Timeout.” As President, Hillary will take a “timeout” from new trade agreements until her administration has formulated a  comprehensive trade policy for the 21st Century—one that is genuinely pro-worker, pro-American, and vigorously enforced.    Reviewing existing trade deals, strengthening enforcement, and formulating a smart trade policy will be her priories.                          

 

Regular Review of Trade Agreements. As President, Hillary will review all of our trade agreements to determine their economic effects and ensure they are working for America. As Senator, she has introduced the Trade Agreement Assessment Act to review all agreements in their 2^nd year, 5^th year, and every 5 years after that. The reviews will assess whether the agreements are benefiting our workers and economy and whether our trade partners are improving their labor and environmental standards.              

 

            

A New Trade “Prosecutor.”  As President, Hillary will vigorously enforce our trade agreements. To that end, she will appoint a trade enforcement officer and double the enforcement staff at USTR.  The current staff is too small to monitor and enforce the increasingly complex trade agreements.  Vigorous enforcement of our trade agreements has not been a priority for President Bush—but it will be for Hillary.

            

Cracking Down on China’s Currency Manipulation. Foreign countries manipulate their currencies to make American goods look expensive on the world market and to make their own goods look inexpensive. This practice hurts American workers and it must end. Hillary is a co-sponsor of legislation that will require the administration to take definitive steps to stop China and other countries from harming American interests by undervaluing their currencies. Currency manipulation by our trading partners is also contributing to our trade deficit.  Hillary has co-sponsored the Foreign Debt Ceiling Act, legislation that will require the administration to draw up an action plan to address our large trade imbalance.              

 

            

Strengthening Support for Workers Adversely Affected by Trade.  The Trade Adjustment  Assistance Program provides job training, income support, a health care tax credit, and job placement assistance.   Hillary will modernize the program to ensure that it is truly helping workers hurt by global trade. First, Hillary will broaden TAA to cover all workers whose plants have moved abroad. Workers are currently ineligible for TAA if their plants relocated to countries with which we have not signed free trade or trade preferences agreements. This outdated rule means that when plants shift from   America to low-wage countries like India and China, laid-off workers are ineligible for TAA. Second, she will extend TAA benefits to service workers. Today, workers who produce a service rather than a product are ineligible for TAA, and therefore call-center operators and other workers are left without assistance. Third, Hillary will double funding for TAA’s job training program to $440 million. And  fourth, she will overhaul the Health Coverage Tax Credit (HCTC) to ensure that it is actually making health care affordable for laid-off workers. She will increase the tax credit to 90% of premiums from the current 65%. And Hillary will fight for a universal health care plan that provides all Americans with quality,  affordable health care.

            

Opposing Trade Agreements That Harm American Workers. President Bush hastily signed the Korea free trade agreement before his fast track authority expired, and the consequence was a deal that will cost America jobs.  Korea has a long history of blocking access to its car market, and yet the agreement has weak provisions for prying that market open.    At the same time, the agreement further opens our own car market to Korean vehicles. Hillary strongly opposed the Korea free trade agreement for these reasons. She also strongly opposed fast track authority for President Bush because he has misused the authority and failed to enforce our agreements.  Hillary opposes the Bush         administration’s trade agreement with Colombia because of the country’s history of violence against union members. She opposes the trade agreement with Panama because the head of the country’s National Assembly is a fugitive from justice in America. And Hillary strongly believes that the President should not rush to sign other trade agreements on his way out of office.

Barack Obama's campaign didn't respond to the Pennsylvania questionaire but his responses to Texas' queries are found here.    

Gore Launches New Climate Change Initiative

Wilkes-Barre is the happening place today with visits from both Hillary Clinton and Barack Obama.  I'm on my way north and will update things after I arrive.  Meanwhile Al Gore is launching a new initiative to stop global climate change.  "An Inconvenient Truth" is playing on premium TV channels so watch it if you haven't and also visit the new website for We Can Solve It.  I'll already anticipate tyler's objections and ask him one question:  what if you're wrong?

What happens if we do nothing?  Catastrophic changes to the way we live, the way we die, the way we interact with other species, the disappearance of thousands, nee, millions of other species is possible.  How many millions, or billions, of people will be displaced.  Where will they go?  What will we do for food and water?  These are huge questions and ones we can answer right now by acting decisively and proactively.  We cannot afford to wait until after a tipping point, a "point of no return" for our planet.

John McCain and Social Security

Directly after denying it towards the end of his 2004 campaign George W. Bush set out in January 2005 to destroy Social Security.  Long a goal of conservative Republicans, Social Security is at the top of the wish list of government programs to end.  Bush lost this battle as Americans saw through his plans and refused to provide a financial windfall to Wall Street firms.  The current recession and economic crisis is more proof that trusting Wall Street for your retirement security is a very risky enterprise.

John McCain lists the privatization of Social Security as one of his priorities as President.  Do you really want to provide him with four more years to strive to destroy this social safety net for senior citizens, orphans and the disabled?   McCain will drag out the lie that the trust fund is in crisis even though it isn't.  He'll try and use fear as a false motivation to scare people to dismantle this critically important program.

John McCain equals four more years of the same failed policies.

BushCo Looking to Further Restrict Abortions

I heard this on NPR earlier this week while on the road and felt I must address the issue.  As a Board member of Planned Parenthood Advocates this is disturbing.   The Bush administration is pushing a rule which reverses a requirement that physicians who refuse to do procedures because of religious grounds must refer their patients elsewhere.  They want to eliminate this and it could cost women's lives.

Poor women especially have few healthcare options.  If you are in an HMO or PPO plan and you must have a doctor's referral, this rule change would prevent you from getting that referral.  If a woman is having a difficult or potentially fatal complication and she seeks medical treatment her doctor may, under this proposal, not only refuse to treat her but refuse to provide a referral to another doctor.  This supposedly "pro life" position will actually kill some woman and their unborn.

ED RENDELL’S HEALTHCARE HOAX (AND THE SINGLE-PAYER SOLUTION)

This is a guest article by Jerry Policoff.  It is published with the permission of the author and first appeared on OpEdNews.com.

ED RENDELL’S HEALTHCARE HOAX (AND THE SINGLE-PAYER SOLUTION)

With Pennsylvania Governor Ed Rendell's Prescription For Pennsylvania all but dead in its original form, his political allies in the State Legislature, led by Todd Eachus, a member of the Democratic Leadership in the House, seem intent upon salvaging what they can via an amended bill they hope will pass the Pennsylvania House this Monday, March 17th.   Gone is "Cover All Pennsylvanians," a title that was never even remotely appropriate. In its place comes "Pennsylvania Access to Basic Care" (PABC), an even weaker  program that is being baselessly hailed by its proponents as  a "huge" step forward toward insuring all Pennsylvanians.

Before examining the new Rendell/Eachus legislative initiative and the accompanying full court press to pass it – with an assist from predominantly favorable, even sycophantic  media coverage --  some background regarding the original Rendell plan might prove helpful and enlightening.

STRANGE BEDFELLOWS

Governor Rendell unveiled Prescription for Pennsylvania amidst much national and local fanfare on January 17, 2007 in the spacious and historically decorated conference room adjacent to his Capitol office in The Harrisburg, Pa. State Capitol Building.  "We can no longer stand by while health care costs spiral out of control," he said at the time, promising  to expand "access" to affordable health care to most of  the "767,000  adult Pennsylvanians" who lacked health insurance.  That is the number of uninsured Pennsylvania adults the Governor has cited ever since (though the number  mysteriously morphed down to 747,000 in the PABC initiative launched earlier this week). It is a number the media has accepted virtually on faith and seemingly never challenged, or questioned, but more about that later. 

There was something of a carnival atmosphere in that large, yet surprisingly packed chamber that day.  The media was there en masse, but they were clearly outnumbered.  The room was virtually swarming with men and women in business attire whose round colored pins identified them as lobbyists, mostly from the health insurance and related healthcare industries.  The Governor also chose to have someone by his side on the podium that day to share this historic moment with him.  It wasn’t another politician or some trusted aide, nor his wife, nor some other loved one.  It was Anita M. Smith, CEO of Capitol Blue Cross, a major Pennsylvania Health Insurance company with headquarters in Harrisburg.  Although the Governor introduced Ms. Smith to the assembled crowd very early in his opening remarks few subsequent media accounts of the press conference mentioned her prominent role at the Governor’s side.   The media also took little interest in the generous campaign finance support Governor  Rendell had received from the health care industry including well over $1 million in contributions to underwrite the $2.5 million cost of his inaugural ceremonies held the same week he unveiled his health care initiative.  Such donations are not regulated by the State Election Bureau because they are not considered campaign contributions.  Capitol Blue Cross, Independence Blue Cross, Keystone Health Plan, United Health Group, Highmark Blue Shield and the University of Pittsburgh Medical Center each contributed $50,000 toward the inaugural festivities while Blue Cross of Northeastern Pa,, GlaxoSmith Kline and Shire Pharmaceuticals contributed a more modest $25,000. One might be forgiven for wondering whether the Governor’s efforts to bring so-called "universal" health care to Pennsylvania would inflict much pain on the health insurance or pharmaceuticals industries, both of which  have contributed toward making American Healthcare by far and away the most expensive in the world while leaving 47 million uninsured and millions more underinsured.

HOW MANY UNINSURED?  GOVERNOR RENDELL’S FUZZY MATH

To hear Governor Rendell tell it Pennsylvania is pretty well off when it comes to health care, having one of the lowest uninsured rates in the country.  The fact that his estimate of 767,000 uninsured adults is based upon a highly dubious 2004 survey and is contradicted by other surveys that utilized far more orthodox methodology does not seem to bother him, nor the media, which has apparently has never heard of the Census Bureau or of Google. 

The uninsured statistics Rendell regularly cites come from a survey commissioned by the Pennsylvania Insurance Bureau in 2004.  The methodology utilized in that survey borders on the bizarre if the true goal was to get accurate and reliable estimates.  This writer feels compelled to wonder if the true objective in commissioning that survey was not a quest for accurate data, but rather an attempt to come up with more conservative numbers than had been arrived at by the Census Bureau, numbers that would make the problem appear less severe than it is, and hence make the Governor’s proposed reforms appear to be more wide-reaching than they really are.

For starters, the survey estimated that 8% of the Pennsylvania population, 900,000 people, was uninsured.  The Governor’s lower number of 767,000 represents that number less the 133,000 estimated uninsured non-adults.  It is unclear why Governor Rendell chooses to include only the number of adults when citing the numbers of uninsured. Those non-adults are, after all, uninsured.  The survey itself was conducted by the research group Market Decisions, utilizing a telephone sample frame and targeting 100 households in each of Pennsylvania’s 67 counties (except for Philadelphia whose sample was 173 households).  Thus Forest County with a population of 4,946 was targeted for 100 interviews (1 in every 49 of the households in the county); Alleghenny County (Pittsburgh), with a population of 1,281,666 was also targeted for 100 interviews (1 in every 12,817 households); and Philadelphia County with a population of 1,517,550 accounted for 173 interviews (one in every 8,772  households).  The sample frame itself poses a problem because non-telephone households tend to be poorer than the general population with a larger percentage of  ethnic minorities – the very demographics most likely to lack health insurance.  A study that specifically examined this issue back in 1990 found that non-telephone households were three times as likely to be uninsured than telephone households and concluded that "there are marked differences between the telephone and nontelephone groups, and adjusting the former is unlikely to result in reasonable overall population estimates or to lead to increased understanding of being uninsured. In this case, telephone ownership appears to introduce a bias unreconcilable by recourse to social demographic and health status measures."  Translation:  Any survey attempting to determine the extent to which a population is uninsured that utilizes a telephone sample frame will understate the extent of the problem.

Moreover, the spreading out of the sample equally across the state’s 67 counties regardless of their population virtually guaranteed a radical under-sampling of the inner city neighborhoods in Philadelphia and Pittsburgh (as well as other smaller cities throughout the state) where residents were most likely to want for health insurance. Finally, Market Decisions interviewed only one individual per household, but collected responses relating to every member of that household from that individual.  Market Decisions’ own web site cautions that this methodology has its drawbacks: "Respondents may not be familiar with coverage of all members in extended household;" and "systematic error – larger households will have a greater error and are also associated with specific demographics." (Read: lower income minority households). The Prescription for Pennsylvania web site acknowledges, but is dismissive of the fact that Market Decisions’ uninsured estimates are lower than those of the Census Bureau.  It states that "the Census Survey contacted far fewer Pennsylvania households than the Insurance Department’s survey did," suggesting that this in itself renders the Market Decisions data more reliable than the Census estimates.   In fact, the Census Bureau survey consists of 6,000 Pennsylvania households per year which, from a purely statistical viewpoint, would generate numbers nearly as reliable as a sample of 6,700.  But the Census Bureau also samples all households, not just telephone households, and their cooperation rate is enhanced by personal visits by Census Bureau employees when all else fails. Moreover, the Census Bureau encourages use of three-year rolling averages with a sample of roughly 18,000 – far more than the 6,700 in the Market Decisions survey.  Only the homeless are excluded from the Census Bureau sample frame, and it is likely that if the homeless were included the estimates for the number of uninsured would increase. 

At a State Democratic Committee workshop held in Lancaster, Pa, this past January 10th,  I challenged RoseMarie B. Greco, director of the Gov.'s Office of Health Care Reform, as to the validity of the 767,000 figure that she, the Governor, and his other surrogates are continually citing.  She responded in a disbelieving voice bristling with contempt: "you’re not suggesting the Census Bureau numbers are more accurate than ours, are you," she asked?   I unhesitatingly responded: "Yes I am."  She quickly moved on rather than engage in a discussion over the accuracy of her numbers.

Susan Korbel, PhD., owner of Core Research in San Antonio, Texas writes:  "Researchers have long known that new arrivals (read: migrants) are less likely to participate in telephone research, especially if it sounds official due to concerns about other governmental institutions.  In order to overcome these obstacles, it is necessary to OVERsample urban areas, as well as those in neighborhoods more likely to have English as a second language."  She adds: "This is a very curious sampling procedure... it does nothing for a state-wide aggregate estimate, and weighting geographically would create very large swings in data, especially if they also were weighting by demographics as well."  Ms. Korbel also dismisses as a "fallacy" the notion that sample size alone "regardless of distribution" is better, citing as an example a football stadium holding 100,000 people filled on one occasion with people who came to see the Pope speak, and on another with people who came to see the Rolling Stones. "Would you say that the responses of the 100,000 sample would be similar for all questions because they were both the same size?  Probably the Pope goers would be able to represent Catholics in the region, but if you were asking about abortion, they wouldn't be representative of all people living in the area, any more than the Rolling Stones fans would be representative respondents."

So just how many Pennsylvanians are actually uninsured?  Estimates vary, but there is a consensus among all except the Governor’s office that the number is considerably higher than 900,000 (or 767,000 adults).  The most recent Census Bureau estimate is 1,255,000, a number that includes only people who are chronically uninsured.  A study released last year by the Center for Disease Control estimated that 10% of Pennsylvania’s population was uninsured, which would project to 1,235,000, virtually the same number arrived at by the Census Bureau.  An October 2005 Keystone Research Center press release concluded that 494,000 Pennsylvanians had lost their employer-sponsored health insurance since 2000, implying that the number of uninsured might be as high as 1.8 million.  It should be noted that Pennsylvania clearly has a lower uninsured rate than the rest of the nation, part of which is explained by its large elderly population resulting in a higher per capita enrollment in Medicare.  Still, any effort to bring true healthcare reform to Pennsylvania is ill-served by the Governor’s attempts to minimize the true scope of the problem by low-balling the estimates regarding the number of uninsured.

A 2003 study by the Congressional Budget Office found that Census uninsured estimates are actually significantly under-stated because they include only people who are uninsured for a full year or more.  They concluded that the real number, including people who were uninsured for only part of the year, was as much as 44% higher than the published Census figures.  This is a shortcoming that researchers at the Census bureau readily acknowledged in discussions with this writer.

"UNDERINSURED," A WORD GOVERNOR RENDELL AVOIDS

A group often left out of the debate over health care is the underinsured who, according to a recent study by Consumer Reports, account for 24 % of the U.S. population.  If these numbers are accurate there are actually 50% more people in this country who are underinsured than are uninsured.  According the Consumer Reports survey, the underinsured have a median household income of "$58,950, well above the U.S. median. Twenty-two percent live in households making more than href="00,000. Still, many of the "underinsured" don’t have the resources to keep up with the rising costs of deductibles and co-pays, so much so that 43% reported that they postponed going to the doctor because they couldn’t afford it."  According to a recent study by Families USA, 2.2 million Pennsylvanians are in families that will spend more than 10% of their pre-tax income on healthcare costs in 2008.  87.1% of them are insured.  These people live with the constant threat of being overwhelmed by their healthcare costs, including health insurance, and when their numbers are combined with the number of uninsured Pennsylvanians the numbers of uninsured or underinsured Pennsylvanians starts to look more like 4 million or more (about a third of Pennsylvania’s population),  rather than the Governor’s 767,000.   The budget the Governor submitted to the Legislature last year, but never drew attention to publicly, and which also went unnoticed by the media, aspired to insure an additional 359,101 uninsured Pennsylvanians by year five if his plan passed.  In his recently submitted 2008/2009 budget (which has also largely escaped notice by the public or the media) that number had declined by more than 40% to 210,214, a number that probably represents only about 12% of Pennsylvania’s uninsured and only about 5% of the combined uninsured and underinsured.  One wonders whatever inspired Governor Rendell to dub this plan  "Cover All Pennsylvanians." Under PABC the year five goal has been further down-sized to 202,466 and even that woefully small number is contingent upon the Governor getting everything he asks for from the Legislature, assuming it even passes. Neither the original nor the new plan does anything to help the millions of Pennsylvanians who are insured but still face financial ruin because of healthcare bills.  Little wonder that more than 46% of personal bankruptcies in this country are directly caused by medical expenses.

THE SINGLE-PAYER ALTERNATIVE

While the media lavishes praise on Governor Rendell’s efforts to reform healthcare in Pennsylvania, and unquestioningly parrots his estimate of 767,000 uninsured adults, a better and cheaper alternative is out there virtually pleading for media coverage.  The Pennsylvania Family and Business Healthcare Security Act would bring true comprehensive universal healthcare to every man, woman and child in the Commonwealth of Pennsylvania.  With little fanfare the act, being promoted by HealthcareforALLPA.org (a group of unpaid citizens from around the State which, in the interests of full disclosure, this writer is a member of) is co-sponsored by thirty-eight members of the Pennsylvania House (HB 1660) and six members of the Pennsylvania Senate (SB 300).  The single-payer bill would preserve privately delivered health care, but would remove health insurance companies from their role as gatekeepers of the healthcare system.  A new Government agency would be created to administer the system, seeing to it that both those in need of healthcare and those providing it are properly attended to.  Under this system co-pays and deductibles would become a thing of the past, and prescription drugs (which would be bulk purchased by the new agency in a manner similar to what the Veterans Administration has employed for years) would also be covered. Virtually the entire industrialized world operates under a single-payer universal healthcare system or something akin to it except for the United States, whose per capita healthcare costs are more than double those of the rest of the world while depriving millions of adequate care. The Pennsylvania plan would be financed with a 10% payroll tax (far less than most businesses contribute to the health coverage of their employees); a 3% personal income tax surcharge (again, far less than the average person pays for insurance, co-pays, deductibles, and prescription drugs); Federal funding that is already available; and proceeds from the tobacco settlement.  Proponents of the plan maintain that it will save billions of dollars a year, and while that figure is difficult to precisely predict in the absence of an Economic Impact Study, they have long urged Governor Rendell to commission one.  Similar studies in other states have found that a single-payer system would save hundreds of millions of dollars, and in the case of California (which actually passed single-payer legislation in 2006 only to see it vetoed by Governor Schwarznegger), $8 billion. 

There are some tantalizing bits of anecdotal evidence out there suggesting that a single-payer plan would represent a financial windfall for Pennsylvania.  A recent study by the Pew Charitable Trust reveals that the City of Philadelphia will spend $374 million for employee health insurance in 2008, a number that represents 26% of payroll and that they anticipate will increase by 23% by the year 2013. The city will spend an additional $43.5 million in 2008 for health insurance for its retirees which brings the total Philadelphia spends for health insurance up to $417.5 million this year alone.  If a single-payer system were currently in place in Pennsylvania where employers healthcare obligations are limited to a 10% payroll tax, Philadelphia’s healthcare tab in 2008 would be $146 million dollars – a savings of nearly $272 million this year alone.  That does not include savings in administrative costs as well as reduced Workers Compensation taxes, among other things.  According to numbers supplied this writer by the Finance Department for the city of Pittsburgh, that city also would realize substantial savings under a single payer system. Pittsburgh currently spends 24% of payroll on employee health insurance, a number that is projected to increase to 27% by 2010.  $136 million is currently budgeted for Pittsburgh employee health insurance over the next three years, a figure that would be reduced to less than $82 million under a single-payer system, for a savings of $54 million dollars.

The Pennsylvania single-payer advocates have one advantage other states with similar initiatives lack.  Governor Rendell has pledged to sign it if it reaches his desk.  At an April 4, 2007 healthcare forum at Franklin & Marshall College in Lancaster, Pa., broadcast around the State by the Pennsylvania Cable Network, Governor Rendell, while minimizing the prospects of a single-payer bill making it through the State Legislature,  said "A single-payer system would serve America well.  Would I like to see a single-payer system?  Would I sign a single-payer bill if it got through the Legislature?  Absolutely." Expressing perhaps a bit more candor than he intended, the Governor later in the same forum observed "Lobbyists are... very, very, very influential... Legislators will stand up to the lobbyists if they believe the public is angry enough.  But you have to let them know that this is important, and that you’re angry enough."

Despite these remarks, the Governor has consistently refused to engage the single-payer advocates and has denied them a seat at the table on any and all discussions regarding Legislative healthcare reform.  At least one co-sponsor of HB 1660 privately admits to having been pressured by the Democratic Leadership not to support the single-payer bill.

DAYS OF DECISION APPROACH

Barring its revival at some future date, Governor Rendell’s "Cover All Pennsylvanians" initiative is dead, but the plain facts are that despite the Governor’s inferences to the contrary, and despite his use of banner props at rallies containing the words "Healthcare for all" ( a slogan he borrowed from the single-payer advocates), The Governor never aspired to cover more than a small fraction of Pennsylvania’s uninsured population, nor to outstretch a helping hand to its millions of underinsured.  His plan did nothing to loosen the grip of health insurance companies whose outrages and monopolistic practices are well-documented in Michael Moore’s documentary, "SiCKO," or to force Pharmaceutical companies to divert some of their immense profits and outrageous CEO compensation packages into lowering the cost of prescription drugs.

The new Rendell initiative, PABC,  is even worse.  It will, over a five year period, provide low-cost, subsidized insurance to a maximum of 137,000 uninsured Pennsylvanians whose family income is below 200% of the Federal poverty level (up to $20,800 per year for an individual and $42,400 for a family of four).  It claims to aspire to insure an additional 65,000 Pennsylvanians who are below 300% of the Federal Poverty level (up to $31,200 for an individual and $63,600 for a family of four), though at an unsubsidized year one cost of $311 per person per month, a cost one finds difficult to imagine too many people in that wage bracket will find affordable.  These are the Governor’s own numbers, and they are maximums that assume that that the Legislature will allow the Governor to divert  $246, million (in year one) from the fund set up by the State of Pennsylvania to protect doctors from runaway malpractice rates (HCRPA), and that the General Assembly will allocate an additional $120 million (again in year one) to cover the cost of the plan.  The anticipated cost of PABC is  $579.2 million in year one, and $1.1 billion in year five.  If the bill passes but is under-funded, enrollment will be frozen when the available money has been spent. Under "Cover All Pennsylvanians," families and individuals earning between 200% and 300% of the Federal Poverty level were eligible for subsidized coverage at a cost to them of $80 per person per month. Under PABC it will cost them $311 in year one and perhaps considerably more in subsequent years.  Persons earning more than 300% of the Federal poverty Line will not be permitted to buy into this plan except under extremely limited circumstances, and even then, only at the unsubsidized year one rate of $311 per month.  Health insurance companies will continue to manage patient care under PABC, insuring continued cost inefficiencies and continued interference with doctors and their judgment regarding required remedies for their patients.  It is unfortunate that the forces rallying around PABC continue to grossly exaggerate its objectives, touting it as "a huge step forward... in the fight to bring quality, affordable healthcare to every Pennsylvanian.  It is also worth noting that even if PABC succeeds in adding 202,000 Pennsylvania uninsured to the insurance roles in the next five years, it is likely that at least that number will lose their insurance during that time, and perhaps many more.  In other words, even if PABC is fully funded and delivers on all of its promises, there will likely be more uninsured Pennsylvanians in 2013 than there are in 2008.

For the very poor and uninsured in Pennsylvania, PABC actually represents a step backwards for many.  PABC will replace and absorb Adult Basic, a program enacted in June 2001 under then-Governor Tom Ridge, that invested the proceeds of the State’s $11 billion Tobacco settlement (over 25 years).  It was designed to provide subsidized basic medical coverage to uninsured Pennsylvanians between the ages of 19 and 64 earning up to 200% of the Federal poverty level, and again was  contracted out to four "for profit" insurance companies.  As of  December 2007 51,056 people were enrolled in Adult Basic while 95,649 Pennsylvanians were on the wait list (up 28% from 74,456 in January 2007).  From the inception of Adult Basic it has been plagued by long wait lists of at least a year.    On the positive side, many of those who have endured a long wait to enroll in Adult Basic will be able to enroll sooner in PABC, but there is a tradeoff.  The monthly cost of enrollment will increase by 19-20% for those at 150-200% of the Federal poverty line, and any one losing their insurance will now have to wait 180 days before qualifying to apply for coverage under PABC – double the 90-day wait period for Adult Basic.

The ball is now in the court of the Pennsylvania Legislature, and in the hands of  Pennsylvania voters who now have an opportunity to press their Legislators to enact true healthcare reform  by supporting and co-sponsoring HB 1660 and SB300.  Attend hearings on the single-payer bill,  due to begin in Harrisburg this coming Wednesday, March 19th.  Send money.  This effort is woefully under-funded and needs your financial support.

Pennsylvania has an opportunity to become a shining beacon for progressive healthcare reform in this country, and it will reap the benefits of a newly energized economy if it does.  If Pennsylvania enacts single-payer universal healthcare other states will follow, and it will not be long before pressure to enact it nationally becomes overwhelming.  Only then will we join the rest of the industrialized world in providing truly civilized healthcare for all.  Can we, in good conscience, do any less?

The Real Healthcare Debate

I’ve been listening to Hillary Clinton and Barack Obama debate their healthcare plans. I’m getting a bit pissed listening to both of them support inferior plans which don’t address the real issue with our broken system: the health insurance industry. We can’t afford to provide full, comprehensive coverage for everyone because too many of our health care dollars are wasted in overhead, salaries, duplication, advertising, marketing, and denial of care.

 The health care industry has the power to cap your benefits, deny you coverage you legally contracted for, delay your medical treatments until you die or it’s too late, and to decide whether you live or die.

 We pay more for healthcare than any other nation but our system ranks below many third world countries. One leading evaluator ranks us 37^th. Folks, these claims that we have the best health care in the world is a myth and a lie. We don’t. None of the plans being put forward by the candidates is the solution. They aren’t the solution because they don’t address these problems.

 House Resolution 676, a national single payer universal healthcare system would solve all these problems. Another bill, sponsored by Bernie Sanders and Tammy Baldwin, would provide a road to single payer by establishing test cases in various states. Pennsylvania Is poised to be the first state to incorporate such a plan through H.B. 1660 and Senate Bill 300.

 Single payer is not socialized medicine because providers remain private. They do not become government employees. What changes is that a single state agency collects all premiums and makes all disbursements to providers (doctors, hospitals, clinics, labs, etc.). We call this “civilized medicine” because every resident receives fully comprehensive medical care including prescriptions, mental health while eliminating copayments and deductibles.

 This is possible because government administered health care is far more efficient than the private sector. Government is not business and business is not government. Some things are better performed by the private sector and others are better performed by the public. Nations all over the globe have proven that medical care is best provided by government.

 30% of our health care revenues are absorbed by overhead in the private sector. Government health care, Medicare, Medicaid, the Veterans Administration, federal employees, the armed forces are all administered by the government at a 5% overhead rate. That 25% differential is enough to provide coverage to everyone.

 Why aren’t Barack Obama and Hillary Clinton proposing to pass such a system? Isn’t this what we should be debating? Let John McCain and his fellow Republicans defend the current system. Let them explain why cancer victims are denied coverage. Let them defend the multi-million dollar CEO salaries for health insurance companies. Let him defend the millions spent on marketing health insurance while millions are denied coverage due to pre-existing conditions. Let his defend a broken system. Let him explain how poor people can possibly work for $7/hour and have funds remaining to put in health savings accounts. Let him explain how these HAS’s will cover catastrophic illnesses or injuries.

 McCain cannot do this because no other plan fixes the central problem: the amount of money wasted in the private sector.

 Let’s look at an example here at home. A Pew Charitable Trust research study is revealing that the City of

Philadelphia

will spend 28% of its budget on employee benefits by 2012.  From 2002 to 2007 the city’s health insurance costs rose 80%.

 

Philadelphia

will spend $374 million (10% of budget) this year for health insurance. The proposed bill in

Harrisburg

would reduce this to 10% of its payroll. How could

Philadelphia

put the rest of this money to use? Better schools, more police, more affordable housing, lower wage taxes, or a myriad of other anti-poverty programs which, in reality, are health prevention programs. When people have quality housing, food, ample utilities and day care they are healthier people.

 Wouldn’t that be a better allocation of these financial resources?

 Why are we debating inadequate healthcare proposals instead of the actual solution?

Accountability

Four years ago I wrote an article we used locally in the Dean campaign where I bemoaned the fact there was absolutely no accountability in the Bush Administration.  No one was being held accountable by the President for anything.  Heck, we Democrats have refused to hold George W. Bush accountable for anything he's done so why should he?  Well, that's whole other issue...

I'm talking this morning about the FISA, domestic wiretapping issue.  Congress (House) passed another bill yesterday in which it reuses to grant retroactive immunity for telecommunications companies which broke the law.  At some point there has to be accountability.  Of course impeaching the president for this would also be in order but we all understand Nancy Pelosi also doesn't believe in accountability.

George W. Bush wants to cover his corporate friends legally for the violations of our constitutional civil liberties he made them violate on his behalf.  The House refuses to cooperate.  Why do any of them think, first of all, they can pass any FISA law which violates the Fourth Amendment?  I remind them that they cannot unless they have five votes on the Supreme Court to allow them to openly and willfully violate the Fourth Amendment.

The constitution requires a warrant based on probable cause before FISA or any other court or government entity can approve or search your communications or property or possessions.  If you want to do that George you have to amend the constitution and repeal the Fourth Amendment.  No FISA bill will suffice.

Of course Bush will get around this by refusing to reveal who among us has been wiretapped and for what reasons.  He claims "national security."  His appointed judges will uphold his claim and we will have entered a new phase in our national consciousness:  the national security state.  This is an important bill and we must not allow a complete lack of accountability and free rein to the government, one which has consistently violated the law in national security letters, to gain this power.

The Race Issue

Geraldine Ferraro's unfortunate and misguided comments this week overshadowed much other campaign news.  I recall when she was the first woman nominated to a federal office running for Vice President.  The glass ceiling for women is only superceded in unfairness in America by our racial divides and prejudices.  We had a reader leave a viciously vile and racist comment here yesterday morning about Sen. Obama.  I deleted the comment and sent an email to the poster informing her that conduct is not tolerated at my blog.  She replied to my email with an even more vicious and vile response.

We all know and understand we continue having stupid, ignorant, bigoted people in this country, in this state.  One method of handling this is letting them know, immediately, that we do not condone or tolerate their attitudes. 

Barack Obama is a magnetic, charismatic, motivational new leader on the scene.  He transcends race and everything else.  His supporters cross all the lines because they are responding to his message of hope, change and optimism.  Let us not bring ourselves down by injecting race into this debate.  Race, creed, gender, these have no place in trying to demean others whether it is the presidential contest or any other facet of our lives.

Judge each person as an individual based on who they are, not whether they are male, female, Black, Hispanic, White or any other race or religion.  We're all people and we should all be able to get along.  I will not tolerate comments which are vicious, vile, racist or misogynistic.  If you do so your comment will be deleted.  A second offense and you will be banned from commenting.  Let's keep this civil folks, let's show how good we are, how good we can be.

The Culture of Consultants

I do some political consulting.  I keep what I do for candidates separate from what I write about here because there are important ethical principles at work.  If I'm providing advice to someone and I have access to privileged campaign information I need to keep that out of what I write here.  It does provide context and background to other information and, if I receive the same information completely independently of those I'm involved with on a campaign (I get lots of emails, for example) then that is a legitimate source and a legitimate story.  I have to keep a wall of separation between the paid consulting and the blogging.

Consultants have lots of conflicts of interest.  The one above is mine.  I try and maintain high ethical standards and test my judgments regularly on this basis.  Some of you assist me in that, LOL.  The culture of political consultants in major campaigns is something else entirely however.  The Clinton campaign is unlike any other significant Democratic operation (not being familiar with GOP operations I'll stick to my Party here) in that they are paying vast amounts of money to DC consultants.

Here's the rub:  these same advisers are advising the campaigns to hire their own firms to do the work they advise the candidate to do for the campaign.  For example, one consultant may own or be a principal in a large bulk, direct mail company.  While working for, and being paid by a campaign to develop strategic advice, they advise that the campaign should engage in a large direct mail strategy as opposed to a major field (ground) operation.  Resources are always finite, even on a presidential campaign so decisions must be made.  So guess what company gets that direct mail business?  Theirs.

When this happens in government we call it corruption.  (If a public official steers public business to his own company he goes to jail.)  In our campaigns it's called business as usual.  It happens in every major facet of a campaign.  Campaign managers design a strategy maximizing major media:  radio and television because they own the firm which makes and places (for a 15% commission to their firm from the networks) the commercials.  These are huge conflicts of interest and we must begin to separate the campaign consultants from placing business with their own firms.

This corrupts the process because the consultant's primary goal is not necessarily winning the race but lining their pockets.  Next year they go on to another Congressional, Senate or presidential campaign.  They lose nothing.  We need to institute rules which prohibit such financial conflicts of interest.  Barring that each responsible candidate must place such restrictions in their consulting contracts.

The Washington Post has a long article today about the Clinton campaign and Mark Penn.  In it they highlight such a case.  In this example it has cause unnecessary friction.   Penn is  being criticized, justifiably, for hiring his own firm to test the commercials HE is developing for the Clinton campaign.  He should be using an independent, outside firm for this work. 

This is about ethics.  We either have them or we do not.  There is no replacement for ethics and we keep losing important elections because the consultants can be more concerned with their own financial stake than the country's.