Monday, December 27, 2010

Convoluted approach to health care

Twisted logic brought us to the stage where we must haggle over details of the Affordable Care Act of 2010.

Legal challenges present arguments against mandatory health insurance which confirm that we should have universal health care. It likewise explains why government should be administering health-care insurance, or at least be the central focus of it.

Opponents dubbed the health-care law unconstitutional because the law dictates that most Americans obtain insurance. Though I am a firm supporter of health care coverage, I wonder if they are right. The clause they are targeting may well be unconstitutional.

This means that to do what is right we must violate the Constitution. Vulnerable people are so powerless that their advocates must resort to an illegal option.

Judge Roger Vinson of Federal District Court in Pensacola, Fla., said during a hearing on Dec. 16 that the law’s mandate for most Americans to obtain health-care insurance would mean “a giant expansion” of the Commerce Clause of the Constitution.

The New York Times quoted Vinson stating, “People have always exercised the freedom to choose whether to buy or not to buy a commercial product.”

The law is being challenged by 20 governors and attorneys general, including my incoming governor and attorney general, Tom Corbett of Pennsylvania; all but one are Republicans.

The parsing, the fine points, the decoding, the decorous proclamations and the interpretations are only beginning to surface. Just reading the emerging arguments is a maddening and annoying experience. Reciting them to Guantanamo prisoners might have succeeded where waterboarding failed.

The Times account explained that the Supreme Court has ruled in the past that Congress can employ its Commerce Clause authority to justify the regulation of “activities that substantially affect interstate commerce.”

Ian H. Gershengorn, a deputy assistant attorney general, told Vinson that the health care market is unique because getting ill is unpredictable and potentially bankrupting. This means that the financial results of lacking insurance, including cost-shifting to others, justify congressional regulation.

Attorneys for the state officials asserted that the new law would for the first time mandate that Americans purchase a commercial product, making it unconstitutional.

Lawyer David B. Rivkin Jr., representing the plaintiffs, proclaimed that the new law “would leave more constitutional devastation in its wake than any statute in our history.”

If Rivkin has a credible argument, why spoil it with prophecies of doom?
Prior to Vinson’s hearing, a federal judge in Virginia - Henry E. Hudson - had already ruled the mandate unconstitutional, prompting Brooklyn Law Professor Jason Mazzone to explain in a Dec. 17 Times op-ed why Hudson may be on sturdy legal ground.

“Judge Hudson explained that whatever else Congress might be able to do, it cannot force people to engage in a commercial activity, in this case buying an insurance policy,” Mazzone wrote.

“The conservative (Supreme Court) justices in particular will no doubt wonder what else Congress can make Americans do if it can make us buy health insurance.”

Mazzone’s commentary triggered a half-dozen responses in the letters section which underscore the need for a government-run system.

“We can all agree on this: 50 million uninsured Americans are going to need medical care at some point,” writes Sandra Schneider, president of the American College of Emergency Physicians. “And we will be required to provide it, whether they pay us or not.”

Writes Harvard Law Professor Joseph W. Singer: “The Constitution does not require us to respect the right not to buy insurance only to force the rest of us either to pay for medical care for others or to deny it when it is needed.”

Andrew Koppelman, a professor of law and political science at the Northwestern University School of Law, adds: “If Congress can’t require people to buy insurance before they get sick, the problem of pre-existing conditions can’t be solved at all. A government in which huge national problems can’t be solved is precisely what the framers were trying to avoid when they replaced the Articles of Confederation with the Constitution.”

Schneider, Singer, Koppelman and the other letter-writers present arguments that only reinforce the steps Congress should have undertaken 60 years ago: Establish a health-care insurance program operated by the government, with more advanced benefits that private insurance companies can provide.

Health care is very much in the public interest. Any disease detected early would prevent epidemics. Preventive care will offset future health problems and free up emergency rooms for real emergencies. Whatever the flaws of government, even senior managers make considerably less money than insurance company executives and their owners.

A government-run health-insurance system will be owned by America’s citizens. Eventually, a public system will probably be far less costly.

Other countries such as Great Britain and Canada may have problems with their systems, but the United States can learn from them and try to avoid said problems.

Our government hardly “insures domestic Tranquility” or “promotes the general Welfare” when it ignores the health needs of up to 50 million of America’s 308 million citizens.

Those phrases are carried in the Preamble of the Constitution, which describes the general intentions of the document. It reads in full: “WE THE PEOPLE OF THE UNITED STATES, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

Much can be made of other phrases in the Preamble to augment arguments for a government-run system.

What our leaders are trying to do with the new law is bizarre and probably unworkable. They are employing a roundabout method to make the system work.

If health care is a critical public interest, how do they expect to make the law work through private enterprise? A government-run system would be supported by reliable revenue sources and transfer of funds from other programs that are cut.

The new law sets up the expectation that money for health insurance will be acquired through the private sector. If everyone must buy health insurance, then this process will need to be monitored and policed. That would not be necessary if government operates the program.

In addition, there will be still be Americans who will not be covered by health insurance, anyway.

That we must contend with these complications is silly. Of course, we are stuck with this system because of politics. Most Republicans and some Democrats watered down this legislation.

The public option - a partial government-run operation - might have passed the Senate if not for the Senate’s filibuster rule which allows 41 senators to block legislation.

However, the mandate may not even be necessary. Former Vermont Gov. Howard Dean said on MSNBC that this provision may make little difference. Young people in their early twenties can still be covered by their parents’ insurance, and those over 25 often reach a stage in which they are making more money and raising families whom they will want covered by insurance.

Also, private insurers can establish a reward-and-punishment system for citizens who do not sign up when they are young and healthy, according to Dean.

If Congress had enacted a more stable system, we would not be having this conversation.

Monday, December 20, 2010

Too many Enzis, too few Sanders

Mike Enzi opposes the Zadroga bill to compensate 9/11 workers sickened during the clean-up of the World Trade Center site. He was even accused of quarterbacking a campaign against the bill with a document that Carolyn Maloney called “a pack of lies.”

Bernie Sanders lent the Senate “a Mr. Smith goes to Washington moment” when he conducted a quasi-filibuster in a vain attempt to bring down the so-called bipartisan deal to retain tax cuts for wealthy Americans.

Two senators, two sharply different outlooks on public policy. Each represents the two least populous states in the country.

One could say that we never know what the system will produce. Actually, no. NBC’s Brian Williams suggested that Sanders’ speech was a “Mr. Smith” moment.

However, “a Mr. Enzi goes to Washington moment” is more predictable. Because of the system, each state is allowed two senators, which means the smallest state has as much clout as the largest state.

As it stands, many of the least populous states are conservative and more populous states are moderate to liberal. Vermont, population 621,00, is as liberal as New York or California, and one of the few states likely to be represented by someone like Sanders.

Dick Cheney isn’t exactly Enzi’s next-door neighbor, but they both spent most of their lives in Wyoming and are just about as conservative. Wyoming’s population, 544,000, is even smaller than that of the congressional district represented by Rep. Maloney, primarily Manhattan’s East Side.

The New York Daily News attributed to unidentified sources the claim that Enzi, ranking Republican on the Senate Health Committee, was behind the opposition to the Zadroga bill, which would spend $7.4 billion over 10 years to provide health care and pay victims.

The revenue would be raised from closing tax revenues on foreign corporations. Because Republicans were against employing this source for revenues, New York Senators Charles Schumer and Kirsten Gillibrand, both Democrats, suggested other funding alternatives.

The News reported that the Republican document ignores their offers and labels the foreign tax provision a job-killer, and blatantly fabricates the claim that 95 percent of the workers were provided for in a recent $625 million legal settlement.

Only 10,000 people who sued, not the 30,000 who received some form of treatment, are covered by the settlement, the newspaper article clarified.

Calling these claims “a pack of lies,” Maloney said, “If these were legitimate concerns, why are Senate Republican leaders only raising them now, at the last minute, instead of years ago?”

Enzi would not respond to these accusations, but a week later he penned an op-ed piece in the News where he claimed that health-care providers that received federal grants for 9/11 health programs “have failed to tell Congress where that money has gone.”

In a follow-up letter to the News, Maloney and Jerrold Nadler (Ground Zero is located in Nadler’s congressional district) wrote that “Enzi has already gotten detailed responses to the questions he raised. We know exactly how the 9/11 health clinics have spent their money, and so does Enzi.”

Someone is lying. Based on their respective records, who do you believe?

In a Dec. 3 editorial, the Daily News employed phrases such as “distort the truth” and “torture decency” to describe Republican tactics. “They should stand at the graves of all those whose lungs were fatally destroyed, starting with NYPD Detective James Zadroga, who labored 450 hours at Ground Zero, and repeat the libel.” The bill was named after Detective Zadroga.

Bernie Sanders is no hero, but his Dec. 12 speech was special. Special because it is rare. If most or all senators were willing to speak out more than eight hours straight against an injustice, he would have had no need to do this.

President Obama’s deal with GOP senators to spend $700 million to extend tax cuts for the wealthy for two years - specifically, those couples earning more than $250,000 yearly - means $700 million less to reduce the debt or use for other pressing needs.

Sanders, the only senator to identify himself as a socialist, takes a straightforward approach to his job. He says what he stands for and works toward these goals. What he does is hardly heroic because it reflects the views of the majority of his constituents. He was doing his job, and he did his job exceptionally well on Dec. 12.

He wins the state by large margins, first every two years as Vermont’s only congressman a number of times and then in 2006 for his first term in the Senate.

He really does not need to walk a tightrope between competing constituencies, partly because of the state’s growing liberalism and its small population. Nearly half of Vermont’s population lives within 50 miles of Burlington, where Sanders was once mayor.

As a side interest, I like to study Jewish communities around the country. Of all small-town Jewish communities, Burlington and environs is hands-down the most interesting. It has been home not only to Sanders but also Madeleine Kunin, Vermont’s first female governor; Deborah Markowitz of nearby Montpelier, longtime state secretary of state and unsuccessful gubernatorial candidate in 2010; ice-cream makers Ben and Jerry; folk singer Peter Yarrow; a gay assistant rabbi at Burlington’s only Conservative synagogue; former Gov. Howard Dean’s wife, a physician; and homosexual state lawmaker Jason P. Lorber, a native Philadelphian who is also a standup comedian.

Most of them are transplants to Vermont. Sanders was raised in Brooklyn.

From this environment, it is no surprise that someone like Sanders makes democracy come alive. In Vermont, he is surrounded by vital people like Lorber and Dean. Too bad he is in the minority in Washington.

Monday, December 13, 2010

End or amend the Senate

U.S. Sen. Chris Dodd argued, if inadvertently, for eliminating the Senate during his otherwise classy farewell speech on Nov. 30.

If historians and pundits agree on nothing else, they firmly concur that delegates to the 1787 Constitutional Convention created the Senate to establish a smaller assembly of wiser, cooler heads to assess the legislation of the far larger House of Representatives before allowing any of it to become law.

Delegates sharply disputed giving each state an equal number of votes in either chamber before they reached a compromise allowing all states two members each in the Senate, while representation in the House of Representatives would be proportionate.

James Madison and other delegates supported this arrangement once they were left with the choice of enacting a Constitution with this clause or leaving Philadelphia with empty hands. Their vote for it was grudgingly given.

Too often, you must wonder if many members of the Senate are deliberately insulting the memory of the Constitution’s framers with their behavior.

While Dodd certainly did not call for abolishing the Senate, he contradicted himself by affirming that the Senate in practice today is too often not the Senate envisioned by Madison.

Dodd said, “Our electoral system is a mess. Powerful financial interests, free to throw money about with little transparency, have corrupted the basic principles underlying our representative democracy. And, as a result, our political system at the federal level is completely dysfunctional.

“…Intense partisan polarization has raised the stakes in every debate and on every vote, making it difficult to lose with grace, and nearly impossible to compromise without cost.”

The cost of the tax compromise will be $700 billion each year to extend tax cuts for our wealthiest citizens.

The senator, who has represented Connecticut for the last 30 years, also said: “The Senate was designed to be different, not simply for the sake of variety, but because the framers believed the Senate could and should be the venue in which statesmen would lift America up to meet its unique challenges.

“The history of this young democracy, the framers decided, should not be written solely in the hand of the political majority. In a nation founded in revolution against tyrannical rule, which sought to crush dissent, there should be one institution that would always provide a space where dissent was valued and respected.”

Huh? In one breath he is saying the Senate structure is being abused, and in the next breath he is repeating the vision that Madison and his fellow framers held for the Senate.

So what is the point of keeping the Senate, or at least the Senate as we know it?

I cannot see any point. The very kind of partisan bickering that consumes the House of Representatives is prevalent in the Senate over most of the same issues. Even if we keep the Senate, its very structure and process requires some fundamental changes.

At the current rate, I would concur with any detractor that little will ever change. However, it is critical that we lay out what is wrong with the system because these are obstacles that prevent any progress.

To change policy, we almost definitely need to change the system.

I imagine that anyone concerned about progressive issues would be frightened if the Senate was abolished this January since Democrats will still be in the majority, while Republicans will control the House.

However, in any future election the Republicans could rule both chambers or, if we only had the House, Democrats might be in control.

As it stands now, we just expend lots of time and effort that end in deadlock and/or bad bargains.

If the Senate was eliminated, its extra responsibilities such as appointing Supreme Court justices and ratifying treaties can be transferred to the House.

In addition, the 100 seats taken from the Senate could be added to the House. That would at least guarantee far more representation in the House. This could benefit progressive causes since Republicans would lose some of the more liberal segments of their congressional districts.

As I have conceded, this will probably never happen. Even so, the Senate must still change. The most obvious problem is the filibuster. The Senate will likely be asked to consider changes that would at least weaken the filibuster, allowing debate to end within a reasonable amount of time.

If it was not for the filibuster, Sen. Bernie Sanders of Vermont would not have needed to conduct his own filibuster of sorts. Unlike many of his colleagues, Sanders views his job as a civic duty, not as an instrument for political calculations. He should be the standard, not the exception.

We will find out early next month what the Senate does.

The most overriding obstacle to accomplishing anything in Congress is the composition of the Senate. Every state is allowed the same number of senators, no matter how many Americans are affected by its decisions.

A rough estimate shows that the 57 Democrats and two independents represent more than 200 million Americans, and next month they will still represent slightly less than 190 million. Republicans will represent roughly 116 million Americans.

New York and California’s four senators, all Democrats, represent a combined one-sixth of the nation’s population.

Even when Republicans held the majority of seats in the Senate, they often fell short of representing the majority of the population.

In 1787, delegates from New Jersey, Maryland and Delaware adamantly contested proportionate representation in either the House or the Senate because they feared large states like Virginia, Pennsylvania and Massachusetts would control the agenda.

As many readers may recall, the Connecticut delegates proposed the famed “Connecticut Compromise” to elect House members on a proportionate basis and allow each state two representatives in the Senate. The Connecticut plan was ignored for four or five weeks until the delegates quietly adopted it in a close vote on July 16.

Madison and four other advocates of proportionate representation buried the issue on July 17 when they learned that no other large-state delegates felt strongly about the matter.

Today, New Jersey outranks Virginia in the population rankings, respectively 11th and 12th, and Massachusetts is 15th and Maryland is 19th. While Delaware ranks 45th, its interests align far more closely with the larger and more progressive states than with the conservative states, many of which are ranked lower in population.

Nine out of 10 senators from those five states are Democrats, and Republican Scott Brown broke Massachusetts’ Democratic streak in the Senate last January in an off-off year election. Democrats still retained all 10 House seats on Nov. 2.

If the Nov. 2 election does not bear out Delaware’s political leanings, I cannot what would. My search for comprehending that is quite bewitching.

It is always possible for a collection of the smaller states to control the Senate. Actually, this is about an ideological combination of smaller states with senators from large conservative states, such as Texas, and swing states like Pennsylvania.

We can hope that moderates and liberals constitute a majority of the Senate, but there are no guarantees.

Most importantly, the Senate would at least become more democratic if the states are represented on a more proportionate basis. If we maintain a 100-seat chamber, the smaller states would need to lose one senator and some larger states would be represented by more than two senators.

Texas would benefit as well as California and New York, while divergent ideological states like Vermont and Wyoming - respectively, 49th and 50th in the rankings - would each be represented by one senator.

If Sanders is the odd man out in Vermont, perhaps he can simply set up residence across Lake Champlain on the New York state side and run for a new Senate vacancy there. After all, he grew up in Brooklyn.

The amendment process works against changing the structure of the Senate, but changing the system is a prerequisite to changing policy.

Maybe we’ll get more people like Sanders in the Senate.

Saturday, December 4, 2010

The new House dummies

As an African-American role model, Allen West must be advising the average black teenager to be a “bayonet.”

Andy Harris asserts that employees should be granted health insurance on their first day on the job, but not for those who are out of work.

If their names are not already familiar to you, you have probably guessed that they are Republicans. In fact, both will become members of Congress next month.

They have already distinguished themselves as hard-right conservatives not ready for prime time. Because Republicans have the majority in the House of Representatives, vulnerable citizens may have to pay for their decisions.

They both ousted incumbent Democrats, West in south Florida and Harris on the eastern shore of Maryland. With these and other episodes, Harris and West tripped a political trap door suggesting that they are hypocritical, incompetent amateurs.

It is true that the majority of voters in their congressional districts put them in office, but they could be considered products of the system - the unrelenting two-party system that leaves little elbow room for independent candidates.

West launched his political career when he made an impromptu speech at a Fort Lauderdale Tea Party rally in 2009 which was viewed by more than 2.3 million times on YouTube, The Washington Post reported.

His words: “You better get your butts out there and understand it’s a fight, and you better fight for America. You need to leave here understanding one simple word and that word is ‘bayonet.’ You need to leave here and charge this enemy for your freedom.”

Bayonet? He joined some bizarre company like Sarah Palin who employ militaristic terms when criticizing political leaders. The word “bayonet” took on a new layer of meaning when he told a Washington Post reporter: “One of the implied responsibilities that I do have as a black member up here is to be a role model and an example.”

Just what is he telling inner-city black teenagers from broken homes who commit crimes? White people who are on constant alert for young black criminals might conclude that he is urging black teens to use longer, sharper knives.

Of course, using the word “bayonet” in any political context is plain reckless irresponsible. Connecting it to his Washington Post quote makes the reference utterly stupid and ridiculous.

Harris has campaigned to repeal the Affordable Care Act which will plug part of the gap in providing health insurance for those who do not have it. According to The Baltimore Sun, Harris denounced the public option “as a gateway to socialized medicine” during a debate on the health-care law.

Less than two weeks after being elected to Congress, Harris attended a briefing on employee benefits for new members of Congress, staff aides and family members where he questioned why he must wait a month for his new health insurance coverage to start, according to Politico, a Capitol Hill newspaper.

He said, “This is the only employer I’ve ever worked for where you don’t get coverage the first day you are employed (as quoted in Politico).”

An unidentified congressional staffer told Politico that Harris reacted “incredulously” when told he would not receive coverage on Jan. 3 when the new Congress is sworn in.

There is more to the incident, but Harris’ question was sufficient to prompt 59 House Democrats - including three of his fellow Marylanders - to sign a letter blasting Republicans for hypocrisy.

The Baltimore Sun reported that in a letter to Republican congressional leaders, they professed surprise that Harris, who was not identified by name, “would complain about not having health care coverage for a few weeks, even after campaigning to repeal the Affordable Care Act, which will help provide coverage to millions of Americans who find themselves without health insurance for months or even years.

“You cannot enroll in the very kind of coverage that you want for yourselves, and then turn around and deny it to Americans who don’t happen to be members of Congress.”

West and Harris’ constituents have the right to vote for these guys, but we can readily question their wisdom in doing so.

One culprit is our two-party system. Obviously, those who voted Republican were disappointed with the Democrats’ track record. They did not believe that President Obama exercised sufficient leadership, or they were fearful of the economy’s future, or they felt desperate about ongoing unemployment.

Democrats lost some Jewish votes, probably because of their view that Obama has at times been abrasive to Israeli leaders. While Israel has been in the wrong at times, I was personally concerned about the president’s approach.

West, who has hawkish views on Israel, probably attracted Jewish votes that were previously cast for Democrats; his district takes in parts of Fort Lauderdale and Boca Raton.

These who voted Republican had legitimate concerns, though they might have had doubts about their final choice. What was their alternative? They wanted to send a message to the Democrats and they were left a single option.

Most independents would come in a distant third because they are weakened by the winner-take-all system. A runoff system, probably Instant Runoff Voting, would have provided voters with three or more choices who would have a better chance of winning.

Moderate and liberal voters also had various reasons to worry about Democratic positions. However, they usually stick with the Democrats because they fully expect the Republicans to be much worse.

So far, two new members of Congress are quite clueless.