REPUBLICANS AND SOCIALISTS AGREE: OBAMA-CARE IS NOT THE ANSWER

by H. N. Burdett

Of all the hyperbolic hysteria bandied about during the debate over health care reform, the most outrageous is that the nation is rapidly sliding down a slippery slope where it will be snapped into the awaiting jaws of Socialism.

Established by people fleeing religious and political persecution, the United States has been throughout its existence a refuge for those running from something which generally falls under such catchall categories as "oppression" and "tyranny."

Thus it is in our DNA that we are, justifiably or not, more than a little wary of Big Government, which gets our blood stirring about the specter of an assortment of evils from the monarchial-sanctioned 15th century inquisitions to the monstrous 20th century concentration camps and gulags that emerged respectively from jackbooted fascism and police state communism .

Merely intoning the threat of Socialism -- cradle-to-grave dependence of the governed on the benevolence of the governing -- is enough to cause the mythical monolith known as the Average American to recoil in fear or lash out in anger.

Egged on by unanimous Republican opposition in the House of Representatives, which sees political advantage in portraying Democrats as the facilitators of rampant collectivism that stands diametrically opposed to the romantic ideal of rugged individualism, the American public, assuming the polls are accurate, is sharply divided over health care reform enacted by Congress and signed into law by President Obama last month.

Proponents of the legislation argue that our economy cannot be stabilized unless and until the runaway costs of health care are brought under control. For good measure, they add that the United States government is the only one in the industrialized world that fails to offer health insurance to its citizens.

Indeed the shadows of the two most prominent American Socialists of the last century loom large over what has been derisively characterized as Obama-care. Eugene V. Debs and Norman Thomas appear to have been at very least prophetic in their pronouncements regarding the direction of the movement they led.

"When great changes occur in history," Debs said, "when great principles are involved, as a rule the majority is wrong."

Thomas was even more direct. "The American people will never knowingly accept Socialism," he maintained. "But under the name of 'liberalism,' they will adopt every fragment of the Socialist program, until one day America will be a Socialist nation, without knowing what happened."

Certainly Thomas's words seem to have resonated with Republicans in the House of Representatives who stood in lockstep opposition to the health care bill. Virtually all agreed that reform was needed, but not the reform offered. Whenever they were asked to improve, revise or correct what was written, they emitted the dense fog of obfuscation. Their response was that they needed to start all over from the beginning with a blank slate -- a mealy-mouthed way of saying, "No way, not today, not now, and not ever." This all brings to mind the observation of one of our country's more beloved founding fathers, Benjamin Franklin: "Conservatives want change, they just don't want it now."

But while Republicans and their right-wing fellow travellers rail against the legislation which they assail as the abomination of "socialized medicine," American Socialists rail against it because it is not.

"This is not a health care reform bill," says Billy Wharton, co-chair of the Socialist Party USA. "It is instead a corporate restructuring of the American health care system designed to enhance the profits of private health insurance companies."

Wharton excoriated the legislation for mandating that all Americans purchase health insurance coverage or face a fine. The bill would also create health insurance exchanges, a brainstorm of the Heritage Foundation, a Washington think tank that could hardly be confused with the politburo.

Under these exchanges, people would purchase health insurance from private companies. Those ineligible for Medicaid but unable to afford insurance would receive public funds to purchase bare bones coverage from private insurers.

Wharton opposes this "restructuring" on grounds that the mandates "allow private insurers to use the corrosive powers of the state to enhance their private profits. Insurance credits will serve as a public subsidy to private companies. It is just another case of public money that could be used for necessary social programs being funneled towards companies that engage in practices that are abusive and detrimental to the overall society."

He said the bill "demonstrates how deeply corporate lobbyists and campaign contribtions have infected the country's political system."

Dr. Margaret Flowers, a leading activist for single-payer national health insurance, maintains that the Democratic party "has moved so far to the right that they have...passed a Republican health care bill. This is no surprise, private insurers and pharmaceutical companies have flooded the electoral system with money in order to guarantee their continued ability to accumulate profits.

"For the first time in American history, citizens will be forced to purchase health insurance or face stiff annual fines. Such a mandate guarantees that millions of people will be herded ino the new 'health insurance exchanges,' an idea created by the Heritage Foundation, in order to fork over their money to private insurers."

Health insurers spent an average of $600,000 a day for lobbying during just the first six months of 2009. "Lobbyists had a seat at the table during all parts of the writing, debate and approval of the bill," Dr. Flowers said. "When single-payer advocates from the Physicians for a National Health Program and Healthcare Now attempted to participate in proceedings at the Senate Finance Committee, they were at first denied a seat and then arrested."

In remarks before the National Press Club, Republican National Chairman Michael Steele accused President Obama of "conducting a risky experiment that will hurt the economy and force millions to drop their current (health care) coverage." Asked if he felt the health care reform measure was "socialism," Steele replied: "Yes."

Rep. Steve King, R-Iowa, told Newsweek that Americans "must take their country back by methodically eliminating every vestige of creeping socialism, including socialized medicine."

A number of Republican lawmakers claim that no one knows everything that is in the health insurance reform bill, but when the facts become known American citizens will be enraged. While this may or may not be, what no one denies is that insurers will be writing up policies for 32 million Americans, who did not previously have health insurance but will now have it subsidized by the United States government.

Newsweek political correspondent Howard Fineman quipped, "If this is Socialism, Warren Buffett is Karl Marx."

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HUNGER POLITICS: OVERCOMING BARRIERS TO A WELL-FED WORLD

Considerable progress has been made in reducing world hunger and boosting food security in recent decades, yet more people are hungry today than were even alive a century ago.


Three challenges central to the global conversation on hunger reduction that need to be addressed, according to a paper produced by the Worldwatch Institute are:

• Unify the food security, climate change and ecosystem agendas.


• Rise above conflicting projections on the causes and solutions to hunger.


• Empower farmers and communities to feed themselves.

"Historically, there has been a major disconnect between policymakers focused on hunger reduction and the newer voices mobilizing around ecosystem conservation and climate mitigation and adaption," says Sara Scherr, president and CEO of Ecoagriculture Partners and co-author of the paper.


She added: "Yet in the midst of all this conflict, a rapidly growing set of individuals and institutions has been exploring innovations for reconciling these objectives for developing landscape mosaics that overcome these challenges simultaneously."


Technical and institutional innovations to boost smallholders productively, gain market access, and restore natural resources are transforming agriculture in ways that can ensure food security, mitigate climate change, and conserve critical ecosystem services, including watershed protection, pollination, and pest and disease control.


Such innovations are often hidden, however, as entrepreneurial farmers are overlooked by national and international government leaders and funders.

,"Despite these obstacles, agricultural innovation is taking place in the fields of Uganda, Ghana, Kenya and elsewhere across Africa to overcome the blight of global hunger," says Danielle Nierenberg, senior reseracher at Wordwatch and co-director of the Nourishing the Planet Project.


"In order to feed the 1.02 billion people who go to bed hungry every night," she stresses, "change-makers must overcome the policy challenges that have plagued this issue for generations and embrace the innovations that have proven most effective to date."


One in nearly six people do not get enough food to be healthy and lead an active life and hunger and malnutrition are the leading risk to health worldwide, greater than AIDS, malaria and tuberculosis combined, according to the United Nations World Hunger Program.


Among the principal causes of hunger are natural disasters, conflict, poverty, poor agricultural infrastructure and over-exploitation of the environment. Recently, financial and economic crises have pushed more people into hunger.


As well as the obvious hunger resulting from an empty stomach, there is the hidden hunger of micronutrient deficiencies which make people susceptible to infectious diseases, impair physical and mental development, reduce their labor productivity and increase the risk of premature death.


Hunger does not only weigh on the individual. It also imposes a crushing economic burden on the developing world. Economists estimate that every child whose physical and mental development is stunted by hunger and malnutrition stands to lose 5-10 percent in lifetime savings.


The WHP observes that whereas good progress was made in reducing chronic hunger in the 1980s and the first half of the 1990s, hunger has been slowly but steadily rising for the past decade.

NEW REPORT CALLS FOR 'MIDDLE WAY' TO DEAL WITH IRANIAN CENSORSHIP

Communications technology can be instrumental in enabling civil society and the Green Movement to work effrectively, and in preventing the Iranian government from using such technology to censor and control civil society, says a new report by The Century Foundation.

A result of the first meeting of the Iran-U.S. Advisory Group, convened by the Century Foundation and the National Security Network, the report presents insights about present-day Iran often missing from public policy discussion.

The advisory group, which is scheduled to meet over the next 12-18 months, consists of Iranian activists with close ties to the opposition movement in Iran, including the Green Movement, and European and American current and retired officials and diplomats.

Iranian members of the group developed a set of recommendations specifically addressing how the United States and other western governmnets can foster connectivity and discourage government surveillance and repression.

Among specific measures recommended are:

• Increase Iranian public access to the Internet by sanctioning companies that assist the Iranian government in Internet filtering, surveillance and eavesdropping.


• Create a secure e-mail service that can be accessed by activists to use inside Iran. There is no major secure free e-mail in Iran.


• Facilitate the provision of high-speed Internet via satellite.


• Dedicate a hardened satellite to host Iranian television and radio channels to enable western news services such as BBC Persian and Voice of America, to escape the Islamic Republic routine jamming efforts.

Titled "Dealing with Iran: Time for A 'Middle Way' Between Confrontation Conciliation," the report was written by Century Foundation fellow Genevieve Abdo, with assistance from the National Security Network.

Abdo is the editor of InsiderIRAN.org, a new website that provides information and analysis from scholars both within and outside of Iran.

Before joining The Century Foundation, Abdo served as liaison for the United Nations' Alliance of Civilization, a project created by the United Nations Secretary General to improve relations between Western and Islamic societies. She was a foreign correspondent for many years in the Middle East and the broader Islamic world.

THE WASHINGTON GAME IS GETTING BOTH ROUGHER AND UGLIER

by John Feffer

In the Mayan game of pitz, the first team sport in human history, two sets of players squared off on a ball court that could stretch as long as a football field. The object of the game was to use hips and elbows to keep the ball in the air and, if possible, throw it through a hoop set high on a stone wall. The ball was roughly the size of a human head.

Indeed, given the sheer number of decapitations in the Popol Voh, the sacred Mayan text that prominently features the game, scholars have not ruled out the possibility that the teams sometimes played with the heads of sacrificial victims. It's also probable that, at the conclusion of the game, one team or the other fell en masse beneath priests' daggers.

Were the Mayans especially bloodthirsty in their combination of play and sacrifice? No more so than Romans egging on the gladiators at the Coliseum. And remember, it wasn't that long ago that we dispensed with ritual reenactments and treated war as a spectator sport.

In July 1861, Washingtonians took their picnic baskets out to Bull Run stream in Manassas, Virginia, to take in the show and root for one side or the other. Today partisans cheer the home team from the safety of the living room, and TV networks are generally careful not to show too much carnage to ruin the evening meal.

Sports and war have long had an intimate connection. The marathon was born during the Greek victory over the Persians at Marathon in 490 B.C., when a Greek messenger allegedly ran 26 miles to Athens to announce the victory. The biathlon -- skiing and shooting -- began as training for Norwegian soldiers. Boxing, fencing and martial arts all bring hand-to-hand combat into the sporting world. Like pitz, the Olympics are a ritual reenactment of battle, where nations compete for gold and glory.

Governments have also used sports more deliberately in the service of war and conquest. In the United States, for instance, "baseball prepped the nation for World War I with its close-order drills at ballparks," writes Foreign Policy in Focus contributor Robert Elias in The Foreign Policy of Baseball.

Ballplayers used their throwing skills to train soldiers in tossing hand grenades. Baseball accompanied the endless U.S. military and corporate interventions in the Caribbean and Latin America, including Nicaragua, Mexico, Panama, Colombia and the Dominican Republic, and even Brazil, Chile and Argentina. According to Albert Spalding, whose sporting goods company was an early supporter of American expansionism: "The United States has no lands or tribes to conquer but it is only to be expected that Base Ball will invade our new possessions and [demonstrate] that possession's American-ness."

Sports have been bloodied by their association with politics. But politics, too, has become a blood sport.

Like pitz, what goes on inside the sacred ring known as the Beltway is a fight to death between two opposing teams. A Republican siding with the Democrats has become as unheard of as a Yankee pitcher striding over to the Red Sox dugout and offering to throw a few for the other side. Team loyalty is absolute. If you don't vote the party line, the party will sacrifice you in the next election.

Then there's the increasingly disturbing connection between tea party anger and guns.

"We are turning our guns on anyone who doesn't support constitutional conservative candidates," tea party leader Dale Robertson said as a warning to moderate Republicans.

Sarah Palin's "Don't Retreat, Reload" campaign, with gun crosshairs over targeted state races, reinforces the image of politics as blood sport.

Anti-government militias are coming out of the woods to sponsor "open-carry" tea party rallies. The tea party movement, which draws on some legitimate populist anger over high unemployment rates and Wall Street excesses, looks more and more like one of those "hooligan firms" affiliated with soccer teams, whose expressed purpose is to brawl with the fans on the opposing side.

I don't get misty-eyed for the days of bipartisanship. After all, the bipartisan consensus on U.S. foreign policy during the Cold War was nothing to get nostalgic about. When we've gone to war, it's generally been a bipartisan affair. But when people start pulling out their guns, I start to worry. The Washington game is getting rougher and uglier. Kicking around human heads may be just around the corner.

Anyone for pitz?

The author is co-director of Foreign Policy in Focus at the Institute for Policy Studies.

MEASURING WHAT MATTERS: GDP, ECOSYSTEMS AND ENVIRONMENT

by John Talberth

Gross Domestic Product (GDP) is no longer the gold standard for measuring a country's progress.

On March 30th an historic gathering of thought leaders, non-governmental organizations, philanthropists and representatives from federal and international agencies met in New York

City with an ambitious yet long-overdue goal to replace GDP as the nation's most common measure of economic progress.

The "Dethroning GDP" strategy session, hosted by Demos, the World Resources Institute and the Institute for Policy Studies, in partnership with the Rockefeller Brothers Fund, featured Nobel Laureate Joseph Stiglitz, WRI founder Gus Speth, former WRI economist Robert Repetto, Gund Institute's Robert Costanza, former Bureau of Labor Statistics Commissioner Katherine Abraham and RealNetwork founder and chairman Rob Glaser.

As an overall barometer of progress, Gross Domestic Product has long been criticized because it simply measures economic stability but not genuine improvements in the quality of lives.

As noted long ago by Robert Kennedy, GDP "measures everything, in short, except that which makes life worthwhile." GDP lumps together costs with benefits, so that activities that enhance welfare (e.g., education expenditures) have equal weight as expenditures that represent the externalized costs of growth (e.g., oil spill remediation).

GDP also tells us nothing about sustainability. It fails to trace the depletion or degradation of natural, human, built, and social capital on which all economic activity ultimately depends. It fails as well to capture the inherent unsustainability of economic activity financed by debt.

Finally GDP fails to recognize the costs of inequality. It counts growth concentrated in the uppermost income brackets as "program," even if income and quality of life are failing for most.

The movement to "green" or replace GDP has proceeded in fits and starts for decades. While dozens of new approaches have been developed, such as Genuine Progress Indicator, Green Savings, and Green GDP, the traditional GDP-based framework of progress only became more ingrained in our economic thinking and policy structure in recent decades.

However, the political landscape has changed dramatically in the wake of the economic crisis and opportunities for fundamental changes in how we measure economic performance and social progress are now significantly more promising than they have ever been. Consider the following:

• In February of 2008, French President Nicholas Sarkozy established the Commission on the Measurement of Economic Performance and Social Progress, led by Joseph Stiglitz. The commission was charged with addressing the growing disconnect between people's perceptions of their own day-to-day economic experiences and official economic performance pronouncements by statisticians and politicians. The commission's initial report specified the major flaws with GDP and outlined the contours of a better measure. The commission is hard at work developing a single new indicator to replace GDP. The scope of the commission's work has now expanded and will be housed under the auspices of the Organization for Economic Cooperation and Development (OECD).


• In February 2007, the European Parliament launched its Beyond GDP initiative, bringing together decision makers and policy experts throughout the world to develop a new set of "headline" indicators that can supplement and gauge a nation's overall sustainability. Eurostat, the European Union's statitistical agency, is now developing a workplan to incorporate new indicators into economic performance evaluations and policy analyses.


• Also in 2008, the OECD launched its Meausring Progress of Societies initiative to foster the development of sets of key economic, social and environmental indicators, sets to inform and promote "evidence-based decision-making, where the effects of policy on these indicators are quantified over time rather than simply being discussed in purely qualitative terms."


• The newly enacted U.S. health care legislation establishes a Commission on Key National Indicators. The commission is charged with partnering into the National Academies to establish, maintain and disseminate indicators responsive to critical public issues including indicators that provide a more accurate portrayal of true economic welfare.


• The Economics of Ecosystems and Biodiversity Initiative -- a major United Nations Environmental Program study on the economics of biodiversity loss -- is researching ways to integrate changes in ecosystem service stocks and flows into national accounts.


• For the first time since the early 1990s, the Bureau of Economic Analysis is set to consider ways to revamp the U.S. statistical architecture to include "(m)easures of sustainability of economic trends. . ." This could provide a critical policy screen -- policies designed to boost GDP must also be shown to be sustainable over time.


• Throughout the country, U.S. states are considering new metrics to replace GDP's state level equivalent -- gross state product. The State of Maryland is leading the way. In February, Governor Martin O'Malley released a Genuine Progress Indicator and sanctioned its use in policy analysis at the state level. The state has expressed interest in coordinating a network of GPI practitioners throughout the United States.

There are two essential features of a macro economic indicator to replace GDP: (1) It should measure genuine economic welfare over time. Proper valuation of natural capital, such as overfishing, are by definition unsustainable, and therefore should not be credited in a measure of sustainable economic welfare since they limit the next generation's prospects.

In addition, depleting natural capital degrades ecosystem services important to current welfare. For example, when we lose forests we also lose clean and regular water supplies. The externalized costs (e.g., expenditures on water filtration or groundwater pumping) now show up as positive contributions to GDP when in fact they represent the costs of poor land management. National accounts should be debited, not credited, to reflect these costs.

Replacing GDP with a measure of sustainable economic welfare is not an end to itself but rather a means for guiding policy. For the past 50 years, growth in GDP has been an overall policy objective pursued by governments at every level. Obsession with GDP growth has spurred policies to liquidate natural capital as quickly as possible. By correctly valuing changes in our stocks of natural capital and the ecosystem services that they provide will help advance a science of new metrics capable of inspiring more sustainable policy choices.

The author is the senior economist with the People and Ecosystems Program of the World Resources Institute.

SORTING OUT BOTH THE WINNERS AND LOSERS IN HEALTH CARE REFORM

By Maggie Mahar

What will health care reform mean for insurers, hospitals, doctors, Medicare patients, seniors who are now on Medicare Advantage, Medicaid patients and state budgets? Who wins and who loses?You may be surprised by some of the answers. The legislation is rich in details that have been ignored. Liberals as well as conservatives are making assumptions that just don’t square with the facts.Below, I focus on the impact that reform will have on the private insurance industry--and on the industry’s customers.


MYTH # 1: Health Care Reform represents a “boon” for private insurers.FACT: It is s true that, beginning in 2014, virtually all Americans will be required to buy insurance, or pay a fine. But while insurers will pick up a boatload of new customers, many will be refugees from a health care system that treated them poorly. Think of the boat as a life raft. These could be very expensive customers.

Moreover, between now and 2014, insurers will face some serious financial hits. These new regulations will make our health care system fairer and more affordable. But the rules also suggest that going forward, for-profit health insurance may not be a viable business--unless these companies learn how to keep patients healthy, while insisting on value for health care dollars. Insurers that over-pay drug-makers or hospitals will find that they can no longer turn a profit by simply passing the added expense along in the form of higher premiums. Consider what will happen in the next three years:

1) This year, Washington sliced funding for private insurers who offer Medicare (a.k.a. Medicare Advantage) by 5%. Next year, payments will be frozen. In 2012, the serious cutting begins. Over ten years, Medicare will slash over-payments to Medicare Advantage insurers by $132 billion.When the Medicare Advantage bill was passed in 2003, Congress agreed to pay Advantage insurers 12 percent more, per beneficiary, than it would cost Medicare to cover those patients itself. Most agree that this is corporate welfare that our health care system cannot afford. But recent years, insurers have become increasingly dependent on the windfall payments from Medicare Advantage. As unemployment rises, insurers have been losing customers in the employer-based insurance market, and Advantage has come to represent a larger share of their profits. Humana, for example, has been receiving 60% of its operating income from Medicare Advantage.Meanwhile, insurers selling plans in the private sector have been scrambling to rachet up premiums fast enough to keep up with the spiraling cost of healthcare. For ten years private insurers’ payouts to doctors, hospitals and patients have been climbing by roughly 8% a year. Rising prices plus volume have driven reimbursements skyward. Each year Americans are taking more medications and undergoing more surgeries and tests. And every year, virtually every product and service in our healthcare system costs more. This is why, according to Morningstar Investment Research, the health insurance industry showed an average profit margin of just 3.4% in 2009. This means that, in terms of profitability, it ranked 87th out of 215 US industries. As Henry Aaron, a highly-respected progressive reformer and senior fellow at the Brookings Institution observed last fall, “Insurance company profits in the larger picture have very little to do with the overall rising cost of health care.” Given the skimpy profits that the industry has seen in recent years, generous subsidies from Medicare Advantage have remained what Carl McDonald, an analyst with CIBC World Markets in New York, calls a “bright spot” for companies such as industry leader UnitedHealth Group.

Good-bye “bright spot.” Only those insurers that can show that they are providing excellent value for Medicare dollars will continue to receive Medicare payments, and their subsidies will be much lower. Most likely, many insurers will simply give up on the once-lucrative Advantage business.


2) Next year, the new rules regarding pay-outs will apply to private sector plans. Insurers selling in the individual and small group market will be required to spend 80 percent of premium dollars on medical services, while plans in the large group market will be expected to spend 85 percent. Insurers that do not meet these pay-out thresholds will have to provide rebates to policyholders.


3) The new pay-out rules will make premium hikes far less profitable for insurers. Even if an company raises its premiums by 10%--for example, lifting a $14,000 annual premium for a family plan to $15,400--the insurer must pay out 85% of the $1,400 increase, or an additional $1,190 to hospitals doctors and patients , keeping only $210 of the $1,400 to cover overhead and profits.


4) Another new cost for insurers: beginning in 6 months, all new group health plans as well as new plans in the individual market will have to provide coverage for preventive services at no charge. Co-pays and deductibles will not apply to recommended services.


(5) Beginning this year, if you become seriously ill, insures won’t be able to drop your coverage on the grounds that you forgot some detail of your medical history when you applied for insurance. They will be able to rescind your policy only if they can prove fraud, or that you intentionally set out to deceive them. This won’t be easy.


(6) In 2011, insurers will no longer be allowed to cap how much they pay out to an individual over the course of his or her life. If a customer suffers from a serious illness that requires multiple hospitalizations and high-tech treatments over many years, the insurer faces an open-ended bill. Starting in 2014, insurers will no longer be able to limit how much they pay out annually.Make no mistake: patients need this protection. Parents should not have to worry that the insurance covering a child suffering from cancer is going to “run out” if her care costs too much in any one year—or if she survives too long. But while the new rule is welcome, it will make the insurance business riskier: Actuaries will have a hard time guesstimating just how high those bills could mount, especially over 10 or 15 years. This is another reason why reform is far from a sweetheart deal for insurers.

(7) In 2011 it will become more difficult to raise premiums. Given falling Advantage reimbursements, coupled with rising expenses, one might assume that insurers would simply lift premiums to make up the difference. But it won’t be quite that easy. Reform legislation helps states insist that insurance companies submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges. Already, some state regulators are getting tougher. In March, the Providence Journal reported that Rhode Island’s state health insurance commissioner slashed proposed premiums increases, keeping rate increases in the single digits, while calling Blue Cross's proposed 14.6-percent hike "just not affordable." And in April the Massachusetts insurance commissioner rejected nearly 9 out of 10 rate increases—ranging from 7% to 34%--that the state’s health insurers had requested for individual and small group plans.Still, many argue that long-term, insurers will emerge as big winners.


MYTH #2: In 2014, when the mandate requiring that everyone must purchase insurance kicks in, insurers will capture millions of new customers, government subsidies in hand, and their profits will, at last, soar.FACT: In 2014, insurers will find that many of those new customers will be coming from low-income households. These are families who are not poor enough to qualify for Medicaid, but too poor to purchase insurance without the government subsidies that will become available in 2014.


Today about one-third, or nearly 15 million of the 47 million uninsured live in households earning between $25,000 and $50,000. These are the families who will be receiving good subsidies—and they are likely to sign up for insurance. But many will need extensive care.


According to a 2009 report issued by the Kaiser Family Foundation, 11% of the uninsured are in “fair “or “poor” health, compared to 5% of those with private insurance. About half of all uninsured adults suffer from a chronic condition. About 75% have gone without insurance for more than one year; 55% have not had insurance for more than 3 years. Some haven’t seen a physician during that time. Others have seen doctors, but have not been able to afford the medications physicians prescribed.


These patients are likely to need more tests, treatments and surgeries than the average customer.Keep in mind that, under the new reform law, insurance companies will not be able to charge these new customers more than they charge others in their community. Moreover, insurers will have to offer all patients comprehensive insurance that meets a high bar defining basic benefits. No more “Swiss cheese” policies filled with holes. This is all fair. But it does mean that insurers will be operating in an unfamiliar marketplace, where the rules are designed to benefit patients, not the corporations that sell them coverage.


Of course, not all of today’s uninsured are poor: 9.7 million live in households earning over $75,000 a year. Why don’t they have insurance? Some suffer from pre-existing conditions that have made it impossible for them to secure insurance. Most likely, they will buy coverage adding to the number of sick patents in their insurers' pool.Many others in this income bracket are healthy, and haven’t bought insurance because they just don’t think it’s a good value.


Under reform rules, most earn too much to receive government subsidies. Unless premiums are significantly lower than they are today, many may well decide to pay the penalty rather than buy insurance.After all, the penalties for individuals who ignore the mandate are surprisingly low: $95 in 2014, $325 in 2015, $695 (or up to 2.5 percent of income) in 2016. Families will pay half the amount for children, up to a cap of $2,250 per family. After 2016, penalties are indexed to the Consumer Price Index.


In addition, roughly 40% or about 19 million of the 47 million uninsured are 18-to-34-years old. Most in this group are healthy, and just don't believe that they need protection. Under the reform legislation, some under the age of 26 will sign up for their parents’ insurance. But many of these invincible youngsters are likely to shrug, and pay the puny penalty.As a result, analysts at Fitch, the bond rating agency, observe: “It is not unreasonable to envision that too many new sick customers will overwhelm the individual segment of the market, driving many health plans from it altogether.”


In other words, these Fitch analysts are suggesting that a fair number oy insurers may not even try to compete for the new but unprofitable business in the Exchange. “This could become most acute under a scenario in which healthy, younger individuals decide to pay the penalty as opposed to purchasing coverage,” the Fitch analysts write, “and older individuals let policies lapse during periods when they do not need medical services, and purchase coverage only when they face a pending medical need, such as a surgery or expensive sets of tests or treatments."This is why I predict that sometime between now and 2014, Congress will lift the penalties, and change the rules to make it impossible for someone to pay a penalty--and then buy insurance when he or she falls ill. The rest of us cannot afford to carry "free riders."


Some have suggested that when a person decides not to buy insurance, he should be required to sign a document saying that he will not try to buy insurance for three years, taking the financial risk that he will be in an accident or become sick during that period of time and wind up broke, with medical debt that he will be paying off for years.We need young, healthy people in the pool or insurance will become unaffordable for everyone.


Make no mistake, there are many unknowns. We don’t yet know whether premiums will be high enough to guarantee that insurers will recover the dollars they spend on new customers. But industry analysts predict that rate increases will be held in check by the new rules on the percentage of premiums’ that insurers must pay out, and by heightened competition for customers, who will have more choice of plans than they currently do in the individual market. Insurers "will be free to price themselves into oblivion if they choose to do so," Sheryl Skolnick, an industry analyst with CRT Capital Group, told the Washington Post.


When all is said and done, it strikes me that the cuts and regs that go into effect in the next four years could easily lead to an industry shake-out. My guess is that some for-profit insurance companies won’t make it to 2014.


On Wall Street, analysts vary in how they assess the net effect of reform legislation on insurers, but no one is jubilant. Keep in mind that most Wall Street analysts would prefer to be optimistic.

Most companies are in the business of selling stocks. It is not good for business to be bearish.But everyone on the Street knows that while insurers will have more customers, profit margins are likely to be even lower than they are now. At best, this could prove to be a wash.Offering a moderate assessment of the damage, Ana Gupte, an analyst with Sanford Bernstein, suggests that "insurers come out a net negative, but not severely net negative."


What Will This Mean For You? If for-profit insurers are going to survive and thrive, they will be compelled to be more creative and efficient than they are today. They will be competing in the Exchanges where they will be offering comparable policies that promise the same essential benefits with less fine print. Thus it will be far easier for customer to make head-to-head comparisons.


If you are buying your own insurance or work for a small business that doesn't offer insurance and are shopping the exchange, you are likely to find that insurers are offering better value for your health-care dollars.

This will not mean that premiums for employer-based coverage will climb. If insurers selling to large corporations try to jack up premiums, many corporations will simply switch to another insurance company. In this new, more regulated environment, buyers will have more leverage. Meanwhile, the best of not-for-profit insurers are likely to do well in a regulated market.



Some already have pioneered using comparative effectiveness research to learn how to keep customers well. Kaiser Permanente, for examples has been honored for its work in preventing heart disease. Some for-profits also have been trying to do a better job of managing chronic disease.


But too many-profit companies have relied on various gimmicks to stay in the black: cherry-picking, selling Swiss cheese policies, canceling policies when patients become ill, putting caps on annual and lifetime pay-outs.


Many have relied on Medicare Advantage to stay afloat, while shifting risk to Advantage customers. Now, they are going to find themselves operating in much more difficult climate.

Some of these companies just don’t know how to make money unless they are able to do it the old-fashioned, predatory way. I suspect that more than a few will go under.If that happens, it is quite possible that non-profits that couldn’t have competed in the laissez-faire environment of the past will become viable.


In the 1980s and early 1990s for-profits with deep pockets drove many non-profits out of business. Now, new non-profits are likely to pop up.Finally, if for-profit insures have difficulty designing affordable plans that meet the new rules, my guess is that Congress will revive the public option.

A senior fellow specializing in health care issues at The Century Foundation, Ms. Mahar is the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins

U.S. JOB MARKET IS SHOWING SIGNS THAT IT IS BEGINNING TO REBOUND

By Gary Burtless

The latest employment report from the U.S. Department of Labor's Bureau of Labor Statistics provides the strongest indicator to date that the U.S. job market has begun to rebound.

After more than half a year in which the nation's economy grew but payroll employment stagnated or fell, we now see clear evidence that employers are adding to their payrolls.

Unlike previous months in which payroll gains were limited to the health and education sectors and to temporary help agencies, the latest report suggests that job gains are now more broadly distributed across the private economy. In March there were small gains in manufacturing, construction and many service producing industries.

The temporary help industry continues to register strong gains. Employment in that industry has risen more than 18% since it began growing again last October. This is usually an early indicator that demand for employers' products is outstripping their ability to satisfy that demand with their present staff.

The March employment gains shown in the household survey are considerably higher than those in the employee payroll survey.

Last month household respondents reported an increase of 264,000 people employed versus only 162,000 additional jobs, according to the payroll surveys. This continues a pattern that has been evident since the start of the year.

Estimates from the household survey show that the number of employed workers has increased 933,000 since last December. That is, employment gains have exceeded 300,000 workers a month.

The rise in the number of employed has been only slightly larger than the increase in the number of Americans in the labor market. This helps explain why the unemployment rate remains stubbornly high.

Nonetheless, it is an encouraging sign that people who were out of the labor force three or four months ago now believe it is worthwhile to look for a job.

In the first two years after the recession began in December 2007, the labor force participation rate tumbled 1.4 percentage points, falling to 64.6% in December 2009. This is the lowest participation rate since the mid-1980s. Since last December, the participation rate has increased 0.3 percentage points.

Another indication of employees' growing demand for labor is the BLB estimate of weekly work hours.

The private sector work week increased 0.1 hour in March. Since December 2009, the private sector work week has increased 0.6%, far outstripping the growth in the number of employees on private payrolls, which increased only 0.1% over the period.

As predicted by many economists, in the early stages of a recovery private employers are more inclined to add to the work week and to overtime hours than they are to add new employees to their payrolls.

When they see stronger evidence for a sustained rebound in demand for their products, I expect they will be more willing to add to the numbers of their permanent staff.

Gary Burtless is a senior fellow in Economic Studies with the Brookings Institute

URBAN SPRAWL IS NOW A PROBLEM IN WORLD'S DEVELOPING COUNTRIES

Urban sprawl, a trend long associated with North American cities, is fast engulfing many developing countries where real estate developers are pushing a "world class" lifestyle.

The Mexican city of Guadalajara is cited as an example in a new report by UN-Habitat. Between 1970 and 2000, the surface area of the city grew 1.5 times faster than the population. The same is true for cities in China, as well as Antananarivo, the capital of Madagascar; Johannesburg, South Africa's largest commercial hub, and the capitals of Egypt and Mexico -- Cairo and Mexico City, respectively.


In many developing countries, urban sprawl comprises two main, contrasting types of development in the same city, says the report entitled, State of World Cities 2010/2011: Bridging the Urban Divide.


One type is characterized by large, peri-urban areas with informal and illegal patterns of land use and is combined with a lack of infrastructure, public facilities and basic services; this is often accompanied by little or no public transportation and by inadequate access roads.


The other is a form of suburban sprawl in which residential zones for high and middle income groups and highly valued commercial and retail complexes are well connected by individual rather than public transportation.


Urban sprawl adds to the urban divide, pushing social segregation along economic lines that result in spatial differences in wealth and quality of life across various parts of cities and metropolitan areas, run down inner cities and more suburbs.


Suburbanization in developing countries happens mainly because people -- rich and poor -- flee poor governance, lack of planning and poor access to amenities. "In a nutshell: sprawl is a symptom of a divided city," the report stresses.


Urban sprawl involving the poor occurs because authorities pay little attention to slums, land, services and transportation. Authorities lack the ability to predict urban growth and, as a result fail to provide land for the urbanizing poor.


In addition, the urban poor are denied land rihts which is one of the main facgtors driving people to the periphery of towns associated with urban spread in developing countries.


Other features typically associated with sprawl include overdependence on personal motorized transportation coupled with a lack of alternatives, limited housing options and urban spaces that discourage pedestrian traffic.


Most South African cities, for example, expand primarily through development of new housing areas located beyond the existing urban periphery, and are therefore relatively unplanned. As a result, the urba periphery consists of pockets of housing developments isolated and separated from each other by trunk roads or open space.


Urban sprawl has a negative impact on infrastructure and the sustainability of cities. In most cases, sprawl translates into an increase in the cost of transportation, public infrastructure and of residential and commercial development.


Moreover, sprawling metropolitan areas require more energy, metal, concrete and asphalt than do compact cities because homes, offices and utilities are set farther apart.


In many places, urban sprawl encourages new developments that cause significant loss of prime farmland. When cities are improperly planned, urban sprawl adds to environmental degradation. Such is the case around several cities in Latin America where sizeable damage has been caused by environmentally sensitive areas including: Panama City, Panama, and its surrounding Canal Zone; Caracas, Venezuela and its adjacent coastline; San Jose, Costa Rica and its mountainous area, and Sao Paolo, Brazil and its water basin.

AFGHANISTAN, IRAQ VETS EXPECTED TO NEED LONG-TERM HEALTH CARE

The Veterans Administration lacks a mandate and resources to forecast the future health care and disability needs of Afghanistan and Iraq war veterans and their families, limiting the agency's ability to plan for infrastructure, work force, and other requirements where demand is likely to be greatest, says a report by the Institute of Medicine.

According to the report, the VA needs to institute a process of forecasting the amount and types of resources necessary to meet the needs of the veteran and their families in the next three decades or more when their demand for health care and disability compensation is likely to peak.

Requests for disability care and compensation by veterans of previous wars did not peak until 30 years or more after their service ended, suggesting that the maximum demand on support services for military personnel of current wars and their families may not occur until 2040 or later, the report notes.

Many wounds suffered in Afghanistan and Iraq will persist over veterans' lifetimes, the report points out, and some impacts of military service may not be felt until decades later.

Requested by Congress and sponsored by the U.S. Department of Defense, the study calls for the VA to institute annual projections of the future health and disability benefits of West Asia war veterans and their families.

Traumatic brain injury (TBI) has been identified as the signature wound of the Afghanistan and Iraq wars. But the VA lacks protocols to manage lifetime effects of TBI because the issue has not been studied in either military or civilian populations.

The report maintains that the VA should sponsor research to determine the efficacy and cost effectiveness of developing protocols for the long-term management of polytrauma and TBI.

To help current and former military personnel of ongoing wars and their families readjust to post-deployment life, the VA and the Department of Defense need to gather information to answer many uncertainties, the study contends.

The information required includes how many mental health care providers are needed and where, what works best in treatment of TBI over the long term, and whether giving service members time to decompress before returning home would be beneficial.

The report further calls for VA and DOD to oversee coordination and communication among the dozens of public and private programs created to serve current and former Iraq and Afghanistan service members, veterans and their families.

An independent evaluation of the programs should be organized by these two agencies, the report suggests, given that it is unclear whether they are effective and whether redundancy among te programs help ensure the needs of service members, veterans and their families.

The study represents preliminary findigs of the two-phase study of the readjustment needs of current and former service members deployed to Iraq and Afghanistan and their families.

In the first phase, the authors sought to identify the most pressing needs of this population through an initial review of the limited scientic literature available as well as reports and testimony from veterans and their families at town hall meetings.

The second phase report will present more detailed findings and recommendations based on an in-depth review of additional information, including data anticipated from several ongoing studies.

The committee that wrote the report was chaired by Dr. George W. Rutherford, Salvatore Pablo Lucia Professor and Vice Chair of the Department of Epidemiology and Biostatistics and Director of Prevention and Public Health Group, Global Health Sciences, University of California.

Members of the committe included representatives of the Harvard Medical School Department of Psychiatry; Duke University Medical Center; Johns Hopkins University Applied Physics Laboratory; Ohio State University Department of Physical Medicine and Rehabilitation; the National Bureau of Economic Research; Georgetown University Department of Psychiatry; George Washington University Department Neurology

VENEZUELAN GOVERNMENT TARGETS CRITICS OF PRESIDENT CHAVEZ

Amnesty International has urged Venezuelan authorities to stop targeting government critics following a series of politically motivated arrests.

At least three individuals seen as opposed to President Hugo Chavez were arrested and charged in March alone.

"Charges brought for political reasons against critics are being used to silence dissent and prevent others from speaking out," said Guadalupe Marengo, Americas deputy director at Amnesty International. "President Chavez must stop persecuting those who think differently or speak out against the government."

Oswaldo Alvarez Paz, former governor of the state of Zulia, was arrested on March 22, after he said in an interview that Venezuela had become a haven for drug trafficking and citing accusations by a Spanish court that the government supports armed opposition groups. He is currently being held in the Heleraido, headquarters of the national intelligence service.

Wilmer Azuaje, parliamentary deputy and a critic of President Chavez, was arrested on March 25. He was accused of reportedly insulting and hitting a woman police officer. He has since been released but faces prosecution.

Guillermo Zuloaga, owner of television station Globavision, was arrested on March 25 and charged with disseminating false information and insulting the President in statements that he made during a recent Inter American Press Association meeting in Aruba. He has since been released but faces prosecution.

In December 2009, Judge Maria Lourdes Afiuni was arrested and charged with complicity in the escape of a former banker because she ordered his release.

Richard Blanco, a member of an opposition party, was arrested in August 2009 and charged with inciting and injuring a police officer during a demonstration.

The evidence against Blanco is based on video footage from the demonstration. Amnesty International has found no evidence in these videos of Blanco inciting violence or injuring a police officer.

Over recent years, the Venezuelan government appears to have established a pattern of clamping down on dissent through the use of legislative and administrative methods to silence and harass critics.

Laws are being used to justify what essentially seems to be politically motivated charges, which would indicate that the Venezuelan governmnet is deliberately targeting opponents, Amnesty International asserts.

The Inter American Commission on Human Rights has stated that the arrest of Zuloaga "evidences the lack of independence of the judiciary and the utilization of the criminal justice system to punish criticism, producing an intimidating effect that extends to all of society."

Following the detention of Judge Lourdes Afiuni, United Nations experts said, "Reprisals for exercising their constitutionally guaranteed function and creating a climate of fear among the judiciary and lawyers' profession serve no purpose except to undermine the rule of law and obstruct justice."

In January, after RCTV and other television channels were suspended from broadcasting, the European Parliament stated, "The National Telecommunications Commission should show itself to be independent of political and economic authorities and ensure equitable pluralism."

MURDER, MAYHEM ON MEXICAN BORDER EXPOSES DRUG PROHIBITION FUTILITY

By Donald A. Collins

In her incisive March 16 column, "The Slaughter on the Southern Border," Michele Malkin again asks why both Presidents Bush and Obama supported the failed Merida policy of subsidizing Mexican law enforcement. She wrote:

"With bipartisan support, the Bush administration handed over $1.6 billion to help Mexico control its border chaos in 2008. The crime-fighting package known as the Merida Initiative funded helicopters, surveillance equipment, computer infrastructure, the expansion of intelligence data bases, anti-corruption initiatives, human rights education and training, and an anti-money laundering program for our southern neighbors.

"President Obama accelerated the release of Merida Initiatve cash to Mexico and tossed even more taxpayer funding into the mix. All of this while our own measly border enforcement initiatives have been shortchanged, demagogued or completely abandoned.

"Critics of the Merida Initiative (including yours truly) warned that lax oversight would lead to inevitable plundering of the money by corrput Mexican government officials and more unabated bloodshed. Calderon cried, 'Racist!' and demanded that aid be forked ober with no strings attached. 'Give it to me. And give it to me without conditions,' he told Congress. "

One of my friends, when we were discussing this deplorable situation, said, "I guess we will have to invade Mexico." Talk about adding another bad idea to the Merida Initiative.

The murder and mayhem on our southern border increases, and we still lack the guts to implement the obvious answer: Legalize all drugs now.

If drugs were cheap, the addicts would not have to steal to get their fixes. If you want to ruin your life on drugs, do it on the cheap. So long as you don't drive a car, or commit felonies, getting

blotto on your time and at your place is okay.

Not only that, but one of America's leading social commentators, Nobel economist, the late Milton Friedman, even noted that prevesent policy causes drugs of the worst quality to be sold to users. American manufacturers could satisfy the demand we created and get better quality for it, drugs that can be taxed like Jim Beam and Marlboros at a time when we need money.

Why do we persist in thinking that drug busts or attacking the powerful cartels means progress?

We, the USA users, have created the market. But we won't take responsibility for this reality.

When will we gain the wisdom of our grandparents who finally, in 1933, realized that Prohibition wasn't going to work?

We repealed, with the 21st Amendment, the ill-fated 18th Amendment to the US Constitution, which had been ratified in January 1919 -- the only Constitutional Amendment ever to be repealed by Congress.

Maybe as we get further down in our depressed economy, we will be smart enough to do the same with drugs.

Repealing the dangerous drugs prohibition would take the huge cash flow away from all the present marketers of these drugs, not only in Mexico but the Taliban and other drug trade criminals. Today's Prohibition equivalent of the Al Capone Mafia, the MS 13 gangs and others, would be crippled without this money. And don't forget, the main pushers in America are 14-17 year-old kids, often killed in the streets -sale melee that our present laws create.

If we really want to get the truth about this sensitive issue, go to the web page of LEAP - Law Enforceent Against Prohibition (motto: Cops Say Legalize Drugs) and learn about this 10,000-member nonprofit organization, composed mainly of law enforcement officials, ex-cops and judges. (Milton Friedman was, prior to his death, a member of LEAP.) In their YouTube presentations, they will powerfully and eloquently tell you about why this idiotic War on Drugs initiated under President Nixon in the early 1970s must end.

How lousy is the U.S. Drug Enforcement Administration (DEA) record, per Wikipedia:

In 2005, the DEA seized a reported $1.4 billion in drug related assets and $477 million worth of drugs.

However, according to the White House's Office of Drug Control Policy, the total value of all of the drugs sold in the U.S. is as much as $64 billion a year, making the DEA's efforts to intercept the flow of drugs into and within the U.S. less than 1% effective. DEA maintains 21 domestic field divisions with 227 field offices and 86 foreign offices in 62 countries. With a budget exceeding $2.415 billion, DEA employs over 10,800 people, including over 5,500 special agents."

We spend from $2 billion - $3 billion a year to stop $64 billion, which, by the way, represents just about the annual sales of one large Standard & Poor's 500 comjpany, but only stop 1% of $64 billion.

Taxable drugs, less cost, less crime. What's the downside?

Oh, sure, there is always a downside. Less profits for the drug dealers, less graft for those officials on the take on both sides of the border, and less business for teenage inner city drug dealers. But this would not mean a person using drugs who commits a vehicular homicide, for example, would not be prosecuted.

The legalization of marijuana is in the process of happening in many U.Sl jurisdictions. As the Wall Street Journal's front page story on March 19 reports:

Medical marijuana is now legal in 15 states for patients suffering certain conditions, including, in Colorado, chronic pain. More than 60,000 Coloradans have doctor recommendations allowing them to buy marijuana; physicians are approving about 400 new patients a day. Pot shops have popped up all over, including at least 250 here in the Mile High City.

So why not opt for the full legalization of all drugs now? It's what the money-fat, so-called drug 'kingpins' fear most.

Donald A. Collins is a Washington, D.C. freelance writer and co-chair of the Federation for American Immigration Reform (FAIR) National Advisory Board. His views are his own. This article is reprinted from VDARE.com with permission.