Month: June 2017

Americans Can Save $1 Trillion And Get Better Healthcare

Posted on June 27, 2017

US health care costs are out of sight, more than $10,000 per person per year, compared with around $5,000 per person in Canada, Germany and France. Obamacare expanded coverage without controlling costs. The Republican plan would ruthlessly and cruelly limit coverage without controlling costs.

Of the two options, Obamacare is vastly more just. The Republican plan is ghastly. But America has a much better choice: health for all at far lower costs.

This might seem like an out-of-reach goal or a political slogan, but it is neither. Every other rich country uses the same medical technology, gets the same or better health outcomes, and pays vastly lower sums.

Why the disparity? Health care in America is big business, and in America big business means big lobbying and big campaign contributions, the public interest be damned.

Health care is our biggest economic sector, far ahead of the military, Wall Street and the auto and tech industries. It is pushing 18% of national income, compared with 10% to 12% of national income in the other high-income countries.

In line with its economic size, it ranks first in total lobbying, with a recorded $152 million in lobbying spending in 2017 and an estimated $273 million in federal campaign contributions in the 2016 election cycle, divided roughly equally between the parties.

Both parties have therefore ducked the hard work of countering the health care sector’s monopoly power. Health care spending is now at $10,000 per person per year, roughly twice or more the total of other high-income countries, or a staggering $3.25 trillion a year.

We should aim to save at least $1 trillion in total annual outlays, roughly $3,000 per person per year, through a series of feasible, fair and reasonable measures to limit monopoly power. Our system would look a lot more like that of the other more successful and less expensive nations.

Here’s a 10-point plan Congress should consider.

First, move to capitation for Medicare, Medicaid and the tax-exempt private health insurance plans. Under capitation, hospitals and physician groups receive an annual “global budget” based on their patient population, not reimbursement on a fee-for-service basis.

Second, limit the compensation of hospital CEOs and top managers. The pay of not-for-profit hospital CEOs and top managers, for example, could be capped at $1 million per year.

Third, require Medicare and other public providers to negotiate drug prices on a rational basis, taking account of research and development incentives and the manufacturing costs of the medicines.

Fourth, use emergency power to override patents (such as compulsory licensing of patent-protected drugs) to set maximum prices on drugs for public health emergencies (such as for HIV and hepatitis C).

Fifth, radically simplify regulatory procedures for bringing quality generic drugs to the market, including through importation, by simplifying Food and Drug Administration procedures.

Sixth, facilitate “task shifting” from doctors to lower-cost health workers for routine procedures, especially when new computer applications can support the decision process.

Seven, in all public and private plans, cap the annual payment of deductibles and cost-sharing by households to a limited fraction of household income, as is done in many high-income countries.

Eight, use part of the annual saving of $1 trillion to expand home visits for community-based health care to combat the epidemics of obesity, opioids, mental illness and others.

Nine, rein in the advertising and other marketing by the pharmaceutical and fast-food industries that has created, alone among the high-income world, a nation of addiction and obesity.

Ten, offer a public plan to meet these conditions to compete with private plans. Medicare for all is one such possibility.

There really no mystery to why America’s health industry needs a drastic corrective.

Visit the website of your local not-for-profit hospital system. There’s a good chance the CEO will be earning millions per year, sometimes $10 million or more. Or go to treat your hepatitis C with Gilead drug Sofosbuvir. The pills list for $84,000 per 12-week dose, while their production cost is a little over $100, roughly one-thousandth of the list price. Or go in for an MRI, and your hospital might have an $8,000 billable price for a procedure that costs $500 in a discount clinic outside your provider network.

All of these are examples of the vast market power of the health care industry. The sector is designed to squeeze consumers and the government for all they’re worth (and sometimes more, driving many into bankruptcy).

As a result, the sector is awash in profits and compensation levels, and the stock prices of the health care industry are soaring. In the meantime, human and financial resources are pulled away from low-cost (but also low-profit) disease prevention, such as low-cost community health workers and wellness counselors who work within the community, including household visits.

The health care sector is a system of monopolies and oligopolies — that is, there are few producers in the marketplace and few limits on market power. Government shovels out the money in its own programs and via tax breaks for private plans without controls on the market power. And it’s getting worse.

Every other high-income country has solved this problem. Most hospitals are government-owned, while most of the rest are not for profit, but without allowing egregious salaries for top management. Drug prices are regulated. Patents are respected, but drug prices are negotiated.

None of this is rocket science. Nor is the United States too dumb to figure out what Canada, the UK, France, the Netherlands, Germany, Japan, Sweden, Norway, Denmark, Finland, Austria, Belgium, Korea and others have solved. The problem is not our intelligence. The problem is our corrupt political system, which caters to the health care lobby, not to the needs of the people.

Ben Jealous On A Single Payer Health System

Posted on June 27, 2017

In this interview with Thomas Roberts of MSNBC, Sanders Institute Founding Fellow Ben Jealous discusses the importance of protecting Maryland families from Trumpcare and standing up for single-payer healthcare.

It’s Time For Medicare For All

Posted on June 27, 2017

Mitch McConnell is delaying a vote on the Senate Republican version of Trumpcare because he doesn’t yet have a majority.

Some Senate Republicans think the bill doesn’t go get rid of enough of the Affordable Care Act. Others worry that it goes too far – especially in light of the Congressional Budget Office’s finding that it would eliminate coverage for 22 million Americans.

What should be the Democrats’ response? Over the next weeks or months, Democrats must continue to defend the Affordable Care Act. It’s not perfect, but it’s a major step in the right direction. Over 20 million Americans have gained coverage because of it.

But Democrats also need to go further and offer Americans a positive vision of where the nation should be headed over the long term. That’s toward Medicare for all.

Some background: American spending on healthcare per person is more than twice the average in the world’s thirty-five advanced economies. Yet Americans are sicker, our lives are shorter, and we have more chronic illnesses than in any other advanced nation.

That’s because medical care is so expensive for the typical American that many put off seeing a doctor until their health has seriously deteriorated.

Why is healthcare so much cheaper in other nations? Partly because their governments negotiate lower rates with health providers. In France, the average cost of a magnetic resonance imagining exam is $363. In the United States, it’s $1,121. There, an appendectomy costs $4,463. Here, $13,851.

They can get lower rates because they cover everyone – which gives them lots of bargaining power.

Other nations also don’t have to pay the costs of private insurers shelling out billions of dollars a year on advertising and marketing – much of it intended to attract healthier and younger people and avoid the sicker and older.

Nor do other nations have to pay boatloads of money to the shareholders and executives of big for-profit insurance companies.

Finally, they don’t have to bear the high administrative costs of private insurers – requiring endless paperwork to keep track of every procedure by every provider.

According to the Kaiser Family Foundation, Medicare’s administrative costs are only about 2 percent of its operating expenses. That’s less than one-sixth the administrative costs of America’s private insurers

To make matters even worse for Americans, the nation’s private health insurers are merging like mad in order to suck in even more money from consumers and taxpayers by reducing competition.

At the same time, their focus on attracting healthy people and avoiding sick people is creating a vicious cycle. Insurers that take in sicker and costlier patients lose money, which forces them to raise premiums, co-payments, and deductibles. This, in turn, makes it harder for people most in need of health insurance to afford it.

This phenomenon has even plagued health exchanges under the Affordable Care Act.

Medicare for all would avoid all these problems, and get lower prices and better care.

It would be financed the same way Medicare and Social Security are financed, through the payroll tax. Wealthy Americans would pay a higher payroll tax rate and contribute more than lower-income people. But everyone would win because total healthcare costs would be far lower, and outcomes far better.

If Republicans succeed in gutting the Affordable Care Act or subverting it, the American public will be presented with a particularly stark choice: Expensive health care for the few, or affordable health care for the many.

This political reality is already playing out in Congress, as many Democrats move toward Medicare for All. Most House Democrats are co-sponsoring a Medicare for All bill there. Senator Bernie Sanders is preparing to introduce it in the Senate. New York and California are moving toward statewide versions.

A Gallup poll conducted in May found that a majority of Americans would support such a system. Another poll by the Pew Research Center shows that such support is growing, with 60 percent of Americans now saying government should be responsible for ensuring health care coverage for all Americans – up from 51 percent last year.

Democrats would be wise to seize the moment. They shouldn’t merely defend the Affordable Care Act. They should also go on the offensive – with Medicare for all.

Tax Reform That Works For All

Posted on June 27, 2017

The Republicans are trying to jam a reckless health care bill through Congress so that they can move on to their real objective: another round of deep tax cuts for the rich, paid for by deep cuts in public services, more debt on the backs of the young, and reckless disregard for the environment. We need tax reform, but of a very different kind.

A real tax reform would address four problems. First, it would raise total revenues as a share of GDP, in order to cut the chronic budget deficit. Second, it would address the crisis of falling wages and disappearing jobs facing working-class America. Third, it would curb carbon pollution, which is dangerously warming the planet. Fourth, to spur saving and investment, it would shift taxes toward consumption rather than income.

To keep public debt from soaring, we will need to cut the deficit. Republican leaders dream of cutting the deficit by slashing Medicaid, education, science, and other vital programs. Yet the public is aghast at such proposals. There are no realistic prospects for major budgetary savings, because we have so many pent-up needs for new infrastructure, expanded higher education, and other public investments. At best, we could cut wasteful areas of federal spending (for example, the military and over-priced drugs) and increase spending for infrastructure, education, R&D, and other public investments.

Tax policy should also help to address the crisis facing low-skilled workers. Technology continues to eliminate low-skilled jobs as workers are replaced by smart machines. The workers are forced to shift to even lower-paying jobs. To boost the take-home pay of low earners, we should expand the highly successful earned-income tax credit.

Tax policy should help to solve global warming by putting a new tax on carbon pollution. A reasonable approach would be to introduce a gradually rising tax on CO2 emission, accelerating the shift to wind, solar, nuclear, and other low-carbon sources of energy. Since the US economy emits around 5 billion tons of CO2 each year, a tax of $40 per ton of CO2 emitted would raise around 1 percent of GDP in revenues.

Finally, tax reform should shift taxation from income toward consumption, to spur higher saving and investment. A smart policy would be to reduce the marginal tax rate on new business investments by allowing companies to expense some or all of their new investments.

We would need new government revenues to cut the budget deficit and offset revenue losses from an expanded EITC and a cut in the marginal tax on new business investments. A new tax on carbon pollution would provide some new revenues but more will be needed.

The best candidate for higher revenues would be a value-added tax, or VAT, essentially a tax on consumption rather than investment income. Liberals traditionally object to a VAT because they say it’s regressive, but its overall effect can be progressive when it finances progressive spending on health, education, job training, science, and an expanded EITC. That’s why the social democracies of Northern Europe have long embraced the VAT. Conservatives, on the other hand, object to the VAT because they dream of slashing the deficit by deep cuts in social programs, against the will of the people.

Therein lies the compromise. Liberals should accept the VAT as the price to pay for properly funding the government, including highly progressive objectives such as health, education, and infrastructure. Conservatives should accept the VAT as the way to fund the cuts in the marginal tax rate on business investment and as the effective answer to the already high and rising budget deficits.

Consider the test of pragmatism. How are the world’s most successful economies funding government? Australia, Canada, Denmark, Germany, the Netherlands, Norway, and Sweden all have lower deficits, better health care, lower tuitions, lower inequality, and less poverty than the United States. All of these countries raise more tax revenues, and offer more generous social policies, than the United States, in part through the VAT. It’s time the United States undertake a tax reform that is truly for the common good.

CBO Score H.R. 1628, Better Care Reconciliation Act of 2017

Posted on June 26, 2017

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Better Care Reconciliation Act of 2017, a Senate amendment in the nature of a substitute to H.R. 1628. CBO and JCT estimate that enacting this legislation would reduce the cumulative federal deficit over the 2017-2026 period by $321 billion. That amount is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House of Representatives.

The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation. By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

Following the overview, this document provides details about the major provisions of this legislation, the estimated costs to the federal government, the basis for the estimate, and other related information, including a comparison with CBO’s estimate for the House-passed act.

Effects on the Federal Budget

CBO and JCT estimate that, over the 2017-2026 period, enacting this legislation would reduce direct spending by $1,022 billion and reduce revenues by $701 billion, for a net reduction of $321 billion in the deficit over that period (see Table 1, at the end of this document):

The largest savings would come from reductions in outlays for Medicaid—spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law—and from changes to the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance (see Figure 1). Those savings would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage: additional spending designed to reduce premiums and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance.
The largest increases in deficits would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage, including repealing a surtax on net investment income and repealing annual fees imposed on health insurers.

Pay-as-you-go procedures apply because enacting this legislation would affect direct spending and revenues. CBO and JCT estimate that enactment would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027. The agencies expect that savings, particularly from Medicaid, would continue to grow, while the costs would be smaller because a rescinded tax on employees’ health insurance premiums and health plan benefits would be reinstated in 2026. CBO has not completed an estimate of the potential impact of this legislation on discretionary spending, which would be subject to future appropriation action.

Effects on Health Insurance Coverage

CBO and JCT estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law—primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

Stability of the Health Insurance Market

Decisions about offering and purchasing health insurance depend on the stability of the health insurance market—that is, on the proportion of people living in areas with participating insurers and on the likelihood of premiums’ not rising in an unsustainable spiral. The market for insurance purchased individually with premiums not based on one’s health status would be unstable if, for example, the people who wanted to buy coverage at any offered price would have average health care expenditures so high that offering the insurance would be unprofitable.

Under Current Law. Although premiums have been rising under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference between that percentage and the premiums for a reference plan (which is the second-lowest-cost plan in their area providing specified benefits). The subsidies to purchase coverage, combined with the effects of the individual mandate, which requires most individuals to obtain insurance or pay a penalty, are anticipated to cause sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.

Nevertheless, a small number of people live in areas of the country that have limited participation by insurers in the nongroup market under current law. Several factors may lead insurers to withdraw from the market—including lack of profitability and substantial uncertainty about enforcement of the individual mandate and about future payments of the cost-sharing subsidies to reduce out-of-pocket payments for people who enroll in nongroup coverage through the marketplaces established by the ACA.

Under This Legislation. CBO and JCT anticipate that, under this legislation, nongroup insurance markets would continue to be stable in most parts of the country. Although substantial uncertainty about the effects of the new law could lead some insurers to withdraw from or not enter the nongroup market in some states, several factors would bring about market stability in most states before 2020. In the agencies’ view, those key factors include the following: subsidies to purchase insurance, which would maintain sufficient demand for insurance by people with low health care expenditures; the appropriation of funds for cost-sharing subsidies, which would provide certainty about the availability of those funds; and additional federal funding provided to states and insurers, which would lower premiums by reducing the costs to insurers of people with high health care expenditures.

The agencies expect that the nongroup market in most areas of the country would continue to be stable in 2020 and later years as well, including in some states that obtain waivers that would not have otherwise done so. (Under current law and this legislation, states can apply for Section 1332 waivers to change the structure of subsidies for nongroup coverage; the specifications for essential health benefits [EHBs], which set the minimum standards for the benefits that insurance in the nongroup and small-group markets must cover; and other related provisions of law.) Substantial federal funding to directly reduce premiums would be available through 2021. Premium tax credits would continue to provide insulation from changes in premiums through 2021 and in later years. Those factors would help attract enough relatively healthy people for the market in most areas of the country to be stable, CBO and JCT anticipate. That stability in most areas would occur even though the premium tax credits would be smaller in most cases than under current law and subsidies to reduce cost sharing—the amount that consumers are required to pay out of pocket when they use health care services—would be eliminated starting in 2020.

In the agencies’ assessment, a small fraction of the population resides in areas in which—because of this legislation, at least for some of the years after 2019—no insurers would participate in the nongroup market or insurance would be offered only with very high premiums. Some sparsely populated areas might have no nongroup insurance offered because the reductions in subsidies would lead fewer people to decide to purchase insurance—and markets with few purchasers are less profitable for insurers. Insurance covering certain services would become more expensive—in some cases, extremely expensive—in some areas because the scope of the EHBs would be narrowed through waivers affecting close to half the population, CBO and JCT expect. In addition, the agencies anticipate that all insurance in the nongroup market would become very expensive for at least a short period of time for a small fraction of the population residing in areas in which states’ implementation of waivers with major changes caused market disruption.

Effects on Premiums and Out-of-Pocket Payments

The legislation would increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law, CBO and JCT estimate. To arrive at those estimates, the agencies examined how the legislation would affect the premiums charged if people purchased a benchmark plan in the nongroup market.

In 2018 and 2019, under current law and under the legislation, the benchmark plan has an actuarial value of 70 percent—that is, the insurance pays about 70 percent of the total cost of covered benefits, on average. In the marketplaces, such coverage is known as a silver plan.

Under the Senate bill, average premiums for benchmark plans for single individuals would be about 20 percent higher in 2018 than under current law, mainly because the penalty for not having insurance would be eliminated, inducing fewer comparatively healthy people to sign up. Those premiums would be about 10 percent higher than under current law in 2019—less than in 2018 in part because funding provided by the bill to reduce premiums would affect pricing and because changes in the limits on how premiums can vary by age would result in a larger number of younger people paying lower premiums to purchase policies.

In 2020, average premiums for benchmark plans for single individuals would be about 30 percent lower than under current law. A combination of factors would lead to that decrease—most important, the smaller share of benefits paid for by the benchmark plans and federal funds provided to directly reduce premiums.

That share of services covered by insurance would be smaller because the benchmark plan under this legislation would have an actuarial value of 58 percent beginning in 2020. That value is slightly below the actuarial value of 60 percent for “bronze” plans currently offered in the marketplaces. Because of the ACA’s limits on out-of-pocket spending and prohibitions on annual and lifetime limits on payments for services within the EHBs, all plans must pay for most of the cost of high-cost services. To design a plan with an actuarial value of 60 percent or less and pay for those high-cost services, insurers must set high deductibles—that is, the amounts that people pay out of pocket for most types of health care services before insurance makes any contribution. Under current law for a single policyholder in 2017, the average deductible (for medical and drug expenses combined) is about $6,000 for a bronze plan and $3,600 for a silver plan. CBO and JCT expect that the benchmark plans under this legislation would have high deductibles similar to those for the bronze plans offered under current law. Premiums for a plan with an actuarial value of 58 percent are lower than they are for a plan with an actuarial value of 70 percent (the value for the reference plan under current law) largely because the insurance pays for a smaller average share of health care costs.

Although the average benchmark premium directly affects the amount of premium tax credits and is a key element in CBO’s analysis of the budgetary effects of the bill, it does not represent the effect of this legislation on the average premiums for all plans purchased. The differences in the actuarial value of plans purchased under this legislation and under current law would be greater starting in 2020—when, for example, under this bill, some people would pay more than the benchmark premium to purchase a silver plan, whereas, under current law, others would pay less than the benchmark premium to purchase a bronze plan.

Under this legislation, starting in 2020, the premium for a silver plan would typically be a relatively high percentage of income for low-income people. The deductible for a plan with an actuarial value of 58 percent would be a significantly higher percentage of income—also making such a plan unattractive, but for a different reason. As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan, CBO and JCT estimate.

By 2026, average premiums for benchmark plans for single individuals in most of the country under this legislation would be about 20 percent lower than under current law, CBO and JCT estimate—a smaller decrease than in 2020 largely because federal funding to reduce premiums would have lessened. The estimates for both of those years encompass effects in different areas of the country that would be substantially higher and substantially lower than the average effect nationally, in part because of the effects of state waivers. Some small fraction of the population is not included in those estimates. CBO and JCT expect that those people would be in states using waivers in such a way that no benchmark plan would be defined. Hence, a comparison of benchmark premiums is not possible in such areas.

Some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care even though benchmark premiums would decline, on average, in 2020 and later years. Because nongroup insurance would pay for a smaller average share of benefits under this legislation, most people purchasing it would have higher out-of-pocket spending on health care than under current law. Out-of-pocket spending would also be affected for the people—close to half the population, CBO and JCT expect—living in states modifying the EHBs using waivers. People who used services or benefits no longer included in the EHBs would experience substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services. Moreover, the ACA’s ban on annual and lifetime limits on covered benefits would no longer apply to health benefits not defined as essential in a state. As a result, for some benefits that might be removed from a state’s definition of EHBs but that might not be excluded from insurance coverage altogether, some enrollees could see large increases in out-of-pocket spending because annual or lifetime limits would be allowed.

Uncertainty Surrounding the Estimates

CBO and JCT have endeavored to develop budgetary estimates that are in the middle of the distribution of potential outcomes. Such estimates are inherently inexact because the ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by this legislation are all difficult to predict. In particular, predicting the overall effects of the myriad ways that states could implement waivers is especially difficult.

CBO and JCT’s projections under current law itself are also uncertain. For example, enrollment in the marketplaces under current law will probably be lower than was projected under the March 2016 baseline used in this analysis, which would tend to decrease the budgetary savings from this legislation. However, the average subsidy per enrollee under current law will probably be higher than was projected in March 2016, which would tend to increase the budgetary savings from this legislation. (For a related discussion, see the section on “Use of the March 2016 Baseline” on page 15.)

Despite the uncertainty, the direction of certain effects of this legislation is clear. For example, the amount of federal revenues collected and the amount of spending on Medicaid would almost surely both be lower than under current law. And the number of uninsured people under this legislation would almost surely be greater than under current law.

Intergovernmental and Private-Sector Mandates

CBO has reviewed the nontax provisions of the legislation and determined that they would impose intergovernmental mandates as defined in the Unfunded Mandates Reform Act (UMRA) by preempting state laws. Although the preemptions would limit the application of state laws, they would impose no duty on states that would result in additional spending or a loss of revenues. JCT has determined that the tax provisions of the legislation contain no intergovernmental mandates.

JCT and CBO have determined that the legislation would impose private-sector mandates as defined in UMRA. On the basis of information from JCT, CBO estimates that the aggregate cost of the mandates would exceed the annual threshold established in UMRA for private-sector mandates ($156 million in 2017, adjusted annually for inflation).

How To Tell If Your Reps Are Serious About Climate Change

Posted on June 26, 2017

Perhaps no president in recent times has unified the country, and the globe, as effectively as Donald Trump. In the hours following his rejection of the Paris climate accord, pretty much everyone who didn’t actually work in a coal mine joined in the condemnation.

Few trollers were quite as adept as the new French president, who issued a video urging climate scientists to emigrate from America, but the honchos at Facebook and Google did their part, weighing in with varied admixtures of shock, indignation and disappointment – in fact, Forbes kept a running tally of billionaires expressing their outrage, one of whom, Michael Bloomberg, pledged up to $15 million to help make up for the money America had promised the planet’s poorest countries. Tesla’s Elon Musk and the head of Disney quit the president’s council of CEO advisers, while a senior Vatican official said exiting Paris was a “huge slap in the face for us.”

Politicians across the nation, noting that majorities of voters in every single state (even West Virginia!) opposed withdrawing from the pact, pledged to keep up the fight. More than 300 mayors and counting have announced a compact to fight for the goals of the Paris accord, and 12 states (including New York and California and representing more than a third of the nation’s economy) formed the U.S. Climate Alliance to reach the targets set in the French capital in 2015. In fact, as the director of Canada’s Climate Action Network said, “Trump’s move to withdraw the U.S. from the accord has resulted in the clearest … call for climate action from every corner of human civilization yet.”

Still, one is allowed just the teensiest bit of cynicism when it comes to CEOs and politicians. The head of Dow Chemical, for instance, had expressed his “disappointment” with Trump, noting in grave CEO-speak that “Leaders don’t leave tables. Leaders stay.” It turned out, however, that Dow was a member of a key lobbying group pushing for withdrawal. In Vermont, the hypocrisy was on display the very same day. Republican Gov. Phil Scott, who called the president’s decision “concerning,” said the state would join the Climate Alliance. And yet, the same afternoon, Scott named as the state’s top utility regulator a lawyer who has spent the past few years fighting new wind and solar power.

All of which is to say, just as physics is unlikely to be intimidated by Trump’s bluster, it won’t pay any heed to meaningless pledges by politicians. Physics cares about how much carbon is in the atmosphere. The time for encouraging messages of support for the climate is over – we need action. This has been a problem for years; Democrats in particular have been able to slip by with simple declarations that they “believe” in climate science. But at this point, who cares? Certainly not the swift heating planet. We need serious and immediate commitment to action. Here are three simple criteria for determining whether your local politicians are serious enough to pass the climate test.

They are committed to converting to 100 percent renewable energy

A few years ago, this would have been a hard test, because while it was clear that we needed to drive carbon emissions to zero in order to have a chance of slowing down climate change, it wasn’t clear we had enough alternative power available. Solar and wind were still expensive, and worse, they operated intermittently: When the sun wasn’t shining or the wind ceased to blow, you were out of luck. But over the past decade, these technologies have gotten cheaper and more powerful. From Abu Dhabi to Chile to Mexico to India, solar power costs less to produce than any other form of energy; across much of America, wind costs the same as or less than coal-fired power. As of this year, wind and solar account for 10 percent of electricity in the U.S., and that’s only a glimmer of our potential. Best of all, the sundown problem is being solved fast, as batteries are able to store the energy from the morning sun and the wind from a gusty evening to keep the power running overnight.

For years, the research teams at places like Exxon have not just been lying about global warming, they’ve also been insisting that change must come slowly – that by 2040 the world will still be relying almost entirely on fossil fuel. But innovation has badly outrun those predictions. At the end of May, Patrick Lee, a vice president at Sempra Energy, one of the country’s biggest utilities, addressed an industry gathering: “I am speaking with confidence. . . . We have a solution now to adjust the intermittency of solar and wind energy that is no longer a technology challenge. Now it is an economic decision.” Three years ago, Lee said, his engineering background made him doubt that 100 percent renewable energy was possible – the grid might always need some coal or gas-fired plants to ensure stability. “But today my answer is: The technology has been resolved. How fast do you want to get to 100 percent? That can be done today.”

That the management at his Southern California utility reportedly made him walk back the statement two days later only underlines the point: Technological possibility now bumps up against the everlasting power of the fossil-fuel industry. Recent studies have raised questions about where the last few percentage points of that energy may come from a decade or three down the line, but those are technical quibbles: In 2017, 100 percent renewable is the test of whether a politician is serious.

That’s why Oregon Sen. Jeff Merkley and Sen. Bernie Sanders introduced a bill in April calling for the 100 percent mark to be reached by 2050 (or, hopefully, sooner – if technological innovation continues apace). It obviously won’t pass the current Congress, but on a planet where an iceberg the size of Delaware is about to calve from the Antarctic ice shelf, that number is now the minimum standard for climate credibility. In the words of the great gospel song/civil-rights anthem, “99 and a half won’t do.” The civil-rights theme is no accident, by the way: What was once the environmental movement is now increasingly the climate-justice movement, led by communities that are choking on pollution and workers who know the next burst of good jobs will come from this renewables build-out.

They will work to keep remaining fossil fuels in the ground

Since we’re committing to 100 percent renewable, there’s absolutely no need for any new fossil-fuel infrastructure – no new pipelines, no new frack wells, no new coal mines like the one Trump lauded in his Paris speech. The reason is obvious: If you build them, given the payback time for investments, you’re signing up for another four decades of heating the planet. This would seem an obvious test for a climate-credible politician – it’s been at the heart of the anti-warming movement since at least 2011, when droves of people went off to jail to protest the Keystone XL pipeline. (Full disclosure, I was one of them.)

The movement has won some of these fights: There are bans on fracking in New York and Maryland; Shell retreated from a proposed drilling operation in Alaska after activists blocked delivery of its rigs; and half a dozen proposed coal ports along the Pacific coast are still unbuilt. Even seeming losses aren’t done deals – in June, a federal court ruled that the Dakota Access pipeline hadn’t gone through the proper reviews, a big win for the Standing Rock Sioux, who may yet shut the project down.

What’s interesting is how hard it’s been to get politicians to help. Republican opposition is easy to understand: The party is a wholly owned subsidiary of the fossil-fuel industry (every time there’s a major vote in Congress, Oil Change International- helpfully publishes a list of how much each of the “ayes” has taken from the hydrocarbon lobby). But too often, Democrats go along as well, even if they’re not getting big Texas money. The week before the November election, and the month after security- guards sicced German shepherds on native protesters, Hillary Clinton released this statement about the Dakota pipeline: All of the parties involved – including the federal government, the pipeline company and contractors, the state of North Dakota, and the tribes – need to find a path forward that serves the broadest public interest. For those of us campaigning for her, that waffling didn’t make it easy to win votes – but it was at least predictable, because she and other Democrats were under pressure from the unions that like building pipelines.

It may get easier now for Democrats and progressives to take a stronger stand, because those construction unions have become some of Trump’s most uncritical supporters. Two days after the Women’s March filled the streets of D.C., the brass from the Building Trades Unions visited the Oval Office, where they had nothing but praise for its new occupant. “We have a common bond with the president,” Sean McGarvey, head of the Building Trades, said. “We come from the same industry.”

Happily, the other three-quarters of the labor movement has increasingly sided with the communities fighting against climate change, in part because it’s obvious that renewable energy will supply the jobs of the future. As Naomi Klein wrote in The New York Times, “Today labor leaders face a clear choice:” Back bogus pipelines or “join the diverse and growing movement that is confronting Mr. Trump’s agenda on every front and attempt to lead America’s workers to a clean and safe future.”

For politicians, that choice is even clearer- – and some have responded. Portland, Oregon, for instance, recently banned any new fossil-fuel infrastructure. Philadelphia has plans to become a fossil-fuel “hub” for the Atlantic seaboard, but a broad coalition of scientists and community groups is putting up a stiff fight. In Virginia, even though he lost the primary, Democratic gubernatorial candidate Tom Perriello put a scare into the party’s hierarchy with an insurgent candidacy powered by his opposition to two pipelines and his refusal to be bankrolled by the state’s utility giant, Dominion Energy – in fact, 61 Democratic- legislative candidates across the state joined Perriello in turning down Dominion campaign cash.

They understand natural gas could be the most dangerous fuel of all

For the past decade, the democratic get-out-of-jail-free card for dealing with climate was natural gas – but as with renewable energy, the passage of time changed the situation enormously. It seemed at first blush a victory when wildcatters began finding vast supplies of natural gas beneath America’s soil in the aughts. Because natural gas produces half as much carbon dioxide as coal when you burn it in a power plant, President Obama seized on this bounty as both an environmental and economic windfall.

But two problems soon emerged. One, to get at the gas, you had to frack (that is, explode) the subsurface geology, and soon communities were reporting all kinds of environmental woes – particularly with contaminated groundwater. Second, researchers began to report that the process of producing gas was releasing so much methane (itself a powerful greenhouse gas) into the atmosphere that it was no better for the environment than burning coal. In fact, satellite data suggested that even though carbon emissions had fallen as coal-fired power plants closed, the U.S. was venting so much more methane that total greenhouse-gas emissions may have increased during the Obama years. Just as bad, the flood of cheap natural gas retards the necessary swift conversion to sun and wind, which produce no emissions at all. Ten years ago, natural gas was seen as a bridge; now, it’s clearly a sharp detour away from renewable energy and toward an ever-hotter future.

Standing up to natural gas will be hard, because it’s where the fossil-fuel industry increasingly concentrates its investments. (Exxon, to the surprise of some, opposed the Paris withdrawal – that’s because the company sees its gas business benefiting as carbon cuts go into effect but methane is left unregulated.) And it’s easy for politicians to play rhetorical games here: If you just talk about “carbon,” then gas looks good. But physics, again, is unimpressed by spin. It just adds up all the greenhouse gases in the air, and then it does its thing. Our job is to make sure that truly clean power comes next – we can’t waste another few decades playing around with gas.

So now it’s up to the rest of us to make sure this dark moment produces real gain. If we let politicians simply “stand up for science” or promise to someday reincarnate the Paris accord, then we will never catch up with climate change. If instead the rage that Trump has provoked catapults us into truly serious action – well, that will be the best revenge.

Trumpcare Truth: A Gift To The 1% And A Kick To The Sick And Poor

Posted on June 26, 2017

The Senate’s bill to repeal the Affordable Care Act is not a healthcare bill. It’s a tax cut for the wealthiest Americans, paid for by a dramatic reduction in healthcare funding for approximately 23 million poor, disabled, and working middle class Americans.

America’s wealthiest taxpayers (earning more than $200,000 a year, $250,000 for couples) would get a tax cut totaling $346 billion over 10 years, representing what they save from no longer financing healthcare for lower-income Americans.

That’s not all. The bill would save an additional $400 billion on Medicaid, which Mitch McConnell, Paul Ryan, and Donald Trump are intent on shrinking in order to cut even more taxes for the wealthy and for big corporations.

If enacted, it would be the largest single transfer of wealth to the rich from the middle class and poor in American history.

This disgrace is being proposed at a time when the nation’s rich own a higher percentage of the nation’s wealth and receive the highest percent of America’s income since the era of the Robber Barons of the late nineteenth century.

Almost all of the transfer is hidden inside a bill that’s supposed to be a kinder and gentler version of its House counterpart, which Trump called “mean, mean, mean.”

Look closely and it’s even meaner.

The Senate bill appears to retain the Affordable Care Act’s subsidies for poorer Americans. But starting in 2020, the subsidies would no longer be available for many of the working poor who now receive them, nor for anyone who’s not eligible for Medicaid.

Another illusion: The bill seems to keep the Affordable Care Act’s Medicaid expansion. But the expansion is phased out, starting in 2021.

The core of the bill – where its biggest savings come from – is a huge reduction in Medicaid, America’s healthcare program for the poor, elderly, and disabled.

This, too, is disguised. States would receive an amount of money per Medicaid recipient that appears to grow as healthcare costs rise.

But starting in 2025, the payments would be based on how fast costs rise in the economy as a whole.

Yet medical costs are rising faster than overall costs. They’ll almost surely continue to do so – as America’s elderly population grows, and as new medical devices, technologies, and drugs prolong life.

Which means that after 2025, Medicaid coverage will shrink.

The nonpartisan Urban Institute estimates that between 2025 and 2035, about $467 billion less will be spent on Medicaid than would be spent than if Medicaid funding were to keep up with the expected rise in medical costs.

The states would have to make up the difference, but many won’t want to or be able to.

One final major deception. Proponents of the bill say it would continue to protect people with preexisting conditions. But the bill allows states to reduce insurance coverage for everyone, including people with preexisting conditions.

So insurance companies could technically “cover” people with preexisting conditions for the cost of, say, their visits to a doctor, but not hospitalization, drugs, or anything else they need.

The Senate bill only seems like a kinder, gentler version of the House repeal of the Affordable Care Act, but over time it would be even crueler.

Will the American public find out? Not if McConnell can help it.

He hasn’t scheduled a single hearing on the bill.

He’s shut out major hospitals, physician groups, consumer advocates and organizations representing millions of patients with heart disease, cancer, diabetes, and other serious illnesses.

McConnell thinks he’s found a quiet way not only to repeal the Affordable Care Act but also to unravel Medicaid – and funnel the savings to the rich.

For years, Republicans have been looking for ways to undermine America’s three core social insurance programs – Medicaid, Medicare, and Social Security. The three constitute the major legacy of the Democrats, of Franklin D. Roosevelt and Lyndon Johnson. All continue to be immensely popular.

Barack Obama’s Affordable Care Act is almost part of that legacy. It’s not on quite as solid a footing as the others because it’s still new, and some wrinkles need to be ironed out. But most Americans support it.

Now McConnell believes he can begin to undo the legacy, starting with the Affordable Care Act and, gradually, Medicaid.

But he knows he has to do it in secret if he’s to be successful.

If this shameful bill is enacted, McConnell and Trump – as well as every Republican senator who signs on – will bear the burden of hundreds of thousands of deaths that could have been avoided, were they not so determined to make rich Americans even richer.

Discussion Of Ideological & Legislative Responses To Terrorism

Posted on June 24, 2017

At this panel discussion and press conference held in New York City on June 24th, 2017 by the Interfaith Unity for Tolerance, Representative Tulsi Gabbard joined a panel discussion about how academic and legislative responses to terrorism are complementary approaches that will provide long term and intellectual responses to terrorism.

In a press release about the event, the IFUT said that this discussion “will lead towards nuanced understanding and informed solutions.”

Gabbard said, “I think that there has been a concerted effort both on the part of some in the media, as well as many in politics, and many in our foreign policy establishment seem to have been advocating for a continuance of these regime change wars, really ignoring the fact of what has been the consequence of these wars in countries like Iraq and Libya and Syria, where each time we have waged these wars, [it] has resulted in the strengthening of terrorist groups like Al-Qaeda or the creation of ISIS [Islamic State, IS, formerly ISIL], and it has resulted in a tremendous amount of suffering and death for the people of these countries.”