In this Real News Network interview Sanders Institute Fellows Bob Pollin & Michael Lighty speak about the different possible versions of Medicare for All. They argue that Medicare for All does not have to, and should not, include private insurers like Medicare does today.
The overwhelming defeat that Britain’s parliament inflicted upon Prime Minister Theresa May’s Brexit plan was fresh confirmation that there is no substitute for democracy.
Members of Parliament deserve congratulations for keeping their cool in the face of a made-up deadline. That deadline is the reason why Brexit is proving so hard and potentially so damaging. To resolve Brexit, that artificial deadline must be removed altogether, not merely re-set.
Leaving the European Union is painful by design. The process any member state must follow to exit the EU is governed by Article 50 of the bloc’s Lisbon Treaty, which, ironically, was authored by a British diplomat keen to deter exits from the EU. That is why Article 50 sets a two-year negotiation period ending with an ominous deadline: If negotiations have not produced a divorce agreement within the prescribed period — March 29, 2019, in Britain’s case — the member state suddenly finds itself outside the EU, facing disproportionate hardships overnight.
This rule undermines meaningful negotiations. Negotiators focus on the end date and conclude that the other side has no incentive to reveal its hand before then. Whether the allotted negotiation period is two months, two years, or two decades, the result is the same: the stronger side (the European Commission in Brussels in this case) has an incentive to run down the clock and make no significant compromises before the eleventh hour.
Moreover, this realisation affects the behaviour of other key players: Tory government ministers opposed to their prime minister, the leader of the Labour opposition, Jeremy Corbyn, members of Labour’s front bench who are opposed to Corbyn, and the German and French governments. Every significant political actor in this game has an incentive to sit back and let the clock tick down to the bitter end.
With fewer than three months left, the prospect of Britain falling out of the EU without a deal is, understandably, terrifying. A natural response is to call for an extension of Article 50, to reset the clock and give negotiations more time. That instinct must be resisted.
Any resetting of the clock would simply extend the paralysis, not speed up convergence toward a good agreement. Giving May another three months, or even three years, would do nothing to create incentives to reveal hidden preferences or to drop fictitious red lines.
Indeed, the worst aspect of May’s deal, which parliament emphatically and wisely rejected, was that it extended the transition process until 2022, with the UK committing to paying around $50bn, and possibly more, to the EU in exchange for nothing more than unenforceable promises of some future mutually advantageous deal. Had Parliament voted in favor of May’s deal, it would have prolonged the current gridlock to a new cliff edge three years hence.
The only plausible reason for resetting the Article 50 clock is the aspiration to hold a second referendum on whether to rescind Brexit altogether. But, unlike the first referendum, which could be framed as a yes-no leave-stay question, there are now multiple options to consider: May’s deal, a softer Brexit keeping Britain within the EU’s single market, a no-deal Brexit, remaining in the EU altogether, and so forth. Agreeing on the precise form of preferential voting between these options is no easier than agreeing on Brexit in the first place.
To synthesise competing views into one coherent position, Britain needs more than a voting scheme: it needs a People’s Debate that the ticking clock makes impossible, even if re-set. The standstill and the phony negotiations will thus come to an end only if the made-up deadline is allowed to expire by a Parliament willing calmly to say “no” to unacceptable deals negotiated by May and the EU. Allowing the clock to run down is now a prerequisite for resolving the Brexit conundrum.
What will happen if the impasse continues until March 29, without a formal extension of the Article 50 period? The threat from Brussels is that the EU will shrug its shoulders and allow a disorderly Brexit, with substantial disruption to trade, transport, and so forth. But it is much more likely that German business, along with the French and Dutch governments, would be up in arms against such a turn, and demand that the European Commission use its powers indefinitely to suspend any disruption in Europe’s ports and airports while meaningful negotiations begin for the first time since 2016.
Once we are at, or close to March 29, heightened urgency will dissolve tactical procrastination. May’s deal will have bitten the dust, and Remainers will be closer to accepting that time is not on the side of a Brexit-annulling second referendum, perhaps turning their attention to the legitimate aim of a future referendum to re-join the EU.
At that point, government and opposition will recognise that only two coherent options remain for the immediate future. The first is Norway Plus, which would mean Britain would remain for an indeterminate period in the EU single market (like Norway), and also in a customs union with the EU. The second is an immediate full exit, with Britain trading under World Trade Organization rules while Northern Ireland remains within a customs union with the EU to avoid a hard border with the Republic of Ireland. Narrowing it down to two options will enable Parliament to choose.
Once MPs acknowledge that freedom of movement between the UK and the EU is a red herring, the most likely outcome is Norway Plus for an indeterminate, deadline-free period. Then and only then will Parliament and the people have the opportunity to debate the large-scale issues confronting Britain, not least the future of the UK-EU relationship.
Norway Plus would, of course, leave everyone somewhat dissatisfied. But, unlike May’s deal or a hasty second referendum, at least it would minimise the discontent that any large segment of Britain’s society might experience in the medium term.
And, because minimizing the discontent, along with a deadline-free horizon, are prerequisites for the people’s debate that Britain deserves, the overwhelming defeat of May’s deal may well be remembered as a vindication of democracy.
The single most important public health measure of 2019 is the replenishment of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. These three diseases, which currently kill around 2.5 million people per year, could be fully contained by 2030, with deaths reduced to nearly zero. The Global Fund is the primary instrument for success, and it needs to raise 10 billion USD per year to accomplish its mission.
The Global Fund, established in 2001 by Kofi Annan, has been credited with saving 27 million lives and controlling the three epidemics to the point that they can realistically be ended by 2030. Although none of the three diseases can be completely eradicated by then, almost all deaths and new infections can be stopped, because diagnostics, prevention, and treatment have improved markedly and become far less costly over the past 25 years.
In the case of AIDS, treatment of the HIV virus not only keeps infected individuals healthy, but also reduces the virus load so much that they are unlikely to infect others. In this sense, “treatment is prevention”: treating a sufficiently high proportion of HIV-positive individuals will largely end the transmission of the virus.
Similarly, advances in diagnostics (a simple pin-prick blood test), prevention (long-lasting insecticide-treated bed nets, among other tools), and treatment (low-cost artemisinin-based combination drugs) make it possible to eliminate almost all malaria deaths (which are already down by roughly 60 percent from their peak in the early 2000s). The recent uptick in infections and deaths is a worrying sign that the world is again underinvesting in the fight.
For TB, the challenge continues to be early diagnosis and effective treatment, with special attention to multidrug-resistant TB. The TB mortality rate has declined by around 42 percent since 2000. With sufficient coverage of effective monitoring and treatment, the remaining deaths could be largely ended as well.
The relatively low costs and enormous benefits of these interventions mean that high-income and upper-middle-income countries should prioritize their health programs and national budgets accordingly. Shockingly, in the United States, only around half of HIV-positive individuals are receiving treatment, owing to the federal government’s neglect.
For low-income and many lower-middle-income developing countries, however, national budgets are not sufficient. Recent calculations by the International Monetary Fund show that these countries lack the means to ensure universal health coverage and other basic services called for by the Sustainable Development Goals.
This was one of two reasons for creating the Global Fund in the first place: to bolster poorer countries’ ability to control the epidemics. The other reason was to bring top global science and rigorous management to bear on the three epidemics. Thanks to its unique business model, the Global Fund does both: it generates and disseminates the knowledge needed to fight the three diseases, and it rigorously monitors the implementation of the projects that it funds.
The Global Fund got off to a great start in the early 2000s, with strong bipartisan support in the U.S. and similar cross-party support in other countries. President George W. Bush was the Global Fund’s strongest backer among world leaders, and Bill Gates was its leading philanthropist. But the Global Fund budget leveled off following the 2008 financial crisis, and a gap opened between what is needed and what is funded.
That gap needs to be closed in October 2019, when the Global Fund is to be replenished for the years 2020-22 at a conference in Lyon hosted by the French government. In the previous replenishment round, the Global Fund identified a total three-year financing need of around 98 billion USD, of which all but around 30 billion USD could be met by domestic budgets and other sources. Yet, instead of filling the 30 billion USD gap (roughly 10 billion USD per year), the donors gave the Global Fund just 13 billion USD. The lack of adequate funding meant that all three diseases continued to kill and to spread unnecessarily.
This time, the entire shortfall must be covered. The Global Fund will soon issue its own assessment of financing needs, but the numbers are unlikely to change much: around 30 billion USD over three years, or 10 billion USD per year.
This is a remarkably small price to pay to save millions of lives. Consider what 10 billion USD per year really means. For the 1.2 billion people in the high-income countries, it means 8 per USD person per year. For the Pentagon, it means roughly five days of spending. And for the world’s 2,208 billionaires, it means just 0.1 percent of their combined net worth (some 9.1 trillion USD).
Here, then, is a basic proposal: The Global Fund should pledge its efforts to raise 30 billion USD for the next three years. Half of the 30 billion USD could come from donor governments. The U.S. should continue its tradition of bipartisan support. China, a past Global Fund beneficiary, should now become a donor. The other half of the funding should come from the world’s richest people, whose wealth has soared in recent years. Gates has set the standard, and, under the Giving Pledge that he and Warren Buffett have launched, hundreds of the super-rich could easily pledge 5 billion USD per year for the period 2020-2022.
In a world divided by conflict and greed, the Global Fund’s fight against the three epidemic diseases is a matter of enlightened self-interest. It is also a reminder of how much humanity can accomplish when we cooperate to save lives.
After hosting a panel at The Sanders Institute Gathering on the Climate Crisis and a Green New Deal, Sanders Institute Fellow, Bill McKibben, sat down with the Real News Network to expand on the vision of a Green New Deal and the consequences if America and the world does not find a path forward to fight the climate crisis.
The most important thing we must do to save our democracy is get big money out of politics. It’s a prerequisite to accomplishing everything else.
Today, big money continues to corrupt American politics – creating a vicious cycle that funnels more wealth and power to those at the top and eroding our democracy.
In the 2018 midterm elections, wealthy donors and Super-PACs poured millions into the campaigns of the same lawmakers who voted to pass the 2017 tax cuts, which gave them huge windfalls.
Consider conservative donors Sheldon and Miriam Adelson, whose casino business received an estimated $700 million windfall, thanks to President Donald Trump and Republicans’ tax cuts. The couple then used some of this extra cash to plow more than $113 million into the 2018 election, breaking the record for political contributions by a single household.
That’s not a bad return on investment – for them.
All told, almost 40 percent of total contributions in the 2018 midterms came from people who donated $10,000 or more. Yet these mega-donors comprise a tiny 0.01 percent of the U.S. population.
It’s a worsening vicious cycle: Lawmakers cut taxes and slash regulations for their wealthy campaign donors. Mega-donors and corporations funnel some of that money back into our political system to keep their lackeys in power. Politicians then propose another round of tax cuts, subsidies or bailouts to secure even more donations.
If this isn’t corruption, I don’t know what is. It also breeds cynicism in our democracy. The game seems rigged because it is. A 2015 poll found that the majority of Americans say lawmakers are corrupt, out of touch with their constituents, and beholden to special interests.
In the 2018 midterms, Americans demanded an end to the corruption. And there are signs lawmakers are finally getting message. House Democrats’ first piece of legislation aims to end the big-money takeover.
We must end this vicious cycle in order to reclaim our democracy. We must get big money out of politics. Now.
A strange phenomena has appeared in the US debate over universal healthcare: a big majority favors a well-known reform—Medicare for All—as the pundits, insurance and pharma lobbyists, and political insiders denied it (since 1992!), then since 2016 opposed it and all of sudden want to re-define it.
The appearance of Medicare for All in the New York Times just before the New Year—as the subject of an in-depth Robert Pear story on December 29th, the type of work he consistently devotes to the hottest healthcare issues in Washington, but rarely has done so about MFA—and in a letters to the editor special on the 30th, featuring readers remedies for the healthcare system, “not surprisingly,” said the Times, Medicare for All “topped the list.”
The Pear story presented the first mainstream journalist examination of Medicare for All in relation to Medicare Advantage, the commercial insurance plans sold as Part C of Medicare, which are the latest hugely profitable windfall carve out of traditional Medicare for insurers, who market them to healthy seniors to fuel their double digit growth projections for these products. In return for an additional payment from the Medicare SMI Fund per enrollee, insurers like Humana, United Health, CIGNA, and Kaiser restrict seniors to a limited set of providers and provide more comprehensive benefits than Part B plans—typically vision, hearing aids, and dental—some incorporating Part D prescription drug benefits, and lower or no co-pay and deductibles.
Ironically, though this approach naturally attracts new enrollees, taxpayers are subsidizing a less efficient, more expensive version of what advocates mean by Medicare for All—an improved version that eliminates co-pays and deductibles for current Medicare recipients and everybody else. It also eliminates those narrow networks that restrict access, closes the co-pay requirements in prescription benefit Part D, lowers prescription drug prices by 40% according to a recent study, and provides comprehensive benefits including dental, vision and hearing with choice of provider (no surprise medical bills!). To say “pre-existing conditions” are covered is an understatement.
So when the Times‘ Pear concludes his article with a quote from John C. Gorman that we should do “Medicare Advantage for All,” allowing the insurance companies to determine payment for care but heavily regulated “like utilities,” he posits a false “third way” that would still allow the insurers to set the providers we can access, how long we are in a hospital, when procedures, prescriptions and tests are covered, all based on their business model. And, of course, this assumes the insurers would go along with “heavy regulation” of their profits.
In light of the almost approved merger of CVS-AETNA, the new Buffet-Bezos-Dimon joint benefits corporation, and consolidation of hospitals into regionally dominant corporate chains, financing healthcare through Medicare Advantage plans as Gorman suggests, would establish another corporate silo, subjecting our health to the dictates of profit and market share, subsidized by our taxes.
Those looking for a silver bullet—like an individual buy-into Medicare for those 55 and over, which relieves the insurers of having to cover their most expensive patients, and undermines the social insurance model of Medicare, or the Medicare Advantage model—only highlight how much existing Medicare is already privatized. In addition to Parts C and D described above there are the Part B out patient and co-pay plans costing $134/mo for most. True enough and likely the cause for why low-income seniors will be paying 40% of their income on average for healthcare by 2030. In truth, Medicare needs to be improved by un-doing all the cost-sharing seniors, like workers, increasingly bear.
Perhaps not surprisingly, these Medicare Advantage plans are hugely popular in Congress. GOPers and Democrats like the lower cost/broader benefit package, and who wouldn’t, especially if it doesn’t disrupt your donors business, and you can dole out dollars to them? As long as corporate money funds elections, and the healthcare industry has seemingly endless monies to buy lobbyists and make contributions, individually or through PACs, we cannot expect the Democratic leadership to lead for what we need.
Only a mass social movement can overcome the huge resource and political advantages of the medical-industrial complex. It requires elected officials having to choose between voters and donors – and creating an overwhelming demand that forces them to accede to fundamental reform. To be clear, that means guaranteed healthcare for all with no barriers to care.
It used to be that people who owned a lot of things could protect themselves and their things by erecting sturdy houses and, if necessary, putting a lock on the door. Today, it seems, that’s not enough. It’s estimated that three million American households live within gated communities – twenty thousand of them, often equipped with private security guards and electronic surveillance systems.
Some years ago, the town of Rosemont, Illinois, erected a beige wrought-iron fence. Rosemont is a suburb of Chicago, with a population of four thousand, and it has one of the largest auxiliary police forces in the United States.
A wall is being erected around the nation, too – an outer perimeter, separating the United States from the Third World. So far, our national wall extends along only sixty-four miles of the nearly two-thousand-mile border with Mexico, but Congress has appropriated funds for lengthening it and also fortifying it.
The urge to erect walls seems to be growing, just as disparities in wealth are widening. Many of the Americans who reside within gates like Rosemont’s have become substantially wealthier during the past several years, whereas a great many Americans who live outside the gates have not. (One man, appropriately named Bill Gates, has a net worth roughly equaling the combined net worth of the least wealthy forty percent of American households.)
On a much larger scale, inhabitants of the planet who reside at latitudes north of the national wall are diverging economically from those who live south of it. The consequence is that at both perimeters – the town wall and the national wall – outsiders are more desperate to get in and insiders are more determined to keep them out. Yet the inconvenient fact is that increasingly, in the modern world, the value of what the insiders own and of the work they do depends on what occurs outside.
Half a world away from Rosemont are places whose currencies, denominated in bahts, ringgits, rupiahs, and won, began toppling more than a year ago, and seem to have come to rest only in the last several weeks at levels far below where they started. This has caused most of these countries’ citizens to become far poorer. An Indonesian who had worked for the equivalent of three dollars and thirty-three cents a day before the rupiah’s decent is now working for about one dollar and twelve cents. Efforts by the International Monetary Fund to build back the “confidence” of global investors in these nations by conditioning loans on the nation’s willingness to raise interest rates and cut their public spending have had the unfortunate side effect of propelling more of their citizens into ever more desperate poverty. After the tremors spread to Russia last summer, and it defaulted on its short-term loans, the worldwide anxiety grew, spreading all the way to Brazil, the largest economy in Latin America, with the widest gap between rich and poor. In return for its promise of austerity, Brazil is now set to receive an international line of credit totaling forty-one and a half billion dollars, designed to convince global investors that its currency will not lose its value, and that, therefore, there is no reason for them to take their money and run.
All this commotion has also diminished the economic security of quite a number of people who thought of themselves as safely walled in. …. Recent government data show that in the third quarter of 1998 the profits and investments of Americans companies shrank for the first time since the recession year of 1991. This is largely because their exports to Asia and Latin America have continued to drop, while cheap imports from these regions are undercutting their sales in the United States. In consequence, they have been laying off American workers at a higher pace, and creating new jobs at a slower pace, than at any time in recent years.
We do not know how many residents of Rosemont will lose their jobs or the value of their stock portfolios because of the continuing global crisis. No burglars will climb over the steel barrier now walling off the United States and then scale Rosemont’s beige wrought-iron fence, but some residents of Rosemont will lose a bundle nonetheless.
The major risks of modern live now move through or over walls, sometimes electronically, as with global investments, but occasionally by other means. A lethal influenza virus originating among a few Hong Kong chickens could find its way to Rosemont via a globe-trotting business executive. Drugs are flowing across the border as well, not because the walls are insufficiently think but because the people behind them are eager to buy. Something these is in capitalism that doesn’t love a wall.
So why do we feverishly build more walls when they offer us less and less protection? Perhaps it is because we feel so unprotected of late. Amid all the blather about taking more personal responsibility for this or that, there is a growing fear that random and terrible things can happen to us. Solid walls at least create the illusion of control over what we call our own, and control is something we seem to need more of these days, when almost anyone can be clobbered by a falling baht.
In discussion with Sharmini Peries, Dr. West discusses the fall of the American imperial project and the role of international solidarity in transforming our society.
In this Ted Talk, Simon Sinek breaks down how great leaders approach any task, company, or even running for office. He demonstrates how they do not begin with “what” they will do, he demonstrates how they “Start with why.”