REFORM IS IMPERATIVE

The time has come to make reform the imperative for our times.  We can no longer function as a government without in-depth reform of our mode of operation.  We can no longer function as a capitalist system without fundamental changes to how business is done.  We can no longer function as a representative democracy without changes to our foundational document: the Constitution.  We can no longer function as the world’s leading nation and Super Power without making changes in our attitude toward other nations and without a commitment to peaceful means of solving problems with others.  In short, we cannot continue the status quo; we must move beyond it; we must progress and not regress; we must reform our institutions and our organizations.   And, we must start with the people we elect to political office and other leadership positions.

The time has come when we must demand a reform plan from every candidate running for any office or leadership position.  It is no longer enough to be a Republican or Democrat, a Conservative or Liberal, a Tea Partier or a Progressive.  We must elect Reformers.  Without a commitment to fundamental change, we cannot move forward as a nation.  The problem, of course, is that there is a breakdown of agreement around which we can coalesce.  Nonetheless, we must attempt to put forth the fundamentals of a reform plan so that debate and discussion may begin.  Here are some basics I offer for your consideration.

1)    We must get private sector money out of politics.  Money in politics is not free speech; it is coercive speech.  Money in politics does not promote freedom; it’s purpose is to defeat and restrict. Third parties, like rich individuals and large corporations, have agendas that they want to impose on others, and money is their way to get politicians to do their bidding.  Dylan Ratigan of MSNBC has made this issue his own, and his effort to seek a constitutional amendment to “get money out of politics” is worthy of praise and our commitment.
    A)    reverse Citizens United decision with a constitutional amendment
    B)    get money out of elections by an amendment calling for limited individual contributions to government, along with the use of a small percent of tax dollars to be put in an Elections Account overseen by an independent Board, including ordinary citizens who are not office holders. Allow only public funding from that Account with limits for every office as to what can be spent for a campaign
    C)    outlaw PACs and all 3rd party advertisements, letters and brochures; enact a Truth in Advertising bill for political campaigns
    D)    limit campaigns for office: primaries to be held on the same date countrywide just as general elections are held on a national day of voting.  Campaigning for office must be limited to a certain number of months - say 6 - before primary day and before election day.

2)   We must get coercive money out of the Congress.  We must undo the use of money  to influence legislation and special favors.
    A)    We need a constitutional amendment to forbid congressmen and senators from accepting any gift, emolument, in-kind contribution, monetary contribution, loan, grant, trip, or enticement of any kind while in office.  Anyone offering, or receiving, such gifts shall be fined, jailed or impeached.
    B)    We also need a constitutional amendment to forbid congressional members (executive and judicial branch members and staff as well) and staff or family members from associating in any way with a corporate law firm, consulting firm, lobbying group or party-affiliated think tank or corporate board while in office and until 12 years have passed since they last held federal office.  Did you realize that, according to Peter Schweizer in Throw Them All Out, just two years ago one-third of the United States Senate members had family members who were registered lobbyists or were working for lobbying firms?
    C)  By law, put restrictions on lobbying by all groups: it must be reported, recorded and published whenever any type of contact is made with a member of Congress, member of the White House staff, or a member of the judiciary.  Failure to do so must result in prosecution and disbarment from public office.
    D)  Apply the provisions of the Freedom of Information Act to Congress
   
3)    We must disallow any special privileges and exemptions for the Congress.
    A)    All laws passed must apply to Congress as they do to others; no exceptions.
    B)    Congress must learn to live without special privileges, such as taxpayer-subsidized surgery provided by army and navy surgeons and on-site clinics run by navy physicians; junkets, limousines, chaplains, chauffeurs, and private jets provided by 3rd parties can go as well.  
    But, most of all, there is absolutely no reason why Congresspersons should be excluded from standards and laws concerning insider trading, conflict of interest, nepotism and cronyism.  Likewise, whistle-blowers deserve protection from reprisal if they report financial corruption within our governmental bodies.  Here are the initiatives, in brief, that Peter Schweizer in Throw Them All Out suggests:

    1.  Create a legal code that makes trading on nonpublic information illegal both for those who offer it and those who trade on it.
    2.  Members of Congress should disclose all transactions above $5,000 within two days, including price and number of shares, to be placed in an online database.
    3.  Members of Congress should not be allowed to trade stock in companies that are overseen by their committees.
    4.  Apply whistleblower laws to Congress, since there are already such laws that apply to federal workers and corporate employees.
    5.  Disallow “sweetheart” IPOs; members of Congress should not be allowed to participate.
    6.  Review, revise and enforce existing conflict-of-interest laws.  Require abstaining from voting when a conflict may exist, or appear to exist.  Place assets in mutual funds rather than individual stocks.  Extend such laws and requirements to senior White House officials and political appointees.
    7.  Earmarks in which a member of Congress will receive a direct, or indirect, (through a third party) financial benefit should not be allowed.
    8.  Family members of legislators (or of executive branch senior members and members of the judiciary) should not be allowed to become lobbyists or “consultants”.
    9.  Campaign contributions should be forbidden when Congress is in session.
    10. The Federal government needs to get out of the business of offering grants and taxpayer-backed loans to friends of legislators, of appointees or of senior officials.

4)   We must have term limits for all federal and state political offices.  We cannot survive a system of office-holding that prevents our government institutions from renewing themselves.  We cannot survive professional politicians who get rich off inside information and lucrative deals that only they can access.  Elsewhere on this BLOG, I have proposed a three-year term for Congressmen with a limit of 12 years (4 terms) overall, plus the same limit of twelve years for a Senator (2 terms of 6 years each).  It is absolutely ridiculous that we apply a two-term limit to the Presidency without a corresponding application to legislators.  Such a one-sided approach promotes an imbalance in our system.

5)   Blind trusts for public officials must be just that.  No more appointment of family, friends, business associates, colleagues, acolytes or cronies as trustees of blind trusts.  Rules of the Senate must be changed to require detailed annual disclosure of assets in a blind trust (which is not a requirement currently). 

That’s enough for now, even though it is just a beginning and not meant to be definitive.  But let me ask you:  when have you heard any such talk from a political candidate?  How many candidates can even present the elements of a reform plan?  They don’t think that way.  But it’s time they did, and, what’s more, it’s past time that we required such a plan of every one of them! 

Let me end by quoting some thoughts from Schweizer’s book:

“The problem with Washington isn’t gridlock.  It isn’t that things aren’t getting done.  The problem is the corruption of the public spirit.  The Permanent Political Class has no sense of urgency to change because, for them, business is good.”

“We need to break the cycle of crony capitalism, land deals, and insider trading.  And we can do it simply by applying the rules that the politicians expect the rest of us to abide by.”

“The rule of law, and the notion that no one is above the law, is fundamental to a healthy democracy.  If we accept crony capitalism with a shrug and an eye roll, we might as well accept a world of bribery and out-and-out vote buying.  Crony capitalism has a corrosive effect on our politics, our economy, and our character.  And we don’t have to accept it.  Let’s be clear: we need to stop coddling these people.”

“What we face is a system that is compromised by the perception that U.S. public policy is a marketable commodity.  It’s time to fix it.  Let’s relegate the Government Rich to the ashbin of history.”

Reform is the imperative for our times.  Are YOU ready and willing to demand a reform plan from every candidate for office, at all levels?

A Flight of Fantasy

I invite you to go with me on a flight of Fantasy.  It seems to me that such a flight should be unnecessary, but it is a necessity if we are to see where we ought to be!

What If:

-- Congress were to become a smaller, more compact group of men & women dedicated to probing and reforming our system of making laws;

-- Congress could be an organization dedicated to resolving the national problems of consequence that have major effects on our lives and that relate only to its constitutionally-invested powers under the Constitution;

-- Congress were to approach law-making as a problem-solving endeavor and hired as many staffers for their problem-solving skills as they now hire for constituent services and political advice and advantage;

-- Congress held hearings to gather information and data on actual problems people face rather than using hearings to advance a political agenda;

-- Congress used polling techniques to gather information and data on actual problems rather than on where they stand politically;

-- Congress surveyed their constituents for real opinions on national problems rather than sending out faux surveys that offer only certain “politically correct” options for them to choose;

--  Congressmen and Senators actually went out among their ordinary constituents and gathered information from them directly; or sat down with groups of ordinary working persons to solicit their views and their concerns;

--Congress revamped its own rules to enable it to move legislation in a planned, efficient and effective process toward a vote up or down on every bill;

-- Congress over-turned all rules that are aimed at restricting, delaying or preventing actual debate and consideration of pieces of legislation: no more filibuster; no more voice votes or roll calls (electronic voting is all that is needed in this modern age); no more amendments unrelated to the bill under consideration; no more “earmarks”; no more “tabling” of  controversial bills; no more delay of consideration; no more scheduling of legislation by political leaders:  all legislation to be scheduled for consideration within a fixed time from when it emerges from Committee or when it is co-sponsored by 25% of the members of either House;

-- Congress had no more political positions in the leadership of the House or Senate, but replaced them with political advisers in the Office of the Speaker and the Office of President Pro Tempore of the Senate;

-- Congress was required to indicate on every piece of legislation, not only its constitutional basis, but the findings of fact on which it is based, and a statement of a specific national problem it is meant to address;

--  Every Congressperson and Senator was mandated to have a “Citizen Advisory Council”, none of whose members could be making over $100,000 per year, none of whose members could be contributors in any way to the legislator’s coffers, none of whom could be currently holding any elective or appointive governmental office; and, what if each legislator was mandated to consult that Council as to the efficacy of every piece of legislation that he or she proposed;

-- Congress was required to give up all its privileges, like health care to which ordinary citizens do not have access, or chaplains that have no business having a permanent office covered under the congressional budget, or chauffeurs and limousines, or rides on corporate jets, or congressional junkets with no other purpose than a paid vacation.

--  Congress was prevented from using inside information to purchase stocks, land, or aid from 3rd parties that enhances their personal wealth or the wealth of any group to which they belong or in which they have any vested interest;

--Congress had to obey every law that it passed, with no exemptions and no exceptions.

We could probably go on and on in this vein, but let us make the main point:  Congress has reached its nadir (at least we hope it has!).  It is concretized; it is institutionalized; it is dysfunctional; it is politicized; it is organized around money and politics rather than the welfare of the people.  Some pundits claim that a number running for Congress now are doing it for the financial gain they can access rather than to serve the electorate.
It doesn’t even seem to understand its own place in the scheme of things which was just recently made so very evident by blaming the President for not being more involved with the Super Committee.  When we had politicians like Byrd & Kennedy & Dirksen & Tip O’Neill & Joe Martin & Mike Mansfield & Styles Bridges & Robert Taft & others too numerous to mention, they understood and coveted the unique role of Congress and would not have expected the President to step into the middle of a committee’s process.  Those Congressional members who themselves berated the President for not being involved, or who led others to think he should be involved, are either ill-informed, or just plain ignorant.

In other words, coming to a landing-point from our fantasy flight, it is time to recognize that Congress is not going to change on its own; it has reached a point where radical reform is necessary to rescue our legislative system and its progenitor, the Congress.  Above all, we can not reasonably expect the Congress to act differently, or to reform itself without pressure, because the tipping point has been reached:  this institution, like most institutions, has set its goals, its processes, its actions in concrete where there is no hope for substantive change.  It is time for us to either reform the Congress or to allow it to become totally irrelevant to the needs of our representative democracy.

A word of caution.  The Occupy Wall Street movement is just the first of substantive indications that there could be a revolutionary, not reformative, movement afoot to say that there must be another way of giving citizens their say, coming to consensus, and deciding on measures that benefit the commonweal.  Ignoring that revolutionary strain of dissent, or trying to shut it down, is no guarantee that it won’t flourish in other forms. 

Reform or revolution?  It is a question built into not only our democratic system, but into all evolving institutions and entities that attempt to deal with the governing or organizing of human beings.  I believe that both are often necessary, but I lean toward reform.  I want to see constitutional amendments that will change our institutions for the better.  I want to see reformers, instead of Tea Party-type destroyers, elected.  I want to see congressional and electoral districts drawn by citizens, not politicians or millionaires.  I want to see private money gotten out of elections and governing.  I want to see ordinary citizens used on all levels of government, in both advisory and official positions, to evaluate, oversee, and recommend changes where necessary in any and all of our governmental entities.

A re-birth of government of the people, by the people and for the people is not a flight of fantasy; it is a mission, a goal, an objective that every generation of citizens of this Republic must take on as their own.

Even More Obama Accomplishments

Recently, we have looked in some detail at two of the largest of President Obama’s accomplishments, at least from the point of view of how much derision of them has come from Republicans.   The “failed stimulus” and “Obamacare” are GOP-manufactured epithets for the American Recovery and Reinvestment Act of 2009 and the  Patient Protection and Affordable Care Act of 2010.  In both cases, time has shined the light of truth on what both Acts have brought to pass, to the extent that the Congressional Budget Office has taken another look and has concluded that neither Act can be said to be a failure.  They have said that the ARRA engendered actual stimulus of a nose-diving economy and the saving or creation of 5-35 million jobs.  Likewise, they cautioned Congress that repeal of the PPACA would bring about some rather dire consequences, not only for individuals and families, but for the economy and businesses.  Such positive support from the CBO has prompted certain Republicans in Congress to deride their methods, and for one particular GOP presidential candidate (Gingrich) to call for their demise.

This week, let us take a look at some more accomplishments of note that have come forth from this President’s efforts but that may have faded from your radar over time:

1)   The Rescue of the U.S. auto industry.  Against all the rants of those who said we should not save the auto industry but let the market decide, the President acted to put incentive money into the industry and to restructure the corporations before bailing them out.      In January 2009, the government used $24.9 billion of the $700 billion bailout fund to bail out two of the Big 3.  

    The purpose of the loans was to provide operating cash for GM and Chrysler, and to keep making auto loans available for car buyers. Ford Credit planned to use funds from the Term Asset-Backed Securities Loan Facility (TALF),a government program for auto, student and other consumer loans.  In return, the companies promised to fast-track development of energy-efficient vehicles, and consolidate operations. GM and Ford agreed to streamline the number of brands they produced. They also won agreements from the UAW union. The three CEO's agreed to work for $1 a year and sell their corporate jets.  Ford made more money in the first six months of this year than in the previous five years combined. G.M. is profitable and preparing for one of the biggest public stock offerings in American history. Even Chrysler, the automaker thought least likely to survive the recession, is hiring new workers. 
    (useconomy.about.com)

    Let us not forget that he also propelled a “cash for clunkers” program into a successful program of car purchases and, at the same time, an environmental clean-up project, as the emphasis was on aged cars without up-dated emissions controls.  Another double-win program was his provision of attractive tax write-offs for those who bought hybrid vehicles.

2)    Made education a priority.  Most importantly, through a program named Race to the Top, the President spurred reforms by providing states with monetary incentives to make positive changes to their education systems.  Race to the Top prompted 48 states to adopt common standards for K-12.  He also put emphasis and money behind new ideas like charter schools, funded early learning programs, funded new school construction, funded greater broadband access to K-12 schools, made college more accessible and affordable through significant increases in scholarships and funding, and even allowed eligible students to refinance their student loans. 

3)   Brought the War in Iraq to an end.  Obama has reduced troops in Iraq from a high of 170,000 to about 7,000 (according to CBS News) with the goal of bringing the rest home for the holidays with any remaining troops focused on training Iraqi forces.  Moreover, he has not only brought troops home, but done it responsibly giving Iraq a reasonable chance of becoming a stable democratic state in the Middle East.  This overlooks the savings that will result from this bold action, except that no one knows exactly what that will be at this time.  Ostensibly, billions being spent in Iraq each month will be available to some extent for domestic needs in the near future.

4)   Financial Industry reform.  Involved in passage of the most sweeping financial industry reform since the Great Depression (Dodd-Frank bill).  Although some cite only its inadequacies, the legislation addresses industry issues that helped create the current recession; provides a system to allow the government to break apart large financial institutions that threaten the economy; creates a council of federal regulators to coordinate detection of risks to the financial system; subjects a wider range of financial companies to government oversight; creates a Bureau of Consumer Financial Protection to protect citizens from unscrupulous practices; reins in banks’ ability to trade in risky financial instruments such as credit derivatives.  Republicans can’t stand these reforms and threaten repeal.  They are also holding up the approval of the President’s choice to run the BCFP.

5)    Foreign Policy reform.  The President visited more countries and met with more world leaders than any other president in his first six months in office; and has continued to repair badly damaged relationships with foreign powers across the globe.  He has worked with other nations to fight Global Warming and Nuclear expansion.  Closed “secret detention” facilities in Eastern Europe and elsewhere.  Shifted focus from Iraq to Afghanistan and changed the military command in Afghanistan, putting emphasis on reducing terrorism, development of infrastructure, providing aid, diplomacy, and good government practices, as well as limiting aerial bombing.  Ended previous policy on torture and emphasized compliance with Geneva Convention standards.  Responded with compassion and leadership to the earthquake in Haiti and nuclear mishap in Japan.   Instituted a new policy on visits to Cuba.  Renewed loan guarantees for Israel.  Sent envoys to the Middle East and other areas that had been neglected; re-engaged in multilateral and bilateral talks and diplomacy; improved relations with Russia, signing an updated START Treaty with that country.

    At the same time, he aggressively supported reform movements in several Mid-east countries, put together a coalition to assist with the ouster of Kaddafi in Libya; approved the mission by Navy Seals to find and eliminate Osama bin Laden, as well as other leaders of Al-Qaida, thus weakening the leadership and effectiveness of that terrorist group.

Before we conclude, let us briefly list several other accomplishments in very brief form:

• Made the environment a national priority and a primary source for job creation; ended previous policy of not regulating and labeling carbon dioxide emissions; energy plants must prepare to produce 15% of their energy from renewable sources
• Appointed the first Latina to the Supreme Court
• Authorized construction and opening of additional health centers to care for veterans
• Began process of reforming and restructuring the military, including new procurement policies, new technology, cyber units and operation, better body armor, ended policy of no-bid defense contracts
• Closed offshore tax havens
• Ended previous practice of forbidding Medicare from negotiating with drug companies for lower drug prices; federal government is now realizing hundreds of millions in savings
• Ended tax benefits for corporations who outsource American jobs; new policy supports in-sourcing: incentives to bring jobs back to America
• New consumer protections from credit card industry’s predatory practices
• Support for stem-cell and new biomedical research
• Established a National Performance Officer charged with making federal operations more efficient
• Provided the VA with more than 1.4 billion to improve services to veterans; improved housing for military personnel; brought about improvements to Walter Reed Military Hospital and other military hospitals; increased pay and benefits for military personnel
• Increased opportunities for national service through AmeriCorps and national youth service program
• Increased infrastructure spending for roads, bridges, power plants, etc.
• Provided tax credits to first time home buyers to help revitalize U.S. housing market
• Limited salaries of White House Aides and limited them from working as lobbyists after their White House tenure
• New federal funding for science and research labs
• Ordered a review of all federal operations to identify and cut wasteful practices and spending
• Missile defense program cut by 1.4 billion in 2010
• Legislation to help homeowners refinance mortgages
• Passed the Lilly Ledbetter Act to give equal pay for equal work
• Modernized the food safety system to better prevent food-born illness
• Increased housing for low-income seniors
• National Alzheimer’s Project Act established project within HHS along with an Advisory Council on Alzheimer’s research, care and services
• Provided tax cuts (payroll tax cuts) for 95% of America’s working individuals and families (Republicans are fighting against extension right now)

And the list goes on and on….  Check out http://3chicspolitico.com,  www.bspen.com, www.slate.com if you want more.  Each of these has been helpful in compiling my own listing.  A suitable conclusion is provided by  H/T of Newmericans on Politico:

“The list of his accomplishments (is) staggering for any U.S. president -- particularly when you compare him against our more recent US presidents.  In less than 2 years, Obama has done what most had said was politically impossible and absolutely essential for us to maintain a competitive economy in the future (universal Health Care), tackled highly challenging and comprehensive economic reforms (Financial Industry reform), and stabilized a very troubling economy.  Even if he did not achieve any more legislative accomplishments during the remainder of his tenure, Obama will have had one of the most productive terms of any president in the history of our country.”

“The Truth will set you free” -- to re-elect President Obama!  He has a record of accomplishment and leadership that cannot be matched by any of the Republican  candidates.  To continue to address a broad perspective of needs, the President needs a cooperative Congress, meaning that returning a Republican Congress will surely undermine our recovery and the future of the middle class.

Another Important Obama Accomplishment

Last week, we took a look at the ARRA (the American Recovery and Reinvestment Act) which has been characterized as “the failed stimulus bill.”  It has not been a failure at all, according to the Congressional Budget Office (CBO).  In fact, it has resulted in millions (between 5-25 million) of jobs both saved and created in the public and private sectors.  It is one of the many positive things that the President has done, or taken leadership to see accomplished, in his three years in office.  In fact, according to several writers and pundits, President Obama accomplished more in his first two years than any other President in history.  Republicans will keep trying to characterize his tenure as an abject failure, but their rhetoric is nothing but lies and distortions that cannot be backed up by facts (which they tend to ignore in any political “debate”).

This week, let us take a closer look at the Patient Protection and Affordable Care Act (PPACA), which Republicans and conservatives try hard to characterize as a failure, and as “government controlled”, and even as “socialism,” derisively referring to it as “Obamacare.”  As a matter of fact, it is less of a government-controlled system then is their own health care insurance, which is entirely organized, managed, and overseen by the OPM (Office of Personnel Management).  To go a step further, the extra health care benefits available to members of Congress includes clinical care on-site operated by naval personnel, and they have access to taxpayer-subsidized surgical/hospital care at Walter Reed Army Medical Center in Washington DC, and the National Naval Medical Center in Bethesda, Maryland. (Senate Minority Leader Mitch McConnell had heart surgery there in 2003). 

So let’s say, first, that the PPACA legislation does not contain a public option; that, under its provisions, the government does not provide services, nor does it control from where you get your health insurance.  You are free under this Act to continue choosing from a number of private insurance companies for your coverage.  The Act does have a provision for state-based Health Exchanges through which individuals and small businesses with up to 100 employees, could purchase qualified coverage, but these Exchanges can be administered by either a state agency or a non-profit organization; presumably, the states can make that choice.  States can also opt in 2017 to set up Regional Exchanges or allow other state Exchanges to operate within a given state.  In addition, the OPM will contract with private insurers to offer at least two multi-state plans in each Exchange.  Going a step further, the Act allows for the creation of non-profit, member-run health insurance companies in all 50 states and DC to offer qualified health plans. 

Are there some requirements in the Act that would involve government implementation and management?  Of course; but that doesn’t make it “socialism” or “government-run.”  There is a federal requirement that everyone be covered, backed up by certain penalties for those who fail to comply.  That is controversial, and will be addressed by the Supreme Court.  Some lesser courts have supported its constitutionality and others have not.  Other restrictions are placed on what can be offered by insurers and what cannot be included.  But, in my opinion, this is no different than many pieces of  legislation that require certain actions, programs, restrictions and innovations that result in changes in administration or management in the public and/or private sector.  One example:  the ADA - the Americans with Disabilities Act.  If the Court rules that the federal government cannot require all people to purchase health insurance then surely logic would say that government cannot require compliance with adaptive measures for all public and private facilities and programs.  In my opinion, it is ridiculous to say that the federal government cannot require certain actions on the part of all citizens when it clearly benefits all, or a major portion of, the citizenry.  We shall see…

Second, let’s take a closer look at the PPACA, and see what it has actually done for consumers in a positive way:

- allows adult children up to age 26 to be on their parents’ healthcare insurance; has already extended insurance coverage to 2.3 million young adults under age 26
- prohibits insurers from citing pre-existing conditions for denial of coverage;
- provides portability between employers;
- expands Medicaid to certain eligible citizens under age 65;
- extends funding for the Children’s Health Insurance Program through 2015;
- provides for a tax credit for eligible small employers (under 25 employees with annual average wages less than $50,000) that purchase health insurance for employees;
- establishes a national, voluntary,  insurance program for purchasing community living assistance services and supports (CLASS)
- prohibits lifetime limits on coverage

Here are some more positives that will occur in the near future:

- will provide refundable and advance premium credits to eligible individuals and families to purchase insurance plans through the State Exchanges
- will require Exchanges to maintain a call center for customer service, and to use a single form for application that can be filed in person, by mail or online;
- will create a temporary insurance program for employers providing health insurance coverage to retirees over age 55 but not eligible for Medicare
- will create an essential health benefits package which is the minimum that must be offered by all health care plans;
- will establish a temporary national high-risk pool to provide coverage to individuals with pre-existing conditions along with subsidized premiums;

And administratively, there are these helpful provisions:

- establish a process for reviewing increases in health plan premiums and require justifications for increases; provide grants to states to support these efforts
- adopt standards for financial and administrative transactions to promote simplification of administration, thus saving money
- impose same insurance market regulations in all markets and exchanges
- establish the Health Insurance Reform Implementation Fund to implement health reform policies
- permit states to create a Basic Health Plan for uninsured individuals in lieu of premium subsidies
- simplify health insurance administration by adopting a single set of operating rules; non-compliance will bring a penalty
- establishes a Council, a Fund, and a grant program to spur prevention, wellness and public health programs
- will require skilled nursing facilities to disclose information regarding ownership, accountability requirements, and expenditures and will publish results on a website so Medicare enrollees can compare facilities
- improve workforce training and development, much of which is focused on graduate medical training, nurse training and retention, and increasing both through scholarships and loans
- impose additional requirements on non-profit hospitals to conduct a community needs assessment every three years and adopt an implementation plan to meet identified needs

And finally, here are some consumer-based reforms that will improve health care insurance and health care delivery:

- will expand Medicaid coverage to all non-Medicare eligible individuals under age 65
- require qualified health plans in Exchanges to meet marketing requirements and will require reporting of information in certain areas of operation, including enrollee rights
- require all new policies offered through, and outside of, Exchanges to comply with one of four benefit categories
- develop internet site to help people identify coverage options
- develop standards for insurers in providing information on coverage and benefits
- establish an office of health insurance consumer assistance or an ombudsman program to serve as an advocate for people with private coverage
- establish an independent Payment Advisory Board to submit legislative proposals with recommendations to reduce the per capita rate of growth in Medicare spending when spending exceeds a certain target rate, and to slow the growth in national health expenditures
- improve care coordination for enrollees with both Medicare and Medicaid
- create an Independence at Home demonstration project to provide high-need Medicare beneficiaries with primary care services at home
- improve access to community care by increasing funding for community health centers, and for the National Health Service Corps, plus support for school-based health centers

This brief summary does not even include all the reforms to Medicare and Medicaid contained in this Act simply because we have discussed those elsewhere.  So, in essence, I have just skimmed what I presume are some of the more important reforms in the Act. 

What can we say, then, to the radical Republicans in Congress, and running for President, who want to repeal this entire piece of important legislation?  I suppose, first of all, we could say, “Do you even know what is in the Act?”  Second, we might ask, “Do you care at all for what ordinary people would give up or lose by your ill-advised action?”  Third, we might point to a letter from the CBO, dated  May 26, 2011, and written to Congressman Henry Waxman, ranking member of the Committee on Energy and Commerce, in which there is some discussion of the consequences of repealing this legislation, or more precisely, of permanently preventing the use of appropriated funds to implement the Act.  Here are some of the CBO points for your consideration:

1)  would result in a significant loss of revenues, particularly from certain fees and taxes that would be collected by the IRS: e.g. 40% excise tax on insurance plans above certain thresholds for persons with incomes above 250k, and certain insurance industry and pharmaceutical industry fees
2)  would significantly alter the effects of many provisions of the ACT, including changes to Medicare and Medicaid; the establishment of health care exchanges, tax credits, and cost-sharing subsidies designed to increase the number of Americans with health insurance
3)  would reduce the number of people with health insurance coverage compared with what would occur if the health care laws are fully implemented
4)  could prevent CMS from modifying Medicare payment rates on an annual basis; preclude CMS from engaging in the rate-setting process and signing contracts with private insurers that offer Medicare Advantage and Part D (prescription drug) plans; the possible result - no Medicare Advantage plans and no more Part D plans for Medicare beneficiaries!
5)  preclude the Secretary of HHS from implementing recommendations of the Independent Payment Advisory Board aimed at limiting Medicare costs
6)  prevent federal government from setting up insurance exchanges if states chose not to
7)  prevent CMS from assessing and collecting its share of higher rebates from pharmaceutical companies for drugs dispensed to Medicaid beneficiaries
8)  payment to doctors would be affected because the calculation of annual rates by CMS would be affected and rates would remain at current levels, and Medicare spending would increase in 2012 and 2013
9)  mandated demonstrations and pilot projects designed to improve efficiency and quality of care would increase spending in some cases
10) in the absence of mandates for insurance coverage, the number of families and individuals covered would be lower than under current law
11) grants to states for setting up exchanges and subsidies for cost sharing would not be available, putting states in a further bind as to health care support
12) CMS would probably be prevented from providing assistance and guidance to states as to their Medicaid and CHIP programs
13) provisions to reduce waste fraud and abuse would be undercut, as would provisions to improve quality of care to enrollees

The Patient Protection and Affordable Care Act of 2010 is not the failure that many conservative Republicans would have you believe.  There are many, many provisions that will not only reform our health insurance provisions, but that will go a long way toward reforming our health care delivery system into one in which quality is primary and preventive care and wellness are of the utmost  importance.  Those who want to destroy the most important health care legislation since establishment of Medicare under Lyndon Johnson, are simply deluded.  It is time to praise this major accomplishment of the Obama administration, and to seek to implement those positive aspects that are pending between now and 2019.  “Obamacares” is an apt title for this major piece of effective legislation.

As with most of the programs (and agencies) that the Republicans want to cripple or destroy, there are real people -- millions of them -- who are in need of the assistance and subsidies which such programs provide.  It is not just a matter of how many positions can be cut, how much money we can save, how big the deficit is.  For every number, there is a face, a life, a story and a person being threatened with the loss of something that for them constitutes a net of safety and assurance. 

Congressmen and presidential candidates who spew the kind of venom that tells “hippies” of OWS to get a job; that says that poor kids need to learn a work ethic and to hell with child labor laws; or who despises union workers and especially government union workers (and takes their collective bargaining rights away).  They want to send “illegals” back to where they came without opportunity for citizenship or for their children‘s education.  They want to deny quality health care insurance help to seniors and children and persons with disabilities.  These same people want, above all, to maintain and support the excesses and power of the richest among us.  It’s past time that we call them out, and ask:  do you even know the people about whom you speak; the people you threaten with a torn safety net (denying help even with home repairs or heating subsidies or food stamps)?  Do you ever meet with them one-on-one or in small groups to discuss their concerns?  Do you care to become acquainted with them and their life stories?  I hope the coalitions they are forming across this country begin to occupy your neighborhoods, and your offices, and even your properties.  The time is coming when you will have to begin to respect the needs of the middle class and the working poor and those who have little or nothing, including a home. 

President Obama has shown by his accomplishments that people matter.  He is our best hope for greater accomplishments in health care and further advances in the welfare of the 99% who do not have a million dollars or more to insulate themselves from real life problems, exigencies and difficulties.  It is past time to laud him for his targeted actions and his many attempts to make our lives and our nation better than the mess left behind by a certain Texas cowboy.  More next time…