Friday, March 24, 2017

GOP right, moderates make ACA reform unlikely; bring on the Dems

The Affordable Care Act and its reform are causing confusion. Here’s what we know.
It covers more people than did the free market system and changes some of the terms of insurance policies, but it does not abolish the market.
Conservatives dislike it because they believe it substitutes government for the free market, costs too much and requires participation.
Progressives like it because it partly substitutes government for the free market, which did not cover millions of people.
Everybody agrees it needs to be fixed.
There are fundamentally only two ways to provide health care insurance to people.
In the U.S., the traditional approach was insurance sold by private carriers. People could choose among policies the companies offered, choose not to be insured, or simply couldn’t afford insurance. Competition among insurers would supposedly control prices. The system was mainly financed by insurance premiums.
In other developed countries, government is the insurer, providing coverage to virtually all people. Government, the “single payer,” pays the bills. As the only customer, the government can control prices and costs. The system is financed by taxes, which replace insurance premiums.
The American system includes elements of single payer: Medicare for older people and the Veterans Administration.
The traditional American system left too many people without coverage, but the single payer system approach was widely considered to give too much power to the government while destroying a key element of free enterprise – competition.
By 2010, Congress included enough Democrats and President Obama to move away from a pure market system, but not to a single payer. Congress would not allow government even to provide a nonprofit competitor in the market. The result was a compromise that shows the defects of a hybrid.
In 2017, Congress includes enough Republicans and President Trump to restore some or much of the market system, allowing competition to attract people to insurance rather than a government requirement. Some elements of the ACA might be allowed to survive.
The ACA imposed some new costs resulting from the inclusion of tens of millions of previously uninsured people and required additional features, like guaranteeing coverage for pre-existing conditions.
It does not control drug or hospital costs, which to continue to rise, though at a slower rate. The new ACA costs are financed by new taxes, mainly levied on the wealthiest taxpayers. Republicans would repeal those taxes.
Rising costs, accompanied by limits on what insurers can charge despite higher premiums, are causing insurers to leave some markets. Trump and GOP critics say that shows the coming collapse of the ACA.
Strong right-wingers don’t want reform; they want repeal. Outright repeal now may be impossible because the program is established, and many previously uninsured people are not only becoming accustomed to it, but find they like it.
Like Social Security, which was once similarly challenged, it may become an integral part of American life. If the ACA cannot be killed now, strong conservatives reckon, it will never be ended.
One element of the ACA that gets much attention is the financial aid offered to states, allowing them to expand Medicaid to include many more low-income people. States could turn this money down, but even many Republican-led states accepted it to provide help to their low-income uninsured.
In Maine, Gov. LePage has thus far successfully blocked the state from accepting more federal Medicaid funds. This year, a referendum could allow Maine voters to expand Medicaid, known as MaineCare, without the governor’s agreement.
As Congress considers the ACA, a conflict exists between those who favor repealing as much as possible and others whose constituents have come to rely on it. Sen. Susan Collins has tried to lead Republicans toward a state-by-state compromise that serves both sides, but it seems to have no chance.
Neither she nor Sen. Angus King is inclined to agree to a deal that strips Maine people of coverage.
Health care costs are increasing and with them insurance premiums from Medicare, the ACA and insurers. Unless costs are controlled, the health care tab will become impossible to pay under the free market, single payer, or anywhere in between.
As a start, when government gives drugs a monopoly, it should be possible for government to impose price controls on greedy pharmaceutical companies. That would be a huge reform in itself.
Whatever happens in Washington, states may adopt their own health care insurance programs. After all, Massachusetts adopted a program in 2006 that became the basis of the ACA. That state now has the lowest rate of uninsured in the country.

Friday, March 17, 2017

Immigrants, refugees face U.S., European nationalism

President Trump wants to build a wall with Mexico. The United Kingdom wants out of the European Union. The Netherlands blocks the Turkish Foreign Minister from campaigning. Gov. LePage wants to keep more refugees out of Maine.
What these policies have in common is a desire to keep a high degree of national identity alive in face of mounting immigration.
That’s “nationalism” and it’s sweeping much of the world. It is incorrectly labeled “populism,” which applies to policies, mostly economic, to support average people against the interests of the rich and powerful. The nearest politician to populism is Bernie Sanders not billionaire Trump.
Countries like Britain, the Netherlands and France have long had immigrant populations, usually supplied from their colonies abroad. Germany has imported Turkish workers to support its strong economic growth.
Under the EU, which aims at creating a single continental economy much like the American, workers are allowed to take up residence in any of its 28 countries. As in the U.S. system, the efficiency expected from a single market requires a single labor force.
Layered over the presence of foreigners in European countries, who may gradually assume citizenship where they live, is the influx of refugees.
In the U.S., refugees, mainly economic but sometimes political, may enter the country without permission. Seen as refugees, they are “undocumented immigrants.” Seen as lawbreakers, they are “illegal aliens.”
Some Americans oppose undocumented or illegal residents because they may threaten to take jobs that otherwise might go to long-time citizens or change the racial mix in which white men have dominated since the founding of the country.
This opposition has a long history. While Chinese were imported to build railroads, work that American did not want to do, they were blocked from immigration until the 1940s, when China was America’s wartime ally. Interestingly, denying votes to women until 1920 reflecting much the same sentiment.
Unlike Europe, the U.S. had a long traditional of allowing, even inviting, immigration as a way of taking control of vast territory. But implicit in this policy was the understanding that the immigrants should look like those already in the country. In short, they should come from Europe.
In Maine, there was once a movement called KPOOM – Keep People Out of Maine. Now, LePage seems to agree with that movement if the newcomers are refugees, who are different from the majority in the least racially mixed state in the Union.
The big exception to U.S. open immigration was Africans, who did not ask to come, but were brought by force. They were not recognized as being eligible to be Americans. It took the Civil War plus a hundred years to change that view.
Today’s anti-immigrant policy promotes the survival of a mentality that does not welcome people who don’t look like the majority. The reason is that the majority can see itself becoming the minority.
In Europe, nationalism based on color and culture has deeper roots. That creates a problem of divided loyalty. For example, the Turks in the Netherlands may have Dutch passports, but they can also vote in Turkish elections. That’s why a Turkish official wanted to campaign in the Netherlands.
The same dual nationality problem, maintaining divided loyalties, arises in other European countries like Germany.
Then there’s the EU. In Britain, an island country, people have become uneasy with what seemed like an invasion of people from eastern Europe. While ex-colonials might not be white, they behaved like the British. But Poles and Rumanians obviously bring their own culture.
The prime force behind Brexit is keeping different Europeans out. The prime cost to Britain may be losing the benefits flowing from open economic links with the Continent.
Add the refugees to all this. As the result of devastating conflict in the Arab Middle East, partly caused by the policies of the U.S. and its European friends, millions of people have lost their homes and their livelihoods. They fled to the nearest area where they could find economic stability and shelter – Europe.
Europe as a whole was not ready for them and had no policy, leaving it up to individual countries. Germany, still overcoming its Hitler legacy, opened its doors, at considerable risk to Chancellor Angela Merkel. Other countries, through which a flood of refugees had to pass, could not handle the influx.
Simple nationalism, dual nationality or open-ended refugee status are not the answer. Workers and refugees moving across borders are no longer unusual. They are the new normal.
National policies are needed that are clear, understandable and possibly uniform across the world.

Friday, March 10, 2017

It's time to expose five recent political myths

Every so often, the political news gets so rich in misinformation or distorted facts, that it becomes time to expose some myths.
Myth 1: President Trump deserves our respect, because he was elected president.
In fact, it’s the presidency that merits our respect. The U.S. is unusual in combining the head of state, the person representing the entire country, with the head of government, the leader of a political party. For example, in the United Kingdom, the queen is the head of state and the prime minister is the head of government.
As for Trump or any president, he or she must earn our respect. But we also respect the presidency. The officeholder has the responsibility of conducting the office to maintain that respect. The American people can then easily rally to support a unifying president in time of crisis.
If the president’s conduct is disrespectful of the office by ignoring his or her responsibility as chief of state, our unusual American approach to government is threatened.
Myth 2:  The American president runs the government. 
Unlike a corporation run by a single person, who may give orders to subordinates and fire them at will, government agencies have powers independent of management by the president.
To protect the administration of justice from political manipulation, laws have been passed by Congress and signed by presidents that shield many Justice Department functions from political control.
Presidents propose laws and carry out policies consistent with the law. They also appoint people to head government agencies. By their broad policies and appointments, they set the course of government and must take responsibility for it, but they cannot run the agencies or instruct agency heads on carrying out their jobs.
For one thing, government, even if it were trimmed down, would be too large to manage centrally. A president may order military action, but he or she will not designate the specific unit assigned to the job. That’s up to the Defense Department.
President Trump appears to have thought he could control Attorney General Jeff Session’s decision to take himself out of Russian election tampering investigations. He was reportedly angry when Sessions did just that. But, in fact, he has no control over such a decision.
In the end, if there is a real conflict, the subordinate may have to leave office. But too many firings or heated resignations could undermine the president’s authority in other matters. Richard Nixon learned that in the Watergate scandal.
Myth 3: Oaths matter. 
 In his confirmation hearing, Sessions swore he would tell “the truth, whole truth, and nothing but the truth.” The term “the whole truth” ought to mean he left nothing out.
But in denying he had talked with Russians during the presidential campaign, he omitted two meetings with the Russian ambassador. Later, he said those meetings had nothing to do with the campaign but only with his job as senator. Fair enough, if true, but still his answer was not “the whole truth.”
He might have avoided subsequent controversy if instead of telling “the truth,” he had revealed “the whole truth.” As a lawyer, he should have known better.
Myth 4: The majority seeks bipartisanship. 
President Trump received much credit for the restrained tone of his first speech to Congress. At times, he called for the two parties to work together. But his dismissive hand gestures toward the Democrats belied his words, indicating they simply ought to fall in line.
Both parties talk about a willingness to come up with a bipartisan approach. But the majority invariably means the minority should cave in and agree with it and, surely enough, we’d have a bipartisan approach.
If we ever see them sit down and negotiate with each side making concessions, that will be bipartisanship.
For Maine Gov. LePage there’s no spirit of compromise. He blames any lack of agreement on the “faulty ideology” of “liberals,” meaning Democrats. Fortunately, legislators of both parties still know how to compromise.
Myth 5: The people are sovereign. 
Under our system, all political power flows from the people. Every bill passed by the Maine Legislature begins with the words, “Be it enacted by the People of the State of Maine.”
Maine voters, like people in 22 other states, can pass laws on their own or veto laws passed by the Legislature. The laws they pass are unquestionably adopted by the sovereign people. But LePage and some legislators tinker with the just-passed minimum wage law, claiming they know better than the sovereign “People of the State of Maine.”

Friday, March 3, 2017

“Fake news” or “alternative facts” – Trump versus the media

Donald Trump is an honest man.
When the president says the traditional media, sometimes labeled “heritage,” “main stream.” or “lame steam,” is publishing “fake news,” he believes it.
How can he think that traditional media reports, backed by sound evidence, are fake, while his claims are accurate? The answer lies in the difference between the worldview of Trump and, say, the New York Times.
Take, for example, Trump’s views that Middle Eastern immigrants are causing unrest, even crime, in the Scandinavian paradise called Sweden. The traditional media immediately jumps to point out there has been no significant surge in crime there and certainly nothing big from immigrants.
Trump does not mean to be taken literally about Sweden. His point is that immigrants disrupt society. He uses crime as a way of describing that disruption. He believes that immigrants cause problems even in Sweden, and that is the clear message of his claim.
In short, he wants you to get his point and not worry about his facts. If the Times takes him to task because he got the facts about Sweden wrong, he slams the door on the Times, because it misses his point.
Some of his closest advisors maintain that his view should be given deference by the media, because he was elected president. If he says it, it must be true. That’s what I have described as “presidential facts” and Kellyanne Conway, one of his advisors, called “alternative facts.”
Beyond relying on his presidential standing, Trump may recall his New York days when he could influence tabloids to accept his version of celebrity gossip, according to a report by a columnist there. That changes when you are president and not merely a colorful real estate mogul.
Trump loves flattery and showers himself with it. When the media finds fault with him, he seems to regard that as “fake news.”
Political leaders sometimes say they “take responsibility” or others charge they should be “held accountable” for their miscues. In practice, with infrequent elections, the only way they can be held accountable occurs when the media highlights their errors.
Politicians do not feel positive about the press that holds them accountable, and Trump, who may deny his own responsibility, is like any other politician.
Many of his supporters continue to line up with him in this war over “fake news.” Their support may be explained by a couple of recent books showing that sound evidence might not change minds.
They report that if you have confidence in another person, you may well accept that person’s version of the facts on matters you do not fully understand. The link that gives some people blank-check confidence in Trump is their common desire to expel illegal immigrants.
From that agreement can flow support for Trump’s views on other issues like the Affordable Care Act and trade, about which supporters may have little or no knowledge. They may get to the point where they reject any facts that contradict Trump’s assertions.
At that point, Trump does not have to travel far to call the media, “the enemy of the people.” a phrase right out Joseph Stalin’s Soviet Union. “The people” consider illegal immigrants dangerous, and if the Times undermines that view, it becomes their enemy.
Some might call Trump’s view a reflection of living in an alternative reality. He sees events, countries, threats and success from a different perspective. Simply attacking his willingness to ignore objective evidence can prove to be frustrating and, even worse, counterproductive.
The media needs to pile up hard evidence and keep presenting it while avoiding what one writer has called “hyperventilating.” Less righteous fury and more explanatory journalism is needed. The traditional media should stop assuming readers and viewers know more than they really do.
If Trump is an honest man in an alternate world, it does not mean that any political statement without evidence is similarly motivated. Some of them are outright lies – when politicians tell you something they know to be untrue.
Take voting. In theory, some people may want to vote without eligibility or more than once. There is no evidence this happens beyond a handful of people across the entire country. Some Republicans admit the claim is untrue. Their efforts to tighten voting access are not about fraud but about turning away Democratic voters.
Deeply held false beliefs exist in the country, and it is difficult to see how they can be quickly corrected. No matter the challenge, the responsible media should provide more light than heat and keep at it.

Friday, February 24, 2017

The difficulty of being Susan Collins -- alone in the middle

Sen. Susan Collins is considered a moderate Republican. That can make life difficult.
First, the “moderate” part. She comes from a Maine Republican tradition that, while supporting the business community, also has focused on good but limited government. Often in the past, Maine Republicans were associated with environmental protection.
A moderate Republican has become a rarity. Since 1995, when the party in Congress adopted strict discipline and conservatives came to dominate, any Republican who votes independently of the party line may find herself under attack.
Jane Mayer’s recent book, Dark Money, relates how billionaire party backers were given the choice between funding a diverse GOP congressional delegation or only hard-right Republicans. They followed the trend and turned right.
As a result, Collins may be subjected to scorching criticism and called a RINO, a Republican in name only. Her party loyalty is challenged because of her unwillingness to stop thinking for herself and simply vote in line with party leaders.
And there may be a price to pay. When Senate Republican leader Mitch McConnell hands out good committee assignments and other political plums, Collins runs the risk of being at the end of the line.
Last week, she was the only Republican to vote against President Trump’s nominee to head the Environmental Protection Agency. A writer once opined that the environment is to Maine as oil is to Texas, so McConnell had to look the other way. Similarly, two coal- and gas-state Democrats voted for the nominee.
Collins did not support candidate Trump, has opposed a couple of his cabinet nominees and, in 1999, voted against convicting Bill Clinton after he was impeached. But some Democrats believe Collins is not moderate enough.
These critics believe she should be more independent of her party and vote more in line with the Democrats, simply because she sometimes agrees with them. If she fails to align more closely with them, they charge her with not truly being a moderate.
A moderate means you are in the middle, but the middle is proving to be a lonely place, open to heated attacks from either side.
What her critics overlook is the second part of her political label – Republican. Susan Collins and her politically active family were Republicans long before the birth of some of those who now attack her supposed lack of orthodoxy, labeling her a RINO.
Collins says being a Republican is part of her identity. The American tradition has been to allow people to define themselves and that is certainly the case for political affiliation. The first thing Collins or anybody else needs to do is to be true to themselves.
She may be trying to help her party survive a narrow and exclusionary self-definition that could result in its ending up as a permanent minority as the U.S. population becomes more urban and diverse. When Republicans attack or exclude her, they may be narrowing their window to the future.
Democrats need to avoid falling into the same camp as the GOP tea party conservatives by insisting on strict adherence to a single set of policies. Their tradition has been to be open to diversity. Still, they cannot reasonably expect a Republican like Collins to align with them.
Instead, they should value her attempts at moderation and see if it is possible to create and expand the bipartisan middle ground that is essential to sound public policy and a stable political system. That requires making some concessions.
This column does not endorse politicians, and this is not an endorsement of Collins. It is meant to highlight the real choice voters face when they vote for her or other candidates for the U.S. Senate or House.
That choice can mean a candidate’s party matters more than his or her positions on the issues. The most important vote a member of Congress makes is to select the party running the show and, for her, it is the GOP. Collins is not a deep conservative, but she enables a party dominated by deep conservatives.
Instead of supporting candidates on policy positions, maybe we ought to support them on their commitment to preserving our system against the demands of rigid or even dangerous ideology.
Legitimately, she might say that she provides a path to compromise. Sticking with a party that may scorn her as a moderate is challenging, and it’s what makes Collins’ political existence difficult.
The problem for a thoughtful legislator like Collins is finding the balance between strict party loyalty and good government. It’s also a problem for voters.

Friday, February 17, 2017

George Washington's warning recalled as we mark his birthday

On Monday, we will celebrate Washington's Birthday.
Not Presidents’ Day. Washington's Birthday is the official U.S. and Maine government designation of the day. To remember other presidents, some outright failures, the day honoring Washington has become a commercial holiday.
But we should remember this country’s good fortune to have been led by this exceptional man. Annually, I write in recognition of Washington.
Washington was an even better statesman than military leader. His strengths were his unwavering commitment to the idea of the United States and to civilian control of the military.
During the Revolutionary War, Washington had the heavy responsibility of unifying the United States. He was the only truly national figure during the war, dependent on voluntary state financial and military contributions that made him a supporter of a strong national government.
When he assumed the presidency, he understood that almost everything he did would set a precedent for history. Each step – from the creation of a functioning executive branch to his relationship with Congress – required careful thought and preparation and showed deep respect for the popular will.
But there was strong opposition from those who worried that the national government would override states’ rights and individual freedoms. Washington accepted the Bill of Rights as an essential part of the deal to make a new country.
A new book by journalist John Avlon examines Washington’s Farewell Address to the country at the end of his presidency. In it, he warned of today’s partisan political problems.
Washington worried about the growth of political parties that he witnessed. He predicted “the spirit of revenge, natural to party dissension ....” He concluded that strong partisanship could undermine the functioning of government.
Avlon calls Washington America’s only independent president, who tried to draw on all views presented to him. Even when he was attacked, he advocated moderation and compromise.
Thomas Jefferson bitterly opposed him on dealing with the rest of the world. The president subscribed to a view later formulated by a British statesman: "Nations have no permanent friends or allies, they only have permanent interests."
For Washington, it made sense to sign a treaty with England rather than France, America's wartime ally, then undergoing a bloody revolution. Jefferson and his allies disagreed, later launching the disastrous War of 1812 against the British.
His disappointment at the development of political parties reached the point that he finally split completely with Jefferson, who had formed an opposition party, based mainly in the agrarian South.
Washington, a southern slave owner, agonized over slavery. He recognized that the two parts of the country had deep differences about its future, and the country might break apart. If it did, a friend reported in 1795, "he had made up his mind to remove and be of the northern."
He believed that slavery would disappear as the nation's economy developed, though he was overly optimistic about its end. He recognized that the future lay in the development of "manufactures" produced by wage labor, as was beginning to happen in the North.
Thus, 70 years before Lincoln's defense of the Union in the Civil War and his willingness to compromise on slavery, Washington used his national standing to hold the country together. His will freed his slaves after his death, and, against Virginia law, he left money for their education.
Washington had a deep religious belief. While some other Founding Fathers were deists, believing that God's role was limited to creating the universe, Washington was a practicing Christian who often prayed.
Yet he did not believe that the United States was a Christian nation, writing, "All possess alike liberty of conscience and immunities of citizenship." He opposed religious "toleration," saying the term implied that "it was by the indulgence of one class of people that another enjoyed the exercise of their inherent natural rights."
Though lacking evidence, some thought he wanted to create something like a hereditary monarchy in the United States. Washington might easily have taken more power, but he carefully avoided making his position regal and always worked closely with Congress.
He resigned as general and declined to serve more than two terms as president. When Britain’s King George III, America’s old enemy, was told that Washington would walk away from high office, he said, “If he does that, he will be the greatest man in the world.”
Washington has become a symbolic figure, causing us to lose sight of him as a real person. He was a general, a president, a statesman and, above all, a great man. We should remember that man.

Friday, February 10, 2017

What goes around comes around

The opponents of political conservatism are adopting a strategy from an unusual source – conservatives.
The decision of a federal district court judge in Washington State to suspend President Trump’s immigration moves is a clear example of that strategy.
Trump had imposed a ban or “extreme vetting” on refugees from some countries, relying on what he claimed were broad presidential powers over immigration. The Washington attorney general questioned those powers and went to the federal district court in Seattle to get Trump’s actions halted.
Giving itself the time to consider the Washington case without yet deciding on its merits, the court ordered a temporary halt to the new policy. Perhaps surprisingly, the judge ruled his decision applied nationally, though his usual jurisdiction is only western Washington.
The law allows any one of the 677 federal district court judges to apply some decisions nationally. This judge found the Constitution requires a uniform rule on immigration and limiting his order only to his area would disrupt national uniformity.
By what authority did he come to this conclusion? He turned to the case in which a federal court in Texas blocked President Obama’s policy not to expel many illegal or undocumented aliens. That case was launched by the attorney general of Texas, but the decision applied nationally.
When Congress found itself powerless to oppose Obama’s executive orders, some states moved into action. Usually led by Texas, they filed cases in courts they thought would be friendly, seeking at least to delay the president’s policies and in the hope the next president would abandon them.
Texas was usually backed by other conservative-led states. The Washington case is backed by 15 states and, unlike the Texas filings, by top American corporations.
The difference between the cases was that “no-drama Obama” did not protest when he lost, while Trump attacked the judge, an almost unheard of assault by one branch of government against another, and asserted he would win on appeal.
The main similarity was that a state, acting on its own initiative, could take on the president and did it. Like the Texas case, an appeals court upheld the ruling.
Conservatives, advocating a reduced role for the federal government, have long argued that more power should be left to the states. They claim that’s what the drafters of the American Constitution intended. While that view had withered, the Supreme Court has worked successfully to bring it back.
Trump’s victory and GOP control of Congress could result in the federal government backing off a broad range of actions from environmental protection to controls on Wall Street. Their policies could lead to more voter suppression and less health insurance coverage.
On all these issues, the states can step in to fill the gap. The 20 states carried by Democrat Hillary Clinton in the 2016 elections are home to 44 percent of the American population. State action there could have a major impact.
California, already a leader on environmental matters, has made clear its determination to protect and expand its policies. The federal government would have a tough time trying to block state action simply because it does not act nationally.
In the Collins-Cassidy proposal to allow states the option of retaining the Affordable Care Act, the two GOP senators would keep federal funds flowing to them. Even if their party would cut the money off, states could keep Obamacare or even adopt single-payer insurance.
In Canada, where there is now national single-payer health insurance, the program started in only one province with a population even smaller than Maine’s. California, with an economy that would make it the sixth largest “country” in the world, could do it.
It’s unlikely that the financial world would abandon Wall Street for Houston if New York State adopted some of the post-recession financial protective rules that Trump wants to abandon.
States could even decide to upset the Electoral College system of electing the president and replace it with the popular vote without amending the Constitution. States with at least 270 electoral votes could decide to bind their presidential electors to voting for the candidate with the most popular votes nationally.
President Trump seems to see himself as the CEO of the United States, expecting the other branches of government to fall in line with him because he won his election. The Washington court action, perhaps even more than Congress at this point, has provided him a basic course in U.S. government.
Progressive states have begun to assert the very kind of independence of Washington long advocated by GOP conservatives. As the old political saying goes, “What goes around, comes around.”