'Medicare for All' policy overkill; universal health care works without it

Gordon L. Weil

When it comes to health care, Democrats may try to do the right thing, but they may be doing it the wrong way.

The party's presidential candidates support a health insurance system for all Americans. They believe health care is a right.

President Obama's Affordable Care Act is the closest the country has come to that system, but it has fallen short. Many people are still not covered and savings have been disappointing if not sometimes invisible. Republicans jeopardize the ACA by trimming it back and challenging it in court.

Meanwhile, the U.S. government operates Medicare, a tax-financed health insurance program for senior citizens. It is costly, but it insures all seniors and has displaced private insurance for their basic coverage. Most seniors buy added insurance to cover costs the system leaves to them.

Sen. Bernie Sanders asserts that the time has come to replace profit-driven private insurance with government, non-profit coverage. Because Medicare is so well-known, Sanders proposes expanding it to cover everybody – "Medicare for All."

Under Sanders' plan, government would be the "single payer" for insurance covering hospitals and doctors. Its buying power would allow it to control costs, higher in the U.S. than in any other developed country.

Financing "Medicare for All" would require massive federal funding. Sanders would raise taxes on wealthy taxpayers and big business. This transfer of funds would also reduce the growing income gap between average people and the rich.

Employers and individuals would no longer buy health insurance. While they would pay higher taxes, these costs would be offset by the elimination of insurance premiums. Government could lower total health care costs by supporting preventive care and controlling runaway costs.

That's the theory, but the proposal worries many people. Theories tend not to work out as planned. The added taxes would be enormous. If you like your current insurance plan, often provided by your employer, why be forced to give it up? "Medicare for All" would bring big changes.

To promote her candidacy and appeal to Sanders supporters and others on the left side of the political spectrum, Sen. Elizabeth Warren adopted "Medicare for All." As she gained credibility as a potential Democratic nominee, she faced demands to go beyond promises and come up with a cost estimate.

Warren's attempt to be specific may have harmed her candidacy more than it helped. Her proposal involves a major change in American politics, allowing a bigger role for government in helping people, financed by higher taxes.

Massive taxes, even offset by insurance and cost savings, increase the role of government and raise, incorrectly, charges that the Democrats favor "socialism." Though the GOP has no plan, it exploits the cost of Democratic proposals. Even if people want universal coverage, they dislike higher taxes.

What Warren really seems to favor is a national health insurance system that covers everybody. But she may have wrapped that appealing idea in the wrong package. If that is her party's goal, other ways exist to achieve it that are less politically vulnerable.

There's the so-called "public option," which Obama failed to win. It would be a non-profit insurer, available alongside traditional insurers. Everybody would be required to have insurance or pay a heavy tax penalty. A non-profit providing better preventive care, the public option would offer lower premiums.

The public option would attract consumers, putting competitive pressure on other insurers and driving premiums down. It could drive out high cost insurers.

This is not pure theory. Maine had the highest worker's comp rates in the country until the state created a mutual insurance company, a non-profit competitor owned by employers and workers. It now insures 60 percent of the market, insurance rates have fallen sharply, and worker safety has improved.

Or, the government could follow the example of Switzerland, a country with a conservative economic tradition similar to the U.S., unlike Scandinavia. Swiss are required to buy health insurance, whose costs are subject to some regulation. For those who cannot afford premiums, the government provides a premium subsidy.

The Democrats could also propose utility-style regulation of drug prices, allowing manufacturers only their costs (without advertising) and a reasonable profit. Drug prices are regulated in many countries. In Europe this year, I bought the same med, produced by the same drug company, for less than 10 percent of its U.S. price.

Even with today's reform fervor, before candidates espouse "Medicare for All," they should combine innovation with caution. After all, it's still true that "politics is the art of the possible."

In impeaching presidents, some in Congress have opposed their party

Gordon L. Weil

Before President Trump, three of the previous 44 presidents faced impeachment and possible removal from office. Mainers played key roles in all three cases.

When the U.S. was still a century and a half in the future, a classic case of impeachment occurred in England. It is similar to what is done now, though the outcome today would be less harsh.

Charles I was the king of England in the 1600s and believed he reigned because God chose him to rule – "divine right." He shut down Parliament for years, levied unauthorized taxes and kept much of the money to support his lifestyle. He was above the law, he claimed.

Parliament insisted on its rights based on Magna Carta, an agreement with an earlier king. In the end, the two sides fought each other, not in London, but on the battlefield.

Documents were uncovered, showing that Charles had sought support from Ireland and countries on the European continent. Even some of his supporters thought he had gone too far. He was taken into custody. Parliament created a judicial commission, and Charles went on trial.

King Charles was charged with having tried to use foreign help for his personal purposes, enabling him to hold onto power. The commission found the king had abused his powers, and, in 1649, Charles was beheaded.

At the Constitutional Convention in 1787, Benjamin Franklin told that story. He insisted that the American Constitution should provide for a president's removal from office, less drastic than execution.

Impeachment by the House and conviction by the Senate would not be a criminal trial, but only a way to remove presidents who abused the broad, but limited, powers that they alone were given under the Constitution.

When authorized, the House procedure starts with its Judiciary Committee. It may propose charges, called Articles of Impeachment. In 1974, Maine Rep. Bill Cohen, a committee member, voted for charges against Richard Nixon, the president of his own Republican Party.

Presidents may object to an impeachment inquiry, but their real defense comes later. They must provide documents and executive branch witnesses. They probably cannot claim the benefits of "executive privilege" – the protection of confidential communications with the president.

President Washington first used executive privilege. But he declared it did not apply in case of impeachment, which is the House's exclusive power under the Constitution.

The next step is a full House vote on the Committee's proposed charges. Representatives Pingree and Golden may vote for some or all of the Articles. If Articles are adopted, the president is impeached, much like a grand jury indictment. The president would be charged, not found guilty.

If a president is impeached, the Senate decides on removal from office, the only possible penalty. The House selects prosecutors, called "managers," from among its members, and presidents provide their own defense lawyers. The Chief Justice presides, and senators act as jurors, saying nothing.

To achieve the overwhelming two-thirds vote required for removal, some of the president's own party would have to vote for conviction.

In the 1868 trial of President Andrew Johnson, the Republicans wanted him removed. Johnson, a Democrat who succeeded the assassinated Republican Abraham Lincoln, was saved by one vote. The first Republican to vote against his removal was Maine's William Pitt Fessenden. .

In 1974, Nixon, a Republican, resigned when he learned that many GOP senators would vote with the Democrats for his removal, achieving the required two-thirds vote. Both Maine senators were Democrats.

In the 1999 trial of President Bill Clinton, whose removal was sought by the Republicans, Olympia Snowe and Susan Collins, Maine's two GOP senators, voted against the charges and the result did not come close to a two-thirds vote for removal.

If Trump is impeached, the charges would likely include his seeking support from Ukraine for his political campaign, his business receiving money, called "emoluments," from foreign governments while he is president, and his attempts to obstruct the impeachment inquiry and other investigations.

The Constitution says that removal may result from conviction for undefined "high crimes and misdemeanors." Ultimately, the Senate would decide if Trump has abused his powers.

This is an unusual historical moment – the formal attempt to remove a president. Removal, though not impeachment by itself, would partly reverse the previous election's result, as Trump claims. But Vice President Mike Pence, elected with Trump, would become president.

Congress is populated by politicians, and its decisions will be both political and patriotic. A few, like Fessenden, Cohen, Snowe and Collins, all Maine Republicans, might not simply follow the party line.

Drugs, suicides cut life expectancy, help sustain Social Security

Gordon L. Weil

Important and worrying truths, even for people far from retirement, are hidden behind in the plentiful advice about Social Security benefits.

Some experts suggest delaying the start of taking benefits, because the payments will be higher if you wait, rather than beginning the year you are eligible for full benefits. That could be helpful advice, depending on your assets, but it may be an illusion.

The advice promoting delay of benefits is often accompanied by suggestions that it is "usually" and "typically" worth doing. Beware of those we words. We are all different, and you may not be usual or typical.

This suggestion also ignores the underlying math. If you start when first eligible for full payments instead of waiting, you receive payments years earlier. If you wait, monthly payments are greater. Your life expectancy is the same in either case, so delay brings you added payments, but for fewer years.

The government is not giving you any special break for waiting. It has figured out that, over the average life span, it will shell out the same amount of money whichever option you choose.

During the early retirement years, you collect from the full-payment option compared with zero, if waiting. Only after 82 does the total of all Social Security benefits received under the delay option become greater than those from the full-payment option. After that, delay keeps bringing you more total government cash.

Will you live that long? Who knows? For the total U.S. population, average life expectancy is less than 79. That "typically" means you are likely to get more out of Social Security if you do not delay.

Now, here's the hidden message.

It is reasonable to believe that life expectancy is increasing. After all, Social Security is increasing the full-payment starting point to age 67, presumably because people are living longer.

But life expectancy in the U.S. is not increasing. It is decreasing. Raising the age of full-payment eligibility is designed to save the system money as more Baby Boomers receive benefits. It is not now about adjusting to people living longer.

Increasing the full payment eligibility age may help save Social Security, but what makes the system more solvent raises far more serious issues.

In 1960, the U.S. had the highest life expectancy of all major developed countries, 2.4 years higher than the average. As people grew wealthier in all these countries, their life expectancy also increased.

By 1990, the U.S. began falling behind. In 2018, American life expectancy was 1.5 years lower than the group's average, and the decline continues.

Why this slippage? Not obesity, though growing at a rapid rate and obvious. Diabetes deaths indicate its lethal effect, and they are climbing, but not enough to explain the major decline in life expectancy.

“We are seeing an alarming increase in deaths from substance abuse and despair,” says the lead author of a study on declining life expectancy. The Centers for Disease Control back this conclusion.

Deaths from the effects of substance abuse have skyrocketed. Though deaths from alcohol keep increasing, the principal substance problem is opioids.

Opioids are painkillers, originally used to ease the suffering of cancer patients. Pharmaceutical manufacturers assured doctors and others that they had little addictive effect. By 1991, doctors began to prescribe them for other kinds of pain.

The makers heavily promoted highly profitable opioids, though they knew that the drugs were virtually certain to be addictive. Thanks to sales without medically proven need, purveyors profited. The Tug Valley Pharmacy, in a West Virginia town of 3,000, dispensed millions of pills.

The markup between the prescription price and the street price of opioids led to a flourishing market and more money for manufacturers, distributors, pharmacies and, finally, drug dealers. The makers knew what they were doing and pushed the market hard.

Opioids took their toll. In 2017, over 70,000 people died from overdoses. The pharmaceutical manufacturers are now being heavily fined and have backed off promoting the drugs. Opioid deaths may decline.

How do you measure despair as a cause of shorter life spans? The suicide rate. It has been increasing each year, especially in rural areas. Maine is the most rural state, and its suicide rate is much higher than the national average.

The study found that suicide rate increases result from an unsatisfied need for public health programs and the lack of help for economically struggling families.

Drug deaths and suicides, cutting life expectancy, should not be ways to make Social Security work better. But they are.

"Deep state" and other political myths we believe

Gordon L. Weil

People can mistake politicians' bluster for boldness and wisdom. Making political assertions without substance has created myths often mistaken for political truth. Time for some myth-busting.

The "deep state" is running the country, according to one myth. The country is secretly under the control of unseen, unelected people. Who are they? Powerful corporations and faceless bureaucrats supposedly carry out their own policies, undermining the government.

In a free market system, major decisions have always been made by major players, not only the government. In fact, when the government steps back from acting, it intentionally leaves decisions to the market place, dominated by corporations. They are seldom held politically accountable.

As for professional public employees, they provide experience about the possible effects of government action. But that does not give them the power of decision. Beyond that, Congress delegates much of its powers, making regulators into almost invisible legislators.

In short, the "deep state" is largely an intentional and open creation of the government. The answers to the "deep state" are "transparency" and "drain the swamp."

"Transparency" supposedly means government in the sunlight. But the continual efforts of elected officials, let alone the "deep state," to keep secrets make "transparency" a sham. It produces government in the shade. If the media digs for the facts, "transparency" is labeled as "fake news."

To "drain the swamp," elected leaders would need to regain control of public affairs by getting rid of interest groups and bureaucrats who pursue their own agendas. They pollute government and influence policy contrary to the broader popular will.

Just how to drain them out remains unclear. Political leaders often do unseen favors for friendly interests that support them. So, just who constitutes the "swamp" may change over time, but its level never subsides.

The "swamp" may simply be evidence that governing has become a far more complex task in the modern world. That could create the impression that government is mired in a mess of its own creation. In a democracy, efficient operation may be too much to expect.

So, reward the people's hopes for draining the "swamp" by giving them less government or, better still, less democracy.

When an official is caught violating the law or long-standing political understandings, they defend their actions, saying, "Well, they did the same thing." They justify their miscues by pointing out that the opposition performed similarly when it held office.

The parallel with the past may not be accurate, but it whitewashes the violation. This is the "two wrongs make a right" approach to government. Precedent, no matter how objectionable, somehow authorizes today's misdeeds.

This rule inevitably leads to a downward spiral in governing standards that can end up with no laws or rules that need to be respected. These days, the U.S. seems to be on that spiral.

The problem with this country is "excessive partisanship." Most people understand that the American system is intended to work through a conflict of partisan views on public policy. The "excessive" part comes from unwillingness to compromise, the essential element when two parties share control.

These kneejerk reactions grow out of a view that the other side must be defeated, either because it is always wrong or morally defective. That kind of bitter partisanship may be gaining, though it is not the majority position.

It also results from "style over substance." Some voters like politicians pandering to them in lurid language on wedge issues. On closer look, they may be giving candidates a blank check to pursue a wider range of issues that are actually contrary to the voters' interests.

We may hope that the untapped army of "moderates" will flex its political muscle and restore a spirit of compromise. In reality, if you scratch a "moderate," you find a partisan. People may support liberal or conservative candidates or proposals from time to time, but that does not make them moderate on any single issue.

The questionable validity of polls and pundits has previously been discussed in this space. Polls are meant to be an exercise in statistical sampling, but often are not. Pundits speculate uselessly about events that will take place soon enough that we don't need their predictions.

We may favor leaders who "talk my language" and make bold decisions instead of listening to the "deep state" or relying on "experts." Instant policy via tweets replaces careful preparation and analysis of the consequences. "They talk my language" often turns out to be "shoot from the lip."

Today, we live by such myths. Maybe we shouldn't.

A newspaper ends, the public loses; on the closing of a paper for which I have written

Gordon L. Weil

This is the last day of the Journal Tribune and, like its readers, I will miss it. I have had the privilege of having my column published in it every week for several years.

It has been a good, local newspaper. That's what it was intended to be, and it has done its job well. Readers could find York County news here that is unavailable elsewhere.

Beyond coverage of its local area, the Journal Tribune was something more. Like other print newspapers and serious online journalism, it published articles of sufficient length to provide readers with detail, allowing them to more fully understand a story. It could offer context to fit a report in a bigger picture.

The print press, including its digital descendent, provides more complete coverage than the traditional networks and cable news.

It has probably taken longer to read a single article in the Journal Tribune than to watch a complete network evening news report on a couple of the day's major stories. A big story (other than a disaster, weather or otherwise) gets about a minute and a-half on television.

An article in the paper has passed through an editor, a person in a position to ensure responsible journalism, which includes hearing from both sides in a dispute, getting the history right, and just plain accuracy. Chances are the editor got to that position after years of experience, learning the trade.

Contrast that form of journalism with what many people think is news. Cable television commentators make bold statements of what they assert is fact, when it is often unsubstantiated opinion. Much of it is stream-of-consciousness, flowing from half-understood news reports and precooked opinion.

Even worse, cable news people use one another as sources, seeming to take another person's opinion as evidence of the truth.

Beyond cable news, often more opinion than fact, are the blogs. Anybody can write a blog and anybody does. It's healthy if everybody has a chance to express an opinion. But it's unhealthy when people use their ability to reach a wide audience to spread lies. Blogs are not subject to editorial review, but many bloggers consider themselves journalists.

Papers like the Journal Tribune try to survive by providing local coverage readers cannot get elsewhere. They try to emphasize the kind of reporting only they can do, leaving the world and the nation to the large media organizations.

As good as the local papers may be in their markets, the national media generally does not do nearly as well in the broader world. Foreign reporting has almost completely disappeared. For example, what do you know about the upcoming Canadian elections? The results will affect many American interests.

What do you understand about current trade wars? Brexit? Race and religious conflicts in India, Myanmar? U.S. warships in the South China Sea?

The list of foreign events and national developments that matter to us is endless, but our ignorance runs deep. Celebrity divorces are more interesting, but much less important.

Then, there's "fake news." Public officials have never liked to be criticized. Yet the purpose of the press is truth. In a democracy, the media tries to uncover facts that will allow people to make their own judgments about what public figures say and do.

Leaders may object that the media did not get the full story or understand its implications. But, if they seek simply to discredit the news, they are also trying to enhance their own power, unchecked by the media. That may work for the political leaders, but it does not work for democracy and the interests of the people.

Out of all this, it turns out that the major stories about the current administration in Washington mostly come from three print newspapers, all of which have been charged by the president as printing "fake news." The Wall Street Journal, the New York Times and the Washington Post have been the chief defenders of democracy by their reporting.

Why do they succeed? There are enough readers who consider them essential. They have enough backing from wealthy owners and readers to provide comprehensive coverage and enjoy protection from attacks. That's simply not true for all papers. The loss of the Journal Tribune or of any other responsible papers is a loss for its readers, reducing their ability to be informed citizens. This paper will be missed.

Americans ignorant of mounting nuclear threat

Gordon L. Weil

A country with nuclear weapons and long-range missiles, increasingly ready to use them, last week abruptly broke off negotiations with the U.S.

Nobody noticed.

Possible impeachment of the president has nudged other stories from the top spot in the news. Meanwhile, North Korea's growing nuclear arsenal and American inability to prevent it got the silent treatment.

Americans are unconcerned and mostly uninformed about the North Korean nuclear threat. North Korea is the only nuclear-armed country that openly menaces the U.S. It seems much more ready to aim missiles at the U.S. and rattle its saber than American rivals China or Russia.

Widespread ignorance of the serious threat from North Korea may lead to the U.S. being unprepared.

The small Asian country is an outlaw with which the U.S. has tried for years to negotiate a disarmament deal. It has offered them food for their starving people, economic development help and increased trade opportunities. President Clinton came close to a decent accord, but the North Koreans promptly cheated.

President Trump, proud of his deal-making ability, apparently believes that he can achieve North Korean denuclearization thanks to the strength of his personal relationship with Kim Jong-un, the latest in the family dynasty that runs the country.

In three face-to-face meetings, Trump has given Kim, previously shunned by all countries, a world stage. He also canceled a U.S.-South Korea military exercise as a diplomatic lure for Kim. Trump says he "fell in love" with Kim, flattery that he hopes will soften the North Korean's policy.

The mere fact that he met with Kim, a legitimizing act that all earlier U.S. presidents rejected, earned Trump praise from his supporters. Paul LePage, then Maine's governor, joined a few other GOP leaders to nominate Trump for the Nobel Peace Prize, merely for agreeing to meet with Kim.

Trump went where no other president has tread and, if he won the Nobel Prize, he would match, if not surpass, the prize awarded to President Obama, whose presidency he wants entirely to erase.

At last week's meeting in Sweden, stern-faced North Koreans ended the discussion in hours, concluding that the Americans proposed nothing new. Because the Trump administration does not want to admit failure, it put a good face on the session and offered to meet again.

The split results from missed perceptions on both sides. When objectives are firmly held and cannot be reconciled, no accord is possible.

Almost the highest priority for North Korea is to be a nuclear power. It fears a possible takeover by prosperous South Korea, backed by the U.S. It exports its nuclear and missile technology, gaining hard currency to finance purchases in the world market. And its nuclear status makes it independent of great power pressure.

The U.S. has long sought to limit the number of countries with nuclear weapons to reduce the risk of a disastrous international conflict. That explains its tough stance with respect to North Korea, which has nuclear weapons, and Iran, which doesn't.

North Korea wants the U.S. to lift sanctions that almost cut off all of its trade with other countries. If all sanctions were lifted, it might agree to freeze its nuclear development at its current, relatively advanced level. It rejects the current American offer, a partial deal requiring a freeze in return for lifting a few sanctions.

The U.S. promises economic aid and the end of sanctions, if North Korea eliminates its nuclear and long-range missile capabilities. It wants the freeze first, to be followed by some sanctions relief. It might then permit a formal end of the Korean War.

The Trump-Kim contacts have revealed that North Korea will not back off. It gets some help from China and Russia, which wink at U.N. sanctions. There's no realistic chance of Kim giving way. Even when he seems to agree, North Korea cheats on the deal.

North Korea appears to have given the U.S. until the end of 2019 to make major concessions. Kim reasons that Trump may want to have a diplomatic trophy for the 2020 elections. But there is little room for the U.S. to give up anything.

Kim reportedly plans to step up nuclear work next year in the belief that Trump will avoid conflict in an election year. North Korea might not attack, but it adds increasingly powerful weapons whose potential alarmed Trump enough to cancel an agreement with Iran that blocked its nuclear development for "only" 15 years.

North Korea may be the most dangerous military threat to the U.S. Chances are, though, you won't hear much about it.