Congress

Jim Hightower: Congress loves socialized medicine -- for itself

Good health care offered within.

Good health care offered within.

Via OtherWords.org

For $3.5 trillion a year, shouldn’t we Americans have a world-class health care system? Yet while we spend the most of any advanced nation in the world to get care — more than $10,000 a year per person — we get the worst results.

No surprise, then, that Medicare for All is now backed by 85 percent of Democrats, 66 percent of independents, and (get this) 52 percent of Republicans!

So — why isn’t Congress responding to this overwhelming public demand for universal coverage?

I suspect that one big reason for Washington’s big yawn over the people’s plea for sweeping reform is that our lawmakers don’t personally feel the financial pain and emotional distress that are inflicted on millions of regular Americans by a system built on private greed.

After all, their health needs are met by a double-dose of the socialistic care that they so furiously deny to our families.

First, they’re given big taxpayer subsidies to cover the cost of their insurance, with you and me paying about 72 percent of the price. But second, there’s a secretive medical center right in the U.S. Capitol building that provides a full-blown system of — shhhhh — health-care socialism to our governing elites.

Called the Office of the Attending Physician (or OAP), it provides a complete range of free medical service for lawmakers. No appointment needed and no waiting — they walk in and doctors, nurses, technicians, pharmacists, and other professionals tend to them right away.

No need to show an insurance card, and they never get a bill. But they do get what a former OAP staffer calls “the best health care on the planet.” Thus, members feel no urgency to restructure a system that’s working beautifully — for them.

So, to get good care for all of us, we might start by taking away the pampered care that lawmakers have quietly awarded to themselves.

OtherWords columnist Jim Hightower is a radio commentator, writer and public speaker.


Geoff Coventry: There's no 'free market'' fix for health-care crisis

    --Photo by Frank Schulenberg    Women shopping at a bazaar in Cairo .

 

--Photo by Frank Schulenberg

Women shopping at a bazaar in Cairo.

The Republicans have big plans for health care in this country: to eliminate coverage for millions of Americans while delivering a big tax cut to the rich.

As someone who stands to benefit from that tax cut, let me just say: I don’t need it, and I don’t want it. No tax cut is worth excluding millions of Americans from the health services they need.

Any new health-care legislation should be focused on providing the best available health services for all Americans, not deliberately putting them out of reach. And yet, this is exactly what the twin monstrosities that came out of the House and Senate would have done.

According to the Congressional Budget Office, the House bill would’ve left 23 million Americans uncovered by 2026. The Senate version was only a shade better, leaving 22 million people out. Those bills were nonstarters with the public — the party was forced to pull them, along with any immediate plans to repeal the Affordable Care Act (aka Obamacare).

This Republican-majority Congress has shown their cards: They favor less coverage for workers and the elderly and lower taxes for the wealthy.

Republicans in both chambers claim they’re doing this to support “freedom” and “choice” for the American people. They say the “free market” is the only way to provide Americans with access to affordable health care. They claim deregulation will help drive down health costs.

Well, for starters, so-called “free markets” are unicorns — fanciful creatures with magical powers that don’t exist in the real world. All markets are designed; they don’t emerge spontaneously from nature. We form, structure, regulate and enforce markets through policy and institutions which reflect private and public interests.

When it comes to health care, we’re talking about something closer to a “natural monopoly” like electricity, not an industry like autos or breakfast cereals. Everyone needs basic medical services on a regular basis, and we need to make sure the same quality is available to everyone — even in hard to reach or low-income areas.

This will always require some form of direct government funding of services, especially with respect to primary care. Failing to do so means we’re not serious about the goal of quality care for all Americans.

This doesn’t necessarily mean an entirely government-run system — there’s plenty of room for private medical practices and businesses to provide some of the spectrum of services we need. But it does mean some degree of public funding is essential.

A fully privatized system can never adequately provision the nation. Rural communities don’t have adequate medical facilities and staff. Underdeveloped urban communities suffer from the same lack of basic resources, and their residents often don’t have the ability or time to travel to other locations.

Republican leaders claim they want affordable access to quality health care for all Americans, but all of their proposals have focused on lowering taxes on businesses and the rich, regardless of the very real cost in terms of human life.

It’s a false choice, and the effects will be cruel.

A healthy nation is a prosperous nation. This is primarily a challenge of real resources and the distribution of those resources, not of money. Congress can and should authorize any necessary funding to achieve the stated public goal simply by appropriating the funds.

This includes designing a system that will ensure there are enough facilities, doctors, nurses, specialists, transportation systems, and all the other elements of quality care in close proximity to all who need it — at any level of need and ability to pay.

Members of the House and Senate were put there by the voters and have an obligation to fight for and protect all of their constituents, not just the ones wealthy enough to bankroll their campaigns.

Geoff Coventry is a member of the Patriotic Millionaires and a founder and principal of Tradewind Energy Inc. 

 

Philip K. Howard: Congress needs to clean out the stables of long-outdated laws

Government is broken. So what do we do about it? Angry voters are placing their hopes in outsider presidential candidates who promise to “make America great again” or lead a “political revolution.”
 

But new blood in the White House, by itself, is unlikely to fix things. Every president since Jimmy Carter has promised to rein in bureaucratic excess and bring government under control, to no effect: The federal government just steamed ahead. Red tape got thicker, the special-interest spigot stayed open, and new laws got piled onto old ones.

What’s broken is American law—a man-made mountain of outdated statutes and regulations. Bad laws trap daily decisions in legal concrete and are largely responsible for the U.S. government’s clunky ineptitude.

The villain here is Congress—a lazy institution that postures instead of performing its constitutional job to make sure that our laws actually work. All laws have unintended negative consequences, but Congress accepts old programs as if they were immortal. The buildup of federal law since World War II has been massive—about 15-fold. The failure of Congress to adapt old laws to new realities predictably causes public programs to fail in significant ways.

The excessive cost of American healthcare, for example, is baked into legal mandates that encourage unnecessary care and divert 30 percent of a healthcare dollar to administration. The 1965 law creating Medicare and Medicaid, which mandates fee-for-service reimbursement, has 140,000 reimbursement categories today and requires massive staffing to manage payment for each medical intervention, including giving an aspirin.

In education, compliance requirements keep piling up, diverting school resources to filling out forms and away from teaching students. Almost half the states now have more administrators and support personnel than teachers. One congressional mandate from 1975, to provide special-education services, has mutated into a bureaucratic monster that sops up more than 25 percent of the total K-12 budget, with little left over for early education or gifted programs.

Why is it so difficult for the U.S. to rebuild its decrepit infrastructure? Because getting permits for a project of any size requires hacking through a jungle of a dozen or more agencies with conflicting legal requirements. Environmental review should take a year, not a decade.

Most laws with budgetary impact eventually become obsolete, but Congress hardly ever reconsiders them. New Deal Farm subsidies had outlived their usefulness by 1940 but are still in place, costing taxpayers about $15 billion a year. For any construction project with federal funding, the 1931 Davis-Bacon law sets wages, as matter of law, for every category of worker.

Bringing U.S. law up-to-date would transform our society. Shedding unnecessary subsidies and ineffective regulations would enhance America’s competitiveness. Eliminating unnecessary paperwork and compliance activity would unleash individual initiative for making our schools, hospitals and businesses work better. Getting infrastructure projects going would add more than a million new jobs.

But Congress accepts these old laws as a state of nature. Once Democrats pass a new social program, they take offense at any suggestion to look back, conflating its virtuous purpose with the way it actually works. Republicans don’t talk much about fixing old laws either, except for symbolic votes to repeal  the Affordable Care Act. Mainly they just try to block new laws and regulations. Statutory overhauls occur so rarely as to be front-page news.

No one alive is making critical choices about managing the public sector. American democracy is largely directed by dead people—past members of Congress and former regulators who wrote all the laws and rules that dictate choices today, whether or not they still make sense.

Why is Congress so incapable of fixing old laws? Blame the Founding Fathers. To deter legislative overreach, the Constitution makes it hard to enact new laws, but it doesn’t provide a convenient way to fix existing ones. The same onerous process for passing a new law is required to amend or repeal old laws, with one additional hurdle: Existing programs are defended by armies of special interests.

Today it is too much of a political struggle, with too little likelihood of success, for members of Congress to revisit any major policy choice of the past. That’s why Congress can’t get rid of New Deal agricultural subsidies, 75 years after the crisis ended.

This isn’t the first time in history that law has gotten out of hand. Legal complexity tends to breed greater complexity, with paralytic effects. That is what happened with ancient Roman law, with European civil codes of the 18th Century, with inconsistent contract laws in American states in the first half of the 20th Century, and now with U.S. regulatory law.

The problem has always been solved, even in ancient times, by appointing a small group to propose simplified codes. Especially with our dysfunctional Congress, special commissions have the enormous political advantage of proposing complete new codes—with shared pain and common benefits—while providing legislators the plausible deniability of not themselves getting rid of some special-interest freebie.

History shows that these recodifications can have a transformative effect on society. That is what happened under the simplifying reforms of the Justinian code in Byzantium and the Napoleonic code after the French Revolution. In the U.S., the establishment of the Uniform Commercial Code in the 1950s was an important pillar of the postwar economic boom.

But Congress also needs new structures and new incentives to fix old law.

The best prod would be an amendment to the Constitution imposing a sunset—say, every 10 to 15 years—on all laws and regulations that have a budgetary impact. To prevent Congress from simply extending the law by blanket reauthorization, the amendment should also prohibit reauthorization until there has been a public review and recommendation by an independent commission of citizens.

Programs that are widely considered politically untouchable, such as Medicare and Social Security, are often the ones most in need of modernization—to adjust the age of eligibility for Social Security to account for longer life expectancy, for example, or to migrate public healthcare away from inefficient fee-for service reimbursement. The political sensitivity of these programs is why a mandatory sunset is essential; it would prevent Congress from continuing to kick the can down the road.

The internal rules of Congress must also be overhauled. Streamlined deliberation should be encouraged by making committee structures more coherent, and rules should be changed to let committees become mini-legislatures, with fewer procedural roadblocks, so that legislators can focus on keeping existing programs up-to-date.

Fixing broken government is already a central theme of this presidential campaign. It is what voters want and what our nation needs. A president who ran on a platform of clearing out obsolete law would have a mandate hard for Congress to ignore.
 

Philip K. Howard, a New York-based lawyer, civic leader and writer, is the founder of the advocacy group Common Good and the author, most recently, of The Rule of Nobody.