Saturday, August 27, 2016

Editorial: Private Insurance Fails

Aetna’s decision to pull out of health insurance markets under the Affordable Care Act in all but four states is further evidence that for-profit corporations cannot be trusted to provide health insurance. Hillary Clinton and other Democrats should push to expand Medicare as a public option.

Aetna’s withdrawal from the health insurance exchanges forces nearly a million customers in 11 states to find coverage from different insurers in markets where their options are reduced. It followed announcements by two other large insurers — Humana and UnitedHealth — that they would scale back their participation, saying they could not sustain financial losses they were incurring in the ACA’s state markets, where 20 million Americans have obtained coverage in the past three years.

The insurance companies claim they aren’t making enough money because too many people with serious health problems are using the “Obamacare” exchanges, and not enough healthy people are signing up.

Aetna announced the withdrawal after the Department of Justice decided to block Aetna’s proposed $37-billion merger with Humana. The Justice Department sued on the grounds that merging two of the nation’s five largest insurance providers was an antitrust violation that would strangle competition in the marketplace.

In a letter to the Department of Justice dated July 5, Aetna CEO Mark Bertolini made a clear threat: If President Barack Obama’s administration refused to allow the merger to proceed, he wrote, Aetna would be in worse financial position and would have to withdraw from most of its Obamacare markets, and quite likely all of them. “[I]t is very likely that we would need to leave the public exchange business entirely and plan for additional business efficiencies should our deal ultimately be blocked,” he wrote.

David Dayen noted at that Aetna is doing precisely what a monopolist does — using its market power and political influence to achieve a goal that would allow it to acquire more power and influence. “It’s heartening that the Justice Department did not base its antitrust decision on Aetna’s threat. But it shows how market concentration in the insurance industry was out of control well before Aetna and Humana decided to team up. If Aetna makes that threat and there are 20 other market participants offering insurance on the exchanges, it rings hollow. Only because of the current concentration is that threat credible. And a concentrated industry that serves as a pillar of the president’s biggest legacy item may not be a reliable partner.”

Wendell Potter noted that even if some of the people enrolled in Aetna’s Obamacare exchanges were sicker than they had anticipated, making it necessary for them to pay more in medical claims than they had wanted to pay, “it got significantly more money from taxpayers ... via the government’s Medicare and Medicaid programs, which have become cash cows for Aetna and many other insurers.”

In fact, although Aetna claimed a pretax loss of $200 million from individual public exchange business in the second quarter, it reported significantly more income in the second quarter of this year than it made during the same period last year — far more than even Wall Street analysts had expected. Aetna’s operating earnings increased 8.5%, from $722.1 million during the second quarter of 2015 to $783.3 million in the second quarter this year. Total revenues for the quarter also increased handsomely, to just a few bucks shy of $16 billion, Potter noted.

The Charlotte Observer noted that Aetna enjoyed a record $6.5 billion in government program premiums in the first quarter. “In other words, doing business with the government isn’t so bad after all. In fact, it’s gotten especially good since Obamacare came along, thanks largely to the Affordable Care Act’s expansion of Medicaid in most states … Medicaid, like Medicare, offers the best of most worlds for insurers – it’s single-payer, government-financed insurance, and it has low enrollee costs. So while insurers like to gripe about the individual Obamacare exchanges, they have no issues with the big Medicaid profits that Obamacare helps provide.”

Aetna’s pullout from Texas will leave seven more counties with only one insurer to offer an individual market plan next year, in addition to 50 counties that had only one insurer last year, the Texas Department of Insurance reported.

In Texas, Sabriya Rice reported in the Dallas Morning News, discussion of the issue might be hampered by the extreme division between pro- and anti- Obamacare groups, said Lance Lunsford of the Texas Hospital Association.

“Too many policymakers in the state run on an ‘anything but Obamacare’ platform,” he said. “Considering the complexity of health care, that’s not a very healthy way to go about thinking about the needs in Texas,” where 1.3 million Texans get insurance from the exchange but 18% of adults still lack insurance..

Richard Mayhew notes at that one of the states Aetna is pulling out of is Pennsylvania, even though, according to the company’s rate application memo, submitted to state regulators in June, Aetna made $13.6 million on the individual market in 2015 and it expected a profit in 2017. “Conditions have not changed enough to make Pennsylvania a money loser in under two months,” Mayhew noted.

But Aetna is pulling out of “nice, profitable, Democratic-leaning Pennsylvania,” Kevin Drum noted at “It’s very peculiar, isn’t it?”

If the pullout of Aetna, Humana and UnitedHealth from the exchanges shows us anything, it is that a “free market” does not work in ensuring equitable health insurance choices without strong government regulation.

If insurance companies want a piece of the action in profitable Medicaid and Medicare Advantage programs, the government should require them also to participate in the exchanges. Those companies should be able to show a profit in the long run, as rising penalties drive more healthy people to participate in the marketplaces.

Hillary Clinton has proposed creating a new “government option” for health care coverage to compete with private insurers taking part in the exchanges. Clinton also has proposed a tax credit to help lower-income people afford their insurance deductibles and copayments. And, in an effort to woo supporters of Sen. Bernie Sanders, Clinton has proposed lowering the eligibility age for Medicare from 65 to 55.

The US Department of Justice also should look into whether Aetna, Humana, UnitedHealth and other insurance companies have engaged in restraint of trade.

Sanders said he will reintroduce legislation to establish Medicare-for-all single-payer system in the next session of Congress. “The provision of health care cannot continue to be dependent upon the whims and market projections of large private insurance companies whose only goal is to make as much profit as possible,” Sanders said in a statement.

Republicans have remained steadfast in their opposition to any fixes in President Obama’s signature domestic program — demanding that it be scrapped entirely. That would put Americans who now get their insurance from the exchanges, regardless of pre-existing conditions, back at the mercy of insurance executives who increase their profits by denying health care for their customers.

Whether you think Obamacare can be fixed, or Medicare should be opened up as a public option to compete with private insurance companies, or Medicare should be expanded to cover everybody, the first step is to elect Hillary Clinton as president and Democratic majorities in the House and Senate. — JMC

From The Progressive Populist, September 15, 2016

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Selections from the September 15, 2016 issue

COVER/Eric Boehlert
Clinton emails - the new Whitewater?

Private insurance fails Obamacare test

Waste not, save more


Big league baseball chasing down its ghosts

RURAL ROUTES/Margot McMillen
Women, play your card smart

Miser Trump demands Clintons shut down charity;
Working Families Party endorses Clinton;
Maternity deaths double in Texas after health budget cuts;
Jill Stein: neither Trump nor Clinton is fit to be president
Green VP nominee: Obama is 'Uncle Tom';
Gore: 'If you care about climate change, don't vote for third party;
Majority of economists favor Clinton on economy;
Trump's business a maze of debts and opaque ties
Dems hope to regain Senate, but need a wave to take back the House;
Trump caught lying 30 times in deposition;
US Army fudged accounts by trillions of dollars, auditor finds ...

The miserable catch 22 of mental illness

Trump enlists the trigger-finger fringe

Sign points to Clinton flexibility on TPP

Trump’s missing money

Something there is that doesn’t love Trump’s wall

Extracting a cold corporate truth

Memo to Trump’s spiritual adviser: You’re fired

HEALTH CARE/Joan Retsinas
The fiscal upside of compassion

We can do big things, but it will cost us

Dystopia on the Potomac

Exxon’s lies and a word from the Pope

Patchwork of state laws for new, expecting parents in labor force, study says

Socialist moment has come again

Florence of the Trachea: Go with the Flo

‘Night’ unfolds

and more ...

Thursday, August 25, 2016

To paraphrase Elvis Costello, what’s so funny about liberty, equality & fraternity?

By Marc Jampole

Since the revolution of 1789, the national motto of France has been “Liberté, égalité, fraternité,” which translated into English and updated to remove any sexism translates to “Liberty, equality, solidarity.”

French beach towns are making a mockery of all three concepts by passing laws that forbid the wearing of burkinis.

The New York Times reports that more than 20 French towns, mostly along the Mediterranean, have banned the burkini, which is a head-to-toes beach garment worn by devout Muslim women. The municipalities’ reasons for passing these bans sound as if they come directly from the America right-wing dictionary of racial code: the garments are not “appropriate,” not “respectful of good morals and of secularism” and not “respectful of the rules of hygiene and security of bathers on public beaches.”  

Just reading these odious racist excuses gives me the same yucky, skin-crawling feeling I get from rolling around in sand immediately after applying greasy sunscreen. The reference to hygiene was especially nauseating, because it reminded me of the ugly things well-bred white Americans used to say—and sometimes still do—about African-Americans during the days of legal segregation.

A few comparisons demonstrate the absurdity of banning a modest garment that shows nothing of a sexual nature.

First, let’s compare the burkini to the standard swimwear in France in the late 19th century. They look practically the same, except for the head covering on the burkini. 150 years ago, French women would likely wear wide brimmed hats on the beach. Back then, if a woman dared to show up in a bikini or topless, the authorities would haul her to jail for public lewdness and immorality. By the way, every French Mediterranean beach I’ve ever visited has allowed women to walk around topless.

Now let’s compare the burkini to a wetsuit, which is still allowed to be worn on the beaches banning burkinis. Again, there seems to be nothing to distinguish the two from each other. A few days back on Facebook, I saw side-by-side photos of a burkini and wetsuit in the same sleek green and black color-combination and I really couldn’t tell much of a difference, even in the way the material covered the head.

Evidently the police of these towns are patrolling the beaches and asking any woman wearing a burkini to leave. By the way, if a man or woman wearing a wetsuit on one of these French beaches also sported a very large cross around her/his neck, the local constabulary would ignore it. Evidently a Christian cross in not a religious symbol, whereas wearing clothes that cover your body and a head covering is. I’ve seen 2016 photos of nuns wearing their habits on Italian beaches. Although the habit resembles the burkini in many ways, I doubt the police will be hassling nuns on French beaches this summer.

These bans make a mockery of the French ideals of liberty, equality and the solidarity between human beings encompassed in the word “fraternity.” The French towns are denying the Muslim women the liberty to wear what they choose. They are making the women and their religion less equal than other religions and cultures. And instead of embracing this group as part of the family of man, they are differentiating them from the mass of humanity and creating laws specifically meant to impede their actions. In the United States, we call that Jim Crow.

One rational for these laws is to ensure the security of bathers on the beach. Really? How does wearing a long garment threaten other bathers? Are the authorities concerned that every burkini could hide a machine guns and grenades?

Far from making bathers safer, these bans make all of French society less safe for two reasons: The banning of burkinis inflames the more radical among France’s Muslims and gives them an additional shred of evidence that the West hates Islam. The banning also encourages the French alt-right because it communicates to them that the authorities, at least in these localities, agrees with them that there is something wrong with Islam and that France should control and mistreat their Muslim citizens and immigrants.

As Elvis Costello pointed out in his 1974 song, there’s nothing funny about peace, love and understanding. If the French are serious about domestic peace, they should show a little love to its Muslim population and some understanding that the overwhelming majority of them are law-abiding citizens who only want to express their liberty and live in equality in a community that shows solidarity to all its members.

Tuesday, August 23, 2016

Emails reveal no conflicts of interest between Clinton State Department & Foundation. Controversy reveals double standard

As an owner of a small business I have been on both sides of requests for access similar to those at the center of the controversy over Hillary Clinton’s time as Secretary of State.  Anytime my company needs to make contact with a company or highly placed individual, the first thing we do is ask ourselves who might know someone we could reference. It’s called “six degrees of separation” marketing, based on the John Guare play. People who want to work for my agency or sell it goods or services often invoke the name of a business friend to get in the door.

The success of using contacts to gain access doesn’t always work. When I needed to reach out to the Justice Department on a sensitive matter for a client about 10 years ago, I called the former campaign manager for a former Pennsylvania governor and a former prosecutor because I thought they would know whom at DOJ I really needed to contact. Didn’t help me one bit.

I’ve been on the other side of the conversation, too. To get a job interview at my firm, one of my very best employees of all time used the name of someone whom she had gotten through another contact—that’s three degrees of separation. 

Virtually every month, someone on my staff gets requests from business friends to interview someone or consider contributing our time or money to a charity. I don’t have much to do with these matters any more, but occasionally I get an email asking me about a request or letting me know we said “no.”

So if I wanted to contact someone at the State Department and I knew someone at the Clinton Foundation, damn right I would call the Clinton Foundation. And if I’m at the State Department, damn right I’m going to turn down all these requests. Except maybe sometimes, I might propose a short meeting if it seemed appropriate, just as I would if it were the chair of General Motors or the executive director of the NAACP.

And if I were the person responsible for fielding requests, damn right, I would occasionally write a memo to my boss. It sure would be embarrassing if HRC met Bono at a party and didn’t know the State Department had turned down his request for high-level help to arrange a live link to the International Space Station for his concerts.

Thus, the key fact in the controversy over whether Clinton Foundation donors got access to and favors from the Clinton State Department is buried in the fifteenth paragraph of the Washington Post’s expose:

State Department spokesman Mark Toner told reporters Monday that there is ‘no clear sign’ donors received access for their contributions.

The Washington Post article gives three examples of requests for access. In two cases, the answer was “no.” The third case was the Crown Prince of Bahrain, a country with which the United States has friendly relations. The Crown Prince also applied directly to the State Department. He participated in one Clinton Foundation event in 2005. In what way is setting up a meeting with the head of a foreign country that’s an ally corruption? Should a State Department turn down all requests for meetings from any organization in which a key executive has gone to college with the Secretary and Undersecretary? Worked for the same law firm? Served on the same board? Lived in the same town?

Corruption comes not in fielding these requests, but in approving a request for any reason other than its merits.

If there were any evidence—any slip of paper or veiled reference—of someone calling the Clinton Foundation and then winning a competitive contract with the State Department or getting their nephew a cushy job, the Washington Post would have published it. If a majority or even close to a majority of requests were granted, the Washington Post would have noted it and not had a “no” as the result of two out of the three case histories it detailed. That The New York Times article used the same Bahrain case history strongly suggests that there was nothing really problematic in the emails.

In other words, what the emails show incontrovertibly is that the system worked. Influential people tried to gain access to the Clinton State Department through the Clinton Foundation and none did, except in those instances that the Clinton State Department was going to say “yes” in any case to a meeting request.

As usual, the Clintons are under a much more careful scrutiny that has not been applied to others. No one has scrutinized the emails of the Condoleezza Rice or Colin Powell State Departments. We swept the illegalities of the torture gulag the Bush-Cheney Administration created under the rug.  No one wonders about the millions of emails the Bush-Cheney Administration destroyed.

Let’s compare. A few people may have been able to meet with State Department personnel because they had a contact with a nonprofit organization that does wonderful work around the world. High-level officers in an Administration concocted a series of lies to convince the United States to begin a war that turned into a quagmire and then engaged in barbaric acts that were illegal under U.S. and international law. Who do we go after?

Or how about this double standard: Do we investigate Benghazi or do we investigate the 13 separate attacks of U.S. embassies during the Bush-Cheney years in which 60 diplomatic officers died?

The most recent of these comparisons comes this week. The right-wing media is putting out false and scurrilous rumors that one candidate has serious health problems and the mainstream news media is correctly telling us that the rumors are baseless—using the experts and facts that right-wing enthusiasts always doubt because it goes against what they know in their hearts must be true. This candidate released a letter from her physician that gives her a clean bill of health, while discussing past medical problems; the letter takes the form and uses the language that virtually every other letter about a candidate’s health has ever employed. The one exception to this standard format for medical letters is the other candidate in this year’s race, who released a letter that sounded as if it were written by an ignoramus, not a physician. The letter said all tests were positive, which is generally a bad thing and asserted that the candidate would be the healthiest president ever, which a physician would never say unless he had personally examined all the others. And yet except for Rachel Maddow and a few other journalists, no one is questioning the authenticity or veracity of this letter. And no one has wondered about the true state of health of this overweight 70-year-old who professes to love unhealthy food and whose primary exercise is riding a golf cart. 

A double standard for Hillary? I would say so.