Healthcare passes—at the expense of women

            Healthcare reform is inching along and if the close vote in the House is any indication of the deep split between liberals, moderates, and conservatives, then the Senate—with a higher concentration of the latter two groups—will have to dilute the bill even more to surmount a filibuster.  Still, the House’s bill is not a resounding victory.  It takes two steps forward and one step backward—in that for all of the great features that will expand health coverage and crack down on insurance companies, this comes at the expense of women’s reproductive rights.

            While abortion coverage (along with illegal immigrant coverage) was always a contentious point of reform, the settlement over the weekend on the Stupak Amendment is not only against women’s rights, but is against working-class women’s rights.  The language of the amendment denies federal funding for abortion services (an already-established provision of the law), but also denies women who are receiving subsidies from the government to purchase public or private insurance in the new Exchange from getting an abortion even if they pay out-of-pocket into their monthly premiums.  A far more sensible amendment was offered by Rep. Lois Capps (D-Calif.) in which federal funds and private funds would be segregated in premium payments, and only the non-subsidized money would be used for the operation.  However, detractors called it an accounting gimmick that could not be enforced.

            The glaring irony is that small-government conservatives of both parties voted in favor of this amendment, even though it expands the reach of federal prerogative right into a woman’s physician’s office.  What’s more, the vast majority of those voting for the amendment would not have voted for the final bill even if the language was not approved.  But alas, the art of politics requires that a tiny fraction of lawmakers be appeased for the country as a whole to progress.

            While the language makes an exception for women whose life is endangered, or who have been the victims of rape and incest, that is little consolation.  A pregnancy is more than a medical condition.  It is an obligation to the woman, the child’s father, and the families of both parents.  But the weight of obligation is sometimes too much for women to bear.  The child might be unwanted or the woman might be physically, mentally, or financially unprepared to bear such a burden.  No one wants any abortion to happen, but when a woman needs more time before  entering into motherhood or when she must weigh the costs of rearing a child to whom she cannot dedicate herself or her material resources, it is unfair for a group of (primarily) men to stipulate that a woman must be dying or traumatized for her to have any choice in the matter.

            It makes little sense to me that this bill will bring opportunity for treatment to millions of working-class and young women—both of whom are most subject to false information and interest group tug-of-wars on the family planning front—so that if they accidentally get injured, they will be fine—but if they accidentally get pregnant, they are out of luck.  Would it not be more practical to simply regulate abortion providers to ensure that women who seek the procedure are not put in jeopardy by back-alley, unlicensed abortionists?  The last time I checked, the Constitution charged our government with promoting the “general welfare” of all its citizens, not simply the welfare of those who are wealthy and already have access to employer-based private coverage and who have an unbiased accounting of their options regarding reproductive rights.

            While the bill should not be sunk on the basis of this one anti-woman provision, it just goes to show that sex discrimination is still acceptable by the majority of elected representatives, even if it takes away a long-established legal right.

Lessons from election ‘09

      We knew it was going to be bad, but not this bad!

This is a real screen capture, but the data are not authentic.  Apparently, someone at the SBE accidently put a 2 in the millions place, producing this comical result.

         Still, in looking at the real returns from tonight, the result is pathetic: a thorough rejection of the Democratic ticket, with gubernatorial candidate Creigh Deeds the worst performer, followed by attorney general candidate Stephen Shannon and lieutenant governor candidate Jody Wagner.  As is sometimes the ironic case, Deeds’s concession speech was the most impassioned bit of oratory he had given to date.  At the victory party, meanwhile, McDonnell thanked God profusely for his win, while Attorney General-elect Ken Cuccinelli quoted Dr. Seuss and vowed to protect Virginia’s “sovereignty” against federal encroachment.

         Today’s election may mean many things: a repudiation of the Obama agenda; a pushback against Deeds’s negative campaigning on social issues; a resassertion of Virginia’s true conservatism; or a declaration of Virginia’s preference for balanced partisan administration between the state and federal levels.  But one thing is clear: given the victors tonight, we may very well know who the next governor will be in 2013.

        In Virginia, attorneys general and lieutenant governors have a habit of running for governor after their term is finished.  Since Virginia is the only state whose governor is elected to a non-renewable term, it is virtually certain that Lieutenant Governor Bill Bolling or Cuccinelli will seek the Republican nomination in 2013.  And, assuming Obama is elected to a second term, there is a good chance they will win.

       To use a phrase that both campaigns employed tonight, Virginia Democrats stand an excellent chance of being in the wilderness for the next eight years.

Protecting unions’ healthcare rights

            Yesterday, Washington Post columnist Harold Meyerson pointed out a widely-overlooked aspect of healthcare reform that ought to be addressed before the final bill is deliberated upon.  Throughout the deliberations on how to pay for increasing coverage, two options have solidified.  The House’s plan is to tax wealthy households and individuals, which will cover about half the cost of the bill.  The Senate, on the other hand, will tax “Cadillac” plans that exceed roughly $21,000, encouraging folks to buy less expensive plans, consume fewer costly treatments, and thus reduce expenditures.

            Liberals are wary of the Senate’s plan because union members have, over the years, settled for lower wages in exchange for generous healthcare benefits, and any tax will ensnare middle-class families who happen to have well-earned, expansive health coverage.  However, it has been pointed out that many union contracts will have to be renegotiated in the coming years and employers can simply reduce the level of healthcare coverage while boosting wages in an attempt to shift the balance between income and non-taxable health benefits.  This will ensure that these workers will not cost the healthcare system as much in treatment and if they need to seek medical help above and beyond what their coverage entails, their extra wages can be used to cover that treatment.

            But Meyerson cautions us not to fall into a rhetorical fallacy: just because two ideas appear to be connected does not mean that there is necessarily a logical link between them.  In this case, we are dealing with the assertion that employers have a “pool” of money for each employee, into which are divided wages and healthcare benefits (in addition to Social Security taxes, pensions, etc.).  If one part of the pool—healthcare—shrinks, the other part—wages—will get larger, and the overall size of the pool will remain unchanged, as long as revenues and expenditures remain constant.

            Yet, this is not an ironclad deduction.  Unions have been successively weakened in America, and many people disdain unions as only serving the purpose of protecting incompetent workers from being fired.  This public condemnation—combined with the fact that in 2008, “top executives at 386 Fortune 500 companies averaged $10.8 million in total compensation, more than 364 times the amount paid to the average American worker”—demonstrates the relatively impotent bargaining position of the average employee.

            Employers could very well shrink the pool—paying less for healthcare, refusing to increase wages, and then pocketing the rest.  Congress ought to write a provision into the bill requiring employers to match dollar-for-dollar any decrease in existing health benefits with an increase in wages.  If that cannot be done without a compelling reason, union leaders should have the right to appeal to the Labor Department for an inquiry and/or punishment.  Among the administration’s many endeavors to reinvigorate the middle class and curtail the rampant greed of corporate culture, ensuring that unions receive proper respect at the bargaining table will prevent the further widening of the wealth gap that is a byproduct of the American myth that what is good for wealthy businessmen is good for the country overall.

Let’s opt out of the “opt-out” idea

            Senate Majority Leader Harry Reid’s (D-Nev.) announcement that the healthcare bill for his chamber will include a government-run option is a double-edged sword.  On the one hand, it is a relief to liberals who consider the public option to be the next-best (and only) alternative to a single-payer system but at the same time it puts moderates of both parties (well, Democratic moderates plus Sens. Collins and Snowe) in an enormous position of power.  Every senator who could potentially vote for this bill is needed and must be accommodated in the search for sixty votes.  It’s an undemocratic system that gives disproportionate advantage to rural states, but that is the way our Constitution works, for better or worse.

            The small state senators have a legitimate point with a public plan which is linked to Medicare, in that doctors already receive lower per-patient reimbursement by the government than by private insurers in their states or by Medicare payments to other states.  In part, this is due to the different costs of living throughout the country, but also it is attributable to formulas which have historically penalized efficient, rural providers such that they cannot afford to take on a good number of Medicare patients and still meet operating costs.  So, from their perspective, private insurers would better compensate doctors.

            Still, the formula can be altered.  What’s more, the people who do not have insurance currently are treated either at neighborhood clinics or in emergency rooms, so all that this legislation is doing is shifting the costs around.  The goal of healthcare reform is to bring down the cost of providing care overall, so the combination of new customers, reduced premiums, lower drug prices, and patient-centered care will, in theory, increase the number of patients that doctors see while decreasing the amount of billable-hours treatment people receive for their illness.

            I am concerned about this new “opt-out” aspect of the public option.  If states are allowed to forgo participation, how will the people currently uninsured find an affordable plan, especially if there is a mandate on individuals to purchase insurance?  Plus, the greater the number of people that participates in the public option, the more the costs of treatment will be spread between healthy and ill people, lowering premiums not just for people in the government plan, but for its competitors.  If half of the states choose not to make the public option available, what will that do to cost estimates which base premium prices on a certain level of participation?

            Lastly, there is a civil rights question here: if states are presented with a means of insuring those who are sick but choose not to make that path available to citizens, is the state liable for every ensuing preventable death?  Will public plan-based insurance be valid if a person seeks medical treatment in a state that has opted out?  And if states opt out, should they have to find another way to ensure that at least 95 percent of their legal residents have insurance or face some penalty, such as being denied funding for highways?

            The top map in this graphic is from Gallup, and I colored in the bottom section with the electoral results from last year’s election.

There seems to be a slight correlation between the percentage of insured adults per capita and the political leanings of the state.  Of course, this map does not indicate which party is in charge of the state legislature or the governor’s mansion.  For instance, even though Virginia voted Democratic in 2008, we will very likely have a Republican governor and legislature when the healthcare bill takes effect.  So, we can say that generally, state governments controlled by Republicans (who will be most likely to opt out) tend to have higher rates of uninsured adults.

            What it comes down to is this: I am worried that the ability to opt-out of the public option will fail to help people in states that most need an alternative method of procuring affordable insurance.  The senators from states such as Arkansas, Nebraska, and Louisiana should look at the 19 to 27 percent of constituents who lack insurance and explain why they were loathe to support a plan that will ensure their wellbeing.

Bob McDonnell, the (probable) next governor

           Between now and November 3, unless Bob McDonnell walks into a hair salon and announces to all the women that they ought to be at home baking cookies and pumping out kids, there is an overwhelming chance that he will be elected the next governor of Virginia.  Conversely, unless Democrat Creigh Deeds surgically attaches Mark Warner to his hip and parades him across the commonwealth, he will probably fare badly.  To be frank, McDonnell probably would have squeaked by on Election Day even if Democrat Deeds had been a stellar candidate with a transportation plan and a clear message on taxes—just because of the natural inclination of Virginians to vote for the opposite party of whomever controls the White House.

            But as it is, McDonnell now has a double digit lead over Deeds.  The same Northern Virginians who gave Deeds his primary victory by wide margins have largely become disenchanted with his overly-negative campaigning, loss for words in the face of reporters, the distance he has tried to put between himself and President Obama, and the latest gaffe in which he said he would consider opting Virginia out of the public option if it were passed in healthcare reform.

            Now, it’s true that what he said—that he’s not convinced the public option is the only way to reduce costs—is essentially what the president has also stated regarding the public plan.  Considering, though, that Deeds has rebuked McDonnell for raising federal issues in debates, Deeds could have said something along the lines of, “I will wait until the bills are completed in the House and Senate before I make a judgment.”  Or, “I will do whatever possible to ensure that the maximum number of Virginians have health insurance.”  Or, “I will speak with members of the Virginia congressional delegation to ensure this legislation results in a net benefit for citizens of the commonwealth.”  Since Deeds’s strategy in the final weeks is to energize Democratic voters, I’m not sure that expressing skepticism over an item on the wish list of many liberals is the best way to impress the base. 

            As it is, many Democrats will probably get over their heartburn about Deeds and vote for him if only to vote against McDonnell.  This bears some resemblance to the 2004 presidential election, where people plainly knew what they disliked about President Bush, but Sen. John Kerry was such an uninspiring and amorphous candidate that the electorate did not have as much confidence in him as a potential commander in chief.  The danger of electing McDonnell is that he could also sweep into office a Republican Lieutenant Governor (who can break tied votes in a nearly evenly-split Senate), a Republican Attorney General (and an ultraconservative, environmentalist-hating, immigrant-bashing, state “sovereignty”-supporting one at that), and a Republican House of Delegates. 

            This means that after eight years of having moderate Democratic governors stand between the people and the legislature, it is probable that there will be laws enacted over the next two to four years that chip away at gun regulations, expand the use of capital punishment, crack down on non-felon illegal immigrant workers and families, fail to raise taxes to maintain our road systems, eliminate the chance of any new funding for public transit, slash welfare benefits, oppose the president’s healthcare proposal, and fail to lessen the burden on public colleges and universities and the financial burden on their students.

            If Glenn Beck is worried that the Democrats are hijacking his country, I am worried that a solidly Republican state government will enact seriously regressive policies that would caricature us as a “Deep South” state.  Of course, congressional Democrats have served as their own check over the past ten months, but an ideologically pure GOP can mobilize their ilk more efficiently.  That’s why I hope that there is at least one Democrat elected statewide to serve as a counterweight, if only in title, to a reinvigorated Republican government.