Health care is an area of concern all unto itself, and it is emblemic of the kind of fundamental changes to government progressive politicians need to solve a whole panoply of problems facing our nation and every person on the planet. That we must proceed stepwise to make progress is obvious. What, then, is the next step?
What step would set the political concrete limiting the options of the Vast Rightwing Experiment now ending? What step would crack open the Beltway insiders' and network media companies' paradigm to the new political reality that our progressive tax system has been rendered regressive by inaction and outright hostility for far too long?
Health care is the natural first, next step in opening this new age of progress in political institutions -- an opening created by the People themselves in two successive elections.
Peace, prosperity and privacy are the watchwords of the progressive revolution. This diary is part of a series on how to apply these lofty principles to issues at hand, and to enact a political realignment for which the People have asked.
In the tipping point, the People decided for realignment. The Republican Party is as unprepared for the changes sweeping the Government in the wake of this decision as the Democratic Party was in the aftermath of Reagan's election in 1980. Barack Obama has obviously studied that realignment in depth, so his strategy for governing will be guided as much by that knowledge as by the political situation we see on the ground now.
After the tipping point, we now must move on swiftly to further this realignment. The first step in that progress, a kind of "shock and awe" move perfectly suited for the task, is passing legislation to transform the health care system of the United States. This step would consolidate the change underway and exemplify its progressive character.
Conyers' bill is already in the wings waiting to move forward. As recently as August Conyers pushed again for its passage in the current Congress. While it diverges from Obama's plan, it is a bill which has been through the vetting process and it engages the real battle for transformation fully and directly.
Moveover, we have already had major elements of the problem to be solved defined here on DailyKos. This excellent diary by Inverted and Inverted's Part One and Part Two of a diary series are a thoughtful and detailed discussion thread which demonstrates the in-depth thinking behind this progressive political movement.
Conyer's bill has, at the heart of it, a use of progressive taxation which exemplifies the battle we must engage with the remnants of the Republican antitax faction to restore fair taxation to the national debate instead of languishing behind the scenes. The antitax radicals have created a back-alley tax system where Lotto, user fees, privitazation of government programs and a host of other unfair and inequal tricks have been imposed on the People. The situation is now so bad that China and Japan are funding our programs because we don't have the political will to bring taxation back to the forefront, where we can debate and analyze the real costs of our government without all these parlor tricks.
(1) IN GENERAL- There are appropriated to the USNHI Trust Fund amounts sufficient to carry out this Act from the following sources:
(A) Existing sources of Federal government revenues for health care.
(B) Increasing personal income taxes on the top 5 percent income earners.
(C) Instituting a modest and progressive excise tax on payroll and self-employment income.
(D) Instituting a small tax on stock and bond transactions.
(2) SYSTEM SAVINGS AS A SOURCE OF FINANCING- Funding otherwise required for the Program is reduced as a result of--
(A) vastly reducing paperwork; and
(B) requiring a rational bulk procurement of medications under section 205(a).
(3) ADDITIONAL ANNUAL APPROPRIATIONS TO USNHI PROGRAM- Additional sums are authorized to be appropriated annually as needed to maintain maximum quality, efficiency, and access under the Program.
text of the bill
This web siteprovides resources and details on the House bill.
Taxation With Representation
Lotto is the ultimate antitax tax scheme. Targeting low-income people down on their luck foolishly wishing their luck would change, it is a cynical, but now vital, way to finance government. States are now so dependent on it that casinos are given special exceptions and status -- the ultimate "hands-off" constituency. Another trick has been the tobacco settlement with several states. The money was ostensibly to be used for antismoking campaigns, but now has been diverted to the general fund. Many states are considering selling government assets such as roads (and, ironically, Lotto itself!) to private parties in exchange for immediate cash. Republican and Democratic state politicians have pushed these hidden tax schemes as far as they can go.
It is time to make the financing of government by citizens the conventional wisdom instead of the false victimization meme reducing us to frightened taxpayers. Progressive taxation makes all tax expenditures the provence of informed citizens instead of hidden funds legislatures and executives move around in desperation while our infrastructure and national "homeland" security suffers.
In this realignment, we must crack the hardest nut of all: the antitax tax collectors in all their glory of entrenched power and oxymoronic talking points. Health care suffers from this broken funding shell game as do all other government programs. Solving it can snap the hold of entrenched interests in exactly the ways the new progressive political coaltion which flexed its muscles in the elections of 2006 and 2008.
This passionate diary points out our new Congress and Administration have an opportunity before them. Not only an opportunity to get this bill passed, but an opportunity to use this bill to break the back of the "socialism" meme of the right wing. Progressive taxation has atrophied and stalled during the "Reagan revolution". Rebuilding our infrastructure, investing in the "green economy" and restructuring our balance of military and diplomatic resources for a 21st-century foreign policy all depend on breaking this bastion of egghead "conservative" thought still dominating our political discourse.
From Lewis Powell's famous memo in 1970 to now, progressive taxation has been the daring of the Vast Rightwing Conspiracy. This memo has been its manifesto and playbook. In addition, the PNAC assertion that Pax Americana must be the way of dealing with the rest of the world is a 20th-century anachronism which must be pushed to the back benches of our political institutions, and fast.
Both of these efforts have moved the Overton Window to positions upon which average citizens are choking right now. That window is moving now, as evidenced by the past two elections. It is moving from government is the problem to some problems only government can successfully tackle. It is moving from we are all taxpayers to we are all citizens. A sense of patriotism based on focusing government, at all levels, on solving problems is waxing while a patriotism based on thinking the powerful will fix everything for us is waning.
This moment is the cusp. Congress and the Administration need to align themselves with the reality the People themselves have asserted with their votes, even if many still fear the magnitude of change which must be made. Those fellow citizens with which the "socialism" meme resonates must not be ignored. Indeed, they benefit as much as anyone else from rededicating ourselves both to progressive taxation and more effective and efficient governance. We do not want Congress to spew forth government programs at will and impose any taxes they choose. We want Congress to work with other Powers in our nation to find a new balance through which the common weal is advanced.
Part of the problem with the Great Society programs which sparked such enduring resistance was the fact that administering such programs is a paperwork nightmare. While we now have technologies to transform the administration of such programs, we also have gained insight into how the Federal government must relinguish control to State and local governments. Problems best solved locally or regionally must be addressed at those levels of governance. Problems best solved nationally, especially in minimum standards and sharing resources local areas cannot muster, must be addressed at the Federal level.
States are trying to serve their citizens, but are hampered in many ways. The Bush Administration and the Do-Nothing Congresses blocked volume purchases of drugs from other countries. They have cynically tinkered with the details of limits on SCHIP and other programs to cut out "welfare" and keep the population being served small -- all of which costs more at all levels of government and private spending.
Half-hearted spending to keep problems small is the most expensive way to do anything. The proliferation of programs providing funding to agencies and business providing care means massive paperwork. Direct care providers can consume up to 70% of their time handling paperwork. Back-office costs at these enterprises eat up more dollars and time. Reaganomics has produced the kind of fractured administration that seems designed to kill the programs themselves instead of efficiently and effectively get out there and solve the problems for which the program was originally designed and to address the issues which initially drove the legislation which authorized the program.
A Period Of Consequences
..the era of procrastination, of half-measures, of soothing and baffling expedients, of delays, is coming to its close. In its place we are entering a period of consequences
- Winston Churchill
In a different domain of public policy, and in a different time, Churchill made this observation. Today, in a whole host of policy domains and a very different time, we can see we are entering a period where the consequences of our decisions will indeed have consequences for generations to come. We must rise to this challenge: We The People. We must demand solutions -- which means first we must become informed so we can see the problems that need solving. We must stop chasing ghosts and start dealing with reality.
Our politicians cannot do any of this without Us. Obama has enjoined us, particularly in this community (but equally to all communities), to embrace this understanding and then enact it. His vision depends on the work of millions of citizens more than on anything any assemblege of experts for our service. Enlivened and empowered by citizens moving firmly to solve real problems facing the citizens of this nation, and of the planet, experts can then fill in the details and have the mojo to be listened to. We must make this happen. We The People.
The Netroots is still different from Congress and the Administration. They are bound by the need to compromise. We are not. If we are to end the endless cycle of half-measures, we must press the fight now before the political opposition has time to reconstitute. Ultimately, it is also in their interest we engage this fight. That our fellow citizens cower in fear of socialism and further disappointment, a fear engendered by half-measures instead of successful governance, is not a surprise. That we would allow them to languish in fear of their momentary opposition on the political stage would be unconsionable.
The progressive community has an obligation to strengthen, refine and redouble our efforts to inform our fellow citizens and those in government that the message of the last two elections cannot be ignored. Compromise will come, of necessity. But until that final deal is struck, we can mold its final shape.
We are uniquely able to rebalance the levels of government. We can advocate locally, statewide and nationally. We can push for AmeriCorps to provide people for home health care, hospice care, meals-on-wheels and rural care. Since current Medicaid funding is delivered by states, we can advocate innovative programs at the state level and encourage states to expand their participation.
Focusing The Light
Light, when focused by a lens or laser, becomes power and heat. Things move and transform under focused light. Pragmatic progressives seek to apply their informed judgement to problems we, and our fellow citizens, face. We also look for those things which hold us back from a more perfect union, satisfying life and properous livelihood. Our principle concerns are peace, prosperity and privacy. In every problem we solve, we want to instill in ourselves the discipline to include ways to further these ideal ends in our actual public lives.
Health care presents all the issues which dissipate the money and work of public servants and private practioners in its policy domain. As such, it allows us to find general policy principles for a wide range of public policy problems by studying it in some detail.
Peace
A nation at peace is naturally properous, as long as each citizen is protected from harms which disturb the prosperity of other citizens is endangered. A fire is addressed by fire fighters, public servants all. If we do not respond to fires equally, the common weal of the whole commuity could be imperiled. Police are primarily to maintain personal safety from harm by others, and do so without bias among all parties. So, too, are medical practioners made available to safeguard the health of we citizens.
That it should be treated differently is rooted in a fear of the costs. Indeed, it would incur costs. How much is debatable, since it is in the future. That it would be significant, if not overwhelming, is obvious. However, more than that cost is presently being borne by our citizens and our enterprises. Whatever that cost may be in the end, part of it now is profit. For whom and how much, again, is debatable. It is now obvious that private organizations involved for profit are not more efficient than the government, and are indeed more wasteful and more likely to end up providing half-measures instead of effective and efficient service.
Add to that natural inefficiency the cost of profit to shareholders, and that is the margin which public servants have the opportunity to replace with less expense, delay and endangerment of the lives and health of fellow citizens. Once we accept this perspective, based on our own research and contemplation of the issue, we can begin to see solutions.
But our national security can be disrupted as easily by Nature or other nations through biological vectors, poisons able to affect large areas, exposure to contagion in our supply chains for food, water, air and products of all kinds. We don't inspect our ports for pests enough, and the pests which get through can devastate our property and food chain.
The public health system has atrophied, and must be restored. Moreover, as part of a single-payer system, they can provide services through other providers as well, and support allocating expensive laboratory and diagnostic equipment among providers with less duplication of investment. In these ways, the threats like flu viruses and AIDSs could be identified, controlled and, ultimately, defeated more quickly and efficiently. Public health systems could bring "MASH" units into disaster areas more quickly and move people to appropriate care most surely than any logistics effort could do now.
In these and many other ways, combining the public health services with the other health care agencies in synergistic ways will streamline care, reduce costs and reduce the likelihood of a national crisis which threatens our national peace will be allowed to go unnoticed until it is too late.
Prosperity
Removing profit from the equation and removing a layer of parties to every transaction (insurance companies) with a single payor entity natually provides the opportunity for simpler, faster and more consistent service delivery. States, being the primary level of government guiding the payment process, can be influenced by local concerns.
Computerized data warehouses, stripped of personal information to protect privacy (one of our bedrock principles), can track real cost profiles and engage in group purchasing for supplies. The number of medical professionals can be identified, and special educational packages can be offered to increase the number of these personnel as needed can be anticipated.
These data can be made available to us all so citizens and public servants can work from a level information playing field. Medical records can be shared across providers (again, with absolute personal ownership of all such information and strict standards to keep it private enforced) electronically.
One of the greatest sources of fear and loathing for the first generation of Great Society programs would be naturally controlled by public data available electronically. Service providers, citizen groups and government decision makers can use this information to root out problems and propose solutions equally. Since all parties have the same information from which to work, the Constitutional principles of the balance of power, and the efficiency it enforces, are instilled in our government programs at all levels.
Public health agencies would be able to provide basic common care to all citizens: immunizations, quarantees, fast action on contagion, detection and prevention of health issues affected diverse populations or geographies, etc.. The public health support of hospitals, including all advanced laboratories for unusual problems in the nation, could expand. Hospitals could develop rural and neighborhood clinics and hospital care facilities to meet minimum standards for citizen access to medical care enforced equally throughout the nation.
Not only efficiency, but expanded effectiveness would result. Prosperity is furthered and strengthened when citizens are assured of proper, professional and available health care without regard to their individual incomes or social situation.
Businesses, freed from health care expenses, could be allowed to use health care funds for pensions and other benefits. The cost per employee is reduced for every business in the nation. The assurance of the health of all employees is attained. Small businesses can be created more easily and attract employees they cannot attract now because the small business would no longer be at a disadvantage with big businesses over health care costs. Citizens could be more flexible in their work, moving to telecommuting and consulting and starting or working in small businesses close to home. Small towns would flower again. The suburban sprawl and city resource strain would be reduced. Mass transit can be required as part of all new development and be expanded in rural areas to mesh with systems already in major urban areas.
Note we quickly start blending many areas of progressive policy solutions when we talk about prosperity. Health care becomes one of the ways citizens are empowered to pursue happiness, both socially and economically, by the wise application of government public services in ways which further private flexibility and mobility.
Health care would allow us to develop standards and solve problems which affect all manner of government programs. Opening government up to citizen oversight in detail, including all providers who, as non-profits (under bill H. R. 676), would not have competitive reasons to withhold information about their costs and revenues. Indeed, it is an open question as to how much information the Federal government would need. If the detail is all available in aggregate to everyone, the Federal government would only need to look at information aggregated to the fifty states and major Federal programs (VA, Medicaid, Medicare, etc.). Thus we properly constrain the Federal government to a volume and character of information appropriate to their purvue and not tempt them to attempt massive databases of the details of every citizen.
Privacy
What information does each player need to provide me health care? In the current system, my personal information is scattered out and duplicated all over the world in database which I, as a citizen, cannot inventory and track. My information is my property. The progressive principle of privacy is simple as it is severe: My property, papers, body, speech, finances and all digital or paper information about me is my property. It cannot be used without my prior notification and permission. This absolute standard is not negotiable. Any chink in this armor means government and private encroachment on my liberties and limitations on my rights. We have seen that, proven in spades by the Church Committeee and demonstrated in detail by the "Reagan revolution" and its progeny.
In health care, this standard is already in place. But the data are scattered all over the place so assuring that security is made more costly and difficult than it needs to be. That any medical information is sent overseas and stored there for any reason other than care I request while overseas is ludicrous. Some medical information is in the public interest: whether I have TB or other communicable diseases, for example. Most medical information is only appropriate for sharing with my medical service provider. To keep the level of relaxation of the absolute privacy principle to exactly what is necessary, I would need to approve any medical information release to any other party. To allow me to truly have this power, the provider must also be restricted from requiring any medical information from me before providing care -- and never expecting to be able to obtain any medical information about me which does not relate to the care they are providing.
By forcing personal information to stay in this country unless necessary, we also keep IT jobs here, contributing to the prosperity of our nation in the bargain. Again, we begin to see synergies among the major progressive principles which work together to further the common good.
What Vengence Scatters, Realignment Gathers
While those of us who have spent forty years in the wilderness want vengence on those who have governed us with cynicism and corruption, ultimately we want to leave the old guard behind in ways from which they cannot recover. To realign our political institutions to a progressive vision of governance, we must strike out boldly into new territory which renders Reagan Revolutionaries unable to go back.
With the health care issue, we will invoke their momentary wrath, but we will implement changes which benefit all citizens. In a realignment gambit, we change the political conversation so thoroughly the current politics of hate is left without a constituency. Obama has asked us to take this high road and get on with it. In this diary, and in many diaries on the Netroots since its inception, the grassroots interests are furthered and rooted so powerfully that our opponents are forced to transform, not just regroup.
Done quickly and forcefully, changes such as this, and others we will discuss in future diaries, will make the current rhetoric of hate impotent by the next election. In each successive election cycle hence, the venom of Palin's hate speech will be sucked out and dissipated. It is time to heal as a nation, and the perfect place to start is with the healing arts as a profession and as a segment of the economy which is simply out of control and heading for a collapse.
Single-payer health care is the natural first strike in a campaign of blows against the empire built up on ignorance and fear. It is the best place to establish a beachhead for a new era of progressive politics. Finally, it is the right thing to do and a gift one group of citizens can give to all fellow citizens. We should not delay when people are hurting. We cannot delay or realignment collapses. In this bill HR 676 we have an excellent foundation from which to hammer out a first solution to the health care crisis.
The consequences of dithering now are too grave to deter us now, in the aftermath of a tipping point crossed and a progressive future ahead of us. The time to act is now.
For background on this diary and context on its conclusions, please check out these diaries and subscribe for more as the series unfolds:
In the tipping point:
Be The Message
Countdown to the death of the Reagan revolution:
Intro
T - 80 days
T - 70 days
T - 60 days
T - 50 days
T - 40 days
T - 30 days
T - 20 days
T - 10 days
T - 5 days
T - 0 days
Please feel free to use this as a common thread. Pimp your own diaries, links and ideas without shame, because I want to hear from you. Promote the words of others that our fellow citizens need to hear as realignment unfolds. Identify inflection points, realized and gathering, that you see. This power is the power of the Internet, of this online community and of the People. Use it now as more and more citizens need real ideas and real debate. Prepare yourselves for the work which many of us have sought to finish for decades, but now can do in ways we could not have imagined before.