universal health care

Paul Crist

Paul Crist — Wed, 03 Nov 2010 17:15:58 -0400

Paul Crist owns and manages Hotel Mercurio, a 28-room hotel catering to LGBTQ visitors in the gay-popular resort city of Puerto Vallarta, Mexico. Relocating from Washington DC in 2002, he has lived in Puerto Vallarta for almost nine years with his Mexican-citizen husband, Luis Tello and two well-dressed Schnauzers, Lola and Lolita. He now divides his time between Washington, DC and Puerto Vallarta.

In addition to his business, Paul is active in a number of political, charitable, and non-profit projects in Mexico and the U.S.:
• He is the founder and President of a large non-profit HIV/AIDS organization serving Puerto Vallarta and other cities on Mexico’s Pacific Coast. The region is among the hardest hit by HIV infections in Mexico. Vallarta Enfrenta el SIDA, A.C. (Vallarta Confronts AIDS, in English) provides free HIV testing; HIV prevention services; medical assistance; and other sexual and reproductive health services.

• Americans for Medicare in Mexico, A.C., also founded and directed by Paul, is working to obtain congressional authorization for a pilot project that would provide Medicare coverage to eligible beneficiaries living south of the border. Mexico is host to almost 200,000 American expatriate retirees, thanks to a favorable year-round climate and low cost of living. Retirees can receive their social security benefits, but currently do not have access for the Medicare benefits for which they paid during their working years in the US.

• Paul is on the National Board of Americans for Democratic Action, America’s oldest Liberal lobbying and advocacy organization, founded by Eleanor Roosevelt, labor leader Walter Reuther, economist John Kenneth Galbraith, and others in the 1940’s.

• He is active with Democrats Abroad in Mexico, where he served as the national Treasurer in 2009-10. He also edited the Democrats Abroad Mexico National Newsletter & Journal, a publication with a readership of 15,000 covering public policy and progressive politics.

• He has been a consultant for AIDS Healthcare Foundation (AHF), a large international HIV/AIDS organization providing treatment and care to 140,000 patients living with HIV in 23 countries. AHF has been a longtime grant funding partner for Vallarta Confronts AIDS in Mexico, and he is now assisting AHF with government relations in Washington, DC.

• Paul is an avid researcher and writer on domestic and international economic policy; U.S. manufacturing and trade policy; labor issues and workers rights; HIV/AIDS and sexual health topics; human rights and LGBTQ equality; and more. He approaches most issues from a proudly liberal and rights-based perspective. His blog is at http://cristpd.wordpress.com/

• He has also worked as a Legislative Aide to Sen. Paul Sarbanes (D-MD, retired); owned and managed a residential design and construction contracting firm; and worked in international energy consulting. (yes, he is very old and has done a lot of different things in life!)

Paul has undergraduate degrees in Architecture and Political Science; and a Master’s Degree in International Economics from Johns Hopkins University – School of Advanced International Studies, with a specialty in Latin America.

He is fluent in Spanish, and continues to ponder what he will do for his “next career.”

For additional information please contact Paul at

Paul D. Crist paul@paulcrist.org
Or by telephone:
(U.S & Canada Toll Free to Hotel Mercurio) 1-866-388-2689
(In Mexico at hotel Mercurio) (+52)322-222-4793
(Mexico Cellular) (+52) 1-322-294-1820
(In Washington DC) 202-367-3324

Courtney McNamara

Courtney McNamara — Wed, 03 Mar 2010 02:45:38 -0500

The Mugging of the Common Good

Robert Borosage — Tue, 15 Sep 2009 12:03:58 -0400

Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
....The best lack all conviction, while the worst
Are full of passionate intensity.
Surely some revelation is at hand

-- William Butler Yeats

President Obama traveled to Wall Street on the anniversary of the collapse of Lehman Brothers that triggered the worst financial debacle since the Great Depression. His purpose was to challenge Wall Street's barons, telling them:

"We will not go back to the days of reckless behavior and unchecked excess..where too many were motivated only by the appetite for quick kills and bloated bonuses"

Those days are over, the president said. It's time for comprehensive legislation. Taxpayers won't cover your bets or your bonuses. And we know once more the threat that financial holdings can pose to the nation.

The president invoked country and the common good. "Instead of learning the lessons...of the crisis, [some in the financial industry] are choosing to ignore them. They do so not just at their own peril, but our nation's." Obama called on Wall Street to act on its own, to overhaul pay systems, to level with consumers, to join with him in defining reform, but his tone was almost wistful. As he knows all too well, for much of Wall Street, patriotism is for suckers. And in Washington, private interests are rolling over the common good.

In the wake of the worst economic downturn since the 1930s, the president has called for fundamental reforms vital to the country's future. Put aside whether he's been too bold or too timid, whether he has pushed hard enough or too hard; there isn't any question he is calling the nation to its senses.

Our health care system is broken and unsustainable. Comprehensive reform is unavoidable. We can't continue to rely on fossil fuels; sustainable energy is a security imperative, not a choice. We need to shackle Wall Street, to shrink the size and excess profits of finance, and force it away from its addiction to gambling and back to the essential business of investing in the real economy. We have to reduce the crony capitalist subsidies that get squandered on agribusiness and Cold War weapons systems and top-end tax cuts, and use that money to invest in education, in a modern infrastructure, in research and development vital to a vibrant, high-road economy.

This really shouldn't be controversial. Yes, disagreements about how to get this done are to be expected, but the status quo is simply indefensible. Despite all the fantasies of the rabid right, Obama is moderate by temperament, creative at compromise. He is, as one of his White House staff members described him, a "raging minimalist." He really does believe you put everyone around a table, have a "civil conversation," find areas of agreement and move forward. He does believe that everyone—from billionaire hedge-fund operators to insurance company CEOS to conservative legislators—will in a crisis put the country first.

But he and his reform program are getting mugged. He's taken on the most powerful private interests in America—Big Oil, Wall Street, the insurance and drug lobbies—and they are winning. Republicans, despite the shattering of their conservative shibboleths, have chosen, with lockstep unity, obstruction over compromise. And too many Democrats have shown themselves more beholden to the private interests that pay for their campaigns than the public interest the president of their own party invokes.

We are witnessing a harrowing test of our democracy. America is a big, bustling and entrepreneurial country. We pursue our own passions and pursuits, are jealous of our freedoms, and begrudge governmental intrusions. But in a crisis—faced with depression or war, our history tells us many become one. We join together for the common good.

Well, it is hard to imagine a greater crisis than the one this country has faced over the last years. A middle class that has suffered a lost decade. Two wars. The Great Recession. Gilded Age inequality. Catastrophic climate change accelerating faster than most predictions.

Yet, we haven't come together. Wall Street lobbies against reform. Derivative traders will ante up hundreds of millions to block regulation of credit default swaps. Goldman Sachs is back to computerized gambling and billions in bonuses. The insurance companies are spending over a million-and-a-half dollars a day against comprehensive health-care reform.

The president's preemptive compromises only feed their appetites. He offers polluters a good portion of the revenue generated by "cap and trade." They lobby to weaken the cap.

He bails out banks rather than taking them over and reorganizing them. They lobby against his financial reforms. He doesn't try to push for Medicare for All, accepting the role of employment-based private insurance, and he's accused of a government takeover of health care.

The teabaggers were in Washington this past weekend. Despite their racial furies and right-wing fantasies, they shouldn't be dismissed. Many are working people, losing ground in an economy that isn't working for them. They are angry at a government that seems to take their taxes to bail out billionaire bankers, while they are left to swim or sink. They have every good reason to believe Washington caters to the wealthy and the connected, and not to them. And it is all too easy to deflect that anger to "them" —illegal immigrants, poor minorities, foreign aid recipients.

This is the test for Democrats. With the White House and majorities in both houses of Congress, Democrats have to produce. If they are too cautious or too compromised, they will feed what could be an ugly populist backlash.

Take health care reform. Sen. Max Baucus has produced a draft for the Finance Committee, making concessions as far anyone can see not for Republican votes, but for insurance lobby approval. He's produced that lobby's dream bill, mandating coverage for everyone without subsidies to make it affordable. His bill would drive people to take the high-deductible, low-coverage plans that are the industry's cash cows. It is hard to imagine a greater disservice to the country or to the party. Take young Americans who vote Democratic in large numbers, force them to buy health insurance that they don't want and can't afford, make them pay for policies that don't cover their health-care costs—and reap the whirlwind that you deserve.

These next months are the reckoning. The president and the Congress will step up to the reforms the country needs—or they will fail the nation in a time of peril. For citizens, now is the time to get engaged. The only way legislators in both parties will rise above partisan politics and private interests is if their constituents allow them no choice.

Middle-income Americans lost income over the last decade, for the first time since we began keeping records. Financial speculation drove the economy off the cliff. Catastrophic climate change is already melting the ice caps. We cannot afford another lost decade. If reason cannot prevail, angry people will increasingly look for a strong man to get something done. And that could make the teabaggers look like a tea party.

Obama's Health-Care Speech: What He Got Right

Isaiah J. Poole — Thu, 10 Sep 2009 13:45:44 -0400

Diane Archer, health care policy expert at the Institute for America's Future, says that President Obama's address to a joint session of Congress Sept. 9 made a compelling case that the federal government can play a uniquely constrictive role in addressing the nation's health care problems. Archer points out that Obama forcefully defended a public health insurance option while addressing cost concerns raised by conservatives.

Health Care Reform And You

OurFuture.org Staff — Mon, 27 Jul 2009 12:22:45 -0400

Voices For Health Care At Capitol Rally

Isaiah J. Poole — Fri, 26 Jun 2009 12:08:37 -0400

Several thousand people rallied in front of the U.S. Capitol June 25 in support of health care reform and heard key Democratic members of Congress vow that they would fight for a public health insurance option as part of that reform.

The rally was the centerpiece of the "Health Care '09: We Can't Wait" lobby day organized by Health Care for America Now! Sens. Sherrod Brown, Robert Menendez and Barbara Mikulski are featured in this video, along with interviews of some rally participants. Several other members of Congress, including Sen. Charles Schumer and Rep. Charles Rangel, participated in the rally.

Former Vermont Gov. Howard Dean, who recently launched a nationwide petition campaign supported by more than 350,000 people in support of a public health insurance option, was a key speaker at the rally.

Progressive Revenue Options to Fund Health Care Reform

OurFuture.org Staff — Wed, 24 Jun 2009 12:52:00 -0400

Make Health Care Affordable And Accountable

Jacob S. Hacker — Tue, 23 Jun 2009 12:08:35 -0400

This is excerpted from written testimony submitted to the House Education and Labor Committee, one of three House committees jointly writing health care reform legislation, on June 23.

For national health care reform to succeed, it must create accountability in American health insurance, expand coverage while making it more affordable for workers and their families, and adequately fund our health care priorities while putting in place the preconditions for long-term savings to the federal budget. The draft legislation prepared by this special House of Representatives tri-committee promises enormous progress in meeting all three of these goals.

Both accountability within the insurance market and shared responsibility are necessary to slow the growth in health care costs not just for workers and their families but also for employers, states, and the federal government.

In recent years, the need for comprehensive health reform has become glaringly apparent. Health insurance premiums have skyrocketed, more than doubling from 1999 to 2008, while the scope and generosity of private coverage have plummeted. Not only have the ranks of the uninsured continued to expand, but, in addition, the number of Americans who have insurance yet lack adequate protection against medical costs has increased dramatically. More than half of bankruptcy filings are related to medical care, with the vast majority of medical bankruptcies involving households that have insurance coverage. Employers, workers, states and localities, and the federal government—all have seen their budgets under siege because of runaway health care costs and all require long-term relief.

Amid the crisis, there has emerged a growing recognition not just of the need for action but also of the virtues of a public-private “hybrid” approach to health reform. The approach to reform embodied in the tri-committee draft legislation is such a model—a model that builds on the best elements of the present system: large group plans in the public and private sectors. By lowering the cost of care and requiring that all firms eventually contribute to the cost of coverage, the legislation would encourage employers to continue to provide health insurance. At the same time, it would put in place a new means—the so-called health insurance exchange—of allowing Americans without access to secure workplace coverage to choose among insurance plans that provide strong guarantees of quality affordable coverage over time.

An essential feature of this new framework for obtaining group coverage is “public plan choice,” the creation of a new public plan modeled after Medicare that would be available to Americans younger than 65 who lack good employment-based coverage. Public plan choice is not by any stretch of the imagination “Medicare for all.” Rather, it simply creates a public health insurance plan with incentives to focus on value and innovation that competes on a level playing field with private insurers within the new insurance exchange. Private employment-based coverage would continue, and workers without such coverage would be able to choose from a menu of options that includes a range of private insurance plans as well as the new public health insurance plan.

Moreover, this new public health insurance plan should be—and is, in the draft legislation—self-supporting after initial setup costs are financed (that is, it should be financed by the same sources as any other plan within the exchange, notably, individual premiums, employer contributions, and income-related subsidies). It should also be—and is—subject to the same rules as the private plans and be separate from the national exchange, so the referee (the exchange) does not have a player (the plan) in the game.

This idea is overwhelmingly popular. In a recent poll conducted by the New York Times and CBS News, 72 percent of those questioned supported a government-administered insurance plan that would compete with private insurance. The support for a public plan came from Republicans and Democrats alike. Half of those who identified as Republicans said they would support a public plan, along with three-quarters of independents and nine out of ten Democrats.

Choice, Accountability, and “Healthy Competition”

The aim of public plan choice is healthy competition—that is, competition to make Americans better cared for and more secure. Such competition requires not an endless array of choices, but rather a reasonable number of meaningfully different choices. In much of the country today, health insurance competition is remarkably limited. Most metropolitan areas have no more than a few dominant insurers in control of the market. And these companies are often unable or unwilling to rein in health care costs. It is often in their interest to pay higher rates to key doctors and hospitals because they can pass on these costs to individuals and employers. In the process, they make it difficult for weaker insurers to build competitive provider networks and bring costs down. Even the largest insurers are hard-pressed to enter established markets.

Because the hospital market has grown increasingly concentrated, moreover, providers wield considerable power of their own to drive up the rates they receive from insurers and restrict competition. In areas where hospital market concentration has grown the most, hospital prices and profitability are very high, yet service and quality of care is no better than in other areas, the evidence suggests. As John Holahan and Linda Blumberg of the Urban Institute explain, “Dominant insurers do not seem to use their market power to drive hard bargains with providers . . . . Competition in insurance markets is often about getting the lowest risk enrollees as opposed to competing on price and the efficient delivery of care.”

A public health insurance plan would provide greater competition for insurers and providers and greater choice for Americans. Indeed, a key reason for public plan choice is that public health insurance offers a set of valued features that private plans are generally unable or unwilling to provide. Stability, wide pooling of risks, transparency, affordability of premiums, broad provider access, the capacity to collect and use patient information on a large scale to improve care—these are all hallmarks of public health insurance that private plans have inherent difficulties providing. On the other hand, private plans are generally more flexible and more capable of building integrated provider networks, and they have at times moved into new areas of care management in advance of the public sector.

In short, public and private plans have unique strengths, and both should have an important role in a reformed system. Public plan choice simply means that all Americans without good workplace coverage, not just the elderly or the poor, should have access to the distinctive strengths of a public health insurance plan, as well as the strengths of private plans. Such healthy competition has long been the stated rationale for encouraging Medicare to include private plans alongside the public program. The argument for a competitive partnership between public insurance and private plans applies at least as strongly to nonelderly Americans as it does to those in Medicare.

Healthy competition is about accountability. If public and private plans are competing on fair and equal terms, the choice of enrollees between the two will place a crucial check on each. If the public plan becomes too rigid, more Americans will opt for private plans. If private plans engage in practices that obstruct access to needed care and undermine health security, then the public plan will offer a release valve. New rules for private insurance could go some way toward encouraging private plans to focus on providing value. But without a public plan as a benchmark, backup, and check on private plans, key problems in the insurance market will remain.

Public Plan Choice is Essential to Cost Control

Perhaps the most pressing of these problems is skyrocketing costs. Public health insurance has much lower administrative expenses than private plans, it obtains larger volume discounts because of its broad reach, and it does not have to earn profits as many private plans do. Furthermore, experience suggests that these lower costs are accompanied by a superior ability to control spending over time.

Medicare has a better track record than private health plans in controlling costs while maintaining broad access to care, especially over the last fifteen years. By way of illustration, between 1997 and 2006, health spending per enrollee (for comparable benefits) grew at 4.6 percent a year under Medicare, compared with 7.3 percent a year under private health insurance.

Over the last generation, public insurance has pioneered new payment and quality-improvement methods that have frequently set the standard for private plans. More important, it has the potential to carry out these vital tasks much more effectively in the future, using information technology, large databases of practices and outcomes, and new payment approaches and care-coordination strategies. Indeed, a new public plan could spearhead improvement of existing public programs as well as private plans.

To be sure, there are reasonable concerns about how a new public plan will use its bargaining power—concerns reflected in current proposals for state-based public plans, consumer cooperatives established by the states, or even private insurers under public contract. Yet a watered-down public plan or a private alternative to a public plan would not serve the three vital functions of a competing public health insurance plan—to be a “benchmark” for private plans, a “backup” to allow consumers access to a good plan with broad access to providers in all parts of the country, and to serve as a cost-control “backstop.” Consumer cooperatives, for example, will be extremely difficult to create and are unlikely to serve as a backup in most of the nation. They will also lack the ability to be a cost-control backstop, much less a benchmark for private plans, because they will not have the reach or authority to implement innovative delivery and payment reforms.

In sum, public plan choice is essential to set a standard against which private plans must compete. Without a public plan competing with private plans, we will continue to lack strong mechanisms to rein in costs and drive value down the road.

Jacob S. Hacker is a professor of political science at the University of California, Berkeley
and co-director of the Center on Health Economic & Family Security at the UC Berkeley School of Law.

Terry Schleder

Terry Schleder — Thu, 28 May 2009 13:55:55 -0400

Progressives have Caved on Health Care

Berry Ives — Mon, 04 May 2009 23:34:33 -0400

I submitted questions to moveon.org's online interview with Howard Dean, trying to nail him down on single-payer. My questions were not among those selected.

I found the whole show to be very disappointing because the single-payer concept was never addressed.

But at least there were two questions from Texas coming from the point of view of supporting single-payer health care. Dr. Dean either doesn't understand what that is, or else he was very disingenuous regarding the single payer alternative. He said we will still have the choice of "single-payer" under the proposed Obama plan. He seems to assume that single-payer is the same thing as having a public option. Far from it.

I don't think he is so stupid as to not know the difference. I used to have some respect for him, but that has now paled into oblivion. He is either inexcusably ignorant or else he is a liar. Single-payer is not the same thing as a public option. He says you can still choose single-payer (the public option), or you can choose a private insurance plan. And if you can't afford the private insurance plan, then we will subsidize your private insurance.

Please Dr. Dean, what about single-payer is being able to choose the public option OR a private? It's just not the same thing, and surely you must know that. As you must have heard somewhere along the line, one of the chief advantages of single-payer is eliminating the inefficiencies of private health insurance. For god's sake, single-payer IS SINGLE-PAYER! It's not multiple payers!

Universal health care was once on the progressive table, but no longer. I can hear the death knell. And if we do manage to cover the presently uninsured, the cost of the whole program will exceed the cost of single-payer by some $350 billion per year.

So do all you so-called progressives feel proud of yourselves for caving in to the insurance corporations and the Obama "bipartisan" political philosophy? What we needed was NON-partisan rational policy formation, not a compromise with far right-wingers who do not support any kind of universal health care. And, you know what, they are winning.

I hope all of you who are making the decisions at moveon and CAF and others feel good about this disaster for progressive health care, which would mean universal health care. I certainly don't, and if I were in Congress, I would vote against it.