Friday, May 31, 2019
AOC Calls for Ban on Revolving Door as Study Shows Two-Thirds of Recently Departed Lawmakers Now K Street Lobbyists
"No lawmaker should be
cashing in on their public service and selling their contacts and expertise to
the highest bidder."
One of Capitol Hill's most
popular new Democrats on Thursday called for a total ban on the revolving door
that allows lawmakers to jump from Congress into K Street lobbying firms as
soon as they leave office.
In a tweet, Rep. Alexandria
Ocasio-Cortez (D-N.Y.) said that former members of Congress "shouldn't be
allowed to turn right around and leverage your service for a lobbyist
check."
"I don't think it should
be legal at ALL to become a corporate lobbyist if you've served in
Congress," said Ocasio-Cortez. "At minimum there should be a
long wait period."
After the Democratic wave in
the 2018 midterm elections, 44 federal lawmakers left office. A Public Citizen
analysis, released Thursday, found that of those 44, 26 "were working
for lobbying firms, consulting firms, trade groups or business groups working
to influence federal government activities."
Among those that made the
switch are former Rep. Joe Crowley, the Democrat who Ocasio-Cortez unseated,
and former Rep. Mike Capuano, a Suffolk County, Massachusetts Democrat whose
progressive credentials weren't enough to stop now-Rep. Ayanna Pressley from
besting him in the 2018 Democratic primary.
Former legislators like
Crowley and Capuano came in for criticism from Public Citizen president Robert
Weissman. In a statement, Weissman took
aim at what the revolving door does to Washington politics.
"No lawmaker should be
cashing in on their public service and selling their contacts and expertise to
the highest bidder," said Weissman. "Retired or defeated lawmakers should
not serve as sherpas for corporate interests who are trying to write federal
policy in their favor."
"We need to close the
revolving door and enact fundamental and far-reaching reforms to our corrupt
political system," Weissman added.
In the study, Public Citizen
provides a path toward fixing the problem.
Several pieces of legislation
would strengthen these ethics laws for former government officials. The For the
People Act (H.R. 1), which passed the House of Representatives in March, enacts
sweeping reforms that would raise ethics standards at all levels of government.
Importantly, H.R. 1 would define "strategic consulting" as lobbying
for former members of Congress, subjecting this activity to the existing
revolving door restrictions. The legislation would also bar former executive
branch officials from doing "strategic consulting" on behalf of a
lobbying campaign as well as making direct lobbying contacts for two years
after leaving government service.
But, as Ocasio-Cortez pointed
out in a series of tweets, there's more to consider than just banning—or at the
least delaying—lawmaker entrance into lobbying firms. The nature of
congressional pay and the necessities of the work, Ocasio-Cortez said, make the
easy money of lobbying very attractive to members of Congress.
"Keeping it real,"
Ocasio-Cortez tweeted,
"the elephant in the room with passing a lobbying ban on members requires
a nearly-impossible discussion about congressional pay."
Asia's glaciers provide buffer against drought
A new study to assess the
contribution that Asia's high mountain glaciers make to relieving water stress
in the region is published this week (29 May 2019) in the journal Nature.
The study has important economic and social implications for a region that is
vulnerable to drought. Climate change is causing most of the region's glaciers
to shrink.
British Antarctic Survey (BAS)
glaciologist Dr. Hamish Pritchard found that during droughts, glaciers become
the largest supplier of water to some of Asia's major river basins. This
melt-water is important for the people living downstream when the rains fail
and water shortages are
at their worst.
Each summer, glaciers release
36 cubic kilometres of water—equivalent to 14 million Olympic swimming pools—to
these rivers. This is enough water to fulfil the basic needs of 221 million
people, or most of the annual municipal and industrial needs of Pakistan,
Afghanistan, Tajikistan, Turkmenistan, Uzbekistan and Kyrgyzstan.
This supply is unsustainable,
though, because climate
change is causing the region's glaciers to lose 1.6 times more water
than they gain each year from new snowfall.
The high-mountain region of
Asia, known as the Third Pole, encompasses the Himalayas, Karakoram, Pamir,
Hindu Kush, Tien Shan, Kunlun Shan and Alai mountains and has 95,000 glaciers
in total. About 800 million people are partly dependent on their meltwater.
Dr. Pritchard analysed
estimates of the glacier contribution with the amount of precipitation in
average years and in drought years. He used climate datasets and hydrological
modelling to calculate the volume of glacier water entering and leaving the
region's major river basins.
Dr. Pritchard says:
""This study is
about answering the question—why do glaciers matter? Even in high-mountain
Asia, they are remote and cover quite a small part of the region. It turns out
that they are particularly valuable to society as a natural store of water that
keeps the rivers flowing through summer, even through long droughts.
"Against a background of
increasing drought-related water and food shortages and
malnutrition, which have been predicted with high confidence for the coming
decades, Asia's glaciers will play an increasingly important part in protecting
downstream populations from drought-induced spikes in water stress—spikes that,
without mitigating changes in the way water is stored and used, are the
potential trigger for a sudden jump in the price of water that could be profoundly
destabilising for this region."
The 2020 Election Hinges on Health Care
Last week, I visited the
Venice Family Clinic in Los Angeles near a public housing project in a poor
neighborhood. Two days later, I drove to a South Los Angeles area where pollution
from the freeway—not to mention mold, rat droppings, dust and
cockroaches—infest crowded apartments, causing asthma that sends children to
the nearby St. John’s Well Child and Family Center.
I visited St. John’s and the
Venice clinic while trying to make sense of the health care debate, which
should be dominating the presidential campaign but has so far failed to do so.
I was angry that Sen. Bernie Sanders’ Medicare-for-all plan, and other
Democratic contenders’ plans for health care reform, are being lost in campaign
news dominated by the ever-present, ever-bombastic Donald Trump. Unbelievably,
this demagogic liar and foe of democratic values, is calling the shots in the
presidential campaign.
To me, the clinics are a ray
of hope in the gloomy political scene. I had first visited them before
President Barack Obama was elected in 2008. Both were strapped for money back
then, with staffs and community supporters spending much of their time drumming
up contributions to support care for their predominantly Latino and African
American patients. Obamacare—the Affordable Care Act—pushed through by
then-President Obama and House Speaker Nancy Pelosi in 2010, changed the lives
of the clinics’ employees and their patients.
In both St. John’s and the
Venice Family Clinic, most of the working poor—defined as a family of four
earning $26,000 a year or less—now receive good medical care thanks to the
Affordable Care Act. At St. John’s, Chief Executive Officer Jim Mangia told me
how Obamacare had permitted expansion of Medi-Cal, the state’s program for
medical help to the poor, expanding it to include those who have jobs but can’t
afford a doctor, a dentist or an optometrist. The number of immigrants enrolled
at St. John’s doubled within two or three years of Obamacare’s passage. In
addition, several thousand more have purchased health insurance policies
through the Covered California exchanges created by Obamacare. “We doubled in
size,” Mangia said.
With $24 million from the
Affordable Care Act, St. John’s grew from nine clinics to 18, plus four new
health centers in public schools. St. John’s added vision care, endocrinology
and podiatry (the latter two fields badly needed for the diabetes that is
prevalent among that hospital’s patients). Mangia said doctors are seeing increased
signs of better health—lower blood sugar counts, lower blood pressure levels,
fewer children with asthma. “Our patients are learning to use the health care
system. People are getting a handle on their health,” he said. Patients are
exercising, eating healthy foods, taking their medicines. Family health habits
are improving, meaning that the children being treated at the clinic now will
likely become healthy adults.
At the Venice Family Clinic, I
met Dr. Rita Evazyan, one of the clinic’s dentists, who sees an average of 20
patients a day. In addition, there are dental hygienists who go to about 20
schools. “You’re busy,” I said. She agreed. Dental services have tripled in
size, said Elizabeth Forer, the clinic’s chief executive officer.
Forer showed me low sinks
where children learn proper tooth-brushing techniques. The result is there are
now 19- and 20-year-olds among their patients who don’t have cavities.
She showed me the kitchen,
where parents and their children learn to cook healthy foods. Fighting obesity
and food education go together. In the clinic’s modern facility, parents and
children learn to cook healthy meals and are educated about how good nutrition
improves all aspects of life. Feeling good, Forer said, encourages exercise and
helps children pay attention at school.
Throughout the nation, the
need for government-financed health care extends beyond the poor into the
middle class. As it stands, more than 27 million Americans are without health
insurance. Another 156 million, almost half of the United States population,
have health insurance from employers, and their combined situations worsen
every year.
In a May 2 article in The Los
Angeles Times, Noam N. Levey reported that “soaring deductibles and medical
bills are pushing millions of American families to the breaking point, fueling
an affordability crisis that is pulling in middle-class households with health
insurance, as well as the poor and uninsured. In the last 12 years, annual
deductibles in job-based health plans have nearly quadrupled and now average
more than $1,300.”
In a survey taken with the
Kaiser Family Foundation, the paper said one of six who get insurance through
work say they have had to make “difficult sacrifices” to pay for health care,
and one in five said health care costs have used up all or most of their
savings. Those losing a job probably lose insurance, too.
These fears resonate among
audiences of Americans following the current presidential campaign.
The Des Moines Register
recently sent reporters to 46 events in Iowa featuring presidential candidates
for the state’s January caucuses, the nation’s first contest of the 2020
campaign. “As it did during the 2018 (midterm) election, health care dominated”
the audience questions, the newspaper reported. In an NBC-Wall Street Journal
poll taken between April 28 and May 1, respondents said health care should be
government’s top priority.
These reactions repeated the
pattern of the 2018 congressional elections when Democrats won the House and
found that the voters were deeply concerned about health care.
It is possible, by looking
closely, to find differences on the health-care issue among the current crop of
candidates.
The most generous plan is that
advanced by Rep. Pramila Jayapal, a Washington Democrat and co-chair of the
Congressional Progressive Caucus. The best known is Sen. Sanders’
Medicare-for-all, a phrase he popularized when he ran for president in 2016. At
the time, it was considered the height of out-of-touch radicalism.
Sanders would put the present
Medicare and Medicaid schemes into a new universal government health plan that
would supplant Obamacare. It would replace most private health insurance,
including plans negotiated by unions, whose members may not want to give them
up. It would cover hospital visits, as well as primary care, medical devices,
laboratory services, maternity care, prescription drugs and vision and dental
care. There would be none of the fast-rising deductibles or out-pocket
expenses. Rep. Jayapal embraces these provisions but would add government
funding for long-term nursing care.
Presidential candidates Sens.
Kamala Harris, Cory Booker and Elizabeth Warren are co-sponsors of the Sanders
bill. Sen. Amy Klobuchar favors the expansion of Medicare and Medicaid, with
government-sponsored insurance plans—the public option—added to Obamacare.
All this would be financed by
higher taxes on the rich and large businesses. Sanders, for example, has
proposed a series of options that would tax offshore profits, impose a special
tax on the very rich, raise the estate tax, limit tax deductions for the
wealthy and impose tax increases that would hit the middle class.
Higher taxes for all might be
enough to sink the Sanders plan, but he argues that the elimination of payments
to insurance companies would more than make up for the higher tax levies.
I talked to Bill Carrick, a
veteran Democratic political consultant who organized focus groups for his
client Sen. Diane Feinstein’s successful reelection campaign in 2018. “These
were middle-class people,” he said. “They were not inclined to all-out opposition
for Medicare-for-all, they just didn’t think it would become law. But they were
very much interested in saving Obamacare.” They wanted provisions assuring
coverage for pre-existing conditions and a chance to buy into Medicare at an
earlier age. And they wanted government-sponsored insurance policies offered on
the Obamacare exchanges—the public option.
That option had been killed
during Obamacare’s rocky road to passage but would offer an alternative to the
increasingly expensive policies, with their high deductibles, available on the
exchanges. “Interestingly,” he said, “nobody wanted the government to take over
health insurance.”
I saw Obamacare at work in the
clinics I visited. It helps a lot but needs fixing. The middle class, oppressed
with increasing deductibles and higher premiums, needs immediate help. Many
more middle-class people should be eligible for subsidies on the Obamacare
exchanges. And the insurance industry, now profiting from Obamacare, requires
tough regulation.
That’s what the Democratic
presidential candidates should be advocating rather than letting the buffoon in
the White House bully them into defeat and low-grade health protection.
Private Equity is a Driving Force Behind Devious Surprise Billing
Eileen Appelbaum
The Hill, May 16, 2019
The Hill, May 16, 2019
Surprise medical bills are in
the news almost daily. Last Thursday, the White House called for legislation to protect patients
from getting surprise doctor bills when they are rushed to the emergency room
and receive care from doctors not covered by insurance at an in-network
hospital.
The financial burden on
patients can be substantial — these doctor charges can amount to hundreds or
even thousands of dollars.
What’s behind this explosion
of outrageous charges and surprise medical bills? Physicians’ groups, it turns
out, can opt out of a contract with insurers even if the hospital has such a
contract. The doctors are then free to charge patients, who desperately need
care, however much they want.
This has made physicians’
practices in specialties such as emergency care, neonatal intensive care and
anesthesiology attractive takeover targets for private equity firms.
As health reporter Bob Herman observed, acquisition of
these health services “exemplifies private equity firms' appetite for buying
health care providers that wield a lot of market power.”
Emergency rooms, neonatal
intensive care units and anesthesiologists’ practices do not operate like an
ordinary marketplace. Physicians’ practices in these specialties do not need to
worry that they will lose patients because their prices are too high.
Patients can go to a hospital
in their network, but if they have an emergency, have a baby in the neonatal
intensive care unit or have surgery scheduled with an in-network surgeon, they
are stuck with the out-of-network doctors the hospital has outsourced these
services to.
This stands in stark contrast
to other health-care providers, such as primary-care physicians, who will lose
patients if they are not in insurers’ networks.
It’s not only patients that
are victimized by unscrupulous physicians’ groups. These doctors’ groups are
able to coerce health insurance companies into agreeing to pay them very high
fees in order to have them in their networks.
They do this by threatening to
charge high out-of-network bills to the insurers’ covered patients if they
don’t go along with these demands. High payments to these unethical doctors
raise hospitals’ costs and everyone’s insurance premiums.
That’s what happened when
private equity-owned physician staffing firms took over hospital emergency
rooms.
A 2018 study by Yale health economists looked at what
happened when the two largest emergency room outsourcing companies — EmCare and
TeamHealth — took over hospital ERs. They found:
“…that after EmCare took over
the management of emergency services at hospitals with previously low
out-of-network rates, they raised out-of-network rates by over 81 percentage
points. In addition, the firm raised its charges by 96 percent relative to the
charges billed by the physician groups they succeeded."
TeamHealth used the threat of
sending high out-of-network bills to the insurance company’s covered patients
to gain high fees as in-network doctors. The researchers found:
“…in most instances, several
months after going out-of-network, TeamHealth physicians rejoined the network
and received in-network payment rates that were 68 percent higher than previous
in-network rates.”
What the Yale study failed to
note, however, is that EmCare has been in and out of PE hands since 2005 and is
currently owned by KKR. Blackstone is the once and current owner of TeamHealth,
having held it from 2005 to 2009 before buying it again in 2016.
Private equity has shaped how
these companies do business. In the health-care settings where they operate,
market forces do not constrain the raw pursuit of profit. People desperate for
care are in no position to reject over-priced medical services or shop for
in-network doctors.
Private equity firms are
attracted by this opportunity to reap above-market returns for themselves and
their investors.
Patients hate surprise medical
bills, but they are very profitable for the private equity owners of companies
like EmCare (now called Envision) and TeamHealth. Fixing this problem may be
more difficult than the White House imagines.
Trump’s shambolic Japan visit and America’s decline
The age of the United States
dominating in Asia is drawing to a close, and the president is leading the way
By JONATHAN MANTHORPE
Donald Trump’s shambolic and
divisive visit to Japan last weekend was yet another highlight in the growing
picture of America’s decline as a nation of power and influence in Asia.
For Washington’s competitors
and potential enemies, especially China, Trump’s four days in Japan were a huge
encouragement.
For the United States’ allies,
the visit was an even more intense wake-up call than past demonstrations that
Trump is an ignorant and untrustworthy partner.
More than that, the context of
the visit shows that the idea is now firmly rooted in Asia that Trump is only a
symptom of America’s relative decline. Even when the Trump nightmare has
passed, the growing internal social and conflicts fostering isolationism in the
US will continue.
On the road in Japan, Trump
gave an Oscar-worthy performance of a self-obsessed, but fundamentally insecure
fantasist whose only concern is to be seen as a winner.
Abe ahead of the game
Japan’s Prime Minister Shinzo
Abe was well ahead of other world leaders in understanding that flattery could
get him everywhere with Trump. In the hours after Trump’s election in 2016, Abe
rushed to Trump Tower in New York to be the first to congratulate the incoming
president.
Abe continued the fawning in
this latest visit to Japan by Trump. The US leader was the first foreign head
of state to meet the new Japanese emperor as “guest of honor.” And Abe pandered
to Trump’s passion for having his name on things by facilitating the creation
of a new sumo wrestling prize called “The President’s Cup.”
But there has always been a
hint of contempt behind Abe’s courting of Trump. One can almost hear Japanese
officials telling Abe: “We know he’s a fool, but we need his support both in
trade and national security. So it is necessary to be nice to him, however
distasteful that may be.”
Trump has been a con artist
since boyhood. So he probably knows, even if only instinctively, he’s being
played by Abe.
Perhaps that is why Trump went
out of his way to be thoroughly rude to his host during the Japanese visit,
although one cannot ignore the view that Trump always acts as a bore without
any social graces.
Missiles ‘standard
stuff’
The American president
dismissed Abe’s concerns when North Korea conducted short-range missile tests
during the visit. Trump said the tests were “standard stuff” that did nothing
to undermine his “friendship” with North Korean leader Kim Jong Un, or erode
his confidence that Pyongyang will give up its nuclear weapons.
But many credible analysts say
the enhanced capabilities of these weapons can penetrate even top-of-the-line
missile defense systems and are a real threat to Japan and South Korea.
In siding with Kim on this,
Trump not only dismissed his supposed ally Abe, but also his national security
advisor John Bolton, who publicly railed against the North Korean tests.
But the young North Korean
leader seems to have a better fix on how to manipulate Trump than do either Abe
or Bolton.
Ahead of Trump’s Japan visit,
North Korea’s state-controlled media attacked former Democrat Vice-President
Joe Biden as a “fool of low IQ.”
Biden is a leading contender
to be the Democrats’ candidate for the presidency against Trump in 2020. So in
one of his Twitter storms while in Japan, Trump embraced this apparent
endorsement by the Kim regime.
In a tweet last Sunday, Trump
said he had “smiled when he (Kim) called Swampman Joe Biden a low IQ
individual, & worse.”
Winning at all costs
Kim clearly understands that
ultimately Trump is only concerned about being seen as a winner at home in the
US. All the pomp and ceremony laid on by Abe over the emperor and the sumo
trophy are fine and dandy, but what really counts with Trump is being hailed as
a winner in New York.
Abe has done all he can to
butter up Trump, but the Japanese leader has understood, since well before the
arrival of the Trump regime, that the age of American dominance in Asia is
drawing to a close.
China overtook Japan as the
world’s second largest economy in 2010, and is set to take the top spot from
the US within a few years. More than that, Beijing has invested in a modernized
military that appears to be capable of projecting power across the Pacific and
Indian ocean regions to defend China’s economic and political interests.
In a hugely significant
gesture, Abe’s finale for the Trump tour was a visit to a major Japanese naval
base at Yokosuka. Here Trump was shown the Japanese warship Kaga, which
has hitherto been called a “destroyer.” It is equipped only with helicopters to
respond to humanitarian crises, such as the 2005 tsunami in Southeast Asia, and
other non-military activities.
However, the “destroyer” Kaga is,
in reality, an aircraft carrier, one of two possessed by the Japanese navy and
the largest warships in what is a potent maritime force.
The Kaga is making a
dramatic change of character and is being fitted out as a true aircraft
carrier. It will be equipped with American-made F35-B stealth fighters, part of
an order of 105 of the state-of-the-art US warplanes Japan is buying.
Responding to China
It is not only Japan that
feels compelled to respond to China’s growing naval might in an age when
Washington’s intervention at times of crisis is increasingly doubtful.
Tokyo’s military and political
co-operation with Australia and, particularly, India have grown in response to
Beijing’s imperial expansion.
New Delhi has modernized and
expanded its own naval forces as Beijing has moved into India’s neighborhood.
China has established civilian port facilities in Sri Lanka and Pakistan, but
made a major military statement in 2017 when it acquired a naval outpost in
Djibouti in the Horn of Africa.
This “string of pearls” is an
important element in Chinese President Xi Jinping’s Belt and Road Initiative.
This massive project aims to invest trillions of dollars modernizing the
transportation and associated infrastructures between China, its sources of raw
materials and its markets for manufactured goods in Asia, the Middle East,
Europe and Africa.
At the political level,
relations between Beijing and New Delhi are better now than they have been for
decades. On Wednesday, freshly re-elected Indian Prime Minister Narendra Modi
announced he will try to extend this rapprochement by holding a second informal
summit with Chinese President Xi later this year.
However, military trust has
not yet caught up with the diplomatic advances, and probably never will.
Generals are paid to prepare against security disasters.
Earlier this year India
announced it has set up a fourth airbase on the Andaman and Nicobar Islands,
which facilitate monitoring Chinese naval activity in the approaches to the
choke point Straits of Malacca between Singapore and Indonesia.
India also plans to set up
military facilities in Mauritius and the Seychelles. These are to enhance its
own naval operations in the Indian Ocean and to prevent Beijing from using
those island nations as bases for its own ambitions.
Thus the balance and
construction of political, economic and military power in the Indo-Pacific is
changing almost by the day. But when future historians come to tell this story,
they may well point at Trump’s May visit to Japan as a milestone along that
road where the geography visibly changed.
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