Obama’s health insurance overhaul a winner in midterms
By GEOFF MULVIHILL and RICARDO ALONSO-ZALDIVAR
Thursday, November 8
WASHINGTON (AP) — The personality looming over the 2018 midterms was President Donald Trump. The issue was health care, the top concern for voters as they decided how to cast their ballots.
This week’s election showed a nation increasingly — if belatedly — in step with former President Barack Obama’s approach to it.
Health care was the top issue for about one-fourth of voters, ahead of immigration and jobs and the economy, according to VoteCast, a nationwide survey of more than 115,000 voters and about 22,000 nonvoters conducted for The Associated Press by NORC at the University of Chicago.
Those most concerned with health care supported Democratic candidates overwhelmingly, helping the party claim the House.
While Republicans’ hold on the Senate grew, putting Democrats in control of the lower chamber makes it even less likely that Trump will be able to undo Obama’s overhaul, which created subsidized coverage for some lower-income people, allowed states to expand Medicaid coverage for others with the federal government picking up most of the cost, and barred insurers from discriminating against people with pre-existing medical conditions.
The law was one of Obama’s key legislative accomplishments, but it proved unpopular after Democrats passed it without a single Republican vote. A backlash propelled the GOP to take control of the House in 2010 and the Senate in 2014, significantly narrowing what Obama could accomplish.
But by last year, “Obamacare” was popular enough that a GOP-controlled Senate blocked an effort to scrap the overhaul.
That vote was a factor in the only Senate race where a Republican incumbent lost a re-election bid.
In Nevada, where the majority of voters said they disapproved of Trump’s handling of health care, Democratic challenger Jacky Rosen attacked incumbent Republican Sen. Dean Heller for supporting Trump’s effort to repeal the health care law.
“In time, changes will be made,” Mike Leavitt, health secretary under President George W. Bush, told the AP. “But repealing the statute is now not possible, even in the mind of the most ardent opponent.”
The health care impact of the election goes beyond Congress.
Voters in the Republican-dominated states of Idaho, Nebraska and Utah all passed ballot measures to expand Medicaid, which could bring coverage for an additional 363,000 low-income adults, adding to the 12 million already covered by the expansion elsewhere. Under the Affordable Care Act, federal taxpayers pick up most of the bill for the expansion. Starting in 2020, states will have to contribute 10 percent of the cost.
“For all the people who have been slipping through the cracks in our health care system in Utah, there is finally good news,” RyLee Curtis, campaign manager for Utah Decides Healthcare, said Wednesday on a conference call with reporters. “Help is on the way.”
Advocates, however, were disappointed by the outcome in Montana, where voters rejected a measure that would have made that state’s Medicaid expansion permanent with financing from a tobacco tax. The debate isn’t over, but it will move to the state legislature instead.
Jonathan Schleifer, executive director of The Fairness Project, which campaigned for the expansion measures, said states including Missouri, Florida and Oklahoma could be pursued for future ballot measures.
Democrats picked up governorships Tuesday in two states that may now expand Medicaid — Kansas and Wisconsin.
In Kansas, health care tied with immigration as voters’ top issue. In Wisconsin, which did not join the federal Medicaid expansion but does allow more adults into the program already, it was the biggest concern identified by about one-third of voters.
In both states, about 7 in 10 of voters who said health care was their main concern voted for the Democrat for governor.
That helped put Tony Evers over the top in his race against incumbent Republican Scott Walker in Wisconsin and pushed Laura Kelly to victory in a close race against Republican Kris Kobach in Kansas.
Kelly got big cheers in her victory speech when she called for a Medicaid expansion, which she said was important “so that more Kansans have access to affordable health care, our rural hospitals will stay open and the tax dollars we’ve been sending to Washington will come back home.”
Medicaid was also a key issue in Maine, where voters last year approved a ballot measure to expand but where the current governor, Republican Paul LePage, refused to implement it. Democrat Janet Mills campaigned on implementing it and defeated Republican Shawn Moody, who campaigned against expansion.
Tuesday’s election results were far less clear on where Americans stand on a move to universal health coverage, an idea that a growing number of Democratic candidates, including several considering presidential bids, have been backing.
In his campaign for governor in Florida, Democrat Andrew Gillum called health care for all a “north star” that the state should aspire to while offering up the intermediate step of expanding Medicaid as a must-do in the nation’s third most populous state. The majority of Florida voters in the AP survey disapproved of Trump’s handling of health care, and 3 in 5 also said it should be the government’s responsibility to provide coverage.
There, health care was tied with immigration as voters’ top concern and Republican Ron DeSantis, a former member of Congress closely aligned with Trump, won.
Meanwhile in Colorado, Jared Polis, a Democrat, was elected governor while promoting a single-payer health system for the state. Voters there rejected a ballot measure to create such a system two years ago.
Charles Idelson, a spokesman for National Nurses United, a group pushing for single-payer health coverage, said the number of supporters of the concept is increasing at all levels of government after the election despite what he called “vilification of that issue and the demagoguery of that issue” by Republicans in campaign ads.
Kathleen Sebelius, health secretary under Obama, told the AP she expects House Democrats to start designing a framework for covering all Americans and for that to be a major issue in 2020 elections.
“One of the things this election clearly demonstrates is that health care for all is a unifying principle for the Democrats,” she said. “We have been working toward that goal since 1965, when Medicare and Medicaid were passed.”
Mulvihill reported from Philadelphia. Follow him at http://www.twitter.com/geoffmulvihill
For AP’s complete coverage of the U.S. midterm elections: http://apne.ws/APPolitics
The US government has huge debts, and House Democrats could lead the way on solutions – an economist explains how
November 7, 2018
Laurence J. Kotlikoff
Professor of Economics, Boston University
Laurence J. Kotlikoff does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Boston University provides funding as a founding partner of The Conversation US.
Now that Democrats control the House, the question on many minds is what they will do with it.
Incoming Majority Leader Nancy Pelosi says Democrats will focus on corruption, money in politics, drug prices, gun control and protecting young immigrants. These are important but, in my view, second-order issues.
The biggest challenges facing the U.S. are much deeper and seriously jeopardize Americans’ future prosperity. Namely, soaring national debt, Social Security’s solvency and the lack of affordable health care.
As an economist, I’ve spent a lot of time researching and writing about these issues. And as a presidential candidate in 2016, I tried to put them on the national agenda when I staged an independent write-in campaign.
Were I leading the House Democrats right now, I would focus on passing three key bills. The Senate would likely turn them down, but their passage would show the country that Democrats are prepared to govern.
The US $200 trillion fiscal gap
It starts by acknowledging the true state of America’s fiscal condition.
No politician that I know of has ever told the truth about this, either because he or she didn’t know the truth or were hiding it. Brace yourself. Here’s where we really stand.
The official debt is $21.7 trillion – more than the value of all goods and services that will be produced in the U.S. this year. But this ignores massive unfunded obligations that have been kept off the books, such as paying for future Social Security, Medicare and Medicaid benefits.
When you calculate the present value of all anticipated future outlays less all the receipts projected by the Congressional Budget Office, you get a whopping $200 trillion fiscal gap. This is how much we – or more accurately our children – really owe.
Closing this fiscal gap will require dramatic changes, including much higher taxes and drastic spending cuts. Yes, Republicans hate the former and Democrats loathe the latter. But the longer we wait to do this, the larger the taxes our kids – or theirs – will pay and the lower the benefits they will receive. And at some point, America’s decades long intergenerational Ponzi scheme will collapse.
There is hope, however. Several simulations and studies I’ve conducted suggest three basic reforms that could largely eliminate the $200 trillion fiscal gap – while reducing rising levels of inequality in the process.
Real tax reform
Let’s start with taxes.
The current fiscal system is riddled with inefficiencies, and what’s worse it lets the super-rich pay literally zero taxes. This means there are ways to increase revenue without creating major burdens on the poor or middle class.
I would ask the now Democrat-controlled House Ways and Means Committee to draw up legislation to get rid of the current corporate income, personal income and FICA taxes. I would replace them with a value added tax, a highly progressive personal consumption tax, a progressive payroll tax and a high carbon tax.
These changes would dramatically improve incentives to work and save, make the rich pay their fair share and help save the climate – all while increasing revenues by 5 percent of GDP.
Modern Social Security
Of our nation’s $200 trillion fiscal gap, $34 trillion is Social Security’s unfunded liability – that is, how much we owe tomorrow’s retirees beyond how much revenue the system is expected to take in. This is why by the early 2030s, Social Security will be out of money, requiring a bailout or a draconian and permanent benefit cut that’s close to one-quarter.
Democratic hero Franklin Delano Roosevelt helped establish Social Security in 1935. As such, it’s the party’s baby. They want to protect and preserve it at all costs.
It’s not just the system’s finances that are a problem but also its structure. The system has hundreds of thousands of incomprehensible rules. It’s a bureaucrat’s fantasy and a user’s nightmare.
The solution, however, isn’t to save it but to retire it – and replace it with something better. Social Security was based on the idea that today’s workers can support today’s retirees. While your benefits are tied to how much you earned, longer lifespans mean the payouts last much longer than a half-century ago.
A simple system that is more directly linked to what each person sets aside for retirement, with proceeds invested in the same global index fund, free of fees, would be simple, transparent and fully funded. The government would match contributions by the poor and contribute in full on behalf of the disabled and unemployed.
Affordable insurance for everyone
Another top priority should be health care, the biggest concern among midterm voters.
Close to 30 million Americans are uninsured – up 3 million since President Donald Trump took office.
Given today’s health care costs, even an unexpected gall bladder operation can bankrupt an uninsured middle-class household. No American should be forced to live with such financial risk. Everyone, not just the president and his family, needs basic coverage. Since a big chunk, roughly $60 trillion, of our $200 trillion debt comes from Medicare and Medicaid, the challenge as I see it is how to make universal basic health care affordable for the government.
Bernie Sanders and other liberal politicians argue the path to universal health care is “Medicare for all.” I advocate something slightly different: “Medicare Part C for all.”
Also known as the Advantage Plan, Medicare Part C pays HMOs to provide basic health care coverage, including outpatient and inpatient care, prescription drugs and other services. It currently covers one-third of Medicare participants. Let’s just expand it to everyone. Yes, Medicare Part C limits you to one provider. But you can change providers annually.
Under the plan, every American would receive an annual voucher based on his or her pre-existing conditions. The voucher would be larger for those with higher expected health care costs. The voucher would be used to purchase, in full, the system’s single basic health insurance plan from one’s chosen health insurer. No insurer could refuse coverage to any participant regardless of their pre-existing conditions or place of residence.
It would be affordable because, although it allows for multiple private providers, it would be single-payer – which would dramatically reduce costs.
‘Heed the call’
There are a lot of issues that I also think should be high on Democrats’ priority list, such as meaningful banking reform and ensuring all American children get an equal education. But tackling America’s crushing debt load and reducing the fiscal gap – issues that Republicans have previously indicated they care about – would pay the biggest dividends and show Democrats can identify and solve real problems.
Will the Democrats take advantage of their “blue wave” and pursue such an agenda? I hope so. There are lots of new blue members of Congress that ran on fixing the country, not playing political games. As they ponder their first steps in 116th Congress, they would do well to heed Bob Dylan’s lyrics:
Come senators, congressmen
Please heed the call
Don’t stand in the doorway
Don’t block up the hall
For he that gets hurt
Will be he who has stalled.
Amazon and counterfeit products
By Robert B. Engel
Imagine what Christmas morning would be like if your kids unwrapped their brand-new Beats headphones or Xbox only to find that they were defective knock-offs.
If you think this is the stuff of urban legend, think again: Given the growing number of counterfeits hiding in plain sight within Amazon’s massive commerce and distribution network, scenes like this one are playing out with increasing frequency. And fake products are not only a let-down, they could pose health and safety risks and make it extremely difficult for legitimate businesses to compete.
The Counterfeit Report, an advocacy group that sheds light on fake products, counted nearly 60,000 counterfeit goods on Amazon over the last two years. Even some of the most popular manufacturers have been affected by Amazon’s failure to adequately address counterfeiting. For example, a 2016 investigation by Apple found that nearly 90 percent of iPhone cables and other Apple accessories sold on Amazon were fake.
Yet beyond the scale of Amazon’s counterfeit problem is the fact that the tech giant’s policies essentially promote fraud from dishonest sellers. Amazon’s hybrid business model — simultaneously acting as a giant marketplace for third-party sellers and also providing end-to-end logistics — certainly gives the company greater ownership of products sold on its platform. This unique way of operating means that Amazon holds, stores, packs and ships the goods from independent retailers. However, many sellers have learned the hard way that this hybrid model invites a host of nefarious activity from dishonest sellers.
Amazon’s stadium-size distribution centers have become ground-zero for counterfeiting due to a little-known product storage process the company calls comingling. When Amazon offers to handle the distribution of a product, sellers are encouraged to allow for their products to be stored in the same handling bin as similar products because doing so will supposedly maximize their chances of being selected by consumers. Sellers are also incentivized to choose comingling because it is the cheaper alternative when compared to other storage and distribution options. But the comingling process makes it nearly impossible for Amazon to conduct appropriate quality controls on the products it offers to consumers.
By storing all similar products in the same handling bins, Amazon allows one bad apple to spoil the whole bunch. For example, a DVD seller had his entire business shut down because pirated DVDs that came from his handling bin were sent out in place of his genuine products. Despite a 97 percent feedback rating from customers, he was told he had to liquidate his merchandise — and had to pay thousands of dollars to do so. This case illustrates the impossible choice Amazon sellers face: reducing their sales by declining the comingling option or inviting the risk of counterfeits that can cause irrevocable harm to their brand.
Amazon’s product storage practices not only put legitimate sellers between a rock and a hard place but also shield dishonest distributors from being caught. As any third-party seller — or multiple sellers — could be responsible for the fakes in any one bin, it becomes almost impossible to trace the fakes back to their fraudulent source. And given the fact that pricing policies incentivize sellers to elect comingling, it seems that Amazon has made a business decision to look the other way when it comes to counterfeits.
Even Amazon itself has admitted that the company struggles to distinguish among merchandise that it warehouses and ships for third-party sellers, which might be why it allows merchants to track their products through the distribution process. But once again, Amazon puts sellers in an impossible position by forcing them to pay for tracking services. Not only does this unfairly place the onus entirely on the sellers to police counterfeits, but it also creates an uneven playing field that disproportionately hurts small businesses. Many small sellers work on razor-thin margins and simply cannot incur additional costs to safeguard against counterfeits — something one of the richest companies in the world should be doing for them.
Of course, all of this ends up hurting the consumer when a counterfeit product is delivered to their doorstep. It might be big business to handle products in ways that shield fraudsters, but if Amazon is unwilling or unable to police its own platform and distribution network for the products it physically handles, regulators must step in to protect consumers and honest sellers.
ABOUT THE WRITER
Robert B. Engel is chief spokesman of the Free & Fair Markets Initiative. He wrote this for InsideSources.com.
US emergency directive after Boeing jet crash in Indonesia
By NINIEK KARMINI and STEPHEN WRIGHT
Thursday, November 8
JAKARTA, Indonesia (AP) — The U.S. Federal Aviation Administration issued an emergency airworthiness directive on how to handle erroneous data from a sensor that investigators believe malfunctioned on a new Boeing jet that plunged into the sea in Indonesia, killing all 189 people on board.
The directive gives regulatory weight to Boeing’s safety bulletin that it sent to operators of Boeing 737 MAX 8 and MAX 9 planes based on findings from the ongoing Indonesian investigation into the Oct. 29 crash of a Lion Air jet. FAA directives are usually followed by other airline regulators internationally.
The FAA said erroneous data from the “angle of attack” sensor, which helps prevent the plane from stalling and diving, could cause flight crew to have difficulty controlling the airplane and lead to “excessive nose-down attitude, significant altitude loss, and possible impact with the terrain.”
The directive instructs airlines to make specific changes to flight manual procedures for responding to the problem. Boeing’s bulletin said it was directing flight crews to existing guidelines.
Indonesian investigators on Wednesday said the sensor was replaced on the Lion Air plane the day before its fatal flight and may have compounded other problems with the aircraft.
The 2-month-old Boeing 737 MAX 8 crashed into the Java Sea 13 minutes after takeoff from Jakarta. Both that flight and its Oct. 28 flight from Bali to Jakarta had erratic speed and altitude shortly after takeoff.
On Wednesday night, Lion Air aborted a flight when one of its planes damaged a wing tip when it struck a lamp pole before takeoff from Bengkulu. The airline faulted the airport’s aircraft movement control personnel who directed the plane from the apron to the taxiway.
Indonesia’s National Transportation Safety Committee earlier this week had said the plane that crashed had a malfunctioning airspeed indicator on its last four flights, based on analysis of the flight data recorder. Chairman Soerjanto Tjahjono said the airspeed indicator and sensor problems are related.
Lion Air’s first two attempts to address the airspeed problem didn’t work, and for the jet’s second-to-last flight the “angle of attack” sensors were replaced, Tjahjono said.
On that Oct. 28 flight, from Bali to Jakarta, the pilot’s and copilot’s sensors disagreed by about 20 degrees. The plane went into a sudden dive minutes after takeoff, from which the pilots were able to recover. They decided to fly on to Jakarta at a lower-than-normal altitude.
On the fatal flight, the plane hit the water at very high speed after the flight crew had been cleared to return to the airport several minutes after takeoff.
“The point is that after the AOA (sensor) is replaced, the problem is not solved but the problem might even increase. Is this fatal? NTSC wants to explore this,” Tjahjono said.
Airline safety experts said pilots are trained to handle a plane safely if those crucial sensors fail and backup systems are generally in place as well.
There are audio signals and physical warnings that can alert the pilot to malfunctioning equipment or other dangers, said Todd Curtis, director of the Airsafe.com Foundation.
“They should have been completely engaged in what was going on inside that cockpit, and any kind of warning that came up, they would have been wise to pay attention to it,” Curtis said.
Investigators are likely focused on how a single sensor’s failure resulted in a faulty command that didn’t take into account information from a second sensor, said John Cox, CEO of Safety Operating Systems.
“We don’t know what the crew knew and didn’t know yet,” Cox said. “We will.”
Indonesia’s search and rescue agency has extended the search until Sunday. Body parts are still being recovered and searchers continue to hunt for the cockpit voice recorder.
Indonesia’s transportation safety committee said it had agreed with Boeing on procedures that the airplane manufacturer should distribute globally on how flight crews can deal with the sensor problems.
The flight procedure recommendations to Boeing were based on how the flight crew responded to problems on the Bali-to-Jakarta flight, said investigator Nurcahyo Utomo.
Lion Air is one of Indonesia’s youngest airlines but has grown rapidly, flying to dozens of domestic and international destinations.
Business Writer Cathy Bussewitz contributed to this report from New York.