Today marks the 60th anniversary of the creation of Medicare and Medicaid — and nearly one month since President Trump’s federal budget slashed nearly $1 trillion from Medicaid to extend tax cuts for the rich. The cuts could lead to tens of thousands of unnecessary deaths every year. “Medicaid has been a lifeline. And without it, people will die,” says Ai-jen Poo, co-founder of Caring Across Generations and the Domestic Workers Alliance, which helped organize a 60-hour vigil last week ahead of the anniversary as part of a broader campaign to fight back against Trump’s cuts. She highlights the role of immigrants, who make up a third of the caregiving sector, and says Trump’s crackdown on immigration hastens the dwindling of care available to the aging and elderly. “We should be adding a trillion dollars in investments in healthcare in this country and in caregiving services in this country,” says Poo. “We need to strengthen these systems and programs for the 22nd century, not gut them.”

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

President Donald Trump’s “big, beautiful bill” now before the Senate could result in over 51,000 preventable deaths each year in the United States. That’s according to public health experts at Yale and the University of Pennsylvania, who sent a letter warning about the bill’s impact to the Senate Finance Committee. An estimated 16 million people stand to lose their health coverage as a result of the changes in the bill, which “imposes onerous paperwork and fails to safeguard healthcare tax credits,” says Alison Galvani, director of the Center for Infectious Disease Modeling at Yale and one of the signatories to the letter. She also notes universal healthcare would have the opposite effect and save tens of thousands of lives each year. “There are a lot of ways we can improve how expensive our healthcare is, but taking healthcare away from people is not how to do it,” says Galvani.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

Trump’s sweeping budget legislation has been described as the biggest Medicaid cut in U.S. history. House Republicans passed the bill early Thursday morning in a 215-214 vote. The legislation would trigger massive cuts to Medicare and Medicaid over the next 10 years, denying coverage to an estimated 7.6 million Americans, according to the Congressional Budget Office. Food assistance under the federal SNAP program would also see $300 billion in cuts, while adding billions in funding for Trump’s mass deportation agenda and giving the wealthiest Americans a tax break.

“The legislation is basically a mugging conducted by the 1% against the rest of us. It represents the single largest upward redistribution of wealth effectuated by any piece of legislation in our history,” says Chris Lehmann, D.C. bureau chief for The Nation.

Senate Republicans, who have voiced some concerns over the bill, will now have to pass their own version of the budget. With all Democratic senators opposed to the package, Republicans are working to use the reconciliation process to avoid a filibuster.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

As a Republican-sponsored budget bill advances through Congress, we hear from Bishop William Barber about how the bill hurts low-income people. “It is about death-dealing and destruction to the poor and the elderly and the youth of our country,” says Barber, citing the bill’s cuts to essential social services like Medicaid and paralleling those cuts to the government’s funding of defense and deportation initiatives. “We have to start talking about this budget as a form of social and political murder.” Barber has been arrested with other faith leaders twice in the past month while protesting cuts, including in the Capitol Rotunda.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

“Private Medicare Advantage plans routinely fail to deliver quality care—especially for seniors and the most vulnerable—and are among the most wasteful, fraudulent, and abusive actors in our healthcare system,” said Emma Freer, Senior Policy Analyst for Healthcare at the American Economic Liberties Project. “For years, these firms have driven seniors into worse care with deceptive marketing and discrimination, but now it’s clear they’re crooks too—bribing brokers behind closed doors because they know no one would choose these plans on a level playing field. We’re thrilled to see the DOJ crack down on Aetna, Elevance Health, and Humana—three vertically-integrated Fortune 40 Big Medicine conglomerates—and urge the DOJ to move swiftly on its ongoing monopolization and fraud investigations in the largest Medicare Advantage plan provider, UnitedHealth Group.”

Medicare Advantage is the privatized version of Medicare and now covers more than half of Medicare patients. Intended to lower costs and improve quality, Medicare Advantage has had the opposite effect. The program is expected to cost taxpayers 20% more per enrollee – or $84 billion annually – than traditional Medicare in 2025. Meanwhile, Medicare Advantage plans deny claims at much higher rates, stranding vulnerable seniors without medically-necessary care to further pad their own profits. Despite its promises to crack down on such wasteful spending, the Trump administration recently announced it would substantially increase payments to private Medicare Advantage plans in 2026, rewarding their bad behavior.

Learn more about Medicare Advantage here.

Learn more about Economic Liberties’ Break Up Big Medicine initiative to address healthcare consolidation here.

Learn more about Economic Liberties here.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

“The American people understand, as I do, that health care is a human right, not a privilege and that we must end the international embarrassment of the United States being the only major country on earth that does not guarantee health care to all of its citizens,” said Senator Bernie Sanders. “It is not acceptable to me, nor to the American people, that over 85 million people today are either uninsured or underinsured. Today, there are millions of people who would like to go to a doctor but cannot afford to do so. This is an outrage. In America, your health and your longevity should not be dependent on your wealth. Health care is a human right that all Americans, regardless of income, are entitled to and they deserve the best health care that our country can provide.”

“It is a travesty when 85 million people are uninsured or underinsured and millions more are drowning in medical debt in the richest nation on Earth,” said Representative Pramilla Jayapal. “We don’t suffer from scarcity in America, we suffer from greed. That’s most clear in our broken healthcare system, which is why we need Medicare for All. People deserve and want comprehensive health care that covers mental health, long-term care, reproductive care, dental, vision and hearing, all without copays, private insurance premiums, sky high deductibles or other hidden fees. Health care is a human right, that is exactly why it’s time to pass Medicare for All.”

“Every American has the right to health care, period. If you’re sick, you should be able to go to the doctor without being worried about the cost of treatment or prescription medicine. Too many families must decide between putting food on the table and getting medical care that they desperately need,” said Representative Debbie Dingell. “A health care system that ties coverage to employment will always leave patients vulnerable. It’s flat-out wrong and Medicare for All would put a stop to it. We’ve been fighting this fight since the 1940s, when my father-in-law helped author the first universal health care bill. It’s time to get this done.”

“As Donald Trump, Robert Kennedy and Congressional Republicans rush to strip health care from millions of Americans, we know this: We must not only block their cruel cuts but move America to a system that provides health care to everyone as a matter of right,” said Robert Weissman, co-president, Public Citizen. “America spends much more than other wealthy countries on health care only to have the worst health outcomes. The system works for health insurers, Big Pharma, hospital chains and private equity firms – but no one else. Medicare for All would ensure everyone in America can get the care they need throughout their lives. It is the realistic, humane, just and efficient reform we need.”

“Nurses see the failure of our country’s profit-driven health care system every time we clock in to work,” said Nancy Hagans, President of National Nurses United. “In the richest country on earth, nobody should be forced to choose between taking their medications and putting food on the table. Yet countless families are pushed to the breaking point while greedy corporations charge astronomical, ludicrous fees for care that our patients have every right to receive. Nurses are fighting for a future in which our patients’ health is put first always and that’s why we are proud to continue our support for Medicare for All. When we guarantee health care for all, corporations and billionaires will no longer be able to deny anyone the care that they need.”

“We are long overdue for a universal health care system that guarantees care for all — free of copays, deductibles, and job-based coverage restrictions,” said Dr. Diljeet K. Singh, M.D., Dr.P.H., and President of Physicians for a National Health Plan. With the passage of the Medicare for All Act, physicians can focus on healing patients, not battling insurers over denials and delays. Patients will finally be able to seek care without the constant fear of crushing medical bills. Physicians for a National Health Program proudly stands with our legislators in the fight to make excellent health care a reality for everyone in America.”

“Postal workers know the value of affordable, universal services, grounded in a commitment to putting people over profits. That’s the type of service we are committed to provide communities across the country, day in and day out,” said APWU President Mark Dimondstein. “For too long, greedy corporations and their Wall Street investors have been able to deny the people of the country the quality, affordable, universal healthcare working people deserve. “Medicare for All,” healthcare as a human right, will make us all healthier and financially better off. A healthcare system that works for working people, not the profits of the insurance companies, is long overdue. It’s time for Medicare for All.”

“Medicaid is a life and death issue for tens of millions of people,” said Jaron Benjamin, Deputy Chief of Campaigns at Popular Democracy in Action. “For years, our network has fought for programs like Medicaid and Medicare that keep families whole: elders aging with dignity, children getting the care they need, people with disabilities living full lives. Instead of protecting what works, Republicans in Congress are pushing cuts to Medicaid so they can hand more money to their billionaire backers. We won’t stand by while our communities are sacrificed for tax giveaways.”

“If you want to renew the public’s faith in our political system, pass The Medicare for All Act of 2025,” said Alan Minsky, Executive Director, Progressive Democrats of America. “This one piece of legislation will instantly end the era, which has lasted far too long, when profits and wealth accumulation are more important than human life, including yours. MFA will return the general welfare, and the well-being of every individual, to the heart of our social contract. That will renew faith in America.”

“It is a travesty when 85 million people are uninsured or underinsured and millions more are drowning in medical debt in the richest nation on Earth,” said Jayapal. “We don’t suffer from scarcity in America, we suffer from greed. That’s most clear in our broken healthcare system, which is why we need Medicare for All. People deserve and want comprehensive health care that covers mental health, long-term care, reproductive care, dental, vision and hearing, all without copays, private insurance premiums, sky high deductibles or other hidden fees. Health care is a human right, that is exactly why it’s time to pass Medicare for All.”

“Health care is a human right and a basic need. Yet instead of getting health care, Americans get delays, denials, and bills they cannot afford. Today, predatory insurance CEOs are poised to reap the windfall from the tax scam giveaways earmarked for billionaires and corporations. The oligarchs that put Donald Trump and Dr. Oz in power want everything we have. We get sicker, make impossible choices, and go broke. They boost the stock prices of corporations – like UnitedHealth – that profit off our pain, and buy more mansions and yachts. We can put an end to those warped priorities through Medicare for All,” said Sulma Arias, executive director of People’s Action Institute. “Working people have made this the wealthiest nation in the history of the world, and there is more than enough if we don’t let the corporate crooks and billionaires steal it. So it’s time to choose: Our health care or their greed?” she added.

“Healthcare is a right, not a privilege. The reintroduction of the Medicare for All Act is a crucial step toward ending a system that profits from people’s pain,” said Analilia Mejia and DaMareo Cooper, Co-Executive Directors of Popular Democracy. “Too many Americans are forced to choose between paying their rent and paying for life-saving medication, while corporations rake in billions. Medicare for All isn’t just a policy—it’s the lifeline working families desperately need. Our communities deserve a healthcare system that prioritizes people over profits. We will fight until we win the healthcare we deserve.”

This content originally appeared on Common Dreams and was authored by Newswire Editor.

NNU members have long supported efforts to achieve guaranteed health care for every person in the United States, through a single-payer system that provides health care based on patient needs, not industry profits. The legislation comes at a critical time when vital lifesaving health care programs, like Medicaid and Veterans Health Administration benefits, are at risk of being completely gutted.

“Nurses are fighting for a future in which our patients’ health is put first always and that’s why we are proud to continue our support for Medicare for All,” said Nancy Hagans, RN and NNU president. “When we guarantee health care for all, corporations and billionaires will no longer be able to deny anyone the care that they need. In the richest country on earth, nobody should have to be forced to choose between taking their medications and putting food on the table. Yet countless families are pushed to the breaking point while greedy corporations charge astronomical, ludicrous fees for care that is every patient’s right to receive.”

The Medicare for All Act builds upon and expands Medicare to provide comprehensive benefits – primary care, vision, dental, prescription drugs, mental health services, home and community-based care, and more – to every person. In addition to allowing patients to have the freedom to choose the doctors, hospitals, and other providers they wish to see without worrying about whether a provider is in-network, the bill would also allow the health care system to negotiate drug prices and reduce exorbitant administrative waste.

Currently, 85 million people in America are either uninsured or underinsured, a number that stands to grow exponentially if Congressional lawmakers choose to gut, rather than defend and strengthen, the country’s public health infrastructure.

“The goal of the current administration and their billionaire buddies is to pile on endless cuts and attacks so that we become too demoralized and overwhelmed to move forward,” said Bonnie Castillo, RN and executive director of NNU. “Registered nurses and our allies don’t step back but step up, during pandemics, climate emergencies, and authoritarian regimes. We won’t let them threaten public services like Medicaid, Medicare, and Social Security or try to eliminate federal workers’ protected union rights. As patient advocates, it is our duty to fight for a system that prioritizes people over profits. So even on our hardest days, we won’t stop fighting for Medicare for All.”

“The American people understand, as I do, that health care is a human right, not a privilege and that we must end the international embarrassment of the United States being the only major country on earth that does not guarantee health care to all of its citizens,” said Senator Bernie Sanders (I-VT). “It is not acceptable to me, nor to the American people, that over 85 million people today are either uninsured or underinsured. Today, there are millions of people who would like to go to a doctor but cannot afford to do so. This is an outrage. In America, your health and your longevity should not be dependent on your wealth. Health care is a human right that all Americans, regardless of income, are entitled to and they deserve the best health care that our country can provide.”

“It is a travesty when 85 million people are uninsured or underinsured and millions more are drowning in medical debt in the richest nation on Earth,” said Representative Pramila Jayapal (WA-07) . “We don’t suffer from scarcity in America, we suffer from greed. That’s most clear in our broken healthcare system, which is why we need Medicare for All. People deserve and want comprehensive health care that covers mental health, long-term care, reproductive care, dental, vision and hearing, all without copays, private insurance premiums, sky high deductibles or other hidden fees. Health care is a human right, that is exactly why it’s time to pass Medicare for All.”

“Every American has the right to health care, period. If you’re sick, you should be able to go to the doctor without being worried about the cost of treatment or prescription medicine. Too many families must decide between putting food on the table and getting medical care that they desperately need,”said Representative Debbie Dingell (MI-06). “A health care system that ties coverage to employment will always leave patients vulnerable. It’s flat-out wrong and Medicare for All would put a stop to it. We’ve been fighting this fight since the 1940s, when my father-in-law helped author the first universal health care bill. It’s time to get this done.”

For more information on the Medicare for All Act, please refer to NNU’s fact sheet.

In addition to the Medicare for All Act, NNU members are advocating for the following federal legislation:

• NURSE STAFFING STANDARDS FOR HOSPITAL PATIENT SAFETY AND QUALITY CARE ACT, sponsored by Rep. Jan Schakowsky: There are no federal mandates regulating the number of patients a registered nurse can care for at one time in U.S. hospitals. As a result, registered nurses (RNs) are consistently required to care for more patients than is safe, compromising patient care and negatively impacting patient outcomes. These dangerous conditions are causing thousands of RNs to leave the hospital bedside. This legislation would improve patient care and increase nurse retention by setting mandated, minimum RN-to-patient staffing ratios.
• THE WORKPLACE VIOLENCE PREVENTION FOR HEALTH CARE AND SOCIAL SERVICE WORKERS ACT, sponsored by Sen. Tammy Baldwin and Rep. Joe Courtney: Violence against nurses and other health care workers in hospitals and other health care facilities is a growing epidemic across the United States. Nurses report being punched, kicked, bitten, beaten, choked, and assaulted on the job — and some have faced stabbings and shootings. The Covid-19 pandemic exacerbated the hazard of workplace violence, with nurses reporting an increase in violent incidents on the job since the beginning of the pandemic. The Workplace Violence Prevention for Health Care and Social Service Workers Act would mandate OSHA to promulgate a standard that would require all covered employers to develop and implement prevention plans to reduce workplace violence incidents. The Workplace Violence Prevention bill passed the House of Representatives in both the 116th and 117th Congress with significant bipartisan support.
• THE RICHARD L. TRUMKA PROTECTING THE RIGHT TO ORGANIZE (PRO) ACT, sponsored by Sen. Bernie Sanders and Rep. Bobby Scott: A union gives workers the ability to act together to advocate for safe working conditions, to improve their wages and benefits, and to protect their workplace rights through collective bargaining and concerted activity. For registered nurses, union advocacy and representation allows us to focus on what we do best: caring for our patients. Attacks on unions and the right to unionize have hurt efforts to improve the lives of working families. Current labor law does far too little to protect and allow workers to exercise our right to join a union. The PRO Act is an important step to protect workers’ rights to organize a union and to stop employers’ attacks so that every worker can organize without fear of retaliation. The PRO Act passed the House of Representatives in the 116th and 117th Congress with bipartisan support.
• THE VA EMPLOYEE FAIRNESS ACT, sponsored by Rep. Mark Takano: Section 7422 of Title 38 of the U.S. Code limits the collective bargaining rights of certain Veterans Affairs (VA) clinical professionals, including registered nurses. This section restricts the ability of registered nurses to speak out about poor working conditions and to resolve disputes with management. As a result, the quality of patient care can deteriorate and problems in VA facilities can go unaddressed. The VA Employee Fairness Act would improve patient care in VA hospitals by expanding the collective bargaining rights of registered nurses and other clinicians employed by the Veterans Health Administration (VHA). The VA Employee Fairness Act passed the House of Representatives in December 2022 with bipartisan support.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

Photo by Hush Naidoo Jade Photography

Although it surely was not intended, Trump’s tariff plan may have opened the door for the Democrats to push for and win Medicare for All(M4A), a longstanding goal for progressives. It does this in two ways. First Trump was able slip by this massive tax scheme with almost no attention from the media. Democrats should demand Trump treatment when they push M4A.

The second reason is that Trump’s tariffs show that it is politically acceptable to tax the middle-class. Trump’s tariff scheme is a tax increase for middle-income households of several thousand dollars annually. If that is politically acceptable, then surely much smaller tax increases that may be needed to cover M4A would surely be politically feasible.

On the first point, Trump did talk about tariffs in his campaign, but there was very little written about how big his tariffs would likely be and how large a hit they would be to middle and moderate-income households. For this reason, most people, including those who follow the news closely, were shocked by the size of Trump’s tariffs. This is why the stock market crashed immediately after Trump’s tariff speech. If investors had expected anything like the tariffs Trump is putting in place, the market would have already priced in the impact of the tariffs.

To be clear, the media did note Trump’s call for tariffs, but they never demanded or received any specificity from Trump. By contrast, any time Vice-President Harris put forward a proposal, like her plan for covering assisted living for senior citizens, the media demanded to know exactly how she would pay for it.

Democrats have to learn to be Trumpian in dealing with the media. They can say we will have M4A, in fact improved M4A that covers dental, vision, and hearing, and we will find ways to pay for it because we’re a rich country: end of story. The days where we just accept that the media demand higher standards from Democrats than Republicans must be over. Trump gets to say f**k you when he doesn’t feel like answering a question. The Democrats need to do this also.

The second takeaway is that it is apparently not politically deadly to talk about tax increases on the middle-class. Trump and every Republican in Congress are just fine with a huge tax increase on the middle-class in the form of his massive tariffs.

In principle, most of the cost of M4A should be covered by lower payments for drugs and medical equipment, by bringing the pay of our doctors and dentists in line with their pay in other wealthy countries. We also will save hundreds of billions of dollars annually by getting rid of private insurers and replacing them with the far more efficient Medicare system.

But we are still likely to need additional revenue. Most of this money should come from the rich, who have been the big winners in the economy over the last half century. But it is likely that we won’t be able to get as much as we need exclusively from taxing the rich.

As our Modern Monetary Theory friends remind us, the purpose of taxation is to reduce demand in the economy and thereby prevent inflation. If we raise another $10 billion a year from increasing the taxes paid by Elon Musk, it’s not clear how much we will reduce demand. Musk will probably continue to consume at pretty much the same level as he did before the tax hike, although he may reduce his campaign contributions to right-wing candidates by some amount.

By contrast, if we raise an additional $10 billion in tax revenue from the middle-class, we can be pretty sure that we will be reducing demand by close to $10 billion, because middle-class people spend the bulk of their income. In the last two decades, Democrats have treated it as sacred first principle that they could never increase taxes on people earning less $400,000 a year.

Since Trump’s tariffs have shown that a large tax increase on the middle-class is just fine politically, they need not fear putting forward a modest one to two percentage point tax increase in order to give people near-free health care. Whatever they do put forward they can put in terms of the Trump tariffs. For example, they could put a ceiling on any middle-class tax hike, saying it will be no more than one-quarter of the tax hit from Trump’s tariffs.

In addition to being good policy, M4A should be great politics. People have come to like Obamacare over the fifteen years since it was made into law. It is now so popular even Trump doesn’t openly talk about ending it. The idea of extending Medicare to cover the whole population is likely to be extremely popular and it is a simple proposal that can be easily understood. M4A is a perfect bumper sticker slogan for cars and pickup trucks all across the country. It tells everyone what Democrats will do for them if they are put in office.

While it certainly was not Trump’s intention, his looney tariff scheme may have opened the door for M4A in a way that normal presidency never would. If democracy survives, we may get some real gains as a result of the Trump presidency.

This first appeared on Dean Baker’s Beat the Press blog.

The post Trump’s Tariffs Open the Door for Medicare for All appeared first on CounterPunch.org.

This content originally appeared on CounterPunch.org and was authored by Dean Baker.

Public Citizen Health Care Advocate Eagan Kemp issued the following statement:

“Dental, vision, and hearing services are crucial forms of health care.” said Kemp. “At the same time Trump and his cronies in Congress try to rip health care away from millions and push for further privatization of Medicare, Senator Sanders and Representative Doggett are showing what one of our top priorities in health care should be – improving traditional Medicare. The introduction of this legislation is an important step to ensure Medicare enrollees can access the care they need, and we hope that Congress will act quickly to pass these common sense reforms. Health care is a human right.”

This content originally appeared on Common Dreams and was authored by Newswire Editor.

“If Oz is confirmed as the CMS Administrator, attacks on traditional Medicare are likely to move into overdrive,” said Eagan Kemp, a health care policy advocate at Public Citizen. “We should strengthen Medicare by improving it and expanding access to it, not weaken it through further privatization.”

Top findings from the brief include:

• Since their inception in 2003, Medicare Advantage plans are estimated to have cost taxpayers more than $600 billion in overpayments. These overpayments are expected to grow to $1 trillion over the next decade.
• Just seven companies account for 84 percent of all Medicare Advantage enrollment. Disclosures reveal that these seven companies spent more than $330 million combined lobbying on all issues over the last five years, according to data from OpenSecrets.
• In 2024, these seven companies sent a combined 328 lobbyists to lobby the federal government. 223 lobbyists — nearly 70 percent of the total — reported specifically lobbying on “Medicare Advantage,” among other things.
• Dr. Mehmet Oz, President Trump’s nominee for Center for Medicare and Medicaid Services (CMS) Administrator, has endorsed the expansion of Medicare Advantage and has been one of the program’s most vocal supporters.

For more information on how Medicare Advantage harms seniors and taxpayers or on Dr. Oz’s conflicts of interest, contact Emily Leach at eleach@citizen.org.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

AMY GOODMAN: President Trump addressed a joint session of Congress in a highly partisan 100-minute speech, the longest presidential address to Congress in modern history on Wednesday.

Trump defended his sweeping actions over the past six weeks.

PRESIDENT DONALD TRUMP: We have accomplished more in 43 days than most administrations accomplished in four years or eight years, and we are just getting started.

AMY GOODMAN: President Trump praised his biggest campaign donor, the world’s richest man, Elon Musk, who’s leading Trump’s effort to dismantle key government agencies and cut critical government services.

PRESIDENT DONALD TRUMP: And to that end, I have created the brand-new Department of Government Efficiency (DOGE). Perhaps you’ve heard of it. Perhaps.

Which is headed by Elon Musk, who is in the gallery tonight. Thank you, Elon. He’s working very hard. He didn’t need this. He didn’t need this. Thank you very much. We appreciate it.

AMY GOODMAN: Some Democrats laughed and pointed at Elon Musk when President Trump made this comment later in his speech.

PRESIDENT DONALD TRUMP: It’s very simple. And the days of rule by unelected bureaucrats are over.

AMY GOODMAN: During his speech, President Trump repeatedly attacked the trans and immigrant communities, defended his tariffs that have sent stock prices spiraling, vowed to end Russia’s war on Ukraine and threatened to take control of Greenland.

PRESIDENT DONALD TRUMP: We also have a message tonight for the incredible people of Greenland: We strongly support your right to determine your own future, and if you choose, we welcome you into the United States of America. We need Greenland for national security and even international security, and we’re working with everybody involved to try and get it.

But we need it, really, for international world security. And I think we’re going to get it. One way or the other, we’re going to get it.

‘A declaration of war against the American people.’  Video: Democracy Now!

AMY GOODMAN: During Trump’s 100-minute address, Democratic lawmakers held up signs in protest reading “This is not normal,” “Save Medicaid” and “Musk steals.”

One Democrat, Congressmember Al Green of Texas, was removed from the chamber for protesting against the President.

PRESIDENT DONALD TRUMP: Likewise, small business optimism saw its single-largest one-month gain ever recorded, a 41-point jump.

REPUBLICAN CONGRESSMEMBER 1: Sit down!

REPUBLICAN CONGRESSMEMBER 2: Order!

SPEAKER MIKE JOHNSON: Members are directed to uphold and maintain decorum in the House and to cease any further disruptions. That’s your warning. Members are engaging in willful and continuing breach of decorum, and the chair is prepared to direct the sergeant-at-arms to restore order to the joint session.

Mr Green, take your seat. Take your seat, sir.

DEMOCRAT CONGRESS MEMBER AL GREEN: He has no mandate to cut Medicaid!

SPEAKER MIKE JOHNSON: Take your seat. Finding that members continue to engage in willful and concerted disruption of proper decorum, the chair now directs the sergeant-at-arms to restore order, remove this gentleman from the chamber.

AMY GOODMAN: That was House Speaker Mike Johnson, who called in security to take Texas Democratic Congressmember Al Green out. Afterwards, Green spoke to reporters after being removed.

DEMOCRAT CONGRESS MEMBER AL GREEN: The President said he had a mandate, and I was making it clear to the President that he has no mandate to cut Medicaid.

I have people who are very fearful. These are poor people, and they have only Medicaid in their lives when it comes to their healthcare. And I want him to know that his budget calls for deep cuts in Medicaid.

He needs to save Medicaid, protect it. We need to raise the cap on Social Security. There’s a possibility that it’s going to be hurt. And we’ve got to protect Medicare.

These are the safety net programmes that people in my congressional district depend on. And this President seems to care less about them and more about the number of people that he can remove from the various programmes that have been so helpful to so many people.

AMY GOODMAN: Texas Democratic Congressmember Al Green.

We begin today’s show with Ralph Nader, the longtime consumer advocate, corporate critic, former presidential candidate. Ralph Nader is founder of the Capitol Hill Citizen newspaper. His most recent lead article in the new issue of Capitol Hill Citizen is titled “Democratic Party: Apologise to America for ushering Trump back in.”

He is also the author of the forthcoming book Let’s Start the Revolution: Tools for Displacing the Corporate State and Building a Country That Works for the People.

Medicaid, Social Security, Medicare, all these different programmes. Ralph Nader, respond overall to President Trump’s, well, longest congressional address in modern history.

RALPH NADER: Well, it was also a declaration of war against the American people, including Trump voters, in favour of the super-rich and the giant corporations. What Trump did last night was set a record for lies, delusionary fantasies, predictions of future broken promises — a rerun of his first term — boasts about progress that don’t exist.

In practice, he has launched a trade war. He has launched an arms race with China and Russia. He has perpetuated and even worsened the genocidal support against the Palestinians. He never mentioned the Palestinians once.

And he’s taken Biden’s genocidal policies one step further by demanding the evacuation of Palestinians from Gaza.

But taking it as a whole, Amy, what we’re seeing here defies most of dictionary adjectives. What Trump and Musk and Vance and the supine Republicans are doing are installing an imperial, militaristic domestic dictatorship that is going to end up in a police state.

You can see his appointments are yes people bent on suppression of civil liberties, civil rights. You can see his breakthrough, after over 120 years, of announcing conquest of Panama Canal.

He’s basically said, one way or another, he’s going to take Greenland. These are not just imperial controls of countries overseas or overthrowing them; it’s actually seizing land.

Now, on the Greenland thing, Greenland is a province of Denmark, which is a member of NATO. He is ready to basically conquer a part of Denmark in violation of Section 5 of NATO, at the same time that he has displayed full-throated support for a hardcore communist dictator, Vladimir Putin, who started out with the Russian version of the CIA under the Soviet Union and now has over 20 years of communist dictatorship, allied, of course, with a number of oligarchs, a kind of kleptocracy.

And the Republicans are buying all this in Congress. This is complete reversal of everything that the Republicans stood for against communist dictators.

So, what we’re seeing here is a phony programme of government efficiency ripping apart people’s programmes. The attack on Social Security is new, complete lies about millions of people aged 110, 120, getting Social Security cheques.

That’s a new attack. He left Social Security alone in his first term, but now he’s going after [it]. So, what they’re going to do is cut Medicaid and cut other social safety nets in order to pay for another tax cut for the super-rich and the corporation, throwing in no tax on tips, no tax on Social Security benefits, which will, of course, further increase the deficit and give the lie to his statement that he wants a balanced budget.

So we’re dealing with a deranged, unstable pathological liar, who’s getting away with it. And the question is: How does he get away with it, year after year? Because the Democratic Party has basically collapsed.

Courts Just Say No to Trump’s Authoritarian Power Grabs https://t.co/wUZspBh6RQ

— Democracy Now! (@democracynow) March 6, 2025

They don’t know how to deal with a criminal recidivist, a person who has hired workers without documents and exploited them, a person who’s a bigot against immigrants, including legal immigrants who are performing totally critical tasks in home healthcare, processing poultry, meat, and half of the construction workers in Texas are undocumented workers.

So, as a bully, he doesn’t go after the construction industry in Texas; he picks out individuals.

I thought the most disgraceful thing, Amy, yesterday was his use of these unfortunate people who suffered as props, holding one up after another. But they were also Trump’s crutches to cover up his contradictory behavior.

So, he praised the police yesterday, but he pardoned over 600 people who attacked violently the police [in the attack on the Capitol] on 6 January 2021 and were convicted and imprisoned as a result, and he let them out of prison. I thought the most —

JUAN GONZÁLEZ: Ralph? Ralph, I —

RALPH NADER: — the most heartrending thing was that 13-year-old child, who wanted to be a police officer when he grew up, being held up twice by his father. And he was so bewildered as to what was going on. And Trump’s use of these people was totally reprehensible and should be called out.

Now, more basically, the real inefficiencies in government, they’re ignoring, because they are kleptocrats. They’re ignoring corporate crimes on Medicaid, Medicare, tens of billions of dollars every year ripping off Medicare, ripping off government contracts, such as defence contracts.

He’s ignoring hundreds of billions of dollars of corporate welfare, including that doled out to Elon Musk — subsidies, handouts, giveaways, bailouts, you name it. And he’s ignoring the bloated military budget, which he is supporting the Republicans in actually increasing the military budget more than the generals have asked for. So, that’s the revelation —

JUAN GONZÁLEZ: Ralph? Ralph, if I — Ralph, if I can interrupt? I just need to —

RALPH NADER: — that the Democrats need to pursue.

JUAN GONZÁLEZ: Ralph, I wanted to ask you about — specifically about Medicaid and Medicare. You’ve mentioned the cuts to these safety net programmes. What about Medicaid, especially the crisis in this country in long-term care? What do you see happening in this Trump administration, especially with the Republican majority in Congress?

RALPH NADER: Well, they’re going to slash — they’re going to move to slash Medicaid, which serves over 71 million people, including millions of Trump voters, who should be reconsidering their vote as the days pass, because they’re being exploited in red states, blue states, everywhere, as well.

Yeah, they have to cut tens of billions of dollars a year from Medicaid to pay for the tax cut. That’s number one. Now they’re going after Social Security. Who knows what the next step will be on Medicare? They’re leaving Americans totally defenceless by slashing meat and poultry and food inspection laws, auto safety.

They’re exposing people to climate violence by cutting FEMA, the rescue agency. They’re cutting forest rangers that deal with wildfires. They’re cutting protections against pandemics and epidemics by slashing and ravaging and suppressing free speech in scientific circles, like CDC and National Institutes of Health.

They’re leaving the American people defenseless.

And where are the Democrats on this? I mean, look at Senator Slotkin’s response. It was a typical rerun of a feeble, weak Democratic rebuttal. She couldn’t get herself, just like the Democrats in 2024, which led to Trump’s victory — they can’t get themselves, Juan, to talk specifically and authentically about raising the minimum wage, expanding healthcare, cracking down on corporate crooks that are bleeding out the incomes of hard-pressed American workers and the poor.

They can’t get themselves to talk about increasing frozen Social Security budgets for 50 years, that 200 Democrats supported raising, but Nancy Pelosi kept them, when she was Speaker, from taking John Larson’s bill to the House floor.

That’s why they lose. Look at her speech. It was so vague and general. They chose her because she was in the national security state. She was a former CIA. They chose her because they wanted to promote the losing version of the Democratic Party, instead of choosing Elizabeth Warren or Bernie Sanders, the most popular polled politician in America today.

That’s who they chose. So, as long as the Democrats monopolise the opposition and crush third-party efforts to push them into more progressive realms, the Republican, plutocratic, Wall Street, war machine declaration of war against the American people will continue.

We’re heading into the most serious crisis in American history. There’s no comparison.

AMY GOODMAN: Ralph Nader, we’re going to have to leave it there, but, of course, we’re going to continue to cover these issues. And I also wanted to wish you, Ralph, a happy 91st birthday. Ralph Nader —

RALPH NADER: I wish people to get the Capitol Hill Citizen, which tells people what they can really do to win democracy and justice back. So, for $5 or donation or more, if you wish, you can go to Capitol Hill Citizen and get a copy sent immediately by first-class mail, or more copies for your circle, of resisting and protesting and prevailing over this Trump dictatorship.

AMY GOODMAN: Ralph Nader, longtime consumer advocate, corporate critic, four-time presidential candidate, founder of the Capitol Hill Citizen newspaper. This is Democracy Now!

The original content of this programme is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States Licence. Republished by Asia Pacific Report under Creative Commons.

This content originally appeared on Asia Pacific Report and was authored by APR editor.

We continue to look at the U.S. health insurance industry and how patients can fight back against their providers with advocate Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York and co-founder of the Health Care for All New York campaign. She says her advice for patients is to always appeal denials and to seek outside help when possible, including advocacy groups like hers and external review boards. She also stresses that much of the chaos of the U.S. health system is due to corporate greed. “Everyone has an incentive to charge more,” says Benjamin. “If we had Medicare for All, we wouldn’t be paying as much, and we would probably have much better health outcomes.”

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

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For years, the home-oxygen industry has failed in myriad ways the million-plus Americans who struggle to breathe. Lincare, the country’s largest distributor of breathing equipment, has a decadeslong history of bilking Medicare and the elderly, as ProPublica has revealed. Philips Respironics hid serious problems with its sleep apnea machines, with devastating consequences, including reported deaths. Other large respiratory companies have paid multimillion-dollar fraud settlements.

But as the current session of Congress hurtles to a close, advocates for oxygen patients — in a seemingly improbable alliance with the companies that have victimized them — are making a final push for legislation that, among other things, would pay the scandal-scarred industry hundreds of millions of dollars more than it currently receives. The patients, many aged and infirm, have been besieging lawmakers with meetings, calls and emails, pressing them to pass the Supplemental Oxygen Access Reform, or SOAR, Act by the end of the year. The corporate and patient advocates vow that if the legislation fails in the current term, as seems possible, they will push to reintroduce it next year.

The SOAR Act would achieve two long-sought goals for the industry, which receives much of its revenues from Medicare. The bill would protect companies from additional reductions in their billings by removing oxygen from Medicare’s competitive bidding program, which has saved taxpayers hundreds of millions of dollars. And it would make it far more difficult for the government to challenge those billings.

The patient groups, in turn, have their own goals: improving the industry’s notoriously poor service and assuring access to costly liquid oxygen for a relatively small group of the sickest patients. That form of oxygen is coveted by patients with advanced lung disease because it provides the high flows they need in easy-to-carry cylinders that last for hours. Emotional accounts of stricken patients, unable to obtain the equipment they need, have been prominent in the lobbying campaign to pass the measure.

“The current situation is pretty horrific,” said Susan Jacobs, pulmonary research nurse manager at Stanford University Medical Center, who has spent more than a decade studying access to oxygen therapy and supports the legislation. “Patients aren’t getting the oxygen devices they need or being educated or trained on use of that device. The SOAR Act addresses multiple issues.”

Jacobs and other advocates acknowledge the history of bad behavior by oxygen companies. “I used to feel like they are the enemy,” Jacobs said. Added Erika Sward, assistant vice president of national advocacy for the American Lung Association, another supporter of the SOAR Act: “Some of the companies were very much acting in bad faith when it came to taxpayer dollars.”

But the patient advocates are now backing the industry’s long-standing complaints that Medicare’s payment cuts have gone too far. “I have become convinced of this over the past five years or so,” Sward said. “They’re not being paid enough under competitive bidding. … I fully believe the suppliers are negotiating from a very good-faith perspective for patients.” She added: “Unless everyone is willing to compromise, nothing is going to change. Obviously they have a financial interest.” (Sward said the American Lung Association receives no funding from oxygen companies or trade groups.)

The SOAR Act, which now has a half dozen sponsors in the Senate and 31 in the House, was first introduced in late February by Louisiana Republican Sen. Bill Cassidy, a physician, and Democratic senators Mark Warner of Virginia and Amy Klobuchar of Minnesota. “Respiratory care is lifesaving for so many patients, but too often access to this care is cost-prohibitive or simply not accessible,” said Warner, in a joint press release issued at the time. Cassidy, Warner and Klobuchar did not respond to requests for comment.

Beyond protecting against further Medicare rate cuts for items such as an oxygen concentrator (the bill would essentially freeze them at current levels), the SOAR Act would create a standardized medical form for authorizing suppliers’ claims; pay companies like Lincare to provide respiratory therapist services; and more than double what the companies are paid for liquid oxygen systems.

The bill is projected to cost taxpayers about $654 million over 10 years, according to a private study partly funded by industry (which the SOAR Act’s supporters have declined to share). The nonpartisan Congressional Budget Office has not yet prepared an estimate. Beneficiaries would also have to pay the companies more as part of their 20% Medicare copay.

Liquid oxygen has long been virtually unavailable even to Medicare beneficiaries who need it most. In 2004, before cuts in the government’s historically lavish payments for oxygen began kicking in, suppliers provided portable liquid oxygen equipment to more than 80,000 Americans.

Fewer than 4,000 Medicare patients received liquid oxygen in 2021, according to Medicare data. That’s a tiny portion of the 1.5 million Americans who now receive some form of supplemental oxygen. The bill’s advocates say there are thousands of Medicare beneficiaries who desperately need liquid oxygen to live more normal lives. “We’re ordering liquid,” Jacobs said. “Our [suppliers] are saying, ‘We don’t have it, and we can’t provide it.’ That’s not acceptable. Patients should be able to have enough oxygen to get out of their house. They’re unable to go to religious services, unable to see family, can’t go to a child’s graduation. These are heart-wrenching stories.”

Under the competitive bidding program that was launched in 2011, oxygen companies were legally required to provide liquid systems to any patient whose doctor prescribed them. But the companies insisted it was too expensive to do it at the rates the companies had agreed to in the bidding process. Providing liquid oxygen, which is stored at freezing temperatures under high pressure in special equipment, requires special trucks, frequent deliveries and hazmat-certified drivers.

Medicare enforcers never cracked down on the companies. Then, in 2019, the federal government “paused” the oxygen bidding program and many of its reimbursement rules — five years later, it can’t say when it may replace or reactivate them — freeing companies from any obligation to provide liquid oxygen.

In a statement, a Medicare spokesperson repeated the program’s long-standing contention, disputed by industry and patient groups alike, that access to liquid oxygen has not been a significant problem: “Although there were some complaints about contract suppliers refusing to furnish liquid oxygen, the suppliers came into compliance and agreed to furnish the liquid oxygen, so no [supplier] contracts were terminated as a result.”

The SOAR Act also includes what advocates call a “patient bill of rights” — and which they view as a major concession by the oxygen companies. Aimed at addressing the dismal service that has predominated, it and other parts of the bill would require suppliers to provide equipment setup assistance and monitoring, patient education and 24/7 coverage for emergencies as a condition for Medicare payment. (Left unresolved is how the federal government, whose enforcement record has historically been less than stellar, would police such rules.)

Lincare has long blamed problems on Medicare’s cuts and what it characterizes as the “flawed” competitive bidding program. The company told the agency in a 2017 letter that low reimbursements and “burdensome documentation requirements” had made it “next to impossible to continue providing quality services to beneficiaries.” Yet Lincare appears to collect substantial profits. It generated about $300 million in profit in 2023, on revenues of $2.4 billion, according to a former company executive. (Lincare declined to comment.) Rotech, another large company in the home respiratory business, was purchased this year for $1.36 billion, after recording $200 million in earnings for fiscal 2023.

Such profits make it possible for the industry to spend lavishly on Capitol Hill. Its lead trade group is the Council for Quality Respiratory Care, made up of six big manufacturers or distributors of oxygen equipment, including Lincare and Philips, and chaired by Lincare’s CEO. Since 2018, each of the six CQRC companies has reached at least one multimillion-dollar settlement with the government alleging it cheated Medicare. The corporations have typically denied wrongdoing.

Lobbying payments by the trade group and its member companies on reimbursement issues have totaled more than $1.4 million since the start of 2023. CQRC’s outside PR firm won an industry “advocacy” award for its 2016 campaign in support of legislation slowing oxygen reimbursement cuts, where it boasted of generating 29,000 emails to members of Congress. Through such efforts, the award commendation read, “an engaged community of concerned citizens was created to help support CQRC’s efforts.”

In a statement responding to ProPublica’s questions, CQRC praised the SOAR Act for providing “long-overdue Medicare reforms” and correcting service woes that patients and their advocates have often blamed on the industry. The trade group blamed “current law” and “chronic underfunding” for leaving patients “often unable to access the medically necessary home respiratory treatments their doctors prescribe,” but it said the bill would establish “clear patient protections and supplier responsibilities” while protecting Medicare beneficiaries from “potential fraud and abuse.”

Meanwhile, a new government-funded academic study is challenging the industry’s claims about the purported harms of competitive bidding for oxygen services. Published in late October in JAMA Internal Medicine, the investigation examined Medicare data to weigh the bidding program’s impact on patients with chronic obstructive pulmonary disease, by far the largest group of Medicare oxygen patients.

Its conclusion: Competitive bidding saved taxpayers and patients hundreds of millions of dollars, without curbing their access to oxygen or hurting their health. Dr. Kevin Duan, an assistant professor of respiratory medicine at the University of British Columbia and the article’s lead author, told ProPublica his team’s review found no evidence of harm: “No drop in claims, no change in clinical outcomes.” Duan said the study has sparked a backlash from the measure’s advocates. “I knew this was directly questioning a part of the SOAR Act,” he told ProPublica. “I feel like I walked into a firestorm.”

“We don’t have a horse in this race,” Duan said. “There’s a lot of blaming the competitive bidding program without much data. Rarely do we have high-quality evidence that can directly inform a piece of legislation. It shouldn’t be ignored.”

Doris Burke contributed research.

This content originally appeared on ProPublica and was authored by by Peter Elkind.

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For most working Americans, paying their share of the taxes that fund Medicare is an unavoidable fact of life. It’s so automatic for many workers that they may not even realize it takes a bite out of every paycheck. In theory, everyone is required to contribute to the country’s health insurance program for seniors, no matter how poor or rich, from cashiers to CEOs.

Not on Wall Street. There, some of the most powerful people in finance found a way to opt out.

The trove of tax records behind ProPublica’s “Secret IRS Files” series contains plenty of examples of billionaire financiers who avoided Medicare tax despite earning huge amounts from their companies. In 2016, Steve Cohen, the owner of the New York Mets, paid $0. So did Stephen Schwarzman, head of the investment behemoth Blackstone. Bill Ackman, the headline-grabbing hedge fund manager, was able to shield almost all his income from the tax.

How do they do it? Business owners, like any self-employed person, whether they’re a freelance Uber driver or a hedge fund manager, have the responsibility to declare their self-employment earnings on their tax returns. Indeed, the vast majority of small-business owners have no choice but to do so and pay the same taxes that wage earners pay, including Medicare.

But high-priced tax advisers, wielding a once-obscure bit of the tax code, found a way to make that obligation vanish. By carefully channeling profits through a company in a way that invokes that obscure provision, even a Steve Cohen, with a tax return showing he received hundreds of millions in profits from his hedge fund, can exempt that income from Medicare tax.

The three billionaires contacted for this article said they followed the law as written. They also pointed to the fact that they paid substantial income tax, which for them carries a much higher rate. Medicare tax is 2.9% for most people and 3.8% for high earners.

But these maneuvers by the rich hasten Medicare’s future crisis. Sometime in the 2030s, the program’s trust fund is due to run dry. Closing the loophole, along with eliminating other ways around the tax for wealthy business owners, could raise more than $250 billion over 10 years for Medicare, according to recent government estimates.

Over the past three years, ProPublica has mined the tax records of the rich to detail the many ways they avoid taxes. We’ve focused on basic structural features of the U.S. system that advantage them. We’ve uncovered maneuvers of questionable legality that seem to have escaped the notice of the IRS. The Medicare tax loophole occupies a gray area. The IRS definitely knows about it, but it’s unclear if the agency will be able to stop it.

The potential of the loophole first surfaced in the 1990s, and the IRS soon expressed the view that active business owners shouldn’t be allowed to exploit it. It was only in recent years, however, that the agency got tough. Today, the IRS continues to battle what it considers a serious abuse, waging a rare, long-shot campaign to prevent some of the nation’s wealthiest citizens from using the loophole.

The story of how America’s richest financiers avoid paying Medicare tax gives unique insight into the peculiar, messy way taxes work in the U.S. No one set out to create the loophole when it first entered the tax code in 1977. But a series of seemingly unrelated policy changes, together with a revolution in how American businesses are structured, conspired to deliver a major tax advantage to the wealthy. On Capitol Hill, interest groups have successfully defended that advantage, branding any effort to close the loophole as a tax hike on Main Street businesses.

Approaching its 50th birthday, the loophole, for now, lives on.

Over the 2010s, years of budget cuts sliced deep into the IRS’ enforcement muscle. Audits, especially those of the wealthy and corporations, plummeted. In response, agency leaders decided to conduct a kind of triage and focus the IRS’ dwindling might on the most pressing and addressable problems. Among the agency’s early priorities was to curb the widespread use of the Medicare tax loophole.

Beginning in 2018, the agency began hunting for business owners who, in its view, were abusing the law. It launched over 80 audits aimed at hedge funds, private equity firms, consultancies and similar businesses. Cohen’s firm was just the sort of thing the agency was looking for.

Before Cohen became popular as the approachable, gap-toothed, sweater-wearing Mets-fan-in-chief, he was a controversial figure on Wall Street, the inspiration for the legal-risk-taking hedge fund lead character in the Showtime series “Billions.” Cohen made his fortune through his original hedge fund, SAC Capital, known for rapid-fire trades with a remarkable track record. In 2013, SAC pleaded guilty to five criminal counts of securities and wire fraud, agreeing to pay $1.8 billion in penalties and effectively shut itself down. Cohen was not personally charged. Turning the page, he soon formed a new hedge fund, Point72.

The IRS’ audit of Point72 focused on one thing: how the profits had flowed to Cohen. In 2015, his firm earned $125 million from clients, and the money was routed to him through Point72 Asset Management LP.

Those last two letters, which stand for limited partnership, were Cohen’s key to accessing the loophole.

For most of the last century, before hedge funds and private equity firms dominated Wall Street, limited partnerships played a very specific role. They allowed investors, as limited partners, to buy into a business — often oil drilling or real estate development — without the usual risks of ownership like being pursued for the business’s debts.

But by the 1970s, creative uses of limited partnerships proliferated. One variety caught Congress’ attention. Government employees were covered by public pensions and thus were not eligible for Social Security, but brokerages were pitching these employees on limited partnerships as a way around that. The government workers could buy a small share of a business and receive self-employment income that qualified them for future Social Security benefits.

The scheme was condemned by both parties. After all, Social Security was meant to reward people’s labor, not their investments. Only income earned by someone actively running a business should count toward Social Security.

The solution, Congress decided, was to exclude most income earned by limited partners. It wouldn’t count toward self-employment income and, as a result, wouldn’t be subject to self-employment tax, which goes to Social Security and Medicare. As part of a major 1977 Social Security reform bill, this soon became the law.

It seemed like an easy fix. At the time, limited partners were, as a rule, passive investors. The line between the two types of partners that made up a limited partnership was real: General partners ran the business, and limited partners didn’t.

“Limited partners were historically forbidden under state law from getting too involved in the business,” said Susan Hamill, professor of law at the University of Alabama. “If they got involved at all, they would simply be treated as general partners, and the liability shield would be stripped away from them.”

Lawmakers assumed things would continue as they’d always been. They didn’t. The 1977 law, it turned out, had passed at the dawn of a new age, one where limited liability became standard for business owners, not a special condition with strings attached.

A new business structure, the limited liability company, exploded in popularity in the ’90s. LLCs limited the legal liability of all owners regardless of their role. Limited partnerships morphed into something that functioned similarly. After the change, the fact that someone was a limited partner said nothing about what they did for the business. They could be the CEO or a passive investor. It became common for owners to serve as both limited and general partners.

In this new world, the 1977 law was no longer a narrow exclusion. It was a broad grant of tax avoidance to anyone with a canny tax adviser.

Point72 Asset Management LP was part of the trend.

To take advantage of the loophole, Cohen needed to channel his firm’s profits through a limited partner before the money reached him.

One obstacle, it might seem, was that Cohen was one person. How could he partner with himself? That part was simple. A partnership requires at least two partners, but they can be companies or people. Cohen created two business entities, each wholly owned by him. One became the limited partner, the other the general partner.

Over 2015 and 2016, Point72 Asset Management earned $344 million in profits; 99.98% of that went to the limited partner and was declared exempt from Medicare tax. While those profits were subject to the 40% income tax rate (as much as $136 million in tax), Cohen’s returns showed $0 in self-employment income both years, helping him avoid up to $11 million in Medicare tax.

The IRS audited those returns and determined that the full $344 million was self-employment income. Last year, Point72 challenged that finding in court in a case that continues to this day. A spokesperson for Cohen declined to comment, citing the ongoing litigation.

Almost as soon as LLCs began their rapid spread, IRS officials recognized the possibility of widespread avoidance of self-employment tax. The problem became more urgent after 1993. Since its beginning, Medicare tax had, like Social Security, been capped. But Congress, in need of more revenues to support Medicare, eliminated the cap. Suddenly, avoiding Medicare tax might save a business owner millions of dollars instead of, in 1993, under $4,000.

In 1997, the IRS proposed a rule that would dictate how the 1977 law should be interpreted. A limited partner would mean essentially what it had meant back in 1977, when the term described passive investors. People who worked more than 500 hours (about three months) annually for the business could not be a limited partner under Section 1402(a)(13), the loophole’s place in the tax code.

IRS rule proposals are usually soporific affairs closely watched only by tax practitioners. But in early April 1997, fax machines in Republican congressional offices spat out a message that ended this rule’s obscurity.

The IRS was about “to slip through a nasty little tax increase on America’s partnerships,” the memo read. It was from Steve Forbes, the millionaire magazine publisher and 1996 Republican presidential candidate. He’d centered his self-funded campaign around the idea of a “flat tax,” under which he promised “the IRS would be RIP.” Now he was rallying his party against what he called a “stealth tax increase.”

His message reached Rush Limbaugh, the conservative radio host, who was then at the height of his influence. Soon after Limbaugh mentioned Forbes’ faxed memo on his nationally syndicated show, Speaker of the House Newt Gingrich, a Georgia Republican, called in.

Congress would “intervene directly,” Gingrich promised. “And as you yourself pointed out earlier, we didn’t get elected to raise taxes. We got elected to lower taxes and simplify them and to end the IRS as we know it,” he said.

“Now, folks, that is fast action,” Limbaugh boasted.

A coalition of powerful trade groups hurriedly formed to pressure Congress to follow through on Gingrich’s vow. The rule change would raise taxes by more than $1 billion over the following decade, they estimated, and must be stopped.

The coalition represented businesses that were both small and decidedly not small (among the members were the U.S. Chamber of Commerce and the Securities Industry Association). But their message emphasized the rule’s impact on the “small business community.”

In fact, most small-business owners already paid Medicare and Social Security taxes. Then, as now, the most common form of small business was the simple sole proprietorship, taxspeak for a business with a single, human owner.

By July, the coalition had prevailed. A short provision of a major bill, the Taxpayer Relief Act of 1997, forbade the IRS from issuing any new rule “with respect to the definition of a limited partner” in the next year.

The IRS had been roundly rebuffed. It would be almost two decades before the agency would seriously consider trying again.

In the meantime, the options for business owners to skirt Medicare tax multiplied. New forms of partnerships arose, and the subchapter S corporation, which offered its own loophole around Medicare tax, emerged as an even more popular vehicle. The breadth of the tax avoidance meant that opposition to closing those loopholes would be even fiercer the next time there was a major threat.

In early 2010, President Barack Obama’s administration and a Democratic Congress were struggling to pass the Affordable Care Act when they hit on a way to help fund it. The proposal boiled down to an expansion of Medicare tax. Whereas before it had only applied to income from work, now, for high earners, it would extend to investment income like dividends and capital gains. The rate would also go from 2.9% to 3.8%.

But, while new forms of income would now be subject to the tax, the proposal intentionally left huge gaps. It wouldn’t touch the ability of business owners to use loopholes to avoid Medicare tax and would even limit their exposure to the new tax on investment income.

Why create a new, complicated tax that favored some forms of income over others, asked Jason Furman, then a member of Obama’s National Economic Council. In a meeting with Obama and his advisers, Furman advocated for a simple, uniform version of the tax that would also close the loophole, he said. The president agreed on the merits, Furman said. But arousing the opposition of the business lobby could endanger the whole bill. It wasn’t worth the risk. “It was 100% political fear,” Furman said.

A monumental health care reform effort like the ACA was already controversial, and members of Congress were looking to get it passed, said Robert Andrews, a former New Jersey Democratic representative and lead negotiator on the bill. They chose the funding option “with the least political risk,” he said.

“This was an ugly compromise, and I think we knew it was an ugly compromise and worth it for the greater good,” Furman said.

As the years passed and no legislative fix came, the IRS vacillated on what to do about the limited partner loophole. The Treasury Department decides which tax regulations to pursue, and under the Bush and then the Obama administration, there wasn’t appetite for another bruising fight over a new rule. At the same time, IRS officials decided they couldn’t ignore what they viewed as widespread abuse of Section 1402(a)(13).

They decided on a middle path, said Curt Wilson, who in 2008 became the senior IRS attorney overseeing partnership issues. “We looked for places where we could push around the edges, so to speak,” he said.

This wasn’t a crusade. But in audits, when the opportunity presented itself, the agency cracked down on what it saw as abuse of the loophole. Agents focused on some of the newer forms of partnerships that had sprouted since 1977. LLCs were the prime target.

“We were looking at hedge funds, private equity firms, things like that where there were big dollars,” Wilson said. The goal was to make a splash with a precedent-setting case.

Landing that big case proved elusive. Instead of fighting it out in court, taxpayers were content to privately settle the audits with the IRS’ appeals division, Wilson said. The IRS did its best to send a message, releasing an advisory letter in 2014 to a hedge fund that said the fund’s LLC members didn’t qualify as limited partners. But that wasn’t a binding rule, and it fell short of a headline-grabbing court decision.

What’s more, the IRS risked playing Whac-A-Mole. Even if the agency succeeded in dissuading taxpayers from using the loophole with LLCs, business owners could simply register their business as a limited partnership instead. As the granddaddy of partnerships with limited liability, the LP, the original limited partnership, offered taxpayers the strongest claim for invoking the loophole.

ProPublica’s database of IRS data includes the tax returns of thousands of wealthy business owners through 2018. These titans of capitalism, despite huge flows of ordinary income, often reported remarkably little self-employment income in the 2010s. The LP appears to have been their favored variety of partnership.

In 2017, Bill Ackman earned $413 million in income through an LP operated by the hedge fund he manages, Pershing Square, famous for taking activist stances in companies. As was typical in other years, Ackman reported self-employment income of $4.7 million, a small fraction of his total business earnings. The difference meant he paid $142,000 in self-employment tax instead of more than $13 million.

In a statement, a spokesperson said: “Mr. Ackman has followed the advice of his tax advisors whose interpretation of the law has been the industry standard since 1977. Should the law change, Mr. Ackman will of course adjust his tax payments accordingly.”

In 2018, at least $143 million flowed via a Blackstone LP to Stephen Schwarzman, the firm’s CEO. As in years past, he exempted the income from Medicare tax. Schwarzman, who sits atop an investment firm with over $1 trillion in assets, reported no self-employment income at all in five of the seven years between 2012 and 2018.

“Mr. Schwarzman is one of the largest individual taxpayers in the country and fully complies with all tax rules,” a spokesperson said.

The IRS’ announcement of its audit campaign in 2018 meant the agency would stop pushing around the edges and unleash a frontal assault: Its audits would target not just the newer form of partnerships but also LPs.

This time, after years of audits and appeals within the IRS, the agency finally got its splashy court case. Many taxpayers chose to settle, but Cohen’s partnership and at least five others took their cases to tax court, the first in 2022. All argued they were following the law.

Soroban Capital, a hedge fund, was audited after converting to an LP from an LLC. Demonstrating the gulf between owners and employees, Soroban’s three partners collected $142 million in income over the two years of the audit, while paying a total of $74 million in salaries and wages (subject to Medicare tax) to the fund’s staff.

Soroban’s founder, Eric Mandelblatt, was once an employee. His compensation from Goldman Sachs cost him $128,000 in Medicare tax one year, according to ProPublica’s IRS database. After he started his own hedge fund and began earning tens of millions more, his Medicare tax bill never exceeded a third of that, the records show. Soroban did not respond to requests for comment.

In 2023, the IRS won a major tax court decision against Soroban. The “limited partner exception of I.R.C. § 1402(a)(13) does not apply to a partner who is limited in name only,” the court said, because Congress had only intended to “exclude earnings from a mere investment.” A “functional analysis,” the court said, was needed to determine whether a partner was really “limited.”

With the Soroban decision, the loophole entered a new stage in its history. It’s the most serious challenge since 1997 when, protected by Congress, the loophole emerged not only unscathed but stronger. This time, it’s up to the federal judges who will be reviewing appeals of the tax court’s rulings in the IRS’ cases.

One of the audit targets, Sirius Solutions, a consultancy, has already sought a more sympathetic venue than the U.S. Tax Court. Last summer, it turned to the 5th U.S. Circuit Court of Appeals, known for its conservative bent. Industry groups representing the hedge fund and real estate industry have filed amicus briefs. Tax law experts told ProPublica they are skeptical the IRS’ position will ultimately prevail.

Still, amid this uncertainty, the Treasury Department and IRS last year announced plans to start work on a regulation for Section 1402(a)(13). It’s a process that could take years if it isn’t halted by the incoming administration. If a new rule is finally released, it might again face a hostile Congress. It would also be subject to challenge in the courts.

As has always been the case, the simplest solution is for Congress to change the law. Democrats will keep trying, said a former senior congressional aide, especially when they propose some new expensive initiative and need ways to pay for it.

Including a fix for the Medicare tax loopholes is “a beautiful pay-for,” he said. “It’s real money, and there are not a lot of options sitting around that are this obvious and relatively straightforward technically.”

The last attempt came a couple years ago, when Democrats needed to cover the cost of their $2.4 trillion climate bill. Build Back Better, as it was initially called, passed the House with a provision similar to Furman’s gap-plugging tax. The proposal was estimated to raise $252 billion over 10 years.

But the bill stalled in the Senate, where Democrats needed every vote. In the summer of 2022, negotiations suddenly approached consensus on a new, slimmer bill, soon dubbed the Inflation Reduction Act. The gap-plugging tax was part of the mix.

As they had 25 years before, business groups quickly rallied. Several dozen trade groups co-signed a letter to congressional leaders. The National Federation of Independent Business launched radio ads. “Now Congress is considering a brand-new tax on West Virginia small businesses, an additional tax wrongly characterized as the closing of a loophole,” ran one ad targeting Sen. Joe Manchin, one of the two key swing votes.

When a deal was finally announced on the bill, the proposal was gone. There had been other, less politically dangerous options to raise revenue.

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This content originally appeared on ProPublica and was authored by by Paul Kiel.

In response, Public Citizen co-president Robert Weissman issued the following statement:

“Privatized Medicare (known as “Medicare Advantage”) is ripping off the American public to the tune of $82 billion a year and growing – all while denying care to seniors who need it.

“The modest and common-sense measures rules proposed by the Biden administration would limit some of this damage, with a major focus on how privatized Medicare plans are unjustly refusing treatment for sick patients.

“The Department of Health and Human Services notes that privatized Medicare plans overturn 80 percent of their denial of care decisions on appeal. But relatively few appeals are filed. So the privatized Medicare plans can aggressively and mechanically deny requests for prior authorization, knowing they can get away with it. The rules proposed today aim to stem these abuses, among others.

“The big question, of course, is what will the Trump administration do with these rules? Will they side with patients needing treatment or care-denying big insurers?

“Unfortunately, despite its populist pretensions, there’s every reason to expect the Trump administration to block these proposed rules from moving forward. Dr. Mehmet Oz, Trump’s nominee to run the Centers for Medicare and Medicaid Services, is a major proponent of expanding privatized Medicare, with nary a worry about privatized Medicare’s rampant abuses and rip-offs of taxpayers.”

This content originally appeared on Common Dreams and was authored by Newswire Editor.

President-elect Donald Trump has tapped several TV personalities for key posts in his incoming administration, including Dr. Mehmet Oz to run the Centers for Medicare and Medicaid Services, an agency that oversees health coverage for 150 million people. Oz, who ran an unsuccessful campaign for Senate in Pennsylvania in 2022, supports privatizing Medicare. “His background really has nothing to do with the Centers for Medicare and Medicaid Services,” says Dr. Robert Steinbrook, director of the Health Research Group for Public Citizen.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

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For Lincare, paying multimillion-dollar legal settlements is an integral part of doing business.

The company, the largest distributor of home oxygen equipment in the United States, admitted billing Medicare for ventilators it knew customers weren’t using (2024) and overcharging Medicare and thousands of elderly patients (2023). It settled allegations of violating a law against kickbacks (2018) and charging Medicare for patients who had died (2017). The company resolved lawsuits alleging a “nationwide scheme to pay physicians kickbacks to refer their patients to Lincare” (2006) and that it falsified claims that its customers needed oxygen (2001). (Lincare admitted wrongdoing in only the two most recent settlements.)

Such a litany of Medicare-related misconduct might be expected to provoke drastic action from the Department of Health and Human Services, which oversees the federal health insurance program that covers 1 in 6 Americans. Given that most of Lincare’s estimated $2.4 billion in annual revenues are paid by Medicare, HHS wields tremendous power over the company.

Sure enough, as part of the 2023 settlement, HHS placed Lincare on the agency’s equivalent of probation, a so-called corporate integrity agreement. The foreboding-sounding document includes a “death penalty” provision: Any “material breach” of the probation agreement, which runs for five years, “constitutes an independent basis for Lincare’s exclusion from participation in the Federal health care programs.” Such a ban could effectively kill Lincare’s business.

That sounds dire. Except that before that corporate integrity agreement was signed in 2023, Lincare was under the same form of probation, with the same death penalty provision, from 2018 to 2023, and violated its terms. From 2006 to 2011, Lincare was similarly on probation and also violated the terms, according to the government. And before that — well, you get the picture. Lincare has been on probation four times since 2001. And despite a pattern not only of fraud, but of breaking its probation agreements, Lincare has never been required to do more than pay settlements that amount to pennies relative to its profits.

This is not an aberration. While HHS routinely imposes the death penalty on small operations, it has never barred a national Medicare supplier like Lincare from continuing to do business with the government. Some companies, it seems, are too big to ban.

Lincare’s lengthy record of misbehavior isn’t a surprise to people in the medical equipment business. What is surprising is the federal government’s willingness to pull its punches with a company that has fleeced taxpayers and elderly customers again and again.

Federal officials have never pursued the company executives who oversee this behavior even though two of them, Chief Operating Officer Greg McCarthy and Chief Compliance Officer Jenna Pedersen, have worked at Lincare through all four of the company’s probationary periods. No one has faced criminal charges for activity the government’s own investigators deemed fraud.

Medicare has continued to pay Lincare billions even as many of the company’s customers revile it. Evaluations on customer-review websites are lacerating, and complaints to state attorneys general abound. On the Better Business Bureau’s website, 888 reviewers gave Lincare an average score of 1.3 out of 5. They cite dirty and broken equipment, charges that continue even after equipment has been returned, harassing sales and collection calls, and nightmarish customer service. As one person wrote in April, Lincare is “running a scam where they have guaranteed income” and “the customer can’t do a thing.”

HHS has always been reluctant to cut off big suppliers. Medicare’s first objective is to make sure nothing interrupts the flow of medications, devices and services to beneficiaries. And were HHS to seek to ban Lincare, the company would surely launch a long, costly legal war. But even if the cost of such combat reached many millions of dollars, it would still be a tiny fraction of the amount lost to fraud, which is yet another contributor to the soaring medical costs that bedevil the country. “This is taxpayer money,” said Jerry Martin, a former U.S. attorney who represented an ex-Lincare executive in a whistleblower suit against the company. “We need to pay people that don’t have four corporate-integrity agreements.”

Weak enforcement is not the only problem. Lincare is paid to rent oxygen equipment to patients, with HHS covering most of the monthly bills. But those rental fees often add up to many times what it would cost simply to buy the equipment. “If this were a rational country,” Bruce Vladeck, who ran Medicare from 1993 to 1997, told ProPublica, “the government would buy a million [oxygen] concentrators and pay Amazon or somebody to deliver them.”

In a seven-month investigation, ProPublica examined how Medicare’s largest provider of home medical equipment has managed to take advantage of its customers for a quarter of a century while fending off meaningful enforcement. ProPublica interviewed more than 60 current and former employees and executives, Medicare and Justice Department officials, patient advocates, and health care experts. ProPublica also reviewed dozens of court cases involving Lincare and thousands of pages of internal company documents, sales presentations and emails.

The investigation reveals a dismal picture of a company with a sales culture that depends on squeezing infirm and elderly patients and the government for every penny. Lincare employees are pressured to sell — whether a customer needs a product or not — on pain of losing their jobs.

And the company’s record of misbehavior and conflict extends far beyond its sales and billing practices. Lincare has paid $9.5 million in settlements for data breaches and mishandling patient and employee records. It has faced claims of violating wage rules, harassing customers with sales and collection calls, and tolerating racist comments to an African American employee. (Lincare lost the latter suit at trial and is appealing.) The company has repeatedly sparred in court with former executives, including a 2017 suit in which longtime executive Sharon Ford claimed that the company had cheated her out of a $1 million bonus. (A judge ruled in favor of Ford at trial before the case was overturned on appeal.) Ford testified that Lincare had earned an industry reputation as “The Evil Empire.” And when Lincare’s CEO, Crispin Teufel, resigned last year to become CEO of a rival company, Lincare sued him for breach of contract and misappropriating trade secrets. Teufel ultimately admitted to downloading confidential company records and was blocked from taking the new job. (Teufel did not respond to requests for comment. His replacement, Jeff Barnhard, took over as Lincare’s CEO in July 2023.)

Lincare declined multiple requests to make executives available for interviews. After ProPublica provided a lengthy document listing every assertion in this article, along with separate such letters to executives McCarthy and Pedersen, the company responded with a three-paragraph statement. It asserted that Lincare is “committed to delivering high-quality and clinically appropriate equipment, supplies, and services” but acknowledged “missteps in the past.” The company said its “new leadership” had “commenced a comprehensive review of our policies and procedures to help ensure we are complying fully with all state and federal regulations” and that “investments and enhancements we have made over the last several months will help prevent these issues from repeating in the future.” Lincare did not respond to follow-up questions requesting examples of the steps the company says it’s taking, including whether it has terminated any executives as part of this push.

When ProPublica asked a top Medicare enforcer why Lincare had eluded banishment, her answer suggested she views probation as a continuing ed class rather than a harsh punishment. “It’s like taking a college course,” said Tamara Forys, who is in charge of administrative and civil remedies for HHS’ Office of Inspector General. “At the end of the day, it’s really up to you to change your corporate culture and to study, to learn to pass the class … to embrace that and take those lessons learned and move them forward.” A spokesperson for the Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment on Lincare but said the agency “is committed to preventing fraud and protecting people with Medicare from falling victim to fraud.”

There’s little incentive to refrain from misbehaving in an environment that tolerates bad behavior, said Lewis Morris, who was chief counsel to HHS’ Office of Inspector General from 2002 to 2012. “As long as that [settlement] check is less than the amount you stole, it’s a good business proposition."

Indeed, Lincare has counted on the government’s tepid response, two former company executives told ProPublica. Top management, they said, responds to fraud warnings by conducting a cost-benefit analysis. “I’ve sat in meetings where they said, ‘We might have $5 to $10 million risk — if caught,’” said Owen Kirk Staggs, who ran one of Lincare’s businesses in 2017 and fell out with the company. “‘But we’ve made $50 million. So let’s go for it. The risk is worth the reward.’”

Libby, Montana, provides a glimpse of the way Lincare operates. Oxygen is an urgent need in this mountain town of 2,857. Libby suffers from the lingering effects of “the worst case of industrial poisoning of a whole community in American history,” in the words of the Environmental Protection Agency. An open-pit vermiculite mine, which operated from 1963 to 1990, coated the area — and residents’ lungs — with needle-like asbestos fibers. More than 2,000 Libby citizens have been diagnosed with respiratory diseases since then; some 700 have died.

Hundreds of ailing residents relied on Lincare for home concentrators, which provide nearly pure oxygen extracted from room air. Medicare and Medicare Advantage plans (which the government also funds) covered 80% of the monthly rental of about $135; patients paid the remaining 20%.

In 2020, Brandon Haugen noticed something suspicious in Lincare’s bills. Haugen was a customer service representative at the company’s local distribution site, one of 700 such locations around the country. (Lincare serves 1.8 million respiratory patients in 48 states.)

Lincare was allowed to charge patients and their insurers for a maximum of 36 months under federal rules. After that point, patients could use the equipment without further charge. Lincare, however, kept billing local patients and their Medicare Advantage plans far beyond 36 months — in some cases, for years. To Haugen, this looked like fraud.

Haugen conferred with center manager Ben Montgomery. The two, who had grown up in the area, had been buddies since seventh grade, after getting to know each other at summer Bible camp. Then 38, earnest and just beginning to gray out of their boyishness, the two men were concerned. The patients the men dealt with were their neighbors.

A regional Lincare manager assured them that charging beyond 36 months for Medicare Advantage patients “is the correct way to bill.” Skeptical, Montgomery raised the issue with Lincare’s headquarters in Clearwater, Florida. Lincare’s compliance director told him, according to Montgomery, that “it’s the patients’ problem to fix it if they want it to stop”; that was “just how it worked.” Further questions, sent to Lincare’s chief compliance officer, Pedersen, went nowhere. “It seemed pretty obvious they were well aware of this,” Montgomery told ProPublica. “For me, these were my customers that you were screwing over.”

Among them was Neil Bauer, now 80, who lives in a ramshackle house “out in the boondocks,” as he put it, 38 miles southeast of Libby. Bauer spent his career as a barber, head of investigations for the county sheriff’s department and a member of the local school board. He’s been on oxygen for more than a decade and quickly gets short of breath. “I can’t do stuff so much now,” he said. His wife is on oxygen, too. “We just have a sick family,” Bauer said.

Neil Bauer needed an oxygen concentrator to cope with asbestosis. Rather than buying one — which costs about $799 today — Medicare Advantage rented one from Lincare and paid 80% of the monthly charges. Bauer covered the remaining 20%. Companies can bill for a maximum of 36 months, after which patients are entitled to use the equipment without further charge.

Lincare had kept billing Bauer for his concentrator for seven years after it was supposed to stop. The monthly copays weren’t huge, but they added up to $2,325 that he shouldn’t have been charged over that period, a daunting sum for Bauer, who lives on a fixed income — and a hefty mark-up over the cost of the equipment, which can be purchased online for $799. For its part, Medicare Advantage paid Lincare $9,299 for Bauer’s concentrator during this period, along with another $5,760 for the months Lincare was legally permitted to bill. All told, the rental payments to Lincare, during authorized and unauthorized periods, were $16,547 for that one $799 piece of equipment. “We paid forever,” said Bauer. “Never was I told that we could have one without having to pay anything.”

Haugen and Montgomery studied billing records. Among the customers in their tiny office, Lincare was improperly charging at least 33 people and their Medicare plans. The two began to wonder how far this problem extended. An employee in Idaho confirmed the same practice was occurring there. “In my mind,” Montgomery said, “I went, ‘This is Libby, Montana. Multiply that by every center in the country. This is obviously a lot bigger deal.’”

Montgomery and Haugen had seen enough. On Jan. 18, 2021, they emailed a joint resignation letter to Lincare’s top management, recounting their concerns about billing that “likely affects thousands of patients company wide.” Citing the lack of response from corporate officials, they wrote, “we can only conclude that this is a known issue that is being covered up by Lincare.”

Haugen had 10 children. Montgomery had four. Neither man had another job lined up. “Had this not happened,” said Montgomery, who had been at the company for 13 years, “I would have seen myself retiring from Lincare.”

Instead, they became whistleblowers. They retained a law firm and sued Lincare in Spokane, Washington, the site of Lincare’s regional headquarters. After federal prosecutors decided to back the case, Lincare settled in August 2023. The company admitted to overbilling Medicare plans and patients across the country for years and paid $29 million to settle the matter, with $5.7 million of that going to Montgomery, Haugen and their lawyers. Dan Fruchter, the assistant U.S. attorney leading the government’s case, told ProPublica that the overbillings likely involved “tens of thousands” of patients.

Lincare agreed to its fourth stint of probation with HHS; the new corporate-integrity agreement took effect on the day after the previous one expired. The conduct Montgomery and Haugen flagged had gone on for years while the company was already on probation. But Lincare got the government lawyers to agree that nobody would try to impose the Medicare death penalty. Lincare asserted in the settlement that it had installed software (which it did only after learning of the government investigation) that will prevent billing beyond 36 months. Lincare promised to ensure “full and timely” compliance with the agreement and prevent future wrongdoing.

Medicare fraud, including in the “durable medical equipment” category that Lincare operates in, has long been an intractable problem. It cost the U.S. Treasury an estimated $60 billion in 2023 alone.

The government deploys large sums to try to stop it. HHS’ inspector general’s office has a $432 million budget and a staff of 1,600. Those resources are effectively extended by whistleblowers — most of the cases against Lincare have been such suits — who can receive a percentage of a civil settlement if they reveal wrongdoing, and by federal prosecutors, who can also bring cases or join those filed by whistleblowers. Last year HHS recovered $3.2 billion from fraudulent schemes.

But the agency’s enforcers have wielded their biggest deterrent almost entirely against small perpetrators. In 2023, they banned 2,112 small firms and individuals from Medicare reimbursement.

HHS hasn’t done the same with companies that operate on a national scale. Forys, the agency enforcer, said she worries that expelling a big provider from Medicare could leave customers in the lurch. In April, Inspector General Christi Grimm defended her office’s work in congressional testimony but also asserted that its resources are inadequate. A lack of staff keeps it from even investigating “between 300 and 400 viable criminal and civil health care cases” annually, she testified, as well as more than half the fraud referrals from Medicare’s outside audit contractors.

A different reason for going easy on big companies was suggested by Vladeck, the former Medicare chief. Seeking to bar a large supplier for repeatedly violating probation would require exhaustive documentation and years of litigation against squadrons of well-paid corporate lawyers. As a result, Vladeck said, “there’s a real incentive, from a bureaucratic point of view, to just slap their wrist, give them a kick and make them apologize. … It’s a cost of doing business.”

There are steps enforcers could take, but almost never do, that would make companies take notice, according to Jacob Elberg, a former federal prosecutor who is now a professor at Seton Hall Law School. (Among his publications is a 2021 law review article titled “Health Care Fraud Means Never Having to Say You’re Sorry.”) Elberg’s research shows that HHS and prosecutors tend to negotiate far smaller civil settlements than the law allows, and they rarely prosecute company executives. They also almost never take cases to trial. In short, enforcers have long signaled to companies that they’re looking for a smooth path to a cash payment rather than a stern punishment for a company and its leaders. “It is generally a safe assumption,” Elberg said, “that the result will be a civil settlement at an amount that is tolerable.”

For its part, Congress may soon be weighing a new law that would reshape how the oxygen industry is paid by Medicare. But rather than clamp down on corporations, the legislation seems poised to do the opposite. A new bill called the SOAR (Supplemental Oxygen Access Reform) Act would hand companies like Lincare hundreds of millions more, by raising reimbursement rates and eliminating competitive bidding among equipment providers. Advocates say the legislation will help patients by making some forms of oxygen more available and improving service. But along the way it will reward Lincare and its rivals.

Congress has a history of treating oxygen companies generously. For years, lawmakers set Medicare reimbursements for oxygen equipment at levels that even HHS, in 1997, characterized as “grossly excessive.” Over the succeeding decade and a half, Lincare took advantage, snatching up hundreds of small suppliers and becoming the industry’s largest player.

In 2006, under pressure to reduce costs, Congress approved steps to curb oxygen payments, including the introduction of competitive bidding and the 36-month cap on payments for equipment rentals. But even those strictures were watered down after the industry poured money into political contributions and lobbyists, who warned that cuts would harm elderly patients.

Lincare compensated by amping up strategies that generated profits, with little apparent regard for Medicare’s rules, which say it will reimburse costs for equipment only when there is evidence of “medical necessity.” The company aggressively courted doctors and incentivized sales, through bonuses the company paid for each new device “setup.” According to a 2016 commission schedule, reps could earn $40 for winning an order for a new sleep apnea machine, $100 for a new oxygen patient and $200 for a noninvasive ventilator. The entire staff of each Lincare center could receive a small bonus for signing up a high percentage of new patients for automatic monthly billing. Patients who refused auto-billing, a company document advised, should be warned they might face “collection activity” and service cutoffs. “Sales is our top priority!” declared a 2020 PowerPoint to train new hires.

Once it had a customer, Lincare would pitch them more costly products and services. One way Lincare did this was through a program called CareChecks. Promoted as a “patient monitoring” benefit, CareChecks were aimed, according to a company presentation, at generating “internal growth.” If a patient exhibited a persistent phlegmy cough, Lincare could persuade their doctor to prescribe a special vibrating vest to loosen chest mucus. Nebulizer patients might be candidates for home oxygen. Patients using apnea devices were potential candidates for ventilators. “We’d make patients think we were coming in clinically to assess them,” a former Lincare manager said, “when really it was to make money off of them.”

Selling replacement parts could also be lucrative. At Lincare call centers that sold items like hoses, masks and filters for CPAP machines (used to treat apnea), hundreds of commissioned agents in Nashville, Tennessee, and Tampa, Florida, were equipped with programs displaying what items each patient was eligible for under Medicare. By law, patients had to request replacement parts. But frequently, that wasn’t what happened, according to Staggs, who oversaw the CPAP business in 2017. He discovered that top salespeople, whose bonuses could total $8,000 a month, averaged just a few minutes on the phone per order. That wasn’t nearly enough time to identify what items, if any, customers actually needed. Staggs listened to recorded calls and found that, after reaching customers, agents often placed them on hold until they hung up, then ordered them every product that Medicare would cover.

At Lincare, results were closely tracked and widely shared in weekly emails displaying the best and worst performers in each region. Notes taken by one manager show supervisors’ performance demands during weekly conference calls: “Unacceptable to miss goal … stop the excuses … If this is not being done, wrong [center manager] in place … If you’re not getting O2 and not getting Care Checks — you shit the bed. Stop accepting mediocre, lazy responses ….”

“If we didn’t meet our quota, they were going to chop our heads,” said former Illinois sales rep Sandra Gauch, who worked for Lincare for 17 years before joining a whistleblower suit and quitting in 2022.

One salesperson was so fearful of missing her quota, according to Gauch, that she signed her mother up for a ventilator that she didn’t need. A company audit in 2018 found that only 10 of 56 ventilator patients at one center were using them consistently. Some patients hadn’t used their devices for years. Yet Lincare kept billing Medicare.

Only one thing mattered as much as maximizing new equipment rentals, according to former employees and company documents: minimizing customers’ attempts to end rentals. A call to retrieve breathing equipment meant that it was no longer wanted or being used, and Lincare was supposed to retrieve it and promptly stop billing Medicare and the patient. The person’s health might have improved. They might have gone into the hospital — or died. The reason didn’t matter; at Lincare, “pickups” were a black mark, deducted from employees’ performance scores, jeopardizing their bonuses and jobs.

As a result, employees said, such requests were dreaded, delayed and deterred. Clinical staff were sent to “reeducate” customers to keep using their devices. Patients were told they’d need to sign a form stating they were acting “against medical advice.”

Lincare managers made it clear that pickups should be discouraged. In a 2010 email, an Ohio center manager instructed subordinates: “As we have already discussed, absolutely no pick-ups/inactivation’s are to be do[ne] until I give you the green light. Even if they are deceased.” In 2018, an Illinois supervisor emailed her deputies that pickups were barred without her explicit approval: “Not even Death that I don’t approve first.”

In February 2022, Justin Linafelter, an area manager in Denver, responded to the latest corporate email celebrating monthly “Achievement Rankings” for oxygen sales by pointing out that almost all of the centers atop the rankings had at least 150 “pending pickups,” customers who weren’t using their equipment but whom the company appeared to still be billing. “Some of these centers are just ignoring pickups to make this list.”

That was only one of Linafelter’s concerns. In July of that year, he emailed headquarters, saying he no longer had “the resources to be successful at my job.” The customer service staff in Denver had been cut in half, Linafelter explained, and he’d been barred from hiring replacements. Denver’s remaining staff was “at a point of exhaustion,” threatening patient care.

The morning after Linafelter expressed concerns to Lincare in 2022, he was summoned to a conference call with the head of HR and fired, for what he was told was a “corporate restructuring.” Linafelter, who had worked at Lincare for nine years, said, “I got thrown away like a piece of trash.”

Other former employees offer similar accounts. In 2020, Jillian Watkins, a center manager in Huntington, West Virginia, repeatedly alerted supervisors that Lincare was improperly billing for equipment that patients weren’t using. Lincare blocked her from firing a subordinate who’d falsified documents supporting the charges, then fired Watkins, citing “inadequate direction and leadership.”

Then came a series of turns. Pedersen, the chief compliance officer, effectively confirmed Watkins’ assertions, belatedly alerting the government about $486,000 in improper billings by Lincare. But Pedersen blamed the billings on Watkins, writing to Medicare that the company had “terminated” her to “prevent [the problem] from recurring.” After Watkins sued, Pedersen admitted in a deposition that Watkins’ firing “had nothing to do with the overpayment.” In April 2024, a federal judge ruled that Watkins had presented “a prima facie case of retaliation.” The suit was privately settled in mediation.

Staggs, too, was ousted, he said, after he warned top Lincare executives about improper practices at the CPAP call centers. Staggs emailed a Lincare HR officer: “Patients are being shipped supplies that they never have ordered. … This is fraud and I have gotten zero support or attention to this matter when I raise the issue to my leadership.” Only months after starting, he was fired in November 2017. He later filed a whistleblower suit; Lincare denied wrongdoing. After the U.S. attorney’s office in Nashville declined to join the case in 2022, Staggs withdrew the action.

Staggs’ account of improper billings matches an industry pattern that appears to continue to this day. In a 2018 report, HHS’ inspector general estimated that Medicare had paid more than $631 million in improper claims for CPAP and other supplies over a two-year period. Another HHS analysis identified an additional $566 million in potential overpayments for apnea devices.

The agency’s oversight “was not sufficient to ensure that suppliers complied with Medicare requirements,” the 2018 report concluded. Six years later, HHS has not taken public action against Lincare relating to CPAPs.

Today, fraudulent billing among Medicare equipment providers remains a “major concern,” according to the inspector general. The agency says it continues to review the issue.

Doris Burke contributed research.

This content originally appeared on ProPublica and was authored by by Peter Elkind.

Dr. Adam Gaffney is a physician, writer, public health researcher, and advocate. Dr. Gaffney practices at the Cambridge Health Alliance and is an Assistant Professor in Medicine at Harvard Medical School. A member of the Cambridge Health Justice Lab, his research focuses on healthcare financing, reform, and equity, and disparities in lung health. He writes about the policy, politics, and history of health care, and is the author of To Heal Humankind: The Right to Health in History.

The reality is we don't need Medigap. We could plug those holes with public coverage. There's no reason to have a role for private insurers to cover a slice of our healthcare when all seniors need the same thing—which is comprehensive universal care.  There's no need for these private stopgap measures, when what we need is a public system of universal care.

Dr. Adam Gaffney

I do think there’s growing interest among physicians in change. Their bosses are increasingly these for-profit companies whose mission is not really medicine. Their mission is money. And what we need to do is to rethink our healthcare system, so it serves communities, is owned by communities, and it returns us to the underlying reason why we went into this profession—which is to help patients, and not to pad the pockets of shareholders.

Dr. Adam Gaffney

Dr. Marty Makary is a Johns Hopkins professor and member of the National Academy of Medicine. He is the author of two New York Times best-selling books, Unaccountable and The Price We Pay. Dr. Makary has written for the Wall Street Journal, the Washington Post, and the New York Times, and he has published more than 250 scientific research articles. He served in leadership at the W.H.O. and has been a visiting professor at 25 medical schools. His latest book is Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health.

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Dr. Marty Makary

David Brock is a Democratic activist and founder of Media Matters for America, a progressive media watchdog group. Following the 2010 elections, Mr. Brock founded the Super PAC American Bridge, which works to elect Democrats. He is a New York Times best-selling author, and his books include the memoir Blinded by the Right: The Conscience of an Ex-Conservative, Killing the Messenger: The Right Wing Plot to Hijack Your Government, and his latest book is Stench: The Making of the Thomas Court and the Unmaking of America.

The Federalist Society was originally founded by three rightwing law students. And it was pitched as a debating society. So I don't think in the original incarnation, they had a master plan. But soon enough, they realized that membership in the Federalist Society could confer on people a certain imprimatur for appointments—and that's appointments not only to the federal judiciary, but all through the executive branch.

David Brock

The scheme to overturn Roe has been going on for all these decades. There were setbacks, of course, because there were times when Republican appointees ended up being independent—Sandra Day O 'Connor, for example, David Souter, for example—and the right was defeated in their effort to overturn Roe. So it took a while and it took a lot of steadfast, patient spending of money on their crusade.

David Brock

[This is] a time when the Biden regime is supporting the destruction of the ancient land of Lebanon— whom he's called in prior years an ally. He's letting Netanyahu destroy Lebanon with the same tactics that Netanyahu applied to the genocide in Gaza.

Ralph Nader

In Case You Haven’t Heard with Francesco DeSantis

News 10/23/24

1. Last week, Israel announced they had killed longtime Hamas leader Yahya Sinwar. As NBC put it, the footage of his death released by Israel “showed Sinwar not hiding in a tunnel surrounded by hostages — as Israeli officials often claimed he was — but aboveground and hurling a stick at a drone with his last ounce of strength.” American political leaders, such as Kamala Harris and Bernie Sanders, are seeking to use Sinwar’s death to argue that Israel has accomplished its mission and should therefore conclude its genocidal campaign in Gaza. Israeli leaders however have made it abundantly clear that they have no intention of pulling out of Gaza, with Benny Gantz – chairman of Israel’s National Unity Party and among Prime Minister Netanyahu’s chief political rivals – stating that the Israeli military “will continue to operate in the Gaza Strip for years to come,” per Al Jazeera.

2. According to POLITICO, during an August 29th meeting in Washington Lise Grande, the top U.S. official working on the humanitarian situation in Gaza told the leaders of more than a dozen aid organizations that “the U.S. would not consider withholding weapons from Israel for blocking food and medicine from entering [Gaza].” It is illegal to block the delivery of humanitarian assistance under both American and international human rights law. As the paper notes, Grande’s “candid assessment…raises questions about the seriousness of recent Biden administration threats to [withhold arms].” One attendee told POLITICO “[Grande] was saying that the rules don’t apply to Israel.”

3. Meanwhile, Israel continues its war on the United Nations mission in Lebanon. On October 20th, UNIFIL released a statement saying “Earlier today, an IDF bulldozer deliberately demolished an observation tower and perimeter fence of a UN position in Marwahin…The IDF has repeatedly demanded that UNIFIL vacate its positions along the Blue Line and has deliberately damaged UN positions. Despite the pressure being exerted on the mission and our troop-contributing countries…We will continue to undertake our mandated tasks.” UNIFIL added “Yet again, we note that breaching a UN position and damaging UN assets is a flagrant violation of international law and Security Council resolution 1701.”

4. In a frankly dystopian story from the United Kingdom, British counterterrorism police “raided the home and seized several electronic devices belonging to The Electronic Intifada’s associate editor Asa Winstanley,” despite the fact that Winstanley has not been charged with any offense. Electronic Intifada reports the raid was conducted under sections 1 and 2 of the 2006 “Terrorism Act,” which deal with the “encouragement of terrorism.” Human Rights Watch has previously urged the British government to repeal the repressive provisions of the 2006 act noting that “the definition of the encouragement of terrorism offense is overly broad, raising serious concerns about undue infringement on free speech.” Electronic Intifada further notes “In August, Britain’s Crown Prosecution Service issued a warning to the British public to ‘think before you post’ and threatening that it would prosecute anyone it deemed guilty of what it calls ‘online violence.’” Winstanley is the author of Weaponising Anti-Semitism: How the Israel Lobby Brought Down Jeremy Corbyn and has been interviewed by the Capitol Hill Citizen.

5. According to the Libertarian magazine Reason, Bob Woodward’s new book War includes a passage about a “shockingly blunt conversation,” between President Biden and Republican Senator Lindsey Graham regarding “Biden's attempts to negotiate a ‘megadeal’ between the United States, Saudi Arabia, and Israel.” Per Reason “Graham reportedly said that only Biden could secure a U.S.-Saudi defense treaty, because it would ‘take a Democratic president to convince Democrats to vote to go to war for Saudi Arabia’” Biden’s response? “Let's do it.” Furthermore, reports indicate this security pact only fell apart after October 7th, with Saudi Crown Prince Mohammad Bin Salman seeing a prominent deal with Israel at that time as a major political liability. Reason cites an article from the Atlantic in January wherein Salman reportedly told Secretary of State Antony Blinken “Do I care personally about the Palestinian issue? I don't, but my people do…Half my advisers say that the deal is not worth the risk. I could end up getting killed because of this deal.”

6. In more international news, the Cuban energy grid collapsed on Friday, under strain from Hurricane Oscar. The complete grid collapse left the entire country of 10 million without electricity, per NPR. Reuters reports that over the weekend, the grid failed three more times as authorities sought to restore power. Brasil de Fato, or BdF, a Brazilian socialist news service, reports China, Venezuela, Mexico, Colombia, Russia and Barbados are offering support to Cuba amid the total blackout. BdF further reports “The Alba Movimientos platform, which brings together more than 400 organizations from 25 countries, issued a statement...[saying] ‘No one can attribute this virtual collapse of the Cuban electricity system to a specific measure by the US government – that would be too simplistic…this is’“the result of a long strategy of planned destruction of the material and spiritual living conditions of the Cuban population…with the financial resources denied to Cuba due to the blockade policy, 18 days of accumulated damages equal the annual cost of maintaining the country's electricity system.” According to the UN, the U.S. embargo cost Cuba $13 million US dollars per day between 2022 and 2023 alone.

7. A new scandal has rocked American Higher Education. Inside Higher Ed reports “Last week a lawsuit accused 40 colleges and universities, as well as the nonprofit College Board, of participating in a price-fixing conspiracy to jack up tuition rates” specifically, for children of divorced parents. The scheme itself had to do with consideration of the non-custodial parent’s income, but the larger issue at stake here is the fact that the universities entered into a “cartel” in violation of antitrust laws. As this piece notes this is the “second major price-fixing antitrust lawsuit filed against highly selective universities since 2022, when 17 institutions…were accused of illegally colluding to set common financial aid formulas. So far, 10 of those institutions have settled for a combined $248 million.”

8. Boeing has offered their striking machinists a new deal, which they hope will end their crippling strike. ABC reports “The new offer delivers a 35% raise over the four-year duration of the contract,” which is short of the 40% raise demanded by the International Association of Machinists and Aerospace Workers but considerably better than the aerospace titan’s previous offer of 25%. ABC continues “The proposal also hikes Boeing's contribution to a 401(k) plan, but it declines to fulfill workers' call for a reinstatement of the company's defined pension.” As this piece notes, the machinists overwhelmingly rejected Boeing’s previous offer last month; this week they will vote on the new proposal. Whatever the details of the final contract, this episode clearly demonstrates the power of a union, even going up against one of the most powerful corporations in America.

9. A stunning CNN investigation reveals the extent of predatory fundraising by the major parties off of elderly people suffering from dementia or other forms of cognitive decline in their old age. According to “More than 1,000 reports filed with government agencies and consumer advocacy groups… deceptive political fundraisers have victimized hundreds of elderly Americans…into giving away millions of dollars.” These heartbreaking stories concern “Donors…often in their 80s and 90s…[including] retired public workers, house cleaners and veterans, widows living alone, nursing home residents…[with] money…from pensions, Social Security payments and retirement savings accounts meant to last decades.” To cite just one just one shocking example: “[an] 82-year-old woman, who wore pajamas with holes in them because she didn’t want to spend money on new ones, didn’t realize she had given Republicans more than $350,000 while living in a 1,000 square-foot Baltimore condo since 2020.”

10. Finally, Congresswoman Rashida Tlaib has sent a letter to Rodney McMullen, Chairman and CEO of Kroger, decrying the company’s “decision to roll out surge pricing using facial recognition technology.” Specifically, Tlaib cites concerns about price manipulation based on external factors like supply as well as discrimination based on race, gender, and other criteria determined through facial recognition. Tlaib ends this letter with six key questions, including “Will Kroger use…facial recognition to display targeted advertisements…?…What safeguards will be in pace?…[and] Are there plans to sell data collected in the store?” among others. Grocery prices continue to be a source of everyday economic hardship for working Americans and corporations are increasingly interested in surge pricing for essential goods. There is some comfort in knowing at least one member of Congress is concerned about this dangerous combination.

This has been Francesco DeSantis, with In Case You Haven’t Heard.

This content originally appeared on Ralph Nader Radio Hour and was authored by Ralph Nader.

Janine Jackson interviewed professor and Physicians for a National Health Program co-founder David Himmelstein about the problems with Medicare Advantage for the June 28, 2024 episode of CounterSpin. This is a lightly edited transcript.

Common Dreams (6/10/24)

Janine Jackson: For decades, people in this country have been suffering and dying due to the cost of healthcare, while public majorities have been saying they want a different system. For decades, US corporations and their political and media megaphones have been telling us that, yes, things as they are are difficult, but a more humane universal healthcare policy is just not possible, not because the policies that would allow doctors to provide the care they deem appropriate, and people to receive that care without going bankrupt, aren’t logistically doable—they are, after all, done in other countries—but because they are not, as the New York Times has repeatedly phrased it, “politically viable.”

So while you’ve likely heard about people choosing between rent and healthcare, and about people rationing their medications, and you have never once heard of people marching in the street chanting, “What do we want? Managed competition! When do we want it? Now!”—here we still are.

The latest gambit is Medicare Advantage, the private sector “alternative” to traditional Medicare in which currently more than half of the eligible Medicare population is enrolled. We were told it would encourage insurers to provide better care at lower cost. New research says, nope, that’s not what’s happening.

Here to help us understand is David Himmelstein, co-author of the new analysis, “Less Care at Higher Cost: The Medicare Advantage Paradox,” appearing in JAMA Internal Medicine. He teaches at Hunter College and Harvard Medical School. He’s a researcher at Public Citizen and co-founder of Physicians for a National Health Program. He joins us now by phone from upstate New York. Welcome to CounterSpin, David Himmelstein.

David Himmelstein: Thanks for having me.

JJ: So the concept of Medicare Advantage is that insurance companies get a lump sum for each patient, the amount of which depends on the person’s health, and it was presented as a way to bring down out-of-pocket costs while also still providing better care. The analysis that you have just carried out showed that that is not at all what’s happening. Talk us through what you found.

David Himmelstein: “The private insurance companies have ripped off taxpayers to the tune of more than half a trillion dollars.”

DH: What we found is that the taxpayers are overpaying these Medicare Advantage private plans by tens of billions of dollars each year. In fact, $82 billion last year alone, and $612 billion since 2007. That’s overpayments compared to what it would have cost to cover those same people in the old public Medicare program. So, in effect, the private insurance companies have ripped off taxpayers to the tune of more than half a trillion dollars, and most of that goes to either their bottom line, or to the paperwork that they carry out to realize those profits. In fact, 97% of the total overpayment stayed with the insurance companies. Only 3% went to the perks that they offer to entice people to enroll in their plans rather than staying in traditional Medicare.

JJ: When you say overpayments, what are the mechanisms of that? How is that working?

DH: The plans really trick the system in a couple of ways. One is that they seek out healthy, low-cost enrollees who are going to be inexpensive for them to cover. So they get the lump sum payment from the Medicare program, but the insurance company doesn’t actually need to pay for care. In fact, for 19% of Medicare enrollees, they cost nothing in the course of a year. So when an insurance company enrolls them, they get something like $10,000 or $12,000 a year, and they pay for no care at all. So that’s one thing—enroll healthy and inexpensive people and avoid sick ones.

The second is: make your benefits tailored to be unpleasant and unsustainable for people who are sick and expensive. So don’t approve rehab care, which Medicare traditional pays for, but the Medicare Advantage plans usually don’t. So if someone needs that rehab care, they’re really pushed to choose to go back to traditional Medicare.

And the third way is by inflating the amount Medicare pays them by making the people who enroll in the Medicare Advantage plans and those private plans look sicker on paper, and that increases how much Medicare pays, but in many cases doesn’t actually increase what it costs the plans to cover them. So they’ve leaned heavily on doctors to, say, add as many diagnoses as you can, even if they don’t cost anything, or don’t imply the need for more care. And, over the years, they’ve also taken to sending nurses into enrollees’ homes, not to help them out, but to try and discover additional diagnoses that could up the payment.

So they avoid the sick, they try and evict the sick once they are sick, and they make people look sicker in order to increase the payment they get from Medicare. And those things together result in what the official Medicare Payment Advisory Commission—so this is the non-partisan commission that advises Congress—they said it costs 22% more to cover a patient under Medicare Advantage than it would’ve cost to cover them under traditional Medicare. And as I said, that’s an $83 billion difference last year alone.

JJ: And you have mentioned taxpayers, and I just want to underscore it, the harms here are not just to the enrollees who are having inflated diagnoses, and then not necessarily getting the care they need, but the harms are even to those who are not enrolled in these plans, right?

DH: Absolutely. I mean, as taxpayers, we’re all paying for it. And the tragedy is, Medicare needs improvement. Medicare enrollees are saddled with high copayments and deductibles, and a lot of services that aren’t adequately covered, like dental care and eyeglasses. And if we took that $600-plus billion that’s been really thrown away in overpayments to Medicare Advantage plans, we could upgrade Medicare coverage for all enrollees, and the taxpayers wouldn’t be paying any more. But at this point, the taxpayers are being ripped off, and Medicare enrollees aren’t getting what they need.

JJ: Let me just extend you from there. What are the recommendations that come out of this research? What can people be calling for?

DH: We’re 40 years into this experiment with privatizing Medicare, the Medicare Advantage program. And what we conclude in this analysis is, it’s time to end that experiment. If we had a 40-year failing experiment on any drug, we’d say, take that drug off the market. It’s time to take Medicare Advantage off the market, and to use the money that we’ve been overpaying them to upgrade coverage for Medicare recipients overall.

We need to go further than that. We need a single-payer, Medicare for All, upgraded system for all Americans. And, frankly, we could save huge amounts on the insurance middlemen, not just in Medicare, but in other sectors as well. I mean, for people with private insurance, they’re being ripped off for the overhead of the private insurers and the vast profits they make. So the immediate call is, let’s abolish Medicare Advantage and upgrade Medicare for seniors. But the longer term call is, let’s move everybody into an upgraded Medicare for All program.

JJ: Just, finally, the phrase “not politically viable” doesn’t leave my head, because it’s corporate news media telling the people to cut our hopes and needs to fit the desires of wealthy companies, which of course is not how some of us define politics. But time and again, people show that they are not too dumb to understand how a single-payer system would work, despite years of misinformation around it. People still, in majorities, call for it. And I guess I wish media would listen to people about solutions, and not just catalog the harms of the current system. Do you have any thoughts about what journalism and journalists could do to move us forward on this?

DH: Well, they need to go beyond the talking points that are supplied by the insurance industry and the rest of the people making huge profits off of our healthcare system–the drug companies, and many of the hospitals, and, frankly, the higher-paid doctors as well. So we need to have a rational system, and the news media needs to actually portray the—I would call them crimes that are being perpetrated on the American people, and not say, “we can’t do better;” we know we can do better–and actually have the in-depth reporting on why it is that a reform could and would work in this country.

JJ: All right, then. We’ve been speaking with David Himmelstein, and you can access the analysis we’ve been talking about through JAMANetwork.com. David Himmelstein, thank you so much for joining us this week on CounterSpin.

DH: Thanks again for having me.

This content originally appeared on FAIR and was authored by Janine Jackson.

Common Dreams (6/10/24)

This week on CounterSpin: Headlined “The Cash Monster Was Insatiable,” a 2022 New York Times piece reported insurance companies gaming Medicare Advantage, presented as a “low-cost” alternative to traditional Medicare. One company pressed doctors to add additional illnesses to the records of patients they hadn’t seen for weeks: Dig up enough new diagnoses, and you could win a bottle of champagne. Some companies cherry-picked healthier seniors for enrollment with cynical tricks like locating their offices up flights of stairs.

Such maneuvers don’t lead to good health outcomes, but they serve the real goal: netting private insurers more money. There is now new research on the problem, and the response. We hear from David Himmelstein, co-founder of Physicians for a National Health Program and co-author of this new analysis of Medicare Advantage.

(CC photo: Jim Naureckas)

Also on the show: You may get the impression from media that marijuana is legal everywhere now, that it’s moved from blight to business, if you will. It’s not as simple as that, and many people harmed by decades of criminalization have yet to see any benefit from decriminalization. Tauhid Chappell has tracked the issue for years now; he teaches the country’s first graduate-level course on equity movements in the cannabis industry, at Thomas Jefferson University. We’ll get an update from him.

Plus Janine Jackson takes a quick look at recent press coverage of Julian Assange.

This content originally appeared on FAIR and was authored by CounterSpin.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

It’s a tale of two countries: In some states, public officials are trying to make government work for their constituents. In others, they aren’t.

This week marks one year since the Great Medicaid Purge (a.k.a. the “unwinding”) began. Early during the pandemic, in exchange for additional funds, Congress temporarily prohibited states from kicking anyone off Medicaid. But as of April 1, 2023, states were allowed to start disenrolling people.

Some did so immediately. So far, at least 19.6 million people have lost Medicaid coverage. That’s higher than the initial forecast, 15 million, even though the process hasn’t yet finished.

Some enrollees were kicked off because they were evaluated and found to be no longer eligible for the public health insurance program — maybe because (happily!) their incomes rose, or because they aged out of a program. But as data from KFF shows, the vast majority, nearly 70 percent, lost coverage because of paperwork issues. …

These “paperwork issues” were added by self-alleged conservatives, or Republicans, in order to reduce the number of beneficiaries, supposedly in order to protect taxpayers against “waste, fraud or abuse,” by poor people, against taxpayers. Wikipedia’s article on Medicaid says:

Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 85 million low-income and disabled people as of 2022;^[3] in 2019, the program paid for half of all U.S. births.^[4] As of 2017, the total annual cost of Medicaid was just over $600 billion, of which the federal government contributed $375 billion and states an additional $230 billion.^[4] States are not required to participate in the program, although all have since 1982. In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities.^[5] As of 2022 45% of those receiving Medicaid or CHIP were children.^[3]

Medicaid also covers long-term services and supports, including both nursing home care and home- and community-based services, for those with low incomes and minimal assets; the exact qualifications vary by state. Medicaid spent $215 billion on such care in 2020, over half of the total $402 billion spent on such services.^[6] Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid, including 1.6 million of the 1.9 million in institutional settings.^[7]

Medicaid covers healthcare costs for people with low incomes, while Medicare is a universal program providing health coverage for the elderly.

Medicaid is means-tested (it’s for only poor people), whereas Medicare is not. President Lyndon Baines Johnson introduced Medicaid in 1965, and Medicare in 1966. President Franklin Delano Roosevelt had introduced the federal taxation-based trust-funded Social Security retirement program in 1935; and both of those Presidents were Democrats, which used to be the Party that had some ideological commitment to workers, whereas the Republican Party, ever since a Confederate’s (pro-slavery) bullet assassinated the first (and the only progressive, or pro-democratic) Republican President, Abraham Lincoln, in 1865, has been, and is, committed only to investors, which is to say, only to the class of only rich individuals, the owners of businesses — managers instead of workers and consumers.

There are just two basic philosophies of government: either it is democratic, meaning one-person-one-vote rule (rule equally by all residents), or else it is aristocratic (rule unequally by residents on the basis of each person’s wealth), meaning one-dollar-one-vote rule (which is the way that a corporation is run: the more shares a person owns, the more of a say in managing it the individual willl have). The Democratic Party used to believe in democracy (government rule as being a right that each resident has equally), and the Republican Party after Lincoln was shot has always believed in aristocracy (government rule as a privilege that only certain residents have, they generally being the rich ones, but also sometimes only Christians). Consequently, the Democratic Party was “populist,” and the Republican Party was “elitist.” (Republicans — after Lincoln — were the Party of “business,” meaning of the owners of corporations.)

In America, as in all countries, there is also race as a political factor, and it’s traditionally categorized as being based upon either nationality or else religion of a person’s ancestors, or else (for instantaneous categorization) the individual’s appearance marks one’s ‘race’. But, whatever a ‘race’ is, racism or support for race being considered as a qualification for receiving a benefit from government or else as being a qualification for exclusion from receiving that benefit, can be supported both by populists and by elitists.

However, whereas racism is intrinsic to aristocracy, it is not intrinsic to democracy. Aristocracy believes in hereditary right, such as to pass wealth on to one’s children, whereas democracy rejects that and can survive only where intergenerational transmission of privately acquired wealth is by law either severely limited or else totally prohibited. And that exclusionary right for an aristocrat, to pass on to the next generation the person’s private wealth, is what produces, after many successive generations, increasingly concentrated wealth, and increasingly widespread poverty, which then institutionalizes aristocratic government and rule by privilege, instead of rule by individuals’ work and merit. Consequently, any democrat (or populist) who tolerates aristocracy, is tolerating the end of democracy.

For example, many of America’s Confederates considered themselves to be democrats but supported slavery of Blacks. Not only the Confederate aristocracy did. But — just as in Israel, there is no democracy, because only the Jews can vote there — the Confederacy was no democracy, because only the ‘Whites’ could vote there.

Similarly, Germany’s Nazis weren’t only the aristocracy, but also many Germans who considered themselves to be populists, and Hitler exploited this widespread illogicality among the public, in order to create his extremely elitist-racist-imperialist (or ideologically nazi) nation.

The theory behind the cutbacks in Medicaid is that the poor are to blame for their poverty. Any aristocrat believes it to at least some extent, despite its being stupid. It is stupid because any aristocrat knows that money is power: the power to hire people to do your will, and to fire ones who won’t or can’t. Any aristocrat experiences that reality all the time. The most-powerless individuals in any society are the poorest. Obviously, something causes a person to be poor, but heredity — being born poor and surrounded by only poor people — will always be the biggest portion of that cause. The people with the power are the aristocrats, the super-rich few who own the vast majority of the nation’s private wealth. They create — and, by means of their lobbyists and media and politicians, constantly impose — the system that produces, the ever-increasing concentration of wealth and so of power. The poor don’t, and can’t. And won’t. Consequently, any theory that the poor ought to be blamed for their poverty is an obvious lie, which benefits the richest. Of course, an individual also has some effect on his or her getting and staying out of poverty, but, in an aristocracy, the system itself has a much bigger effect on that.

By contrast against the aristocratic view, an intelligent democrat acknowledges (not merely to oneself but also publicly) that money is power, and consequently blames the super-rich — the very few who possess most of it — for society’s problems. Not the poor. And not any ‘race’. This isn’t to say that there aren’t intergenerational factors that help to explain how wealthy a given individual is — of course, there are (and that is the problem). But whereas a democrat tries to reduce them, an aristocrat tries to enlarge them. And that’s the ideological difference between an aristocrat and a democrat.

If America’s supposed effort to increase economic opportunity for poor people is to rely upon the poor ‘raising themselves up by their own bootstraps’, then it isn’t relying upon the billionaires to have the responsibility for solving this problem. But they, the super-rich, are the ones who actually caused the problem by their controlling not only their corporations but the press, and the lobbyists, and the politicians, who have so deceived and so controlled the public, as to have instituted this widely oppressive system, which the poorest suffer the most. It would not exist in an authentically one-person-one-vote government and nation and culture. It can exist only in an aristocracy (which is what post-WW2 America is).

The most efficient way to minimize social inequality is to replace aristocracy with democracy. It’s that simple, and that difficult. Only the super-rich possess the means to do it, but none of them actually wants to. Are all of them psychopaths? They benefit from the system that they have imposed. They benefit not only in wealth but in their corporate protective immunity from having to go to prison for any corporate crimes they require their subordinates to do in order to generate their wealth. For example, on April 10, Good Jobs First headlined “The Trillion-Dollar Mark: Corporate Misconduct Cases Reach a Dubious Milestone,” and reported:

Regulatory fines, criminal penalties, and class-action settlements paid by corporations in the United States since 2000 have now surpassed $1 trillion. Total payouts for corporate misconduct grew from around $7 billion per year in the early 2000s to more than $50 billion annually in recent years, according to a new report by Good Jobs First.

This amounts to a seven-fold increase in current dollars — a 300% increase in constant dollars.

These figures are derived from Violation Tracker, a wide-ranging database containing information on more than 600,000 cases from about 500 federal, state and local regulatory agencies and prosecutors as well as court data on major private lawsuits.

• Explore Violation Tracker.

The database shows that 127 large parent companies have each paid more than $1 billion in fines and settlements over the past quarter-century. The most penalized industries are financial services and pharmaceuticals, followed by oil and gas, motor vehicles, and utilities. …

Among the findings:

• Bank of America has by far the largest penalty total at $87 billion. It and other banks, both domestic and foreign, account for six of the 10 most penalized parent companies.

• Other bad actors include BP (mainly because of the Deepwater Horizon oil spill), Volkswagen (because of its emissions software cheating scandal), Johnson & Johnson (largely because of big settlements in cases alleging its talcum powder causes cancer), and PG&E (due to cases accusing it of causing or contributing to wildfires in the West).

• Recidivism is a major issue. Half a dozen parent companies—all banks—have each paid $1 million or more in over 100 different cases, led by Bank of America with 225. Two dozen parents have at least 50 of these cases on their record.

• All of the top 10 and 95 of the 100 most penalized parent companies are publicly traded. The most penalized privately held company is Purdue Pharma, which is going out of business for its role in causing the opioid crisis.

• In more than 500 of the cases involving criminal charges, the U.S. Justice Department offered the defendant a deferred prosecution or non-prosecution agreement. …

That’s $1T during the reported 23-year period, and these fines are mere wrist-slaps to those stockholders’ annual profits. But the victims lost vastly more than that, and this report made no mention of anyone having gone to prison for any of these corporate crimes, though at least two of them did — Bernie Madoff and Sam Bankman-Fried, both of whom had robbed their fellow-investors. But, for example, the Purdue Pharma case had killed at least hundreds of thousands, if not millions, of people, and yet none of the Sackler family that owned it, and that drove their employees to perpetrate it, had even a possibility of going to prison for any of those deaths, nor for the vast other harms that their personal wealth-building had driven.

In an aristocracy, the only super-rich who ever get imprisoned are ones who have harmed other corporate investors — never ones who have harmed or even killed vast multitudes of the middle and bottom economic classes.

Remarkably, the corrupt Democratic Party President of the United States has taken to the hustings in his fake-‘populist’ re-election campaign by citing a 2021 White House economic study, which calculated that America’s billionaires are taxed at far lower rates of income than regular Americans are. It found that if the 400 richest (highest-wealth) Americans (all of whom were multi-billionaires, and not merely billionaires, and who donate collectively around 30% of all of the money that is expended in U.S. political campaigns) had been taxed including their “income” from the corporate stock that they own (which now and always has essentially never been taxed because there are so many ways to avoid ever being taxed on it), then they were collectively being taxed at only an 8.2% rate on all of their income. It was a sound study. However, the billionaires-controlled think tanks and media slammed it by deceiving their public about it. For example, PolitiFact rated Biden’s statement “False” because (and this displays its contempt for the intelligence of its readers): “Under the current tax code, the top 1% of taxpayers pay an effective tax rate of 25% on the income the government counts.” But that’s exactly what the White House economists had been criticizing! They were criticizing the current tax-laws in the U.S., which DON’T include as reported income those stock profits.  For once (while campaigning for re-election), Biden told the truth, even though it’s a truth that his billionaire backers want the public NOT to know. (And PolitiFact is funded by numerous billionaires, both Democratic Party ones such a Soros’s Open Society, and Republican ones such as the Charles Koch Institute.) Is it any wonder, then, why the U.S. wealth-distribution is becoming increasingly skewed to the billionaires, even though so much of their wealth is being hidden and not even reported to the Government?

This content originally appeared on Dissident Voice and was authored by Eric Zuesse.

“The private insurance industry is used to getting its way, but this year we out-organized them.

“Medicare is one of the most popular government programs because it delivers health care to people when and where they need it. Private insurance companies like UnitedHealthcare spent millions in advertising and lobbying in Washington to demand more of our public money for privatized, so-called ‘Medicare Advantage’ plans.

“We countered their lobbying by helping people share their stories with lawmakers about how Medicare Advantage plans harmed them by denying care when they needed it most. We commend the Biden administration for listening to our people and refusing to cave to the insurance lobby’s demands.

“We urge President Biden to do more to rein in abuse of the Medicare program by private corporations and reinvest public funds into expanding and strengthening traditional Medicare.”

Medicare Advantage is a privatized form of Medicare in which the federal government gives Medicare funds to private health insurers to administer Medicare plans. These corporations use much of this money to invest heavily in advertising while skimping on care. These privatized plans create opaque bureaucracies and extraordinary fees. The corporations that run these private plans profit while denying care, spending 15-25% less than traditional Medicare on their enrollees' medical services while being paid 23% more.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

Ocasio-Cortez noted that "years of grassroots organizing on behalf of vulnerable Americans led to the creation of the first federal public housing units—but, for decades, the federal government has allowed our limited public housing stock to fall into disrepair."

"Residents are dealing with mold growth, lead-based paint hazards, lack of central cooling and heating, failing water infrastructure, and numerous other safety concerns," the congresswoman said. "It is beyond time for the federal government to take responsibility and pass legislation that offers comprehensive, public solutions."

"The Green New Deal for Public Housing Act will allow for an increase in public housing units, create an estimated 280,000 jobs, and invest up to $23 billion a year over 10 years for highly energy-efficient developments," she explained. "This will produce on-site renewable energy, expand workforce capacity, and focus on community development. Every American deserves to live in a safe, vibrant, and environmentally conscious community—including public housing residents. I am confident this legislation is how we make that a reality."

The jobs estimate comes from an analysis released Thursday by the Climate and Community Project and the Socio-Spatial Climate Collaborative—which also found that the proposed upgrades to U.S. public housing stock would cut carbon emissions by 5.7 million metric tons, the equivalent of taking 1.26 million cars off the road each year.

"Public housing is an essential source of stable and affordable housing for 1.7 million Americans, and our research shows we are rapidly losing units to conversions, demolitions, and deterioration," said Kira McDonald of Climate and Community Project. "This legislation would constitute decisive action to stave this loss and transform living conditions for public housing residents. In so doing, it would improve residents' health, safety, help eliminate carbon emissions, and help build the new green industries we need to decarbonize."

As Ocasio-Cortez's office summarized, the bill would:

• Expand federal programs to provide residents with meaningful work investing in their communities, to own and operate resident businesses, to move toward financial independence, and to participate in the management of public housing;
• Expand resident councils so that public housing residents have a seat at the table for important decisions regarding their homes; and
• Replenish the public housing capital backlog and repeal the Faircloth Amendment, which limits the construction of new public housing developments.

The legislation would also create two grant programs for deep energy retrofits; community workforce development; upgrades to energy efficiency, building electrification, and water quality; community renewable energy generation; recycling; resiliency and sustainability; and climate adaptation and emergency disaster response.

As world leaders dragged their feet on climate action last year, declining to demand a global phaseout of planet-heating fossil fuels at the most recent United Nations climate conference, all life on Earth was forced to contend with record high temperatures. The United States alone saw 28 disasters that each caused at least $1 billion in damage, collectively costing at least $92.9 billion.

"In these difficult times, we must move forward boldly to address the systemic and existential crises facing us today and that includes urgently combating climate change and making sure every American has a safe and decent place to call home," Sanders said Thursday. "It is unacceptable that, on a single given night in America, over 650,000 people are homeless."

That record number comes from an annual report released by the U.S. Department of Housing and Urban Development in December. As Common Dreamsreported at the time, academics and advocates have long stressed that the formal figure only represents a faction of the people dealing with housing insecurity nationwide.

"It is unacceptable that, in the richest country in the history of the world, people are choosing between paying rent and putting food on the table," argued Sanders. "It is unacceptable that our nation's public housing is in a state of chronic disrepair and energy inefficiency after generations of government neglect. It is unacceptable that we have not done more to transform our energy systems, our communities, and our infrastructure away from fossil fuels and toward renewable energy. This legislation is a major step in the right direction, and I am proud to partner with Congresswoman Ocasio-Cortez in introducing it today."

Joining the pair in backing the bill are 55 other House Democrats and Sens. Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Ed Markey (D-Mass.), Jeff Merkley (D-Ore.), Alex Padilla (D-Calif.), Elizabeth Warren (D-Mass.), and Peter Welch (D-Vt.).

Markey, who has spearheaded the broader battle for a Green New Deal with Ocasio-Cortez, said that "in the five years since its introduction, Green New Deal advocacy has catapulted environmental justice to the top of the national agenda, helped deliver historic victories, and charted a course for a better future."

The Green New Deal for Public Housing Act is also endorsed by over 70 advocacy groups and labor unions, including the American Federation of State County and Municipal Employees, American Federation of Teachers, Center for Popular Democracy (CPD) Action, Movement for Black Lives, MoveOn, National Low Income Housing Coalition, Public Citizen, and Sunrise Movement.

"Our opponents use tactics like the Faircloth Amendment to defund our public housing. And then they point to our public housing and say, 'Look, it's not working.' That's what they do—but we're not confused," declared DaMareo Cooper, co-executive director of CPD Action.

"We're in another awakening right now. People have been through too much. They are tired. We are tired. Enough is enough," Cooper added. "We all know that it's impossible for you to think that a government in this day and age cannot create housing for everyone."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

This year, the majority of Americans eligible for Medicare coverage chose to enroll in private Medicare Advantage (MA) plans rather than Traditional Medicare. Insurance companies that run these MA plans spend significant sums of money to blanket seniors with marketing that highlights the supposed advantages of MA like low upfront costs, supplemental coverage, and other unique perks like subsidizing gym memberships. However, the ads leave seniors in the dark on the downsides of MA like heavily restricted networks that damage one’s choice of provider along with dangerous delays and denials of necessary care. At the same time, both the Biden Administration and many members of Congress from both parties have voiced support for the further privatization of Medicare through growing Medicare Advantage.

In this article, we will debunk several pervasive myths about MA that proponents and insurance giant owners push in their effort to continue privatizing Medicare at the expense of patients.

Myth #1: Medicare Advantage Is Medicare

The inclusion of the term Medicare in Medicare Advantage — otherwise known as Medicare Part C — is incredibly misleading, as the program is de facto government-subsidized private insurance.

Traditional Medicare is public insurance, where tax revenues are directly used to cover healthcare for seniors and some disabled people. It employs a fee-for-service (FFS) payment model, where the Centers for Medicare and Medicaid Services (CMS) directly pays for each covered service by a healthcare provider.

In contrast, MA consists of thousands of different plans mostly provided by health insurance giants like UnitedHealthcare and Humana. Seven large insurance companies accounted for 84% of MA plan enrollment in 2023. Rather than directly covering care as needed, the federal government pays lump sum Medicare dollars, known as capitated payments, to these private insurers for each patient. MA plans make money by spending as little as possible on patient care in order to keep as much of the leftover taxpayer money as possible.

In other words, MA is private insurance supported by government subsidies, and it is a form of managed care by health insurance companies. MA is not a government-managed public health insurance program like Traditional Medicare.

Myth #2: Medicare Advantage Saves Money

Medicare Advantage has never saved taxpayers money as a substitute for Traditional Medicare. In fact, according to the Medicare Payment Advisory Commission (MedPAC), taxpayers have spent more on financing MA than they would have if everyone was covered under Traditional Medicare.

In fact, Congress and CMS have been working to try to stop MA companies from gaming the system to steal taxpayer money. A 2023 study by the Physicians for a National Health Program (PNHP) estimates that CMS overpaid MA plans between $88-$140 billion in 2022 alone through various practices like pretending patients were sicker than they were along with targeting healthier, less costly seniors to enroll in their plans. Overpayments have also caused all Medicare beneficiaries to pay billions in higher Medicare Part B premiums.

Through taking taxpayer subsidies, MA has been significantly more profitable for insurance companies than the private plans offered to the rest of Americans. In 2021, MA companies had a gross profit margin of $1,730 per enrollee, which is more than double their profit margin on the individual market ($745). In 2023, Humana ended its entire commercial insurance business in order to entirely focus on government-funded programs like MA.

Some who claim MA saves money point to how MA spending is growing at a slower rate than Traditional Medicare. However, their point assumes that people enrolled in MA and Traditional Medicare share the same characteristics, which is false. MA targets and enrolls people who are healthier, less likely to use medical services, and, thus, less expensive to cover than those in Traditional Medicare.

Myth #3: Medicare Advantage Is Necessary To Save Beneficiaries Out-of-Pocket Spending

One of the primary appeals of Medicare Advantage is the idea that it saves beneficiaries money. However, this is highly dependent on how much care someone needs. The extent to which MA does save money for patients is not a natural result of its supposed superiority; it is due to intentional political sabotage and decision making.

Patients in both MA and Traditional Medicare have to pay a monthly premium for Medicare Part B ($174.40 in 2024). Then, Traditional Medicare covers 80% of costs for outpatient services. Beneficiaries are responsible for paying the remaining 20%, with no limit on out-of-pocket (OOP) payments. However, Traditional Medicare fully covers inpatient services such as hospitalization after a patient meets a deductible ($1,632 in 2024). For prescription drug coverage, Traditional Medicare beneficiaries pay a monthly premium for a Medicare Part D plan run by a private insurer ($40 average in 2023).

Traditional Medicare beneficiaries can purchase a supplemental Medigap insurance plan to cover most OOP spending (average monthly premium of $139 in 2023), which a plurality (41%) did in 2021. Eighty-nine percent of people in Traditional Medicare had some form of supplemental coverage in 2023, such as through Medicaid (19%) or their employer/union (31%).

In MA, premiums, coinsurance rates, and deductibles vary across the thousands of different plans. However, the average monthly premium is very low ($18.50 estimate for 2024), and many plans have $0 premiums. Additionally, CMS mandates that MA plans have an OOP spending limit. The average limit for in-network services was $4,835 in 2023; when accounting for both in- and out-of-network services, the average limit was $8,659. Ninety-seven percent of MA beneficiaries are in plans that incorporate drug coverage, and the average premium is $10 per month (73% of enrollees had no premiums for drug coverage).

For healthy individuals without need of expensive healthcare services and products, MA saves money due to its low premiums. However, while Traditional Medicare users with a Medigap plan spend more money upfront due to higher premiums, they can save thousands of dollars for expensive care that would reach their OOP limit if they were enrolled in MA.

However, many seniors simply cannot afford purchasing a Medigap plan, so they have little choice but to enroll in MA. In 2023, 52% of MA beneficiaries earned annual incomes around $25,000. Income limitations disproportionately lead Blacks (65%) and Latinos (69%) to choose MA compared to Whites (48%), as 78% and 81% of Black and Latino MA beneficiaries earn less than 200% of the federal poverty level, respectively.

Traditional Medicare beneficiaries without any form of supplemental coverage (11% of Traditional Medicare users in 2021) most certainly have to pay more for healthcare due to Part A deductible and the lack of any OOP cap. However, the lack of an OOP cap in Traditional Medicare is entirely a result of politics and can be changed. While CMS requires MA plans to have an OOP cap, policymakers have elected not to create one for Traditional Medicare. Congress could legislate a $5,000 OOP cap for Traditional Medicare; this would cost just $39 billion annually or just 28-44% of the overpayments made to MA plans in 2022.

Considering the fact that MA has never saved taxpayer money, the history of billions of dollars in overpayments to MA plans, and the fact that Congress could cost-efficiently lower costs for those in Traditional Medicare, it is a myth that MA is necessary to save patients money.

Myth #4: Medicare Advantage Improves Health Outcomes

Through incentivizing the use of preventative care, Medicare Advantage’s capitated payment model should supposedly increase the health of its beneficiaries. However, there is not sufficient evidence to prove this. Additionally, the sickest patients opt for Traditional Medicare and low reimbursement rates decrease the willingness of healthcares providers to accept MA patients.

The Kaiser Family Foundation (KFF) reviewed existing studies and found that there is not strong evidence of widespread significant differences in health outcomes between Americans enrolled in MA versus Traditional Medicare. MA plans push patients to more preventative care visits, and they also incentivize beneficiaries to take on healthy habits like getting and using a gym membership. In contrast, Traditional Medicare is more likely to send its beneficiaries to higher-rated cancer facilities, nursing facilities, and home health agencies. Issues with data quality and differences in the populations who choose MA versus Traditional Medicare also render direct comparisons between the two programs quite weak.

Incentivized to spend as little as possible, MA plans pay healthcare providers less than Traditional Medicare. As a result, an increasing number of doctors and providers are declining to accept MA patients, further restricting MA networks and access to care. Additionally, lower payments can prevent doctors from providing the best quality care. In comparison, around 99% of non-pediatric physicians accept Traditional Medicare.

Medicare Advantage is a great option for relatively healthy beneficiaries who do not expect to need intensive care for serious illnesses and injuries. Capitated payments do incentivize MA insurance companies to save money by investing in healthy, preventative care and programs. At the same time, the model also incentivizes MA plans to avoid covering the highest quality care for the people most in need.

To restrict care that beneficiaries would otherwise receive in Traditional Medicare, MA companies delay and deny care through prior authorizations (PAs) and payment denials. In 2021, patients and their providers had to file 35 million PA requests in order to receive medical care. MA companies denied 2 million of these requests. People only bothered to appeal 11% of the time; however, those that did had a 82% success rate. In 2022, 94% of physicians surveyed by the American Medical Association reported experiencing PAs which caused delays to necessary care; 56% reported this occurring always or often. Eighty percent reported that PAs caused the abandonment of recommended treatment, and 33% reported that they caused a serious adverse event for their patients.

There are many reasons for poor health outcomes in the United State: lack of healthcare access, high costs, low income, poor diet, and lack of exercise to name a few. The strategy of giving lump sums of money — mostly to insurance giants — and incentivizing them to spend as little as possible is not supported with evidence of improved health outcomes and does not directly tackle these greater issues.

Myth #5: Medicare Advantage Offers Benefits That Traditional Medicare Simply Cannot Match

A primary selling point of MA plans is that they offer supplemental benefits — mainly coverage for dental, vision, and hearing care — that Traditional Medicare does not provide. While this is true, it is misleading because it does not reveal the quality of this coverage.

While the vast majority of MA plans offer supplemental benefit coverage, there isn’t evidence that their beneficiaries actually utilize dental, hearing, and vision services much more than people enrolled in Traditional Medicare. In fact, there is some evidence to the contrary regarding dental care. This is because MA supplemental “coverage” does not protect patients from having to spend significant sums of money out of their own pockets.

Most MA plans have high coinsurance rates along with low annual caps on how much insurance will cover. So, MA coverage predominantly doesn’t help patients with expensive dental, hearing, or vision treatments. This prevents many seniors from being able to afford care even though they technically have coverage. Ultimately, MA plans constantly advertise that they offer supplemental coverage, but they leave Americans in the dark on how little financial help they will actually receive.

Additionally, taxpayers and Traditional Medicare beneficiaries are effectively subsidizing these additional benefits. Not only has MA never saved taxpayer money, it is further depleting the Medicare Trust Fund and raising Part B premiums for all Medicare beneficiaries. These higher premiums and taxpayer overpayments allow MA companies to market supplemental benefits along with the aforementioned low premiums which attract healthier and lower-income seniors.

Instead of enriching MA companies, Traditional Medicare could provide dental, hearing, and vision benefits for less than $42 billion in 2025, which is 30-48% of the overpayments taxpayers made to MA in 2022. Unlike in MA, this coverage would not be limited to restricted provider networks.

Myth #6: Medicare Advantage Is Necessary To Lower Healthcare Spending

Healthcare spending overall and Medicare spending specifically increase every year more than inflation. The United States spends more money per capita than any other country on healthcare. The average cost of healthcare per person in other wealthy nations is roughly half as much as the United States.

To lower Medicare spending, proponents of Medicare Advantage tout the benefits of “value-based” care compared to Traditional Medicare’s FFS model. Critics claim that FFS incentivizes wasteful spending and opportunities for doctors to become rich by billing Medicare for services unnecessary to patient health.

In contrast, “value-based” care involves CMS giving lump sums of money (capitated payments) to MA companies for each patient, supposedly incentivising efficient healthcare spending on preventative care. Through spending less and, ideally, keeping patients healthier, MA companies get to keep more money.

While there are case studies of mission-driven organizations succeeding with capitated payments, this does not hold true for the large, for-profit insurance giants that dominate MA. Rather, the major MA companies’ primary goal is to maximize profit. Therefore, they typically take as much taxpayer money as feasible by gaming the system while restricting care in order to spend less and keep as much as possible.

However, the entire premise that reducing healthcare usage with a more restrictive insurance policy is the best means to lower healthcare spending is baseless. The United States does not use healthcare services more than the other countries who spend far less, and the same is true for Medicare compared to similar foreign populations.

Then why is healthcare so expensive in the United States? Prices. Healthcare prices in the United States are significantly higher than other countries. This reality is a result of factors like market consolidation (lack of competition), patents, administrative waste, and more.

Rather than combat the large hospitals, pharmaceutical companies, private equity companies, insurance giants, and other powerful private interests who control armies of lobbyists and excesses of campaign cash, MA proponents provide a simple solution: make people get less care. This is a convenient solution which happens to also further enrich and get the blessing of dominant insurers like UnitedHealth Group.

All in All, Medicare Advantage Is a Scam

Congress created Medicare Advantage with the 2003 Medicare Prescription Drug Improvement and Modernization Act (MMA). After signing the bill into law, President George W. Bush boasted how MA would lower costs, expand benefits, afford seniors more choices, and improve quality of care. However, this supposed modernization of Medicare was really a scheme to privatize, gifting billions of dollars to insurance companies while seeking to end Traditional Medicare.

In reality, MA has never saved taxpayer money. Through gaming the system of capitated payments, MA insurance companies have reaped billions in overpayments — which have also increased the amount all Medicare beneficiaries pay in Part B premiums.

Through restricting care and taxpayer subsidies, MA plans do offer a lower cost alternative to Traditional Medicare, especially for beneficiaries who cannot afford a supplemental Medigap plan. Additionally, it can offer supplemental benefit coverage unavailable under Traditional Medicare, even if the quality of such coverage is poor and provides limited financial support. However, this reality is not because of its inherent design; it is a result of the political sabotage of Traditional Medicare. Congress can cap OOP expenses and provide supplemental coverage for Traditional Medicare with the same money it overpays to MA insurance giants lining their profit margins.

The only choices MA afforded seniors has been which private plan they want to choose. The program destroys beneficiaries’ choice of doctor due to restricted networks. Additionally, there is not sufficient evidence that MA significantly improves health outcomes while health providers are increasingly dropping MA plans due to low reimbursements, further limiting the number of providers MA patients can see. At the same time, current comparisons between MA and Traditional Medicare are unfair as long as policy makers refuse to fix the cost gaps in the latter.

Within both the Medicare and entire American populations, healthcare costs are rising at the same time as health outcomes are worsening, especially in comparison to peer nations. While MA is a convenient solution for insurance companies, it neither addresses the causes of high prices nor poor health outcomes.

MA proponents consistently point to the increasing share of beneficiaries who choose MA over Traditional Medicare as evidence of success. Along with millions of dollars spent on deceptive advertising by insurance companies, this is the consequence of policymaker’s failure to update Traditional Medicare.

It’s past time Medicare beneficiaries are given a real choice. Instead of overpaying insurance giants to the tune of hundreds of billions of dollars, Congress can cap OOP expenses at $5,000 annually and provide supplemental benefits in Traditional Medicare.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

Social Security and Medicare have long been targets in the GOP shooting gallery. Lots of Dems take aim at them too – senator Joe Biden did throughout his congressional career. But despite mendacious yelps about the Social Security fund going bankrupt or Medicare “needing to be fixed,” they remain the two most effective antipoverty programs in the history of the Republic. Not that there have been many. There was welfare, axed by Bill “Crush the Poor” Clinton. We Americans also have food stamps, Medicaid and veterans have the VA with its top-of-the-line, free health care. All periodically come under attack by right-wing Republicans and managerial-class-worshipping Dems. But things took a turn for the worse in mid-January, and here’s how…

Three Democratic representatives on the congressional Budget Committee voted, along with 19 Republicans, to send a bill to the House, establishing a commission that Common Dreams on January 18 called “a Trojan Horse for Social Security and Medicare cuts.” Who were these Judases with their scarcely concealed ageism? Jimmy Panetta (California), Earl Blumenauer (Oregon) and, most responsible, Scott Peters (California). This piece of nastiness is called the Fiscal Commission Act, and make no mistake: it will help dispossess ordinary, older Americans.

Needless to say, the Budget Committee ditched amendments to tax “the rich to bolster Social Security and Medicare,” because plutocrats’ bank accounts are sacred. According to Pennsylvania House member Brendan Doyle, “there are absolutely those who are getting ready to use a commission as a back doorway to force through unpopular cuts” to the two programs. How unpopular? Let’s just say no public person in his or her right mind would propose such cuts, knowing full well that it would turn him/her into a political leper tout de suite. So what they can’t do in public, these shameless hypocrites do in private and with deceit.

The left advocacy group Demand Progress sent out a fundraiser that got right to the point: “Republicans have been hell-bent on destroying Social Security for decades, and they have unveiled a devious plan to finally accomplish their goal THIS YEAR. Here’s the plan: create a closed-door commission to gut Social Security – and then schedule a straight up-or-down vote on the commission’s recommendations during the lame-duck session of congress right AFTER the election. That way members of Congress can promise not to cut Social Security during the election and then turn around and do just that.” So listen up candidates: Commit to vote against the commission’s recommendations, or lose your precious election! As for presidential contestants Joe “I’d Veto Medicare-For-All” Biden and Donald “Rich People Need Lower Taxes” Trump – vow to veto any bill cutting these two lifesaving programs or face the wrath of senior citizen voters! And remember, no one goes to the polls more reliably than elderly retirees.

So who are the these three Dems dedicated to impoverishing elderly Americans? Well, Jimmy Panetta represents liberal Santa Cruz, California, and boasts accomplishments like an affordable housing project and “partnerships at all levels of government to address the cost of housing in our community,” according to his website.

This is especially germane, because when septuagenarians lose their Social Security checks, thanks in part to Panetta’s Budget Committee vote, many will decamp to the sidewalk to sleep under the stars. Maybe Panetta could arrange for cheaper housing to be indexed to the age of the destitute elderly – penniless nonagenarians go to the head of the line, followed by octogenarians and so forth. That way, senior citizens in wheelchairs might not have to struggle to fit their devices into a tent – if they don’t have to sell their wheelchairs once they lose their Social Security check.

Also from California, we have Scott Peters, another lawmaker whose big smile raises the question: What have you got against old folks, Scott? His website advertises the deadly Fiscal Commission Act and the Fiscal State of the Nation Act as HIS legislation. In other words, we can thank a Democrat for cooking up the poisonous gallimaufry that could ultimately kill Social Security. And he’s proud of it!

True, Peters couches his praise of his commission in terms of avoiding “automatic and across-the-board cuts to Social Security and Medicare.” Oh, so instead we’ll get carefully tailored cuts to these programs, their size conveniently tbd. In other words, the Demand Progress fundraiser and Common Dreams screed hit the nail on the head. This commission IS a Trojan Horse ready to defund the programs. If Peters really is in an altruistic frenzy about across-the-board cuts of 23 percent, which kick in in a decade, he’d introduce legislation to eliminate or scale back those automatic cuts. And get the money where, you ask? I’ll tell you: by repealing Trump’s tax cuts for the rich and by slashing Pentagon spending. Billionaires don’t need lower taxes, and our military has famously lost track of over $1 trillion. Let them help fund Social Security.

Last but not least among the Three Musketeers sworn to snatch Social Security checks from the gnarled fingers of the elderly is Earl Blumenauer, founder and co-chair of the Congressional Cannabis Caucus. Because yep, that’s what our seniors will clamor for, as their furniture is thrown on the street due to eviction for non-payment of rent – marijuana. Maybe Blumenauer from his lofty perch in this caucus could author legislation legalizing pot for old folks stressed out by bankruptcy. Given his vote for this awful Social Security commission, that’s the least he could do. He could also thus win points with his liberal Oregon constituency, amirite?

Not to gang up on the Dems, I should repeat that this attack on Social Security had the support, in committee, of 19 Republicans. Just as, when it reaches the House floor, it will doubtless get the vote of EVERY Republican reptile in the chamber. The economic woes of senior citizens do not move them. Tax decreases for the fantastically rich, billions of dollars for more tanks, guns and bombs – that’s what makes the GOP tingle with delight. They’ve wanted to defund Social Security since Franklin Roosevelt signed it into law in the mid-twentieth century. Now, with the help of three, two-faced Dems, they may finally get their chance.

This content originally appeared on CounterPunch.org and was authored by Eve Ottenberg.

This content originally appeared on CounterPunch.org and was authored by Ed Grystar.

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The year 2023 was a banner one for hospice reform. Spurred by media reports, letters from Congress and pressure from lobbying groups, the Centers for Medicare and Medicaid Services increased oversight of end-of-life care. It retooled inspections to focus on quality of care. It made ownership data public for the first time. And, kicking off a plan to visit every hospice provider in the country, its staff made appearances at 7000 sites. Following the tour, the Medicare billing privileges for 46 nonoperational hospices were revoked.

In July, the agency also rolled out a special enforcement program to target hospices in Arizona, California, Nevada and Texas — states with alarming spikes in the number of providers. The increase in hospice numbers had raised concerns inside and outside the agency about fraudulent bills for unneeded services and market oversaturation. During its “period of enhanced oversight,” the agency said, it would scrutinize the claims from new hospices in these states before paying them.

These reforms, however, have done little to slow the region’s hospice boom. CMS data from last year shows that these four states continued to drive most of the growth of new Medicare-certified hospices in the country, with two-thirds of all certifications taking place there. The nation’s leading trade groups for end-of-life care have repeatedly recommended that Medicare impose a moratorium on certifying new hospices in counties that have seen an explosion in questionable startups. This would prevent bad actors from draining Medicare funds, the groups contend, while regulators can investigate fraudulent networks. In response to questions about this recommendation, CMS told ProPublica in a written statement that “if state officials believe there is a hospice issue in their state, they can pursue a state-based hospice license moratorium under their state laws/regulations such as what was done in California.”

California, however, offers an example of why this approach may not be working: Last year, the state temporarily banned new hospice licenses altogether after its auditors found evidence of “a large-scale, targeted effort to defraud Medicare,” with providers charging for patients who did not need hospice care or, in some cases, did not exist. But without a federal moratorium on certifications, the large crop of licensees that were established in the past three years can continue to bill Medicare. “The Department of Public Health is doing a fantastic job of trying to clean it up here in California, but they can’t clean it up fast enough if CMS keeps allowing new hospices to charge for patients,” said Sheila Clark, the president of the California Hospice and Palliative Care Association, a trade group for providers.

Indeed, the agency’s data shows that last year it continued to certify hospices located in buildings that have been flagged by auditors and journalists as potential fraud hot spots. In 2023, Medicare certified 15 more hospices at a two-story building in Los Angeles that is home to more than 100 hospices. It also certified three new hospices last year at a Phoenix address that purportedly houses dozens of providers, all of which have materialized in the past two years.

CMS said that without “evidence of sanctions” that would authorize it to deny certification, the agency cannot prevent these hospices from entering the program. In a recent blog post it added that “we take our role as stewards of the Medicare Trust Funds seriously, and we work to ensure that taxpayer dollars are spent on high-quality, necessary care for each beneficiary.”

Hospice fraud doesn’t just drain Medicare reserves. It also harms patients who are not actually dying, since enrollment cuts them off from curative care. Karen Joy Fletcher, communications director at California Senior Medicare Patrol, which runs a hotline for patients and families, said that hospice fraud continues to be a big problem in the state despite the moratorium.

A few weeks ago, for instance, the hotline received a call from Anna Duran, whose mother has been in a nursing home in Los Angeles County since 2010. Duran was surprised to discover that her mother was unable to get her pacemaker checked because she’d recently been enrolled in hospice by a doctor she’d never heard of. Duran, who holds power of attorney for her mother, determined that no one at the nursing home had enrolled her mother — or thought, for that matter, that she was about to die. She had dementia and high blood pressure, but she was still walking. Each time Duran called the number for the hospice business, no one picked up. An analyst from Medicare has now been assigned to untangle the case, but so long as Duran’s mother is still on hospice, she no longer qualifies for her regular physical therapy appointments. Medicare, meanwhile, has paid the hospice more than $7,500. “Nobody knows how this happened,” Duran said.

This content originally appeared on Articles and Investigations - ProPublica and was authored by by Ava Kofman.

“The industry tells us that Medicare price negotiations will make it hard to research and develop new drugs. What they leave out is that many are already spending far more to make their executives and shareholders rich than on R&D,” said Peter Maybarduk, Access to Medicines program director at Public Citizen. “When these corporations complain about the impact of price negotiations on innovation, we should be deeply skeptical.”

Additionally, the report notes that researchers and the Congressional Budget Office conclude there is no connection between a drug’s research and development cost and its future price, and that the current price of drugs reflects what companies believe the market will bear in response to their monopolistic pricing power. Additionally, the United States is an outlier that does little to protect its residents from the unfair pricing power of drug companies – and bringing American policy into alignment with those of other countries, including its high-income peers, would not destroy the incentive to innovate new medicines.

“These findings undermine industry claims that reducing corporate profits in Medicare price negotiation will impact capacity to invest in research and developing new drugs,” said Jishian Ravinthiran, researcher with Public Citizen and lead author of the report. “These companies are not strapped for resources, as they spend massive amounts of money on self-enriching activities.”

The report also reveals that manufacturers of the 10 drugs with the highest annual expenditures by payers in Maryland spent $9 billion more on stock buybacks, dividends, and executive compensation than on research and development expenses in 2022. Seven states, starting with Maryland in 2019, have established Prescription Drug Affordability Boards charged with analyzing the excessive costs of prescription drugs and identifying solutions to medicine inaccessibility. As other states consider creating their own Boards with the authority to limit the price of drug transactions, or consider expanding these Boards’ authority to deliver relief to more residents, they can rely on this report’s finding that industry has ample resources to invest in drug innovation.

At a press conference today, Maryland Healthcare for all will kick off a campaign to pass major legislation in 2024 to expand the authority of the Maryland Prescription Drug Affordability Board and continue the work of bringing down high costs for medications.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

Photograph Source: U.S. Government – Public Domain

As a Thanksgiving present to readers, Washington Post columnist Catherine Rampell decided to tell us again how old-timers are robbing from our children with their generous Social Security and Medicare benefits. This is always a popular theme at the WaPo, especially around the holiday season.

The story is infuriating for four reasons:

+ Even by the calculations highlighted in the piece, Social Security is not a big subsidy to retirees,

+ Medicare appears to be a large subsidy only because our healthcare system is so inefficient,

+ What counts as a government payment, as opposed to a market outcome, is arbitrary, and

+ We pass on a whole society to our children, focusing on these programs to the neglect of the larger social and physical environment is close to absurd.

Social Security

The Social Security program has always been reasonably well-funded, even as slower growth and the upward redistribution of income over the last five decades have hurt the program’s finances. It is now projected to face a shortfall in a bit over a decade, but the gap between scheduled benefits and taxes is not exceptionally large, as calculated by Gene Steurele and Karen Smith, Rampell’s source.

Source: Steurele and Smith, 2023.

The chart below above shows Steurele and Smith’s calculations for lifetime Social Security benefits and taxes, for people turning 65 in 2025, for men and women at different earnings levels. There are a few points worth noting on these calculations.

First, they are highly stylized, assuming that a worker puts in 43 years from age 22 to age 65 always earning the same wage relative to the overall average. This means that their wage rises year by year in step with inflation and the increase in average wages. No one actually would follow this pattern.

They are likely to earn less early in their career and more later in their career. They also are likely to have some years of little or no earnings. This is especially the case for women who are likely to spend some time outside of the paid labor force caring for children or parents. These adjustments would generally lead to higher benefits relative to taxes.

The second point is that the calculations assume that everyone lives to age 65 at which point they start to collect benefits. Some people will die before they can collect benefits, so we are looking at the benefits for workers who survive to collect benefits. (Social Security also has survivors’ benefits that go to spouses and minor children of deceased workers, so their tax payments are not necessarily a complete loss.)

The third point is that Steurele and Smith have opted to use a 2.0 percent real (inflation-adjusted) interest rate to discount taxes and benefits. This is a standard rate to use in this sort of analysis, but one could argue for a higher or lower rate. A higher rate would make the program seem less generous, while a lower rate would raise benefits relative to taxes.

As can be seen, low earners are projected to receive more in benefits than they pay in taxes. An important qualification here is that there is a large and growing gap in life expectancies between low and higher earners. These calculations assume that everyone of the same gender has the same life expectancy regardless of their income. This means that the benefits will be somewhat overstated for low earners and understated for high earners.

Ignoring the life expectancy issue, the chart shows that projected benefits end up being less than taxes once we get to high earners ($105,800 in 2023). For men projected lifetime taxes exceed benefits by $106,000. For women the gap is smaller at $49,000, reflecting their longer life expectancy.

Moving to maximum earners, people who earn the income at which the payroll tax is capped ($160,200 in 2023), the gaps become larger. In the case of men, projected lifetime taxes exceed benefits by $319,000. For women, projected lifetime taxes are $249,000 more than benefits.

There are some simple takeaways we can get from the Steurele and Smith analysis. First, for low and middle-wage earners Social Security does indeed pay out more in benefits than workers pay in taxes. However, the gap is not very large. For average earners, who got $66,100 in 2023, (not shown to keep the size of the graph manageable), the gap is $3,000 for men and $46,000 for women.

For higher income earners taxes actually exceed benefits. In the case of maximum earners, these excess payments are actually fairly large, as noted $319,000 for men and $249,000 for women.

This raises an interesting issue, if we are looking to cut benefits to reduce the “subsidy” to the elderly provided by Social Security. We can cut back benefits by a substantial percentage for low earners to bring their lifetime benefits more closely in line with their lifetime taxes, but do we really want to reduce retirement benefits for people who had average earnings of $29,700?

We can make some cuts for more middle-income workers, but someone earning $66,100 during their working lifetime was not terribly comfortable, and there is not much subsidy here to start, especially with men. When we get to higher earners, taxes already exceed benefits. We can still make cuts to their benefits, but we would not be taking back a subsidy by this calculation, we would be increasing their net overpayment to the program.

It’s also worth noting who is a high earner in this story. The high earner had annual earnings of $105,800 in 2023. President Biden promised that he would not raise taxes on couples earning less than $400,000. That puts his cutoff of $200,000 at almost twice the high earner level, and the calculation of lifetime benefits and taxes turns negative at a considerably lower income than the stylized high earner.

These calculations show that if we just take Social Security in isolation and want to reduce the subsidy implied here we either have to cut benefits for people who are not living comfortably by most standards, or we have to cut benefits for people who are not currently receiving a subsidy. We may decide that the latter is good policy, but we should be clear that it is not taking back a subsidy.

There is an important qualification to this discussion. Married couples will generally do better in these calculations than single workers. This is because the spousal benefit allows the spouse to collect the greater of their own benefit or half of their spouse’s benefit. Also, a surviving spouse will receive the greater of their own or their deceased spouse’s benefit. For these reasons, lifetime benefits for couples will generally be higher relative to taxes than for single individuals.

The Medicare Subsidy and the Broken Healthcare System Story

The Steurele and Smith analysis shows much larger subsidies for the Medicare program, as shown below.

There are a few qualifications to these calculations that should be noted. First, the same caveats about earnings patterns that were noted with the Social Security calculations also apply to the projected value of Medicare taxes.

Second, the differences in life expectancies by income matter here also when assessing the size of the tax penalty or subsidy. The program is less generous for low earners than shown in this figure and more generous for high earners.

The third point is that, unlike with the designated Social Security tax, the Medicare tax is not capped. This means that people earning above the Social Security cap will be paying more taxes to support the program. For very high earners ($185,000 for men and $207,000 for women), projected taxes would exceed benefits. The size of the tax penalty increases further up the income scale.

Finally, high-income people also pay a designated Medicare tax on capital income, like dividends and capital gains. For these people, it is virtually guaranteed that their Medicare taxes exceed their projected benefits.

With these caveats, we see the same general story as with Social Security, where there is more of a subsidy for lower earners than higher earners. While the overall gaps are larger for Medicare, projected benefits exceed taxes by a larger amount, this changes less with income than in the case of Social Security.

This is due to the fact that, unlike Social Security, the payout is not designed to be progressive, with all retirees getting in principle the same benefit.[1] This is qualified by the fact that higher-income retirees can expect to receive benefits for a considerably longer period of time, making the benefit regressive.

I have added a third bar to this graph, labeled “Benefits-Canada.” This is a calculation of what the cost of benefits would be if we paid the same amount per person for our healthcare as Canada does. The Medicare program appears as a huge subsidy to beneficiaries primarily because we pay so much more for our health care than people in other wealthy countries.

According to the OECD, we pay 57 percent more per person than Germany, 107 percent more than France, and 99 percent more than Canada. This sort of massive gap can be shown with U.S. costs relative to every other wealthy country. We don’t get any obvious benefit in terms of better healthcare outcomes from this additional spending. Life expectancy in the United States is considerably shorter than in most other wealthy countries.

The “Benefits-Canada” bar allows us to assess the value of Medicare benefits if our healthcare costs were more in line with those in other countries. It multiplies the projected value of Medicare benefits by the ratio of per person health care costs in Canada to costs in the United States (50.3 percent).

As can be seen, if we calculate Medicare benefits assuming that we pay as much for our health care as people in Canada, most of the calculated subsidy goes away. Low earners still receive a substantial subsidy, $102,000 for men and $122,000 for women, but this quickly goes away higher up the income ladder.

If we assume Canadian health care costs, a high-earning male has a net Medicare tax penalty of $21,000, while a high-earning woman has a net tax penalty of just under $1,000. For those earning at the Social Security maximum, the net tax penalty for men is $111,000, and for women it’s $91,000.

The implication of this calculation is that the seemingly large subsidies that Medicare provides to retirees is not due to the generosity of benefits, it is due to the fact that we overpay for our healthcare. Medicare is not providing a large subsidy to retirees, it is providing a large subsidy for drug companies, medical equipment suppliers, insurers, and doctors. (In case you are wondering, people in the U.S. are not generally paid much more than people in other wealthy countries. Our manufacturing workers get considerably lower pay.)

We pay roughly twice as much in all of these categories as people in other wealthy countries. It is misleading to imply that these overpayments are generous to retirees. While all of these interest groups have powerful lobbies, which makes it politically difficult to bring their compensation in line with other wealthy countries, we should at least be honest about who is getting subsidized by the high cost of our Medicare program.

What Do Subsidies Mean, When the Government Structures the Market?

There is another aspect of these calculations that should have jumped out at people when I noted that the designated Medicare tax is not capped and also applies to capital income. The taxes that are designated for these programs are arbitrary. We can designate other taxes that people pay as being Social Security and Medicare taxes, and apparent subsidies will disappear.

In fact, the idea that we can make a clear distinction between income that people have somehow earned, and income that is given to them by the government, is in fact an illusion. The government structures the markets in ways that allow some people to get very wealthy and keep others on the edge of subsistence.

Those who make big bucks in the healthcare industry are just one example. While our trade policy was quite explicitly designed to open the door to cheap manufactured goods, we actually have increased the barriers that make it difficult for foreign-trained doctors to practice in the United States.

We have made patent and copyright monopolies longer and stronger. The government subsidizes bio-medical research and then gives private companies monopoly control over the product. In a recent example, we paid Moderna to develop a COVID vaccine and then gave them control over it, creating at least five Moderna billionaires.

We have allowed our financial sector to become incredibly bloated, creating many millionaires and billionaires, even as we demand efficiency elsewhere. We give Elon Musk and Mark Zuckerberg Section 230 protectionagainst defamation suits that their counterparts in print and broadcast media do not enjoy.

And, as was recently highlighted with the UAW strike, our CEOs make far more than the CEOS of comparably sized companies in other wealthy countries. The difference is as much as a factor of ten in the case of Japanese companies. This is not due to the natural workings of the market, this is the result of a corrupt corporate governance structure that allows the CEOs to have their friends set their pay.

Yes, I am again talking about my book (it’s free). It is absurd to obsess about tax and transfer policy while ignoring the ways in which the government structures the market to determine winners and losers. It is understandable that the right would like tax and transfer policy to be the focus of public debate, since the default is a market outcome that leaves most money with the rich.

However, it is beyond absurd that people who consider themselves progressive would accept this framing. We can structure the market differently to get more equitable market outcomes. This should be front and center in public debate. Unfortunately, the right wants to hide the fact that we can structure the market differently, and progressives are all too willing to go along.

Future of the Planet

There is a final point on the sort of generational scorecard implied by these calculations of Social Security and Medicare benefits. We don’t just hand our children a tax bill, we hand them an entire economy, society, and planet.

If we experience anything resembling normal economic growth, average wages will be far higher twenty or thirty years from now than they are today. Will the typical worker see these wage gains? That will depend on distribution within generations, not between generations.

We also see costs from items like the military. When I was growing up in the 1960s we paid a much larger share of our GDP to support the Cold War. (Young men were also drafted.) We will again pay lots more money for the military if we have a new Cold War with China. The implied taxes don’t figure into the Social Security and Medicare calculations, but will be every bit as much of a drain on the income of people in the future as taxes for these programs.

And, we should always have global warming front and center. If we paid off the national debt and eliminated the programs to support retirees, but did nothing to restrain global warming, our children and grandchildren would not have much reason to thank us. First and foremost, we must give them a livable planet.

Phony Answers to a Phony Question

The whole subsidy to retiree story is a diversion from the many important issues facing the country. Even the core idea, that we don’t adequately support the young because we give too much to the elderly is wrong.

We saw this very clearly in the debate over the extension of the child tax credit. As with everything in Congress, much is determined by narrow political considerations. Republicans had no interest in giving President Biden and the Democrats a win, but the bill could have passed without Republican votes.

The deciding factor was the refusal of West Virginia Senator Joe Manchin to support the bill. Senator Manchin was very clear on his concerns. He didn’t argue that we were spending too much on retirees, he didn’t want low-income people to have the money.

This is in general the story as to why we don’t have adequate funding for early childhood education, children’s nutrition, day care and other programs that would benefit children. There is a substantial political bloc that does not want to fund these programs. And, they still would not want to fund these programs even if we didn’t pay a dime for Social Security and Medicare.

Note.

[1] This is not strictly true, since the premium payment that retirees make for Part B and Part D of the Medicare program depends on income in retirement.

The post Social Security and Medicare: Fun with Numbers Time appeared first on CounterPunch.org.

This content originally appeared on CounterPunch.org and was authored by Dean Baker.

An "energy carrier," hydrogen stores and transports energy produced from resources such as biomass, fossil fuels, and water—but FOEI says industry promises of hydrogen's potential should not be trusted.

"Hydrogen, just like the fossil fuels and other false climate solutions pushed by that same industry, further reinforces neocolonial patterns of extractivism and exploitation."

The group's paper begins by debunking the hydrogen "rainbow." Citing the International Energy Agency, it states:

Globally, more than 62% of hydrogen production is derived from fossil gas (known as grey hydrogen, blue hydrogen when coupled with carbon capture and storage, or turquoise hydrogen when produced from methane pyrolysis). About 21% comes from coal and lignite (black/brown hydrogen), 16% is produced as a byproduct at refineries, 0.5% derived from oil, whilst only 0.1% is produced via water electrolysis (green from renewable electricity, purple/pink from nuclear).

While some groups support green hydrogen, critics including FOEI emphasize that along with being incredibly uncommon, it "demands huge amounts of cheap renewable electricity to function, rendering the process highly inefficient," and "requires vast amounts of water, an increasingly rare and precious resource that shouldn't be wasted."

"Pushed by the same fossil industry that has caused—and continues to fuel—the climate crisis, hydrogen is yet another false solution, sold by the industry as a magical fix which allows business as usual to continue," the paper asserts. "Like other false solutions, it represents a dangerous distraction from the urgent, deep, real emission cuts that are needed to address the climate crisis."

Climate scientists and energy experts have long said that humanity must rapidly phase out fossil fuels to avoid the most catastrophic effects of heating the planet and meet the Paris agreement goal of limiting global temperature rise this century to 1.5°C. A U.N. analysis revealed Monday that currently implemented policies put the world on track for 3°C of warming by 2100.

The FOEI paper points out that in addition to propping up polluters by "justifying more fossil gas, hydrogen conveniently allows the fossil industry to push another one of its lifelines: carbon capture and storage," an "unproven techno-fix" that global climate groups are also warning about in the lead-up to COP28 in the United Arab Emirates.

"It is unsurprising that hydrogen, just like the fossil fuels and other false climate solutions pushed by that same industry, further reinforces neocolonial patterns of extractivism and exploitation," the publication continues, highlighting how the oil and gas sector "has shown time and again its disregard for communities and the environment, especially in the Global South."

Yegeshni Moodley from Friends of the Earth South Africa/groundWork said in a statement that "in the Global South, 'green hydrogen' receives public money yet serves only private interests. As governments collude with corporations over mega-infrastructure projects, communities struggle to keep their ancestral lands and scant water resources intact."

The paper notes that like other "false solutions" to the climate emergency—including geoengineering, offsets, and so-called nature-based solutions—on top of "disproportionate social and environmental costs, hydrogen also comes with a high financial cost."

FOEI advocacy officer Lise Masson argued that "rather than betting on unproven and inefficient hydrogen technologies, we need rich countries to put their money towards a just energy transition, one that puts power in the hands of people, not corporations."

Already, some governments are pouring money into hydrogen. U.S. President Joe Biden last month announced a "historic investment" of up to $7 billion for seven hubs across the United States, the nation that has historically contributed the most to human-caused global heating.

Meanwhile, in the European Union, "the gas lobby has succeeded in securing several pieces of legislation promoting hydrogen—including legislation that allows public funds to go to fossil gas infrastructure as long as it promises to be 'hydrogen ready' despite the fact that Europe already has more gas infrastructure than necessary," FOEI detailed.

In Belgium, the European Commission, Hydrogen Europe, and the Clean Hydrogen Partnership are co-hosting European Hydrogen Week 2023—which activists with We Smell Gas disrupted with a protest involving fake green vomit on Tuesday.

"From Chile, to Namibia to South Africa, the story is the same. Communities are not being consulted on [hydrogen projects] destined for European consumption [with] the costs of false solutions violently outsourced," We Smell Gas said on social media Tuesday. "Hydrogen imports are imperial greed painted green."

"Our current energy system relies on appropriating space, resources, and cheap labor from racialized and working-class people inside and outside European borders," the group continued. "For the profit of E.U. multinational and the economic dominance of Western states. [Hydrogen] at scale reproduces this system."

The FOEI position paper stresses that "addressing the climate crisis can only come through deep systemic change, dismantling the neocolonial, patriarchal, neoliberal capitalist system that created the crisis, to build a more just and equitable world for all."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

"Israel's repeated attacks damaging hospitals and harming healthcare workers, already hard hit by an unlawful blockade, have devastated Gaza's healthcare infrastructure," said A. Kayum Ahmed, special adviser on the right to health at Human Rights Watch. "The strikes on hospitals have killed hundreds of people and put many patients at grave risk because they're unable to receive proper medical care."

Over the past week, Israeli forces have surrounded and intensified their bombardment of several hospitals in northern Gaza including al-Shifa, the enclave's largest medical facility. Israel has also bombed ambulances and people desperately attempting to flee hospitals as they've come under attack.

"On November 3, the Israeli military struck a marked ambulance just outside of Gaza City's al-Shifa hospital," HRW said. "Video footage and photographs taken shortly after the strike and verified by Human Rights Watch show a woman on a stretcher in the ambulance and at least 21 dead or injured people in the area surrounding the ambulance, including at least 5 children."

"An IDF spokesperson said in a televised interview that day: 'Our forces saw terrorists using ambulances as a vehicle to move around. They perceived a threat and accordingly we struck that ambulance,'" the group added. "Human Rights Watch did not find evidence that the ambulance was being used for military purposes."

HRW similarly questioned Israeli assertions that Hamas is using Gaza's hospitals, including al-Shifa, for military operations.

Targeting hospitals is a war crime under international law, but medical facilities can lose their protected status if they're used to commit an "act harmful to the enemy," according to the International Committee of the Red Cross (ICRC).

HRW argued that Tuesday that "no evidence put forward" by the Israeli government thus far "would justify depriving hospitals and ambulances of their protected status under international humanitarian law."

"When a journalist at a news conference showing video footage of damage to the Qatar Hospital sought additional information to verify voice recordings and images presented, the Israeli spokesperson said, 'Our strikes are based on intelligence,'" HRW said. "Even if accurate, Israel has not demonstrated that the ensuing hospital attacks were proportionate."

The group said Israel "should end attacks on hospitals" and urged the United Nations' Independent International Commission of Inquiry on the Occupied Palestinian Territory and the International Criminal Court to investigate.

"Israel's broad-based attack on Gaza's healthcare system is an attack on the sick and the injured, on babies in incubators, on pregnant people, on cancer patients," said Ahmed. "These actions need to be investigated as war crimes."

The new analysis came amid horrific reports of the impact that Israel's assault is having on healthcare workers, patients, and displaced people seeking refuge from near-constant airstrikes.

Reutersreported that people trapped inside al-Shifa Hospital "plan to start burying bodies within the hospital compound" on Tuesday "because the situation has become untenable." The World Health Organization said over the weekend that the facility is "not functioning as a hospital anymore" due to power outages and a lack of supplies, which have caused the deaths of a number of patients—including premature babies.

Dr. Ahmed Al Mokhallalati, a surgeon at al-Shifa, told Reuters that "the bodies were generating an unbearable stench and posing a risk of infection."

"Unfortunately there is no approval from the Israelis to even bury the bodies within the hospital area," he said. "Today ... civilians started digging within the hospital to try and bury the bodies on their own responsibility without any arrangements by the Israeli side. Burying 120 bodies needs a lot of equipment, it can't be by hand efforts and by single-person efforts. It will take hours and hours to be able to bury all these bodies."

Doctors Without Borders, known internationally as Médecins Sans Frontières (MSF), said that on Tuesday morning, "bullets were fired into one of three MSF premises located near al-Shifa hospital and sheltering MSF staff and their families—over 100 people, including 65 children, who ran out of food last night."

"Thousands of civilians, medical staff, and patients are currently trapped in hospitals and other locations under fire in Gaza City; they must be protected and afforded safe passage if they wish to leave," the group added. "Above that, there must be a total and immediate cease-fire."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

The resolution is the culmination of years of advocacy by Chrissy and Art Holt, Phil Ateto and Rob Smith, all members of the Maryland Progressive Healthcare Coalition, with support from National Nurses United Progressive Maryland, Our Revolution Maryland and Public Citizen.

Lisa Rodvien, who represents Anne Arundel County's 6th District, introduced the resolution. “This resolution will add another voice to the growing call for Medicare for All,” said Rodvien. “It is long past time to ensure that every American, regardless of income or employment status, has access to comprehensive healthcare.”

Anne Arundel County is the sixth municipality in Maryland and the 125th nationwide to pass a resolution in support of Medicare for All, following Prince George’s County, Montgomery County, Charles County, Annapolis and Frederick.

The Anne Arundel County health department cites the persistence of racial, income, and geographic disparities in health measures for county residents, noting a 15-year difference in life expectancy between the census tracts with the lowest and highest life expectancies in the county. In 2020, COVID-19 caused 19.8% of deaths for Hispanic residents, compared to 5.9% of white residents. At the start of the COVID-19 pandemic, 18% of Hispanics and 6.9% of Asians in Anne Arundel County were uninsured, compared to 3.2% of white residents.

Medicare for All is single-payer, universal healthcare represented by two federal bills: S-1655 in the Senate, introduced by Bernie Sanders (D-VT); and HR-3421, led by Rep. Pramila Jayapal (D-WA). Medicare for All would be free at the point of service, include dental, vision, and long term care, and cover everyone. Studies have shown that Medicare for All would create better health outcomes, at significantly lower costs, resulting in savings for taxpayers, communities, and municipal, county, and state governments.

“The current health system is not sustainable or equitable,” said Chrissy Holt of Annapolis. “The global COVID-19 pandemic made it clear that we can’t afford not to have universal healthcare. On top of this, Medicare for All makes financial sense. According to the Congressional Budget Office, it would provide the American people and our entire healthcare system $650 billion each in savings each year, improve the economy, eliminate all out-of-pocket healthcare costs, and save precious lives.”

"Medicare for All would save our local government a chunk of money and provide quality healthcare to everyone in the county. It really is that simple,” said Phil Ateto of Annapolis.

"Yes, Anne Arundel County has a low overall uninsurance rate, but that hides a lot and we could do better,” said Robert E. Smith, a county resident in Crofton. “For example, according to Health Department statistics, in 2020, 18% of Hispanic residents were uninsured. COVID-19 became the leading cause of death for Hispanics, accounting for 19.8% of deaths. That’s unacceptable. The COVID-19 pandemic exposed shortcomings in terms of both access to and continuity of care within our current healthcare system. Medicare for All would guarantee health care for EVERYBODY and ALL THE TIME with no gaps in that care."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

This content originally appeared on The Intercept and was authored by Deconstructed.

This content originally appeared on The Intercept and was authored by Deconstructed.

The Biden administration has taken a major step to rein in price gouging for prescription drugs in the United States. Medicare will now be able to negotiate prices on 10 of the most expensive drugs used to treat diabetes, cancer, heart disease and more. That list is set to expand over the years. In what’s seen as a blow to Big Pharma, the White House says the move, a part of the Inflation Reduction Act, will benefit more than 9 million people in the U.S. and lead to $100 billion in savings over the next decade. Pharmaceutical companies have already filed at least eight lawsuits contesting the new rule. “We’re paying far more than the rest of the world, and there’s no rational basis for it,” says Peter Maybarduk of the nonprofit consumer advocacy organization Public Citizen. Maybarduk joins us to discuss how the new negotiation process aims to break up drug monopolies and disband the pharmaceutical industry’s profit incentive.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

“Just over a year ago, President Joe Biden signed the Inflation Reduction Act, giving Medicare the power to negotiate lower prices on prescription drugs. Today, Biden announced the first ten drugs subject to negotiation, and Big Pharma corporations are furious.

These are among the most outrageously priced drugs on the market, Pharma’s prized cash cows. For the first time ever, our government will stop Pharma corporations from charging as much as they want for life-saving and life-sustaining medications.

Over 8 million Medicare beneficiaries rely on these medications. In 2022, Medicare spent $50.5 billion on them — about 20 percent of total Part D prescription drug costs. Beneficiaries paid $3.4 billion in out-of-pocket costs, which were as high as $6,497 per enrollee.

This is just the beginning. Within a decade, Medicare will have the power to negotiate lower prices on well over 100 drugs. That’s a huge win for seniors and people with disabilities.

This is the biggest defeat Big Pharma has ever suffered — and it won’t be the last. We are going to keep fighting until every single person in America can get the medications they need.”

This content originally appeared on Common Dreams and was authored by Newswire Editor.

Photograph Source: Haxorjoe – CC BY-SA 3.0

The New York Times editorial board came to a shocking realization this week: we are living on borrowed money. That was the headline of an editorial it ran calling for deficit reduction.

Having discovered the deficit, the piece then went on to call for a combination of increased revenue and reduced spending to reduce the need to borrow. In this process, it insisted that cuts to Social Security and Medicare must be on the table.

Needless to say, this insistence caught the eye of many people. Republicans, and many Democrats, have been looking to cut and/or privatize these programs for decades. Beating back these efforts has been a major victory against the drive to give all the money to the rich.

Seeing the NYT join the ranks of those demanding cuts is more than a bit disturbing. Of course, this is not the first time the NYT’s editorial board has joined with those on the right. Back in the 1980s the paper famously told readers that the “right minimum wage” was $0.00.

But let’s step back for a moment and look at the bigger picture. The NYT is indisputably correct in saying that we are running unusually large annual deficits. However, the piece is more than a bit off the mark in focusing on the debt, rather than these deficits.

Here it spends a lot of time getting into the “really big number” game, telling us:

“Over the next decade, the Congressional Budget Office projects that annual federal budget deficits will average around $2 trillion per year, adding to the $25.4 trillion in debt the government already owes to investors.”

The NYT has a very educated readership, but I am fairly certain that almost none of its readers has any idea what $2 trillion a year means, nor do they have a good idea how large $25.4 trillion is over the course of a decade. And, I am also pretty sure the NYT editorial board knows that its readers don’t know what these really big numbers mean. But hey, this is a good way to scare people.

The piece does tell us the debt is projected to hit 115 percent of GDP by the end of this period. If that’s scary, consider that Japan’s debt is over 250 percent of GDP, and its economy has yet to collapse.

But, there is potentially a real issue here, if we get beyond the really big number silliness. Deficits can get so large that they raise inflation to unacceptable rates. Here the problem is not that we are borrowing (we can always print money, as out MMT friends remind us), the problem is that we are creating too much demand in the economy.

This can be a concern, but it seems as though that is not the case just now. We did have a bought of inflation in the last two and a half years, but that was largely driven by the pandemic and the fallout from Russia’s invasion of Ukraine. The rate of inflation is now dropping by almost every measure and we are moving back towards the Fed 2.0 percent target, even if the pace of the decline may not be fast enough for some people. This suggests that deficits may not be too large.

It is also worth noting that when we look at deficits as a share of GDP, they are projected to be below 6.0 percent of GDP for the rest of this decade, with the exception of a projected deficit of 6.2 percent in 2025. That is high by historic standards, but not hugely out of line with what we have seen in the past. The deficit was 4.6 percent of GDP in 2019, when inflation was still at the Fed’s target, with no evidence of inflation rising out of control.

Many prominent economists, like Larry Summers, argued that the economy faced a problem of “secular stagnation” meaning there was too little demand in the economy to keep it running near its capacity. This was due to the fact that huge amount of income had been shifted upward to people who were less likely to spend it, and also that slower labor force growth meant less need for companies to invest to accommodate a growing workforce. In that context, large deficits were actually needed to keep the economy near full employment.

As a practical matter, we don’t know exactly how large those deficits have to be. Before the pandemic, a deficit near 5.0 percent of GDP seemed fine. Is a deficit near 6.0 percent of GDP also fine? Given the recent course of inflation data, it seems that it might be, but we can at least acknowledge it is an open question.

Reducing the Deficit Versus Reducing Demand in the Economy

Let’s assume for the moment that we really do have a problem with inflation. The issue is not the deficit per se, but rather too much demand in the economy. So, we should be asking the larger question of how we can reduce demand in the economy, not just the narrow question of how we can reduce the government deficit.

One way the government creates demand in the economy is through its granting of patent and copyright monopolies. While discussion of these government-granted monopolies seems to be strictly forbidden in the pages of the New York Times, they are actually a huge deal in terms of the economy. These monopolies cost us on the order of $450 billion a year (1.8 percent of GDP) in the case of prescription drugs alone. We will spend over $550 billion this year on prescription drugs that would likely cost less than $100 billion in a free market.

Drugs would almost invariably be cheap if they were sold in a free market without patents or other related protections. Instead, drugs that might sell for $20 or $30 a prescription as generics, will instead sell for thousands or even tens of thousands of dollars with a government-granted monopoly. If we want to get serious about reducing inflationary pressures in the economy, we could talk about scaling back these monopolies, which inflate prices not only for drugs, but also medical equipment, computers, software, and a wide range of other items.

Unfortunately, this possibility never gets raised in the context of deficit reduction. Perhaps it hits too close to home for the people who control major news outlets, since the beneficiaries of these monopolies likely include many of their friends and relatives. It’s possible to talk tough about cutting Social Security and Medicare, but not the payments that those at the top end of the income distribution get as a result of these government-granted monopolies.

There are of course many other areas where changing the rules can lead to large reductions in demand. If we were as determined to have free trade for doctors’ services (a possibility enhanced with telemedicine) and the services of other highly paid professionals, as we were with cars and clothes, we could save hundreds of billons annually in payments for a wide range of services.

A financial transactions tax, comparable to the sales taxes that we pay on most items we buy, could reduce the resources wasted in the financial sector by well over $100 billion a year (0.5 percent of GDP). But again, the industry is so powerful that this is not discussed in polite circles.

Anyhow, I could go on (see Rigged, it’s free), but the point here should be clear. For whatever reason, the NYT editorial board decided it had to show it’s tough by putting Social Security and Medicare on the table, programs that working people depend on to protect them in their old age and in the event of disability. However, when it comes to the rules the government has put in place that are responsible for the massive inequality we see in the economy today, well, the NYT editorial board is not that tough.

This first appeared on Dean Baker’s Beat the Press blog.  

This content originally appeared on CounterPunch.org and was authored by Dean Baker.

"It is time to end this absurdity," declared Sanders, who chairs the Senate Committee on Health, Education, Labor, and Pensions (HELP). "It is time for the United States to join nearly every other major country in the world and finally guarantee paid sick leave."

"In the richest country in the history of the world, it is a total disgrace that millions of workers are having to choose between their job and caring for their family, their newborn child, or themselves when they are sick and in need of care," he asserted. "It is time Congress passed this legislation to ensure workers receive the basic dignity and benefits that they deserve."

DeLauro and Gillibrand (D-N.Y.) also unveiled an updated version of the Family and Medical Insurance Leave (FAMILY) Act, which would ensure that all workers in the United States have access to paid leave for serious medical events. The legislation would provide up to 12 weeks of partial income annually and ensure those with the lowest pay earn up to 85% of their normal wages.

The FAMILY Act would also ensure workers who have been at their job for over 90 days have the right to be reinstated after their leave, allow states to continue administering existing programs, and establish a new Office of Paid Family and Medical Leave. As DeLauro noted, she and Gillibrand have been fighting for versions of their bill for the past decade.

"Thirty years ago, we broke ground by enshrining the Family and Medical Leave Act into law, providing unpaid family and medical leave for working Americans," she said. "Let's break ground again by making it paid. Since 2013, I have been proud to be joined by Sen. Gillibrand in introducing the FAMILY Act, which would establish the nation's first universal, comprehensive paid family and medical leave program. This year, the fight continues, as we reintroduce a strengthened FAMILY Act to meet families where they are now and ensure no one has to make the impossible choice between their job and the health of themselves or their loved ones."

The proposals are backed by dozens of advocacy organizations and unions, with several groups and activists demanding swift passage of both bills—though the odds are unlikely, with slim Democratic control of the Senate and the House's GOP majority.

"I had my first child, I was a public school teacher, and I had to drain all my sick time to try to maintain some income during my unpaid maternity leave," said Rachel Shelton, a MomsRising member from Asheville, North Carolina, in a statement.

"That was a huge challenge, because babies get sick!" Shelton explained. "When I had my second, I made the tough decision to leave my job because the situation was unsustainable. It shouldn't be this hard to balance caregiving and work. We need Congress to pass the FAMILY Act and Healthy Families Act, now. It's past time we guarantee all working people the paid leave and paid sick days we need to care for our families and for ourselves."

National Nurses United also supports both bills. The organization's president, Jean Ross, said that "nurses want what is best for patients, and that's why our union supports paid sick and family leave for all workers. Nurses see the negative health consequences on patients when they are unable to take leave due to their own illness, or the need to care for family."

"Nobody should have to choose between their own health or the health of their loved ones, and their livelihood," Ross stressed. "Further, nursing is a majority female profession, and paid sick and family leave is essential to ensuring that nursing becomes a sustainable profession."

The introductions—which also featured remarks from Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Appropriations Committee Chair Patty Murray (D-Wash.)—come after a year of railway workers, backed by key congressional allies including Sanders, gaining national attention for their fight for paid leave in the face of dangerous working conditions and industry greed.

Mike Baldwin, president of the Brotherhood of Railroad Signalmen, said Wednesday that "the BRS would like to thank those members of Congress who support paid sick leave. Rail workers were deemed essential during the pandemic. They came to work sick because they didn't want to miss a day's pay, or worse be disciplined for their absence."

"This legislation is important to rail workers," he said of the HFA. "It is an essential need, and it isn't just a frivolous want."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

"It is time to end this absurdity," declared Sanders, who chairs the Senate Committee on Health, Education, Labor, and Pensions (HELP). "It is time for the United States to join nearly every other major country in the world and finally guarantee paid sick leave."

"In the richest country in the history of the world, it is a total disgrace that millions of workers are having to choose between their job and caring for their family, their newborn child, or themselves when they are sick and in need of care," he asserted. "It is time Congress passed this legislation to ensure workers receive the basic dignity and benefits that they deserve."

DeLauro and Gillibrand (D-N.Y.) also unveiled an updated version of the Family and Medical Insurance Leave (FAMILY) Act, which would ensure that all workers in the United States have access to paid leave for serious medical events. The legislation would provide up to 12 weeks of partial income annually and ensure those with the lowest pay earn up to 85% of their normal wages.

The FAMILY Act would also ensure workers who have been at their job for over 90 days have the right to be reinstated after their leave, allow states to continue administering existing programs, and establish a new Office of Paid Family and Medical Leave. As DeLauro noted, she and Gillibrand have been fighting for versions of their bill for the past decade.

"Thirty years ago, we broke ground by enshrining the Family and Medical Leave Act into law, providing unpaid family and medical leave for working Americans," she said. "Let's break ground again by making it paid. Since 2013, I have been proud to be joined by Sen. Gillibrand in introducing the FAMILY Act, which would establish the nation's first universal, comprehensive paid family and medical leave program. This year, the fight continues, as we reintroduce a strengthened FAMILY Act to meet families where they are now and ensure no one has to make the impossible choice between their job and the health of themselves or their loved ones."

The proposals are backed by dozens of advocacy organizations and unions, with several groups and activists demanding swift passage of both bills—though the odds are unlikely, with slim Democratic control of the Senate and the House's GOP majority.

"I had my first child, I was a public school teacher, and I had to drain all my sick time to try to maintain some income during my unpaid maternity leave," said Rachel Shelton, a MomsRising member from Asheville, North Carolina, in a statement.

"That was a huge challenge, because babies get sick!" Shelton explained. "When I had my second, I made the tough decision to leave my job because the situation was unsustainable. It shouldn't be this hard to balance caregiving and work. We need Congress to pass the FAMILY Act and Healthy Families Act, now. It's past time we guarantee all working people the paid leave and paid sick days we need to care for our families and for ourselves."

National Nurses United also supports both bills. The organization's president, Jean Ross, said that "nurses want what is best for patients, and that's why our union supports paid sick and family leave for all workers. Nurses see the negative health consequences on patients when they are unable to take leave due to their own illness, or the need to care for family."

"Nobody should have to choose between their own health or the health of their loved ones, and their livelihood," Ross stressed. "Further, nursing is a majority female profession, and paid sick and family leave is essential to ensuring that nursing becomes a sustainable profession."

The introductions—which also featured remarks from Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Appropriations Committee Chair Patty Murray (D-Wash.)—come after a year of railway workers, backed by key congressional allies including Sanders, gaining national attention for their fight for paid leave in the face of dangerous working conditions and industry greed.

Mike Baldwin, president of the Brotherhood of Railroad Signalmen, said Wednesday that "the BRS would like to thank those members of Congress who support paid sick leave. Rail workers were deemed essential during the pandemic. They came to work sick because they didn't want to miss a day's pay, or worse be disciplined for their absence."

"This legislation is important to rail workers," he said of the HFA. "It is an essential need, and it isn't just a frivolous want."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

"It is time to end this absurdity," declared Sanders, who chairs the Senate Committee on Health, Education, Labor, and Pensions (HELP). "It is time for the United States to join nearly every other major country in the world and finally guarantee paid sick leave."

"In the richest country in the history of the world, it is a total disgrace that millions of workers are having to choose between their job and caring for their family, their newborn child, or themselves when they are sick and in need of care," he asserted. "It is time Congress passed this legislation to ensure workers receive the basic dignity and benefits that they deserve."

DeLauro and Gillibrand (D-N.Y.) also unveiled an updated version of the Family and Medical Insurance Leave (FAMILY) Act, which would ensure that all workers in the United States have access to paid leave for serious medical events. The legislation would provide up to 12 weeks of partial income annually and ensure those with the lowest pay earn up to 85% of their normal wages.

The FAMILY Act would also ensure workers who have been at their job for over 90 days have the right to be reinstated after their leave, allow states to continue administering existing programs, and establish a new Office of Paid Family and Medical Leave. As DeLauro noted, she and Gillibrand have been fighting for versions of their bill for the past decade.

"Thirty years ago, we broke ground by enshrining the Family and Medical Leave Act into law, providing unpaid family and medical leave for working Americans," she said. "Let's break ground again by making it paid. Since 2013, I have been proud to be joined by Sen. Gillibrand in introducing the FAMILY Act, which would establish the nation's first universal, comprehensive paid family and medical leave program. This year, the fight continues, as we reintroduce a strengthened FAMILY Act to meet families where they are now and ensure no one has to make the impossible choice between their job and the health of themselves or their loved ones."

The proposals are backed by dozens of advocacy organizations and unions, with several groups and activists demanding swift passage of both bills—though the odds are unlikely, with slim Democratic control of the Senate and the House's GOP majority.

"I had my first child, I was a public school teacher, and I had to drain all my sick time to try to maintain some income during my unpaid maternity leave," said Rachel Shelton, a MomsRising member from Asheville, North Carolina, in a statement.

"That was a huge challenge, because babies get sick!" Shelton explained. "When I had my second, I made the tough decision to leave my job because the situation was unsustainable. It shouldn't be this hard to balance caregiving and work. We need Congress to pass the FAMILY Act and Healthy Families Act, now. It's past time we guarantee all working people the paid leave and paid sick days we need to care for our families and for ourselves."

National Nurses United also supports both bills. The organization's president, Jean Ross, said that "nurses want what is best for patients, and that's why our union supports paid sick and family leave for all workers. Nurses see the negative health consequences on patients when they are unable to take leave due to their own illness, or the need to care for family."

"Nobody should have to choose between their own health or the health of their loved ones, and their livelihood," Ross stressed. "Further, nursing is a majority female profession, and paid sick and family leave is essential to ensuring that nursing becomes a sustainable profession."

The introductions—which also featured remarks from Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Appropriations Committee Chair Patty Murray (D-Wash.)—come after a year of railway workers, backed by key congressional allies including Sanders, gaining national attention for their fight for paid leave in the face of dangerous working conditions and industry greed.

Mike Baldwin, president of the Brotherhood of Railroad Signalmen, said Wednesday that "the BRS would like to thank those members of Congress who support paid sick leave. Rail workers were deemed essential during the pandemic. They came to work sick because they didn't want to miss a day's pay, or worse be disciplined for their absence."

"This legislation is important to rail workers," he said of the HFA. "It is an essential need, and it isn't just a frivolous want."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

At a time when more than 1 million people in the United States have lost their lives to the coronavirus pandemic—at least one third of which have been linked to lack of health insurance—and 15 million Americans are at risk of losing Medicaid coverage, Sen. Bernie Sanders (I-Vt.), Rep. Pramila Jayapal (D-Wash.), and Rep. Debbie Dingell (D-Mich.) today came together with 14 of their colleagues in the Senate and more than 110 in the House of Representatives to reintroduce the Medicare for All Act, historic legislation that would guarantee health care as a fundamental human right to all people in the U.S. regardless of income or background.

Sanders, Chairman of the Senate Health, Education, Labor, and Pensions Committee, and Jayapal are joined on the 2023 legislation by Sens. Tammy Baldwin (D-Wis.), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Kirsten Gillibrand (D-N.Y.), Martin Heinrich (D-N.M.), Mazie Hirono (D-Hawaii), Ben Ray Luján (D-N.M.), Ed Markey (D-Mass.), Jeff Merkley (D-Ore.), Alex Padilla (D-Calif.), Brian Schatz (D-Hawaii), Elizabeth Warren (D-Mass.), Peter Welch (D-Vt.), and Sheldon Whitehouse (D-R.I.).

"The American people understand, as I do, that health care is a human right, not a privilege," said Sanders. "It is not acceptable to me, nor to the American people, that over 85 million people today are either uninsured or underinsured. As we speak, there are millions of people who would like to go to a doctor but cannot afford to do so. That is an outrage. In America, your health and your longevity should not be dependent on your bank account or your stock portfolio. After all the lives that we lost to this terrible pandemic, it is clearer now, perhaps more than it has ever been before, that we must act to end the international embarrassment of the United States being the only major country on earth to not guarantee health care to all."

"We live in a country where millions of people ration lifesaving medication or skip necessary trips to the doctor because of cost," said Jayapal. "Sadly, the number of people struggling to afford care continues to skyrocket as millions of people lose their current health insurance as pandemic-era programs end. Breaking a bone or getting sick shouldn't be a reason that people in the richest country in the world go broke. There is a solution to this health crisis — a popular one that guarantees health care to every person as a human right and finally puts people over profits and care over corporations. That solution is Medicare for All — everyone in, nobody out. I'm so proud to fight for this legislation to finally ensure that all people can get the care they need and the care they deserve."

"Every American has the right to health care, period. If you're sick, you should be able to go to the doctor without being worried about the cost of treatment or prescription medicine. The United States is the only industrialized nation in the world that doesn't guarantee all its citizens access to health care," said Dingell. "The COVID-19 pandemic didn't create the flaws in our health care system, but it brought to light many of the shortcomings that have caused unnecessary and preventable hardship for countless American families for decades. We've been fighting this fight since the 1940s, when my father-in-law helped author the first universal health care bill. It's time to get this done."

"Health care should be a right for all, not a luxury for some," said Blumenthal. "In the United States of America, millions of Americans go to sleep at night worried about a procedure they can't access or a treatment their family can't afford. Our status quo is unacceptable. Regardless of age, income, or zip-code, access to quality, timely medical care should be guaranteed for all who need it. I'm proud to join my colleagues in introducing this landmark legislation."

"Despite the progress we've made in the past decade, millions of Americans still struggle to afford the quality health care they deserve," said Booker. "Health care is a human right, and it is unacceptable that the wealthiest nation on the planet lags behind other countries in guaranteeing access to quality and affordable care for all its citizens. It's time to put an end to the medical bankruptcies and exorbitant health care costs that burden families across the nation and work toward Medicare for All. I am proud to join in reintroducing this bill that will build a health care system that ensures that no one is left behind."

"The American health care system leaves millions of individuals without coverage and it needs fundamental change. In the richest country in history, your health should not be determined by your income or zip code," said Gillibrand. "I am proud to join my colleagues in the fight for Medicare for All, which would guarantee high-quality health care for every American and enshrine into law that health care is a right, not a privilege."

"New Mexicans should never have to choose between putting food on their table and accessing health care," said Heinrich. "That's why I am proud to cosponsor the Medicare for All Act to expand health care coverage and provide access to hospital services, emergency services, prescription drugs, oral health, vision, and audiology services to all Americans."

"Everyone should be able to get the health care they need, regardless of their income or insurance status," said Hirono. "As we continue to recover from the COVID-19 pandemic, adopting Medicare for All is an important thing we can do to help expand access to comprehensive health care for all communities. I am proud to support this bill and other legislation to help people across the country access quality, affordable health care."

"Health care should be a right for every single American, not a privilege reserved for the healthy and the wealthy," said Merkley. "Our current health care system is incredibly complex, fragmented, and expensive, and Americans could have so much more peace of mind if we had a simple, seamless system where, solely by virtue of living in America, you know that you will get the care you need. It's time to simplify health care and lower patients' costs, and embrace Medicare for All."

"Health care is a basic human right—no one should ever go broke because of a medical bill or have to ration life-saving medications to make ends meet," said Warren. "Medicare for All works to guarantee that every American will be able to afford and access the health care that every person deserves."

"Medicare for All will help every Vermonter access essential health care, regardless of means. That's worth fighting for, and I'm proud to join Sen Sanders to reintroduce this essential and lifesaving legislation," said Welch. "No person should ever have to worry that they can't afford the medical care they need — period."

Today in the U.S., 68,000 Americans die each year because they cannot afford the health care they desperately need, millions more suffer unnecessarily because of delayed treatment, and more than 85 million Americans are uninsured or under-insured because of high deductibles and premiums. In addition, health care spending in the U.S. constitutes over 18 percent of its Gross Domestic Product (GDP), according to the Centers for Medicare & Medicaid Services. Yet health outcomes, life expectancy, and infant mortality rates in the U.S. remain much worse than many other major countries. The U.S. has the highest infant mortality rate of almost any other major country on earth.

While estimates show 44 percent of the adult population, some 112 million Americans, are struggling to pay for the medical care they need, the seven major health insurance companies in America made over $69 billion in profits last year—up 287 percent since 2012. As millions of American families face bankruptcy and financial ruin because of the outrageously high cost of health care, the CEOs of 300 major health care companies collectively made $4.5 billion in total compensation in 2021. While one out of four Americans cannot afford the life-saving medicine their doctors prescribe, last year ten of the top pharmaceutical companies in the United States made over $112 billion in profits, and the top 50 executives in these companies made a combined $1.5 billion in total compensation.

Implemented over four years, the Medicare for All Act would provide comprehensive health care coverage to all with no out-of-pocket expenses, insurance premiums, deductibles, or co-payments. This includes coverage for primary care, vision, dental, prescription drugs, mental health, substance use disorder, long-term services and supports, reproductive health care, and more. The legislation would create a more streamlined and cost-effective system, allow patients not to worry if their doctor is "in-network," and substantially reduce the cost of prescription drugs by allowing the federal government to negotiate with pharmaceutical companies.

According to the Congressional Budget Office, Medicare for All would save the American people and the entire health care system $650 billion each year. A study by Yale epidemiologists, which was published in the peer-reviewed journal The Lancet, estimates that Medicare for All would save some 68,000 lives per year simply by guaranteeing health care to all as a right. A study by RAND found that moving to a Medicare-for-all system would save a family with an income of less than $185,000 about $3,000 a year, on average.

In 2020, 69 percent of the American people supported providing Medicare to every American.

Nearly 200 national, state, and local organizations endorsed the Medicare For All legislation, including: National Nurses United, American Medical Student Association, People's Action, Public Citizen, Social Security Works, National Organization of Women, SEIU, AFA—CWA, International Alliance of Theatrical Stage Employees, International Federation of Professional and Technical Engineers (IFPTE), United Electrical, Radio & Machine Workers of America (UE), United Mine Workers of America, Brotherhood of Maintenance of Way Employes Division, Center for Popular Democracy, and National Domestic Workers Alliance.

Read the bill summary, here.
Read the bill fact sheet, here.
Read the list of organizational support, here.
Read the bill text, here.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

As Sen. Bernie Sanders and Rep. Pramila Jayapal prepare to reintroduce legislation to establish a national health program expanding Medicare to all Americans, the two lawmakers announced on Friday their plans to hold a town hall at the U.S. Capitol on May 16 regarding the need for Medicare for All.

As many health policy experts have since the coronavirus pandemic began in 2020, Sanders on Friday pointed to the public health crisis as an event that made the need for universal healthcare clearer "than it has ever been before."

"The American people understand, as I do, that healthcare is a human right, not a privilege," said the Vermont Independent senator, who chairs the Senate Health, Education, Labor, and Pensions Committee. "It is not acceptable to me, nor to the American people, that over 85 million people today are either uninsured or underinsured. As we speak, there are millions of people who would like to go to a doctor but cannot afford to do so. This is an outrage. In America, your health and your longevity should not be dependent on your wealth."

The deaths of at least one-third of the 1.1 million people in the U.S. who died of Covid-19 were linked to a lack of health insurance, said the senator, who has advocated for Medicare for All for decades—and has been dismissed by corporate Democrats and Republicans who have claimed the proposal is unpopular, too expensive, and "unrealistic," despite the fact that other wealthy countries have government-run health programs, lower health costs, and better health outcomes than the United States.

A poll by Morning Consult in 2021 showed that 55% of Americans support a Medicare for All program, and in January Gallup released a survey showing that 57% of respondents believe the federal government should ensure everyone has healthcare.

"We live in a country where millions of people ration lifesaving medication or skip necessary trips to the doctor because of cost," said Jayapal (D-Wash.). "Sadly, the number of people struggling to afford care continues to skyrocket as 15 million people lose their current health insurance as pandemic-era programs end. Breaking a bone or getting sick shouldn't be a reason that people in the richest country in the world go broke."

"There is a solution to this health crisis—a popular one that guarantees healthcare to every person as a human right and finally puts people over profits and care over corporations," she added. "That solution is Medicare for All—everyone in, nobody out. I'm so proud to fight for this legislation to finally ensure that all people can get the care they need and the care they deserve."

The lawmakers are introducing the legislation as 44% of adults in the U.S. struggle to pay for their medical care and 68,000 people die each year due to the cost of healthcare.

Amid those devastating health outcomes, Sanders said on Twitter Friday, private health insurers have spent $141 billion on stock buybacks since 2007 while healthcare costs for the average household have skyrocketed.

"It is long past time to end the international embarrassment of the United States being the only major country on Earth that does not guarantee healthcare to all of its citizens," said Sanders.

On Tuesday the lawmakers will be joined by doctors, nurses, and patients who will speak about how their lives and work have been affected by the healthcare crisis.

The event will be livestreamed on Sanders' social media pages.

This content originally appeared on Common Dreams and was authored by Julia Conley.

U.S. Sen. Bernie Sanders on Wednesday paid his respects to the victims of insulin price gouging in front of the Big Pharma CEOs who are responsible and reiterated the need to make all lifesaving prescription drugs affordable.

Sanders (I-Vt.), chair of the Senate Committee on Health, Education, Labor, and Pensions (HELP), opened the panel's hearing by acknowledging "the many Americans who have needlessly lost their lives because of the unaffordability of insulin" and "the thousands who wound up in emergency rooms and hospitals suffering from diabetic ketoacidosis—a very serious medical condition as a result of rationing their insulin."

"This is a problem that is unique to the United States."

Diabetes—a disease that can wreak havoc on organs, eyesight, and limbs if left unmanaged—affects more than 37 million U.S. adults and is the country's eighth leading cause of death, according to the U.S. Centers for Disease Control and Prevention. Although it costs less than $10 to produce a vial of insulin required to treat diabetes, uninsured patients in the U.S. pay nearly $300 per vial of the century-old drug because Eli Lilly and Company, Novo Nordisk, and Sanofi—the three pharmaceutical corporations that control 90% of the nation's lucrative insulin market—charge excessive prices with little resistance from federal lawmakers.

As Sanders noted, such corporate profiteering—a problem compounded by the widespread lack of coverage under the nation's for-profit healthcare system—forces many people to skip doses, with deadly consequences. Recent studies found that 1.3 million people in the U.S. ration insulin, including an estimated 1 in 4 people with Type 1 diabetes. People without insurance are the most likely to do so, followed by those with private insurance.

Ahead of the hearing, Sanders released a video featuring diabetes patients sharing their struggles to afford insulin in the U.S.

"Imagine just three companies having worldwide market dominance over such necessities as air and water," Steve Knievel, an advocate with Public Citizen's access to medicines program, said Wednesday in a statement. "This is what people with diabetes face with insulin."

Addressing the CEOs of the three aforementioned firms during the hearing, Sanders outlined how each has jacked up prices in recent decades:

Eli Lilly increased the price of Humalog 34 times since 1996 from $21 to $275—a 1,200% increase. The same exact product. No changes at all. The only reason for the huge increase in price during that period was that there was no legislation to stop them. In America, the drug companies could charge any price they want.

But it's not just Eli Lilly. Novo Nordisk increased the price of Novolog 28 times from $40 in 2001 to $289—a 625% increase.

And then there is Sanofi, a company that increased the price of Lantus 28 times from $35 in 2001 to $292—a 730% increase.

"In every instance it is the same exact product that rose astronomically," said Sanders. "And let's be clear. This is a problem that is unique to the United States. In France, 20 years ago, the cost of Lantus was $40. Today, it has gone down to just $24."

Sanders has famously accompanied Americans with diabetes on a two-mile trip from Detroit, Michigan to Windsor, Ontario. In Canada, people can purchase the exact same insulin product for one-tenth of the price they would pay in the U.S.

"We cannot rely on limited price concessions from insulin corporations to ensure this essential resource is accessible and fairly priced for Americans who need it."

Also in attendance at Wednesday's hearing were the leaders of CVS Health, Express Scripts, and OptumRX, three major pharmacy benefit managers (PBMs). Sanders took them to task, noting that "as insulin manufacturers continued to increase prices, PBMs signed secret deals to increase their profits by putting insulin products on their formularies not with the lowest list price but the ones that gave PBMs the most generous rebates."

Thanks to sustained public pressure and fresh policy changes—namely the Inflation Reduction Act's provision limiting Medicare beneficiaries' insulin copayments to $35 per month—Eli Lilly, Novo Nordisk, and Sanofi have all recently pledged to significantly lower the list prices for some of their insulin products. As Sanders explained:

Eli Lilly announced it would reduce the price of Humalog by 70% later this year—from $275 to $83. Eli Lilly also decreased the price of its generic Humalog to $25 per vial.

Novo Nordisk announced it would reduce the price of Novolog by 75% beginning next year—from $289 to $72.

Sanofi announced it would reduce the price of Lantus by 78% beginning next year—from $292 to $64.

While Sanders thanked the three companies for taking what he called "an important step forward," he stressed that "we must make sure that these price reductions go into effect so that every American with diabetes gets the insulin they need at an affordable price," vowing to "hold a hearing early next year to make certain that happens."

Knievel, meanwhile, said that "we cannot rely on limited price concessions from insulin corporations to ensure this essential resource is accessible and fairly priced for Americans who need it, regardless of their insurance status or age."

His message was echoed by Margarida Jorge, head of Lower Drug Prices Now.

"Certainly, these multimillion-dollar CEOs will spend their time in front of the committee patting themselves on the back for bowing to public pressure and lowering the cost of insulin," Jorge said in a statement. "But let's be clear, the tens of millions of Americans who cannot afford their prescription medication should not have to depend on the goodwill of greedy corporations who have repeatedly shown they care about profits more than people to bring them relief from skyrocketing prescription costs."

Sanders and Rep. Cori Bush (D-Mo.) recently introduced the Insulin for All Act of 2023, which would cap insulin prices at $20 per vial.

Only federal legislation of this sort can "put an end to decades of price gouging that has led to preventable suffering and costs the lives of people with diabetes who need insulin to live," Knievel emphasized.

Meanwhile, Sanders made clear that the unaffordability of insulin is part of a much broader crisis and proceeded to ask:

If Eli Lilly can lower the price of Humalog by 70%, why is it still charging the American people about $200,000 for Cyramza (CYR-AMZA) to treat stomach cancer—a drug that can be purchased in Germany for just $54,000?

If Novo Nordisk can lower the price of Novolog by 75%, why is it still charging Americans with diabetes $12,000 for Ozempic when the exact same drug can be purchased for just $2,000 in Canada?

If Sanofi can reduce the price of Lantus by 78%, why is it still charging cancer patients in America over $200,000 for Caprelsa—a drug that can be purchased in Japan for just $37,000?

"Lowering the cost of insulin is only one part of what we must accomplish," said the senator. "This committee is determined to end the outrage in which Americans pay, by far, the highest prices in the world for virtually every brand name prescription drug on the market—whether it is a drug for cancer, heart disease, asthma, or whatever."

"We want to know why there are Americans who are dying, or are becoming much sicker than they should, because they can't afford the medicine they need," he continued. "We have got to ask, how does it happen that nearly half of all new drugs cost over $150,000? How does it happen that cancer drugs which, in some cases, cost just a few dollars to manufacture are selling on the market for over $100,000?"

"Americans die, get sicker than they should, and go bankrupt because they cannot afford the outrageous cost of prescription drugs, while the drug companies and the PBMs make huge profits. That has got to change."

"I know that our guests from the drug companies will tell us how much it costs to develop a new drug and how often the research for new cures is not successful," said Sanders. "I get that. But what they are going to have to explain to us is why, over the past decade, 14 major pharmaceutical companies, including Eli Lilly, spent $747 billion on stock buybacks and dividends."

"They will also have to explain how as an entire industry pharma spent $8.5 billion on lobbying and over $745 million on campaign contributions over the past 25 years to get Congress to do its bidding," Sanders added. "Unbelievably, last year, drug companies hired over 1,700 lobbyists including the former congressional leaders of both major political parties—that's over three pharmaceutical industry lobbyists for every member of Congress."

In Sanders' words, "That could well explain why we pay the highest prices for prescription drugs in the world and why today drug companies can set the price of new drugs at any level they wish."

"While Americans pay outrageously high prices for prescription drugs, the pharmaceutical industry and the PBMs make enormous profits," he noted. "In 2021, 10 major pharmaceutical companies in America made over $100 billion in profits—a 137% increase from the previous year. The 50 top executives in these companies received over $1.9 billion in total compensation in 2021 and are in line to receive billions more in golden parachutes once they leave their companies. Last year, the three major PBMs in America made $27.5 billion in profits—a 483% increase over the past decade. These PBMs manage 80% of all prescription drugs in America."

"In other words, Americans die, get sicker than they should, and go bankrupt because they cannot afford the outrageous cost of prescription drugs, while the drug companies and the PBMs make huge profits," Sanders lamented. "That has got to change and this committee is going to do everything possible to bring about that change."

Jorge, for her part, described the Inflation Reduction Act as a "milestone" law that "will help tens of millions of seniors."

"But it is just the start," said Jorge. "Congress should pass legislation to bring the prescription drug reforms that are saving Medicare patients and taxpayers billions to people of all ages, so that everyone can get lower drug prices on medicines they need—including insulin."

"Congress, not greedy corporations trying to redeem their tarnished reputations, should be leading the way on reforms that put patients ahead of pharmaceutical profits," she added.

This content originally appeared on Common Dreams and was authored by Kenny Stancil.

Drugcompanies keep making excuses for why they do not have to live up to their 340B statutory obligations. Since 2020, 21 drug companies have restricted the number of contract pharmacies where 340B nonprofits can fill patient prescriptions. Their attack undermines the intent of the 340B statute.

Drug companies insist they have legitimate oversight concerns, yet their supposed good governance concerns belie the pharmaceutical industry’s true intent. Simply stated, drug makers want to extract every dollar they can from their products, even if it means breaking an agreement with the federal government to sell a tiny percentage of their drugs at a discount to the nonprofits that reinforce America’s healthcare safety net.

Healthcare nonprofits rely on 340B drug discount savings to care for the most vulnerable Americans. For patients to access life-saving medicines, they must be able to pick up their prescriptions from community pharmacies. Many low-income, uninsured Americans lack the time and resources to travel far from their work and homes—often passing by multiple pharmacies—to a single drug company-approved prescription drug dispensing site. The 2010 Affordable Care Act (ACA) recognized that problem, empowering the Health Resources and Services Administration (HRSA) to promote medication access through contract pharmacy use. Federal guidelines wisely allow nonprofits to engage in multiple contract pharmacy agreements.

Simply stated, drug makers want to extract every dollar they can from their products, even if it means breaking an agreement with the federal government to sell a tiny percentage of their drugs at a discount to the nonprofits that reinforce America’s healthcare safety net.

So why did drug companies wait until 2020—10 years after the HRSA guidelines went into effect—to begin enacting contract pharmacy restrictions? The answer is simple. Just one year earlier, in 2019, a little-known ACA provision which requires drug makers to submit drug pricing information to a database finally came online. The “ceiling price” database provides nonprofits with the requisite data to ensure drug companies do not charge above the 340B ceiling price. Companies that overcharge are subject to a civil monetary penalty. The 340B statute requires those companies to then sell the offending drug at just one penny in the next calendar quarter.

Data transparency shows that drug companies have broken the law, frequently overcharging healthcare nonprofits for prescription drugs. The pre- and post-ceiling price data reveal a stark contrast in how often HRSA uncovered drug company malfeasance. From 2015 to 2018, only 6% of HRSA audits uncovered instances of drug company overcharging. After January 1, 2019—when mandatory drug company database reporting began—audits found overcharging in 67% of cases. In 2021 alone, 80% of audits revealed drug company overcharges.

Take Eli Lilly as just one example. In December 2022, the drug maker announced refunds for 340B overcharges for the fifth time that year. It is no coincidence that restrictions began apace with the advent of the ceiling price database.

Essentially, drug companies had no issue with nonprofits using multiple contract pharmacies when they could get away with rampant overcharging. And why would they? Without the government watching, multiple dispensing sites afforded drug companies more opportunities to overcharge nonprofits. Drug companies got away with nearly a decade of overcharges, with no recourse for nonprofits. Now, the same companies that ran wild when the government was not watching, decry the lack of federal oversight when it comes to nonprofit contract pharmacy use.

For the record, 340B nonprofits are subject to audit by the federal government and drug makers. Failure to comply removes a nonprofit provider from the 340B program.

Contract pharmacy restrictions couched as best practices represent a cynical ploy by drug companies. Drug companies caterwaul that oversight lapses result in double-charges for 340B discounts, once by nonprofits and once by state Medicaid agencies.

Simply saying something does not make it true. HRSA conducted 638 hospital audits since 2018 to ensure Medicaid fee-for-service compliance rules, and not one 340B contract pharmacy duplicate discount occurred. Drug companies want to be able to raise list prices year-over-year without 340B statutory penalties, and, now that a federal agency is watching, program obligations threaten the bottom line. Drug makers now consider 340B discounts as financial exposure to be avoided at all costs.

Ignore drug industry duplicity when it comes to 340B. Drug companies have repeatedly acted in bad faith, finding any loophole possible to abrogate statutory obligations.

If drug companies no longer wish to participate in 340B, they can leave the program and no longer sell their products to Medicaid and Medicare. Perhaps that is a deal they can finally honor.

This content originally appeared on Common Dreams and was authored by John Arcano.

An alliance of senior advocacy groups, progressive organizations, and labor unions demanded Wednesday that Congress quickly approve legislation to increase the debt limit without any conditions, warning the House GOP's pursuit of steep spending cuts is risking an "economic calamity" and imperiling key benefits.

In a letter shared exclusively with Common Dreams, Social Security Works, MoveOn, Indivisible, and nearly 30 other organizations implored Democratic and Republican congressional leaders "in the strongest possible terms to swiftly pass a clean debt limit bill."

"There are real disagreements among elected officials about the role of government, budgetary matters, and tax policy," the letter reads. "We understand that and welcome a robust debate and seeing where the American people stand. There's a time and place for that debate. This is not that time. The entire economy and the financial security of every working family is at stake."

The letter, also signed by the Alliance for Retired Americans and the AFL-CIO, comes days after House Speaker Kevin McCarthy (R-Calif.) said in a speech on Wall Street that his caucus is assembling and preparing to vote on legislation that would lift the debt ceiling for roughly a year while slashing federal spending and imposing punitive new work requirements on recipients of Medicaid and federal nutrition assistance.

But it's unclear whether McCarthy will even have enough votes to get such a measure through the GOP-controlled House, given that Democrats are unanimously opposed and some far-right Republicans have already criticized the outlined package, claiming it wouldn't cut spending aggressively enough.

"Kevin McCarthy is holding the debt limit hostage, and can't even get his caucus to agree on a ransom demand," Alex Lawson, executive director of Social Security Works, told Common Dreams. "He is endangering the benefits that seniors rely on to survive, just to score political points."

"The only solution," Lawson added, "is for McCarthy to release his hostage and work with Democrats to pass a clean debt limit."

"Only a clean debt limit bill is standing up for seniors and working families."

If Congress doesn't raise the debt ceiling—an arbitrary borrowing limit that progressives want abolished—the U.S. is expected to default on its debt sometime this summer, an outcome that experts say would be devastating for the U.S. and global economies.

A default could also have major implications for Social Security and Medicare, potentially causing payment delays and other disruptions.

In a memo released earlier this year, the National Committee to Preserve Social Security and Medicare (NCPSSM)—a signatory to Wednesday's letter—warned that "if Congress fails to raise or suspend the debt limit and allows the government to default on its legally binding financial obligations, an economic catastrophe would likely result and payment of Social Security, Medicare, and Medicaid benefits would be jeopardized."

"The Treasury Department must have cash to pay benefits when they are due," the group explained. "Every month, the Treasury Department is required by law to make over $90 billion in payments to the 65 million retirees, disabled workers, widows, widowers, children, and spouses who receive Social Security benefits. The Treasury may not have enough incoming revenue to make those payments without the authority to cash in these securities."

"Absent the legal authority to borrow beyond the current ceiling," NCPSSM added, "Social Security, Medicare, Medicaid, and other payments will not be made on time and in full unless Congress approves an increase in the debt limit."

\u201cIt's long past time for \n@SpeakerMcCarthy and @HouseGOP to prioritize protecting seniors, families, and people with disabilities over political gain! \n\n#BackOffOurBenefits\u201d

— Social Security Works (@Social Security Works) 1681754240

House Republicans have previously floated plans to raise the Social Security retirement age—a move that would cut benefits across the board—but McCarthy insisted Monday that his caucus would not touch Social Security and Medicare in their debt limit proposal, which has yet to be finalized.

In their letter on Wednesday, the senior advocacy coalition recalled that "at this year's State of the Union, everyone stood up and clapped in agreement with President Joe Biden, signifying that they stand up for seniors and working people who rely on Social Security and Medicare."

"Only a clean debt limit bill is standing up for seniors and working families," the groups argued. "Certainly, cutting Social
Security or Medicare as a condition for raising the debt ceiling is not standing up for seniors. Nor is cutting Medicaid, SNAP, housing assistance, energy assistance, or any of the other myriad domestic programs that our families, retirees, and communities depend on to make ends meet."

"More fundamentally, risking an economic recession and threatening the financial security of every working family in this country would be a failure of Congress to fulfill its duty," the letter continued. "Congress raised the debt limit repeatedly without conditions during President Trump's four years in office. It should take that same step now, without delay. This should not be political. Rather, it is simply part of the job that everyone in Congress chose to seek."

On Wednesday morning, the bipartisan Problem Solvers Caucus released a plan to avert a U.S. default if the House GOP refuses to agree to a clean debt limit increase by this summer.

The proposal would suspend the debt ceiling through December 31 and "establish an independent commission—modeled after a Pentagon panel that determines which military bases to close—to recommend a package to stabilize the debt and deficit, which would be voted on by Congress," Axios reported.

The White House quickly threw cold water on the proposal, with press secretary Karine Jean-Pierre saying that "our position continues to be not to negotiate... over a default."

Social Security Works tweeted that the White House is "absolutely right," calling the Problem Solvers Caucus' framework "a terrible plan" and cautioning that "a 'fiscal commission' is code for cutting Social Security and Medicare behind closed doors."

"Congress must pass a clean debt limit increase, with NO CUTS to Social Security, Medicare, Medicaid, or any other program," the group wrote.

This content originally appeared on Common Dreams and was authored by Jake Johnson.

The post Media Matters: Polarization and Propaganda; and Medicare and Ongoing Privatization of Healthcare in the US appeared first on Project Censored.

This content originally appeared on Project Censored and was authored by Project Censored.

The chief executive of UnitedHealth Group told investors Friday that he "appreciates" the Biden administration's decision to more slowly implement its crackdown on overbilling in Medicare Advantage, a privately run, government-funded program that the Minnesota-based insurance behemoth touted as a key profit driver in its newly released first quarter earnings report.

UnitedHealth, one of the largest Medicare Advantage providers in the U.S., reported $91.9 billion in revenue for the first three months of 2023—15% growth year-over-year—and more than $8 billion in earnings from operations, exceeding analysts' expectations.

UnitedHealthcare, UnitedHealth Group's insurance business, "is pacing strongly to its outlook for another year of market-leading growth in serving more people through its Medicare Advantage offerings," the company said in its earnings release. The company said Friday that it added 655,000 new Medicare Advantage members in the first quarter of the year.

UnitedHealth's earnings report came after the company helped lead an aggressive lobbying campaign against new Biden administration rules aimed at limiting Medicare Advantage insurers' ability to overcharge the federal government by making patients appear sicker than they actually are.

According to The New York Times, UnitedHealth CEO Andrew Witty appeared on Capitol Hill in person to lobby against the proposed changes, which the lucrative Medicare Advantage industry falsely characterized as cuts to the program that now provides insurance to nearly half of the overall Medicare population.

Late last month, the Centers for Medicare and Medicaid Services (CMS) offered a number of concessions to the industry, agreeing to impose its policy changes over a period of three years instead of all at once and boosting Medicare Advantage payment rates by more than expected.

As STATreported last week, Wall Street investors were "overjoyed" by the Biden administration's move, which drew criticism from progressive lawmakers and healthcare analysts who warned the slow phase-in will allow Medicare Advantage plans to continue their abusive practices. UnitedHealth, like other Medicare Advantage insurers, has been accused of wrongfully denying or attempting to deny patients necessary care, in some cases utilizing artificial intelligence to determine when to end coverage.

When it comes to excess billing, CMS recently estimated that overpayments to Medicare Advantage totaled $11.4 billion in fiscal year 2022—a significant drain on the Medicare trust fund.

Citing one industry analyst, STAT noted that UnitedHealth could reap $900 million in additional profit next year alone thanks to the administration's decision to delay full implementation of the reforms.

In an analysis published in February, former insurance executive Wendell Potter noted that UnitedHealth is one of just seven large for-profit insurance companies that now control 70% of the Medicare Advantage market, which is dependent on taxpayer money.

According to Potter, who now heads the Center for Health and Democracy, insurance giants UnitedHealth, Cigna, CVS/Aetna, Elevance, Humana, Centene, and Molina saw their combined revenues from taxpayer-supported programs grow 500% between 2012 and 2022.

"They've essentially been bailed out by taxpayers," Potter said of for-profit insurance giants like UnitedHealth in a recent interview with The American Prospect. "And members of Congress, and various administrations, have been just standing on the sidelines, not paying attention to what's been going on."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

It’s a tale of two cities, East Palestine, Ohio, and Libby, Montana–small-town communities of modest means poisoned by the chemical and industrial pollutants of colossal corporations in pursuit of profit.

Libby was the victim of W. R. Grace, whose asbestos-laced vermiculite mine sickened and killed thousands in the surrounding area as the wastes from the mine were carried home, used in gardens, even spread on the running track at the local high school.  Not just the miners but their families and the entire community were unknowingly sickened.  The corporation knew the danger but hid it.  Heroic citizens battled to get to the bottom of the mysterious poisoning.  In the end, W. R. Grace, faced with legal and health liabilities, declared bankruptcy, leaving the community without help.

East Palestine, Ohio, is the site of a Norfolk Southern train wreck on February 3, 2023.  The vinyl chloride that poured from the broken railcars causes liver, brain, and lung cancers as well as lymphoma and leukemia.  The company increased the hazards by burning the waste.  “We basically nuked a town with chemicals so we could get a railroad open,” said the retired Youngstown Fire Chief, a hazardous materials expert.  “…(W)e’re going to be looking at this thing five, ten, fifteen, twenty years down the line and wondering, ‘Gee, cancer clusters could pop up, you know? Well water could go bad.”  The community is already reporting widespread rashes, coughing, nausea, and other illnesses as the company and the EPA assert all is well.

A little-known clause, Section 10323 in the Affordable Care Act (ACA), connects Libby and East Palestine.  In 2009-2010, Montana Democratic Senator, Max Baucus, Chair of the Senate Finance Committee, was writing the health care bill under the guidance of the insurance industry’s representative, Liz Fowler.  Fowler was a former Vice President of Wellpoint and currently presides over the Medicare Innovation Center, directing the privatization of Medicare.  Baucus slipped an earmark into the ACA that provides Medicare coverage for the poisoned people of Libby, even as he arrested the proponents of single payer health care who asked to be heard in the Finance Committee hearing.  Knowing that the provisions of the ACA would not come anywhere near solving the profound suffering of Libby, Baucus granted Medicare coverage to Libby and its surrounding area just as he slammed the door on a publicly-funded, improved Medicare for everyone.

The Baucus earmark in the ACA provides Medicare coverage for everyone in a certain Montana geographical area who is diagnosed with any of the conditions caused by exposure to asbestos.  The area is defined by an Emergency Environmental Public Health Order of 2009.

After the ACA was passed, Social Security officials were sent to Montana and descended on Libby, Whitefish, and Kalispell to sign the people up.  Unlike for the rest of Medicare beneficiaries around the country, age was of no concern.  People were eligible for Medicare regardless of age and without regard to having paid into the Medicare system.  This was a special instance, and coverage was immediate.  No one had to wait until two years beyond the substantiation of their disability.  Max Baucus used federal Medicare monies to pick up the debt of W. R. Grace to the people of Libby as he left the rest of the nation to deal with a failing health care system under the control of profit-making giants.

The health insurance industry went on to reap the benevolence of Baucus and Fowler with increased billions in profit in the following years.  In 2018, the Council of Economic Advisors reported:   “…(T)he ACA Medicaid coverage expansion and subsidies to insurers have resulted in a large increase in health insurer profits. Health insurers’ stock prices more than doubled the impressive gain in the S&P 500 since the law’s main provisions took effect on January 1, 2014.”

The corporate-oriented plan that Max Baucus gave the nation instead of the Improved Medicare for All advocated by those he arrested, improved coverage for some even as it brought escalating levels of underinsurance—a condition in which patients have health insurance yet still cannot afford care.

By 2022, health insurance companies were making record profits even as those newly insured under the ACA were dealing with costs of $12,000 annually before the benefits of insurance kicked in.

The Baucus clause for Libby in the ACA became Section 1881A of the Social Security Act.  It includes a possibility for future Medicare coverage for those who are the subject of a new Environmental Public Health Emergency Declaration.  Does that mean that the people of East Palestine will have Medicare coverage given the proper declaration of a public health emergency?

In a February 22, 2023, article, Newsweek’s Aleks Phillips asserts that the ACA defines hazardous substances and pollutants according to a list which includes vinyl chloride, one of the toxic chemicals spilled in East Palestine.  Newsweek has reached out to the White House and the Department of Health and Human Services with a request for comment on the issue of eligibility for Medicare for East Palestinians.

“At the very least, East Palestine residents deserve this universal coverage after being exposed to a known carcinogen,” tweeted Krystal Ball, a political commentator.

Our nation is now trying to recover from a pandemic that still claims lives at the rate of 95,000 a year.  Covid 19 exposed our broken health care system that failed every test as the United States came in last of industrialized countries, losing over one million people to the disease—a rate far above that of other nations.

In 2021, the United States suffered 900,000 excess deaths, only half of which could be attributed to the pandemic. Much of the rest of the suffering and dying—over 400,000 in that year—can be chalked up to this train wreck of a for-profit health care system.  The figure is astronomical–a little over 400,000 matches the number the United States lost in all of World War II.  Life expectancy in the US is dropping far below that in any other industrialized country.

An environmental, public health emergency declaration based on Section 1881A of the Social Security Act should have kicked us into a universal Medicare for All to begin to cope with the extent of the Covid disaster.  The enormity of that colossal tragedy was insufficient to break the chains that bind the political system to corporate insurance interests.  Will the United States ever enact a national, not-for-profit, single payer health care program, an Improved Medicare for All?  Only if the demand escalates beyond the pitiful calls for incremental change to a boldness and urgency commensurate with the depth of the crisis.

This content originally appeared on CounterPunch.org and was authored by Kay Tillow.

UnitedHealth Group, a dominant force in the lucrative Medicare Advantage market, has seen its stock jump over the past week as Wall Street analysts and investors embrace the Biden administration's decision to delay reforms aimed at tackling abuse in the privately run, government-funded health program.

STATreported late last week that "Wall Street was overjoyed" by the announcement from the Centers for Medicare and Medicaid Services (CMS), which said it would phase in changes to the model that dictates how much government funding Medicare Advantage insurers receive to cover patient care.

Instead of implementing the changes all at once, the Biden administration will roll out the reforms over a three-year period, allowing Medicare Advantage insurers to continue overbilling the federal government in the meantime.

Recent federal audits and investigative reports have detailed how Medicare Advantage plans overcharge the government to the tune of billions of dollars a year by making patients appear sicker than they are, piling on diagnoses with little to no supporting documentation. Medicare Advantage plans also frequently deny necessary care and use algorithms to prematurely end coverage.

In addition to delaying full implementation of its reforms, CMS—which has faced aggressive lobbying from UnitedHealth and other major Medicare Advantage players in recent weeks—announced it would boost payment rates for Medicare Advantage plans by 3.3% in 2024—a larger-than-expected increase.

CMS said Medicare Advantage payments would rise by nearly $14 billion next year under the new plan.

As STAT's Bob Herman noted, "health insurance companies that participate in Medicare Advantage will retain billions of extra taxpayer dollars next year" thanks to the Biden administration's changes, which drew criticism from progressive lawmakers and some policy experts.

"The phased-in approach will continue to reward those insurers with the most abusive practices over the next two years," warned Mark Miller, executive vice president of healthcare for the philanthropy Arnold Ventures.

Herman reported that following the CMS announcement, "investors raced to buy stocks of the largest Medicare Advantage insurers, including UnitedHealth, Humana, CVS Health, Elevance Health, and Centene." STAT cited one analyst estimate suggesting that UnitedHealth Group could see $900 million in additional profit next year thanks to the CMS policy revisions.

"It was 'a sigh of relief' for the industry, according to Jailendra Singh, a healthcare stock analyst at Truist Securities," Herman wrote. "Chris Meekins, a health policy analyst at Raymond James, called the White House's move 'a clearing event for the space.'"

Those companies have been at the forefront of what The New York Times recently described as a "lobbying frenzy" on Capitol Hill, a blitz that appears to have influenced the Biden administration's decision to go easy on Medicare Advantage despite promising bold reforms.

The Times noted that the administration's earlier proposals to revise the Medicare Advantage risk-adjustment model "unleashed an extensive and noisy opposition front, with lobbyists and insurance executives flooding Capitol Hill to engage in their fiercest fight in years."

"The largest insurers, including UnitedHealth Group and Humana, are among the most vocal, according to congressional staff, with UnitedHealth's chief executive pressing his company's case in person," the newspaper reported. "Since the proposal was tucked deep in a routine document and published with little fanfare in early February, Medicare officials have been inundated with more than 15,000 comment letters for and against the policies, and roughly two-thirds included identical phrases from form letters."

The Better Medicare Alliance, a lobbying organization backed by top Medicare Advantage insurers, purchased a Super Bowl ad decrying the Biden administration's earlier reform proposals as an effort to "cut" Medicare Advantage.

Rep. Pramila Jayapal (D-Wash.), chair of the Congressional Progressive Caucus, said in a statement late last week that she was disappointed by the Biden administration's decision to weaken its reforms in the face of industry pressure.

"It is now clear that Medicare Advantage is simply a profiteering venture that hurts patient care," said Jayapal. "Without a complete overhaul, it will be impossible to stop bad actors. These plans have spent years scamming seniors and overcharging the government to pad their own profits. We were on the cusp of immediate reform when the Biden administration proposed fixes to stop price gouging by insurance companies."

"Sadly," she added, "health insurance companies used taxpayer dollars meant for medical care to instead buy Super Bowl commercials and desperately lobby to stop these changes that would cut down on their profiteering."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

The corporations that run Medicare Advantage plans are engaged in widespread waste, fraud and abuse, resulting in tens of billions of dollars of overpayments to them every year. The advocates and government agencies overseeing Medicare Advantage have spent nearly two decades reporting on this fraud and waste and urging Congress to overhaul the program. Few in Congress or the administration were listening. Now, the Biden administration is finally taking action, but it’s only a first step.

The Biden administration has just finalized a rule that begins to rein in these overpayments, at last putting a spotlight on an issue that Congress and the public have long overlooked. The new rule addresses some of the overpayments to the Medicare Advantage plans and protects the integrity of the Medicare Trust Fund, though it is not nearly enough.

The insurance industry’s fierce opposition and the multi-million dollar fear campaign the health insurance corporations launched against the proposed rule was their admission that Medicare Advantage plans can’t provide coverage at a reasonable cost. Medicare Advantage only works for the insurers if they are wildly overpaid and profiting exorbitantly. It was their admission that they cannot do what they were created to do and are legally obligated to do. They cannot deliver Medicare coverage anywhere near as cost-effectively as traditional Medicare, let alone at lower cost, as they had promised.

The fight over small improvements to the flawed Medicare Advantage payment system reveals how challenging it is to fix Medicare Advantage and free it of the bad actors who are engaged in massive — sometimes fraudulent — overbilling of Medicare. Medicare Advantage is in need of a substantial overhaul, as the advocates, along with the Medicare Payment Advisory Commission, the Government Accountability Office and the Office of the Inspector General, have all been saying for years.

The Biden administration’s final rule — which includes good technical fixes to the payment model but allows tens of billions a year in overpayments to continue — is a small step forward, and at the same time a tacit admission that the government cannot rid Medicare Advantage of the bad actors who are threatening Medicare’s financial health. Without an overhaul, there’s no stopping the bad actors.

The Biden administration also recently finalized another rule, aimed at addressing widespread and persistent inappropriate delays and denials of care in Medicare Advantage. Among other things, the rule attempts to streamline the Medicare Advantage prior authorization process. It spotlights and begins to address the serious risks some Medicare Advantage plans pose to the health and well-being of their enrollees — our nation’s sisters and brothers, parents and grandparents.

Though it goes further than any past rule in its attempt to protect Americans from the bad actor Medicare Advantage plans, it does not provide the public with important information as to which plans are the bad actors. Nor will it lead to the government’s cancellation of contracts with the worst-performing Medicare Advantage plans. Therefore, it will not keep the bad actor Medicare Advantage plans from continuing to inappropriately delay and deny critical care.

Consequently, as one NBER analysis found, some 10,000 Medicare Advantage enrollees will continue to die needlessly each year for lack of access to critical care in their bad actor Medicare Advantage plans. This final rule also underscores what we already now know — Medicare Advantage cannot be fixed. Without an overhaul, there’s no stopping the bad actors.

Strengthening traditional Medicare by adding an out-of-pocket cap is the best and most cost-effective fix our government could make. Adding the cap would give people — including the most vulnerable Americans, such as people with low incomes and people of color — a meaningful choice of traditional Medicare. Adding an out-of-pocket cap to traditional Medicare would free people from being locked into Medicare Advantage. And, according to the Congressional Budget Office, an out-of-pocket cap in traditional Medicare could save the Medicare program money, while ensuring older adults and people with disabilities can access the care they need without a Medicare Advantage corporation coming between them and their doctors.

This content originally appeared on Common Dreams and was authored by Diane Archer.

Noting that progressives in Congress recently helped lead the White House to the brink of implementing far-reaching reforms to Medicare Advantage and bringing relief to taxpayers who for years have been overpaying insurers that run the program, Rep. Pramila Jayapal on Thursday criticized the Biden administration's plan to delay making changes to the system following aggressive lobbying by the insurance industry.

"We were on the cusp of immediate reform when the Biden administration proposed fixes to stop price gouging by insurance companies," said the Washington Democrat, who chairs the Congressional Progressive Caucus (CPC). "Sadly, health insurance companies used taxpayer dollars meant for medical care to instead buy Super Bowl commercials and desperately lobby to stop these changes that would cut down on their profiteering."

As Common Dreams reported, the Biden administration announced last Friday that instead of immediately introducing updates to the Medicare Advantage risk adjustment model, which determines a patient's predicted use of healthcare services and how much the federal government will pay an insurer to cover the costs, the Centers for Medicare & Medicaid Services (CMS) will phase in the changes over three years.

"It is now clear that Medicare Advantage is simply a profiteering venture that hurts patient care. Without a complete overhaul, it will be impossible to stop bad actors."

The administration backed away from plans to implement the changes all at once after insurers which participate in Medicare Advantage—and their Republican allies in Congress—claimed the updates would result in higher premiums for beneficiaries. The lobbying campaign came after numerous audits, academic studies, and reports showed that the Medicare trust fund was drained of about $11.4 billion in overpayments to Medicare Advantage in 2022.

"It is now clear that Medicare Advantage is simply a profiteering venture that hurts patient care," said Jayapal. "Without a complete overhaul, it will be impossible to stop bad actors."

Jayapal noted that pressure from the CPC pushed the Biden administration to pursue changes to the Medicare Advantage risk adjustment system and address rampant fraud, but said "there is an incredible amount of work left to do to ensure seniors and people with disabilities in Medicare are protected from the greed of health insurance companies."

"The administration must refuse to be bullied by health insurers, and instead must side with patients when deciding future policies. These policies can mean life or death for Medicare beneficiaries," she said.

The CPC chair also reiterated that the Biden administration should implement changes the caucus demanded in the Executive Action Agenda it released last week, including requiring Medicare Advantage to cover services from any medical provider that accepts Medicare's approved rate, prohibiting plans from forcing seniors who use the program to try cheaper medications before obtaining the treatment they need, and prohibiting the use of algorithms to determine coverage and provider payments.

Those reforms would "quickly show profiteering private insurance companies that harm patients with their fraud and abuse that this is an administration that will stand up to this powerful lobby and protect patients."

Jayapal noted that the administration's decision to delay implementing Medicare Advantage reforms came shortly after a decision by the U.S. Department of Health and Human Services (HHS) to not require the manufacturer of Xtandi, a prostate cancer drug, to lower the medication's nearly $190,000 annual price tag—five times the price in other countries.

As Common Dreamsreported last month, HHS said it would not act to immediately grant march-in rights—which would allow the government to grant a patent license to companies other than the drug's manufacturer.

Instead, the agency said it "will pursue a whole-of-government approach informed by public input to ensure the use of march-in authority is consistent" with legislation meant to ensure the public availability of government-funded inventions such as Xtandi.

"Here too, the Department of Health and Human Services is delaying, announcing it would review its 'march-in' rights to lower the cost, rather than putting them to immediate use," said Jayapal. "Our constituents continue to be crushed by the costs of healthcare and prescription drugs. We cannot let that continue."

Also included in the CPC's Executive Action Agenda is a call for the administration to "ensure widespread and equitable access to taxpayer-funded pharmaceuticals and medical technology" and to "use existing legal authorities to dramatically lower costs of essential drugs" including Xtandi, as well as establishing "reasonable terms" under march-in rights legislation.

This content originally appeared on Common Dreams and was authored by Julia Conley.

Janine Jackson interviewed Public Citizen’s Eagan Kemp about Medicare Advantage for the March 31, 2023, episode of CounterSpin. This is a lightly edited transcript.

Janine Jackson: You may have seen television ads warning ominously of “DC liberals” breaking promises to seniors with proposed cuts to Medicare Advantage, and calling on local legislators to fight back.

American Action Network (3/3/23)

You might wonder why a multimillion-dollar scare campaign would be the first recourse of a deep-pocketed industry that was genuinely concerned with senior citizens’ healthcare and well-being. But the health insurance system in the United States is nothing if not confusing.

And as with any situation created and sustained by human actions, you’re right to wonder: Is this the best we can do? How can we do better? Or, more pointedly, why can’t we do better, when we know we have a population that needs healthcare, and a country that can afford it?

News media could play an informing and an explaining role here, but that’s not what seems to happen.

Eagan Kemp is healthcare policy advocate at Public Citizen, and he joins us now by phone from Salt Lake City. Welcome to CounterSpin, Eagan Kemp.

Eagan Kemp: Thanks so much for having me.

JJ: I’m going to ask you multiple things, and we can’t do justice in the time we have. But I do want to ask you just to orient us a bit, because, right now, we’re kind of in the midst of competing claims.

The proposed changes to Medicare Advantage are either going to take needed medicine away from seniors, or they’re about combating fraud and overbilling.

Understanding that we’re not talking about a perfect response to a perfectly defined problem, what are we kind of looking at right now with Medicare Advantage and the Biden proposals on changes? What’s a useful way to understand that?

Eagan Kemp: “Traditional Medicare has always cost less. It’s always served seniors more consistently. But it doesn’t place ads.”

EK: Yeah, it’s really a crucial time for Medicare Advantage and for the Medicare program more generally. I think the reason that you’re seeing these ads trying to scare people into getting their legislator to protect Medicare Advantage is that a lot of Medicare Advantage insurers have been caught with their hand in the cookie jar.

Just to step back briefly, traditional Medicare has been around for a long time, and has served hundreds of millions of Americans.

But the Medicare Advantage plan is more recent; it’s just around in the past couple of decades, but it’s been growing quickly. And the Medicare Advantage plan, the big difference there is they’re able to profit off of the healthcare for seniors, whereas traditional Medicare is nonprofit. It serves seniors where they are in terms of what they need.

And as Medicare Advantage has grown, it’s become more profitable, and these companies have gotten better at taking advantage of seniors, and now they’ve been caught. And so there’s been more research highlighting areas where seniors have struggled to get the care they need, how much extra it costs the US in terms of, if you just covered those seniors through traditional Medicare.

So they really are trying to defend their profits at a time when they can see the Biden administration and Congress really put them in the crosshairs, and begin to make steps to hold them more accountable for their actions.

JJ: So who’s behind this current information campaign, and what are their goals here?

EK: Yeah, it’s a great question. And the biggest player is what we refer to as AHIP, or America’s Health Insurance Plans, which really is sort of a cabal of all the biggest insurers that put money in, and then use AHIP as cover for lobbying and direct political influence, glad-handing with politicians and, to the extent possible, with the White House.

And so they are always going to work on behalf of insurers’ ability to profit, regardless of what that means for seniors. They’re seeing the losses that pharma has had recently when it comes to things like insulin, when it comes to things like negotiating the cost of some drugs with Medicare.

And insurers are scared too. They see that they’re next on the chopping block, because they’ve had it so good for so long, and Medicare Advantage has never delivered on the promise of actually lowering the cost of care, or improving the quality of care.

Washington Post (3/23/23)

JJ: Let me ask you how that fits with the Washington Post editorial I saw, I guess, a couple of weeks ago, “A Fiscally Responsible Government Cannot Keep Its Hands Off Medicare.”

I was trying to sort of mentally separate Medicare and Medicare Advantage. I see you connecting them. And I see now the Washington Post saying, we just got to get into those funds. Like, what’s the connection there?

EK: Yeah, it’s a really important connection. And I think it’s one of the more challenging ones, because I think one of the things that the Medicare Advantage plans and the private insurers that profit off this do well is conflating the two, conflating Medicare Advantage and traditional Medicare.

And the real issue is that traditional Medicare has always cost less. It’s always served seniors more consistently. But it doesn’t place ads, it doesn’t fill the airwaves the way that Medicare Advantage plans do when someone’s turning 65.

These Medicare Advantage plans do a lot of often misleading advertising, so that they can do what we refer to as cherrypick the healthiest seniors, and then “lemon drop” sicker seniors, and make sure that they stay in traditional Medicare.

And it’s something that Medicare Advantage plans have gotten better at. And the more people that are in Medicare Advantage, the more it’s a threat to the long-term health of the entire Medicare program.

Right now we’re close to 50% of seniors on Medicare Advantage. And we know that it would cost a lot less to cover those seniors in traditional Medicare. And so it is existential for the Medicare program.

And it’s something that in the short term, the Biden administration and Congress really need to crack down on bad actors in Medicare Advantage, but in the long term, moving towards a system that both improves and expands traditional Medicare, while at least putting Medicare Advantage on a level playing field. But in the long term, it’s just unclear that there’s any positive role for Medicare Advantage.

Public Citizen (3/21/23)

JJ: Let me ask you, because I wanted to give you an opportunity to connect this, and to talk about a new report that Public Citizen has done, but I know listeners will understand, who are regular media consumers: For elite media, if anything is a public/private partnership, well, then that is the holy grail. That is exactly what we want. Because heaven forbid anything be wholly public, or publicly supported.

And so public/private is the exemplar, just narratively, is my feeling from elite media.

And I know that you’ve just released a new report on the role of private equity in healthcare. The “role” maybe is too gentle of a phrase. The report is called “Private Equity’s Path of Destruction in Healthcare Continues to Spread.” So let me just ask you to break down a little bit for listeners: What is the problem that you’re mapping here? And how does it connect with these broader healthcare issues?

EK: Yeah, I think it really connects at the nexus of profit. So private equity companies are generally large, privately held, they don’t have a lot of accountability or transparency.

Many of them, even if you knew their name, and then you tried to search them on Google or somewhere else, you would not be able to find an ounce of information. They’re very secretive. They hold their secrets and investments close. Some of the bigger ones, you might be able to find a bit about. But they are shady actors, and their primary drive is profit above all else.

And in healthcare, that’s particularly scary, because they also move much more quickly than even traditional healthcare actors. To me, they’re even scarier in terms of their actions than traditional insurers, that are also focused on profit, but do have a longer timeline that they plan to have in the industry.

If you’re a private equity company, you want to buy in and you want to get out within three to five years, and you want to pull as much as you can in terms of profit out. So it means really taking underhanded tactics, like selling a hospital out from under the hospital administration.

So you might buy this entire healthcare system, you sell that hospital immediately, cash that check, and now you’re charging that hospital that you just bought a very expensive lease. If this is not a high-margin hospital, or if it’s in a rural area or an urban area, it may have a really difficult time staying in business.

But as a private equity company, you don’t care, because you’re about to sell that, or you’re about to flip it to somebody else, and you’re going to move on, and that’s a real dedication to profit across the healthcare industry. And that’s really what we go into the report, over nearly 15 different areas where private equity has engaged recently in the healthcare system, and scary places where they’re going next, such as hospice or end-of-life care.

JJ: I’m just going to ask you, finally and briefly, and we’ll clearly talk much more in the future, but we know that policy is shaped by people’s understanding of what is possible. And we know that news media shape that understanding.

So for me, corporate news media are chockablock with what they would call “news you can use,” like: Can I apply for disability while on Medicaid? Does it make sense to divorce my spouse so that we could see if maybe I could get my meds covered?

It’s reporting that assumes that you’re over a barrel, and that masses of us are over a barrel, but is somehow too timid to say, this is crazy and cruel and unnecessary, and to talk about systemic change. And if anybody does, well then they’re a freak, and they’re actually a problem that needs to be contained.

And so knowing that you can’t say all you’d want to say, what are your thoughts about media coverage of this issue?

EK: Yeah, it is a challenging area. I think that some of the real bad actors in both private equity and in Big Pharma, and Medicare Advantage and other insurers, I think there is starting to be a bit of a different tone.

I think Americans are having enough pain points, and talking about them or coming together to push for things like Medicare for All. I think that’s why, during the 2016, the 2020 presidential debates, there was just so much angst and frustration around the healthcare system, and real support for things like Medicare for All.

And the corporate media are certainly not there yet. But I think enough stuff is starting to break through that they can’t just ignore it. And so you are starting to see even the New York Times or the Washington Post really cover in more detail some of the fears around prescription drugs, or around Medicare Advantage, or some of the abuses that we’re seeing, even during Covid-19, by insurers and others.

And it’s an important time for folks to tell their stories and to also get engaged, because the industries want us to stay demoralized and separated. But it’s when we come together that we can really push for the change that we need.

JJ: I’m going to end on that note. We’ve been speaking with Eagan Kemp. He’s health policy advocate at Public Citizen. You can find their work, including this new report on private equity and healthcare, online at Citizen.org Thank you so much, Eagan Kemp, for joining us this week on CounterSpin.

EK: Thank you, appreciate it.

The post ‘Medicare Advantage Has Never Delivered on the Promise’ appeared first on FAIR.

This content originally appeared on FAIR and was authored by Janine Jackson.

The Biden administration announced Friday that it will allow Medicare Advantage plans to continue overbilling the federal government in the short term after the insurance industry lobbied aggressively against proposed rule changes aimed at cracking down on fraud in the privately run program.

The Centers for Medicare and Medicaid Services (CMS) said it is still moving ahead with the changes despite industry pressure to drop or completely overhaul them.

But instead of implementing the reforms all at once, CMS outlined a plan to phase in the changes over a three-year period, a concession to large insurers that dominate the Medicare Advantage market—which is funded by the federal government.

"How Washington really works: Medicare Advantage providers whined for months that they simply couldn't survive without being able to rip off the government, so the government said 'you can rip us off for just a little longer,'" The American Prospect's David Dayen tweeted in response to the CMS announcement.

The changes involve tweaks to the Medicare Advantage risk-adjustment model, which determines how much the federal government pays insurers to cover patient care.

Medicare Advantage plans are notorious for piling on diagnoses to make patients appear sicker than they are to reap larger payments from the federal government. CMS estimates that overpayments to Medicare Advantage totaled $11.4 billion in fiscal year 2022, a sizeable drain on the Medicare trust fund.

"Nearly every large insurer in the program has settled or is facing a federal fraud lawsuit for such conduct," The New York Timesnoted Friday. "Evidence of the overpayments has been documented by academic studies, government watchdog reports, and plan audits."

Mark Miller, the executive vice president of healthcare for the philanthropy Arnold Ventures, expressed concern that the Biden administration's decision to phase the Medicare Advantage changes in over three years will "continue to reward those insurers with the most abusive practices over the next two years."

"We are disappointed to hear that reasonable changes targeting abuse and waste in Medicare Advantage will be phased in over three years rather than fully implemented immediately," said Miller. "The coding abuses by insurers in Medicare Advantage have led the independent Medicare commission (MedPAC), which was created to advise Congress, to call for a 'major overhaul' of Medicare Advantage policies."

Medicare Advantage insurers have been fighting the Biden administration's proposed changes for months, running ads warning that the reforms would result in higher premiums and worse care for patients—claims that federal health officials adamantly rejected.

Axiosreported that the Better Medicare Alliance, a Medicare Advantage lobbying group, "has spent $13.5 million on advertising since the beginning of the year, targeting markets with competitive 2024 Senate races. Their ads painted the CMS proposal as a cut to Medicare that will eat into consumer benefits."

But Stacy Sanders, an adviser to Health and Human Services Secretary Xavier Becerra, told the Times last month that "we will not be deterred by industry hacks and deep-pocketed disinformation campaigns."

Becerra himself pushed back on social media, writing, "Leave it to deep-pocketed insurance companies and industry front groups to characterize this year's proposed increase in Medicare Advantage payments as a pay cut."

Biden administration officials sounded a different note on Friday. "We were really comfortable in our policies, but we always want to hear what stakeholders have to say," CMS Administrator Chiquita Brooks-LaSure told the Times, admitting that industry lobbying impacted the agency's decision to drag out its implementation of the changes.

CMS projected Friday that under the finalized rules, Medicare Advantage plans will see a payment increase of 3.32%—nearly $14 billion—in 2024 compared to this year.

The payment boost will come as Medicare Advantage insurers are facing growing scrutiny from progressive lawmakers over their business practices, including widespread overbilling, the use of artificial intelligence to cut off patient care, and denials of necessary care.

"Federal audits have found that taxpayers have been overpaying bad actors running Medicare Advantage plans by billions of dollars every year, threatening the stability of both Medicare Advantage and traditional Medicare," Sen. Jeff Merkley (D-Ore.) said earlier this week. "This fraud has to end."

Sen. Elizabeth Warren (D-Mass.), who joined Merkley last week in criticizing the massive profits of Medicare Advantage insurers, tweeted Saturday that CMS is "making progress, but these delays are a step backward."

"For years, private Medicare insurers have been gouging taxpayers and denying care for seniors and people with disabilities," Warren wrote. "There is a lot more work to do to curb these abusive practices."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

The board of trustees for Medicare and Social Security released a report Friday showing the programs' trust funds will be able to cover all benefits and expenses until 2031 and 2034 respectively, findings welcomed by advocates as further confirmation that the key lifelines are strong and can be expanded.

Nancy Altman, president of the progressive advocacy group Social Security Works, argued in a statement that "the takeaway from this report is that whether to expand or cut Social Security's modest but vital benefits is a question of values, not affordability."

The board of trustees, which consists of top government officials including Treasury Secretary Janet Yellen and Acting Labor Secretary Julie Su, estimated that even if Congress doesn't act, Medicare's trust fund would be able to pay 89% of total scheduled benefits after 2031.

The Old-Age and Survivors Insurance (OASI) Trust Fund, meanwhile, would be able to pay 77% of scheduled benefits after 2033 in the absence of congressional action. The OASI Trust Fund had roughly $2.7 trillion in reserves at the end of 2022, according to the trustees report, while the Disability Insurance (DI) Trust Fund had $118 billion in asset reserves.

If the OASI and DI trust funds are combined, the report notes, the resulting fund would be able to pay 100% of total scheduled Social Security benefits until 2034.

“Contrary to conservative claims, Social Security is not 'going bankrupt'; the program will always be able to pay benefits because of ongoing contributions from workers and employers," said Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare. "This is yet another trustees report showing that Social Security remains strong in the face of turmoil in the rest of the economy. Its projected insolvency date has stayed roughly the same even after a global pandemic and recent economic upheavals."

Richard Fiesta, executive director of the Alliance for Retired Americans, echoed that message, saying the trustees report proves the Social Security trust fund is "strong and solvent, with enough money to cover full benefits and expenses until 2033, one year earlier than reported last year."

"Further, the Medicare Part A Trust Fund for hospital care has sufficient funds to cover its obligations until 2031, three years later than reported last year," Fiesta added. "The trust funds are strong because most Americans contribute to them with every paycheck. They could be even stronger if the wealthiest Americans paid their fair share."

Richtman, Fiesta, and other advocates urged Congress to expand Social Security benefits by lifting the cap on income subject to payroll taxes.

The cap, which is $160,200 this year, allowed millionaires to stop paying into Social Security in late February, not even two full months into the year.

Skyrocketing inequality over the past several decades has meant that a larger share of earnings at the very top has been exempt from the payroll tax, costing the Social Security trust fund an estimated $1.4 trillion since 1983.

Last month, Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) introduced legislation that would subject all income above $250,000 a year to the 6.2% payroll tax, a move the lawmakers said could fund a $200-per-month benefit expansion for all Social Security recipients.

Rep. John Larson (D-Conn.) said Friday that he will soon reintroduce separate Social Security expansion legislation.

"Now is the time to not merely protect but to also expand benefits that have not been addressed in over 50 years," Larson said in a statement.

Despite pressure from Sanders and other progressives, Biden did not include a Social Security expansion plan in his latest budget request, which did contain a proposal to shore up Medicare's trust fund by raising taxes on the rich.

Congressional Republicans, for their part, have floated unpopular proposals to slash Social Security benefits across the board by raising the retirement age and partially privatizing the program.

"Unfortunately, Republican politicians are not listening to their voters," Altman said Friday. "The most recent budget of the Republican Study Committee, which consists of about three-quarters of the House Republicans, includes deep cuts to both Social Security and Medicare. Other Republicans are trying to create fast-track commissions that operate behind closed doors, aimed at forcing cuts that would not be supported in the sunshine."

"To see the results of cutting earned retirement benefits through an undemocratic process, one only needs to look across the Atlantic Ocean, where the French people are rising up in anger," said Altman. "Congress should take action to expand Social Security and close the system's modest shortfall. Democrats have put their ideas on the table. Now, Republicans should do the same, so that Congress can debate Social Security's future in the light of day."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

Ciudad Juárez detention center fire

This week on CounterSpin: There are a number of issues or realities where good-hearted people are overwhelmed and frankly misled about how isolated they are in their view, and what levers of power they may have to pull on. We can live in a better world! And we should interrogate those who say, “Oh no, you don’t get it; we’re smarter and we say you just can’t.”

One such story is migration, or immigration—or, to be real, do Black and brown people have a right to move freely in the world? If not, why not? We’ll get some ideas of where to start this week with Silky Shah, executive director at Detention Watch Network, about the Ciudad Juárez fire and what it tells us about immigration policy.

Image: Health & Human Services

And on healthcare: Do we really need to be making choices between seniors getting needed healthcare and other folks getting needed healthcare? Do we have to run our healthcare system on for-profit incentivizing? Is there truly no other way? We talk with Eagan Kemp, healthcare policy advocate at Public Citizen, about the fight around Medicare and Medicare Advantage, and what it says about concerns about seniors and about health, in the US.

The post Silky Shah on Detention Center Fire, Eagan Kemp on Medicare Advantage appeared first on FAIR.

This content originally appeared on FAIR and was authored by Fairness & Accuracy In Reporting.

Sen. Elizabeth Warren joined healthcare campaigner Ady Barkan and others on Monday in sounding alarm over a recent investigation showing that Medicare Advantage insurers are using unregulated artificial intelligence systems to determine when to end payments for patients' treatments, a practice that has prematurely terminated coverage for vulnerable seniors.

STATreported earlier this month that while "health insurance companies have rejected medical claims for as long as they've been around," AI is "driving their denials to new heights in Medicare Advantage," a privately run program funded by the federal government.

"Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient's treatment," the outlet found. "The denials that follow are setting off heated disputes between doctors and insurers, often delaying treatment of seriously ill patients who are neither aware of the algorithms, nor able to question their calculations."

"Older people who spent their lives paying into Medicare, and are now facing amputation, fast-spreading cancers, and other devastating diagnoses, are left to either pay for their care themselves or get by without it," STAT continued. "If they disagree, they can file an appeal, and spend months trying to recover their costs, even if they don't recover from their illnesses."

Barkan, co-executive director of Be a Hero and an ALS patient who is acutely aware of the injustices at the heart of the United States' for-profit healthcare system, tweeted Monday that STAT's reporting is "outrageous and terrifying" and circulated a petition imploring the Biden administration to crack down on the Medicare Advantage industry's use of AI.

"This barbaric practice must end," the petition states. "We're calling on President Biden and the [Centers for Medicare and Medicaid Services] to stop this practice immediately."

Warren (D-Mass.), who blasted the huge profits of top Medicare Advantage insurers last week, echoed Barkan in a tweet of her own.

"Medicare Advantage insurers make patients look as sick as possible to overcharge taxpayers billions," Warren wrote, referring to a common industry practice known as upcoding.

"At the same time, they deny seniors and people with disabilities care—with the help of AI algorithms," the senator continued. "We must crack down on these abuses. No more #DeathByAI."

An analysis published last year in the Journal of Medical Internet Research found that "despite the plethora of claims for the benefits of AI in enhancing clinical outcomes, there is a paucity of robust evidence."

But that lack of evidence hasn't stopped hugely profitable private healthcare companies from increasingly using AI tools to "help make life-altering decisions with little independent oversight," STAT determined after reviewing secret corporate documents and hundreds of pages of federal records and court filings.

"Over the last decade, a new industry has formed around these plans to predict how many hours of therapy patients will need, which types of doctors they might see, and exactly when they will be able to leave a hospital or nursing home," STAT reported. "The predictions have become so integral to Medicare Advantage that insurers themselves have started acquiring the makers of the most widely used tools."

"Elevance, Cigna, and CVS Health, which owns insurance giant Aetna, have all purchased these capabilities in recent years," the outlet continued. "One of the biggest and most controversial companies behind these models, NaviHealth, is now owned by UnitedHealth Group."

"President Biden has the power to stop this. We're meeting with White House staff this week to discuss this outrage."

In 2020, a UnitedHealthcare algorithm determined that 89-year-old Dolores Millam—who broke her leg in a fall that year—would only need to stay in a nursing home for 15 days following surgery, STAT reported.

After the 15 days were up, Millam "received notice that payment for her care had been terminated." Millam's daughter, Holly Hennessy, told STAT that "she couldn't fathom UnitedHealthcare's conclusion that her mother unable to move or even go to the bathroom on her own—no longer met Medicare coverage requirements."

"Hennessy said she had no choice but to keep her mother in the nursing home, Evansville Manor, and hope the payment denial would get overturned," STAT reported. "By then, the bills were quickly piling up."

UnitedHealthcare rejected Millam and Hennessy's appeal, forcing them to pursue relief in federal court—an arduous process.

A federal judge finally ruled months later that UnitedHealthcare improperly denied Millam that she was entitled to full coverage.

The total bill for her nursing home stay was $40,000, according to STAT.

Barkan warned Monday that "insurance behemoths using AI to squeeze every cent out of us." Just seven healthcare companies control more than 70% of the Medicare Advantage market.

"President Biden has the power to stop this," Barkan wrote of Medicare Advantage plans' use of AI. "We're meeting with White House staff this week to discuss this outrage."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

Sens. Elizabeth Warren and Jeff Merkley are calling attention to the massive profits and "exorbitant" executive salaries of top Medicare Advantage insurers such as UnitedHealthcare and Humana, which are leading a lobbying blitz against efforts to combat widespread fraud in the privately run healthcare program.

“In 2022, the seven major Medicare Advantage health care insurers—UnitedHealthcare, CVS/Aetna, Cigna, Elevance Health, Humana, Centene, and Molina—brought in revenues of $1.25 trillion and reported total profits of $69.3 billion, a 287% increase in profits since 2012," the Democratic senators wrote in recent letters to the companies' CEOs, citing an analysis by Wendell Potter of the Center for Health and Democracy.

"But rather than investing in benefits for patients," they added, "these seven health insurers instead spent $26.2 billion on stock buybacks."

Warren (D-Mass.) and Merkley (D-Ore.) also highlighted the "extraordinary salaries" of the insurance giants' CEOs and other top executives. Brian Thompson, who became UnitedHealthcare's CEO in 2021, brought home nearly $10 million in total compensation that year, according to SEC filings.

Humana chief executive Bruce Broussard raked in more than $17 million in 2021.

The letters were sent Wednesday as the insurance industry continues to ramp up its attacks on Biden administration proposals aimed at reining in upcoding and other tactics that Medicare Advantage plans use to reap larger payments from the federal government, which funds the program.

Critics of Medicare Advantage argue that such overpayments—which topped $15 billion in fiscal year 2021 alone—are "depleting the Medicare Trust Fund" at the expense of patients, who are frequently denied medically necessary care.

"MA plans are consistently paid more for seniors' care," Warren and Merkley noted, "and MedPAC projects that total Medicare payments to MA plans in 2023 will be $27 billion higher than if MA beneficiaries were enrolled in traditional Medicare."

"Rather than investing in benefits for patients, these seven health insurers instead spent $26.2 billion on stock buybacks."

Even though the Biden administration's proposed reforms would still leave Medicare Advantage plans with payments that are around 1% higher per enrollee in 2024 compared to this year, the insurance industry has characterized the changes as a cut and warned that their implementation would lead to higher premiums and worse care for beneficiaries.

In their letters, Warren and Merkley accused the for-profit insurance industry of attempting "to scare seniors and people with disabilities into opposing changes that will reduce waste, fraud, and abuse" in Medicare Advantage.

As The New York Timesreported earlier this week, "Medicare officials have been inundated with more than 15,000 comment letters for and against the policies, and roughly two-thirds included identical phrases from form letters."

"Insurers used television commercials and other strategies to urge Medicare Advantage customers to contact their lawmakers," the Times added. "The effort generated about 142,000 calls or letters to protest the changes, according to the Better Medicare Alliance, one of the lobbying groups involved."

That group—which counts Aetna, Humana, and other insurance giants as "ally organizations"—purchased a Super Bowl ad urging the White House not to "cut" Medicare Advantage:

Warren and Merkley voiced outrage that Medicare Advantage insurers would respond to the Biden administration's proposed policy changes by threatening "actions that hurt seniors"—such as premium hikes—"instead of reducing exorbitant salaries or the massive payouts to your shareholders and executives."

"It is outrageous that industry groups, on your behalf, are putting your plan's enormous profits over care for seniors," the senators wrote to the insurance company CEOs.

This content originally appeared on Common Dreams and was authored by Jake Johnson.

In the wake of numerous studies and investigations detailing the staggering level of fraud in the privately run Medicare Advantage program, the Biden administration proposed a new rule aimed at cracking down on upcoding—a common industry practice whereby plans describe patients as sicker than they actually are to reap larger payments from the federal government.

The rule, finalized by the Centers for Medicare and Medicaid Services (CMS) earlier this year, sparked a furious lobbying blitz that has only intensified in recent weeks, with the for-profit insurance industry's most powerful players leading the fight against the proposal and other policy changes that they have falsely characterized as Medicare Advantage "cuts."

The New York Timesreported Wednesday that insurance industry executives and lobbyists have been "flooding Capitol Hill" in an effort to protect their lucrative business model, which often leaves patients without necessary care.

"The largest insurers, including UnitedHealth Group and Humana, are among the most vocal, according to congressional staff, with UnitedHealth's chief executive pressing his company's case in person," the Times reported. "Doctors' groups, including the American Medical Association, have also voiced their opposition."

The insurance industry has also taken to the media, using sponsored content to launch misleading attacks on the Biden administration's reforms.

In addition to the proposed crackdown on Medicare Advantage upcoding and overbilling—an effort that federal health officials estimate will recover $4.7 billion in improper payments over the next decade—the Biden administration is pushing for technical changes to the formula used to calculate Medicare Advantage payments.

Under the proposed changes, the Kaiser Family Foundation (KFF) has noted, "CMS estimates that Medicare Advantage plan payments per enrollee will be 1% higher in 2024 than they are this year."

"The proposed payment changes for 2024, taken together, are unlikely to have a meaningful impact on the trajectory of Medicare Advantage spending, which CBO estimates will exceed $7 trillion (cumulative) through the decade that ends in 2032," KFF explained.

Nevertheless, industry groups and insurance giants have reacted with outrage to the Biden administration's proposals, focusing their ire specifically on plans to tweak the risk adjustment model that dictates how much the federal government pays Medicare Advantage plans to cover beneficiaries.

"Since the proposal was tucked deep in a routine document and published with little fanfare in early February, Medicare officials have been inundated with more than 15,000 comment letters for and against the policies, and roughly two-thirds included identical phrases from form letters," the Times reported Wednesday. "Insurers used television commercials and other strategies to urge Medicare Advantage customers to contact their lawmakers. The effort generated about 142,000 calls or letters to protest the changes."

The Medicare Advantage industry and its Republican allies in Congress insist the Biden administration's proposed changes would result in higher premiums for the program's tens of millions of beneficiaries and potentially impact the quality of care—but experts, advocates, and progressive lawmakers are pushing back.

During a Senate Finance Committee hearing on Wednesday, Sen. Elizabeth Warren (D-Mass.) defended the administration's proposals against Medicare Advantage industry "scare tactics" and argued that "these companies have built entire businesses around making beneficiaries look as sick as possible."

"The more diagnosis codes that a beneficiary has, the higher the payment, and whatever insurers don't spend on care they actually get to keep," Warren said. "Unsurprisingly, government watchdogs have discovered widespread abuse."

Kaiser Health Newsreported late last year that government audits have uncovered "widespread overcharges and other errors in payments to Medicare Advantage health plans, with some plans overbilling the government more than $1,000 per patient a year on average."

One Cigna executive, according to a lawsuit against the insurance giant, privately described certain diagnoses as "golden nuggets," an apparent reference to larger government payments for patients who are presented as sicker.

A KFF analysis published last month found that "Medicare Advantage plans have far higher per person gross margins—more than double those seen in other markets in 2021."

Advocacy organizations—including groups representing physicians, nurses, and seniors—have attempted to counter the torrent of industry-backed criticism of the Biden administration's proposals via the public comment process.

"The proposed reforms resulting in a limit of 1% increase is still an increase, which we understand is being opposed by the [Medicare Advantage] industry and their associations, and being mischaracterized as a cut. It is a cut only as far as it doesn't replicate the huge 8% increase granted last year," said California State Retirees.

Physicians for a National Health Program (PNHP), an advocacy group that supports single-payer healthcare, said earlier this month that "accountability to both Medicare beneficiaries and taxpayers instead of to investors and corporate greed is long overdue."

"We encourage CMS not to give in to industry lobbying pressure, and to implement the proposed changes without compromising, and we believe even stronger measures are needed. After all, it is the mission of CMS to protect the integrity of the Medicare program," PNHP added. "The profitability of MA plans has rested heavily on gaming strategies and fraud."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

There’s an ongoing debate in Washington about the need to trim government spending. As our representatives in Congress wrangle over words like “cuts” and “reforms,” the salient issue remains that long-standing entitlement programs like Social Security and Medicare are on the chopping block. It’s time that we acknowledge just how essential these programs are to supporting home and medical care for older Americans and the caregivers who provide that care.

Care benefits are mistakenly deemed unnecessary but any cuts to this lifeline would be devastating to both older adults and their caregivers. Cuts to Medicare, in particular, would do grave harm to caregivers – direct care providers and unpaid family members alike – who spend countless hours making sure those in their charge live dignified and rewarding lives despite their challenges.

These cuts will only make a hard job infinitely harder by limiting resources and expanding the health burden caregivers bear in their work. We know this because we work with caregivers on a daily basis at Culpepper Garden to serve low-income older adults in our independent- and assisted-living residences. That’s why we urge our Congress to immediately take Medicare off the chopping block during these debt ceiling deliberations. Instead, they must preserve, and even strengthen, it.

There are about 65 million Americans on Medicare, and, according to the AARP, one in five Americans in 2020 had been a caregiver — that’s about 53 million adults. Of those, most are female Baby Boomers and the vast majority are women of color taking care of a family member. Given how many people are affected, questions about Medicare’s future are far from insignificant.

Among the proposals to cut Medicare benefits include reducing reimbursements that providers receive for treating Medicare patients. In fact, this has already occurred and some doctors argue that decreasing their payments from the federal health insurance program will mean fewer of them will agree to take on new Medicare patients because they just can’t earn enough money doing so. This, in turn, will make it harder for patients to access the care they need and that, of course, means they will get sicker and rely on their caregivers for care that should be provided by a doctor.

Access to high quality care is critical – not just to treat disease, but also to prevent it. According to the CDC, chronic diseases are not only responsible for $4.1 trillion in healthcare costs every year, they are also the nation’s leading cause of illness, disability, and death. Properly funding Medicare, and supporting caregivers and assisted-living programs, will improve health outcomes for older adults and will ultimately help the economy by reducing healthcare costs.

Another change is limiting home health benefits for Medicare patients that cover at-home services like direct care, therapists, and so on. Many of our residents rely on these benefits and cutting them would mean more of them would either need frequent hospitalizations (that many already can’t afford) or end up at a nursing home. Outcomes that ultimately send patients back to institutional care simply cost more than when a patient stays at home, where most Americans prefer to receive care in the first place.

Protecting these benefits is why Reps. Terri Sewell (D-Alab.) and Vern Buchanan (R-Fla.) introduced H.R. 8581, the bipartisan Preserving Access to Home Health Act of 2022. We urge our lawmakers to bring this bill to a vote immediately and pass this bill to protect critical Medicare services that low-income older adults rely on. Doing so would better millions of lives and save the economy trillions of dollars.

This content originally appeared on Common Dreams and was authored by Marta Hill Gray.

Customers in line outside the Silicon Valley Bank headquarters in Santa Clara, Calif., on March 13, 2023.

Photo: David Paul Morris/Getty Images

This content originally appeared on The Intercept and was authored by Jon Schwarz.

While blasting the White House's proposed $886 billion in military spending as "madness," progressives on Thursday also praised portions of U.S. President Joe Biden's fiscal year 2024 budget for sizable social investments that could lead to "broader opportunity, greater economic and health security, lower levels of hardship, and a nation where everyone can thrive."

"No one in the White House seriously believes that Congress will adopt it in its current form," Politiconoted of Biden's blueprint. "It's a messaging exercise. And as such, the White House sees no downside whatsoever to throwing out things that will never pass the Republican-controlled House. The fight is the point."

Still, the scope of the budget—which includes significant funding for the climate, childcare, democracy, education, healthcare, housing, violence prevention, and more, made possible in part through tax hikes for wealthy individuals and corporations—was celebrated by the likes of Sharon Parrott, president of the Center on Budget and Policy Priorities (CBPP).

"President Biden's budget is driven by what we know works: investments in the people who keep our economy running."

"President Biden's 2024 budget invests in people and communities and creates a 21st century tax system that supports these investments to build toward an economy that works for everyone," Parrott said. "It lays out an agenda that would move us closer to a nation where everyone—regardless of their background, identities, or where they live—has the resources they need to thrive and share in the nation's prosperity."

Erica Payne, the founder and pesident of the Patriotic Millionaires, declared that "President Biden's proposed budget is the most ambitious tax plan we've seen from a president in decades—and a clear emphasis of the values that he and the Democrats stand for: investing in our country, fighting off corporate profiteering, protecting the social safety net, and doing so all while reducing our nation's budget deficit."

"The wealthiest Americans and corporations can easily afford to pay more—and hundreds of patriotic millionaires and billionaires are ready and eager to do their part to make sure all Americans can thrive," Payne added. "Let's be clear: As President Biden's budget lays out—we can invest in America, expand the social safety net, fight income inequality, and do it all while lowering taxes for working people—if we simply require the wealthiest Americans to pay their fair share."

The president's proposals to help American families include expanding the child tax credit from $2,000 per kid to $3,000 for those ages six and above, and to $3,600 for children under six; enabling states to increase childcare options for millions of kids; and funding a federal-state partnership that provides high-quality, universal, free preschool.

The budget also calls for boosting prevention services to reduce the number of children entering foster care as well as changes to the adoption tax credit to better serve families with lower incomes and those who choose legal guardianship.

Biden advocates for $59 billion in funding and tax incentives to increase the affordable housing supply; $10 billion to remove barriers to affordable housing developments; and $10 billion to address racial and ethnic homeownership and wealth gaps. The president proposes providing $4.1 billion for the Low Income Home Energy Assistance Program—and allowing states to use some of that money to provide water bill assistance to poor households, since a related program expires at the end of 2023.

Along with fighting for billions of dollars to ease hunger, the administration aims to pour money into high-poverty school districts as well as improve the affordability of higher education by increasing the discretionary maximum Pell Grant by $500, expanding free community college, and subsidizing tuition for students from families earning less than $125,000 enrolled historically Black, tribally controlled, or minority-serving institutions.

"Time and again, President Joe Biden delivers on his promise to fight for American families, his commitment to fairness for all Americans, and his belief that everyone should have the freedom and opportunity to build a better life. This budget reflects those priorities and values by helping people continue to rebuild," said American Federation of Teachers President Randi Weingarten, who highlighted various proposed investments in education and major federal programs.

In terms of healthcare, Biden pushes for putting billions of dollars into tackling cancer, increasing funds for veterans exposed to environmental hazards, and providing $471 million for reducing maternal mortality and morbidity rates, especially among Black, American Indian, and Alaska Native women. He also wants to expand coverage of mental health benefits and make historic investments in the behavioral health workforce.

The president advocates for making healthcare premium cuts permanent and providing Medicaid-like coverage to individuals in states that have not expanded their programs under the Affordable Care Act. There are also provisions to cut prescription drug costs, improve Medicaid home and community-based services, and expand the National Health Service Corps as well as programs that train and support nurses.

Biden would also extend the solvency of the Medicare trust fund by at least 25 years. In addition to investing in Social Security Administration staff, a White House fact sheet says that the Biden administration "looks forward to working with the Congress to responsibly strengthen Social Security by ensuring that high-income individuals pay their fair share."

Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, said that "while the conservatives' approach is to 'cut, cut, cut!' earned benefits for future generations of retirees, President Biden's budget would fortify Medicare for the future by asking the wealthy to pay their fair share."

"Instead of 'kicking the can down the road' as some previous administrations and Congresses have done, the president's budget confronts the trust fund shortfall head-on—without burdening beneficiaries," Richtman continued. "In a society with massive wealth inequality, the wealthy can afford to pay a little more. Future seniors cannot afford benefit cuts."

While welcoming Biden's efforts to protect Medicare, Lisa Gilbert, executive vice president of Public Citizen, also suggested that "looking ahead, the administration should crack down on Medicare Advantage plans that profit by cherry-picking healthy seniors and restricting care for enrollees; expand dental, vision, and hearing benefits for Medicare enrollees; work with Congress to cap out-of-pocket expenses for seniors; and take a bolder stand against Big Pharma greed by expanding drug price negotiation to bring down the prices of more drugs sooner and cover all Americans, not just people on Medicare."

On the climate front, the budget proposes spending $4.5 billion on clean energy, $16.5 billion on climate science and clean energy innovation, and over $24 billion on conservation and to help build communities' resilience to devastating storms, drought, extreme heat, floods, and wildfires. The administration also pushes for investing nearly $2 billion in environmental justice efforts.

A coalition of over a dozen green groups stressed in a joint statement Thursday that "as our country deals with inflation, high energy prices, public health crises, biodiversity loss, and climate change, it is now more important than ever that Congress fully funds the agencies responsible for addressing these critical issues."

Varshini Prakash, executive director of the youth-led Sunrise Movement, said that "President Biden's proposed budget—especially its investments in clean energy, jobs, and an end to oil and gas subsidies—is the kind of thing young people in this country want to see ahead of 2024."

"But President Biden has the power to act on climate and issues important to our generation without having to go through a Republican House," she noted. "He can reject the Willow Project, which goes against his own agenda to stop the climate crisis, and can do everything in his executive authority, like declaring a climate emergency and invoking the Defense Production Act, to jump-start our transition to clean energy."

Given the current conditions in Congress—with Republicans controlling the House and a Senate where the president's agenda is often thwarted by not only the GOP but also right-wing Democrats and a new Independent—Biden is certainly in for a battle.

That's especially the case considering that, as CBPP's Parrott noted, "the president's budget priorities stand in stark contrast with the emerging House Republican agenda—an agenda that pushes more tax cuts for the wealthy and profitable corporations, and holds the economy hostage by demanding deep spending cuts in areas like K-12 schools, healthcare, medical research, college tuition help, and help buying groceries as the price for raising the debt limit."

"Taken together, this emerging agenda would increase hardship and narrow access to opportunity; widen already large differences in outcomes by race, ethnicity, and geography; and hurt the country as a whole," Parrott warned of GOP lawmakers' priorities.

ProsperUs coalition spokesperson Claire Guzdar argued that "President Biden's budget is driven by what we know works: investments in the people who keep our economy running. Lowering costs for families, strengthening Medicare and Social Security, and delivering investments in healthcare, housing, and climate are key to widespread prosperity and economic growth."

"President Biden must now fight to enact this budget and continue to reject dangerous calls for austerity and cuts to programs that strengthen our communities and our economy," Guzdar added.

A U.S. Senate Budget Committee hearing for the president's proposal is scheduled for the morning of March 15.

This content originally appeared on Common Dreams and was authored by Jessica Corbett.

The Massachusetts Democrat has in recent months called on federal agencies including the Transportation Security Administration (TSA) and Immigration and Customs Enforcement (ICE) to stop using such surveillance mechanisms to identify people who may have committed crimes, warning the TSA last month that a recent federal study found "Asian and African-American people were up to 100 times more likely to be misidentified than white men by facial recognition technology."

The use of facial recognition stands "in the way of progress and perpetuate[s] injustice," said Markey in a statement.

"The year is 2023, but we are living through 1984. The continued proliferation of surveillance tools like facial recognition technologies in our society is deeply disturbing," said Markey. "Biometric data collection poses serious risks of privacy invasion and discrimination, and Americans know they should not have to forgo personal privacy for safety."

In addition to imposing a strict ban on the use of facial recognition and biometric technologies by federal entities, said Markey, the legislation would:

• Condition federal grant funding to state and local entities, including law enforcement, on those entities enacting their own moratoria on the use of facial recognition and biometric technology;
• Prohibit the use of federal dollars for biometric surveillance systems;
• Prohibit the use of information collected via biometric technology in violation of the law in any judicial proceedings;
• Provide a private right of action for individuals whose biometric data is used in violation of the act and allow for enforcement by state attorneys general; and
• Allow states and localities to enact their own laws regarding the use of facial recognition and biometric technologies.

In Maryland, Alonzo Sawyer was recently arrested near Baltimore for assaulting a bus driver and stealing their phone, despite the fact that he was home at the time of the attack and his wife confirmed his alibi. An intelligence agency used facial recognition technology to match Sawyer to CCTV footage from the bus.

Sawyer was just the latest Black American man to be arrested after being misidentified using facial recognition technology.

Those wrongful arrests are "why I have long called on government to halt the deployment of facial recognition technology," said Jayapal. "This legislation will not only preserve civil liberties but aggressively fight back against injustice by stopping federal entities from irresponsibly using facial recognition and biometric surveillance tools."

"Facial recognition has continued to harm vulnerable communities and erode our privacy, making this legislation more important than ever," said Caitlin Seeley George, campaigns and managing director for digital rights group Fight for the Future, which supports an outright ban on law enforcement use of the technology. "We cannot afford to wait any longer to put this invasive technology in check, and any lawmaker who claims to care about privacy and justice must prove it by supporting this legislation."

As they introduced the bill, Markey and Jayapal were joined by Sens. Jeff Merkley (D-Ore.), Bernie Sanders(I-Vt.), Elizabeth Warren(D-Mass.), and Ron Wyden (D-Ore.) and Reps. Ayanna Pressley(D-Mass.), Rashida Tlaib(D-Mich.), Earl Blumenauer (D-Ore.), Cori Bush (D-Mo.), Greg Casar (D-Texas), Adriano Espaillat (D-N.Y.), Barbara Lee (D-Calif.), Eleanor Holmes Norton (D-D.C.), Jamaal Bowman(D-N.Y.), and Jan Schakowsky (D-Ill.).

As Common Dreamsreported Tuesday, a lawsuit filed by the ACLU unveiled a "major investment" by the FBI in the development of facial recognition software.

"This sweeping government surveillance software is a nightmare for our privacy rights," said the ACLU Tuesday. "Lawmakers need to close the door on government abuse of this technology now, before it's too late."

The newly reintroduced legislation demonstrates that "Markey understands Congress should not be using federal funds to underwrite the use of technologies that threaten our most sacred civil rights and civil liberties," said Chad Marlow, senior policy counsel for the organization. "The ACLU applauds Sen. Markey's leadership on this issue and thanks all the members of Congress who join him in safeguarding our freedoms against the prying eyes of unchecked government surveillance."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

President Joe Biden on Tuesday unveiled a plan to extend Medicare's solvency into the 2050s by raising taxes on high-income Americans and cutting prescription drug costs, a proposal that Biden presented as an alternative to GOP attacks on the healthcare program used by tens of millions of seniors.

"If the MAGA Republicans get their way, seniors will pay higher out-of-pocket costs on prescription drugs and insulin, the deficit will be bigger, and Medicare will be weaker," the president wrote in an op-ed for The New York Times. "The only winner under their plan will be Big Pharma. That's not how we extend Medicare's life for another generation or grow the economy."

According to an outline released by the White House on Tuesday morning, Biden's proposal would "extend the solvency of Medicare’s Hospital Insurance (HI) Trust Fund by at least 25 years" by raising the Medicare tax rate from 3.8% to 5% on both earned and unearned income above $400,000.

"When Medicare was passed, the wealthiest 1% of Americans didn't have more than five times the wealth of the bottom 50% combined," Biden wrote Tuesday, "and it only makes sense that some adjustments be made to reflect that reality today."

The plan also proposes empowering "Medicare to negotiate prices for more drugs and bringing drugs into negotiation sooner after they launch," building on provisions of the Inflation Reduction Act that Biden signed into law last year. The White House plan would then credit the savings from the drug price reforms—an estimated $200 billion over 10 years—to the HI Trust Fund.

"Let's ask the wealthiest to pay just a little bit more of their fair share, to strengthen Medicare for everyone over the long term."

The Medicare plan is part of the president's sweeping fiscal year 2024 budget blueprint, scheduled for release later this week. The budget will likely include a range of administration proposals that don't stand a chance of clearing the Republican-controlled House.

In its 2022 report, the Board of Trustees for Social Security and Medicare projected that the HI Trust Fund—Medicare Part A—"will be able to pay scheduled benefits until 2028, two years later than reported" in 2021.

"At that time," the trustees report noted, "the fund's reserves will become depleted and continuing total program income will be sufficient to pay 90% of total scheduled benefits."

In his Times op-ed, Biden declared that "we should do better than that and extend Medicare's solvency beyond 2050."

"Let's ask the wealthiest to pay just a little bit more of their fair share, to strengthen Medicare for everyone over the long term," the president wrote. "This modest increase in Medicare contributions from those with the highest incomes will help keep the Medicare program strong for decades to come. My budget will make sure the money goes directly into the Medicare trust fund, protecting taxpayers’ investment and the future of the program."

Biden put forth his plan as he continues to face progressive criticism for operating a pilot program called ACO REACH, which physicians warn could result in the privatization of traditional Medicare.

The president's plan also comes amid a debt ceiling standoff that Republicans are attempting to exploit to secure long-sought cuts to federal programs. House Republicans have also floated changes to Medicare, including an increase in the program's eligibility age.

"MAGA Republicans on the Hill say the only way to be serious about preserving Medicare is to cut it," Biden wrote in a Twitter post on Tuesday. "Well, I think they’re wrong. I'm releasing my budget this week. In it, I'll propose a plan to extend the life of Medicare for a generation, without cutting benefits."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

Spurred by a statewide organizing effort by Our Revolution, the city council of Newark, New Jersey on Wednesday passed a resolution officially declaring support for legislation to expand Medicare to all U.S. residents, guaranteeing healthcare as a right.

"The Municipal Council and the mayor of the city of Newark, Ras J. Baraka, supports and urges Congress to work toward the immediate enactment of the Medicare for All Act of 2021 (H.R. 1976) by assuring appropriate and efficient healthcare for all residents of the United States," reads the resolution.

Our Revolution New Jersey has now successfully pushed 15 cities across the state to pass similar resolutions, while more than 100 counties, cities, and towns across the U.S. have backed Medicare for All.

In recent weeks, Cleveland and Boulder County, Colorado passed resolutions. Other cities backing the legislation include Philadelphia, Denver, and Los Angeles.

Newark's resolution was applauded by the People's Organization for Progress, a grassroots group based in the city.

"It is absolutely reprehensible that the United States, the richest country in the world, does not have free universal healthcare when most of the other wealthy nations provide this benefit to their citizens," said Lawrence Hamm, the group's chairman. "The resolution brings us one step closer to making Medicare for All a reality in the U.S. during our lifetime."

Campaigners in New Jersey have ramped up efforts to convince local lawmakers to back Medicare for All—which is supported by nearly 7 in 10 Americans—following a 20% premium increase in the state health benefit plan. The out-of-pocket healthcare cost hike came on the heels of a vote by lawmakers to allow the state health plan to operate as a for-profit entity.

"At a time when health insurance companies are making record profits, plans to increase health care costs for New Jersey public employees are a betrayal of thousands of hardworking members of Newark's municipal family, who are already being harshly impacted by rising costs of living," said Baraka when the premium increase was announced in September.

Nearly 20% of people under the age of 65 in New Jersey do not have health insurance, and a report released in September by Healthcare Value Hub showed that 36% of state residents were unable to get care when they needed it due to medical debt.

"Medical debt represents a crushing weight on many families in our community," said Matt Dragon, co-chair of Our Revolution Essex County. "Deferring or skipping medical care due to the cost exacerbates the health impacts for individuals, creates higher costs down the road, and in some cases ends in a loved one gone far too soon. Medicare for All also represents a racial justice policy as uninsurance rates in Black and Hispanic communities outpace those of white populations."

Our Revolution New Jersey expressed gratitude to Baraka, who championed the resolution.

"Medicare for All represents conscientious policy that is not based on zip code, class, economic status, etc. but is designed for everyone," said Baraka. "Here in Newark, we make sure that the needs of our residents are at the forefront of our initiatives, policies, and legislation through an equitable lens. The passing of today's resolution affirms our stance and makes clear: Newark will always work to advance the quality of life of its residents and having affordable and adequate healthcare is important to our community."

This content originally appeared on Common Dreams and was authored by Julia Conley.

Tennessee joins Alabama, Arkansas, Arizona, South Dakota, Tennessee, and Utah in outlawing or restricting gender-affirming care for trans youth—and, in the case of Alabama, anyone under age 19. Federal judges have blocked Alabama and Arkansas from implementing their bans. Meanwhile this year, at least 24 states have introduced legislation to prohibit or restrict such care.

Lambda Legal—which along with the ACLU and ACLU of Tennessee announced its intent to sue—accused Lee and Republican lawmakers of "taking away the freedom of families of transgender youth to seek critical healthcare" and "putting the government in charge of making vital decisions traditionally reserved to parents in Tennessee."

"They've chosen fearmongering, misrepresentations, intimidation, and extremist politics over the rights of families and the lives of transgender youth in Tennessee."

"We will not allow this dangerous law to stand," the groups said in a joint statement. "Certain politicians and Gov. Lee have made no secret of their intent to discriminate against youth who are transgender or their willful ignorance about the lifesaving healthcare they seek to ban."

"Instead, they've chosen fearmongering, misrepresentations, intimidation, and extremist politics over the rights of families and the lives of transgender youth in Tennessee," the groups added. "We are dedicated to overturning this unconstitutional law and are confident the state will find itself completely incapable of defending it in court. We want transgender youth to know they are not alone and this fight is not over."

Ivy Hill, director of gender justice for the Campaign for Southern Equality, said in a statement after the bill passed that "my heart is breaking for transgender youth all across the country and throughout the South."

"We've known for years that it's never been easy to access gender-affirming care in states like Tennessee and the passage of this bill will only make it harder," they added. "But the trans and queer community across the South will do what we've always done: come together, support each other, and chart new systems that help people live authentic, thriving lives where they know they are loved and supported."

Dr. Allison Stiles, a Memphis physician, said that "this bill, I feel, was born out of fearmongering—out of false rhetoric that we are doing sex-change operations on our children."

"The hate has grown, and we now have a bill that could get parents arrested for taking their gender-dysphoric child to the physician, and their physicians for taking care of them," she asserted.

"There are at least four human beings that I have touched with my hands who are this side of the grave because of the gender-affirming care."

"Just to throw in a little science here... there are four independent aspects to our sexuality," Stiles added. "Our genetics—which could be XX, XO, XY, XXY, XYY—there is our outward appearance, our gender identity, and our sexual preference. The XX and XY fetus are identical, actually, until six weeks of gestation."

Proponents of gender-affirming care noted it saves lives.

"There are at least four human beings that I have touched with my hands who are this side of the grave because of the gender-affirming care," Rev. Dawn Bennett of the Table Nashville, a faith group that centers the LGBTQ+ community, recently asserted.

According to the ACLU, Republican lawmakers in more than 20 states are trying to ban gender-affirming care for trans youth—and in some cases, even adults.

Lee also signed a bill on Thursday making Tennessee the first state to criminalize public drag shows. The governor signed the measure amid allegations of hypocrisy following the revelation that he dressed in drag at least once while in high school in the 1970s.

"Drag is not a threat to anyone. It makes no sense to be criminalizing or vilifying drag in 2023," Lawrence La Fountain-Stokes, a professor of culture and gender studies at the University of Michigan who has performed in drag, told the Associated Press.

"It is a space where people explore their identities," La Fountain-Stokes continued. "But it is also a place where people simply make a living. Drag is a job. Drag is a legitimate artistic expression that brings people together, that entertains, that allows certain individuals to explore who they are and allows all of us to have a very nice time. So it makes literally no sense for legislators, for people in government, to try to ban drag."

Other GOP-run states—including Idaho, Kentucky, Montana, North Dakota, and Oklahoma—are considering similar drag bans.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

Sen. Bernie Sanders warned Monday that without swift congressional action, the $5.8 billion in federal funding relied on each year by community health centers around the United States will expire on September 30, resulting in a devastating "primary care cliff."

"Congress can and must avoid" such a scenario, says a statement from the Vermont Independent's office.

Sanders announced that the Senate Health, Education, Labor, and Pensions (HELP) Committee he chairs is scheduled to hold a hearing this Thursday at 10:00 am ET titled, "Community Health Centers: Saving Lives, Saving Money."

Millions of people in the U.S. currently receive lifesaving services from community health centers in thousands of neighborhoods nationwide.

“In America today, community health centers are providing cost-effective primary medical care, dental care, mental health counseling, and low-cost prescription drugs to 30 million people regardless of a person's bank account or insurance status," said Sanders.

"Not only do these health centers save lives and ease human suffering," Sanders continued. "They save Medicare, Medicaid, and our entire healthcare system billions of dollars each year because they avoid the need to go to expensive emergency rooms and hospitals."

"In the midst of a broken and dysfunctional healthcare system, I will be doing everything I can to expand community health centers so that every American has access to the primary care that they need and deserve," he added.

According to the senator's office:

Nearly 100 million Americans live in a primary care desert, nearly 70 million live in a dental care desert, and some 158 million Americans—nearly half the country's population—live in a mental healthcare desert. Today, 85 million people are uninsured or under-insured, over 500,000 people go bankrupt each year because of medically related debt, and more than 68,000 people die each year because they cannot afford the healthcare they desperately need. Expanding community health centers will begin to address this urgent crisis.

The following individuals are scheduled to testify at the hearing: Amanda Pears Kelly, chief executive officer of Advocates for Community Health and executive director of the Association of Clinicians for the Underserved; Ben Harvey, chief executive officer of Indiana Primary Health Care Association; Robert Nocon, assistant professor at Kaiser Permanente Bernard J. Tyson School of Medicine; Sue Veer, president and chief executive officer of Carolina Health Centers; and Jessica Farb, managing director at the Government Accountability Office.

This content originally appeared on Common Dreams and was authored by Kenny Stancil.

Guess so, since it gave Brian Riedl, a senior fellow at the Manhattan Institute, plenty of space to say things that are extremely deceptive, if not outright lies. The gist of Riedl’s piece is that it will not be possible to sustain Social Security and Medicare without tax increases on the middle class.

Much of the piece is the standard line about an aging population posing an impossible burden that we have been reading in the NYT and elsewhere for many decades. For example, Riedl includes an old favorite:

“The ratio of workers supporting each retiree, which was about 5:1 back in 1960, will fall to just over 2:1 by the next decade.”

This is of course largely true. The deceptive part is that most of the decline in ratio of workers to retirees took place long ago. The ratio of covered workers to beneficiaries had dropped to 3.2:1 by 1975. It hovered around this level until the baby boomers began to retire at the end of the first decade of the century.

The ratio of workers to retirees is now down to 2.8 to 1. It is projected to fall to 2.4 to 1 by the next decade. Are you scared yet?

Riedl also tells us, “people who live until age 90, a fast-growing group, will spend one-third of their adult life collecting Social Security and Medicare benefits.” There are two problems with this assertion.

First, the people who live to 90 will be disproportionately higher-income workers. Many will have delayed collecting Social Security benefits until they are age 70, or close to it. Also, if they continue working and have employer-provided health insurance, Medicare will not be the primary payer until they retire. If “adult life” starts at age 18, then we are looking at people who live to age 90 collecting benefits for a bit more than a quarter of their adult life (20 years out of 72 years).

But the more important point is that life expectancies have not increased for everyone. As a recent report from the Congressional Research Service documented, there has been almost no increase in life expectancy at age 65 for workers in the bottom half of the age distribution. The story of increasing life expectancies is overwhelming a story of higher income workers living longer.

Getting Beyond Deception

Riedl also tells us that, “today’s typical retiring couple will receive Medicare benefits three times as large as their lifetime contributions to the system.” This is true, but it leaves out two important points.

First, the reason that the value of Medicare benefits is so high is that we pay twice as much for our health care, per person, as people in other wealthy countries. This is not due to better care. People in the United States do not do better by most outcome measures.

Our higher costs are the result of the fact that we pay twice as much for everything. We pay the drug companies twice as much for prescription drugs. We pay the medical equipment manufacturers twice as much for medical equipment. We pay our doctors twice as much as doctors in Europe and Canada. And, we throw hundreds of billions annually at insurance companies, because they have powerful lobbyists who can get them these handouts. Our expensive Medicare benefits are not a story of the elderly living the high life, they are a story of powerful interest groups ripping off the healthcare system.

But these are just the standard deceptions we have come to expect since the days when private equity billionaire Peter Peterson was leading the charge against Social Security and Medicare. But the other problem with Reidl’s Medicare comment gets to the outright lie part.

Unlike Social Security, Medicare is not designed as a system where a dedicated tax is supposed to fully fund the program. Traditional Medicare has three parts: Part A is the hospital insurance portion of the program, which is supposed to be paid from the dedicated Medicare tax. Part B covers doctors’ payments. This is only designed to be partially funded by premium paid by beneficiaries. Part D is for drug coverage, which is also designed to be only funded by beneficiary premiums. (There is also Part C, Medicare Advantage, which is intended as a way to funnel money to insurance companies.)

Since much of the Medicare program is not even designed to be covered by payments directly to the program, it makes no sense to include these portions of the program in complaints about Medicare’s deficit. When Riedl tells us that Medicare is projected to run a $48 trillion shortfall over the next three decades, the overwhelming majority of this projected shortfall is due to portion of the program that is not covered by Medicare-specific taxes by design.

It is comparable to telling us that the Defense Department is running an $890 billion deficit this year (3.4 percent of GDP) because that is the extent to which its spending will exceed its designated taxes. I assume that the NYT would not allow the piece complaining about the huge Defense Department deficit on its opinion page, because it makes no sense. Why is this complaint about the Medicare deficit allowed?

There actually is a very interesting story about the projected deficit for the Medicare Part A program: it has fallen sharply in recent decades. In 2000, it was projected that Medicare would face a shortfall of 0.4 percent of GDP (around $90 billion a year) by now, rising to 1.0 percent of GDP by 2040 (Table III.C1). The most recent Trustees Report shows a shortfall of just 0.04 percent of GDP this year, rising to 0.42 percent in 2040 and then falling through the rest of the century.

This improvement in the program’s finances is due to sharp slowing of healthcare cost growth. Needless to say, if we got our health care costs in line with costs in countries like Germany and Canada, the program would be showing an enormous surplus. The Affordable Care Act played a role in curbing healthcare cost growth over this period. President Biden is trying to go further, with his proposals to limit drug costs, if Republican “deficit hawks” don’t stand in his way.

Do We Have to Tax the Middle Class?

There are two further points work making on Reidl’s piece. First, there is an issue that Social Security will soon need additional revenue beyond what is projected to come from its designated payroll tax. This can come, at least in part, from raising taxes on higher-income earners. The tax is not collected on wage income above $160k.

When this cutoff was set in 1982, only 10 percent of wage income was above the cap. As a result of the upward redistribution of income over the last four decades, close to 18 percent of wage income is above this cutoff. Subjecting a larger portion of the wages of high-income earners to the tax would help to close the projected shortfall.

We could also turn to other taxes, such as taxes on non-wage income or higher corporate income taxes. This would move away from the practice of funding benefits from the dedicated Social Security tax, but it’s not clear many people would be bothered by this shift.

It is also worth noting that in prior decades we did raise the Social Security tax rate repeatedly. The Social Security tax was increased over the five decades following its inception, from 2.0 percent in 1937 to 12.4 percent in 1990. It has not been increased at all in more than thirty years.

As I noted yesterday, it was possible politically to increase taxes so much in part because, at least through the first thirty-five years of the program’s existence, real wages were rising at a healthy pace. Taxing away a portion of the wage gains workers receive every year is an easier matter than asking workers to give up a portion of paychecks that are stagnant or even declining in real terms.

It appears that real wages are back on an upward path. Beginning in the middle of the last decade, real wages were rising at a rate of close to 1.0 percent annually for the typical worker. Pandemic inflation briefly stopped this growth, but it appears that real wages are again rising, especially for those in the bottom portion of the wage ladder. If this trend continues, modest increases in Social Security taxes should be a possibility, if that proves necessary.

The other issue is that we may not need additional taxes at all, at least from a macroeconomic standpoint. Many economists, most notably former Treasury Secretary Larry Summers, have argued that the biggest problem facing an aging society is “secular stagnation.” This is a story where there is not enough demand to keep the economy operating at its potential and to keep workers fully employed. This is 180 degrees at odds with the story that we won’t have the resources needed to support a growing elderly population. If Summers’ secular stagnation view proves correct, then there would be no reason to have tax increases, since the economy is suffering from too little demand, not too much.

In short, the fear lobby is up to its old tricks which genuinely serious people (as opposed to “very serious people”) have been combating for decades. Social Security and Medicare are great success stories which tens of millions of people depend upon. We should not allow dishonest scare stories to be a basis for slashing and/or privatizing these programs.

This content originally appeared on Common Dreams and was authored by Dean Baker.

Here's one of many indicators about how broken the United States healthcare system is: Guns seem to be easier and cheaper to access than treatment for the wounds they cause. A survivor of the recent mass shooting in Half Moon Bay, California,reportedly said to Gov. Gavin Newsom that he needed to keep his hospital stay as short as possible in order to avoid a massive medical bill. Meanwhile, the suspected perpetrator seemed to have had few obstacles in his quest to legally obtaina semi-automatic weapon to commit deadly violence.

Americans are at the whim of a bewildering patchwork of employer-based private insurance plans, individual health plans via a government-run online marketplace, or government-run healthcare (for those lucky enough to be eligible). The coverage and costs of plans vary dramatically so that even if one has health insurance there is rarely a guarantee that there will be no out-of-pocket costs associated with accessing care.

It's hardly surprising then that the latestGallup poll about healthcare affirms what earlier polls have said: A majority of Americans want their government to ensure health coverage for all. In fact, nearly three-quarters of all Democrats want a government-run healthcare system.

Gallup also found that a record high number of people put off addressing health concerns because of the cost of care. Thirty-eight percent of Americans said they delayed getting treatment in 2022—that's 12 percentage points higher than the year before. Unsurprisingly, lower-income Americans were disproportionately affected.

Women are especially impacted, with more women than men delaying treatment as per the same Gallup poll. The findings were consistent withresults published by researchers at New York University's School of Global Public Health, which found that women's healthcare was increasingly unaffordable, compared to men's—in a study that solely focused on people with employer-based health coverage. Imagine how out-of-reach healthcare is for uninsured women.

Added to that,Republican-led abortion bans have made it even harder for American women to obtain reproductive healthcare. On the 50th anniversary of the recently overturned Supreme Court decision Roe v. Wade,abortion providers in Massachusetts, for example, reported a steady stream of people driving to their state—one where abortion remains legal—to access care.

President Joe Biden and the Democratic Party appear to think that this grim status quo is perfectly acceptable. Democrats' reliance on the Obama-era Affordable Care Act (ACA) as a bulwark against Republican opposition to any government intervention in healthcare seems to be resoundingly successful—at least on paper. In December 2022, Biden touted the fact that 11.5 million Americans, a record high number, had signed up for ACA plans during the last enrollment period. He said, "Gains like these helped us drive down the uninsured rate to eight percent earlier this year, its lowest level in history."

His administration, rather than working to fulfill what a majority of his party's constituents want—a government-run healthcare system—has continued instead to tweak the ACA by extending a period of discounted monthly premiums for private insurance plans. Such tweaks are not permanent. Neither are they a panacea for accessing adequate care. If anything, they are a façade protecting profit-based private insurance companies.

Asurvey by the Commonwealth Fund found that although the number of insured Americans is now at an all-time high, more than 40% of those who bought ACA plans and nearly 30% of those with employer-based plans were underinsured—that is, the plans were inadequate to cover their healthcare needs.

By focusing solely on the number of people who had health plans as a measure of success, the White House is participating in a great coverup of the ongoing American healthcare tragedy.

Meanwhile, just over the horizon from Biden's celebration of record numbers of ACA signups is the fact that millions of people currently enrolled in the Medicaid government health plan could lose access because of theend of an emergency provision that allowed for "continuous enrollment." That provision expires at the end of March 2023. If all Americans were automatically enrolled in government-provided healthcare regardless of eligibility, this would not be a concern.

Right-wing sources, so terrified that too many Americans want a government-run health system, are busy shaping public opinion against it. The Pacific Research Institute'sSally Pipes recently published an op-ed about how Canada's national health system was a good reason why the United States should not have a similar program. Using the deadly logic of a free marketeer, she wrote, "In Canada, healthcare is 'free' at the point of service. As a result, demand for care is sky-high."

The implication is that charging people for service would reduce the demand, just as it would for, say, an electric vehicle. In Pipes' world, people are accessing healthcare just for fun, and if they were charged money for it, their ailments might resolve themselves without treatment.

TheHeritage Foundation also published an attack on Britain's National Health Service (NHS), gleefully claiming that it is "cratering," and warning that it is a lesson for American liberals who might support a similar "single-payer" system in the United States.

The Wall Street Journal's editorial boardpublished a similar warning, claiming that the NHS was "failing patients, with deadly consequences."

It's puzzling why the Pacific Research Institute, Heritage Foundation and Wall Street Journal appear unconcerned about the330,000 Americans who lost their lives during the Covid-19 pandemic simply because they don't live in a nation with a universal healthcare program.

The United Statesspends nearly twice as much per capita on healthcare than other comparable high-income nations. According toHealth Affairs, excessive administrative costs are the main reason for this discrepancy—these are non-medical costs associated with delivering healthcare in a patchwork system of employer-based private health and publicly subsidized plans. In fact, "administrative spending accounts for 15 – 30 percent of health care spending."

Again, right-wing media outlets and think tanks appear unconcerned by this disturbing fact. They only want to convince Americans that a government-run health plan is a bad idea. And, sadly, the Democratic Party leaders like Biden seem to agree.

The National Union of Healthcare Workers, together with Healthy California Now,created an online calculator for individuals to determine how much money they would save if the United States had a single-payer system.

I have an employer-based healthcare plan that is considered very good. Using the calculator, I determined that I would save more than $16,000 if California, the state where I live, had a single-payer system. That's money I could be saving for my children's higher education or for my retirement.

The victims of mass shootings, like the Half Moon Bay survivor, are saddled with high costs of care on top of the trauma of having been shot. Every year, there are more than80,000 survivors of injuries from firearms in the United States. Having a single-payer healthcare system would not fix our epidemic of gun violence. But it would certainly make it easier to bear.

Canada and Britain's state-run systems of health care may be imperfect, but they are a vast improvement on the survival-of-the-fittest approach that the United States takes.

This content originally appeared on Common Dreams and was authored by Sonali Kolhatkar.

Progressives expressed gratitude and appreciation for former U.S. President Jimmy Carter late Saturday after his family announced he has opted to enter hospice care at age 98.

Carter has faced some health issues in recent years and received treatment for cancer in 2015. The Carter Center, the organization he established with his wife Rosalynn after his presidential term ended in 1981, said he has had "a series of short hospital stays" recently."

"Former U.S. President Jimmy Carter today decided to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention," said the Carter Center. "He has the full support of his family and his medical team. The Carter family asks for privacy during this time and is grateful for the concern shown by his many admirers."

An outpouring of condolences followed on social media, with progressives acknowledging the Democrat's four-decade post-presidency as one that has exemplified public service.

The Carter Center was founded "on a fundamental commitment to human rights and the alleviation of human suffering," and has led efforts to fight disease and strengthen public health systems in the Global South as well as promoting peace in countries including South Sudan, Haiti, and Ethiopia.

Advocates for Palestinian rights noted that Carter has been an outspoken critic of Israel's violent policies in the occupied Palestinian territories, authoring the New York Times bestseller Palestine: Peace Not Apartheid in 2006.

While acknowledging that "no one leading the U.S. empire can have an impeccable moral record," Public Citizen communications director Omar Baddar applauded Carter as striving to be "decent and principled" in his post-presidential years.

Others acknowledged Carter's hands-on volunteer work with Habitat for Humanity, which he and Rosalynn Carter first joined in 1984, helping to renovate an abandoned building in New York City to help families in need of affordable housing. The couple volunteered with the organization every year until the coronavirus pandemic began in 2020.

Former U.S. Rep. Mondaire Jones (D-N.Y.) posted a video of Carter debating former Republican President Ronald Reagan in 1980, in which Carter noted that his opponent "began his political career campaigning around this nation against Medicare."

"Now we have an opportunity to move toward national health insurance," said Carter, "with an emphasis on the prevention of disease; an emphasis on outpatient care, not inpatient care; an emphasis on hospital cost containment to hold down the cost of hospital care for those who are ill."

"During his presidency, he advocated to have Medicare cover all Americans," said former Ohio state Sen. Nina Turner. "After his presidency, he continued humanitarian works that everyone, regardless of political affiliation, should respect."

This content originally appeared on Common Dreams and was authored by Julia Conley.

President Biden's State of the Union speech earlier this week included the president's observation that Republicans want to cut Social Security and Medicare, something that's been demonstrably true since 1935. That triggered a heated exchange between the president and his Republican hecklers, who insisted it wasn't true. "So, folks," said Biden, "as we all apparently agree: Social Security and Medicare is off the books now, right? All right, we've got unanimity!"

Unfortunately, we can't count on that. There's plenty of evidence Republicans want to gut those programs (while acknowledging it would be "political suicide" to openly admit it). And the so-called "third way" conservative Dems spent many years calling for "entitlement" cuts after Bill Clinton's presidency.

The party's expressed change of heart is welcome. Unfortunately, we can't be sure that representatives from both parties won't collaborate on ways to slash these programs without calling them "cuts" – e.g., by raising the retirement age, sing inflation adjustments, or punting the question off to yet another "bipartisan commission."

It would be wrong to underestimate the deep aversion this country's elites have toward the elderly. Pundits, politicians, and "experts" have long insisted there is a "generational war" between struggling young people and supposedly wealthy oldsters. That sleight of hand draws attention away from the real "war" – the inequality-driven class war waged by the rich against everyone else.

The United States doesn't have a "generational wealth" problem. It has a "wealthy people's wealth" problem. The inequalities within generations are far greater than the inequality between generations. Notably, the countries that spend the most on seniors also spend the most on children—perhaps because equitable societies don't take a "divide and conquer" approach toward their members.

The United States doesn't have a "generational wealth" problem. It has a "wealthy people's wealth" problem.

But this misdirection isn't just a stratagem. Elite contempt for the elderly is real and palpable, even when the elites are elderly themselves. Case in point: former GOP senator Alan Simpson, tapped by President Obama to co-lead a "deficit commission," who was effulgent with vitriol toward his fellow oldsters.

The latest example of this elite contempt comes from Ross Douthat, a conservative commentator for the New York Times. Douthat doesn't just dislike the elderly. He thinks they're our greatest global threat.

Seriously.

General Sclerosis

Douthat is the kind of conservative that liberals love. He writes well and seems thoughtful. Douthat, the son of a successful New Haven, Connecticut lawyer, attended both a private high school and Harvard. He suffered the debilitating effects of an underrecognized (and sometimes stigmatized) disease and wrote about it.

It is therefore both ironic and unfortunate that Douthat seems incapable of recognizing the pain and stigmatization of the old. "There are two kinds of people in the world," Douthat writes. "Those who believe the defining challenge of the 21st century will be climate change, and those who know that it will be the birth dearth, the population bust ... the old age of the world."

Darkened. Stagnant. Sclerotic. Swollen. For Douthat, aging is a global horror that will clot the planet's lifeblood in its varicose veins.

Don't look up, Earthlings. Grandma's headed your way.

An entire essay could be written about the ageist language in Douthat's opening paragraphs alone. In the coming "old-age era," he writes, China will be hobbled by "a darkened future where it grows old and stagnant." Developed nations will be threatened by "general sclerosis, a loss of dynamism and innovation, and a zero-sum struggle between a swollen retired population and the overburdened young."

Darkened. Stagnant. Sclerotic. Swollen. For Douthat, aging is a global horror that will clot the planet's lifeblood in its varicose veins.

Cleaning Up After the Privileged

Here's Douthat's first rule: "The rich world will need redistribution back from old to young."

This is the thumbnail version of the generation war meme. But generations don't have wealth. People do—people, for example, who send their children to private high schools and Harvard. People don't live in generations; they live in families. If someone suffers, it is their family and not their generation who suffers with them.

Douthat has shown a capacity for that kind of understanding. He wrote of his Harvard experience:

"For all that I abhorred most of (the left's) ideas …[t]hey at least shared my sense that there was something wrong with Harvard, and with the entire culture of meritocracy and achievement and cheerful capitalism—something that had to do with greed and ambition and corruption, with the lavish spreads that awaited us at McKinsey and Bain recruiting sessions and the hollow-eyed weariness of the immigrant women who cleaned up the mess afterward, long after we had sought out the bars and then our beds."

Some of those "hollow-eyed" workers have surely retired by now—if "retired" is the right word for a person whose body fails after a lifetime of manual labor. The empathetic Douthat would now eviscerate whatever small sources of income those "immigrant women" possess.

Generations don't have wealth. People do—people, for example, who send their children to private high schools and Harvard.

After a dutiful slap at the elite "technocrats" he once condemned, Douthat continues:

"But in an aging world, the technocratic desire to reform old-age entitlements will become ever more essential and correct—so long as the savings can be used to make it easier for young people to start a family, open a business, own a home."

There are no "technocrats." There are only ideologues who have learned to shroud their biases in a cloak of manipulated numbers. Like they say: Garbage in, garbage out.

Young people do need economic help, desperately. Their finances have been decimated by student debt, bank criminality, and skyrocketing inequality. Somebody has to pay for that help, and if it's not going to be the comfortable residents of New Haven ... well, then, those immigrant women will have to clean up after Ross and his friends one last time.

How Wealthy Are the Old?

What Douthat calls "old-age entitlements," Social Security and Medicare, also serve millions of children, spouses, and working-age disabled people. And older people on Social Security have typically spent decades working and paying taxes into the system.

Are older Americans really "wealthy"? In the third quarter of 2022, Americans 70 years of age and older held a total of $34.2 trillion in wealth. The average net worth of households over 65, by one measure, is in the $1 million range. But that's the average. Presuming they teach the difference between the mean and the median at Harvard, our columnist should understand that the median or average net worth for households over 65 is roughly $250,000. That means half these households have less—sometimes much less.

Here, too, class matters. Matt Bruenig of the People's Policy Project notes that the top ten percent of people over 65 held more than 70 percent of that age group's wealth in 2019, roughly mirroring our economy's overall inequality.

Households with $250,000 in assets may seem wealthy to members of younger generations. But 40 percent of all older households have no income except Social Security, one of the most meager pension systems in the developed world. Even after this year's widely-publicized inflation adjustment, Social Security's average monthly benefit will be only $1,827, with women receiving significantly less on average than men. And the National Council on Aging reports that more than half of seniors also have debt.

A 2019 government study found that the median income of older people in the United States was $27,398 ($36,921 for men and $21,815 for women). Jeff Bezos makes that much in the first few seconds of each new year. It also found that 4.9 million people 65 and older lived below the poverty level, while another 2.6 million were "near-poor. That's one older person in three.

And the pandemic has hit older workers especially hard, as economist Elise Gould notes, which means many will enter retirement with even less resources than expected. The Economic Policy Institute documents the racial and educational factors that make the retirement crisis even worse for some.

Resources and Needs

Real estate comprises a large part of older people's assets, and it can be a challenge to use that wealth. Older people must depend on assets (if they have any) for many things, including the cost of health care (hearing, dental, and vision, as well as out-of-pocket medical costs) and the possible need for nursing home care in the near future. And if people sell their homes, they'll still need to pay rent.

What happens if an older person becomes infirm and needs nursing care? Another 2019 study found that 70 percent of people who reach age 65 will need long term support and services at some point, while a 2021 study found that "about one-third of retirees do not have the resources to afford even minimal care and only about one-fifth could cover severe needs."

Less wealthy seniors tend to have poorer health, so the cost burden falls disproportionately on those least able to afford it. And it's getting worse.

Health care costs can eat up $250,000 in the blink of an eye. Nursing home care is so expensive that many people are forced to spend themselves into poverty to qualify for Medicaid. And the nursing home industry (why should it be an "industry"?) is in chaos following the Covid pandemic.

Less wealthy seniors tend to have poorer health, so the cost burden falls disproportionately on those least able to afford it. And it's getting worse. As Kaiser Health News reports, "Cuts in government payments for patient care and less construction of new nursing homes are already taking a toll."

A Vision Problem

While Ross Douthat scolds seniors, the 400 people on Forbes' list of wealthiest Americans hold combined wealth of more than $4 trillion. That comes to $122,580 for every senior household in the country – all 34.1 million of them.

There's one thing America's billionaires and cash-strapped seniors have in common: public policy choices put them both where they are today. But most seniors need the money, even after a lifetime of work, while billionaires don't. And yet, we still see headlines like this one from the New York Times: "Baby Boomers: Rich With Real Estate and Not Letting Go."

Ageism like Douthat's doesn't just lead to bad policy prescriptions. The bigotry also harms the health of older people in invisible yet measurable ways. That can lead to earlier deaths for seniors, a concern that spurred research by the World Health Organization. Nor is ageism restricted to the right. It was a regular feature of programs like Rachel Maddow's, too, back when our elderly president was a Republican.

"We are aging, comfortable and stuck," Douthat wrote of Western societies in 2020. But who, exactly, is "we"? We're all aging, of course, from the moment of our birth until the hour of our death. But the comfort which Douthat takes for granted is far from universal. Millions of people of all ages are decidedly uncomfortable. Many can't afford to be "stuck," even in their senior years, because they must keep working into their seventies and eighties to survive.

Speak for yourself, pal. This country is hobbled by cocoons of privilege, not senescence.

The women who cleaned up after Harvard's students were probably not "hollow-eyed" at all. My guess is that a youthful Douthat drew that phrase from literature rather than observation. In any case, the vision problem isn't theirs. It belongs to an elite-driven political culture that cannot envision a world whose resources are democratically guided and used for the benefit of all.

"We," Douthat frets, are "burrowing into cocoons from which no chrysalis is likely to emerge, growing old unhappily together in the glowing light of tiny screens."

Speak for yourself, pal. This country is hobbled by cocoons of privilege, not senescence. The soft light inside these tiny shells casts the rest of the world into shadow, rendering invisible both the pain of living and the promise of collaborative change. The promise, like the pain, is real. It's the reward for being part of a community, one among many.

They're sad, really, these people in their dark and narcotizing cocoons. Out here in the sunlight there are butterflies as far as the eye can see, visible to young and old alike. All it takes is the spirit and the will to see them.

This content originally appeared on Common Dreams and was authored by Richard Eskow.

But the newspaper's ostensibly neutral, both-sides coverage of the high-stakes healthcare fight was interspersed with ads purchased by the Coalition for Medicare Choices, an innocuously named organization that serves as a front group for the private insurance industry's powerful lobbying group, America's Health Insurance Plans (AHIP).

The Post, owned by billionaire Jeff Bezos, states in the email version of its newsletter that the Friday coverage was "presented by" the Coalition for Medicare Choices, which bills itself as a "national grassroots organization" while acknowledging—in small font at the bottom of its website—that it's "powered by AHIP."

The large banner ad positioned at the top of the Post's newsletter features a senior accompanied by text that reads, "Don't Cut My Care."

The sidebar ad makes clear that the Coalition for Medicare Choices is concerned not about traditional Medicare, but about the finances of Medicare Advantage—a privately run program funded by the federal government.

The supposed "cut" highlighted by the ads refers to the Biden administration's 2024 payment plan for Medicare Advantage.

Insurance industry groups and their Republican allies in Congress claim that the payment proposal outlined by the Centers for Medicare and Medicaid Services (CMS) would result in a $3 billion cut to Medicare Advantage plans—a small fraction of large Medicare Advantage providers' annual revenues.

The Biden administration says the insurance industry and the GOP are "cherry-picking" numbers and insists the CMS plan would entail a limited increase, not a cut, in payments to Medicare Advantage plans, which are notorious for overbilling the federal government and denying patients necessary care. The federal government expects to pay more than $6 trillion to Medicare Advantage issuers over the next eight years.

CMS has also proposed a rule that would allow the federal government to claw back Medicare Advantage payments that were distributed improperly as a result of industry overbilling—a crackdown that the U.S. public overwhelmingly supports.

Republicans, who often conflate traditional Medicare and Medicare Advantage, have falsely described the new CMS rule as a Medicare Advantage cut.

"So-called 'Medicare Advantage' plans are not Medicare," Linda Benesch, communications director for the progressive advocacy group Social Security Works, told Common Dreams on Friday. "They are private plans run by corporations for the purpose of extracting as much money out of Medicare beneficiaries and the government as possible."

"Republicans, desperate to deflect from their own plans to cut Medicare, are claiming that limiting the annual increase in payments to these private plans is 'cutting Medicare,'" Benesch added. "Nothing could be further from the truth. By limiting the payments, the Biden administration is defending Medicare by slightly leveling the playing field between for-profit plans and actual Medicare. This is only a small first step. The Biden administration should do far more to regulate for-profit plans and protect Medicare beneficiaries."

Diane Archer, the president of Just Care USA and a senior adviser on Medicare at Social Security Works, added in a statement to Common Dreams that "to strengthen benefits and rein in costs for everyone with Medicare, President Biden and Kevin McCarthy should agree to end the tens of billions of dollars in overpayments to Medicare Advantage plans."

"The public strongly opposes this massive government waste and Medicare Advantage profiteering, as should policymakers on both sides of the aisle," Archer

"So-called 'Medicare Advantage' plans are not Medicare. They are private plans run by corporations for the purpose of extracting as much money out of Medicare beneficiaries and the government as possible."

It's hardly unusual for corporate media outlets in the U.S. to publish newsletters sponsored by business groups with a vested interest in the topic being covered, whether it's Medicare, drug prices, or Big Tech.

In October, the new media outlet Semaforsparked widespread derision and outrage by launching a climate newsletter sponsored by the oil giant Chevron, one of the world's biggest climate villains.

As The Levernoted in a 2021 look at the corporate-sponsored content of Punchbowl News and other publications, "These kinds of editorial choices are being made so frequently, they aren't even conscious decisions anymore—they are media culture."

"While it's not accurate to say there is an explicit newsroom quid pro quo in such editorial focus," the outlet continued, "it's also ridiculous to presume that all that cash from corporate sponsors has no influence at all."

The Coalition for Medicare Choices has been making use of the corporate media's embrace of sponsored content for years, placing its defenses of the fraud-riddled Medicare Advantage program and fearmongering about looming cuts in prominent outlets such as Politico.

In addition to touting the supposed benefits of Medicare Advantage, the insurance lobbying group that controls the coalition has lobbied aggressively against efforts to include hearing, dental, and vision coverage in traditional Medicare.

As The American Prospect's Robert Kuttner wrote in a column last week, "Medicare Advantage plans are popular and they are rapidly crowding out public Medicare" because they provide coverage that traditional Medicare doesn't, including hearing, dental, and vision.

Roughly half of the Medicare population was enrolled in a Medicare Advantage plan last year, according to the Kaiser Family Foundation.

"Despite the extra coverage ostensibly provided, studies have found that Medicare Advantage plans are more profitable than most other health insurance industry products, because of the opportunities they provide to game the system," Kuttner noted. "And that suggests that there is a much larger problem here that won’t be solved by a cat-and-mouse game of more aggressive audits—creeping privatization."

"Partial privatization insidiously leads to more privatization, leaving government to pay the added expense," he added. "Despite the promises of greater efficiency, it doesn't save costs but adds costs, as more money goes to industry middlemen and government has to spend more on monitoring... Medicare for All doesn't work if it includes privatized Medicare Advantage. Best to keep public programs public."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

Since President Joe Biden accused them of wanting to cut Medicare in his nationally televised State of the Union address earlier this week, congressional Republicans have attempted to posture as the program's true defenders by touting their support for privately run plans that are riddled with fraud and abuse.

"It’s Joe Biden, NOT Republicans, who is proposing Medicare Advantage cuts," tweeted Sen. Steve Daines (R-Mont.), referring to a new payment plan that the Centers for Medicare and Medicaid Services (CMS) unveiled last week.

Under the CMS proposal, Medicare Advantage plans—which are run by private insurers and funded by the federal government—would see a payment increase of just over 1% next year.

Industry groups reacted furiously to the proposal, claiming it would actually amount to a potential $3 billion cut in Medicare Advantage payments.

According toSTAT, "Medicare officials want to update data and coding systems that are used to explain the health conditions of an insurance company’s enrollees. Under that new system, insurers would not get paid as much for members with certain diagnoses."

Politicoreported late Wednesday that Biden administration officials expressed confidence in their payment projections and dismissed claims of a looming cut as "cherry-picked numbers by an industry-backed group trying to protect profits."

Ahead of Biden's speech Tuesday, the Better Medicare Alliance—which counts major Medicare Advantage providers such as Aetna and Humana as "allies"—wrote in a memo to congressional lawmakers that CMS "just proposed BILLIONS in cuts to
Medicare Advantage."

"Medicare Advantage IS Medicare," the industry group wrote, a premise that critics adamantly reject. "We strongly urge President Biden and congressional leaders—Republicans and Democrats alike—to keep their promises to our seniors and protect Medicare beneficiaries."

The Coalition for Medicare Choices, a project of the powerful lobbying group America's Health Insurance Plans, also criticized the CMS proposal, warning the changes "could result in cuts to the program."

Republicans wasted no time echoing the industry's narrative, claiming that the Biden administration's new payment proposal for Medicare Advantage plans proves that the president—not the GOP—is pursuing Medicare cuts.

"The fact is, just last week the Biden administration cut Medicare programs by administrative fiat," Rep. Kevin Hern (R-Okla.), chair of the Republican Study Committee, told the right-wing Daily Caller News Foundation on Wednesday. "These cuts will impact millions of seniors.”

Hern also claimed in a tweet Wednesday that the Biden administration is "slashing nearly $5 BILLION from Medicare Advantage," an apparent reference to a new CMS rule that aims to recoup up to $4.7 billion over the next decade by ramping up audits of Medicare Advantage plans to crack down on overbilling—a common practice in the industry.

As Kaiser Health Newsreported in December, "The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans," which are notorious for presenting patients as sicker than they actually are to get more money from the government.

"CMS has estimated the total overpayments to health plans for the 2011-2013 audits at $650 million," the outlet noted.

But mounting evidence of fraud by for-profit Medicare Advantage providers hasn't dissuaded the GOP from singing their praises and condemning oversight of them as an attack on Medicare itself.

"For Joe Biden to continue to lie and say that Republicans will cut the benefits you earned is just a gross, political lie," said Rep. Brian Mast (R-Fla.). "He's the one who just cut billions from Medicare Advantage."

"Newsflash: President Biden is cutting Medicare, not Republicans," added Rep. Vern Buchanan (R-Fla.). "Fact: He's slashing more than $3 billion from Medicare Advantage (used by over 50% of seniors) next year."

Medicare Advantage boasts significant bipartisan support in Congress and has grown rapidly in recent years, now covering roughly half of all Medicare recipients.

Beneficiaries often turn to Medicare Advantage because traditional Medicare doesn't cover dental, hearing, or vision, despite efforts by Sen. Bernie Sanders (I-Vt.) and other progressive lawmakers to expand the program.

But Medicare Advantage plans have also been found to falsely advertise their benefits and frequently deny patients medically necessary care.

"Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program," The New York Timesreported last year, citing findings from the inspector general's office of the Health and Human Services Department.

Earlier this month, as Common Dreamsreported, Reps. Mark Pocan (D-Wis.), Ro Khanna (D-Calif.), and Jan Schakowsky (D-Ill.) reintroduced legislation that would change the name of Medicare Advantage to make clear that the plans are run by for-profit insurers.

"Medicare Advantage is private insurance," Khanna wrote in a social media post on Sunday. "It profits by tricking patients into enrolling, and then denying them coverage."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

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• The death toll surpasses 20,000 in Turkey-Syria earthquake
• President Biden doubles down on his warnings about Republican threats to Medicare and Social Security
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Congressional Republicans made a show of jeering President Joe Biden Tuesday night when he said during his State of the Union address that some in their ranks have expressed support for cutting Social Security and Medicare—and even sunseting the programs completely.

"Liar!" Rep. Marjorie Taylor Greene (R-Ga.) shouted from the audience in response to the president's comment.

After taking in the loud expressions of outrage from Greene and other Republicans in the House chamber, Biden said that "we all apparently agree, Social Security and Medicare is off the books now, right?"

"So tonight, let's all agree—and we apparently are—let's stand up for seniors," the president declared, sparking applause from Republicans and Democrats. "Stand up and show them we will not cut Social Security. We will not cut Medicare."

The exchange—and the bipartisan standing ovation that capped it off—became one of the most-discussed moments of the president's 73-minute address, but Social Security and Medicare defenders warned that it should not be taken as a sign that the programs are safe from Republican attacks.

"Even many Republicans stand for protecting Social Security and Medicare—but they've shown they can't be trusted to keep that promise," the progressive advocacy group Social Security Works tweeted late Tuesday. "Republicans have told us over and over again that they want to cut Social Security and Medicare. One moment of applause doesn't change that."

MoveOn, another progressive group, called the GOP show of support for Social Security mere "theatrics," pointing to Sen. Rick Scott's (R-Fla.) proposal to sunset all federal laws—including those authorizing Social Security and Medicare—every five years.

Beyond Scott's plan, the Republican Study Committee—the largest caucus of House Republicans—released a budget proposal last year that advocated gradually raising the retirement age, a change that would cut Social Security benefits across the board.

The Washington Postreported last month that some House Republicans have "resurfaced" the above plan and other possible changes—including bipartisan trust fund "commissions"—in recent days as they push for far-reaching federal spending cuts in exchange for any agreement to raise the U.S. debt ceiling.

As part of a speakership deal with far-right House Republicans, McCarthy agreed to advocate for a cap on federal spending at fiscal year 2022 levels, which would entail deep cuts to education spending, public health programs, and other critical areas.

In a statement ahead of Biden's speech, Alliance for Retired Americans executive director Richard Fiesta said that "we frankly don't believe" House Speaker Kevin McCarthy (R-Calif.) when he insists the GOP has no intention of pursuing cuts to Social Security and Medicare as part of its austerity spree.

"More than 160 House Republicans endorsed a budget plan for fiscal year 2023 that increased the Social Security and Medicare eligibility age, privatized Social Security, and reduced Social Security benefits by changing the formula used to calculate them," Fiesta noted.

“Equally troubling is the recent letter two dozen Senate Republicans sent to President Biden on January 27," he added. "In it they vowed to vote against any bill to increase the debt ceiling that does not include 'real structural spending reform that reduces deficit spending and brings fiscal sanity back to Washington.' Seniors know that is code for Social Security and Medicare cuts."

In an op-ed for Common Dreams on Wednesday, Social Security Works president Nancy Altman wrote that "Democrats should make it clear to the American people which party supports Social Security by holding a vote on expanding, never cutting, Social Security's modest benefits."

"Democratic legislators have already authored several plans to do just that. President Biden ran on a similar plan. Now, he should release an official White House plan that expands Social Security with no cuts and requires the wealthiest to pay their fair share," Altman continued. "Then, Biden should challenge Republicans to release their own plan for Social Security and hold a vote. Let the American people see, in the light of day, the plan that each party has for the future of our earned benefits."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

"BP correspondingly now aims for a fall of 20% to 30% in emissions from the carbon in its oil and gas production in 2030 compared to a 2019 baseline, lower than the previous aim of 35-40%," the company said in a press release.

The oil giant also said it plans to pour just as much money—up to $8 billion—into its fossil fuel businesses as its so-called "transition growth engines," which include renewables, by 2030.

BP's announcement came a day after the head of the United Nations said fossil fuel companies that can't establish credible plans to sharply reduce carbon emissions "should not be in business."

"We need a renewables revolution, not a self-destructive fossil fuel resurgence," said U.N. Secretary-General António Guterres.

BP's decision to scale down its climate goals drew the ire of campaigners and scientists, who stressed that growing fossil fuel production is imperiling global hopes of staving off even more catastrophic warming.

"Just when we need to be rolling back oil and gas production, BP is rolling back its climate commitments," said Doug Parr, Greenpeace U.K.'s chief scientist. "Don't let the spin disguise it. This looks like BP edging back to being a traditional oil company."

Climate scientist Bill McGuire argued BP's announcement further demonstrates that fossil fuel companies can't be trusted to voluntarily cut production and potentially sacrifice short-term profits for the sake of the climate, no matter how splashy their pledges and rebrands.

"BP cuts its emissions pledge and plans a greater production of oil and gas over the next seven years compared with previous targets," McGuire tweeted. "This is criminal. [Fossil fuel] corps must be forced to stop drilling. It is our only chance now."

"These companies are not serious about climate action or transitioning away from oil and gas."

BP is the latest oil and gas behemoth to report record-shattering profits for 2022, a banner year for fossil fuel companies thanks in large part to the ongoing energy market impacts of Russia's war on Ukraine.

In its fourth quarter earnings announcement, BP said it would boost its dividend and buy back an additional $2.75 billion worth of its own shares. The company repurchased $11.25 billion of its stock last year.

"Importantly, we are delivering for our shareholders—with buybacks and a growing dividend," BP CEO Bernard Looney said in a statement. "This is exactly what we said we would do and will continue to do—performing while transforming."

Freya Aitchison, oil and gas campaigner at Friends of the Earth Scotland, called BP's profits "sickening" and said fossil fuel giants "are being allowed to bank billions in profits whilst millions of ordinary people struggle to pay their bills."

"Bosses and shareholders at these big polluters are being allowed to get even richer by profiteering from one of our most basic needs. The harm caused by the fossil fuel energy system couldn't be clearer," Aitchison added. "These companies are not serious about climate action or transitioning away from oil and gas. The evidence shows they are spending just a tiny fraction of their profits into truly green projects."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

The Biden White House made clear on Monday that it opposes the creation of commissions to devise changes—and possible cuts—to Social Security and other U.S. trust funds, rejecting an idea embraced by Republicans and Democratic Sen. Joe Manchin amid a dangerous standoff over the nation's debt ceiling.

In a statement to Bloomberg Government, White House spokesperson Andrew Bates called the proposed commissions a "death panel for Medicare and Social Security," repurposing a term that GOP lawmakers used frequently in their attacks on the Affordable Care Act.

Bates said the GOP's renewed push for Social Security and Medicare commissions represents the "latest in a long line of ultimatums about how they'll act to kill jobs, businesses, and retirement accounts if they can't cut Medicare and Social Security benefits."

The commissions in question are central to legislation known as the TRUST Act, which Sens. Mitt Romney (R-Utah), Kyrsten Sinema (I-Ariz.), Manchin (D-W.Va.), and other lawmakers reintroduced in 2021 and have frequently touted as a potential path to a bipartisan compromise on Social Security and Medicare.

But advocates warn that the commissions—modeled after the infamous Obama-era Bowles-Simpson initiative—are an attempt to fast-track cuts to Social Security and Medicare. Under the TRUST Act, bipartisan panels of lawmakers would be established with a mandate to craft "legislation that restores solvency and otherwise improves" the programs—a vague and highly subjective standard.

The legislation would then receive expedited consideration in Congress, with no amendments permitted.

"We need to expand Social Security's modest benefits, never cut them."

As recently as last month, Manchin floated the TRUST Act as a possible way to reach a deal with the House GOP to avert a debt ceiling disaster. Republicans have demanded steep cuts and changes to Social Security, Medicare, and discretionary spending—which includes education, healthcare, and climate outlays—as part of any deal to raise the federal government's borrowing limit.

Bloomberg Lawreported Monday that House Republican committee and caucus chairs have gotten behind the idea of forming Social Security and Medicare commissions in recent days.

"I don't believe we’re going to do what is necessary and right, which is save and strengthen Social Security and Medicare, without having a bipartisan mechanism," Rep. Jodey Arrington (R-Texas), chair of the House Budget Committee and a co-sponsor of the TRUST Act, told the outlet.

Social Security Works, a progressive advocacy group that has been a vocal opponent of the TRUST Act, applauded the White House's stated opposition to the TRUST Act.

"They are absolutely right—the TRUST Act is a ploy to gut Social Security and Medicare behind closed doors," the group tweeted late Monday. "We need to expand Social Security's modest benefits, never cut them."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

Sometimes a little socialism is a very good thing. But don’t tell Mike Pence or the billionaires who bankroll him and his GOP colleagues.

Or, for that matter, the 109 Democrats who were suckered into joining every single Republican in the House of Representatives to vote for a resolution saying that:

“Congress denounces socialism in all its forms, and opposes the implementation of socialist policies in the United States of America.”

The resolution leads up to that conclusion by quoting President Thomas Jefferson wildly out of context. Here’s what the resolution says:

“Whereas the author of the Declaration of Independence, President Thomas Jefferson, wrote, ‘To take from one, because it is thought that his own industry and that of his fathers has acquired too much, in order to spare to others, who, or whose fathers have not exercised equal industry and skill, is to violate arbitrarily the first principle of association, the guarantee to every one of a free exercise of his industry, and the fruits acquired by it.’”

The Republican authors of the resolution, however, neglected to include the context or the next sentence from Jefferson’s May 18, 1816 letter to Joseph Milligan about their combined efforts to translate A Treatise on Political Economy by French economist Destutt de Tracy.

Milligan and Jefferson were discussing Tracy’s call for a national sales tax (like what the GOP proposed last week), which both men opposed. Which is why the next sentence got right to the heart of the matter:

“If the overgrown wealth of an individual be deemed dangerous to the State, the best corrective is the law of equal inheritance to all in equal degree; and the better, as this enforces a law of nature, while extra [sales] taxation violates it.”

Jefferson, in other words, was calling for an inheritance tax — rather than a sales tax — to fix “overgrown wealth” that was “dangerous to the state,” something the Republicans who drafted this resolution would certainly call socialism.

This entire bit of legislative theater, in fact, is preparation for the 2024 election and the GOP’s new plan to end “socialism” in America.

By socialism, of course, they don’t mean subsidies to the fossil fuel industry that made their billionaire donors rich.

They don’t mean the hundreds of billions we shovel at defense contractors every year for unnecessary boondoggles.

Nor do they mean farm supports dear to their rural voters.

They mean Social Security, Medicare, and Medicaid.

Mike Pence drew the battle lines last week around the same time House Republicans were forcing the vote on their anti-socialism screed:

“There are modest reforms in entitlements that can be done without disadvantaging anybody at the point of the need. I think the day could come when we could replace the New Deal with a Better Deal. Literally give younger Americans the ability to take a portion of their Social Security withholdings and put that into a private savings account.”

Republicans have been calling Social Security “socialism” ever since it was put into law on August 14, 1935. In part this is because arguably it is: it’s a form of social insurance.

But the larger reason is that the GOP has been funded by morbidly rich banksters ever since the early 1920s, and those banksters would give nearly anything to have Social Security’s trillions in their banks instead of invested in treasuries.

Social Security isn’t a savings account: it’s insurance against poverty in old age.

And like all insurance policies, some people make out better than others. People who live a long life may take more out of it than they put in; people who die young leave behind much of their working life’s contributions.

That’s how insurance is supposed to work. It’s how your life and health insurance policies work.

But the GOP wants Americans to think of Social Security as a simple savings account, so they can move Social Security’s trillions from government control into the hands of Wall Street.

And that’s just the beginning. Republicans in Congress are still 100% down with the platform on which David Koch ran for vice president back in 1980:

— “We urge the repeal of federal campaign finance laws, and the immediate abolition of the despotic Federal Election Commission.”
— “We favor the abolition of Medicare and Medicaid programs.”
— “We oppose any compulsory insurance or tax-supported plan to provide health services, including those which finance abortion services.”
— “We also favor the deregulation of the medical insurance industry.”
— “We favor the repeal of the fraudulent, virtually bankrupt, and increasingly oppressive Social Security system. Pending that repeal, participation in Social Security should be made voluntary.”
— “We propose the abolition of the governmental Postal Service.”
— “We oppose all personal and corporate income taxation, including capital gains taxes.”
— “We support the eventual repeal of all taxation.”
— “As an interim measure, all criminal and civil sanctions against tax evasion should be terminated immediately.”
— “We support repeal of all law which impede the ability of any person to find employment, such as minimum wage laws.”
— “We advocate the complete separation of education and State. Government schools lead to the indoctrination of children and interfere with the free choice of individuals. Government ownership, operation, regulation, and subsidy of schools and colleges should be ended.”
— “We condemn compulsory education laws … and we call for the immediate repeal of such laws.”
— “We support the repeal of all taxes on the income or property of private schools, whether profit or non-profit.”
— “We support the abolition of the Environmental Protection Agency.”
— “We support abolition of the Department of Energy.”
— “We call for the dissolution of all government agencies concerned with transportation, including the Department of Transportation.”
— “We demand the return of America’s railroad system to private ownership. We call for the privatization of the public roads and national highway system.”
— “We specifically oppose laws requiring an individual to buy or use so-called “self-protection” equipment such as safety belts, air bags, or crash helmets.”
— “We advocate the abolition of the Federal Aviation Administration.”
— “We advocate the abolition of the Food and Drug Administration.”
— “We support an end to all subsidies for child-bearing built into our present laws, including all welfare plans and the provision of tax-supported services for children.”
— “We oppose all government welfare, relief projects, and ‘aid to the poor’ programs. All these government programs are privacy-invading, paternalistic, demeaning, and inefficient. The proper source of help for such persons is the voluntary efforts of private groups and individuals.”
— “We call for the privatization of the inland waterways, and of the distribution system that brings water to industry, agriculture and households.”
— “We call for the repeal of the Occupational Safety and Health Act.”
— “We call for the abolition of the Consumer Product Safety Commission.”
— “We support the repeal of all state usury laws.”

The real target Republicans are gunning for, in other words, is — as Mike Pence admitted — the New Deal itself.

When FDR came into office in 1933 he began a fundamental transformation of American government from one rooted in Laissez-faire to one rooted in democratic socialism.

It was so successful that Roosevelt was elected President of the United States four times in a row, serving from 1933 to his death in office in 1945.

While the American people loved Roosevelt’s New Deal democratic socialism—and still do—the morbidly rich have always opposed any programs that lift up average working people.

— They don’t want workers empowered to challenge their bosses through unions.

— They don’t want their tax dollars to go to help “moochers” and “takers” who weren’t born wealthy.

— They don’t want wealth broadly distributed across America because it might mean they can’t hoard as much as they want.

Almost as fascinating as Pence and the GOP’s efforts to privatize Social Security and “end socialism” are the media’s response to them.

Two weeks ago the GOP put forward a 30 percent national sales tax (ironically, just like Tracy was proposing in 1816). Last week the former Vice President and unannounced candidate for the White House, Mike Pence, openly called for privatizing Social Security.

But there was no mention of either on any of the Sunday “politics” shows that I saw. Instead, the day was filled with Republicans bashing President Biden for his great economy and failing to shoot down a Chinese spy balloon over populated areas.

Will Republican extremism and hate for the New Deal—programs that have become absolutely essential to our even having a robust middle class—ever become grist for the media mill? Will they actually expose to the American people and discuss these GOP plans?

I’m not holding my breath.

This content originally appeared on Common Dreams and was authored by Thom Hartmann.

The White House on Saturday condemned a newly introduced Republican bill that would repeal the Inflation Reduction Act, a law that includes a number of changes aimed at lowering costs for Medicare recipients.

Unveiled Thursday by freshman Rep. Andy Ogles (R-Tenn.), the bill has 20 original co-sponsors and is endorsed by several right-wing groups, including the Koch-funded organization Americans for Prosperity.

The Biden White House argued that rolling back the Inflation Reduction Act, which also contains major climate investments, would represent "one of the biggest Medicare benefit cuts in American history" as well as a "handout to Big Pharma." According to Politico, which first reported the White House's response to the GOP bill, the administration is planning to release "state-by-state data indicating how this would affect constituents in different areas."

"House Republicans are trying to slash lifelines for middle-class families on behalf of rich special interests," White House spokesperson Andrew Bates said in a statement. "Who on earth thinks that welfare for Big Pharma is worth selling out over a million seniors in their home state?”

The Inflation Reduction Act authorized a $35-per-month cap on insulin copayments for Medicare recipients, as well as an annual $2,000 total limit on out-of-pocket drug costs.

The bill will also, among other long-overdue changes, allow Medicare to begin negotiating the prices of a subset of the most expensive prescription drugs directly with pharmaceutical companies, which fiercely opposed the law and are working with Republicans to sabotage it. The newly negotiated prices are set to take effect in 2026.

Ogles, whose two-page bill would eliminate the above reforms, repeatedly attacked Medicare, Medicaid, and other federal programs and protections during his 2022 campaign for the U.S. House.

\u201cNEW @Campbell4TN ad in TN-5: \u201cExtreme Andy Ogles in his own words \u2014 a SUPERCUT\u201d\n\nWatch @AndyOgles back a no exceptions abortion ban, cutting Medicare & Medicaid, eliminating Dept of Ed, impeaching Biden, deny the election was legit, etc\u2026 do better, TN-5.\nhttps://t.co/YhCRGXIPsU\u201d

— The Tennessee Holler (@The Tennessee Holler) 1667748662

The White House's critique of Ogles' bill comes as Biden is facing pressure from advocates and physicians to cancel a Medicare privatization scheme that his administration inherited from its right-wing predecessor and rebranded.

It also comes as the White House is locked in a standoff with House Republicans over the debt ceiling. Republican lawmakers have pushed for deeply unpopular cuts to Medicare, Social Security, and other critical federal programs as a necessary condition for any deal to raise the country's borrowing limit and avert a catastrophic default.

"In less than a month, MAGA extremists have threatened to drive the economy into a recession by defaulting on our debt, promised to bring up a bill to impose a 30% national sales tax, and now have introduced legislation to repeal the Inflation Reduction Act," Patrick Gaspard, president and CEO of the Democratic Party-aligned Center for American Progress said in a statement. "This will cut taxes for corporations who earn billions in profit while empowering Big Pharma and Big Oil to continue ripping off the American people."

"It is vital that all Americans understand what is at risk if MAGA extremists succeed in passing their latest dangerous idea: millions of lost jobs, millions more without health insurance, and higher costs for lifesaving insulin, utilities, and more," Gaspard added.

This content originally appeared on Common Dreams and was authored by Jake Johnson.

More than 100 U.S. House Democrats—including some of the wealthiest members of Congress—joined with Republican lawmakers on Thursday in passing a resolution "denouncing the horrors of socialism," a largely symbolic gesture that opponents warned is nonetheless a step toward slashing Social Security, Medicare, and other safety net programs.

House Concurrent Resolution 9, which "denounces socialism in all its forms and opposes the implementation of socialist policies in the United States," was introduced by Rep. María Elvira Salazar (R-Fla.), the staunchly anti-communist daughter of Cuban exiles who once interviewed then-Cuban President Fidel Castro for Telemundo.

"I think it's the best resolution that has ever been presented before the United States Congress," Salazar told Insider at the U.S. Capitol before the vote. "Our youth are being penetrated by this ideology through media and academia."

The measure—which followed the vote to oust Rep. Ilhan Omar (D-Minn.) from the House Foreign Affairs Committee—passed 328-86, with 14 lawmakers voting "present" and six members not voting.

One hundred and nine Democrats—many of them members of the corporate-friendly New Democrat Coalition—joined with every Republican lawmaker in voting to approve the resolution. Prominent Democrats who voted "yes" include: House Minority Leader Hakeem Jeffries (N.Y.), former House Speaker Nancy Pelosi (Calif.), and House Assistant Democratic Leader Jim Clyburn (S.C.), all of whom played prominent roles in defeating Sen. Bernie Sanders' (I-Vt.) presidential campaigns, which were based on popular democratic socialist policies and principles.

\u201cOne of these "New Democrats" is Congresswoman @SuzanDelBene - the new chair of the @DCCC, the House Democrats' PAC.\n\nThis is their plan to win the majority: not to pass popular bills like #MedicareForAll, but to ATTACK progressives and stoke another Red Scare.\n\nEmbarrassing.\u201d

— Our Wisconsin Revolution (@Our Wisconsin Revolution) 1675369788

Many of the Democrats voting for the resolution also rank among the wealthiest members of Congress, including Pelosi, whose 2018 net worth was over $114 million, according to OpenSecrets.org; Suzan DelBene (Wash., $79 million net worth); Dean Phillips (Minn., $64 million); Scott Peters (Calif., $60 million); and Ro Khanna (Calif., $45 million). Khanna along with Reps. Adam Schiff and Eric Swalwell of California and Rubén Gallego of Arizona, are either current or prospective candidates for U.S. Senate.

Denouncing the measure on the House floor, Rep. Jim McGovern (D-Mass.)—who voted "no"— said that "the socialism resolution is useless. It does nothing. It does not matter. Are we talking about public schools? Are we talking about roads? Are we talking about Social Security? I mean, give me a break."

\u201cThe GOP has called Social Security, Medicare, the Affordable Care Act, & even free public schools "socialism" to scare ppl. Today, House R's wasted our time by debating a sham resolution in an attempt to justify cuts to programs that millions of Americans have paid into & earned.\u201d

— Congressman Maxwell Alejandro Frost (@Congressman Maxwell Alejandro Frost) 1675355277

Rep. Mark Pocan (D-Wis.), Chair Emeritus of the Congressional Progressive Caucus, invoked his experience as a capitalist to lambaste the anti-socialism resolution.

"For 35 years now I've owned a small business, giving me significantly more experience as a capitalist than the vast majority of members on the other side of the aisle. So as a capitalist, let me tell you: This resolution is plain ridiculous. It jointly condemns Pol Pot and Norway," Pocan said during floor debate, referring to the former Cambodian dictator, who was supported by the Republican Reagan administration after leading a genocidal regime that killed at least 1.5 million people.

Pocan continued:

Here's what this is really about: More and more members on the other side of the aisle are calling for cuts to Social Security and Medicare, and many have referred to these programs as "socialism" throughout their existence. The other night in the Rules Committee they showed their cards. Republicans refused an amendment to declare that Social Security and Medicare is not socialism. This resolution is little about intelligent discourse and everything to do about laying the groundwork to cut Social Security and Medicare.

Rep. Maxine Waters (D-Calif.), another "no" vote, called out the hypocrisy of Republicans who support corporate welfare or are personal beneficiaries of social programs. Waters took aim at House Small Business Committee Chair Roger Williams (R-Texas), who summarized his support for the resolution as: "Socialism bad. Capitalism good. In God we trust."

"Mr. Williams is my friend," said Waters, "but I do wonder whether Mr. Williams views the $1.43 million he received in debt forgiveness [to be] consistent with his views on socialism? I don't get it."

\u201cGOP logic:\n\nPublic Housing= Socialism\nSocial Security and Medicare=Socialism\nInfrastructure=Socialism\n\nRepublicans always have and always will brand programs to help working families as socialism. That's why I'm voting no on this distraction of a resolution.\u201d

— Rep. Nydia Velazquez (@Rep. Nydia Velazquez) 1675354158

After Rep. Brad Sherman (D-Calif.), who voted against the measure, noted during floor debate that there have been numerous democratic socialist leaders around the world who've been "allies of America and NATO," Rep. Patrick McHenry (R-N.C.) quipped, "If this resolution would just simply draw out my Democrat colleagues to just say, yes, they are in favor of socialism, maybe this is a worthwhile endeavor."

Rep. Summer Lee (D-Pa.), a former organizer from Pittsburgh's Democratic Socialists of America chapter who voted against the resolution, shrugged off Republicans' red-baiting and the New Democrat Coalition's support for the GOP resolution.

"They're going to call you socialists anyways," Lee said.

This content originally appeared on Common Dreams and was authored by Brett Wilkins.

In an effort to crack down on the misleading practices of Medicare Advantage providers, Democratic Reps. Mark Pocan, Ro Khanna, and Jan Schakowsky reintroduced legislation Tuesday that would ban private insurers from using the "Medicare" label in the names of their health plans.

The legislation, titled the Save Medicare Act, would formally change the name of the Medicare Advantage program to the Alternative Private Health Plan, an attempt to make clear to seniors that the plans are run by private entities such as Anthem, Humana, Cigna, and UnitedHealthcare.

"Only Medicare is Medicare," Pocan (D-Wis.) said in a statement. "It is one of the most popular and important services the government provides. These non-Medicare plans run by private insurers undermine traditional Medicare. They often leave patients without the benefits they need while overcharging the federal government for corporate profit."

Khanna (D-Calif.) declared that "it's time to call out 'Medicare Advantage' for what it is: private insurance that profits by denying coverage and the name is being used to trick seniors into enrolling."

"That's not right," he added. "This bill will end the scam by preventing private insurers from profiting off the Medicare brand. Our focus should be on strengthening and expanding real Medicare."

The bill, which faces long odds in the Republican-controlled House, was introduced as GOP lawmakers push for cuts to traditional Medicare as part of their broader austerity campaign.

It also comes as the Biden administration is moving ahead with a Medicare privatization scheme known as ACO REACH, a pilot program that critics warn could fully engulf traditional Medicare in a matter of years.

The Democratic trio's legislation does not specifically address ACO REACH, opting to zero in on Medicare Advantage plans that are notorious for denying necessary care to vulnerable seniors and overbilling the federal government.

The measure would impose a $100,000 penalty each time a private insurer uses the Medicare name in the title of one of their plans.

"So-called Medicare Advantage is neither Medicare nor an advantage. It is simply another scheme by the insurance companies to line their pockets."

Earlier this week, the Biden administration proposed a new rule that would strengthen audits of Medicare Advantage plans, which are paid an annual per-person rate by the federal government. Recent investigations have exposed how Medicare Advantage plans frequently overcharge the government by making patients appear sicker than they are, resulting in a higher payment.

The federal government currently expects to pay Medicare Advantage providers more than $6 trillion over the next eight years.

"Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people," Kaiser Health Newsreported in December. "But federal officials rarely demand documentation to verify that patients have these conditions, or that they are as serious as claimed. Only about 5% of Medicare Advantage plans are audited yearly."

Medicare Advantage has grown rapidly over the past decade, with more than 28 million people in the U.S. enrolled in such plans as of 2022. MA plans often provide coverage for hearing, vision, and dental—benefits not offered by traditional Medicare, despite the efforts of progressive lawmakers to expand the program.

Some Democratic lawmakers have warned that part of the massive growth rate of Medicare Advantage plans could be due to their deceptive advertising practices.

In November, Senate Finance Committee Chair Ron Wyden (D-Ore.) released an investigative report laying out evidence of a range of "predatory actions" by private insurance companies that offer Medicare Advantage plans.

"Agents were found to sign up beneficiaries for plans under false pretenses, such as telling a beneficiary that coverage networks include preferred providers even when they do not," the investigation found. "Of particular concern to the committee were reports across states of agents changing vulnerable seniors' and people with disabilities' health plans without their consent."

Wendell Potter, president of the Center for Health and Democracy, said Tuesday that "so-called Medicare Advantage is neither Medicare nor an advantage."

"It is simply another scheme by the insurance companies to line their pockets at the expense of consumers," said Potter, a former health insurance executive with first-hand experience of the industry's misleading practices. "I applaud Congressman Pocan and Congressman Khanna for introducing this vital legislation. The healthcare market is confusing for consumers and misleading branding like so-called Medicare Advantage just makes it worse."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

On January 17, the Center for Medicare and Medicaid Innovation (CMMI) announced 48 new model participants in a controversial pilot program called Accountable Care Organization: Realizing Equity, Access, and Community Health, better known as ACO REACH. CMMI, created by the Affordable Care Act, is supposed to test alternative payment models for Traditional Medicare to lower costs and improve, or at least not worsen, the care of 30 million seniors and people with disabilities.

The program, launched in the waning days of the Trump Administration as Direct Contracting, was greenlighted by the Biden Administration in 2021 and renamed ACO REACH in 2022. The model, which started with 53 contracting entities under Trump has grown to 132 participants with 131,772 health care practitioners and organizations providing care to over 2 million beneficiaries on Traditional Medicare under President Biden. Startling research found many of the ACO REACH participants have a history of Medicare fraud. Nevertheless, Medicare continues to sign contracts with them.

ACO REACH is a program designed to privatize what is left of public Medicare. Half of Medicare has been privatized through Medicare Advantage plans, which receive up-front “capitated” payments for Medicare beneficiaries from the Center for Medicare and Medicaid Services (CMS) and have the power to decide whether and how much of those Medicare dollars to spend on the beneficiaries who signed up for their plan. The Affordable Care Act allows Medicare Advantage plans to keep up to 15% of these Medicare dollars for administrative fees and profit (although they have clever ways to get around this restriction). To make these profits, Medicare Advantage plans create narrow networks for their beneficiaries, deny and delay care, and get overpaid by CMS, cashing in on billions of Medicare dollars.

What earthly reason would there be to exclude companies from ACO REACH but allow them to continue their plunder in Medicaid, Medicare Advantage, and subsidized on the ACA Exchanges?

ACO REACH uses similar tactics to those found in Medicare Advantage to profit from Medicare by overcharging Medicare, financially incentivizing providers to control healthcare costs for beneficiaries, and increasing the number of beneficiaries in their plans. But while some seniors “choose” to participate in Medicare Advantage, seniors and people with disabilities are auto-enrolled into an ACO REACH through their primary care physicians (PCPs). Thus, it is physicians and physician practices which are being lured into or forced to join the ACO REACH (Many physician practices are being swooped up by private equity or created whole-cloth). Physician practices, or their controllers, are enticed by the “shared savings” they will collect if they save money on their patients, shredding the trust between doctors and patients.

Once the PCP joins, their patients are automatically enrolled into the ACO REACH, without their informed knowledge or consent. While Medicare Advantage plans are allowed to keep 15% of the capitated fee for profits and administration, ACO REACH organizations, which include private equity and venture capital firms, as well as Medicare Advantage plans and insurance companies, can keep up to 40% of the capitated, up-front fees from Medicare as profit, guaranteeing themselves excessive payouts as they play out the eventual demise of the Medicare Trust Fund.

We were assured by CMMI that the new vetting process for all applicants was supposed to “ensure participants’ interests align with CMS’s vision.” They promised to protect beneficiaries and the model with “more participant vetting, monitoring, and greater transparency.” They pledged to employ “increased up-front screening… monitoring… and stronger protections against inappropriate coding and risk score growth.”

Yet, in a letter sent by Senator Elizabeth Warren (D-Mass.) and Congresswoman Pramila Jayapal (D-Wash.) to CMS Administrator Chiquita Brooks-LaSure in December 2022, they called on CMS to investigate nine organizations that had signed contracts to become an ACO REACH: Centene, Sutter Health, Clover Health, Adventist Health System/AdventHealth, Humana, Vively Health, Cigna/CareAllies, Bright Health/NeueHealth, and Nivano Physicians. The letter pointed out that all these organizations have been accused, investigated, settled claims, and/or sanctioned by governmental agencies for Medicare fraud and abuse.

Recently, CMMI Director Liz Fowler—a poster child for the revolving door in D.C.—was a guest speaker at the ACO REACH educational forum held by the California Public Employees Retirement System, the largest public pension fund in the country. When asked about private equity in ACO REACH, Fowler responded, “My personal opinion, you can’t say that private equity is inherently bad or good, but the way we viewed it, we want to make sure that the organizations in our program are in it for the right reasons.” And the right reasons for Fowler might very well be profit, given that six of the nine organizations identified by Warren and Jayapal are publicly traded in the stock market.

The entire apple cart needs to be overturned and replaced with a national, non-profit, single-payer healthcare system that covers everyone from birth to death...

Given Director Fowler’s personal opinion of private equity firms, it comes as no surprise that most of the Medicare fraudsters—including: Cigna/CareAllies, accused by the Justice Department of using a primary care program to defraud Medicare; Bright Health/NeueHealth, fined $1 million by the Colorado Division of Insurance for complaints from consumers and providers; Clover Health, which failed to let investors know it was under investigation by the DOJ as it was going public and even fined by CMS in 2016 for engaging in marketing activities that misled their beneficiaries; AdventHealth (formerly Adventist Health System), that paid $115 million to settle allegations of improper financial arrangements with referring physicians and for miscoding claims; Humana that overcharged Medicare by $200 million according to a federal audit; and Nivano Physicians, previously under a corrective action plan with the Department of Managed Health Care for lacking financial solvency—all made it through and became approved as ACO REACH.

Only three of the original nine identified in the Warren-Jayapal letter failed to get a contract with CMS: Centene, Sutter Health, and Vively Health. Fowler refuses to say whether these corporations pulled out on their own, or were rejected.

The Centene Corporation, with Medicaid contracts in 29 states, settled potential fraud claims in a dozen states to resolve Medicaid fraud claims for an estimated $1.25 billion. Sutter Health, a major California-based healthcare system, agreed to pay $90 million to settle allegations of knowingly submitting inaccurate information about the health of beneficiaries in the Sutter Medicare Advantage plans. DaVita HealthCare Partners Inc., one of the largest for-profit kidney dialysis providers and parent company of Vively Health, paid $450 million in 2015 to settle a whistleblower lawsuit, which accused DaVita of “intentionally wasting medications in order to overbill Medicare.”

What earthly reason would there be to exclude companies from ACO REACH but allow them to continue their plunder in Medicaid, Medicare Advantage, and subsidized on the ACA Exchanges?

The hypocrisy of CMS and CMMI is on full display. As is their collusion with the profiteers. Sadly, getting the fraudsters out of ACO REACH will not improve a program designed to enrich corporations and harm patients. The entire apple cart needs to be overturned and replaced with a national, non-profit, single-payer healthcare system that covers everyone from birth to death with all necessary medical services including long-term care, hearing, vision, dental, and prescription drugs. Only then can we stop worrying about the fraudsters.

This content originally appeared on Common Dreams and was authored by Kay Tillow.

"Raising the debt ceiling is not a negotiation; it is an obligation of this country and its leaders to avoid economic chaos."

"Mr. President: I received your staff's memo," McCarthy tweeted Tuesday. "I'm not interested in political games. I'm coming to negotiate for the American people."

The document—authored by National Economic Council Director Brian Deese and Office of Management Budget Director Shalanda Young—and McCarthy's response came after the speaker claimed Sunday during an appearance on CBS News' "Face the Nation" that he would take cuts to Medicare and Social Security "off the table" but also wants to "look at every single dollar we're spending, no matter where it's being spent," and "eliminate waste wherever it is."

As Common Dreams previously reported, McCarthy added that "we've got to make sure we strengthen" those programs but declined to elaborate on how—which White House spokesperson Andrew Bates called "the latest giveaway that House Republicans have been telling the truth over the last year as they reiterate time and again that they want to cut Medicare and Social Security."

Before the splintered GOP took control of the U.S. House of Representatives and McCarthy ultimately won the speakership—after 15 votes and various concessions to far-right members of his party—supporters of Medicare and Social Security urged Democrats to lift the debt limit during the lame-duck session, fearing Republicans' threats to attack the social safety net programs.

However, Democrats in Congress refused to act after the midterms last year, setting up the current debt ceiling battle—which requires Treasury Secretary Janet Yellen to take "extraordinary measures" to temporarily prevent the first-ever U.S. default.

CBS' Margaret Brennan on Sunday asked McCarthy whether he "will guarantee" that the United States will not default on its debt.

"We're not going to default," he responded while arguing that, in the months ahead, "the responsible thing to do is sit down like two adults and start having that discussion. Unfortunately, the White House was saying before, like they wouldn't even talk. I'm thankful that we're meeting on Wednesday, but that's exactly what we should be doing. And we should be coming to a responsible solution."

Citing GOP sources, CNNreported Monday that "privately, Republicans have floated a range of ideas in exchange for an increase in the debt limit, including capping domestic spending at fiscal 2019 levels and bringing defense programs down."

Reiterating his aim to "negotiate" cuts—even if they aren't to Medicare or Social Security—McCarthy insisted Sunday that "there will not be a default. But what is really irresponsible is what the Democrats are doing right now, saying we just raise the limit."

The White House and other critics have taken such comments as the Republican leader not committing to preventing a default.

"Speaker McCarthy's unwillingness to-date to taking the threat of default off the table makes him an outlier, including among current and former leaders of his own party," says the new memo, pointing to statements from not only Biden, Senate Majority Leader Chuck Schumer (D-N.Y.), and House Minority Leader Hakeem Jeffries (D-N.Y.) but also Senate Minority Leader Mitch McConnell (R-Ky.) and former Republican Presidents Donald Trump and Ronald Reagan.

"In Wednesday's meeting, President Biden will seek a clear commitment from Speaker McCarthy that default—as well as proposals from members of his caucus for default by another name—is unacceptable," the document continues. "President Biden will ask Speaker McCarthy to publicly assure the American people and the rest of the world that the United States will, as always, honor all of its financial obligations."

As Government Executivereported Tuesday:

There is no blueprint for how the government would operate if it reached and broke through its debt ceiling, though it is clear agencies would not be able to carry out their normal operations. Because typical spending outpaces the revenue the Treasury Department brings in on a given day, the federal government would only be able to pay 60% of its bills in a given month of a default scenario, according to a Bipartisan Policy Center estimate.

Analysts and Treasury officials have sketched out two possible outcomes during a default: The government would either delay payments until it collected enough revenue to cover them, or prioritize some payments while allowing others to go unpaid. In either scenario, agency payments to beneficiaries, states, grantees, contractors, and, potentially, their own employees, could be disrupted. Some federal workers could be furloughed or asked to continue working on the promise of back pay in the future.

The White House memo highlights that the debt ceiling is just one of two of Biden's priorities for the Wednesday meeting. The president also plans to ask, "When will Speaker McCarthy and House Republicans release their budget?"

"President Biden will release a budget on March 9," according to the memo. "It is essential that Speaker McCarthy likewise commit to releasing a budget, so that the American people can see how House Republicans plan to reduce the deficit—whether through Social Security cuts; cuts to Medicare, Medicaid, and Affordable Care Act (ACA) health coverage; and/or cuts to research, education, and public safety—as well as how much their budget will add to the deficit with tax cuts for the wealthiest Americans and large corporations, as in their first bill this year."

Asked on Monday what his message for McCarthy will be, Biden said, "Show me your budget, I'll show you mine."

This content originally appeared on Common Dreams and was authored by Jessica Corbett.

A coalition of progressive advocacy groups on Monday launched a campaign urging every member of Congress to pledge to "never vote to cut Social Security or Medicare under any circumstances," an effort that comes as House Republicans are weighing attacks on the two programs as part of their sweeping austerity spree.

Led by Social Security Works and More Perfect Union, the new campaign highlights the massive stakes of the ongoing showdown over the U.S. debt ceiling, which House Republicans have said they will refuse to raise unless congressional Democrats and the Biden White House agree to major federal spending cuts—including damaging changes to Social Security and Medicare.

"To be clear, the debt ceiling legislation is not about new spending; it's about paying our bills," the progressive groups said Monday. "Failure to raise the debt limit will not only wreck the nation's economy; it will wreck the economy of the whole world."

In a launch video for their campaign, the progressive coalition includes footage of Republican lawmakers expressing support for raising the retirement age—a move that would cut Social Security spending across the board—and falsely blaming "entitlements" for the ballooning national debt as Congress hurtles toward another round of debt ceiling brinkmanship.

"Democrats were elected on the promise that they would defend Social Security against Republican attacks," said Alex Lawson, the executive director of Social Security Works. "Now is the moment of the truth. Democrats must refuse to cut Social Security. And they must refuse to create a mechanism—such as a closed-door commission—to cut Social Security down the road."

The campaign was launched ahead of President Joe Biden's planned Wednesday meeting with House Speaker Kevin McCarthy (R-Calif.), who has joined the far-right flank of his caucus in pushing for federal spending cuts as a condition for raising the borrowing limit.

In a Sunday appearance on "Face the Nation," McCarthy suggested that he won't insist on cuts to Social Security or Medicare in talks with the president, saying, "Let's take those off the table."

But the Republican leader went on to say that while Biden has expressed opposition to including Social Security or Medicare changes in any debt ceiling legislation, "we've got to make sure we strengthen those." When pressed, McCarthy declined to elaborate on what he meant by "strengthen."

In response to McCarthy's comments, White House spokesperson Andrew Bates said that McCarthy's "slip—and his evasiveness after—is the latest giveaway that House Republicans have been telling the truth over the last year as they reiterate time and again that they want to cut Medicare and Social Security."

"For years, congressional Republicans have advocated for slashing earned benefits using Washington code words like 'strengthen,' when their policies would privatize Medicare and Social Security, raise the retirement age, or cut benefits," Bates added. "It's like saying, 'You're not being laid off—we just want to make a change.' House Republicans refuse to raise revenue from the wealthy, but insist they will 'strengthen' earned benefits programs. You do the math. They have—they just won't show you."

While many congressional Democrats have publicly said they would join the White House in opposing any proposed cuts to Social Security and Medicare, at least one lawmaker—Sen. Joe Manchin (D-W.Va.)—has floated the possibility of cutting a deal with the GOP on the programs, an idea adamantly rejected by the progressive groups behind the new pressure campaign.

"It is critical for the Democrats to stay united and stand their ground against this latest effort to gut Social Security and Medicare," said Faiz Shakir, executive editor at More Perfect Union.

On their new website, the progressive groups will keep a running tally of the lawmakers who have taken the pledge to oppose Social Security and Medicare cuts, as well as those who are "equivocating" or outright "refusing" to make the promise.

"The only way that Democrats can win this game of chicken is if they stay united and do not blink," the groups said. "Standing with the overwhelming majority of the American people against all cuts to Social Security and Medicare should be the easiest promise any politician can make, so let's make them promise."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

The largest union of federal workers in the U.S. urged Congress this week to raise the debt ceiling without mandating reductions in social spending, arguing that President Joe Biden is right to reject the GOP's attempt to use the nation's borrowing limit as leverage to force through devastating cuts.

"The debt limit must be cleanly raised to avoid default and ensure the continuation of funding for the government and critical programs like Social Security, Medicare, veterans' benefits, and the U.S. military," Everett Kelley, president of the American Federation of Government Employees (AFGE), wrote in a letter sent to every member of Congress on Monday. "No negotiation that puts these programs or any aspect of federal employee compensation at risk should be considered."

Several House Republicans are threatening to block the lifting of the country's borrowing cap—an arbitrary and arguably unconstitutional figure set by Congress—unless Democrats agree to slash government spending, including on vital social programs

Notably, Capitol Hill's deficit hawks oppose reducing the Pentagon's ever-growing budget and rescinding former President Donald Trump's tax cuts for the wealthy.

The U.S. government's outstanding debt officially hit the statutory limit of $31.4 trillion last Thursday, at which point the Treasury Department started repurposing federal funds.

Treasury Secretary Janet Yellen recently told congressional leaders that "the use of extraordinary measures enables the government to meet its obligations for only a limited amount of time," possibly through early June. She implored Congress to "act in a timely manner to increase or suspend the debt limit," warning that "failure to meet the government's obligations would cause irreparable harm to the U.S. economy, the livelihoods of all Americans, and global financial stability."

A 2011 debt ceiling standoff enabled the GOP to impose austerity and led to a historic downgrading of the U.S. government's credit rating, but the country has never defaulted on its debt. Economists warn that doing so would likely trigger chaos in financial markets, resulting in millions of job losses and the elimination of $15 trillion in wealth.

Aware that an economic calamity is at stake, many Republican lawmakers "have announced that they will not support an increase in the debt ceiling without concomitant reductions in spending, possibly in the form of reductions to Social Security, Medicare, and Medicaid," Kelley wrote in the letter sent earlier this week.

"The White House says it will not negotiate such an arrangement," he added. "AFGE strongly supports the administration's refusal to negotiate on this matter."

"No negotiation that puts these programs or any aspect of federal employee compensation at risk should be considered."

In a Wednesday speech from the floor of the upper chamber, Senate Majority Leader Chuck Schumer (D-N.Y.) criticized "the House GOP's reckless approach to the debt ceiling" and challenged Speaker Kevin McCarthy (R-Calif.) "to level with the American people" on which popular programs his party wants to cut.

"The debt ceiling is a subject of the highest consequence, and using it as a bargaining chip, using it as brinkmanship, as hostage-taking, as Republicans are trying to do is exceedingly dangerous," said Schumer.

"If the House of Representatives continues on [its] current course and allows the United States to default on its debt obligations, every single American is going to pay a terrible and expensive price," Schumer continued. "The consequences of default are not some theoretical abstraction; if default happens, Americans will see the consequences in their daily lives."

"Interest rates will go soaring on everything from credit cards, and student loans, to cars, mortgages, and more," he added. "That's thousands of dollars for each American going right out the door, and it will happen through no fault of their own."

As many observers pointed out repeatedly in the wake of the midterm elections, Democrats had the power to prevent this high-risk game of brinkmanship altogether by raising the debt ceiling—or abolishing it completely—when they still controlled both chambers of Congress.

Despite ample warnings from Sen. Elizabeth Warren (D-Mass.) and other progressive lawmakers and advocacy groups, conservative Democrats refused to take unilateral action during the lame-duck session.

On Wednesday, Schumer pleaded with GOP lawmakers to simply raise the debt ceiling without demanding policy concessions in exchange.

"I'd remind my Republican colleagues that they did it before when Trump was president three times; no Democratic obstruction or hostage-taking," said Schumer. "We did it once together when Biden was president. And much of this debt comes from spending when Trump was president, voted on by a Republican House and a Republican Senate."

"It's a bit of hypocrisy now to say that they can't do it again, and they are holding it hostage and are playing a dangerous form of brinksmanship," Schumer argued. "It shouldn't matter who is president. It's still bills we already incurred that must be paid for the good of all Americans."

This content originally appeared on Common Dreams and was authored by Kenny Stancil.

Not even a month after assuming the majority in the House, Republicans have begun seriously considering a range of proposals to cut Social Security, Medicare, and other federal programs that millions of people across the U.S. rely on to meet basic needs.

The Washington Postreported Tuesday that "in recent days, a group of GOP lawmakers has called for the creation of special panels that might recommend changes to Social Security and Medicare" while other Republicans "have resurfaced more detailed plans to cut costs, including by raising the Social Security retirement age to 70"—a change that would impose across-the-board benefit cuts.

Rep. Kevin Hern (R-Okla.), the leader of the Republican Study Committee (RSC), told the Post that Congress has "no choice but to make hard decisions" even as experts dispute the GOP narrative that Social Security is in crisis.

Last year, the RSC suggested several possible changes to Social Security, including partial privatization and gradually raising the "full retirement age" from 67 to 70.

Rep. Rick Allen (R-Ga.), a supporter of raising the retirement age, claimed earlier this month that people "actually want to work longer."

"MAGA extremists in Congress are eager to use the debt they exacerbated with tax breaks for wealthy corporations as an excuse to threaten the health and retirement security of millions of hard-working Americans," Liz Zelnick, director of the Economic Security and Corporate Power Program at Accountable.US, said in a statement Tuesday. "It says it all about the MAGA majority fringe economic plan: Deep cuts to earned benefits for seniors and working people while protecting or even expanding wasteful tax breaks for billionaires and giant corporations."

"For nearly nine decades, Social Security has kept generations of seniors and Americans with disabilities out of poverty and allowed seniors to live out their Golden Years with dignity," Zelnick added. "For nearly 60 years, Medicare has provided millions of seniors with access to life-improving health benefits no matter their income or condition. MAGA extremists want to break the promise of guaranteed benefits that has been kept for generations—benefits earned through years of hard work—rather than ask for any contribution from their biggest and wealthiest donors, especially greedy corporations."

"Today, a billionaire pays the same amount into Social Security as someone making $160,000 a year."

Due to soaring income inequality, a rising share of rich people's earnings has not been subject to Social Security payroll taxes, which didn't apply to any wage income above $147,000 in 2022. Because of that $147,000 cap, millionaires stopped paying into Social Security on February 24 of last year.

Over the weekend, Sen. Bernie Sanders (I-Vt.) said he plans to reintroduce his legislation that would "extend Social Security's solvency for the next 75 years and expand benefits by $2,400 a year" by lifting the payroll tax cap.

"Today, a billionaire pays the same amount into Social Security as someone making $160,000 a year," Sanders wrote on Twitter. "Let's end that absurdity."

But scrapping the payroll tax cap is not among the changes that House Republicans have floated in recent weeks as they threaten another round of debt ceiling brinkmanship.

As the Post noted Tuesday, the RSC proposal released last year raised the "possibility that lawmakers could rethink payroll taxes, allowing the money to fund private-sector retirement options."

Republicans and one Democrat— Sen. Joe Manchin of West Virginia—have also spoken favorably of the TRUST Act, a bill led by Sen. Mitt Romney (R-Utah) that would establish bipartisan committees to craft "legislation that restores solvency and otherwise improves" the nation's trust funds, including Social Security.

"The idea could gain some traction in the House, where [Rep. Vern Buchanan (R-Fla.)] pointed to the bill as he stressed the need to 'work together and not make this so political,'" the Post reported Tuesday. "Another top Republican, Rep. Jodey Arrington (R-Texas), led a group of Democratic and GOP lawmakers two years ago in calling for 'special, bipartisan, bicameral rescue committees' to study Social Security, Medicare, and other federal trust funds."

While many House Republicans gun for cuts and other regressive changes to Social Security, Sens. Bill Cassidy (R-La.) and Angus King (I-Maine) are working on legislation that "would see the federal government create a new fund with borrowed money, which it would invest in stocks to cover future retirement benefits," Semaforreported last week.

"That maneuver is designed to cash in on the higher returns that equities usually earn compared to the Treasury bonds that Social Security’s current trust fund invests in," the outlet explained.

The American Prospect's Ryan Cooper welcomed the idea as "splendid and long-overdue" but acknowledged that something like the TRUST Act "probably has a better political chance of success than Cassidy and King’s more fair and technically competent approach."

"Official Washington prefers elite politicians making 'hard choices' to slash benefits for seniors on fixed incomes," Cooper wrote in a column on Monday. "But a social wealth fund is an idea worth underlining."

President Joe Biden and congressional Democrats have vowed to oppose any GOP push for Social Security cuts, demanding clean legislation to raise the debt ceiling and avert an economic disaster.

“Republicans won a majority in the House and they’re allowed to advocate for their priorities, but it is unacceptable to take American families and the economy hostage in this way," Sen. Ron Wyden (D-Ore.), chair of the Senate Finance Committee, said in a statement last week. "Democrats will not entertain these threats from Republicans, particularly to Medicare and Social Security. Republicans must stand down on the debt limit immediately."

Rep. Mark Pocan (D-Wis.), chair emeritus of the Congressional Progressive Caucus, wrote on Twitter Tuesday that "Medicare and Social Security are non-negotiable."

"Americans work hard and contribute to these programs with every paycheck," Pocan added. "Republicans raised the debt ceiling three times under Trump. Risking default or robbing seniors of hard-earned benefits are not options."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

Sen. Joe Manchin provoked outrage Wednesday by suggesting congressional Democrats should agree to pursue changes to Social Security as part of a debt ceiling agreement with Republicans, an idea one advocacy group condemned as "negotiating with legislative terrorists."

In an interview on Fox Business—conducted at the annual gathering of corporate and political elites in Davos, Switzerland—the West Virginia Democrat said that "we have a debt problem" and argued members of both parties should "work together" on solutions. The senator singled out Social Security, even though the program can't by law add to long-term deficits.

While Manchin voiced opposition to GOP calls to privatize Social Security, saying such proposals "scare the bejesus out of people," he said Congress "should be able to solidify it, so the people who have worked and earned it know they're going to get it."

The problem, from the perspective of Social Security defenders, is Manchin's suggested avenue for reforms: Bipartisan congressional committees that critics have denounced as "a Trojan horse to cut seniors' benefits."

"Hell no to even a single penny of cuts to Social Security's earned benefits," the progressive group Social Security Works tweeted Wednesday in response to Manchin's comments. "Hell no to fast-track commissions designed to cut benefits behind closed doors."

Under legislation that Manchin has introduced alongside Sen. Mitt Romney (R-Utah), Congress would establish bipartisan "rescue" committees for the nation's trust fund programs—including Social Security and Medicare—and give the panels 180 days to devise "legislation that restores solvency and otherwise improves each." (Analysts and advocates reject the notion that Social Security is in financial crisis and needs "rescuing.")

The bills produced by the bipartisan committees would then be placed on an expedited path to floor votes in both chambers of Congress, with no amendments allowed.

Manchin and Romney's legislation, known as the TRUST Act, is explicitly modeled after the infamous Simpson-Bowles Commission that recommended deep cuts to Social Security in 2011. Former Republican Sen. Alan Simpson (Wyo.) and former Clinton White House Chief of Staff Erskine Bowles, the Obama-appointed chairs of the commission, both endorsed the TRUST Act in 2021, calling the bill "important and vital."

Manchin told host Maria Bartiromo that he has spoken "briefly" with House Speaker Kevin McCarthy (R-Calif.) about the TRUST Act. Asked about the White House's stand against attaching any conditions to a debt ceiling agreement, Manchin said he "really" thinks the administration will reverse course and negotiate with Republicans.

Alex Lawson, the executive director of Social Security Works, told Common Dreams that President Joe Biden should "reiterate his commitment to only signing a clean debt limit increase, and specifically rule out a closed-door commission designed to cut Social Security," in response to the West Virginia Democrat's comments.

"Manchin is providing cover for Republican attacks on Social Security and Medicare," Lawson said. "Democrats must stand with President Biden in his calls for a clean debt ceiling [increase] and an end to Republican attacks on our earned benefits."

"MAGA extremists plan to use national debt they exacerbated with tax breaks for billionaires and profiteering corporations as an excuse to gut Social Security and Medicare."

Manchin's interview came hours before the federal government officially hit the $31.4 trillion debt ceiling on Thursday, prompting the Treasury Department to begin implementing "extraordinary measures" to ensure it can continue meeting its obligations as it awaits congressional action.

"The period of time that extraordinary measures may last is subject to considerable uncertainty, including the challenges of forecasting the payments and receipts of the U.S. government months into the future," Treasury Secretary Janet Yellen wrote in a letter to congressional leaders on Thursday. "I respectfully urge Congress to act promptly to protect the full faith and credit of the United States."

Lindsay Owens, executive director of the progressive Groundwork Collaborative, said it is "economically, fiscally, and morally irresponsible" for House Republicans to be playing games with the debt ceiling and "there's absolutely no reason for Sen. Manchin or anyone else to play along."

"We saw this movie in 2011 when politicians negotiated over the debt limit and ended up strangling the economy with years of devastating cuts for workers and families," Owens added. "We can't let that happen again.”

Failure to raise the debt limit—an arbitrary and arguably unconstitutional figure set by Congress—could result in the first-ever U.S. default and a devastating financial crisis, potentially wiping out millions of jobs.

Liz Zelnick, director of the Economic Security and Corporate Power program at Accountable.US, said in a statement Thursday that "whether or not the nation suffers a default crisis that could crush jobs is entirely up to MAGA extremists in Congress."

"The MAGA majority could vote today to meet the nation's prior debt obligations but instead a growing number want to manufacture a crisis to cut apart social safety nets for the most vulnerable Americans," said Zelnick. "Make no mistake: MAGA extremists plan to use national debt they exacerbated with tax breaks for billionaires and profiteering corporations as an excuse to gut Social Security and Medicare benefits for America's seniors and working people. They're dusting off an old conservative playbook: Make everyone else pay for their reckless giveaways to wealthy special interests."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

The national ACLU and its Arizona arm sought the records after U.S. Senate Finance Committee Chair Ron Wyden (D-Ore.) revealed last year that "Homeland Security Investigations (HSI), a law enforcement component of the Department of Homeland Security (DHS), was operating an indiscriminate and bulk surveillance program that swept up millions of financial records about Americans."

Following a February 2022 briefing with senior HSI personnel, Wyden wrote a March letter urging DHS Inspector General Joseph Cuffari to launch a probe into the Transaction Record Analysis Center (TRAC)—a nonprofit created as a result of a settlement between the Arizona attorney general's office and Western Union, a financial services company that fought in state court against the AG's attempt to obtain money transfer records.

As the ACLU released records about TRAC, Wyden on Wednesday shared a new letter requesting that "the Department of Justice (DOJ) Office of Inspector General (OIG) investigate the Federal Bureau of Investigation (FBI) and Drug Enforcement Administration's (DEA) relationship" with the Arizona-based clearinghouse.

"My oversight activities over the past year have uncovered troubling information, revealing that the scale of this government surveillance program is far greater than was previously reported," Wyden wrote to DOJ Inspector General Michael Horowitz.

"Between October and December of 2022, my office received information from three other money transfer companies—Euronet (RIA Envia), MoneyGram, and Viamericas—which confirmed that they also delivered customer data in bulk to TRAC, in response to legal demands from HSI and other governmental agencies," the senator divulged.

Some customs summonses—a form of subpoena—applied to transfers of $500 or more between any U.S. state and 22 other countries and one U.S. territory. Those summonses were withdrawn "just 10 days after HSI had briefed my staff" in February, Wyden noted, adding that HSI has not yet scheduled his requested follow-up briefing.

Summarizing the documents acquired by the ACLU, Freed Wessler and Walter-Johnson wrote:

From 2014 to 2021, Arizona attorneys general issued at least 140 administrative subpoenas to money transfer companies, each requesting that the company periodically provide customer transaction records for the next year. Those subpoenas were issued under the same state statute that the Arizona Court of Appeals held in 2006 could not be used for these kinds of indiscriminate requests for money transfer records. This means the Arizona attorney general's office knowingly issued 140 illegal subpoenas to build an invasive data repository.

The documents we obtained reveal the enormous scale of this surveillance program. According to the minutes of TRAC board meetings we obtained, the database of people's money transfer records grew from 75 million records from 14 money service businesses in 2017 to 145 million records from 28 different companies in 2021. By 2021, 12,000 individuals from 600 law enforcement agencies had been provided with direct log-in access to the database. By May 2022, over 700 law enforcement entities had or still have access to the TRAC database, ranging from a sheriff's office in a small Idaho county, to the Los Angeles and New York police departments, to federal law enforcement agencies and military police units.

As Freed Wessler told The Wall Street Journal, which exclusively reported on the materials, "Ordinary people's private financial records are being siphoned indiscriminately into a massive database, with access given to virtually any cop who wants it."

The Journal also spoke with TRAC director Rich Lebel, who "said the program has directly resulted in hundreds of leads and busts involving drug cartels and other criminals seeking to launder money," and "because money services companies don't have the same know-your-customer rules as banks, bulk data needs to be captured to discern patterns of fraud and money laundering."

According to the newspaper:

Mr. Lebel said TRAC has never identified a case in which a law enforcement official has accessed data improperly or the database has been breached by outsiders. The program has seen an increase in use in recent years because of the surging opioid crisis in the U.S., he said.

Law-enforcement agencies use TRAC's data to establish patterns in the flow of funds suspected of being linked to criminal activity, Mr. Lebel said, and the more comprehensive the data, the better the analysis. TRAC manages data that law enforcement provides, he said, and what it is receiving and storing is often in flux.

While declining to discuss TRAC's funding, Mr. Lebel said the nonprofit was originally stood up with money from the Western Union settlement that has since been exhausted. Mr. Wyden and others have said TRAC is federally funded.

Wyden wrote in his letter to Horowitz that "this unorthodox arrangement between state law enforcement, DHS, and DOJ agencies to collect bulk money transfer data raises a number of concerns about surveillance disproportionately affecting low-income, minority, and immigrant communities."

"Members of these communities are more likely to use money transfer services because they are more likely to be unbanked, and therefore unable to send money using electronic checking or international bank wire transfers, which are often cheaper," he explained. "Moreover, money transfer businesses are not subject to the same protections as bank-based transactions under the Right to Financial Privacy Act."

The senator's office said Wednesday that he "is working on legislation to close legal loopholes and ensure people who use money transfer services have the same privacy as those who use banks or money transfer apps."

Freed Wessler and Walter-Johnson also highlighted that "because members of marginalized communities rely heavily on these services rather than traditional banks, the burden of this government surveillance falls disproportionately on those already most vulnerable to law enforcement overreach."

"The government should not be allowed to abuse subpoenas and sweep up millions of records on a huge number of people without any basis for suspicion," the pair argued. "This financial surveillance program is built on repeated violations of the law and must be shut down."

This content originally appeared on Common Dreams and was authored by Newswire Editor.

A national physician group this week called for the complete termination of a Medicare privatization scheme that the Biden White House inherited from the Trump administration and later rebranded—while keeping intact its most dangerous components.

Now known as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the experiment inserts a for-profit entity between traditional Medicare beneficiaries and healthcare providers. The federal government pays the ACO REACH middlemen to cover patients' care while allowing them to pocket a significant chunk of the fee as profit.

The rebranded pilot program, which was launched without congressional approval and is set to run through at least 2026, officially began this month, and progressive healthcare advocates fear the experiment could be allowed to engulf traditional Medicare.

In a Tuesday letter to Health and Human Services Secretary Xavier Becerra and Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure, Physicians for a National Health Program (PNHP) argued that ACO REACH "presents a threat to the integrity of traditional Medicare, and an opportunity for corporations to take money from taxpayers while denying care to beneficiaries."

The group, which advocates for a single-payer healthcare system, voiced alarm over the Biden administration's decision to let companies with records of fraud and other abuses take part in the ACO REACH pilot, which automatically assigns traditional Medicare patients to private entities without their consent.

CMS said in a press release Tuesday that "the ACO REACH Model has 132 ACOs with 131,772 healthcare providers and organizations providing care to an estimated 2.1 million beneficiaries" for 2023.

"As we have stated, PNHP believes that the REACH program threatens the integrity of traditional Medicare and should be permanently ended," Dr. Philip Verhoef, the physician group's president, wrote in the new letter. "Whether or not one agrees with this statement, we should all be able to agree that companies found to have violated the rules have no place managing the care of our Medicare beneficiaries."

Among the concerning examples PNHP cited was Clover Health, which has operated so-called Direct Contracting Entities (DCEs)—the name of private middlemen under the Trump-era version of the Medicare pilot—in more than a dozen states, including Arizona, Florida, Georgia, and New York.

PNHP noted that in 2016, CMS fined Clover—a large Medicare Advantage provider—for "using 'marketing and advertising materials that contained inaccurate statements' about coverage for out-of-network providers, after a high volume of complaints from patients who were denied coverage by its MA plan. Clover had failed to correct the materials after repeated requests by CMS."

Humana, another large insurer with its teeth in the Medicare privatization pilot, "improperly collected almost $200 million from Medicare by overstating the sickness of patients," PNHP observed, citing a recent federal audit.

"It appears that in its selection process [for ACO REACH], CMS did not prevent the inclusion of companies with histories of such behavior," Verhoef wrote. "Given these findings, we are concerned that CMS is inappropriately allowing these DCEs to continue unimpeded into ACO REACH in 2023."

While the Medicare pilot garnered little attention from lawmakers when the Trump administration first launched it during its final months in power, progressive members of Congress have recently ramped up scrutiny of the program.

Last month, Sen. Elizabeth Warren (D-Mass.) and Rep. Pramila Jayapal (D-Wash.) led a group of lawmakers in warning that ACO REACH "provides an opportunity for healthcare insurers with a history of defrauding and abusing Medicare and ripping off taxpayers to further encroach on the Medicare system."

"We have long been concerned about ensuring this model does not give corporate profiteers yet another opportunity to take a chunk out of traditional Medicare," the lawmakers wrote, echoing PNHP's concerns. "The continued participation of corporate actors with a history of fraud and abuse threatens the integrity of the program."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

Nearly 40% of people in the United States said they or a family member delayed medical care last year due to the prohibitively high cost of treatment under the nation's for-profit healthcare model, according to a Gallup survey published Tuesday.

As U.S. residents faced soaring prices for private insurance, the percentage of them forgoing medical services as a result of the costs climbed 12 points in one year, from 26% in 2021 to 38% in 2022. Of those who reported postponing treatment last year, 27% said they or a family member did so "for a very or somewhat serious condition," up nine points from the previous year.

"After health insurance companies raised prices 24% last year and made nearly $12 billion in profits last quarter, 38% of Americans now report they or a family member put off needed medical care because it was too expensive," Sen. Bernie Sanders (I-Vt.) tweeted in response to the new findings. "We must end this corporate greed. We need Medicare for All."

Gallup has been collecting self-reported data on this issue since 2001. The firm's latest annual healthcare poll, conducted from November 9 to December 2, found the highest level of cost-related delays in seeking medical care on record, topping the previous high of 33% (2019 and 2014) by five points and marking the sharpest annual increase to date. The proportion of people who said they or a family member postponed treatment for a serious condition in 2022 (27%) also surpassed the previous all-time high of 25% (2019).

Lower-income households, young adults, and women in the U.S. are especially likely to have postponed medical care due to high costs.

According to Gallup:

In 2022, Americans with an annual household income under $40,000 were nearly twice as likely as those with an income of $100,000 or more to say someone in their family delayed medical care for a serious condition (34% vs. 18%, respectively). Those with an income between $40,000 and less than $100,000 were similar to those in the lowest income group when it comes to postponing care, with 29% doing so.

Reports of putting off care for a serious condition are up 12 points among lower-income U.S. adults, up 11 points among those in the middle-income group, and up seven points among those with a higher income. The latest readings for the middle- and upper-income groups are the highest on record or tied with the highest.

Another recent survey found that just 12% of Americans think healthcare in the U.S. is handled "extremely" or "very" well. Such data provides further evidence of the unpopularity of a profit-maximizing system that has left 43 million people inadequately insured, kicked millions off of their employer-based plans when the coronavirus caused a spike in unemployment, and contributed to the country's startling decline in life expectancy.

Last week, prior to the publication of Gallup's poll, Rep. Ro Khanna (D-Calif.) wrote on social media: "If you don’t believe corporate greed has deadly consequences, take a look at the decline in American life expectancy. We need Medicare for All, and we must raise the minimum wage."

While the current, profit-driven U.S. healthcare system—which forces millions to skip treatments to avoid financial ruin and allows the pharmaceutical and insurance industries to rake in massive profits—is deeply inefficient and unpopular, polling has consistently shown that voters want the federal government to play a more active role in healthcare provision, with a majority expressing support for a publicly run insurance plan.

Recent research shows that a single-payer system of the kind proposed in Medicare for All legislation introduced by Sanders and Rep. Pramila Jayapal (D-Wash.) could have prevented hundreds of thousands of Covid-19 deaths in the U.S. over the past two and a half years.

Not only would a single-payer insurance program guarantee coverage for every person in the country, but it would also reduce overall healthcare spending nationwide by an estimated $650 billion per year.

"Millions of Americans across this country are avoiding seeking lifesaving medical care because they're afraid it will bankrupt them," Khanna, a universal healthcare advocate, tweeted last week. "In many cases, their fears are well-founded. We need Medicare for All."

This content originally appeared on Common Dreams and was authored by Kenny Stancil.

Treasury Secretary Janet Yellen just announced that the federal government will hit the limit on total federal debt on January 19, just two days from now.

After that, the Treasury Department will be forced to take “extraordinary measures” to avoid defaulting on the debt, which would likely trigger a global financial crisis.

Congress could defuse this bomb by simply raising the debt limit, as it has dozens of times under presidents of both parties for decades. But the MAGA radicals now in control of the House of Representatives are refusing to raise the debt ceiling unless President Biden agrees to devastating cuts to Social Security, Medicare, and other key programs.

I was involved in a similar fight over the debt ceiling fight twenty-eight years ago, which holds some lessons for what happens now.

In November 1995, Republicans refused to raise the debt ceiling unless Bill Clinton agreed to a package of sweeping spending cuts, welfare overhaul, restraints on Medicare and Medicaid growth, and a balanced budget within seven years.

I and other Clinton advisers urged him not to negotiate. Even if the public didn’t understand that the debt ceiling had less to do with the nation’s future debt than with obligations the United States had made in the past, we couldn’t allow the Republicans to hold the economy hostage. The full faith and credit of the United States was at stake. It should not be negotiable.

Clinton agreed. “If they send me a budget that says simply, ‘You take our cuts or we’ll let the country go into default,’ I will veto it,” he said. He called the Republican tactics “economic blackmail,” which they were.

When the Republican House then passed a bill increasing the debt ceiling through December, as well as a continuing resolution that included higher Medicare premiums and other spending cuts, Clinton vetoed both bills. “America has never liked pressure tactics, and I would be wrong to permit these kind of pressure tactics to dramatically change the course of American life,” he said. “I cannot do it, and I will not do it.”

What happened next? The government shut down. And as you may recall, the American public was furious — with the Republicans, who paid dearly in the subsequent midterm elections.

The budget standoff was resolved in early January 1996 but the debt ceiling issue remained. When Treasury Secretary Robert Rubin wrote to Speaker of the House Newt Gingrich that Congress had only until March 1 before the Treasury defaulted on its obligations, Moody’s rating agency announced it was considering downgrading the rating on U.S. Treasury bonds.

Republicans quickly folded, offering to raise the debt ceiling in return for a few modest measures.

The debt ceiling fight of 2011 was different. The Obama administration did negotiate with House Republicans, resulting in the Budget Control Act of 2011. When the debt ceiling had to be raised again in 2013, Obama returned to negotiations. During this standoff, the government was partially closed down. Here again, Republicans took the brunt of the blame.

In these fights, some Republicans presented a fallback position: Instead of raising the debt ceiling, the federal government should prioritize which bills to pay — starting with interest payments to lenders to the United States (holders of federal bonds). That way, they argued, there’d be no technical default.

The idea never went anywhere because such prioritization would still spook credit markets. It would also cause the economy to tank and the stock market to plunge because of the sudden elimination of huge amounts of government spending.

But now, so-called “debt prioritization” is back. According to Friday’s Washington Post, it was part of the secret agreement Kevin McCarthy made with his detractors to support him for Speaker. They agreed that when Republicans hold firm on not raising the debt ceiling, they’ll pass a bill instructing the Treasury to prioritize: 1) first, debt service payments, 2) next, Social Security, Medicare and veterans benefits, and 3) third, military funding.

Everything else would be sacrificed—including critical federal expenditures such as Medicaid, food safety inspections, border control, and air traffic control. The U.S. would be forced to halt payment for as much as 20 percent of money it already promised to spend.

This could be the most economically irresponsible backroom deal in Republican history (even conservative economists are warning that the consequences could include a stock-market spiral and significant job losses).

It’s also the most politically foolish. It would, in effect, put the interest of bondholders — including Chinese lenders to the United States — over the wellbeing of Americans.

As George W. might say, “bring ‘em on.”

This content originally appeared on Common Dreams and was authored by Robert Reich.

Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill to get Members of Congress and Senators of both parties to sign on to a letter designed to put them on the record “expressing strong support” for the scam that is Medicare Advantage.

But here is the truth: Medicare Advantage is neither Medicare nor an advantage.

And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.

During my two decades in the industry, I was part of an annual collaborative effort to persuade lawmakers that Medicare Advantage was far superior to traditional Medicare—real Medicare. We knew that having Congressional support for Medicare Advantage was essential to ensuring ever-growing profits—at the expense of seniors and taxpayers. We even organized what we insiders derisively called “granny fly-ins.” We brought seniors enrolled in our Medicare replacement plans to Washington, equipped them with talking points, and had them fan out across Capitol Hill.

Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems... Congress should work to lower the cost of health care.

I regret my participation in those efforts. Over the 20 years since Congress passed the Medicare Modernization Act, the Medicare Advantage program has become an enormous cash cow for insurers, in large part because of the way they have rigged the risk-scoring system to maximize profits. As Kaiser Health News reported last month, the Center for Medicare and Medicaid Services estimated “net overpayments to Medicare Advantage plans by unconfirmed medical diagnoses at $11.4 billion for 2022.” That was for just one year. Imagine what the cumulative historical total would be.

The Medicare and Medicaid programs have become so lucrative and profitable for insurers that UnitedHealth Group, the nation’s largest health insurer and the biggest in terms of Medicare Advantage enrollment, got 72% of its health plan revenues in 2021 from taxpayers and seniors. In fact, all of UnitedHealth’s enrollment growth since 2012 has been in government programs. Enrollment in the company’s employer and individual health plans shrank by 370,000 between September 30, 2012, and September 30, 2022. Much of the $81 billion UnitedHealth collected in revenues in the third quarter of last year was subsidized by American tax dollars.

Members of Congress on both sides of the political aisle–and both sides of the Capitol–are at long last calling for more scrutiny of the Medicare Advantage program. Sen. Chuck Grassley has called for aggressive oversight of Medicare Advantage plans to recoup overcharges and was quoted in the Kaiser Health News story. As was Sen. Sherrod Brown, who said that fixing Medicare Advantage is not a partisan issue. And as Rep. Katie Porter commented, “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

I know that Democrats and Republicans alike care about the financial stability of the Medicare program. Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems, and in the process helping Big Insurance make massive profits, Congress should work to lower the cost of health care.

Medicare Advantage is a money-making scam. I should know. I helped to sell it.

This content originally appeared on Common Dreams and was authored by Wendell Potter.

My doctor, a very dedicated physician and caring human being has no idea why. She has asked around, but the responses have been few, and certainly not very encouraging. To be honest, most doctors don’t know the answer, and as far as the patients, how many of them do you know, that measure and record their blood pressure readings while they are asleep? We have tried different types of blood pressure medication, and I have rejected some for their harsh side-effects (skin bruises or cancer). The results have not been any different. Both myself and my doctor are aware that, unless we achieve some success, the final result could be a heart attack or a stroke for me, which neither one of us wants.

What should we do to find the answer? Quite obvious, further research, consultation, and testing. 

The problem is our physicians are often overworked and have no more time than 15 minutes (or 20 per patient), for the really good ones. In order to satisfy the neo-liberal system’s appetite for more profits, they are every day given a bigger list of patients assigned to them. To the blood-thirsty CEOs of insurance companies and healthcare outfits, their earnings are never sufficient. In my case, I volunteered to do some further research on my own, but my physician has already indicated to me that she will not be able to satisfy her quota, if we continue down the same path, and I don’t blame her. It’s her job that’s on the line.

What I described to you is just one of the destructive aspects and outcomes of this neo-liberal system of “profits before the people”. Each aspect is alone capable of bringing the system down to its knees. There are many more components that define the characteristics of the broken system. From the greed and desires of the drug companies for a bigger bottom-line, to the victimization of the public every year in order to sign them up, often for no reason at all, with a different insurance network — we are all set up for the big fall. Yes, the invisible hand of the neo-liberal capitalism might eventually adjust itself, but when and at what price? Just look at the healthcare industry’s statistics on COVID-19: number of people lost, the private sector’s profits.

No worries, down the road to perdition, but is America going to be great again!?

This content originally appeared on Dissident Voice and was authored by Andres Kargar.

As Treasury Secretary Janet Yellen warned Friday that the United States is likely to reach its arbitrary borrowing limit next week, progressives denounced congressional Republicans for threatening to use a debt ceiling standoff to force cuts to popular federal programs including Medicare and Social Security.

"They have the tiniest majority of one house and they are prepared to use it to get concessions they know are incredibly unpopular," Dean Baker, co-director of the Center for Economic and Policy Research, toldThe Washington Post. "It would be a terrorist attack on the economy."

Yellen announced that once the outstanding debt of the U.S. hits the statutory limit of $31.4 trillion—an event that is projected to happen on January 19—the Treasury Department will start repurposing federal funds to delay the date the government runs out of money. Until Congress raises the debt limit, the Treasury cannot borrow additional money, including to pay for spending that has already been authorized.

In a letter to congressional leaders, Yellen wrote that "the use of extraordinary measures enables the government to meet its obligations for only a limited amount of time," possibly through early June. She implored Congress to "act in a timely manner to increase or suspend the debt limit," warning that "failure to meet the government's obligations would cause irreparable harm to the U.S. economy, the livelihoods of all Americans, and global financial stability."

House Speaker Kevin McCarthy (R-Calif.) suggested—before the GOP won its slim House majority during November's midterms—that if elected to lead the chamber, he would refuse to lift the country's borrowing limit unless Democrats agreed to slash the social safety net and climate investments in return.

To secure enough votes to win his drawn-out battle for the speaker's gavel, McCarthy made undisclosed promises to far-right lawmakers, including several House Freedom Caucus members who have expressed opposition to raising the debt ceiling even if all of their demands, from shredding vital social programs to passing draconian immigration restrictions, were met.

The fight over the debt ceiling represents one of McCarthy's "most difficult balancing acts," CNNnoted recently. The California Republican will "need to work with Senate Democrats and President Joe Biden to cut a deal and avoid economic catastrophe without angering his emboldened right flank for caving into the left."

McCarthy told reporters Thursday that "he hoped to 'sit down with [Biden] early' to work through a number of outstanding fiscal issues, potentially including the looming need to raise the debt ceiling," the Post reported. "In doing so, McCarthy reaffirmed Republicans' interest in seeking an agreement that could cap spending in exchange for votes to address the country's borrowing cap."

"We've got to change the way we're spending money wastefully in this country," McCarthy said. "And we're going to make sure that happens."

Notably, Capitol Hill's deficit hawks do not support reducing the Pentagon's ever-expanding budget or hiking taxes on the rich to increase revenue. On the contrary, the first bill unveiled by House Republicans in the 118th Congress seeks to rescind most of the Inflation Reduction Act's roughly $80 billion funding boost for the Internal Revenue Service—a move that would help wealthy households evade taxes and add an estimated $114 billion to the federal deficit.

A 2011 debt ceiling standoff enabled the GOP to impose austerity and also resulted in a historic downgrading of the U.S. government's credit rating, but the country has never defaulted on its debt. Economists warn that doing so would likely trigger chaos in financial markets, leading to millions of job losses and the erasure of $15 trillion in wealth. Knowing that a painful recession is at stake, "many leading Republican lawmakers are demanding that their new House majority use the debt limit as leverage to force the Biden administration to accept sweeping spending cuts that Democrats oppose, creating an impasse with no clear resolution at hand," the Post reported.

According to CNN, some Republicans—fearful of both a disastrous default and political backlash for attacking popular programs—remain uneasy about using the debt ceiling as a bargaining chip,recalling how then-Rep. Paul Ryan's (R-Wis.) proposal to privatize Medicare "became fodder for attacks that depicted him rolling an elderly lady in a wheelchair off a cliff."

Sen. Elizabeth Warren (D-Mass.), however, has warned that GOP lawmakers desperate to win the White House in 2024 will "blow up the economy" and run ads blaming Biden for it.

The Biden administration on Friday urged Republicans to drop any plans they have to hold the nation's economy hostage, saying it has no intention to conduct debt ceiling negotiations and calling on lawmakers to raise the nation's borrowing limit to preserve its credit.

"We have seen both Republicans and Democrats come together to deal with this issue," White House spokesperson Karine Jean-Pierre told reporters. "It is one of the basic items that Congress has to deal with and it should be done without conditions."

In a joint statement, Senate Majority Leader Chuck Schumer (D-N.Y.) and House Minority Leader Hakeem Jeffries (D-N.Y.) said Friday that "a default forced by extreme MAGA Republicans could plunge the country into a deep recession… Democrats want to move quickly to pass legislation addressing the debt limit so there is no chance of risking a catastrophic default."

As many observers pointed out repeatedly in the aftermath of the midterm elections, Democrats had the power to prevent this high-risk game of brinkmanship from proceeding any further by raising the debt ceiling—or abolishing it altogether—when they still controlled both chambers of Congress.

Despite ample warnings from Warren and other progressive lawmakers and advocacy groups, conservative Democrats refused to take unilateral action during the lame-duck session.

In the absence of congressional action, Yellen—who has supported proposals to permanently eliminate the federal government's borrowing cap as most countries around the world have done—still has the authority to avert an economic calamity by minting a trillion-dollar platinum coin.

This content originally appeared on Common Dreams and was authored by Kenny Stancil.

Republicans who have pledged to use their narrow majority in the House to pursue steep federal spending cuts have sent a clear message in recent days: The bloated Pentagon budget is safe, but Social Security, Medicare, and other key government programs are not.

Rep. Michael Waltz (R-Fla.) expressed that sentiment during a Monday interview on Fox Business, saying, "I'm all for a balanced budget, but we're not going to do it on the backs of our troops and our military."

"If we really want to talk about the debt and spending, it's the entitlement programs," said Waltz, referring to Medicare and Social Security, among other programs. (By law, Social Security cannot add to the federal deficit.)

The office of Rep. Chip Roy (R-Texas)—one of the far-right Republicans that initially opposed Rep. Kevin McCarthy's (R-Calif.) bid for House speaker—was particularly adamant in a Twitter post on Sunday, declaring that "cuts to defense were NEVER DISCUSSED" in talks with McCarthy.

"In fact, there was broad agreement spending cuts should focus on NON-DEFENSE discretionary spending," Roy's office wrote, singling out a broad category that includes federal budgets for healthcare, education, environmental programs, and more.

The Texas Republican's staff was attempting to dispel reports last week that McCarthy opponents were seeking to cap federal spending across the board at Fiscal Year 2022 levels, a demand that—if fulfilled—would lop tens of billions of dollars off the historically high Pentagon budget in addition to slashing non-military domestic programs.

The reports of potential Pentagon cuts on the horizon contributed to a recent decline in the stock prices of major military contractors such as Lockheed Martin and Northrop Grumman.

Politicoreported Monday that McCarthy did ultimately agree to hold a "vote on a budget framework that caps discretionary spending at fiscal 2022 levels and aims to balance the federal budget in a decade," but Republicans have insisted this week that any proposal to cut the U.S. military budget—something progressives in the House support—would likely go nowhere, even though the Pentagon is rife with waste and abuse.

"Most of us won't vote for cuts to defense," Rep. Don Bacon (R-Neb.), a member of the House Armed Services Committee, told Politico.

Rep. Rosa DeLauro (D-Conn.), the top Democrat on the House Appropriations Committee, said in a statement last week that the non-military spending cuts floated by House Republicans "would harm communities and families across the United States who are already struggling with inflation and the rising cost of living."

"From cuts to public health investments to decreases in funding for education," DeLauro added, "this secret deal endangers so much of the progress we made to help children and families, create better-paying jobs, strengthen our national security, and protect our environment."

"The same Republicans who plunged the House of Representatives into chaos last week are prepared to plunge America into an economic crisis... unless Democrats agree to their demands to cut Social Security and Medicare."

The omnibus spending package that Congress approved last month over the objections of Roy and other far-right Republicans includes $858 billion in military funding, making up more than half of the $1.7 trillion measure. Adjusted for inflation, the $772.5 billion allocated to non-military discretionary programs in the package represents a cut compared to the previous fiscal year.

In recent months, House Republicans–including Texas Rep. Jodey Arrington, who was just chosen to head the chamber's budget committee—have said they want to target both discretionary government outlays and mandatory spending that includes Social Security and Medicare, potentially using the debt ceiling as leverage to secure changes to the popular programs.

Bloomberg Governmentreported in October that Arrington said an "increase in the eligibility age for both programs would be a commonsense change," a sentiment echoed by several other House Republicans.

"There it is in black and white"

A slide shown during a House Republican conference meeting on Tuesday indicates that the party is committed to exploiting a debt ceiling showdown to push for spending cuts—even though such cuts would likely be a non-starter for the Senate and White House.

The seventh point on the slide, titled "Budget and Spending," states that the House GOP "will not agree to Debt Limit increase without budget agreement or commensurate fiscal reforms."

The slide also signals that the House GOP will push for "reforms" to mandatory spending programs and "reject any negotiations with the Senate" on spending unless their proposals "reduce non-defense discretionary."

"There it is in black and white," Rep. Brendan Boyle (D-Pa.) tweeted in response to the presentation.

In October, Boyle led a group of House Democrats in imploring party leaders to raise the debt ceiling during the lame-duck session to avoid a potentially damaging 2023 showdown with Republicans. The Democratic leadership did not heed Boyle's call.

"House Republicans are openly plotting to hold the full faith and credit of the United States hostage—threatening to blow up our entire economy—because they want to force cuts to Social Security and Medicare," Boyle wrote Tuesday.

The progressive advocacy group Social Security Works similarly warned that "the same Republicans who plunged the House of Representatives into chaos last week are prepared to plunge America into an economic crisis... unless Democrats agree to their demands to cut Social Security and Medicare."

This content originally appeared on Common Dreams and was authored by Jake Johnson.

Very early Saturday morning, Kevin McCarthy finally won on the 15th round of voting for Speaker.

In return, the right-wing Freedom Caucus got a promise from McCarthy that he would not approve a simple increase in the debt ceiling unless spending was held back at 2022 levels — which, with more than 7 percent inflation, would require huge cuts in everything from defense spending to Social Security and Medicare. And if McCarthy breaks his promise, any member of the Freedom Caucus can move to remove him from the Speakership.

For years now, a major goal of the extreme right has been to undermine Social Security and Medicare, the most popular programs in the federal government. The extremists will not succeed. But the coming fight over raising the debt ceiling seems likely to become the defining battle over the next six to nine months. (In 2011, the mere possibility that the U.S. might not be able to pay its bills rattled markets worldwide.)

Note, too, that Congress must also fund federal agencies and programs before the current fiscal year ends on Sept. 30. The current $1.7 trillion spending “omnibus” measure was adopted in the waning hours of 2022. A failure to replace it would be a second cause for a government closure in the fall.

The three parts of the Congressional Republican Party — the fiscal conservatives, the cultural warriors, and the MAGA anti-democracy Trumpers — have come together behind fiscal conservatism — draped in warrior language, with the potential for a MAGA anti-democracy outcome. They are more dangerous than ever.

This content originally appeared on Common Dreams and was authored by Robert Reich.

The refusal by U.S. House Republicans to collectively get behind a speaker candidate in six rounds of voting so far this week has renewed concerns about the coming fight over raising the debt ceiling to prevent an unprecedented government default.

After the GOP won a narrow House majority in the November midterm elections, economists and progressives in Congress called for raising the federal borrowing limit during the lame-duck session. However, Democrats failed to pass standalone legislation or include a provision in the omnibus package President Joe Biden signed last week, setting up the battle for this year.

The arbitrary cap was last increased by $2.5 trillion to $31.381 trillion in December 2021 and is expected to be reached no sooner than the summer. Although that means lawmakers likely have months to act, some Republicans have signaled that they intend to use the threat of a potential default—which could cause a global economic crisis—to force concessions.

Specifically, GOP lawmakers have set their sights on cuts to Medicare and Social Security. While Biden vowed in November that "under no circumstances" would he go along with GOP attacks on such programs, the political theater in the House on Tuesday and Wednesday has fueled fears that some Republicans would be willing to force the first-ever default.

The House adjourned Wednesday afternoon until 8:00 pm ET, after a trio of votes in which far-right House Republicans repeatedly denied Congressman Kevin McCarthy (R-Calif.) the speakership—events that followed three similar voting rounds on Tuesday. Members briefly returned to the chamber as planned Wednesday night and narrowly voted to adjourn until noon on Thursday. The chamber can't move forward with any legislative business until the leadership position is filled.

"The 20 opposed to McCarthy want all-out war against Democrats and Biden," Institute for Policy Studies fellow Sanho Tree said of the Republicans blocking his path to speaker. "They think that by taking the debt ceiling hostage this year, the House can force the Senate and [White House] to agree to slashing spending, a border wall, and cuts to Medicare and Social Security."

Rep. Andy Barr (R-Ky.) suggested to Punchbowl News' Brendan Pedersen that the speaker fight doesn't "necessarily portend a problem with the debt limit," adding that "I think there will be a way forward," but some Democrats aren't convinced.

"If House Republicans can't even get it together to choose their leader, they can't be trusted with the debt ceiling, fighting inflation, or helping families make ends meet," Rep. Sara Jacobs (D-Calif.) tweeted Wednesday evening. "They've proven they can't lead."

One of the House Freedom Caucus members who has repeatedly voted against McCarthy for speaker, Rep. Ralph Norman (R-S.C.), discussed the debt limit with journalists on Wednesday, reportedly saying: "Is he willing to shut the government down rather than raise the debt ceiling? That's a non-negotiable item."

According toThe Intercept's Ryan Grim:

A reporter asked Norman if he meant default on the debt, as the debt ceiling and a government shutdown are not directly linked. "That's why you need to be planning now what agencies—what path you're gonna take now to trim government. Tell the programs you're going to get to this number. And you do that before chairs are picked," he said, referring to the process of choosing and installing House committee chairs.

A quirk of parliamentary procedure requires Congress to authorize spending, then appropriate money for those authorized expenditures, and then to authorize the Treasury Department to issue debt in order to pay for that appropriated money. Some constitutional scholars argue that the debt ceiling is unconstitutional, but currently both parties recognize it as a legal and valid restriction on the government's ability to issue debt.

Appearing on a Bloomberg Radio program Wednesday, Rep. Brad Sherman (D-Calif.) floated the possibility of trading Democratic voters in favor of McCarthy for a debt limit deal.

"Eventually, he's going to have to cut a deal with Democrats, because it's going to be easier to get a deal with us than with his 20-headed monster he has over there," Sherman said. "He's going to have to agree with Democrats to not hold hostage the full faith and credit of the United States, to not put us in a position where we're going to shut down the government. And eventually, I think Americans will benefit from this ugly picture of chaos."

The New York Daily Newsreported Wednesday that though Rep. Alexandria Ocasio-Cortez (D-N.Y.) "emphatically ruled out supporting embattled" McCarthy, the progressive congresswoman suggested to journalists that there was potential for a compromise speaker who agreed to raise the debt ceiling along with "a combination of" other concessions.

Meanwhile, some critics of the Republican Party used the ongoing speakership drama to remind Americans that no matter who ultimately ends up at the helm, "they all want to cut your Social Security" and protect wealthy tax dodgers.

This content originally appeared on Common Dreams and was authored by Jessica Corbett.