A Good Checklist for Grading an Obamacare Replacement

Greenville   In the chaotic back and forth over what may be about to happen to the Affordable Care Act, it is becoming almost impossible to follow the real issues as the bull passes our knees and rises towards our chin on all sides of the debate. We know something bad is about to happen, but we need a good checklist to measure the extent of the disaster even as we know the pain is likely to be terrible.

Harold Pollack from the University of Chicago and Timothy Jost from Washington and Lee University School of Law did all of us a favor in an op-ed in the Times by listing what they called “seven important questions that Congress must answer before repealing the Affordable Care Act.” Many of their questions are also clearly benchmarks for measuring the minimum standards for equity and justice that should be demanded by all Americans for any so-called replacement coming from Congress.

Here’s their list in brief:

1. How many millions of Americans will lose coverage? They also make the point often lost in the debate that tax credits and deductions are “nearly worthless” to lower income filers who would likely be priced out without direct subsidies.
2. Will people over 55 pay higher health premiums for the same coverage? This is a critical equity and cost issue for senior citizens with fixed incomes. The current Act limits the premium for older Americans to no more than three times that for younger citizens. Speaker Ryan has proposed going five times, which would be a budget buster for seniors.
3. Will the new plan let insurers charge women higher premiums than men while offering them less coverage? Obamacare in a critical reform banned this practice? Will the Republicans attack and penalize women for being women?
4. What other services are likely to be cut? Before Obamacare a third of the market policies did not cover addiction treatment and “nearly 20 percent lacked mental health coverage.” Will Republicans embrace the tragedy and roll this back along with other benefits?
5. Will the new plan let insurers reinstate annual or lifetime limits on coverage? Will Republicans allow a life-threatening illness to bankrupt victims and families while giving insurers a free-ride? We have to ask what insurance is for if there’s no coverage?
6. What will happen to the more than 130 million Americans with pre-existing conditions? This is huge and Congress needs to have the right answer because this was a critical reform of Obamacare and one that was popular enough that Trump even echoed its promise during the campaign.
7. How much more will those with costly illnesses or injuries have to pay in out-of-pocket costs? Costs are now capped at $7150 for individuals and $14,300 for families, and that’s way too much. Current Republican proposals thus far offer no cap to either deductibles, which are already leaving lower income workers outside of coverage in healthcare and service jobs, or cost sharing. You could drive a truck over people unless this loophole is closed.

This list of questions is really only the starting point, but any replacement at the least needs to answer these questions correctly to even pretend to be called a national healthcare protection plan. Keep them handy to grade the outcome in the common debate.

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Bad News – Bullying Is Working

Source: Politico

New Orleans   No matter what any of us would want to believe or have taught our children about bullying, we’re going to have to think again or say it louder for those who aren’t getting the message. We’ve always said it was just a mask for cowardice and insecurity, and a slap back or a shout out would send a bully cowering. Maybe that’s still right, but we need to work harder to teach that lesson outside of the schoolyard, because President-elect Trump seems to be proving over and over again that being a bully still scares people, including mighty corporations, trade associations, and a lot of other big dogs as well.

Big automakers are at least pretending to lay back and re-position some of their plans for fear of a Twitter barrage. Certainly, they are claiming, “Hey, we were going to do this anyway,” and absolutely Trump is claiming credit for more than he’s doing, but there seems to be no way to deny that they are looking for cover from the chief Twitter-finger.

They aren’t the only ones. Reportedly H&R Block’s ads this tax season are in reaction to Trump having taken them on during the campaign by claiming he was going to make the tax code so simple he’d put them out of business. Boeing, Vanity Fair, Lockheed Martin have all been under a tweet-attack, and other brands are worried about what might come their way.

Hey, maybe they deserved it, we might say, but how does that explain the chicken clucking from the health care industry even as 30 million Americans are on the verge of losing health care coverage with the coming assault on the Affordable Care Act. Where are the industry voices from hospitals, doctors, and even big pharma that would loud and strong during the passage of the act?

Robert Pear of the New York Times quotes California-based, but nationally operating, Kaiser, a leader for Obamacare:

Kaiser Permanente, the managed care company that serves more than 10 million people, declined to comment specifically on Republican plans to repeal the Affordable Care Act. Instead, it offered a statement of general principles saying that people should have access to health care and that “we must continue to accommodate those who have pre-existing conditions.”

More tellingly, Pear writes:

Some companies, anxious about changes in health policy, said they were afraid to speak out because they feared that Mr. Trump would attack them on Twitter, as he has badgered Boeing, Ford, General Motors, Lockheed Martin and Toyota.

See what I mean, bullying is working. Rather than seeing the healthcare industry stand up for their patients, most of them are trying to roll under the radar hoping to save themselves and somehow make it through the killing field that may disgorge millions without protection. Even the bully can’t seem to control what he has set in motion. He’s now tweeting that a replacement for Obamacare needs to be ready when it is repealed, while most Republicans in Congress are saying, “What, what did you tweet? I can’t hear you?” and propelling people into a disaster.

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Steamrolling the Cabinet Choices is a Mistake; Tillerson is an Example

Rex Tillerson, CEO of ExxonMobil, at the World Gas Conference, Paris, June 2015

New Orleans    Well, we may not have a new President in the US quite yet, but Congress is back in session and the elephants are trying to stampede nominations through the Senate committees in lightning speed. Granted, most of these folks are going to end up exactly where Trump has appointed them to serve and where Congress is trying to apply the grease, but it’s fair to ask, whose house is on fire?

Former ethics lawyers with experience in this vetting and confirmation process for both the last Bush Administration and the current Obama Administration, seem horrified that the Republicans are trying to steamroll these nominees to approval before they have even completed their forms and provided full financial disclosures. Furthermore, according to the ethics review folks, they are swamped partially by the extent of the wealth and diverse investments that tangle some of these billionaires and multi-millionaires on the Trump team. Nobody seems to be dilly-dallying here, but it takes a lot of shovels to dig through this mess.

What’s the logic behind the speedup? It’s hard to imagine that these folks are going to not end up being approved given the votes that line up in the Senate, so why not have the problems come up early where they can be sorted at the committee level, rather than later when opponents, reporters, and public interest groups stumble on the problems, as they inevitably will, and it becomes a scandal for the new administration?

Some of the questions seem softball anyway. A number of Democratic Senators say they want to ask all of the nominees about their views on whether the Russians were behind all of the hacking. They will all read a prepared statement and go with a party line there. Nothing new is going to come out of that line of questioning, it’s just playing for the cheap seats, but I can’t even figure out where the theater is at this point.

Take Rex Tillerson though as the nominee from ExxonMobil for Secretary of State. My last piece of vacation reading was Steve Coll’s Private Empire: ExxonMobil and American Power. The book is a couple of years old, published in 2012, but well-researched and objectively reported, as usual by Coll. Reading the book, you can’t help but have a list of questions for Tillerson. They start with his relationship with Putin and their dealings in Russia, which were what won the CEO job for Tillerson more than a decade ago. What about the side deal with the Kurds was also made by Tillerson while in the top job was outside of the lines drawn by American policy in Iraq and in some ways skirting the letter of the law on sanctions. There has been some attention there already, but how about Equatorial Guinea, Chad, Nigeria, and Indonesia where ExxonMobil, including under Tillerson’s watch maintained virtual private armies and flaunted exceptions to the Foreign Corrupt Practices Act, especially in Equatorial Guinea, with a straightforward argument that they should be allowed to “pay to play” with the ruling family. How about the general policy under Tillerson and his predecessors to coddle dictators and prop up their regimes where oil and gas comes first and are the only flag ExxonMobil flies? How about tense relationships of the company in Venezuela and what that will mean in a Tillerson-run State Department to our relationships in Latin America? When Tillerson’s qualifications are his contacts with state oil companies and the heads of state and bureaucrats where ExxonMobil has had commercial transactions, how do those relationships get realigned to the public good rather than the private enterprise, when his job is America and not ExxonMobil? And, I’m putting the little matter of his likely request for a special certificate to escape capital gains on cashing out $180 million in ExxonMobil shares for a huge tax break at the bottom of the list.

And, Tillerson may be one of Trump’s better nominees for all I know, but there’s no way it’s in the public’s interest to steamroll the process. It’s even bad politics.

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Three Treats on the Yucatan Peninsula

hanging bridge over mangrove forest

New Orleans   I’ve always wanted to visit the historic Mayan archeological sites on the Yucatan Peninsula, and if my father was still alive they would be on the top of my list of descriptions when he would ask, as he often did in his later years, that I tell him those things he would most like to know about where I had visited. I would also tell him more about industrial tourism than he would want to know from the rental car rip-offs to the hawkers at Chichen Itza to the weird way the airport disgorges arrivals to the industry, while offering no services, yet runs a mall on departures to get the your peso.

Besides the awe and wonder of the pyramids, there are a couple of special treats that I would share with him, and you, were you to visit, though it is unlikely that I will go again.

cactus growing up a tree

At the top of my personal list would be Jardin Botanico Doctor Alfredo Varrera Marin. My tribe and I like botanical gardens. Wherever we visit, if we can, we go to get a sense of the local flora and a private window into how the local culture sees their environment. We’ve visited such gardens all around the world from Amsterdam to London to our personal favorite in Rio de Janeiro and scores of others as well, so we know a little bit about what we’re talking about here. The Jadin Botanico is almost invisible right off the highway south of Puerto Morales, which also was one of the few beach towns we found that had not been totally industrialized yet, but, sadly, we’re sure it will be in another decade. The garden is 65 hectares with two kilometers worth of trails. It took us a bit more than an hour to navigate all of the main stops, though we wished we had had more time. The garden is well organized and immaculately maintained down to a leaf blower on the main trail, but natural at the same time as you walk in silence over roots and rocks on the paths. The signage is excellent, trees and plants are well labeled and overall the garden highlights sections for ferns, orchids, palms, succulents, and so forth, including observation towers that allow you to climb up and see this last stretch of mangrove and natural forest between Cancun and Playa del Carmen all the way to the sea, and leave the tower on a swaying wood and wire, hanging bridge. The garden has politics, too, including an excellent and educational look at chiclet production using some of the harvested trees they found and elucidating the lives and work of the chicleteros. There was also a Mayan altar found in the forest that allowed them to explore the issues there as well. Not surprisingly, we found that the garden was maintained by a women’s collective from a city much farther down the peninsula. We loved having the entire garden to ourselves, though we hope others find it in the future.

chiclet tree…X’s are the cuts to drain the sap to make the gum and not kill the tree

at Lagartos

We had left our morning at Chichen Itza and driven more than an hour and a half that day to the Ria Lagartos Biosphere Reserve. The town Rio Lagartos is at the eastern end of the coastal strip of the Yucatan Peninsula with the Gulf of Mexico at its northern edge. We didn’t take one of the many small motorboats where guides would get closer into the biosphere, but we loved the town and had our best meal of the trip sitting on a balcony eating fresh seafood in a steady breeze and watching pink flamingos through my binoculars across the water as they fed along the shore. Gorgeous and wild. Pelicans swooped down along with other birds and pairs of kites, the birds, not the plastic with string and tail, flew over us constantly. Although the guide books all say that you will see crocodiles, they are just confused because lagartos, meaning lizard, was originally what the Spanish called alligators to distinguish them from crocodiles, which they knew from Egypt and Africa, and in fact el lagartos became the English word, alligators, when Florida changed hands between the Spanish and the British, and the Spanish began using caimen in order not to confuse alligators for lizards which we find in the Grand Caymen Islands for example. Regardless, a deep dive into the biosphere might be one of the few treats that would bring me back to the Yucatan.

at Lagartos

at Lagartos

Last on my personal list was a trip at 6 am on the Punta SAM ferry from Isla de Mujeres to Cancun to fly back home. Leaving nothing to chance, we were second in line, arriving just before 5 AM, as the rope was lowered on a Saturday morning, knowing that if we missed the predawn trip, we would miss out flight home. The fast track for tourists is the passenger-only ferry at Puerto Juarez. This is a working ferry. There were already trucks parked and waiting overnight who were the main business of the boat. The dozen or so passenger cars and pickups were almost an afterthought to the big rigs. For an hour we were part of the islands’ community. The ticket collector put out instant coffee, Styrofoam cups, and constantly refilled hot water, and we joined the drivers in stirring a cup in the darkness of the predawn, as they chatted and joked, and in some cases woke from the seats of their trucks, while waiting to cross the water to work. The ferry crew managed to whistle and cajole the trucks and our few cars into the tight spaces for the 40 odd minute ride over. Even without a car, just being part of this, watching the loading, and the beauty of the sea crossing would be worth the trip form Punta SAM and a feeling of the authenticity of the island, before tourism overwhelmed it.

looking over the side as Isla de Mujeres shore retreats

My daughter would add snorkeling and swimming in a cenote, and if I had done either, they might be on this list as well, but the Mayan ruins and these three treats were more than enough for me and my companera.

close fits

working cargo

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Suggestions for the Anti-Inaugural

just some of the protests

Puerto Aventuras   Charles Blow, Louisiana native, New York Times columnist, and committed Trump resistor, wrote a piece on the Anti-Inauguration, as he called it. Blow made sure to point out that everyone needed to keep it positive, etc, etc, so that he could keep his day job, and you could keep yours in the uncertainty of regime change, but he threw a laundry list out there: protest, volunteer, donate, subscribe, read, watch, write, and connect.

Ok, some of this is a bit lame and spitting-in-the-wind, but his heart is good and his anger is real. Subscribe is about keeping the press alive. Read was a mild antidote to fake news. Watch was really just donate under another subhead and involved a California telethon or some such. Write is old school sending letters or emails to your local Congressperson, although between the lines Blow seems to be advocating a bit of hounding and stalking in this area, since he says, “Make them remember your name,” and that involves some persistence if you’re not sending them a big check. Connect is about lobbying your close friends and family, so good luck with that, but I would add that you should make sure you keep the paths cleared and the bridges in good repair so that you can make more progress once some smoke clears and the Trump body count builds and comes closer to home.

Now, protest, well that’s an opportunity worth a look in DC and closer to home, but frankly it’s not really enough, and I have to be honest with you, I’m not sure it’s effective right this minute. Take the Women’s March which is projected at one-hundred to two-hundred thousand, which is great, but from all reports, no demands, which makes it something of a “I am Woman, Watch me Roar” thing. That’s not bad of course, and certainly appropriate, but…there’s no way to get around the fact that protests, to be something more than symbolic, need real targets, real issues, where we can point out the rightness, and even morality of our cause, and where we are committed to hanging in until we win. There will be plenty of opportunities to come. In fact more than any of us – and our organizations – can handle.

Which brings me to “volunteer.” With tongue in cheek I’ve been talking about ACORN and our “volunteer army” for years, but I think there’s a lot that is real in that. My work in the Netherlands over the last quarter of 2016 convinced me of how much can be done when you can put up to 1000 volunteers to work on a campaign. ACORN’s own work around hospital accountability in the USA, electric cooperatives in the rural South, analysis of Bollere scandals in Africa, and banking practices in the United Kingdom has all been done 100% by volunteers. We are finding in our tenant organizing in Scotland and England that volunteers are able to organize new chapters all around the country and take action. I’ve touted the new book by Zack Exley and Betsy Bond on their experience with the Sanders’ campaign which points real directions in this area. If a couple of hundred to a thousand people would agree to volunteer even 20 hours a month, we could organize something different in this country, so, hey, call me maybe!

And, on the “donate” suggestion, I’m all for that, too, go directly to ACORN International  and it will show you how, and muchas gracias!

But, some things not on Blow’s list that anyone can do should include speaking out and reaching out.

Speaking out is hard, but it can’t be someone else’s job. It must be everyone’s responsibility now, and can’t be left to the victims. Injustice must be confronted and can’t be ignored, particularly when it is expressed as racism and misogyny. It’s time for no more Mr. or Ms. Nice on this. When it shows its face, it has to be named, shamed, and stopped.

Reaching out is going to be necessary for everyone as well. There will be millions of victims hit by the train wrecks coming our way from Washington soon. People are going to need help. It’s going to be complicated, obfuscated, and confusing. People are going to need a hand navigating the future for themselves and their families. Reaching out, you could make a difference. Find a way.

There’s no disagreement with Charles Blow on one count. There’s plenty to be done, and the time is now.

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The Sweet Sounds of the Street in the Mexican Pueblo

Puerto Aventuras   Ok, I’ve fretted about hawkers on some of the world’s most famous archeological sites in Mexico, the current and coming crisis around water for the burgeoning local – and tourist – population draining the Yucatan Peninsula dry, and the socio-spatial apartheid exclusion of Mexicans from their legally entitled access to beaches on the Mayan Riviera at the hands of industrial tourism, so why are we enjoying our time in Mexico and especially in this small pueblo so much? You simply have to love the people and especially the sweet sounds of the street in the community.

I’m not saying it’s for everyone, but sound in the streets is everywhere from the pre-dawn until late in the night. One of our favorites is the clown-car like horn for the helado or ice cream bicycle vendor as he slowly pedals up the side streets. The moto-taxis like to honk at each other as they pass on the street with a toot-toot wave of their own to their fellow drivers. The collectivo jitneys picking up service and hotel workers, already uniformed to head for neighboring resorts up and down the coast, all have a distinctive horn as they begin before 5 am and drop off after nightfall.

There is music everywhere in a low key battle of the bands from various businesses and casa to casa, house to house, as any walk along the few streets lined with small houses will greet you. The music is delivered, almost as a community service, from boom boxes in the front patios amidst cooking grills and hanging laundry in a symphony provided to someone’s own taste. In other houses, the streets are lit with the reflections of television screens from inside the front door, always on, but rarely being watched it seems.

Everyone is in the street all the time. Walking to work and walking back. Children playing. The sidewalks are for show, the street if for travel. When business is slow, a plastic chair sits in front of the open doorway of the establishment as the proprietor watches – and listens – as the world goes by.

And, then there are the loudspeakers built into the trunks of cars or on top of pickup cabs or protruding from back windows. The is a community outside of the range of television and internet advertising, so the hawking, whether for politicians or goods and services, is loud, direct, and sometimes even funny. In Mexico City we fell in love with the song of the junk dealers driving up and down and looking for whatever might be ready for them. In Puerto Aventuras, bread, vegetables, and fruit all have their carts or bicycle vendors with their own songs and shouts.

For several mornings we have heard a sermon of sorts down the block for an hour or two. No one minds. People proceed calmly within the cacophony of sounds. After a while it all becomes natural in the way one tunes out train whistles and ship foghorns near the train tracks and along the Mississippi River where we live in New Orleans. All of these are the sounds of security, safety, and community, and a reminder of how all of our communities may have been when they were loud with people out and about, rather than locked behind closed doors.

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