Wednesday, October 24, 2018

Medicare for all -- what is it? -- Oct. 11, 2018 column (posted belatedly, so out of order)

Candidate Donald Trump promised better, cheaper healthcare for all.
Just days before his inauguration, he said he’d deliver “insurance for everybody.” His plan to repeal and replace the Affordable Care Act would come “in a much simplified form – much less expensive and much better,” he told The Washington Post.
It never happened. About 28 million Americans remained uninsured last year, up from 27.3 million from 2016, according to a Census Bureau report released last month.  
Despite Trump’s repeated attacks, Obamacare keeps ticking. Nearly 12 million Americans signed up for coverage this year.
Trump finally did come up with an alternative, of sorts. His administration unveiled new rules in August to allow skimpy, low-cost, short-term insurance plans that critics called junk.
These plans lack the 10 essential health benefits required in ACA exchange plans. If healthy people choose the new plans to save money, it could raise insurance costs for sicker people in the plans, analysts warn.
Coverage of pre-existing conditions -- the most popular element of Obamacare – animates many midterm contests, as House Republicans who voted to repeal Obamacare scramble to assure voters they’ll protect that coverage.
Emerging in the midterms and likely a hot issue for the 2020 presidential race is “Medicare for all.”
Asked if they support Medicare for all, seven in 10 people said they do, a Reuters-Ipsos poll in August reported. That includes 85 percent of Democrats and 52 percent of Republicans.
But what, to paraphrase Freud, do consumers want?
“Medicare for all” is shorthand for a range of plans.
Medicare for All – with a capital A -- would throw out the current employer-based health insurance system and replace it with a single-payer, government plan. It is what Sen. Bernie Sanders, independent of Vermont, proposes. 
But Medicare for all -- lower case a – could describe various national plans proposed by Democrats that would move incrementally toward universal healthcare coverage.  
Two questions in a Kaiser Family Foundation survey in March illustrate how wording of the question matters.
Asked: “Do you favor or oppose having a national health plan, or Medicare-for-all, in which all Americans would get their insurance from a single government plan?” about 60 percent said they favor it.
But when asked about “having a national Medicare-for-all plan open to anyone who wants it but people who currently have other coverage could keep what they have,” support surged to 75 percent.  
Sanders, who first introduced a single-payer bill in 1993, is not as lonely as he once was. His Medicare for All bill has about 15 cosponsors.
About 70 Democrats in Congress have formed a Medicare for All Caucus, and a Democratic House member from Washington state announced a Medicare for All PAC to back candidates financially. 
On his website, Sanders is unequivocal: “Health care must be recognized as a right, not a privilege . . . The only solution to America’s health care crisis is a single-payer national health care program.”
The sticking point, of course, is the cost. Sanders insists individuals would save money on insurance and medical bills, but both the liberal Urban Institute and libertarian-leaning Mercatus Institute at George Mason University estimated federal expenditures would rise at least $32 trillion in the first 10 years.
The Congressional Budget Office has not run estimates, apparently because Sanders’ plan has so little chance in the Republican-controlled Congress.
As president, Barack Obama backed away from a single-payer plan, but he now calls Medicare for all a “good new idea.”
Democratic Sens. Tim Kaine of Virginia and Michael Bennet of Colorado are cosponsors of Medicare X, a phased-in plan that would allow all Americans to buy into Medicare. Starting in counties where the ACA exchanges lack competition, it  would open nationwide in 2023 and to businesses in 2024.
Corey Stewart, Kaine’s Republican opponent for the Senate in November, promises “full repeal” of Obamacare.
Critical to the debate is the 56 percent of Americans who get health insurance through their employers. In a strong economy, they may have little incentive to switch to a government plan.
Virginians as well as voters in other states soon will start deciding what Medicare for all might mean for them.
©2018 Marsha Mercer. All rights reserved.

Ireland's literary, historical feast still inspires -- Oct. 25, 2018 column


Joe lifted the wire-rimmed eyeglasses from a small wooden desk and held them as tenderly as he would a religious relic.

“These were his,” he said, “and this was his desk.”

Joe, a guide at the Yeats Memorial Building in Sligo, Ireland, was giving two American tourists an impromptu tour of an exhibit on poet William Butler Yeats’s family and the people and places that influenced him.

Nobody was around, so Joe let me sit at the desk, briefly.  

Since I fell in love with Yeats and James Joyce in college, I’d wanted to visit Ireland. I was thrilled to find my literary lights undimmed, but I never dreamed I’d sit at Yeats’s desk. That was magical.

When the Irish refer to a “full Irish,” they mean a big breakfast, but my traveling partner and I had a full Irish literary and historical feast this month.  

For two weeks, traveling independently by train, bus and on foot, we visited many sites dedicated to keeping alive the memories of Irish authors and of patriots who gave their lives for Irish independence. We saw ancient treasures, forts, churches, national parks and stunning scenery – more often than not on dry, sunny days we were assured were “unIrish weather.”

Yeats, who lived from 1865 to 1939, spent much of his boyhood in County Sligo, his mother’s home in the country’s northwest. After the tour and lunch at Lily’s and Lolly’s CafĂ©, named for his sisters, we hired a taxi to visit Yeats’s gravesite just outside town.

Yeats wrote his own epitaph -- “Cast a cold Eye on Life, on Death. Horseman, pass by.” -- for his gravestone that faces photogenic Drumcliffe Church and also Benbulben, the dramatic mountain beneath which he wished to be buried.

Our driver, a quiet, older gentleman named Gabriel Doherty, turned off the meter and told us to take our time visiting while he had a cup of tea in the tea shop nearby.

In the stone church, I was warmly greeted by a tall, bearded man in a cassock. He showed me a brass plaque honoring Yeats’s paternal grandfather, who was rector in the 19th century. We talked about the importance of remembering history.

Doherty then kindly offered to take us to Glencar Waterfall, which figures in the Yeats poem, “Stolen Child,” and he went out of his way so we could take pictures of majestic Benbulben. 

Ireland celebrates its literary and historical heroes unapologetically and without angst. It’s a stark contrast with the very American urge to examine fully the faults in our past.  
After suffering severely under British rule, Ireland ultimately gained independence and became a republic after the bloody Easter Rising of 1916. Rebels seized the General Post Office building in Dublin, and their leader, Patrick Pearse, a poet himself, read the Proclamation of Independence there on Easter Monday. Executed by British firing squad, Pearse became a martyr.

Today, the GPO Museum tells the Easter Rising story poignantly and dramatically. Posters of the proclamation are all over the city, so people never forget.

At the National Library of Ireland, the “Yeats: The Life and Works of William Butler Yeats” exhibition opens in a space where you hear recordings of Yeats himself and others reading his poems before you explore the exhibits.

Yeats and the three other Irish writers who won the Nobel Prize for Literature are among authors celebrated in the Writers Museum. The James Joyce Centre a few blocks away tells the novelist’s story.

“The Dead,” a 1987 movie directed by John Huston based on Joyce’s masterful short story, plays on a loop. In the courtyard is the original door from No. 7 Eccles Street, Leopold Bloom’s address in “Ulysses.” The house was demolished but the door was saved.

On our last full day in Ireland, we lucked into a taxi whose driver attended the same Jesuit high school as Joyce -- Belvedere College -- and is a writer. Driving slowly past the school, he asked if we’d seen the statue of playwright Oscar Wilde in Merrion Square with his quotes. We hadn’t.

“You must,” the driver insisted. “If you aren’t inspired, you aren’t alive.”

He was right, of course. The statue was colorful and the quotes thought-provoking – just like Ireland.

©2018 Marsha Mercer. All rights reserved.

Wednesday, October 3, 2018

Supremes take up case of endangered frog -- Oct. 4, 2018 column


As the Brett Kavanaugh saga played out, it was reassuring to see the Supreme Court at work and focused on, of all things, the fate of a frog.

This was not the Celebrated Jumping Frog of Calaveras County made famous by Mark Twain but the endangered dusky gopher frog, now found only in Mississippi. The frog gets its name from the gopher tortoise holes where the mature frog lives.

The first oral argument of the court term Monday weighed the federal government’s responsibility to protect critical habitat of an endangered species under the Endangered Species Act against the rights of landowners. 

Historically the dusky gopher frog (Rana sevosa) lived in Louisiana but was last seen there in the mid-1960s. It was declared endangered in 2001, and the U.S. Fish and Wildlife Service designated 1,544 acres in St. Tammany Parish in Louisiana as critical habitat in 2012.

The property has ephemeral or temporary ponds where the frog could breed, making the land necessary as a Plan B should efforts to save the frog in Mississippi fail, the government said.

But the land is a commercial tree farm, leased to Weyerhaeuser Co., and thickly planted in loblolly pines. Gone are the canopy of longleaf pines and the grassy understory the frog needs, but the government says the land is “restorable with reasonable effort.” 

The landowners, who want to develop the parcel, say the critical habitat designation has cost them $34 million. After six years of legal battles, the case, Weyerhaeuser Co. v. U.S. Fish and Wildlife Service, landed in the Supreme Court.

It’s risky to draw conclusions from questions at oral arguments, but three of the four conservative justices seemed sympathetic to the landowners who want the government to butt out. Justice Clarence Thomas, as usual, asked no questions. The four liberals seemed sympathetic to saving the frog.

But, Lisa Heinzerling, law professor at Georgetown University Law Center, wrote in her analysis on “It was not even clear whether the justices were puzzling mainly over whether the Louisiana parcel was `essential’ to the conservation of the frog or over whether it was `habitat’ at all. The case seems more complicated after today’s argument than it seemed before.”

The frog case came to the court as the Endangered Species Act is under assault from President Trump and House Republicans.

The administration has proposed three changes in how federal agencies implement the act. In a letter Sept. 24, three professional organizations – the American Society of Mammalogists, Society for Conservation Biology North America and American Ornithological Society wrote:  

“We strongly believe that if these three proposals are enacted, they will severely weaken protections for endangered and threatened species and, counterproductively, could result in more extinctions of plants and animals in the United States.”

House Republicans are pushing a package of bills they say will “modernize” the act but which environmentalists say will ruin it.

The bills “undermine key provisions of the Endangered Species Act and result in increased harm to protected species and their habitat,” Robert G. Dreher of Defenders of Wildlife told a Sept. 26 hearing of the House Committee on Natural Resources. 

He called the package “a prescription for extinction.”

But many Republicans, especially those from Western states, view the act and other environmental laws as impediments to development.

When his committee approved the bills, House Natural Resources Chairman Rob Bishop, R-Utah, said “these bills honor our heritage, lighten regulatory burdens for communities, increase transparency, and strengthen relationships between states and the federal government. Ultimately, these bills aim to bolster our country’s natural resources.”

The frog case reflects the importance of the swing seat held for decades by Justice Anthony Kennedy. If the court splits four-four, the 5th Circuit Court of Appeals decision in favor of the Fish and Wildlife Service’s support for the frog would stand. 

But once the ninth justice is confirmed, the court could order new oral arguments. Conservative Kavanaugh likely would be the swing vote.

And that is why those who care about a little frog may be breathing a bit more easily -- but only for now.

©2018 Marsha Mercer. All rights reserved.