How Access to Abortion Has Been Federally Limited

Published by Anonymous (not verified) on Mon, 13/11/2017 - 4:51am in

 Guttmacher Institute

When Roe v. Wade made abortion legal for all women in 1973, Medicaid covered abortions just like other health care procedure. But three years later US Rep. Henry Hyde (R-IL), an abortion foe, attached an amendment to a Department of Health and Human Services appropriations bill to ban the use of Medicaid funds to provide abortions.

Hyde knew this would put abortion out of reach for many low-income women. “I certainly would like to prevent, if I could legally, anybody having an abortion — a rich woman, a middle-class woman or a poor woman,” Hyde said at the time. “Unfortunately, the only vehicle available is the … Medicaid bill.” In the 1990s three very narrow exceptions were added to Medicaid coverage of abortion: if a woman’s life is at risk, or if her pregnancy is the result of rape or incest.

The Hyde Amendment, which blocks federal funding for abortion services, was passed in 1976 and upheld by the Supreme Court in 1980. The legislation affects low-income women and particularly women of color who depend on Medicaid, the joint federal-state program that provides basic health-care services to people with limited resources. It is no accident that the most vulnerable women have the least choice.

Women of Color More Likely to be Uninsured or Covered by Medicaid, 2012 — Graph from Kaiser Family Foundation

The Hyde Amendment impacts all federal programs that provide or pay for women’s reproductive health services, including federal prisons and ICE detention centers; the Peace Corps; Indian Health Services; the Federal Employees Health Benefits Program; and the US military’s TRICARE program. There is also language in the Affordable Care Act that restricts the abortion coverage in plans sold through the marketplace and for women who receive federal income-based subsidies to buy private health insurance.

When women are denied abortion coverage by federally funded health-insurance programs, they often don’t have the money to pay out-of-pocket. In-clinic surgical abortions can cost up to $1,500 in the first trimester, or $3,000 in the second trimester. The cost in a hospital is often more. The abortion pill, known as a medication abortion, can cost as much as $975. According to the Guttmacher Institute, the average cost of a first-trimester surgical abortion in 2011 was $480, and an early medication abortion was $504. Nearly 60 percent of the women who delayed their procedures said it was because they had to raise the money or search for a low-cost provider. Others divert money that they and their families need to live on. In addition to the expense of the procedure, there is the cost of travel and missing work. One in four women is forced to carry her unwanted pregnancy to term.

The Hyde Amendment added a temporary “rider” to the Medicaid funding bill that is approved by Congress every year. And every year low-income women in general, and low-income women of color in particular, are disproportionately denied coverage to end unwanted pregnancies, except in extreme cases. Medicaid is the largest source of health-care funding for low-income and poor people in the United States. One in five of all women of reproductive age depend on Medicaid’s sexual and reproductive health services. In 2015, 31 percent of this group was black, 27 percent was Hispanic and 16 percent were white.

State Funding
While the Hyde Amendment bars Medicaid from using federal funds to cover abortion, states may use their own nonfederal funds. Seventeen states have a policy requiring the state to provide abortion coverage under Medicaid, but according to the Guttmacher Institute, just 15 states appear to be doing so in practice. In September 2017, Illinois became the first state in decades to enact a law that expanded Medicaid and state employee insurance to cover abortion.

Sixteen percent of the US military — more than 355,000 individuals — are women, most of whom are in their childbearing years. According to a military study last year, the rate of unwanted pregnancy in the armed services ranges from 50 to 62 percent, the same as in the civilian population.

TRICARE, the military health care program for service members, reservists and dependents, is supposed to cover birth-control pills and other forms of contraception, but access can be challenging. A study conducted in 2013 found that, among the women they surveyed, one-third could not get the birth control they wanted before deploying, and 41 percent had trouble refilling prescriptions while on duty. Getting pregnant is taboo “in theater,” when a woman is actively deployed, and it can derail her career. Even so, Congress made the ban on funding abortion services for servicewomen and their dependents permanent in 1984, except for life endangerment. An amendment introduced by Sen. Jeanne Shaheen (D-NH) in 2012 extended the coverage to cases of rape or incest. In all cases, the Department of Defense bans military treatment facilities from performing abortions, even if the patient pays out of pocket.

Indian Health Service
Some 2 million Native Americans get their health care from the Indian Health Service (IHS), which is funded through the Department of Health and Human Services. The IHS is often the only option on a remote reservation, but the federal government will allow abortion coverage only if a woman’s life is at risk or in cases of rape and incest. Even then, according to a 2014 report, 85 percent of the IHS Service Units the researchers contacted were out of compliance with the IHS abortion policy. Many IHS clinics do not have abortion facilities at all. For rural Native women the trip to a city to terminate a pregnancy can be prohibitively expensive, requiring transportation, often a waiting period, and overnight lodging.

Peace Corps
There are some 7,200 US citizens who volunteer for the Peace Corps. Of them, 63 percent are women. But until recently the federal government has prohibited coverage, with no exception, for abortion services requested by volunteers or trainees — many of whom live on a monthly stipend of $250 to $400. In 2015, coverage was expanded to include cases of rape, incest or life endangerment. If a volunteer decides to pay out-of-pocket for an abortion, however, there are no restrictions on funding a medical evacuation to a location where abortions are legal and there are adequate medical facilities.

Financial Help
For women struggling with the financial burden of an abortion procedure, there are organizations that offer help.

Although Medicaid covers abortion procedures in certain states, for most, that is only the case when a woman seeking an abortion became pregnant as a result of rape or incest, or is in a life-threatening health condition as a result of her pregnancy.

Clinics offer some financial assistance and there are local organizations in many states that offer help. The National Network of Abortion Funds helps women cover the cost of an abortion in 38 states. Some of the financial help NNAF provides is for the costs associated with an abortion beyond the procedure itself, such as travel, child care, lost work hours, feminine pads and pain medication for the recovery period.

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The GOP’s Big Problem Is Big Money

Published by Anonymous (not verified) on Fri, 06/10/2017 - 3:05am in

This post originally appeared at The American Prospect.

There are lots of explanations for why Republicans have backed themselves into a corner both legislatively and politically, unable to either enact an agenda or to contain a populist uprising that now poses as great a threat to GOP incumbents as it does to Democrats. The most obvious issue is that the GOP’s intransigence, anti-government attacks and culture wars have unleashed a monster that Republicans can no longer control. But another, less apparent, problem that helps explain the GOP’s vicious cycle of paralysis and unpopularity has to do with big money.

As the champions of campaign-finance deregulation and unrestricted corporate spending, Republicans on Capitol Hill are now more in tune with their billionaire conservative donors than with the average GOP voters who rallied behind Trump. This shows up in both the shelved GOP health-care bill and in the pending Republican tax overhaul, which both cater to ultra-wealthy donors while ignoring that most Republicans actually support Medicaid and do not favor cutting taxes for the rich.

RELATED: Democracy & Government

Demonstrator Randall Grey protests a taxation of the wealthy during a rally at Occupy Wall Street San Diego on Oct. 13, 2011 in San Diego, California. (Photo by Sandy Huffaker/Corbis via Getty Images)

How Did We Become A Billionaires’ Republic?

BY Jedediah Purdy | July 21, 2017

Ousted Trump strategist Steve Bannon gestured to Republicans’ money problem on Tuesday, when GOP incumbent Luther Strange lost the Alabama primary to Christian conservative zealot Roy Moore in a stunning rebuke to the party establishment. Big spending outside groups allied with McConnell had spent more than $10 million to defeat Moore. “Who’s sovereign, the people or the money?” Bannon asked at Moore’s victory party.

Moore’s upset doubly stung Republicans because Trump had backed Strange, and because it coincided with the demise of GOP senators’ latest bill to repeal Obama’s signature health-care law. Both the primary and the GOP health-care failure are emboldening ultra-conservatives bent on challenging Republican incumbents in Senate primaries. This could make it easier for Democrats to pick up seats in the 2018 midterms, since some far-right Republicans could win primaries but prove too conservative to win a general election.

Vulnerable Senate Republicans, such as Jeff Flake of Arizona, and Dean Heller of Nevada, already face primary challenges from the right. Nasty and potentially costly primary battles could also be shaping up in Mississippi, Texas and Tennessee, where incumbent Sen. Bob Corker announced his retirement last week. Waiting in the wings to bankroll some of these challengers are deep-pocketed conservative donors like hedge-fund tycoon Robert Mercer and his daughter, Rebekah, a part owner of the far-right Breitbart News Network. The Mercers backed Moore in the Alabama primary, though they spent far less than McConnell and his allies.

This probably isn’t what McConnell had in mind when he helped convince the Supreme Court in 2010 to lift all limits on corporate political spending in its Citizens United v. Federal Election Commission ruling.

This probably isn’t what McConnell had in mind when he helped convince the Supreme Court in 2010 to lift all limits on corporate political spending in its Citizens United v. Federal Election Commission ruling. The GOP calculus back then appeared to be that Republicans would have an easier time winning over corporate sugar daddies than Democrats would. Now some ultra-conservative billionaires are helping bankroll primary challengers in McConnell’s own party.

Big donors reportedly also played a key role in Republicans’ decision to hustle through a deeply flawed Senate bill to repeal the Obama health care law. Republican lawmakers are fond of warning that GOP voters will punish them if they didn’t follow through on their promises to repeal “Obamacare.” But behind the scenes, disappointed mega-donors appear to be the ones driving the repeal train. GOP governors and voters actually now broadly support Medicaid’s expansion, says Richard Fording, a political science professor at the University of Alabama, who noted that attacks on Obama resonate less with GOP voters now that he is no longer president.

“Just because you promised it six years ago doesn’t mean you have to follow through on it if voters changed their minds,” says Fording of the Obamacare repeal effort. Republicans, he added, “should be concerned about the election that’s happening in 2018, and not the one that happened in 2010.”

Congressional Republicans may also find it hard to sell to their party’s populist wing on a tax plan heavily tilted toward slashing taxes for corporations and the wealthy. The big-spending conservative group Americans for Prosperity, backed by the billionaire industrialists Charles and David Koch, is gearing up to spend millions to back the GOP tax overhaul. Yet large percentages of Republican voters favor raising corporate tax rates, not lowering them, and a majority think that taxes for those earning $250,000 a year should either stay the same or be raised.

It remains to be seen whether Democrats can capitalize on Republicans’ self-inflicted legislative failures and intra-party power struggles. Democrats have their own internal battles and cozy ties with big donors, while 10 Democratic senators are up for reelection in states won by Trump last year. But every GOP primary brawl drains Republican resources and creates a potential opening for Democrats. The Democrats’ ridicule of the GOP tax plan as “welfare” for the rich has a populist ring that is tailor made for the growing ranks of GOP primary challengers seeking to oust incumbent Republicans.

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Chris Sterry Reblogs Article in Autism Magazine on How American Parents Can Get Help

Published by Anonymous (not verified) on Wed, 27/09/2017 - 1:23am in

One of the great commenters on this blog, 61chrissterry, also blogs himself about disability issues. Looking briefly at his site just now, I found an article he’d reblogged from Autism Parenting, an American magazine for the parents of children with Autistic Spectrum Disorders. These disorders cover autism, which can vary greatly in terms of severity, and Asperger’s, which is now increasingly seen as simply high-functioning autism. It’s a condition that affects many children. The current policy is to include autistic children, except when severely disabled, in mainstream schools, and teacher training now includes course on special needs children. These include autistic, dyslexic and children with Attention Deficit Disorder. The article in the magazine discusses ways parents can get help. It talks about the social security budget and the available funding for children with autism, and Medicaid. The article is about a course the writer attended in South Carolina.

I don’t know if this will be any help to anyone over the other side of the Pond with an autistic child, or has friends or relatives that do. But I mention it because it might, and it may interest British and European readers, who want to keep informed about what is going on internationally in the way autistic people are being treated by the state.

My Sister Served in the Army. The Biggest Threat to Her Survival is Congress.

Published by Anonymous (not verified) on Fri, 15/09/2017 - 4:00am in

This post originally appeared at Talk Poverty.

RELATED: Democracy & Government

Mary Mayhew, commissioner of Maine's Dept. of Health & Human Services (left) and Gov. Paul LePage answer questions during a news conference to announce changes to the MaineCare system in Augusta, Maine, on Dec. 6, 2011. (Photo by Joe Phelan/Portland Press Herald via Getty Images)

The War on Medicaid Is Moving to the States

BY Greg Kaufmann | September 5, 2017

My older sister, Lynn, was always getting into trouble when we were kids. I was the goody two-shoes in the family, but if I did ever get myself in trouble, she’d get in even more trouble to help me out. She was a good sister in that way — always looking out for me. When I was little, I didn’t like to sleep by myself during thunderstorms, and she’d let me crawl into bed with her because she knew I was afraid.

Now, in some ways, I’m her big sister. I do my best to take care of her.

Lynn — a 62-year-old army veteran — cannot walk. Her dementia makes it impossible for her to remember to take her medicine. Her forgetfulness has life-or-death implications, since she has diabetes, high blood pressure and high cholesterol. As a result, Lynn has been in a nursing home for the past four years. Medicaid pays the bills for that — just like it does for most people who need nursing home care — and I’m terrified of what would happen without it.

She’s not trying to take more than her fair share of the pie.

Lynn joined the army right out of high school. When she was in boot camp, she had a traumatic head injury during basic training. The military doctors held her for observation, diagnosed her with a concussion and then released her. She served her time as a private, then was honorably discharged and got married.

A few years later, she was struck by a car. She was at a crosswalk, and the car in front of her stopped to let her cross. But the car behind it was impatient, so it swerved around the first car, plowing into the crosswalk and hitting my sister. That left her with her another traumatic head injury, as well as the beginning of hip problems that will plague her for the rest of her life.

RELATED: For the Record

An elderly woman shows her gratitude to President Lyndon B. Johnson for his signing of the Medicare health care bill in July 1965. (Photo by © CORBIS/Corbis via Getty Images)

LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’

BY Bill Moyers | July 30, 2017

Over time the hip problems worsened, until she finally had a hip replacement in her mid-50s. She was able to walk without pain for a while, but she then contracted a MRSA infection in her new hip joint. That can happen with artificial joints — it’s rare, but once you have the infection it’s hard to remove. Lynn’s infection spread quickly, and it almost killed her. Doctors tried to treat her with some very powerful drugs at first, which made her thoughts so fuzzy that she said her brain was buzzing.

Eventually, doctors had to remove her hip bone to control the MRSA. Medicaid paid for this surgery, too — otherwise, we wouldn’t have been able to afford it.

Just four years ago, Lynn was working multiple jobs to put her daughter through college: in the cafeteria at her daughter’s school, at Walmart and at a deli. Now Lynn can no longer walk, or work. The doctors say the drugs impaired her brain and made her dementia onset much more quickly.

But this isn’t a sob story. I don’t want you to feel bad for her, or take pity on her. Lynn is still the same person I’ve always known, full of life and warmth. She can break the tension in a moment better than anyone I know. I still remember a moment a few years ago, when she was recovering from her first hip surgery. She flew into Washington, DC, to visit us, and we were trying to get her out of baggage claim and into the elevator in her wheelchair. The doors started to close, and nobody wanted to hold them — she was far away, and she was moving so slowly. But she shouted, “I’m coming as fast as I can!” across the airport. They actually held the door for her. In the elevator, she chatted with them amicably, asking how their Christmas was going. Strangers were smiling and talking to her — that’s a rare sight in DC.

Lynn would be lost without Medicaid. She served her country and worked hard to provide for her family. She’s not trying to take more than her fair share of the pie. She’s just somebody who needs care — and she didn’t expect to need the care that she needs as young as she is.

When our elected representatives decide to cut Medicaid — whether through repeated attempts to repeal the Affordable Care Act or a budget that cuts $3.6 trillion from services such as Medicare and Medicaid — they should think about what this means to people like me and my family. They should think about Lynn, and the millions of other veterans who have turned to Medicaid.

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The War on Medicaid Is Moving to the States

Published by Anonymous (not verified) on Wed, 06/09/2017 - 4:00am in

This post first appeared at Talk Poverty.

In the early 1960s, as the Kennedy and Johnson administrations worked to enact Medicare and Medicaid, then-actor Ronald Reagan was a spokesman for the American Medical Association. He made a recording that warned of the dangers of the legislation — it was distributed to small gatherings across the country. “Behind it will come other federal programs that will invade every area of freedom as we have known it in this country,” said Reagan. “Until one day … you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

Reagan set the tone for a conservative war against Medicaid that is now in its 52nd year. Recent congressional proposals to repeal and replace the Affordable Care Act would have reduced Medicaid enrollment by up to 15 million people, and, despite being defeated, congressional Republicans aren’t done yet: It’s likely they will attempt to gut the program during the upcoming budget debate. Meanwhile, more than half a dozen conservative governors are trying to take a hatchet to the program — at the open invitation of the Trump administration — through a vehicle known as a “Medicaid waiver.”

RELATED: For the Record

An elderly woman shows her gratitude to President Lyndon B. Johnson for his signing of the Medicare health care bill in July 1965. (Photo by © CORBIS/Corbis via Getty Images)

LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’

BY Bill Moyers | July 30, 2017

Waivers are intended for state pilot projects designed to improve health care coverage for vulnerable populations. But that’s not what conservative governors are pursuing. In Maine, for example, as citizens prepare to vote on a referendum that would force the state to expand Medicaid to 70,000 people, Gov. Paul LePage (R) is moving in the opposite direction. His Department of Health and Human Services has requested permission to create a 20-hour-a-week work requirement, impose copays and premiums, and implement a $5,000 asset cap on Medicaid beneficiaries. The result, health care experts warn, will be that low-income people in Maine will be kicked off the program.

LePage’s administration argues that the work requirement will help people earn more and become more self-sufficient. But according to Hannah Katch, a senior policy analyst at the Center on Budget and Policy Priorities and a former administrator of the California Medicaid program, 80 percent of Medicaid patients nationwide are already in working families. “The vast majority of people who aren’t working are either taking care of a family member, have a physical or behavioral health condition, or are in school, or have a combination of these factors,” said Katch. “While a work requirement is unlikely to help them get a job, it is very likely to take away health coverage from people who can’t work.”

While Maine’s application specifies categories of exemptions for the work requirement — including for individuals receiving treatment in a residential substance abuse program, caring for a child under age 6, or who are “physically or mentally unable to work” — Katch said that the exemptions are likely to be difficult to obtain. “The burden could fall on an individual to prove their exemption,” she said. “If a person is low-income and has a disability, or a substance abuse disorder, or has young children — proving an exemption in a specified time period with the proper and often extensive documentation can be really difficult.” As a result, Maine’s work requirement would likely result in a much broader population being kicked off of assistance than intended — or at least than explicitly intended. (Maine Department of Health and Human Services did not respond to requests for comment.)

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Rally in Support of the Affordable Care Act at the White House on Feb. 25, 2017. (Photo by Ted Eytan/ flickr CC 2.0)

Maybe This Is the Article That Will Convince You Not to Cut Medicaid

BY Katie Fernelius | June 20, 2017

Of equal concern is the people who likely wouldn’t qualify for an exemption under Maine’s proposal. Previously, the state allowed a limited Medicaid expansion for women with low incomes who need family planning services, and for people who are HIV-positive. Katch said that these are two of the groups who could be deemed “able-bodied” and required to work for their coverage — people who clearly need consistent access to their medications. (Low-income parents and young adults aging out of the foster care system are also of particular concern.)

Direct service providers in Maine share Katch’s apprehension. Kara Hay is CEO and president of Penquis community action agency, which serves approximately 17,000 people annually through 80 programs across the state, including Head Start and child care, legal aid, housing, transportation, business training and financial support, health care assistance and more. Hay said that the state’s waiver request “is not new, innovative or designed to deliver care more efficiently” to low-income people, as waivers are supposed to be. In addition to a work requirement that offers no access to transportation, child care or training — common barriers experienced by her agency’s clients — Hay takes issue with the state’s proposal to force people with little to no money to pay co-pays and premiums, and to deny coverage to people with $5,000 or more in assets. Maine used asset tests for public assistance programs for 40 years and they were “complicated to administer, devilishly inefficient, and problematic to document,” Hay said. “They often cause people who would be eligible to give up during the application process.”

That seems to be LePage’s ultimate goal: forcing people out of the program.

Another problem with Maine’s proposal is that with far fewer people having Medicaid coverage, the costs of caring for the uninsured will fall on “rural hospitals and providers — who are the least capable of absorbing these additional costs,” Hay said. “It unintentionally sets up the foundation for a collapse in rural health care. It’s a recipe for escalating rural decay.”

Maine is not the only state trying to tighten its Medicaid requirements. Wisconsin, Kentucky, Utah, Indiana, Arizona, and Arkansas have requested similar waivers. Health and Human Services Secretary Tom Price and the administrator of the Centers for Medicare and Medicaid Services, Seema Verma, have made clear that waivers granted to one state will be an option for other states. That means that for now, the front lines in the conservative war on Medicaid are in the states, where the fight might be a little quieter than in Washington, but equally dangerous.

This article was produced in partnership with The Nation.

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Why Down Under Comes Out on Top in Health Care

Published by Anonymous (not verified) on Wed, 09/08/2017 - 3:21am in

When I arrived in New York as a young journalist from Sydney, Australia in 2003, not even the dazzle of the big city could conceal the extent of my surprise over three conditions of American society.

One, the racism that still played out; a dark underbelly of a nation painted on the resigned faces on the 4 subway as I traveled home to Crown Heights every day. Two, the air of individualism you could smell on the streets. Yes, there were the Wall Street financiers, but it was everywhere — in the delis, on the bikes of restaurant delivery boys peddling furiously into the night. It seemed to whisper, “Hey girl, you might make it if you try hard enough, but you’re on your own now, good luck!”

There’s good reason why American politicians are gushing over health care down under. Bernie Sanders was back at it again on the Senate floor last week, and even Donald Trump has praised Australia’s health care system this year. Here’s why.

— Christine Kearney

And then finally, there was the American health system. If the first two issues were steeped in American history, health care seemed different. To the outsider, it was nearly unfathomable why the most prosperous nation on earth had not fixed a decades-old problem, that was only becoming a costlier and increasing burden as each year passed.

We had all heard about it. Horror stories spread back home of Australians who had forgotten to take out travel insurance in the US only to end up with six-figure hospital bills. But it was different when right before my eyes — back then some 45 million people carrying the burden of being uninsured. (Little did I know I would soon join them.)

Despite coverage of 2003’s Medicare Prescription Drug, Improvement and Modernization Act, when I quizzed American journalists why there were not more stories, why there didn’t seem any sense of urgency to overall change, I would often be met with a small shrug, and resignation that all those stories had been done before. Change had failed. It wasn’t a scoop.

If that was the sense among some journalists, I still wondered why the public wasn’t more restless. I had to conclude many everyday Americans were simply clueless about how other countries worked.

But now, they’re beginning to know. A couple weeks ago, Americans heard Bernie Sanders gush how Australia’s universal health care is wildly more efficient and effective than America’s. Sanders told the Senate floor: “Not only does Australia guarantee universal health care, spend less on health care per capita, and pay less than we do for many health services, they have better health outcomes.”

Sanders was capitalizing on Donald Trump admitting back in May to a visiting Australian Prime Minister Malcolm Turnbull, “you have better health care than we do.” Yet analysts say the now defeated “skinny repeal” of Obamacare Trump backed would have made the US system less like Australia’s, not more. And Democrats have rightly pointed out the Australian system includes a publicly funded Medicare system far more comprehensive than America’s that covers all ages.

This isn’t refutable. Study after study ranks America way down and Australia among the best overall health care in developed nations. Just two weeks ago, a new study by a team of American researchers found the United States spends far more on health care than other high-income countries, with spending levels rising continuously over the past three decades.

A recent study by the Commonwealth Fund think tank compared the quality of health care systems of 11 high income countries based on 72 indicators, ranking Australia’s mixed public-private system among the top three overall, along with the UK and The Netherlands. It also ranked highest on Administrative Efficiency and Health Care Outcomes.

Despite the praise, Australia’s health care system still depends on a mixed market structure (like the US), using both public and private sectors to provide funds to deliver health care. And it’s not without its failings, including sliding down the world rankings on equity, with people in rural and poorer areas less able to access quality health care, and in general out-of-pocket costs for everyone continuing to increase.

The federal government funds Medicare, a universal public health insurance program providing free or subsidized access to care for Australian citizens…Private health insurance (PHI) is readily available and offers more choice of providers, faster access for nonemergency services, and rebates for selected services.

— The Commonwealth Fund

But that is little consolation for the US, which ranked last overall, last in access, equity and health care outcomes, and next to last in administrative efficiency, as reported by patients and providers. Only in care process did it perform better, ranking fifth.

The authors concluded: “Despite spending nearly twice as much as several other countries, the country’s performance is lacklustre.”

That America’s health care system overspends isn’t exactly news to Americans.

But the tendency to reject change isn’t just politics, say analysts, it’s also human nature, whether in Australia or America.

RELATED: Money & Politics

A small group of activists rally against the GOP health care plan outside of the Metropolitan Republican Club, in New York City on July 5, 2017.. Republicans in the Senate will resume work on the bill next week when Congress returns to Washington after a holiday recess. (Photo by Drew Angerer/Getty Images)

The Battles Ahead: Meet the Biggest Opponents of Single-Payer

BY Michael Corcoran | July 7, 2017

“There’s the human tendency to get used to the benefits you have, or the system you have,” says Australian-American relations expert, Associate Professor Brendon O’Connor of the Sydney-based think tank The US Studies Centre.

Another underlying reason Americans might have difficulty changing their thinking on health care could be buried in the second of my initial observations in New York — the overall effects of such a free-market leader, he noted. Not least the view that Australians see health care as a right, while in America’s that’s still debatable.

O’Conner believes that is why in America “you have some of the world’s best health care, and you also have some of the biggest gaps in coverage.”

“It goes to a little bit to the heart of America as a more free-market, laissez faire, more capitalist society,” he said. “The idea of a government providing a one-stop shop for health care like the United Kingdom, or even like ours, I would argue is an anathema to American values and traditions.”

Still, while for now a Republican-controlled Congress is hardly going to push for an increase in the government’s role, O’Conner believes “something is sort of changing” and any new president and new Congress might give hope to more universal health care.

“People realize it’s a very expensive system, it doesn’t cover as many people or [offer] benefits like other systems in the western word, so a little bit of comparative analysis rightly leads American politicians and a lot of policymakers to think, ‘Hang on, this system isn’t all its cracked up to be and it’s got a lot of faults.’”

In the meantime, while America’s health care system remains broken, it still plays an important role in Australian politics.

“The American model is presented as bit of monster, politically, in campaigns,” said O’Conner. “It’s one of those good examples of America being a kind of dystopia or disfunction that Australians want to avoid. It’s been a pretty regular trope of the Labor Party to say, ‘Look, we don’t want to go to that American model.’”

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LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’

Published by Anonymous (not verified) on Mon, 31/07/2017 - 12:53am in

Watching the craziness in the Senate this week, as Mitch McConnell and the GOP’s zealots drove their clown car into a brick wall and yet another effort to take away health care coverage from millions crashed and burned, I thought back to a different turn of events.

It was 52 years ago this Sunday — July 30, 1965. Two American presidents celebrated the birth of Medicare, the most significant advance toward national health insurance in America’s history.   

I was a White House assistant at the time, working for President Lyndon B. Johnson as he coaxed, cajoled, badgered, buttonholed and maneuvered Congress into enacting Medicare for the aging and Medicaid to help low-income people. For all the public displays over the years of his outsized personae and powers of persuasion, this time he had kept a low profile, working behind the scenes as his legislative team and career health care experts practically lived on Capitol Hill, negotiating with members of Congress and their staffs.

From the White House, LBJ worked the phones; invited senators and representatives singly and collectively in for coffee, drinks or dinner; listened attentively in private to opponents and proponents from interests as varied as business, labor, medicine and religion; and kept in his head a running tally of the fluctuating vote count.
As it had been for decades, it was a tough fight down to the wire. A look back is instructive, not only to show how long it can take to move a legislative dream to reality but also to illustrate how a president with a grasp of history and knowledge of how government works is crucial to making success possible.

In 1935, when President Franklin Roosevelt first tried and failed to get health insurance included as part of Social Security, I was 1 year old and my family was broke. The Great Depression had ended my father’s tenant farming. He took a job for a dollar a day as a laborer on the construction of a highway in southeast Oklahoma.

Earlier, my mother had lost twin girls — one at birth, the other some months later — because the nearest doctor was too far away to arrive in time to help. My parents moved into town. To pay the doctor who delivered me, my father lugged large stones by hand to the site the physician had bought to build his first office. It’s still there.

At about this time in Washington, Republicans, conservative Democrats and the American Medical Association (AMA) were winning their fight to sink President Roosevelt’s proposal for health insurance. Congress was intimidated, and in August 1935 FDR gave up, signing the Social Security Act without health coverage.   

Eight years later, in the midst of World War II, he once again called for social insurance “that will extend from the cradle to the grave.” And again, his proposal went nowhere.

On FDR’s death, Harry Truman became president. In his 1948 Message to Congress on the State of the Union, he said:  

This great nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care. Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health.


Congress still refused to budge. Running for election in his own right that year, and way behind in the polls, Truman won an upset victory after demanding that health care insurance and civil rights be included in the Democratic Party platform. That same year, congressman Lyndon Johnson of Texas, whose home district was Democratic and liberal in a state turning increasingly Republican and conservative, was running for election to the US Senate. He opposed Truman’s health care plan as socialistic and was elected.  

In 1952, Republicans won control of Congress for the first time since 1932 and hardened their stand against a national health care program. War hero Dwight Eisenhower won the presidency for the Republicans. He, too, opposed the plan that had been shelved by Congress before Truman left office.

Ike only was willing to support subsidizing private insurers to cover certain low-income groups and no more. With the continuing opposition of the nation’s doctors — amplified through their political lobby, the AMA, as well as the US Chamber of Commerce — the notion of Medicare appeared finished once and for all.    

Yet when he yielded the presidency to Eisenhower, Truman lamented his failure but was prophetic when he said: “[It] has only delayed and cannot stop the adoption of an indispensable health insurance plan.”

He was right. The battle heated up. In 1957, the AFL-CIO brought its 14 million members to the fight. The American Hospital Association, which bore the brunt of the problems older people encountered as they aged, signed on, too.

Public opinion was swinging in favor of national health insurance. When John F. Kennedy and Lyndon Johnson were nominated as the Democratic ticket in 1960, they made health care for Social Security retirees a major plank in the platform and endorsed a bill in the Senate that in time would become Medicare.

Though he was Kennedy’s running mate, Johnson was still the powerful Senate majority leader, that body’s top Democrat, and responsible for steering its legislative agenda. After a long day on the campaign road, or in the Senate, we would get to his home late and he would stay up until after midnight, making phone calls to one or another member of Congress urging passage of the Medicare bill.

Despite his efforts, it failed by four votes. LBJ had studied the polls and knew public opinion was building for national health insurance; he feared this defeat might cost Democrats the election. It didn’t, although the margin of victory was incredibly slim. As soon as they were inaugurated, now President Kennedy and Vice President Johnson championed yet another effort known as the Medical Care for the Aged bill. Still adamantly opposed by the Republicans and the AMA, it also failed — this time by two votes.

In early 1963, the bill was reintroduced in Congress, only to fail again. Some observers again pronounced it once and forever toast. But in November of that year, an assassin killed John Kennedy, tragically catapulting Lyndon Johnson into the White House. Just days later, in a dramatic speech to Congress and the nation, he slowly and deliberately drawled: “Let us continue!” With that challenge, LBJ set out to enact Kennedy’s legislative agenda — with a good chance, he thought, of passing the Medicare bill.

As before, the opposition fought back with everything they had, which now included the AMA’s new pitchman, Ronald Reagan. Not yet a candidate for public office, the actor was hired to warn the country against letting government get between doctors and their patients. He made a popular recording played at thousands of small meetings around the country in which attendees heard his pitch warning of “socialized medicine” and predicting “behind [Medicare] will come other federal programs that will invade every area of freedom as we have known it in this country.” Just think if he’d had Twitter.

Our strategy that year came to naught, producing in the early fall a stalemate. The Senate actually did pass a national health care bill for the elderly (despite the opposition of the Republican nominee for president, Barry Goldwater of Arizona, who interrupted his campaign and returned to Washington to vote no). But the powerful and conservative Democratic chairman of the House Ways and Means Committee, Wilbur Mills, would not agree to a medical care provision of any kind. A conference meeting to work out differences between the House and Senate ended in deadlock.

Johnson gritted his teeth and returned to the campaign, winning a four-year term in his own right.

Elections matter — surely no one doubts that fact anymore — and the ’64 election mattered dramatically. Not only did it deliver LBJ a landslide victory, but it brought Democrats their biggest majorities in the House and Senate since FDR. “If we can’t get Medicare through now,” the president told me after the election, “we don’t deserve what we just won.”

So as soon as he and Vice President Hubert Humphrey were inaugurated in January 1965, we started over. You can get a glimpse of the intensity of LBJ’s drive from a conversation I had with him around that time. With others, I had urged that the new bill include a provision for a retroactive increase in Social Security payments as an economic stimulus. He called me to say okay, but wanted me to understand it wasn’t because of the economy:

…My inclination would be … that it ought to retroactive as far back as you can get… because none [of the elderly] ever get enough. They are entitled to it. That’s an obligation of ours. It’s just like your mother writing you and saying she wants $20, and I’d always sent mine a $100 when she did. I never did it because I thought it was going to be good for the economy of Austin. I always did it because I thought she was entitled to it. And I think that’s a much better reason and a much better cause and I think it can be defended on a hell of a better basis…. We do know that it affects the economy… it helps us in that respect. But that’s not the basis to go to the Hill, or the justification. We’ve just got to say that, by God, you can’t treat grandma this way. She’s entitled and we promised it to her.


He understood the legislative process like no one I ever met. “Nothing given, nothing gotten — that’s the rule!” he told us in an Oval Office meeting on how to break yet another Capitol Hill deadlock. He sent his senior legislative aide to play sweet with a still-recalcitrant Wilbur Mills and warned, “I’ll tell you this, Wilbur Mills will take your pants off unless you’ve got something that he’s got to trade for.” When Mills still wouldn’t budge, the president let loose a string of invectives that would have made even Anthony Scaramucci blush. The next day he was courting Mills again, as if nothing had happened.

As the cherry blossoms bloomed that spring of ‘65, the president thought Congress was moving too slowly. The civil rights movement was under siege in the South, violence was continuing against blacks and we were working around the clock to pass legislation  to end discrimination. Even so, he wouldn’t let us slow down on Medicare — or other pending priorities. When he thought we were lagging, he took us to the woodshed, as you can see in a telephone conversation with Vice President Humphrey and me:

They [the House and Senate] are bogged down. The House had nothing this week — all goddamn week. You and Moyers and Larry O’Brien [his chief congressional expert] have got to get something for them. And the Senate had nothing… So we just wasted three weeks… Now we are here in the first week in March [1965], and we have just got to get these things passed… You’ve got to look each week and say, what is the Senate doing in committee this week and when will they be through, what is the House doing… You’ve got to be running into these guys [members of Congress] in the halls, and going over and having a drink with them in the evenings… I’ll put every Cabinet officer behind you, I’ll put every banker behind you, I’ll put every organization that I can deliver behind you… I’ll put the labor unions behind you.

A few days later, breakthrough. LBJ’s now-gentler courting of Wilbur Mills paid off, and the House Ways and Means chairman pieced together a bill from several options championed by different interests. He got it past the committee’s conservative coalition with a straight party vote, 17-8.   

Remembering our defeat the previous fall, our team fretted over how to make the final sale to the full House and Senate. The president had some more advice for us. As he told Larry O’Brien, the White House chief legislative honcho: Give bragging rights to anyone who voted on the final version of both Medicare — and the big education bill also in the pipeline:     

[Tell them] that every guy that votes for Medicare and education, his grandchildren will say my grandpa was in the Congress that enacted these two… So it makes ‘em proud. And they can go back home and say I was one of the 54 [who voted yes], or my daddy was one of the 54… so all his children and grandchildren are bragging about being one of the 54.


Medicare passed the House by a vote of 313-115. But in the Senate, liberal Democrats added $800 million to its cost, outraging conservatives (and vexing LBJ, who knew such overreach would give opponents more fuel to attack).  

Back the bill went to a conference committee between the House and Senate. Then to the House floor again, where it survived more than 500 amendments before passing on July 27 by majority vote, 307-116. One day later the Senate passed it, 70-24. All that was needed now was the president’s signature and Medicare and Medicaid would become the nation’s first public health insurance programs.  

And that’s how it came to pass that 52 years ago, on the morning of July 30, 1965. President Johnson loaded up two planeloads of dignitaries and headed toward Independence, Missouri, hometown of former President Harry Truman. He intended to sign the bill at the side of the man whose original proposal LBJ had dismissed as socialism. Now he revered Truman as “the real daddy of Medicare.” Here’s the actual moment Medicare became the law of the land:

President Lyndon Johnson flips through the pages of the Medicare bill for former President Harry Truman in Independence, Missouri on July 30, 1965. Johnson flew to Independence to sign the bill in front of Truman, the man who originally proposed the legislation almost two decades before. Behind Johnson and Truman are Mrs. Johnson (left), Vice President Hubert Humphrey and Mrs. Truman. (Photo by Bettmann Collection via Getty Images)

President Lyndon Johnson flips through the pages of the Medicare bill for former President Harry Truman in Independence, Missouri on July 30, 1965. Behind Johnson and Truman are Mrs. Johnson (left), Vice President Hubert Humphrey and Mrs. Truman. (Photo by Bettmann Collection via Getty Images)


After signing the bill, Lyndon Johnson turned to Harry Truman and signed him up as Medicare’s first beneficiary. It was high drama, touched with history, politics, sentimentality, showmanship and compromise.

The legislation was far from perfect. LBJ once told me never to watch hogs slaughtered before breakfast and never ever show young children how legislation gets enacted.

Too much secrecy surrounded the bill’s passage. Even as the president signed it into law, we weren’t sure of all that was in there. As some principled conservatives warned, there were too few cost controls. The experts feared copays and deductibles would become a burden.  

“Those can be fixed,” LBJ said, “once it sinks in that Medicare is here to stay.”

Meanwhile, as historian Robert Dallek has written, although Medicare and Medicaid did not solve the problem of care at reasonable cost for all Americans, “the benefits to the elderly and the indigent… are indisputable.”

Perhaps the biggest mistake was one of imagination — our failure to anticipate the advent of new and expensive technology to treat the sick or the demand on the system that would rise from a burgeoning population. That spring President Johnson had warned, “We will face a new challenge and that will be what to do within our economy to adjust ourselves to a life span and a work span for the average man or woman of 100 years.”

That, and the cost, we reckon with today.

Now that the eight-year effort of conservatives to repeal the Affordable Care Act (itself a flawed but significant extension of the effort to help more people get decent coverage) is stalled, the next steps are crucial. Going back to the status quo — a system driven by the profit motive and rationed health care based on income — is unthinkable. At the website Common Dreams, Dr. Carol Paris, president of Physicians for a National Health Program, writes:

“Clearly, the system is broken. Like a cracked pipe, money gushes into our health care system but steadily leaks out. Money is siphoned into the advertising budgets of insurance companies and the army of corporate bureaucrats working to deny claims. Even more dollars are soaked up by the pockets of insurance CEOs who have collectively earned $9.8 billion since the Affordable Care Act was passed in 2010. Nearly a third of our health care dollars go to something other than health care.”

Yes, our health system is broken, but broken systems can be fixed — not easily, but they can be fixed.  

Watching recent events, I thought of the long and arduous process I’ve just related, the many steps that brought Medicare into being, and how I was afforded a modest role in the supporting cast.

I came away from the experience with three lessons. First, whether health care is a right may be debatable, but it assuredly fulfills a basic human need — and without it, human beings without means will live and die suffering unduly.

Second, building that more perfect union which the founders of this republic defined as the mission of government has always been slow, hard, acrimonious, frustrating, tiring and elusive, because we as individuals are ourselves imperfect and because there are always among us those predators who regard democracy as an obstacle to their avarice.

Against such realities, the only way for democracy to succeed is for enough people to take up the cause where and when they can, as so many did for Medicare and are doing now for our eroding social covenant. That’s the third lesson I learned: It is harder to build something than to burn it down, but build we must.

Note: I am greatly indebted to Larry DeWitt, the historian of the US Social Security Administration, whose outstanding research and organizing talents have helped so many of us recollect with greater accuracy and context such experiences as I have recounted here. The author of numerous articles and essays — including “The Medicare Program as a Capstone to the Great Society — Recent Revelations in the LBJ White House Tapes,” on which  I have often relied — Mr. DeWitt also created, one of the largest history-related web sites in the federal government. It’s a national treasure.  Check it out.

— Bill Moyers

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Belabored Podcast #131: A Crisis of Care, with June Barrett and Saba Waheed

Published by Anonymous (not verified) on Sat, 15/07/2017 - 7:04am in

Home care is one of the most rapidly growing fields in the country, but workers and care recipients will be under threat if Trump slashes Medicaid. We talk about what’s at stake in the healthcare reform fight.

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A New American Revolution: Can We Break Out of Our Nation’s Culture of Cruelty?

Published by Anonymous (not verified) on Wed, 12/07/2017 - 4:00am in

This post originally appeared at Salon.

The health care reform bills proposed by Republicans in the House and Senate have generated heated discussions across a vast ideological and political spectrum. On the right, senators such as Rand Paul and Ted Cruz have endorsed a new level of cruelty — one that has a long history among the radical right — by arguing that the current Senate bill does not cut enough social services and provisions for the poor, children, the elderly and other vulnerable groups and needs to be even more friendly to corporate interests by providing massive tax cuts for the wealthiest Americans.

Among right-wing pundits, the message is similar. For instance, Fox News commentator Lisa Kennedy Montgomery, in a discussion about the Senate bill, stated without apparent irony that rising public concerns over the suffering, misery and death that would result from this policy bordered on “hysteria” since “we are all going to die anyway.” Montgomery’s ignorance about the relationship between access to health care and lower mortality rates is about more than ignorance. It is about a culture of cruelty that is buttressed by a moral coma.

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On the other side of the ideological and political divide, liberals such as Robert Reich have rightly stated that the bill is not only cruel and inhumane, it is essentially a tax reform bill for the 1 percent and a boondoggle that benefits the vampire-like insurance companies. Others, such as Laila Lalami of The Nation, have reasoned that what we are witnessing with such policies is another example of political contempt for the poorest and most vulnerable on the part of right-wing politicians and pundits. These arguments are only partly right and do not go far enough in their criticisms of the new political dynamics and mode of authoritarianism that have overtaken the United States. Put more bluntly, they suffer from limited political horizons.

What we do know about both the proposed Republican Party federal budget and health care policies, in whatever form, is that they will lay waste to crucial elements of the social contract while causing huge amounts of suffering and misery. For instance, the Senate bill will lead to massive reductions in Medicaid spending. Medicaid covers 20 percent of all Americans or 15 million people, along with 49 percent of all births, 60 percent of all children with disabilities and 64 percent of all nursing home residents, many of whom may be left homeless without this support.

Under this bill, 22 million people will lose their health insurance coverage, to accompany massive cuts proposed to food-stamp programs that benefit at least 43 million people. The Senate health care bill allows insurance companies to charge more money from the most vulnerable. It cuts maternity care and phases out coverage for emergency services. Moreover, as Lalami points out, “this bill includes nearly $1 trillion in tax cuts, about half of which will flow to those who make more than $1 million per year.” The latter figure is significant when measured against the fact that Medicaid would see a $772 billion cut in the next 10 years.

It gets worse. The Senate bill will drastically decrease social services and health care in rural America, and one clear consequence will be rising mortality rates. In addition, Dr. Steffie Woolhandler, co-author of a recent article in the Annals of Internal Medicine, has estimated that if health insurance is taken away from 22 million people, “it raises … death rates by between 3 and 29 percent. And the math on that is that if you take health insurance away from 22 million people, about 29,000 of them will die every year, annually, as a result.”

Leftists and other progressives need a new language to understand the rise of authoritarianism in the United States and the inhumane and cruel policies it is producing.

Leftists and other progressives need a new language to understand the rise of authoritarianism in the United States and the inhumane and cruel policies it is producing. I want to argue that the discourse of single issues, whether aimed at regressive tax cuts, police violence or environmental destruction, is not enough. Nor is the traditional Marxist discourse of exploitation and accumulation by dispossession adequate for understanding the current historical conjuncture.

The problem is not merely one of exploitation but one of exclusion. This politics of exclusion, Slavoj Žižek argues, “is no longer about the old class division between workers and capitalists, but … about not allowing some people to participate in public life.” People are not simply prevented from participating in public life through tactics such as voter suppression. It is worse than that. Many groups now suffer from a crisis of agency and depoliticization because they are overburdened by the struggle to survive. Time is a disaster for them, especially in a society that suffers from what Dr. Stephen Grosz has called a “catastrophe of indifference.” The ghost of a savage capitalism haunts the health care debate and American politics in general.

What does health care, or justice itself, mean in a country dominated by corporations, the military and the ruling 1 percent? The health care crisis makes clear that the current problem of hyper-capitalism is not only about stealing resources or an intensification of the exploitation of labor, but also about a politics of exclusion and the propagation of forms of social and literal death, through what the late Zygmunt Bauman described as “the most conspicuous cases of social polarization, of deepening inequality, and of rising volumes of human poverty, misery and humiliation.”

The fear of disposability has created a new ecology of insecurity and despair that murders dreams, squelches any sense of an alternative future and depoliticizes people. Under such circumstances, the habits of oligarchy and authoritarianism become normalized.

A culture of myopia now propels single-issue analyses detached from broader issues. The current state of progressive politics has collapsed into ideological silos, and feeds “a deeper terror — of helplessness, to which uncertainty is but a contributing factor,” as Bauman puts it, which all too often is transformed into a depoliticizing cynicism or a misdirected anger fed by a Trump-like politics of rage and fear. The fear of disposability has created a new ecology of insecurity and despair that murders dreams, squelches any sense of an alternative future and depoliticizes people. Under such circumstances, the habits of oligarchy and authoritarianism become normalized.

Traditional liberal and progressive discourses about our current political quagmire are not wrong. They are simply incomplete, and they do not grasp a major shift that has taken place in the United States since the late 1970s. That shift is organized around what Bauman, Stanley Aronowitz, Saskia Sassen and Brad Evans have called a new kind of politics, one in which entire populations are considered disposable, refuse, excess and consigned to fend for themselves.

Evidence of such expulsions and social homelessness, whether referring to poor African-Americans, Mexican immigrants, Muslims or Syrian refugees, constitute a new and accelerated level of oppression under casino capitalism. Moreover, buttressed by a hyper-market-driven appeal to a radical individualism, a distrust of all social bonds, a survival-of-the-fittest ethic and a willingness to separate economic activity from social costs, neoliberal policies are now enacted in which public services are underfunded, bad schools become the norm, health care as a social provision is abandoned, child care is viewed as an individual responsibility and social assistance is viewed with disdain. Evil now appears not merely in the overt oppression of the state but as a widespread refusal on the part of many Americans to react to the suffering of others, which is all too often viewed as self-inflicted.

Under this new regime of massive cruelty and disappearance, the social state is hollowed out and the punishing state becomes the primary template or model for addressing social problems. Appeals to character as a way to explain the suffering and immiseration many people experience are now supplemented by the protocols of the security state and a culture of fear.

The ethical imagination and moral evaluation are viewed by the new authoritarians in power as objects of contempt, making it easier for the Trump administration to accelerate the dynamics and reach of the punishing state. Everyday behaviors such as jaywalking, panhandling, “walking while black” or violating a dress code in school are increasingly criminalized. Schools have become feeders into the criminal-prison-industrial complex for many young people, especially youth of color. State terrorism rains down with greater intensity on immigrants and minorities of color, religion and class. The official state message is to catch, punish and imprison excess populations — to treat them as criminals rather than lives to be saved.

The “carceral state” and a culture of fear have become the foundational elements that drive the new politics of authoritarianism and disposability.

The “carceral state” and a culture of fear have become the foundational elements that drive the new politics of authoritarianism and disposability. What the new health bill proposal makes clear is that the net of expulsions is widening under what could be called an accelerated politics of disposability. In the absence of a social contract and a massive shift in wealth and power to the upper 1 percent, vast elements of the population are now subject to a kind of zombie politics in which the status of the living dead is conferred upon them.

One important example is the massive indifference, if not cruelty, exhibited by the Trump administration to the opioid crisis that is ravaging more and more communities throughout the United States. The New York Times has reported that more than 59,000 Americans died of drug overdoses in 2016, the largest year-over-year increase ever recorded. The Senate health care proposal cuts funds for programs meant to address this epidemic. The end result is that more people will die and more will be forced to live as if they were the walking dead.

A politics of disposability thrives on distractions — the perpetual game show of American politics — as well as what might be called a politics of disappearance. That is, a politics enforced daily in the mainstream media, which functions as a “disimagination machine,” and renders invisible deindustrialized communities, decaying schools, neighborhoods that resemble slums in the developing world, millions of incarcerated people of color and elderly people locked in understaffed nursing homes.

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President Donald Trump announces his decision to withdraw the US from the Paris Climate Accords in the Rose Garden of the White House in Washington, DC, on June 1, 2017. (Photo by Brendan Smialowski/AFP/Getty Images)

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We live in an age that Brad Evans and I have called an age of multiple expulsions, suggesting that once something is expelled it becomes invisible. In the current age of disposability, the systemic edges of authoritarianism have moved to the center of politics, just as politics is now an extension of state violence. Moreover, in the age of disposability, what was once considered extreme and unfortunate has now become normalized, whether we are talking about policies that actually kill people or that strip away the humanity and dignity of millions.

Disposability is not new in American history, but its more extreme predatory formations are back in new forms. Moreover, what is unique about the contemporary politics of disposability is how it has become official policy, normalized in the discourse of the market, democracy, freedom and a right-wing contempt for human life, if not the planet itself. The moral and social sanctions for greed and avarice that emerged during the Reagan presidency now proliferate unapologetically, if not with glee.

Cruelty is now hardened into a new language in which the unimaginable has become domesticated and “lives with a weight and a sense of importance unmatched in modern times,” in the words of Peter Bacon Hales. With the rise of the new authoritarianism dressed up in the language of freedom and choice, the state no longer feels obligated to provide a safety net or any measures to prevent human suffering, hardship and death.

Freedom in this limited ideological sense generally means freedom from government interference, which translates into a call for lower taxes for the rich and deregulation of the marketplace. This right-wing reduction of freedom to a limited notion of personal liberty is perfectly suited to mobilizing a notion of personal injury largely based on the fear of others. What it does not do is expand the notion of fear from the personal to the social, thus ignoring a broader notion: Freedom from want, misery and poverty. This is a damaged notion of freedom divorced from social and economic rights.

Democratically minded citizens and social movements must return to the crucial issue of addressing how class, power, exclusion, austerity, racism and inequality are part of a more comprehensive politics of disposability in America, one that makes possible what Robert Jay Lifton once called a “death-saturated age.” This suggests the need for a new political language capable of analyzing how this new dystopian politics of exclusion is buttressed by the values of a harsh form of casino capitalism that both legitimates and contributes to the suffering and hardships experienced daily by the traditional working and middle classes, and also by a wide range of groups now considered redundant — young people, poor people of color, immigrants, refugees, religious minorities, the elderly and others.

We are not simply talking about a politics that removes the protective shell of the state from daily life, but a new form of politics that creates a window on our current authoritarian dystopia. The discourse and politics of disposability offers new challenges in addressing and challenging the underlying causes of poverty, class domination, environmental destruction and a resurgent racism — not as a call for reform but as a project of radical reconstruction aimed at the creation of a new political and economic social order.

Such a politics would take seriously what it means to struggle pedagogically and politically over both ideas and material relations of power, making clear that in the current historical moment the battleground of ideas is as crucial as the battle over resources, institutions and power. What is crucial to remember is that casino capitalism or global neoliberalism has created, in Naomi Klein’s terms, “armies of locked out people whose services are no longer needed, whose lifestyles are written off as ‘backward,’ whose basic needs are unmet.”

This more expansive level of global repression and intensification of state violence negates and exposes the compromising discourse of liberalism, while reproducing new levels of systemic violence. Effective struggle against such repression would combine a democratically energized cultural politics of resistance and hope with a politics aimed at offering all workers a living wage and all citizens a guaranteed standard of living, a politics dedicated to providing decent education, housing and health care to all residents of the United States. The discourse of disposability points to another register of expulsion — one with a more progressive valence. In this case, it means refusing to equate capitalism with democracy and struggling to create a mass movement that embraces a radical democratic future.

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