April, 25 2013, 12:14pm EDT
Insured But Unable to Afford Health Care
Affordable Care Act will leave tens of millions underinsured, facing choice between ‘life or debt,’ say Journal of General Internal Medicine editorialists
WASHINGTON
In an editorial responding to a new study on skimpy health insurance among low-income, insured Americans, two policy experts review extensive data showing that tens of millions of insured Americans have grossly inadequate coverage, and that the problem of underinsurance is growing.
The editorial in the Journal of General Internal Medicine (JGIM) was approved by the journal's editors for publication on today's date and will appear on its website next week.
Paradoxically, the Affordable Care Act (ACA) may actually increase underinsurance, say the editorialists, Drs. Steffie Woolhandler and David Himmelstein.
"Obamacare is lowering the bar for health insurance," said Dr. Himmelstein, a professor of public health at the City University of New York and primary care doctor. "The new coverage sold through the insurance exchanges will leave many families paying 40 percent of their health costs out-of-pocket even after they've laid out thousands for premiums. And the administration is allowing states to institute co-payments under Medicaid, even for the poorest of the poor."
Himmelstein continued: "Under the ACA a 56-year-old making $46,100 will pay a premium of $10,585 for coverage through the exchange and still face up to $6,250 in co-payments and deductibles."
Dr. Woolhandler, the lead author of the editorial who is also a physician and professor of public health at CUNY, said: "Over the past 25 years the financial protection offered by health insurance has steadily eroded. The consequences are grave, not only financially but also medically. For instance, we know that heart attack patients who face high co-payments delay coming to the ER, threatening their lives."
Woolhandler and Himmelstein (who also serve as visiting professors at Harvard Medical School) were co-authors with Elizabeth Warren of a widely cited study that showed that illness and medical bills contribute to 62 percent of personal bankruptcies; most of the medically bankrupt were insured. Sen. Warren played no role in the JGIM editorial.
"Obamacare is making underinsurance the new normal," said Woolhandler. "It will reduce the number of uninsured from 50 million to 30 million, but the new coverage is full of holes. Americans deserve the kind of first-dollar, comprehensive coverage that Canadians already have. But that's only affordable under a single-payer system that cuts out the private insurance middlemen."
"Life or Debt: Underinsurance in America," Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. Journal of General Internal Medicine, approved for publication on April 25, 2013.
The related article:
"Prevalence and Predictors of Underinsurance Among Low-Income Adults," Hema Magge, M.D., M.S., Howard J. Cabral, M.P.H., Ph.D., Lewis E. Kazis, Sc.D., and Benjamin D. Sommers, M.D., Ph.D. Journal of General Internal Medicine, published online Feb. 1, 2013.
Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 21,000 members and chapters across the United States.
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'Macron Resign!' French Protests Intensify Over Attempt to Force Retirement Age Hike
"This forced passage with the use of Article 49.3 must be met with a response in line with this show of contempt toward the people," declared one union leader as MPs introduced no-confidence motions.
Mar 17, 2023
Protests in Paris and across France have ramped up since President Emmanuel Macron's government on Thursday used a controversial constitutional measure to force through a pension reform plan without a National Assembly vote.
Fears that the Senate-approved measure—which would raise the retirement age from 62 to 64—did not have enough support to pass the lower house of Parliament led to a Council of Ministers meeting, during which Macron reportedly said that "my political interest would have been to submit to a vote… But I consider that the financial, economic risks are too great at this stage."
"This reform is outrageous, punishing women and the working class, and denying the hardship of those who have the toughest jobs."
After the meeting, French Prime Minister Élisabeth Borne announced the decision to go with the "nuclear option," invoking Article 49.3 of the French Constitution—a calculated risk considering the potential for a resulting motion of no-confidence.
Members of Parliament opposed to the overhaul filed a pair of no-confidence motions on Friday, and votes are expected on Monday. Although unlikely, given the current makeup of the legislature, passing such a motion would not only reject the looming pension law but also oust Macron's prime minister and Cabinet, and likely lead to early elections in France.
As Deutsche Wellereported:
"The vote on this motion will allow us to get out on top of a deep political crisis," said the head of the so-called LIOT group Bertrand Pancher, whose motion was co-signed by members of the broad left-wing NUPES coalition.
The far-right National Rally (RN) filed a second motion, but that was expected to get less backing. RN lawmaker Laure Lavalette however said her party would vote for "all" no-confidence motions filed. "What counts is scuppering this unfair reform bill," she said.
Leaders of the Les Republicains (LR) are not sponsoring any such motions. Reutersexplained that individuals in the conservative party "have said they could break ranks, but the no-confidence bill would require all of the other opposition lawmakers and half of LR's 61 lawmakers to go through, which is a tall order."
Still, Green MP Julien Bayou said, "it's maybe the first time that a motion of no-confidence may overthrow the government."
Meanwhile, protests against the pension proposal—which have been happening throughout the year—continue in the streets, with some drawing comparisons to France's "Yellow Vests" movement sparked by fuel prices and economic conditions in 2018.
Not long after Borne's Article 49.3 announcement on Thursday, "protesters began to converge on the sprawling Place de la Concorde in central Paris, a mere bridge away from the heavily guarded National Assembly," according toFrance 24.
As the news outlet detailed:
There were the usual suspects, like leftist firebrand Jean-Luc Mélenchon, thundering against a reform he said had "no legitimacy—neither in Parliament, nor in the street." Unionists were also out in strength, hailing a moral victory even as they denounced Macron's "violation of democracy."
Many more were ordinary protesters who had flocked to the Concorde after class or work. One brandished a giant fork made of cardboard as the crowd chanted "Macron démission" (Macron resign). Another spray-painted an ominous message on a metal barrier—"The shadow of the guillotine is nearing"—in the exact spot where Louis XVI was executed 230 years ago.
Police used tear gas to disperse the Concorde crowd. Interior Minister Gérald Darmanin told RTL radio 310 people were arrested nationwide—258 of them in Paris. He said, "The opposition is legitimate, the protests are legitimate, but wreaking havoc is not."
Anna Neiva Cardante is a 23-year-old student whose parents, a bricklayer and a cleaner, "are among those who stand to lose most."
"A vote in the National Assembly was the government’s only chance of securing a measure of legitimacy for its reform," Neiva Cardante told France 24 as police cleared the crowd Thursday. "Now it has a full-blown crisis on its hands."
"This reform is outrageous," she added, "punishing women and the working class, and denying the hardship of those who have the toughest jobs."
Across the French capital early Friday, "traffic, garbage collection, and university campuses in the city were disrupted, as unions threatened open-ended strikes," DW noted. "Elsewhere in the country, striking sanitation workers blocked a waste collection plant that is home to Europe's largest incinerator to underline their determination."
"Article 49.3 constitutes a triple defeat for the executive: popular, political, and moral," declared Laurent Escure, secretary general of the labor union UNSA. "It opens up a new stage for the protests."
The French newspaper Le Mondereported that "the leaders of France's eight main labor unions called for 'local union rallies' on the weekend of March 18 and 19 and for a 'new big day of strikes and demonstrations' on Thursday, March 23."
Philippe Martinez of the CGT union asserted that "this forced passage with the use of Article 49.3 must be met with a response in line with this show of contempt toward the people."
Fellow CGT representative Régis Vieceli vowed that "we are not going to stop," tellingThe Associated Press that flooding the streets and refusing to work is "the only way that we will get them to back down."
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Ilhan Omar Warns 'The Next Iraq Will Be Even Worse'
"Have we fully learned the lessons from this failed war of aggression, or are we doomed to repeat it?" the progressive lawmaker asked on the eve of the 20th anniversary of the U.S.-led invasion.
Mar 17, 2023
Congresswoman Ilhan Omar on Friday marked the upcoming 20th anniversary of the George W. Bush administration's invasion of Iraq—where thousands of U.S. troops remain today—by asking if Americans have learned anything from the "failed war of aggression" and warning that waging another such war will have even more dire consequences.
In a Twitter thread, Omar (D-Minn.) asserted that "20 years later, the Iraq War remains the biggest foreign policy disaster of our generation, one that took thousands of American lives and hundreds of thousands of Iraqi lives."
As Common Dreamsreported Wednesday, the Costs of War Project at Brown University's Watson Institute for International and Public Affairs estimates as many as 580,000 people were killed in Iraq and Syria since 2003 and nearly 15 million people were made refugees or internally displaced by the war—which is forecast to cost a staggering $2.9 trillion by 2050.
The war was waged—under false pretenses against a country that had nothing to do with the September 11 attacks—by neoconservative Republicans in the Bush administration who since before 9/11 had sought a way to invade Iraq and oust erstwhile ally Saddam Hussein. The horrors of war and occupation included torture, indiscriminate killing, sex crimes, environmental devastation, and soaring birth defects caused by the use of depleted uranium weapons.
What then-White House Press Secretary Ari Fleischer called Operation Iraqi Liberation—OIL—devastated much of Iraq but enriched multinational corporations while creating a power vacuum that was eventually filled by Islamic State, whose rise to power in much of Iraq and neighboring Syria led to a second phase of the war launched during the administration of former President Barack Obama that continues today.
"Have we fully learned the lessons from this failed war of aggression, or are we doomed to repeat it?" Omar asked.
"Our foreign policy discourse remains fundamentally pro-war," Omar noted. "Think tanks (often the same ones who cheerled the Iraq War) outflank each other to justify armed conflict and derail diplomacy with adversaries like Iran."
Omar—whom Republicans recently ousted from the House Committee on Foreign Affairs—continued:
Instead of seeing China as a geopolitical challenge to be managed, politicians gin up jingoistic sentiment and nationalism to see who can be the most "anti-China."
Our spending on Pentagon waste and new weapons continues to rise uncontrollably—with weapons contractors wielding more lobbying power than ever in Washington.
Our national media too often treat war as a game—a way to juice ratings as fewer Americans turn into TV news—rather than the most horrific state of conditions to be avoided at all costs.
Claims from senior national security officials are reported as fact, even when no evidence for those claims is presented.
Much like the lost Iraqi lives lost were often ignored 20 years ago, we continue to ignore the pain and suffering of Black and Brown people in places like Syria, Yemen, Ethiopia, Myanmar, Haiti, and more.
"To truly be able to avoid another Iraq, we need a national reckoning with how we got into it the first place," argued Omar, who fled civil war in Somalia with her family when she was a child.
"We need accountability for those who got us into this war," Omar said. "But most of all we need to see all of our lives connected as part of the human fabric—to understand that the parent who loses a child in war could be us, that the child who is displaced could be our child."
"Because the next Iraq," she added, "will be even worse."
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Six Island Nations Commit to 'Fossil Fuel-Free Pacific,' Demand Global Just Transition
"As Pacific leaders shoulder the burden of climate leadership," this call "is a reminder that despite the doom and gloom, another world is possible, a fossil fuel-free world that is just, equitable, and sustainable."
Mar 17, 2023
Climate justice advocates celebrated Friday after a half-dozen island nations committed to building a "fossil fuel-free Pacific" and urged all governments to join them in bringing about an equitable phaseout of coal, oil, and gas.
From Wednesday to Friday, Vanuatu and Tuvalu co-hosted the 2nd Pacific Ministerial Dialogue on Pathways for the Global Just Transition from Fossil Fuels in Port Vila, Vanuatu. The summit came amid an ongoing state of emergency in Vanuatu, which was hammered earlier this month by a pair of Category 4 cyclones. Participants described the current devastation as "just the most recent example of the extensive and ongoing fossil fuel-induced loss and damage suffered by" Pacific Islanders.
At the conclusion of the three-day meeting, ministers and officials from six countries—Vanuatu, Tuvalu, Tonga, Fiji, Niue, and the Solomon Islands—agreed on the Port Vila Call for a Just Transition to a Fossil Fuel-Free Pacific.
The resolution—issued "on behalf of present and future generations, communities on the frontlines, and all of humanity"—calls for immediate international action to accelerate a just transition from dirty to clean energy in accordance with what experts have shown is necessary to avert the worst consequences of the climate crisis.
"The science is clear that fossil fuels are to blame for the climate emergency," says the document. "This is a crisis driven by the greed of an exploitative industry and its enablers. It is not acceptable that countries and companies are still planning on producing more than double the amount of fossil fuels by 2030 than the world can burn to limit warming to 1.5°C."
"Every second wasted on climate inaction and clinging to fossil fuels puts lives, homes, livelihoods, cultures, and ecosystems in jeopardy."
Among other things, the resolution implores policymakers in the Pacific and around the world to join the Beyond Oil and Gas Alliance (BOGA) and negotiate a fossil fuel nonproliferation treaty (FFNPT) to end the expansion of coal, oil, and gas extraction and to expedite a fair global shift to renewables. It also cautions lawmakers to avoid phrases like "unabated" or "inefficient," warning that such terminology "creates loopholes for fossil fuel producers."
In a statement, Oil Change International global policy lead Romain Ioualalen said, "Faced with devastating climate impacts resulting from the world's continued addiction to fossil fuels, Pacific governments have once again demonstrated what true leadership looks like."
"The contrast between the U.S. and other rich countries approving new oil and gas fields in clear defiance of science, and the commitment to build a prosperous and resilient fossil fuel-free Pacific could not be more obvious and highlights the complete disregard the fossil fuel industry and its enablers have for people and communities most affected by the climate crisis," said Ioualalen. "Countries must urgently heed the call for an immediate end to fossil fuel expansion that is emanating from the Pacific. We look forward to Pacific countries continuing to be vocal champions for a just and equitable phaseout of fossil fuels on the global stage, including at COP28 later this year."
Samoan climate justice activist Brianna Fruean said that "this dialogue of Pacific ministers is stepping outside of the box and acknowledging that we must try new ways to save ourselves—and that is going to require a fossil fuel nonproliferation treaty."
"While the guilty continue to reap profit off the expansion of fossil fuels behind our backs," said Fruean, "the meeting is bringing renewed energy to Pacific leadership that will not just echo across our islands but drive action with our allies globally."
Despite bearing almost no historical responsibility for the climate crisis, Pacific Islanders are acutely vulnerable to rising sea levels and increasingly frequent and severe extreme weather. Policymakers from the region have long been leaders in demanding ambitious efforts to slash greenhouse gas pollution at speed and scale, including by putting the idea of a FFNPT on the table in 2016. Just last year, Vanuatu and Tuvalu became the first national governments to endorse such a measure, while Tuvalu also recently joined the BOGA as a core member.
"Every second wasted on climate inaction and clinging to fossil fuels puts lives, homes, livelihoods, cultures, and ecosystems in jeopardy," said Lavetanalagi Seru, regional policy coordinator at Pacific Islands Climate Action Network. "As Pacific leaders shoulder the burden of climate leadership, the Port Vila Call for a Just Transition to a Fossil Fuel-Free Pacific is a reminder that despite the doom and gloom, another world is possible, a fossil fuel-free world that is just, equitable, and sustainable."
The region's new resolution states that "we have the power and responsibility to lead, and we will. Pacific leaders called for the Paris agreement to limit warming to 1.5°C, and have demanded an end to the development and expansion of fossil fuel-extracting industries, starting with new coal mines. Pacific civil society has challenged the world to step up the fight for urgent fossil fuel phaseout and effective climate action."
In recent weeks, Vanuatu has been leading an ongoing push for an advisory opinion from the International Court of Justice (ICJ) on "how existing international laws can be applied to strengthen action on climate change, protect people and the environment, and save the Paris agreement."
The document unveiled Friday calls for "redoubled efforts to reaffirm, strengthen, and codify legal obligations with respect to the global phaseout of fossil fuels," including by supporting the adoption of the Vanuatu-led ICJ resolution at the meeting of the U.N. General Assembly at the end of this month.
"The contrast between the U.S. and other rich countries approving new oil and gas fields in clear defiance of science, and the commitment to build a prosperous and resilient fossil fuel-free Pacific could not be more obvious."
According to Seru, "The phaseout of fossil fuels is not only a challenge, but an opportunity to promote economic development and innovation in the Pacific region."
To that end, the Port Vila document calls for "new Pacific-tailored development pathways based on 100% renewable energy."
350.org Pacific managing director Joseph Sikulu welcomed this week's developments, saying in a statement that "our people need global leaders to follow the innovation of Pacific representatives at the Pacific Ministerial Dialogue, it is a matter of survival."
"Our people also need energy to power their homes, their fishing boats, and their schools, which is where we are ready to work with governments in their commitment to progress the development and implementation of fossil-free development pathways at the grassroots level," he added.
In order to make that a reality, the document calls for increasing "public and private finance for the just transition from fossil fuels to renewable energy at the scale required, with innovative, simplified mechanisms and reforms of existing financial institutions."
Cansin Leylim, 350.org associate director of global campaigns, applauded Pacific Island nations for "once again showing immense leadership in the fight against the climate crisis, a crisis they had no part in creating."
"Pacific leaders have told us time and again—in order to stay below 1.5°C, the historically responsible countries need to immediately commit to a fossil fuel-free future without loopholes," said Leylim. "This means ensuring adequate and grant-based climate finance is swiftly mobilized to both adapt to the crisis and limit the heating to survival limits, ensuring energy independence and resource resilience with renewable energy."
Tzeporah Berman, chair of the Fossil Fuel Non-Proliferation Treaty Initiative, predicted that this week's "historic meeting" will "have far-reaching consequences."
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