Ever since Congress adopted the Affordable Care Act Republicans have been committed to repealing it. In fact, many party members up for re-election successfully employed the mantra "repeal and replace Obamacare" during their campaigns. Now that they have a majority in both houses and a President in the White House, Republicans face the daunting prospect of needing to deliver. They are finding out that it is much easier to make bold political promises than it is to follow thru on them, and that replacing an intricate framework for one-sixth of the economy is easier said than done. Lousise Radnofsky, writing in the Wall Street Journal, summarized the conundrum as follows: "Republicans are caught between competing forces: a desire to take bold steps in remaking health care along conservative lines, and the political restrictions that come with a six-year old law that is already entwined through the American health system." She also published the results of a new Wall Street Journal/ NBC New poll that finds that right now 45% of Americans think that the health law is "a good idea," for the first time out-polling those who dislike the law.
During a recent interview, President Trump announced that he has a plan that will simultaneously repeal and replace the Affordable Care Act. He has just been waiting for his nominee for Secretary of Health and Human Services, Rep. Tom Price, R-Ga., to be confirmed. (Under pointed questioning from senators considering his nomination, Dr. Price admitted that he was unaware of such a plan). To kick-start the process, Trump's first executive order directed government agencies to scale back as many aspects of ACA as possible. Meanwhile both the House and the Senate approved budget resolutions that would allow Republicans to repeal the tax and spending provisions of ACA with simple majority votes, bypassing a possible Democratic filibuster. House Speaker Paul Ryan referred to these as part of a "rescue mission."
Although the mechanism for "repeal" much of the law was agreed upon, proposals on how to replace what is taken away are nowhere near complete. Some have advocated for repeal, and delay implementation to some date beyond the next election cycle, which is two years away. This strategy was suggested, in part, because they really don't agree on how to proceed, and partially because many Republicans have serious concerns about political fall-out during the upcoming mid-term elections. An estimated 22 million Americans who gained coverage under ACA could lose their insurance. Many more have pre-existing health conditions insurers were able to deny coverage for, or who were charged excess premiums prior to ACA. Repeal of the Medicaid expansion prompted by the law will not only remove millions of low-income Americans from their insurance coverage, by converting the program to so-called "block grants" to the states will effectively eliminate it as an entitlement. The American Hospital Association estimates that during the 2018-2026 period hospital operating costs will increase by $400 billion. And, on top of these and other disturbing statistics, budget conscious legislator point out that, during the next ten years , a suitable replacement for Obamacare will add an estimated $9.7 trillion to the national debt.
Given that the discussion in Washington has turned into a political circus lacking a safety net, communities across the country are attempting to anticipate the consequences of repeal, and are constructing responses. A few weeks ago I became aware of one of these efforts in a community not far from Seattle, Washington. Its key health advocate expressed the group's mindset as follows:
"In a rural county of 33,000 people, I am helping to organize a network of community health advocates. The goal is to support our neighbors in wellness. That means helping people learn about health resources, access care and have a health plan that is adequate and affordable. Two groups are key to this organizing effort: a resource team of individuals with experience in education and care; and an outreach team with representation from a broad base of community and neighborhood organizations. Our aim is to provide basic training and information for as many local groups as possible throughout the county, so that each will have their own community health advocate. Two examples: A volunteer health advocate is available each week at the town food bank, and volunteer community health advocates are serving in congregations to assists individuals who have unmet medical and mental needs. We are reaching out to senior groups, social service programs, voluntary organizations of all kinds, small businesses, parents and student groups, recreational programs and cultural groups.
Since both political parties have an important role to play in our health conversations, I am also interested in how, with the help of the local Republican and Democratic organizations, community health advocates could be made available in every precinct in the county.
Wellbeing is not simply an individual matter. When we are ill we need the support of others. Very few of us can afford to save or bear the cost of care for an accident, a long-term illness or a chronic condition. None of us alone have all the knowledge we need to lead healthy lives. Healing and wholeness involves encouraging relationships with others, the help of family and friends, and the support of the wider community."
The principal organizers of this effort are hard at work developing a structure that will allow them to replicate successes across their county, and ultimately across the country. Perhaps our politicians should stop their ideological grand-standing, and consider elements from attempts designed to offset the anticipated changes people are worried about.
Friday, January 27, 2017
Monday, January 16, 2017
FROM RUSSIA WITH LOVE
On January 6, American intelligence officials published a declassified version of a report on Russian hacking. It concluded that, in 2016, Russian President Vladimir Putin "ordered an influence campaign aimed at the US presidential election." Their assessment was that the Russian government developed "a clear preference for President-Elect Trump." Trump did not endorse these conclusions, but he did commit to task his administration with "devising a new plan to aggressively combat and stop cyber attacks."
Although the conclusions generated by this intelligence report had been public for many weeks, they were aggressively challenged by the incoming administration. However, most of our allies have been well aware of Kremlin attempts to re-shape anti-Russia, pro-America policy positions. While absorbing condemnation for annexing Crimea, suffering from punishing economic sanctions assessed by a unified European Union, guided and supported by the US, and facing what he considers a stranglehold on Russia's "sphere of influence" by a NATO alliance intent on constructing a missile defense system on its doorstep in Romania and Poland, Vladimir Putin actively, and often openly, strategized to divide and neuter the Western alliance. In a rapidly evolving political landscape, Mr. Putin's multi-level attempt appears to be bearing fruit.
Putin's approach involves the use of, both, pre- and post-Soviet methods. A case in point, reminiscent of cold-war antics, is that of Czech Republic President Milos Zeman. Zeman was Prime Minister from 1998 - 2002. He brought the Czech Republic into the EU, but lost his 2003 presidential bid, and retired. During subsequent years Mr. Zeman was actively courted by Russian operatives. He attempted a comeback in 2013, and won the presidency in an election campaign which, opponents charged, was financed by the Kremlin. Time and influence managed to dramatically change Mr. Zeman's political ideas, converting him from being a dominantly pro-Western and pro-EU politician to one openly favoring Russian interests and opposing the EU. In 2015 he even called for a Czechzit referendum to withdraw from the European Union. (Neil MacFarquhar, "How Russians Pay to Play in Other Countries," New York Times, December 30, 2016.)
Post Soviet infiltration methods include directly, and openly, financing political parties sympathetic to the Russian cause. In 2014, France's "National Front" received a $10.6 million loan from the Russian controlled First Czech Russian National Bank to help support its presidential campaign. This was said to be the first installment of a $42 million dollar loan. NF founder Jean-Marie Le Pen received a $2.65 million loan from a Cyprus based bank owned by a former KGB agent. Hungary secured a $10.8 billion Russian investment to finance expansion of a nuclear power plant that produces 40% of the country's electricity. Political observers suggest that this was not just a financial transaction. It appears to have been intended to buy influence, and pump money into the Hungarian economy in advance of the 2018 election campaign of pro-Russia, Eurosceptic, populist President Viktor Orban. Other instances of Russian financial support of right-wing opposition parties are widely suspected, but scarcely admitted.
It is clear that not all efforts to unpick the fabric of European unity emanate from Moscow. For its part, the European right sees the Russian leader as a staunch defender of national sovereignty and conservative values "who has challenged US influence and the idea of "Europe" in a way that mirrors its own convictions." (Alina Polyakova, "Strange Bedfellows: Putin and Europe's Far Right," World Affairs, September/ October 2014.) On the political left many of the insurgents are attracted to Russia's antipathy towards globalization and its challenge to the US dominated international capitalist order. ("Putin's Friends in Europe," European Council on Foreign Affairs, October 19, 2016.) "National Front" leader Marine Le Pen refers to Putin as someone who "does what is good for Russia and the Russians." Nigel Farage of the "UK Independence Party" goes a step further describing Putin as "a brilliant strategist who can outwit the West." Of all world leaders he admires Putin the most. Le Pen considers the sanctions imposed on Russia in response to its annexation of Crimea "American meddling in European affairs." She is not alone. Francois Fillon, the center-right candidate who will likely compete with her for the French presidency this coming May, argues for rapprochement with Russia as well. He opposes continuing the sanctions. Given that the EU requires unanimity among all its members if it wants to renew these when they expire next June, chances are excellent that Putin's courting of Europe' populist fringe is paying dividends.
It appears unlikely that the US will continue to take the lead in countering Russia's influence peddling. President-Elect Trump, Putin's favorite candidate, has openly supported the Russian leader. He characterized Putin's New York Times op-ed in 2013, ripping into the notion of American exceptionalism, as "a masterpiece." He denied that Putin assassinated opponents, saying that he "had not seen that. However,, if he did, that could be forgiven. At least, he is a leader." He celebrated Brexit, denounced NATO, and continues to insist that the Russians did not attempt to influence our 2016 election. One can only hope that, once he ascends to the White House, he will recognize that Mr. Putin's overtures are not designed to be benevolent. They are intended to change the political landscape in Russia's favor.
Although the conclusions generated by this intelligence report had been public for many weeks, they were aggressively challenged by the incoming administration. However, most of our allies have been well aware of Kremlin attempts to re-shape anti-Russia, pro-America policy positions. While absorbing condemnation for annexing Crimea, suffering from punishing economic sanctions assessed by a unified European Union, guided and supported by the US, and facing what he considers a stranglehold on Russia's "sphere of influence" by a NATO alliance intent on constructing a missile defense system on its doorstep in Romania and Poland, Vladimir Putin actively, and often openly, strategized to divide and neuter the Western alliance. In a rapidly evolving political landscape, Mr. Putin's multi-level attempt appears to be bearing fruit.
Putin's approach involves the use of, both, pre- and post-Soviet methods. A case in point, reminiscent of cold-war antics, is that of Czech Republic President Milos Zeman. Zeman was Prime Minister from 1998 - 2002. He brought the Czech Republic into the EU, but lost his 2003 presidential bid, and retired. During subsequent years Mr. Zeman was actively courted by Russian operatives. He attempted a comeback in 2013, and won the presidency in an election campaign which, opponents charged, was financed by the Kremlin. Time and influence managed to dramatically change Mr. Zeman's political ideas, converting him from being a dominantly pro-Western and pro-EU politician to one openly favoring Russian interests and opposing the EU. In 2015 he even called for a Czechzit referendum to withdraw from the European Union. (Neil MacFarquhar, "How Russians Pay to Play in Other Countries," New York Times, December 30, 2016.)
Post Soviet infiltration methods include directly, and openly, financing political parties sympathetic to the Russian cause. In 2014, France's "National Front" received a $10.6 million loan from the Russian controlled First Czech Russian National Bank to help support its presidential campaign. This was said to be the first installment of a $42 million dollar loan. NF founder Jean-Marie Le Pen received a $2.65 million loan from a Cyprus based bank owned by a former KGB agent. Hungary secured a $10.8 billion Russian investment to finance expansion of a nuclear power plant that produces 40% of the country's electricity. Political observers suggest that this was not just a financial transaction. It appears to have been intended to buy influence, and pump money into the Hungarian economy in advance of the 2018 election campaign of pro-Russia, Eurosceptic, populist President Viktor Orban. Other instances of Russian financial support of right-wing opposition parties are widely suspected, but scarcely admitted.
It is clear that not all efforts to unpick the fabric of European unity emanate from Moscow. For its part, the European right sees the Russian leader as a staunch defender of national sovereignty and conservative values "who has challenged US influence and the idea of "Europe" in a way that mirrors its own convictions." (Alina Polyakova, "Strange Bedfellows: Putin and Europe's Far Right," World Affairs, September/ October 2014.) On the political left many of the insurgents are attracted to Russia's antipathy towards globalization and its challenge to the US dominated international capitalist order. ("Putin's Friends in Europe," European Council on Foreign Affairs, October 19, 2016.) "National Front" leader Marine Le Pen refers to Putin as someone who "does what is good for Russia and the Russians." Nigel Farage of the "UK Independence Party" goes a step further describing Putin as "a brilliant strategist who can outwit the West." Of all world leaders he admires Putin the most. Le Pen considers the sanctions imposed on Russia in response to its annexation of Crimea "American meddling in European affairs." She is not alone. Francois Fillon, the center-right candidate who will likely compete with her for the French presidency this coming May, argues for rapprochement with Russia as well. He opposes continuing the sanctions. Given that the EU requires unanimity among all its members if it wants to renew these when they expire next June, chances are excellent that Putin's courting of Europe' populist fringe is paying dividends.
It appears unlikely that the US will continue to take the lead in countering Russia's influence peddling. President-Elect Trump, Putin's favorite candidate, has openly supported the Russian leader. He characterized Putin's New York Times op-ed in 2013, ripping into the notion of American exceptionalism, as "a masterpiece." He denied that Putin assassinated opponents, saying that he "had not seen that. However,, if he did, that could be forgiven. At least, he is a leader." He celebrated Brexit, denounced NATO, and continues to insist that the Russians did not attempt to influence our 2016 election. One can only hope that, once he ascends to the White House, he will recognize that Mr. Putin's overtures are not designed to be benevolent. They are intended to change the political landscape in Russia's favor.
Monday, January 2, 2017
WILL EUROPE'S DISINTEGRATION ACCELERATE IN 2017?
During the Summer of 1971 I spent three months in Western Europe interviewing politicians and labor leaders as part of a research project designed to evaluate the level of opposition to the concept and implementation of the European integration process, which, at the time, was still in its infancy. Some were entirely opposed to the idea of giving up national independence and identity, others were concerned that the process was not taking place fast enough. On balance, the objective of creating a European Union was accepted as inevitably necessary to prevent a recurrence of the wars that wrecked the European continent throughout history.
That was 45 years ago. The initial alliance was created by the Treaty of Rome in 1958, and included Germany, France, Italy, Belgium, The Netherlands and Luxembourg, and would not be expanded until shortly after I spent my time there. The U.K., Ireland and Denmark joined January 1, 1973, and during subsequent decades the European Union expanded to include 28 member states. The optimistically anticipated inevitability of progress towards an ever-intensifying union did not materialize as smoothly as expected, however. The Schengen Agreements, which eliminated internal border checks and allowed free movement throughout the E.U., signed in 1985 and effective 1995, still suggested significant unanimity, even though the U.K., Ireland, and a few Eastern European members did not sign on. The 1999 roll-out of the Euro, intended to become the official currency of the Union, only attracted 19 members. But the big challenge came in 2004 when the European Parliament attempted to pass a treaty that would have established a constitution for Europe. This constitution was designed to replace existing treaties with a single document, and, among other things, allow for qualified majority voting to replace henceforth mandated unanimity requirements. But French and Dutch voters, in a referendum, voted against adoption, and killed the proposal.
One could argue over why the progression towards the establishment of a unified European state slowed, came to a halt, and regressed. Expansion may have been too great and too fast. New members were likely seduced by anticipated benefits of economic integration, but less inclined to relinquish much of their political independence. The rule that all states had to agree before new policies could be adopted stymied progress. More recently, however, several other significant issues accelerated the disintegration of what, up to then, had grown into one of the most important economic and political powers in the world. The 2008 recession identified a debt crisis in a number of, mostly Southern European, countries, placing significant stress on the Euro-Zone, and illuminating systemic problems within the organization. The overwhelming flood of migrants coming in from the Middle-East and Northern Africa put the continued desirability of the Schengen Agreements to the test, while strengthening nationalist and populist political movements in many member countries. The politicization of these influences created a crisis within the organization, which, in 2017, may well accelerate its disintegration.
In June of 2016 the U.K. voted to leave the Union. In January the British Supreme Court will deliver their verdict on whether Prime Minister Theresa May can use the "royal prerogative" and begin Brexit negotiations with the E.U. without approval of Parliament. If she is not allowed to, members could actually vote against the onset of negotiations and block exit from the Union. In March, in a general election, Dutch voters are expected to give Geert Wilders' anti-E.U., anti-immigrant, anti-Muslim Party For Freedom a majority in its House of Representatives. If he succeeds, the Dutch may also be asked to vote to leave the E.U.. France's presidential election is scheduled for April 23 (primary) and May 7 (general). Marine Le Pen, leader of the National Front, has a real chance of taking over the country's presidency. If she does, she has promised to hold a referendum on a French exit (Frexit). Germany holds its general election sometime between late Summer and early Fall. The nationalist AfD (Alternative for Germany), anti-E.U., anti-immigrant and anti-Muslim party will likely give Angela Merkel's Christian Democrats a run for their money. Italy's Prime Minister Matteo Renzi's recent resignation has left the door wide open for Beppe Grillo's Five Star Movement in an election that could take place later this year. Greece may be headed towards an election as well, since there are signs that Prime Minister Alexis Tsirpas seems to be positioning himself to defy his government's debt restructuring agreement with the European Central Bank.
And so it goes.
Whether the European Union will survive the populist onslaught remains to be seen. Thus far it survived many of the financial skirmishes resulting from the recession in 2008, even though significant debt related systemic issues remain. The more immediate, political, challenges confronting the organization are concentrated in many of its member states, and can't be resolved within its supranational structure. It is telling that roughly one third of the 751 members of the European Parliament are considered "eurosceptic." High unemployment, coupled with a growing refugee crisis affecting most member states, led to the election of these, essentially anti-E.U., MEPs. The average unemployment rate within the E.U. still approaches 10%, with Greece exceeding 23% and Spain hovering around 19%. These statistics won't diminish voter displeasure. The flood of non-European migrants, which produced a cultural identity crisis in many member states, is giving the political parties these eurosceptic MEPs represent the ammunition they need to advance their agenda. Those need to be dealt with in-country, and those are the ones that can eventually further the disintegration of the European idea. Poland and Hungary, countries which joined the E.U. as recently as 2002 and 2004, are already run by eurosceptic governments. Those are the movements to watch.
The next election for the European Parliament won't take place until 2019. A lot can happen between now and then. For those who don't think this issue is important to us, that Europe is far away, and what happens there won't really affect us, just consider that between the U.S. and the E.U. we transact about $1 trillion in business every year, that together we represent 60% of global GDP, that, strategically, we built the strongest military defense alliance in the world, and, as a bloc, we play a leading role in international relations. Disintegration will only benefit our adversaries. It will severely, negatively, affect our national interest.
That was 45 years ago. The initial alliance was created by the Treaty of Rome in 1958, and included Germany, France, Italy, Belgium, The Netherlands and Luxembourg, and would not be expanded until shortly after I spent my time there. The U.K., Ireland and Denmark joined January 1, 1973, and during subsequent decades the European Union expanded to include 28 member states. The optimistically anticipated inevitability of progress towards an ever-intensifying union did not materialize as smoothly as expected, however. The Schengen Agreements, which eliminated internal border checks and allowed free movement throughout the E.U., signed in 1985 and effective 1995, still suggested significant unanimity, even though the U.K., Ireland, and a few Eastern European members did not sign on. The 1999 roll-out of the Euro, intended to become the official currency of the Union, only attracted 19 members. But the big challenge came in 2004 when the European Parliament attempted to pass a treaty that would have established a constitution for Europe. This constitution was designed to replace existing treaties with a single document, and, among other things, allow for qualified majority voting to replace henceforth mandated unanimity requirements. But French and Dutch voters, in a referendum, voted against adoption, and killed the proposal.
One could argue over why the progression towards the establishment of a unified European state slowed, came to a halt, and regressed. Expansion may have been too great and too fast. New members were likely seduced by anticipated benefits of economic integration, but less inclined to relinquish much of their political independence. The rule that all states had to agree before new policies could be adopted stymied progress. More recently, however, several other significant issues accelerated the disintegration of what, up to then, had grown into one of the most important economic and political powers in the world. The 2008 recession identified a debt crisis in a number of, mostly Southern European, countries, placing significant stress on the Euro-Zone, and illuminating systemic problems within the organization. The overwhelming flood of migrants coming in from the Middle-East and Northern Africa put the continued desirability of the Schengen Agreements to the test, while strengthening nationalist and populist political movements in many member countries. The politicization of these influences created a crisis within the organization, which, in 2017, may well accelerate its disintegration.
In June of 2016 the U.K. voted to leave the Union. In January the British Supreme Court will deliver their verdict on whether Prime Minister Theresa May can use the "royal prerogative" and begin Brexit negotiations with the E.U. without approval of Parliament. If she is not allowed to, members could actually vote against the onset of negotiations and block exit from the Union. In March, in a general election, Dutch voters are expected to give Geert Wilders' anti-E.U., anti-immigrant, anti-Muslim Party For Freedom a majority in its House of Representatives. If he succeeds, the Dutch may also be asked to vote to leave the E.U.. France's presidential election is scheduled for April 23 (primary) and May 7 (general). Marine Le Pen, leader of the National Front, has a real chance of taking over the country's presidency. If she does, she has promised to hold a referendum on a French exit (Frexit). Germany holds its general election sometime between late Summer and early Fall. The nationalist AfD (Alternative for Germany), anti-E.U., anti-immigrant and anti-Muslim party will likely give Angela Merkel's Christian Democrats a run for their money. Italy's Prime Minister Matteo Renzi's recent resignation has left the door wide open for Beppe Grillo's Five Star Movement in an election that could take place later this year. Greece may be headed towards an election as well, since there are signs that Prime Minister Alexis Tsirpas seems to be positioning himself to defy his government's debt restructuring agreement with the European Central Bank.
And so it goes.
Whether the European Union will survive the populist onslaught remains to be seen. Thus far it survived many of the financial skirmishes resulting from the recession in 2008, even though significant debt related systemic issues remain. The more immediate, political, challenges confronting the organization are concentrated in many of its member states, and can't be resolved within its supranational structure. It is telling that roughly one third of the 751 members of the European Parliament are considered "eurosceptic." High unemployment, coupled with a growing refugee crisis affecting most member states, led to the election of these, essentially anti-E.U., MEPs. The average unemployment rate within the E.U. still approaches 10%, with Greece exceeding 23% and Spain hovering around 19%. These statistics won't diminish voter displeasure. The flood of non-European migrants, which produced a cultural identity crisis in many member states, is giving the political parties these eurosceptic MEPs represent the ammunition they need to advance their agenda. Those need to be dealt with in-country, and those are the ones that can eventually further the disintegration of the European idea. Poland and Hungary, countries which joined the E.U. as recently as 2002 and 2004, are already run by eurosceptic governments. Those are the movements to watch.
The next election for the European Parliament won't take place until 2019. A lot can happen between now and then. For those who don't think this issue is important to us, that Europe is far away, and what happens there won't really affect us, just consider that between the U.S. and the E.U. we transact about $1 trillion in business every year, that together we represent 60% of global GDP, that, strategically, we built the strongest military defense alliance in the world, and, as a bloc, we play a leading role in international relations. Disintegration will only benefit our adversaries. It will severely, negatively, affect our national interest.
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