The $12 Million Dog - A Pony Show for the Estate Tax

Please don't get me wrong. I am, in fact, a dog lover. I am pleased that the late Leona Helmsley's dog

will continue to live an opulent life, and then be buried alongside her in a mausoleum

But it occurs to me that this story should be the poster child in the fight to restore the Estate Tax to an equitable level.

What is the Republican argument in this dog fight? That Helmsley's dog deserves a $12 million trust fund? Leona Helmsley

became known as a symbol of 1980s greed and earned the nickname "the Queen of
Mean" after her 1988 indictment and subsequent conviction for tax evasion. One
employee had quoted her as snarling, "Only the little people pay taxes."

Well, the "little people" continue to pay taxes at a higher rate on their labor than the rich pay on their investments. Are the Republicans going to say that a better use could not be found for that $12 million? How about health care for the uninsured children of the "little people"?

Let's give the "death tax" rhetoric the death penalty. If anyone needs a dog and pony show to convince them, point them here.

Leaving Money on the Table and Kids Uninsured

In a story in today's Orlando Sentinel, we get the following intertwined pieces of information:

Florida ranks 43rd in the country when it comes to children's health-insurance coverage, said Dr. Edward Zissman, chief executive officer of Altamonte Pediatric Associates.

And from the same source, there is this:

Last year, Florida returned $20 million in 2005 federal matching dollars because it did not enroll enough children.

The federal grant matches 71 cents for every 29 cents the state spends, said Tara Klimek, a spokeswoman for state Chief Financial Officer Alex Sink. Since 1998 the state has returned $140 million, she said.

What can be done about this abysmal situation? State Rep. Scott Randolph, D-Orlando, has an idea. Randolph called on Gov. Charlie Crist to include KidCare reform in next month's special session.

"We've got to put this on the calendar or face losing federal matching dollars," Randolph said. "For every dollar we refuse to put in . . . we send $3 back to Washington."

The US House of Representatives recently passed an expansion of the SCHIP program. However, Florida's Republican Representatives voted against this bill. The DCCC responded by launching radio ads targeting these Roadblock Republicans. At least one of the targets, Old Bill Young, did not take kindly to being targeted. Bill Young

angrily pointed to a new radio ad campaign this week by Democrats accusing him of opposing increased benefits in Medicare for seniors.

Maybe Charlie Crist will have a more temperate response to the health care needs of Florida's children?

Bill Nelson Pinellas Town Hall

Bill Nelson started off his August Congressional "vacation" by holding a Town Hall meeting in Pinellas County today. Nelson answered questions for one hour from the over 150 in attendance. One remarkable thing about this event? Nobody asked about Iraq.

The first question Nelson fielded did allude to the Bush administrations trampling of civil rights in the guise of the global war on terror. Nelson professed not to know about a controversial classified Executive Order recently issued by Bush. He did talk about this weekend's FISA vote however. He stressed that what was done was a temporary measure that sunsets in six months. Nelson went on to say that the legislation was meant to protect the warrant requirement for US Persons, but not for foreign sources. Nelson lambasted the "mishandling" of the Terrorist Surveillance Program for the last five years. There was also the chance to bash embattled Attorney General Alberto Gonzales. Nelson related that one of the biggest sticking points in the bill was the administrations' insistence that the Attorney General be in charge of certifying compliance for this program. Nelson said this was unacceptable to a bipartisan group of Senators. The solution? Having the Director of National Intelligence share this responsibility.

OK, now we have a man that nobody believes and the man in charge of spying certifying compliance for this spy program. Some compromise. And as the 2008 election will be all that much closer in 6 months, does anybody expect that the Congress will show more backbone then?

The questions next turned to domestic issues. Nelson said that a wholesale reform of health insurance delivery would be coming "down the road". Nelson, a former Florida Insurance Commissioner explained that the principle of insurance - spreading risk over large pools of people - was just not working in health insurance. The reason - health insurance pools are too fragmented. The current system only seems to work, if at all, for very large employers. Nelson did tout the recent passage of the children's health care program (SCHIP). Nelson also said that legislation would be introduced soon to induce health insurers to provide more mental health benefits. In response to a question about support for a breast cancer research program, Nelson related how on his space shuttle flight, his primary experiment was for cancer research. He did this shortly after a very dear friend had died from breast cancer.

Nelson got a couple of questions from local elected officials, who were well represented in the audience. The first came from a Gulfport City Commissioner who asked for help regarding changes in the rules for Community Development Block Grants. Nelson responded that his office would be happy to assist in helping communities obtain the grants, but seemed to miss the impact of the change in rules on these communities. He did take the opportunity to point out how the property tax "reform" in the Florida Legislature has impacted his office. He is now getting deluged with requests for Federal funding from local governments. Seems the local governments are turning to the Federal government for funding projects and programs that were once funded by their own property tax revenues or by the state.

The other question was from St. Petersburg City Council Member Renee Flowers, who also is the President of the Florida League of Cities this year. Flowers asked for Nelson's help in securing adequate funds for affordable housing, including the re-authorization of Hope VI grants. Nelson said that the prospects were grim for passage due to the requirement in the Senate to get 60 votes to move a bill. Nelson said that as long as the administration opposed a funding level, Bush's Republican enablers in the Senate would make sure that the 60 votes would not be forthcoming.

Nelson was asked about the upcoming re authorization of No Child Left Behind. His initial response was that he was in favor of fully funding NCLB, something the Bush Administration has not done. As he continued to talk about NCLB, however, he seemed to be talking himself into some major modifications to the program, if he was to vote for re authorization at all.

When asked about outsourcing of jobs, Nelson responded that there were no simple answers in this complicated, interconnected world. He did say he favored changing the tax code to remove rewards for companies off shoring jobs. He went on to say that in order to remain competitive in a global economy, America's advantage would be its intellectual capital, which all comes back to education.

The final question came from Linda Osmundson, Director of CASA (Community Actions Stops Abuse). She asked for help in increasing the availability of FHA Section 8 vouchers. The availability of these vouchers has all but dried up. CASA has used these vouchers to place battered women in temporary housing as a way stop in helping these dislocated victims find permanent housing. Nelson failed to see the particular significance of this question and referred back to his previous answer about affordable housing funding and the 60 vote roadblock. Seems to me the answer is to elect a bigger Democratic majority and get a Democrat in the White House in 2008.

Nelson closed the meeting by noting that no one had asked him about Iraq. He then proceeded to explain his position on Iraq. Mainly, he supports the Iraq Study Group conclusions that the US should have begun a phased withdrawal of troops from Iraq and a change in the mission of the remaining troops. That changed mission would be to provide training for Iraqi forces; to provide border security and force protection and targeted missions against Al Qaeda in Iraq. Nelson also pointed out the ISG's call for increased diplomatic activity to create a regional solution for Iraq. This allowed him to point out his earlier visit to Syria and the criticism he had received. However, he is getting the last laugh as the administration now seems to be talking more to the Syrians, and they are even talking to the Iranian Ambassador in Baghdad.

Overall, this was a good performance for Nelson. He has been doing Town Hall meetings for 35 years and is very comfortable in this format. Despite my nitpicking above, he answered all questions put to him. He talked about what a privilege it was for him to serve. You got the feeling that he meant it. While I do not always agree with Bill Nelsons' votes on specific issues, he is a trustworthy man of his convictions. As Ronald Reagan said, someone who votes with you 80% of the time is your friend, not your enemy.

Nelson continued his vacation with another Town Hall meeting later in the day in Pasco County. Enjoy your "vacation", Senator Nelson.

RoadBlock Republicans Vote AGAINST Health Care for Children

Tampa Bay's Roadblock Republicans showed their true colors once again yesterday. How did they do it this time? They voted against Hr 3162 a bill

to extend and improve the children's health insurance program, to improve beneficiary protections under the Medicare, Medicaid, and the CHIP program

Here is the list of Tampa Bay's Roadblock Republicans who voted against health care for children:

• Gus Bilirakis
• Ginny Brown-Waite
• Vern Buchanan
• Adam Putnam
• Bill Young

What is the matter with these people? Why would they vote against expanding health care for children? Here is the red herring that Ginny Browne-Waite threw out responding to a letter from Charlie Crist supporting this initiative:

"I am disappointed that your letter fails to mention that SCHIP funding should not come at the expense of Florida's seniors."

Where is Ginny Brown-Waite getting this idea? Here is what the far right Human Events Magazine reports:

cutting $157 billion from the Medicare Advantage ... This scenario could result in seniors losing their current health care provider or being subjected to increased costs and decreased services.

But what is Congress really doing? They are cutting subsidies to Medicare Advantage HMO's. These are the insurance industry darlings who pushed through the Republican controlled Congress the hare brained scheme that they should be paid more than traditional Medicare benefits for denying more services.

So these Roadblock Republicans are not really standing up for seniors. They are standing up for insurance companies instead of providing more health care for children.

Isn't it time to get rid of these people?

WE Can Fix Health Care Now!

We all know the "healthcare" system is broken and it seems everyone has a "plan". It is shameful that America's healtcare system is ranked near the bottom among industrialized nations.

The World Health Organization (WHO) ranks the U.S. as 27th in the industrialized world for infant mortality. The average life expectancy, according to the WHO, in the U.S. is age 78, ranking 25th among industrialized nations. The average number of good health years is 69, also ranking 25th, and below Slovenia. According to the Institute of Medicine, 18,000 deaths in the U.S. are caused by lack of health insurance.

The good news is that we already have a system in place and we can fix health care now!

We all know the "health care" system is broken and it seems everyone has a "plan". It is shameful that America's health care system is ranked near the bottom among industrialized nations.

The World Health Organization (WHO) ranks the U.S. as 27th in the industrialized world for infant mortality. The average life expectancy, according to the WHO, in the U.S. is age 78, ranking 25th among industrialized nations. The average number of good health years is 69, also ranking 25th, and below Slovenia. According to the Institute of Medicine, 18,000 deaths in the U.S. are caused by lack of health insurance.

Link

The good news is that we already have a system in place and we can fix health care now!

Americans annually spend $5,267 per capita on health care, while the industrialized world’s median is $2,193. The U.S. spends more on health care than any other country in the world. Presidential candidate John Edwards remarked, "We're spending more on health care costs than any other country in the industrial world and getting one of the worst products out the other end."

In other words, we have the most expensive and least effective health care system in the world. The term "health care" itself is a misnomer when applied to our system . Our system does not promote health it treats sickness. It is a sickness system and the overall system is sick.

"Every other industrialized nation in the world provides universal health care to its citizens," Rep. Jim McDermott (D) of Washington. The fact that this country does not provide universal health care to its citizens is a crime and our government is responsible. That crime is negligent homicide and millions have already died.

There is no perfect system but obviously ours is seriously flawed and must be changed. Rather than creating a new system from whole cloth, Medicare can be turned into a national health care system that will provide coverage to all Americans. We simply need to change the eligibility rules and eliminate that 20% that the insurance lobby insisted that Medicare not cover

Let us move right now to solve this critical problem. The solution is simple but not easy however, it is doable right now. It can be funded by removing the income caps on Social Security and Medicare. This will have the advantage of putting both programs on solid fiscal ground.

How to Talk About Universal Health Care Insurance: Part 2

In How to Talk About Unviersal Health Care Insurance: Part 1 I talked about how the main crisis is not health care delivery, rather it is health care insurance.

This conversation was sparked by the response to another diary of mine published in December, How to Talk to Small Business People . Almost all the responses from small business people mentioned health care. They told me they are looking for a good way to get affordable health care insurance for themselves, their families and their employees. Of course these responses came from small business people who are progressive enough to comment and / or post on Daily Kos.

This diary is for people who want to advance the cause of Universal Health Care Insurance by persuading others. So let's get started...


If you have seen any of the other How to Talk to diaries, then you know the drill. If you are new to this, here is how we go about the task of talking to people already on our side. The purpose is to give them the tools to persuade people who should agree with us, but don't, that our ideas are the better ones.

The first thing to do is to define the values that relate to the task at hand. Here is my list of values applicable to this subject:

• Community
• That the promise of America is equal opportunity for all and special privilege for none
• Mutual Responsibility
• Inclusion
• Work and Family

We then have to incorporate those values into an argument that fits into these tasks:

Define the Overarching Strategy

Define the Terminology

Mangle the Memes

We start with the strategy.

Define the Overarching Strategy

When you talk to the other side, you should start with your goal in mind. So first, you need to define your goal. Only then can you determine the best overarching strategy to achieve your goal without compromising your values.

As in most of these tasks, our goal is to persuade people who should agree with us but do not yet. We need to do this in a way that does not lose our audience at hello. The target community must receive our message in a way that resonates with them on a personal level. This can best by done by research and real world examples. First, some research.

Some of the best and most persuasive resarch done in this field has been has been done by physicians%20themselves.%20 This research covers topics ranging from the huge administrative cost of our current system, taxes and who actually pays for these costs, and the sad fact that we already pay for national health care insurance, but don't get it.

If that isn't impressive enough, consider the research done by medical students . If the physicians already working in the health care delivery system and the medical students working to join them are in agreement, why would anyone else tell them that they are wrong?

Define the Terminology

Defining the terminology is akin to choosing the battlefield. If you let the other side define the terminology, you will be fighting your battle on the other guys’ battlefield. Any tactician will tell you that he who determines the battlefield has the much better chance of winning the battle.

We also must remember our audience. We are not preaching to the choir here. Out goal is to reach out and create a majority coalition in support of Universal Healthcare Insurance. Our target audience to get this coalition into the majority is twofold:

• Small Business people who already know how hard it is to obtain affordable health care insurance in the current inefficient market.
• Middle class taxpayers who mostly already have health insurance through their jobs.

The best way to reach this audience is to craft arguments where our values intersect with theirs. As we saw in Part 1, the census bureaus's research brought us these two telling tidbits:

• 73% of the uninsured in the workforce worked sometime during the year.
• 63% of the uninsured who worked during the year worked at companies with fewer than 100 employees.

This data give us the first things we can say about Universal Health Care Insurance - Most people who are uninsured are actively in the workforce. We are not talking about some giveaway program going mainly to those who are unwilling to work. We are talking about folks who work for a living just like you and I. Also, nearly 2/3rds of the uninsured in the workforce work for small businesses. This is just one more area where small businesses get the short end of the stick in this country.

So who are the uninsured? They are folks in our community who mostly work for small businesses. One would think that in a country that values entreprenuership, work and family, that we would take care of our workers and their families by making sure they all have equal opportunity to access quality, affordable health care no matter the size of the business they work for.

The other argument that should resonate particularly with small business people is the inefficiency of the current system. Health care insurance is ridiculously expensive, particularly so for folks who are not part of large byuying groups (big business, unions, professional associations, etc.). One of the reasons for the heavy cost is that the private insurance delivery system is incredibly inefficient in delivering the product. Small buisness people know better than most how crucial it is to control costs. The big business of health insurance delivery seems to believe thay can just pass these cost along to us.

What most of us don't know is that the government is already paying the lions' share of health insurance costs in this country.

the amount of public health spending in the U.S. is greater than the combined public and private spending of nations which provide universal comprehensive health insurance. A single-payer system could provide such coverage to all Americans with no need for additional health dollars.

So we could provide equal opportunity for an all inclusive health care insurance sytem without spending additional tax dollars. Is that not a win-win for middle class taxpayers and small business people?

So why do we not already have such a sytem?

Mangle the Memes

The first thing to understand is that there is a powerful lobby in this country that is determined to maintain the status quo. One of the main ways this lobby goes about maintaining the status quo is by demonizing the alternatives. So let's talk about what we are not suggesting.

We are not talking about socialized medicine. Remember, this discussion is about health care insurance. The main problem is not with our health care delivery system. So do not let anyone get away with telling you that it is.

We are not talking about some inefficient government bureacracy deciding who gets what health care procedure and when. In fact, an efficient health care insurance system will put even more of the choice for health care decisions back into the hands of the doctors and their patients. Doctors and patients will take back the decision making from some faceless private insurance bureaucrat.

How do we do that? With a single payer universal health insurance plan, we would wring the waste out of our health care insurance delivery system. Turns out this is a case where private industry is less efficient than government.

administration consumes 31.0 percent of U.S. health spending. Average overhead among private U.S.
insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer
system and 3.6 percent for Medicare.

Who would have thought that the US government provides health insurance administration at one third the cost of private insurance?

We have a mutual responsibility to include working families in the health care insurance system. Healthy communities are productive communities. W can provide equal opportuity for access to affordable health care insurance at no additional costs to taxpayers. Ultimately we will have the luxury of seeing health care insurance costs falling for everyone.

So, get away from the keyboard and get out into your communities. Deliver thse messages to your elected officials and other opinion leaders in your community. A concerted netroots / grass roots campaign for single payer universakl health care insurance could get this issue past the tipping point.

What are you waiting for, someone else to do it? Start today.

How to Talk About Universal Health Care Insurance: Part 1

A few weeks ago I posted a diary titled How to Talk to Small Business People . So many of the comments were about health care issues that it become apparent that this was a topic in desperate need of further conversation. So instead of "How to Talk To..", today it is "How to Talk About..."

Usually you will see this subject discussed using the short hand of "Universal Health Care" as if that were the issue. That is not the issue. As we will see below the fold, we already have Universal Health Care. What we do not have is Universal Health Care insurance.

So follow along and we'll see what can be done about this situation.

We need to make one thing perfectly clear right from the start. That is that we do not have a health care crisis in this country. We do have a health care insurance crisis. No one in need of care who presents themselves for treatment is denied treatment. Ok, almost no one. But the general rule is that if you present yourself for health care, you will receive it. From VOANews.com:

Karen Davenport, executive director of health care policy for the Centerfor American Progress:"The ones that are probably of greatest concern would be the people who areuninsured who delay care and who end up using not just emergency room services,but more complex, more complicated, more intensive services when they do getcare," she said.

Since they are uninsured, these patients run up bills that they are unable to pay. More from VOANews:

"I think that we provide a high amount of uncompensated care here at Children's National Medical Center, anywhere from $28 and $30 million a year that we report that is provided as uncompensated care," noted Chavanu. "And that's really approximately eight to ten percent of our population."
According to the American Hospital Association, hospitals doled out $27 billion in uncompensated care in 2004.

Like any other business, hospitals pass along the cost of bad debts to their other customers in the form of higher prices. Unlike other businesses, hospitals are not able to control their credit risk. They treat whoever shows up. We all wind up paying for this in the form of higher hospital bills which ultimately turn into higher health care insurance premiums. So what can be done to alleviate this situation?

MALCOLM GLADWELL lays out some of the facts about our current health care system in this article in the New Yorker:

Americans spend $5,267 per capita on health care every year, almost two andhalf times the industrialized world’s median of $2,193; the extra spending comesto hundreds of billions of dollars a year.

<snip>

The United States spends more than a thousand dollars per capita peryear—or close to four hundred billion dollars—on health-care-related paperworkand administration.

Other countries pay around 30% of what we spend on health care related adminstrative overhead. Between the uncompensated service hospitals provide and the excess cost of administration, there is about $300 billion needless spending in our current health care system. That comes to more than $1,000 per year for every man, woman and child in this country.
So we have plenty of room for improvemnt in the administration of our health care delivery system. There is one other myth to bust about health care in this country. We already have a working model for a single payer health care system up and running in the United States. It is called Medicare.

So who are the uninsured? The Census Bureau provides us with this information:

• In 2004, 45.8 million people were without health insurance coverage, up from 45.0 million people in 2003.
• The percentage and number of children (people under 18 years old) without health insurance in 2004 was 11.2 percent and 8.3 million.
• With a 2004 uninsured rate at 18.9 percent, children in poverty were more likely to be uninsured than all children.
• The uninsured rate and number of uninsured in 2004 was:
• 11.3 percent and 22.0 million for non-Hispanic Whites, and
• 19.7 percent and 7.2 million for Blacks.
• The number of uninsured increased in 2004 for Hispanics from 13.2 million in 2003 to 13.7 million; their uninsured rate was 32.7 percent.

These figures show us that an undue burden is placed on people of color, who also tend to be at the lower levels of the socio-economic ladder. Blacks and Hispanics make up 46% of the uninsured population. They account for only 19% of the total population.
How about some characteristics of the uninsured? Again, from the Census Bureau :

• 73% of the uninsured in the workforce worked sometime during the year.
• 63% of the uninsured who worked during the year worked at companies with fewer than 100 employees.
• 62% of the uninsured in the workforce had a high school diploma or less.

It turns out that the uninsured are not only the unemployed. In fact, nearly 3 out of 4 uninsured in the workforce had been employed during the year. Of this group, nearly 2 out of 3 worked for small businesses (less than 100 employees.) And nearly 2 out of 3 uninsured in the workforce had only a high school diploma or less.

Some of the issues and makeup of the health insurance problem have been laid out. This is the first step. In Part 2, we will talk about some proposed solutions and how to talk about them.

In the meantime, talk amongst yourselves. But be gentle.