Our Editorial in the New York Times: “We Stand For Access”

As a member of the American Society of Law, Medicine & Ethics, I’m proud to add my name to this letter to the editor in the New York Times:

To the Editor:

We, many of the nation’s health law and health policy professors from law, medical, public health and graduate schools across the United States, write to address one of the most fundamental issues impacting our country: the potential repeal and replacement of the “Affordable Care Act” (“Obamacare”). It is clear that the House-passed “American Health Care Act,” as well as the legislation likely to be considered by the Senate, will cause severe, lasting harm to all of us, especially our society’s most vulnerable and middle class.

Today we raise our voices to oppose these proposals. While the Affordable Care Act has its shortcomings that should be fixed, the current proposals are merely “repeal,” with no effective “replace.” These proposals are wrong, and must be rejected. At a time when we are seeing significant declines in the number of uninsured and inadequately insured in our country, the House and Senate proposals represent a giant step backward. By cutting Medicaid funding, eliminating federal assistance for families securing private coverage, and encouraging individuals to either not purchase insurance or to buy barebones coverage, these proposals will result in a less equitable, less accessible system of health care. Ultimately, the public’s health will decline as needed care is forestalled or not sought, and costs will rise as a shrinking pool of Americans with “good” insurance pay more to subsidize those without.

Given the many health care challenges that we face— an aging population needing an increasing amount of health care services; a young and middle age population facing growing rates of obesity, heart disease, and other chronic conditions; a rapidly expanding “gig” economy of independent contractors needing to secure insurance without employer subsidies; and a rising number of individuals addicted to new and more prevalent illegal drugs— reducing access to health care services simply cannot be an acceptable policy option.

We also are deeply concerned about what this new legislation portends for women and children. Currently, the United States leads the developed world in maternal mortality. More women die during childbirth in the United States than in any other Western nation. Despite the urgency to protect women’s health and strive for better outcomes, lawmakers have specifically targeted maternal health coverage for cuts.

The same is true for infants in the U.S, whose health care is also at risk with these proposals. Our nation ranks 50th in the world on infant mortality. By shifting more families off of Medicaid, and creating a larger uninsured and under-insured population, children’s access to health care services will decline.

The Affordable Care Act protects all Americans from discrimination based on preexisting conditions, expands coverage for mental health treatment and drug addiction, and fosters preventive care. Millions of Americans have health insurance for the first time, and we are at an all-time low in the percentage of citizens who lack coverage. The reform legislation under development proposes to wipe away these essential gains, returning Americans to the pre-Affordable Care Act era of coverage limitations and exclusions thwarting the provision of essential health care services.

In 1966, Dr. Martin Luther King explained to a group of health providers, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” We agree.

Our American Discourse, Ep. 6: Federalism and the Battle for Partisan Power

We think we know how federalism works. Republicans believe in states’ rights, and Democrats want a strong federal government, right? Not so fast. New research reveals a whole different tug of war playing out on Capitol Hill. Our legislators don’t always do what they say, but they do have a strategy to design and implement our laws. It turns out that federalism is ground zero in their battle for partisan power — and now we finally know how the game is being played.

In this episode, we go behind-the-scenes with the researcher who uncovered these terms of engagement, Pamela Clouser McCann.

Prof. McCann is an assistant professor in the Sol Price School of Public Policy at the University of Southern California. Her new book, The Federal Design Dilemma: Congress and Intergovernmental Delegation, was published by Cambridge University Press in September.

To listen to this episode of Our American Discourse, click the orange arrow in the Soundcloud player at the top of this post. Or you can download it and subscribe through iTunes, Soundcloud, or Google Play.

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“Our American Discourse” is produced by Aubrey HicksJonathan Schwartz, and myself, and mixed by Corey Hedden.

Watch Me Discuss the Future of the Economy on The Sam Lesante Show!

Let’s start 2016 by getting up-to-speed on the American economy! Here’s an interview with me, just in time for the holidays, on The Sam Lesante Show, where we cover everything from the federal budget deal to the Federal Reserve rate hike to the lingering problem of inequality:

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You haven’t heard from me for a few months because I’ve been busy doing research on these economic issues. In 2016, I’ll be writing about my findings. I hope you’re as excited as I am for the new year and all the debate it brings!

The Minimum Wage Shows Why (and How) We Should Vote Today

It is time for the states to lead.

Every once in awhile in the history of this great country of ours, the federal government just can’t get the job done. Partisan gridlock, constitutional uncertainty, public distrust all play a role. But one of the great strengths of the American system is that the states — those laboratories of democracy, as Louis Brandeis called them — can act when Washington will not. Abolitionism, women’s suffrage, health care reform, gay rights: All started at the state level.

This is one of those times. Our national system is inert. Our national leaders are mired in the muck of inaction.

And yet there is hope. For today is Election Day, and on this day, we will elect 36 governors. This is no time to stay home when the polling places are open. This is a time to choose leaders who will act where Washington has not.

I can think of no better example of the choice we face as a country today than the minimum wage.

After World War II, Congress set the minimum wage at approximately half the average wage in the country. In today’s dollars, it was over $10 an hour. Earning the minimum wage, one full-time worker could support a family of three above the poverty line.

Today, the federal minimum wage is $7.25, less than 36 percent of the average wage. It’s so low that it can’t even keep a family of two out of poverty.

Unlike Social Security or Medicare payments, the minimum wage is not indexed to the cost of living. Only Congress can raise it. The last time they did so was 2009. Democrats proposed raising it again earlier this year, but the majority of senators opposed it.

The feds have failed to act. It’s time for the states to lead.

And we have ample evidence that they can. Twenty-three states already have minimum wages higher than $7.25. Five states — Alaska, Arkansas, Illinois, Nebraska, and South Dakota — have an initiative on today’s ballot to increase theirs.

But not everyone is onboard.

“I don’t think it serves a purpose,” said Wisconsin’s Republican governor Scott Walker last month.

“I don’t think as governor I want to be the cause of someone losing their job,” said Greg Abbott, the Republican candidate for governor in Texas, in explaining his opposition to raising the minimum wage. Pennsylvania’s Republican governor Tom Corbett made a similar argument when stating his opposition last year.

At least they pretended to know what they were talking about. When Republican Governor Rick Scott was asked what Florida’s minimum wage should be, he said, “How would I know?”

These men are on today’s ballot in four of our nation’s largest and most influential states.

And they are tragically out-of-step with the lessons of economic history. In a recent study, the economists Hristos Doucouliagos and T.D. Stanley survey the vast research that economists have done measuring the impact of the minimum wage in recent decades — 64 papers in total — and they find “little or no evidence” that minimum wage increases caused job losses.

On the contrary, raising the minimum wage is a clear boost to the economy. In another recent paper, the economist Arindrajit Dube found that raising the minimum wage significantly reduces the poverty rate, a finding that is consistent with the other 12 studies economists have published in recent years measuring the same effect in different ways.

Only a politician severely out-of-touch with the modern economy could think otherwise. Today’s corporations don’t have to cut back jobs when wages rise. They have to cut back profits, which are at an all-time high. In the long run, they might not have to cut back anything. Higher wages lead to higher productivity, better health, fewer strikes, lower turnover, and higher consumption, which in turn leads to more demand for their products and therefore higher profits.

Individual companies may not want to raise wages if their competitors won’t, but when everyone does it, everyone benefits.

Trying to save money by keeping the minimum wage low is like trying to improve your health by starving yourself. It’s classic shortsighted behavior, hardly the visionary leadership that we’d like to see in the governor’s mansion.

That’s why today’s election matters. In this age of do-nothing politics, it’s easy to despair, but we must remember the intent behind the design. The same founding fathers who created a federal system that resists radical change also created a state system that encourages experimentation. Today we celebrate their creation, and we direct its attention to the challenges of our time.

If the feds do not act, the states will. We the voters will make sure of it.

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This op-ed was originally published in the Huffington Post.

How Obama Cut the Deficit in Half — and Made Us Pay the Price

U.S. Budget Deficit Over Time

Remember when everybody was talking about the budget deficit?

It wasn’t that long ago. In fact, it was one of the biggest factors in the 2012 presidential election. After all, it was over $1 trillion at the time.

Today, it’s $500 billion. And falling.

This, of course, is one of Barack Obama’s legacies. He raised taxes on the rich and cut spending across the board. Even with strong growth in mandatory programs like Social Security and Medicare this year, the federal government is going to spend about the same amount of money it spent in 2012 — and less than it spent in 2011. Adjusted for inflation, the government has shrunk.

But it has come at a cost.

Case in point: We have run out of money to fight wildfires.

A couple decades ago, wildfires in the western United States typically consumed 2 to 4 million acres in a year. Nowadays, they consume 6 to 8 million acres. As a result, the cost of wildfire suppression has more than tripled in that amount of time. And yet, Congress continues to allocate funding based on what it cost a decade ago, instead of what it costs today.

So it’s not surprising that Agriculture Secretary Tom Vilsack ran out of money to fight wildfires this year, forcing him to divert money away from programs that preventwildfires — magnifying the problem in years to come.

Traveling to the other side of the country, a Pennsylvania official testified in court earlier this week that he and his fellow regulators didn’t investigate chemical leaks that were allegedly poisoning citizens’ drinking water near natural gas wells.

But this shouldn’t surprise us either. After all, the Associated Press recently discovered that 40 percent of new oil and gas wells haven’t been inspected in this country. The report described the regulators as “so overwhelmed by a boom in hydraulic fracturing, or fracking, that [they have] been unable to keep up with inspections of some of the highest priority wells.”

It’s not like those investigations really matter, right? The Pennsylvania trial revealed that landowners were drinking water with “explosive levels of methane.” Meanwhile, a new paper published this week by researchers at Stanford and Duke showed that even tiny amounts of fracking wastewater can contaminate drinking water with toxic compounds.

So I guess it’s no big deal that regulators are so underfunded that they’re neglecting almost half the country’s drilling wells.

You’d think we would’ve learned this lesson last year when the IRS scandal revealed that auditors were singling out political groups — conservative and liberal, by the way — for investigation without any apparent probable cause.

For years, the IRS has been underfunded. The National Taxpayer Advocate said so. A Boston Globe investigation said so. The Government Accountability Office said so. And they all predicted that underfunding would result in less enforcement and more cutting corners. In fact, they said taxpayers would lose money because every dollar in budget cuts led to seven dollars in lost tax revenue that they would’ve collected if they’d had the manpower to do so.

Then the scandal hit, revealing that IRS officials were so “overworked” that they felt they had no choice but to take shortcuts through the “flood of applications” on their desks.

These are only a few examples of the price we have paid for a smaller deficit.

Barack Obama deserves credit for delivering on his promise to shrink the deficit — a promise that Mitt Romney and his tax cuts would surely have violated — but Americans have to ask themselves whether they really want a smaller government. Do we really want millions of acres destroyed by fire, and drinking water contaminated with toxic chemicals, and government officials harassing the innocent? I know I don’t.

And I also know there’s a better way. It begins with the understanding that, for all its faults and inefficiencies, our government does many good, essential things in our society. And yes, those things come at a price. But that is a price worth paying.

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This op-ed was published in today’s South Florida Sun-Sentinel and Huffington Post.