After eight dismal years of healthcare policy from an administration more interested in engorging the nation’s insurance and pharmaceutical industries, how refreshing to hear a State of the Union speech that calls for comprehensive reform and recognizes the real pain and suffering of American families priced out of access to care.

So President Obama deserves plaudits for his emphasis on healthcare reform, and pledge to getting it done this year amidst the deepening economic gloom.

But it won’t do our nation — or the President and Congress — any good to expend the political capital necessary to pass legislation unless we actually fix the problem.

And any bill, like so many of those short sighted proposals now being considered in several legislative committees, that leaves the insurance companies in control of our health won’t curb the rise in costs that are devastating families today or do anything about the now all too routine denials of care.

Only one reform, single-payer, or an expanded and upgraded Medicare for all, effectively controls costs at the source, by eliminating the stranglehold of the insurance giants and the price gouging we see in ever-rising premiums, co-pays, deductibles, and other daily costs that have caused so much harm to so many. A bill that gets us there, John Conyers’ HR 676, has been recently reintroduced in the House.

A report just out today from the Institute of Medicine reaffirms the problem, Markowitz noted. Average premiums for family coverage have soared by 119 percent the past decade – three and a half times the growth of family incomes.

The IOM noted that many companies are dumping full-time positions, and replacing them with part-time, contract, and temporary jobs that don’t offer health benefits. Also, more and more areas around the country are experiencing severe problems with limited hospital access to emergency care and in-patient bed capacity as the result of the growing number of uninsured and underinsured Americans.

There’s an added bonus. Single payer reform is that it not only guarantees coverage for everyone, controls costs, and ensures complete choice of provider — it also promotes economic recovery.

A recent study by the Institute for Health and Socio-Economic Policy (IHSP), research arm of the California Nurses Association/National Nurses Organizing Committee, finds that single payer reform would create 2.6 million new good paying jobs, infuse $317 billion in new business and public revenues, and inject another $100 billion in wages into the U.S. economy. The study may be viewed at www.CalNurses.org.

While 30 percent of the new jobs would be in health and social services, the ripple effect of job creation goes throughout the economy, with gains in retail trade, accommodation and food services, manufacturing, and administrative services, as well as healthcare.

Originally posted at Spotlight on Poverty and Opportunity.

An impressive gathering of political leaders, advocates and policy wonks were in attendance on Monday in San Francisco for a major forum examining the social and economic factors that influence health and the role those issues should play in the upcoming health care reform debate.  The event was jointly sponsored by the California Endowment, the Stanford Center for the Study of Poverty and Inequality, and Spotlight on Poverty and Opportunity.

A series of speakers spoke eloquently about the vicious cycle of poverty and poor health, making clear that as Congress begins debate in the coming months on health care policy reform the discussion will need to be about far more than health insurance.

The ball is already rolling in that direction at the state level.  Speaking at the Monday forum, California State Assembly member Dave Jones, who is chair of the Assembly’s Committee on Health, said that his committee will hold hearings in the next month on what can be done in California to address racial and ethnic disparities in health.

Several speakers also pointed to provisions in the Obama Administration’s economic recovery package that directly or indirectly affect health, including increased funding for food stamps, education and even transportation.

Paula Braveman, director of the Center on Social Disparities in Health at the University of California, San Francisco, noted the direct link between poverty, low education attainment, low-paying jobs and poor health.  Poor education, she said, leads to low-income which leads to an inability to purchase healthy food and have access to regular exercise. All of this also leads to greater stress, which in itself results in poorer health compared with those who are better educated and have secure, well-paying jobs.

For a complete look at the days events and to view clips of forum speakers, please click here.

Anthony Wright of Health Access has a good piece musing about whether or not we’ll still need additional spending cuts or revenue increases before the next fiscal year budget in June 2010.  It basically hinges on two things: the May 19 special election, where close to $6 billion in budget money is on the line, and the federal stimulus, which if it provides enough money to the state could trigger some reductions in cuts and taxes.  First, the trigger:

Although the budget contains a number of spending cuts, it also contains a mechanism to restore some of those cuts using federal funds authorized by the American Recovery and Reinvestment Act of 2009 (ARRA) signed by President Obama on February 17, 2009. The mechanism requires that in order to restore cuts, the state must receive at least $10 billion in federal funds to offset General Fund costs. In other words, $10 billion of federal funds are needed to “trigger off” some of the cuts.

The precise amount of federal stimulus funds for California is still being determined, however, the Director of Finance and the Treasurer must determine by April 1, 2009 whether federal funds meet the $10 billion threshold to trigger off the spending cuts. Specifically with respect to health care cuts discussed above, if there is sufficient federal funding, Medi-Cal benefits would not be eliminated and public hospital payments would not be reduced. If there is insufficient federal funding, those cuts and others–including steep cuts in SSI/SSP, IHSS, and CalWORKS would be implemented July 1, 2009.

Hopefully, these funds will make it to California’s shores to stave off the worst cuts.  Ultimately the federal government should seek a goal of stopping all cuts in public services and layoffs of staff, and should fill the gap in revenue in the short term.  The states are being punished through little fault of their own, and counter-cyclical cuts threaten the success of recovery.

The next element is the May 19th special election.  We’ll be covering that in the weeks to come, but Wright lays out the most important initiatives that relate to the budget.

* Proposition 1D would amend Proposition 10, which was passed in 1998 and increased the tobacco tax to be used exclusive for services for children up to five years old. This budget, subject to voter approval, would redirect Proposition 10 funds of up to $340 million in the first year and $268 annually for the following five years to be appropriated by the Legislature. As a result, local First Five Commissions would have to cut the programs they fund, such as county “Healthy Kids” coverage initiatives.

* Proposition 1E would amend Proposition 63, which in 2004 raised the income tax for the upper-tax bracket to earmark funding specifically for mental health services. This budget, subject to voter approval, would redirect Proposition 63 funds of up to $226.7 million in the first year and $234 annually for the following year from Proposition 63 mental health services to backfill the existing Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program.

* Proposition 1A would pass a Constitutional amendment to institute a spending cap, to limit the amount of revenue that can be appropriated for the General Fund. It also would extend the temporary taxes to last from two to five years. Under the spending cap, any revenues above a forecasted amount must be put in a “Budget Stabilization Fund,” and can only be accessed under certain circumstances. In other words, the spending cap locks up money making the state less able to fund education, health care, and other core state services.

Wright doesn’t mention Prop. 1C, which would sell the state lottery to fill a $5 billion dollar hole in the short term, but cost the state money in the aggregate in the long-term from the loss in consistent revenue.  I’ve always thought it was a stupid and shortsighted idea and would be unlikely to support it in May.

But clearly, Prop. 1A is the most dangerous measure in the long-term, locking the state into deep cuts into the distant future, which would ratchet down services regardless of demand or growth.  This is the long-sought effort by the far right to drown government in the bathtub.  And yet to this point, no opposition has been found to this measure.

The last time Gov. Arnold Schwarzenegger asked California’s voters to permanently cap state spending, organized labor dumped millions of dollars into a successful campaign to defeat his proposals.

Four years later, Schwarzenegger and other proponents are hoping the unions will sit out the May 19 special election in which the governor is again asking voters to enact a spending cap. That measure was placed on the ballot by the Legislature as part of last week’s deal to resolve the state’s cash crisis.

The official ballot arguments have been submitted, and in what administration officials hope is an encouraging sign, the best-funded labor groups opted not to weigh in against the measure. At least not yet.

In addition, the state’s major antitax groups have split over the measure, with at least two supporting it even though it would prolong the tax increase that the Legislature passed last week. The California Taxpayers’ Assn. signed the ballot measure backing the spending cap, and Lew Uhler of the National Tax-Limitation Committee said he also favors the measure, called Proposition 1A.

The above-mentioned provision that extends the taxes passed by the Legislature makes for approximately the easiest demagoguery in the history of California initiatives.  Jon Coupal at the Howard Jarvis Taxpayers Association says his group will try to defeat the measure.  The fact that the ballot arguments had to come in so quickly may be driving this perceived silence on the part of slower-moving unions, but they need to make themselves clear.  Do they support a spending cap that will unquestionably take the state backwards in the future, or will they oppose it – and back up that talk with action?  We shall see.

Former Huntington Beach Mayor Debbie Cook stopped bad developments in parks and beaches, and led the efforts to clean up the water off Orange County’s coast. In the meantime, she became a national leader on energy issues.

Costa Mesa City Councilwoman Katrina Foley has led the fight to improve her city’s quality of life, fought for better parks and increased opportunities for her city’s youth as others on the Costa Mesa City Council were more concerned with ugly immigrant bashing.

Irvine Councilwoman Beth Krom helped to create Orange County’s visionary Great Park, and her leadership has made Irvine a model of sustainable planning, green building and environmental stewardship.

You can meet them this Saturday, Feb. 28 as they join the Orange County League of Conservation Voters for a roundtable discussion on building a green political farm team for Orange County.

Environmental Roundtable

“2010 Goal:  Progressive Change in Orange County”

Saturday, February 28, 2009

9:30 am to 12:30 pm

Santiago Creek Wildlife and Watershed Center

600 E. Memory Lane, Santa Ana

To RSVP contact Robin Everett at [email protected] or call 949-338-5356

(cross-posted from Orange County Progressive)  

(cross-posted from Orange County Progressive)

It’s exciting to follow the news about a proposed Constitutional Convention that might make California and all of its government agencies more governable.

In the process, there’s encouraging talk about eliminating counties, or redrawing the lines, so that Orange County might follow its namesake citrus groves into history.

It’s really frustrating at times watching what goes on in Orange County and being puzzled by how our county government has bollixed things up. For example, our County Parks have been hamstrung for years as their revenue has been redirected to paying off bankruptcy bonds. As a result, thousands of acres of open space preserved by development agreements may end up managed by an unaccountable conservancy under control of Irvine Company directors.

Orange County still maintains a planning department despite a shrinking area of responsibility where the vast majority of us live in 34 cities, an oft-sued bureaucracy that couldn’t plan its own budget in a department that changes its name frequently.

Our libraries, traffic control systems, street names, water and sewer departments,planning, et cetera are a crazy quilt of competing and overlapping jurisdictions where agencies like SARFPA, SARWQCB, OCCOG and SCAG operate far outside the coverage resources of our hapless local media outlets.

As part of the legacy of low OC taxes before Prop 13, our county government receives a much lower share of property tax than other counties, an item that Lou Correa helped rectify when he had veto power over the state budget.

There’s a great background piece about how the idea for rewriting the Constitution came from the business community.

A thin LA Times story doesn’t offer much detail and a Chronicle piece focuses on the 2/3 budget rule

The best coverage came from outside the traditional media, including some great posts at Blockbuster Democracy Blog and the live feed from Robert Cruickshank with a tremendous follow-up this morning at Calitics.

This is truly significant news for us all, if a coalition of business, progressives, and good government advocates can design an initiative that will call a Constitutional Convention, figure out a way to elect delegates who will produce a new framework for organizing and financing government, and bring that back to the people of California.

We all know that the system’s broken, but we need a Big Fix instead of one more failed crapola budget deal that pushes problems down the road another year, and increases future problems so we can avoid facing them for another year.

And it’s time to take a close look at why we maintain a structure of counties that were originally constructed based on how far a man could ride a horse in a day.

Yesterday’s Constitutional Convention Summit was actually an autopsy. For five hours both panelists and the audience dissected the reasons for the death of the California Dream and all agreed, even if they did not explicitly say this (though many more did than I ever expected), that California’s government was murdered by Prop 13 and its accomplices. A Legislature that in the late 1960s was rated as the nation’s best has now become one of the most unpopular and ineffective institutions in American politics.

What the Summit revealed is that at the core of California’s political crisis is that the people of this state have no way to hold anyone accountable for a system that has totally and deliberately failed. By completely eviscerating the method by which public services are financed, and by locking into place a conservative veto over state government, Prop 13 and the 2/3 rule in particular ensured that the Legislature would never be able to enact effective policy again. And that to produce solutions, voters would have to fill the Legislature with Democrats, something that isn’t possible given our self-segregating electorate.

The Chronicle’s John Wildermuth also noticed the centrality of the 2/3 rule to the discussions, and several folks, including Mark Paul of the New America Foundation emphasized how pathologically dysfunctional it has made our government.

It would be very wrong to say that the supporters of a convention in that room were solely motivated by the wreckage of 1978. Many attendees wanted to focus on the need to increase popular engagement with government. Proportional representation and smaller legislative districts (i.e. more legislators) were common proposals. Steven Hill of New America Foundation in particular has had some good ideas on reforming our democracy – you can find some of them on their Political Reform Blog.

But more important was the spirit of popular engagement that suffused almost every panelist’s comments. There was a recognition that if our state is to be fixed, and if a convention is the way it’s going to be done, the people themselves really do have to be empowered. A convention, and their government, have to be made relevant to the lived experience of Californians. They have to trust that they can control a convention, and that its outcomes will make their lives better.

Much more over the flip.

The lone conservative Republican who agreed to attend as a panelist, Michael Capaldi of the Orange County Lincoln Club, spent his time proving that the Zombie Death Cult literally has nothing to offer California other than the status quo. He kept talking about what “fiscal conservatives” want, as if anyone is still fooled by them. They had the run of the state for the last 30 years. Until last week the last time the Legislature agreed to a tax increase was 1992. They’ve had the governor’s office 22 out of the last 30 years.

The Zombie Death Cult, as witnessed by Bobby Jindal’s ridiculous joke of a speech, is particularly unaccountable. They use the 2/3 rule to shape policy, and then blame the result on the majority party, while they become more and more doctrinaire and cult-like. Hence their name – they’re a cult (deviance from the truth is not tolerated), they are producing death (that of the state and its residents) and they’re zombies (a political party that hasn’t had a hope of winning elections in this state since the mid-1990s, but somehow walks among the living).

Capaldi did, however, understand what was up. He said “fiscal conservatives have the most to lose from a convention” and this is of course true. The entire reason people are speaking of calling a convention is to fix what he and his ideological allies broke. The reason we need to make a convention and government relevant again to the people and their lives is because he helped make government irrelevant and in fact unable to help improve their lives.

Capaldi also made some revealing comments about public service – namely, he thinks it’s for saps. His attacks on elected officials motivated one woman, a former mayor of Morgan Hill, to rise in defense of local electeds. She pointed out that she had been one of the few women elected to local government, was there to speak for working mothers, and that she took it seriously and as a point of pride when constituents would talk to her about issues in the supermarket, or on the soccer field, or wherever else. Capaldi’s attitude is one of a man who has tried to destroy the ability of a community to improve itself, and to denigrate those who try to make things better through government.

I spend time on him to illustrate what is the second key outcome of the Summit – a de facto recognition that the right-wing no longer has a place in California politics. I may be quicker to see this than others in the room, but it’s true. The convention, and state politics in general, are becoming the domain of the center and the left.

The same thing is revealing itself in Washington DC. In federal and state politics the only thing keeping the right-wing relevant are supermajority procedural rules – the Senate filibuster and the 2/3 rule (although a media that has been trained to parrot whatever a Republican says has a role too, but the media is either dying or about to be rudely awakened by massive public support for Obama and his agenda).

For the last 30 years the center has seen the left as their primary threat, and seen the right as either useful idiots or desirable allies. I believe this is starting to change, as some in the center are starting to see the right as their primary threat and the left as either useful idiots or desirable allies. (As someone firmly on the left, I don’t take offense, since I’m not all that worried about the center dominating things anyway. They’re going to struggle to remain relevant too.)

Interestingly, the center and the left can work together because they both agree on something fundamental: good government is essential to social happiness and prosperity. The right-wing rejects all of that. But because Californians now demand good government to help solve this dire economic crisis, the right-wing is effectively cutting itself out of the conversation. Whether it’s Jindal attacking the notion of unemployment insurance or Zed Hollingsworth attacking the notion of funding public schools, the result is the same: marginalization and irrelevance.

Whether in a constitutional convention or state politics as a whole, debates between center and left are going to become of prime importance. On a convention, for example, a question is whether the convention should be limited or broad in scope. Most progressives don’t want the convention to address social issues. But many of us would like to use it as an opportunity to dramatically reshape the relationship of government and the people – and ideally to tear down those divides. Perhaps a unicameral legislature with 300 representatives, some picked by proportional representation. The center would want a more narrowly focused convention whose brief is confined to some structural fixes but that don’t really reshape how California’s democracy works.

Another potential divide is delegate selection. Most progressive organizations want to throw the doors open to the people, to allow them to elect their representatives – as many as 15-20 per district. Some centrist groups, like the League of Women Voters, seem to prefer an indirect method, where a Prop 11-style commission would pick through some arcane formula designed to produce a more neutral (but perhaps less accountable) set of delegates.

There will be other debates, and I know I’ve only scratched the surface of the specific proposals. And that’s partly deliberate. As several folks who spoke yesterday recognized, if this is to work it really must provide the people with meaningful and genuine empowerment. It has to be their convention. The people are, after all, sovereign. We can and should offer suggestions and ideas, but this can’t be a top-down affair. Of course, I’m happy to discuss specific ideas in the comments.

If you’ll forgive me, I want to close with a very good quote on this from my boss at the Courage Campaign, Rick Jacobs, who told the crowd:

What we have is so broken that I can’t even imagine that we get something worse…If we ever get to the point where there is a constitutional convention, I think it ought to be big, it ought to be broad, and we ought to trust the people.

Not surprisingly I agree, and I hope you all do as well. The next moves on this have to be a big and broad public conversation where we go directly to the people and say “we trust you to fix this state. what do you want to do, and how would you do it?”

When you look at food stamp (now called SNAP) participation rates, California as a state ranks 4th from the bottom. And if you look at the food stamp participation rates of the 24 largest metropolitan areas in the nation, San Diego ranks dead last. This means hungry people don’t eat, but it also means that San Diego county loses $144 million annually. And that’s $144 million in the form of the very best economic stimulus the government can give us – each dollar of food stamps generates about $1.80 in economic activity.

Let’s take a look at San Diego as a case study: Why aren’t San Diegoans getting food stamps? And what can we learn from San Diego that might help us increase the participation rate nationally.

First up, those eligible for food stamps don’t all participate at the same rate. Take a look at this:

Food Stamp Participation in 2003

56% of total eligible population

74% of eligible children

28% of eligible elderly individuals

62% of individuals in households with no earnings

47% of individuals in households with earnings

Source: Sources of Variation in State-Level Food Stamp Participation (PDF)

So when you see the HUGE discrepancy between the 89.5% of eligible food stamp recipients who participated in Missouri in 2003 and the miserably low 29% of those who participate in San Diego, that explains part of what’s going on. If San Diego’s eligible population is made up of demographics that are less likely to participate, then naturally San Diego’s participation rate will be lower as a result.

That explains SOME of the discrepancy but not all. Another possible explanation is that differing state policies make it more or less likely for those eligible to apply or receive food stamps. For example:

• Certification period – How frequently must an applicant reapply (between 3-12 months)
• Reporting requirement – Are applicants required to report any changes in income? (And if so, how frequently?)
• Categorical eligibility – Is any group of people automatically eligible for food stamps if they are eligible for another government program?
• Fingerprinting – Are applicants subject to fingerprinting, which might discourage some from applying?
• Application page length
• Work requirements – Are able bodied adults required to work?
• Number of visits required to apply
• State outreach – Does the state engage in any outreach activities?

I can imagine that if your state makes it a real pain in the butt to apply for food stamps, you might just give up. Especially if you wouldn’t receive very much in benefits anyway. Maybe you’d make that first trip to apply but if subsequent visits were required, they want your fingerprint, and the application’s long, maybe you don’t bother. Or maybe you bother the first time, but three months later when they want you to re-certify, it’s just not worth the hassle.

The USDA crunched the numbers to see if the make-up of the population accounted for the differences in participation rates (it did some, but not too significantly), or if different state policies explained the discrepancies. The answer? Well, they couldn’t find any statistically significant difference in participation rates based on the policies.

However, they also say that they doubt that the variation in participation rates is totally random. And it’s hard to believe that a state that makes its application process difficult and obnoxious wouldn’t have any effect on its participation rate.

The USDA suspects that their inability to account for differences in participation may be due to lack of sufficient data or overly imprecise data, or perhaps similar policies are implemented differently, making statistical comparisons between them impossible. (For example, if two states had an identical policy but implemented it differently. When the USDA does its number crunching these states would be lumped into the same category but in reality food stamp applicants in either state would have very different experiences.) Another possibility is that “aggregate measures may mask meaningful local variations.” Last, perhaps state procedures – how the states actually do what they do – are more important than state policies.

I’m glad the USDA is looking into this, and I hope they can find an answer that explains why 70% of those eligible for food stamps in San Diego do not receive them.

Participation Rate (%) by State (2003)

Missouri 89.5

Oregon 85.7

Tennessee 83.1

Hawaii 79.1

DC 74.3

Oklahoma 73.0

Maine 69.9

Kentucky 68.9

Mississippi 67.9

Georgia 67.5

Louisiana 66.2

South Carolina 65.9

Ohio 65.2

Michigan 65.1

Arizona 65.0

West Virginia 64.9

Indiana 63.6

Minnesota 63.1

Alaska 61.5

Vermont 60.8

Illinois 60.6

Nebraska 60.5

Arkansas 60.1

North Dakota 57.8

Iowa 57.2

Delaware 54.8

South Dakota 54.3

Idaho 54.2

Alabama 54.1

Pennsylvania 54.0

Connecticut 53.8

Wisconsin 53.3

Kansas 53.0

New Mexico 53.0

Rhode Island 51.9

Virginia 51.5

Washington 51.4

Utah 50.9

New York 50.2

New Hampshire 49.7

Wyoming 49.2

Florida 48.9

New Jersey 48.7

Maryland 48.1

Texas 47.4

Colorado 45.5

North Carolina 45.4

California 45.3

Montana 44.6

Nevada 41.0

Massachusetts 40.1