Rotten To The Core

So Senate Democrats on the Finance Committee offered an amendment that would enable the federal government to bargain for lower drug prices for their bulk purchasing, a direct assault on the White House/Big Pharma deal from a few months back. Basically it would shift poor seniors back onto Medicaid for their drug purchasing, where the government can negotiate discounts. This would save the government over $80 billion dollars.

And Tom Carper of Delaware defended the secret deal in the most amazing of ways:

I was not involved in negotiations with PhRMA but I believe that the administration was, obviously PhRMA was, and I presume this committee was involved in some way in those negotiations.

And what PhRMA agreed to do through those negotiations is to pay about
80 billion dollars over 10 years to help fill up half the donut hole. That's my understanding. And they are prepared to go forward and to honor that commitment. As I understand it, the commitment from our colleague Senator Nelson would basically double what was negotiated with PhRMA.

And whether you like PhRMA or not -- remember I talked earlier today in our opening statements, I talked about four core values, and one of those is the golden rule, treat other people the way I want to be treated?

I'll tell you -- if someone negotiated a deal with me and I agreed to put up say, 80 dollars or 80 million dollars or 80 billion dollars and then you came back and said to me a couple of weeks later -- no no, I know you agreed to do 80 billion and I know you were willing to help support through an advertising campaign this particular -- not even this particular bill, just the idea of generic health care reform? No, we're going to double -- we're going to double what you agreed in those negotiations to do. That's not the way -- that's not what I consider treating people the way I'd want to be treated.

That just doesn't seem right to me.

This is incredible. The deal is transparently one to protect drug industry profits. There's just no doubt about this. Carper is saying that it's more important to get a few generic ads in support of health care reform than to save the US taxpayers $80 billion dollars. Backroom deals must be honored even if they hurt people. That's the "golden rule" in Washington.

Did Carper not know that cameras were rolling when he said this?

The Dope On The Baucus Plan

I alluded to it before, but here's the draft framework for Max Baucus' plan from the Senate Finance Committee. If you don't have the time to read all 16 pages, Ezra Klein has posted a summary.

I'm trying to figure out who, if anyone, gets better health care coverage from this plan. So far I can only come up with one class: people making 100-133% of federal poverty level who can now qualify for Medicaid. For everybody else, the quality of coverage looks to my eye to be worse, though I could be missing something.

Folks in Medicare get 50% off of any prescription drugs that fall in the donut hole, but the grants of patents well beyond current law will cost them more for drugs they could be getting generically in the long run. We don't know the effects of making Medicare more efficient, but they're designed to be invisible, i.e. offering the same care at a lower cost to the government. So I'd call that a wash.

Those in the exchanges will get subsidies, of dubious affordability, up to 300%, and between 300-400% the cost of premiums will be capped. However, the coverage itself can be crappier than current law, and almost certainly will be. The out-of-pocket limits are good, but that only exists for "covered services" - for anything else you're on your own. Those covered services have to include the following:

...preventive and primary care, physician services, outpatient services, emergency services, hospitalization, day surgery and related anesthesia, diagnostic imaging/screenings (including X-rays), maternity and newborn care, pediatric services (including dental and vision), medical/surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services that meet minimum standards set by federal and state laws.

They also would restrict caps on lifetime benefits. Which is fine. But there will now be a whole insurance industry sector in how to properly define what falls inside and outside primary care, surgical care, hospitalization, etc. And remember, the entire regulatory apparatus for these major insurance reforms, which will be fought in court by multi-billion dollar companies, is a state-level ombudsman's office. And even with those credits, the coverage doesn't appear to be affordable.

If you get insurance through an employer, your health care coverage is about to get a whole lot worse.

Employer Responsibility. Employers would not be required to offer health insurance coverage. However, employers with more than 50 full-time employees (30 hours and above) that do not offer health coverage must pay a fee for each employee who receives the tax credit for health insurance through an exchange. The assessment is based on the amount of the tax credit received by the employee(s), but would be capped at an amount equal to $400 multiplied by the total number of employees at the firm (regardless of how many receive a credit in the exchange). Employees participating in a welfare-to-work program, children in foster care and workers with a disability are exempted from this calculation.

As a general matter, if an employee is offered employer-provided health insurance coverage, the individual is ineligible for the tax credit for health insurance purchased through an exchange. An employee who is offered unaffordable coverage by their employer, however, can be eligible for the tax credit. Unaffordable is defined as 13% of the employee’s income. The employee would seek an affordability waiver from the exchange and would have to demonstrate family income and the premium of the lowest cost employer option offered to them. Employees would then present the waiver to the employer. The employer assessment would apply for any employee(s) receiving an affordability waiver. Within five years of implementation, the Secretary must conduct a study to determine if the definition of affordable could be lowered without significantly increasing costs or decreasing employer coverage.

A Medicaid-eligible individual can always choose to leave the employer’s coverage and enroll in Medicaid. In this circumstance, the employer is not required to pay a fee.

Coverage offered by an employer of any size, including fully insured and self insured plans, is not required to comply with the list of benefits required of plans in the non-group and small group markets. Employers must provide first dollar coverage for prevention services (except where value-based insurance design is used), however, and cannot have a maximum out-of-pocket limit greater than that provided by the standards established for Health Savings Accounts (HSAs).

So small businesses can opt out of giving their employees health insurance and pay a fraction of the cost, about $20,000 for 50 employees. That will become the chic thing to do. If the employees aren't paid more than the requirement for Medicaid, employers can scrap coverage and let their employees take Medicaid and pay no fee. They are incented not to give their employees a living wage, in other words. And if they make coverage available for those above 133% FPL, they are bound by no standards like that coverage on the exchange, and their employees couldn't reject that coverage for something half-decent. Assuming regression to the mean, virtually every employer will immediately move to offering the shittiest coverage imaginable. They could only get to the exchange if the employer coverage is unaffordable, or 13% of their total income. So an employer, "AlmartWay" in Marcy Wheeler's construction, could conceivably take 12.9% of an employer's income for offering a plan that probably wouldn't cost that much.

Hell, if I were a rapacious manager like AlmartWay's completely hypothetical managers were, I'd turn employee health care into a profit center because (if I read this right) you could require employees to pay back 12.9% of their income for health care, and the only thing you'd really have to promise in return is preventative care. So I predict, if this bill passes in anywhere near this form, that AlmartWay will start making its own employee health care a big profit center because they will be stuck.

By golly. This is even a health care plan Blanche Lincoln and Mark Pryor and their biggest constituent could love!! Though frankly, Bad Max's plan is even worse than Wal-Mart itself--with a call for part time mandates and no disability discrimination--called for (though maybe Wal-Mart was thinking of the free subsidy for its Medicaid eligible employees all along).

And... there is no employer mandate, but the "free rider" aspect of the coverage will, in all likelihood, incentivize employers not to hire anyone who doesn't have family money.

Under the proposal, employers who do not offer health coverage would have to pay the full cost of the subsidies provided to employees who purchase coverage through the new health insurance exchange and qualify for a subsidy because their family income is below 300 percent of the poverty line. [1] But employers would not have to contribute to the health insurance costs of employees with higher family incomes. The new requirement would apply to firms with 50 or fewer employees.

The proposal would make it considerably more expensive for employers to hire workers from lower-income families than workers from higher-income backgrounds to do the same job. As a result, it would distort hiring decisions. Employers would have strong incentives to tilt hiring toward people who have a spouse with a good income (or have health coverage through a family member), teenagers whose parents make a decent living, and people without children (since the eligibility limit for the subsidies in the new health insurance exchanges will increase with family size). Low-income women with children in one-earner families would be particularly disadvantaged [...]

While language could be included to try to ban such discriminatory effects, it would be virtually impossible to enforce effectively. It would be extremely difficult to prove in court that an employer has passed over one applicant and hired another because of the health surcharge that employers would face if they hired people receiving health insurance subsidies.

Moreover, most low-income job applicants who do not get hired could not afford to hire attorneys to initiate legal proceedings. For the tiny number that might be able to institute proceedings, the legal complaint likely would take months and, more likely, years to adjudicate. In short, the fact that low-income workers would cost an employer up to several thousand dollars more to perform the same job could not easily be overcome.

This differential treatment of workers based on their family income also would likely influence employer decisions about which of their employees to let go when they trim their workforces to cut costs, such as during a recession. Workers from low-income families would cost the firm significantly more to retain than other workers who are paid the same wage to do the same job.

Although this clearly is not intended, the proposal likely would have discriminatory racial effects on hiring and firing. As noted, it would discourage the hiring of lower-income people. And since minorities are more likely to have low family incomes than non-minorities, a larger share of prospective minority workers would likely be harmed.

This is essentially legalized class-based discrimination.

So, worse coverage for employers, arguably worse coverage for individuals and small businesses, same for Medicare patients, probably better for a sliver of Medicaid patients. And it criminalizes people for not giving 13% or so of their paycheck to private health insurers. The affordability credits are nice, but don't look sufficient. Here's a contrary view.

The legislation really would protect millions of Americans from medical bankruptcy. It really would insure tens of millions of people. It really will curb the worst practices of the private insurance industry. It really will expand Medicaid and transform it from a mish-mash of state regulation into a dependable benefit. It really will lay down out-of-pocket caps which are a lot better than anything people have today. It really will help primary care providers, and it really will make hospitals more transparent, and it really will be a step towards paying for quality rather than volume.

To put it more starkly, it really will be the most important progressive policy passed since Lyndon Johnson. The subsidies should probably sit at 400 percent of poverty, and the employer mandate should be reworked, but such failures are relatively easy to fix, and may well be patched over by the time the legislation arrives on the Senate floor. The fact that a bill of this size and scope can still be considered disappointing is evidence that the doors of the possible have been thrown wide open.

This ignores the reality that most insurers, like now, won't abide by the rules because there's no policeman to enforce them (an ombudsman? Really?). As well as the reality that the subsidies don't make health care affordable. And it will be hard to expand on this reform, considering that there's no public option, a weak insurance exchange and useless co-ops. In fact, considering that it cements in the broken system we already have and just fills in the cracks, it looks basically like it was written by the industry itself. That's because it was.

Poor People Can Just Go To Free Clinics

I'm sure that the right thinks there's no need for health care reform because the system works great right now. If you get sick you go to the emergency room, and Bob's your uncle. Here's GoOPer Jack Kingston saying basically that. And here's Connecticut for Lieberman's own Joe Lieberman saying how great the current system working, meaning there's no need for a public option.

On Planet Reality, the only reason that the American system doesn't look like a total nightmare, I mean a people-dying-in-the-streets nightmare, is because of numerous local efforts to keep things afloat. The "just go to the ER" approach adds tens of billions to health care costs. But even that isn't being used to the extent it could, because of the existence of free community clinics. Which will cease to exist before long, on the current trajectory.

The Mission of Mercy, a group of traveling clinics that circulate through towns in Maryland, Pennsylvania, Texas and Arizona, is one of more than 1,200 free clinics across the nation that are feeling the effects of the economic downturn.

Their patient lists are growing as Americans lose their jobs and their health insurance, but as demand grows with rising unemployment, their donations are dwindling. This year, Mission of Mercy has $350,000 less than it did last year; it takes no government funds for its services.

"People are so afraid to give now, because they're thinking they could lose their job next," said Linda Ryan, the executive director of Mission of Mercy. "We're squished because we have more people in need; we need to grow now more than ever — who knows what will happen with health care?"

Over the past year, free clinics across the country have seen a 20 percent decrease in donations and a 40 percent to 50 percent increase in patients, said Nicole D. Lamoureux, the executive director of the National Association of Free Clinics. Last year, the clinics the association represents — which largely have been excluded from the health care debate — treated 4 million people. This year, Lamoureux expects, they'll serve some 8 million, 83 percent of whom come from homes in which at least one person works full time.

"Quite frankly, the need is so great at some point in time we'll hit a place where we have to say we need to start cutting," Lamoureux said. "We'd like to be a part of those discussions (on health care.) We really need to make sure that this legislation gives the people we serve access to quality health care."

The New York Times did a good story on one of these clinics, in Milwaukee, which is doing its best but cannot hope to survive given the increase in demand.

The current system forces many of the nation's poor, even people who have jobs, EVEN PEOPLE WHO HAVE COVERAGE through Medicaid or Medicare, to visit these community clinics, which just don't have the funds to survive. There are often no other options for primary care. These clinics are the last line of defense and they're failing. They're staffed by good people who selflessly seek to protect and care for everyone regardless of ability to pay. They won't exist in a decade.

And then everyone will TRULY see the consequences of a for-profit health care system, if no reform is accomplished.

Wow, This Just Gets Worse And Worse

New details emerged today on that Baucus caucus draft.

The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.

The plan, circulating among some committee members of both parties, would also offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger. In addition, it would provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.

I don't even see how such a bill could pass the Finance Committee. Is Jay Rockefeller going to go along with two-tiered Medicaid? What about the non-coverage coverage to those 25 and younger? And of course, that is aside from the weak co-op substitute for the public option. Also, considering how high a percentage of covered expenses Baucus is allowing insurance companies to pass on to the consumer, I would argue that ALL the coverage is catastrophic coverage. To make a profit in a more regulated environment, insurers will cover less and charge more. There's very little in the Baucus draft to stop that, as far as I can see.

The President is vowing to make specific his desires in health care reform in his speech tomorrow night. We'll see if he uses the Baucus plan to deliver lower-quality health insurance to every American as his template.

...on the point of it passing the Finance Committee, Brian Beutler reports they'll vote it out, so they can leave the committee behind and change it on the Senate floor and in conference. I don't have a ton of faith in their ability to do that.

A Lesson In What Not To Do

George Steph on how to properly punch hippies:

Here are the five key sets of questions they have to confront, both in the Roosevelt Room and in their consultations with Congress:

1. What is "death with dignity" for the public option? Is it better for the president to sacrifice it himself? Or convince Democratic leaders behind closed doors to come to him? Some will argue for taking the public option issue to the floor, passing it through the House and sacrificing it in conference -- but once you've gone that far, it may be impossible for House Democrats to back down. So, giving it up on the front end in some fashion is likely the preferred option.

2. How do you get the price tag down, likely to about $700 billion? At that cost the most unpopular tax increases will not be necessary. And moderates in both the House and Senate have already signaled that they can live with it at that level. Which leads to question 3:

3. Can you still make a convincing case that the country is on a path to universal coverage? What mix of phase-ins and triggers are necessary to make that case?

I can't take it. (If you're interested, 4 asks if any Republican votes other than Olympia Snowe can be gathered - even the White House knows that answer is no - and 5 queries how to do the speech, possibly with a joint session to Congress.)

Stephanopoulos is very plugged in, and so this could very well be the discussion at the White House. Who apparently have yet to figure out that forcing millions of Americans into buying crappy insurance that can only come from private industry will be so massively unpopular that, if Republicans don't repeal it, Democrats will be forced to themselves. That would be the quickest and easiest way to squander the majority possible, which at times I think is the Washington Democratic establishment's metier.

Number two is arguably scarier. Practically all of the money spent in this health care bill goes to two things - expanding Medicaid and subsidies for individuals to buy insurance. That's it. Reducing the cost of the bill either keeps more people off Medicaid or reduces the subsidies, making forced insurance under an individual mandate unaffordable. There's this notion that bloggers and progressive groups don't care about the poor, but we're not writing the bill, and kowtowing to the lunatic moderates who put a price tag above morality except when talking about war. I have understood that the coverage expansion elements of the bill were crucially important, and the same thinking that artificially lowered the stimulus cost to the detriment of state budgets and public investment would doom the coverage expansion elements.

And after all that, after assuring us that the wise course would be to ditch a public insurance option that would only exist to cut costs, and reducing the coverage expansion funds and subsequently putting the burden of universal coverage on the backs of poor people, Stephanopoulos asks, basically, "How can we lie about this to the public?"

I find it hard to believe that the White House would be so stupid as to think that making the least popular choices to the majority of Americans making under $50,000/year would be just the ticket to increase the President's popularity. Actually, just kidding, I don't find it so hard.

Wading Through The Concern Troll Maze

Nobody wants to kill health care reform. OK, I guess Bill Kristol does. But nobody else. They're just very concerned with the speed of the legislation, and some of the provisions and they just want to take the time, do it right, we can do it bay-bee.

You'd expect the RNC to weigh in on the side of the status quo. But Michael Steele is so clueless about the topic of health care that, as you can see from this compilation, he would probably be stumped if you asked him what a doctor does.



Later on, he didn't understand the individual mandate, only the central issue in the most intensely watched primary campaign in American history. He has found his metaphor, though, calling it a reckless and risky "experiment," both in his remarks and in this new ad, which I think makes the point that Barack Obama is experimenting on children.



Not really a new argument, nor is the idea that the new health care plan would "ration" care. Peter Orszag parries that nicely.

ORSZAG: This is the biggest canard that is floating throughout this debate. The fact of the matter is right now politicians and insurance companies are making decisions. We're saying we want doctors to be making decisions, and I think that will lead to a higher-quality, lower-cost system over time.

WALLACE: But when you say they're making decisions, they would be saying, you can have this treatment, you can't have that treatment.

ORSZAG: Do you think that politicians are currently rationing care, are insurance companies currently rationing care? There's no set of decisions that this commission would have that is not currently resting with either members of Congress or insurance companies.

WALLACE: So they would be rationing care.

ORSZAG: No! Because I don't think we're rationing care today, and similarly they would not be in the future. What they would be doing is setting reimbursement rates and moving towards a higher-quality system.

These arguments from the right are both silly and transparent. They are designed not to advance any debate about health care or create some alternative set of proposals. They are, as Orszag said on a different Sunday show, designed simply to kill any bill. They not only want to break health care, but break Obama, as Jim DeMint very clearly stated. Delay equals defeat in this case.

Which is why it's so disconcerting to see Democrats engage in the same tactics. For example, Gov. Brian Schweitzer of Montana criticized the expansion of Medicaid in the bill because it would leave an unfunded mandate for the states, but under the House bill, at least, the federal government picks up ALL of the costs for that expansion, at no cost to the states whatsoever. Schweitzer may consider this a slippery slope, and in that case, he should advocate for taking state participation out of Medicaid entirely. But instead, he's chipping away at Congress' bill, as are other governors of both parties, and eventually that tactic leads not to getting the policy right, but burying it.

If moderate Democrats have legitimate concerns with the bill, they have every opportunity to address them, but they seem more concerned with shooting arrows at it, which will only destroy the bill, and probably their political future as well.

But the question isn't whether Republicans understand the power of successful opposition. It's whether Democrats understand the dangers of failure. And that's most true for the Democrats who are most likely to weaken the effort: The Democrats who are cool to health-care reform because they fear the conservative tilt of their state are the Democrats who will lose their seats if Obama loses his momentum and the Democratic majority begins to lose on its major initiatives. Legislative defeats will not threaten Henry Waxman's seat. But it will imperil Mary Landrieu's. And Ben Nelson's.

Bill Kristol is right that defeating Obama's health-care plan is a first step for Republicans who want to pick off vulnerable Democrats in the 2010 midterms. But the converse is also true: Passing health-care reform is the first step for vulnerable Democrats who want to save their seats.

In the end, I'm not sure that those moderates really want universal health care. So they concern troll it and ask for delays and we eventually spend another couple decades with a broken system and no progress. I'm hopeful that isn't the case this time, as Obama steps to the front of this debate. But at this point, turning away from the sausage-making is probably best for my heart.

Denying Legitimate Medical Care

I caught a hint of this today too:

Chris Matthews just asked Senators Richard Durbin and Orrin Hatch several questions in a row about the possibility of a public health care plan might include federal funding of abortions.

The question Matthews didn't ask? "Abortions are legal medical procedures. Why shouldn't a public health insurance plan pay for a legal medical procedure?"

Instead, Matthews' questions all seemed to assume that such funding shouldn't be allowed; he ultimately told Hatch "I think it's going to be an issue, Senator. I think your side may win this ultimately."

Later on in the show, Howard Fineman said, "the health care bill's in enough trouble, why would they add this issue into it?

I'm sure Fineman and Tweety will ask the same thing about cancer screening, dialysis, and other legal medical procedures that are available in over 86% of all private insurance plans. Seventeen states fund abortions through Medicaid in spite of the Hyde Amendment limiting participation from the federal government to rape, incest or the life of the mother. I can think of no other legal medical service denied to so many. It's completely unacceptable to continue this denial, no matter how icky it makes old men like Chris Matthews feel. Hopefully the public plan won't cover his Viagra and he can see how the other half lives.

Making A Horrendous Plan Worse

John McCain's health care idea is to get employers to throw their workers off of their health plans by taxing the benefits, leaving employees to the wilds of the individual insurance market armed only with a tax credit that is too small to actually pay for health insurance. Barack Obama's campaign has been hammering this of late, so McCain's team adjusted the tax hit, applying it to income taxes and not payroll taxes. But I guess the budget numbers didn't match up, so to pay for that too-meager tax credit, it turns out that McCain wants to cut Medicare.

John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs.

The Republican presidential nominee has said little about the proposed cuts, but they are needed to keep his health-care plan "budget neutral," as he has promised. The McCain campaign hasn't given a specific figure for the cuts, but didn't dispute the analysts' estimate.

To be clear, creating efficiencies in the marketplace and applying cost controls would reduce Medicare spending in the same way it would reduce overall health care spending, but McCain isn't advocating that. He just wants to cut Medicare. To fill in his budget gap for his insufficient health care tax credit. I guess when Sarah Palin used a Reagan quote about how "if we aren’t vigilant, we’ll end up telling our children and our children’s children about a time when America was free," wherein Reagan was talking about what would happen if Medicare were enacted, she was being descriptive and not allusive.

Paul Krugman further explains McCain's dangerous health care plan today, and he wrote it even before this attempt to gut health care entitlements:

The good news, such as it is, is that more people would buy individual insurance. Indeed, the total number of uninsured Americans might decline marginally under the McCain plan — although many more Americans would be without insurance than under the Obama plan.

But the people gaining insurance would be those who need it least: relatively healthy Americans with high incomes. Why? Because insurance companies want to cover only healthy people, and even among the healthy only those able to pay a lot in addition to their tax credit would be able to afford coverage (remember, it’s a $5,000 credit, but the average family policy actually costs more than $12,000).

Meanwhile, the people losing insurance would be those who need it most: lower-income workers who wouldn’t be able to afford individual insurance even with the tax credit, and Americans with health problems whom insurance companies won’t cover.

And in the process of comforting the comfortable while afflicting the afflicted, the McCain plan would also lead to a huge, expensive increase in bureaucracy: insurers selling individual health plans spend 29 percent of the premiums they receive on administration, largely because they employ so many people to screen applicants. This compares with costs of 12 percent for group plans and just 3 percent for Medicare.

By the end, Krugman announces himself "terrified" by the McCain campaign's ideas. You should be too.

...SEIU has an ad out about healthcare today as well.

No Child Left

Conservatives nationwide have hailed the decision in Gonzales v. Carhart, which upheld the federal partial-birth abortion ban that passed Congress in 2003. They share their concern for the unborn and their determination that they ought to be protected and defended. But once the gestation period ends, from the approximate ages of 0-23, Republicans have shown with their policies a total lack of concern for the life, liberty and happiness of these same children, thrusting them instead into a YOYO ("you're on your own") society where they are neither protected or defended, recalling the old adage by Rep. Barney Frank that for the GOP, "life begins at conception and ends at birth."

The very act of delivering the child, which gets far less emphasis than the medical decisions made beforehand, is becoming an increasingly dangerous practice in America, particularly in the American South.

For decades, Mississippi and neighboring states with large black populations and expanses of enduring poverty made steady progress in reducing infant death. But, in what health experts call an ominous portent, progress has stalled and in recent years the death rate has risen in Mississippi and several other states.

The setbacks have raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors, and, many doctors say, the growing epidemics of obesity, diabetes and hypertension among potential mothers, some of whom tip the scales here at 300 to 400 pounds.

“I don’t think the rise is a fluke, and it’s a disturbing trend, not only in Mississippi but throughout the Southeast,” said Dr. Christina Glick, a neonatologist in Jackson, Miss., and past president of the National Perinatal Association.

To the shock of Mississippi officials, who in 2004 had seen the infant mortality rate — defined as deaths by the age of 1 year per thousand live births — fall to 9.7, the rate jumped sharply in 2005, to 11.4. The national average in 2003, the last year for which data have been compiled, was 6.9. Smaller rises also occurred in 2005 in Alabama, North Carolina and Tennessee. Louisiana and South Carolina saw rises in 2004 and have not yet reported on 2005.

481 babies died during childbirth in Mississippi in 2005, and this increase tracked with drastic cuts to Medicaid for the poor.

Jamekia Brown, 22 and two months pregnant with her third child, lives next to the black people’s cemetery in the part of town called No Name, where multiple generations crowd into cheap clapboard houses and trailers.

So it took only a minute to walk to the graves of Ms. Brown’s first two children, marked with temporary metal signs because she cannot afford tombstones.

Her son, who was born with deformities in 2002, died in her arms a few months later, after surgery. Her daughter was stillborn the next year. Nearby is another green marker, for a son of Ms. Brown’s cousin who died at four months, apparently of pneumonia [...]

In 2004, Gov. Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children’s health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent.

As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years. According to the Mississippi Health Advocacy Program in Jackson, some eligible pregnant women were deterred by the new procedures from enrolling.

One former Medicaid official, Maria Morris, who resigned last year as head of an office that informed the public about eligibility, said that under the Barbour administration, her program was severely curtailed.

“The philosophy was to reduce the rolls and our activities were contrary to that policy,” she said.

And if you are cursed with the affliction of being poor in America, and yet you manage to get born, don't expect to be educated, because that money for your education has to go to rich cronies who steal it:

The Justice Department is conducting a probe of a $6 billion reading initiative at the center of President Bush's No Child Left Behind law, another blow to a program besieged by allegations of financial conflicts of interest and cronyism, people familiar with the matter said yesterday.

The disclosure came as a congressional hearing revealed how people implementing the $1 billion-a-year Reading First program made at least $1 million off textbooks and tests toward which the federal government steered states.

"That sounds like a criminal enterprise to me," said Rep. George Miller (D-Calif.), chairman of the House education committee, which held a five-hour investigative hearing. "You don't get to override the law," he angrily told a panel of Reading First officials. "But the fact of the matter is that you did."

Stealing money from the Reading First program is pretty low. Of course, the NCLB has always been an unfunded mandate that forces schools to "teach to the test" which rewards anyone who prints those testing materials, including the President's brother. The lesson learned by Republicans on this, of course, is to dump education altogether as a priority rather than fund initiatives that help failing schools succeed.

Meanwhile, at those schools, students are taught abstinence-only education instead of responsible sex ed, which is both completely ineffective and medically dangerous, as it gives young people precious little information on sex and contraception, thus increasing the spread of venereal disease.

And once those kids go to college and require financial aid to get the kind of education they need to compete globally, rapacious student-loan companies search private data to prey upon anyone who takes out a loan with mass mailings and the like, including the potential for identity fraud and seriosu abuse. Further, the Administration has turned over the Education Department to lending companies:

The cozy relations that developed among the Bush administration, the Republican-led Congress and the lenders have left the loan industry essentially unregulated. Some observers liken it to the Wild West: Lenders and colleges pursue their own self-interest with little regard for students or taxpayers.

Every company wants to be a college's "preferred lender," competing fiercely to get on such lists. But the dirty little secret of the guaranteed student-loan market is how concentrated it is: Only 32 lenders hold 90% of the loan volume. What's more, the Education Department has found that at about 300 colleges, one lender controls 99% of the loan volume — essentially holding a monopoly on those campuses.

Any company trying to break into the market has to rely on unconventional means. Some upstarts have promoted revenue-sharing arrangements, in which colleges get a cut of each loan that their students take out. Established lenders, worried about losing market share, have taken up similar kickback practices. One of the most egregious schemes is called an "opportunity pool," which was pioneered by loan giant Sallie Mae. Here's how it works: A lender hands a college a fixed amount of private loan money that the institution then can lend to students who otherwise wouldn't qualify for loans because of credit problems. These are private loans — ones that typically come with higher interest rates and fewer consumer protections. In return for the "opportunity pool," the college makes that company its exclusive provider of federally backed loans.

Essentially, lenders are freezing students out of any competition in the student-loan market, forcing them to accept increased rates.

So all of this concern for the children is a lot of bluster, but when you look at the facts, the Republican Party has little more than contempt for them, excepting rich scions of privilege, of course.

P.S. Maybe this is why young people are moving to Democrats more and more, because they see them as the only Party reflecting their interests. This is a great piece on rising Party star and thirtysomething Rep. Tim Ryan.

Moral Budgeting

John Edwards' appearance on Meet the Press yesterday was notable for the unveiling of his health care plan (see Ezra Klein for analysis; he likes it because public plans can actually compete with the private sector in employer-funded "Health Markets"). He said it would cost between 90 and 120 billion dollars to get going, and that he'd have to raise taxes to do it.

So that was the headline all over the place: John Edwards will raise your taxes. Because that's more important than reaching a goal where every American in this country can get good quality health care. Americans have spent 40 years hearing from conservatives that low taxes are an inalienable right, and they've gotten us to a point where 47 million Americans don't have equal access to health care, and we pay for it anyway in higher premiums to cover ER visits by the uninsured.

By contrast, look at the setting of priorities in the President's budget, which increases military spending to nearly 5% of GDP, while making permanent the tax cuts responsible for massive deficits, and takes $70 billion out of Medicare and Medicaid. So at PRECISELY the time when so many are acknowledging that there is a major crisis in health care, the President wants to remove some of the last remaining ways for the poor and the elderly and the infirm to have access to it.

Additionally, the President's budget eliminates all spending for Iraq and Afghanistan by 2009, so I guess that means we're out in two years. Actually, it's a dishonest means to hide the true costs and get to an imaginary accounting of a balanced budget by 2012.

We need a more moral budgeting system, one that recognizes the finite amount of money we have to spend and then prioritizes that spending according to actual public needs. This piecemeal way of rewarding friends rather than understanding needs has got to stop.