Tuesday, December 22, 2009

The Case for a Strong Estate Tax

By Brian Miller

On New Year's Day the estate tax, an essential part of the U.S. tax system for nearly 100 years, will disappear because Congress failed to act in December. Congressional leaders now are pledging to act in early 2010 to reinstate the federal estate tax retroactive to Jan. 1. In the meantime, rhetoric over the estate tax will heat up while Congress grapples with what to do now.

This crazy situation is the result of the Bush tax cuts for the super-rich, tax cuts that were supposed to lead to “trickle-down” prosperity for the rest of us. What we have seen instead is stagnation of wages for most Americans, while those at the very top have become extraordinarily rich. In fact, disparities of wealth and income are now at the highest level since the Gilded Age just before the stock market crash of 1929.

With so much wealth in so few hands, our economy has begun to operate more like a casino, with high-risk speculation fueling boom-and-bust cycles that have wrecked communities across our country. The gilded yachts of the super-rich have left in their wake capsized rafts of the unemployed and whole communities drowning in foreclosures. That’s not what America should be about.

Instead of pandering to the whims of the super-rich and their heirs, we need Congress to strengthen the Main Street economy, beginning with a vibrant middle class and a respect for honest, hard work. Giving a huge tax giveaway to the heirs of America’s wealthiest families is entirely the wrong approach.

Under the weakened 2009 law, before full repeal in 2010, the first $7 million for a couple ($3.5 million for an individual) is exempt from the estate tax. That means two children of a wealthy couple can each inherit more, tax free, than the average American earns in two lifetimes, or more than 240 minimum-wage workers earn in a whole year. But unlike the lucky heirs who won the genetic lottery, these real, Main Street workers will be paying taxes on earnings. These kinds of misplaced priorities fly in the face of an economy that supposedly rewards those who work hard.

Not all high-wealth individuals want this tax-giveaway either. In fact, more than 2,000 likely estate-tax payers have signed a petition in support of its preservation. At a recent press event, Bill Gates Sr., Vanguard Group founder John Bogle and Richard Rockefeller called on Congress to pass a robust estate tax. After the group discussed the ways our government helped make their prosperity possible, from protecting copyrights to investing in new technologies and transportation systems, Gates, Sr. said, “It’s clear that those who become wealthy did not do it alone. The people owe something back to society that enables them to create that wealth.”

In the end, the estate tax is fundamentally about recycling opportunity. Like the farmer who tills under leftover crops at the end of the season, the estate tax helps promote fertile fields of opportunity for the next generation to build upon. It’s about giving each generation a fresh start and a chance at achieving the American dream through their own merit.

It’s time to stop showering wasteful tax breaks upon the super-rich. We instead must call upon Congress to strengthen the federal estate tax and support proposals that find a middle ground between the weakened 2009 estate tax and the pre-Bush level of 2001.
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Brian Miller is executive director of United for a Fair Economy (UFE), a national organization that works to promote a more broad-based prosperity and to eliminate extreme inequalities of wealth and income. UFE is online at http://www.faireconomy.org
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Copyright (C) 2009 by the American Forum. 12/09


By Mark Mellman

A few months ago, I warned that some folks were attempting to misuse health care reform to restrict access to abortion. They have come a long way since then, endangering the vital struggle for health care — indeed, torpedoing reform is a key goal for many involved in this effort.

Americans oppose using abortion as a means of derailing health care reform and oppose using health care reform as a means of restricting abortion. The more voters find out about what is happening on Capitol Hill with respect to this issue, the angrier they are getting, because language inserted in the House bill will take away coverage for abortion that tens of millions of women already have.

Taking away existing coverage not only violates the public will, but also does fundamental violence to Democrats’ explicit promise that if you like what you have, you will be able to keep it.

In a national survey we conducted for the Women Donors Network, nearly half (47 percent) of the electorate said, “Political differences should not prevent us from moving forward on an otherwise good health care reform plan.” Another 22 percent believe that health care reform should not move forward unless “a woman’s right to choose an abortion is protected.” Only a 26 percent minority believe that health care reform should not move forward unless “we are certain that government money will not be used for abortion.”

Voters clearly oppose the restrictions embodied in the House bill, rejecting even their underlying premise. By over a 20-point margin, voters believe that those who receive partial subsidies should be able to buy plans that cover abortion. By two-to-one, voters would feel less favorably toward a member of Congress who voted to prohibit subsidy recipients from purchasing an insurance policy with abortion coverage.

Indeed, voters’ antipathy to placing abortion restrictions in health care reform is so strong that their inclusion leads voters to oppose reform itself. By a 16-point margin, voters would oppose a health reform plan that prevented private insurance plans from covering abortion.

Debate on the issue strongly favors opponents of abortion restrictions. We presented voters with an argument against allowing coverage of abortion focused around the view that “taxpayer money should not fund abortion.” Matched against an argument in support of covering abortion that suggested, “health care — not politics — should drive” these decisions, 59 percent subscribed to the pro-choice viewpoint and just 36 percent took the anti-choice position.

At a more fundamental level, voters simply do not want Congress making these decisions. Just 14 percent favor Congress and the president making coverage decisions with respect to abortion. Indeed, despite popular disdain for insurance companies, twice as many would prefer they decide whether to cover abortion instead of having politicians make that determination. A significant plurality (43 percent) support empowering an independent commission to make coverage decisions on abortion.

Americans do not want reform to be an excuse for tightening restrictions on abortion or for taking away health coverage millions already have. Nor do they want an abortion debate to stop reform. Voters want an abortion-neutral health care reform.

The way out of this conundrum is clear to voters, if not to legislators. A compromise offered by Rep. Lois Capps (D-CA) enjoyed majority support and was fully acceptable to the small minority that favors further restrictions on abortion. What opposition there was to the Capps compromise came primarily from pro-, not anti-choice voters. Nonetheless, the House swept it away in favor of language much more drastic and deeply unpopular.

The Capps language affords an opportunity to untie the Gordian knot in favor of the anti-choice forces, but does so in a way that is at least minimally acceptable to the pro-choice majority.
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Mellman, is president of The Mellman Group and has worked for Democratic candidates and causes since 1982. Current clients include the majority leaders of both the House and Senate. This column first appeared in The Hill newspaper. Mellman writes a regular column for The Hill.
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Copyright (C) 2009 by the American Forum. 12/09


COLORADO EDITORIAL FORUM

By Emilie C. Ailts and Vicki Cowart

As national health care reform faces its next hurdle -- a conference committee bill that reconciles the House and Senate bills -- we believe it's critical to draw attention to a provision contained in the House bill. This provision, brought by Reps. Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.) and known as the Stupak abortion coverage ban, would create barriers to women's reproductive health care far worse than any encountered since the Supreme Court's 1973 Roe vs. Wade decision legalizing abortion.

This new abortion coverage ban makes insurance coverage for abortion virtually unavailable for millions of women purchasing insurance plans through the newly created health insurance exchange.

Federal law already bans use of federal funds for abortions, but the Stupak measure goes much further. It denies use of private money -- not just public money -- to cover abortions.

Six of Colorado's nine-member congressional delegation, Sens. Mark Udall and Michael Bennet and Reps. Diana DeGette, Jared Polis, Betsy Markey and Ed Perlmutter, understood the danger posed by the Stupak abortion coverage ban and its Senate companion and voted against it. The remaining three, Reps. Doug Lamborn, Mike Coffman and John Salazar, voted for the House Stupak provision, choosing to strip women of health insurance benefits they already have and imposing further restrictions on their access to a full spectrum of reproductive health care services.

The Stupak amendment has real-life implications for all women obtaining health insurance through the new health insurance exchange. This exchange is intended to provide a source of affordable, quality health insurance coverage for Americans who are uninsured, self-employed or work for small businesses. In Colorado, small businesses vastly outnumber large employers and are a major force in the state's net increase of new jobs. Because so many women potentially will be insured through the exchange, millions of women would lose reproductive health care benefits they now have.

As the health care reform debate continues, our goal is clear -- to pass health care reform while stopping the Stupak abortion coverage ban. The Senate's health care proposal maintains the status quo, ensuring that no federal funds pay for abortion. While we fundamentally do not agree with this, as since 1976 this policy has codified discrimination against low-income women, we acknowledge a compromise is necessary to advance the health care reform package. Yet, we strongly oppose going beyond the status quo, which the Stupak abortion coverage ban does.

Since the onset of health care reform, President Obama often has articulated a central tenet that no one lose benefits she or he currently has and likes. The Stupak abortion coverage ban would break this promise.

Defenders of the House amendment say that women who purchase health insurance through the exchange will be allowed to buy a single-procedure insurance policy, sometimes called a "rider," providing abortion coverage. Such a provision is as discriminatory as it is illogical, and it contradicts a basic objective of health care reform -- to ensure that all Americans have the health insurance they need.

Insurance by definition should protect us from the unexpected. As with diabetes or prostate cancer, both unplanned pregnancies and complications late in wanted pregnancies are unexpected events. Women who need a legal medical procedure in these situations should not be denied coverage any more than individuals with other unexpected health needs.

We all have different opinions about abortion. However, the debate about health care reform shouldn't focus on those differences. And real health care reform shouldn't cause women to lose insurance coverage they already have for a legal medical procedure.

Health care reform provides an opportunity to advance women's health.

With the exception of the Stupak abortion coverage ban, federal health care reform efforts include many provisions of benefit to women.

They include banning gender discrimination of premium rates, protecting survivors of breast cancer from being denied coverage because of a "pre-existing" condition, and covering preventive care, e.g. cancer screenings.

The President and Congress have moved us closer than we've ever been to achieving affordable, quality health care for all. But health care reform won't be fair -- and will not succeed -- if it comes at such high cost to women.
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Ailts is executive director of Denver-based NARAL Pro-Choice Colorado. Cowart is CEO & president of Planned Parenthood of the Rocky Mountains.
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Copyright (C) 2009 by the Colorado Editorial Forum. 12/09
12/09

By Susan Shaer

A flu pandemic is nasty, brutish, and a global danger. All U.S. Senators and other leaders agree, and leap to keep everyone safe and healthy.

Another nasty, brutish and global danger, which additionally is outrageously expensive and out of sync with today’s defense needs, is the continued maintenance of our huge stockpiles of nuclear weapons. All our senators should agree on this.

However, since there are threats and plotters, the U.S. needs to have a strong and effective defense.

In his speech at the Nobel Peace Prize ceremony, President Obama acknowledged these threats; and he also reiterated his call for a world free of nuclear weapons. As he has noted, they pose too much risk to all of us, as humans sharing a single planet. The longer nuclear weapons lurk, and grow, the graver the danger that they could fall into the wrong hands.

So how do we proceed toward the goal of liberating the world from the threat that nuclear weapons pose? The answer is simple: step by step. The road to disarmament is, necessarily and rightly, long, and will take time and patience, and many steps that guarantee our safety and prevent any cracks in our security.

One of the first steps is to take stock of the existing nuclear arsenals – and then reduce the number. The reality is that it is possible, and it’s in the works. President Obama and President Medvedev committed to this goal months ago; and will soon sign onto a new START agreement (Strategic Arms Reduction Treaty) that pledges and ensures the U.S. and Russia will chip away at their huge stockpiles.

The fact is that the U.S. and Russia still hold onto around 95 percent of the world’s roughly 23,000 nuclear weapons. When the Cold War was drawing to a close, both countries acknowledged the urgent need to reduce these stockpiles, and signed onto START I. It was the largest and most complex arms control treaty in history.

Since that treaty expired on December 5 of this year, the U.S. and Russia have been working to fashion a new treaty acceptable to both. A critical piece is a reliable system to provide an accurate assessment of the size and location of each country's nuclear forces. The new treaty will reduce the strategic deployed arsenals of each country by about one quarter (to a ceiling of 1,675 within seven years).

After the treaty is finalized, it heads to the U.S. Senate for consideration– first in committee hearings, and then on the floor. There will be ample time for debate. There are many reasons for the Senate to ratify this treaty, and to do so with deliberate speed.

We have more than enough nuclear weapons to provide a strong defense; and to destroy life on the planet. We need to begin the long process of dismantling some of the thousands before they slip into the wrong hands.

Maintaining these many thousands is enormously, and wastefully, expensive.

We have better information than ever about Russia’s situation, and so are assured they are acting in accordance with the treaty. We should cultivate a positive relationship with Russia, particularly today.

The world is waiting for its leaders to choose a sane path to help keep from destroying the planet.

At least 67 Senators must vote to ratify START. This is a considerable number. And yet, really, it should have the support of all 100. START is in the interests of the U.S., it makes us safer, and ideally, it helps to build momentum toward the ultimate goal of a safer world without nuclear weapons.
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Shaer is executive director of Women’s Action for New Directions.
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Copyright (C) 2009 by the American Forum. 12/09

By Riane Eisler

The Copenhagen Climate Change Conference makes evident potential catastrophic effects of climate change, including its enormous economic and human tolls. It also clearly shows how poor nations in Africa, Southeast Asia, Latin America and island states will suffer most from the inevitable floods, droughts and other weather disasters.

But there’s more that needs to be made clear in Copenhagen. If we look closely, there’s a hidden truth with huge implications that we must bring to the attention of conference delegates to ensure that allocated funds actually protect those most vulnerable to these natural disasters.

Studies show that women are 14 times more likely to die in natural disasters. One heart-rending study of a Bangladesh flash flood found that 90 percent of casualties were female. Many factors contributed to this high casualty rate, all were avoidable. A woman’s role in this Southeast Asian nation, as in most of the Middle East and parts of Africa, is one of dependency -- so of course, these Bangladeshi women were not taught to swim. But perhaps the most important factor was that they lived and died in a culture where women are so rigidly controlled that they aren’t permitted to leave their homes without being accompanied by a male family member. When the flash flood occurred, they sadly stayed and drowned.

Such cultural restrictions are inhuman, not only to women, but to children. Yet, their implications for any Copenhagen climate pacts are still generally ignored.

Also ignored are studies showing that when women become involved in disaster-response planning and training there are far fewer casualties -- not only of women, but of children and the elderly. One study even found no casualties when women engaged in disaster-response preparedness.

It’s incumbent upon us to bring this information to the attention of U.N. officials such as Yvo de Boer, executive secretary of the United Nations Framework Convention on Climate Change (UNFCCC), and to official national delegations and nongovernmental groups attending the Copenhagen meeting.

In contributing funds for disaster training and response, the U.S. should insist that a sizable portion be given to women’s organizations. This is essential if our monies are to be used effectively and equitably.

We can use the Copenhagen conference as a way of changing restrictive traditions that are egregious human-rights violations (forbidding persons to leave their home alone is a form of house arrest!). We can also help the U.N. carry through on its promise to institute gender architecture mainstreaming. This will promote equal partnership between men and women, and show that when we speak of democracy and human rights, we really mean it.
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Eisler is the author of “The Real Wealth of Nations: Creating a Caring Economics” and president of the Center for Partnership Studies.
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Copyright (C) 2009 by the American Forum. 12/09

Monday, December 14, 2009

Stimulus Needs Better Reporting

By Greg LeRoy

Aside from health-care reform, probably the most divisive issue in Washington today is the $787 billion economic stimulus program.

One camp argues that the Recovery Act has done a good job in preventing the country from plunging into a more serious crisis than the one we’ve got, while another camp says the whole effort has had little effect and was an expensive mistake. We suspect the former conclusion is correct, but would like better evidence.

Most arguments are based on differing assessments of the first round of jobs data released in October. The Recovery Act’s exemplary transparency provisions cover direct federal contracts and some of the grants to states—a limited part of the overall stimulus program. They counted about 640,000 jobs created or saved so far.

There’s been much media attention given to instances in which job numbers seem to have been seriously exaggerated. Yet, there also are cases in which they were apparently understated. More than 2,000 contract and grant recipients report that their stimulus projects are more than 50 percent complete—yet they claim not to have created or saved a single job.

Clearly, there is confusion about the right way to report stimulus-related jobs. This is not surprising, given that tens of thousands of companies, government agencies and nonprofits are being asked to do this for the first time.

But the blame is not entirely with recipients. Instructions given by the Office of Management and Budget (OMB) did not adequately consider the variety of situations reporting entities would face. For example, exactly how does an employer determine which existing workers put on stimulus projects should be counted in computing the number of saved jobs?

Should they include only those who were about to be laid off before Recovery Act money was received—or should they also include those who might have been let go at some later point in the absence of those funds?

The furor over the quantity of stimulus-related jobs has obscured the question of their quality. Despite efforts of the Coalition for an Accountable Recovery (CAR) and others, the OMB decided not to collect data on wages, benefits or the number of full-time vs. part-time positions. Without this information, we cannot tell to what extent the Recovery Act is generating jobs that allow workers to support their families in a decent fashion.

Nor can we tell who is getting Recovery Act jobs. CAR also argued strongly for collection of data on the demographic characteristics and residential area of workers on stimulus projects. With information on factors such as race, gender and neighborhood of residence, taxpayers would be able to determine whether all communities are getting a fair share of Recovery Act employment.

The Recovery Act is a many-sided law meant to lessen what has turned out to be a more serious economic downturn than anyone expected. In the same way it may need to be adjusted because of the magnitude of the crisis, so must its reporting and transparency provisions be refined to reveal how well it is working and who it is serving.
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LeRoy is executive director of Good Jobs First, a nonprofit resource center on economic development accountability that is co-chairing the Coalition for an Accountable Recovery.
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Copyright (C) 2009 by the American Forum. 12/09


NEW MEXICO EDITORIAL FORUM

By Max Bartlett and Jose Aguilar

One issue has generated little discussion during the heated health care reform debate: whether states should have the right to develop their own approaches to universal coverage.

The Health Security for New Mexicans Campaign wants to see language included in the national proposal that gives states flexibility to develop their own approaches to solving rising health care costs and growing numbers of uninsured.
The focus of current health care reform proposals is to create “insurance market exchanges.” These one-stop-shopping insurance exchanges must offer consumers -- primarily the uninsured -- choices of different insurance products, including some type of public option. A less than robust public option is in the proposal passed by the House of Representatives. The Senate is in the process of negotiating an alternative to the House version.

Unfortunately, the health care reform debate has skirted the issue of whether states can take a different path that reaches the same goals. States always have been laboratories for innovation. Women’s suffrage, civil rights, child labor and minimum-wage laws were developed in the states first and then became federal law. Why shouldn’t states be allowed to continue that role in health care reform?

If a state can develop an approach that is not based on the insurance market exchange model, an approach that still provides comprehensive health coverage for its residents and contains rising health care costs, why shouldn’t it be encouraged to do so?

The recently passed House bill contains no language enabling states to develop anything other than an insurance market exchange. The merged Senate bill now under consideration mandates that by 2014, states must set up an insurance market exchange and experiment with it for three years before requesting any waivers.

Why should states be forced to go through a long, expensive, complex and time-consuming process when they already may be working on approaches more appropriate to their circumstances?

In New Mexico, the Health Security Act offers a different solution from that based on an insurance market exchange. It is a “home-grown” solution that has earned enormous public support -- 146 diverse organizations are part of our coalition, and 32 New Mexico counties and municipalities have passed resolutions endorsing it.

The Health Security Act would enable New Mexico to set up its own health care plan that automatically covers most New Mexicans, provides comprehensive benefits and guarantees freedom of choice of doctor even across state lines.

Instead of creating a system of competing insurance plans, each with different provider networks, this proposal would shift the role of private insurance companies to provide supplementary coverage – as they do with the original Medicare program. Any individual, employer or group wishing to purchase additional coverage could do so. A non-governmental, geographically representative citizens’ board would be in charge of the plan.

Two separate studies have concluded that if such a health plan were established in New Mexico, health care costs would be reduced by hundreds of millions, if not billions, of dollars within five years.

Why is this so? Because this approach simplifies a very complex private insurance system with its hundreds of policies, different benefits, co-pays and deductibles, all of which affect administrative overhead of doctors, hospitals and clinics – and which, in turn, negatively affect health care costs.

In a state such as ours, with a small population, it makes economic sense for most residents to be covered under one health risk pool.

Coalitions in other states -- California, Minnesota, New York, Pennsylvania, Washington and Oregon, to name a few -- have been working on proposals that are not based on an insurance market exchange and are adapted to the particular needs of those states.

Acknowledging these developments, the National Conference of State Legislators recently passed a resolution containing a provision asking that states be allowed to create solutions that go beyond any federal requirements. New Mexico was counted as one of the resolution’s supporters.

In addition, New Mexico State Sen. Dede Feldman and others from the House and Senate sent a letter to our five-member congressional delegation, which included a request that states be given flexibility to develop their own comprehensive plans.

Health care reform should clearly encourage state experimentation. Aside from the need for state flexibility language in the national legislation, the Health Security for New Mexican Campaign believes states deciding to develop their own health plans also should have the right to access the same federal dollars as those states choosing to set up their own insurance market exchanges.

At this critical juncture, Congress needs to tackle this issue.


TENNESSEE EDITORIAL FORUM

By Dick Williams

The Tennessee Voter Confidence Act (TVCA) requires replacement of paperless touchscreen voting machines with optical ballot scanners by November 2010. Optical-scan voting systems read marked paper ballots and tally results, providing a tangible record of the voter's intent. They are now the most widely employed voting systems in the nation, used by 60 percent of voters in other states.

The TVCA was adopted nearly unanimously by the Tennessee Legislature – by both Democrats and Republicans -- and in 2008 enthusiastically signed into law by Gov. Phil Bredesen. But implementation of the law has been ensnarled in legalities and technicalities.

Tennessee's secretary of state and coordinator of elections have argued that the new law requires scanners be federally certified to 2005 standards, and because no machines have yet been certified to that standard, the law cannot be put into effect in time for 2010 Elections.

That’s why Common Cause Tennessee and other voters' rights advocates, in an effort to break the logjam, filed a lawsuit seeking clarification of the law's language. Nothing is more important than having verifiable ballots. There is no good reason for running the 2010 elections with systems that are vulnerable to error and don't allow a recount or an audit.

In a November 5 ruling, Chancellor Russell T. Perkins concluded that the TVCA does not require new ballot scanners to meet those 2005 standards, but declined to issue an injunction forcing application of the law. Still, the court ruled that the secretary of state was "obligated to take prompt, effective steps to meet the statutory deadline" as long as their choice of standards "does not jeopardize meeting the Legislative mandate to implement…on or before the November 2010 election."

Tennesseans need – and deserve – to have verifiable ballots in place for the 2010 election. Paperless systems are subject to unintended errors and possible hacking; hence votes might not be recorded as intended. Without a paper ballot available for audit or contested election, there is no way to tell whether a voter's intent was accurately recorded. These are not just abstract, theoretical concerns. California, after rigorous testing, decertified the same machines which are still deemed acceptable in Tennessee. Are California’s votes more precious, more sacred than the vote of Tennesseans?

Steven John Mulroy, a University of Memphis law professor and Shelby County commissioner, who represented the plaintiffs in the case, said, “This is a vindication of the election reformers’ position all along. The court agrees with us that, contrary to what the secretary of state has been saying, the TVCA allows us to use currently available voting machines, and that the secretary is legally required to begin doing so immediately.”

State Coordinator of Elections Mark Goins said the court's conclusion could force the state to obtain obsolete equipment that would have to be replaced. But an affidavit submitted by voting technology expert Dr. Douglas Jones, associate professor in the Computer Science Department of the University of Iowa said that if election officials wish, optical scanners certified to 2002 standards could be upgraded to 2005 standards without difficulty.

After the ruling, plaintiffs’ attorney Gerard Stranch stated “The ball is now in the secretary of state’s court. Hopefully, they will have greater respect for the will of the court than they did for the will of the legislature.”
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Williams is state chair of Common Cause Tennessee.
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Copyright (C) 2009 by the Tennessee Editorial Forum. 12/09


By Susan Wysocki and Susan Scanlan

It’s not surprising that women are confused about the recently changed recommendations for cancer screening and prevention. New guidelines from the American College of Obstetricians and Gynecologists (ACOG) – the leading medical group that provides health care for women – say women should wait longer to begin cervical-cancer screening and that they should be screened less frequently. On the heels of similar changes to breast-cancer screening guidelines, it’s understandable that many women might see this as a step backward.

On the contrary, the new cervical-cancer screening recommendations reflect advances in our understanding of this disease and in tools now available to prevent it. More importantly, they present an opportunity to educate women about the significant opportunity we have to further prevent – if not eliminate – cervical cancer.

New ACOG screening guidelines recommend women should begin getting Pap tests at age 21 (as opposed to within three years of becoming sexually active) and that, from ages 21 to 29, most women should have Pap tests every two years instead of annually. Additionally, screening for women 30 and older with a history of normal Pap test results now moves to every three years.

To understand the rationale for these changes, it’s important to first know how the disease develops. Cervical cancer is caused by “high-risk” types of the human papillomavirus (HPV), a common sexually transmitted infection. Most women will have HPV at some point in their lives, but their immune systems will typically clear the virus without symptoms or treatment. HPV infections that persist over time – typically many years – can cause cell changes that can potentially lead to cervical cancer. Because cervical cancer is slow-growing, it generally allows ample time for screening to detect problems that can be treated before the cancer can develop. The majority who die of cervical cancer in the U.S. have either never been screened or have not been screened in many years.

A Pap test is the traditional means of screening for cervical cancer. It involves examining cervical cells under a microscope to detect abnormalities that can then be treated, if necessary. Since its use became widespread 60 years ago, the Pap test has helped to significantly reduce cervical cancer rates. So, if the Pap test has been such a success, why change the guidelines? First, newer research shows that cervical cancer is extremely rare in women under 21. Cervical abnormalities among sexually active girls in this age group are common, but they typically go away on their own. Newer studies, however, show that treatment for these abnormalities that would most likely resolve themselves can cause later pregnancy complications, such as premature birth. This is one instance in which treatment can cause more harm than good. By delaying the start of screening, we can hopefully avoid unnecessary treatment.

The rationale for less-frequent screening is similar. Evidence shows that screening with a Pap test every year does not offer any additional benefit over screening every two or three years. Waiting longer between screenings can help avoid unnecessary treatment of abnormalities that likely will go away on their own.

Also, new technological advances offer women 30 and older – the group most at risk for cervical cancer – more protection against this disease. For these women, an HPV test is now available and uses molecular technology to determine whether HPV is present. An HPV infection that continues for years is what leads to increased risk of developing cervical cancer. If an HPV infection is found, a woman can be monitored more closely by her clinician. A negative HPV test in tandem with a normal Pap test can give a clinician and her patient increased reassurance that the woman is not at risk of developing cervical cancer for at least the next three years. The HPV test also is used for women of all ages to help clarify inconclusive Pap test results. The HPV test is not used routinely in women under 30 because HPV is so common in this age group that a positive HPV test could lead to unnecessary treatment.

While screening is critical to preventing cervical cancer, two HPV vaccines – the first-ever vaccines to fight a cancer – are now FDA-approved and offer significant potential to help reduce cervical cancer rates.

Remember, these new screening recommendations are simply guidelines and that clinicians, in conjunction with patients, need to determine the most appropriate cervical-cancer prevention approach for each woman. These new guidelines provide an opportunity for more conversation on this issue between women and their health-care providers. After all, few things are better for women’s health than educated and empowered patients.
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Wysocki is president and CEO of the National Association of Nurse Practitioners in Women’s Health. Scanlan is chair of the National Council of Women’s Organizations.
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Copyright (C) 2009 by the American Forum. 12/09

Wednesday, December 9, 2009

Reducing the Nuclear Risk

By Nan Orrock

When President Obama accepts the Nobel Peace Prize on December 10, it is an opportunity to articulate a new international direction, away from nuclear proliferation, away from nuclear tests, and away from loose materials and increased risk. Hopefully, he will join the Nobel Committee in putting out the call that we must act now to reduce the enormous arsenal of nuclear weapons.

It will not be easy, or quick. And it shouldn’t be. As long as nuclear weapons exist, the U.S. must have a safe and reliable arsenal. The road to disarmament is, necessarily and rightly, long, and will take many years and many small steps to guarantee our safety and prevent any cracks in our security. But it is also vital; the longer nuclear weapons lurk, and grow, the graver the danger that a rogue state or a terrorist will use one.

One of the first steps should be to prevent new nuclear weapons. The easiest way to do this is to ban nuclear weapons tests.

We have a chance today to ban nuclear testing by signing onto the nuclear Comprehensive Test Ban Treaty (CTBT). The CTBT would impede the ability of nuclear-armed countries to perfect new and more deadly nuclear bombs, and would help prevent new nuclear weapons programs. U.S. ratification would clearly demonstrate renewed leadership on the world’s most pressing security threats while stopping the spread of nuclear weapons and preventing nuclear terrorism.

The time is right for the U.S. to finally support and sign the CTBT. It has profound and widespread support across all political spectrums and around the world. It has been signed by 182 nations and ratified by 151, including all NATO countries and other key U.S. allies. An array of bi-partisan military experts and senior statesmen supports the CTBT. In 2007, former Secretaries of State George Shultz and Henry Kissinger, former Secretary of Defense William Perry, and former Senator Sam Nunn (GA), all called for the Senate to ratify the treaty. Former chairmen of the Joint Chiefs of Staff – including Generals John Shalikashvili, Colin Powell, David Jones and Admiral William Crowe -- also support CTBT.

It is in our national security interest to prevent nuclear weapons testing. The U.S. hasn’t tested a nuclear weapon in nearly 20 years. We already know our stockpile is safe and reliable so we don’t need further tests. By doing so, we can lead by example and show other countries that nuclear testing and proliferation is wrong. It is time for the U.S. to ratify this treaty, permanently ending nuclear test explosions worldwide.

The truth is that as long as nuclear weapons exist, there are parties who will struggle to find a way to make and use them. The only way to prevent such a terrible tragedy is to find a way to reduce and eventually eliminate the weapons. In accepting the Nobel Peace Prize President Obama has the opportunity to set an example for the world by supporting the Comprehensive Test Ban Treaty.

See my i-Commentary about this topic here:


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Orrock is a George State Senator (D-Atlanta) and President of the Women Legislators’ Lobby, a national network of women state legislators launched by Women’s Action for New Directions.
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Copyright (C) 2009 by the American Forum. 12/09

MISSOURI FORUM

By Timothy D. McBride

Despite the importance of passing health care reform, it appears that the general public has very little understanding of the scope and importance of these reforms, or how the wide-ranging positive benefits will have on average Americans.

Much of this is due to overheated rhetoric, a misunderstanding of the proposals by the press, purposeful distortions by both sides of the debate, and the complexity of health reform. For example, much attention has been paid to the so-called “public option” which the right wing has described as a “government takeover of health care,” and the left wing has described as the only provision worth fighting for because it will keep the insurance plans “honest.” Both claims overstate the significance of the public option since by all estimates, even if it survives, not many will sign up for it, and the plan will resemble private plans, not a Medicare plan.

When the reforms are phased in, 96 percent of American citizens will be covered by health insurance -- up from an insurance rate of 83 percent today -- according to Congressional Budget Office estimates. Contrary to fears that the legislation will lead to a government-run health system, 58 percent of the persons obtaining coverage will obtain coverage from private insurers, in a new Health Insurance Exchange. This Exchange will be much like the array of private insurance plans offered to Congress and the President today. The remaining persons insured under the plan would be low-income children and adults insured through Medicaid and the children’s health insurance plan.

In Missouri, over 800,000 persons are estimated to be uninsured today. However, the Congressional reforms would reduce the number of uninsured by over 604,000 reducing the uninsured rate to less than 4 percent (from a current rate of 16 percent). Over 270,000 persons would obtain insurance through the Health Insurance Exchange, another 200,000 adults through Medicaid, and 130,000 children through Medicaid.

Although much of the focus has been on the provisions that would expand coverage for the uninsured, little attention has been paid to other provisions which could have wide-ranging impacts on the health sector. For years there has been little attention paid to public health issues. Most chronic diseases (such as obesity) can be prevented through lifestyle and environmental changes. So the proposal would implement policy changes to encourage preventive health and wellness, encourage physical activity and good nutrition, enhance the public health system, encourage health promotion activities, and enhance access to behavioral health services.

Also receiving very little attention are significant provisions to enhance the infrastructure of the health system. Since the health reforms are estimated to lead to 36 million more persons obtaining health insurance, this could significantly strain the medical care system. However, significant new funds to enhance the health workforce for primary care physicians, nurses, physician assistants, social workers, and public health workers are found in the proposal. Funds are also included to resolve payment problems afflicting physician payment, at least temporarily.

The recession led Congress to pass significant stimulus spending which has made the public concerned about the rising federal budget deficit. It should be comforting then that the President has promised he will not sign a bill unless it is deficit neutral.

While it is worth noting that much of the costs of increased coverage is paid for by the previously uninsured themselves (if they can afford it), the remaining costs are covered by taxpayers. About half of these costs will be covered by reductions in Medicare spending, and a significant share of these reductions will come from reductions in a program widely recognized to be in need of spending reductions, the Medicare Advantage program. The remaining costs will likely be covered by tax increases, most likely on a combination of high-income taxpayers (as President Obama promised in his campaign) or on high-priced health insurance plans.

As health care reform continues to move forward we can take significant steps towards removing the scar of the uninsured that has long stained our country. The proposals are not perfect, nor will they solve the problem overnight. But we cannot let the perfect be the enemy of the good. We just have to get started on solving this problem.
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McBride is Associate Dean for Public Health in the Brown School at Washington University in St. Louis.
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Copyright (C) 2009 by the Missouri Forum. 12/09


GEORGIA FORUM

By Timothy Sweeney, MPA

Leading congressional health insurance reform proposals include expanding Medicaid, which could not only bring coverage to nearly one million low-income, uninsured Georgians, but would provide at least 90 percent of the funding to do so.

Despite the obvious and significant benefits to the state’s economy and its citizens, Gov. Perdue, Lt. Gov. Cagle, and others opposed to reform are arguing that Georgia cannot afford its share of the proposed Medicaid expansion in either the House or Senate proposal.

They claim that expanding Medicaid will cost Georgia more than $2 billion over six or seven years, but they rarely mention the billions in new federal funds that would flow to Georgia’s economy during this time.

But their calculations are misleading. The cost on a yearly basis of expanding Medicaid for hundreds of thousands of uninsured citizens with little access to coverage is not only affordable, but is a bargain for Georgia.

The Georgia government’s own estimate of the House proposal forecasts $93 million in additional state costs the first year (2013). This equates to an increase of less than 5 percent of Georgia’s existing Medicaid budget and less than 1 percent of the overall state budget.

In addition, these state costs would be accompanied by hundreds of millions in new federal funds flowing into Georgia each and every year, contributing to the state’s healthcare sector and local economies.

Over time, these costs would increase as the state’s economy and population grows. As more people enroll, and as medical costs increase with inflation, the Georgia government estimates that costs could reach $500 million a year by 2019. However, this number must be put into perspective as well. Relative to the overall state budget a decade from now, these costs will remain a small percentage and surely will be manageable.

Although Georgians across the income spectrum have seen their access to employer-sponsored coverage decline in recent years, low-income families have been most affected.

A mere one-quarter of Georgians in families with incomes below twice the poverty level ($36,600 for a family of three) have employer coverage, compared to 76.6 percent for families with income above this threshold.

As a result, low-income individuals and families in Georgia are far more likely to be uninsured (35.9 percent) than their higher income counterparts (10.9 percent). In total, nearly 1.7 million non-elderly Georgians (nearly one in five) lacked health insurance in 2007-2008.

Those opposed to expanding health insurance coverage should also consider the likely effects on Georgia’s uninsured children and adults if they remain uninsured. Uninsured people have less access to timely medical care, worse health outcomes, and are more likely to die prematurely than their insured counterparts.

There is plenty of time for Georgia’s leaders to ensure the state has adequate funds to pay what the federal government does not so that we reduce our high number of uninsured citizens. Both proposals give states several years to comply with the new Medicaid eligibility standards, and both provide full federal funding for the first two to three years of implementation.

Our elected leaders should be tackling Georgians’ growing needs, not posturing against national reform. Georgia's uninsured rate is tenth in the nation, approximately one in seven people lived in poverty in 2008, and our job loss rate is fifth in the nation. Vulnerable groups are hit hardest during recessions, and low-income workers are losing employer-sponsored health insurance faster than others.

Rather than using misleading multi-year figures to argue that the state cannot afford to expand Medicaid coverage to its struggling citizens, Georgia’s leaders should realize that we cannot afford to lose out on this incredible opportunity to insure its neediest citizens and bring hundreds of millions of dollars into the state’s economy annually.
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Sweeney is the senior healthcare analyst for the nonpartisan, independent think tank, the Georgia Budget & Policy Institute.
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Copyright (C) 2009 by Georgia Forum. 12/09


MISSISSIPPI FORUM

By Lynn Evans

This was certainly not the way Gov. Haley Barbour wanted to end his term in state office. Tax revenues are down $371 million and counting. State budget alternatives are grim, with cuts of at least 12 percent for most agencies, including education.

Seeking opportunity amid crisis, Barbour is recommending major government realignment and simplification, as well as consolidation in K-12 and at the university level. By including such incendiary proposals as combining Alcorn State and Mississippi Valley with Jackson State University, Barbour took the chance that his proposals will be dead on arrival at the Capitol in January. His challenge to support his proposals or “come up with a better way” ought to be taken seriously.

Cuts and consolidation should not be the only options on the table. The kind of cuts the governor is proposing will be a severe shock to the economy, just when Mississippi and the nation are trying to climb out of the Great Recession. This decade’s declining growth in Mississippi’s major revenue sources – personal and corporate income and sales taxes – should have lawmakers looking at the state’s tax structure.

There at least five ways Mississippi could adjust its tax structure to help make it through the current economic troubles and to build a better revenue picture for the future.

1. Mississippi could join the 20-plus other states in the Multistate Tax Commission to prevent large corporations from playing shell games to avoid paying state taxes.

The U.S. Government Accountability Office reported last July that 30 percent of corporations with earnings of $50 million or more paid no federal income taxes between 1998 and 2005. In 2003, the Multi-state Tax Commission found that large corporations avoided $7 billion in state corporate income taxes by, among other tactics, shifting reports of profits from state to state. Corporate income tax revenue accounts for only about 5 percent of overall revenues in Mississippi.

The solution is to join the Multistate Tax Compact and require every multistate corporation to follow uniformity guidelines when reporting income and profits. This will give the state a way to validate corporate returns. It works for other states and it could work here, too.

2. Mississippi could increase the top personal income tax for the wealthiest among us. Personal income taxes make up about 25 percent of state and local tax revenue. The wealthiest 20 percent of all Mississippians take home almost half of all income earned. The real income of top earners has increased 23 percent from 1999-2005, while the bottom 60 percent of Mississippians saw a drop in real income when adjusted for inflation – even while worker productivity increased. Creating a new state income tax bracket of 6 percent for taxable income over $125,000 certainly would be a better alternative than closing 10 mental health crisis centers and hospitals.

3. The National Association of State Budget Officers suggests that each state monitor tax breaks it gives corporations. If the return from these tax breaks falls short of promised benefits to the state economy, a state could choose to impose a surcharge. Hiring more tax auditors also could net millions of dollars.

4. The Mississippi House has tried for a number of years to increase fees and fines to generate revenue, and to ensure that fees for state services actually reflect the cost of those services. Penalties and fines for violations of labor safety and environmental regulations, for example, should be costly enough to deter such practices, to clean up problems, and to adequately support state agency efforts to oversee and enforce regulations protecting the public. DUI fines also could be increased for each succeeding arrest, as is done in Louisiana.

5. Many health advocates support following the lead of Arkansas and other states in taxing sugary soft drinks and nutrition-poor, salty and sugary snacks. Mississippi still has the nation’s highest obesity rate. Making foods that contribute to obesity more expensive will help families choose healthier foods, and help persuade food manufacturers to change ingredients in those unhealthy snacks.

By not including any proposals to increase state revenues, Gov. Barbour is sticking to the GOP playbook of “Government is the problem --Don’t raise my taxes.” But this budget crisis is severe enough that, combined with the devastating farm losses throughout the state, it could send Mississippi’s economy back into recession. Our government should be better than that. It is time to look at the big picture and re-imagine what we expect from state government. There is another way, if only there are enough real leaders to champion it.
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Evans is a Jackson health care activist and writer.
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Copyright (C) 2009 by the Mississippi Forum 12/09


NORTH CAROLINA EDITORIAL FORUM
by Melissa Reed


The House vote to establish near-universal health-care coverage came at a steep cost to women. That cost, issued as an amendment by Rep. Bart Stupak (D-Mich.), eliminates abortion coverage by private insurance companies even when women are paying for all or most of the premium.

Stupak’s amendment is a cynical attempt to push an anti-choice agenda that imperils badly needed reform. His amendment restricts women’s access to abortion coverage in the private health insurance market as well as in a “public option,” undermining the ability of women to purchase private health plans that cover abortion. It reaches much further than the Hyde Amendment, which has prohibited public funding of abortion in most instances since 1977.

Before its introduction, health-care reform measures in both House and Senate contained agreed-upon compromise language regarding abortion. Public funding for abortion would remain prohibited and women with private health insurance would continue to receive benefits they already have. Though this language satisfied neither side completely, it enabled health-care reform legislation to move forward without being derailed by abortion politics.

In addition to undermining the reform effort, the amendment would affect more than one in four American women who have at least one abortion during their reproductive years. Tens of millions of women will be required to pay for health-care coverage that expressly excludes one of their most commonly requested medical procedures.

The Stupak Amendment, like the Hyde Amendment, only allows abortion in cases of rape, incest and for medical complications that “place the woman in danger of death unless an abortion is performed.” However, if the woman’s health is in jeopardy – if her pregnancy risks organ failure or infertility, but not death – then there is no coverage for care. The woman’s health is placed at risk.

Women’s health care should not be sacrificed on the altar of reform. President Obama has repeatedly said that under health care reform, “no one will lose the benefits they currently have.”

The House bill now embraces a lesser ideal: No man will lose the benefits he currently has.

Is this sexual discrimination or abortion politics? Frankly, the two are inseparable. The 11th-hour amendment is just the latest example of statutes, regulations, medical standards and corporate policies that have historically caused women to pay more, suffer more and receive less.

Examples abound even today. Pharmacists refuse to fill prescriptions for birth-control pills. The FDA imposed unwarranted and unscientific age limits on over-the-counter access to emergency contraception. Health insurance companies demand higher premiums from women employees than for men.

It’s no wonder women pay nearly 68 percent more than men – much of it resulting from the uninsured expenses of reproductive health care.

The promise of reform was supposed to remedy all that. Health-care reform sought not only to expand coverage but also to reduce gender discrimination. No longer would women have to pay more than men for the same insurance policy. No longer could pregnancy or womanhood be treated as pre-existing conditions. No longer would women be denied affordable contraceptives.

And all women’s health centers would finally be recognized as essential community providers no less than centers that cater to other segments of the population.

Because of Rep. Stupak, the House further entrenched a two-tiered health-care system that limits access to care for women.

If Congress is capable of enacting health-care reform, it is capable of treating women as equals who don’t have to settle for less. Already, members of the House and Senate pro-choice caucus are pledging to withhold their final votes unless the Stupak Amendment is removed.

Abortion politics should not scuttle health-care reform. The Stupak Amendment must be eliminated.
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Reed is the vice president for public policy at Planned Parenthood Health Systems.
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Copyright (C) 2009 by the American Forum. 12/09

by Sarah van Gelder

As the Copenhagen Climate Summit approaches, some world leaders predict there will be either no deal or one so weak that it will be virtually worthless.

Little wonder. Climate change could be one of the toughest issues the world has ever faced, less because of the technical challenges than the politics. That’s why the growing climate movement is so important to watch. Its success could determine if world leaders feel enough heat to take action.

What makes the politics of this moment so challenging? Unlike other critical issues, this one requires that we take action, based on science, before we see much damage. If we wait until the effects of long-term pollution are fully felt, climate scientists tell us, we will have passed critical thresholds that will make it difficult, if not impossible, to turn down the global thermostat.

Even now, these changes do more than cause occasional heat waves, droughts, and monster storms. As the effects of greenhouse gas pollution accelerate, millions of people will experience flooding, rising seas, crop failures, food shortages and drought conditions like those of the dust bowl era.

Still, it’s not too late. Climate scientists say we can yet avert the direst consequences if we halt the increase in pollution by 2015, then bring it down sharply. That means taking action now.

Yet, politicians worldwide have short-term reasons to pass this hot-potato issue off to future generations. After all, “cheap” coal-fired electricity offers high profits for a few companies and their shareholders, while the resulting climate damage is distributed to other people around the world.

And dealing with the crisis requires massive investments toward a transition to clean energy. While such investments will benefit economies in the long run, in the short term they will cost taxpayers money. And entrenched, powerful interests — from the oil and gas industry to mega-banks — use their money and connections to push for government handouts to subsidize business as usual. Some are even funding the think tanks and AstroTurf front groups that foster confusion and doubt about climate science.

In poorer countries, citizens want economic growth. They demand it. They want the cars, airline trips, big houses and high energy use we’ve grown accustomed to in the U.S. And without seeing the wealthier countries stepping up, they won't allow their governments to reduce carbon emissions.

Although every community, every nation and every family stands to lose without action on global warming, the political leaders gathering in Copenhagen to negotiate a climate treaty haven’t felt heat from their own citizens -- at least not yet.

The good news is that around the world there are climate heroes, those doing what they can -- putting up solar panels, standing in the way of coal plants, cutting their own household carbon footprints and promoting the clean energy technology we need.

And the pressure is mounting from those who want action. Young people, for instance, are mobilizing into a powerful force for change. Unlike the leaders meeting in Copenhagen, they know they will have to live with consequences of failing to avert climate chaos. These young people are lobbying, they are getting trained in green jobs, and they are building a movement they say is simply about survival.

Don’t underestimate these youths. Their energy and hard work helped elect the country’s first African-American president.

But it isn’t only the youth who are stepping up. People in all sectors of society are coming to see that our elected officials can’t get the job done unless they feel the heat at home. That puts a special responsibility on Americans. The world is waiting for leadership from the U.S., the country with one of the highest rates of greenhouse gas pollution. The future of our planet may hinge on whether “we the sovereign people” of the U.S. insist that our leaders step up to this global threat and lead the world toward a viable agreement.
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Sarah van Gelder is executive editor of YES! Magazine www.yesmagazine.org, which has just published a special issue on climate action.
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Copyright (C) 2009 by the American Forum. 12/09

TENNESSEE EDITORIAL FORUM

By Dr. Sekou Franklin

The emergence of a grass-roots movement pushing for green economic solutions to climate change and poverty has been a surprising development. This movement believes environmentally sustainable policies and the shift to a clean energy economy can lead to reduction of pollution and greenhouse gases. It also believes green-collar employment – family-supporting jobs in the clean and renewable energy sector – must be accessible to residents of economically distressed communities.

The Green-Collar Jobs Task Force of Nashville-Davidson County (a network of environmentalists, work-force development professionals, and social justice activists) was formed in 2008 to advocate for an inclusive green economy. In meetings with state and local officials, task force members have pushed for green work-force training programs modeled after similar initiatives in Chicago, IL; Washington, DC; Oakland, CA; Providence, RI; Boston, MA; Portland, OR; and Newark, NJ. These programs share a common thread: As public-private partnerships, they provide work force development (vocational training, wraparound services, career coaching, environmental literacy) in the clean energy sector for underemployed workers and veterans, formerly incarcerated persons, transitional housing residents, low-income women, and workers with language barriers.

Sadly, no major city in the Southeast has a public, privately backed, green training program targeting the aforementioned populations, even though it is the most polluted and poorest region in the country.

Although Gov. Phil Bredesen’s Task Force on Energy Policy and Nashville Mayor Karl Dean’s Green Ribbon Committee want to position middle Tennessee as a regional leader in clean and renewable energies, they have yet to put political weight behind green jobs initiatives for communities suffering from chronic unemployment and underemployment.

Consider a green jobs program targeting hundreds of at-risk young adults from Nashville’s inner-city neighborhoods. Imagine if this program were extended to struggling workers in rural communities devastated by deindustrialization. Or consider the creation of green-based micro-enterprises for women in low-income communities shunned from manufacturing jobs and government contracts. These initiatives would offer an antidote to ecological decay, poverty and the hopelessness that contaminate these communities. Civil rights, women’s rights and youth groups also believe that green jobs initiatives can potentially reduce racial and gender inequities in the clean energy sector.

The NAACP, the Climate Equity Alliance, the Commission to Engage African-Americans on Climate Change, Wider Opportunities for Women, the National Urban League, and the Hip-Hop Caucus’s Green the Block initiative insist green jobs programs can remedy the structural violence (and twin evils) of poverty and pollution.

As indicated in a May 2009 study, "The Climate Gap," authored by the University of Southern California’s Program for Environmental and Regional Equity, green economic solutions also can reduce public health epidemics in low-income communities and communities of color.

Green jobs and environmentally sustainable practices will be the focus of the Compass VI Conference on Green Jobs sponsored by the Tennessee Alliance for Progress (www.taptn.org) Dec. 4-5 at Nashville’s Cohn Adult Learning Center. Organized in collaboration with the task force, the conference will bring together leading environmental and social activists from across the state and country. All are welcome to attend. See you there.
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Franklin is an associate professor in the Department of Political Science and coordinator of the Urban Studies Program at Middle Tennessee State University. He is also a founding member of the Green-Collar Jobs Task Force of Nashville-Davidson County.
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Copyright (C) 2009 by the Tennessee Editorial Forum. 12/09


By Anita Kuennen, RN


A glaring absence of the Emperor’s clothing seems to be escaping our attention in the recent House health care reform proposal with the inclusion of the Stupak amendment. The Emperor is naked and while everyone is critiquing, arguing and validating the fabrics, thread and adornment of his new clothes, those of us looking at his bare bottom wonder how everyone became so deluded.

The collective blindness of the Kingdom is truly exposed in the concession of excluding abortion care to pass a House proposal that included a public option. Using women’s health and reproductive justice as the deal breaker once again demonstrates that reform is not intended to address basic issues of health care disparity in our country.

Similar to the members of the Emperor’s Kingdom, who believed there was substance to the garments, we are overcome with disillusionment. The grand solution of tweaking health insurance to magically cure the ingrained, systemic issues at the core of our health care failure is the ultimate fairytale.

Like the Tailor who spins the invisible threads of deception, Congress has focused on the interests of only the most powerful: corporate interests, singular religious dogma, the medical status quo and their distorted reflection. The Tailor’s magic is strong, and the crowd wants to be deceived, partly because any acknowledgement of their illusion is to admit their grand hypocrisy. Counteracting the filters of greed, disempowerment, marginalization and lack of compassion, would be like standing in front of the crowd naked – and for that, they have the Emperor.

Truly what this reform process has demonstrated is that our governance performs as a biased arbitrator of spending money provided by taxpayers for the infrastructure of our country, but the purpose is clear: furthering the agenda of the most powerful, wealthy and influential among us. What leverage is provided for those most impacted by gaps, omissions and downright disregard implied by a band-aid approach? People in the trenches of health care disparity understand that in order to change poor health outcomes and care spending, an emphasis on access for people to receive care that meets their needs is what we need, not a newly formulated insurance policy. Eliminating insurance coverage for access to abortion care only emphasizes that reproductive justice will once again suffer at the hands of the blinded elite.

Instead of restructuring and further segregation of who receives care, we should be looking at shifting the focus to actual health priorities and positive outcomes, not a fixation on the need to have everyone insured. As if a policy alone has anything to do with actual health or access to care. As the money allocations line up for the Emperor’s budget for prevention and new initiatives, one glaring omission stands out –support for service delivery. Another coalition, duplicative prevention planning forums, and research will not necessarily translate to real access for direct care that women can’t afford.

Reproductive health is a key determinant of women’s overall health and well documented evidence has shown that treatments and services that promote comprehensive reproductive health should be part of any national health reform. Abortion care, although not the only disparity in our current health care system, reflects the bargaining chip that is most easily traded for the invisible clothing our Emperor now sports.

For true reform, the emphasis needs to be on a system where people participate in the decisions regarding their own health, prevention opportunities are not cost prohibitive, and naked people deluding the masses are arrested for indecent exposure.
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Kuennen is executive director of the Blue Mountain Clinic.
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Copyright (C) 2009 by the American Forum. 11/09

Monday, November 23, 2009

No Turkey and Gravy for All


GEORGIA FORUM

By Sarah Beth Gehl

As families gather for Thanksgiving this week, we should consider that in just a decade Georgia has deteriorated from average (ranking 22nd) to 4th highest for food insecurity in the nation.

One in seven Georgia households experienced food insecurity during 2006-2008, according to a recently released report by the USDA. The share of Georgia households lacking resources for adequate meals rose from 10.9 percent during 1996-1998 to 14.2 percent during 2006-2008.

These sobering numbers highlight the importance of focusing solutions on combating hunger and poverty in our communities.

How do we do this? Communities across the state are providing support to hungry families through local food banks and pantries to address just this issue. In metro Atlanta, for example, the Atlanta Community Food Bank has distributed 24 percent more pounds of food through October of this year compared to the same period last year to meet the growing need.

Beyond local responses and resources, another important tool is public policy. By thoughtful budgeting and policymaking, the state government and local advocates have a powerful opportunity to reduce the number of Georgians experiencing food insecurity.

For example, expanding participation rates within the federally funded nutrition programs, especially among the unemployed, should be a top priority. Food stamps, school lunches and breakfasts, and summer programs will reach more than one million Georgians this year, providing critical resources for nutritious meals. Additional benefits are available through the federal stimulus package passed by Congress and signed by President Obama in February, increasing food stamp benefits by 13.6 percent and sending more than $650 million to Georgia tables over the next five years.

However, many more families remain eligible for federal nutrition assistance but are not enrolled. Participation levels in federal food aid programs in Georgia range from only 11 percent to 68 percent, and hit children worst of all — the very people who need adequate nutrition in order to develop their brains and bodies, and the ones least able to advocate for themselves.

The state needs skilled staff to reach and qualify residents who can benefit from the millions of untapped dollars in federal nutrition assistance available to Georgians. Although the federal stimulus package includes funds for state food stamp eligibility workers, lawmakers have chosen to furlough already-stretched eligibility workers to address the daunting loss of state revenues.

Moreover, the Georgia Department of Human Services plans to lay off 733 federal benefit eligibility workers in the coming year if the governor requires an additional 3 percent cut in services, as he states in his contingency plan. As stimulus funds expire next year, programs serving the elderly such as the Meals on Wheels will also be in danger.

At a time when more families are struggling with hunger and food pantries are stressed to the limit, we must all ensure public efforts are not diminished. Donations to food pantries are an essential ingredient, but they must be combined with thoughtful public policy and budgeting. Georgia has made great strides in reducing hunger in the past — we must do so again.
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Gehl is deputy director of the Georgia Budget and Policy Institute, an independent, nonpartisan organization engaged in research and education about Georgia’s fiscal health. To find county-by-county estimates of food insecurity, download the Institute’s report Reaching Georgia’s Tables at www.GBPI.org.
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Copyright (C) 2009 by the Georgia Forum. 11/09


MASSACHUSETTS FORUM
By Peter Enrich

Our local and state governments provide many of the vital public structures that build strong communities and ensure opportunity for us and our children such as schools, transportation, public safety, parks, and health and social services.

Yet, the tax structures that enable us to pay the price for a civilized society suffer from two severe flaws. First, state and local taxes are exceedingly volatile, dropping calamitously during economic downturns, when the revenues are most badly needed. State and local governments, unlike the federal government, can only spend what they take in.

Second, unlike the federal income tax, state and local taxes are regressive: households with lower incomes pay a higher share of their incomes for the support of state and local government than do their wealthier neighbors. This regressivity is largely due to heavy reliance on sales taxes; even with exemptions for groceries and other necessities, lower income households spend far more of their incomes on taxable items than do higher income families. A recent study showed that low-income Massachusetts households spent 5.4 percent of their incomes on sales taxes, compared to 1.2 percent for wealthy households.

While we depend on and demand the services of state and local governments, we resist the reforms that would provide a healthy tax system. So, we find the state cutting essential services and turning to gambling, sin taxes, and gimmicks to try to pay its bills.

Instead, there are three directions in which Massachusetts should look to improve our ability to pay fairly and adequately for the service we all need:

• Follow the federal example and rely more heavily on income taxes, especially income taxes designed to require those with greater means to contribute a greater share to the common good. Even here in Massachusetts, where the constitution forbids graduated rates, personal exemptions and differential rates on investment income can build substantial progressivity into an income tax system. And small rate increases can yield impressive new revenues.

• Broaden the scope of our sales taxes to reach, not only sales of goods, but also a wider range of sales of services, such as club memberships, entertainment, personal and property care, and professional services. Many states presently tax some services, but often only a handful. Massachusetts only taxes 18 of the 168 services identified by the Federation of Tax Administrators and is the only state taxing none of 40 household service categories identified by the Center on Budget and Policy Priorities. Extending the tax to more services reduces an irrational inconsistency in the current sales tax, dramatically increases the tax’s revenue yield at a time when a growing share of household spending is on services, and diminishes both the regressivity and the volatility of the sales tax.

• Increase the share of taxes that are collected from businesses, rather than families. By one measure, businesses paid half of all state and local taxes in the 1950s, but only a quarter by the 1990s, and probably substantially less than that at present. By ending some of the tax incentives that have been shown to be ineffective in guiding business location decisions, closing the loopholes that have encouraged increasingly sophisticated corporate tax “management,” and reversing some of the rate cuts granted to businesses during better times, the state could go a long way to providing needed revenues while restoring the historical balance between taxes on individuals and businesses.

Each of these steps will demand courage on the part of political leaders and education of citizens about the workings of the tax system. Most importantly, they will require a revived recognition by all of us that taxes are an investment in, not an obstacle to, our shared future prosperity.
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Enrich is a professor at Northeastern University School of Law, specializing in issues of state and local governance and finance, and a former general counsel to the state’s Executive Office for Administration and Finance under both Gov. Dukakis and Gov. Weld.
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Copyright (C) 2009 by the Massachusetts Forum. 11/09

Friday, November 20, 2009

Keep Religion Out of Health Care Reform


By M. Patricia West, MSSW

Elected officials' religious views should be their own private affair, neither imposed by them upon the nation, nor imposed by the nation as condition to holding public office. This means their private religious views should not be imposed via the current debate over health care reform.

Important life decisions are responsibilities of individuals and families, not of government or religious groups. On that, most of us can agree. There is also a strong history of separation of church and state in America, and one of our founding principles is of freedom from religious intolerance. That's why I was deeply offended when Roman Catholic Church bishops lobbied Congress on health care reform in order to deny millions of women access to abortion.

As an American I am proud of our constitutionally guaranteed right to worship or not as one sees fit, and of our prohibition of government-imposed state religion. But what started out to be about health care for all has morphed into a referendum and debate on abortion unduly influenced by the church. Health care legislation passed by the House of Representatives compromises our personal choices and subverts the principle of abortion neutrality.

The Stupak-Pitts amendment potentially goes farther than any other federal law to restrict a woman's access to abortion. By prohibiting women who receive partial federal subsidies from buying insurance plans that cover abortion, the Stupak amendment bans abortion coverage by any insurer participating in the health exchange. The amendment favors one religious view of abortion and enlists the federal government as enforcer. As such, it is an egregious assault on the rights of women and an enormous step backward for those who believe in separation of church and state.

President Obama has said, "If you're happy and satisfied with the insurance that you have, it's not going to change." But this House proposal potentially reduces health care coverage for the more than 80 percent of typical employer-based insurance plans that now cover abortion.

Women supposedly will be able to obtain abortion coverage by purchasing a separate, single-service "rider." However, according to the National Women's Law Center, in the five states that currently require a separate rider for abortion coverage, there is no evidence that plans offer such riders. Furthermore, women are unlikely to buy a rider to cover abortion, because they do not plan for unplanned pregnancy or one that is needed for medical or health reasons.

A number of national polls have shown that Americans strongly believe health insurance should include complete women's reproductive health services and that women have a full range of choices offered. A recent poll commissioned by Moving Forward, a values-based research initiative developed by the Women Donors Network and the Communications Consortium, found that a majority, 56 percent, believe those receiving subsidies should be able to purchase a health insurance plan that covers abortion. The House proposal does not reflect that view.

Meaningful reform has the potential to bring health care to more American women and their families than ever before. But Congress should not be in the business of restricting choices for women, particularly for religious reasons. As presidential candidate, John F. Kennedy said, "I believe in an America where the separation of church and state is absolute ... where no public official either requests or accepts instructions on public policy from the pope, the National Council of Churches or any other ecclesiastical source -- where no religious body seeks to impose its will directly or indirectly upon the general populace or the public acts of its officials ..."

Instead of kowtowing to Catholic bishops, Congress should stand up for what the majority of Americans want in health care reform -- and they want choices, not limitations.
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West is a public health consultant who lives in Philadelphia. She is a member of the Women Donors Network and involved with their Moving Forward initiative.
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Copyright (C) 2009 by the American Forum. 11/09


COLORADO EDITORIAL FORUM
By Robin Baker

The excise tax on so-called “Cadillac” plans is a central feature of the Senate Finance Committee's health proposal. Most often, Cadillac plans are described as the "overly generous" or "gold-plated" plans offered to Wall Street types.

In theory, levying a tax on these gold-plated plans will encourage lower spending and help slow the growth rate of health insurance and health care costs.

In addition, the revenue generated from the tax on insurers would provide a significant source of funding for subsidies to help families with low to moderate incomes afford health insurance. The Congressional Budget Office (CBO) estimates revenues will be about $5 billion in 2013 and increase to $53 billion by 2019.

At the outset, most Americans would not be affected by the tax, but that could change over time.

The Senate Finance Committee's proposal would impose an excise tax on employer-sponsored insurance beginning in 2013 for plans with costs above $8,000 for an individual and $21,000 for a family. In Colorado, the average annual premium cost in 2008 for an individual was $4,900 and $11,952 for a family.

It seems like a reasonable plan, but like so many other pieces of health care, it's complicated.

A brief by Milliman Inc., the world's largest independent actuarial and consulting firm, notes that high-cost plans have as much to do with the beneficiary's geographic location, profession, age, gender and health status as with the richness of benefits.

Milliman uses the example that a typical employer-sponsored plan for a family of four in Miami in 2009 is $20,282. In comparison, the cost of plan for a similar family in Phoenix is less than $15,000. Given that the medical costs have grown between 7 percent and 10 percent over the last few years, it is possible that benefits in some geographic areas could exceed the tax trigger by 2013.

Those in high-risk professions, such as firefighters and coal miners, have higher utilization costs and would easily be subjected to the excise tax. A new provision, however, would increase the allowable benefit amount to $9,850 for an individual and $26,000 for a family.

Age and gender also make a difference in the cost of premiums. Milliman notes that the national average per-member, per-month cost for a 30-year-old male is $155 per month – less than $2,000 per year. But the cost for a 60-year-old female is $717 per month, or $8,604 annually, which exceeds the tax threshold.

Age is a significant factor, especially with the percentage of workers 55 and older increasing and remaining in the labor force longer. It is estimated that 93 percent of the growth in the labor force from 2006 to 2016 will be among workers ages 55 and older.

As people age, health care premiums increase and it is possible that those that did not exceed the threshold in 2013 may be taxed in the future. The cost of plans could become a problem for employers with an older workforce.

In 2014, the taxable amount would increase by inflation as measured by the Consumer Price Index for Urban Consumers (CPI-U). The problem is that heath care inflation has grown at a faster pace than general or consumer inflation for more than a decade. In 2008, CPI-U actually decreased 1.5 percent while health care costs increased 7.4 percent -- the lowest increase in five years.

Because health insurance premiums will outpace the tax threshold, more plans will be subject to the excise tax over time.

The Milliman report argues that the dramatic increase in the CBO's estimates of the tax revenue in a six-year period – from $5 billion in 2013 to $53 billion in 2019 – suggests that the excise tax will "dip substantially further into the mainstream of health plans."

This isn't necessarily bad. The existence of a ceiling will likely encourage insurers to create products that are under the cap. Insurers though may look to create a plan that does not exceed the threshold but instead increases co-pays, co-insurance or deductibles based on minimum benefit levels. How benefits are put together and the ratio of benefit value to the total cost (actuarial value) is something to watch.

In the end, we must ask if we have a societal responsibility to protect the health and well-being of our fellow citizens – this includes making health care accessible and affordable for all. To do this we need to cover the cost. There may be other ways, but an excise tax on insurers offering high-cost plans can provide a significant source of funding for subsidies.
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Baker, is a senior policy analyst and director of the health project at the Bell Policy Center, a nonprofit, nonpartisan policy research center.
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Copyright (C) 2009 by the Colorado Editorial Forum. 11/09