We all remember “legislation by administrative decree”, right? That is what the Bush-Cheney used to do when they wanted to roll back environmental protections or make torture legal. They did not leave it up to Congress to write the law and the federal courts to interpret the law. They did it all themselves.
The Obama administration recently revealed that it also believes in the power of the executive branch to create the law. I refer to the case in which a federal judge ordered spousal benefits for lesbians. Rather than appealing the ruling the Obama DOJ made its own ruling. It said that the judge was wrong. Period.
Since Obama believes in the expanded powers of the executive branch which Bush-Cheney promoted, I think it is time for him to put those powers to
good use.
He can start by enacting health care reform by administrative decree.
I. Expand Medicare to Cover All the Nation’s Chronically Ill Some of those folks out there with brittle diabetes and unstable angina can not wait until 2014 for health care. Turns out, they do not have to.
There is a bill in Congress that would phase out the two year waiting period that applies to everyone with a medical disability (except end stage renal disease on dialysis and amyotrophic lateral sclerosis aka Lou Gherig’s disease). The bill is H.R. 1708. There is a companion bill in the Senate. The health insurers should love this one, since they will be able to punt all the sick people straight to Medicare. However, there is a loophole in the law which Obama could use to actually provide care to needy people (and not just increase the profit margins of health insurers.)
The bills would extend the exception to all "life-threatening conditions." These are not delineated in the bills, but defined as conditions that are "fatal without medical treatment." The Secretary of Health and Humans Services would be responsible for compiling a list of such conditions, with regular updates. To compile the list, the Secretary would be required to consult with various federal health agencies and to annually review the SSA "compassionate allowances" list.
http://www.nosscr.org/medicarewait.htmlGet that? If Kathleen Sebelius says that your diseased coronary arteries are a “life-threatening condition” because you could die from a heart attack tomorrow without medical treatment, then CAD joins ALS and ESD as a Medicare waiting period free condition. COPD, asthma, autoimmune diseases like lupus and all forms of cancer are fatal without proper treatment. Even gallstones could qualify, since the gallbladder could become gangrenous or cause a fatal case of pancreatitis.
So, let’s see the administration lobby for this bill and then use it to provide affordable, comprehensive care to everyone in desperate need of care. Think of all the lives that can be saved before 2014 even gets here.
II. Increase the Number of Federally Funded Community Health Centers Right now there are 1200 Federally Funded Community Health Centers which treated approximately 7 million uninsured Americans in 2008. Now, this might seem like a drop in the bucket compared to the 40 plus million Americans without insurance, but every little bit helps.
http://www.usatoday.com/news/health/2009-04-09-freeclinics_N.htmFor those Americans who do not have a “life-threatening” disease, centers like this can make preventive care affordable. That is because these clinics charge a sliding scale fee for their services.
These clinics are authorized by the Public Health Service Act, linked here:
http://www4.law.cornell.edu/uscode/42/254b.html For purposes of this section, the term “health center” means an entity that serves a population that is medically underserved, or a special medically underserved population comprised of migratory and seasonal agricultural workers, the homeless, and residents of public housing, by providing, either through the staff and supporting resources of the center or through contracts or cooperative arrangements—
(A) required primary health services (as defined in subsection (b)(1) of this section); and
(B) as may be appropriate for particular centers, additional health services (as defined in subsection (b)(2) of this section) necessary for the adequate support of the primary health services required under subparagraph (A);
for all residents of the area served by the center (hereafter referred to in this section as the “catchment area”).
The list of services provided is impressive. Be sure to read the above link. Cancer screening, immunizations, family planning services are all included.
Note that grants are available for new clinics at the discretion of the federal government (i.e. Sebelius). I suggest that the federal government increase the capacity of these clinics (and start up some new ones) in order to provide preventive and necessary medical services to folks without insurance who are too broke to pay cash.
III. Spend More of the Stimulus Money on Health Care As I pointed out in my journal “Books, Not Bombs: How Military Spending Hurts the Economy and Education Spending Helps”
http://journals.democraticunderground.com/McCamy%20Taylor/440Education spending gives the best return on your investment if you want to create jobs. Tax breaks and military spending are the worst. Health care and infrastructure are also pretty good at jump starting an economy plagued by unemployment---
And if you use your funds to provide necessary health care services in a time of high uninsured rates (which go hand in hand with high unemployment) you are getting double rewards for your money.
HHS has already jumped on this one with grants such as this:
The Department of Health and Human Services (HHS) today announced the release of $120 million in American Recovery and Reinvestment Act (ARRA) funds for prevention and wellness programs for U.S. states and territories, building on the recent announcement of the $373 million funding opportunity for communities and tribes around the country. In all, the comprehensive Communities Putting Prevention to Work initiative will make $650 million available for public health efforts to address obesity, increase physical activity, improve nutrition, and decrease smoking.
http://www.hhs.gov/news/press/2009pres/09/20090929d.htmlWe need more spending like this. Maybe the administration can move around some Pentagon funding “by executive decree.”
IV. Make It Easier (and Safer)For Americans to Order their Drugs From Canada I was just amazed when I compared the prices of drugs in Canada to the prices in the U.S. Some are four times more expensive here. Some do not have a generic available in this country, but they do in other countries, which saves even more money.
I was also surprised to read that it is
absolutely legal for people here to order drugs from Canada, as long they only get 90 days supply at a time and as long as they have a prescription. You can read more about the federal legislation at wiki’s “On Line Pharmacy” page here:
http://en.wikipedia.org/wiki/Online_pharmacyNote that Customs still has the right to intercept your medication (though they rarely do so). This may discourage some people from making use of this opportunity to save money. I suggest that the Obama administration stop all seizures of medications from Canada—at all levels, federal, state and local. Just declare it protected, legal international commerce.
V. Start Prosecuting Insurance Companies for Price Fixing and Other Anti-Trust Violations ASAP There is a problem with this one. Right now, the insurance industry is exempt from anti-trust laws. So, they are able to merge into single behemoths that completely control a wide geographic area. A bill in Congress, introduced by Leahy, would strip the industry of this protection. It is languishing (of course) because insurers hate the legislation. However, if the federal government can force us to buy private insurance, it must have a way to keep the insurers from price gouging---especially since the new “National Insurance Plans” will be exempt from state and local regulation which have been used to check the industry’s greed up until now.
We need to call upon Congress to pass the bill---and Obama to become active in his support of the bill. The insurance industry will not be able to claim (as they so often do) that this law will raise rates. This law can only lower rates and keep them at a reasonable level. It will cut down the amount the feds pay out for premium support, too, which will lower taxes. Without an economic justification to quash the bill, the insurance industry will have to kill it in stealth. Do not let them.
Here is info about HR 3596, The Health Insurance Industry Antitrust Enforcement Act of 2009
http://www.opencongress.org/bill/111-h3596/showPassing the bill will be only half (of) the (uphill) battle. Obama’s DOJ will have to enforce the law. They will be reluctant to do so---just look at how aggressively they have prosecuted the banksters. However, since voters will feel the effects almost immediately through reductions in their health care premiums, it will be worth it, politically speaking. Would not it be great to have a
choice of insurance carriers again? Would not you feel safer if you knew that you were buying security for your family from a company that did not take your business for granted?
If anyone knows of any other ways that the administration can get a head start on health care reform, please post them. Obama is not powerless. Congress does not control everything. Plenty of stuff gets done in this country through executive agencies. Obama and Sebelius should move heaven and earth to serve the voters---that is the best way to ensure that Obama is not a one term president. When the system has let you down, you want a president who is willing to buck the system.
Here is the one I wish we would see (but probably won't):
VI. Obama Declares War on Preventable Disease. Demands that Congress act fast to authorize special wartime powers for the executive branch We had a war on poverty once. Why not a war on needless death and suffering?
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