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Originally Published: 6/4/2008

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How does Medicare work? How does Medicaid work? Why doesn't Congress just expand these programs to cover vulnerable, uninsured populations, such as low-income families and children?


You obviously misunderstand the issue. “[U]ninsured populations, such as low-income families and children” are already covered. The debate currently isn’t about these populations. It’s about everyone else – people who are paying out ungodly sums of money for their private health insurance, making housing, food, transportation, etc. out of financial reach; people who are working 2 or 3 jobs just to support their families due to these unbelievable costs; people who are being denied coverage by their private, for-profit insurance companies because their profits would be reduced and, thus, dividends to investors and CEO salaries would be reduced; people filing bankruptcies due to extraordinary healthcare costs (more than 60% of bankruptcies filed in 2007 were due to healthcare costs); and people dying because they’re denied treatment. The system is broken for everyone. It’s not about poor people getting care.

Medicare and Medicaid, along with the State Children’s Health Insurance Program (SCHIP), are all paid for with taxpayer money. Those of us who are working – not the elderly, the disabled, or the poor – are the ones paying the escalating costs for this 100 billion+ population, more than one-third of the U.S. (Medicare, about 52 billion, Medicaid, about 59 billion, SCHIP, about 6 billion.) The out-of-control costs funneling through to providers’ profits are being borne by the taxpayers. In addition, think about all the taxpayer dollars going to healthcare providers for foster care, and other state programs. On top of that we have to pay for our own health insurance, either directly or through lost wages that employers use to pay profit-centered health insurance companies.

Medicaid is a needs-based federal program that already covers low-income families and children. SCHIP, which extends children’s health care to lower-income families who do not qualify for Medicaid, is another health care program designed to help those in need. Both are federal-state partnerships where the bulk of the money is provided by the feds and the rest by the states. Each state decides how they work, with approval by the feds, so it is different in each state and the amount of funding, and thus the amount of coverage, is different in every state. Due to the hodge-podge of funding, implementation, and oversight, it is very inefficient. To expand this to a larger population would result in a healthcare system similar to that in Canada, which is based in the provinces and is different in each province. This is where complaints about Canada’s system have come from. Some provinces have good resources, are well managed, and provide excellent care. Some are poorly managed, like Ontario, and these are where the majority of complaints originate.

Medicare is a national, single payer system for senior citizens and disabled persons. To extend this to any citizen who wants it is what many are referring to when promoting a single-payer system. It has many benefits, including being great for the economy. Employers are dropping insurance coverage for their employees because of the costs. Those that are continuing the coverage are becoming less and less competitive in the global marketplace because other countries have universal healthcare and the costs are not borne by the corporations. However, this is probably politically not feasible.

Expanding Medicare to anyone who wants it would dramatically lower the profits of private health insurance companies and may even put some out of business. If you have a choice of paying $1,000 a month to Aetna, Blue Cross, or one of the other companies, or paying nothing or even $1,000 a year to the feds for the same coverage, what would you do? Then there are the cost savings. With probably close to 200 billion people signing on to a federal health plan, costs would be negotiated, which may lead to a reduction in profits for many hospitals and other health-related businesses, forcing them to go under or become not-for-profit. Now, with all these corporations facing the possibility of losing trillions of dollars over the next 10 years, do you really expect that this will happen? The people in Congress who’d have to vote for this were put there primarily with campaign contributions from these same companies. Ain’t never gonna happen.

Additionally, other legislation needs to be implemented, such as banning doctors from owning hospitals which lead them to ordering unnecessary tests and surgeries for patients so that they can reap the profits. (See The Weekly Wonk, Physician-Owned Hospitals, 8/1/09.) You think the American Medical Association is going to stand for this? (See below.)

I could go on and on – and I have and I will continue to do so – about the exorbitant costs of health care all in the name of profits for corporations and whopping amounts of money for CEOs along with the lack of health care for so many people. But, in short, let’s face it. Our government is wholly owned by the corporations. You can vote, but they don’t care what you want.


Who is behind the lobbying against health care reform? Can you break it down by group, i.e., AMA, insurance companies, for-profit hospitals? I'm interested to see who's paying the bulk of the lobbying costs, all of which will get passed through to patients somewhere.


This is almost impossible to determine. However, by piecing together some reports, we can get a pretty good idea about where the money is coming from.


Clearly, the biggest spenders are the health insurance companies. The AP reported that “Health care companies poured $484 million into lobbying efforts in 2008, and are on pace to exceed that this year.”


Next are the drug companies. The Pharmaceutical Research and Manufacturers of America (PhRMA), in the second quarter of this year alone, spent $40 million. (Kaiser Health News) The American Association of Retired Persons (AARP) spent $9.3 million in the second quarter backing the drug companies. (CQ) Expenditures by individual drug makers is a little more difficult, but I did find that Pfizer spent $6.2 million in the second quarter of this year. (AP) Eli Lilly spent $3.6 million, GlaxoSmithKline spent $2.3 million, CVS Caremark spent $2 million, Bayer spent $1.9 million. And biotech companies got into the act with Amgen spending $3.4 million and Novartis and the Biotechnology Industry Organization (BIO) spending $1.8 million each. (AP)


The Arizona Hospital Association (AHA) comes in next, with $7+ million this year. (Washington Post)


The American Medical Association (AMA) spent $4 million in the second quarter. (AP)


If you read the articles I’ve linked here you’ll notice that they’ll differ in the amounts they report. This is due to the reporting system and how each analyst attributes certain expenditures. But I’m sure I haven’t found nearly all the organizations lobbying on behalf of one of these interest groups. However, I’ll bet dollars to donuts that the spending pecking order would stay the same no matter how much money is piled on. You have to wonder what they expect their return to be when they “invest” this kind of money. Clearly, the “dividends” won’t be going to the American people.




Darrel Dochow is a senior bank regulator who was director of the Office of Thrift Supervision's West Division and who allowed IndyMac Bank to alter its records to help make it seem as though it was in better financial shape that it actually was. (The Weekly Wonk, What Happened to Regulation?, 12/27/08) But, he was demoted back in the 1980s for doing the same kind of thing for Charles Keating's Lincoln Savings & Loan. How did he get put in charge? Who appoints the director of the Office of Thrift Supervision?


The Office of Thrift Supervision is an office within the U.S. Treasury. There are 5 regions and Darrel Dochow (see bio) was named the director of the West Region in 2007. (See also the Treasury Department’s orgazational chart.) John Reich is the Director of the Office of Thrift Supervision, responsible to Robert Kimmitt, Deputy Secretary and, ultimately, Henry Paulson, Secretary of the Treasury. Reich was nominated by George W. Bush and confirmed by the Senate in 2005. (Interestingly, his bio is not available at the Treasury website. Here’s a bio from Wikipedia.) So, Reich, a Bush political appointee, is responsible for naming Darrel Dochow as a regional director.




Why won't the Democrats take any action on impeaching President Bush?

As you know, impeachment is an indictment. It means that there is enough evidence that crimes may have been committed to warrant a trial. For U.S. officials, this process takes place in Congress. The House of Representatives is responsible for investigating alleged crimes. If they believe there is enough evidence that crimes have been committed, they impeach. The Senate then has the responsibility of holding the trial.


In order to impeach President Bush the House of Representa-tives has to vote to impeach. Senator Dennis Kucinich (D, OH) has offered Articles of Impeachment against both President Bush and against Vice President Dick Cheney. Both have been voted on by the House, sending Articles against both to the House Judiciary Committee for investigation. Rep. John Conyers (D, MI), chair of the Judiciary Committee, has done no investigation on the Articles against Dick Cheney. It is expected that he will do no investigation on the Articles against George Bush. It is widely believed that this is due to an order from Speaker of the House Nancy Pelosi (D, CA).


Publicly we hear that the reason for not pursuing impeachment against Bush and Cheney is due to the composition of the House of Representatives. All 435 members of the House are up for re-election every 2 years. Currently, of the 435, 237 or 54.4%, are Democrats, a slim majority. Of those, about 48 are what is known as “Blue Dog Democrats;” that is, they are moderate to conservative Democrats and are usually from primarily Republican districts. Speaker Pelosi, who has been blocking impeachment, argues that, since the Blue Dogs probably won’t vote with the rest of the Democrats, they won’t be able to get a majority to impeach and, if they were to get it, there are not enough votes in the Senate to get a conviction. If they are to impeach, she fears, there will be backlash against the Democrats and they may lose seats in the November election. She is also afraid that if Blue Dogs voted to impeach their seats would probably be lost in November. She said she fears losing the House’s Democratic majority. In her view impeachment is, at best, a waste of time and, at worst, a loss of Democratic seats.


There is another, less-spoken-of reason for Pelosi’s refusal to investigate potential crimes of Bush and Cheney and it has to do with the so-called “Gang of 8.” The Gang of 8 includes the leaders of each party from the House and the Senate and the chairs and ranking members of the intelligence committees in each house. Currently the Gang of 8 includes Nancy Pelosi; John Boehner (R, OH), House Minority Leader; Harry Reid (D, NV), Senate Majority Leader; Mitch McConnell (R, KY), Senate Minority Leader; Silvestre Reyes, Chair of the House Permanent Select Committee on Intelligence; Peter Hoekstra (R, MI), Ranking Member of House Permanent Select Committee on Intelligence; John Rockefeller (D, WV), Chair of the Senate Select Committee on Intelligence; and Kit Bond (R, MO), Ranking Member of the Senate Select Committee on Intelligence.


From 2002 to 2005, members of the Gang of 8 changed occasionally. They have, at various times, included: Dennis Hastert (R, IL), Speaker of the House; Nancy Pelosi (D, CA), House Minority Leader; Bill Frist (R, TN) and Tom Daschle (D, SD), Senate Minority and Majority Leaders; Porter Goss (R, FL) and Peter Hoekstra (R, MI), Chairs of the House Permanent Select Committee on Intelligence; Nancy Pelosi (D, CA) and Jane Harman (D, CA), Ranking Members of the House Permanent Select Committee on Intelligence; Bob Graham (D, FL) and Pat Roberts (R, KS), Chairs of the Senate Permanent Select Committee on Intelligence; and Richard Shelby (R, AL) and John Rockefeller (D, WV), Ranking Members of the Senate Select Committee on Intelligence.


There is quite a bit of evidence that, from about 2002 to 2005, the Gang of 8 were probably complicit in Bush and Cheney’s crimes. You’ve heard Bush say many times that he has fully advised the Congressional leadership of various controversial policies. This would be a good strategic move on his part and is probably true. Remember James Comey’s testimony that the "Gang of 8" had been fully briefed on the warrantless wire-tapping? And it came out last December that the “Gang” had been regularly briefed on the CIA’s kidnapping, extraordinary rendition, and torture techniques since 2002. If you look at the people involved in the Gang of 8 from 2002 to 2005 you’ll see that they encompass the highest ranking Democrat and Republican elected officials, people who, even if no longer serving, still wield much power. If an investigation into the crimes of Bush and Cheney would expose such “prestigious” power brokers as these, it’s no wonder that, in the words of Nancy Pelosi, “impeachment is off the table.”




With the new law passed in California making same-sex marriage legal and the move by New York to recognize same-sex marriages, how likely is it that a case will make it’s way to the Supreme Court? What has to happen before a case can go to the Supreme Court?


Here’s an uncomprehensive overview. There are 2 roads to the U.S. Supreme Court. The primary road is through a case that is in federal jurisdiction. These would be cases regarding federal law, treaties, cases in which one party is a state, etc. These are cases that are started in U.S. District Courts, appealed in the U.S. Courts of Appeals, with the U.S. Supreme Court being the final appeal court. The other road, and the bulk of the cases, is through state courts, where a case is brought before a state trial court, appealed to a state Court of Appeals, further appealed to a state Supreme Court. If that decision is appealed it then goes to the U.S. Supreme Court. For the U.S. Supreme Court to take these cases the petitioner must file a Writ of Certiorari and this must be granted by 4 of the 9 justices.


A case regarding same-sex marriage could get to the Supreme Court by a challenge of the 1996 Defense of Marriage Act. Traditionally the federal government played no part in marriage issues and recognized any marriage recognized by any state, even if other states did not recognize it. This changed with the Defense of Marriage Act which defined marriage as a union between one man and one woman for the purposes of federal law. Now, no act or agency of the federal government can recognize same-sex marriage. The law has been criticized as unnecessarily interfering with states’ decisions regarding marriage. A challenge to this law would be the fastest route to the U.S. Supreme Court. However, given the current make-up of the Court, advocacy groups have deliberately avoided such a challenge, preferring to work within the states instead.


However, the U.S. Supreme Court has already weighed in on the issue. The 6-3 Lawrence v. Texas decision decriminalized homosexual behavior. In the case of Romer v. Evans the U.S. Supreme Court ruled 6-3 that Colorado’s constitutional amendment that would have prevented any laws banning discrimination against gays and lesbians was unconstitutional. However, in Standhardt v. Superior Court of the State of Arizona, the Supreme Court upheld an Arizona Statute banning same-sex unions, saying that the state has a legitimate interest in encouraging procreation and child-rearing within the marital relationship and that limiting marriage to opposite-sex couples is rationally related to that interest. (For those of you so inclined, here’s a report by the Congressional Research Service, Same-Sex Marriages: Legal Issues.)


There may be more challenges coming and it is certainly expected that there will be some challenge either to California’s Supreme Court decision or to a constitutional amendment banning same-sex unions if such a proposition passes in the up-coming election.



Is there a federal statute that provides for the death penalty? I seem to remember something about an anti-terrorism bill that included the ultimate sanction.

When British colonists came to the New World, they brought the death penalty with them. Laws varied from colony to colony and the laws were incorporated into the state governments and the federal government when the union was created.

By the mid-1700s, abolitionists were arguing against the death penalty. The first attempt to due away with capital punishment came from Thomas Jefferson. He introduced a bill in Virginia to use the death penalty only for crimes of murder and treason. It was defeated by only one vote. The movement, however, continued and, in 1794, Pennsylvania repealed the death penalty for all offenses except first degree murder and many states followed by reducing the number of capital crimes and building state penitentiaries. In 1834 Pennsylvania became the first state to carry out executions in correctional facilities, rather than have public executions. In 1846 Michigan became the first state to abolish the death penalty for all crimes except treason. Thereafter Rhode Island and Wisconsin abolished the death penalty for all crimes. However, most states held onto the death penalty, particularly for slaves, but made it discretionary rather than mandatory.

The early 20th Century saw a “progressive” era and 6 states completely outlawed the death penalty. 3 limited it to treason and first degree murder of a law enforcement official. However, it didn’t last long. After the Russian Revolution, the fear of the “Red Menace” and the aftermath of World War I reinvigorated capital punishment. 5 of the 6 states that abolished the death penalty had reinstated it by 1920.

In the 1960s and early 1970s the Supreme Court started whittling away at the death penalty. [U.S. v. Jackson (390 U.S. 570); Witherspoon v. Illinois (391 U.S. 510); and Crampton v. Ohio and McGautha v. California, (consolidated under 402 U.S. 183)]. A 1972 Supreme Court decision [Furman v. Georgia, Jackson v. Georgia, and Branch v. Texas (known collectively as Furman v. Georgia (408 U.S. 238)] effectively voided 40 death penalty statutes, commuted the sentences of 629 death row inmates around the country, and suspended the death penalty saying that current statutes were unconstitutional.

The federal government has also used capital punishment for certain crimes, such as murder of a government official, kidnapping resulting in death, running a large-scale drug enterprise, and treason. (See list of federal statutes.) In 1988 a new statute was enacted for murders committed in the course of drug trafficking activities. In 1994 President Bill Clinton signed the Violent Crime Control and Law Enforcement Act which expanded the federal death penalty to some 60 crimes, 3 of which do not involve murder: espionage, treason, and drug trafficking in large amounts.

2 years after the Oklahoma City Bombing, President Clinton signed the Anti-Terrorism and Effective Death Penalty Act of 1996 which restricts review in federal courts by tightening the deadlines, limits evidentiary hearings, and allows for only a single habeas corpus filing in federal court.

Since 1927 there have been 37 federal executions. There were none from 1963 to 2001 and, since 2001, 3 federal prisoners have been executed.

The U.S. military has its own death penalty statute, although no executions have been carried out since 1961. There were 160 soldiers executed between 1930 and 1961. The last Navy execution was in 1849. Currently there are 9 men on military death row, 6 of whom are African-American.

The Military Commissions Act of 2006 established special military commissions for detainees held at Guantanamo Bay and provides for the death penalty for certain offenses.

The United States is the only industrial, fully developed, Western country that still uses the death penalty.


When were superdelegates invented?  Who did it?

The formal name is “unpledged delegates” as opposed to the “pledged delegates” who are voted upon in the primary elections and caucuses. “Superdelegates,” however, is the commonly used moniker, so I’ll keep using it. The term applies to the Democratic Party only, although the Republican Party also seats some party officials as delegates. Superdelegates are delegates based on the positions they hold, such as senators and representatives, and a certain number from each state named by the state party.


In the early 1960s, the Mississippi Freedom Summer resulted in the formation of the Mississippi Freedom Democratic Party which sent a delegation to the 1964 national convention. They were denied being seated by the all white male Democratic Party leadership. Things got worse by 1968 where people demanding civil rights and women’s rights, along with anti-war activists, were beaten in the Chicago streets outside the Democratic convention. Inside dissidents were gagged by the party bosses on the convention floor. Outrage led to the formation of the Democratic Party’s Commission on Party Structure and Delegate Selection, known now as the McGovern Commission.


The purpose was to take the selection out of the “smoky back rooms” and out into the light with lots of input from party members. Proportional representation rules were adopted to include previously excluded constituencies, like blacks, women, and young voters. Superdelegates were made part of the process in order not to disenfranchise party leaders. Under the original plan, superdelegates would have made up 30% of all delegates. But when the process was finally implemented in the 1984 election (yes, it took that long), they were only 14% of the total delegates. Over the years the number was increased and today superdelegates are about 20% of the total.


In 1984 Walter Mondale was only slightly ahead of Gary Hart for the nomination, but won the support of almost all super-delegates and became the nominee. However, in 2004, Howard Dean had the lead by securing most superdelegate votes before the first primary was ever held. However, in the primaries and caucuses, John Kerry defeated Dean and got the nomination. So, under both scenarios the Democrats can turn out losers.


Do you think Signing Statements will continue under a Democratic president?


Of course they will. Signing statements have been used by presidents for a long time. However, prior to the Reagan administra-tion they were rarely used and then usually only to congratulate or admonish Congress. However, it was Ronald Reagan who changed this and started using Signing Statements to protect presidential prerogatives. In The Issue Wonk article on Signing Statements, I cited Christopher Kelley as stating that from the Monroe administration to the Carter administration, there were only 75 signing statements that protected presidential prerogatives and 34 instructing the executive branch agencies on the interpretation of the bill.


From the Reagan administration through the Clinton administra-tion both these numbers increased tremendously – 322 based on executive branch prerogatives and 74 instructing agencies on bill interpretation. So, even a Democratic president used Signing Statements liberally – no pun intended. I’m going to take a leap here and assume that your concern stems from the excessive use by George W. Bush. In his first term alone, he issued 435 statements and by early 2006 the number had climbed to about 750. And, his statements directly defy the law he was signing. He should have vetoed the bill but, of course, that would have given Congress the possibility of overriding the veto and following the Constitution in that manner is anathema to Bush.


So, yes, a Democratic president will use Signing Statements. However, whether he/she would use them to the extent and for the purposes that Bush has is, of course, pure speculation. I’m not a constitutional scholar so I am unable to address whether there is any way that Congress can stop the usage of Signing Statements, but I highly doubt it.


How does the Electoral College work, what law makes this a commandment, and why can’t we change it?


Our unique system of electing a president is set out in the U.S. Constitution, Article II, The President and the Executive Departments, and in the 12th Amendment and the 23rd Amendment for the District of Columbia. Article II says:


Each State shall appoint, in such Manner as the Legislature thereof may direct, a Number of Electors, equal to the whole Number of Senators and Representatives to which the State may be entitled in the Congress: but no Senator or Representative, or Person holding an Office of Trust or Profit under the United States, shall be appointed an Elector.


The body of electors is referred to as the Electoral College. Changing the system would require a Constitutional Amendment. This proposal has been made several times but, due to the difficulty of amending the Constitution (See Amendments), it has never succeeded.


The Constitution allows each state to determine how the electors from that state are chosen. At one time in many states the state legislators determined who the electors were but, now, in all states the public votes for the electors who pledge to cast their votes for a particular candidate. In some states there are laws requiring the electors to vote for the pledged candidate but in many there is no law and, theoretically, electors can vote for another candidate.


The Electoral College is composed of 538 electors. Each state has a number of electors equal to the number of its Representa-tives in Congress and its Senators (always 2). The District of Columbia is given the number of electors equal to the number held by the smallest state. U.S. territories cannot participate. Each elector casts 2 votes – one for president and one for vice president. The candidate that receives the greatest number of electoral votes wins. If no presidential candidate receives a majority of electoral votes, the House of Representatives decides the election. If no vice presidential candidate receives a majority of electoral votes, the Senate decides the election.


At the current time 48 states and the District of Columbia have a “winner-takes-all” system; that is, the candidate who gets the majority of popular votes receives all of the electoral votes for that state. However, Maine and Nebraska have different systems referred to as the Congressional District Method. With this method the state is divided into the districts represented by its Representatives and 1 electoral vote is allocated to each district. The winner of each district gets the electoral vote. The statewide winner gets the remaining 2 (the Senate) electoral votes. Maine has used this method since 1972 and Nebraska since 1996 but neither has ever split its electoral votes.


With our system, it is possible for a candidate to become president without winning the majority of the popular vote. This has happened several times: John Quincy Adams in 1834, Rutherford B. Hayes in 1876, Benjamin Harrison in 1888, and George W. Bush in 2000. Critics argue that the system is inherently undemocratic and gives swing states a dispropor-tionate role. Adherents argue that it protects the smaller states from constantly being overruled by the larger states, which is why the system was set up in the first place.






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