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Blue States Can Pave the Way for Single-Payer |
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Written by <a href="index.php?option=com_comprofiler&task=userProfile&user=49144"><span class="small">David Dayen, In These Times</span></a>
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Wednesday, 02 January 2019 14:27 |
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Dayen writes: "No single issue powered Democrats to midterm victories more than healthcare."
Supporters of Medicare for All. (photo: Getty)

Blue States Can Pave the Way for Single-Payer
By David Dayen, In These Times
02 January 19
Democrats were elected on promises of affordable healthcare. Here’s what states can do even under Trump.
o single issue powered Democrats to midterm victories more than healthcare. Republicans were roundly condemned for threatening a return to the pre-Obamacare denial of coverage for pre-existing conditions. Expansion of Medicaid passed in three deep-red states (Idaho, Nebraska and Utah). Dozens of Democrats endorsed plans like Medicare for All, and won.
With a Republican president and Senate, the forecast for meaningful healthcare changes at the federal level before 2021 remains bleak, but 14 states now have a Democratic “trifecta”: control of both chambers of the legislature and the governorship. Those states can build the model for a universal, humane healthcare system, right?
Hang on. State-based single-payer would require a waiver to utilize federal Medicare and Medicaid dollars and Obamacare subsidies. And Donald Trump isn’t the likeliest president to grant such a waiver.
But that should not dampen hopes for state-level improvements in healthcare. In fact, by cutting costs and increasing access, blue states can pave the way for a smoother rollout of single-payer nationwide after 2020, should we be so lucky.
Single-payer merely means that the government would take over the health insurance market. In theory that’s great, as government can use the large pool of patients to bargain down the cost of healthcare. But private companies would still deliver treatment and medications. And those companies have aggressively concentrated, building near-monopolistic bargaining power.
As Phillip Longman of the Open Markets Institute has pointed out, in over 40 percent of the country, a single entity controls all local hospitals. Pharmaceutical companies have also consolidated, and the supply chain for prescription drugs is dominated by a handful of middlemen. In the most recent quarterly earnings reports, just 10 healthcare companies earned half the industry’s profits, nine of them drug makers.
This has had dramatic consequences for cost and access. Hospitals that dominate regions and drug companies with a monopoly on particular medications can simply raise prices on patients with impunity. And as unprofitable providers shut down, particularly in rural areas, people cannot get the treatment they need.
States can fight this monopolization of healthcare; in fact, it’s essential that they do. Even a government single payer would have difficulty dictating terms to a hospital network monopoly that controls a large metro area. There simply wouldn’t be an alternative. That’s to say nothing of the political muscle large healthcare providers can leverage.
But Democrats just got an electoral mandate to deliver cheaper, higher-quality healthcare. They have to use it, and here’s how.
States can reject health system mergers and promote more competition. California, for example, recently passed a law enabling the Department of Managed Health Care to deny mergers with an adverse impact on patients.
States can also lower prescription drug prices. They could resurrect an unsuccessful 2016 initiative in California, which would have reduced the price for all drugs purchased by the state—through Medicaid or public employee health plans—to the level paid by the VA. They also could emulate Vermont’s law allowing wholesale importation of safe, cheap prescription drugs from Canada.
Pharmacy benefit managers (PBMs), the unheralded thirdparty administrators that negotiate drug prices for health plans, have been criticized for skimming billions off the top when they negotiate rebates. Increasing transparency and making PBMs a fiduciary that must act in the best interest of their clients can drive down costs; California adopted that this year.
There are even options to leverage insurance markets. Covered California, the state exchange, recently instituted a program that rewards or penalizes hospitals and physicians based on quality of care. That could begin to move giant providers away from predatory practices that hurt patients. States that control their own exchanges could create their own standards. And Democratic trifecta states like Maine and New Jersey, which use HealthCare.gov, could build their own state exchanges, insulating them from Donald Trump’s attempts to weaken the law.
In Maine and Kansas, GOP governors were the last obstacles to expanding Medicaid under Obamacare; the incoming Democrats will likely get that done. Governors there, along with new Democrats in Michigan and Wisconsin, could also reverse the implementation of Medicaid work requirements, which are designed to restrict access. And more than a dozen state legislatures have explored a “Medicaid buy-in” concept, where residents who cannot afford private health insurance would be able to purchase a low-cost, state-run public option based on Medicaid rates. (Call it “Medicaid for All.”)
These are just some solutions available. None of them would cost much to implement—in fact, they’d save states and patients money by constraining outsized provider profits. More important, it puts the country in a better position to enact single-payer plans that have a chance of actually working.
It will take substantial political will to take on entrenched special interests like hospitals and drug companies. But we saw Republicans win elections in numerous states in 2010 and stop at nothing to implement their policies. Democrats need to be just as bold.

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The Moral Horror of America's Prisons |
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Written by <a href="index.php?option=com_comprofiler&task=userProfile&user=49872"><span class="small">Tyler Cowen, Bloomberg</span></a>
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Wednesday, 02 January 2019 14:27 |
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Cowen writes: "Congress isn't doing enough to fix the current U.S. penal system, which is a failure of historic proportions."
Not something America should be proud of. (photo: Justin Sullivan/Getty)

The Moral Horror of America's Prisons
By Tyler Cowen, Bloomberg
02 January 19
Congress isn’t doing enough to fix the current U.S. penal system, which is a failure of historic proportions.
ow that President Donald Trump has signed a bipartisan criminal justice bill into law, it is worth looking at this issue in more fundamental terms. I would like to suggest a radical — but to me commonsensical — conclusion: Much of the American penal system is an unconstitutional moral horror.
The law, called the First Step Act, will expand early-release programs and change sentencing laws, for instance by weakening mandatory minimum sentences for some classes of nonviolent offenders. I’m all for those changes, but most of the bad features of the current system will remain intact.
For instance, it is widely accepted that rape is commonplace in American prisons. Precise numbers are hard to come by, but estimates are that between 2 percent and 21 percent of prisoners have been victims. Note that in prison even apparently voluntary interactions can have a strongly coercive element, such as when a prisoner trades sexual favors for protection or privileges. So it is not just the number of rapes. It is the broader system under which the very notion of voluntary interaction is often meaningless.
Even if a prisoner is never raped, that threat can be hanging over their heads for their entire stay. In the #MeToo era, this should be clear by now.
The upshot is that many incarcerated people suffer cruel and unusual punishment far beyond any issues they might raise about the unfairness of their sentence. Furthermore, once they are in prison, they often have little recourse to the rule of law if they are beaten, harassed, raped or intimidated — including, of course, by prison guards. In essence, they are being sentenced to live outside the protection of a system of laws, and that is clearly not the intent expressed in the Constitution. It is not unusual for a prison to be found guilty of violating common standards of decency, never mind constitutionality.
I am familiar with the cynical riposte that jail isn’t supposed to be fun. But we Americans can do better than that. The punishments received should be those mandated by the legal system, as properly expressed through the decisions of judges and juries. Some people might wish to argue for tougher penalties for some crimes and thus for some criminals, and that is a debate worth having. That is precisely the point: Such judgments should be made after public debate, not by gang powers within a prison.
Two additional features of the system further militate in favor of prison reform. First, because of DNA testing, there is increasing evidence of numerous false convictions, including for murder. That should make penal reform all the more imperative.
Second, the constitutional right to a fair trial has been badly battered. Most criminal court systems are overloaded, and too many defendants are encouraged to make a plea — and those that do not are often accompanied by a presumption of guilt (and often, if found guilty, a harsher sentence). Too many parts of the U.S. court system have ceased to be venues for the accurate, factual examination of innocence and guilt. Instead, they are dominated by a series of procedural kludges designed mostly to keep the process orderly but certainly not fair.
So what then to do? The first and most important step is for Americans to realize they have been creating and sanctioning a moral horror, and to treat it as a major political issue. Step No. 2 is to modify the career incentives for prosecutors to seek out ever tougher sentences. Step No. 3 is to experiment with more electronic monitoring of criminals, and to see if that can limit the number of people behind bars. Step No. 4 is to frame prison reform in more straightforward economic terms. It is not only about guaranteeing rights on paper. It’s also about designing the economic incentives for prisons to create secure and orderly environments. That has hardly been the focus of current systems. Finally — and this idea is broader in scope — the decriminalization of additional offenses should also be considered.
I realize these are complex issues, and potential remedies require far more consideration than I can give them here. But if you think America’s current penal system is the very best we can do, that is about the most pessimistic verdict on this country I have ever heard. Has anyone ever suggested that the American prison system is the world’s best? The can-do attitude is one of my favorite features of American life. We just need to apply it a little more broadly.

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FOCUS: The FBI's Interrogation of Reality Winner Was Like a Play - and Has Now Been Turned Into One |
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Written by <a href="index.php?option=com_comprofiler&task=userProfile&user=49871"><span class="small">Alisa Solomon, The Intercept</span></a>
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Wednesday, 02 January 2019 12:49 |
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Solomon writes: "'Is This a Room' is just one of a number of artistic responses to Reality Winner's case."
Actor Emily Davis rehearsing as Reality Winner at The Kitchen Theater for the play 'Is This A Room', on Saturday, Dec. 22, 2018, in Manhattan, N.Y. (photo: Roy Baizan/The Intercept)

The FBI's Interrogation of Reality Winner Was Like a Play - and Has Now Been Turned Into One
By Alisa Solomon, The Intercept
02 January 19
he experimental theater maker Tina Satter saw something familiar last winter when she clicked on a link from a journalistic story about Reality Leigh Winner, the federal contractor convicted in June of leaking a classified National Security Agency report describing a Russian attempt to hack American voter databases on the eve of the 2016 elections. “It looked like a play,” Satter said of the document that opened on her screen. At the top of the first page, the phrase “Verbatim Transcription” appeared like a title and, below it, the list of “participants,” like dramatis personae. In fact, Satter was reading the official record of FBI agents’ June 3, 2017, search and interview of Winner at her home in Augusta, Georgia. But to her, the dialogue in the transcript — its stutters, short sentences, and strained geniality — resembled the emotionally cool neorealism of the contemporary American playwright Richard Maxwell. Then, the more absorbed she became, the more the text started to seem like a thriller. Satter knew the outcome of the case but still couldn’t help getting caught up in wondering, “How is she going to get out of this?”
By the time Satter was some two-thirds of the way through the transcript, she had become fascinated by the interrogation’s structure and language, what she calls the “shifts in conversation” that bring Winner to admit — on the 56th of the transcript’s 80 pages — that she had printed out and mailed the intelligence report to an online media outlet. (While the name of that news site is blacked out in the FBI account, several publications reported that Winner sent it to The Intercept, which published a story in June 2017 based on a leaked NSA document detailing Russian phishing attacks against the U.S. election infrastructure. The Intercept has said that it received the document anonymously and has published a statement about its role in the case.)
The transcript set Satter’s theatrical imagination ablaze. “As soon as I finished reading it,” she said, “I’m like, God, I think there’s something I’d love to do with this.” After a year of workshopping the material with actors, designers, and a musical composer, that something has turned out to be an artful staging of the unadulterated FBI text — right down to silent pauses for redacted passages. Titled “Is This A Room: Reality Winner Verbatim Transcription,” the play runs at the Manhattan performance space The Kitchen from January 4 to 12. (The show takes its title from a question an FBI agent asks during the interview, interrupting at a pivotal moment as he presumably looks at a door inside Winner’s house.) Considering the events through an artistic lens, Satter has said, “allows the story to move beyond the headlines into a larger, necessary discourse.”
The play can do so precisely because of its nonrealistic form. Though it stays entirely faithful to the FBI transcript, Satter does not see “Is This A Room” as lining up directly in the tradition of documentary theater, which includes plays like Peter Weiss’s “The Investigation” (based on the Frankfurt Auschwitz trials of the mid-1960s), Emily Mann’s “Execution of Justice” (drawn from Dan White’s trial for the murder of Harvey Milk and George Moscone), or Jessica Blank and Eric Jensen’s “The Exonerated” (built from first-person narratives and legal records of people wrongly convicted of capital crimes). Satter’s play, she said, isn’t trying to capture “the moral outrage on the surface” of Winner’s story — though she and the rest of the artists involved certainly feel it. Nor are they trying to present a biographical re-enactment of Winner’s life at the moment the FBI snags her — though they have been in touch repeatedly with her mother, Billie Winner-Davis, who said she is “thrilled” by the project; and the actor portraying Winner, Emily Davis (no relation) has corresponded with Winner and visited the town in central Texas where she grew up.
Rather, Satter has set out to “track the dynamics” of the encounter between Winner and the agents. Tightly choreographed and performed on a bare stage, “Is This A Room” unpacks the power relations at play when a 25-year-old woman, a decorated veteran of the Air Force, is cornered by an all-male law enforcement team. What’s more, it reveals how an FBI interrogation resembles the con game of theater: Both try to persuade an audience — the interviewee in the FBI case — to believe in the world created by their language and movement. It feels as sinister as the creepiest Strindberg drama.
“Is This A Room” is the most overtly political piece Satter and her company, Half Straddle, have made throughout their decade of work. As Satter wrote on the project’s Kickstarter page, “Reality and her story are literally at the center of a vital conversation about patriotism, honor, access, and power in this gut-wrenching American moment.” (The Kickstarter campaign raised $15,062 from 206 donors.)
The play is also, in some respects, a formal departure for Half Straddle. For starters, their work typically collages a variety of found and invented texts into a complex set of revelatory, high-jinks juxtapositions. “In the Pony Palace/FOOTBALL” (2011), for instance, cast nine female and transgender actors as the players, cheerleaders, and coaches of a high school football team and combined gridiron lingo, sports movie dialogue, and adolescent chatter into a hilarious and insightful parody of masculine athletic culture. For “SEAGULL (Thinking of you)” (2013), Half Straddle mashed up Anton Chekhov’s play with contemporary conversation about love and Russian-inflected metal songs. “Ancient Lives” (2015) followed a teacher and several young students into the witchy woods, quoting Emily Dickinson, “The Crucible,” “The Prime of Miss Jean Brodie,” Shakespeare, and 1980s movie plots, among other texts; while “Ghost Rings” (2016) twined a personal story about estranged siblings around the recounting of a fictional romance, all through the medium of an original song cycle. With puppets.
“Is This A Room” — apart from relying on just the single FBI text — has a more sober tone, despite some humorously absurd moments. (The agents’ subject-changing non sequiturs, said Satter, sound just like downtown playwriting.) But at the same time, it extends Half Straddle’s longstanding interest in themes of belonging, commitment, and self-sovereignty, as well as in deconstructing gender. Their work always centers female and/or queer and trans characters and paradigms, and the new play is as much an exploration of male power as it is of nationalistic hubris or, more, of their inextricable connection. As the composer of “Is This A Room’s” score, Sanae Yamada, put it, the play focuses on a young woman of conscience working in intelligence, “at the heart of the patriarchal machinery.”
The play — and FBI transcript — begin with Winner arriving home from grocery shopping one early June Saturday to find a bunch of men looking for her. Two end up conducting the interview — Special Agent Justin C. Garrick (played by Pete Simpson) and Special Agent R. Wallace Taylor (played by T.L. Thompson). A third, “Unknown Male” (played by Becca Blackwell), pokes around, taking photos, and reporting back to Garrick and Taylor, with an occasional remark to Winner. More men helped search Winner’s small, red brick house and Nissan Cube that day — about a dozen agents swarmed in on her in all. Satter represents them through the grunts and unintelligible sounds coming through a walkie-talkie and a cellphone that Blackwell carries. The transcript describes these interactions simply as “noise” or “background conversation”; Yamada has woven them into a soundscape of growls, grumbles, zhoozhes, faint gongs, chimey arpeggios, and low drones, all contributing to the increasingly surreal space of Winner’s world on that stifling day.
The interrogation begins outside Winner’s house, then moves inside and, eventually, into a space behind the kitchen that Winner tells the agents she never uses because she finds it “creepy” and “weird.” We see the feds maneuver the encounter there exactly for that reason, though in the production, that space is established by language and action alone. The set (designed by Parker Lutz) is an unadorned long platform, raised an additional couple feet at each end and covered in thin, gray carpeting — the sort that both Winner and the FBI agents might find in their workplaces. Spectators are seated on either side of the stage, as if we’re watching a sports or chess match, in which we can scrutinize each move and assess its impact.
Satter has staged the action meticulously to highlight this effect, engaging the company in finding what Davis called the “molecular” relationship between Winner and her interrogators at any given moment. The rhythm of Winner’s speech has guided her physicality in the role, Davis said, while Simpson noted that Garrick’s coughs and stammers have been keys to his character-building. Sometimes the three agents flank Winner, sometimes they stand in a wall-like line. Sometimes one gets quietly right up in her face; sometimes they give her room to stride up to their limits, just like her dog, which they secure in an outdoor pen upon their arrival. “She does not like men,” Winner warns drily when they ask if her dog is friendly.
The men never directly threaten her — part of the FBI’s dubious claim that this was a “noncustodial” interview, which meant that they did not have to read Winner her Miranda rights — and they spend a lot of time ingratiating themselves by shooting the breeze about pets (Winner is a devoted animal lover, who expresses concern about her dog and cat throughout the encounter) and CrossFit training (she is a competitive power lifter and fitness enthusiast). They never mention that she could face up to a decade in prison, but cajole her with feigned sympathy. “I don’t think we’re coming in here to say you’re some big, bad mastermind, prolific spy kind of thing,” Taylor tells her. “What we both think is that maybe you made a mistake.”
The staging subtly uncovers the actor-like nature of the agents’ job. The theatrical metaphor keeps resounding once one’s ears are tuned to it: “Look, you’ve had a good career. You have. If there’s something that just pushed you over the edge on this, now is the perfect time,” Garrick says as he and Taylor close in. And he essentially invites Winner into the spotlight: “This is a podium.”
Satter noted, “I really do like the meta-ness” of reminding audiences that they are in a theater space. Even the characters’ names support this distancing effect: The hero happens to be called Reality and the lead interrogator shares a surname with David Garrick, the legendary 18th century actor, who, as any undergraduate student of theater history can tell you, revolutionized his art, replacing a bombastic style of proclaiming from the stage with a quieter new style of realistic acting.
Avoiding bombast and outright bullying, the agents assert their dominance in a way that displays an unspoken principle of masculine power: They simply assume it, as “Is This A Room” lays bare. Simpson comes off as especially menacing when he keeps his deep eyes cast down at the floor, and his voice low. Satter said she knew the show needed to exhibit “male energy” and, simply by casting artists she has worked with before, ended up with two of the agents — “these archetypes” — played by trans actors. “Fuck yeah,” Satter exclaimed, delighted that such casting is inherently political.
The show frames the way the agents are, as Thompson put it, “performing masculinity,” and, as a result, heightens the ways in which Winner is in part defeated by her feminine accommodation. In one telling moment, Garrick compliments her linguistic skills in Farsi, Dari, and Pashto, then quips, “I’m barely able to speak English.” Winner replies, so reassuringly, “English is hard.” Davis pointed out that Winner frequently intersperses a “just” into her sentences — “such an inherently apologetic word.” The men seize on her well-trained girlish solicitousness.
In August, in a deal in which Winner pleaded guilty to one count of violating Section 793 of the Espionage Act, she was sentenced to 63 months in prison to be followed by three years of supervised release — the longest federal sentence ever imposed on anyone for an unauthorized release of government information to the media. As Winner’s mother recently wrote, the punishment seems particularly galling when those who perpetrated and benefited from the Russian hacking that Winner helped expose have gotten off so easily.
Winner-Davis said she is grateful for any efforts to keep her daughter in the public eye, and she is planning to attend “Is This A Room” along with her husband and a group of Winner’s supporters. She’s excited about the play, though, as she has let Satter know, anxious about its potential emotional impact: “I don’t know if I can sit through it.”
“Is This A Room” is just one of a number of artistic responses to Reality Winner’s case. There have been posters, at least one song, and, according to Winner-Davis, Hollywood talks about a feature film. But theater has a unique power that TV, movies, and other genres can’t supply, Winner-Davis said. “Being there live, hearing the music, being with the actors — it gives you the sense that you are there,” she explained. “You’re living it.”

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FOCUS | The Trump Tax Cut: Even Worse Than You've Heard |
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Wednesday, 02 January 2019 11:35 |
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Krugman writes: "The 2017 tax cut has received pretty bad press, and rightly so. Its proponents made big promises about soaring investment and wages, and also assured everyone that it would pay for itself; none of that has happened."
Economist Paul Krugman. (photo: Getty Images)

The Trump Tax Cut: Even Worse Than You've Heard
By Paul Krugman, The New York Times
02 January 19
Skeptical reporting has still been too favorable.
he 2017 tax cut has received pretty bad press, and rightly so. Its proponents made big promises about soaring investment and wages, and also assured everyone that it would pay for itself; none of that has happened.
Yet coverage actually hasn’t been negative enough. The story you mostly read runs something like this: The tax cut has caused corporations to bring some money home, but they’ve used it for stock buybacks rather than to raise wages, and the boost to growth has been modest. That doesn’t sound great, but it’s still better than the reality: No money has, in fact, been brought home, and the tax cut has probably reduced national income. Indeed, at least 90 percent of Americans will end up poorer thanks to that cut.
Let me explain each point in turn.
First, when people say that U.S. corporations have “brought money home” they’re referring to dividends overseas subsidiaries have paid to their parent corporations. These did indeed surge briefly in 2018, as the tax law made it advantageous to transfer some assets from the books of those subsidiaries to the home companies; these transactions also showed up as a reduction in the measured stake of the parents in the subsidiaries, i.e., as negative direct investment.
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