Monthly Archives: May 2016

The wealthy are ruining American health care

This piece was co-written with Vijay Das, a healthcare advocate at Public Citizen. 

In a hard-hitting New York Times op-ed on Friday, senior New York Democratic Rep. Steve Israel put all of Washington on notice. He is fed up with campaign fundraising. He joins Sen. Barbara Mikulski, D-Md., this year and Sen. Tim Johnson, D-S.D., last year in retiring from Congress. They’ve had enough of shaking down America’s superrich.

Corporate lobbyists and wealthy activists dictate much of American politics today. In the 2012 presidential race, 0.01 percent of Americans contributed almost 30 percent of the money spent in that entire election cycle. Corporations spend billions of dollars annually on lobbying. America’s big spenders exert tremendous influence over elected leaders and have dramatically different priorities from everyday citizens’.

Nowhere is that clearer than in the political battle over the Affordable Care Act’s Medicaid expansion, which exemplifies how very wealthy political donors impair access to health care.

The law raised the income threshold for low-income Americans to qualify for Medicaid. Households with income up to 138 percent of the federal poverty line are eligible. However, the Supreme Court ruled this provision optional for states. For states that expand Medicaid, the federal government picks up all costs to cover additional Medicaid populations until 2017. States pick up 5 and then 10 percent of the tab thereafter. Twenty states have failed to expand Medicaid, leaving 3.1 million Americans uninsured. With a new executive order in Louisiana, the number will fall to 19 states, and an additional 200,000 Americans will eventually become insured.

Medicaid expansion is vital. If it were expanded in every state, it could have prevented 7,115 to 17,104 unnecessary deaths and 240,700 racked-up catastrophic medical bills each year.

Expansion also saves money. With it, states could spend far less on uncompensated emergency care. If Pennsylvania alone expanded Medicaid coverage, Rand Corp. economist Carter Price found that it could add $3 billion to the state’s GDP and create 35,000 jobs.

Yet expansion is being held up because of politics. New research shows that Charles Koch and David Koch’s advocacy group Americans for Prosperity is having great success blocking state Medicaid expansion. The organization’s 34 state chapters currently spend large sums to build its grass-roots advocacy and place political ads. It’s paying off in Florida, where Gov. Rick Scott has all but retreated on his openness to expand Medicaid to cover 567,000 low-income Floridians.

This trend is unfortunate, because there’s fertile ground for Medicaid expansion nationwide. New research suggestsif public health activists could better mobilize, they could pressure lawmakers to expand Medicaid. Citizen advocates can trump the austerity-first agendas of billionaire-financed interest groups. They simply have to organize better.

The priorities of rich donors are out of line with voters. Brian Schaffner’s analysis from the 2014 cooperative congressional election study shows a large gap in opinion about Medicaid expansion between the average GOP supporters and the richest among them. Sixty-two percent of nondonor Republicans surveyed said they would refuse the Medicaid expansion, compared with 77 percent of donors who gave much more than $1,000.

AJAMHeatlhcare1Medicaid expansion aside, the political influence of the extremely rich undercuts American health care.

A study of wealthy Americans by political scientists Benjamin Page, Larry Bartels and Jason Seawright finds that while average Americans favor national health insurance, which would be publicly financed on the basis of one’s ability to pay, only 32 percent of the wealthy surveyed said they support the policy, compared with 61 percent of all Americans. When asked if average Americans were willing to “pay more taxes in order to provide health coverage for everyone,” 41 percent of the rich said yes, compared with 59 percent of the general public.


Donations from the wealthy and corporate contributions for lobbyists have also resulted in attacks on Medicare, the half-century-old national health insurance program for seniors and people with special needs. Raising Medicare’s eligibility age from 65 to 67 is a frequency cited idea among the current crop of Republican presidential candidates, even though it would dramatically curb health access for seniors. It’s not crazy to expect House Speaker Paul Ryan to sneak it into this year’s budget. President Barack Obama even offered it as part of a large budget deal in 2011.

This policy would force people off their health coverage, particularly in states that have not expanded Medicaid. An estimated 435,000 seniors would lose coverage by 2021 if the eligibility age were raised. If the eligibility age had been raised in 2014, seniors would have had to pay $3.7 billion more in out-of-pocket costs that year, preventing many of them from obtaining necessary treatments.

Most troubling is that this proposal would increase overall health care spending. Medicare is much better at controlling costs than private insurance, and it has lower administrative costs. Individuals kicked off Medicare likely would get private coverage, and their health care bills would add to overall U.S. health care spending. Thus any Medicare savings achieved by increasing the eligibility age would be canceled out. The Center for American Progress found that raising Medicare’s eligibility age would cost individuals, businesses and states twice as much as the federal savings suggested by the reform.

Though a large majority of Americans opposes raising the retirement age, it remains a fixture in health and federal budget discussions. Why? Because the policy has a powerful big money constituency in Washington. Most trade associations share the interests of their wealthy members: recklessly shrinking federal spending in the name of balancing the budget and eliminating tax obligations, no matter the consequences to the economy and public health.

Trade associations have outsize lobbying muscle. According to a seven-month analysis in 2014 by the Center for Public Integrity, nearly 85 percent of corporate donations for lobbying flowed to trade associations. For every dollar spent on lobbying on behalf of labor unions or citizen interests, corporations and their associations spend $34. Of the 100 organizations that spend the most on lobbying, 95 consistently represent business.

Lobbying to gut Medicare and Social Security is a long-standing problem. Since 1998, the top three health care industry groups have spent three times as much on lobbying as AARP. The Business Roundtable and the U.S. Chamber of Commerce are the biggest spenders year after year. Both advocate raising the Medicare eligibility age.

There are ways to improve and save Medicare that align with citizens’ interests. We could lower the Medicare age to boost its solvency and achieve better health outcomes. We could save Medicare billions of dollars by allowing it to negotiate the price of prescription drugs. We don’t have to slash benefits and curb access for our hard-working seniors.

As candidates parade around the nation rattling their cups at $40,000-a-plate fundraising dinners, the health of American democracy worsens. When industry-sponsored evening banquets blanket the first 100 days of the next president, we will all suffer.

Many solutions can address the concentrated role big money plays in our politics. Public funding of campaigns is one way to renew the people’s faith in our elections because it would create a more level playing field, allowing a wider range of candidates to compete. At a minimum, we should empower voters by mandating disclosure of all contributions.

The very rich’s austerity agendas are literally killing people. It’s imperative we take the required steps to restore confidence in our democracy.

This piece originally appeared on Al Jazeera America. 

Racial attitudes still divide the two major parties

Barack Obama’s presidency has been marked by heated debates about the Republican Party’s racial attitudes. Many liberals have noted the dog whistles —subtle cues that play on stereotypes and may trigger taboo sentiments — employed in Republican attacks on the president. Former House Speaker Newt Gingrich, for instance, famously called Obama a “food stamp president,” former Sen. Rick Santorum accused him of giving welfare to “blah people,” and many conservatives have claimed Obama couldn’t have been born in the United States.

For the most part, the public abhors and condemns such blatant racism. But recent data on public sentiments suggest that many Americans hold beliefs affirming subtler, structural racism and that the popularity of these believes divides sharply along party and political lines.

I began my examination of whether there is a partisan divide on racial issues with the American National Election Studies 2012 survey. The first set of questions I examined measures racial stereotyping, asking respondents whether they believe that black people are “hard-working” or “lazy,” “intelligent” or “unintelligent” and whether they have “too much influence” or “too little influence” in politics — in other words, questions measuring explicitly racist attitudes.

The second set of questions I examined measures what scholars call racial resentment. These questions measure perceptions of the persistence of racial inequality and discrimination by asking respondents whether they agree or disagree with these statements:

• Irish, Italians, Jewish and many other minorities overcame prejudice and worked their way up. Blacks should do the same without any special favors.
• Generations of slavery and discrimination have created conditions that make it difficult for blacks to work their way out of the lower class.
• Over the past few years, blacks have gotten less than they deserve.
• It’s really a matter of some people not trying hard enough; if blacks would only try harder, they could be just as well off as whites.

I also looked at responses to the question “How much discrimination do black people face?”,as well as whether respondents support government assistance to African-Americans, including employment protections.

This second group of questions examines issues related to colorblind racism. As sociologist Eduardo Bonilla-Silva writes in “Racism Without Racists,” colorblind racism is “racism lite,” in which “instead of proclaiming God placed minorities in the world in a servile position, it suggests they are behind because they do not work hard enough.”

Among non-Hispanic whites, there are strong and persistent gaps between Republicans and Democrats, with at least 22-point gaps in opinion on each issue I examined. The deepest divide is on whether blacks should work their way up, as Irish- and Italian-Americans supposedly did, which divided members of the two parties by 30 points.


On racial stereotyping, the gaps are smaller, with only an 8-point gap in the share saying black people are unintelligent, but an 18-point gap in the share saying they are “lazy.” While only 7 percent of Democrats believe that blacks have too much influence over politics, 25 percent of Republicans do. With regard to the government’s role in ameliorating racial inequality, the split was even larger, with 35-point gaps on whether the government should help blacks or blacks should help themselves, and on whether or not it is the government’s job to ensure fair treatment in the workplace.


Examining self-identified conservatives and liberals gives similar results, with gaps of 26 to 38 percentage points on issues related to colorblind racism, gaps averaging 17 points on the stereotyping questions and gaps averaging 40 points on questions about government aid.


In a piece last year, journalists Nate Silver and Allison McCann investigated whether white Republicans were more racist than white Democrats. They focused on questions that examine racial stereotyping, such as whether blacks are lazier or less intelligent than whites and whether a white person would feel comfortable with a close family member marrying a black person. On many of these questions, partisan gaps have disappeared. However, on the question of whether blacks “lack the motivation to pull themselves out of poverty,” the partisan gap is large: In the 2012 survey, 57 percent of white Republicans and 41 percent of white Democrats agreed.

Silver and McCann concluded that “there’s a partisan gap, although not as large of one as some political commentators might assert. There are white racists in both parties. By most questions, they represent a minority of white voters in both parties.” However, assuming Bonilla-Silva is correct that institutional racism is the primary problem today, the questions Silver and McCann used didn’t adequately address the real partisan gaps on race.

My analysis suggests that focusing on stereotyping and other explicitly racist attitudes rather than structural racism obscures much of the differences between how Republicans and Democrats think about race. The two parties are significantly divided on whether entrenched barriers still hamper upward mobility for blacks and whether government should intervene.

That said, we cannot be sanguine about how explicit racial stereotyping influences conservative politics. Those who claim, as economist Alex Tabarrok did before the 2012 election, that “it is undeniable that some Americans are racist but racists split about evenly across the parties” are mistaken. In reality, while 23 percent of Democrats say black people are lazy, 41 percent of Republicans do. And among strong Democrats and strong Republicans, the numbers become even more stark, 20 percent compared with 46 percent. Furthermore, 41 percent of whites who say they are extremely conservative believe black people are lazy, compared with 14 percent of whites who say they are extremely liberal. On the question of whether black people are unintelligent, it’s 30 percent for extremely conservative whites versus 11 percent for extremely liberal whites. This clearly suggests that racial animus is more prevalent among conservatives and Republicans.

It also accounts for why debates about race in America are subject to such deep partisan conflict. Since the civil rights movement, Americans have broadly rejected explicit expressions of racism. On the question of black intelligence, the gaps are smallest between the two parties, suggesting that views of inherent black inferiority are rejected across the political spectrum — or are simply too taboo to admit. But on issues of discrimination, the persistence of racism and the importance of history, the parties are sharply divided.

Law professor Ian Haney Lopez argued, “We have to get away from this idea that there is one sort of racism and it wears a Klan hood. Of course, that is an egregious form of racism, but there are many other forms of racism. There are racisms.” He noted that these other forms of racism “are easily used to manipulate broad swaths of the American electorate.”

In 2005, Republicans apologized for the post-1968 Southern strategy of targeting white voters with thinly veiled racial appeals. But a decade later, as the rise of Donald Trump illustrates, they haven’t stopped using it.

This piece originally appeared on Al Jazeera America.