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Hard for California to Calexit federal government | The Sacramento Bee
"California and some other parts of the U.S. are in different political orbits when it comes to presidential picks. But the nation’s largest state and the federal government are more deeply entwined than ever on tax, spending and other fiscal matters.

In the wake of the presidential victory by Republican Donald Trump – who lost to Democrat Hillary Clinton in California by nearly 4.3 million votes – some Golden State denizens have suggested more autonomy if not outright independence from the rest of the United States.

Little mention is made of the federal government’s major role in the lives of Californians, from the $47.5 billion in federal contracts awarded to state businesses and other recipients in federal fiscal year 2015, or the nearly $96 billion in federal funds in the current state budget, representing more than one-third of the budget total.

About 344,000 Californians work directly for the federal government, according to the most recent census data, paying state taxes and generating economic activity.

Some Trump supporters, meanwhile, have opined that the rest of the country would be better off without California and its Democratic-leaning electorate.

Yet those people rarely note that California, which represents about 12 percent of the country’s population, generated 13.5 percent of the total federal income tax payments in 2014, the most recent data available – the most of any state.

Compared to most other states, California generally has paid more to the federal government than it receives in federal spending.

A report last year by the New York Office of the Comptroller concluded that California received 99 cents in federal spending for every dollar it paid in federal taxes during the 2013 federal fiscal year, one of 11 states that received less federal money than they paid in taxes.

California, though, has outsized involvement in some federal programs. For example, the state has embraced the federal Affordable Care Act, known as Obamacare, opting to expand Medi-Cal to cover more than 3.5 million new participants.

If Trump and congressional Republicans follow through on their threat to repeal the law, annual federal funding for Medi-Cal would drop by more than $15 billion, according to the California Budget and Policy Center."
california  calexit  us  money  government  data  2016  taxes  healthcare  employment  obamacare  affordablecareact  medical  economics 
december 2016 by robertogreco
What Aetna’s Withdrawal Means for Obamacare - The New Yorker
"Obamacare is being hobbled by the political compromises made to get it passed. The program’s basic principles were the right ones: everyone would be able to get insurance, regardless of preëxisting conditions, and everyone would pay the same price for a given policy, with upward adjustments made only for older people and smokers. In short, insurance companies were prohibited from managing risk by charging healthy, low-risk people less than frailer, high-risk people. Since managing risk is typically key to how insurers make money, it would have made sense to leave them out and just enroll everyone in a government-run program like Medicare. Politics, of course, ruled that out. Shoring up the private-side approach would require penalties stiff enough to get young, healthy Americans to buy health insurance, but politics ruled that out as well.

Conservatives point to Obamacare’s marketplace woes as evidence that government should stop mucking around with health insurance. In fact, government hasn’t mucked around enough: if we want to make universal health insurance a reality, the government needs to do more, not less. That doesn’t require scrapping the current system: the Netherlands and Switzerland both demonstrate that you can get universal coverage through private insurers. But their examples also show that to do so we’d need to make it much harder to avoid buying insurance, and we’d need to expand subsidies to consumers.

Alternatively, we could implement the public option, which Obama himself called for in that 2009 speech: a federal program, modelled on Medicare, open to anyone on the individual market. The public option would guarantee that there was always at least one good choice available in the marketplace, and would provide competition for private insurers. If it used the government’s bargaining power to hold down costs and expand access, it could offer good benefits at a low enough price to attract younger, healthier patients.

There are solid arguments for both of these models. Either would work, if there were a shift in the political mood and it were given a shot. Even if nothing is done, Obamacare will continue to limp along, probably turning into something akin to Medicaid. But the departure of big insurers like Aetna has made it clear that, if we don’t do more to help cover people in the individual market, the program will never make good on its original promise of truly comprehensive reform. So don’t hate the players; fix the game."
medicine  jamessurowiecki  2016  obamacare  policy  us  aetna  healthinsurance  healthcare  politics  medicare  netherlands  switzerland 
september 2016 by robertogreco
Is Obamacare failing? - Vox
"Obamacare’s drafters didn’t envision the marketplaces looking so much like a Medicaid program. But is it a bad thing if that's how the exchanges ultimately shake out?

The answer likely depends on what you think is most important in creating universal coverage — and what metrics we use to judge whether the Affordable Care Act is working.

Obamacare’s marketplaces aimed to prioritize choice and a shopping experience as an important good to deliver to consumers. Legislators saw inherent value in letting consumers pick the plan that was right for them.

Consumers seemed to value the shopping experience too: Between 2015 and 2016, only one-third of marketplace enrollees kept the same plan. People who bought Obamacare coverage really did seem to shop for coverage that fit their needs.

If the marketplaces become more like Medicaid, that’s the type of experience that gets lost. The promise Medicaid makes isn’t one about choice. Medicaid enrollees get little say in what hospitals they can visit or which doctors will take them. It's much more of a one-size-fits-all program.

Medicaid doesn’t guarantee options, but it does promise coverage. It doesn’t provide access to all doctors, but it provides access to a doctor who, without the program, might be out of reach. When I’ve talked to people who have enrolled on both, some prefer the latter.

Earlier this year I spoke with Kaylynn Maxfield, who recently moved from Utah to Pennsylvania with her husband and young son. Maxfield generally found signing up for Medicaid a better experience than enrolling in the marketplace.

"With the marketplace, you have so many options that it's overwhelming, like which one do I choose, and how do I make sure I choose the right one," she says. "With Medicaid there are three options, and you know they’re all offering the same level of coverage. It was so much simpler."

For Maxfield, choice didn’t really matter that much. What she wanted was the ease of mind that comes with health coverage — and for her, Medicaid offered a better experience by that metric.

There are millions of shoppers who buy coverage who have different priorities when it comes to what they want from the marketplaces. There are those, like Maxfield, who just want a guarantee of coverage and find shopping a hassle. But there are many others who did shop, and took advantage of the choices the marketplaces offered. These are the losers of a Medicaid-style marketplace, as the law shifts from what drafters envisioned to what health insurers are actually willing to build."
healthcare  us  policy  obamacare  2016  insuarnce  healthinsurance  politics  switzerland  netherlands  medicaid 
september 2016 by robertogreco
Sha Hwang - Humans, Labour and Technology - Video Archive - The Conference by Media Evolution
"Sha Hwang is an information designer whose work focuses on designing complex systems while staying human.

Sha is a cofounder of Nava, a team formed as a part of the efforts to fix HealthCare.gov that now works with government agencies to radically improve their services. In this talk he speaks about how tech companies enhance or subvert systemic abuse, who gets disrupted when disruption happens and how policy shapes technology, and vice versa"
shahwang  2016  organzation  civilrightsmovement  montgomerybusboycott  rosaparks  nava  technology  labor  displacement  unknownfieldsdivision  humans  policy  healthcare.gov  government  obamacare  governmentservices  systemsthinking  shipping  unions  containerization  malmo  theconference  lebbeuswoods  resistance  work 
august 2016 by robertogreco
The American Way over the Nordic Model? Are we crazy? - LA Times
"In my long nomadic life, I've been to both poles and most countries in between. I still remember when to be an American was to be envied. The country where I grew up after World War II seemed to be respected and admired around the world.

Today, as one of 1.6 million Americans living in Europe, I instead face hard questions about our nation. Wherever I travel, Europeans, Asians and Africans ask expatriates like me to explain everything odd or troubling about the conduct of the United States. Polite people, normally reluctant to risk offending a guest, ask pointedly about America's trigger-happiness, cutthroat free-marketeering, and "exceptionality."

Their questions share a single underlying theme: Have Americans gone over the edge? Are you crazy?

At the absolute top of the list: "Why would anyone oppose national healthcare?" Many countries have had some form of national healthcare since the 1930s, Germany since 1880. Some versions, as in France and Britain, have devolved into two-tier public and private systems. Yet even the privileged would not begrudge their fellow citizens government-funded comprehensive healthcare. That so many Americans do strikes Europeans as baffling, if not brutal.

In the Scandinavian countries, long considered to be the most socially progressive in the world, a national (physical and mental) health program is a big part — but only a part — of a more general social welfare system. In Norway, where I live, all citizens also have access to free education from age 6 through specialty training or university; low cost, subsidized preschool; unemployment benefits, job-placement and paid retraining; paid parental leave; old age pensions, and more. These benefits are not a "safety net" — that is, charitable payments grudgingly bestowed upon the needy. They are universal: equally available as a human right, promoting social harmony.

In the Scandinavian countries, long considered to be the most socially progressive in the world, a national (physical and mental) health program is a big part — but only a part — of a more general social welfare system. In Norway, where I live, all citizens also have access to free education from age 6 through specialty training or university; low cost, subsidized preschool; unemployment benefits, job-placement and paid retraining; paid parental leave; old age pensions, and more. These benefits are not a "safety net" — that is, charitable payments grudgingly bestowed upon the needy. They are universal: equally available as a human right, promoting social harmony.

This is the Nordic Model: a balance of regulated capitalism, universal social welfare, political democracy and the highest levels of gender and economic equality on the planet. It's their system, begun in Sweden in the 1930s and developed across Scandinavia in the postwar period. Yes, they pay for it through high taxation. (Though compared with the U.S. tax code, Norway's progressive income tax is remarkably streamlined.) And despite the efforts of an occasional conservative government to muck it up, they maintain it. Why?

They like it. International rankings cite Norway as the best place to grow old, to be a woman and to raise a child. The title of "best" or "happiest" place to live on Earth comes down to a neighborly contest among Norway and the neighboring Nordic social democracies, Sweden, Denmark, Finland and Iceland.

All the Nordic countries broadly agree that only when people's basic needs are met — when they cease to worry about jobs, education, healthcare, transportation, etc. — can they truly be free to do as they like. While the U.S. settles for the fantasy that every kid has an equal shot at the American dream, Nordic social welfare systems lay the foundations for a more authentic equality and individualism.

These ideas are not novel. They are implied in the preamble to our own Constitution. You know, the part about "We the People" forming "a more perfect Union" to "promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity."

Knowing this, a Norwegian is appalled at what America is doing to its posterity today. That top chief executives are paid 300 to 400 times as much as an average employee. Or that Govs. Sam Brownback of Kansas and Chris Christie of New Jersey, having run up their state's debts by cutting taxes for the rich, now plan to cover the loss with money snatched from public pension funds. That two-thirds of American college students finish in the red, some owing $100,000 or more. That in the U.S., still the world's richest country, 1 in 3 children lives in poverty. Or that the multitrillion-dollar wars of Presidents George W. Bush and Obama were fought on a credit card, to be paid off by the kids.

Implications of America's uncivilized inhumanity lurk in the questions foreign observers ask me: Why can't you shut down that concentration camp in Cuba? Why can't you stop interfering with women's healthcare? What is it about science and climate change you can't understand?

And the most pressing question of all: Why do you send your military all over the world to stir up trouble for all of us?

Europeans often connect America's reckless conduct abroad to its refusal to put its own house in order. They've watched the United States unravel its flimsy safety net, fail to replace decaying infrastructure, weaken organized labor, bring its national legislature to a standstill and create the greatest degree of economic inequality in almost a century. As they see it, with ever less personal security and next to no social welfare system, Americans are bound to be anxious and fearful. They understand as well why so many Americans have lost trust in a national government that for three decades has done so little for them (save Obama's endlessly embattled modest healthcare effort).

In Norway's capital, where a statue of a contemplative President Franklin D. Roosevelt overlooks the harbor, many America-watchers think he may have been the last U.S. president who understood and could explain to the citizenry what government might do for all of them.

It's hard to pin down why America is as it is today, and — believe me — even harder to explain it to others. Some Europeans who interrogate me say that the U.S. is "crazy" — or "paranoid," "self-absorbed," or simply "behind the times." Others, more charitably, imply that Americans are merely "misguided" or "asleep" and may still recover sanity. But wherever I travel, the questions follow, each suggesting that the United States, if not exactly crazy, is decidedly a danger to itself and others."
2015  annejones  us  healthcare  healthinsurance  socialsafetynet  scandinavia  norway  germany  uk  europe  inequality  equality  americandream  progressivism  socialism  capitalism  politics  policy  parentalleave  pensions  universality  nordiccountries  sweden  denmark  finland  iceland  individualism  equity  education  obamacare  affordablecareact  fdr 
january 2015 by robertogreco
This One Chart Shows Everything That’s Wrong With Liberal Politics | Notes on a Theory...
"Let’s leave aside the fact that federal dollars do materialize out of thin air. Transferring money from the rich to the poor is precisely what conservatives don’t want to do. Normally this complaint is about “redistribution” but the reality is that conservatives (especially elite conservatives) are opposed to any distributions that don’t transfer money upward. They support policies that make the poor more insecure, more miserable, and they oppose those that prevent the rich from having more wealth and power. They will pay the costs when it comes to these goals. As I’ve said before, ‘big government’ is any action that enforces the law against the rich or provides protections to the poor while ‘small government’ is any and all protections and benefits for the rich or punishments for the poor. This is the conservative project, not spending less federal dollars as a matter of principle.

Every once and a while there’s a renewed effort among liberals to insist that the GOP is the party of death because they oppose universal health care (or more to the point, somewhat more universal). People die without health care, people don’t get health care without health insurance, so those who oppose expansion of health insurance are ensuring people die. But if we admit that people die without health care than what do we say about not fighting to change that? The Democratic Party has still not engaged in a serious effort to fight for Medicaid expansion. The original bill was designed to coerce states into accepting it, and when the Supreme Court took that mechanism away, Democrats mostly threw up their hands. (I mean officials and candidates. Even then there are exceptions. There are people out there fighting for this, and they are to be commended and supported). The party put most of its resources and attention on the Senate, never really made a case for why people should vote for them, never tried to move passive supporters of Medicare expansion or various other policies into active supporters, and the GOP ended up racking up large victories in state houses around the country in addition to taking the Senate.

The thing is that Medicaid expansion is popular. It’s popular in red states. It gives Democrats a wedge to use in less hospitable places.  But to translate that position into political support takes work. And charts won’t do that. Facts won’t do that. ‘Cost’ arguments won’t do it. Only contestation will."
obamacare  democrats  republicans  politics  policy  healthcare  insurance  2014  inequality  poverty  medicaide  affordablecareact  georgia  redistribution  biggovernment  government  elections 
november 2014 by robertogreco
CBO: Obamacare Will Increase Voluntary Leisure | Demos
[See also this follow-up post that deals with conservative reactions: http://www.demos.org/blog/2/5/14/conservatives-are-apparently-arguing-huge-tax-increases
And this: http://www.motherjones.com/kevin-drum/2014/02/how-did-media-blow-it-so-bad-yesterdays-cbo-report ]

"The CBO released its budget outlook today. In it, they estimate that Obamacare will lead to more voluntary leisure:
CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024 almost entirely because workers will choose to supply less labor given the new taxes and other incentives they will face and the financial benefits some will receive. Because the largest declines in labor supply will probably occur among lower-wage workers, the reduction in aggregate compensation (wages, salaries, and fringe benefits) and the impact on the overall economy will be proportionally smaller than the reduction in hours worked.

So in essence, business demand for labor is not projected to decline, but the willingness of workers to supply it is projected to shrink slightly. So it is not the story conservatives have been telling about employers hiring less because of regulations and costs and whatever. Instead, it is that some workers (low-wage workers in particular according to the CBO) will withhold their labor because, with expanded access to health insurance, they don't need to work as much.
 
This is awesome.
 
The U.S. has some of the highest numbers of hours worked in the OECD."
obamacare  leisure  time  economics  work  2014  labor  mattbruenig 
february 2014 by robertogreco
An Entirely Other Day: Bugged
"“I got mine” are just about the ugliest words in the English language. They’re also, increasingly, a mantra for the same people who shout “We, the people” out of the other side of their mouths.

I love this country, more than I can properly express in words. It’s my home. It’s my future. Its history and achievements are awe-inspiring. Its idea, its founding purpose, is the most important the world has ever known. We are bound together by the notion that we are all created equal, committed to one another as a single body politic, held by the strength of our lives and our fortunes and our sacred honor. We put a man on the moon and an SUV on Mars and we made sure that tens of millions of our fellow citizens can know that a goddamned insect — or an accident or a disease or any of a billion other random, faultless happenstances — isn’t going to send them to the poor house."
healthinsurance  precarity  economics  politics  gregknauss  universalcoverage  socialsafetynet  medicine  health  2012  policy  healthcare  obamacare  ppaca  us 
september 2012 by robertogreco

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