Still stuck in the waiting room

Published at Socialist Worker.

IN YET another concession to big business demands to weaken its health care law, the Obama administration announced earlier this month that the so-called "employer mandate"--which requires companies with 50 or more full-time workers to offer affordable health insurance to their employees--would be postponed from a 2014 deadline into 2015.

The Treasury Department made the announcement on July 2, claiming that after months of "a dialogue with businesses," the administration had decided a delay was the best way to help Corporate America comply with the Affordable Care Act (ACA) in a "careful, thoughtful manner."

But the delay is really about being "careful" to protect big business profits. Low-wage employers that tend to offer employees few if any benefits--like fast-food chains making hefty profits off the working poor--have been vocal in their criticism of the health care law, and the mandate in particular.

The delay is a victory for them--and a lucrative one: The administration had estimated that the federal government would receive about $10 billion in penalties from companies that didn't abide by the employer mandate. Then there's the money that at least some companies would have spent to conform--which is now money in the bank, at least for another year.

Republicans immediately tried to exploit the announcement as justification for their crusade to get rid of the health care law altogether. A July 10 letter to Obama written by Republican Sen. John Thune of South Dakota and cosigned by 45 Republican senators cynically pretended that their call for the rest of the law to be "permanently delayed" was out of concern that it would cause "significant economic harm to American families."

But the Republicans' all-out opposition to the Obama health care law obscures the bigger truth--that plans for "reform" of the U.S. health care system have been twisted at every step to be as advantageous as possible to big business. The remaining positive provisions of the ACA are being further hollowed out under pressure from industry lobbyists--and those provisions are outweighed anyway by ones that will penalize working people and help expand the profits of the medical-pharmaceutical-insurance complex.

Thus, even if the employers' mandate had kicked in as planned in 2014, it wouldn't go nearly far enough to ensure that companies offer quality, affordable health coverage to workers.

The burden for paying for health care has increasingly shifted away from those who can afford it most--Corporate America, with its record profits--and onto individual workers and families. The terms of the mandate allow this shift to continue. Now, the delay in implementing the penalties for not providing insurance will make those terms even more generous for big business.

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THE HEALTH care law's "employer mandate" was designed to encourage large employers to offer what the legislation deems to be affordable health coverage to full-time employees.

This provision isn't to be confused with the "individual mandate"--the law's requirement for everyone in the U.S. to have health insurance, or pay a tax penalty. The individual mandate will go into effect in 2014 as planned--there won't be any postponement for workers.

Despite speculation that they will be delayed, too, the state-level "insurance exchanges" established under the law, which are supposed to provide a place for people to purchase coverage, are still set to be open for enrollment on October 1. As of January 1 of next year, individuals with an annual income of over $10,000 ($20,000 for families) will have to pay an annual penalty with their taxes if they don't have insurance. Next year, the penalty will be $95 for an individual and up to $285 for a family--but this will quickly increase, hitting $696 for individuals and up to $2,085 every year for a family in 2016 and after.

The criticism of the individual mandate, of course, is that the uninsured would have to buy the insurance industry's notoriously inadequate policies, complete with weak coverage and high deductibles--or fork over a big chunk of their income anyway in penalties.

With the employer mandate, any business with more than 50 full-time workers (or the equivalent in part-time workers, based on hours worked) would face a penalty if they don't offer affordable health insurance that meets the requirements under the ACA, and at least one of their employees receives a tax credit to purchase health insurance on the exchanges. The penalty was set to begin in 2014 at $2,000 per employee, and $3,000 for those who receive government subsidies.

The White House and leading Democrats in Congress claim that about 95 percent of companies with 50 or more full-time employees already offer health insurance, so the delay in enforcing the mandate impacts a relatively small percentage of the workforce--about 1 percent of U.S. workers, or 1.5 million people.

But other analysts say that millions more workers will be impacted by the delay since they work for large employers that offer insurance to some employees, but not all. Similarly, some big employers who do offer health coverage may not have insurance plans that meet the ACA's requirements for a minimum level of coverage and affordability.

There's a further question that health care experts are asking about the employer mandate--whether the $2,000 per employee penalty is a sufficient incentive to force companies to offer insurance.

That $2,000 is less than the cost of government subsidies to pick up the slack. The Congressional Budget Office estimates that the average subsidy to help people buy insurance coverage on the exchanges will be $5,290 per person per year.

Even more telling, the penalty is much smaller than the average cost to private employers of providing health insurance--which in 2012 stood at $4,224 for individual coverage and $10,704 for family coverage, according to the Kaiser Family Foundation. (That doesn't include the contributions from workers, which averaged $1,053 for individuals and $4,495 for a family plan in 2012.)

So even if and when the employer mandate takes effect in 2015, companies might still conclude that they're better off paying the penalty than coming up with an insurance plan that covers all their workers.

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A FURTHER pitfall in the employer mandate is whether the coverage offered by big employers is deemed to be "affordable."

Under the terms of the health care law, employer-sponsored insurance is considered unaffordable if the employees' share of the premium is greater than 9.5 percent of household income. But earlier this year, the Internal Revenue Service (IRS) released a ruling clarifying that this benchmark will apply only to individual coverage.

So employers whose insurances plans for individuals would cost employees more than 9.5 percent of their household's incomes would be liable for the now-delayed fine under the employer mandate, and the employee could qualify for subsidies on the insurance exchange.

But family coverage is much more expensive than individual coverage. According to the Kaiser Family Foundation's statistics, workers at private employers pay nearly 30 percent of the cost of health insurance for family plans, compared to nearly 20 percent for individual plans.

By defining what makes coverage "unaffordable" on the basis of "self-only coverage," the IRS will "deny federal financial assistance to millions of Americans with modest incomes who cannot afford family coverage offered by employers," according to the New York Times.

In fact, this definition opens up a gaping loophole to corporations scheming to conform to the letter of IRS regulations while keeping costs down. They can offer decent coverage to individuals that meets the IRS standards of affordability, but prohibitively expensive coverage for families--which, of course, is a primary concern for many working people.

Or companies will decide, in the words of Bloomberg BusinessWeek, "to get out of the health insurance business" altogether. Studies by financial analysts estimate that anywhere from one in 10 to one in three employers that currently offer coverage will drop health insurance as a benefit for employees. The Congressional Budget Office agrees, projecting that "8 million fewer people will be covered by employer plans five years from now under the ACA than without it."

The cost of health care coverage for these millions of workers will fall on workers themselves--both directly for the individuals workers who lose employer-sponsored insurance and indirectly through the taxes paid by workers that subsidize health care coverage.

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HEALTH CARE is a basic human need. The uninsured and underinsured can--and are often forced to--go without health insurance for a time, but eventually, everyone gets sick and requires health care. That's a fact of life. What is contested is who pays for it.

As it stands now, companies that profit off low-wage labor and that don't offer affordable insurance to their employees have their bottom line effectively subsidized by taxpayers, who pick up the bill for health care of these workers, via the Medicaid and Medicare government programs and many other means.

Thus, the same low-wage employers that complained to the Obama administration about the mandate and claimed they would have to pass the costs onto their customers are already passing these costs onto working-class people--just through another means: taxes.

And those costs are huge: A Congressional report released in May found that because Wal-Mart pays such low wages and offers such meager benefits to employees that they qualify for public assistance, including Medicaid, "a single 300-person Wal-Mart Supercenter store in Wisconsin likely costs taxpayers at least $904,542 per year and could cost taxpayers up to $1,744,590 per year--about $5,815 per employee."

Meanwhile, as the report points out, "In the third quarter of 2012, corporate profits reached $1.75 trillion, their greatest share of GDP in history. During that same quarter, workers' wages fell to their lowest share of GDP on record."

With wages so low--and household income, adjusted for inflation, down more than 7 percent between when the recession began at the end of 2007 and early 2013--many workers will find that paying 9.5 percent of their income for health care, and a higher percentage than that for their families, is far from "affordable."

The ugly truth is that the Obama health care law does not represent the reform of a broken system, but the continuation of the trend of putting the burden of providing health care onto workers themselves. As CNN reported, quoting a study by the Commonwealth Fund:

Some 80 million people, around 43 percent of America's working-age adults, didn't go to the doctor or access other medical services last year because of the cost...That's up from 75 million people two years ago and 63 million in 2003. Not surprisingly, those who were uninsured or had inadequate health insurance were most likely to have trouble affording care. But 28 percent of working-age adults with good insurance also had to forgo treatment because of the price.

That's an indictment of the warped priorities of a health care system driven by profit rather than people's needs--and of an Obama administration that promised to fight for genuine reform of the system, but knuckled under to big business, again and again.

Immigrants need not apply for Obamacare

Published in Socialist Worker.

AS THE negotiations and maneuvering over promised immigration legislation drag on, the Democratic Party has demonstrated once again its willingness to sacrifice the interests of its base supporters for the sake of a lousy "compromise" with Republicans.

Late last month, House Minority Leader Nancy Pelosi reiterated that immigrants who embark on the twisted "path to citizenship" under the bipartisan proposal will not qualify for affordable health insurance under the Obama administration's health care law during the 10 to 15 years it will take to complete the process.

According The Hill, Pelosi said, "It is stated very clearly in the Affordable Care Act, [and] it is our position in the immigration bill: no access to subsidies in the Affordable Care Act. Secondly, no access to Medicaid; no cost to the taxpayer...That has always been the Democratic position."

Pelosi's statement is also a reminder of how the health care law's mandate to purchase private health insurance, which kicks in next January, will fall far short of ensuring universal coverage, let alone providing quality, affordable health care for all. The 11 million undocumented immigrants living and working in the U.S. will be consigned to a health care underclass under this law.

This follows on the heels of the betrayal of another component of the party's base: Democrats on the Senate Judiciary Committee bowed to Republican threats and didn't propose amendments to immigration legislation that would have allowed U.S. citizens to sponsor same-sex partners for citizenship or legal residency, as opposite-sex couples are allowed to do.

Then there is the bipartisan "Gang of Eight" proposal itself. It would fund even more border security measures; includes background checks, fines and tax payments just to embark on the legalization process; and would establish several different statuses for guest workers. As Lance Selfa wrote for SocialistWorker.org, the punitive legislative is geared more to the needs of business to exploit immigrant labor than in providing the rights that immigrants deserve.

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THIS ISN'T the first time that immigrants have been excluded from under a law that was supposed to represent health care "reform."
In a move that foreshadowed the problems with Obama's Patient Protection and Affordable Care Act, the state of Massachusetts just a few years ago discontinued subsidized Commonwealth Care health insurance for 30,000 documented immigrants who had been living in the U.S. for less than five years.

Though Republicans continue to deny it, Massachusetts' health care law, passed while Obama's 2012 challenger Mitt Romney was governor, was a model for the Obama health care law. It includes a mandate to purchase private health insurance, enforced with tax penalties; an insurance "exchange" that acts as a market for approved plans; and subsidies for residents who are determined to need help to be able to afford insurance.

Eventually, benefits were partially restored to the immigrants who were cut off in Massachusetts, but they were greatly reduced--worth about a third of the original coverage provided under Commonwealth Care--leaving affordable care out of reach for many if not most. The deal made to partially restore benefits brought in Centene Corp. to provide second-class coverage for immigrants.

This attack on immigrants' access to health care wasn't just mean-spiritedness at the state level--it was connected to a discriminatory federal law. Legislators cut immigrants off the Commonwealth Care program because they more expensive to cover--as the result of a federal law that bars matching funds for "means-tested" benefits like food stamps and Medicaid to immigrants who have been permanent residents for less than five years.

As in so many other ways, the Massachusetts experience provides a preview of what's to come under the Obama health care law.

Immigrants who are currently undocumented are almost certain to be excluded entirely from the subsidies available to low-income households to help them afford the mandate to purchase private insurance.

Meanwhile, documented immigrants who have had permanent residency status for five years or less won't be eligible for the same benefits that everyone else receives. Under the health care law, they will qualify for subsidies to assist them in purchasing health insurance on the exchanges--but they won't qualify for Medicaid, the government insurance program for low-income individuals and families. Even poor children and pregnant women will be excluded, unless they live in one of the 22 states that opt to extend Medicaid coverage to them.

That's a recipe for second-class health care. According to the U.S. Department of Health and Human Services, "[S]ubsidies for out-of-pocket cost-sharing will provide much less generous coverage than that offered through Medicaid, so even if poor immigrant families enroll, many may delay necessary care because of cost."

The irony in all this is that non-citizen immigrants are more likely than most people to be uninsured--and therefore need the help of subsidies or the Medicaid program to get access to health care. As of 2009, just over 50 percent of non-citizen immigrants were uninsured, compared with 20 percent of naturalized citizen immigrants and 17.4 percent of citizens born in the U.S.

In particular, the undocumented are more likely to live below the federal poverty line--meaning they would qualify for health care coverage under Medicaid if they weren't banned until they have had legal residency status for at least five years. Half of all documented immigrants who have lived in the U.S. for less than five years have incomes below 138 percent of the federal poverty level, which means they would qualify for Medicaid if they weren't excluded.

Immigrants also work in more dangerous jobs, such as meatpacking, construction, agriculture and housekeeping--and so they therefore have higher rates of injuries and death on the job than do workers born in the U.S.

It isn't only a small minority of people that will be affected by these anti-immigrant restrictions. According to a study by the Robert Wood Johnson Foundation, of all low-income, nonelderly adults living in the U.S. today, fully one in six are undocumented or recent documented immigrants.
Even undocumented immigrants who have health insurance face the threat of deportation when they seek care. More than 600 people have been deported from hospitals in the last five years.

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AT ITS heart, the Obama health care law protects the status of health care as a commodity to be sold for a profit rather than provided as a human right. Thus, even when the health insurance exchanges kick in next year, there will be multiple tiers when it comes to access to health care.

As now, the wealthy will be able to afford world-class care. Meanwhile, workers who receive health insurance from their employer or from the exchanges set up under the health care law will pay up to 9.5 percent of their income in out-of pocket health care costs--more for family coverage--before their coverage is deemed unaffordable, and various provisions such as subsidies kick in. That's $1 in every $10 in wages disappearing at a time of shrinking or stagnant household income and attacks on the government programs workers rely on.

Even after the law is fully implemented, nearly 30 million people will remain uninsured--a "privilege" that many will pay for in tax penalties.

Millions of undocumented immigrants will be excluded from receiving any government assistance, even as they work and pay taxes--and, if the Gang of Eight proposal passes, pay penalties along the obstacle-strewn "path to citizenship." And another 3 million documented immigrants who live in poverty and who have resided in the U.S. for less than five years won't qualify for the Medicaid benefits they would otherwise receive.

Immigrants--whose labor is critical to the U.S. economy and whose low wages boost record corporate profits--have been condemned to second-class status in yet another area.

Generation out of luck

Published in Socialist Worker, Truthout, and Alternet.

What happens to a dream deferred?
Does it dry up
like a raisin in the sun?
Or fester like a sore--
And then run?
Does it stink like rotten meat?
Or crust and sugar over--
like a syrupy sweet?
Maybe it just sags
like a heavy load.
Or does it explode?
--Langston Hughes

COLLEGE GRADUATION is supposed to be a time of celebration--a time for graduates to look back on years of hard work and achievement, and forward to a bright future filled with promise.

Yet the class of 2013--the young women and men who were submitting college applications in the fall of 2008 as the world financial system came to the brink of Armageddon following the collapse of Lehman Brothers--are facing a future of further uncertainty and diminished prospects.

They are the latest entrants into what has been dubbed the "lost generation"--so-called because the high rates of unemployment and underemployment its members endure at the start of their working lives drag them down throughout their working lives, making it more and more difficult to maintain the standard of living of their parents.

Only half of recent graduates have been able to find a full-time job that makes use of their degree. Yet all are still left with the bill from college, with the average student loan burden nearing $30,000. With the number of new graduates expected to outstrip the number of new jobs requiring a degree over the next several years, this trend will only get worse.

If the current priorities of big business and the politicians who serve them continue to set the agenda, millions of young people will be robbed of their hopes for the future.

But this isn't inevitable. For most of the class of 2013, their best possibility for a decent future lies not in the rat race for ever-scarcer decent jobs, but joining together to fight to improve conditions in the jobs they do have and to demand a fundamental transformation of a system that treats them as expendable.

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A REPORT released last month by the Economic Policy Institute (EPI), titled "The Class of 2013: Young graduates still face dim job prospects," paints a picture of a jobs crisis for youth that has multiple layers.

To begin with, nearly 9 percent of college graduates aged 21-24 who aren't in graduate school are unemployed, actively looking for work and unable to find it. This is more than double the rate for college graduates over age 25.

Those who have been able to find jobs are making less money. Average hourly wages, adjusted for inflation, for young college grads were $16.60 in 2012, the lowest they've been since 1997--when most recent grads were in elementary school--and just 25 cents greater than they were in 1989, before many were even born. Had wages kept up with the inflation-adjusted growth in the gross domestic product, which rose by 72 percent over this period, the hourly wage would be over $28 today.

Once student debt is factored in, there has plainly been an outright decline in living standards. The average recent graduate with $25,000 in debt pays between $200 to $300 a month, depending on their repayment plan--a huge burden given the stagnant or dropping income.

Recent grads are also much less likely than previous generations to find jobs with benefits. Just 31.1 percent of employed recent grads have employer-provided health insurance, compared with 60.1 percent in 1989. Just 27.2 percent have a pension.

An increasing number of college grads are working jobs that pay minimum wage. According to the Wall Street Journal, nearly 300,000 people with at least a bachelor's degree are making the minimum wage, double the number in 2007.

The lack of decent jobs with benefits makes it easier for employers to take advantage of young workers, who they know have few other options. Maria, a health care worker in Massachusetts in her early 20s, who earned her bachelor's degree while working full time, explains her situation:

I worked as a switchboard operator when I completed my associate's degree. I took a promotion to case manager, and my new supervisor assured me that I would get a raise after I got my degree. I took the job, and in my last semester, while completing my bachelor's, I was offered a job at another agency. It was better-paying, but I had to turn it down because I was pregnant and needed the paid maternity leave at my current job, which the new job didn't offer, and because I was promised a raise. It's been more than a year after I got my bachelor's, and I still haven't received a raise or found a job in my field.

Beyond joblessness, rising debt and falling wages, there's the issue of underemployment: those unable to find full-time work, and those working in jobs for which they are overqualified.

An increasing percentage of recent graduates qualify as "underemployed," which includes those who are unemployed, those working part-time but seeking full-time work, and those who looked for work in the past year but have given up. According to the EPI report on the Class of 2013, the rate of underemployment for recent college grads jumped from 11.2 percent in 2008, at the beginning of the Great Recession, to a peak of 19.8 percent in 2010, just after the official beginning of the "recovery." Underemployment was still at 18.3 percent in 2012.

As the EPI researchers point out, this "does not include "skills/education-based" underemployment (e.g., the young college graduate working as a barista)." College graduates working in jobs that don't require a college degree is not a new phenomenon, but has gotten worse in recent years, the EPI report found:

[I]n 2000--when jobs were plentiful and the unemployment rate was 4.0 percent--40 percent of employed college graduates under age 25 worked in jobs not requiring a college degree...[T]he share of young college graduates working in jobs not requiring a college degree increased over the 2000–2007 business cycle, increased further in the Great Recession, and has not yet begun to improve...

[I]n 2007, 47 percent of employed college graduates under age 25 were not working in jobs requiring a college degree, and...this share increased to 52 percent by 2012. This increase underscores that today's unemployment crisis among young workers did not arise because these young adults lack the right education or skills.

As the EPI researchers and other economists have shown, these effects will have a lasting, if not permanent, impact on the future prospects of recent graduates. "Research shows that entering the labor market in a severe downturn can lead to reduced earnings, greater earnings instability, and more spells of unemployment over the next 10 to 15 years," the study reports.

Less than half of recent grads are working in a full-time job that requires a degree. Even some of those who have a full-time job have had to take a second just to make ends meet. Gloria, who graduated from Rutgers last year with a journalism degree, finally found a full-time job in her field after nine months of searching, while working in retail and living with a relative:

I started applying for jobs in January of 2012, four months before graduation. By graduation, I was excited, but so stressed out...I had done everything right! Double major, minor, decent GPA, tons of extracurricular activities, study abroad, unpaid internship. I took advantage of everything that my school had offer: I wrote for the paper, volunteered at the radio station, worked for the television channel and even created my own website.

Now I finally have a job in my field, but it's only a temporary position, and I work a second job that I wouldn't have taken in high school, just to afford to live in a dorm-sized studio apartment with roaches. Honestly, it's hard. This past year has been the toughest one yet. All my dreams and all the stuff that I had believed growing up had collapsed...it's all a lie.

This doesn't mean that the alternative--not going to college--is any better. If young college graduates are facing a jobs crisis, young workers with only a high school diploma are facing a catastrophe.

For the 40 percent of high school graduates aged 17-20 not enrolled in higher education, official unemployment averaged 29.9 percent from March 2012 to February 2013, more than three times that of recent college graduates. Underemployment for young high school grads stands at a shocking 51.5 percent--which means more than half are unemployed, working part-time when they'd rather work full-time or have looked in the past year, but have since given up.

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THE JOBS and career crisis facing the class of 2013 begs several questions: What is causing this crisis? Is this a temporary blip or the "new normal"? What can be done to change it?

The most obvious cause of the crisis for young workers is the one afflicting working people of all ages. According to the Center for Budget and Policy Priorities, nearly four years into the official "recovery" from the Great Recession, there are still more than three people looking for work for each job opening:

[T]he economy has recovered only about 6.2 million of the 8.7 million jobs lost between the start of the recession in December 2007 and early 2010...employment was 1.9 percent (2.6 million jobs) lower in April 2013 than it was at the start of the recession.

According to the EPI's Heidi Shierholz, it would take more than 8 million jobs to replace those and keep up with population growth, which could take more than five years at current rate of monthly employment increases.

Recent graduates are at a disadvantage when competing for jobs since they lack the experience of older workers. And increasingly, older workers have been forced to look for jobs that were once considered entry level. A survey by Rutgers University found that of the 23 percent of respondents who suffered a layoff during the Great Recession, more than half of those who had found another job were making less than they were before.

As Brad Plumer illustrates at the Washington Post's Wonkblog, some 60 percent of the jobs lost during the Great Recession paid between $13.84 and $21.13 per hour, yet only 22 percent of the new jobs created since then fall into that category. The majority of the new jobs, some 58 percent, are low wage, paying less than $13.84 an hour.

So mid- and late-career workers are taking jobs that used to be entry-level positions for recent grads or jobs that don't even require a degree, placing them in greater competition with younger workers to the detriment of workers of all ages. As Sherry Wolf, an author and contributor to SocialistWorker.org, explains:

I graduated college in 1987, have worked since I'm 14 years old and am now a highly skilled writer, editor and copy editor, yet I've spent the last year receiving unemployment insurance for the first time in my life, supplemented by freelancing gigs. What's stunning to me about the current economy is not just the paucity of full-time jobs with benefits, but that neoliberal restructuring has meant that experienced white-collar workers like me are now being paid a piece rate on the level of recent college graduates, while 20-somethings are forced out of my field almost entirely, and compelled to find jobs as baristas.

If trends continue, things are only going to get worse for young college grads. A recent report by the Center for College Affordability shows that from 2010 to 2020, "The number of college graduates is expected to grow by 19 million, while the number of jobs requiring a bachelor's degree is expected to growth by fewer than 7 million. We are expected to create nearly three new college graduates for every new job requiring such an education."

Finally, it's important to keep in mind that not all college degrees are created equal--nor are outcomes anywhere near equal for all college graduates. Higher education, like the society as a whole, has become increasingly unequal in recent decades. Rather than a means of mobility between classes, colleges often function as a means to maintain class stratification and reproduce inequality.
As Thomas B. Edsall pointed out in a New York Times blog last year:

Seventy-four percent of those now attending colleges that are classified as "most competitive," a group that includes schools like Harvard, Emory, Stanford and Notre Dame, come from families with earnings in the top income quartile, while only three percent come from families in the bottom quartile...in the nation's 1,000-plus community colleges, almost 80 percent of the students came from low-income families.

The elite schools are a key place for the wealthy to develop social networks that they will use--in addition to family connections--to land high-paying jobs after college. And elite college alumni networks will aid them in obtaining employment throughout their careers.

Poor and working class graduates will find themselves locked out of these networks. Thus, they will need to take up the task of organizing with co-workers to fight for rights at jobs for which they are overqualified.

Just as it took the union drives of the 1930s to make industrial jobs "good jobs" with decent pay and benefits, and the struggles of the 1960s and '70s to do the same for public-sector jobs that provided a way out of poverty for many African Americans and women, the majority of today's working class college graduates will need to focus on collective struggle, rather than hope that individual striving will allow them to make it against the odds.

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ULTIMATELY, THE mismatch between the number of young graduates and the jobs that require degrees raises questions about the nature of higher education in society, our relationship to work, and whether education should be shaped by the needs of business or the collective social needs of the majority of people in society.

Businesses, although they complain that college students aren't qualified, benefit enormously from a situation where the supply of the commodity they need to purchase--in this case, the labor power of college-educated workers--exceeds the demand. This drives down the price of that commodity--the wages and benefits of workers.

And with students and their families shouldering an increasing burden of the cost of higher education while companies cut back on training programs, businesses are able to pass along the cost of training a new generation to be exploited onto workers themselves.

This state of affairs makes sense--and money--for employers, but is disastrous for the vast majority of people. With so many highly educated people underemployed, not only are they worse off, but society as a whole can't benefit from their wasted talents.

Meanwhile, in a society so wealthy that a fraction of the bloated military budget could make higher education free for all, there's no reason not to expand access to higher education--and to create the public-sector jobs that could provide people with the opportunity to use their education to serve those in need.

For example, average class size in public secondary schools is nearing 25 and is almost double that of private schools. Doubling the number of public school teachers would remove this disparity and create more than 3 million jobs, which would finish replacing the jobs lost during the recession and then some.

There are about 2.4 doctors for every 1,000 people in the U.S., among the lowest ratios in the industrialized world, trailing countries with much less wealth like Kazakhstan (3.8), Cuba (6.7) and Lebanon (3.5). Training an additional 400,000 doctors would put the U.S. in a comparable position with other advanced countries like Germany and France. It could easily be paid for with the savings from switching to single-payer health care.

Clearly, the need exists for more college-educated workers, not fewer. But creating opportunities for them to use their training and talents will require a major shift in social priorities--and achieving that will require mass struggle and organizing.

If the class of 2013 wants a future, they will have to fight for it.

The real disability myth

Published at Socialist Worker.

ARE FEDERAL disability benefits one big scam?

We're familiar with that claim coming from the right-wingers who make a career out of attacking "big government" programs. Back in the mid-1990s, then-House Speaker Newt Gingrich declared that poor children were being coached by their parents to fake crippling diseases in order to qualify for the government's Supplemental Security Income (SSI) program. Gingrich claimed kids were "punished for not getting what they call crazy money, or stupid money. We are literally having children suffering child abuse so they can get a check for their parents."

But that's par for the course from a reactionary hater of the poor like Gingrich. It's much more surprising to hear a version of this argument--dressed up in kinder language, but no less biased and deceptive--coming from National Public Radio's normally excellent show This American Life.

This American Life's episode was called "Trends with Benefits" and featured Chana Joffe-Walt, a journalist with NPR's "Planet Money" unit, on the rapid growth in government programs providing benefits for the disabled.

Over the course of an hour, Joffe-Walt implies that disability programs share the blame for everything from high unemployment (they keep the unemployed from finding a job) to low test scores in public schools (they discourage disabled children from trying hard).

The same basic story was repackaged for a series of reports on NPR's All Things Considered news show and for a website feature titled "Unfit for Work: The Startling Rise of Disability in America." (I'll concentrate on the website feature in order to quote directly from her writing.)
In all three places, Joffe-Walt's basic contention is that disability benefits have become "a hidden, increasingly expensive safety net" that has taken the place of welfare--in the wake of "welfare reform" passed under Bill Clinton in the 1990s--as a government program to be abused.

But the reality is quite different. Disability payments provide fairly meager help to some of the most vulnerable people in society--people born with disabilities, disabled veterans, people injured on the job, and older workers who have chronic conditions that make it impossible to continue in a job.

Though it comes from NPR, with its reputation for being "liberal," Joffe-Walt's reporting is part of an ideological campaign that seeks to justify the austerity agenda that dominates U.S. politics--and to provide cover for further cuts in what remains of the social safety net, from programs for the disabled to Social Security retirement benefits and the Medicare and Medicaid health care programs.

As is the case with these other targets of the budget-cutters, there's actually plenty of money to provide the aid that people need to cope with disabilities--if the government would tax the rich, switch off the Pentagon war machine and cancel the giveaways to Wall Street and Corporate America.

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JOFFE-WALT'S reports begin with Hale County, Ala., where just under one in four working-age people are on disability. According to Joffe-Walt, people with conditions such as chronic back pain, diabetes and high blood pressure have been declared disabled by a local doctor, while other people with the same affliction--ranging from a Hale County judge to Joffe-Walt's editor at NPR--aren't considered disabled.

The difference, as Joffe-Walt admits, is that for most people in Hale County--the judge aside--the only jobs available require manual labor that is difficult if not impossible to perform with a condition like high blood pressure. Joffe-Walt seems to accept this reality--yet she wonders if one particular doctor "was running some sort of disability scam, referring tons of people into the program."

Moving to the general picture, Joffe-Walt admits: "Part of the rise in the number of people on disability is simply driven by the fact that the workforce is getting older, and older people tend to have more health problems." But she then goes on to declare that

disability has also become a de facto welfare program for people without a lot of education or job skills. But it wasn't supposed to serve this purpose; it's not a retraining program designed to get people back onto their feet. Once people go onto disability, they almost never go back to work. Fewer than 1 percent of those who were on the federal program for disabled workers at the beginning of 2011 have returned to the workforce since then, one economist told me.

The implication is that going on disability is a choice people make in order to drop out of the labor force. Joffe-Walt suggests that it's the existence of a social safety net--and not a persistent jobs crisis or, for that matter, the many hazards of today's society, ranging from war injuries to more dangerous workplaces--that keeps people out of work.

Joffe-Walt also--stunningly--takes aim at disability benefits for children, including cash benefits for the very poor in the form of Supplemental Security Income. In one of the many anecdotes that Joffe-Walt substitutes for facts, she reports, "People in Hale County told me that what you want is a kid who can 'pull a check.'"

She uses the case of Jahleel, a child with a learning disability, to argue that because his mother depends on SSI payments that are contingent upon Jahleel's disability status, the program discourages children from going to school, doing well in school and becoming independent adults.

Finally, Joffe-Walt goes after what she calls the "disability-industrial complex"--which she argues works to "push more people onto disability" while the government allegedly has nobody on its side to defend against cases of fraud.

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SEVERAL JOURNALISTS and policy analysts poked gaping holes in Joffe-Walt's reporting.
Writing at The Century Foundation website, Harold Pollack pointed out that NPR listeners:

might be surprised to discover that the final award rate for disability applications has averaged about 45 percent. Moreover, low employment rates among denied applicants suggest that disability assistance is not inducing otherwise-employable people out of the workforce. The misfortunes of people wrongly denied benefits, the problem of sick people bleeding money as the ponderous bureaucratic process moves along, the plight of disabled people stick on the Medicare waiting period--these matters were also left unexplored.

Pollack also documents that rise of children receiving SSI benefits--which Joffe-Walt made a big deal about in her reports--has been "dwarfed by the decline in the number of children receiving cash assistance after the 1996 welfare reform." According to Pollack, there is little evidence that disability payments have picked up the slack from millions of people being dropped from the welfare rolls.

According to Michelle Chen, writing at In These Times, most of the increase in disability rolls in recent decades is attributable to an aging workforce, the entrance of women into the workforce and the increase in the retirement age before seniors can receive full Social Security benefits. For those who do receive disability payments, this is the only thing standing between them and abject poverty.
As Chen concludes:

"The real story is that disability does pretty much what it's supposed to. Established during the growth era of the late 1950s as a stopgap for people forced out of work by long-term impairments, the program issues meager monthly benefits to workers and their families through the Social Security Administration, averaging $1,100. Some heavily disadvantaged people with disabilities receive additional Supplemental Security Income payments.

The roughly 9 million worker beneficiaries tend to skew older--their average age is 53--and are disproportionately African-American, reflecting underlying racial health disparities...As long as gaps in class and social mobility persist, then disability insurance helps blunt the sharpest edges of vicious economic inequities.

Hannah Groch-Begley, writing at the Media Matters website, also systematically debunked Joffe-Walt's reporting.

Among other facts, she points out that more children are receiving SSI today not because their parents are using them to "pull a check," but because child poverty has increased to shocking levels, from 11.6 million in 2000 to 15.5 million in 2009. At the most basic level, this means many more children now meet the income requirements to receive SSI benefits.

Groch-Begley also shows that rather than a system of largesse, disability benefits are highly restrictive: more than one-half of all claims are eventually denied, and just one in four children with disabilities qualify.

While the benefits are relatively meager, SSI is a vital resource, according to the Center for American Progress, which "reduces costly and harmful institutionalization of children with severe disabilities" and "reduces poverty and increases economic security."

With millions of people out of work, an aging population faced with an uncertain future in retirement and mounting health care costs, and millions of children in poverty, there's a need for a stronger social safety net. But the U.S. ruling class is pushing a different agenda: reduced living standards for the working class, which are intended to increase the competitiveness of U.S. corporations worldwide.

Reports like Chana Joffe-Walt's smear of disability programs fit perfectly with the ideological campaign required to justify cutting away what remains of the social safety net.

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A MORE honest look at disability would paint a very different picture. Life for the disabled and their families is far from easy. They are more likely to live in poverty and suffer from unemployment than the population at large.

In 2011, median household income for families that include a working age person with a disability was $36,700--meaning half of such households survived on less than that. This is more than $13,000 less than median household income for the country as a whole, according to the U.S. Census Bureau.

Poverty rates are much higher for disabled people--27.8 percent in 2011, nearly twice the overall rate of 15 percent. And these numbers understate the true poverty rate, since the official federal poverty line, which in 2011 was $11,484 for an individual and $23,021 for a family of four, is abysmally low.

Joblessness is also much higher among the disabled than the national average. According to the 2011 Disability Status Report, just one third of working-age people (aged 21 to 64) with disabilities were employed--and only one in five had full-time, full-year work.

Disabled people face multiple barriers to receiving the health care they need. According to the Centers for Disease Control, in 2009, 27.4 percent of disabled people reported that the cost of health care limited their access to treatments they needed. This is more than twice the percentage for non-disabled people.

Then there is the question of transportation, which many people take for granted. For the physically disabled, particularly those who rely on the use of a wheelchair, access to adequate transportation is a major problem. According to the National Organization on Disability, "Approximately 30 percent of Americans with disabilities deal with inadequate transportation, compared to only 10 percent of those without disabilities."

On top of all of that, applying for and receiving benefits is incredibly difficult. From 2001 to 2010, just 28 percent of initial disability benefit applicants were awarded benefits on average, according to the Social Security Administration. Even after reconsideration on appeal, disability claims were denied 53 percent of the time.

The benefits for those who do qualify are meager. In February of this year, Average monthly disability benefits were $978.52, and the average monthly SSI payment was just $526.41.

Theresa, who has Crohn's disease, lives in New York City on $730 per month in disability benefits. She described the process to get benefits as a bureaucratic nightmare:

It took three years and a hearing in front of a judge. It was a constant documentation of every hospital stay, every hospital I had ever been to, along with every doctor, every name and address, every medication, and every employer, my salaries and length of employment. It was a nightmare of paperwork that had to be re-filed after every denial. It was devastating to be denied, and I would never have been able to keep going without my mother and my rep's help. That is deliberate, and everyone in the process except the patients know it.

And yet the money is certainly there to make the lives of people like Theresa far more comfortable. In just three months last year, corporate profits totaled $1.75 trillion, more than twice the amount spent on Social Security benefits for the entire year and more than 10 times the amount spent on disability programs.

With corporate rates at a 40-year low, raising taxes on business and lifting the regressive income caps on payroll taxes could easily cover an increase in benefits so that the disabled don't live in poverty--as well as a jobs program to deal with the unemployment crisis.

In reality, it all comes down to priorities: What's more important, providing for the needs of the many or indulging the boundless greed of the few?

Stop-and-terrorize

Published at Socialist Worker and the Indypendent.

Written with Wesley House

THE NEW York Police Department's "stop-and-frisk" policy is nothing less than state-sponsored persecution, explicitly designed to "instill fear" in Black and Latino youth.

That's the ugly picture emerging from the first weeks of testimony in Floyd v. City of New York, a federal class action lawsuit challenging the legality of the NYPD's policy on these searches.
Witnesses have painted a picture of a police department driven by quotas for stops and racist contempt for youth of color, who are routinely and systematically targeted for harassment. The vast majority of the victims are innocent of any crime, and only a fraction of the searches turn up a weapon of any kind.

The trial has proven already that stop-and-frisk encourages New York cops to racially profile and abuse young Blacks and Latinos. After all, that's what their bosses intend. According to the explosive testimony of a state senator and former officer, NYPD Commissioner Ray Kelly told him explicitly that the purpose of stop-and-frisk was to make youth of color fear an encounter with police whenever they step out the door.

Stop-and-frisk has been the focus of increasing opposition and protest by New Yorkers, including a dramatic silent march of tens of thousands in Manhattan last June. This energy has kept the issue in the media, especially in New York, and put pressure on politicians and the courts to allow the class-action lawsuit to move forward.

Now, with a hoped-for favorable ruling in the case, the movement may be poised to achieve a landmark victory against the largest and most prominent program of racial profiling in the U.S. today.

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THE NYPD's stop-and-frisk policy allows officers to stop and search people anyone they suspect may be committing a felony, a misdemeanor or in possession of a weapon.

Touted by New York City Mayor Michael Bloomberg as "a strategy that we know saves lives," supporters of stop-and-frisk claim the goal is to confiscate guns and reduce crime. However, according to the New York Civil Liberties Union (NYCLU), no research has ever proven stop-and-frisk to be effective in decreasing the city's crime rate. Nearly 90 percent of those stopped since 2002 were innocent of any crime whatsoever, and guns were uncovered in less than 0.2 percent of cases.

The racial bias of the program is impossible to deny. In 2012, of the 533,042 New Yorkers stopped by police officers, 87 percent of them were Black and Latino. During the year prior, according to the NYCLU's analysis, more young Black men were stopped by the NYPD than their numbers in the population of New York City--meaning young Black men was stopped more than once, on average.

Even in neighborhoods that are predominantly white, youth of color bear the brunt of this racist policy. In 2011, Black and Latino New Yorkers made up 79 percent of stops in Park Slope in Brooklyn, though they were less than one-quarter of the neighborhood's population.

In filing the Floyd lawsuit, the Center for Constitutional Rights (CCR) is challenging the legality of stop-and-frisk under the constitution. As the CCR said in a press statement, "The case charges the police department with a policy and practice of unreasonable, suspicionless and racially discriminatory stops in violation of the Fourth Amendment's prohibition against unreasonable searches and seizures and the Fourteenth Amendment's Equal Protection Clause barring racial discrimination."

There are four chief plaintiffs in the case--David Floyd, David Ourlicht, Lalit Clarkson and Deon Dennis--representing the grievances of hundreds of thousands of New Yorkers, mostly African American and Latino, who have been subjected to millions of stops.

The vast majority of those stopped are harassed and intimidated simply for walking down the street while being a person of color. In an interview with ColorLines.com, David Floyd said:

The whole experience is humiliating and embarrassing. It doesn't matter how tough you are, it's a scary thing when you don't know what's going to happen with your life or your freedom...This type of activity is unacceptable, and I don't like walking around, feeling like I'm being treated like a nigger. And I say that because that's what it feels like when people stop you and threaten to take your freedoms away.

The itself has galvanized activists, cultural groups, and community and religious organizations, which have come together to demand police accountability and an end to racial profiling. As Aidge Patterson, coalition coordinator for the police watchdog and community empowerment coalition Peoples' Justice, said:

The Floyd case is of utmost importance to the police brutality movement right now, as stop-and-frisk acts as the main feeder for the mass incarceration of NYC communities of color, while NYPD practices are being spread across the U.S. and internationally. While ending stop-and-frisk will not end police violence or harassment against our communities, it is a powerful step we can take toward taking power out of the hands of the NYPD and back in to the hands of the people.

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ONE CRUEL aspect of institutionalized racism in the U.S. is that it is generally not enough to prove in court that a criminal justice policy has a disproportionate impact on racial minorities. Proving illegal discrimination in a U.S. court requires evidence of intent. This can be difficult to present, since racial bias isn't always overt, and code words are often used--many in the NYPD talk about stopping "the right people," for example.

However, the testimony in the Floyd case has cleared that hurdle by a long ways--revealing the overt racism of the stop-and-frisk program.

Most notoriously, according to New York state Sen. Eric Adams, a 22-year veteran of the NYPD, Commissioner Ray Kelly "stated that he targeted and focused on [Black and Latino men] because he wanted to instill fear in them that every time that they left their homes they could be targeted by police."

Testimony from two NYPD whistleblowers shows that supervisors below Kelly got the message loud and clear.

Pedro Serrano, an NYPD officer in the Bronx, testified that the pressure he faced to make a certain numbers of stops led him to secretly record his performance reviews with his supervisor, Christopher McCormack.

On the tape, which was played in court, McCormack criticizes Serrano for not stopping enough people. McCormack then goes on to insist that Serrano has a duty to prevent crime by stopping "the right people at the right time [and] the right location." When pressed by Serrano on what that meant, McCormack replied, "I have no problem telling you this. Male blacks 14 to 20, 21."

Adhyl Polanco, another Bronx officer, presented tapes that also confirmed the existence of quotas, as well as the racial bias encouraged in officers. According to Polanco, if officers see a group of Black or Latino kids on a street corner, they re to "handcuff the kids" even if they aren't committing a crime.

Tapes provided by NYPD officer Adrian Schoolcraft further revealed the contempt many officers have for youth of color--who are referred to, for example, as the "fucking riff-raff on the corners." Another officer is heard to say, "They might live there, but we own the block."

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WHENEVER THE New York police have been confronted with accusations of racial profiling in the past, they have claimed that stop-and-frisk prevents violence. "Commissioner Kelly said he wants gunmen to be deterred from carrying weapons on them in the streets, particularly in those communities most victimized by gun violence," said NYPD spokesperson Paul Browne in October 2011.

But far too often, it's the police who are the gunmen, shooting down young people of color in their own communities and even their homes.

Just nine days before the Floyd trial began, officers killed 16-year-old Kimani Gray in Brooklyn, sparking furious outrage and nightly protests. Police claim that Gray was armed and pointed a gun at officers, but eyewitness accounts contradict this claim. Officers from the very same precinct shot unarmed 23-year-old Shantel Davis and left her to bleed to death on Brooklyn streets late last spring.

These latest killings have given fresh urgency to the movement to confront the NYPD's serial violence. Key to that struggle has been the participation of family and friends of the cops' victims in recent years--such as Ramarley Graham, gunned down in his own bathroom while his 6-year-old brother and grandmother were nearby; 22-year-old Noel Polanco, a National Guardsman shot during a traffic stop; and Reynaldo Cuevas, a 20-year-old bodega worker shot by police as he fled armed men robbing the store where he worked.

While the potential always exists for a stop-and-frisk to turn deadly, more often, they result in arrests for possession of small amounts of marijuana--supposedly decriminalized in New York. According to a report by the Drug Policy Alliance, since 2002, the NYPD has spent 1 million hours making some 440,000 arrests for marijuana possession, at a cost of hundreds of millions of dollars.

Because of racial profiling, Blacks and Latinos are much more likely to face charges for marijuana possession. As Harry Levine of Queens College wrote in the Brooklyn Rail:

The arrests unjustly target young African Americans and Latinos and their neighborhoods. United States government surveys consistently find that young whites use marijuana at higher rates than young Blacks and Latinos. But for many years, New York City has arrested African Americans at seven times the rate of whites, and Latinos at nearly four times the rate of whites...For the last 15 years, 87 percent of the people arrested for marijuana possession have been blacks and Latinos, who use marijuana at lower rates than young whites.

The city's warped priorities are such that Mayor Bloomberg would rather close schools and devote resources to harassing and arresting youth than provide the jobs and services proven to actually reduce crime.

As of 2012, fewer than one-half of African Americans in New York City of working age had employment of any kind. Instead of spending hundreds of millions of dollars criminalizing Black and Latino youth, a jobs program would do much to improve the lives of youth of color while actually reducing crime in low-income communities.

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ACTIVISTS HAVE played a central role in exposing the racist nature of stop-and-frisk, creating the political space for the Floyd trial to move forward. In recent years, they have engaged in civil disobedience and held mass marches to protest racial profiling in particular--in addition to organizing around cases of police brutality and murder.

Black and Latino youth are leading the way in challenging the policy that targets them, in particular by documenting and speaking out about how stop-and-frisk impacts them.

For example, last fall, a Harlem teenage name Alvin recorded and distributed a tape of NYPD brutality against him. Tyquan Brehon of Brooklyn--who estimates he was stopped and frisked 60 times by the time he turned 18, was featured in a New York Times short film called "The Scars of Stop and Frisk."

The trial itself is drawing activists and New Yorkers fed up with stop-and-frisk--day after day, they pack the courtroom to listen to the testimony.

On March 28, LGBTQ groups, including the Aurdre Lorde Project and FIERCE, showed up to raise awareness of the way sexual minorities, particularly LGBTQ youth of color, are targeted by the NYPD. The day before, Muslims United Against Stop-and-Frisk attended, organized by the Muslim American Civil Liberties Union.

The week before, Jews for Racial and Economic Justice and the Arab American Association of New York were at the courthouse, joining forces for a march and street seder, while VOCAL-NY and New York Communities for Change mobilized their forces as well.

According to Five Mualimm-AK, an activist with the Campaign to End the New Jim Crow:

This landmark trial in New York is a beacon that shines a light on the sad fact that New York needs help policing its police. Every day since its start, droves of citizens, tired of being abused, have poured into the court as witnesses, supporters, and advocates for their communities, and to say New York has had enough. Even NYPD officers themselves have testified that they are pressured by this COMPSTAT performance quota system into making false arrests.

David Floyd, the lead plaintiff in the case, is a member of the Malcolm X Grassroots Movement (MXGM), which released a study last year showing that a Black person was killed somewhere in the U.S. by police, security guards or vigilantes once every 36 hours in the first half of 2012. According to Linda of MXGM, who spoke at the trial on April 2, things have gotten even worse--since then, "every 28 hours, someone who looks just like us is shot and killed," she said.

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THE TRIAL and the publicity surrounding it have put increasing pressure on politicians to take a stand.

For example, Democratic City Council Speaker and candidate for mayor Christine Quinn broke her silence on the Community Safety Act, a collection of bills that would target discriminatory street stops and create an independent Inspector General to oversee the NYPD. Quinn vowed to pass a bill creating an Inspector General, and to override Bloomberg's threatened veto.

The Floyd case also comes on the heels of another legal victory in January, when federal judge Shira Scheindlin, who will also rule on Floyd, declared that the NYPD's "Clean Halls" program in the Bronx--a "stop-and-frisk" program focused on apartment buildings--was unconstitutional.

But two weeks later, Scheindlin issued a stay on her ruling after New York City lawyers argued that immediately halting the unconstitutional stops outside Bronx apartment buildings would place an "undue burden" on the NYPD--one that apparently outweighs the burden on Bronx residents subject to illegal searches.

The city is determined to continue its policies of racial profiling--so even if there is a favorable decision in the Floyd case, continued pressure from below will be needed to ensure that court decisions are enforced and that the NYPD doesn't simply replace stop-and-frisk with another racist policy.

A victory in Floyd v. City of New York would be a big step forward, but no matter what outcome is, the struggle against police racism, abuse and violence will continue.

Natalia Tylim and Lee Wengraf contributed to this article.

The sickening cost of health care

Published in Socialist Worker.

HEALTH CARE costs in the United States continue to skyrocket, with dire consequences ranging from personal bankruptcies to the growing national debt. Yet the even more outrageous fact is that these inflated costs--the highest in the world--produce health outcomes that trail countries which spend far less.

In a Time magazine special report titled "Bitter Pill: Why Medical Bills Are Killing Us," published in February, investigative journalist Steven Brill pulls back the curtain to expose the price-gouging and profiteering that explains why health care in the U.S. costs so much.

Brill's article details the devastating impact that health care costs--which are behind six in 10 personal bankruptcies--have on working-class people. As Time managing editor Richard Stengel pointed out, Brill "inverts the standard question of who should pay for health care and asks instead: Why are we paying so much?"

Barack Obama used the urgency of this crisis to press Congress to pass his health care law. But the Patient Protection and Affordable Care Act does little to address rising health care costs.

On the contrary, it will almost certainly make things worse by requiring the uninsured to get coverage from for-profit companies and providing subsidies from taxpayer revenues to pay the premiums. Rather than challenging industry giants, Brill writes, "Obamacare enriches them. That, of course, is why the bill was able to get through Congress."

Meanwhile, outsized health care costs--which continue to rise faster than inflation--are a central reason for big government deficits, which the very same politicians then use as a pretext to push for cuts in "entitlement" programs like Social Security and Medicare, by reducing payments for the former and raising the eligibility age for the latter.

However, as Brill points out, Medicare, the government's universal health care system for the elderly, is one of the few bright spots in the current system. Whatever its flaws, caused by cuts and restrictions over the past few decades, it is still far more efficient than private insurance, it offers universal coverage while even Obama's health care law will leave tens of millions of people uninsured--and it has mechanisms to keep costs down.

If Medicare, instead of being cut, was expanded to cover everyone and to provide even better care than it does now, it would save about $380 billion per year by cutting down on administrative waste, according to a study published in the New England Journal of Medicine--and on top of that, it would actually improve health care.

Over 10 years, that's just about the same amount--$4 trillion--that Barack Obama's deficit reduction commission proposes to save, with massive cuts to entitlement programs that dwarf proposed increases in taxes.

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IT'S TRUE that government spending on Medicare has been rising much faster than inflation and is a major cause of government deficits. Medicare spending, after adjusting for inflation, increased fivefold from $110.2 billion in 1990 to $554.3 billion in 2011, according to the Centers for Medicare & Medicaid Services (CMS). And that was after it nearly tripled in 10 years from $37.4 billion in 1980.

In fact, according to Congressional Budget Office figures, protected increases in health care costs are behind most of the expected growth in government debt.

While a significant part of this increase is the result of a growing and aging population, much of the increase in Medicare spending is being driven by increased health care costs overall. The CMS reports that total per capita health care spending in the U.S., adjusted for inflation, more than tripled from $2,854 in 1990 to $8,680 in 2011. Health care accounts for nearly one-fifth of the GDP in the U.S..

Other advanced industrial countries such as Germany have a significantly higher percentage of their populations over age 65. Yet they spend much less on health care than the U.S.--and achieve better outcomes.

In "Bitter Pill," Brill examines hospital bills to expose how extreme price inflation generates massive hospital industry profits, while driving health care costs sky-high--a price that is ultimately paid by consumers.

According to Brill, hospitals charge patients different amounts for the same equipment and procedures, depending on what kind of insurance they have. While Medicare and Medicaid pay a set amount for each item, various insurers negotiate the rates they pay. Many insurers negotiate a discount off the "chargemaster"--a hospital's list of charges for everything from aspirin and gauze to major procedures and cancer drugs that cost tens of thousands of dollars each.

Because hospitals use the chargemaster as a starting point in negotiations, these prices are much higher than the items actually cost. To cite one example, Brill points out a hospital that charges $24 for a niacin pill which costs about 5 cents in an ordinary pharmacy: a markup of 47,900 percent.

Hospitals also gouge patients by charging multiple times for the same procedure. In the article, Brill quotes Patricia Palmer, who is paid to negotiate with hospitals on behalf of patients to lower exorbitant bills:

First, they charge more than $2,000 a day for the ICU, because it's an ICU and it has all this special equipment and personnel. Then they charge $1,000 for some kit used in the ICU to give someone a transfusion or oxygen...And then they charge $50 or $100 for each tool or bandage or whatever that there is in the kit. That's triple billing.

For the un- or underinsured, tragic illnesses can be a financial catastrophe. The terminally ill can even be forced into an impossible choice: whether to extend their lives and leave their families with a crippling debt, or give up time with their families to avoid burdening them financially.

This was the choice faced by Steven D., who Brill profiles in his article. After being diagnosed with terminal cancer, Steven's wife Alice, who earns about $40,000 a year, racked up over $900,000 in debt to pay for treatment to keep her husband alive for an extra 11 months. Although Alice was able to get Medi-Cal (Medicaid) coverage and hired an advocate to negotiate with the hospital, she still ended up owing $142,000, more than three times her yearly salary. Not only did she have to cope with losing her husband, but she was left financially crippled as well.

When pressed by Brill, hospital administrators weren't able to give a plausible explanation for the chargemaster rates, except to say that they are only a starting point and patients aren't actually expected to pay them. The grim irony is that it is the uninsured patients--those among the least likely to be able to afford it--who are charged full chargemaster prices. And many don't know negotiation is an option.

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WHILE THE majority of hospitals are technically "non-profit," they generate immense amounts of revenue, with some of the biggest bringing in billions of dollars each year. While they don't pay dividends to shareholders, executives are rewarded with lavish salaries, and hospitals frequently invest earnings, which can run into the hundreds of millions, in new capital projects.

Many "non-profit" hospital CEOs make more than $1 million a year. For example, Dean Harrison of Northwestern Memorial Hospital in Chicago raked in $9.72 million in 2010.

Of course, the majority of hospital employees make much less. In addition to overcharging patients, hospitals make a killing by paying staff much less than the revenue they generate through their work.

Brill cites a case where the Memorial Sloan-Kettering Cancer Center in New York City charged a patient about $800 per hour for the services of a nurse. The nurse, of course, didn't receive nearly that much. Assuming a 40-hour workweek, $800 an hour works out to around $1.7 million per year, more than 20 times the actual average salary for a registered nurse in the New York metropolitan area.

And if you ever wondered why Washington politicians--Democrats as well as Republicans--are so eager to serve the health care bosses, consider all the legalized bribery, otherwise known as lobbying and campaign contributions.

According to the Center for Responsive Politics, the hospital industry spent over $481 million spent on lobbying in 2012, trailing only FIRE (finance, insurance and real estate) among the various economic sectors. This helps explain why during the debate over health reform, proposals like a single-payer health care system were never even on the table, and every option considered protected industry profits.

The health care industry's case for forcing the rest of us to pay these inflated costs might be more reasonable if they resulted in better care. But while the U.S. spends far more per capita on health care than any other nation, health outcomes in many areas are poor compared to other industrialized countries. Life expectancy in the U.S. is actually over one year less than the OECD average, despite the fact that Americans spend double the average on health care.

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RATHER THAN Medicare and Medicaid being a model to construct a rational system for providing health care, the health care industry increasingly encroaches on the government programs. And now there's worse to come as Democrats and Republicans alike propose further cuts in entitlements in the name of deficit reduction.

The latest attack has come in the form of the "the sequester"--across-the-board cuts in discretionary spending that will total $85 billion this year and $1.1 trillion over the next decade. The sequester is another manufactured crisis which provides the justification for more and more harsh austerity measures that disproportionately hit workers and the poor. Medicare is one of the big victims of the sequester, with a 2 percent cut in payments to physicians that, along with other reductions, will total nearly $10 billion this year.

In addition, the debate over what to do about the sequester is providing a cover for proposals for even deeper cuts. For example, according to Reuters, "conservative Republican Senator Lindsey Graham of South Carolina said he was open to raising $600 billion in new tax revenue if Democrats accepted significant changes"--translation: cuts--"to Medicare and Medicaid as part of a long-term budget deal." A few days later, Obama said once again that he's open to exactly this kind of deal that cuts hundreds of billions in Medicare, Medicaid and Social Security, in exchange for some increased tax revenue.

Obama's offer is nothing new. In 2010, Alan Simpson and Erskine Bowles, appointed by Obama to chair the National Commission on Fiscal Responsibility and Reform, released a report recommending making poor people pay more for Medicaid and introducing caps that would force "force Congress and the President to increase premiums or co-pays or raise the Medicare eligibility age," as Talking Points Memo described the report.

Obama offered cuts to Medicare again in the debt ceiling debate in the summer of 2011, as well as during the fiscal cliff negotiations at the end of last year.

While Republicans seek to privatize Medicare--the former Republican vice presidential candidate wants to replace the program with vouchers to purchase private insurance, which would fall far short of the cost of caring for seniors--Obama and the Democrats are in favor of whittling away at the program. Hence, the debate in Washington centers around how much to cut, not whether to cut.

Left out of the debate entirely are the opinions of the majority of people in the U.S. In a Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health poll from January, 58 percent opposed any cuts to Medicare, while only 10 percent supported major cuts. Medicare is overwhelmingly popular: 60 percent of people said it is "working well," including 80 percent of those aged 65 and up, the age of eligibility for Medicare.

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BRILL'S CONCLUSIONS correlate with public opinion concerning Medicare--the program is much more efficient than private health care, keeps costs down by tying reimbursements to actual costs and is universally available to everyone aged 65 and over.

Contrary to the ideas that the private sector is more efficient than government, Medicare administrative costs are much smaller than those of private insurers. Brill compares Medicare, which spends less than 1 percent of total claims on administration and management, to major private insurer Aetna, which spends 29 percent. Medicare pays out more than 20 times the amount in claims that Aetna does, while spending less than half overall on things besides health care.

And Medicare would be even more effective at controlling costs if it weren't prevented by law from negotiating with drug companies to get better prices.

Because Medicare is so much cheaper than private insurance, the claims that raising the Medicare eligibility age to 67 will reduce the deficit ring hollow. In fact, this measure would most likely increase government spending on health care overall.

As Brill points out, many of the 65- and 66-year-olds who would no longer receive Medicare would instead have to purchase private policies when the health-care exchanges in the Affordable Care Act kick in next year--and these purchases would in turn be subsidized by the government. According to Brill, "[T]he cost of that private insurance--and therefore those subsidies--will be much higher than if the same people were enrolled in Medicare at an earlier age."

While Brill doesn't think it's politically realistic, he does admit that the same logic against raising the Medicare eligibility age would apply to extending Medicare to all under a "single-payer" system where everyone has insurance. Not only would this be much cheaper than the Affordable Care Act's subsidizing of private health insurance, but it would be truly universal health care--some 30 million are expected to remain uninsured after the Obama health care law fully kicks in.

According to the Center for Economic and Policy Research, if the U.S. spent as much on health care as Britain--whose public universal health care system, according to the Commonwealth Fund, outperforms the U.S. while spending less than half as much per capita--we would save $3.7 trillion over the next 10 years.

If Democrats and Republicans were serious about reducing the government deficit, they would take on health care costs--price gouging by hospitals, the outrageous profits of the industry, and the vast administrative waste of the medical-pharmaceutical-insurance complex. This would also produce a system that's much more effective at meeting the needs of people in it.

Instead, the government debt crisis is used as a pretext for policies that put profits before people.

No justice, no pizza!

Published at Socialist Worker.

DOMINO'S WORKERS staged a rally on February 27 outside a Domino's franchise in Manhattan to announce an important victory in their struggle for basic rights and fairness--one that could have far-reaching implications for all fast-food workers.

Chanting "no justice, no pizza," about 50 Domino's pizza workers, other delivery and food service workers as well as supporters picketed and rallied for workers' rights and fair treatment in front of a Domino's at Third Avenue and 32nd Street.

The rally was organized by the "Justice Will Be Served" campaign sponsored by the Chinese Staff and Workers Association, National Mobilization Against Sweatshops, and 318 Restaurant Workers Union. It is part of a struggle for justice going back over two years.

According to a press release, for the first time, workers at a franchise are able to sue the parent corporation--in this case, Domino's Pizza Corp.--for alleged violations committed by franchisee Dave Melton.

The lawsuit was originally filed in 2010 by six workers alleging Melton violated state and federal labor laws. More workers joined the next year, bringing the total to over 70 plaintiffs. Workers' grievances include allegations of paying workers less than minimum wage, requiring unpaid overtime, denying workers time for breaks and lunch, unsafe working conditions (including being forced to make deliveries on bicycle in severe rain and snow), as well as retaliation against workers for standing up against these offenses.

Former Domino's worker and plaintiff Carlos Rodriguez told the crowd that Melton and Domino's "make millions of dollars by forcing the workers to work under all kinds of horrible conditions whether there are storms [or] hurricanes."

Victor, another former Melton employee, spoke at the rally, saying, "We want to end this exploitation, and we call on the corporation to also take responsibility for the abuses we suffered as workers there. Many of us worked many hours doing deliveries and we were cheated out of 20 to 25 hours per week of our pay. We call on everyone to join us to end this exploitation."

Vincent Cao, a former worker at Saigon Grill who is part of another Justice Will Be Served campaign against similar conditions at his former employer, spoke as well. "I was fired because I spoke against unfair labor practices," Cao said. "We're here today to support the Domino's Pizza workers. We say enough sweatshop conditions! All the sweatshop owners, they use asset transfers, closing down, fake bankruptcy, to try to run away and avoid lawsuit. So we will fight to get justice."

In fact, Melton himself just recently filed for bankruptcy, claiming poverty due to legal fees related to the lawsuit. Workers called on Domino's and the franchise owner to "take responsibility, pay workers what they are owed, rehire those workers fired for speaking out and end their sweatshop conditions."

After a round of speakers, Carlos Rodriguez and others went into the Domino's location to hand a copy of the judge's decision to a manager. The manager refused to meet with Carlos and other workers, but when the latter refused to leave, he sent an employee to collect it.

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THE ABILITY to include the Domino's corporation as a defendant in the lawsuit against Melton is an important victory, as major corporate chains like Domino's have in the past evaded accountability for violations of labor law committed by franchisees--who own their own restaurants, but pay a fee to the parent corporation to use the brand.

Domino's, which demands significant franchise fees and nearly 10 percent of sales after taxes, makes tens of millions from its franchises, and has seen a spike in profits in recent years. As Victor said, "The corporation, Domino's, knows what is going on in these stores, and tolerates this exploitation."

According to Forbes, Domino's corporate CEO J. Patrick Doyle took home over $6 million in total compensation in 2011. Yet the franchise system, where stores are owned by private "partners," enables chains like Domino's to plead innocence when it comes to dirty deeds done by franchisees. These workers are not only taking on a major corporation, but they are standing up to Dave Melton, a prominent Domino's franchisee.

Ironically Melton, who owns several Domino's restaurants in New York City and Connecticut, was celebrated in a 2008 New York Times story for how well he supposedly treats his employees and all of the opportunities available for them at his restaurants.

Melton even co-authored a book with a top Domino's executive entitled "Hiring the American Dream." On the promotional website, Melton claims that "my minimum-wage workers find their work fun and rewarding."

Melton said to the Times about his restaurants: "This is one of the places where so many people get their first experience in America," he said. "It is fun exposing them to the way capitalism and business in America works."

According to former Melton employees at the rally, this means subjecting them to an experience all too common for immigrant workers in the U.S.: ruthless exploitation made possible through intimidation.

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THE JUSTICE Will Be Served campaign has called for a citywide rally on April 2 at the same Dave Melton's Domino's Pizza location at 464 Third Avenue and 32nd Street to keep the pressure on Melton and Domino's. The rally will demand that Domino's take responsibility, pay workers back for stolen wages, and rehire those fired for taking a stand. They are calling on workers from across the city to join the demand for justice.

Carlos Rodriguez said, "We're calling out to all Domino's workers from different franchises to join us so we can unite against this exploitation and...we are reaching out to all other workers including those of McDonalds and Dunkin' Donuts and Wendy's to come together so we can end this exploitation."

"We're facing the same issue, and we should unite, no matter Latino, Chinese workers--we should come together," stated Vincent Cao of the Boycott Saigon Grill effort. "They use many different ways to divide the workers, documented/undocumented, Chinese versus Latino. They want workers to support the boss, not join a union."

Cao spoke about the importance of continuing with actions against Domino's and other sweatshop employers: "Picket lines are important. You have a base, an opportunity for other workers to join you, not just Domino's and Saigon Grill. Workers see there are so many workers there, and if they join there is a bigger chance to win."