Then Jehovah said to Satan: "where do you come from?" At that Satan answered Jehovah and said: "From roving about in the earth and from walking about in it.
"O how you have fallen from heaven, you shining one, son of the dawn! How you have been cut down to the earth, you who were disabling the nations! As for you, you have said in your heart: "To the heavens I shall go up. Above the stars of God I shall lift up my throne, and I shall lift up my throne, and I shall sit down upon the mountain of meeting, in the remotest parts of the north. I shall go up above the high places of the clouds; I shall make myself resemble the Most High...."
Jerry Hagstrom in Beyond Reagan: The New Landscape Of American Politics (1988) predicted that the final judgment on the Reagan record is, of course, decades away [from 1988]. Only then will historians be able to judge Reagan on such cosmic questions as whether his free trade policies help or hurt the United states, whether his administration's response to acquired immune deficiency syndrome (AIDS) was appropriate for the times or an abrogation of presidential responsibility and whether his treaties with the Soviet Union signaled the end of the cold war or were foolhardy gestures by a president determined to go down in history as "peaceful." But much earlier we will be able to judge the effect of his policies on the economic, political and social lives of every American.
If the United States does not prove capable of maintaining a middle-class life style for the majority of its citizens, the social fabric and all the advances of the last quarter-century could be torn apart. Whites could be pitted against blacks, men against women, the old against the young, and region against region. If that happens, many Americans might look upon the Reagan years as the last good times and mutter wistfully "If only he were here." But if they do, they must remember whose policies got us to this point.
A new plan for health care in America, the American Health Care Act (AHCA), which is currently being debated by Congress, would replace the Affordable Care Act (ACA).
According to the new Congressional Budget Office (CBO) report, this plan has the potential to make many changes to health care policies in America. While it reduces the federal deficit by $337 billion over 10 years, it's also estimated to leave 24 million Americans uninsured by 2026.
During this River to River interview, host Ben Kieffer talks with Pete Damiano, Director of the University of Iowa Public Policy Center, about how the new plan could affect Iowans.
Reaction to the CBO report.
The CBO report is reflecting what many who study health policy would have expected because of the types of changes that have been discussed both during the campaign and in some of the previous Republican proposals that have come through in the last few years. If you’re going to try to reduce the federal role in health care and health care spending, you’re going to end up, logically, with having more people who are uninsured, underinsured, and pushing more of the costs onto states’ local governments and individuals, and I think that’s pretty much what the CBO report said.
What would be the biggest differences for Iowans?
There’s obviously a big difference in priorities between the Affordable Care Act and the American Health Care Act… In terms of trying to cover the uninsured, with the Affordable Care Act we’ve covered approximately 20 million people with health insurance coverage, and have declined the number of uninsured in the country to the lowest point it’s been basically in recorded time. With this plan, over the next ten years, it is estimated the number of uninsured would go back up to similar number of what it was, any maybe even slightly more than what it was prior to 2010 when the ACA was passed and really prior to 2014, when a number of the key provisions of the ACA kicked in.
How could this affect poor or disabled Iowans?
About 150-170,000 people in Iowa gained coverage through the Medicaid expansion, they won’t necessarily automatically loose coverage, that’s to be determined, but the state won’t get the same amount of money that they did for those people.
In the end, who benefits and who’s put at a disadvantage under the new proposal?
In general, if you are younger, healthier, or wealthier—because all of the paymentside,if you will—how the ACA was financed, all of those are going to go away and most of those were relatively small taxes on wealthier people. So there’s going to be a big cost shift to both younger, healthier folks and the wealthy, and then the older adults [who are] pre-Medicare, especially those with a health condition, their costs are going to go way up.
John Nichols in The Nation lists Representative Paul Ryan as one of the Young Guns "helped" into office. Nichols states that If the Tea Party really is all about debts, deficits, spending and taxes—as opposed to the witchcraft, immigrant-bashing, birther fantasies and generalized Obama-hatred that forms its caricature—then Paul Ryan is the movement’s Congressman. Handsome, good-natured and blessed with an ability to reduce the most complicated fiscal issues to conservative talking points that just happen to echo Wall Street’s wish list, the Wisconsin representative has none of the rough edges of Michele Bachmann or Rand Paul. He is resolutely polite, certain without being overbearing, confident at the debate podium and, to a greater extent than any prominent Republican of the past two decades, Reaganesque.
Unfortunately, he has something else in common with the fortieth president: an approach to budget issues that owes more to Ayn Rand’s paranoid fears about making even the most minimal civic demands on "productive" elites than to facts, figures or economic realism. Ryan’s devotion to Rand, the author of dystopian novels like Atlas Shrugged and The Fountainhead and a favorite of the Tea Party movement’s Glenn Beck wing, is fanatical. He requires Congressional staffers to read Rand’s books and heaps praise on the prophetess of selfishness in YouTube videos that even fellow Republicans quietly acknowledge are unsettling.
Like another Rand devotee, former Federal Reserve chair Alan Greenspan, Ryan sees government not just as the "problem" Reagan described but as a greater threat to freedoms than the most extreme Tea Partisans imagine. Come January the Wisconsinite, who at 40 is one of the youngest members of Congress, will finally be in a position to address that perceived threat as chair of the Budget Committee, perhaps the most important in the new House. But this is not a case of an outsider storming the battlements and seizing a position of power. For all his Tea Party trappings, Ryan is a consummate insider, with a DC résumé extending back to the days of the first Bush presidency. This native of the hard-pressed Wisconsin factory town of Janesville spent almost a decade as an aide to conservative senators and twelve years representing a swing district that previously sent Democrat Les Aspin to chair the House Armed Services Committee. Ryan is about to put his long apprenticeship to work as one of the most definitional members of the new Congress.
Ryan’s role as Budget Committee chair is almost certain to put him in conflict with President Obama, with whom the Congressman clashed earlier this year during a session on budget matters and entitlement spending. That, in turn, will buttress a profile that is sufficiently prominent to have stirred speculation that Ryan might be a 2012 GOP vice presidential prospect and, ultimately, a presidential contender.
A natural campaigner and landslide winner in a district that voted for Obama, Ryan has meticulously extended his influence in recent months as a star speaker on the Tea Party circuit, a campaigner for fellow Republicans and a guest on Beck’s radio show and on Fox TV. Ryan now has a formal platform from which to argue for the radical shift in spending priorities outlined in his Roadmap for America’s Future. That document, which he drafted as his party’s prospects sank toward the close of George W. Bush’s presidency, became an unofficial manifesto for economic conservatives during the 2010 election season.
Ryan, a faithful follower of free-market orthodoxies outlined by Milton Friedman and Friedrich von Hayek, will thus be the highest-profile advocate for what many imagine to be "Reaganomics" since Reagan. But Ryan goes much further than did the fortieth president. The Congressman’s latest version of the Roadmap for America’s Future would:
§ begin the process of privatizing Social Security;
§ replace Medicare as we know it and most of Medicaid with a voucher program that would eventually reduce the value of the vouchers;
§ abolish the State Children’s Health Insurance Program (S-CHIP);
§ abolish the corporate income tax;
§ abolish the estate tax and the alternative minimum tax;
§ eliminate income taxes on capital gains, dividends and interest;
§ provide across-the-board tax cuts to even the richest Americans;
§ explore flat tax and consumption tax models that do away with progressive taxation.
Those proposals are sure to provoke fights—not just with the White House and Congressional Democrats but with some Republicans too. When Ryan proposed an alternative budget in 2009, it won only 137 votes in the House, with thirty-eight Republicans joining Democrats to oppose the plan. Ryan was sharply criticized in 2009 for failing to make even a minimal attempt to balance his budget proposal.
Dismissing Ryan’s Roadmap as a "sham," Nobel Prize–winning economist Paul Krugman says that, if implemented, it would cause a $4 trillion revenue shortfall over the next decade. Krugman frets that Ryan’s approach "would raise taxes for 95 percent of the population" while cutting them for corporations and the wealthiest Americans so deeply that policy-makers would be faced with a choice between gutting popular programs like Medicare and ballooning the deficit.
Even sympathetic economists like Ted Gayer argue that Republicans would need to amend many of Ryan’s proposals in order to avoid a severe revenue shortfall. But Ryan’s fans, led by former House majority leader and Tea Party patron Dick Armey, are mustering a coalition to oppose any such compromise. Armey promises to use his Freedom Works network to promote the Roadmap. Ryan’s ideas "will be taken more seriously if there are outside forces [pressuring] members of Congress," Armey says. "Republicans have been too timid to make his arguments. Now those same ideas have a ready-made audience."
Ryan is ready. Like Greenspan, he’s a true-believing long-distance runner who will devote all the time it takes to popularize ideas borrowed from the economic fringe and the Ayn Rand library. He won’t implement his agenda in 2011. His purpose is to shape the debate and, with the help of Armey’s Tea Party and its amen corner in the media, position Republicans for 2012 victories that he believes will allow him to design a future in which Wall Street has our Social Security money, Medicare is a memory and billionaire Atlases can shrug off the last of their tax burdens and regulatory responsibilities.
THE STRANGE RELATIONSHIP BETWEEN PAUL RYAN AND AYN RAND
Paul Ryan is a strict individualist. John Higgs in Stranger Than We Can Imagine: An Alternative History Of The 20th Century (2015) notes the importance of individualism in the United States, which he notes was always uncomfortable with the rigid hierarchy of empire. Higgs state a proof the fact that few American town planners embrace European-style motoring roundabouts. Roundabouts are faster, cause fewer accidents and save fuel in comparison to traffic-light junctions, but they are viewed as being suspiciously un-American. As Dan Neil, the motoring correspondent at the Wall Street Journal, has noted, "This is a culture predicated on freedom and individualism, where spontaneous cooperation is difficult and regimentation is resisted. Behind the wheel, we're less likely to abide by an orderly pattern of merging that, though faster for the group, may require an individual to slow down or, God forbid yield."
The most influential proponent of the argument in favor of taking a fundamentalist approach to personal liberty was probably the Russian-American novelist Ayn Rand. Rand was born Alisa Zinov'yevna Rosenbaum in St. Petersburg in 1905. When she was twelve-years old, Rand's happy childhood was overturned by the October [Russian] Revolution of 1917. Her father's property was confiscated and her teenage years became a time of uncertainty, desperation and poverty. This left her with a deep hatred of communism, socialism or any type of collectivist ideas. All these, she felt were excesses to steal from those who earned and deserved their wealth.
After coming to America, failing as a screenwriter, she wrote a novella called Anthem. Anthem describes a dystopian totalitarian future where the world "I" was banned and replaced by "we." The hero of his novel, who is initially named Equality 7-2521 but later calls himself Prometheus, vows to fight this collectivist tyranny. "I am done with the monster of "We," the word of serfdom, of plunder, of misery, false hood and shame," he says. "And now I see the face of god, and I raise this god over the earth, this god whom men have sought since men came into being, this god who will grant them joy and peace and pride. This god, this one word: "I." Equality 72521 makes this declaration fully aware of the isolating nature of individualism: "I shall choose friends among men, but neither slaves nor masters. And I shall choose only such as please me, and them I shall love and respect, but neither command nor obey. And we shall join our hands when we wish, or walk alone when we so desire. For in the temple of his spirit, each man is alone."
Ayn Rand did not believe that concern for the well-being of others should limit personal liberty. With her striking short black hair, cold piercing gaze and ever-present cigarettes, she quickly attracted a dedicated following. Her individualist philosophy, which she named Objectivism, promoted what she called "the virtue of selfishness." Like contemporary occultist Aleister Crowley's religion philosophy, which he called Thelema, which differed from Christianity in that it did not demand the bending of the knee to anyone, in words of his book The Book of the Law, "Every man and every woman is a star," Rand viewed her mission as the establishment of a new, post-Christian morality. She made this clear in 1959 CBS television interview with Mike Wallace, who put it to her that:
"You are out to destroy almost every edifice of the contemporary American way of life, our Judeo-Christian religion, our modified government-regulated capitalism, our rule by majority will. Other reviews have said you scorn churches and the concept of God. Are these accurate criticisms?" Rand's response was "Yes. I am the creator of a new code of morality."
Crowley, who by then was a fan of Rand's, wrote in a 1947 letter that Rand' novel The Fountainhead is one of the finest books he had ever read. In turn, Rand's philosophy inspired Anton LaVey, the founder of the Church of Satan. LaVey was the author of the Satanic Bible, the most influential text in contemporary Satanism, which has sold over a million copies. LaVey's Satanism was more goat-based than Objectivism, but he readily admitted that his religion was jut "Ayn rand, with trappings."
Higgs posits that as well as Satanists, Rand also has admirers in the right-wing American Christian and business communities. Ronald Reagan was an admirer. Alan Greenspan, who would spend nineteen years as chairman of the Federal Reserve, was a member of her inner circle. The Republican Congressman Paul Ryan said in 2005 that "I grew up reading Ayn Rand and it taught me quite a bit about who I am and what my value systems are, and what my beliefs are. It's inspired me so much that it's required reading in my office for all my interns and my staff. We start with her longest and last novel Atlas Shrugged."
Crawley, Rand, and her follower Ryan and other American Satanists assume that an individual was/is a self-contained, rational agent with free will. The true definition has turned out to be considerably messier.
The Tea Party is the Party of Euthanasia. Euthanasia is the act of painlessly ending the life of a person for reasons of mercy, due to the logical rationality of cost to the public. The Tea Party mercy has to do with Deficit Spending and doing the will of the 1%. Ronald Formisano in The Tea Party: A Brief History (2012) posits that on April 15, 2009, "Tax Day," Tea Party demonstrators reportedly gathered in some 750 towns and cities across the country. The largest, in Atlanta, attracted several thousand. Similar demonstrations occurred on July 4. A powerful media engine promoted these protests: the Fox News cable network, owned by right-wing billionaire Rupert Murdoch and run by former Republican campaign manager Roger Ailes. Neil Cavuto broadcast live from the Sacramento rally surrounded by Tea Partiers and proclaimed that, just as the original Boston Tea Party was about "taxation without representation" so too was this protest because, even though Barack Obama had been voted into office, voters had not voted for his economic policies.
However the Tea Party's most significant political noise came in august 2009 when, spurred on and transported by Freedom Works and other corporate entities, Tea Party activists appeared at local congressional town hall meetings being held for representatives to discuss the Democrat's' health insurance legislation. Instead of allowing Congressmen to answer questions, however, "outraged" activists did their best to disrupt the meetings. Although coached to so from above (the Koch brothers etc.), the militants needed little prodding to shout and scream. The anti-government mood ventured into the absurd when protesters shouted, "Keep you government hands off my Medicare! But critics who focused on illogical complaints were missing the point: this was political theater staged to create the impression of the unpopularity of health insurance reform.
A HISTORIOGRAPHY OF THE NATION'S HEALTH SYSTEM
Securing affordable health care has always been problematic in the United States. Louis Harris in Inside America (1987) declares that health is a decidedly no-nonsense subject. When you have it, there is nothing more precious. When you lose it, not much else matters. In turn, in assessing how a health care system works, an acceptable criterion for a satisfactory rating can hardly be "Well, it's working pretty well," or "I guess it's not too bad." This might be an acceptable standard for a transportation system, a garbage collection service, or even a supermarket. But not for a health care system. Anything less than high satisfaction must be taken as a signal that all is not well. By the same token, when people speak about downright dissatisfaction with health care, there is real cause for alarm.
In the mid-1980s in America, there is no major part of our health care system that has a majority of the people willing to express high satisfaction with it. One of the most important criteria: Cost to you and your family results. Harris writes that this is the fiscal bottom line of medical care--how much it costs you out of your own pocket, after what your insurance covers. Only a meager 26% are highly satisfied with the costs of health care these days, compared with 73% who are less than very pleased (28% somewhat satisfied and 45% dissatisfied). Here is the last straw about health care in the country. Not only do people have genuine doubts about the quality of doctors, their ability to find them when they need them, the availability of a key specialist, the quality of hospital care, and the round-the-clock availability of medical care, but the cost of it all is viewed as out of control unbearable.
AN OVERALL JUDGEMENT ABOUT THE AMERICAN HEALTH SYSTEM
When asked to assess the health system as a whole, by a substantial 74% to 26%, a majority reject the claim that "on the whole the health care system works pretty well, and only minor changes are necessary to make it work better." Instead, 49% say, "there are some good thing in our health care system, but fundamental changes are needed to make it work better," and another 21% reach the radical conclusion that "the American health care system has so much wrong with it that we need to completely rebuild it."
Those who would defend the present health care system in the U.S. might well ponder the fact that the number of people who want to radically change it--presumably in favor of some form of state-sponsored health plan--total 21%, almost as many as the 26% who would opt essentially for the status quo.
When a cross section of physicians was asked to make their judgment in an identical question 54% of them came down in defense of the current system, compared with only 26% of the public. Another 43% of the doctors opted for fundamental change to make things better, compared with 49% of the public. But only 3% of the physicians want radical surgery on the system, compared with 21% of the public. Clearly most doctors want to keep the status quo, while most of the people they service want aspic, if not radical changes in the health care system.
HMOS: AN OPTION THAT GAINED FAVOR
Harris posits that one of the fastest-growing forms of the delivery of medical services in the United States is health maintenance organizations. From 1976 to 1984, the estimated number of HMO members in the country rose from 6 million to over 15 million, and it is projected that they will at least double again by early in the next decade.
However when a cross section of HMO participants are asked to rate the health care system on the same item as the general public, they are less dissatisfied with the quality of their doctors, more satisfied with the availability of doctors when they are needed, more satisfied with the availability of specialists, most satisfied with the quality of hospital care available to them, much more pleased with the availability of round-the-clock medical services, and less dissatisfied with the waiting time when they have an appointment.
But the most dramatic evidence is that while the general public is downright unhappy with the cost of medical services, 59% of the HMO members nationwide are highly satisfied with the cost to them.
OBSERVATION: ALL IS NOT WELL
While HMO's are not the only alternative to the prevailing health care system in the U.S., obviously they are working better than the rest of the system, judging by a comparison of the relative satisfaction of the general public with their medical care experience and that of HMO members. The fact remains that by the mid-1980ss the high cost of health services continued to act as a spur upon patients and those vested with the responsibilities to underwrite the system and to make it work to come up with something more than patch-and-fill solutions. The American people are patiently willing to make sacrifices and even to change long-standing habits in obtaining medical care in return for cost relief. They are not willing, however, to compromise on the ultimate quality of medical care. However, if they can find alternatives that in fact increase the quality of delivery and also give them some cost relief, such options are clearly going to be big winners.
Physicians by and large still tend to be the odd people out. They still cling to the status quo. To being paid in fees instead of in salaries, to not having suggested prices set for standard medical procedures, and a host of other long-standing practices. But, for the first time, a plurality of younger physicians are now willing to accept compensation in the form of salaries rather than fees, as is the case with HMOs, and Individual Practice Associations (IPAs), an alternative based on principles similar to those of HMOs, are growing even more rapidly than group practices and HMO installations.
For a nation that has long been highly self-indulgent in its convictions that it can violate all the rules of good health and be rescued by a vast safety net of superb physician service, America now appears to be making a fundamental and deliberate shift toward opting for preventive medicine--albeit this choice is driven by the frightening extent of medical costs.
For decades the Koch brother operated under the radar funding the Tea Party as well as right-wing think tanks, books magazines, and what must candidly be called propaganda efforts to advance a libertarian vision that relentlessly promote their own economic interests. They have poured millions of dollars into efforts to deny climate change, to oppose laws to reduce carbon emissions and to keep regulations of pollution lax. Recently, they have put their resources into lobbying against Wall Street regulation and net neutrality, an internet ground rule opposed by broadband suppliers who want to charge for different levels of service. They have contributed millions to the campaigns of conservative politicians at the national and state levels, mostly Republicans and, recently Tea Party candidates. From 2006 to 2009 they spent $37.9 million lobbying congress and state legislatures on oil and energy issues. A complete account of their dozens of political activities and libertarian ideological campaigns could easily fill a book.
The Kochs' relatively invisibility as political activists and ideological warriors came to an end, however, with an investigative essay by Jane Mayer in the New Yorker issue of august 30, 2010. "Indeed," wrote Mayer, "the brothers have funded opposition campaigns against so many Obama Administration policies--from health-care reform to the economic--stimulus program--that in political circles, their ideological network is known as the Kochtopus." The article immediately attracted enormous attention from other media, and the brothers have become a favorite target for liberal critics.
The ties of the Kochs and Americans For Progress (AFP) to the Tea Party have been well documented. In April 2009, AFP's thirty-four national office employees and thirty-five state-level employees worked hand in glove with the Tea Party to promote the Tax Day protests.
In August the organization spend several million dollars to fund "Hands Off My Health Care" bus tours of Tea party activists to attend and disrupt the town hall meetings at which congressmen were attempting to discuss the new health care legislation. Thus, some of the angry protesters at those town hall meetings did not actually reside in those districts. A Freedom Works organizer reportedly circulated a memo to trainees for the movable protest: "You need to rock-the-boat early in the Rep's presentation.
While Tea Party supporters brim with passion in calling for repeal of the Affordable Care Act (83% favor repeal), majorities of them want nevertheless keep certain popular provisions. The health law debated sharpened public awareness of private health insurance companies' denial of coverage to patients with preexisting conditions. An October 2010 Bloomberg poll found that 57 percent of Tea Party supporters would keep this part of the reform. Fifty-two percent would add more prescription drug benefits for Medicare users, and 53 percent would require states to set up plans for people with major health problems.
Some Tea Partiers do find themselves in a dilemma when asked if they wish to discontinue Social Security or Medicare, programs from which many of them personally benefit. A Wall Street Journal/NBC News poll in early 2011 found that over 70 percent of Tea Partiers feared that Republican legislators would not cut enough spending. But by a nearly 2-to-1 margin, movement supporters responded that cuts to Social Security would be "unacceptable." One resolved this dilemma by saying, "I guess I want smaller government and my social Security."
Conservative Media Divided Between Trump And GOP Lawmakers