#what does medicare cover

[lifeandinsurances]

Your Medicare Coverage Guide for 2023

[scientia-rex]

Good morning! I have a question. When I look up info about vitamin D, I come across many claims that people generally don't get enough of it. In a recent episode of Maintenance Phase, however, the hosts called it a "scam" or overblown, at least (I don't remember the exact wording). So, like, what's the deal with vitamin D? Do Americans get enough of it?

Probably, mostly. At the very least, people should be tested before starting repletion. It probably has a role in osteoporosis treatment and prevention, BUT how much to take and what form and when is HOTLY debated and frequently conclusions are changing.

Just to take you on a spin through the most recent Cochrane reviews (THESE ARE NOT SINGLE STUDIES, in case any of the research-naive out there want to get pissy about them; look up what a Cochrane review actually is before trying to shit on it; also note that I did NOT say this will cover every fucking person and every hypothetical they can come up with, jesus CHRIST):

No role for vitamin D in asthma

Insufficient evidence to recommend it in sickle cell

Raising vitamin D levels in cystic fibrosis patients is not beneficial

No evidence of benefit of vitamin D in MS

Supplementing vitamin D in pregnancy may have small benefits but also risk of harms

No clinically significant benefit from vitamin D supplementation in chronic pain

Insufficient data on vitamin D in inflammatory bowel disease, but no evidence of benefit

No evidence of benefit of vitamin D supplementation in liver disease

Vitamin D does not appear to prevent cancer in general population

No evidence for benefit in supplementation of vitamin D in premenopausal women to prevent bone density loss

Possible small mortality benefit of D3, but not D2, in elderly patients, but also increased risk of kidney stones and hypercalcemia

Vitamin D alone ineffective, but combined with calcium may be effective, in preventing bone fractures in older adults

Insufficient evidence for vitamin D improving COVID-19 outcomes

Now, vitamin D plus calcium in people who have post-menopausal bone density loss does seem to prevent fractures. This is why doctors routinely recommend it. However, dosage and formulation are still debated as data are insufficient, and uncertainty still large.

So, do you need to supplement? Probably not. There is some fairly weak evidence that vitamin D supplementation may help with depression, but I would argue that it's going to be most relevant in people with pre-existing deficiencies, which Medicare is just hellbent on not letting me test for anymore. They've narrowed the coverage codes for testing so now even know vitamin D deficiency isn't considered a good enough reason to test. So Medicare has very clearly decided it's not relevant, for whatever that's worth, I spit on their graves, etc. Of course, then you get into the question of what counts as a deficiency, which we also really don't know.

And to be clear, I wasn't looking through the Cochrane review results with an angle--those are most of the first page of search results on their site, with the only one skipped being similar to another one I mentioned, and I stopped when I got bored. These should not be paywalled, as I am not logged into anything and I can read it all, so try clicking the side menu on the right if you have trouble getting into the weeds.

If anything, running through this little exercise has made me less likely to recommend vitamin D supplementation, so do with that what you will.

[robotslenderman]

About a month before Awful Coworker quit we hired another dude. It’s his first ever job.

His career ambition, apparently, is to become her spiritual successor.

New boss gave him a uniform. New coworker showed up the next day without it. Boss went wtf. New coworker went “wait, it’s compulsory?”

Showed up an hour late today. Apparently he does that a lot.

Tried to get the practice manager to tell all the doctors to stop sending xrays over because he’s “too busy.”

(Me to boss: “does he think people get xrays for fun?”)

Thought the OPG machine was broken because it wasn’t starting fast enough.

Told his receptionist she was wrong about Medicare and argued with her until boss showed up and backed her up. At this point he’d been working for three weeks. I have no idea why he believed he was a Medicare expert. I’ve been here a year and I still don’t know shit about Medicare and work with it every single day.

Booked in a breast ultrasound as a fine needle aspiration when he was covering my site this weekend. Had a very confusing conversation with the involved patient when I was trying to fix that one. “Uhh, what do you mean there’s needles?”

I look forward to monitoring his career with great interest.

[anotherdayforchaosfay]

Wonderful.

Medicare won't cover my nebulizer medication. What's a nebulizer? It's the machine some of asthmatics has that requires you either wear a little mask or use a mouthpiece and it give a higher and more concentrated dose of albuterol. That medicine is used for treating asthma attacks as well as severe asthma. The only pharmacy that carries said medicine in my area is Walgreens. It costs $73, which I don't have. This is ridiculous!

Ugh.

Well, let's hope smoke doesn't get too bad in my area. An emergency inhaler isn't enough when wildfire smoke decides to camp out, which it usually does when August rolls in. Bleh.

I'll see about acquiring free samples of the medicine from the allergy and asthma clinic on Monday when I go in for my allergy shot and a followup appointment regarding my asthma. The doctor wants me on another medicine, but all the medicines she wants to put me on contain milk proteins, which are used to hide the nasty taste of the medicine. Milk proteins make my eczema flare up like fireworks on New Year's Eve. That, and I develop a nasty ball of snot in the back of my throat and constantly have to clear it out. This results in frequent coughing and spitting out phlegm, and my voice sounds like RFK Jr's. It's awful! I will not use that shit again. It's been two months since the last time I used it, and I'm still dealing with itchy painful eczema patches. It's especially bad in my ear canals.

Please don't send money. I'd rather you purchase my work either as a commission or from my shop. My focus is paying off debt right now, and money left over from the purchase will cover medicine and a debt payment.

Thank you.

[passerkirbius]

You might not know his name, but if you've been listening to fiction podcasts, you've almost definitely heard his work. Erin Kyan is a transman artist in Melbourne, Australia, and you may well have heard the show he wrote, produced and co-starred in, Love and Luck. You might also have heard some of his other work, having co-wrote and co-produced Nym's Nebulous Notions and Floodlight Viscera, as well as a whole bunch of acting credits to his name, on shows such as Interference, The Nuclear Solution, Mars' Best Brisket, or you might have heard his writing on the Someone Dies in This Elevator episode Hot Wheels, as well as a bunch more appearances in other podcasts as well.

He's done a lot, is what I'm saying.

Erin came out as trans 20 years ago, and unsurprisingly, trans health care in Australia wasn't particularly great for fat trans men at the time, and has spent a long time being unable to get the care he needs. But 20 years is a long time, and things are changing - not only are the gatekeepers no longer there to stop him, but there are surgeons willing to do top surgery, even on fat people like Erin - the surgery date is even booked!

Of course, even in Australia, this kind of surgery costs a lot - It's not on Medicare, you need to go Private. And so, like so many others, he's opening himself up to the generosity of others to help cover at least some of the costs of this surgery.

So, if you would like to give back to an amazing trans man within the fiction podcast world, and you have the capacity to do so (he's very clear about this - if you're making less than $40K a year, you need that money more than he does), Please considering donating to his surgery fund. Even if it's just a little bit, every bit helps.

And if you can't? Reblogging this so that as many people as possible can see it would be a wonderful thing.

[latefrequencies]

Big life update that I'd like everyone to know about.

Many of you were probably at least somewhat aware of my family's plan to move to Canada and for me to come with them. Due to being disabled and dependent on them for housing, I assumed I had no choice but to move there.

I have received the information that a waitlist for Section 8 vouchers in my area is opening up, and I am going to apply.

Some of the reasons I prefer to live in where I have lived my whole life than Canada:

-I have no social circle in Canada, and I am now too disabled to reliably create a new one -While I can still receive SSI money in Canada, it will be drastically less than I receive now -I will not receive food stamps in Canada -The Medicare I get from disability benefits here covers medication (which I require to function), but Canadian healthcare does not

Today, I talked to my mother about it, and she told the rest of the family. While I was fully prepared to find a way to do this without help from anyone, she and my father are going to provide material support in the form of paying for moving costs and helping me furnish the new apartment to some extent.

Due to a variety of factors, I am reasonably sure that I will be approved for housing and am therefore treating it as though it is a certain thing.

My parents agree that this is the best possible outcome for me, and this will likely occupy a lot of my attention, both in stressful ways and in nice ways (such as thinking about how nice it will be to live in my own place).

After I get some details worked out, I will post a GoFundMe (or something similar). While I believe I will be able to afford everything I need to, I would still like to see what kind of support I can get from my blog's readership.

I am very happy with this decision, and while I will be very stressed about this situation, I will also be very happy, and when I get that housing, it will be one of the best things to ever happen to me.

[tomorrowusa]

When you vote for president, you are voting for the person who appoints federal judges – including those on the US Supreme Court. When you vote for US senator, you are voting for one of the people who confirms those judges.

Federal judges have lifetime appointments. So bad choices for president or senator live on long past the four-year or six-year terms of the elected officials who put those judges on the bench.

If you want to know what a fully Trumpified federal judiciary would be like, check out the US Court of Appeals for the Fifth Circuit. It covers Texas, Louisiana, and Mississippi. The Fifth Circuit makes the current US Supreme Court look liberal and capable.

The latest atrocity from the Fifth Circuit involves a decision where a state law forbidding abortion takes precedence over the survival of woman seeking emergency treatment.

The case is Texas v. Becerra, and all three of the United States Court of Appeals for the Fifth Circuit’s judges who joined this opinion were appointed by Republicans. Two, including Kurt Engelhardt, the opinion’s author, were appointed by former President Donald Trump. The case involves the Emergency Medical Treatment and Labor Act (EMTALA), a federal statute requiring hospitals that accept Medicare funds to provide “such treatment as may be required to stabilize the medical condition” of “any individual” who arrives at the hospital’s ER with an “emergency medical condition.” (In limited circumstances, the hospital may transfer the patient to a different facility that will provide this stabilizing treatment.) EMTALA contains no carve-out for abortion. It simply states that, whenever any patient arrives at a Medicare-funded hospital with a medical emergency, the hospital must offer that patient whatever treatment is necessary to “stabilize the medical condition” that caused the emergency. So, if a patient’s emergency condition can only be stabilized by an abortion, federal law requires nearly all hospitals to provide that treatment. (Hospitals can opt out of EMTALA by not taking Medicare funds but, because Medicare funds health care for elderly Americans, very few hospitals do opt out.) This federal law, moreover, also states that it overrides (or “preempts,” to use the appropriate legal term) state and local laws “to the extent that the [state law] directly conflicts with a requirement of this section.” So, in states with sweeping abortion bans that prohibit some or all medically necessary abortions, the state law must give way to EMTALA’s requirement that all patients must be offered whatever treatment is necessary to stabilize their condition. It is important to emphasize just how little EMTALA has to say about abortion. EMTALA does not protect healthy women who wish to terminate their pregnancies. Nor does it preempt any state regulations of abortion, except when a patient is experiencing a medical emergency and their doctors determine that an abortion is the appropriate treatment. But when an emergency room patient presents with a life-threatening illness or condition — or, in the words of the EMTALA statute, that patient has a condition that places their health “in serious jeopardy,” that threatens “serious impairment to bodily functions,” or “serious dysfunction of any bodily organ or part” — then Medicare-funded hospitals must provide whatever treatment is necessary. The Texas case, in other words, asks whether a state government can force a woman to die, or suffer lasting injury to her uterus or other reproductive organs, because the state’s lawmakers are so opposed to abortion that they will not permit it, even when such an abortion is required by federal law. And yet, despite the fact that the EMTALA statute is unambiguous, and despite the fact that this case only involves patients whose life or health is threatened by a pregnancy, three Fifth Circuit judges told those patients that they have no right to potentially lifesaving medical care.

Of course the ruling by the Fifth Circuit lacks basic logic. If the mother dies, the fetus is likely lost as well anyway. d'oh!

All three judges on the panel are Republicans – two having been appointed by Trump. Don't expect judicial genius from these folks.

Engelhardt’s opinion is surprisingly brief for such a consequential decision, and for one that reads a straightforward federal law in such a counterintuitive way. The section of the opinion laying out Engelhardt’s unusual reading of this federal law is only about eight pages long — yet it contains at least three separate legal errors.

This case will probably end up before SCOTUS. The best we should expect is for the Supremos to toss out the decision because of the legal errors made by the Fifth Circuit.

But in the long run, to protect reproductive freedom it's necessary to keep Republicans out of the White House and out of the majority in the Senate for the foreseeable future.

Be A Voter - Vote Save America

[generalchelseamayhem]

Unpopular Opinion: "Men suffer from toxic (you know what goes here) and Women suffer from sexism" is a fancy way of saying women are allowed to snap from trauma, whereas men should blame themselves and make sure they're never a danger to anyone else.

And boy, does society love that last one. Victim blaming at its finest.

This ask hits kind of a personally relevant note for me, so apologies if this is longer than you expected.

I think there's some kind of logic behind this, like people will say this about a woman on the assumption that she has exhausted every possible avenue of help, and found no help forthcoming, whereas they will say the other thing about a man on the assumption that help has been offered to him and he flatly refused to take it. Men will do anything rather than go to therapy! etc. etc.

And I think what this misses is the ways that everyone, including these same people, can even unknowingly disincentivise men from actually getting help.

I haven't told anyone I know IRL about this, but yesterday, I started therapy. It's costing me money out of my own pocket because Medicare only covers about 65% of the full price of an appointment—and that's if you've already gone to a GP and paid more money to get a referral. I digress. The point is, every single one of my friends I opened up to about my problems was like "Dude. Seek help. Now." It kinda made me feel ashamed for opening up about my problems in the first place, to anyone other than a trained professional. Yes, there was also a 2nd, 3rd, 4th, 5th place, so I can understand how it might have been hard to deal with, but the feeling remained.

Eventually, it reached the point where I could no longer justify my "self-improvement using only myself" regimen against my punishingly restrictive budget. Not only because my ability to cope reached an end, but because my budget finally got a bit more relaxed. So I listened to my friends and booked an appointment with my GP, then with a psychologist she referred me to.

First impressions are everything, and I have to be frank, I don't think I built much of a rapport with this guy. But the main issue was—

If you've ever had mental health issues, what's the one thing that always prevents you from seeking help?

Correct, that your problems are tiny and not worthy of consideration next to the grand scale of human suffering. Why should the psychologist be helping you, when there are actively suicidal people or people in prison or abuse survivors, all with way worse problems than you, whom he could be helping instead?

People around you will insist that all mental health struggles are valid, that there isn't, like, a minimum standard for how desperate you need to feel before you seek help.

I wasn't really sure how to start, so I just told him the story of what happened to me during the pandemic. The way my ex and I drifted apart, the way I sacrificed some of my needs during that time to make sure hers were met, the financial pressure I felt from my parents cajoling me into buying a house, other seemingly close friends (at least 3 of them?) ghosting me without the slightest explanation.

And all he could say at the end, when I'd run out of things to talk about, was "What do you want me to do here?"

I can understand why a question like that might be asked in therapy settings, but hearing it so bluntly like that... it genuinely made me feel like my problems were insignificant on a scale I hadn't imagined. It was said in a way that suggested there was nothing here for us to latch onto, nothing for us to improve upon, just me whining about stuff that happened ages ago. It hurt.

Obviously I didn't have much of an answer to give. If I knew what to do about the things that were making me feel sad, I would have done them myself without paying $60 for a middle-man to tell me to do them. Broadly speaking, I would like the bad feelings to go away and my awkward behaviour in certain situations to stop! Was that not obvious? You're the expert! If you listened to me talk for 40 minutes and you don't think there's a clear and obvious way forward, what does that say about the scope and severity of my problems?

I don't think I'll stick with this guy. My point here is, I think people should be a lot more careful about recommending therapy to men, because they can be so careless about dismissing men's problems out of hand with the other side of their mouth. Whether that takes the form of mocking people for male tears, or chastising them because women aren't your therapists and can't be expected to perform that kind of emotional labour, or any other of a number of subconscious biases that still insist "Your problems aren't actually real."

To be quite honest, I don't even think therapy will be a productive avenue for me. That kind of thing never factors into these conversations though, and I think that's because a lot of "men need therapy" discourse is entirely performative.

[harmcityherald]

How well does Medicare cover end-of-life care? It depends on what type

[franciskirkland]

Hypermobile Françoise anon here!!

1. I hope things start going better for you :c

2. What are your Gerita headcanons, if you have any?

3. Do you have any crackships you enjoy? (For example, I'm a Sweden/Italy enjoyer)

1 - thank you!! <3 i am so exhausted 100% of the time i literally cannot keep up with basic life expectations which in turn contributes to the ongoing misery of my living situation. i've had the last couple days off from work and i haven't gotten much done as far as writing bc i needed to catch up with housework and rest. i work for the next 3 days so i might go quiet bc i need to sleep for at least 12 hours or i'll disintegrate. i have a Blood Doctor appt on monday that i've been waiting literally 5 months for but i might need to cancel it bc my medicare card is expired. sobbing emoji x 5

2 - tbh idrk what ppl mean when they ask for non-specific headcanons like without context i'll forget every thought i've ever had. like my general thoughts on them or... ? i love gerita they're really sweet... i've been thinking about starting a fic soon! they're husbands with each other this is canon actually. it's such an essential ship to me like i can't see them not together unless one of them died lol

before getting together their lifestyles and habits were so incompatible but ludwig has learned to be less rigid and likewise feliciano is forced to clean up his act re: being a lazy little slob.

i feel like they'd have a lot of pets, specifically dogs and cats. like everything in their house is covered in fur, their pets are so pampered and they refer to themselves as mutti and vati when talking to them...

the introvert/extrovert couple of all time. ludwig can't stand PDA but they're so sappy behind the scenes.

feliciano packs ludwig lunch every day and puts the most embarassing little notes in it.

their refrigerator is covered in stickers for some reason? no children were responsible for this.

ludwig is the designated driver bc feli is so reckless but feli complains that he's too slow and begs him to let him drive. he never does.

they've almost broken up over putting together ikea furniture.

3 - crack ships? not that i can really think of?? i like most ships tbh so i see potential in pretty much any characters that have interacted.

for pure crack value i'm sure there's something but sorry my brain is mush rn. what about crossover ships like mad men lane pryce x france hetalia lmfao. napoleon x france? england x his hand?? england vs queen elizab - no let's not do that please.

prumano is crack to me bc (in my opinion) they're too chaotic to actually work, like in close proximity i give them a week until they kill each other by accident or intentionally.

gilbird and pierre are nesting partners. get it? bc they're birds.

[davidzoltan]

Accountability.

What all the pageantry and the celebrities and the big names are supposed to distract you from is that our primary job as voters during election season is accountability. Indeed, the mood being set was one of bringing “joy” to this election so as not to highlight the deficiencies in real answers. Or for where real answers were provided that didn’t stack up.

Vice President Kamala Harris, in her historic acceptance as the first Black woman and first person of Asian descent nominated for the presidency from a major political US party, spoke to her commitment “for the people”. The rest of her speech with its scant details makes one continue to question though, “Which people?” and the answers so far do not all point in the right directions.

Most glaringly perhaps, at least to be stated boldly out loud, was a promise to have the “strongest, most lethal fighting force in the world”. Which people are asking for this? Indeed, how does one make a military that is exponentially larger than all the other militaries in the world stronger and even more lethal? Who benefits from this statement?

The obvious answer is the military industrial complex. But let’s name names which is important. The top 10 defense contractors as of last year included: Lockheed Martin, Raytheon, General Dynamics, Pfizer, Boeing, Northrop Grumman, Humana, HII, L3Harris, and BAE Systems.

And while those certainly represent jobs which put food on the table for many thousands of families, it is incumbent upon us to ask if the capacity for destruction, direct or indirect, that these companies create is not better spent, those jobs better assigned to production that benefits the people in a broader sense, for a better world for all.

“Every gun that is made, every warship launched, every rocket signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed.” - President and former 4-star General Dwight D. Eisenhower (R) 

Indeed, a recent study has proposed that we could have all our human and civil rights met with but 30% of our current production power if that production were directed towards the needs of the people. If we weren’t stealing from the poor for the benefit of the rich and powerful, we could make marvels.

While I do not deny the need in this current world as it stands that there is a need for a standing military, even that being an admission that some of my fellow leftists would consider grotesque but that I consider sadly realistic, we need a strong military that is used incredibly selectively, in coalition with other nations, and only where the human and civil rights of the people of the world are endangered. A military that spends a TENTH of what we do at present would better serve us all. A military that pays its servicepeople a living wage and that ensures that after they serve they enter a country that has Medicare for All to cover their medical needs and a VA with proper funding that serves the additional supports that their service in the military must address. A military that can’t potentially be turned against its own people should an authoritarian ever actually ascend once more to the Oval Office with a plan like Project 2025 that could truly initiate a full fascist government rather than the proto-fascist one we have in place now.

All of this, of course, also turns our attention to the great injustice of the genocide in Gaza. I am careful to lead with calling it a genocide, because that word, genocide, was carefully editted out, one might even use the word censored nearly appropriately here given the context of this spectacle being part of our governmental process, for better of for worse,of any and all speeches given inside the convention. Even as protesters diligently spoke of the genocide outside the walls of the United Center, it was demurely called simply a “war” within them.

Wars are acceptable. We can fund wars. We can supply weapons from those companies mentioned above and hundreds more to a war. Profiteering off of war is quite nearly as old as humanity itself. It’s how kings and queens and billionaires are made.

But we have laws against supporting genocide, and as long as that word isn’t uttered in the halls of power, a gentleman’s, and now gentlewoman’s, understanding can be made that all is normal. All is good.

That can’t be further from the truth. In the Talmud, we are taught as Jews that to save a single life is to save the entire world. At least 40,000 worlds have already been snuffed out by this genocide. The killing is not indiscriminate as the Israeli army has the most sophisticated American technology allowing them precise control over who lives and who dies. Hospitals, schools, refugee camps obliterated with the press of a button. Palestinians used as human shields. Children, babies even, not given even a chance for life, a chance for peace.

It must stop. An arms embargo is the very least we must do. A funding embargo should also be put in place. Until Israel ends its genocide and its aggressions into other war footing, we cannot continue to enable them. Period.

Harris spoke of the right for Israel to defend itself and went so far as to promise to arm them to do so in open defiance of the calls for an arms embargo. Let’s set aside if a colonialist project can ever be said to be defending rather than, by its very nature, continuing an offensive that started with Theodore Herzl inventing Zionism in the first place in 1897. But what is defense truly? We call our war machine the “Department of Defense”, but when was the United States last on the defensive in a conflict not of our own making?

My example of defense comes from the stories of my grandmother who was a freedom fighter in Budapest in the Shoah. She did not fight with guns. She helped run an underground cell of Jews, moving from building to building, protecting each other and keeping each other alive. She spoke of using the skills she learned in her village in Ukraine from her family, cooking, sewing, healing, caring for one another, holding each other as bombs exploded overhead and guns fired in the streets outside. She won against the Nazis because they survived.

Where is this kind of defense for the Israeli people? Indeed, most of the families of the hostages realized long ago that their loved ones were being used by Bibi to hold onto power. They are not being defended with care and compassion. They are pawns for power, and they’ve spoken out against it. Former Israeli Defense Forces members that retired their military careers in protest have confirmed this from their own experiences while still in the IDF and from sources they have still inside. What we have enabled as the US through our war machine is not defense but a human rights disaster.

This alone is enough to call Harris to account in her bid for the presidency. Not only on moral grounds, but on the grounds that this is going to be an incredibly close race, scarily so given what the other party is offering, and standing on the wrong side of these issues of enabling genocide and fueling the military industrial complex will absolutely keep people from coming out to vote. Votes that Harris needs desperately.

Votes that could desperately use her message of what she calls an “Opportunity Economy” that is being lost under the sounds of bombs. There is little doubt that despite propaganda by the rich suggesting falsely that the economy does worse under Democrats, the people could benefit from many of the proposals that Harris suggests. Depending, of course, on how it is done.

Expanding Medicare negotiations on drug prices beyond the 10 already done would be excellent, and that work shouldn’t stop until it covers every drug and medical device. That’s work that would be necessary even under Medicare for All, though we’d have even far more leverage if M4A was in place than we already have with just Medicare, so it is small-p progressive work to be certain.

Passing a federal law enshrining Roe v. Wade is essential to personal liberties. Full stop.

Going after grocery companies gouging prices is good. We’ve all seen the charts showing the virtual monopolies that have developed in most sectors, food chains included. Breaking down price gouging and possibly even breaking up those monopolies would do some real good there.

Passing the John Lewis Voting Rights Act (Rest in Power, legend) and the Freedom to Vote Act would prevent real abuses by white supremacists that especially Black and Brown voters are facing right now.

All that said though, even some of her rosier sounding domestic projects require accountability. Not just needing more details which the campaign still has not released in any way, especially by punting on the national platform by just passing what was planned under a Biden presidency. We must truly examine how we transform our broken-on-purpose system to a government whose first goal truly is one of enabling and ensuring our human and civil rights. A government founded on compassion and care.

Let’s start, perhaps predictably for me, with housing.

The solutions that got us into this housing crisis cannot get us out of it. When every major city has a glut of vacant housing, enough to house the entire unhoused population many times over, the call to build starts to sound like exactly what it is. A solution to benefit the real estate industry, not the people in desperate need of alternatives.

We don’t have a housing supply problem. We have a landlord greed problem.

The primary public policy need for building is to ensure affordable accessible housing which accounts for less than one percent of current housing. There are a few, especially rural communities, that also need actual units for the populations they serve, need for sustainability, or simply to accommodate people that wish to live there and be part of that community, but that have been stymied by NIMBYism and disinvestment, just another form of that landlord greed problem.

But fundamentally, putting our human right to housing in the hands of the landed gentry (the continued use of the title of land-lord is not an aberration) and tying it to financialization, all a modern form of the feudalism that white men brought with them to these shores, have completely distorted housing in America and in many places abroad as well. A standard that has infected the nonprofit “affordable housing” sector as much as any other, indeed creating some of the most prolific slumlords in practice. An alternative is needed, and it must be pursued aggressively.

That starts with supporting Rep. Delia Ramirez’s bill to repeal the Faircloth Amendment. Since 1998, the federal government has been prohibited from direct investment of funding to building additional public housing and placed limits on what individual local housing authorities could create. Of course with no federal funding coming for nearly three decades, local housing authorities are far from pushing those limits. Quite the opposite, in fact.

Public housing has been divested, privatized, and largely neglected. This was by design, of course, so that private real estate could maximize profits, and now we stand at a time where more than half of renters are paying more than 30% of their income in rent and rent expenses, also known as rent-burdened.

Moreover, finding the next evolution of what public housing can look like, has been stymied as well. That evolution, called social housing for its emphasis on community control, can be found in most other nations, the gold standard being in Vienna, Austria. This takes public funding of housing and expands upon it to make it permanently affordable, community-owned and tenant-governed. That means largely out of the control of politicians and bureaucrats, and, most especially, fully out of the control of landlords, vesting that control in the communities and especially the residents of the housing itself. And as it is publicly funded and community focused, it also is designed to meet our chief public policy goals of meeting accessibility needs and green infrastructure needs.

American experiments towards this end are underway already in Seattle and Hawaii with Chicago already having starting funding in place and getting ready to get started soon as well. Montgomery County, MD has something adjacent to social housing too. Seattle and Chicago are hoping to be inspired by the Vienna model while Hawaii is looking to the Hong Kong model. California and other states and local governments continue to study social housing too, and they hope to move forward soon.

But until the coffers at the federal level open up, this will all be difficult at best to pursue. Harris should be talking about these alternatives to the privatization model that got us in this mess, not creating more tax incentives to build millions more of the same.

The venerable Rep. Maxine Waters (D-CA), Ranking Member of the House Financial Services Committee in the US House that oversees housing matters, even remarked that she is now “basically opposed to tax incentives because I think that all it does is give rich people, the builders and the developers, more money than they should have when they claim that they’re building affordable housing.” I agree fully, and I would go further to say that those tax incentives and “public/private partnerships” that evolved as a result of federal policy in the wake of Faircloth have created a scenario that encourages slumlords as landlords are more dependent on government money than tenant rents for their revenues (profits by a non-profit name) that enrich executives, salaries and incentives sometimes reaching upward of millions of dollars, and given that the government is not a tenant nor enforces its own laws properly, there is no reason for landlords to keep their properties in habitable conditions.

Which brings us, of course, to immigration, and especially the influx of migrants from countries like Venezuela that US foreign policy has created.

We talk a whole lot about “border security” but not nearly enough about the roles of the CIA and foreign policy in general that created the influx of people to our borders. To Harris’s credit, she seemingly takes a position that immigration on the whole is good. Under certain conditions. If you do it exactly the way she proscribes.

To that end, Harris proposes passing the “bipartisan border security bill”, but this bill would increase funding to ICE and concentration camps on US soil. Not ok.

She proposes reforming the immigration system and creating an “earned” pathway to citizenship, but she provides no details nor justification for why citizenship must be earned for immigrants now when our country’s original sins of colonialism and slavery certainly didn’t require earning that citizenship for white people or the Black slaves they brought to serve them. If, as Harris implies, America is better off with immigration and certainly the studies confirm that we are, then what more must be earned than a desire to be here and to add to the vitality of our communities?

Indeed, most immigrants even pay taxes into our national, state, and local coffers without many of the benefits that come with citizenship, so what more would we ask of them on that basis alone?

Meanwhile, holding Harris to account on her tax proposals in general is key. She proposes a sweeping and vague tax cut on the poorly defined and some would say divisive group she calls the “middle class” that would touch 100 million people. To damn her with faint praise again, it is indeed better than Trump’s additional tax cuts for the wealthy which we know never works, but without details, that’s the best that can be said of the proposal.

And what about the poor? A part of the working class that has been growing by the day. She has mentioned in other speeches made recently bringing back and expanding the child tax credit which has been one of the most expansive poverty measures in recent years and done some real good. But it is far from enough, especially for all the families out there that have made the decision not to bring a child into the world under poverty conditions.

And while we are reducing the price of groceries, let’s also talk about expanding SNAP benefits too to put more food on the table for those in need. SNAP is consistently one of the best poverty measures, helps create more demand for farmers’ products, and has one of the highest velocities of money for any government program as it’s putting the money in the hands of the people directly and circulating through every level of the economy. Putting more money in the hands of more people by raising federal funding to the states for SNAP to both expand benefits for current users and raising the caps on the current means testing to include more people and allow beneficiaries to earn more without losing access to food would help a tremendous number of people.

Harris speaks of protecting Social Security and Medicare, but protecting is not the same as expanding to ensure that it meets the real needs of lifting people out of poverty conditions. We need not just a Living Wage for workers, but we also need a Living Wage for Social Security. This would be a feasible part of the discussion if Harris were willing to commit to ending the cap on Social Security taxes and even proposing a progressive taxation to reduce the burden on the working class and greatly expand what the wealthiest earners contribute to the program.

And, obviously, passing and enacting the Improved Medicare for All bill as she once promised to do as a senator before becoming a presidential candidate.

Indeed, that’s not all to talk about where taxes are concerned as it has become increasingly obvious that there is a great need to not just capture the wealth of the most wealthy to compensate for our broken systems that create billionaires through exploitation or inheritance. Where is talk of not just reducing the tax burden on the working class but increasing the tax burden on those that can handle it with ease and that use that wealth to unduly influence power?

We need a wealth tax. I’d like to see a 100% wealth tax on estates worth more than $1 billion with a progressive system on excessive wealth below that, but I’d settle for something closer to Spain’s 1.7-3.5% to start with. Indeed, Massachusetts has already brought in $1,8 billion just this year alone with their 4% surtax on income over a million dollars.

While we rework the tax code, Harris seeks to send capital to small business owners and entrepreneurs and founders. Certainly, promoting small businesses should be a major priority. Community businesses that serve their communities in various ways deserve funding, and innovation comes from small business far more often than from large ones who seek more to protect their turf and suck up competition to maintain their profits for investors.

But that very difference highlights the vast problems in our current tax code that provides endless loopholes and subsidies and benefits for some of the largest and most profitable industries on the planet, often involving corporations that are also the most exploitative of our natural resources and labor. If we’re going to actually refocus on small businesses, let’s go all in.

Start by cutting off the fossil fuel industries completely. Then keep going from there until we’re sending out money to small businesses alone or as nearly so as national priorities allow. And as these industries will no doubt try to raise prices, put more dollars into working class family pockets, tax those corporations more, and keep them honest especially through antitrust actions and going after retaliatory price hikes with legal resources and using the bully pulpit to call them out for trying to keep the profits flowing to investors and executive pockets rather than prioritizing their customers. All while starting to fund the small businesses with even a fraction of that money saved to create the future competitors that will challenge the monopoly or cartel power they have.

While we’re at it, we can end the preferential treatment that investment money has currently as well as other abuses of the system that the rich and powerful have carved out for themselves in investment circles. We can strengthen the inheritance tax once again to prevent massive fortunes from giving some people opportunities at the expense of others and extending the wealth disparities down the generations.

And we can talk about reparations. Long, long overdue reparations for slavery. If we really want to talk about accountability, that must be on the table as well as land back to Indigenous people. We must be accountable as a nation for our original sins, and that leadership should be coming from the White House. How is our potentially second Black president not talking about these incredibly important issues as she touts her civil rights cred on stage?

Now let me be accountable to you, the reader, for just a moment about myself. I am not a member of the Democratic Party now, nor have I been for a very long time. I have no obligation to vote for Democrats, but as a leftist, our current voting system forces me to do so. But that is one of many reasons that I do work as a human rights activist that specializes as an expert in housing and disability policy. To change the system. To keep it accountable as much as I can and to put pressure on it in the hopes that eventually there will be a party that will represent me and my ideals.

In truth, voting is the start of democracy. Far from the totality of it. You must engage further than just showing up to vote. Organizing for justice is essential.

When the change from Biden to Harris happened, I, like many out there, were excited. Change was needed, and we all saw it. We organized for it and finally won. I was ready to throw down in the hopes that the message was heard, and that Harris would offer a new path, especially on the genocide. She proved last week that that wasn’t the case, even doubling down on the war footing. Plus, her policy platform remains largely an elusive, amorphous, largely undefined moving target.

I will vote for Harris because the alternative is truly horrific on all counts. We’ve seen their policy. In great detail. I know I would die or have to flee the country if Trump wins. Harris at least keeps me in the fight here in the US. But my ability to actively support her, to do work of my own accord, to spend spoons for her has been nullified completely, just as it was for Biden. I have to vote for her, but I won’t work on behalf of genocide.

There will be others that can’t even bring themselves to vote for her without a tremendous push in the direction I outline above. The joy is gone. For especially our Palestinian brothers, sisters, and non-binary family, despair has set in, and all the promises taste like the ash that covers Gaza. I can’t blame them.

A better world is possible if we reach for it. We can have a government grounded in compassion and care if we demand it. Ensuring that every single person in this country has their human and civil rights is absolutely feasible if we hold our elected officials accountable for it.

Or in the words of Chairman Fred Hampton, “Peace to you if you’re willing to fight for it.”

[ridenwithbiden]

"Donald Trump's Plan for America is called "Agenda47" and it's a helluva thing.

Here are the top ten worst agenda items:

#1 Agenda47: President Trump Calls for Death Penalty for Human Traffickers President Donald J. Trump pledged to end the scourge of human trafficking and defend the dignity of human life.

This is the worst. Firstly, capital punishment is reserved for people who have committed murder (eye for an eye) of the most horrible and horrific crimes, involving mass casualties, rape, torture and/or mutilation.  Human trafficking is not that, but honestly, if someone was murdered during the process of human trafficking that would probably already be covered.  This standard is supported by SCOTUS case law, so without murder, it might not even be possible legally.

Secondly, this reminds me of Trump's call for the death penalty against the Exonerated Central Part 5 who were children at the time. He wanted them executed even though the victim, who was assaulted and raped, survived the attack.  She was hurt badly but it simply wasn't a capital offense, and the judicial murder of children is an international crime.

Continued.

#2 Agenda47: Protecting Students from the Radical Left and Marxist Maniacs Infecting Educational Institutions For many years, tuition costs at colleges  and universities have been exploding, and I mean absolutely exploding  while academics have been obsessed with indoctrinating America's youth.  The time has come to reclaim our once great educational institutions  from the radical Left, and we will do that

This isn't about tuition costs, it's about the same cultural indoctrination, book-banning, censorship, harassment, intimidation, reverse-racism CRT and Trans panic that we've seen in Florida.  Trump wants to take that crap national. He liked this idea so much, he listed it twice.

#3 Agenda47: Using Impoundment to Cut Waste, Stop Inflation, and Crush the Deep State I will use the president’s long-recognized  Impoundment Power to squeeze the bloated federal bureaucracy for massive savings. This will be in the form of tax reductions for you. This will help quickly to stop inflation and slash the deficit.

This is about purging the government of his enemies and dissidents. Anyone who might impede or resist the agenda. Notice he doesn't mention anything about keeping the function and implementation of government in good quality. He doesn't care about whether government employees do their jobs well and efficiently - he just wants payback against the so-called "Deep state." It also won't lead to tax cuts because that would have to be separate legislation. And it's a laugh to expect that you would reduce the deficit with a job purge, people that aren't working don't pay taxes - so incoming receipts go down and the deficit goes up.  Trump promised to "eliminate the debt" the first time, but in the end, his tax cuts increased the deficit by $400 Billion during his first 3 years, then another $2.2 Trillion with his 2 Covid recovery packages.  He left office with a deficit of $3.3 Trillion.

#4 Agenda47: Ending the Scourge of Drug Addiction in America Too often, our public health establishment  is too close to Big Pharma—they make a lot of money, Big Pharma—big  corporations, and other special interests, and does not want to ask the  tough questions about what is happening to our children’s health.

This is a laugh because the GOP would never let him undercut their donor base with massive cuts to pharma. Yes, they do make a lot of money - and they spend a lot of it on Congress, they aren't letting him destroy their cash cow.  The GOP doesn't like that Medicare can negotiate with big Pharma now, they aren't letting everyone do it. However, the larger problem of actual *addiction* won't be solved by making drugs cheaper. It's pretty arrogant of him to think he can solve a problem he doesn't begin to understand.

#5 Agenda47: Day One Executive Order Ending Citizenship for Children of Illegals and Outlawing Birth Tourism As part of my plan to secure the border, on  Day One of my new term in office, I will sign an executive order making  clear to federal agencies that under the correct interpretation of the  law, going forward, the future children of illegal aliens will not  receive automatic U.S. citizenship

It's kinda cute and pathetic that he thinks he can reverse most of the 14th Amendment with an executive order. Who the fuck taught this guy "government?"  Yeah, Let me just cross out the bit that reversed the Dred Scott decision that said that no one of African descent was a citizen using a Sharpie.  Besides the Xenophobia of this "Anchor Baby" shit - just imagine the potential ethnic and racial abuse possible with something like this in place.

#6 Agenda47: Ending the Nightmare of the Homeless, Drug Addicts, and Dangerously Deranged For a small fraction of what we spend upon  Ukraine, we could take care of every homeless veteran in America. Our  veterans are being treated horribly.

You can end homelessness, drug addiction *and* mental illness for less than the cost of Ukraine? Wait I thought you already fixed drug addiction, why is that still a problem?  it's simply amazing what you can accomplish with just 1/5th of the VA budget.

#7 Agenda47: Rescuing America’s Auto Industry from Joe Biden’s Disastrous Job-Killing Policies Joe Biden is waging war on the U.S.  auto-industry with a series of crippling mandates designed to force  Americans into expensive electric cars, even as thousands of electric  cars are piling up on car lots all unsold,” President Trump said. “This  ridiculous Green New Deal crusade is causing car prices to skyrocket  while setting the stage for the destruction of American auto production.

The auto industry is doing fine and EV sales are expected to reach 35% of the market soon.  The only really "expensive" EVs are Teslas [some of them], most of the rest of them and hybrids are completely affordable. Plus what you save on not buying gas which keeps us dependent on states like Saudi Arabia, Iran and Russia. The Green New Deal didn't pass. Also, jobs are doing fine also.  Better than literally ever.

#8 Agenda47: Liberating America from Biden’s Regulatory Onslaught No longer will unelected members of the Washington Swamp be allowed to act as the fourth branch of our Republic

You mean like Train Safety regulations that could have prevented the East Palestine disaster? Or regulation that could have prevented Silicon Valley Bank from collapsing? Or the regulation rollback that led to the Great Recession? Or the ones that led to Enron? Cutting regulations is supposed to boost the market just like cutting taxes, but Trump's GDP never got near the 5% he predicted, it averaged at 1.7% pre-Covid and went negative after. Biden's first year had over 5% GDP.

#9 Agenda47: Rebuilding America’s Depleted Military In a new Agenda47 video, President Donald  J. Trump announced his plan to rebuild America’s depleted military,  address the military recruitment crisis, and restore the proud culture  and honor of America’s armed forces.

The Military is simply not "depleted" - military spending went from $758 Billion in 2021 to $814 Billion in 2023.  What he really means is that he's going to replenish the stock prices for Defense Contractors.

#10 Agenda47: Ending Biden’s War on the Suburbs That Pushes the American Dream Further From Reach President Donald J. Trump announced his  plan to end Joe Biden’s war on America’s suburbs in a new Agenda47  video. Biden’s proposed rule that every state, county, and city submit  “equity plans” to the federal government will push the American dream  out of reach for countless American families.

So we're still suffering from decades of deliberate racial terrorism, redlining, spreading pollution, jobs deserts and education deserts - but let's not consider trying to *FIx* any of what was deliberately and purposefully broken over the last 2 centuries.  Let's just leave it all fucked up. the way it already is.

White Power Y'all. Yeah, 'Murica!"

[the-daily-tizzy]

China does NOT hold the largest amount of U.S. DEBT; U.S. Social Security Administration does!

A woman, or man dies at age 65 before collecting one benefit check.

She/He and her employer paid into the system for almost 50 years and she collected NOTHING

Keep in mind all the working people that die every year who were paying into the system and got nothing.

And these governmental morons mismanaged the money and stole from the system, so that it's now going broke.

And they have the audacity to call today's seniors "vultures" in an attempt to cover their ineptitude.

The real reason for renaming our Social Security payments is so the government can claim that all those social security recipients are receiving entitlements thus putting them in the same category as welfare, and food stamp recipients.

By changing the name of SS contributions, it gives them a means to refute this program in the future.

It's free money for the government to spend under this guise.

The Social Security check is now (or soon will be) referred to as a Federal Benefit Payment ?

The government is now referring to our Social Security checks as a "Federal Benefit Payment."

This is NOT a benefit.

It is OUR money, paid out of our earned income!

Not only did we all contribute to Social Security, but our employers did too!

It totaled 15% of our income before taxes.

If you averaged $30K per year over your working life, that's close to $180,000 invested in Social Security.

If you calculate the future value of your monthly investment in social security ($375/month, including both you and your employers' contributions) at a meager 1% interest rate compounded monthly, after 40 years of working you'd have more than $1.3+ million dollars saved .

This is your personal investment.

Upon retirement, if you took out only 3% per year, you'd receive $39,318 per year, or $3,277 per month

That's almost three times more than today's average Social Security benefit of $1,230 per month, according to the Social Security Administration. (Google it – it's a fact).

And your retirement fund would last more than 33 years (until you're 98 if you retire at age 65)!

I can only imagine how much better most average-income people could live in retirement if our government had just invested our money in low-risk interest-earning accounts.

Instead, the folks in Washington pulled off a bigger Ponzi scheme than Bernie Madoff ever did (or Lyndon Johnson).

They took our money and used it elsewhere.

They "forgot"(oh yes, they knew) that it was OUR money they were taking.

They did not have a referendum to ask us if we wanted to lend the money to them…and they didn't pay interest on the debt they assumed.

And recently they have told us that the money won't support us for very much longer. (Isn't it funny that they NEVER say this about welfare payments ?)

But is it our fault they misused our investments?

And now, to add insult to injury, they are calling it a benefit, as if we never worked to earn every penny of it

This is stealing !

Just because they borrowed the money, does not mean that our investments were for charity!

Let's take a stand.

We have earned our right to Social Security and Medicare.

Demand that our legislators bring some sense into our government.

Find a way to keep Social Security and Medicare going for the sake of the 92% of our population who need it.

Then call it what it is: Our Earned Retirement Income .

[battleangel]

Who Cares About a Bunch of Dead Black & Brown People?

"Canadian wildfires" from this summer, if you remember them, were a "100 wildfires that started simultaneously in Canada". Yeah, okay.

Yet, if you recall, all the videos on the news and social media were of the smoke that completely filled and covered the sky on the east coast of the U.S. like a literal alien attack movie, like ID4.

People on social media reported seeing mushroom clouds and bombs being tested in NYC.

This is because the government was testing alien weaponry including bombs.

Right after the "Canadian wildfires", a former CIA director admitted in a Congressional hearing that "non-human remains" aka alien remains had been found by the government for years.

During this time this past summer, record levels of air pollution and toxicity were reported on the east coast as well as record humidity.

Yes, due to climate change but also due to government testing of confiscated alien weaponry and bombs that polluted the air and created unheard of levels of humidity.

Climate change has been known for decades and yet nothing real has been done about capitalism which drives every aspect of climate change, from the destruction of the rainforest by fast food conglomerates, to greenhouse gas emissions fueled by the auto industry, factory farming practices responsible for ethane from animal feces which is a huge climate change contributor plus all the millions of gallons of water required, drilling for oil, oil spills, oceanic pollution from non-biodegradable trash that ends up in the ocean, endless Amazon warehouses, endless SHEIN & Amazon landfills, air conditioning house at 70 degrees at all times, endless cars clogging the highway all rushing to nowhere to sit in traffic to waste the day away inside in a building wasting your life away for a paycheck & benefits, emitting pollutants out of your exhaust pipe smoke smog killing the environment depleting the ozone layer creating smog difficult to breathe, dirty machines belching smoke and gas on concrete highways to hell.

Yet noone does anything about rampant overconsumption, wastefulness, mindless spending, mindless buying, keeping up with the joneses, wasting money at IKEA, buying furniture to impress guests that never even come over, consumerism, materialism, oversized portions of food at restaurants, fast fashion worn today thrown in a landfill tomorrow, private jets killing the environment flying to nowhere for nothing, drones delivering Amazon packages that nobody needed in a day much less an hour and nobody does anything but to demand Amazon Prime deliveries in half an hour and Elon Musk is colonizing Mars and Bezos is flying rich wypipo to the moon.

This weekend, IGN via Bloomberg  reported 50k year old zombie viruses being released due to climate change causing Siberian glaciers to melt.

Government wants disabled, immunocompromised, elderly, lower income black and brown people gone. As many as possible.

Whoever else dies is just collateral damage.

Why?

Because by 2030, white people will become the minority in the US if current birthing trends continue and they will be replaced with blacks and hispanics making up the majority as their birth rates are much higher than white peoples especially amongst hispanics.

The elites are using the government to do whatever it can to reduce and delay this trend before white people become the minority in the US.

The government also wants to reduce Medicaid and Medicare enrollment as well as the money spent on these programs and what better way to do that than weaponizing viruses (COVID & 50k year old "zombie" viruses) via policies to kill off lower income food service, fast food and big box retail employees, people living in inner cities, disabled and the elderly, the majority of whom are black and hispanic?

Look at Beyonces and Taylor Swifts concerts over the summer, all the crowds and unmasking despite an increase in COVID cases, mutated COVID cases and long COVID cases with severe health consequences including extended hospitalizations and lung damage.

Why did noone care that this COVID resurgence was happening alongside the Eras and Renaissance tours with literally over a million people in attendance, extremely large crowds gathering with a real chance of concert attendees infecting one other?

Because, as we saw with George Floyd and the temporary black squares on Instagram, once the performative virtue signaling stage of COVID was over, nobody gave a fuck anymore and the elites know most people dont really gaf about poor, disabled, elderly black & brown people so the new COVID mantra became "stay tf inside if youre vulnerable, I aint wearing a mask to Eras or Renaissance cuz I look tew cute".

They correctly surmised people were o-v-a-h it and most had been summoned back to their wage slave 9 to 5 life of drudgery so they knew people wouldnt complain about the concerts as they had already done their "say her name Breonna Taylor" performative virtue signalling bullshit and now they wanted to shake their dreads to Slayonce and Taylor.

Who cares about a bunch of dead poor, disabled, elderly black & brown people anyway?

[absolute-immunities]

Personal takes:

The liberals were right in NFIB v Sebelius, 567 US 519 (2012): Congress can condition Medicaid reimbursement rates on coverage standards.

The conservatives were right in King v Burwell, 576 US 473 (2015): “the State” in “established by the State” doesn’t include the Secretary of Health and Human Services.

The Court was right in California v Texas, 141 S Ct 2104 (2021): a $0 ‘penalty’ isn’t a cognizable injury.

The Roberts CJ plurality on the Spending Clause, joined by Breyer and Kagan JJ, is as ridiculous today as the day it was decided.

Here, the Government claims that the Medicaid expansion is properly viewed merely as a modification of the existing program because the States agreed that Congress could change the terms of Medicaid when they signed on in the first place. The Government observes that the Social Security Act, which includes the original Medicaid provisions, contains a clause expressly reserving "[t]he right to alter, amend, or repeal any provision" of that statute. 42 U.S.C. § 1304. So it does. But "if Congress intends to impose a condition on the grant of federal moneys, it must do so unambiguously." Pennhurst, 451 U.S., at 17. A State confronted with statutory language reserving the right to "alter" or "amend" the pertinent provisions of the Social Security Act might reasonably assume that Congress was entitled to make adjustments to the Medicaid program as it developed. Congress has in fact done so, sometimes conditioning only the new funding, other times both old and new. See, e.g., Social Security Amendments of 1972, 86 Stat. 1381–1382, 1465 (extending Medicaid eligibility, but partly conditioning only the new funding); Omnibus Budget Reconciliation Act of 1990, § 4601, 104 Stat. 1388–166 (extending eligibility, and conditioning old and new funds).

The Medicaid expansion, however, accomplishes a shift in kind, not merely degree. The original program was designed to cover medical services for four particular categories of the needy: the disabled, the blind, the elderly, and needy families with dependent children. See 42 U.S.C. § 1396a(a)(10). Previous amendments to Medicaid eligibility merely altered and expanded the boundaries of these categories. Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level. It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage.

The argument that extending Medicaid to people “below 133 percent of the poverty level” makes it “no longer a program to care for the neediest among us” does not pass the laugh test.

It’s barely distinguishable from what Congress did in the Omnibus Budget Reconciliation Act of 1990, § 4601, 104 Stat 1388–166, which extended Medicaid coverage to families of minor children up to 100 percent of the poverty level, and extended the class of covered children from children under eight to children under nineteen.

Gisburg J also notes the Medicare Catastrophic Coverage Act of 1988, §302, 102 Stat 750, and the Omnibus Budget Reconciliation Act of 1989, §6401, 103 Stat 2258, which “required participating States to include among their beneficiaries pregnant women with family incomes up to 133% of the federal poverty level [and] children up to age 6 at the same income levels.”

Those enactments, Roberts CJ concludes, amended but continued the program created by the Social Security Amendments of 1965, §121(a), 79 Stat 343, but the Affordable Care Act of 2010, which extended coverage to “the entire nonelderly population with income below 133 percent of the poverty level,” repealed and replaced it.

Beyond its careless ontology, the Roberts CJ plurality fails to find either a constitutional basis for its limitations on the Spending Clause or a workable standard for identifying coercion.

On the former count, the Roberts CJ plurality discovers that the Spending Clause protects State interest in having federal disbursements to their citizens continued on substantially unchanged terms.

Congress can create new programs, with new funding, but “Congress is not free . . . to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”

The plurality infers that prohibition from the Court’s anticommandeering and Spending Clause precedents, the latter of which found the principle implicit in “Congress shall have Power . . . to pay the Debts and provide for the common Defence and general Welfare of the United States.”

Maybe your copy of the Constitution includes a term barring Congress from “taking away [the States’] existing Medicaid funding,” but I can’t find it in mine.

On the latter count—the coercion standard—the plurality doesn’t even try:

The Court in Steward Machine did not attempt to “fix the outermost line” where persuasion gives way to coercion. 301 U. S., at 591. The Court found it “[e]nough for present purposes that wherever the line may be, this statute is within it.” Ibid. We have no need to fix a line either. It is enough for today that wherever that line may be, this statute is surely beyond it.

For Roberts CJ, coercion is like hardcore pornography. He knows it when he sees it.

It’s remarkable to think that Breyer and Kagan JJ joined the Spending Clause part of the opinion in full. It strikes me as unusually lawless, even for a federalism case.

[yourreddancer]

HEATHER COX RICHARDSON

November 1, 2022 (Tuesday)

The Biden White House has tried since President Joe Biden’s inauguration to move past the Trump years and to focus instead on strengthening democracy by rebuilding the American middle class and by renewing our alliances and friendships with democratic allies. As his message has repeatedly been drowned out by the cultural messaging of the Republicans, Biden has begun to criticize their economic plans more directly, especially in the last few weeks. Today the White House released a fact sheet laying out exactly what it would look like to have the Republicans’ economic plans put into effect.

The Republican Party as a whole has not put forward a legislative agenda before this election to attract voters. Senate minority leader Mitch McConnell (R-KY) told donors, lobbyists, and senators in December 2021 that the party would focus only on attacking Biden and the Democrats. 

A Republican operative told Jonathan Swan and Alayna Treene of Axios, “One of the biggest mistakes challengers often make is thinking campaigns are about them and their ideas…. No one gives a sh-t about that. Elections are referendums on incumbents.”

Other Republicans disagreed with McConnell and have offered plans that cater to their base but run the risk of alienating non-MAGA voters. The White House highlighted some of those points today, focusing on prescription drug costs, Social Security, and Medicare.

The Inflation Reduction Act, which passed in August with Democratic votes alone, allows Medicare to negotiate the price of prescription drugs with pharmaceutical companies, caps the annual cost of medication at $2,000, caps insulin costs for those on Medicare at $35 a month, and lowers health care premiums for those whose coverage comes from the Affordable Care Act.

The White House said that Republicans want to repeal these measures, and in October, Senate Republicans James Lankford (OK), Mike Lee (UT), Cynthia Lummis (WY), and Marco Rubio (FL) in fact introduced the “Protecting Drug Innovation Act” to remove the negotiation ability, price caps, and health care premium adjustments in the Inflation Reduction Act “as if such parts had never been enacted.” Lee explained that “price controls never work” but instead “exacerbate the problems they seek to resolve. Mandating fixed prescription drug prices will ultimately result in the shortening of American lives.”

Republican leaders have also called for policies that threaten Social Security and Medicare. Senator Rick Scott (R-FL), chair of the National Republican Senatorial Committee, which funds senatorial campaigns, issued an eleven-point plan to “Rescue America” that called for—among other things—sunsetting all laws five years after passage and reauthorizing the ones that lawmakers wanted to keep. (Scott later added a twelfth point to the plan: cutting taxes.)

When challenged that his plan would threaten Medicare, Scott has repeated a talking point that Politifact, the Washington Post Fact Checker, CNN, and FactCheck.org have all called false: that Democrats are threatening Medicare because they “cut $280 billion out of Medicare.” In fact, the Inflation Reduction Act saves the government—and therefore taxpayers—somewhere between $237 billion and $288 billion by permitting it to negotiate with pharmaceutical companies; it does not cut services. In other words, Scott is lying that reduced government spending on Medicare thanks to the Inflation Reduction Act—savings the Republicans want to end—is the same thing as calling to sunset the program in five years. 

Senator Ron Johnson (R-WI) has called for making the funding for Social Security and Medicare discretionary, meaning it would have to be voted on annually, rather than leaving it as mandatory, covered by statute. "We've got to turn everything into discretionary spending, so it's all evaluated, so that we can fix problems or fix programs that are broken, that are going to be going bankrupt," Johnson told a right-wing radio show. "Because, again, as long as things are on automatic pilot, we just continue to pile up debt." 

 (NOTE - WHAT ABOUT THE TRILLIONS IN TAX CUTS TO THE RICH BY TRUMP?)

Like the plans of other Republicans, those of the Republican Study Committee (RSC), chaired by Representative Jim Banks of Indiana, start from the position that taxes on the wealthy hurt workers by causing “the misallocation of capital, creating a less robust economy, and leading to slower wage growth and job creation.” The RSC released a budget in September that rejected the idea of raising taxes to stabilize Medicare and Social Security and instead called for increasing the age for Medicare eligibility to 67 and that for Social Security eligibility to 70.

The Republican argument for weakening these popular programs is that they are too big a drain on the federal budget and that it is important to continue cutting taxes on the wealthy in order to free up capital for them to reinvest in the economy. This has been Republicans’ argument since 1980, but it has never produced either the economic growth or the tax revenue its supporters promised. In contrast, Biden and the Democrats maintain that cutting the nation’s social safety net will create hardship that will not be offset by tax cuts for the wealthy. 

 Biden and former president Barack Obama, who has been speaking in states with close races, have repeatedly made the point that Americans pay into Social Security throughout their working lives and have earned the payments they eventually receive. Today, in front of an audience in Florida, Biden read directly from Scott’s plan to sunset laws, quoted Johnson’s plan to make Social Security discretionary, and said “Who in the hell do they think they are?”