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chuck grassley
As Medicare Turns 58, It Still Must Be Protected and Expanded
Despite the demise of Build Back Better, we should not give up on expanding traditional Medicare. Real change takes time and persistence.
Jul 31, 2023
President Lyndon Johnson signed Medicare into law 58 years ago Sunday—on July 30, 1965. Before Medicare, most American seniors could not obtain health insurance; they had to rely on charity or help from relatives with medical bills.
"Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness,” said President Johnson at the signing ceremony. “And the time has now arrived to help them attain that opportunity and to help them get that protection."
Medicare was modeled on a typical Blue Cross/Blue Shield plan in 1965. The average health insurance plan 58 years ago did not include hearing, vision, or dental coverage. As Kaiser Health News points out, “Back in 1965, life expectancy was lower and health care (including dental) was more affordable.”
“When Medicare was created, its architects assumed expansion… in terms of benefits. (But) they didn’t anticipate the shift in American politics to the right.”
Today, life expectancy is longer and healthcare costs have skyrocketed. But traditional Medicare still does not cover hearing, vision, and dental care—leaving beneficiaries to bear the full cost of care for their ears, eyes, and teeth. Hearing aids, dental crowns, and eyeglasses can amount to thousands of dollars in out-of-pocket expenses, which many seniors simply can’t afford.
President Joe Biden’s original Build Back Better plan finally would have added hearing, vision, and dental coverage to traditional Medicare. The White House ultimately dropped dental and vision care from its plan after objections from Democratic centrists, leaving hearing coverage as the only potential benefit expansion. Then, the entire Build Back Better plan was killed at the end of 2021 when Senator Joe Manchin (D-W.Va.) withdrew his support, effectively ending any real chance to expand traditional Medicare benefits while Democrats controlled the White House and both houses of Congress.
As Jonathan Oberlander, professor of health policy at UNC-Chapel Hill, observed, “Medicare is the kind of program where you’d expect the benefits to be expanded over and over again.” But other than the addition of Part D prescription drug coverage (administered by private plans) in 2003, Medicare benefits have not been expanded in the 58 years since the program was enacted.
“When Medicare was created, its architects assumed expansion… in terms of benefits,” Oberlander told Kaiser Health News. “(But) they didn’t anticipate the shift in American politics to the right.” This shift, which took root with the election of Ronald Reagan in 1981, emphasized tax cuts for the wealthy and corporations, increased military spending, and spouted a lot of bluster about reducing deficits (hard to accomplish given the first two items on the list).
What President Biden called “human infrastructure”—services for everyday Americans struggling to thrive in a global economy amid growing wealth inequality—became a tougher political sell after 1981. The ill-fated Build Back Better plan was an earnest attempt to begin investing more resources in “human infrastructure.” Despite the demise of Build Back Better, we should not give up on expanding traditional Medicare. Real change takes time and persistence.
In fact, there has been real progress on Medicare in other ways. The Inflation Reduction Act (the reconstituted version of Build Back Better) finally allows Medicare to negotiate prescription drug prices with Big Pharma—an historic reform that took some 20 years to enact. The Inflation Reduction Act will cap beneficiaries’ out of pocket drug costs at $2,000 per year (starting in 2025), limits seniors’ insulin costs to $35 a month, and penalizes drug-makers for raising prices above the rate of inflation.
While Congress was unable to enact a hearing benefit for traditional Medicare enrollees, legislation introduced by Senators Elizabeth Warren (D-Mass.) and Chuck Grassley (R-Iowa) required the Food & Drug Administration (FDA) to create a rule greatly expanding access to over-the-counter (OTC) hearing aids, which the FDA did in 2022. These OTC products (suitable for mild-to-moderate hearing loss) can be significantly less expensive than prescription hearing aids. And while the president’s proposed dental benefit for traditional Medicare did not survive the legislative process, the Biden administration has expanded the definition of “medically necessary” dental care under Medicare Part B.
A 2021 study by Kaiser Family Foundation indicated that MA customers “still generally end up with significant out-of-pocket costs” for hearing, dental, and vision care.
Some Medicare Advantage (MA) plans do offer hearing, dental, and vision coverage—but those benefits are extremely modest and don’t always make up for the disadvantages of Medicare Advantage. Many MA insurers are under investigation for overbilling the government, denying authorizations for reasonable medical procedures, and misleading customers through celebrity ad campaigns. Meanwhile, Medicare Advantage plans restrict beneficiaries to limited networks of providers and sometimes don’t cover medical care outside of a patient’s home region.
A 2021 study by Kaiser Family Foundation indicated that MA customers “still generally end up with significant out-of-pocket costs” for hearing, dental, and vision care. “It stands to reason there would be lower out-of-pocket spending in Medicare Advantage than in traditional Medicare, but the differences are not as large as one might expect,” Tricia Neuman, a senior vice president at Kaiser Family Foundation, told Kaiser Health News.
These privatized Medicare plans, which unfortunately are growing in market share under the power of their advertising (boosted by a pro-MA bias during the Trump administration), were not part of the original vision for Medicare when President Johnson signed it into law. Traditional Medicare is the bedrock program which has provided seniors with health security since 1965. It must be preserved—and expanded—in accordance with the real needs of 21st century seniors.
On this 58th anniversary of Medicare, let’s recommit to President Johnson’s promise of the “opportunity to achieve and enjoy good health” and provide “security against the economic effects of sickness.”
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Sanders Unveils Bill to Force Pentagon to Pass an Audit—or Return Part of Its Budget
"The Pentagon and the military-industrial complex have been plagued by a massive amount of waste, fraud, and financial mismanagement for decades. That is absolutely unacceptable."
Jun 22, 2023
A bipartisan group of lawmakers led by Sen. Bernie Sanders introduced legislation Wednesday that would require the Pentagon to return a portion of its enormous and ever-growing budget to the Treasury Department if it fails another audit in the coming fiscal year.
The Audit the Pentagon Act, an updated version of legislation first introduced in 2021, comes amid mounting concerns over rampant price gouging by military contractors and other forms of waste and abuse at an agency that's set to receive at least $842 billion for fiscal year 2024.
"The Pentagon and the military-industrial complex have been plagued by a massive amount of waste, fraud, and financial mismanagement for decades. That is absolutely unacceptable," Sanders (I-Vt.) said in a statement as he unveiled the bill alongside Sen. Chuck Grassley (R-Iowa).
"If we are serious about spending taxpayer dollars wisely and effectively," said Sanders, "we have got to end the absurdity of the Pentagon being the only agency in the federal government that has never passed an independent audit."
In December, the Pentagon flunked its fifth consecutive audit, unable to account for more than 60% of its $3.5 trillion in total assets.
But congressional appropriators appear largely unphased as they prepare to raise the agency's budget to record levels, with some working to increase it beyond the topline set by the recently approved debt ceiling agreement. Watchdogs have warned that the deal includes a loophole that hawkish lawmakers could use to further inflate the Pentagon budget under the guise of aiding Ukraine.
Late Wednesday, following a lengthy markup session, the House Armed Services Committee passed its version of the National Defense Authorization Act, which proposes a total military budget of $886 billion. Rep. Ro Khanna (D-Calif.) was the only committee member to vote no.
A huge chunk of the Pentagon's budget for next year is likely to go to profitable private contractors, which make a killing charging the federal government exorbitant sums for weapons and miscellaneous items, from toilet seats to ashtrays to coffee makers.
"Defense contractors are lining their pockets with taxpayer money while the Pentagon fails time and time again to pass an independent audit. It's a broken system," said Sen. Ed Markey (D-Mass.), a co-sponsor of the new bill. "We need to compel the Department of Defense to take fraud and mismanagement seriously—and we need Congress to stop inflating our nation's near-trillion-dollar defense budget."
"Putting the wants of contractors over the needs of our communities," he added, "isn't going to make our country any safer."
"If the Department of Defense cannot conduct a clean audit, as required by law, Congress should impose tough financial consequences to hold the Pentagon accountable for mismanaging taxpayer money."
If passed, the Audit the Pentagon Act of 2023 would force every component of the Defense Department that fails an audit in fiscal year 2024 to return 1% of its budget to the Treasury Department.
A fact sheet released by Sanders' office argues that "the need for this audit is clear," pointing to a Commission on Wartime Contracting in Iraq report estimating that "$31-60 billion had been lost to fraud and waste."
"Separately, the special inspector general for Afghanistan Reconstruction reported that the Pentagon could not account for $45 billion in funding for reconstruction projects," the fact sheet notes. "A recent Ernst & Young audit of the Defense Logistics Agency found that it could not properly account for some $800 million in construction projects. CBS News recently reported that defense contractors were routinely overcharging the Pentagon—and the American taxpayer—by nearly 40-50%, and sometimes as high as 4,451%."
Further examples of the Pentagon's waste and accounting failures abound.
Last month, the Government Accountability Office released a report concluding that the Pentagon can't account for F-35 parts worth millions of dollars.
Earlier this week, as The Washington Postreported, the Pentagon said it "uncovered a significant accounting error that led it to overvalue the amount of military equipment it sent to Ukraine since Russia's invasion last year—by $6.2 billion."
"The 'valuation errors,' as a Pentagon spokeswoman put it, will allow the Pentagon to send more weapons to Ukraine now before going to Congress to request more money," the Post noted.
Sen. Ron Wyden (D-Ore.), chair of the Senate Finance Committee and a supporter of the Audit the Pentagon Act, said Wednesday that "taxpayers can't keep writing blank checks—they deserve long-overdue transparency from the Pentagon about wasteful defense spending."
"If the Department of Defense cannot conduct a clean audit, as required by law," said Wyden, "Congress should impose tough financial consequences to hold the Pentagon accountable for mismanaging taxpayer money."
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Billionaire Harlan Crow Also Bankrolled GOP Lawmakers Blocking SCOTUS Ethics Reform
A new analysis shows Republicans on the Senate Judiciary Committee have received more than $450,000 from the same GOP megadonor who has lavished Justice Clarence Thomas with undisclosed gifts.
May 09, 2023
The Senate Judiciary Committee on Monday sent a letter asking Harlan Crow—the billionaire GOP megadonor who has secretly showered U.S. Supreme Court Justice Clarence Thomas with hundreds of thousands of dollars in gifts since the mid-1990s—to provide a full accounting of his financial ties to Thomas and any other judges on the high court.
It comes as "no surprise" that none of the panel's nine Republicans signed the letter, Accountable.US declared Tuesday, because they have collectively accepted nearly half a million dollars in campaign cash from Crow since the turn of the century, as a new analysis from the watchdog group shows.
Last month, one day after ProPublica published its bombshell report on Crow's under-the-table funding of near-annual luxury vacations for Thomas—the first of what would become many revelations about the two men's financial relationship—Accountable.US calculated that the current Republican members of the Senate Judiciary Committee received $453,300 from Crow between 2001 and 2022. The group revised that figure up to $457,000 on Tuesday in light of a $3,700 donation Crow made to Sen. John Cornyn (R-Texas) earlier this year.
The following is a list of Crow's total contributions to the nine GOP lawmakers on the panel as well as their affiliated PACs and joint fundraising committees, in descending order:
- Cornyn: $294,800
- Sen. Chuck Grassley (Iowa): $46,600
- Sen. Tom Cotton (Ark.): $23,900
- Sen. Ted Cruz (Texas): $23,500
- Sen. Lindsey Graham (S.C.): $20,600
- Sen. Mike Lee (Utah): $19,500
- Sen. Thom Tillis (N.C.): $13,400
- Sen. John Kennedy (La.): $8,300
- Sen. Marsha Blackburn (Tenn.): $6,400
"There should be bipartisan outrage about the undisclosed gifts and travel billionaire megadonor Harlan Crow has given Justice Thomas," Accountable.US president Kyle Herrig said last month. "Senate Judiciary Republicans should join their Democratic colleagues to act. However, their silence so far may be because they have received hundreds of thousands of dollars from Crow as well."
"The highest court in the land should have the highest ethical standards," he added. "When it doesn't, Congress should exert its oversight authority."
Not only have Republicans on the Senate Judiciary Committee with apparent conflicts of interest refused to join their Democratic colleagues in trying to establish enforceable ethics rules for the Supreme Court, but they have attempted to downplay the seriousness of the court's growing crisis of legitimacy.
Several of the panel's GOP members used last week's hearing on proposed Supreme Court ethics reforms—a hearing Chief Justice John Roberts refused to testify at despite mounting evidence of possible corruption involving Thomas and others, including Roberts himself as well as Justice Neil Gorsuch—as "an opportunity for political grandstanding and performative outrage," Accountable.US noted Tuesday.
\u201cNEW BLOG: The Supreme Court is facing a full-blown legitimacy crisis thanks to the corruption of three of its conservative justices.\n\nWithout reform, public trust in one of our core American institutions will continue to plummet \ud83d\udc47\nhttps://t.co/cygCcY8TsJ\u201d— Accountable.US (@Accountable.US) 1683654643
"Cornyn claimed Congress did not have the authority to regulate the courts due to separation of powers—a claim that was disproven by an expert witness that testified at the hearing," Accountable.US pointed out. "Cruz claimed the hearing was not about judicial ethics, but instead, was an attempt to attack Justice Thomas for having rich friends."
Lee went so far as to say that "when this chapter of American history is written, those who attack Justice Thomas today will be justly dismissed as intolerant bigots."
Meanwhile, Graham, the ranking member, accused the left of trying to "delegitimize the court and cherry-pick examples to make a point." Echoing his right-wing ally, Grassley argued that recent revelations are part of a long-term effort to "cast doubt on certain judges and justices, all because the left is opposed to recent court rulings."
Kennedy, for his part, denounced "attacks on conservative justices" as "targeted" and "exaggerated" and dismissed proposed Supreme Court ethics rules as "unnecessary."
Two days after right-wing senators accused reform advocates of launching what Cruz called a "smear campaign" against Thomas, ProPublica revealed that Crow also paid tens of thousands of dollars for the jurist's grandnephew to attend a pair of elite private schools. This came after earlier exposés about Crow footing the bill for yacht trips, buying and remodeling Thomas' mother's home, and more.
Given the mounting evidence of potential connections between Crow's gifts, which Thomas sought to keep hidden, and Thomas' inclination to rule in ways favorable to his superrich benefactor, calls for the judge to resign or face impeachment are growing.
Not only does Crow have links to numerous right-wing groups involved in Supreme Court cases since Thomas was first confirmed to the bench in 1991, but his own real estate company, Crow Holdings, was directly implicated in a 2021 case before the court.
As The Lever reported last month, Thomas voted to end the Covid-era federal eviction moratorium after Crow Holdings called the lifesaving policy a threat to its "profit margins." Now, as a group of New York City landlords prepares to ask the high court to overturn local rent control laws condemned by Crow Holdings—a move that would endanger rent stabilization efforts nationwide—"there is no indication" Thomas would recuse himself, the outlet noted.
Moreover, as Common Dreams reported last week, an Americans for Tax Fairness analysis of campaign finance data shows that after Thomas provided a deciding vote in the Citizens United v. Federal Election Commission case, the Crow family's average annual campaign contributions soared by 862%, from $163,241 before 2010 to $1.57 million since.
This massive increase, which is partly reflected in Crow's donations to Republicans on the Senate Judiciary Committee, underscores how the 5-4 ruling that effectively legalized unlimited political spending has strengthened the wealthy's ability to shape electoral outcomes, further undermining U.S. democracy.
On Tuesday, The Leverargued that the main goal of Crow and other billionaires who provide gifts and outside money to members of the Supreme Court is not to obtain certain decisions in specific cases, given that the court's right-wing ideologues would likely rule conservatively anyway, but to prevent GOP appointees from becoming more liberal over time—a phenomenon that has occurred in the past.
Alluding to Monday's letter from Senate Judiciary Committee Chair Dick Durbin (D-Ill.), The Washington Post reported that "if Crow ignores the request for information by the committee's May 22 deadline, it's unclear what Durbin's next move would be."
The San Francisco Chronicle reported Tuesday that Sen. Dianne Feinstein (D-Calif.) is returning to Capitol Hill after an illness kept her away from the Senate since February. Feinstein's absence has left Durbin without a majority on the panel, enabling the GOP minority to impede action, but her return would open up options.
In an interview with CNN on Sunday, Durbin did not rule out the possibility of a subpoena, saying that "everything is on the table."
In addition to the implementation of robust ethics rules, progressives have called for other far-reaching changes to disempower the country's "rogue" Supreme Court justices, including expanding the court. Seats have been added seven times throughout U.S. history.
Polling data shows that public approval of the nation's chief judicial body has decreased sharply in the months since its reactionary supermajority eliminated the constitutional right to abortion care, among other harmful and unpopular decisions. According to a survey conducted last month, nearly two-thirds of U.S. adults no longer have confidence in the high court.
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