Carter Bundy

Following the health-care debate is nearly a full-time job. The minutiae of health-care policy is overwhelming.

Lost in the whole health-care debate, though, are simple questions, like what kind of system creates the best incentives for people to stay healthy.

The answer to that question was made clear to me this week by CIGNA. I’m lucky enough that my mom is taking our whole family on a trip to the Dominican Republic, but part of that kind of travel involves precautions against malaria.

I was stunned when CIGNA emphatically and repeatedly denied a claim for relatively inexpensive anti-malaria pills -classic preventative medicine.

Bending the cost curve – up

The CATO Institute and Sarah Palin will tell you that having the consumer pay for medicine, even preventative medicine, “bends the cost curve.” No es verdad. Only one of three things happens when insurance denies coverage for preventative care:

• I buy the medication anyhow, which is still a systemic health-care cost, and probably more expensive because it’s not covered in a group plan.

• I don’t buy the medication, I get malaria, it’s covered, and the insurance company (read: other premium payers and myself) pay much, much more to treat me for the rest of my life (oh, and by the way, I would have malaria and be less productive, further hurting the economy).

• I don’t buy the medication, I get malaria, it’s not covered, and I end up sticking the taxpayer with a big bill for treatment in emergency rooms the rest of my life (oh, and by the way, I would still have malaria, miss work and hurt the economy).

Fortunately, I’m pretty responsible and I can afford the $72, so I’m going to pay and hopefully not get malaria.

But I guarantee you that there’s some young college student who is going to skip out on the $72 expense, thinking “I’m healthy, I have mosquito repellant, and I can’t really afford $72 right now.” Or, human nature being what it is, “I might be able to afford the $72, but I’d rather spend it on something else.”

I know what some curmudgeons are thinking right now: “Then it serves them right if they get malaria.” Well, that’s a shoddy response when you’ve just given a healthy young person an expensive disease for the rest of his or her life – that we’ll all end up paying for one way or another – simply because no one at the insurance company gives a damn about the actual health of their customers.

Even if only one in 100 people is irresponsible – and we all know that number is higher in real life – to have that one person get malaria is going to be far more expensive than covering preventative medication. The current system bends the cost curve, but in the wrong direction – up.

Even they know

It’s certainly not the fault of the nice woman at the CIGNA call center who could only say, “Sorry, it’s not covered,” so I politely asked to speak with a manager. When I finally talked to a manager, he agreed that it would make sense to have preventative medicine covered, but that “travel medication” wasn’t covered.

OK, I understand I’m not going to the Dominican for work, but if I snap my Achilles tendon playing hoops, it probably wasn’t for work, either. The point of health coverage isn’t just to keep people healthy on the job, it’s to keep people healthy regardless of where they are and to treat them if they become ill. And to incent good behavior like taking preventative medicine.

Refreshingly, the manager agreed with me, and said he’d already sent dozens of e-mails to “the powers that be” asking them to cover preventative medicines. But, he said, there was nothing he could do because it wasn’t covered and “the powers that be” weren’t going to change.

Which got me to thinking:  If the insurance company had any interest in my health, or in the health of any of its customers, or in long-term health costs, it would have gladly covered preventative care, and it would be a basic part of every plan.

Different, in a bad way

In any other developed country in the world, and even some less-developed countries, plans would have covered preventative medicine because it helps keep citizens healthier and keeps long-term costs down.

The people who run the health systems in other countries actually have an incentive to have their people be healthy and to bend the long-term cost curve downward. That’s because, ultimately, the people elect the leaders of those health-care systems.

When you put the bulk of the power and decision-making in the hands of for-profit insurance companies that don’t care a whit about the health of their customers or about long-term financial health of the entire system (beyond their next quarterly reports), you get a sicker population and higher costs. That’s exactly what for-profit insurance has given America. Talking to CIGNA this week, that big picture has never been clearer.

I just hope Representatives Teague, Heinrich and Luján decide to stand for smart, cost-effective, commonsense health care instead of propping up the current, broken system.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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Carter Bundy

One part of our state budget negotiations that has drawn almost no attention from the media or from advocates is that the bulk of revenues being discussed are scheduled to be phased out. They’re being called “temporary.”

Keeping that “T” word in revenue legislation would be an enormous mistake, both fiscally and politically.

Why box ourselves in now?

Even if we want to end some of the revenue enhancements once the economy picks up – and I think there’s a very strong case for doing so for less progressive taxes like GRT or reinstatement of the food tax – why would anyone lock it in now?

Remember, we’re going to be losing hundreds of millions in federal stimulus money during the next two years. Ending revenues automatically without any real-world circuit-breaker is going to make that cliff insurmountably high and requiring at least a partial re-raising of the revenues they called “temporary.”

Setting themselves up

There’s a good chance they wouldn’t be able to re-raise revenue, leading to a further decimation of our state services, health care, public safety and education. Even if they could re-raise revenue, imagine the political blowback from reneging on their pledge of “temporary.”

Politically, it’s especially short-sighted for the Senate to make revenue “temporary.” They’re not up for election this cycle, but if the sunset of revenues puts them in a position of having to re-raise revenue or make even deeper cuts in ‘11 and ‘12, they’re unnecessarily putting themselves at political risk.

It’s going to get partisan

Let’s face it:  Ideological considerations aside, the state Republican Party has decided to follow a combined legislative/electoral strategy of opposing virtually every single new revenue source available.

And it’s not because government is more bloated than it used to be. Remember, we’ve already lopped $700 million off the state budget and have fewer employees per capita than at any time in at least the last 16 years – and that includes all of the GOP Johnson administration. That’s pretty damn lean, but there are as yet no Republicans voting for a balanced approach of roughly equal revenues to match our $700 million worth of cuts.

The House Republicans even voted in lockstep against the simplest of proposals: to collect taxes already due to the state from out-of-staters. I mean, whatever happened to the idea of enforcing current laws? (To their credit, Senate Republicans realized what a no-brainer this was and voted for it).

So Dems have to govern responsibly and alone, with a mix of cuts and revenues. The GOP will come after them this November whether the increases are temporary or not, and their political allies will mock Dems for calling the revenue “temporary.” It’s already happening every day on talk radio and in conservative columns.

A defense that works

The Dems’ best defense is going to be that we needed a balanced approach, because our necessary, basic services were already cut to the leanest levels in 16 years and a cuts-only approach unfairly hurt kids, seniors and public safety.

As polls and two referenda in Oregon show, if given a choice between progressive revenue enhancements and further cuts to Medicaid, education, public safety and other core services, voters are supportive of more revenue.

One of those polls showed that by a 65 percent to 31 percent margin, voters in New Mexico favor increasing the marginal rate on income over $250,000.

Interestingly, when one tells the voter that the increase is only temporary, the numbers move only by the tiniest amount: 65 percent in favor to 30 percent opposed. Why doesn’t “temporary” help?

Those who favor adding some progressivity to our income tax for fairness argue that “fair” should never be temporary. Opponents of the tax are opposed to any increase, and don’t believe that it will be temporary anyhow. “Temporary” is not a defense.

What reason is left?

If there’s no political advantage to calling something “temporary,” and there is a significant chance (read: virtual certainty) that we won’t have enough of an economic recovery to make up for both the disappearing federal funds and a phase out of this new revenue, why on earth would anyone make any of these increases temporary?

It’s not just fiscally irresponsible to sunset revenue, it’s a big political blunder: Politicians will get zero credit – none – from voters for making revenue temporary.

By contrast, if the taxes are not temporary, then when the economy does turn around, the Legislature will be in a position to take political credit for passing tax cuts, just like they did in 2003.

Hopefully Democratic strategists will point out the no-win nature of making the revenues temporary, and economists will point out the danger of boxing the state into more deficits. Sound fiscal policy and smart political strategy are aligned here, and House and Senate Dems alike would serve the public and themselves well by eliminating the “T” word during the special session.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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Carter Bundy

What an amazing Super Sunday… underdogs, fighting against the odds, finally getting the praise and recognition they deserve. A nation rooting for blue-collar guys working their hearts out.

Of course, I could be talking about the New Orleans Saints, but the above applies equally to the superb new CBS show “Undercover Boss.” A COO or CEO goes undercover to find out how his front-line workers perform, what their working conditions and pay are like, and what it’s like to work for the company.

I watched “Undercover Boss” with an outspoken, unabashed conservative and two middle-of-the-road friends. Each of us was moved by the stories of the workers being understaffed, underpaid, and facing inflexible workplace mandates.

Conservative, liberal, moderate – all of us – and even the COO on TV, saw value in watching front-line workers up close. Everyone had a better appreciation of just how hard most Americans work every day, and how meager the rewards are for those on the front lines. The COO concluded that he needed to change the way WMI does business, from workplace rules to compensation to getting ideas from the front lines.

Some cabinet secretaries go out into the field and try to learn from the workers on the front lines. I’m sure many good secretaries do this, but I know for certain that CYFD Secretary Dorian Dodson goes the extra mile to understand the day-to-day conditions at her facilities and to learn from her employees. Her only advice was that it be done for a full day, not an hour-long drop-by.

Shrunken government

The main question this legislative session is how much of our deficit should be remedied by cuts, and how much should be solved with revenues. Understanding our current levels of government is critical to answering that question.

Here’s a shocking stat that can be garnered by doing a Freedom of Information Act Request: On Dec. 31, 2002 — the last day of libertarian Gov. Gary Johnson’s eight-year run — there were 22,933 employees in all branches of state government (excluding education). As of Feb. 1, 2010, that total number of employees had grown to 24,715. Big increase, right? Not when you consider our population growth.

According to the U.S. Census and UNM’s Bureau of Business and Economic Research, we will have grown from about 1.86 million residents on January 1, 2003 (Census data) to 2.16 million residents on July 1, 2010 (from BBER — the Census hasn’t done a 2010 projection recently that I could find) — an increase of about 16.3 percent over a 7.5-year period.

The state now has one employee for every 87 residents. Under libertarian Gary Johnson? One employee for every 81 residents. The current state government is leaner than it was eight years ago, and if you look at classified, front-line employees, the difference is even more dramatic — classified employees are about 15 percent lower per capita than they were at the end of Johnson’s term.

Anti-government zealots who recently penned a study for the Rio Grande Foundation noted that New Mexico is 5th in public employees per private employee. How is that a relevant measure? It’s precisely because New Mexico is a poor state that there are fewer private-sector jobs, and also a higher demand for government services.

But let’s humor Grover Norquist’s acolytes and ignore, for a moment, the fallacy of their measurements. Who else is in the top 10 states in public employees per private employees?

In order, with dominant party (by last three presidential elections): South Dakota (Republican); North Dakota (Republican); Wyoming (Republican); Montana (Republican, mixed at state level); Idaho (Republican); Utah (Republican); Kansas (Republican); and Washington (Democratic).

What do they all have in common, other than 8 of the 10 are Republican bastions? They’re all western and rural. Is it a coincidence? Of course not. Does it mean Republicans are all about big government? No. Does it mean rural people believe in waste? Nope. Is there something in the water west of the Mississippi that makes legislators and governors over-grow government? Not at all.

Still think there’s meaning? California is lowest in state employees per capita. Does that make California a smaller government state than Utah or Idaho or Wyoming? No. It means they have economies of scale by being both highly populated, dense, and with good concentrations.

Lean

New Mexico has a low population, large land mass, and also has low concentrations of population. Even Nevada, with a similar population and land mass, has far more “efficient” concentrations than New Mexico because about 95 percent of Nevadans live in two metro areas: Las Vegas and Reno/Sparks.

We’re as lean as we’ve been in a long, long time. The private sector’s demands on state government are as big as they’ve been in decades. We’ve cut thousands of positions and are smaller than under even a libertarian administration.

I hope legislators on both sides of the aisle start to acknowledge how trim our state government has become and work toward a balanced approach to filling our budget gap.

If they don’t believe the numbers, maybe they’ll consider putting a request in to a cabinet secretary to be an undercover worker, or at least to shadow workers, for a day. Just like the COO of WMI, my guess is they’ll be surprised at just how lean and hard-working our state employees are.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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The Roundhouse in Santa Fe (Photo by Peter St. Cyr)

While there will be disagreements over how to close the budget gap in the next few weeks, that gap can be made considerably smaller just by enforcing existing laws and closing loopholes

Despite population growth of over 10 percent, the State of New Mexico has fewer classified state employees than at the end of libertarian Gary Johnson’s last term as governor. Not just per capita, but in raw numbers.

Presumably, a good libertarian like Johnson wouldn’t grow government faster than the population, so assuming he didn’t, that means classified state employment is at its lowest level in at least 16 years.

Are there more exempt employees than before? Yes. But there’s a way to thin that herd without layoffs, which I’ll discuss below.

The big point is that, for the vast majority of state government, we’re lean. Leaner than under the Johnson years. We’ve already cut $700 million from state government, and state employees have already given up about three weeks’ worth of pay. That’s a big deal to people with an average income of just over $30,000 per year.

There’s no way — none — to continue using a cuts-only approach without directly hurting New Mexicans even further. The good news is that there are a variety of sensible revenue ideas that don’t hurt economic recovery. The bad news is that there’s substantial disagreement between representatives, senators, and the administration on which ones are best.

Carter Bundy

Fortunately, because we haven’t paid much attention to revenue over the last few decades, there is some low-hanging fruit just waiting to be grabbed.

Revenue without taxes

Conservatives like to say that government should be run like a business. Leaving aside that government provides critical services that should never be designed to turn a profit, at a minimum we can all agree that any good business would first collect the revenues that are owed to it.

There are two bills that would enable us to collect revenues already owed: The first is Speaker Lujan’s bill to require withholding on out-of-state workers who earn their money in New Mexico.

Even the Greater Albuquerque Chamber of Commerce and the Association of Commerce and Industry saw this as an obvious way to bring in more revenue without increasing taxes, and testified in support of House Bill 120.

And it has the added benefit of collecting revenue from out-of-staters who owe us the money and have been skipping out on their obligations.

Combined reporting is more complicated, but follows the same principle: if you make a profit in New Mexico, you have to pay taxes just like New Mexico businesses. It’s that simple.

Every other western state with a corporate tax has combined reporting, and the horror stories told by the talented, clever, powerhouse corporate lobbyists in those states never came true.

Legislators in every other western state succeeded in ending the corporate shell game and bringing tax fairness for in-state businesses. Why does New Mexico have to be the one state that gets trampled on?

A third way to generate revenue without raising any tax rates is to end the loophole that allows itemizers to pretend their income is lower this year simply because they paid their taxes last year.

Only four other states allow this fiction, and most of them are looking to end it. Why not us?

Triple play

The lowest of the low hanging fruit has bipartisan support: There is near universal agreement among Republicans and Democrats to end double dipping.

Done right, there will be three major benefits: The general fund may save about $40 million per year, PERA may save hundreds of millions in the next few years, and we can cut the size of the political appointments significantly without layoffs.

There are two ingredients in the recipe for a good double dipping bill:

First, ban all double dipping going forward. Period. If we need to hire someone, we can pay market rates, just like our state did successfully for almost all of its 98-year history.

Second, give current double dippers a year-long phase-out. Ending it immediately would be unfair to many of them, since they’ve planned their family budget for the year (and you can’t blame double dippers for taking advantage — they aren’t breaking the law).

They’ve been on notice for at least two years that double dipping might end. Many are at-will employees anyhow. Giving them until Jan. 1, 2011 to choose either retirement or full-time paychecks seems a pretty generous compromise. They don’t have to leave their jobs. They don’t have to give up their pension. They just can’t do have both simultaneously.

Sure, there will be lawsuits. But I can’t find anything in the federal or state constitution guaranteeing the right to get both checks at the same time.

The beauty of the phase-out for current double dippers is that it is fair and it will also lead many of the political exempt employees to choose retirement.

If half of the state’s 1,200 or so double dippers chose retirement, and even if we had to fill half of those positions, that would mean a reduction of 300 employees — many of them high- and mid-level political appointees.

That’s tens of millions of dollars in general fund savings without laying off a single worker. Further, most of the new vacancies would come at the upper levels of government, which wouldn’t hurt nearly as much as further cuts to already-depleted front-line services citizens expect.

While there will be disagreements over how to close the budget gap in the next few weeks, that gap can be made considerably smaller just by enforcing existing laws and closing loopholes.

Grab the low-hanging fruit first.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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Carter Bundy

The tragedy of the Haitian earthquake has generated a large outpouring of support from New Mexicans. If you’ve been thinking about doing something but haven’t had the chance yet, here’s another link to the Red Cross: redcross.org.

You can also simply text “Haiti” to 90999 and your phone company will donate $10 to the Red Cross and add it to your next bill (it’s not a scam — the Red Cross Web site asks people to do this). If you can afford more, of course, simply go to the site itself.

Beyond immediate monetary contributions, there are long-term changes that need to be made in Haiti, most of which involve a good, proactive government.

This is no time for politicking and proselytizing, and shame on Rush Limbaugh and Pat Robertson for their opportunistic, bizarre use of the catastrophe to bash Democrats and Catholics, respectively.

While politicking over Haiti is wrong, there’s nothing wrong with looking at why a 7.0 quake in Haiti kills 100,000 or more Haitians while a similar temblor in similarly dense Los Angeles kills only a handful of Americans.

Haiti: What government?

The main answer? Government regulation, government programs, government infrastructure and government employees.

In America, we have long valued the role of creating safety standards and enforcing them. Critics call these rules “anti-business” and they call the good people who enforce them “bureaucrats.”

Nonsense.

The efforts California has made in the last few decades to retrofit buildings have met with resistance and derision from right-wing ideologues and rich corporations who claim that that building codes are stifling.

In reality, that kind of pro-active government regulation is exactly what keeps millions of Angelinos safe every year, because you can be sure the developers and builders weren’t going to quake-proof buildings on their own.

It’s not just our legislators, planners and code enforcement officers who deserve our thanks. In America, we value other public services like 911, police, fire, National Guard and emergency medical care.

Those are all government programs staffed by government employees, and the lack of good public safety, law enforcement and public medical facilities in Haiti are another reason why a horrible tragedy turned catastrophic.

There’s more. Our public agencies and government employees guarantee clean water and efficient, safe waste disposal (solid waste and wastewater alike). The lack of these good government programs in Haiti is contributing to additional disease and death even after the earth has stopped moving.

What government does

Over the course of New Mexico’s upcoming 30-day legislative session , you’ll hear generic anti-government rants from corporations, ideologues and tea partiers, but you’ll almost never hear them say what programs need to be cut.

That’s because when you get into the specifics of what government does, people really like what they get for the money. Especially if there’s accountability and auditing, which there absolutely should be. Here’s where well over 90 percent of our state and local money goes:

• Creation and maintenance of infrastructure like roads, airports and power.

• Law enforcement, including police.

• Other public safety, like fire, emergency medical services and 911.

• The judicial system, including prosecutors, public defenders and judges.

• Corrections (which, with all due respect to the other public servants on this list, is the toughest job in America in my opinion).

• Commonsense regulation and enforcement that ensures safe food, strong buildings and safe roads.

• Clean water in every house in New Mexico.

• Sanitary wastewater and solid waste disposal.

• National Guard.

• Parks, recreation centers and open space.

• Enforcement of laws keeping our air, water and land clean.

• Health care for poor children and the elderly, neither of whom are in a position to pay the full actuarial value of their care by themselves.

• Preventing or stopping child abuse.

• Meager, temporary help to keep the poor or unemployed from becoming homeless or starving to death.

• K-12 education, community colleges, vocational training and universities.

America and New Mexico are much better off because of the things our taxes fund. We should be wary of people who make blanket statements bashing government or the revenue it requires.

God knows that both before and after the earthquake, Haiti would love to have had a generally good government like ours, and they wouldn’t complain about the necessary resources to make it happen.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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The U.S. Capitol building (Photo by Heath Haussamen)

In Washington, 2009 was the year of complicated legislative decisions. Preventing another Great Depression, regulating greenhouse gas emissions and reforming our complex health-care system are all difficult, often involving conflicting, complex policy concerns.

If 2009 was complicated, 2010 can and should be the year of the no-brainer. Here are four upcoming issues with relatively easy solutions, but with some tricky emotional or special interest opposition.

Reform immigration

Good reform punishes criminals, puts undocumented immigrants to the back of the line, brings an underground economy out of the shadows with earned citizenship (not amnesty), and enforces our immigration laws for the first time in decades. Doing so isn’t that complicated.

We also should require basic English proficiency, not because other languages aren’t great (my New Year’s resolution is to put in at least 10 minutes a day on Rosetta Stone Spanish). Rather, we should require basic English proficiency because we’re not doing anyone a favor, least of all immigrants, if we don’t.

The current system is bad for almost everyone, excepting race-baiters and the big agribusiness, construction and hospitality conglomerates.

It’s bad for honest businesses — including those in agriculture, construction and hospitality — because they can’t compete with the unscrupulous employers who prey on immigrants’ desperation by paying them a few bucks an hour.

Carter Bundy

It’s bad for citizens and other legal workers, because flooding the supply side of the labor market with people who will work for half the minimum wage and no benefits reduces everyone else’s compensation.

It’s bad for immigrants, who are far less likely to report things like domestic violence, and who are in no position to ask for help when their employers steal their meager wages.

It’s bad for taxpayers, because we’re not getting the full measure of taxes out of people who use some government-funded services, including water, sewer, roads and schools.

It’s bad for national security and domestic law enforcement, because our not knowing who is here is always an asset to terrorists and criminals.

If done right, immigration reform can end decades of illegal immigration and the nightmares created by our current system of an underground society.

End ‘don’t ask, don’t tell’

You say you want to win the war on terror? How about starting by allowing good, patriotic Americans to serve their country with honor? We’ve discharged thousands of American servicemen and women merely for who they love. Many of them, by the way, were our best Arabic translators. Whoops.

This policy is cruel to those patriotic individuals, and also undermines our national security. We need to grow up as a nation and embrace the contributions of gays to our military.

This is a no-brainer. You can dislike gays in your personal and religious life all you want. We’re a free country and I’m not advocating silencing anti-gay thought or speech. Just don’t put our servicemen and women — and innocent civilians — at risk in furtherance of your own personal prejudices.

Allow the option of unions

Obviously this is near and dear to me, but it should be for every working American. Even if you never join a union or never want to, you should respect the rights of others to do so — especially since the benefits that union workers achieve often spill over into the non-unionized workforce.

The central element of any labor reform is to restore the rights of workers to join a union democratically without fear of losing their jobs. America was at its strongest when unions were at their strongest. At a minimum we should allow workers that choice again.

Revamp trade policies

Perhaps the single most important policy change we need is in trade. Creating a level playing field for American businesses and workers is another no-brainer to help our economy.

It’s hard for our home-grown companies and workers, union or not, to have a decent standard of living when we stack the deck against them by incenting those companies to move to places that readily abuse workers and the environment.

Our current trade agreements encourage (who’s kidding who — they virtually force) companies to move to countries that have no environmental standards, no consumer protections, no health and safety rules for workers, and no basic human rights (like a ban on child labor).

Trade has great potential to make everyone wealthier. But if trade agreements don’t set minimum standards, they actually lower the quality of life in both the developed and developing world.

We’ve lost millions of good manufacturing jobs to China, creating misery here, but it’s miserable over there, too. They have skyrocketing cancer rates caused largely by Western factories and their byproducts. This link gives the visual evidence backing up what any economist will tell you was a natural outgrowth of unbalanced trade policies.

Setting minimum standards for trade is a populist, commonsense idea that should unite conservatives and liberals alike. With it, we can start to reverse our long-term economic slide.

All it takes

If Dems can find the backbone to support these reforms that benefit almost all Americans, and the GOP can find the decency to resist fear-mongering against workers, gays and immigrants, 2010 can be a golden year of bipartisan reform.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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Carter Bundy

As 40 Republicans and one Joe Lieberman dig in their heels to protect big insurance companies, it’s becoming clear that health reform is going to be watered down significantly.

There’s one major exception though, and it’s called “guaranteed issue.” If you’re uninsured, or are ill and can’t get the treatment you need now, in the future you will be able to get coverage and treatment.

Guaranteed issue victory

The House and Senate bills both have guaranteed issue, which goes a long way toward solving our national access problems.

Not only will almost all Americans have the security of coverage and treatment, but that security will enable people to pursue the jobs they want instead of being stuck in the job they have for fear of losing coverage.

That freedom means significant efficiency gains in the national labor market, something conservatives and business should embrace as enthusiastically as workers’ advocates.

There is a moral hazard problem associated with guaranteed issue, though. If people are guaranteed coverage even after they become sick, most rational consumers would never pay anything into the system until they become sick and are about to incur hefty bills.

That’s why the individual mandate is so important. Fortunately, the House and Senate bills do have an individual mandate, so the system won’t collapse when we guarantee insurance for all.

Paying for guaranteed issue

In turn, the individual mandate requires subsidies for lower-income and middle class Americans. One of the open questions about the current bills is whether we help make coverage affordable for the middle class by taxing, ironically, middle-class and lower-income workers with good benefits.

Most of these “Cadillac plan” workers make in the $20,000-$50,000 range, and many of them gave up raises to get decent coverage. Others fall into the Cadillac category simply because of a pre-existing condition, or because they work at a small company. Taxing the middle class and lower-income workers to subsidize other middle class and lower-income workers makes absolutely no sense.

The alternative is to apply a surtax to the millionaires who have gotten trillions in tax breaks over the last decade, almost all of whom have absurdly good health coverage. Seems like a pretty easy choice, both from a policy perspective and politically.

Setting standards

Minimum standards of coverage are an important aspect of guaranteed issue, and the House and Senate bills include them. By combining guaranteed issue and minimum standards, for the first time in American history, we’re poised to finally join the long list of countries whose citizens can get care when they’re sick.

By contrast, the libertarian proposal to allow cross-state shopping to increase “competition” merely means insurance companies will offer even less complete plans than they already do.

Blown chances on cost

Despite being on the verge of a major access victory with guaranteed issue and minimum standards, there are dozens of changes that should be made to our health care system that aren’t even on the table right now.

Here are four examples of how the obstructionist Republicans (plus Lieberman) and the often-too-timid Dems seem to have blown opportunities to start seriously containing costs:

• Delivery overhaul - The most glaring omissions from current proposals are systemic changes in how care is delivered. No one will entertain changes to our fee-for-service structure that often encourages costly treatment at the expense of cheaper (and less profitable) preventative care, early diagnosis or less costly treatment alternatives.

• Public option - Another opportunity to rein in costs is the public option, but that appears to be facing its own death panel in the Senate.

For all the Republican lip service about fiscal responsibility, they’ve consistently opposed the one piece of reform — a public option — that would have introduced real competition and lower prices in the private insurance market. But those private insurance company contributions don’t come without strings.

• Smart tort reform - Another critical cost-containment measure that is being left out is tort reform. Democrats won’t bring it up, and the Republicans’ simplistic approach of damages caps isn’t the answer. Caps haven’t been terribly effective in states like Texas, and caps remove an important incentive to practice safe medicine.

The tort changes we need give more protection to providers if they follow evidence-based standards of diagnosis and care. Dems should show leadership by forcing trail attorneys and providers to come together to fashion sensible reform to protect good-faith, talented providers while punishing negligent and reckless providers.

• The other elephant in the room - Beyond the obstructionist GOP, there’s another elephant in the room: No one is talking about real cost controls surrounding end-of-life care. That’s because proposals to do something about spending in the last six months of life (when about 2/3 of all health care costs are incurred) get called “death panels” by the same conservatives who hypocritically fight against Medicare.

We all know there’s wasteful end-of-life spending, but it’s untouchable. At a minimum, Congress should have the courage to make living wills mandatory.

Bottom lines

Don’t be fooled: Washington — especially Senate Republicans and Lieberman — punted on addressing the costs of health care.

The current watered-down Senate proposals do only one big thing: by including guaranteed issue, they solve most of the access problems facing the uninsured and the insured who get sick.

Despite the resistance to cost reforms by 40 Republican senators and one independent from Connecticut, guaranteed issue is still a major access victory worth keeping.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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Carter Bundy

The confluence of health and budget debates occurring in Washington and Santa Fe lends itself to a simple philosophical, political and moral guideline developed by American philosopher John Rawls.

Rawls developed a formulation for just policy premised on the idea that if none of us knew what our place in the world would be before deciding on policy, we’d arrive at something that was fair, just and effective.

Policymakers should intentionally put themselves behind a “veil of ignorance,” as Rawls called it, about his or her gender, race, wealth, nationality, religion, language, orientation, physical assets, mental talents, parents, society, education, health, luck, everything.

Imagine if our founding fathers had used the veil of ignorance in deciding whether to grant freedom and full rights to slaves. Instead of seeing themselves as wealthy, white landowners, they would have approached the issue from an uncertainty about whether they themselves might be subject to slavery. We’d have had a very different, and much better, history.

The veil of ignorance in Washington (insert joke here)

In our capital right now, there is a debate as to whether we should create a rule that if you get sick in America, you get health care.

The sad reality of today’s system is that even if you have the best insurance, if you’re sick enough, unlucky enough, or your insurance company’s lawyers are slick enough, there is no guarantee of being treated when you’re sick.

Apply the veil of ignorance to health care: If you were setting policy without knowing if you’d live a completely healthy life, battle disease throughout your life, or live (as most of us do) with a mix of health and sickness, wouldn’t you want a guarantee of good care when you fell ill?

Alone in the entire developed world (well, maybe with South Africa), America doesn’t have that guarantee. If you didn’t know whether you’d be born into a situation where you had health care, even if you thought you had an 80 percent chance of being covered by insurance, wouldn’t you want that guarantee for yourself and your family? When presented like that, most of us would.

You’d favor that guarantee even more if you knew that even if you were technically covered, there was a chance you could be denied treatment if you fell prey to your insurance company’s small print.

That’s the central question of the health care debate: whether we make sure that every American, including those of us who currently have insurance, gets health care when they fall ill.

Hopefully our elected leaders in Washington will see health care not from the position of privileged, wealthy, powerful senators with excellent coverage, but from behind Rawls’ veil of ignorance. It’s hard to imagine anyone using that perspective and voting against reform.

The choice in Santa Fe

In Santa Fe, the policy choices are basically lining up like this: Would you rather have a system that consistently rewards millionaires with lower effective tax rates than the middle class? Or would you want a more progressive revenue system that resulted in the semblance of safety, education and health for everyone?

If you didn’t know who would be your eventual employer, would you want a system that allows big companies with hundreds of lawyers and accountants to pay a lower tax rate than small businesses? Or would you want corporate taxation to be equal for all companies?

If you didn’t know whether you would end up being a connected insider, would you want a system that took everyone’s taxes and paid a group of double dippers nearly twice the salary of everyone else? Or would you advocate for a fair system that allows for decent pay and good retirement, but not both at the same time?

It’s a near certainty our legislators would choose safety, education and health for all New Mexicans over lavishing millionaires, slick out-of-state businesses, and connected insiders with continued special treatment if legislators operated from behind the veil of ignorance.

The Golden Rule

The veil of ignorance doesn’t have to lead to traditionally “liberal” results. If you didn’t know your background or talents, most of us would still be attracted to the idea that if you work hard, have talent, or get lucky — or some combination — you’d be able to improve the material well being of yourself and your family.

That’s why even though the veil of ignorance leads most people to support comprehensive health, safety and education, it also leads to policies that reward effort, merit and achievement.

Those two ideas are not mutually exclusive. In fact, they’re complementary. You can’t have a real meritocracy without something approximating equal opportunity for all.

Rawls’ veil of ignorance is a philosophers’ way of giving us a practical tool to apply the Golden Rule to policy decisions both small and large. Do unto others as you would have done unto you simply means, in the policy world, creating rules that you’d want applied to you if you were in someone else’s situation.

Thanksgiving is my favorite holiday. It is reflects the best of America and the best of our religious traditions in the qualities it embraces: gratitude, sharing, love, family, equality, inclusion, opportunity and empathy. Yet it isn’t as limiting as some religious holidays, which by definition are more exclusive.

This Thanksgiving, as we all celebrate everything good in our lives, I hope our legislators in Santa Fe and Washington view policy choices from behind the veil of ignorance, unsure that they or their own families would be in the relatively fortunate circumstances enjoyed by almost everyone reading this site.

After all, being grateful means understanding that we’re all a bit lucky, and being gracious enough to extend the opportunities we’ve been afforded to everyone else.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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Carter Bundy

We’re in the middle of the worst budget crisis in decades in New Mexico. One can finger-point all day long, but let’s face it:  The entire country is in a crisis, with many places worse off than New Mexico even as our revenues continue to collapse.

That means that fundamentally, while New Mexico could have and should have been less generous with our massive millionaires’ tax breaks and should have paid attention to tax loopholes, the problem is bigger than our state. It’s going to require everyone to get serious about surviving the current downturn and positioning ourselves for a stronger balance sheet in the future.

Everyone, from state workers to educational employees to millionaires to out-of-state corporate giants, needs to realize we’re in a genuine crisis. Sacrifice is going to be needed from everyone, but if we’re smart about how we cut, we can preserve many of the public safety, health and educational gains over the last seven years.

Counter-cyclical services

That shared sacrifice is particularly important during our national recession, because many state services, including Medicaid, food stamps, unemployment, job training, community colleges, universities, domestic violence services, corrections, juvenile justice, courts, and probation and parole, are counter-cyclical.

In other words, as the economic cycle gets worse, the demand for these services grows. There’s no crueler fate than to pay taxes your whole life and then see services gutted the one time you need them.

Slashing all of those programs dramatically while no one else in the state tightens belts is counterproductive and hurts the state much more than if everyone does a little bit.

Privatization is expensive

The proof is in the pudding:  When the Department of Corrections was scrambling for more savings this year, they didn’t contract out more inmates to private prisons. Instead, they actually brought more convicts back into the state system.

The Department of Corrections knows that it is less expensive to house inmates at state facilities because the state doesn’t need to advertise. The state doesn’t need to turn a profit. The department doesn’t have a large lobby budget to ensure that it is given no-bid contracts. And as outlandish as some state double-dippers’ take-home pay may seem, no one at the state is making anywhere near the millions of dollars that private prison executives pull in.

Guess who pays those multi-million dollar salaries for high lifestyle executives in South Florida? New Mexico taxpayers. That kind of backscratching may go unnoticed by the public in good times, but not now.

So before New Mexicans have to sacrifice even more, one easy place to save money is to rein in out-of-control, expensive contracts with giant out-of-state corporations who fleece the taxpayer for the gain of their owners and executives alone.

The administration has taken a lot of criticism of late on the budget. Some criticism is justified; for example, there’s no way taxpayers should be paying nearly double the money for one person to be in an already good-paying job by allowing double dipping. But scaling back private prison contracts is a commonsense way to save taxpayers money, and the governor and Department of Corrections deserve credit.

January fixes

When times were good, millionaires and out-of-state corporations were given special tax breaks and loopholes were ignored. Now that times are bad, those same lucky few refuse to share in our common responsibility for keeping the peace, ensuring public safety, maintaining roads, educating our children and providing temporary assistance for people who, through no fault of their own, have been laid off.

(Ironically, many of those layoffs around the country and in New Mexico are done by the very out-of-state corporations who seek special tax status while they force jobs overseas.)

Most of the labor community in New Mexico believes in shared sacrifice, but that can’t just mean the workers who belong to those unions that recognize that we’re in a crisis. Sacrifice has to include millionaires, out-of-state corporations who have gotten a free ride for a long time, contractors, double dippers and administrative overhead and bureaucracy even in the most important areas of public service.

It doesn’t mean that every part of government, or every tax bracket, or every type of corporation will have to suffer to the same degree. Fellow columnist Michael Swickard and many others have made the point that surgical cuts make sense. It does mean that taking whole areas of spending or revenue entirely off the table is irresponsible and bad for the state.

There is no shortage of clichés to support the idea that spreading the budget pain around many segments of government-funded services and revenue sources is the right thing to do. My favorite is “Many fingers make light lifting.”

It’s an overstatement to say that a multi-pronged approach to balancing the budget will constitute “light lifting.” Getting out of the hole we’re in is going to hurt. But if everyone chips in, all of us — citizens, taxpayers, workers and business — will get through this crisis in better shape than if we single out a few targets to balance the budget while others deny a crisis even exists.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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Carter Bundy

The big question in the aftermath of the Oct. 6 Albuquerque municipal elections is whether the GOP mayoral and city council wins are a precursor to the Nov. 2, 2010 statewide elections.

While there are certainly some lessons that are relevant to statewide matchups, there are also significant differences.

‘Burque Breakdown

Mayor Chávez did an outstanding job of securing organizational support, lining up national Dems and recruiting and sustaining a strong volunteer base. He used the power of incumbency effectively on everything from press conferences to new projects.

Richard Romero energized progressives and a week out was in an arguably stronger position than similarly situated Eric Griego had been in 2005. The Brian Sanderoff poll nine days before the election had Romero 2 points below Griego’s final number of 26 percent, with 19 percent undecided— and most undecideds usually break against the incumbent.

But Mayor Chávez made a strong case that he was the more electable of the two Dems, with assists from well-respected progressive voices like Barb Wold at Democracy for New Mexico and national figures like Howard Dean and L.A. Mayor Antonio Villaraigosa.

The structure of Albuquerque’s elections, with no primary, played a big role in the Dems’ division on Election Day. Albuquerque may be a Dem-leaning town, but it’s not so overwhelmingly Democratic that Dems can survive having no primary, a fractured Democratic Party and a unified Republican Party.

Pointing out the structure of the municipal elections takes nothing away from Mayor-elect Berry. He ran a strong race, unified his party, and is likable enough to be a viable alternative for independents and Dems suffering from Marty fatigue or otherwise looking for change.

Lesson No. 1: cornered elephants unite

The biggest lesson of the 2009 mayoral race is that the Republican Party is more poised for unity this election cycle than any since 1998.

In 2005, with control of the House, Senate and White House, it was hard for Republicans to feel threatened by Dems, at least on a national level. By 2009, with the GOP out of power everywhere, the discussion for conservatives can focus on their shared disdain for progressive politics and policies. That’s a unifying force, and it hurt Mayor Chávez’s ability to draw moderate Republicans at the same level he’d done previously.

While Republicans alone didn’t carry Berry to victory, GOP unity, not seen in a long time in Albuquerque, was critical to his nearly 44 percent showing.

The right stuff

In my decade of doing political work, Berry and Gary King stand out for being gracious winners. Those of us who work in Santa Fe during legislative sessions aren’t surprised.

Mayor-elect Berry’s win was also largely a vindication of his style. He seems genuinely willing to listen to others, reach across the aisle and tell you up front where there’s the possibility of agreement and where there’s not.

As is obvious from the detailed account on this site of the McCleskey’s approach to the race, Berry ran a professional campaign with well-developed messaging and targeting. Good candidate, good campaign, good results.

Lesson No. 2: take public financing

Another significant political lesson to be derived from the 2009 Albuquerque elections comes from city council district 5: Take public financing. That means getting in the race early enough to qualify for public financing and committing to it.

Not only did Dan Lewis smartly do that and acquire a significant financial advantage, but Councilor Cadigan’s failure to do so allowed mega-developer SunCal to jump into the race with a large independent expenditure.

One of the signature features of the Albuquerque finance law that makes it effective in limiting special interest influence is that anyone receiving public financing gets matching funds when an outside group comes in supporting another candidate.

With Cadigan playing outside the public financing structure, SunCal’s deep bench of talented political professionals were able to unload on him without triggering any matching funds.

Statewide precursor?

While the GOP is rightly proud of its municipal victories, it’s unclear how much it means statewide.

Unlike the Albuquerque Dem divisions, at the state level Dems seem solidly unified behind Lt. Governor Diane Denish. Also unlike Albuquerque, there will be a dogfight to be the Republican standard-bearer.

While the 2009 race indicates that Republicans will be more unified than in 2005 or 2006, it’s not likely that the GOP will be as unified statewide as they were in Albuquerque.

Denish is from Hobbs, has worked hard on rural issues, understands and supports business, and may benefit from a GOP primary in which the social conservatives once again battle it out with the business wing of the party.

As for the second Albuquerque lesson of public financing, even basic campaign finance limits — weaker than Albuquerque’s public financing — won’t apply statewide until after the 2010 elections. Denish has a strong fundraising lead, likely lack of a primary and, to-date, Republican fundraising has been poor (fractured four ways, no less, and largely self-financed by GOP candidates).

That means the financial advantage that helped Republicans take the city council will probably work the other way in the fight for the governor’s mansion.

Will Nov. 2 look like Oct. 6? Maybe, maybe not, but it should be an interesting year.

Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.

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