Monday, July 3, 2017
Arming Saudi Arabia is not best solution for U.S.
We Kentuckians ought to be proud of our Sen. Rand Paul for his efforts to halt arms sales to Saudi Arabia at a time when the Saudi government is waging a merciless war against the people of Yemen.
On June 13, Paul and Sen. Chris Murphy of Connecticut introduced a measure that would have blocked a $500-million sale of precision-guided munitions to Saudi Arabia, which is but part of a much larger proposed $110 billion series of arms sales. The measure was defeated 53-47.
Paul made a compelling case on the Senate floor, with an argument rooted solidly in humanitarian concern and common sense. Every American should take a look at it: Search on YouTube for “Rand Paul’s Speech on Saudi Arabia Arms Deal.”
Saudi Arabia has been waging a brutal campaign against Houthi rebels in Yemen, creating one of the worst humanitarian catastrophes in the world today. The Saudi military has targeted civilians. One airstrike in October 2016 targeted a funeral, killing more than 100 people. One United Nations estimate puts the war’s death toll at 10,000 at this point.
The Saudi bombardment has also been aimed at civilian infrastructure, including related to food production. In August, for example, airstrikes destroyed the cranes used to unload ships at Yemen’s only major port, Hodeidah, as well as a World Food Program warehouse. The Saudi government has imposed a naval blockade, further cutting off the population’s access to food. Accordingly, millions are at risk of starvation, and now there is a cholera outbreak.
How can we Americans allow our government to assist Saudi Arabia in this brutal war by allowing its government to purchase sophisticated weaponry developed using our tax dollars? It’s blood on our hands.
American involvement in this brutal war will come back to haunt us and our children. It is in this sort of humanitarian nightmare of slaughter, starvation and disease that new terrorists are created. And these terrorists will never forget what role the U.S. played.
The counterarguments: Our other Kentuckian in the Senate, Mitch McConnell, acknowledging the loss of civilian life in the war thus far, urges that “precision-guided” weapons are just what the Saudi military needs in order to limit future civilian casualties.
This argument utterly ignores that the Saudi military is pursuing a strategy of starving the population of Yemen into submission. The problem is not so much the munitions, but the lack of respect for international humanitarian law.
Sen. Lindsey Graham put forward the other main argument: The U.S. needs to support the Saudi’s military campaign in Yemen, no matter the bloodshed, because the Iranian government is supporting the Houthi rebels. The U.S. must contain Iran at all costs.
Indeed, Iran is supporting the Houthis, but the Houthis are not Iranian puppets. Iranian meddling in Yemen is hardly sufficient reason to aid Saudi Arabia when it’s committing war crimes on a massive scale.
What the U.S. needs to be concerned with is whether Iran is able to obtain a nuclear weapon. This is why the U.S. concluded the “Iran Nuclear Deal” in 2015, which provided for an inspections regime. The U.S. should be trying to avoid a conflict with Iran.
Furthermore, as Paul pointed out, Saudi Arabia already outspends Iran on defense by a factor of 8 to 1. By further arming Saudi Arabia, the U.S will likely fuel an arms race in the Middle East.
Accordingly, we must demand that the weaponry our tax dollars develops is not used by the sort of government which targets civilians and civilian infrastructure and attempts to starve a civilian population into submission. Yemen is on the verge of a horrible humanitarian catastrophe, and we Americans must demand that our legislators change course before that happens.
http://www.kentucky.com/opinion/op-ed/article158850424.html
Are Israel and Saudi Arabia Becoming Fast Friends?
“And take heed that ye be not slack herein; why should damage grow to the hurt of the kings?’” Ezra 4:22 (The Israel Bible™)
By Sean Savage/JNS.org
Building off the last few years of rumors and reports regarding clandestine relations between Israel and Saudi Arabia, mainly motivated by their shared concerns over Iran’s nuclear program and destabilizing regional activities, two recent developments highlight a potential route for Israel to firm up support within the Arab world.
Egyptian President Abdel Fattah El-Sisi ratified a treaty to hand over two strategic islands in the Red Sea to Saudi Arabia. Meanwhile, Saudi Arabia’s King Salman promoted his 31-year-old son, Mohammed bin Salman, to crown prince, making him next in line to be king.
The deal to hand over the islands of Tiran and Sanafir was reached in 2016 after a visit to Egypt by King Salman. The uninhabited islands that sit on the southern entry to the Gulf of Aqaba were originally given to Egypt in 1950 by Saudi Arabia, in order to protect them from Israel. Later, the islands played an important role in setting off the 1967 Six-Day War when Egypt closed the Straits of Tiran to Israeli ships, preventing Israeli access to the Red Sea and Indian Ocean.
United Nations peacekeepers maintain a presence on Tiran Island as part of the 1979 Israel-Egypt peace treaty. Under the treaty’s terms, Israel gave its approval for the Egyptian-Saudi agreement as long as the Saudis maintained the treaty’s clauses pertaining to Israeli shipping through the Straits of Tiran.
According to Joshua Teitelbaum, a senior research associate at the Begin-Sadat Center for Strategic Studies and a professor of Middle Eastern Studies at Israel’s Bar-Ilan University, it is not of utmost importance to Israel who controls the Tiran and Sanafir islands as long as the Jewish state has unimpeded shipping access.
Instead, Teitelbaum argued, the constructive cooperation between Egypt and Saudi Arabia is more crucial for Israel as it relates to the Arab alliance to counter radical Islam and the Iranian threat.
“Israel wishes to keep that camp strong,” Teitelbaum told JNS.org. “If Egypt and Saudi Arabia can get together, whether on confronting Iran or Qatar, or even the exchanges of these two islands, then that is beneficial for Israel. This firms up the Saudi-Egyptian relationship.”
Mohammed bin Salman’s rise to crown prince signals a new direction in Saudi Arabia, and may have implications for Israeli-Saudi ties and the Israeli-Palestinian peace process.
Saudi Arabia is dealing with low oil prices, its rivalry with Iran, a dispute with Qatar, and civil wars in Yemen and Syria. In his former role as defense minister, Prince Salman sought to boost ties with the U.S. as well as to overhaul and diversify the Saudi economy, which is heavily dependent on oil.
In a rare public comment on Saudi Arabia by an Israeli official, Communications Minister Ayoub Kara said the appointment of the new crown prince “means more economic cooperation in the Middle East, and not just regarding oil.”
“The strengthening of relations with the Trump administration is the beginning of a new and optimistic time between Saudi Arabia and regional states, including Israel and the Jewish people,” Kara said, adding, “This crown prince is really one of the architects of this post-Arab Spring Saudi policy that has pushed for…an anti-Iran and anti-radical Islam policy, which includes targeting Hamas….Israel will be pleased to cooperate with the new crown prince.”
Prince Salman has already been tied to rumors that he has met with Israeli officials as part of efforts to establish closer economic and security relations.
“In terms of the general trend of things, the Saudi prince is the guy who has been running Saudi foreign policy for the past two years,” Teitelbaum said. “During that period, there’s been an increasingly closer relation between Israel and Saudi Arabia. That’s going to likely continue.”
Israel and Saudi Arabia are discussing allowing Israeli businesses to operate in the Arab Gulf as well as letting Israel’s El Al airline to fly over Saudi airspace, the London Times recently reported, citing Arab and American sources. Prince Salman has been in talks with Jared Kushner, President Donald Trump’s son-in-law and senior adviser, about improving Saudi ties with Israel as a step towards Israeli-Palestinian peace, the report added.
Despite the Saudi-Egyptian cooperation and reports of Prince Salman’s interest in ties with Israel, Teitelbaum cautioned against expectations for official diplomatic ties between Israel and Saudi Arabia.
“There is a limit on the relationship, with most of the relations being clandestine,” he said. “The Saudis don’t really have a motivation to make these relations overt because they get what they need from Israel—intelligence, security, technology—without open diplomatic relations.”
In May, The Wall Street Journal reported that Gulf states such as Saudi Arabia would take steps to normalize relations with Israel if Prime Minister Benjamin Netanyahu makes gestures for the Palestinians, such as freezing settlement construction or easing trade restrictions in Gaza.
“In order to bring Israeli-Saudi relations out into the open, the Saudis would really need to see major progress on the Israeli-Palestinian track. And that is really tough,” Teitelbaum said, adding that “we are a long way from full diplomatic relations.”
Read more at https://www.breakingisraelnews.com/90766/israel-saudi-arabia-becoming-fast-friends/#GgMcF28YePwwvUoy.99
Driving attention to women's rights in Saudi Arabia
Manal al-Sharif is sometimes called "The Saudi Rosa Parks." She was arrested and imprisoned for driving while female in Saudi Arabia.
There is no public transit system in The Kingdom. And there is no mention of sex or gender in the Saudi traffic code.
Al-Sharif was punished for challenging something far more dire — tradition. She wrote about her experience in the book "Daring to Drive" and she spoke with MPR News producer Marcheta Fornoff about her experience.
Manal al-Sharif never set out to be an activist.
In fact, if you knew her as a teen, she'd probably be the last person you'd suspect to start a protest.
Back then, she stridently adhered to rules and made sure that her family followed them as well. She once melted her brother's Backstreet Boys cassettes in the oven in the name of protecting his salvation.
As she got older, her perspective started to change.
Al-Sharif graduated from King Abdulaziz University. She had a good job at Aramco, the Saudi Arabian Oil Company, and owned her own car.
Despite having a vehicle, she still had to rely on men for transportation outside of the Aramco compound where she lived.
Like many Saudi women, al-Sharif relied on family or car services to get around.
Eventually, she had to hire a driver. Many of the "professional" drivers for hire required room and board, and several were unlicensed (police frequently turn a blind eye to this practice).
The expense, inconvenience and unwanted attention from the drivers all took a toll on her.
One night, after a late doctor's appointment she was unable to find a driver. She had no other choice but to walk home in the dark. Drivers honked, yelled slurs and one car started to follow her.
When she got home she decided that she was going to drive outside of her compound. Later that year, she did.
Within hours of posting a video of herself driving on YouTube, it had hundreds of thousands of views. For this, she was arrested, imprisoned and ultimately released. Her life was drastically changed by her decision to drive. She left a job that no longer supported her and eventually moved out of the country.
People in Saudi Arabia used the blowback al-Sharif faced to make her into an example and to warn against following her corrupt example.
The warnings didn't work. "I'm happy to say I corrupted a lot of girls," al-Sharif said.
In spite of everything that happened in Saudi Arabia, al-Sharif still loves her country. She hopes to return some day — and drive.
https://www.mprnews.org/story/2017/07/03/daring-to-drive
Qatar's Ace is Saudi Nemesis
The draconian deadline by the Saudi axis on Qatar failed to force surrender. Saudi Arabia and other Arab countries have now extended the deadline till later this week. In a battle of nerves, the Saudi rulers blinked first.
This is partly because the Saudi-led coalition of Bahrain, United Arab Emirates (UAE) and Egypt have over-reached in their showdown with Qatar. The tiny gas-rich emirate may be a lightweight in terms of territorial size and population, but it is proving to be no push-over.
And there are sound reasons why the Qataris are defiant. Owing to its superabundant natural gas reserves and a native population of only some 300,000, Qatar is the richest country in the world on a per capita basis. The blockade mounted by the other Arab countries is not harmingthe emirate, especially given that it has found alternative trading sources for food, water and other goods from Turkey and Iran.
Since the imposed deadline nearly two weeks ago by the Saudi group, Qatarhas adamantly said it would not acquiesce to a list of severe demands. Those demands included the Al Thani rulers in Doha ceasing all diplomatic ties with Iran, expelling Turkish troops from the territory, financial reparations, and closing down the Al Jazeera news station. It was always an unrealistic ultimatum. As the Qatari rulers noted, the move was simply an audacious bid to over-ride the country’s sovereignty.
The sweeping demands also show that the original claim by Saudi Arabia and its allies of confronting Qatar over its alleged support for regional terror groups was disingenuous. It is evidently all about cowing Qatar into submission under Saudi diktat.
Having run their own oil-rich economy into dire straits from a two-year disastrous war in Yemen, the Saudi rulers are making a power-grab to seize their Qatari neighbor’s prodigious energy wealth.
However, in doing so, the Saudi axis has over-stretched. For a start, the hypocritical terror claims are fooling no-one apart from US President Donald Trump who rashly bought into the Saudi allegations against Qatar. No doubt so that he could flog massive weapons deals.
Russia and European nations have instead called for diplomatic negotiations. In other words, they are undermining the Saudi position of unilateral diktat to Qatar. As times goes on, the Saudi axis will appear increasingly untenable.
Despite Trump’s foolish endorsement for beating up on Qatar, his State Department has been recently trying to limit the damage to American interests in the Persian Gulf. With 10,000 US troops stationed in Qatar and a major air base for its military operations in Syria, Secretary of State Rex Tillerson has lately been trying to cool things down. Even Trump, after his initial flubbing foray into regional politics, has begun “working the phones” to mediate a resolution.
So, if the House of Saud and its regional partners thought they could browbeat Qatar with threats of isolation, the gambit is turning out to be a huge miscalculation. Far from being isolated, Qatar has enough international leverage and financial resources to withstand the pressure. After pushing the crisis to the brink – and failing this week with a hollow deadline – the Saudis and their allies stand to lose major political capital.
Henceforth, the Qataris will be emboldened to turn the tables on their Saudi rivals.
The Qatari-owned Al Jazeera news network based in Doha could step up its critical journalistic coverage on the deep internal problems residing in its neighbors. The channel, which began in 1996, has garnered an enormous following in the Arab region and indeed around the world. This is why Saudi Arabia and the others are hostile to Al Jazeera. By stepping up, legitimately, its news focus on social problems and political repression within Saudi Arabia, Bahrain, UAE and Egypt those regimes will become exposed to greater popular backlash on their streets.
More darkly, Qatar, with its deep pockets and financial muscle, could take on a role of covertly sponsoring dissident political groups within Saudi Arabia and other members of the Arab axis.
Saudi Arabia is particularly vulnerable to internal instability. And being closely related historically and culturally to Saudi Arabia, the Qataris will be well aware of the fissures within their bigger Arabian Peninsula neighbor which they can exploit.
After all, Saudi Arabia was something of an artificial creation under the British Empire. The House of Saud was established through a bloodbath in which the British-backed tribal leader Ibn Saud was able to form “the kingdom of Saudi Arabia” in 1932 largely by massacring rival tribes and repressing their families.
The British-orchestrated power grab was enabled by the Ibn Saud tribe and its Wahhabi fanaticism being given a free hand to conquer rivals across Arabia, from the Hejaz, Nedj, Asir and over in the oil-rich eastern province of Qatif. The latter continues to be a hotbed of dissent against the House of Saud among the mainly Shia population there. Despite lack of news coverage, the Saudi rulers are in a virtual state of civil war in Qatif, deploying artillery and helicopter gunships in a bid to restore a semblance of order.
The House of Saud, currently headed by 81-year-old King Salman, one of the many sons of the original founder, Ibn Saud, comprises some 2,000 “princes” who form the inner circle of national power. But that Saudi cabal only represents about 0.01 per cent of the country’s native population of 20 million. The power structure is therefore inherently unstable. Saudi instability has been further accentuated with the recent elevation of Salman’s son, Mohammed, to the Crown Prince position.
There are emerging reports that the former Crown Prince who was ousted in favor of the king’s son, has now been placed under house arrest by the Saudi rulers out of fear of a counter-coup.
Thus, inside and outside, the House of Saud is riven with rivalries and vendettas over a bloody and sordid past.
The knives are out for the newly appointed Crown Prince, the 31-year-old Mohammed bin Salman. He is widely seen as arrogant, reckless and undeserving of his unprecedented promotion, a promotion which has left many potential heirs to the Saudi throne out in the cold. The Crown Prince is also blamed for dragging Saudi Arabia into the ongoing Yemeni quagmire, whose burgeoning cost is ruinous and is rebounding with social discontent among young Saudis.
This Crown Prince is also seen as the main instigator of the blockade on Qatar. That blockade is turning out to be another fiasco which is infuriating ordinary Arabs across the region due to their families being torn apart and their livelihoods upended. All just because of some despotic scheme.
After weeks of outrageous intimidation, the Qataris are emerging as unbowed and confident. And if they have an inclination to seek revenge, they will find Saudi Arabia an exceedingly rewarding place.
We are not talking about Qatar arming insurgents inside Saudi Arabia or anything necessarily illicit. All that’s needed is to fan the embers of discontent within the kingdom and it will soon burst into a rage against the creaky House of Saud.
China - MOFA: US warship sailing territorial waters a 'serious provocation'
China has dispatched military vessels and fighter planes to warn off the missile destroyer USS Stethem that had trespassed China's territorial waters off the Xisha Islands earlier on Sunday, according to a statement by the Ministry of Foreign Affairs of China.
In the statement, spokesman Lu Kang said the act was "a serious political and military provocation."
Lu said the Xisha Islands are an inherent part of the Chinese territory and Chinese laws have explicit provisions on the entry of foreign military vessels' into the territorial.
The spokesman said the US sending a military vessel into China's territorial waters under the pretext of "navigation freedom" violated the Chinese law and relevant international law, infringed upon China's sovereignty, disrupted peace, security and order of the relevant waters and put in jeopardy the facilities and personnel on the Chinese islands.
China and ASEAN member states have worked together to improve the situation in the South China Sea, said Lu. He added the US were deliberately stirring up troubles in the South China Sea.
China has urged the US to immediately stop such kind of provocative operations, stressing it will take all necessary means to defend national sovereignty and security.
This is the second operation of its kind since US President Donald Trump took office in January. On May 25, US warship USS Dewey sailed within 12 nautical miles of Meiji Reef of China's Nansha Islands in the South China Sea, a maneuver which – according to the US – came under the “freedom of navigation” principle.
Sino-Russian partnership solidify amid uncertain ties with US
The call from Washington came on the same day as Xi's departure for Moscow, and when juxtaposed like this, the twists and turns in the Sino-US relationship in recent weeks provide a contrast with the long-term stability of China-Russia relations. Perhaps many in China will think the US is an unreliable partner, while China and Russia are true friends.
As strategic mutual trust reaches a high level, the leaders of the two countries have met frequently. Since taking office, Xi has visited Russia six times while Xi and Russian President Vladimir Putin have met 21 times.
The two sides are not developing strategic cooperation for short-term purposes. The China-Russia comprehensive strategic partnership of coordination has concrete content and both sides consider it their most important diplomatic asset, while their bilateral ties are a bulwark in dealing with a complex world.
Managing ties with Washington is crucial to both Beijing and Moscow; however it's a difficult, if not impossible, task for both to have a smooth relationship with the US.
Strong anti-Russian sentiment in the US has forced Trump to nearly abandon his plan for a Washington-Moscow détente. The US strategic circle is also increasingly advocating a hard-line policy toward China, arguing the engagement policy of the past decades has failed.
Up to now, Washington has not given up its attempts to "transform" Beijing. On the one hand, it coordinates with Beijing to maximize its economic interests, and on the other, strategically restrains the latter to ensure its absolute advantage in security.
The US holds a sophisticated attitude toward Russia as well. It attempts to squeeze Russia's strategic space through NATO's eastward expansion, but meanwhile doesn't want to have a strategic showdown with the Kremlin. The Washington-Moscow relationship is always full of uncertainties.
China's relationship with the US cannot be simplistically compared to that with Russia. The Sino-US relationship is complicated and multilayered. Their bilateral trade is one of the largest in the world, bringing concrete benefits to both countries, and this may explain the unique resilience of Sino-US ties under the surface tensions.
We cannot be too pessimistic or optimistic about Sino-US relations. The two powers should seek more common interests in risk management.
The China-Russia relationship is the most significant factor in the current global strategic balance, and should continue to develop in the direction of an all-weather strategic partnership.
The more balanced the world is, the more active world powers will seek friendly ties with each other. Washington may someday get bored of its geopolitical calculations and divert its attention to its internal affairs.
Close China-Russia partnership underpins global strategic stability
Chinese President Xi Jinping on Monday departs for a state visit to Russia, a trip that is set to further cement the partnership between the two large neighboring countries.
Given the myriad challenges beleaguering today's world and the important role China and Russia play in international affairs, the visit is also set to boost confidence in global strategic stability.
In Moscow, Xi and his Russian counterpart, Vladimir Putin, will meet for the third time this year, hold extensive talks, and witness the signing of a series of bilateral cooperation deals.
The two leaders are expected to deepen political mutual trust, promote bilateral exchanges and cooperation in all fields, and chart the course for the future development of the China-Russia comprehensive strategic partnership of coordination.
The vigor of bilateral cooperation can be easily traced. China has been Russia's largest trading partner, while Russia-made electro-machines and other high-tech products make up a large part of China's import market.
Statistics show that bilateral trade surpassed 32 billion U.S. dollars in the first five months of 2017, up 26 percent from the same period last year. Progress has also been made in major projects like the manufacturing of long-range wide-body aircraft and the Moscow-Kazan high-speed railroad.
In addition, the increasingly close alignment of the China-proposed Belt and Road Initiative and the Eurasian Economic Union provides an excellent springboard for boosting economic cooperation both between China and Russia and across the region.
Besides energizing their own and regional development, the two sides also set an example of major-country relations for the world. They respect each other's core interests, pursue win-win cooperation, and commit themselves to safeguarding world peace and stability.
As both presidents have pointed out, the two countries' active communication and coordination as well as mutual support on major international issues have become important stabilizing factors for the world.
At a time when the global strategic stability is faced with a raft of severe challenges, including surging protectionism, feeble global economic recovery, an obsolete world governance system and rampant terrorist threats, that is particularly significant.
Given that, the latest stroke of top-level diplomacy between China and Russia also serves as a reflection of the sense of responsibility on the part of the two international heavyweights.
And their contribution as stabilizer of global stability should be acknowledged and followed by others on the world stage.
Xi meets Putin, underlines coordination on major issues
Chinese President Xi Jinpin
met with his Russian counterpart Vladimir Putin to discuss bilateral ties and major global issues in Moscow on Monday.
President Xi urged closer coordination between the two countries on major issues of regional and global concern.
Xi arrived in Moscow on Monday for a two-day state visit. This marked the third meeting between Xi and Putin this year, with both sides expected to sign more than 10 cooperation documents.
Following his visit to Russia, Xi will begin a state visit to Germany, where he will attend the 12th G20 Summit in Hamburg on July 7 and 8.
Chinese President Xi Jinping met with his Russian counterpart Vladimir Putin to discuss bilateral ties and major global issues in Moscow on Monday.
President Xi urged closer coordination between the two countries on major issues of regional and global concern.
Xi arrived in Moscow on Monday for a two-day state visit. This marked the third meeting between Xi and Putin this year, with both sides expected to sign more than 10 cooperation documents.
Following his visit to Russia, Xi will begin a state visit to Germany, where he will attend the 12th G20 Summit in Hamburg on July 7 and 8.
http://en.people.cn/n3/2017/0704/c90883-9236569.html
Chinese president arrives in Moscow for official visit
Chinese President Xi Jinping has arrived in Moscow for an official visit at the invitation of his Russian counterpart Vladimir Putin. The Chinese leader’s plane landed in Moscow’s Vnukovo airport on Monday.
More:
http://tass.com/world/954452
At the airport, Xi Jinping was met by Russian Deputy Foreign Minister Igor Morgulov, Russian Ambassador to China Andrei Denisov and Chinese Ambassador to Russia Li Hui.
This is Xi Jinping’s sixth visit to Russia as head of state. On July 4, the Chinese president will hold talks with Vladimir Putin, during which the parties will discuss the full range of issues related to comprehensive partnership and strategic cooperation between Russia and China and pressing international and regional issues. According to Russian Presidential Spokesman Dmitry Peskov, the two leaders will also meet with representatives of the Russian and Chinese public, business circles and media community.
Later in the day, the Chinese leader will met with Russian Prime Minister Dmitry Medvedev. During the top-level meeting it is planned to discuss bilateral cooperation in trade, investment, energy sector, industry, transport infrastructure and agriculture.
China’s Assistant Foreign Minister Li Huilai earlier told a press briefing that contracts worth about $10 bln will to be signed during the visit.
More:
http://tass.com/world/954452
Column - Republicans say Medicaid doesn't work, so it should be cut. Here are all the ways they're wrong
Michael Hiltzik
The dirtiest little secret of the Republicans’ Obamacare repeal campaign is that its genesis has nothing to do with the Affordable Care Act as such, but with a long-cherished desire to gut Medicaid, which predated the ACA by nearly a half-century.
To advance this goal, conservatives and GOP leaders have asserted consistently that Medicaid doesn’t work or even “harms its beneficiaries.” Health economist Austin Frakt of Veterans Affairs and Boston University now has done Medicaid’s defenders an important service by issuing a call to collect in one place all the claims that the program is broken or harmful, and then pointing us to research debunking those smears.
To be fair, the goal of gutting Medicaid as part of Obamacare repeal isn’t really much of a secret. House Speaker Paul Ryan, R-Wisc., gave the game away in a videotaped discussion with National Review’s Rich Lowry in March. There he confessed, “So Medicaid, sending it back to the states, capping its growth rate, we've been dreaming of this since I've been around — since you and I were drinking at a keg.... I've been thinking about this stuff for a long time.”
Ryan is 47 now, so he would have been dreaming about cutting Medicaid in the early 1990s while “drinking at a keg,” perhaps at frat parties at his alma mater, Miami University of Ohio. The ACA was enacted in 2010.
So Medicaid, sending it back to the states, capping its growth rate, we've been dreaming of this since...you and I were drinking at a keg.
Other examples abound of Republican and conservative hostility to Medicaid. A 2013 survey of 13 state governors who opposed its expansion under the ACA found five who listed as a principal rationale that it’s a “‘broken system’ [that] harms its beneficiaries.” Health and Human Services Secretary Tom Price told a congressional hearing in March that Medicaid has “decreased people’s ability to access care.” The right-wing American Action Forum says the program is “harming those who need it most.”
We reported last week on a drive-by attack on Medicaid — wholly unsupported by the facts — launched by right-wing pundit Ben Domenech on the CBS program “Face the Nation,” and on right-wing healthcare commentator Avik Roy’s long crusade against the program.
In perhaps the most appalling example, Seema Verma, who as the administrator of HHS’ Centers for Medicare and Medicaid Services is in charge of the program, cast doubt in an op-ed last week that “Medicaid works for those it was designed to serve.” Verma based her conclusion that Medicaid had “justifiably taken a lot of heat” in recent years on three studies that have been widely questioned and even more widely misinterpreted.
None of these claims is true. So let’s look at this evidence.
Here’s a short-cut version, produced in 2011 by Frakt and co-authors Aaron Carroll, Harold Pollack and Uwe Reihardt: “If Medicaid actually harmed health, instrumental variables studies would show that; they don't,” they wrote in the New England Journal of Medicine. “Other complementary research, such as the RAND Health Insurance Experiment and studies of patients 65 years of age or older who were uninsured before entering Medicare, support the belief that basic public health insurance coverage improves health.”
One of the most oft-cited studies questioning the efficacy of Medicaid is a 2010 study of surgical outcomes from the University of Virginia. The 900,000 surgeries in the sample were from 2003 to 2007. The researchers found that in-hospital mortality for Medicaid patients was worse than for uninsured or privately insured patients, though lower than Medicare patients.
But as an analysis by the Milbank Memorial Fund observed, there were lots of questions about this conclusion. The Virginia researchers tried to adjust for some risk factors distinguishing the Medicaid population from the others, but they couldn’t adjust for everything.
Among the factors they acknowledged might contribute to mortality and skew the results, the Medicaid patients had the highest incidence of AIDS, and metastatic cancers, “depression, liver disease, neurologic disorders, and psychoses.” They suffered from social factors associated with poverty, including drug abuse and delayed diagnoses, and lacked support and resources for care at home.
Despite all that, it turned out that Medicaid patients actually did better than some other patients in such surgeries as lung resections, pancreatectomies, and aortic aneurysm operations, and had fewer complications in some categories. A blanket conclusion that Medicaid patients did worse simply was unwarranted.
It’s also the case, as Kevin Drum of Mother Jones points out, that mortality is an inadequate metric for assessing a healthcare program, since “the vast majority of doctor visits aren’t for life-threatening conditions.” But they can be for conditions that can profoundly affect one’s quality of life, not to mention one’s financial condition, if they go untreated. In any case, he adds, since the average age of Medicaid enrollees is 38, there won’t be much mortality in that group to begin with, so any changes are unlikely to be meaningful.
The best-known study of the effect of Medicaid coverage is the so-called Oregon Experiment, which has the best pedigree of all such studies: It was done by researchers at Harvard and MIT, including such supporters of universal healthcare as Jonathan Gruber. Medicaid critics constantly cite it as proof that having Medicaid coverage is “no better than being uninsured,” to quote Avik Roy.
The problem here is that the authors of the study disagree with that. The study, which followed newly enrolled Medicaid patients for two years, found no improvement in three markers associated with cardiac health and diabetes: cholesterol, high blood pressure and blood sugar levels. But the figures for those were not statistically significant, which makes them useless for assessing the program’s effects.
The researchers did, however, find a statistically significant reduction in the incidence of depression, a significant increase in the diagnosis of diabetes and the use of diabetes medications, and in cholesterol screening, pap smears, mammograms and other screening tests. They also found a significant “reduction in financial strain from medical costs.” Catastrophic expenses, defined as those exceeding 30% of income, were “nearly eliminated.”
These benefits can be traced directly to Medicaid coverage, and they’re not trivial. The fact that Medicaid’s critics return to the Oregon results over and over, cherry pick a few findings, and misinterpret those should tell you something. It’s that declaring Medicaid to be useless, or no better or even worse than having no insurance at all is merely a shibboleth.
It’s an incantation that gets endlessly repeated as truth, even though empirical studies show that there’s no truth in it at all. Verma, by citing both the Virginia and the Oregon studies in her op-ed without acknowledging their limitations, turned in a shameful performance.
The congressional Republicans backing the Obamacare repeal bills that cut the meat and bones out of Medicaid to the tune of $800 billion to $1 trillion, must have some ulterior motivation. It can’t be improving its users’ health, because what they’re planning would achieve just the opposite. What could it be?
Subscribe to:
Posts (Atom)