Health Care Reform: What Does the Populace Really Want? A Look Back at California in 1994

A couple of weeks ago, I predicted that in pushing through a controversial and arguably ill=conceived health care reform bill, Trump would suffer the fate of Bill Clinton in 1994 and Barack Obama in 2010 — loss of his party’s control of the midterm congressional elections. And just this past Thursday, Peggy Noonan’s Wall Street Journal column explained why. See also Alan Tonelson’s blog post today. (I highly recommend his blog in general. I should cite it more often, but if I did, I’d spend more time citing than on writing my own posts. ūüôā )

Yet with all the hoopla over the health care issue, I would submit that we as a nation have never clearly set out desiradata for it. And, as with most issues, We the People have never been asked, other than the odd state ballot measure such as California’s Proposition 186 in 1994. (More on this below, where it will become the major point of this post.)

I submit the following as axioms:

  • Health care is a public good, just like education. Our nation offers free public education because it benefits society as a whole, and the same should hold for health care. Timely treatment of diabetes, for instance, can avoid later blindness and mobility problems, thus saving on welfare costs and so on.
  • Even before the advent of Obamacare, we had been providing government-sponsored health care for many, many years, via Medicare, Medicaid, tax-loss writeoffs for emergency room care for the uninsured etc.
  • The American people do not want uninsured people dying in the streets.

The ultraconservatives in Congress need to recognize these points, and recognize that the genesis of Obamacare was a proposal by the Heritage Foundation, a prominent conservative think tank, and its implementation in Massachusetts by Republican governor Mitt Romney. The vast majority of Americans would agree to the above axioms. The intransigent members of Congress are letting their hatred of Obamacare (and, perhaps, their hatred of Obama himself) affect their good judgment. Get over it, Freedom Caucus!

For their part, the Democrats are refusing the recognize the failings of Obamacare. To be sure, something had to be done about health care, both in terms of access and rising costs, and arguably the Democrats did the best they could in 2010. But the program lacks long-term viability financially, and is producing victims even in the short term. Open your eyes, Democrats!

Given the axioms, the central question is, just what is it that we all want the government to provide (directly or via subsidies)? Do we, for instance, want to cover maternity benefits and mental health care? It is one thing to force young, healthy people to buy insurance, in order to subsidize the older, more medically expensive segment of society, on the grounds that most of the young people will eventually become seniors. But in this era of declining birth rates, many people will never become parents, or at least will do so much less often than in previous generations. How do the American people feel about that subsidy? What about subsidizing visits to shrinks for those who are merely unhappy, as opposed to those who are alarmingly out of touch with reality? How about the subsidies for heroic treatment of catastrophic diseases? I’ve never seen any polls on such things, but really isn’t this a central issue, Where to draw the line?

Again, arguably maternity care is another public good, as is mental health treatment. But again, where do we draw the line? Many believe the Democrats drew that line too liberally in 1994, and even many of us who don’t hold that view decry the obstinacy of the Democrats in flatly refusing to revisit it, and we resent¬†the failure of both parties to ask us common folk just how much we want to subsidize.

One of the rare instances in which the populace was given a say occurred in California in 1994, in Proposition 186. The much more memorable ballot measure that year was Proposition 187, which would have denied state government services to unauthorized immigrants, but Prop. 186 was quite significant. The proposal would have established single-payer health insurance in the state. California voters, among the most liberal in the nation, overwhelmingly voted No. And though that was more than 20 years ago, my sense is that it would be soundly defeated today as well.

In other words, the problem is less the issue of whether the government gets involved in health care, rather it is, Just how far do we want the government to go?

To make this question concrete, suppose the Republican bill had passed the House yesterday, and later passed by the Senate and signed into law by Pres. Trump, but without coverage of some of the basic types of treatment guaranteed by Obamacare. Would California take up the slack? If there were a ballot proposition to restore all that coverage using taxpayer money,  I submit that the measure would likely be defeated. Again, one of the most liberal states in the Union would vote against (forgive the provocative and possibly unrepresentative example) taxpayer-subsidized use of Viagra.

During that 1994 election campaign for Prop. 186 (on which I voted Yes), there was a striking example of the problem. A Chinese-American physician was a guest on KTSF, a Bay Area TV station specializing in Chinese-interest and other ethnic programming. The doctor was a progressive politically, as was the host of the show, Anni Chung, a Chinatown political activist. The physician was urging viewers to support Prop. 186.

Chung asked the MD, “Would Prop. 186 cover the undocumented?” The doctor immediately answered (emphasis added), “Oh, definitely not. We couldn’t afford it.” In other words, even this ultraliberal doctor was unwilling to draw the line that far.

And that is my point. We the People need to be consulted as to where to draw the line. “All the rest is commentary.” ūüôā

That 60 Minutes Episode

I had to fight the temptation to title this post, “The Bruce Morrison Show.” It certainly would have been an apt title, but just too snide. I have seen indications that Mr. Morrison sincerely believes in his cause, so I’ve toned things down a bit with the more mundane title.

But the fact remains that the show was a travesty, with Morrison as the main character. I know that many victims of the H-1B program were thrilled with the broadcast, feeling that “They are finally telling our story.” But the program, especially Morrison, completely mischaracterized the core problems with H-1B, and did so in exactly the manner the tech industry has been promoting: The message is that the firms I call the “Intels,” meaning those that hire H-1Bs as foreign students at U.S. universities, are using the visa program responsibly, while the “Infosyses,” the mainly Indian firms that hire H-1Bs directly from abroad and then rent them out to U.S. firms, are the Bad Guys.

Before I continue, I must clarify that I mean the “Intels” to include not only the large tech firms, but also many, many employers such as Bank of West, a Bay Area financial institution. The BofW also hires foreign students from U.S. campuses, just like Intels. So instead of describing the tech industry’s lobbying message as Intels Good, Infosyses Bad, let’s use a slightly less succinct term, F-1s Yes, Direct Imports No. (The student visa is F-1.)

Now, back to Morrison and the organization he represents, IEEE-USA. Morrison was the ONLY “expert” 60 Minutes chose to put on the show. (As I mentioned last week, the producer originally scheduled me to be filmed when they were in the Bay Area for the UCSF case, but canceled the next day.) Please bear with me here, because it is paramount to understand how egregious 60 Minutes’ choice of Morrison was as the star of their show.

Morrison, as the show mentions, was one of the original architects of H-1B in 1990. As too often is the case, he later became a lobbyist, from which he has been raking in the bucks. A major client is IEEE-USA, an organization of about 200,000 electrical engineers (many of whom are actually programmers). Why would those engineers be interested in Morrison, given my statement above that Morrison is really promoting the interests of the tech companies rather than tech workers?

The answer of course is that those engineers didn’t hire Morrison; their “leadership” did. (With many if not most being unaware of this.) And in turn, the leadership was motivated by¬†survival. In the 1990s, IEEE-USA was in the forefront of opposing the H-1B program. However, this didn’t sit well with the IEEE parent organization, which is dominated by the industry and academia, the two sectors benefiting from H-1B. There were even public threats by the parent group, as I recall, and apparently the parent ordered IEEE-USA to back off. The main IEEE-USA staffer who was lobbying Congress against the visa program was reassigned, and his excellent Web page was taken down. And, by the way, calls by some members for the body to poll its members on the H-1B issue were refused.

And IEEE-USA hired Morrison, who with his former associate Paul Donnelly, who had moved to IEEE-USA, formulated the F-1s Yes, Direct Import No idea, in the form of granting green cards rather than work visas. This became what in recent years has become known as Staple a Green Card to Their [the Foreign Students in U.S. Schools’] Diplomas.

Here is the core of the issue:

  • The “Intels” are just as culpable regarding H-1B (and OPT etc.) as are the Infosyses.
  • The “Intels” have publicly admitted that their PR strategy is F-1s Yes, Direct Imports No. Demonizing the Infosyses distracts attention away from themselves.
  • Morrison was hired due to industry pressure on IEEE-USA, and he has been one of their main messengers promoting¬†F-1s Yes, Direct Imports No.

60 Minutes knew of these things. As I mentioned before, the producer had talked to me on the phone for an hour. He and I have also had extensive e-mail exchanges. He was clearly very sharp, and the above points are verifiable. Yet they chose to make Morrison the hero of the show.

Granted, the show did briefly mention that companies like Google and Facebook (and CBS) use H-1Bs, and then juxtaposed it with a quote of Morrison, giving viewers the impression that the Intels too are abusing the system. Perhaps Morrison was alluding to the fact that some clients of the Infosyses are Intels.

But basically the show — including the thrust of Morrison’s commentary — was all about the Infosyses and the Direct Imports: The interviewed laid-off programmers were all victims of Infosyses; the entire narrative was about H-1Bs replacing Americans, as is the habit among the Infosyses, ignoring that there is just as much problem with H-1Bs being hired by the Intels¬†instead of Americans; Morrison’s “loophole” involves the Infosyses; all the firms 60 Minutes listed as replacing Americans by H-1Bs — Disney, SCE, Northeast Utilities etc. — did so via the Infosyses.

Note that in the show, 60 Minutes knew, but did not tell viewers, that Morrison is a lobbyist who has made tons of money by delivering this message. 60 Minutes knew, but did not tell viewers, that Morrison’s description of a “loophole” was highly misleading. 60 Minutes knew, but did not explain to viewers (other than one fleeting instance of using the word young) that the core enabler of abuse of the visa is NOT the loophole, but instead is AGE, with employers hiring younger, thus cheaper H-1Bs in lieu of older, thus more expensive Americans.

Morrison’s loophole, implemented in the 1998 legislation that temporarily doubled the H-1B, was aimed at the Infosyses. This was the theme of the congressional discussion, Intels Good, Infosyses bad. The statute defined an “H-1B dependent” employer category, consisting of employers with 15% or more of their workforce being H-1Bs, and required such employers to give Americans hiring priority. (H-1B in general has no such requirement.) The 15% figure was strategically set; originally a 10% threshold was planned, but the Intels howled. H-1B dependent firms were then also required to pay at least $60,000 a year.

Morrison, both on 60 Minutes and in his numerous other public statements, gives the impression that all Congress need do is raise that $60K figure and the problem is solved. He doesn’t tell you that the Intels would not be subject to this, as they are not H-1B dependent employers.

One of those Intels, for instance, is IBM. That company is also into the outsourcing business, and even if the Infosyses were shut down tomorrow, companies like IBM would take up the slack. And with Staple, a likely ingredient to any legislation, Disney etc. would just hire from that new pool. Result: No additional jobs freed for American workers.

Morrison’s favorite line — used repeatedly in mantra-like fashion by him and his surrogates — is “The H-1B visa was not intended to be used for cheap labor.” This is clearly an incorrect claim, as can be seen for instance in the low wage floors defined in H-1B law. Instead of a single wage floor for a given occupation and region, there are multiple levels of experience defined, enabling the core of H-1B abuse — hiring younger, thus cheaper, H-1Bs in lieu of older, thus more expensive Americans. Indeed the change from two levels to four in the 2004 legislation had been pushed by the American Immigration Lawyers Association for years, and by the way, was endorsed by this same IEEE-USA. Small wonder the vast majority of H-1Bs are at Levels I and II (for both the Intels and the Infosyses).

And there’s a lot more. Morrison’s legislation defined the wage floor as the average wage for the given occupation, region and experience level. This is a more subtle, though even more pernicious, hidden loophole, as follows. The employers claim they hire H-1Bs for their rare skill sets, but rare skill sets command a premium wage in the open market, not the average one. In other words, the employer is getting a more valuable worker for just an average wage.

But of course, none of this was stated in the 60 Minutes report either. The bottom line is that Morrison couldn’t have asked for a better platform for his misleading message.

60 Minutes on H-1B, Sunday

Some activist critics of H-1B are quite excited that 60 Minutes will run a piece on H-1B this Sunday. But I will not bother to watch, as this preview shows that the 60 Minutes people are doing exactly what I urged them NOT to do: Portray the H-1B visa as basically sound and helpful to the nation, except for the Indian outsourcing firms and their U.S. clients. In other words, they are propagating what I call the Intels Good, Infosyses Bad myth.

A bit of background: 60 Minutes actually did an excellent show on H-1B back in 1993. Interestingly in light of the situation today, their target was HP, one of the Intels. But in 2003, they did a complete about-face, in a segment in which correspondent Leslie Stahl gave a gushing tribute to the IIT universities in India, the graduates of which often are hired by the Intels, an implicit endorsement of the Intels’ use of H-1B. Requests from readers for an opportunity to respond, just in a televised letter to the editor (a 60 Minutes feature at the time) were denied.

Well, last Fall, I was contacted by a 60 Minutes producer who wanted to do a piece on H-1B. He actually volunteered the opinion that the 2003 segment was deliberate propaganda, and he had really done his homework. He had read my work on the topic, and understood quite well my point about the Intels Good, Infosyses Bad myth, which he promised (I believe) to avoid.

But a couple of months later, he and another producer, presumably his boss, called me again. They were coming to the Bay Area to interview workers at UCSF who are slated to be replaced by H-1Bs and offshore workers. They wanted to film me, and we set up a time. But the next day they canceled our appointment, and of course now what we see is that they are going to propagate the Intels Good, Infosyses Bad myth after all.

Some people ask me, “Isn’t it worthwhile to at least clamp down on the Infosyses, even if the Intels aren’t touched or are even rewarded?” They believe I am unreasonably waiting for a perfect reform proposal. But I am not. I have just one simple criterion: ¬†Would a given reform proposal increase the number of jobs open to American tech people?

If a proposed solution is not predicated on the fact that the Intels a widely culpable too — say a solution that punishes the Infosyses but expands the number of visas for the Intels, by increasing the H-1B cap and/or a Staple a Green Card system — then there is no forward progress at all. Disney, for instance, would either switch from HCL to IBM or would hire the young Staple people.

There are people who hate the Infosyses so much that they are blinded to this. Yes, absolutely, the Infosyses are no angels. But getting them out of the way would only shift the problem, NOT solve it.





Fake News about Whiz Kids

Often there is a news item, typically based on some highly misleading “study” by an even more highly biased analyst who has a direct vested interest in the outcome, that I would rather just ignore. Time is precious.

But occasionally such a news item is so widely disseminated that I get a number queries about it from my readers. Worse, in many cases those readers are taken in by said news item/”study.”

I’m referring in this case to the study by the National Foundation for American policy, reported in Forbes¬†under the headline, “83% Of America’s Top High School Science Students Are The Children Of Immigrants.” The implication is that this is yet another “benefit” from the H-1B work visa and related programs. (NFAP is apparently a one-man operation. That one man is Stuart Anderson, the author of the Forbes article, who has long made his living by doing research favorable to H-1B.)

I’m sorry, but to me this is the worst possible rationale for H-1B, because ¬†I consider the competitions, e.g. the Intel Science Talent Search, discussed in the study to be not only meaningless, but destructive.

Why my “I’m sorry” comment above? It is one thing for me to write blog posts that rail against the H-1B program, the employers who abuse it (which means almost all of them, large and small), the corrupt politicians who are bought off by the industry campaign contributions, the equally-corrupt “researchers” who accept money from the industry, the complicity of the universities, and so on. But my statement about the Intel contests will be construed by some to be critical of the kids. I can confidently predict that, because it has already happened, when I wrote a Bloomberg piece on this very topic; some of the reader comments treated me as some sort of ogre. How could I denigrate these hardworking kids’ stellar success? Indeed, after that, Bloomberg stopped inviting me to write pieces for them; no comment made, but I think this was cause-and-effect.

Yes, indeed, these kids are enormously dedicated. Good for them. But the claim that these are the top science kids in the U.S. is just plain false. As I wrote,

The contest doesn’t rank talent in the same way we identify the fastest hurdlers or longest jumpers.

First of all, most top science and math students don’t participate in such national contests. The commitment required is scary, and even energetic, motivated students may think their time is better spent on other pursuits. Participation in these competitions is largely a function of what school one attends. When Westinghouse ran the event, there were “Westinghouse schools,” with special programs designed to encourage participation, and today some schools have turned this into an art form.

Second, the project-oriented contests such as Intel aren’t measures of scientific brilliance. Yes, those who succeed are bright, extraordinarily dedicated kids. But the ideas for the centerpiece of the contest, the student’s research project, often originate with the student’s university mentor. The student will join a project already in progress and be given a piece to work on. During that work, the student will come up with ideas for refinements, but a focus on “their solutions” is exaggerated. Those “High School Student Finds Cure for Cancer” headlines are seriously misleading…

Professor Miriam Rafailovich, who runs an organized mentoring program for high school researchers at SUNY Stony Brook, told me in an e-mail interview that the contestants “get massive coaching from the schools.” There is even a how-to book, “Success With Science: The Winners’ Guide to High School Research,” written by winners of these national science competitions.

Moreover, the fact that so many of the kids who do so well in these contests are children of immigrants is no coincidence. I wrote,

As the book and Rafailovich point out, a big motivation for many contestants is to bolster their admission chances to selective colleges. That is a fine goal, but it also explains why many contestants have immigrant parents — who often have a “Harvard or bust” viewpoint. Those kids are more likely to participate. Given that the contests don’t really measure pure scientific talent, the demographics of the winners’ lists shed little light on what U.S. immigration policies should be in terms of maintaining excellence in science research.

A few years ago, I was at a research conference, and decided to attend a talk whose title interested me. In fact, the title seemed vaguely familiar; as I waited for the talk to start, I suddenly realized why: The young man presenting the talk had been an Intel award winner earlier that year, and his mentor was a professor whom I knew somewhat. This professor has mentored many such high school contestants. Well, the young man gave a great talk, but in the Q&A it became clear that his knowledge of his research was superficial. He gave answers like, “I don’t know; you’d have to ask my research adviser.” Again, it was an outstanding talk, very polished and professional, and my hat is off to the student. But the research that won him that award wasn’t his.

The Asian parents love these contests (the above student is South Asian), for the reason cited earlier: They believe (correctly in some cases) that the contests are steppingstones to the Ivy League. Most readers here are probably at least vaguely aware of this, but may not realize just how deep it goes. The contests are just one more way of gaming the system.

I must say that even I, with my connections to the Chinese immigrant community, was floored a few months ago in a discussion with Chinese friends about the college admissions application process. They easily bandied about their own acronyms that I eventually guessed the meaning of, saying things like “In my second meeting with the AO, I discussed the chances of my son getting accepted ED…” (Admissions Officer, Early Decision). And they took it for granted that this “market research” is cynically conducted by all parents of high school students, at least those who can afford tens of thousands of dollars for admissions counselors who have an “in” with the admissions offices of various elite schools.

Of course, “gaming the system” is a very pejorative term, but what else can one call it? And the worst part of it is that I consider this very destructive. Many have pointed out the emotional scars suffered by many of the kids. That’s bad enough, but the effect on American science is much, much worse. It teaches the kids that studying science is just a way to build up a CV for college applications, rather than something that is fascinating and potentially a boon to mankind. So sad.






1994, 2010 and (?) 2018

Right after taking office in 1993, Bill Clinton — a Democrat with a Democratic Congress — decided to take on the issue of health care policy, putting Hillary in charge. She came up with an innovative but highly complex plan that failed politically, resulting in the Democrats losing the midterm elections in 1994.

Right after taking office in 2009, Barack Obama — again, a Democrat with a Democratic Congress — ignored past history and did the same thing, reportedly fulfilling a promise made to the Kennedys in return for their backing him instead of Hillary in the 2008 primaries. Granted, he did succeed, but again at a huge cost, with the Democrats losing the midterm elections in 2010.

If I remember correctly, originally health care was not a major issue with Trump. And he was a strong supporter of preserving Social Security, a very un-Republican view, and one that is arguably close to the goal of Obamacare in spirit. But like Obama, he had to make a deal to get the support of powerful elements of his party, and he eventually made the repeal and replacement of Obamacare a big goal. And now he could end up suffering the same consequences as did Clinton and Obama in the midterm elections.

The people Trump championed during the election campaign, the little guy, the working people — are exactly the types of folks who tend to be enjoying the benefits of Obamacare today. Will he abandon them?

Let me offer three obvious (to me, at least) facts:

  • No one, even the most extreme Republicans, wants to see people dying in the streets. The federal government does have a role, indeed a responsibility. It’s too big for the states, and even if the feds give them block grants, some states, say in the South, would adopt draconian policies.
  • Many people, especially the stereotypical Trump supporters, live paycheck to paycheck. Tax breaks, health savings accounts and the like are useless to this large group of people. It’s an insult to offer them such things, a let-them-eat-cake solution.
  • Obamacare was a bold step that filled a void that desperately needed to be filled. But it was built on various assumptions that apparently were shaky. It is not sustainable in its current form. Already some insurers have withdrawn from certain markets.
  • The Republicans now are making their own shaky assumptions, e.g. that a 30% penalty, for those who forego insurance but then suddenly need it, is the right “price” for not doing their part to support the system. Really? Why shouldn’t it be 5% or 50%, say? No one knows.

So what is my solution, you ask? Don’t be silly; of course I don’t have one. This is nowhere near my area of expertise. It’s possibly the most complex policy problem our nation has ever faced. But doing nothing is not an option.

Nevertheless, I do have one concrete suggestion, for both political parties: Borrow from the software engineering notion of use cases. Set up 5-10 examples, such as a working single mother,a small business owner, a professional in her 50s who simply can’t get a decent job because of her age, a salaried middle manager with a severely autistic child, a new college graduate working at Starbucks while trying to find work, and so on. In every debate on health care policy, both/all sides of the debate would address the question of how each of these use cases would fare under the policy they advocate.

In 2009, the biggest tragedy was the Obama never tried to sell to the American people to need for big reform. And the second-biggest tragedy was that he OVER-sold it, e.g. with the famous “You can keep your present insurance policy and present doctor” line. Both the Democrats and Republicans need to explain to the nation how they view the problem and how to solve it.

But speaking in abstractions — e.g. invoking the glories of the free market — is unacceptable. Tell us, all you guys on the Hill with your free, high-quality health care, exactly what would happen in each of those use cases under your plan? Give us real analysis with real people, no superstition. Then we might actually be able to solve the problem, and for once people might think Congress is concerned with the well-being of the people after all.


Sen. Warren Got Off Easy

I am a huge fan of Senator Elizabeth Warren. I believe that she does need educating on some issues, but she is highly admirable. Anyone who is concerned with the plight of the working poor, or has something of a feminist bent, should read her book. A Fighting Chance. Any proposal for replacing Obamacare must first address the question, “During Elizabeth Warren’s childhood, would her family have had access to health care under this policy?”

But — well, call me quaint if you wish — fair is fair, and rules are rules. A few weeks ago, when Warren tried to denigrate then-Senator Jeff Sessions during the hearing on his appointment as Attorney General, she was asked to take her seat, as a Senate rule forbids personal criticism of fellow senators. The Democrats howled! Yet just weeks later, the Democrats in the California State Senate did the same thing.

State Senator Janet Nguyen, a Republican Vietnamese-American whose Orange County constituency includes a large number of ethnic Vietnamese, stood up on the Senate floor to castigate her fellow legislator Sen. Tom Hayden, who died recently and had been the subject of a Senate memorial just two days before Nguyen spoke out. She too was violating Senate rules in doing so, not to mention violating an unwritten rule of decency concerning those recently passed away. She finally had to be “escorted” out of the room by guards¬†(see the lower left of the video a couple of minutes in), more dramatic and humiliating than in the Warren incident. And this time the Republicans howled.

The actions taken in both instances, against Warren and Nguyen, were correct. And frankly, I side with Hayden on this issue. But like millions of people, I am concerned with the total lack of civility, and extreme partisanship, in current U.S. politics. I would accuse Nguyen of lacking civility, but I am most concerned with the partisanship. What next? Fist fights on legislative floors, as happened frequently in Taiwan in the 90s? We are in absolute gridlock, to the tragic detriment of the American people.

To be sure, the Democratic leadership of the State Senate did later indicate regret for their action against Nguyen. But the incident brings up other issues.

First, there is the disturbing trend here in California of treating the words minority and immigrant as synonymous with Latino. As George Skelton of the LA Times wrote,

Many of the same politicians, after all, seem to be spending every waking moment trying to protect Latinos who, unlike Nguyen, migrated to this country illegally. Good for them. But where’s the compassion for a legal immigrant colleague who was living the American dream until Democrats briefly turned it into a nightmare?

How true!

Since the issue of refugees is so salient today, Nguyen’s example shows that often refugees, and indeed other immigrants and foreign guests, not only bring with them a desire for a better life but also bring the politics of their homelands. My recent report on the Chinese foreign students protesting UC San Diego’s choice of the Dalai Lama as a commencement speakers comes to mind immediately. And to some people, Nguyen’s choice to deliver the first part of her tirade against Hayden on the Senate floor in Vietnamese may be troubling.

As I have said, if nothing else current politics is making for good theater. But the price of this theater ticket is steep.