Nader: Nuclear Nightmare, Cruel Cuts to Medicare

https://www.commondreams.org/view/2011/03/19-0

Nuclear Nightmare

by Ralph Nader

CommonDreams.org: March 19, 2011

The unfolding multiple nuclear reactor catastrophe in Japan is prompting overdue attention to the 104 nuclear plants in the United States—many of them aging, many of them near earthquake faults, some on the west coast exposed to potential tsunamis.

Nuclear power plants boil water to produce steam to turn turbines that generate electricity. Nuclear power’s overly complex fuel cycle begins with uranium mines and ends with deadly radioactive wastes for which there still are no permanent storage facilities to contain them for tens of thousands of years.

Atomic power plants generate 20 percent of the nation’s electricity. Over forty years ago, the industry’s promoter and regulator, the Atomic Energy Commission estimated that a full nuclear meltdown could contaminate an area “the size of Pennsylvania” and cause massive casualties. You, the taxpayers, have heavily subsidized nuclear power research, development, and promotion from day one with tens of billions of dollars.

Because of many costs, perils, close calls at various reactors, and the partial meltdown at the Three Mile Island plant in Pennsylvania in 1979, there has not been a nuclear power plant built in the United States since 1974.

Now the industry is coming back “on your back” claiming it will help reduce global warming from fossil fuel emitted greenhouse gases.

Pushed aggressively by President Obama and Energy Secretary Chu, who refuses to meet with longtime nuclear industry critics, here is what “on your back” means:

1. Wall Street will not finance new nuclear plants without a 100% taxpayer loan guarantee. Too risky. That’s a lot of guarantee given that new nukes cost $12 billion each, assuming no mishaps. Obama and the Congress are OK with that arrangement.

2. Nuclear power is uninsurable in the private insurance market—too risky. Under the Price-Anderson Act, taxpayers pay the greatest cost of a meltdown’s devastation.

3. Nuclear power plants and transports of radioactive wastes are a national security nightmare for the Department of Homeland Security. Imagine the target that thousands of vulnerable spent fuel rods present for sabotage.

4. Guess who pays for whatever final waste repositories are licensed? You the taxpayer and your descendants as far as your gene line persists. Huge decommissioning costs, at the end of a nuclear plant’s existence come from the ratepayers’ pockets.

5. Nuclear plant disasters present impossible evacuation burdens for those living anywhere near a plant, especially if time is short.

Imagine evacuating the long-troubled Indian Point plants 26 miles north of New York City. Workers in that region have a hard enough time evacuating their places of employment during 5 pm rush hour. That’s one reason Secretary of State Clinton (in her time as Senator of New York) and Governor Andrew Cuomo called for the shutdown of Indian Point.

6. Nuclear power is both uneconomical and unnecessary. It can’t compete against energy conservation, including cogeneration, windpower and ever more efficient, quicker, safer, renewable forms of providing electricity. Amory Lovins argues this point convincingly (see RMI.org). Physicist Lovins asserts that nuclear power “will reduce and retard climate protection.” His reasoning: shifting the tens of billions invested in nuclear power to efficiency and renewables reduce far more carbon per dollar (http://www.nirs.org/factsheets/whynewnukesareriskyfcts.pdf). The country should move deliberately to shutdown nuclear plants, starting with the aging and seismically threatened reactors. Peter Bradford, a former Nuclear Regulatory Commission (NRC) commissioner has also made a compelling case against nuclear power on economic and safety grounds (http://www.nirs.org/factsheets/whynewnukesareriskyfcts.pdf).

There is far more for ratepayers, taxpayers and families near nuclear plants to find out. Here’s how you can start:

1. Demand public hearings in your communities where there is a nuke, sponsored either by your member of Congress or the NRC, to put the facts, risks and evacuation plans on the table. Insist that the critics as well as the proponents testify and cross-examine each other in front of you and the media.

2. If you call yourself conservative, ask why nuclear power requires such huge amounts of your tax dollars and guarantees and can’t buy adequate private insurance. If you have a small business that can’t buy insurance because what you do is too risky, you don’t stay in business.

3. If you are an environmentalist, ask why nuclear power isn’t required to meet a cost-efficient market test against investments in energy conservation and renewables.

4. If you understand traffic congestion, ask for an actual real life evacuation drill for those living and working 10 miles around the plant (some scientists think it should be at least 25 miles) and watch the hemming and hawing from proponents of nuclear power.

The people in northern Japan may lose their land, homes, relatives, and friends as a result of a dangerous technology designed simply to boil water. There are better ways to generate steam.

Like the troubled Japanese nuclear plants, the Indian Point plants and the four plants at San Onofre and Diablo Canyon in southern California rest near earthquake faults. The seismologists concur that there is a 94% chance of a big earthquake in California within the next thirty years. Obama, Chu and the powerful nuke industry must not be allowed to force the American people to play Russian Roulette! 

Ralph Nader is a consumer advocate, lawyer, and author. His most recent book - and first novel - is, Only The Super-Rich Can Save Us. His most recent work of non-fiction is The Seventeen Traditions

http://www.commondreams.org/headline/2011/03/28-1

Dems: Potential Cuts to Medicaid Outlined by Administration 'Cruel'

by Mike Lillis

The Hill: March 28, 2011

An Obama administration letter outlining potential Medicaid cuts to help states balance their budgets was "cruel" and "disappointing," according to several prominent Democrats.

The lawmakers are concerned the letter will encourage states to clip health coverage for some of the country's poorest people amid a poor economy when they could use the benefits most.

"It's cruel," said Rep. Dennis Kucinich (D-Ohio), "and it's nothing you would expect from a Democratic administration."

The potential for cuts highlights the pickle facing federal lawmakers as they try to expand healthcare coverage while simultaneously reining in soaring healthcare costs. It underscores the pressures on state leaders to balance budgets during a period of high unemployment and deflated revenues. It accentuates the structural flaw plaguing Medicaid, which often sees enrollment spike during bad economies when states can least absorb the extra costs. And it foreshadows potential troubles with the new health reform law, which leans heavily on an enormous Medicaid expansion to cover millions of uninsured Americans in the years to come.

The controversial letter, sent to the nation's governors last month by Health and Human Services (HHS) Secretary Kathleen Sebelius, acknowledges the severe budget conditions tormenting states and offers "new tools and resources to achieve both short-term savings and longer-term sustainability" under Medicaid.

The suggested strategies are wide-ranging, including efforts to rein in fraud, shift patients into managed care and encourage generic drugs in lieu of name brands. But atop the list are ways states can scale back non-mandatory benefits and shift higher costs onto Medicaid patients.

"While some benefits, such as hospital and physician services, are required to be provided by State Medicaid programs, many services, such as prescription drugs, dental services, and speech therapy, are optional," Sebelius wrote. "In addition, States may add or increase cost sharing for services within limits."

The message was a response to an earlier letter from 33 governors asking Sebelius to lift a provision of the new reform law – called the maintenance of effort (MOE) requirement – preventing states from trimming Medicaid rolls ahead of the law's broad 2014 expansion.

Mary Kahn, spokeswoman for the Centers for Medicare and Medicaid Services (CMS), said the Sebelius letter "does not encourage states to drop coverage, it simply outlines the flexibility available to states under current law."

But some liberal lawmakers say even that was a step too far. Kucinich, a long-time advocate for a single-payer healthcare system, is wondering why the country's most vulnerable populations should shoulder the burden of state efforts to balance budgets.

"When you consider that – in a for-profit healthcare system, about 30 percent, and as much as 33 percent, of all spending goes for corporate profits, stock options, executive salaries, advertising, marketing, processing paperwork – it's cruel," Kucinich said of the HHS letter.

Rep. Elijah Cummings of Maryland, the top Democrat on the House oversight committee, was also critical. Focusing specifically on Medicaid dental coverage, he said the HHS letter is "disappointing," and called on the agency "to revisit" its reminder that certain dental services are optional under the program.

"Dental care is something that's easy to resolve. I'm talking about stuff like sealants; I'm talking about check-ups; simple things," Cummings said. "I would hope that [Sebelius] would revisit that, and instead of making it a second-tier or third-tier health priority, she would put it on the first level."

The lack of dental care in Medicaid can have tragic consequences. In 2007, a 12-year-old Maryland boy named Deamonte Driver was hospitalized when bacteria from an abscessed tooth spread to his brain. Six weeks, two operations and hundreds of thousands of dollars later, he died. An $80 procedure might have saved him, but his mother couldn't find a dentist who would accept his insurance plan. It was Medicaid.

Because dental coverage for kids is mandatory under Medicaid, states cannot cut those services in search of budget savings. But they can eliminate dental coverage for adults, and cut reimbursement rates for doctors and dentists that can affect patients of all ages.

Jocelyn Guyer, co-executive director at Georgetown University's Center for Children and Families, an advocacy group, called the latter option "a back-door strategy" for cutting costs that can also erode access to care.

"They end up just pulling out people's teeth," Guyer said, "because it's cheaper."

Guyer noted that the HHS letter didn't contain anything that Medicaid experts – both advocates and state officials – don't already know. Still, she said she was "surprised they put the benefit cuts first" among the cost-saving options.

Medicaid, a federal-state partnership, is a prominent target for state budget hawks not only because it represents an enormous chunk of state budgets, but also because the low-income beneficiaries tend to hold much less sway politically than better-heeled special interests.

The Center on Budget and Policy Priorities (CBPP), a liberal policy group, says 31 states have already slashed public health benefits to balance budgets in response to the recession, with most of those cuts targeting Medicaid. Additionally, CBPP has identified at least 23 states that have proposed additional Medicaid cuts in their coming-year budgets.

Mike Leachman, a CBPP analyst, said many state officials are focusing their deficit-reduction efforts disproportionately on Medicaid because they've taken tax hikes off the table.

"Many governors," he said, "are proposing much deeper cuts than are necessary."

The debate over further cuts comes at a time when access to care under Medicaid is already at remarkably low levels. Only about 40 percent of physicians accept all new Medicaid patients, versus 58 percent for Medicare patients, according to a 2009 study from the Center for Studying Health System Change, which randomly surveyed more than 4,700 physicians.

Gaining access to dental care is even tougher. A 2007 survey by the American Dental Association found that fewer than 27 percent of respondents treated Medicaid-insured patients.

The reason is no mystery: Medicaid payments, despite a 12 percent increase between 2003 and 2010, represent just 69 percent of what Medicare pays for the same services, said Stephen Zuckerman, health policy analyst at the Urban Institute.

"This is serious stuff," Cummings said. "It's not just [about] the Deamonte Drivers of the world."

Other House Democrats downplayed the significance of HHS' menu of Medicaid cuts. Rep. Henry Waxman (Calif.), senior Democrat on the Energy and Commerce Committee, said Sebelius was simply reminding states of their ability to make changes to Medicaid – "even reductions that I don't think would be wise."

"She was interpreting the law for them in a way to show there are things the states can do – there are services that are optional, there are populations that are optional," Waxman said. "I wouldn't want to see a state not cover pharmaceuticals for the Medicaid population, but they do have that option. If they took that option, they wouldn't be spending their state share on what I think is an essential part of medical care – but it's their prerogative."

Rep. Frank Pallone (N.J.), senior Democrat on the Energy and Commerce health subcommittee, agreed. He said the Sebelius letter "essential shows that there's flexibility" for states trying to balance budgets.

"I'd rather have this flexibility than have people dropped from the program," Pallone said.

As the debate rumbles on, HHS is sending teams across the country to help local Medicaid officials devise ways to control costs. Eighteen states have requested help thus far, said CMS' Kahn, but the outreach program is just getting started, and CMS officials "haven't done extensive work yet."