Just a few weeks before the earthquake that lead to a tsunami, that led to a nuclear powerplant explosion in Japan, Obama’s State of the Union Address was used to promote the use of more nuclear power in the United States. Last year, weeks before the BP Oil deluge in the Gulf of Mexico off the coast of Louisiana, Mississippi and Alabama, Obama announce the Administration’s interest in expanding offshore drilling. I was thinking about blogging about this, and saw Politico.com had just reported a story along the same lines:

Obama’s all-in on nuclear power has been building since he came into office. He pushed cap-and-trade legislation that federal studies showed would lead to construction of 100 reactors and backed spending on research into new plant designs.

In November, he said nuclear energy was an issue of potential compromise with Republicans; and earlier this year, he used his State of the Union address to call for nuclear to be counted alongside traditional renewables such as solar and wind as part of a national “clean” energy standard.

“The bottom line is this,” Obama said. “We’ve been having this conversation for nearly four decades now. Every few years, gas prices go up; politicians pull out the same old political playbook, and then nothing changes. And when prices go back down, we slip back into a trance. And then when prices go up, suddenly we’re shocked. I think the American people are tired of that.”

Obama embraced new offshore drilling during the oil price spike in 2008, which carried through to the BP spill last year. At that point, he pivoted off images of oil-soaked wildlife and fears of an ecological disaster in the region to impose a moratorium on offshore drilling and went to work beefing up safety standards. Republicans and Gulf Coast Democrats have criticized the administration for slow permit approval. A Gallup Poll released Monday found 60 percent of Americans want to increase oil and gas drilling, up 10 percentage points from May.

Every time I think there’s an opportunity for him to take a current crisis to flip the national debate (WI workers should have resulted in the call for a robust Employee Free Choice Act that included public sector workers, but none has come.), he does nothing of the sort.

But one point of interest for me is the  $940 million for AIDS drug assistance programs (ADAP), an increase of $80 million above 2010 levels to support access to life saving HIV-related medications for approximately 13,000 additional people living with HIV/AIDS.This is particularly important as there are now 6000+ people on waiting lists around the country whom states have dropped from ADAP rolls, in an effort to save $$ from their dwindling coffers.

“We’re getting through a tough couple years until we get to the Affordable Health Care Act, but we’ve really stepped up our efforts to ensure HIV treatment until the provisions in the act take hold in 2014,” said Jeff Crowley, Director of Office of National AIDS Policy.

Health Care Reform would provided more opportunities for people with HIV/AIDS to have health insurance, mostly due to ending pre-exisiting condition bans by private insurers, and by making Medicaid more accessible by raising the income requirements.

None of this will happen of course, if the Republicans have their way with the budget. According to AmFAR, here’s the GOP’s proposed HIV/AIDS cuts announced late last year:

Domestic:

• Domestic HIV/AIDS discretionary spending will be cut by 6.5% (from $7.58 billion to $7.09 billion)
• Prevention: reverting to FY2008 spending levels for HIV prevention at the CDC will reduce funding from $799 million to $732 million—an 8.3% cut
• Treatment: more than 4,300 people will need to be removed from the AIDS Drug Assistance Program (ADAP) program—adding to the more than 4,000 people already waiting to be enrolled—putting their access to lifesaving treatment in jeopardy
• Research: the proposed cuts will slash AIDS research funding at the National Institutes of Health (NIH) by 8%, from $3.18 billion to $2.93 billion, forcing the NIH to make serious reductions in current research efforts while also curbing new ones

Global:

• Global HIV/AIDS discretionary programs will be cut by 13.1% (from $6.74 billion to $5.86 billion)
• Treatment: despite the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), more than 9 million people in low- and middle-income countries need HIV/AIDS treatment but do not have access to it; a return to FY2008 funding levels will reduce bilateral HIV/AIDS investments by 12.4%, from $5.74 billion to $5.03 billion and could result in a need to remove people who are already receiving treatment
• Pediatric and orphan services: as of September 2009, 3.6 million vulnerable children were receiving HIV-related care and support; a return to FY2008 funding will require serious cutbacks in services to children

The question is, how much are the Dems willing to fight for HIV/AIDS prevention, research and treatment? How much are we willing to fight to keep these things funded?

Before the gays break out the champaign–I don’t like the idea of government-funded social service programs to religious institutions. I don’t care who is on the decision making body (and if you look at the rest of the body, it is not clear that this is the most progressive of faith-based leaders, and they’re almost entirely Christian). Since the Bush Administration began the faith-based initiative project several years ago, it also allowed for faith-based institutions taking federal grant money to make decisions about hiring based on their, or an applicant’s, religious (read: moral) preferences. Obama, in announcing this new (but not new) office, has held off reversing this decision, which they say is under legal review, according to a story published in US News & World Report. Also, listed among the goals of the office, is to work on “abortion reduction and fatherhood participation” initiatives–both of which have the potential for more liberal, Daniel Patrick Moynihan-esque social policy that is about supporting patriarchial family structures in poor (and especially Black) communities.

I am all for churches who do good work–feeding people, caring for the sick & elderly, providing community spaces for people to gather. But I don’t want them to take money to do that work, and then turn around and preach shitty things about queers, or racist & misogynist fundamentalist churches as well. Also, what does this do to further paralyze Black churches, who have all but abandoned mass action and community organizing, to only turn them into service providers. Black churches historically have done both, but will getting government money further move them in that direction?

NOTE: I should say that I have known about Davie for many years. I used to work in workforce development where Davie is well known and very well regarded in progressive circles (you can find some of his speeches on the PPV website which seem OK. I don’t care for faith-based initiatives with government money, and have strong reservations about the office itself.

For you skeptics, who think, as my friend Donald said, the Pointer Sisters began with “I’m So Excited”–think again! Watch the clip. No group since has touched their harmony, and moved so easily from soul and funk, to pop, jazz and country as the Pointer Sisters did throughout their career.

[youtube=http://youtube.com/watch?v=b-ULwExPXvg]

So Hillary Clinton, because of her real expertise on the issue is being talked about in the press as having the upperhand. But no one has taken seriously Obama’s concerns about a health care mandate–enforcing a healthcare mandate when you haven’t made it affordable enough will do more harm than good.

Though Clinton says she would work to lower overall costs to make healthcare affordable, her plan would then fine people for not having it, or garnish people’s wages to ensure it. So, you fine me, garnish my wages so I may lose money to buy food or pay rent–how am I helped by that? Wouldn’t that ruin my overall health outcomes? And would you have more people dodging the healthcare system, and only showing up to emergency room when they are in the most dire of situations? Wouldn’t that drive costs higher in the end?

I think her plan, in all seriousness shows the intelligence of a policy wonk–brilliant in it’s scope, but falls short in terms of practicality for many poor and working class people.

Obama’s plan would give people universal access–would drive costs down, ensure all children, but wouldn’t force people into getting it. He has said that he thinks most people who don’t have health insurance don’t have it not because they don’t want it, but because its not affordable. In the last Democratic debate, he knows the mandate would create potentially more damaging public health outcomes than it would improve, especially for people who make too much for Medicaid but not enough to pay for their own out of pocket.

NY Times columnist Paul Krugman has repeatedly slammed Obama’s plan in his columm, most recently yesterday. But the reality is, Clinton’s plan won’t cover everyone either. The best critique of Krugman, and the naysayers of Obama’s plan I’ve read is from a health policy blog called the Sentinel Effect. The blog interviews Obama health policy advisor David Cutler in December, and here’s his take (Cutler is in quotations, Interviewer in italics):

Then the devil is in the details, isn’t it? What would premiums costs? Who would get a subsidy, and for how much? Nobody is debating these issues with any specificity, and yet that’s where – arguably – the real debate should take place.

“That’s why we’re suggesting that we lower costs first. Otherwise, you’re saying you want to force people to buy something, but we don’t know how much it will cost or what you’ll get in return.”

There’s been talk that a consensus is forming among policy analysts that 10% of income is the right number for total out-of-pocket health costs, including premiums, copays, and deductibles. But that’s a very high number for lots of people.

“Well, healthcare is 16% of the GDP now. Some of that cost is being borne through taxes already. So it depends what you want to count.”

But 10% for whom? $4,000 for a family of four with income of $40,000 is a devastating figure. Whereas there are probably very few people in the top 2% of income who spend 10% on healthcare.

“That’s where the subsidy debate comes in, and is another reason to address the cost issue first.”

The reality is, in order to have “universal health care” you’d hae to get rid of the insurance companies–or severely limit their role to one of simply administration. But why would you need them in a single payer system? The government would just pay the providers directly. Since the insurance companies aren’t going anywhere if they can help it, they best thing to do is to drastically lower costs and make it affordable and accessible for people to get. t