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"Historic" Health Reform

(The Nation) The U.S. House of Representatives answered “the call of history” put to it by President Obama Saturday and voted 220-215 in favor of the most sweeping expansion of health-care coverage since the enactment of Medicare and Medicaid Act of 1965.

House Democrats burst into sustained applause at 11:08 EST as the majority-making 218th vote was cast in favor of the the Affordable Health Care for America Act.

The measure ultimately received the votes of 219 Democrats.

Only one Republican, Louisiana’s Joseph Cao, supported it. (Cao, who represents an overwhelmingly-Democratic district dominated by the city of New Orleans, frequently breaks with the GOP leadership. He was one of the few Republicans who was seriously lobbied by the White House and Democratic leaders in the House, and it worked.)

Thirty-nine Democrats joined 176 Republicans in rejecting reforms that polls suggest are broadly supported by Americans.

A handful of “no” votes came from Democrats who felt that the legislation promoted by the Obama administration and House leaders was an inadequate response to the health care crisis. Among the progressive “no” voters was Ohio Democrat Dennis Kucinich, a leading proponent of a single-payer “Medicare for All” system that would replace private insurance companies with a public program.

Said Kucinich:

This health care bill continues the redistribution of wealth to Wall Street at the expense of America’s manufacturing and service economies which suffer from costs other countries do not have to bear, especially the cost of health care. America continues to stand out among all industrialized nations for its privatized health care system. As a result, we are less competitive in steel, automotive, aerospace and shipping while other countries subsidize their exports in these areas through socializing the cost of health care.

The reform plan shepherded through the House by Speaker Nancy Pelosi, is indeed flawed, as even the speaker acknowledges.

But it dramatically expands options for the tens of millions of Americans who are not currently covered by private insurers.

That was enough for Pelosi, who accepted what was for her a bitter compromise on the issue of abortion in order to secure the votes needed to pass the measure.

Late Saturday night, the speaker announced that her chamber had indeed “made history” with its endorsement of the reform plan.

Epic depictions of the House vote were commonplace Saturday, as Democrats compared their measure with historic legislation of the past.

“This is an historic moment for our nation. House passage of H.R. 3962, the Affordable Health Care for America Act, marks the first step toward ensuring health care for all Americans,” said Wisconsin Democrat Tammy Baldwin, who helped craft the legislation as a member of the House Energy and Commerce Committee. “I truly believe that we’ll look back years from now and view the passage of this Act to be as significant as the passage of the Social Security Act in 1935 and the Medicare and Medicaid Act in 1965.”

In truth, the House merely wrote a first draft of history.

The Senate still must act on a very different reform proposal.

The House and Senate bills then must be reconciled, after which they will have to be approved once more by each chamber. Only after those final votes will the Obama have a chance to sign a health reform bill.

It will not be a quick or easy process, as was evident Saturday.

Before the House vote, Democratic representatives heard a “now is the time to finish the job” pep talk from Obama, which helped to achieve relative unity within a caucus that wrangled to the last minute over issues ranging from abortion to immigration to cost estimates for the $1 trillion bill.

Late Friday and early Saturday, bitter battling over the hot-button issue of abortion fight came close to derailing the debate.

House Democratic leaders were pressured by several dozen anti-choice Democrats to add language preventing federal funds from paying for abortions. To get the votes she needed, Pelosi found herself in the ugly position of bartering off assurances that low-income women would have access to reproductive health services.

The tortured final negotiations put serious cracks in Thomas Jefferson’s “wall of separation” between church and state, as abortion foes such as Pennsylvania Democrat Jason Altmire openly acknowledged that they would not vote for health-care reform legislation unless they were told it was appropriate to do so by Catholic bishops in their home districts.

Pro-choice Democrats, led by Colorado Democrat Diana DeGette, pushed back.

That created a stalemate that Pelosi sought to break by allowing a vote on an amendment to establish limits on the funding of abortions within the new framework that would be established by the Affordable Health Care for America Act. Pro-choice Democrats opposed the amendment, with Illinois Democrat Jan Schakowsky, the co-chair of the Congressional Women’s Caucus, urging her colleagues to vote against the move to restrict a woman’s right to chose and force many women to pay more their insurance.

Said Schakowsky:

This amendment goes far beyond current law which already bans the use of federal funding for abortions. It goes far beyond the language already in this bill that guarantees no federal dollars are used for abortion. This amendment says that a woman CANNOT purchase coverage that includes abortion services using her own dollars; middle class women, using exclusively their own money will be prohibited from purchasing a plan including abortion coverage in every single public OR PRIVATE INSURANCE PLAN in the new health care exchange. Her only option is to buy a separate insurance policy that covers only abortion – a ridiculous and unworkable approach since no woman anticipates needing an abortion. This amendment is a radical departure from current law and will result in millions of women losing coverage they already have.

This health reform bill is about improving access to care, not further restricting a woman’s right to choose. Our bill is about lowering health care costs for millions of women and their families, not further marginalizing women by forcing them to pay more for their care. This amendment is a back door way of overturning Roe v. Wade; it is a disservice and insult to millions of women throughout our country. I urge my colleagues to vote against this amendment.

Despite Schakowsky’s appropriately impassioned argument, the amendment was approved on a vote of 240 to 194. Sixty-four Democrats voted with 176 Republicans to attach the amendment that De Gette condemned as “the greatest restriction of a woman’s right to choose” passed by Congress “in our career.”

“Party of ‘No’” opposition to reform was such that even pro-choice Republicans joined their anti-choice colleagues in a fully-unified GOP vote for the amendment.

The abortion fight, like a battle over restrictions on the coverage of immigrants that particularly upset members of the Hispanic Caucus, made Saturday a difficult and at times uncertain day for Pelosi and her lieutenants.

But Obama was confident enough to expend political capital on a calm, yet effective, appeal for Democratic unity.

The president made a classic “no bill can ever contain everything that everybody wants” appeal for what the vast majority of House Democrats agreed was — despite its less-than-robust public option and the ugly compromise of abortion rights — an imperfect-but-necessary piece of legislation.

Said Obama:

The bill that the House has produced will provide stability and security for Americans who have insurance; quality, affordable options for those who don’t; and lower costs for American families and American businesses. And as I’ve insisted from the beginning, it is a bill that is fully paid for and will actually reduce our long-term federal deficit.

This bill is change that the American people urgently need. Don’t just take my word for it. Consider the national groups who’ve come out in support of this bill on behalf of their members: The Consumers Union supports it because it will create — and I quote — “a more secure, affordable health care system for the American people.”

The American Medical Association and the American Nurses Association support it on behalf of doctors and nurses and medical professionals who know firsthand what’s broken in our current system, and who see what happens when their patients can’t get the care they need because of insurance industry bureaucracies.

The National Farmers Union supports this bill because it will control costs for farmers and ranchers, and address the unique challenges rural Americans face when it comes to receiving quality care.

And the AARP supports it because it will achieve the goal for which the AARP has been fighting for decades — reducing the cost of health care, expanding coverage for America’s seniors, and strengthening Medicare for the long haul.

Now, no bill can ever contain everything that everybody wants, or please every constituency and every district. That’s an impossible task. But what is possible, what’s in our grasp right now is the chance to prevent a future where every day 14,000 Americans continue to lose their health insurance, and every year 18,000 Americans die because they don’t have it; a future where crushing costs keep small businesses from succeeding and big businesses from competing in the global economy; a future where countless dreams are deferred or scaled back because of a broken system we could have fixed when we had the chance.

What we can do right now is choose a better future and pass a bill that brings us to the very cusp of building what so many generations of Americans have sought to build — a better health care system for this country.

Most House progressives accepted the “what-we-can-do-right-now” line as a reasonable one.

California Congressman Pete Stark, a senior Democrat who has advocated for decades on behalf of replacing the current for-profit scheme with a “Medicare for All” system, summed up progressive sentiments when he explained why he was voting for a measure that was far weaker than he would have preferred.

“At my age,” said Stark, “I’ve learned to take what you can, when you can get it.”

Sweeping Health Care Plan

(The New York Times) WASHINGTON — Handing President Obama a hard-fought victory, the House narrowly approved a sweeping overhaul of the nation’s health care system on Saturday night, advancing legislation that Democrats said could stand as their defining social policy achievement.

After a daylong clash with Republicans over what has been a Democratic goal for decades, lawmakers voted 220 to 215 to approve a plan that would cost $1.1 trillion over 10 years. Democrats said the legislation would provide overdue relief to Americans struggling to buy or hold on to health insurance.

“This is our moment to revolutionize health care in this country,” said Representative George Miller, Democrat of California and one of the chief architects of the bill.

Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage, a wrenching compromise for the numerous abortion-rights advocates in their ranks.

Many of them hope to make changes to the amendment during negotiations with the Senate, which will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.

Democrats say the House measure — paid for through new fees and taxes, along with cuts in Medicare — would extend coverage to 36 million people now without insurance while creating a government health insurance program. It would end insurance company practices like not covering pre-existing conditions or dropping people when they become ill.

Republicans condemned the vote and said they would oppose the measure as it proceeds on its legislative route. “This government takeover has got a long way to go before it gets to the president’s desk, and I’ll continue to fight it tooth and nail at every turn,” said Representative Kevin Brady, Republican of Texas. “Health care is too important to get it wrong.”

On the House floor, Democrats exchanged high-fives and cheered wildly — and Republicans sat quietly — when the tally display showed the 218th and decisive vote, after the leadership spent countless hours in recent days wringing commitments out of House members.

“We did what we promised the American people we would do,” said Representative Steny H. Hoyer, Democrat of Maryland and the majority leader, who also warned, “Much work remains.”

The successful vote came on a day when Mr. Obama traveled to Capitol Hill to make a personal appeal for lawmakers to “answer the call of history” and support the bill.

Only one Republican, Representative Anh Cao of Louisiana, voted for the bill, and 39 Democrats opposed it. The House also defeated the Republicans’ more modest plan, whose authors said it was a more common-sense and fiscally responsible approach.

The Democrats who balked at the measure represent mainly conservative swing districts, signaling that those who could be vulnerable in next year’s midterm elections viewed voting for the measure as politically risky.

“Today’s may be a tough vote, but it was in 1935 when we passed Social Security,” Representative John Dingell, Democrat of Michigan and the dean of the House, said as the debate drew to a close late Saturday.

Some Democrats said they voted for the legislation so they could seek improvements in it. “This bill will get better in the Senate,” said Representative Jim Cooper, a Tennessee Democrat who has been outspoken in his criticism of some provisions of the bill but decided to support it. “If we kill it here, it won’t have a chance to get better.”

After the vote, Mr. Obama issued a statement praising the House and calling on the Senate to follow suit. “I am absolutely confident it will,” he said, “and I look forward to signing comprehensive health insurance reform into law by the end of the year.”

Senator Harry Reid of Nevada, the majority leader, said he would bring a bill to the floor as soon as possible.

The vote came on the third anniversary of the 2006 Democratic takeover of the House, and the passage moves the bill well beyond the health care overhaul attempted by President Bill Clinton in 1993.

Lawmakers credited Mr. Obama with converting a final few holdouts during his appearance at a closed-door meeting with Democrats just hours before the vote. Democratic officials said that Mr. Obama’s conversation Saturday with Representative Michael H. Michaud, Democrat of Maine, was crucial in winning one final vote.

Many Democrats also credited Speaker Nancy Pelosi for pulling off a victory that proved tougher than many had predicted. “She really threaded the needle on this one,” said Representative Jim McGovern, Democrat of Massachusetts.

A critical turning point was the decision by Ms. Pelosi late Friday night to allow anti-abortion Democrats to try to tighten restrictions on coverage for the procedure under any insurance plan that receives federal money. That concession eased a threat by some Democrats to abandon the bill, but also left Democrats who support abortion rights facing a choice between backing a provision they bitterly opposed or scuttling the bill. The new abortion controls were added to the measure on a vote of 240 to 194.

Mr. Obama made his rare weekend appearance on Capitol Hill as part of an all-out effort to rally Democrats to support the biggest health care legislation since the creation of Medicare for the elderly four decades ago.

During the private meeting with Democrats in the Cannon Caucus Room, the president acknowledged the political difficulty of supporting major legislation in the face of unanimous Republican opposition and tough criticism from conservatives.

But, those present said, he urged them on, saying, “When I sign this in the Rose Garden, each and every one of you will be able to look back and say, ‘This was my finest moment in politics.’ ”

Republicans said the measure was too costly and would end up burdening the nation for decades to come. Some Democrats expressed the same view in explaining their opposition.

“This bill is a wrecking ball to the entire economy,” said Representative Jack Kingston, Republican of Georgia. “We need targeted specific reforms to help people who have fallen through the health care cracks.”

But Democrats said that Republicans were intent on protecting the status quo in health care and that the new Democratic approach would vastly improve the ability of Americans to gain affordable health insurance.

“Now is the chance to fix our health care system and improve the lives of millions of Americans,” Representative Louise M. Slaughter, Democrat of New York and chairwoman of the Rules Committee, said as she opened the daylong proceedings.

The wall of Republican opposition gave Democrats little room to maneuver, and they worked to corral as many party members as they could. But the preliminary approval to clear the way for the debate came on a 242-to-192 vote, suggesting that Democrats had a victory within reach.

The House vote was a significant step in the long-sought Democratic goal of enacting broad changes in the way health care is delivered in the nation. But the Senate has yet to bring its own emerging measure to the floor for debate, and the two chambers will still need to negotiate and approve a final bill in the weeks ahead.

The struggle House Democrats had in lining up the minimum number of votes for the measure was a clear indication of how difficult it would be to get final legislation to the president’s desk.

The House legislation, running almost 2,000 pages, would require most Americans to obtain health insurance or face penalties — an approach Republicans compared to government oppression.

Most employers would have to provide coverage or pay a tax penalty of up to 8 percent of their payroll. The bill would significantly expand Medicaid and would offer subsidies to help moderate-income people buy insurance from private companies or from a government insurance plan. It would also set up a national insurance exchange where people could shop for coverage.

Republicans forced a House vote on their much more modest plan that would expand coverage to just three million of the uninsured. But its authors said it would bring down the costs of private insurance premiums, which they argued was the chief concern of most Americans.

“More taxes, more spending and more government is not the plan for reform the people support,” said Representative Virginia Foxx, Republican of North Carolina and one of the conservatives who relentlessly criticized the Democrats’ plan.

But Democrats said their proposal was long overdue, would relieve the mounting anxiety of Americans struggling to get and retain health insurance, and would ultimately improve the economy by bringing spiraling health care costs under control.

“Our plan is not perfect, but it is a good start toward providing affordable health care to all Americans,” said Representative Peter A. DeFazio of Oregon.

infantile et fétichiste

(Le Monde) Dans l’ombre de la visite d’Angela Merkel, solennellement reçue par le Congrès des Etats-Unis, mardi 3 novembre, une délégation de l’Union européenne (UE) s’est rendue à Washington pour participer au sommet qui réunissait, mardi et mercredi, l’UE et les Etats-Unis. Le faste accordé à l’une et la discrétion réservée aux autres illustraient à point nommé quelques-unes des thèses, peu flatteuses pour l’UE, développées par une nouvelle étude sur les relations transatlantiques publiée par l’European Council on Foreign Relations, un centre de recherche européen lié à la fondation Soros.

Ses deux auteurs, l’Américain Jeremy Shapiro, chercheur à la Brookings Institution, et le Britannique Nick Witney, ancien directeur de l’Agence européenne de défense, estiment que les Européens, par leurs divisions et leur empressement à faire valoir auprès de Washington leurs intérêts particuliers, sont aujourd’hui incapables de construire une relation équilibrée avec Washington. La redistribution des pouvoirs au profit de pays émergents accentuerait encore leur déphasage.

Ils ont choisi des mots caustiques pour décrire la relation qu’entretiennent les Etats européens avec les Etats-Unis, une relation, selon eux, “infantile et fétichiste”, nourrie d’“illusions”. Parmi les plus dommageables, il y a celle selon laquelle les intérêts des Américains et ceux des Européens sont fondamentalement les mêmes ; ou bien encore, la croyance que la sécurité de l’Europe dépend encore de la protection américaine. Enfin, tout aussi dommageable, figure la conviction de nombreux Etats européens qu’ils ont une “relation spéciale” avec les Etats-Unis. “Relation spéciale” qui rendrait contre-productive l’idée de faire bloc, face aux Etats-Unis, avec les autres Etats européens. “Vu de Washington, écrivent-ils, il y a quelque chose de presque infantile dans la manière dont les gouvernements européens se comportent à leur égard - un mélange de recherche d’attention et d’esquive des responsabilités.”

“Déférence européenne”

Cette approche ne se manifeste pas de manière flagrante sur le terrain économique et commercial, où l’Europe a appris, à travers ses institutions communautaires, à aborder de manière plus pragmatique ses relations avec Washington. Mais c’est en revanche le cas sur les questions de sécurité. Ni sur l’Afghanistan, ni sur la Russie, ni sur le conflit israélo-palestinien, par exemple, les Européens n’ont jusqu’à présent été en mesure de définir des intérêts et une stratégie communs face à ceux de Washington, relèvent les auteurs de l’étude.

Or “le problème de la déférence européenne envers les Etats-Unis, c’est qu’elle ne marche tout simplement pas”, assurent Jeremy Shapiro et Nick Witney. Et elle fonctionnera de moins en moins dans un monde “post-américain” où les pouvoirs se redistribuent en faveur d’Etats émergents du Sud. Les Etats-Unis ont, pragmatiquement, adapté leur diplomatie à l’émergence de ces nouvelles puissances. Pas les Européens. Figés dans des réflexes anciens, les gouvernements européens s’accrochent, selon eux, aux vertus supposées d’une relation transatlantique sans même s’interroger sur les bénéfices qu’ils peuvent en attendre dans la nouvelle répartition des pouvoirs.

L’élection de Barack Obama aggraverait encore le décalage entre les deux partenaires. Soulagés de le voir succéder à George Bush et convaincus de reconnaître en lui un “proeuropéen”, les gouvernements du Vieux Continent n’auraient pas pris la mesure des implications du “pragmatisme” fondamental du nouveau président américain, qui le conduit à “travailler avec qui lui permet le plus efficacement d’atteindre les objectifs qu’(il) s’est fixés”. A l’heure actuelle, l’UE, comme acteur politique, est trop faible et divisée pour pleinement jouer ce rôle.

Sur le Web : http://www.ecfr.eu/

il falso mito del nucleare di terza generazione

(Le Monde) Le programme EPR, le réacteur nucléaire de troisième génération d’Areva, est menacé par un défaut de conception. Dans une déclaration commune publiée lundi 2 novembre, les autorités de sûreté française (ASN), britannique (HSE/ND) et finlandaise (STUK) demandent aux futurs exploitants de ces centrales d’“améliorer la conception initiale de l’EPR”.

C’est le système de contrôle-commande, le cerveau du réacteur, qui est en cause. Deux systèmes de contrôle seraient trop interconnectés, ce qui mettrait en cause la sûreté en cas d’incident. En cas de défaillance de l’un, il faudrait que l’autre puisse continuer à fonctionner, ce qui en l’état actuel n’est pas assuré. Les experts relèvent que la “complexité” de l’architecture du système “rend difficile l’élaboration d’une démonstration de sûreté satisfaisante”.

L’ampleur du problème est telle que l’ASN a demandé à EDF de préparer un plan “B”, au cas où les recommandations des autorités de sûreté ne pourraient pas être prises en compte. Le directeur général de l’ASN, Jean-Christophe Niel, demande à EDF “d’examiner dès à présent des dispositions de conceptions différentes”, car la “certitude d’aboutir in fine à une démonstration de sûreté acceptable fondée sur l’architecture actuelle n’est pas acquise”.

Nicolas Sarkozy a fait de l’exportation du nucléaire civil un axe stratégique de sa diplomatie et de sa politique industrielle. Les revers d’Areva menacent cette stratégie. “Cette entreprise n’est pas gérée. Mais changer Anne Lauvergeon maintenant serait un terrible aveu vis-à-vis du monde”, dit un proche du président.

Anne Lauvergeon est sous surveillance depuis la nomination de Jean-Cyril Spinetta à la présidence du conseil d’Areva. “Elle aurait dû choisir un directeur général qui soit son inverse : un industriel de terrain qui complète ce qu’elle sait faire, la stratégie”, poursuit ce proche de M. Sarkozy.

Les associations antinucléaires ont immédiatement saisi cette occasion pour réclamer, une fois de plus, l’arrêt du programme EPR. La “renaissance du nucléaire est décapitée”, s’est ainsi réjoui le mouvement Sortir du nucléaire.

“La déclaration conjointe de ces trois autorités de sûreté nucléaire remet fortement en question les deux EPR actuellement en construction dans le monde, l’un à Olkiluoto, en Finlande, et l’autre à Flamanville, en France (Manche), estime pour sa part Yannick Rousselet de Greenpeace. Qu’attend la France pour appliquer le principe de précaution au nucléaire et pour arrêter le programme EPR ?”

Chez Areva, on affiche la sérénité. “Cela fait partie des discussions techniques normales à ce stade d’avancement des dossiers, affirme son porte-parole, Jacques-Emmanuel Saulnier. Le problème avait été soulevé par la Finlande en décembre 2008 et résolu : STUK (l’autorité de sûreté finlandaise) a validé le contrôle-commande. EDF est face aux mêmes questions qu’en France et en Grande-Bretagne. Il va y répondre avec la collaboration d’Areva. Mais cela ne remet en cause ni les fondamentaux de l’EPR, ni le calendrier.”

DEUX UNITÉS EN INDE

La mise en garde des trois autorités de sûreté n’en arrive pas moins au plus mauvais moment. Quatre EPR sont en cours de construction : un en France sur le site de Flamanville, un en Finlande et deux en Chine. Mais Areva espère d’autres commandes. A Abou Dhabi, le consortium français Areva-GDF Suez-Total, épaulé par EDF, est en concurrence avec les Américains (General Electric) et les Coréens pour la vente de six à dix réacteurs.

Areva a été présélectionné pour la vente d’au moins deux unités en Inde. EDF a choisi de faire des “clones” de Flamanville pour le Royaume-Uni, où il compte construire au moins quatre unités. Il vient de finaliser son accord avec le groupe américain Constellation Energy et prévoit d’en installer au moins quatre aux Etats-Unis, même si Henri Proglio, qui succédera à Pierre Gadonneix à la tête d’EDF fin novembre, est plus que réservé sur cette implantation outre-Atlantique. Cela le conforte dans son analyse : EDF ne peut avoir qu’un seul réacteur, l’EPR, dans son catalogue.

Plusieurs groupes étrangers, comme l’italien Enel, ont aussi choisi l’EPR pour se développer dans l’énergie nucléaire. En partenariat avec EDF, Enel va en construire quatre dans la péninsule. Les groupes allemands E.ON et RWE l’ont aussi choisi pour participer à la relance de l’atome civil au Royaume-Uni.