Archive for May, 2018

The Democrats Cave on Torture – posted 5/20/2018

May 20, 2018 2 comments

I think Jeanne Shaheen has been a good senator. I have voted for her numerous times both when she ran for governor and as a senate candidate. In any long political career it is likely there will be troubling votes and Shaheen has made some. But, for me, her vote, along with five other Democratic senators, for Gina Haspel as CIA Director is the worst.

It was the votes of six Democratic senators that assured Haspel would become CIA Director. Three Republican senators – Rand Paul, Jeff Flake and John McCain – all opposed Haspel’s nomination. McCain was too ill to vote but was very much on record. Without the Democrats, Haspel’s nomination would have lost.

Why is the Haspel choice so disturbing? While there is much we do not know about her career as an intelligence operative because it remains classified, we do know that Haspel was in charge of a secret black site prison in Thailand known as Cat’s Eye from October to December 2002.

She oversaw the interrogation and three-time waterboarding of a Saudi detainee named Abd al-Rahim al-Nashiri. Nashiri is a suspect in the bombing of the USS Cole in October 2000 in which 17 U.S. sailors died. Captured in Dubai, he was handed over to the CIA. The CIA first rendered him to Afghanistan and then flew him to Thailand. He now resides in Guantanamo.

After her stint in Thailand, Haspel, a career CIA officer, returned to the agency’s Counterintelligence Center where she worked for two more years while the torture program was at its height. According to the 2014 Senate torture report, at least 119 men were tortured in this time period. In her CIA Director confirmation hearing, Haspel refused to specify her role in torture during these two years.

In a 2014 book, Company Man, John Rizzo, a longtime senior CIA lawyer, wrote that Haspel was in charge of the interrogation program and was responsible for the incommunicado detention and torture of potentially dozens of men. Rizzo wrote Haspel ran the interrogation program. Supporting Haspel’s nomination, in early May this year Rizzo revised his view and said Haspel did not “run” the torture program. Rizzo would not say why he changed his mind.

In 2005, as chief of staff to the Director of National Clandestine Services, Haspel participated in the destruction of 92 videotapes documenting the torture and interrogations conducted against Nashiri and Abu Zubaydah. Sen. Tim Kaine pointed out that Haspel wrote a cable directing the CIA to destroy the interrogation videotapes, effectively destroying evidence.

There is important information in the public domain about Haspel’s actions. Jeremy Scahill, an investigative journalist for the Intercept, has reported on information provided by an American doctor and Naval Reserve Officer, Dr. Sandra Crosby. Dr. Crosby did extensive medical evaluation of almost 20 men who were tortured in U.S. custody, including Nashiri.

Dr. Crosby, who is now a professor of public health at Boston University, wrote Sen. Mark Warner, the vice chair of the Senate Intelligence Committee, to oppose Haspel’s nomination. Dr. Crosby wrote:

“I urge Senator Warner to oppose Ms. Haspel, who did not have the courage or leadership to oppose the Rendition, Detention and Interrogation program.”

While some of the techniques used against Nashiri remain classified, Dr. Crosby listed the torture techniques used against Nashiri.

  • suffocated with water (waterboarding)
  • subjected to mock executions with a drill and gun while standing naked and hooded
  • anal rape through rectal feeding
  • threatened that his mother would be sexually assaulted
  • lifted off ground by arms while they were bound behind his back (after which a medical officer opined that shoulders might be dislocated)

On May 7, in a briefing to Senate Intelligence staffers, Dr. Crosby described the torture graphically:

“The terror of being kept naked in pitch-black, shackled to the ceiling while music blared, covered in urine and feces while insects crawled on their bodies, in dank cells that were freezing cold or unbearably hot. The horrific conditions in between interrogations were in some cases as bad as the interrogation. These torture methods were inflicted for hours and days, for weeks at a time, over the course of years. The men became disoriented with no sense of when the abuse would stop. Some of the men wished for death.”

Dr. Crosby is one of the only health professionals to have ever talked to Nashiri about his torture. She concluded:

“He is irreversibly damaged by torture that was unusually cruel and designed to break him. In my over 20 years of experience treating torture victims from around the world, including Syria, Iraq, and the Democratic Republic of Congo, Mr. al-Nashiri presents as one of the most severely traumatized individuals I have ever seen.”

Torture, such as the actions committed against Nashiri, violates the U.N. Convention against Torture and is clearly illegal under international law. Because the U.S. has signed and ratified the Convention, torture is always illegal under U.S. domestic law as well.

In her public testimony at her confirmation hearing, Haspel refused to renounce torture, her role in its use and she did not condemn the practice of waterboarding. When questioned by Sen. Kamala Harris, she explicitly refused to say that the “enhanced interrogation techniques” she oversaw at the black site in Thailand were immoral.

After her hearing, in a statement explaining why he would vote against Haspel, Sen. John McCain said:

“Her refusal to acknowledge torture’s immorality is disqualifying.”

By promoting someone so intimately engaged with torture, the Trump Administration is almost guaranteeing such crimes will be committed in the future because there has been no reckoning with the past abuses. It is likely the CIA will see Haspel’s elevation as vindication of both torture and its efforts to obscure history.

Considering Trump’s unmatched amorality, his support for Haspel is hardly surprising but Democrats did not have to go along with the President.

The failure of the six Democratic senators to oppose Haspel reflects a lack of values. There is no more fundamental moral issue than torture. Torture is a dividing line between modernity and medievalism and still these Democratic senators voted the wrong way.

This vote speaks to a core identity problem for mainstream Democrats: they do not stand for anything. They think being against Trump is enough and here they are not even against him.

A part of the problem goes back to the Obama Administration and their politics of impunity toward torture. Obama said he would not punish torturers because he was looking forward, not back. What this means is a willful decision not to punish wrongful acts and a total lack of accountability.

In fairness, it must be acknowledged that Americans have demonstrated a bi-partisan inability to tackle torture that goes back at least 50 years. The Phoenix Program in Vietnam, teaching torture to Latin American militaries, and the George W. Bush-era torture have all ultimately been swept under the carpet. The historian Alfred McCoy calls it “public forgetting”.

The Haspel vote undermines respect for fundamental rights and the rule of law. Torture is evil. The vote sends a horrible message to the rest of the world about America’s lack of commitment to human rights.

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Medicaid Work Requirements Do More Harm Than Good – posted 5/14/2018

May 15, 2018 Leave a comment

It appears that for now the issue is settled: New Hampshire’s Medicaid program will have work requirements. In early May, the U.S. Center for Medicare and Medicaid Services approved the State’s plan to require most adult Medicaid recipients to work at least 25 hours per week. The plan could apply to as many as 53,200 recipients in the state although many are already working.

Medicaid beneficiaries, adults aged 19 to 64, will be required to participate 100 hours per month in “community engagement activities” such as work, education, job skills training or community service. That “engagement” will be a condition of their health care eligibility.

The new rules do offer important exemptions for the elderly, the medically frail and those people with children.

New Hampshire becomes the fourth state to introduce a Medicaid work requirement. The requirement has been instituted in Indiana, Arkansas and Kentucky and six other states have pending applications for approval. This is quite a departure for Medicaid which for over 50 years has never had any requirement like this.

While this plan sounds superficially good because it encourages work and personal responsibility, it is fraught with problems, and I expect it will do more harm than good. The idea that most people on Medicaid do not work is completely unfounded.

More than half of all adult Medicaid recipients already work and 78% live in a home where an adult works. The new rules are largely responding to stereotypes that see low income people as loafers and bums.

Considering how many people are already working, you have to ask if these new rules will do anything beyond knocking more people, who do not meet some new imposed requirement, off Medicaid.

Unfortunately, there are many ways that individuals can potentially have their Medicaid terminated that have nothing to do with a willful desire not to work.

People working lower-wage jobs are more likely to have irregular working hours or gaps in their employment. This is not because of the worker. Employers often schedule part-time hours for their own financial reasons. Workers who want to work may fall under the 100 hour a month marker because employers want them off their own health insurance coverage and they need to keep them under their own hourly threshold.

Lower-wage jobs typically offer fewer regular hours and are subject to seasonal changes. For example, food service, retail and construction jobs tend to be more volatile and less stable year-round. For instance, a holiday season may permit increased hours in retail whereas bad weather in winter can reduce hours for construction workers.

The work requirement rules assume low wage workers can find steady, regular full-time employment but the low wage job market is not like that. Many employers will not hire more than 24 hours a week because they want to avoid benefit costs. Even individuals who work substantial hours could lose coverage under the new work requirement.

Workers may not know in advance of the end of the month that they will fall under the 100 hour monthly threshold because employers may end up offering less hours. If workers fall under the threshold because of the wage-cutting actions of employers will that count against them?

How New Hampshire will interpret the failure of a worker to meet the 100 hour monthly threshold must be a matter of concern. Past experience in public benefits suggest many will be terminated from Medicaid due to a quite literal interpretation of rules and a bureaucratic approach.

Some workers will have difficulty verifying compliance with rules. For example, there are workers who may have difficulty producing pay stubs or timesheets even if they have worked.

The state will need to set up a new verification system. Red tape, backlogs and delays are a likely consequence. Many adult Medicaid beneficiaries lack internet access and will need to use snail mail or personal visits to prove compliance. It is not unusual for Medicaid beneficiaries to have transportation difficulties. The workers will still need to prove the work hours.

Homeless people will bring a unique set of issues. If you live in a shelter, you may have to choose between getting in line in the afternoon for a bed and working required hours. The lack of access to a shower or washing machines poses hygiene issues for workplaces. Also, not having a home mailing address or a working telephone can make employment success harder. Employment stability and just the ability to be in touch with an employer is compromised when there is no home.

Those with disabilities are at great risk. The term “medically frail” could mean many things and those claiming medical frailty will have to prove they qualify for an exemption. Obtaining necessary medical documents can be difficult especially if beneficiaries lack coverage. Low wage workers often may not have had any access to health care. It is much easier to get an exemption as a disabled person if you have a treating doctor.

Among those with disabilities, I would especially mention those with mental health issues. How will those with mental health issues fit under the definition of medical frailty? There are many who may not be in any disability program who have significant problems with concentration, clear thinking and social interaction. Those skills are often needed to meet documentation and reporting requirements.

The opioid crisis also must be noted. Will those with substance abuse disorders be seen as “medically frail”? How will work requirements impact recovery efforts? It is reasonable to assume that the burden of proving exemptions will cause people to lose coverage. Many people who suffer from substance abuse disorders have a hard time even acknowledging their condition.

Those who lose Medicaid or face an interruption in coverage can have very adverse health consequences. Those with chronic health conditions like diabetes or depression may require regular access to medications or other treatment. Disrupting access to care can impact the continuation of employability. Interruptions in coverage likely will mean increased emergency room visits and hospitalizations.

As a matter of public policy, I think it is a bad idea to make employment a precondition to Medicaid services. Work requirements actually block access to medically necessary services that individuals need to be able to work. The purpose of Medicaid has been to furnish medical assistance, rehabilitation, and other services that will help individuals attain and retain independence and self-care. Rather than making work a qualifying precondition, we need to see health care as a universal right.

Work requirements guarantee thousands more will be cut off health insurance. That is not the direction we as a society should be going.

According to the Center for Disease Control, over 28 million people in the U.S. under age 65 remain uninsured. That is a little over 12% of the population of those ages 18 to 64. Obamacare made some strides in reducing the number of the uninsured but not enough.

Universal coverage should remain the goal of health care advocates. Work requirements are rooted in uninformed, negative judgments about low income people. It is a safe bet these new requirements will do far more damage than good.

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