The Brookings Institution has a fascinating report on the opportunities to improve our nation’s decaying cities in the American heartland. Economic growth has been concentrated on the coasts and in big cities. Economic decline has been occurring in smaller and mid sized cities and counties in the industrial Midwest and Northeast for the last 46 years surveyed.

I have been immersed in Ron Chernow’s biography of Ulysses Grant, the leading General of the Civil War, two term President, an extraordinary champion of civil rights and symbol of corruption. There is a lot of resonance and hard lessons for our own turbulent times.

About 4 million Americans are uninsured because the politicians in their states (18 at the moment and shrinking) refuse to implement the Medicaid expansion component of the Affordable Care Act for the working poor. Maine and Virginia are close to closing this gap.

Medi-Cal began as health coverage for children and single parents, seniors and the disabled receiving cash assistance. MediCal had become an entirely different program, one dominated by low income working families, even before the advent of the ACA. The traditional “welfare” component of the program, called CalWorks in California, is now only 400,000 low-income children and parents, of its total 13.5 million program enrollees.

Marshall Tuck is endorsed by Arnie Duncan, Obama’s Education Secretary, by George Miller, long time Chair of the House Education Committee, by the California School Administrators and by Monica Garcia and Nick Melvoin, Chair and Vice Chair of the Los Angeles, Unified School District.

Our long time friend Deb Haaland is running for Congress in the New Mexico First Congressional District. If elected, she will be the first Native American woman elected to Congress.

Counties and federal waivers played a crucial role in California’s successful implementation of the ACA. Beginning in 1988, California counties, the state and the federal government began to develop stopgap funding to shore up the local safety net.

California has become an extraordinarily diverse state attracting immigrants from around the world working in and contributing to the success of the state’s technology, agricultural, entertainment, international trade and tourist industries. Immigration in all forms is critical to many aspects of the California economy from high tech to agriculture.

All reform proposals but an employer mandate are difficult to finance in California without major federal financial assistance. Single payer would cost more than the entire budget of the state of California; this is not because it is so much more expensive than the current system but rather due to the need to replace most private sector premiums and cost sharing with new state taxes.

Several weeks ago my car was in the shop, and I walked home along the Pacific Coast Highway. Nearly every parked car along one long stretch, not too much of an exaggeration, was occupied by a sleeping young homeless person. 

Yesterday I rose early to kayak, expecting the rains would come hard later in the day. The skies were leaden and the air cool and crisp.

It would cover every American, give them a choice of plans and fill in the holes in the current state and federal and private insurance plans. It's a coherent vision for the future evolution of our health system. The Center for American Progress calls it Medicare Extra.

There are already many different models for single payer in this country – Medicare, Medicaid, the VA, public hospitals and Kaiser Permanente. If you prefer model of single payer which one do you want? What features do you prefer?

Last year, the Assembly Speaker held up the single payer bill, SB 562 (Lara) to assess whether and how the measure could be financed. Its major proponents, the California Nurses Association were furious.

There will be continuing efforts to undermine and repeal the Affordable Care Act, and we need to defend its important progress. Now is the time to discuss and begin to decide on the next steps to  improve it. California has done a remarkable job in its implememtation, but we can do even better. Here are some preliminary thoughts.

Russia intervened in our elections to see that its favored candidate won. Much to everyone’s surprise their favored candidate, President Trump, did so. Whether there was or was not collusion with the Trump campaign, we’ll know at some point.

Essentially, there are five issues for decision in the Senate immigration debate (when and if it ever happens): status for the dreamers, impact on their parents, funding for the wall, restrictions on legal immigration and sanctuary cities. There are a lot of moving parts. 

The President in his most recent budget proposes the following: