MichUHCAN Blog

Getting There from Here

2010-07-01T12:18:00.000-07:00

by Sam Stark

We're not “there” yet, are we?
National Health Care-wise, that is. The Affordable Care Act was an important first step, especially after more than 100 years of trying. But despite bringing much needed help to millions of Americans, the bill fell short of the progressive goal of universal coverage, uniform benefits and effective cost controls through non-profit financing, fundamentals of all national health care systems around the world.
Just as Social Security and Medicare evolved and were improved, so will our new health care system. It's a first step, but a first step to where? And when we finally get “there,” what is “there” going to look like?
The first thing to remember is that none of the national health care systems around the world look exactly alike. In fact, Canada doesn't even look like it's supposed to and they've been “there” since 1964.
Over here, Canada's single-payer health care system is sometimes portrayed as perfect. It covers everybody, includes all services, doesn't cost Canadians a single penny in co-pays or deductibles, and there are no mean, nasty private insurance companies mucking things up.
A closer look, though, reveals that, technically speaking, Canada is not single-payer at all. With 13 Canadian provinces and territories operating their own health authorities and sharing costs and rules setting with the federal government, Canada is a 13-payer system. That's why some provinces require co-pays and others don't.
Some of them also don't cover certain prescriptions, dental and vision services, ambulance travel or private hospital rooms. That's why there are still private insurance companies around selling supplemental coverage to 2/3 of all Canadians.
While Medicare is Canada's most popular social program and a source of national pride, Canadians freely admit that “timely access to services,” or wait times, is a problem.
Not what most of us imagined a single-payer system would look like, eh?
All this is not intended to denigrate a health care system that provides excellent care to all its citizens – and outsiders – for $3,000 per person less than the U.S. and is overwhelmingly supported by citizens regardless of political party.
It is intended, however, to warn against any and all forms of idealistic or dogmatic thinking within our own health care movement.
So let's agree. Not every health care system looks exactly alike. No national health care system is perfect. And ours won't be, either.
American journalist T.R. Reid, author of, “The Art of Healing,” explains national health care looks different around the world because each country has its own unique political, economic, social and cultural traditions. Thus, the health care system is decentralized in Canada because it has a history of decentralized government.
The lesson for American activists is for us to really get to know our nation's own political, economic, social and cultural traditions so well that we can lead an evolution from the ACA to a national health care system that Americans can identify with and proudly claim as their own.
We have much to learn from other countries and their health care systems, but we also have much to learn from American history and our own people.
We can begin that learning process by explaining what benefits ACA has to offer. First, it gets us out there talking to people and engaging them in greater numbers than we did during the struggle leading up to passage of the ACA. We also have to undue some of the damage Tea Partiers have done to any kind of health care reform.
Second, this Implement and Improve process can help us find out what Americans are thinking: what they like about reform, what they don't like about it and what they would like to see changed. And we won't learn anything from people if all we do is lecture at them.
The third thing we need to do in the process of getting “there,” is to frame the health care issue in a way that wasn't done very well or consistently during the campaign: health care as a moral issue.
Reid writes, “The design of any nation's health care system involves political, economic and medical decisions. But the primary issue for any health care system is a moral one. If we want to fix American health care, we first have to ask a basic question: Should we guarantee medical treatment to everyone who needs it?”
Or put more bluntly: “Should a homeless person receive the same level of health care as a bank president?”
Once we, as a nation, can answer that question with a resounding “Yes,” does it really matter whether our American health care system looks like Canada's, France's or something totally different?
Whoa, wait a minute there. What's France got to do with it?
Ranked as the Number One health care system in the world by the World Health Organization, France is one of many nations that look like single-payer but are, in fact, multi-payer health care systems. In France, Germany, Denmark, The Netherlands, Japan, Switzerland and Israel, private insurance companies collect premiums and pay all health care bills under strict government regulation for NO profit. These health care systems resemble their nation's traditions where sickness funds and employer-based private insurance preceded the transition to national health care.
So how do we finally get “there?”
To speculate, we might evolve toward a multi-payer system because we have a tradition of employer-based health care. Many of the structures for that kind of national health care system have already been put in place by the ACA.
We could possibly evolve toward a single-payer system since we also have a single-payer tradition with our Medicare program. We could build on state experiments with single-payer like Vermont's, or we could lower of the age for eligibility for Medicare to 55, as was proposed in Congressional debate this year. We could also open up Medicare to all Americans by allowing them to buy into it at any age, as the conservative editor of a conservative local newspaper recently suggested. And when we get “there,” we might turn out to be 50-payer system with each state operating its own health care authority. Who knows?
There are lots of good ways of getting “there,” so let's keep open all possibilities. And, above all, let's listen to the directions Americans are giving us.

From our Friends at MOSES:

2010-05-06T08:51:00.000-07:00

Community Involvement a MOSES Perspective

DMC leadership approached MOSES for a meeting after the decision was made to sell to Vanguard. The press release was already distributed; the brochures printed and the powerpoint completed – designated staff supporters recruited and the show was ready for the road. That’s not community involvement that’s marketing.

Active, direct community involvement and communication ought to be the foundation of a transition of essential community health assets from a non-profit to a for-profit status. Why?

Individuals and communities have a right to participate directly in the decisions that effect their health and well-being
Accountability – Direct civic involvement makes public entities accountable to the people they serve
Direct Grassroots Involvement – People directly affected by decisions such as the change in status from a non-profit hospital governed in Detroit to a for-profit owned and governed by and out-of-state investment group, should be involved and able to participate directly as decisions are contemplated and made.

When decisions are made that will influence health care in Detroit and Southeast Michigan for generations to come – all stakeholders should be at the table. The community is a significant, perhaps the significant, stakeholder in decisions regarding the future of the DMC. Yet, we weren’t at the table for the discussions because we weren’t invited.

Genuine community involvement means an invitation to be at the table before decisions are made, while options are being entertained. It means regarding the community as a significant stakeholder with a right to participate. It takes a willingness to deal with the messiness of sometimes competing interests and the frustration that agendas may change and that outcomes can’t be predicted at the onset. It takes trust in a transparent, more democratic process that includes the regular folks who live, work, worship and get healthcare in Detroit and SE Michigan.

Report From Michigan: What State Residents Stand To Gain From Health Reform

2010-04-20T08:53:00.000-07:00

Jonathan Cohn, Senior Editor of The New Republic, recently posted on Mike Cox's lawsuit:

On their way to Washington last week, Tea Party activists stopped in Lansing, Michigan. And among the officials who addressed them was Mike Cox, the state’s Republican attorney general. Cox recently announced he would be among more than a dozen state officials filing lawsuits challenging the constitutionality of health care reform. And, at the rally, he whipped the conservative crowd into a frenzy: “Can’t you just see them running around (Washington) D.C. saying, ‘So much to spend, so much to spend, so little time to spend it’?”

Most legal experts seem to think the lawsuits won’t succeed. Among other things, it turns out that the U.S. fought a large war, about a hundred and fifty years ago, in order to settle the issue of state nullification. But if the officials filing these suits seem not to understand that history--or at least, not to care about it--their opposition to the Affordable Care Act, like their supporters’, seems genuine. If they had their way, their states really would reject the new health care law.

Particularly since many of these officials are running for even higher office, it’s worth asking: What would happen to their states if they succeeded?

Consider Michigan, where Cox is running for governor and where, it so happens, I live. Despite the state’s economic troubles, the percentage of residents without health insurance is actually lower than the national average. Still, it’s more than 1.1 million people--and there would be even more of them in the next few years if we were stuck with the health care system we have today.

But we’re not stuck with the health care system we have today. Reform is now law of the land. And, as a result, there won’t be an increase in uninsured. In fact, the number should fall—dramatically.

Thanks to the Affordable Care Act, the vast majority of the would-be uninsured should gain access to affordable insurance. Based on the official estimates, around 400,000 of them will get it through Medicaid, which the Act will expand. Most of the rest will get them through the new insurance exchanges--that is, the new regulated marketplaces through which individuals and small businesses will be able to purchase the same sort of coverage large businesses get.

The people shopping in the exchanges should have more choices than they do today and the choices will be, by and large, good ones: plans with comprehensive basic benefits, no exclusions or higher rates for pre-existing conditions and lower. Those who can’t afford even these reduced premiums will be eligible for generous tax credits, so that premiums never go higher than around 10 percent of income.

Does Michigan’s Cox prefer a world in which families making $45,000 a year miss out on thousands of dollars in tax credits? Where people with pre-existing medical conditions have to pay astronomical rates on coverage, if they can get insurance at all? Does he think those 400,000 people set to get Medicaid coverage would be better with no insurance? And, if so, has he taken this up with the professionals and hospitals struggling, every day, to provide charity care for these people?

To be sure, Cox and his supporters aren’t necessarily very worried about the uninsured. Recent polling suggests the Tea Party movement is relatively affluent and their protests certainly suggest their primary concern is that reform could diminish the insurance coverage they currently have. (They seem unaware that the market will likely diminish that coverage all on its own.)

The full name of the health care law is the Patient Protection and Affordable Care Act. And there’s a reason for that “Patient Protection” part: The law also bolsters coverage for those people who have it. It eliminates cost-sharing for preventative services. It imposes a binding appeals process for people who think insurers wrongly denied treatments. It forces insurers to spend more on patient care and less on overhead --and that’s not to mention the many people who pay for insurance now, but will pay less starting in 2014, thanks to the tax credits.

Perhaps Cox should explain to Michiganders why, in his view, they should keep paying out-of-pocket fees for regular checkups, why some insurers should continue to have unchallenged authority to overrule doctors on treatment and why it’s better if stockholders take a bigger chunk out of everybody’s premium dollars. And while Cox is at it, perhaps he can explain to senior citizens why they should continue to get stuck in the donut hole of Medicare Part D--the gap in prescription drug coverage that the Affordable Care Act would gradually close.

To be fair, it's not the coverage and access benefits that Cox and other state officials are talking about in their speeches. It's the threat of what "socialism" will do to medical care. It’s the burdens the new law will supposedly place on their states, businesses and citizens. But while plenty can go wrong as the new law comes on line--just watch how quickly insurers find loopholes in the regulations--most of the state officials’ complaints don't really hold up under scrutiny.

Just consider what they are saying about Medicaid. The federal government and states run Medicaid jointly, which means that if the program expands states will have to spend more money on it. But look more closely at the law: For the first ten years, according to the Congressional Budget Office, the federal government is going to cover 98 percent of the cost of the Medicaid expansion. The federal contribution declines after that, but only to 90 percent. So for every additional dollar the states put into Medicaid, they’re drawing in nine from Washington. Does Cox really want to turn down that money?

And, oh yes, the Affordable Care Act would do one other thing. It would put in place a whole series of cost-cutting measures designed to promote quality medicine and, over time, curb the year-to-year spikes in health insurance premiums. The law would encourage coordination among health care providers, begin to scrutinize treatments for comparative effectiveness and link hospital payments to performance, among other things.

Does Cox think Michiganders are better off when their physicians don’t consult with one another, when they pay more for inferior treatments and when Medicare continues to pay high reimbursements to hospitals that take the simple steps necessary for preventing infections around catheters? For that matter, does he think Michigan businesses--already struggling with health care costs--prefer a world in which the government doesn't start to reduce overall health care spending?

Of course, what’s true for Michigan is true for the rest of the country. The state officials leading the nullification campaign in places like Idaho, Minnesota, and South Carolina talk a lot about what their citizens stand to lose as the Affordable Care Act takes effect.

But the real loss will be if, somehow, the opposite were to happen--and the people living in those states were left dealing with the same dysfunctional health care system that exists today.

Rescued Archives

2010-04-01T11:46:00.000-07:00

After some unfortunate ISP issues our blog died. This is what I managed to rescue vie google's cache of our page:

2010-01-27
Permalink 03:12:59 pm, by nick Email , 165 words, 6 views English (US)
Categories: Announcements [A]
Ezra Klein on the State of the Union

It will be huge. Right now the Democrats don't know what to do. They could go with the Senate bill, start over, or give up. They'll probably do whatever Obama proposes tonight, if he proposes something and doesn't dodge.

Every Hill office I've spoken to in the past week has had the same complaint. "Where," they ask, "is the White House?"

There's been no clear message on the way forward for health-care reform. No clear articulation of preferences. No public leadership to speak of. The administration is taking temperatures rather than twisting arms. The White House press team is blasting out speeches where the president says he'll never stop fighting on health care but pointedly refuses to throw a punch. The president is giving interviews where he seems to endorse paring the bill back and also seems to argue against doing anything of the kind. The daily message has run from banks to freezes, and early leaks suggest that tonight's speech will focus on education.

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2010-01-20
Permalink 05:47:28 pm, by nick Email , 628 words, 77 views English (US)
Categories: Announcements [A]
A Lot of Us Will Be Upset

A Lot of Us Will Be Upset

If our U.S. Congress passes, or fails to pass, healthcare reform legislation this year, one thing is for sure: either way, a lot of us will be upset. There will be few happy campers.

We will be upset because it will either cost too much or cover too few of the millions of uninsured Americans, compete too much or too little with private health insurance, undermine or encourage high-benefit health insurances gained by labor unions, restrict too much or too little federal funding for abortion, expand Medicaid coverage for too many or too few poor people, upset us for reasons of our own, & or, all of the above.

If healthcare reform legislation is passed by Congress and signed by the president, it will probably get amended many times.

The Social Security Act of 1935 was comparably complex legislation and it was amended many times. Originally it covered only workers in commercial and industrial occupations. It also provided for federal grants to assist the states with programs for the disabled, the aged, child welfare services, public health services, and vocational rehabilitation.

Amendments to the Social Security Act, in the year --

1) 1939, added benefits for seamen, and for dependents and survivors of workers;
2) 1950, broadened the coverage to include full-time farm and domestic workers, many self-employed persons, employees of state and local governments, and employees of non-profit organizations;
3) 1951, added railroad workers to those covered;
4) 1956, extended coverage to members of the armed forces and self-employed professionals;
5) 1956, provided benefits to workers 50 years of age and older who became permanently and totally disabled;
6) 1962, lowered the age of eligibility for retirement benefits from 65 to 62, but with lower benefits for persons retiring before 65;
7) 1965, provided Medicare for persons over the age of 65, and an accompanying Medicaid program for the indigent regardless of age;
8) 1965, added divorcees over age 65, who had been married for at least 20 years, remained unmarried, and were dependent on their ex-husbands;
9) 1972, transferred administration of Supplemental Security Income (SSI) from the states to the federal government;
10) 1972, tied increases in Social Security retirement to increases in the Consumer Price Index;
11) 1972, established a minimum benefit;
12) 1972, increased benefits through Delayed Retirement Credit for those who delayed retirement past age 65;
13) 1977, recalculated the procedure for adjusting price and wage increases as the basis for cost of living adjustments (COLA), giving rise to Notch beneficiaries;
14) 1983, allowed partial taxation of benefits for upper-income recipients;
15) 1983, included federal employees under Social Security;
16) 1996, excluded eligibility of applicants for Social Security or SSI disability benefits if drug addiction or alcoholism is a material factor in their disability;
17) 1996, ended by welfare reform legislation the categorical entitlement to Aid to Families with Dependent Children, by implementing time-limited benefits with a work requirement;
18) 1996, terminated SSI eligibility for most non-citizens;
19) 1996, ordered all federal payments to be made electronically, i.e., no more paper checks;
20)1999, set payroll deductions at 6.2% of annual wages below $72,600, and payroll deductions for Medicare at 1.45% of all annual wages, with employers contributing matching amounts;
21)1999, enabled disability beneficiaries to obtain a ticket for vocational rehabilitation, employment, and other support services from a network of their choice;
22) 2000, eliminated the earnings limitation for beneficiaries above 65.

(Reference: A History of Social Security by Larry DeWitt, of the SSA Historian s Office, available with a helpful bibliography @SocialSecurityOnline.)

Healthcare reform legislation, or its absence, will be a major influence in the lives of millions of Americans for decades to come. Only the delusional would call this legislation ideal. Its evolution reflects our contentious American politics. It is political sausage making at its worst or at its best, depending on one s point of view.

If this legislation is enacted into law, the United States will join all other 17 most industrialized nations of the world in having some system of national healthcare insurance.

Joseph A. Gagnon
Marysville, Michigan

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2010-01-07
Permalink 04:28:05 pm, by nick Email , 880 words, 517 views English (US)
Categories: Announcements [A]
What If?

What if this is 1935 and Congress is getting ready to vote on the Social Security Act?

As political progressives, union activists, or whatever, do you support the bill or oppose it?

No brainer, right?

So what if I told you that by supporting the 1935 Social Security Act you would be selling out the working-class and capitulating to right-wing interests who wrote half the bill?

Didn t see that one coming didja?

To get Social Security passed, progressives had to agree to exclude nearly Ω of the working class, including 2/3 of African Americans and more than Ω of all women.

Yep, that s the deal you had to agree to in 1935 to pass what we now know as one of the most successful and progressive government programs of all time. Bur in 1935, it didn t look that way when progressives had to accept the deal racist, reactionary Southern democrats laid down in exchange for their votes.

These backward elements held power over key committees that could have scuttled Social Security and even prevented a vote. Their deal? Exclude al domestic workers, agricultural labor, state and local government employees, and many teachers, nurses, hospital workers, librarians, and social workers. Their special interest? Keeping power by keeping intact the American-styled apartheid system they presided over.

So what do we do? Kill the bill and try to come back later or take what you can get now?

Remember this deal was made during the Left s Glory Days. That s when we had one of the most progressive presidents ever in the White House, the most progressives ever in Congress and the biggest mass movement ever out in the streets. And progressives still had to cut a deal with the devil.

Protesting is easy. Governing is a b*tch.

So let s bring this What If game to the present

What if you are a member of Congress in 2009, do you vote for the deal cun in the Senate or vote to kill the bill?

Not so easy anymore, is it?

We know the flawed Social Security bill was strengthened over the years, adding household workers in 1950 and agricultural, hotel, laundry, and state and local government workers in 1954. What we don t know is the future of our flawed health care bill?

The nice thing we do know is that improving it will be a lot easier than passing the original bill. As New York Times columnist Paul Krugman pointed out, many of the future improvements can be through reconciliation with simple majority vote as opposed to the anti-democratic, super-majority 60-vote process that gave sociopath Joe Lieberman the power to kill the public option and prevent lowering the enrollment age for Medicare to 55.

So what do we do now?

We still have to figure that one out. But one thing we can t afford to do is make single-payer a dogma. Such rigidity in strategy ties our hands and limits our options. Looking at the world we see that more nations have accomplished the goal of health care for all through a multi-payer system. Only Canada, Taiwan, and South Korea have chosen to go single-payer.

France is considered to be the world s best health care system while Japan has the longest healthy life expectancy. Single payer systems? Hardly. French citizens are covered by 14 private insurance companies. The Japanese have about 3,500 private health insurance plans. These multi-payer systems succeed because private insurers there are not allowed to make a profit selling health insurance.

Every nation that has committed itself to providing health insurance for all its citizens has followed its own unique path to get there. It s a sure bet that the United States will never adopt the socialized medicine system of Great Britain, even though the Veteran s Administration is already a socialized system with government-owned, government-run hospitals and government-hired doctors.

We could build on this flawed health care bill by expanding Medicare to all Americans of all ages. That would be the most direct route to single-payer since the structure already exists, is quote popular (Even Tea Baggers love their Medicare) and operates way more efficiently than private insurance with it s 3% administrative costs verses 20-30 percent for private insurers.
But it s not certain most Americans are prepared to kill a whole industry even if many of the clerical workers are absorbed by Medicare to serve the new enrollees.

The private sector has always had a role in our government-run health care. Most of the Medicare workers who process sand pay claims are employees of private insurance companies. That was the result of deal struck in 1965 to help win support for passage of Medicare.

With the creation of health insurance exchanges under both the House and Senate bills and the Senate s provision that private insurance companies must reduce their administrative costs to 10% could move us in the direction of a French-German-Japanese-Swiss model. In these and other multi-payer countries, private insurers collect premiums set by government regulation, pay all claims immediately under rates set by government negotiations with doctors and hospitals, and cannot deny coverage for any reason under strict government regulation.

So what if it turns out that most Americans decide they prefer a multi-payer over a single-payer health care system?
Protesting is easy. Governing is a b*tch.
Author: Sam Stark
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2009-12-21
Permalink 03:08:24 am, by nick Email , 469 words, 767 views English (US)
Categories: Announcements [A]
Senate Bill a Step Towards German-Style Healthcare

Health care reform will not be what we all hoped for or what this country deserves and needs. But its passage can possibly lay the basis for future improvements. Here are two reasons:

1) The Health Insurance Exchange, as passed by the House, will give the appointed federal health commissioner the power to negotiate premium costs with private insurance companies that wish to be included in the Exchange..

Combining this with the Senate's requirement that 90 percent of premium dollars must be spent on medical benefits, as opposed to administrative costs, moves us closer to how Germany, France, Japan, Switzerland and others achieve universal health care and affordability. (By comparison, Medicare pays out about 97 cents for every health care dollar.)

Based on their political, economic and cultural history and traditions, these countries cover every citizen and immigrant through an employer-based, multi-payer private insurer system in which no company is allowed to make a profit off of providing health insurance. Negotiations with doctors and hospitals over costs is standard with these systems, as well.

These countries also happen to achieve better health outcomes and lower costs than Canada does, although Taiwan's single-payer system beats all nations with the lowest administrative costs around.

2) Up until now, our mish-mash, mostly employer-based system has led to a consumer mentality in which most people, left on their own, end up asking the question first and above all, "What's in it for me?" This framework has not led to a national thinking of the common good.

Health care reform, as flawed as it is, has the potential of creating a mind shift nationally where Americans may now be able to see and accept that it is government's role to provide quality, affordable health care for all.

As a nation, we still lack the social solidarity that exists in other capitalist countries when it comes to health care. We have been fighting the predominant "You're On Your Own" ethic in this country, a legacy of 30 years of a Reaganist/Clintonist anti-government, free market and individualistic philosophy.

We have a chance to succeed with a "We're In This Together" framework once it is established in the minds of most American that government protection of Americans goes beyond national defense, police and fire, food and drug safety and other issues to also include protecting Americans' health and protecting us from medical bankruptcy and greedy insurance companies.

As progressives we need to continue the fight for equity in health care for all Americans. And as every other experience has shown, that goal cannot be achieved under a for-profit system.

Single-payer has worked well for Canada, Taiwan and South Korea, the only single-payer countries in the world. However, it may not be the non-profit system preferred by Americans. We may need to consider a mind shift of our own.

Author: Sam Stark
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2009-12-19
Permalink 07:10:22 pm, by nick Email , 271 words, 918 views English (US)
Categories: Announcements [A]
McConnel Misinforms

December 17, 2009

Earlier today, Senator Mitch McConnell's office posted a press release criticizing the attempt to "rush" through the Health Care Reform Bill, arguing that Congress has not spent sufficient time on this legislation in comparison with other important bills.

Republicans average 10 days on big ticket legislation.

McConnell overlooks the fact that when the Republicans were in charge, the entire Congress averaged 10 days on critical trillion dollar items of legislation: 9 days spent on H.J.Res.114, the bill authorizing the invasion of Iraq, considered from Oct. 2 to 11, 2002; 11 days spent on H.R. 1836, the First Bush Tax Cut, considered from May 15 to 26, 2001; and 10 days spent on H.R. 2, the Second Bush Tax Cut (after Sen. Grassley's amendment gutted the first version on May 15, 2003), considered from Feb. 27/ May 15 to May 23, 2003. (For details see: http://rethinkingpatientsafety.typepad.com/ )

Why aren't over 400 hearings spanning 70 years enough?

In contrast to this 10 day average for Republican consideration of big ticket items of legislation, Congress has spent over 70 years on health care reform, holding 451 hearings, 175 hearings during Democratic administrations (Roosevelt: 8 hearings, Truman: 71, Carter: 11, and Clinton 85), and 276 hearings during Repubican adminstrations (Eisenhower: 19, Nixon: 73, Ford: 56, Reagan: 22, Bush 1st: 77, Bush 2nd: 29) . (See: http://tinyurl.com/hearings-on-health-care )

McConnell ignores the fact that Republicans introduced health care reform (Theodore Roosevelt in 1912), and championed it nearly a century ago (See the 1928-32 publications of 28 volumes by Committee on the Costs of Medical Care chaired by Republican AMA Pres. Dr. Ray Lyman Wilbur).

Do not let McConnell's misinformation further delay our long overdue health care reform.

Lee Tilson

Detroit, Michigan
President
Year
Number of Hearings
Roosevelt
1938 8
Truman
1946 36
1947--1948 11
1949 24
Eisenhower
1954 19
Nixon
1970 2
1971 46
1972 1
1973 7
1974 17
Ford
1975 35
1976 21
Carter
1977 1
1978 3
1979 4
1980 3
Reagan
1983 6
1985 1
1986 4
1987 8
1988 3
Bush (GHW)
1989 12
1990 10
1991 24
1992 31
Clinton
1993 41
1994 34
1995 3
1996 1
1997 2
1999 2
2000 2
Bush (GW)
2001 5
2002 7
2003 3
2004 2
2005 1
2006 1
2007 6
2008 4