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What is a liberal!All this bickering over liberal vs conservative argument was ushered out of the conversation when Trump took office. This is no longer a mere disagreement on policy. No longer a “let’s agree to disagree”, laissez-faire attitude towards each other. The GOP is no longer Republicans but Trumpublicans. But the erosion of the conservative party began way before Trump.“Neoconservatives blame the “adversarial” counterculture of the 1960s, which dismissed traditional values and religion as old-fashioned, irrelevant, or even reactionary”. They maintain that liberal degeneration represents a real and present danger to Western civilization”. So, folks like Newt Gingrich, Mitch McConnell, Carl Rove, Roger Ailes, Chris Jankowski, (the guy behind the Republican RedMap, gerrymandering scheme), emerged as a new breed of Republicans that relegated the sense of fair play to a winner takes all no matter what, attitude. A relatively small sect (about 1%) including The Koch Brothers, the Mercers, the Mellon family, The Heritage Foundation, John M. Olin, the De Vos’, and the Coors family are part of a cabal of financial elites that joined with the neo-conservatives and together financed a well-crafted message of an ideology, which has simmered below the surface of conservative thought for half a century and has now boiled to the top and become the new “alt-right” politics, economics, and culture.One of the benefits of a democratic society are institutions that constrain any abuse of one group over another. In theory, the federal government is the only power the collective people have against such abuse. The government has been hijacked and corrupted beyond its purest intention. Why? Because we have made money and ideology the king of power over the rule of law and representation. Yet, one can understand why ideologues and corporations try to demolish the power that constrains them. If they can’t do what they want, the next best thing is to buy and control the restrainer. The neo-cons and corporate elite realized that the only way to gain control is to initiate a unified campaign to manipulate public opinion. They propagate the belief that liberal society, has become amoral, adrift, and degenerate. The corporate elite bought politicians, litigators, educators, talk radio, cable television, social media, and paid entertainers to arouse the disenfranchised population.The elite don’t have a party. They play party politics. They hedge their bets by financially contributing to both candidates. They see this as a way to get things done without getting dirty themselves. But when Liberals encourage people to question established authority, criticize religion, and reject traditional beliefs, the corporate elites realized that aligning themselves with neo-con and extreme religious ideology could really work. They spin a pernicious and deceitful new narrative that intellectuals are ‘a privileged liberal elite’ out of touch with ‘the real people.’ Although, the neo-liberals are a part of the corporate elite and in many ways just as guilty of buying politicians. The alt-right have deliberately made the word ‘liberal’ a sinister epithet. The dark-money funded message use phrases like ‘free enterprise,’ vs socialism/communism, ‘individual rights,’ vs government intrusion, ‘patriots,’ Nationalists and ‘America first’ to describe themselves as the opponents of liberalism.This covert clan pull off a clever yet devastating coup by diverting public anger away from financial and corporate power and turning it on experts, journalists, and intellectuals. They also, allege that taxing the rich to aid the poor is enabling, creates dependency, undermines individual initiative, ambition, and responsibility. In their eyes, the liberals want to turn America into communists where the poor largely consists of 'looters and moochers' stealing from society's hardworking productive class. Massive government abuse and corruption adds fuel to the anti-liberal-government message, which helps to infect the minds and hearts of people who were already becoming disillusioned by the dismantling of the American dream.The final straw was when a black man became the president of the United States. The elite/neocons created a political action group known as the Tea Party, which started a rapid shift in the political landscape. They spent fortunes on focus groups and propaganda techniques. It’s all about slogans and catchy titles. “Big bad government is out to get you.” “Drain the Swamp”, “Make America Great Again.” They don’t need to define what that means; they just need to repeat it enough times where it sticks in the psyche of enough people. The followers don’t ask for a definition; they will fill in the blanks themselves.Trumpublicans are not the cause -- they are the effect. And Trump is just the cherry on top. The real ruling class creates a culture war and replaces the fight against inequality with anti-intellectualism, (dubbing them, communists, socialists, snowflakes, fake news and the enemy of the people). And now we have the interesting twist of Putin and the anti-democracy movement. So, what does a catchy title like the Tea Party represent to any of us?How ‘bout Revolution against tyranny? No taxation without representation?That’s what most people think the Boston Tea Party was about—the colonial Americans protesting high taxes on imported British tea, without a say in the matter. This is just a bullshit myth. The truth is—it was a revolt against tax exemptions, specifically, one to give a monopoly to the East India Trading Company. This tax break allowed the East India Company to sell tea for half the old price and cheaper than the price of tea in England, so they could easily undercut the prices offered by the mom-and-pop tea merchants. Today it’s called, Amazon, Home Depot, Wallmart, etc, there is nothing “free enterprise” about these huge corporations, the little guy can never compete with these giants. Colonists resented this favored treatment of a major company. ‘Taxation without representation’ meant hitting the average person and small business with taxes while letting the richest and most powerful corporation in the world off the hook. It was government sponsorship of one corporation over all competitors. Sound familiar? And most Americans fight for this distorted form of capitalism. The new Tea Party named themselves after a revolt against the very type of government they elected today.It’s all about crafting the message around survival. Make your livelihood, and safety, appear to be in danger or difficult to afford because of outsiders. Make education, which gives you opportunities to compete too expensive and unattainable, and eventually, fear begets primal thinking… Blame and violence are inevitable. The well-crafted narrative is designed to stoke the flames of fear and confusion. Blame the government, blame the minorities, blame the liberals…blame the conservatives. It’s like a card trick. A classic sleight of hand. Distract you over here while the trick is being played with the other hand. History has shown us that great empires always fall from within. Keep the message confusing—polish and reinforce beliefs in the churches and media. And so, it becomes…blame turns into violence and chaos, and eventually control, authoritarianism and oppression ensue. All while Putin plays his fiddle.I think the biggest challenge society faces is not immigration but technology. We are advancing faster than society can keep up with, and our government institutions are as antiquated as the rotary dial phone. The older generation was brought up on the idea that every U.S. citizen should have an equal opportunity to achieve success and prosperity if they worked hard and followed the rules. But when that hard work at the factory or in the coal mine goes away, either because technological advances or globalization has made it obsolete, what happens? The people get pushed aside. And many Americans are feeling abandoned. We, as a society, have not figured out how to compensate for that dilemma.Originally, it was industrialists who were the real power in the American economy — men and women who actually made things. America made a dramatic shift in the '80s when we started to transform ourselves from a manufacturing economy to a financial economy. That’s when Wall Street turned America upside down. They call it financialization, where, instead of making products, they made transactions — financial products, like credit default swaps and collateralize debt obligations. So, a new generation of corporate owners began to rear its ugly head in America. This is when old established companies that actually cared about their company, the integrity of their products, and their employees, either sold out for big profits or were forced to. This was the beginning of the fall of our working class. Companies such as Bain Capital, Romney’s Company, and others like the Carlyle Group made their fortunes by borrowing vast sums of money that other people were forced to pay back.Romney, for example, is known as the leverage buyout king of America. Companies like Bain would put a small percentage down and borrow the rest to take over a company. But here’s the trick, they don’t have to pay it back. The company they take over is responsible for the debt. Once Bain takes over, they force it into what’s called, ‘dividend recapitalization,’ which essentially means that the company has to cash in a bunch of shares and pay Bain and its investors a huge sum of money. In other words, they take over a struggling company, faced with threatening changes in the industry, and they force them to cash out entirely and pay all their money to the new owners. In essence, these fine, upstanding, vulture capitalists pile up more debt onto unsuspecting companies, write enormous checks that other people have to cover, and eventually drive the company out of business.Thanks to deregulating Wall Street when the already struggling company now goes into massive debt, they are forced to cut salaries and benefits and, lay off employees or outsource to countries like China and Mexico. The new owners, like Bain, don’t give a shit about people, or the company for that matter. They only care about profit. Workers are irrelevant in this scam. In many cases, they have the audacity to make the employees go to Mexico, India, China, or wherever they outsource and make them train the new foreign employees before they’re laid off.Oh, but here is the best part. When the company pays the monthly debt service, that service is deductible, which makes these schemes economically feasible. Those deductions are your government handouts. Talk about corporate welfare. And to add insult to injury, because it’s an investment and not considered income, assholes like Romney don’t pay income tax; they pay capital gains tax at 15%. And with all the tax loopholes, he ends up paying less than 14%. Romney’s worth about $250 million and pays less than 14% in taxes. While lazy moochers like the working class are strapped with the tax burden. Yet the conservatives call things like Social Security and Medicare, “entitlements”.That’s the craft of the messaging. They aren’t entitlements in the derogatory sense—they are not government handouts. But actually, you are—in fact—entitled to these benefits. Everyone who has paid taxes since their first job have been paying for their Social Security and Medicare their whole life. But there’s an example of deliberate wordsmithing. The alt-right uses that word ‘entitlement’ because, out of context, it sounds pejorative. You think those words are used by accident? No word is used by accident by the spin doctors. Think tanks and focus groups are paid handsomely to craft the best words to manipulate the minds of the public. Then they repeat them over and over again, until they become part of the psyche. This is psychological warfare, and they are winning.” repeat a short, clever slogan over and over, and it will be accepted by many as truth, without question. This is a classic propaganda technique. Edward Bernays called it ‘engineering consent.’”Bernays was the nephew of Sigmund Freud, father of public relations and Madison Avenue. He pioneered the scientific technique of shaping and manipulating public opinion. His writings on these techniques were used by the Nazis in World War II. Ironically, Bernays was a Jew. One technique is the use of language and other forms of communication in order to influence brain behavior. Once, he was quoted as saying, “The conscious and intelligent manipulation of the organized habits and opinions of the masses is an important element in democratic society. Those who manipulate this unseen mechanism of society constitute an invisible government which is the true ruling power of our country.”One may say -- Well, people’s hardships are not my problem. I’m not my brother’s keeper. Survival of the fittest and all that. First of all, out of 320 million Americans: seventy-three million are children. Forty-six million are elderly. And fifty-three million are disabled—3.8 million are vets. That’s 175.8 million right there. The rest, according to the latest 3.8% employment statistics, over 96.2 percent of the entire population, are working. Yet even though they are working, forty-five million people live below the poverty line. Now, one still may ask why should I be responsible for everybody else? It is proven that when a society feels safe, and all of its members are thriving there is less crime, less violence, less illness and drug abuse and much more productivity; which in turn creates a much healthier economy as a whole, not just for the 1%.Here are 16 simple things that Lori Gallagher Witt wrote, which I added further discussion on several points in italics and included citations, that describe what I have also come to espouse as a liberal:1. I believe a country should take care of its weakest members. A country cannot call itself civilized when its children, disabled, sick, and elderly are neglected. Period. Trump, his cabinet, Mitch McConnell and his Trumpublican cabal disagree : Trump Budget Deeply Cuts Health, Housing, Other Assistance for Low- and Moderate-Income Families2. I believe that in a civil society that healthcare is a right, not a privilege. Somehow that's interpreted as "I believe Obamacare is the end-all, be-all." This is not the case. I'm fully aware that the ACA has problems, that a national healthcare system would require everyone to chip in, and that it's impossible to create one that is devoid of flaws, but I have yet to hear an argument against it that makes "let people die or go bankrupt because they can't afford healthcare" a better alternative. I believe healthcare should be far cheaper than it is, and that everyone should have access to it. And I don’t have a problem raising taxes on people who make over $10 million a year. Trumpublicans have made it their mission to take this away. Trump’s new health insurance rules expected to hurt ObamacareI am for some kind of Universal Healthcare. And don’t say we can’t afford it. If you’re married with at least one child, you pay in premiums alone about $1,200-$1,400 per month. If you’re single, it’s probably closer to $300. That’s before any deductibles you have to pay on any health care services you receive or medications you are prescribed. With all of that, the average American spends about $10,345 a year on health care. Despite paying into my social security and Medicare my entire adult life, I personally pay $132.19 for Medicare plus my supplement of $104. Totaling $236.19 a month.Here's how much the average American spends on health careLet’s take a look at Canada’s health care system. Canada spends about $230 billion per year on their universal health care system. That money ensures that all 36 million Canadian citizens are covered by health care. This means that the system costs Canada $7,666 per citizen per year. Based on that number, a similar system would cost the United States a little less than $2.2 trillion per year, in order to cover the 289 million US citizens living in the US.We currently spend:$672 billion on Medicare$565 billion on MedicaidAnd $79 billion of the VA’s Budget is for Veteran’s Medical Care.All three of these programs are now unnecessary because the new system covers everyone.So, The first $1.3 trillion is already covered.That leaves 915 billionNow. There are 142 million taxpayers in the United States.The average salary is $56,516, 1.45% of which goes to Medicare through payroll tax, $819 per year. Consider, instead of paying private for-profit insurance companies their premiums and paying all of your deductibles, paying $5,629 per year more into a Medicare for All System.The average American saves $3,897 per year, and the entire system is deficit neutral.There are other things in the $4 trillion budget that can be cut to cover more of that cost and make it even easier on the average American taxpayer, but the numbers are the numbers, and even if the average taxpayer is covering the entire additional cost, they are still ahead an average of $324 per month. Meanwhile, you don’t have to worry about what happens if you get laid off and your wife has cancer. How Much Does Breast Cancer Treatment Cost in the U.S? You don’t have to worry about the rising cost of insulin to treat your diabetes. https://health.usnews.com/health... You don’t have to consider taking an Uber to the hospital while you’re having a stroke, or you’ve been bitten by a rattlesnake because you’re worried about how much the ambulance bill’s going to be. https://www.washingtonpost.com/n... Vets don’t have to wait on the VA anymore; they’re citizens too. All you have to worry about now is keeping lawmakers in charge who won’t spend all their time cutting the system to make it crappy. It’s a common myth/criticism that liberals want “Free stuff from the Government.” Wrong. There are certain services, education, for example, public safety, roads, etc., that we all expect the government to provide, and we pay taxes to cover those costs. What’s wrong with adding health care to that list if it saves you money?3. I believe education should be affordable and accessible to everyone. It doesn't necessarily have to be free (though it works in other countries today, and in America in the 60s, so I'm mystified as to why it can't work in the US today), but at the end of the day, there is no excuse for students graduating college saddled with five- or six-figure debt. The Trumpublican cabinet has no interest. DeVos escalates fight with states over student loan companies4. I don't believe your money should be taken from you and given to people who don't want to work. I have literally never encountered anyone who believes this. Ever. Every society will have bad actors. A lot of people who are out there on the streets are, mentally ill, and or drug addicts. Now, many of those drug addicts are on opioids prescribed by the medical doctors who are on the take. I just have a massive moral problem with a society where a handful of people can possess the majority of the wealth, while there are people literally starving to death, freezing to death, or dying because they can't afford to go to the doctor. Fair wages, lower housing costs, universal healthcare, affordable education, and the wealthy actually paying their share would go a long way toward alleviating this. Somehow believing that makes me a communist. The Trumpublican rich get richer on the backs of the middle class and stick them with the bill. CHARTS: Here's How GOP's Tax Breaks Would Shift Money To Rich, Poor Americans5. I don't throw around "I'm willing to pay higher taxes" lightly. If I'm suggesting something that involves paying more, well, it's because I'm fine with paying my share as long as it's actually going to something besides lining corporate pockets or bombing other countries while Americans die of poverty and neglect. How the Tax Act Embodies the Republican Culture of Corruption6. I believe companies should be required to pay their employees a decent, livable wage. Somehow this is always interpreted as me wanting burger flippers to be able to afford a penthouse apartment and a Mercedes. What it means is that no one should have to work three full-time jobs just to keep their head above water. Restaurant servers should not have to rely on tips, multibillion-dollar companies should not have employees on food stamps, workers shouldn't have to work themselves into the ground just to barely make ends meet, and minimum wage should be enough for someone to work 40 hours and live. Millions of low-wage workers in the US are struggling to survive7. I am not anti-Christian. I have no desire to stop Christians from being Christians, to close churches, to ban the Bible, to forbid prayer in school, etc. (BTW, prayer in school is NOT illegal; *compulsory* prayer in school is - and should be - illegal). All I ask is that Christians recognize *my* right to live according to *my* beliefs. When I get pissed off that a politician is trying to legislate Scripture into law, I'm not "offended by Christianity" -- I'm offended that you're trying to force me to live by your religion's rules. You know how you get really upset at the thought of Muslims imposing Sharia law on you? That's how I feel about Christians trying to impose biblical law on me. Be a Christian. Do your thing. Just don't force it on me or mine. And stop being a hypocrite! BTW, if you think Trump is a Christian, I’d like to sell you some underwater land in Florida. Under Trump, America's religious right is rewriting its code of ethics8. I don't believe LGBT people should have more rights than you. I just believe they should have the *same* rights as you. Trump administration dismantles LGBT-friendly policies9. I do not believe in “open boarders”, I don't believe illegal immigrants should come to America and have the world at their feet, especially since THIS ISN'T WHAT THEY DO (spoiler: undocumented immigrants are ineligible for all those programs they're supposed to be abusing, and if they're "stealing" your job it's because your employer is hiring illegally or you’ve got the crappiest job in the world and you should consider bettering yourself. I'm not opposed to deporting people who are here illegally, but I believe there are far more humane ways to handle undocumented immigration than our current practices (i.e., detaining children in cages, splitting up families, ending DACA, etc). Many immigrants have literally walked over 1000 miles with nothing but the clothes on their back to escape, being raped, murdered, or enslaved. Do I want them here? The honest answer is NO! But there are a lot of Americans I don’t want here either. Who am I to say they can’t be? What did I do to get here? I slipped out of my immigrant mother’s vagina. Impressive! America is better than Trump's cruel immigration policiesFACTS:Illegal immigrants increase the national GDP by around $1.6 trillion per year. Over half of farm workers are illegal immigrants, not to mention construction workers and maintenance and domestic workers. All the shit you white guys will never do. Undocumented workers are a major driving force in the economy. Sadly, because employers can get away with paying them below minimum wage with no benefits, you and everyone else can purchase low-cost food and other goods and services while corporations make outrageous profits. Besides the fact that immigrants pay taxes, including sales and excise, personal income, and property taxes. In addition, they contribute as much as $1.5 billion to the Medicare system and $7 billion to the Social Security system even though they will never be able to collect those benefits when they retire. https://www.americanprogress.org...Most welfare programs require proof of legal immigration status, and under the 1996 Welfare Law, even legal immigrants cannot receive these benefits until they have been in the United States for more than five years. Undocumented workers cannot apply for welfare, unemployment, disability, Medicare, or food stamps due to their immigration status. https://www.nilc.org/issues/econ...10. I don't believe the government should regulate everything, but since greed is such a driving force in our country, we NEED regulations to prevent cut corners, environmental destruction, tainted food/water, unsafe materials in consumable goods or medical equipment, and bank and corporate fraud and abuse etc. It's not that I want the government's hands in everything -- I just don't trust people trying to make money to ensure that their products/practices/etc. are actually SAFE. Is the government devoid of shadiness? Of course not. But with those regulations in place, consumers have recourse if they're harmed and companies are liable for medical bills, environmental cleanup, etc. Just kind of seems like common sense when the alternative to government regulation is letting companies bring their bottom line into the equation. The aforementioned cabal of corporate oligarchs have a vested interest in deregulating all of their interests. Oil, coal, Wall street, Big Pharma, Big Agra, Big Chemical, etc. for obvious reasons. Tracking deregulation in the Trump era11. I believe our current administration is fascist. Not because I dislike them or because I can’t get over an election, but because I've spent too many years reading and learning about fascist characteristics to miss the similarities. Not because any administration I dislike must be Nazis, but because things are actually mirroring authoritarian and fascist regimes of the past. Opinion | Noah Berlatsky: Is the U.S. government fascist? Signs suggest we're headed in that direction12. I believe the systemic racism and misogyny in our society is much worse than many people think, and desperately needs to be addressed. Which means those with privilege -- white, straight, male, economic, etc. -- need to start listening, even if you don't like what you're hearing, so we can start dismantling everything that's causing people to be marginalized. How the Republican Party Became The Party of Racism13. I am not interested in coming after your blessed guns, nor is anyone serving in government. What I am interested in is sensible policies, including background checks, that just MIGHT save one person’s, perhaps a toddler’s life by the hand of someone who should not have a gun. Opinion | How to Reduce Shootings14. I believe in so-called political correctness to a degree. Not because everyone is a delicate snowflake, but because as Maya Angelou put it, when we know better, we do better. The Trump era has brought out the worst in our society and given permission to expose our darkest side as acceptable and even encouraged. Unfiltered Voices From Donald Trump’s Crowds Insult Politics: Donald Trump, Right-Wing Populism, and Incendiary ...15. I believe in funding sustainable energy, including offering education to people currently working in coal or oil so they can change jobs. There are too many sustainable options available for us to continue with coal and oil. The evidence that man does in fact contribute to climate change is overwhelming. But even if climate was not a concern, toxicity and pollution are. Clean air, water and soil is imperative for sustaining the health of the planet and its inhabitants. And it is our right over your profit. I am a health care specialist, specializing in detoxification so if you want to argue this any further, hold my beer. Benefits of Renewable Energy Use16. I believe that women should not be treated as a separate class of human. They should be paid the same as men who do the same work, should have the same rights as men and should be free from abuse. And the right to control their own body. Why on earth shouldn’t they be? What do men get that women don't? Here are a few thingsI don’t like to be pigeon-holed into any ideology. The truth is I'm not a Democrat or a Republican, a Libertarian or a Socialist. I am a female, conscious, sovereign human being. I believe in civil rights. I believe in women's rights, and Gay rights, I believe in a "living wage", (for God sake!) and equal pay, I believe in the division of church and state, I believe in pro-choice and pro-life, in other words, I believe in the right to bodily integrity, what I -- as a sovereign human being-- do with my own body is MY business, not the governments, yet I believe you cannot say you're a "pro-lifer" and be pro-gun, pro war and pro capital punishment. I believe in being a good steward to my planet and my fellow beings, all-be-it, human, animal or plant. I believe that serving the whole will benefit the individual (that's been mathematically proven by the way, see John Nash's economic theory). I believe that love is more powerful than hate and that somehow love shall prevail.If you share these principles, then surprise – you’re a liberal.

Below are the Campaign promises listed as broken by poilitifact. You can argue that he didn’t get a lot of help from the right, but he didn’t exactly do much to bridge the gap himself.There are things on this list that required no help from the right such as recognizing Armenian genocide as well. There was no excuse for not crossing that one off the list.Obama was what he was. An under-qualified community activist that was in over his head and led astray by senior Democratic officials.The Obameter: Campaign Promises that are Promise BrokenEliminate all oil and gas tax loopholes"Eliminating special tax breaks for oil and gas companies: including repealing special expensing rules, foreign tax credit benefits, and manufacturing deductions for oil and gas firms."Expand the child and dependent care creditExpand and make refundable the child and dependent care credit.Require publicly traded financial partnerships to pay the corporate income taxRequire publicly traded financial partnerships to pay the corporate income tax.Close loopholes in the corporate tax deductibility of CEO payCongress has set rules regarding the tax deductibility of the salaries of CEOs, but forms of non-salary compensation have become popular. Obama would look at revamping definitions of compensation.Create a foreclosure prevention fund for homeownersCreate a $10 billion fund to help homeowners refinance or sell their homes. "The Fund will not help speculators, people who bought vacation homes or people who falsely represented their incomes."Provide option for a pre-filled-out tax formWill direct the Internal Revenue Service to "give taxpayers the option of a pre-filled tax form to verify, sign and return to the IRS or online. This will eliminate the need for Americans to hire expensive tax preparers and to gather information that the federal government already has on file."Create a mortgage interest tax credit for non-itemizersCreate a refundable tax credit equal to 10 percent of mortgage interest for nonitemizers, up to a maximum credit of $800.Require automatic enrollment in 401(k) plansAutomatic enrollment in 401(k) plans for workers whose employers offer retirement plans.Create a retirement savings tax credit for low incomesA tax credit for retirement savings up to $500 (couples) or $250 (singles). Phases out when incomes exceed $65,000 (couples) or $32,500 (single). Indexed for inflation.End income tax for seniors making less than $50,000"Will eliminate all income taxation of seniors making less than $50,000 per year. This will eliminate taxes for 7 million seniors -- saving them an average of $1,400 a year-- and will also mean that 27 million seniors will not need to file an income tax return at all."End no-bid contracts above $25,000"Will ensure that federal contracts over $25,000 are competitively bid."Create a $60 billion bank to fund roads and bridges"Will address the infrastructure challenge by creating a National Infrastructure Reinvestment Bank to expand and enhance, not supplant, existing federal transportation investments. This independent entity will be directed to invest in our nation's most challenging transportation infrastructure needs. The Bank will receive an infusion of federal money, $60 billion over 10 years, to provide financing to transportation infrastructure projects across the nation. These projects will create up to two million new direct and indirect jobs and stimulate approximately $35 billion per year in new economic activity."Tax carried interest as ordinary incomeCarried interest is a way of compensating executives by giving them ownership stakes, or "interest," in a business. Carried interest is taxed as a capital gain, which has a lower tax rate than ordinary income. Obama proposes taxing carried interest at the same rate as regular income.Sign the Employee Free Choice Act, making it easier for workers to unionize"Obama is a cosponsor and strong advocate of the Employee Free Choice Act (EFCA), a bipartisan effort to make the unionization process more transparent and increase penalties on companies that violate employee rights. He will sign EFCA into law as president."Lift the payroll tax cap on earnings above $250,000"Barack Obama believes that the first place to look to strengthen Social Security is the payroll tax system. Obama believes that one strong option is increasing the maximum amount of earnings covered by Social Security by lifting the payroll tax cap on only earnings above $250,000."Forbid companies in bankruptcy from giving executives bonuses"Protect the jobs and benefits of workers and retirees when corporations file for bankruptcy by telling companies that they cannot issue bonuses for executives during bankruptcy while their workers watch their pensions disappear."Allow workers to claim more in unpaid wages and benefits in bankruptcy court"Increase the amount of unpaid wages and benefits workers can claim in bankruptcy court against their employer."Require full disclosure of company pension investments to employees"When companies fund their pensions, many do not disclose their investments with the employee's pension dollars. This lack of transparency can make it easier for fund managers to make imprudent or even fraudulent investment decisions. Obama will ensure that all employees who have company pensions receive annual disclosures about their pension fund's investments, including full details about which projects have been invested in, the performance of those investments and appropriate details about probable future investments strategies."Allow imported prescription drugs"Allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S."Prevent drug companies from blocking generic drugs"Prevent drug companies from blocking generic drugs from consumers."Allow Medicare to negotiate for cheaper drug prices"Allow Medicare to negotiate for cheaper drug prices."Appoint federal-level coordinator to oversee all federal autism efforts"They will appoint a Federal ASD Coordinator to oversee federal ASD research and federal efforts to improve awareness of ASD and improve the training of medical professionals to identify and treat ASD. By establishing one top-level point person to coordinate ASD efforts in the White House, they will ensure that ASD receives the recognition and priority it deserves in the federal government. The Federal ASD Coordinator will also be tasked with eliminating bureaucratic obstacles that may be delaying implementation of important ASD measures and ensuring that all federal ASD dollars are being spent in a manner that prioritizes results. The Coordinator will work with state task forces on ASD to ensure effective communication and collaboration among federal, state, and local agencies."Double federal funding for cancer research"Will double federal funding for cancer research within 5 years, focusing on NIH (National Institutes of Health) and NCI (National Cancer Institute)."Direct the Secretary of Health and Human Services to conduct a study of federal cancer initiatives"As president, Barack Obama will immediately direct his Secretary of Health and Human Services, in collaboration with agency officials, academic researchers, cancer survivors and advocates for people with cancer, and state public health officials, to comprehensively examine the various cancer-related efforts of federal agencies, and provide recommendations to eliminate barriers to effective coordination across federal agencies and between the federal government and other stakeholders."Provide the CDC $50 million in funding to determine effective approaches for cancer patient care"Will provide the CDC $50 million in new funding to determine the most effective approaches that assist not only navigation of cancer patients through diagnosis and treatment processes, but also provide easy-to-understand information on the necessary follow-up steps to ensure continued lifelong health."Sign the UN Convention on the Rights of Persons with Disabilities"As president, Barack Obama will renew America's leadership by making the United States a signatory to the UN Convention on the Rights of Persons with Disabilities; the first human rights treaty approved by the UN in the 21st century and a vital foundation for respecting the rights of people with disabilities worldwide He will urge the U.S. Senate to ratify the Convention expeditiously."Fully fund the Individuals with Disabilities Education Act (IDEA)"Barack Obama has been a strong and consistent advocate for fully funding the Individuals with Disabilities Education Act (IDEA). Congress promised to shoulder 40 percent of each state's "excess cost" of educating children with disabilities, but it has never lived up to this obligation. Currently, the federal government provides less than half of the promised funding (17 percent)."Create a National Commission on People with Disabilities, Employment, and Social SecurityCreate a national commission charged with "examining and proposing solutions to work disincentives in the SSDI, SSI, Medicare, and Medicaid," among other things.Change rules so small businesses owned by people with disabilities get preferences for contracts."Barack Obama and Joe Biden would direct the Small Business Administration to amend regulations under the Small Business Act that provide preferences in federal contracting to small businesses owned by members of socially and economically disadvantaged groups to include individuals with disabilities."Reduce the threshhold for the Family and Medical Leave Act from companies with 50 employees to companies with 25 employees"The Family and Medical Leave Act (FMLA) provides eligible employees of larger employers (i.e., 50 or more employees) with 12 weeks of unpaid leave to care for a family member's or their own serious health condition. Barack Obama and Joe Biden will guarantee that millions more workers have access to FMLA leave by reducing the threshold for which employers are covered from companies with 50 or more employees to those with 25 or more."Provide a $1.5 billion fund to help states launch programs for paid family and medical leave"As president, Barack Obama and Joe Biden will initiate a 50-state strategy to encourage all of the states to adopt paid-leave systems (as part of the Family and Medical Leave Act). Barack Obama and Joe Biden will provide a $1.5 billion fund to assist states with start-up costs and to help states offset the costs for employees and employers. Obama's Department of Labor will also provide technical information to the states on how to craft paid-leave programs consistent with their local needs."Require employers to provide seven paid sick days per year"Require that employers provide seven paid sick days per year – which may be taken on an hourly basis – so that Americans with disabilities can take the time off they need without fear of losing their jobs or a paycheck."Amend the Medicare "homebound" rule to allow some travel without loss of benefitsAmend the Medicare 'homebound' rule, which requires severely disabled recipients to stay in their homes to retain benefits, so that they have the freedom to leave their homes without fear of having their home-health benefits taken away.Reduce the Veterans Benefits Administration claims backlog"There are currently over 400,000 claims pending within the Veterans Benefits Administration, and over 800,000 claims receipts are expected in 2008 alone. … Obama will hire additional claims workers and convene our nation's leading veterans groups, employees and managers to develop an updated training and management model that will ensure that VA benefit decisions are rated fairly and consistently, and stem from adequate training and accountability for each claims adjudicator."Expand the Family Medical Leave Act to include leave for domestic violence or sexual assault"Expand the purposes for which leave can be taken under the Family Medical Leave Act to include reasons related to domestic violence or sexual assault."Form international group to help Iraq refugees"Will form an international working group to address" the problem of "more than five million Iraqis (who) are refugees or are displaced inside their own country."Provide at least $2 billion for services to Iraqi refugees"Provide at least $2 billion to expand services to Iraqi refugees in neighboring countries."Work with Russia to move nuclear weapons off hair-trigger alert"The United States and Russia have thousands of nuclear weapons on hair-trigger alert. Barack Obama believes that we should take our nuclear weapons off hair-trigger alert -- something that George W. Bush promised to do when he was campaigning for president in 2000. Maintaining this Cold War stance today is unnecessary and increases the risk of an accidental or unauthorized nuclear launch. As president, Obama will work with Russia to find common ground and bring significantly more weapons off hair-trigger alert."Clarify legal status for defense contractor personnel"Establish the legal status of contractor personnel, making possible prosecution of any abuses committed by private military contractors."Double U.S. spending on foreign aid to $50 billion a year by 2012"Barack Obama would target this new spending towards strategic goals, including helping the world's weakest states to build democratic institutions, foster healthy and educated communities, reduce poverty and generate wealth."Establish a Global Education FundBarack Obama would use part of increased U.S. assistance to establish a $2 billion Global Education Fund to "offer an alternative to extremist schools."Launch a new 'America's Voice Corps'"Obama also would launch a new 'America's Voice Corps' to rapidly recruit and train fluent speakers of local languages (Arabic, BahasaMelayu, Bahasa, Farsi, Urdu, and Turkish) with public diplomacy skills, who can ensure our voice is heard in the mass media and in our efforts on the ground."Develop an alternative to President Bush's Military Commissions Act on handling detainees"He will reject the Military Commissions Act, which allowed the U.S. to circumvent Geneva Conventions in the handling of detainees. He will develop a fair and thorough process based on the Uniform Code of Military Justice to distinguish between those prisoners who should be prosecuted for their crimes, those who can't be prosecuted but who can be held in a manner consistent with the laws of war, and those who should be released or transferred to their home countries."Restore habeas corpus rights for "enemy combatants""The right of habeas corpus allows prisoners to ask a court to determine whether they are being lawfully imprisoned. Recently, this right has been denied to those deemed enemy combatants. Barack Obama strongly supports bipartisan efforts to restore habeas rights. He firmly believes that those who pose a danger to this country should be swiftly tried and brought to justice, but those who do not should have sufficient due process to ensure that we are not wrongfully denying them their liberty."Establish regulations to secure chemical plants"Barack Obama will establish a clear set of federal regulations that all plants must follow, including improving barriers, containment, mitigation, and safety training, and, where possible, using safer technology, such as less toxic chemicals."Improve port security through better radiation detection"Will redouble our efforts to develop technology that can detect radiation and determine the danger it poses, and he will work with the maritime transportation industry to integrate this technology into their operations so as to maximize security without causing economic disruption."Strengthen the International Atomic Energy Agency (IAEA) and double its budget in the next four years"The IAEA is understaffed and underresourced at a time when demand for its expertise are growing. Barack Obama and Joe Biden will seek to ensure that the Agency gets the authority, information, people, and technology it needs to do its job. They will work to double the IAEA budget in the next four years (increasing the U.S. annual share to about $225 million). They will press countries to adopt the "Additional Protocol," -- which grants the IAEA the right to conduct more intrusive inspections, including at undeclared facilities — and seek agreement among members of the Nuclear Suppliers Group not to transfer nuclear technology to NPT countries that have not adopted the Additional Protocol. They will work to gain agreement on effective global standards for nuclear safety and security. And they will call for establishing IAEA verification procedures that go beyond the Additional Protocol to strengthen the agency's ability to detect clandestine facilities and activities."Secure ratification of the Comprehensive Test Ban Treaty (CTBT)"The United States has maintained a moratorium on testing since 1992. It signed the Comprehensive Test Ban Treaty (CTBT) in 1996, but it has not been ratified yet. Since the U.S. Senate last considered the treaty in 1999, significant progress has been made in our verification capability to detect nuclear explosions, even at extremely low yields, and to ensure confidence in the reliability of our nuclear stockpile without nuclear testing."Require companies to disclose personal information data breaches"California and other states have laws requiring a company that may have disclosed a resident's personal information without authorization to inform the victim of the disclosure. Barack Obama and Joe Biden believe that all Americans deserve the same right to know and will push for comparable federal legislation."Seek to negotiate a political agreement on Cyprus"As president, Barack Obama will show U.S. leadership in seeking to negotiate a political settlement on Cyprus. He believes strongly that Cyprus should remain a single, sovereign country in which each of the two communities on the island is able to exercise substantial political authority within a bi-zonal, bi-communal federation."With the G-8, launch Health Infrastructure 2020"Barack Obama and Joe Biden will take the lead at the G-8, working with and leveraging the engagement of the private sector and private philanthropy, to launch Health Infrastructure 2020 – a global effort to work with developing countries to invest in the full range of infrastructure needed to improve and protect both American and global health."Reinstate special envoy for the Americas"In the past, American presidents have filled the position of special envoy to bring senior-level attention to hemispheric matters that might otherwise get buried in the normal diplomatic process. Unfortunately, the position was eliminated after the post was vacated in June of 2004. As president Barack Obama will reinstate the position."Double the Peace Corps"Barack Obama will double the Peace Corps to 16,000 by its 50th anniversary in 2011 and push Congress to fully fund this expansion, with a focus on Latin America and the Caribbean."Seek independent watchdog agency to investigate congressional ethics violations"Will use the power of the presidency to fight for an independent watchdog agency to oversee the investigation of congressional ethics violations so that the public can be assured that ethics complaints will be investigated."Create a public "Contracts and Influence" database"Will create a 'contracts and influence' database that will disclose how much federal contractors spend on lobbying, and what contracts they are getting and how well they complete them."Expose Special Interest Tax Breaks to Public Scrutiny"Will ensure that any tax breaks for corporate recipients — or tax earmarks — are also publicly available on the Internet in an easily searchable format."Allow five days of public comment before signing billsTo reduce bills rushed through Congress and to the president before the public has the opportunity to review them, Obama "will not sign any non-emergency bill without giving the American public an opportunity to review and comment on the White House website for five days."Tougher rules against revolving door for lobbyists and former officials"No political appointees in an Obama-Biden administration will be permitted to work on regulations or contracts directly and substantially related to their prior employer for two years. And no political appointee will be able to lobby the executive branch after leaving government service during the remainder of the administration."Double funding for Federal Charter School Program and require more accountability"Will double funding for the Federal Charter School Program to support the creation of more successful charter schools. An Obama-Biden administration will provide this expanded charter school funding only to states that improve accountability for charter schools, allow for interventions in struggling charter schools and have a clear process for closing down chronically underperforming charter schools. An Obama-Biden administration will also prioritize supporting states that help the most successful charter schools to expand to serve more students."Double funding for afterschool programs"Will double funding for the main federal support for afterschool programs, the 21st Century Learning Centers program, to serve one million more children."Create scholarships to recruit new teachers"Will create new Teacher Service Scholarships that will cover four years of undergraduate or two years of graduate teacher education, including high-quality alternative programs for mid-career recruits in exchange for teaching for at least four years in a high-need field or location."Regulate pollution from major livestock operations"In the Obama Administration, the Environmental Protection Agency will strictly monitor and regulate pollution from large Concentrated Animal Feeding Operations (CAFOs) - which raise more than 40 percent of U.S. livestock - with fines for those who violate tough air and water quality standards."Provide a path to citizenship for undocumented immigrantsWill support "a system that allows undocumented immigrants who are in good standing to pay a fine, learn English, and go to the back of the line for the opportunity to become citizens."Sign the Deceptive Practices and Voter Intimidation Prevention Act into law"Will sign the Deceptive Practices and Voter Intimidation Prevention Act into law and charge the Voting Rights Section with vigorously enforcing that law and the provisions of the Voting Rights Act. The act will will enable investigations into deceptive and fraudulent practices. It establishes significant, harsh penalties for those who have engaged in fraud, and it provides voters who have been misinformed with accurate and full information so they can vote."Eliminate caps on damages for discrimination casesWill sign into law the Equal Remedies Act of 2007 "to do away with the caps on compensatory and punitive damages under Title VII that presently impede the ability of victims of racial and gender discrimination to fully recover for the wrongs they have suffered."Ban racial profiling by federal law enforcement agencies"Will sign legislation that will ban the practice of racial profiling by federal law enforcement agencies and provide federal funding to state and local police departments if they adopt policies to prohibit the practice."Allow bankruptcy judges to modify terms of a home mortgageWill repeal provisions of the Chapter 13 law that prohibit bankruptcy judges from modifying the original terms of home mortgages for ordinary families -- regardless of whether the loan was predatory or unfair or is otherwise unaffordable -- "so that ordinary families can also get relief that bankruptcy laws were intended to provide."Increase the supply of affordable housing throughout metropolitan regionsWill support "efforts to create an Affordable Housing Trust Fund to develop affordable housing in mixed-income neighborhoods. The Affordable Housing Trust Fund would use a small percentage of the profits of two government-sponsored housing agencies, Fannie Mae and Freddie Mac, to create thousands of new units of affordable housing every year...Will also restore cuts to public housing operating subsidies, and ensure that all Department of Housing and Urban Development (HUD) programs are restored to their original purpose."Increase the minimum wage to $9.50 an hour"Will further raise the minimum wage to $9.50 an hour by 2011, index it to inflation and increase the Earned Income Tax Credit to make sure that full-time workers can earn a living wage that allows them to raise their families and pay for basic needs such as food, transportation, and housing."Restore Superfund program so that polluters pay for clean-ups"Will restore the strength of the Superfund program by requiring polluters to pay for the cleanup of contaminated sites they created."Fully fund the COPS programWill fully funding the Community Oriented Policing Services (COPS) program "to combat crime and help address police brutality and accountability issues in local communities."Support tax deduction for artistsWill "ensure tax fairness for artists" by supporting the Artist-Museum Partnership Act, introduced by Sen. Patrick Leahy, D-Vt. "The Act amends the Internal Revenue Code to allow artists to deduct the fair market value of their work, rather than just the costs of the materials, when they make charitable contributions."Re-establish the National Aeronautics and Space CouncilWill re-establish an organizational authority in the federal government with a sufficiently broad mandate to oversee a comprehensive and integrated strategy and policy dealing with all aspects of the government's space-related programs, including those being managed by NASA, the Department of Defense, the National Reconnaissance Office, the Commerce Department, the Transportation Department, and other federal agencies. This Council reporting to the president "will oversee and coordinate civilian, military, commercial and national security space activities. It will solicit public participation, engage the international community, and work toward a 21st century vision of space that constantly pushes the envelope on new technologies as it pursues a balanced national portfolio that expands our reach into the heavens and improves life here on Earth."Support human mission to moon by 2020Will "endorse the goal of sending human missions to the Moon by 2020, as a precursor in an orderly progression to missions to more distant destinations, including Mars."Direct revenues from offshore oil and gas drilling to increased coastal hurricane protection"Will also direct revenues from offshore oil and gas drilling to increased coastal hurricane protection."Create a national catastrophe insurance reserve"Will create a National Catastrophe Insurance Reserve that would be funded by private insurers contributing a portion of the premiums they collect from policyholders. Such a framework would neither distort the insurance market nor discourage risk avoidance and risk mitigation investments because insurers would not be forced out of high-risk markets for fear of bankruptcy in the event of a disaster. With this program in place, disaster victims would no longer have to depend solely on taxpayerfunded federal disaster aid loans."Establish a Global Energy Corps to promote green energy in developing countries"Will extend opportunities for older individuals such as teachers, engineers, and doctors to serve overseas. This effort will include a Global Energy Corps to help reduce greenhouse gas emissions overseas and promote low-carbon and affordable energy solutions in developing nations. One of this century's great challenges will be promoting the use of green energy in developing countries, which will face exponential increases in energy demand. This Corps will be composed of scientists and engineers who will work with local partners overseas."Expand service-learning in schoolsWill tie a plan to give schools a substantial infusion of funds to support teachers and principals and improve student learning to the condition that school districts develop programs to engage students in service opportunities. "Obama and Biden believe that middle and high school students should be expected to engage in community service for 50 hours annually during the school year or summer months. They will develop national guidelines for service-learning and community service programs, and will give schools better tools both to develop successful programs and to document the experience of students at all levels. They will encourage programs that engage with community partners to expand opportunities for community service and service-learning opportunities, so that students can apply what they learn in the classroom to authentic situations that help the community. These programs will also involve citizens from the community engaging students in service opportunities through the Classroom Corps."Pay for the national service plan without increasing the deficit"Will maintain fiscal responsibility and prevent any increase in the deficit by offsetting cuts and revenue sources in other parts of the government (to pay for a national service plan that will cost about $3.5 billion per year when it is fully implemented). This plan will be paid for in part by cancelling tax provisions that would otherwise help multinational corporations pay less in U.S. taxes starting in 2008 by reallocating tax deductions for interest expenses between income earned in the U.S. and income earned abroad. The rest of the plan will be funded using a small portion of the savings associated with ending the war in Iraq."Seek treaty to control fissile materials"Will lead a global effort to negotiate a verifiable treaty ending the production of fissile materials for weapons purposes."Encourage diversity in media ownership"Will encourage diversity in the ownership of broadcast media, promote the development of new media outlets for expression of diverse viewpoints, and clarify the public interest obligations of broadcasters who occupy the nation's spectrum."Improve and prioritize student science assessments"Will work with governors and educators to ensure that state assessments measure…a student's higher order thinking skills including inference, logic, data analysis, interpretation, forming questions and communicating these skills."Reduce the number of middle managers in the federal workforce"Barack Obama will thin the ranks of Washington middle managers, freeing up resources both for deficit reduction and for increasing the number of frontline workers."Limit subsidies for agribusiness"Obama will implement a $250,000 [farm commodity] payment limitation so that we help family farmers, not large corporate agribusiness. Obama will close the loopholes that allow megafarms to get around the limits by subdividing their operations into multiple paper corporations."Strengthen anti-monopoly laws to favor independent farmers"Obama will strengthen anti-monopoly laws and strengthen producer protections to ensure independent farmers have fair access to markets, control over their production decisions, and fair prices for their goods."Give tax incentives to new farmersObama "will also provide tax incentives to make it easier for new farmers to afford their first farm. Obama will increase incentives for farmers and private landowners to conduct sustainable agriculture and protect wetlands, grasslands and forests."Strengthen the Age Discrimination in Employment Act"Obama will fight job discrimination for aging employees by strengthening the Age Discrimination in Employment Act and empowering the Equal Employment Opportunity Commission to prevent all forms of discrimination."Limit term of director of national intelligence"Will insulate the Director of National Intelligence from political pressure by giving the DNI a fixed term, like the Chairman of the Federal Reserve. Obama and Biden will seek consistency and integrity at the top of our intelligence community -- not just a political ally."Call for a consultative group of congressional leaders on national security"I will call for a standing, bipartisan consultative group of congressional leaders on national security. I will meet with this consultative group every month and consult with them before taking major military action."Give annual "State of the World" address"I'll give an annual 'State of the World' address to the American people in which I lay out our national security policy."Reduce earmarks to 1994 levels"Barack Obama is committed to returning earmarks to less than $7.8 billion a year, the level they were at before 1994."Work to ban the permanent replacement of striking workers"He will work to ban the permanent replacement of striking workers, so workers can stand up for themselves without worrying about losing their livelihoods."Establish a low carbon fuel standard"Will establish a National Low Carbon Fuel Standard (LCFS) to speed the introduction of low-carbon non-petroleum fuels. The standard requires fuels suppliers in 2010 to begin to reduce the carbon of their fuel by 5 percent within 5 years and 10 percent within 10 years. The Obama-Biden plan will incentivize increased private sector investment in advanced low-carbon fuels and has a sustainability provision to ensure that increased biofuels production does not come at the expense of environmental conservation. The LCFS is an important mechanism in ensuring that our efforts to reduce our oil dependence also reduce carbon emissions."Require 25 percent renewable energy by 2025"Will create a federal Renewable Portfolio Standard (RPS) that will require 25 percent of American electricity be derived from renewable sources by 2025, which has the potential to create hundreds of thousands of new jobs on its own."Enact windfall profits tax for oil companies"Will require oil companies to take a reasonable share of their record-breaking windfall profits and use it to provide direct relief worth $500 for an individual and $1,000 for a married couple. The relief would be delivered as quickly as possible to help families cope with the rising price of gasoline, food and other necessities. The rebates would be fully paid for with five years of a windfall profits tax on record oil company profits."Create cap and trade system with interim goals to reduce global warming"Will set a hard cap on all carbon emissions at a level that scientists say is necessary to curb global warming - an 80% reduction by 2050. To ensure this isn't just talk, I will also commit to interim targets toward this goal in 2020, 2030, and 2040. These reductions will start immediately, and we'll continue to follow the recommendations of top scientists to ensure that our targets are strong enough to meet the challenge we face."Use revenue from cap and trade to support clean energy and environmental restoration"A small portion of the receipts generated by auctioning [cap and trade] allowances ($15 billion per year) will be used to support the development of clean energy, invest in energy efficiency improvements, and help develop the next generation of biofuels and clean energy vehicles – measures that will help the economy and help meet the emissions reduction targets. It will also be used to provide new funding to state and federal land and wildlife managers to restore habitat, create wildlife migration corridors, and assist fish and wildlife to adapt to the effects of a warming climate. All remaining receipts will be used for rebates and other transition relief to ensure that families and communities are not adversely impacted by the transition to a new energy, low carbon economy."Require plug-in fleet at the White House"Within one year of becoming President, the entire White House fleet will be converted to plug-ins as security permits."Require new federal fleet purchases to be half plug-in hybrids or electric vehicles"Half of all cars purchased by the federal government will be plug-in hybrids or all-electric by 2012."Require more flex-fuel cars for the federal government"Government should lead the way here. I showed up at this event in a government vehicle that does not have a flexible-fuel tank. When I'm president, I will make sure that every vehicle purchased by the federal government does."Mandate flexible fuel vehicles by 2012"Will work with Congress and auto companies to ensure that all new vehicles have flexible fuel (FFV) capability . . . by the end of his first term in office."Double federal program to help "reverse" commuters who go from city to suburbs"Will double the federal Jobs Access and Reverse Commute (JARC) program to ensure that additional federal public transportation dollars flow to the highest-need communities and that urban planning initiatives take this aspect of transportation policy into account. JARC funds have been used to connect low-income workers around the country with job opportunities."Require energy conservation in use of transportation dollars"Will require governors and local leaders in our metropolitan areas to make energy conservation a required part of their planning for the expenditure of federal transportation funds."Provide an annual report on "state of our energy future""I will report to the American people every year on the State of our Energy Future."Devote federal resources to promote cellulosic ethanol"Will invest federal resources, including tax incentives, cash prizes and government contracts into developing the most promising technologies with the goal of getting the first two billion gallons of cellulosic ethanol into the system by 2013."Sign the Freedom of Choice Act"Throughout my career, I've been a consistent and strong supporter of reproductive justice, and have consistently had a 100% pro-choice rating with Planned Parenthood and NARAL Pro-Choice America. ... And I will continue to defend this right by passing the Freedom of Choice Act as president."Allow penalty-free hardship withdrawals from retirement accounts in 2008 and 2009"Obama and Biden are calling for legislation that would allow withdrawals of 15% up to $10,000 from retirement accounts without penalty (although subject to the normal taxes). This would apply to withdrawals in 2008 (including retroactively) and 2009."Give the White House's Privacy and Civil Liberties Board subpoena power"Strengthen the Privacy and Civil Liberties Board with subpoena powers and reporting responsibilities."Recognize the Armenian genocide"Two years ago, I criticized the Secretary of State for the firing of U.S. Ambassador to Armenia, John Evans, after he properly used the term 'genocide' to describe Turkey's slaughter of thousands of Armenians starting in 1915. … as President I will recognize the Armenian Genocide."No family making less than $250,000 will see "any form of tax increase.""I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes."No signing statements to nullify instructions from Congress"While it is legitimate for a president to issue a signing statement to clarify his understanding of ambiguous provisions of statutes and to explain his view of how he intends to faithfully execute the law, it is a clear abuse of power to use such statements as a license to evade laws that the president does not like or as an end-run around provisions designed to foster accountability. I will not use signing statements to nullify or undermine congressional instructions as enacted into law."Negotiate health care reform in public sessions televised on C-SPANTo achieve health care reform, "I'm going to have all the negotiations around a big table. We'll have doctors and nurses and hospital administrators. Insurance companies, drug companies -- they'll get a seat at the table, they just won't be able to buy every chair. But what we will do is, we'll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies. And so, that approach, I think is what is going to allow people to stay involved in this process."Create a public option health plan for a new National Health Insurance Exchange."The exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency."Cut the cost of a typical family's health insurance premium by up to $2,500 a year"I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family's premium by up to $2,500 a year."Bring Democrats and Republicans together to pass an agendaObama and Joe Biden will "turn the page on the ugly partisanship in Washington, so we can bring Democrats and Republicans together to pass an agenda that works for the American people."Introduce a comprehensive immigration bill in the first year"I cannot guarantee that it is going to be in the first 100 days. But what I can guarantee is that we will have in the first year an immigration bill that I strongly support and that I'm promoting. And I want to move that forward as quickly as possible."End the war in Afghanistan in 2014"President Obama responsibly ended the war in Iraq and will end the war in Afghanistan in 2014."

What is the role of government?In China, the central government has overall responsibility for national health legislation, policy, and administration. It is guided by the principle that every citizen is entitled to receive basic health care services, with local governments—provinces, prefectures, cities, counties, and towns—responsible for providing them, with variations for local circumstances. Health authorities include the National Health and Family Planning Commission and the local Health and Family Planning Commissions, which have primary responsibility for organizing and delivering health care and supervising providers (mainly hospitals). Health authorities at the prefecture, county, and town levels have limited flexibility in carrying out provincial health policies.Who is covered and how is insurance financed?Generally, health insurance is publicly provided and financed by local governments.Publicly financed health insurance: In 2014, China spent approximately 5.6 percent of its gross domestic product (CNY3,531 billion, or USD992 billion1) on health care, with 30 percent financed by the central government and local governments and 38 percent by publicly financed health insurance, private health insurance, or social health donations.2There were three main types of publicly financed insurance: 1) urban employment-based basic medical insurance (launched in 1998); 2) urban resident basic medical insurance (launched in 2009); and 3) the “new cooperative medical scheme” for rural residents (launched in 2003).Urban employment-based basic medical insurance is financed mainly from employee and employer payroll taxes, with minimal government funding. Participation is mandatory for employees in urban areas; the insured population was 283.3 million in 2014.3Employees’ nonemployed family members are not covered. Urban resident basic medical insurance, which is voluntary at the household level, covered 314.5 million self-employed individuals, children, students, and elderly adults in 2014. Both urban employment-based and urban resident basic medical insurance are administered by the Ministry of Human Resources and Social Security and run by local authorities. The rural new cooperative medical scheme, administered mainly by the National Health and Family Planning Commission and run by local authorities, is also voluntary at the household level and covered a rural population of 736 million in 2014, representing a coverage rate of 98.9 percent of rural residents.Urban resident basic insurance and the new cooperative medical scheme are financed mainly by government, with minimal individual premium contributions. In regions where the economy is less developed, the central government provides the largest share of subsidies, with provincial and prefectural governments accounting for the rest. In more-developed provinces, most subsidies are locally provided (mainly by provincial government).The financing strategies and coverage benefits of urban resident basic insurance and the rural cooperative medical scheme are similar. In 2016, China’s central government, the State Council, announced that it will merge the two, with the expectation that doing so will expand the risk pool and reduce administrative costs.4Each province was required to make merging arrangements by June 2016; prefectures and cities need to have developed implementation plans by December 2016.Coverage by publicly financed health insurance is near-universal—exceeding 95 percent of the population since 2011.5The few permanent foreign residents are entitled to the same coverage benefits as citizens. Undocumented immigrants (there are very few) and visitors are not covered by publicly financed health insurance.Private health insurance: Complementary private health insurance is purchased to cover deductibles, copayments, and other cost-sharing, as well as coverage gaps, in publicly financed health insurance, which serves as the primary coverage source for most people. Private health insurance is also called commercial health insurance, because it is provided mainly by for-profit commercial insurance companies. The total of collected private health insurance premiums increased from CNY67.7 billion (USD19.0 billion) in 2010 to CNY241.0 billion (USD67.7 billion) in 2015, representing an annual growth rate of 28.9 percent.6In 2015, private health insurance premiums accounted for 9.9 percent of total premiums collected in the entire insurance industry, or 5.9 percent of total health expenditures.7Purchased primarily by higher-income individuals and by employers for their workers, private insurance often enables people to receive a better quality of care and higher reimbursement, as some health services are very expensive or are not covered by public insurance. There are currently no statistics on the percentage of the population with private coverage, but the Chinese government is encouraging development of this market. Growth in private coverage has been rapid, with some foreign insurance companies recently entering the market.What is covered?Services: Publicly financed insurance covers primary, specialist, emergency department, hospital, and mental health care, as well as prescription drugs and traditional medicine. A few dental services (e.g., tooth extraction, but not cleaning) and optometry services are covered, but mostly such services are paid for completely out-of-pocket. Home care and hospice care are often not included either. Local health authorities define the benefit packages. Preventive services such as immunization and disease screening are included in a separate public-health benefit package funded by central and local governments; every resident is entitled to these without copayments or deductibles. Coverage is person-specific; there are no family or household benefit arrangements.Cost-sharing and out-of-pocket spending: Inpatient and outpatient care, including prescription drugs, is subject to different deductibles, copayments, and reimbursement ceilings. There are no annual caps on out-of-pocket spending. In 2014, out-of-pocket spending per capita was CNY1,306 (USD367) and CNY754 (USD212) in urban and rural areas, respectively—representing about 32 percent of total health expenditures.8Most out-of-pocket spending is for prescription drugs. Reimbursement ceilings are significantly lower for outpatient care than for inpatient care. For example, in 2016, ceilings were CNY3,000 (USD843) for outpatient care in primary care facilities, CNY10,000 (USD2,809) for outpatient care in secondary/tertiary hospitals, and CNY180,000 (USD50,562) for outpatient care in the rural new cooperative medical scheme in Beijing.Provider networks are specific to the insurance scheme, normally at the prefecture level for urban employment-based basic health insurance and urban resident basic health insurance (which may share the same network, but with different benefits) and at the county level for the new cooperative medical scheme. People can use out-of-network health services (even across provinces), but these have higher copayments. There are no universal cost-sharing arrangements, and each risk-pooling unit (network) has its own policies. Cost-sharing in primary care facilities (village clinics, rural township hospitals, and urban community hospitals) is also different from that in secondary or tertiary hospitals, with the lowest copayments in the former. Secondary and tertiary hospitals are accredited by the local health authorities based on their qualifications, and both provide primary care, outpatient specialists, and inpatient hospital care. Migrant populations face much higher cost-sharing and out-of-pocket spending, since they often use out-of-network care. Fee schedules for primary and secondary care are regulated by the local health authorities and the Bureaus of Commodity Prices, and it is unlawful for public clinics and hospitals to charge patients above the fee schedules. To encourage nongovernmental investment in health care, in 2014 China began allowing private clinics and hospitals to charge more.9Safety net: For individuals who are not able to afford individual premiums for publicly financed health insurance or who cannot cover out-of-pocket spending (which is not capped), a medical financial assistance program, funded by local governments and social donations, serves as a safety net in both urban and rural areas. In Beijing, individual poverty-level income in 2016 was defined as CNY800 (USD225) per month in both rural and urban areas; poverty levels for other provinces may be lower than in Beijing. Medical financial assistance programs prioritize inpatient care expenses. Funds are used mainly to pay for individual deductibles, copayments, and medical spending exceeding annual caps, as well as individual premiums for publicly financed health insurance. In 2014, 67.2 million people (approximately 5% of the Chinese population) received such assistance for health insurance enrollment, and 24.0 million people (1.8% of the population) received funds for direct health expenses.10There are other financial assistance programs to help with unreimbursed emergency department and other health expenses. These are funded mostly by local governments.How is the delivery system organized and financed?Primary care: Primary care is delivered mainly through village doctors and health workers in rural clinics, general practitioners (GPs) in rural township and urban community hospitals, and medical professionals in secondary and tertiary hospitals. Village doctors, who are not licensed GPs, can work only in village clinics. In 2014, there were 1.06 million village doctors and health workers.11Although rural patients are encouraged to seek care in village clinics or township hospitals and urban patients in community hospitals—as such providers are associated with lower cost-sharing rates—residents can also see any GP in upper-level hospitals directly.Registration with a GP is not required and, except for the very few areas that use GPs as gatekeepers, referrals are generally not necessary to see outpatient specialists. In 2014, China had some 173,000 licensed and assistant GPs, representing 6.0 percent of all licensed physicians and assistant physicians.12Unlike village doctors and health workers in the village clinics, GPs rarely practice solo or through partnership but instead work in a hospital with nurses and nonphysician clinicians. Village clinics in rural areas receive technical support from township hospitals.Fee schedules for primary care in government-funded health institutions are regulated by local health authorities and the Bureaus of Commodity Prices. Village doctors and health workers in the village clinics receive income through reimbursement of public health services (e.g., immunizations and chronic disease screening) and clinical services, as well as through markups on prescription drugs and government subsidies. Incomes vary substantially by region.GPs at hospitals receive a base salary along with activity-based payments (e.g., patient registration fees, surgeries performed). With fee-for-service still the dominant payment mechanism for hospitals (see below), hospital-based physicians have strong financial incentives to induce demand. It is estimated that wages constitute only one-quarter of physician incomes; the rest is thought to be derived from practice activities.In 2014, 47 percent of outpatient revenues and 38 percent of inpatient revenues were from prescription drugs provided to patients in tertiary hospitals.13Care coordination is generally not incentivized, although it is always encouraged by health authorities.Outpatient specialist care: Outpatient specialists are employed by and usually work in hospitals, through which they obtain their practice licenses. Although practicing in multiple settings is being introduced and encouraged in China, most specialists practice in one hospital only. They receive compensation in the form of a base salary plus activity-based payments. Patients can usually see outpatient specialists without GP referral and have a choice of specialist through their hospital.Administrative mechanisms for direct patient payments to providers: Patients pay deductibles and copayments to hospitals at the point of service. Hospitals directly bill insurers for the covered payment at the same time if the payment mechanism is fee-for-service or a diagnosis-related group (DRG) system. Hospitals receive annual lump-sum payments under global budgets or capitation.After-hours care: Because village doctors and health workers often live in the same community as patients, they voluntarily provide some after-hours care when needed. Rural township hospitals and urban secondary and tertiary hospitals have emergency rooms or departments (EDs) where both primary care doctors and specialists are available, minimizing the need for walk-in after-hours care centers. In EDs, nurse triage is not required and there are few other restrictions, so people can simply walk in and register for care at any time. (Urban community hospitals often do not provide after-hours care, given the availability of secondary and tertiary hospitals.) ED use is not substantially more expensive than usual care for patients. Information on patients’ emergency visits is not routinely sent to their primary care doctors.Hospitals: Hospitals can be public or private, nonprofit or for-profit. Most township hospitals and community hospitals are public, but both public and private secondary and tertiary hospitals exist in urban areas. Rural township hospitals and urban community hospitals are often regarded as primary care facilities—closer to village clinics than “true” hospitals. In 2014, there were 13,314 public hospitals and 12,546 private hospitals (excluding township hospitals and community hospitals), of which 17,705 were nonprofit and 8,155 were for-profit.14In 2014, there were 491,885 public primary care facilities and 425,450 private village clinics.Hospitals are paid through a combination of out-of-pocket payments, health insurance compensation, and, in the case of public hospitals, government subsidies—the last of these representing 13.2 percent of total revenue in 2014.15A significant number of patients pay 100 percent out-of-pocket, because they receive out-of-network services. Although fee-for-service is dominant, DRGs, capitation, and global budgets are becoming more popular in selected areas. Local health authorities set fee schedules, and doctors’ salaries and other payments are included in hospital reimbursement.Mental health care: Mental health care, including disease diagnosis, treatment, and rehabilitation services, is provided in special psychiatric hospitals and in the psychology departments of tertiary hospitals. Patients with mild illness are often treated at home or in the community; only severely mentally ill patients are treated in psychiatric hospitals. Both outpatient and inpatient mental health services are covered by insurance, with benefits subject to lower copayment rates. In 2014, there were 34 million mental health patient visits to special psychiatric hospitals, and on average one psychiatrist treated 4.8 patients per day.16Mental health care is not integrated with primary care.Long-term care and social supports: In accordance with Chinese tradition, long-term care is provided mainly by family members at home. There are very few formal long-term care providers. Family caregivers are not entitled to financial support or tax benefits, and long-term care insurance is virtually nonexistent; expenses for care in long-term care facilities are paid almost entirely out-of-pocket. Local governments often provide some subsidies to long-term care facilities.On average, conditions in long-term care facilities are poor, and there are long waiting lists for enrollment in high-end facilities. Formal long-term care facilities usually provide only housekeeping, meals, and basic services such as transportation, with very few health care services. Some, however, may coordinate health care with local township or community hospitals. Governments encourage integration of long-term care and health care services, particularly those funded by private investment. There were 3.9 million beds for aged and disabled people in 2014.17Some hospice care is available, but it is normally not covered by health insurance.18What are the key entities for health system governance?In 2013, the Ministry of Health and the National Population and Family Planning Commission were merged into the National Health and Family Planning Commission as the main agency for health controlled by the State Council. The State Administration of Traditional Chinese Medicine is affiliated with the new agency. The National People’s Congress is responsible for health legislation. However, major health policies and reforms may be initiated by the State Council and the Central Committee of the Communist Party as well, and these are also regarded as law.The National Development and Reform Commission, which has been heavily involved in the recent health care system reform, oversees health infrastructure plans and competition among health care providers. The Ministry of Finance provides funding for government health subsidies, health insurance contributions, and health system infrastructure. The Ministry of Human Resources and Social Security runs urban employment-based basic insurance and urban resident basic insurance. The China Food and Drug Administration is responsible for drug approvals and licenses, but assessment of health technology and cost-effectiveness has not played a significant role yet. The China Center for Disease Control and Prevention is administrated by the National Health and Family Planning Commission, although it is not a government agency. The Chinese Academy of Medical Science, under the National Health and Family Planning Commission, is the national center for health research.The National Health and Family Planning Commission directly owns some hospitals in Beijing, and national universities directly administrated by the Ministry of Education also own affiliated hospitals. Local government health agencies, usually the Bureau of Health or the Health and Family Planning Commission in each province, may have a similar structure and often own provincial hospitals. Local governments (of prefectures, counties, and towns) may have departments of health and own hospitals directly. Centers for disease control and prevention also exist in local areas and are administered by the local bureaus or departments of health. At the national level, the China Center for Disease Control and Prevention provides only technical support to the local centers.Both the national and local Health and Family Planning Commissions have comprehensive responsibilities for health quality and safety, cost control, provider fee schedules, health information technology, and clinical guidelines.What are the major strategies to ensure quality of care?The Department of Health Care Quality, which is within the Bureau of Health Politics and Hospital Administration and is overseen by the National Health and Family Planning Commission, is responsible at the national level for the quality of care. The National Health Service Survey is conducted every five years (the latest was in 2013), and a report is published after each survey highlighting data on selected quality indicators.To be accredited, hospitals must obtain a license from the local health authority. Physicians get their practice licenses through hospitals; licenses are subject to renewal. Several national rankings of hospitals are published by third parties, although there are no financial incentives for hospitals to meet quality targets.19No public information about individual doctors is made available.Following release of the “Temporary Directing Principles of Clinical Pathway Management” by the former Ministry of Health in 2009, clinical pathways are now regulated nationally and used in a similar manner as clinical guidelines are in Western countries. Previously, pathways were created at the hospital, rather than the national, level.What is being done to reduce disparities?There are still severe disparities in accessibility and quality of health care, although China has made significant improvements in this regard in the past decade. Income-related disparities in health care access were especially serious before the reform of the health insurance system more than 10 years ago, as most people did not have any coverage at all. Health coverage through publicly financed insurance is now nearly universal, and there are safety nets for the poor (see above). As a result, income-related disparities have been reduced substantially.Remaining disparities in access are due mainly to variation in insurance benefit packages, urban and rural factors, and income inequality. Urban employment-based basic insurance offers broader benefit packages than the other two insurance schemes. To improve benefit packages and reduce disparities, central and local governments intend to consolidate insurance schemes, an effort that has already been piloted in selected areas, such as Dongying City in Shandong Province and Jinhua City in Zhejiang Province. In addition, central and local government subsidies of urban resident basic insurance and the rural newly cooperative medical scheme have increased in recent years.Most good hospitals (particularly tertiary hospitals) are in urban areas, where there are better-qualified health professionals. Village doctors are often undertrained. To help bridge the urban–rural health care divide, the central government and local governments sponsor training for rural doctors in urban hospitals and require new medical graduates to work as residents in rural health facilities. Nevertheless, the China Health and Family Planning Statistical Yearbooks show that substantial disparities remain.What is being done to promote delivery system integration and care coordination?Medical alliances are regional hospital groups, often including one tertiary hospital and several secondary hospitals and primary care facilities, that provide access to primary care facilities for patients with minor health issues. The aim is to reduce the need for people to visit tertiary hospitals. At the same time, patients with serious health problems can be referred to tertiary hospitals easily and moved back to primary care facilities after their condition improves. It is hoped that this type of care coordination will meet the demand for chronic disease care, improve health care quality, and contain rising costs. The hospitals within a medical alliance share a common electronic health record system, and results of labs, images, and diagnoses are easily available within the alliance.There are three main medical alliance models.20Hospitals in the Zhenjiang model have only one owner (usually the local bureau of health). Those in the Wuhan model do not belong to the same owner, but administration and finances are all handled by one tertiary hospital. Hospitals in the Shanghai model share management and technical skills only; ownership and financial responsibility are separate.What is the status of electronic health records?Nearly every health care provider has set up its own electronic health record (EHR) system. Within hospitals, EHRs are also linked to the health insurance systems for payment of claims, with unique patient identifiers (insurance ID or citizenship ID). However, EHR systems vary significantly by hospital and are usually not integrated or interoperable. Patients often must bring with them a printed health record if they want to see doctors in different hospitals. Even if hospitals are owned by the same local bureau of health or affiliated with the same universities, different EHR systems may be used. Patients generally do not use EHR systems for accessing information, scheduling appointments, sending secure messages, refilling prescriptions, or accessing doctors’ notes.How are costs contained?Health expenditures have risen significantly in recent decades because of health insurance reform, an aging population, economic development, and health technology advances. Health expenditures increased from CNY584 (USD164) per capita in 2004 to CNY2,582 (USD725) in 2014.21The key cost-containment strategy is reform of provider payment. Prior to the introduction in 2009 of DRGs, global budgets, and capitation, fee-for-service was the main provider payment mechanism, and consumer- and physician-induced demand increased costs significantly. Global budgets have been used in many regions, since these are relatively easy for authorities to implement. As noted above, government encourages the use of community and township hospitals over the more expensive care provided in tertiary hospitals. Hospitals compete on quality, level of technology, and copayment rates.In township, community, and county hospitals, a campaign of “zero markups” for prescription drugs was introduced in 2013 (see below) to contain the rising drug costs. The National Development and Reform Commission places stringent supply constraints on new hospital buildings and hospital beds, and the National Health and Family Planning Commission controls the purchase of high-tech equipment such as MRI scanners.What major innovations and reforms have been introduced?Sales of prescription drugs have been a major revenue source for hospitals, which are allowed a 15 percent markup, and providers have strong financial incentives to induce demand for more and expensive drugs. Prices for services, on the other hand, are rather low, in accordance with traditional health practice in China. However, as of 2015, 3,077 public county hospitals and 446 public city hospitals were participating in a government-financed pilot program to eliminate the markup of prescription drug prices. At the same time, 224 prefectures and cities in 21 provinces adjusted the prices of health care services upward to reflect true costs. In 2016, more public city hospitals participated in the zero-markup drug policy. For example, all public city hospitals in Beijing and Hunan Province were to end markups by the end of 2016, and by 2020 all public hospitals in the country are to do so as well. Where it has been implemented, zero markup has been found to have significantly reduced total medical spending.22Another important health reform was the introduction in 2015 of special health insurance for severe diseases, such as cancers, kidney disease, and acute myocardial infarction, that supplements the regular publicly financed schemes. Severe-disease health insurance provides reimbursement beyond the rather low reimbursement ceilings. It is also mostly publicly financed, particularly for urban resident basic insurance and the current rural cooperative medical scheme, and administrated by local health authorities. However, private commercial health insurance companies, given their experience in providing complementary insurance, are heavily involved as well. In 2016, the central government provided CNY16 billion (USD4.5 billion) in subsidies to severe-disease insurance. By 2016, severe-disease insurance is expected to be available throughout China.References1Please note that, throughout this profile, all figures in USD were converted from CNY at a rate of about CNY3.56 per USD, the purchasing power parity conversion rate for GDP in 2015 reported by OECD (2016) for China. Organisation for Economic Co-operation and Development (OECD), OECD.Stat. (2016), 4. PPPs and exchange rates; accessed Aug. 8, 2016.2National Health and Family Planning Commission, China Health and Family Planning Statistical Yearbook 2015 (China Union Medical University Press, 2015).3Ibid.4The State Council, The State Council’s Suggestion on Merging Urban-Rural Resident Basic Health Insurance (2016) (in Chinese); accessed Aug. 8, 2016.5C. Jiang and J. Ma, “Analyzing the Role of Overall Basic Medical Insurance in the Process of Universal Health Coverage,” Chinese Health Service Management, 2015 2(320):108–10.6Z. Song and Q. Hu, “Development Forecast of Commercial Health Insurance in the Period of the Thirteenth Five-Year Plan,” China Insurance, 2016 5:12–15.7National Health and Family Planning Commission, Statistical Communiqué of China Health and Family Planning Development in 2015 (2016), accessed Aug. 2, 2016.8National Health and Family Planning Commission, China Health and Family Planning Statistical Yearbook 2015 (China Union Medical University Press, 2015).9National Development and Reform Commission, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security, Announcement About Issues Related to Market Adjustment Prices of Health Care Services by Non-Government-Funded Health Institutions (2014), accessed Aug. 8, 2016.10National Health and Family Planning Commission, 2015.11Ibid.12Ibid.13Ibid.14Ibid.15Ibid.16Ibid.17National Bureau of Statistics, China Statistical Yearbook 2015 (China Statistics Press, 2015).18X. Chen, “Hospice Care: Pass Away with Warmth,” China Social Protection, 2014 12:64–65.19S. Dong, S. Guo, L. He, et al., “Study of Present Situation and Countermeasures of China’s Hospital Rankings,” Chinese Hospital Management, 2015 35(3):38–40.20L. Jiang, S. Song, and W. Guo, “Study on the Models and Development Status of the Regional Longitudinal Medical Alliance in China,” Medicine and Society, 2014 27(5):35–38.21National Health and Family Planning Commission, 2015.22C. Fu and J. Yang, “Influence of Carrying Out Zero Price Addition Policy of Drugs on Public Hospital Expenses in Shenzhen,” Chinese Hospital Management, 2013 33(2):4–6.CHINAHealth System and Public/Private Insurance RoleGOVERNMENT ROLESupervision by health authorities (Health and Family Planning Commissions) at the national, provincial, and local levels; some direct provision through public ownership of hospitalsPUBLIC SYSTEM FINANCINGThere are three main publicly financed health insurance types with local-area risk pooling: urban employer-based (mainly payroll taxes, for formally employed urban residents), urban resident basic (mainly government-funded, for urban nonemployed residents), and rural cooperative medical scheme (government-funded, for rural residents)PRIVATE INSURANCE ROLEComplementary to cover cost-sharing and gaps, as well as better health care quality and/or higher reimbursements. No data on coverage, but growth has been rapid.Provider OwnershipPRIMARY CAREPrivate/public mix (private village doctors and clinics; public township and community hospitals providing general practitioner services)HOSPITALSPublic (~55%)/private (~45%) mix (mainly public in rural areas, public and private in urban areas)Provider PaymentPRIMARY CARE PAYMENTFee-for-service for private providers, salaries and fee-for-service for general practitioners employed by hospitalsHOSPITAL PAYMENTMainly fee-for-service, with some pilot projects using case-based payments, capitation, or global budgetsPrimary Care RoleREGISTRATION WITH GP REQUIREDNot generally, with exceptions in some areasGATEKEEPINGNot generally, with exceptions in some areasBenefit DesignCAPS ON COST-SHARINGNoEXEMPTIONS & LOW-INCOME PROTECTIONGovernment subsidies to low-income families for insurance contributions and out-of-pocket costs; emergency assistance by local governments for specific diseases and unpaid emergency department or other expensesDemographics and Health Risk Factors1,360.72Total population (millions of people), 20149.6%Percentage of population age 65 and older, 201426%Percentage of adults who report being daily smokers, 20147%Prevalence of obesity (BMI>30), 2014Health System Statistics$420Health care spending per capita, 2014n/aOut-of-pocket health care spending per capita, 20141.9Number of practicing physicians per 1,000 population, 2014n/aHospital spending per discharge, 2014n/aPrimary care physicians’ use of electronic medical records, 2015PUBLISHED BY THE COMMONWEALTH FUNDCOUNTRY PROFILESHEALTH SYSTEM FEATURESHEALTH AND SYSTEM STATISTICSSURVEY DATAABOUTE-ALERTS ON INTERNATIONAL HEALTHPOLICY AND PRACTICE. 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