A proposed program to cover counseling sessions for seniors on end-of-life care has risen from the ashes of health care reform and found a new life in Medicare regulations, Jason Hancock of the American Independent reports.
In August, former Alaska governor Sarah Palin started a rumor via her Facebook page that the the Obama administration was backing "death panels" that would vote on whether the elderly and infirm had a right to live. In reality, the goal was to have Medicare reimburse doctors for teaching patients how to set up their own advance directives that reflect their wishes on end-of-life care.
Patients can use their advance directives to stipulate their wishes for treatment in the event that they are too sick to make decisions for themselves. They can also use those directives to demand the most aggressive lifesaving interventions.
Waste not, want not
Though end-of-life counseling was ultimately gutted from the Affordable Care Act (ACA), the legislation will eventually ensure health coverage for 32 million more Americans. However, Joanne Kenen in The American Prospect argues it will do comparatively less to curb the high costs of health care. The architects of the ACA had an opportunity to include serious cost-containment measures like a robust public health insurance option to compete with private insurers, but they declined to do so.
Kenen argues that the government should more aggressively target waste within the health care delivery system, especially Medicare and Medicaid. Unchecked and rising health care costs through Medicare and Medicaid are a significantly greater driver of the deficit than Social Security or discretionary spending:
"The waste is enormous," says Harvard health care economist David Cutler. "You can easily convince yourself that there is 40 to 50 percent to be saved." Squeezing out every single bit of that inefficient or unnecessary care may not be realistic. But it also isn't necessary; eliminating even a small fraction of the current waste each year over the next decade would make a huge difference, he added. Health care would finally start acting like "a normal industry." Productivity would grow, in the one area of the economy where it has not, and with productivity gains, prices could be expected to fall.
The new end-of-life counseling program will help reduce waste in the system, not by pressuring people to forgo treatments they want, but by giving them the tools to refuse treatments they don't want.
Teen births down, but why?
The teen birth rate has dropped again, according to the latest CDC statistics. Births to women under the age of 20 declined by 6% in 2009 compared to 2008. One hypothesis is that the reduction is an unexpected consequence of the recession, an argument we pointed to in last week's edition of the Pulse. John Tomasic of the Colorado Independent is skeptical of the recession hypothesis. He writes:
Emily Bridges, director of public information services at Advocates for Youth, agrees with other observers in pointing out that teens aren't likely to include national economics as a significant factor in pondering whether or not to have unprotected sex. Peer pressure, badly mixed booze, general awkwardness, for example, are much more likely than the jobless recovery to play on the minds of horny high schoolers.
Some states with weak economies actually saw a rise in teen birth rates, Tomasic notes. However, this year's sharp downturn in teen births parallels a drop in fertility for U.S. women of all ages, which seems best explained by economic uncertainty.
It's true that prospective teen moms are less likely to have jobs in the first place, and so a bad job market might be less likely to sway their decisions. However, young women who aren't working are unlikely to have significant resources of their own to draw on, which means that they are heavily dependent upon others for support. If their families and partners are already struggling to make ends meet, then the prospect of another mouth to feed may seem even less appealing than usual.
Abortion is the elephant in the room in this discussion. The CDC numbers only count live births. Logically, fewer live births must be the result of fewer conceptions and/or more terminations. Some skeptics doubt that economic factors have much to do with teens' decisions about contraception. However, it seems plausible that decisions about abortion would be heavily influenced by the economic health of the whole extended family.
Last year's decrease was notably sharp, but teen birth rates have been declining steadily for the last 20 years. The Guttmacher Institute, a New York-based non-profit that specializes in research on reproductive choice and health, suggests that successive generations of teens are simply getting savvier about contraception. Births to mothers between the ages of 15 and 17 are down 48% from 1991 levels, and births to mothers ages 18 to 19 are down 30%.
Stupid drug dealer tricks
Martha Rosenberg of AlterNet describes 15 classic dirty tricks deployed by Big Pharma to push drugs. These include phony grassroots patient groups organized by the drug companies to lobby for approval of dubious remedies. Another favorite money-making strategy is to overcharge Medicare and Medicaid. Pharmaceutical companies have paid nearly $15 billion in wrongdoing settlements related to Medicare and Medicaid chicanery over the last five years.
This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.
Generally speaking, when people care about something, they know something about it. Think (stereotypically, I admit) of women and shoes, or men and sports. As a kid, I cared about baseball. I knew Willie Mays' statistics from his rookie year onward by heart. (I even think I knew his minor league stats.) Knowing about something is part and parcel of caring. So what does it mean when, in 1996, after years of dramatic deficit cutting by Clinton, a large chunk of Americans had no idea that Clinton had slashed the deficit? From Larry Bartells via Paul Krugman:
A plurality of all voters, and a majority of Republicans thought that Clinton had increased the deficit. Less than 10% of any group of voters gave the correct answer--that Clinton had decreased the deficit a lot:
Clinton Heralds Drop in Federal Budget Deficit
October 29, 1996|PAUL RICHTER | TIMES STAFF WRITER
UNIVERSITY CITY, Mo. - President Clinton took credit for another drop in the federal budget deficit Monday in a final swing through three Midwestern states, where he mocked GOP opponent Bob Dole's warnings about voter apathy.
Whirling through a battleground region where polls show he clearly holds the upper hand, Clinton hailed newly released figures showing that the federal budget deficit will close 1996 at $107.3 billion, a decline of 63% from its 1992 level and the lowest figure in 15 years.
What makes Obama--or anyone else, for that matter--think it will be any different this time?
One more thing. One of Krugman's commentators made a very good point:
I think debt/deficit is a proxy for "size of government". Hence the bizarre correlation between concern about deficits and support for tax cuts.
People in the 90's thought that Bill Clinton had expanded the role of government, at least somewhat.
Of course, that doesn't make sense all the time--as when people fearmonger that the debt will bankrupt us. But that's the beautiful thing about proxies, they can serve multiple functions. Nothing that's being talked about is what it seems. Everything is code for something else, and the codes can switch as fast as necessary to keep the game of three-card monte going.
I've pointed out before that main reason the deficit has gone up is not because "spending has expoloded"--it has gone up some, as it always does during a recession--but because government revenues have dropped so much:
People being out of work is not only bad for them, it's bad for the economy and bad for the government, too, especially the federal deficit. If we want to cut the deficit, the most effective tthing we can do, it turns out, is to also handle our most pressing problem: putting people back to work!
The current downturn had led to the worst period of sustained unemployment since the Great Depression. This suffering is especially tragic because, like the Great Depression, it is entirely the result of misguided economic policy.
Unemployment corresponds to lost production of goods and services. Construction workers could have been providing safe and energy efficient housing to people who lack adequate shelter, but instead they were left sitting idle. Manufacturing workers, who could have been producing more fuel-efficient cars and appliances, are instead getting unemployment checks. Health care workers who could have been ensuring that people received adequate care and teachers who could have been in classrooms, helping educate our children, are instead spending their time looking for work.
This is an incredible loss not only for these workers who must struggle to make ends meet, but also for our economy and society. The CEPR Recession Waste Clock allows people to see the value of the goods and services that we have lost in this downturn. It measures the gap between potential GDP (as calculated by the Congressional Budget Office) and actual GDP.
Given the current unemployment rate of 9.6 percent, the amount of lost GDP as measured by this gap increases at the rate of $2.873 billion per day. This comes to $120 million an hour, $2 million a minute or $33 thousand a second.
You can also see the amount of lost output measured in units of houses, college educations, or personal mp3 players.
The calculation of lost output is based on the gap between potential GDP as estimated by the Congressional Budget Office and actual GDP. The projection going forward assumes the same quarterly output gap as the last quarter for which data are available.
Weekly Audit: Curbing the Deficit, Cat Food, and You
by Lindsay Beyerstein, Media Consortium blogger
The deficit commission released its much anticipated list of helpful money-saving tips for the federal government last week. These tips include tax cuts for the rich, reducing unnecessary printing costs, and cutting the jobs of federal contractors.
Weekly Audit: Banks Get Big Bucks, Consumers Get Bupkis
by Lindsay Beyerstein, Media Consortium blogger
Last week, the Federal Reserve announced a plan to buy an additional $600 billion worth of Treasury bonds in an attempt to stimulate the economy. On Democracy Now!, economist Michael Hudson argues that the $600 billion T-bill buy will help Wall Street at the expense of ordinary Americans.
Last week, Social Security advocates learned something they had long suspected. Arguments for cutting Social Security aren't really about economics or the deficit. They're all about waging war on social services.
The same conservatives who spent the past year senselessly screaming about the U.S. budget deficit are now demanding an extension of the Bush tax cuts for the rich. The extension simply doesn't make sense, and the policies implied are a recipe for massive job loss in the middle of the worst employment crisis in 75 years.
Congress finally authorized an extension of unemployment benefits on Wednesday, providing a critical lifeline to families across the country and an absolutely essential boost to the economy.
After months of modest gains, the U.S. economy lost 125,000 jobs during June. That's the worst jobs-related news this year. Without serious action soon, the struggling U.S. economy is going to get even uglier. Unfortunately, President Barack Obama's economic team was slow to recognize the severity of the jobs crisis, and now seems unable to get Congress to actually do something about it.
As David Corn notes for Mother Jones, the recent jobs data is actually much worse than the 125,000 figure implies:
"The economy needs about 150,000 new jobs a month to keep up with population growth and new entries into the jobs market. It needs a lot more than that to make up for the 8 million or so jobs lost in 2008 and 2009."
Recession 2.0
Although the economy sluggishly recovered from the catastrophic events of late 2008, economists are warning of a "double-dip" recession in which mass layoffs return. So why is Congress refusing to deal with the jobs crisis in the face of such terrible economic conditions?
Part of the problem, Corn notes, is that Obama didn't do a very good job selling his economic stimulus package to the public. The bill, which Obama pushed through in early 2009, really did improve the economy-it's the only reason why the unemployment rate is hovering around 10 percent instead of 12 percent or 13 percent. But by refusing to counter Republican attacks on so-called "wasteful spending" included in the package, Obama failed to show the public how much good the stimulus has done. Instead, the bill is widely perceived as another wasteful giveaway to special interests and akin to the bank bailout.
Spending is stimulus
In reality, government spending is the best way to stimulate the economy during a deep recession. It makes up for the shortfall in spending from consumers who have lost their jobs.
There are all kinds of ways the federal government can spend money to create jobs, including extending unemployment benefits to laid-off workers, providing funding to states to allow them to hire more teachers and cops, and hiring people to build roads and buildings. The government did all of these things with the stimulus package from early 2009, but it didn't do enough of any of them. The stimulus package was simply spread to thin.
Roots of recession
As Robert Reich explains for The Nation, the recession itself was created by deep economic inequality. By 2007, the wealthiest 1 percent of Americans made 23.5 percent of the nation's total income. Figures like that had not been seen since 1929, when the richest 1 percent made 23.9 percent of the nation's total wealth. All of this concentration at the top means that the elite enjoy a disproportionate share of economic gains, but it also sets the entire economy up for massive shocks.
When the rich have all of that money, they have to invest it somewhere. When the majority of citizens are seeing sluggish wage growth, or even a drop in wages, as the U.S. experienced during the Bush years, there aren't enough valuable assets out there that can absorb that investment. As a result, rich people put their money in speculative asset bubbles. When those bubbles burst, the entire economy can come crashing down, as it did in both 1929 and 2008.
Rampant inequalities around the globe
As Melinda Burns highlights for AlterNet, rampant inequality in not unique to the U.S. More than half of the world's population lives on less than $2 a day, and decades of conservative economic policies have been unable to reverse that hardship.
One of the best ways to relieve global poverty is also one of the most intuitive-give money to the poor. Brazil has made an aggressive push to cope with widespread poverty by providing $31 billion in pensions and grants to the poor every year. As a result, the nation's poverty rate has declined from 28 percent in 2000 to 17 percent in 2008, while child malnutrition was cut in half. These policies make good economic sense. When poor people have money to spend, they spend it and fuel growth that benefits the entire economy.
Social insecurity
And yet in the U.S., Obama is seriously considering cutting Social Security in order to reduce the federal budget deficit. As Margaret Smith emphasizes for In These Times, Obama has created a bipartisan "debt commission," and packed it full of ideologues from both political parties who have been fighting for years to slash Social Security.
This doesn't really make sense, because Social Security is funded by its own dedicated tax revenue, and is sitting on a multi-trillion-dollar surplus created by those taxes. It really can't do much to reduce the deficit. With interest rates at record lows, lawmakers do not currently have any reason to be worried about the deficit. But if they wanted to take action on it, they'd have to deal with long-term issues like the rising cost of health care, the bloated defense budget and absurdly low tax rates on the rich. Cutting off income for senior citizens won't help.
Blocking economic stimulus won't help
And neither will efforts to block short-term economic stimulus. But Obama's emphasis on the budget deficit plays into the hands of Congressional opportunists who want to block his economic recovery efforts. If we're told over and over again that the real economic problem is the budget deficit, no money is going to be dedicated to problems like jobs-even if that money would actually help the government's fiscal position by fueling economic growth.
The American economy is in the middle of an absolute employment crisis. Without strong federal action, it's going to get worse.
This post features links to the best independent, progressive reporting about the economy by members of The Media Consortium. It is free to reprint. Visit the Audit for a complete list of articles on economic issues, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Mulch, The Pulse and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.
Two things that have taken a lot of heat lately is the Economic Stimulus and the Social Security insurance for America. In front of the federal budget deficit commission he argued that deficit spending is the best way to reduce and stabilize the national debt by stabilizing the economy and creating jobs. Meanwhile, others are defending Social Security against those who would continue to eliminate or privatize it.
As expected the Republicans in the Senate said no to those whose livelihoods they gutted when they controlled Washington. Forget the fact that men like Mitch McConnell and yes, Ben Nelson who is a Republican and should get out of our party soaked up huge salaries while soaking the middle-class with policies that decimated them while enriching Corporate fatcats and the Chinese Communists. Of course the whole Republican Party, Mitch McConnell and Ben Nelson want you to forget. What they do not want is to bear any of the responsibility of their actions both in the past and now as working Americans who paid the price from Republicans and Corporate Democrats and the robber-barons in Corporate America getting fat, crashing the economy, and getting bailed out.
Harold Meyerson, writing in the WaPo, has a great piece today that accentuates a drumbeat we've been beating here at OpenLeft. A few weeks ago, Chris wrote in response to Blue Dogs winning a "victory" in taking down a jobs bill:
This is only a victory if self-immolation is considered a victory. Consider:
1. Blue Dogs slash aid to states;
2. In response, states will engage in massive layoffs of public sector workers;
3. These layoffs will exacerbate an already dismal employment picture;
4. Voters will likely turn against Democrats as a result;
5. More Democrats in vulnerable seats will lose re-election;
6. Blue Dogs are disproportionately from vulnerable seats.
So yes, truly a big victory for the blue Dogs. They managed to reduce their own chances of re-election. Awesome!
Apparently various Senators have the same theory on jobs:
1. More unemployment
2. ?
3. The deficit is reduced!
Not to mention:
4. Get re-elected by my still-unemployed constituents who are happy I prioritize the deficit over their economic well-being! Woo!
Meyerson nails it:
Earlier this year the Blue Dogs, and many other Democrats, were saying they would welcome an end to the debate over health-care reform so they could turn their attention to jobs, jobs, jobs. But now that President Obama and Democratic legislative leaders have done that, the Blue Dogs have largely turned skittish.
Efforts by the leaders in both houses to pass bills that would save the jobs of teachers and police officers, maintain states' ability to make Medicaid payments and extend unemployment insurance have hit not only the expected bumps in the road (unified Republican opposition) but also fresh potholes: Blue Dog resistance to countercyclical spending.
[...]
Until recently, virtually every Democratic member of Congress could be counted on to support some level of countercyclical spending. That was one of the basic ways Democrats distinguished themselves from the laissez-faire right. But today, the Blue Dogs insist on offsetting stimulus with cuts, which can create a self-negating position. Suppose you vote for a stimulus that enables the states to save teachers' jobs, while offsetting that expenditure at the federal level by reducing spending on, and jobs in, building rail lines. In aggregate economic terms, you may well have zeroed out the net effect of your action. It's hard to believe that anyone ran for office to craft such exquisitely balanced nullities.
The problem here is that the Blue Dogs, like much of the public, conflate the issues of the nation's long-term fiscal sustainability with the short-term deficits created by the worst downturn since the '30s. Thus the Democratic imperative of creating jobs in 2009 became, earlier this year, one of creating jobs and reducing the deficit, and now, for some Blue Dogs, has become chiefly one of reducing the deficit. In polls, meanwhile, the public rates "jobs" as its chief concern, with the deficit lagging far behind. But because this recession is deeper and longer than any since the '30s; because the job-creating component of the first stimulus, while considerable, was clearly too small; and because the administration did not concentrate those jobs in visible agencies, as Franklin Roosevelt did in the Works Progress Administration, only a minority of Americans credit the stimulus with saving or creating jobs. For millions of Americans, concern over the deficit is at least partly a concern over the government's broader inability, as yet, to "fix" the economy. Reducing the deficit now, however, will make the economy worse.
Yet the Blue Dogs' short-term deficit hawkery is more than bad economics. It's bad politics, too. Even pragmatic centrists -- especially pragmatic centrists -- have to be in favor of something. The Blue Dogs don't seem to know what exactly that might be.
What interests me most about this is that there are two routes to defeating Blue Dogs- one is, as Chris described this morning, through increased progressive base performance in primaries. The other is, as I suspect will be the case for many Blue Dogs this cycle, going down at the hands of a Republican. As is the custom in electoral world, lots of political groups, pundits, strategists, etc. do "why what happened on Election Day happened" post-election op-eds and strategy memos. There is an opportunity here to link unemployment and electoral performance, along with potential exit polling demonstrating that among those who voted against the Blue Dog, the #1 reason was jobs, in making a case that Blue Dogs spelled their own electoral defeat here. In fact, that would be pretty useful and timely right now.
Alan Greenspan, Ayn Rand cult member (literally) and father of economic bubble & collapse, is the latest "deficit hysteria" voice. Yes, the same Alan Greenspan who said we need the Bush tax cuts because Clinton was paying off the debt "too fast." Paying off the debt was bad when Bush wanted to give enormous tax cuts to rich people, but now the resulting debt is baaaaad and we have to gut Social Security for working people. Get it?
Here is Greenspan's reasoning. You see, even though the US can currently borrow at one of the the lowest rates ... ever? ... we "could" or even "may soon" have to pay higher rates, so therefore we need to gut Social Security.
Former Federal Reserve Chairman Alan Greenspan said the U.S. may soon face higher borrowing costs on its swelling debt and called for a "tectonic shift" in fiscal policy to contain borrowing.
. . . Greenspan rebutted "misplaced" concern that reducing the deficit would put the economic recovery in danger, entering a debate among global policy makers about how quickly to exit from stimulus measures adopted during the financial crisis.
After urging Bush to increase debt to benefit the wealthy and corporations, he complains when it benefits working people.
The public has been led to believe that the enormous debt is the result of Obama "spending." The public also conflates the bank bailouts with the stimulus. In fact, the $1.4 trillion deficit was the last Bush budget year, with the "stimulus" just kicking in and contributing very little. But now all the voices that called for huge tax cuts for the rich are clamoring for cutting off benefits to working people.
One after another the "grownups" are saying we need to cut spending on things working people benefit from, because of the Reagan/Bush debt. (Never forget that Reagan and Bush said this was the point of creating the debt.)
Public investment and return vs private gain for a few: Anyone who has read The Shock Doctrine understands what is going on. The public is being spampeded into accepting even more privatization and de-democratization so that a few can gain at the expense of the rest of us. But the fact is that the country can borrow money now at the lowest interest rates in a long time, and we have a lot of people who need jobs, a lot of infrastructure work we need to do, we can retrofit buildings to be energy efficient, we can build high-speed rail, we can modernize the electrical grid and so many other projects. And these projects will have a payoff. Over the long run they will bring in more than they cost, and that money will cover Social Security and health care and shorter workweeks and things for We, the People. As long as we use public investment to get them done, and the return comes back to us, We, the People.
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