Showing posts with label Health care. Show all posts
Showing posts with label Health care. Show all posts

Monday, September 2, 2019

Whether the Issue is Gun Control or Inequality, It Always Comes Back to Race/Racism


I was trying to define wherein lies the fervor of the supporters of the NRA and the gun lobby.  It isn’t their love of guns.  It isn’t even that they’re right wing.  It’s that they fear being attacked, or more broadly, being overwhelmed by Black men and more recently Hispanics.

It always comes back to race and racism.  They say they need arms for self-defense.  Who do they see as potentially attacking them?  

Other whites, even white robbers?  Hardly.  They fear being attacked by Black men.  Nowadays they also fear the Hispanic “invasion.”   The fear of the black boogyman is alive and well in the United States.  And their fear of losing their special status as white Americans is increasing each year as we approach the day when whites will be in the minority.  Hence their hatred of Hispanics.

Right wing militias may say that they fear government oppression.  But what is that oppression?  Its essence is being placed on an equal footing with people of color.  You’ll never find a Black man or other person of color in a right-wing militia.  It’s not that there aren’t right-wing people of color; it’s that militias are nativist, white supremacist, anti-semitic.

America does not want to admit that racism has a presence in virtually all sectors of our society.  But it does.  Some strains may be more subtle, some more violent.  But racism, in all its forms, infects the national discussion of many issues.  

And it is racism that continues the propagation of inequality in our democratic nation.  For example, whether the issue is education, health care, or welfare, it is racism that causes the antagonism of conservatives to efforts to create more equal opportunity for the poor, which they view as being primarily Blacks and Hispanics  

(Note, however, that this is in fact just barely true.  While Blacks and Hispanics do have a much higher poverty rate, there were more white people living in poverty (17 million) in 2017 than either Blacks (9 million) or Hispanics (10.8 million).  Combined they accounted for just 51% of people living in poverty.  Also, minorities have historically accounted for no more of the welfare caseload than Whites.)

This racial antagonism explains why conservatives who were so deficit conscious when Obama was president and fought against programs to help the poor became so un-deficit conscious when they took control and spent money on the things that they considered important … like tax breaks for the rich and defense.  Their deficit talk during the Obama years was just a smoke screen for their racism.

Until we get over racism (see my post, “We Need a National Discussion on Race and Racism”) our country will be divided and hobbled.  We will never be truly great in the sense our country was meant to be great by our Founders.  We are far from meeting their aspirations.

In fact, we are less great now under Trump than we have been since the ratification of the 19th Amendment giving women the vote and the 1964 Civil Rights Act.  Seen in this light, Trump’s slogan, “Make America Great Again,” is highly ironic.  For it is Trump himself who has denigrated not just the office of President but America’s inner strength and standing in the world.

Thursday, July 27, 2017

Why I’m Quiet on the Trump Front

I have not written anything regarding the President since June 8.  Obviously, things occur almost daily that deserve comment.  

While it is important that his daily transgressions be put before the public, he must be held accountable, I would say that at this point my comments, and indeed most comments, are mostly wasted breath in the sense that they are unlikely to change anything, to improve the situation.  They will not change the President’s mind or anyone in his circle.  They will not change the mind of his supporters.  They will not change the mind of Republican politicians who are not ardent Trump supporters but want him to sign their legislation, should they ever manage to pass any.  

They also unfortunately are unlikely to encourage the masses of politically unengaged people in the country, who would tend to vote Democratic, to become engaged and thus greatly alter the dynamic of the 2018 election.  That will only happen through a combination of good Democratic policy development and the grass roots involvement of organizations who can reach these people.

The only real reason to continue to comment on things like his latest snap decision to ban transgender people from the military is to continue the protest against both the substance of his policy decisions and the manner in which they are made.  But there are ample commentators and organizations doing that.  My voice doesn’t add anything.

The same is true for his and the Congressional Republicans’ actions on health care.  The process and substance are beyond belief.  They show a total disdain both for the historic processes and procedures of Congress as well as the American public.  

Unfortunately, what else is new!  What’s more, this administration has shown a disdain for the very institutions that form the framework of our democracy.  His Advisory Commission on Election Integrity, a poorly disguised attack on the voting rights of the poor and immigrants, is just one example.

Commentators have to write because that is their job.  I on the other hand only write when there is something that warrants a new post, when I feel that my voice adds something to the public discourse.

Rest assured, I will be heard from again on this topic.

Sunday, March 19, 2017

The Unconscionable Republican Health Care Proposal

According to The New York Times, reporting on the CBO report on the Republican’s American Health Care Act, the impact of the Act on Americans in their 60s would be catastrophic.  In addition, millions of the poor who benefited from Medicaid expansion will loose their insurance.

The proposed law bases subsidies for people not on their income … like just about every other subsidy system in the world does … but on their age.  So for example, a 21 year-old would have a net (after subsidy) premium of $1,450 a year.  A 40 year-old would have a net premium of $2,400.  A 64-year old would have a net premium of $14,600!

So a 60 year-old, low-middle income person earning too much to be eligible for Medicaid and too young for Medicare, would be stuck with a huge bill that he could not afford.   All commentators assume that such people will opt out of the system which will leave them uninsured.  If the Republicans create a high-risk pool, which in the past was typically very expensive and provided bad coverage, that would not be a practical option. 

For the Republicans to do this to 60-year-olds in order to keep premiums down for the young, encouraging them to buy insurance, is evidence, if that were needed, that Republicans lack a social conscience.  It is unconscionable.

For the Republicans to also gut Medicaid expansion resulting in millions of the poor losing their insurance while at the same time providing for a $600 billion tax cut over 10 years for wealthy Americans, as they would no longer be subject to the taxes that had been assessed to pay for Obamacare subsidies, so that the net effect of the act is still a significant budget saving for the government, is more proof of their lack of social conscience and is unconscionable.

In their press conferences, they of course do not mention these details.  Instead, they emphasize the CBO finding that overall rates will go down, after initially rising for a few years.  And that the Act would result in savings of $337 billion over 10 years.  This is deceitfulness at its worst.

All middle-aged and older Americans, and the poor, should bombard their Congressmen with calls and emails telling them to vote No on the American Health Care Act.

Tuesday, September 15, 2015

Growing a Stronger America - More Self-sufficient, a Stronger Citizenry, a World-Class Infrastructure

America is a great country.  But we are slipping.  If we want to remain great, we need to grow a stronger America.  America must become more self-sufficient.  It must do everything it can to create a better educated, healthier, more engaged citizenry and rebuild a strong middle class.  And it must either replace or repair an aging, often archaic, infrastructure with one that will both meet the needs of the citizenry as well as support our economy’s competitiveness into the next century.

More Self-Sufficient:  The impact of globalizations has been a disaster for America’s well-being.  Instead of the advertised promise of globalization, it has become a curse for all but the multi-national corporations engaged in it.  Yes, most of us do like spending less money for all sorts of merchandise, and it has kept the inflation rate down, but we have paid a heavy price for that benefit.

First there is the well-publicized loss of good-paying, middle class jobs.  This has resulted in millions of previously well-employed men either being unemployed, employed in a new field at a fraction of their previous wage, or at the same job but at a wage that has stagnated for decades.  This has decimated the middle class.

That impact may have gotten the most publicity, but there is much more.  The loss of earning power by a large segment of the population has resulted in a weaker domestic economy.  You can’t buy as much when you’re not earning as much.  It’s as simple as that.  And the influx of less-expensive goods from abroad together with our dependence on imported oil has worsened our balance of trade deficit, thus weakening our economic independence.  Foreign countries own 34% of US debt, and China alone owns over 7% or $1.2 trillion.

Beyond weakening the domestic economy by reducing spending, globalization together with tax policy has increased income inequality.  From 1980 to 2014, the US per capita GDP increased from $28,133 (adjusted for inflation) to $50,211.  That’s an increase of 78%.  (The figures vary considerably, so I used the ones showing the least growth.)  By comparison, the increase in the US median personal income (not the average, but the center point) rose from $20,919 to $28,829, an increase of only 37%.  By contrast, looking at the increase in average personal income, which is skewed by the increase of those in the top income categories, the increase is 104%.  

The economy has grown, multi-national corporations have profited, the rich have gotten richer, but the average worker has not.  Without question, the middle class has been left behind and adversely impacted by these forces.  This is not healthy for our economy or our society.

Further, we have now become more dependent on the health of other, specifically Asian, economies.  The fortunes of our corporations and thus the stock market are subject to the vagaries of these economies, as we’ve often seen.  The stock market has been more volatile since globalization than before.  And surprisingly it doesn’t matter how strong or unconnected with global trade a company is … markets are so interconnected that when there’s a rumble in Asia’s economy, all U.S. stocks go down.

Lastly, but significantly, because what is happening in distant corners of the world has become even more important to American corporations and our economy, it has given more credence to the argument that we need a huge military able to go to any spot in the world to defend our national security.  We are witnessing an increased blurring between what is in our national security interest and what is in the interest of our multi-national corporations.  But they are not the same.  

That’s really what happened in Iraq, as our national security was never at stake, not even had there been WMDs in Iraq. We should never be in a position of going to war to protect corporate supply lines.  We should never expend the lives of our youth and our material wealth for such a purpose.

For all these reasons, we must do everything we can to make America more self-sufficient.  We must bring manufacturing back through tax and other policies.  And we must engage in a serious effort both to conserve energy use as well as wean ourselves from our addiction to oil by developing alternative energy sources and alternative energy transport.

A Stronger Citizenry.  The United States, when compared with the rest of the industrialized world, ranks nowhere near the top, more often near the bottom, on various markers that measure the strength of its citizenry:  education, health, and political engagement.

Education.  Whether we look at the PISA (Program for International Student Assessment) math and science scores which show the US ranking  25th and 24th, respectively, among 30 OECD countries, or data that places us 18th out of 23 comparing high school graduation rates, or 15th in college completion, or 10th in the percentage of 25-34 year-olds holding an associate degree or higher, the status of US education is definitely not world class.  (Note: the number of OECD countries used for comparison varies because of the number that have available data.)

Health.  Looking at health status compared with the other OECD countries, the US again does not fare well.  The US ranks 26th in life expectancy, has the 7th highest rate of infant mortality, ranks dead last (first) by far in the percentage of overweight and obese children and adults, has the 6th highest rate of diabetes, ranks 18th in 5-year survival for cervical cancer though it does rank 1st in breast cancer survival, and ranks dead last in access to health care (2013, so before Obamacare fully kicked in) … oddly the US ranks 1st in people self-reporting that they were in good health … all this despite the US spending 2 1/2 times the OECD average on health care per capita.

Political Engagement.  The US ranks 31st out of the 34 OECD countries in the percentage of voting age population who actually vote.  The result is that a rather small minority typically decides who governs us.  For example, in 2000, the voter turnout was 
51.2%.  Since Bush won with 47.9% of the popular vote (actually less than Gore got), only 24.5% or less the 1/4 of the voting age population elected Bush.  In 2008, the voter turnout rate was higher, 58.2%.  And Barack Obama won with 52.9% of the vote.  But that still meant that 30.8%, less than 1/3, of the voting age population elected him.  

It should be a point of extreme concern and embarrassment, if not shame, that the US … the founder of the modern democratic state and the wealthiest and economically strongest country in the world … has its elections decided by such a small minority of its voting-age population.  That election results express the will of the majority is even more important now that the two major parties have such extremely divergent positions on most issues.

Regardless what the cause is … voter apathy, voting barriers (for example, our elections occur on a weekday whereas most occur on the weekend or a declared holiday), poor campaigns, lack of education … something is not right and it must be addressed.  For starters, just changing the day that our elections are held, or declaring at least Presidential elections a national holiday, would most likely make a significant difference.  

But Republicans seem intent on doing everything they can to create more barriers to voting, not less.  Could this be because studies consistently show that non-voters are disproportionately poor or less well-off, younger, and tend to favor higher taxes and more government spending?  For example, 46% of nonvoters have household incomes below $30,000, while the percentage among voters is 19%.  43% of nonvoters are people of color, while only 22% of voters are.  And 34% of nonvoters are under 30, while only 10% of voters are.

Our democracy is based on the philosophy of majority rule.  But the reality is far from that.

How can we be a great country, let alone the leader of the world, with a citizenry that is relatively poorly educated, less healthy, and not politically engaged when compared with other developed countries?  A country’s strength and competitiveness are not based on the strength of the top 20% of its citizens, but on the strength of all its citizens.  

In addition to these factors on which there is comparative data, I noted in a recent post, “Our Failed Economic/Social/Political System,” that America has not lived up to its promise or its potential to provide true equal opportunity regarding “life, liberty, and the pursuit of happiness” and that this was critical to our country’s future well-being.  I noted there that in addition to various factors, including equal access to health care and a quality education, rebuilding a strong middle class was critical.

Improving education, health care, and political engagement, providing meaningful equal opportunity, and rebuilding a strong middle class will require more than a band-aid approach.  We must find the strength to rethink these issues at the most fundamental level and devise a strategy for each that will lift America’s citizenry up to an appropriate level for a country that proclaims itself to be the best in the world.

A Healthy Infrastructure.  In another recent post, “Our Archaic Transportation System,” I lamented how our transportation system is not up to meeting our needs now, let alone in the coming decades.  The same has been reported elsewhere on everything ranging from our electric grid to the state of our water and sewer systems.  

We pride ourselves on being a great and powerful country, on the cutting edge of technology, and yet in many important areas of our nation’s infrastructure, not only is it outdated but it is often crumbling and undependable.  This situation must be corrected if we are to continue being a strong nation and a world leader.  

Addressing most of the issues I’ve noted will necessitate a shift in our national priorities, as I’ve noted in various posts.  If we are serious about growing a stronger America, improving our nation’s health, it will require us to reexamine what is important and how best to use our resources to provide what is needed.  This will require a nation and a Congress who first and foremost ask, “What is in the best interest of the nation,” because they understand that what is in the nation’s best interest is ultimately also in our own individual best interest.

Wednesday, September 2, 2015

Our Failed Economic/Social/Political System

America has a failed economic/social/political system.  I did not use the word “broken” because America has never reached its promise, never fulfilled its potential.  What is the promise of America?  It’s found in the words of the Declaration pf Independence … “that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty, and the pursuit of happiness.”

We are a country of great wealth, the strongest economy in the world, and yet we live in a country where a vast portion of our population have never tasted the fruits of equality and where income inequality is greater than it’s ever been.  We live in a country where for a vast portion of our population, because of the lack of meaningful equal opportunity, the rights to life, liberty, and the pursuit of happiness are almost meaningless, a cruel tease.

First, let’s be clear what is meant by “equality” and “all men are created equal.”  When the writers of the Declaration used that phrase, they were speaking in a spiritual sense, not a practical one.  It was a statement of the Enlightenment’s vision of natural rights, as elucidated by John Locke, among others.  
Obviously, all men are not created or born equal because they are born to vastly different circumstances, whether to poverty or wealth, whether disabled or healthy, whether black or white.  What the Declaration meant is that all men (and women) come out of the womb equal in the sense that they all have the God-spirit inside them, they are all of equal value.

And because they are all of equal value in the eyes of their Creator, they all have and deserve an equal right to life, liberty, and the pursuit of happiness.  This equality does not mean that they all have a right to have or achieve the same status and wealth, but that every person has an equal opportunity to life, liberty, and the pursuit of happiness.  

What each person makes of that equal opportunity is that person’s responsibility.  But it is the system’s responsibility to insure that everyone have that equal opportunity.  That latter thought is expressed in the Declaration when it says, “that to secure these rights, governments are instituted among men.”

How has our system fared in that regard?  In answering this question, I shall limit myself to the period post-Civil War, post-14th Amendment, post-19th amendment.  Clearly, before those points, even viewed in a strictly legal sense,  the vast majority of the population was in no sense equal, either because they were female or they were black.

First, though, the question must be asked, what is necessary, what is the foundation that an economic/social/political system need provide, in order for there to be meaningful equal opportunity?  I think the following:
  • The laws must provide for equal opportunity.
  • Social authority and peer pressure must not tolerate any deviation from equal opportunity and discrimination must be denounced as unacceptable.  
  • All children, regardless of background, must have an equal education opportunity both with regards to its quality and to its accessibility.  
  • Recognizing that a certain minimum standard of living is necessary for a person’s feeling of self-worth because it enables them to secure safe housing and sufficient food, the system must provide a method to secure that standard of living for those who cannot obtain it of their own accord.
  • All people must be guaranteed access to adequate health care; if you do not have your health, you cannot make full use of equal opportunity.
  • The system must foster a sound middle class, which is often a launching pad for further upward mobility.  
1.   Legal equal opportunity.  With the glaring continuing exception of sexual orientation (and gender identity), Federal law and most state laws provide that discrimination is illegal in all areas of the public sphere … employment, housing, entertainment, restaurants, etc.  By executive order, discrimination on the basis of sexual orientation is illegal in federal employment.  And by virtue of the Supreme Court decision, discrimination in marriage laws is now illegal.

2.   De facto discrimination.  But despite all the laws on the books, de facto discrimination towards blacks and towards other people of color is rampant.  Discrimination towards women is not uncommon, and certainly pay equality is not a general practice.  

Part of the reason for this continuing discrimination is our history … old attitudes die hard …  but the other part is we cannot say that “social authority and peer pressure” do not tolerate discrimination and denounce it.  Some social authorities do, and in some communities peer pressure does, but as a general matter, discrimination is the elephant in the room.  It’s there but few care to discuss it.  Those in power in our society appear to have little or no interest in ending this discrimination.

3.    Equal opportunity of education.   Before children even enter school, a significant factor impacts their educational opportunity … the extent to which they are exposed to basic learning skills, including reading, during their pre-school years. Not surprisingly, inner city children living in poverty suffer most from a lack of such exposure. We cannot change the family circumstances into which a child is born, but we can insure that every child receive full exposure to learning skills through pre-school programs.

Regarding primary and secondary education, there is huge inequality in the quality of education between states, within states, and within metropolitan areas.   The reason is that very little funding comes from the federal government (10%).  The rest comes from state and local sources, with local property taxes accounting for 50-70% of available funding in most localities.  Thus, the funding available varies greatly depending on the wealth of the school district’s residents.  

While quality of education is not solely dependent on the amount of money spent per student, it does have a real impact.   The other significant factor impacting quality is the attitude of teachers.  Many teachers in inner city school seem to view their students as hopeless and so put forth little effort beyond crowd control.  

The combination of these two factors delivers a double whammy to inner city school children.  The average high school graduation rate in the 50 largest cities was only 53% according to a 2009 report.  And for those who did manage to graduate, without a solid primary and secondary education the thought of higher education is so far out of reach it isn’t even a dream for most.  

That such students are in fact, however, not hopeless is shown by the ample examples of schools run with a different attitude that achieve "amazing" results with underprivileged children. 

4.   Minimum standard of living.  The Federal government spends a huge amount of money (11% of the Federal budget) on a variety of programs to provide financial assistance to those in need, primarily to families with dependent children.  This funding is augmented somewhat by the states.  With regards to food stamps, it should be noted that a large percentage of recipients work … the working poor.  But despite all of this spending, not only do we have a stubborn poverty rate that hovers around 14%, but the living conditions that most people in poverty encounter are horrendous and homelessness is a serious problem.  

What has gone wrong?  I understand the problem is complex, but rather than spend money on education and jobs to bring people into the workforce, we have doled out money to people and thus not surprisingly their status has typically not changed; they have become more dependent, not less so.  And there is no talk of fundamentally changing the system to help raise the poor out of poverty.  The reason … those with power in society really aren’t interested.  Clinton’s workfare program was a farce.  All the Republicans want to do is cut aid.  They seem to think that if you’re poor, if you don’t have a job, it’s your fault.  You’re lazy.

5.   Universal health care.  Despite all the effort to pass Obama’s Affordable Health Care Act, and the increase in the numbers of insured Americans that resulted from that measure, we still have a very inefficient, cumbersome system that relies primarily on private insurers.  And while many more are insured now, the plans that they can afford are mediocre in their coverage and many who previously had better employer-sponsored plans now find themselves with either plans that cost them more or provide less coverage and thus ultimately cost them more if there is a health emergency.  

This criticism is separate from that of our health care system which has so many serious problems that it is almost dysfunctional.  We continue to have both a health care system and accessibility to it that is substantially inferior to most of the other industrialized countries.

6.   A sound middle class.  This is the one area where the United States really used to excel.  We had a large sound middle class.  But then globalization and the trade agreements that fostered that movement resulted in millions of jobs leaving the U.S.  This was great for multi-national corporations, but bad for workers.  As a result, many formerly middle-class men are now unemployed, or they have found work at only a fraction of their former wage, or if still at their former jobs their wages have stagnated since the mid-70s because of overseas competition.   

Why would successive administrations, both Republican and Democrat, support this disastrous movement?  Because power in the U.S. lies with the major corporations and they wanted to be free to move jobs where labor costs less.  And because economic theorists said it was the right thing to do.  There has been no movement to either build new middle-class wage jobs or bring old ones back.  What effort there has been recently is to raise the wages of service workers, as in the fast food industry, to a living wage, which is important but does not create a middle class

Bottom line on all these fronts … our economic, social, and political system is controlled by powerful corporations and people with substantial wealth.  These forces have shown no interest in the betterment of their fellow citizens.  Their only interest is their pursuit of ever more wealth and power.  As a result, the Republican Party has no interest in the issues I’ve raised.  And Democrats, while they have an interest, lack the courage to stand up to these interests and call for a massive restructuring of how our government provides for the common good and helps those in need.  

And so the rich and powerful have gotten richer and more powerful, while the poor and middle class have gotten poorer and more powerless.   The problem is not so much one of insufficient funds or sources of revenue.  The problem is “the vision thing,” a lack of leadership and skewed priorities.  A disconnect from the promise of our founding documents.

This problem is far-reaching, extending into all areas of government responsibility, not just those affecting the poor and middle class.  As has become increasingly clear to me through my writing, regardless what the issue … the environment and energy policy, tax fairness, globalization, financial institution regulation, our archaic transportation system, replacing/repairing our infrastructure, education, health care, civil rights, foreign policy, and defense … it all comes back to real power residing with powerful corporations and the wealthy, not the voters who elect their representatives and the President.  We have a democracy in format, but not in substance.  

Money and power have of course always been a factor in American, and indeed all, politics.  It’s the nature of the beast.  And it’s also appropriate.  Business and finance have an important role to play in the health of our economy and should be supported.  

But the grip on power and influence by major corporations and the wealthy has increased greatly over the course of the last decade or more to the detriment of the common good.  Our system has lost its balance.  The Supreme Court decision in Citizens v United will surely aggravate the situation.  

If we are to reclaim government of the people, by the people, and for the people. then we must find a way to get big money if not totally then mostly out of politics.  Public financing of election is one obvious way.   There may be others, but that is not the topic for this post.

This will require an aroused electorate, because this will be the first test of the power of the people v the power of corporations.  (See my post, “How the Koch Brothers Hijacked the Middle Class Revolt and How To Take It Back.”)  Only if there is a popular movement so strong that members of Congress know that if they do not implement the will of the people they will be turned out of office does this have a chance of getting passed into law.

Wednesday, October 22, 2014

Education and Health - Fundamental Rights

We have been bludgeoned over the past few years with the Republican’s mantra that if you haven’t made it, it’s your fault (see my post, “The Mendaciousness of the Responsibility Game”).  So it was with a huge feeling of nostalgia that I was reminded recently of a time not so long ago when a large segment of Republicans had a very different perspective on life and the role of government, or at least the role of the broader society.

In reviewing a new biography of Nelson Rockefeller, the reviewer noted Rockefeller’s credo, “If you don’t have good education and good health, then I feel society has let you down.”  WOW!  How times have changed.

If someone said that today, even if a Democrat said that today, they would be viewed as a left-wing radical.  It sounds so over the top.

But it isn’t.  Let me quote, as I often do, from the Declaration of Independence, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed . . .”

If one is going to have a meaningful right to life, liberty, and the pursuit of happiness, certainly two of the most essential elements of that right are having a good education and having good health.  No one would argue with that.

But the Declaration goes further and states that the purpose of government is to secure these rights, which in this context would mean access to good education and access to good health.  I am not downplaying the importance of personal responsibility.  As the old saying goes, “You can lead a horse to water, but you can’t make him drink.”  But it is the government’s responsibility to provide the water.

So at a minimum, the government is responsible under this standard for supplying access to a good education (meaning good schools, good teachers, etc.) and good health (meaning comprehensive health care ... medical, psychological, and dental ... that is affordable or free, depending on your circumstances).  Note: Obamacare has not come close to providing the latter because although the basic premiums may be affordable due to government subsidies, the large deductibles and out-of-pocket caps of the basic plans discourage people from getting health care except in emergencies.

If that is the minimum, you might ask, what else is there?  While good schools can make a huge difference even in the midst of a bad inner-city neighborhood, growing up in an area where poverty, drugs, and crime are the norm and often impact family life creates major obstacles to being able to take advantage of a good school.  

Government, together with private agencies and organizations, must do much more to improve the broader context within which such children grow up.  Whether it’s creating more jobs, providing adult education, making prisons focus on rehabilitation, creating social policies that encourage two-parent households (as opposed to the old welfare rule that broke up families by penalizing them if an adult male was living in the household) ... there are ample ways that government and society working together could dramatically change the context of inner-city life.

It is time for Rockefeller’s credo to become the credo of government and of our society.  It is past time for this great, rich, but unconscionably unequal, nation to live up to the promise stated in the Declaration of Independence.

Thursday, April 18, 2013

American Exceptionalism - A Myth Exposed


American political leaders and average Americans too take great pride in trumpeting the United States as the greatest country in the world.  We are the strongest, the richest; we have the best medical system; we have the best educational system; and the list goes on and on.

But are we the greatest country?  While it is incontrovertible that we are the strongest country in the world militarily, and that we are the richest country in the world in terms of the size of our economy, when it comes to the health and welfare of the American people we are far from the greatest, as the data below will show.  And I believe it is in the ability of all Americans to pursue the American promise of “equality” and “life, liberty, and the pursuit of happiness” that our greatness is best measured.

You might ask, “Why bother exposing this myth?”  Because we have many problems in this country which seem to be intractable, largely because people ... both most leaders and the average American ... refuse to acknowledge the facts, let alone view them as presenting a serious problem that must be addressed.  Most people are so caught up in how great we are and how good life in this country is that we have come to believe the illusion and cannot see the gritty reality which is quite different.  

Only when our leaders and the public are able to see and admit these significant problems that limit our greatness will the political will exist to do what is necessary to fix them.  And they can be fixed.  We have the riches and the knowledge to do all that needs to be done.

In the data below, the United States is compared with the rest of the developed world, and at times the entire world.  The areas I will examine ... health, education, income inequality, violence/security, social mobility, and equal opportunity ... are essential to the ability of our country to live up to the promises made in the Declaration of Independence and truly be the great nation we aspire to.

Health:  Despite having by far the most costly health system in the world, the United States consistently underperforms on most measures of the quality of health care.  Looking at quality of care, access to care, efficiency, equity, and living healthy lives, the US ranks last or next-to-last when compared with Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom.  Most troubling is the failure of the US in the area of health outcomes ... people leading healthy lives.

The summary table below says it all:

                                       AUS     CAN      GER     NETH       NZ    UK       US
Overall Ranking (2010)         3          6             4             1            5       2          7
Quality of Care                     4           7            5             2             1      3           6
Access                                 6.5        5            3             1             4      2         6.5
Efficiency                             2           6            5             3             4      1           7
Equity                                  4           5            3             1             6      2           7
Long, Healthy Lives               1           2            3             4             5      6           7
Health Exp/Capita (2007)   $3357   $3895   $3588  $3837   $2454  $2992  $7290

This data, which comes from a report by The Commonwealth Fund, is consistent with the findings of other reports and surveys.  For example, a recent report sponsored by the National Research Council and the Institute of Medicine compared the US with 17 other developed countries, and the US came in last.  The report shows a “strikingly consistent and pervasive” pattern of poorer health at all stages of life, from infancy to old age.  Further, the report shows that even white, well-off Americans live sicker and die sooner than similarly situated people elsewhere. 

Education: The US fares somewhat better in education comparisons, in that it was not dead last.  This is the one area regarding which the media will occasionally ring the alarm bell that “we are falling behind.”  In data comparing the G-8 countries, American 15-years old come in 3rd in Reading, 6th in Math, and 5th in Science.  In looking at high school graduation rates, the US and Canada tie for the lowest rate, 76%.  The other 6 G-8 countries range from 85% (Italy) to 97% (Germany).   This is a huge failure of our system.

Income Inequality: In a report on income inequality in 17 developed countries based on various studies, the United States had the greatest income inequality.  The top 1% of income earners accounted for 17.4% of US income while at the other end, in the Netherlands, the top 1% accounted for only 5.4% of income.  In looking at World Bank figures for the entire world, with the exception of China and Hong Kong, only undeveloped or developing countries, mostly in Africa and Central and South America, had greater income inequality than the US.

And income inequality is been increasing steadily in the US over the past 50 years.  For example, in 1949, the top 1% accounted for 11% of income, similar to or less than many developed countries at that time.  But for 10 of the 17 countries, income inequality has actually decreased in the past 50 years while those that have increased have experienced a much lower percentage increase than the US.

In looking at total net worth, the top 1% in the US accounted for 34% of net worth, the top 10% accounted for 70%, while the bottom 80% accounted for only 15%.  According to a UN report on the distribution of household wealth worldwide, only 4 countries in the world had greater inequality in household wealth than the US!

Violence/Security: In 2003, there were 30,000 fire-arm related deaths in the US  (homicides and suicides).  According to an American Bar Association report, the rate of death from firearms in the US is eight times higher than in other industrialized countries.  According to the U.S. Centers for Disease Control,  the fire-arm related death rate among US children younger than 15 is nearly 12 times higher than among children in 25 other industrialized countries combined.  The US has the highest rate of youth homicides and suicides among the 26 wealthiest nations.  

In a UN report comparing the intentional homicide rate (i.e. excluding suicide) worldwide, the US at 4.8 per 100,000 people was the highest for a developed country.  The next highest was 2.2 for Finland.  Germany, Italy, and France were 0.8, 0.9, and 1.1 respectively.  The United Kingdom was 1.2.

It would seem that our vaunted right to purchase firearms of all sorts has helped to create a more violent, less secure environment for Americans, rather than a less violent, more secure one as argued by gun proponents.  Interestingly, in a recent article regarding the Texas District Attorney and his wife who were murdered in their home, it was reported that he had 60-72 guns of all types planted all over the house and that both he and his wife were expert at using them.  But apparently all those guns were to no avail.

Social Mobility:  America has always prided itself as being the land of opportunity.  Over the years, especially the late 1800s and early 1900s, tens of millions of immigrants came to the US because of the American dream.  And indeed, while data for that period is not available, certainly anecdotal stories of the upward mobility of immigrants abound.  Surveys show that Americans still think of their country as being a meritocracy; that is, if you have what it takes and you are hardworking, you will succeed.

But the data from two recent studies show that the image is far from true.  Yes, there is still social mobility, but the US is hardly the leader in this area.  In a study by the PEW Economic Mobility Project of 10 developed countries, the US had a lower generational income mobility than that of the other countries.  That means that a child’s income (as an adult) was more a function of his father’s income.  Likewise, in a study that compared 6 developed countries regarding the likelihood of children remaining in the same income quintile as their their father, 42% of American children in the poorest quintile remained in that quintile, a rate of poverty persistence far greater than the 30% in the United Kingdom and the 25-28% range found in the Scandinavian countries.  Likewise in looking at the percentage who moved from the lowest quintile to the highest quintile, the US rate was 7.9%, while the rate in the other 5 countries was 11 - 14%.

Equal Opportunity:  The United States has many laws guaranteeing equal opportunity, meaning freedom from discrimination.  But even if those laws worked perfectly and there was no more discrimination in this country, which of course is far from the case, there would still be a significant lack of equal opportunity because your parents’ income usually determines where you live and the quality of education that you receive, which in turn determines the range of your opportunity.  Given the high income inequality in the US, that means that true equal opportunity is really a phantom in our country.  

While this lack of equal opportunity is not just a function of unequal funding, legal and legislative efforts to alter this dynamic by changing the way in which schools are financed ... equally by the state rather than unequally by school districts ... have not gained traction anywhere because of the opposition of those who fare better under the current system.  While there is no comparative data on this specific issue with other countries, the data on social mobility reflect this reality.

In summary, the data show that the United States has the worst health system in the developed world, even if it is by far the most expensive.  It has a mediocre educational system compared with other developed countries.  It has the highest income inequality in the developed world and almost the highest wealth inequality in the entire world.  It has the highest rate by far of people dying from firearms in the developed world.  The social upward mobility of Americans from generation to generation is now significantly lower than that in other developed countries.  And equal opportunity is not available because lower income Americans receive an inferior education.

This data is cause for our political leaders and the public to stop and consider what has caused these problems to develop and what needs to be done to return America to the path of greatness.  It is not just a matter of throwing more money at a problem.  Each of these problems reflects structural defects in our system that must be corrected.  The American people are hurting.  Further, the combined impact of these problems will lead, if not addressed, to a steadily weaker America on the world stage.

Thursday, October 4, 2012

What Obama Should Have Said But Didn't

Opening Statement:  I want to be a president for all the people, whether rich or poor, Democrat or Republocan ... not just the 54% that don't receive any government benefits.  I will not write off any American.

Entitlements:  Just a few weeks ago, Governor Romney, in a private gathering of donors, sounded very different from the way he is sounding tonight speaking to all of you. He said that the 46% of Americans who receive government benefits feel like victims, that they have become dependent on government. It sounded like he felt they were losers.  I strongly disagree.  The seniors who have paid into Social Security all their lives, the injured veterans coming back from Iraq and all our wars after having fought for their country ... these are people who have paid their dues, they are indeed entitled to support from the government at this point in their lives.  What about the poor?  The poor who have never had a fair chance to get ahead because of poor schooling, a government obligation, deserve the support of the government to help them pursue their dreams of life, liberty, and happiness.  That is why President Clinton turned welfare into workfare.

The Role of Government: As it says in the Declaration of Independence, the role of government is to "secure these rights" ... meaning the right to life, liberty, and the pursuit of happiness. In other words, government's role is to create a situation where everyone has at least an equal opportunity to pursue those rights. The government needs to be there for all the people, and especially those who are at a point in their lives when they are facing hardship and are vulnerable ... whether it is from old age, from natural disaster, from injury received in defense of their country, from unjust discrimination, or being born on the wrong side of the tracks. That is the ethic of the American sense of government, the American social contract.     

Health Care:  No, Governor, you're wrong.  We do not have the best health care system in the world.  Far from it.  Despite spending more money by far on health care per person than the rest of the world, the United States consistently scores near the bottom of the pack of industrialized countries on almost every measurable outcome of national health. That is why the board, that you are so fond of mentioning, was created.  While places like the Cleveland Clinic and several others have instituted practices that have delivered better health care at lower cost, the rest of the health care industry has not embraced those examples and so our costs keep rising while we have unsatisfactory health care outcomes. This is clearly confirmed in a recent report by the Institute of Medicine.  The board was created so that these excellent health care practices developed by private clinics would be mandated for the entire health care industry.  So that we can at the same time significantly lower costs while improving people's health.
Closing:  I have tried to be the President for all Americans.  Countless times during my first four years, I have reached across the aisle on all the major issues to try to work with Repulican legislators.  But in virtually each and every case, the Republicans just said, "no."  They have stated very bluntly, as did the Senate Minority Leader Mitch McConnell, that their sole goal was to see that I would be a one-term president.  Every decision they have made was to weaken me by weakening the country. During the Republican primary season and at the nominating convention, Governor Romney sounded like the most radical of the radical Tea Party Republicans.  He wrote off almost half of America's citizens, half of you. Tonight he tried to make you believe he is now once again the old caring Mitt Romney who was Governor of Massachusetts. I ask you ... who is he?  How will he really govern?

Friday, August 24, 2012

Republicans’ Seven Biggest Lies


The propaganda theory of “the big lie” is that if you tell a lie big enough often enough, people will begin to believe it, and the Republicans are masters of this tactic. The Republican Party has been selling the American public a bill of goods and unfortunately the public is falling for the scam. They want the average American to think that they are going to protect their interests and that the Democrats will ruin them.  This is a classic “big lie” if ever there was one.

Their “argument” is based on the following subsidiary lies, which fall predominantly into two categories … the economy and health care/Obamacare:

Lies About the Economy

Lie #1: The financial crisis and joblessness is the fault of big government, of government regulation.
            Fact:  The financial crisis was caused by rich investment bankers and mortgage brokers trying to find a way to make a fast buck at the expense of ordinary Americans or small-fry investors. It happened because people in the financial industry are greedy and cannot be allowed to regulate themselves.

Lie #2: The financial crisis continues because of the failure of the Obama stimulus package and the increasing government deficit.
            Fact:  The Obama stimulus package, while not creating many new jobs, resulted in preventing the elimination of millions of jobs, especially state and local jobs.  This kept the country out of a second Great Depression.
            Fact:  Once the stimulus funds were spent, Republican-led efforts to slash the budget in order to cut the deficit have made the jobless crisis far worse by reducing support for state and local governments, causing increased unemployment in that area that the stimulus had prevented and stalling the recovery.
            Fact:  The deficit, while large and undesirable, is more of prac†ical concern to investors in government bonds, and interestingly rather than fleeing from US bonds, investors continue to flock to them as a safe haven in this volatile global financial market.

Lie #3: The key to getting the American public back to work is cutting taxes for the rich and corporations, as well as cutting the deficit.
            Fact:  Cutting taxes for the rich only helps the rich get richer.  There is no trickle down effect, as was proven during the Reagan years.   Reducing corporate taxes only results in corporations and their investors making more money; it does not encourage investment and job creation unless the tax cuts are specifically tied to that effort. Corporations are into doing more with less labor; they have no interest in job creation or giving raises.  It’s not that they don’t have the money … they are sitting on $1.74 trillion … yes trillion … dollars of cash.
            Fact: Income inequality between the very rich and the rest of us is worse now than at any time in US history.  And income stagnation for the average American is a real crisis. 
            Fact:  Cutting the deficit by cutting funding for all sorts of programs and support for state and local governments will only make the job situation even worse by increasing layoffs at all levels, as it has already done.

Lie #4:  The answer is not the government; government is the problem.
            Fact:  The crisis was caused by market forces working in a for-all-practical-purposes unregulated atmosphere.  Its only guide was greed.  Even Alan Greenspan has admitted that his theory that the market would be self-regulating was an error.  The answer to protecting the American public from this type of thing happening again is regulation of the financial sector that has teeth in it.  The Republicans are dead set against such regulation. The Democrats support it.
            Fact: We got out of the Great Depression through massive government spending including the WWII effort.  In a financial crisis, the private sector has no interest in investing.  Their only concern is protecting or growing their profits.  Thus they find ways to do less with more, which is great for their shareholders, but bad for the American worker.  We need more government stimulus, hang the impact on the deficit, in order to get the unemployed back to work.

The Lies About Health Care/Obamacare

Lie #5: Obamacare will get between you and your doctor and reduce the quality of your medical care.
            Fact: There is nothing whatsoever in Obamacare that would do this.  It is built on the existing private insurance system. It is not a “government takeover” in any sense, which Medicare actually was, although interestingly everyone loves that.

Lie #6:  Obamacare will force individuals to get health insurance. The implication of this is that individuals who cannot afford health insurance will be forced to buy it or suffer a penalty.
            Fact: One of the main drives behind the enactment of Obamacare was to provide health insurance to the millions of Americans who don’t have it as part of their jobs and who can’t afford to buy it.  It does this by subsidizing health insurance for those who can’t afford it. The individual mandate will provide health insurance and proper medical care to millions of Americans who currently can’t afford access.
            Fact: Republicans have for the last 20 years urged the individual mandate as part of any health care reform.  It was central to the bill that Governor Romney supported in Massachusetts. Now they are against it solely because it’s a Democrat-passed program.

Lie #7: Obamacare will ration health care.
            Fact: There is nothing in Obamcare that would ration health care. There are measures in the law that encourage the medical profession to apply their group knowledge more consistently so that everyone gets the best care and money is not wasted on unnecessary or counterproductive procedures.
            Fact:  Contrary to the statements of Republican talk show hosts and some Congressmen, there is no “death panel” in Obamacare. What the law does encourage is for doctors to talk about end of life issues with their patients so that the patients’ desires regarding various levels of medical effort will be known and respected.

Bottom line … Republican politicians and radio talk show hosts have presented a Big Lie to the American public. And by saying it over and over again, and by the Democrats not effectively countering the lie, a large segment of the American public has come to believe the lie. But in fact, Republicans are only concerned with protecting the interests of the rich and corporations; they have no concern for the average American. It is instead Democrats who are fighting to protect the well-being of the average American.

There is no question that government is not the entire solution … the private sector and individuals have a major role to play … but government is certainly a necessary part of the solution.