Sunday, July 31, 2011

A Decision I Made Today

To be honest, the discussion about the national debt and the debt ceiling is over my head. As citizens we have an obligation to be as well-informed as possible, yet when the best experts on the topic are miles apart in their analyses and recommendations, what are we to do? I have tried to read all sides of the discussion and post links to the articles and ideas that seem most accurate or the wisest to me, but who knows?

Today I simply want to focus on one aspect of this conversation, the impact on healthcare. Here again I can claim no particular expertise, even though I have worked in healthcare all of my life. By this I mean that I have no training or experience in healthcare finance and administration. Still, my "expertise" in this arena is greater than for, say, banking or mortgages or the stock market.

This morning Kaiser Health News (KHN) reported hints of another debt deal this weekend that includes possible Medicare cuts. From the reports quoted, it is hard to say what kinds of cuts are included, but it is no secret that many Republicans have called for deep cuts in Medicare. Yesterday KHN surveyed the media coverage of possible fallout for healthcare of a default. For example, from CNN Money
"[Some physician groups] have started to warn their members that a possible default means their Medicare paychecks may not get mailed. ... In 2010, the federal government paid out $515.8 billion in total Medicare benefits to health care providers, including doctors, hospitals, nursing facilities, home health care centers and pharmacies. ... The Centers for Medicare & Medicaid Services declined to say whether Medicare payments to health care providers would be affected if a default occurs" (Kavilanz, 7/29).
Yesterday was the 46th anniversary of Medicare. On the website Physicians for a National Healthcare Program (PNHP) Dr. Margaret Flowers argues that the Republican and Democratic plans for Medicare and Medicaid are misguided and that the push for privatization will accelerate costs and deaths. This article was picked up by the Institute for Public Accuracy (IPA) and then under the title "Medicare is the Answer, Not the Problem." A few days earlier, Robert Reich (whose opinions I have come to respect greatly) made the same arguments on KevinMD.

Now I acknowledge that this topic is much broader and much more complicated than can be covered in a posting here. I also admit that many aspects of Medicare need overhaul. Therefore it is not my intention here to "make the case".

My intention is simply to give a small bit of the rationale for why I have (today) decided to join Physicians for a National Healthcare Program (PNHP).

Friday, July 29, 2011

A Conversation about the Debt

My experience with Facebook conversations, at least those started by individuals, is that a length of 64+ comments is unusual. And when it does happen, that is often the end of it. I would like to continue this conversation.

The conversation I am referring to is here. First, I admit that the cartoon that started it was provocative. It was deliberately so, and for that I can hardly apologize, but I also admit that it is an exaggeration. That is what cartoons do. But the conversation that ensued brought up much more substantial issues, which I hope will result in further (and hopefully) deeper discussion.

The issue that started all of this was the need to raise the debt ceiling. I think we all agree that Deficits Do Matter and that reducing rather than raising the debt should be the goal. No one disagrees, right?

Andrew suggested that Congress should just refuse to raise the debt ceiling. "We can't spend more than we bring in," which we just agreed is the goal. "Then it is up to the president to determine where cuts are made. He can choose to 'default' or not."

Not so fast, says Cheryl. "They already drank the beer--it's gone." Yes, we need to figure out how to stop deficit spending, but to simply cut programs and services in a massive way is also irresponsible. Surely some of the programs and services for which our taxes are paying are wasteful and unnecessary, but massive across the board cuts are not the answer. Brett says we can find plenty of places to cut without "having to cut funding for things like children's hospitals." (I should hope so.) But Doug points out that perhaps the departments that Brett wants to eliminate or fold under another department serve an essential service. In any case, eliminating whole departments cannot take place (responsibly) within a few days.

While we are talking about spending, MOST of us would agree that defense spending is something we should consider reducing dramatically. I put MOST in all caps, because there might be some who disagree. Nonetheless, the wars in Afghanistan and Irag are costing us enormous amounts of money that we can ill afford, and frankly with little benefit to show for it. Had I been an congressman at the time, I likely would have voted for the military action (war) in Afghanistan, and given the information available at the time I might have even agreed to going into Irag. In hindsight (always 20/20) I definitely would not agree to the invasion of Iraq, and might not even agree to going into Afghanistan. Though Bin Laden is now dead, it can be argued that he won that exchange.

Whatever else you think about the original motive for going into Afghanistan, it is clear that massive spending on both wars is a significant reason behind our deficit spending now. Then there is the question about the "illegal" war on Libya. Reasonable people (like Doug) find valid reasons for humanitarian intervention in Libya and elsewhere. I am inclined to believe this might be the case, but Brett has helped bring me back to my core beliefs (from when I was back in Kansas City) that war is wrong, anytime, anyplace. This is not necessarily a conservative view, but I applaud Brett for coming to and advocating for this position.

On the flip side, I posted a link to suggest the crisis is not one of spending, but a crisis of revenue. This is an area where I expect lots of differing opinions, so let me be clear that my own opinion is just that, opinion. As I see it, however, much of the current deficit crisis is a direct result of the Bush tax cuts. When we talk about letting these expire, the uproar is that if we raise taxes on the richest Americans again, they will withdraw and not create much needed jobs. I see no merit in this argument whatsoever. When the rich get tax cuts they do not spend it on new jobs. Period. When the rich are taxed they do not stop creating jobs as a result. The ONLY thing that they respond to is demand. If the middle class is spending, entrepreneurs find ways to meet the demand. Period.

This brings me to another underlying theme, which is the widening gap between the rich and the poor in this country. This deserves a post in its own right, but suffice it to say that this widening gap is not good for the economy, nor is it good for our society. I am not saying that it is the job of government to rob from the rich and give to the poor, but I do believe it is the role of government to establish policies that protect the poorest and curb the greed of the rich. That is a gross over-simplification, I admit, and a more nuanced analysis is called for. But I'm just sayin'.

Finally there is the issue of government regulation. I will just tell you that in my own industry (healthcare) I complain as much as anyone about unnecessary regulation, whether it is from "voluntary" organizations, such as the Joint Commission, or whether these regulations are from government such as CMS and the State Health Department. Such regulations often seem unnecessary and counterproductive. In my saner moments, I recognize that these regulations have served a HUGE role in improving healthcare overall in this country. For example, central-line infections used to be thought of as an unavoidable risk. Such infections are now rare and considered entirely avoidable, largely because that is the expected standard from a government agency. Despite my gripes, healthcare is better for it.

I agree that regulation can be excessive, and probably often is so. But I will also tell you that "voluntary" self-regulation has many, many examples of complete and miserable failure. Is there a middle ground? I should hope so, but those who advocate no regulation, government or otherwise, simply do not want to see reality. Yes, regulations sometimes get in the way of true progress, but they also protect the innocent from exploitation and worse.

So much for my soap box. I believe there is room for disagreement and civil disagreement. I welcome comments.

Sunday, July 3, 2011

When is Outrage Appropriate?

Earlier today I posted a link on Facebook to a NY Times article about executive pay at large companies rising nearly 25% last year. My comment was, "why are we not ALL outraged by this?" A short time later I posted on my status that I was enjoying a cup of Luwak coffee that we had brought back from Indonesia. Obviously I was in a better mood.

Actually I was not in a bad mood when I posted the NY Times link, and I was not "outraged" in the sense of "feeling" any kind of anger or rage. I was simply "disturbed." I was disturbed by the unfairness, not for myself. I have no complaints, nor do I have any reason to complain. I was and am disturbed that a few individuals are extravagantly rewarded for a mild (and possibly transient) upturn in the economy, while millions have seen almost no improvement in their lot, rarely through any fault of their own and many of whom are children.

Early this morning I was tempted to post another link on Facebook, What if You Held Class War and No One Showed Up? In reaction to right-wing Marco Rubio's criticism of President Obama's recent press conference, writer Kevin Drum responds:
"For about the thousandth time, my mind wanders over the past ten years. Republicans got the tax cuts they wanted. They got the financial deregulation they wanted. They got the wars they wanted. They got the unfunded spending increases they wanted. And the results were completely, unrelentingly disastrous. A decade of sluggish growth and near-zero wage increases. A massive housing bubble. Trillions of dollars in war spending and thousands of American lives lost. A financial collapse. A soaring long-term deficit. Sky-high unemployment. All on their watch and all due to policies they eagerly supported."
So why did I not post that link?. After all, I happen to believe there is considerable truth in it, not just in the quote above, but in the entire article. But the fact of the matter is that the deeper I dig into questions about the economy the more complicated it becomes.

Moreover, it seems clearer and clearer to me that much of the problem is partisanship. Both sides seem more intent on seeing the other side fail than in solving the real problems of real people. Another case in point is that several of my Facebook friends have recently posted links to articles from the conservative or right-wing viewpoint. I thoughtfully read these articles to get another viewpoint, and in all three cases, the purpose of the article was to be critical and tear down the other side. In none did I find any suggestions for ways to make our nation better.

Several times, many times actually, since I joined Facebook, I have forsworn ever posting any thoughts or links of a political or economic nature again. There are plenty of other issues to update my FB friends on, things like safe drinking water, human rights, human trafficking, child abuse, religious tolerance, spiritual development, and more. But even though I do not have all the answers, maybe very few, nonetheless economic and political issues have very real moral and spiritual implications. So I will try to be more circumspect in my postings, and especially try to be better about not polarizing these issues, but I cannot stop speaking out.

No doubt there will be times when my ire will be provoked. There will surely be times when moral "outrage" is called for. But never should I hope to distance myself from my friends. If we disagree, and we may well, my goal would be to step back a bit and find a way to dialog. 

So let me end with another link. This one is to How the Left and the Right can Unite from Yes! Magazine. I have read this article carefully at least twice and mostly agree with it. I have not yet taken the time to research Yes! Magazine, but I intend to. Here is a quote from David Korten.
"If those on each side of America’s deep political divide could see the merit in the arguments of those on the other, we might come together as a powerful citizen alliance. We could break up concentrations of corporate power, get money out of politics, end senseless wars, achieve an equitable distribution of wealth, downsize government, and hold politicians accountable to an authentic popular will. That is an agenda that principled conservatives and liberals should all be able to get behind."
I like that so much, I may even post a link to it separately. Have a nice day.