Exhibits 1-10 Why Public Healthcare Controls Costs Better Than Private Healthcare

This week you’ll be hearing a lot from the Republican Convention about how public healthcare can’t compete with private healthcare. Via Paul Krugman, the Incidental Economist’s “overwhelming evidence that public programs exert greater control over health care spending than private insurers.”

• If the Medicare age is raised to 67, it will save the government $5.7 billion in 2014 butcost others twice that amount.
• Government payments to private, comprehensive Medicare plans (Medicare Advantage) have been well above the cost of the program’s public option (traditional Medicare) for years.
• The rate of growth in per person spending by private health care plans has exceeded that of Medicare for 40 years.
• Private, per person growth in physician spending has exceeded that of Medicare in the last decade, if not longer.
• The CBO has scored a public option as cheaper relative to a private-only exchange system.
• The CBO and other organizations have scored single payer proposals as cost savings (system wide) relative to the status quo.
• The VA (and Medicaid) purchase drugs far more cheaply than Medicare’s private drug plans.
• Our wealthy, peer nations have a greater proportion of their health spending funded publicly and spend dramatically less on health care than we do, even as a proportion of their economies.…
• There are arguments in favor of private insurance, but they are not based on lower spending or spending growth.
• FEHBP program spending has grown at about the same rate as Medicare’s. However, FEHBP has gotten more generous.

Great Article by Ta-Nehisi Coates On Race & Obama

If you haven’t read Ta-Nehisi Coates’ piece, Fear of a Black President, you should definitely check it out. It’s a very smart, nuanced portrayal of the complicated balancing act that both President Obama and African-Americans who support & criticize him have to struggle with. Normally I would quote my favorite parts, but with an essay this good, you’re better off reading the whole thing.

Coates is a great writer, and I’m thrilled that the folks at the Atlantic seem to be giving him more of a spotlight. He’s definitely someone to put on your RSS reader.

Brain Dump: Can I Stuff Most of My Framework into We're Not As Smart?

I’ve been toying with an idea: just how much of my framework can I stuff into We’re Not As Smart? So here’s a quick brain dump to simmer on the back burner.


 

We have more power than we think we do to create an economy that is more just and more prosperous.

To get there:

1) People need more power than corporations and the rich
– to stop getting screwed, to stop injustice
– to get what we really want, including the trade-offs we want
 

2) We need to embrace the fact that We Aren’t As Smart As We Think We Are
– we can’t control the economy, but so what? Making decisions in an uncertain world is what businesses do every day
– central to the solution: more democracy

A) People need more power in the economy as well as in the government
- Players over Policy: regulators can’t keep up, need something more dynamic — a balance of power
- gets to issue of accountability I’ve previously covered under We’re Not As Smart — e.g., “more savings leads to more jobs” vs reality of what happens, all comes down to who has the power to decide which interests get served

B) Democracy, aka everyone has real say, drastically reduces risk because see issue from many perspectives
– Old Open Source saying: with 1,000 eyes, all bugs are shallow

C) Movement Perspective
– e..g, fantasy of “if we all do our part” vs. thinking about how to scale up

D) Big vs. Small (Decentralized vs. Centralized: no apriori answer, only learn from experience
– economists who say decentralized wins over government planning vs. experience of Japan, S. Korea, etc (Ha Joon Chang on Toyota)
– not one vs other but finding the right mix through experience (e.g., parklettes vs. community planning)
– Focus not on big vs small but on what we actually want

E) Creating Institutions that encourage folks to take real ownership
– structures that encourage making tough tradeoffs
– structures that encouage folks to look at problems from all sides — from Organizer, Entrepreneur, Practitioner (e.g., charette )

Just How Much Leverage Did We Have over Banks: Remember Robosigning?

This week, several bloggers got into a dustup with Ezra Klein over whether Obama could have done more on the housing crisis (Ezra said Obama was basically hamstrung by the Republicans). In the course of that dustup, law prof Adam Levetin made an interesting point:

But while we’re on the topic of missed opportunities, there’s a huge one that’s been omitted from the list: the robosigning investigation. There have been three times when the Administration has had enormous leverage over the banks: the initial bailout, the first stress tests, and the robosigning investigation. Each time the Administration had the ability to force the banks to reduce principal or do whatever else it wanted, and each time it shied away. Bottom line here was that the Administration chose to protect the banks rather than deal with the losses in the housing market, and that’s not a decision it can disown.

Mind you, the whole conversation fell into the trap of focusing on what Obama could’ve done rather than what we could’ve twisted his arm into doing. Expecting any president to stand up to the banks given how much power they have seems incredibly naïve. But it does point out a key leverage point that we could have dragged him into using.

It also points out one of the challenges of Occupy Wall Street. The robosigning scandal broke after Occupy Wall Street had taken off, and yet Occupy Wall Street wasn’t able to turn it into a cudgel. Why OWS didn’t use that opportunity is a question worth trying to answer – not as way of beating up on OWS but as a useful lesson for the next time there’s an upsurge of activism.

Applied Research Center Report: Nitty-Gritty on Green Jobs in the Hood

If you’re interested in learning more about the nuts and bolts issues behind yesterday’s post — about what it would take to create green jobs that would help folks in poor neighborhoods get out of poverty — you should check out the Applied Research Center’s report, Green Equity Toolkit: Standards and Strategies for Advancing Race, Gender, and Equity in the Green Economy. Although it was written in 2009, it’s still one of the best summaries out there.

Solving Poverty: How about We Try Good Jobs?

On Sunday the New York Times‘s cover story was about Obama’s lack of progress in tackling one of the biggest issues that drove him into politics – solving poverty in desperately poor neighborhoods like Chicago’s Roseland, where Obama got his start as a community organizer. After doing a pretty decent job of describing life in Roseland and the president’s trajectory since, the article concludes:

What Roseland needs is not necessarily a big new infusion of federal dollars. What it needs more than anything else is an antipoverty strategy that is much more comprehensive and ambitious than what exists there today, an approach that focuses on improving outcomes for children from birth through adolescence…

Finding a new approach won’t be easy, of course. Back in Anacostia in 2007, Obama acknowledged that “changing the odds in our cities will require humility in what we can accomplish and patience with our progress.” But real change would take more than that, he said: “Most importantly, it will require the sustained commitment of the president of the United States.”

I really, really don’t understand why in 2012, in the middle of the worst economic crisis we’ve had since the Great Depression, moderate do-gooders still don’t get it. Yes, poverty is complicated. But getting folks out of poverty isn’t freaking rocket science. First and foremost, it takes lots and lots of good jobs.

How can I be so sure? Take what happened to black unemployment – not a bad proxy for what’s happening to poor folks overall – during the 1990s tech bubble.

The tight labor market of the late 1990s was very beneficial for African Americans. The black unemployment rate fell from 18% in the 1981-82 recession, to around 13% in the early 1990s, to below 7% in 1999 and 2000, the lowest black unemployment rate on record.

In a span of a few years, black unemployment was cut in half. Was it because we had suddenly cured the “pathologies” of poor neighborhoods? No. It was because as hundreds of tech companies scrambled to hire enough workers, the labor market got tighter.

What was particularly striking about this dramatic drop in black unemployment was that it happened without aggressive action. Employers in Silicon Valley incessantly wined about how hard it was to find employees – and how much they had to pay to get them and keep them. And yet there was Oakland, right across the bridge from Silicon Valley, with tons of young people without jobs. Silicon Valley was drenched in money, and yet no one was interested in investing in the dozens of community groups and community colleges who knew how to give these young people many of the skills Silicon Valley desperately needed. As a Bay Area lefty working in tech, it infuriated me. But in spite of this obscene neglect, the tight labor market was enough to lift an awful lot of folks out of poverty – at least while the bubble lasted.

So if we could cut black employmennt in half when we weren’t trying, what could we do if we were trying?

Suppose we said that for 11 years – as long as we’ve been in Afghanistan – we’re going to create plenty of good jobs targeted at folks who live in high poverty areas?

We wouldn’t want to pay for these jobs forever. In the long run, having the government directly create lots of jobs isn’t very efficient. We could approach it with the same kind of mindset the Japanese had towards their auto industry before it took off – massive government intervention will ruthlessly aimed at a very specific goal. In our case, we’d want to go in with a plan to build up for six years followed by a five-year build down and transition.

The jobs we’d temporarily create wouldn’t be makework; we’ve got lots of needs we could use them to address. The most obvious is combatting climate change: painting rooftops white, retrofitting buildings to be energy efficient, planting trees – which will also help cool down cities – installing solar panels, etc. There’s also plenty we could do to increase community resilience in the face of climate change, much of which requires a mix of low-skill and high-skill jobs. And we could create pools of startup capital for sustainable coops, using the very successful Cleveland -based Evergreen Cooperatives as an example.

And as we were doing so, we could provide job training, including wraparound services using the Pinderhughes model, provides

• Case management and follow up—Each student is managed by a mentor, who personally tracks the student’s progress through the program and follows up with the alumni for up to 12 months after graduation and placement into the first green job.
• Applied basic skills—Reading and math classes accompany specific technical training that is constructive and relevant to their chosen career path.
• Job readiness, life skills and financial literacy skills—Training in a variety of professional and personal skills is provided, helping students overcome institutional and internalized barriers associated with race and gender inequities.
• Critical thinking and curriculum in environmental and social justice—Students learn to develop their skills to find 21st century employment and understand their role in the large movement to sustain the planet and its peoples—an awareness that contributes to satisfaction with one’s profession.
• Stipends, housing vouchers, paid internships, childcare, training centers accessible by public transportation

Like Tough, I think comprehensive services are good idea. But if good jobs aren’t the driving force of our plans for tackling poverty, we don’t have much chance for success. As an Applied Research Center report points out,

. Since the 1980s, much of the federal funding for workforce development has supported training over actual job creation. For example, under the Job Training Partnership Act (JTPA), training is funded but actual jobs are not. Therefore, young and adult workers graduate from training without a job awaiting them. In addition, training programs and providers haven’t been linked to union apprenticeship programs. As a result, graduates have been unable to secure specialized skill jobs or the pathways they provide into the middle cla

Would this strategy get rid of all poverty? Maybe not. But it could make a much bigger dent than anything else we’ve tried.

At the end of his article, Tough worries:

It’s a challenge for any politician in troubled economic times: how do you persuade voters to devote tax dollars to help the truly disadvantaged when the middle class is feeling disadvantaged itself? The problem is that universal economic progress will not help those in deep poverty — or at least not enough. Places like Roseland need specific, targeted, effective help if they are ever going to change.

That, in a nutshell, is what’s wrong with the approach that people like Tough take. If targeted efforts aren’t tied to “universal economic progress,” they’re dead in the water. The only way we could build the political coalition needed to break poverty’s back is if speaks to the needs of the 99%.

But the problem we’ve had so far isn’t that we’ve adopted programs to create universal economic progress that haven’t helped the poor. The problem is that we haven’t had programs to create universal economic progress. Giving the bottom 15% more help while we’re trying to help the 99% isn’t that hard a sell (especially if you tell folks we’re not creating more welfare, we’re giving people who’re willing and able to work hard a real chance at a good job and a career). The Tough sell is agreeing we need to help the 99%.

Ryan 2002 to Ryan 2012: Keynes Rules!

Normally I don’t cover the presidential campaign – if you’re reading blogs, you’re probably already saturated by terrific coverage by other folks. But I couldn’t resist this get by Chris Hayes’ staff.

Whenever he gets a chance, 2012 Ryan attacks Obama’s stimulus as “a wasteful spending spree,” “failed neo-Keynesian experiment,” and “sugar-high economics . Ryan 2002?

Rep. Paul Ryan offered a forceful, full-throated defense of stimulus spending — when then-President George W. Bush wanted it in 2002… . “What we’re trying to accomplish today with the passage of this third stimulus package is to create jobs and help the unemployed,” Ryan said in video that aired today on Up w/ Chris Hayes. The remarks came during a House debate on the measure on Feb. 14, 2002…

“What we’re trying to accomplish here is the recognition of the fact that in recessions, unemployment lags on well after a recovery has taken place,” Ryan said at the time. “We have a lot of laid-off workers, and more layoffs are occurring. And we know, as a historical fact, that even if our economy begins to slowly recover, unemployment is going to linger on and on well after that recovery takes place.”…

“You have to spend a little to grow a little,” Ryan told constituents at a town hall in Wisconsin in January 2002, according to the Journal-Times, a local newspaper. “What we’re trying to do is stimulate that part of the economy that’s on its back.”

But what about the deficit that Ryan 2012 keeps harping about?

“We’ve got to get the engine of economic growth growing again, because we now know because of recession, we don’t have the revenues that we wanted to, we don’t have the revenues we need, to fix Medicare, to fix Social Security. To fix these issues we’ve got to get Americans back to work,” Ryan said. “Then the surpluses come back, then the jobs come back. That is the constructive answer we’re trying to accomplish here on, yes, a bipartisan basis.”

Is it possible that something happened in the last 10 years to convince Ryan 2012 that Ryan 2002 was wrong? I can’t think of anything in the economy that’s happened that could explain it.

When historians write the history of the age of Obama, I don’t think they could find a better story to capture what’s going on. This is not a battle of economics or even ideology. This is about the 1% versus the 99% and who’s in the White House.

Stiglitz, Zandi: Mass Refinance Housing Now!

How do you know when the economy’s really stuck in a rut? When liberal economist Joseph Stiglitz and Moody’s moderate economist Mark Zandi write a New York Times op-ed arguing that there’s only “one housing solution left: mass refinancing” similar to what the Home Owners’ Loan Corporation during the Great Depression.

Well over half of all American homeowners with mortgages are paying rates that would appear to make them excellent candidates to refinance. Many of those with stable jobs, good credit scores and even a modest amount of home equity have already done so, taking out 30-year loans at rates around 3.5 percent, some of the lowest rates since the 1950s. But many others can’t refinance because the collapse in house prices has wiped out their home equity.

Senator Jeff Merkley, an Oregon Democrat, has proposed a remedy. Under his plan, called Rebuilding American Homeownership, underwater homeowners who are current on their payments and meet other requirements would have the option to refinance to either lower their monthly payments or pay down their loans and rebuild equity.

A government-financed trust would be used to buy the mortgages of homeowners who had refinanced at an interest rate that was about 2 percentage points more than the record-low Treasury rates at which the government borrows. This would generate enough interest income to cover the costs of any defaults, administration of the trust and other expenses. Families would have three years to refinance; after that, the trust would stop buying loans and eventually wind itself down as homeowners repaid their loans.

Homeowners would see lower mortgage payments and rebuild equity more quickly. Taxpayers would get their money back, with interest, and would gain further as a stronger economy lifted tax revenues. Banks and other mortgage investors would get potentially troubled loans off their books. Some banks won’t like losing the large amounts of interest income they are earning on their current mortgages, but if the refinancing market were working properly these loans would have been refinanced long ago.

If the program was very successful, we envisage that two million outstanding loans could be placed in a Rebuilding American Homeownership trust at its peak. If the average mortgage balance was $150,000, then at the peak there would be $300 billion outstanding.

The plan could be financed through the Federal Housing Administration or the Federal Home Loan Banks, “or the Federal Reserve could underwrite the plan.”

If we don’t do it, it’s hard to see how the economy will recover anytime soon – not to mention the millions of American homeowners who will be forced to needlessly suffer. Seems like a no-brainer to me.

My Strongest Points

I’ve been wrestling with a problem: I sum up my framework with a bunch of points that feel strong, but when I shrink them down to a more manageable size, they lose their oomph. So today, rather than worrying about shrinking the list down to a more manageable number of points, I’m just going to post the points that feel strong to me, then let them simmer on the back burner for a while.


 

1) We have more power than we think we do to create an economy that is more just and more prosperous.

2) To get there, people need more power than corporations and the rich
– to stop getting screwed, to stop injustice
– to get what we really want, including the trade-offs we want

3) People need this power both in the state and in the economy
(different levels of power in both the state & economy: as individuals, as groups, as a community)

4) to succeed, we need to have a Movement Perspective – we need to think about how we get from here to there (e.g., “If we all do our part” vs. scaling up)

5) We Aren’t As Smart As We Think We Are
– we can’t control the economy, but so what? Making decisions in an uncertain world is what businesses do every day
– part of the solution: more bottom-up democracy

Are Ron/Rand Paul Socialists When It Comes to Doctors?

Recently I’ve been getting into more arguments with libertarians. One of the things that’s been striking about these arguments is that is for all their talk about how Obama is socializing healthcare, libertarians rarely bring up one of the biggest, most coercive government interventions into the market: requiring that doctors be licensed and banning other medical practitioners from performing their work. So the last time I tangled with a libertarian who was a big fan of Ron Paul I asked them, what does the good doctor say about the government violence-backed monopoly that physicians have? He didn’t know, so I decided to take a look online.

On Dr. Ron Paul’s 2012 campaign website, his message on health care is simple:

FREEDOM NOT FORCE
The answer to our nation’s health care crisis lies in freedom – not force.

As President, Ron Paul will fight to put you back in control of your health care decisions, save you money on medical expenses, and institute reforms that will once again make America’s health care system the standard for other nations to follow.

OK, I thought. That sure sounds like a call to end the government monopoly of requiring everyone who’s a doctor to be licensed by the state – and of prohibiting nurses, PA’s, etc. from doing the work that doctors do.

Ron Paul M.D. has a very long laundry list of ways to put you back in control and save you money. For example:

* Allow purchase of health insurance across state lines…

* Ensure that those harmed during medical treatment receive fair compensation while reducing the burden of costly malpractice litigation on the health care system by providing a tax credit for “negative outcomes” insurance purchased before medical treatment.…

* Stop the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) from interfering with Americans’ knowledge of and access to dietary supplements and alternative treatments.

* Prevent federal bureaucrats from tracking every citizen’s medical history from cradle to grave by prohibiting the use of taxpayer funds for a national database of personal health information.

But getting rid of doctors’ government-imposed, violence-backed monopoly? Not a word.

How about his son, Dr. Rand Paul? Continue reading