Thursday, May 2, 2013
While the Affordable Health Care Act comes closer to full implementation, Congressional Republicans continue to repeal the legislation, as financially-strapped Americans (53 million) are reluctant to visit the doctor.
According to a 2012 survey by the Center for Disease Control, 15.3 percent of the population doesn't have health insurance. Furthermore, approximately 20 percent of the population weren't insured, at some point that year.
|U.S. Census Statistical Abstract|
At the same time, the cost of health care has been rising. From 1994 until 2011 the the cost of health care increased from $970 Billion to $2.5 trillion. The United is the second highest spender (18 percent) on health care as a percentage of GDP. Government spending on health care accounts for 50 percent of the healthcare expenditure.
|U.S. Census Statistical Abstract|
Why Does it Cost so Much?
One reason for the escalating cost of health care is because of defensive medicine. In order to prevent medical malpractice lawsuits many physicians will run several medical test. Medical professional often have to take out large insurance liability insurance with heavy premiums. According to the American Medical Association, medical liability cost $84 to $151 Billion a year. Majority of the time doctors are exonerated from accusations of medical malpractice but still spend an estimated $100,000 for legal defense.
Another reason for the rise in healthcare is because of medical technology. While America may have the most innovative technology, it is continuing to become expensive to maintain that equipment. According to a study from the University of Arizona, Physicians who owned diagnostic imaging equipment ordered four times more imaging exams than other physicians.
Lastly, it is impossible to ignore the rising cost of prescription drugs. In 2009 the Pharmaceutical industry spent $26 million on lobbying. Drug manufactures are seeing the fruits of their investment. For example, Pfizer has watched its profits increased to $3.8 Billion.
HOW ARE WE GOING TO PAY FOR THIS?
Sources for funding through taxation includes insurance companies, drug manufactures, and tanning salons.
In particular, one unpopular source of funding is taxing companies that manufacture medical devices. Opponents of the measure, say it will stifle innovation, investment and could result in massive lay-off at the planets where these devices are produced. Advocates of the tax, which will contribute $29 billion, argue that the tax will hardly affect profits. Moreover, the cost will be offset because the expansion of people who will have health insurance will increase demand.
"YOU MUST GET HEALTH INSURANCE"
Last year, controversy intensified over the legality of requiring citizens to have healthcare. Although many conservatives argue that the mandate is unconstitutional, it is conservatives who supported the position. In her book, the Truth About Obamacare, Sally Pipes, President and Chief Executive Officer of Pacific Research Institute, wrote that individuals will be require to pay $700 for not having health insurance. Furthermore, Pipes quotes Representative Steven King of Iowa, who stated that the IRS will hire 17,000 tax agents for the mandate.
However, concerns over the implementation of the individual mandate may be overstated. According to a 2012 CBO report, out of the 46 million Americans who are uninsured only 6 million will be subject to pay a penalty. Many people will be exempted from the penalty because of religious beliefs, income, or legal status (Undocumented immigrants.)
Many conservatives are worried that the new law will exasperated unemployment because it will charges business $2,000 if it does not offer health insurance for its employees. Moreover, some families that get their health insurance through an employer might also be negatively affected.
Attempts to overhaul the entire legislation are problematic. There are key pragmatic items in the bill that should receive more attention from republicans. For example, one provision forces insurance companies to use more of the money accumulated from premiums on medical claims rather than marketing and advertisement. Another, provision allows young adults to stay on their parents health insurance plan until they are 26 years-old.
One issue that invariably is needed to be address for comprehensive health care reform is the shortage of doctors. According to the Association of Medical Colleges the number of doctors will continue to shrink. In 2015, it is estimated that there would be 70,000 fewer doctors than needed namely because of the expansion of health insurance and the increase demand in geriatric health services. Demographic data shows that senior citizens are expected to become 20 percent of the population by 2030. That is almost double what it is today.
|U.S. Census Statistical Abstract|
The issue is further complicated for poorer patients that rely on public programs like Medicaid.Many doctors are reluctant to accept Medicaid payments due to the comparatively lower reimbursement rate. According to the Center for Disease Control, only 69 percent of physicians accepted patients with Medicaid compared with 82 percent for private insurance. The reason for this reluctance is because reimbursement rates for Medicaid are lower than private insurers.
The ACA tries to remedy this problem by increasing Medicaid payments for primary care services by 10 percent. This is important because 215 million people visit primary care offices ever year. However, the problem again becomes complicated by the fact that 70 percent of doctors work in specialized medicine with larger student debt than regular doctors. In fact, the number of students entering medical school for primary care has dropped in the last 15 years.
The legislation is making a concerted effort to manage this shortage, by encouraging medical students to provide services to minority neighborhoods by alleviating student loan debt.
|National Ambulatory Medical Care Survey Electronic Medical Supplement, 2011|
Still, not all criticism, of the health care policy is reasonable. Some opponents are eager to equate ACA with "Socialized Medicine." Perhaps, the most outrageous comments came from former Minnesota republican contender Michelle Bachmann.
To be fair, many conservatives understand there is an urgent need for health care reform. In fact, it was Obama's predecessor, George W. Bush who upset many conservatives when he decided governmental intervention was necessary in reforming health care when he signed the Medicare Modernization Act.
The legislation would add prescription benefits to Medicare but use market forces to pay for them through private insurance. The bill passed passed the Senate but narrowly passed the House (216-215) In 2008, 22 million seniors signed up for the program.
This new policy known as Medicare part D, was originally estimated to cost 1.2 Trillion dollars over ten years (2003-2013) but was cut in half to $520 billion. Moreover, the new policy reduced the cost of premiums by 40 percent.
Another popular solution, among republican and conservative circles, is portability. Rather than allow only a few health insurance companies to dominate a the market, consumers can have more options. In 36 states one insurance company has a hold on 33 percent of the market. The problem is worse in 16 states where major insurance companies have over half.
Ideally, in a free-market society, absent government restraints, consumers are able to evaluated alternative products and services and choose the one that best fits their needs. However, in a marketplace that consist of 1300 Insurance companies and over 22,000 items, and medical procedures available, the byzantine process is less helpful. According to Consumer Union, a consumer advocacy group, as the number of options for a product increase the probability that the consumer will make the best selection decreases. The group cited a study on Medicare part D, that found that even medical students have a hard time choosing the best insurance policy as options increase.
This is problem especially for Americans who are denied certain payment of specific medical claims such as a Stacey Grondin, grocery store manager from Nashville, who went to the hospital for heart problems. Grondin had to pay $1,000 because her health insurance company refused to pay for the ER and ambulance ride. Anecdotal stories like Grondin are abundant.
Although, the country has made remarkable improvements in health, there is still room for improvement. The U.S. ranks 56 in life expectancy, and has the sixth highest percentage (32 percent) of obese adults. There are serious concerns over the new health care legislation however, repealing the entire bill is not going to help, it is only going to make it worse.
Friday, April 19, 2013
|Congressional Budget Office|
There are a variety of reasons why the government's budget has retain a deficit for the last eight years. Lawmakers on both sides of the political spectrum are urgently trying to find a solution to this problem.
Stubbornness exist on both sides of the political spectrum, Democrats are cautious over spending cuts that will increase unemployment, Republicans, wax political over a bloated government that tax too much. The central economic theme of the GOP is built around cutting taxes and spending, while maintaining a strong military.
Theoretically the problem is quite simple. The government spends more money than it takes in as revenues.
The Democrats are known for increasing taxes to spend on social programs. Democrats, are guided by Keynesian economics that stipulated government spending stimulates the economy. in contrast, the Republicans believe that tax cuts incentivize businesses to expand their operations and hire more people. History shows that neither party are confined to their economic orthodoxies once a member of their own party assumes the oval office.
The national debt has risen precipitously since this century began.
SPEND! SPEND! SPEND!Much of the rise in the national debt can be attributed to the spending habits of Obama's predecessor. In his first year Bush took a $236 Billion dollar surplus and turned it into a $158 Billion deficit. Bush's spending increased so much that he even had trouble convincing Republicans to allocate a quarter of a billion dollars to community colleges for job training his second term.
Still, for all the criticism Bush received he did cut discretionary spending as a percentage of GDP from 3.4 percent in 2002 to 3.1 percent in 2006. moreover, the deficit decreased from 3.5 percent of GDP in 2004 to 1.2 percent in 2007. However, some dispute that number.
|U.S. Government Spending|
- 27 states reducing health-benefits to low income children
- 34 states cut college assistance
- 13 states have announced layoffs
- 32 states reduced state workers wages
MIDDLE OF THE ROADAlthough Obama has been profligate in his first year he has made numerous attempts to cut spending in return for modest tax increases. Obama has proposed to cut spending by $400 billion on health programs and $200 billion from other parts including the democrat's sacred cows such as federal employee retirement accounts, and unemployment compensation. In fact, Obama $3.77 Trillion budget, is expected to cut the annual deficit by more than $200 Billion from $744 Billion to $973 Billion in 2014.
Still, despite Obama's continuous efforts to move more toward the center, the Republican party has become increasingly intransigent.Obama's original olive leaf to the republicans was an ambitious $1.2 trillion in tax increases over ten years. Realizing the Republicans were not going to budge, Obama moved the chess piece back to $600 billion. Still, many Republicans such as Eric Cantor refuse to concede on raising taxes even though Obama planned to balance the budget over ten years with a mix of spending cuts (80 percent) and tax increases (20 percent.) Under Obama's plan, the deficit would shrink to 1.7 percent of GDP by 2023.
It is hard to curtail spending when nearly half of all households receive some form of government assistance compared with 37 percent in 1998. At the same time period the amount of money spent on programs like Social Security increased from close to 40 cents for every tax dollar to 66 cents. This has led former Republican presidential contender, Newt Gingrich to refer to the U.S. safety net as a spider web. Furthermore, According to the New York Times, for every dollar that is contributed to medicare, the beneficiaries will receive three dollars in return. Indeed, medical benefits are expected to rise by 66 percent in the next decade.
One proposal suggest by Obama's budget to curtail the growth of Medicaid is to reduce payments to prescription drugs and to minimize fraud and abuse. Another proposal floating around that has upset progressive groups is the implementation of the "Chain CPI" for social security benefits in exchange for more revenue. According to the Center on Budget Policy Priorities, CPI would add $230 billion worth of savings.
Another example, is the sequestration, 85 billion dollars in spending cuts in exchange for allowing the Bush tax cuts to expire. Under this economic policy many government programs, both discretionary ($71 billion) and mandatory ($14 billion), were to receive a 5 percent cut.
Although 85 billion dollars is not enough to make any significant change, many groups are worried that the cuts will mostly effect people who need the assistance the most. Nearly, a million jobs might be lost due to the sequester.
Moreover 775,000 low-income mothers may loose access togovernmental programs such as WIC that provide supplemental nutritional food items. This should be particularly important given the rise in single motherhood over the last decade. According to a New York Times article, more than half of all births in America to women under thirty are out-of-wedlock. More than 66 percent are of all births in America are from women under thirty. Although, the rate of single mothers has risen sharply in the last decade it only accounts for 29 percent of all white children, 51 percent of Latinos and 73 percent of African Americans.
One of the items in President Obama's budget that might attract single mothers is expanding preschool. The Center for Budget Policy Priorities notes that Obama plans to allocate $75 billion dollars for states to expand access to preschool for families 200 percent under the poverty level. This program would also help middle income families.
It will be interesting to see how the demographic shift will influence government spending.
|Source: U.S. Bureau of the Census|
Still, the spending cuts proposed by Obama are mild compared to his GOP counterparts such as Paul Ryan. Under Paul Ryan's "Road to Prosperity" the prince of austerity, would cut the federal budget by 40 percent. Over the course of ten years, Ryan would cut taxes by $4 trillion and reduce spending by $6 trillion.
Moreover, Ryan's plan is hard to take seriously because he has no intention of cutting the military which, accounts for 20 percent of the federal budget. The Iraq and Afghanistan Wars are prime examples why the government should exercise frugality on military expenditures especially because it is harder to document all the expenses. The lack of accounting transparency has led David Walker, Comptroller General, to testify before Congress on DOD accounting. The interest to finance the wars is estimated to reach $1 trillion by 2017. According to economists Joseph Stiglitz and Linga Bilmes, The Department of Defense spends $500 billion a year with little transparency. Since 1997 DOD has failed the annual financial audit even the DOD"s own Inspector General testified before Homeland Security about the Department's lack of transparency in accounting.
It is important to note a few things about the Military budget, defense spending is separate than the spending on war which is done under an appropriations committee. Second, much of the cost are not accrual, which means that the budget does not take into account future costs. This is important because the total cost for caring for veterans of the World War two did not peak until 1993. Furthermore, the wars also have an effect on other parts of the budget such as Social Security and Medicare.In 2007 it was estimated that 45,000 returning veterans will be filing for social security disability claims. Moreover, the cost of treating veterans including medical cost and unemployment insurance may reach $700 Billion. Trying to balance the budget while ignoring military spending is not smart policy. Of course the Republicans are not the only party reluctant cut the defense budget. With a military budget the size of the next 20 largest militaries in the world, I think Obama can afford to cut more than $100 billion of defense spending over the next ten years.
Spending cuts are only part of the solution, any comprehensive plan is invariably going to include some adjustments to taxes. According to conservative groups like Americans for Tax Reform Obama's new budget is filled with to many tax hikes such as
- Tax on "carried interest" on investment
- Tax on private retirement funds such as IRA and 401(Ks)
- Tax on tobacco products
- Energy Taxes
One of the tax item that have been of particular interest in the media that was identified by the Americans for Tax Reform are the profits earned overseas by American corporations which will add $158 billion in revenues. While the tax bill on corporations is expected to rise, corporate taxes as a percentage of the economy is expected to remain low.
|Congressional budget Office|
It should also be noted that although corporate taxes have increased so has net profits over the past couple of decades.
Still, many conservatives feel that the rich already pay more than their fair share of taxes.
According to the organization, Center Budget Policy Priorities, Obama's budget would eliminate deductions that are used by the top two percent to lower their total tax bill. This would generate close to $529 billion in new revenue over ten years. Similarly, the new Obama budget wants to tax at least 30 percent of the income of millionaires. Moreover, the budget would like to restore the 2009 estate tax, which taxes the first $3.5 million estate for individuals.
Moreover, the United States still pays considerably less in taxes than other western industrialized countries.
The government needs to take some action to curtail the rise of the national debt. Although the deficit is expected to drop to $845 billion next year, however, if no intervention is taken by the government, then the deficit will increase $7 trillion over within the next decade according to the Congressional Budget Office. Furthermore CBO estimates that the national debt will equal almost 80 percent of GDP by 2023.
The Republicans should respond accordingly through raising taxes it would indicate that they are serious about growing the economy. Likewise, the democrats should realize that balancing the budget, will inevitably lead to serious reforms in spending, especially mandatory spending. While, Obama's federal budget plan is not an economic panacea it's a noble start.
Friday, March 29, 2013
A person who has seen a million television commercials might well believe that all political problems have fast solutions through simple measures
Of course, Democrats are not the only party with mutinous fringe groups. In the last CPAC gathering, Islamophobes Pamela Gellar and Robert Spencer claimed that CPAC has been infiltrated by members of the Muslim Brotherhood.
CPAC has ties to the MUSLIM BROTHERHOOD:
Even in the realm of diplomacy there are noticeable differences. While neo-conservatives want to isolate
Political nuance is also reflected in social policy as well. While Obama is known as the Deporter-in-Chief for deporting more illegals than his predecessor, Reagan was more lax with immigration.
During his second term in office Clinton became more socially conservative, by enacting DOMA, Defense of Marriage Act, getting tougher on crime, and placing more restrictions on welfare. In contrast, President Dwight D. Eisenhower, spearheaded key parts to the civil rights legislation.
According to the study, many of the reports that came from the media during the campaign seamed to reiterate what the candidates where saying rather than challenge them.
A good example of the symbiotic relationship between the mainstream media and the government was illustrated on Al Jazeera:
Of course this is not the first time a president has used the media to propagate policies. When Woodrow Wilson was in power, the former president established the Committee on Public Information, to control information about the first World War.
The problem is becoming more pronounced because the media does not have enough resources to filter all the information they receive from various interest groups due to budget constraints. Whatever, the reason may be, It is noteworthy to point out that a third of respondents in the study said they had abandon a news outlet.
The main point is that many people on both sides of the spectrum only consume media that appeals to their ideology. Liberals and conservatives become so engulfed by their selective media outlets that they begin to lose any ambition for dissent within their own ideological group. Instead of using logic to address numerous issues, Ideologically driven news, as reflected during the Campaign, has created a political environment rich in ad hominem attacks, slippery Slope fallacies, and straw men rather than concrete facts and well-researched analysis.
The state of the media report, offered some useful insight into the relationship between media and democracy. Unless the media undergoes serious reform, it will cease to become a conduit of critical information but instead turn into an oasis for entertainment and extremism.
Saturday, March 23, 2013
The united states invaded Iraq on march 23, 2003 under the pretense that Saddam Hussein possessed weapons of mass destruction and that he might use terrorist groups like AL Qaeda to launch attacks against America. Moreover, Saddam needed to be removed from power because he was a threat to his people as a dictator and a threat to his neighbors including Saudi Arabia, Kuwait, Iran, and Israel.
Evidence eventually surfaced that proved these accusations were false. The liberal narrative that emerged from the war was that Bush purposely misled the American public to legitimize war with Iraq to secure lucrative oil contracts. Another liberal view is that Bush was behind 9-11.
Liberal commentators salivated with rage at the motivations for invading Iraq
It's easy to criticize the former president George W. Bush without knowing all the facts.
Prior to the invasion of Iraq, the Intelligence community prepared a National Intelligence Estimate which investigated the former Iraqi dictator's WMD programs and concluded that "Baghdad has chemical and biological weapons." In the 90s UN inspectors had stumbled upon thousands of bombs, shells and warheads containing "chemical agents." The report stated that Saddam had a nuclear weapons program. Moreover, in 1995 Saddam admitted that he had a weapons program that included anthrax and botulinum toxin.
It was not just the American government who believed that Saddam had WMDs but numerous countries' intelligence agencies arrived at similar conclusions including Germany China and Russia. Huessin even confessed to FBI agents that he was pretending that he had WMDS to deter Iran.
I encourage skeptics to look at the testimony of Swedish diplomat Hans Blix to the United Nations in early 2003.
"The message they're sending is that any country which fears a veto from the UN can take unilateral action. that means they're introducing chaos into international affairs"
Ironically, one of the countries opposing U.S. intervention in Iraq was Israel.
The international and congressional consensus gave the impression that Saddam Huessin had WMDs.
Of Course WMD's was not the only reason why the United States decided to invade Iraq. In the aftermath of 9-11. A fictitious relationship between Al-Qaeda and Saddam Huessin emerged, even though Saddam was a secular nationalist leader and Al Qaeda was a pan-jihadist terrorist network. However, Saddam did support other forms of regional terrorism including Abu Abbass, and Abu Nidal who killed 19 people in Europe. Still, the 9-11 terrorist originated from Saudi Arabia, NOT Iraq. Furthermore, Iraq became a magnet for terrorists.
The third reason why the United States invaded Iraq was because Saddam was a brutal dictator. A Dictator's dictator. Saddam has a laundry list of human rights abuses including
- Killing more than 140 Shia Muslims after a failed assassination attempt in 1982.
- Numerous prisoners were subjected to electrical shocks
- Women were raped by Iraqi police
- In one case a women giving birth in prison was denied medical attention, which caused the baby to suffocate One women was denied medical care, the baby got stuck between the women's legs and died from suffocation.
- Saddam gassed thousands of Kurds. In 1988 as many as 10,000 Iraqis were gassed.
- Saddam scalded Iraqis with acid and cut out the tongue of political dissidents
Furthermore, Saddam Hussein was in violation of 16 Security Council resolutions.
Still, many political observers are skeptical of this rational because much of the human rights abuses carried out by Saddam were during the Iran Iraq war, when the historical record shows U.S. government favoring Iraq during the Iran-Iraq war.
Reading the news reports would seam to suggest that Saddam and the United States government are eternal enemies. a Cursory glance at history shows otherwise. During the Kennedy administration, the Central Intelligence Agency used Saddam Huessin's anti-communist party to overthrow Abdul Karim El-Kassem.
Unfortunately the usurpation of Saddam Hussein and his Baathist party did not produce a more justice and equitable society. The Shia and Kurdish forces that took control in a post-Saddam Iraq have been accused of engaging in abductions, assassinations, and other "acts of intimidation."
Ayad Allawi, secular Shia Muslim, told the London newspaper the Observer, that the de facto Shia security forces have initiated "Death squads" and "Secret torture centers." At one time 173 detainees were found in a government building, some had been tortured or malnourished.
Of course, the proliferation of WMDS, the spread of terrorism and the oppressive force of a dictator are global issues that require an international solution. In some cases military force can work to eliminate these problems. History has shown that an interventionist foreign policy can have mixed results. Notwithstanding the international concerns over Iraq, the reckless and excessive use of force has deepened fault lines and made the Iraqi public more skeptical over the United States intentions.
The first example of this occurred before the Iraq war officially started when the London Times stumbled upon a government document known as the Downing Street Memos. The Downing Street memos, reported that the United States in conjunction with the UK used 22,000 sorties to strike Iraq, hitting 391 targets. The Iraqi public vociferously protested the attacks to the UN.
Additionally, incidences such as the capture of Fallujah (which was a target of a U.S. hell-fire missile killing 140 civilians during the Gulf War) Haditha and the murder of two Reuters reports as revealed in Wikileaks cables, severally damaged the United States reputation for providing security.
However, it should be noted that it is difficult to engage in combat operations when the majority of the population is located in urban areas (66 percent).
The death of innocent civilians was just one of the obvious effects of war. The invasion of Iraq produced numerous unintended consequences. Malnutrition doubled within less than two years after the occupation. Numerous checkpoints spread across the country has caused delays in the transportation of food and medical supplies, which caused inflation.
According to a study from Brown University, the number of Iraqis living in slums had skyrocketed to 53 percent in 2011 from 17 percent before the war. In 2008 the UN World Food Program issued a report that details concerns over food insecurity as well as other health concerns.
Not all the social economic problems facing Iraq are a result of the Iraq War. Much of these problems stem from 12 years of sanctions. The sanctions has led to a humanitarian crisis and a struggling economy. This has led numerous Iraqis to take refugee in religious institutions. Some of the consequences of the sanctions included:
- The downgrading of Iraq's ranking in the UN Human Development index from 126 to 174
- a serve deterioration of the healthcare system
- rise in the cost of imported goods
- UNICEF reported in 1999 that Iraq was ranked 188th out of 188 countries for having a high-rate of child mortality.
- These are just some of the ways the sanctions impacted Iraq
In the book "Three Trillion Dollar war" Joesph E. Stiglitz describes the Humanitarian crisis:
"The Country's roads, schools hospitals homes and Museums have been destroyed and it's citizens have less access to electricity and water than before the war."
Still, the UN Human Development data for Arab States has shown mixed results for Iraq in the last decade. The GDP has fluctuated greatly.
Interestingly, despite the mass exodus of the Iraqi Middle Class, the number of physicians to citizens has remained relatively the same (.6 per 1,000 citizens).
Additionally the data shows that women's participation in society is mixed while the participation of women in the labor force has increased, Women have not increased their representation in politics as reflected in the Iraqi Parliament despite a 25 percent increase of the female population from 2000.
Lastly, NGO workers should be careful lest they be seen as embedded with coalition forces.
Iraqis are not the only ones bearing the cost of the war. The Iraq war has caused U.S. tax payers over two trillion dollars. In fact, tax payers are stilling paying over $4.3 billion dollars in benefits, to more than 200,000 veterans from the last Iraq war. The current war has been largely financed by borrowing from other countries rather than through revenue.
National Priorities Projects has outlined different ways the money could have been used domestically:
- 8 million more housing unites
- 15 million additional public school teachers
- 530 million children receiving healthcare for one year
- 43 million students receiving a four-year scholarship to attend a state university.