Fri, 28 Aug 2009

Freedom's just another word...

I was at Representative Langevin's "town hall" meeting last week at Warwick City Hall. It was a pretty raucous event, as I'm sure you've heard already. Being late with the news is part of the routine for a weekly column.

A number of people spoke movingly about freedom while asking questions of Langevin. There was talk about freedom of speech, of course, though precious little about any accompanying responsibility to allow the same for one's fellow citizens. A woman told a moving story about how a brain tumor had cost her job, which then cut off her insurance, leaving her facing brain surgery without a way to pay for it. In the middle of this, someone yelled "No funding abortion!" forcing her to stop momentarily. Other people yelled "Liar!" and "Doubletalk!" at Langevin while he spoke. One woman in the front row brought a sign that simply read, "Boo," which she held up from time to time.

Beyond the irritating stuff, there was a lot of earnest concern shown by people who are worried about what reform might mean to them. These people deserve real answers, and it's to Congress's shame that they haven't been able to come up with a real bill yet. But in addition to earnest questions, there were also a lot of crazy ideas on display: comparisons between Obama and Hitler, claims that health care reform leads to socialism, and so on. But the claim that I find amazing was implicit in so much of what was said: that only government can oppress.

Freedom is an important thing, and certainly plenty of people have fought and died for it. I honor their sacrifice, but I also wonder if they would all agree that government is the only danger to freedom. After all, my favorite paean to freedom was made famous by Tennessee Ernie Ford:

You load sixteen tons and what do you get?
Another day older and deeper in debt.
St. Peter don't you call me, cause I can't go.
I owe my soul to the company store.

See more ...

10:36 - 28 Aug 2009 [/y9/cols] link

Tue, 25 Aug 2009

History: Leveraged buyouts

Apropos of issue 38, out tomorrow, here's some good reading about how government policy encouraged layoffs in the 1980's, from those radicals at Forbes magazine. Remember, the shape of today's economy wasn't randomly forged by impersonal forces of nature. It is largely the result of consciously chosen government policies. Read here.

14:19 - 25 Aug 2009 [/y9/au] link

Fri, 21 Aug 2009

We're in it together

In order to deal with the ongoing budget crisis, it seems that East Providence may be losing 13 police officers. Earlier this spring, Woonsocket and North Providence narrowly averted similar layoffs.

There are a bunch of reasons to worry about news like this -- it's an obvious symptom of financial catastrophe, for one thing -- but the big one for me is about preventing crime.

Police officers are the most cost-efficient way we have of combating crime. During the 1990's, the nation's crime rate dropped precipitously. To this day, experts debate the reasons why, and there is not yet a consensus. But I like an important contribution to the debate that came in 2004, from University of Chicago economist Stephen Levitt. He published an article that year called "Understanding why crime fell in the 1990s: Four factors that explain the decline and six that do not." (It was reprinted in his book, "Freakonomics," and you can find it here.)

See more ...

23:37 - 21 Aug 2009 [/y9/cols] link

Mon, 17 Aug 2009

How do they do that?

Some places in America are not doing so badly controlling health care costs. Some other places are simply awful. What makes them different and which are they, anyway? An interesting conference called "How do they do that?" attempted to get at some of these points, and a New Yorker article found there picks up some, too.

What's the answer? Seems to be one of those unsatisfying and villain-less, but likely correct, stories about the culture of the place, and what people think is normal.

21:52 - 17 Aug 2009 [/y9/au] link

Health care information from the White House

I appreciate lists of things, as anyone can tell. So here are some good lists of eight things. I'd only suggest that some uses of "myth" below are a little kind. I think "lie" might be equally appropriate.

8 ways reform provides security and stability to those with or without coverage

1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Ins urance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

Learn more and get details: http://www.whitehouse.gov/health-insurance-consumer-protections/

8 common myths about health insurance reform

1. Reform will stop "rationing" - not increase it: It's a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.
2. We can't afford reform: It's the status quo we can't afford. It's a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.
3. Reform would encourage "euthanasia": It does not. It's a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.
4. Vets' health care is safe and sound: It's a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.
5. Reform will benefit small business - not burden it: It's a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.
6. Your Medicare is safe, and stronger with reform: It's myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.
7. You can keep your own insurance: It's myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.
8. No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you - and the same rules of privacy will apply as they do for all other electronic payments that people make.

Learn more and get details: http://www.whitehouse.gov/realitycheck http://www.whitehouse.gov/realitycheck/faq .

8 Reasons We Need Health Insurance Reform Now

1. Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults - 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market - were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/- denied_coverage/index.html
2. Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html
3. Roadblocks to Care for Women: Women's reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more: http://www.healthreform.gov/reports/women/index.html
4. Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates o f poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes
5. Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured - 13 million people - are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline
6. The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction
7. Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov- /reports/inaction/diminishing/index.html
8. The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.whitehouse.gov/- assets/documents/CEA_Health_Care_Report.pdf

08:46 - 17 Aug 2009 [/y9/au] link

Sat, 15 Aug 2009

As predictable as mushrooms after rain

Some things are easy to predict: mushrooms will bloom three days after the rain; mosquitoes will come out at dusk; and property tax increases will follow a disastrous state budget cycle like we saw this spring. I admire the weird delicacy of the mushrooms, but otherwise watching these events unfold gives me no pleasure. But they do have an oddly reassuring feel, a sign that indeed the world is still spinning on the same axis, sigh.

Much of the state is now enjoying substantial property tax increases in order to pay for the tax cuts to the rich that survived yet another General Assembly session. Around half the towns in the state are going to see increases over 4%. The City of Pawtucket is looking at an 8% increase this year. They and others were granted an exemption to the 4.75% limit because of the cuts in state aid. I also see that the Woonsocket school committee has settled its Caruolo suit seeking more funds from the city, but Pawtucket's suit is still pending. West Warwick's suit appears to have collapsed into a morass of finger-pointing, Cranston has an appeal pending for the 2008 school year, and, well, it's hard to tell exactly what's going on in East Providence.

See more ...

18:51 - 15 Aug 2009 [/y9/cols] link

Tax cuts and tea parties

Speaking of tax cuts, I see from a press release they sent me that "RI Tea Party" activists, Colleen Conley and Marina Peterson, met with Reps. Langevin and Kennedy to request public meetings during the recess this August. Langevin had already scheduled two meetings, August 19th at the Warwick Police Station in Apponaug, from 6 to 7PM, and another in Westerly on September 3, 4:30PM at the Wilcox Park bandstand. (Please attend.) Rep. Kennedy has not made plans yet for public events, though he may hold some sessions at the state house.

Today's column is about predictable events, and I predict that the reason the tea partiers want to have public meetings is so they can flex their muscles in much the same way that allied activists in Tampa, Ohio, St. Louis, Arizona and other places have flexed theirs in the past week. In each of these places, public meetings by Democratic Representatives have been broken up, drowned out and dominated by shouting activists seeking to preserve the perquisites of health insurance and drug companies. In these other places, we've seen people carrying signs comparing health care reform to the Holocaust, almost a dictionary definition of loss of perspective.

These folks seem determined to let us all know that they -- a minority of the population according to all the polls I know about -- insist the rest of us continue to muddle by with our insane overspending on health care. (Health care is, of course, a major source of the angst at school committees, but also at my house, and probably yours, too.)

Just remember, we spend a huge amount of money on health care compared to other countries, and get worse results on almost all the important indicators. According to the OECD, in 2003, we spent $5,711 per person on health care. France spent $3,048, Canada $2,998, Germany $2983, Norway $3769, Switzerland $3847, and so on. Other people get more and pay less. Why not us, too?

Why are activists willing to overlook these facts and come out to shout at members of Congress? The sad truth is there is a certain perverse pleasure in focused hate, and the opportunity to yell about it for a bit. In George Orwell's 1984, the leaders of Oceania had everyone participate in a daily "Two Minute Hate" because it helped keep everyone focused. I predict that the local tea partiers want to have an event in order to keep their allies focused, and because it is politically convenient to weaken Democrats, even at the expense of fixing a health care system as broken as ours. That is, political advantage is more valuable to them than helping figure out how to get you the health care you need at a price that won't cripple our economy further.

I also predict that by predicting these things, I will become the focus of some of the activists' ire, but I further predict that they will be slightly less likely to become disruptive at Langevin's meetings in order to prove how wrong I am. I generally don't like to be proven wrong, but in this case, I welcome it.

18:50 - 15 Aug 2009 [/y9/cols] link

Fri, 14 Aug 2009

Public Appearances

Hear me talk about my book, Ten Things You Don't Know About Rhode Island at 2pm, August 13, on Dan Yorke's show on WPRO (99.7FM and 630AM), and then again on Citadel Community, Sunday August 16, 790AM (5am), 106FM (6am), 105FM (6:30am), WPRO 99.7FM and 630AM (8am).

Update: Podcast of the Dan Yorke segment is here

13:50 - 14 Aug 2009 [/y9/au] link

Sun, 09 Aug 2009

Just FYI

Health care spending per capita in the industrial countries, according to a 2003 OECD survey. Go look.

20:50 - 09 Aug 2009 [/y9/au] link

Is it worth it?

Last week, Andrew Cuomo, the Attorney General of New York, put out a list of the bonuses paid to bank executives whose banks had received funds from the bank bailout of last winter.

Citigroup, a bank that has received $45 billion from the "Troubled Asset Relief Program" (TARP), awarded $5.33 billion to a few hundred employees. Over 700 Citigroup employees received bonuses of over $1 million, 44 received bonuses of more than $5 million, and 3 got more than $10 million. Citigroup has not repaid any of the bailout money, and only survives to this day because accounting rules have been modified so they would not seem insolvent.

At Bank of America, who has also received $45 billion, they're giving away $6.9 billion in bonuses. (BOA only got $35 billion in TARP money, but another $10 billion went to Merrill Lynch, which they now own.) That's 868 employees getting more than $1 million, and 18 getting more than $10 million.

These bonuses are not only huge and inappropriate, but they were clearly made with your tax dollars. Merrill Lynch, for example, lost $27.6 billion last year.

Put another way, all the income tax I paid last year, along with all the tax from hundreds of thousands of my peers, went to pay the bonuses for a few hundred executives at a handful of companies who were at the center of a financial storm largely caused by their recklessness. I don't know about you, but I feel proud to be doing my part to protect the marvels of our great system of free enterprise. I'll sleep better at night knowing that my tax dollars are going to fund the expansion of some lovely private homes in Greenwich, Connecticut.

See more ...

20:25 - 09 Aug 2009 [/y9/cols] link

Sat, 01 Aug 2009

Fiscal responsibility: A good thing or not?

Is fiscal responsibility a good thing or not? Sometimes it's hard to tell. I was reading last week about the Congressional debates on health care. It reminded me of the last big health care overhaul Congress took on. This was the 2003 "Medicare Prescription Drug, Improvement and Modernization Act," and its passage has some things to teach us, or remind us, anyway.

For one thing, part of the reason health care reform is taking such a tortuous path through Congress is the professed concern among many of our representatives that the reform bill include a source of revenue to pay for the benefits. But this is complicated. Perhaps the money should come from a tax on millionaires. Maybe from taxing health benefits. Or maybe from taxing soda, or from savings squeezed out of the system. So, like any bill with complicated details, it's easy for people to find something to pretend an objection to, when their real goal is just to deep-six the whole thing.

Let's remember that the 2003 Medicare Act was all expense, and contained not a single dime of revenue. And yet, remarkably, it got most of the Republican votes, and lots of Democrats voted for it, too.

See more ...

23:12 - 01 Aug 2009 [/y9/cols] link

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