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1

Ryan turns knife on Medicare, Medicaid

By Margaret Flowers, MD
FireDogLake, April 6, 2011

Rep. Paul Ryan of Wisconsin, the Republican chairman of the U.S. House Budget Committee, unveiled two proposals this week which if enacted would constitute a mortal threat to our nation’s health – particularly to the health of our seniors and our most vulnerable populations.

The first proposal, Senate Joint Resolution 10, would amend the Constitution by imposing rigid and arbitrary restraints on federal spending. The second, his fiscal year 2012 federal budget resolution (misleadingly and eerily called “The Path to Prosperity”), would essentially kill the Medicare program and gut Medicaid, among its other nasty effects.

Both proposals should be emphatically rejected.

Ryan clearly has health care on his hit list. He stressed the problem of health care costs during his final testimony to President Obama’s bipartisan National Commission on Fiscal Responsibility and Reform last December. He said then that he would borrow pieces of the commission’s report for the federal budget, but his latest proposals are in fact much more radical.

The Deficit Commission report stated that if the national health law did not control health care costs, then that ought to trigger more drastic changes in health care spending. Rather than wait for a trigger, Ryan is moving full steam toward the dismantling of our public health programs for the poor and elderly, and the creation of an even more fragmented, privatized and dysfunctional health care landscape than we have now.

Seniors to join the growing ranks of the under-insured

Ryan would change Medicare from a guaranteed benefit program to a limited spending program which pushes more seniors into the private market. Similar to the new federal health law, seniors would be given a defined amount of money that they could use to purchase private insurance on an exchange. Such subsidies are expected to grow more slowly than overall health care costs, so that as insurance premiums rise, seniors would be pushed into skimpier plans that would leave them unable to afford needed care and financially vulnerable should they have a serious accident or illness.

The dismantling and privatization of Medicare, which would be completed by 2022, would actually lead to higher overall health care costs and poorer health for our Medicare population. Health care costs would be higher because of the added private-insurer expenses of profit and inefficient administration. For example, Medicare Advantage plans, run by the insurers, currently cost about 10 times more to administer than the traditional Medicare program.

It is also possible that increased cost-sharing in the form of higher co-pays and deductibles would cause seniors to delay or forgo necessary care leading to greater costs on the back-end for a greater number of and lengthier hospitalizations. (In a darker, bone-chilling moment, one economist recently remarked that delayed care leading to early deaths results in reduced U.S. health spending.)

Further privatization of Medicare will also increase the fragmentation of our health care financing, which will weaken the program’s ability to negotiate fair prices for goods and services.

Ryan describes this change as similar to Medicare part D, for which he voted in 2003. This is another scary thought. The result of Medicare part D was greater confusion and obstacles for seniors, a huge new burden on taxpayers, and windfall profits for the pharmaceutical industry.

Medicaid will shrink in a time of growing need

Regarding Medicaid, Ryan proposes to change the federal portion of the program’s funding to block grants. This means that rather than deciding what part of the population qualifies for Medicaid and adjusting the amount of money allocated based on need, as we do now, states will instead receive a defined lump sum to use as they see fit.

This approach is misleadingly marketed as providing states with greater flexibility. However, Ryan also wants to cut Medicaid spending by $1 trillion over the next 10 years, which will effectively eliminate the Medicaid expansion envisioned under the federal health law and impose even more severe limitations on the number of people and services that will be covered.

In times of growing unemployment and poverty, with more people needing Medicaid, there will be fewer dollars and no guarantee that people will be able to enroll. This will effectively leave millions of our most vulnerable citizens unable to receive necessary services, leading to increased suffering and deaths.

Ryan seriously suggests that those who qualify for Medicaid should be put into the private insurance market in the mistaken belief that this will provide greater choice and cost efficiency. But this is ludicrous, given the well-known track record of the private insurers.

Correct diagnosis, wrong prescription

Ryan does get one thing right: he correctly observes that health care costs are intimately tied to our nation’s budget problems. Health care expenses are expanding way out of line with our economic growth. And yet for all of this spending, a third of our population is either un-insured or under-insured, the medical bankruptcy rate is high, and our health outcomes are relatively poor.

What Ryan fails to understand is that Medicaid and Medicare are not the cause of our rising costs, but rather are the victims of our broken health care system. Medicaid and Medicare costs are actually rising more slowly than our private sector costs. For more on this, see this summary from a congressional briefing on Medicare and the deficit.

Ryan’s plans mirror the austerity measures being pushed in many states across the country and represent an escalation of the worst proposals put forth by the bipartisan Deficit Commission. These growing threats to our social programs require that we step up our defense of the public health infrastructure and make an even louder case for an improved Medicare for all.

As for Ryan’s proposal for a constitutional amendment to cap federal spending, one wonders how much of it is driven by political grandstanding.

S.J.Res.10 would limit federal spending to 18 percent of the gross domestic product, something that hasn’t occurred since 1966. (It’s currently around 24 percent of GDP.) This may sound like a laudable goal until one realizes that during an economic downturn, as we are currently experiencing, there is a much greater need for government spending on programs such as food stamps, unemployment benefits and public health insurance.

A new, arbitrary ceiling on federal outlays could prove disastrous. Noted economist Joseph Stiglitz makes the case that a temporary increase in investment in public programs is required in a downturn in order to make economic recovery possible.

Rep. Ryan hinted at his true agenda during the final meeting of the Deficit Commission when he said that he liked discretionary caps. Significantly, his constitutional amendment would exempt military expenditures in times of war (a seemingly permanent condition for the U.S. today) from such caps.

Greater urgency to protect our right to health care

Section 4 of S.J.Res.10 is also a matter of concern, particularly for single-payer advocates. It states that any bill that raises taxes or imposes a new tax may only pass with a two-thirds majority vote in Congress. Because a national single-payer program would replace current health spending on insurance premiums and out-of-pocket expenses with a new, equitable, and progressive system of taxation to finance universal care, this undemocratic amendment would constitute another obstacle to enacting an improved Medicare for all.

Yet it is precisely single payer that’s the solution to our health care and economic crises: an improved and expanded Medicare-like system that covers everyone. This will achieve the goals of a universal, comprehensive health system which controls our health care costs, relieves businesses of the burden of providing health care coverage and provides a framework within which quality of care and health outcomes will improve. My testimony and that of others presented to the Deficit Commission last summer made that argument.

It is imperative that we take a strong stance to end this assault on our health. Speak to your elected officials today. Tell them to reject Ryan’s proposals. And tell them you want a real solution to our health care crisis: single-payer national health insurance as embodied in H.R. 676.

Margaret Flowers, M.D., is congressional fellow at Physicians for a National Health Program.

http://www.pnhp.org/news/2011/april/ryan-turns-knife-on-medicare-medicaid

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Paul Ryan’s plan would modernize a program stuck in 1965.

Liberals seem delighted that Paul Ryan and the GOP have decided to charge the fixed bayonets of Medicare reform, denouncing the new House budget as a crime against seniors, humanity, and so on. Republicans are taking a huge political risk, but they are now setting the reform agenda, and their honesty may even oblige a national debate about the future of an entitlement state that can’t survive in its current form.

Mr. Ryan’s core insight is that Medicare needs to be modernized if it is to survive. The federal insurance program for the elderly has barely changed since 1965, several health-care revolutions and trillions of misspent tax dollars ago. The GOP plan—known as premium support—would rationalize Medicare’s burden on taxpayers, while introducing market competition to control costs.

As Democrats build their re-election bids around Mediscare demagoguery, they’re pretending that the choice is between “privatization” and a free lunch. Mr. Ryan has done a service in exposing this illusion. Nothing will sooner finish off “Medicare as we know it” than to continue its present march into insolvency. His is the first credible plan endorsed by either party for preserving the safety net.

Today traditional Medicare is the largest buyer of health care in America. It is also the worst buyer. The government sets prices for thousands of services, then pays nearly any doctor or hospital that a patient visits. The same arbitrary fee schedule applies to the best hospital and the worst hospital, regardless of the quality or value of the care delivered, and the bills are sent to taxpayers.

This deliberate suppression of the price mechanism has helped to turbocharge U.S. health costs. Providers who find ways to deliver better medicine at a lower cost aren’t rewarded, as they would be in any other industry. Medicare spending is growing at a 7.2% annual clip, far faster than the economy. Spending is due to double over the next decade, feeding on more and more of the federal fisc and national wealth. (See the nearby chart.)

The 45 million Medicare beneficiaries enjoy the security of “free” health care and its no-questions-asked payments. Still, the entitlement is stuck in a Great Society time warp. It offers no protection against catastrophic expenses, the most basic function of insurance. Coverage doesn’t keep up with medical progress; prescription drugs weren’t added until 2003. Seniors are docked a $1,000 deductible for a single hospital stay, though nine of 10 buy medigap coverage to backfill these and other holes. Where else do people buy insurance for their insurance?

Under the Ryan premium support model, seniors would instead choose from a menu of guaranteed private insurance options of the kind younger, private-sector workers have come to expect. These plans would be subsidized by a “defined contribution,” roughly equal to what the government now spends per person. This subsidy, about $15,000, would grow over time with consumer prices, but seniors who wanted more expensive plans would pay the difference out of pocket.

Premium support would create a market reward for the services that consumers value. Because seniors would be chipping in at the margin, only above the fixed-dollar subsidy, most would favor lower premiums. Insurers would compete to supply them, and providers in turn would have a reason to innovate in health-care delivery and improve what has been their negative productivity rate.

Premium support would not cure all of America’s health ailments, and missing in action in the House budget is a comparable reform for the rest of the market. But Medicare is so big that if it doesn’t change, nothing else can. Simply unwinding Medicare’s price controls would be an historic achievement.

That said, Granny will not be turned loose unsupervised into the market wilds. The subsidies will flow through Medicare, only to regulated insurers and government-approved plans. It does not go as far as Mr. Ryan’s previous “roadmap,” which offered direct cash vouchers for individuals who preferred to buy insurance themselves. The subsidies are means-tested, so the poor would receive more support, as will sicker and chronically ill patients. They wouldn’t kick in until 2022, more than enough time for people to adapt and exempting everyone older than 55 if they wished.

Mr. Ryan moderated his ambitions not merely because the fiscal crisis is so urgent, but because reforms of this order are so unusual. Seniors and other voters may be unnerved, especially when AARP and politicians beat the Mediscare drums. As they inspect the details, however, seniors may be surprised to learn that premium support is not an untested idea. It is even routine in parts of Medicare itself.

Traditional Medicare would look a lot like Medicare Advantage, which gives almost one of four seniors today private alternatives. Premium support forms the architecture of the Medicare drug benefit too, and as a result it has cost 30% less than almost anyone predicted.

The same concept governs the Federal Employee Health Benefits Program, which insures everyone from postal workers to Members of Congress. The same is true for several large university systems and Calpers, the benefits program for public workers in California. None are known as incubators for the pitiless ideology that Democrats impute to Mr. Ryan.

Despite this experience, one common criticism is that the subsidies wouldn’t keep pace with the rising health costs that Medicare now promotes. But medicine has always proven adept at reorganizing itself when the incentives change, and costs would fall over time if more patients were demanding their money’s worth.

Health care’s lack of accountability to consumers helps explain why Medicare’s unfunded liabilities over the next 75 years are about $31 trillion. That number is beyond human comprehension and among the reasons that creating one more new entitlement in ObamaCare was so reckless. Keeping Medicare’s generational promise—that children assent to be taxed to pay for their grandparents’ health care so that their grandkids can one day pay for theirs—would mean under current trends that every income tax rate, in every bracket, would need to more than double.

The brutal arithmetic is that total federal health spending is about 10% of GDP today and on pace to hit 15% in 20 years. The liberal response is more central planning and eventually the political rationing of care, even as taxes continue to climb. The alternative that Mr. Ryan has offered, including an ObamaCare repeal and a conversion of Medicaid into block grants to states, would bring that share down to 6% as premium support began to limit Medicare’s open-ended spending.

The reality that Mr. Ryan has recognized is that Medicare can’t be fixed with nips and tucks. Premium support is easily as important an advance as the shift from defined-benefit pensions to 401(k)s, and the transition could be as smooth. Major changes to the social compact must be grounded in some rough public consensus, and Republicans now have an obligation to persuade the country that their reform is the only one with a chance of saving Medicare for future generations.

To see chart:

http://online.wsj.com/article/SB10001424052748703712504576244790420274226.html?KEYWORDS=Paul+Ryan

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Dr. Flowers, your plan of health care will lead to rationing. If you want to control people like Kent Thiry and want to force him to work for his millions, market competition is the way to go. The laws of Economics apply to Kent Thiry as they do to everyone else. This will force companies like Davita to be very responsive to the needs of dialysis patients. As stated by the article, this plan works like the Federal Employees Benefit Plan. I have a very good friend who has it, low costs and he really likes it. It is high time to hold these people accountable for the very crappy way that they have treated us. I have heard this wailing and whining all of my life, ever noticed all of the terrible things that this group claims will happen, never do? Remember this??? “Seniors will be eating dog food, Seniors will be thrown in the streets, Children in the School Lunch program will starve.” More B.S. It is time to make people like Kent Thiry and his flunkies work.

4

What else should we expect from the Rupert Murdoch owned WSJ?

Medicare is not an “entitlement” program; it is a social contract. Labelling it as an “entitlement” immediately guides people into the mindset of, “You’re getting something that I am not, and that’s not fair.”

There is nothing “courageous” or “historic” about Paul Ryan’s plan. In this political climate, there is nothing brave about promoting screwing the vulnerable.

We have to be very careful whenever there is talk about letting free market principles and competition entirely guide our health care system. We can choose when, where and why we buy a new pair of shoes. We can compare prices and let competition guide our decisions. But we none of us choose to become ill with a deadly, incurable disease, and most of us are not able to shop around for the most competitively priced ER, clinic or diagnostic imaging facility. How many price tags are we able to even look at when we are throwing up or bleeding out?

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As I like to say, the free market - when it comes to health insurance - has only been free to take advantage. Where is all this “choice” when a person actually gets sick and what other health insurance in it’s right mind is going to want to take a person that is going to cost them. Organizations like the non-partisan CBO have been saying since the '90s single-payer, a “Medicare for All” type program, would save money:
http://www.pnhp.org/facts/single_payer_system_cost.php?page=1

Medicare should be expanded - not killed.

Maybe they will do for Medicare what they have already done for Medicare Advantage:
http://www.pnhp.org/news/2007/december/curbing_medicare_adv.php

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[QUOTE=MooseMom;21020]What else should we expect from the Rupert Murdoch owned WSJ?

Medicare is not an “entitlement” program; it is a social contract. Labelling it as an “entitlement” immediately guides people into the mindset of, “You’re getting something that I am not, and that’s not fair.”

There is nothing “courageous” or “historic” about Paul Ryan’s plan. In this political climate, there is nothing brave about promoting screwing the vulnerable.

We have to be very careful whenever there is talk about letting free market principles and competition entirely guide our health care system. We can choose when, where and why we buy a new pair of shoes. We can compare prices and let competition guide our decisions. But we none of us choose to become ill with a deadly, incurable disease, and most of us are not able to shop around for the most competitively priced ER, clinic or diagnostic imaging facility. How many price tags are we able to even look at when we are throwing up or bleeding out?[/QUOTE]

I doubt the editorial would have been any different whether Murdoch was there or not.

From The Huffington Post:

“The president understands very well that health care spending is a major driver of our deficit and debt problem,” Carney said. “He believes … we can achieve those savings in ways that protect the people that these programs are supposed to, and were designed to, support and help.”

One proposal in the debt commission’s report last year would rework Medicare’s deductibles and copayments so that most beneficiaries have to pay a share of their everyday bills – cost shifts that in a few years would add up to more than $100 billion in taxpayer savings. In exchange, Medicare recipients would get better protection against catastrophic costs."

http://www.huffingtonpost.com/2011/04/11/obama-health-care-cuts_n_847723.html

I have to be honest, I have never heard of Medicare being called “a social contract”. It is an entitlement, in other words, not everyone is entitled to Medicare, such as healthy adults at the age 30, for example. Programs like this were started by German Chancellor Otto Von Bismarck in 1870’s Germany.

Quite Honestly, health care is the only industry where there is not any price competition. If any other industry did this, it would be considered a national scandal. I do not understand why you think it is a wonderful idea for the medical profession to keep taking every worker wage increase and an ever increasing share of Our Nation’s Gross Domestic Product. Competition is the way to solve this issue. For example, why do you think it is that when tartar sauce is at a lower price at Kroger than at Wal-Mart, the every next day, the tartar sauce was cheaper at Wal-Mart than at Kroger???

Economist Adam Smith:

"Someone earning money by his own labor benefits himself. Unknowingly, he also benefits society, because to earn income on his labor in a competitive market, he must produce something others value. In Adam Smith’s lasting imagery, “By directing that industry in such a manner as its produce may be of greatest value, he intends only his own gain, and he is in this, as in many other cases, led by an invisible hand to promote an end which was no part of his intention.”

Adam Smith has influenced Karl Marx, John Maynard Keynes, and Milton Friedman. Market forces are much more brutal than Government regulation in controlling individuals who want to charge more than the market will bear. Individuals that want to charge more than market prices will be pushed out of business and forced to stop the waste of resources. We use competition to shop for everything under the sun, why would medical prices be any different? People are using their resources such as the computer to shop for the best quality at the lowest price. The time to do this is before you are puking at the hospital. I have faith in the American public, while others only have faith in Government bureaucrats, by the way, what is the record of the American public to get prices down down against the record of the Government bureaucrat???

In the past, Government intervention has been a disaster. For example, after the 1929 stock market crash, unemployment was at 5 percent, almost full employment. Then, in December 1929, it rose to 9 percent. However, it went back down to 6.3 percent in June 1930. Then, Hoover and Roosevelt decide on a huge scale to meddle in the economy. The result??? You ask??? Unemployment did not fall below 20 percent from February 1932 until January 1935, when unemployment dropped to 19.3 percent. FDR’s policies were just a much bigger extension of government regulation that began under Hoover. Why do we keep repeating the same mistakes of government intervention, when they have shown to be a disaster.

I am not sure why you want to give the health care system easy access to the next new house or yacht. Do you not believe that they should be paid based on quality? Any business hates to have competition, people in business detest competition with a passion. The competition of the free market system will force the dialysis industry to treat us as people, not as a disease.

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OK, tell me right here and now how you propose to introduce “competition” into the dialysis industry.

And why do you assume I want to personally subsidize Davita’s CEO’s new house or yacht? Of course they should be paid on quality, but it seems that you need ever more government interference/regulations to ensure quality because none of these people are more interested in delivering quality than in delivering profits.

It is not true that market forces are more “brutal” than government in containing healthcare costs. That might be the most efficient mechanism in other industries, but it is actually Medicare that has been most efficient in containing healthcare costs. And that’s my point. I am a believer in competition to get the best service, the best product, but for whatever reason, that paradigm just doesn’t seem to work in healthcare. To get answers to your questions, you’d have to ask the medical, insurance and pharma lobbyists peddling their wares in Washington.

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[QUOTE=MooseMom;21023]OK, tell me right here and now how you propose to introduce “competition” into the dialysis industry.

And why do you assume I want to personally subsidize Davita’s CEO’s new house or yacht? Of course they should be paid on quality, but it seems that you need ever more government interference/regulations to ensure quality because none of these people are more interested in delivering quality than in delivering profits.

It is not true that market forces are more “brutal” than government in containing healthcare costs. That might be the most efficient mechanism in other industries, but it is actually Medicare that has been most efficient in containing healthcare costs. And that’s my point. I am a believer in competition to get the best service, the best product, but for whatever reason, that paradigm just doesn’t seem to work in healthcare. To get answers to your questions, you’d have to ask the medical, insurance and pharma lobbyists peddling their wares in Washington.[/QUOTE]

The simple answer to this is competition. For example, in the State of Ohio, there are only two companies that are offering Supplemental Insurance in the state. The first one is Liberty National and the second one is Sterling. Yet, across the river, in Kentucky, which is on the border with Cincinnati, there are numerous secondary insurance companies and the price is very reasonable. If this were set up like the Federal Employee Benefits program, there would not be this issue and it would be much cheaper. Companies, regardless of the sector of the economy, raise prices when they have a monopoly, without exception, read Adam Smith “Wealth of Nations.” Believe it or not, Adam Smith does not say anything positive about the business field, nothing. Medicare has restricted the cost of medicine??? If that is true, why is it that costs keep skyrocketing??? Do you remember when the phone companies were highly regulated and long distance used to cost a fortune? Now, you can use your phone to call long distance on a reasonable flat rate pricing system. Business can deliver prices at a much lower cost without government regulation, again, look at phone prices.

Government does not need to be nor is Constitutionally authorized to be in the field of medicine, privacy, remember, how they chanted??? For example, yesterday, I was buying asthma medication and Medicare asked whether or not, I owned or rented a certain breathing machine. Quite honestly, that is none of their business and a waste of taxpayer money and time. WHO CARES??? I could also point out all of the questions that they ask on the Census forms that are none of their business.

If the dialysis consumer is buying the insurance and they have the authority to make decisions, the dialysis clinic had better respect that or they will be out of business. The more profit in the system, the more companies will jump into the system, driving down costs, then, the clinic will be at the mercy of the dialysis consumer. Anytime, there is profit in any sector of the economy, that invites many other companies to challenge the established companies. If dialysis clinic A abuses the dialysis consumer, the dialysis consumer will fire dialysis clinic A and have the choice of dialysis clinic B-Z, just not clinic B and C. If there is more profit in the system, then capitalists will try to develop technology that will trump the tech of the clinics and steer the profits to themselves. If people can make a profit, they will develop new tech products that will push the dialysis clinics out of business, a crying shame? Under Socialism, that day will take much longer to come or it will be very far off in the future. Competition will protect the dialysis consumer, each and every time, much more so than government regulation.

The intelligence and decision making of the market, with over 300 million consumers is a much stronger and overpowering force than a few thousand bureaucrats. Centrally planned economics and systems have been shown to be complete failures. The only people that think regulation is a great thing are the people who work in clinics, not paying the outrageous prices for Epogen or Renagel. YES, there is more than enough money to pay for dialysis, vote out people who want to raise your taxes. Vote for people that will put into place massive tax cuts. There is a problem and it is a SPENDING PROBLEM AND A PROBLEM WITH GOVERNMENT CONTROL FREAKS. Anyone who tells you there is not enough money for dialysis, regardless of who is, is filled with B.S. . THERE ARE MANY PEOPLE WHO HATE TAX CUTS, BECAUSE THEY THINK WE ARE TOO STUPID TO KNOW WHAT TO DO WITH OUR MONEY! Basically, their condescending attitude is, YOU CAN’T MAKE IT WITHOUT ME, BROTHER. Baloney! PEOPLE WILL ONLY DO TO YOU WHAT YOU LET THEM. This community is too passive, unreal.

9

Speaking of competition between dialysis clinics, here is one company I would like to see expand. Too bad we only have a couple in Colorado: http://www.dciinc.org/news.php?id=8

But getting back to the ryan proposal, looks like the Congressional Budget Office is none too impressed:

"Long-Term Analysis of a Budget Proposal by Chairman Ryan

Congressional Budget Office
April 5, 2011

A private health insurance plan covering the standardized benefit would, CBO estimates, be more expensive currently than traditional Medicare. Both administrative costs (including profits) and payment rates to providers are higher for private plans than for Medicare. Those higher costs would be offset partly but not fully by savings from lower utilization stemming from two sources. First, private health insurers would probably impose greater utilization management than occurs in Medicare. Second, private plans might restrict enrollees’ ability to purchase supplemental insurance plans; enrollees would thus face higher out-of-pocket costs than they do in Medicare, and that increased cost sharing would encourage lower utilization. On net, for a typical 65-year-old in 2011, CBO estimates that average spending in traditional Medicare will be 89 percent of (that is, 11 percent less than) the spending that would occur if that same package of benefits was purchased from a private insurer."

http://www.pnhp.org/news/2011/april/cbo-medicare-privatization-would-increase-costs

I can understand how competition between clinics could work, but health insurance is another matter because of the way insurance companies compete. They compete not-so-much with each other, but by competing for the healthiest pool of patients - and woe to the person who becomes a liability.

10

Plugger:

I really do like DCI, have talked with them at length and I do like their way of thinking. How would a private insurance company restrict someone’s ability to purchase secondary coverage, I would think that would be illegal. I do like CBO for the most part, however, I do not like their grading system on tax cuts, too static. Tax revenues grow under tax cuts, it has been proven time and again, under Kennedy and Reagan. The other issue I have with this, government plans are also highly expensive, they do not just collect premiums, but, people do not think of all of the taxes. If you combine premiums and taxes, I would think it would be much more expensive. The Government has tons of overhead. The lack of competition in Ohio and in other states, along with excessive government regulation has driven prices thru the roof. We both want the same thing, just differ on how to get there.

Mark

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Nice to see we both can agree on DCI. Might even be able to find some common ground on tax cuts for the middle-class and lower income people. However I’ll remind you the top tax rate during the 50’s and 60’s (boom times) was 70% to 90% - compared to 35% now! http://mjperry.blogspot.com/2009/03/90-tax-rate-back-to-1950s.html

I also agree there are probably government programs that are a waste. I’m old enough to remember Senator Proxmire and his Golden Fleece awards. However, I can also point out government programs that look to do very, very well. Besides Medicare I’m thinking of the VA, which even BusinessWeek says delivers great service at lower cost:
http://www.dialysisethics2.org/forum/index.php?topic=495.0 My daughter is doing a pharmacy internship there by the way and says she has been impressed by their system. I think she will fit in there just fine - having been raised by a crazy vet.

Anyway, I’ll say it took me awhile to accept that government can do a much better job with matters of infrastructure: roads, fire department, police, libraries, schools, public utilities - and health care. But I can understand where your doubts come from.

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I believe in across the board tax cuts or a very low rate flat tax. The point of the low rate flat tax is to drop or greatly reduce the taxes that the middle and working class pay to the Government. The rich would pay more under a low rate flat tax than they would under the current system. In addition, this system would funnel in billions of dollars to our local economies. It is my belief that the people closest to the situation, make the best decisions, you in your community, etc. As I have said before, I do not care about the rich, one way or the other. However, I understand economics. I do not trust the insurance companies, the drug companies, the dialysis industry or any of those other groups, they just care about themselves, Unions care about Unions, Corporations care about Corporations, etc. Yes, tax rates were much higher in the 1950’s and 1960’s, in the 70 percent-90 percent range. Yet, the American standard of living is much higher in 2011. The United States Economy is larger than the next 4 largest economies combined. (New York Times Almanac)

I would disagree that the public schools are better than the private schools. The claim that the private school has a better selection of students happens to be false. In fact, in the early 1900’s, African-American schools outperformed White schools with students whose parents were mostly lower middle class, not physicians or lawyers. I also disagree that a monopoly in public utilities is the most effective way to go, a monopoly creates higher prices, as does a monopoly in dialysis or any other product or service.

In regards to the VA, I have heard very mixed reviews from retired service personnel. I have seen studies that say 90 percent of retired service members avoid the VA. Interested in your thoughts.

Mark

13

Don’t know if it is 90% of veterans that avoid the VA or not. I do know the VA does get a bad rap from problems they had in their earlier years. My daughter told me even some of her professors would knock the VA for being backwards etc… She has found it totally to be the opposite. As for my own experience, I’ve used them for a number of years and they seem more thorough than private doctors I’ve had. I also had a major problem they took care of and got under control, sure looked like they knew what they were doing to me - and I’m still here.

Guess I’m eyeballing your claims about a flat tax with some skepticism and would have to see sources I could trust. As for a higher standard of living in 2011 it might depend on who you are. Last I heard income inequality has never been greater. As for monopolies, in general they aren’t good. But as in many cases there are exceptions. I understand during revolutionary times there were competing fire departments and it didn’t work very well: redundant resources, fighting with each to put out a fire, not putting out fire at an adjacent house because they weren’t covered, etc… Understand it was Benjamin Franklin who put a stop to it. How would you like the fire department showing up while your house is on fire and asking to see your insurance? Then maybe only putting out fires in certain rooms because not everything is covered - sort of like our health insurance system now.

14

As for schools, sure there are a lot of good private schools - if mom and dad have the money. And parochial schools do a fine job.

However just recently there was big scandal with for-profit schools cranking out worthless degrees and charging a whole lot for it:
“Though for-profits get the lion’s share of their tuition from financial aid, the default rates on loans for students who attended for profit schools are alarming. About 50 percent of the students at for-profits drop out, according to Eisman, so schools need to keep adding new students, and have to try to recruit just about anyone – even those most vulnerable in society, he says.”
http://abcnews.go.com/TheLaw/profit-education-abc-news-undercover-investigate-recruiters-university/story?id=11411379&page=1

For educating most of us, it is hard to beat the public sector - of course where you live has a lot to do with it.

15

[QUOTE=plugger_;21041]As for schools, sure there are a lot of good private schools - if mom and dad have the money. And parochial schools do a fine job.

However just recently there was big scandal with for-profit schools cranking out worthless degrees and charging a whole lot for it:
“Though for-profits get the lion’s share of their tuition from financial aid, the default rates on loans for students who attended for profit schools are alarming. About 50 percent of the students at for-profits drop out, according to Eisman, so schools need to keep adding new students, and have to try to recruit just about anyone – even those most vulnerable in society, he says.”
http://abcnews.go.com/TheLaw/profit-education-abc-news-undercover-investigate-recruiters-university/story?id=11411379&page=1

For educating most of us, it is hard to beat the public sector - of course where you live has a lot to do with it.[/QUOTE]

I was talking about the grade school and high school levels of education. Those for-profit schools are a rip-off.

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Since you quote data from OH, I found this report card on OH schools in the 8 largest urban areas that shows that more OH charter scored C or below than public schools. It looks like at most only 26% of schools in in OH (public or charter) got grades above a C in 2009-2010.
http://www.edexcellence.net/publications-issues/publications/2009-10-ohio-report-card.html

I realize charter schools aren’t the only private schools in the U.S. But I found a 2009-2010 report on charter vs. public schools in 16 states. Looks like the outcomes vary, dependent on several factors.

I am concerned that states are cutting education funds to public schools to try to balance their budgets. At this rate, it won’t be long before our country will have even more people who are not able to do the research necessary to separate fact from fiction or even take into consideration what might motivate a speaker/writer to take a position one way or another on an issue.

17

[QUOTE=Beth Witten MSW ACSW;21051]Since you quote data from OH, I found this report card on OH schools in the 8 largest urban areas that shows that more OH charter scored C or below than public schools. It looks like at most only 26% of schools in in OH (public or charter) got grades above a C in 2009-2010.
http://www.edexcellence.net/publications-issues/publications/2009-10-ohio-report-card.html

I realize charter schools aren’t the only private schools in the U.S. But I found a 2009-2010 report on charter vs. public schools in 16 states. Looks like the outcomes vary, dependent on several factors.

I am concerned that states are cutting education funds to public schools to try to balance their budgets. At this rate, it won’t be long before our country will have even more people who are not able to do the research necessary to separate fact from fiction or even take into consideration what might motivate a speaker/writer to take a position one way or another on an issue.[/QUOTE]

Not really a big fan of Charter schools. When I think of private schools, I think of Catholic schools and in that comparison, it is not even close. The spending for the public schools has been out of control for years. Professor Walter E. Williams, Professor of Economics, George Mason University, Former Chair of the Department:

"Dr. Thomas Sowell addresses the issue in his book “Inside American Education.” In 1980-81, students majoring in education scored lower on both the verbal and math portions of the Scholastic Aptitude Test (SAT) than students majoring in any other subject. Only 7 percent of high-school seniors with SAT scores in the top 20 percent, and 13 percent in the next quintile, chose to major in education. At the other end of the academic spectrum, more than half of those with SAT scores in the lowest 20 percent chose education as a major. Eighty-five percent of high SAT-scoring students who actually become teachers leave after a brief career.

Does more teacher-training help? In the early 1960s, when student SAT scores peaked, fewer than one-fourth of all public-school teachers had a postgraduate degree; 15 percent lacked even a bachelor’s degree. By 1981, when SAT scores hit bottom, a bit more than half of all teachers had master’s degrees and less than 1 percent lacked a bachelor’s degree."

In that time span, education spending exploded, how can you explain that?

Professor Williams:

"Let’s examine the education establishment’s more-money, better-education sham. New Jersey ranks No. 1 in the nation in terms of expenditures per student ($10,900). Washington, D.C., is a close second at $10,300. If educationists are right, New Jersey and Washington should have the highest level of student achievement in the land.
Think again. New Jersey ranks 29th in student achievement. As for Washington, the only thing preventing it from being dead last in student achievement is Mississippi.

Minnesota ranks first in the nation in terms of student achievement, and Iowa ranks second. If we accepted the more-money-better education sham, we’d think Minnesota and Iowa are really up there in per-student expenditures.

Think again. Minnesota ranks 27th in expenditure per student ($6,300), and Iowa ranks a lowly 30th ($6,000). There is no relation between expenditures and student performance."
http://www.jewishworldreview.com/cols/williams020599.asp

If the schools would have done the job that they should have done, Obama would never, ever have been elected to the White House, ever. I could care less about his color, it is his policies that are a disaster. Tax revenues exploded under the tax cuts of Coolidge, John Kennedy, and Ronald Reagan, and George W. Bush. By the way, the New York Times admits that the rich pay the vast majority of the nation’s taxes.

18

As I mentioned, the school system does vary a lot by where you live. You did cause me to recall from years ago the voucher system they were trying in Cleveland - believe they have been trying it for quite a few years now. This recent article had this to say:

“The push is on to expand school voucher programs in Ohio, but new state data suggests that students who attend private schools with the help of taxpayer-funded vouchers don’t necessarily fare better academically than the children they leave behind.”

These kids are coming from the same neighborhood, wondering if that has to improve before the schools do - or export teachers from Minnesota.

19

[QUOTE=plugger_;21059]As I mentioned, the school system does vary a lot by where you live. You did cause me to recall from years ago the voucher system they were trying in Cleveland - believe they have been trying it for quite a few years now. This recent article had this to say:

“The push is on to expand school voucher programs in Ohio, but new state data suggests that students who attend private schools with the help of taxpayer-funded vouchers don’t necessarily fare better academically than the children they leave behind.”

These kids are coming from the same neighborhood, wondering if that has to improve before the schools do - or export teachers from Minnesota.[/QUOTE]

I would look for progress over time. For example, if a student from Holy Name Grade School graduates from the eighth grade and performs well at XYZ Catholic High School, this is a reflection on the parents and Holy Name Grade School, not XYZ Catholic High School. It is amazing to me that the individuals who oppose school choice for individuals in the inner-city would never, ever let themselves be controlled in this manner. Low income individuals can learn at the same level as high income individuals.

Stanford Economist Thomas Sowell:

“Asian-American students from families with incomes of $6,000 or less scored higher on the mathematics portion of the SAT than black, Mexican-American, or American Indian students from families with income of $50,000 or more. Such patterns are not peculiar to the United States. In the British colony of Hong Kong, Chinese school children outperformed the English school children on nonverbal tests, despite the higher socioeconomic level of the English in Hong Kong. The Chinese outperformed the Malays in Singapore and the Indonesians in Indonesia.”

NDXUFan writes:

In addition, many African-American institutions of learning outscored White schools on standard tests in the early 1900’s in the New York area. Moreover, the students in the African-American schools did not have professional parents, such as physicians or lawyers. In fact, the vast majority of the parents in the African-American schools were in the lower middle class ranks.

20

Let’s get back to home dialysis, please, y’all. Schools are off-topic for these boards.