Quick Post: Health Care Costs in Nevada

Sources: If you want to see a comparison of the prices for various medical procedures and treatment in southern Nevada the LVRJ has an article posted.  The full report (Excel format) is here.  The Washington Post also provides a link.  Information regarding the Northeastern Nevada Regional Hospital (Elko) is listed here in the CMS report.  There are no listings shown for Lovelock, Battle Mountain, or Winnemucca.  There are links for Renown (Reno) Carson Tahoe (Carson City) St. Mary’s Regional Medical Center (Reno).

Results: One of the more common items for comparison might be good old fashioned pneumonia,   “194″ in the parlance of the database.  Treatment at St. Mary’s Regional Medical Center will cost an average of $23,022.  The same category at Renown costs $26,254.72.  At Carson Tahoe Hospital the average charges are $26,827.44.  Northern Nevada Medical Center average charges in the #194 category are $33,326.77.  A #194 will cost an average of $29,775.81 in Elko.

Not a lot of this will make much difference to someone in an ambulance — it takes some time to figure that the ‘related links’ on the original page is where you want to go in order to use the search feature to find area hospitals — an unconscious patient won’t care if it takes forever to download and then view the full Excel version, but this really isn’t helpful for “medical expense planning purposes.”

Another point to remember is that these numbers are from CMS-Medicare which only deals with patients 65 and over, and other restricted categories.  Thus, we’re dealing with costs associated with treatment for elderly or disabled patients.

The problem with health care costs — other than the fact that they’re entirely too high –is their opacity, a feature described in this handy Consumer Reports article.   There’s more in the Business Day section of the New York Times as well.

Quick Hits

** The Las Vegas Sun has a quick list of bills that made it past the “Tuesday Deadline” for consideration in the Nevada Legislature.  Looking for bills that failed to meet the deadline? It’s here.  For information on other bills start with this link.

** Heads up: The Reno Gazette Journal will run an article on Sunday concerning the closing of the ATF office in Reno, NV, and how this has impacted the efforts to stop gun trafficking.  The Leahy-Collins amendment to curtail gun trafficking in the U.S. failed in the Senate on a 58-42 vote during which Republicans sustained their filibuster of the amendment. [TheHill] Senator Dean Heller (R-NV) voted to sustain the GOP filibuster. [Vote 99]

** Did we know? “Sixty-six Americans were killed in mass shootings by non-Muslims in 2012 alone, twice as many fatalities as from Muslim-American terrorism in all 11 years since 9/11.” [Politicususa] And, did we know that the NRA and Conservatives in Congress have made it more difficult to track or monitor non-Muslim extremists in this country since 2001?  Crooks and Liars posts a list of recent “eliminationist” attacks.

** It’s been a bad week for the Austerians.  First, comedian Stephen Colbert launched a devastating critique on the economic theorists.  Additionally, many others have piled on.  There’s Austerity as Flim-Flam.   There’s Who is Defending Austerity Now?  There’s rethinking austerity.   There’s the EU calling for diminishing austerian policies.  And, for good measure, there’s the choking effects of austerity policies in the UK.  Thus the House GOP budget plan is based on a seriously flawed study.

** What economic recovery? For 7% of this country it’s been a nice rebound, for the remaining 93% not so much.

“During the first two years of the nation’s economic recovery, the mean net worth of households in the upper 7% of the wealth distribution rose by an estimated 28%, while the mean net worth of households in the lower 93% dropped by 4%, according to a Pew Research Center analysis of newly released Census Bureau data.” [PewResearch]

Graph it out and it looks like this:

** Watch H.R. 1549 carefully. It would “Give sick people without insurance temporary access to crappy private plans at exorbitant rates as part of a strategy aimed at pulling the rug out from under them entirely at the end of the year, all the while mewling about one’s concern for sick people.” [WashMon]  When astro-turf organizations like Freedom Works and AMAC line up for something it’s time to head the other direction.  The best description for this legislation is “ruse and trap.”

** Republicans Behaving Badly.  Let’s start with the Tennessee legislator who thinks pressure cooker bombs are humorous.  Followed, of course, by his non-apology-apology.  His rationale is that advocates of sensible gun safety legislation should have stayed quiet after Newtown…  Then there’s the Conservative group that photo-shopped ethnic minority people from its mailer about voting restrictions.  And who could have missed GOP behemoth, Rush Limbaugh, comparing the Boston bombers to Trayvon Martin?  That Arkansas legislator who called for using “2nd Amendment” solutions to Medicaid expansion, “Most likely won’t kill lawmakers who support Medicaid expansion.”  Most likely? How nice.

** Lady’s Days:  Ann Coulter, scourge of all operative grey cells residing in every cerebral cortex, calls for women to to prosecuted for wearing the hijab.  So, do we tell nuns to refrain from wearing their habits?  A Washington state pastor tells women to submit to their husbands and not nag “like Chinese water torture.”  The adherents of the Church of Perpetual Intolerance (aka the Family Research Council) are trying to convince us that “many” experts believe Plan B contraceptives should not be available over the counter — there are a few critics, and those critiques tend to be based on religiosity not science.  Rebuffed last year, Ohio Republicans are taking another swipe at funding for Planned Parenthood women’s health care services in that state.

What’s a little fraud among friends? Medicare, Medicaid fraud enforcement

There is a 31 year old Las Vegas, Nevada resident who recently pleaded guilty to two felony counts related to health care fraud. [LVSun] There were 100 prosecutable health care fraud cases in Nevada in 2012, that would be 100 too many.  The frauds come in a variety of manifestations: drug abuse, bogus claims, over-billing, identity theft, and staged “accidents and injuries.”  Some felony-minded souls appear to believe that a little fraud is allowable in order to reap a bit of reward from the burgeoning coffers of the health insurance corporations.  It isn’t.  The situation becomes unconscionable when Medicare and Medicaid are the targets of the fraudulent activities.

Last year saw some particularly egregious cases, such as the following:  “federal authorities announced on May 2 they had arrested 107 health care providers, including doctors and nurses, in several cities and charged them with cheating Medicare out of $452 million.”  [Forbes]

Speaking of Medicaid, in  April 2012 an Inspector General’s report for FY 2011 informed us:

In fiscal year 2011, MFCUs conducted 10,685 Medicaid fraud investigations and saw 824 convictions. MFCUs conducted 4,134 investigations into patient abuse and neglect, including patient funds cases, and saw 406 convictions. [FHC] *MFCU: Medicaid Fraud Control Units

The top five states for Medicaid fraud prosecutions were: California, Texas, New York, Ohio, and Kentucky.  [IG2012]  The report on Medicare wasn’t any more comforting:

Federal officials set up the Medicare Fraud Strike Force in 2007, which visited at random nearly 1,600 businesses in Miami, ground zero for Medicare fraud, that had billed Medicare for durable medical equipment.  Officials found that nearly a third of the businesses, 481, didn’t even exist, yet they had billed Medicare for $237 million over the previous year, according to National Public Radio. [Forbes]

Medicare and Medicaid aren’t functions of those ravenous profit centers otherwise known as the health care insurance corporations, thus even the dubious rationalization doesn’t apply.  That hasn’t stopped the fraudsters:

“Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 825 individuals who collectively have falsely billed the Medicare program for more than $2 billion .  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.”  [DoJ]

That’s the bad news, there is some good news to report on the subject of Medicare fraud:

“The Obama Administration has made important strides in reducing fraud, waste, and abuse across the government. Over the last two years, the Centers for Medicare & Medicaid Services (CMS) has implemented powerful new anti-fraud tools and designed and implemented large-scale, innovative improvements to our Medicare program integrity strategy to shift beyond a “pay and chase” approach to preventing fraud before it happens. CMS is also collaborating more with the private sector, law enforcement, and our state partners to harness best practices in our fight against health care fraud.

These efforts are paying off. In FY 2012, the government recovered a historic $4.2 billion and has returned a record-breaking $14.9 billion dollars to taxpayers between 2009 and 2012, up from $6.7 billion dollars over the prior four years.”  [DHHS]

We could happily note the improvement in Medicare fraud enforcement efforts and the returns that accrue to American taxpayers, BUT the House Republicans — in the “interest” of saving taxpayer dollars (and not raising taxes on millionaires and billionaires) — offer their “serious” budget proposal which transforms Medicare into a voucher/coupon program in which the Every Man For Himself policy extends into the health care insurance domain.

What could possible go wrong? Let us count the ways.  (1) Nothing in the GOP or Ryan Plan puts the brakes on the increases in health care costs — only in the individual’s remuneration for health care insurance costs.  There is no inducement in this proposal to reduce either the costs or the urge to game the system because of the mounting out of pocket costs.  (2) It is assumed that if Medicare as we know it is mutated into a privatized system that the fraud enforcement costs will be reduced at the federal level, which totally ignores the expenses incurred at the state levels wherein much of the anti-fraud activities take place.  (3) We cannot assume that the expenses involved in prosecuting national cases of interstate health care insurance fraud will be magically disappear by merely transferring the locus of funding — the Department of Justice might still exercise its authority to prosecute such cases — of course at public expense for the benefit of the health care insurance industry.

What we should be considering, in our own economic self interest, is the enhancement of funding for Medicaid Fraud Control Units, and the efforts to increase the effectiveness of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint project of the Department of Health and Human Services and the Department of Justice.

Reading Roundup

Good news, bad news — there is only a seven month inventory of bank owned residential properties in the Las Vegas, NV area.  The housing market appears to be leveling out in this region.  Good news for homeowners who’ve been waiting for their investment to appreciate, bad news for buyers.  [LV Sun] [RGJ]

Pure Fiction — the radical right rant in the RGJ on the 2nd Amendment which manages in a couple of short paragraphs to be almost fact free.  Best line? “The Second Amendment states the right to bear arms, not shotgun or long rifles. That means what it says, arms, tanks, machine guns and all other forms of arms so that the people would be on a parity with the government.”   May we ask, where in the city of Sparks do you intend to park your aircraft carrier?

Nevada Progressive discusses the Senate Judiciary committee hearings yesterday, complete with video of former Representative Gabby Giffords’ brief but poignant testimony.  ICYMI, Vegas Jessie looked at the NRA’s newly discovered interest in mental illness, as a distraction from the real issues.  TPM traces the new nullification efforts by radical conservatives.

Lady’s Day — Good reading at The Sin City Siren about the Feminist Files: If you aren’t outraged you aren’t paying attention.  Arkansas joins the ranks of Republican legislatures determined to keep women pregnant and in the kitchen.   And, then there’s Lawrence O’Donnell’s take down of the conservative lady who ardently believes that we should be defending our children with assault rifles.

Energy — Green tech firms, especially those seeking to increase our use of wind and solar power are seeking tax relief benefits from Congress, similar to those granted to the fossil fuel giants. [DealBook]  While the Chinese are gasping, the U.S. is learning that metal mining is responsible for 46% of “toxic releases” in our environment. [Earthworks] 15% is from power generation.

Unhealthy Ideas — a GOP legislator in our neighbor to the north (as in Idaho) compares the Affordable Care Act to the Holocaust — thus demonstrating she doesn’t understand either.   Meanwhile there’s the problem of the Unlucky Ducks and Medicaid.

Chart of the Day:

Once more we repeat with fervor: Austerity Doesn’t Create Prosperity.

Leverage?

Some members of the chatterati may have taken Archimedes a bit too literally: “Give me a place to stand and with a lever I will move the whole world.”  Often too much emphasis is placed on the fulcrum and not quite enough on the part about the ancient mathematician needing a place to stand.  The word of the week sounds like “leverage” in Washington, D.C. Who has it? Who doesn’t? And, so what? The So What part isn’t all that interesting.

Although the pundit class is thoroughly fascinated at the moment with how much leverage the President and the Republicans may each possess after the self inflicted Fiscal Cliff fiasco, most of their comments can be categorized as post game “analysis” of the variety which is more commonly associated with post game “analysis” of a sporting event.  It’s never quite enough to declare one team or another victorious based on the scoreboard numbers — “we” have to “know” why one team won and the other lost.  In reality, we really don’t.

So, in the parlance of political reporters emulating the post game questions of their sports writer colleagues — can the President win the next game? A game of Debt Ceiling already scheduled by the Republicans and given official status by the post game analysts.

It depends on where you stand.

There are two major elements of the federal debt that deserve serious scrutiny.  First, during the Bush Administration’s policy of credit card conservatism we racked up two wars (off the budget and supported by supplemental appropriations), a major addition to the Medicare program (Medicare Part D, also unpaid for) and one major Recession.  All were guaranteed to increase the national debt.  The first two increased spending and the latter cut into the tax base.

Secondly, we do need to reduce the national debt, but how we do it is important.  This is one of those occasions which calls for a scalpel, not a meat axe.

It is also important to stand on firm ground.

A few facts are in order.  The first part of standing on terra firma before attempting to leverage anything is to dismiss some media mythology about trends in the national budget deficits.  The following chart should provide an illustration of the inaccuracy of the Now That A Democrat Is In The White House The Deficit Is Out Of Control Myth:

The chart illustrates what happens when two wars, one major Medicare addition, and a nasty Recession contribute to national spending. It also shows the effect of Obama Administration policies mentioned earlier, a point at which we should note that the Bush Administration toted up about $5.1 trillion in expenses, while as of last June the Obama Administration’s policies resulted in about $983 billion in spending.

In short, if we are really serious about deficit reduction then we need to eschew the policies that got us into this mess in the first instance, i.e. unnecessary tax cuts, and two very expensive wars.

OK, so if we don’t get involved in more military operations, we resist the myth that tax cuts somehow cause economic growth (which they never have), and we regulate our financial markets more effectively in order to mitigate the excessive enthusiasm of traders who created the last great mess, then where do we cut?

It’s time for another reality check.

Here’s where the money goes:

Since Social Security is a self-funding program, which as President Reagan famously cautioned in 1984 doesn’t add to the federal deficit (video), we can take that 20% out of the equation right now.  Anyone who is truly serious about the single issue of Social Security solvency should be clamoring to increase the cap on earnings liable to the payroll tax, currently set at a measly $110,000. We also need to remove the mandatory spending from the discussion because what we cut will have to be from discretionary spending.

The FY 2013 budget calls for spending $666.2 billion by the Department of Defense.  Another $80.6 billion is allocated to the Department of Health and Human Services (Medicare, Medicaid), and the Department of Education (Pell Grants, Title I, student loan guarantees, etc.) is scheduled to spend or entail $67.7 billion while the 4th largest chunk of the budget goes to the Veterans Administration which has $60.4 billion in scheduled spending.

In short, we’ve budgeted for $1,510 billion in discretionary spending in FY 2013.  The Department of Defense is on track to receive 44.12% of ALL the discretionary spending in the national budget.   Yet calls to cut military spending brings on the wailing of voices, the gnashing of teeth, and the rending of garments about “making us less safe” in an uncertain world.  In spite of all the wailing, gnashing, and rending — that one single department consumes 44.12% of the entire pot of discretionary spending is something we ought to be discussing.

Medicare is another matter.  IF we are truly serious about deficit reduction then we need to have more than the simplistic discourse already in evidence.  There is a false choice being presented, as though the only options are to privatize the Medicare program (give Granny a coupon and let her go out and find her own insurance) or to create a Single Payer national health care system.  While I wouldn’t be sorry to see a Single Payer system, this is an argument for another day.  The point is that there are options between these two proposals.

The central focus point should be that nothing which doesn’t have a bearing on health care cost containment is going to make much difference in the spending levels.   Privatization doesn’t address the cost containment issue, and a single payer system without cost containment elements is merely a recipe for increased expenses.

Now that the campaign season is over we can dismiss the Republican rhetoric about “Obama cut $716 out of Medicare,” and consign to the dust bin the notion that the Affordable Care Act somehow impinges on Medicare benefits.  Business Week explains:

From 2010 to 2019, Obamacare trims payments to providers by $196 billion. They agreed to take a cut because they will get so many new patients, thanks to the individual mandate. Another $210 billion will be generated by raising Medicare taxes on the wealthy (that’s households earning more than $250,000). Another $145 billion comes from phasing out overpayments to Medicare Advantage. About 25 percent of seniors use the program—in which private plans compete for Medicare dollars—instead of traditional fee-for-service Medicare. Under Obamacare, the government has to keep Medicare Advantage costs in line with those of traditional Medicare. More savings come from streamlining administrative costs.

Thus, if we trim payments to providers, phase out over-payments for profitable private health care policies, and put some reins on administrative costs we’ll find about $716 billion in savings for the Medicare program.  Other cost savings may also be the result of more efficient record keeping, especially in the pharmaceutical segment.  Anyone who’s dealt with the medical issues of an elderly parent knows of multiple prescriptions written from several physicians who may or may not consult with one another.  The result can be as minimal as two (or three) prescriptions for the same medication at different dosages; or, as detrimental as two prescription medications which should not be taken together.

However, the bottom line is still the bottom line — unless and until we are ready to discuss health care cost containment we’ll be immersed in the rhetoric of low bludgeon and high dudgeon without much result.

When we discuss funding for the Department of Education it’s important to note that the FY 2013 discretionary requests yield an official number, $69.8 billion — if we include Pell Grants.  Pell Grants constitute about $22.8 billion of the total, a decrease from $23.8 billion in the FY 2011 budget.  Without the Pell Grants the total discretionary spending in the FY 2013 budget is $47 billion.   There are two constituencies with major stakes in arguing about these funds.

Parents.  Unless one is amenable to the elitist argument that kids should have access to only the level of education their parents can afford (which makes social mobility a moot point) parents are going to need assistance paying for their children’s education.  Whether we like it or no, education is a labor intensive business.  We can trim educational spending by continuing what the Obama Administration has started — saving approximately $61 billion by cutting the banks out of their role as middlemen in the student loan program [NYT]– but it really doesn’t do to cut efforts to educate our young people.  It also doesn’t make economic sense since a college degree is worth money in the marketplace.

Local school districts.  Cash strapped and semi-starved local school districts rely on funds for Special Education programs, Title I services, School Lunch programs, to make up budget shortfalls.  While the level of federal involvement at the local level isn’t all that much it does cover expenses local districts would be hard pressed to meet were the monies cut.

Hostage Taking

How we fund, or de-fund, these major activities depends on who is being held hostage and by whom.   Did the President allow the Republicans to gain “leverage” by taking the tax rates off the table in the next Congressionally manufactured debt ceiling debacle. Or, are we going to change hostages?

Will the Republican stance be that all other programs must be cut in order to spare the 44.12% consumed by the Department of Defense?

Will the GOP position be that Medicare must be privatized in order to practice “sound fiscal responsibility?”

Will the GOP position be that Social Security must be “reformed” (read cut) in the interest of “fiscal accountability and deficit reduction” even though it adds not a nickel to the federal debt?

Will the Administration simply say — You manufactured this debt ceiling “crisis” live with it?  Remembering that if the national credit rating is downgraded this will likely mean that the cost of borrowing (yields paid to those who invest in Treasuries) will go up, exacerbating the problem rather than addressing it.

Will the point be made to the American people that while the credit card analogy is handy, the United States of America doesn’t have creditors it has investors.  Our federal government accesses funds by issuing bonds.   And WE own most of those bonds.

Here’s the little chart again:

42.2% of the money “borrowed” by the U.S. government is an asset for U.S. individuals and financial institutions.   Today’s yield curve doesn’t indicate a government which is having to pay all that much to get people and institutions to invest in it:

Even 30 year bonds are paying only 3.0% interest.

The amount of leverage always depends on where one stands and places the fulcrum.

Things that could get me to toss confetti in 2013

There are things that could get me to toss confetti for 2013.   Not many, mind you, which would justify the consequent vacuuming, but a goodly handful.

#1. The Senate of the United States of America does something constructive with the FILIBUSTER rule.   The original rule was intended to prevent the willful trampling of minority points of view, but the abuse of the rule is now part of the clichéd “Washington Gridlock.”  There is a delicate balance between Majority Rule and Minority Rights, but Obstruction for its own sake is not a laudable occupation.

#2. The Republicans in the House of Representatives eschew the  Hastert Rule , under which a majority of the majority party caucus must agree to the passage of a bill before a vote can be taken on the House floor.  This might have been a lovely idea if the current majority party caucus weren’t the replication of that other cliché– a wheelbarrow load of frogs.  Governance requires compromise, and compromise demands the admission that we don’t always get everything we want.  Ideological posturing is not a substitute for principled discourse.

#3.  Someone in a position to do something about it finally figures out that arguments over raising the debt ceiling are academic at best and consummately silly at worst — rather like announcing that because I overspent my budget for this holiday season I’m going to chop up my credit cards and not pay the bills.  Aside from being the most fiscally irresponsible action imaginable, it’s also a manifestation of the idea that the full faith and credit of the United States is some kind of bargaining chip in ideological squabbling.

#4. The National Rifle Association (aka No Rational Argument) stops pretending to care about the right of our citizens to keep and bear arms, and honestly announces that its ultimate intention is to promote the sale of as many firearms as its manufacturing donors can create.  After that, it should be far easier to discuss comprehensive background checks, closing the gun show loophole, and banning military style assault weapons.

#5. More people, perhaps even more people in the national media, stop referring to “The” government and start calling it what it is — OUR government.   “The” government calls to mind the institution which cracks down on Moonshiners, or enforces school integration, or ignores calls to make Jefferson Davis’s birthday a national holiday.  “The” government didn’t decide to integrate public schools — “our” government did. “The” government didn’t decide to enact regulations to prevent air and water pollution — “our” government did.  And, “The” government didn’t create the Food Stamp (SNAP) program — “our” government did that.  And so it goes.  Continual references to “The” government is an unfortunate holdover from the Reaganesque caricature of government designed to promote the financial health of the economic elite by appealing to the discontent with those laws “our” government enacted to promote OUR general welfare.

#6. Our representatives on Capitol Hill learn to say “____ isn’t the end of the world as we know it.”  I could do with a great deal less hysterical hyperbole.  “This is the Largest Tax Increase In The History of the Universe!”  Probably not.  “This is the worst violation of human rights ever!” Probably not that either.  “This will create the worst calamity known to man.” Probably not.  “This will destroy our ____.”  Again, probably not.  Excuse me while I chuckle at the pomposity of this meaningless prognostication.

#7.  Journalists who seek to inform me via the television set prove to be (1) knowledgeable about the subject under discussion, and (2) include fact checking as part of the “context” of which they speak so often.  If a statement made by a politician is factually inaccurate, they will tell me; and I hope they’ll be able to offer a correction.  I really don’t care if they are correcting the record in the wake of Left Wing Larry or Right Wing Richard’s pontification.  The object of the exercise should be to impart accurate information so far as it can be known — I can get my “entertainment” elsewhere.  Bluntly, the “he said, she said, and then he said” reactions from professional chatterati or elected representatives is less entertaining than a good professional wrestling match, which at least has the grace to admit it’s a scripted farce.

#8. Somebody finally declares the Culture Wars over and done with.  Our contemporary version appears to incorporate a toxic dose of good old fashioned misogyny.  Women make up about 51% of our population and telling them they cannot have an abortion (even in the cases of an ectopic pregnancy or as the result of a rape) is paternalistic to the core.  Worse still would be telling them that their employer can decide if their health insurance plan covers contraceptive medication.

#9.  On a related note, it really doesn’t do to blame God for everything.  I’d cheer the week that some blowhards weren’t showcased in the media for pronouncing God’s Wrath for … whatever.  Hurricane Katrina — God’s wrath for a Gay Pride gathering? Really?  God’s wrath because we don’t pray hard enough?  That certainly doesn’t explain the attack on congregants in the Knoxville Unitarian church.  God’s Wrath because we don’t have organized  prayer in schools? Huh?  No one at Columbine High School, Platte County High School, Northern Illinois University, Virginia Tech University, or Sandy Hook Elementary knew how to pray and practiced it regularly? Spare me the Westboro Wannabes who “know” the mind of God better than a six year old child.

#10.  The confetti will fly when we begin to have a serious discussion about global climate change without having to incorporate the phony “science” offered up by the fossil fuel industry.  No, there isn’t a “controversy” here. And, no reputable science deflects our responsibility as human beings for the contamination of which we are clearly capable.

Speaking of the Almighty, there’s an old story about the man caught in a flood which seems appropriate at the moment.  “Why, he cried out to God, am a trapped in these flood waters?”  The Almighty, sorely tired of listening to the wailing, said, “I sent you warnings.” “When?”  “When?” responded the Deity. “When indeed.” “I sent you warnings on the radio. You ignored me. I sent you warnings in television broadcasts, and you ignored me. I even sent a deputy sheriff to personally advise you to evacuate. And, you ignored him too.”  ….

We’ve been visited with major named storms, watched ice caps diminish, seen glaciers disappear… and all together too many people are ignoring the warnings.

How To Waste $37 Billion Per Year

The funerals are still being conducted in Newtown, CT, and the tragedy has a grievous grip on our attention as the year ends.  We’re all too aware of the human cost.  There are lives lost, families shattered, hearts broken, minds in upheaval.  The personal and social impact of this heart wrenching event should be foremost in our thoughts (and prayers for the families) but we’re paying other costs as well.  Economic ones.  It is no secret that there are economic costs to gun violence in this country.

The Public Health Issue Intersects With The Economy

Increasing health care costs in this country put a strain on our health care delivery system.  We could mitigate these if we could find a way to reduce the number of gun violence victims who arrive at treatment centers each day.  Add up the direct medical costs, combine them with  lost productivity, and the amount of money we’re losing is significant.

“Combining the direct medical costs of treating fatal gun injuries with the economic damage of lost lives, firearms-related deaths cost the United States $37 billion in 2005, the most recent year for which a CDC estimate is available. Non-fatal gun injuries cost an additional $3.7 billion that year, according to the agency.”  [HuffPo]

However, it doesn’t end there.   There’s a matter of the non-fatal injuries to consider.  The result of some of those injuries will be a lifetime accumulation of medical care costs for rehabilitation, assisted living, and continuing treatment, and we’ve known this since 1999:

In a 1999 study in the Journal of the American Medical Association, Cook and his colleagues concluded that gunshot injuries in the U.S. in 1994 produced $2.3 billion in lifetime medical costs. Taxpayers footed half of that through Medicaid, Medicare, workers’ compensation and other government programs. [SeattlePI]

Yes, that’s taxpayers… and for those who profess to be concerned about the waste of taxpayer dollars this should be illuminating.  Back in 1994 taxpayers paid $1.15 billion toward continuing medical expenses incurred because of gun violence.  The price tag has gone up, like everything else, in the last 18 years.

And, it has.   The following information comes from an article published in December 2009.

“The health care and economic costs of gun violence in the US are equally staggering. According to the Public Services Research Institute in 2008, firearm homicide and assault cost federal, state and local governments $4.7 billion annually including costs for medical care, mental health, emergency transport, police, criminal justice and lost taxes. They also state that when lost productivity, lost quality of life, and pain and suffering are added to medical costs, estimates of the annual cost of firearm violence range from $20 billion to $100 billion.”

$20 billion (the low end estimate) for economic costs of gun violence sinks in a bit deeper when we consider that in FY 2009 the total spending for public schools in the State of Nevada was $3.12 billion from their general funds.  [NVPlan pdf]

And then there’s the insurance issue:

“According to the National Center for Disease Control, the cost of firearm fatalities is the highest of any injury-related death. In fact, the average cost of a gunshot related death is $33,000, while gun-related injuries total over $300,000 for each occurrence. Unlike car crash victims who are privately insured, roughly 80% of gunshot victims are uninsured. In the Journal of the American Medical Association (June 14, 1995), researchers found that private health insurance pays for the majority of the treatment of firearm-related injuries though it may cover only about one-fourth of the total injury victims. As a result taxpayers and insurance holders are unfairly burdened by the enormous and largely preventable health care cost associated with firearm violence.”  [HuffPo]

Want to help control health care costs  and related economic losses in this country?  Then how about mitigating the $33,000 we lose in gun related deaths and the $300,000 it costs when someone is injured?

Additionally, if we’re truly concerned about the housing market in the United States there’s the issue of lost real estate value as associated with homicides, some 67% of which are gun related:

“On average, a reduction in a given year of one homicide in a zip code causes a 1.5 percent increase in housing values in that same zip code the following year. We applied these findings to available data on the value of the housing stock in the metropolitan areas of all eight cities. The estimated increases in the value of the housing stock for the eight cities and their immediate metropolitan areas, following a 10 percent reduction in homicides, range from $600 million in Jacksonville and the surrounding area to $800 million in the Milwaukee area, to $3.2 billion in Philadelphia and the surrounding suburbs, and $4.4 billion in the Boston area. Unfortunately, inconsistent reporting of other types of violent crime—rapes, assaults, and robberies—preclude a reliable analysis of the impact on housing values of changes in the incidence of those crimes.”  [CAP]

Anyone who is sincerely interested in not only mitigating the personal and social costs of gun violence,but also interested in helping contain rising health care costs, interested in reducing the cost of Medicaid services, interested in maintaining worker productivity, or even just interested in the value of their own real estate has a dog in this particular altercation.   We need more, not less, information about the price tag for this issue, but we may not get it.

Keeping US and us Blind

There’s an other issue which precludes a rational discussion of the economic costs of gun violence — the NRA’s opposition to research related to gun violence and medical issues.   The Atlanta Journal Constitution explains:

“At one time, the Atlanta-based Centers for Disease Control was at the forefront in that debate, dedicated to addressing gun violence as a matter of public health. But gun rights advocates cried foul, accusing the CDC of practicing politics rather than science, and Congress agreed, stripping the agency of funding for gun-related research.  [...]

Researchers say the means to prevent such tragedies are lacking in part because the National Rifle Association’s campaign against the CDC intimidated scientists across the nation. Those who oppose gun control say the scientists sponsored by the CDC were biased and a threat to fundamental American rights.”  (emphasis added)

We’ll have a better grip on the relationship between gun violence and public health issues — and on the economic ramifications of that matrix when the hysterics at the NRA stop obsessing about “Government Tyranny” and start realizing what their policies are costing their members, in taxes, in government supported health care expenditures, and even on their own property values.

Yes, We Could Be Having A Serious Deficit Reduction Discussion?

At some point in the ongoing discussion about federal debts and budget deficits everyone needs to get serious.  Serious, that is, about doing that which will reduce our federal deficit spending.  Really serious, not as in “let’s wave a Debt Crisis Flag every three months to advance an agenda including the privatization of Social Security and the voucherization of the Medicare program.”

Let’s start with the obvious.  Social Security doesn’t add a dime to the national debt.  If the words of a progressive blogger won’t suffice, how about listening to former President Ronald Reagan?  (video here)  So, discussing “reforms” to the self funded Social Security program as a means to reduce the national debt is extraneous to any serious deficit reduction discussion.

One way to approach the privatization of Social Security is to change the frame of reference, such as altering the connotation of “entitlement” from some earned benefit to which we are entitled because we paid for it, to one which has a tinge of “welfare” about it.  Social Security is not a welfare program — it is an earned benefit.  People who have paid into it all their working lives have every right to expect to be getting something back.  Social Security is not a retirement program.  It is a program which seeks to prevent abject poverty for elders.   Nothing in the Social Security program prevents anyone from maintaining a self-contributory retirement account of any shape or form.   Indeed, the benefits from Social Security are low enough that retirement to the Gated Golf Paradise Of Your Choice can only happen if you have a self-contributory retirement savings program. Anyone suggesting that “entitlements” such as Social Security “have to be reformed” to ease the burden on the federal debt (1) doesn’t have a clue what they are talking about, and (2) is regurgitating anti-safety net talking points from radicals who want to privatize all retirement income programs to the benefit of Wall Street investment firms.

Medicare does have some issues.  The first, and most readily apparent, is that the Medicare Part D (prescription drug) segment is, and always has been, underfunded.  However, the really big monster under the Medicare bed is the increasing cost of health care in America.  When private health care corporations started buying up religious organization/private, state, and locally supported hospitals the profit motive surged in the sector.  Health care must now generate a profit.  Savings, which were once achieved for the purpose of reducing costs for local tax payers or donors to religiously based institutions, now accrue to the corporate bottom line — not to taxpayers, donors, or patients.

The second factor is technology.  We do have the best medical treatment providers in the world.  However, best often translates into “most expensive.” We have all manner of devices and gadgets and equipment and gear to save or sustain lives.  Our hospitals take it as their mission to save or sustain life, which is all well and good until the emotional meets the economical.  There are “death panels” in this country, but they aren’t governmental — they are familial, with families making ‘end of life’ decisions which horrifically in some instances are based on what the family can afford.   Frankly speaking, we don’t do a very good job of educating our citizens about advance directives.  Some conservatives set up a howl when they noticed the Affordable Care Act provided for paying physicians or other medical professionals who provided ‘end of life’ counseling for their patients — however, a little counseling might go a long way toward reducing the anxiety of hospital personnel and the trepidations of family members.  It could also provide some savings in the long run.

Returning to the Big Problem — the Medicare Part D component; we knew in 2003 that the Part D segment would  cost approximately $534 billion.  [Foster pdf] Simply put, “the drug benefit had no dedicated financing, no offsets and no revenue-raisers; 100% of the cost simply added to the federal budget deficit,..” [Forbes]  The part about “dedicated financing” is important.  While the Social Security trust funds have dedicated financing (payroll taxes) there were no provisions to increase the revenues available to finance the Part D enhancement.   There is something unappealingly ironic about the current GOP insistence on “entitlement reform” because “Medicare is broken,” when it was the GOP majority in 2003 that Broke the Program.

Ways to ‘reform’ the Medicare program have been suggested which do not require “voucherizing” the entire thing and sending seniors back to pounding pavement in order to find affordable health insurance plans.  We could consider means testing for the prescription drug benefit.  We might take under advisement lifting the earnings cap for payroll taxes from the current $110,000 level and dedicating a portion of the revenues toward the Part D program.  We could allow the Department of Health and Human Services to negotiate for prescription drug prices the way the Veterans Administration bargains for prescription drugs for VA hospitals and clinics.

If we are REALLY REALLY SERIOUS about ‘reforming’ Medicare then it would be helpful to get past the silly voucherization proposals, referred to as “structural reform” in Speaker Boehner’s response to the President, [Boehner pdf]  and get to the core of what makes health care expensive — we could talk about health care cost containment, dedicated financing for Medicare, and lifting the earnings cap.   We might also want to take a deep breath and see if the Affordable Care Act’s provisions, such as eliminating tax payer subsidies for profitable private Medicare Advantage insurance policies, could achieve some savings over the next decade.

However, it’s getting relatively obvious that the Republicans aren’t terribly serious about deficit (debt) reduction when their offers are strictly ideological (privatize and voucherize) and the proposals don’t address the monster of their own creation — the lack of financing for Medicare Part D.

Buzz Words and Generalities.   Speaker Boehner is offering (pdf) “pro-growth tax reform that closes loopholes and deductions while lowering rates.”   This phrasing is coming perilously close to the older verbiage: Waste, Fraud, and Abuse.  As if we could make up any gaps in program funding by simply cutting out the WFA.  Most anti-tax advocates cite the WFA as some massive potential figure which if reduced could cure all our fiscal woes.  When pressed to provide total figures associated with the largely mythical WFA these advocates provide outlier examples of welfare fraud, some particularly egregious Pentagon payments to contractors, and perhaps a bit of information from Internet e-mail chain letters.  The WFA numbers have yet to yield up the level of financing needed to close budget gaps in the Pentagon or any other government activity.

The arithmetic from “loopholes and deductions” doesn’t add up either.  The same sort of fantastical thinking is required to equate the WFA savings and the L&D revenues.  These mythological creatures are based on the same gossamer upon which anti-tax advocates conjure up the notion that an inordinate amount of the U.S. budget is allocated to foreign aid.  The average American has come to believe that foreign aid takes up 10% of the federal budget, when if fact it consumes only 1%. [NYM]

The Republicans also appear to be consuming their own rhetoric on savings associated with reductions in federal employee compensation.

“Cutting pensions and benefits for government workers is popular, but once again most Americans overestimate how much that costs the government. On average, Americans think the federal government spent 10 percent of its 2010 budget on pensions and retiree benefits; the OMB figures indicate the real number is about 3.5 percent.” [CNN]

The moral of this story is that if the amounts of spending on pensions and benefits, or the amounts that can be retrieved by closing loopholes and eliminating deductions, are grossly inflated, then the resulting policy and budget decisions will be widely off the mark.

Unfortunately, the same type of ideologically based proposals which are the core of Speaker Boehner’s “structural reforms” i.e. voucherization and privatization of Medicare appear to inform his suggestions about federal employee compensation, and another favorite GOP target, SNAP (food stamps.)

The program is already under assault from all sides, considering the appropriations being entertained in the agriculture bill.

The Senate’s version of the farm bill would reduce overall funding by $23 billion, with a reduction in food stamps of $4.5 billion over five years. The House Agriculture Committee is proposing to cut funding by $35 billion — with nearly half the overall cut coming from reductions in food stamps by $16 billion over five years. [Atlantic]

But there’s a problem here.  Food stamps have a beneficial effect on the national economy.

“Those who believe in cutting SNAP funding as a cost-saving measure should know that food stamps boost the economy — not put a strain on it. Supporters of federal food benefits programs including President George W. Bush understood this, and proved the economic value of SNAP by sanctioning a USDA study that found that $1 in SNAP benefits generates $1.84 in gross domestic product (GDP). Mark Zandi, of Moody’s Economy.com, confirmed the economic boost in an independent study that found that every SNAP dollar spent generates $1.73 in real GDP increase. “Expanding food stamps,” the study read, “is the most effective way to prime the economy’s pump.” [Atlantic]

If the object of the game is to increase federal revenues by generating a higher GDP along the formula proposing that a growing economy produces jobs, and more jobs yield more taxable income, and more taxable income means more revenue — then the GOP has the SNAP portion of the argument exactly backwards.  They are proposing to cut a program which actually generates more economic growth.   If one seriously believes that economic growth means more revenue and hence less indebtedness, then one can’t seriously advocate cutting programs which elevate levels of economic growth.

All Pain and No Gain.  The two sides don’t seem to be speaking to the same fiscal slope, cliff, gully, whatever.  From the Republican perspective the damage to the economy might be done by The Specter of Rising Taxes.  Those legendary Job Creators — who are now seeing record corporate profits while wages continue to stagnate — might not invest, and hence there will be no economic growth.  This is fundamental Supply Side Hoax thinking.  That it has been, and still is, a hoax is demonstrated neatly by this graph from the Federal Reserve Bank of St. Louis:

The blue line represents wages, the red line corporate profits.  If corporate well being were the driver of overall economic growth and  well being then why has the blue line been trending downward since 1970?  The answer is simplicity itself: Supply Side Economics is a Hoax of the First Water.

A deficit reduction plan predicated on ideology, urban legends, misunderstandings, and economic illiteracy isn’t SERIOUS.   That conclusion further advances the argument that the Republicans aren’t really serious about debt or deficit reduction, but merely see the issue as a flag to be waved in the van of their attack on the social safety net, a banner of privatization signaling their allegiance to Tea Party politics.

Talking Turkey in the Thanksgiving Season

Now that the Trick or Treaters have departed, the election is over, and Thanksgiving is upon us — it’s time to consider what arguments may break out with Crazy Uncle and which debate techniques will be utilized over the bird carcass.   Forewarned is forearmed, and the following is intended to prevent the flinging of cranberry sauce, and the jabbing of forks in anything other than the baked turkey.

Rule One:  Green Bean Casserole does not provide sufficient cover to prevent onslaughts of “We’re on the Road to Wrack and Ruin.”   Even the most timid inquiry as to why this might be the case will suffice to insure the continuation of the rant — which was probably going to happen anyway.   Continue to smugly munch the sweet potatoes secure in the knowledge that:

Fact: We are not headed the way of Spain, Greece, Portugal, Italy, Ireland … or any other disrupted economy.  The aforementioned countries would love to be in the same “shape” as just one state in this Union — California. [Atlantic]

Fact: Regulations are NOT killing American bid’ness.  In reality a lack of adequate regulation diminishes trust, and diminished trust is an open invitation to corruption — which IS a problem in countries like Greece.  To Wit:

“One issue is trust and corruption. One of the most difficult aspects of modern social life is that the world is a big place and cooperating with strangers is difficult. After all, they might rip you off. You could appeal to the authorities, but the authorities are likely to be strangers, too. In societies with poorly functioning institutions, high levels of corruption, and low levels of social trust, it makes sense to try to stick with smaller-scale entities.” [Slate]

Fact:  There has been no government take over of anything.  That includes health care.  The Affordable Care Act, begotten of the Heritage Foundation and delivered by the U.S. Congress, requires a “free market” solution to individual health insurance coverage by giving tax breaks to companies that provide group health insurance plans, by requiring individuals to purchase individual policies if they can do so, or to purchase their own insurance policies from the corporations participating in the exchanges.

Fact: There is no horrible, heinous, terrible Debt that’s going to immediately hurl the American economy into the Next Great Big Crisis.  Yes, we do need to deal with the residual problems of Bushian Credit Card Conservativism. However,  if we finish operations in Afghanistan, get the millionaires and billionaires to pay tax rates they were paying during the Clinton Administration — when the arithmetic made sense — and get the economy going a a slightly higher rate, most of the horrible heinous terrible Debt will be erased.

Fact: Austerity doesn’t create prosperity.  We have pictures for this.  Here’s a picture of economic growth in the Eurozone:

Now, here’s a picture of U.S. economic growth, from the Department of the Treasury (pdf) :

Rule Two: Crazy Uncle’s contentions, allegations, and assertions will be no more organized than the flight from the table to the television.  All the rules about the construction and presentation of arguments have no more substance for Crazy Uncle than the cream whip on top of the pie.

Tactic:  When losing the point in the face of overwhelming facts to the contrary, change the terms.   For example, when Crazy Uncle asserts that small government is always better and someone has the temerity to mention that national disasters like Hurricane Sandy are not well contained by local agencies themselves reeling in the wake, Crazy Uncle may respond by attempting to compare disaster relief to local nutrition programs.  “Who knows the local situation better? Some bureaucrat in Washington, or the local people in the neighborhoods?“  The analogy doesn’t work any better than those marshmallows on the yams, but there is a sentient response. The answer, of course, is that local agencies do have hands on experience with such local issues, BUT the capacity of the local agencies to provide nutrition programs to the people they know in their neighborhoods often depends on federal funding levels.

Tactic:  When the facts don’t fit deny them.  When Crazy Uncle is faced with the information that the administrative costs for Medicare range from 3.6% to 5% while industry rates range from 11% to 12% [Politifact] expect a reply to the effect that (1) I’ve never read that. OR (2) That’s what the lame stream media says. OR (3) That’s some government figure, can’t trust’em.  Having internalized the notion that no media information is to be trusted from any source other than the notoriously fact free right wing radio environment, Crazy Uncle isn’t inclined to believe anything from anyone about any topic which doesn’t have the imprimatur of a radio ranter.   Forget him — continue to enjoy playing with the wish-bone.

Tactic:  When the territory can’t be shifted, or the facts can’t be denied, implement Operation Bullshit.  Those who watched the Presidential Debates may recognize the Gish Gallop.

“It is often successfully combined with the “point refuted a thousand times” (PRATT). The gallop must consist of as many points as possible, and even old and worn out arguments are useful in overwhelming the respondent and bamboozling the audience. The technique also takes advantage of the one single proof fallacy, since if a respondent only manages to refute 99 out of 100 points there is still one point that proves the galloper correct.

The trick is to press Crazy Uncle on a single point.  Narrow the argument to something like “which economy had the consistently higher rates of growth in 2011 — the U.S. or the Eurozone?“   The necessity of defending a single point at a time puts the reins on the Galloper.

Rule Three:  Since Crazy Uncle has his very own reality distant from, and unrelated to, the remainder of the population on this planet, the only way to completely obliterate his rambling rants is to find a televised athletic event upon which most of the diners can agree, and turn the sound up.

 

Playing Percentages With Grandma? Romney-Ryan Medicaid Budget Cuts in NV

The median annual household income in Nevada is $55,726. [Census]  The total population estimate for 2011 is 2,723,322 and of these approximately 12.5% are over 65 years of age.  Some simple arithmetic shows that about 340,415 Nevadans are over 65 years old.   So what?

The question is important because some of these individuals will need home care services to deal with infirmities, some will need assisted living to remain independent, and others will require institutional care, aka nursing facilities.

As we can see from the Kaiser Family Foundation graph above,  more Medicaid resources have been allocated for home and community based care since 1995.  Long term care, which prior to 1995 meant institutional care for the most part, is now 43% home/community based health care services.   The issue now becomes do we want to fund the Medicaid program at a level which will allow more low income  Nevada residents over the age of 65 to remain at home, or do we cut program services such that we cope with only the most medically fragile?

The family issue, for that household earning the $55,726 annually, is how to provide care for an elderly relative who requires medical assistance beyond the financial capacity of the family to provide but who doesn’t need institutional care?  There is no answer to this inquiry from the Romney/Ryan budget.

In fact, if as Senator Heller and some of his colleagues recommend,  we repeal the Affordable Care Act (Obamacare) and do what the Republican ticket suggests — transform the Medicaid program into a block grant scheme — we cut approximately 38% from Medicaid services. [KFF pdf]  If we drill down into state by state statistics, if Obamacare were repealed and the Ryan Budget was adopted our Medicaid program in Nevada stands to lose about 44% of its funding. [KFF pdf]

No one would (or should) be so callous as to suggest we slash funding for those with the most serious medical needs, especially those who need nursing facility care.  However, if we’re looking down the line at a 44% reduction in Medicaid funding for state services then the obvious cuts would come “at the margins.”

Who’s marginal?  Are low income single mothers with two dependent children under the age of 6 marginal?  Are low income elderly persons who can still function — albeit barely –  independently marginal?

The Medicaid program in Nevada* is an insurance program which pays servicers to perform some or all of the following tasks:

-Adult Day Care
-Assistance Shopping for Essentials
-Caregiver Respite
-Case Management
-Companion Care
-Homemaker
-Housekeeping
-Laundry
-Meal Preparation
-Personal Care
-Personal Emergency Response System (PERS)

* In order to qualify for the Nevada Home and Community Based Waiver as of 2012, the applicant’s monthly income must be less than $2,094.  Their countable assets must be valued at less than $2,000.

Now, how many families can afford privately financed adult day care, companion care, housekeeping help, meal preparation, personal care, and shopping assistance? On $55,726 a year?  On an income of approximately $2,000 per month?

The obvious conclusion is that perhaps the Republicans are advocating for Crowded Housing?  If they bemoan the fact that recent college graduates are staying home with parents in a tight economy, think how much more familial the entire living situation becomes when the grandparents — or Uncle Festus or Aunt Minerva — move in?  Especially when the elderly relatives are simply in need of the kinds of home or community based services likely to be declared marginal in cost cutting binges?

While this might all sound a little facetious, the fact is that most houses in the U.S. ( some 67%) have two or three bedrooms. [Census] Every parent’s dream for when the offspring depart, be it the new guest room, the man cave, the sewing room — whatever — fails when a no long total independent older relative needs a safe place to live.

A modicum of concern for middle income families who are struggling to maintain their standard of living might be in order.   If we can assist middle income families with the costs associated with the care of a low income elderly relative; if we can chip in a bit so that a low income  elderly person can remain independent as long as possible — then why is is necessary to cut 44% of the Medicaid program in Nevada so that millionaires and billionaires won’t have to revert to paying the income taxes they were paying back in the Clinton years –  39.6%.  (They are current paying 35%.   All this for 4.6%. )

Let’s guess that the hedge fund managers and Wall Street wizards won’t be decimated by a 4.6% tax increase, but a 44% reduction in Medicaid funding in Nevada will have a profound effect on the other 99.99%.