Social Safety Net – Page 2 – The Wrongologist

Biden’s Plan To Cut Drug Prices

The Daily Escape:

Mars on left, Earth on right – image by alofeed

The Biden administration released its list of 10 prescription medicines that will be subject to the first-ever price negotiations by Medicare. This is a big deal because Medicare covers 66 million older Americans, people who routinely take very expensive drugs.

Until recently it was illegal for Medicare to negotiate prices with drug companies. But the Inflation Reduction Act (IRA), passed last August, gives Medicare that power. It also forces companies to pay a rebate to Medicare if their drug prices rise faster than inflation. The Congressional Budget Office estimates that price-capping measures will reduce Medicare expenses (and the federal deficit) by $96 billion by 2031.

The list includes drugs for diabetes, arthritis, and Crohn’s disease, and could sharply lower medical costs for patients. Reuters says that the US Centers for Medicare & Medicaid Services (CMS) spent $50.5 billion between June 1, 2022 and May 31, 2023 on these 10 drugs. That was about 20% of the total cost of drugs in the Medicare prescription drug program known as Part D.

The WaPo had an opinion piece by David Goldhill, CEO of SesameCare.com, a digital marketplace for discounted health services: (brackets and emphasis by Wrongo)

“The pharmaceutical industry earns almost 50% of its worldwide revenue here [the US], as do medical information-technology firms. [Medical] Device makers earn 40% of their money in the US. And this understates things, because US revenue is generated from higher prices, so margins are greater. If the US accounts for half of a company’s revenue, it probably contributes at least 75% of its profits.”

This has always been the business plan for Big Pharma: Make your money in the US and take whatever scraps of profit you can get in other markets.

That market subsidy is paid by American taxpayers generally (through the funding of Medicare) and by US pill-takers specifically when they pay higher co-pay prices for the drugs that help with their chronic conditions. The Economist points out that prescription medicines in America cost two to three times more on average than in other wealthy countries:

The blue dots are the price paid in the US for brand name drugs. The grey dots are prices paid in the various countries for all US drugs sold in those countries. The comparison of brand name to generics shows how much greater the cost is to an American. It also follows that US patients’ out-of-pocket expenses, (the slice of drug costs not covered by insurance), are among the highest in the world.

It’s understandable why Biden’s move to start negotiations on some of the most expensive drugs has been fiercely opposed by the pharmaceutical industry. Essentially, high US drugs costs underwrite what amounts to a subsidy for buyers of the same drug sold when it’s outside the US.

Many of the Big Pharma have jumped on the legal bandwagon, challenging price-setting provisions in the IRA. More from the Economist:

“Since the law’s passage over 50 companies have blamed the IRA in earnings calls for clouding their prospects.”

A quick primer on drugs. Most medicines are either small-molecule drugs or large-molecule drugs. The former are the kind of pills that line our medicine cabinets. Large-molecule drugs, (also called biologics), are more complex and must be injected. The IRA grants biologics 13 years of pricing freedom after a drug is approved, while small-molecule drugs get only nine years post-approval before they must face Medicare’s bean counters. The industry estimates that small-molecule brands could lose between 25% and 40% in overall revenue due to the earlier cap on prices.

PhRMA, the pharma Industry’s lobbyist argues (and Republicans back them) that high US prices reflect the high cost of drug development. The pharmaceutical manufacturers are, of course, suing to stop the price negotiations. They say that allowing the government to negotiate lower bulk prices for drugs will stifle innovation, and will cut funds for research.

One thing that Big Pharma wants to avoid showing us is that they rely on smaller, more agile biotech firms for ideas. Between 2015 and 2021, 65% of the 138 new drugs launched by Big Pharma originated mostly from smaller firms. So, while innovation isn’t totally gone from the big firms, what they’re mostly doing is marketing the intellectual property of small pharmaceutical firms.

It didn’t take long for Republicans to jump on the decision to allow Medicare to negotiate drug prices. From Politico:

“Piggybacking on the pharmaceutical industry’s strategy, Republicans are working to persuade Americans that the Biden plan will stifle innovation and lead to price controls.”

Politico quotes Joel White, a Republican health care strategist:

“The price control is a huge departure from where we have been as a country….It gets politicians and bureaucrats right into your medicine cabinet.”

Politico says that the GOP effort to reframe the drug price debate may hurt them, since they plan largely to run on inflation, while the Biden plan will lower drug prices. Also they quote a new poll from the Kaiser Family Foundation (KFF) that shows 58% of independent voters trust Democrats to lower drug costs compared with 39% of Republicans.

Our politicians and pundits have bleated at us for years about being an “exceptional nation” – but what we really are is exceptionally gullible. As long as the large healthcare and pharmaceutical companies insist on standing between American consumers and their health needs, maximizing their profit will always come first.

We also continue to elect leaders who lobby for keeping corporations unleashed so that they can make as much profit as possible, while saying that the “market” will decide where the public good is prioritized. This keeps us hopelessly mired in a grossly expensive, and often ineffective healthcare system.

We continue to let ourselves be convinced by corporations and our politicians that reforming healthcare is impossible. That the solutions and methodologies used by other developed nations are substandard, and/or somehow immoral.

The Hill reported that the 14 leading US drug companies paid out more in stock buybacks and dividends from 2016 to 2020 than they spent on research and development. Those firms spent $577 billion from 2016 to 2020 on stock buybacks and dividends, $56 billion more than the $521 billion they spent on R&D. So, it’s oblivious how Big Pharma could easily fund their R&D with lower drugs prices.

It is also useful to remember that America has more healthcare billionaires AND healthcare bankruptcies than any other country. Those two things are inextricably linked.

As long as the pharmaceutical companies can maximize profits by buying politicians rather than by charging higher prices in other countries – the American people are the ones who will continue to get screwed.

Rural Hospitals Are No Longer Providing Maternity Care

The Daily Escape:

Perseid meteor shower, from Mt. Evans, CO – August 13, 2023 photo by Paul Blais Photography

Welcome to our Saturday Soother, but first, Wrongo intends to spin you up before eventually letting you slow down.

There’s a crisis in rural healthcare in America. Rural hospitals are closing at a rapid rate. Our county (Litchfield) in Connecticut has one of three remaining hospitals that are designated as rural in the state (Sharon Hospital).

A problem for rural hospitals is that many are closing down their labor and delivery services in order to try and remain economically viable. WSHU, a CT-based NPR affiliate, has covered the impact of these closures to Connecticut. They quote Peiyin Hung, a researcher on maternal and rural health at the University of South Carolina:

“My team has been tracking nationwide, hospital-based obstetric unit closures since 2008 up to 2022,…. Almost 300 hospitals closed their OB units.”

WSHU points out that more than 60% of those closures were in rural areas. Why are so many hospital groups moving away from delivering babies in rural locations?

WSHU quotes Dr. Robert Roose, chief medical officer at Johnson Memorial, a hospital in rural Stafford Springs, CT that closed its obstetric unit. He said that it’s a safety issue. Hospitals with fewer than 200 deliveries a year, like Johnson Memorial, are considered low-volume birthing centers:

“There is a clear and critically important correlation between volume and quality of services provided when it pertains to labor and delivery and maternity care…”.

Three years ago, Hartford HealthCare’s Windham Hospital in Willimantic, CT stopped delivering babies, citing the same concern.

Also, malpractice insurance rates go up for low birth-volume hospitals because insurers feel the risk is higher if doctors aren’t getting sufficient practice with birthing. Hung says another problem is the level of reimbursement:

“Medicaid…pays half as much on average [as] private insurance pays for labor and delivery across the country”.

That’s important because about four in 10 of all Connecticut deliveries are covered by Medicaid. Simply put, delivering babies doesn’t pencil out for many rural hospitals.

There are other factors: Rural America’s demographics skew older. Young families in general prefer living in the suburbs or exurban areas. Couple that with America’s lower birth rate and rural hospitals really can’t maintain the birthing volume they need to remain economically viable.

The Center for Healthcare Quality and Payment Reform, (CHQPR) a Pittsburg-based health policy group published “A Crisis in Rural Maternity Care in the United States” which shows the problem:

“Fewer than half (45%) of the rural hospitals in the US currently offer labor and delivery services, and in 9 states, less than one-third do. Over the past decade, more than 200 rural hospitals across the country have stopped delivering babies”.

“Hundreds of additional communities are at risk of losing maternity care because of the financial challenges rural hospitals are facing….More than 1/3 of the rural hospitals that still have labor & delivery services have been losing money on patient services, so their ability to continue delivering maternity care is at risk.”

CHQPR reports that more than half of small rural maternity care hospitals lost money in 2021-22.

They suggest that a primary reason rural hospitals are losing money is that private insurance plans pay them less than what it costs to deliver many of the services they offer patients, not only maternity care. They point out that while rural hospitals are losing money on uninsured patients and Medicaid patients, the losses from private payers have the biggest impact on their overall profit margins.

CHQPR suggests that a potential solution is to require that health insurance payments actually cover the cost of rural maternity care. With more than 40% of births (on average) in rural communities paid for by private health plans, having the private insurers pay more would help keep rural maternity care viable:

“Payment amounts must be higher in communities that have difficulty attracting staff, and payments must also be higher in communities with smaller numbers of births to ensure that revenues cover the fixed costs.”

This means that the fee-for-service model isn’t working in low-volume hospitals. Rural hospitals are only paid when they actually provide a service, but a small hospital has proportionally higher overheads than larger hospitals, since they must be staffed and ready to deliver a baby at all times, even if there are no deliveries at all. Read CHQPR’s report “A Better Way to Pay Rural Hospitals”.

Back to Connecticut, Sharon Hospital has proposed closing its labor and delivery unit. There will be a public hearing to consider the closure later this year. But Sharon is about an hour from its affiliated hospital (Danbury Hospital) that has a fully-staffed labor and delivery facility. Sharon may actually be closer to two other unaffiliated hospitals in New York state than it is to its own parent facility.

It’s now time for our Saturday Soother. Litchfield County is having beautiful weather this weekend. We’re taking advantage of it by going to a live Baroque music concert, and possibly heading off to the annual fair in a local town.

To help you relax and zone out from all of the Trump indictment analysis, grab a chair outside in the shade and watch and listen to “Gortoz a Ran” (I’m Waiting) sung by Denez Prigent and Lisa Gerrard. The language in the song is Breton, spoken in Brittany, France. It is closely related to Cornish and Welsh, and all three are Celtic tongues. When the Angles, Saxons and Jutes invaded Britain in the fifth century (400-500 AD), many of the Britons in Cornwall, Devon, and the West Country fled across the English Channel to France. Because of the influx of Britons, the region became known as Brittany.

Most of the images in the video are of Scotland, England, Wales, and Brittany. Lisa Gerrard isn’t singing in any language; she’s just vocalizing. The Uilleann pipes, an Irish instrument, are heard at 3:50:

Lyrics: English Translation

I was waiting, waiting for a long time
In the dark shadow of grey towers
In the dark shadow of grey towers

In the dark shadow of rain towers
You will see me waiting forever
You will see me waiting forever

One day it will come back
Over the lands, over the seas

The blue wind will return
And take back with it my wounded heart

I will be pulled away by its breath
Far away in the stream, wherever it wishes

Wherever it wishes, far away from this world
Between the sea and the stars

The song describes waiting, possibly forever: Aren’t we all waiting? What are we waiting for? For whom are we waiting? Happy Saturday!

The Problems With Childcare

The Daily Escape:

Sunset with Cosmos flowers, Blue Ridge Mountains, Franklin, NC – August 2023 photo by Amy Barr

Monday’s Wake Up Call is that we’re in the middle of a childcare crisis, one that dates back to WWII. Daycare costs too much, daycare workers don’t earn enough, and many daycares don’t make money and are going out of business.

Today, anyone who has tried shopping for day care knows that it’s a tough marketplace. Care.com, an online platform where people can hire housekeepers, pet caretakers, nannies, and more, publishes a yearly Cost of Care Report to help US families understand the cost of childcare. Their June 2023 report found that on average, US parents spend 27% of their household income on childcare expenses:

“Households with children make up 40% of the total US population. And with a national family median household income of $91K, child care costs for the typical American family are even more staggering:

– 45% of families earning less than $100K annually will spend more than $18,000 on childcare in 2023, amounting to 18% of their household income (HHI).

-43% of families earning less than $75K will spend more than $18,000, amounting to 24% of their HHI.

-39% of families earning less than $50K per year will spend more than $18,000, amounting to a whopping 36% of their HHI.”

And increasingly, economists are saying that more women would be working if childcare was available. From Axios:

“In a research note about Friday’s jobs report, the chief economist at consulting firm RSM US did something surprising: Instead of talking about rate hikes or soft landings, he made the case for universal child care.”

Axios quotes RSM’s Joe Brusuelas:

“Childcare for kids under the age of 5 is increasingly an issue for more mainstream economists who are concerned about the prospect of long-term labor shortages in the US. Universal childcare is the most realistic way to help expand the labor force at a time when the economy needs workers the most,”

“The US needs more workers, and there are more women sitting on the sidelines of the labor market than men.

-Right now, close to 86% of working-age men are employed compared with 75% of women. That’s a record for women, but it’s also far below the rates for men — there’s room to grow.

-Substantial childcare investments, like those proposed in the now defunct Build Back Better bill, could increase mothers’ employment by 7 percentage points, with bigger jumps for low-income families, according to estimates in an NBER paper published last year.”

The underlying problem is the economics of childcare. First, it’s difficult to get information about childcare costs either online or over the phone: Daycares often only share their prices after you have visited their facilities. And many daycares have waitlists stretching from six months to a year.

Economists say that long waitlists are a classic sign that something’s wrong with that particular marketplace. In this case, waitlists indicate that daycare prices are too low. But parents say that the price for daycare is actually too high. NPR reports that the median price in daycare for an infant in a large county in the U.S. is $17,000 a year. Also, more than 60% of families can’t afford the full cost of quality day care.

Meanwhile, daycare owners can barely afford to stay open. NPR interviewed a daycare provider in Iowa who said that salaries are 83% of their monthly budget:

“Five percent goes to their loan payment. 4% is operating expenses, cleaning supplies, snow removal, play kitchens, things like that. Three percent is utilities. Another 3% goes to groceries….And 2% is for their insurance and their building insurance and worker’s comp.”

Along with labor, that equals 100%, meaning the center makes no profit. It’s probable that the daycare owner’s pay is in the 83% labor total, but still it means zero profit. The Iowa daycare pays its staff between $12 to $15 an hour, while the local Chick-Fil-A advertises $16.75/hour to start. The Iowa daycare has a census of 72 kids, which requires 25 staff.

Daycares are required by law to hire a ratio of staff/per child, a higher number than other low-wage industries, like fast foods need. In fast food, labor is about 25% of the total costs, and the volume of sales is in the tens of thousands, not the 72 kids that a wage increase would effect in the Iowa daycare.

Since labor costs are such a high percentage of total costs in daycare, increasing wages means prices paid by families of children in daycare have to rise drastically to cover the higher costs. Wrongo did a back of the envelope calculation for the Iowa center. If their base pay was $12/hour and it was raised to $15, the average monthly charge for one of the 72 children already in daycare would increase by $360/month, or about 47%!

The broken system is made worse in the US because we don’t have long maternity and paternity leaves.

Funding for childcare that was put in place during the pandemic is set to run out in September. Once we hit that “childcare cliff,” 3.2 million children will lose federal funding. More centers will either have to raise prices, cut staff or shut their doors.

Universal childcare has a tortured history in the US. During World War II, women replaced men in the domestic workforce. But who would take care of the children? The US government answered by enacting the Lanham Act, the first and only universal child care program in American history. An estimated 550,000 to 600,000 children received care through these facilities, which cost parents 50 to 75 cents per child, per day. The program ended in 1946.

Nixon vetoed a universal childcare bill in 1971 that would have created federally-funded public childcare centers across the US because Conservatives argued that the bill was communist and that it would be the end of the American family. A group called Iowans for Moral Education asked “Whose Children? Yours or the State’s?”

Time to wake up America! If you don’t want society to help take care of kids, you’re an asshole no matter what reason you give for being against funding. These kids didn’t ask to be here and they have done nothing to deserve not having societal support. If you think you can make America great again by making it harder to take care of kids, you’re wrong.

To help you wake up, watch and listen to a scene from the 2003 film “Daddy Daycare”. In this scene, Charlie (Eddie Murphy) and Kim (Regina King) try to find a good preschool for their son Ben, but it turns out to be impossible. Life’s still like this 20 years later:

Saturday Soother – May 6, 2023

The Daily Escape:

Mt. Adams sunrise with orchards in bloom, WA – May 2023 photo by Mitch Schreiber Photography

(Wrongo and Ms. Right give a group hug to family member Bob W. His mother has a grave health crisis. We’re thinking of you Bob.)

There’s a book called “A Terrible Country” written in 2018 by Keith Gessen. It’s about life in Russia a few years before Russia became a pariah in Europe. But the title could easily describe the US in 2023. If you doubt that, maybe you aren’t aware of the video of a NYC subway rider choking a homeless man to death last week. The video lasts for four minutes.

The NYT describes the video:

“The homeless man, Jordan Neely, is seen writhing, trying to get free from the arms and legs of the other subway riders who are pinning him down. As the minutes tick by early Monday afternoon on a northbound F train in Manhattan, Mr. Neely visibly weakens as the arm wrapped around his neck stays tight.”

After he stops moving, the riders hold him down for about another 50 seconds. Neely was later pronounced dead at a nearby hospital. Jordan Neely was homeless. He was a Michael Jackson impersonator. Neely’s race (Black) and that of his killer (White) are a depressingly familiar story. What’s different is that his assailant wasn’t a cop and didn’t use a gun.

What’s also familiar is that the assailant has not been charged by the NYPD.

What’s also disturbing is that the subway car held bystanders most of whom remained bystanders, watching a former Marine choke the life out of Neely for (apparently) behaving erratically.

After the fact, we learned that Neely had more than 40 arrests including an open warrant for punching a 67 old woman. No one should portray him as simply a misunderstood soul. But did he deserve to die in that subway car?

If you’ve been paying attention, you know that there’s been news nearly every day about Americans being killed over mundane, mostly non-threatening actions, or for being in the wrong place at the wrong time.

The NYT’s Roxanne Gay:

“We are at something of an impasse. The list of things that can get you killed in public is expanding every single day. Whether it’s mass shootings or police brutality or random acts of violence, it only takes running into one scared man to have the worst and likely last day of your life. We can’t even agree on right and wrong anymore.”

How did the country get this way? Why is there so much fear and paranoia about the “other”? Why do select elements of our society cultivate this fear by marketing it?

Neely’s killing is partly an outcome of the relentless political rhetoric that has contributed to the public’s false beliefs about actual crime levels in America’s cities. And NYC’s Mayor and NY’s Governor wouldn’t even condemn the killer. Elizabeth Bruenig writes in The Atlantic:

“This process, through which mundane uncomfortable situations are transformed into terrifying ordeals by…incidents of random gun violence…is one means by which a healthy community becomes a violent society. Nobody looks forward to encountering people behaving erratically on the subway…but killing a mentally ill man on a train….represents the loss of a peaceful commons, the absence of compassion, and the overwhelming fear we have come to accept in our culture of violence. This is the country we have become.”

Yep, we’ve become a terrible country. Back to Roxanne Gay:

“There is no patience for simple mistakes or room for addressing how bigotry colors even the most innocuous interactions. There is no regard for due process. People who deem themselves judge, jury and executioner walk among us, and we have no real way of knowing when they will turn on us.”

And on Thursday, four of the Proud Boys, among paranoia’s finest, were convicted of committing vigilante justice against our democracy. Let’s leave the final words to Gay, who says we’ve become:

“…a people without empathy, without any respect for the sanctity of life unless it’s our own…”

Or fetuses.

Time for Wrongo to wash up after digging in this cultural dirt. It’s time for our Saturday Soother where we try to forget about whose drones hit the Kremlin, and try to center ourselves before another demanding week begins,

Here at the Mansion of Wrong, Wrongo and Ms. Right are spending the weekend in NYC seeing two musicals.

But as a public service to the rest of you, grab a seat outdoors on what looks like a beautiful day in the northeast. Now watch and listen to Erzsébet Pozsgai play the first movement of “Spring” from the “Four Seasons” by Antonio Vivaldi on solo violin, live in Budapest in 2013:

Saturday Soother – March 11, 2023

The Daily Escape:

Sunset, Santa Elena Canyon, Big Bend NP, TX – March 2023 photo by Rick A. Ludwig. Cliff on left is in Mexico, the one on the right is in US. The Rio Grande is in the middle.

Signs that we’re starting to think about the 2024 election are everywhere. Wrongo wants to connect a few dots regarding Biden’s recent efforts to move the Democratic Party more to the middle on crime and immigration while staying left on financing the country’s social and military needs.

Biden proposed a budget to reduce the deficit, protect Medicare and Social Security, and raise taxes on wealthy individuals and corporations. From the NYT:

“In a speech in Philadelphia on Thursday, Mr. Biden said that his budget was designed to ‘lift the burden on hard working Americans’ and drew sharp contrasts with the proposals that Republicans have offered, which the president argued would threaten the nation’s social safety net programs and benefit the rich.”

This contrasts with Biden’s right-leaning position on the recent DC crime bill. Since DC is controlled by the Congress, it’s legislation can be vetoed by the US Senate. Also from the NYT:

“The Senate…voted overwhelmingly to block a new District of Columbia criminal code that reduces mandatory minimum sentences for some violent offenses, with Democrats bowing to Republican pressure to take a hard line on crime in a move that underscored the rising political potency of the issue ahead of the 2024 elections.”

By an 81-to-14 vote, with 31 Democrats voting with the Republicans, the Senate passed the Republican-written measure to undo the District’s law. It now goes to Biden, who after initially opposing it abruptly changed course and said he would sign it.

So, Biden’s tacking left on spending but to the center-right on crime. He’s making a series of calculated moves to position his Party to compete successfully in 2024. Still, it’s disappointing that Biden and 31 Democrats joined with the Right to deny DC residents the right to govern their own city.

But this shouldn’t be surprising. Last year, Biden and the Democrats turned their backs on labor during their contract battle with the railroads.

Here’s Nick Catoggio in the Dispatch: (Brackets by Wrongo)

“[Biden has]…begun to tiptoe toward the center lately on another major Democratic liability, immigration…..Centrist analysts…have warned Biden and his Party that their political viability depends on escaping the…“cultural bubble” in which an unsecured border is treated as a civic good.”

And last week Biden changed his immigration policy. He’s requiring asylum seekers to seek refuge in nations they pass through rather than waiting to do so in the US.

These new policies bring Biden closer to public opinion. Among Democrats, a plurality want to see the number of asylum applicants increased rather than reduced. Among the overall public, it’s the opposite. Biden is tilting toward the latter.

Biden wants to be seen as strong on crime. Democrats walk a fine line of being against crime but not wanting to wholly support the police. Doing that would risk looking anti-Black in cities that are so important to their political success. Dems support compassionate justice and not retributive justice, so they get tied up in knots when violent crime increases, which is rising in America. The problem of course is that the descriptor “violent” isn’t consistently applied.

Biden’s idea is to try to win more votes from people who are not fanatic MAGA types. That means picking off White suburban voters, Asian voters and Hispanic and Black voters, all of whom are concerned about crime.

Tom Sullivan points out that while the moderate-to-conservative White population is in slow decline, their votes remain significant, and that Democrats shouldn’t ignore them over the next two years:

“Sadly, Democrats often do. Campaigning in concentrated urban areas that tend to vote your way is simply easier and more cost-effective. What it means for largely rural states like North Carolina is that while it remains possible to elect a Democrat like Roy Cooper as governor, Democrats’ urban focus bequeaths him a Republican-dominated legislature…”

Sullivan says the Democrats need to start acting like the big-tent party that they used to be.

And that’s what Biden is attempting to do.

Time to say “enough” to war-gaming the 2024 election. It’s time for our Saturday Soother. The daffodils have sprung through the snow, a sure sign of spring. We turn back the clocks tomorrow night, another win for those who hate dark days.

So, it’s time to take a few minutes to center yourself. Start by sitting in a comfy chair and watch and listen to Lili Boulanger’s “D’un matin de Printemps” (On a spring morning). She wrote this piece in 1917 when she was 23. Boulanger battled bronchial pneumonia throughout her short life, dying a year later at age 24. Here, it is played by the Seattle Symphony conducted by Cristian Măcelaru.

Listen and think about her writing this during the darkest days of her life:

What To Do About Social Security and Medicare

The Daily Escape:

Lupine and poppies, near Glendale, AZ – March 2023 photo by Marion Cart

From Joe Perticone:

“Social Security and Medicare are headed for insolvency—that’s just a mathematical, demographic fact. But when it comes to addressing the problem, there’s virtually nothing the two parties actually agree on. For years, Republicans have waffled between proposing cuts and kicking the can down the road.”

Republicans are correct that Social Security (SS) and Medicare (M) are marching toward insolvency. But they trip over their own feet with their proposals to save them. Republicans are wrong to think they can solve the solvency questions without raising taxes. Once the Republicans take taxes off the table, they’re left without any real solutions to propose.

The Biden administration has done a good job in pre-emptively going after Republican’s ideas about cuts in Social Security and Medicare benefits. The result is that the GOP is squabbling between themselves and scrambling to come up with a plan they could take to the public.

It’s not just the federal debt that should be discussed. Dr. Donald Berwick head of Medicare and Medicaid during the Obama administration wrote in JAMA: (emphasis by Wrongo):

“A total of 41% of US adults, 100 million people, bear medical debts. One of every 8 individuals owes more than $10,000. In Massachusetts, 46% of adults say they skip needed care because of costs. As of 2021, 58% of all debt collections in the US are for medical bills.”

The WaPo explains why people who live in the American South have bad credit scores. It turns out that neither race nor poverty were the deciding factors. It was medical debt:

“Of the 100 counties with the highest share of adults struggling to pay their medical debt, 92 are in the South, and the other eight are in neighboring Oklahoma and Missouri…”

But why the South? Yes, as a region, it’s unhealthy. But there are several Northeastern states where residents struggle with chronic health conditions but have good credit. One thing that stands out is the lack of Medicaid:

“…a recent analysis in the Journal of the American Medical Association…found that medical debt became more concentrated in lower-income communities in states that did not expand Medicaid after key provisions of the Affordable Care Act took effect in 2014.”

So bad health and bad credit are because of Republican governors’ refusal to expand Medicaid to cover more poor people. Leave it to the south to show a MAGA future for all of us: undereducated, unhealthy, and neck-deep in debt.

What’s The GOP Plan For Negotiating On The Debt Limit?

The Daily Escape:

Dream Lake, Estes Park CO – January 2023 photo by Rick Berk Photography

(Wrongo and Ms. Right send healing thoughts to friend and blog reader Gloria R.)

We’re all aware that House Republicans are refusing to lift the debt ceiling unless Biden gives them well, something? And Republicans still haven’t decided what they want. The GOP also wants a balanced budget, but they can’t say what should go, or what should stay.

From the WaPo: (Brackets by Wrongo)

“They [GOP] say they want to reduce deficits — but meanwhile have ruled out virtually every path for doing so (cuts to defense, cuts to entitlements, wiping out nondefense discretionary spending, or raising taxes).”

The fact that Republicans are up in the air about what to do highlights the likely Democratic strategy is against their threats about the debt ceiling. Again, from the WaPo:

“Sensing Republicans are on the verge of a blunder in their schemes to use the debt ceiling to hold the economy hostage and try to extract draconian spending cuts, the White House has developed a two-part response strategy.

Part 1: Lay out the simple argument that Republicans are recklessly inviting an economic meltdown even by talking about a possible default.

Part 2: Force House Republicans to put forward a plan on the table and watch as they struggle with the fallout.”

The Democrats along with Senate Minority Leader McConnell (R-KY) are daring Republicans to put forward a plan. Senate Majority Leader Schumer (D-NY) said:

“If House Republicans are serious about taking the debt limit hostage in exchange for spending cuts, the new rules that they adopted require them to bring a proposal to the floor of the House and show the American people precisely what kind of cuts they want to make….”

Everyone who follows politics knows that Republicans never take much interest in fiscal sobriety when their Party is in control. They agreed to raise the debt limit three times while Trump was in power.

It seems that Republicans are doing the Democrats’ job for them. They are asking for an economic catastrophe and seeking draconian cuts that their base doesn’t want.

Consider the Republican desire to reduce our deficits. They have pledged to balance the budget (that is, to have a zero annual budget deficit) within 10 years. But they haven’t laid out any plausible mathematical path for getting there. And of the current debt ceiling, 90% of it was committed before Biden took his job.

Some Republican House members want to cut military spending, an idea that both Speaker Kevin McCarthy (R-CA) and Rep. Jim Jordan (R-OH) are on board with. But others, including House Appropriations Chair Kay Granger (R-TX), have said defense spending cuts aren’t on the table. Rep. Michael Waltz (R-FL) said:

“We’ve got to get spending under control, but we are not going to do it on the backs of our troops and our military,”

Waltz thinks Republicans should focus on “entitlements programs,” such as mandatory spending programs like Social Security, Medicare, and Medicaid. But the bi-partisan popularity of these programs makes them hard to cut.

And last Sunday, Rep. Nancy Mace (R-SC) was asked to name one thing she was willing to suggest as a spending cut. She instead stated things she wouldn’t put on the table:

“Well, obviously no cuts to Medicare or Medicaid or Social Security….That’s a nonstarter for either side.”

Wrongo has repeatedly suggested tax increases which would help lower deficits, but Republicans have ruled that out.

Instead they’ve changed the House rules so tax cuts will be much easier to pass, and tax increases harder to pass. The House’s rules package now says that any increase in taxes would require a three-fifths vote (60%) rather than a simple majority as previously.

They’ve also proposed doing away with income taxes, payroll taxes, estate taxes and even the IRS itself in favor of a supersized sales tax that would provide most revenue to the government. Republicans would substitute a 30% sales tax on all purchases and in exchange, do away with income, Social Security and Medicare taxes.

That means workers would keep the gross amount of their paychecks. But it also means that buying everything from groceries to automobiles would be hugely more expensive. It also provides a big tax cut for the wealthy and businesses.

The result is a smaller tax burden for the highest earners and a bigger one for people in the middle.

Once you reject trimming entitlements or defense spending and bake in the cost of the GOP’s proposed tax cuts, you’re left with an additional $20 trillion hole in the Federal budget over the next decade.

OTOH, the White House is expected to release its detailed budget in early March. It will build on budgets it has released previously. Republicans want Biden to negotiate on what to do about money we’ve already spent.

Try doing that with YOUR creditors.

A MAGA Idea Wrongo Supports

The Daily Escape:

Sunset, Tucson, AZ – January 2023 photo by Leila Shehab

Sometimes your worst political enemies are on the same page with you. Axios reports that a:

“…threat of cuts to US defense spending has emerged as a flashpoint in House Republicans’ first week in the majority, widening the GOP’s isolationist fault line and exposing the fragility of Kevin McCarthy’s young speakership.”

The backstory here is that according to Bloomberg, among the concessions new House Speaker McCarthy made to secure the job was to agree to vote on a budget framework that caps 2024 discretionary spending at fiscal 2022 levels. Unless the Pentagon is exempted, that could result in a $75 billion drop in defense spending:

“National defense spending, which primarily funds the Pentagon, was about $782 billion in fiscal 2022 and rose $75 billion to $857 billion in fiscal 2023.”

The deal that McCarthy has apparently agreed to would have the House commit to passing bills that would cap all discretionary spending at fiscal year 2022 levels, or roughly $1.47 trillion.

But one of the big wins for Senate Republicans in last year’s budget talks was a bigger defense budget. Sen. McConnell might want to check in with the House MAGA Republicans, since they’re going in the opposite direction.

Wrongo agrees that the idea of cutting $75-$100 billion (or more) from the Pentagon should be up for discussion. Consider that in 2021, the Congressional Budget Office (CBO) released a study that outlined three options for saving over $1 trillion in Pentagon spending over the next ten years without damaging our defense capabilities.

All three options involved cutting the size of the armed forces, avoiding large boots-on-the-ground wars like Iraq and Afghanistan, and relying on allies to do more in their own defense.

Wrongo wrote about the 2021 CBO study here. The CBO report put the potential cut in historical perspective: A $1 trillion cut (14%) over a decade would be far smaller than the cuts to America’s military spending in 1988-1997 (30%), and the 25% cut we had in 2010-2015.

A $1 trillion saving isn’t chump change. Those funds could be used to prevent future pandemics, address climate change, or reduce economic injustice. These are all pressing American problems.

The MAGA’s ideas on defense spending cuts might find support from a few progressives in Congress, including Reps. Barbara Lee (D-CA) and Mark Pocan (D-WI), who pitched a $100 billion haircut for the DoD earlier this year. But this year’s Pentagon budget boost easily passed both the House and Senate on a bipartisan basis.

Both Republican and Democratic House war hawks will resist the idea of cutting defense spending. Some will cite the defense of Ukraine, which will only account for $45 billion of military spending in the coming year. Some will mention Taiwan, citing China’s aggressive military stance toward the island nation.

But how about developing a clear global military strategy along with the willingness to carry it out? Instead of simply talking about how many dollars we should spend.

And the CBO’s proposed strategic shifts don’t account for what could be saved by streamlining the Pentagon by reducing its cadre of over half a million private contractors, many of whom perform tasks at prices higher than it would cost to do the same work with government employees.

The likely outcome is that House Republicans will fail to cut defense spending while sticking to their plan of holding the 2024 discretionary spending flat. So Republicans will focus on social spending to reduce the fiscal 2024 budget to 2022 levels. But if you ask Americans what spending they want to see cut, they will never say that we ought to cut people’s retirement security.

Wrongo has little hope that this 118^th Congress will work to solve the three great problems that face America: Our revenue problem, our social spending/cost inflation problem, and our defense spending problem. As Jennifer Rubin says in the WaPo:

“The danger for the GOP has always been that a short stint in irresponsible governance will wake up the electorate to their manifest unfitness, thereby dooming the party’s chances in 2024. The danger for the country is that, in the meantime, the MAGA extremists will do permanent damage to the U.S. economy and national security.”

The hard Right MAGAs and the anti-democracy Republican Party must be made into a permanent minority, as it was during the Roosevelt years, and for decades thereafter.

The battle for 2024 starts now.

Thanksgiving Week

The Daily Escape:

Turkeys on the fields of Wrong – November 2018 photo by Wrongo

(This is the last column before Thanksgiving. Words from Wrongo will resume on 11/28.)

Thanksgiving is Wrongo’s favorite holiday. As a secular holiday, you’re not required to do anything. The celebration is subdued, and around here, we focus on gratitude. Wrongo always thinks about how grateful we should be to live in this wonderful country of ours, and how grateful we are for all of America’s gifts.

We’re lucky to live in a land of plenty: Most of us have employment, most have access to quality healthcare. Most of us have a warm place to sleep at night, most have hope for their kids’ future.

There are many of us who do not have those things, and it is our collective responsibility to help them get to a place where they are physically and mentally secure. They need our help. And we know what to do, and we know how to do it.

This is our 2498^th column. Wrongo wants to thank all who have stuck around since the beginning in 2010. He thanks all of you who read it now, and that includes readers in more than 60 countries. Special thanks to long haulers Monty B, Fred VK, David P, Pat M, and Terry McK, among others. Wrongo is very grateful to all of you!

Wrongo’s wish is that you allow yourself to feel gratitude today and share it with those around you. The secret of life is to affect others in a positive way.

We’re truly grateful for those who came before us, and to our family members and friends who we can’t be with today. We’re thankful to those who are on the front lines in military service, or at home in our hospitals, schools, firehouses, and police stations. Happy Thanksgiving!

The NYT has an article about how online gambling companies have gotten their noses under the tents at colleges and universities:

“In order to reap millions of dollars in fees, universities are partnering with betting companies to introduce their students and sports fans to online gambling.”

The Times says that Michigan State University’s athletic department inked a deal with Caesars Sportsbook in 2021. Caesars proposed a deal worth $8.4 million over five years. Michigan signed on the line. Other schools have also struck deals to bring betting to campus. More from the NYT:

“After Louisiana State University signed a similar deal in 2021 with Caesars, the university sent an email encouraging recipients — including some students who were under 21 and couldn’t legally gamble — to “place your first bet (and earn your first bonus).”

Since the Supreme Court’s decision in 2018 to let states legalize online betting, gambling companies have been working to convert traditional casino customers, fantasy sports aficionados and players of online games into a new generation of digital gamblers.

And universities, with their captive audience of easy-to-reach students, have emerged as an especially enticing target. So far, at least eight universities have become partners with online sports-betting companies.

And a dozen other universities’ athletic departments and booster clubs have also signed agreements with brick-and-mortar casinos. For example, Turning Stone Resort and Casino is the official resort of Syracuse University’s ‘Cuse Athletics Fund. These gambling partnerships bring in funds that schools can use to sign marquee coaches and build their sports teams.

Wrongo rarely gambles, but he has a mostly lassiez faire attitude about it. He’s skeptical about prohibiting it. But the idea by universities of “let’s introduce our students to online gambling for our profit” sounds, well, wrong. The hypocrisy here is that the sports betting companies are offering “a piece of the action” to schools that not long ago swore that gambling would ruin college sports.

It isn’t exactly the same, but do you recall that back in the 80s, banks introduced credit cards and credit card debt to students? And how did that work out? You can almost imagine hearing: “Want to go double or nothing on those student loans, kid?” The most relevant quote from the NYT is:

“College athletics have become profit maximizing opportunities for athletic directors and coaches.”

Wrongo thinks this has nothing to do with the educational mission of colleges and universities. OTOH, the ol’ ball coach is saying: “Wanna bet”?

Let’s cruise into the holiday by listening to a tune that is new to Wrongo, Josh Groban’s “Thankful” performed live from his “Noel” album. It’s on point with Wrongo’s thinking about Thanksgiving:

Lyrics:

Somedays we forget
To look around us
Somedays we can’t see
The joy that surrounds us
So caught up inside ourselves
We take when we should give.

So for tonight we pray for
What we know can be.
And on this day we hope for
What we still can’t see.

It’s up to us to be the change
And even though we all can still do more
There’s so much to be thankful for.

Look beyond ourselves
There’s so much sorrow
It’s way too late to say
I’ll cry tomorrow
Each of us must find our truth
It’s so long overdue

So for tonight we pray for
What we know can be
And every day we hope for
What we still can’t see

It’s up to us to be the change
And even though this world needs so much more
There’s so much to be thankful for

Saturday Soother – August 27, 2022

The Daily Escape:

Super moon over Lake Champlain, Burlington, VT – August 2022 photo by Adam Silverman Photography

Republicans are outraged this week about Biden’s cancellation of student loan debt! Americans now owe a total of more than $1.6 trillion for higher education. From the WaPo: (emphasis by Wrongo)

“The result is one of the most significant changes to American higher education policy in decades — and a new cornerstone of the president’s economic legacy. Biden’s decision will dramatically change the financial circumstances of tens of millions of Americans, fully erasing the student loans of roughly 20 million people.”

Student debt played a minor role in American life through the 1960s when Wrongo accrued his $5k of college debt while attending Georgetown. But it increased during the Reagan administration. It then shot up after the 2007-2009 Great Recession as states made huge cuts to funding for their college systems.

But the argument that “tuition has gone up because public support for higher education has declined” isn’t the only one. While it’s valid for some institutions, it doesn’t explain the “arms race” among colleges and universities to add student amenities and layers of administrative staff over the past 10 years.

Over the last decade, revenue at independent (non-religious) private colleges and universities in the US has increased by 148% on an inflation-adjusted (real) per student basis. At religiously affiliated private colleges and universities revenue has increased by 87% in real per-student terms over the last 10 years.

Meanwhile, at public institutions, revenue has increased by just 23.4% on the same basis. However, this is still 36% greater than per capita GDP growth over the same 10 years.

The headline is that our elite educational institutions have gotten obscenely wealthy. And many of our second tier institutions chased after them, causing education budgets everywhere to explode.

It’s become another example of America’s new gilded age.

Opinions differ about the ethics of loan forgiveness for student debt, and that’s understandable. The general thrust of the Republican railing about the educational loan forgiveness is about how unfair it is when one group of Americans is getting a benefit at the cost of other Americans.

This tweet from former Trump White House press secretary Sarah Huckabee Sanders is on point for most of the GOP:

“Joe Biden wants those who didn’t go to school, didn’t take out loans, or already paid off their loans to pay off $300 billion of other people’s debts…..It’s socialism, it’s un-American, and only makes his record-setting inflation worse.”

But it isn’t socialism when our government bails out one group at the expense of another; it happens all the time. No Republican complained about the Trump tax cuts which were directed at America’s wealthy and its corporations. No Republican complained about the bank bailout in 2008. No Republican objected when Trump gave $16 billion to farmers hurt by the Trump tariffs.

Second, despite what the GOP is saying, the $300 billion in loan forgiveness isn’t inflationary. It’s true that it’s money that student borrowers won’t be paying back. But because of the student debt moratorium, they had already stopped payments in 2020, so there’s no change going forward. They simply won’t have to restart making payments on that $10,000 of debt.

It isn’t clear that there will be much impact to inflation or the Consumer Price Index. Since they weren’t making payments, it’s likely they were already spending those funds that might have gone to loan repayments. So no new spending.

We can have a debate about how much higher education should cost per student. We live in a society that is a whole lot wealthier than it was 40 years ago, but many of our students do not come from those few wealthy families.

The political calculus of Biden’s decision will be seen in November. The WaPo reported that a majority of Americans support limited debt forgiveness. Biden’s pollster, John Anzalone said:

“This is a motivator for young people….It’s a huge issue for young people — the support levels for them are in the high 60s.”

Let’s hope they turn out to vote on November 8.

Now, it’s time for our Saturday Soother, where we decompress from another week of body blows to America and find a few moments to gather ourselves for the week to come.

Here on the Fields of Wrong, we had a day of very satisfying brush clearing although we’re still waiting for rain.

Go get a big mug of decaf cold brew coffee and grab a chair in the shade. Now listen to Schubert’s “Impromptu in G flat Op. 90 No. 3”, written in 1827, and played here in 2012 by Olga Jegunova at the Bishopsgate Institute in London:

Schubert really understood how to capture emotion in his music.

The Wrongologist

Geopolitics, Power and Political Economy

Category: Social Safety Net