Saturday, September 19, 2009

Who Is Minding The Budget?

In this season of irresponsible rhetoric instead of reasoned debate about all kinds of genuine national issues and needs, I offer the following historical comparative history of our budget deficits since 1969. As people try to self-portray themselves as the “party of change” or the “party of fiscal conservatism,” or whether budget deficits matter or not, a look at the actual track record of federal deficit spending and who was in charge may prove to be helpful to us in some part.

Year / Budget Result / President / Senate Control / House Control
1969: -0.5B (Johnson-D; Senate-D; House-D)
1970: -8.7 (Nixon-R; Senate-D; House-D)
1971: -26.1 (Nixon-R; Senate-D; House-D)
1972: -26.1 (Nixon-R; Senate-D; House-D)
1973: -15.2 (Nixon-R; Senate-D; House-D)
1974: -7.2 (Nixon-R; Senate-D; House-D)
1975: -54.1 (Nixon-R; Senate-D; House-D)
1976: -69.4 (Ford-R; Senate-D; House-D)
1977: -49.9 (Ford-R; Senate-D; House-D)
1978: -55.4 (Carter-D; Senate-D; House-D)
1979: -39.6 (Carter-D; Senate-D; House-D)
1980: -73.1 (Carter-D; Senate-D; House-D)
1981: -73.9 (Carter-D; Senate-D; House-D)
1982: -120.6 (Reagan-R; Senate-R; House-D)
1983: -207.7 (Reagan-R; Senate-R; House-D)
1984: -185.3 (Reagan-R; Senate-R; House-D)
1985: -221.5 (Reagan-R; Senate-R; House-D)
1986: -237.9 (Reagan-R; Senate-R; House-D)
1987: -168.4 (Reagan-R; Senate-R; House-D)
1988: -192.3 (Reagan-R; Senate-D; House-D)
1989: -205.4 (Reagan-R; Senate-D; House-D)
1990: -277.6 (G.H.W. Bush-R; Senate-D; House-D)
1991: -321.4 (G.H.W. Bush-R; Senate-D; House-D)
1992: -340.4 (G.H.W. Bush-R; Senate-D; House-D)
1993: -300.4 (G.H.W. Bush-R; Senate-D; House-D)
1994: -258.8 (Clinton-D; Senate-D; House-D)
1995: -226.4 (Clinton-D; Senate-D; House-D)
1996: -174.0 (Clinton-D; Senate-R; House-R)
1997: -103.2 (Clinton-D; Senate-R; House-R)
1998: -29.9 (Clinton-D; Senate-R; House-R)
1999: +1.9 (Clinton-D; Senate-R; House-R)
2000: +86.4 (Clinton-D; Senate-R; House-R)
2001: -32.4 (Clinton-D; Senate-R; House-R)
2002: -317.4 (G.W. Bush-R; Senate-D; House-R)
2003: -538.4 (G.W. Bush-R; Senate-D; House-R)
2004: -568.0 (G.W. Bush-R; Senate-R; House-R)
2005: -493.6 (G.W. Bush-R; Senate-R; House-R)
2006: -434.5 (G.W. Bush-R; Senate-R; House-R)
2007: -342.2 (G.W. Bush-R; Senate-R; House-R)
2008: -638.1 (G.W. Bush-R; Senate-D; House-D)
2009: In Process (G.W. Bush-R; Senate-D; House-D)

SOURCE: non-partisan Congressional Budget Office

Fiscal years end October 31; budget proposed and passed in prior year by prior President and Congress.
Amounts shown are in Billions

Tuesday, September 8, 2009

Health Care - What We Need

Over the past two blogs, we have looked at the significant distortions that have permeated the health care reform debate. Unfortunately, that ugly distortion will most certainly continue. But now we are coming down to the wire. What will we aim for, what we will accomplish or not, all will crystallize as everyone comes back from the summer. It has been a summer of phony town meetings and rabble-roused theatrics at the expense of bringing health care relief and security to Americans. As the political name-calling and bartering and headline grabbing continue, what should be our health care priorities for all Americans?

1. All American citizens should have access to a basic package of life-sustaining care regardless of age or income. The bar for that basic level care should be the same for all.
2. All American citizens should have the right to purchase additional health care services above that basic package to the extent of their financial capability. The reality of life is that certain high-tech, high-intensity services will never be able to be sufficiently marshaled and delivered to all who need it. De facto rationing is, and always will be, present. This two-tiered system for health care is the same as we now have for public/private education.
3. Access to care, and the scope of coverage for that care, should be independent of one’s employment status or having a specific employer. Health care is a personal requirement, not an employer responsibility. The unemployed also deserve to be healthy. Employer-provided health benefits for coverage above the national base package should be allowed but taxed as additional compensation. This is no different than any other employment perk that is truly additional employee compensation.
4. Those people who refuse to take care of their own health should legitimately be penalized in some relevant manner for their lack of self-responsibility. Good health first requires us to do our own part.
5. Health care starts at birth and ends at death. It follows us throughout our life, always present with us. There is no “pre-existing condition.” Life is our pre-existing condition.
6. It is NOT important to provide health insurance is everyone. Nor is it important to financially support or guarantee health insurance company income. It IS important to provide health treatment to everyone who needs it.
7. It is NOT necessarily important to have a public insurance plan. It IS important to stop having medical decisions made on the basis of impact on company profits.
8. Medical decisions need to be made by medical personnel who provide direct services, not by insurance or government administrators.

We can accomplish these objectives any number of ways if we look at them creatively, free from past thinking, absent of emotional hysteria, and from a comprehensive perspective. For instance:

1. Acknowledge once and for all that we do not have a health insurance system in America. Rather, the health insurance industry has in reality become the system for health care DELIVERY, dictating what will be provided to whom. This unbridled control must be ended.
2. Offer a public insurance alternative that provides universal basic coverage that is guaranteed, and leave the private insurers to compete for enhanced-level or non-critical services.
3. In lieu of public insurance, leave medical treatment funding with private insurers, but regulate them heavily to achieve the above objectives. Do this regulation on a national level to ensure consistency. States do this now with all other forms of insurance (e.g. automobile, homeowners); the federal government has long done this with financial institutions. Why do we not regulate the critical areas of health insurance and delivery?
4. Limit tort malpractice lawsuits which have skyrocketed hidden health care costs. But open up medical complaints to easily-accessible public viewing so people can identify medical practitioners with consistent performance problems. Stop the hidden “old boy medical network” cover-up with a Medical Better Business Bureau and other enforcement mechanisms.
5. Implement the medical record technologies now available in order to reduce medical errors and allow for the ability to share medical test results. Multiple testing and uncoordinated treatments are another significant hidden cost. Like all businesses know, this will be a significant upfront investment that will not show dividends until much after the startup money is spent.
6. After cost-saving programs are established, define base-level medical care within “what is affordable” for government/private sponsorship. In the beginning, this will not to be sufficient to meet all medical needs. But it will be a START towards treating everyone. And it will negate the “we can’t afford it” barrier used to stop changes or reform being made. Getting the universal concept in place is the higher short-term goal than seeking to adopt a desirable but unrealistic set of comprehensive services.
7. Simplify the current legislative proposals. We need to quit writing minute details into the enabling legislation, and end the Christmas tree gift-giving and/or micro-managing of health care by politicians, lawyers, and lobbyists. Set up the framework for now, then get out of the way of the medicos, monitor results, and verify and police outcomes. That is where our focus should be for now.

If we get clear about our priority objectives, it really is not that hard. Keep it simple for this step. Stand off our personal soapboxes. Accomplish the things that are really important to the American people. Clean up the details later. To do otherwise is to lose the opportunity for yet another generation. And that would be the far greater tragedy.