The GOP’s Health Policy Cynics
The health care community is discovering to its shock and dismay that it’s not simply traditional Republican conservatives who have taken control of the House of Representatives, it’s a new group of cynics.
Conservatives, like liberals, have a more-or-less coherent set of ideas. They use political power to push preferred policies, whether related to health care, housing or a hundred other possible issues. William F. Buckley Jr., one of the fathers of modern American conservatism, “had a way of … making conservatism a holistic view of life not narrowed to the playing fields of ideology alone,” as one admirer put it.
Although cynics may claim conservative credentials, their view of government is really nothing more than a quarrel about its cost. It brings to mind Oscar Wilde’s immortal phrase, “The cynic knows the price of everything and the value of nothing.”
The contrast between the two viewpoints was on stark display at two recent marquée meetings, AcademyHealth’s yearly policy conference and the sprawling Health Information and Management Systems Society — HIMSS – Health IT Conference and Exhibition.
AcademyHealth’s “Running of the Wonks” (my term, not theirs) is a magnet for researchers and policy mavens who are inured by long experience to most political rhetoric. Yet at the general session featuring a bipartisan dialogue among congressional staffers, the harsh rhetoric from the GOP participants stunned the crowd. The new federal health law, it seemed, was evil incarnate, and the rhetoric of “repeal and replace” was wielded with a fundamentalist zeal.
“The bureaucracies that administer ObamaCare” must be cut, declared one aide to a powerful congressional leader, setting the tone. And in case anyone didn’t get the point, the word “ObamaCare” was deliberately repeated every few syllables in a tone of disdain combined with wonder at how such a monstrosity had ever come to be. (AcademyHealth meeting rules said the staffers could not be quoted by name.)
The audience of wonks quailed, then quietly queued up for the question-and-answer period. They knew, after all, that the health law’s fine print incorporates a generous helping of initiatives championed by both conservatives, and those on the left. Besides, these were staffers speaking, not politicians playing to the press. Surely, gentle reason would triumph. Alas, it was not to be.
The Prevention and Public Health Fund? “You mean, the prevention health slush fund, as we like to refer to it?” replied a GOP staffer.
The Innovation Center at the Centers for Medicare & Medicaid Services? “An innovation center at CMS is an oxymoron,” responded a Republican aide, before adding a personal barb aimed at the attendees: “Though it’s great for PhDs who come to Washington on the government tab.”
There was also no reason the government should pay for “so-called comparative effectiveness research,” another said.
“Everything’s on the chopping block,” said yet another.
Everything? At HIMSS, where GOP staffers also spoke, attendees were chagrined to learn that “everything” applied to them, too. The subsidies for health information technology that were part of the American Recovery and Reinvestment Act were targeted in legislation introduced in late January by Rep. Jim Jordan, R-Ohio, chairman of the Republican Study Group. His bill would repeal this funding and eliminate all remaining stimulus spending, including about $45 billion in unspent health IT funds.
Those focused on the substance of health policy might be forgiven for feeling blindsided. After all, the McCain-Palin health policy platform in the 2008 presidential election called for coordinated care, greater use of health information technology and a focus on Medicare payment for value, not volume. Once-and-future Republican presidential candidates such as former governors Mike Huckabee (Ark.), Mitt Romney (Mass.) and Tim Pawlenty (Minn.), as well as ex-Speaker of the House Newt Gingrich, have long promoted disease prevention, a more innovative federal government and increased use of information technology. Indeed, federal health IT “meaningful use” requirements can even be seen as a direct consequence of Gingrich’s popularization of the phrase, “Paper kills.”
Ah, but that was back before the Republican cynics swept into power. It was back before traditional GOP conservatives — worried that any suggestions outside a single-minded focus on slashing spending would be seen as disloyal — eschewed ideas in favor of ideological declarations.
This column was filed just days after a two-week compromise was signed into law to avoid a federal government shutdown. It allowed funding for health reform to continue, but instituted other budget cuts. Obviously, the cynics yielded a bit, at least for the moment, to the conservatives, and the liberals and centrists have given ground to both.
Still, one wonders what the urbane Buckley would think of a movement that seems intent on ignoring the real-world context of its actions. Buckley launched his lifetime crusade against liberalism with God and Man at Yale, a book that took aim at the academics who’d taught him as an Ivy League undergraduate. Alas, the GOP cynics are cocooned instead in an underground bunker of their own design, as impervious to realities they’d prefer to ignore as the ivory tower academics they’ve come to scorn.
By: Michael Millenson, The Health Care Blog, March 9, 2011. Post Originally appeared in Kaiser Health News.
Social Security Hysteria Rebutted, Yet again
The WaPo editorial board apparently despises old people as much as Alan Simpson, given what they’re willing to put on their op-ed pages. Unfortunately, though, Charles Krauthammer doesn’t disintegrate into quite the degree of gibberish as Simpson, though he’s a liar. He particularly attacks OMB director Jacob Lew, and Lew’s assertion that Social Security is solvent until 2037 and doesn’t add to the deficit. Krauthammer’s argument: the Treasury bonds Social Security funds are invested in are “worthless” and Lew’s arguing otherwise is “a breathtaking fraud” because the “Social Security trust fund is a fiction.”
Dean Baker refutes.
It’s nice that Mr. Krauthammer thinks that government bonds are worthless…. While he is welcome to believe anything he wants, the bonds held by the Social Security trust fund are backed by the full faith and credit of the U.S. government. Krauthammer may want to default on bonds that belong to the nation’s workers, but his desires are not the same as reality.Selling these bonds to fund Social Security no more raises the deficit than the decision of a rich person to sell bonds to finance their consumption raises the deficit. The deficit was incurred when the money was lent to the Social Security trust fund in the first place.
The size of the deficit, including the money borrowed from Social Security — the on-budget deficit — is reported in every budget document put out by the government (e.g. here and here). Krauthammer might try to learn a bit about how the budget works before he goes off ranting about Jack Lew and Social Security….
In reality, the projected shortfall in the program is relatively distant and minor. The country has far more urgent concerns, like putting 25 million unemployed or under-employed people back to work. This should be the focus of our political leaders right now.
And Jacob Lew defends his, and Social Security’s honor:
Krauthammer is correct when he writes that there is no “lockbox” that keeps the money sent in by workers for until they retire. By design, when more taxes are collected than are needed to pay benefits, funds are invested in Treasury bonds and are held in reserve for when revenue collected is not enough to pay the benefits due. Yet these Treasury bonds are backed by the full faith and credit of the U.S. government in the same way that all other U.S. Treasury bonds are, making them anything but ”worthless IOUs” as Krauthammer suggests. The government has just as much obligation to pay back the bonds in the Social Security trust fund as we do to any other bondholders.Responsibly honoring that obligation – one that we planned for and always knew was there –entails undertaking fiscal policies that would make it easier, not harder, to meet these obligations. When I last was OMB Director at the end of the Clinton Administration, the Congressional Budget Office estimated $5.6 trillion in budget surpluses over the next decade because of fiscally responsible measures that Democrats and Republicans, working together, had taken….
This is the most important point: the problem is not with Social Security, but in the near term the mismatch between what we take in and what we spend in the rest of the budget. Working people had payroll taxes taken from their salaries to pay for future benefits, and instead the money was used to pay for tax cuts and other initiatives. It is hardly fair now to say that those working people caused the problem just when they are ready to collect benefits.
Krauthammer’s argument is inside out. We should not blame Social Security for our current fiscal problems when it is the irresponsible fiscal behavior of the past that has presented the country with future challenges to fund our commitments, including Social Security over the next two decades.
That irresponsible fiscal behavior was unfortunately extended by the tax-cut deal and intensifed by the payroll tax holiday, making it even easier for Social Security to be the target of deficit peacocks and the Very Serious People who believe “shared sacrifice” means everybody but the rich and corporations sacrifice. That aside, Lew is absolutely correct. Social Security is not the problem. Massive tax cuts for the rich and two unsustainable wars are the problem.
By: Joan McCarter, Daily Kos, March 12, 2011
Invest In Your Child’s Future: Pay Teachers More
From the debates in Wisconsin and elsewhere about public sector unions, you might get the impression that we’re going bust because teachers are overpaid.
That’s a pernicious fallacy. A basic educational challenge is not that teachers are raking it in, but that they are underpaid. If we want to compete with other countries, and chip away at poverty across America, then we need to pay teachers more so as to attract better people into the profession.
Until a few decades ago, employment discrimination perversely strengthened our teaching force. Brilliant women became elementary school teachers, because better jobs weren’t open to them. It was profoundly unfair, but the discrimination did benefit America’s children.
These days, brilliant women become surgeons and investment bankers — and 47 percent of America’s kindergarten through 12th-grade teachers come from the bottom one-third of their college classes (as measured by SAT scores). The figure is from a study by McKinsey & Company, “Closing the Talent Gap.”
Changes in relative pay have reinforced the problem. In 1970, in New York City, a newly minted teacher at a public school earned about $2,000 less in salary than a starting lawyer at a prominent law firm. These days the lawyer takes home, including bonus, $115,000 more than the teacher, the McKinsey study found.
We all understand intuitively the difference a great teacher makes. I think of Juanita Trantina, who left my fifth-grade class intoxicated with excitement for learning and fascinated by the current events she spoke about. You probably have a Miss Trantina in your own past.
One Los Angeles study found that having a teacher from the 25 percent most effective group of teachers for four years in a row would be enough to eliminate the black-white achievement gap.
Recent scholarship suggests that good teachers, even kindergarten teachers, increase their students’ earnings many years later. Eric A. Hanushek of Stanford University found that an excellent teacher (one a standard deviation better than average, or better than 84 percent of teachers) raises each student’s lifetime earnings by $20,000. If there are 20 students in the class, that is an extra $400,000 generated, compared with a teacher who is merely average.
A teacher better than 93 percent of other teachers would add $640,000 to lifetime pay of a class of 20, the study found.
Look, I’m not a fan of teachers’ unions. They used their clout to gain job security more than pay, thus making the field safe for low achievers. Teaching work rules are often inflexible, benefits are generous relative to salaries, and it is difficult or impossible to dismiss teachers who are ineffective.
But none of this means that teachers are overpaid. And if governments nibble away at pensions and reduce job security, then they must pay more in wages to stay even.
Moreover, part of compensation is public esteem. When governors mock teachers as lazy, avaricious incompetents, they demean the profession and make it harder to attract the best and brightest. We should be elevating teachers, not throwing darts at them.
Consider three other countries renowned for their educational performance: Singapore, South Korea and Finland. In each country, teachers are drawn from the top third of their cohort, are hugely respected and are paid well (although that’s less true in Finland). In South Korea and Singapore, teachers on average earn more than lawyers and engineers, the McKinsey study found.
“We’re not going to get better teachers unless we pay them more,” notes Amy Wilkins of the Education Trust, an education reform organization. Likewise, Jeanne Allen of the Center for Education Reform says, “We’re the first people to say, throw them $100,000, throw them whatever it takes.”
Both Ms. Wilkins and Ms. Allen add in the next breath that pay should be for performance, with more rigorous evaluation. That makes sense to me.
Starting teacher pay, which now averages $39,000, would have to rise to $65,000 to fill most new teaching positions in high-needs schools with graduates from the top third of their classes, the McKinsey study found. That would be a bargain.
Indeed, it makes sense to cut corners elsewhere to boost teacher salaries. Research suggests that students would benefit from a tradeoff of better teachers but worse teacher-student ratios. Thus there are growing calls for a Japanese model of larger classes, but with outstanding, respected, well-paid teachers.
Teaching is unusual among the professions in that it pays poorly but has strong union protections and lockstep wage increases. It’s a factory model of compensation, and critics are right to fault it. But the bottom line is that we should pay teachers more, not less — and that politicians who falsely lambaste teachers as greedy are simply making it more difficult to attract the kind of above-average teachers our above-average children deserve.
By: Nicholas Kristof, Op-Ed Columnist, The New York Times, March 12, 2011
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