Friday, March 29, 2013
Economic Reality Transforms the American Dream
Welcome to
the new version of the American Dream.
It may look
the same as the old one – personal prosperity and owning your own home – but
fewer people are likely to live it, and if they do, it will happen later in
life.
The
transition Americans are undergoing is not merely recovery from a deep
recession with life soon returning to the way it was before 2008. It is a complete redesign of the American
economy.
Two news
stories last week prove the point.
“The
situation for today's adults in their 30s and younger is particularly gloomy,”
reports the nonpartisan Urban Institute.
“When it comes to building wealth -- adding to savings, owning a home,
paring down debt, growing a retirement nest egg -- those under age 40 have
stagnated,” it says.
Instead of
earning more than previous generations, younger people get less pay than what
their parents were paid when they were the same age.
We also read that two states – Maine and West
Virginia – now see deaths exceeding births each year. By one measure, Maine is the oldest state in
the country with West Virginia coming in third.
They are the bellwethers of the United States
as a whole. In the first nine years of
this century, the median age in the country increased by one and a-half years.
Older people have not saved enough for their
retirement years, so they cannot be the big-spending consumers they used to
be. In other words, older people are a
larger share of the population, and they have less to spend.
American
businesses are adjusting to these new realities. To survive and remain competitive with
foreign suppliers in what is now a global marketplace, they must reduce their
costs.
And the place
where they cut is paying their employees.
Labor costs as a share of total national production are now at record
lows.
High paying
jobs have been lost, forcing many to accept new jobs with less income. Even worse, some have been pushed out of the
work force, making the unemployment rate look better than it really is.
Many people
have become more realistic about having enough income to afford a new
home. While that means they must wait
longer for their dream home, the chances of losing it in foreclosure are less.
There’s some
good news.
Jobs that
went abroad are coming home. As wages
rise in China and elsewhere in the developing world while they stagnate in the
United States, imports are beginning to lose some of their attractiveness.
Taking into
account transportation, heavily influenced by the price of fuels, and the
narrowing labor cost difference, “Made in the U.S.A.” is staging a comeback.
While people
struggle to find decent jobs, American corporations are doing well. Unemployment may still be too high, but the
stock market, which reflects what investors see as the economic future, has
broken through to new highs.
U.S.
manufacturing, long in decline, seems to be gaining again, thanks to the jobs
that are coming home.
In fact, as
American-made goods are priced close to world market prices, U.S. exports could
improve, which would help promote job growth.
Business is
profitable partly because labor costs are down.
Workers – from airline pilots to assembly line labor – have accepted pay
reductions in order to keep their employers competitive. Perhaps as big as government bailouts are the
sacrifices made by employees.
Even with
this improved outlook for business, the total picture is far from rosy.
Government
programs that depend on income-based taxes will have less money to meet the
growing financial needs of Social Security and Medicare.
Rep. Paul
Ryan’s proposed Republican budget would keep these programs solvent by sharply reducing
benefits. While these programs might
then pay their own way, older people would suffer.
One
alternative is higher taxes to help support these essential programs. In an economy with fewer workers relative to
the total population and lower pay scales, those workers might have to pay more
to the government.
Another
option is for people to save more for retirement. Like higher taxes, more saving would reduce
the amount people could spend.
The new
American economy would depend less on consumer spending, now its main driver,
as more money went either to taxes or savings.
A rapid
increase in the working age population could help slow or reverse this
trend. That’s why immigration reform may
turn out to be essential.
Perhaps this
new version of the American Dream is not inevitable. But nobody has yet offered a way to save the
old version.
Monday, March 18, 2013
The High Cost of Health Care is Its Biggest Issue
The problem
with health care is not Medicare, Medicaid, or Obamacare.
It’s what health
care costs.
The United
States leads the world in one area of health care – it costs more here than in
any developed country. Higher cost
does not mean better care. The United
States lags many other countries in length of life and infant mortality.
Most
industrialized countries have some version of a single payer system in which
the government is the insurer and can influence the prices it pays for various
procedures and medications.
In this
country, the government, insurers, and individuals all pay for health
care. And, when the government is not
paying, health care providers are free to set prices that everybody must pay.
Why are
hospital costs so high? A recent report
by Steven Brill in Time magazine provided answers.
He revealed
that both non-profit and for-profit hospitals make money, with non-profits
doing better.
Where does
the money go? It pays for more sophisticated
equipment, whether it is needed or not, advertising to attract more patients,
and astronomical salaries for the top officials.
And for
lobbying Congress to keep the system just as it is. The health care industry spends more on lobbying
Washington than the defense, aerospace, and oil and natural gas industries
combined.
The industry
is rapidly becoming a monopoly. In most
areas, there is no longer any choice among hospitals. There is one in each area, making the concept
of a “market” purely theoretical.
As the number
of hospitals is reduced, so is the number of independent doctors’ offices. In the near future, it is expected that 75
percent of physicians will be on hospital payrolls.
To boost
hospital income, these doctors are often required to see more patients each
day, resulting in less attention to any individual. And insurance reimbursement is more
profitable for hospitals, Brill says, with doctors in-house.
The hospitals’
big profits are obvious, when the costs charged to the uninsured based on
hospitals’ “chargemaster” price lists are compared with Medicare payments.
The
chargemaster sets prices well above cost and even levies outlandish charges for
simple bandages, which ought to be included in overhead costs.
In one case
Brill cites, a hospital bill came to $121,414, but the hospital accepted
$16,949 from Medicare.
Hospitals and
doctors are not required to participate in Medicare. If they are not paid enough, they can quit
the system.
But they
don’t. In fact, in Florida, where many
patients are on Medicare, hospitals advertise for retirees to use their
services.
Even Medicare,
the largest single customer for health care in the country, is prevented from
bargaining to get the lowest prices for drugs.
If one medication is better than another and cheaper, Medicare must still
pay the average price of all approved drugs of the same type, which means it
must overpay.
The Veterans
Administration, which also buys a lot of prescription medicines, does not have
such a rule, and its costs are estimated to be 40 percent less than Medicare’s.
Obamacare
will not fix the problem. It can only create
competition among insurers, though one of the players in each state will be a
non-profit company.
Opponents of
Obamacare see this so-called “exchange” as being able to underprice the private
companies so that it ends up as the single payer.
That would
have to happen at some point in the indefinite future if the non-profit insurer
could ever be powerful enough to force the industry to bring its costs under
control.
Meanwhile, the
health care industry is increasingly acts like an unregulated monopoly where,
for the time being at least, the insurers have little ability to place a brake
on its charges.
Experience
shows there are essentially only two ways to deal with the pricing power of
“natural” monopolies, those that cannot simply be broken up, because of the
type of services they provide.
We can see
how such controls work, because both approaches having been applied to electric
utilities, which are natural monopolies.
One is
regulation, where “just and reasonable” prices are set by independent
regulatory bodies, acting like judges.
Those areas where competition is possible – electric generators or equipment
manufacturers in the health care sector – are left largely unregulated.
The other
solution is government as the single payer.
For electricity, government takes the form of the municipal utility. It makes no profit and bargains for what it
will pay for power.
We seem to be
moving toward the point in health care where regulation or the single payer or
both will become essential and inevitable.
Friday, March 8, 2013
Cutting government waste better than “sequester”
A few months
ago, I helped a municipality deal with a U.S. government agency that wanted to
buy services from the town.
My experience
revealed a lot about why the federal budget is out of control.
The amount of
the contract was less than $200,000, but I dealt with five federal officials
for about two months to get an agreement that should have taken one person
about an hour.
The officials
questioned the profit margin in the deal, so I had to convince them that the
town charges actual cost and makes no profit.
When we
received the federal contract, it referred to about a dozen previously
unmentioned requirements that were tacked onto it. The town would have to agree to them before
it could supply the federal government with a municipal service that it usually
provided to anybody within its borders – without any contract.
It took some
effort to find out what these other documents contained. When I finally saw them, they were mostly
irrelevant. Under one, the town had to
promise that its employees would not text while driving. There was no driving involved in the
contract.
At the end of
the process, I was convinced that the federal government could have saved
thousands of dollars, if it operated more efficiently.
But presidential
appointees heading such agencies are unlikely to spend the time and effort to
manage agency operations to eliminate such waste.
With all the
talk about cutting government spending, most critics want to slash entire programs,
each with its own constituency, rather than really getting serious about
efficiency and wasteful spending.
Sen. Tom
Coburn, an Oklahoma Republican, is an archconservative who would like to cut
back government. But he has come up with
a non-ideological idea that could work.
In 2010, he
got Congress to ask the non-partisan Government Accountability Office to draw
up a list of all government programs.
The GAO was also to show where they overlapped.
It may amaze
some that there was no single list of federal government programs. Less amazing is the fact that of the hundreds
of programs, many overlap.
For example,
the GAO found 47 job training and employment programs being carried out by nine
different agencies. These programs had
budgets totaling $18 billion a year.
And the
politically neutral agency reported that all but three of the programs
overlapped one another.
Without
proposing that any of the programs should be eliminated, the report showed that
there were many duplicative managerial and administrative offices that could be
dropped.
One of the
major risks when many programs do the same thing is that outside organizations
can apply for and receive grants for the same activity from several different
agencies that have no idea what others are funding.
Why can’t
such overlap be eliminated?
Many federal
programs, including those run by the Defense Department, are supported because
they create jobs. For a member of
Congress to bring new jobs to his or her state or district is far more
important politically than the tasks performed.
And then
there’s turf. Various programs doing
just about the same thing are under the jurisdiction of separate congressional
committees. Each is reluctant to give up
control of any subject or agency on its agenda.
Even more
serious are the turf empires of the major departments themselves. Power and influence may be measured in
Washington by the number of employees in an agency or the size of its budget.
Each agency
lobbies congressional committees to preserve its programs, each of which is “essential.”
Shouldn’t
there be one central office responsible for reducing the inefficiency that
results from duplication?
That should
be the White House Office of Management and Budget, which finally got around to
looking at Coburn’s initiative last year, but only selected a few agencies for
a pilot program. Since then, nothing
more has been heard from OMB.
At the
beginning of March, the first automatic cuts in federal spending – called the
sequester – went into effect. They
amount to $85 billion in the remaining seven months of the federal fiscal year.
Eliminating duplication
in the government programs found by GAO in just the first two years of its
review plus requiring greater efficiency might well produce that amount of
saving not only this year but every year.
No activity
needs to be eliminated, though jobs would be cut and the size of government
reduced by simply making it more efficient.
Sequester? We can do better. After all the empty political promises about
cutting government waste, Coburn has helped us know just what to do.
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