Tag Archives: costs

One More Time…

Can you stand one more post about the scam that goes by the name of educational vouchers?

This time, I want to begin by suggesting that we may be on the cusp of reversing the effort to destroy public education in the name of parental “choice,” although not before considerably more harm is done.

The Arizona Mirror recently published a report under the headline “Arizona’s universal school vouchers are a cautionary tale for the rest of the nation.”

Here’s the lede:

The nation is watching as the devastating impacts of Arizona’s universal voucher program unfold. The most expansive and least accountable in the country, Arizona’s ESA voucher program is an unmitigated economic disaster with very real human impacts.

Arizona, like Indiana, has a legislature dominated by Republicans, and those legislators sold the concept of universal vouchers by insisting (as they did in Indiana) that it would help low-income students. They also insisted that the additional cost to the state would be negligible.

As the paper reports, just one year into what it calls “this  failed experiment,” it has become apparent that universal ESA vouchers are welfare for the wealthy. They are also on a path that will “devastate the state’s budget and lead to school closures, teacher layoffs, and eventually cuts to services like firefighters, health care, roads and more.”

The newspaper’s analysis was devastating:

  • Vouchers hurt Arizona’s economy: After universal expansion, ESA vouchers are on track to cost Arizona taxpayers over $900 million this school year — nearly 1400% higher than initially projected. The legislature could have used this funding for teacher and staff salary increases, building safety, 21st-century learning, and so much more. Instead, Arizona school districts are already looking at cuts and school
    closures.
  • Welfare for the wealthy: Universal ESA vouchers are primarily claimed by families whose children were already in private school and could already afford this option; now, these vouchers represent an entirely new cost to the state.
  • Arizona’s vouchers have no accountability: Unlike other states, Arizona’s universal vouchers have little to no transparency to taxpayers, zero academic accountability, and zero safety standards. There are no requirements to teach state standards, conduct background checks on teachers or tutors, or ensure site safety — meaning children will inevitably get hurt.
  • Vouchers hurt rural and low-income students: ESA vouchers are primarily claimed by more affluent families in wealthier zip codes and are concentrated in large, suburban areas. This robs funds from low-income and rural communities, leaving them behind.
  • With vouchers, students lose protections: ESA vouchers require parents to sign away federal rights, including protections for special education students, and are leading to many instances of state-funded discrimination against LGBTQ students, English Language Learners, and students with disabilities.

The article noted that other states have begun rethinking their voucher programs. In Texas,  a bipartisan coalition was able to block Gov. Abbott’s repeated attempts to pass ESA vouchers–the Texas legislature rejected voucher schemes five times this year. (One Texas Republican was quoted as saying “I believe in my heart that using taxpayer dollars to fund an entitlement program is not conservative, and it’s bad public policy. Expanding government-defined choice programs for a few without accountability… undermines our constitutional and moral duty to educate the children of Texas.” )

The Illinois legislature eliminated that state’s voucher program, concluding that it had enabled discrimination on the basis of religion, disability status, and LGBTQ+ status. And Georgia and Idaho have refused to institute voucher programs after concluding that the programs are both incredibly costly and lack essential accountability.

An earlier article from Politico confirmed that vouchers simply enrich wealthier Americans. It reported that the new vouchers in many cases lift—or even eliminate—household income caps, thus giving wealthier families state cash to send their kids to private schools–and data shows that many of these students aren’t leaving public schools for private ones.  Instead, most are going to students already enrolled in private schools.

Perhaps the most significant observation in the Arizona newspaper’s report was contained in the last paragraph of the article, which pointed to the underlying purpose of the voucher movement:

Universal ESA vouchers threaten to accomplish in Arizona exactly what they were designed to do: dismantle public education. Arizona would be wise to follow the nation in learning from our mistakes — before it’s too late.

Will Indiana’s legislators learn from Arizona and other states? I’m not holding my breath…but at least other states seem to be catching on.

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A Doctor’s Prescription

As the primary battles heat up, “Medicare for All” (or in Mayor Pete’s more “do-able” formulation “Medicare for All Who Want It”) has become perhaps the hot-button issue.

The Trump Administration continues to wage war on the Affordable Care Act, a/k/a Obamacare–part of Trump’s determination to erase anything and everything Obama accomplished– and thanks to Mitch McConnell’s success in placing partisans on the federal bench, that attack may succeed.

Anyone who follows the news, or has a Facebook feed, knows what we “consumers” think, and polling confirms that large majorities of Americans would welcome some form of national, universal healthcare. But what about doctors? What do medical professionals who have to work within today’s uneven patchwork of a system have to say?

I asked my cousin, the cardiologist whose insights I periodically share.

I encourage you to click through and read his post in its entirety, but I want to share several observations that I found particularly telling. The first is his reminder that we don’t go “shopping” for healthcare the same way we shop for a new pair of shoes.

Although comparison shopping makes sense when we buy a product like an automobile, such market forces do not apply to health care. Negotiation of prices of various treatments is seldom available, especially not for the complex needs of the desperately ill who consume a large share of resources. Multiple private insurance plans obscure this issue even further.

He then cites a recent study that found a significant part of the variation in medical spending–and more than half of all Medicare spending– to be determined by capacity rather than by medical need.

And speaking of cost…

In contrast to the ACA’s requiring private insurers to spend at least 80-85 percent of their revenue on delivery of health care, more than 98 percent of Medicare’s expenditures are so devoted. Estimates vary, but one-quarter to one-third of our current costs are driven by insurance company overhead, profits, and the administrative costs. Roughly half of these costs would be recovered under single-payer and could instead be devoted to the delivery of meaningful health care.

And then there are drug prices.

Drug prices must be controlled:  Acceptable drug lists vary widely among health plans. Negotiated prices depend strongly upon the buyers’ purchasing volume. Only a single-payer system enables the kind of unified bulk purchasing of drugs and medical devices that would give the buyer adequate power. A model for this structure exists today here in the Department of Veterans Affairs (VA). Due to governmental authority to negotiate drug prices for the VA, it pays roughly half the retail price of drugs.

I italicized that last sentence, because it astonished me. No wonder other countries allow government to negotiate drug prices–and we can all guess why Congress expressly forbids our government to do the same.

But what about doctors’ pay? Shouldn’t doctors’ incomes compensate them for those years of medical training and residencies? Wouldn’t we lose medical personnel under a national system?

A recent analysis found that a single-payer model does not lead to a loss in physician income, allowing for care-givers to receive adequate reimbursement of expenses plus fair profits, while ensuring value for taxpayers. Streamlined billing under single payer would also save physicians vast overhead costs, enhanced by reducing the need for the many employees to fulfill the varied requirements and forms of the private insurance companies. Moreover, physicians might best be compensated with regular salary-type payments rather than the current “fee for service” model, which encourages excess medical tests and procedures that drive up costs without providing better outcomes.

And finally, what about private insurance? Opponents of a single-payer system warn that people who love their current coverage (these are people I’ve yet to encounter, but I’ll assume for the sake of argument that someone, somewhere, actually likes Anthem, et al) would lose it. My cousin seems to be recommending Mayor Pete’s “Medicare for All Who Want It” approach. He also makes a point that Kamala Harris made in a recent interview:

The population of the U.S. would likely require additional tiers of care provided by private insurers, which might add extra services to basic care such as private room selections, lower waiting periods for non-urgent problems, elimination of co-pays, long-term care, dental care, etc.

The bottom line: the doctor has diagnosed America’s current approach to healthcare as deathly ill and probably terminal. You can read his prescription in its entirety at the link.

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On The Other Hand, Good Things ARE Happening

The news, and my comments on that news, have been pretty bleak of late, so I thought I would look for evidence that good things are also happening in the world. (Probably even in the U.S.)

And I found some things!

I particularly looked for technological breakthroughs that might mitigate climate change or otherwise represent environmental progress, and this one struck me as especially promising, not least because I’ve been driving in “pothole city”–aka Indianapolis.

Jambulingam Street, Chennai, is a local legend. The tar road in the bustling Nungambakkam area has weathered a major flood, several monsoons, recurring heat waves and a steady stream of cars, trucks and auto rickshaws without showing the usual signs of wear and tear. Built in 2002, it has not developed the mosaic of cracks, potholes or craters that typically make their appearance after it rains. Holding the road together is an unremarkable material: a cheap, polymer glue made from shredded waste plastic.

Jambulingam Street was one of India’s first plastic roads . The environmentally conscious approach to road construction was developed in India around 15 years ago in response to the growing problem of plastic litter. As time wore on, polymer roads proved to be surprisingly durable, winning support among scientists and policymakers in India as well as neighboring countries like Bhutan. “The plastic tar roads have not developed any potholes, rutting, raveling or edge flaw, even though these roads are more than four years of age,” observed an early performance reportby India’s Central Pollution Control Board. Today, there are more than 21,000 miles of plastic road in India, and roughly half are in the southern state of Tamil Nadu. Most are rural roads, but a small number have also been built in cities such as Chennai and Mumbai.

According to this and other articles, so-called “modified” asphalts, consisting of virgin polymers (and sometimes ground-up old tires), have been used here in the U.S., and have been found to perform well: Illinois has used them to build high-traffic roads used by lots of trucks, and Washington State uses them for noise reduction. They tend not to buckle in extreme heat the way conventional roads do.

But the modified asphalts being used here are pretty costly–they can increase the cost of a road anywhere from 30-50%. The paving being used in India costs less than conventional roads.

While polymer roads in the US are made with asphalt that comes pre-mixed with a polymer, plastic tar roads are a frugal invention, made with a discarded, low-grade polymer. Every kilometer of this kind of road uses the equivalent of 1m plastic bags, saving around one tonne of asphalt and costing roughly 8% less than a conventional road….

In India, plastic roads serve as a ready-made landfill for a certain kind of ubiquitous urban trash. Flimsy, single-use items like shopping bags and foam packaging are the ideal raw material. Impossible to recycle, they are a menace, hogging space in garbage dumps, clogging city drains and even poisoning the air.

That same plastic trash has become a huge hazard in the oceans.killing marine life and littering previously pristine beaches. In the middle of the Atlantic, there is an area that spans the distance between Virginia to Cuba called the Great Atlantic Garbage Patch: it has  up to 26 million plastic particles per square kilometer.

Turning plastic trash into cheaper, longer-lasting roads–now that should make us smile! (At least until civil engineers and construction special interests block adoption of the technology here….)

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As The Bullets Find Their Mark..

I will never understand the GOP obsession with repealing Obamacare.

I could certainly understand efforts to improve it, or even replace it with a different mechanism (not the smoke and mirrors sort of replacement that Trump yammered about but was unable to describe, but a different way to deliver actual healthcare).

It is hard for me to accept that there are people who genuinely believe poor folks aren’t entitled to medical care, that being unable to afford a doctor means you don’t deserve one. On the other hand, I recall that telling–and chilling– moment in a GOP debate when Ron Paul was asked what should be done with people who don’t have insurance, and the audience members yelled “let them die.”

So there’s that…

Even though Paul Ryan and his cronies couldn’t manage a complete repeal of the Affordable Care Act, they did manage to make it less workable. They didn’t kill it–they just made it more incoherent and costly.

According to Michael Hiltzik in the L.A. Times,

Those fiscal geniuses in the White House and Republican-controlled Congress have managed to do the impossible: Their sabotage of the Affordable Care Act will lead to 6.4 million fewer Americans with health insurance, while the federal bill for coverage rises by some $33 billion per year.

Also, by the way, premiums in the individual market will rise by an average of more than 18%.

These figures come from the Urban Institute, which on Monday released the first estimate of the impact of two GOP initiatives. The first is the elimination of the individual mandate, which is an offshoot of the GOP tax-cut measure signed by President Trump in December. The measure reduced the penalty for not carrying insurance to zero as of next Jan. 1.

The second is Trump’s plan to expand short-term insurance plans, which don’t comply with many of the ACA’s essential benefits requirements and allow insurers to reject or surcharge people with preexisting medical conditions or histories.

Both of these provisions siphon younger, healthier people out of the insurance pool–an entirely foreseeable (and indeed, widely foreseen) consequence. When the pool of insured individuals contains older, sicker participants not offset by as many young healthy ones, insurers must raise premiums.

Because government premium subsidies rise in tandem with premium increases, the cost of subsidies borne by the government will rise by $33.3 billion next year, or 9.3% — to $391.4 billion from $358.1 billion under existing law.

It isn’t only taxpayers who will get hosed by the changes Trump is so proud of. The article goes through a variety of ways in which people needing health insurance will get screwed over, and I encourage you to click through and read the whole analysis.

It’s hard to disagree with Hiltzik’s conclusion:

The damage estimate can’t be restricted to the immediate impact on individuals and families, the researchers observed. “As healthier enrollees exit for short-term plans, insurers will by necessity reexamine the profitability of remaining in the compliant markets. This may well lead to more insurer exits from the compliant markets in the next years, reducing choice for the people remaining and ultimately making the markets difficult to maintain.”

In other words, the Republican sabotage will continue to undermine health coverage in the U.S. The only alternative, it becomes clearer with every day, is some form of single-payer, Medicare-for-all coverage. That’s increasingly becoming part of Democratic Party orthodoxy, and it’s about time.

One more reason why we need a wave election in November.

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Now For The Numbers….

So–the nonpartisan Congressional Budget Office has released its analysis of “TrumpCare.”

Here are their numbers:

14 million Americans will lose their insurance by 2018
21 million Americans will lose their insurance by 2020
24 million Americans will lose their insurance by 2026
There will be 52 million Americans with no health insurance by 2026 (for comparison, there were 46 million uninsured before Obamacare became law)
The bill will cut $880 billion from Medicaid by 2026
15 percent of Planned Parenthood patients will lose access to care
A 64-year-old making $26,500 would have to pay $14,600 for insurance in 2026 (for comparison, that 64-year-old pays $1,700 under Obamacare), and

After transferring $275 billion from public-health spending to the richest 1 or 2 percent via tax cuts,  it will reduce budget deficits by $336 billion between 2018 and 2026.

AHCA–aka “Trumpcare” or perhaps “Ryancare”– would reduce deficits by $336 billion but would cut government spending on healthcare programs by $1.2 trillion.

When you think about it, this is a brilliant approach to deficit reduction that we could apply across the board.

We can cut billions out of the budget if we stop paving Interstate highways and inspecting and fixing bridges. We can reduce the deficit significantly if we stop hiring those high-priced CPAs to monitor bank compliance with financial regulations and enforce the SEC’s oversight of corporate securities offerings. We can save another bundle if we no longer enforce rules against air and water pollution (actually, Scott Pruitt, the new EPA Chief, has already begun that effort.) Betsy DeVos assures us that schools don’t need oversight, so we don’t need the Department of Education. We probably don’t need those bean-counters at the CBO or the Bureau of Labor Statistics, either.

And of course, we could stop paying Social Security to all those useless old people. Think of what that would save us!

It’s true that if we did all these things, government would no longer function, and we’d be thrown into a Hobbesian, dog-eat-dog world, but that’s actually the result many Republican Congress-critters have been working toward. The President wouldn’t mind, because he really has no idea what most of government does anyway.

Of course, if we wanted to make a real dent in the national debt, we could dramatically reduce the bloated amounts we spend on the military. But something tells me that might be a bridge too far…..

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