Relevant and even prescient commentary on news, politics and the economy.

FGM in Minnesota

The Minnesota Star Tribute has a bizarre story entitled Minnesota bill against female genital mutilation raises opposition.

It begins:

Opposition from some members of Minnesota’s immigrant and refugee communities is slowing the momentum of a bill that would impose stiff penalties for parents involved in cases of female genital mutilation.

Let’s call it like it is: there are people who are opposed to a law designed to reduce child abuse, and in particular, the abuse of girls.

The Council for Minnesotans of African Heritage, a nonprofit called Isuroon and other groups argue that the legislation carries overly harsh punishment and unintended consequences, including the possibility that newcomers from countries where genital cutting is widespread would not seek medical care and other services for their children. They call for a less punitive approach focused on educating parents.

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SAVINGS, INVESTMENT & THE DEFICITS

Over the past decade, thanks to fracking, the US has approached self-sufficiency in oil. Since 2008 the trade deficit in oil fell from over half of the overall trade deficit to under 10% in 2016.

TRAADE DEFICIT

 

 

 

 

 

 

 

 

 

Surprisingly, however, the massive decline in the oil deficit did not lead to a contraction of the overall trade deficit. Rather, the non-petroleum deficit expanded to offset the improvement in oil.  Actually, it should not be a surprise as this is a beautiful example of the standard economic analysis that the current account balance  (the trade deficit plus certain capital transactions) equals  the gap between domestic savings and investments.

When it first became obvious that the Reagan tax cuts were going to lead to a very large structural federal deficit, main stream economic forecasters started to talk about crowding out.  If you look at the US economy as a closed system, domestic investments must equal domestic savings and  interest rates are the price that changes to ensure that tat identity holds.

FED DEFICIT BY PRESIDENT

 

 

We clearly got a massive increase in the federal deficit as after the Reagan tax cuts the federal deficit exploded from -2% to – 6% of GDP.  Moreover, this occurred during the time of very strong economic growth that should have caused the deficit to contract.  But interest rates did not rise and the crowding out analysis was discredited.  Vice President Cheney even went so far to claim this demonstrated that deficit do not matter.

savings invest gap 2

 

 

 

 

 

 

 

 

 

 

But the view that savings must equal investments only holds in a closed economy. In those days virtually everyone looked at the US economy as a closed system and ignored the international aspects of the economy. In an open economy, however,  savings does not have to equal investments because foreign capital inflows can finance a gap between savings and investments.  In  a closed economy, interest rates adjust to ensure this identity.  But in an open economy both interest rates and the currency can move to ensure that economic identity prevails.

As the chart shows, the US has sustained a large gap between savings and investments since the 1980s.  Initially, the large federal deficit following the Reagan tax cut was accompanied by a massive 50% surge in the dollar.  This was generated by foreign investors bidding up the dollar as the demand for dollars exceed the supply.  But with a lag, the strong deficit lead to an increase in the current account deficit — the supply of dollars–and the supply and demand for dollars balanced without the dollar rising..  But this analysis brings up another identity that hold in an open economy; the domestic savings-investment gap must equal the current account balance.

savings-current account

 

 

 

 

 

 

 

 

 

 

As the chart shows, the identity that the savings-investment gap must equal the current account deficit has clearly held over the years.  We had crowding out after the Reagan tax cuts, it just worked through the dollar to hurt the economic sectors exposed to foreign competition  rather than interest rates to impact the interest sensitive sectors.  Moreover, as this analysis shows that the trade deficit is not a function of NAFTA or the other things that President Trump claims.  If you look at the US as an open economy it is obvious that the large  trade deficit and the loss of many manufacturing jobs has been caused by the Republican tax cuts that produced a structural federal deficit, a large domestic-savings gap and the large current account deficit.  Moreover, if Trump is able to implement another round of large tax cuts it will lead to a widening of the domestic-savings gap and  the current account –trade — deficits.  His tax policies will severely damage the American manufacturing worker that elected him in hopes that he could make America great again.

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Did Recep Tayyip Erdogan Make War on the USA ?

I assume the reader is familiar with the recent violence at the Turkish embassy & Turkish ambassador’s residence in Washington DC. “Body guards” (really thugs) brought by Turkish president Recep Tayyip Erdogan attacked peaceful demonstrators. It is clear how the fight started, a rather thin not too tall man in a suit attacked. He has a receeding hairline, a mustache and wore a black suit and a dark blue tie.

Phillip Bump (of the Washington Post) says this is the moment it started.

The striking thing is that seconds earlier someone in the back seat of the car in which Erdogan was sitting said something to a middle aged man who leaned over to hear. That man said something to a young thin man with a receeding hairline and a mustache who was wearing a black suit and a dark blue (or purple) tie. That young man nodded twice and walked off briskly to the demonstration just before the fight started.

He returned a minute later and said something to Erdogan (who had gotten out of the car).

Is this man who takes instructions from someone who took them from Erdogan the man who started the brawl ?
ymm3

The brawl starts with a man in a suit punching a man wearing a blue t-shirt.

ymwm

The assailant has a receeding hairline and a mustacheymwm

Here @pbump shows the order coming from the car

Here a longer clip shows the young man with a mustache get some instruction, walk briskly towards the demonstration then return and report to Erdogan in person.

Here notice that the man who started the brawl by punching the man in a blue t-shirt leaves (heading generally in the direction of Erdogan) while the brawl continues. Cowardice or mission accomplished ?ymm4

These stills are from this youtube video

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Toward a Jobs Guarantee at the Center for American Progress (!)

(Dan here…hat tip NDd for this post.  Very long and well worth reading)

By Lambert Strether of Corrente\

Toward a Jobs Guarantee at the Center for American Progress (!)

I had another topic lined up today, but this (hat tip alert reader ChrisAtRU) is so remarkable — and so necessary to frame contextualize immediately — I thought I should bring it your attention, dear readers. The headline is “Toward a Marshall Plan for America,” the authors are a gaggle of CAP luminaries with Neera Tanden leading and Rey Teixeira trailing, and the “Marshall Plan” indeed includes something called a “Jobs Guarantee.” Of course, I trust Clinton operatives like Tanden, and Third Way types like Teixeira, about as far as I can throw a concert grand piano. Nevertheless, one sign of an idea whose time has come is that sleazy opportunists and has-beens try to get out in front of it to seize credit[1] and stay relevant. So, modified rapture.

In this brief post, I’m going to look at the political context that drove CAP — taking Tanden, Teixeira, and the gaggle as a proxy for CAP — to consider a Jobs Guarantee (JG), briefly describe the nature and purpose of a JG, and conclude with some thoughts on how Tanden, Teixeira would screw the JG up, like the good liberals they are.

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Medicare does “NOT PAY FOR ITSELF”

In the comments section of an earlier post (1/3 of Medicare is Wasted), Maggie Mahar had stated to everyone; “Medicare Does Not Pay for Itself.” This is what I meant by that comment:

“For more than a decade the the federal government has borrowed to pay for the rising cost of Medicare. Debt-financing of Medicare will increase sharply as the population over 65 doubles from 2010 to 2030 and the number of beneficiaries over 85—with the greatest medical needs—triple.”

Note, using borrowed money to finance Medicare is not something happening in the future as it began more than a decade ago. Yet, as the article notes: “Members of Congress are reluctant to argue with constituents who sincerely believe that they have ‘paid for’ Medicare with payroll taxes and premiums. Most find it more convenient to tiptoe around the minefield of Medicare financings.” So the charade continues even today.

People who believe that they have paid for their Medicare with payroll taxes and premiums are terribly naïve and do not realize how much Medicare actually costs or how much “Medicare for all” would cost.

The article goes on to explain the history of how we arrived where we are today and why I make the comment on Medicare:

“In the mid-1990s, Democrats proposed to balance the Medicare budget by limiting fees paid to physicians for services, while Republicans sought to contain the costs by transferring the program to managed care insurers and capping the annual per capita rise in premium subsidies.

In 1997 the leadership in both parties agreed to a plan that would eliminate borrowing for Medicare, principally by limiting the growth in the level of fees paid to physicians. That Medicare reform, along with increasing general revenues paid by taxpayers in the highest bracket, led to a federal budget that balanced in fiscal year 2000.

The balance turned out to be short-lived. In 2001 and 2003 Congress passed debt-financed reductions in income tax rates. And in 2003 it also suspended the application of ceilings on fees set in 1997. Later that year Congress used debt to finance a new Medicare prescription drug benefit and higher payments to Medicare managed care plans.

As a result, the portion of Medicare paid for with dedicated taxes dropped from 73 percent in 2000 to 53 percent in 2010, the year that the first of the Baby Boom generation became eligible for Medicare.”

“After the 2008 election of President Obama, Democrats sought Medicare ‘savings’ for the purpose of expanding other medical services rather than balancing the budget for Medicare. In order to offset the cost of expanded PPACA medical services for families with low incomes; they placed restrictions on reimbursement rates, provided incentives for more efficient delivery of medical care, raised the Medicare tax paid by taxpayers with high-earned incomes, and applied Medicare taxation to gains from investment.”

On the other side of the political spectrum, “Republican House Budget Chairman Paul Ryan exemplifies his party’s ambivalence toward Medicare reform. He ran as the vice presidential candidate on a ticket in 2012 that attacked the Affordable Care Act’s limits on Medicare reimbursements. Yet before and after that election, he incorporated those very cost-saving measures into his own budget plans.”

Incumbents from “both parties find it awkward to even talk about the practice of borrowing to pay for Medicare. Obviously, an extra layer of interest on debt simply increases the program’s long-term cost. Any attempt to highlight that issue naturally invites the question of whether to cut Medicare costs or raise tax revenue dedicated to the program. No mainstream politician seeks to cut benefits by almost half and down to the level payable by revenues from premiums and payroll taxes. Democrats condemn any increase in payroll taxation as ‘regressive,’ while most congressional Republicans have signed a pledge to oppose any tax increase.”

Both sides of the aisle feint a reluctance to either cut Medicare benefits or increase Medicare withholding taxes and an honest discussion with their constituents regarding Medicare financing knowing full well something must be done. Indeed, it is politically expedient to kick the can or the bucket into the next decade avoiding the third rail of Medicare.

What can we do? I will answer that question in my next post.

Notes and References:
1. “Pay As You Go Medicare” Washington Monthly, Bill White, June 23, 2014

2. Maggie Mahar writes the Health Beat Blog Maggie is also the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006). Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex Gibney. Before she began writing about health care, Mahar was a financial journalist and wrote for Barron’s, Time Inc., The New York Times, and other publications. Her first book, Bull: A History of the Boom and Bust 1982-2003 (Harper Collins, 2003) was recommended by Warren Buffet in Berkshire Hathaway’s annual report.

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The “Tapes” Threat

by Sandwichman

The “Tapes” Threat

This may be so obvious it needs no explanation — but allow me to explain. This tweet puts on notice anyone who has a conversation with the POTUS that whatever they say MAY be recorded and selectively “leaked” for the purpose of blackmail, extortion and/or intimidation.

That should be an effective strategy for ensuring candid, confidential communication and advice. Mitch McConnell and Paul Ryan may be too stupid to realize the implications or too corrupt to care but there is no putting this genie back in the bottle.

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1/3 of Medicare Spending is Wasted

This was initially posted at Angry Bear September 14, 2014 by Maggie Mahar of Health Beat A little history: Dan and I invited Maggie Mahar to write at Angry Bear Blog as I was covering much of the Healthcare debate and Maggie could add much more in-depth knowledge and analysis of healthcare than I could. This is an important post as it gets down to the nitty-gritty of Medicare-For-All, things we need to know, and why it may not work.

Maggie Mahar in answer to a commenter:

You write: “That claim that one-third of Medicare spending is wasted sounds pretty questionable to me.”

This is your opinion. If you had spent the last 20 years working as a medical researcher investigating unnecessary treatment, your opinion would be of great interest to all of us; but, I’m assuming you have not done so.

Thus, you might be interested in some facts . . .

Dr. Donald Berwick, who headed up Medicare and Medicaid during the 1st half of the Obama administration has said, repeatedly, that at least 1/3 of Medicare dollars were wasted on unnecessary tests, procedures and drugs that provide no benefit for the patient. He is only one of dozens of health policy experts who have made the same statement. (Google “Health Affairs” the leading medical journal that focuses on health policy and “unnecessary treatments” Over the past 30 years, researchers at Dartmouth have provided stacks of evidence documenting unnecessary care in the U.S.

You also write: “I doubt that treatment protocols in the U.S. are all that different from other countries.”

Again, this is your opinion. Unfortunately, you are wrong.

In other countries, doctors and hospitals tend to follow evidence-based guidelines. In the U.S. a great many doctors object to the idea of someone telling them how to practice medicine even though that “someone is “science”. They value their autonomy and prefer to do things the way they have always done them. Of course this is not true of all doctors; but even when you look at protocols at our academic medical centers, you find that the way they treat similar patients varies widely.

Here, I’m not talking about how much they charge for a procedure (which also varies widely) but how many tests they order, how often they prescribe spine surgery for someone suffering from low-back pain, how often they tell a woman she needs a C-Section . . .

One big problem is that our doctors and hospitals are paid on a “fee – for service basis;” in other words, the more they do, the more they are paid.

As Dartmouth’s Dr. Eliot Fisher points out: “U.S. patients are not hospitalized more often than patients in other countries; but in the U.S., a lot more happens to you while you’re there.”

In addition, traditionally our medical schools have trained doctors to practice very aggressive medicine. The resident who orders a battery of tests is praised. Students are told “Don’t just sit there (and think). Do Something!” Traditionally, our medical culture has been a very macho culture and it is just beginning to change.

Finally, Americans tend to think that “more is always better.” Larger servings in a restaurant, bigger cars, bigger homes, etc. And when it comes to healthcare, patients in the U.S. tend to think that “more care is better care.” They are wrong. Every medical product and service carries some risk. If it provides no or little benefit, the patient is exposed to risk without benefit.

When medical protocols in the U.S. are compared to how medicine is practiced in other countries, researchers have found: —- Much unnecessary spine surgery. The rate of back surgery in the U.S. is five times higher than in the UK. Studies have shown little difference in long-term outcomes for patients who undergo back surgery compared to those who select non-surgical treatment.

The U.S. does more testing than other countries. For instance, the number of MRI and CT tests for every 1,000 people in 2010 was double the average in other OECD countries. Comparatively, there were also more tonsillectomies, caesarean sections and knee replacements. Regardless of how much more, nearly every procedure, scan and drug costs; it’s nothing compared to how out-of-whack the medical heroics thrown at Americans in the last stages of life The Cost of Health Care: A Country-by-Country Comparison

Colonoscopies are prescribed and performed more frequently than medical guidelines recommend and are given preference over less invasive tests that screen for colon cancer. Those less invasive tests are not only routinely performed in other countries, they’ve also been proven to be just as effective by the U.S. Preventative Services Task Force.

“We’ve defaulted to by far the most expensive option, without much if any data to support it,” said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.

In the U.S. many more patients die in ICU’s getting futile care. This is a painful, lonely way to die. In other countries, more patients are treated in hospices or allowed to go home where nurses and even doctors visit them.

Half of all heart surgeries (using stents) do no good. We know which half! But stent-makers and other providers have turned this into a big business.

- Our drug companies enjoy 20% profit margins.

- Our device-makers boast 16% profit margins.

We are over-medicated (particularly older people), and undergo too many surgeries that involve very expensive devices. Medicare covers virtually everything (even drugs that have been shown to be dangerous–until they are taken off the market). If it does not cover all of the newest treatments and products lobbyists would howl– and Congress makes sure that heads roll.

This is one reason why we don’t want to give everyone 40 to 65 a chance to enroll in Medicare. No one could afford it. (This idea was considered in the late 1990s. Do you have any idea how much 40-65 year olds would have to pay for our extraordinarily inefficient and wasteful Medicare system? On top of that and like people over 65, they would have to pay hefty sums for MediGap to Medicare advantage — private insurance plans that cover all of the things that Medicare doesn’t.

Medicare is now beginning to cut back, and over time it will refuse to pays for unnecessary surgeries (heart surgeries, unproven prostate cancer surgeries, and some hip and knee replacements, unless the patient has tried physical therapy first–and losing weight, if possible. (Some people just can’t lose weight, even under a doctor’s supervision.)

Medicare will also stop covering every new drug that comes on market, setting up a formulary and only paying for drugs that are effective — and cost-effective. The same will be true of devices.

Then — and only then — we might talk about letting people 40-65 sign up for Medicare, though in many cases, research on quality of care suggests that they would be better off with the best of our non-profit insurers: Kaiser, Geisinger, etc.

Medicare is a highly politicized bureaucracy and inevitably, Congress dictates what it can and can’t do. Medical guidelines should be set by medical researchers and doctors who have no financial interest in the outcome.

Maggie Mahar is the originator and author of the Health Beat Blog. Maggie wrote “Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006),” and was the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex Gibney.

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Burning a Source ?

Who thinks that Trump is “in the grip of some kind of paranoid delusion” ? That is the very hottest quote in the must read Phllip Rucker “analysis” of what is very wrong with the President.

I immediately tried to guess who had told Rucker that. The source is “One GOP figure close to the White House “. My first guess was Newt Gingrich (who can be relied upon to stab everyone close to him in the back). However, I now think Rucker made it very clear who is the “GOP figure”.

Later in the article I read

Robert M. Gates, a former defense secretary who informally advised Trump during the transition, criticized his handling of Comey’s ouster.

“Not terribly well done,” Gates told John Dickerson in a CBS News interview scheduled to air Sunday on “Face the Nation.”

Hmm Gates is a GOP figure close to the White House who Rucker might have asked to supply additional cutting comments.

The second to last paragraph in the article is

“Trump is so unsophisticated about government, and he lacks even basic knowledge about how the government functions, of what the unwritten but very important rules and traditions are. His attitude toward all those things is they don’t matter: ‘I’m going to drain the swamp!’ ” said a veteran of past Republican administrations who is close to the Trump White House and spoke on the condition of anonymity to candidly critique the president.

That anonymous source is virtually identified as Gates (to the extent that I searched for the quote by searching for “Gates” and had to scroll down and find it by hand to remind myself that the name wasn’t, quite, spelled out.

In other transparent anonymity I read “a third person denied that Bannon first learned Comey had been fired from television news reports and said that he had actually counseled Trump to delay his decision to lessen the political backlash.” Uh what “third” person could be the one who claims that Bannon wasn’t out of the loop, is familiar with Bannon’s thoughts, and notes that they were prescient ?

How about Patrick Caddell (the most hacktacular hack in the world) later identified as “Pollster Patrick H. Caddell, a longtime confidant of Bannon who served in Jimmy Carter’s White House,”? Rucker couldn’t find a Republican to Ballance the general view that Trump is destroying his presidency, so he had to go to old reliable Caddell for the Democrats in disarray distraction.

It’s like reliving the Carter administration on steroids,” Caddell said. “This is an outsider administration being surrounded by Apache knives. Every inch of the political class and both parties are going after him. The president can’t afford in this type of environment to not execute these kinds of announcements better.”

Look at how far down the hack depth chart Rucker (et Costa et Paletta) had to go to find someone willing to say anything sympathetic about the Trump administration. Does anyone (but me) even remember who Caddell was 40 years ago when he was a somebody ?

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