First, let me say I told you so. I spent the last two years (here, here and here) I have been talking about our economy and the recession. I talked about some of the causes of our financial collapse. I talked about some of the strategies for getting things turned around. I said that the government must spend money. There’s no other entity within the United States that has the power and size to be able to move our economy. Republicans, on the other hand, have been running around screaming that the government is too big. We have too much regulation and business is being strangled. It’s hard for me to figure out how business is being strangled with record profits rolling in. How can business be dying on the vine when they’re not paying any taxes? House Republicans are insisting on budget tax cuts.
The new jobs numbers are out today. There’s clearly some encouraging news. The economy made over 200,000 jobs last month. The unemployment rate is now 8.8%. Most of these jobs involve the private sector. So, conservatives can’t scream that all of these are government jobs. It is way too early to start doing the happy dance, but it appears that a thoughtful approach to economic policy is actually working.
Long-term unemployment is still a huge problem. There are still 6.1 million Americans who’ve been unemployed for more than six months. 24.5 million Americans are either unemployed or underemployed. In spite of the fact that March was one of the best months we’ve seen in this country in years (source jobs growth) the economy really needs to heat up in order to alleviate some of the pain and suffering that many Americans are feeling. If the economy continues to hire at a rate of 212,000 Americans per month it will be 2018 before the unemployment rate reaches the level that it was before the Great Recession. We’ve got work to do.
Tax cuts and budget cuts are clearly the wrong policy as the economy is beginning to turn around. We need the house Democrats and the Senate Democrats to stand strong against this budget-cutting GOP. The only reason that I can see to enact major budget cuts at this point in our economic recovery would be to stall or kill the economy before it really gets going. The GOP wouldn’t want to sabotage an economic recovery, would they?
I would like to say that I will come up with something brilliant never before said about New Orleans and Hurricane Katrina. I wish that were true. There have been endless books investigating the Hurricane Katrina tragedy from multiple angles. David Brinkley’s book, the Great Deluge, maybe the most complete. New Orleans’s own daily newspaper, the Times Picayune, has done a magnificent job at relentlessly chasing down details. Finally, Spike Lee’s documentary, When the Levees Broke, personalizes some of the pain and suffering.
Before Hurricane Katrina, Hurricane Georges hit the Gulf Coast in 1998 and narrowly missed New Orleans. This hurricane revealed several problems. City, state and federal officials met in 1999 in order to plan an adequate response. The state of Louisiana formally wrote FEMA and requested a planning exercise in August of 2000. It took four years before the exercise actually happened. In July 2004, Hurricane Pam began. There were over 300 participants in this five-day exercise. Hurricane Pam, by all accounts, was a realistic category three hurricane with sustained winds up to 120 mph. Using simulations from the National Weather Service and the US Army Corps of Engineers, the participants simulated over 20 inches of rain falling in parts of southern Louisiana. The storm surge topped the levees. The simulation assumed that over 300,000 people could not get out of the city in spite of mandatory evacuations. They also assumed that over half million buildings would’ve been destroyed. Over 100,000 people were injured and 60,000 killed. This was serious.
After the simulation, an after action report was filed. The most remarkable thing about this after action report is the number of areas where the letters TBA (to be announced) up here in the report. The report is incomplete. Large responsibilities have not been decided. In football, there is a saying, “You play like you practice.” In this case, the simulation showed huge gaps in our response. In reality, there is huge gaps in our response. In my opinion, any serious look at Katrina must start with a look at Hurricane Pam and the inter-agency problems that Pam revealed.
Over four years ago Sen. John Edwards, during a debate with Darth Vader VP Dick Cheney, talked about the two Americas. When Sen. Edwards ran for president in 2008, he also talked about the two Americas. He was talking about the very rich and everybody else. When you look at this debate they were having over healthcare, the debate has been characterized as a moral issue for covering those who don’t have healthcare. We’re talking about the poor or the working poor. I think it’s a lot more than that.
I think John Edwards was partially right. I think that America is really divided into three distinct groups: the poor, the rich and those of us who are in between. I like to talk about those of us who have “adequate health insurance.” For 90% of the medical ailments that may come up during our lifetime, these folks who have “adequate” health insurance will be fine. Their health insurance will suit them just fine. If you have a ruptured appendix, an uncomplicated heart attack or a gallbladder attack, your insurance will cover you and you’ll be back on the job in no time. On the other hand, if you’re in a major car crash and have a head injury or you have a significant pelvic fracture requiring prolonged rehabilitation, your insurance may only cover part of your overwhelming expenses.
An article in the New York Times, published yesterday, is unfortunately the typical variety of sensational case report which dominates the healthcare discussion. This article, which is probably accurate, describes the personal pain and suffering that medical bankruptcy has bestowed upon several people. The article never pulls back and shows us the whole picture. What do all the medical bankruptcies in the United States do to our economy? What happens when thousands of Americans have to sell their homes because of a medical bankruptcy? According to recent study, medical bankruptcies affect about two million Americans every year. (I’m not sure how you define “affect” in this context.) Average out-of-pocket expense is over $11,000 before bankruptcy. Remember, these are Americans who have insurance.
This is what the healthcare debate is about. It’s about fighting for you and me. It’s about fighting for all Americans. We need universal healthcare. We need a public system that will cover all Americans. No more medical bankruptcies. We need a system that is not going to bleed us dry. We need a system that will improve our healthcare and help us live happier, healthier, longer lives.
“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
Here’s how we get there. Medicare and Medicaid will be rolled into this universal healthcare. The federal government will be allowed to negotiate with pharmaceutical companies and medical product companies, both of which will drive down costs. Primary care physicians will be paid to take care of a population of patients. They will be given added incentives if their population of patients who are in fact healthier at ,the end of every year (better sugar control in their diabetic patients, better blood pressure control in the hypertensive patients and better weight control in their overweight patients — these are just a few examples). Patients who adhere to their doctors regiments and lose weight, stay on a strict diet and monitor their sugars will necessarily be given tax rebates. All of this will be driven by proven medical data. The medical studies will be paid for by the $700 billion that we will save by excluding insurance. Patients can still choose their own doctors and go to their own hospitals.
Finally, there are some who have bemoaned the fact that insurance companies have been made the villains. Insurance companies, for the most part, deserve their reputations. Even with complete universal healthcare coverage, insurance companies will still have a viable product to sell to the wealthy. They will sell supplemental insurance. Universal healthcare will be driven by the best medical data that is available. For those Americans who want treatment outside of these constraints, supplemental insurance may be able cover some of these costs.
For me, the bottom line is doing the right thing for America. The right thing is universal healthcare.
Update: An interesting article on healthcare reform was sent to me by a good friend. I’ve been arguing that healthcare reform, universal health care, makes sense for a number of reasons. I’ve tried to stay away from finger-pointing and name-calling. It is clear that over the years the insurance and pharmaceutical industries have made huge profits. These these profits are not huge compared to Halliburton or Exxon-Mobil, but they are large compared to historical standards. Robyn Blumner, writing for the Columbus Dispatch, argues that the government is the only thing that can keep these large insurance companies honest. She is probably correct. We need more than simple regulation since, as we saw seen during the Bush administration, even the best written regulations can be ignored by an industry-friendly government.
Update II:DemFromCT has a great update on the Daily Kos of a new poll that was released from Quinnipiac. It is clear that most Americans want a public option. In spite of what Joe Scarborough said the other day that all ABC/Washington Post polls were skewed, in every single poll that I have seen recently supports a favorable public option. Are they all skewed? Interestingly, in the Quinnipiac poll, 72% of Americans didn’t want to pay any more than $500 per year for this public option. To me, this clears up the debate significantly. This means universal healthcare. This is the only option in which Americans don’t put out any more out-of-pocket expense. Any public-private option will cost billions if not trillions of dollars. So where’s the problem?