Jeff G Also note, I clearly don't have as cynical a view of the role of govt as the libertarians or even many in the GOP, nor do I support any of the tactics undertaken by those seeking a wholesale dismantling of govt. But it's time for the Democratic party to take a bit more of a clear-eyed view of what's really happening with our fiscal trajectory and, yes, do something about it sooner rather than later. Having spent time researching healthcare policy, I can assure you "doing something" entails neither sacrifices in quality nor access to healthcare for seniors. It entails realizing and coming to grips with the staggering and unnecessarily high price we pay for healthcare and the rate of increase -- far above what would be expected based simply on population aging.
Jeff G Benjamin, as one working in USG, I can absolutely affirm that the encroachment of entitlement spending throughout the federal budget is rapidly strangling everything else that government seeks to accomplish. Look at levels of non-defense, discretionary spending and you see that the number already comes in south of $500 bn/year and is getting dropped and chopped every year forward. There may not be a fiscal crisis coming within 2, 3, or even 10 years, but make no mistake that entitlement spending is not-so-gradually eviscerating govt's ability to operate effectively in other areas *today*. The competition for resources is intense, and many agencies are struggling to achieve their mission with growing workloads and dwindling resources. This is unmistakably due to the loud vacuum sound emanating from entitlement spending. Please view the article I wrote on this last year: http://www.policymic.com/articles/5945/30-slides-that-get-you-up-to-speed-on-u-s-health-care-policy
Jeff G Wow, awesome history - thanks for the write-up. Any other sources around exposing this as a PR stunt? Btw, I wouldn't quite say it was a "badly executed drama production." It looked pretty real. though I did wonder how/why the weapon would've failed.
Jeff G Also, another suggestion I'd love to see applied to BOTH parties that might go a long way and has probably been overlooked as a solution to gridlock: open primaries. It's the closest way to achieve something akin to multi-party/run-off voting that we can approximate in the confines our two-party/winner-take-all system.
Jeff G John, I can understand why you're looking ahead to 2014 rather than focusing on the here and now. That being said, I might suggest that perhaps the smartest thing the GOP has (partially) done or may continue to do - though it may grate against what you believe - is to throw Grover Norquist under the bus (and back up and roll over him several times over, if possible). Setting aside policy arguments for a moment, as a political strategy, moving ahead with the limited tax hikes agreed to so far can effectively allow the electorate to move past the issue and deal with spending. In addition, it finally allows the GOP to cast itself as the practical, reasonable, moderate and (most importantly) *compromising* grown-ups, and signals to voters that they've made *real* concessions and have skin in the game, i.e. are negotiating in good faith to lower the deficit. It also allows voters to SEE (rather than just hear) that raising taxes alone doesn't effectively mitigate the deficit.
Jeff G The biggest policy problem in the long term is that those per-capita healthcare costs are not only rising faster than the effect of population aging would suggest, but are also growing much faster than the rest of the economy. With federal Medicare spending tied to this excessive rate of growth, we're going to find ourselves again in a situation where money is going out of federal coffers at a faster rate than economic/revenue growth will replenish it. That's not a problem when it results from short-term economic shocks but is much worse when it a chronic imbalance results from poor fiscal oversight. So the question of why healthcare cost growth far exceeds the growth of revenue/GDP (and isn't adequately explained by population aging) is inevitably the central focus of entitlement reform.
Jeff G Adam, from further down the article in your link: Health Care Costs Pose Significant Longer-Term Challenge: "Though it would stabilize the debt over the coming decade, an additional $1.4 trillion in deficit reduction would not be enough to address the longer-term budget problem. In ensuing decades, the aging of America’s population and projected increases in per-capita health care costs — which are likely to rise faster than per-capita GDP — will put considerable pressure on federal health and retirement programs, returning the budget to an unsustainable path of rising debt as a share of the economy. Nevertheless, by stabilizing the debt for the next decade, an additional $1.4 trillion in deficit savings would give experts and policymakers time to figure out how to slow the growth of health care costs throughout the U.S. health care system without impairing the quality of care."
Jeff G Jack, Chris - in addition, here is some recent reporting on the NICS database, including GAO findings. A law was passed in 2007 to strengthen it following VA Tech (which the NRA also supported), but state reporting is still stalled by different factors. http://www.thecrimereport.org/news/crime-and-justice-news/2012-08-gun-database-lacking-mental-recs http://www.npr.org/2012/08/16/158932528/states-arent-submitting-records-to-gun-database http://www.gao.gov/products/GAO-12-684 http://www.washingtonpost.com/wp-dyn/content/article/2007/12/19/AR2007121902279.html
Jeff G Too true. Though as the article states, "That may seem too low a value to put on someone's life, but it's a lot better than nothing." Most importantly, it provides an incentive for the owner to guard against his weapon from falling into the wrong hands, and it's that change in behavior that can save lives (which is a better goal than finding suitable reimbursement for loss of life).
Jeff G Great proposition Darwin. A recent article made essentially the same suggestion, calling it mandatory liability insurance -- much as we also already do with autos. It even mentions the NRA itself offers a form of personal liability insurance worth up to $100k, for a premium of about $165. So that's a market-based approach that might be similar to what you propose, which sounds more along the lines of civil/legal liability legislation. http://www.economist.com/blogs/democracyinamerica/2012/12/gun-control-0
Jeff G Just to clarify, Obama's initial plan was never based on a "single payer" model, it was to include a public option (different). Nor are single-payer vs. individual mandates dichotomous alternatives to one another, but just different mechanisms by which to extend and pay for healthcare. Also, the the public option approach didn't have quite enough support within the Democratic party at the time the law was being drafted (blue dogs, etc.).
Jeff G Matt, nice exposition of the privacy issues involved if doctors were required to report PHI to the NICS system. As to the discussion on "more" vs. "better" gun control, I think the nexus of gun access and mental illness is definitely the first place to start (clip size and other legitimate AWB discussions notwithstanding). In regards to the NICS database, here are a few other sources I've come across recently. State reporting to the database isn't working well, despite a 2007 passage of a law to strengthen it (following VA Tech), which the NRA actually supported. http://www.thecrimereport.org/news/crime-and-justice-news/2012-08-gun-database-lacking-mental-recs http://www.npr.org/2012/08/16/158932528/states-arent-submitting-records-to-gun-database http://www.gao.gov/products/GAO-12-684 http://www.washingtonpost.com/wp-dyn/content/article/2007/12/19/AR2007121902279.html
Jeff G On the point about existing vs. new gun legislation: a few other things I've read come to mind -- seems there's a nexus between those clamoring for gun legislation/etc. vs. more mental health support. The NICS database isn't working, despite the 2007 passage of a law to strenghthen it, which the NRA actually supported. Figuring out why this is the case may be some low-hanging fruit -- at least in terms of political will. Yet there are different reasons why the system hasn't been implemented well that need to be addressed. http://www.thecrimereport.org/news/crime-and-justice-news/2012-08-gun-database-lacking-mental-recs http://www.npr.org/2012/08/16/158932528/states-arent-submitting-records-to-gun-database http://www.gao.gov/products/GAO-12-684
Jeff G To your point about requiring more screening, that may be something to look at. Note that many servicemembers go through required annual and post-deployment screenings ("post-deployment health assessments") based on questionnaires about traumatic experiences/reactions, but most troops know what the "right" answer is when it comes to appearing healthy on paper. Some veterans groups are advocating for face-to-face screening for all service members coming home from a deployment.
Jeff G Edward, you've made a good outline of some of the right questions to be asking, and it's also right that for the first time mental health issues have entered into the discussion much more prominently. I'd add an additional point on that, which is that much of what gets mentioned in terms of mental health services is the issue of 'access' to it. However, an issue that looms at least as large, if not larger, is the issue of Stigma. One place to learn from here is the US military, which is expending a great deal of effort to enhance access as well as reduce stigma among service members, which can itself be the greatest "barrier" to access. They've done some work to catalog and profile what's being done, but more evidence is needed on "what works": http://www.rand.org/pubs/technical_reports/TR950.html
Jeff G cont... "Also: Remember that people with mental illnesses are no more violent than the next person and are far more likely to be a victim." Relatedly, an excellent blog post on the same subject: http://www.theaccidentaladvocate.org/
Jeff G cont... "and place. The combination of how tough the symptoms can be and how hard it often is to get the services these kids need can make parents look (and feel) like bad parents when they're not. Parents of children who live with mental illnesses need support. A lot of it. If you know such a parent, listen to him or her. Non-judgmentally. Bring them a casserole when the going gets tough. Send their kid a "get well" card if they go to the hospital. Connect the parent with other parents through NAMI. Learn about the mental illness the child has. Never, ever say "give me your child for a week and I'll set them straight" (yes, people tell parents this). Don't ask if the parent has tried discipline or some other thing (yes, people say this too; and yes, they tried it and lots of other things). And don't tell the parent you understand what they're going through because your kid who doesn't live with a mental illness did x, y or z a few times.... cont.
Jeff G Rachel, rather than simply denounce your article as "a reeking pile of manure," "pseudo- intellectual drivel," "pious baloney," or bordering on evangelical zealotry, I have to stop and ask: are you even a parent? Surely you must at least know people who are. But I'll digress, and simply re-post a statement from a friend who works for the National Alliance on Mental Illness and had something much more edifying to say: "Don't blame the CT tragedy on bad parenting. It's the wrong thing to do. There are too many fb posts about that today. My office (NAMI) responds to thousands of calls from parents who are working their tails off to do right by their kids, including adult kids. These parents have been through hell and high water, would do anything for their kids, and are their kids' best and often only advocates. Raising a child with a serious mental illness is no easy task, and we don't have enough mental health services and supports that people can access at the right time... cont
Jeff G Mike, good article and you raise some interesting points. I also know that healthcare costs are quite high for vets coming home from war (more an argument for less foreign intervention than cuts to vets' healthcare, hopefully an obvious point). Incidentally I also came across this quote today in the context of an op-ed piece: "It is doubtful that future threats will call for many of the expensive weapon systems advocated by parochial interests and some political leaders -- a system such as the F-35 joint strike fighter. Developing this plane has cost more than was spent on veterans in the last 20 years." http://www.cnn.com/2012/12/12/opinion/gard-johns-military-spending/index.html?hpt=hp_bn7
Jeff G Lindsay I think something that the libertarians on here are getting at (I don't count myself one of them) is sensitivity around the legal implications of the terminology around "rights" - specifically positive rights. I think the declaration is laudable in the sense of being aspirational or articulating a vision statement of what the world should be working towards. In my agency we focus on implementing sound development policy with private sector-led economic growth as the overriding objective and performance metric. However even as activities are developed and conceptualized, there is always legal counsel close at hand to ensure that we're not legally bound or accountable for outcomes for which we're neither reasonably responsible nor expect would be achieved. In any case, it's partly a framing issue but it also relates to the strategy for achieving one's goals. Universal access to food/housing etc. should be something to strive for and achieved via effective development practice.
Jeff G Rick, not to pile on or anything... but, I actually work on development policy and aid effectiveness issues for USG, and, you're really shooting in the dark in terms of the overall objectives of aid. As Max points out, the long-term goal is to promote economic growth by getting low-income countries to create space for private sector-led investment, and to transition countries away from chronic aid dependency. You're right that the development community has learned lessons over the past decades about what doesn't work, but the bottom line is Africans by and large *do* want to engage in trade regionally and globally rather than subsist on aid over the long term. Even major recent innovations such as micro-finance (think Kiva.org or Grameen Bank) relies on financing small enterprises. To the extent you are interested in the subject, I recommend any of the following books: http://www.amazon.com/Dead-Aid-Working-Better-Africa/dp/0374532125 http://tinyurl.com/cxb9y9j