How Do the Elderly Spend Money and the Difficulty of Protecting Against Social Security Cuts

Dec 18, 2012Mike Konczal

Dean Baker and Doug Henwood both have good analysis on the cuts involved in chaining inflation. Since the rumored cuts to Social Security will hinge on this way of calculating inflation, I want to dig one level into the data to convey what it will mean and then look at some of the distributional impact.

I.

Let's start with two groups of people. The first is urban wage earners and clerical workers, one select group of the population, who purchase a representative basket of goods and services. How much does the basket of goods they purchase increase in price over time? This cost is called CPI-W, and it is currently used for adjusting Social Security benefits. The second group is all people aged 62 and over. Since the 1980s, the government has calculated the cost of goods and services for this group as well, and it is referred to as CPI-E. What do they spend money on? Here's the relative importance of major categories of spending, provided by the BLS, for each group from December 2007:

Green is where the group spends compartively less. As we can see, the elderly spend a lot more of their (more limited) money on housing, utilities, and medical care. And as you probably know, health care costs have been rising rapidly over the past several decades. With the notable exception of college costs, the things urban wage earners spend money on haven't increased in prices as fast as what the elderly purchase. As a result, the CPI-E has increased 3.3 percent a year from 1982 to 2007, while the CPI-W has only increased 3.0 a year.

But wait, what's this chained thing that is being proposed? Picture that in response to a price increase for one good you could substitute similar items. So if the price of chicken goes up, you could eat more beef. Or if the price of a movie went up, you would rent movies more often. This substitution effect blunts some of the price increases. As such, inflation is lower when you take this into account. It's more complicated than that, but it is a start for a definition.

But we don't have a "chained" version of the CPI-E. And the items that the elderly purchase probably aren't impacted in the same competitive way. If the price of beer goes up, you can drink more wine; if the price of utilities go up, your options are limited. The areas where the elderly pay more don't have the same competitive pressures, and their geography is going to be more limited. We could get a chained version of the CPI-E if Congress told economists to make one. However it's likely not to have the cuts built in the same way.

II.

Brad Delong, who signed a letter from over 300 economist experts and social scientists organized by EPI arguing that there's no empirical basis for the COLA change, says that "Chained-CPI" is code for "let's really impoverish some women in their 90s!" This will fall on those who live the longest and rely on Social Security the most. But can we find a way to have this impact the poor less so that it doesn't fall too hard on those with the least?

The White House is saying that there will be such a set of protections, and think tanks have proposed some, but we won't know what they'll entail until they are better reported. No matter what additional measures are proposed, it's important to understand how compressed the distribution of income is for those receiving Social Security. From the Social Security Administration, here's a chart on the importance of Social Security relative to total income by income quintile for beneficiary families over 65 years of age (Table 9.B6):

I hate using charts that have so many percents of a percent of a percent, but this data is really important. To get a sense of what this chart is telling us, let's look at a box. From this chart, in the botom 20 percent of income, or those that make $11,417 or less, 65 percent of beneficiaries families get 90 percent of their income from Social Security. So the poorest are very dependent on Social Security, and a large cut will impact them harshly.

But let's say we wave a policy wand and protect those in the bottom 20 percent. The problem is that the income here is very compressed, and that Social Security is a major source of income up the ladder. Even for those in the 60-80 percent of income bracket, 41 percent of their income comes from Social Security. The group around the middle, in the third quintile, have only around $20,000 a year to live on and get a majority of their income from Social Security.

This is not a program that just helps the destitute; it provides a broad level of income security in old age for the majority of retirees. The average elderly family receiving Social Security gets 58.2 percent of their income from the program. A quarter of families get 90 percent or more of their income from Social Security. Once you leave the top income quintile, Social Security is the major source of retirement security. It is hard to see how means-testing these across-the-board cuts will be sufficient to prevent this from having a serious impact on our most vulnerable.

 

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Dean Baker and Doug Henwood both have good analysis on the cuts involved in chaining inflation. Since the rumored cuts to Social Security will hinge on this way of calculating inflation, I want to dig one level into the data to convey what it will mean and then look at some of the distributional impact.

I.

Let's start with two groups of people. The first is urban wage earners and clerical workers, one select group of the population, who purchase a representative basket of goods and services. How much does the basket of goods they purchase increase in price over time? This cost is called CPI-W, and it is currently used for adjusting Social Security benefits. The second group is all people aged 62 and over. Since the 1980s, the government has calculated the cost of goods and services for this group as well, and it is referred to as CPI-E. What do they spend money on? Here's the relative importance of major categories of spending, provided by the BLS, for each group from December 2007:

Green is where the group spends compartively less. As we can see, the elderly spend a lot more of their (more limited) money on housing, utilities, and medical care. And as you probably know, health care costs have been rising rapidly over the past several decades. With the notable exception of college costs, the things urban wage earners spend money on haven't increased in prices as fast as what the elderly purchase. As a result, the CPI-E has increased 3.3 percent a year from 1982 to 2007, while the CPI-W has only increased 3.0 a year.

But wait, what's this chained thing that is being proposed? Picture that in response to a price increase for one good you could substitute similar items. So if the price of chicken goes up, you could eat more beef. Or if the price of a movie went up, you would rent movies more often. This substitution effect blunts some of the price increases. As such, inflation is lower when you take this into account. It's more complicated than that, but it is a start for a definition.

But we don't have a "chained" version of the CPI-E. And the items that the elderly purchase probably aren't impacted in the same competitive way. If the price of beer goes up, you can drink more wine; if the price of utilities go up, your options are limited. The areas where the elderly pay more don't have the same competitive pressures, and their geography is going to be more limited. We could get a chained version of the CPI-E if Congress told economists to make one. However it's likely not to have the cuts built in the same way.

II.

Brad Delong, who signed a letter from over 300 economist experts and social scientists organized by EPI arguing that there's no empirical basis for the COLA change, says that "Chained-CPI" is code for "let's really impoverish some women in their 90s!" This will fall on those who live the longest and rely on Social Security the most. But can we find a way to have this impact the poor less so that it doesn't fall too hard on those with the least?

The White House is saying that there will be such a set of protections, and think tanks have proposed some, but we won't know what they'll entail until they are better reported. No matter what additional measures are proposed, it's important to understand how compressed the distribution of income is for those receiving Social Security. From the Social Security Administration, here's a chart on the importance of Social Security relative to total income by income quintile for beneficiary families over 65 years of age (Table 9.B6):

I hate using charts that have so many percents of a percent of a percent, but this data is really important. To get a sense of what this chart is telling us, let's look at a box. From this chart, in the botom 20 percent of income, or those that make $11,417 or less, 65 percent of beneficiaries families get 90 percent of their income from Social Security. So the poorest are very dependent on Social Security, and a large cut will impact them harshly.

But let's say we wave a policy wand and protect those in the bottom 20 percent. The problem is that the income here is very compressed, and that Social Security is a major source of income up the ladder. Even for those in the 60-80 percent of income bracket, 41 percent of their income comes from Social Security. The group around the middle, in the third quintile, have only around $20,000 a year to live on and get a majority of their income from Social Security.

This is not a program that just helps the destitute; it provides a broad level of income security in old age for the majority of retirees. The average elderly family receiving Social Security gets 58.2 percent of their income from the program. A quarter of families get 90 percent or more of their income from Social Security. Once you leave the top income quintile, Social Security is the major source of retirement security. It is hard to see how means-testing these across-the-board cuts will be sufficient to prevent this from having a serious impact on our most vulnerable.

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Social Security cards image via Shutterstock.com.

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A Cost of Living Adjustment for Social Security in the Fiscal Cliff?

Dec 17, 2012Mike Konczal

I haven't been writing about the various trial balloons and back-and-forths in the fiscal cliff austerity phase-in negotiations. But I do want to make a comment on the latest one. From Ezra Klein, there's rumors that there will be more revenue, some extended unemployment insurance, and additional stimulus money. However, "the Democrats’ headline concession will be accepting chained-CPI, which is to say, accepting a cut to Social Security benefits." Krugman isn't sure if this is better than no deal.

I think it's terrible, and the best way to understand it is by comparing it to the two reasons some liberals, Kevin Drum for instance, give for making a deal on Social Security. This is not my argument, but it's a useful comparison. The first reason is that by proactively changing Social Security you can secure a deal that has more revenue and fewer cuts than you would otherwise. The second reason is that by making a deal on Social Security you take the issue off the policy table. Sure, the people who think Social Security is a form of tyranny will still be after it. But all the deficit scolds will pack up and go home on the issue.

This deal would do neither. You'd cut Social Security without putting in any new revenue. And it wouldn't be sufficient to close the long-term gap, so the issue would stay on the table. Indeed, it's obvious that Very Serious People would view this as a "downpayment" on future cuts, and require any future attempts to get more revenue for Social Security, say by raising the payroll tax cap, to involve significant additional cuts.

From CBO's Social Security Policy Options, you can see 30 options for Social Security. 

The CBO puts the 75-year actuarial balance deficit at 0.6 percent, and this chart shows how much of that 0.6 percent would be filled by various options. The last one, basing the cost-of-living-adjustments (COLA) on the chained CPI-U, is only 0.2, or about a third of what the deficit hawks will say is necessary. From the CBO, it would only extend the trust fund four years. There will be demands for going back to Social Security in the years ahead, and those changes will not come solely from revenue increases. That's giving up a major piece for nothing in terms of Social Security, which is a very bad deal.

Personally, I think changing the COLA is a bad idea in general. The elderly face a higher rate of inflation since their spending is so dependent on health care, which is difficult to adjust or comparison shop for (the idea behind chaining the inflation rate). More importantly, of the three legs of the stool of retirement security - Social Security, private savings and employer savings plans - the two that aren't Social Security are struggling. Employer pensions will become less secure and less available going forward. Housing wealth was wiped out in the crash. 401(k)s appear to have been a great way to shovel tax savings to the rich, but are in no shape to take over for a lack of pensions. Median wages have dropped in the recession, and are likely to show little growth in the years ahead, which makes building private savings harder. Social Security will become more important, not less, in the decades ahead. Its benefits should be expanded, not cut.

UPDATE: Kevin Drum has a similar conclusion on the deal.

I haven't been writing about the various trial balloons and back-and-forths in the fiscal cliff austerity phase-in negotiations. But I do want to make a comment on the latest one. From Ezra Klein, there's rumors that there will be more revenue, some extended unemployment insurance, and additional stimulus money. However, "the Democrats’ headline concession will be accepting chained-CPI, which is to say, accepting a cut to Social Security benefits." Krugman isn't sure if this is better than no deal.

I think it's terrible, and the best way to understand it is by comparing it to the two reasons some liberals, Kevin Drum for instance, give for making a deal on Social Security. This is not my argument, but it's a useful comparison. The first reason is that by proactively changing Social Security you can secure a deal that has more revenue and fewer cuts than you would otherwise. The second reason is that by making a deal on Social Security you take the issue off the policy table. Sure, the people who think Social Security is a form of tyranny will still be after it. But all the deficit scolds will pack up and go home on the issue.

This deal would do neither. You'd cut Social Security without putting in any new revenue. And it wouldn't be sufficient to close the long-term gap, so the issue would stay on the table. Indeed, it's obvious that Very Serious People would view this as a "downpayment" on future cuts, and require any future attempts to get more revenue for Social Security, say by raising the payroll tax cap, to involve significant additional cuts.

From CBO's Social Security Policy Options, you can see 30 options for Social Security. 

The CBO puts the 75-year actuarial balance deficit at 0.6 percent, and this chart shows how much of that 0.6 percent would be filled by various options. The last one, basing the cost-of-living-adjustments (COLA) on the chained CPI-U, is only 0.2, or about a third of what the deficit hawks will say is necessary. From the CBO, it would only extend the trust fund four years. There will be demands for going back to Social Security in the years ahead, and those changes will not come solely from revenue increases. That's giving up a major piece for nothing in terms of Social Security, which is a very bad deal.

Personally, I think changing the COLA is a bad idea in general. The elderly face a higher rate of inflation since their spending is so dependent on health care, which is difficult to adjust or comparison shop for (the idea behind chaining the inflation rate). More importantly, of the three legs of the stool of retirement security - Social Security, private savings and employer savings plans - the two that aren't Social Security are struggling. Employer pensions will become less secure and less available going forward. Housing wealth was wiped out in the crash. 401(k)s appear to have been a great way to shovel tax savings to the rich, but are in no shape to take over for a lack of pensions. Median wages have dropped in the recession, and are likely to show little growth in the years ahead, which makes building private savings harder. Social Security will become more important, not less, in the decades ahead. Its benefits should be expanded, not cut.

UPDATE: Kevin Drum has a similar conclusion on the deal.

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New Paper: Against the Coupon State

Dec 3, 2012Mike Konczal

Imagine if current neoliberal policymakers had to sit down today and invent the idea of a library. What would it look like? They'd likely create a tax credit to subsidize the purchasing and reselling of books, like much of our submerged welfare state. They might require a mandate for people to rent books from approved private libraries run by Amazon or Barnes and Noble, with penalties for those who don’t and vouchers for those who can’t afford it, like the recent health care expansion. 

Or maybe they’d create means-tested libraries only accessible to the poor, with a requirement that the patrons document how impoverished they are month after month to keep their library card. Maybe they’d also exempt the cost of private library cards from payroll taxes. Or let any private firm calling itself a library pay nothing in taxes while exempting their bonds from taxation and insuring their losses by, say, paying for books that go missing. You can imagine them going through every possible option rather than the old-fashioned, straightforward, public library, open to all, provided and run by the government, that our country enjoys everyday.
 
I have a new white paper out with New America's "Renewing the American Social Contract" series, titled "No Discount: Comparing the Public Option to the Coupon Welfare State." Here's the introduction, and here's the full pdf.
 
Given that the state wants to provide a certain good, I wanted to find the arguments over whether or not the government should provide that good itself or provide coupons for purchases in the private market. Surprisingly, there were few cohensive summaries, so I created one myself. Though not explicitly stated, It's relevant for discussions over whether or not the welfare state should be entirely replaced with cash (the ultimate coupon).
The rest of the papers in the series are very much worth your time too. I hope you check them out. Mine starts out with:
 
The fundamental ideological conflict surrounding the Welfare State in the U.S. is no longer over the scope of government, but instead how the government carries out its responsibilities and delivers services. The conservative and neoliberal vision is one of a government that provides a comparable range of benefits as conventional liberals, but rather than designing and delivering the services directly, it provides coupons for citizens. Coupons – whether by that name or more anodyne terms such as “vouchers” or “premium support” or tax subsidies – could then be used to purchase the services in the private market. Whenever neoliberals have sought to expand the scope of the welfare state or conservatives have tried to fundamentally shrink it, both have come bearing coupons.
 
Read the rest at New America.
 
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Imagine if current neoliberal policymakers had to sit down today and invent the idea of a library. What would it look like? They'd likely create a tax credit to subsidize the purchasing and reselling of books, like much of our submerged welfare state. They might require a mandate for people to rent books from approved private libraries run by Amazon or Barnes and Noble, with penalties for those who don’t and vouchers for those who can’t afford it, like the recent health care expansion. 

Or maybe they’d create means-tested libraries only accessible to the poor, with a requirement that the patrons document how impoverished they are month after month to keep their library card. Maybe they’d also exempt the cost of private library cards from payroll taxes. Or let any private firm calling itself a library pay nothing in taxes while exempting their bonds from taxation and insuring their losses by, say, paying for books that go missing. You can imagine them going through every possible option rather than the old-fashioned, straightforward, public library, open to all, provided and run by the government, that our country enjoys everyday.
 
I have a new white paper out with New America's "Renewing the American Social Contract" series, titled "No Discount: Comparing the Public Option to the Coupon Welfare State." Here's the introduction, and here's the full pdf.
 
Given that the state wants to provide a certain good, I wanted to find the arguments over whether or not the government should provide that good itself or provide coupons for purchases in the private market. Surprisingly, there were few cohensive summaries, so I created one myself. Though not explicitly stated, It's relevant for discussions over whether or not the welfare state should be entirely replaced with cash (the ultimate coupon).
The rest of the papers in the series are very much worth your time too. I hope you check them out. Mine starts out with:
 
The fundamental ideological conflict surrounding the Welfare State in the U.S. is no longer over the scope of government, but instead how the government carries out its responsibilities and delivers services. The conservative and neoliberal vision is one of a government that provides a comparable range of benefits as conventional liberals, but rather than designing and delivering the services directly, it provides coupons for citizens. Coupons – whether by that name or more anodyne terms such as “vouchers” or “premium support” or tax subsidies – could then be used to purchase the services in the private market. Whenever neoliberals have sought to expand the scope of the welfare state or conservatives have tried to fundamentally shrink it, both have come bearing coupons.
 
Read the rest at New America.
 
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The Simpson-Bowles Consensus Isn't Common Sense. It's Nonsense.

Nov 28, 2012Jeff Madrick

Capping federal spending at 21 percent of GDP is arbitrary, short-sighted, and wrong for America.

Capping federal spending at 21 percent of GDP is arbitrary, short-sighted, and wrong for America.

The Simpson-Bowles budget balancing plan seems to have become the common-sense standard for dealing with America’s future budget deficits. I’d say this move toward the right is dangerous to the future of the nation and essentially cruel—far more dangerous than the level of the deficit over the next 15 years. The commission, formally known as the Commission on Fiscal Responsibility and Reform, appointed by President Obama, achieves its deficit reduction by reducing government spending to do two-thirds of the job and raising taxes to do only one-third of the job. Even 50-50 would not be fair in such a low-tax nation. The commission proposed cuts in Social Security benefits of 15 percent for medium earners, for example.

But easily the most short-sighted objective is to hold federal spending to 21 percent of Gross Domestic Product into the future. How did they get this number? It is roughly the average level of federal spending since 1970. This is not a reasonable standard—it is not even a way to think about the issue. So where did the idea originally come from? The answer: the right-wing Heritage Foundation.

Now our most respected elder statesmen of the economy, Paul Volcker and Warren Buffett, are endorsing the 21 percent level in recent editorials. It may have been missed in Buffett’s piece, which endorsed a 30 percent tax on the rich, and correctly so. But he said it plain as day: “Our government’s goal should be to…spend about 21 percent of G.D.P.”

Oh my. Did they do any analysis at all about what that level would mean for retired, sick, and middle-income-to-poor Americans? Did it occur to them how vastly the U.S. economy has changed over those years? There are many more retirees, health care is more expensive and more extensive, the U.S. has chosen to fight expensive wars, and its infrastructure and educational needs are dire.

The words of the wise oracles should not be taken seriously. One wonders whether Volcker would have run the Federal Reserve or Buffett picked stock on such skimpy analysis. They present no evidence, nor do I think they have done any research or even reading that shows that a 21 percent spending level will make the economy more efficient than, say, a 24 percent level of spending. 

And they beat their chests as the exemplars of responsibility in an otherwise irresponsible America. Moreover, Pete Peterson, of course, is now financing a road tour for Bowles and Simpson to fight their great moral battle to get America’s budget under control—as a reminder, not by raising taxes significantly but by cutting social entitlements significantly. America cannot be run by men like these. America’s great moral battle is for social justice and adequate federal investment.

The heroic and correct analysis of the Simpson-Bowles plan has been done by Paul Van de Water of the Center on Budget and Policy Priorities. Some think of the CBPP as left-wing, but it is only mildly so. It makes deficit reduction a top priority, and its analysis is typically excellent. 

Van de Water concludes that keeping federal spending at 21 percent of GDP would require deep cuts in Social Security, Medicare, and Medicaid over time, as well as virtually all other federal programs. He wrote this before the Budget Control Act and the sequester we now face, but its principles still apply.

Moreover, he reminds us that the Brookings Institution held panels on the future budget, and in general, centrists on those panels agreed that spending as a percent of GDP should be 23 to 25 percent 20 years from now. He thinks the Simpson-Bowles plan is simply wrong for America. In truth, Social Security is inadequate today, and Medicaid tragically so. The latter in particular needs building up.

And then the 21 percenters generally have the audacity to demand more investment in education and infrastructure. How?

Centrists had better get together and remind America, with analysis, pragmatism, and a keen sense of justice and America’s future, how deeply wrongheaded most of the basic principles of Simpson-Bowles are. This thinking has led to today’s fiscal cliff, and as a blueprint for the future it is both damaging to the economy and cruel for most Americans.

Roosevelt Institute Senior Fellow Jeff Madrick is the Director of the Roosevelt Institute’s Rediscovering Government initiative and author of Age of Greed.

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Are We at the End of the Welfare State?

Nov 21, 2012Mike Konczal

I have a piece at the American Prospect, The Great Society's Next Frontier, about potential futures for the welfare state. It attempts to answer the question over whether or not the passage of Obamacare means that the welfare state is now complete.

I have a piece at the American Prospect, The Great Society's Next Frontier, about potential futures for the welfare state. It attempts to answer the question over whether or not the passage of Obamacare means that the welfare state is now complete. If we take the project of American liberalism to be Keynesian economics, plus the mixed economy, plus social insurance, plus political liberalism, can we check the social insurance part as complete? I decided to ask several scholars of the welfare state what they see as potential steps in the decades ahead, and lay out their answers.

The "completed welfare state" usually means a few different things. One is that the major committments of social insurance are now determined, and it is just a matter how broadly or narrowly to construe those committments. That's many people's answer for the issue. Dylan Matthews gave a similar answer on bloggingheads recently, noting that things like universal pre-K will fall out of our obligations to provide universal K-12 schooling. Many of the changes experts in the piece proposed were extensions of already functioning programs, like the EITC or unemployment insurance or expanding K-12 schooling to a younger age.

Another is that the level of expenditure and revenue is set for the near future, so if social insurance is expanded it'll require a more fundamental change in what we are willing to pay for our government. And indeed many of the debates going forward will be about spending less than projected on health care through controlling costs, or changing how we fund things, such as taking the tax expenditures for 401(k)s and making them more progressive. There are many things that don't require changing the level of expenditure and revenue, such as raising the minimum wage (which compliments the EITC quite well). This is one reason we may see more of a focus on "predistribution" policy in the years ahead.

I wanted to add this point from Envisioning Real Utopias about a basic income, but also pertains to both the minimum wage and things like Demos' call for raising retail wages. In addition to reducing coercion as workers aren't separated from the means of subsistence, eliminating poverty without creating the major pathologies of means-tested anti-poverty transfers, recognizing the value of decommodified care-giving activities and subsidizing the social and cooperative market economies, a basic income also does the following:

Second, universal basic income is likely to generate greater egalitarianism within labor markets. If workers are more able to refuse employment, wages for unpleasant work are likely to increase relative to wages for highly enjoyable work. The wage structure in labor markets, therefore, will begin to reflect more systematically the relative disutility of different kinds of labor rather than simply the relative scarcity of different kinds of labor power. This, in turn, will generate an incentive structure for employers to seek technical and organizational innovations that eliminate unpleasant work. Technical change would therefore have not just a labor-saving bias, but a labor-humanizing bias.
This connection between cheap labor and technology change is a constant theme of Peter Frase, who mentioned the Prospect piece in a recent post.
 
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The GOP's Holiday Gift Guide: Pain for the Poor, Ponies for the Rich

Nov 21, 2012Tim Price

Republicans are using the fiscal cliff to extract payback for all the "gifts" President Obama has given to Americans.

Republicans are using the fiscal cliff to extract payback for all the "gifts" President Obama has given to Americans.

Before Americans have even finished digesting their Thanksgiving turkey, the holiday shopping season will have officially begun. But according to Mitt Romney, Christmas came early for those who voted for Barack Obama. The failed Republican presidential nominee and latter-day Scrooge told donors last week that President Obama had won reelection by “giving targeted groups a big gift.” And what generous stocking-stuffers they were! For the young and the poor, health coverage under the Affordable Care Act. For Hispanics, an executive order halting deportation of the children of undocumented immigrants. For women, free contraception for use in all their filthy lady activities. If Malia and Sasha don’t find a pair of baby unicorns under the White House Christmas tree this year, they have a right to feel jealous.

Romney’s comments met with disapproval from fellow Republicans who hope to have a future in elective office, but the truth is that they reflect an understanding of the American public and its relationship with government that is widely shared among conservatives. Paul Waldman argues that it fits right in with their “makers vs. takers” ideology, the notion that the country is divided between “the brave individualists needing nothing from anyone, and the blood-sucking parasites who rely on government.” But Republicans don’t just want to reset policy to some sort of neutral state where everyone gives and receives his or her fair share (slow down there, Karl Marx). Instead, they seem to view the fiscal cliff as an opportunity to impose austerity measures that would redistribute the gifts to their Nice List and punish those who have been spoiled by Obama’s socialist Santa. 

The fiscal cliff is in fact better described as an “austerity bomb,” a term coined by TPM’s Brian Beutler and echoed by Paul Krugman. Despite what the cliff terminology might suggest, the problem isn’t that the federal deficit is about to explode, but that conservatives who have spent years demanding swift and substantial deficit reduction are about to get exactly what they wanted. If this mix of scheduled tax increases and spending cuts is allowed to take effect, it will carve $560 billion out of the budget next year – so why are deficit scolds suddenly terrified of the consequences? Krugman argues that they’re implicitly conceding that “Keynesians were right all along, that slashing spending and raising taxes on ordinary workers is destructive in a depressed economy, and that we should actually be doing the opposite.”

But are Republicans really worried about the plight of the working man? You wouldn’t know it based on the alternatives they’ve proposed, which involve swapping one set of austerity measures for a slightly different set of austerity measures. Their real concern is what the fiscal cliff will mean for their friends and supporters, not what it will mean for the broader economy. Sure, the poor will take the hit first, as is their lot in life, but taxes will go up on rich people, too! That’s money coming straight out of the 2014 campaign coffers. And what about those poor defense contractors who will suffer from cuts to the Pentagon’s budget? They have mouths to feed, too.

The terms that Republicans have set for the fiscal cliff negotiations provide clear evidence of this favoritism. Chastened by President Obama’s reelection, they keep claiming they’re open to compromise, but they steadfastly refuse to raise tax rates on the rich. Instead, they insist any new revenue must come from “closing loopholes,” a hoary Beltway cliché that means nothing in particular, and they’ll only concede that much if Democrats agree to “reform entitlements,” which is even less specific but more ominous. Oh, and they also want “changes” to the Affordable Care Act to be on the table. In fact, if Barack Obama would just go ahead and resign from office, it would be a real show of good faith and bipartisan spirit.

Proposing to cut Social Security benefits or raise the retirement age as part of a fiscal cliff deal is a non sequitur at best. With all due respect to financial masterminds like Lloyd Blankfein, it’s hard to believe that anyone could be told that Congress is about to pull the rug out from under the fragile recovery and honestly conclude that the solution is to make old people work longer. It’s the equivalent of the president being told that we’re on the verge of nuclear war and replying, “I’ll have the soup.” As Jeff Madrick has explained at length, Social Security is not in crisis, and there are plenty of easy fixes available for its future financial shortfall. (Medicare is a thornier problem, but one that probably shouldn’t be dealt with on a timer.) Senator Mark Begich, for instance, has proposed to cover the gap and pay for more generous benefits by eliminating the payroll tax cap. But don’t expect that plan to be taken very seriously by the Very Serious People, because it asks the rich to sacrifice more instead of inflicting some character-building pain on everyone else.

Aside from being unnecessary, such cuts would have a disproportionate impact on the poor. The right’s claim that Social Security wasn’t designed to handle increased life expectancies is based on a serious misunderstanding of history and human biology, but it is true that life expectancy has risen dramatically – for the rich. Workers on the lower rungs of the economic ladder haven’t been so lucky, so a higher retirement age is just a massive benefit cut for them. Of course, any such changes would only be phased in for younger workers, who (purely coincidentally) don’t vote Republican, not current retirees who do. That will teach those spoiled little punks. Er, I mean, preserve the promise of Social Security for future generations.

The same logic, if you can call it that, applies to demanding changes to the Affordable Care Act. The current law will save $109 billion over the next 10 years, so in theory, the deficit hawks should love it, right? Well, there are two problems with that theory. The first is that those cost savings are based on CBO projections, which, like Nate Silver’s electoral analysis, fall into that category of “liberal math” that Republicans find inherently suspect. The other is that the ACA achieves those savings while helping poor people -- that’s what makes it a gift, according to Romney. But deficit reduction isn’t supposed to make life easier; it’s supposed to be tough love that forces people to fend for themselves in a harsh and unforgiving world. Like exercise, the pain means it’s working. Or maybe you just tore a tendon. You should probably check with your doctor, assuming you can afford health insurance.

This barely concealed impulse to punish the undeserving is the source of Republicans’ internal conflict over the fiscal cliff and the biggest hurdle they must overcome in their efforts to become viable contenders for the White House again. They may not see it as punishment; to them, it’s just a teaspoon of unpleasant medicine that will eventually make the country much healthier. But things like government-funded health care, education, and retirement security only look like gifts from the perspective of the man who has everything. What Republicans see as unaffordable luxuries, the rest of us see as essential to a basic standard of living. Until they realize that, we might be able to reach a compromise on the fiscal cliff, but we’ll never really find common ground.

Tim Price is Deputy Editor of Next New Deal. Follow him on Twitter @txprice.

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The Fiscal Cliff Showdown Will Set the Agenda for the Next Four Years

Nov 16, 2012Richard Kirsch

As part of our series "A Rooseveltian Second Term Agenda," a look at the four biggest budget issues that will be debated in the next four months.

As part of our series "A Rooseveltian Second Term Agenda," a look at the four biggest budget issues that will be debated in the next four months.

The very next day after the election, congressional leaders held dueling press conferences in Washington to start the stampede to the fiscal cliff. But December 31st is not a cliff; it’s a slope. Actually, the better metaphor is a showdown between two different visions for the country – a showdown that will not only take place over the next four months, but will dominate debate about the economy for the next four years.

It is true that if Congress allows the tax hikes and spending cuts to be fully implemented, the economy will go into a tailspin, with four million people forced out of their jobs. But that won’t happen on January 1st. The impact of both tax hikes and spending cuts take time to accumulate. If Congress acts on taxes early in the year, it can make lower tax rates retroactive to the beginning of the year. Between federal contracts already in place and the time it takes to implement program cuts, budget cuts too will take a while before they slow down the economy. Better for Congress to walk down and back up the slope early in the year than be stampeded into bad decisions.

In this showdown we have a choice between two paths: prosperity for working families and the middle class or more for millionaires and CEOs. While the showdown will play out in the next few months, the issues will continue to set the economic agenda for the president’s second term. Both the immediate and continued battles will be over four issues: taxes, social insurance, federal discretionary spending, and investments to create jobs.

1. Taxes: The immediate battle will be whether or not to end the Bush tax rates on income over $250,000. The president has rightly made this his line in the sand. If Republican don’t budge, Democrats should wait until next year when all the Bush tax cuts expire, forcing House Republicans to continue to protect tax preferences for the wealthy while taxes go up on working and middle-class families.

The four-year agenda is to restore progressivity to the tax system. Progressives should define tax reform as taxing wealth at the same rate as income from work and enacting higher rates on the highest incomes. With corporate taxes the lowest they have ever been as a share of federal revenue, our agenda should be to end the loopholes and tax preferences for corporations that ship profits and jobs overseas and the breaks from exploiting our natural resources. We should raise more money from a loophole-free corporate tax system.

2. Social insurance: The big three social insurance programs – Social Security, Medicare, and Medicaid – are all protected from the automatic spending cuts, but that hasn’t stopped deficit hawks from trying to bring them into the upcoming debate. Changes to Social Security, like the Simpson-Bowles plan’s “adjustments” to the COLA that will result in 15 percent or more cuts in benefits to middle-class recipients, may well be put on the table as part of “grand bargain.” Democrats should follow Senate Majority Leader Harry Reid, who declared that Social Security is not on the agenda. Over the next four years, progressives should push for the obvious fix to the projected shortfall in the Social Security trust fund: raising or eliminating the cap on how much of earnings are subject to Social Security payroll taxes. That solution would extend the life of the trust fund to 2075 and beyond. It is politically popular, easy to explain, and fits within the broader progressive theme of a tax system that bolsters working families and the middle class by requiring a little more from those with more.

While Social Security does not add a dime to federal deficits, the same can’t be said of the rising pressures of health care spending on Medicare and Medicaid. Both programs should remain off the immediate fiscal showdown agenda, with Democrats pointing out that health care inflation over the past two years is at the lowest level in decades. Some of that is because of changes being put in place by the Affordable Care Act, which has a number of measures to control health care spending in Medicare by eliminating wasteful care and overpayments to health insurance companies. The big agenda for the next four years on health care is to continue to accelerate the changes put in place by the ACA, including that new panel – which the right likes to demonize – that will push Medicare to force providers to provide better care or see their revenues drop. Another top priority is for the federal government as well as states to follow what Massachusetts is doing: use the new health care marketplaces to review health insurance company rate increases and pressure health care providers to provide better quality care at lower cost.

3: Federal discretionary spending: The choice here is straightforward: the amount of revenue raised from ending the Bush tax cuts on income over $250,000 is almost the same as the total cuts to federal discretionary spending. Republicans are eager to stop the Pentagon’s half of the automatic cuts. While many Democrats want to protect the Pentagon, they also want to block the slashing of vital services for families and all the other things – from environmental protections to diplomatic functions – that the federal government does. Progressives should focus on those services that most support low-income and working families, like Pell grants, Head Start, WIC, and food stamps. These are very popular with the public and make the choice crystal clear.

In response to the Pentagon lobbying for more, progressives should argue that Pentagon spending can easily be trimmed, since even if the automatic cuts go through the Pentagon will still be spending more than at the height of the Cold War. Over the next four years, progressives will need to drive home the point that Pentagon spending creates far fewer jobs than spending on health care, education, and other domestic programs, so that reshaping the Pentagon for the 21st century makes both military and economic sense.

It is crucial that progressives link spending choices to jobs. For example, if unemployment insurance for the long-term unemployed is allowed to expire at the end of the year, the loss of benefits to 5 million people will result in another 448,000 being pushed onto the unemployment rolls in 2013. In fact, the biggest job losses among the many choices facing Congress would come from ending long-term unemployment insurance and cutting domestic spending.

4. Good jobs: One thing not on the immediate fiscal agenda is a program to create good jobs. It should be, as the sluggish economy and long-term decline in wages and benefits promises to keep millions of Americans out of work and a growing share of the workforce struggling to make ends meet. Progressive should use the fiscal showdown to go beyond highlighting the job impact of spending cuts. Instead, we should put forth a two-pronged jobs agenda and make this the central push for the next four years.

One prong is investment to create jobs: infrastructure, green jobs, “caring jobs” like day care, elder care, and putting more teachers in our classrooms. We should be pushing for a big youth jobs program. The second prong is job quality: restoring the rights of people to effectively organize unions, modernizing basic work standards by doing thing like raising the minimum wage and indexing it to inflation, and requiring all employers to provide a set number of paid sick days.

The Affordable Care Act will address the growing problem of jobs not coming with health care; here implementation is key. We should also be pushing for the establishment of a new retirement program, such as proposed by Senator Tom Harkin, under which workers would put aside a share of earnings in a pooled, professionally managed plan, with guaranteed, lifetime benefits at retirement or upon permanent disability.

The push for the comprehensive progressive economic agenda above – fair taxes, stronger social insurance programs, protecting vital public services for working families, and investment in good jobs – should start with the upcoming fiscal showdown. The battle between a vision of prosperity for working families and the middle class versus more for millionaires and CEOs is one we should wage for the next four years.

Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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Going on the Offensive Against Poverty in America

Nov 14, 2012Georgia Levenson Keohane

As part of our series "A Rooseveltian Second Term Agenda," suggestions for how Obama can get serious about combating poverty.

As part of our series "A Rooseveltian Second Term Agenda," suggestions for how Obama can get serious about combating poverty.

Hurricane Sandy’s violence was a tragic reminder of some important truths in American life: climate change matters, government matters, and caring for the vulnerable – for those severely afflicted by circumstances beyond their control – not only matters, it is the essence of who we are as a people. Today, our country’s vulnerable include the 46 million people – nearly one in six – who live in poverty, and 16 million of those are children. This deprivation is particularly grievous in context: earnings for the wealthiest continued to grow last year, while income for the rest stagnated or fell. These levels of poverty and inequality are not only unconscionable, they threaten our economic security.  When it comes to fighting poverty, what do we make of the Obama team’s record and, more importantly, what should be its priorities for the next four years?

The Poverty of the Debate on Poverty

Poverty’s notable absence during the campaign season disappointed and galvanized many progressives who hoped to insert the issue into the election platform and political debates. Those concerns echoed earlier remonstrations that that the president had failed to address poverty over the last four years with the passion or federal muscle promised in his 2008 campaign. “Barack Obama can barely bring himself to say the word ‘poor,’ Bob Herbert wrote this spring in The Grio. Paul Tough, Herbert’s public conscience heir at the New York Times, explains the political conundrum behind the administration’s focus on the economic woes of a broader set of struggling Americans rather than on the poorest per se: “how do you persuade voters to devote tax dollars to help the truly disadvantaged when the middle class is feeling disadvantaged itself?”

While we may long for the soaring rhetoric of 2008, the fact is these broad-based policies have worked. They have not eradicated poverty, but many important domestic programs – the stimulus, in particular, which included new and expanded tax credits, enhanced unemployment insurance, and increased eligibility for food stamps – kept an estimated seven million out of poverty and cushioned against even greater hardship for more than thirty million people already below the federal threshold. Not to mention that health care reform extended coverage to tens of millions of uninsured Americans (in part by expanding access to Medicaid). The federal poverty measure does not take into account non-cash transfers, including food stamps, housing subsidies, and health care benefits like Medicare and Medicaid. When these are factored in, it appears as though poverty has not increased under Obama’s tenure.

Pivot from Defense to Offense

When it comes to a new kind of war on poverty, the Obama administration must recognize that it now has the freedom – and, arguably, an electoral mandate – to address need in this country in ways that serve the struggling middle class and target programs and policies to help the poor. This is not an either/or proposition. And of course job creation is the primary lever: there is no better way to help all Americans in the next four years and beyond.

In terms of programs to address persistent poverty, however, Obama’s second term agenda must pivot from defense to offense, graduating from “could have been worse” blood staunching to an even greater commitment both to long-term investments in human capital and interim supports that shield children and families from some of the most severe privations of life in poverty.  Here are three places to begin:

(1)  Redouble investment in comprehensive and community-wide approaches to fighting poverty. Tough laments that, while in 2008 Obama called for “billions” for programs like Promise Neighborhoods that are modeled on Harlem Children’s Zone’s and provide a broad swath of interventions for poor children and their families, the administration to date has spent just $100 million on pilot programs in 37 communities across 18 states. Ongoing and expanded support for these kinds of holistic programs in cities across the country would make for a sound investment in human potential, using federal structure and funds to support local and community generated solutions.

(2)  Commit more fully to investments in high quality early childhood education and childcare, which yield substantial returns in the school success and life prospects of low-income children and their working parents. This means expanded tax credits and other financial supports for families paying for childcare. It also means increased funds for proven programs like Head Start and Early Head Start, particularly when state governments across the country, with budgets in crises, have been forced to cut Pre-K programs. Head Start and Early Head Start are chronically underfunded and therefore do not reach many eligible families.

(3)  Reform welfare reform, so that it provides real ‘safety’ for poor families in tough economic times. Although it has long been touted as a success of the Clinton administration, the 1996 welfare reform, which devolved much of TANF to the states and linked cash assistance to stringent work requirements, was structurally flawed. First, it was not indexed for inflation (and is funded at its 1996 level). Second, as a block grant it leaves poor people dependent on (now) cash-strapped states for support. Third, the original work requirements were predicated on the existence of work, not on the stubbornly high unemployment rates of this recession. The federal government must reclaim a greater role in the redesign and provision of temporary assistance for needy families to help keep them out of extreme poverty in the way it has done with other critical strands of the safety net like food stamps and unemployment insurance.

With this second term, the Obama administration has the chance to broaden opportunity and to make vital advances in the fight against poverty.  

Georgia Levenson Keohane is a Fellow at the Roosevelt Institute.

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All Aboard the Pro-Government Bandwagon

Nov 13, 2012Jeff Madrick

Cracks are beginning to show in conservatives' opposition to government, but progressives still need to make the case for higher tax revenues.

So now everyone is climbing aboard the government-is-necessary bandwagon. I use as my litmus tests David Brooks and Ross Douthat, conservative op-ed columnists of The New York Times.

Cracks are beginning to show in conservatives' opposition to government, but progressives still need to make the case for higher tax revenues.

So now everyone is climbing aboard the government-is-necessary bandwagon. I use as my litmus tests David Brooks and Ross Douthat, conservative op-ed columnists of The New York Times.

To myself and my colleagues, who have been fighting this battle for some time, the Johnny-come-latelys, even among the Democrats, are welcome. I wrote a book called The Case for Big Governmentpublished in 2008, based on lectures I gave back in 2006. A few years before that, I wrote a speech for Senator Ted Kennedy on this subject, largely with historical references about what government did for America in the preceding 200 years, that he gave to considerable notice from his own senatorial colleagues. I was writing a monthly column in The New York Times before that, which persistently sounded this theme. I can’t remember many of the editors being enthused. When I complained about education decline or lack of good wages, one reporter told me to look at how high a proportion of people now owned a home. Many, if not the vast majority, in the media who covered such matters believed in the new “American model,” not to mention the “Washington consensus" -- that is, deregulation, low taxes, and Wall street hegemony.

The financial crisis, Hurricane Sandy, foreclosures, and ultimately the lack of jobs in a Great Recession have changed some of that. We at the Roosevelt Institute started Rediscovering Government with enthusiastic support from Roosevelt’s management and similarly enthusiastic financial support from Bernard Schwartz and a couple of others. We plan to keep sounding the theme about restoring faith in government and take the program to a new level in 2013, bearing down in particular on government and jobs.

Meanwhile, some traditional Republican voices are sounding a bit more constructive about government than they used to. Make no mistake, they are still hesitant, but the language is changing.

David Brooks is now talking about how the big-government-versus-small-government argument is no longer that relevant. He suggests it’s because of the changing composition of the American voting public. “The Pew Research Center,” he writes, “does excellent research on Asian-American and Hispanic values. Two findings jump out. First, people in these groups have an awesome commitment to work. By most measures, members of these groups value industriousness more than whites. Second, they are also tremendously appreciative of government. In survey after survey, they embrace the idea that some government programs can incite hard work, not undermine it; enhance opportunity, not crush it.”

Now, don’t be surprised the Brooks twists American history into something so simplistic it is unrecognizable in order to make the Asian and Hispanic electorate sound like an unprecedented cultural shift in the nation. He says the old Protestant nation had disdain for government and now they are—so he implies—losing their influence. He of course does this kind of simplistic reading of American history from time to time. Who supported the great progressive revolution of the 1930s well before the Asian and Hispanic rise? This kind of idea—that culture explains so much—is generally dangerous.

But the point here is that Brooks is now saying Republicans have to get off the anti-government kick. He goes on: “Moreover, when they look at the things that undermine the work ethic and threaten their chances to succeed, it’s often not government. It’s a modern economy in which you can work more productively, but your wages still don’t rise. It’s a bloated financial sector that just sent the world into turmoil. It’s a university system that is indispensable but unaffordable. It’s chaotic neighborhoods that can’t be cured by withdrawing government programs. For these people, the Republican equation is irrelevant. When they hear Romney talk abstractly about Big Government vs. Small Government, they think: He doesn’t get me or people like me." 

Well, that’s a heck of a breakthrough, even if argued on spurious grounds about how more and more Americans don’t have old-fashioned American cultural roots. Let’s just get away from the cultural stuff. Who elected Teddy Roosevelt and Woodrow Wilson before Hispanics voted? Who backed the progressive income tax at the start of the 20th century?

Anyway, the conservative punditry is shifting. Ross Douthat, the other conservative regular on the Times op-ed page, has a firmer grasp of historical context than does Brooks. He only partly buys into the “demographic excuse,” as he puts it. As he says, “Republicans are also losing because today’s economic landscape is very different than in the days of Ronald Reagan’s landslides. The problems that middle-class Americans faced in the late 1970s are not the problems of today. Health care now takes a bigger bite than income taxes out of many paychecks. Wage stagnation is a bigger threat to blue-collar workers than inflation. Middle-income parents worry more about the cost of college than the crime rate. Americans are more likely to fret about Washington’s coziness with big business than about big government alone. “

And he recognizes that Hispanics are not a one-issue demographic group. A simple change in immigration policy won’t win them over to the Republicans. He importantly concedes that Latinos tend to see government more as an ally than a foe. And increasingly others in his political camp are talking that way. He notes, “As the American Enterprise Institute’s Henry Olsen writes, it should be possible for Republicans to oppose an overweening and intrusive state while still recognizing that 'government can give average people a hand up to achieve the American Dream.' It should be possible for the party to reform and streamline government while also addressing middle-class anxieties about wages, health care, education and more."

And now some conservatives are even saying the Republicans should give up their resistance to higher rates on upper income Americans. Bill Kristol of the Weekly Standard made headlines when he said just that the other day. 

Glenn Hubbard, a former Romney adviser, says we can raise taxes on the rich by putting caps on deductions like mortgage interest, charitable contributions, and business provided health insurance. This deduction cap is gaining adherents among Democrats. But the devil here is in the details, and when one reads more closely what Hubbard has to say, one sees the dangers if one thinks the battle is won. By no means.

One issue is the refusal to raise income tax rates themselves, say the top bracket to 42 or 43 percent. Hubbard claims this reduces incentives. This was the same argument Martin Feldstein made when he said Bill Clinton’s income tax rate increase on the rich would hurt the economy. The Clinton boom soon followed. There is no accepted evidence that higher rates on the rich would dampen economic growth. A research report to that effect was completed and about to to be published by the non-partisan Congressional Research Service, and it was suppressed by the Republicans.

The more important point Hubbard makes is that most deficit-cutting should be accomplished by reducing government spending, not tax increases. And to him this necessarily means cutting the safety net and, probably, public investment.

Hubbard makes the critical point, however, as much as he disagrees with it. If Americans wants a bigger government, most Americans, not just the rich, will have to pay. But a lot more of the taxes can come from the rich than he admits. There’s a lot of room to raise taxes in America compared to tax bites in other rich nations. 

The battle for an active, constructive use of government will remain a tough one, even as the conservatives start compromising modestly. And the fight should ultimately be over tax increases, once the economy starts growing rapidly again (and not until then!).

So, for those of us who believe in the constructive purpose of government, we have to show how higher tax revenues can be put to critical work. We can do that. 

Roosevelt Institute Senior Fellow Jeff Madrick is the Director of the Roosevelt Institute’s Rediscovering Government initiative and author of Age of Greed.

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The Fight for Health Care Reform Isn't Over Yet

Nov 13, 2012Rahul Rekhi

As part of the "Millennial Priorities for the First 100 Days" series, a call for President Obama to finish the health care overhaul he began with the Affordable Care Act.

As part of the "Millennial Priorities for the First 100 Days" series, a call for President Obama to finish the health care overhaul he began with the Affordable Care Act.

While the principle focus of this year’s presidential campaign was clearly the economy, the election carried more profound implications for the future of American health care then any other area of policy. The choice was clear: would we see the reaffirmation of the Affordable Care Act and with that, an opportunity for its provisions to be phased in at last? Or would we see a rapid repeal and systemic overhaul under the ascendant Romney administration? With the reelection of President Obama, the signature health care legislation of his first term is secure. But to truly reform our health care system, he still has much more work to do in his second term.

Because of President Obama’s historic win, he will be able to fully implement provisions that extend health coverage to over 30 million Americans, end denial of care on the basis of pre-existing conditions, and allow young Americans nationwide to remain covered while continuing their education. But despite this leap forward, significant challenges to our health care system remain. Though the Affordable Care Act tackled the coverage problem, concerns about ever-rising health care costs--and the concomitant budgetary pressures--remain at the forefront. Moreover, debates about end-of-life care, prevention, and the proper role of medical technology in our health care system remain unresolved.

Some of these health policy concerns will take years to tackle. Others must necessarily extend beyond even President Obama’s term limit. But there should be a particular focus on issues regarding health science and technology that we must tackle in the first 100 days, while the electoral mandate remains clear.

The consensus among health economists of all stripes is clear: medical technology is the single most significant driver of rising health care costs in America. These advancements, while making significant gains in extending our lifespans and improving the quality of life for the U.S., simultaneously impose significant cost burdens and threaten the fiscal sustainability of our health care system. The Affordable Care Act takes steps to address this concern, most notably by funding so-called “comparative effectiveness research,” a systematic means of assessing the therapeutic efficacy of clinical treatments and weeding out those that exhibit no health benefits despite their substantial costs. This isn’t rationing—it’s rational.

However, due to political pressures, “Obamacare” contained no provision or mechanism for the results of such comparative effectiveness research to be implemented in a meaningful way. Even the one model that it did call for—the Independent Payment Advisory Board, a “Federal Reserve” of medicine—has been effectively neutered by congressional officials and only served an advisory role. If we are to truly and systematically address the cost burdens of health technology in a meaningful way, what we need is a form of health technology assessment, such as the one pioneered by the National Institute for Health and Clinical Excellence in the United Kingdom. Until then, we will have a patchwork policy at best, and a downright nonexistent one at worst.

Realizing the benefits of these technologies will also necessitate a regulatory overhaul. Despite (occasional?) failures and controversies, the Food and Drug Administration deserves great acclaim for helping to ensure the safety of the American patient for the last century. But the critical nature of this mandate does not obviate the benefits that could be derived from a deep overhaul of the FDA approval process. For instance, there is ample opportunity to bring the FDA into the 21st century, with opportunities to authorize statistical modeling techniques that allow for smaller, leaner, and quicker clinical trials guidelines, and by mandating that the results of all drug trails be published online. These are measures with potentially broad bipartisan support.

Policy has also fallen short in the development of these technologies. Case in point: funding for the National Institutes of Health has largely remained flat in recent years, even under the Obama administration. Yet the importance of biomedical research in maintaining America’s edge in innovation cannot be overstated. It’s no coincidence that over half of the Nobel Laureates in medicine have come from within our borders; it is this edge on health science and technology that has allowed life-saving treatments such as statins, angioplasty, and MRIs into the clinic. As other nations begin to ramp up their investments in biomedical research, it is critical that the U.S. not lose its position of global leadership.

These health policy areas represent means for the president to reaffirm his vision for our health care system. Admittedly, with a looming fiscal cliff, persistently high unemployment, and issues of energy and immigration beginning to enter the national spotlight, turning back to health care may carry with it great political risk. However, while the Affordable Care Act was initially highly polarizing and contentious across the electorate, there is emerging evidence that as its provisions are phased in, support among Americans is growing—and fast. Reaching across the aisle early with these bipartisan policies to further advance our nation’s health care can cement the president’s principle legacy, setting the tone for another transformative term. Ultimately, their impacts will extend well beyond the next 100 days or even the next two years, for the path to a truly 21st century health care system lies ahead.

Rahul Rekhi is a student at Rice University and the Senior Fellow in Health Care Policy for the Roosevelt Institute | Campus Network.

 

Barack Obama image via Shutterstock.com.

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