February 21, 2013

Posted by orrinj at 4:36 PM

CUTTING OFF THE WELFARE QUEENS:

A Simple Route to Major Deficit Reduction (MARTIN FELDSTEIN, 2/21/13, WSJ)

Limiting the tax savings from all deductions and the two major tax exclusions to 2% of an individual's adjusted gross income would reduce the deficit in 2013 by $220 billion. This 2% cap does not refer to the amounts of the deductions and exclusions but to the tax saving. This means that for someone taxed at a 25% marginal tax rate, the 2% cap would limit deductions and exclusions to 8% of that individual's adjusted gross income.

The 2% cap could also be modified to retain the existing deduction for all charitable contributions and to allow employees to exclude the first $8,000 of employer-paid health-insurance premiums from the cap. This would still reduce the current year's deficit by $141 billion. That translates to about a $2.1 trillion reduction in the national debt over the next decade.

Higher tax rates, in short, are not necessary in order to raise substantial revenue. Indeed, some of the $2.1 trillion could be used to reduce current tax rates and promote growth.

Posted by orrinj at 1:25 PM

SOMETHING BESIDES CHOCOLATE AND CUCKOO CLOCKS?:

The future of free-market healthcare (Douglas Holtz-Eakin and Avik Roy FEBRUARY 20, 2013, Reuters)

The great irony of Obama's triumph, however, is that it can pave the way for Republicans to adopt a comprehensive, market-oriented healthcare agenda.  The market-oriented prescription drug program in Medicare has controlled the growth of government health spending. Similarly, conservatives can use Obamacare's important concession to the private sector -- its establishment of subsidized insurance marketplaces -- as a vehicle for broader entitlement reforms.

While most Americans view their healthcare system as "free-market," Switzerland actually has the most market-oriented healthcare system in the West. It translates into universal coverage and low entitlement costs. Swiss government entities spent about 3.5 percent of gross domestic product on healthcare in 2010, compared to 8.5 percent in the United States. That's a difference of more than $5 trillion over 10 years: real money, especially relative to our $16 trillion debt.

There is no "public option" in Switzerland. Instead, citizens qualify for means-tested, sliding-scale subsidies and choose among a variety of regulated, private-sector insurance products. The Swiss have the freedom to choose their own doctors, as Americans do, and access to the latest medical technologies. They also have short waiting times for appointments.

Posted by orrinj at 1:08 PM

STINKIN' HIPPIES:

What's the Matter With Vermont? : Anti-vaccine activists derailed a bill that could have blunted the whooping cough epidemic. (Helena Rho, Feb. 21, 2013, Slate)

Act 157 originated when a pediatrician neighbor of Till's came to him with a concern. In a local kindergarten class, 75 percent of students were not fully vaccinated. Till researched the issue and thought it was reasonable to get rid of the philosophical exemption in order to increase vaccination rates. Till proposed a bill in the House, and state Sen. Kevin Mullin proposed an almost identical bill in the Senate.
The Senate bill passed quickly, but not so in the House. Delays sometimes happen in Vermont's "citizen legislature," where lawmaking is a part-time endeavor by ordinary people for just 18 weeks of the year. The bill languished in the health care committee. Then the Legislature was off for a week because the first Tuesday in March is reserved for town meetings in communities across the state.

By the time the Legislature reconvened in the capitol building, the anti-vaccination community had organized itself. "They were in the building every day, in people's faces," Till says. The activists blared the discredited claims of Andrew Wakefield that vaccines do more harm than good, that vaccines cause autism. Wakefield, a British physician, was stripped of his medical license for fabricating a connection between vaccines and autism. Till could not believe what was happening: "He is God to these people." Millions of lives have been saved through vaccines, numerous scientific studies have debunked the myth that vaccines cause autism, and the only studies to show a link have been exposed as frauds. Yet anti-vaxxers were successfully spreading misinformation.

The most egregious was their exploitation of the death of 7-year-old Kaylynne Matten of Barton, Vt. The anti-vaccine community claimed her death was due to adverse effects of the flu vaccine. However, the coroner listed the cause of death as complications from parainfluenza virus, a different category of virus from influenza.

State Rep. Warren Kitzmiller initially supported the bill in the House. He suffered from polio as a child, a terrible disease that regularly killed or crippled tens of thousands of children in the United States during an outbreak. Polio has been almost eliminated thanks to vaccines, but it persists in parts of the world because of suspicion about vaccines. After the anti-vax lobbying effort, Kitzmiller said that he could hardly remember his illness. He said he made a miraculous recovery. He voted against the bill.

Till could not even convince his own health care committee in the House that Vermont's declining vaccination rates were a public health problem.
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Posted by orrinj at 5:34 AM

HUMANITARIAN-IN-CHIEF:

What George W. Bush did right (Christian Caryl, February 21, 2013, Chicago Tribune)

In his 2003 speech, Bush called upon Congress to sponsor an ambitious program to supply antiretroviral drugs and other treatments to HIV sufferers in Africa. Since then, the U.S. government has spent some $44 billion on the project (a figure that includes $7 billion contributed to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a multilateral organization). By way of comparison, America's most recent aircraft carrier -- which will join the 10 we have in service -- is set to cost $26.8 billion. One medical expert calls PEPFAR the "largest financial commitment of any country to global health and to treatment of any specific disease worldwide."

It's impossible to tell exactly how many lives the program has saved, though Secretary of State John Kerry recently claimed that 5 million people are alive today because of it. That's probably as good an estimate as any.

Just to give you an idea of the scale, here are some headline figures from a recent op-ed by U.S. Global AIDS coordinator Eric Goosby:

"In 2012 alone, PEPFAR directly supported nearly 5.1 million people on antiretroviral treatment -- a threefold increase in only four years; provided antiretroviral drugs to prevent mother-to-child transmission of HIV to nearly 750,000 pregnant women living with the disease (which allowed approximately 230,000 infants to be born without HIV); and enabled more than 46.5 million people to receive testing and counseling."

So it's safe to say this one program has been a titanic force for good over the past decade. The number of deaths from AIDS has been steadily declining over the past few years, and PEPFAR has certainly been a big help. But ask an American -- or a Western European -- if they've ever heard of the program, and they're almost certain to draw a blank. That's partly because the United States has done very little to publicize the success of PEPFAR, and partly because the Bush presidency was overshadowed by much more high-profile aspects of his foreign policy (such as the invasion of Iraq).

Indeed, Bush still enjoys high popularity ratings in Africa, where he's widely regarded as one of the continent's great benefactors. (Meanwhile, the Obama administration's proposed PEPFAR cuts have triggered protests around Africa -- even in Kenya, where the president's family ties have ensured him plenty of favorable coverage.)

"Bush did more to stop AIDS and more to help Africa than any president before or since," says New York Times correspondent Peter Baker, who's writing a history of the Bush-Cheney White House that's due to appear in October. "He took on one of the world's biggest problems in a big, bold way and it changed the course of a continent. If it weren't for Iraq, it would be one of the main things history would remember about Bush, and it still should be part of any accounting of his presidency."

Nor is liberating 30 million Iraqis and setting off the Arab Spring anything to sneeze at.

Posted by orrinj at 5:34 AM

HUMANITARIAN-IN-CHIEF:

What George W. Bush did right (Christian Caryl, February 21, 2013, Chicago Tribune)

In his 2003 speech, Bush called upon Congress to sponsor an ambitious program to supply antiretroviral drugs and other treatments to HIV sufferers in Africa. Since then, the U.S. government has spent some $44 billion on the project (a figure that includes $7 billion contributed to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a multilateral organization). By way of comparison, America's most recent aircraft carrier -- which will join the 10 we have in service -- is set to cost $26.8 billion. One medical expert calls PEPFAR the "largest financial commitment of any country to global health and to treatment of any specific disease worldwide."

It's impossible to tell exactly how many lives the program has saved, though Secretary of State John Kerry recently claimed that 5 million people are alive today because of it. That's probably as good an estimate as any.

Just to give you an idea of the scale, here are some headline figures from a recent op-ed by U.S. Global AIDS coordinator Eric Goosby:

"In 2012 alone, PEPFAR directly supported nearly 5.1 million people on antiretroviral treatment -- a threefold increase in only four years; provided antiretroviral drugs to prevent mother-to-child transmission of HIV to nearly 750,000 pregnant women living with the disease (which allowed approximately 230,000 infants to be born without HIV); and enabled more than 46.5 million people to receive testing and counseling."

So it's safe to say this one program has been a titanic force for good over the past decade. The number of deaths from AIDS has been steadily declining over the past few years, and PEPFAR has certainly been a big help. But ask an American -- or a Western European -- if they've ever heard of the program, and they're almost certain to draw a blank. That's partly because the United States has done very little to publicize the success of PEPFAR, and partly because the Bush presidency was overshadowed by much more high-profile aspects of his foreign policy (such as the invasion of Iraq).

Indeed, Bush still enjoys high popularity ratings in Africa, where he's widely regarded as one of the continent's great benefactors. (Meanwhile, the Obama administration's proposed PEPFAR cuts have triggered protests around Africa -- even in Kenya, where the president's family ties have ensured him plenty of favorable coverage.)

"Bush did more to stop AIDS and more to help Africa than any president before or since," says New York Times correspondent Peter Baker, who's writing a history of the Bush-Cheney White House that's due to appear in October. "He took on one of the world's biggest problems in a big, bold way and it changed the course of a continent. If it weren't for Iraq, it would be one of the main things history would remember about Bush, and it still should be part of any accounting of his presidency."

Nor is liberating 30 million Iraqis and setting off the Arab Spring anything to sneeze at.

Posted by orrinj at 5:27 AM

MAKE THE CUSTOMERS WASTE THEIR OWN MONEY:

Do You Really Need That Test? Doctors Warn on 90 Treatments ( YUVAL ROSENBERG, 2/20/13, The Fiscal Times)

The new list adds 90 more treatments that should be scrutinized, with the stated intent of prompting conversations between patients and doctors about which are really necessary. Doctors might order tests that aren't needed in order to placate patients, increase profits or avoid potential lawsuits and accusations of negligence.

"We always talk about this campaign as removing waste, improving quality and improving safety," says Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation. "As a byproduct, it might or might not reduce costs. We hope that it would, but it's not our primary objective. Our primary objective is to change the American public's attitude that more is always better and physicians' attitudes about their responsibility to be good managers of resources on behalf of their patients."

While the campaign itself won't measure any cost reductions achieved, there are billions in savings to be had by eliminating waste. The U.S. spends an estimated $2.5 trillion a year on health care, or more than $8,000 per person - far more than in other developed countries. Much of that money is wasted. The U.S. health care system squandered about $750 billion a year as of 2009, or more than a third of total health care expenditures, according to a report released last year by the Institute of Medicine. That included some $210 billion in excess costs due to unnecessary services.