Error: Unable to create directory /home/demockra/public_html/wp-content/uploads/2010/09. Is its parent directory writable by the server? GOP Response: They’re Going to Have to Try Harder

Here’s the Republican plan, as articulated (badly) by Gov. Piyush “Bobby” Jindal:

• create jobs by lowering income tax rates for working families;
• cutting taxes for small businesses;
• strengthening incentives for businesses to invest in new equipment and hire new workers;
• stabilizing home values by creating a new tax credit for home-buyers

The Republican evaluation of these plans is that they “would cost less and create more jobs.” I assume the less and more adjectives refer to the Democratic plan. Here is what the American Recovery and Reinvestment Act does, viz a viz the above Republican bullet points:

• A refundable tax credit of up to $400 per individual and $800 for couples in 2009 and 2010. It is calculated at a rate of 6.2 percent of earned income and is phased out for individuals with adjusted incomes over $75,000 and couples with incomes over $150,000. How does this not lower tax rates for working families?
• Small businesses with gross receipts of up to $15 million can write off 2008 losses against five previous tax years. Current laws allows a two-year carryback of losses. How does this not cut taxes for small businesses?
• An $8,000 tax credit for first-time home buyers for homes purchased between Jan. 1 and Dec. 1, 2009. The tax credit phases out for individuals earning more than $75,000 and couples earning more than $150,000. How is this not a new tax credit for home-buyers?

So, what’s the difference? Republicans want to cut taxes and decrease spending. We’ve seen that before in recessions, and the results weren’t good. Sure, Gov. Jindal and the Republicans believe that “empowering you” is the best way to stop this recession. But what if you don’t have any money? That was precisely the problem that led to the Great Depression, and as noted in the link above, the government’s reaction — to increase taxes and decrease spending — made the problem worse. When no one wants to buy anything, it’s hard to “empower” the consumer to spend money. This is why, in a time of recession, the government intentionally incurs debt in order to increase aggregate demand. Then — and this is the part that Republicans either willfully or negligently don’t mention — when the economy recovers, the government increases taxes and cuts spending in order to pay itself back!

On the Issue of “Small Businesses”

Republicans are fond of conflating individual income taxes and “small business taxes.” There is no such thing as a “small business tax.” The owner of a small business pays himself as an employee, and he pays the marginal tax rate for the salary he pays himself. Concurrently, the small business (which is a corporation if it is incorporated, which it probably is) pays the marginal tax rate for its amount of taxable income. The top corporate tax rate is 38%, which is for taxable income between $15,000,000 and $18,333,333. According to an IRS report from 2005 (the most recent date that the report was issued), 6,082,975 returns were filed for corporations in 2005 (this is adding the number of forms 1120 and 1120S that were filed for 2005, which are by far the most common types of corporate tax forms filed). Of these six million or so returns, 5,475 were for corporations with net income of greater than $15,000,000. That’s 0.09% of corporations. So, when Republicans talk about corporate taxes “hurting” “small businesses,” that’s a lie. The largest single category of business size (as defined by net income) is the “under $25,000″ range.

According to the Small Business Administration, in 2006 (the most recent date that comprehensive figures were available), there were 17,403,814 “firms” in the United States, of which 10,755,262 (62%) have 20 or fewer employees. I think we can agree that the majority of businesses are small by sheer number of employees; this is a purely qualitative evaluation, however, as there are no technical definitions of “small.” This figure does not include nonemployer firms (see below).

Now, if you qualify as self-employed, you pay a flat rate of 15.3%. This rate takes into account the fact that, as a person who is self-employed, your normal payroll taxes — specifically, Social Security and Medicare — don’t happen like they do for people who get a regular payroll check. Also note that only the first $102,000 of self-employment income is subject to the 12.4% Social Security component of the self-employment tax.

The term “small business,” much like the term “partial-birth abortion” and “death tax,” is a public relations phrase, not a legal one. The U.S. Census Bureau, the Internal Revenue Service, and the Small Business Administration (oddly enough) all use the term “employer firm” or “nonemployer firm.” SBA defines a nonemployer firm as “one that has no paid employees, has annual business receipts of $1,000 or more ($1 or more in the construction industries), and is subject to federal income taxes.” There is a larger quantity of nonemployer firms, but there is a far greater amount of revenue from employer firms.

So, in summation, “small business owners” fall into the “working class” tax brackets that get tax cuts, anyway, so they will necessarily get tax relief. Businesses that don’t make a whole lot of money — and that’s the vast majority of them — do get tax breaks. And, in case farms enter the discussion, these numbers don’t include farms. Farms are taxed and regulated differently from every other business.

Republicans like to play up the notion that “Joe the Plumber” would be hurt by Democratic tax policies. In truth, Joe would get a tax cut, and the “small business” that he works for would probably get a tax cut, as well. I doubt, though, that “facts” will stop them from trying.

Labor Watch: New York Has a Better Idea

If the Department of Labor isn’t the most obscure Cabinet level agency in the federal government, it’s at least in the running.  So the fact that the confirmation vote of Obama’s Labor Secretary designee Hilda Solis drew even a little a bit of attention that way seems an opportunity not to be missed. Let’s, then, cast an eye upon something new in labor law enforcement that’s happening in the state of New York called Wage Watch.  And let’s also hope that Solis – and the labor officials of the other states – pay attention as well, because it’s a program that could change the way we conduct government.

With the current bailout regime having thawed our previously frozen national discussion of the economy to the point where the supposed immutable laws of the free market can now be challenged, the idea of limiting how much money the people at the highest levels of the corporate world can take home is finally seeing the light of day.  But the question of whether those at the other end of the economy are even getting what the law already demands remains as much in the dark as ever.  That would change in New York, however, if the month-old program that the state’s Labor Commissioner M. Patricia Smith, calls a “one-of-a-kind grass-roots tool in the fight against illegal labor practices” succeeds.

For its first six months Wage Watch will set in motion six local organizations in New York City and Long Island to spread knowledge about the basics of minimum wage and overtime law among the low wage earning communities they already work with.  The range of practices that New York’s Department of Labor refers to generally as “wage theft” also includes tip stealing.  The six groups, all with prior experience with labor issues, will receive training and materials, in Spanish or Chinese where appropriate; disseminate information to local employees and employers; and facilitate direct contact with the Labor Department for complaints as needed.

Given how hard many people find it to even imagine living on the minimum wage – which at New York’s $7.15 an hour minimum would give a 40 hour, 52 week worker $14,872 in annual gross wages (the $6.55 federal minimum totals to $13,624) – it might seem like the problem couldn’t be too widespread.  And yet the department reports that last year it collected $25 million in unpaid wages for 17,000 workers throughout the state.  With bailout and stimulus bills in the air that are nearing a trillion dollars, $25 million can itself start to seem like small potatoes.  But the fact is that the average minimum wage, small potatoes worker who was a beneficiary of this program recouped about ten percent of an annual minimum wage income, or about five weeks wages.

In some industries cheating is already known to be widespread – the agency found that 78% of New York City car washes were committed wage law violations.  But the problem is not confined to businesses that might be considered marginal – Yellow Rat Bastard, a SoHo retailer (named after a comic book) that New York magazine’s website calls “three rooms of name-brand sportswear and accessories with a punk edge” agreed to pay nearly $1.5 million to settle a wage theft lawsuit.  Nor are high profile institutions immune – the Saratoga Race Course underpaid its backstretch workers and Erie County Fair bathroom attendants worked only for tips and were even forced to give half of them back to a subcontractor.

All in all, then, the Labor Department has reason to believe that there’s a lot more wage theft going on out there than it could ever hope to ferret out with its own staff resources, hence Wage Watch, which Stuart Appelbaum, President of the Retail, Wholesale and Department Store Union, one of the participating groups, calls “labor law enforcement at the purest, most grassroots level.” After the first six month trial period of working with these half dozen experienced organizations, the Labor Department plans to expand the program and recruit religious, student, union, business, neighborhood, and community organizations statewide, with no requirement of past labor law experience.

While the program’s relevance for wage law enforcement on the federal level and for other state labor agencies is obvious, its implications extend well beyond this one particular task.  For instance, in 2006, the United Nations’ International Labour Office (ILO) found the US Occupational Safety and Health Administration (OSHA) woefully understaffed for the responsibilities with which it is charged.  ILO standards call for one inspector for every 10,000 workers in industrialized nations like ours.  The US has 2,100 labor inspectors, or about one for every 70,000 workers, well below even the one-per-40,000 workers recommended for nations with relatively low levels of industrialization.

The AFL-CIO has analyzed this question by considering how many years it would take to inspect all of the job sites in each state with current levels of OSHA staffing.  They found only six states whose worksites could be covered in under fifty years.  Most would require from fifty to one hundred and fifty years, and in seven states it would take longer than that.  (About 16 American workers are fatally injured on the job each day while more than 11,000 are injured or made ill by workplace conditions.)

In order to reach the ILO’s recommended staffing level, OSHA would need to add more than 12,000 new inspectors at a cost in the neighborhood of $1.5 billion annually.  Given that the nation’s largest workers compensation insurer, Liberty Mutual, puts the direct cost of disabling workplace injuries at nearly $1 billion a week, this would be money well spent.  Yet we know all too well that over the next several years the government is going to face an unprecedentedly broad range of needs on which money could be well spent.  What then, if OSHA were directed to follow the lead of the New York Department of Labor and seek out and train organizations that would then train the workforce itself to identify and effectively call attention to conditions that threatened its well being?  It might well have a cheaper, less bureaucratic, and more effective operation.

Even this is relatively small compared to the potential impact of directing an institution like the Environmental Protection Agency (EPA) to socialize its work.  There is probably no aspect of government currently enjoying greater support among the general public than environmental protection and the fight against global warming.  So it’s hard to imagine that an EPA foray into the world of community organizations would not turn up hundreds of them interested in training their members in methods of helping the government to help the environment.

According to Labor Commissioner Smith, the genesis of Wage Watch lies in an entirely other realm of government – the Neighborhood Watch schemes to assist police that started in Queens in the 1960s.  In fact, it’s hard to imagine that there is any branch of government that might not benefit from a perspective of expanding the public’s role in their work (although the CIA might disagree.)

If all of this talk about empowering workers and community organizations sounds a little, well, radical, don’t forget, we’re all socialists now – I read it on the cover of Newsweek.  And even if you’re a Time magazine reader, this development in New York has got to be considered good news because you know what they say – if they can make it work there, we can make it work anywhere.

Error: Unable to create directory /home/demockra/public_html/wp-content/uploads/2010/09. Is its parent directory writable by the server? “Buy American” Policies: More Hurtful than Helpful?

Last week’s $787 billion dollar stimulus promised aid to education, infrastructure projects, jobless benefits, and a whole host of other programs designed to stimulate the economy. While the bill was pretty straight forward, there were a few provisions that stood out and inevitably were nixed (i.e.,  the clause specifying that no federal money was to go to former Illinois governor Rod Blagojevich). However, one short, but very controversial clause on page 189 did make it to the final bill. There, section 1605 states: “None of the funds appropriated or otherwise made available by this Act may be used for a project for the construction, alteration, maintenance, or repair of a public building or public work unless all of the iron, steel, and manufactured goods used in the project is produced in the United States.”

There are some exceptions (for instance, if the cost of American raw materials will increase the overall cost of the project by 25 percent, the party purchasing the materials can apply for a waiver) but the real significance of this clause is that it sets a very negative and narrow tone on the global economic crisis. Even President Obama stated in an ABC interview that this stipulation was “a potential source of trade wars” and John Bruton, the EU ambassador to the US, cited it as a “dangerous precedent.” Although the provision does state that it “shall be applied in a manner consistent with United States obligations under international agreements” it still forces many companies, such as the struggling Caterpillar, to spend more of their fiscal resources on raw materials instead of preserving jobs or raising wages. Also, given the fact that 37 percent of all manufactured goods sold in America are not made here, this stipulation seems hard-lined and, at some level, woefully misguided.

Moreover, the other underlying and more significant impact of this “Buy American” policy is this: If American companies are forced to purchase domestic raw goods for the public works projects, then what is stopping other countries from enacting the same jingoistic economic policies? This economic crisis is a global one and if every country decides to enforce a “buy me first” approach, this crisis will get far worse before it gets better. Not long after Congress announced its plan, major international news outlets such as Japan Today, Canada’s CBC NEWS, and China’s Xinhua criticized the measure. The International Herald and Tribune also noted that the United State’s protectionist policy could incite a backlash in which other nations stipulate a Don’t-Buy-American policy on foreign goods.

Although I understand Congress’s desire to promote the construction of new roads and bridges, green technology, and car manufacturing while supporting what little domestic manufacturing industry we have left, the reality is that (a) we don’t produce enough of these materials to support the sweeping projects they want to see enacted, and (b) even if we did, we may be shooting ourselves in the foot, so to speak, if we don’t work to stimulate other nations’ struggling economies in the process of stimulating our own. Maybe this approach would be acceptable, or even relevant, if this were just an ordinary American recession. But we are in the midst of a global crisis, and our economy will not get better if everyone else’s is suffering.

I believe a smarter and more fitting approach would have been a “Make American” initiative. Not an ultimatum like the “Buy American” provision, but a tax-break incentive encouragement for either domestic companies to expand their production of vital goods or for foreign ones to locate some of their operations in the United States. In both scenarios, there would be job creation and more spending. Instead of forcing companies to purchase domestic raw materials, encourage them to make products that can be purchased here or abroad. In Louis Uchitelle’s article on this issue for the New York Times last week, he cited the example of mass transit—while the stimulus bill calls for the expansion of mass transit, there are no US companies that manufacture the train cars necessary for that expansion. Now these projects will have to rely on American steel, iron, and manufactured goods while they also negotiate their express need for a specific foreign good they cannot get domestically. Wouldn’t it be nice (and much cheaper for taxpayers) to let cities purchase some raw materials from China or India and let the United States encourage these more specialized industries to move some of their operations here since we will be purchasing such a high volume of these products?

Of course, America will never return to its manufacturing hey day, and I’m not suggesting that domestic production will solve all our economic woes. But by encouraging a responsible, inviting economic policy, we could perhaps not only pave the way for global economic recovery, but also mend some broken foreign policy fences we need to repair from the past administration. Yet, despite the demands of this myopic economic policy, I hope that the Obama administration can find other ways to encourage growth domestically and promote more foreign investment in America’s future without ostracizing our trade partners and fellow economically struggling nations.

Error: Unable to create directory /home/demockra/public_html/wp-content/uploads/2010/09. Is its parent directory writable by the server? Blowback: The Economy or the Military?

During the long years of the Cold War, not many dared to question the US military budget. Since then, however, the budget has continued to expand, often sending troops overseas to situations that were created by previous diplomatic blunders. Some of those blunders have directly created the morasses that we attempt to extricate ourselves from today. As such, let’s take a look at some of the history of what the CIA refers to as blowback for the U.S.

Brief Blowback History

In 1953, Iran, or Persia as it was then called, had a functioning democratic system. A successful coup by the CIA and British Intelligence overthrew the democratically elected government and replaced them with the hereditary Shah of Persia. His abuses and misrule led directly to the Islamic Revolution and the problems we have encountered with their Islamic government ever since. In the early 1980s, Iraq thus was encouraged to invade Iran, by the US in a fit of pique, and was supplied with arms in the resulting war. This assistance helped solidify Saddam Hussein’s military ambitions and indirectly encouraged his invasion of Kuwait in 1991, all of which led to the mess in Iraq today.

Meanwhile during the 1980s, the military assistance given to the tribes opposing the Russian occupation of Afghanistan led to the Taliban taking over the country. These people, who were responsible for 9/11 (despite what the Bush administration’s claims to the contrary), are whom we continue to fight today in Afghanistan. In addition, they also have brought the war on terror to the nuclear-power country of Pakistan.

Bill Clinton didn’t help matters, when he, in the midst of the Monica Lewinsky affair, launched Tomahawk missiles against suspected Al Qaeda munitions facilities at a site in Sudan and the Bora Bora site in Afghanistan where Osama Bin Laden was thought to be. This was in retaliation after US embassies in Kenya and Tanzania had been previously bombed. One of Tomahawks destroyed a human and veterinary manufacturing plant in Sudan, killing at least 20 Sudanese and putting many out of work. The Sudanese government immediately cut off all ties with the U.S. and released an important Al Qaeda suspect they had been about to hand over to the U.S. The Tomahawks in Afghanistan missed Bin Laden totally–he was in Kabul at the time. He in turn sold an unexploded Tomahawk to the Chinese for 10 million dollars. Worse, almost all of Africa, who had been outraged over the Embassy bombings by Al Qaeda, swung against the US policy after the bombings. Sound familiar?

In addition, it is clear to most of the world, though rarely reported in the US, that huge military assistance to Israel keeps them so dominant that they often disdain from entering into meaningful dialogue with the Palestinians or other nations in the region. Without meaningful legitimate political channels, arguably, that may have in turn indirectly led to the cult of the indefensible and grotesque suicide bomber.

Similar situations of blowback have occurred on all continents. It is alleged that the policy of supporting vain, immoral megalomaniacs as leaders in the more unstable areas of the world could be summed up as, “We don’t care if he’s a bastard so long as he’s our bastard”.

In too many situations today, previous meddling in the internal affairs or politics of other countries has led directly or indirectly to these messes that we may now face. If intervention leads to revolution or serious instability in the country involved, it is often inevitable that the beneficiaries of the situation will be the worst possible choices. It takes many generations for the situation to settle down and for the voices of reason make headway over the radicals who are always the initial power base. The French Revolution, The Russian Revolution, and the Persian [Iranian] Revolution are all cases in point

To return to the end of the Cold War, there was at that time, along with a feeling of relief that we were all suddenly safe, a hope that the troops could come home, and be discharged. That of course never happened. Why not?

The Military Industrial Complex

Today the US spends 46% of the total world’s military budget. The next 4 nations, the UK, France, Japan and China spend between 4-5% each. The US military budget has risen from 250 billion dollars in 2001 to over 700 billion in 2008. Thus, the sensible solution to help our failing economy would logically have to be to cut the military budget and bring everyone home. Wouldn’t that give us iron clad security at home? Maybe we could even make our inner cities safe and bring down the horrendous murder rate from the 17,000 yearly victims it is today.

Of course that is about as realistic as overall world peace. But why?

The answer to why that apparently sensible solution is currently a pipe dream was first given by President Eisenhower in 1961. Eisenhower was the first President, as a former General, to recognize the power of the Military Industrial Complex.

That term refers to an over friendly relationship between the government, the military, munitions manufacturers, and defense contractors. All in this relationship benefit financially, and unfortunately peace can get in the way. Eisenhower as a military man saw what could occur when future Presidents without military experience tried to go up against this Complex. They would be easily maneuvered by the military to react where no reaction was necessary, and to keep the US military equipped with constantly updated equipment and every new technology. Today, there is a defense contractor in every State of the Union. If there are cutbacks, you can be sure these workers will be out in force rallying senators and representatives at every level. The President will be lambasted across the nation and the Republicans will make hay. Any President to take on this issue will be lauded by history, but unlikely to win a second term.

Will Barack Obama be able to break this endless cycle to prevent the never ending cycle of blowback? If recent history is a good predictor, it certainly won’t be easy. For the sake of the rest of the world, let’s hope for the best.

Celebrity Pawn Shop

It seems like in the last week the media has turned to stories about how the recession is affecting the wealthy, from fashion to Hollywood to celebrities. While they’re amusing articles to read, let’s be honest: do we really care if the rich are taking a hit to their pocketbooks because the rest of us aren’t consuming like normal?

I say to hell with the rich. Save some of your hard earned cash and don’t buy their designer brands or their mindless products or even pay full price to see their movies. There are so many ways to have access to quality, generic goods and free entertainment that we shouldn’t be wasting our dollars so they can pay the mortgage on their third vacation home. This year learn to be cheap, and let rich, spoiled celebs watch a million or ten go out the door…hence, “Celebrity Pawn Shop”:

Error: Unable to create directory /home/demockra/public_html/wp-content/uploads/2010/09. Is its parent directory writable by the server? What’s a Republican Governor To Do?

You know, it’s hard out there for a governor, when he’s trying to make the money for his state budget, and all the infrastructure and unemployment insurance money’s spent, and all the RNC leadership is talking … too much.

Not a single House Republican voted in favor of the “bipartisan” H.R. 1, the American Recovery and Reinvestment Act, signed into law by President Obama last Monday. Republicans were proud of their united opposition to what they called a bill filled with “pork,” though, technically, “pork-barrel spending” is defined as non-essential spending made for specific, pet projects in a congressman’s home district — say, for a $398 million bridge from one scantily-populated town to an airport. Using that definition, there is no pork in this bill, since it allocates money for only large, federal projects, with no mention of specific projects and nothing targeted at specific districts (in fact, the bill’s flaw may just be its breadth, with line-items for things like “Science” within NASA’s budget).

So, anyway, Republicans are very proud of themselves. But it may be a case of cutting off their noses to spite their faces. On the one hand, they want this stimulus bill to be their first major conflict with the Obama administration, so that they have a clearly defined message in opposition to his; i.e., “wasteful spending.” On the other hand, states are seriously hurting for money. Just this last week, the Great State of California finally closed a $40 billion chasm in its budget for next year. (Although, in spite of that, Governor Schwarzenegger terminated 10,000 state employees and cut the salaries of thousands more in an effort to save some cash. Hasta la vista, employees.)

Republican governors are also in charge in some of the poorest states, like Louisiana, South Carolina, and Mississippi, where this money could be really useful! At what point does adherence to ideology actually start hurting people? You may wish to ask the citizens of Louisiana, where Republican Governor Bobby Jindal may refuse $4 billion in infrastructure funds allocated to it under the stimulus plan, according to CBS News. The New York Times reports that Governor Jindal has already refused expanded unemployment benefits because it would raise business taxes.

Republicans don’t want to appear to be hypocrites, so they’ll do the next-best thing: appear to be obstinate. Of course, all of this posturing isn’t being done because Republicans staunchly adhere to their ideals. What did you think this was, Bizzaro United States? Oh, no; these governors are refusing the money because they plan on running for president in 2012! Refusing stimulus money may cause real damage to millions of people in states where demand for social services and entitlement benefits is on the rise, but that clearly isn’t important to Republican presidential contenders who need to be able to point back to a time when they were 100% in line with the Republican talking points about the stimulus.

Thankfully, Governor Schwarzenegger is not running for president (unless they amend the Constitution. Fingers crossed!). Maybe that’s why he will not only take the stimulus money allocated to California, but why he is urging other Republican governors to do so (although he also said he would gladly take whatever money the other governors don’t want). Unless, of course, the other governors are so unselfish that they’re willing to risk the welfare of their states for a cynical attempt at appearing “fiscally responsible” so that they can make a run for the Republican presidential nomination in 2012 by out-conservativing each other. That’s change we can sink in!

Let this serve as another example of why Republicans lost so much in November: as it turns out, they may not care about people. That may be a generalization (and it is!), but I wonder about the guy in New Orleans who’s been laid off and who can no longer make his mortgage payments. I know it will do his heart good to know that Governor Jindal is fighting to prevent him from getting any help because, in so doing, Governor Jindal would boost his chances of being elected president. What does the word “constituency” mean, anyway? Especially when you have to choose between an electorate that can only drag you down and a Republican elite that could be your meal ticket to the presidential nomination.

I’ll give this much to them, though: they stick to their guns, even if those guns will send them hurtling over a cliff. You’ve got to respect someone who is self-centered enough to play chicken with other people’s lives simply to prove a stupid point.

Or not. Which is good, because I don’t.

Error: Unable to create directory /home/demockra/public_html/wp-content/uploads/2010/09. Is its parent directory writable by the server? Health Care in America: A Way Forward

As previously stated, the purpose of this two part series is to set forth my views on changing health care delivery in America to make it more efficient, more effective, and, most importantly, more compassionate.

In Part 1 of this series, Health Care in America: A Time for Change, I laid out my personal experiences that led me to write this series and outlined the problem. In Part 2 of this series, I will explore ways of making health care better for all citizens of the US, starting with the concept of triage.

TRIAGE – WHERE IS HAWKEYE WHEN YOU NEED HIM

In the old sitcom, MASH, Hawkeye Pierce would perform triage for his MASH unit. His job in triage was to separate the injured into three groups:

1. Those who needed care immediately to deal with a life threatening or a rapidly deteriorating situation.

2. Those who needed care, but who could wait for a time period with little or no effect on the patients’ wellbeing.

3. Those who could not be helped by health care (either they were not sick or they were so badly injured and sick that normal health care procedures could improve the situation).

Hawkeye heroically performed triage for the MASH unit, and by doing so, used the unit’s limited resources for maximum effect. And why was he a hero? Because he made tough decisions about prioritizing the needs of patients based on triage. The system was not perfect, but decisions were made, and the doctors got on with the job of caring for the sick and wounded. And through appropriate triage, care was provided most efficiently given the limited resources at hand.

In the UK, this triage function is essentially how the national health care system works. Resources are indeed limited in the UK within the NHS, and everyone knows it. Indeed, this obvious limitation of resources does cause issues (e.g., waiting lists). However, it also forces the people and the doctors in the system to focus on what is important; it forces the doctors to make the tough decisions necessary to give care to those that are in most need. The classic triage function is returned, not to insurance companies, lawyers, or accountants, but rather to medical professionals. Indeed, this is what doctors are paid to do – not just provide care, but to provide care to the sick with recognition of the limitations of resources. They are not just health care technicians, but they also perform a much more important role – TRIAGE.

Indeed, in the case of my son’s broken arm and my cancer treatment, the triage system worked just as it is supposed to work. In both of these situations, the doctors recognized a problem that needed to be addressed quickly, and even though their resources were limited, we were cared for quickly and efficiently with the resources at hand.

In America, this triage system has been distorted by the market system – a market system which has less to do with medical priorities than it does with economics, litigation, and profit. The market system ensures that the ones with the most money get the best health care in a timely fashion. The ones without money get what they can get. The market system also ensures that those with access to lawyers will receive health care, often unnecessary health care. Large sums of money in America are spent on defensive health care, where diagnostic procedures or tests are performed for the sole purpose of defending against potential lawsuits. Finally, the market system, through the prospective payment system, ensures that many wasteful procedures, tests, and office visits will occur, not necessarily for the benefit of the patient, but for the benefit of the provider who will earn more money by performing more procedures and tests.

The table below is a simple demonstration of the inefficiencies of the US health care system

Country	$ Spent Per Capita on Health Care(USD)	Health Care as % of GDP	CT Units per 1 million persons	MRI Units per 1 million persons	Infant Mortality per 1,000 births	Life Expectancy (years)
USA	6,347	15.2	33.9	26.5	6.9	77.8
Canada	3,460	9.9	12.0	6.2	5.4	80.4
Denmark	3,179	9.5	15.8	10.2	4.4	78.3
France	3,306	11.1	10.0	5.3	3.8	80.2
Netherlands	3,156	9.5	8.2	6.6	4.9	79.4
Spain	2,260	8.3	13.9	8.8	3.8	80.4
UK	2,580	8.2	7.6	5.6	5.1	79.4

Source: OECD Health Data 2005

The first two columns of the table show how the US spends approximately twice as much on health care as comparable Western countries. The third and fourth columns are an indication on how that money is spent. The money is spent on fancy machines and diagnostic tools (CT and MRI); these columns show the US usage of MRIs is 3-6 times higher than other countries in Europe. Although these types of tests are a useful tool in diagnosing certain diseases, there use in the USA is certainly out of proportion when compared to other countries. Indeed, I believe the high use of such technology is not driven by patient need, but rather by profit motivation and the fear of litigation.

Finally, the last two columns show that for all the money spent and the technological advances (such as MRI and CT), the US lags behind other countries when it comes to two objective measurements of health care – infant mortality and life expectancy.

In summary, the market system of US health care forces costs to rise and rise and rise again with no objective benefit to the population. These costs are driven by all the players in the system:

1. Lawyers – who through the threat of litigation lead many doctors to perform unnecessary and non-cost effective treatments.

2. Managers (motivated by profit) – who want to provide more care (as long as it is covered by insurance, Medicare or Medicaid programs) because more care leads to more procedures leads to more revenue, which in turn leads to more profits.

3. Insurance Companies (and HMOs) – who tend to provide more care (more coverage) and increase premiums incrementally across its insurance pool. This is especially true since the costs of increased premiums are often negotiated with employers, and the costs are invisible to the employee (the actual customer). Ultimately, more care means more revenue, which usually leads to more profits for the insurance company or the HMO.

4. Doctors – who (bless them) want to provide more care because that is what keeps their patients healthy; but we also must remember that sometimes, doctors also have a financial motivation whereby more health care and more procedures will lead to more money in their pocket. In addition, the current system gives no financial incentive for doctors to coordinate care with other providers.

These four players in the system are all motivated to provide more health care and more expensive health care. The system is fixed to continually increase because there is no one in the system who is manning the brakes!

THE WAY FORWARD

The solution to these issues is simple in theory and more complicated in practice. This solution is a return to triage. Provide health care to the ones who need it, when they need it. The solution, however, given the ensconced positions of each of the players, will not be a quick fix. The US health care system has evolved and been shaped by the market, culture, and technology for over 100 years. A miracle cure will not happen overnight; any new law or system will need to be assimilated into the culture and have its own evolutionary process. However, change needs to happen, and that change must address the incentives and motivations of each of the constituent parties (the doctors, the managers, the insurance companies, and the lawyers).

However, the strategy for health care reform is simple: a return to triage – this entails three steps.

1. Define the resources (set the budgets): At a regional (manageable) level (state, county, or city) define the budget and resources which are available to each entity in any given year. Money, operating rooms, MRIs, hospitals, and all of the other resources available and the cost thereof must be defined and budgeted.

2. Define the health care needs of the population being serviced: At a regional level (state, county, or city), an actuarial study will need to define the health care needs of that particular population; any population of 50,000 persons or so can be studied from an actuarial viewpoint, and a very good estimate of health care needs of that population can be developed.

3. Allow medical professionals to make resource decisions: Doctors and medical professionals then need to make medical decisions on how to use these resources to best service the population. This will be a hard job; there is no doubt about it. However, it is the essence of triage and what doctors should be trained to do and, indeed, what they are paid to do. A limited budget means that not everyone can get an MRI; not everyone can have the expensive course of drugs that has a marginal effect. These are difficult decisions which need to be made, but without a budget limitation, the decision will not be made. These medical professionals, who should be appointed to significant staggered terms to avoid political winds, will have the flexibility to spend money on programs that provide more bang for the buck. They, in effect, will perform triage for the American health care system.

Finally, three other political decisions need to be implemented to allow this strategy to work.

First, health care must be universal and include all citizens. There needs to be an acceptance and realization that we as a country will take care of the basic health care needs of our citizenry. Patient finances should not be the determining factor when providing basic health care. This in turn will make it much easier to define the population and the health care needs of that population (because it is everyone, except those who opt out for private health care). This will also eliminate the universal problems of gaps in coverage when one changes jobs, issues relating to pre-existing conditions, and other problems caused by a private insurance system.

Second, all citizens will be allowed to opt out to a private system. If a person wants to spend his or her money for a special medical procedure, medical “gap” insurance or whatever he thinks is appropriate, he can. It is envisaged that only the relatively wealthy will opt for this type of coverage, but anyone who wants to spend his money on more health care can do so. (This would be analogous to a private school system whereby parents can opt out of the public system at their choice for a fee.)

And finally, and perhaps most importantly, we need to greatly reduce the dollars which are spent on lawyers and procedures performed only to placate the lawyers. Through major tort reform, we need to stop paying the lawyers to police the system. We must eliminate large litigation payouts and thereby eliminate most of the defensive medicine that today is necessary simply to provide an appropriate defense for many doctors. Fair reparation should be paid in certain cases where mistakes are made. However, the multimillion dollar payouts, and more importantly from a cost standpoint, all the waste which comes from defensive medicine in response to such lawsuits need to be eliminated.

These of course are only strategy statements. Work, work, and more work must be accomplished before this strategy can become reality. As such, these are no more than first steps meant to start a dialogue. I welcome discussion and debate which can lead to developing an American health care system which can be the best, the most efficient, and the most compassionate in the world.

Error: Unable to create directory /home/demockra/public_html/wp-content/uploads/2010/09. Is its parent directory writable by the server? Slumdog Millionaire and What to Do About Global Poverty

I walked out of Seattle’s old Harvard Exit Theater on a cold Friday night in December. I had just seen the film Slumdog Millionaire and overheard two people talking. One was telling the other how she had seen Bollywood movies before and that all they contained were dance scenes and Jane Austen-like plots. She hesitated, “Actually, maybe what I’ve seen were spoofs of Bollywood movies and this was, like, a real Bollywood movie.” I smiled.

At the time, Slumdog Millionaire hadn’t yet won Best Picture at the Golden Globes. It hadn’t been nominated for the Best Picture Oscar (nor was it running as the heavy favorite to win Best Picture and Best Director), and director Danny Boyle and the movie’s two young lead actors – Dev Patel and Freida Pinto – hadn’t yet been hosted and gushed over by Oprah and Ellen. It was playing at a single, mostly empty theater in Seattle. Contrary to what many American viewers believe, Slumdog Millionaire is no Bollywood movie, but it is certainly a film with plenty of genuine Indian elements. It is based on the novel Q & A by Indian diplomat Vikas Swarup. Most of its music is by Bollywood super-composer AR Rahman, and it even contains a (relatively mediocre) song and dance routine. Lead roles are played by famous Indian actors Irrfan Khan and Anil Kapoor. It was filmed entirely in India and the child actors were all Indian – some of them slum dwellers themselves. There is plenty of melodrama and a love story. While Slumdog Millionaire clearly draws inspiration from Bollywood, it is directed by an Englishman and is mostly in English, leading many Indians to treat it as just another Hollywood movie.

By now you’ve probably heard of Slumdog Millionaire. It is the story of three street kids growing up in Mumbai. It is part rags-to-riches fairytale, part love story, and part horrifying look into the difficulties of street life. It has been scooping up awards and critical acclaim in the US and the UK while being dogged by more controversy than other Oscar-nominated films. Most of the debate centers around the poverty shown in the film, and whether a white British male (Boyle) has the right to present Indian society in such a way in a commercially successful feel-good (kind of) film. To tell an Indian story through the lives of impoverished street children embarrasses and enrages much of India’s upper-class who see the film as a stereotypically Western view of India as poor, chaotic, violent and dirty. They see Slumdog Millionaire as a “white man’s imagined India.” Some Hindu organizations accuse the film of denigrating Hindu gods. Some human rights groups in India have condemned the film for its use of the term ‘slumdog’ (a term not commonly used that recalls the days of British colonizers calling Indians ‘dogs’). Others see Boyle’s slick, colorful production of such impoverished settings as “poverty porn” – rendering Indian poverty visually appealing and exciting for a mostly white, Western audience. Finally, the compensation given to the film’s young actors is, with Slumdog Millionaire’s success, seen to be inadequate and a way of exploiting real life slum children. No matter how Slumdog Millionaire does at the Oscars, these controversies are unlikely to die down, even if they fall off the pages of US newspapers.

I do not intend to debate each of these controversies here, though I find some of the accusations frivolous while others have some validity. What is most interesting to me is the way in which Slumdog Millionaire has brought the issue of global poverty into the limelight (literally) and has exposed our collective squeamishness with having images of it thrown in our face by a film. If we middle-class Americans must see poverty, we like to see it portrayed in a particular way – most likely in a low-budget documentary that condemns it and that offers a way out. A movie like Born into Brothels does this very well. But Slumdog Millionaire treats poverty and those who live in poverty differently, not as faceless objects of pity, but as individuals – as a story must – with agency and the capacity to be happy and full of dreams in the midst of often horrifying surroundings. In this way Slumdog Millionaire resembles Rohinton Mistry’s impressive novel A Fine Balance – also set in India, that does not shy away from the poverty that is a given in many people’s lives, but something that need not rob people of their humanity, that need not reduce them to objects to be pitied by the world’s wealthy. With this perspective poverty need not limit the range of human experience and emotions. Those who are poor have a story like everyone else, and in fact, those who are poor make up a huge amount of the world’s population. Confronting middle-class Westerners (and Indians for that matter) with the horrors of poverty and the injustice of their own affluence, while avoiding defining the poor by this label alone is something few films do. Slumdog Millionaire does it well. And if it does well at the box office, all the better.

When discussing global poverty and the political and social attempts to alleviate it, it is easy to be overwhelmed by the numbers and to be numbed to the experiences of individuals who must live in such dire conditions. It is easy to feel guilty that you are not the one living in extreme poverty or to feel that those who are poor deserve it, that they just need to try harder. It is also easy to feel hopeless in the face of such a widespread and complex problem. How exactly should the global community address the problem of poverty? Should we place an emphasis on greater individual incomes and saving and buying power? Or should the emphasis be in developing societal infrastructure to improve quality of life by ensuring better health care, education, access to employment, etc.? Some put their faith in the free market to lift all boats, but then the free market seems to demand that many people remain poor, and it doesn’t provide any plan for improving societal shortcomings that contribute to poverty. Some believe government programs are the answer, but improving education, health care, job training programs and the like can be costly and complicated, and simple welfare schemes may perpetuate poverty. A host of non-governmental organizations and foundations play a growing part in addressing poverty, but can arbitrarily bestow charity that perpetuates cycles of economic dependence. The work of groups like the UN’s Development Program connects these participants and strategies offering a practical and promising way of addressing poverty on a global scale.

But uplifting the poor is not all that is needed. Our relatively new found awareness of the toll we inflict upon the environment requires that the discussion about alleviating poverty must include the using and distributing resources. Ending poverty through growing economies and enabling hundreds of millions of Indians and Chinese to drive gas-guzzling cars and to use energy as recklessly as we in the US do is no longer an environmentally viable option. And neither is telling people in poorer countries that they can’t have what we do, that they can’t live how we do. Rapidly developing countries need to do their part to make their growth politically and environmentally sustainable, no question. In a way, the more difficult task is ours however. If global economic growth continues (a given in most minds before the last six months of economic turbulence) most other people in the world will be increasing their consumption and use of resources. The Brazilian student may move up from a bike to a scooter, the Vietnamese family may upgrade to an oven from a cook top stove. In the US however, unless we plan on aggressively defending our unfair hoarding of resources from the global community, we will need to begin to reduce the amount of resources we use. Drastically. Even if free markets can lift all boats, it will mean environmental disaster. The middle class American lifestyle has never been sustainable. We are realizing this just as the world’s two largest countries are economically booming, and striving for that lifestyle. No longer will the United States – six percent of the world’s population – be able to consume 30% of the world’s resources. That’s a fact.

But, I suspect it is a fact that will go ignored or denied. Sure, we may use compact florescent bulbs instead of incandescents. We may recycle and compost. But most of us probably won’t give up our car (or even our second car). Most of us won’t give up our washer and dryer, or our oven, or our spacious homes. In the end, I suspect that we’re all just a bit too selfish and stuck in our ways to make large personal sacrifices for an abstract common good. We want to end poverty, but we don’t want to give up what we’ve been blessed with, and without this sacrifice on the part of the better-off, poverty will continue no matter how much effort is directed at alleviating it.

Like any movie, Slumdog Millionaire has its shortcomings. Its plot is somewhat thin and its characters are not very well-developed. It is a movie more about image than substance. Its details are easily refuted by Indian audiences. However, its vividly showing audiences who have not faced poverty and hardship the lives that many in this world are compelled to lead allows it to be more than just a film. It gives poverty a face and a story that will open most audiences’ eyes to something new – hopefully bringing tangible benefits to the world’s poor while eliciting an honest introspection about what people often must and can do without.

Error: Unable to create directory /home/demockra/public_html/wp-content/uploads/2010/09. Is its parent directory writable by the server? 4-G iPhone has Bible Thumpers a-Thumpin’!

I just started this Theatre of the Absurd column a few weeks ago, so I hope readers will be patient while I play catch-up on some pet peeves. First, all the lame iPhone jokes on the morning talk shows. Gee, can it shave you? Can it percolate your coffee? Make your waffles for you? Yahdayahdayahda.

In response, Apple has offered a special 4-G bible-thumper edition of the iPhone. Steve Jobs, the company’s founder, speaks about the new application in his keynote address to a Southern Baptist convention at Liberty University in Virginia.

“We’ve designed something wonderful,” he says. “It’s a smart phone without a keyboard, it has a 3.5-inch, HD widescreen, it’s thinner than any other handset, it has a digital cam and it does everything but make Chinese bird’s-nest soup.

“But that’s not the half of it. Point it at your TV, touch the Sopranos icon, and it instantly and automatically sanitizes The Sopranos reruns. It makes A&E’s slashed-up, goody-two-shoes versions look like Sodom and Gomorrah. It’s a revolutionary new function in that it doesn’t censor the raunchy dialogue. No! Instead, it actually rewrites it, making Tony Soprano sound like Ned Flanders.”

“Praise the Lord!” the crowd shouts like a chorus of little angels.

“It even changes the visual background as needed.  No more Bada Bing strip club—that’s definitely out. Instead, for R & R the crew goes to the opera.”

“Ooh! Aahh!”

“Yeah, the fat lady always brings them to tears. Business, meanwhile, is conducted in a back room of the local Sunday school. Take a look.”

The huge HD screen comes to life showing an excerpt from a Sopranos episode. In it, a nasty surprise greets the crew when they discover Christopher in the Sunday school with a stripper on his lap and some white power on his nose.

He’s totally out of it, singing “I’ll be comin’ round the mountain with a bimbo on my knee…”

“Yo, hidilly-ho!” Tony exclaims, “What the dickens is this?  I hate to be Suspicious Aloysius on you, but are you inhaling cocaine through your nostrils again?”

“And biblically getting to know the exotic dancer, too,” Paulie Walnuts says.  “Goodness gracious. This is all too much for me.”

Adriana is beside herself. “Christophah!  Oh my God, Christophah…how could you? And we were supposed to get married!”

“Gee willikers,” says Tony, “we all trusted you.”

“Golly, I’m sorry, Tony.”

“You’re darned tootin’ you’re sorry—a sorry spectacle. You little munchkin, you wascally wabbit, you’re done for!  You’re done-diddly-done for.  You’re done-diddly-doodly-done-diddly-doodly done-diddly-doodly.”

And Larry, Larry, Larry, what’s up with the lame questions? Something the iPhone should do for Larry King the next time he interviews Paris Hilton (or anyone, for that matter): MAKE HIM ASK SOME TOUGH QUESTIONS FOR A CHANGE. Is that asking too much? It’s not exactly a revolutionary task, you know. Doesn’t the iPhone have a teleprompter application? Why couldn’t some savvy producer key in some sensible questions? Remember Paris Hilton on Larry King when she couldn’t think of her favorite biblical quote—after claiming the Bible was her favorite book in jail? No-nonsense, hardboiled, hard news question like:

1.  Paris, do you like older men?

2.  How about older men in suspenders?

3.  I know, I know, it’s really tough to remember Bible stories. All right, you’ve done a little, er, acting, right?  Let’s pretend the Bible is one long porno movie. Say the parting of the Red Sea is like…parting your legs.  Which prophet did Charleton Heston play in this movie?

4.  Are you wearing panties now?

Mahmoud Make My Heart Beat

I watched a video on CNN.com about Valentine’s Day in Iran. It is becoming increasingly popular, despite being frowned upon by the government and the clerics.  I’m sure that it drives The Iranian Clerics -who are similar to Fundamentalists of the first order – crazy because they have no control over this celebration of “free love.” Young people are deciding for themselves which relationships they want to be in, and that doesn’t necessarily lead to marriage.

In addition, the people who are really benefiting from the holiday are the merchants selling the same sentimental crap, er, memorable “I love you” items that we sell in the US. I say good for them. The Clerics know they can’t compete with “fun” and secretly I’m betting they want in on it. After all, even tyrants need love:

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