Opinion

The Great Debate

Despite stimulus, middle class still struggles

Five years ago Monday, President Barack Obama signed the signature economic proposal of his presidency, saying that the passage of the $787 billion economic stimulus package heralded the “the beginning of the end” of the Great Recession.

The president told a Denver audience that he was “keeping the American Dream alive in our time.” But for millions of Americans, he made things worse.

It is now clear that bold White House predictions about stimulus jobs “saved and created” were just a prelude to later pledges about keeping your doctors and falling premiums.

Equally maddening has been the president’s unwavering belief that an economic recovery could be engineered by Washington’s central planners. It’s as if he isn’t aware of the cynicism engendered by a stimulus bill that seemed to have been designed not so much on the basis of real need or an empirical study of what would actually help people get back on their feet, but on ideology and political connections.

From the tens of billions that have been poured into green energy to an executive order that basically excludes non-unionized workers from major construction projects, for many Americans the stimulus looked more like political payback than a jobs bill — all compliments of the taxpayer.

The middle class’s missing $1.6 trillion

The United States was the world’s first middle-class nation, which was a big factor in its rapid growth.  Mid-19th-century British travelers marveled at American workers’ “ductility of mind and the readiness…for a new thing” and admired how hard and willingly they labored. Abraham Lincoln attributed it the knowledge that “humblest man [had] an equal chance to get rich with everyone else.”

Most Americans still think of themselves as middle class.  But the marketing experts at the big consumer goods companies are giving their bosses the unsentimental advice that the middle class is an endangered species. Restaurants, appliance makers, grocery chains, hotels are learning that they either have to go completely up-scale, or focus on bargains for the struggling and budget-conscious.

Current income surveys, for statistical reasons, usually segment families by broad categories, which obscure the recent radical shift of income to a thin stratum of the super-rich. Well-to-do people may buy $100 coffee pots, but the lion’s share of the income growth has been going to folks with five houses and staff to make the coffee.

Even with a working website, we must tackle healthcare’s opacity

Would you purchase a new phone without knowing its data plan? For almost everybody, the answer is an obvious “no.” We simply cannot make a good choice if we don’t know how much coverage the phone will offer, or how much money it will end up costing us.

Unfortunately, this type of blind decision is exactly the sort that many could face when purchasing a plan in the new health insurance marketplaces — assuming Healthcare.gov will remedy the basic functionality issues that have dogged it in the weeks since launch.

Beginning January 1, 2014, everyone will be required by law to have health insurance; the marketplaces will help consumers find and purchase new plans. But what happens then? Are there easily available doctor appointments covered by these plans, or will patients come up empty-handed when seeking care? Is an insurer’s online directory up-to-date or wildly inaccurate? Which plans have better customer service and which have none?

Internet access is a vital healthcare tool

When Mark Zuckerberg announced a new private sector initiative last month to make affordable Internet access available to people in developing countries, he breathed new life into a long-simmering debate within the global development community — what is the value of technology in societies suffering from urgent social, economic and humanitarian challenges? Familiar voices of criticism have been heard, pointing out that in communities lacking food, clean water and medicine, getting people online is hardly a priority.

Some of these critics are trusted friends and colleagues within the healthcare and humanitarian sector. But as someone with over thirty years of field experience in developing countries, I humbly disagree with them. Achieving greater Internet access in developing countries can save lives, transform communities and revolutionize the quality and provision of healthcare for hundreds of millions of people today. Not only should connectivity be part of the global development agenda, it must be recognized as a vital enabler of the entire agenda.

There are several important reasons for this.

First, better tools for diagnosis and communications can lead to differences in health outcomes. One group of students at Stanford, through our Liberation Technology course, recently produced a mobile app to improve clean water delivery in a large slum in Kenya, allowing users of the app to locate the cheapest prices for water in their community, comment on quality and identify sources of water that make people ill. Another app for community workers targets cholera treatment in areas without any physicians. While many of us in the developed world use our mobile phones for triviality, in developing countries they can be the first line of defense in a public health emergency. This isn’t about cat pictures or Angry Birds — mobile phones can be the difference between life and death.

from Nicholas Wapshott:

Robert Fogel and the economics of good health

Robert Fogel, who died this week, won a Nobel for economics by mining historical data and in the process shook up the study of history forever. Just as with cholesterol, it seems there is good data mining and bad data mining. Fogel’s was undoubtedly the good kind.

As a teenager when World War Two was ending, he switched from chemistry and physics to study economics at Cornell because he feared, as did others, that when military spending was withdrawn the economy might retrench and sink back into a reprise of the Great Depression. It didn’t turn out that way.

Governments in the Western world switched from spending money on arms to spending on hospitals and schools and the buoyancy kept another slump at bay until the economy was on its feet. Fascinated by figures, as an academic Fogel applied quantitative methods used in economics to test whether historians’ hunches about the cause and effect of events were correct. His findings led to immense controversy and, eventually, a Nobel Prize.

President must address Obamacare ‘train wreck’

When even a key architect of Obamacare says the law’s implementation will resemble a “train wreck,” it is clear that its biggest remaining supporters need to finally level with the American people about what’s in store — starting with President Barack Obama.

The president must step into the breach and explain to the public that skyrocketing premiums and a raft of new taxes, penalties and fees are coming their way.

It may not be easy, but the president has a responsibility to explain as frankly as possible what this law will mean — before its major components take effect. He could start by delivering a major address, just as he did to push the law’s passage, laying out exactly what Americans can expect. He should also instruct his Cabinet secretaries to explain what this could mean as well. Families and businesses across America need time to prepare — and that means they need to know the facts.

Obama’s Two Choices: Good and Better

President Barack Obama must like the view from 1600 Pennsylvania Avenue right now. Politically speaking, the sky is clear, and the few clouds on the horizon have silver linings.

Because where things now stand with Congress, if he wins – he wins. And if he loses – he wins.

Getting Republicans to bend to his will on any of the banner issues this year – whether immigration reform, gun control or deficit reduction – will help enshrine him as a president of real achievement. If he fails, however, these same issues can be used as bludgeons to pound Republicans as heartless, even racist, knuckle-draggers who only want to service their rich masters.

from The Edgy Optimist:

Obama sees the limits of government

President Barack Obama made the middle class the focus of his State of the Union address on Tuesday. He was lauded by some as fighting for jobs and opportunity, and even for launching a “war on inequality” equivalent to President Lyndon B. Johnson’s 1960s War on Poverty. He was assailed by others for showing his true colors as a man of big government and wealth redistribution.

Yet the initiatives Obama proposed are striking not for their sweep but for their limited scope. That reflects both pragmatism and realism: Not only is the age of big government really over, so is the age of government as the transformative force in American society. And that is all for the best.

Wait a minute, you might reasonably object: What about healthcare? What about the proposals for minimum -wage increases, for expanded preschool, for innovation centers, for $50 billion in spending on roads and infrastructure? Surely those are big government and aim, effectively or not, for transformation?

from The Great Debate UK:

Quality of care the missing link between coverage of care and health improvements

--Jocalyn Clark (@jocalynclark) is Senior Editor at PLOS Medicine. The opinions expressed are the organisation's own.--

While coverage of health care has increased considerably since the international community defined its millennium development goals to improve health around the world, health gains remain stubbornly elusive, especially in developing countries, and poor quality of care may be the reason why.

These are the conclusions of leading maternal health scholar Dr. Wendy Graham and her colleagues as they reflect on the global progress in women’s and children’s health in preparation for the global maternal health conference in Arusha, Tanzania this week that brings together 700 delegates and political leaders from around the world.

Now is the time to focus on healthcare affordability

Now that the Supreme Court has provided legal certainty on the recent healthcare reform law, the nation must turn its attention to affordability. While the law expands coverage to millions of Americans, a goal health plans have long supported, major provisions of the law need to be changed to avoid significant cost increases for consumers and employers.

Healthcare affordability is an issue that touches every part of our nation: single parents struggling to make ends meet; two-income families trying to get ahead in challenging times; and retirees trying to stretch their budgets. Equally important, rising medical costs crowd out government spending on other priorities, such as education and infrastructure, and put our nation’s businesses at a competitive disadvantage in a global economy.

The first priority is to address a number of the reforms taking effect in 2014 that will make healthcare coverage more expensive.

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