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Voter awareness and discomfort about the $1.6 trillion deficit this year, does not translate into wanting to see spending cuts in Medicare, Social Security and popular programs. It is the view of public opinion that is determining political leaders inaction on these issues, which are at the heart of controlling spending and the deficits. It is no surprise then that the Obama budget showed no action on these issues. Both parties are careful not to talk about cuts to popular programs without broad public support. The Pew Research Center survey shows 12% of Americans want to cut spending on Medicare or on Social Security, only 6% want to reduce spending on veterans benefits. Politicians can do the math from these numbers. They may be sending loud signals to Democrats and Republican politicians that voters will punish those who cut these popular programs. Polling done by the Wall Street Journal and NBC News produced similiar numbers.

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In this editorial the Wall Street Journal says it supports the "sequester" or trigger of automatic cuts in 2013 if the Supercommittee in the U.S. Congress fails to reach agreement on budget cuts. Across the board budget cuts are not the best option, but says the Journal given that politicians have failed to come to agreement this is the best option available. This will generate $68 billion in savings in 2013. The Congressional Budget Office estimates cuts will be 7.8% for domestic programs, and defense will take a 10% cut. Medicare spending will fall by 2%, mostly payments to providers. To put this in perspective the Journal points out that total domestic discretionary spending doubled to $614 billion in 2010 from $298 billion in 2000, providing a higher starting point for cuts. It says some of the cuts in defense could be restored through a supplemental bill as planned by Sen. McCain.

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Biden's very conservative choices for his cabinet which one British reader of The Times calls UK One Nation type choices. Many of the cabinet members could easily have served under a Republican administration before Trump or a Democratic administration in the tradition of Harry Truman in the 1950's. No members of the cabinet belong to the Bernie Sanders wing of the Democratic Party.  A look at the Truman administration after 1950 shows John Wesley Snyder, who headed a bank in St Louis and worked for the Reconstruction Finance Corporation under Franklin Roosevelt performing a key role for integrating 8 million GI soldiers into the economy, and implementing the Marshall Plan. A similar job awaits another banking official Janet Yellen in Biden's cabinet to keep people employed during the pandemic. Xavier Becerra, currently attorney general of California, and formerly Congressman for 24 years, who endorsed "medicare for all" is the new Health Secretary. He grew up in a one room apartment with his Mexican parents. Secretary of State goes to Anthony Blinken, Dean Acheson was in this role under Truman as the Cold War surged with the Berlin crisis and the Iron Curtain in Eastern Europe. Today the challenges from Russia and China are taking the shape of a revival of tensions. George Marshall who led American forces in the war, was secretary of defense. This position is given to a soldier Gen. Lloyd Austin who led forces in the wars in the Middle East. This has the potential to deliver better results after the years when America veered off course under the administrations of Reagan, Clinton, Bush and Obama, following the Truman, Eisenhower administrations that setup the recovery after World War II. Today after the banking crisis of 2009, disastrous healthcare and infrastructure neglect in the U.S., followed by the pandemic, a recovery like the one after World War II is needed.   ...

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See Tim Walz's full speech at the Democratic National Convention in Chicago, August 21, 2024 in his video from CBS News. Lyrarc has selected excerpts from Tim Walz's speech above showing what the Trump Republican party plans to do that will gut Social Security and Medicare, and kill the Affordable Care Act, gut efforts to lower exaggerated cost of medical drugs and healthcare. This excerpt shows what Harris will do to build a better life for workers and families and people across all 51 States, in education, childcare, healthcare, cost of living, and housing costs- "We’ve got something better to offer the American people. It starts with our candidate, Kamala Harris. From her first day — as a prosecutor, as a district attorney, as an attorney general, as a United States senator, and then our vice president — she’s fought on the side of the American people. She’s taken on the predators and fraudsters. She’s taken down the transnational gangs. And she’s stood up to powerful corporate interests. She has never hesitated to reach across that aisle if it meant improving your lives. And she’s always done it with energy, with passion and with joy. Folks, we’ve got a chance to make Kamala Harris the next president of the United States. But I think we owe it to the American people to tell them exactly what she’d do as president before we ask them for their votes. So this is the part — clip and save it, and send it to your undecided relatives so they know: If you’re a middle-class family, or trying to get into the middle class, Kamala Harris is going to cut your taxes. If you’re getting squeezed by prescription drug prices, Kamala Harris is going to take on Big Pharma. If you’re hoping to buy a home, Kamala Harris is going to help make it more affordable. And no matter who you are, Kamala Harris is going to stand up and fight for your freedom to live the life that you want to lead, because that’s what we want for ourselves, and it’s what we want for our neighbors."       ...

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The costs of fraud in medical care from spurious Medicare claims to kickbacks for unecessary services is estimated at $125 to 175 billion. Costs of unnecessary care from overuse to unnecessary lab tests are between $250-325 billion. The amount wasted for on treatment for preventable conditions such as heart disease and diabetes. is $25-50 billion. This number is much higher when all the complications from obesity are figured in. These amounts alone add up to $500 billion. Add to it the problems and the costs of medical errors leading to bad drug reactions or other misdiagnosed procedures which cost an estimated $75-100 billion and the the total is upto $600 billion. These amounts are not going to be tackled by computerization of medical records. The whole manner and ways in which medicine is practiced today and the manner in which the public takes care of its health would have to change for an impact to be made in these numbers.

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The startling truth about health "reforms," - they won't control spending, and without that the whole system of health care will rapidly become unaffordable and unsustainable. Obama's Council of Economic Advisors points out in new report that since 1975 annual health spending per person, adjusted for inflation has grown 2.1 percentage points faster than overall economic growth per person. At this rate health spending which was 5% of the GDP in 1960, and is 18% of GDP today, would grow to 40% of GDP in 2040. Medicare and Medicaid would increase from 6% of GDP now to 15% in 2040, or equal to three fourths of federal spending. Employer paid insurance premiums for families which grew 85% in inflation adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040. This would force employers to reduce take home pay. Samuelson says the uncontrolled health spending is singlehandedly determining national priorities, reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs, while it is producing large amount of waste in medical spending. See the link to Prof. Tyler Cowen of George Mason University in NYT, 6/14/ 2009, who cites the habit of doctors to write many expensive tests as one of the prime culprits in the wasteful spending. And in the process it delivers higher cost for lower overall quality of health for the American people. This at a time when many European countries provide live examples of doing it in a better way- lower cost, better health. The serious problem with the Obama health reforms says Samuelson is that it talks about restraining spending but may end up increasing spending. Its talk about controlling spending he says is good intentions, but based more on hopeful thinking, public realtions and risks becoming cosmetic reform. Because to really control spending will require coming to grips with its fundamental cause- hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, private or governmental. Such a system encourages doctors and hospitals to provide more services, expensive tests, favors heavy use of expensive medical technologies to increase profits, and for patients to expect them. Samuelson puts his finger on the root of the problem - there is no incentive and every disincentive for all the players in this game , doctors, hospitals and patients to seek reform of this system. For doctors and hospitals the hope would be that this cosmetic "reform" would leave the system basically unchanged, and patients to continue with a lifestyle and expectations that do not not acknowledge the fact that a lot of healthcare does not come from spending but from preventative care, education, good eating and exercize habits, and healthy lifestyles. And the uninsured are no exception, they would simply start consuming the expensive care for lower quality of overall health like everyone else. With this kind of situation confronting us, the views of Samuelson, and Professor Tyler Cowen of George Mason University, as welll as a growing chorus of informed public opinion on this subject, is that insuring the uninsured is a good idea, but doing it within the bounds of the present system, can only increase the costs. And too much is at risk, to rely on what Samuelson calls a scattershot of measures to control costs made up by Congress such as "evidence -based guidelines," "electronic record-keeping," "bundled payments to hospitals, to give the illusion of progress that won't make a serious difference. A sweeping restructuring of health care is needed, that would overhaul "fee-for-service" payment and reduce the fragmentation of care. It will also need what has not even be touched on adequately in the debate. This is the massive need for education in the schools about nutrition, eating, exercize, healthy lifestyles. It would also require opinion leaders in each field from sports and other fields to lead by example and with constant public presence, the media, and companies to form a partnership with private institutions to change existing eating habits and lifestyles that encourage obesity, smoking, fast food eating habits, large portions in restaurants....

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Leonhardt points out that public workers receive lower salaries and higher benefits than private workers. They are being paid in the wrong ways. For example with health insurance coverage that require little or no co-payment, which lead to overuse of healthcare services that don't necessarily improve health. Politicians and unions appear to have accepted this practice over the years. Public sector unions have blocked efforts to improve efficiency and find better ways of doing things from the classroom to work in government offices. Reforms in states such as Indiana have produced some results. But even these improvements do not address the magnitude of the problems facing the U.S. which stem from the public's desire to have it all- from large defense spending, public services, low taxes and no changes to Social Security and Medicare. Polls show Americans want to reduce deficit spending, but the same polls show Americans unwilling to make some difficult choices.

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House Majority Leader Eric Cantor talks with Joseph Rago of the Wall Street Journal. There is a fundamentally different world view between Obama and Cantor. Cantor does not hesitate to present his view and says President Obama did not like to be challenged on policy grounds in debt negotiations, leading to the famous "I'll call your bluff Eric" remark by Obama. Cantor sees no chance of reaching an agreement with Obama that would go towards solving the fiscal crisis and feels it would be best to focus on incremental wins. He says of the Obama-Boehner deal that it did not address the problems with Social Security and Medicare. Without the transformational changes that are needed in those programs he did not think it was worth the cost. Cantor is mainly responsible for the Republicans not agreeing to include revenue increases in the negotiations or the final deal. Cantor says the super-committee part of the deal which has to come up with savings, will only lead to incremental progress- considering the huge divide that separates their world view and that of President Obama. The real fight says Cantor is to prevent President Obama from getting re-elected....

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Lipton, Austin and LaFraniere of the NYT tell the story of how the serious differences between the prime contractor for the federal healthcare website, CGI Federal, and the Obama administration officials handling the website, evolved into conflicts that could not be resolved. This led to the flawed website being rolled out on schedule ignoring serious problems with the website. The detailed report comes after interviews with Obama administration officials and specialists who worked on the project and looking into government and contractor documents. A month ago in October 2013 the healthcare website for the Obama healthcare law was up only 42% of the time with 10 hour failures happening frequently. Basic steps for the functioning of website backup systems in case there is a failure, testing to ensure negligible or no outages, were not secured. The government officials responsible for the rollout did not have the capabilities to handle such a project. Henry Chao, who worked in the Medicare agency for 19 years was left to oversee day to day questions for the website HealthCare.gov, but lacked a formal background in software engineering and no authority to make the decisions needed. The $630 million project was setup inside the Medicare Agency, instead of a separate agency specially setup for this project and staffed with the appropriate skills as originally proposed. Five different lower level government officials made decisions without the authority needed and no one person with the necessary skills was given overall responsibility and decisionmaking. A series of missteps were allowed to take place- settting many added requirements that made it difficult for contractors to focus on basic steps and get them right, use of the MarkLogic database system instead of systems from IBM or Oracle against the advice of contractors, multiple contractors without a way to control the overall project, shifting requirements from the government and bureaucratic delays for resolving basic issues such as use of social security numbers, all worked to create delays. With the delays came a deterioration of relations between Obama administration officials and the contractors. The government officials response was to stick to the deadline of Oct. 1 rollout, with Michelle Snyder, chief operating officer of Medicare agency telling people she would fire the contractor if possible. In the end no one took responsibility for a safe reliable rollout, even though the system failed a test of 500 users in late September and was down half the time in mid-October. President Obama or his advisors were either not kept fully informed, or did not grasp the significance of the collapse in relations between contractors and the government and a project out of control. His aloof distanced approach was not an asset in such matters- saying about the rollout and use of the website: "this is real simple" like using the Kayak website for travel bookings- and he saw no need to take action leading to the major failure for the administration that followed....

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U.S. president Trump's 2017 budget is an effort to reshape spending priorities by the Republican party. Apart from Medicare and Social Security all other entitlement programs from the days of Lyndon Johnson's Great Society are subject to cuts. Deep cuts to Medicaid and food stamps, including introducing work requirements. The philosophy behind it is that compassion will now be measured not by how large these programs are but by how much the government can get people "off these programs and back in charge of their lives,"  according to Budget Director Mulvaney.  The cuts are $616 billion to Medicaid and Children's Health programs, $193 billion in cuts to Food Stamps, $143 billion in student loans, $72 billion in disability programs. The overhaul of the Affordable Health Care Act is part of this change. The reallocation would put more money into infrastructure for $200 billion, and in tax cuts, $19 billion in a parental leave program and $29 billion for veterans programs, plus added spending on the military. William Hoagland of the Bipartisan Policy Center, a Republican who worked on budget issues says it will be politically difficult as the cuts to lower income groups come with tax cuts for small businesses and higher income individuals.  Beyond the policy priorities there is an area where both Republicans and Democrats are skeptical of the budget. This is how it impacts the U.S. debt. Under Congressional Budget Office estimates the U.S. debt as a percentage of GDP which rose to about 75% after the Great Recession starting in 2008, is projected to grow to about 85%. In sharp contrast the Trump administration estimates of the Office of Management and Budget are for it to drop to 65% based on rosier estimates of 2% inflation, 3% growth for the decade ahead. Experts say this is unlikely once the Fed raises interest rates and the unemployment rate currently at 4.4% leads to rising inflation, undercutting growth which has remained below 2% for a long period. These concerns are also voiced by Hilsenrath in the WSJ based on the experience of other countries such a Britain that cut corporate taxes without seeing an uptick in economic growth. ...

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The Obama adminstration and Democrats start the U.S. "fiscal cliff" negotiations with a call for $1.6 trillion of additional tax revenues, twice the amount of $800 billion discussed in talks with Republicans in the summer of 2011. During the Obama-Boehner talks in mid-2011, the Republicans and Democrats neared agreement for a plan to cut the deficit by $4 trillion over 10 years, with new revenues of $800 billion. Obama then pushed to raise the revenue to $1.2 trillion and talks collapsed afterwards. The Republican side through GOP senior aides says $1 trillion in new tax revenues is where this could end up. The Republicans would agree to cap deductions for the wealthy as proposed by Feldstein-Romney, and the Democrats would agree to changing Social Security and increasing the Medicare eligibility age to above 65 as proposed by Rep. Chris Van Hollen (D., Maryland) in such a scenario.

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"No amount of misrepresentation or statistical contortion can conceal or blur or smear that record. Neither the attacks of unscrupulous enemies nor the exaggerations of over-zealous friends will serve to mislead the American people." FDR said this  on October 31, 1936, it could also be president Biden.The current Media and Hollywood efforts to choose presidential candidates of their choice runs contrary to "We the People," contrary to views of ordinary Americans, of voters, workers and families. President Kennedy was told he should not take the nomination because he was too young. Kennedys' response was that it was he not Humphrey that went to state after state and won the votes in the primaries, no one else made the effort to run in the primaries in each state. President Biden has the support of 14 million in the primaries. George Chidi from Atlanta reports that undecided voters number about 1 million in the swing states and most are much older than the average. Most may feel insulted by talk about age when they are in the same category.  A 102 years old Lockheed engineer in Atlanta suburbs says he is a Republican but will not vote for Trump. There is also the women's vote in Georgia and Atlanta suburbs with abortion ban as the issue as it was in Kentucky and Kansas. How many vote will also be a factor, making energizing the base a key factor. The idea that one party is doing better than the other is refuted clearly by some of the people in Georgia shown here, and the age factor does not get the prominence the Media have given it, as long as the government is functioning well. Media has failed to look at the policy details of each candidate in a colossal failure that calls for alternatives. Older voters who are the major part of the 1 million or so voters in swing states that are undecided also say that the fact is that with both the candidates- as it is with administrations that are led by young presidents seen as too young to lead (JFK) the opposite of today- many of the decisions are made with an experienced group of advisers around the president. Many if not all also realize that the vast experience of an older president is also an asset. Much of Biden's legislation for chips science, infrastructure, the Inflation Reduction Act have not happened in Germany, France or the UK, and would not have happened in the US without the ability of president Biden to get the bipartisan support from being the one with the most experience in Congress in a long time. The result is the hundreds of thousands of jobs created each month and a growing economy, inflation down from 9 to 3% as the first step to further cost of living action to support ordinary workers and families. Only LBJ comes close and he signed landmark legislation for Medicare and Medicaid, and for civil rights into law 60 years back. By removing America from the wars that Reagan and Bush started and Obama and Trump failed to end president Biden has given the US an opportunity to inspire and lead the free world in a way that has not happened in many decades and build a growing economy, a bright future for the Nation. ...

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Allan Blinder gives a spirited account of what he sees in the Paul Ryan Republican deficit reduction plan. He says that with the voucher plan retirees would fall further and further behind the increasing cost of health insurance. With no explicit cost containment proposals it assumes that some kind of miracle will occur for costs to be kept in check- especially as Republicans want to repeal the cost containment proposals in the President's healthcare plan. He asks whether someone is saying, that we have to destroy Medicare so it can be saved. Ryan woulld also turn Medicaid into a block grant, then underfund it and let the states figure it out when they are in a budget squeeze. Blinder points to the estimates of the Center on Budget and Policy Priorities, that show about two-thirds of Ryan's budget cuts would come from programs that serve low and moderate income Americans. And to make matters worse the steep spending cuts go to finance tax cuts that largely benefit the wealthy. He calls this Robin Hood operating in reverse, and coming on top of 30 plus years of rising inequality. David Stockman makes a similiar point on the editorial pages of the New York Times, April 24, 2011; also adding the point that the middle class will have to pay higher taxes for the deficit to be addressed, something President Obama's plan fails to do. Blinder says that the Bowles-Simpson and Rivlin -Domenici proposals attack the deficit reduction problem in a better way, that asks something from all classes and interests. ...

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Senators Elizabeth Warren and Bernie Sanders defend Medicare for All, a version of free healthcare for all, and free university, from attacks by moderates. So far in the campaign in the Democrats part the moderates have failed to gain traction. Warren and Sanders lead the field. The only other contender is from the old Obama presidency, Mr. Joe Biden. Warren and Sanders say now is the time for bold ideas. Sanders won the Michigan and Wisconsin primaries, by articulating this vision in the last campaign 4 years ago.

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U.S. states want flexibility in applying the Medicaid program which covers 53 million Americans earning lower levels of income. This amount was $11,616 a year for working parents in 2009, according to the Kaiser Fondation. Some states have a higher income level, as high as $48,400. The problem for states are serious budget deficits, with Medicaid comparing with education as a major cost. The recession and job losses has added 8 million Americans to Medicaid rolls. The Federal government supports 57% of the Meddicaid budget on average. A provision in the 2010 health care law says states cannot limit Medicaid eligibility, or they would lose funding by the federal government. The Obama adminstration's position is that eligibility or provider cuts will not bring in large savings, and will allow larger cost-sharing by Medicaid users, with only minor cuts in eligibility. Its position is also that the law does not give the federal government waiver authority. Some of the issues raised relate to the structure of Medicaid cost and its rapid escalation. Health and Human Services says 1% of benificiaries, especially the long term care, use up 25% of the Medicaid expenditures. One astonishing fact is that two thirds of all U.S. nursing home residents are on Medicaid. The total cost is rising, from $187 billion for Medicaid in 2000, to $346 billion in 2009, according to the Centers for Medicare and Medicaid Services. In July 2011, $26 billion in additional federal Medicaid funding expires, which will be added to state expenses as they struggle with large deficits. In states like Maine, with generous benefits, about one fourth of all residents are in the Medicaid program. ...

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The influence of the AMA convened Relative Value Scale Update Committee (RUC) on how the Medicare payments to doctors is shared, and on the growth of the Medicare budget. Concern that the interested party is driving the decision making process. Medicare costs went up by 9% in 2009. Fears that doctors have too much control over the dollars in the $500 billion Medicare program. The tendency to focus on more expensive procedures and short change preventive and less costly care. Medicare spends $60 billion on doctors fees. The older codes remain in place even when costs are reduced, leading to higher costs for the Medicare budget each year. And there is little incentive for doctors in RUC to revise overvalued codes.

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As remedies for the $1.6 trillion federal budget deficit for 2010, which says Hubbard threatens to compromise Americas economic future, set agggressive targets for reducing discretionary spending limiting growth to 2%. Hubbard also wants to see 1% reduction in projected entitlement spending growth for Social Security and Medicare. This can be done progressively, he says, by lowering the growth in spending for middle and upper income households and strengthening the safey net for lower income people. And third he would have a broad based consumption tax to pay for added social spending. Hubbard was adviser to president George W. Bush and is Dean at Columbia Business School.

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With 5.7 million jobs lost since December 2007 fewer people are paying payroll taxes to support Medicare and Social Security says Labor Secretary Solis. As aresult Medicare will run out of funds by 2017, 2 years earlier than predicted last year. Medicare and Social Security issued their annual report yesterday, suggesting the nation cannot afford the cost of Medicare at the rate of current expenditure growth. Social Security will run out of money by 2037 four years earlier than predicited before. The only way to keep Medicare solvent says Mr Geithner is to reduce the rate of growth of health care costs.

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A new report by Medicare trustees found that the Medicare hospital trust fund would face insolvency by 2029, which is 12 years after the projection made last year. But Medicare's chief actuary questioned this by saying that this assumes cuts in payments to medical providers in the health reform bill would be implemented. Not realistic he says, considering that many doctors would drop out of Medicare causing difficulty for seniors. After 2029 Medicare would be able to pay 85% of the benefits according to this report. Separately the Social Security fund is expected to need a $41 billion cash infusion, with more paid out in benefits, than collected in tax receipts in 2010 and 2011, with this situation getting worse by 2015.

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The worst flaw in the health care bill says the Economist is that "fee for service" and doctors billing for each test done continues as before.The whole idea of medical services based on medical necessity and value for money has been left out of the billsin Congress. Alan Meltzer also pointed this out in his discussion of the deficits and debt over the next decade; that the 25% reduction in medical expenditures does not look anywhere closer to reality, worsening the deficits. This is also the view expressed in the discussion of health care reform in the November 2, 2009, issue of Business Week. Never mind said BW that the doctors and hospitals account for one third of medical expenditures and there is waste in Medicare spending. Congress said BW has made no changes in the "fee-for-service" system of medical care that has inflated medical costs, by paying doctors for the volume of services delivered and not the quality of services delivered.

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The US is facing a new pattern of demographic changes and their impact on Medicare and Social Security programs. The number of people on Medicare will grow in 2 decades, 2010- 2030, from 47 million to 80 million for Medicare, and from 44 million to 73 million for Social Security, according to this estimate. The workforce will grow more slowly and the tax base wiill shrink accordingly during this period. This pending worker-pensioner imbalance and the jump in the cost of the bill for Medicare and Medicaid, as well as the federal health benefit for poor people, create a major problem for the US. At the same time the group of people over 65 will rise in these 2 decades from 17% of the voting age population to 26%. This group and the people who expect to soon join this group will resist any changes to Medicare or Social Security programs, making it that much harder for the political process to tackle these issues to make the programs sustainable in the long run.

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The structure of the deal that is coming up for a vote in Congress on August 1st, a day before the August 2 deadline. A deal put together mainly by Senate minority leader Mitch McConnell and Vice President Biden after other deals failed. It gives the government $400 billion immediately and another $500 billion in the fall for raising the debt ceiling. Another 1.2 trillion will be added in 2012. The entire burden for raising it falls on Obama. Obama will be able to get the debt ceiling raised without another long struggle before 2012 elections. On spending cuts- agency spending will be cut by $900 billion over the next 10 years. A new legislative committe will be set up to come up with $1.2 trillion in additional savings by the end of 2012. The mechanism that would force the committe to act or make sure spending cuts were taken if the committee failed, was set up as one in which the trigger is to force automatic across the board cuts. The automatic across the board cuts would be for $1.2 trillion to agency budgets for the next 10 years, and split this half and half between domestic programs and defence. Programs aiding the poor including Medicaid and Social Security would be exempted, but Medicare payments to providers could be touched. No new taxes are part of this deal....