You can't help but wonder what information people use to decide on who to elect.  Consider this map based on data from the U.S. Bureau of the Census (Link to data source).  This map provides you with the distribution of poverty percentages by county in 2009.  The red areas are the areas with the highest levels of poverty. 

There is an interesting relationship between the states with the most counties with high levels of poverty and the voting paterns of those states.  The political red states are also the poverty red states.  It is certainly an oversimplification to suggest that there is a cause and effect relationship in either direction.  That said, it is hard not to puzzle over why the states with the highest level of poverty tend to support politicians that are the least willing to take steps to address poverty.

I am not talking about opposition to welfare.  I am talking about politicians who eschew funding for a vast array of services that serve to provide people with the education and support systems to rise out of poverty.  The question is if our national economy can effectively recover with so many people living in poverty.  

Economists are increasingly discussing the potential problems associated with high levels of poverty and wider and wider gaps in the distribution of income.  This is often cast off as a form of class warfare, but the wider issue is the degree to which we are in the midst of a decline in our standard of living. It's nice to believe that poverty is something that anyone can rise out of given hard work.  If it were only so.     

The Wealth Gap

I believe that a picture is worth a thousand words, so I am providing a link to a website that offers some very interesting maps of poverty and wealth:  http://www.visualizingeconomics.com/2007/08/11/united-states-poverty-map/ .  If you look at the three maps, one on poverty, one on income inequality, and one on household income, a pattern is revealed.

The worst-off part of the country is the South.  In fact, there is a striking relationship between those states that are called red states and having sizable areas of the state that fall into the lower-income categories.  Of course, this high-level cut of the data makes any conclusions about the meaning of this relationship suspect.  I will leave it to the reader to ponder the issue and consider the possibilities.

What can be said is that there are consequences that are reverberating through the United States as income inequality increases.  These gaps show up in those with lower incomes having lower health status, less educational attainment, and even less motivation as workers.  In addition, even as we extol the virtues of education as one of the saviors of our economy, states, especially the poorest, are cutting education budgets at every level. 

As wealth increasingly rests among the few, the traditional mechanisms of educational funding, including property and sales taxes, have become strained.  The explanations for this is simple.  First, wealth now rests in the investments of a smaller and smaller subset of the population, investments that once were sources of property taxes such as manufacturing plants, but are now often in non-taxable investments that are outside of the U.S.  This is compounded by the fact that that share of income that is paid in sales taxes tends to go down, so as income distributions become more skewed, the proportion of sales taxes goes down. 

There is probably no easy solution to this problem, but if we don't begin to look at it and address it, we will see the standard of living of our country decline.  

Lie to me

If you've watched the show, "Lie to Me," you have a pretty good sense of the latest motto for most Americans.  Nothing drives me crazier than the unending assault of prevaricators who will offer one theory or another, but never be challenged to back up the assertion.  Consider this map based on U.S. Census data on the uninsured.  The greener the area, the higher the proportion of the uninsured.  The fact is that many of the uninsured are agricultural workers in Texas, California, and Florida.  Given the rhetoric of both parties, you would either believe there are no uninsured at all, or that they are everywhere. 

Then there are those who seem to think that the best way to save the economy is to cut government spending.  I'll be the first to step up and argue that there is a great deal of waste in what government does, but consider the number of private bankruptcies each year.  People just mess up, whether they are in the government or the private sector.

Now let's consider the spending cut idea.  First, short of Iraq and Afghanistan, this is not just money being thrown out the window.  It's money going to businesses for purchases and to pay employees.  So, logic tells you that if you cut spending, there will be fewer purchases and fewer jobs.  Doesn't that make us worse off?  Now if capital was flowing freely into the private sector and cutting spending would boost that, OK, but who are you kidding?  Common sense tells you that cutting spending is just not a good idea in the middle of a recession.  If someone tells you it is, I suggest you watch the show, "Lie to Me," and see if you can pick up the signs.

Faith in government

The attack on government at every level is unending.  As others have pointed out, this is not new.  During the late 60s, protesters railed against both the Johnson and Nixon adminsistrations.  Today we have the tea parties demonstrating agains the government takeover of the United States.

In both times we experienced a dramatic decline in our faith in government.  But these time are different and more dangerous.  The loss of faith in government is occurring at a time when our economy is at its lowest point since the Great Depression.  For many Americans, the only source of support they have is support provided by unemployment insurance, a government program.

I believe, however, that the loss of faith in government goes much deeper.  It is, in fact, a loss of faith in those who are in power to provide needed national leadership.  In his book, The Power Elite, Charles Wright Mills articulated that political, industrial, academic, and military positions of leadership represent an elite that is driving and control public and economic policy.

Any even casual examination of recent history will find many of the same players regardless of the party in power.  There are those who suggest we are headed toward socialism, and they may be correct, but it is a socialism that is rooted in plutocracy .  Now I wish that this was government by a Disney character, but unfortunately its root is the Roman God Pluto, the god of the underworld and its riches.  Plutocracy, then, it government by those who hold wealth.

It is no accident that as a candidate from either party rises in the polls, the donations from wealthy interests moves to the projected winner.  Time and again politicians make the argument that their decisions are not influenced by campaign contributions.  But this is simply semantic parsing to avoid what the contributions do accomplish. 

The principle driving force behind government policy is access.  Wealth and contributions afford access.  Common sense alone tells us that what someone believes and does will be fundamentally shape but what he is exposed to.  If the circles in which the politicians walk are always the circles of the wealthy, then they will make decisions that are in tandem with what supports the needs of those with wealth.

Rightly or wrongly, the Supreme Court recently ruled to allow corporate campaign finance, ultimately widening the access doorway to the wealthy.  How does this all go back to the loss of fairth in government?  At some level most of us recognize that the government is not some sort of neutral entity operating separate and appart on behalf of constiuencies.  It is an entity that is at best a collaborator with the other members of the "Power Elite."  What we have seen in recent years is the failure of that group at every level:  failed government, failed industries, and failed military strategy.

These were not simply mistakes, but profound errors in judgement and ethics that have taken the United States and much of the rest of the world to the brink. 

Health Reform Part 2

The amazing thing in the process of health reform is that neither party appears to have the slightest idea about how the actual system works. I can only assume that they have been so taken over by special interests that they lack the capacity to express anything close to what is real.

As I said in the previous comment, a big part of the problem is the reimbursement system. One additional complicating factor is balance billing. Balance billing laws prohibit physicians from charging more than the negotiated contract price, even if they do so openly.

Let's put this in perspective. Can you imagine any product or service that was price controlled such that differences in quality could not be accounted for in the price? Of course not. Yet, that's what physicians are stuck with.

The arguments in favor of preventing balance billing focus primarily on preventing physicians from adding fees that are not specifically covered by insurance. This seems like a good protection for patients, especially in th4e face of a health crisis. But, unfortunately, the baby has been thrown out with the bathwater.

The laws also prohibit the patient from negotiating with the physician. What if I want to establish an agreement that the physician will see me in no more than 10 minutes, but I'm will to pay 10% more for that? You can get express passes at Disney World, but you can't get an express pass with your physician?

Let's put some economic reason back into health care. The desire for economic reason is not at odds with a goal of ensuring all Americans have the health care they need. How someone gets health care paid for is separate from how the reimbursement system works and the mess it makes things.

Health Reform Breakdown

I started my career back in the days when we were trying to control health care costs by using certificate of need reviews. For those of you who don't remember, that was the effort in the late 1970s to control health-related capital spending. The assumption was that we were duplicating too much capital investment. Not much has changed.

Then came diagnostic related groups. I'm afraid the folks in Washington didn't figure that hospitals would figure out how to game the system. Again, health care costs kept going up.

In spite of evidence that DRGs did not work, a similar system was imposed on outpatient services based on what are called relative value units. Doctors don't get paid for an office visit, they get paid a standardized fee based on the diagnosis. If you wonder why your doctor doesn't spend time with you, it's because after somewhere between 7 and 10 minutes, they don't get paid especially well for their time.

The fact is that nothing in health care reform has even begun to address this Byzantine system that ends up requiring physicians to have specially trained staff to help them properly code their bills.

Don't think for a minute that somehow the single payer system will help all this along. The brain trust behind DRGs and RVUs is the Centers for Medicare and Medicaid Services (CMS http://www.cms.gov/).

Can we fix this mess? You bet. It starts by freeing physicians from this absurd reimbursement system and letting payments become a transaction between the patient and the doctor. Consumer driven health plans are a step, but without getting rid of the current reimbursement system, they simply cannot work. Doctors don't know what the cost of a visit will be until after the diagnosis, so price transparency is impossible. Other professionals charge for their time. Why can't doctors?

A Lack of Indignation

It seems to me that we are a culture that has lost the notion of righteous indignation. I see an administration that labels any critic unpatriotic, corporate leaders who come up with scam after scam to feather their nests, and government officials so corrupt that they must go into hiding.

The only place to find indignation is by listening to assorted comedians as they try to make a comic turn of this sad state. Why are the interviewers so polite? The first question I'd ask nearly any politician I encountered is, Do your really believe that? So many spew unfettered drivel that is nothing more than an ideological chant that it seems they believe if repeated enough might give birth to truth.

If this is the best we have to offer as a culture, then there is little hope for we are doomed to be mired in delusion. Do not stand for it. When you see a wrong, speak to the moral vacuousness of that wrong. Hold people accountable. Consider the effort to make the ten commandments visible in public places. Are those who advocate that willing to live by them? Remember, thow shalt not bear false witness. Live by that one alone and there would be no campaign commericals.