I support reform of Social Security, Medicare and Medicaid; this is also essential. We have to refashion needed social support programs so that they can be carried out within our means. You could add public education as well. But I believe those programs have to serve effectively and cost-efficiently those who need to be served. They have to be cost-efficient based on global best practices and, with the exception of public education, they should be focused on serving only those who really need them and can't afford them. And that would exclude me. All should be means-tested. And fraud must be policed, rooted out, and punished, consistently.
I view these essential programs--Social Security, Medicare and Medicaid--as public insurance for those who can't afford them, not universal entitlements. And in the area of public healthcare, heroic efforts and extraordinary costs in the last year of life--cases of terminal illness or advanced age--now account for 35-40% of all healthcare costs. Extraordinary cost to keep someone alive for another week, month or months is not something we can afford as a nation. For each of us there comes a time to die; let us learn to do it with understanding and dignity. Most such cases should be directed to hospice care. For those who would so elevate the value and public cost of another day at the end of their lives to such a level, there is available private insurance. A much more responsible public trade-off is to better provide or subsidize care for young and working-age people in need.
But I cannot fly false colors, I also support single-payor--government--health insurance for the general population, at the very least as an alternative. Some form of universal healthcare is almost as important to our economy and society as education. But the varied financial interests in the healthcare industry and their political proxies have frightened the public, often those who would most benefit from it, and their combined voices have assured that it's just not going to happen anytime soon. So, pragmatism dictates that we deal intelligently, responsibly, accountably, with the system we have.
Those social support programs and public education are critical to our increasing need for better educated, healthier and more productive sources of skilled labor and intellectual capital--from every corner of society. But the marketplace, by its very nature and dynamics, does not distribute public goods effectively, equitably to all. It distributes them by amount and quality according to ability to pay. Markets insure that those without most often remain without. That's just the reality of it, the way it works. That's why there is the notion and programs called "public goods," those services needed for all to strengthen and protect our people, grow our country, and maintain its stability, those services that only government can provide on that basis.
But let's say more about the whole issue of social and political stability, especially as it is threatened by a shrinking middle-class of decreasing means. We should be mindful of the dynamics of social and political instability, it's causes and potential results, something we have too little experience with to treat seriously. Nevertheless, it is something we should take more seriously, something about which history and so many failed or dysfunctional international states in modern times inform us. And the relationship between failed or failing social support functions and social and political instability is strong. And a signal, a warning of potential issues of instability is a weakening or disappearing middle class.
If these social goods are as important to our economy and society as I believe, then after reforming them as much as possible, making them as cost-efficient, focused and effective as possible, if there is still a budget shortfall--and everything I've read suggests there will be--then taxes must be raised, and first on those who can most afford to contribute more. And while I would likely be among those affected, another 3% or so will not change my life; I paid that in the '90s. So I would count it my duty and privilege to play a larger part in financially supporting those values, and those social/economic goals. That, to me, is also patriotism. (And yes, I also served my country in the military. I was six years an enlisted man, a sergeant in the Marine Corps during the Vietnam War era. Only after did I attend college on the government's GI bill and loans, then law school and graduate business school.)
Then there is the attraction of a balanced budget requirement, which sounds good, but is too often unworkable, or at least too limiting. There have been those times when economic disaster threatened, 1929, 1937, and 2008, and to a lesser extent in every recession, when deficit government spending was important or essential to avoid economic calamity. We ignorantly took the wrong road in both 1929 and 1937, but took the right road in 2008--even if we have a major defit challenge to address as we struggle back toward economic growth. We have to retain the fiscal flexibility to meet the economic challenges facing our country, whatever that may require. And if in the past, the congress has been irresponsible in managing the budget and deficits--and it has, for a long time--then it's time to vote in people who will be more responsible and balanced, not hamstring the congress when it has to lead in those worst of economic times.
Finally there is the question of timing. Substantial progress on deficit reduction has to move forward, even if it must be in the nature of commiting us to measures that will not take effect for a few years. I say that because that is the warning that most credible economists are now sounding, and a concern I raised in a recent post, "I Have Questions." Anti-stimulative measures--reducing government spending or increasing taxes--at a time when the economy remains weak, even fragile, and the original stimulus programs have run their course, runs a substantial risk of either driving us back deeper into recession or significantly extenting the time for meaningful recovery and job creation. We heard little of this in the government and public debate, but it is nonetheless a significant consideration. Only now, in the last couple of days, is it being made clear that this is a further problem that must be treated seriously as deficit reduction planning moves forward.
Of course, there are many who do not agree with--or don't understand--the economic importance I place on these social programs and education, and the responsibility, the duty, we have to pay our fair share of taxes to support them. It is part of the price and privilege of sharing and growing in the American experience, the American dream. I'm sure many of those folks are as sincere and convinced of the rightness of their views as I am of mine. But as a former corporate executive for 20 years, I have become convinced of their importance to meeting the increasing demands of global competition, the need for enhanced capability and increased contribution at all levels of the talent pool, and to the stability and happiness of an advancing society.
Now, as a 21st-century man, and having lived the life of American possibilities for almost 65 years, I also want to be part of the next step in providing for the economic and social advancement of American society, for increasing the breadth and depth of access to opportunity, to education, healthcare, and retirement security, and for broadening the sense of civic responsibility and accountability. That means a strong economy is essential, as is budget responsibility; but it also means that government must play its part in providing the necessary public goods equitably to all, and we all must recognize the duty and necessity of financial support that falls to all who have benefited from them.
1 comment:
I almost wish there were something I could disagree with here -- but I can't. Thanks for putting what I also believe into words far better than I could.
Marc
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