The Real Debate Over Health Care: the Role of the Insurance Companies

A lot is being written over the fissures within the Democratic Party on Health Care. Some, like Bernie Sanders, unequivocally support Medicare-for-All. Others, like Amy Klobuchar and Sherrod Brown, both Midwest senators with more conservative constituencies, want a more incremental approach, a Medicare buy-in option for example, or lowering the age for Medicare eligibility from 65 to 50.

Sounds good, right. Medicare-for-All is way too radical. A more moderate approach stands a better chance of getting the broad-based support needed to get through Congress and be signed into law.

Except that the insurance companies, with their web of campaign contributions and armies of lobbyists, will pounce on any compromise and turn it into a variation of what we have today – a system with huge overhead and administrative costs that rewards waste and inefficiency over positive health outcomes.

Sound familiar – that’s essentially what happened with Obama Care. State-by-state exchanges just to make sure there are no incentives to create national plans that operate more transparently and efficiently.

So Bernie Sanders is right – it is time for universal health coverage in a nationwide program that takes the insurance companies out of the mix, thereby saving U.S. economy and the American consumer huge amounts of money that today are wasted on a system that rewards administrative inefficiency over the health of the American people.

Memo to Donald Trump: Want to Fix Our Crumbling Inner City Neighborhoods? Here’s How.

Philadelphia Mural Arts

Relocating Federal workers to inner city neighborhoods is one way to help revitalize those neighborhoods and stimulate much needed investment. Federal tax credits would also help …

America has one of the highest poverty rates in the industrialized world.  It is a living tragedy and a national disgrace, as TDV wrote recently.  Much of the poverty is located in rural areas, including Appalachia, the deep South and Southwest.  But many big cities also have high poverty rates, including Philadelphia, which ranks among the most poverty stricken urban areas in the country.

And yet in Philadelphia and other big cities it sometimes feels like a Tale of Two Cities.   Millennials are moving back and downtown and surrounding neighborhoods are booming.  Travel outside the downtown areas, however, and you will still find sections of the city that time forgot, with vacant houses, potholed streets and dilapidated buildings.

Donald Trump has called for increased investment in our inner cities, labelling them “ghettos” and  a “disaster.” He has also been roundly criticized, and rightly so, for overstating how bad things really are.

In many urban neighborhoods, there is a resilience and vibrancy that is easy to miss if you don’t get out of your car.  The “drug bazaars” of old are largely gone; crime is down, and commercial areas are coming back in many areas.

But Trump is right about one thing:  the infrastructure of many urban neighborhoods is in bad shape and now is a good time to invest, to build on the progress that has been made in reducing crime and revitalizing commercial districts.

But we need to throw out the old playbooks, think more creatively, and develop more comprehensive approaches.  These include, in addition to rebuilding infrastructure, attracting business, fixing the often broken school systems and providing quality support services including low and moderate income housing, job training and child care.

A good way to start the ball rolling is to move government agencies into those neighborhoods.  Such an approach provides an economic anchor that can be used to better deliver services while attracting additional investment and jobs.

One model is the Sharswood / Blumberg Transformation Plan in North Philadelphia where the Philadelphia Housing Authority intends to locate it headquarters, anchoring a revitalizing commercial district including low and moderate income housing and rehabilitated public schools.

But why limit it to just local agencies? How  about moving Federal agencies to our inner cities?  Such as approach was recently proposed by Fred Kupiec, a resident scholar at the American Enterprise Institute, writing in the Wall Street Journal:

Many towns and cities across America would welcome the economic development and stability that accompanies a well-paid federal-agency workforce like the FBI or the Labor Department. The expense of managing the federal government should be used to spread wealth beyond the nation’s capital and revitalize the economies of America’s ailing cities.

The Federal government should also provide tax credits to those who build affordable housing in our inner cities.  The burden for providing credits to stimulate investment in our inner cities falls too heavily on local governments whose budget is already strained by a diminished tax base and high demand for services.

Let’s hope Donald Trump keeps his word.  Our inner cities can use the help, and it is long past time for the Federal government to do its bit.

Some of Worst Poverty in America a Subway Ride Away from DNC

PhilaPovertyMap7

More than a half century after President Lyndon Johnson announced the War on Poverty, poverty rates in the U.S. average 15% of the population, or 47 million people, among the highest in the industrialized world. It’s a living tragedy and a national disgrace, and TDV has called for a “New War on Poverty.”

Sadly, tackling poverty in the U.S. does not seem to be high on the agenda of either major political party. The Republicans are busy whipping the country into a frenzy of fear and paranoia which helps divert attention from their real priority – more tax breaks for the wealthy.

Meanwhile, many of those attending the Democratic National Convention in Philadelphia this week seem strangely out of touch with what is going on in the real world, more adept at “sloganeering” than  tackling the major issues of concern to ordinary Americans – a lack of opportunity and decent paying jobs.

Perhaps delegates to the Democratic National Convention should spend less time attending fancy receptions and cocktail parties and more time out in the neighborhoods, getting to know the people who actually live in the City of Brotherly Love.

Like many urban areas, Philadelphia has enjoyed something of a renaissance in recent years.  Young millennials have flocked downtown and surrounding areas where they can easily walk to work, get around on public transportation and enjoy a vibrant nightlife of hip bars and eateries.

That’s the Philadelphia that many conventioneers are likely to see, with most events scheduled to take place in South Philadelphia or Center City where much of the “millennial renaissance” has occurred.

But just north of Center City, still in the shadow of the iconic statue of William Penn atop City Hall, are some of the most blighted neighborhoods in America. Philadelphia is the poorest of America’s large cities, with more than 25% of its residents living below the poverty line. In many areas of North and West Philadelphia, the rate is 50% of more – twice the city average (see above chart of poverty rates by zip code).

Here’s a suggestion for those attending the Democratic National Convention – as you leave the Wells Fargo Center where the convention is being held, walk about a block north on Broad Street to AT&T station. Take the subway – the fare is $2.25 – through Center City, past Temple University to Broad & Erie, about a 25 minute ride.

BueryBuildingThere you will find a vibrant – if dilapidated – commercial district. Look up and you will see the long vacant Beury Building, a graffiti covered Art Deco classic that has been sitting vacant for years. Walk a few blocks in any direction, and you’ll see trash strewn vacant lots and crumbling buildings everywhere. Visit any of the neighborhood schools and you’ll find children who haven’t had a decent meal all day and teachers paying for food and supplies out of their own pockets because the state has cut funding and diverted resources to privately run “charter” schools.

We must eliminate poverty in the US by attacking it where it lives, in the neighborhoods of Philadelphia and other cities and rural areas across the US. We must fix the crumbling infrastructure, provide a safe environment and quality education for all children, and decent jobs and job training for adults struggling to find work in a faltering economy.

When we do that America really will be “the Greatest Nation on Earth,” as Michelle Obama said in her speech Tuesday night. But with all due respect to the First Lady, who gave an otherwise great speech, as long as there are 47 million people living in poverty in the US, we have a long, long way to go to claim that mantle.

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Wide Eyes on the Streets of Brooklyn

PeopleinBrooklynParkTDV travelled to Brooklyn yesterday to visit with family members.

On the surface, Brooklyn is an exciting and vibrant place, and we had a wonderful time walking Ft. Greene Park and surrounding avenues with great little shops, restaurants and bars.

Beneath the surface, however, as Spike Lee has discussed recently, it felt like something was happening that is, well, maybe not so cool.

  • An asset bubble with condos and row houses selling in the millions
  • Gentrification on a grand scale.
  • Social stratification with rich and poor, black and white, rubbing elbows but not really mixing

From a public policy perspective, how do you deal with such a situation? Well, among other things, you might want to use some of those new found tax revenues on million-dollar condos to help stimulate jobs growth and housing opportunities for low and moderate income residents.

And, oh by the way, isn’t that what Mayor de Blasio has been trying to do?

And he has been taking a lot of heat for it in some quarters, as evidenced by mounting opposition to the planned Brooklyn Bridge Park project.

But perhaps his critics have not walked the streets of Ft. Greene lately with eyes wide open.

 

Poll: View that Economy is Rigged Transcends Racial Divide

A New York Times / CBS poll conducted July 14 to 19 finds a fairly sharp increase in people, white and black alike, who think race relations in the US are deteriorating. 68% of black respondents said relations were generally bad, while 57% of white respondents felt that way.   Prior to this year, this level of pessimism in race relations in the U.S. has not been seen on a sustained basis since the 1990’s, according to the data.

The good news is that, in the wake of the Charleston, SC church shootings, a majority appear to recognize the problem and we now seem open to at least having the conversation. The bad news is the conversation is not easy; the problems are deeply ingrained in our society, and they won’t be easy to fix.

Among the problems that need to be addressed, and there are many, is a general lack of economic opportunity that the NY Times / CBS poll suggests transcends the racial divide. The poll found that whites and blacks, at 57% equally within each group, share the view that it is “mainly just a few people at the top who have a chance to get ahead”

Perhaps if we were to do a better job of leveling the playing field for all our citizens – white, black, Hispanic and Asian – it would make the conversation on improving racial discrimination go just a little easier, and yield results a little quicker.