Category Archives: deficit

The Fundamental Driver of Our Debt Problem: the Cost of Healthcare

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How to grow the economy faster. How to get our rapidly growing national debt under control.  These are the two main problems facing our country which I address over and over again on this blog.  Finding satisfactory solutions to these two problems will determine our future strength and prosperity as a nation.  Today’s discussion is about the major cause of our debt and deficit problem.
CaptureI recently came across the above chart showing the steady rise of overall American healthcare spending (public and private).  In 1960 it was less than 6% of GDP.  Now it is approximately 18%, a tripling, compared to the overall size of the economy, in just 55 years. Of course it is the cost of public healthcare programs such as Medicare, Medicaid and the Affordable Care Act which directly contribute to our growing deficits and to the accumulated debt.
However we will never be able to limit the cost increases of these public programs until we get the fundamental drivers of private healthcare costs under control. As pointed out (in the chart below) by several scholars from the American Enterprise Institute, the basic reason for the high cost of private American health care is that “we don’t have enough skin in the game” as shown by the chart just below.  We are paying less and less of total healthcare costs out of our own pockets because more costs are paid directly by third party insurers.  This means we have less incentive to control our own healthcare costs.
Capture2The AEI has suggested several reform measures to improve this situation such as:

  • Placing an upper limit on the tax exemption for employer-paid insurance premiums.
  • Expanding the use of Health Savings Accounts to be used in conjunction with high deductible plans.

We have a stark choice in front of us. Either we move in this direction in the near future or we will face another, much worse, financial crisis.  In the latter case we will end up with an inferior healthcare system, much less responsive to our wants and desires.

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Another Way to View the Presidential Candidates

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As regular readers of this blog well know, I constantly advocate for two major changes in government policy:

  • Speeding up economic growth, which has averaged an anemic 2.1% per year since the end of the Great Recession in June 2009. This will create the new and higher paying jobs that country so badly needs.
  • Shrinking annual deficits, ideally down to zero, so that our huge public debt (on which we pay interest) will begin to decrease as a percentage of GDP over time.

My last post compared the President’s proposed budget for 2017 with a proposal from the House Budget Committee. Basically the President’s budget increases both taxes and spending while the House budget keeps revenues at a steady 18.2% and leads to a balanced budget after ten years.
Capture2The non-partisan Committee for a Responsible Federal Budget has just produced an interesting report, ”How Much More Would Government Spend Under the Next President?” It compares the spending plans of the remaining five presidential candidates from both parties.  It finds that:

  • Only John Kasich would actually decrease spending over the next decade from 22.1% of GDP (under current law) to 21.5%.
  • The other four candidates would all increase spending: Hillary Clinton (to 22.5%), Donald Trump (to 22.7%), Ted Cruz (to 23.4) and Bernie Sanders (to 29.5%).

Mr. Kasich’s spending restraint would amount to a 2% decrease over current law while Ms. Clinton, for example, would increase spending by 2%.
As I showed a year ago,  reining in spending by 2% per year over current law is a major achievement and will lead to a balanced budget in ten years. In other words, Mr. Kasich’s spending plans are in sync with the latest House Budget Committee proposal.  Perhaps this should not be surprising since Mr. Kasich served as Chair of this House Committee in the 1990s!
Easy question: Which presidential candidate and which chamber of Congress are acting in the most fiscally responsible manner?

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The House Budget vs the President’s Budget: Another Reason for a Balanced Budget Amendment

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In January I had several posts advocating in favor of a Balanced Budget Amendment to the U.S. Constitution.  Briefly, the argument runs as follows:

  • Our public debt (on which we pay interest) is now at 74% of GDP, the highest it has been since the end of WWII.
  • Democrats want to raise taxes and increase spending; Republicans want to cut taxes and decrease spending. The only way to satisfy both parties simultaneously is to run huge annual deficits which is exactly what has happened ever since the end of the Great Recession in 2009.

Current planning for the next budget year beginning October 1, 2016 has now begun. Both the House Budget Committee and the President have budget proposals for next year. As reported by the Peterson Foundation, these two budgets differ substantially:
Capture0

  • The President’s budget would hold the public debt at about 75% of GDP over the next ten years by both raising taxes and increasing spending on a variety of programs.
  • The House Budget Committee plan keeps revenues steady at 18.2% of GDP over the next ten years and achieves a balanced budget after ten years. By 2026 the debt held by the public would fall to 57% of GDP from its current 74% level.

Here are two significantly different ten year budget plans. What is likely to happen is a complete standoff without any bipartisan agreement.  This means that no appropriations bills for individual government agencies will be enacted by October 1.  Finally, as usual, an omnibus spending bill will be put together by Congressional leaders and forced through at the last minute to avoid a government shutdown.
A BBA would make both sides compromise and come up with an overall plan.  It would likely contain both spending restraint and new sources of revenue.  Then the various Congressional committees would hammer out the spending details for individual agencies and department.  It would be a far more sensible and transparent process than the way things are done now.
Congress and the President have to be forced to act in such a reasonable manner.  A Balance Budget Amendment is perhaps the only way to make this happen.

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Why I Lean Republican II. Priorities for the Next President

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In my last post, “Why I Lean Republican,” I endorse the ten year budget plan just released by the House Budget Committee which will lead to a balanced budget within ten years.  It represents an excellent starting point towards addressing one of our country’s most serious problems, our huge and rapidly growing national debt.
Capture1
Jim Vanderholm responded to this post by giving his own top priorities for the next President. They are:

  • Job Formation. All sorts of other problems would be addressed in the process. Record high numbers of unemployed and underemployed. Record numbers of people on 85 different welfare programs at a cost of over $1 trillion per year.
  • Highly targeted education/training of the workforce to fill the newly created jobs with American citizens.
  • Reducing annual deficits. Growing the economy by putting more people back to work will bring in more tax revenue. Along with slowing the growth of spending this will lead to lower annual deficits. Once the deficit is reduced by half or more of its current value (about $500 billion), then the debt as a percentage of GDP will begin to shrink.
  • Reduced focus on divisive social issues. The basic structural problems referred to above will not be solved by more gun control, higher carbon tax, shuttering the coal industry, free pre-school and college education, or discontinuing tax-payer funding to Planned Parenthood.

In other words, we need a new President who will focus on basic economic and fiscal issues and not be distracted by divisive social issues. In fact, an ideal division of labor would be for the House Budget Committee to take the lead in getting spending under control while the new President attempts to implement policies to get the economy growing faster. This would lead to real progress on both fronts!

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Why I Lean Republican

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In the midst of a tumultuous presidential campaign season, it iscommon for partisans of the left and the right to question the integrity, motives and values of those on the other side of the political divide. For example, the rise of Donald Trump in the Republican primaries has led some observers to declare that the Republican Party has lost its way and no longer has any sort of basic, coherent and broadly acceptable political philosophy.
On the contrary, I think that Republicans do by and large share the following two general attitudes towards government which are favorite topics of discussion on this blog:

  • Economic growth in recent years has been much too slow and it should be a major goal of government to substantially speed it up.
  • Our national debt is much too high and Congress and the President should be making serious efforts to balance the budget on an annual basis.

The House Budget Committee has just made a big contribution towards the second goal with, “A Balanced Budget for a Stronger America. Fiscal Year 2017 Budget Resolution.”
Capture0Here are its basic components:

  • The federal budget will be brought into balance over a ten year period.
  • Devolving power back to the states.
  • Prioritizing the responsibilities of the federal government and concentrating on the most important.
  • Strengthening government functions that are critical to the health, retirement and economic security of millions of Americans.

Such a budget plan as this could make an excellent first step towards an eventual bipartisan agreement that would address some of our country’s biggest problems. Instead it is likely to be ridiculed or dismissed by the Democratic Party as mere political posturing by the Republican majority in Congress. What could be a beginning to real progress on urgent issues will probably just be washed down the drain.

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The Quality of American Health Care

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One of the most common themes on this website is the high cost of American healthcare. What I am saying is that our annual deficits are way too high and that our accumulated debt is increasing too fast.  Furthermore, the only way to get the cost of healthcare entitlements, Medicare and Medicaid, under control, is to get the overall cost of private healthcare under control as well.  And, of course, I support specific policies to do just this.
CaptureIt so happens that I have just had a major interaction with the American healthcare system in Omaha NE where I live.  I go jogging first thing in the morning, five days a week, all year around.  I have done this all my life and have never had a problem – until last Monday morning when I slipped on some ice, fell down and fractured my wrist.  What I did then was:

  • Call off my 8:00 A.M. Calculus class
  • My wife, Sharon, took me to a Minor Medical facility at 8:00 A.M. just as it opened.
  • The facility x-rayed my wrist and determined that I had broken several bones.
  • They then located an orthopedic surgeon who could see me the same day at 2:50 P.M.
  • The surgeon scheduled me for surgery the very next morning.
  • The surgery was successful and I am now recovering.
  • In other words, 30 hours after my accident occurred, I had had an intense inter-action with American medicine and came through with flying colors.
  • To say the least, I am very impressed with the quality of the facilities and healthcare professionals with whom I interacted.

It may cost an arm and a leg for this superb medical treatment but then I have excellent health insurance which I have seldom had to make use of.
Conclusion: Although we must make significant changes in healthcare delivery in the U.S., to make the system more cost efficient, we should try hard to do this without affecting the high degree of quality inherent in the system.

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Why the GOP Should Reconcile with Donald Trump II. How to Do It.

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As I have stated over and over again on this blog, It Does Not Add Up, my greatest concern for our country is the lack of fiscal responsibility amongst our national leaders.  The public debt (on which we pay interest) is $13 trillion, which is 74% of GDP.  This is way too high for peacetime and, furthermore, it is very likely to just keep getting worse until serious steps are taken to shrink it (as a percentage of GDP).
CaptureIt is my opinion that the Republicans are more serious than the Democrats about fixing this problem.  Therefore I want the Republicans to nominate a presidential candidate who has a good chance of being elected in November.  I don’t know if Donald Trump is that candidate but he is attracting a whole new group of people to the Republican cause.  They are working class whites who have fallen away from the Democratic Party.
Republicans can reach these voters, as Trump is doing, with suitable policies such as:

  • Immigration. Rather than “Comprehensive Immigration Reform” which would put most of our current illegal immigrants on a path to citizenship, we should adopt the principle, “All the immigrants we need but only the immigrants we need.”  A tightly constrained Guest Worker program, enforced with border control and eVerify, would accomplish this.
  • Free Trade. Trade agreements are still possible but need to include provisions like Trade Adjustment Assistance or other programs to help retrain laid-off workers for the millions of well paying, high skill jobs in the U.S. which are hard to fill.
  • Tax Policy. Rather than skewing tax cuts mainly for the wealthy, as most of the Republican candidates propose, they should be applied equally to all income levels, and fully paid for by shrinking deductions which mostly benefit the wealthy. This would put more money in the pockets of all middle income workers and create more and better jobs at the same time by speeding up economic growth.

Conclusion. Donald Trump has lots of negatives as a presidential candidate but Republicans can, and hopefully will, learn a lot from his very successful campaign so far.

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Why the GOP Should Reconcile with Donald Trump

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I am a non-ideological fiscal conservative. I don’t judge government as being either too large or too small.  I just want to pay for however much government we do have without going into debt.  Such an approach normally leads to political compromise whereby Congress tries to operate efficiently and hold costs down, only raising taxes as a last resort when it is impossible to squeeze any more low priority programs out of the system.
Such common sense used to be a fundamental operating principle, adhered to by both political parties.  Unfortunately in recent years we have moved away from this model.  In fact our public debt (on which we pay interest) has rapidly accumulated to $13 trillion, 74% of GDP, and will continue to grow much higher unless we strongly change our ways.
In some ways our current presidential campaign is following a conventional path.  Both of the major Democratic candidates, Hillary Clinton and Bernie Sanders, want to expand federal programs and raise taxes to pay for the new spending.  The Republican Tea Party candidate, Ted Cruz, is a constitutional and social conservative and wants to cut back on government programs.  The leading Republican establishment candidate, Marco Rubio, supports modest new programs, such as expanding the Earned Income Tax Credit, and also modest tax reform to stimulate the economy.
Capture0The wild card in the presidential race is Donald Trump.  He is a secular populist with unconventional and even contradictory policy views.  He not only leads the Republican field in most polls, he is steadily pulling ahead.  He is doing all this by attracting huge support from working class white voters who have fallen away from the Democratic Party.  In other words, he is potentially expanding the Republican base and therefore should be taken very seriously.
Question. Can a fiscal conservative (who just wants to balance the budget!) but who also wants to address the very serious social problems in American society, support a Donald Trump candidacy for president?  I am struggling with this question.  Stay tuned!

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Health Care Spending is Driving Budget Deficits

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In my last post, “Annual Deficits are Starting to go Back Up,” I refer to a new report from the Congressional Budget Office to show that it is the large annual increases in federal healthcare spending (Medicare, Medicaid, CHIP and Obamacare) which is the main driver of our annual deficit spending which is going to start increasing again unless we do something serious about it.
CaptureThe basic problem is, as shown by the above chart, that Americans, in general, don’t have enough skin in the healthcare game, i.e. we don’t pay enough of our health care expenses out of our own pockets, and therefore we don’t directly feel the pain of high and rapidly increasing health care costs.
A group of policy experts from the American Enterprise Institute have come up with a practical plan to address this problem.  Its elements are:

  • Retain employer provided coverage. This is how half of Americans get health insurance. The only change would be an upper limit on the tax preference for employer-paid premiums so that only the most expensive plans would exceed it.
  • Tax Credits. Individuals without employer coverage would get a tax credit with no strings attached to pick any state-approved plan that meets their needs.
  • Continuous coverage protection. As long as people stay insured, they cannot be denied enrollment based on health status.
  • Medicaid reform. The federal government would give states fixed, per-person payments based on historical spending patterns. Able bodied adult and their children could combine Medicaid and the (refundable) federal tax credit to enroll in a private insurance option.
  • Medicare reform. Medicare would provide a fixed level of assistance which seniors would use to purchase a health plan of their own choosing.
  • Expanded Health Savings Accounts. These are intended to be used with catastrophic insurance with a high deductible. HSAs could be established with a one-time $1000 tax credit and unused funds rolled over from one year to the next.

Such a system does not repeal, but rather improves the Affordable Care Act. It keeps the ACA exchanges and introduces cost controls in a flexible manner, i.e. without mandates.  It is the type of system the U.S. needs to get health care costs, and therefore overall deficit spending, under control.

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Annual Deficits are Starting to Go Back Up!

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As regular readers of It Does not Add Up know well, I am highly alarmed about the large budget deficits and slow economic growth in the U.S. in recent years.  Some people respond that deficits are falling and that we have entered a new era of slow-growth secular stagnation which is unavoidable.
CaptureA new report from the Congressional Budget Office, our most reliable source for objective fiscal and economic information, now predicts that the deficit for 2016 will be $544 billion, a large increase over the $439 billion deficit for 2015.  Furthermore, CBO predicts that for future years deficits will continue to grow, exceeding $1 trillion by 2022. Here is a summary of the CBO predictions:

  • Federal outlays are projected to rise by 6% this year, to $3.9 trillion, or 21.2% of GDP. This represents a 7% rise in mandatory (entitlement) spending, a 3% increase in discretionary spending, and a 14% increase in net interest on the national debt.
  • Under entitlements, Social Security payments will increase by 3% and healthcare (Medicare, Medicaid, CHIP (children’s health) and Obamacare) payments will increase by 11%.
  • Revenues will increase by 4% in 2016, to $3.4 trillion, or 18.3% of GDP.
  • Deficits are projected to increase from 74% of GDP in 2015 to 86% of GDP by 2026.
  • Spending for mandatory programs will increase from 13.1% of GDP in 2016 to 15% of GDP in 2026.

First Conclusion: The spending increases from 2015 to 2016, outlined above, illustrate a clear and alarming trend which is evident in the full ten-year set of CBO data. Discretionary spending will rise but at a sustainable rate of about 3% a year or less.  Mandatory (entitlement) spending will rise at a much faster and unsustainable rate.  It is healthcare spending, i.e. for Medicare, Medicaid, CHIP and Obamacare, and not Social Security, which is driving the rapid increase in mandatory spending.
Second Conclusion:  Although it is government healthcare spending which is driving our rapidly worsening deficit and debt problem, this is just part of the larger problem of the rapidly increasing cost of overall (including private) healthcare spending in the U.S.  This is the basic problem we need to focus on to get both fiscal and economic policy back on the right track.

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