Posts Tagged ‘Government spending’


May 25, 2016

I came across an op-ed piece in our local newspaper recently by Eliot Cohen. His commentary boiled down to a call for a third-party candidate. He termed Hillary Clinton “easily the lesser evil” and posited that a third-party candidate would send her a message to “govern from the center.”

A bit later in the week I had a brief political sidebar with a patient (this seems to arise more often these days), and he expressed disgust with the current polarization and voiced a similar wish for more cooperation and a move to the center.

Now, I’ve been persistently perplexed by the rise to the top of two deeply flawed candidates who share at least one thing in common: They have the highest unfavorable ratings of the pack. So what would possess the American public to ostensibly rally around their least favored candidates? The call for a move to the center gelled a theory I’d been harboring.

But first, getting back to the patient, I inquired if he were $100,000 in debt, would he reduce his spending to neutral, “governing from the center,” as it were, or would he tighten his belt in an effort to climb the uphill road to fiscal recovery?

For decades now progressive Democrats and Republicans have doubled down on unprecedented “grow and spend” policies that have become so entrenched that much of the electorate cannot imagine a viable alternative. Many have adopted a similar personal fiscal policy, planning little for the future while enjoying the moment. The lines for $5 and $6 dollar Starbucks’ beverages grow even while we hear of increasing joblessness and a shrinking economy. The illusion of the status quo is buttressed by a growing welfare state supported by unprecedented borrowing, printing, and their associated campaign promises.

But the odd bird of an election we’re witnessing reflects an unease that’s starting to ripple across a growing segment of the country: a realization that things are not working. For many, the solution has taken the shape of a call for an outsider; someone who will do something—anything—differently. For some this “savior” takes the form of a blustering, fist-shaking, non-politician who talks a lot about “winning,” with populist catch-phrases in search of elusive policies and substance. For others, it’s the siren call of wealth redistribution, the indomitable phoenix of socialism and its comrade “social justice,” once again rising from the ashes even as the world watches its demise again…and again. And yet others crave a return to the only normal they can fathom after decades of intransigence, just a few more years of comforting printing and spending, and things will eventually work themselves out. This, even if the promises come from someone they don’t really trust…and who might be indicted. Finally, a growing but stunted group made an aborted attempt to place a voice that spoke to the only solution that makes sense: Shrinking government, reducing spending, stopping crony capitalism, and growing the private sector economy. But this messenger was tainted ideologically. Those on the left are conditioned to see this this viewpoint as espoused by narrow-minded bigots who love only corporate fat cats, and many in the center were put off by exhortations weighed down by right-to-life and other perceived religious undertones.

When faced with the knowledge that something must be done and the one obvious solution you’ve been told is evil, cognitive dissonance occurs, and the paradox creates…the Hillarump-Trillary Syndrome. Side effects include mini-riots at campaign stops and spending an inordinate amount of media time distracting oneself with the pros and cons of a minute fraction of the public’s right to choose which bathrooms they may enter.

A third party candidate? Americans have always been an exceptionally innovative people. Given time, I’m certain we can come up with a someone we like even less.



May 19, 2013

A couple of weeks ago I received a report from an out-of-area cardiologist regarding a mutual patient who spends part of the year in another state. The note referenced a 3-year-old cardiovascular test ordered by me with intent to repeat. There was no record of the more recent study done a few months ago, perhaps forgotten by the patient. I contacted the patient only to learn the repeat study has been completed a day earlier.

If you think this unnecessary duplication of effort is an isolated event, think again. It’s just another example of the 20-30% of the waste in the system. An industry characterized by third-party payers and often little to no patient out-of-pocket expense lends itself to this scenario. The insurers don’t have the ability to track all of this, and perhaps lack the incentive as well, as long as they can raise premiums and maintain robust profit margins. Usually the quick fix is employed—the blunt instrument of progressive reductions in reimbursement for the most commonly employed tests and procedures, regardless of their appropriateness or complexity.

If you think this is isolated to the heath care industry, think again. Waste is the new god of Western society. Its worship takes the form of long-term government guarantees of retirement benefits regardless of market conditions, funded by loans and wave after wave of “quantitative easing,” the green ink flowing like a verdant waterfall. The largesse even spills into the private sector, from time to time. When General Motors decided, at the behest of the union leadership, to emulate the government’s modus operandi with unsustainable retirement guarantees in the form of defined benefits, the ruling class stepped in with freshly printed and borrowed money to prevent the inevitable implosion. The move was applauded by many; the alternative would have been near-term hardship on a major scale. The future fall-out from this is … well, in the future.

A majority of the electorate is perfectly happy to allow this state of affairs to continue. Retirement, unemployment and welfare benefits provide comfort, and a reasonable standard of living. It’s also comforting to attribute the current economic malaise to the failure of the wealthy to pay their fair share, rather than indiscriminate borrowing and unbridled printing. Some believe it will all heal when the economy magically recovers. Others don’t think about it at all. The more informed and cynical will try to get whatever they can before the end of the road is reached.

I don’t know how long the road is. Perhaps it ends when our debt-to-GDP ratio reaches 170%, as in Greece. I do know that history, ancient and present, proves that it is not infinite.

So clink your glasses in salute to the new god. Green beer is a one day event—green money is forever. Or is it?


April 30, 2012

I’ve ranted in the past that we, as a society, seem to be playing ostrich-in-the-sand when it comes to the dire state of our economic duress. Here are some more clues that we’re clueless:

A ninety-year-old patient came to the office for routine a routine follow up visit (whether nonagenarians are good candidates for specialist evaluation in this financial climate is a discussion beyond the scope of this rant). She had recently been seen in the emergency room for abdominal discomfort and constipation. The physician on duty dutifully ordered an abdominal CT which was negative. I asked the patient if an old-fashioned digital exam had been done (forgive me for those of you who are squeamish) and the answer was no. She reportedly received no effective treatment for the complaint, and the daughter cured her with an enema after they returned home. I can only imagine the hospital charges for this unproductive visit.

I recently used one of those handy “double deal” coupons to buy dinner from a barbecue place I hadn’t patronized in a long time (please don’t tell my patients). I was shocked by the rise in prices over the past few years—about 85%. The meal was barely worth the discounted price, in my estimation. Yet, they seemed busy enough, mostly with young folks. Perhaps these youthful patrons were availing themselves of the same deal, although, based on the cost of one young couple’s order relative to the coupon value, I doubt it. I wondered how all of these customers, almost certainly in a much lower tax bracket, could afford these prices.

Two seemingly unrelated events, each illuminating the same principle: We’ve moved further and further away from the common sense frugality that characterized the mindset of our Founding Fathers. In any case, I’ve seen this pattern over an over: Movie theater popcorn, a large McDonald’s Coke, pricey designer jeans with strategically placed holes. I read about the large percentage of people that haven’t put aside anything for their retirement, much less their future health care needs, and can’t help but wonder if they’re the ones standing on the daily Starbuck’s line. It often seems to me the concept of value has vanished from the American consciousness, replaced by the notion that lifestyle comes before sacrifice, and that the government safety net will always be there. Perhaps our rulers are nothing more than a reflection of this mindset.

I think it’s time we all look down and realize we’re walking a tightrope, not a path, and the safety net below is frayed and riddled with holes. And the repair crew is miles away, sipping Starbucks.


September 18, 2011

The federal government is everywhere. It’s in the gas tank of my car, my kids’ lunchroom (or used to be, before I got gray and they flew the nest), and my closet—that’s one of the rooms I light with—horrors!—incandescent bulbs. Thankfully, (and forgive me Mr. Edison), these will be relegated to the status of eight-track tapes and floppy disks in 2012 when the president bans them. One pundit says we use more electricity on a single Google click than an incandescent bulb burns in an hour. I haven’t confirmed the truth of this, but I think a $2 million government study is in order to find out.

The point is, we can’t begin to cut back on government spending until we shrink government back to its proper size. And to determine its proper size, we need to agree on a job description: For me, it’s to provide for the common defense. I define this broadly, as I’ve indicated in prior rants, to include legislating to preserve the marketplace and protect capitalism, the economic engine of our great nation, from corruption. It’s hard to do this while distracted by lunchroom menus, warm, fuzzy closet lighting, and big lobbyist checkbooks.

So, where do we start? I propose with the Departments of Energy and of Education. The superfluous nature of the latter bureaucratic institution and its intrusion on the constitutional mandate that powers not expressly granted the federal government are the purview of the states was obvious to me. Those of you that feel strongly that the education of our kids is of such importance to our nation’s future that Uncle Sam needs to be involved should examine closely the state of our educational system and the performance of our students. I grant you that much improvement in state and local management is needed (I direct the interested reader to John Stossel’s investigative documentary “Stupid in America”) but I fail to see how the lumbering, expensive bureaucratic involvement at the federal level is helping.

Glenn Beck brought the excesses of to the Department of Energy to my attention in Broke, his analysis of the country’s economic woes. This cabinet-level monstrosity was created by Jimmy Carter in the 1970s to end our dependence on foreign energy and to regulate oil prices. Another great success. They’ve morphed into a crusade to “save the planet” according to a 2009 agency financial report cited by Beck. He argues that most of the DOE’s tasks can be privatized or eliminated. It’s beyond the scope of this short treatise to detail his arguments, but those interested are invited to evaluate this on their own.

I tell my patients that diets don’t work because the results tend to be short-lived; only true lifestyle changes structured to the maximum level of long-term implementation have a chance. The same is true of whittling down our government institutions. If we don’t have a fundamental change in the way we view the purpose of our government, even if we manage to surmount the tremendous hurdles immediately before us, in a few decades we’ll be right back where we started.

Next: On the road to a new lifestyle


September 12, 2011

Cynics say the government doesn’t do anything well, but they fail to give credit where credit is due: No one kicks the can down the road better than our ruling class. If we weren’t running out of road, they’d still be doing it. Lord knows,  at least half of them are still trying.

When it comes to cutting spending they’ve squirmed, squealed and squabbled. When they realized it was only a matter of time before the printing presses would run out of green ink, Congress abdicated its responsibility to a small committee of people that can fight in closer quarters. In fairness, we’ve enabled them; doing what they should do mandates major give-backs by us, things we’ve been granted in return for our sweet votes. Freebies our elected benefactors didn’t have the assets to offer in the first place. But the shiny printing presses were just too inviting. As I’ve said in prior rants, the government is addicted to spending.

The answer is simple, the consequences hard. Instead of endless, fruitless negotiations, we need to cut spending to 2008 levels. 2005 might even be better. There is a glimmer of hope that something dramatic may occur—people in  the electorate and in government are actually talking about the sacred cows, Social Security and Medicare, something that has been termed for decades the “third rail” of politics. Although they still gasp in horror when a presidential candidate refers to Social Security, a program that uses the money of relatively small numbers of players to pay for the burgeoning numbers of older participants, without putting aside a dime, as a “Ponzi scheme.” Oh, well, change comes slowly.

Cutting spending across the board doesn’t mean every governmental institution needs to remain sacrosanct. As crucial to our well-being as each and every agency may seem to the bureaucrats that nurture them, perhaps we can find a few modifications we can live with.

Next: Cutting the fat