Another Important Obama Accomplishment

Last week, we took a look at the ARRA (the American Recovery and Reinvestment Act) which has been characterized as “the failed stimulus bill.”  It has not been a failure at all, according to the Congressional Budget Office (CBO).  In fact, it has resulted in millions (between 5-25 million) of jobs both saved and created in the public and private sectors.  It is one of the many positive things that the President has done, or taken leadership to see accomplished, in his three years in office.  In fact, according to several writers and pundits, President Obama accomplished more in his first two years than any other President in history.  Republicans will keep trying to characterize his tenure as an abject failure, but their rhetoric is nothing but lies and distortions that cannot be backed up by facts (which they tend to ignore in any political “debate”).

This week, let us take a closer look at the Patient Protection and Affordable Care Act (PPACA), which Republicans and conservatives try hard to characterize as a failure, and as “government controlled”, and even as “socialism,” derisively referring to it as “Obamacare.”  As a matter of fact, it is less of a government-controlled system then is their own health care insurance, which is entirely organized, managed, and overseen by the OPM (Office of Personnel Management).  To go a step further, the extra health care benefits available to members of Congress includes clinical care on-site operated by naval personnel, and they have access to taxpayer-subsidized surgical/hospital care at Walter Reed Army Medical Center in Washington DC, and the National Naval Medical Center in Bethesda, Maryland. (Senate Minority Leader Mitch McConnell had heart surgery there in 2003). 

So let’s say, first, that the PPACA legislation does not contain a public option; that, under its provisions, the government does not provide services, nor does it control from where you get your health insurance.  You are free under this Act to continue choosing from a number of private insurance companies for your coverage.  The Act does have a provision for state-based Health Exchanges through which individuals and small businesses with up to 100 employees, could purchase qualified coverage, but these Exchanges can be administered by either a state agency or a non-profit organization; presumably, the states can make that choice.  States can also opt in 2017 to set up Regional Exchanges or allow other state Exchanges to operate within a given state.  In addition, the OPM will contract with private insurers to offer at least two multi-state plans in each Exchange.  Going a step further, the Act allows for the creation of non-profit, member-run health insurance companies in all 50 states and DC to offer qualified health plans. 

Are there some requirements in the Act that would involve government implementation and management?  Of course; but that doesn’t make it “socialism” or “government-run.”  There is a federal requirement that everyone be covered, backed up by certain penalties for those who fail to comply.  That is controversial, and will be addressed by the Supreme Court.  Some lesser courts have supported its constitutionality and others have not.  Other restrictions are placed on what can be offered by insurers and what cannot be included.  But, in my opinion, this is no different than many pieces of  legislation that require certain actions, programs, restrictions and innovations that result in changes in administration or management in the public and/or private sector.  One example:  the ADA - the Americans with Disabilities Act.  If the Court rules that the federal government cannot require all people to purchase health insurance then surely logic would say that government cannot require compliance with adaptive measures for all public and private facilities and programs.  In my opinion, it is ridiculous to say that the federal government cannot require certain actions on the part of all citizens when it clearly benefits all, or a major portion of, the citizenry.  We shall see…

Second, let’s take a closer look at the PPACA, and see what it has actually done for consumers in a positive way:

- allows adult children up to age 26 to be on their parents’ healthcare insurance; has already extended insurance coverage to 2.3 million young adults under age 26
- prohibits insurers from citing pre-existing conditions for denial of coverage;
- provides portability between employers;
- expands Medicaid to certain eligible citizens under age 65;
- extends funding for the Children’s Health Insurance Program through 2015;
- provides for a tax credit for eligible small employers (under 25 employees with annual average wages less than $50,000) that purchase health insurance for employees;
- establishes a national, voluntary,  insurance program for purchasing community living assistance services and supports (CLASS)
- prohibits lifetime limits on coverage

Here are some more positives that will occur in the near future:

- will provide refundable and advance premium credits to eligible individuals and families to purchase insurance plans through the State Exchanges
- will require Exchanges to maintain a call center for customer service, and to use a single form for application that can be filed in person, by mail or online;
- will create a temporary insurance program for employers providing health insurance coverage to retirees over age 55 but not eligible for Medicare
- will create an essential health benefits package which is the minimum that must be offered by all health care plans;
- will establish a temporary national high-risk pool to provide coverage to individuals with pre-existing conditions along with subsidized premiums;

And administratively, there are these helpful provisions:

- establish a process for reviewing increases in health plan premiums and require justifications for increases; provide grants to states to support these efforts
- adopt standards for financial and administrative transactions to promote simplification of administration, thus saving money
- impose same insurance market regulations in all markets and exchanges
- establish the Health Insurance Reform Implementation Fund to implement health reform policies
- permit states to create a Basic Health Plan for uninsured individuals in lieu of premium subsidies
- simplify health insurance administration by adopting a single set of operating rules; non-compliance will bring a penalty
- establishes a Council, a Fund, and a grant program to spur prevention, wellness and public health programs
- will require skilled nursing facilities to disclose information regarding ownership, accountability requirements, and expenditures and will publish results on a website so Medicare enrollees can compare facilities
- improve workforce training and development, much of which is focused on graduate medical training, nurse training and retention, and increasing both through scholarships and loans
- impose additional requirements on non-profit hospitals to conduct a community needs assessment every three years and adopt an implementation plan to meet identified needs

And finally, here are some consumer-based reforms that will improve health care insurance and health care delivery:

- will expand Medicaid coverage to all non-Medicare eligible individuals under age 65
- require qualified health plans in Exchanges to meet marketing requirements and will require reporting of information in certain areas of operation, including enrollee rights
- require all new policies offered through, and outside of, Exchanges to comply with one of four benefit categories
- develop internet site to help people identify coverage options
- develop standards for insurers in providing information on coverage and benefits
- establish an office of health insurance consumer assistance or an ombudsman program to serve as an advocate for people with private coverage
- establish an independent Payment Advisory Board to submit legislative proposals with recommendations to reduce the per capita rate of growth in Medicare spending when spending exceeds a certain target rate, and to slow the growth in national health expenditures
- improve care coordination for enrollees with both Medicare and Medicaid
- create an Independence at Home demonstration project to provide high-need Medicare beneficiaries with primary care services at home
- improve access to community care by increasing funding for community health centers, and for the National Health Service Corps, plus support for school-based health centers

This brief summary does not even include all the reforms to Medicare and Medicaid contained in this Act simply because we have discussed those elsewhere.  So, in essence, I have just skimmed what I presume are some of the more important reforms in the Act. 

What can we say, then, to the radical Republicans in Congress, and running for President, who want to repeal this entire piece of important legislation?  I suppose, first of all, we could say, “Do you even know what is in the Act?”  Second, we might ask, “Do you care at all for what ordinary people would give up or lose by your ill-advised action?”  Third, we might point to a letter from the CBO, dated  May 26, 2011, and written to Congressman Henry Waxman, ranking member of the Committee on Energy and Commerce, in which there is some discussion of the consequences of repealing this legislation, or more precisely, of permanently preventing the use of appropriated funds to implement the Act.  Here are some of the CBO points for your consideration:

1)  would result in a significant loss of revenues, particularly from certain fees and taxes that would be collected by the IRS: e.g. 40% excise tax on insurance plans above certain thresholds for persons with incomes above 250k, and certain insurance industry and pharmaceutical industry fees
2)  would significantly alter the effects of many provisions of the ACT, including changes to Medicare and Medicaid; the establishment of health care exchanges, tax credits, and cost-sharing subsidies designed to increase the number of Americans with health insurance
3)  would reduce the number of people with health insurance coverage compared with what would occur if the health care laws are fully implemented
4)  could prevent CMS from modifying Medicare payment rates on an annual basis; preclude CMS from engaging in the rate-setting process and signing contracts with private insurers that offer Medicare Advantage and Part D (prescription drug) plans; the possible result - no Medicare Advantage plans and no more Part D plans for Medicare beneficiaries!
5)  preclude the Secretary of HHS from implementing recommendations of the Independent Payment Advisory Board aimed at limiting Medicare costs
6)  prevent federal government from setting up insurance exchanges if states chose not to
7)  prevent CMS from assessing and collecting its share of higher rebates from pharmaceutical companies for drugs dispensed to Medicaid beneficiaries
8)  payment to doctors would be affected because the calculation of annual rates by CMS would be affected and rates would remain at current levels, and Medicare spending would increase in 2012 and 2013
9)  mandated demonstrations and pilot projects designed to improve efficiency and quality of care would increase spending in some cases
10) in the absence of mandates for insurance coverage, the number of families and individuals covered would be lower than under current law
11) grants to states for setting up exchanges and subsidies for cost sharing would not be available, putting states in a further bind as to health care support
12) CMS would probably be prevented from providing assistance and guidance to states as to their Medicaid and CHIP programs
13) provisions to reduce waste fraud and abuse would be undercut, as would provisions to improve quality of care to enrollees

The Patient Protection and Affordable Care Act of 2010 is not the failure that many conservative Republicans would have you believe.  There are many, many provisions that will not only reform our health insurance provisions, but that will go a long way toward reforming our health care delivery system into one in which quality is primary and preventive care and wellness are of the utmost  importance.  Those who want to destroy the most important health care legislation since establishment of Medicare under Lyndon Johnson, are simply deluded.  It is time to praise this major accomplishment of the Obama administration, and to seek to implement those positive aspects that are pending between now and 2019.  “Obamacares” is an apt title for this major piece of effective legislation.

As with most of the programs (and agencies) that the Republicans want to cripple or destroy, there are real people -- millions of them -- who are in need of the assistance and subsidies which such programs provide.  It is not just a matter of how many positions can be cut, how much money we can save, how big the deficit is.  For every number, there is a face, a life, a story and a person being threatened with the loss of something that for them constitutes a net of safety and assurance. 

Congressmen and presidential candidates who spew the kind of venom that tells “hippies” of OWS to get a job; that says that poor kids need to learn a work ethic and to hell with child labor laws; or who despises union workers and especially government union workers (and takes their collective bargaining rights away).  They want to send “illegals” back to where they came without opportunity for citizenship or for their children‘s education.  They want to deny quality health care insurance help to seniors and children and persons with disabilities.  These same people want, above all, to maintain and support the excesses and power of the richest among us.  It’s past time that we call them out, and ask:  do you even know the people about whom you speak; the people you threaten with a torn safety net (denying help even with home repairs or heating subsidies or food stamps)?  Do you ever meet with them one-on-one or in small groups to discuss their concerns?  Do you care to become acquainted with them and their life stories?  I hope the coalitions they are forming across this country begin to occupy your neighborhoods, and your offices, and even your properties.  The time is coming when you will have to begin to respect the needs of the middle class and the working poor and those who have little or nothing, including a home. 

President Obama has shown by his accomplishments that people matter.  He is our best hope for greater accomplishments in health care and further advances in the welfare of the 99% who do not have a million dollars or more to insulate themselves from real life problems, exigencies and difficulties.  It is past time to laud him for his targeted actions and his many attempts to make our lives and our nation better than the mess left behind by a certain Texas cowboy.  More next time…

HAVE YOU HEARD ABOUT OBAMA‘S ACCOMPLISHMENTS?

Elsewhere on this Blog, I have criticized President Obama for not trumpeting certain of his accomplishments in health care, the economy, and foreign policy.  However, his reticence does not restrain the rest of us.  In light of the refusal of the Congress to deal forthrightly with deficit reduction, we have to begin to point out what the President’s administration has done for us, sometimes with congressional backing, sometimes without their participation because of Congressional gridlock.  The 112th Congress (and perhaps the 111th as well, depending how you look at it) has failed miserably, even in mundane matters, mainly because the Republican Party has become captive to the policies and philosophy of the Tea Party represented in Congress by a do-nothing minority who have simply scared the Republican leadership with their intransigent no-taxes, no-more-spending mantras. 

It is no secret that the primary objective for the Tea Party, thus the Republican Party, is to defeat President Obama in November 2012 (don’t forget, the Senate Minority Leader, Mitch McConnell announced this as their priority), which explains why the Republicans have consistently supported rich power-brokers with their tax breaks and loopholes, de-regulation, and protections for the rich 1% of society.  No matter how you slice it, Republicans are not working for reform or citizen support; for fairness or justice.  They care nothing for these principles.

Their platform is one of cow-towing to the privileged in order to keep themselves in their positions as shills for the rich.  A large part of this is diminishment or destruction of all social welfare or entitlement programs for the broad middle class and the poor.  After all, 47% of the current members of Congress are millionaires!  They have partial control; they want more (i.e. the Senate and the Presidency).  Give it to them, and you will be in for the most overt and covert attack upon the middle class ever seen in this country.  If you don’t believe that, just look around at certain states where, under Republican Governors, you find the slashing of teachers, police, firemen, government workers, and of benefit programs for the poor and the middle class. 

So the time has come to understand why this 2012 election is about where you will end up if you fail to give Barack Obama another term, and equally important, if you don’t turn out of office the millionaires, the Tea Party, the radical Republicans, while maintaining a democratic Congress.  It’s time to talk about Obama administration accomplishments about which you may not have a lot of information.   

Let’s start with one of the bigger pieces of legislation that has drawn Republican ire and criticism:  the “bailout” or economic “stimulus package” (the American Recovery and Reinvestment Act of 2009) which the Republicans characterize as a “failure.”  Have they ever told you exactly what part of ARRA is a failure?  Just exactly what failed?  Don’t be bamboozled by the right-wing; they are (in)famous for their distortions and big lies repeated endlessly.

Did you know that the bill actually was constructed for “making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for the fiscal year ending September 30, 2009“?  More specifically, its purposes included:

(1) To preserve and create jobs and promote economic recovery.
(2) To assist those most impacted by the recession.
(3) To provide investments needed to increase economic efficiency by spurring technological advances in science and health.
(4) To invest in transportation, environmental protection, and other infrastructure that will provide long-term economic benefits.
(5) To stabilize State and local government budgets, in order to minimize and avoid reductions in essential services and counterproductive state and local tax increases.

Division A of the Act made appropriations to a broad number of departments and agencies of government to aid in this stated effort.  For instance, the Labor Department received $3.65 billion to use for adult employment and job training, for youth employment, for dislocated workers and their training, for a program of competitive grants for worker training and placement in high growth and emerging industry sectors, preparing workers for careers in energy efficiency and renewable energy and priority to projects that prepare workers for careers in the health care sector.  This careful targeting of money for particular areas of need is what characterizes this legislation throughout.

Did You Know that one-third of the $862 billion economic stimulus went for tax cuts? Biggest reduction: The Making Work Pay tax credit reduced income taxes $800 for married couples earning up to $150,000. (USA Today).

Did You Know that most of the stimulus money went to states to help with saving the jobs of teachers and police and other first responders?  And now we learn that the Congressional Budget Office (CBO) has revised the numbers of jobs saved, indicating that at least 5 million jobs were saved and that without the stimulus, the economy would have gotten much worse.  The non-political CBO has essentially vindicated the President’s stimulus program while Republicans continue their ill-informed and un-informed attacks on the stimulus as a “failure.”  It isn’t a failure; it is one of the many major accomplishments of the Obama administration!

In fact, according to the Liberal Examiner of Nov. 23, 2011:  “in the CBO report, ‘Estimated Impact of the American Recovery and Reinvestment Act on Employment and Economic Output from July 2011 Through September 2011,’ a breakdown by year shows that the ARRA created or saved from 5 million to 25.4 million jobs from March 2009 through September 2011, as follows:

   2009:  a low estimate of .9 million jobs to a high estimate of 3.6 million jobs     2010:  a low estimate of 2.6 million jobs to a high estimate of 13.2 million jobs     2011:  a low estimate of 1.5 million jobs to a high estimate of 8.6 million jobs

“In addition, according to the CBO, the stimulus is expected to help create or save another .3 million to 2 million jobs in the fourth quarter of 2011, another .8 million to 4.6 million jobs in 2012.
“According to the CBO report, the ARRA contained programs designed to help the struggling economy on several levels by:
‘Providing funds to states and localities, for example, by raising federal matching rates under Medicaid, providing aid for education, and increasing financial support for some transportation projects;
Supporting people in need, such as by extending and expanding unemployment benefits and increasing benefits under the Supplemental Nutrition Assistance Program (formerly the Food Stamp program);
Purchasing goods and services, for instance, by funding construction and other investment activities that could take several years to complete;
Providing temporary tax relief for individuals and businesses, such as by raising exemption amounts for the alternative minimum tax, adding a new Making Work Pay tax credit, and creating enhanced deductions for depreciation of business equipment.’

“Through these actions, the ARRA resulted in the creation of millions of public sector jobs as well as millions of private sector jobs.  The bill also significantly helped to grow the ailing Gross Domestic Product, which would have remained in negative territory for a greater and more substantial amount of time without such aid.”

So there you have it.  Now what do we see happening?  Consider this gem from the Examiner of Nov. 10th:

“Increasingly frustrated by CBO analyses showing that the 2009 economic stimulus worked as designed, that the Paul Ryan GOP Medicare rationing plan would massively shift costs to seniors, that income inequality is at record levels and, most damning of all, the Affordable Care Act reduces the national debt, Republican leaders have slandered the agency's work as ‘smoke and mirrors’ and ‘budget gimmicks, deceptive accounting, and implausible assumptions used to create the false impression of fiscal discipline.’  Now in the latest escalation of the GOP's attack, former House Speaker and resurrected 2012 Republican presidential candidate, Newt Gingrich, wants to abolish the CBO altogether.”

That’s exactly what we can expect from Republican ideologues: when facts go against them, they will lash out with lies, or distortions, or smears, or threats to abolish an offending agency or department.  No matter where you look -- from Newt Gingrich to Rick Perry to Mitt Romney to Eric Cantor to Mitch McConnell to Dick Armey to Grover Norquist to Rush Limbaugh -- you will find this same pattern.  The Republican radicals cannot stand criticism, facts, or Democrat success, especially when each refutes their cherished concepts and underlying assumptions.  More on Obama administration accomplishments next time.  

Disconnected Republicans

Recently, we spoke of a major disconnect between the Republicans in Congress and the reality of their constitutional responsibility, i.e. their control of the national purse strings.  Their attempts to blame others -- particularly the President -- for the national debt is simply misguided.  The Congress has the constitutional duty to appropriate taxpayer funds, with the proviso that they must use those funds to provide for the common defense and general welfare of the United States.  The Executive is not given power over those purse strings.  The President cannot legislate nor can he appropriate funds; he cannot pay on the debt or borrow money or coin money unless directed to do so by legislation.  All of these responsibilities fall to the Congress in Article I of the Constitution. 

So, if we have a huge national debt, or expenditures that are out-of-control, or lack of adequate revenue, a bloated bureaucracy or loans from foreign countries like China, the Congress must bear the responsibility -- and blame -- for all of it!  The Congress has legislated it all -- they passed the bills that got us into the financial mess we are currently in.  No amount of political rhetoric can make this fact into fiction.  The Congress owns these problems, even if the bills they passed were recommended by the President.  Just as they legislated us into this mess, they must legislate the way out of it.  Unfortunately, their greatest disconnect is that they are acting as though they do not bear any responsibility for solving real national problems!

Let us take a look at some of the other problems that demand attention from the Congress, and at the same time note the disconnects that exist between reality (the facts) and what the Congress has created as the fiction (disconnect).  And, what better place to start than with a very obvious fact of modern life: there are not enough jobs available, unemployment is way too high and manufacturing jobs are moving overseas at an alarming rate.  Let’s take a brief look at some facts about this.

On Nov. 4th, the Bureau of Labor Statistics reported:

--  Both the number of unemployed persons (13.9 million) and the unemployment rate (9.0 percent) changed little over the month. The unemployment rate has remained in a narrow range from 9.0 to 9.2 percent since April
--  Although employment in the private sector rose, with modest job growth continuing in professional and business services, leisure and hospitality, health care, and mining,  manufacturing employment changed little in October 2011 (+5,000) and has remained flat for 3 months. In October, a job gain in transportation equipment (+10,000) was partly offset by small losses in other manufacturing industries.
--  The number of persons employed part time for economic reasons (sometimes referred to as involuntary part-time workers) was 8.9 million in October. These individuals were working part time because their hours had been cut back or because they were unable to find a full-time job.
-- In October, 2.6 million persons were “marginally attached” to the labor force, meaning that they wanted and were available for work, and had looked for a job sometime in the prior 12 months but were not in the labor force.
--  In October, the number of long-term unemployed (those jobless for 27 weeks and over) stood at 5.9 million, or 42.4 percent of total unemployment.
--  In October,  no major private-sector industry stood out with significant employment changes over the month
-- Construction employment declined by 20,000 in October, largely offsetting an increase of 27,000 in September. Employment changes in both months were concentrated in nonresidential Construction
-- Government has lost 323,000 jobs over the past year.  In October, government jobs losses were concentrated in state government, excluding education, which lost 16,000 jobs as budgets remained tight.

It is also a fact that multi-national corporations almost uniformly report that their largest growth is in their foreign markets.  Companies on the S&P 500 generate 46% of their profits outside the U.S., and many, like Coca-Cola, report much larger foreign profit percentages (80% for Coke), with a larger percentage of employees in foreign countries.

It is more than fair to ask:  how do these statistics (facts) fit into the problem-solving that is needed from both the Executive and Legislative branches on the national level?  

Republicans say that one of the major problems we face is that taxes are too high on the “job creators” -- presumably those who are at the top of the income ladder, e.g. corporate CEOs.  Republicans claim that high tax rates prevent “job creators” from creating jobs because they lack confidence to innovate or invest, and therefore, they signed a pledge not to raise any taxes.  Secondly, they insist that over-regulation by government agencies contributes to this lack of confidence.  But this statement of the problems we face flies in the face of certain facts and statistics.  It is abundantly clear that the job creators are choosing to create jobs in foreign countries, not here, in spite of what the Republican presidential candidates claim for their plans to grow the economy.   It is also clear that corporations are sitting on almost $2 trillion in profits that they are not investing.

Problems should be defined carefully using facts and reputable studies (statistics, e.g.) to back up the definition of a particular problem.  When asked to identify the “job creators,” and the specific jobs the “creators” have created or will create, the silence is deafening.  When asked to identify the specific regulations that are preventing the creation of jobs, we are met with more silence, or the absence of specifics.  Instead, we are bombarded with agencies that should be “deep-sixed” like the EPA or FEMA or the Departments of Education, Commerce, and uh-h-h, um-m-m - that 3rd one -- ENERGY.  Not once have we been given specific facts or statistics that link job creators to job creation, or current taxes to lack of jobs, or regulatory agencies and specific regulations causing specific job reduction.  Where are the facts that link the claims to the realities?

Statistics indicate that one of our problems is that jobs are disappearing overseas.  Or, to put it another way, job creators are going where the biggest profits are.  They are going to developing countries who have the ability to offer all the things that corporations most desire: very low or no taxes; much lower wages; incentives to build; lack of regulations on safety and health; lack of unions; infrastructure creation; areas of growing consumerism, etc.  Thus, if the richest 1% are truly “job creators,” they are creating jobs elsewhere because that’s where the profits continue to be. 

So, one of the problems we have in reality is that certain jobs are not going to be retrieved from abroad, unless this country regresses to the status of a developing country willing to give the same huge favors to corporations -- lower taxes, very low wages, no unions, etc. -- as those entities now receive from the countries in which they exist.

Thus, it is necessary that we concentrate on creating new industries, new services, innovative processes.  Instead of concentrating on lower taxes for the richest 1%, we need to concentrate our efforts on how best government at all levels can work directly with innovators in such areas as alternative energies, bio-tech and computer science to move us forward into leadership in these areas.  Some of these businesses -- like the solar company Solyndra -- will not succeed but that is not a valid reason to back off such support.  It is my opinion that government needs to concentrate on creating immediate jobs, but at the same time, gather its resources to assist new businesses -- especially in high-tech areas -- to start-up and then to flourish.  This takes strategic planning, and must involve all agencies of government taking part in that Plan.

Another real problem we have is that of competition from everywhere in the world.  Therefore, we must raise education in this country to the highest possible level in order to provide a workforce with the highest skill sets for the new industries and processes that will save our economy and our society.  Instead, we find Republicans concentrating on the dubious solution of laying off teachers, refusing to improve school buildings, and downgrading the place of science in our lives.  Their rationale is that budget-cutting is more important than investment and that education is being compromised by teacher unions.  Of course, once again, we have been given no facts or statistics to back up these made-up problems.  This is simply political rhetoric designed to get them elected so they can control the purse strings at all levels of government.

Are you ready to face some more of the Republican disconnects?  Here are just a few to think about:

-- cutting back on research because of a suspicion of, and opposition to, scientific method and inquiry in a world that needs more scientists
-- cutting back on college grants, Pell grants, and tuition relief while the competitive world demands greater skills and more education
--  cutting Medicare and Medicaid at the same time that aged and disabled population is growing: baby boomers reaching 60-65.
--  decreasing school days and weeks; cutting back on federal grants to schools when new world demands world-class education
--  cutting school programs like art and music when it has been demonstrated that the effects of art and music on the brain are considerable, indicating that children with such influence also seem to do well in math and science.
-- claiming that job creation is their highest priority, they refuse to pass jobs & infrastructure bills, propose no solutions of their own, filibuster to death almost every part of the President’s jobs bill (except incentives to hire veterans), and through their Senate leader, admit that their top priority is to make President Obama a one-term president.

Finally, it is clear that because Republicans do not define problems in a specific, fact-supported manner, they end up wasting resources and energy on false or manufactured problems and their solutions.  This is the greatest disconnect of all: solutions offered for manufactured problems.  Take the country’s motto: is there evidence anywhere to show that this is a problem?  Hardly.  It’s a distraction; an attempt to distract people from their real concerns, such as the need for immediate jobs.  Another one: the bargaining rights of public employees: when did this become a real problem for the nation?  Republicans reply that it is costing taxpayers and the states a great deal.  But the evidence for such claims is refuted by the repudiation of this approach in Ohio, and the blow-back from taxpayers in other states.

And that brings us to the made-up problem of when life begins.  Is this a true problem for the citizens of the United States?  No; it is a problem for a minority of fanatics who think that their view is the only view to hold, and that they must make everyone else agree.  The defeat of the proposition on the ballot in Mississippi shows that even in conservative states, voters are basically opposed to the idea of the government defining life’s beginnings. 

Oh yes, and how about “ObamaCare?”  We have never been told specifically what is wrong with this legislation (except perhaps for the mandate that all must have insurance), nor have we been told what Republicans would put in its place.  Instead, we get made-up problems:  cuts to Medicare (I thought Republicans favored cuts to Medicare -- these cuts are mainly related to hospital administration and to subsidies for higher income folk); government control of the patient-doctor relationship (a totally bogus proposition since there is no data to indicate any change in such relationships); new taxes on employers (there are penalties or fees for both employers and individuals who fail to comply with mandated coverage, but nothing is said about the subsidies to individuals and tax credits for small businesses to assist with obtaining coverage). 

So it comes down to Republicans having ascribed a name to this legislation that raises the specter of a problem, but does not actually produce a defined problem backed-up by facts, statistics, studies, actual cases.  What most Republicans will never indicate is that millions of people - especially the young and the old -- have already benefited from initial changes made in the Patient Protection and Affordable Care Act (there are more to come which will also be beneficial).  And, to their detriment, those benefits are going to keep growing and people who opposed the bill because they never knew of its benefits, are going to change their minds.  At that point, Republicans will reap the fruits of their lies, innuendos, and false claims.

That seems to be the modus operandi for Republicans: get people to believe there is a problem where none exists, and do not deal in facts, ever.  Republicans love to make-up problems that distract voters or that play well in elections.  Republicans have no ideas for solving real problems because they don’t define those problems accurately.  The more bamboozled people are -- especially independent voters -- the easier it is for Republicans to take advantage and to be elected.  This time around, their office-holding could be disastrous, just as it has been already in Wisconsin and Ohio and Florida.  Solving manufactured bogus problems is not what this country needs!

Republican Candidates for What?

Are you kidding me?  These are Presidential candidates?  The Republicans have lost their marbles in proposing any of these clowns as presidential timber.  The Presidential “debate” of Nov. 9th on economic matters reached an all-time low of disingenuousness and lack of specifics.

Take Herman Cain…please!  He blamed everyone but himself for the allegations of sexual harassment made against him.  And, to make matters worse, the audience booed the questioners and applauded his blaming of the media!  But that’s not the worst of it. 

He continued backing the absurd 9-9-9 Plan displaying an intransigence and lack of intelligence that is mind-boggling.  Perhaps the only saving grace is that his Plan wants to rid us of the current tax code.  But he has never demonstrated to anyone that he knows what that entails or what it will engender in the execution of it.  Above all, the flat tax of 9-9-9 is a giveaway to the rich and a further burdening of the poor and middle class.  Can you imagine paying a tax on goods that includes a federal tax of 9% on top of a state/local tax of somewhere between 5-9%?  You buy an item of clothing for $30 and pay another $4.20-5.40 in tax?  Or how about when you buy a new car for $20,000 -- are you ready for the extra $2800-3600 you will owe the national, state and local governments?  Herman Cain is a joke.

Speaking of jokes… just what we need: another Texas buffoon.  Rick Perry doesn’t just have a memory problem (what‘s that third agency?…oops!); he’s got an intelligence problem (not unlike another Texan who unfortunately made it to the WH).  This man wants a flat tax of 20% for everyone, but will give those who don’t want or like it the option to stay with the current tax rates and tax code with all its attendant improprieties.  He’s so anxious to bring the tax rates for the richest 1% down to 20% that he can’t see the forest for the trees.  And, above all, that 20% is not the effective tax rate, it’s just what the corporations and the rich will start at before they use existing tax loopholes to lower that to 0-10% actually paid!    It’s like the MSRP of car-selling: no one believes that is the actual rate to be paid!  Ah-h-h-h Texas: the promised land for oil tycoons, corrupt judges, state executions, pseudo-education textbook publishers, land speculators, scams, and secessionists!

And then there’s Mitt Romney, who’s never seen the side of an issue that he didn’t like!   Here’s the man who established a health care reform plan in Massachusetts that served as a model for so-called “Obamacare.”  He denies the approbation.  Here’s the man who wants Medicaid to be handed to the states to run, but he never makes it clear that each state already administers its own Medicaid program while the federal Center for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.  Apparently, he wants the states to take on those latter responsibilities, which would price Medicaid administration out-of-reach for many states.  Because state programs already differ from one another, according to each state’s needs (which Romney says he wants to have happen even though it already exists), a few states even have their own names for Medicaid, such as "Medi-Cal" in California and  "MassHealth" in Massachusetts. States may bundle together the administration of Medicaid with other programs such as the Children's Health Insurance Program (CHIP), so the same organization that handles Medicaid in a state may also manage additional programs. Separate programs may also exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors.  In some states Medicaid is also subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly.

Something else that Romney doesn’t tell his audience is that State participation in Medicaid is voluntary; however, all states have participated since 1982.  Since he now opposes the way Medicaid is managed, perhaps he should have dropped Massachusetts from the mix during his tenure as Governor of Massachusetts from 2003-2007.

In his own state of Massachusetts, their version of Medicaid doesn’t adequately cover people under age 65 with other than a developmental disability.  They don’t cover case coordination, for example, nor do they provide other essential services needed for community integration, such as adequate counseling or housing support.  To put it mildly, their coverage stinks -- and that’s exactly what we know about several other states.  With completely state-run programs, we could expect that many other states would have to use federal block grants to increase administrative cost coverage, but not the enhancement of services.  Devolvement of Medicaid to the states would be the death knell of adequate Medicaid programming for the poor and disabled.  

Let’s also call out Mitt Romney for his inaccurate claim that the current Medicaid program is a “one size fits all” program.  Does he know anything about Medicaid Waivers that allow states to develop their own versions of Home & Community Based services to meet particular needs of particular populations: those with mental challenges, the aged, others with brain injury or HIV/AIDs?  Maybe if he had taken the leadership to obtain the “Nursing Home Transition and Diversion” waiver, he might have been able to develop more appropriate community services for adults with MS or Parkinson’s Disease who wanted to stay out of nursing homes, or who wanted to transition from such facilities to community housing and services.

Give me a break, Governor.  When you had the chance, you accessed only three of the many existing waivers allowed under Home & Community-Based Waivers, section 1915(c) (MR/DD, TBI, and Aged).  North Dakota and West Virginia are the only states to have fewer Waivers.  New York state, on the other hand, has eight HCBS Waivers including: MR/DD, Aged, Aged & Disabled, TBI, NHTD, HIV/AIDs, children, and CDPAP. 

So, Mitt, are you sure you know how these programs -- and Medicaid itself -- work?  If you do know how Medicaid works, why don’t you tell the truth, instead of leading us down a primrose path?  Medicaid is already a state-run program, funded by both state and federal funds.  There are already enough options within Medicaid to allow for development of programs for particular needs.  State programs already differ substantially from each other, and use different names to emphasize that fact.  Why don’t you admit that Massachusetts had its chance to develop home and community-based services for special populations and chose not to, leaving a child and adult population of disabled persons in great need.    

And distortions don’t stop there.  Romney (and others on the stage) wrongly blamed Fannie Mae and Freddie Mac as primary causes of the housing crash.  But, in truth, the Financial Crisis Inquiry Commission reported in 2011 that the FMs were not primary causes of the crash; it was private lenders who were the main causes of the crisis with their lack of down-payments, anything-goes lending practices that did not take into account ability to pay, aggressive accounting practices, and their questionable terms and liquidity. 

Let’s take a minute to look at some of the history of Fannie Mae (based on “Reckless Endangerment” by G. Morgenson and J. Rosner).  One of the things that can be strongly said about this agency is that it made many friends in Congress in order to keep its government subsidies flowing into its coffers.  After facing certain critics in Congress, the Chairman of Fannie Mae, Jim Johnson, came up with an idea in 1993 that Fannie Mae needed a local presence in communities across the country in order to win the hearts of people on Main Street and to insulate itself against its critics.  Soon Johnson’s company was opening storefronts in cities and towns where it was possible to partner with local officials, first, to promote home ownership and second, to promote its reputation as a good-deed doer.  His so-called Partnership Offices cemented the company’s relationships with members of Congress, by encouraging lawmakers to take credit for housing initiatives in their districts.  Fannie Mae even provided the publicity for the very congressmen and women whom it relied on for help and protection in Washington.

Guess what?  When Johnson traveled to Atlanta in February 1995, to open the new Partnership Office there, he made sure to invite some powerful Republicans to join him on the podium.  The focus of the Atlanta Office would be to create mortgage products for first time homebuyers, and low and moderate-income consumers.  There to celebrate the Fannie Mae commitment, and office-opening, was none other than the Georgia Republican who happened to be Speaker of the House, Newt Gingrich, who was a big proponent of reducing the size of government.  Here’s what Gingrich had to say on that occasion:

“Fannie Mae is an excellent example of a former government institution fulfilling its mandate while functioning in the market economy.”  Strange, you say; wasn’t Gingrich one of those on the debate stage on Nov. 10th who was bemoaning the government status of Fannie Mae and Freddie Mac?  That’s right; there was nothing “former” about Fannie Mae’s government status in 1995 -- it was receiving government subsidies even then.  And here at this Atlanta podium was Newt Gingrich wrongly telling people that this was a private entity functioning in the market economy.  Please Newt, say it isn’t so.  He went on to laud the agency:  “Fannie Mae has had a regional presence in Atlanta for over 40 years, and the announcement of a partnership office demonstrates its continued commitment to affordable housing in the Atlanta metropolitan area.” 

So which is it Newt?  Is Fannie Mae to blame for the housing crisis, or not?  Is it a government entity, or not?  Is it part of the market economy, or not?  Should it be privatized, or not?  Newt Gingrich likes to extol his own penchant for history.  Too bad he can’t remember a lot of his own history before he shoots off his know-it-all mouth.  He’s as bad as Mitt Romney in covering multiple sides of an issue.

The lesson to be learned:  watch out voters!  These candidates are out to bamboozle you -- to “treat you as baboons.”  They are so far away from the middle class and the poor that they live in another world devoid of concern for your needs.  Their programs and principles have been in effect since the Reagan years, and since that time, our economy has favored the rich over anyone else.  We have seen lowered top tax rates, deregulation in many areas, cut-backs in government spending, and incentives and breaks of all kinds for corporations, resulting in tremendous profits.  What we have also seen is the movement of manufacturing jobs overseas, effective tax payments and rates of 0-15% for top corporations, and the outrageous growth of wealth for the 1% of our population known to Republicans as “job creators.”  Problem is: although these measures have not worked to produce many new jobs (but a deep torrent of layoffs instead), Republicans propose more of the same as their only Plan for Prosperity. 

Beware!  You are being taken for the proverbial ride!  We will not recover manufacturing jobs that have gone overseas!  We will not see multinationals innovating here when they can make more profit in other countries.  We will not recover our economic leadership without investment in education, infrastructure,  new industries, single-payer health insurance, and new alternative energy companies.  Republicans since Reagan have led us into the current banking, investing, lending, housing, and unemployment crises.  To give them another chance to produce the same results is the definition of insanity.  Are YOU being bamboozled?

Republicans Are Disconnected

The Republicans in Congress seem to me to be disconnected, not only from what is needed in our nation, but from what they need to be doing as elected representatives of the people.

First of all, they are in a budget-cutting mode and mood.  But nowhere do we have a definition of a problem that will be solved by such budget-cutting.  Nor do we have any strong data that backs up the budget-cutting propounded by the Republicans in Congress.  For instance, what data exists to prove that budget-cutting is more effective than say government reform and raising the taxes of the rich?  Oh yes, we hear over and over that we are spending too much and that our children and grandchildren will be stuck with the bill.  That is not the definition of a problem; that is a statement based on political rhetoric; nothing more.  The problem we face is multi-faceted: not simply that we are spending too much; rather, the basic problem is that Congress is spending taxpayers’ money in poorly-conceived ways, and raising revenue in poorly-constructed methods that do not advance the welfare of our commonweal.  That is the fault of our elected leaders, but let us be careful to examine which leaders.

Let us not forget that it is the constitutional responsibility of the Congress to  “provide for the common defense and general Welfare of the United States…to borrow money on the credit of the United States… to regulate Commerce…” It is Congress’s duty to sponsor bills for raising revenue (which must originate in the House of Representatives);  ...all money drawn from the Treasury must be appropriated by the Congress… and Congress has the responsibility “to make all Laws which shall be necessary and proper for carrying into Execution the foregoing powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.” 

In stark contrast, we note in Article II of the Constitution that the Executive -- the President -- is much more limited in his responsibility, especially concerning the power of the purse.  He can recommend measures to the Congress “for their consideration” as “he shall judge necessary and expedient…”, but it is Congress that ultimately legislates what it wishes of such recommendations: the President proposes; Congress disposes.  So, although the President can propose plans, and legislation, and budgets, and ideas, it is Congress that has the responsibility for the purse and for all legislation.  Yes, the President has great power that is recognized throughout the world, but that power has evolved because of his role as Commander-in-Chief, because of his responsibility for foreign relations in the area of treaty making and diplomacy, and perhaps because of the need, in this modern and complicated world, to be able to act decisively whenever the nation is confronted with outside forces (of many kinds) that could negatively impact our welfare and our very existence. 

In spite of this recognized “imperial” power, the Executive does not have the power to make laws or to appropriate funds.  It is not the constitutional duty of the President to raise revenues, nor to give a regular accounting of the receipts and expenditures of public money (except as the Congress may legislate for him to do); nor to draw money from the Treasury except as authorized by the Congress; nor to borrow money on the credit of the United States; nor to coin money or regulate its value.  It is not the President’s constitutional duty to pay the debts, nor to provide for the common defense and general welfare of the United States.  All of that is part of the constitutional duty of the Congress! 

My point?  Congress is not living up to its responsibility to legislate, to appropriate, to borrow, to raise revenue and to control, oversee, and report on its actions.  Yes, that’s right: the Congress is required by the Constitution to make “a regular Statement and Account of the Receipts and Expenditures of all public Money (which) shall be published from time to time.”  Are you getting your report on ALL receipts and expenditures of ALL public money?  I’m not.  As a matter of fact sometimes it is almost impossible to obtain such information (for instance on “member items” or “earmarks”) and often requires an FOIA to get such information from the Congress or from a federal department or agency. 

Why isn’t the Congress living up to this responsibility?  Because Congress doesn’t want you to know how poorly they are doing their job!   They do not want you to know how poorly they spend your money.  They do not want you to know where they spend the most and on what they spend the least.  They do not want you to know that they are not living up to their constitutional responsibility to oversee all spending.  Which means, my friends, that it is the Congress that is responsible for the fiscal mess we find ourselves in.  It means that the responsibility for the deficit does not fall to the Executive, but to the Congress which has a constitutional mandate to oversee all public expenditures.

So, are we being bamboozled?  You bet.  The Congress, as it is wont to do, has tried to blame the budget deficits and the national debt on the President.  They say that his “stimulus package” was a failure; that “Obamacare” will run up the deficit and the debt; that his budgets will add trillions to the national debt.  Wait a minute….are the Republicans in Congress trying to tell us that the President has the power of the purse and not them?  Are they trying to shift blame to the Executive who constitutionally has to carry out the legislative mandates given him by the Congress?  Are they telling us that it is the President who legislates and that the Congress is just a puppet?  NONSENSE!

Whether Republican or Democrat, the Congress is to blame for all of our deficits and debts.  They have the power to legislate our way out of this, but if they fail to act, or act timidly (more accurately: in a political manner) then they cannot shift the blame.  It is the fault of Congress that we are in the fiscal mess that we are in, and no amount of rhetoric can change that fact.  They make the laws; they appropriate the money; they approve draws on the Treasury; they oversee the Executive branch’s execution of the laws they enact; they have the power of the purse.  The rhetoric that comes out of the mouths of Boehner and Cantor, and Ryan; of Sen. McConnell and his cohorts is nothing but misleading, overblown, false: it is meant to make baboons of (“to bamboozle”) the public.

It is my contention that the Republican Congress, and the Republican minority in the Senate, are abusing the legislative process, and therefore acting against their constitutional mandates.  They are disconnected from their main task: to provide for the general welfare of the people of the United States.  Congress is now led by people who think it acceptable to block legislation, to say no to anything that would give the President a legislative “win,”  to bring government operations to a halt if it serves their ends; all of this being contrary to their duty to “make all laws necessary and proper for carrying into Execution the…powers…vested by this Constitution…”  Instead of resolving problems with innovative legislation, this Congress is content to repeal existing legislation that addresses national problems like health care, rapacious Wall Street activities and environmental cleanup.   At its worst, the Congress has obstructed the creation of jobs that would address a crumbling infrastructure, even while claiming that their number one priority is to put people back to work.  The disconnect between reality and rhetoric is overwhelmingly obvious.  You are definitely being bamboozled!

More next time on other disconnects exhibited by the Tea Party-controlled-Republicans in the Congress, and why we must elect Representatives and Senators dedicated to a new era of problem-solving that will redound to the health and welfare of this nation.   

Way To Go, Mr. President

Hooray for President Obama!  He has finally made some bold moves to point up the failures of Congress while taking actions that support the broad middle class.  What’s more, he is finding ways to do this by Executive Order, acting in spite of an uncooperative Congress. 

Strangely enough, I spoke of the need for this kind of bold action at least a year ago when I wrote to the White House.  My latest call for such action, titled “Bold Action Is Imperative”, appeared on this Blog on June 12, 2011.  What I said then was “what Obama needs to do is to come up with a PLAN of bold steps touted with massive publicity that is unrelenting.”  I even suggested that parts of that Plan should be: the faster draw-down of troops in Iraq and Afghanistan; a massive infrastructure/jobs bill; extension of unemployment benefits; and, an increase in tuition grants and loans for college students.  

I certainly can’t take credit for the President’s Plan, but I, for one, am grateful for his actions.  From some reports, he has more such actions up his sleeve, and I hope they include the use of already-appropriated, but unspent, funds that could legally be used for the creation of jobs or job-related activities.  I spoke here of such possibilities in my Blog of May 15, 2011, when I listed several areas of jobs that can be created and offered through the Corporation for National and Community Service, through the Labor Department and through OPM, the Job Corps, and the Veteran’s Administration, to name a few. 

What I would suggest is that the President’s staff should be culling through various departments and offices of the federal government (and talking with governors of states) to determine what unspent funds are available to be used for job creation and support (such as training).  Even with the government under a Continuing Resolution for FY2012, there are unspent funds available. 

Secondly, what about stimulus monies that have gone unspent in TARP, ARRA, and TANF?  Certainly at the end of 2010, we heard a great deal about such unspent funds, or at least of projects that were not “shovel-ready.”  There is no greater stimulus needed than jobs, job training, and incentives for job creation in the private sector. 

There have to be funds already authorized and appropriated that have gone unspent.  How about it, Mr. President?  Can you and your administrative staff find ways to use this money NOW for our greatest needs: job creation and job stimulus?  And, by the way, if Congress puts up a fuss because they want that unspent money to be cut from our budget deficit, tell them that the American people are suffering and there is no greater need right now than that of relief for the broad middle class!

Here are some recent examples of unspent funds that I have been able to find:

1)  Temporary Assistance for Needy Families (TANF) - apparently, not only are there carry-over funds available, but there is an Emergency Fund also available.  It seems likely that the Emergency funds can be used to subsidize employment.  Previously, carry-over funds could only be used to provide assistance (the ongoing basic needs payment, and supportive services such as transportation and child care to families not employed). Now jurisdictions (States, Territories, D.C., and Tribes) may use any unspent Federal TANF money from a prior fiscal year to provide any allowable TANF benefit, service, or activity – i.e., not just assistance

2)  Troubled Asset Relief Program (TARP) - 
This was originally meant by the Bush administration to relieve big banks from some of their toxic assets, so they could maintain liquidity and solvency.  In February 2009, President Obama’s administration proposed to use some of the unspent TARP money to aid small businesses (and to pay down the deficit).  The debacle that ensued ended up with Congress wanting to spend all money returned to the fund on the deficit.  Question is, is there any money leftover still from the TARP legislation, and if so, can it be used creatively to aid more middle class homeowners, small business owners, and unemployed workers? 

3)  American Recovery and Re-Investment Act (ARRA) - the $48.6 billion State Fiscal Stabilization Fund, the $10 billion in additional Title I aid and the $11.3 billion in additional special education funds—were supposed to be spent by states by October 1, 2011 but an extension to spend has been granted.  According to a recent article by Michele McNeil, the states have $2.28 billion left to draw down between those three funds—a total that doesn't include smaller special education programs, such as the one for infants, Title I School Improvement Grants, and Race to the Top, which have a longer spending timeline.   Again, money is leftover, so is there any way to involve states with such money to hire additional teachers for special education, and construction workers to rehab rundown schools?

4)  Is there any unused or un-granted or wasted money that can be used toward job creation?  Here’s a thought for President Obama:  find a useless program in the Executive branch (like the outmoded RUS of DoA); offer to shut it down and use the saved money for job creation if Congress will agree to shut-down a useless office (like that of Chaplains) and do the same.  Quite seriously, the GAO Report of March 2011 on Opportunities to Reduce Duplication in Government Programs offered numerous examples of waste and duplication that could produce needed funds, not just for deficit reduction, but for job creation.

Here’s a thought: why not announce an evaluation of all government programs and contracts in order to find savings that can be used for job creation?  Let’s get serious about re-inventing government and, at the same time, use savings to create job opportunities. 

Unfortunately, the path that the President has chosen has its limits, both constitutionally and politically.  He can only get so far with Executive Orders because the Congress is not going to put up with that forever.  He is also limited in the scope of Executive power by the Constitution, which gave the lion’s share of central power to the Legislature and limited the scope of the Executive’s power.  Of course, the evolution of a so-called “Imperial Presidency” has helped to grow the President’s ability to act on his own.

So now that the President has found his BOLD side, let us not waste this opportunity.  Progressives should take this as their opportunity to make suggestions to the White House for ways to divert money into job creation without involving the do-nothing Congress.  Any thoughts out there?  Please share them at my e-mail address:  impublius2@hotmail.com.

A Vision for Healthcare - Part VI

What would be some of the savings from a single-payer health care system?  Well, first of all, it is estimated by the Physicians for a National Health Program (PNHP) that “the reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.  Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $400 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.”

Second, PNHP intends that National Health Insurance (NHI) would pay each hospital a monthly lump sum -a global budget - to cover operating expenses.  This amount would be negotiated yearly based on past expenditures, fiscal and clinical performance, projected changes in levels of services, wages and input costs, and proposed innovations.  Hospitals would not be allowed to bill for services covered by NHI, but equally important could not use any of their operating budget for expansion, profit, excessive executive incomes, marketing, or major capital purposes.  The latter would come from NHI funds and would be appropriated separately based on community needs.  Privately-owned hospitals would be converted to non-profits and their owners would be compensated for past investment.  These methods of payments to hospitals would shift the focus of administrators from the bottom line of profit and thus of lucrative services, and hopefully toward providing optimal care and services to meet patient needs.  This “global budgeting” would virtually eliminate billing, freeing substantial savings for enhanced clinical care.  Prohibiting use of operating funds for capital improvements would eliminate the primary financial incentive for excess interventions and services as well as its opposite (skimping on care) since neither strategy could result in institutional gain.

Third, the PHNP says NHI would include three payment options for physicians and other practitioners:  fee-for-service; salaried positions in institutions; salaried positions within group practices or HMOs.  Privately-funded HMOs and group practices would also be converted to non-profits.  Only institutions that actually deliver care could receive NHI payments, thus excluding many HMOs and groups that currently sub-contract services but don’t maintain clinical facilities.

Fee-for-service would include a negotiated binding fee schedule.  Payments would include only physicians and their support staff, but not reimbursement for costly office capital expenditures like MRI scanners. 

Institutions like hospitals, health centers, group practices, clinics, and home care agencies could elect to receive a “global budget” for delivery of care, as well as for education and preventative programs.

HMOs and other institutions could elect to be paid capitation premiums to cover all outpatient, physician, and medical home care.  Regulation of payments for capital expenditures would be similar to that for hospitals.

The three proposed payment options uncouple physician payment and other operating costs from capital purchases.  According to PNHP, this is necessary to minimize entrepreneurial enterprises, contain costs, and facilitate health planning.  The fee-for-service option would greatly reduce physician office overhead by simplifying billing to one payer.  It is also possible that there might need to be a cap on spending for program administration and reimbursement bureaucracy - perhaps 3% of total costs.  Global negotiated budgets for institutional providers would eliminate billing costs; at the same time providing a stable and predictable financial support.  It could also stimulate development of community prevention programs (e.g. smoking cessation). 

Fourth, NHI will cover disabled Americans of all ages for all necessary nursing home and home care.  According to PNHP, a “local public agency in each community would determine eligibility and coordinate care.  Each agency would receive a single budgetary allotment to cover the full array of long term care services in its district.  The agency would contract with long-term care (not-for-profit) providers for the full range of needed services, eliminating the perverse incentives in the current system that often pays for expensive institutional care but not the home-based services that most patients would prefer.”  The program would encourage home and community-based services by supporting the 7 million unpaid caregivers that provide 70% of the care, and by supporting the expanded training of geriatric physicians, nurses and social workers who would assume leadership of this system.

Finally, NHI would pay for all medically necessary prescription drugs and medical supplies, based on a national formulary, established and updated by an expert panel.  The most important provision of this would be the negotiation by NHI with the drug and equipment manufacturers, based on costs (excluding extras like advertising and lobbying costs).  Suppliers would bill the NHI directly for any item in the formulary that is prescribed by a licensed practitioner.  Because of its single payer status, the NHI could exert substantial pressure on pharmaceutical companies and equipment manufacturers to lower prices, resulting in very substantial savings which is not happening under the current multiple private-payer system.

Of course, this single-payer system will have start-up and transition problems.  Surely it will not solve all problems; i.e. improvements in environmental and occupational health will not automatically follow; need for improvements in quality will remain; medical school problems of high tuition and lack of minority representation will continue; some physicians will still succumb to temptations to enhance their earnings by encouraging unneeded services.  However, a framework for addressing such problems will be in place. 

And, it’s better than the alternatives, including:  the current multiple-payer debacle; defined contribution schemes with lower-paid employees forced into skimpy plans; tax subsidies and vouchers; turning Medicaid over to states.

An article under the heading of the PNHP concludes:  “Incremental changes cannot solve these problems; further reliance on market-based strategies will exacerbate them.  What needs to be changed is the system itself.”

This change to a new system of health care insurance and delivery is still one of the most important steps we could take to save money and thus affect the national budget, to give relief to businesses, to cover all citizens with health insurance, and to literally bring relief to the pocket-books of millions thereby restoring confidence in our healthcare system and increasing the likelihood of better research and innovation than we have seen in a long time.

Dissent - part of the American Vision

Dissent is built into the foundation of the American nation (Declaration of Independence); it is woven into the fabric of our democracy (Constitution & Bill of Rights); it is the well-spring from which greater civil rights have been nurtured and realized (e.g. Women’s Rights movement, the Union movement and the Civil Rights movement).  Dissent is a 100% American tradition; a patriotic action; a legitimated form of redress of grievances with judicial affirmation.  It’s non-violent form is most acceptable, but it’s violent formulation cannot simply be eschewed when precipitated by dictatorial and tyrannical governmental means that attempt to destroy the very foundations upon which our democracy is built (the Revolutionary War).

Dissent is on my mind today because of two major happenings in our country: the “Occupation of Wall Street” protests throughout the nation and the dedication of the Martin Luther King, Jr. Memorial on the Mall in Washington, D.C.  They are both monuments to the place of non-violent dissent in the furthering of the American Ideal of rights to Life, Liberty and the pursuit of Happiness; of the American Vision of a government of the people, by the people, and for the people; of the American Dream of one nation indivisible with liberty and justice for all.  But, they are more than simple representations. 

The Martin Luther King Memorial reminds us vividly of the many people who put their lives on the line to protest American apartheid: the segregation of races in public facilities, particularly in schools and housing, the discrimination against people of color in jobs and wages, in banking, in living accommodations, in voting, in all manner of ways that were intended to keep “them in their place” which was always a lesser place; a place which targeted and maintained “them” as inferiors.   Such discrimination was the poisonous plant that grew out of the defiled soil of slavery.  Slavery of black people, and the elimination or herding of native Americans onto restricted reservations, were two stains upon the formation of our Republic because they influenced our Constitution,  public policy and the prejudices of our citizenry, for generations. 

Let us never forget that many people actually gave their lives in this great civil rights struggle, including Dr. King and so many of his followers.  I think today of the four young girls lost in the bombing of the Sixteenth Street Baptist church in Montgomery, of Viola Liuzzo the homemaker, of Jonathan Daniels the seminarian, of Michael Schwerner organizer, James Chaney apprentice, and Andrew Goodman student, of Medgar Evers army veteran and activist leader.  And, there are so many more….

I think today of one of my personal heroes, who put herself in jeopardy by going to St. Augustine, FL in the summer of 1964 to participate in a sit-in. The arrest of Mary Peabody-- the 72 year old mother of the governor of Massachusetts and wife of retired Episcopal Bishop, Malcolm Peabody-- for attempting to eat at the segregated Ponce de Leon Motor Lodge in an integrated group, made front page news across the country, and brought the civil rights movement in St. Augustine to the attention of the world.  If ever there was a woman who could be seen as a comfortable, white Protestant of patrician background, Mrs. Peabody was it.  But nothing could be farther from the truth: she was an activist involved in many endeavors (see more about Mary Parkman Peabody at oasis.lib.harvard.edu/oasis/deliver/~sch01116)

She was someone I was privileged to have known.  In fact, she and her retired husband lived just a few doors down from me at the Episcopal Theological Seminary in Cambridge, MA.  Her husband, Malcolm Peabody, the former Episcopal Bishop of the Diocese of Central New York, under whom I began my quest to become a student at the seminary, was my Bishop for as long as I can remember, from my days as an acolyte in my local church to my acceptance at ETS.  The first summer after my first academic year at ETS was a busy one, but was made all the more bearable by the kind offer of their house for the summer for me and my new bride, which they kindly extended again during my second summer at ETS. 

Between those summer sojourns at Phillips Place, there was a snowstorm in the Boston area that was unrelenting, and that disrupted transportation and other services (most likely January 20, 1961).  As I was about to walk to God-knows-where, I walked by the Peabody home and there was a figure bundled up in a substantial hooded jacket, trying to shovel out their long walkway to the street.  I thought it was the Bishop, but when I got closer to ask if I could take over the shoveling, it turned out to be Mrs. Peabody who was determined she was going to dig them out, no matter what.  Upon my insistence that I would be glad to do the shoveling in thanks for their on-going generosity, she relented (I was careful not to say anything about age or gender!).  Let me tell you, that was the longest, toughest walkway I have ever shoveled, before or since!  I was exhausted at the end of it. 

Mrs. Peabody never shrank from a task; she was not satisfied until a difficult situation or problem was addressed with vigor, just as she did not shrink from the call to address the national injustice known as segregation; she viewed it as a duty.  She was nearing 70 when she tried to shovel that walk; she was 72 when she went to St. Augustine to stage a sit-in.  I’ll just bet you there were times when she influenced her Bishop husband and her Governor son on their commitments, their duty, and their responsibilities!  I write about her in this context because she clearly represents the heritage of our founding fathers (and mothers); she represents that ideal that we must address injustice; that we must dissent when government or public policy leads to tyranny or just plain discrimination. 

We are individually responsible for the health and well-being of the American Ideal, the American Vision, the American Dream.  The demonstrations reportedly now going on in over 190 cities throughout these United States are live protests in response to the dysfunctional nature of our government and of our economic system.  It is too early to say how significant these will be, but this we do know: these are not hippie demonstrations; they are not unorganized; they are not purposeless; they are not attempts to abrogate law and order. 

At our local “Occupation”, I saw many signs of what this protest is about. It‘s about:
- the threat of plutocracy or oligarchy to our democratic system: the 1% dictating policy and outcomes for the other 99%
- the inequality of our economic system: the advance of the profits and riches of the 1% versus the stagnation of the wages and benefits for the broad middle working class; and
- the use of governmental entities and legislation to ensure that this subsidization of the rich remains intact;
- the duty of the rich to pay their fair share in taxes and contributions to the nation’s welfare;
- the overwhelming need for American jobs;
- the tax breaks and policies and incentives that have favored large corporations and enabled them to do what they want, when they want;
- the unfavorable treatment of labor unions and their collective bargaining rights; their destruction;
- the destruction of our democratic system by the infusion of vast amounts of money into our politics in order to influence legislative and regulatory outcomes in favor of the 1%;
- overturning the unfortunate Supreme Court Citizens United decision which sees money in politics as unrestricted free speech for corporations as individuals;
- other concerns include: war, the environment, education costs.

When mass dissent raises complicated issues and questions that must be addressed and answered by our governmental and societal leaders, it is important for us to remember its place in our history, and to respond accordingly.  The narrow response of law and order borders on oppression; the response of personal attacks represents elitism, and the response of indifference speaks to nothing less than irresponsibility.  Reasoned and reasonable dissent requires a positive response from our government and our people for it is the life-blood that keeps renewing and strengthening our exceptional democracy.  To be intent on oppression of every form of dissent is to be on the side of anti-democratic responses that betray American values, and that deny this important thread of our heritage.  

Purposeful dissent is part of My Vision for America.  It is woven into the fabric of our Democratic Republic; it is part of what makes us great, for many of its forms and manifestations have advanced us toward our Ideal, our Vision, our Dream.  We as a nation can never accept the status quo as all there is meant to be, for we know that there is greater freedom, broader rights, and stronger justice toward which we must strive.  We are a nation of strivers who believe, with Martin Luther King, Jr. that we have a Dream to be realized. That is why we are called to let freedom ring; to keep hope alive; to pledge ourselves to liberty and justice for all.  It is why we revere Lincoln’s words in the Gettysburg Address that call us to look beyond ourselves and our failings to a greater cause:

“It is for us the living… to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced… to be here dedicated to the great task remaining before us. . . that this nation, under God, shall have a new birth of freedom, and that government of the people, by the people, for the people shall not perish from the earth.”

My Vision for America -- Part IV

As we have said, education is a primary key to America’s future.  Friedman and Mandelbaum in their book, “That Used to be Us” go even further by declaring that “Today…more than ever before, our national security depends on the quality of our educational system.”  They connect education quality to economic growth which is the key to national power and influence in today’s flattening world.  They quote President Obama on this same subject: “the country that out-educates us today will out-compete us tomorrow.”  This is why Friedman and Mandlebaum have concluded: “Today, what matters is not how your local school ranks in its county or state but how America’s schools rank in the world.”

We have explored one of the six areas in which they say our schools must improve, i.e. the need to have excellent teachers and principals.  To that, I have added my own thoughts for improvement.  It is now time to explore the other five areas, but first I offer once again my own Purpose Statement for Public Education which I believe must overlay all that I say about education reform.

“To involve an entire community of educators (administrators, teachers, students, parents, volunteers and other interested citizens) in the teaching of traditional and foundational curricula (history, English, mathematics, science, language, technology);  in the drawing out of experiential learnings (through the arts, simulated games, business internships and problem-solving) and in the discovery of skills, talents, concepts, beliefs, values and verities, in order to produce accomplished individuals, informed citizens, critical and independent thinkers, lifetime learners, cultural literates, world-class workers and competitors, and compassionate human beings willing to advocate for the welfare of the human family.”

The second area of improvement must be parents who are more involved and demanding of what will pass as quality education.  This also speaks to the third necessity of having students who come to school prepared to learn.

This must start before parents actually have children in school.  It starts with excellent pre-natal care.  It starts with as small a thing as playing classical music when a child is still in the womb.  It starts with reading to children at very early ages.  It starts with parents teaching the alphabet and letter sounds and the recognizing of objects and body parts.  It starts with an attitude on the part of parents that children can start discovering and learning as soon as they exit the womb.  Parents have a responsibility from the moment of conception to find out, to discover, to research how they can be educators for their children.  That means that society needs to be more focused on helping parents to realize this goal.  We need school districts concentrating on how they can assist parents of pre-school age children.  If public schools are to become community centers of learning, we need districts to provide home visitors who can teach appropriate education skills to parents.    

When their children are in schools, parents need to be more like Chinese parents, like Amy Chua who wrote “Battle Hymn of the Tiger Mother,” who issued a wake-up call to American parents.  As she said in her book, “Studies indicate that compared to Western parents, Chinese parents spend approximately 10 times as long every day drilling academic activities with their children.  The Chinese believe that the best way to protect their children is by preparing them for the future…arming them with skills, work habits and inner confidence that no one can ever take away.” 

While there may be a fine line between such involvement and “making your kid neurotic”, in general, Friedman and Mandelbaum believe that Chua has two things quite right: the need to hold children to the highest standards that push them out of their comfort zones, and the need to be involved in their schooling.”  Trophies for everyone is a travesty on standard-setting.  Rewarding kids simply for effort is short-sighted;  they should be rewarded for excellence, and American parents especially need to learn this.

Clearly, parents need to be involved in the life of the school community.  A PTA of the past is not adequate.  We need parent mentors and teachers in the classrooms.  We need parent organizations who become advisers to their districts and their school systems.  We need parent representatives who will meet with other parents and express their frustrations, ideas and opinions to the system overseers.  In other words, parents must organize to push for policies, standards and actions that will challenge their schools and their children while also caring about their futures.
   
A fourth need is for politicians who push to raise educational standards.  Politicians need to understand what we have already said: that education is the key to our economy and our position in the world.  Politicians must themselves become educators and learners.  As a whole, they themselves are inadequately prepared to be either.  They need to become better informed on what is going on in schools throughout this country, and throughout the world.  Perhaps an education “junket” to understand best practices in education would be a better use of tax dollars than some of the “vacations” that some politicians have disguised in the past as “learning experiences.”
 
Politicians, especially governors, cannot be content with the standards they set under “No Child Left Behind” legislation.  Some states set standards that were blatantly inferior so that students could pass the tests.  Some governors have now laid off teachers and administrators and shortened the school week or day, in order to save money.  Was this action based on educational criteria, or simply on the need to cut spending?  In my opinion, they are sabotaging the long-term growth and competitiveness of their students, their citizens, their economies, and their states.  Governors need to raise standards, fund best practices, test against personal education goals and against other countries, connect education with real jobs through internships, increase education hours, push community service as learning, and invest heavily in teacher and administrator training.  That’s a beginning.

Finally, we need neighbors ready to invest in schools even though their children are not there, and business leaders committed to raising educational standards in their communities.

We cannot make enough progress in our public schools unless neighbors appreciate, and involve themselves with, the schools in their neighborhood.  After all, the status of their schools greatly affects the whole neighborhood.  A good neighborhood school draws concerned and competent families and therefore the economy of a neighborhood may depend a great deal on the health of their schools.  Go to board of education meetings, organize to demand better education, join with parents in their efforts, but most of all, become involved in the schools as volunteers, as mentors, as classroom aides; in whatever role will enhance the status of that school as a healthy learning community.

Business leaders have a unique opportunity to influence the education and development of students and their schools.  But, where are the business leaders?  Increasingly, they are less interested in the big picture that includes educational endeavors, than in their narrow concern for profitability.   With all the money they spend on lobbying for their own interests, could they not devote some of their lobbying toward improvement of education in this country?  It’s really in their short-term and long-term interest to be more active in influencing legislation which will support higher education standards, top-notch technical schools, world-famous teacher training academies, school re-construction, and classroom resources.  Why isn’t there a coalition of leading companies intent on doing this? 

Why aren’t Apple, IBM, Microsoft, Hewlett-Packard, Intel, Verizon, etc. joining together to make sure that every public school has high-speed broadband communications capability, has powerful laptops for every student, and desktops for every classroom and lab?  I don’t know the definitive answer, but emphasize that it is imperative for the future economy.

There are some good examples of internships for high school students in local businesses and some corporations.  That kind of on-the-job experience is vital for students of all kinds, but it is currently just a trickle.  Business leaders need to be in the schools and classrooms as well, giving presentations on how businesses operate, what they expect from employees, and how to go about getting interviews and jobs, and even internships, with their companies.

Business leaders need to push politicians, not only about the quality of American education, but they need to push for immigration policies that will attract talent to this country in high-skill jobs.  A view that restricts such immigration, or that restricts education and careers for foreign students, is again short-sighted in terms of our economic health and growth.  Business leaders need to come out of the shadows of corporate greed and get involved in producing an education system that will benefit us all.

Friedman and Mandelbaum have a conclusion worth your consideration: “we simply cannot escape the fact that we as a society have some catching up to do in education generally.  When you are trying to catch up, you have to work harder, focus on the fundamentals, and get everyone to pitch in.  Give us a country where everyone feels that he or she has a real stake in improving education…and we promise you the best teachers will become even better, the average ones will improve, and the worst ones will truly stick out.”

My Vision for America–Part III

Discussion of education reform is going on right now somewhere near you because many in this country are concerned about the education of our children and grandchildren, and millions of these people are quite worried. 

I have referred in my recent blogs on education to a current  book written by Thomas Friedman and Steven Mandelbaum titled:  “That Used to Be Us”.  Once again, I will take that book as a launching pad, exploring one of six items that the authors say is needed to bring America to where we need to be related to both the economy and education.  But first, I must again put this discussion into the context of my evolving Purpose Statement for public education which I continue to amend:

“To involve an entire community of educators (administrators, teachers, students, parents, volunteers and other interested citizens) in the teaching of traditional and foundational curricula (history, English, mathematics, science, language, technology);  in the drawing out of experiential learnings (through the arts, simulated games, and problem-solving) and in the discovery of skills, talents, concepts, beliefs, values and verities, in order to produce accomplished individuals, informed citizens, critical and independent thinkers, lifetime learners, cultural literates, world-class workers and competitors, and compassionate human beings willing to advocate for the welfare of the human family.”

The first and primary need is for  better teachers and better principals.  According to research, the most decisive factor in student achievement is excellent teaching, and yet many of our teachers are poorly educated.  Unfortunately, we have not made great strides in developing excellent teachers.  Friedman and Mandelbaum suggest a first step might be a new National Academy, modeled after our military academies.  In my opinion, regional academies might be more practical and more accessible. 

However, I think we must start at a wholly different point:  in high school (maybe Junior High), current teachers and administrators must make a conscious effort to identify young people who are, or could potentially be, in the top 10% of their class; who may already be tutoring or mentoring their peers; who may already demonstrate some passion for teaching.  Current teachers and administrators need to start identifying these students early on and engage in leading them toward a teaching career, perhaps by visiting their families, or having them teach a class, having them visit other schools and teachers, showing them some results of good teaching by relating success stories of students, or having them actually meet with the persons who have become successful because of excellent teaching.  While their target should be those in the top 10%, the recruiting teachers should always be on the look-out for potential teachers below that level who can be tutored or mentored into the top 10% , and who have that passion for teaching that can also be nurtured.  Current teachers must become recruiters, tutors and mentors for potential teachers. 

In order to have this first step mean anything, however, there must be some other criteria in place:

--  How many of you have ever heard of a famous school of education at a college or university?  Schools of education at various universities and colleges must advertise and promote themselves more vociferously; they must become schools of excellence as well known as the Wharton School of Business, or MIT, or West Point, or the Duke Medical Center.  Maybe they could become regional academies with names that are known throughout the world.  After all, prestige is a strong incentive. 

I strongly believe that these schools must, above all, be the instigators of change in the teaching profession.  It is simply not enough to train teachers in the history of education theory, child development,  or the mechanics of teaching in a classroom.  Teachers must be trained to be facilitators: they must understand group process, they must have an understanding of how to use new technologies to advance learning, they must have an understanding of counseling techniques, they must know how to work with a team of educators including student peer-teachers and volunteers; they must have instruction in experiential learning, in the scientific method, in the facilitation of learning through use of unexplored or additional resources; they must know how to involve parents, businesses, and citizens in the education process and in the education community.  This is not your grandparents’ world.  This is a new world we are living in, and new methods of approaching it must be part of every educator’s repertoire.

--  Students must be able to see the teaching profession as one of the top five career choices.  One way to do this, of course, is to have the beginning salary for teachers reflect the salaries of other professions in an area.  We cannot recruit, let alone maintain, excellent teachers if we do not make salaries commensurate with excellence!  Until excellent teachers can be provided with salaries that engender prestige, status, success, and passionate commitment to that profession from the community, we can forget about making substantial progress in public education.  How do we pay for it?  Anyway we can.  If we can afford to pay professional athletes six-figure salaries for playing games, we can find a way to pay our teachers prestigious salaries.  I have suggested previously that school boards need to explore ways to obtain operating expenses for education; a small  education levy on everyone is one way to do it.  Is that asking too much?  Not if the future of this country rests so clearly on the excellence of our teachers!

--  Recognition of excellent teachers must be part of every district’s operation.  School boards should be in charge of providing that recognition on an on-going basis.  It should include ceremonies, bonuses, awards, plaques, national recognition, every possible way to bring excellence in teaching before the public and to laud our teachers for what they are doing.

--  One form of recognition and the producing of passion for teaching is the on-going development of teaching excellence.  We need teachers exchanging classes with other teachers in their own schools as well as in other schools, we need teacher-to-teacher mentoring programs, we need regional and national institutes for teachers, we need new ways to upgrade skills.    Without this kind of professional development strategy in place, we cannot expect excellent teachers to grow beyond their current skill-level. 

--  We also need established career ladders for teachers and principals who are identified as highly effective.  Too many excellent teachers leave our schools because they can’t see a future beyond where they started.  We need “mentor teachers”, “teacher coaches”, “senior teachers” -- new levels for people who have become experts, specialists, and tutors who can help other teachers be all they can be.  Friedman and Mandelbaum remind us that China has four levels of proficiency in their teaching profession, and in order to move up a level, teachers must demonstrate their excellence to a private review board.   

What about administrators?  Much of what we have said about teachers can also be said about training of principals: prestigious academies, appropriate salaries, professional development, recognition, etc.  After all, it is clear that entire schools can be affected by a good or bad principal.  But one thing I envision is that every principal must have some sort of teaching experience in their background.  It doesn’t necessarily need to be in a public school,  but every principal needs some understanding of the types of challenges which every teacher faces.  If we are going to ask principals to oversee a budget, to develop and supervise teachers, and to deal with the community’s concerns, we must give principals more ability to construct their budgets, to choose (and to un-choose!) their own teachers, and to be supported by their boards of education in their community roles.  According to one expert, great principals attract great teachers, but terrible principals drive out great teachers.

--  In the case of both teachers and principals, there needs to be a fair and unbiased evaluation of their performance. Probably at least 50% of every teacher’s and principal’s performance evaluation should be based on student growth, but “growth” must be evaluated on criteria that include skills and attitudes that go beyond grades alone, as related to criteria mentioned in the above Purpose Statement.  Teachers and principals should also have a say on what is included in evaluation criteria and instruments that are utilized.  Evaluations like this should provide the criteria for reductions in force: based on effectiveness, not tenure.  Anyone rated “ineffective” for 2-3 years should lose their jobs. 

In my opinion, evaluation by students of their teachers and their principals must be included.  Leaving students out of on-going evaluation leaves a gap that cannot be filled by anyone else.  Students know when they are being short-changed.  Students can be fair, especially if the evaluation instrument is well-constructed (with student and teacher input) by a contracted group or by a local board with expert help. 

A final word on evaluation:
According to the President of the AFT, a key question is how teachers are evaluated.  She said: “We need evaluation systems based on multiple measures of both teacher practice and what students are learning.”  I would agree wholeheartedly, but would add that “learning” should be more than grades on tests, as indicated in the above Purpose Statement.  Some of the most important “learnings” never show up on tests, like values learned, social skills acquired, caring attitudes gained, community involvement demonstrated.  If student growth was evaluated based on an Individual Education Plan for each pupil, instead of on criteria imposed by higher authorities, there would open-up a whole new method of performance evaluation related to learning and growth, and a whole new methodology for building and re-formulating curricula, peer mentoring, intervention from parents, community involvement, etc.

There are six items to consider and we have just skimmed the surface of one: the need for better teachers and better principals.  Next time, I hope to say a bit about my Vision for Education in the following five areas also mentioned by Friedman and Mandelbaum:

Parents who are more involved
Politicians who push to raise educational standards
Neighbors ready to invest in schools even though their children are not there
Business leaders committed to raising educational standards in their communities
Students who come to school prepared to learn