The end of Medicare

The debt hawks are to economics as the creationists are to biology. Those, who do not understand Monetary Sovereignty, do not understand economics. If you understand the following, simple statement, you are ahead of most economists, politicians and media writers in America: Our government, being Monetarily Sovereign, has the unlimited ability to create the dollars to pay its bills.
==================================================================================================================================================

It’s one thing to call for “smaller federal governement” or for “less federal spending” or for “cost savings” as vague, general, feel-good concepts. It’s quite another to see the actual effects of reduced federal spending.

Consider Medicare. Relative to the real cost of medicine, Medicare payments to doctors and hospitals have gone down. Many people cheer these payment reductions as evidence doctors have been making too much and charging too much, and that the government is trying to be frugal in its payments. And isn’t frugality a good thing?

Here are some excerpts from an April 2nd, 2011 article by Ricardo Alonso-Zaldivar, of the Associated Press.

Every year, thousands of people make a deal with their doctor: I’ll pay you a fixed annual fee, whether or not I need your services, and in return you’ll see me the day I call, remember who I am and what ails me, and give me your undivided attention.

But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama’s health overhaul.

The spread of “concierge medicine,” where doctors limit their practice to patients who pay a fee of about $1,500 a year, could drive a wedge among the insured. Eventually, people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.

Doctors are people. Nurses are people. They have personal lives. They have families. While there may be a certain amount of altruism associated with being a medical care giver, ultimately people, particularly the best people, drift toward money. So restricting Medicare payments tends, over time, to reduce the number and quality of people willing to be educated and trained in medicine, or willing to practice, particularly in primary care.

Hospitals are businesses. Potentially more lucrative businesses attract more investors than do less lucrative businesses. So restricting Medicare payments reduces the number of hospitals, and reduces the sophistication of equipment and systems in the remaining hospitals.

Medicare recipients, who account for a big share of patients in doctors’ offices, are the most vulnerable. The program’s financial troubles are causing doctors to reassess their participation. But the impact could be broader because primary care doctors are in short supply and the health law will bring in more than 30 million newly insured patients.
If concierge medicine goes beyond just a thriving niche, it could lead to a kind of insurance caste system.

“What we are looking at is the prospect of a more explicitly tiered system where people with money have a different kind of insurance relationship than most of the middle class, and where Medicare is no longer as universal as we would like it to be,” said John Rother, policy director for AARP.”

As Tea (formerly Republican) Party Patriot member dance about, hoisting their signs, Medicare slowly shows signs of distress. Doctors have begun to opt out of a system they feel is uneconomical and even unfair.

The trend caught the eye of MedPAC, a commission created by Congress that advises lawmakers on Medicare and watches for problems with access. It hired consultants to investigate. Their report, delivered last fall, found listings for 756 concierge doctors nationally, a five-fold increase from the number identified in a 2005 survey by the Government Accountability Office.

The transcript of a meeting last September at which the report was discussed reveals concerns among commission members that Medicare beneficiaries could face sharply reduced access if the trend accelerates. “My worst fear — and I don’t know how realistic it is — is that this is a harbinger of our approaching a tipping point,” said MedPAC chairman Glenn Hackbarth, noting that “there’s too much money” for doctors to pass up. Hackbarth continued: “The nightmare I have — and, again, I don’t know how realistic it is — is that a couple of these things come together, and you could have a quite dramatic erosion in access in a very short time.”

Another commissioner at the meeting, Robert Berenson, called concierge medicine a “canary in the coal mine.” . . . MedPAC’s Hackbarth declined to be interviewed. But Berenson, a physician and policy expert, said “the fact that excellent doctors are doing this suggests we’ve got a problem. The lesson is, if we don’t attend to what is now a relatively small phenomenon, it’s going to blow up.”
When a primary care doctor switches to concierge practice, it means several hundred Medicare beneficiaries must find another provider.

And why is an excellent concept like Medicare being dismantled? Because of the false beliefs our Monetary Sovereign federal government “can’t afford” to support universal health care, or the government is “too big,” or people should learn to “take care of themselves.”

The next time you hear a Tea (formerly Republican) Party Patriot (ironic, isn’t it?) scream their latest chant, “Cut it or shut it,” understand you are witness to the tolling of the Medicare bell – as well as the bell for so many other valuable federal projects. These people might as well be screaming, “Cut the American life style. Make us third world.”

My prediction: Rather than fund Medicare properly, as a Monetarily Sovereign nation easily could do, Congress will attempt to outlaw concierge doctors or add a tax to medical services provided by these doctors. This will exacerbate the problem, as fewer people will enter and remain in the medical profession, but addressing a bad law with a worse law often is Congress’s knee-jerk approach.

Rodger Malcolm Mitchell
http://www.rodgermitchell.com

No nation can tax itself into prosperity, nor grow without money growth.

MONETARY SOVEREIGNTY

Is John Mauldin winning the battle with Barry Ritholtz for economic ignorance?

The debt hawks are to economics as the creationists are to biology. Those, who do not understand Monetary Sovereignty, do not understand economics. If you understand the following, simple statement, you are ahead of most economists, politicians and media writers in America: Our government, being Monetarily Sovereign, has the unlimited ability to create the dollars to pay its bills.
==================================================================================================================================================

John Mauldin is an author who repeatedly will remind his readers his book has been on the New York Times best seller list for weeks, along with several other books of fiction.

He spends so much time with self-promotion, he may not have the energy for learning. He writes about economics, yet seems not to understand Monetary Sovereignty, the basis for all modern economics.

Here is what he said in a recent article titled, “The Plight of the Working Class”

. . . the only way you can show a positive GDP for the last decade is with government spending. . . . Without government spending, “real” GDP would be at levels it was over ten years ago.

And it is real growth that drives wages and creates jobs.

Correct. He makes it sound like some sort of crime, but the need for federal spending increases is a fundamental tenet of Monetary Sovereignty, as is demonstrated in these charts: “Is federal money better than other money?”

My book calls for a large increase in funded infrastructure spending through a fuels tax. . .

How is it possible to be a famous economics writer, yet repeatedly confuse monetarily non-sovereign governments with Monetarily Sovereign governments? It’s like a musician confusing a piano with an oboe.

A Monetarily Sovereign government (i.e. the U.S.) does not spend tax money. If federal taxes were zero, this would not reduce by even one penny, the federal government’s ability to spend.

By contrast, monetarily non-sovereign governments, example: Illinois, do spend tax money. Mr. Mauldin still doesn’t get it, despite many reminders.

Yes, we have to make cuts to government programs. A 33% growth in federal discretionary spending (not including stimulus money) the last three years alone is not reasonable, given the size of the deficit.

Double talk. What does “reasonable” mean? And why is money creation unreasonable? And specifically, what is wrong with the deficit? A growing economy requires a growing money supply. The misnamed “deficit” is the federal government’s method for adding money to the economy. So what is the problem? He never says anything supported by facts.

The last recession was not caused by too little government.

More double talk. There is a massive difference between too little government and too little federal spending. The last recession was precipitated by several factors, one of which was too little federal government spending. Every depression and most recessions follow decreased federal spending growth. See: What causes GDP growth?

I am worried about the survival of the country economically. Another crisis caused by the bond market driving up interest rates . . .

The market does not determine interest rates; the Fed does. It controls the Fed Funds rate, which translates to all other interest rates. So this best selling author doesn’t understand bond markets, either. By the way, what are the rates these days? Too high?

. . ., because they become concerned about the size of the debt and deficits, will seriously reduce the choices we have – with none of them being good. Ask Ireland or Greece how it feels.”

Can you imagine? He does not seem to realize Ireland and Greece are monetarily non-sovereign, while the U.S. is Monetarily Sovereign! He is making a patently false comparison, something like saying since water and gasoline both are liquids, it doesn’t matter which liquid you pour on a fire.

. . . my friend Barry Ritholtz . . .

Two prolific economics authors, neither of whom displays even the vaguest concept of Monetary Sovereignty, are friends. Wouldn’t you know it.

As I have written many times, cutting government spending will mean lower GDP numbers in the short term, but survival in the longer term.

As is typical with debt hawks, there never is any data or even a mechanism for the stated claims. These people think it is sufficient to say, in effect, “Debt is big; therefore debt is bad,” without such details as:

–What kind of debt? Personal or government?
–What kind of government? Monetarily Sovereign or monetarily non-sovereign?
–Specifically, how will a reduction in federal money creation raise GDP in the short or long terms?
–Why would the federal government be unable to “survive” federal spending?

In short, I view Mr. Mauldin as a prominent fraud, who makes his money by quoting popular wisdom, and by supporting his views with no facts. He just goes along with the intuitive “debt is bad” mantra, and by doing so, hurts America.

But he is a best selling author, which says much about the reading habits of the American public.

Rodger Malcolm Mitchell
http://www.rodgermitchell.com

No nation can tax itself into prosperity, nor grow without money growth.

MONETARY SOVEREIGNTY

–Why the politicians, the media and even many economists still don’t get it.

The debt hawks are to economics as the creationists are to biology. Those, who do not understand Monetary Sovereignty, do not understand economics. If you understand the following, simple statement, you are ahead of most economists, politicians and media writers in America: Our government, being Monetarily Sovereign, has the unlimited ability to create the dollars to pay its bills.
==========================================================================================================================================================================================

Among the Tea (formerly Republican) Party’s many hates, is the hatred for federal deficits, and they share this antagonism with nearly every American. Yet, based on my own personal reading, I believe the media and the politicians, and many economists do not even know what a federal deficit is, let alone how it relates to the federal debt.

Let’s begin with semantics. A quick trip to dictionary.com says:

DEFICIT: 1. the amount by which a sum of money falls short of the required amount.
2. the amount by which expenditures or liabilities exceed income or assets.
3. a lack or shortage; deficiency.
4. a disadvantage, impairment, or handicap: The team’s major deficit is its poor pitching.
5. a loss, as in the operation of a business.

Look at all the negative words: Fall short, lack, shortage, deficiency, disadvantage, impairment, handicap, poor, loss. From the standpoint of intuition, clearly a “deficit” is something to be avoided. Yet, a federal deficit merely is the arithmetic difference between two, mostly unrelated numbers: Federal taxes collected vs. federal dollars spent.

These numbers are mostly unrelated, because federal taxes do not pay for federal spending. Either can exist without the other, and subtracting one figure from the other is meaningless — or at least has been since 1971, when we went off the gold standard. Prior to then, federal taxes did pay for federal spending, so there was some justifiable logic in comparing taxes with spending. Today, such a comparison is like subtracting the number of runs the Cubs score in a particular game, from the number of people who attend that game.

Having said that, one reason to subtract taxes from spending does remain, and it is an important one. Because the federal government creates federal dollars by spending, and federal taxes destroy federal dollars, federal deficits are the net amount of federal dollars the federal government creates each year.

Does creating federal dollars sound like an activity which should be viewed as “falling short, lacking, a shortage, a deficiency, a disadvantage, an impairment, a handicap, something poor or a loss”? When you think about it, doesn’t creating federal dollars come closer to positive words like: “Income, surplus, profit, accumulate, increase, build and benefit”? And when you think about it further, isn’t that exactly what the so-called “deficit” does for our economy? A growing economy requires a growing supply of money, and the federal deficit supplies that money.

Because the word “deficit” historically has had negative connotations, many people find positive connotations to be impossible to imagine, thus the ongoing efforts to reduce the deficit, when in fact, the efforts should be to increase the deficit. But it gets worse. There is widespread belief that federal deficits increase the dreaded federal debt, and that federal debt is nothing more than an accumulation of federal deficits.

Wrong.

Like “deficit,” debt is a word with strong pejoratives. According to thesaurus.com, words related to “debt” are: “bankrupt, beggared, behindhand, insolvent, liable, minus, not paying, owing, unable to make both ends meet, unpaid, unremunerated, unrequited, unrewarded, worse than nothing.” With a family history like that, is it any wonder that “debt” has such bad press?

Federal “debt” actually is an accumulation of federal debt instruments, of which the four majors are: T-bills (one year), T-notes (10 years), T-bonds (30 years) and TIPS (Treasury Inflation Protected Securities — 5, 10, and 30 years). The debt process is this:

1. Federal government creates dollars out of thin air, by crediting a creditor’s bank account. At this instant, dollars and deficit are created but no “federal debt.”
2. Federal government elects to create T-securities also out of thin air, when it exchanges them for previously-created dollars. At this instant, federal debt is created. The money supply does not change, as the dollars are destroyed the instant the T-securities are sold.
3. To redeem the T-securities, the federal government re-creates dollars, exchanging them for T-securities and destroying the T-securities. Again, the money supply doesn’t change.

So all federal “debt” is nothing more than the total of outstanding T-securities, which are created and redeemed with no effect on the money supply, other than liquidity (dollars are more liquid than T-securities). Neither creating, nor redeeming T-securities has any inflation repercussions, and because a Monetarily Sovereign government does not use income for spending, T-securities are a useless relic of the gold standard days, neither affecting, nor affected by, federal tax collections, federal spending, economic growth or the federal deficit.

For such a benign investment — one neither causing nor reducing inflation, neither increasing nor reducing taxes, neither increasing nor reducing the deficit, and one whose sole effect is to reduce economic liquidity — federal “deficit” surely has acquired a bad name, based on the almost universal desire to reduce it. And strangely, this effort at debt reduction does not take the logical step of merely eliminating the creation of T-securities, but rather it focuses on reducing federal deficits, which do not have an operational relationship with federal debt.

Isn’t it amazing that your favorite politician, your favorite newspaper editor, your favorite talk-show moderator, your favorite columnist and the vast majority of the world’s economists do not understand this basic, operational truth: Even were federal taxes to equal federal spending (a deficit of zero), this would not change the Treasury’s need or ability to create/sell T-securities, and even were T-security creation/sales to be eliminated, this would not change the federal government’s ability to create dollars. Instead, they spend their lives decrying the federal deficit, which is necessary for economic growth, and decrying the federal debt, which has become meaningless for virtually all economic purposes, rather than focusing on properly directed methods for improving our lives.

So, the next time you read or hear some self-anointed “expert” saying the federal debt must be reduced, or the federal deficit increases the federal debt, or worries about whether other countries will buy our debt, or worries that “paying off the debt” will cause inflation or the current favorite bogey man, hyperinflation, know this: No matter what the credentials, that person simply does not know what he/she is talking about. Period.

After so many years, the flat-earth, leech-applying, flag-flying, evolution-denying, deficit-decrying, logic-defying, repeatedly-lying still rule, stomping through our lives, damaging everything in their path. With barely a whimper from us.

Rodger Malcolm Mitchell
http://www.rodgermitchell.com

No nation can tax itself into prosperity, nor grow without money growth.

MONETARY SOVEREIGNTY

–How to fix Medicaid, plus an idea for universal health care.

The debt hawks are to economics as the creationists are to biology. Those, who do not understand Monetary Sovereignty, do not understand economics. If you understand the following, simple statement, you are ahead of most economists, politicians and media writers in America: Our government, being Monetarily Sovereign, has the unlimited ability to create the dollars to pay its bills.
====================================================================================================================================

Here are excerpts from an article titled, “Medicaid bills settled in a hurry before aid ends,” by Dennis Cauchon, USA TODAY:

State governments are rushing to pay billions of dollars of medical bills before special federal assistance for Medicaid expires July 1.

The “hurry-up-and-pay” effort will put an extra $1 billion or more into the pockets of financially struggling states — and increase the federal deficit by a similar amount.
[…]
The federal stimulus law and a later extension provided states an extra $80 billion in 2009 and 2010 for Medicaid, the nation’s health care program for the lpoor. This was done by reducing the states’ share of the program from a national average of 40% to 28%.
[…]
Because states run the $400 billion a year program — while the federal government reimburses them — states can time payments to maximize the federal share.

Two thoughts: First, why doesn’t our Monetarily Sovereign federal government pay for 100% of Medicaid, instead of asking our monetarily non-sovereign states to pay? Can anyone answer that?

Second, wouldn’t the idea of having states run Medicare as a universal health care program, with the federal government funding it, satisfy the “anti-big-government” people? I know it won’t satisfy the debt-hawk contingent of the Tea (formerly known as “Republican”) party. Nothing short of a depression will satisfy them. But at least federal funding combined with state operation, should remove the fear of big government and so-called “socialism” from universal health care. Then no American would need to do without health care.

Rodger Malcolm Mitchell
http://www.rodgermitchell.com

No nation can tax itself into prosperity, nor grow without money growth.

MONETARY SOVEREIGNTY