“Your Cash Shouldn’t Be Trash:” How To Save $1.83 Trillion in 10 Years

It’s after 3 pm, so I’m listening to the blues on WGBO-FM online and thinking about science. I love this old music recorded on machines built with vacuum tubes. It has a coloring and a presence that is a part of the music’s character, and hearkens a bygone era filled with the harmony and truth of living that found its way into the era’s songs. We used to sit on the porch under the full moon and look out at the landscape, talking softly about our dreams.

But its a new day; time and technology advance. And the technology is invading the night. Specifically, the way we light the night. Imagine saving $1.83 trillion over a decade and reducing carbon dioxide emissions. Imagine saving 962 million barrels of oil and closing 280 global power plants in the next ten years.

Two scientists, E. Fred Schubert and Jong Kyu Kim, who research and teach at Rensselaer Polytechnic Institute, the nation’s oldest technical university, say such claims are modest, as the next scientific revolution occurs when LED’s, light emitting diodes, the same technology that lights cell phones and computer screens, advance to home lighting.

LED lights require 20 times less power than conventional light bulbs and 5 times less than fluorescent bulbs. 

And this change will have broad effects, leading to innovations in transportation, farming, and health care.

LED lighting will reduce energy consumption, reduce pollution and save money. It provides a way for India and China to deploy these benefits as their energy footprints grow.

Toxic waste and terrorist potential are also reduced.

And all of these benefits can be derived from further developing technology at hand and already in use!

Currently, lighting accounts for 8 percent of America’s energy use. The Department of Energy’s current goal is to reduce energy used for lighting by 50 percent by 2025. National standards and standard test methods, to ensure performance and product quality, have already been set. Energy security is a opportunity for innovation, and LEDs are lighting the way.



The Invisible Government Health Care System

Health Care Reform is confusing and scary. Will the proposed changes make costs go up or come down? How will the quality of service be effected? Will treatment improve or worsen? And who will make the decisions that determine how cases and patients are handled? An unknown bureaucrat in Washington or one of the ten federal regions, or an unknown bureaucrat at the end of an 800 number who works for a private insurer and turns down a request for treatment as being outside of standard protocol? And who will pay for the changes? Can the nation afford to cover the 44 million uninsured? What loopholes are unforeseen?

Perlo doesn’t have a crystal ball, juju beads, or oracle bones, but it clicked through Google and Bing and discovered an already massive, invisible system of government health care that no one is talking about and that your tax dollars pay for.

The federal government is already deeply, deeply involved in health care in a myriad of ways, from the labels on packages to manufacturing standards to expanding markets to building roads and buying ambulances to operating clinics and subsiding nutrition to funding training to reimbursing service providers for minor treatment and major operations.

A good way to assess future performance is to look at past results. There is a huge amount of data and performance reports available that can guide the national conversation about health care priorities, costs, and potential savings, and can help identify needs and a sensible path to new policies.

As Booker T. Washington, the Virginia-born founder of Alabama’s Tuskegee Institute, said in his 1896 Atlanta Exposition speech, “cast down your buckets where you are.” To gain a fuller picture of the dollars the federal government is currently spending, examine the annual budgets of only a few programs and departments from the government’s invisible empire of health services.


In 2009, there were 1,961 mentions of “health” in 181 federal budget documents .

  • Among these “mentions,” the FDA (Food and Drug Administration) charged with keeping the nation’s food and drug supply safe, requested $2.4 billion.
  • The National Institutes of Health were appropriated a combined $30.3 billion. The Center for Disease Control and Prevention requested discretionary authority budget of $6.35 billion. The CDCP monitors and tracks infectious diseases, chronic diseases, environmental and occupational health illness, and state and federal bio-terrorism preparations.
  • The Health Resources and Services Administration which funds clinics and health centers, rural health care, funds training and scholarships, some organ transplant services, among other services, asked $6.8 billion.
  • In 2009, for legislated mandates, Indian Health Services was expected to receive $4.08 billion.
  • In the 2008 budget, the WIC (Women, Infants, and Children) program, which provides nutrition assistance to women with infants and services 45 percent of all US born infants, was budgeted at $5.5 billion.
  • So far, in 2009, the US government has purchased $3 billion of flu vaccine components-which may prevent an epidemic of H1N1, currently the biggest threat to cause a global pandemic.
  • The newly passed Children’s Health Insurance Program (CHIP), for children of families caught in the income gap between private insurance and medicaid, is requesting $6.9 billion to spend this year.

Examine the invisible government health care expenses by several themes: treatment, costs for specific illness, drug prices, public payer, public health care providers, breath and scope of federal health services in all departments.

  • One out of eight federal dollars-nearly $80 billion-is spent on services and treatment for Americans with diabetes. In fact, one study, (http://bit.ly/nE00G), reports 18 out of the 21 federal departments spend money on diabetes. Annual federal diabetes expenses exceed the entire annual budget of the Department of Education. While diabetes is preventable or manageable through diet and exercise, the government spent only $4 billion on prevention.
  • Overall spending is a theme with staggering implications. Without any reform, for 2009, the federal government plans to spend $2.24 trillion on health care with 1.84 trillion of that total funded by deficit spending.(http://www.usgovernmentspending.com/) .
  • $602 billion in 2004, 44% of all monies spent covered emergency room treatments. Still, more than half of all visits went unpaid.
  • American drug prices are the highest in the world, and account for 13 percent of all costs, or $202.24 billion in 2007.
  • By class, cardio-vascular drug purchases reached $31.5 billion, central nervous system agents accounted for $23.7 billion, hormones, $24.5 billion, and psycho-therapeutic drugs for $17.9 billion.
  • Current health care annual rates of spending increase are a whooping 8.6 percent.
  • The US as a whole spends $4.33 billion on health care in corrections.
  • The US has the highest infant morality rates of any developed country.
  • Medical debt is the number reason cited in the US for personal bankruptcies.
  • Non-profit hospitals represent 70 percent of US hospital capacity.
  • Currently, no nationwide system federally owned health facilities are open to the public (e.g., the Veterans Administration system only accepts veterans).
  • Hospital care accounts for 31 percent of all current health care costs.
  • In 1996, one percent of those receiving public treatment funds accounted for 27 percent of total costs.
  • Government health care programs currently cover 28 percent of Americans, 83 million people.
  • The US operates the largest national public health unit in the world, the US Public Health Service Commissioned Corps, one of America’s seven uniformed services.
  • Every department of the federal government is involved in funding health care as a public activity, including Agriculture, Defense, Education, HUD, Commerce, Interior, the Department of Justice an the others. The departments offer initiatives, trade mission, program goals, funding, outreach, treatment services, state grants, consumer protection against malpractice and fraud, transport, research, safety certification, guidelines and standards, and planning, both long term and contingency.

At first reaction, the numbers from every corner are staggering. Health care, clearly, has created a “giant sucking sound,” that tax dollars are flying into, inside and outside of treatment care. Reform is necessary, if only to stop the rapidly increasing flow of dollars.

The Director of the Congressional Budget Office wrote these powerful words on his blog, about his recent testimony before Congress:

” Under current law, the federal budget is on an unsustainable path, because federal debt will continue to grow much faster than the economy over the long run. . . Unless revenues increase just as rapidly, the rise in spending will produce growing budget deficits. Large budget deficits would reduce national saving, leading to more borrowing from abroad and less domestic investment, which in turn would depress economic growth in the United States.

Measured relative to GDP, almost all of the projected growth in federal spending other than interest payments on the debt stems from the three programs–Medicare, Medicaid, and Social Security. For decades, spending on Medicare and Medicaid has been growing faster than the economy. CBO projects that if current laws do not change, federal spending on Medicare and Medicaid combined will grow from roughly 5 percent of GDP today to almost 10 percent by 2035. By 2080, the government would be spending almost as much, as a share of the economy, on just its two major health care programs as it has spent on all of its programs and services in recent years.

In CBO’s estimates, the increase in spending for Medicare and Medicaid will account for 80 percent of spending increases for the three entitlement programs between now and 2035 and 90 percent of spending growth between now and 2080.”

Clearly, the first goal of reform must be to cut costs, reduce expenses, save money. Do any of the current plans meet this goal?

Secondly, waste, duplications, inefficiencies, and hidden costs abound throughout the systems and much of the real costs are off the books and are deeply embedded in each federal department. Critical and close oversight of these widely disbursed costs must be achieved. Through coordination, cooperation, and consolidation, it appears that real, significant savings in administration, services, and support can be achieved. The expenses connected to diabetes hidden in the system are a screaming poster child for theneed for teamwork. Grouping all health care expenses on a spread sheet that cuts across cabinet lines must be a high priority.

Thirdly, costs must be matched to measurable targets. How do only one percent of all users of the system account for 27 percent of the costs? Strategies for chronic users must be developed, better profiles created, alternatives explored. Name the top three creative ideas in the current reform plans. Without new ideas, how can there be reform?

Fourthly, drug costs must be severely curtailed.

Fifth, the cost of routine procedures must be reduced. Child birth is an example of a procedures whose costs have skyrocketed. Why?

Sixth, the government does efficiently provide medicaid, medicare, veteran health care, public immunization, disease mapping, research, and large grants to communities and individuals.

Seventh, so does the private sector. But in both cases, costs are raising to rapidly.

Lastly, future fears are being used to shield the maladies, malaprops, and out of control spending of the present. The US territories, Guam, American Samoa, Puerto Rico, for example absorb a large percent of health care funding. How exactly will reform affect the territories? And why are the current bankruptcies, unfathomable bills, and budget-breaking proscription costs not a part of the public debate?

Oh, watch carefully the special interests that suggest the government will enact forms of euthanasia for the elderly, or develop a plan with cracks so wide that legions will fall through, or increase private costs more rapidly. Having chased answers for treatment and services from the smallest detail to major conditions (a few years ago, my father suffered pulmonary edema over a weekend while in the hospital and it took five days for the family to get an assessment from the primary physician-while the consulting cardiac physician refused to speak at all to a family member despite repeated requests), I believe the answer to improved care lies in better values. The culture of American medicine must be reformed, along with its cost and payment structures, and the culture of its stake holders, the unions, medical/hospital/pharma/insurance associations who tremble and fear change, and resist it even worse than the American public.

Follow Walt at twitter.com/walterrhett, as he takes special note of the news, folly, and business of living at all levels around the globe.

The Obama Rules

Let’s stop denying the election wasn’t a plebiscite on creating new revenue to reduce the deficit by raising taxes on the top 2%. This is to balance cuts in direct benefits. Let’s stop overlooking the taxes represent 4 additional cents on a dollar’s income over $250,000. Let’s stop deluding ourselves and others that the election was either/or, not the total package of women’s rights, tax cuts, infra-structure investment. Let’s not repeat the lie or political myth that any person got paid $30M during the campaign.

Cap2012fallLet’s do remember the $400K was a part of a larger, more complex deal, not the bare bones deal Congress is now tasked with. Let’s remember, like in any negotiation, the $400K threshold can be revisited, and put back into play in a larger, comprehensive deal. Let’s stop finger pointing. The President has proved to be a reasonable, keep-the-promise executive, and has offered Republicans a way out of the very plan that Boehner gloated 2 years ago gave him “98%” of what he wanted from the President. Now Boehner won’t bring a vote to the floor on that 98%!

(See page 2 for a great look at the US Capitol, from the Revolutionary War to the Civil War to Sandy Hook, through architecture, photography, photos (Lincoln’s 2nd inaugural!), and friezes, frescoes, and statuary found in the Capitol.)

Another side of rape in India; the rape of international women studying or working in India. This is a first observer’s report of a recent Delhi case involving a Rwandan student raped by several men and the local police failure to take an immediate report. (Read more . . .)

Africa is a Country (Old Site)

A year ago, there was some minor hullabaloo created when African students in India were not permitted in some bars. But yeah, it remained a minor tempest. Most likely, prevalent attitudes towards Africans (and dark-skinned people in general) in South Asia didn’t change. A few days ago, I heard about the sexual assault of a Rwandan student in Delhi via Twitter, and asked Prasanto Kumar Roy, a Delhi-based writer to provide us with insight.

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98% Of What The GOP Wanted Now Gets Their No Vote

Media omits 3 facts about this mis-named, major legislative story. First, this is the very bill Boehner forced on Obama and then gloated that the President gave him “98%” of what he wanted. This bill, including sequestration, is a Republican bill; crafted, approved, and accompanied at the time by much celebration as Democrats were left deflated. Now, when offered 98% of what the GOP wants on taxes, Boehner refuses to let the House vote. Looking back, Boehner and the GOP House made a bad bet.

Second, by failing to bring bills to the floor, Boehner is using the House as a shield. All appropriations bills, by the Constitution (Clause 1, Section 7, the Origination Clause), must originate in the House. In part, that is why Boehner withdrew his $1M threshold bill when he couldn’t get a GOP majority; he has insisted the negotiations begin with a bill the House has passed, so he and the GOP House can (perhaps, rightly) claim credit and the political high ground (no!) for passing the bill later signed. This is a key Boehner point!

Third, by not voting to fix their bad bet, Boehner provides cover for representatives who would have voted no. He shields them from accountability. Not having their names attached to a vote, they throw stones in the dark and mortally wound the economy, families, health care, the unemployed. They should be exposed. The media silence on the contradiction between the GOP demanding cuts and their eagerness to restore the cuts they passed omits a key element of the story, as does not pointing out the contradiction of their willingness to let taxes rise on all in an attempt to preserve tax cuts for the rich.

Barack’s vision of democracy is consistently committed to the process of governing by compromise (which some see as “caving”). Often cautious on policy, legislatively, he does take greater risks. But 2 years ago, he knew, if he won, in this legislative cycle, he would have the upper hand.