In this column, we address the challenge of expanding health insurance coverage. First, we explore why our employer-based system leaves gaps in coverage, even for people with jobs. Second, we discuss the challenge of relying on the individual insurance market, which has to fill these gaps.
Remember “mutual assured destruction?” MAD was the dominant principle of the Cold War: The Soviet Union would not attack us as long as we retained the ability to retaliate. They might surprise us and obliterate New York, Chicago, Los Angeles, and Washington, but our nuclear subs and hardened silo-based missiles would respond in kind, turning Moscow, Leningrad, Kiev and Vladivostok into historical footnotes (if mankind survived to write any more history).
A kind of financial “MAD” became our consolation in the 1990s as China continued to accumulate foreign exchange, the vast majority of which was in dollars (or financial assets like bonds that were priced in dollars). At present, China’s holdings of dollar assets top $1.5 trillion, says the Peterson Institute for International Economics.
I sent my Nissan Quest to the crusher for a lousy $4,500. Yes, I could see into the engine compartment without opening the hood—but it ran like a top! Now the feds will have their way with my car. Some minion will replace its engine oil with sodium silicate and fire up the unsuspecting engine—until it seizes up, never to run again. It’s the automotive equivalent of “hung from the neck until dead.” What have I done?
As cars fly out of the showroom and the dealerships are clogged with eager buyers, many of us are questioning this bit of Washington wisdom.
Consolidating local governments in New York is a hot topic across the state. Proponents maintain consolidation is a way to make local governments more efficient and less costly. Opponents argue that services will be cut, local representation will be lost, and savings will be minimal at best. Every week, I receive calls from local government officials across upstate asking what is involved in studying how to share or consolidate services. Almost invariably, the caller starts out by saying, “I’m not necessarily in favor of dissolving or consolidating, but I feel it is my responsibility to the taxpayers to look at every avenue to reduce our local taxes.”
The Rochester community confronts problems that will test the mettle of our leaders in coming decades. Our core challenges persist and others will emerge, yet help from external sources will become scarce. We are thrust back on our own devices, thus on the ability of our leaders to forge community solutions to community problems.
The City of Rochester will continue to struggle with its central economic problem: too many school dropouts and too many graduates who are ill-prepared for further schooling or a career. There is no challenge more difficult or more important.
In unprecedented numbers, communities across the state are looking at the potential for consolidating government services, either through shared service agreements or outright merging of governments. Why? Because citizens have reached the point where the high cost of local taxes has motivated them to stand up and ask that governments reconsider in fundamental ways who should deliver services, and how.
Study after study makes it clear that consolidation is not a magic bullet for drastically reducing costs and can’t provide the 10% to 30% immediate savings that many taxpayers want. Rather, research suggests that consolidation realistically reduces total costs by 2% to 5%, which critics use to raise the question – why bother? Based on 10 studies over the past three years where the Center for Governmental Research examined shared services and consolidation in towns, villages, cities and school districts across New York, I suggest five reasons why consolidation should be considered.
After I made some cautionary comments on the pending fiscal stimulus plan on a local television news program, a friend said that I “sounded like a Republican.” I never did find out whether this was intended as a compliment or a criticism. Regardless of her intent, I found her comment troubling. Should caution have a partisan label?
I despair that elected officials seem to remember only half of a course in economics. We get more-or-less balanced policy in normal times because they remember different halves. Republicans remember 18th Century political philosopher Adam Smith proclamation that competition can harness initiative and build a stronger economy—yet forget Smith’s injunctions against concentrations of economic power. In this crisis, Democrats remember 20th Century economist John Maynard Keynes’ observation that public spending can stimulate the economy—yet forget that what we spend our money on and the amount of debt we incur matters rather a lot.
Originally published in Rochester Business Journal
1/9/2009, 1/16/2009, 1/23/2009
Part OneEarly signals from our health insurer led us to expect another double-digit increase in our insurance premiums—perhaps a 15% hit. Frankly, I thought that we were just being softened up for something lower—If I were led to expect 15%, then a mere 11% bump should make me (relatively) happy. I was stunned when the final price of the most popular of our plans would go up 21% in 2009.
The big increase in price led us to explore cheaper plans, particularly a policy that includes a “Health Savings Account” (HSA). The discussion below refers to the specific plans we were offered by Excellus BlueCross BlueShield.
CAUTION: The remainder of this column discusses insurance premiums, deductibles, out-of-pocket maxima and other arcane health insurance jargon. Readers looking for lighter fare might prefer IRS Publication 17 or, perhaps, a William Faulkner novel.
This week’s conference on the state’s budget crisis—sponsored by the Empire Center on State Policy and the Center for Governmental Research Inc.—was organized around a technical question: What can be cut from New York’s budget to fix a deficit estimated (today, at least) at $12.5 billion? Yet the overriding problem is not technical but political. My colleague Erika Rosenberg, moderator of one of the sessions, asked the panelists this question: “What’s it going to take for the Legislature to make the unpopular decisions that are needed to balance the budget?”
Gov. David Paterson made the correct technical decision in calling the Legislature back for a special session on Nov. 18. Yet the brutal reality of New York politics eliminated any possibility of progress. With control of the state Senate still in question and the political risks starkly clear, the session never convened.
Back in 2002, CGR reported on the many buildings around the state bearing the names of elected officials. To illustrate our point, we included a picture of the Joseph L. Bruno Stadium at Hudson Valley Community College, built with $14 million contributed by the generosity of then Senate Majority Leader Bruno. Of course, he was being generous with OUR money.
Bruno Stadium
In hindsight, it was risky to use the Bruno example. A political friend told me what he’d have done to me had he been on Bruno’s staff. Standards of decency and editorial policy prevent me from saying more.
A lot of money flows to community projects through the goodwill of legislators. The NYS Legislature has long divvied up $200 million in “member item” cash—money from the annual budget that can be allocated by a member of the legislature with no more process than the permission of his or her political leader. In 2006, my colleague Erika Rosenberg reported that the problem extended to several billion dollars in additional money that was borrowed to fund projects sponsored by individual members. We called these funds “Capital Pork.”
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