Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts

Wednesday, October 7, 2026

Expand the Middle-Class Again: The money supply of the middle- and lower-class has been diverted for 40+ years

     Once upon a time, before Ronald Reagan’s group of associates invented the fantasy of “trickle-down” economics, many more people made a living. People were able to save, a person making minimum wage could live off of it, medical and college expenses did not put you into debt for the rest of your life, …

     But “trickle-down”, created by the rich to suck in more wealth, kept reducing the amount that the non-rich could keep and save. Minimum wage slowly descended into starvation wage and not only were the non-rich not able to save but they ended up plunging into a huge pool of debt (national and personal).

Who Did It?

     Neither political party (leaving out parties other than GOP/Dems, sorry folks) has anything to be proud of. While it is true that national debt expanded much faster under the GOP tradition of “borrow and spend”, it still went up (except under Bill Clinton) slowly under the Democratic tradition of “tax and spend”. Although “tax and spend” is a much more reasonable budget approach, it is easy to notice that both approaches have SPEND dominantly in the approach. The GOP approached spending with giving out huge military contracts, starting wars, and reducing taxes for the wealthy who already had much more than they needed or could reasonably spend. Democrats spent on creating band-aids that would allow more people to survive the various things going on in the country but did not have the backbone to address the underlying issues.

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Why Did They Do It?

     I doubt anyone can give a solid answer to this. It is much easier to call out the reasons why it continues to get worse and worse. Most legislators don’t know much about anything other than their own profession (and about 40% are lawyers). So they rely on their aides and the industrial sector to put together the words of legislation. Need a bill to create a national dairy policy? Listen to the Dairy Lobby (note, they represent the larger dairy distributors much more than the dairy farmers), maybe ask them to write it and then have your aides go over the potential legislation with them. How about a farm bill? Talk to the lobbyist associated with the international grain market (once again, this has very little connection to the individual farmers (decreasing in number every year)), and put them to work.

     Some of this is necessary. Every member of Congress cannot know the ins and outs of every sector of the economy. But they are talking almost exclusively with the highest echelons of that economic sector. Call them the “executive class”. These lobbyists know what the high-level people in the business want and are able to pass along legal campaign donations as well as (much too often) illegal trips to Paris and subsidized ground care for the country hideaway and so forth. This by-passing of the people who actually do the labor and production leads to laws, and funding bills, that continue to favor the rich and ignore the working folk.

Reduce Influence of the Super-Rich on Government and Tax Policies

     There are no grounds for thinking that we could ever get rid of all inequality between people. We just aren’t perfect and that would require full, selfless, cooperation between all people. Although it is probably worst in the United States’ “uber-capitalism” where taxes are used to support businesses rather than businesses supporting the general populace, the over-influence of the wealthy/powerful exists all over the world and under many types of government and economic systems.

     But that doesn’t mean it isn’t very much worth the effort to try. In the United States, the oligarchic-supporting “Roberts Court” of the U.S. Supreme Court has made a number of rulings that twists the Constitution to pamper oligarchs. Unless explicitly mentioned in the Constitution (in which case, Amendments are required), most rulings can be overridden by laws enacted by Congress. (Of course, such laws are reviewable, once again, by the Court system.)

     So, make laws that eliminate the notion of a company as a person and part of the general electorate. Get rid of the possibility of the super-rich legally purchasing legislators (still might happen behind the scenes). Forbid ex-legislators from becoming lobbyists and using their inside knowledge of the workings of Congress to bypass the limited checks and balances on the system.

Reversal of the Elimination of the Middle-class People.

    As should be obvious, make sure that the people doing the labor and production receive enough income to live. That includes being able to save so they have a financial cushion needed to survive the normal ups and downs of life. Right now, there are areas of the country that have increased the “minimum wage” above the national wage but, even in those states, the minimum has not been lifted to beyond survival wage amounts.

     We have an issue on the rise, right now, in that AI and robotics are being used to eliminate jobs for people and increase profits for the owners. This is without any type of national guidelines or some type of path of least pain. It is said that AI and robotics will remove folks from the more routine tasks to leave more time and (new jobs) to tackle the abstract and creative. Perhaps so — but it won’t get to that point without some type of coordination.

“Minimum” wage and the ability to make ends meet

     Most landlords will rent (without a co-signer) only if the rent does not exceed 50% of the person’s income. In Washington state, the current (as of this writing) minimum wage is $17.13/hour. For a four-week month (February), this gives a total GROSS income of $2741/month. Half of this is $1370.50. While there are small apartments that cost this amount (or a little less), the average rent is still above this amount. The NET income of one of my sons, who makes “minimum wage”, is $2418/month. Half of the gross leaves him $1047.50 to live on. Given a budget for groceries, transportation, insurance (car and medical), internet/communication, and so forth, he can probably meet his survival needs — with no savings or cushion. In the book “Nickel and Dimed: On (Not) Getting By in America” by Barbara Ehrenreich, she shows how easily a person can get off the path of survival (16 years ago, it is now much worse).

     The above example is based on the minimum wage of Washington state. The national minimum wage in the United States is $7.25/hour. Given that amount, the above formula (for February) gives $1160/month (a qualified rent of $580/month) and it is easy to see that the national minimum wage does not even reach survival amounts. What does a person do if they only make this amount? Work two jobs (if they can find them). Forget about medical insurance. Forget about housing and live in your car if you can find a place to park safely. People do manage but most would not call it living. Survival, yes.

     Minimum wage must be based on the cost-of-living of the local area. It must also have an automatic Cost-Of-Living-Adjustment (COLA) with a local review of sufficiency every ten years (COLA rarely matches true inflation rates).

Make common emergencies survivable

     Beyond a living wage, medical costs are highly unpredictable and will create havoc in the United States. Having a national “Healthcare for All” eliminates this. It is politically difficult in the United States because it drastically reduces profits for healthcare insurance and it decreases administrative and general costs. Imagine (easy to do in all the countries, other than the US, which have had universal health care for years or decades) going to a medical office, discussing your health, have references issued, prescriptions written, and further care. No “am I covered?” questions. No “Can I afford the procedure (or medicine)”. Simple, straight-forward. The cost efficiency easily saves enough to pay for the expansion of number of clients.

Bubble-Up versus Trickle-down

     I addressed this in another newsletter, but almost all economists agree that “trickle-down” does not work. That statement is not really true. It does work for its true purpose of redirecting money from the middle-class and poorer (and even some of the lower upper-class) to the wealthy and ultra-wealthy. It just doesn’t work for the STATED goal of making the economy work better. This downslide of the economy began in the 1980s under the theoretical oversight of President Ronald Reagan.

     If we want to restore the middle-class, it is not unreasonable to capture the environment of when middle-class was healthy and still bringing people up out of the lower-class pool of people. Note that there were still problems in the 1980s and it is no good to just say “everything back to 1982”. That $7.25/hour minimum wage would translate to $25.17/hour nowadays. Make it so with the addition of COLA. Tax rates were slightly lower in 1982 than today but the EFFECTIVE tax rates does not have such a blissful analysis. For the very rich, they make use of various “legal” (but not moral) methods of tax avoidance. Much is associated with a method called “unrealized appreciation”. There are also a large number of other LEGAL loopholes. Some do also make use of illegal methods. I am not qualified, and the issues are much too large, for me to expand upon this topic. Google, wikipedia, GenAI it.

     When the large pool of people earning middle to low amounts have more money, they spend more money. I call this “bubble-up” and it is acknowledged by most economists (always say “most”). This circulation of money between creators of wealth and the need for other specialized services keeps money circulating and the economy growing from the bottom up.

Conclusion.

     So, there are a few major areas to re-expand the middle-class (and upper lower-class). Change minimum wage to a COLA living (above survival) wage. Legislate the oligarchs to reduce undue influence over legislation and tax codes. Have national policies to help, guide, and support transitions to new technologies and labor practices. Establish universal health care. Enact some rational policy about education, including university-level degrees. Close tax loopholes (aim for ALL, settle for most with the rest VISIBLE). De-stress the country and increase the happiness index and quality of life.

Tuesday, April 21, 2020

Flattening that curve -- what does it mean?



[ Numbers are as accurate as possible at time of writing -- but continually changing]

     At this moment, much of the world is on "lockdown" -- isolated from one another and moving around only if a person is categorized as performing "essential" work or if a person must leave the house to perform an "essential" activity (obtain food, medicine, repair, ... as defined per state or country). An essential worker is a person who is performing that essential work.

     At the "front lines" are the medical workers, ambulance drivers, ERTs, and often police and fire department workers. Being at the front line means that you are being confronted, and working, with those who ARE sick -- not just someone who MIGHT be sick (which is about everyone). Others who are providing essential services -- grocery store workers, postal and delivery people, sanitation workers, truckers, agricultural and meat processing workers, pharmacists, people who work in take-out/curbside/delivery of food, and many others -- are interacting with people who might be sick. In some of these cases, because they are interacting with so many different people, their personal risk (and, indirectly, risk of their families and others with whom they may be in regular close contact) may be high.

     A total lockdown (nobody contacts anyone else), can stop the spread of a virus (in the current case, covid-19, but applicable to any viral pandemic). But such an absolute isolation would cause many deaths -- directly from the illness (not being able to go to a hospital) and indirectly from lack of food and other needed supplies. And testing would still be needed -- somehow -- to determine when it was safe to release the lockdown. Not an easy scenario and if you miss even one case before you ease the lockdown -- back to square one.

     So, we go towards the above, essential allowed, lockdowns. This cannot stop the spread of the virus but it can SLOOOOOW down the spread of the virus.

     Yes, until a vaccine is approved and administered, people will continue to get ill. Slowing down the spread is called "flattening the curve". The main reason for this is that if spread is allowed to go unchecked it will overwhelm the available healthcare system. The Center for Disease Control (CDC)  has the following diagram:

In simpler terms, the graph says that you want to delay the period at which you have the most active cases of people not being well AND you want that highest number of active cases to be as small as possible.

     Healthcare involves hospital space (beds), sufficient staff (doctors, nurses, administrative, ...), equipment (ventilators, masks, protection hoods, ...) and medicines. Overwhelming the capacity in any of these areas will put the "overflow" into danger mode. At that point, the staff will have to "triage" the infected people with treatment going to the most badly infected and the rest will have to hope to survive on their own.

     Much of the time, equipment and medicines are insufficient but there isn't much that a regular citizen can do about that situation. Staff, unfortunately, will fluctuate as people get sick and (hopefully) recover -- proper protective equipment can help with that. What people can best have an effect on is the number of infected cases -- and that can be done by reducing the chance of an infected person infecting other people.

     Hospital beds are easy to count, so lets use those numbers to determine the maximum "peak" of the curve that will not overwhelm the system. Note that lack of staff, equipment, and medicines may DECREASE the maximum that the healthcare system can handle.

     Let us say that, in my county, the hospitals have 617 beds (which should be close to accurate, according to noted average numbers of beds -- 1.9/1000 times 325 (my county has approximately 325,000 people)). Approximately 2/3 of those beds are already occupied at a given "normal" period of time. That leaves 207 beds available for emergency needs. If not too many health care workers get sick (such that we are unable to staff for a fully case load) then as long as the number of hospitalized cases stay under 207, it can be handled.

     One additional factor is what percentage of cases need to be hospitalized? All cases need to be identified and treated but not all require a hospital bed. Without universal, daily (or every two days), testing precise numbers are not possible -- because there is no way to know exactly how many people are infected. Some early reports indicated that MAYBE 1/5 of the cases need to be hospitalized. Therefore, a number greater than 1035 cases will overwhelm the number of hospital beds (1035 / 5 = 207) in my county. Recorded numbers (as of today) of cases for my county is 536 -- so we are not overwhelmed as of yet but our numbers continue to increase daily. We are still very much in danger.

     If we apply the same formulas to the situation in New York, we see (as of today) that there are approximately 270 hospital beds per 100,000 (2.7/1000). If 2/3 of these beds are already occupied, that leaves us with 90 beds per 100,000 As of today, there are 1302 cases per 100,000. 1/5 of 1302 is 260 expected hospitalized cases. We see that New York state has far exceeded the number of hospital beds (almost 3 times). And, New York may have 270 hospital beds per 100,000 for the STATE but hospital beds and cases are not equally spread out within the state. Thus, the New York City metro area is in much worse condition than what would be seen from the initial formula. That is why so many temporary hospital beds are being set up -- but just adding beds does not add equipment, medicine, or staff.

     What happens if we do exceed the number that can be handled? We can see that in areas of the country that have had cases rise out of control for too long. Death rates rise. In Italy, this has also happened. The same holds for cruise ships and other confined areas such as retirement homes.

     So, when can an "essentials only" lockdown be cleared? This is associated with the idea of "herd immunity" where the contagion factor (how easily the disease is passed along to others) is associated with how many people are no longer able to be infected (recovered or naturally immune or vaccinated). The contagion factor is improved by isolation and lockdown. There are too many factors involved for me to even venture a guess.

     In the Spanish Flu Pandemic (1918 through 1920), there were "waves" of infection. Lockdowns, followed by ease of restriction, followed by increasing infection, followed by lockdowns, followed by ease of restriction. Health care is potentially much better than in 1918 but many political and economic factors are involved with treatments and population restriction.

     As mentioned earlier, full accurate numbers are not available. We don't really know just how many people are, or have been, infected. We don't know how many people who have died and had their reasons marked down in error. But we do have ways to slow the rate of spread of infection and we have real world examples of what happens if the rate of infection overwhelms the healthcare available.

     Best of futures to all. Stay safe.

Capitalism: There are variants of all economic systems

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