> Dear Marta, Jessica, et al.:
>
> Properly understood, the standard idea of efficiency
> presents no problem for progressive advocacy. Like
> other principles, of course, it can be distorted
> beyond recognition.
>
Well yes, and it frequently does. There is the example of Larry McAffee who broke his neck and became a quadriplegic. The state of Georgia refused to supply him with an attendant so he could remain at home. They shipped him all over the country to skilled nursing facilities - away from his family, friends and away from the computer retraining he wanted to continue his engineering career as a quadriplegic. After several years of this he became despondent and petitioned the court for the right to die. The court granted his wish, the judge called him "heroic" for wanting to die. The system backed Larry into a corner where he had so little quality of life that he wanted out. It wore him down but then it was more than willing to get rid of him.
Now, when the state refused Larry the attendant it did so in the name of "efficiency," social services claimed that it would cost too much to provide Larry with an attendant (at minimum wage). The crazy thing about it was that the state had put McAfee in Grady Hospital in intensive care for seven months - unecessarily. Medicare, which got the bills for McAfee's hospital stay, recognized that he did not need to be hospitalized and refused to pay the $175,300 bill offering only $3,000 to $8,000 for his stay. By failing to provide McAfee with the attendant which could be cost out at $1500 per month, the state ended up with a hospital bill roughly $22,350 more per month than it would have cost to allow McAfee to live at home. McAfee could have lived happily in his own home with attendants for more than nine and a half years with the money spent on Grady Hospital for seven months, instead he was granted the right to die.
This is how "efficiency" gets thwarted into social Darwinism. Dick Lamm, former Governor of Colorado, said that the elderly and disabled "had a duty to die and get in the way" - he meant that in an efficient system, they would already be dead. So we must understand the broad range of acts that this word justifies. It is dangerous because it can marginalize people who are considered to "cost" too much whether the perception is real or a bureaucratic bungle as in Larry's case.
> Strictly speaking, only entitlements come
> under PAYGO. These include social insurance
> of all types, Food Stamps, Medicaid, and some
> other programs for low-income persons. Moreover,
> PAYGO means a spending increase is possible with
> a tax increase. What is called discretionary
> spending is capped, so it is "paygo" in the
> different sense that an increase in one item
> must be offset by a decrease in another. The
> difference is that it is possible to expand the
> size of the public sector only by expanding
> entitlements, not discretionary.
One recent noxious example of an increase being offset by a decrease has to do with the Return to work (RTW) legislation (Kennedy-Jeffords) proposed to alter disability work disincentives in Social Security policy. There will be costs attached to setting the RTW program into action, so insidiously the cuts to SSI (for two disabled people living under one roof, and other slices in benefits) was proposed to be slipped into the RTW legislation. What that amounted to was that those who could work (if lucky enough to get a job) would be doing so on the backs of those who cannot.
> This is important because getting rid of the
> caps, even under paygo, would be a step forward.
> Then we could more easily support "tax and spend"
> measures. Better, we could then raise the issue
> of why we need paygo if the budget is in surplus.
Yes these are excellent pragmatic points. But by the time we get to a budget surplus so much damage will already have been done by the entitlement destroyers busily replacing the New Deal with a business deal. Why go that far? Being in debt is not a bad thing - hasn't the country been in debt since its inception? The debt itself was not at a precarious level under Reagan (at $2.7 trillion) relative to the GDP, and it is even less so today. There is a difference between going into debt for good reasons and for bad ones. The case can be made for running up the debt when it benefits all of society.
Best, Marta