Marta Russell wrote:
> Max Sawicky wrote:
>
> > 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