Assisted Suicide Letter to the New York Times

To the Editor

New York Times

Scheduled for Publication 11/4 - 11/5/2012

In his essay of October 28^th, “Four Myths About Doctor-assisted Suicide”, October 27, 2012, 2:45

(http://opinionator.blogs.nytimes.com/2012/10/27/four-myths-about-doctor-assisted-suicide/?hp). 

Ezekiel Emanuel uses a flawed rationale to challenge the legitimacy of assisted suicide While he seems to agree that it would be acceptable in cases of severe, intractable physical pain, he suggests that it is not legitimate if motivated by emotional pain or depression.  The appropriate response in such cases, he maintains, is to provide “counseling and caring”.  As a retired Clinical psychologist, I must point out that there is a vast difference between the depression of a terminally ill patient, who realistically perceives his or her situation to be hopeless, and a physically healthy patient suffering from clinical depression.  In the latter case, feelings of worthlessness and hopelessness are the product of demonstrably inaccurate perceptions of self and circumstances - mental distortions produced by the illness itself.  For such individuals, appropriate treatment can produce marked improvement. The same cannot be said for terminally ill patients whose feelings of hopelessness are, sadly, all too realistic and whose depression is often a normal response to a disheartening reality.  While “counseling and caring” can provide comfort, they cannot change the reality of a patient whose quality of life has diminished to the point that each day is just another round of frustration and pain - be it physical or emotional.   If I should become terminally ill, I would not want to cede to a third party the right to determine when my life is no longer worth living. 

James Hawthorne, PhD

2418 Pickwick Rd.

Baltimore, MD 21207

443-813-2100

It's Private, not Public, Debt That's the Problem

The following excerpt is from a review of the book, "Debt: The First 5,000 Years", by David Graeber. The review was written by Robert Kuttner and appears in the New York Review of Books, May 9, 2013 (they deliver the magazine way ahead of the publication date). The main point is that conservatives have succeeded in persuading Americans that government debt is the big threat to our economy when, in reality, it is private debt that caused the recession and private debt that poses the real threat to future economic growth.

"At the heart of the argument about how to revive a depressed economy is the question of debt. When political leaders and economists debate the subject, they refer mostly to public debt. To conservatives, the economy’s capacity for recovery is impaired by too much government borrowing. These escalating obligations, they claim, will be passed along to our children and grandchildren, leaving America a poorer country. Liberal economists, such as Paul Krugman and Joseph Stiglitz, have replied that only faster growth rates and higher gross domestic product will reduce the relative weight of past debts. Budget austerity, in their view, will shrink demand and slow growth, making the debt burden that much heavier.

As important as this debate is, there’s something missing. Public debt was not implicated in the collapse of 2008, nor is it retarding the recovery today. Enlarged government deficits were the consequence of the financial crash, not the cause. Indeed, there’s a strong case that government deficits are keeping a weak economy out of deeper recession. When Congress raised taxes in January at an annual rate of over $180 billion to avoid the so-called fiscal cliff, and then accepted a “sequester” of $85 billion in spending cuts in March, the combined fiscal contraction cut economic growth for 2013 about in half, according to the Congressional Budget Office. Moreover, some of the causes of public deficits, such as Medicare, reflect to a large extent inefficiency and inflation in health care rather than profligacy in public budgeting.

It was private speculative debts—exotic mortgage bonds financed by short-term borrowing at very high costs—that produced the crisis of 2008. The burden of private debts continues to hobble the economy’s potential. In the decade prior to the collapse of 2008, private debts grew at more than triple the rate of increase of the public debt. In 22 percent of America’s homes with mortgages, the debt exceeds the value of the house. Young adults begin economic life saddled with student debt that recently reached a trillion dollars, limiting their purchasing power. Middle-class families use debt as a substitute for wages and salaries that have lagged behind the cost of living. This private debt overhang, far more than the obsessively debated question of public debt, retards the recovery."

The Deficit Revisited - Overview

THE DEFICIT REVISITED

OVERVIEW

In this and subsequent posts, I revisit and update the series that I posted two years ago.  I am pleased to report that nothing that I have seen over the past two years has given me any reason to modify the main conclusions that I presented in that series of post and, if anything, some of the new material that has emerged since then has left me more confident in those conclusions.

I have updated some of the original material with more recent data and have added much new content.  As before, most of the analyses are based on data from original sources such as the Official Budget of the United States, the Bureau of Economic Analysis, the Treasury Department, the Congressional Budget Office, and the Organization for Economic Cooperation and Development (OECD).  I have provided detailed source information so that readers who are so inclined can check for themselves.

My analysis of deficits and the national debt will be limited to the years preceding 2009.  The great recession that began towards the end of 2008 has created an economic environment that is so different from previous years that it really needs to be addressed separately.  I will do this in a later post.

The posts that follow will provide the evidence to support the following conclusions:

We Are Not Over-taxed.

• In 1960, when Dwight Eisenhower was President and we had a balanced budget.  Taxes then amounted to 15.8% of Gross Domestic Product (GDP); in 2008 they were 13.0% of GDP - a loss of tax revenues equivalent to $400 billion in 2008.  The deficit that year was $642 billion

• Not only is our tax burden lower than it was 50 years ago, it is also significantly lower than in other developed countries.  The mean tax burden (local, state, and Federal) in OECD^[1] countries is 35% of GDP; for the US^[2] it is 30%.

Spending As Such is Not the Problem.

• Whether spending is excessive depends on what you think of the programs for which the money is spent.  If you view Medicare and Medicaid as misguided government intrusions into areas better left to the private sector then you will view spending for them as unnecessary and excessive.  If you think that agricultural subsidies to huge corporate farming operations are vital to the national wellfare, you will view those expenditures as a prudent allocation of resources.

• In 1960, Medicare and Medicaid did not exist.  Those two programs alone cost $643 billion in 2008.  Despite the fact that we have increased spending for those and many other programs, our tax bill in 2008 was nearly $400 billion lower than it would have been under Eisenhower’s tax policies.  (To put these numbers in perspective, the 2008 deficit was $642 billion.)

• Eliminating the deficit without raising taxes would require draconian cuts in services to the most vulnerable segments of the population.  It would also involve major cutbacks in programs and services that are taken for granted by middle- and upper-income Americans. 

• Tea Party enthusiasts don’t have a clue about the way in which their lives would be affected by the spending cuts they are clamoring for.  If they understood, you can rest assured that they would be considerably less enthusiastic about their spending cuts.

•  Programs like Food Stamps and Subsidized Housing are popular targets for right wing talk show hosts who love to spin yarns about outrageous abuses.  In reality, total spending for all of those programs amounts to 4% of federal spending.  Even if 25% of participants are committing fraud, we are looking at only 1% of the budget, hardly a promising place for deficit reduction.

The Deficit And Debt “Crises” Are Not The Result Of Irresponsible “Tax And Spend” Policies Of Liberal Democrats. 

• At the close of 2008, 75% of our national debt had been generated by the “borrow and spend” policies of just three Presidents - Ronald Reagan, George H.W. Bush, and George W. Bush.  The remaining 25% of the debt was accumulated by the 39 Presidents who preceded Ronald Reagan.

•  The dramatic surge in the 2009 deficit can be attributed to five events:

1. The recession  (27% of the deficit).  An analysis done by The Center for Budget and Policy Priorities (CBPP) has shown the recession to be the single largest cause of deficit spending.  Recessions deliver a double whammy to the federal budget.  They trigger large, automatic, increases in expenditures for safety net programs like unemployment insurance, Medicaid, and food stamps.  At the same time, they also result in a substantial drop in tax revenues.
2. Running close behind the recession are the Bush tax cuts (24% of the deficit)
3. The Wall Street bailouts (16% of the deficit).  (Signed into law by George W. Bush, by the way).
4. The economic stimulus^[3] (12% of the deficit).  This is the only part of the deficit that can be attributed to President Obama.  Most mainstream economists agree that the stimulus headed off a catastrophic economic catastrophe and more than paid for itself.
5. Two unfunded wars (12% of the deficit).

The Real Threats to Our Economic Future

• Rising health care costs - and we are not talking about publicly funded programs like Medicare and Medicaid.  Expenditures in employer-based, private sector health programs are rising faster than those in publicly funded programs.

• Our Inefficient health care system - We spend 18% of GDP on health care compared to 11% in OECD countries, and yet the United States lags behind those countries in virtually every measure of population health, from infant mortality to life expectancy.

• If our health care system were as cost effective as the systems in those “socialist” OECD countries, we would save 7% of GDP each year, equivalent to $1.0  trillion in 2008 (when the deficit was a mere $642 billion).

•  The US defense budget ($663 billion) is larger than the combined defense budgets of the 20 next largest countries ($654 billion).  Can we and should we continue to play the role of world super-power?

• Too Big to Fail Financial Institutions.  The fallout from the financial crisis goes far beyond the tax dollars used to rescue Wall Street banks from the results of their reckless and irresponsible financial speculation.  It must also include trillions of dollars in foreclosed homes, lost jobs, and lost tax revenues, not to mention the continuing provision of free money in the form of near-zero loans from the Treasury Department.  

• The same financial institutions that triggered the recession are now bigger than ever and are now “too big to jail” according to testimony by Attorney-general Eric Holder before the Senate Finance Committee on 3/6/2013.  Holder stated that the Justice Department is hesitant to initiate criminal cases against  some of the largest financial institutions because prosecution could seriously disrupt both the US and the World economies.  So the folks who made a killing by manipulating LIBOR rates and who knowingly laundered money for Iran and for the Mexican drug cartels no longer need to worry.

---

^[1] Organization for Economic Cooperation and Development.  Member countries include Western Europe, the UK, Canada, Australia, and developed East Asian countries like South Korea and Japan.

^[2] After adjusting for the fact that the tax burden in OECD countries is higher because a much higher proportion of health care costs is born by government in those countries.

^[3] Otherwise known as the American Reinvestment and Recovery Act (ARRA) of 2009

Media Reporting on Gun Violence

The following post is an expanded version of an email I sent to Marketplace Money, a public radio program on personal finance.   I was irked by the reporter's glib observation that mass shootings can occur in countries with very strict gun controls and be absent in countries with high rates of gun ownership.  This observation has been regurgitated repeatedly by the media with the goal of enlightening us about  the relationship between the availability of guns and gun violence.  It is not clear whether the reporter was just mindlessly repeating a piece of conventional wisdom or whether he intended to suggest that there is no relationship between the availability of guns and the frequency of gun violence.  Unfortunately, many listeners would be left with that impression.  The reality is more complicated as I explain below.

The report by Stephen Beard about gun control in Europe that aired on Dec 26, 2012 was misleading and did a disservice to your listeners.  After describing the much tighter controls on guns imposed by European countries, Mr. Beard went on to make the observation, which has been parroted by every media outlet on the planet, that mass shootings can occur in countries with very strict gun controls (such as Norway) and can be rare in countries where gun ownership is very high (such as Switzerland).  While factually accurate, the observation is misleading because it leaves the impression that there is no relationship between homicide rates and the availability of guns.  The reality is much more complicated.

The US, with its easy access to guns and high rates of gun ownership also has one of the highest homicide rates in the world.  Of 145 countries surveyed in 2007 by the United Nations Office on Drugs and Crime (UNODC), 124 had lower 2010 homicide rates than the US and only 20 had higher rates.  As Table 1 shows, that puts the US in some interesting company

                                                                      Table 1

Twenty Countries with the Highest Homicide Rates

Source: (http://www.unodc.org/unodc/en/data-and-analysis/homicide.html.)

 

Let’s take a closer look at Norway, where the attack on students at a summer camp on July 22, 2011 claimed 77 lives even though, as Mr. Beard was careful to note, Norway has some of the strictest gun controls in the world.  What Mr Beard failed to report was that prior to the 2011 shootings Norway also had one of the lowest homicide rates in the world.

 Table 2

2007 Homicide Rates per 100,000 population

In 2007 (the most recent year for which complete data are available) there were 0.05 gun homicides per 100,000 people in Norway.  That’s one twentieth of a homicide for every 100,000 people.   The corresponding rate in the US was 3.87,  66 times higher than Norway.  To put it another way, had the US experienced the same low rate of gun violence as Norway in 2007, US fatalities would have been 154 rather than the 11,630 that actually occurred. 

While strict gun controls did not prevent the Norway mass murder, there is no denying that the country has had extraordinarily low levels of gun violence for decades.  While Norway is exceptional in this regard,  it is really the US, with its exceptionally high rate of gun homicides, that is the real outlier. US rates of gun related homicides are 6 ½ times higher than in Canada, 12 times higher than in the UK, and 16 times than in Europe as a whole.

Table 2

Ratio of US Homicide Rates to Countries with

Stricter Gun Control Laws 

The reader will note that the US does not differ that much from other countries in terms of non-gun.  Clearly, the big difference between the US and the other countries shown in Table 2 is its sky-high rates of gun homicides.

To be sure, the availability of guns is only one of many factors that contribute to the level of gun violence in a particular society.  The list contributing factors would include the severity of illicit drug trafficking, unemployment rates, poverty, school quality, social cohesiveness, and a host of others.  The magnitude of a any one factor’s contribution will vary as will the difficulty of ameliorating its affects.  All the more reason to go after contributing factors that (1) have a significant impact and, (2) are within our power to change.  Using these criteria, the imposition of reasonable controls on guns and ammunition on a National level is a no-brainer.  It is something that could be done relatively quickly and at relatively low cost if we could just get past the politics and the paranoia driven ideology of gun-rights advocates. 

 

We also need to think of the relative costs and benefits of different policy choices.  What exactly are the benefits to society of allowing access to assault  rifles with 30 or 100 cartridge magazines?  There are much better weapons for hunting and a wide range of perfectly good alternatives for self-defense.

 Yet, the mass shootings in Columbine, the Aurora movie theater in Colorado, and Newtown Elementary School in Connecticut have one thing in common - the use of semi-automatic guns with high capacity magazines.  At Columbine, one of the shooters wielded a 9 mm semi-automatic handgun and carried one 52-, one 32-, 
                         Intratec TEC-9                                   

The man charged in the Aurora movie shootings, carried an AR 15 with a 100-round barrel magazine.  The Newtown shooter also used an AR15, this one with a 30 round magazine.

Perhaps the NRA would be good enough to describe for us the benefits to our country of making such weapons freely available and how these benefits justify the obvious costs. 

Ron Moon co-owner of CJI Guns in Tucker, Ga., holds 

a pair of 100-bullet-capacity magazines for an AR15 

semi-automatic assault rifle.  The same magazine was used

 in the Aurora shootings.