Friday, October 08, 2004

Looking Forward to Next Debate?
A Bit of Proactive Fact-checking

By now, I'm sure everyone is wondering what will come up during the next debate, as it has become clear that the debates are having an effect on voter attitudes.  On Friday, we will see the the two major candidates for the Presidency debate in front of a town-hall type of meeting.

There is no way of knowing what topics will come up. Given the recent unfavorable reports out of Iraq, that is certain to be one topic.  The economy, health care, and education are other likely topics.  In fact, you may recall that Mr. Bush previously referred to himself as an "education president," based in part upon the changes he directed in the public school system in Texas.  That may be eclipsed somewhat, though, because the No Child Left Behind (NCLB) initiative is now the centerpiece of his education initiative.

Granted, education it is not thought  to be the most important topic.  Although it makes the list  of top voter concerns, it is only number six.  Therefore, it is not likely to influence many votes.  Only five percent of people ranked it as their highest concern.  Most recent polls indicate the "the economy" is the highest priority.  This is short-sighted, but true. 

The reason I say that it is short-sighted (to rank economic issues ahead of education) is that a strong economy actually depends upon good education -- as does national security, health care, and any other issue you might care to consider as a priority for our political system. 

How about if we do a little fact-checking before  the debate?

If education is discussed in the debate, Mr. Bush is sure to mention that he increase funding for schools.  He may neglect to mention that the costs necessitated by NCLB, and the declining income to school districts resulting from overall economic decline, have together eaten up any funding increases. 

Is the Education Prez Making the Grade?
Richard Dunham

[...] As he decried the "soft bigotry of low expectations" that limited the horizons of inner-city children, Bush did more than appeal to moderate voters. Once in office, he pushed for passage of the No Child Left Behind Act in early 2002 -- an achievement that helped Republicans wipe out the Democrats' traditional advantage on support for schools.

But Bush's advocacy of education reform has proved to be a mixed blessing. Local school boards around the country -- joined by top Democrats such as John Kerry -- are howling about the tough new law. NCLB requires schools to meet performance standards by 2012. But critics, including many local officials, contend the Administration hasn't provided the funding or the flexibility for school districts to clear the bar.[...]

Juanita Doyon, a Spanaway (Wash.) mother of four who is running for state school superintendent as an independent, has staked her bid on eliminating her state's exam. "[The test] has destroyed teaching and academic freedom," she says. Besides the testing issue, many localities are raising property taxes to pay for what critics call the largest unfunded federal mandate of recent times.

Mr. Bush also might mention the effects of school reforms in Texas, under his direction, when he was governor there. 

A Public Policy Failure

PUBLIC policy experiments rarely produce complete successes or total failures. They usually leave room for people with different goals or values to keep arguing.

Occasionally, however, there's a policy disaster so catastrophic that everyone agrees that something has to change. California's convoluted attempt to deregulate electricity was one example. Texas's decade-long experiment in school finance equalization - universally referred to as Robin Hood - is another.

"In less than a decade, the system is approaching collapse; it has exhausted its own capacity," write Caroline M. Hoxby and Ilyana Kuziemko, economists at Harvard, in a new working paper for the National Bureau of Economic Research. "We show that the collapse was predictable." (The paper, "Robin Hood and His Not-So-Merry Plan: Capitalization and the Self-Destruction of Texas' School Finance Equalization Plan," is available at http://post.economics.harvard.edu/faculty/hoxby/papers.html.) [...]

The article by Virginia Postrel also appears on her blog.  The reason this is important is that it shows that, not only is the Texan plan failing, but that the failure was predictable. 

A gradual failure could be forgiven, perhaps, if there were some kind of good to show for it.  Indeed, Mr. Bush spoke of the "Texas Miracle" when he was campaigning for president last time.  But the "miracle" actually was a fraud. 

The 'Texas Miracle'
Aug. 25, 2004

[...] All in all, 463 kids left Sharpstown High School that year, for a variety of reasons. The school reported zero dropouts, but dozens of the students did just that. School officials hid that fact by classifying, or coding, them as leaving for acceptable reasons: transferring to another school, or returning to their native country.

"That's how you get to zero dropouts. By assigning codes that say, 'Well, this student, you know, went to another school. He did this or that.' And basically, all 463 students disappeared. And the school reported zero dropouts for the year," says Kimball. "They were not counted as dropouts, so the school had an outstanding record."

Sharpstown High wasn't the only "outstanding" school. The Houston school district reported a citywide dropout rate of 1.5 percent. But educators and experts 60 Minutes checked with put Houston's true dropout rate somewhere between 25 and 50 percent.

"But the teachers didn't believe it. They knew it was cooking the books. They told me that. Parents told me that," says Kimball. "The superintendent of schools would make the public believe it was one school. But it is in the system, it is in all of Houston."

Those low dropout rates - in Houston and all of Texas - were one of the accomplishments then-Texas Gov. George Bush cited when he campaigned to become the "Education President." [...]

There is more information about these topics at factcheck.ORG. They seem to be having server problems, which I assume result from the tremendous number of hits they must be getting.  But you can see their fisking of the Bush education ad, using the Google cache here.  (Original reference courtesy of Madeline Begun Kane, who incidentally has written a poem about NCLB.)

Mr. Kerry, meanwhile, has a much more distinguished record on the subject of education.  His record on education (as well as many other subjects) can be found at www.vote-smart.ORG.  A summary of his statements and actions pertaining to education can be found at www.issues2000.ORG.  His campaign website has a summary of his education platform.  This includes a few talking points about Mr. Bush's education record:

  • Under-Funded No Child Left Behind by $27 Billion. Bush’s last four budgets have cumulatively provided $27 billion less than what was pledged under NCLB. [President’s FY 2005 Budget, www.ed.gov; historical data at www.ed.gov]
  • Cut Funding for the School District He Praises Today. In today’s radio address, George Bush praises a school district in Asheville, North Carolina. Yet George Bush cut Title I funding for that district by more than $100,000. North Carolina has been one of the nation’s leaders in education reform since the era of Jim Hunt, North Carolina’s “Education Governor.” [Center for American Progress, 04/06/04]
  • Proposed Cutting 500,000 Children from Afterschool Programs. In his 2004 budget, George Bush proposed cutting afterschool funding by 40%, cutting off afterschool opportunities for 500,000 children. [www.afterschoolalliance.org; ed.gov, FY 2004 Budget data]

There are many objections to NCLB.  My personal objections are documented in a previous post.   Reading that old post now, I am struck by how vociferously I attacked NCLB.

(Note: The Rest of the Story/Corpus Callosum has moved. Visit the new site here.)
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Sunday, October 03, 2004

Preview of Domestic Policy Issues:
Pharmaceutical Prices

The New England Journal of Medicine has published an opinion piece on the subject of prescription drug prices.  They kindly have made it available without subscription or registration. 

Election 2004

Volume 351:1375-1377 September 30, 2004 Number 14

Prescription-Drug Prices
Richard G. Frank, Ph.D.
In 2002, the United States spent $162.4 billion on prescription drugs. Government has traditionally played a smaller role in purchasing prescription drugs than in paying for health care services overall,1 accounting for 22 percent of prescription-drug spending as compared with 44 percent of all spending on personal health. The Medicare Modernization Act adds a prescription-drug benefit to the Medicare program, thereby reshaping the government's role as a payer for prescription drugs: the federal government's share of the country's prescription-drug spending can be expected to increase to between 30 and 40 percent during the first two years. The prices that the government pays for prescription drugs will be critically important. They will affect the cost of the new drug benefit, the financial stability of the Medicare program, and the incentives for prescription-drug manufacturers to develop new pharmaceutical agents. [..]

Richard Frank is a professor of Health Care Policy at Harvard Medical School.  His article is short and well-written.  In fact, I think it will be understandable to anyone who cares to read it.  It was written without bias, so I will take the liberty of providing the appropriate spin. 

The introduction of the article is quoted above; the rest of the article provides an overview of the major issues that have arising in the presidential campaign, regarding the prices of prescription drugs.  The main issues are: reimportation of prescription drugs, and direct governmental negotiation of drug prices; also discussed are the costs. risks, and benefits associated with reimportation and direct price negotiation. 

Dr. Frank points out that the main argument for reimportation is that it could lower costs to consumers.  The main arguments against it are: it might not lower costs very much, and there could be safety concerns.  Mr. Kerry is in favor of reimportation, but acknowledges that safety would have to be assured.  Mr. Bush is opposed to reimportation, citing a Congressional Budget Office report that concludes that price improvements are likely to be minimal.  Dr. Franks points out flaws in the CBO analysis, and concludes that modest price reductions are likely. 

The safety issue was mentioned by Mr. Bush's spokesperson, Mark McClellan:

Administration officials cite concerns about health and safety as justification for this reluctance to permit importation. Mark McClellan, the former commissioner of the Food and Drug Administration (FDA), observed that "there is no evidence that unapproved imported drugs are becoming safer or more reliable" and noted that "we are concerned with any measures that increase the flow of these unapproved drugs."

This appears to be a dumb thing for his to say, although perhaps it does not appear so inane if presented in full context.  He uses the word "unapproved" twice, which implies that there must be something wrong with them.  However, the lack of FDA approval does not mean that there is a problem; rather, it means that the FDA has not approved every aspect of the transportation and handling of the drugs.  These are real issues, but they are issues that can be addressed, and there is no reason to think that there is any intractable problem.  Stating that "there is no evidence that [they] are getting safer" implies that there is evidence that they are not safe.  In some cases, that is true.  In most cases, it is not.  Again, this is a problem that can be solved.

The issue of direct governmental negotiation for better prices is addressed next.  Mr. Bush opposes it; Mr. Kerry favors it.  The Bush opposition is based, in part, on the notion that "best health care system is that health care system generated in private markets."  This seems like a strange argument, since the Medicare Modernization Act prohibits direct price negotiation.  How is the prohibition of price negotiation consistent with the concept of a free market?  It is not.  Of course, Bush did not actually say "free market;" he said "private market."  What is the theory behind that?  The VA routinely negotiates prices that are 40% lower than those gotten by private insurance companies.  This would seem to prove that "private markets" do not always get the best prices. Mr. Bush also argues against price negotiation by saying that we need to be sure that drug companies have an incentive to develop new drugs.  If it were true that negotiation could not save much money, then there would be little to fear.  The incentive goes down only if significant cost savings result from the negotiations. 

In any case, the issue of reducing industry incentive is an important one, but Mr. Bush addresses only one side of the question.  If the incentives were reduced and the money just disappeared, that would be a problem.  But of course the money does not disappear; it gets spent somewhere else.  Republicans are fond of saying that taxpayers are the ones who know how best to spend their own money.  If that is true, why are we giving the money to drug companies?  If people want better drugs, they can donate the money to a foundation, such as the American Cancer Society. 

What Dr. Franks does not say, is that the pro-business stance of the Bush Administration is not really consistent with the purported values of the Republican Party.  It is more consistent with the values of someone who wants to curry favor with big business, and let the citizens suffer as a result.  Of course, the NEJM would not have published the article, if he had said that. 

(Note: The Rest of the Story/Corpus Callosum has moved. Visit the new site here.)
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