Is the federal government too big? Will Medicare become insolvent? What can we do better?

Two related beliefs — both false — are promulgated by the rich to widen the income/wealth/power Gap between the rich and the rest. The false beliefs are:

1. The federal government is too big and
2. Medicare, Social Security and the entire government are going insolvent.

I. The “Government is Too Big” Myth

You often hear claims that many departments should be eliminated and/or many government jobs should be eliminated. Generally, the “too big” myth revolves around two other myths:

Myth A. It’s a waste of taxpayer dollars. Most people do not comprehend federal finances, wrongly equating them with state/local government finances.

The two are nothing alike — as similar as a stick of butter and a butterfly.

State/local government finances are similar to personal and business finances. You, your state, county, city, and business are all known as “monetarily non-sovereign.” This means you can spend only as much as you can borrow plus your income.

You cannot create dollars from thin air. Your state and local governments run on tax dollars and borrowing, plus what they get from the federal government. They can run short of money.

The federal government is Monetarily Sovereign. It’s finances are precisely the opposite.

It never borrows dollars. It does not use tax dollars (It destroys all the tax dollars it receives.)

It does create dollars from thin air. And it never can run short of dollars.

Whatever you believe about personal finances does not apply to federal finances. Black and white differences.

Myth B. The federal government is a vast bureaucracy that doesn’t care about my problems as well as my local government does. People who believe this have been swayed by populist politicians who pretend to “be on your side.”

The federal government is not a bunch of robots living in DC. It is your Senator living in your state and your Representative living in your community. It needs to be big because America is big and requires big service.

Politicians who tell you they will fire thousands of government workers don’t tell you who will provide government services to this vast nation. These politicians often complain about “unelected officials” who make decisions. But would anyone really want to take the time and effort to vote for all the government workers.

When the Postmaster fired people, the postal service went down, and prices went up.

It’s like firing soldiers and hoping this will strengthen the army. Generally, politicians who say they will fire “government bureaucrats” hire friends and relatives of big donors—people who have no experience and don’t know or care what they are doing.

II. The “Medicare is Going Insolvent” Myth.

Myth A. Medicare is supported by taxes, and with fewer working people and more old people, Medicare is running out of dollars. Medicare is a federal agency. It cannot become insolvent unless Congress and the President wish. The federal government can add any number of dollars at any time, merely by voting.

Medicare is not supported by tax collections. No federal agency is. All federal tax dollars are destroyed upon receipt. When deducted from your paycheck, they come from the M2 money supply measure, but the instant they reach the Treasury, they cease to be part of any money supply measure. They are effectively destroyed.

Myth B. Everyone says that Medicare trust funds will be insolvent. This is part of “the Big Lie” that federal finances are like your personal finances. The lie is promulgated at the command of the rich, who don’t want you to receive benefits. They want to widen the Gap between the rich and the rest, making them richer.

Given the above facts, please read the following excerpts:

Innovations from Rural Communities Are Improving Health Care
By Carrie Arnold

On a frigid winter evening about five years ago, a desperately ill young woman walked through the doors of the Sanford Bemidji Medical Center in rural Minnesota.

Several weeks before, she had labored alone for hours in her tiny mobile home to bring a new baby into the world.

The woman had received no prenatal care and no medical attention at delivery—the kind of situation that has made maternal mortality rates for Native American women in rural areas twice as high as those of white women.

The only reason she was showing up now was that the baby wasn’t eating.

She had no running water to make formula. The hospital was her only option.

Johnna Nynas, the obstetrician on call, quickly diagnosed her patient with postpartum preeclampsia, a rare condition that affects people after pregnancy and can be deadly if untreated.

For Nynas’s pregnant patients, the hospital in Bemidji is the only option between Duluth, Minn. (three hours away), and Fargo, N.D. (2.5 hours away).

The surrounding area is one of the poorest in Minnesota.

Some residents of the nearby Leech Lake, Red Lake and White Earth Indian Reservations don’t have reliable access to running water.

Transportation (especially in winter) and child care for medical visits that require a several-hour car ride and possibly an overnight hotel stay are often unaffordable, even if Medicaid covers the cost of the health care.

For the Monetarily Sovereign federal government, no expense is unaffordable.

There is not one financial reason why this woman in America has been left too poor to afford running water, prenatal care, medical attention, proper food, and transportation.

There is not one financial reason why federally financed clinics cannot exist in the empty spaces between for-profit hospitals.

Yes, there are no financial reasons, but there is a reason: the American public’s economic ignorance.

If you were aware that providing this woman with lifesaving care would not cost you one cent, would you deny her the care? If you knew the government could fund free clinics in the surrounding area, at no cost to you or anyone, would you opt against them.

Nynas, who was born and raised in rural Minnesota, says that by the time an expectant parent arrives in her office, they may have a list of health concerns that have gone untreated for years. She links this lack of care directly to the elevated risk of pregnancy-related deaths and complications in the region.

“When we first meet patients, it’s probably the first contact they’ve had with the health-care system in quite some time,” Nynas says. Haunted by her patient’s preeclampsia emergency, she set out to remove barriers to needed care. Loaned blood pressure cuffs and bathroom scales let many of her low-risk patients receive checkups over the phone.

This communication made it easier to schedule in-person visits for ultrasounds and blood tests.

Here is a private citizen attempting to solve a real problem the federal government refuses to solve because of its fake problem: A supposed lack of money.

David Driscoll, director of the Healthy Appalachia Institute at the University of Virginia, isn’t surprised that the impetus for change began in a rural area. The regions that face staggering health inequalities are developing innovative solutions to enhance well-being for everyone.

Rural communities’ perpetual need to do more with less and to overcome obstacles not found elsewhere has led to modernized care delivery. Although many of the innovations are tech-centric, not all require Internet access to work.

These shifts are helping doctors bring world-class medical care to even the most far-flung patients.

“World-class” care? Doubtful. If they were “world-class,” you can be sure the rich would already use them.

One challenge for rural health experts is to ensure solutions don’t exacerbate existing disparities. Doctor visits via a video call won’t help someone without an adequate Internet connection, for example. But advocates say thoughtful action paired with infrastructure investment will broaden access to services.

Simple equipment sent home with low-risk pregnant patients helped Nynas’s northern Minnesota families deliver healthy infants. Nynas’s success with home devices such as bathroom scales, blood pressure cuffs and fetal heart-rate monitors convinced her to expand her reach.

Unnecessary poverty in America is so severe that people cannot even afford bathroom scales, blood pressure cuffs, and fetal heart rate monitors, much less conveniently located clinics, doctors, and nurses to monitor these devices.

Not only is poverty financially unnecessary in America, but it is morally re[rehensible and ignorant. It is compounded by the “Why should they get benefits?” attitude of those who can afford what the poor cannot.

An American who would willingly provide a neighbor’s emergency transport to a hospital hours away, may not want the federal government to provide the same service at no cost to anyone.

It is the irony of human nature that so many of us would deny others aid simply because we did not receive the same aid.

Collaborating with several local community groups, Nynas applied for a grant from the federal government’s Rural Maternity and Obstetric Management Strategies program.

With this funding, Nynas was able to not only expand patients’ virtual care but also provide additional local resources, such as an in-hospital food pantry, transportation services and a visiting-nurses program.

The money exists. Do the people realize they have to ask for it?

She is setting up a satellite clinic at an Indian Health Service facility, which typically has limited prenatal services. This approach will let patients without home Internet or phones upload their data and connect with nearby providers in consultation with remote experts for complex pregnancies.

Health-care micro sites such as these act as a bridge between major medical centers and small communities and are showing huge promise in rural health, says Michael Carney, interim provost at the University of Wisconsin–Eau Claire.

They combine the best of telemedicine and in-person care. Patients without broadband Internet can go to a local clinic and talk to a specialist online. Nurses and other providers at the local clinic can do bloodwork, measure vital signs and nurture the doctor-patient relationship.

These micro sites are the flagship of the University of Wisconsin’s ongoing rural health partnership with the Mayo Clinic, Carney says, and are intended to bolster the health of his hometown. Carney says practitioners worldwide are asking, “How do we deliver health care in a cost-effective way to people who can’t come to a traditional clinic?”

In southwestern Virginia, where Driscoll grew up, the distances between two points aren’t that far as the crow flies. But the residents of the area’s tiny towns and hollers aren’t crows. The narrow, winding roads mean even seemingly short drives can take hours.

Without public transportation, many of the area’s older adults can’t travel to medical appointments. Driscoll’s first job, in the 1990s, was with a community organization that drove local patients to clinics and hospitals.

Driscoll chatted with his passengers, listening to their problems. Many said the doctor’s visit they were headed to was their first in years because they had been physically unable to get to appointments. Multiple, untreated chronic diseases such as asthma, diabetes and hypertension were the rule, not the exception.

With poverty rates high and grocery stores few and far between, most of his passengers experienced food insecurity, and their diets lacked fresh fruits and vegetables. The few people who had home Internet relied on dial-up because broadband wasn’t available yet.

As is common, the solution resides in the statement of the problem. The federal government has the ability and the obligation to eliminate poverty in America. Social Security for All and Medicare for All would go a long way toward that goal.

Rural communities in Virginia and around the world face many of the same challenges—lack of clean drinking water, unreliable transportation, lagging investments in infrastructure and technology, and hospital and clinic closures.

The federal government has the financial resources to address and solve all the above problems. The stumbling blocks are the trio of false beliefs:

1. Federal deficits should be reduced (False. They should be increased as this adds growth dollars to the economy)
2. Federal taxpayers fund federal spending. (False. All federal spending is funded by new dollar creation)
3. If I didn’t get it, why should they? (Pitiful.)

Today, with a $5.1-million federal grant, Driscoll is addressing problems that have been amplified by the COVID pandemic. According to one study, so-called diseases of despair, including opiate misuse and overdose, suicide and alcohol-related liver disease, spiked by 40 percent in central Appalachia during the beginning of the pandemic.

As a result, the number of premature deaths in Appalachia is 25 percent higher than in the rest of the U.S.

Like many rural health programs, the efforts at the University of Virginia rely extensively on telehealth. That’s largely because in the mid-1980s, awareness of these kinds of health disparities (and their origins) dovetailed with emerging technological breakthroughs.

As a policy analyst at the Virginia Department of Health, Kathy Wibberly began working to connect small hospitals with their large, urban counterparts via videoconferencing and other technologies. Rural physicians could consult with on-call specialists in distant parts of the state to stabilize or manage fragile patients.

This approach, she says, “saved lives and saved brains and saved disability further down the road.” In 2019 more than one quarter of U.S. hospitals had the capacity for telehealth-based stroke care.

The Australian government is also Monetarily Sovereign, but like the U.S. government, it pretends to be monetarily non-sovereign. Read this.

A diagnosis of kidney failure is life-altering. For residents of the remote Australian outback, it can be doubly so. 

Those who needed dialysis had to leave to receive care at the nearest clinics in Alice Springs or Darwin. Indigenous peoples such as the Pintubi make up almost 4 percent of Australia’s population and more than 14 percent of people on dialysis in the country.

In 2016 research showed that Aboriginal people’s kidneys reached end-stage failure decades sooner than the kidneys of non-Indigenous Australians and New Zealanders, and an earlier study had found they were 1.5 times more likely to die on dialysis. For those who survived, quality of life was low.

Aboriginal Australians wanted to be “on country”—to live in their ancestral homelands with loved ones—while on dialysis. When the Australian government rebuffed their requests, Indigenous artists auctioned their work to raise more than $1 million (AUD) to build a nonprofit dialysis clinic, Purple House, in Kintore.

But bringing dialysis to an area where sheep overwhelmingly outnumbered people wasn’t an easy proposal. What’s more, dialysis is a thirsty procedure, using hundreds of liters of water for a single week’s treatment. Such a water-intensive therapy is ill-suited to the outback, which contains some of the driest biomes in the world. Purple House CEO Sarah Brown, who was tapped to lead the organization after a long career as a bush nurse, needed a therapy she could bring to her patients that merely sipped from the region’s scarce water supply.

To make matters worse, what limited water does exist in the area’s deep wells has too much fluoride and other contaminants to be drinkable, let alone used in dialysis.

Problems stay problems until someone invests in solutions. A Monetarily Sovereign government has the infinite ability to invest in solutions.

To address the problem, a team of engineers developed a way to filter the water so it could be used for dialysis. Then, rather than discarding it, the clinic devised a setup that let it reuse the water to provide pressure for the system. Brown knew they also needed to work with community leaders to integrate traditional Aboriginal beliefs and healing into dialysis treatments.

Over the next 20 years the Purple House transformed dialysis in Australia. In recognition of its efforts, the government created a special billing code to allow more nurses to deliver dialysis in remote communities. “We have gone from the worst survival rates in the country to the best,” Brown says.

Brown remade dialysis from the ground up. “We’re disruptors,” she says. “You don’t have to assume that something is going to stay the same. You can work together, and you can change the system.”

Transportation issues aren’t limited to rural settings; they can affect urban areas, too. So can lack of broadband access, food insecurity, and other disparities.

These disparities can be addressed and potentially solved with the application of money, which is infinitely available.

Because many innovations developed in rural areas target these broad problems, urban and suburban areas can also benefit from them. Telehealth is a prime example, Wibberly says. The advantages of telemedicine first appeared most obvious for rural areas, but the approach has gone mainstream. She is confident that other rural health programs will become standard medical practice.

Nature 634, S30-S33 (2024)

THE BOTTOM LINE 

The world is filled with problems that can be addressed and often solved by applying money, human talent, and will. The Monetarily Sovereign U.S. government has infinite money but acts as though it were monetarily non-sovereign.

I suggest that the U.S. federal government take the following steps to protect and improve the lives of the people, the sole purpose of any government.

1. Teach the populace about Monetary Sovereignty. Teach the people how the federal government never borrows but can create infinite dollars funding benefits to the people and can control the value of those dollars.

Teach the people that federal taxes do not fund spending but assure demand for the U.S. dollar while helping the government control the economy.

Stop lying about the federal government’s non-existent dollar shortage. Be truthful about the federal deficit (which grows the economy) and the federal debt (which is not a burden on the government or taxpayers but a safe protection system for unused dollars).

2. Stop collecting FICA. It has no useful purpose. It is recessive (taking growth dollars from the economy) and regressive (taking less from the rich, thereby widening the Gap between the rich and the rest) and does not fund anything.

3. Create and fund free, comprehensive, no-deductible Medicare for every American of all ages, to include prescription drugs; routine dental care like cleanings, fillings, and dentures; routine vision care like eye exams, eyeglasses, and contact lenses; routine hearing care like hearing exams, hearing aids, and related services; long-term care such as such as nursing home care;  and cosmetic surgery.

4. Create and fund Social Security for all Americans of all ages, at generous enough levels to end poverty in America

5. Fund free education, from kindergarten through post-grad, for all Americans who want it, plus a salary for attending school to encourage nation-building education.

6. Eliminate all federal personal and business taxes. They merely serve to punish the economy while providing no benefits. However, do tax what the government wishes to reduce, i.e. smoking and alcohol drinking, carbon emissions, gambling, and inheritances above median per capita wealth (to narrow the income/wealth/power Gap).

7. Federalize all banks.  When notorious bank robber, Willie Sutton was asked why he robbed banks, he responded, “Because that’s where the money is.” Private ownership of banks serves no public purpose. Federalization would eliminate the crime-encouraging, bankruptcy-risking profit motive that has caused so much public loss and the need for extensive monitoring.

8. Institute a per-capita Fund for States—money that each state could use at its discretion for infrastructure, homelessness, transportation, and other needs peculiar to that state.

9. More generous funding of the sciences, with a focus on research and development:  National Aeronautics and Space Administration (NASA), National Science Foundation (NSF), Food and Drug Administration (FDA), National Institutes of Health (NIH): National Oceanic and Atmospheric Administration (NOAA): Department of Energy (DOE): National Institute of Standards and Technology (NIST): United States Geological Survey (USGS). Also increase funding of university science R&D while federalizing the resultant inventions.

Federalize all electronic communications so that no private organization like Starlink can control America’s electronics.

10. Move toward democracy. Eliminate the Electoral College and the U.S. Senate. Elect the President and Vice President by a national majority or with a run-off for the two highest. The House of Representatives should have per-capita representation, beginning with one Representative for the least populous state. Repeatedly electing a President who receives fewer votes than his opponent is anti-democratic and leads to distrust of government.

Rodger Malcolm Mitchell

Monetary Sovereignty

Twitter: @rodgermitchell
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MUCK RACK: https://muckrack.com/rodger-malcolm-mitchell;
https://www.academia.edu/

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The Sole Purpose of Government Is to Improve and Protect the Lives of the People.

MONETARY SOVEREIGNTY