Report | Georgia PIRG Education Fund | Health Care

The $3 Trillion Question

Without health care reform, the United States is projected to spend over $40 trillion on health care in the next decade.  Experts estimate that thirty percent of that spending – up to $12 trillion dollars – will be wasted on ineffective care, pointless red tape, and counterproductive treatments that can actually harm patients.    

As a result, American families and businesses are weighed down by high premiums that continue to increase twice as fast as inflation.  Meanwhile, cost-benefit analyses performed by the Business Roundtable show that, dollar for dollar, we get less for our health care spending than the rest of the industrialized.

Health care reform holds out the golden promise of addressing both of these problems at once.  By aligning incentives within the health care system in favor of quality treatment, by investing in health information technology, and by conducting better research on which treatments work for which kinds of patients, we can make health care both more affordable and higher quality. 

Report | Georgia PIRG Education Fund | Health Care

The Facts About Comparative Effectiveness Research

As Congressional and public debate over health care reform grows more intense, comparative effectiveness research (CER) has emerged as an unlikely flashpoint of controversy. Opponents’ claims that CER results in the rationing of health care or a government takeover are belied by the true nature of such research: it is simply fundamental scientific research of medical treatments aimed at determining the most effective ways to treat sickness and injury. It is the basis of all advancements in the field of medical science and has been used throughout history to improve medical treatment. The results of such research are used to create treatment guidelines, which are then incorporated by physicians in determining the best course of care for each individual patient.

The tremendous need for this research is made clear by studies showing that only a minority of medical treatments currently being used are supported by valid research. As medical innovation accelerates, and new techniques, drugs, and devices enter the market daily, the need to gauge the effectiveness of these innovations increases.

Failure to use effective treatments results in worse medical outcomes and higher medical costs, resulting from the need to re-treat patients or to address complications following ineffective treatment. Evidence-based medical protocols, developed from the findings of CER, have been shown to yield cost savings and improvements to patient health.

A recent report released by the Institute of Medicine of the National Academies concluded that “the country needs a robust CER infrastructure” and listed the top 100 priority topics for comparative effectiveness research.

Opponents claim that CER will mandate doctors’ treatment options. Generating data on effective medical treatment is a separate issue from the use of that data. These studies are a tool that can assist doctors in determining the best treatment for their patients, in conjunction with their own knowledge of the unique needs of each patient. In some cases, the results of CER indicate that there is in fact a best practice that should be followed in nearly all circumstances. In others, research can help establish which kinds of patients are most likely to benefit from which treatment options. Doctors and care providers should be encouraged to keep current with effectiveness research findings and use them to improve patient care.

Much of this research today is conducted or paid for by the manufacturers of the drugs or medical devices being tested. Such research has been shown to be biased toward a finding that the drug or device is beneficial. Thus it is necessary that CER be funded by neutral parties who do not have an economic interest in the result. The federal government is ideally situated to perform such research and to fund nonprofit institutions to do it.

To improve patient care and reduce the costs of unnecessary and improper treatment, the federal government should expand its funding and support for comparative effectiveness research.

Report | Georgia PIRG Education Fund | Health Care

Putting America Back to Work

As the national health reform debate begins in earnest, some pundits have suggested that America cannot afford to invest in health reform. The resounding response from political and thought leaders has been that America can't afford not to.

Report | Georgia PIRG Education Fund | Democracy

Savings Dollars, Savings Democracy

The strong turnout of 2008 was only possible because millions of new voters were added to the rolls. This surge in voter registration occurred both as a result of extraordinary registration efforts by partisan campaigns, independent expenditure groups and non-partisan organizations, and because of the diligence of local officials in data-entering their information. While there is much to celebrate in the expanded participation of traditionally underrepresented groups – for example, 3.4 million more young voters than the previous election – it is also important to recognize the enormous obstacles and cost inefficiencies that occur in our current registration system.

Report | Georgia PIRG Education Fund | Tax

Tax Shell Game

Many of the largest corporations in our country hide profits made in the United States in offshore shell companies and sham headquarters in order to avoid paying billions in federal taxes. The result is massive losses in revenue for the U.S. Treasury – which ultimately must be made up by taxpayers.  The debt of a few is transferred to many – and to future generations. The U.S. Senate confirmed in the recently-passed fiscal year 2010 budget resolution that the use of offshore tax havens by large corporations “means that honest taxpayers face a higher burden.”   

Key Findings
• The cost to taxpayers due to the use of offshore tax havens is as high as $100 billion per
year - $1 trillion over 10 years. U.S.-based individuals and corporations who pay taxes
on their revenues must shoulder this burden for those who do not.
• Taxpayers must shoulder the burden – WashPIRG Education Fund calculated each
state’s taxpayer contribution proportional to their yearly federal contribution to make up
for the $100 billion lost (See Figure 1). The total burden shifted to Washington taxpayers
is as high as $2,456,043,505 a year.
• Our allies in other nations are also calling for decisive action to reign in these abusive
tax havens. The Group of 20 (G-20), which provides a forum for world financial leaders
to promote global economic stability, recently issued a communique providing for
sanctions against tax haven countries.
• Last year, Congress overwhelmingly passed, and President George W. Bush signed, the Fair Share Act, which closed the tax loophole that had allowed private government contractors, including Kellogg, Brown, and Root (KBR) to avoid paying almost $100 million a year in payroll taxes for its U.S. employees by setting up foreign subsidiaries. This law closed these loopholes for payroll taxes for companies applying for subsequent federal contracts.

• The federal government should relieve taxpayers of this unfair burden by closing the loopholes in the tax code that allow the use of offshore tax havens.
The impact of companies diverting profits to tax havens is real and it is both global and local in its reach. As American taxpayers face their yearly responsibility to report all of their earnings, policymakers should be reminded that there are many corporations who continue to hide theirs.



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