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David Walker: The Mission Ahead

David Walker: Dave Walker, President and CEO of Peter G. Peterson Foundation and former Comptroller General of the United States.

 

Question: What got us into this financial mess?

David Walker: There are a number of common denominators between the factors that led to the current mortgage based sub-prime crisis and the federal government’s own deteriorating financial condition. First, a disconnect between the players who benefit from current policies and practices and those who will bear the risk and pay the price if things hit the fan. Secondly, a lack of transparency about the nature and extent of magnitude of the real risk. Thirdly, too much leverage, too much debt. And, fourthly, a failure of both private sector and government risk management mechanisms in the case of the mortgage related sub-prime, a failure of those to act despite clear and compelling warning signals going off in order to prevent a crisis.

What we saw in the case of the mortgage based sub-prime is laggardship , not leadership, that’s a new word. What laggardship is, it’s a failure of leadership and its waiting [sic] ntil there is a crisis at your doorstep to act and then acting precipitously in the face of such a crisis. What we need is leadership both on the public sector and the private sector, and what that leadership means, it means looking ahead, seeing key trends, identifying challenges and opportunities, taking affirmative steps to be able to capitalize on those opportunities to meet those challenges and to avoid crisis that’s what we need. More leadership, less laggardship.

 

Question: What should President-elect Obama do immediately?

David Walker: A) focus on getting the economy turned around and restoring confidence in the short term, and B) putting processes in place like a fiscal future commission or something along those lines that would be able to do work for about a year and then make recommendations to the new president and the new Congress to get our own federal financial house in order so we can avoid a super sub-prime crisis that we don’t ever want to see.

 

Question: What do we need to do for the long term?

David Walker: There’s no question that after we turn the economy around, we need to have some type of statutory budget controls in place in order to restore the type of discipline that existed in the 1990’s and early in this millennium that helped us go from large and growing deficits to large and growing surpluses. We need things like pay-as-you-go rules.

We need things like caps on discretionary spending. We need things like to understand what the long term cost beyond 10 years of tax cuts and spending increases are, but we also need to do things that we didn’t have back in the 1990’s and early in this decade, we need to be able to force elected officials to be able to disclose the long term cost, the discounted present value dollar cost, major spending in tax proposals before they are enacted in the law. We need to be able to have reconsideration triggers for major mandatory spending programs and major tax preferences, deductions, exemptions, credits exclusions, so that we reconsider those and that we don’t allow them to continue to grow on autopilot.

Believe it or not, the federal government’s budget for fiscal 2007, 62% was on autopilot and growing every year, and of the 38% that wasn’t on autopilot, believe or not, every expressed and enumerative responsibility envisioned by the founding fathers for the federal government was in that 38%.

 

Question: Would you reform the tax code?

David Walker: In my view, we need to streamline and simplify the tax code because even people who want to comply would have a difficult time complying and knowing that they have complied is complex as it is. We need to be able to eliminate a lot of the special exclusions, deductions, exemptions, the special interest provisions to be able to broaden the base that subject to taxation so we can keep rates low, so we can try to end up encouraging the economy to grow, all right?

So we are going to need a broader base, flatter but not flat income tax, and we’re probably over time going to have to supplement that with some type of a consumption tax probably geared towards healthcare because we’re not going to be able to deal with the basic and essential needs of healthcare under our current revenue structure, although, any healthcare reform should be designed to meet those four pillars or at least further progress on those four pillars and to save money as compared to current law.

 

Recorded on: November 4, 2008

 

 

The former United States Comptroller General outlines his action plan for America's future.

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The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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