Tuesday, May 23, 2017

Medical School Problems

Medical Schools follow the money.  Most of it comes from government and big Pharma.  The research grants support the faculty and staff and have been required to attract the best research teams and the “prestige” that brings. Medical Schools are also attached to teaching hospitals to give students exposure to actual healthcare.  The third component is the medical school curriculum.

Medical Schools need to recognize that the current model is unsustainable. In the 1960s Medical Schools supported adding federal tax dollars to subsidize treatment. The Medical Industrial Complex formed by Big Pharma, Medical Equipment companies and Hospitals. They supported the emergence of “medical specialties”.

We’ve invested $trillions into healthcare since the 1960s and we have failed to find out what cancer is, but treatment costs are through the roof on everything. Healthcare is overpriced and under-performing. Patients are complaining about the cost and believe providers have a conflict of interest and will not implement cost-saving measures. The article below describes how converting grades to “pass-fail” caused panic with internships.

A disturbing truth about medical school — and America’s future doctor,

You may be surprised to learn that medical students at many of the best schools in the country aren’t given grades during the first two years of their medical education. They either pass their coursework or they fail. And then, they take one high-stakes test that affects their medical future.

While the effort to allow medical students to take two years of course work on a pass-fail basis was driven by an effort to make the notoriously difficult life of medical students easier, the high-stakes testing consequence creates problems of its own.

In this post, Brenda Sirovich, a physician and professor at Dartmouth College’s medical school, writes about how this approach threatens to compromise both the community of medicine and the quality of patients’ care. She is a 2017 Public Voices Fellow with the OpEd Project, a social venture with both a nonprofit and for-profit arm that is aimed at increasing the range of voices and quality of ideas contributing to national and international debate.


News that a federal educational experiment failed to supply evidence in favor of Education Secretary Betsy DeVos’s school choice agenda has undoubtedly elicited schadenfreude in some Democratic circles. Somewhat lost in the story, however, is scrutiny of how students’ educational success or failure is measured.

The trend toward near-exclusive reliance on standardized testing to measure educational achievement now extends all the way to medical school. Many may not realize that the readiness of aspiring doctors to enter the world of clinical medicine is now based overwhelmingly on a single, standardized, closed-book, multiple choice test.

Scores on the test, the U.S. Medical Licensing Step 1 Exam (a.k.a. the Boards), taken after two intense years of classroom education, will overwhelmingly determine where students do their residency training. And their professional futures.

Such reliance on Board scores wasn’t always this way. About 30 years ago, I took the Boards. I passed, and have absolutely no idea how I scored (even though I am the kind of person who still remembers the exact score I got on my SATs).

But a decade or so ago, residency programs suddenly started caring, a lot, about Board scores — an unintended consequence of a well-intentioned move by medical schools to grade the first two years pass-fail, to foster student wellness.

Residency programs abruptly found themselves in desperate need of a yardstick by which to measure and compare student applicants. Board scores were suddenly paramount.
Behold the mismatch: We aim to prepare students for a career characterized by collaboration, complexity, nuance and uncertainty; yet, we evaluate them on their ability to select autonomously and without research among radio buttons representing a discrete range of right-or-wrong responses.

After 20-odd years in practice, I have yet to see a patient come in with a list of four or five possible diagnoses, and ask that I select the most appropriate response.  Nor have I, while searching online for current evidence or recommendations, heard a patient cry out, “Stop!  This is a closed book appointment!”

Here’s the thing: Students understand how they’re assessed; they’re all quite brilliant in this way, whether they’re in medical school or high school or third grade. They figure out with lightning speed what they need to do to maximize their performance on the assessment that matters.

As a result, here is my students’ To Do list:
1.    Do not attend class, unless attendance is specifically required.
2.    Complain about the (modest) number of class hours requiring attendance.
3.    Resist discretionary learning opportunities, no matter how interesting.

Their logic is impeccable. Each student’s sweet spot for MCQ mastery involves some combination of lecture videos at double speed, late nights, ear buds, coffee and little human interaction.

It works beautifully in achieving the desired outcome of a good Board score.But what is the desired outcome? My students and others like them are the doctors of tomorrow. They’ll care for me and you as we age. For our parents facing life threatening illness and difficult decisions at the end of life. For the children we haven’t yet contemplated.

The desired outcome should not be about test scores. We should hope students will have learned how to find, evaluate and apply knowledge; how to work collaboratively; how to tolerate and manage uncertainty; how to reason; how to walk in someone else’s shoes; how to relentlessly pursue what’s best for each patient; how to debate, be wrong, fail — and embrace and learn from it, each time; how to become who they want to be.

It’s tough to do alone. It’s really tough with ear buds in. To be sure, the medical students I teach believe all these capabilities are genuinely important. But they are keenly aware that these are not what will bring them educational success. The contrast exemplifies the pernicious and corrosive power of standardized metrics of success in any educational setting — to transform what we value and how we learn.

“Every system is perfectly designed to get the results it gets”: It’s taken me years to fully appreciate this deceptively simple observation by one of the fathers of health-care improvement science. Change the last two words to “by which we choose to measure it,” and the paradigm clearly applies as well to education as to the health-care systems Paul Batalden describes.

Clearly, we need objective and reproducible measures of achievement. But when we permit the easy availability and seeming objectivity of one measure to exalt itself as sovereign, we become singularly capable of removing the joy from teaching, fragmenting a community of learning, and undermining our commitment to foster curiosity, nourish problem solving and inspire a love of lifelong learning.

http://news.doximity.com/entries/7539355?authenticated=false


Cobb School Board Problems

The following letter was published in the Friday, May 19, 2017 edition of the Marietta Daily Journal

Dear Editor:
Last year, the incumbent Chairman of the Cobb County Board of Directors, Tim Lee, was thrown out of office by a nearly two to one margin, largely because the voters demanded more transparency and inclusiveness in conducting the people's business, and were not getting it with Lee. Apparently, the Cobb County School Board is tone deaf when it comes to hearing what the voters were saying; I refer specifically to their policy on public comment during school board meetings. Of all the governmental agencies in Cobb County, the School Board is far and away the most restrictive, with the possible exception of the Marietta School Board, where a few years ago I actually had to make an appointment over the phone to speak before them, and my request had to be approved by the School Superintendent!

Which brings me to my point. What does the School Board have to fear from hearing from the folks who pay their bills? On the contrary, most school board meetings are formatted to give the public and media the impression that all is well in Shangri La, where they tout out and recognize teachers and students who have done well and made a difference. While there is some merit in providing that kind of dog and pony show, if the Board can take the time from their busy schedules to allow for that, then surely they can allow more time for citizens to express their concerns -- and heaven forbid -- even their grievances.

Moreover, the Board's policy is arbitrary and capricious, and actually serves the purpose of stifling dissent, as witnessed by Board Chairman David Chastain's restriction to two minutes for comment at a recent meeting, even when the "official" policy allows for up to five minutes. When I last rose to speak before them against the $40 million slush fund they tacked onto the SPLOST, I was limited to three minutes. I just hope the next time I go before them, and exceed my time limit, I won't get hauled off in handcuffs like opponents of the Braves Bond deal did when expressing their opposition to that boondoggle.


Sincerely yours, Lance Lamberton, Cobb Taxpayers Association

Failing Media Trump Coup

INSIDE LEFT'S SECRET PLOT FOR COUP AGAINST TRUMP, 'They cannot allow the world to see he could make the country better, by Garth Kant, 5/21/17, WND

WASHINGTON – The formula for a de facto coup against President Trump is pretty simple and it’s happening before our very eyes, according to one of the nation’s top scholars and most esteemed political analysts. And evidence for that theory is backed up by equally renowned political observers.

This is how it works, according to classics scholar, Stanford fellow and National Review columnist Victor Davis Hanson: The mainstream media pumps out anti-Trump stories to undermine the president. That creates doubt and uncertainty among lawmakers, especially those from “purple” states (those that are not overwhelmingly Republican or Democratic.) Removing the support of the “purple” GOP lawmakers gives Democrats a de facto majority to stop the Trump agenda, even though Republicans have majorities in both the House and the Senate.

Speaking with Tucker Carlson on Fox News on Thursday, Hanson described how it began with the creation of a narrative of a failing presidency.

“What were seeing here, I don’t want to be too dramatic, it’s sort of, historically, a slow-motion coup where you have a nexus of celebrities, academics, the Democratic and progressive parties, and then you have the media, and they feel they can delegitimize a president with a thousand nicks, none of them significant in themselves, but they coalesced to build a narrative that Trump is inexperienced, that he is uncouth, that he’s crude, that is reckless,” explained the scholar.

Those small wounds take a collective toll, paralyzing the administration and the government by disabling the Republican majority. “Each day, the point is to drive his popularity down one half a point, one point, until he can’t function in Congress because purple state congressional representatives don’t want to take the risk to further his initiatives.”

Hanson described how the mainstream media doesn’t need to find any actual or provable wrongdoing by the administration to keep the Democrats’ anti-Trump agenda in the headlines and hobble the president.

“I mean we’ve had a whole cadre of Washington and New York reporters that have done nothing other than, for six months, using all of their tools at their disposal, their genius, their experience to prove that Donald Trump colluded with the Russians, and they can’t find anything. They haven’t spent commensurate time to look at who was unmasking individuals. That may come out from the House Intelligence committee.”

Even the Washington Post’s most accomplished and famous reporter, Bob Woodard, has warned the media about losing their objectivity by “binge drinking the anti-Trump Kool-Aid,” and advised them to “Stick to the reporting.”

Speaking on MSNBC Friday, Woodward observed, “One of the realities we have here is we have a good, old newspaper war going, the New York Times and the Washington Post and some very powerful stories.” “At the same time, I think it’s time to dial back a little bit because there are people around who are kind of binge drinking the anti-Trump Kool-Aid. And that is not going to work in journalism. Let the politicians have that binge drinking.” Perhaps Woodward has been sobered recently by the sensational anti-Trump stories coming from his own newspaper that have turned out to be not true.

On May 10, the Post reported that FBI Director James Comey had requested more resources for the Russia investigation shortly before he was fired by the president.
The very next day, interim FBI Director Andrew McCabe contradicted that, saying, “I’m not aware of that request, and it’s not consistent with my understanding of how we request additional resources.” He added, “I strongly believe the Russia investigation is adequately resourced.”

Also on May 10, the Post reported that Deputy Attorney General Rod Rosenstein threatened to resign after the White House said his memo prompted Trump to fire Comey. The very next day, Rosenstein said that simply was not true. Critics have cited a profit motive for newspapers to publish what could be considered fake news.

An article on the Post in Lifezette on Wednesday asserted, “Bashing Trump is good business, and the newsroom has gotten the message.” The article discussed the reaction in the Post newsroom to a story that claimed Trump had improperly divulged classified information during a meeting, on May 10, with the Russian ambassador.

National Security Adviser H.R. McMaster forcefully called that story “false.”False or not, the story was profitable. Lifezette reported, “At the Washington Post, the newsroom broke into applause as the story surpassed the Post’s own record for most readers-per-minute originally set by the ‘Hollywood Access’ story, according to Glenn Kessler, the Post’s ‘fact checker’ columnist.”

Among luminaries on the left, it’s not just Woodward who is worried about the current state of reporting at such venerated news outfits as the Post. “I am appalled at the behavior of the media,” lamented the influential feminist philosopher Camille Paglia on Tuesday. “It’s the collapse of journalism.”

“I’m looking forward to voting Democrat again,” she remarked. But she predicted Trump would be re-elected because, “I feel that the media has so utterly lost its credibility that I think people are going to vote against the media again.”

Echoing Hanson’s observations, Paglia charged, “Democrats are doing this in collusion with the media obviously, because they just want to create chaos.” “They want to completely obliterate any sense that the Trump administration is making any progress on anything.”
And why would they want to do that?

Rush Limbaugh had an answer for why the media seem to have become so desperate to stop Trump they would resort to tactics that would discredit their reporting even in the eyes of such as Woodward and Paglia. 

On May 11, the top radio talk-show host painted stopping Trump as the defining life-or-death issue for the left. “They cannot allow for the world to see that something like this (the Trump agenda) could make the country better,” Limbaugh explained. “They cannot permit that to happen. They cannot permit Trump to improve the economy. They cannot permit Trump to make the nation more secure. They cannot permit Trump to win in international conflicts. They cannot permit it! It must not happen.”

He concluded, “Every victory Trump has is just another sign of how useless and phony the establishment is.” How does Trump fight back against the coup? He may have just decided not to play their game.

On Friday, the Washington Examiner reported the president’s enraged reaction to a New York Times story that he was about to shake up his staff and fire Press Secretary Sean Spicer. “F— the New York Times,” Trump reportedly said. “They’re not our friends. We’re never going to win them over.”


Corruption in Congress

Congressman Says Corruption in Washington Is ‘Worse Than You Think’, by Rachel del Guidice, 4/14/17

Corruption on Capitol Hill is “worse than you think,” Rep. Ken Buck, R-Colo., insists. “When you first get here, you think that you are in some sort of fairy-tale novel,” Buck said. “They wine and dine you and they show you just exactly what it’s like if you play the game. It’s a wonderful life.” Things quickly change, however, if “you don’t play the game.” “If you don’t play the game it becomes a much less conformable existence here,” Buck said.  

Buck, who has served Colorado’s 4th Congressional District since 2015, previewed his new book, “Drain the Swamp: How Washington Corruption is Worse Than You Think,” published on Tuesday.  

Chapters in Buck’s book include “Why Washington is a Swamp,” “Play the Game–Or Else,” “Beating the Beltway Bullies,” and “What You Can Do To Drain the Swamp.” Buck said his book addresses corruption present in government today that he was not prepared for after being elected to Congress in 2014.

“One of the things that I found startling when I got here is that you have to pay dues to be on a committee,” Buck said. During the time he served on the House Judiciary Committee, Buck said he had to pay periodic dues of $200,000 to the National Republican Congressional Committee, the campaign committee of the House of Representatives.

Now, as a member of the House Rules Committee, Buck’s periodic dues are $450,000. The obligation to pay dues, Buck said, forces members of Congress to hold fundraising receptions and encourages corrupt influences from special interest organizations who attend the fundraisers.

“Who comes to those receptions with checks?” Buck said. “Lobbyists, special interests that want something in return. So there is a game that goes on that you owe the party money and you are expected to vote with the chairman and you are expected to help special interests groups in Washington, D.C.”

Buck said there is also a significant amount of corruption in how Congress justifies spending for new project or programs. “In the book, I list very specific ways that we need to change the incentives that we have in Congress,” Buck said. “I talk about what we call ‘pay–fors.’ When we have new spending, we find ways to pay for that new spending program.”

Some of the ways Congress could pay for a new project or program are through tax increases or cuts to other programs, both of which are unlikely, Buck said. Instead, Congress “makes up” sources of revenue.

Buck explains: So we pass a transportation bill, and in the transportation bill we say that we’re going to sell oil in a strategic petroleum reserve to pay for that transportation bill. Now, what’s fascinating about this is that the average price that that oil was purchased at is $76. The price when we sold that oil was $48. Only in government is that considered a profit.

An issue with this system, Buck said, is that revenues from “pay–fors” have already been accounted for. “One of the problems is that that barrel of oil that was used in the transportation bill as a ‘pay–for’ was already sold twice before,” Buck said. This form of governing, Buck said, is irresponsible. “If everything’s been paid for for so long, how did we get $20 trillion dollars in debt?” Buck said.  

In an effort to bring transparency to the “pay–for” phenomenon, Buck introduced a bill last Thursday that would require the Office of Management and Budget to track and report the revenue that “pay–fors” actually bring.

“One of the bills that I just recently dropped would ask the Office of Management and Budget to do an annual report to Congress so it is available to the American people on how much revenue did those ‘payfors’ generate,” Buck said.  

Buck’s goal, he said, is to educate the American people about the corruption in government so they are not as naive as Buck found himself when he started working in Congress.

“Before I got here, I knew that D.C. was broken, I didn’t know the specifics,” Buck said. “I’m hoping that by giving the American public the specifics, we actually have the record out there just to make sure that people are aware.”   

http://dailysignal.com/2017/04/14/congressman-says-corruption-in-washington-is-worse-than-you-think/


DNC Murder Cover-up

BAR MANAGER: COPS NEVER TALKED WITH STAFF ABOUT NIGHT SETH RICH WAS MURDERED, Statement backs claim from private investigator that police told to 'stand down', by Liz Crokin, 5/21/17, WND

A manager of the Washington, D.C., bar where Democratic National Committee worker Seth Rich was last spotted hours before he was shot and killed last summer told WND that D.C. police officers never interviewed the bar’s staff or requested any evidence from the bar, including the bar’s surveillance video from that night, as part of an investigation into Rich’s murder. The revelation backs up a claim made by a private investigator who worked on the case who said D.C. police were told to “stand down” on the investigation.

WND also can report that the investigator recently was ordered to “cease and desist” his work on the murder case. “The police never asked for the surveillance video from that night,” a manager of Lou’s City Bar told WND.

His name is being withheld for this story. He said the bar’s surveillance video runs in a cycle of 30 days and that, by now, any footage that may have existed of Rich the last night he was seen alive has been taped over.

Furthermore, the manager said police never asked for any other kind of evidence from the bar such as Rich’s bar receipt from that night. The manager did note he wasn’t sure if Rich paid using a credit card or cash.

The manager also said he’s not aware of the police ever interviewing any of the bar’s staff members as part of their investigation into Rich’s murder. “The only time that I talked to police was during the memorial for Seth,” the manager said, noting that those conversations were more casual and friendly. He did not believe the conversations were part of official police interviews regarding Rich’s murder investigation.

The statements back up a claim by private investigator Rod Wheeler – a retired D.C. police detective who was hired to independently investigate Rich’s murder – that police were told to stand down on Rich’s murder investigation.

Wheeler told FOX 5: “I have a source inside the police department that has looked at me straight in the eye and said, ‘Rod, we were told to stand down on this case and I can’t share any information with you.’ Now, that is highly unusual for a murder investigation, especially from a police department.”

Wheeler has also suggested that Rich could have been the insider source who leaked DNC emails to WikiLeaks. He cites an anonymous federal investigator who has claimed to have proof Rich sent thousands of DNC emails to WikiLeaks.

Now Rich’s family has asked Wheeler to stop working on the case, according to a WND source close to the situation. “He’s been told to cease and desist,” the source said. Furthermore, the source said Rich’s family ordered that Wheeler not talk about any aspect of the case to anyone.

“It’s really unfortunate he’s been taken off the case, because Rod truly believes he was very close to solving this murder,” the source said. “Rod is not a political person – he genuinely just wanted to find out who murdered Seth. He doesn’t care if it’s a Republican or a Democrat – he just wants to get the truth out there.”

Rich’s family members have not spoken publicly about Rich’s death in months. Instead, professional Democratic crisis consultant Brad Bauman, from the Pastorum Group, has been speaking on the family’s behalf.

Bauman has emphasized that he and the Rich family want police to get to the bottom of Rich’s case regardless of where it leads. However, he blasted Wheeler for suggesting publicly any suspicion of the DNC’s involvement. The Rich family is “devastated” Wheeler has not ruled out a WikiLeaks connection, Bauman said.

“Every single time a story is reported, it is just hearsay, it is lies, it is politically driven or politically motivated hearsay,” Bauman said. “And it actually causes the opposite of what everyone wants. It causes the inability for the police and for independent investigators to figure out what actually happened.”

The source said that since Wheeler spoke to the press about some of his findings, he has received a ton of backlash. “Rod wishes that he never got involved in this case in the first place,” the source said. “He did not know that there would be such a big political component involved with this case or that there would be such backlash directed at him for trying to do a good deed.”

The source said Wheeler was just trying to do right by the family and find justice for Rich. Even though Wheeler’s no longer allowed to investigate or discuss the case with anyone, the source said he hopes others continue to look into this case and report on it.

WND calls to Rich’s family were not answered or returned. And a relative close to Rich’s girlfriend, Kelsey Mulka, said she is not interested in talking to the media, either. “She’s devastated,” the relative said of Mulka. “Can you imagine what she’s gone through? She just wants this to go away and to be left alone.”

Despite reports of fights at Lou’s City Bar the night that Rich died, the manager he’s not aware of anything that happened that was out of the ordinary that night. He said he’s extremely saddened by Rich’s untimely death.

“He was the nicest guy in the world,” the manager said. “If someone gave me trouble in the bar, Seth would be standing right there defending me.” The manager said Lou’s City Bar held a memorial for Rich. He said Rich could not have come from a better family. “They’re wonderful people,” he said. “I wish I could’ve done something to save him.”

WND reported earlier on Bauman’s dissatisfaction with Wheeler’s comments about the case. Those criticisms followed Wheeler’s statement that he had just learned from Rich’s family that the DNC contacted them about the case.

“How did that DNC person know I had called the police? That is what is baffling me,” Wheeler said. “I just found out from [Rich’s] family that the DNC knew I contacted the police – they hadn’t told me that all this time.”

Bauman blasted him: “I don’t think at this point, given Detective Wheeler’s lack of credibility – that I am going to dignify any accusations that he makes with any sort of discussion, I’m sorry.” Anyone who believes Rich may have leaked DNC emails “deserve a place in hell,” Bauman said angrily.

WND also has reported on the eerie similarities between Rich’s death and several deaths of individuals linked to former President Bill Clinton and twice failed presidential candidate Hillary Clinton.

Just as in the Rich case, several of the people who died mysterious deaths were shot spontaneously and in public places, sometimes from behind, sometimes by unknown assailants and often just before they were set to release incriminating evidence concerning the Clintons’ activities. In most cases, there were no signs of theft at the crime scenes. And while some of the deaths were ruled suicides, other cases remain a mystery.

As WND reported, Rich was murdered July 10, 2016, near his affluent neighborhood in Washington, D.C. He was shot in the back with a handgun at 4:18 a.m. while he walked home, and nothing was taken from him. Rich, who called several people as he later walked home, was talking on the phone with his girlfriend, Mulka, when he was accosted a block from his house. He was transported to a local hospital and was pronounced dead at 5:57 a.m.

On July 22, just 12 days after Rich’s death and days before the Democratic Party Convention in Philadelphia, WikiLeaks released 20,000 emails from DNC officials.

The leaked emails revealed, among other things, that the DNC tried to tip the scales in favor of Hillary Clinton’s campaign and prevent Democratic candidate Bernie Sanders from becoming the party’s nominee. The leaks were cited by some Democrats as one explanation for Clinton’s election loss. Many accused the Russians of “hacking” and turning the tide for Donald Trump.

In one email released by WikiLeaks, Clinton campaign Chairman John Podesta said he would like to “make an example” out of the person who leaked the emails.
“I’m definitely for making an example of a suspected leaker whether or not we have any real basis for it,” Podesta wrote on Feb. 22, 2015, according to WikiLeaks.


http://www.wnd.com/2017/05/bar-manager-cops-never-talked-with-staff-about-night-seth-rich-died/


Spending Cuts Ahead in Connecticut

Connecticut, Nation’s Wealthiest State, May be Tapped Out on Taxing the Rich

Connecticut’s budget office expects 2017 income-tax collections to fall for the first time since the recession, by Joseph De Avila, 5/19/17

The wealthiest state in the U.S. is having trouble collecting enough money to pay its bills, and the Democratic governor doesn’t think taxing the rich is the answer anymore. After two decades of robust growth, Connecticut forecasts it will come in $400 million short in income-tax collections this fiscal year, worsening a budget crisis that has prompted all three major ratings firms recently to downgrade the state’s credit rating. Connecticut’s budget office estimates that income-tax collections will fall in fiscal 2017 for the first time since the recession.

About $200 million of the drop in receipts came from the state’s closely watched top 100 earners, who are the source of an outsize proportion of the state’s revenue. Many of the state’s richest residents work for hedge funds, which have been hurt by a downturn in the industry.

Gov. Dannel Malloy has twice before bet that taxing the wealthy would help solve the state’s fiscal problems. But neither increase resulted in sustained revenue growth, according to his administration, which says it would be a mistake to do it a third time. A spokesman for Mr. Malloy’s budget office referred questions to the state’s Department of Revenue Services.

Tax Gap Connecticut annual tax liability, by income THE WALL STREET JOURNAL Source: Connecticut Department of Revenue Services.billion Up to $1M More than $1M 2010’11’12’13’14’1501234567$8

“You can’t go back to that well again,” said Kevin Sullivan, commissioner of the Department of Revenue Services. “The idea that there is yet another significant amount, in terms of long-term stability, to get out of that portion of the population is just not true.

”The tax question in Connecticut, where several thousand tax filers with adjusted gross incomes of more than $1 million a year account for about a third of all income tax receipts, comes amid a shift in tax policy nationally.

President Donald Trump, who campaigned on promises to lower taxes, has proposed lowering business and individual rates. But he is also seeking to repeal a deduction on state taxes that will especially hit high-income earners, making it tougher for states to raise taxes among the richest.

Connecticut’s fiscal troubles come as a majority of states face budget holes this cycle, according to a recent report issued by Standard & Poor’s. At least nine states are considering some form of tax increase, such as raising corporation taxes and sales taxes, according to the report.

Connecticut is one of seven states, including Pennsylvania, New Jersey and Illinois, that is vulnerable to fiscal stress “even as the broader economy shows signs of gathering momentum,” the report concluded.

It’s a strange turn for Connecticut, which has the highest per capita income in the country, according to the Bureau of Economic Analysis, and is home to hundreds of hedge funds, Yale University, and businesses like insurer Aetna Inc. and industrial giant United

Technologies Inc.Connecticut Governor Dannel P. Malloy delivered his 2017 State of the State Address at the State Capital in Hartford on Jan. 4. He helped put through tax income increases in 2011 and 2015, raising the top rate to 6.99%.

The state projects a $5.1 billion budget deficit over the next two fiscal years, fueled by increases in fixed costs over that period including pension obligations, health-care expenses and debt servicing.

In its recent downgrade, which landed Connecticut with the third-lowest rating for a state, Moody’s Investors Service flagged the state’s shrinking population since 2013—the current population is 3.58 million—as contributing to an underperforming housing market and weak labor-force growth.

Some states that rely heavily on the wealthy for income taxes, such as New York, also have growing populations, which may better prepare them to weather bad times, said Mark Robbins, professor of public policy at the University of Connecticut.

“If you can count on a steady influx of new residents, you can count on some additional revenue for them,” Mr. Robbins said. But in Connecticut “where the population is flat, that is one thing you don’t have to look to.

”Connecticut pitched leafy suburban neighborhoods and good schools for decades as a way to lure residents away from New York. But urban revival has gained steam, drawing away recent college graduates who aren’t interested in such bedroom communities. The shift motivated General Electric Co. last year to move its top executives from Fairfield, Conn., to a new base in Boston.

Now state lawmakers are looking at options to address fiscal problems and reviving the debate on whether to increase taxes at the top.

Connecticut introduced its income tax in the early 1990s, and income-tax growth averaged 9% a year from 1993 through 2008. Since then, the average has been 2% a year. Mr. Malloy put through two tax income increases, in 2011 and 2015, raising the top rate to 6.99%.Opponents of the past tax hikes have said yet another one would scare away the very people the state relies on. The number of tax filers leaving Connecticut have exceeded the number of filers moving into the Nutmeg state since at least 2010, according to the Internal Revenue Service. Yet data from the state revenue department shows the number of full-time

Connecticut tax filers with an adjusted-gross income of $1 million or more grew to 11,223 in 2015, a 21% increase over 2011. The state says fewer than five of its top 100 taxpayers have fallen out of the ranking since 2014.Mr. Sullivan of the state’s revenue department said after each of the past two income-tax increases, the average tax liability for the state’s 100 wealthiest residents would increase in one year and then fall. He said that suggests those wealthy residents either adjusted their tax strategies or earned less money in the down years.

The current decline in income taxes also could be the result of wealthy people deferring 2016 income in anticipation of national tax reform, he said. Patrick Hayes, a Darien, Conn., resident who works in architectural interiors, says the state’s fiscal mess proves that raising taxes on the wealthy can’t solve Connecticut’s problems. “We need a better plan,” said Mr. Hayes, 49, who noted he is among the group of top earners in the state. “Has this strategy failed previously? Then why we do we keep pursuing it?”

To address the revenue shortfall, Mr. Malloy is seeking $700 million in concessions from public-sector unions and has threatened pink slips if unions won’t come to the table. He also wants to cut $700 million in state funds to cities and towns. Public-sector unions, however, maintain that the state’s wealthy should help solve the state’s fiscal problems. State lawmakers should consider “asking Connecticut’s wealthiest taxpayers and largest corporations to sacrifice and pay a little more to protect the services that people rely on,” said Larry Dorman, a spokesman for Council 4, the state’s largest public-sector union.Write to Joseph De Avila at joseph.deavila@wsj.com
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https://www.wsj.com/articles/connecticut-nations-wealthiest-state-may-be-tapped-out-on-taxing-the-rich-1495186203