Health Care Reform

The argument has been made that the US “has the best health care system in the world” therefore we shouldn’t change it because that would lead to lower quality health care. That claim is supported by the anecdote that people come to the US for health care they couldn’t get in their own country.  While it may be true that some people, those who are wealthy enough to afford it, do come here for treatment and it may also be true (no one has offered objective evidence) that we have the most technologically advanced medical establishment, there is more to a health care “system” than technology. Equally important is access and delivery. It is inadequacies in those aspects of the system which the administration is trying to address.  If you aren’t wealthy, if your health insurance refuses to pay for it or you have no insurance, it might as well not exist.

The fact is that despite having what may well be the most technologically advanced system, the US’s health outcomes are at the bottom of the barrel as compared to other industrialized countries. Compared to the 19 most advanced nations the US is dead last (pun intended) in deaths that could have been prevented by “timely and effective health care” according to a study by the Commonwealth Fund. Forty one countries have longer life expectancies. Among the G7 nations we are at the bottom. According to Wikipedia there are 32 countries that have lower infant mortality rates than the US. Those abysmal statistics are a reflection of the failures of the access and delivery part of our health care system.

To make matters worse we are paying twice as much per capita than those countries that have better outcomes. To add insult to injury, the cost is going up at 2, 3 or more times the rate of inflation every year. We need to reform the delivery part of the system now. Not step by step over time, but now. If we allow the insurance system to remain as it is the rise in cost over the next ten years will make the administration’s reform proposal look like an after Christmas sale price and we’ll still be at the bottom of those lists because millions will still not have insurance and insurance companies will still be denying treatment. Write or call your senators and representatives and tell them not to listen to the nay sayer's and the lobbyists. Vote for change. Vote for the people they represent, not the insurance industry.

Open Letter to the Media

This morning on the radio I heard a news story saying that Rick Lazio is now ahead of Gov. Patterson in the latest polls. Already we are into reporting the “horse race” rather than information that is useful to deciding whom we want to vote for. Please, rather than grabbing the latest poll as a headline story, do a bit of digging. Interview the candidates and report on their positions, their solutions to problems that face society. Press them for real proposals not just broad stroke party ideology. Report on their speeches and make note if they change their message for different audiences. When there is an opportunity to directly question candidates, confront them on anything vague or inconsistent. Lastly tell us who is funding their campaign. Please be journalists, not just conduits for political spin.

Health Care Debate

From today's FactCheck.org "In 2008, U.S. health care spending is estimated to have been $2.4 trillion. It is projected to nearly double to $4.4 trillion in 2018."

So we'll be spending more than the 1.5 trillion that opponents are complaining that the proposed health care overhaul will cost over the next 10 years whether or not the health care plan President Obama wants is passed. The difference will be in how it is spent and what we get for the money.

Currently (according to some sources) 30% of all health care dollars go to insurance company overhead and profit . The CEO of United Healthcare (the largest of the health insurers) not only has a salary in the millions but has accumulated stock options of almost ¾ of a billion. Allegedly one of every 700 dollars spent on health care in the US goes into his pocket.

Many years ago I read an article in which the author said the way to get rich was to put yourself in a "gatekeeper" position, find something people need and position yourself between them and the thing they need so that you can collect a fee for letting them have it. That is what health insurance does. It adds nothing to the health care system, it simply acts as a gateway through which you must go to get health care. The health care you get is what the insurance company decides it is willing to pay for and that decision is based on preserving its profits.

Ideally an insurance system is one of shared risk, meaning that all members contribute and the money helps those who most need it. You may pay in more than you get back for many years, like the driver who has no accidents, but at the point where you do need it there are more resources available to you than you would have on your own if you were not a member of the insurance plan. That is the irony of the complaint by opponents who object to a public option on the grounds that it is socialism. The concept of shared risk though insurance is essentially socialist, a group of people looking out for each other. The only thing that makes private insurance different is that it allows the insurance company to add profit to the cost of the system and puts the decision making over who gets what benefit into the hands of those who own the company instead of people who are accountable to the insurance holders.

Personally I think it is sad that a single payer system is not one of the options on the table. According to several polls that is what most people would prefer. It would be the most economical. I often wonder if the 30% that is currently eaten up by overhead and profit would not be sufficient to cover all those who are not now covered. True, there would be overhead with a public option. Currently Medicare (a public insurance plan that covers everyone in the country that is over 65 and those who are permanently disabled) has an overhead of 3%. Putting everyone on Medicare would still save 27% ($756 billion in 2008) and that would go a long way toward covering everyone.

Addendum: A friend in Texas sent this link to a YouTube video of some Canadians commenting about the health insurance reform debate going on here in the US. As readers of this blog know I have relatives in Canada and while they have problems of distribution too, theirs are based on how to spread the services where they are needed rather than who can afford care and who can't. You may have to wait for some non-urgent services but if you need care it is there whether or not you can pay.

Discrimination

I'll probably be on the wrong side of the fence with my liberal friends but I agree with the Supreme Court decision on the Connecticut Firemen. Before anyone leaps to the conclusion that I condone discrimination against minorities, I don't. I'm a firm beliver in civil rights and I believe the laws against discrimination were, and still are, needed. OTOH they can be carried too far.

As an illustration I'll relate an incident from my own past. After I graduated from college I intended to teach art in the public school system but I graduated just as the state universities produced a glut of teachers and I found myself searching for a non-existent job. At one point I ran onto an SBA (Small Business Administration) brochure that was promoting small business loans to individuals who had skills they could turn into a business but had resources too small to support themselves much less get a traditional loan. That was me at the time.

Per instructions in the brochure I went to my local bank and asked to speak to the loan officer who handled SBA backed loans . The loan officer listened to my proposal but said he'd never heard of this program. I showed him the brochure and he promptly called the SBA and asked about it. After a conversation with several "Uh-huh"'s and a "No" he said "Thank you" and hung up the phone. He then told me that although there was such a program and I met all the qualifications that the brochure listed, he couldn't help me because I lacked one qualification that was not in the brochure, I wasn't black.

I didn't sue. I had no money to get a lawyer and at that time, almost 40 years ago, it probably wouldn't have gone anywhere in the courts anyway. After three and half years of temporary minimum wage jobs interspersed with periods of unemployment and food stamps I finally found a steady job that I didn't like but felt lucky to get so I stuck with it until retirement 30 years later. Because of my experience though I sympathize with those firemen. If the city couldn't show that the test was actually discriminatory against minorities, those who passed should have gotten the jobs. Discrimination is discrimination no matter who it is against.

Banking Takeover?

According the news I’m hearing on the radio the president’s bill for bailing out the banking industry contains no provision for Congressional oversight. That is the same kind of hands-off policy that got our economy into this mess. If we hand over the $700B or more to the banks with no oversight, the taxpayers won’t be taking over the banks, rather the banks will be taking over the US Treasury. Congress needs to have oversight authority.

Also according to reports the banks say that if oversight and limits on executive compensation then they won't sign up for a bail out. How dire an emergency is it if they can walk away from the deal? The way this situation has been presented to the public is that we either bail them out or they go broke and take all our retirement plans down with them. The executives should not be given seven figure (or any) parachutes as a reward for running their institutions into the ditch. The average citizen is not rewarded for screwing up on the job. Why should they be rewarded? Fire them and let them apply for unemployment benefits. Let them try living on that for a while and maybe they’ll learn the value of a dollar.

There Should Be Outrage

I hear this morning that the Associated Press has objected to the McCain campaign's distortion of things they reported about the Obama campaign. What the McCain campaign did was to cut & paste words and phrases from articles in the same manner an extortionist clips words from a newspaper and glues them in a different order and then plugged them into TV ads to give the impression that AP was saying something about Obama that it did not. A search of the headlines on-line this morning however reveals that AP's protest was apparently low key as there is virtually no mention of it. There should be outrage. In distorting their words to discredit Obama McCain has also discredited the veracity of the AP.

For a candidate who pledged at the start of the campaign to stay positive and deal with issues, the recent ads run by McCain are shameful. If a candidate will lie and cheat to get into office, how can we trust that person to be honest and trustworthy in office?

Different?

Tonight on the news Charles Gibson interviewed Sarah Palin. She continues to present herself as a change candidate, a Washington outsider, but when asked questions with a request for a yes or no answer she repeatedly answered in 273 word sentences that avoided answering either yes or no. Even when the question was repeated and the request for a yes or no response was repeated she continued to evade giving a direct answer. Different? She sounds exactly like the current president and VP to me.

Shifting The Ground

I'm not talking about earthquakes. It's time to post some opinion again. This is about the "quaky" stats that the media keeps feeding us. This morning on one of the news broadcasts the commentator said that fatalities in Iraq were "way down" in July. Only 11 US troops died compared to 80 military & civilian deaths a year ago.

Did you notice the statistical shift in that statment? 11 US military deaths vs 80 total (combined US, coalition military, Iraqi forces plus civilian) deaths from a year ago. Talk about comparing apples and oranges. Maybe they should have thrown in how many expatriate Iraqis died of cancer while outside the country a year ago to inflate the comparison further.

Those figures are bogus anyway. The devil is in the details, the details in this case being which deaths get counted. The iCasualties website lists 13 US military dead in July 2008 and I distinctly recall reading only a week or two ago about bombings that killed at least 80 civilians. And then there is the practice of not counting as war deaths those US soldiers who are air lifted out of the country for treatment and then die in a military hospital in Germany or the US.

Is violence down in Iraq? Are the number of deaths from insurgent attacks down? When we can't trust the numbers we are being fed and there is limited to no reporting on such events as the Iraqi Christians being driven out of the country or into hiding, it is hard to agree that the surge has really "improved" the situation and stability of Iraq unless you consider an ethnically purged society a stable society. I fear that all we have done in Iraq is changed one bad situation into a different bad situation.

What's the Difference?

In the latest debate Hillary Clinton emphasized her experience again while Barach Obama said that being right on day one was more important than being experienced and ready to take charge on day one.

According to the analysis that I've read there is roughly 5% difference in their positions on the issues so Obama's argument is that, for the sake of that 5%, we should sacrifice experience in handling the other 95% where they are in total agreement. Considering that who's right (in a political discussion I really should say 'who's correct') that other 5% of the time is a matter of opinion, I think Obama is making a pretty feeble argument for abandoning experience in favor of hope.

Campaign Coverage

Bill Clinton got it right when he told CNN reporter Jessica Yellin "You live for this. This hurts the people of South Carolina... the people don't care about this," he added. "They never ask about it". Recent media coverage of the democratic campaign reminds me of my high school days when provocateurs would run back and forth between two guys who were antagonists saying 'do you know what so & so said about you?' then run back to the first guy with the response until they got a full fledged fight going. Then they'd stand around the fighting pair in a circle yelling "fight, fight".

That's our media, a bunch of juvenile provocateurs.

I'm all for investigative journalism, for speaking truth to power in the tradition of Edward R. Murrow, but that is not what these people are doing. They are engaging in petty muck raking for the purpose of promoting controversy because it makes 'good TV' (or radio, even NPR's On-Point is guilty) that pumps up ratings. It's time our media grew up and stopped promoting controversy solely for its entertainment value.

Watching the Debates/Thoughts about Obama

A couple of days ago we watched the back-to-back Republican & Democratic debates on ABC. Apparently from the NH polls since a lot of people were taken by Senator Obama's performance which seemed lackluster to me but watching them did clarify what bothers me about Obama.

When pressed about the 'change' he advocates, instead of making concrete proposals, he responded to the effect that his message inspires people to press for change and he will continue as president to inspire people with the result that the people will be empowered and change will be inevitable. His message is very short on what he has done or will do beyond inspiring people.

This notion that 'if everyone believes, it will happen' is what I call Tinker Bell politics. In the old Peter Pan movie when Tinker Bell is dying Peter looks out of the screen and pleads with the audience to clap saying if everyone believes and claps Tinker Bell will be well. Tinker Bell survived in the movie of course because the movie was following a script and the result was fixed on the film for all time even if no one in the audience clapped. The Bush administration has tried the same philosophy urging everyone to support his war plans and believe even when they are failing, contending that if only everyone would get behind the president it would work. Unfortunately in the real world there is no script and no future outcome is already frozen on film to be played back to reassure the skeptical that belief was justified. To allude to another movie, in Return of the Jedi when asked about the future Yoda replies that "the future is constantly in motion" meaning that it depends on what happens in the present. While belief that change is possible is indeed essential to changing the course of events, to change the direction events take requires more than belief, it requires effective action. We need a president who can not only inspire, but also write the script and direct the action.

When pressed further for an example of the change he advocates from his past record he presented his support for a bill that prevents lobbyists from buying meals for members of congress. As the moderator immediately pointed out however, the ban only applies to sit down meals. Members of congress can still accept meals while standing, so the net effect is that, in future, members will have to be served wine and hors d'oeuvres by lobbyists instead of soup or steak.

Presenting that slight of hand as a serious change strikes me as very Washington insider, old fashioned, political spin, BS. For all his charm and rhetoric, which is admittedly inspiring, I have yet to be convinced that Obama is the candidate who can or will take the action needed.

DON'T Let it snow, let it snow, let it snow.

I have cleared the driveway and walks every day this week. I thought I would escape shoveling/blowing snow today but no, the snowplow pushed a ridge of frozen snow/ice across the end of the driveway and the turnout area for the newspaper delivery guy. Another morning of shoveling snow. At least I've no want of exercise.

The temperatures are forecast to be in the 30s later today and as high as 50 tomorrow. That will be good weather for finally putting out some Christmas lights. For some reason I just haven't gotten around to it this year. Not many other people have either. There are few outside decorations this year. Perhaps it is the expense of energy. Electricity hasn't gone up as badly as gas and oil but you have to cut corners somewhere and it is easier on decorations than heating the house. The last delivery of fuel oil was at $3.40/gallon. That's more than regular gas which is bad enough at $3.35 around here. It seems like buying either involves two hoses these days, one to pour the fuel into your tank, the other to suck your money from your wallet.

The price of fuel has caused the collapse of local air service in the North Country. Big Sky Airline which was providing service is having their planes repossessed because they can't afford to make payments on them and buy fuel. Consequently after the new year there will be no air service North of the Syracuse - Albany line unless some other airline steps in quickly. Thank you Exxon/Mobil, Shell, etc. The administration just successfully fought off an attempt by congress to remove tax breaks from big oil companies who are making record profits so a big "thank you" is also due to the Bush administration for protecting those poor abused multi-billionaire oil producers from having to pay a fair tax on their profits. Beginning with the Reagan administration the free market capitalists have been telling us that wealth "trickles down". I'm still waiting and that second hose is still attached to my wallet but it is pumping out, not in.

Impeachment

I try not to get into politics too much on my blog but here goes again. I watched Bill Moyers Journal Sunday which was a rebroadcast of a July 13th program. His two guests are advocating the impeachment of both Cheney and Bush. The Bush supporters are of course dismissing it as so much left wing media bias but apparently they didn't watch very closely. The guest who argued most passionately for impeachment and even contended that Bush & Cheney's abuses were worse than Nixon's, was Bruce Fein a conservative who wrote the 1st article of impeachment against Bill Clinton. So much for left wing media bias.

Both guests argued for impeachment of both Cheney & Bush not on partisan grounds but on Constitutional grounds. They believe that the expansion of presidential power claimed by Bush & Cheney represents a long term threat to the balance of powers set up in the Constitution and thus to our democracy. For those who might not have seen the program there is a full transcript available at http://www.pbs.org/moyers/journal/07132007/transcript4.html. Both guests are Constitutional scholars whose credentials I respect. It is (IMHO) well worth reading the full transcript.

Unfortunately our Congress seems to have no stomach for protecting the Constitution or their own powers under the Constitution. They have taken impeachment "off the table" and most recently legalized one of the illegal acts of this administration by passing a bill that allows domestic spying by the administration without congressional or court oversight. I don't know if that bill also grandfathered in the illegal spying that the administration has been engaged in since 2003 which is now common knowledge. Perhaps congress's solution will simply be to pass bills that make all the abuses of this administration legal. If so we will have reached the point Ben Franklin referred to in his final address to the Constitutional Convention:
"I agree to this Constitution with all its faults, if they are such; because I think a general Government necessary for us, and there is no form of Government but what may be a blessing to the people if well administered, and believe farther that this is likely to be well administered for a course of years, and can only end in Despotism, as other forms have done before it, when the people shall become so corrupted as to need despotic Government, being incapable of any other."

One observation by Bill Moyers was that the average citizen seems to be ahead of congress on impeachment. If you are interested in pursuing impeachment on your own it seems that there is a provision for the average citizen to do just that. Go to http://impeachforpeace.org/index.php for an explanation of how and the forms necessary to initiate a citizen impeachment initiative. My own hope is that we have not reached the point that Ben feared.