Thursday, August 13, 2009
Healthcare: No Relief in Sight
Sunday, July 5, 2009
Ignoring the Obvious
Sarah Palin was a small town mayor who parlayed a couple of smart political moves and an attractive presentation into winning the governorship of a state that’s hardly known for conventional judgment. She was picked out of obscurity by John McCain in an insane and inane move to bolster his candidacy, a move that failed badly. She never was, is not, and never will be an even remotely viable candidate for national office. To include her name in the same context as "national office" is disinformation for marketing purposes that only belongs with the other entertainment celebrity news at the grocery store checkout counter.
However, to steal a phrase from A Coal Miner’s Daughter; the lady may be dumb…but she’s not stupid. I think she knows she’s not Vice-Presidential (let alone Presidential) timber, and to her credit she’s seems to have figured out she’s not Governor material either. She knows that remaining in office as the Governor of Alaska carries risks with it that could easily undermine her maximizing her potential, much like a football star might realize that spending two more years at the college gridiron might forever end his chances for making it big in the pros with one crushing tackle. Whether it is some bonehead scandal or an incompetent administration, she runs the potential of undermining the unique credibility she has with her fans. At the very least, finishing out her term as governor could use up precious time, and possibly leave her as an historical (and hysterical) blip in the American past.
In all likelihood she has seen how Rush Limbaugh has a reported worth of $400 million and is often described as the number one influence of what remains of the Republican Party. This former beauty contestant, turned local sportscaster, turned media starlet has probably seen that niche and fashions herself nestling into it. She couldn’t be more correct. She may want to sell the idea that she is in it for God, truth, justice, and the American way (good grief, even Rush Limbaugh touts that as his objective) and she may be delusional enough to believe that such is a half-truth, but the reality is that she wants what many of national fame have tasted: money and power. You can't fault her much for that. The beauty is that she’ll be able to do it right from her broadcast booth in Wasilla. She may end up owning more of Alaska than anyone other than Exxon-Mobil.
Wednesday, June 24, 2009
Exchange on Healthcare
Friend:
Well, I'm not going to be much help there. I'm not very medical. I've never really been sick, never had surgery, well oral surgery but I don't think that counts. But anecdotally I can give you some of my experiences.
In 1988 my daughter had bacterial pneumonia and spent 3 days at Children's Hospital ICU. Children's treated us like royalty. Gave us a place to stay next door and full access anytime we wanted it. I think we had Pilgrim Health Care through work which cost me $17 a paycheck. When the bill came from Children's it was around $3000 and it was marked paid in full. No deductible, no questions. And I never looked at it in any detail. Then in the 90's Hillary Clinton got on the healthcare bandwagon. It didn't last long but when she finally gave it up after a couple of years I was paying $34 a paycheck, had a deductible and the system was all screwed up. Thanks Hillary, good job.
In the late 90's Oliver North was running for senate I think. During the campaign he floated a brand new idea of the Health Saving Account. It was then that I got my first explanation of what an HSA was and how it worked. Instead of one Federal watchdog on medical costs, waste, and fraud, HSA's create 300 million watchdogs of the costs charged to their own accounts. Pretty neat idea I thought. Well, Ollie didn't get elected [whew, he was kind of a crazy] but I remembered the HSA. When I retired without any insurance, that was one of the first things we did. Now when we go to the doctor we ask. What is this test for? Why do you need these blood tests? I just had xrays last year, why again this year? Isn't it true that xrays are no longer considered an effective tool for detecting lung cancer? Ok, so why do you order the xrays? etc., etc. etc. I never did that before, And when I look back and compare my attitude before, it's no wonder that all kinds of fraud and abuse takes place. People don't ask. If somebody else is paying, let THEM ask. Well the HSA is your money in your account. The money you put into it is tax deductible and the premiums you pay for catastrophic insurance is also tax deductible.
You want a solution? In my view, there's your solution. Make everyone manage their own health care through their own account. 300 million watch dogs. Can't beat it.
OK, now having said that, I don't want to stop innovation, discovery, invention, etc. You make a strong case against profit, but it is a terrific motivator. The only reason the human gnome was mapped and currently in use by everyone is because they originally thought there was some money to be made from it. Little did they know all the possible applications that would come from it. But pure research is an essential part of a thriving society. Thousands of discoveries have come from it. Pennicillin was discovered without any idea what it's uses might be. Pure research however, is very expensive. Can we really chance not discovering the cure for AIDS, cancer, alzheimers, parkinsons, and dozens of other diseases because we somehow can't afford pure research? Can we really afford to halt the experiments of the supercollider just because no one knows what the results will be used for?
One last idea. Our founding father's did a great job.
We the People of the United States, in Order to form a more perfect Union, establishJustice, insure domestic Tranquility, provide for the common defence, promote thegeneral Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.They could have added "provide for the common education" and/or "provide for the common health care" but they didn't. They only "provide for the common defense" so as to ensure an environment where you as individuals can provide for yourselves.We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.That all men are created equal. Not that all men are equal, but when they are born they are created and begin their lives "equal". After that [by design] you're on your own. And clearly all men are not even close to being equal. And so, by design those of you who are better than the median can provide for yourselves better than those below the median. We are the ones with this wonderful system.
This system that attracts waiting lists of immigrants from all the other countries. Many other countries have nationalized health care. They pay a 40% tax for it. We are a nation of individuals whose individual liberties are ahead of all other concerns. While this quote is a bit out of context, They that can give up essential liberty to obtain a little temporary safety, deserve neither liberty or safety... Franklin It occurs to me that the nationalization of the health care industry would constitute just such a forfiture of liberty. I would advocate an increase in responsibility to the individual for his own well being. I believe nationalization would relieve the individual of all responsibility for their own well being, and as such, violate what Jefferson and his bussies had in mind.
My Reply:
Good morning - funny that you started your last email with "...not going to be much help" then proceeded to pump out a thousand words (997 to be exact). We truly do have some things in common. But plenty not in common too, as I read through your message. That's a good thing.
I'll take issue with your points this way (not sure where it will end):
Many of the arguments you presented are familiar and, for me, quite frustrating when I get into discussions on the subject. I think you set the tone correctly in your first paragraph when you implied that your experience defined your view. Perfectly reasonable. However, I believe the anecdotal approach to defining healthcare is precisely what creates the inertia we find ourselves in, much to the benefit of a select sector of our society.
In those discussions, personal experiences, good and bad, expound ad nausium. Further, people quote the personal experience of other people (as in other countries) with virtually no recollection of the source for that information. I find it frustrating that I can't (in a polite and un-aggressive way) get those individuals to look at the bigger picture. I feel it is the same, almost lemming mentality that viewed the dot.com companies in the late 90s and real estate in the mid 2000s on the other side of the balance sheet. You can make opposing lists of stories about how each system (profit/single payer) works and doesn't work that could stretch to the moon. The winner in that kind of analysis is always the status quo. People have just got to ask the question: who doesn't want things to change?
It's all about cost. Not about your cost or his cost or my cost, but the total cost. You read the piece I wrote last year, so I shouldn't need to repeat. But I just don't understand why one of the verifiable facts about healthcare doesn't resonate - total cost. People hear healthcare in Britain is great, others hear horror stories, it can all be suspect, but the fact is as a nation they care for 2.4 people for every one we take care of here (and their system is expensive by world wide standards). Why doesn't that make people here spin in their seats? Every other quantitative fact regarding healthcare (death rates, infant mortality, per capita hospital beds - US#27, per capita Drs US#52, etc) the US is either on par or below other countries. What are we getting for this huge transfer of wealth, and who's getting the money? Why is it so difficult for people to see that the (dis)information they receive about how (anecdotally) we have such a great medical system is most likely being provided by those who stand to lose if we converted to a single payer system.
Take your research argument, a popular one. Still, most medical research in this country today is done through our University system and it is mostly (if not nearly entirely) publicly funded (which includes charity - bolstered by tax policy as you described). The private (multi-national) pharmaceutical industry operating in this country has become so focused on profits and ROE that they've become counter-productive as expeditures directly relate to healthcare research. Did you read my piece on drug advertising? That aspect is like a metaphor for the entire industry. There are very few other countries that allow such to exist - for very good reason. To make the assumption that very smart dedicated people will stop pursuing careers in medical research because they won't make mega dollars at some corporation is unreasonable and doesn't reflect human behavior accurately. I would venture many if not most of those kinds of people hate working for such companies (simply because of the pressures for profits and ROE), are less productive, and work shorter careers because they can't wait to get out of that atmosphere (I clearly and personally empathize with that).
I don't even think the tax debate is relevant. We pay it one way or the other. For myself alone I pay (with my company subsidized insurance) about $8500 a year in insurance and deductibles. My tax could skyrocket and I'd be no worse off. Although with our system I am also given (at no extra cost) the added anxiety of never knowing if my own insurance costs will eventually outpace my resources or if medical illness or accident to anyone in my family will wipe out my assets. Of course, that may oddly help medical costs, since that kind of stress probably cuts years off of people's lives.
You provide a good Libertarian approach to managing cost, but I really believe that ideal ended in this country a hundred and fifty million people ago, at a time when technology was less complex and the profit aspect of medicine (by comparison to today) didn't really exist. Remember profit is defined as that in excess of fixed and variable expenditures (which includes labor). The healthcare industry in this country today (as I wrote) is almost totally inelastic. The demand side of the equation is currently unaffected by price increase. We either pay, exhaust our resources and have government pay, or decline services and die. There is virtually no impetus in the private sector for efficiency in medical care, because to do so would reduce profits, dollar for dollar. You may wisely refuse an x-ray today, but try doing it when your 85 and drooling in your wheel chair. Besides, you still pay the cost whether it's you getting the x-ray or the crack addict who bumbles into the emergency room. There has to be oversight in an industry which must meet the needs of every human in the country.
Despite what you say, I don't sense you're an 'everyone for himself' kind of guy, where healthcare is only for those smart, clever, and resourceful (or lucky) enough to properly work the system. However, you are correct that if access to adequate healthcare is not considered one of those basic "all men are created equal" inalienable rights (maybe under the “Life” right), then nationalized healthcare has no place in this country. Then you would also need to start advocating the elimination of the publicly supported healthcare already in this country (which is huge - Medicare being the biggest piece - and supplies much of the profit to the private sector) and get ready to start looking like most other third world countries with deformed children begging in the streets with their inalienable right for the pursuit of happiness.
Monday, May 11, 2009
Marriage
I think a good marriage is built on a foundation of 3 ‘Cs’ – Commitment, Compromise, and Compassion…and probably in that order. I’m guessing being engaged has all the same factors, only instead of Commitment you have Commit without the (ce)ment.
I use the term foundation since the complexities of a relationship are so immense that to simplify the totality of a relationship is both futile and foolhardy. Therefore, you find simple axioms to act as a base on which one can deal with the minutia. If we accept that certain basic things remain constant, anchors if you will, we just might keep the boat from running adrift when the currents and individual waves begin splashing over the gunnels. Like all axioms these 3 ‘Cs’ are not subject to analysis, just as one keeps a faith. By agreeing to them, however, doesn’t mean they don’t require work, but it does mean they are not up for debate…they are not ‘gray’.
Commitment is the most important and most difficult. It is what takes you through the inevitable periods of questioning, second guessing, and (for lack of a better term) the bad times. Frankly, it is also relatively rare, but it is as necessary as yeast is to risen bread for those relationships that actually go the distance. Somewhere in the development of a relationship it must be overtly and clearly confessed to each other and then it requires periodic reinforcement, neither of which is easy to do. As difficult as it is, I feel one cannot over emphasize the importance of making the effort. The attempt, or lack thereof, will be as telling to the relationship as the Sun, or lack of it, is to vacation weather.
Compromise is the grease that allows the Commitment gears to mesh with less friction. Like Commitment, you enter into Compromise without analysis or other great truckloads of personal garbage. The point of compromise is the basic understanding that there can be no winner in a contest without a loser. Of course, I’m not talking about Scrabble or arm wrestling, but rather in the judgments we make in viewing the actions of someone else. What we compromise is our judgment itself. Outside a marriage to do so may be foolish or even dishonorable. However, in a marriage it is Romance without equal, because it accepts and confesses the understanding that there is someone in your life without which life would have little meaning. Like all Romances it is something to strive for, but unlike Commitment there can be real day to day evidence of the attempt. It is like money in the Bank. You may not know the balance of your account, but you’ll feel mighty rich with each deposit.
Compassion is the great reward. It should be obvious, but let me clarify anyway; Compassion is not the romance, sex, churning stomach, longing, or other treats of a new relationship. Compassion exists when you realize (not easily) that your lust for life is intrinsically bound with your chosen partner. It’s the source of such sappy (but meaningful) movie lines as “…you complete me”. It is different from simple passion because at its root it demands that it be a shared experience. But just like passion it provides the palette of colors we all search for, to paint our lives as we’d like to think they should look. Like Compromise, it should be communicated often and overtly, giving credit where credit is due. Compassion is what makes confessions like “I love you” have real meaning.
There it is, 3 'Cs'. How simpler could it be? Of course, that's like saying growing vegetables is just seed, dirt, and water. Think that and don't count on tomatoes in July.
Wednesday, January 14, 2009
Obamanomics?
When I majored in Economics the discipline was quite a bit different…and not. It makes me recall the old saying; everything is different…nothing has changed. Back then, we were on the waning cusp of the Keynesian Revolution, and the Monetarists, led by (the later Nobel Lauriat) Milton Friedman were happily waxing. The theories were different than what we see today, but the fundamental approach has remained unchanged. That lack of change continues to be the bane of most economists, politicians, and financial soothsayers of every description.
After 35 years since graduation, and even with my attempts to remain well-read, I would probably be challenged to get a respectable grade in an Econ 101 course. Nevertheless, the fundamental I took from my education remains fresh and, I believe, timeless. It is this simple fact: Economics is a behavioral science, not an exact science. That fact would not receive much debate in academic circles, yet the practical application of it seems to be lost in the practical application of economics in the real world.
The unchanging part of formal Economics is the insatiable desire to apply formula to human behavior. Our politicians are currently struggling to do just that and with resources (in the form of debt) that have no precedent (that I can think of), certainly on a scale never before imagined. Our leaders, including Obama, are tapping into their favorite economists to give them direction, probably based on what economists are currently in favor. Yet economists are like stabled horses; you check out their papers, look at their teeth, examine their gate, admire their confidence, but when you get on to ride you can’t be sure what’s going to happen. In all likelihood the economists or economic theorists chosen are the ones with the latest successes, but those successes might have been on a dry track and perhaps now the raceway is inches deep in mud. That may explain why I occasionally hear that some politicians (and academics) want to saddle up Maynard Keynes again to see if he’s good for another spirited ride.
I do believe that certain economic assumptions have value if they are consistent with the understanding that human behavior is inherently inconsistent (or erratic, to be less gentile) and it begs for the application of common sense. Human behavior, economic behavior included, reacts to two opposing stimuli: risk and certainty (more accurately predictability since certainty doesn’t exist except perhaps in natural science). In the real world, individuals (of varying numbers) get rich in an environment of risk, but societies economically flourish in an environment of predictability. What the Bush and (it appears) the Obama administrations are trying to do is create growth by heaving great loads of cash into the system, which Monetarist theories tell them will accelerate the economy. Several other nations are doing the same. What they fail to understand is that these attempts very likely will have no effect on growth since they don’t address the major underlying problem: the perceived lack of predictability by the people who comprise the Economy.
Take what most people, including me, feel is the major stumbling block to economic stability: the housing market.
Why the housing market as opposed to say, the job market (another good choice)? Housing is, I believe, one of the great fundamentals of human behavioral stability, along with food and safety. More importantly we have matured as a specie to think of the stability of our habitat as a precursor to much of the rest of our decision making (maybe we always did – leave that to the anthropologists). Of course this doesn’t include all people, but certainly a vast majority enough to drive economies. As we have come to rely on the certainty of our dwellings, and more over the value of those dwellings, we are freed to approach many other economic adventures with a sense of predictability. Now many are uncertain of the viability of remaining in their homes and most everyone feels uncertain as to the value, present and future. Restoring predictability to the housing market is what is needed, not attempting to restore value, or keep people in homes they never should have owned in the first place.
If I had the opportunity to lobby Mr. Obama, I would push him in the one direction everyone seems to be running from; underwriting prospective homebuyers who do not qualify under our current standards. Basically, go back to what many think got us (and the financial markets) into this problem in the first place, sub-prime lending. However, I would trim the fat in three ways; it would be publically funded (eliminating the greed that drove that last perfect storm), direct it only to buyers who do not currently own a home, and not eliminate the income or equity (appraisal) portion of the mortgage qualification.
The underwriting would be to lower the threshold on credit score. This would all be geared to starting the domino effect that has always been part of the modern real estate housing market, the movement of individuals from one home to another. Many renting individuals who may have defaulted on a sub-prime mortgage due to the size of the mortgage relative to the value of their home (a home they should never have been in) would be able to get the opportunity for finance to a smaller home, provided their income supports it. Just the smell of inflation in the housing market, however slight, due to movement of homeowners, would help jumpstart the entire process.
It’s impossible to predict what level housing values may evolve to in such a process or even how long it would take. However, I’m comfortable with one forecast: once the housing market has achieve a level of predictability where individuals can feel comfortable about what their home is worth and that the opportunity to leave that home or stay in it is a matter of simple choice and not necessity, then the rest of our economy (in the absence of catastrophe or conflict) will begin to show its own renewed sense of predictability and growth. The economists will rewrite their new formulas and we’ll just get on with the next crisis. I’m concerned, nonetheless, that if our leaders, especially Obama and his advisors, continue to widen this tsunami of debt in the attempt to buy confidence, then we will be left with simply a widened crisis…and some very, very rich people.