A popular definition of insanity is "repeating the same actions and expecting a different result".
The private medical expense insurance industry has been around in one form or another for more than sixty years. The insurers trumpet the mantra that the industry
offers healthy competition in benefits and costs, so if it ain't broken, why fix it? Particularly if the evil, ineffective "government" would get involved in the fix.
The facts contradict the industry's hype. If the private system is so efficient, and benefits are provided to everyone, at reasonable cost, and the quality of the care
for which they will allow payment is so high, why have we had a health care crisis over more than 40 years? Why is congress spending so much time in every session
on the subject?
Under the surface many in congress are aware that a single payer system would be the
best solution. The powerful vested interests that are arrayed against such a solution control the votes of enough members to prevent such a plan from coming to a vote. So they will come up with a patchwork plan with just enough changes to give the appearance of progress but which will preserve the status quo, and the problems
and inequities within it.
Health care consumes such an enormous share of the nation's assets that recovery
from the current depression cannot occur unless its costs are reigned in. The status quo will mean deficits increasing annually, a drag on business recovery (to say nothing of expansion), and an increasing portion of the public without health care insurance. Don't we have a right to expect better from our Congress?
Saturday, June 27, 2009
Tuesday, June 23, 2009
Health Care--Redux
The conservative pundits, George Will in the lead, are savaging Obama's proposal
for a gov't run alternative to private, for profit insurance plans that presently
cover an estimated 250 million persons. Their mantra is that such a plan, because it
would use the enormous bargaining power of the government, would price the private plans out of the market, limiting choice and diminishing the benefits of "healthy"
competition. If the private plans are so healthy, and competitive, why are we in a health care crisis?
The private health insurance industry consumes hundreds of billions of dollars annually, in which about 33% goes to overhead, profits and dividends. That 33% grows annually by inflation while producing no benefits to patients. In addition, because the insurers must control costs to assure profits, they impose costly and onerous
burdens on providers by pre-treatment approvals, limits on permitted procedures, and claims filing and paperwork. The practice of medicine has become an assembly line business with office managers, computer techs and automated claims and billing.
Medical care is NOT a commodity. Seeking it is not like purchasing an auto, or a Dunkin Donut. Illness and accidents are not optional, and treatment must be sought
without regard for ability to pay. Therefor society must provide it, but in the most efficient manner, recognizing that public resources come from the public.
If a single payor non profit plan were established, the premium dollars allready being payed, plus the savings of 33%, and cost reductions to providers, could easily cover the cost of insuring the 45-50 million currently uninsureds.
There would be some painful readjustments for the for-profit insurers, but we cannot
maintain a failed system just to avoid those.
It will take political courage by the President and Congress to effect such a change.
It is easier to accomplish now, when public pain is fresh, the failures of the status quo are so evident, and the private sector has no solutions to offer. Go for it Mr. President!
for a gov't run alternative to private, for profit insurance plans that presently
cover an estimated 250 million persons. Their mantra is that such a plan, because it
would use the enormous bargaining power of the government, would price the private plans out of the market, limiting choice and diminishing the benefits of "healthy"
competition. If the private plans are so healthy, and competitive, why are we in a health care crisis?
The private health insurance industry consumes hundreds of billions of dollars annually, in which about 33% goes to overhead, profits and dividends. That 33% grows annually by inflation while producing no benefits to patients. In addition, because the insurers must control costs to assure profits, they impose costly and onerous
burdens on providers by pre-treatment approvals, limits on permitted procedures, and claims filing and paperwork. The practice of medicine has become an assembly line business with office managers, computer techs and automated claims and billing.
Medical care is NOT a commodity. Seeking it is not like purchasing an auto, or a Dunkin Donut. Illness and accidents are not optional, and treatment must be sought
without regard for ability to pay. Therefor society must provide it, but in the most efficient manner, recognizing that public resources come from the public.
If a single payor non profit plan were established, the premium dollars allready being payed, plus the savings of 33%, and cost reductions to providers, could easily cover the cost of insuring the 45-50 million currently uninsureds.
There would be some painful readjustments for the for-profit insurers, but we cannot
maintain a failed system just to avoid those.
It will take political courage by the President and Congress to effect such a change.
It is easier to accomplish now, when public pain is fresh, the failures of the status quo are so evident, and the private sector has no solutions to offer. Go for it Mr. President!
Saturday, June 20, 2009
Slap on the Wrist, Pat on the Head!
President Obama has released his grossly inadequate plan to improve regulation of large financial institutions. I am deeply disappointed. It is tinkering around the edges without addressing the rot that greed has planted in our banks, investment firms, insurance companies and mortgage brokers. They will evade its provisions with ease.
Obama was elected with a substantial mandate to fix the corrupt system which arose from the De-regulatory zeal of Congress in the 1990's. The traditional business models for commercial banks, savings banks, and insurance companies, which established
separate and distinct functions for each, carefully regulated, and which had served the nation and its economy well, was suddenly abolished. In its place we got an "anything goes" model. When anything goes, GREED goes fastest.
In his campaign Obama promised to overhaul the system to re-establish accountability
for the financial institutions, and to put in place a traffic cop to keep them in their traditional roles.
I am aware that his governing technique is to build concensus for change, and he is
by nature a cautious man. But with his broad public support he could ram through major reform. If he rallied the public for that, even the powerful financial lobbies
and their purchased congressmen would be overcome. After all it is the public which lost jobs, homes, retirement portfolios and savings. If they are informed of what is at stake, they will choose to do the whole job, not a band-aid. There may not be another opportunity when the public pain is fresh and the causes of our problems are so obvious, to pass the reform legislation which is so necessary to prevent another financial meltdown.
Mr. President, this is no time for timidity.
Obama was elected with a substantial mandate to fix the corrupt system which arose from the De-regulatory zeal of Congress in the 1990's. The traditional business models for commercial banks, savings banks, and insurance companies, which established
separate and distinct functions for each, carefully regulated, and which had served the nation and its economy well, was suddenly abolished. In its place we got an "anything goes" model. When anything goes, GREED goes fastest.
In his campaign Obama promised to overhaul the system to re-establish accountability
for the financial institutions, and to put in place a traffic cop to keep them in their traditional roles.
I am aware that his governing technique is to build concensus for change, and he is
by nature a cautious man. But with his broad public support he could ram through major reform. If he rallied the public for that, even the powerful financial lobbies
and their purchased congressmen would be overcome. After all it is the public which lost jobs, homes, retirement portfolios and savings. If they are informed of what is at stake, they will choose to do the whole job, not a band-aid. There may not be another opportunity when the public pain is fresh and the causes of our problems are so obvious, to pass the reform legislation which is so necessary to prevent another financial meltdown.
Mr. President, this is no time for timidity.
Sunday, June 14, 2009
BANG! You're dead.
Daily life can be stressful. In bad economic times the stress level rises, and not everyone is equipped to cope. The sane, normal person recognizes that events are
not always in his/her control and rolls with the punches. But in all societies there are failed personalities that look for places and people to blame for the the turn of events and their own inadequacies. There are among them persons who are obviously insane as manifested by bizarre, violent or anti social behavior. They are easily
identified and can be dealt with. But the disaffected person who is functional is
difficult to identify if he wishes to remain obscure. That is the individual who represents a great danger to society because at some point he will act upon his frustrations by striking out at the imagined cause of his difficulties. His act
could be directed against an individual, as in an assassination, or a symbol of the institution he abhors, such as a Timothy McVeigh.
The frustration is aften directed against entire groups, such as the Nazi anti-jewish crusade, or the KU KLUX KLAN against people of color.
In order to carry out a violent act a weapon is required, be it a physical one, or
a psychological one such as mass hysteria stirred up by a dynamic personality--
a Hitler, or a David Duke.
For the individual hater the weapon of choice is a firearm. A gun is easy to conceal, it kills from a distance so human contact with the victim does not interfere with the task at hand, and allows distance to escape. With the universal
availability of guns in our violent society, any nut case can be as powerful as the head of state, even to the point of igniting a world war as the asassination of
an Archduke did for WWI.
And we love our guns---more than our children; witness the number of children who kill themselves or other children after finding a loaded gun in the home. The parents could have avoided that tragedy by locking up the gun, but then "it wouldn't be handy if I had to shoot a burglar."
When an agitated hater is stirred up and validated by extremist politicians and pundits, on Radio, TV and in the press, he feels that he is performing a noble service to society by murdering a museum attendant, a physician, a government official who is "coming to take away his guns", or a President who is selling out the nation to the Muslims. Aren't those rabble rousers accesories to the crime?
What happened to civility and tolerance for other opinions in politics? Why do the divisive, strident voices dominate the debate? Is it because they can't win in the arena of ideas?
not always in his/her control and rolls with the punches. But in all societies there are failed personalities that look for places and people to blame for the the turn of events and their own inadequacies. There are among them persons who are obviously insane as manifested by bizarre, violent or anti social behavior. They are easily
identified and can be dealt with. But the disaffected person who is functional is
difficult to identify if he wishes to remain obscure. That is the individual who represents a great danger to society because at some point he will act upon his frustrations by striking out at the imagined cause of his difficulties. His act
could be directed against an individual, as in an assassination, or a symbol of the institution he abhors, such as a Timothy McVeigh.
The frustration is aften directed against entire groups, such as the Nazi anti-jewish crusade, or the KU KLUX KLAN against people of color.
In order to carry out a violent act a weapon is required, be it a physical one, or
a psychological one such as mass hysteria stirred up by a dynamic personality--
a Hitler, or a David Duke.
For the individual hater the weapon of choice is a firearm. A gun is easy to conceal, it kills from a distance so human contact with the victim does not interfere with the task at hand, and allows distance to escape. With the universal
availability of guns in our violent society, any nut case can be as powerful as the head of state, even to the point of igniting a world war as the asassination of
an Archduke did for WWI.
And we love our guns---more than our children; witness the number of children who kill themselves or other children after finding a loaded gun in the home. The parents could have avoided that tragedy by locking up the gun, but then "it wouldn't be handy if I had to shoot a burglar."
When an agitated hater is stirred up and validated by extremist politicians and pundits, on Radio, TV and in the press, he feels that he is performing a noble service to society by murdering a museum attendant, a physician, a government official who is "coming to take away his guns", or a President who is selling out the nation to the Muslims. Aren't those rabble rousers accesories to the crime?
What happened to civility and tolerance for other opinions in politics? Why do the divisive, strident voices dominate the debate? Is it because they can't win in the arena of ideas?
Wednesday, June 10, 2009
Medical care; Who gets, who pays?
The nation is now engaged in a vigorous, and sometime heated, debate about universal
medical care insurance. On one side are a broad spectrum of private, for profit, insurers, including insurance companies, the Blues, HMO's, Preferred Provider networks, and a variety of physician and hospital sponsored plans. These are offered
primarily to large groups sharing some common affiliation, by employers, and in somewhat limited fashion to individuals.
On the other side are plans offered by various government agencies such as the one
provided to members of congress, municipality employees, Medicaid, children in low income families, and the like.
Overlying all are Medicare and Veterans care facilities.
Certain facts and vested interests influence the debate:
The total cost of medical care in the United States has been increasing at a rate far greater than the rate of general inflation.
Approximately 50 million Americans have no health insurance, and millions more
have limited coverages which subject them to expenses beyond their ability to pay.
There are tens of thousands of employees and executives on the payrolls of
the private plans, and stockholders who invest in them in the hope of profit.
The cost of health care for the uninsured is borne by taxpayers, in the form
of higher premiums, by providers in the form of unreimbursed services, and the
uninsureds in the form of neglect of treatment with all the consequences that implies.
The overhead costs, profits, marketing expense, dividends, increased administration procedures, etc in the private plans add at least an estimated 33%
to the cost of medical care, with no commensurate benefit to patients. Inflation
increases that load each year, on top of the increase in the cost of providing the care itself.
Despite the high cost the quality of care in the U.S. is inferior to that in most of the other highly developed countries, which provide better care at much lower cost, to everyone.
There is also the philosophical question; Is health care a basic right for citizens
which must be addressed by government? Is it the responsibility of each individual and therefor a matter of survival of the fittest? Is untreated illness a danger to, and a burden on society as a whole, and thus society's responsibility?
Because health care is one of the largest fiscal crises facing the nation
everyone must become involved in the debate, not just the vested interests. The
forgoing information may be helpful. Let your opinion be known to your members of
Congress!
medical care insurance. On one side are a broad spectrum of private, for profit, insurers, including insurance companies, the Blues, HMO's, Preferred Provider networks, and a variety of physician and hospital sponsored plans. These are offered
primarily to large groups sharing some common affiliation, by employers, and in somewhat limited fashion to individuals.
On the other side are plans offered by various government agencies such as the one
provided to members of congress, municipality employees, Medicaid, children in low income families, and the like.
Overlying all are Medicare and Veterans care facilities.
Certain facts and vested interests influence the debate:
The total cost of medical care in the United States has been increasing at a rate far greater than the rate of general inflation.
Approximately 50 million Americans have no health insurance, and millions more
have limited coverages which subject them to expenses beyond their ability to pay.
There are tens of thousands of employees and executives on the payrolls of
the private plans, and stockholders who invest in them in the hope of profit.
The cost of health care for the uninsured is borne by taxpayers, in the form
of higher premiums, by providers in the form of unreimbursed services, and the
uninsureds in the form of neglect of treatment with all the consequences that implies.
The overhead costs, profits, marketing expense, dividends, increased administration procedures, etc in the private plans add at least an estimated 33%
to the cost of medical care, with no commensurate benefit to patients. Inflation
increases that load each year, on top of the increase in the cost of providing the care itself.
Despite the high cost the quality of care in the U.S. is inferior to that in most of the other highly developed countries, which provide better care at much lower cost, to everyone.
There is also the philosophical question; Is health care a basic right for citizens
which must be addressed by government? Is it the responsibility of each individual and therefor a matter of survival of the fittest? Is untreated illness a danger to, and a burden on society as a whole, and thus society's responsibility?
Because health care is one of the largest fiscal crises facing the nation
everyone must become involved in the debate, not just the vested interests. The
forgoing information may be helpful. Let your opinion be known to your members of
Congress!
Friday, June 5, 2009
Obama in Cairo
Obama's speech in Cairo was masterful. An American President told it like it is, ignoring domestic politics, false sensitivity and hypocrisy.
He asked the contending factions in the East and West to recognize their common
humanity, set aside partisan parochial interests and compromise on the goal of a better life for all.
To reach that goal everyone would need to abandon Alphonse-Gaston behavior; "after
you Alphonse, no after you Gaston", so neither passes through the door. Perhaps a
neutral party could arrange a simultaneous compromise so both make
the passage at the same moment. Once on the other side the obvious benefit would generate its own momentum.
An obstacle to this happy result has been the "camel in the tent" syndrome. Israelis have learned that concessions to the Arabs are absorbed as in a sponge; as a down payment on more in the gradual erosion of the Jewish state. The Arabs think in terms of centuries, the West in decades. It is not only the Jews that must be expelled from Arab lands, it is all unclean infidels. If Israel falls, Lebanon is next, then Pakistan goes Taliban. From where would the U. S. mount a counter offensive?
Our highly developed, densely populated nation is particularly vulnerable
to Pakistani nukes in the hands of fanatics. Their societies are much less vulnerable. And their culture of death accepts the consequences as a passport
to Paradise.
Until there is a deep seated and sincere change of heart among the Arabs, we face
a choice of Confrontation from a position of strength or Accommodation and eventual defeat. Where is a Solomon when we need him?
He asked the contending factions in the East and West to recognize their common
humanity, set aside partisan parochial interests and compromise on the goal of a better life for all.
To reach that goal everyone would need to abandon Alphonse-Gaston behavior; "after
you Alphonse, no after you Gaston", so neither passes through the door. Perhaps a
neutral party could arrange a simultaneous compromise so both make
the passage at the same moment. Once on the other side the obvious benefit would generate its own momentum.
An obstacle to this happy result has been the "camel in the tent" syndrome. Israelis have learned that concessions to the Arabs are absorbed as in a sponge; as a down payment on more in the gradual erosion of the Jewish state. The Arabs think in terms of centuries, the West in decades. It is not only the Jews that must be expelled from Arab lands, it is all unclean infidels. If Israel falls, Lebanon is next, then Pakistan goes Taliban. From where would the U. S. mount a counter offensive?
Our highly developed, densely populated nation is particularly vulnerable
to Pakistani nukes in the hands of fanatics. Their societies are much less vulnerable. And their culture of death accepts the consequences as a passport
to Paradise.
Until there is a deep seated and sincere change of heart among the Arabs, we face
a choice of Confrontation from a position of strength or Accommodation and eventual defeat. Where is a Solomon when we need him?
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