Saturday, January 26, 2008

The $150B Christmas Tree

A few weeks back, President Bush and Congress were locked into yet another legislative confrontation. This time it was over finalizing the 2008 federal budget (already 3 months late). The fight centered on the usual what to spend federal dollars on, and who should pay the taxes to support that spending. But it was also on the total size of the spending. Bush’s veto threat was aimed squarely at holding total spending to stay within a specified limit to minimize any resulting deficit.

Fast forward to the end of January, 2008. A light bulb seems to have gone off in the White House (no doubt helped by lobbying assistance from major banks and other corporations) that, golly darn, we could soon have a recession! A recession primarily brought on by self-imposed wounds to the financial industry. Wounds caused by a few years of stupid and predatory mortgage lending to people who clearly could not maintain such mortgages over the long term. Apparently a planned bill to rescue troubled mortgagees that also lets the lending companies off the hook for their mistakes is not enough. Now the entire country has to come to the rescue of inept corporations.

So how do government leaders sell this to us? As is typical, by bribery. Here’s $600, $1200, or some such amount, along with some good old Republican tax breaks. Go out, feel good, and spend your way into economic recovery. And let’s do it to the tune of $150,000,000,000.00!

And where did this $150B magically come from? One month ago we had no money to insure more kids against sickness, no money to invest in our crumbling infrastructure, no new money to support many legitimate opportunities that could make a significant difference in this country’s future. Of course, there was still plenty of unaudited money to support our Iraq misadventure, and the number and amounts of earmarked dollars to special congressional constituents seems to be virtually unchanged. But all that was supposed to be it. All the money that was available. So did Santa Claus decide to make a second round of handling out free gifts?

No, this $150B comes from yet again more borrowing, more debt. It will be underwritten by prosperous foreign countries, the same ones making a financial fortune off of their one-sided sales to us. It is debt that will stagnate and never really be paid back. Yet more debt passed on to our kids, and more limits on future discretionary spending for this country.

Now the detailed questions start to arise on how we should best spend this newly-discovered “pool of wealth.” Republican and Democratic leaders for once are in agreement: send almost everyone a check. Even though everyone agrees that “fast action” is required to stave off this recession, and this approach won’t be felt economically until the end of the year. Conversely, virtually all economists agree that expanding food stamps and unemployment benefits could be effected immediately and have the greatest impact the quickest; but those populations are not significant blocks of voters. I am willing to leave a specific approach to the wisdom of others, but please do not pander to what you obviously consider my apparent stupidity.

Mike Huckabee came out recently with the smartest idea for spending $150B we didn’t know we had. Instead of a 1-time money for folks to buy gasoline from oil companies already flush with incomprehensible profits, invest that short-term money in something tangible that will pay long-term recurring dividends. Investments like a crash rebuilding of our roads or other public benefit projects. Remember FDR’s WPA project in the 1930s? Rather than handing out cash, he hired people to build and create, and to keep them employed. 70 years later, we still have many of the roads, post offices, courthouses, schools, national park facilities to show for this wisdom.

Instead, we are just going to sprinkle play money like fairy dust all around the country to try to numb people into thinking that these government leaders of both political parties are being responsive to the country’s needs. For many of us, this will simply enlarge our cynicism towards this government’s irresponsibility and its inability to think and act with intelligence and substance. It is simply cash as a feel good drug to mask the economic pain. Principles and common sense be dammed. Yet another avoidance of our collective personal responsibility that has hallmarked these last 7 years.

Thursday, January 17, 2008

The Politics of Health

One of the major issues in this year’s presidential election is about health care for Americans. Apparently all of the candidates are politically wise enough to agree that people who are sick should get medical attention. A few of those candidates are even wise enough to believe that preventing illness might be a better investment of health care resources than just treating the sick. But apparently that is about where agreement ends. HOW health care should be delivered seems to be a road traveled differently by each party and candidate.

It has been recommended that health care delivery should be evaluated against criteria of quality, access and coverage. Regarding quality, the US on the whole provides care backed with innovation and medical knowledge that is enviable throughout the world. But at the specific level, with individual doctors / hospitals / laboratories / support functions, it is clear that quality varies widely among geographic locations and among all sizes and types of facilities. We as individuals have minimal awareness of the quality and competency of medical services that we receive unless we go to a nationally recognized facility in the specialty of our illness. Part of that is because medical care is a closed industry. Failure rates, complaint histories, price, and comparative performance information is not available to the consumer/patient. Quality is a factor you only know about AFTER the work is done, which is often way too late. This inability to be “an informed consumer” of individual providers is the major flaw in those (particularly Republicans) who advocate “health care delivery by the free enterprise market.”

Which raises the access question: if quality is a variable and in fact often reflects a price tag, who is able to obtain medical care, much less has access to quality medical care? The estimate is that 48 million out of 300 million Americans have no health care. That should outrage each of us. Many of these are people who typically do not go for treatment except as a last resort. Even among those with coverage, day-to-day decisions are made about what care they can afford above the insurance reimbursement, or what life supports (food, shelter, heat, clothing) they must sacrifice to pay for medical expenses. So is quality care truly available to the public?

Regarding coverage, this is the quicksand beneath our feet. Whether or not you agree with his presentation tactics or his specific conclusions, Michael Moore’s “Sicko” movie correctly identified the very real and critical issue of insured Americans not adequately covered. Many of us walk around with our health insurance card in our pocket, believing we are protected from medical calamity. Until we find out otherwise, most often after we have received care. We face deductibles / copayments to be made, limitations on choices of doctors and/or treatments, disagreements of claims over “pre-existing conditions,” or ultimately the stamp of “Not Covered” on our claim form. Worse still are the people trapped in a bad job they cannot give up because they cannot transfer to a new job their employer-based insurance on which they depend.

It’s broken. And it is broken badly. And in this country of outlandish executive pay vis-à-vis worker pay, it is obscene that access to adequate medical care causes any debate at all. The Republicans raise the very old and tired bogeyman of “socialized medicine” when someone talks about government servicing all who need health services. They simply ignore the fact that government has been doing reasonably well (certainly no worse than the private sector) already servicing 8 million children, plus millions more senior citizens, millions of military veterans, and, oh yes, thousands of Congressmen and government officials. State and federal governments have long underwritten health care for a substantial portion of America, so let’s just give up on that scare phrase invented by the American Medical Association in the 1950s. Conversely, the Democrats see an expanded government role in health care, but they are so scared off by the Hillary Clinton reform disaster of the 1990s that they will only stick 1 or 2 toes in the water, keeping the rest of the leg high and dry. Could we please have some truly fresh “change” thinking here?

The two fatal flaws in our current concept of health care delivery are:
-Employer-Based Insurance: not everyone is an employee, so Bush’s tax credits are a nonsensical approach. Health care costs inflate business costs and reduce economic competition with the rest of the world. Employees now change jobs frequently but health coverage does not transcend the workplace.
-Health Insurance: buying insurance to cover your medical costs from someone for whom your needs are their costs and reduced profit is inherently a conflict of interest. You cannot reconcile these two differing objectives in a profit-based competitive marketplace. Especially if you offer insurance on a line-item, illness-by-illness basis. The resulting horror stories from this approach are legion. I insure my car against damage; I do not opt to insure my headlight versus door versus transmission versus motor. If medical insurance is going to be the approach, the industry should do its risk analysis and projections against aggregate total costs of the insured pool and parcel that out, like any other insurance. This is basic insurance 101.

We need to stop talking about how to make health insurance available to everyone. Because health insurance does not work and is not the answer. We need to start over and talk about how to make health SERVICES available to everyone. We need to get doctors and patients back together, while eliminating the incredible waste, inefficiencies and duplication that exist in today’s delivery systems. And you know what? This can be achieved if we focus on those two true objectives.

Thursday, January 3, 2008

Primary Preview

After an excessive year of pre-election campaigning by our presidential candidates, we are now down to the beginning of primary voting. The first six weeks of 2008 will be telling, and all will look very different as early as mid-February. Even though it is all happening way too soon and for too long, it will be good to start sorting out the current playbill. Hence some observations below about where a year of 2007 campaigning has brought us:

The Republican field is shallow and un-inspires its own base; it still sounds like “more of the same,” with many aspirants but no one winning the “Reagan mantle.” The Democratic field is strong on credentials with enthusiastic supports; in the end they will galvanize around their final candidate.

The major issues are: Iraq; the emerging economic downturn; illegal (and legal?) immigration; and health care. People’s determining factors: fear of terrorism; desire for change of direction; end to government paralysis and polarization; need for competence in government. The person who connects on these wins. And the candidates:

- Biden: has been very impressive in his foreign affairs expertise and overall
manner, but just hasn’t caught on as a viable president.
- Clinton: not “inevitable,” and has stumbled, but has shown she would be a
formidable candidate; still unclear if she can win over her negatives and
demonstrate “change” versus her obvious intelligence and competency.
- Dodd: an effective Connecticut senator, but never viable nationally as president.
- Edwards: dead-on right about the corporate give-aways of this decade; but may be
too strident for those Americans looking for reconciliation in government.
- Gravel: Too harsh to be heard, regardless of message; disappearing from view.
- Guliani: Biden described him best --- “a noun, a verb, and ‘9/11” is all he can
speak to; the politics of fear needs to end.
- Huckabee: wins the Republican right platform with the least scary version of their
cause, and fulfills my early prediction of being “the sleeper” candidate; but is
there any substance under the good-humored folksiness?
- Kucinich: Don Quixote still lives, with ideas that still need to be voiced; could
still be the Secretary of Peace that he espouses in another’s administration.
- McCain: has thankfully rediscovered his integrity, but probably too late.
- Obama: clearly the freshest voice, very natural, confident and genuine; has not
fully answered “the experience question,” if that is ultimately deemed truly
- Paul: following a unique path and message , showing surprising resonance and
strength with a specific constituency.
- Richardson: a good governor, a future cabinet member; has never found a
presidential personality.
- Romney: Joe Klein (Time magazine writer) said it best: “Mitt Romney seems
incapable of finding an issue where integrity trumps expediency”; the plastic man
is following an all-image / no substance path, and we have had 7 years too much of
that already.
- Thompson (Fred): the man riding the Republican right white horse has been a
complete bust; the pickup truck never got out of the garage.

GONE: Brownback, Hunter, Tancredo, (Tommy) Thompson.

On January 3, 2008, it’s all still very much a toss-up.