Government As A Business Concern

Posted March 27, 2017 by zukunftsaugen
Categories: Uncategorized, Politics, Republican Party, Democratic Party, Conservatives, GOP, congress, Donald Trump

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Over the weekend reports emerged that President Trump’s son-in-law, Jared Kushner had been tapped to lead a “government efficiency” commission. Kushner’s task was said to be about bringing business efficiency to government operations. Get the message, government is inefficient and businesses are efficient. Hmmm.

Governmental agencies are organizations which can be prone to bureaucracy and become tone deaf to the voice of the customer. Some business efficiency experts claim this tendency is part of the human condition and all organization must guard against inward focus. So what is so special about Kushner’s new assignment?

First, one must recognize that his assignment presumes two suppositions, (1) government agencies are inherently inefficient, and (2) business operations are inherently efficient.

One must remember, however, that government agencies are not “pop-up” operations which establish themselves around a perceived opportunity (customer demand). Government agencies are instead consequences of laws passed by Congress. Often Congress passes other laws which consequently set up other agencies creating confusion or conflict. And frequently, Congress does not pass new legislation when the original need has passed. In other words, some agencies simply outlive their original purpose and take on a new raison d’etre. So, in addition to efficiency, a useful question asks “do we need the agency at all”.

Choosing any particular business to model a government agency against has some key factors to consider.  Businesses mostly are about making a profit, the more the better. Businesses exist normally in a world of competition, both locally and globally. Businesses can hire and fire (for just cause). And, if a business fails, it can declare bankruptcy and simply go out of business. Hmmm.

So would one pick a Wall Street hedge fund as the model for improving the efficiency of air traffic controllers? Or select Google as the model for the Treasury Department? Or, Exxon for the State Department?

For sure there are business practices, like salary administration, performance measurement, and quality practices which have direct application to government agencies and should be considered.

Kushner’s task will be better understood when there is word on which Government agencies or work processes he is interested in improving.

Second, we must also recognize that many conservatives are primarily intent upon reducing the size of government. One way that could be imagined is to “bid” out government operations to the private sector. Compare, for example, Internal Revenue Service tax collection with offerings from outside vendors. Then, suggest that some company like “Turbo Tax” or “PwC” could do it less expensively (that is more efficiently). Eliminate the IRS and elevate a private sector, for profit company as the replacement. Hmmm.

There are huge obstacles awaiting Kushner. Government agencies represent employment and those jobs are often located in one party’s political district. This could be circumvented by requiring the new operating company to hire existing employees. Civil Service would most likely end for those impacted workers and hire/fire could begin with the oldest employees out the door first. You can complete the what could go wrong description.

Insidiously, one could speculate that new, private sector management could take over operations seamlessly and actually improved operations. What pressure do you think might fall upon the new operators top management from political operatives who sought further efficiency improvements or in lieu, political donations. Hmmm.

No doubt, there exists government agencies which could improve efficiency and others which do not need to exist. Kushner’s work could be beneficial or a Don Quixote like dream with consequences detrimental to current government employees and the US citizens who are the intended customers.

Let’s watch carefully.

A Week Of Eye Opening

Posted March 26, 2017 by zukunftsaugen
Categories: ACA, affordable care act, Barack Obama, congress, Conservatives, Democratic Party, Donald Trump, federal debt, GOP, health insurance companies, Healthcare, medicaid, medicare, obamacare, Politics, Republican Party, Uncategorized

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This past week has been an eye opener for what a new Republican Congress stands for. How about “for everything” and “for nothing”? Or, maybe “for effective government” and “for ineffective” government? Or, maybe “for sincere government” and “for insincere government”? Hmmm.

This first revelation was striking. Republicans had passed legislation to repeal Obamacare about 80 times during the past 6 years and had campaigned in 2016 for the complete repeal and replacement of Obamacare. Yet when the opportunity was there, Republicans had no replacement plan.

The GOP had many plans, all disingenuous, but there was no one plan Republicans could agree upon. Hint: do you realize GOP candidates lied about their intentions?

The most popular refrain the GOP used was lowering the premium costs which “Americans” are experiencing. To some degree, in some places, this claim seems justified but Republicans were happy to leave this claim unclear. Americans receiving healthcare coverage from their employer, Medicare, or Medicaid, received no staggering premium price increases. These Americans were shielded from the increases some individuals in certain areas experienced.

So why would Republicans make such a claim? Could it be that most all Americans experience some form of uncontrolled healthcare cost increases (as they did yearly before Obamacare) and don’t understand why hospitals, doctors, and drugs cost so much?

Few, if any of our politicians called out for a universal, single payer system to replace Obamacare. Shamefully, Republicans instead called for changes to Obamacare which were designed to reduce cost increases pressure by insuring less people! How do those politicians sleep at night?

But simply reducing coverage was not good enough for some Republicans. The “Freedom Caucus” members sought to change Medicaid from an entitlement for the most needy to a capped block grant which would become the sole responsibility of States in a few years.

The “Freedom Caucus” wants to deconstruct the Federal Government and healthcare seemed an opportune way to begin the process. “Freedom Caucus” members represent a clear and present danger to modernity.

Most Americans have little skin directly in the healthcare game. Next up on Congress’ docket is likely to be “tax reform” where almost all Americans have an opinion.

While there is much good that can be achieved (like eliminating or vastly reducing the number of tax loopholes, exemptions, and deductions), changes which will lower the overall tax revenue or the progressive nature of the tax code, are sinisterly designed to reward the wealthy and to starve the Federal Government and its ability to function.

With tax reform, even more than with healthcare, it will be critical to study what any proposed changes might accomplish before voting upon any bills. The devil will almost certainly be in the details.

This past week revealed a White House and a Congress whose intentions are hidden.   On one hand, the Republicans seem unfit to govern and on the other hand, seem not a friend to the average American.

I wonder whether this GOP leadership will have learned anything that might restore faith in their intentions? I really wonder whether the White House or the Freedom Caucus care?

Utah Shoots… At Wrong Target

Posted March 24, 2017 by zukunftsaugen
Categories: Healthcare, Politics, Uncategorized

Tags: , , ,

Utah Governor, Gary Herbert hailed the Utah Legislature’s passing of a law which would lower the drunk driving blood alcohol level threshold from .08 to .05, making Utah the lowest limit State. The Governor reassured Utah residents that the new limit would save lives. Hmmm.

Deaths due to drunk driving have risen in recent years to 45 in 2014 and then receded to 38 in 2015. In total there were 275 automobile accident deaths in Utah in 2015. Hmmm.

I wonder what Utah is doing about opioid overdose deaths which are running one per day.

There certainly are no good reasons for any traffic deaths but if .05 is better, wouldn’t .04 be even better? Utah appears to be shooting for an ever smaller diminishing marginal return.

Utah, of course, has the right to put its efforts where it thinks best. But why would going from .08 to .05, or from 38 drunk driving deaths to say 25 or 30 (if the lower limits were to work) justify any effort when they have opioid induced deaths piling up at one per day, and no apparent plan to reduce?  Hmmm.

Distraction any one?

Free Market Health Care

Posted March 23, 2017 by zukunftsaugen
Categories: ACA, affordable care act, congress, Conservatives, Democratic Party, Donald Trump, Economics, GOP, health insurance companies, Healthcare, Politics, Republican Party, Uncategorized

The Republican sponsored “American Health Care Act” is floundering in Congress. The replace portion (as in repeal and replace Obamacare) is in trouble for curious reasons given that Congress and the Presidency are both in Republican hands. The political farce which is unfolding casts a sharp light on the undeniable fact that there is no Republican Party united around a core set of principles. Rather today’s Republican Party is a party of convenience which unite around not being Democrat or progressive.

The shallowness of this union shows through in the Republican argument over repealing Obamacare and trying to agree upon a replacement. Maintaining “no pre-existing condition” or “no life time benefit limits” exclusions along with keeping children on parent’s policies until age 26 showed the world Republicans were caring and compassionate (or so they said).

But doing away with the individual mandate and dropping certain taxes has brought into focus the difficult task of how to pay for these benefits and keep the same number of Americans on the insured roles. The inescapable GOP conclusion is that insurance costs will not come down unless, Republicans say, the free market kicks in. If this mysterious free market does not bring down the cost of insurance, then individuals and Medicaid will see large increases in cost.

The most conservative Republicans, true believers in everyone should have access to the best healthcare they can afford, are now proposing to eliminate the 10 healthcare benefits mandated in Obamacare. Hmmm.

  1.  Outpatient care—the kind you get without being admitted to a hospital
  2. Trips to the emergency room
  3.  Treatment in the hospital for inpatient care
  4.  Care before and after your baby is born
  5.  Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6.  Your prescription drugs
  7.  Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8.  Your lab tests
  9.  Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
  10.  Pediatric services: This includes dental care and vision care for kids

It shouldn’t take a genius to realize that without some requirement like these 10, insurance companies can price policies high and steer customers to stripped down version such as  catastrophic coverage. Moderate Republicans, especially those representing poor or inner city districts, see a huge backlash coming in the next election if the ultra conservatives prevail.

Conservatives are quick to counter, “doesn’t everyone have the right to buy only as much insurance as they want? Why would a single young man want to pay for pre and post natal coverage if he is not married?”

That strikes right to the heart of the matter. Healthcare costs, are generated by hospitals, doctors, and drug companies and don’t change simply because of insurance changes. The number of pre- and post natal visits will be the same regardless of whether a young man chooses to carry broad coverage or just a stripped down policy. The implication, however, should not be lost, everyone else will pay more if the young man is allowed to buy stripped down policies. That is the definition of insurance.

Republicans are ringing their hands over this dilemma. Conservatives say they will vote against the American Health Care Act if the bill looks too similar to Obamacare and Moderates say without certain coverage and federal assistance (like tax credits and Medicaid) they will vote against it.

Congress members appear to be living in a make believe world. If somehow Congressional leaders along with President Trump can work out a compromise and pass the American Health Care Act, then just looking at the reduce insured numbers and the fewer services many Americans want (and need), Republicans will lose in 2018.

“Americans” Expect Us To Act

Posted March 22, 2017 by zukunftsaugen
Categories: ACA, affordable care act, Barack Obama, congress, Conservatives, Democratic Party, Donald Trump, entitlements, federal debt, GOP, health insurance companies, Healthcare, Politics, Republican Party, Uncategorized

How many times have you heard GOP leaders repeat ad nauseam the mantra “the American people elected us to X or Y”, or “the American people want this or that”? The correct terminology  would be “Some American people…” with emphasis on “some”.

This type of honesty and absence of hyperbole would diminish the pomposity and self importance GOP elected officials want to present. (I fear this is a Republican disease today simply because Republicans are in the majority and in truth, Democrat leaders might fall under the same spell if roles were reversed.)

No better example of the misleading nature of “Americans expect” is the current healthcare debate. Republican Congressional leaders are moaning about those Republican Congress members who are threatening to vote against the American Health Care Act (the replace plan for Obamacare). “Americans expect us to pass this bill” leaders cry while all sorts of non-partisan studies point out that the replacement bill will maintain some popular Obamacare benefits but at the end of the day provide less coverage and insure fewer people.  No more appropriate subject does “some Americans” apply than here.  “Most Americans” are not impacted as a benefit recipient by Obamacare

For some Republican Congress members, the AHCA does go far enough in rolling back entitlements and for others, it goes too far. Hmmm, I wonder what Americans really want?

Senator Rand Paul elaborated today on his proposal which could gradually eliminate Medicare expansion and streamline the individual market. Paul has proposed creating a pool of all uninsured and the allowing the “free market” to drive down price through competition amongst insurers.  As lower policy prices emerged,  government supports would decrease until they disappeared. Hmmm.

Paul deserves credit for proposing a clever way out of the box Republicans have created for themselves. His proposal, of course, has it own set of pitfalls, the most obvious of which is whether “for profit” insurance companies will want to offer policies at prices the pool will demand and people can afford. None the less, Paul proposal deserves a careful review.

The irony of the current healthcare repeal and replace drama is that greedy Republicans are far more interested in diving into “tax reform”. We will hear again that “Americans expect us to lower taxes” when in fact “some Americans”, like the top 1 or 2% wealthiest Americans will alone reap huge benefits. Most American will see little impact and no benefit. More insidious will be the knock on effects of such a large tax cut. Where will the Government get revenues to pay its expenses?  Think there will be more cut in government services?

The Republican tax reform odyssey will make “searching for a free lunch” dinner time conversation.

The Jacksonian Revolt, Is That What’s Really Happening In Washington-Land

Posted March 21, 2017 by zukunftsaugen
Categories: congress, Conservatives, Democratic Party, Donald Trump, foreign affairs, foreign policy, George W Bush, Iraq War, Politics, Republican Party, Uncategorized

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There are some bizarre events taking place in the nation’s capital. The President is tweeting (bizarre enough on its own) outrageous charges about President Obama which impugn the office and are completely baseless, and the President refuses to admit his mistake. The Senate is itching to confirm a new conservative Supreme Court Justice as if it were a long overdue (thanks to obstructionist Democrats) even though the Republican majority refused 12 months ago to consider Merritt Garland. And in Senate hearings, FBI Director James Comey confirmed that the FBI had open investigations focused on possible collusion between Russian operatives and members of President Trump’s campaign staff. Most Republicans dismissed the implications and instead wanted to talk about who might have leaked this information earlier.

How can grown intelligent people act this way?

“Foreign Policy” is carrying an article by Walter Russel Mead titled The Jacksonian Revolt. Mead lays out various US foreign policies (Hamiltonian, Wilsonian, Jeffersonian, and Jacksonian) and their points of emphasis. Broadly, Hamiltonian and Wilsonian have dominated foreign policy thinking since World War II while Jeffersonian and Jacksonian have taken a back seat. Now the prospect that President Trump might be a 21st century Jacksonian is getting people’s attention.

What’s so wrong with Jacksonian foreign policy?

Both Jefferson and Jackson sought a low profile for the US. They believed this posture would be the least costly and the least likely to entangle the US in foreign wars. America first, so to speak.

Hamilton thought the US needed a sturdy presence around the world in order to fend off other countries who might interfere with foreign commerce. Neither school of thought sought conflict and both thought their strategy was superior.

Since the Second World War, US (Hamiltonian) foreign policy sought to build alliances globally and through economic development stabilize foreign actors who might be prone to war otherwise. Wilsonian believers tended to emphasize human rights and rule of law as key components of US foreign policy. With one off exception of Korea and Vietnam, the world has been relatively free of war (regional ones but no world wars) until the Gulf War I.
Saddam Hussein invaded Kuwait and a coalition of western countries combined to over turn the invasion and expelled Iraqi forces.

In 2003, for reason still unclear, George W Bush’s Administration felt compelled to once again invade Iraq and in doing so, opened Pandora’s box. There are no mitigating explanations for what will be recorded in history as a tragic foreign policy failure but happen it did. Seventy years of broad based foreign policy support began to erode and 19 century world views once again seemed credible.

Mead speculates that Jacksonian Americans saw nothing good about US foreign policy but were more concerned (and felt personally threatened) by a changing US population demographic. Immigration was a direct threat, one cleverly encouraged by Democrats, thought the typical Jacksonian American. Donald Trump was their Andrew Jackson, and had come at not a moment too soon.

Mead’s concerns are strictly foreign policy and domestic policy and its attendant politics are secondary it seems. Mead does not support isolationism, but warns that future efforts on world order must consider to a greater degree the needs of other nations to feel their identities are respected (I think he is saying a little less Wilsonian flavor).

What Mead does not say is also important. Jacksonian Americans are still a minority. The coalition which elected President Trump and who have precipitated the US foreign policy rethink are far from a single mind on future steps. Libertarians and Neoconservatives feel free to plot new courses for the US.

America is not living in the age of sailing ships or horse drawn artillery as Jackson knew it. America is living whether we like it or not in the age of nuclear weapons, missile technology, and cyber warfare. Jeffersonian or Jacksonian foreign policies are incompatible with America’s best interests.

A rethink of Hamiltonian and Wilsonian foreign policy principles is probably necessary but with a President who seems unable (or unwilling) to value truthfulness, the prospects of more neoconservative policies (like invading Iraq) present a greater threat to our way of life.

Is The Free Market The Answer?

Posted March 20, 2017 by zukunftsaugen
Categories: affordable care act, Barack Obama, congress, Democratic Party, Donald Trump, health insurance companies, Healthcare, medicaid, medicare, obamacare, Politics, Republican Party, Uncategorized

The “repeal and replace” gang have been telling Americans for a long time that healthcare needs to be about choice, that the high cost of healthcare is because the free market is not working, and things will get better when Government no longer comes between the patient and the doctor.

Admittedly, supporters of Obamacare have been handicapped because healthcare spending is still high and rising annually. How can one speak against what Republicans are saying when what Republicans are criticizing is not working well either?

Whoa. Let’s slow this down and review some inconvenient facts.

The Affordable Care Act (Obamacare) is about insuring more Americans, not directly dealing with how much healthcare costs. So right away if voters don’t want to pay (via subsidies and expanded Medicaid) for more insured, than it is entirely unnecessary to put forth misinformation about more choice and better healthcare, just admit that as an American one feels no need for universal healthcare coverage. Full stop.

Now if one wishes to invest energy and tinker with the Affordable Care Act, let’s consider a few popular Republican myths.

  • Get the Government out from between you and the doctor. Is the implication that I should accept (for profit) insurance companies making better decisions on what treatments are covered or what drugs are acceptable? At the very best of possibilities, how are these two options different? And, with insurance companies public corporations with a requirement to make a profit, how can insurance companies not be more costly?
  • Competition is the answer to lowering healthcare costs. The suggestion is that with more policies available (selling insurance across State lines) natural free market principles will drive down costs. Insurance prices are related to real healthcare costs which are generated by hospitals, doctors, and drug companies, not insurance companies. Insurance companies simply hitch a ride on basic costs.  Insurance premiums assumes usage and underlying costs PLUS insurance company profit. If insurance companies guess wrong, they just raise the price of their policies.
  • Patient centered Healthcare puts the individual in charge. This “wordsmith” slogan “Patient Centered” has no connection with underlying costs. “Patient Centered” is about providing the patient with information about their health status and suggested medical treatments and services tailored to improve health outcomes. Is this not what we have today?
  • American Healthcare is the best in the world. This myth is put forth whenever there is a suggestion that other countries have better healthcare delivery systems and surprisingly achieve that superiority at substantially lower costs. There is little to be gained from disputing how good the Mayo Clinic, the Cleveland Clinic, or Johns Hopkins might be, or for that matter many other large teaching hospitals across the country. Most Americans, however, only read about these institutions and do not receive medical treatments from them. Life expectancies, percent of residents receiving basic healthcare, and treatments for serious illnesses rank American healthcare well down the list of modern, developed countries.

The number one problem with America’s healthcare delivery system is cost. Americans spend twice as much as most other modern countries (with healthcare outcomes equal to or superior to America’s). The number two problem is that America’s healthcare delivery system does not include all Americans since cost puts it out of range for poorer, sicker, and older Americans.

These are not myths, these are facts. So all the smoke and fiery words about repeal and replace the Affordable Care Act miss the primary targets as did Obamacare.

Given all this, is the free market even remotely likely to improve a fundamentally flawed healthcare delivery system?