Archive for October 2009

Lucy and the Public Option

October 23, 2009

In years recently past, this time of year was special.  Lucy would put the football down and hold it ready for Charlie Brown to kick. As he ran to kick, Lucy would pull the ball out of the way and Charlie, of course would miss and fall on his back side. Every day Lucy would plead that she would not do it again, and low and behold, she did.

The newspapers today report again that the leadership of both house of Congress are on the verge of including a “public option” in the health care reform bill. The reasoning would be clear if we thought Congress responded to the wishes of most Americans, or at least to common sense. There is so much more at play in these debates that it is not clear what the motivation or intentions are that cause Congressional leadership to signal the public option again.

For example, including the public option may be a longer term strategy to permanently identify those who vote against it as health care and health care reform opponents and unworthy of voters interest. It may also be a “get even” blow against the insurance industry that has shamelessly opposed any real reform. It may also be again a false balloon where the fall back position is a “trigger” which at some later time might bring a public option into play.

It seems to me that eliminating any reasons for uninsurability (pre-existing conditions) and adding requirements that everyone should purchase coverage (with appropriate tax incentives) are the bare minimum step to reform health care. But I can also write the script for the demise of private insurance (at least the large scale use of it)depending upon the behavior.

  • The American health care delivery system is the most expensive (by a huge margin) in the world today, and delivers mediocre health outcomes. It is not close to the best in the world by any measure.  Insurance industry representatives do not acknowledge this, and they have no proposals how to reduce health care cost AND improve outcomes.
  • On top of its absolute high cost, health care costs are rising each year unchecked at rates 2-3 times the rate of inflation.  Sooner or later it will break the bank.
  • There will be no relaxation in the Wall Street pressure to increase private insurance companies’ profits, and the greed of top executives to earn even greater salaries and bonuses will continue unabated.

It is simply not clear to me whether the greed of the private insurance industry or the inclusion of a public option will bring the Country to its senses. Health care is a right and not a place for manufacturing profits. Health care must be paid for but what we pay must make sense when compared to other equally modern countries.

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Pay Cuts

October 22, 2009

The Government “Pay Czar” has been reported ready to claw back 2009 pay from executives of companies the Federal Government bailed out. Reports suggest that the top executives will experience roughly a 50% drop from 2008 level. Is this fair? Is this the Governments business?

First, let’s vent. These are the leaders who were absent for duty during the time leading up to the collapse of Wall Street and the associated economy driven losses by General Motors and Chrysler. While there was probably different degrees of culpability between General Motors, AIG, Bank of America, and Citigroup, the unmistakable facts are that their CEOs (and top executives) presided over their companies and were responsible for decisions and the consequences that culminated in severe financial difficulties. These leaders had regularly accepted generous (if not obscenely high) remuneration packages before their company’s collapse. Pay cuts were the minimum just due.

Second, can the Government do this? It is dubious what the legal footing is, and as a precedent, what exactly would be the conditions under which the method could be used again?

Like most reactions to some terrible event, the reaction is often excessive. In the case of the pay level and, for sure, the bonus level, the Financial Services top executives have received remunerations that it is difficult to justify, either by performance or by reference to others such as doctors, teachers, the President, or most corporate CEOs. The auto companies are junior to banks in earnings but the principle is the same. The forced pay cuts seem just and do send send a message about punishment.

The real questions, however, might be, did these high remuneration packages drive the executives to greater performance levels, or will these pay restrictions evoke poorer job performance? I am sure the answer is “no” to each.  Further, it is my guess that this event will have no effect on the ethics or morality of the industries going forward. Something is wrong with the their parenting or their education from MBA producing machines that spit out these executives.

Marriage

October 21, 2009

Last evening at the National Constitution Center, in Philadelphia, PA, a discussion concerning the Constitutional nature of Gay and Lesbian requests for same gender marriage to place. David Boise and Keith Boykin argued “for” and Maggie Gallagher and Glenn Stanton argued against. This discussion went something like this.

For: It is unclear how today’s Supreme Court will decide on this issue, not withstanding their conservative leanings. If they decide that marriage is an important enough right, than a majority (as in California) can not deny a right from a minority (gays and lesbians). Under this light, gays and lesbians should not be denied the right to marry. If the Supreme Court decides this is a State issue, then it will be decided in each State.

Against: Marriage is a very special “idea”. It is, by definition, a union between a man and a woman, and has been so since antiquity. It is only a man and a woman who can conceive a child, and children are very important to perpetuation of the race. Further the “ideal” situation for a child is to grow up in a household composed of one man and one woman who are in a loving relationship and care about the child. (The notion here is that neither a gay couple nor a lesbian one can meet this criteria (no matter how sincere, committed or loving they may be), therefore they are not ideal. There was no also no recognition of all the marriages that end in divorce, contain incest, or are simply parented by immature and unfit adults. Some model of ideal.)

The idea of equal rights and that a majority can not over ride a minority on Constitutional issues was the mainstay of the “For” arguments. The “Against” speakers were more emotional. Marriage was so clearly the province of a man and a woman that society should decide.

The evening’s discussion at times seemed surreal. The “Fors” stuck to legal precedents although they did point out the generational difference where Americans under 30 overwhelmingly favor allowing same sex marriage. The “Againsts” used example after example which went tangential to the core legal argument and instead grew out of some religious or ideological belief.

Motives are hard to decipher and some say should not even be considered. I wonder, however, what are the motives behind those who champion either position. For sure, gay and lesbians want to gain equal rights and garner the emotional advantages of adoption and sick bed visitation. I am sure. also, the economic pluses like marital tax deductions and inheritance are also prime goals.

But why do the “Against side” protest so strongly. Do they believe these advantages they enjoy will disappear if same sex marriage becomes the norm? Or do they hold some strong Biblical or religious doctrinal belief that same sex relationships are inherently abhorrent? Or, are they even more basic and are championing this course because it is their job and others will pay them for their services?

In the question and answer section, one young woman made a statement that she felt same sex marriage “cheapened” her marriage. Astonishing is the only words that came to mind. Later I thought that this, clearly sincere person, had not a clue about what was involved in marriage and would sadly wake up someday to see her children hold entirely different view (and even sadder, can you imagine if one of her children becomes the 1 in 10 who are naturally homosexual?).

Sugar Beverages, and Oil & Gas

October 20, 2009

We have been treated recently to a very small view of what being an American is all about. Spending gobs of money, lobbyists, working on behalf of the makers of soda and other sweetened beverages along with lobbyists from the oil and gas industries, have treated us to a barrage of television ads. These commercials warn Americans that Congress is considering legislation that might tax their products. Their products are quite different and enter the economic mainstream at quite different place, but their messages are strikingly similar.

“Tell Congress not to tax __________ (fill in the blank) because our economy is weak and taxes can’t help”.

Where does anyone think the money will come from to continue extending unemployment checks or how will we fund the proposed $ 250 per senior (in lieu of a social security cost of living increase? And just in case someone may have been sleeping for the past year, the US is facing a projected $10 trillion national debt and appears not to have a clue how to avoid it.

Oh, we have heard Senator Fluster say, “my plan is to cut government spending and eliminate waste”. His colleague, Senator Bluster reinforces this message with, “we have to end big Government and get it out of the way of Americans”.

A more reasoned argument against taxing sweetened beverages is “why me”. These supporters claim the proposed tax is nothing more than a sin tax and that is no way to run the rail road. Strangely, doctors and medical experts all point to obesity as the number one health threat, and these beverages are loaded with calories and generally no other worthwhile ingredients. Citizens of Italy, France and Germany who all consume far more alcoholic beverages and far less sweetened ones, all live longer than Americans.

The proposed oil and gas tax is far more worthwhile than even the sugar tax. With an oil and gas tax, the US could begin the process of introducing disincentives for the wasteful use of fossil fuel. Proceeds could be used to develop alternate energy sources which would have the knock on effect of helping to lower our dependance on foreign energy source (balance of payments) and the chicken hawk’s need to every so often undertake an invasion and occupation.

Senators Fluster and Bluster, however, have never met a tax they liked and would prefer to hid the cost of any new Government spends by borrowing. Like with the Vietnam War Memorial, I hope when the day of our national debt’s day of reckoning, we can erect a similar monument. There, for everyone to see, will be the names of Senators Fluster and Bluster, and all the single interest (at the expense of everyone else) lobby groups.

Public Option Wiggle Room

October 19, 2009

Yesterday the Sunday morning talk shows were flooded with Obama Administration members. The subject seemed to be health care reform and in particular, the public option. “The President favors this options as he believes it makes the reform better, but of course, he is open to consider all ideas.”

What do those words mean? There is nothing in second place with respect to the public option unless we are talking single payer or that all insurance companies suddenly renounced profit and re-chartered themselves as a non-profit.

In my opinion stressing the public option is a disservice. The emphasis takes the discussion away from why is the current US health care system by far the most costly in the world, and one of the poorest (among modern civilized industrial countries) in medical outcomes.

The only question I have is what basis does any Congressman have for opposing the public option? You must believe in fairy tales if you expect the current group of health insurers to become active in reducing health care costs AND improving the outcomes. You are left with only two unflattering conclusions about the basis of opposition. Either the Congress person is owing to insurance companies (a political campaign costs so much), or misinformed by his or her staff.

The President has chosen to move health care reform forward in a two step or two phase manner. This year’s reform will get rid of the obscene arbitrary insurance company practices of denying coverage and significantly increasing the number of residents who are insured.  In the years ahead, when this reform finally goes economically bust, as would our current health care system, we will be introduced to health care reform II (most likely a single payer system).

How Do They Ask?

October 18, 2009

In hundreds of military recruiting stations across the US, young Americans begin a process that for many leads to joining the Army, Navy, or Air Force. I wonder how these recruiters close the deal. Do they say things like this?

“You know there is a probability that you will die during your military service. In that case, your grateful Country will welcome your body (that is what we can find of it) home and you will rest in heaven knowing that family and friends consider you a hero…..  Not only that, bankers and investment firm leaders will be able to continue making millions, and equal rights will be available for some people just like health care”

There is a similar but different conversation taking place elsewhere in the Muslim world, particularly in Iraq, Afghanistan, and Pakistan. The process must get to the same end point.

“You are very fortunate. Allah has picked you to become a Martyr. Your family will be honored and of course, you will enter Paradise and begin a life of happiness. Me and the other religious leaders will continue to live better than others and wait until old age to die”

In some respects these are similar conversations but they do differ in some very important points. There is no Allah, there is no Heaven or Paradise, and suicide bombing is not a defensive act.

If the recruit in Chicago or Karbul does not ask their recruiter some direct questions and apply some commonsense to the answers, I guess it is not too important what the actual recruiting process was.  It seems clear there are not enough follow up questions being asked.

Washington Two Step

October 17, 2009

The Texas “two step” is probably better known, and if you like a certain type of dancing, is a lot more fun. In Washington DC, Congress knows a “two step” but rarely applies it to dancing. Their motto is “why fix something once when you can patch it and fix it a second time?”

This appears to describe aptly the process health care reform is taking. After much ado about nothing (such as death panels and government run health care), the outlines of a health care reform bill are emerging. It appears the legislation will provide worthwhile service in curbing the unconscionable  insurance company practice of denying coverage at their discretion. The bill will also likely enable (and may require) far more residents to enroll in insurance coverage. But whether the bill contains a “public option” or a trigger device that might subsequently call for a public option, the fact remains that US health care will remain the world’s most expensive and one of the worst in coverage and outcomes among industrialized modern countries.

This is where the “two step” comes in. Congress will celebrate the enactment of this reform as something that happens once or twice a century. Medicare, the last major change, took place almost 60 years ago. Unfortunately, this reform will leave Americans still on the edge of a financial precipice. More and more Americans with private or employer provided insurance will find their coverage too expensive, and if they switch to the “public option” (like extended Medicare), government expense will sore even faster. In the end we will be faced with ever expanding budget deficits and at the point of disaster, Congress will stand tall, puff up its chest, and proclaim the time has come again for health care reform.

This all could come a lot sooner, and at a lot less expense, if Americans would avail themselves of information already available. Study health care systems in use around the world. And should you not believe the written word, travel to Canada or Germany or France or Japan, and besides meeting some nice people, you would quickly see that there are not sick people dying in the streets. You would see doctors and hospitals that care about patients, and if you looked long enough, you would see people who were living longer than the average American.

I would say that was health care to reform to.