Archive for June 2017

Worrisome People, Worrisome Proposal

June 23, 2017

On June 21, 2017, Dick and Liz Cheney penned an op-ed article in the Wall Street Journal. The subject, “Congress and Obama Depleted the Military”. Catch your breath, the Cheney’s are back and just as sure they are right again.

The article points to 8 years of President Obama and 6 years of Congress’ Budget Control Act as the prime culprit behind a “sagging” US military. One might think there has been a time warp or a cerebral malfunction since the Cheney’s seem unable to recall relevant history and Republican involvement. I wonder why?

The Budget Control Act stems from a partisan budget and deficit standoff. Congress’ inability to pass any budget and facing a Government shut down, prompted Congress to pass legislation which said in the event of budget cuts, these cuts must be done proportionally across all budget items including Defense. Noteably this Act only applied to “discretionary” items omitting Medicare, Medicaid, or Social Security. Conservatives have howled about this agreement for the past 6 years.

We should recognize that US Defense spending amounts to almost $600 billion each year, several multiples of any other country and roughly 1/3rd of the worlds total. Recognize also countries such as China and Russia, combined are only a third of the US expenditure. So assume for a moment, the Cheneys are correct in pointing out deficiencies in the US Defense position, one ought to first ask how is that possible with so much total spending?

The Cheney’s appear conveniently forgetful that it was none other than Vice President Dick Cheney who got the US into nation building in Afghanistan and into a failed invasion and occupation of Iraq.  Most estimates put both of these endeavors’ cost in the trillions of dollars level.  Both of these ventures have yielded none of the promised goals.

The Bush Vice President, more than anyone else is responsible for the wheels coming off the Middle East wagon and creating a power vacuum which is consuming our military’s time and resources. But sometimes people forget those things that don’t support their current agenda.

Today’s world is a different place from 2004 when the US invaded and occupied Iraq. China has become a formidable military force and shows little signs of ceasing its military growth. Russia, also a nuclear country, is stronger and more focused under Vladimir Putin than it was in 2004.

The US should rightly be concerned about security concerning both of these countries. But the answer can’t be simply to rebuild the traditional armory (ships, planes, troops) and think China and Russia will be intimidated.  What about cyber and space warfare? The US must get smarter and while maintaining strength, must use foreign policy, economic influence, and diplomacy to greater degree.

And I wonder if the Cheney’s are aware that the Trump Administration has proposed sharp cuts in State Department funding? Do the Cheney’s realize that the Trump White House has threatened more than once to use trade as a negative foreign policy tool? Trade restrictions, historically, has been one of the fastest ways to generate armed conflict.

The Cheney “op-ed” piece is a thinly veiled attempt to promote Ms Cheney as a tough conservative who needs to be considered for future positions of greater responsibility.

Hmmm.

If this happens, Americans should expect Dick Cheney 2.0 and advance Ms Cheney at their own peril.

Healthcare Math

June 22, 2017

News reports quoting prominent Republicans say Republicans are worried, because the healthcare industry makes up about 1/3 of the entire US economy. Rash cuts might kill the golden “jobs creation” goose. Hmmm.

This is a mind boggling statement for Republicans to admit. The GOP ran in the last election on repeal and replace and previously during the Obama Administration tried to hinder the Affordable Care Act when ever and where ever they could. Now suddenly Republicans are waking up to the broader role healthcare plays?

Now for the math. Total healthcare spending in 2016 came in around $3.2 “trillion”. The US population was about 320 million. That means that on average, each American consumed about $10,000 of healthcare (per capita). In actuality, some Americans consumed little or none and others consumed a lot more.

So, a family of five (mom, dad, brother, sister, sister) represent, if they were average, $50,000 a year on healthcare costs. That would represent $4166 per month from this families budget. So even if the household head earned $15 per hour ($31,200 per year), this family can not buy health insurance.

Most people, especially young and healthy Americans do not consume $10,000 a year in healthcare costs. From an insurance company’s perspective, those who consume less help offset those who consume more. In a somewhat complicated process, insurance companies dial in rates (young and healthy pay less, older and sicker pay more) and there you have it, the American healthcare delivery system.

Let’s consider the pending Republican “repeal and replace” healthcare legislation. What math questions arise?

First and foremost, and unfortunately never asked publicly, is $10,000 spending per capita reasonable? Does the US possess a older or sicker population, or are Americans more prone to serious illness than other parts of the world?

In comparison with the rest of the world, especially other modern economies like the US, the US spends almost twice as much as other modern countries. There are no indicators other than over consumption and inefficiency to explain this difference.

So does the Republican plan tackle this spending issue? Regrettably no. One would assume that cutting Medicaid and individual subsidies is intended instead to simply reduce the number of people seeking healthcare coverage, not increasing the number. Since those without insurance seem to consume a lot of healthcare once enabled to get coverage, cutting Medicaid and individual subsidies would help to keep rates from rising too much.  I suppose this could be viewed darkly as a cost control mechanism.

 

Second, the Republican plan shifts the tax burden away from those who can most afford paying to those who can the least. Estimates show an approximate $200 million tax cut for the wealthy while at the same time making it more difficult for lower income Americans to afford healthcare coverage.  This is an unforced error.

 

Third, pre-existing condition bring a bazaar ingredient to healthcare. The Affordable Care Act required insurers to cover all Americans regardless of pre-existing conditions. Republicans have been all over the map with respect to whether pre-existing conditions would be covered, how long, and for how much.

Covering pre-existing conditions, but charging exorbitantly higher premiums is tantamount to not covering those conditions.

 

Fourth, cutting Medicaid enrollment which provides coverage for the sickest and least able to afford insurance is a prescription for increasing the uninsured rolls. Republicans spin this issue by saying States are better able to determine how to deal with the poor.

What?

The nation’s poor are US citizens who just happen to live in a particular State. Some richer States can afford (at the same tax burden) to provide benefits and other States can not. How can healthcare be viewed as a privilege owing to which State one happens to live in?

 

Fifth, value add of insurance companies? The Republican plan doubles down on the existing cadre of healthcare insurance companies. Each healthcare insurance company demands healthcare service providers (hospitals, doctors, and drug companies) to use specific reporting forms for pre-approval and payment. As a consequence, healthcare service providers have increased their operating costs significantly by necessarily adding “non-medical” staff to process paper work.

 

Sixth, fee for service is alive and well. The Republican proposals are silent on changing the basis for paying hospitals, doctors, and drug companies. Republicans claim that the “free market” will magically pit one insurer against another with the average American coming out the winner. This is a delusion.

Summary. There are gaps in the Affordable Care Act coverage (not everyone is covered) and there are anomalies in subsidies such that some Americans still can not afford to purchase subsidized insurance. And, the real healthcare cost drivers are not addressed sufficiently. There exists a pressing need to improve/reform Obamacare.

The Republican proposal does nothing to address Obamacare defects nor does it portend to deal with reigning in the obscene yearly cost increases. What a shame the country is being lead towards third world healthcare delivery standards (best healthcare money can buy) instead of rivaling the best of the best.

Democracy’s Message

June 20, 2017

When Donald Trump was elected President, the US democratic process spoke loudly. Americans had elected someone inexperienced, uninformed, and some said unqualified emotionally to become President by a narrow electoral college margin (Trump lost the popular vote by 3 million votes). What was democracy’s message?

American democracy approximates one man, one vote but it actually reflects the popular vote in each State times the number of House and Senate members apportioned to that State. Therefore it is possible to win the popular vote but lose in the electoral college. So is that why Donald Trump is President?

There’s more. Along with electing Donald Trump, voters returned the Republican Party to majorities in both the House and the Senate. And with these majorities, GOP leaders feel a mandate to roll back much of what constitutes “entitlements” and “excessive regulations”.

Republicans favor less healthcare coverage, less Medicaid spending, and have proposed large changes to Medicaid and even Social Security. On the regulatory front, Republicans are pro-fossil fuels, less regulations on banking and industry, and anti-labor. How can this type of negative, past looking policies appeal to a majority of Americans regardless of which State they reside in?

As usual, there is another way to see life. Republicans claim that best government policy is that which is originated closest to the people (State and local levels). Therefore by definition, healthcare, tax levying, and regulations should be done at the lowest government level which is practical.  Since the governing process is complicated, this simple explanation has appeal. Hmmm.

Traditionally, two key Republican Party segments have been the wealthy and business/banking leadership. Not surprisingly, lower taxes, more fossil fuels, more dependence upon healthcare insurance companies, and anti-labor policies directly benefit these groups. But strangely Republican policies put far more regular people at risk. So, once again, how did American democracy elected a Republican majority and a President of questionable ability?

Hmmm.

  • Could there have been too many litmus issues? Like is a woman’s right to choose, or the protection of individual rights of other Americans regardless of sex, gender preference, or gender identity.  Are these considerations more important than healthcare, a progressive tax code, or reasonable controls (checks and balances) on banking and industry?
  • Could it be that many Americans choose to believe what their elected officials tell them and do not fact check their assertions?
  • Could it be that too many Americans want it all but do not want to do the hard work of paying for what they receive?

Democrats lost the 2016 election mainly because they could not, and would not tell the voter what the voter needed to hear. Democrats equivocated on the big issues and pander on the social issues.

And by the narrowest of majorities, Americans have gotten what democracy delivers, this time an incompetent President who harbors no agenda, a Congress with a shameful agenda currently split along serious fault lines but teetering on choosing the darkest options, presenting the average America with no reasonable outlook for good jobs, more discretionary income, or hopes for a secure future.

Democrats need to wake up. Rather than stand by and watch Republicans promise the moon and deliver dirt, Democrats need to tell voters what is realistic to expect and why Americans can expect a Democrat to deliver.  That was democracy’s message in the 2016 election.

Loss Of Ethics?

June 19, 2017

Ethical behavior seems at times a much sort after characteristic. Most everyone prefers to think of themselves as “ethical”. All to often, however, individuals confuse ethical with legal (I’m for law and order) and continue to act on the belief that what they are doing is both correct and legal, not considering that while not illegal, their actions may be highly unethical. Hmmm.

In the 1980’s General Motors along with the other major American car manufacturers designed and made automobiles which performed poorly, lacked durability, and were often unsafe, yet were highly marketed, promising the buyer years of great performance. Independent automobile evaluations (side by side comparisons) told a different story and slowly but surely, consumers weighed in favor of competition from Europe and Japan.

In the period 2000 to 2008, financial institutions told clients (such as pension funds) to buy certain securities, especially mortgage backed securities knowing full well that the securities’ credit rating was false. Compounding this terrible behavior, these financial firms used depositors money to purchase credit default swaps betting that the securities they had just sold would subsequently fail.

Now we are looking at a Congress that is determined to reduce healthcare coverage for those who are most vulnerable, yet claiming their plan offers “great” healthcare. This same Congress is proposing to undertake tax reform which will translate into a huge tax cut for the wealthy. Hmmm.

In each of these situations, those involved acted lawfully and as requested by their superiors. In each of these situations, their actions’ consequences were hurtful to others. Their behavior was unethical.

One hears everyday from company X, Y, or Z, or from Chief Executive A, B, or C, that the basis for complaints (even law suits or indictments) were “unfounded”, that their product or service met (or exceeded) applicable standards or regulations, that their product or service when used according to manufacturer’s recommendations, were completely safe, and when confronted with overwhelming evidence that consumer complaints were genuine, these executives and companies claimed “no law” was broken.

One is left with the impression that all types of conduct are “ok” unless specifically denied by law or regulation. Where has the importance of ethical behavior gone? Where has the importance of ones word gone? How can our schools and universities “educate” so many, so highly, yet produce graduates so absent of ethical skills?

The Columbia University Cannon, which requires students to relive history from the perspective of past great minds, at least exposes students to critical thinking. But how many other colleges or universities can say the same?

Other institutions such as churches, law enforcement, and public office holders once provided visible examples of a well lived life. Americans could look to their pastor, their policeman (the policeman is my friend), or their Mayor, Governor, or Congressman for a model of what was right or wrong. No so today.

Church leaders argue over whether certain naturally occurring life styles are acceptable while preaching love they neighbor (but maybe only this type of neighbor). Policemen have morphed into a junior version of soldiering and in the process too many have lost the perspective of the public they serve. (Shoot first, ask questions later). And probably the most devastating has been the self serving, money talks nature of politics. Rare, instead of expected, is the public official who chooses that profession to “serve”.

So, one is left with the question, have our institutions failed us and lead to the apparent loss of ethical behavior, or has a broader, more pervasive cause infected every corner of American life, including our institutions?

What type of pervasive cause could move America to deny global warming or take any responsibility to find a remedy? What would cause Americans to accept healthcare where 25 to 50 million fellow Americans will be unable to access basic healthcare? And, what would make educated and well off Americans push so hard for tax cuts which shift more of the tax burden to those less able to carry it?

Heated Rhetoric

June 16, 2017

Following the baseball field shooting of Republican legislators, bi-partisan cries have gone out calling for an end to heated (often misguided and misinformed) rhetoric. “Enough”, cry some of the most practiced in the art of partisan politics. Does anyone really mean those words? Doubtful.

Why doubtful?

While those words calling for a return to civility were echoing through Congressional halls, Senate Republicans were huddling behind closed doors attempting to cobble together a healthcare plan which met the test of reducing healthcare coverage and still keeping a Republican majority to pass the bill. No public hearings, no open discussion, no Democrat input. Do you think that is bipartisan behavior?

Like climate change and the abdication of the Paris Agreement, or the pending “huge” tax cut for the wealthy, or the private sector infrastructure proposal designed to put money is special pockets, Republicans are stacking the deck with intentions favorable to a few, neutral to a few more, and dangerous to the many.

Criticism opposing legislation kept in secret is called heated rhetoric by some. One wonders why?

Special interests?

Our elected officials are called politicians for a reason. Congress members first must convince enough citizens in their districts to choose them over their opposition. Promises are usually part of the bargain and in that lies the seeds for the problems we see today.

Instead of advocating for rebuilding the infrastructure, it is preferred to call for tax cuts. Instead of warning about global warming and taken specific steps towards control, it is easier to question the science and play for time. Instead of calling for basic healthcare availability, it seems wiser to claim (falsely) that America is exceptional and has the world’s greatest healthcare system.

Heated rhetoric could be a “generation thing”. In other words, current public officials inherited a wealthy country have done little or nothing themselves to create national wealth. With no practical experience in what it takes to build a nation, it should not be a surprise that Congress members’ sphere of vision is simply themselves. The role of today is to survive and worry about the future tomorrow. Hmmm.

While there are plenty of examples to support this theory, there is also a more sinister hypothesis. Americans are people. People are by nature greedy. Politicians are people and therefore without adequate checks, are greedy too.

Share that realization with clever and also greedy wealthy citizens and in not too much time, politicians learn to promise one thing but do another (and what they do is what their financial backers want).

Heated rhetoric may simply be the natural end which occurs when politicians make one false claim after another, long enough. Explaining behavior which leads no where can only be done so long before citizens sense dishonesty or incompetence. Raising the tempo, going negative, and if necessary, using “dog whistles” of race, religious, or national origin helps mold the electorate into “we” and “them”. Hmmm.

IMO, Congress reflects middle and upper class American. Congress’ ineffectiveness and willingness to engage in “heated rhetoric” is what any of us would do if public life were our chosen field. Fortunately, most Americans do not seek public office and the power to change government lies in our hands.

Ask the simple question, “what is the problem awaiting a fix”?

The problem is not necessarily that the US is spending too much money as those who say “the Federal Government” is too large. Rather, if there is a problem, one must cite the problem first.

For example, Medicare is often cited as a major contributor to the growing federal debt. Why not collect more fees and taxes to eliminate the deficit? The problem, rather is not the spending amount, it is whether there a need for Medicare at all.

Once there is agreement on why some healthcare subsidy for those on fixed incomes is fair and warranted, then the discussion on how Medicare should be paid for should begin. The same applies to Medicaid, Social Security, and healthcare in general.

Each American can figure out whether the incumbent is interested in the problem or just some special interest outcome (like paying less in taxes). Term limits by voting the incumbent out of office is the fastest way to get Congress members’ attention and to begin to lessen this problem.

I bet, however, that “heated rhetoric” will rule the day until Americans use the ballot box to over come “dark money” and other special interests.

10 Years Later, Characters Different, Issues The Same

June 13, 2017

Regaining the Center, 10 years ago, published a post over the hypocrisy surrounding the popular candidacy of Fred Thompson. Thompson, a former Senator but more famous as a TV star, turned out to be totally unqualified as a Presidential candidate and relatively quickly disappeared from the campaign trail. Far less bombastic or boorish than Donald Trump, Thompson quickly showed he could not fill the “real” shoes a President must.

What is particularly eye opening may be that the underlying issues facing Candidate Thompson remain today.

At the time of the 2007 posting (Litmus and Fred), the Republicans were still beating the tax cut, no healthcare reform is good healthcare, and the Middle East is the focus of US foreign policy drum. Little, apparently, did the GOP realize that the economy was about to crash (lax regulatory tone), that fracking technology would soon make America free from dependency on Middle East Oil (ignorance of science), or that Federal Deficit were just begin a ten year rise (balancing the budget with necessary taxes).

Five months into President Trump’s administration, Republicans seems ready to move forward without demonstrating any learnings from the past.

Check this out – Litmus and Fred

Free Market Health Care

June 11, 2017

When President Obama set in motion steps to expand healthcare coverage, in the wealthiest country in the world, for more Americans than ever before, he and his aides made a questionable decision to build the expansion around traditional healthcare insurance companies, like Aetna, Cigna, Anthem, etc. These cowardly chickens are now coming home to roost.

The Obama White House convinced the legacy healthcare insurers that their margins would be protected when they were presented with new enrollees who might not be able to pay for the entire premium. There would be government subsidies in other words.  That promise was enough to get the insurance companies loyalty.

With this promise (and recognition that there would be another 7 years with a President Obama), healthcare insurers signed on citing the importance of new customers and their dedication to improving Americans’ health.

When the Democrats lost control of Congress, the wheels soon began to come off the Affordable Care Act wagon. Republicans tried their best to outright repeal Obamacare and when not possible, the GOP tried to jeopardize the subsidy streams. Any uncertainties about rate coverage was enough to send healthcare insurer CEOs into orbit.

“Oh my, our shareholders simply won’t accept that”, these CEOs moaned.

In quieter moments, healthcare insurers raised rates and cited the “higher than expected” number of “sicker than average” enrollees. Imagine, these big name insurance companies were finding that previously uninsured Americans were devouring healthcare services at amounts greater than the average American?

After thought (and realization that not much more money was coming from the government), these insurance companies proposed a resolution. They would exit the market!

The Aetna’s of this world would no longer sell policies to exchanges and abandon the exchange market to someone else. So, unless the government renewed its pledge to provide adequate subsidies, these newly healthcare covered Americans would join the ranks of the uninsured again.

So much for these insurance companies’ concern about individual healthcare.

One might fantasize that a Government truly interested in its citizens’ healthcare might say to these companies that they might as well withdraw from the rest of the State’s health insurance business. Cheery picking is not in the publics best interest.

Should that hard ball tactic not convince the insurance company to stay, then employing the “public option” might win the day. Expanding Medicare (with its requirement for paying premiums) would be quick and easy to roll out. Insurance companies might then think carefully on whether they needed to become more efficient or face the creeping invasion of “single payer” insurance.

Republicans might jump up and say “how is the government going to fund the public option?  Of course the answer is through taxes combined with individual payments.  And if the Affordable Care Act is repealed or simple succumbs to the death spiral, how is the cost of the 25 million or so Americans without coverage to be covered?

How about taxes and higher doctor and hospital payments?  Which path seems more humane?  Oh, I forgot the Republicans want to cut taxes, not increase them.  Take a hike you 25 million soon to be without insurance Americans.

Hmmm.