Archive for March 2019

Healthcare All Over Again?

March 29, 2019

Like a flash brush fire, the subject of US healthcare has blazed anew.  Dumbing the complex healthcare situation down, the President and loyal Republicans are chanting for the ACA’s elimination and good things will follow.  The President has promised the best healthcare ever, one with “pre-existing” coverage and no individual mandate.  Of course the President wants first the ACA repealed, or ruled un-Constitutional in the courts, and then… “trust me”… the GOP will introduce a beautiful new healthcare bill.  Hmmm.

The silver lining of this “bad dream again” issue is that there are compelling reasons to reopen the healthcare “can of worms” again.  The ACA represented an honorable, ethical, and moral effort to improve upon what existed in 2008 and provide access to basic healthcare for all Americans.  Republicans tell us that ACA is not so. 

The inconvenient truth about US healthcare (the current ACA or the version before ACA) is that

  • healthcare spending per capita is twice that of other developed countries,
  • does not still cover everyone (estimated 20 million more however), and
  • mediocre healthcare outcomes compared to many other countries.  (Healthcare available through institutions such as the Mayo Clinic, Johns Hopkins, Cleveland Clinic and most major University teaching hospitals are as good as there are in the world but those located in the suburbs, depressed inner city areas, and the rural areas across the country are not delivering on the highest standards. And, not to be overlooked, US healthcare is not affordable or not available to too many Americans.)

Affordability, and availability rise above the partisan solutions such as “Medicare For All”, “the replace of Repeal and Replace”, and “keep government out on my healthcare”.  There is no known credible reasons to justify current US healthcare cost and outcomes. 

  • Drug prices are non-negotiable for Medicare.  How is that possible? 
  • A growing number of Americans are learning that they can buy prescription drugs in Mexico or Canada the exact same medications they currently purchase in the US for substantially less.  Why would the Government not demand the best global price? 
  • Republicans have embraced private sector solutions built around private healthcare insurance. Let the insurance companies police costs, the GOP says.
  • Insurance is based upon pooling risks. .  So how can the GOP fight to eliminate the individual mandate? Without the individual mandate the insurance revenue pool will shrink.  In addition, individuals without insurance will go to Emergency Rooms where they will, by law receive treatment.   In essence, no individual mandate means a free pass for those who do not wish to buy insurance, cost everyone more, and makes everyone else a sucker.  How does this make sense? 
  • Estimates put US healthcare spending at 18% of the approximate US $20 trillion GDP (almost $4 trillion).  If the actual spending was on a parr with 20 other major world countries, there could  be $1-2 trillion savings each year extra for investment in infrastructure or paying off the national debt.  What are Republicans thinking?

President Trump and Republicans are disingenuous about healthcare reform.  Democrat candidates who are singularly focused on insuring everyone and overlooking the inexplicable cost differences with other modern countries are destined to make the GDP cost even larger.  The US deficit can not be reduced or brought under control without first dealing with healthcare costs.  Even more dangerous, in the world of income inequality, unless basic healthcare is made affordable for all, there is destine to be social upheaval.

Time To Move On

March 27, 2019

The long awaited Mueller Report arrived this past weekend.  Attorney General Barr has rendered his summary.  President Trump and a large number of his supporters are ecstatic.  And predictably, all those who “knew” the President had stolen the election were depressed.  Hmmm.

Scholars such as Jonathan Turley sighed and said “I told you so”.  Turley has long believed that Mueller would have a difficult task of connecting (proving beyond a reasonable doubt) Donald Trump to initiating a conspiracy with Russia.  While Mueller had indicted two large groups of Russian hackers, one group who exploited American social media, and the other which hacked into the DNC computers, neither of these acts were unique and neither could easily be connected to a directTrump’s initiative.  Hmmm.

With regards to “Obstruction of Justice”, Turkey reasoned that even though President Trump had acted un-Presidential and unseemly, no conspiracy was found, so how could there have been obstruction of justice?  So what has the nation learned and how should the nation feel?

  • Learned.  Hmmm, that is difficult to say.  Sadly, the nation, or at least large parts of it, may have learned nothing.  President Trump remains a sorry excuse for a human being and totally unfit to be President. That’s not the learning. The nation’s lesson, however, should be “you elected him”. 

Waiting to be learned will be the consequences of the impulsive action the chief executive has undertaken with apparently no regard other than his own reelection.  The shoes waiting to fall include the

  • Chinese trade war,
  • the “stick it in the eye of European allies tactics”,
  • the withdrawal from the Paris Climate Accords,
  • the abdication of the Iran Nuclear Agreement,
  • the senseless focus on a Mexican border wall,
  • the reckless, unfunded, and unfair tax cuts,
  • the suicidal withdrawal from the Trans Pacific Partnership, and
  • the ludicrous example of top down diplomacy Trumps efforts with North Korea represent to the world. 

But regrettably too few Americans see these events as far more telling about President Trump than Russian collusion.

  • Feelings.  The nation (both Trump supporters and detractors) would do well to offer a sigh of relief that the nation will not have to endure a divisive impeachment process.  Detractors should consider that the “Russian interference” was not ballot alteration and nothing that US based special interest groups didn’t do also.  Democrats lost the elections more than Trump won it.

The 2018 mid-terms offer an instructive insight for Democrats.  Healthcare, college debt, and a more comprehensive and balanced approach to immigration were vote getters, not an attack on President Trump.  Trump supporters cannot hear criticism of the President but they can understand policies that do not work for them.

There was no “exoneration” for Trump to be found in Mueller Report. There was, however, references to acts and events which did not reach the threshold of beyond reasonable doubt. 

Still uncontested in public opinion, there wasn’t a rock Trump would not have climbed under in order to win the election.  In his private life, no reputable bank will lend to him or his corporations based on past experience.  Laundering of money charges will almost certainly await Trump following his term in office. 

But so what.  President Trump and his policies and strategies to achieve are counterproductive and will hurt Americans and the American economy in the years ahead.  In 2020, American voters have the chance to make a better choice than they did in 2016.     

The Crisis In Education

March 24, 2019

The story of Elizabeth Holmes and her company, “Theranos” have been the subject of dozens of full length “tell alls” found on most business channels and associated podcasts.  The linkage to former Secretary of State George Shultz and big time lawyer David Boies gives the story of Holmes’ rise to fame as a fraud perpetrator, an even more fantastic flair.  But is the story simply that a Silicon Vally person sold an intriguing idea to eager investors and then found ways to fend off owning up to the failed idea?  Maybe but maybe not.

For sure, Holmes conception of rapid blood testing using a few drops of blood offered potential.  And Holmes herself was a dynamic and utterly believable person.  So, start-up money was there to be had. 

And let’s not forget that start-up funders bet on “people” rather than details, and these investors are use to guessing wrong a high percentage of the time.  It would seem that Holmes was the right person in the right place and ready to draw one more card in a high stakes poker game.

Reports indicate that routinely buggered demonstration blood testing fooling news reporters and investors into thinking her machines were actually performing as advertised.  Other reports describe the Theranos organization as intentionally constructed with figurative walls separating each functional area (like finance, sales, marketing, technical, engineering and manufacturing) so that each was unaware of what the other was doing or experiencing.  In any case, wholesale fraud and misinformation was generated and disseminated and few if any Theranos employees said “Hold on, wait a minute”.

I wonder why?

Some would say that Theranos was a product of a criminal mind, a one off, end of story.  But when one considers stories about FaceBook, Google, or Apple where apparent covenants between these companies and their users are twisted into ways those companies can secretly “monetarize” their relationship with its users hints at a deeper question.  Have these corporations eroded fundamental employee ethics or, even more dangerous, have these employees arrived at these corporations with weak or simply absent ethical behavior standards?

Universities which covert their reputations as top notch or elite place of education must look beyond the meat and potatoes of their degrees.  They must educate the entire student.  

Lawyers must know more than just the rote law, medical doctors must, especially with the use of new technology, consider consequences which their patients might not.  Finance graduates must see beyond the column of numbers and understand how these results are being used.  Business and marketing majors must temper their drive to make money with the concept of making money the “right way”.

Elizabeth Holmes is surely an exceptional case, one might say.  But what if our colleges and universities have taken a “ethics” holiday and are producing bright graduates who are intent only upon accumulating wealth… at all cost.

Hmmm.

Electoral College, Goodbye?

March 21, 2019

As one after another Democrat announces their candidacy for President, each person is fighting for “air space”.  How am I different from the others?  One of the popular differentiators is ending the electoral college.  I wonder why?

In 2000 George W Bush was elected President (with a lot of help from the Supreme Court) by winning Florida and tipping the Electoral College towards him.  Bush lost the national popular vote.  In 2016, Donald Trump won the Electoral College vote while losing the national popular vote by 3 million. Is that what these candidates are thinking?

The electoral college arrangement protects all States from rule by a few, very populous ones.  And, not withstanding the infamous Supreme Court meddling in Bush v Gore, the Electoral College has been neutral arbiter for a long time.  And, most of the time, the Presidential winner is also the popular vote winner.  So why the alarm?

Let’s consider the details and a “what if”.

In most States, there is an election of “Electoral College Electors”, mostly little known State residents who will on a January day, “caste their vote” and actually elect the next President.  The assumption is that the electors will caste a vote corresponding to the popular vote winner in their State.  So, if a State has 10 electoral votes, there would be 10 electors who would caste 10 votes for whomever had won the popular vote in that State.  (There are two States which allow their State electors to caste their electoral college vote depending upon how a particular congressional district had voted.  So if one candidate won the popular vote in 4 of the 10 congressional districts, that candidate would receive only 4 electoral votes, not the full 10 even if that candidate also had received the most votes in the entire State.  Hmmm.

In many States, electors “pledge” they will vote for the popular vote winner although they are not legally bound to that pledge.  Hmmm.

So why not direct elect?  The candidate that receives the most votes nationally is the winner?

The country is used to two main candidates (and often a number of minor party candidates) on the ballot.  So normally the candidate with the most votes is also the candidate with the most electoral college votes too.  But what would the world look like if there develops viable third (or fourth) party candidates?  On can imagine results where no candidate receives sufficient electoral college votes to win.  In such cases, the House of Representatives takes over and elects the next President.  Hmmm.

It would seem that rather than worrying about doing away with the Electoral College, a more urgent issue is whether it is a good idea to elect a President by the House of Representatives.  Rather than concerning ourselves about Electoral College versus House of Representatives, we should think through the path to elect a President with a majority of those who vote. Doesn’t this mean a “run off” follow-up election?

The Anti-S Word

March 10, 2019

Anti-Semitism is one of many hate filled belief systems.  Anti-Semitism purports to call those of Jewish heritage unfit to live freely among the world community and assigns all sorts of calamities to conspiracies amongst Jewish persons.  Anti-Semitism extremists seeks the “final solution” as demonstrated in Nazi Germany.  So to label someone as an anti-Semite is a serious charge.  Hmmm.

Ilham Omar, a newly elected Democrat Representative from Minnesota, has been awarded the label “anti-Semite” twice in the last couple of weeks.  First, Omah referenced “it’s the Benjamins, baby” for why Jewish lobbying groups were successful promoting aid for Israel.  Omar was referencing AIPAC and the flow of lobbying money aimed at influencing US foreign policy.  Hmmm.

Next, Omar questioned out loud how someone could be loyal to the US and Israel at the same time.  At a minimum, Omar was calling out the apparent hypocrisy of many in Congress who are outspoken about their unconditional support of Israel (and by extension Israel’s mis-treatment of Palestinians in the occupied territories).

Now if one has been watching and reading current events and recognizes the name Sheldon Adelson and still denies that money has been used to steer US foreign policy, it will be difficult to discuss this topic further.  Along the same lines, if one does not recognize the extra-legal actions where Israel confiscate Palestinian lands in order to build Israeli settlements, or creating roads within the occupied lands where only Israelis can drive are signs of misguided domestic policy if not outright apartheid, then anti-Semitism will have no practical definition bounds.  Any criticism of Israeli policy will be definition be “anti-Semitic.   Hmmm.

Israeli’s conservative (both religious and political) government often denies the existence of lobbying activity or the planned creation of new settlement and permanent occupation of the West Bank.  Subsequently, the Israeli Government will admit the facts and justifying them on the need for self defense.  “Israel must (will) defend itself”.   Who could expect less.

And clearly Arab extremist groups have and continue to plan horrible atrocities against Israelis. Neighboring Arab countries still deny, 70 years after the establishment of a Jewish State, Israel’s right to exist.  So why shouldn’t Israel execute extraordinary policies to ensure its survival?

Unfortunately, when a State becomes theocratic (for example Israel’s constitution defines Israel as a “Jewish State”), all paths to rational debate ceases.  (God gave the land to Israelis, the Bible tells us)  Concerned?

Think about Iran which is also a theocracy.  Is Iran a rational State?

Israel has in the past agreed to take a path towards a “two state solution” where a sovereign state of Israel exists along side of a sovereign state of Palestine. While avowing a two state solution, Israel’s specific behavior has been anything but that.  Is that an anti-Semitic statement?

Pundits and critics should be careful about how easily they throw around the term “anti-Semitic”.  Representative Omar is both young and inexperienced.  Her choice of words may also have been poor but to throw the “Anti-S” word was premature, shut down discussion, and elicited sophisticated hypocrisy from those with hidden motives. 

Instead, one should insist upon learning the facts such as “how much money does flow from Jewish lobbying groups to US legislators”, “what due process has been used (and how often) to take land from West Bank Palestinians and build new Israeli settlements”, and “how does US “Israel Policy” serve US national interests”?

Representative Omar is a poor target for Israel supporters to justify using the “anti-S” word.  Rather, if Representative Omar’s words upset Israel supporters, they would be better served ignoring Omar (and not giving her a public stage) and temper their worries by studying whether Omar’s claims have merit.   

National Emergency. Hmmm

March 7, 2019

President Trump has proclaimed a “national emergency” and accordingly, announced a plan to transfer already authorized funding to build his vision of a tall border wall.  The law the President is using has been used numerous times before by previous Presidents, mostly for events like hurricanes or tornados. Congress has never objected to the Presidential declaration but this time is different.  Why?

The law envisioned an emergency situation which would be urgent and temporary in nature.  Congress anticipated situations where speed was appropriate. The law did allow Congress to subsequently deny approval if Congress so felt necessary.   Congress is now poised to vote non-approval and the reasons are many.

Commonsense would conclude that in the third year of the President’s term, and after the GOP controlled Congress for the first two years, and the President has made no secret of his desire to build a wall without success in getting funding, there must be some new event which constitute a bonafide “emergency”.  In other words, what is different now?

The short answer is nothing. 

The President insists, however, that through the US-Mexico border passes drugs, undocumented aliens, criminals, and sex traffickers. There is no evidence that (1) that these situations occur predominantly in the non-walled or non-fenced border areas and once walled these incidents would dramatically decrease.  Or, (2) that prevailing expert opinion supports the view that border security improvements in the authorized ports of entry would be effective and make a far larger return on the money spent.  For example, an estimated 80% of drug smuggling occurs in freight passing through legal ports of entry.  New border walls will not impact this.

Republican Senators are caught in a pickle.  These GOP members are not absent commonsense and can understand the “national emergency” does not exist, or even if it did, building more barriers is a waste of time and money.  Instead these GOP members are mincing words about supporting the President because he is the President. Other GOP members cite “separation of powers” between the Executive Branch and the Legislative Branch and wish the President had not invoked a national emergency… without addressing the fact that there is no emergency, rather there is a chronic border situation.

Congress over the past two years has had ample time to prepare budget authorization for border security.  In each offering, Congress has dodged the option to fund a “big beautiful wall” which President Trump says he wants.  The President’s invoking of a “national emergency” is a naked attempt to subvert the Constitutional responsibility Congress has to approve appropriations.

Worse, the President’s attempts will accomplish nothing versus his stated reasons for a wall.  Any wall would require years (maybe 5-10) to be built assuming the President could overcome legal challenges. 

Could this kerfuffle be really intended as a distraction from other Presidential missteps?

Running To The Left

March 3, 2019

Political pundits are aghast that Democrat 2020 Presidential hopefuls are trying out “leftist” each other.  “The Green Deal”, “Medicare For All”, and “Free College Education” are slogans which can trigger the label “socialist”.  Republicans and President Trump smile and see a pathway to victory.  Why?

I think the reasoning goes as follows, 35% who identify as the President’s “base” would not vote for someone else regardless of what Donald Trump has done or will do.  So the task becomes attracting 15% more from the population in general.  The GOP’s reasoning is to play the “communism/socialism” card and create enough fear that otherwise sensible citizens will vote Republican.  Hmmm.

It is difficult to imagine any other strategy available to Republicans.  Could they run on “more walls”, “more green house gas emissions”, or “more tariffs paid for by US tax payers”?  For sure “abortion” and “another Supreme Court Justice” are Republican crowd pleasers but those promises are already foreseen in the 35%.  So, let’s try the socialist path.

Democrats need to take a deep breath and appreciate that “The Green Deal” is about protecting the environment for future generations not providing jobs, “Medicare For All” is about truly affordable healthcare for all Americans, not free healthcare, and “Free College Educations” is about producing a population that can think critically and possess the necessary skills to provide a living for themselves and their family.  In short, Democrats should be about helping the average person thrive and have a chance to see their children do even better.

Practically speaking, without a sweep of the Senate and House along with winning the Presidency there is no chance that the “Green Deal” or “Medicare For All” or “Free College Education” could be enacted into law.  So why promise something that arguably can’t be delivered? 

Aspirational objectives with promises of manageable incremental steps is more believable and less likely to scare voters.  Add to that commonsense trade objectives, a return to our time honored respect for immigrants, and a promise to return fiscal sanity to our nation’s finances should complete the list for Democrats.

Unfortunately this perspective does not include what candidates think is necessary to win the nomination (how each candidate can make themselves distinctive).  The notion of running far left in the primaries and then tacking towards the middle is an oft practiced tactic.  With social media as it is, this “extreme to middle” approach is open to unkind surprises.

Hmmm.