Posted tagged ‘Healthcare’

Republicans Versus Socialists?

September 10, 2019

There is a “infomercial” running this past weekend in Pennsylvania featuring Republican Senator Pat Toomey.  I suspect twin infomercials are running in other States just substituting the local Senator.  A breathless woman narrator tells us that Pat is looking out for Pennsylvanians by standing against “socialist price controls” which hurt consumers and stunt medical research.   When it comes to healthcare services, Toomey supports free market forces.  Hmmm.

Did you catch the dog whistles?  Try “Socialist”, “Price Controls”, and “Free Market”.   One is supposed to read these dog whistles as Republicanism corner stones.  In Republicans parlance everything liberal or progressive as “socialist” and the first step down the road to America becoming Cuba or Venezuela. Communism is on the way.

Republicans do not seem concerned that voters will recognize that Cuba and Venezuela for both authoritarian States lacking a free press as well as open and free elections.  Republicans do not point out that most of Europe operate on social democratic government and provide better healthcare per capita than the US,

And the only thing worse than price controls is socialist price controls.  Sort of Government interference.  (The last use of price controls was during Richard Nixon’s, a Republican, Presidency.  Hmmm.)  Through out American history, Government has had to step in when “unfettered capitalism” threatened the American economy.  Big oil, railroads, and war time shortages all needed the Government to hurd in capitalist excesses.  

But wait, isn’t the free market the answer for capitalist excesses?

Unfortunately not in all cases.  Entrepreneurs have tried withholding product as a means to drive up prices.  Others have colluded with competitors to set prices.  And still others have bought out their competition and set prices knowing there would be no competition.  Consumer protection was left to the “buy, don’t buy” decision.

What is very helpful in a “buy, don’t buy” decision is knowledge and the consumer’s ability to assess whether the article or service was worth the value the seller was asking. Consider the decision of whether to buy tap water versus some high priced specialty water.  It is not unreasonable to assume most consumers understand tap water is safe and as good for ones health as available.  High priced water is a reasonable purchase if the consumer valued fancy packaging, serving size, or prestige more than the cost difference with tap water.

Healthcare, however, is not close to a “fee market” because most consumers simply do not understand medical diagnoses or the underlying costs.  There simply must be some transparency such as what makes up the initial price and what justification exists for price increases.

So, what’s going on? Why is Senator Toomey even interested.

Could it be that there is mounting information and more damning data to be released concerning the greedy and predatory pricing practices prevalent in the US drug industry.  Could it be that “Medicare for All” campaigning is familiarizing Americans that their healthcare industry spends twice as much per capita as two dozens other modern countries and delivers no better outcomes.  Could it be that Americans are wondering why well known established drugs like insulin have suddenly risen several hundred percent ?

Senator Toomey is not taking his marching orders from the RNC I would guess.  Rather lobbyists representing the drug industry are trying to frame the issue of serious drug reforms as some scary socialist plot.  One really can tell what “big Pharma” thinks of the average American.  Easy to distract? Uniformed on what’s really going on? Insulated from most healthcare costs (the average diabetic can’t be fooled but everyone else doesn’t need insulin).

The Toomey infomercial speaks to the notion that “capitalism-free markets-America’s prosperity” go together like apple pie and hot dogs.  Transparency and reasonable controls on healthcare costs makes common sense when viewed on a global basis.  Transparency, like sunlight, is so needed before the US healthcare delivery system bankrupts the American economy.

Hmmm. 

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Medicare For All

July 31, 2019

Democrats are playing with fire.  With Bernie Sanders and Elizabeth Warren playing the “Medicare For All” music with great vigor, the other candidates are worried about how to position themselves.  Are they against healthcare, or just Medicare For All?  And why?

Healthcare is symbolic of a class of social issues which income inequality has aggravated and hurts most Americans.  The US healthcare delivery system is reasonably good for the top 2% earning Americans.  For everyone else, healthcare is problematic.  The notion that health care is an enterprise just like buying an automobile or dishwasher, in other words a service appropriate for free enterprise, is simply ridiculous.

US healthcare costs twice as much as two dozen other modern countries, does not cover all Americans, and delivers (on average) mediocre outcomes.  What’s wrong with this picture?  So why isn’t Sanders and Warren on the right track?

When Democrats (or anyone else) campaigns on “Medicare For All”, these candidates, however, do so at their own risk.  Why should anyone believe that “Medicare For All” would reduce healthcare costs, make healthcare affordable and available to all Americans, and not break the bank in the process WHEN most Americans do not realize their healthcare is not the best in the world?

President Trump’s campaign staff can hardly contain their glee at the prospects of campaigning against “Medicare For All”.  From the opening soft ball, “you mean I have to give up my current health insurance like Blue Cross for something I know nothing about” to the fast ball, “you want me to wait endlessly to see a doctor like they do in Great Britain”, Trump will have a field day taking about his “beautiful healthcare” even without a shred of detail.

The issue should be healthcare which is affordable and available, for all Americans, at world class standards of cost and outcomes.  Candidates should share the facts about Germany, France, Japan, Canada, etc in terms of spending per capita and ask why that could not be possible in the US?

There are dozens of US medical institutions (for example, the Mayo Clinic, Johns Hopkins, or most of the university affiliated teaching hospitals) where the best healthcare in the world can be found… if you can afford it.  Why not speak of an aspirational goal of world class healthcare for all?  Why not challenge Americans to elect someone who is committed to improving current healthcare delivery and its exorbitant cost with the goal of matching “the world’s best” in 20 years?

Experts in healthcare delivery systems know this problem is complex. Preventing disease is much cheaper than curing a disease once someone is sick.  Economically challenged Americans are most likely to forgo preventative health check ups or follow post doctor visit follow up plans.  And for sure, research on new cutting edge medicines and medical procedures do not come free.  But what other country in the world has some inherent advantage that the US, with its resources, could not match or surpass?

If there is one issue that could unite the average Democrat and Republican, world class healthcare would be my pick.  Why not talk about healthcare instead of Medicare For All?

Misery Of Pure Socialism

September 4, 2018

The Philadelphia Inquirer published a “Commentary” by Antony Davies and James R Harrigan under the title “Misery of Pure Socialism”.  Both writers are sitting professors at two different universities.  One wonders, however, whether these gentlemen have been paid to write commentaries such as this.  Hmmm.

In the body of the piece, the writers equivocate over how a country that tries “pure socialism” or “pure capitalism” would fail to satisfy their respective populations.  But it is the opening paragraphs, the second to be precise, that one gets the drift of their message.  The authors warn of socialism’s ills with reference to Venezuela, North Korea, China, and Russia.  Look how bad those economies are, the writers say.

What?

First, those cited countries are also authoritarian states with huge restrictions on what an entrepreneur can do.  Second, where is reference to Germany, Finland, Denmark, Belgium, France, etc where socialism is far more present than in the US, yet seem to be doing quite well.  

The authors make reference also to Bernie Sanders and Alexandria Ocasio-Cortez (who recently upset a long term sitting New York Representative on a socialist program).  Ms. Cortez advocated for “Medicare for all”.  So, hmmm, maybe there is a motive behind this unscholarly commentary.

The word “socialism” simply scares the wealthy.  The knee jerk reaction is the masses are going to take my wealth in order to provide medicare for all.  Now remember that the wealthy 1% make over $450,000 per year and the really wealthy reside in the 1/2 of 1%.  Do you know any of them personally?

It is well known that the US ranks worldwide about 23rd in terms of healthcare.  The US spends the most per capita (2x) and delivers (on average) mediocre healthcare outcomes (Mayo Clinic and a few other teaching hospitals excepted.  These institutions provide unparalleled healthcare at huge cost).

US capitalist corporations have pretty much deep six-ed “defined benefit” pension plans and a growing number are trying to “de-risk” their bottom lines by outsourcing pension obligations.  These companies see the “de-risking” as protecting their shareholders and not turning their former employees out in the cold.  Hmmm.

In European social democracies the government insists that companies pay into government funds in order to cover their healthcare and retirement obligations.  Businessmen are the same the world over and if given the chance a German CEO will de-risk too.  

Healthcare and Pensions are not single variable notions. Without proper oversight bad things can happen.  Healthcare providers can turn profiteer and shortchange the customer.  Pension boards can make poor investments and fail to achieve returns they have promised.  But, in the sunlight of public disclosures, this is more difficult to occur.

Most important, socialism and capitalism are economic theories.  Venezuela and North Korea may employ socialism but key decisions are made by an authoritarian leadership interested in their own well being, not of the general population.  If these are failed States, it is because they are authoritarian not because they embrace socialistic policies. 

Next Stop, Social Democracy?

December 5, 2017

These past 11 months have witnessed war against Government regulations, a skewed (towards the wealthy) tax reform, and the wanton disregard for healthcare and the environment.  Thanks Mr. President.  To be fair, this is not just a President Trump issue, rather it is the true face of the current Republican Party.

And, more than any other factor, these past 11 months have demonstrated the maturation of years of focused work directed by ultra conservative groups under the Koch Brothers’ flag.

The Koch’s and most of their zealous followers see the world largely from a libertarian perspective. In their minds this means much less government, far fewer regulations, much less government services, and consequently much lower taxes. The Koch’s legions act as a model for others to see what hard work and drive can produce.

Tax reform now rests in a joint Congressional committee charged with reconciling the House and Senate’s tax reform versions into one bill both Houses can accept. Barring a miraculous reenactment of Dickens’ “Christmas Carol”, Americans can look forward to more income inequality as a Christmas present.

In other Trump administrative action, curbs on Big Banks will be slackened, hints companies may not need to provide their employees healthcare, and  “Medicare, Medicaid, and Social Security” will be tossed to the “private” sector severing any connection to the Government or its promises.

For the Koch-type people, panacea could not look better. Hmmm.

One can imagine two outcomes given current choices Republicans are making.

  1. A total breakdown in America’s social contract. The majority of Americans will lose faith in Government and jump to the belief that paying taxes, following laws, or supporting the Country as a whole are no longer a duty since their Government no longer looks out for them.
  2. A strong electorate reaction which in turn elects a government with the mandate to secure access to affordable healthcare, retirement assistance (social security, Medicare, and pension guarantees), and a kind/caring safety net collection of services, (after all America is the wealthiest country in the world).

With respect to these two options, option #1 should increase gun sales and return America to a period more similar to pre-revolutionary times. With option #2, America will be seamlessly connected to the global economy and viewed by others as the latest, intelligent “Social Democracy”. Hmmm.

Governing Part I

October 29, 2017

There has been much written about the inability of the 115th Congress, one with Republican majorities in both Houses, to pass meaningful legislation. In the 113th Congress, Elements within the Republican Party orchestrated a Government shut down squabbling over an ideological but relatively pointless issue. The question is why are current day Republicans so inept when at the Ship of State’s helm?

Could it be there internal inconstancy among policies Republicans claim they hold dear such as:

  • Federal Debt – “Massive, out of control, and an unfair burden for our grandchildren”. In fact, US Federal Debt is about average for all the countries in the world. US Debt is higher than Switzerland, about the same as Germany, and lower than Japan. The real underlying problem with US Federal Debt is that it results from the Congress’ inability to make rational decisions on spending and taxation.
  • Tax Reform – When Republicans mention “Tax Reform”, the are really voicing a free lunch message around “tax cuts”. Republicans claim tax reform will lower (big time) Middle Class tax burden when in fact the tax cuts are premised on lowering the tax for the wealthiest of Americans. Oh, and what about the Federal Debt? This is a shameful policy and consequently Republicans must use all sorts of misdirection and misinformation to keep the voting public from seeing through their scheme before tax cuts are enacted.
  • Healthcare – In the past, Republicans were mainly agnostic about healthcare. Since the enactment of the Affordable Care Act (Obamacare), Republicans have been like a dog chasing after a meat wagon. Not surprisingly the Republican mantra overlooks the fact that some 20 million more Americans have healthcare access with Obamacare than before, or that the US pays twice as much for healthcare than other modern countries. It would appear that the national Republican Party goal is to reduce Medicaid involvement and to eliminate taxes which the wealthy pay, and in return Republicans are willing to see millions less Americans receiving coverage. Hmmm.
  • Medicaid – Even if there was not a broader fight over healthcare, Republicans support only a much smaller application of Medicaid. Many Republicans see Medicaid as “an entitlement” (something Americans do not earn) and a naturally growing government handout.
  • Social Programs – Republicans use this broad terminology to imply that Government aid for specific social programs is a wasteful and wrong headed idea. Surprisingly, the tone was different this past week when President Trump declared an emergency around the growing (predominantly white population deaths due to overdosing with opioids. Hmmm.
  • Environment – when it comes to government policy towards issues such as smoking, industrial discharge into rivers, land, and the air, and most recently global warming, most Republicans have been unusually skeptical on the “science” demanding controls. Could campaign contributions drive Republicans to favor businesses and overlook the welfare of its citizens?
  • Immigration – One of the most convoluted arguments Republicans have made is the danger posed by Mexican undocumented workers. The approximate 11 million illegal workers has been labeled as the cause of most violence, a huge drain on social programs, and “line breakers” who are trying to gain citizenship by not following the rules. Mexicans are mostly church goers, family centered, and extremely hard workers who make model Americans if given the chance. Could it be that Mexicans, if given the vote, might vote Democrat?
  • Faith Based Issues – Probably the most shameful and hypocritical position Republicans candidates have taken lie around the issue of god and religion. Republicans stand firmly by the Constitution when they pander to gun owners but are willing to twist the Constitution and accept discrimination based upon ethnicity, gender, or sexual orientation (if the discriminator is motivated by deeply held religious beliefs). This is akin to one Bill of Rights phrase, overriding all other rights if it is favored by a large number of bible totting voters.

The reality of this boils down to who elects Congress members and which issues are the most important. Distorting the otherwise democratic process is the unparalleled amounts of campaign donations coupled with the “legal” and huge amounts of “issues” money.   Mostly all of this money has emanated from the wealthy, and has driven the political conversation to elect a majority of RINOs (Republican in name only). This group, depending upon where in the country they represent, bring a range of intensity to the issue mentioned above.

If instead of keeping the single name “Republican”, each member chose a more applicable name like Christian Republican, No-tax Republican, Big Business Republican, etc, then the current Republican Party would not hold the majority and power would shift to others. So, banding together, even with vastly different depth of feelings around specific issues, makes the Republican brand the majority.

Republicans, however, are showing that being the majority and providing effective governance are two different matters. This year’s Republicans are hopelessly compromised owing so much to so many (tax cuts to the wealthy contributors, discrimination rights to bible thumpers, anti-immigration action to the xenophobes, anti-science policies to short sighted business leaders, and second class and hugely expensive healthcare policies to ignorant (uninformed) Americans.

Republican Congress members are complex and thinking people. Most, if not all, know the real nature of this Post’s issues. Unfortunately too many are willing to “go along”, thereby making unbalanced choices which are setting in motion collisions between common sense and prejudices or flatly unsupportable policies. In such an environment, facts are not important, and democracy suffers while governance becomes problematic.

 

An Anxious Waiting

July 28, 2014

The fall elections cannot come soon enough for 2016 potential Presidential candidates.   There are so many juicy events, both domestically and international, which Presidential demagogues could jaw about but they, for the most part, are resisting the urge to brag the limelight. I wonder why?

Why, for instance, does a Ted Cruz or Marco Rubio not wax eloquently (on national TV) contrasting what the Obama Administration is doing (or not doing) with what a Cruz or Rubio Administration would do?

Or, why hasn’t Chris Christie or Rick Perry not sold their children in order to raise funds for Israel in its latest Palestinian clash?

And, although not 2016 candidates, why hasn’t John McCain or Lindsay Graham lectured the President on how he has lost the Iraq and Afghanistan wars?

Why, indeed, when these subjects still make the front page with one headline after another? Are these suddenly mute GOP leaders wasting an opportunity?

It is, of course, summer and vacation time. Accordingly, it could be that relaxing, recharging the batteries, and keeping off the national stage might be a sufficient answer. Hmmm, maybe not.

And it could be that none of these candidates has a better idea (almost assuredly true). Hmmm. I don’t think that excuse has prevented them from “speaking to Americans” in the past.

I would suggest a more basic motive. From poling data, the GOP has a definite chance of capturing both the House and the Senate this fall. Why take a chance by pontificating on one of these issues and un-intendedly turn voters against the party?

All of the issues facing the President these days are complex, thorny, and nuanced.  These issues require careful analysis and mostly require long term strategies for which there is no national consensus. Efforts to build a national consensus does not fit 10 second sound bites. Worse, any serious recommendation ties the candidate to a position which can be later evaluated.  Hmmm.

Latin American immigration, support for Israel, and the Middle East (including Afghanistan) are all issues which are not new. The GOP learned as recently as 2012 what a hard line on immigration reform would bring. And while 2016 will see both parties stand up to say how much a friend of Israel they are, the American public can count and know the difference between 800+ and 2 civilian deaths in the current Gaza crisis. And strangely, most Americans have had a stomach full of Iraq, Afghanistan, and the Sunni-Shiite-Taliban craziness.

The 2016 hopefuls could turn their attention to jobs but there is a reasonable chance that after a slow but steady decline in unemployment that the percentage might fall below 6%.  Think about these previous hot button topics… debt, deficit, jobs, tax cuts, and healthcare.  Only healthcare has not had enough time to play out and undermine the conservative position.

There is for sure plenty of room for GOP candidates to offer alternative routes to achieve debt reduction or balancing the budget.  There is plenty of room for creative ideas on job creation and tax code reform.  And there is an ocean of room for how to bring US healthcare into the 21st century.  Among the many thoughtful proposals, however, one would not find “leave it to the States” or “cut taxes and cut social network spending” or “increase defense spending while decreasing any other spending”.

So, come Thanksgiving, I wonder what we will hear from these now silent candidates?

The Argument For Pension Reforms

July 24, 2014

Across the country many public workers in States, localities, and school districts are experiencing pressure from authorities to renegotiate pensions (and benefits). Why are these previous promises under threat of not being kept?

In most cases authorities cite either demographics (the public sector workers are living too long) or that there is not enough money in the pension fund because the already invested pension money is not earning what it was projected to earn. In either case, the underlying reason is tax payers do not wished to pay more to make up for any short fall.

But aren’t promises, promises?

Another line of reasoning is that pension (and benefit) reform is based upon comparison with the private sector. There has been a massive shift in the private sector’s approach to pensions (and benefits). For competitive reasons, the private sector has moved to make less rich both the pension and the benefit plans. In short, pensions and benefits as originally promised were becoming prohibitively expensive.  Consequently, companies were losing competitiveness versus companies which produced products overseas.

So the argument became, no change, no job.

Regrettably, many private sector unions did agree to reform and still their jobs were swept away to low cost countries. So much for promises.

The math dealing with pensions or any other benefit (mainly healthcare) is pretty straight forward. The employers and the worker must contribute enough money from current pay that when it is invested, will yield enough to cover actual payout costs for the life of the employee. With Americans living longer, the payout period will be longer than when most of these plans were first instituted.  Investing pension funds is much harder given the practical zero interest policy of the Federal Reserve.

Something has to change if the funds are too meet their obligations.

All aspects of pensions and benefits are negotiable. There are not hard and fast rules binding either employer or employee. The reality, however, is that some agreements will not serve either the employer or the employee well. Too much employer costs risk jobs, too much employee costs makes everyday living more difficult given how Americans have become use to spending their income.

Oh what a mess.

There are other methods for covering workers with retirement or healthcare. European countries have adopted methods where there is a nationwide safety net while individuals can contribute or save for a more generous retirement. These European systems, however, involve all citizens and all companies.

Anyone can save more and any company (or government organization) can provide more generous benefits but nobody can provide less than the standard.  Hmmm.

Can you hear the howl “socialized pensions or socialized medicine” coming?

Maybe, but so what. If Americans slip into the spot where pensions are inadequate for the elderly to live, the public will be asked to subsidize. You can pay me now, or pay me later.