IDEOLOGY!

Here is something the media does not much cover and as usual the reason is that if it DID cover it, many people would be offended and reject that media outlet.  In the age of the Internet, there are so many media alternatives that the turn off rate would be very painful for any media outlet to endure.  As a media outlet, you can't offend your customer and then expect to thrive.

What am I talking about?  The problem that is "ideology."  I use this term to encompass all belief systems from religions to secular ideologies such as liberalism, conservatism, libertarianism, communism, socialism, fascism, anarchism, capitalism and much more.  Here is the key feature of an ideology: it's beliefs are accepted beyond question by the adherent.  Adherents often have their own set of facts to justify their ideology.  All can be explained, adherents believe, by their belief system.  No matter the miserable results of their ideology, adherents will remain faithful to their ideology!

One easily see how religions fall into this category and there is almost no need to explain the problem of religious ideology to a rational person (I know you're out there somewhere!) but secular belief systems can likewise fall into this same trap.  If a free enterprise economy leads to general and widespread prosperity, a Marxist will raise the very theoretical problem of the "alienation" of workers.  If a free market system leads to incredible income disparity and misery that begs for regulation or solution, libertarians will call the regulations or solutions "tyranny."

It is interesting that no ideologue can actually point to the actual existence of an ideal economic or political system in practice - they've never existed and the reason is simple; we humans are not ideal.  We are not reasonable so everything we do will be screwed up in some way by human nature.  A free market will be ruined by greed; socialism ruined by sloth.  Free speech is ruined by lies; government controlled speech is ruined by lust for power.  If humans were perfectly reasonable, an ideal system would arise organically - reasonable solutions would present themselves and reasonable humans wold adopt those solutions.  But since we are not always (or often) reasonable, and we don't adopt reasonable solutions, but instead cling to ideological solutions, all economic and political systems will scream out for limits, rules and patches to address the weak points that human nature will exploit in these ideological systems.

Even total freedom is a frightening prospect; anarchists seems to ignore the danger of the sociopaths and psychopaths among us; how does one enforce anarchy anyway, aside from "might makes right?" And of course, we need to look no further than North Korea to see the opposite system where the government tries to control everyone's very thoughts.

Think about the current debate over health care; one side objects to the "tyranny" of a government regulated system that steals money from the rich and sends it to the poor in the form of subsidies for health care insurance.  There are those on the other side, however, that simply hate "big pharma," insurance companies, hospital systems and so on, ideologically because they are part of the capitalistic system that we use in the U.S.  They would prefer a socialistic system where the government controls it all, from hospital, pharmaceutical companies and doctors.

A non-ideological approach would be to observe the facts around the world and ask "what works?"  The answer increasingly looks like a "Medicare for All" system actually delivers more health care to more people for less cost.  Those who live in those countries actually live longer while spending less on healthcare.  These observations are verifiable.

If one attempts to be reasonable and non-ideological, one can see the merit in this kind of approach.  As an example, George Will, generally a conservative commentator, pointed out this week that the American Public has started to see heath care as something similar to a "right."  In this country, we all are entitled to police protection, protection against invading enemies and so on.  These protections are somewhat similar to "rights" in that we have agreed, in this country, to provide them to everyone.  No one is clamoring for police protection as if it were the latest iPhone.  We need police protetion and defense for the country but we would like to be safe for as little cost as possible.  Now, it's not as if we are clamoring to be treated for being ill; we NEED to be treated when we are sick - this is not a market decision.  We just want our health if needed for as little cost as possible.  We need to treat health care the way we treat police protection and national defense, and this is without regard to the free market aside from encouraging some efficiencies.  We all need it, but want only what is necessary and for as little cost as possible. Medicare for All may accomplish this.  Imagine if we all individually had to pay for police protection or national defense and if we did not were excluded somehow?

Why shouldn't we all, from innocent children, to the elderly, to the disabled, to the poor and everyone else be protected from sickness and injury?  Indeed, why not?  The only argument against this is the selfish argument, the "tyranny" argument - the wealthy being resentful of some of their wealth being used to assist others by democratically and constitutionally enacted law.  For some reason they believe their minority position should trump the position of the majority on this subject.  It's as if those who support that position really believe humans are islands - it's as if we are all really on our own.  All the evidence, however, points to the fact that humans need each other - that is one of the feature of being a human.  That's why democracy seems to be a necessary component of a thriving society.

Ultimately it seems reasonable to take the approach that no "pure" system will ever work as long as humans are selfish, greedy, lazy and irrational.  When we become perfect, no system will be necessary.  That is why ideology is to be avoided like the plague it is.

But here is the irony: in the way that "faith" which is the rejection of reason in favor of a comforting though unjustified (by the actual evidence or logic) belief, is thought to be a virtue, being "ideological" is also thought to be virtuous in public discourse.  It is not; accepting the overwhelming evidence that humans are not perfect and that ideologically based systems to guide our lives are sure to be ruined by imperfect human nature is imperative.  We are far from reaching that imperative.

The only systems worth having are those tested by their results, with the knowledge that the tests are ongoing and the results never assumed to be permanent. Change and adaptation is to be expected and even welcomed as we think of better ways to do things.  We need to turn "ideology" into a dirty word.

Fixing Obamacare for Real!

The current debate, dominated by the Republicans since they are 100% in power in Congress and the Executive branch, has avoided at all costs any discussion of far more simple, fair and MORAL fixes to Obamacare.  Everyone knows what the possible fixes are:

1) The Public Option

2) Single Payer/Medicare for All

3) Allowing the Federal Government to negotiate on price for pharmaceuticals and medical device equipment

I will not take any credit for any of these ideas, of course; they have been around for a long time.  The primary reason that these common sense and real solutions are not implemented are twofold: a) the health care industry is the largest lobbyist in the country, larger than the military-industrial complex, and b) ideology prevents many, including most Republicans and Conservatives, from even considering this solution even though Medicare, Medicaid and Social Security are highly successful and popular programs that spring from the same ideology of the government providing a social safety net for all Americans.

Learn about these solutions here:

Here is an actual piece of legislation proposed by the Democrats and scored by the CBO:
https://www.congress.gov/bill/113th-congress/house-bill/261

A quick explanation of the public option:
https://en.wikipedia.org/wiki/Public_health_insurance_option#cite_note-16

A news article from January 2013 when Obama was President:
http://thehill.com/blogs/floor-action/house/277505-house-dems-push-again-for-creation-of-government-run-health-insurance-option

A news article before the ACA was passed:
http://www.nbcnews.com/id/32718713/ns/politics-white_house/#.WNahRsDyvIU

Politifact confirms it is true that the Federal Governmentis prohibited from negotiating on prices:
http://www.politifact.com/wisconsin/statements/2017/jan/17/tammy-baldwin/tammy-baldwin-federal-government-prohibited-negoti/

An article this year about Trump considering Federal Gov't. negotiating drug prices:
https://www.nytimes.com/2017/01/23/health/the-fight-trump-faces-over-drug-prices.html?_r=0

Obamacare vs. Anarchy-care

Exactly what did Obamacare try to accomplish?  It really only tried to widen access to affordable health care insurance.  It was a reform that was long past overdue despite the fact that it falls short of accomplishing what is actually needed, which is the control of health care costs.

I should know. After my wife's permanent layoff from her job at a large company, I needed to purchase health care insurance as a very small business owner for my family. Since my company had way fewer than 50 employees, the choices were not abundant despite living on Long Island, NY.  I had 3 insurance companies in  total to choose from.  All the policies were odious.

The first year, 2002 or 2003, the cost of insurance was a shock to the system after being covered for relatively little out of pocket cost under my spouse's coverage from her job. But it got worse - much worse.  By 2009, health care was costing before taxes $25,000 per year counting premiums, deductibles and co-pays.  Unbelievable!

Fortunately, in 2010, my wife found a job with good benefits but the damage was done - we had spent about $175,000 on health care over about 7 or 8 years even though we were relatively healthy.  Boy do we miss that $175,000!

The loss of this money to health care costs is particularly bothersome to me because I am all too well aware that our "system" of health care is so idiotic; it's the most expensive in the world and it's not close to being the best.  In Canada, our neighbor to the north, the costs are a fraction of ours, yet Canadians live longer than we do.  There is no way to justify what we do compared to what the Canadians do; they simply have it better.  Anecdotal stories aside, the fact remains that Canadians are not clamoring to change their "Medicare for All" system.  In fact, they probably would rebel if their system was changed into OUR system.  Who wouldn't rebel?  Our system is nothing more than anarchy.

Is that too strong a word?

Health and Human Services Secretary Kathleen Sebelius has released an enormous data file containing the secret "Chargemaster" price lists of hospitals from around the country revealing an almost completely random, arbitrary and capricious pricing of various hospital services that vary wildly from hospital to hospital.  Truly the prices are inexplicable!

Steven Brill, who wrote the masterful article "Bitter Pill" highlighted in an earlier blog post, wrote on 5/8/2013, "For example, the first line in the more than 163,072 lines of data in the CMS file released May 8 covers the treatment of “extra cranial procedures” (“without complications”) at the Southeast Alabama Medical Center in Dothan, Ala. When Medicare reviewed the list prices on bills it received for 91 patients getting that treatment at the Dothan hospital in 2011, the average Chargemaster bill claimed by the hospital was $32,963. Medicare paid only an average of $5,777...

Helpfully, Sebelius points out in her announcement that “average inpatient charges for services a hospital may provide in connection with a joint replacement range from a low of $5,300 at a hospital in Ada, Oklahoma, to a high of $223,000 at a hospital in Monterey Park, California. Even within the same geographic area,” she notes, “hospital charges for similar services can vary significantly. For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colorado, and from a low of $9,000 to a high of $51,000 in Jackson, Mississippi.”

"  Go to
http://swampland.time.com/2013/05/08/an-end-to-medical-billing-secrecy/ .

Please note that the hospital, which makes a profit at the payment level that Medicare pays, would try to charge the uncovered about 600% more than it charges Medicare.  Those persons would most likely be lower income persons.  Furthermore, the Chargemaster price lists are the basis for their negotiations with health care insurers, none of whom have anywhere near the bargaining power of Medicare which has a monopoly on older health care consumers.  It is Medicare's bargaining power that is the key to lowering health care costs.  The only times Medicare is ineffective in bargaining is when its hands are tied legislatively; Congress prevents it from bargaining fully with medical equipment companies and drug companies.  Why?  Because these companies are the biggest lobbyists in Washington DC and spend huge amounts supporting their political candidates.  What a shock!

Is this crazy or not?  Why would we all not want Medicare for all?  If you think your taxes would go up, think again - the money saved in insurance premiums, deductibles and co-pays would be far greater than any tax increase since the total cost of health care expenses would decrease - a lot!  That decrease ends up in our pockets and it comes out of the pockets of hospitals, medical equipment companies and Big Pharma.  Do not cry for them, they will not starve.  But if we do not adopt some form of Medicare for All, perhaps we, the American taxpayer and consumer, will starve.

Don't Take My Word For It: Cutting Medicare Does Not Save Money

My last blog post was on the topic of whether cutting Medicare benefits saves any money; the answer was it does not save money unless you do not mind getting sicker or dying outright.  At about the same time a highly publicized article was published by Time Magazine entitled, "Bitter Pill: Why Medical Bills Are Killing Us."  This outstanding article was written by Steven Brill and should be required reading for all Americans.  Here is the key nugget; Americans are paying about $750million more per year in health care costs than they would almost anywhere else but do not receive better health care for it.

In the article Mr. Brill takes 6 case studies of incredibly expensive and outrageous medical bills incurred by ordinary Americans, some with health care insurance, some without.  The analyses of these bills should make you livid.  You can and should read the article at: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/.  

Mr. Brill does not go deeply into solutions; he does note where the major problems are, however.  First, hospitals and hospital chains, including non-profits, have pretty much cornered markets to the point where they can charge fees in incredible excess of their costs.  Since most people are not able to use just any hospital in the country because of distance and the limitations of their health insurance, there is no free market operating in this area.  For hospitals, its a seller's market, period.

Even large health insurance companies do not have enough clout, which means customers, to negotiate favorable rates.  Only one insurer does have enough clout to get a decent rate - the government, in the form of Medicare and Medicaid.

Yes, Medicare pays only a fraction of what private insurers pay, and they do it with less overhead as well.  It's simply a function of market share.  Since Medicare covers all older Americans they have enormous clout and can force hospitals to negotiate more reasonable deals on service costs.  Even though hospitals are paid only a fraction of what hospitals are paid  by private insurers or individuals, they still make money on Medicare patients.  In other words, Medicare is working.

The other area where we bleed money in health care is in drug costs.  Medicare is legally prevented by Congress from negotiating drug prices with drug companies.  Instead Medicare must pay 6% more than the average cost of any specific drug.  The rest of the world pays less, far less, than do Americans for many of the same drugs, yet drug companies are still making money on those other less excessive sales in foreign countries just the same.  With America's buying power, we should be paying the least of anyone in the world.  We can thank those in Congress who give lip service to a "free market" but either have no idea of what is going on in the real world, or if they actually do have an idea, have been corrupted by campaign contributions.

As I have written in the past, it is now time for us to catch up to numerous other countries and adopt a universal health care system that either controls health care costs via government regulations or is a single payer plan such as in a "Medicare for All" plan.  By simply instituting a "Medicare for All' system in this country, along with taming defense spending, we could go a long way towards solving our debt problems. 

Some would claim that such a system would be socialism or some form of tyranny.  The answer to these claims is this; the most free nations on earth have universal single payer or highly regulated systems.  Canada has not succumbed to tyranny because of their "Medicare for All" system.  Neither would we.

Why Cutting Medicare Does Not Save Money; Why Cutting Defense DOES Save Money

My daughter has decided that she will be saving some money.  From now on, she will not spend any more money she gets from the allowance that I give her on lunches at school.  No, from now on, I will simply deposit via the online web site the appropriate amount of money into her lunch account at school which she can then automatically access via her school ID card.  And of course, her allowance and appetite will remain otherwise unchanged.  Correct me if I'm wrong, but according to my math, I think that although she may be saving some money, I will be spending at least that much more.

In reality this story is not quite accurate.  My daughter hasn't really tried to attempt this crass ploy on me - she would know better.  In reality this ploy is being foisted on all of us - all Americans - by those who claim that cutting Medicare and Medicaid benefits actually would actually save us - Americans - money.  No it would not, that is, not unless you don't mind being unwell, sick or dead.

In the example I began with, it becomes obvious nothing is saved overall if the spending is merely shifted.  In the case of Medicare or Medicaid, a benefit cut by the Government means health care expenses are merely being shifted from the government to the individuals needing the health care services.  True, the person could forgo the health care expense and then money would truly then be saved; that is, of course, unless the sick get sicker and then need even more expensive emergency care, which, it would follow, if we really want to save  money, the sick person would also have to forgo.  Ultimately the greatest savings would occur if the person needing the health care would simply just die in the first place.

Here is another irony; due to its enormous buying power, health care purchased and paid for by government is less expensive than that purchased by individuals.   The rate of increase in Medicare costs is less than the rate of increase in private health care plans. Wow, a double whammy!

May I submit that this is no way to save money.

This does not mean that we cannot save money in the general field of health care.  In fact, it is well-known that the United States spends more money per person and more money as a percentage of GDP on health care than any other country in the world while having fairly mediocre results to show for it.  Do not take my word on this; go to the World Bank for extensive data on the subject:  http://data.worldbank.org/topic/health.

At this point in the development of our country there really is no excuse for the U.S. not having a coherent health care system such as those that exist in Canada, Germany, France, Singapore or the Netherlands, to name a few examples.  All of the above countries spend less and live longer and better.

Yes they SPEND LESS overall on health care via the various universal health care system solutions that they employ than we do in the U.S. for our non-universal chaotic system.  There is simply no excuse for this. I suggest that our budget woes could be partially cured by studying these various systems used around the developed world, identifying the best one in practice, tweak it to mitigate its weaknesses, and then implement it here.  It might be no more traumatic than extending, more or less, Medicare, or some modification of it, to include everyone.

Now contrast the cutting of Medicare with the cutting of the Defense Budget.  If there ever were a part of government that is rife with fraud and waste, the Defense Department would be it.  There are whole billion dollar weapons systems that the Defense Department does not want that exist only to create jobs in the districts of various elected politicians.  This is known as "pork."  Yes, the Defense Department, if cut judiciously and with a sincere eye on America's security, could yield enormous "true" savings.

Why would they be true?  If a useless weapons program is cut, American citizens would not be reaching into their pockets to replace the benefit.  We would not be personally chipping in to fund the latest billion dollar stealth fighter out of our savings accounts. The money would really be saved.  The useless fighter would not get built.

Now you may argue that cutting defense would mean that jobs would be lost.  The same argument, however, applies to all spending cuts made by the government.  Health care jobs would be lost if Medicare or Medicaid were cut; educational jobs are lost when school funding is cut, and so on.  This argument does not only apply to Defense jobs.  Government spending/cutting affects jobs in both directions.

But there is one other thing; Defense Spending that is not vital to maintaining our security or freedom does us no other good.  It does not create housing, food, entertainment, health care, clothing or anything else of any use.  It does nothing to increase the wealth of America and in fact only decreases it by wasting precious resources.  When someone is employed to build a house, a house results. Someone uses it.  When someone builds a bomb, it either explodes and destroys itself or is stored away and never used.  No one benefits unless its use was vital to the maintenance of our freedom and way of life.  In other words, most of the expense goes to waste.

Cutting Defense then truly saves money; cutting health care benefits truly does not.  The solution is to cut Defense spending that does not compromise our ability to defend our security and freedoms and to institute a health care system that is at least as efficient as that used in many other other developed nations.  What are we waiting for?

To Fall or Not to Fall: The Fiscal Cliff

Should we or should we not fall off the "Fiscal Cliff"?  The quick answer is we'd prefer not to, but it really depends on the alternative.

If the alternative permanently enshrines low tax rates for the wealthy, well, then go off the cliff.  Ditto if the alternative also enshrines low tax rates for capital gains, dividends and other income that typically only the wealthy realize.  Go off the cliff if otherwise it means that the elderly will not be able to afford health care or retirement in general.  Go off the cliff if otherwise it means that the Defense Department budget is totally out of proportion to our need to truly defend ourselves.

If a partial measure is proposed that preserves tax cuts for those who earn $250,000 and under and extends the debt ceiling (or eliminates the need for it to be extended altogether) go for it but if it does that while extending the unjustifiable, forget it.

The "grand bargain" that is so often mentioned truly should be a no-brainer.  Here is what it should contain:

1. A very progressive income tax structure - more progressive than the current structure, probably with more tax levels, such as 0%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, etc., as income increases.  This should be the goal: the share of taxes paid by the wealthier in proportion to their increase in wealth should increase, not decrease as it has for the last couple of decades.  Apologists for the wealthy like to point out that the rich pay a higher percentage of the total tax burden than ever before but they deliberately fail to note that the income of the wealthiest Americans has grown far greater than the proportion of the tax burden that they pay has grown.  In other words, their tax burden has increased less than their wealth.  The slack has, in the past, been picked up by the Middle Class.  This has contributed to a shrinking Middle Class and reduced demand and a more slowly growing economy.
2. No special treatment for capital gains, dividends, etc.  Income is income.
3. A corporate income tax that is more competitive internationally, perhaps around 28% to 30%.
4. Tax reform; elimination of all deductions and credits except for local taxes.  This could be phased in over 10 years, with a 10% reduction in allowable deductions each year until there are no deductions.  This could be made revenue neutral by adjusting the income levels for each tax bracket.  This will also help the Middle Class if the tax brackets are done correctly.
5. Deep defense cuts as per the Simpson-Bowles commission.
6. Universal health care - Medicare for All which should decrease the rate of growth overall of US health care spending if not decrease the cost of health care overall as it does around the world, without a sacrifice in quality of health care.  There are numerous examples of superior health care systems around the world, including Canada, on which to base our system.  This would solve two problems at once - saving money for US citizens and covering all citizens for health care.  All kinds of tweaks are possible, such as means testing, incentives, payments based on results, not based on pointless tests, etc.  Business will finally be free from providing health care, a boon to them!
7. Tweaks to Social Security to stabilize it for the next century.
8. Stimulus - for infrastructure, education and energy self-sufficiency - and jobs.  If we do the above, we can easily afford this, and all of these items are necessary and productive uses of capital.

You might ask, "aside from # 5, where are the tax cuts?"

Actually, to the US citizen, #6 is a huge spending cut; it's just that not all of it is a tax cut.  Does it matter to you whether you save money by having lower taxes or having health care cost less?  Health care is not exactly discretionary unless you don't mind suffering or dying.  If you consider that total health care costs might be 40% less than what they are now if a Canadian type system is  instituted (approximately 7% to 8% of GDP saved) would you complain?  Although no one is talking about it, controlling government spending pretty much consists of cutting defense and reforming health care costs, and not simply reforming Medicare and Medicaid. 

Well I think my work is done.  That was simple.

You're welcome!