This problem with Wisconsin is not what the GOP governor was trying to accomplish, it was the way in which he did it. All workers deserve respect and if the workers want a union, that union should be respected and negotiated with. I say that despite my personal belief that unions do not serve the interest of their workers well, but that only affects my unwillingness to be a part of a union and my career choice to not have that option.
Joe Nocera's column today is well worth reading.
Teachers are part of the solution, but how do we get there?
Tuesday, September 18, 2012
Oh, Mitt; Reveal thy true inner self, Please!!
David Brooks column today is well worth reading given that he wants to support Romney but wonders what Governor Romney really stands for as I have been asking for months now.
David Brooks column 9/18/12
My particular angst with Governor Romney's statement is that 13% of his 47% are over the age of 65 and by definition on Medicare and probably receiving Social Security. They have worked a life time and paid through withholding income on which they paid taxes to receive these benefits in the future. That is hardly free loading and looking to the government for a handout. Add to that the working poor who work but make too little to pay income tax, but certainly pay sales and gas taxes and possibly real estate taxes, are they free loaders?
The GOP accuses the Democrats of dividing the country. But what has the GOP done. They refused to compromise on anything since President Obama was elected convincing the GOP supporters that President Obama is somehow a Muslim, anti-christian, foreign citizen, anti-capitalist, anti-freedom illegitimate President. They know that to not be true but they make untruthful statements all the time because they believe hatred will get them a victory in 2012.
Now many of those in the leadership doing this really want to just keep tax rates low so they have more money in their pockets. If the GOP really believed in efficient government would the Bush II administration have allowed financial regulators to become so ineffective that they could not see fraudulent behavior in mortgage securitization or in certain hedge funds?
The GOP believes in only one thing. Cut spending and lower my taxes. They don't really care if the working poor have good jobs as long as they are working and not on the dole. They don't care if poor people have access to affordable health care. They don't care if anybody other than themselves have access to health care because they can afford an insurance policy that costs $36,000 a year. That is the mentality that was on display by Governor Romney and his approving audience that May evening in Florida.
Now if only the Democrats can create little ad's that display this sentiment in a positive light for what they will do in the future to keep retirement benefits stable without bankrupting the government.
David Brooks column 9/18/12
My particular angst with Governor Romney's statement is that 13% of his 47% are over the age of 65 and by definition on Medicare and probably receiving Social Security. They have worked a life time and paid through withholding income on which they paid taxes to receive these benefits in the future. That is hardly free loading and looking to the government for a handout. Add to that the working poor who work but make too little to pay income tax, but certainly pay sales and gas taxes and possibly real estate taxes, are they free loaders?
The GOP accuses the Democrats of dividing the country. But what has the GOP done. They refused to compromise on anything since President Obama was elected convincing the GOP supporters that President Obama is somehow a Muslim, anti-christian, foreign citizen, anti-capitalist, anti-freedom illegitimate President. They know that to not be true but they make untruthful statements all the time because they believe hatred will get them a victory in 2012.
Now many of those in the leadership doing this really want to just keep tax rates low so they have more money in their pockets. If the GOP really believed in efficient government would the Bush II administration have allowed financial regulators to become so ineffective that they could not see fraudulent behavior in mortgage securitization or in certain hedge funds?
The GOP believes in only one thing. Cut spending and lower my taxes. They don't really care if the working poor have good jobs as long as they are working and not on the dole. They don't care if poor people have access to affordable health care. They don't care if anybody other than themselves have access to health care because they can afford an insurance policy that costs $36,000 a year. That is the mentality that was on display by Governor Romney and his approving audience that May evening in Florida.
Now if only the Democrats can create little ad's that display this sentiment in a positive light for what they will do in the future to keep retirement benefits stable without bankrupting the government.
Sunday, September 16, 2012
Explaining the Closeness of the Election redux
OK Students, here we go again and I hope it does not disappear again as I know I do not have another one in me.
My slowness in returning to this is indicative of what will happen in the future. I have returned to the workforce to seek my shot at returning to the 2%. I know, you are thinking who are they? Well they are the 1% and those working stiffs who fall just short of being in the 1%. I, fortunately, have spend most of the last 20 years earning enough to make it to the 2% but never made it to the 1% (except possibly for the year in which I got a boatload of stock in my last employer which became worthless so I don't count that).
I am basically working for the cost of health insurance plus my cost of commuting and not being at home for breakfast or lunch. I am also contributing a little to Medicare, social security and the income tax authorities to pay public servants, the park system, and help those who make less than I do.
However, it is eye opening to work for so little because I am earning 2x the poverty level. Once I buy an individual health care policy (because my employer cannot afford to buy it for me and keep me employed), I have only enough to cover the cost of commuting. So when I go buy a couple of weekend dinners in the grocery store, I suddenly find I have spent $120 which I have not made (thankfully, I have been a saver all my life and have savings to cover the cost of life). However, it puts into perspective, the challenge people who make less than I do have in covering the cost of life while saving any money for their elder years. Not to mention, why they create costs, that the rest of us pay for, in hospital E.R.'s when they need service and do not have health insurance.
How does this translate into the closeness of the election?
Well, the electorate is a complicated mass of interests. If only it were as simple as it was when we were growing up. Then it was, who will help business around the margin or, who will help workers around the margin.
Now it is filled with complex mixtures of who care about social issues above all else, who cares only about cutting taxes above all else, who cares about a strong military above all else and so on. Throw in a little hatred for the other side in terms of personalities and a belief that power is the force to rule by and thwart rule by and you have the political system in the U.S. of today.
The election is close because many people's minds are rooted in the economy they grew up in . They believe that somehow the U.S. can return to that economy and they believe that Washington can create policies that will return the U.S. to that economy. Less Taxes and less regulation for the Republicans and fair taxes and prudent regulation for the Democrats. However, it is not that simple.
The driving forces of economic growth in the 1990's were tax increases that balanced the budget combined with the peace dividend from the USSR's collapse combined with Federal Reserve success in reducing inflation. The tech bubble burst all that so Bush II's fiscal stimulus threw tax cuts shortened that recession, but then the War on Terror started and that boosted the fiscal stimulus by borrowing 100% of the War on Terror without raising tax revenues to pay for it. This created the housing bubble (along with a failure to regulate prudently) and when real estate bubbles burst, everyone loses.
Add to that the realization now that the productivity improvements in the private sector that have been generated over the last 20 years and raised pay for those who remain employed in the private sector have not been matched by productivity improvements in the public sector, but pay has gone up in the public sector. Now property taxes have reached their limits, municipalities cannot honor promises they made and people want a solution that stabilizes local finance. Many people are attracted to the belief that if you starve the beast of government by not allowing any tax increases you will force a solution. However, a near equal number of people believe government does good and should be paid for. They also believe transitions should be managed and gradual.
Now people are angry, disappointed, desperate in some cases and feeling lost by the system. That is why this election is so close and why it is so important that President Obama be reelected. I believe in managed gradual solutions. That is what is good for business, good for employment and good for people
There are limits on what the government can do. Real estate collapses take 5 to 10 years to work through. The U.S. is probably only half way through this mess. Yet, the realities of the fiscal framework require that a long term solution to restoring fiscal balance be found. It must include increases in revenues with a fix for entitlements. But you cannot fix entitlements without finding health insurance for the uninsured. I once remember a figure of something like $2,000 of health insurance premium goes to pay for the uninsured. So Medicare is paying $2,000 per retiree to cover the uninsured. That alone will not fix Medicare, but it will help.
My slowness in returning to this is indicative of what will happen in the future. I have returned to the workforce to seek my shot at returning to the 2%. I know, you are thinking who are they? Well they are the 1% and those working stiffs who fall just short of being in the 1%. I, fortunately, have spend most of the last 20 years earning enough to make it to the 2% but never made it to the 1% (except possibly for the year in which I got a boatload of stock in my last employer which became worthless so I don't count that).
I am basically working for the cost of health insurance plus my cost of commuting and not being at home for breakfast or lunch. I am also contributing a little to Medicare, social security and the income tax authorities to pay public servants, the park system, and help those who make less than I do.
However, it is eye opening to work for so little because I am earning 2x the poverty level. Once I buy an individual health care policy (because my employer cannot afford to buy it for me and keep me employed), I have only enough to cover the cost of commuting. So when I go buy a couple of weekend dinners in the grocery store, I suddenly find I have spent $120 which I have not made (thankfully, I have been a saver all my life and have savings to cover the cost of life). However, it puts into perspective, the challenge people who make less than I do have in covering the cost of life while saving any money for their elder years. Not to mention, why they create costs, that the rest of us pay for, in hospital E.R.'s when they need service and do not have health insurance.
How does this translate into the closeness of the election?
Well, the electorate is a complicated mass of interests. If only it were as simple as it was when we were growing up. Then it was, who will help business around the margin or, who will help workers around the margin.
Now it is filled with complex mixtures of who care about social issues above all else, who cares only about cutting taxes above all else, who cares about a strong military above all else and so on. Throw in a little hatred for the other side in terms of personalities and a belief that power is the force to rule by and thwart rule by and you have the political system in the U.S. of today.
The election is close because many people's minds are rooted in the economy they grew up in . They believe that somehow the U.S. can return to that economy and they believe that Washington can create policies that will return the U.S. to that economy. Less Taxes and less regulation for the Republicans and fair taxes and prudent regulation for the Democrats. However, it is not that simple.
The driving forces of economic growth in the 1990's were tax increases that balanced the budget combined with the peace dividend from the USSR's collapse combined with Federal Reserve success in reducing inflation. The tech bubble burst all that so Bush II's fiscal stimulus threw tax cuts shortened that recession, but then the War on Terror started and that boosted the fiscal stimulus by borrowing 100% of the War on Terror without raising tax revenues to pay for it. This created the housing bubble (along with a failure to regulate prudently) and when real estate bubbles burst, everyone loses.
Add to that the realization now that the productivity improvements in the private sector that have been generated over the last 20 years and raised pay for those who remain employed in the private sector have not been matched by productivity improvements in the public sector, but pay has gone up in the public sector. Now property taxes have reached their limits, municipalities cannot honor promises they made and people want a solution that stabilizes local finance. Many people are attracted to the belief that if you starve the beast of government by not allowing any tax increases you will force a solution. However, a near equal number of people believe government does good and should be paid for. They also believe transitions should be managed and gradual.
Now people are angry, disappointed, desperate in some cases and feeling lost by the system. That is why this election is so close and why it is so important that President Obama be reelected. I believe in managed gradual solutions. That is what is good for business, good for employment and good for people
There are limits on what the government can do. Real estate collapses take 5 to 10 years to work through. The U.S. is probably only half way through this mess. Yet, the realities of the fiscal framework require that a long term solution to restoring fiscal balance be found. It must include increases in revenues with a fix for entitlements. But you cannot fix entitlements without finding health insurance for the uninsured. I once remember a figure of something like $2,000 of health insurance premium goes to pay for the uninsured. So Medicare is paying $2,000 per retiree to cover the uninsured. That alone will not fix Medicare, but it will help.
Wednesday, September 5, 2012
I can't believe it. This blog was written and then disappeared.
Jim, it was my explanation of the universe. I don't understand why my rant from this a.m. didn't save. I no longer have the passion that I did then.
This one is having problems too. I may have to find a new blog service.
This one is having problems too. I may have to find a new blog service.
Health Care II
or maybe it is CXI.
Anyway, continuing my take away from the New Yorker article I wrote about yesterday.
Do not fear hospital combinations, loss of community hospitals, or the corporatization of medical practices. This is the part of the health care system where market competition will deliver cost savings to the economy. And it is a direct result of the Affordable Health Care Act seeking to begin a transition from pay for service to pay for outcomes. And repealing the Affordable Heath Care Act will delay the push toward this.
What will not drive this in any way is market competition in health insurance. Health insurance is a utility which is already regulated by government (usually a state). Meanwhile, Medicare does the same thing and spends less than 10% on administration. Private insurance companies spend between 18 and 20% on administration and have created a patch work system that leaves tens of millions of people outside the system while their costs remain in the system through their unpaid visits to the E.R.
We must find a way to transition to Universal Health Insurance (with everyone paying something, if they are working) and eliminating private insurance in a manner that is gradual so the employment shifts are not too dramatic on economic growth.
The costs that are breaking the back of the economy are in my mind and in no particular order:
(i) the elderly with dementia on Medicaid,
(ii) unproductive end of life care,
(iii) diabetes,
(iv) unnecessary medical tests,
(v) a failure to curb malpractice law suits,
(vi) pay for service rather than results, and
(vii) pharmaceutical solutions that are permanent and maybe fall into category ii.
I need to go to work.
Anyway, continuing my take away from the New Yorker article I wrote about yesterday.
Do not fear hospital combinations, loss of community hospitals, or the corporatization of medical practices. This is the part of the health care system where market competition will deliver cost savings to the economy. And it is a direct result of the Affordable Health Care Act seeking to begin a transition from pay for service to pay for outcomes. And repealing the Affordable Heath Care Act will delay the push toward this.
What will not drive this in any way is market competition in health insurance. Health insurance is a utility which is already regulated by government (usually a state). Meanwhile, Medicare does the same thing and spends less than 10% on administration. Private insurance companies spend between 18 and 20% on administration and have created a patch work system that leaves tens of millions of people outside the system while their costs remain in the system through their unpaid visits to the E.R.
We must find a way to transition to Universal Health Insurance (with everyone paying something, if they are working) and eliminating private insurance in a manner that is gradual so the employment shifts are not too dramatic on economic growth.
The costs that are breaking the back of the economy are in my mind and in no particular order:
(i) the elderly with dementia on Medicaid,
(ii) unproductive end of life care,
(iii) diabetes,
(iv) unnecessary medical tests,
(v) a failure to curb malpractice law suits,
(vi) pay for service rather than results, and
(vii) pharmaceutical solutions that are permanent and maybe fall into category ii.
I need to go to work.
Tuesday, September 4, 2012
More Health Care Musings
While I was riding the train to work this a.m., I was reading an article in the 8/13-8/20 New Yorker entitled Big Med in which the author, a Dr, analyzed how CheeseCake Factory ran its kitchens and compared that to the manner in which health care is delivered. I have not finished the article yet but as you might imagine he is discussing the need for care to be coordinated, fixated on delivering useful care in the most efficient fashion, and not surprising, illustrating the manner in which neither is being done presently.
On the more optimistic front, he has already stated that hospitals are becoming more like chain stores and, in response to prompts in ObamaCare, are starting to try and figure out how they do these things in a more efficient manner.
But then on my train, a man who could not get a seat (nor did I have one) suddenly collapsed. I saw the nurses, and maybe a Dr, on the train assemble and start to service the guy without any regard to malpractice concerns. I was shaken by my own lack of any useful knowledge as to how to help the individual other than stay out of the way and near tears that people who could help were there as fast as possible.
I then overheard some people discussing the situation later. They apparently knew the individual and were witness to the collapse. He apparently has Parkinson's Disease, but was not exhibiting the signs of it prior to the collapse. My thoughts at that point ran to the fact that when the EMS got him to an ER, he was going to be subject to all kinds of tests and some insurance scheme was going to pay for them. To What End? His Dr in the suburbs could probably tell them what specific tests to run and keep it simple. What should have cost the system $1,000 or so, will probably cost the system $10,000 or so. This what we need to find a way to end. Have the Dr's who know a patient consult with the Dr's who are treating the patient so patient history has an immediate effect on what is done for the patient rather than having to run a whole battery of tests to reconfirm the patient's status because they ended up in a different hospital.
On the more optimistic front, he has already stated that hospitals are becoming more like chain stores and, in response to prompts in ObamaCare, are starting to try and figure out how they do these things in a more efficient manner.
But then on my train, a man who could not get a seat (nor did I have one) suddenly collapsed. I saw the nurses, and maybe a Dr, on the train assemble and start to service the guy without any regard to malpractice concerns. I was shaken by my own lack of any useful knowledge as to how to help the individual other than stay out of the way and near tears that people who could help were there as fast as possible.
I then overheard some people discussing the situation later. They apparently knew the individual and were witness to the collapse. He apparently has Parkinson's Disease, but was not exhibiting the signs of it prior to the collapse. My thoughts at that point ran to the fact that when the EMS got him to an ER, he was going to be subject to all kinds of tests and some insurance scheme was going to pay for them. To What End? His Dr in the suburbs could probably tell them what specific tests to run and keep it simple. What should have cost the system $1,000 or so, will probably cost the system $10,000 or so. This what we need to find a way to end. Have the Dr's who know a patient consult with the Dr's who are treating the patient so patient history has an immediate effect on what is done for the patient rather than having to run a whole battery of tests to reconfirm the patient's status because they ended up in a different hospital.
Saturday, September 1, 2012
Health Care is a more complex issue than Politicians' Campaign Slogans
As usual, it is discussions of Health Care in this country that have me sitting here typing.
I could comment on how without Medicaid serving the poor we would have (i) Alzheimer's Patients wandering the streets tying up EMT people and ER's when they collapse in the street or bankrupting their children, and (ii) poor people going without medical care until they ended up in the E.R. without any ability to pay and the hospital having to give them service under a Federal Law passed by a Republican Congress and signed by Ronald Reagan. Of course, the cost of that is passed onto all of us with Health Insurance through higher hospital bills.
I have to admit that having had 1st hand experience with Medicaid and an Alzheimer's Patient, I recognize both the expense it represents to the system and the conflicts present in deciding what generational support arrangements and obligations there should be in place when there are children to do so. But that complex issue does not have any bearing on what to do with people who have no children and have dementia.
But what really got me to sit down here was the FDA approval of a new drug for men with advanced stages of Prostate Cancer. This drug will cost $7,450 per month and extends the life of its average taker from 13.6 months to 18.4 months. I know that while men are taking this drug it will encourage the drug researchers to investigate whether variations on it will extend life further or even potentially cure the cancer and there is value in that. But is $134,500 in incremental pharmaceutical expense ( and I am sure there is more expense than that for this regime) worthy when life is extended by 5 months?
If that allows a 55 year old man to see his grandson born or his youngest daughter married or sell his business so his wife has funds or any number of other reasons, perhaps. But couldn't a lot of this be accomplished anyway without spending $3.7 billion on this drug for the 28,000 men that die annually from Prostate Cancer?
The difficult question is how do we manage the cost of end of life care in an intelligent manner? How do we promote the discovery of drugs that help people continue life while we do not spend money on things that only continue life for a matter of months? The Medical System and Politicians must figure out how to answer this question. Otherwise, healthcare is going to either bankrupt the system or leave people dying in the gutters as they did in the Middle Ages.
I could comment on how without Medicaid serving the poor we would have (i) Alzheimer's Patients wandering the streets tying up EMT people and ER's when they collapse in the street or bankrupting their children, and (ii) poor people going without medical care until they ended up in the E.R. without any ability to pay and the hospital having to give them service under a Federal Law passed by a Republican Congress and signed by Ronald Reagan. Of course, the cost of that is passed onto all of us with Health Insurance through higher hospital bills.
I have to admit that having had 1st hand experience with Medicaid and an Alzheimer's Patient, I recognize both the expense it represents to the system and the conflicts present in deciding what generational support arrangements and obligations there should be in place when there are children to do so. But that complex issue does not have any bearing on what to do with people who have no children and have dementia.
But what really got me to sit down here was the FDA approval of a new drug for men with advanced stages of Prostate Cancer. This drug will cost $7,450 per month and extends the life of its average taker from 13.6 months to 18.4 months. I know that while men are taking this drug it will encourage the drug researchers to investigate whether variations on it will extend life further or even potentially cure the cancer and there is value in that. But is $134,500 in incremental pharmaceutical expense ( and I am sure there is more expense than that for this regime) worthy when life is extended by 5 months?
If that allows a 55 year old man to see his grandson born or his youngest daughter married or sell his business so his wife has funds or any number of other reasons, perhaps. But couldn't a lot of this be accomplished anyway without spending $3.7 billion on this drug for the 28,000 men that die annually from Prostate Cancer?
The difficult question is how do we manage the cost of end of life care in an intelligent manner? How do we promote the discovery of drugs that help people continue life while we do not spend money on things that only continue life for a matter of months? The Medical System and Politicians must figure out how to answer this question. Otherwise, healthcare is going to either bankrupt the system or leave people dying in the gutters as they did in the Middle Ages.
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