TFP Column: I'm Going To Hell For This

They say that you should never speak of politics and religion in public places, but I decided to defy conventional wisdom with this week's effort for the TFP. (And why not, I've defied pretty much everything else.)  "I'm Going To Hell For This" is probably a fairly apt description of the future that lies in store for me after calling out a number of the Catholic prelates who are suing the federal government to prevent at least one part of Obamacare from becoming a burden on businesses owned by the Church.

It's not that I want going concerns owned by the Catholic Church to have to pay for things that violate their doctrines (though quite frankly, their doctrines have no place in creating or enforcing the law), it's that I don't want any of us to have to pay for government dictate that's a violation of the limits placed on it by the Constitution.

But listen, while my doom is undoubtedly written large in the Great Book, there's probably some much more cheerful reading to be had in the mid-week Free Press 'Star' edition.  If that's not enough to brighten your spirits and save you from sharing my eternal damnation, there's only a few days to wait before Toledo's largest Sunday circulation and Ohio's best weekly newspaper for the last three years, the Toledo Free Press.

SCOTUS v Patients Affordable Healthcare Act

The Supreme Court has now heard testimony and has probably even reached a judgment regrading the “Patients Affordable Healthcare Act”; though we're going to have to wait to know what it is until they finish writing their learned opinions on the subject. We're told by our President that it would be wrong because of the current crisis in healthcare in this country (a statement he later performed the Olympic backpedal on), for SCOTUS to even consider striking down the law.

There are a great many things wrong with this statement however, and that makes it hard to know where to begin responding to it. But let me try this simple one … Bullshit! I've spoken before about the responsibilities of the highest court in the land to address Constitutional issues, but let's at least get the facts straight.  The law currently under review by the court is not one designed to provide universal health care to citizens in this country and by its authors admissions, it does not. It was instead one passed in order to provide universal access to health care 'insurance' in this country. We could even say in this law's case, provide is far too tame a word; and that it's design is to mandate that everyone in this country be covered by some form of health insurance. (If not by private insurers, then by the government.) This law has far less to do with whether health care will be accessible than with who will pay for it.

Oh sure comes the response, but stop nitpicking and confess that there is in fact a crisis in healthcare in this country that must be dealt with. In fact, I do not concede this. If health care in this nation were so bad, then why does every national leader in world come to this country to receive treatments for serious illness, rather than stay in their own? Why are most medical breakthroughs made in this country rather than in others? There is no crisis of care in this country.  

There are however inequities as to access to treatments in this country based on their cost. (There are similar inequities to home ownership, automobile ownership, and luxury items.)   Where healthcare is concerned, we know that not everyone can get access to treatments that their doctors deem necessary to their continued health and perhaps even survival. Part of this has to do with health insurance industry, as issues of pre-existing conditions, approval of the treatments for general use, or cost vs efficacy continue to remain in a field filled with miracles and patent medicine. As often happens where such weighty issues where constant change is involved, there are invariably stories (some true) of seeming injustice and personal tragedy that go along with them. The question we should be asking ourselves however, is whether those in government are best suited to provide the answers to any of the questions. It's government after all, that got us into this mess in the first place.

During WWII, progressive saint President Franklin Delano Roosevelt imposed wage and price controls on the nation, in the misguided thinking that any one man or government could actually control a national economy. It and he couldn't of course, and clever employers who wanted better workers and could no longer offer them more in the way of wages, instead began to circumvent the spirit if not the letter of the law by offering benefit packages that included health care insurance to attract them. Forced by a competitive employment market, their competitors soon followed suit and another well-intentioned law was effectively bypassed, while reaping a full harvest of long-term, unintended consequences.

Skip forward some 20 years and we find ourselves in 1965 and see government enter into another well-intentioned effort, this time to provide health care insurance to seniors who were now unlikely to have it after leaving the employer who had provided it during their working career (because of the previously mentioned govt intervention). Congress therefore passed Title XVIII of the Social Security Act, better known these days as Medicare to address the issue. Not content with the scope and scale of the program however, it sought further redress and addition through program expansions in 1972, 2001.

Since providing medical insurance for our aged only (regardless of income), would be unfair to those younger who couldn't afford it, and whose employers didn't provide it, we at the same time added Title XIX to that same Social Security Act in order to provide even more potential government protection to yet another group. Of course the program known as Medicaid would be managed by the States, but with the Federal government monitoring.

These programs have existed now for some forty-seven years, and in typical government fashion their often obvious ineffectiveness is met with bureaucratic cries that the only way to fix the problem is to expand the programs. Having become the medical insurance provider for our elderly and impoverished, we must double down and make government the primary health insurance carrier for the nation. We must likewise turn control of the type and level of health coverage to what Congress believes is best for us; in spite of the fact that they will not be participating in the program.  Legislators it seems, have once more exempted themselves in favor of their own program of health care (much like they did with Social Security).

Having been told that it's wrong that we should have to deal with faceless insurance company employees and program managers, we're told that we'd be better off dealing with faceless bureaucrats instead. Having been convinced that evil insurance companies have and will provide little competence in serving our medical needs, we should instead turn our health care over to those whose efficiencies in the DMV and Post Office are legendary. Seeking to save us from being abandoned by the evil and unfeeling capitalists in the insurance industry, we should instead turn the quality of our very lives to the same government that has provided the kindness and compassion shown by those of the IRS.

Can anyone, with a straight face and a clear conscience point to something in its past or present that the government does better than the private sector in a truly free market environment? (And don’t point to national defense on me, as the limited efforts to sub-contract minor bits of even this have proven just as successful and often more cost-efficient than the government version; even with the normal graft and corruption of such contracts involved.)

No the Supreme Court should not rule against the “Patients Affordable Healthcare Act” because it extends the power of the Federal Government far beyond the limits placed on it by the Constitution.  Neither should it rule against the Act because of the current so-called health care crisis, because of the slim majorities and lack of bi-partisan support for the issue in the legislature, or because the President doesn't want them to rule his signature bit of legislation Unconstitutional (especially in an election year). Beyond all of these reasons, some more Constitutionally valid than others, they should rule against in order to save us from a government that's long proved itself incompetent under either party's rule to run such programs, and especially one that will forever place our health in its hands.

The Health Care Recipe

On this weekend of what will apparently be the deciding vote on the future of health care reform in this country, it's interesting to understand some of the history and human nature involved with the recipe for health care that we are cooking. What we are trying to prepare here is a dish from the tax exclusion of employer provided health benefits. 


This all began under a rather famous progressive President, Franklin Delano Roosevelt, whose administration during WWII instituted wage and price controls to keep corporations from profiteering from the war ("excess" profits were taxed at an extremely high rate) and to keep them using such profits in a bidding war for employees. Employer provided health benefits were exempt from these laws however, so companies plowed profits into such plans to retain their best and brightest. 


Hence today, if you try and buy private health insurance, you do it with money that you are taxed on. If you receive it from an employer, the money is untaxed ... clearly a better bargain. Human behavior then makes its way into the recipe, by following the golden rule that anything provided to a person for free will be considered of little or no value. In the days of low-deductible, low co-pay insurance, there can therefore be no harm in abusing the use of something that costs you nothing. 


As a consequence, people and doctors took full advantage of this "free" service provided by employers. The government re-entered the process with Medicare and Medicaid. Well intentioned as the programs might have been, they provided further "free" medical care to those already not covered under employer programs and encouraged further abuse of the system. Not only did they cater to the potential abuse of a program which the patient didn't seem to directly pay for, but they contributed additionally by setting fixed benefit payments structures for certain procedures. This had the doubly negative consequences of readmitting government price controls to a part of the process and allowing (or forcing) doctors to recover lost revenue by charging higher prices to those not covered by these government programs. 


Added then to the ingredients of this were the efforts of trial lawyers, who sought to maintain the confusion between honest human error and criminal behavior for the purposes of personal financial gain. Capitalizing on a combination of greed (personal and professional), carefully bought and paid for tort law, and the natural sympathy of juries for those they feel have been wronged; they turned medical malpractice into a winning lottery ticket. Pain and suffering were turned into potential free rides for those unlucky enough to have been injured, but lucky enough to have a good case and better lawyer. This liability lottery in turn led to malpractice insurance rates that further drove up the cost of medicine and a massive increase in testing procedures (and their billable costs) in a vain attempt to cover the posteriors of doctors against future lawsuits. 


The final ingredient of course is the creativity of the human mind. Given time, opportunity, and the opportunity to make a profit by doing so; Man (and Woman) will seek ways to extend their own existence and that of their fellows through and increase of medical science. New technology, new drugs, and new treatment procedures will inevitably drive up the cost of medicine and the length of time that a given human being has access to it. 


Stir such mixture together and bake in a Congress that has no concept of fiscal responsibility and you get the spiraling increases in the cost of medical care in this country today. 


 There is a further truth here however and since I know of no other way to do so, I will just say it: "Government has never been able to control the cost of any good or service, only the payment given for it." Thus the recipe for health care reform currently on the table seeks to change the nature of the result without changing any of the ingredients used. It does not take into account the nature of the cooks or the way that the dish has been prepared for over 60 years. In a argument far too typical of government policy, they tell us however that this recipe will undoubtedly achieve a better and more palatable result if we just make it in a much larger batch.

The Stupid Treatment

Is it just me, or has the world begun treating people as a lot more stupid in recent history? I find myself asking this question regularly as I look at the way that we are being treated by everything from entertainment to politics. I submit the following as evidence:

• Television networks seemed convinced that we will be entertained by shows about about the lives of people whose company we would take great pains to avoid.
• Pharmaceutical companies attempt to convince us in commercials to have a doctor put us on medications that have the potential of causing such side effects as rectal bleeding or death.
• Syndicated radio shows that we can listen to for free attempt to convince us that I should instead pay them a monthly fee to watch them perform this show on our computers. (How we are supposed to work using that computer while doing so is strangely left unexplained.)
• Infomercials seemed convinced that our lives would be truly fulfilled if we would only start that collection of quarters, buy a new set of knives, or trade in a working vacuum cleaner for any one of a dozen different new ones. (That is of course, when they are not telling us that they know the secret of making money, and they will share it if we share some of our money with them. I know it too, it's getting a bunch of mooks to send you a check to learn your secret.)
• The lawyers in Congress tell us that health care is too expensive because the doctors make too much money, while the doctors say that the cost increases in medicine are mostly about the cost of hiring lawyers to defend themselves in lawsuits.
• Car companies provide a warranty on the engine and drive train of up to 100,000 miles, but provide little or no warranty on the body or interior of the car. (What good the engine and drive train will do me without the body and interior has yet to be explained.)
• Some scientists tell us that the human race must stop producing greenhouse gases before they drive the temperature up from 2 to 10 degrees and melt the polar ice caps causing cataclysmic floods. Then they tell us that if we do so, it will only make about .5 degrees difference in those increases.
• Karl Rove (the Deputy Chief of Staff under former Republican president George W. Bush) wants us to believe that what's wrong with the country today is that Democrats are spending too much money, when the Administration that he worked for was doing pretty much the same thing on only a slightly smaller scale.
• Democratic Speaker of the House Nancy Pelosi tells us that Congress needs to pass health care legislation first, so that we can learn what's in it afterward. (which may not make sense but does kind of solve the problem that Congress has been having in reading bills before voting on them)

I'm sure that there is a reasonable and logical explanation for the apparent disconnect of such information, but I'm damned if I can figure out what it is, which is I suppose why I at least am considered stupid. 


Now perhaps there is a government study currently going on somewhere, consuming vast amounts of tax-supported resources to come up with a truly scholarly work on the subject. Have no fear however, when and if the answer is finally released in such a ponderous document written in academic code, we will all probably be too stupid to understand it.

Health Care Compromise Meeting

Updated 
(after rest and additional coherent thought) I did not watch the coverage of the health care compromise meeting held yesterday between the President and member of both house of Congress (one should never watch the sausage being made). I did read a number of the summaries of this meeting however, as well as watching some clips pulled from the sessions and the roundtable discussions of political pundits attempting to spin the meeting one way or the other. 


I have come to my own conclusion on these sessions after digesting all of this information and thought that it might be worth sharing. The version of compromise that the President and Democrats are proposing to Republicans seems to boil down to this, "You must compromise your legitimately held principles, or we will compromise your virtue." 


This is the essence of the reconciliation process in Congress, and the Republicans have used it more in the past than the Democrats. The process of the Thursday meeting however was additionally marred by the Democrats leaking the fact that they were looking at the reconciliation process days before the meeting was held, seeming to indicate that it was far from their intent. The gathering was likewise held up as little more than poor theater and sham politics as both sides postured before the cameras (somehow it seems impossible to keep politicians from overacting when cameras are running). 


The president managed to solidify his position as "Abuser In Chief" by monopolizing the conversation that he had called in order to listen, and by slapping down opponents during a meeting designed to foster bi-partisan support. To paraphrase Douglas Adams, author of the 'Hitchhiker's Guide to the Galaxy', "Ah, this is obviously some strange usage of the word Compromise that I wasn't previously aware of."

Mass. Election Strategy

Today is the day of the special election in Massachusetts, and I have been struck in recent days by the assumption of an apparent defeat of health care legislation if Scott Brown defeats Martha Coakley for the Senate seat vacated with the death of Ted Kennedy. It is not surprising that Republicans sense that this is their opportunity to break the filibuster-proof stranglehold that Democrats have on the Senate. Rather, it is shock that Democrats seem so willing to concede the death of legislation that the President and they have set so much stock in and worked so hard for. 


Somehow it simply seems incomprehensible that they should be so easily throwing in the towel on an issue that they have been trying to get passed for 20 years, and have never been closer to. Now it's apparent that Martha Coakley has run a feeble campaign at best since winning the Democratic primary. Perhaps she simply assumed, as did most of the rest of the nation, that Senator Kennedy's seat, held by him for some 47 years, was a title that should pass by divine right to the heir selected by his party. Perhaps Scott Brown simply ran a much better campaign than his rival, simultaneously distancing himself from the Washington DC crowd and the Republican party. 


But could this apparent surrender in fact be a savvy last minute strategy (or perhaps the only strategy left) for Coakley and the Democrats to win this election? I believe it is. Why else would such political luminaries of the Democratic party like former President Bill Clinton and current President Barack Obama tie their reputations to an effort considered already lost? 


This apparent concession however, does lend itself to two scenarios: 
1. The Coakley effort succeeds and the Democrats are able to claim that in spite of her poorly run campaign, this vote is a referendum on the President, the health care legislation, and the policies of Barack Obama and the Democratic-led Houses of Congress. The victory of Ms Coakley will be expected to shore up sagging support during final compromises in such health care legislation as many begin re-election campaigns, and empower Democrats to continue to move forward on the agenda outlined in the first year of the president.
 2. The Coakley effort fails and Democrats throw her under the bus, talking about just how poorly her campaign was handled and that perhaps she was not the best person to fill the shoes of a giant like Ted Kennedy. Likewise, they will say that this is a nothing more than a local election and that these are the yammerings of a few disgruntled Independent voters and "Teabaggers". As such, it has nothing to do with the President's agenda or Congress. 


In fact, Democrats must now unite behind the President and its leaders in Congress or face a return to the bad old days of Bush. Either way, rest assured (or as in my case, lay awake all night worrying) that there is in fact a Plan B, Plan C, and Plan Ad Infinitum still waiting in the wings out there for the current legislative agenda regardless of the results of this election. I simply find it more likely that Democrats have once again proved far more clever than Republicans give them credit for, and will use this apparent concession to energize their voters and get them out on voting day in the last days of this special election by threatening dire consequences to the "hope and change" only just begun in this country. 


It is likewise highly improbable that Democratic political operatives across the nation should be able to find nothing in their bag of tricks to turn this situation around and surrender, especially in a state that has traditionally voted Democratic politicians into office. 


As for the Republicans, they had best hope that in their exuberance over the turnaround in the polls in Mass. and the potential of winning of a long held Democrat Senate seat, that they have not once again blinded themselves to the political realities of the situation. They should hope that their but recently hoped for taste of joy be not turned to dust in their mouths by the cardinal sin of complacency by the time that this special election is over. 


(While I was at it, I couldn't help but throw in the "tin foil hat explanation": The Democratic Party, knowing that there was little or no chance to reach a compromise on health care legislation, asks Martha Coakley to take a dive for the team. She loses the election, health care legislation dies by filibuster after Brown takes his seat, and the Democrats get to blame the Republicans for being obstructionists and of abandoning the American people to evil insurance companies at the very beginning of the 2010 election cycle. I know, crazy ...)

Health Care Quote

Well, the combined Congressional Health Care bill is out, to the tune of just under 2000 pages. There is so much that I would like to say about this odious piece of legislation, but right now I am simply dumbfounded by the carbon footprint of printing it out, let alone the time and effort of reading it. While I am sure that I will have more to say on the subject after I have done so, I wanted to at least say something. Here it is:  

"If this is the future of health care in America, I fear that my long term plans to deal with personal illness will fall under much the same category as that of many southern states when dealing with snowfall. God put it here, and He can take it away." 

What Health Care Reform Doesn't Say

To say that I watched with interest the President's speech to a joint session of Congress last week would be stretching a point (OK, it would be flat out lying). In fact, the only bits of it that I managed to catch were in the process of channel surfing in order to see if it was over yet. 

You see, political speeches are for the most part well choreographed pieces of water ballet. They can be beautiful if viewed from the proper angle. They can even be exhibitions of athletic prowess when performed by professionals (as the President is). They are in the end however, performances that for the most part contain about as much intelligence and importance as a Marx Brother's movie in which Zeppo sings. 

This is no offense to the speechwriters, carefully crafting phrases to stir patriotism, fervor, and zeal among the faithful (and sometimes even among those not so faithful), after running each word and phrase through spin groups of various ages and ethnicity, and just as carefully tracking the results. This is no offense either to the actors/politicians who attempt to bring out the nuances of each written word and every pregnant pause, read them to their audience with the proper reverence, and hopefully manage to play their role in the piece with proper respect and without laughing at the insanity of it all. 

No matter how well crafted the speech however, or skilled the performance; in the end it's never what is said in these speeches that is important, but what is not. For example, in spite of the furor over the Joe Wilson "liar" remark, it was at least stated in the speech that illegals would not be provided care under the latest plan. What was of more importance however was that it was not said that no one was going to check those asking for treatment if they were a citizen (but there's no need to look behind that curtain). Likewise, what no one talked about and no pundits questioned in the later analysis was who wasn't going to be forced to participate under the plan.

• No one for example, asked if the President or the members of Congress, blessed with some of the best medical plans that money can buy, were going to be forced to give up those plans and participate ... they aren't.
• No one asked if an ever-growing number of union government employees at the federal, state, and local levels, who are the fastest growing number of workers in Washington DC (and the fastest growing percentage of union workers in many parts of the country ) were going to give up the health plans carefully negotiated by their union leaders and participate ... they aren't.
• No one even asked if workers at auto manufacturers who had just received government bailouts and have reorganized in such a way that the union workers had received substantial cash and stock to pay for retirement and health plans for current and retired workers were going to give up that money and stock and sign on to this government plan ... they aren't.

So while once more we were presented with a great deal of pomp and circumstance, while we are provided with information that is likely to change faster than the weather, and while we were presented with facts and figures that are subject to more dispute than the basis of many religious conflicts, in the end what we were given a piece of prose that would make the former writers of the episodes of "The West Wing" proud (and be almost as full of carefully crafted fiction). What we were left once again were far too many questions unasked and far too much left unsaid. 

Coincidence?

The time is fast approaching for President Obama's health care speech to a joint session of Congress. I have no intention of listening to another speech either by the president, or by anyone on health care in this country again this week. 

 As a consequence the search for available options was on. Surfing around my limited cable service, I noticed that one of the alternatives was a movie on American Movie Classics (AMC). It is an old Arnold Schwarzenegger and Gabriel Byrne film from 1999, "The End of Days". I know that the movie played over the holiday weekend on this same channel, but I have to ask: "Could the timing of a showing a movie about the end of the world playing at the same time as the president's speech to Congress be a coincidence?" 

A Public Option?

When did we ever get to just try a government program? 

 I have been reading a lot of US History lately, and in none of it can I discover the answer to this question. Oh there have been bad laws passed by Congress that have been repealed, Supreme Court decisions which have been made and later reversed, there was even the 18th Amendment (Prohibition) which was later overturned with the passage of the 21st Amendment. There has never however, been a government program that once begun has not been continued, no matter how much money it cost or how great a failure that it proved. Take for example:

• Federal Income Tax
• Social Security
• Medicare / Medicaid
• The War on Poverty
• The War on Drugs

Federal Income Tax is now costing the government more in enforcement than it brought in during its first year, with a legal code numbering in the ten of thousands of pages. No one likes it, no one (including the IRS) understands it, and no one thinks that it's fair; but we keep it going. Social Security is for all intents and purposes bankrupt. It will not provide the support it was intended to, has been expanded into areas that it was never intended for, and is almost universally hated by those it was intended to aid. As for Medicare and Medicaid, they have simply proved that what the government doesn't know about supporting its poor and aged is only equaled by what they don't know about their medical care, which I guess can be assumed to be alright, since this program is also currently bankrupt.  

As for the War on Drugs and the War on Poverty; not since the War of 1812, where the US lost almost every battle of the war (except for the Battle of New Orleans which was technically fought after the war was officially over) and had the capital captured and burned has such a fight proved so disastrous. Not only did we fail to achieve the objective, but the billions of dollars squandered in the process without achieving any level of victory is almost treasonous when compared to comparably costing military campaigns.

And yet, as we're standing on the threshold of asking the government to take on the entire burden of medical care for the citizens of this country, we seem to expect a different result. Looking back on consistent and overwhelming failure on the part of the federal government in projects of such scope and importance, we seem prepared to try again. Recognizing throughout history that once this road has been started down, we will never be able to turn back, we appear almost eager to begin the journey.  

This proposal is not an experiment. If the federal government once establishes a bureaucracy to take on the burden of national health care, it will never relinquish control of either the money or the power that will come to the petty bureaucrats that assume it. No matter how it fails or what the cost in money, happiness, or human life; we will never be able to stem this tide.

And so I ask that if nothing else, before we allow ourselves to be bullied into yet another government failure, before we place not just our health, but our very lives in the hands of self-serving government officials who will not participate in the very program that they demand that we do, before we allow yet another government travesty to be perpetrated upon us, that we at least realize what we do. Once we commit ourselves to this program, there will be little left to us but the Public Option.

Side Effects

I have at long last come to believe that the pharmaceutical companies are one of the true banes of Mankind. This is not to say that I have bought into the conspiracy theory that they are charging too much and making obscene profits from the treatment and cure of disease, or that I have drunk the Kool-Aid and now agree that they are in a secret conspiracy to defraud the public while secretly keeping the cure for cancer or some other such disease from us. No, their crime against humanity is much more grievous in type and insidious in nature than that. 

That crime, for those of you too busy watching the TiVo reruns of the "X-Files" or "The Daily Show" instead of news stories, is that somehow these evil doers have convinced us to take their medications, the side effects of which are far more scary, painful, and humiliating than the conditions which they purport to treat; even after they've informed us in their commercials of the true nature and gory details of those effects. 

In the process of treating things like depression, addiction to cigarettes, or erectile dysfunction they are exposing us to other conditions of a far more serious nature. (I know, I know, what could be more serious than erectile dysfunction?) I mean come on people, who wants to be cured of nicotine addiction with the side effects of depression, loss of will to live, or suicidal thoughts. 

Speaking of depression, what does it mean about a product that treats such a condition when its side effects include continued thoughts of depression or suicidal thoughts. (Is it just me, or does it seem to you that such side effects actually mean that the medicine isn't working?) 

And as to erectile dysfunction, even if you had the side effects, how would you find the strength of character to admit them? Who is going to the Emergency room to report that they have been able to perform sexually for over four hours, and continue to remain ready to do so? (Other perhaps, than the exhausted partner of such a potential patient, of course.) 

And lest we believe that these are not the only conditions that we have to look forward to in our moments of physical weakness as we submit ourselves to the tender mercies of these Marquis de Sades, let me go on. Rashes, shortness of breath, heart palpitations, and anal leakage wait just around the corner for those of us willing to place our health in the hands of these so-called miracles of modern medicine. 

I have to ask myself whether such travesties of medical science will be allowed to continue under whatever surfaces from the ongoing health care debate. Will a government, never very good at predicting nor capable of dealing with the unintended consequences of their actions be able to cope with the licensed dispensing of the chemicals that the health care industry suggests we ingest? What will they be and how can such government health care hope to handle the "side effects". 

Kenneday Kare

Does it disturb anyone else that the passing of Senator Edward "Ted" Kennedy has inspired some members of Congress to capitalize on the death of one of its more famous and notable liberal lions by using it to pass the currently proposed piece of health care legislation and naming it after him? 

Can anyone else see the irony of the fact that this rather well-to-do legislator received care that would have been consisting of expensive and experimental treatment that any of us would have been denied in similar circumstances based on age, history of an unhealthy lifestyle, and current health? Is anyone else aggravated by the fact that if the plan had already been passed and implemented, that it would have made little difference in the care that this member of Congress would have received; as under the proposed plan such government employees (along with members of certain unions) would not be forced to participate in the very plan that they would like to force on us? 

Taxation As Behavior Modification

Is it just me, or has anyone else noticed that most of what Congress seems to be doing lately seems to have some rather shady undertones to it? Maybe I am completely wrong here (something that I have grown used to with shocking regularity), but most of the recently instituted or recently changed regulation and taxation seems little more than a thinly disguised effort at government behavior modification?

• Gasoline taxes go up and we drive a bit less.
• Property taxes go up and we move into a smaller house or to a place where the taxes are less (or of course we get foreclosed on, and lose the house) .
• Business taxes go up and we lay off people or move the business to a more business-friendly environment.
• Tobacco taxes go up and we either quit or cut down on smoking (except for me of course).
• City and state income taxes go up and we reduce our lifestyles or move to a place where taxes are less.
• Federal taxes go up and we reduce ... well, pretty much everything that we do.

And if you think that the government hasn't noticed how effective that this modus operandi is, you're kidding yourself. Members of Congress may not be the brightest bulbs on the tree, but they are master manipulators. (This may in fact, be the greatest understatement ever made in the history of Just Blowing Smoke.)  

Consider the taxes our various levels of government are considering, or have already passed in some areas around the country to perform such modification:

• Banning or taxation on the use of trans fats in the cooking process of foods
• Taxing carbonated drinks with sugar in them (and for those that think that this will mean only soda pop and therefore pass them by, consider that most energy drinks contain sugar).
• Taxes on purchase of goods and services on the Internet.
• The massive taxes on energy that will come if the Cap & Trade legislation manages to get through the Senate, something which affect every aspect of our lives and every action that we take.
• And last but not least, the taxes on that are being considered on employer supplied health benefits as the first step down a path to socialized medicine. Medicine that will in turn be rationed by government bureaucrats who will judge our need on how well we follow all of these new government guidelines

I find it funny that as we continue to congratulate ourselves as the "Land of the Free", we allow such restrictions on our freedom from our elected leaders. Oh sure, we tell ourselves that this is not what's actually going on, that we in fact change our behavior on our own and not at the impetus of government, or that such behavior modification is not the intended goal of such legislation; and yet it continues. 

Even when we recognize that we have been hoodwinked we allow it to continue without real complaint. Even when the government recognizes that they have in fact taxed a behavior all but out of existence, the process continues and sometimes even accelerates. Even when we do raise our voices in complaint, we fail to sustain such dissension, choosing rather to become a more complacent, more compliant, and a more manipulated population. 

Pop Go The Weasels

Having changed forever the way that we look at capitalism, our government is ready to move on to its next "crisis". This is a crisis that must be dealt with NOW, or the very life and health of the American people is at stake. Of course this problem is what to do about health care. 

Now like me, many of you out there may have a failing memory. You may therefore not remember that we had this same crisis with us (and many of the same answers proposed) the last time that we had a Democratic president. It was back in 1993, and First Lady Hillary Clinton chaired the task force on health care reform. 

The conclusions reached 16 years ago, strangely enough, was that even then we were all doomed unless the government stepped in and began to take control over a major portion of America's health care. Congress however, did not seem nearly as anxious to meddle in this rather significant part of the GDP as the President and First Lady however, and in spite of the Chicken Little predictions of the world's ending, they failed to pass any new health care legislation. 

Amazingly enough, somehow we survived. The Obama Administration however, seems to be on a roll these days. No one seems to know how to say "no" to this man on any amount of money, any level of bureaucratic increase, or any level of control or interference that he sees fit to make in the private sector. In fact the government seems to have shifted the argument on health care to how much of an additional role the federal government will have and how much control it will have in deciding treatment rather than whether such a role for the government is necessary in the first place. 

The dirty little secret that few like to talk about in these days of multi-trillion dollar debt however is how much it will cost and who will pay for it. According to a June 16th Wall Street Journal article by Greg Hitt and Laura Meckler, the first 9 years of this plan are expected to cost at least 1 trillion dollars (a number that used to mean something until a couple of months ago). Government speak tells us that if this is the estimate now, the reality will in fact be far more, how much more nobody really knows. 

This is a lot of money to raise for the Fed's coffers now that tobacco has been taxed to the point that any further raises in the rate might kill the golden goose. Enter soda pop... It seems that some in government think it a good idea to pay the bill for government health care expansion by taxing soda pop with sugar in it. After all, such liquids have been linked to both obesity and to diabetes in the past. Since these diseases will likely add to the overall cost of a person's health care, such taxation seems only logical.  

So goes the slippery slope of a tax and spend, progressive, statist point of view. First it was tobacco and now it's soda pop (I guess memories of Prohibition are scaring them away from alcohol for now). When they find out there's not enough money to be had in soda taxes, you won't have to wait long for the french fry tax, the cheeseburger tax, the cheesecake tax, and maybe even a doughnut tax. It will all be argued as a logical necessity to our health and well being, but is truly nothing more than government behavior modification through taxation. 

We will allow the government to take just a bit of our freedom in the name of our health, in effect punishing us for making choices that they do not approve of. And as these rodent bureaucrats scurry around Washington, gnash their teeth, and salivate over their petty victory over us, as they gloat while counting our money in their wasteful pockets, as they do truly chase "us" around the mulberry bush (instead of as the lyrics of the nursery rhyme go); it will be "Pop!" goes the weasels.

SCHIP Update

For those of you cigar smokers who have not been following the SCHIP bill State (or more accurately, Socialist) Health Insurance Program, our president called together a rather hastily gathered group and quickly signed the final bill passed by Congress. 

Having found enough traitors to sign on to this massive step on the path to socialism and national health care, and desperately needing a victory in a week that his seen his Cabinet nominations going up in flames, our fearless leader signed legislation that has rather dramatically increased the taxation rate on hand rolled, premium cigars. In fact, he has increased that rate of taxation from approximately $.04 per cigar to approximately $.42 per cigar. Calling this "only the first step", in meeting his campaign promise of getting health coverage for every American (you know, the nationalized health care that we have been rejecting since the first Clinton Administration), the president lauded the efforts of Congress in quickly acting in the interests of the children of America. 

Even with this first step however, the numbers appear to tell us that President Obama will need another 23 million smokers over the next four years to reach the revenue levels required for a balanced budget on this program (at a time when there is money in the stimulus package to reduce the number of smokers in this country). What will happen if this additional tax or the efforts put forward by the stimulus package causes more people to stop smoking no one has yet explained, but perhaps the president will address this in his next press conference on health in the US.

The Cost of Medicine

With a great deal of idle time on my hands, I am often struck by strange thoughts while driving down the highway. This is something I have been doing a lot lately. (I mean driving down the highway part, not the strange thoughts. No, on second thought the strange thoughts come a lot lately as well, but oh ... never mind.) The thought that hit me on this particular trip came as I was nearing one of the cigar Meccas of the US, the JR Cigar store in Statesville, NC. I was thinking about loading up on cigars, because the SCHIP (State Children's Health Insurance Program) appears large on the Congressional radar screen. Without George Bush in the White House to veto that bill again, there is a better than even chance that it will pass and be signed into law. If it does, the tax on cigars will go up significantly in order to fund this program (and my anguish will likewise increase), and "Just Blowing Smoke" will become a lot more expensive for me.

This got me thinking about a different cost of health care however. It is one that will not be picked up by the SCHIP program, or any other government health program. It is also a cost that is not picked up by the health insurance currently provided by my employer, even after my deductible is met. In fact, it is a cost that entirely picked up by me, the consumer. It is also a cost that is directly attributable to the health care provider. This cost has nothing to do with the care provided or the technology required to provide it. In fact, there is plenty of technology available to alleviate the problem, not that it will ever be used. This cost instead is about nothing other than the lack of efficiency in the care provided. It is the cost of waiting.

I know that I have you now. There is none of us out there who has not sat idly, whiling away the hours in a waiting room well past our appointed time. No matter how punctual that we are in showing up to see our health care providers, it is rare indeed if they are equally so in providing such care. For those of us who have, or have had children who cannot get themselves to their appointments (Yeah I know , but you just can't get them to drive themselves to the doctor for at least the first 16 years) that total of wasted hours goes through a significant multiplier, as children require a great deal more care than adults and pediatricians seem even less able at clock management where appointments are concerned. I couldn't help but wonder over the thousands of hours wasted.

- How much the cost to each person or family in lost wages?

- How much cost in lost hours of productivity?

- How much the cost in wasted vacation and personal time?

- How much the cost in frustration, aggravation, and sanity?

- What is the cost to the consumer, their employer, and the nation based on any realistic pay scale?

My guess is that if the number could be determined, it would be staggering. Enough perhaps to pay for SCHIP? Enough perhaps to contribute significantly to perscription drugs for the elderly? Enough perhaps to reimburse taxpayers for the illegal aliens or people without health care who gain unreimbursed treatments in the emergency rooms across the US?

No matter however. While Congress and the politically correct commend themselves on striking a blow for children's health care, while the anti-smoking lobby pat themselves on the back for yet another blow to those who indulge in the evil pleasures of tobacco, while the forces for government expansion exchange their secret handshakes over another step on the road to nationalized health care; perhaps some few will step back far enough to recognize the monster hiding in the corner. Perhaps someone with begin to notice the inefficiency in handling the simplest of business dealings on the part of health care providers today, as it continues to be the dirty little secret of the cost of medicine.

 

Suffering Through Health Care

As many of them do these days, the idea for this posting came from an article I read in the Toledo Blade. This one, dated August 24th, talked about how the doctor-patient relationship is suffering in modern medical care; and why this is the fault of the insurance companies and a litigious society. 

I might be willing to give them some slack on the concept of medical lawsuits, as the only profession committing more a more egregious abuse of power than the doctors is lawyers. As for the rest, I have a few things to say on the subject. (Big surprise, huh?) 

Doctors tell us that they don't like being second guessed by the insurance companies. I can tell you that many likewise don't like questions from the patient or the family of the patient either. Society's recent creation of individuals who live for self-esteem has produced a group of doctors of almost unparalleled arrogance. If you question the tests being run, the number of prescriptions being written, or the standard of health being used as a guideline you are labeled as misguided, uninformed, or simply stupid. 

How dare anyone question the mighty medical professional in the performance of their duties! While we are on the subject of tests and prescriptions, does anyone believe that the never-ending gobstopper of tests being performed on each and every patient these days is contributing to the spiraling costs of medical care? 

Before any doctor will venture a guess about treatment, they ask for more tests than the combined number of exams that they took during medical school. This has us paying not only the hospital costs for the tests themselves, but the lab costs to process results from the bodily fluids and pictures taken and the follow up doctor's visits to discuss these endless reports. 

And what is done with the results of all of this modern scientific testing? The physician inevitably treats the test results instead of the patient. The goal becomes an experiment to produce a certifiably healthy person through the achievement of pre-approved test values. If the tests don't produce the desired result, change the parameters of the experiment through a different combination of chemicals, and retest. 

Lost however in this example of modern scientific medicine is the quality of life of the lab rat (I mean patient) who must submit to such endless experimentation without complaint or question. Let's not take out the profit motive either. What happens to the doctor-patient relationship when the person we normally deal with is not our doctor? We now rarely see those professionals, as a great deal of the work is done by nurses, nurse practitioners, and physician's assistants. 

All of these folks may have our best interest at heart, but let's be honest enough to say that it also facilitates the ability of a medical practitioner to run many more bodies through a version of assembly line medicine. Every caregiver does their part while moving the patient down the line, with the doctor doing periodic quality checks and consultation. While I would like to say that this helps provide greater care, I suspect that it might have more to do with producing better cost efficiencies and a greater revenue to patient ratio. 

Now in fairness to practitioners of the medical profession, they are not the only people exhibiting greed in this industry. Insurance companies are corporations, and as such operate on the profit motive. They do everything that they can to deliver less for the premiums paid in order to maximize their own profits. The relative health of those paying the premiums means no more to them than the people buying gas mean to Exxon. Pharmaceutical companies follow a similar corporate path, with the additional questionable practice of enlisting doctors into their misbehavior. Free samples, medical conferences in exotic locales, and experimental research sponsorships all skate a fine line (and often cross it) in the relationship between doctors and patients. 

And what shining example do these corporations have model themselves on, why the Federal Government. This model of management efficiency, limited bureaucracy, and fiscal responsibility all but insures that abuse of the system (and the patient) will be the order of the day.  

As for the lawyers, they are just the scavenging bottom feeders of the process. Taking a depersonalized system and the mistakes that are bound to occur with "assembly line" medicine, they simply try and turn any of the quality control issues into a winning lottery ticket. 

Oh there are real wrongs to be righted and evildoers to be brought to justice, but I fear that more often than not these situations would be better brought before "Judge Judy" than a jury or our peers who see no wrong in multi-million dollar settlements for pain and suffering. Doing so might allow a bit of common sense to intrude into the process and would certainly reduce the cost of malpractice insurance, and as such, on medical care itself. 

But listen, if the medical profession thinks that it's difficult to deal with insurance companies while trying to do the best job that they can for their patients, if they think that the paperwork and regulations are constricting and overwhelming now, if they think that they have seen what life can be like when dealing with an unfeeling and uncaring bureaucracy; just wait and see what happens if we get "National Health Care" and the government takes over. 

All of this discussion of the current state of medicine is making me feel a little woozy. I think that I'm going to go lie down.

 

Personal Health Crisis - Government Fails To Act

I am one of a growing number of individuals with a serious health concern, one almost reaching the level of a crisis because my government refuses to take action. You see, I get serious allergic reactions when exposed to a certain pollutant which far too many of my fellow citizens seem to show little or no concern about the production of. These allergic reactions can lead to serious asthma attacks which can make breathing all but impossible for me. And where is my government on this? Nowhere to be seen. 

Oh they continue to make them more difficult to purchase; but the truth of the matter is that my government has made it abundantly clear that it will take little or no action to alleviate my suffering, afraid of the loss of revenue involved and a desire to appease those who feel the need for such purchases.  

Trapped in buildings both public and private which are permeated by this substance that is toxic to my system, I am left gasping for breath while my government, who tells me that they are so concerned about my health, treat this situation as nothing more than an opportunity to generate additional revenue through taxation with no real concern for the potentially fatal risks that I and others face. Impervious to my protestations, my fellow citizens not only choose to indulge in this disgusting purchase; but in fact seem to revel in the possession of such things, counting themselves better than we who reject this particular form of air pollution. 

Complaints of my suffering are met with a shrug, and the implication that this is my problem and really none of their concern Perhaps some day, some real attention will be directed to resolving this growing health crisis, and the purchase of these misbegotten things will in fact be banned once and for all as the health hazard that it is. Meanwhile I will soldier on bravely, inhaler clutched tightly in hand, my every next breath in constant jeopardy. For those of you who haven't already figured it out, I am speaking about ... CATS!  

This is nothing against cats, in spite of their unintentioned (at least as far as I know) attempts to end my existence. The point here is that isn't it amazing what some things can look like from a slightly different perspective?  

"The cat could very well be man's best friend, but would never stoop to admitting it."
- Doug Larson

 

I Am Sick of Health Care

Now I have talked about health care before and I have talked about government. I have even talked about government involvement in health care when I talked about how the passage of the SCHIP was going to affect my stogie smoking habit; but evidently I need to be clearer on the subject so that my voice will be heard. So here it is: GOVERNMENT HAS NO BUSINESS IN HEALTH CARE!  

The truth of the matter is that government has no business in any business, but health care is far too important a thing to turn it over to bungling politicians. Let me be very clear right up front that I do not believe in denying health care to children and old people. A Curmudgeon I might be, but as Christmas fast approaches I would like to think I have far more like Santa than Scrooge in my nature. 

And because I am concerned about people, young and old, rich and poor, and even myself for that matter; that I beg you keep government from gaining more control of the health and well-being of its citizens. What will happen to the young, the old, the poor? How will they be able to afford proper health care? My answer is simple, "Who do you think made health care so expensive in the first place? Who forces us to pay for the endless forms, the printing of the rules, regulations, and guidelines? Who demands that we pay for the faceless bureaucrats who created this overly complex and incomprehensible system that medical practitioners have to operate under?" 

Perhaps if we had less government involvement in health care, those very groups that we are most concerned about would have better access to more affordable care than they do today. It is government that regulates everything from the certification of doctors to the process of drug testing. It is government that creates the paperwork that doctors and hospitals have to fill out before and that takes time away from actually treating people. It is government that demands tests that doctors don't want to give to patients who don't want to have them. It is government that mandates what treatments will and will not be used, regardless of their potential benefit. 

Without spending the mind-boggling number of hours that it would take to assemble all of the facts and figures on the costs of all of this(besides someone considerably smarter than me has probably already done so), I feel pretty safe in saying that the Federal health care programs of Medicare and Medicaid probably spend as much money, if not more, on administration and bureaucracy as they spend on the care that is being provided. And like every other failed government program, what we find is that very government excepting itself from participation while asking us to consider more government involvement. 

So what about us? Are we at fault for the state of medicine in this country? The short answer is yes. We all seem to sit here fat, dumb, and happy; looking for our piece of the prize. We have paid health insurance premiums and tax dollars for Federal programs, and we would like to get our money back (and a little more if we can manage it, please). Where do we think the money comes from? The money that funds these programs is our money, and if we weren't paying it out in taxes, we could use it for the very medical care that we seek. That little bit extra is some else's piece, and there can never be enough to give everyone a little bit more (especially when you subtract the graft and inefficiency that our government has become famous for). Fortunately for the government, we all appear to be dumb enough to buy into all of this in the name of "better care". Few of us seem to realize that this can never be a zero-sum situation as long as we leave it in the hands of government. Can we really believe that the politicians and bureaucrats that have bankrupted the Social Security System can and will do any better if we turn over more of our hard-earned money and our freedom of choice in the hope of being protected when we get sick? We would be far better off being protected from these very politicians and bureaucrats who may end up protecting us to death. 

The Declaration of Independence speaks of the unalienable rights of "Life, Liberty, and the pursuit of Happiness". Those rights are not results, but opportunities for citizens to seek those things for themselves without government interference. The Founding Fathers specifically limited the power and responsibility of government because they understood the danger inherent in not doing so. 

The Tenth Amendment to the Constitution specifically talks about the fact that "powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." For those of you who suffered through public education, that means that any powers not given to the government by the Constitution belong to the people, and that the only way that this can change is for us to surrender them. In my parents day there was not only no government support for health care, there was not even health insurance. 

Somehow, during those dark days, when dinosaurs still roamed the earth, people were able to afford health care the same way that they afforded homes, food, and cars. Not everybody lived in as nice a home as everyone else, or ate food that was as fancy, drove the same kind of cars, or were treated in private rooms in private hospitals; but they were able to live good, happy, and relatively healthy lives. They did it in the case of health care because they decided what kind of care that they wanted, who they wanted it from, and how much of it they were able to afford. They did it with money that they were free to earn, largely unburdened by taxation and without the interference of the government. Our only hope of survival may be to return to those days. We don't need more government health care, we need none. 

The "Practice" of Medicine

I promised, when I verbally abused the legal profession, that I would do the same for the medical profession. Taking my word seriously (It may be in fact, about the only thing that I take seriously) I am therefore happy to present the following: Like most people my age (yeah, yeah I know, older than dirt), I am dealing with the fact that my body does not function the way that it used to, that I expect it to, or that I would like it to. I don't feel the need to be terribly concerned; but much like proper auto care, preventative maintenance is the best way to keep the old heap around, so I attempt to make the effort that is required. It sometimes seems to me however, that the actions of the medical professionals that I have placed in charge of my health could be what ultimately causes my demise. The methods to extend an existence which I am sure some people think has already lasted too long is causing me to agree with these critics. Like the medicine commercials that you often see on TV, the side effects of the treatment appear to be worse than the disease itself. Perhaps this is just the nature of managed health care as we know it today. Health care professionals I suppose, in an effort to treat as many and as much as they can, appear to be experimenting on us most of the time (it is called a practice after all). Treatment consists mostly in the taking of tests and medications that can then be adjusted to reach an baseline established by a bunch of medical researchers who probably have no lives themselves. Add a little this, take a little of that away, and pretty soon you get where they want you to be. This is a great way to make chili (and I gotta tell you that I have learned to make great chili this way over the years), but I'm not sure about using it to make a great ... me, and I have a few problems with it:

• It makes me feel like a backyard pool whose chemicals you adjust every time you take a water sample. Why can't I just take a medicine (or combination of them) and feel better? Why is it necessary to adjust the combinations and doses endlessly?
• Second, adding and subtracting these chemicals costs MONEY! Even with health insurance, the cost of these medications is more than I would like to be spending in the hopes that some day my numbers will look good on somebody's chart. (In fact, the amount is enough to lease a really nice car, and is fast approaching a house payment.)  
• None of this ever seems to be designed in order to make me feel any better. Instead, all it appears to do is make my personal numbers closer to the accepted guidelines. (Maybe it would be easier for them to treat the chart instead of me.)
• All of this experimenting has what the professionals call "side effects". Drug interactions, drug resistance, and (the big one) negative reactions during this seeming never-ending process have profound effect on quality of the life that I am supposedly taking these medications to achieve.
• Failures in the proscribed treatments are not failures on my part. The fact that the guesses being made on my behalf are not working is not because I have done something wrong, or that I don't want my numbers to get better ... so stop trying to make me feel guilty about your failed predictions.
• Finally, that having achieved a certain momentum in the path of life that I have been following, I am not all that willing to make drastic changes in order to ahieve little more than making these health care professionals happy. Beyond a certain age, all of us resist and resent change, no matter how altruistic or beneficial the motives.

Our health professionals need to start realizing that the patient is a person and a customer to be served, not a servant to be ordered about; and certainly not an experiment to be successfully completed. I am willing to be counselled and guided, but not to be scolded and ordered. They need to understand that most of the things being done in the hopes of keeping us healthy make us feel pretty lousy and are keeping us in the poor house (which makes us feel even worse). They also need to realize that the charts that they are asking us to conform to are only the latest in a series of numbers that the researchers change more often than they change their clothes. The Quality of a Life should be as important as any concern in this process; and that information won't be found on any chart, nor discovered by any test. I therefore ask that they keep in mind a bit of wisdom that at the very least, is becoming a meaningful part of my life these days:

"Having given up everything that I need to in order live longer, I now find that I no longer wish to..."