Monday, August 31, 2009

Here’s The “Greatest Compromise’ Senator Ted Kennedy Should Have Achieved

There has been a lot of talk this past weekend about whether now-deceased Senator Edward Kennedy of Massachusetts was the 20th century equivalent of the 19th century ‘Great Compromiser’, Senator Henry Clay of Kentucky.

Democratic republics in history always have relied on brave leaders who stand up to the major challenges of their time to work with other elected leaders to lead the public to a solution, be it in war or domestic policy. Henry Clay’s work as a compromiser earned him the name of ‘The Great Pacifier’ since civil war was averted by close to 40 years due to his diligent efforts in the US Senate.

We had a chance, one fleeting moment in history in 1998 when a truly “Great Compromiser’, as Senator Kennedy has been described lately, could have stepped forward as a true American hero to forge a compromise that would have saved us from the spectre of this $20 trillion debt now being bandied about. We could have had a massive compromise then that would have arrested the upward cost spiral in federal entitlement programs that now appears out of control.

Had Senator Kennedy done that, we might have personally led a fundraising campaign to etch his visage along with those of President Bill Clinton, House Speaker Newt Gingrich, Republican Leader Dick Armey and Republican Whip Tom DeLay on the next Mount Rushmore had they succeeded, as strange as that fivesome might seem today.

But they failed to seize the moment to do something truly great for our nation for a very simple reason as you will soon see and ruefully regret, for your sake and your generations to follow.

The one over-riding problem, national crisis really, that neither Senator Kennedy nor any other American leader over the past 30 years has been able to slay for good has been to address and redress the spiraling costs of federal entitlements, mostly the exponential rising costs of Medicare and Medicaid. Apparently, the excessive costs of these programs just didn’t concern or impress Senator Kennedy enough to tackle; he was content to pass expansions of both programs without much regard or concern for the costs that we or our children are going to have to pay down the road.

The ‘Golden Opportunity That Was Lost’ came in 1998 soon after the heels of the passage of the Budget Act of 1997 that led to the only 3 balanced budgets the vast majority of us Americans have ever seen in our lifetimes, or will ever see again. (Think about that for a moment and let that sink into your cerebral cortex some)

President Clinton and the Republican leaders in Congress were riding high on the heels of being able to come together and act like adults to compromise and pass the balanced budget act for the good of the nation.

Efforts began almost immediately behind the scenes on both ends of Pennsylvania Avenue to come together swiftly on a far larger, comprehensive entitlement reform package that would have finally structurally changed these programs before they break the U.S. Treasury.

Raising the age eligibility to more realistic levels, erasing the almost preposterous notion that billionaires such as Bill Gates and Warren Buffett must be included in entitlement benefits in order to insure their support for both programs (we estimate that both gentlemen pay their full contributions to FICA in, oh, let’s say, about 5 minutes at the beginning of each new year) and other fundamental reforms that absolutely must be passed by Congress to start the budget trend lines turning downward, not upward for generations to come.

And the whole monumental effort to save our national fisc was derailed by three words early in 1998: ‘Monica’, ‘Lewinsky’, and ‘Impeachment’.

What is that old saying about “For the want of a nail, a war was lost?”

That’s it and that is the truth. All of the goodwill and trust that had been engendered during the 1997 Budget Act effort just the year before was summarily tossed out the window into the Potomac River never to be seen again. We have been struggling with almost the total lack of bipartisanship, compromise and statesmanship in Washington ever since.

So when you hear stories about Senator Kennedy being a great legislative dealmaker, get on your knees and say your prayers that we will see a true ‘Great Compromiser’ come to the forefront very soon to deal with these exploding entitlements. It will most likely take another ‘Nixon Going to China’ moment where some extremely brave Democrat leader is willing to stand up to the AARP and say the future of this nation is more important than cow-towing to that supposedly non-political body and make the hard decisions we need to move forward.

President Obama could be that transformational leader if he takes up this challenge. Let's hope he is. Our nation needs him to be.

Wednesday, August 26, 2009

“Will You Still Need Me, Will You Still Feed Me When I’m 64?”

If our kids have any money left over after paying taxes for the interest on the national debt, maybe they will.

We want to be positive about things so let's put it this way: ‘We can do better than this, all you Boomers out there!’

And if we don't, our children might not feed us in our dotage as Paul McCartney so eloquently asked in his great song.

We, the Baby-Boomers born post-World War II from 1946- 1964, the most idealistic, ideologically-separated generation in America since the Transcendentalists pre-Civil War, have the chance to leave behind for our kids and grandkids either a clean campground or one filled with enormous debt.

Like the $20 trillion in projected debt the Obama Administration just announced this morning. People will complain and say that it is Obama's debt or Bush's debt. It is our collective debt; it reflects our conflicting desires to have it all now and not pay for it with current tax dollars and we have been doing it for the past 40 years.

Typical modern-day American attitude, isn't it?

Liberal or conservative, libertarian or independent. Pro-life, pro-choice, green or non-green. We all have a joint stake in leaving behind a better future than this massive debt that is now accumulating at an alarming rate.

It just isn’t right.

Now, it is true that we have lived with what many have considered to be outrageous amounts of debt from roughly 1965-on. When I went to work for Congressman Alex McMillan in 1985, we were trying to reduce the then-enormous $221 billion budget deficit on a $946 billion annual federal budget. The national debt was $1.5 trillion.

That was scary then, scary enough to make me run to Congress to 'fix it'. It only took 13 more years to actually see a balanced budget.

The economy was roughly $5 trillion in size in 1985. But GDP has almost tripled since then and is now about $14 trillion even with this nasty recession going on. So we have survived and even prospered as a Republic as the debt stepped up to $3.4 billion by the time President Clinton left office in 2001.

The Obama Administration started with a $9 trillion debt left by the Bush Administration and a republican Congress from 2001-2006 and a democratic Congress from 2007-on. And now with this announcement, we are staring at $20 trillion in debt by 2017 unless we make some radical modifications to our national spending spree.

We can handle certain amounts of national debt in this country. After all, we are still the United States of America, aren’t we? We will grow our way out of this, won’t we? We have lived pretty well with debt levels ranging from 25-35% of GDP for the past 3 decades now.

But being 'able' to grow with enormous debt loads doesn't mean we 'have' to do it. That would be like being able to drink a gallon of whiskey because you are 21 doesn't mean you have to do it, now does it?

Why put ourselves at too much risk? What happens if the interest rates on 10-year treasury bonds go to 10% as they did in 1979? 10-year treasury notes currently yield about 3.5%.

Going to $20 trillion in national debt is just too gigantic to ignore. That will be close to 100% of GDP and stay there for years and years. Even if the GDP doubles in size by 2017 to $28 trillion, that $20 trillion debt will represent 71% of GDP then. CBO estimates that the GDP in 2019 will be only be $23 trillion in nominal terms.

Here is the sobering truth of the matter: If we do get to $20 trillion in federal debt, it will take 200 years to get it paid back down to zero if it is paid back at $100 billion per year. At the very least, just getting it back down to around 35% of GDP, we will have to pay down perhaps $200 billion per year for at least 65 years, assuming we don’t keep adding to the debt burden.

We have always followed periods of high national debt by paying it down and allowing the economy to grow out of it. But in each of the previous cases, the national debt went sky-high when we were fighting wars of massive magnitudes to gain or preserve our freedom. This is not the case nowadays.

It is a reckless and careless path we are now embarked on as a nation. Since the generations that have come before the Boomers have failed to arrest its growth, we are the ones left standing with the means and the responsibility to do it on behalf of ourselves and our children.

So, Boomers, let us all resolve to continue to have our differences about abortion, global warming and all of the other issues we have been so compelled to argue about over these past 30 years. They are energizing, important and in some cases, entertaining to have as intellectual discourses go.

But the one thing we all have to band together and agree upon, right now, this second in this moment in time, is that we will not tolerate the expansion of our federal debt to the $20 trillion level as lodged in current economic projections.

We can do better. We have to. It is that simple.

Sunday, August 23, 2009

“Stick a Fork In the Obama Health Care Reform Bill”

The President’s own OMB (Office of Management and Budget) Director is about to announce revised projections upward of over $2 trillion over the next 9 years to the nation’s budget deficits and national debt accumulation.

That is BEFORE any projections are put in there about the $1.4 trillion (we think it will be $3 trillion) health care program now under consideration in Congress.

Put quite simply, there is a saying on Capitol Hill that “you can now stick a fork in the bill because ‘It Is Done!’”

There is absolutely no way on God’s green earth that any sentient, intelligent, thoughtful congressional representative can now vote for such a massive expansion of federal spending in the face of $2 trillion more in deficit-spending. (I know that leaves a lot of room for non-sentient representatives and senators but you get my point)

The only reasons why anyone in Congress can possibly say now that they are going to vote for this monstrous expansion of federal spending in the face of yawning deficits that your kids will have to pay, somehow, are the following:

1. I can’t read or write.
2. I can’t add or subtract.
3. I know nothing about economics, business cycles, monetary or fiscal policy.
4. I have never read the federal budget.
5. I think it will all work out in the end….don’t you?

Seriously, if you don’t consider running against any one of the people now representing your district in Congress if they vote for this monstrosity in the face of the truth about these deficits, you are doing your country a disservice and you are not a patriot. Your nation needs you!

Here is a way to test and see if your representative or senator is really serious about wanting to reform the health care system in America. And this will not cost one bloody red cent to the federal taxpayer. In fact, it will save hundreds of billions over time. And it could be passed tomorrow in an emergency session of Congress:

Ask them to pass a bill that deals with tort (legal) reform and malpractice insurance reform and let’s see what happens.

If doctors fees, hospital costs and health insurance premiums start to dip down in the next year or two, then we have hit one of the smaller veins of the Mother Lode of Health Care Reform similar to the silver rush in Nevada in 1858 with the discovery of the Comstock Lode.

And it won’t cost you, as the taxpayer, one copper penny or your kids one dollar of borrowed funds from their future prosperity.

Now that the explosion of volcanic ash debt from OMB has killed off this health care bill, let’s try to see if something else more reasonable works.

Friday, August 21, 2009

Will Having a “Public Option” or “Co-Ops” Lower Health Care Costs?

Did the competitive pressure of having the ‘non-profit’ Blue Cross/Blue Shield health care organizations help lower health care costs over the years?

They originally were formed as a ‘non-profit’ alternative to private health insurance companies back in the 1920’s to help teachers in Texas find health insurance coverage.

The presumption is that with non-profit status, a company could provide any service or good at a reduced price to the consumer simply because they don’t have to pay any taxes to the federal government.

Apparently, non-profit health insurance companies have not been the silver bullet to provide lower price competition over the years. 100 million people are now covered by BCBS non-profit entities. And yet, health care costs have been rising at 3-4 times the rate of inflation for the past 30 years.

Is there any tangible reason to strongly believe that adopting a public option, or even its cousin, the ‘co-op’ approach, will drive down costs in the health care system of America in and of itself as its advocates promote?

There has to be something else more fundamental going on beneath the surface of health care in America.

And there are, just to name a few:

  • Defensive medical practices by physicians
  • Duplicative medical diagnoses and claims by patients
  • New and expensive medical procedures and therapies
  • Expensive proprietary drugs that can help cure or contain anything from cancer to AIDS to high blood pressure.
  • An unhealthy lifestyle by most Americans, of whom 66% are overweight, obese or morbidly obese.
Without changes in these structural areas in health care, including tort reform, it is unlikely health care costs will plummet solely because there was a public option or co-op established nearby the currently operating for-profit or non-profit health insurance entities.

Here’s what we think would happen if the ‘public option’ or even the ‘co-op’ concept gets passed by Congress: Costs to the taxpayer will skyrocket over the next 10 years, probably to the tune of $3 trillion or triple the current cost estimate of 'only' $1 trillion.

“How can you possibly say that and mean it?” you might ask.

Because it has happened before, many times, in other government-run programs and not just in Medicare to Medicaid to state and local medical-related health programs. History is always a guide to future results in this regard.

It is the natural propensity for government programs to grow once they are passed into law. The problem with federally-supported health care since 1965 is that their growth in cost has been exponential in nature, not just keeping in line with inflation.

The natural order of any federal program is to be birthed amidst great hoopla and never die. Since the Reagan Revolution of 1980, the Clinton years, the 1994 Republican Revolution and the George W. Bush era, precisely one federal program has been abolished out of existence. Federal programs are the closest thing to having eternal life on earth, Ronald Reagan once famously said.

Once an altruistic program such as Medicare gets set into the law of the land, it becomes a natural vehicle for add-ons by well-meaning politicians and lobbying groups. It is never in large chunks but in such incremental steps that proponents can make opponents look like devils and insensitive clods if they stand in opposition to an add-on amendment that ‘helps grandma and grandpa” or “prevents needless suffering and death”.

Pretty soon, you go from a $5 billion Medicare program in 1968 to a $500 billion program in 2009. That is an expansion of over 100 times the original estimate of cost.

So before you get too enamored with the public option, into which the Detroit automakers will dump all of the employees and retirees into with seconds of President Obama signing the bill, if it ever comes to that, have a talk with your sons or daughters and grandchildren and see if they are ok with paying all of these enormous costs down the road.

It is on their tab, not ours.

Sunday, August 16, 2009

“We Don’t Want Socialized Medicine!”

One of the signs you see at all of those health care town hall meetings is this: “We Don’t Want Socialized Medicine!”

(Take it from someone who has been inside of politics and government for more than 30 years: The GOP is incapable of coordinating such directed protests on this sort of massive scale. If they were, they would have won the presidency and Congress last year. President Obama, as Community Organizer-in-Chief, based on the campaign he ran and won last year…now that is someone who knows how to organize people!)

But if ‘we don’t want more socialized medicine!’, then what do ‘we’, as a nation, really want? More ‘privatized’ medicine? The ‘same’ current unique combination of private utilization of health care supported by broad-based federal taxes on the entire population?

What in the name of George Washington and John Wayne is going on here?

No one seems to want true socialized medicine; no one seems to ‘like it’. And yet, the Obama Administration and the Democrats running Congress at the current time all seem to “want more of it”.

Here is what we would like to throw out there to just think about for the time being:

“What would it take to get the American health care system and attendant health insurance program heading towards a more privatized system?”

We have asked this question before. (see 'Principles') But now that we are flying right into the maw of the heated health care debate, we thought we would raise the issue again, to be more pointed about it.

Let’s face the basic facts of the matter. We have a privately-based health care ‘insurance’ system in America today, mostly funded by employers through the workplace, that pre-pays for 95% of all the health care costs we consume each year. The large majority of Americans are basically happy with it as it stands today.

Close to 50% of the current funding for all of the health care consumed in America comes from 3 pots of money paid by taxpayers: 1) payroll taxes; 2) general tax revenues and 3) borrowed billions from future generations. These taxpayer funds go to cover the costs of Medicare and Medicaid.

Don’t ever believe that the premiums paid by Medicare enrollees of approximately $300/month for Part B services cover the entire cost of Medicare. It does not, not even by a long shot. Those premiums cover 25% of the cost; 75% comes from the American taxpayer. The full cost of offering the standard, full-blown coverage for the average senior citizen in America is now around $1000 per person, per month.

That is around $24,000 per retired couple per year, ladies and gentlemen. And growing each and every day. We have got to find new ways to administer true health care ‘insurance’ not only for these seniors but for the entire population.

Let’s call our current health care system today something other than a ‘private’ or ‘partially socialized’ system. Maybe something distinctive like ‘Amerialism’.

Each of us wants to maintain 100% personal control over our health care decisions. But the vast majority of seniors can not afford the full standard health care programs and neither can those people who are living in poverty. We spend close to $1 trillion annually from federal taxpayer-supported health programs such as Medicare and Medicaid.

The real question right now before us is this: “Do we want to move towards more socialized medicine? Or do we try to turn this aircraft carrier around and point it more towards a true privately-based adminstered and funded health care ‘insurance’ system?”

We believe the first step is to recognize that we want to insure everyone against truly catastrophic outcomes that can wipe out family finances and then go from there. The next step is to reallocate sufficient funds from the existing Medicare and Medicaid programs to help pay for such high-level ‘insurance’ coverage for every person, not just seniors and poverty-level families. Adjust the federal-allocated share based on household income and net wealth status and provide some sort of assistance up to 300% of the poverty level. 1)

And then allow every person to decide for themselves which insurance plan to buy into regardless of state or area. Freedom of choice works in the GI college program and the VA housing program; why not in health care as well? For those who are incapable of making those decisions for themselves, the family unit or a government agency can help them make that decision.

Under such a plan, this ship will be rightly turned back towards a more private system and other reforms can be passed later to finally break the upward death spiral in health care costs in this country. Without such fundamental structural reform in the entire health care industry, we will not be able to meet the other very basic needs of our nation in a very short time.

1) See 'Jefferson Health Plan’

Thursday, August 13, 2009

Mythbusters and Medicare

Here are some questions you might want to ask your friendly neighborhood congressman or senator at the next health care town hall meeting:

1) What is the difference between Medicare and Medicaid? (Medicare is for seniors; Medicaid is for low-income people)

If they get that $100 question right, they get to try the $1 million question:

2) What do Parts A, B, C and D in Medicare cover? (A=hospital care; B=physician care; C=Medigap insurance plans and D=prescription drugs, all for seniors)

"And please, no cheating by asking a staffer for the answers, Senator/Congressman!"

If they can't answer these basic questions about the largest federal health plan they oversee in Congress, it is doubtful they should be making major decisions on re-arranging close to 16% of the GDP by voting for this health care proposal now before us.

Everyone knows there is a funding problem for Medicare and Medicaid staring us right in the face. Close to $50 trillion in net present value unfunded liabilities to be exact about it. We have some significant heartburn thinking about expanding such similar federally-run health services to the broader population when we really don't know for sure if we are spending every single tax dollar in an optimal way right now in Medicare and Medicaid.

Maybe proving or dispelling some of the ‘myths’ below might help first:

1) 20% of Medicare is “waste, fraud and abuse” (WFA)

This ‘factoid’ is so commonly thrown around that you almost have to believe it is true.

The Obama White House people ‘swear’ that they will be the first Administration to ferret out all of the WFA in Medicare and while they are at it, Medicaid, with the wonders of computer technology. This will unleash untold billions of dollars of savings that can then be turned around to spend on covering the 44 million ‘uninsured’ (which is more like 24 million, see '44 million?')

Well, the cynical side in us says that we had a computer revolution starting in 1980. Here we are 30 years later and we still can’t seem to find a way to get those elusive 20% WFA Medicare savings anywhere.

I have a friend in Washington who is a Medicare auditor and he says with conviction that on every single audit they do for Medicare, 20% of it is WFA. When I asked him if he wanted to go talk to some congressional committees about it, he said: “What do you think I am, nuts? I started in 2000 with 3 accountants and now I have 175 working for me. That’s as good of a business as you are ever going to see!”

Verdict: True. There is about $100 billion per year in WFA in Medicare, (20% of $500 billion). Let's actually find the savings first, save them and book them, and then maybe think about expanding services. Or how about reducing the national debt by $100 billion per year, maybe?

2) 20% of Medicare is spent on defensive medical practices (DMP)

When you sit in any congressional testimony on health care, you routinely hear doctors say they feel so threatened by potential litigation that they prescribe any and all medical procedures just to protect themselves legally, regardless of medical necessity.

You see it mostly in end-of-life situations such as when a doctor will prescribe “heroic’ measures in order to keep a loved one alive for a few more days, weeks or months, even in a comatose state. Why, you ask? Because only 29% of the American public have a ‘living will’ and a legal power of attorney that directs a physician not to engage in any heroic measures if their lives are coming to an end without any hope of recovering to full capacity. (Do you have both? If not, then you are part of the problem as well)

Until there is significant tort (legal) reform with compelling malpractice insurance reform, these defensive medical practices will continue ad infinitum. Even under the ‘public option’ that is supposed to bring costs down. All that means is the taxpayer will then be footing the bill for spurious lawsuits, not the doctor or the hospitals.

Verdict: Probably True. Another $100 billion down the drain in non-medical delivery to the patient costs. Let's get rid of DMPs for 100% sure before we expand services. Or maybe pay down another $100 billion per year in the national debt, perhaps?

3) People use too much medical services when the bulk of the insurance is paid for by a third party such as Medicare or a private employer. Maybe 20% more?

Well, if it is true that you can get something for nothing, you will probably take advantage of it, wouldn’t you? Would you use ‘less’ health care if you thought you were going to have to pay more directly for it in premiums, copays and deductibles? Probably so.

Verdict: Possibly true. $100 billion more in Medicare costs shot. Perhaps we could save this amount first, book them on the government accounts and then expand services to the uninsured. Or did anyone say maybe pay down the national debt another $100 billion per year?

4) Duplicative Medical Services. 10% or more in costs?

There is enough evidence that with a transient population and the desire to find a ‘good’ diagnosis versus a bad one, health care costs in general might be 10% higher than they should be due to ‘duplicative medicine'. If someone ‘shops around’, especially under a relatively loose and inefficient Medicare management system, for positive diagnoses from different doctors, who is to say that it can’t be as high as 10%, or $50 billion per year?

That brings us to around $350 billion per year in annual savings in Medicare alone if it was run ‘perfectly’, however that is defined. Out of a $500 billion annual budget..and growing.

Is this possible? Probably not. There has to be a lot of overlap between each of these categories. But can this $500 billion Medicare program be run better and more efficiently? Of course it can. When current government-run programs have so much spending unaccounted for, even if it is only $1 billion per year, we should not be so intent on expanding into other areas of coverage.

Let's do something truly radical: Find the actual budget savings first before spending the 'potential' savings (cause they might not ever materialize) on expansion of services.

These are some of the major structural issues that have not been addressed in the current health care debate at all. And until they are addressed and solved, any attempt at comprehensive reform is doomed to fail to arrest the upward spiraling costs to the taxpayer…or rather to your kids and grandkids.

Your congressman and senators should already know that. Ask them yourself.

Saturday, August 8, 2009

When You Go To A Town Hall Meeting on Health Care...

Know more about it than your average congressman. It won't be as hard as you think.

Read this excellent report from the Congressional Research Service (CRS), when you have time: "Medicare Primer" (especially pp.20-22)

And then go armed with actual knowledge and facts when you attend one of the many town hall meetings this summer in your area put on by your elected representatives in Washington. If they are brave enough to show up for them, that is…there are already reports of many of them ‘canceling for unspecified reasons’.

At a time when we are considering re-arranging the deck chairs on the USS Health Carrier representing over 16% of our national economy and the critical patient/physician relationship, you really need to know what is really going on. This CRS report is an excellent summary of the complexities and challenges we now face in solving Medicare, and in a broader sense, health care.

We will point out some other inconsistencies in the Medicare program later that need to be corrected but we wanted to fill you in on a couple of things about the town meetings you are hearing so much about on the news lately.

It is doubtful that many elected representatives or senators have ever read such a detailed report as this one from CRS. They rely on young staff to do that for them, many of whom have degrees in English, history, political science or philosophy, not health care. ‘Not that there is anything wrong with that’ as Jerry Seinfeld would say. The average age on the House side for staffers is now 24 years old; perhaps 25 years old on the Senate side.

There! Don’t you feel much, much better knowing that your health care system is going to be re-arranged with the help of young, inexperienced staff people who basically have zero experience ever working in the health care field? They are great people, ambitious and smart…I hired dozens of them right out of college.

But they are not health care experts in any way, shape or form. And neither are the majority of elected representatives and senators …there might be a small handful of maybe 5-10 people with some form of real health care industry experience now serving in Congress.

For many ambitious, idealistic young politicos on congressional staffs, this current health care debate is a dangerous and exciting game of chicken and politics. The thrill of riding the legislative roller-coaster is intoxicating to many of them, simply because an issue like health care reform is the “Super Bowl of all legislative Super Bowls” to them. It can lead to lucrative lobbying positions down the road where they can triple or quintuple their salaries, for example. (not that that is any great shakes when you start out making $23,000 as a legislative aide in many offices)

But to be a part of any historic landmark passage of legislation while serving in Congress, well….it only comes around about once every decade or so and to be a part of our nation’s history is too great of an opportunity to pass up.

This unsettling fact about the youthful makeup of congressional staffs is a major reason why you, as a registered concerned voter * have got to contact your elected officials in droves to express your opinion, plus or negative. Congressional staffs will respond to the pressure of hundreds of thousands of phone calls or emails; they can all count. When they see thousands of incoming messages like the Barbarians storming the gates of ancient Rome, they tell their boss: “Senator/Congressman So-and-So: You had better pay attention to these concerns!” (subliminal message to self: “…or else I am going to lose my job when you lose yours in the next election!”)

If you are upset that so many congresspeople seem so nonchalant about reading a 1000-page health care bill, or don’t seem to understand it, just remember that less than 10% of any sitting Members of Congress or the U.S. Senate at any one time really and truly understands health care policy in America. Some prefer to be an expert in foreign affairs; some in agriculture. So many of them default to their staff to tell them what to do on health care policy. Many of whom then just default to the talking points put out by their respective "study" or policy committees or the 'talking points' put out by the White House or the respective political parties.

Which is why you, as a registered voter, have got to go to any town hall meetings this summer to meet with your duly-elected representative in Washington and tell them what you think. Politely, of course.

Or email and call their offices….their links are conveniently located just to the right of this column. After reading just this one attached CRS report, you might quite possibly know more than the congressman or senator standing before you.

Don't let anyone ever tell you reasoned, passionate dissent based on facts, knowledge and history is a 'bad' thing. "Reasoned Dissent" is what founded our nation 220 years ago. It is your freedom to go tell your representatives what you now know and think about this health care reform package. It is one of the very few duties required of you as a responsible citizen of this great country of ours.

*If you are not a registered voter, stop reading Telemachus right now and go out and register right this very second! Because in the eyes of your elected officials, you do not count one whit until you are a registered voter. Sorry about that, but that is the truth.

Thursday, August 6, 2009

The ‘Umbrella Rebellion' Over Health Care, 1989

One of the unspoken truths about legislation at any level of government is this:

“If there is a hurry to get it done, it probably is not very good in the first place!”

If a bill can not stand the public scrutiny of the nation and its proponents can’t make the case that it is the best legislation for the nation as a whole through the mere power of thoughtful, intelligent persuasion, then it is not worth passing.

After all, isn’t this supposed to be a law that will be ‘for, by and of’ the people, not the professional politicians and lawyers who run Congress and all the legislatures nowadays?

If the professional politicians in Washington can’t explain this health care bill to us in terms we can understand, we do not want or need them to pass it in the dark of night under the cloak of secrecy and then come out into the light later and tell us what it means…when it is too late.

We tried that in 1988 under the aptly-named “Medicare Catastrophic Bill” a bill that hardly anyone still alive remembers anymore. When the most powerful man in Congress, Ways and Means Chairman Dan Rostenkowski went home to Chicago during the August recess break, angry senior citizen ladies chased him back to his limo and beat him over the head with umbrellas, they were so angry! (‘The Umbrella Rebellion”, it shoulda been called. see *Rosty* below)

Anyway, that bill was swiftly repealed in toto soon thereafter, further proving the old political adage that if you can’t explain it in 20 seconds or less, ‘it ain’t gonna fly!’

The intent of the bill was to provide funds to cover the truly catastrophic costs of the relatively very few seniors who experience the highest total cost of health care due to complications from disease and illness.
70% of the costs of health care each year are devoted to complications from just 4 illnesses; heart attack, stroke, diabetes and cancer. All of which are ‘preventable’ to some extent or another by better diets, less alcohol consumption, stopping smoking and getting some exercise.

70% of these costs occur in the final 6 months of a person’s life, although no one knows for sure when those last 6 months are going to occur.

When you have an annual budget of close to $500 billion for Medicare for seniors alone, (Medicaid covers low-income people), and many billions of it is spent on a very few number of seniors each year for the reasons described above, having pure catastrophic coverage makes a lot of sense.

But it was not explained very well in 1988, just as the Obama Health Care plan is not being explained very well this time around.

If this is a stalking horse to get to a single payor plan, tell us, the American public…we can take it. Explain it to us in explicit detail with all the gory codicils clearly written out and posted on the Congressional websites so we can all download it and read it for ourselves. (As of this posting, much of the House pieces of the legislation have not been posted for public consumption)

If it is as great as the proponents say it is, the American people will come running to it with palm fronds waving and singing hosannas in the highest to anyone who votes for it.

But if it is still a lot of the ‘same-old, same-old’ expansion of federal power into the private health care insurance field as we have witnessed for the past 40 years, with little- to-zero cost containment or major league reforms in the tort (legal) area, malpractice insurance reform or protections against excessive costs through defensive medical practice, then the American people will smell right through that charade and organize umbrella rebellions all over the land.

Just ask Chairman Rosty about what it felt like to be beat over the head with an umbrella in 1989.

*(August 20, 1989--Washington Post, Mike Causey) 'According to the front page of the Chicago Tribune, he got it from angry senior citizens seeking a confrontation on Medicare premiums. The newspaper said he was "booed and chased" down a street after a meeting with a group of senior citizen leaders about the political situation in Poland. The Trib said, "Eventually the 6-foot-4-inch [Dan Rostenkowski] cut through a gas station, broke into a sprint and escaped in his car, which minutes earlier had one of the elderly protesters, Leona Kozien, draped over the hood."

Rostenkowski is viewed by many senior citizens as the chief architect of the new Medicare health insurance plan for catastrophic illness. It could cost some upper-income retirees $800 in a surtax payable when they file their 1989 taxes.

Many also see him as the Lone Ranger holding up a Senate-House stampede to revise or repeal the surtax. His Senate counterpart, Lloyd Bentsen (D-Tex.), got so much heat from retirees that he agreed to revise the issue, setting the stage for possible changes in the surtax."