LJWorld.com

The Senate finally passed legislation last Friday that would reverse the 21% cut in Medicare (seniors) and TRICARE (Veterans and serving military families) payments that took effect on June 1. Leadership form both parties agree the cuts needs to be reversed. House leaders, however, are saying that they will not fix the problem unless the Senate passes House-approved jobs measures.

So Mrs. Pelosi is holding medical care for seniors and soldiers hostage. Why must these citizens suffer because the Republicans are demanding we pay for any additional extension of unemployment (we are already paying for a year)? The Senate found funding to pay for the Medicare fix. Why doesn’t Mrs. Pelosi find the funding for the jobs measures?

Why are we doing this? Why have we not heard about it from the media (FOX, CNN, all the rest)? Are we playing politics with our soldiers and seniors?

In my recent history, I have attended several symposiums on how to present a message – in these cases “frame” the message. If you wish to advocate something, how should you present it too those you hope to convince. This concept does not suggest lying but finding a specific and related concept that is favorably viewed by the group to be influenced.

For example, if you wish to establish another massive federal dependency – in this case for health care – you do not address the income transfer required to achieve your goal. You do in this example argue that reform is needed. You find a demon in the form of insurance companies and focus on real and imagined malfeasance. You can even help your advocacy by indirectly encouraging others to represent that the cost is low and the benefits high. If any one challenges you, the issue is “reframed” to reform and the meanness of those who do not support it. At all costs, you avoid arguing about money – an argument you might lose. The real issue here is reforming our system to remove some generally agreed upon shortcoming – not creating a massive income transfer program

Another example is our “Save our Schools” initiatives. The issue is “framed” as preserving neighborhood schools. There is some truth in that. What is neglected is that the specific schools to be saved are somewhat unique. Even if one were closed, the remaining smaller schools would still be within the definition of neighborhood schools in Lawrence. We demonize the administrators, an easy task, neglecting to admit that there are functions to perform and others will have to do them. You concoct solutions that seem reasonable but conceal the disproportionate impacts. The real issue, is of course, how to we fairly and equitably address a systemic and probably long-term deficit in school funding.

Another example is our recent initiative on resourcing our public bus system. The issue was framed as a necessary step to enable the poor to have transportation to and from work. It was generally concealed that there were other alternatives of lesser cost that would have served the poor. Anybody that suggested alternatives was demonized as being against the poor. As a result, we saddled ourselves with a long-term sales tax. Now, it seems to be evolving, that the funding sought may be inadequate so we may have to make up future shortfalls from our general revenue stream. The real issue here should have been how to support the transportation needs of a small segment of our community and not continuation of an underutilized system – especially given the KU system.

It seems to me that some of my fellow bloggers are very adept in “framing” issues. They are very committed to their advocacy. They seem to be willing to use every debate technique – to include misrepresentation and in some case misdirection - to sell their product. Perhaps the rest of us should be more alert to those techniques. Failure to do so may yield consequence that may be very detrimental to our community.

Some years ago, President Reagan started a game with the intention of reducing public expenditures. After entering office, he quickly prevailed on a Democratic Congress to lower tax rates. A major deficit resulted. Federal expenditures were significantly reduced. That tactic has been tried again, not always with success.

Democrats have relatively consistently raised taxes early in their term to try to recover some of the lost federal programs. President Clinton also cut some social programs of his own (big ones) that enabled him to balance the budget while in office.

President Obama appears to have a different approach. He has significantly increased federal expenditures (about 25% increase). He is also striving to create a major new entitlement by assuming a federal responsibility to buy health care for many. The combined affect of these increases when added to the already unfunded liabilities for Medicaid, Medicare, Social Security, CHIPS and others will consume the entire Gross national Product in a little more than a decade.

Now, I speculate this is a reverse Reagan. President Obama will now call for frugality. He will place the nation between a significant tax increase or cutting services to a majority of the population. So taxes will go up. The increases will not be confined to the wealthy; in my humble opinion, the wealthy will pretty much skate despite a return to Clinton era tax rates. The middle class will get hit, and hard.

We will also ask seniors to take a hit in their medical care and in their social security. We will probably try to move rapidly to means testing those programs. This in spite of the fact that all living seniors have more than paid for their Social Security and a good part of Medicare Part A benefits. Rationing of health care under Medicare will also slowly evolve. Veteran’s services will be cuts. Combat wounded veterans will be asked to pay for their medical care, as they were earlier last year. Other veterans will pay more. Government retirement programs will be retroactively cut – significantly. Everyone with health insurance will see a significant increase. The Administration will argue it is the insurance companies. It will most likely be the costs of all the health care mandates sought by the Democrats. Commercial health insurance will decline in coverage to match federal health programs. More people will be forced into the insurance pool - means tested.

Bottom line: The long sought Democratic goals of reducing most of us to an equality of outcome will be achieved. Only the elites will have quality health care, comfortable retirements and satisfying jobs. The rest of us will find employment in the service sector with the ensuing lower wages and less attractive work environments. That, or we will be on public assistance. As happened in Great Britain, the politically connect unions and groups will seek and receive special treatment in return for voting correctly. The rest - well enjoy the ride.

You wanted change. Hopefully you can make it into the élites or other protected groups otherwise it will be all down hill from what our sitcoms portrayed as the desirable American life. Unfortunately, this ride will likely end in a train wreck but not before it irretrievably changes our social, financial and political systems and eventually leads to bankruptcy because nobody is paying and everybody is taking.

So, forgive me if I do not see the benefits in all these changes. I will be a loser – a big loser. I will resist this game. I will help the Republicans take back control of the Congress. I will still probably be had. So glad I was stupid enough to trust my government!!

The LJW ran an editorial yesterday and it has drawn out the continued debate. I read the posts and became increasingly confused.

Free Market solutions: Health care reform that allows for high deductible insurance, interstate sale of insurance and the like lacks any representation of where people get the money for the initial co-pay. Are the fees those renegotiated by insurance companies, or set by CMS or are they floating? How do we avoid interstate sale of insurance yielding a race to the bottom in terms of quality and coverage? Will the presumption of market forces on an inelastic product yield higher costs rather than cost control? One could go on.

Obama Care: Just what is it? Lots of rumors? There appears to be a big entitlement associated with it. There are also reforms such as portability, protection from pre-existing conditions and others. Others like tort reform are missing. Just what is the cost and who pays? Lots of noise but few supportable facts. Even the CBO could not really price it as the bill is structured to delay costs until the out years. Would it really raise costs for all those with existing insurance as it did in the Commonwealth? Would there still be commercial insurance/supplements? Who gets to pay for the massive unfunded subsidy- those already dependent on previously promised government programs? ? Can we really require people to have insurance? Are the savings projected real? One could go on!

National Health Care: Just what is meant by this term? Are we following a model where everybody works for the government? Are we following a Medicare model where the government pays but the program is administered in the market? A lot of numbers are thrown around. Where do they come from, which model are they following and what are the assumptions. Are things like the cost of transition, capital costs and the like included? There is one basic reality here; we do not really know what it will cost because all the numbers are the product of various advocates. I do not think we even really know the true costs of the current system as different advocates include different costs. One could go on!

How can anyone form an opinion about health care reform as it is being developed? I wonder if anyone has really interpreted the nearly 3000 pages. For example, are my insurance rates going to go up because I am overweight? Who defines that? Will we impose similar strictures on those on Medicaid or those receiving subsidies? What else is buried in there as a bone to the insurance companies to shut up?

Then there is the process. Two of the big bribes to Congresspersons have surfaced. What about the "gimmie" to the auto unions – insurance far in excess of what the average American has. How many more sweetheart deals are there? Transparency translates into traditional behind closed-door negotiations. I though we were against such or are we only against it if they are plotting torture?

Maybe the American People should be more involved in the process with shared details rather than grandiose promises, we all know about government promises like Medicare and Social Security. In distilling the numbers, it sounds like only about 15% of us lack health care and may not be able to afford it. Should we be in such haste to help these people that the rest of us have no input into what is going on? Maybe if we did this slowly and incrementally we could all participate and have results that are equitable and lasting.

Recently, I wrote a blog about my perception of inconsistencies related to our snow shoveling ordinance. The response seemed to tie social security to owing service to the state. A lot of discussion about social security ensued. A good topic. Next year Mr. Obama has vowed to try to tame that beast.

The exchange revealed a lot of misinformation or maybe just plain greed. In the interest of the former one would hope we do our homework before we end up in a massive generational fight.

The argument of the left at this point appears to focus on means testing social security. Not a bad idea if we don’t suddenly drop the bucket on those already on the program and who have paid a substantial sum for their expected benefits. Remember the very people pushing the notion of immediate major sacrifice are the very people who spent the trust fund on social programs and wars and make this an immediate problem rather than a 30 year out problem. The argument of the right has been to privatize the program (all or part). The left unified to block that approach during the Bush administration.

One interesting point. The very people who argue for health care reform conveniently forget that a major component of the Democratic Party bill is another massive entitlement- upwards of a trillion a year. How can we afford to make that commitment when we are talking about reneging on commitments already made?

We could pass a health care bill that reformed insurance, broadened availability, and eliminated abuses with out such a massive cost. We just need to strip the subsidies from the bill along with all the goodies for big pharm and big insurance.

What do you think? Should we all learn a bit more so we can make informed choices next year and not be driven by those who want to renege on promises made. Yes, whatever we do will be painful. Pain should be broadly and equitably shared

I am accused of picking on the left. In retroflection that is probably true. The right is not making many waves. The left is. I am responding to their proposed changes. In our immediate future three significant initiatives emanating from the left will likely drive really significant change. What will our country look like in 2050 given those changes? Below I have generated a thought piece that I think represents the fears of the right at this time. I admit it is extreme but the lack of definition of where these changes are going certainly allows for such a flight of fancy. If we are to reduce CO2 emissions by 50% by 2050 while lifting up the smaller countries it will certainly stress our economy. Could it lead to what I present?

The need to rapidly implement remedial actions to drastically cut CO2 as required by the climate accords of 2010 through 2020 led to a number of fundamental changes

To address the generation of CO2 from personal domiciles, groups were formed to review the stock of housing and to assign individuals to a home appropriate for their family size. At group direction and without remuneration many older homes were raised and new multi-family, more ecologically appropriate homes were built. Newer larger homes were modified to be multi family. By 2025 only certain families were allowed to remain in single family homes – most lived in small government subsidized structures.

To address the generation of CO2 from transportation sources the American transportation system has been changed. Railroads were significantly expended. Over the road long haul trucks were eliminated. Public transportation was expanded significantly. Groups were established to review application for personal autos. Only government officials and certain individuals were allowed to own one. By 2020 the stock of automobiles in the United States had been reduced to slightly more than a million.

Groups were established to identify what food products could be used. For the most part food is generated locally. High CO2 generating products had been minimized. Only certain people as determined by the various governments are allowed to consume delicacies such as meat, sea food, crops out of local season and so on. The farm population has expanded significantly with most farm land in the hands of the government as a result of the Commercial Farming Act of 2015 that confiscated all but a small number of individually owned farms.

The second major theme involves changes to health care. The health care reforms of 2010 and 2011 extended health care to everyone. Costs naturally escalated. Efforts to reduce costs significantly impacted the availability of doctors. Government was forced to recruit doctors and assign them to appropriate locations. To address the continued escalation of costs and to reduce the human footprint health care was more rigorously controlled. Health panels were established to review individual needs for care in consideration of costs and individual contributions. Seniors were routinely denied costly services. Live births were restricted to one per family. Costly routine care required permission from the local health panel. However, certain individuals as determined by governments, were provided better care so as to insure that the civilization functioned properly.

The third major theme is economics. The costs to implement climate change remediation proved truly immense. The cost of health care continued to stress the system. The diversion of resources to government directed activity all but eliminated the ability of the country to compete in the international arena. The financial expectations of 2010 were inconsistent with available resources. The population was too large for the available domestic jobs. Large corporations had fled the United States and established their headquarter in countries that were non-responsive to the Climate Accords of 2010 through 2020. Small business were unable to turn a profit given the tax rate necessary to adjust to the Climate Accords of 2010 through 2020 and as a result the Jobs Creation Acts of 2015-2020 saw most business become government owned. In order to hold down costs and to distribute population, committees were established to assign individual based on testing to specific careers and locations. By 2020 over 95% of the American populace was living at the same level as that of the1920s.

Now just maybe saner heads will prevail and change will be more gradual with due consideration for the maintenance of jobs and appropriate recognition to individuals who contribute more to the society then others. If the necessary technologies were then to mature as needed we might just thrive. However, making international agreements betting on the timely development of certain high risk technologies and significant and rapid changes to human activity just may not be a good approach!

I noted in yesterday’s LJW a letter to the editor about our LMH. I, of course, am sympathetic to the thrust of the letter. I am going to use it to address a topic that it avoids. Who pays?

Day after day, there are articles documenting some form of human tragedy or misfortune. Day after day there is a direct or not so direct call for somebody to do something. In most cases the implied somebody is government. What is always lacking is some indication of an understanding that if government is to do something, somebody has to pay. That somebody is inevitable those of us with and income through our taxes.

In a society that already extracts close to $40K of a $100K income for taxes you would hope that those demanding more would have a suggestion as to where the resource is to be found. Should we go to 50%? Is there some group not paying a just contribution? Maybe the lower end of the income distribution should pay at least some tax?

Perhaps all future LJW articles should include some inkling of where the resources to right the documented wrong are to be obtained. What part of the existing budget should be decremented to find the resource? Whose taxes should be increased to pay for righting the wrong?

There comes a point where the society takes so much from the productive elements that the desire to be productive wanes. That happened in Britain before Mrs. Thatcher and we benefited from a large brain drain. That happened in our own District of Columbia some decades ago when many tax paying enterprises moved to another state to avoid what some considered confiscatory taxes. It is happening now in California.

There are parts of the world that well reward productive citizens and before long, if we are not more circumspect, we could be the society experiencing the drain. Maybe, you don’ think it can happen here. You would be wrong. Lawrence, because of high taxes, is in the opinion of some already experiencing a loss of jobs and a decrement in population-despite being a government enclave. When the productive people leave all the goodies we feel are so important will be lost because there will be no resources to pay for them.

Where is the tipping point? Is it in the larger interest of the society to keep pushing toward it? Should we start looking to priorities rather than new revenues? Alexis DeTouqville, the distinguished French commentator on our affairs, noted that a society where the majority of the people benefit from public largess may not long survive. Are our days numbered?

Today my government provided health care reared up and bit me where it hurts – my wallet! Now to be factual all the health care my wife and I receive is provided by governments. We both have Medicare. I have Tricare for Life. She has a supplement through her public school retirement program. These are all government programs but they are all administered by publicly held health insurance corporations and use a set of doctors of my choice available to the general public. Only a small veneer is actually employed by any government and it sets the policy as to what is covered and what is not through large books distributed to the client- note the insurance companies do not determine what is covered.

The system that bit me is a true government administered, operated and executed system – everyone is a government employee. That system is the VA. Last week I received a bill for a medication I have been taking for a service/combat connected disability. Normally medications for service connected disabilities are free to the recipient as the acknowledgement of a grateful nation for the consequence of services delivered. I have been receiving that medication for over a year from the VA. Somebody made a determination within the last month that the medication was no longer required for my service connected disability. Unfortunately nobody told me. I have no desire to take a medication I do not need. I have no desire to use VA resources for something not required.

That said, you would think the great government operated system would communicate better with their patients. What is even more galling is that nobody at the VA seems to be responsible for telling me about the change and nobody can reverse the erroneous charge for a medication now determined to not be required. To add insult to injury, they have now sent me a second ninety day supply that I did not ask to receive and do not want. Apparently, they also want me to pay for that.

Why is this important? Because this is why many of us fear a government operated and manned health care system. When my government paid insurance programs run amuck I can and have appealed and there are people with the authority to address the appeal and redress the problem. Apparently this is not the case in the VA. I have been told essentially to “man-up” and pay the bill. We are not talking a lot of money in this case but I can see the day when my Democratic party driven single payer Canadian like system sends me a bill after the fact for a medical procedure costing a great deal and I am told to “man–up” and pay it because it was determined to be uncovered after the fact!

Is this what many of you in the LJW blog world want! Just maybe some of us with long experience have reasons other than being part of the great ugly race bating right wing conspiracy to fear too much government involvement. Government manned systems are regrettably known for making unilateral decisions, not communicating them and then falling back on sovereign immunity to avoid responsibility.

On another blog, I ran into a number of posts suggesting a bipartisan approach to health care reform exists. This is supposedly so because some Republican ideas are included in 3200(??) or something(??). Really! Merriam-Webster defines bipartisan: of, relating to, or involving members of two parties; specifically: marked by or involving cooperation, agreement, and compromise between two major political parties.

Key words are agreement and two major political parties. Something is bipartisan only if the leaders and most of the members of both parties say that it is. While those of us in Lawrence who seemingly know more than the average bear might think otherwise, we do not define what is bipartisan

I promised a blog on my perspective on health care reform. I will start with the top-level goals I believe the President set

1.) Universal Coverage 2.) Cost savings

There were other elements that were identified such as no increase in federal outlays, continuity on present insurance programs, more preventive care, portability, denial of care and ( ) (pick your own).

I would argue one and two are mutual exclusive on their face and that precluding increase in federal outlays is an overly restrictive statement that has hampered all the efforts.

I would suggest that cost reduction as a goal be deferred to a bi-partisan study panel of experts that would define a standard level of coverage for a minimum program (consolidate the 50 or so we now have). We can then discuss within the political process who gets what care. It is just too hard to try to extend coverage and reduce costs at the same time within the framework of the existing system (winners and others).

The only way you can enforce no increase in federal outlays without major short-term cuts in services is to allow longer term focus by the CBO so that the results of adding preventive care can be properly included. I suggest we just drop it and try hard to minimize cost increases (do we really need to subsidize insurance up to four times the poverty level).

I will now focus on point one at the top level

To achieve universal coverage (almost).

1. Expand Medicaid to cover those who can not afford insurance (maybe 2-3 times the state poverty level)
2. Mandate acceptance of coverage if available
3. Mandate Portability (eliminate exclusion for pre-existing conditions)
4. Make insurance more accessible (the so called exchange in 3200)
5. Expand Medicare to cover those who can not obtain insurance anywhere else (with charges for coverage)
6. Allow the elderly and the poor into the pools (escape from Medicare plus supplement)

To police up the environment

1. Stop termination of coverage because of evolving conditions
2. Establish an appeals process outside insurance companies to protect consumers
3. Limit compensation to executives/stock holders
4. Preclude incentives to limit care
5. Standardize prices
6. Increase coverage of preventive services
7. Establish criteria for processes and timeliness of care
8. Limit punitive damages and standardize compensatory damages for medical error/malpractice
9. and a host of others (feel free to add your own)

To pay for it

The above will probably cost between $500B and 1 trillion over ten years. Money to pay comes from:

1. Establish tax equity on percentage of income taken by dollar value (truly progressive system)
2. Either allow all to pay insurance with pre-tax money or allow none (lot of money here)
3. Increase income taxes on all of us (poor included) (or levy a fee through the tax process) to make up the rest (If this is important all should get to pay)

Most everyone will get coverage with the above. We do not need to create a new government program to do so, but should use what we have! The President promised continuity with your current plan so single payer is off the table. Abuses on the part of insurance companies/government need to end. It will cost money and we need to accept that up front.