•
The right wing crowd holds out hope for President-Elect Obama to get the hook on inauguration day. The same whack-jobs that brought you fake birth certificates from the grassy knoll are now calling for full investigation into any communications between anyone associated with the President-Elect and Rod Blagojevich, the governor of Illinois. Do they have any idea how much time it would require of the Obama Transition Team to truthfully answer that question? Of course there were communications. It was Obama’s seat for Pete’s sake. Republicans need to listen to their former nominee, Senator John McCain, when he tells them the Obama people need to be doing something else. People inciting this move toward a Blagogate must also understand they may not get answers to these questions until the trial of U. S. versus Rod R. Blagojevich. In the end, pursuing Blagogate might help set free one of the biggest crooks to ever enter politics and prove to leave the United States vulnerable to a rapidly deteriorating security and economic situation.
Politics seems to be the only thing on the mind of right wing radio and some of the mainstream press. It’s a sort of country last mentality that puts political brinksmanship above all else. Laura Ingraham and even PBS’s Gwen Ifill seem to want a scandal to develop. Ifill asks “what does we mean, what is involvement” of David Axelrod, one of the President-Elect’s closest advisors. Apparently, his statement, “we were not involved,” was not good enough. Laura Ingraham, a right-wing talk radio host, posts on her website:
QUOTE OF THE DAY
“I’m not going to say a word to you. I’m going to do this with my children. Don’t do that. I’m a father. I have two kids. I’m not going to do it.”
-Rahm Emanuel, ducking reporters’ Seat-gate questions outside his children’s music performance.
Is she mad because he wants to spend some time with his kids? Last I checked, that would qualify as an example of family values. I’m sure he has worked 24/7 since Obama named him chief of staff. Her website says she is a lawyer. Doesn’t she understand how the Obama Transition Team could torpedo the case against Blagojevich by publicly telling what they knew? Maybe smearing and hobbling the Obama administration trumps seeing Blagojevich go free.
One man who absolutely does not want Blagojevich going free is the U. S. Attorney for the Northern District of Illinois, Patrick Fitzgerald. Fitzgerald is the Republican Bush Appointee who made the decision to indict Blagojevich before he could fraudulently appoint someone to Obama’s senate seat. By all accounts, his case is dicey. By moving so soon for indictments, he may not have the smoking gun evidence he needs to put a real political crook in jail. Instead of keeping quiet, his potential witnesses are being asked to lay out his case for Blagojevich’s defense lawyers. Congressman Jessie Jackson, Jr., David Axelrod, Rahm Emanuel and others could all be needed to give testimony in court. Fitzgerald obviously does not believe his witnesses are involved. His public statement tells us they are completely innocent. Can’t the purveyors of Blagogate take Patrick Fitzgerald’s word for it?
One person who seems to have taken Fitzgerald’s at his word is Senator John McCain. McCain appeared on This Week with George Stephanopoulos today for his first interview since the Presidential election. Politics seem to be the last thing on John McCain’s mind. His “country first” mentality leads him down a different path than the right-wingers in his party. Instead of hobbling the new administration, he seems to believe the world is a very dangerous place and Obama’s team need more focus than ever.
Again, I’m not playing Paul Revere, OK? But I am saying that there are enormous challenges throughout the world. We have the situation in Afghanistan. The situation in Iraq is still dangerous. There are efforts by Al Qaida to continue to cause difficulties and launch attacks in different areas of the world. So — the Israeli situation is certainly unsettled, as they go through a new election period of uncertainty. So there is — there’s incredible national security challenges, which mandates — doesn’t argue for but mandates that we all work together as much as possible.
To John McCain, working together doesn’t seem to include blagogate. McCain may feel Blagogate is not only wrong but, dangerous too.
•
This is the 4th and final in a series of articles on the state of healthcare in America
So, where do we start if we choose to thumb our noses at 20 years “Harry and Louise”? You remember those two. They were the ones who were trotted out by the healthcare industry during the last attempt at reform. Their TV commercials stopped the previous debate cold. Let’s pretend we have a blank check. Let’s pretend all of our emotional issues which surround healthcare won’t be exploited. If we could do anything, we should start with extraordinary pharmaceutical industry profits (see previous article about how). But, what else might be done to reform a broken system. Yes, the system is broken. If you don’t believe it, just multiply your current health insurance premium by fifteen percent a year. After you multiply your employer’s portion by fifteen percent, ask yourself two questions. How many years will you be able to afford coverage and what will you have to do without? How many years can your company sustain these costs and stay competitive in the global economy. See, companies have to pay a sort of tax on American labor in the form of healthcare premiums. As a labor force, no matter how productive we are, Americans are becoming uncompetitive due to healthcare. So the obvious question is, will we be able to allow everyone timely access to prudent lifesaving treatment AND remain competitive? Well, I hope so. Our economy and well being depends on it. We really can’t take no for an answer.
One thing that has become increasingly disappointing in this political season is how the third rail of healthcare is being ignored. Costs have become the political third rail because any candidate that mentions the cost of healthcare is always accused of rationing. The word rationing is so incendiary no politician will touch it. Many proposals that would limit costs are quickly labeled rationing by the healthcare industry and their political stooges. Sure, some of our skyrocketing premiums provide the best healthcare in the world; but, much of those dollars end up providing extraordinary rates of return for healthcare companies. So, how do we get an industry so politically connected to submit to cost controls? Is it possible to slow down costs which increase at five times the rate of inflation while insuring life saving advances continue in medical technology? Well we just do it, that’s how. Mark Twain popularized a quote from Benjamin Disraeli that claimed there were three kinds of lies, “lies, damned lies and statistics.” That being said, we could mandate by law that healthcare related companies submit to audits for a span of two years. At the end of those two years, we could compile the numbers and conduct a top to bottom town hall meeting. In that meeting, we can sort out all the lies, damn lies and statistics. If a healthcare sector, for example, claims they are charging more for their product or service due to litigation, we will know exactly what and how much it costs. We would be able to take a steely-eyed look at inefficiencies and profiteering. At that point, we as a nation could determine which sector needs regulation or nationalization. I have a feeling we will find sectors that have not been good corporate citizens and have helped create a great drag on our economy.
Secondly, we should cover people whose healthcare costs are passed on to us anyway. Many studies tell us covering the 47 million uninsured Americans would actually partially pay for itself. These claims are based on savings generated by these Americans getting preventative medicine. This preventative approach would save us from having to pay for health problems that have festered and become expensive. The common sense approach tells us there would be savings in productivity, bankruptcies and savings we can’t even contemplate. Truth is, there is so much cost shifting in our healthcare system, knowing how much it would cost to cover the uninsured or be saved is next to impossible. I have purposely stayed out of philosophical debate on the uninsured. This debate asks whether or not basic healthcare is a right or a privilege. Many times these debates are more about political cover than philosophy anyway. Instead, I have tried to look at this debate about the uninsured from a strictly economic standpoint. Regardless of morality, covering uninsured could save all Americans money.
Another problem that needs attention is health insurance portability for the insured. This is particularly critical in the new global economy. Thomas Friedman, the famous New York Times columnist tells the only way to compete in the new global economy is universal portability. In his book, The World is Flat, he says a global economy moves so fast we should be able to change jobs and retrain for both our personal and national economic survival. He might be correct regarding world competitiveness issues. However, the only way to execute Friedman’s suggestion might be “single payer”. Single payer probably scores pretty high on the left wingometer. While single payer would be socialized medicine, many right wingers suggest we only have an insurance problem. They suggest we trash 50 years of state insurance regulations and allow people to buy insurance as national groups. Oversight of the new national insurance companies would be non-existent and you can bet the right wingers won’t support a Washington oversight bureaucracy to fill in for the states. The answer is probably somewhere in the middle. A mix of state based public and private insurance with the price controls discussed earlier is probably where we will end up. Even smaller groups with pre-existing condition protection will become viable with responsible price controls.
There is also the problem of pay for procedures. Much of the money in healthcare is spent on surgery and other drastic last ditch efforts that could have been avoided by good preventative medicine. One of the best examples I have heard of is diabetic amputations. If we had paid the family doctor for good patient care plan and rewarded the patient in premium reductions for taking care of himself, we would all be much richer. Instead we pay a surgeon tons of money to chop off a limb. Some blood tests, a little training and some insulin is better for everybody. We have to find a way to help general practitioners help us. Today, a family doctor sees 100 patients a day and gets paid the same a surgeon does in 15 minutes. Our current system needs to change.
Finally, we need to get involved. Yup, you with the Twinkie, that means you. It also means the smoker and others. If people insist on being a heart attack waiting to happen, they should pay more for their insurance. Now, we must have reasonable goals and not cholesterol, blood sugar and other targets generated by pharmaceutical company research. The goal should be a healthy body. The goal should not be to sell more Lipitor.
•
This is the third in a series on the state of healthcare in the United States. This article explores a few ways to lower the cost of prescription drugs. Remember, these are presented as common sense solutions from a dumb engineer.
First and foremost, we should eliminate direct marketing to patients. It is a waste of money and many doctors tell us it is dangerous. It is especially true when more is spent marketing Vioxx than Pepsi. Some of the claims were actually false and dangerous. With this direct marketing system doctor’s find themselves defending drug choices which are actually cheaper and may be safer to patients who have neither the training nor education for the debate.
Secondly, we need to re-introduce supply and demand into our prescription drug market. Several years ago, my company’s drug coverage was converted to a “point of sale” policy. I had to pay for my drugs and then be reimbursed by the insurance company. I was made painfully aware of the costs of my drugs. This system may not work well for lower income families and some allowances may have to be made in their case. But, having to float the insurance company a loan for prescription drugs made me ask my doctor about cheaper alternatives from time to time. Some drug stores would have to begin charging actual market price for some generics. Insurance companies and drug companies would also have to eliminate formularies for a system like this to work. The beauty of real supply and demand without direct patient marketing is how a doctor, patient and the pharmacy have to work together in a constructive way to eliminate waste and improve safety.
Some say the most constructive way to eliminate waste in the prescription drug market would be to critically examine doctor’s relationship with drug companies. Today, doctors depend on drug companies for drug samples and continuing education. Although samples, if used correctly, are an excellent resource for doctors, they may come at too high a price. The price becomes daily propaganda from a drug rep. Doctors have become too dependent on drug companies for annual continuing education requirements for medical licenses. Since continuing education classes sponsored by pharmaceutical companies are free to the doctors, a requirement to maintain a medical license and held in Cancun, pharmaceutical continuing education has become the only source of that education for some physicians.
The pharmaceutical industry frequently tells us importing drugs from Canada will destroy their ability to conduct real research and development. If that is the case, we must be subsidizing the rest of the world’s research. Shouldn’t we allow the wholesale importation of drugs so that market forces will even the playing field?
Finally, as the recent news from Wall Street will attest, corporate America will often trade immediate profits for long-term stability. If the pharmaceutical industry insists on making the kind of profits outlined in the previous article, government might need to review the patient system for drugs. They obviously need no protection.