DOING HEALTH CARE RIGHT

I have a boat.  It is a very small sailboat, a Sunfish for you boat literati.  I have abused that boat shamelessly.  I have put holes in the bottom of the boat.  I have patched hole after hole, until now the bottom of the boat has very little of its original cover.  It floats — well, it will when I fix the last hole I put in it — but there is little hope for the poor thing.  It is quite likely that the next hole will end its useful life, and I will need to either give up sailing or get a new boat.

We in the United States are doing exactly this with health care.  We have a health care system that is leaking worse than my little Sunfish.  We are paying outrageously more than other countries for medical services, medical devices and procedures and for pharmaceuticals.  Example:  my brother was paying seven dollars per pill for a medication, and, when he visited his in-laws in Belgium, he was informed that they were buying the same medication for seven cents per pill.  In addition, we are paying for the administration of our health care triple what other countries are paying.

Yet we are pretending to solve the problem of the cost of health care, a problem that Warren Buffett calls the biggest economic problem in the nation, in the very same way that I treat my little boat.  We patch here, paint there, but we never have the nerve to face the fundamental issues, and those are not very hard to identify.  We pay too much for the treatment, and we pay too much for the administration.

To those two problems, there is a solution, and there is only one solution.  We must completely abandon our patchwork of health care, and we must install a system of universal health coverage.  To do this, we must stop the political nonsense and join hands, Republican and Democrat.  The Republicans are right about administration.  It is better done by private industry than by government.  Democrats are right about cost.  It must be controlled by negotiation and fee schedules.

So, one more time, here is the radical solution, the new Sunfish of health care.  First, mandate universal care.  Yes, some non-citizens are going to benefit, just as Americans do when they get treatment in other countries.  Take the premiums out of wages as we do with Social Security.  Provide the poor with basic coverage, as we now do so inefficiently with emergency rooms.  However you do it, cover everyone.

Second, give it to the private insurers to administer.  Divide the country with a grid.  Auction off the sections of the grid to private insurers, and give them a monopoly in the areas they purchase.  Put a Public Service Commission over them to control their profits.

These two radical steps will save enormous amounts, in two ways.  First of all, it will allow us to negotiate as a group with medical providers, most particularly with pharmaceutical companies and providers of medical devices, and it will allow us to control the present outrageous profits of the health systems.

Second, it will allow us to eliminate the overlapping coverage we now are required to purchase.  Since all health care is taken care of, it can be eliminated in other policies — worker’s compensation, auto insurance, products liability coverage, homeowner’s coverage, etc.  For example, medical expense was once forty percent of the cost of worker’s compensation coverage.  It is now seventy percent.  Remove medical expense from worker’s compensation claims and you slash the cost of that coverage for industry.  The same goes for auto coverage, malpractice coverage, products liability coverage, homeowners coverage and others.

We are draining the resources of this nation for no good reason except to assuage the lobbyists for the moneyed interests in health care.  That is not the doctors or the nurses or the host of other real health care providers.  We, we, must stop patching the boat and take these radical steps.  If we do not, this particular boat will sink, and it will take us all with it.

 

 

 

PLAIN SPEAK ON INVESTIGATIONS

President Trump has been under constant attack since the day he was elected.  He has been attacked for narcissism, for saying untruths, for incompetence.  Now, however, two different kinds of investigations have been launched.  One is a criminal investigation.  It is now headed by Robert Mueller.  The other is a congressional investigation.  It is being done by committees in both the Senate and the House of Representatives.  It is informational only, although, if it revealed crimes, it could refer the matter to the Attorney General.  What it can also lead to, however, is a motion in the house to impeach the president.

The elements needed to prove a crime are very different from what is needed to impeach, and then to convict, a president.  A crime is established only when it is proven that a criminal law has been broken, and that the one charged with that crime intended to break that law.  So, for instance, proving the crime of obstruction of justice requires proof that the one charged either told an untruth to an authorized government investigator, or prevented that investigator from obtaining relevant information regarding that investigation, for instance by coercing a witness or hiding or destroying documents.  It also requires proof that the one charged did these things with the intent to obstruct the investigation.

The elements necessary to justify impeachment and conviction are far less clear.  What is clear is that impeachment is not the same as conviction.  Impeachment is only a statement of charges, like an indictment.  It requires only a majority of the House of Representatives to begin impeachment proceedings.  If impeached, the president is then tried by the Senate, and can only be convicted by a two-thirds majority of the Senate.

The Constitution states the grounds for impeachment as “Treason, bribery, or other high crimes and misdemeanors.”  What that means is not clear, but we know what it does not mean.  A president cannot be impeached for incompetence or negligence in the conduct of his or her office.  Only two presidents have actually been impeached, and both of them (Andrew Johnson and William Clinton) were acquitted.  Nixon resigned before impeachment proceedings were completed.  Conclusion:  it is very, very tough to impeach, and convict, a sitting president.

Nothing revealed or even inferable from what has been revealed establishes that Donald Trump committed a crime.  Others around him may have done so, but there is no evidence that Trump participated in a crime, and, absent a smoking gun (think the Nixon tapes), it is highly unlikely that he will ever be convicted of a crime regarding the evidence involved here.

If he is not likely to be convicted of a crime, then it is also highly unlikely that there will be justifiable grounds for impeachment.  Nixon was clearly guilty of obstruction of justice.  Clinton was clearly guilty of lying under oath.  Trump is narcissistic, incompetent, a chronic liar, and perhaps even hazardous to the health of the nation.  None of those are grounds for impeachment.

So what is this all about?  It is about what is being called “the Russia thing.”  Those pursuing Trump want to prove that Trump’s staff colluded with the Russians to manipulate the election or colluded with the Russians to use the office of the president to profit the president or his family.  Either one of these should and would result in a huge political swing away from the right in America.  That is a political goal, and it should be pursued politically.

What I am implying here is that talk of criminal investigation or impeachment investigation is at best way too early and at worst counter-productive.  If Robert Mueller concludes, as he very likely will, that the evidence does not establish that the president committed a crime, it will allow the president to gloss over all his true failings.  The political pursuit of crimes or impeachment would only serve to encourage more incompetence and more damage to the country.  If his real “crime” is incompetence and policies damaging the people, the real solution is the ballot box.

 

 

 

 

 

 

 

 

 

 

WHAT WE REALLY WANT

There is an article in the most recent issue of The Economist in which the author discusses whether the mood of America is Jacksonian or whether it is more Jeffersonian.  The author spends some time defining the two terms, which illustrates rather well that his readership likely has no grasp of the meaning of the terms.  If that is true, you can rest assured that the average American voter neither knows nor cares.

The question underlyng the discussion is, however, both extremely important and extremely difficult.  What is the mood of the nation?  What were the American people calling for when they chose a complete outsider over a complete insider?  One might want to say that they were choosing isolationism and self-interest over globalism and a concern for others, but that is unfair to a people who have historically been the most generous in the world.  One might want to say that it is a conservative victory, but the people who put this administration over the top are the heart of liberalism, and they immediately demonstrated that with their calls for universal health care and full rights for all genders.

One might also say that it was bigotry that drove this vote, and it is not as easy to put that aside.  Few people are overtly racist, but there is a kernel of truth in those overt bigots who say that we want to be a people sharing characteristics.  The history of America is replete with periods of what we might call anti-otherism, often quite ugly periods.  Jackson was also famous for encouraging the genocide of native Americans.  The post-Reconstruction period in the South, ugly as it was, is fully matched by the long and sad history of de facto segregation in the North.  Today it is Muslims and Hispanics who are getting a version of the same treatment.  Not long ago it was the Italians or the Irish or the Asians.

Silly as it may sound, we are afraid of being brown.  We still have the residue of our predecessors’ commitment to their roots in Europe or the United Kingdom.  My Irish grandmother referred to the entire population as either “one of ours” or “not one of ours.”  She was pure Irish despite being third generation American, and so were my parents as fourth generation.  The nation is not quite the melting pot it pretends to be.  The German neighborhoods and the Polish neighborhoods and the Italian neighborhoods may have slipped away, but we still have this odd urge to be a physically identifiable people.

That, however, lies in direct opposition to our stated ideals, the recognition of the inalienable rights of all human beings.  One hopes that the present xenophobia is the last gasp of this modern bigotry.  One hopes that, in a few generations, it will be difficult to find someone without some level of African or Hispanic or Asian or Middle Eastern heritage.  We need to hope that we will grow more and more to identify ourselves by those ideals rather than our physical makeup.  I still believe that what we really want is to be a people defined by the recognition of the rights of all humans.

 

 

 

 

 

 

Yet, in a few generations, it will likely be difficult to find an American who does not have some African or Asian or Hispanic or Middle Eastern heritage.

 

 

 

 

 

 

 

 

 

 

WHO ARE WE?

Eighty years ago, in 1937, the government of Franklin Roosevelt proposed the program of social security.  When the secretary of labor, Frances Perkins, was testifying about the proposal to Congress, Senator Thomas Gore asked him, “Isn’t this socialism?”  “Oh, no,” said Perkins, to which Gore sarcastically responded, “Isn’t this a teeny weeny bit of socialism?”

We are today faced with exactly the same question, but this time it is about the prospects for universal health care.  The fundamental objection to universal health care, even in its present diluted form which we call Obamacare, is that it is socialism, defined roughly as Big Brother or even Communism.  Think, for instance, of Trump calling Bernie Sanders his “Commie friend.”

Is it socialism?  Well, that depends a great deal on how you define socialism.  If by socialism you mean government ownership of all property, then it clearly is not.  However, if by socialism you mean government payment for a service provided to all people, then it certainly is.  But then, so is the government payment for defense, the government payment for infrastructure like roads and bridges, the government payment for education and libraries, and the government payment for the administration of the government.  Under this definition, for instance, the government’s payment for the salary of Paul Ryan is socialism.

What we pay for through government, which is to say what we pay for as a group rather than merely as individuals, pretty much defines who we are as a people.  Those who condemn governmental payment for social services and clamor only for less taxation are proclaiming a morality of self-interest.  Their goal is a world in which each fends for himself or herself, and government exists only to prevent chaos.  This view has been gaining ascendancy for years now, and has come to be personified in the views of Paul Ryan.  It has been with us before, and it has led to the same disasters toward which it is bringing us today.

Franklin Delano Roosevelt pulled us out of a decades long, unabated plunge into the morality of self-interest.  Its most blatant promoters had dragged our population into get-rich schemes that ended in the near total collapse of the economy, and left that population in pure misery.  In his second inaugural address, having begun to lift the country from massive unemployment, Roosevelt said, “We are beginning to abandon our tolerance of the abuse of power by those who betray for profit the elementary decencies of life.”

That tolerance somehow crept slowly back into our world, abetted by our own touch of larceny, a hope that perhaps we too could gain the luxuries of a great fortune.  But is that who we really are?  Do we really, in our hearts, want personal fortune at the possible cost of widespread misery?  I think not.

President Obama, when accused of socialism for wanting universal health care, stated, “As long as there are nine million children in the United States with no health insurance, it is a betrayal of our ideals that we hold as Americans.  It is not who we are.”

So who are we?  We are Americans, not because we are capable of making individual fortunes, but because we hold, as self-evident truth, that all human beings have certain inalienable rights.  We are Americans because we are committed to the rights of other people.  As President Roosevelt put it, “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BY HIS DEEDS, PART THREE

First, two key points drive my observations here.  First, Donald Trump lies.  That point has been exhaustively demonstrated, and it needs no further comment here.  Second, a group of good, honest, hard-working people voted for Donald Trump because they believed those lies.

Donald Trump has now demonstrated to those people that he was lying about the very things that caused those good people to vote for him.  There are many things that he lied about that have been exhaustively catalogued elsewhere.  “Putin is our friend” and “China is a currency manipulator” are on that list.

The two lies that most betray the working people who voted for him have now come starkly clear, not by mere words but by his deeds.  Trump promised those people that he would replace Obamacare with an insurance program that 1) insured everyone, 2) cost less, and 3) covered more procedures.  The program presented by Paul Ryan, and endorsed by Donald Trump, does exactly the opposite of all three points.  It insures fewer people, costs more, and covers less.  Don’t take my word for this.  Listen to how Ryan presents it, and listen to how Trump lies about it.  For instance, Trump said recently that Ryan’s plan preserves the ban on denying coverage for pre-existing conditions.  The most recent version of the proposal allows states to increase rates for people with pre-existing conditions, which will make it impossible for those people to afford the plan.  Trump and Ryan make it sound like the program covers everyone by saying that the plan provides “access” for all to insurance.  That is the same as saying that we all have access to purchasing jet planes.

Trump’s second lie may be even worse than the first.  He promised those hard-working people that he would reform the tax laws and, by doing so, give a huge boost to jobs and to the economy.  “You’re going to win so much you’re going to get sick of winning,” he said.  Now the “tax plan” has arrived.  It provides enormous tax breaks.  The problem is that you have to have an income in excess of a million dollars a year to see any of it.  Worse, the gigantic tax breaks he gives himself and others of his income level will cause the national debt to skyrocket, and that will lead to the biggest economic collapse this country has ever seen.

Neither one of these plans will succeed, because a number of reasonable conservatives have, so far, rejected Trump’s efforts to put these things in place.  Whether they can continue to do so remains to be seen.  What should be clear to those who were swindled into voting for Trump is that he lied to them about the things that most mattered to them — income and health care for their families.

We will likely have Trump for three and a half more years.  He will continue to damage both the substance and the image of America throughout that time.  On these two issues, however, if he and Ryan and their cronies succeed, America will not be the place into which you were born.

 

 

 

 

 

 

 

 

 

y of it.