Technology, aided by the information revolution and faster and cheaper computers, has exploded. Newer and more powerful imaging devices, moving cardiac cath labs out of the hospital, enhanced lab analyses and creating a completely new flow of information are making medical decisions easier and faster. For some physicians, they can be on call and never leave their homes. An orthopedic surgeon can have a huge LCD screen in his living room. The hospital and some of the clinics where he works can route digitized X-ray images to that screen and he can then decide the next step.
Rural America has benefited by having high-speed information flow to and from major medical centers.
But it’s not clear whether all this new technology is helping the bigger picture. Are we a healthier nation? Are our mortality rates dropping? Are we better off now than X-number of years ago?
And, the cost of health care in the aggregate for the nation soared some more.
The pharmaceutical revolution also played a role in the high cost of medical care. With a “free market” and a compliant Federal Drug Administration, Big Pharma began pumping drugs into the public’s minds through massive direct-to-consumer advertising campaigns — huge ad campaigns on TV and, since women make many of a family’s health decision, women’s magazine. It’s massive, but only part of the sales job.
Pharmaceutical representatives called on doctors to “educate” them on the latest and greatest therapy. Some of these drugs have not proven to perform better than cheaper and older generic stand-bys, but writing the prescription for the brand name drug earned the doctors’ privileges — like being asked to tear himself away from his Minnesota practice in February to present company-authored research at the Maui Hilton. The firms covered the air fare, hotel and greens fees.
Then, of course, the pharmaceutical industry told the American people three other things it hoped the public would believe.
The first is that it costs millions of dollars to bring a new and drug to market. And yet the industry had to contend with problems with drugs like Vioxx that was pulled from the market for being tied to heart attacks. It doesn’t take much research to see the problem. About twice a month we read about the need to pull a drug from the market or to change the labeling because of nasty side effects. Until either a lawsuit or congressional probe, the public may never know how much it will cost to bring a new drug to market.
Second, BigPharma invented drugs and found a disease it would treat, filling the public’s mind with made up problems in direct-to-consumer ads. An example? Restless leg syndrome. Effexor found generalized anxiety disorder (GAD); and, a patient’s depression about Effexor’s cost can mean a prescription for Prozac.
Third, by tweaking a formula, drug companies tried to convince the ethical physicians that the older formula won’t work as well or it’s not designed for the therapy. An example: Genentech makes Avastin and Lucentis. Both are ranibizumab. It marketed Avastin for treating colorectal and lung cancers and Lucentis for macular degeneration and some other rare conditions. Avastin is about $75 a dose; Lucentis is about $2,500. Genentech argues that using Avastin for eye treatments is “off-label” and shouldn’t be done. But a reputable retina specialist will tell you that Avastin is just as good, if not better, for treating certain eye diseases. And, the recent ruling against Johnson & Johnson over Risperdal, which it marketed “off label” pretty much tells the story of BigPharma’s hypocrisy as it contradicts itself.
These massive and multi-million dollar efforts to convince Americans a little pill will do you had to be paid for by someone and those costs, too, were passed on to the consumer or the insurance company.
But insurers noticed how their drug costs were rising, and those brand name drugs are costly. Now, they set limits on which drugs doctors can use and the costs. If the drugs don’t meet the profit criteria for the drug company after insurance firms cut costs, then the consumer has to pay the difference. Or the consumer has to forgo taking the drug.
The reason that the current approaches to health care reform will not work are because neither the politicians nor the public wishes to educate itself on the history of health care in the United States. Further, by ignoring the history public policy makers are ignoring solutions that may work. But, clearly the other reason the public won't benefit from health care reform are:
• The medical community shot itself in the foot by loosing control of the medical decisions and will have a hard time getting control back;
• The institutional part of the health care industry has betrayed its charitable history, its decency and its doctors and patients by accepting the free market model without a fight. Leaders of the industry and the medical profession need to decide what the system should look like, curb any greed, which is not good, and stand up for what’s right — show some courage; as a former hospital administrator, I can say I’ve never met a group with less backbone.
• The insurance industry became the more powerful player in the system, taking away choices from patients and doctors alike. Congress needs to regulate it, treating health care insurers including all forms of HMOs as public utilities; but, it won’t.
• Congress has been useless, lacking the will to tackle the problem. They are, almost to a person, bought and owned by the corrupt corporate interests and don’t want to give up the bribes, both blatant and subtle that go with protecting the system;
• The media have failed our nation. Corporate media will not offend the advertisers. And, it would rather report on celebrities than do a good job of explaining our failing systems. Media leaders need to accept a lower rate of return and recognize that with press freedom comes press responsibility and change the business model to do so. And it needs help foster a renewed appreciation for education; and,
• Consumers and patients have failed themselves, tolerating politicians who pander and line their pockets from a corrupt system. And they too would rather read about Britney and Paris, rich ne’er do wells, than serious stuff that actually affects their lives. Parents and older people should also engender an appreciation for education and knowledge and should assist in boycotting those businesses that continue to foster the problems outline above.
Thursday, November 21, 2013
Why health reform won’t work — a historical perspective - Part 2
Ronald Reagan had won the 1980 election and his pro-big business push for supply-side economics, lower taxes and deregulation changed the course of America’s economy. Remember the famous line from the movie “Wall Street,” uttered by Michael Douglas’ character, “The point is, ladies and gentleman, that greed, for lack of a better word, is good. Greed is right, greed works. Greed clarifies, cuts through, and captures the essence of the evolutionary spirit. Greed, in all of its forms; greed for life, for money, for love, knowledge has marked the upward surge of mankind. And greed, you mark my words, will not only save Teldar Paper, but that other malfunctioning corporation called the USA.”
And what of the health care industry?
First and foremost was the illusion that the entire American economy was classical free market. The rules that applied to food and air travel and other transactions now were said to apply to the health care industry. Some of this was sold as “consumer driven” health care.
But health care is not a “free market” commodity. The basic free market, supply and demand rules don’t apply. Here is why:
1. There is little price elasticity, which means no matter how many doctors there are, the price won't change much because (a) patients/consumers don't have free market knowledge of the price, (2) patients/consumers won't price shop because they don't choose their physician that way even if they could and (c) because the private insurance company sets the price through negotiation with the doctors, hospitals and other providers. And, don’t forget, these are products that, in the main, most people really don’t want to buy.
2. There's no free entry into the market. Physicians are licensed by the state and must graduate from an accredited school of medicine or osteopathy and not everyone can get into a school of medicine or osteopathy. Or pass licensure exams. You just can’t hang out your shingle and pretend to play doctor. And, to argue that the market action and lawsuits over bad outcomes would prevent this is illusory because it’s only the survivors could sue. Let that sink it.
3. There is no free choice among doctors and hospitals because private insurance provide high disincentives for patients going "out of network." Or your private HMO won't allow a certain test or x-ray — a decision made by a bureaucrat in private industry, not a qualified medical professional.
4. Buyers and seller don't have equal knowledge of the product or service — unless the patient is another clinician, the consumer can't choose by quality, which means "competition" is based on non-rational factors while the marketplace is supposed to be rational.
5. Supply creates its own demand and raises prices because with an over-supply there is under-utilization, leading to spreading overhead over a smaller patient base, which all insurers pass on as premiums.
In the 1980s, the reason for turning the patient into a “consumer” was easy because of a backlash against the medical profession. The paternalistic approach of many physicians was such that they bristled that a patient or patient’s family could question them. But after the tumultuous 1960s and early 1970s, aided by the women’s movement, all consumers wanted to be empowered. And, to be fair about it, many folks were better educated and could ask decent questions about their medical issues. The majority of the population still didn’t understand the sea change in the economics of health.
Then, with Kenneth Cooper and aerobics and the “get healthy” movement grew, the insurance firms saw another way to shift the burden of cost to consumers. If you weren’t in shape, exercising and eating health, any disease problem was the patient’s fault. Never mind that it as unfair to millions who became ill through no fault of their own. But, it was an easier sell to tell people they were responsible for their own health care decisions — and for paying for gym memberships — than it was to deal with lower profits from paying hospital and doctor bills.
Deregulation also dismantled the national mandate for Certificate of Need although some states retained their capital regulation programs; but, for the most part, Reaganomics opened the door to massive building booms and equipment acquisitions that continue to this day. Contractors, big equipment manufacturers (GE, Picker, Siemens), medical device makers and suppliers had a field day.
But the floodgates that opened the competitive free-for-all had consequences: overbuilding meant over-supply and those costs had to be recouped. So, the list prices of the services skyrocketed and some of the insurers and HMOs put their collective feet down. So did Medicare and, consequently Medicaid, which took much of its guidance from Medicare regulations. One could argue, by the way, that Medicare was the first to try reining in costs and insurance firms followed.
Either way, what matters is that the revenue that hospitals and others lost had to come from somewhere. And it came from those insurance plans that could hike premiums as they saw fit or from those without insurance or who chose to pay. The two “uninsured” groups were the very rich, who in their own way are self-insured; and the poor and working poor who couldn’t afford the premiums or whose employers didn’t have health coverage. For the former, the massive bills didn’t matter; for the latter, the burden was crushing.
The cost of health care in the aggregate for the nation soared.
But the deregulation also killed another program before it could really help rationalize the system. The comprehensive health planning legislation of the mid-1970s recognized that emergency medical and trauma services needed to be coordinated. The levels of trauma care were established and systems of routing patients to different levels of hospitals had begun. But the deregulation ended that initiative also.
And, the cost of health care in the aggregate for the nation soared.
Meanwhile, the hospital administrators had sold the doctors down the river a long time ago. Certificate of Need programs gave them the excuse they needed to not buy capital equipment, especially in non-competitive markets. Of course, that led to friction with physicians, who — especially in competitive markets — were no angels either. In those instances, medical staff played hospitals off against one another.
Hospital administrators also jumped on the marketing bandwagon. “Branding” became popular, so basic maternity services got an interior decorator and the name “Women’s Center.” Fitness services led hospitals to build or invest in health clubs.
The lack for regulation opened the door for some other moves. First, skilled nursing facilities, nursing homes and long term care facilities, boosted by Medicare and Medicaid revenues, burgeoned. For-profit companies dominated the industry, lured by promises of an aging population and Medicare’s focus on controlling hospital costs. Add to that, the rise of for-profit HMOs as part of the for-profit insurance industry and the focus become one of bottom line, not patient care. Then, to escape the scrutiny of hospital regulations and the controls on revenue, outpatient facilities blossomed, including the free-standing surgery centers, diagnostic imaging centers, GI labs and treatment centers.
And, the cost of health care in the aggregate for the nation soared some more.
Few hospital administrators stood up to the public policy makers to tell them that health care wasn’t just another commodity. Few hospital administrators saw the flaws in the deregulation and, out-numbered by the sycophants who dared not upset the powerful in Washington, cowered in the corner. Few hospital administrators really allied with physicians and their medical staff to create a real team.
While not much in the economic model has changed since the 1980s, two other trends have influenced the health care industry.
And what of the health care industry?
First and foremost was the illusion that the entire American economy was classical free market. The rules that applied to food and air travel and other transactions now were said to apply to the health care industry. Some of this was sold as “consumer driven” health care.
But health care is not a “free market” commodity. The basic free market, supply and demand rules don’t apply. Here is why:
1. There is little price elasticity, which means no matter how many doctors there are, the price won't change much because (a) patients/consumers don't have free market knowledge of the price, (2) patients/consumers won't price shop because they don't choose their physician that way even if they could and (c) because the private insurance company sets the price through negotiation with the doctors, hospitals and other providers. And, don’t forget, these are products that, in the main, most people really don’t want to buy.
2. There's no free entry into the market. Physicians are licensed by the state and must graduate from an accredited school of medicine or osteopathy and not everyone can get into a school of medicine or osteopathy. Or pass licensure exams. You just can’t hang out your shingle and pretend to play doctor. And, to argue that the market action and lawsuits over bad outcomes would prevent this is illusory because it’s only the survivors could sue. Let that sink it.
3. There is no free choice among doctors and hospitals because private insurance provide high disincentives for patients going "out of network." Or your private HMO won't allow a certain test or x-ray — a decision made by a bureaucrat in private industry, not a qualified medical professional.
4. Buyers and seller don't have equal knowledge of the product or service — unless the patient is another clinician, the consumer can't choose by quality, which means "competition" is based on non-rational factors while the marketplace is supposed to be rational.
5. Supply creates its own demand and raises prices because with an over-supply there is under-utilization, leading to spreading overhead over a smaller patient base, which all insurers pass on as premiums.
In the 1980s, the reason for turning the patient into a “consumer” was easy because of a backlash against the medical profession. The paternalistic approach of many physicians was such that they bristled that a patient or patient’s family could question them. But after the tumultuous 1960s and early 1970s, aided by the women’s movement, all consumers wanted to be empowered. And, to be fair about it, many folks were better educated and could ask decent questions about their medical issues. The majority of the population still didn’t understand the sea change in the economics of health.
Then, with Kenneth Cooper and aerobics and the “get healthy” movement grew, the insurance firms saw another way to shift the burden of cost to consumers. If you weren’t in shape, exercising and eating health, any disease problem was the patient’s fault. Never mind that it as unfair to millions who became ill through no fault of their own. But, it was an easier sell to tell people they were responsible for their own health care decisions — and for paying for gym memberships — than it was to deal with lower profits from paying hospital and doctor bills.
Deregulation also dismantled the national mandate for Certificate of Need although some states retained their capital regulation programs; but, for the most part, Reaganomics opened the door to massive building booms and equipment acquisitions that continue to this day. Contractors, big equipment manufacturers (GE, Picker, Siemens), medical device makers and suppliers had a field day.
But the floodgates that opened the competitive free-for-all had consequences: overbuilding meant over-supply and those costs had to be recouped. So, the list prices of the services skyrocketed and some of the insurers and HMOs put their collective feet down. So did Medicare and, consequently Medicaid, which took much of its guidance from Medicare regulations. One could argue, by the way, that Medicare was the first to try reining in costs and insurance firms followed.
Either way, what matters is that the revenue that hospitals and others lost had to come from somewhere. And it came from those insurance plans that could hike premiums as they saw fit or from those without insurance or who chose to pay. The two “uninsured” groups were the very rich, who in their own way are self-insured; and the poor and working poor who couldn’t afford the premiums or whose employers didn’t have health coverage. For the former, the massive bills didn’t matter; for the latter, the burden was crushing.
The cost of health care in the aggregate for the nation soared.
But the deregulation also killed another program before it could really help rationalize the system. The comprehensive health planning legislation of the mid-1970s recognized that emergency medical and trauma services needed to be coordinated. The levels of trauma care were established and systems of routing patients to different levels of hospitals had begun. But the deregulation ended that initiative also.
And, the cost of health care in the aggregate for the nation soared.
Meanwhile, the hospital administrators had sold the doctors down the river a long time ago. Certificate of Need programs gave them the excuse they needed to not buy capital equipment, especially in non-competitive markets. Of course, that led to friction with physicians, who — especially in competitive markets — were no angels either. In those instances, medical staff played hospitals off against one another.
Hospital administrators also jumped on the marketing bandwagon. “Branding” became popular, so basic maternity services got an interior decorator and the name “Women’s Center.” Fitness services led hospitals to build or invest in health clubs.
The lack for regulation opened the door for some other moves. First, skilled nursing facilities, nursing homes and long term care facilities, boosted by Medicare and Medicaid revenues, burgeoned. For-profit companies dominated the industry, lured by promises of an aging population and Medicare’s focus on controlling hospital costs. Add to that, the rise of for-profit HMOs as part of the for-profit insurance industry and the focus become one of bottom line, not patient care. Then, to escape the scrutiny of hospital regulations and the controls on revenue, outpatient facilities blossomed, including the free-standing surgery centers, diagnostic imaging centers, GI labs and treatment centers.
And, the cost of health care in the aggregate for the nation soared some more.
Few hospital administrators stood up to the public policy makers to tell them that health care wasn’t just another commodity. Few hospital administrators saw the flaws in the deregulation and, out-numbered by the sycophants who dared not upset the powerful in Washington, cowered in the corner. Few hospital administrators really allied with physicians and their medical staff to create a real team.
While not much in the economic model has changed since the 1980s, two other trends have influenced the health care industry.
Why health reform won’t work — a historical perspective Part 1
The economic model of the United States’ health care system — which really isn’t a system — is not the supply and demand free market model some would have you believe. And some of those who want you to believe that it is a free market knows full well it isn’t, but fooling the public serves certain purposes.
And one of the business sectors foisting this lie on the public is the insurance industry.
It is little known that Blue Cross/Blue Shield not only has its roots in Texas, its seeds were planted by group of Dallas teachers contracting with Baylor University Hospital, according to University of Iowa master’s thesis by Frederic R. Hedinger also credited Baylor. What’s more important than that detail is the plan worked and that it spread across the country, especially during the Depression.
Blue Cross was a benefit plan, meaning it paid for what the doctors thought the patient needed. If the patient needed surgery, the patient got it. And Blue Cross paid the hospital for its charges. The premiums were based on community ratings, which meant that the entire population’s medical needs were estimated and were the basis for the premiums.
Meanwhile, in California, Kaiser-Permanente was formed, becoming the first true HMO. It was a closed panel HMO because the physicians worked for the Permanente Medical Group and the medical group contracted with the insurance plan, Kaiser, which also owned the hospitals. This gave the insurers control of the costs and it succeeded in lowering costs of health corer.
But something happened on the way to the 21st Century.
First, some hospitals and some doctors took advantage of the benefit plans’ no-questions-asked fee-for-service system. Some greedy doctors (surgeons got most of the bad rap) got profligate with diagnoses based on wallet biopsies and performed hysterectomies and tonsillectomies and adenoidectomies. The old joke about hysterectomies was that the only criteria for those procedures were the presence of a uterus and a Blue Cross card, and the uterus wasn’t always needed.
The few rotten apples spoiled the basic for everyone because as people who paid for health care discovered the greed and looked for ways to curb the abuses. So began such things as peer review and utilization review, with the former being doctors who looked over each others’ shoulders and the latter involving non-doctors — and that opened the door for the insurance companies to gain control of the medical decision-making.
Kaiser had a better handle on how to deal with inappropriate utilization. The Permanente Medical Group, which contracted with Kaiser, was essentially told: Here are X-number of lives and our actuarial tables tell us that they will require Y-amount of care. So, here’s the math and the dollars. You take care of folks within that amount and anything you do over it, you eat; you keep the difference to distribute among yourselves.
The doctors watched over the utilization and took care of the over-users. In short, at this point, they retained some semblance of control of the decision-making.
Another part of the story is important and coincides with these mid-20th Centaury events.
Recognize that the structure of the system was that the hospitals were predominantly nonprofit and so there was a certain lack of business pressure with respect to performance and the bottom line. In addition, the people with the financial responsibility on board of directors were the moneyed movers and shakers of the community. Physicians, while having plenty of interest in the hospitals’ functioning well, were neither employees nor contractors. They were free agents within their own organization.
In some communities, working with the medical staff was like herding cats. It’s not that the doctors were evil. It’s that they wanted some things and the hospitals sometimes couldn’t give it. The entire structure was complicated.
At the same time — this was post-World War II and Korea — the population was growing, the need for a full range of services was being demanded and the federal government was there to help. The passage the Hill-Burton Act spurred a boom in hospital contraction that lasted from the late forties until the mid-1970s. While the main purpose was to build hospitals in communities that didn’t have them — read rural — like most federal programs, people who played the game well got the money and hospitals sprang up everywhere. Or, existing hospitals got new wings.
Policymakers came to realize, however, that supply created its own demand. If a hospital built the beds, ORs and x-ray suites and so on, they had to be used to cover the debt service. At the micro level, the community had to pay for the over-building and cover the costs of the resources. At the macro level, pumping patients through the system to fill beds and finance the growth added up to higher costs for the country.
And guess what came along to help fill them? Medicare and Medicaid. They created another revenue stream for the system. In economic terms, they created demand. Remember, though, that some of that demand wasn’t need based on clinical judgment and evidence-based medicine. The model for paying doctors by the procedure and service still prevailed in the early days of those huge programs.
But they also filled hospitals and clinics and added to the total medical and health care costs for the nation. Combine this influx of revenue with the supply creating its own demand, and medical costs skyrocketed. By the way, some researchers noticed that all of these medial resources didn’t lower what were then considered key indicators of a nation’s health — infant and material mortality, life expectancy and other measures of morbidly and mortality.
Around the mid-1960s, scientific advances and medical technology were having a greater effect on medical care .The first kidney transplant had already occurred in Boston in the 1950s. By 1967, Dr. Christian Barnard stunned the world with the first heart transplant. The first CAT scanner came along in the 1970s, but the people who came up with the idea had developed it in the 1960s. And so it went.
But, for all the good the technology did, and it did no doubt, it also drove up the costs. And it was around the mid-1960s we began to hear the word “crisis,” which we’re still hearing today. Some of those people taking about “crisis” were members of Congress. One would think that if they could call it a crisis for 40-plus years, they might have found a way to solve it, but that’s another story.
One of the answers Congress had for cutting costs in the 1970s was to control capital expenditures. It passed a series of law establishing coordinated planning for communities that required states to institute programs to assure that expensive capital expenditures could be justified by community need and not duplicate other services. This was called Certificate of Need, or CON, and remains on the books in some states. If a hospital wanted a new CAT scanner, or someone wanted to build a new nursing home, they had to get approved through a process that justified the expense. The theory was that if s need was proven, the utilization would be optimized.
Some hospital administrators understood this was a good thing for the community, the nation and the system. But as a group they fought CON. Then they got smart and began to work with their doctors and gamed the system — except in two hospital towns. Behind the scenes, medical equipment and hospital construction interests (contractors, architects, etc.) fought CON. But despite the political nature of the local competition for new toys, many felt that the legislation provided for a rational distribution of resources and to some degree held back the growth of health care costs, if only a little.
Was the approach to controlling costs by treating the system as a quasi-public utility a success?
Policymakers will never know. The programs were not in place long enough to fully test them because in 1982, something happened to change the landscape once again.
That and how these forces got the United States to where the system is today are in the next installment.
And one of the business sectors foisting this lie on the public is the insurance industry.
It is little known that Blue Cross/Blue Shield not only has its roots in Texas, its seeds were planted by group of Dallas teachers contracting with Baylor University Hospital, according to University of Iowa master’s thesis by Frederic R. Hedinger also credited Baylor. What’s more important than that detail is the plan worked and that it spread across the country, especially during the Depression.
Blue Cross was a benefit plan, meaning it paid for what the doctors thought the patient needed. If the patient needed surgery, the patient got it. And Blue Cross paid the hospital for its charges. The premiums were based on community ratings, which meant that the entire population’s medical needs were estimated and were the basis for the premiums.
Meanwhile, in California, Kaiser-Permanente was formed, becoming the first true HMO. It was a closed panel HMO because the physicians worked for the Permanente Medical Group and the medical group contracted with the insurance plan, Kaiser, which also owned the hospitals. This gave the insurers control of the costs and it succeeded in lowering costs of health corer.
But something happened on the way to the 21st Century.
First, some hospitals and some doctors took advantage of the benefit plans’ no-questions-asked fee-for-service system. Some greedy doctors (surgeons got most of the bad rap) got profligate with diagnoses based on wallet biopsies and performed hysterectomies and tonsillectomies and adenoidectomies. The old joke about hysterectomies was that the only criteria for those procedures were the presence of a uterus and a Blue Cross card, and the uterus wasn’t always needed.
The few rotten apples spoiled the basic for everyone because as people who paid for health care discovered the greed and looked for ways to curb the abuses. So began such things as peer review and utilization review, with the former being doctors who looked over each others’ shoulders and the latter involving non-doctors — and that opened the door for the insurance companies to gain control of the medical decision-making.
Kaiser had a better handle on how to deal with inappropriate utilization. The Permanente Medical Group, which contracted with Kaiser, was essentially told: Here are X-number of lives and our actuarial tables tell us that they will require Y-amount of care. So, here’s the math and the dollars. You take care of folks within that amount and anything you do over it, you eat; you keep the difference to distribute among yourselves.
The doctors watched over the utilization and took care of the over-users. In short, at this point, they retained some semblance of control of the decision-making.
Another part of the story is important and coincides with these mid-20th Centaury events.
Recognize that the structure of the system was that the hospitals were predominantly nonprofit and so there was a certain lack of business pressure with respect to performance and the bottom line. In addition, the people with the financial responsibility on board of directors were the moneyed movers and shakers of the community. Physicians, while having plenty of interest in the hospitals’ functioning well, were neither employees nor contractors. They were free agents within their own organization.
In some communities, working with the medical staff was like herding cats. It’s not that the doctors were evil. It’s that they wanted some things and the hospitals sometimes couldn’t give it. The entire structure was complicated.
At the same time — this was post-World War II and Korea — the population was growing, the need for a full range of services was being demanded and the federal government was there to help. The passage the Hill-Burton Act spurred a boom in hospital contraction that lasted from the late forties until the mid-1970s. While the main purpose was to build hospitals in communities that didn’t have them — read rural — like most federal programs, people who played the game well got the money and hospitals sprang up everywhere. Or, existing hospitals got new wings.
Policymakers came to realize, however, that supply created its own demand. If a hospital built the beds, ORs and x-ray suites and so on, they had to be used to cover the debt service. At the micro level, the community had to pay for the over-building and cover the costs of the resources. At the macro level, pumping patients through the system to fill beds and finance the growth added up to higher costs for the country.
And guess what came along to help fill them? Medicare and Medicaid. They created another revenue stream for the system. In economic terms, they created demand. Remember, though, that some of that demand wasn’t need based on clinical judgment and evidence-based medicine. The model for paying doctors by the procedure and service still prevailed in the early days of those huge programs.
But they also filled hospitals and clinics and added to the total medical and health care costs for the nation. Combine this influx of revenue with the supply creating its own demand, and medical costs skyrocketed. By the way, some researchers noticed that all of these medial resources didn’t lower what were then considered key indicators of a nation’s health — infant and material mortality, life expectancy and other measures of morbidly and mortality.
Around the mid-1960s, scientific advances and medical technology were having a greater effect on medical care .The first kidney transplant had already occurred in Boston in the 1950s. By 1967, Dr. Christian Barnard stunned the world with the first heart transplant. The first CAT scanner came along in the 1970s, but the people who came up with the idea had developed it in the 1960s. And so it went.
But, for all the good the technology did, and it did no doubt, it also drove up the costs. And it was around the mid-1960s we began to hear the word “crisis,” which we’re still hearing today. Some of those people taking about “crisis” were members of Congress. One would think that if they could call it a crisis for 40-plus years, they might have found a way to solve it, but that’s another story.
One of the answers Congress had for cutting costs in the 1970s was to control capital expenditures. It passed a series of law establishing coordinated planning for communities that required states to institute programs to assure that expensive capital expenditures could be justified by community need and not duplicate other services. This was called Certificate of Need, or CON, and remains on the books in some states. If a hospital wanted a new CAT scanner, or someone wanted to build a new nursing home, they had to get approved through a process that justified the expense. The theory was that if s need was proven, the utilization would be optimized.
Some hospital administrators understood this was a good thing for the community, the nation and the system. But as a group they fought CON. Then they got smart and began to work with their doctors and gamed the system — except in two hospital towns. Behind the scenes, medical equipment and hospital construction interests (contractors, architects, etc.) fought CON. But despite the political nature of the local competition for new toys, many felt that the legislation provided for a rational distribution of resources and to some degree held back the growth of health care costs, if only a little.
Was the approach to controlling costs by treating the system as a quasi-public utility a success?
Policymakers will never know. The programs were not in place long enough to fully test them because in 1982, something happened to change the landscape once again.
That and how these forces got the United States to where the system is today are in the next installment.
Thursday, November 14, 2013
A Change in Situation
As long as I’ve been a journalist, I’ve felt ethics and transparency were keys to how I comported myself and how I guided The Amarillo Independent. I tried to uphold high standards when the Indy was a print product and then when I converted it to a news website.
The Independent’s political and public policy positions, when in print and online, mostly reflected my own views, although sometimes molded and tempered by others working with me. Then, at the end of August, I converted the website to a blog — a personal blog for which I was solely responsible.
But I now must disclose a change in my situation. I have accepted a position consulting with KVII - ProNews 7. My part-time effort working with the ProNews 7 staff will focus on hard news and investigative reporting.
What needs to be clear here is that to the degree that I express either public policy positions on this blog, those remain mine and only mine. However, note that I will also promote ProNews 7 on my blog now.
Please let me know if you have any questions.
Wednesday, November 6, 2013
Is the defeat of the bond issue for the ARC a backlash against city leaders?
Backlash.
That’s the word that comes to mind to describe the defeat of the $31.5 bond issue for the $37.5 million Amarillo Recreation Complex. The measure, which would have raised taxes $25 per $100,000 valuation per year for homeowners to put the city further in debt, had the backing of the “establishment,” a/k/a the good ole boy network that includes the newly renamed City Council.
Why the backlash?
The public perception was the city leadership rolled the plan out and shoved it at the voters at the last minute. And, in doing so, the plan followed the city’s similar last minute move in acquiring the old Santa Fe Depot from auctioneer Bob Goree. Both moves were seen as fast and slick, and not in a good way. But the negative perception didn’t stop there.
Proponents of the ARC couldn’t convey that they’d raised the $6 million in private money to supplement the bond issue and bring the capital raised to the full $37.5 million project. On the other hand, opponents, without the help of the big marketing campaign, reminded voters that the Globe-News Center
In short, the pitifully few voters, some 16 percent of the registered voters in Amarillo, simply didn’t trust the City Council to be good enough stewards of taxpayer money to permit the city to and ask property owners to shell out more for a what is essentially a big loan.
Whether the City Council gets that message or comes up with some other spin to justify other unpopular moves remains to be seen.
Sunday, November 3, 2013
Don't increase the Amarillo City Commission's powers -- reject charter changes
Tuesday is Election Day.
With no candidate on the ballot you’d think that this isn't an unimportant election with no significance for the future of the city of Amarillo . If you think that, you’re wrong. This election is more important than the last one at which we elected people to the City Commission.
Why?
Because the City Commission is asking voters for approval to “update” the 100-year-old City Charter. To modernize it, they say. Be careful. Propositions 11 through 21 would concentrate the power of the commission further and make it harder for the citizenry to buck the commission. They are designed to make it more difficult to petition the commission and to run for mayor. Please go to the page on the city website to look at the proposed changesto the charter. Some are relatively harmless.
If you’ve followed the city’s business as closely has I have, you will understand why these changes should be rejected. The City Commission’s efforts to “revitalize” downtown Amarillo started with a bad premise and became a runaway train. Instead of asking for a bond issue to renovate the Civic Center , something that would have passed with little controversy because the venue’s deficits are obvious, the commission went down an Alice in Wonderland rabbit hole. Who knows what the commissioners, past and present, were smokin‛, drinkin‛ or chewin‛ to come up with third-rate developer Wallace Bajjali and a $113 million package for a convention center hotel, parking garage and baseball park to cure whatever woes they thought needed curing.
If people want some key pieces of information, I’ve gone back to the original video of a Nov. 16, 2010 City Commission work session. The commission’s delay in awarding a contract to Wallace Bajjali Development Partners came at that meeting. The Amarillo Independent had just broken the story on Wallace Bajjali’s troubled history — I’ve retrieved it from The Amarillo Independent’s former website backup — and posted it here. The story, which then-Mayor Debra McCartt acknowledged during the meeting, forced commissioners to step back from the slam-dunk that Amarillo Globe-News Publisher Les Simpson clearly wanted. At the time, Simpson was president of the Downtown Amarillo Inc. board — a clear conflict if one subscribes to the Society of Professional Journalist’s Code of Ethics.
Simpson, former Commissioner Ron Boyd and Commissioner Brian Eades statements at that work session show why the commission hasn’t been held accountable and why those changes to the charter shouldn’t occur. Let’s look at those:
·At about 2½ minutes into the meeting, after explaining that Wallace Bajjali was recruited to Amarillo , Simpson said, “… I know the feeling from Wallace Bajjali is any proposal they would ask you to consider would be one in which they would not get any payment for projects unless those projects were completed. They come prepared to put some skin in the game.”
But two years ago and without any progress, the City Commission approved paying almost $1 million to the developers.
That’s a broken promise.
·At that same meeting, a little past 9½ minutes into the video, Boyd clearly implied that the citizens would get to vote on the downtown proposal. The commission went forward without giving Amarillo ’s voters a chance to formally endorse this plan. There was a good reason, of course. McCartt and others expressed concern they couldn’t get the votes.
That’s another broken promise.
·David Wallace, on Nov. 9, 2010, had pitched the City Commission. His bravado about being able to bring financing to the project hasn’t panned out. Instead, as evidence that the “skin in the game” may be the city’s taxpayers, not Wallace Bajjali’s, in a well-spun presentation, we learned last week that the developers couldn’t even put together the hotel deal they said they could as promised in the Globe-News’ Nov. 2, 2009story cited above. By all accounts, the city finessed a deadline for the developers using the Amarillo Government Corp. to front for the developer’s failure.
That’s another broken promise.
Let’s also not forget how quickly the City Commission moved on acquiring the old Santa Fe depot, with little public notice. The same holds true with the bond issue for the Amarillo Recreation Complex. In these two cases, my issue isn’t my position on those matters. It’s the lack of the city’s transparency and notice in moving on them.
I could reach back to 2008 when the commissioners acted with thoughtless abandon in adopting design standards for downtown while treating those who object with shoddy disdain — a pattern that continues to this day for anyone who dares question the commission. And, I could cite some other actions the commissioners pushed through based on false and faulty information. The two most glaring that come to mind is the over-reaching hands-free cell phone ordinance and the red light camera program.
Don’t get me wrong, I think texting and driving is reprehensible and should be barred. I also think it’s stupid to talk on one’s cell phone without a hand’s-free device. But the commission knowingly passed this measure on the basis of the chairwoman of the Traffic Commission misrepresenting the traffic group’s findings in its “extensive” study of the issue. It kind of reminds me of the run up to the war in Iraq when the Bush administration lied about weapons of mass destruction. As for the red light cameras, none of the data posited by the Amarillo Globe-News or other outlets used proper statistical techniques such as used by the Insurance Institute for Highway Safety.
Under these circumstances, it’s my belief we need more than an election every two years to impose checks and balances on city government. The proposed changes to the City Charter move in exactly the opposite direction needed. Please vote against these changes in the charter.
Original Text of article describing Wallace Bajjali's troubled past - published Nov. 16, 2010
By Gina Haschke, Greg Rohloff and George Schwarz
The Amarillo Independent
The principals in the development firm that the Amarillo City Commission is considering as the master developer for downtown revitalization are no strangers to litigation, with one of the firm’s showcase Houston area projects the subject of a foreclosure and lawsuit. And, those same principals, David G. Wallace, and Costa Bajjali, are on the periphery of an ongoing Securities and Exchange Commission fraud investigation.
Last Tuesday, Wallace, co-founder and chief executive officer of Wallace Bajjali Development Partners, Inc., impressed city commissioners and staff with a presentation touting his experience with developments in his hometown of Sugar Land, where he served as mayor until 2008. He also touted his firm's developments in other cities, including Waco and the Houston area.
(See the video of Wallace’s presentation here.)
But at least one development has soured — the Creekmont Plaza mixed use commercial development in Fort Bend County.
According to a petition filed June 10, 2010, Frost National Bank foreclosed on the Creekmont Plaza Development in Missouri City.
The two men took out a loan of more than $1.9 million with Frost in August 2008 as the general and limited partners in Creekmont Plaza Partners, L.P. and personally guaranteed the loan.
“Despite demand for payment of the balance due, Mr. Wallace and Mr. Bajjali have failed to pay the balance due,” the petition alleges.
The petition states that the property was sold in a foreclosure sale in April at the Fort Bend County Courthouse. But the sale, which brought $1.1 million, was almost $820,000 short of the loan amount. At that time, taxes on the property were also overdue.
“The delinquent taxes for the years 2007 through 2009 were in the amount of $157,494 if paid on March of 2010, plus the 2010 taxes and the Defendants are jointly and severally liable to Plaintiff for the taxes plus interest thereon as allowed by law,” the petition alleges.
The petition asks for payment of the shortfall of the sale, interest, court costs and lawyer’s fees.
All the defendants have entered a general denial and, as of Monday, the case is set for trial in March 2011, according to Harris County District Court records.
A search of additional Harris County District Court records shows Wallace involved in several other lawsuits, including litigation in 1995 with Mark Thatcher, son of former British Prime Minister Margaret Thatcher and Wallace’s former business partner in several United States-based businesses.
How much Downtown Amarillo, Inc. is aware of all the court actions isn’t clear.
Melissa Dailey, executive director of Downtown Amarillo, Inc., said she had done “quite a bit” of background research on the firm. She said she had not looked into the Thatcher alliance in detail, but added, “I’m more interested in his development activities here in the United States.”
When asked about a Securities and Exchange Commission investigation, she said she was “aware of the situation.”
It has little negative reflection on Wallace Bajjali, Dailey said, adding, “In fact, it’s a positive.”
Daily wouldn’t discuss the matter further, saying instead Wallace would talk about it when he was in Amarillo in the next week or two “because he knows the details much more intimately than I do.”
Several calls and repeated messages left for Wallace for comment were not returned.
The SEC investigation focuses on Kaleta Capital Management, or KCM, a Houston business known as BizRadio, and may yet reach Wallace and Bajjali or some of their business entities.
The year-old litigation — the SEC filed suit Nov. 13, 2009 — names Albert Kaleta and KCM as defendants in a claim that they defrauded investors of $10 million.
According to a July 2010 update on the receivership website, “Based upon the recent inclusion of BizRadio in the Receivership Estate, negotiations have now been commenced with respect to potential liability of the Wallace Bajjali entities and their principals with respect to investments by members of the public in BizRadio directly, and in other related investment vehicles. To date no agreements have been reached with respect to these matters.”
On Monday, Thomas L. Taylor III, the Houston attorney who is overseeing the SEC-ordered receivership of KCM, said neither Wallace nor Bajjali or their entities are yet named in any of the court papers but he would also neither confirm nor deny that they could be pulled into the federal investigation at a later time.
In negotiations with Taylor, Wallace has paid back $92,348 and Bajjali has paid back $45,550 to date, according to the publicly available information.
Taylor said negotiations are ongoing about further repayments by Wallace and Bajjali.
Nevertheless, DAI’s Dailey said Monday, “We have not come across anything negative. When we looked into it in detail, it all was positive.”
The Amarillo Independent
The principals in the development firm that the Amarillo City Commission is considering as the master developer for downtown revitalization are no strangers to litigation, with one of the firm’s showcase Houston area projects the subject of a foreclosure and lawsuit. And, those same principals, David G. Wallace, and Costa Bajjali, are on the periphery of an ongoing Securities and Exchange Commission fraud investigation.
Last Tuesday, Wallace, co-founder and chief executive officer of Wallace Bajjali Development Partners, Inc., impressed city commissioners and staff with a presentation touting his experience with developments in his hometown of Sugar Land, where he served as mayor until 2008. He also touted his firm's developments in other cities, including Waco and the Houston area.
(See the video of Wallace’s presentation here.)
But at least one development has soured — the Creekmont Plaza mixed use commercial development in Fort Bend County.
According to a petition filed June 10, 2010, Frost National Bank foreclosed on the Creekmont Plaza Development in Missouri City.
The two men took out a loan of more than $1.9 million with Frost in August 2008 as the general and limited partners in Creekmont Plaza Partners, L.P. and personally guaranteed the loan.
“Despite demand for payment of the balance due, Mr. Wallace and Mr. Bajjali have failed to pay the balance due,” the petition alleges.
The petition states that the property was sold in a foreclosure sale in April at the Fort Bend County Courthouse. But the sale, which brought $1.1 million, was almost $820,000 short of the loan amount. At that time, taxes on the property were also overdue.
“The delinquent taxes for the years 2007 through 2009 were in the amount of $157,494 if paid on March of 2010, plus the 2010 taxes and the Defendants are jointly and severally liable to Plaintiff for the taxes plus interest thereon as allowed by law,” the petition alleges.
The petition asks for payment of the shortfall of the sale, interest, court costs and lawyer’s fees.
All the defendants have entered a general denial and, as of Monday, the case is set for trial in March 2011, according to Harris County District Court records.
A search of additional Harris County District Court records shows Wallace involved in several other lawsuits, including litigation in 1995 with Mark Thatcher, son of former British Prime Minister Margaret Thatcher and Wallace’s former business partner in several United States-based businesses.
How much Downtown Amarillo, Inc. is aware of all the court actions isn’t clear.
Melissa Dailey, executive director of Downtown Amarillo, Inc., said she had done “quite a bit” of background research on the firm. She said she had not looked into the Thatcher alliance in detail, but added, “I’m more interested in his development activities here in the United States.”
When asked about a Securities and Exchange Commission investigation, she said she was “aware of the situation.”
It has little negative reflection on Wallace Bajjali, Dailey said, adding, “In fact, it’s a positive.”
Daily wouldn’t discuss the matter further, saying instead Wallace would talk about it when he was in Amarillo in the next week or two “because he knows the details much more intimately than I do.”
Several calls and repeated messages left for Wallace for comment were not returned.
The SEC investigation focuses on Kaleta Capital Management, or KCM, a Houston business known as BizRadio, and may yet reach Wallace and Bajjali or some of their business entities.
The year-old litigation — the SEC filed suit Nov. 13, 2009 — names Albert Kaleta and KCM as defendants in a claim that they defrauded investors of $10 million.
According to a July 2010 update on the receivership website, “Based upon the recent inclusion of BizRadio in the Receivership Estate, negotiations have now been commenced with respect to potential liability of the Wallace Bajjali entities and their principals with respect to investments by members of the public in BizRadio directly, and in other related investment vehicles. To date no agreements have been reached with respect to these matters.”
On Monday, Thomas L. Taylor III, the Houston attorney who is overseeing the SEC-ordered receivership of KCM, said neither Wallace nor Bajjali or their entities are yet named in any of the court papers but he would also neither confirm nor deny that they could be pulled into the federal investigation at a later time.
In negotiations with Taylor, Wallace has paid back $92,348 and Bajjali has paid back $45,550 to date, according to the publicly available information.
Taylor said negotiations are ongoing about further repayments by Wallace and Bajjali.
Nevertheless, DAI’s Dailey said Monday, “We have not come across anything negative. When we looked into it in detail, it all was positive.”
Thursday, October 31, 2013
New developer for convention center hotel
In an orchestrated presentation, Chuck Patel from NewcrestImage and Costa Bajjali, of Wallace Bajjali Development Partners, told the ALGC and gathered guests that Patel’s firm will take over the financing and development of a new hotel. NewcrestImage’s predecessor firm developed the Courtyard by Marriott in the Historic Fisk Building
But, while the soil sampling and site work is going on now, the financing isn’t completely nailed down, according to Patel, who gave a short interview here. Bajjali’s interview, in which he said the firm has met contractual requirement with the city of Amarillo and the ALGC, can be found here; and, city Manager Jarrett Atkinson’s clarification can be found here.
The full meeting is here.
Wednesday, October 30, 2013
Is another failure for downtown development coming? - corrected headline
One of the nice things about being retired is that I can blog — nor not — as I am so inclined. I posted a few things in the past two weeks, but nothing extensive. In part, it’s a conflict between maintaining a sense of peace and expressing an opinion or clarifying what is generally false information spread by the Amarillo Globe-News. The latter task lately would be a full-time job. I’ll pass on the critiques for the moment. Should I choose to pursue those more vigorously, I can do so at my own pace.
But, we do having something brewing for which I’d like to give my readers a “heads-up.” On Thursday (Oct. 31, 2013), the Amarillo Local Government Corp.’s agenda calls for a discussion of a co-developer for the convention center hotel. The financing for that hotel was to be in place by Nov. 1 as part of the $113 million deal that master developer Wallace Bajjali put together with the City Commission in November 2010. It’s not clear if The Amarillo Independent’s warning to the City Commission, which was kludged around through the panel’s own form of denial, will lead to an “I Told You So” column.
To prepare for whatever comes out of the ALGC meeting tomorrow, I’ve posted two videos to The Amarillo Independent’s YouTube channel. The first is the Nov. 9, 2010 City Commission work session at which Melissa Dailey and David Wallace pitched the commission; and the second is the Nov. 16,2010 work session at which the City Commission backed off on immediately awarding Wallace Bajjali a contract after the commissioners saw the Independent’s vetting of Wallace Bajjali,.
As you watch these videos, note how the project has evolved and how, despite promises, taxpayer money has been arabesqued into the deal. You’d know that if you follow the media coverage on the project since then. In addition, note that Ron Boyd, when he was a commissioner, implied that the citizens would get to vote on this pojrect.
We’ll report here tomorrow to let you know what happens. Stay tuned.
Sunday, October 13, 2013
Another business screw up
The next time someone bashes government and problems signing up for the Affordable Care Act, take note that business can screw up "better." From TechCrunch.com, "Yahoo Mail has been experiencing a major bug, following its revamp earlier this week.
According to a number of reports, the service has been automatically forwarding emails to users’ “alternate,” external email addresses – a setting that was switched on without users’ permission. Yahoo has replied to some help requests via its Twitter account @YahooCare, but it hasn’t replied to help requests on its UserVoice forum, nor has its Customer Care site offered a solution to this problem."
According to a number of reports, the service has been automatically forwarding emails to users’ “alternate,” external email addresses – a setting that was switched on without users’ permission. Yahoo has replied to some help requests via its Twitter account @YahooCare, but it hasn’t replied to help requests on its UserVoice forum, nor has its Customer Care site offered a solution to this problem."
Tuesday, October 8, 2013
Sunday, October 6, 2013
When will the Globe-News stop lying to readers?
Sometime in 2005, I don’t remember exactly when, I decided that I could no longer work at the Amarillo Globe-News. It wasn’t because I disagreed with the paper’s political stances on the editorial and op-ed pages. It was because it committed what I feel is the worst of ethical breaches — publishing a story in which known facts are excluded so as to change the story itself or (in the same vein) refusing to publish a story to suppress facts. It is now clear to me that slanting the news and spreading falsehoods on the editorial and op-ed pages are part of a concerted propaganda effort. Here is the story in the New York Times.
An example of the first that I experienced firsthand was a story about a disagreement between orthopedic surgeons and Baptist St. Anthony's Health System over how the doctors should be paid for emergency room coverage. I had gathered information that made the case that clinical factors should determine who and when a doctor would be called into the hospital off-hours, typically the middle of the night. None of the information got into the published version of the story, which portrayed poor little ole BSA as the victim of doctors’ greed. It’s as if the article’s author was BSA itself.
The second story also involved BSA, this time one documenting a failure to meet legal charity care requirements under Texas law in place in 2005. The executive editor at the time wanted to run the story but the publisher, who is still at the paper, wouldn’t let it run without a personal review of the information. The publisher never could find time for a meeting, so thanks to passive-aggressive avoidance, the story never made it into the Globe-News.
I concluded that Amarillo needed honest journalism, which is why I established The Amarillo Independent. Amarillo still needs honesty from its paper of record and, while editorials express opinions, editorial writers have a moral and ethical obligation to use facts to back up the opinions. On Oct. 1, the Globe-News ran an editorialthat flat-out lied by repeating a Tea Party talking point about the Affordable Care Act. I called out the paper and the editorial page editor, Dave Henry, on it.
So, here we are Oct. 6 and the Globe-Newscontinues — as it always will — to paint a false picture of a situation. It would be forgivable were these falsehoods done from ignorance. But they aren’t. As I said, they are part of a concerted propaganda effort and, in this case, it’s to be an apologist for the boorish behavior of a Tea Party Republican.
“This isn’t some damn game.”
This was a quote from U.S. House Speaker John Boehner this past Friday — and the speaker is correct.
Unfortunately, the shutdown of the federal government is a game to some in Washington , D.C.
If that’s the case, then the entire government shut down shouldn’t be a pawn for trying to derail the Affordable Care Act. Accept it’s the law and work through legitimate channels to modify it.
West Texas lawmaker Randy Neugebauer, R-Lubbock, took some heat this past week for confronting a National Park Service employee when barricades were erected at the World War II Memorial in Washington — preventing access for members of The Greatest Generation, at least temporarily.
Does Neugebauer deserve to get dinged? To a degree (a federal employee was the wrong target), but those who think the congressman from Lubbock is the only one deserving of such treatment need more than a partisan perspective.
Neugebauer is exempt from approbation to a degree? He was a hypocritical, boorish and arrogant piece of political offal, and so far the only one to vent his vomit-like spleen on a helpless employee. There is no “partisan perspective” for common courtesy and decency.
The closure of the WWII Memorial, even temporarily to veterans, was an act of gamesmanship — pure and simple.
And shutting down the federal government by refusing to pass a clean continuing resolution isn’t? You can’t have it both ways and the GOP and the Globe-News are making pawns out of the visitors to the WWII Memorial.
The big picture:
■ As syndicated columnists Charles Krauthammer and Diana West pointed out (AGN Media ran their columns Saturday), the $182 million memorial was paid for with $197 million in private funds, with the extra money in a memorial fund.
And then turned it over to the National Park Service to run. Sort of like the center for performing arts was turned over to the city of Amarillo
■ Republicans in the U.S. House of Representatives approved three bills for national parks funding, but Democrats balked.
Of course they balked. So did the GOP on the ACA. Good for goose, good for gander.
■ For crying out loud, the WWII Memorial is open-air, how much of a presence is really required by the National Park Service to staff this facility? And how much taxpayer money was used to trot out those ridiculous, if not offensive, barricades?
See above.
■ It also interesting that the federal government found the money to send U.S. Secretary of Defense Chuck Hagel and Secretary of State John Kerry to Japan this past Thursday to “pay their respects” (according to The Associated Press) at a national cemetery in Tokyo for Japanese soldiers who died in World War II.
This was part of a bigger picture which the Amarillo Globe-News conveniently but not surprisingly leaves out.
The federal government — if not the White House — can write a check for whatever it wants, and in this case, the WWII Memorial, if not the nation’s veterans, was used to score political points.
Again, we’re not letting Congressman Neugebauer off the hook. His scorn was directed at yet another pawn in this political power play (a federal employee), and he should have known better.
However, those who want to pile all the blame for the shutdown of the federal government on the congressman are just as misdirected.
You are letting Neugebauer off the hook. Not only are you making excuses for him, but you’re throwing out a red herring. No one is “piling all the blame for the shutdown” on this lackluster back-bencher. The condemnation is for his boorish behavior and being a hypocrite for attempting to blame a lowly employee for something the Lubbock-based political hack supported.
Politicians can't be allowed to backtrack on their stupidity
“Misspoke” and “out of context” have become the common excuse of politicians trying to make an excuse of being openly stupid. It is, in the jargon of people who think themselves Beltway
Two recent examples come to mind, one of which we’ve already mentioned on this blog. Rep. Randy Neugebauer, perhaps unknowingly because of his mental deficiencies, mistreated a National Park Service employee, trying to blame her for the government shutdown that he supported. The encounter, caught on videoby the NBC station in Washington , was a stunning insight into the plutocratic yet deficient mentality of a Texas politician.
The Lubbock Avalanche-Journal reported that Neugebauer claimed the video was out of context because “the encounter followed a visit he and other members of Congress had investigating why the National Park Service installed barricades around the open-air memorial that usually does not have controlled access.”
The A-J, which is owned by the same right-wing corporation that owns the Amarillo Globe-News, didn’t post or link to the NBC video. But readers of this blog can find it here. Judge for yourselves whether Neugebauer is being treated unfairly in the media. Or, by Citizens for Responsibility and Ethics, which filed a complaintagainst Neugebauer, for bringing discredit to the United States House of Representatives.
Another example is from one of the least mentally capable people and another Texas politician — Rick Perry, currently suckling at two public tits, one a salary for government and another pulling down retirement funds. During a visit to New Jersey , Perry tried to criminalize the Affordable Care Act and the mandate to enroll people in the program. According to NJ.com, Perry said, “If this heath care law is forced upon this country, the young men and women in this audience are the ones who are really going to pay the price. And that, I suggest to you, reaches the point of being a felony toward them and their future. That is a criminal act, from my perspective, to put that type of burden on them — to mortgage their future like that.”
A day later, the Houston Chronicle reported that “Perry also tempered a remark he made earlier this week in New Jersey , when he said the implementation of the president's national health care overhaul was ‘a criminal act.’ Perry said Friday that he used the word figuratively.”
The United States Congress passed the Affordable Care Act, the president signed it and the Supreme Court ruled the measure was constitutional. What part of all this does Perry not understand? Either none of it, reflecting his ignorance or, more likely and even worse, all of it but spinning it to cater to the right wing base that supports him and similar politician like Red Cruz and Neugebauer.
Saturday, October 5, 2013
Analysis of shutdown requires looking at the big picture
On Friday, I bloggedthat my day started a little differently — veering toward a place of peace. I tried to stay away from politics until late in the day. Then, a thread on Facebook became active. I thought the comment I posted to the threadwas more peaceful and neutral than an advocacy position I would normally hold.
Then, a former employee of the Amarillo Globe-News chimed in and did exactly what I said was unproductive. He claimed I was strategizing on how to hurt Americans and blame it on the Republicans. You can read the comment at the end of the thread.
My main point yesterday was this, “This government shutdown is a battle for the hearts and minds of Americans. It is a crude attempt to get at this question: What should be the role of the federal government in American lives?”
The rise of the Tea Party since 2008 has triggered this crude battle in our country. It seems the Tea Party activists and libertarians want government’s role to be so minimal as to almost destroy government itself. The role of the government would reflect in the starkest possible terms the invisible hand of an amoral free market, even if the very structure of a market segment doesn’t accommodate the free market-capitalist paradigm. If one looks carefully at the right wing conservative positions on what should and shouldn’t be part of the federal government’s role, the positions amount to two major directions: Remove government from regulating large corporate interests; and, continue to feed the military-industrial complex, which would flow money back through the corporate ruling structure.
Even in his latest essay, the esteemed Bill Moyers in his Friday musings, missed somewhat the overarching role of the corporatist takeover of the United States government. Moyers didn’t totally miss the point. He recognized that one of the goals of the Koch-inspired (if not led and financed) Tea Party is to destroy the Environmental Protection Agency. It’s no wonder that the right-winger conservatives, who perseverate the inability to think critically, overlook that their populist view of the Tea Party movement is sadly misplaced. How ironic.
And the evidence to buttress my position about the lack of critical thinking and intellectual dishonesty, the trigger for the Republican-led shutdown is the futile attempt to kill off the Affordable Care Act (who can honestly dispute that as the proximate cause of the shutdown?). While much of the resistance to the act is based on disinformation (or should I say outright lies?), the final version of the law has something for every big-money corporate health care interest. The pharmaceutical industry won price protection. The medical equipment industry (and the hospitals and hospital administrators with edifice complexes) on a national level continue spend capital dollars even if the new toys and buildings are not needed. And the biggest winner, the insurance lobby, gets to be the conduit for coverage even when the more efficient Medicare system could be the more efficient system for insuring Americans.
I can’t gainsay what another Facebook poster noted, although he seems to have pulled his posts since making the statement that both parties are complicit. And so are the voters. I’ve long and often said we get the government we deserve.
Still, what is more important to me at this point is seeing the big picture. Being mentally anchored in the Texas Panhandle gives a skewed view of that picture. The view of the role of government in this reddest and more religiously conservative part of red-state America is far different than other parts of our vast nation. I won’t condemn people for having and adhering to their beliefs, but I will condemn them for not recognizing others have different beliefs. And more, I condemn the Republican-Tea Party politicians for their slanted view leading to this shutdown.
Friday, October 4, 2013
Channeling peace this Friday
I started my day as I normally do: I checked my email, floated over to Facebook to see what is happening on my newsfeed and then over to the 15 or so news sites I normally peruse. But my direction shifted when my “Unapologetically Episcopalian” postingnoted that Oct. 4 commemorates St. Francis of Assisi . Along with the text posting, Unapologetically Episcopalian linked to a videoof “Make me a channel of your peace,” also known as the Prayer of St. Francis, sung by the Choir of Chester Cathedral, England from the album “Sing for Joy - Cathedral Praise 2.”
The music put me in a different frame of mind today and sent me on a search for the text, or lyrics, for the music. As it turns out, the history of the prayer and the music, are interesting and, according to Wikipedia in a well-sourced article, the attribution to St. Francis came hundreds of years after his death. So obviously, several versions of the original prayer and the lyrics exist, with one version of the song on YouTube showing the lyrics as the tune is sung clearly. I am particularly touched by this today, and so I also sought the wording for this prayer in the Book of Common Prayer of the Episcopal Church in the United States being:
Lord, make us instruments of your peace. Where there is
hatred, let us sow love; where there is injury, pardon; where
there is discord, union; where there is doubt, faith; where
there is despair, hope; where there is darkness, light; where
there is sadness, joy. Grant that we may not so much seek to
be consoled as to console; to be understood as to understand;
to be loved as to love. For it is in giving that we receive; it is
in pardoning that we are pardoned; and it is in dying that we
are born to eternal life. Amen.
hatred, let us sow love; where there is injury, pardon; where
there is discord, union; where there is doubt, faith; where
there is despair, hope; where there is darkness, light; where
there is sadness, joy. Grant that we may not so much seek to
be consoled as to console; to be understood as to understand;
to be loved as to love. For it is in giving that we receive; it is
in pardoning that we are pardoned; and it is in dying that we
are born to eternal life. Amen.
Does that mean the news and behavior of some politicians out there aren’t bad enough to rile me up? Yes and no, but in the spirit of trying to channel peace, I am going to express sadness at the tone of the battle for the hearts and minds of the American people.
I have things to say and I’ll be back later.
Thursday, October 3, 2013
Pure & Simple: Rep. Randy Neugebauer is a jerk
Rep. Randy Neugebauer, a Tea Party wannabe who sided with the rest of the right-wing crazies on the government shutdown, displayed such an egregious lack of class toward a federal employee who here.
was trying to do her job. The report of the the incident is on video
I guess I've gotten used to politicians being inveterate liars and mealy-mouthed jerks, but my blood pressure jumps to great heights when I see this kinds of hypocrisy. It's hard to get directly to politicians of Neugebauer's ilk, but I am putting a print out of my email to him in the snail mail as well. A photo of it is to the left.
I doubt this jackass will every see it or even care, but maybe if we get enough to his staff, he might admit he "misspoke." Of course ,that will be another lie.
Who's with me?
I guess I've gotten used to politicians being inveterate liars and mealy-mouthed jerks, but my blood pressure jumps to great heights when I see this kinds of hypocrisy. It's hard to get directly to politicians of Neugebauer's ilk, but I am putting a print out of my email to him in the snail mail as well. A photo of it is to the left.
I doubt this jackass will every see it or even care, but maybe if we get enough to his staff, he might admit he "misspoke." Of course ,that will be another lie.
Who's with me?
Wednesday, October 2, 2013
Defense cuts should be targeted
A friend of mine in Los Alamos, NM makes an interesting point on Facebook. He wrote:
"Attached is a pie chart I put together of US Budget for 2010 (the most recent year for which I was
able to find complete data). The three big things that we spend money on are: social services, the military, and interest on the debt, which in total accounts for just over 80% of our national spending. Everything else that the government does (e.g. - NIH, NEA, DOE, NASA, NSF, FAA, DOI, etc...) falls under the remaining 20%. Now, let's compare this with our income: in 2010, our government had a revenue of $2.16 trillion, and they spent $3.45 trillion. Thus, even if we eliminated the 'Everything Else'category of our expenditures, we would still be overspent by $600 billion.
"The point of all of this is that (it) greatly amuses me when our elected officials start talking about the need to balance the budget, but state that we can't reduce spending on social services or the military."
Now, if my math is right, we have $64.515 billion tied up in "defense" spending, with many of the programs devoted to feeding the military-industrial complex that the late President Dwight D. Eisenhower warned us about. I am not going to break this $64 trillion down, but I would point out that former Vice President Dick Cheney's Halliburton and other well-connected firms have profited directly from the Middle East adventurism. Our country's ability to wage war far exceeds our need to wage war.
As we endure the immature, kindergarten-like behavior from the 535 politicians who, more than any other government class, suckle at our taxpaying tits, we should keep in mind where the money goes and who is hurt by where it goes.
I don't know where we're going with this government shutdown, nor do I know the repercussions for the nation and for the leeches in Congress, but I can only hope that the backlash in the mid-term elections will be severe, wide-ranging and devastating to the incumbents who are owned by the military-industrial corporatist plutocrats who "get theirs" at the expense of the least of us getting anything.
"Attached is a pie chart I put together of US Budget for 2010 (the most recent year for which I was
"The point of all of this is that (it) greatly amuses me when our elected officials start talking about the need to balance the budget, but state that we can't reduce spending on social services or the military."
Now, if my math is right, we have $64.515 billion tied up in "defense" spending, with many of the programs devoted to feeding the military-industrial complex that the late President Dwight D. Eisenhower warned us about. I am not going to break this $64 trillion down, but I would point out that former Vice President Dick Cheney's Halliburton and other well-connected firms have profited directly from the Middle East adventurism. Our country's ability to wage war far exceeds our need to wage war.
As we endure the immature, kindergarten-like behavior from the 535 politicians who, more than any other government class, suckle at our taxpaying tits, we should keep in mind where the money goes and who is hurt by where it goes.
I don't know where we're going with this government shutdown, nor do I know the repercussions for the nation and for the leeches in Congress, but I can only hope that the backlash in the mid-term elections will be severe, wide-ranging and devastating to the incumbents who are owned by the military-industrial corporatist plutocrats who "get theirs" at the expense of the least of us getting anything.
Guv race could be closer than you think
Democrats may not need to be so pessimistic about one of their taking the Texas governor race after all.
According to a Texas Lyceum Poll as reported in the Texas Tribune, state Rep. Wendy Davis has is only 8 percentage points behind Greg Abbott, the putative Republican nominee, in a hypothetical race for Texas governor. Those 8 points are more significant when viewed in context. First, in the overall polling, fully half the respondents were undecided, meaning it could be anyone’s race. Then, there is the gender gap, and Abbott suffers from it.
“Abbott’s lead shrinks to 2 points, within the margin of error, when only women are counted. In that slice of the electorate, Abbott had 25 percent and Davis was at 23 percent, with 51 percent undecided,” the Tribune reports.
Davis holds sizable leads in the black and Hispanic population, but suffers among independents — until the 74 percent undecided segment in the latter groups is considered.
The Tribune cites that Davis’ biggest deficit is in the size of the Abbott war chest, said to be $22 million while hers sits at less than 5 percent of Abbott’s.
But what the Tribune isn’t reporting, and so far none of the other media eight now, is how much of his staff on the state payroll are pumping out his public relations pieces to buttress his run for governor. When The Amarillo Independent last covered Abbott on a visit to Amarillo, it was to Amarillo College for Abbott to tout his war on sexual predators. He had several of his own camera and sound crew and it was clear this was a public relations event for him.
All that said, if the Democrats want to capture the top spot in Texas, it’s time for fund-raising in high gear now and time to go negative often and early on Abbott. He is plenty vulnerable.
+(2).JPG) |
Abbott at AC with his taxpayer-supplied video crew. |
According to a Texas Lyceum Poll as reported in the Texas Tribune, state Rep. Wendy Davis has is only 8 percentage points behind Greg Abbott, the putative Republican nominee, in a hypothetical race for Texas governor. Those 8 points are more significant when viewed in context. First, in the overall polling, fully half the respondents were undecided, meaning it could be anyone’s race. Then, there is the gender gap, and Abbott suffers from it.
“Abbott’s lead shrinks to 2 points, within the margin of error, when only women are counted. In that slice of the electorate, Abbott had 25 percent and Davis was at 23 percent, with 51 percent undecided,” the Tribune reports.
Davis holds sizable leads in the black and Hispanic population, but suffers among independents — until the 74 percent undecided segment in the latter groups is considered.
The Tribune cites that Davis’ biggest deficit is in the size of the Abbott war chest, said to be $22 million while hers sits at less than 5 percent of Abbott’s.
But what the Tribune isn’t reporting, and so far none of the other media eight now, is how much of his staff on the state payroll are pumping out his public relations pieces to buttress his run for governor. When The Amarillo Independent last covered Abbott on a visit to Amarillo, it was to Amarillo College for Abbott to tout his war on sexual predators. He had several of his own camera and sound crew and it was clear this was a public relations event for him.
All that said, if the Democrats want to capture the top spot in Texas, it’s time for fund-raising in high gear now and time to go negative often and early on Abbott. He is plenty vulnerable.
High school students show kindness and class
Sometimes I have to take a break form the political fray and look at the brighter side of life. A story on this morning’s Houston Chronicle website gave me the chance to do so. And, it restored some faith in the younger generation.
It seems that Libby Klein, a 19-year-old student at Fredericksburg High School, was crowned homecoming queen this past Saturday night. What made this high school ritual different is that Klein has Down syndrome. But, as the story notes, this wasn’t a sympathy vote. It was recognition that Klein was kind, outgoing and upbeat.
I hope that the students at Fredericksburg High School are proud of themselves for showing class and kindness in a world that sometimes seems too focused on just the opposite. And I hope that this honor for Klein and for all who support her is an inspiration for further achievement and excellence.
It seems that Libby Klein, a 19-year-old student at Fredericksburg High School, was crowned homecoming queen this past Saturday night. What made this high school ritual different is that Klein has Down syndrome. But, as the story notes, this wasn’t a sympathy vote. It was recognition that Klein was kind, outgoing and upbeat.
I hope that the students at Fredericksburg High School are proud of themselves for showing class and kindness in a world that sometimes seems too focused on just the opposite. And I hope that this honor for Klein and for all who support her is an inspiration for further achievement and excellence.
Tuesday, October 1, 2013
Stop Lying
In my previous post (below), I refer to the false balance that affects — or should I say, “infects” — journalism.
I must, for he sake of conscience and what truth there may be in public discourse these days, take my discussion a step further. In Amarillo, the Amarillo Globe-News goes far beyond false balance and peddles lies. Here is a quote from today’s editorial, “While a government shutdown is not going to help Republicans (and won’t derail the federal government’s takeover of health care), there is a simple but legitimate question we ran across recently related to Obamacare that puts the problem in perspective.”
First, the Affordable Care Act is not a government takeover of health care. As I’ve pointed out on many occasions, the ACA restructures many of the mechanisms for financing health services, but it is not a “takeover.” As Winthrop Quigley so clearly and brilliantly points out in his Albuquerque Journal column today, “As it happens, Obamacare has very little to do with health and everything to do with finance. It is an attempt to rescue the nation’s for-profit health-care financing system from itself.”
In short, Dave Henry and Les Simpson you two are either too stupid to understand what the act is about or you do understand and you continue to spread disinformation. That makes you liars, but it wouldn’t be the first time you’ve either shown abysmal ignorance or mendaciousness.
Henry and the AGN editorial goes on to ask, “What reason is there for optimism that a government-mandated takeover will work, now or in the future?”
If you define “government takeover” as the Veteran’s Administration or the military medical services, then I share your pessimism. Those are not the shining lights of systems that consistently and across the board deliver the best of American medical care. Oh, some places do, especially those affiliated with university-based training programs; but those are the exception.
On the other had, if you define “government takeover” as the financing mechanism, then the Centers for Medicare and Medicaid Services far outshines any of the private insurance firms. As I’ve pointed out, the retention rate for Medicare is generally around 2 percent, far more efficient than the administrative and overhead costs of the private insurance companies.
At the end of the disinformation — maybe we should refer to the AGN as Amarillo’s Disinformation Station — the editorial almost incoherently states, “Don’t forget, there is a reason this country is $17 trillion in debt, give or take a few trillion or million, which shouldn’t be a problem for the federal government.”
Well, Dave, some of us haven’t forgotten why we’re this far in debt. It’s because the former Republican president and his corrupt and lying vice president and defense secretary lied the United States into two Middle Eastern wars. And, because they turned their heads on the corrupt acts of the Wall Street bankers who triggered the Great 2008 Recession.
As Daniel Patrick Moynihan pointed out, “You are entitled to your opinion. But you are not entitled to your own facts.”
I must, for he sake of conscience and what truth there may be in public discourse these days, take my discussion a step further. In Amarillo, the Amarillo Globe-News goes far beyond false balance and peddles lies. Here is a quote from today’s editorial, “While a government shutdown is not going to help Republicans (and won’t derail the federal government’s takeover of health care), there is a simple but legitimate question we ran across recently related to Obamacare that puts the problem in perspective.”
First, the Affordable Care Act is not a government takeover of health care. As I’ve pointed out on many occasions, the ACA restructures many of the mechanisms for financing health services, but it is not a “takeover.” As Winthrop Quigley so clearly and brilliantly points out in his Albuquerque Journal column today, “As it happens, Obamacare has very little to do with health and everything to do with finance. It is an attempt to rescue the nation’s for-profit health-care financing system from itself.”
In short, Dave Henry and Les Simpson you two are either too stupid to understand what the act is about or you do understand and you continue to spread disinformation. That makes you liars, but it wouldn’t be the first time you’ve either shown abysmal ignorance or mendaciousness.
Henry and the AGN editorial goes on to ask, “What reason is there for optimism that a government-mandated takeover will work, now or in the future?”
If you define “government takeover” as the Veteran’s Administration or the military medical services, then I share your pessimism. Those are not the shining lights of systems that consistently and across the board deliver the best of American medical care. Oh, some places do, especially those affiliated with university-based training programs; but those are the exception.
On the other had, if you define “government takeover” as the financing mechanism, then the Centers for Medicare and Medicaid Services far outshines any of the private insurance firms. As I’ve pointed out, the retention rate for Medicare is generally around 2 percent, far more efficient than the administrative and overhead costs of the private insurance companies.
At the end of the disinformation — maybe we should refer to the AGN as Amarillo’s Disinformation Station — the editorial almost incoherently states, “Don’t forget, there is a reason this country is $17 trillion in debt, give or take a few trillion or million, which shouldn’t be a problem for the federal government.”
Well, Dave, some of us haven’t forgotten why we’re this far in debt. It’s because the former Republican president and his corrupt and lying vice president and defense secretary lied the United States into two Middle Eastern wars. And, because they turned their heads on the corrupt acts of the Wall Street bankers who triggered the Great 2008 Recession.
As Daniel Patrick Moynihan pointed out, “You are entitled to your opinion. But you are not entitled to your own facts.”
Congressional Turds
Last night’s midnight deadline came and went without Congress agreeing on the budget and the debt
ceiling. Try as I might, I can’t think of a civil thing to say to the 435 United States House members who have allows this to happen.
Thanks, however, to the New York Daily News, I am aided in my communication to the right wingers who have visited this upon our nation and on the taxpayers. What is gratifying to me about the Daily News’ front page today is that it says (perhaps a bit more gently than I wish) what I feel and perhaps what many others feel today too. But because it’s the Daily News, it will be hard for those inhabiting the Beltway Bubble to avoid seeing the disdain we the people have for them. At this level of exposure, I suspect it’s difficult, if not impossible, for the members of Congress to miss this message.
Whether these bought-and-paid-for folks care is another matter altogether. Most are smug in their cocoons, protected from the wrath of their lowly constituents. First, unless you pay to play by making big contributions, these parasites don’t give a damn about your position. Second, they really never see the negative communications they get from constituents. Those are handled by staffers who vomit form letters that duck the issues and ignore the lowly concerns.
We are in our own civil war in the United States. It’s a war being fought for the hearts and minds of voters using the most sophisticated propaganda techniques known to man. In fact, I am going to start using a term that I’ve only recently learned: “false balance.” Also known as the balance fallacy, false balance gives equal weight to both sides of an argument, implying either that the truth is somewhere in the middle or that both arguments have equal weight.
We know, at least in journalism, or news media terms, false balance occurs far too often. It’s our job as journalists to fact-check and in doing so, we eliminate false balance. But if you’re either lazy or part of the propaganda machine, like the corporatist news media is, people aren’t going to see the false balance.
Which brings me back to the picture. As much as House Speaker John Boehner is to blame, it’s false balance to not include all the Tea Party members of the House and most of the Republicans. And some blue dog Democrats, too. Still, the part that’s right is calling them, all too gently, “turds.”
Thanks, however, to the New York Daily News, I am aided in my communication to the right wingers who have visited this upon our nation and on the taxpayers. What is gratifying to me about the Daily News’ front page today is that it says (perhaps a bit more gently than I wish) what I feel and perhaps what many others feel today too. But because it’s the Daily News, it will be hard for those inhabiting the Beltway Bubble to avoid seeing the disdain we the people have for them. At this level of exposure, I suspect it’s difficult, if not impossible, for the members of Congress to miss this message.
Whether these bought-and-paid-for folks care is another matter altogether. Most are smug in their cocoons, protected from the wrath of their lowly constituents. First, unless you pay to play by making big contributions, these parasites don’t give a damn about your position. Second, they really never see the negative communications they get from constituents. Those are handled by staffers who vomit form letters that duck the issues and ignore the lowly concerns.
We are in our own civil war in the United States. It’s a war being fought for the hearts and minds of voters using the most sophisticated propaganda techniques known to man. In fact, I am going to start using a term that I’ve only recently learned: “false balance.” Also known as the balance fallacy, false balance gives equal weight to both sides of an argument, implying either that the truth is somewhere in the middle or that both arguments have equal weight.
We know, at least in journalism, or news media terms, false balance occurs far too often. It’s our job as journalists to fact-check and in doing so, we eliminate false balance. But if you’re either lazy or part of the propaganda machine, like the corporatist news media is, people aren’t going to see the false balance.
Which brings me back to the picture. As much as House Speaker John Boehner is to blame, it’s false balance to not include all the Tea Party members of the House and most of the Republicans. And some blue dog Democrats, too. Still, the part that’s right is calling them, all too gently, “turds.”
Monday, September 30, 2013
Understand the health care act before slamming it
As Oct. 1 brings the nation to the first major step in implementing the Affordable Care Act, or Obamacare, all manner of media are reporting, analyzing and generally trying to bring clarity to a murky and difficult topic. The difficulty of this topic arises from the unique nature of health economics and the egregiously wrong application of general economic and free market principles to the discussion of health care.
While much of the rock-ribbed conservatives are railing against the ACA, the nation as a whole supports health care reform and much of the country is willing to give the reform act a chance. I spent 25 years in all aspects of the health care industry, with my early years witnessing the implementation of Medicare and Medicaid. As a journalist for some18 years, I always had health care as a beat. I have only seen a handful of reporters who “get it” and can explain how the system works. Nevertheless, I would offer these observations:
• First, I heard all the same arguments in 1967 with the passage and implementation of Medicare and Medicaid — and those programs turned out to be a boon for the hospital and health industry. And physicians no longer had to trade services for chickens.
• Second, most of the people posting about and complaining about the ACA are ill-informed and don’t understand anything about health economics, including the concept that the “free market” doesn’t work for health care. It never has and never will. If you want to make intelligent remarks about the ACA, learn about health economics and health insurance. Or get a master’s degree in health care like I did and then come back and make a fact-based argument about these issues.
• Third, the entire underwriting concept of the ACA working is community ratings, which deals with the issue of pre-existing conditions and other matters. It means that we’re trying to spread the risk over the widest population base possible. This will, in the long term, lower costs and accommodate the pre-existing conditions. It will also accommodate, from an underwriting standpoint, the more robust benefits the act imposes on insurers.
• Fourth, one of the reasons the ACA passed was the private insurance companies, BigPharma, hospitals, the organized physician community and the medical equipment industry “got theirs” as part of the bill. The negotiations with them saved the legislation. And, by the way, don’t believe the lies that the GOP tells abut not being part of the process: Iowa’s Chuck Grassley and Sarah Palin being two of the biggest liars claiming the GOP was cut out of the legislative process. The GOP was invited and didn’t play. It’s a typical bush league tactic.
• Fifth, saying government can’t run anything efficiently and it will make the act unworkable isn’t accurate, as popular as bashing government may be. Claiming government can’t run anything well isn’t accurate when focused on health care. Medicare has the lowest retention rate of all the insurers, which is a good thing and reflects the program’s efficiency. In short, it’s run better than all the private insurers could ever hope for.
• Sixth, the ACA has a long-range implementation period and, like Medicare and Medicaid, will need amendments, adjustments and other tweaking. Perhaps, as part of the tweaking, a certificate of need program like the one we had in the 1970s (before Ronald Reagan’s administration ruined it by buying into the “free market” health care idea ruined it) would stem some of the costly competition in capital expenditures. Perhaps a return to regional comprehensive health planning would make sense.
Seventh, the law is constitutional. Those who argue otherwise reject the rule of law. You can't cherry-pick Supreme Court rulings for their legitimacy.
Eighth, objections without constructive discussion is useless.
Finally, for those citing individual cases, you're too narrow. This is a systems problem requiring a systems overview.
Somehow the vitriol and disinformation about public policy decisions has to stop for us to solve our problems — but that’s another topic.
While much of the rock-ribbed conservatives are railing against the ACA, the nation as a whole supports health care reform and much of the country is willing to give the reform act a chance. I spent 25 years in all aspects of the health care industry, with my early years witnessing the implementation of Medicare and Medicaid. As a journalist for some18 years, I always had health care as a beat. I have only seen a handful of reporters who “get it” and can explain how the system works. Nevertheless, I would offer these observations:
• First, I heard all the same arguments in 1967 with the passage and implementation of Medicare and Medicaid — and those programs turned out to be a boon for the hospital and health industry. And physicians no longer had to trade services for chickens.
• Second, most of the people posting about and complaining about the ACA are ill-informed and don’t understand anything about health economics, including the concept that the “free market” doesn’t work for health care. It never has and never will. If you want to make intelligent remarks about the ACA, learn about health economics and health insurance. Or get a master’s degree in health care like I did and then come back and make a fact-based argument about these issues.
• Third, the entire underwriting concept of the ACA working is community ratings, which deals with the issue of pre-existing conditions and other matters. It means that we’re trying to spread the risk over the widest population base possible. This will, in the long term, lower costs and accommodate the pre-existing conditions. It will also accommodate, from an underwriting standpoint, the more robust benefits the act imposes on insurers.
• Fourth, one of the reasons the ACA passed was the private insurance companies, BigPharma, hospitals, the organized physician community and the medical equipment industry “got theirs” as part of the bill. The negotiations with them saved the legislation. And, by the way, don’t believe the lies that the GOP tells abut not being part of the process: Iowa’s Chuck Grassley and Sarah Palin being two of the biggest liars claiming the GOP was cut out of the legislative process. The GOP was invited and didn’t play. It’s a typical bush league tactic.
• Fifth, saying government can’t run anything efficiently and it will make the act unworkable isn’t accurate, as popular as bashing government may be. Claiming government can’t run anything well isn’t accurate when focused on health care. Medicare has the lowest retention rate of all the insurers, which is a good thing and reflects the program’s efficiency. In short, it’s run better than all the private insurers could ever hope for.
• Sixth, the ACA has a long-range implementation period and, like Medicare and Medicaid, will need amendments, adjustments and other tweaking. Perhaps, as part of the tweaking, a certificate of need program like the one we had in the 1970s (before Ronald Reagan’s administration ruined it by buying into the “free market” health care idea ruined it) would stem some of the costly competition in capital expenditures. Perhaps a return to regional comprehensive health planning would make sense.
Seventh, the law is constitutional. Those who argue otherwise reject the rule of law. You can't cherry-pick Supreme Court rulings for their legitimacy.
Eighth, objections without constructive discussion is useless.
Finally, for those citing individual cases, you're too narrow. This is a systems problem requiring a systems overview.
Somehow the vitriol and disinformation about public policy decisions has to stop for us to solve our problems — but that’s another topic.
Saturday, September 28, 2013
Ted Cruz is a hypocrite
An open letter to Ted Cruz:
As you continue to reincarnate Joseph McCarthy, remember he emptied his own political chit basket by acting like you are acting now — offending good and decent and thoughtful people with lies, invective and utter lack of compassion and decency.
You seem to be doing it more quickly than did the late undistinguished senator from Wisconsin, Your fake filibuster fooled no one — save perhaps the sheeple of the Tea Party — and alienated conservatives in the senate who could have helped your agenda. I am glad you offended them as much as you offended me.
I write you this because you work for me; you’re my employee because you “represent” Texas and because I pay your salary with my taxes. But you also “represent” me because I get to vote for or against you. At the rate you’re going, I’ll be voting for whomever runs against you.
Here is my evaluation, which I know reflects the feeling of many in Texas: You are on the verge of being part of a government shutdown, but according to The Associate Press in this story, you won’t forgo your salary. You are a 24-carat hypocrite.
I hope your time in the United States Senate will be short-lived, at one term. But then, I hope the 535-member kindergartners, even ones who reflect my views, get turned out on general principle.
As you continue to reincarnate Joseph McCarthy, remember he emptied his own political chit basket by acting like you are acting now — offending good and decent and thoughtful people with lies, invective and utter lack of compassion and decency.
You seem to be doing it more quickly than did the late undistinguished senator from Wisconsin, Your fake filibuster fooled no one — save perhaps the sheeple of the Tea Party — and alienated conservatives in the senate who could have helped your agenda. I am glad you offended them as much as you offended me.
I write you this because you work for me; you’re my employee because you “represent” Texas and because I pay your salary with my taxes. But you also “represent” me because I get to vote for or against you. At the rate you’re going, I’ll be voting for whomever runs against you.
Here is my evaluation, which I know reflects the feeling of many in Texas: You are on the verge of being part of a government shutdown, but according to The Associate Press in this story, you won’t forgo your salary. You are a 24-carat hypocrite.
I hope your time in the United States Senate will be short-lived, at one term. But then, I hope the 535-member kindergartners, even ones who reflect my views, get turned out on general principle.
Friday, September 27, 2013
Learn more before bashing the health care act
As Oct. 1 brings the nation to the first major step in implementing the Affordable Care Act, or Obamacare, all manner of media are reporting, analyzing and generally trying to bring clarity to a murky and difficult topic. The difficulty of this topic arises from the unique nature of health economics and the egregiously wrong application of general and free market principles to the discussion of health care.
While much of the rock-ribbed conservatives in this area a railing against the ACA, the nation as a whole supports health care reform and much of the country is willing to give the reform act a chance. Having spent 25 years in the industry, with my early years witnessing the implementation of Medicare and Medicaid, and 18 years as a journalist who always had health care as a beat, I have only seen a handful of reporters who “get it” and can explain how the system works. I would offer these observations:
• First, I heard all the same arguments in 1967 with the passage and implementation of Medicare and Medicaid — and those programs turned out to be a boon for the hospital and health industry. And physicians no longer had to trade services for chickens.
• Second, most of the people posting about and complaining about the ACA are ill-informed and don’t understand anything about health economics, including the concept that the “free market” doesn’t work for health care. It never has and never will. If you want to make intelligent remarks about the ACA, learn about health economics and health insurance. Or get a master’s degree in health care like I did and then come back and make a fact-based argument about these issues.
• Third, the entire underwriting concept of the ACA working is community ratings, which deals with the issue of pre-existing conditions and other matters. It means that we’re trying to spread the risk over the widest population base possible. This will, in the long term, lower costs and accommodate the pre-existing conditions. It will also accommodate, from an underwriting standpoint, the more robust benefits the act imposes on insurers.
• Fourth, one of the reasons the ACA passed was the private insurance companies, BigPharma, hospitals docs and the medical equipment industry “got theirs” as part of the bill. The negotiations with them saved the legislation. And, by the way, don’t believe the lies that the GOP tells abut not being part of the process: Iowa’s Chuck Grassley being one of the biggest liars claiming the GOP was cut out of the legislative process. Bull! The GOP was invited and didn’t play. It’s a typical bush league tactic.
• Fifth, saying government can’t run anything efficiently and it will make the act unworkable isn’t accurate, as popular as bashing government may be around here Claiming government can’t run anything well isn’t accurate when focused on health care. Medicare has the lowest retention rate of all the insurers, which is a good thing and reflects the program’s efficiency. In short, it’s run better than all the private insurers could ever hope for.
• Sixth, the ACA has a long-range implementation period and, like Medicare and Medicaid, will need amendments, adjustments and other tweaking. Perhaps, as part of the tweaking, a certificate of need program like the one we had in the 1970s (before Ronald Reagan’s administration ruined it by buying into the “free market” health care idea ruined it) would stem some of the costly competition in capital expenditures. Perhaps a return to regional comprehensive health planning would make sense.
Somehow the vitriol and disinformation about public policy decisions has to stop for us to solve our problems — but that’s another topic.
While much of the rock-ribbed conservatives in this area a railing against the ACA, the nation as a whole supports health care reform and much of the country is willing to give the reform act a chance. Having spent 25 years in the industry, with my early years witnessing the implementation of Medicare and Medicaid, and 18 years as a journalist who always had health care as a beat, I have only seen a handful of reporters who “get it” and can explain how the system works. I would offer these observations:
• First, I heard all the same arguments in 1967 with the passage and implementation of Medicare and Medicaid — and those programs turned out to be a boon for the hospital and health industry. And physicians no longer had to trade services for chickens.
• Second, most of the people posting about and complaining about the ACA are ill-informed and don’t understand anything about health economics, including the concept that the “free market” doesn’t work for health care. It never has and never will. If you want to make intelligent remarks about the ACA, learn about health economics and health insurance. Or get a master’s degree in health care like I did and then come back and make a fact-based argument about these issues.
• Third, the entire underwriting concept of the ACA working is community ratings, which deals with the issue of pre-existing conditions and other matters. It means that we’re trying to spread the risk over the widest population base possible. This will, in the long term, lower costs and accommodate the pre-existing conditions. It will also accommodate, from an underwriting standpoint, the more robust benefits the act imposes on insurers.
• Fourth, one of the reasons the ACA passed was the private insurance companies, BigPharma, hospitals docs and the medical equipment industry “got theirs” as part of the bill. The negotiations with them saved the legislation. And, by the way, don’t believe the lies that the GOP tells abut not being part of the process: Iowa’s Chuck Grassley being one of the biggest liars claiming the GOP was cut out of the legislative process. Bull! The GOP was invited and didn’t play. It’s a typical bush league tactic.
• Fifth, saying government can’t run anything efficiently and it will make the act unworkable isn’t accurate, as popular as bashing government may be around here Claiming government can’t run anything well isn’t accurate when focused on health care. Medicare has the lowest retention rate of all the insurers, which is a good thing and reflects the program’s efficiency. In short, it’s run better than all the private insurers could ever hope for.
• Sixth, the ACA has a long-range implementation period and, like Medicare and Medicaid, will need amendments, adjustments and other tweaking. Perhaps, as part of the tweaking, a certificate of need program like the one we had in the 1970s (before Ronald Reagan’s administration ruined it by buying into the “free market” health care idea ruined it) would stem some of the costly competition in capital expenditures. Perhaps a return to regional comprehensive health planning would make sense.
Somehow the vitriol and disinformation about public policy decisions has to stop for us to solve our problems — but that’s another topic.
Wednesday, September 25, 2013
Is Amarillo's purchase of a train station on the right track?
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| EuroStar trains poised to return to London from Paris' Gard du Nord station. |
I would like to remind the community that The Amarillo Independent broke this story more than a year ago after attending a “Rail Summit” in Fort Worth in august 2012. At that meeting, we learned that the cost for keeping the Chief on its present route — the so-called traditional one — would be $100 million over the next 10 years. Those dollars were to maintain the tracks from Kansas into Colorado and over Raton Pass into New Mexico so the train could travel the 79 mph needed to meet its schedule.
While calling 79 mph high-speed is laughable, it is also no secret that the United States is far behind Europe with transportation infrastructure, so, I guess, in American terms, it is. But both in Great Britain and on the continent, trains cruise in the triple-digit range. An intercity train from London to York or Peterborough in England, somewhat the equivalent of going, say, from Fort Worth to Amarillo, travels at 125 mph. And, of course, the EuroStar connecting London to Paris in 2½ hours or less zips across parts of the countryside at 186 mph. Other trains on the continent run much faster as do the bullet trains in Japan. And all this rail travel is generally safe, greener than flying and contributes to less crowded skies. The U.S. should do the same, but it seems we are better these days at bombing and destroying countries than building up our own.
Meanwhile, back at the ranch, Burlington Northern Santa Fe Railway has stopped freight service over the Raton Pass trackage and curtailed right of way maintenance; the Chief could not run “high speed” on the tracks. Colorado, New Mexico and Kansas were asked to come up with the money, but not only have they not so far, but New Mexico Gov. Susana Martinez also cut and ran from a contract to buy BNSF tracks from Raton to Lamy. That deal would have let the New Mexico Railrunner serve the route from Belen, N.M. to Raton, N.M., opening opportunities for economic development and funneling passengers to the Chief.
As the time grows short and communities along the traditional route panic about losing service, The Garden City Telegram reported the cost of the maintenance doubled to $200 million. That puts the traditional route farther out of reach but it bodes well for the train being routed along the BNSF Trans-Con, which would take the Chief through Amarillo and into Clovis before turning west for the remaining miles to Los Angeles.
So, while there is a certain nostalgic appeal to using the old Santa Fe depot as the Amtrak station, the City Commission and city leadership have not leveled with the community about the full cost. Nor, have they told us about any of the alternatives, some of which could be much cheaper. First, the building isn’t worth $2.6 million and, even with the additional land that City Manager Jarrett Atkinson said was part of the deal, I have to ask if that is the highest and best use. I understand that the platform needs significant renovation to meet Amtrak’s standards and no one has posited what those dollars would be or from when they would come. Nor, if the station were to become a multi-modal hub à la the old Alvarado Hotel in Albuquerque or the multi-modal center in Fort Worth, have the commissioners and the city told us what those costs would be and how those expenses would be funded. This will be especially tricky in light of the “no new taxes” pledge for downtown development.
Further, while the appeal is undeniable for the Amtrak stop to be downtown, were any options explored for another location?
The decision for routing the Chief through here is a long way off, but I commend the city leadership for looking at it. It’s something I pushed for. But the city has played this one too close to the vest, as it does with most things. The commissioners continue their arrogant ways of dismissing real and valid citizen and taxpayer concerns. That may be a good way to run a railroad, but railroading this deal isn’t a good way to run a democracy. Ultimately, the taxpayers will pay for the mistakes. Here’s hoping the ride won’t be too expensive.
Who Pays Off rick Perry?
Rick Perry's trip and advertising expenses to poach jobs from other states is another one of this political offal's lies and deceptions. Perry is suckling at the tit of the big corporatist puppet masters and he is dancing to their tunes. Here is a link to show how Perry is in the thrall of corporate America and how he is not working for Texans.
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