VINDICATED! Today a New Dawn Rose for a Healthier America

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CONSTITUTIONAL!

It is a day that even I wondered would ever come.  I began Extreme Thinkover with posts on the topic of comprehensive health care for all Americans.  I wrote in September of 2008:

The typical arguments for or against universal health care always focus on what the government will have to spend, what taxes will have to be raised to finance it at any level, or providing health care to consumers, i.e., virtually the whole population, has been, from my perspective, approached from the wrong frame of reference.

I put forth the argument on numerous occasions.  The Affordable Care Act, from my perspective, is a just solution to a miserably broken health care non-system.  It is just in the sense that this law creates a new level of access to medical assistance that Americans have never enjoyed, but that virtually every other First World country (and a number of smaller nations) has offered its citizens for decades.

The Affordable Care Act is the cornerstone of an inalienable right that makes possible in a tangible manner the chance for every person in the country to be healthier, and consequently enjoy the Blessings of Liberty. Yes, I can imagine the eyes rolling over that assertion.  But though it will take a generation, maybe more, to make that difference, doing nothing, that is, to go back to the pre-ACA situation, Americans would continue to be less healthy, costing perhaps trillions of dollars in avoidable care.  Now, at least we have a law, a system, that can turn that trend around.

Having worked in a hospital for over a decade and a half with daily patient contact, I can attest to the misery and personal suffering that those who have no insurance are forced to bear.  Add to that, my hospital is Catholic, with a mission to serve the poor and uninsured, and I have seen the incredible stress this very broken way of providing medical care has placed on my organization, restricting our capacity to plan for the future because tens of millions of dollars annually are required to subsidize those with no insurance.

I fully realize that the success of this change depends on individuals taking personal responsibility for their health.  I would contend, however, based on my experience with chronically ill patients who are poor or unemployed, they are caught in a vicious circle that all too often results in their getting the short end of the stick economically, for which access to medical care for wellness simply does not exist.

I could also put it this way, with the Supreme Court’s decision today, health care in America has finally stepped into the 20th Century.  The challenge now to us living in the 21st Century is fend off those who would overturn the law and plant us firmly back into the 19th Century.

People.  Real, live people with real live medical needs.  That is what the ACA is really about.  That is why for nearly four years, I’ve objected to the argument put forth by the law’s opponents that it was all about money and government.  I rejected that argument on both moral and ethical grounds.  Those who grouse that they are only paying for others bad habits are short-sighted, and in my opinion, fundamentally selfish.  To me, that argument is both highly ironic and paradoxical, because my experience with my neighbors has uniformly been that Americans possess a natural selflessness and generosity to help anyone in need.  But somehow getting the connection tied between to the two has been an uphill battle and continues to be.

For example, I have no doubt that if Sen. Mitch McConnell, Rep. John Boehner, Rep. Michelle Bachmann, or Sarah Palin were in a setting in which total strangers were injured and needed immediate emergency medical care, that every one of them would step up and wade in to help.  But all of them today condemned this law, despite the fact it acts on their behalf as well, so that their fellow citizens will receive that care as a matter of course.  And those patients won’t be nearly as likely to end up bankrupt as a result of seeking out that care.

Simply put, I don’t get it why they don’t get it. (I’ve got a pretty good notion why they think they don’t want to get it, however). Because of that great contradiction, conservatives like those mentioned above still want to overturn it legislatively.  I will continue to write to defend it.

(Yee-haw!)

The Supreme Court and the ACA: The Ultimate Death Panel?

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I started Extreme Thinkover in the fall of 2008.  The presidential race was in full swing.  Universal health care was one of the major topics that the candidates, media, and the public were debating.  One of my primary motivations for creating the blog was to have a forum in which to express my ideas about the health care debate.

I’ve worked in the health care industry for nearly 16 years and have daily contact with patients and families in the hospital.  I hear their stories, good and bad, about what these hospitalizations are doing to their lives.  Yes, what the hospitalization is doing to their lives.

Here in America, going to the hospital is not just about getting medical treatment; it’s also about entering a very broken and extremely expensive system. It nevertheless tries to limp along: In all fairness to the medical professionals who work very hard on behalf of their patients, in most cases, if you find yourself hospitalized, you get reasonably good medical care.

However, in the middle of this is an ongoing battle with the major health care players (hospital systems, health insurance, pharmaceuticals, medical equipment providers, etc.) all wanting to maximize their profits in an economic power race that too often is at the expense of the quality of care delivered to the patients who pay for their services, as well as forcing ever-increasing demands on their care givers to do more with less.  Admittedly, it doesn’t happen everywhere, but it is far too pervasive in Rube Goldberg “system” that passes for health care in America.

I wrote in fall 2008:

Here’s the question: What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?

That perhaps is not the question you expected to hear. The national conversation has focused on how much will it cost to provide all Americans with health insurance, how will the spiraling costs of health care be brought under control, will taxes have to be raised to pay for it, what will the roles of the health insurance industry, and the medical industries, and most of all the federal government be? Tough questions all around.

That question, “What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?” remains the key to a successful national health care program.  It also remains almost totally ignored by politicians, lobbyists, and, sadly the American public, none of whom have yet realized that without answering this question first, in my opinion, the debate about the cost cannot be resolved.  I contend this is why the health care law polls low for national support.

The current law, the Patient Protection and Affordable Care Act, passed in 2010, nibbles at the edges of what I think is essential, but it, also, is far too focused on trying to control medical costs.  And in case you are wondering, yes, I’ve read the law cover to cover.

Beginning Monday, March 26, the Supreme Court of the United States is going to hear arguments for and against the PPACA.  The primary question before the Court is whether Congress overstepped its authority regarding the interstate commerce clause of the U.S. Constitution by mandating all Americans (sort of) be required to purchase health insurance.  The debate is guaranteed to be rancorous, even in the sedate and forcibly polite setting of the Supreme Court.  The debate, though, once again is all about the money.  A healthy America will likely never even come up. The pundits will have a field day with this, without question, but I doubt any will see the fundamental flaw in all the arguments, based on my point of view.

Will the justices see past the smoke screen of political ideology, special interest group pressure, and inflammatory rhetoric that is fueling these proceedings?  If they do, and declare the law constitutional, there is hope that the ACA can continue to be refined, actually moving toward being a mechanism to support a healthier America.  If they don’t, by striking down all or parts of it, the Supreme Court will, for all intents and purposes, become the Ultimate Death Panel, condemning tens of millions of Americans to poor health, premature, and in some cases, an agonizing death because they will have been denied the right to even the most basic level of health care.  And that, tragically, just months before a law already on the books would have given them the care snatched away by the Supreme Court Death Panel.

Now we wait to see how this court rules on the fate of Americans’ health for generations to come.

The Thinkover:  When Patrick Henry uttered those iconic words, “Give me liberty or give me death!”  he wasn’t suggesting that death was preferred outcome of that stand for patriotism.  So far, the opponents of the ACA have been clueless to this obvious distinction in demanding “liberty” from the ACA mandate.

A Recession Forty Years in the Making–Updated

This Great Recession  Didn’t Happen by Magic…My Rant

The Sniffer Returns. Photo Courtesy: Smith Detection UK

When last the Sniffer’s image appeared here on Extreme Thinkover, he (well, I think he’s a he) was celebrating the passage the the health care reform act, having sniffed out the “radiation” of American Health Insurance Providers and other members of Big Medicine’s failed assault against the legislation, spending undoubtedly hundreds of millions of their subscribers’ dollars in the process.  That money was intended by those who paid it, whether it was the funds directly from the insured or their employers, to pay for health care not to pay lobbyists and advertising to defeat every effort and piece of legislation devised to make it better.  Fortunes spent without consent.  A cruel form of taxation without representation.

We will probably never know how much money Big Medicine squandered in their complete and total defeat, as the benefits of health care for all Americans already taking effect, item by item, promises a future of access to medical care that for over two centuries we have never had the right and many have been denied by sheer accident of their socioeconomic status or a simple preexisting condition.

Now we have the right.  Obviously, we should be celebrating, right?  Right?

Political Memory Distortion

Some of our citizen sisters and brothers continue to snort and paw like an angry bull over the fact that they now have to participate in a society that cares for the medical needs of  all its citizens (joining finally nearly every other First World nation and many others), not just as country that rewards those who would hoard their worldly goods as if none of those around them had any role in the accumulation of that wealth.  In their anger, from distorted recollections of an earlier geopolitical battles, they call it socialism, an incoherent misunderstanding of that term in the history of political systems.  It is not socialism.

A Republic’s Highest Value

To the contrary, it is the highest value of a democratic republic: Sharing.  It is that simple.  In a democratic republic, one of the blessings of liberty is sharing.  To treat another as you would want to be treated.  We are now a large nation, over 300 million people and growing.  The day of a flat birth rate has passed.  It takes a lot of organizational structure to insure that the ideals and the order of a democratic republic are nourished over time.  It cannot be done by stinginess, or by isolationism.  The age of the Rugged Individualist has passed.  We now are connected in ways even those of us in our middle age could not dream of.  We now live in a shared world, a shared connectivity at the speed of light, the evolution of human ingenuity turned up on high, the 20th Century a platform for the 21st.

Equality consists in the same treatment of similar persons–Aristotle, 384-322 BCE.

Most of all it cannot be done by refusing to share in such a way that those with the most are continuously provided with more through no merit of their own, denying the dreams of those in the middle to improve their lot in life, it too a blessing of liberty, and effectively squelching the chance of those at the lowest rungs of life from ever daring to dream that those above them might welcome them to take those steps and dream those dreams out of their poverty.

The right to achieve prosperity in a democratic republic is not the exclusive right of those who have already achieved it through their own effort or inheritance.  At the same time, those who have achieved prosperity have no right to hoard their prosperity so that those who are trying to achieve it as well are denied their right to share in its blessings, regardless of their beginning station in life.  With all due diligence those who are prosperous must ensure that the efforts of those who desire to be so as well are rewarded and their growing prosperity welcomed.  But because human beings all have differing gifts, desires, capacities, and health, a democratic republic can exist living by its highest ideals when the prosperity of the whole also ensures the rights of the whole.

Rant complete.

An Unexpected Proof of Concept: 40 Billionaires’ Pledge

What I wrote in the previous paragraph is not just a flight of fancy or a theoretical construct that never would be tried by the very most prosperous people in our country.  On August 4, 2010, the foundation begun by billionaires Warren Buffet and Bill Gates announced that 40 billionaires have so far pledged to give away at least half of their fortunes during their lives or at their death.  Called The Giving Pledge, the list is available publicly online and, according to Buffet and Gates, this is only the beginning of their project.  For instance, the Wall Street Journal reported one of the pledger’s rational:

In an interview, Tom Steyer, founder of hedge fund Farallon Capital Management LLC in San Francisco, said he and his wife had planned to give away their wealth but decided to go public after Mr. Buffett called.

Mr. Steyer made the pledge to support what he sees as an effort by Mr. Buffett to show how those who profit from capitalism can help improve society.  “We want him to succeed in reshaping the way people think about the private enterprise system,” Mr. Steyer said.

MSNBC reported that the United States has about 400 billionaires, some 40% of the world’s total, and their net worth is estimated at $1.2 trillion.

Some of the billionaires have a very specific goal in mind for their pledge.  George Lucas, filmmaker and creator of the vast Star Wars empire stated,

“My pledge is to the process; as long as I have the resources at my disposal, I will seek to raise the bar for future generations of students of all ages,” filmmaker George Lucas said. “I am dedicating the majority of my wealth to improving education.”

Finally, Warren Buffett co-founder, remains ever the optimistic example for First Citizen in our democratic republic:

“We contacted between 70 and 80 people to get the 40. A few were unavailable. We don’t give up on them. Every saint has a past, every sinner has a future. We’ll keep on working,” Buffett said.

Thank you, Mr. Buffett and Mr. Gates.  You get it.  But we are not done here…

So What Next: A Recession Four Decades in the Making

How bad is it?  Ironically, out of the past a major player has come to the horrified realization that the policies of the past forty years, in which he played a major role, beginning with the disgraced Richard Nixon, set in motion the recessionary calamity we are trying to survive.

David Stockman, who was the director of the Office of Management and Budget under the evangelist of  “trickle down economics” and the fomenter of the doctrine that all government is essentially bad, Ronald Reagan, wrote these words published in the New York Times:

Republican pretense that its new monetarist and supply-side doctrines are rooted in its traditional financial philosophy. Republicans used to believe that prosperity depended upon the regular balancing of accounts — in government, in international trade, on the ledgers of central banks and in the financial affairs of private households and businesses, too. But the new catechism, as practiced by Republican policymakers for decades now, has amounted to little more than money printing and deficit finance — vulgar Keynesianism robed in the ideological vestments of the prosperous classes.

This approach has not simply made a mockery of traditional party ideals. It has also led to the serial financial bubbles and Wall Street depredations that have crippled our economy. More specifically, the new policy doctrines have caused four great deformations of the national economy, and modern Republicans have turned a blind eye to each one.

Although I politely disagree with Mr. Stockman’s criticism of Keynes, arguing as would Paul Krugman, Nobel Prize winning economist, that had Keynes’ economics been followed, instead of Reagan’s supply side fantasy, we might have avoided some of the damage Mr. Stockman places right at the door of the Republicans, who claim they want more of the same.

As our nation moves along the unstoppable path of time toward the General Election in November of this year, Mr. Stockman’s accusations against his own party are even more troubling.  He continues:

But in the end it was a new cadre of ideological tax-cutters who killed the Republicans’ fiscal religion.  Through the 1984 election, the old guard earnestly tried to control the deficit, rolling back about 40 percent of the original Reagan tax cuts. But when, in the following years, the Federal Reserve chairman, Paul Volcker, finally crushed inflation, enabling a solid economic rebound, the new tax-cutters not only claimed victory for their supply-side strategy but hooked Republicans for good on the delusion that the economy will outgrow the deficit if plied with enough tax cuts. (Emphasis added)

Delusion or Voodoo Economics: Your Choice

Dr. Krugman, however, agrees with Mr. Stockman on one major point: tax cuts will not help our economy outgrow the deficit now, any more than they did by the time Ronald Reagan left office in 1989.  Earlier this  month, also in the New York Times, Dr. Krugman wrote:

Now there are many things one could call the Bush economy, an economy that, even before recession struck, was characterized by sluggish job growth and stagnant family incomes; “vibrant” isn’t one of them. But the real news here is the confirmation that Republicans remain committed to deep voodoo, the claim that cutting taxes actually increases revenues.

It’s not true, of course. Ronald Reagan said that his tax cuts would reduce deficits, then presided over a near-tripling of federal debt…

But we’re talking about voodoo economics here, so perhaps it’s not surprising that belief in the magical powers of tax cuts is a zombie doctrine: no matter how many times you kill it with facts, it just keeps coming back. And despite repeated failure in practice, it is, more than ever, the official view of the G.O.P. (Emphasis added).

Are we at an impass: Yes.  I have done a lot of counseling during my career and one thing I have seen dozens of times is that a person who is suffering a delusion is not aware of the distortion of reality that is affecting them.  Voodoo, and I will place it squarely in the Hollywood horror genre’ and not the religion of many who live in and around the Caribbean, and the image of zombies, plays on our deep fears of somehow having our dead bodies overtaken and made to do nasty things to, well, anyone, but, in this instance screaming attractive American teenagers.

In terms of economics, the accusation of either, is to say something is deeply wrong, but we know that.  What we are suffering from, is the gathering force of economic distortions that have gathered for forty years.  Forty years.  How many really smart people, in both parties, noticed this, and said exactly nothing?  Was it delusions or voodoo?  How could that be, though?  The delusional cannot recognize their delusions, and the zombie’s revivified by voodoo do not know they aren’t supposed to be in that very state.  Does that mean there are not any really smart people left in either party who can figure it out?  A tantalizing question to ponder, I admit, but the answer is no.

If the Answer is “No,” What was the Question, Again?

The question, in the end, is not whether there were smart people following the economy for the last forty years; there were.  The question is how over forty years did nobody get it?  Since Richard Nixon brought the Union to its knees politically and economically, hundreds of economic models have been built, hundreds rejected because they didn’t work.  Computer modeling has entered the 21st Century–Economists of all stripes have access to these computers and run probably terabits of data through them to test the accuracy of their latest theory.

And yet we wallow in the debris of a Recession still threatening our national prosperity and influence, whose roots are easily traced to forty years ago.  This is a topic that must be more closely examined in the months ahead as the election approaches.  I think the Sniffer has a new assignment.