Are the new democrat party proposals affordable?

I have not written any articles for the past few years, as I have been focused on my other endeavor, Healthcare Reform 2.0 ( However, as of late, the over the top rhetoric of the people running for president, on the democratic side has begun to disturb me due to the lack of anyone questioning the cost and affordability of these programs. So, I decided to take some time and investigate for myself.

Please note, I am not trying to be partisan or express a hard right-wing conservative view here. I do have more conservative views than liberal when it comes to fiscal issues, but from social programmatic areas I tend lean more liberal.

I have been, like most of us, listening to the expanding promises of the democratic parties running for president and have become more and more dismayed by the lack of anyone taking a real hard look at the cost, to each of us, as working, Tax-Paying, American households. It is not that I am faulting these candidates for their zeal and ideological goals, I am finding their arguments wanting in an explanation of the impact all of their programs will have on each of us. My question is, “could these programs actually be paid for in the manner they suggest?” Further, before I embarked on my own analysis, and based on my experience doing my cost analysis of the Affordable Care Act, that I was able to predict quite accurately, the sheer incredulity of their statements as to who will be harmed and who will benefit have been quite astounding in their underestimation; not to mention the potential negative effect on the economy due to job loss, loss of international competitiveness and many other factors..

My 2010 estimate for the real cost of the ACA was $3.2 trillion over ten years. At the same time the CBO estimate was $800 billion over the same time-frame. The current estimate is over $3.6 trillion

I took the past week to dig deeper into the costs of the programs outlined. Granted some, maybe even many, may not be the final planks of the platform of the selected democratic presidential candidate, but at this moment there is little reasoned push-back on the drive to implement these goals they claim will benefit a little more, or less, than 50% of America (this percentage amount is guesstimated based on whom they say they are targeting to bring help to – a number that as you will note in the downloadable worksheet is likely vastly over-inflated.)

I am sure there are parties that will immediately say the analysis is unfair or invalid for a variety of reasons. As I said, this is my analysis based on about a week’s worth of reading, research, and analysis. I freely admit that I can be wrong. If so, I am willing to share my spreadsheet, and you can then modify it to make your own analysis. In the words of Billy Joel, “You may be right, I may be crazy, but I just may be the lunatic your looking for!”

2019 Democrat Programs Affordability Analysis

Screen Shot of Program Analysis Worksheet. If you would like a copy of the analysis spreadsheet for your own analysis, send me an email with your email address using the form at the bottom of the article

The following is a summary of the findings I have based on my independent, simple analysis. In these analyses, I am not adjusting for the continued spurious printing of new money (due to dilution of the dollar and inflation), nor am I factoring in any effect of potential positive or negative changes to the economy. Although I suspect if these programs, and their respective costs, were to come to pass, the economy will be very severely negatively affected, and all bets are off that even the bad numbers will look this good.

Here are the basic assumptions. They have been run in a best-case – worst-case perspective. The best-case is what the various party pols are touting as their plan(s). The worst-case analysis is based on an outside parties assessment – one that I believe is somewhat fairly derived (in other words, if its nothing but pure bias, I did not select those numbers).

Programs Analyzed

The programs I used in my analysis are:
• The estimated cost of Medicare for All
• The estimated cost of Free College Tuition
• The estimated cost of $1,000 living wage
• The estimated cost of the Green New Deal


I am using recognized sources for the current census projections of the following;

  • Number of Working Americans broken out by full-time, part-time and total number of Households in America
  • The population of people in the U.S. 18-64 years old
  • The current estimates of the income ranges of the poor, middle class and rich in America
  • The percentage of what each of these classes makes up of the total income and population of earners
  • The latest US budget projections from the Office of Management and Budget (OMB) from 2019 through 2029.

Key Calculations

  • I have estimated what would be the actual tax rates that would be necessary in order to cover the best-case scenario. Using the rates quoted by the current crop of candidates is not even close to realistic, so I won’t embarrass anyone by including them.
  • All calculations cover a ten year period to be consistent with how the government calculates program costs.


  • The total cost of all of these programs over ten years will be $74 trillion on the best-case side and $127 trillion on the worst-case analysis. A total cost of $22,482.51 per American per year. Perhaps a better way of looking at it is by cost per worker, and this is a staggering $46,326 per year – equally divided across all economic classes; poor, middle class, and rich.
  • The federal budget expenses also need to be reduced from federal revenue during this time frame, and the total of money consumed by the existing federal government for the ten years is approximately $62 Trillion. Looking at just the individual program cost is significantly misleading.
  • The total of both new programs as proposed and the existing budgets for ten years are – are you ready for this you may want to sit down – $179 trillion.
  • Total Federal Revenue based on Effective Tax Rates by earnings segment assumptions are as follows:
% Of Households 2019 Population % Share of Income 2019 Number of earners 2019 Average Earnings 2019 Effective Tax Rate
Top 5% 19.0% 30,343,000 $ 209,400.00 90.0%
Top 20% 46.4% 74,100,800 $ 111,900.00 75.0%
40% 17.8% 28,426,600 $ 69,800.00 58.0%
60% 9.3% 14,852,100 $ 55,300.00 45.0%
80% 4.4% 7,026,800 $ 43,300.00 35.0%
Bottom 20% 3.2% 5,110,400 $ 22,600.00 0.0%


  • In the best-case, at the end of ten years, we have a cumulative deficit of
    $ 595,234,641,000

This is $595 billion if you are having a hard time with all the digits

  • In the worst-case it is $ 54,375,234,641,000

This is a $54 trillion deficit

  • Obviously, we cannot pay for these programs with only a tax hike on the wealthy, or if we include the upper part of the middle class, or even if we include all the rungs in the income ladder, including the poor, whom no one thinks should have to pay taxes.

So, in conclusion. This is my analysis, and I am NOT presenting it as an indisputable fact. I am trying to get you, the reader, to take a hard look and use your education and simple math skills – or my spreadsheet – to look at the effect anyway you want. Google and Bing are a wonderful tool to find the numbers that you think are most likely. I hope this is somewhat helpful.

HealthReform 2.0 Updated Site

Welcome to the HealthReform 2.0.

We are the only place for people with a curious mind and a desire for a better healthcare system.

HR20 001.2

As most of you know, I have been working on understanding how to revive our failed healthcare system with one that can provide an easy transition, be efficient and effective, lower costs and improve outcomes.  I have recently been joined by my friend Tim Henning in producing a Podcast and YouTube channel in order to discuss how we got here with the quagmire of a healthcare NON-system. Where we really are with what medical and other healthcare providers can actually deliver, and laying out a way for all of us to work together to get the kind of healthcare system we want.

WWW.HR-20.COM is now updated and ready for your participation.

Our latest Episode 1.2 is the continuation of how we got to where we are in the Quagmire that we mistakenly call our healthcare system.  This episode is about Health in the New World,  Hospitals, Doctors & Physicians and Patent Medicine Kings.

We will tell you where Doctors and Physicians came from – hint they didn’t start out as the same occupation – the start of America’s first “drug cartels,” and how some of the issues in our current healthcare system have strong roots in decisions that were made 100’s of years ago.

You can access the Video on our YouTube Channel, here.  You can also find our podcast on: iTunes, Google Play Music, Spotify, TuneIn Radio, Stitcher, and more.

Remember our updated website is  If you have a question, you would like us to address on an upcoming episode contact us at  Ask Your Question.

Remember to LIKE our shows – if you do like them of course.  Also, don’t forget to SUBSCRIBE to get notice of future shows.

Also if you like short topical notes drawn from the news, don’t forget to check out HealthyBytes – our podcast of Quick Points for Fast Learners. Check them out here.


I hope you will come check out our updated site and subscribe to our new show.

We Can Have a Reformed Healthcare System – Do we want one?


Health Reform 2.0


Beyond partisan divide lies pragmatic solutions.

(I have been engaged in a significant effort for the past year or so and not able to publish my work – that process has completed. My work on a reformed healthcare system has not abated, in fact there are others now adopting many of the concepts described here.  If you find these ideas valid, please refer to others. We can reform our healthcare system. We can do so much more easily if we do it from within.)


How do we ever expect to gain an effective, efficient and affordable healthcare system when every discussion of healthcare becomes instantly divisive? Calling the recent health reform law the ACA or the Affordable Care Act alienates some on the right that feel this affords legitimacy to legislation that should not exist. Alternately, referring to the law as ObamaCare removes any hope of consideration of the ideas that follow by some on the left as the illegitimate ranting of greedy right-wing conservatives who are only out to exploit and hurt the poor.

In the end, it is clear that whether you call it the ACA, the Affordable Care Act or Obamacare, this law itself is neither fixing nor breaking our healthcare system. The issues the act does address are too many steps removed from the root causes of the problems to effectively fix anything. In fact, we work from the premise that we are trying to correct a system that is not, nor has it ever been, a “system.”

Why we still need more reform

There are numerous systemic flaws in what we call our healthcare system. Yet perhaps the biggest issue we have with achieving a goal of effective, efficient and affordable care for all Americans lies within ourselves. Benjamin Franklin advocated for a style of “compromise through tolerance.” We no longer value this form of solution. Today almost all of our debate is mired in an all-or-nothing outcome based approach. This “I win – you lose” desire is epitomized in the latest healthcare legislation and the ongoing and unproductive debate. Further, what we consumers actually expect from our healthcare system is so far from the reality of what it can deliver to be almost unbelievable in its naiveté.

The debate continues to rage with selected arguments used to support some positions with what appears to be a purposeful ignorance of other issues. Yes, parts of the law are working for the benefit of individuals. Yes, parts of the law are failing because the overall costs are rising. We have problems with the composition of networks, the beginning of restrictions on both access and extent of care and a realization that the cost projections, like Medicare and Medicaid in 1964, are woefully underestimated. The problem with both sides of the arguments for the laws success or failure is that nothing in the law was meant to address the systems fundamental problems. Rightly or wrongly, the law was written for the most part to gain control over, and drive profit out of, the healthcare system. And none of this is actually helping us get what we need or what we want.

A new approach is needed

It is now crystal clear that the methods, some would say madness, that we have promulgated over the past 225 years to define the mechanisms we needed in order to provide healthcare to Americans have worked both spectacularly, and miserably, depending on your perspective and measures. America’s healthcare system has become a collection of practices, methods, and mechanisms that neither integrate nor properly manage the efficient, effective and appropriate level of care that citizens need nor does it provide an appropriate method to deliver the care we want.

How we got to this point

It is thus compromise on the basis of tolerance for others’ opinions that lead us to good solutions . . . – Benjamin Franklin

During the same 225 years, our overall understanding of America and our expectations of services have materially shifted. We now expect significantly more from our country – and by extension, its governmental structures: federal, states and commonwealths – than we did at its founding. We no longer value the role of tolerance in compromise as we once did. This has led to a frozen governmental structure where we are trapped between two ideological extremes. Everything we now attempt to do becomes locked in an all or nothing outcome based approach. The latest healthcare legislation, and more recent proposals, can be seen as the culmination of this dysfunctional approach.

For a variety of historical reasons, all seemingly reasonable and appropriate at the time, we have adopted a series of changes, often in the form of rules and laws, to try to affect corrections to one part of this non-system or another. All of these approaches, in the parlance of medicine, have affected the symptoms of the disease but they have not cured the underlying fundamental problems.

We must identify and agree on the fundamental problems

In order to correctly define an effective, cost efficient, and appropriate healthcare system for all Americans, we must first address the fundamental issues, disconnects, and problems of our historical non-system. In order to begin to actually address the needed fundamental fixes – therefore deal with the disease not the symptoms – we need to first identify and agree on what the fundamental problems are.

We have many beliefs about healthcare, and its underlying core of modern medicine, that have caused us to establish a set of unrealistic and unobtainable expectations when it comes to the care we receive. Much of what we believe about healthcare and the practice of medicine is wrong. We have ingrained these myths into the basic discussion of care so tightly that what we say is often obviously disconnected from what we actually mean. We speak of single payer systems, and specific cures for diseases. We routinely confuse popular beliefs or historical methods with actual scientifically backed best practice. We misunderstand the true extent of medicines capabilities, effectiveness and the cost of their increasing side effects. We conflate our heath needs with our health wants and ascribe equal weight and priority to both. We have so disconnected ourselves as consumers of care that we do not truly understand the real effect of the care we receive. More often than not it is our body’s natural ability to heal that is the cause of our perceived benefit, not what modern medicine can reliably deliver.

We have such fundamental flaws in our care system that the simple process of seeking care is now statistically one of the most dangerous activities we can do in our lives. 264 people per 100,000 die each year as a result of seeking healthcare. The next deadliest activity is that of being a commercial fisherman – think Deadliest Catch – where only 200 per 100,000 who practice this line of work dies.

Clearly, America is caught in this crossroads. Since we are now trapped between two ideological positions. It is because it is so often that neither party can find ground for compromise due to intolerance that we often say, “The only thing that we tolerate today is intolerance!” The principal of tolerance was a key characteristic that made America the leader of the free world it became. Specifically in the pursuit of efficient, effective and affordable healthcare we will need to regain this principal.

The Plague of Myths

  • We believe we have a healthcare system
  • We believe that we already have, or are near to having, cures for everything
  • We believe what is good for us as individuals is good for the human species
  • When it comes to healthcare we think that what we want is the same as what we need
  • We either believe only government should have the role of providing care or we believe that government should have no role at all
  • We believe that America can afford it – whatever it is
  • We believe that Employer Sponsored Insurance has been a good thing
  • We believe Co-Pays and Deductibles have helped lower costs and reduce consumption, and
  • We also believe that American Healthcare costs too much.
  • We believe many, many other myths as well.

It is in the codification of these myths that we have defined a healthcare system that can never meet our expectations. In summary, this thing that we call a healthcare system is really a collection of self-predatory practices and methods that promulgate massive increases in costs, erosion of effective checks and balances, little accountability and responsibility, and exponential unintended consequences to patients, providers, facilitators and program sponsors. Luckily, we have discovered a solution!

There is a solution

The solution to our healthcare systemic conundrum will require quite a bit of work, much debate and a healthy dose of tolerance. In the end, we believe we can find a compromise that will yield a much simpler, stronger, efficient and affordable system for Americans to get the care they need in crisis and also the care they want by choice. It is in the assured concept of an effective safety net for all, integrated with American’s need for choice that holds the key. Both parts of the system simply cannot exist without full integration as they will become predatory and consuming of each other. They must exist in a manner that systemically provides certain controls, checks and balances. Price certainty, transparency, portability and effectiveness need to be codified as requirements of any solution. At the same time, effective allocation of appropriate regulation, oversight and responsibility at the federal, state and individual level also need to be integrated into any system. Any solution must provide an effective safety net for all the helpless while filtering out the clueless – who inadvertently significantly increase costs and utilization of scarce resources – and the fraudsters – who purposely defraud the system in order to inappropriately receive disproportionate and unnecessary gain while also consuming available resources from those who desperately need them. Finally, the solution shall at its safety net, basic care level, provide the same access, scope and treatment options for all regardless of income or means with no additional hidden costs, taxes, fees or shifting of costs from one side of the system to the other.

We Need a Bifurcated System

Life Care – Market

  • A solution that converts “Patients” from inactive recipients of ineffective health services, to active Participants in the selection, management, delivery and prevention of care.
  • Assures price certainty, cost transparency, and full care portability. Assures coverage regardless of pre-existing condition or disease state. Provides full cost disclosure for all parts of healthcare, no hidden reimbursement systems, no rebates and no self-propagating cycles that obscure full and true cost
  • Requires no Deductibles, no Co-Pays, no hidden fees – all costs easily defined, certain and accountable
  • Allows no government “Death Panels” instead provides a representative citizen group, appointed by the states, of participants, facilitators, providers and sponsors that are empaneled to determine what constitutes basic health needs, treatments and therapies and establishes effective payment rates for providers under basic LifeCare Plans
  • Assures appropriate, effective, and efficient delivery of basic health needs. Delivers the ability to seek the provider(s) of their choice – No Networks
  • Effectively balances care outcomes expectations to healthcare’s ability to deliver effective services. And, Improves Participant outcomes
  • Transforms employers from the provider of healthcare to facilitators of wellness and prevention.
  • Incentivize employers to provide stipends to employees to help afford basic health needs, LifeCare plans and effectively plan and save for Quality of Life Advantage services.

Life Care – Plans

  • All companies wanting to sell health insurance should be required to sell basic LifeCare plans
  • All LifeCare plans from all insurers should be identical in scope, breadth and extent of treatment.
  • Treatments should be to standard best practice protocols for the care that people need to survive, be productive and maintain viability – but doctors should not be bound to the published protocols, preserving their, and their patients, choice.
  • Reimbursements for services should be fixed, based on the best practice protocol. LifeCare plan services and Quality of Life care services can be mixed by providers adding choice to basic offerings.
  • All LifeCare plans can be purchased from any insurer in any state regardless of where people live
  • Premium pricing should be based on the initial age and sex of the plan purchaser, and should stay the same, subject to COLA, for the rest of their life as long as coverage is uninterrupted
  • All licensed providers in America should be eligible to accept reimbursements under any LifeCare plan – Eliminating the need for networks
  • An in-force LifeCare plan becomes the basis for any healthcare coverage through the LifeCare market.

LifeCare is where Americans will receive fair and equal basic services and treatments that are geared to keeping us alive and productive. There must be a structure that provides efficiency, wide breadth but manageable effective extent of care, transparency, transportability, simple access through one point of administration, coverage certainty, improved outcomes, full access and affordability. We should eliminate extraneous constructs like care networks, co-pays and deductibles. This side of the care continuum will be focused on delivering the care that people need. This is the core of a national health safety net.

Life Care – Safety Net

  • The basic LifeCare plan becomes the core of any safety net offering.
  • The state and federal governments should no longer contract, or pay directly, for services. When necessary the government should step in and provide premium payment support.
  • Permanently Disabled – should receive monthly subsidies to pay for their LifeCare policy as long as they maintain eligibility
  • People in need of temporary support – displaced workers, catastrophic event or other support should be provided through premium loans. Once assistance is no longer appropriate, the amount advanced should be converted to loans amortized over the remainder of productive life (as an example to age 68).
  • Participants keep their providers and continue with coverage unabated in their community with no stigma nor interruption of coordination of care

We need a safety net. To have an effective safety net, everyone needs to have it. It needs to be incorporated into our overall system. It needs to use the same infrastructure and be seamless when needed. It should be immediately available upon eligibility

Quality of Life Care – Market

·         Quality of Life Care begins where the LifeCare plan ends

·         While the LifeCare system is predicated on high volume, highly efficient, pre-fixed low cost routine treatment modalities with some free market effects to lower cost, Quality of Life providers should evolve to be more market driven in nature.

·         Quality of Life Care should be where individuals get the additional care and treatment they desire based on their own individual priorities, responsibilities and choice.

·         Participants can choose to pay for Quality of Life Care services at the time of service through any means acceptable to the provider(s).

·         Participants can pay via cash, through tax free Life Health & Wellness Savings Accounts or they can purchase Quality of Life Advantage plans from any qualified health care insurer, or all three!


Because we are human, we strive to want and obtain more. We need a system to provide for choice without preying on others to get it. In fact, we need to have those who exercise choice participate in order to help increase the economies of scale for those who do not want, or can’t afford, choice. Quality of Life Care is the place where patient choice holds sway and value drives margin for providers.

We need two markets but one infrastructure and we need to enable people so they can self-actualize in order to have choice. If not effectively integrated, these two systems would prey on each other the same way our current structures have preyed on each other over the past 70 years.

If properly integrated, these disparate systems become mutually supportive systems and give us the best model to both pay for care for the helpless, minimize the cost of the clueless and the fraudsters and provide choice and increased margin to satisfy people’s wants.

Life Health & Wellness Savings Accounts

  • Like existing HSAs these accounts form the basis for healthcare payments via either the LifeCare or Quality of Life Care markets.
  • Not mandatory – Highly encouraged through significant tax incentives for both the individual and employer
  • While there should be limits to annual deductibility there are no lifetime caps
  • Unused balances remaining after death can be passed tax-free to beneficiaries
  • Means-tested larger contributions should be eligible based on certain catastrophic illnesses
  • Plans should be required for state or federally funded LifeCare premium support loans or permanent disability premium support.
  • Employers should get a tax deduction (up to a maximum amount) for monthly stipend to employees regardless of how employees use the funds
  • Employees should loose tax deductions on amount of funds not spent for eligible healthcare services and should also be subject to a penalty for funds ineligibly spent

We have HSAs today and HSAs but they are not effective and they do not clearly enable our access to an effective healthcare system. We can have effective HSAs and we can enable access to Quality of life care as we age and we can do so at less cost to the system and the country than the current system does.

Single Point of Administration Full Coordination of Care & Benefits System

  • Repurpose the current healthcare exchange infrastructure
  • One universal point of administration to locate, research, apply for and coordinate all care services.
  • True Participant Centered System coordinating Facilitators, Providers and Sponsors with the Participant (patient in the old system) as the center point for all care coordination. Through a virtual care group infrastructure, Participants, or their designated facilitators, maintain full control of all their information regardless of location.
  • Providers will now be aware at point of application and eligibility for all potential benefits from, federal and state programs to philanthropies, charities, institutionally sponsored programs, etc. reducing double claims, doubled services and double costs.

Regardless of how the system is constructed or evolves, we need to integrate the disparate parts to gain economies and efficiencies to provide for the care needs of participants in the low-cost economic LifeCare Side while providing a value based choice market for services people want in the Quality of Life side. We also can go a long way to reducing costs through the elimination of duplicated services, duplicate payments, fraud and abuse currently over half of every healthcare dollar spent.

National LifeCare Congress NLCC

We need a national regulatory body as a key part of any construct. It needs to be fully representative, it needs to cover all economic strata, all disease states, and all specialties, in the four legs of the healthcare stool:

  • Participants – include representatives from a fully representative economic, ethnic, geographic and disease-state sub-groups,
  • Facilitators – representatives from various sub-groups; faith-based, social workers, case workers, family/friends, guardian-ships, parole/probation, volunteer and public service, etc.,
  • Providers – representatives from physicians/doctors, nurses, nurse practitioners, pharmacists, therapists, etc. and representative subspecialties within these groups and
  • Sponsors – Federal, State, Municipal, Philanthropies, Corporate, Insurers, etc.

Other Key Points

  • NLCC is designed as a bi-partisan national governing body appointed by the various states composed of representatives from the four key healthcare constituent groups; Participants, Facilitators, Providers and Sponsors.
  • Representatives have a 3 year term – initial terms staggered
  • When a rep’s term is up the position should be randomly assigned to another state to appoint that rep position.


We have only scratched the surface as to the features and benefits of these solutions.  We have not touched on specific bipartisan agreed upon goals, nor have we spoken of the integrated objectives that need to be crafted into any solution. These are available on the Health Reform 2.0 Website at under Principals, Goals & Objectives.  We have not discussed in-depth the impact of our own myths and misunderstandings about what is really deliverable in terms of the scope and extent of care from medicine today. We also have not had the space to discuss how the solution provides for a true “Participant Centered” approach which is also key to lowering costs, lowering excess utilization and improving outcomes. These and many other topics are discussed in the draft Whitepaper, Summary Sheets and Articles on the Health Reform 2.0 website.

We believe that the solutions we proposed will fit neatly into a comprehensive approach that Americans will be able to embrace. We do not expect everyone to like every solution proposed in the system but, we do believe in the end these solutions are designed fit closely together to solve for a marketplace that will provide Americans with an affordable, cost-effective, efficient, fair and appropriate market, and safety net, required to get the Life Care they need; while preserving the options for a choice based system to get the additional Quality of Life Care they want. We do not want this to be seen as “The Solution,” but as a series of solutions that are interconnected. These ideas are not inviolate and must surely change. To achieve the goal that we seek, will require a Franklin style compromise, either from a renewed interest in bipartisan, bicameral solutions in Washington DC or from the real power-base of America – the American People.

Franklin’s Farting Challenge: 234 years still no solution!

Constitutional Republic

Constitutional Republic

Throughout most of my life I have had a great respect for Benjamin Franklin. He was not just a founding father of the United States of America.  He was a key architect of the republic. He was a great communicator. He was a prolific writer. He was the co founder of one of America’s first hospitals. He was a statesman, diplomat, humorist and also a wondrous scientist.

He studied electricity and batteries to store it. He invented a number of devices that worked to better the lives of Americans in his day like the Franklin Stove, which some still use today. He was also dedicated  in his day to curing the ills of humanity, both sociological and biological.  The following is a letter he wrote to The Royal Academy of Brussels in 1781 to request that they issue an alternative scientific challenge to their constituent scientists in order to deal with the natural endemic problem of ill wind, instead of their proposed mathematical challenge.

Franklin did not seem to believe it was possible to eliminate the actual passage of foul gasses from the body, in fact, he writes that to restrain these gasses is not a good idea. To do so, he postulates, can lead to pain, illness and sometimes death. He was therefore not asking the worlds scientists to waste time trying to eliminate these gasses. Instead he challenged them to come up with a way to make farts smell good. He wanted to free people to pass gas in public and have it become a pleasant occasion due to the fine perfumes.  I think you will enjoy his insight.

Benjamin Franklin
to The Royal Academy of Brussels


I have perused your late mathematical Prize Question, proposed in lieu of one in Natural Philosophy, for the ensuing year, viz. “Une figure quelconque donnee, on demande d’y inscrire le plus grand nombre de fois possible une autre figure plus-petite quelconque, qui est aussi donnee”. I was glad to find by these following Words, “l’Acadeemie a jugee que cette deecouverte, en eetendant les bornes de nos connoissances, ne seroit pas sans UTILITE”, that you esteem Utility an essential Point in your Enquiries, which has not always been the case with all Academies; and I conclude therefore that you have given this Question instead of a philosophical, or as the Learned express it, a physical one, because you could not at the time think of a physical one that promis’d greater Utility.

Permit me then humbly to propose one of that sort for your consideration, and through you, if you approve it, for the serious Enquiry of learned Physicians, Chemists, &c. of this enlightened Age.

It is universally well known, That in digesting our common Food, there is created or produced in the Bowels of human Creatures, a great Quantity of Wind.

That the permitting this Air to escape and mix with the Atmosphere, is usually offensive to the Company, from the fetid Smell that accompanies it.

That all well-bred People therefore, to avoid giving such Offence, forcibly restrain the Efforts of Nature to discharge that Wind.

That so retain’d contrary to Nature, it not only gives frequently great present Pain, but occasions future Diseases, such as habitual Cholics, Ruptures, Tympanies, &c. often destructive of  the Constitution, & sometimes of Life itself.

Were it not for the odiously offensive Smell accompanying such Escapes, polite People would probably be under no more Restraint in discharging such Wind in Company, than they are in spitting, or in blowing their Noses.

My Prize Question therefore should be, To discover some Drug wholesome & not disagreable, to be mix’d with our common Food, or Sauces, that shall render the natural Discharges of Wind from our Bodies, not only inoffensive, but agreable as Perfumes.

That this is not a chimerical Project, and altogether impossible, may appear from these Considerations. That we already have some Knowledge of Means capable of Varying that Smell. He that dines on stale Flesh, especially with much Addition of Onions, shall be able to afford a Stink that no Company can tolerate; while he that has lived for some Time on Vegetables only, shall have that Breath so pure as to be insensible to the most delicate Noses; and if he can manage so as to avoid the Report, he may any where give Vent to his Griefs, unnoticed. But as there are many to whom an entire Vegetable Diet would be inconvenient, and as a little Quick-Lime thrown into a Jakes will correct the amazing Quantity of fetid Air arising from the vast Mass of putrid Matter contain’d in such Places, and render it rather pleasing to the Smell, who knows but that a little Powder of Lime (or some other thing equivalent) taken in our Food, or perhaps a Glass of Limewater drank at Dinner, may have the same Effect on the Air produc’d in and issuing from our Bowels? This is worth the Experiment. Certain it is also that we have the Power of changing by slight Means the Smell of another Discharge, that of our Water. A few Stems of Asparagus eaten, shall give our Urine a disagreable Odour; and a Pill of Turpentine no bigger than a Pea, shall bestow on it the pleasing Smell of Violets. And why should it be thought more impossible in Nature, to find Means of making a Perfume of our Wind than of our Water?

Tolerance-RealCompromiseFor the Encouragement of this Enquiry, (from the immortal Honour to be reasonably expected by the Inventor) let it be considered of how small Importance to Mankind, or to how small a Part of Mankind have been useful those Discoveries in Science that have heretofore made Philosophers famous. Are there twenty Men in Europe at this Day, the happier, or even the easier, for any Knowledge they have pick’d out of Aristotle? What Comfort can the Vortices of Descartes give to a Man who has Whirlwinds in his Bowels! The Knowledge of Newton’s mutual Attraction of the Particles of Matter, can it afford Ease to him who is rack’d by their mutual Repulsion, and the cruel Distensions it occasions? The Pleasure arising to a few Philosophers, from seeing, a few Times in their Life, the Threads of Light untwisted, and separated by the Newtonian Prism into seven Colours, can it be compared with the Ease and Comfort every Man living might feel seven times a Day, by discharging freely the Wind from his Bowels? Especially if it be converted into a Perfume: For the Pleasures of one Sense being little inferior to those of another, instead of pleasing the Sight he might delight the Smell of those about him, & make Numbers happy, which to a benevolent Mind must afford infinite Satisfaction. The generous Soul, who now endeavours to find out whether the Friends he entertains like best Claret or Burgundy, Champagne or Madeira, would then enquire also whether they chose Musk or Lilly, Rose or Bergamot, and provide accordingly. And surely such a Liberty of Expressing one’s Scent-iments, and pleasing one another, is of infinitely more Importance to human Happiness than that Liberty of the Press, or of abusing one another, which the English are so ready to fight & die for. — In short, this Invention, if compleated, would be, as Bacon expresses it, bringing Philosophy home to Mens Business and Bosoms. And I cannot but conclude, that in Comparison therewith, for universal and continual UTILITY, the Science of the Philosophers above-mentioned, even with the Addition, Gentlemen, of your “Figure quelconque” and the Figures inscrib’d in it, are, all together, scarcely worth a


234 Years later and we still have not solved Franklin’s equation. With all the interest in healthcare now in all the technical centers around the world perhaps one of this new crop of entrepreneurs could tackle this vexing issue and, once and for all, free society to break wind at will!

2014 in review

The stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

A New York City subway train holds 1,200 people. This blog was viewed about 8,000 times in 2014. If it were a NYC subway train, it would take about 7 trips to carry that many people.

Click here to see the complete report.

Time to Think Differently with Healthcare Reform: Time to lead!

New Republicans, are you ready to lead?

New Republicans, are you ready to lead?

We are at an historic position.  There has been a major political shift, one, that to no small degree, was driven by executive overreach over the ACA, or Obamacare if you feel better calling it that.  Now that the republican party has again been given the chance to lead the nation, can they do it responsibly? There are many pundits and many partisans that will conspire to do almost noting for the next two years other than to prove the republicans can’t .

For republicans, this is a chance to set a new and more prosperous tone for the nation and to prove to many more Americans that your ideals are correct, just, fair and will improve the lot of America and its people.

This is not simply about republicans or democrats any more.  This is about a populace that is disenchanted with government overall, that has lost face in our founding principals. We may be approaching a crossroads where our disillusionment over the American Experiment becomes so engrained and pervasive that what has been America for over 200 hundred years will fundamentally shift in ways we neither can predict nor will we want to see happen.

Both sides political ideologies have become all too important to their parties destiny.  No longer is it about what is good for America and then for Americans; it is now about what is good for us to be able to defeat the other guys in two years and again take control. Therefore, it is now apparently all about control.  If this continues then no member of the professional political class will ever be able to truly lead this nation again.  Now is the chance to get us back to leading!  Doing what is right for America, not simply rationalizing what is right in order to get the free stuff we want.

So to the new republican leadership: PROVE IT!  Prove you can lead!  Prove you can do what is right! Prove your only interest is in making America greater, and improving the lot of Americans!  Prove your ideals will be good for all, even when there is so called “Tough Love” involved in the process.

You can start by curtailing the partisan rhetoric over the ACA, Obamacare and healthcare in America.  Curtail the drive to make this the cause celeb. Curtail the need to win something. Embrace Ben Franklin’s form of “Compromise Through Tolerance!” Ignore the partisans and find real solutions.  Ignore the past of Obamacare, do not make change a resolution on Obamacare.  Make change by fixing what is wrong with the healthcare system in America.  Ignore the sins of the past and focus on fundamental change and build a blueprint for the future that will deliver the care we need to all and preserve the care we want for those that are willing to sacrifice to get it.

This can be done. Someday it will be done.  If you – republicans – prove you can do it, you may get granted another expansion of your authority in a few years.  If you can’t then you will not only doom your party, you just may doom the sacrifices of the founders of our great nation to the dustbin of history as yet another failed sociopolitical system of ideas that did not work.

If you want some fresh ideas on how to change the dialogue and deliver a truly effective, efficient and fair system see this: Health Reform 2.0: Beyond the Partisan Divide lies pragmatic solutions. If you agree and want to help get the new leadership motivated, tell everyone.

Why Ebola petrifies us: One reason is healthcare’s unobtainable expectations.

Ebolacare givers practice safe procedures

Ebola caregivers practice safe procedures

Petrified & Angry

We are petrified of Ebola. It is a deadly disease, but we are much more scared of this today than we were of Polio, and Tuberculosis years ago. Why?

In the 1940s and 50s, modern medicine was a bit less advanced than we are today.  We had many more diseases to be afraid of.  Polio was an epidemic. Outcomes from Polio were not particularly good. Tuberculosis (TB) was a significant issue as well.  People with TB were quarantined.

Travel in that period was not as easy and ubiquitous as it is today yet, we routinely restricted affected people’s movements. In some cases we incarcerated them in sanitariums to protect the public at large. Despite these actions and the lack of effective treatment for these, and many other, diseases, people were no where near as panicked then as we see them today with the current Ebola crisis.

People who grew up in this era will tell you that most Americans accepted the dangers these microbes presented as a regular part of life. Sure, they were afraid of the diseases but they recognized that they had little control over potential infection. If they became infected they understood that HealthCare did not have cures. While there may have been many things to help ease the symptoms, odds were usually not very good that they would see their symptoms eliminated. Continue reading

Breast Cancer and Environmental Causes: Links not as clear as we’ve hoped.

The latest research is finding that real links between environmental causes, genetics and occurrence of Breast Cancer continue to be elusive. Perhaps, it’s for a reason. Are we thinking of cancer in the wrong way?

Published in Aquila Style (click to read original article)

Published in Aquila Style
(click to read original article)

October is National Breast Cancer Awareness Month.

The above graphic is from an interesting article titled, Suprises in Hunt for Environmental Links to Breast Cancer, published by , 6:30 pm Monday, 11th November 2013 on The article is about one of the latest studies trying to find a definitive link to breast cancers’ origins. Many studies have tried to find links to environmental and genetic causes. So far the research has not been definitive to say the least. We do know that genetic mutations are present in many cancers, but we also know that they are sometimes not there in some – where we expect them, and are there in many – where do not see the cancer develop.

“We have still got 80 percent that has got to be environmental,” said Reinlib, who is part of the Breast Cancer and the Environment Research Program (BCERP) program that has received some $70 million in funds from the US government since 2003.

The above quote from the article seems to indicate that there is clear evidence that the causes simply have to be environmental because we have ruled out that family history is the main indicator. Yet, this may be a false premise as well.  Just because a white jelly bean is not vanilla flavored, does not mean it must therefore be coconut flavored. It can be any flavor at all or have none! Most of the research into environmental, family history and genetic mutation indicators have shown relatively slight correlation to the actual development of breast cancers.  These indicators may statistically increase the chances a few percent but they do not provide definitive guidance that one will, or will not, get cancer.

Recently, some researchers are starting to discuss cancer, less as a disease — even though the outcome is devastating on the individuals and the family — but more of a naturally occurring process — perhaps necessary in the species. Perhaps this same process that sometimes evidences as cancer, is a natural part of the core engine that drives natural selection to improve the species. Changing how we think about and classify cancer may have more of an effect on how we learn to adapt to it than “cure it” as time goes on.

We have found many genetic markers in the past decade or so that we felt were the main drivers of disease, like the BRACA genes for breast cancer, only to find that they turned out to not be specific. BRACAs were considered a key indicator specifically for breast cancer but recently has been shown to exist for prostate — not much of a surprise as prostate and breast tissues are histologically very similar — lung and now many other cancers as well. BRACAs are more likely broad based cancer markers as time will likely tell.  Most genetic markers are likely relatively nonspecific. In fact, our genes may be good blueprints for building the body and its systems but may not be the control point for what happens with these things when they are built.

Further, genetic markers themselves have been know to not be definitive for the occurrence of a cancer. You can have the markers and not get the cancer, and you can sometimes have the cancer and not have the markers. Some other researchers now believe there is a different biochemical system at work. Undiscovered, this other system has been dubbed epi-genetic — meaning above the gene. Numerous studies over the past 15 years have indicated the presence of some other control point. Don’t forget that it took many decades for actual chemistry of DNA to be identified and proven; even though we understood the theory of its presence for many years.

It is likely in the years to come we will find more answers to these new questions and new theories will fundamentally change how we think of cancer and reset our expectations on its treatment and occurrence.

Please remember all those who have died due to this horrible disease!

Continue reading

Why the Middle Class is Still Getting Crushed: Lets look back!

It is now crystal clear that the middle class are being destroyed. Politician’s explanations are based on pure biased rhetoric. The real reason is much simpler. It is the mechanics of how we are trying to fix the economy.

This is a reprint of an earlier Article, originally published September of 2013, on some of the reasons the middle class in America are declining. At the end of the article will be links to a couple other articles relating to this issue.

man_question_mark DemoCare demolishes America’s Middle Class

The Affordable Care Act is often called ObamaCare but I think from now on it should be called “DemoCare” because it’s going to demolish care in America and along with that demolish America’s Middle Class.

There are quite a lot of things about the way this law works that make it undesirable.  Mostly, the causes are not in the debate that we hear so much about nor are they in the parade of facts that we are about to be inundated with over the next 90 days from those selling the benefits or arguing against them.  Like most debates the truth in the rhetoric is somewhere between the extremes. There are many flaws, there are some benefits but there are massive amounts of unintended consequences. This is why, I do not call for its repeal.  I call for amendment and alteration. Continue reading

Report Reveals Employed Physicians Losing Money for Employers

The Physicians Foundation has once again published their excellent report, 2014 Survey of America’s Physicians Practice Patterns and Perspectives. The Foundation once again contracted with Merritt Hawkins – a subsidiary of AMN Healthcare – to conduct the survey. For those of us who like these kinds of reports, this one carries some of the interesting trends and data from their 2012 report forward, and adds a number of pertinent and timely new questions to the mix. The 2014 report is chocked full of interesting information, trends, data points and facts about how physicians are responding and adapting to the Affordable Care Act. Over the coming days we will be assimilating more of this information and relating it to other trends, reports and raw data. Keep checking back as we do so to stay abreast of this new information as it is digested, analyzed and evaluated.

As so often happens, one small entry grabbed our attention as it is highly indicative of a trend-line that is becoming of significant concern to us and many others. The foundation reports that for 2012 the median LOSS for an employed physician – meaning a doctor that is an employee of a hospital or group practice, a Continue reading

Doctors NOT taking insurance may actually be a good thing for healthcare!


Questioning Our Preconception of HealthCare

In an Aug. 23, 2014 Reuter’s article called, “‘I don’t take insurance’ not always a doctor deal breaker,” author Beth Pinker, explains how this typically plays out for a person seeking care.

As more and more people realize the extent of the funds they will need to spend before they gain access to insurance coverage — the average deductible is now $5000 — Physicians are waking up the fact that insurance and government reimbursements are too low for their “business” of medicine to survive. Recent numbers indicate that 40 to 50% — in some cases more — have already decided to opt out of insurance and move to so called concierge, i.e. retail, medicine.

The attraction for the physician is faster payment, and in most cases, a higher margin on the services performed. One of the big drivers is the total size of the pot of deductibles that will need to be spent for full insurance to kick in for the insured.

Some argue that the average deductible is not really $5000, that it is closer to $3000 per year. Still, with over 186 million insurance policies in the U.S. this lower estimate yields a total available market — called TAM by marketers —  of $500 billion that must be spent before insurance coverage kicks in. Any marketer will tell you, this Continue reading

When Mammograms Lie: An article by Sharon Kirkey published on Canada.Com

When Mammograms Lie: How cancer can sneak past our greatest screening techniques

Just because the results of your mammogram are negative, doesn’t mean you don’t have cancer

By Sharon Kirkey, Postmedia News May 23, 2014 (CLICK THE LINK TO READ THE ARTICLE)

“Four months after her mammogram came back “normal,” Susan Quinn-Mullins discovered the lump herself, a smooth, hard mass on her left breast the size of a big marble. An ultrasound revealed a tumour nestled deep in dense breast tissue. It was stage 3 — aggressive, invasive breast cancer that was spreading to the surrounding lymph nodes…”

Breast Density Types

Breast Density Types

This interesting article not only chronicles the story of people who initially relied on mammography to check the health of their breasts but also serves as an incitement over the undue reliance on this as the sole modality. It also brings in some contra posing views on the debate over dense breast notification laws.

Breast Cancer is the number two killer of women in America, lung cancer is number one at the moment. The issue of dense breast related problems in imaging has been long known but for the most part hidden. It is a sordid tale Continue reading

Healthcare Reform 2.0 – Better Solutions Summary

We have put together a summary of the Healthcare Reform 2.0 solutions. Please take a look and remember we are soliciting feedbalck and comments now. This will change.

Health Reform 2.0

The ACA – ObamaCare is failing, and will surely fail, but not for the populist reasons being discussed so readily today!

Overview – Why We Still Need More Reform

We now expect significantly more from our country’s healthcare system – and by extension its governmental structures: federal, states and commonwealths – than we did at its founding. We no longer value the role of Benjamin Franklin’s style of “compromise though tolerance as we once did. Everything we now attempt to do becomes locked in an all-or-nothing outcome based approach. The latest healthcare legislation, and more recent proposals, can be seen as the culmination of this dysfunctional approach.

For a variety of historical reasons, all seemingly reasonable and appropriate at the time, we have adopted a series of modifications, often in the form of rules and laws, to try to affect corrections to one part, or another, of this non-system. All…

View original post 2,843 more words

John C. Goodman: Obamacare – A Costly Failed Experiment

Health Reform 2.0

[testimonial author=”John C. Goodman March 21, 2014 The Wall Street Journal]With Sunday marking the fourth anniversary of the Affordable Care Act being signed into law, it’s worth revisiting the initial purpose of the president’s signature legislation: Universal coverage was the main goal. Four years later, not even the White House pretends that this goal will be realized. Most of those who were uninsured before the law was passed will remain uninsured, according to the Congressional Budget Office…

…So four years into this failed experiment, what are the alternatives? Getting rid of the mandates, letting people choose their own insurance benefits, and giving everyone the same universal tax credit for health insurance would be a good start. More easily accessible health savings accounts for people in high-deductible plans is another good idea.[/testimonial]

Mr Goodman starts and ends his excellent article, A Costly Failed Experiment, with a clear and concise summary…

View original post 954 more words

Health Reform 2.0 Site Launches


HealthReform20 site picFor some time, we have been working on taking the years of work and effort of understanding the issues that have plagued our healthcare system and why none of the legislation or proposals, so far, have been able to deliver on their promises.  When I was researching my last book, The History and Evolution of Healthcare in America, I came to the conclusion that many of the problems were rooted in most of our past decisions and fixes. What we now think of as a system is mechanically incapable of performing as one. Most of the things we believe about our healthcare system, and to a large part, the practice of medicine lives more in the land of myth and fantasy than reality.

I have written extensively about most of the issues and I have chronicled many of the deficiencies in the Affordable Care Act, aka ObamaCare. In the past few months I have been working with an increasing number of individuals, on both sides of the aisle, to find a more pragmatic — less partisan solution.

As a result of many of these meetings, speeches and various other activities we began to develop a white paper, recently published here. Initially, I thought this effort would produce some higher level recommendations and my role would be very limited. This has not been the case.  The more we have discussed the core principals, the more buy-in we have received on the general concepts.

This broad level interest has resulted in a commitment to provide a more focused location for interaction to see if we can’t cut through some of the rhetoric and get traction on fixing the fundamental issues that have plagued our healthcare market.  I don’t know if we will make any difference whatsoever, or if we can even get enough people to read and comment to make a difference at all.  I do know that we can try.

We have created a location called Health Reform 2.0 linked above to the graphic.  If you want to tell someone about it and what we are trying to do, here is the URL spelled out: (that’s “two” dot “zero”)

We have pushed all of the earlier material that appeared on this site to this new location and we encourage you not just to visit the site but to also read the materials, and most importantly, lend your voice to the solutions by posting comments.  We will continue to cross post the articles on this site as they get published.

Thank you for your support on Healthcare: Crisis in America and I hope you will subscribe to this new site as well.


Tom Loker

Article 3 – The Plague of Myths – Myth 2: Healthcare, It’s Good for What Ails You!

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the third of a series of articles that will be published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

Do our expectations of Healthcare match reality?

We have a large number of myths that govern our beliefs about our current Healthcare system – or non-system to be more accurate.  One of the larger set of myths that drive our perceptions of both the positives and negatives of our healthcare system are our beliefs and expectations as to what we should get from healthcare and the underlying medicine.  We believe, that modern medicine has cures for almost anything we face.  We believe that the continual research and discovery that has occupied much of the past 164 years has led to a firm and almost complete understanding of the science of disease, injury, and treatment.  We believe that there is little difference in cost between the things we need for survival and the things that we want to improve our lives.  We believe that the current methods of treatment and the discoveries we have made over the past 80 years are making us a stronger more robust species.  We believe that the doctor is typically the best and most qualified person to deliver the care we need. And we believe that in most cases going to the doctor is safe and leads to improvements in our health. These are just a few of the myths and misconceptions we have about the current state of medicine and what we should expect from our healthcare system. Continue reading

Internet Scams: Thank God for the internet!

You just gotta love the people who sit around and think these things up! Over the past two days, I received two e-mails, the first (copied as sent below as Letter 1), was a very official looking letter from Mr. Edward Meyers who was polite enough to inform me that no less than the Government Accountability Office (GAO) of United States Government and also the International Monetary Fund (IMF) had instructed he, Mr. Edward Meyers, working on their behalf, to immediately within 72 banking hours – wow this must have been very important – to transfer to me the sum of US$45 Million. Nice!



From The Desk Of Mr Edward Meyers
Phone: +1 530 540 5419
Dear valued Customer,

My Name is Mr Edward Meyers, A citizen of the United States,52 years Old. I reside in Hobbs, New Mexico,My residential address is as follows;1320 Linam Street, Hobbs, NM 88242, USA,i work in the remittance department with Bank Of America in collaboration with Gulf General Investment here in New Mexico, United States Of America.

Am contacting you concerning your overdue payment of US$45 Million which have been endorsed for onward transfer to your destination depending on your choice to receive your full payment,you have the legal rite to indicate by return email, the preferable method to receive your payment within 72 Banking hours.

Bank Of America will be willing to receive your full  contact details in your next email,so as to furnish you with the necessary steps to deliver your funds within 72 Banking hours.

Considering the latest payment instruction we received few days ago from THE UNITED STATES GOVERNMENT ACCOUNTABILITY OFFICE(GAO) AND ALSO FROM INTERNATIONAL MONETARY FUND(IMF),You will not be required to pay for any money transfer charges until your funds are delivered to your bank account,but you must present valid and verifiable details of your payment to my office prior to the final release of your payment so as to indicate and assure that you are the rightful beneficiary to the funds in our custody.

Do not hesitate to call me on  my contact phone numbers given below for more details or send an email.

I will be expecting to hear from you urgently

Sincerely yours,

Mr Edward Meyers
For Bank Of America,
Direct phone: +1 530 540 5419

(I have highlighted the errors in the letters in red)


Of course I thought, finally, the government is going to reimburse me my share of the profits from the car companies for those bail out loans Continue reading

To David Brooks: Its not just leaders its their point of origin

The Leadership Revival By David Brooks Article

The Leadership Revival
By David Brooks Article (click to read the original article)

I like David Brooks! He is one of the pre-eminent writers in this era and along with Charles Krauthammer one I try to read on a regular basis. Always thoughtful and cogent, his observations typically are well worth reading, educational and stimulating. Continue reading

4 Straight Years of Slowing Health Care Costs: Really?


U.S. Marks 4 Straight Years of Slowing Health Costs(click to read the article) so blasts the headline from ABC News today, January 7, 2013. Like so much of the debate over Healthcare reform, many that read the article will walk away believing that things relating to healthcare costs are really improving—along with the economy. After all the article proudly says that the percentage that healthcare costs make upon of the Gross Domestic Product (GDP) has declined for the fourth straight year. This must be a good thing—one would think! But, like so much of the reporting Continue reading

HIV/AIDS: The face has changed but disease still wreaking havoc

The Gift of the Human Hand

The Ryan White Care Act—the prime funding source for HIV/AIDS treatment assistance—is due to sunset this year.  The strongest advocate for RWCA, Senator Ted Kennedy, not long before his death fought a hard fight to update the law.  The fight to update the law was unsuccessful due to a highly Continue reading

Half Full or Half Empty: Another Happy New Year!

It is often said, “A picture is worth a thousand words!” Perhaps, unlike no other time of the year this is best considered at the birth of another new year! We seem to go on each year, new resolutions in hand, gradually returning to our prior ways. Sometimes we may keep one of our new hard-one habits for a bit longer than normal, but for the most part we revert to who we were before—continuing to creep along at our own petty pace from day to day, with our sound and fury intact signifying nothing. Still, it is good to wonder and consider. It is, in retrospect, likely something we should all do more often than we do. At a minimum, maybe we should complete this one simple exercise each year whether we need to or not. Whether we are people who routinely see the glass half full, or half empty—in the end we will find gratification.

With this in mind I offer the following video. I hope it helps you in your own consideration find a ponderous start to your new year!.

From those of us at the Health Care: Crisis in America blog and

Happy New Year to you and yours and thank you for being a loyal reader in 2013 and for your consistent referrals to others to help in their considerations. You have helped this blog and twitter find more than 9,000 regular readers!

Value Based Insurance: it sounds so – “valuable”

Value based insurance, sounds so - valuable!

Value based insurance, sounds so – valuable!

Value Base Insurance Coverage, it sounds so — valuable. But is it really valuable? Is Value Based Insurance Coverage (VBIC) what you really want — what you may need? Well, perhaps, that simply remains to be seen. As we move through the implementation of the Affordable Care Act, ObamaCare, VBIC will become the next big thing we need to pay close attention to. You can be sure that soon this item will be getting quite a bit of ink as the potential ramifications become apparent.

Like so many things in life, the reality of this “value” based system may be fraught with unintended consequences for the individual and massive values and benefits for Continue reading

The ACA Exchange Poster Child – Covered California: Works for some, not for others

CoveredCaCalifornia, has long had the reputation as being one of the most progressive, or liberal, states in the nation. Often in a neck and neck battle with New York over who gives more free-stuff to its people at any given time, California long ago adopted the philosophy that what is good for some should also be good for all. The concept of income redistribution though higher taxes is not a new one for California residents.  Yet this state, nicknamed “the Golden State,” and home to Hollywood, Biotech, Oil and Silicon Valley fortunes often confounds because there are also strong anti-tax forces that from time to time rise up and limits California’s spending power through measures like Proposition 13. Continue reading

Obamacare Insurance Cancellation: Welcome to the #ObamaNation

Welcome to the ObamaNation where we know better than you!

Welcome to the ObamaNation where we know better than you!

The cancellation letters people are now receiving for their earlier choice based plans– you know the ones that President Obama said they could keep, PERIOD–out of courtesy and perfect declaration should open with this line,

“Welcome to the #ObamaNation where we know better than you!”

Those of us who have warned of these effects under the law, and a number of other predictable negative outcomes that are only beginning to show up, have been called fear mongers, and haters. The shouted counter argument becomes a diatribe of how this law is going to be so great. How it will provide insurance for so much less cost. How it will lower the cost to the nation and the individuals. How you will get whatever you want and have to pay almost nothing for it! Continue reading

Jay Carney’s recent statement may be quite revealing!

Recently, Gov’t spokesman, Jay Carney, said he could not answer questions about the exchange sites because, in his own words, “I’m not a computer expert and I don’t build websites!” But, he is the spokesman for the #ObamaNation, i.e. the Federal government.  So in this capacity as speaking for the Government or the president’s administration, he is admitting that they are not computer experts and they don’t build websites! Then why on earth did they take on the challenge to try to build this one.
I understand that they hired subcontractors to build its parts. But unlike most projects, they did not hire a contractor to manage the project, to take the pieces and integrate them into a cohesive final system.  This is the way virtually every other project the government does is handled.
Carney is correct, the government has no experience in computer engineering, architecture, design and development. They do not build websites! They spend most of their IT assets maintaining ever aging mainframes systems that cost huge amounts to keep running and are difficult, if not impossible, to interconnect with newer more efficient systems. So why did they try to take on such a role in this case?
Is it possible, that they simply did not want any third party to find out how the site would be used? Is there some “secret systems built into this massive infrastructure that the government doesn’t want people to know about? Is there some hidden data system slurping our information as some people have surmised? These would be something that any outside contractor would need to know about in order to build the system and have it work.  It could also explain why a system that should at most have 10s of millions of lines of code has 500 million.  Could it be that like the NSA’s recent incursions into the lives of American Citizens, there is a much bigger, “Big Data” game afoot that the #ObamaNation does not want Americans to find out?  Why else would a government, who admittedly is not computer programmers and does not build web sites decide to take on such a task in the first place.  Every part of their reputations were riding on the success of these sites. And clearly money was no object. There has to be a much bigger reason they did not want to bring in real experts to do the job!  Maybe the American People need to have someone come in and audit the code and find out just what else may have been afoot here!
Hey I’m just asking!!!

The ACA Exchange Connundrum


I have a friend, lets say she is in her 50s, a single mom and has been out of work for quite a while. She created her own business through hard work but has been unable to purchase insurance for a while.  She has one adult child that lives at home with her. I believe that she deserves affordable insurance and that she has a right to coverage regardless of her disease state.  From time to time, she gets frustrated with my positions on ObamaCare thinking that I am advocating for its repeal and that even the changes I speak of will harm her ability to get affordable insurance. This is not the case, but I can understand how she feels and why she feels this way. It is my friend and many others like her that need the very sections of ObamaCare that I think should stay in place and this is why I do not support a blanket repeal.

She is a very good person, intelligent and industrious. She is a strong supporter of ObamaCare. When Covered California, opened yesterday I went to the site to see what the new deal will be for people like my friend. It took two attempts to get into the site, although it was not a long wait, perhaps 20 seconds. My friend will be able to get insurance, as the law promises, and because of her circumstances she will be able to get subsidies as well. In fact according to the site (which provides estimates only) she has options under the Bronze plan that after subsidies she will be paying just $1.00 per month.  Yes, you read that correctly $1.00 per month for the premium. But she will also have a deductible of about $2500. before she gets to coverage. Some items are exempted from the deductible so in some cases she doesn’t have to pay anything.

I have not spoken to her but I would bet that she will think this is a good deal at this point. Depending on how the actual deductible plays out in her circumstances, she may or may not find this is a good deal 6 months from now. While this is a good deal for her, is this a good deal for most? Or the better question is this a good deal for America inclusively?  And, it is here that there is a rub. While the government is simply printing money out of thin air to pay for the bills, this new money still comes out of our pocket by reducing the real value of the dollar. And as we age, we disproportionately cost rise more and more for the care we need. From birth to age 70 we cost about $100,000 for care, and from 70 to 75, we cost about $500,000 for care.  The same curve happens from birth to 50.  So at mid 50s we cost significantly more than someone who is in late 20s early 30s. As a result those later life spiraling costs get disproportionately allocated to the younger insured. And the actuarials are not static numbers. Due to many factors they continue to rise and they will rise exponentially under the current rules. This is not due to greed, corporate profits, or expensive technology, it is due to simple mathematics. As we live longer that curve of costs goes ever higher. And under the current law the costs, are neither constrained nor controllable. They simply get reallocated.

I am truly very happy that my friend is able to get coverage, but I am also very concerned that we are hiding the overall cost and stacking increasingly unsustainable burdens on these future generations. The math is clear, even if we just don’t want to see it.  We not only are placing the rising cost burden on the young whose own costs will get exponentially higher as we continue to extend their lives beyond our own,  but we will also present them with a huge moral burden as well for while this generation will not create the death panels as promulgated buy the extreme edge of the republican party, the will have to made a determination of at what age quality of life care is suspended for elderly under government programs and their parents and grandparents own savings or additional private policies pick up the costs. Otherwise the cost for them in their early lives will be increasingly unpayable and the nations economy will collapse under the cost..

ObamaCare becomes DemoCare: Demolishes Middle Class!

DemoCare demolishes  America's Middle Class

DemoCare demolishes America’s Middle Class

The Affordable Care Act is often called ObamaCare but I think from now on it should be called “DemoCare” because it’s going to demolish care in America and along with that demolish America’s Middle Class.

There are quite a lot of things about the way this law works that make it undesirable.  Mostly, the causes are not in the debate that we hear so much about nor are they in the parade of facts that we are about to be inundated with over the next 90 days from those selling the benefits or arguing against them.  Like most debates the truth in the rhetoric is somewhere between the extremes. Continue reading

Dan Brown’s Inferno: A Coming Global Crisis?

Light summer reading

    Population Graph from "Inferno" by Dan Brown

Population Graph from “Inferno” by Dan Brown

In his latest book, Inferno, author Dan Brown explores a world where past symbols and artifacts from Dante Alighieri’s Italy, and his famous work The Divine Comedy, become the vehicle to unravel a diabolical and deadly plot of a modern day bio-terrorist. I originally grabbed this book because we were coming to the close of summer and I just finished working on a series of articles about the current issues of our healthcare system that will be appearing later this fall. Frankly, I was looking for a diversion from the complicated world of healthcare reform and Obamacare. I wanted a respite, a brief mindless romp in Dan Brown’s always entertaining world. Having read much of his prior work, I was confident that Mr. Brown would not let me down.

I found this work characteristically suspenseful, interesting, thought provoking and fun to read till I got to the following section which, in the story, lays the groundwork for the epic conflict between the antagonist, Bertrand Zobrist , a world renowned biochemist and leading geneticist and the protagonist, Elizabeth Sinskey, M.D. Continue reading