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

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

http://www.physiciansfoundation.org/uploads/default/2014_Physicians_Foundation_Biennial_Physician_Survey_Report.pdf

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!

man_question_mark

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

Article 4 – The Plague of Myths – Myth 3: We Can, and We Should, Live Forever!

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 fourth of a series of articles that are being 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!

We all want to live longer

It is clearly an historical ideal to live longer. We all, for the most part, desire not to die anytime soon. I am sure that for most of us it is a completely natural instinct to continue to live. We often find it morally abhorrent to want to die prematurely – like from suicide. It would be completely counter intuitive from what we know about the survival instinct, and the laws of natural selection to decide to become premature feedstock for the organisms that prey on us. Our individual desire to survive is primitive and persistent for most of our lives. And it is safe to say we have been built this way! Continue reading

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

Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much

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 second 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!

The Plague of Myths

There are many myths that pervade our beliefs and therefore underlying assumption about our so called healthcare system. We believe that;

  • We have a healthcare system,
  • We believe that we already have, or are very near to having, cures for almost 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 believe many, many others myths as well.
  • We also believe that American Healthcare costs too much! Continue reading

4 Straight Years of Slowing Health Care Costs: Really?

man_question_mark

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

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

The ACA Exchange Connundrum

Aside

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

President Trumpets Obamacare Rebates as Deadline Approaches: Beware of Greeks Bearing Gifts!

President Trumpets Obamacare Rebates as Deadline Approaches - Time Swampland

President Trumpets Obamacare Rebates as Deadline Approaches – Time Swampland

Nought from the Greeks towards me hath sped well. So now I find that ancient proverb true, Foes’ gifts are no gifts: profit bring they none.” So observed the great philosopher and teacher Sophocles about 430 BCE.  Today we loosely translate this as, “Beware of Greeks bearing gifts!

No quote could be more apropos in regard to the supposed $500 million in insurance rebates being sent to 8 million Americans under #Obamacare. Like most ponzi schemes, at first blush this appears to be a great deal for America and Americans. Continue reading

Tax Code Driving ObamaCare Implementation: California’s ACA Odyssey Preview

Click to access the Original Article by John Gonzales

John M. Gonzales reporting for the California Healthcare Foundation Center for Health Reporting wrote a must read article called, How the U.S. tax code will drive Obamacare implementation, starting April 15. I strongly suggest all read it.

The negative effects of Obamacare on costs and care were immediate, and the ongoing negative effects are just starting to be disclosed and to build. Yesterday, I participated at a Health Care Summit put on by Continue reading

Does fear of death cause our irrational drive to unlimited healthcare?

Recently I have been wondering how we have arrived at the point where our desire for unfettered, and unlimited access to health care is rapidly outstripping our ability to pay for the care we desire. Our understanding of our supposed healthcare system is so specious that the myths of our expectations far outweigh the reality of the system we think we have to deliver it. In fact, we have built an entire culture of props and supports around patently false beliefs that underscore everything we expect and require from healthcare. To a great extent we are obsessed in Continue reading

Charles Blahous Channels Wilbur Mills: Warns states to not expand MediCaid!

Charles Blahous, Medicaid Trustee warns state to NOT expand MedicAid

Charles Blahous, Medicaid Trustee warns state to NOT expand Medicaid (image by Charles Blahous)

In an excellent article, Charles Blahous, one of Medicare’s Trustees, warns states of the dangers of the expansion of Medicaid.  He makes many of the same arguments that I have been making for quite a while, his warning, as a Medicare Trustee, may finally cut through the background noise and get some people to actually pay attention.  You can read the full Report by Mr. Blahous here: http://mercatus.org/sites/default/files/Blahous_MedicaidExpansion_v1.pdf

Mr. Blahous reminds me of Wilbur Mills who Continue reading

Steve Brills Article, “Why Medical Bills are Killing Us:” is a lesson of right and wrong at the same time!

Steve Brill's Time Cover Story (Click to read)

Steve Brill’s Time Cover Story (Click to read)

Time Magazine contributor Steven Brill has created a bit of a sensation due to his recent, February 20, 2013, article and Time Magazine cover story entitled, Bitter Pill: Why Medical Bills Are Killing Us: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LkTuy5lv.  Mr. Brill caused controversy both due to the length of the article, 26,000 words, and his revelations about the high prices and seemingly arbitrary pricing methods in our so called healthcare system.  His article has prompted a number of other reporters to pick up the themes and provide both points Continue reading

On Football, Smoking, Soda and Obamacare: There is a spending problem!

Yes Football is a violent sport!

Yes Football is a violent sport!

After reading a recent spate of articles on how the president should, could or would ban or regulate football, I started to wonder what my father or grandfather might say? Then I wondered, how we got to this place where things that others choose to do to themselves is now our responsibility to monitor, manage, restrict and pay for?

50 years ago if we  spoke to our parents about the federal government making laws regulating football, or restricting peoples access to cigarettes and punitively taxing soda, they would think we had lost our minds.  Cleary, Continue reading

More Challenges to the ACA (Obamacare)

No Taxation Without Representation!

No Taxation Without Representation!

From Boston Massachusetts

By now, we all know that the Supreme Court upheld the insurance mandate of the Affordable Care Act (ACA) also known as Obamacare.  To recap, 26 states brought action to have the mandate, declared as an unconstitutional expansion of federal power under the commerce clause, the necessary and proper clause, and as a minor point its taxing authority.  The Supreme Court agreed with the states and found the mandate unconstitutional under the commerce clause, and the necessary and proper clause. However, in what many felt was a stunning decision by Justice Roberts­—and judicial over reach, the court upheld the mandate as a Continue reading

The Truth About Medicare/Medicaid and Social Security: Ok What Do We Do Now?

President Roosevelt signs the Social Security Act of 1935

“We can never insure one hundred percent of the population against one hundred percent of the hazards and vicissitudes of life, but we have tried to frame a law which gives some measure of protection to the average citizen and his family against the loss of a job and against poverty-ridden old age.”

President Franklin Delano Roosevelt said as he signed the Social Security Act into law August 14, 1935.

“Care for the sick. Serenity for the fearful”

were the words Lyndon Johnson expressed some thirty years later Continue reading

The Supreme Court Decision: It hurts to be wrong-but it hurts more to be right and still wrong!

Now that we have all heard the decision by the Supreme Court on the Patient Protection and Affordable Care Act (Obamacare), perhaps it is time for some reflection.  I know as I read the decision Thursday morning, while I was waiting in the queue preparing for a radio interview on the issue, I felt both vindicated in my initial analysis, but also left wanting and inadequate for not seeing the sideways tax justification for its declared constitutionality.

First a recap

There were four questions heard by the Supreme Court in this case. Continue reading

Obamacare Supreme Court Ruling Likely Tomorrow: What will it mean to me?

If the discussion around water-coolers across the nation, or if the intensity of the discussion I have been having at meetings, discussions, or speeches I have given lately is any indication; then regardless of the decision from the Supreme Court tomorrow on the Affordable Care Act, or Obamacare if you prefer, the nation will once again find itself in a vitriolic and unnecessary national argument.

If you want to find out about the background of the core issue, you can read my Health Care Mandate and the Commerce Clause Articles or you can read, Supreme Court to hear arguments on Obamacare: An enigma, based on a canard, wrapped in a conundrum and read how the decisions could come down.

Regardless of the decision, it is clear that we will again have a major upheaval over any decision.  Passions are still running extremely high, and everyone seems to think this is the “be all and end all” of our future life, liberty and pursuit of happiness.  And all of us are wrong!

The decision, regardless of how it comes down, will neither further harm our healthcare system, nor will it improve our healthcare system because we just do not have a system in the first place.  What we have is clearly not a system.  In my recent book, The History and Evolution of Healthcare in America: The untold backstory of where we’ve been, where we are, and why healthcare needs more reform!, available at Barnes and Noble and  Amazon, and other fine bookstores, I discuss how we got to what we have today, how the practice of healthcare has evolved over the years – sometimes not for the benefit of patients – how we arrived at the point where what we believe and expect from healthcare is more mythical than reality, and some ideas on what we need to do to make available both choice and effective care for all.  It is a result of our collective mythical vision of healthcare and inaccurate focus on the symptoms, not the problems of our healthcare system, in the current bill, that we find ourselves with a collective national angst that will in the end just yield political discord not fix the fundamental problems.

As I write this, I am listening to the debate on the Eric Holder contempt of congress issue, also pending determination tomorrow.  Again we are in the middle of a huge national division and if one is cynical enough, we may come to the conclusion that this is all part of some diabolical plan. Since we have come to the place where instead of citizen politicians, we now have a professional political class whose job is to sell us free stuff and fulfill our wants, more than our needs, in exchange for our votes, and thereby significant power and riches; perhaps this is why we seem to have become a nation of thirds who argue everything, and find our leaders unable, or more likely unwilling, to fix the problems.

We are now composed of about 1/3 hard left progressive, 1/3 hard right conservative, and about 1/3 of the nation seem caught in the middle.  You should wonder, what would politicians have to get reelected on if they stop giving us free stuff; and how, on earth, would they get us to give them money so they can afford campaigns, if we are not mostly extremely irritated over something?  I am starting to think it is not our integrity and character that gets us engaged in critical issues anymore, but more likely it is just our passions.

There are some who declare that “Fast and Furious,” was a planned effort to create a national outrage in order to continue to clamp down on gun rights and perhaps severely restrict the second amendment.  Some label this actual fact, and some call this nothing more than wild conspiracy theory.  We all participate in this to some extent because we now habitually believe there can only be one extreme or another, not some logical blend in the middle.  The problem for those of us who are not trying to find conspiracy at every corner, is that we are at a nexus of a number of events created by the actions of the current and prior administrations that all seem to have at least some conspiracy elements in the actions.

In addition to “Fast and Furious,” you have the the actions and events over immigration reform, and the President’s recent unilateral action to implement some form of a dream act. You have the Supreme Court’s ruling on the Arizona Law and the administrations action to shut down the rulings effect by suspending the cooperation between ICE and Arizona’s police departments, and if you look back at the Affordable Care Act debate in congress. You have on the record, statements from people like Barney Frank and Charlie Rangle, and some others, who stated that the health care bill would be the path to a National Single Payer Healthcare system.  While you can look at each item discretely, and argue there is no Machiavellian agenda, when you look across the entire spectrum one needs to wonder if there is some agenda at work after all. And of course, the answer becomes; Yes –  there is an agenda.

Of course there is an agenda, and hopefully it is because those pursuing it truly believe what they are doing is right for America and Americans.  But being right for America and right for Americans may not always yield the same decision.  If may seem right for Americans to have congress conflate the promise given by the Constitution to all for Life, Liberty and the Pursuit of Happiness into an extrapolated promise of free heath care for everybody paid for by the government.  Conversely, at the same time it may not be right economically for the viability of America, to assume what historically was a personal responsibility if the assumption of these costs would bankrupt the nation.  Both decisions, in the narrow view, are good and reasonable decisions.

One path to a decision, has the benefit of giving something to political constituents that will help endear politicians to their electorate and gain reelection.  The other, could change the last fifty years of building the expectation that it is the government, not the individual, that needs to be responsibility for their own heath.  Regardless, this is just not a good situation for any of us, and it is partly why the bill that passed to become the law that is Obamacare is not really liked by either side or the middle.

While the 1964 extension of Social Security Act to include Medicare and Medicaid, was sold as a safety net, the reason for the passage was political gain, clearly on display if you listen to the Johnson tapes available today on-line.  And, subsequent to passage, regardless of whether or not there really was a Machiavellian plan, we have continued to want, and/or allow, Congress to convert the “safety net” into a national entitlement.  The end point is the same.

This is the reason that as we await the decision from the Supreme Court tomorrow, I do not think it will matter one iota in actually addressing the problems that we need to solve or developing a real system to make available both choice and effective healthcare for everyone.

History and Evolution of Healthcare in America now released

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The History and Evolution of Healthcare in America is now released. Click here or on the image to order your advance copy today!

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From the beginning of mankind, health and health issues have played a major role in life, but the issues and care have evolved enormously from the time when the first settlers set foot in America to the present. In The History and Evolution of Healthcare in America, author Thomas W. Loker provides a historical perspective on the state of healthcare and offers fresh views on changes to Obamacare.

Insightful and thorough, The History and Evolution of Healthcare in America offers a look at

  • what healthcare was like at the birth of the nation;
  • how the practice of providing healthcare has changed for both caregivers and receivers;
  • why the process has become so corrupt and expensive;
  • what needs to happen to provide both choice and effective and efficient care for all;
  • where we need to most focus efforts to get the biggest change;
  • what is needed to get control over this out-of-control situation.

Loker narrates a journey through the history of American healthcare—where we’ve been, how we arrived where we are today, and determine where we might need to go tomorrow. The history illustrates how parts of the problem have been solved in the past and helps us understand what might be necessary to solve our remaining problems in the future.

Medicare-Medicaid: A Chicken in Every Pot

“. . . I think we’ve got you something that we won’t only run on in ’66, but we’ll run on from hereafter!” - Wilbur Mills to President Johnson on Medicare in 1965.

As Congressman Wilbur Mills commented to President Lyndon Johnson, in a taped private conversation in 1965, he was encapsulating the primary benefit that the democrats of the day felt they would gain from the Medicaid and Medicare extension to the Social Security Act of 1935, and the primary reason that President Johnson and his team pushed so hard for the reform to include new entitlement programs for the elderly, the disaffected, and disillusioned.

The Historical Perspective

Wilbur Daigh Mills, democratic member of the U.S. House of Representatives, and the chairman of the powerful Ways and Means Committee, was considered, by many, to be the only person in Congress who truly understood the actuarial basis of Social Security, and was recognized as the Congress’s primary tax expert.  At the start of the war on poverty in 1964, Mills had serious concerns as to the affordability of the existing Social Security Act of 1935 for the nation, let alone any extension of the current benefits to include what was then viewed as a health care “safety-net” for the underserved and the elderly.

Mills did not believe that the nation’s tax system could fund the liability of Medicare.  In his paper, “The Origins of Medicare,” published in 1999, Robert B. Helms writes,

Even in the face of strong political pressure from other Democrats, Mills had been so consistent in his opposition to adding a medical benefit to Social Security that many suspected him of being sympathetic to the AMA’s socialized medicine arguments. He used his detailed knowledge of Social Security to question both the Kennedy and Johnson administrations’ cost estimates and to point out that estimating future medical costs was a much more difficult task than estimating the future costs of a cash benefit.

In a 1964 speech, Mills said: “In practical terms, this meant that if the hospital insurance system which would be created by the bill was to remain sound, the taxable wage base would have to be increased by $150 each year. Clearly, this would be a case of the tail wagging the dog.” (The taxable wage base increased an average of $46 per year from 1959 to 1964)

In that same speech, he pointed out that hospital costs were increasing at a rate of 6.7 percent, while average earnings were increasing at only 4 percent (1955 – 1963), and that he saw no reason to assume that the situation would change. His support for the final version of Medicare in 1965 was apparently due to the effects of Democratic gains in the House in the elections of 1964, President Johnson’s personal appeals for support, and the many technical changes that he was personally able to insert into the bill during its various stages of development.

We now know that Chairman Mills’ skepticism was justified: In 1964, the administration projected that Medicare, in 1990, would cost about $12 billion in 26 years (which included an allowance for inflation); the actual cost was $110 billion. We may not know until the year 2025 if today’s actuaries are any more accurate than those in 1964 in making twenty-six-year projections, but at least the current crew is leaving no stone unturned to tell everyone who will listen that the Medicare Part A trust fund does not meet their standards for short-term or long-term actuarial soundness.

Despite Mills’ dire warnings, and his correct calculation that the wage base would have to increase by 300% each year over the existing rate to afford this new entitlement, Johnson felt he was swept in with a clear mandate from the people due to his landslide victory in the 1964 election. So, to help drive increases in the Democratic Party majority in congress, he made the push for Medicare one of his primary platform goals. Johnson was so focused on getting Medicare pushed through congress, he was willing to leverage anyone, and everyone, with every tool he had at his disposal to get this divisive legislation approved. The following transcript, of a taped meeting with his Vice President, Hubert Humphrey, in the first days after the election, is quite telling.

Johnson: “They are bogged down. The House had nothing this week-all god-damn week. You and Moyers and Larry O’Brien have got to get something for them. And the Senate had nothing . . .  So we just wasted three weeks . . .  Now we are here in the first week in March, and we have just got to get these things passed . . .  The ones that I’m really interested in . . .  one of them is education, one of them is Medicare, and one of them is Appalachia . . .  I think the medical care will go through like a dose of salt through a widow-woman . . .  You’ve got to look each week and say, what is the Senate doing in Committee this week and when will they be through, what is the House doing . . .  You’ve got to be running into these guys in the halls, and going over and having a drink with them in the evenings . . .  I want that program carried. I’ll put every Cabinet officer behind you, I’ll put every banker behind you, I’ll put every organization that I can deliver behind you . . .  I’ll put the labor unions behind you.

Johnson’s election didn’t just change the Democratic Congress’s advantage over Republicans; it also changed Mills’ political view. Seeing the writing on the wall, Mills made another speech where he announced, “I can support a payroll tax for financing health benefits just as I have supported a payroll tax for cash benefits (meaning social security).”
Thus, began what has been termed by many as the greatest Ponzi scheme to ever be foisted on the American people. With Mills’ support, the measure passed. There were still several hurdles to overcome, but in the end, Johnson got the legislation he wanted, regardless of the consequences. On March 23, 1965, Johnson’s Oval Office taping system records the call he has been waiting for from Wilbur Cohen (architect of much of Social Security and Medicare), Wilbur Mills (Chairman of the Ways and Means Committee), Carl Albert (Democratic Majority Leader) and John McCormack (Speaker of the House) telling him the bill has just passed out of the Ways and Means Committee. It is the first time Johnson finds out what Cohen has just actually agreed to in Johnson’s name: (Listen to the Johnson Tapes on-Line)

Mills: We wound up, and I got instructions, we’ll introduce the bill at noon tomorrow, and will report it at 12:15 . . .  I think, we’ve got you something that we won’t only run on in ‘66 but we’ll run on from here after.
Johnson: Wonderful. Thank you, Wilbur.
Mills: Now here is Wilbur Cohen.
Johnson: When you going to take it up?
Mills: We could have it on late next week, if not, early the following week.
Johnson: For God sakes, let’s get it before Easter.
Mills: Oh, there’s no doubt about that.
Johnson: . . . I sure do congratulate you on getting this one out . . .  I congratulate you and thank you.
Cohen: I think it’s a great bill Mr. President.
Johnson: Is that right?
Cohen: Yes sir. I think you got not only everything that you wanted, but we got a lot more . . .  It’s a real comprehensive bill.
Johnson: How much does it cost our budget over what we estimated?
Cohen: Well, it would be, I would say, around $450 million more than what you estimated for the net cost of this supplementary program.
Johnson: What do they do under that? How is that handled? Explain that to me again, over and above the King-Anderson, this supplementary that you stole from Byrnes.
Cohen: Well, generally speaking, it’s physician’s services.
Johnson: Physicians. All right, now my doctor that I go out and he pumps my stomach out to see if I’ve got any ulcers, is that physicians?
Cohen: That’s right.
Johnson: Any medical services that are M.D. services?
Cohen: Any M.D. services.
Johnson: Does he charge what he wants to?
Cohen: No, he can’t quite charge what he wants to because this has been put in a separate fund and what the Secretary of HEW would have to do is make some kind of agreement with somebody like Blue Shield, let’s say, and it would be their responsibility . . .  that they would regulate the fees paid to the doctor. What he tried to do was make sure the government wasn’t regulating the fees directly . . .  the bill provides that the doctor can only charge the reasonable charges, but this intermediary, the Blue Shield, would have to do all the policing so that the government wouldn’t have its long hand . . .
Johnson: That’s good. Now what does it do for you the patient, on doctors. It says you can have doctor’s bills paid up to what extent or how much? Is there any limit?
Cohen: The individual patient has to pay the first $50 deductible, then he’s got to pay 20 percent . . .  of everything after that . . .
Johnson: That keeps your hypochondriacs out?
Cohen: That will keep the hypochondriacs out. At the same time, for most of the people it will provide the overwhelming portion of their physician’s costs.
Johnson: Yes sir, and that’s something nearly everyone could endure. They could borrow that much, or their folks could get them that much to pay their part . . .  I think that’s wonderful. Now remember this, nine out of ten things I get in trouble on is because they lay around. Tell the Speaker, and Wilbur, to please, get a rule just the moment they can . . .  That damn near killed my education bill, letting it lay around. It stinks. It’s just like a dead cat on the door. When a Committee reports it, you better either bury that cat or get it some life.

In the end, Medicare and Medicaid became the law of the land. And, as can now know, Mills was correct to have his doubts about the actuarial basis of Medicare, Medicaid, and Social Security when the bill was passed in 1965. But, like the Social Security Act of 1935, the 1965 Act was not an ending, but a beginning of a perpetual series of expansions of the benefits provided by these programs.

It is now painfully clear that Wilbur Mills was correct in his initial assumptions about both the solvency of the original Social Security Act of 1935 and its unprecedented expansion in the 1965 amendment that pushed through for significantly political reasons by President Johnson.  Mills estimates of what would be required in real taxable earnings gains in order to fund this “safety net” were eerily prescient. By 1974, the failure of the GDP to support the nation’s expenses for these entitlements, and the accumulating trade deficit, had placed the country in a significant cash shortage with few means of escape.

President Richard Nixon took us off the gold-standard, and by the late 1980s the significant, arbitrary increases in the currency had elevated almost everyone’s wage base to where they began to feel prosperous once again.  But, the costs were just being temporarily outpaced by the injection of this new currency, the day of reckoning was still coming and finally hit with a vengeance in 2009. It is now starting to become clear that the feeling of prosperity we all experienced was not the reality of our economy just the benefit of more baseless cash.

The Modern Perspective

Enter a few days ago our current President, Barack Obama. In the past few days, it is clear to me that the president still believes what Wilbur Mills told President Johnson in 1965.  He clearly believes that he should be able to run on the entitlements of Medicare and Medicaid to secure the votes for this free stuff, just like President Johnson.  The concept of “a chicken in every pot,” i.e. votes for free stuff, was not as much the hallmark of the Democratic Party prior to President Johnson.

Although President Franklin D. Roosevelt leveraged these ideals to help the country rise out of the Great Depression and prepare for WWII, and Herbert Hoover is often credited with the phrase; “A Chicken in Every Pot” is a quotation that is perhaps one of the most mis-attributed in American political history. Variously assigned to each of four presidents serving in the years between 1920 and 1936, it is most often associated with Herbert Hoover. In fact, the phrase has its origins in seventeenth century France; Henry IV reputedly wished that each of his peasants would enjoy “a chicken in his pot every Sunday.” Although Hoover never uttered the phrase, the Republican Party did use it in a 1928 campaign advertisement touting a period of “Republican prosperity” that had provided a “chicken in every pot—and a car in every backyard, to boot.” You see, we need to understand that political duplicity is not a democratic or republican affectation; it is a politician’s con.

But here we are once again, and even though President Obama is not uttering this phrase, it is clear that this is what he sees as his ticket to re-election.  Perhaps I am too cynical, but reading transcripts of committee hearings on what became the Affordable Care Act, listening to our congressional leadership saying things about the legislation like, “this is the path to a federal single payer system,” or “we need to pass it so we can see what’s in it,” and other equally ludicrous statements, and listening to the political agendas so blatantly expressed in the Johnson, or Nixon, tapes can do that to a person!

Based on my own experience, and backed up by the historical record all the way back to Mr. Mills, it is clear that the current system simply cannot work.  Frankly, and I don’t think I am telling anything out of school, none of our elected officials think it can work either.  They are currently almost evenly split between the “we know it can’t work and we need to fix it crowd,” and the “We know it can’t work but we can run on it again, and again, and again… crowd.” Regardless, to everyone it should now be clear that it can’t work.

So, it is astounding to me that the President of the United States, Barack Obama, now stands before the American people and making a reverse Robin Hood argument declares that the other party, Republicans, in this case, those evil people, want to take everything you have away and give it to the rich!  And what is more astounding is he says this is not class warfare!  People seriously can’t believe that such a bald faced lie can be true, can they? I have met many of our congressional leaders; republican and democrat.  I have not met one that was not concerned about all Americans.

To make a statement that one political party is dedicated to the destruction of poor and helpless people is beyond unconscionable it is simply irresponsible.  And it would be equally irresponsible for similar invectives to come from the other side as well.  We are in a significant national, social and economic crisis.  If our leaders do not get serious about solving the problems then we need to get new leadership.  If all we have left when someone talks of hard choices is to damn them as a pawn for the rich, then I do not see how we will survive.

As we move beyond this primary election cycle toward the presidential election, we need to elect a leader that will realize that he can’t promise America that there will not be a chicken in every pot.  You see Mr. Obama; the chickens have finally come home to roost!

(for those of you who may be interested in more on this issue, it is discussed in more detail in my upcoming book, “The History and Evolution of Healthcare in America,” go to my website at www.loker.com and sign up to receive notice of its release.)

The wheels of justice not only turn slowly they often confuse the common man

If you want to listen to the lengths modern law and its practitioners, lawyers, go to spin reality and obscure common sense to convince courts that which otherwise normal people would deem ludicrous, just go to and listen to yesterday’s oral arguments on the Tax Anti-Injunction Act part of the Affordable Care Act (Obamacare) Supreme Court review of its constitutionality.

It is interesting to note that the Solicitor General, representing the government, seems to be schizophrenic as he attempts to argue for the Obama administration’s position that the court cant here the case because of the act—as the President does not want the decision to come till after the election—and on the other hand in representing the position of the government (the people in general) he tells the court that he thinks the court should hear the case.

Another point to note as it has very particular relevance is that in his argument yesterday, he describes the assessed fee for not purchasing insurance, under the mandate clause of the act, is a tax.  Tomorrow he will be arguing that it is in fact a tax.  This schizophrenic position has been confounding the government’s position since they debated the law and passed it in the first place.  In arguing why the case can be heard, Solicitor General, Donald Verrilli, argues that the penalty is not a tax for the purpose of the Tax Anti-Injunction Act.  Tomorrow he will argue that the “penalty” is in fact a tax to justify the federal government’s position that it can levee it and therefore it is not violating state’s rights.

It is very important to note that like congress and the president, the power of the judicial branch, including the Supreme Court is granted, loaned if you will, from We, the people of the United States.  As such, if the decisions rendered make no sense to We, the people, then it is either because they are wrong or not crafted to reflect well on our intentions as a people.

We need to begin to exercise our responsibility as the grantors of these very important and solemn powers and demand that all decisions and arguments be rendered with a standard of language that we can all understand and does not obscure whether or not our constitutional rights are being upheld.

I encourage everyone to take the time to listen to the arguments in the first person, not as reported by others.  Yes they will take a combined six to nine hours but to allow others to police our rights is to grant them the power to help obscure the elimination, or neutering, of our rights.

To quote and old friends mother, “Pay attention, you can learn something from a fool!”  I worry that in the end the fool will be us!

Stupidity or Duplicity: WE pay anyway!

Click to link to original ABC News Article

Do you think they just don’t get it? In a supposed attempt to find some “middle-ground” in order to make the “middle-men” whole as to the cost of birth control, the administration is acting like we are in the “middle-ages”—all poor and uneducated. First, the administration’s talking heads took the position that the cost of free birth control would be a savings for employers, now forced to pay for it because, pregnancies and abortions are much more expensive. The employers now have to pay for a product, to prevent a cost that their health plan is paying. The premise is that paying the lower cost birth control will lower the plan’s coverage cost and the health plan will then, in turn, lower the premium cost to the employers—not hardly!

Also, there is a big assumption that the rate of single mother and unwanted pregnancies will decrease because of improved access to birth control. I am not sure I agree with this either. Free or subsidized birth control is widely available, it just is not conveniently available everywhere. I am not attacking a woman’s right to have access to birth control. We have a very strong habit, of late, of confusing the discussion of access with no-cost access. It is the no-cost access I have the most problem with. The cost is not free, we all end up paying for it anyway, and the system that is based on mandates, despite the method of the mandate naturally inject inefficiencies and vagaries of control, so that a significantly reduced percentage of dollars spent actually go to pay for the good or service. Look at the healthcare debate numbers from the president’s round table at Blair House with republicans in 2010. By numerous authorities, from both sides of the aisle, only about 35 – 45 cents on the dollar ever make it to real care. So why do we do it this way?

The government now classifies birth control as preventative care, because the ACA or Obamacare requires health plans to cover prevention at no cost. Exercise prevents heart disease, so this should be classified as prevention, as well. Health plans really should cover gym membership at no cost. And, you know having fresh fruit prevents scurvy, health plans need to cover free fruit. Listening to peaceful music lowers stress levels, and therefor prevents high blood pressure and the risk of stroke so good music systems are preventative and should also be covered for free. And of course a warm, comfortable home is clearly preventative to lots and lots of health related problems so I guess “health plans” should provide this as well. This is the same issue I have with the insurance purchase mandate and the rationalization of its constitutionality by the extension of federal power justified by pointing to prior extensions of federal power under the commerce clause.

It is not the idea of helping people; women in this case, get access to care that is the issue. It is the duplicitousness of the need for access by extension to now mean everybody else needs to pay for it, and the effort to obscure the nature of the extension logic that I am finding most troubling. The argument that is being used, now over and over again, goes like this . . . Someone, or some group, needs access to something—or for political gain, we can convince them that they are being discriminated against because they do not have this access and we want to give them access so they will see us as looking out for them, what we are providing is now considered preventative, we passed the law that says if its preventative it must be provided at no cost, ipso facto, you have to pay for this group to get it because it’s the law.

The straw that is breaking the back of many on this issue is now that this administration is saying well, since you are objecting to assuming this cost, we, the government, will find some way to make you whole here, you won’t have to shoulder the cost. Everything the government does cost the people of the United States money. No matter how they try to spin this, it costs us money. We are the government and we are the only source of money. So nothing they can do at the federal level is going to make anyone whole without laying it on the backs of all of us in the long run. Simply saying OK we will let you get a credit to reduce something you pay us over here, just reduces the income the federal government needs to pay what is already spent ten years ago. Do they really think we believe they will not increase fees somewhere else to get the money? If they lay it on the back of some other industry, they are going to increase prices that we all pay so once again it is out of our pockets. There is no escape from zero-sum economics. Even if they just print new money out of thin air, as they have been doing for forty years now, it reduces the buying power of our currency and prices go up, again we pay.

Finally, it is time we realize that we only have finite resources, and everything we do costs us in one way or another. Paying for birth control for everyone is just reducing the money we need to pay for everything else. People are now living much longer and as we crossed from average life expectancy at the mid-seventies to where we are not in the eighties, the average cost of care has rapidly increased. Now we demand that heal plans no longer just cover basic life-saving procedures, we expect they also cover quality of life items as well. The technologies we have developed to make this real gain in median life span is based on very expensive technologies adding to the costs, and the magic bio-chemical bullets we have developed to fight the war with the other species, like bacteria, and viruses, etc. are increasingly costing more and causing more side effects as these species have evolved to be resistant. All of this, with some other reasons as well, is causing the steadily increasing cost for our healthcare. Sometime soon we need to begin to discriminate at what point people are individually responsible for at least some of these costs.

So I wonder are the people coming up with these ideas really this stupid. If they are not stupid, then do they think we are this stupid? Or are they simply Machiavellian? My initial reaction is they are not smart enough to be this duplicitous, but perhaps I am mistaken!