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

FreshLook1

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.)

Introduction

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.

Summary

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 http://healthreform2dot0.org 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.

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

Article 1: Introduction to the Real Healthcare System

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 first of a series of articles that will be published over the coming days and weeks. The series 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 Published 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!

 We don’t have a system

When it comes to America’s, so called, Healthcare System, one of the biggest reasons that most of the attempts to “fix” our healthcare system have consistently yielded more unintended consequences than benefits is that we treat the symptoms of the disease not the disease itself. We have a number of misconceptions about our healthcare system and the first and foremost is that we believe that it is, in fact, a system.  It’s not!  It never has been.  What we think of as our healthcare system is really nothing more than a disjointed, tangled collection of practices, methods, procedures, policies, laws and guidelines that have been developed over the past 200 plus years.  Most of this collection of things were developed for the furtherance of one failing group or another.  Most were promulgated to preserve the business of individual practitioners – doctors, physicians, pharmacists, hospitals, pharmaceutical manufacturers, insurers, nurses, therapists, program sponsors, etc. With rare exception, many of this collection of things were not focused on the needs of the patient. 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

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

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

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

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

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

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

Random Thoughts: More or Less!

A few random, and not so random, thoughts that have been circling in my brain for the past week.  Here are a few issues worth thinking about a bit.

Microsoft’s little-screen, big-screen interactive future

Big and little screens interacting. That’s Microsoft’s vision of a collaborative future nirvana.

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A new world revealed!

20 years ago, when most of us were still dumb kids despite our relative ages, I was at a meeting with Bill Gates of Microsoft. He gave a presentation on the future of computing as he saw it. He predicted how we would interact with the things around us. He spoke of three devices; a personal interactive device, a portable interactive device and a social interactive device.  He explained how all three of these devices would deliver the same content in roughly the same manner from any point on the globe. He predicted that the underlying system would be ubiquitous and the information could come via wire, or through the air in a variety of forms.  The most 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

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.