Memorial Day

Lets also remember the Love they gave as well as the sacrifices they made.


image from Stuck in Customs

Right vs Left: US Government

There certainly is a difference in expectations between the left and the right regarding the role of the US government. I have noticed that there are still plenty of bumper stickers decrying the war on terror. Yet, waging war is well within the purview of what a government, any government, does. In my opinion the primary goal of any government should be protecting its citizens against foreign power whether it be another national government, band of corsairs, or terrorists. I empathize with the pacifist sentiments of the left regarding war in general, and I also acknowledge their disagreement whether it was a just war or not in Iraq. I happened to think we should do more than retaliate against the perpetrators of 9/11 and if Iraq succeeds as a democratic state, I believe this will move Arab jihadists just a little away from terrorism. South Asians are another matter completely and deserves its own post. I bring this up because my abhorrence of the Obamacare must feel similar to the left regarding the WoT/Iraq. Yet I just do not see how Obamacare is within the purview of the US government at least as laid out in the US Constitution. That the discussion of Obamacare even occurred and considered at all is astounding. Not to mention how it came to pass seems very undemocratic.

The WoT/Iraq was about whether the US government should or should not wage war.
Obamacare was about whether the US government could or could not be in the business of providing healthcare. There is just no constitutional basis for this discussion to even get to a disagreement.

One might argue that Obamacare is not about US governement healthcare ... until you realize that the regulations imposed will increase the cost of providing private insurance, thus herding more and more people toward government care.

Socialist Holy Grail

I think most people who are against the current health care reform believe that re-election pressure on the Democrats would be sufficient to stop the legislative process of health care reform. I do not believe that the normal legislative process is in play here. Health care reform is the holy grail of the socialist left. Now that it is within reach, they will risk everything to achieve it. The Democratic leadership will risk even losing the congressional majority to achieve this. Yet I believe this is short sighted because it should be more than achieving health care reform, it should be about achieving durable health care reform. Without bipartisan support, should the Republican win back majority in either house or senate, the health care reform will come tumbling down.

Health Care Reform

With Scott Brown election to the US Senate from Massachusetts on Tuesday, the Democrats' proposed health care plans are doomed. Certainly this is good news not because health care in the US shouldn't be reformed but because their proposal had more to do with government control than health care reform itself. Any future proposals for health care reforms must address the following issues, though not necessary all together as a composite proposal.

1. Malpractice Reform. Health care must first be about the delivery of health care. Malpractice reform will make it easier for health care professional to deliver quality care in an efficient manner.

2. Provide care for for those in need but without coverage. This predominantly pertains to those with preexisting conditions. One way to do so might be to provide tax advantages for commercial insurance companies to include this population.

3. Stimulate competition in the health care insurance market. Allow companies to offer policies across state lines.

4. Stimulate consumer cost awareness. When the consumer feels more of the cost, they will price and quality shop. Perhaps co-pays should be based on a percentage rather than a flat fee. Naturally health care providers will also have to make both their fees and their results available. Results may be given as percentage-brackets rather than raw values.

I support Scott Brown as the next US Senator from Massachusetts. Why?

1. His election would give Republicans 41 votes, enough break the Democrats current filibuster proof 60 votes.
2. He has promised to vote against Obama care.
3. He is running for the People of Massachusetts' US Senate seat, not dead Kennedy's US Senate seat.

I have given money once already and have just given again. You can do so as well here.

Humor: Our National Debt

Passing It On: "The Way We Get By"

Every day and night since May of 2003, a group of people in Bangor, Maine, have been on call for an uncommon, self-appointed duty at the city's international airport: to greet every flight carrying troops returning from, or departing for, Iraq and Afghanistan. All of the greeters featured in "The Way We Get By" (PBS Wednesday, 9-10:30 p.m. ET, but check local listings) are elderly and battling illness. The soldiers we see them cheering look uniformly fit and bursting with youthful health. As the film progresses, the interaction between the young (who face a possible death) and the old (who are staring at a more-certain one) sheds new light on the meaning of service. Along the way it also stuns us with unforgettable portraits of Americans of all ages in the fullness of life.

Bangor International Airport has been the first (or last) landfall in the U.S. for more than 900,000 troops (and dozens of dogs) from Iraq and Afghanistan. Sometimes there are six or more flights a day, each duly recorded on an airport wall chart by the greeters. As the war-zone returnees file off the planes here—everyone we see is clad in light-colored camouflage fatigues—the first person they hear inside the terminal often is 87-year old veteran Bill Knight, standing ready to shake every passing hand. Sometimes he cries out "Welcome home, heroes." Alert viewers will see even battle-hardened soldiers choking up.

On some faces there is joy. But for many, it takes more than landfall to break a grim spell; it takes the sight of these American civilians waiting in the terminal to say thanks. "You feel dull until you walk down the ramp and see these people," one apparently battle-hardened soldier explains in a wobbly voice. Then "you get tears in your eyes."

Some of the most affecting moments here involve contemporary soldiers stopping to hug and honor the greeters, whom they see as the generation of GIs who went before. "We're standing on their shoulders," one returnee says, and "what they've done in years gone by. We're just now starting to appreciate [that service] because we had to go through it ourselves."

Read more at Uncommon Calls to Duty.

Election 2009 Thoughts

1. A huge congratulation to the Republicans of Virginia for their huge wins.
2. Congratulations as well to Governor Elect Christie of New Jersey.
3. State elections are about state issues. The current issue in Virginia is the economy. McDonnell had a more positive message than Deeds. I think this was a significant factor in his win. Had Obama's administration economic policies been better, Obama and Deeds would have done better. Personality only go so far in politics, especially once you have to govern.
4. The NY-23 election was also about local issues. The take home lesson for conservatives and the GOP is that both have to work together to win. A third party candidate is not viable from the outside. But threats of a third party run may be preempted by cooperation between the GOP and conservatives. Had Hoffman won in NY-23, there would have been a greater impetus to field third party candidates elsewhere in NY in 2010 (given the established nature of the Conservative Party in NY) and maybe elsewhere nationally as well.
5. I think #4 is also significant regarding the Arctic Fox Palin. She would be more effective to shape the direction of the GOP better than building a third party movement.

Republicans, Conservatives and Independents

Since the November loss, not just for the presidency but also regarding seats in the Senate and the House of Representatives, there has been an ongoing debate on how to rebuild the party. The two predominant ideas are either to make the party more appealing to Independents or to return to core principles of conservatives. This competing idea is playing out in the NY23 race where the GOP nominated a moderate candidate Dede Scozzafava (as they called her) with the belief she will be more appealing to independents. In response, conservatives and conservative commentators have come out roaring against a candidate they consider either a RINO at best, or a far left at worse, in favor of a non GOP candidate from the Conservative party of NY, Doug Hoffman.

Conservatives Call On Scozzafava To Withdraw
Conservatives roar; Republicans tremble

I believe the GOP bosses are making several huge mistakes. Firstly, all successful organizations need people to do the work and believe in the work. Without the base, the party is certain to fail.

Rasmussen: 73 percent say GOP leaders have lost touch with Republican base

Secondly, there is also a divergence of the party's goal and the base's goal politically. The party wants to win election. Thus it makes perfect sense for the party to focus on candidates they believe are electable with appeals to the middle. But the base is more concerned with how the party will govern once elected. By having candidates that are far removed from the base's ideology, once elected they don't necessarily vote with the party. See Arlen Specter and Olympia Snowe as examples.

Thirdly, the choice between electability and adherence to party ideology is a false choice because you could have both. Independent voters are frequently not wedded to a particular ideology. They do not have their own party or party platform. They thus choose from what is offered by the current parties come election time. Thus when the choice is between idea X and idea similar to X, the tendency will be to go with idea X itself rather than X-lite. But when the choice is between X and Y, where both are clearly different, Y becomes distinguished and appealing in its own right.

Obviously if an idea is clearly bad, it will not be chosen. I do not believe this is the case with the ideas of Conservatism. I believe the ideas of Conservatism continue to be sound and appealing to most of Americans, not just conservatives. As is, conservative outnumber liberals and twice as many Americans are becoming more conservative than more liberal.

While some politicians focus on winning elections,
On the NY23 Race, We Have A Practical Choice To Make

other remembers why why politicians are elected for office to begin with.

The votes of every member of Congress affect every American, so it's important for all of us to pay attention to this important Congressional campaign in upstate New York. I am very pleased to announce my support for Doug Hoffman in his fight to be the next Representative from New York's 23rd Congressional district. It's my honor to endorse Doug and to do what I can to help him win, including having my political action committee, SarahPAC, donate to his campaign the maximum contribution allowed by law.

* * *

Political parties must stand for something. When Republicans were in the wilderness in the late 1970s, Ronald Reagan knew that the doctrine of "blurring the lines" between parties was not an appropriate way to win elections. Unfortunately, the Republican Party today has decided to choose a candidate who more than blurs the lines, and there is no real difference between the Democrat and the Republican in this race. This is why Doug Hoffman is running on the Conservative Party's ticket.

2010 Election: the States

Recently at the Horse Race Blog Jay Cost posted this

Above all, the RNC needs to focus on its fundraising infrastructure. It must be ready for the Obama money tsunami that will be crashing ashore in the fall of 2012. If you thought the President raised a lot of money last cycle, you haven't seen anything yet! Also, the party needs to figure out why the Democrats have managed not only to catch up to, but actually exceed, the Republicans in fundraising - this after the banning of soft money, which had historically helped the Democrats. That's a puzzler that should have Republicans - above all Michael Steele - thinking about innovation. This should be happening to the exclusion of guest hosting radio shows, Mr. Chairman!

I emboldened the money quote. As I thought about it, I was at first skeptical to attribute Obama’s victory to money spent. After all, wasn’t it a nation tired after 8 years of W and ready and take a chance with a promise “Hope and Change?” And now that “Hope and Change” is revealing itself as empty rhetoric and dangerous far left ideology, I do not believe any sum of campaign money be spent to reverse the distrust the nation has acquired by then. So how can a money advantage possibly make a difference? Through vote fraud.

No, money may not buy enough vote to win election, but money can be spent through organizations such as ACORN. ACORN through shady voter registration efforts and with sufficient funding may have won Al Franken his Minnesota Senate seat. Steps must be taken to prevent voter fraud and I don’t think community vigilance will suffice. The law must be clarified to prevent illegal voter registration and a legal strategy must be planned for as contingency for illegal vote counts. I believe controlling the state legislature will be essential for the fair legislative over sight of the electoral process. In most states judges are appointed, usually by the Governor. Thus efforts to elect favorable governors are necessary. In a few states judges are elected and attention must be made to there judicial races as well.

Previously I discussed to importance of the 2010 state election in order to be in position to redraw the Congressional district maps as the result of the 2010 Census. It now appears to me that state elections are even more crucial than I previously thought. We all must pay close attention to and expand our efforts to win out states.

A Rational Voice in Congress on Health Care

Insurance Deductable

I took my car into the shop yesterday for some body work after a minor collision. Because all i had to do was to pay the co-pay, i didn't really shop around for the best deal. I suspect the same mentality applies to most people when it comes health insurance and co-pays. Thus as long as everyone charges a similar amount, they can all over charge without concerns, and the consumer doesn't really care.
A better system might have been instead of a flat co-pay, use a percentage based co-pay, with plans for 5%, 10%, 20% etc co-pays. Thus there would be an incentive for the consumer to price shop. For health care, cost must be itemized and be more transparent. And to assist consumers in choosing the right provider, a rating system for the provider must be available. Any such ratings must consider how sick his/her patient is before care, and how sick they are after care.

What is a Tax?

What is a tax? Apparently Obama does not know.

Sarah Palin in Hong Kong

Once again Palin pre-empts Obama's speech, this time on the international stage. Sarah was invited to speak in Hong Kong at the CLSA Asia Pacific Markets Conference. Exerpts below are from the WSJ:

On Conservatism:

You can call me a common-sense conservative. My approach to the issues facing my country and the world, issues that we’ll discuss today, are rooted in this common-sense conservatism… Common sense conservatism deals with the reality of the world as it is. Complicated and beautiful, tragic and hopeful, we believe in the rights and the responsibilities and the inherent dignity of the individual.

We don’t believe that human nature is perfectible; we’re suspicious of government efforts to fix problems because often what it’s trying to fix is human nature, and that is impossible. It is what it is. But that doesn’t mean that we’re resigned to, well, any negative destiny. Not at all. I believe in striving for the ideal, but in realistic confines of human nature…

On Liberalism:

The opposite of a common-sense conservative is a liberalism that holds that there is no human problem that government can’t fix if only the right people are put in charge. Unfortunately, history and common sense are not on its side. We don’t trust utopian promises; we deal with human nature as it is.

On what caused the financial crisis:

While we might be in the wilderness, conservatives need to defend the free market system and explain what really caused last year’s collapse. According to one version of the story, America’s economic woes were caused by a lack of government intervention and regulation and therefore the only way to fix the problem, because, of course, every problem can be fixed by a politician, is for more bureaucracy to impose itself further, deeper, forcing itself deeper into the private sector.

I think that’s simply wrong. We got into this mess because of government interference in the first place. The mortgage crisis that led to the collapse of the financial market, it was rooted in a good-natured, but wrongheaded, desire to increase home ownership among those who couldn’t yet afford to own a home. In so many cases, politicians on the right and the left, they wanted to take credit for an increase in home ownership among those with lower incomes. But the rules of the marketplace are not adaptable to the mere whims of politicians.

…

Lack of government wasn’t the problem. Government policies were the problem. The marketplace didn’t fail. It became exactly as common sense would expect it to. The government ordered the loosening of lending standards. The Federal Reserve kept interest rates low. The government forced lending institutions to give loans to people who, as I say, couldn’t afford them. Speculators spotted new investment vehicles, jumped on board and rating agencies underestimated risks.

On greenhouse gas legislation:

It seems like some are looking to ever more ways that will actually destroy economic opportunities today. Take for example, Washington’s cap-and-trade scheme. I call it the “cap-and-tax” scheme. Right now we have the highest unemployment rate in 25 years, and it’s still rising. And yet some in D.C. are pushing a cap-and-tax bill that could cripple our energy industry or energy market and dramatically increase the rates of the unemployed, and that’s not just in the energy sector.

American jobs in every industry will be threatened by the rising cost of doing business under this cap-and-tax plan. The cost of farming will certainly increase. That’s going to drive up the cost of groceries and drive down farm incomes. The cost of manufacturing, warehousing and transportation will also rise. We are all going to feel the effects. The Americans hardest hit will be those who are already struggling to make ends meet today, much less with this new tax every month…

I am not indifferent to environmental concerns. Far from it. As governor, I created a sub-cabinet to study the impacts of climate change in my state. And I was the first governor to do so. It took us in a new direction…

I’m a supporter of nuclear power and renewables. We can develop these resources without destroying our economy. And we can help the environment and our economy through energy independence.

On health care:

I seem to have acquired notoriety in national debate. And all because of two words: death panels. And it is a serious term. It was intended to sound a warning about the rationing that is sure to follow if big government tries to simultaneously increase health care coverage while also claiming to decrease costs. Government has just got to be honest with the people about this….

As I said, it’s just common sense to realize that government’s attempts to solve large problems like the health-care challenges that we have, more often create new ones, and a top down one size fits all plan will not improve the workings of a nationwide health-care system that accounts for some one-fifth of our economy.

Common sense also tells us that passing a trillion dollar new retirement program, that’s not the way to reduce health-care spending. Real health-care reform is market oriented, patient centered and result driven. It would give all individuals the same tax benefit, that an ideal plan that I would have in mind, same tax benefits as those who get coverage through their employers. And give Medicare recipients vouchers so that they can buy their own coverage. And reform tort laws and change regulations to allow people to buy insurance across state lines. Rather than another top down government plan, we should give Americans themselves control over their own health care with market friendly responsible ideas.

On relations with China:

We engage with a hope that Beijing becomes a responsible stakeholder, but we must take steps in the event that it goes in a different direction. See, we all hope to see a China that is stable and peaceful and prosperous. Optimism that yes, it will be.

Asia is at its best when it is not dominated by a single power. In seeking Asia’s continued peace and prosperity, we should seek, as we did in Europe, an Asia whole and free. Free from domination by any one power…

On China’s relations with Taiwan, and other controversial issues:

We simply cannot turn a blind eye to Chinese policies and actions that could undermine international peace and security. Here, China has some one thousand missiles aimed at Taiwan and no serious observer though believes that it poses a serious threat to Beijing. Those same Chinese forces make our friends in Japan and Australia kind of nervous.

China provides support for some of the most questionable regimes, from Sudan to Burma to Zimbabwe. China’s military buildup, it raises concern from Delhi to Tokyo because it’s taking place in the absence of really any discernable threat to it. China, along with Russia, has repeatedly undermined efforts to impose tougher sanctions on Iran for its defiance of the international community in pursuing its nuclear program. And the Chinese food and safety, uh food and product safety record, of course it’s raised alarms from East Asia and Europe to the U.S. and domestic instance of unrest. From the protest of Uighurs and Tibetans to Chinese workers throughout the country rightfully makes a lot of people nervous.

On human rights and democracy in China:

The more politically open and just China is, the more Chinese citizens of every ethnic group will be able to settle disputes in court rather than on the streets. The more open it is, the less we’ll be concerned about its military buildup and its intentions. The more transparent China is, the more likely it is that they will find a true and lasting friendship based on shared values as well as interests. And I’m not talking about a U.S.-led democracy crusade. [We’re] not going to impose our values on other countries. We don’t seek to do that. But the ideas of freedom and liberty and respect for human rights, it’s not just a U.S. idea. They’re very much more than that. They’re enshrined in the Universal Declaration of Human Rights and many other international covenants and treaties.

On China-U.S. economic relations:

Our economic interdependence drives our relationship with China. I see a future of more trade with China and more American high tech goods in China. But in order for that to happen, we need China to improve its rule of law, and protect our intellectual property. We need to avoid protectionism and China’s flirtation with state assisted national champions. On our part we should be more open to Chinese investment where our national security interests are not threatened. In the end though, our economic relationship will truly thrive when Chinese citizens and foreign corporations can hold the Chinese government accountable when their actions are unjust.

Read more at Texas for Palin.

All the above just makes common sense. Contrast the above with the apologetic nonsense the Obamassiah had to say to the UN yesterday.

In an era when our destiny is shared, power is no longer a zero-sum game. No one nation can or should try to dominate another nation. No world order that elevates one nation or group of people over another will succeed. No balance of power among nations will hold. The traditional division between nations of the south and north makes no sense in an interconnected world. Nor do alignments of nations rooted in the cleavages of a long gone Cold War.

...

Democracy cannot be imposed on any nation from the outside. Each society must search for its own path, and no path is perfect. Each country will pursue a path rooted in the culture of its people, and - in the past - America has too often been selective in its promotion of democracy. But that does not weaken our commitment, it only reinforces it. There are basic principles that are universal; there are certain truths which are self evident - and the United States of America will never waiver in our efforts to stand up for the right of people everywhere to determine their own destiny.

ACORN is Despicable

Previous I posted about ACORN and Fraud. The revelation documented by Hannah Giles, James O'Keefe, and Andrew Breitbart at Big Government deserves big applause. Both the House and the Senate now have taken steps to stop funding ACORN. I am sure they will find a way (both the Democrats in bed with ACORN and ACORN themselves) will find a way to continue their activities. The key though is that their taint is now in the public domain.

What is exemplary about this episode isn't just about breaking open how despicable and corrupt ACORN is, but also how corrupt and lazy the main stream medias are. In the process it also underscores how new media, as well as concerned citizens can make a difference that shame and make irrelevant the legacy media. Again, kudos to the folks at Big Government! Happy hunting.

Read the Bill

Yesterday on the way home National Public Radio had a piece on protesters expecting congressmen to read a bill before they vote on it. It was clear that pushing bills through votes before the bill is read is the norm in Congress. I suspect that most congressmen simply trust the bill's content, constructed by congressional committee, to be firstly what it purport to be and secondly to be legally sound. Given this implied or practical trust, that it would be reasonable for most of Congress to vote on a bill they have not read. NPR's slant was that this has been going on all along and thus should be acceptable. It is not. Just because a process has continued to occur, and perhaps even accepted as standard practice, does not make it either sound or acceptable. Truly faulty reasoning.

If they think that such trust is sufficient, then the bill should be voted on by all citizens in the US. But that is currently not possible. Until then, I expect my congressman to at least give a damn, show some professional curiosity to know and understand what is in a bill when they vote for it. If they cannot understand it, they either should not be a congressman or the bill is too complicated to pass. Passing a tortuous complicated bill into law results in either enlargement of a faceless bureaucracy that implement such laws, and or loop holes that would devalue the intent of the law. Either is unacceptable.

911

Remember 911.



Fight terrorism.

Obama & the Managerial High Ground

In a previous post I looked at what appears to be Obama attempt to stay above the political realm by staking out the moral high ground.

Most of Obama's words thus far suggest that he is staking a claim for the Moral High Ground. He has released the torture memos because he believes he is better than the Bush administration in this regard. He is releasing the pictures of "torture" prisoners for the very same reasons. When he was oversea he apologized for past US actions, because he nominally believe the US could have done better, and that under him we will. There are two things to consider here.

First is that if he thinks this will make the US safer or better he is wrong. Those who work toward our destruction do so not because of some reasoning, but some hatred. That we could have been better angers them. That we believe we could be better also angers them. There mere fact that we are different from what they want to be angers them, regardless of how good we are. Staking claim to the Moral High Ground may make things worse for us. It certainly not keeps us safer. Those that seek to compete against us will not treat us better, or help us further our goals. They compete against us because they think they can beat us. Given any opportunity to do so they will certainly try regardless of who has the Moral High Ground.

Second is that if he thinks he can claim the Moral High Ground he is also wrong. This sort of thinking seems rampant to those without practical experience in life, living by concepts they believe the world should operate by rather than the principles the world lives by. This is akin to a rich couple believing their wealth keeps their estate well maintained, rather than understanding that it is still the housekeepers and gardeners' labors over dirt. Or a hospital CEO proclaiming how many lives his hospital saves, without acknowledging it is the doctors and nurses work in soilage and pus. Or a general believing he won the battle rather than the soldiers killing and maiming. The difference between Obama's Moral High Ground and reality is the difference between Ideals and Practice.

At best, his stake for the Moral High Ground only shows his naïveté. What it clearly reveals is his hubris, not his humanity. And through it all, he has also demonstrated willingness to use politics to further himself.

I return to this topic after reviewing two recent events pertaining to the current Obama administration.

The first is his attempt to push through a health care reform package that he did not craft, that he doesn't know much about, and doesn't really care too much regarding the details other than it gets done and gets done quickly. Some commentators have suggested that he is trying to avoid the mistakes of Clinton's own attempt to reform health care, which was to too involved in its creation. To me it seems Obama have decided to allow others to craft the reform, and he would just be the catalyst to make it happen. This naturally allow him to take credit for its passage, should it pass, as well as distance himself from it, should it fail (and it should).

The second is his "allowance" of the Justice Department to investigate the CIA interrogation of captured terrorist (note it really just one terrorist that this is all about, the guy who helped planned the 911 attack Khalid Sheikh Mohammed). To me he is putting both attorney general Eric Holder out on the limb as the one person actually politically responsible for the investigation (though certainly another person as lead investigator actually will do the factual work) as well as as Leon Panetta as the current head of the CIA. This way he will appease the far left who have clamored for an investigation. The political fall out during the investigation will now be between the CIA and the Justice department with him as the overlord observer. Should the investigation finds something, Panetta will certainly be the fall guy within his own CIA for allowing the investigation. Should the investigation finds nothing, Holder will be left holding an empty bag and suffer the rantings of the unhinged left. Either way Obama is shirking actual responsibility for the investigation, or the even more responsible decision not to investigate at all.

Everything points to Obama being a very poor leader. He may be inspiring to his supporter but he doesn't take ownerships of his decisions, letting others fall away while he takes credit for their success or distance himself for their failure. A true leader lead by leading, not by being.

"Spreading the Wealth" for Health Care

Over at Bookworm room, she reports a conversation with he Kaiser Permanente Doctor.

The doctor had a very interesting take on the current uninsured. I said that a lot of people are opposed to the proposed plan because they recognize that those numbers being bandied about regarding uninsured are false. That is, the 45 million (or whatever) uninsured aren’t uninsured simply because of poverty. The vast majority are either illegal aliens (and you can see his views about those above) or voluntary uninsured. As to the latter, my friend thinks they’re the real problem. He understands that these people are voluntary uninsured because they are young and healthy. They’re gambling that they won’t need insurance. Or they might be marginally insured, in that they buy a $10 policy with a $10,000 deductible, just in case something really bad happens. They are not putting money into the system.

What this doctor likes about mandatory universal health care is that it forces the voluntary uninsured into the system. He thinks it grossly unfair that they are not paying into the system, while people who need insurance are paying. If there were more money in the system, the person with a preexisting condition would not be required to pay as much for his insurance. In other words, he thinks that the insurance system should be a cross between an uninsured motorist requirement and social security. He freely admits that this is a government mandated spread the wealth approach, and one of which he approves.

Because he has a philosophical approach that requires everyone to be in the health care market, whether they want to be or not, he is unperturbed by CBO numbers projecting vast increases in the cost of health care under the new plan. He thinks the CBO people, being accountants and not doctors, have no idea what they’re talking about. What he envisions is a brave new world in which the government simply provides more insured people who will use medical services. He finds it inconceivable that universal health care (which is a system by which all people are insured, but medical care providers continue to be privately owned) can shade into a single payer, government-owned system.

He does not believe that having the government as an insurance provider will change the system and drive out private insurance. Nor does he believe that, even if all private insurance is gone, with the government being the only bill-payer, that this will do anything other than purify the private medical system of the current social injustices that plague it. He also refused to believe that, in other countries that have socialized medicine, there are treatments that are denied to people, not because the treatments don’t work, but because the people are deemed (by government mandate) to be too old or too ill to be worthy of treatment. As for government lists of treatment, he says we have them already, because every care provider is in thrall to Medicare and related government programs. He did not see a difference between the fact that Medicare sets prices, but does not yet set age or health boundaries for providing treatments.

He is very disturbed by the opposition to the health care plan, which he sees as the product of Republican cabals who are shipping agitators into local town hall meetings. The absence of any concrete evidence of such busing (such as buses) does not change his mind.

I explained that people are also concerned that they’re being sold a bill of goods that is not as promised. The rush to pass a bill (three weeks “deliberation” to change a sixth of the economy) didn’t bother him at all. “That’s how things go.” When I raised specific concerns about the existing bill (the inability to stick with your insurance if you change jobs, the incentive for employers to dump insurance and drive people into the government system, the government decision boards re treatments, the enhanced access the government will have to our finances) he just didn’t care. He thought those were petty concerns and was sure I was wrong. He also discounted the hidden taxes in the bill. “Obama promised that he’d veto any taxes.”

The doctor also dismissed the fact that many of the bill’s proponents — including the president himself — are on record as supporting single-payer care (which is different from the universal care this doctor supports). He denies that Obama lied at the New Hampshire townhall when he when he said ““I have not said that I am a supporter of a single-payer system,” despite several past instances of his having said precisely that. “There’s no lie there,” said my doctor friend. “Obama did not say that he ‘never’ supported single payer care. He’s talking in the present tense. He doesn’t support it now.” I said that, if that’s what the great communicator meant, that’s what he should have said, including explaining why he’s changed his mind. “Nah,” said the doctor. It was clear.

The conversation ended there.

My response, with some additional comment not posted there in italic, is as follows.

1. Unnecessary tests rarely profits the doctor ordering it, whether it be lab tests or procedures. When a doctor sends a patient to get endoscopy, the gastroenterologist profits (if not on salary) from the procedure, not the referring physician. Yes the referring doctor could have just given you a trial treatment, as well as the gastroenterologist. Kaiser though also would not profited from the endoscopy it this was an in-network service. Kaiser predominantly profit from the subscription/insurance fee of its members by taking more in than they spend, by taking money from people who use less of kaiser services and spending some (but not all) of it on those who need and use more.

2. Health systems thus profit by taking money from those who subscribe for health services but do not use as much of it as they put in. If we look at our national health care system overall, the problem may seem that the uninsured are not putting money into the system and thus your doctor’s impression may seem correct but it is not. The uninsured do put money into the system already through taxes they pay to the local, state, and federal system. Those who choose to go uninsured likely believe that they would not need to be insured because they don’t expect to use health care should have that choice respected. In large part these are young people who really don’t need to. To think we should force them, or those who cannot afford insurance, to buy insurance or buy into the health care finance system seems coercive to me.

3. I have no problem with the doctor being agreeable to the government spreading the wealth in this regard for health care. If you think it is a form of taxation for the general well being of the nation, like that of national defense for instance, or border control, or disasters relief a health care tax might even seem reasonable. What is not reasonable is to think that as a democracy that rose party out of refusal to pay unfair taxes, that the doctor would take exceptions to people, whether it be a majority or a minority voice of protest. Isn't that the essence of the Tea Parties and the townhall protests currently underway regarding what the current government proposes. And should the majority decides against this tax should it be forced on them anyway?

4. For a learned person, the doctor still made several gross error in analysis and judgment. The first being a sampling error based on anecdotal experience. Just because the Kaiser system works does not mean a government managed system would. Yes clearly a “public” option will drive private plans out of business because the government plan will get income from everyone through taxation, even the already insured will pay them, thus the government’s “public” option plan will always have a higher ratio of pay-ins to pay-outs than any private plan could match. And since the government has the right to set health care standards for all, private health system cannot hope to compete. In addition, the government has never been known for being efficient financially or in service provided whether it be Amtrak, the post office, or Veterans Health Administration. What partly work now, or even what works well now, can work even less later. Not all reforms make things better.

5. The second error the doctor made is likely based on hubris of being an educated physician thinking he knows better for the patient than the patient himself. Though the current drive for health care reform is really about reforming to control costs rather than improve care access (though some will certainly benefit from improved access), when it comes to the ultimate and primary recipient of health care, it is about quality of care. The current anxiety and consternation among the majority of Americans center around the care they are currently getting as contrasted to the care they may or may not get with the reform. The doctor likely believe he can deliver the same (high?) level of care to his patients and are thus is dismissive of patients general concern over health care reform. He may not realize some patients may not think so highly of his delivery, and he certainly underestimate how someone smarter (or perhaps even less smart than he but has a better political pedigree) than he, another physician installed as a health care czar, may feel inclined to believe he is wasteful and starts to dictate how he could do better, placing him in a position to have to change his standards of practice to conform to someone else’s standards. When one is smart, there is a tendency to believe that one is right and that this right is self evident to anyone else with half a brain.

6. The third error the doctor made is allowing his own convictions and bias blind him to information challenging the veracity of his own beliefs.


I have frequently noted that when a doctor speaks out for or against in the current health care debate, they are given special status and what they say seems to gain greater significance. But shouldn't the truth and the justice of any argument be equally valid and valued regardless of the speaker? It is all really rather amusing.

The Cost of Health Care

As part of the justification to "reform" the health care system in the US is predicated on the argument that the cost of health care in the US is too high. How do they know? It is because our the amount of money we spend on health care is higher than that of other industrialized nations without a better outcome? In these analysis, one such better outcome is typically measured as survival of some sort or another. I think survival measures are misleading for several reasons. Take infant survival for instance. Yes, as reported to the World Health Organization the US has higher infant mortality rates than most Western nations. Why is this? Partly because of how we calculate the mortality figure; what constitute a death is obvious but what constitute a birth is not always so obvious. The WHO specifies a birth as a "viable birth" but in some nations, if a live infant is born without meeting their ability to keep alive, it isn't considered a "viable birth".
Using mortality as a measure of health care outcome also doesn't show the whole picture. In the US we spend a significant amount of resources on palliation to improve quality of life without improving the over all survival. Medicare spends about 25-30% of its budget each year on the last year's of life. We typically do all we can to save a life and spends the resources to do so. But it isn't just in the last year of life. In Germany for instance, post operative analgesia are typically aspirins and ibuprofen, analgesics we can get over the counter here in the US. Here in the US, nearly all post operative analgesics are narcotic based, with pills for outpatient care and patient controlled intravenous injection of narcotics for inpatient recovery. These things cost money without extending longevity.
But for somethings longevity is better in the US. Take cancer survival for instance. But longevity also varies across the globe that has nothing to do with health care delivery. The US has a significantly higher population of obese patient and a higher incidence of heart disease, likely due to our diet.

The second motive to reform health care is to reign in health care inflation. I remember the same arguments a decade ago for Health Maintenance Organization (HMOs). For a few years, health care inflation was reigned in but afterward, it resume at previous rates of increase. The chart below is interesting in that this isn't just in the US but the health care inflation is on a similar projection in the UK as well as France.


What this graph signifies again is that there a cultural component the health care cost and health care inflation that is not being discussed. Western nations have rapidly rising health care cost, Japan does not. That there is cultural variation on what we spend money on should come as no surprise. For instance, most homes in the US has air conditioning and thus we have less consequences of heat waves. In France this isn't so.
All in all, we get what we pay for. In the US we spend more on palliative measures and this in actuality is a mark of our wealth. Health care isn't about survival in the US, health care is also about quality of life. This is a choice our society has decided on. Yes like any choice we can change our mind but we need to be cognizant what the debate should entails. I suspect some advocate for health care reforms knows this but also realize that a supposed cost saving argument is easier made than a cultural changing argument.