The cost of health care in our country is exorbitant, and it will probably rise as a result of the new health care legislation that I hope will pass. Covering the uninsured and those with pre-existing conditions is costly - but it is the right thing to do. How then can we reduce the cost? Here are four suggestions.
1. Increase the penalties for health care fraud, and hire a lot more inspectors. I recently read that annual Medicare fraud may cost taxpayers as much as $800 billion dollars. Even if it's only half that number, we could pay 50,000 new inspectors $100,000 each for only $5 billion annually and save a bundle. Catch the crooks put them away for a long time!
2. Bust the professional groups that, in effect, are unions that engage in medical featherbedding.
For example, today I read that the New York governor has issued an "emergency" executive order that will allow Swine flu shots to be administered by dentists, paramedics, pharmacists, and other health care professionals, all of whom need to be specially trained for the job. Perhaps I am missing something, but it seems to me that if a paramedic is already qualified to inject powerful life-saving meds, without supervision, they might be qualified to give a flu shot! Can you believe that a PA can't even give a flu shot under normal conditions? The medical "special interest groups" have far too much power, and their featherbedding adds a lot to the cost of health care.
3. Revisit the paperwork and patient confidentiality rules.
Many of us veterans remember standing in long lines to get rapid-fire innoculations. Hundreds of soldiers got their "shots" in no time. Yet in this "national emergency", the paperwork and "confidentiality" crap associated with giving flu shots make the lines move at a snail's pace. Snail's pace processes are expensive.
HIPPA, a law originally intended to stop insurance companies from misusing health care information, somehow morphed into a law that puts sand in the gears of the entire health care complex. For example, a patient being rushed to the hospital with chest pains has to sign a statement saying he's been told that his patient information will not be mis-used? Are we nuts?
4. Make physicians justify why elderly patients with certain terminal conditions should receive certain very expensive treatments rather than moved to hospice care. It's just silly that we spend an immense fraction of our health care dollars on persons who die shortly afterward of problems previously known to be terminal.
Common sense has been absent in many areas of health care, resulting in increasingly expensive processes for doing simple things and a huge medical fraud industry. Who is tackling these obvious problems? It's time to start complaining, and loudly!
Friday, October 30, 2009
Saturday, October 17, 2009
More Troops - More Deaths
Americans seem believe war is like video war games; you play for awhile, lots of characters fall down or are blown up, and then you turn off the game and everyone magically comes back to life. But war is not like a video game. Real people die and never come back to life.
Obama is debating whether or not to send more troops to Afghanistan. What's not said often enough is that if more are sent, more will die. How many American deaths is an Afghanistan "liberated" from the Taliban worth?
Don't get me wrong. I believe that if the Afghanistan war is really in America's best interests to win, then more troops may be necessary. But, we must not be naive about casualites. There will be many of them, and there will also be more Afghan civilian casualties.
While listening to Diane Rehm on NPR this week, I heard an "expert" say that we had killed many Al Queda leaders with Predator air strikes. Diane immediately said, "But there also were civilian casualties!" That was a naive comment, but a telling one. Many Americans just don't understand that war is a messy business.
So, if we increase troops we must also willingly accept more of our soldiers being killed and wounded. We must also accept the idea that Afghan civilians will be in the way and be killed. Our soldiers must not be asked to fight with hands tied behind their back, risking even more danger than they should.
Will the American public support our really "going to war" in Afghanistan? I don't know.
Obama is debating whether or not to send more troops to Afghanistan. What's not said often enough is that if more are sent, more will die. How many American deaths is an Afghanistan "liberated" from the Taliban worth?
Don't get me wrong. I believe that if the Afghanistan war is really in America's best interests to win, then more troops may be necessary. But, we must not be naive about casualites. There will be many of them, and there will also be more Afghan civilian casualties.
While listening to Diane Rehm on NPR this week, I heard an "expert" say that we had killed many Al Queda leaders with Predator air strikes. Diane immediately said, "But there also were civilian casualties!" That was a naive comment, but a telling one. Many Americans just don't understand that war is a messy business.
So, if we increase troops we must also willingly accept more of our soldiers being killed and wounded. We must also accept the idea that Afghan civilians will be in the way and be killed. Our soldiers must not be asked to fight with hands tied behind their back, risking even more danger than they should.
Will the American public support our really "going to war" in Afghanistan? I don't know.
Thursday, October 15, 2009
Health Care - My Almost Final Word
The health care debate is slowly coming to a conclusion. Most of the horses have been traded, most of the spears have been thrown, most of the insults spewed, and most of the numbers added. In my mind, the issues still remain rather basic.
1. Will the bill provide a way for a great number of uninsured working people and people who have worked in our economy to get affordable care if they are sick or injured?
2. Will the bill provide means and incentives for health care providers to reduce costs while maintaining or improving the quality of care?
3. Will the bill provide incentives for Americans to adopt more healthy lifestyles and to make informed choices about end of life care?
Every person who has honestly evaluated the American health care non-system understands that it is far too costly and far too inefficient. We need to make progress on solving these problems, or they will simply get worse. This will not be easy, and it may be incremental, but we must make progress. Anything else will be a major failure of government.
Both radical liberals and radical conservatives have staked out positions in opposition to major planks that will likely be in the final bill. Liberals who represent several major unions object to taxes on the high cost "Cadillac" health plans they've negotiated with employers. For example, they support the idea that teachers should be able to get four pair of new eyeglasses each year, for free. Conservatives in hock to the industry object to the idea that working people should not go bankrupt if they happen to get really sick and incur hundreds of thousands of dollars in doctor and hospital costs. Both groups are hindering progress toward a reasonable solution.
On balance, the conservatives have been most outrageous in their objections. If you listen to them, you soon realize that they never describe the problems with the system or suggest ways to solve them. They are almost 100% negative. Some believe (this is true!) that those unable to pay for hospital procedures shouldn't get them; "survival of the financially fittest" is their motto. Others, when asked why they object to health care reform, say they don't want to pay for illegal immigrant health care, something that is not in the bill. The absurdities go on and on...such as, "don't let the government get involved with my Medicare". In short, I only pay attention to those who seem concerned to improve America's health care, and I don't think those who focus only on negatives are interested in that at all.
I've been pretty close to the health care industry for the past 10 years, and I understand it a lot better than most Americans. Our system is broken; it must be fixed. If we don't make some real progress on reforming it, we have shot ourselves in the foot, or maybe even in the upper leg. So, support those who have positive ideas and ignore the others! Let's get something good done, and soon.
1. Will the bill provide a way for a great number of uninsured working people and people who have worked in our economy to get affordable care if they are sick or injured?
2. Will the bill provide means and incentives for health care providers to reduce costs while maintaining or improving the quality of care?
3. Will the bill provide incentives for Americans to adopt more healthy lifestyles and to make informed choices about end of life care?
Every person who has honestly evaluated the American health care non-system understands that it is far too costly and far too inefficient. We need to make progress on solving these problems, or they will simply get worse. This will not be easy, and it may be incremental, but we must make progress. Anything else will be a major failure of government.
Both radical liberals and radical conservatives have staked out positions in opposition to major planks that will likely be in the final bill. Liberals who represent several major unions object to taxes on the high cost "Cadillac" health plans they've negotiated with employers. For example, they support the idea that teachers should be able to get four pair of new eyeglasses each year, for free. Conservatives in hock to the industry object to the idea that working people should not go bankrupt if they happen to get really sick and incur hundreds of thousands of dollars in doctor and hospital costs. Both groups are hindering progress toward a reasonable solution.
On balance, the conservatives have been most outrageous in their objections. If you listen to them, you soon realize that they never describe the problems with the system or suggest ways to solve them. They are almost 100% negative. Some believe (this is true!) that those unable to pay for hospital procedures shouldn't get them; "survival of the financially fittest" is their motto. Others, when asked why they object to health care reform, say they don't want to pay for illegal immigrant health care, something that is not in the bill. The absurdities go on and on...such as, "don't let the government get involved with my Medicare". In short, I only pay attention to those who seem concerned to improve America's health care, and I don't think those who focus only on negatives are interested in that at all.
I've been pretty close to the health care industry for the past 10 years, and I understand it a lot better than most Americans. Our system is broken; it must be fixed. If we don't make some real progress on reforming it, we have shot ourselves in the foot, or maybe even in the upper leg. So, support those who have positive ideas and ignore the others! Let's get something good done, and soon.
Friday, October 09, 2009
Thankfully, Youth Will Prevail
I visited an old friend in a nursing care facility today. I've been helping his family work out the financing for his extremely expensive care. (He's a great commercial for long term care insurance, since he didn't have any.) I've got nothing else to do in my spare time.
This eighty-something gentleman and I have been friends for more than 30 years. He's a staunch Rotarian and a pretty congenial guy, but he shows a strong strain of independence as a result of his upbringing on the sparcely populated and storm-tossed Atlantic coast of Maine. And, he is a radical conservative - almost anti-government - and clearly a right wing radio addict. I love him anyway.
Today I broke the news to him that Obama got the Peace Prize. He was horrified. He said that there's nothing about Obama that he can agree with. So, I pressed him on his views. "What is it, exactly, that you have against the president", I asked. After he responded, "Everything", I asked him what the big problem was. My friend then opened up. "I think he's a Muslim", he said. Well, that was all I needed to hear. Hopeless, this conversation.
American is cursed with an older generation who were in their 30's and 40's before integration was legal. A great number of them strugged hard to come out of the depression, and they got some pretty racist attitudes when they participated in the war. Limbaugh and Beck say things that resonate with them. And, sadly, these folks vote.
Amidst my sadness about this conversation I'm encouraged by Amercan demographics. Every year a lot more people who are not racists, who are not natually fearful of the "other", and who see the world as a small, shared place begin to vote. And people like my friend go on to whatever lies ahead for them. Progress is inexorable, and I'm thankful there's a good chance I'll live long enough to see the group of folks like my friend become an immaterial minority.
Postscript: If Obama is ever shown to be a Muslim, I'll try to walk across the Genessee River with an anvil in each hand. But it wouldn't matter to me if he was.
This eighty-something gentleman and I have been friends for more than 30 years. He's a staunch Rotarian and a pretty congenial guy, but he shows a strong strain of independence as a result of his upbringing on the sparcely populated and storm-tossed Atlantic coast of Maine. And, he is a radical conservative - almost anti-government - and clearly a right wing radio addict. I love him anyway.
Today I broke the news to him that Obama got the Peace Prize. He was horrified. He said that there's nothing about Obama that he can agree with. So, I pressed him on his views. "What is it, exactly, that you have against the president", I asked. After he responded, "Everything", I asked him what the big problem was. My friend then opened up. "I think he's a Muslim", he said. Well, that was all I needed to hear. Hopeless, this conversation.
American is cursed with an older generation who were in their 30's and 40's before integration was legal. A great number of them strugged hard to come out of the depression, and they got some pretty racist attitudes when they participated in the war. Limbaugh and Beck say things that resonate with them. And, sadly, these folks vote.
Amidst my sadness about this conversation I'm encouraged by Amercan demographics. Every year a lot more people who are not racists, who are not natually fearful of the "other", and who see the world as a small, shared place begin to vote. And people like my friend go on to whatever lies ahead for them. Progress is inexorable, and I'm thankful there's a good chance I'll live long enough to see the group of folks like my friend become an immaterial minority.
Postscript: If Obama is ever shown to be a Muslim, I'll try to walk across the Genessee River with an anvil in each hand. But it wouldn't matter to me if he was.
Obama and Rangel
I'm celebrating President Obama's being awarded the Nobel Peace Prize. It's surprising, but it's warranted. He's viewed as a person who, by virtue of his pursuit of reconciliation over confrontation, has dramatically changed the tenor of international relations. People everywhere yearn for those in power to take thoughtful and positive action when dealing with matters of life and death importance around the world. I don't doubt Obama's capability to use force when all other alternatives fail, but I believe his emphasis on respectful and honest negotiations sets a tone of hope for the future. If the award helps him to accomplish his agenda, it's a winner.
On the other hand, I'm bemoaning the democratic party's plodding investigation of Rep. Charlie Rangel, who deserves prompt censure for cheating on his tax reporting and other corrupt acts. Rangel represents one facet of the party's seedy side, the facet of entrenched politicians who feel their status entitles them to waivers of laws they enforce on other citizens. The only way for the party to keep the allegiance of many independent voters is to demonstrate its ability to hold accountable its wayward members. The Rangel debacle is doing a lot of damage.
Obama and Rangel. The new and the old. The world needs more of the former and less of the latter.
On the other hand, I'm bemoaning the democratic party's plodding investigation of Rep. Charlie Rangel, who deserves prompt censure for cheating on his tax reporting and other corrupt acts. Rangel represents one facet of the party's seedy side, the facet of entrenched politicians who feel their status entitles them to waivers of laws they enforce on other citizens. The only way for the party to keep the allegiance of many independent voters is to demonstrate its ability to hold accountable its wayward members. The Rangel debacle is doing a lot of damage.
Obama and Rangel. The new and the old. The world needs more of the former and less of the latter.
Tuesday, October 06, 2009
Another Printer Dies...Help Me!
I'm fed up with junk printers! In the past two years I've had to scrap a fairly expensive Brother wireless printer because the paper feed mechanism was balky, and more recently a Canon printer that seems to have a dead power supply. Both required expensive ink that didn't last long. I've got to get a new one, but my criteria have changed. I want a durable printer that uses ink in a miserly fashion!
These printers were my "downstairs" printers. I have a small desk in the family room where I park my laptop when it's not traveling with me. Good Witch asked me to get it so I'd not be disappeared into my "upstairs" office for protracted periods. Now I check email and Facebook, and do my blog, while she reads her book in the chair not far away. It's TOGETHERNESS! But I digress.
My upstairs printer is an old HP K80 that I've had forever and put to hard use. It is super durable and takes huge ink cartridges that I seldom replace. Of course, HP is not foolish enough to be making that version any more, but I'd buy another one except that it's too large for my tiny downstairs desk. I need a tidy, unobtrusive printer that won't ask me to replace ink every month or two.
Any suggestions, dear readers?
These printers were my "downstairs" printers. I have a small desk in the family room where I park my laptop when it's not traveling with me. Good Witch asked me to get it so I'd not be disappeared into my "upstairs" office for protracted periods. Now I check email and Facebook, and do my blog, while she reads her book in the chair not far away. It's TOGETHERNESS! But I digress.
My upstairs printer is an old HP K80 that I've had forever and put to hard use. It is super durable and takes huge ink cartridges that I seldom replace. Of course, HP is not foolish enough to be making that version any more, but I'd buy another one except that it's too large for my tiny downstairs desk. I need a tidy, unobtrusive printer that won't ask me to replace ink every month or two.
Any suggestions, dear readers?
Thursday, October 01, 2009
Afghanistan is a Losing Proposition
Obama is weighing his course of action in Afghanistan, but even he can't do the impossible, and that's what Afganistan is. I'm not for increasing troop strength there, and I'm probably for reducing it. It's a no-win situation.
Don't get me wrong. I sympathize with those many Afghan people, especially the young people and women, who've had a taste of modernity and individual rights. If we pull out, they suffer. But, if we stay in, we suffer too much. Maybe it's time to let Afghanistan work out its own future, whatever that is.
Al Queda is a danger to us, and the Taliban have harbored them. Therefore, the Taliban is our enemy and Al Queda can hide as guests among them. As a consequence, we can't just leave Afganistan. We've got to keep the pressure on them, make the lives of the bad guys miserable and always fearful until, if ever, they decide to be more accomodating to us. But we don't need to occupy the country to do that; we can operate from a fairly small footprint and keep casualties down. No nation-building. Search and destroy. I know this doesn't sound Christian, but these guys have stated their aims and self-defense is no sin. Biden is right.
Our generals want a big war. War is their thing; it's what they've trained for all their lives, and they want to be seen as being good at it. And they have lots of cheerleaders, especially the contractors who make fortunes providing the materials of war. Nuts to them! McChrystal may be a top-notch soldier, but we don't need to provide him a big war as his playpen.
Why am I so amadant about this? Two reasons. First, Afghanistan is just too big, too rough, and too backward to occupy and "win over". The cost of trying would be astronomical, and the American people would be right to conclude there are far better places to spend their money. Second, we can fight Al Queda without controlling Afghanistan. We can do it with drones and special forces based near Kabul and major population centers with plenty of guards. We don't need the casualties we'll get if we continue this pattern of making forays through the Taliban-dominated countryside.
It's hard to believe, but our greatest threat to the Taliban might be to decriminalize drugs in the U.S. Afghanistan is the largest producer of opium in the world, and we could take the profits out of their largest market in no time. That would deprive them of the revenue they use to buy weapons and pay their soldiers. I'm for that. Freedom for us (even freedom to rot some of our brains) and no money for them. I'm all for making fundamentalist Afghan boneheads penniless.
So, no more troops. No more grandiose plans for a girls school on every corner and paved roads everywhere. Just find a way to be really nasty to the bad guys and leave Afghanistan to work out its problems mostly on its own. Maybe give them cheap computers and free satellite internet, and let them figure out for if they want to be modern. In the meantime, wreak havoc on any kind of major Taliban facility or meeting center we can find. Perhaps they'll get as tired of hiding out as I'm tired of hearing about IED's and dead G.I.'s who died in a no-win war.
Don't get me wrong. I sympathize with those many Afghan people, especially the young people and women, who've had a taste of modernity and individual rights. If we pull out, they suffer. But, if we stay in, we suffer too much. Maybe it's time to let Afghanistan work out its own future, whatever that is.
Al Queda is a danger to us, and the Taliban have harbored them. Therefore, the Taliban is our enemy and Al Queda can hide as guests among them. As a consequence, we can't just leave Afganistan. We've got to keep the pressure on them, make the lives of the bad guys miserable and always fearful until, if ever, they decide to be more accomodating to us. But we don't need to occupy the country to do that; we can operate from a fairly small footprint and keep casualties down. No nation-building. Search and destroy. I know this doesn't sound Christian, but these guys have stated their aims and self-defense is no sin. Biden is right.
Our generals want a big war. War is their thing; it's what they've trained for all their lives, and they want to be seen as being good at it. And they have lots of cheerleaders, especially the contractors who make fortunes providing the materials of war. Nuts to them! McChrystal may be a top-notch soldier, but we don't need to provide him a big war as his playpen.
Why am I so amadant about this? Two reasons. First, Afghanistan is just too big, too rough, and too backward to occupy and "win over". The cost of trying would be astronomical, and the American people would be right to conclude there are far better places to spend their money. Second, we can fight Al Queda without controlling Afghanistan. We can do it with drones and special forces based near Kabul and major population centers with plenty of guards. We don't need the casualties we'll get if we continue this pattern of making forays through the Taliban-dominated countryside.
It's hard to believe, but our greatest threat to the Taliban might be to decriminalize drugs in the U.S. Afghanistan is the largest producer of opium in the world, and we could take the profits out of their largest market in no time. That would deprive them of the revenue they use to buy weapons and pay their soldiers. I'm for that. Freedom for us (even freedom to rot some of our brains) and no money for them. I'm all for making fundamentalist Afghan boneheads penniless.
So, no more troops. No more grandiose plans for a girls school on every corner and paved roads everywhere. Just find a way to be really nasty to the bad guys and leave Afghanistan to work out its problems mostly on its own. Maybe give them cheap computers and free satellite internet, and let them figure out for if they want to be modern. In the meantime, wreak havoc on any kind of major Taliban facility or meeting center we can find. Perhaps they'll get as tired of hiding out as I'm tired of hearing about IED's and dead G.I.'s who died in a no-win war.
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