Thursday, September 29, 2005

Health Care Story

I met an interesting man the other night. I decided to go to the restaurant bar where I stay in the Silicon Valley for a glass of wine and dinner, while watching the news. No sooner had I settled in to watch the news, when my neighbor on the next stool decided he wanted to strike up a conversation. It was only a bit of a conversation – he talked, I listened. He was an older fellow (80 years old it turned out), who was living at the motel for awhile. He had come from Hawaii to take care of getting health insurance for his wife from his union. Therefore, he was kind of “between homes” at the moment. He was originally from the area, so was not a stranger in town.
As his health story unfolded it became clear that he had some chronic problems that needed to be fixed. He has cataracts and needed the second eye to be repaired (the first had been successfully fixed some time ago). He also had an ongoing problem with swallowing, something about his throat needing to be “opened up” to allow him to swallow solid food – he appeared to be drinking his dinner so that problem wasn’t interfering with him that night. He had some other on-going problem which I can’t seem to recall at this time. Whatever it was, it was a minor irritation rather than a real health problem.
He was telling me how great his insurance was. He had a combination of medical and union insurance which took care of his health care needs. That sounded pretty good. Then he told me his plans for the weekend. He was going to enter the hospital by going through the emergency room. He complained that it has become harder to get in that way, you can only do it with a call to 911. So he plans on calling 911 on Friday evening, and take an ambulance to the hospital. He could easily walk in, but they don’t allow it so he will ride in instead. Once there, he knows that they will be too busy to take care of him on the weekend, so he plans on staying there until they can get to him on Tuesday or Wednesday, which will save him five or six days of living expense at the motel!!! Then he figures they will take care of his eye, his throat and whatever else he has wrong and that will be that. Since he has medical, all of his expenses will be covered by the State and he will save five days living expenses by staying at the hospital. Not only that, but the nurses will take care of him and change his bed for him.
I thought this was a very telling story. And we wonder why we can’t seem to afford to take care of the medical needs of Americans. What an amazing abuse of the system, and what a huge waste of money and resources. I am not sure that his plans will all work out, but it was clear from his stories that this is his normal approach to health care, and that he had no concept that there was anything wrong or unusual about it. It seems that his approach is the common approach among the people that he knows. I asked him why he didn’t take the route of going to a doctor and setting up a normal appointment for these things. He said that it would take far too long to get treatment that way. He would have to do it three different times, which could take months (or years) because of the delays associated with getting treatment for such things. His approach gets it all taken care of at once in less than a week.
I don’t exactly know what to do or say about this, but I found it to be interesting, and disturbing.

Tuesday, September 20, 2005

The impoverishment of America

Am I just imagining things, or is America sliding away from the “American Dream”?
It seems to me that we are gradually losing the things that we have been fighting over the past couple of centuries.  One thing that seems to be going away is the dream that if we work hard enough we can pick ourselves up by our boot straps.  That is clearly possible for some, but it seems to be impossible for larger and larger segments of our society.  What appears to be happening is that the rich are getting richer and the poor are getting poorer, and that trend is accelerating.  I seem to have somehow or another fallen on the “getting better” side of the curve, but I know that I am the exception rather than the rule. I have never expected the poor to get rich, but it seems like many are falling further and further into poverty – losing their ability to have reasonable homes, food, education and health care.  It has been going on for so long that I have lost faith that it will, or can, get better.
It also looks like the entire country is little by little becoming more and more impoverished.  The roads are decaying, the schools are falling apart, and levees are not kept up and maintained.  In general, much of our public infrastructure seems to be collapsing because of inadequate maintenance.  Luckily, we did a great job of building these things in the first place; otherwise they would be decaying at a far faster rate.  I am noticing more and more things being put off or left undone.  For example, a couple of years ago when a car went off of the freeway and through the fence, the fence would be repaired in a couple of days.  I am now watching holes through the fences that have been there for more than six months, and the numbers of them keep growing because of new accidents.  Obviously, there is not enough money to fix them like we did just a couple of years ago.  This problem of lack of repair and upkeep can be found in most (maybe all) government owned facilities.  We seem to be living off of the hard work of the last generation, not our current efforts.
Our health care crisis is a symptom of this impoverishment.  We used to have one of the best health care systems in the world.  Now we seem to be somewhere near the bottom of the “first world” countries. Maybe it has gotten even worse than that.  Apparently we have millions of citizens who go without healthcare until their problems become true emergencies, when medical care becomes much more expensive and much less likely to be successful.  I am sure that there are millions who should have health care but don’t get it at all because it is not available to them.  Then there is that big (but rapidly shrinking) middle class that spends a huge portion of their income on health care.   We are getting far less service for a much larger percentage of our income.  
Our education system is another example of this deterioration.  When I went to school, America was known as having one of the best, and possible the best, education system in the world.  California was at the top in the nation.  Now California is somewhere near 48th from the top, and the nation as a whole has dropped to be towards the bottom of the developed countries.  We have move from being the leaders in education to barely being the followers.  I don’t think it is because of a lack of will, I don’t think we can afford to lead any longer (I also don’t think we can afford not to).  California is getting what it pays for. The amount that we pay per student is about 48th from the top, and we get results that align up pretty well with our spending.  I hear people say that we spend too much for education because we spend half of the State’s budget on it.  That doesn’t mean we spend too much on education, it means we spend too little overall.  We are not spending enough to keep up because we can’t afford to do more.
We consider ourselves to be very generous in helping the rest of the world, especially the poor and hungry.  If that is true, how come we are among the bottom of those contributing to world causes?  We seem to be spending about a tenth (per capita) as other developed countries. I don’t think it is because we are stingy and don’t want to contribute our fair share, I don’t think we can afford to do more.  We can’t even take care of our own, more or less those in other countries.  We are very generous at providing bombs and such to a few countries, and in trying to figure out how to repair the damage that those bombs did.  It would be far better to have used the last 200 billion dollars or so for taking care of business, rather than destruction.  We simply cannot afford to squander our resources on efforts such as the Iraq mess.  (It is clear that this money was squandered, there was no requirement to use the approach that we did.   There were many other much less expansive and less destructive approaches that could have been used but were not even tried.)
Not only do we seem to be losing ground rapidly in the realm of individual and government wealth, but we seem to be losing ground in social areas.  We are becoming meaner to each other and others in the world.  Rather than being open and caring, we seem to becoming selfish and prejudiced.  We would rather give up our freedoms so that we can invade other’s privacy than to just let other people be.  Our country seems to have taken the point of view that people who are different are “bad” and bad people need to be punished and forced to be like we want them to be. (I am not saying that we all do that – I personally try to avoid it.  I am talking about the majority and the government.  I think it is important to think of what our government does as being our will, it is not something that they do, it is something that we do, or we let happen.)
We seem to have exchanged our generally positive world view as being “the good guys” for one of being pushy, mean spirited, greedy and more of a problem than a solution.  In the terms used by our current President, it feels like we are using up our political capital.  We used to be the country and government that was looked up to as the goal.  Now we are shunned as the enemy.  We simply cannot continue on that path without paying the price that is inevitable.  We need to be viewed as a friend, not as an enemy or a problem by our peers.  
In addition to all of this, we are using up our natural resources rather than taking care of them.  We are trying to pump the last bits of oil out of our country rather than moving quickly toward alternatives and conservation.  It feels like the big oil folks are afraid that we really will find ways to get by without using up every last ounce of oil and that they will then end up missing an opportunity to sell all of the oil.  We are treating our forests and water in similar fashion.  We are hell bent on getting every dollar out of our resources as soon as possible, rather than looking at them from the long term prospective.  Our concern for the environment seems to be decreasing in step with our inability to pay for the other things that we need to be taking care of. Maybe it isn’t that we don’t care any longer, maybe we just can’t afford to take care of it any longer.

Wednesday, September 14, 2005

Under God

I was listening to KGO radio today and heard that once again the issue of whether or not the phrase "under God" as in "one nation, under God" belongs in our pledge of allegiance. It was really a two part question. Part 1 was, "does it belong in the pledge?" Part 2 was, "if it does not belong there, is it worth the effort to try to remove it?"
I think that it is clear that the answer to the first part is that it does not belong there. The "God" being referred to is clearly a Christian god and if it is a Christian god, then having it in a pledge that is recited in public schools seems to be a clear violation of the separation of church and state. Even if it turns out that "God" does not refer to a specific religion (which is really a stretch since it is so clearly intended to mean Christianity), there is no reason for it to be included in the pledge. It was only put there in 1954 as a response to the "Godless" communist party of the USSR. The pledge was not enhanced by the addition of the phrase.
Now the question of whether or not it is important enough to fight to have it removed. My first feeling on the subject is that it really doesn’t make much difference. Other then when I had to relearn the pledge to include this phrase, it hasn’t really made much difference to me. However, that is probably because at some level I have always been a Christian so didn’t even really notice that it was there. However, as I have become clearer on the subject over the past years, it has become clear that it was put there for religious reasons in direct conflict with the constitution. It makes no difference that the word God is used in other government activities such as swearing in ceremonies or on our money. I think those are also in conflict with the constitution, but that is another issue altogether.
As I listen to the conservative, religious folks about this issue it is very clear that to them it is a powerfully important issue. Obviously it is not just a couple of words, it has deep meaning to them, which is exactly the reason why it is worthwhile fighting it. Since they respond with such anger and panic, it is clear that they feel that it is indeed a religious message. I wonder what this could mean. It appears that it means that those folks take it to mean that the country is special because their God is in support of the country – meaning that we have a religious superiority to other countries that do not have this special relationship with God (the Christian god that is).
I have become convinced that many (or possible most) of the problems with the country are directly the result of Christian religion weaseling its way into our politics. The source of many of the inhumane and "unloving" actions of the USA seem to be created by the feeling that the Christian point of view must be upheld by governmental actions and laws.
My personal feelings are that the government should not support any religion in any way, including providing tax exemptions to religious organizations. They should stand on their own and not be supported by taxes. As a minimum, tax exemptions should not be given to any organizations that are involved in any way with politics. Any political activity should result in the losing their tax-exempt status. I think it would be better to just not give these exemptions.

Sunday, September 11, 2005

Suspension of the Davis-Bacon Act

I hear that Bush suspended the Davis-Bacon act in the hurricane hit areas. The Davis-Bacon Act, passed in 1931 during the Great Depression, sets a minimum pay scale for workers on federal contracts by requiring
contractors to pay the prevailing or average pay in the region. Suspension of the act will allow contractors to pay lower wages.

It sure sounds fishy to me. What in the world is he up to now? What will the effects of this be? I really can't quite figure it all out. The only thing that makes sense to me is that the Republicians have opposed the act since it was begun, and this is a chance to knock it down. Is it an attempt to support big business while taking money from the workers? Will they now be forced to bid using the prevailing wages, but then be able to pay whatever they want?

However, I kind of wonder about the Davis-Bacon act in the first place. I can't really understand why it was ever needed. I guess the point must have been to prevent contractors from bring in cheap labor to high labor areas (for example, using labor from Louisiana to work on jobs in San Francisco). Now it seems to be turned upside down. Will contractors be able to find a workforce that will work for less than the prevailing wage in the area? If they do find such a workforce from the area, this seems to mean that the prevailing wage in the area fell to whatever they paid. I doubt that they can find a workforce in the States that would work for less. I guess the only thing that makes sense is that the contractors don't want to use the local labor, they want to import Mexicans who will do the work for far less. If this is true, sounds like Bush is trying to set it up so the contractors can outsource their labor to another country instead of using those folks who are already there.I guess it is really an effort to allow the use of non-labor workers. If that is the case, I am not at all sure what I think of it. I am not too much in love with organized labor, so don't know if I should be for it or against it. I am certainly against the idea of bring labor in from the outside instead of using the labor that is already there. However, maybe there isn't enough labor there to do they job - in which case they will have to import it from somewhere.

I woke up this morning wondering about a very similar issue. I keep hearing calls for people to donate their time and go help out in New Orleans. One of the organizations said that they need 40,000 more volunteers. I am wondering what this is all about. It seems to me that they have 100,000 or more displaced people who would love to have something to do. Is there some reason that they can't be their own volunteers? Bringing in 40,000 more people will mean finding places for them to stay, food for them to eat, etc. I don't know if these volunteers get paid too. In any case, if they can find food and housing for 40,000 more volunteers, why in the world are they not using what they already have? It somehow sounds like the displaced folks are injuried, stupid, or somehow incapable of helping. They need to be helped instead. Does this make sense?

Friday, September 9, 2005

The Next Election

I have been watching the events of the past week and am slowly coming to the realization that the administration is turning this whole mess into a political windfall. W is showing great compassion and is getting a chance to look very "Presidentual" at his press conferences. Nevermind that he is in large measure responsible for the total chaos that followed the levee breaks.

Putting that aside for the time being, I am wondering what changes are going to occur to bring the "liberals" (my side of the isle I think) back into graces with the majority of the population. As it stands, I haven't seen anything or anyone that looks appealing or shows strong leadership. We (the liberals that is) seem to be caught in a moras of self-pity and inaction, probably created by fear.

I keep hearing that the only way to "win" is to move "toward the center" - in other words to adopt more conservative positions. This is making less and less sense to me the more that I think about it. I think we are already at the center. We are at the place that makes sense and will work. Any further movement to the right just moves the center of the entire spectrum of choices further to the right and continues the mess that we are currently caught in.

I think out biggest problem is that we don't seem to have a position. The Democrat leaders seem to be hunting for votes, hunting for polls and trying to find what is going to be there position from looking "out there" rather than in their hearts. Personally, I am not interested in voting for someone who is playing at being a liberal so they can get elected. I am interested in voting for people who are liberals in their heart and are willing to take chances for their beliefs. Enough of the wishy-washy approach to politics.

I think it is time for the liberal politicians (and citizens) to be brave enough to voice clearly what they believe in. Let the polls and votes do what they do. If we never have the guts to say what we believe we will never know if it is supported by the majority or not. I would much rather lose the battle but present good, clear arguments expressing our point of view than win (or most likely lose) the battle by putting on the clothing of a conservative.

We need to have the guts to say that we are trying to reach equality for all. That we are trying to make sure that everyone has adequate shelter, healthcare, food and education. That we want to be friends and partners with the other countries of the world. That we want to help where we can help, locally and internationally. That we want to do what we can to protect the environment by caring for our land, getting us off of the petrochemical orgy, caring for our forests, caring for wildlife and plants, and our neighborhoods. We want to root out and destroy corruption in our politics. We want to reduce the power of big business over us. We want to tax the rich more than we want to tax the poor. We want good jobs for everyone and a chicken in every pot. We need to be in support of women's rights, the right to choice, the right to marry whoever we want to marry (in the governmental sense, not necessarily the religious sense). We want religion out of politics - completely! (Personally, I want to eliminate all tax breaks for religious organizations. Maybe something for their truly humanitian efforts, but nothing for their religious teachings.) We want to stop the control of politics by big money. We want to stop, or at least minize, the system where those who give a lot to election funding get a lot in return later on.

I am not quite sure what belongs on the list, or how long it would get, but I think you get my point. We need a bunch of clear "planks" to our position and those should be plainly stated. No hedging or beating around the bush. No trying to expess it in terms that might confuse those on the other side enough to vote for us even though they don't agree. It has to be clear enough that there is no question about the positions being expressed. If that isn't good enough to win, then at least we lost with dignity. As it is, the entire process is an embarrassed and I am getting sick and tired of being embarrassed by politicians who claim to support the ideas that I believe in, but then mush up the message so much that nobody could support their position (including me).

It is time to stand up and be counted, to be clear and to be proud of the positions that we believe in.

Thursday, September 8, 2005

New Orleans

Has any besides myself begun to wonder what in the world is happening in New Orleans? There seems to be a steady stream of news about private citizens offering huge amounts of support and goods (food, water, gasoline, shelter, communication systems, medical support, medicines, boats for evacuation, transportation out of there, etc.) which keeps getting turned down by the powers that are in "control" of the situation. I am beginning to wonder how there could be that much incompetence on such a large and ongoing scale. I understand that nobody was prepared (although they should have been), and that there is a great deal of confusion (once again, a bit of planning would have helped), but I don't understand the refusal to accept aid when it is right there at hand.

I am finding it impossible to convince myself that it is all just because of stupidity. It is beginning to look that there is something more, something political, going on. One possibility is that the ones in control (FEMA??) are using this as a power play to get more funding, more power and to show how important their functions are. If the private sector (citizens, charitable organizations and businesses) can do what is needed to respond to the emergency, then it is obviously not so important that the big government bureaucracies be in place to do that.

I have no actual information about what is going on and why it is so bad, but I am getting suspicious that politics has gotten in the middle of the relief effort. If so, that is really a terrible thing. It adds fuel to the question of who is the government supporting - us or them?

Stop the blame game

I keep hearing from the local governments and the feds that we should stop "playing the blame game" concerning Katrina.

Why in the world would we want to do that? Of course the folks who might be to blame would like everyone to stop trying to find out who is at fault. If we stop doing this for long enough we are likely to get distracted by another event of some sort (or just forget about it) so nobody has to take responsibility.

I think it is very important right now to keep researching who is at fault. I don't see how this is interfering with the rescue and emergency procedures. However, right now is when the evidence if on the surface and we might actually be able to figure out what happened (and is happening), rather than wait until things have been smoothed over (and possibly hidden). This is a great time to figure out who is responsible for what.

One of the reasons that we might want to play the blame game right now is that some of the folks who are to blame are still in positions of authority. If they are to blame because they are incapable of doing the job, we better find that out, get them out and replace them with folks who are capable of doing the job. It is totally stupid to avoid looking at this while it is going on if it means leaving incompetent people in charge - we are not yet finished with the work.

Thursday, September 1, 2005

Universal Health Care in America

A conversation came up at a birthday party this weekend concerning "Universal Health Care in America". It strikes me that there is enough confusion about this that it is an easy mark to shot down rather than support. It seems that it isn't clear what this means. For example, Bush and company refer to it as the ability for everyone to have access to health insurance (I think this means that if you can afford the insurance you should be able to get it - which is actually an advancement from the current situation). I think it means that everyone can get health care, and nobody needs insurance. All citizens get health care just by being a citizen (and maybe something to do with some of the folks who are legally here from other countries). The government pays the bills, and the money comes from taxes.

My understanding is that this can be done cheaper than we are now doing using insurance. The extra overhead in the insurance approach more than offsets the extra cost that we would have because of additional people getting health care. The overall cost that has to be paid goes down, not up. I don't think we will all get a break. Some of us, such as myself, will end up paying more in taxes to offset what we are now paying to the insurance companies. The big advantage is that if a big, expensive medical thing happens to someone in my family it won't bankrupt me. Basically, it would give me better high end coverage than I can currently obtain. The low end people who can't afford health insurance will still not have to pay much, or anything, because they also don't pay much or anything in taxes. The advantage is that they will be able to get lower cost care at a doctor's office, rather than very expensive care at emergency rooms.

I don't think it necessarily means going to a government run health care system. The current approach to giving care can stay pretty much like it is. A mix of private and government hospitals, and private doctors. HMOs and PPOs would be a thing of the past, so some of the artificial organizations that have come about in the past decade or so will probably go away and go back to what they were before the insurance companies forced the doctors and hospitals to join into groups based upon the type of insurance plans they will accept.

In summary, it could be a single payer system, but not a government run health care system.

Oh yes, it would still be possible to purchase medical insurance for certain types of "extra" care (maybe better rooms, maybe some types of elective procedures, etc). This is done in other countries and seems to work just fine. The extra usually seems to be quite inexpensive and allows a little increase from a basic level of care.

I think those who believe that we need to provide healthcare for everyone need to get clear about what is meant. Most of the arguments that I hear about the proposal are centered upon people's fears of what would happen if the government ran the health care facilities. I agree with those fears, I think it would likely be a terrible mess. However, that isn't necessarily the way that it would get implemented. I think we can have the same (or better) health care facilities, using the system that we used to have here (before the times of "managed" - or mangled - care), it would just be funded differently.

There are lots of other costs that would go down with this approach, especially the health care insurance issues that are charged multiple times but only paid once. For example, health care is a large portion of automobile insurance, worker's compensation insurance, business insurance, and others. If health care was provided regardless of the cause, then that portion of the expenses could be removed from all of the other insurance plans.

This whole approach would give business a much needed relief from the pressures and costs of insurance, and would increase the level of care to our citizens. I think it is an idea that is way past the time to implement it. I am personally embarrassed to have the type of health care mess that we currently have. It is one of many deep embarrassment that I have about America (such as our sterling response to Katrina).