health care-bottom line

Okay, so let me put in my two cents reagrding health care. The bottom line is the cost to provide prompt quality care to every American is too expensive. Although I believe this would be a reasonable way to spend our national treasure, to extend the lives of the people who generate the treasure, the cost would eat up a major portion of the GDP. To avail everybody of all the technological advances and heroic treatments available would be cost prohibitive. So what is the solution to provide universal care to all Americans? By the way, guaranteeing insurance to people does not guarantee care as there may not be a doctor who accepts your insurance.
The end game has to be a two tier system as exists in other countries. A public and a private system. Everybody will obtain a package of insurance that provides basic care. That insurance may be from an insurance company or more likely from the government. Most likely it will not be profitable enough for an insurance company to participate. The availabilty of that care will be depend on reimbursements to providers. If it acceptable then people will be seen and treated promptly. However, the more likely scenario is if payment to providers is poor then as in other countries access to a doctor, obtaining tests and receiving operations will be delayed and waiting lists will be the norm. Most doctors offices, radiological facilities, hospitals, are for profit businesses. If profit is no longer possible or too low then the availability of those services will decrease. This will generate a second tier of private medicine where a person can see a doctor or get a test promptly for direct payment. This second tier is profitable to the provider/owner and will be provided promptly. There may be an insurance policy for this second tier of healthcare.
I see a system where a doctor spends some time in a public clinic seeing patients in the basic tiered insurance and then has another private office where he sees his private patients. The public clinic could be located in the hospital because the doc will not be able to or want to pay rent to see poorly reimbursable patients. The office hours will be limited and the number of patients limited resulting in waiting lists.
To avoid runaway healthcare costs and keep the expense neutral the solution is either to maintain current reimbursements and volume of patients thus rationing care as more volume comes online (more patients in the system). Alternatively, to increase the volume at lower reimbursements resulting in waiting lists (as described above) which also rations care by default. In either case care will be rationed. By including everybody, by necessity, access will be reduced. Only those that can afford it will obtain immediate access to healthcare. Universal coverage is a noble goal, but don't expect the access to care which that coverage provides to remain what it is today.

Rush

It seems that Obama-Pelosi are implementing the strategy I discussed in a previous entry, although I intended for the republicans to use it. Their strategy is to select the standard bearer for the republicans and portray him as the leader of the party. By selecting Rush Limbaugh they have picked an idealogue who is a very polarizing character. You either love him or hate him, strongly agree or think he is a nut job. He in not a politician trying to be inclusive of as many followers as possible. He believes in a certain ideology and sticks with it. Unfortunately, this is not a recipe for a succesful politician but is for a radio talk show host. His concern is a loyal audience, not necessarily to appeal to the masses. So if he alienates some, that is fine as long as his ratings remain strong. By selecting him, the democrats have elevated Rush, and are thus attempting to distance many moderates from the republican party.
This game is effective and should be played both ways. Nancy Pelosi is an idealogue as well, and is a polarizing figure in her own right. In addition, she is the speaker of the house which makes her more naturally the spokesperson for her party. Alot more reasonable than selecting a nonpolitician, radio talk show host as the spokesperson. The republicans must focus on her and demonstrate how she is shaping the democratic party and the current agenda. This is not a falsehood but actually the truth. The republicans have no shot at this time trying to bring down Obama. He is too smart, charismatic, and loquacious with too much mass appeal. They must portray the dems as a far left party under the leadership of Pelosi, with Obama just following her lead, allowing her to shape policy, and marketing her ideas. The more we see Pelosi the worse it will be for the dems.
I just hope the republicans figure this out before Obama does. If Obama was smart he would distance himself from the far left wing of the party. He should demonstrably go against the policies of Pelosi. This would enable him to capture the moderates of both parties and ensure his popularity as a mainstream politician.

disingenuous

There is no justification for the wreckless fiscal policy of the Bush administration especially since it was done under the banner of conservatism. His policies have given the democrats tremendous power and freedom to enact far reaching legislation under the rationalization that the conservative principles of the Bush administration were a failure. The truth is that on the spending side, the Bush administration was a failure and was far from fiscal conservatism. On the other side, the revenue aspect, the last eight years were a remarkable success. Every year the revenues taken in by the treasury far exceeded the projections and this was due to his tax policy. The tax cuts implemented by Bush strongly stimulated the economy resulting in the strong inflow of taxes.
Having said that, I must say that Obama-Pelosi and the democrats are completely disingenuous. They basically say that the economy is in the current state due to the the policies of Bush and his tax policy. This is a blatant lie and Obama-Pelosi are intentionally, with full knowledge perpetuating a lie in order to advance their agenda and reverse the Bush policies.
The state of the economy has nothing to do with the Bush tax cuts and is purely due to the deleveraging that is occurring as credit is reduced and the housing market corrects. An unfortunate excess of the economic cycle perpetuated by lack of adequate oversight and the credit frenzy perpetuated by both parties.
To lie to the American people and say the economy is in the condition it is in due to Bush's tax policy is misleading and disingenuous. I believe that the proposed tax increases will further handicap the economy as the redistribution of wealth continues. Somehow I think Obama understands this. He is too bright not to see the evidence of the revenue stream brought in by the last administration. He has to be more about Obama and not Obama-Pelosi. I think with time he will move away from the far left Pelosi crowd towards the center and use tax policy to stimulate the economy.

Obama-Pelosi, Obama-Pelosi, Obama-Pelosi

After watching the speech Tuesday night by Barack Obama I must say he is a teriffic orator and a wonderful salesman for the policies of the democrats. He speaks beautifully, with great clarity and gives the listener the sense that he is talking directly to them. He is, in fact, the pitch man for the democratic agenda and is able to persuade listeners to agree with his plans, a talent that is highly valuable to democrats. It is critical to look past the messenger and look at the message.
In contrast, our last president was the exact opposite, unable to sell his program to the American people. His poor communication skills led people to question him, his intelligence, and his policies. This demonstrates the importance of charisma, appeal, and TV presence in the marketing of ideas and policies. The truth is, those skills are a talent like any other and really do not correlate with intelligence. Many people in history were able to coerce the populace through language but later tuned out disastrous. Obama is not necessarily more intelligent than Bush or a better leader than Bush solely due to his oratory skills.
In contrast, there is no one that turns me off quite as much as Nancy Pelosi. She comes off as extremely arrogant and one who memorizes talking points with very little depth. Now I dont know if this actually the case but this is her TV personae. This is how she comes off on television, similar to the robotic personality that Al Gore portrayed.
I think a great strategy for the republicans would be to tie Obama to Pelosi as much as possible. They should always address the democratic agenda as the Obama-Pelosi plan. This is exactly what the democrats did to Mccain in the election by always referring to his plan as the Mccain-Bush agenda. Regardless of the veracity of this tie, it was effective. I believe it would be effective against the democrats as well.
Sadly, we as voters care more about appearances than substance. We are too lazy to explore deeper than the most superficial layers. At best we listen to short sound bites rather than to take the time to understand complex issues. We put more imporatance on how someone looks or sounds rather than the content of what they are saying. This is why politics has become more of a marketing battle rather than a true debate on the issues.

pilots and doctors

I have been reading the reaction of Chesley (Sulley) Sulenberger regarding the financial situation of pilots. Sulley is the pilot from US Air that landed in the Hudson River a few weeks ago saving many people. I remember when he was interviewed right afterwards he mentioned that many hours of experience prepared him for that one moment. I was impressed how bright and eloquent he is. He is surely a treasured product of this country. This country through its educational and military structure has produced such a wonderful yet humble man. I believe as a young man he could have done anything with his life.
Recently he has been commenting on the fact that due to the financial situation of pilots, specifically, the decreasing renumeration, the many hours on the job, etc., it will be dificult to attract future pilots with the similar skills and experience. This will cause a more dangerous and risky environment in which to fly in the years to come. Perhaps the disaster that occurred two weeks later in Buffalo is an example of this situation.
I couldnt't help but notice the comparison to the medical field. I have noticed that the smartest kids are not pursuing medical carreers like in the past. They have figured out that the duration of training, the cost of the education, and the lost opportunities while training make it a poor choice. Additionally, the hassle of the insurance companies, the crazy lopsided malpractice environment, the overwhelming number of hours at work, and ultimately the declining income of doctors have steered the best and brightest away from medicine. This will ultimately lead to a lesser quality doctor although this will take time as the well trained doctors slowly retire. But be sure that down the road we will all pay a price by cutting the quality of our doctors. When some of us will require emergency surgery who do we want operating on us? The mediocre student who just got by through medical school, or the Sulley of medicine who was the best and brightest.
If we want the best pilots and doctors we must create incentives for young adults who are exeptional to enter these fields. Instead, where are the incentives now? to go to a hedge fund to try and strike it rich, or to go to law school to worsen our already litiginous society and produce nothing except jackpot judgements. We must make the right choice, it is a matter of life and death.

as goes california so goes the nation

I have always been under the opinion that what happens in California fortells what will happen in the the country in general. Culturally, trends often start in California such as fashion and media. Trends in health care such as the rise of HMOs started in California. Legal issues such as gay marriage began in the golden state. It has always been on the cusp of future developments.
This is very depressing considering what California is going through at this time. Its financial situation is essentially bankrupt. The government has spent or committed to spend more money than it has or could possibly raise through taxes and fees. The government of California has made the mistake of deciding that it is the governments role to fix the problems that effect society. This has exploded the demand for government services for which it is unable to keep up. They are in a viscious cycle where to obtain more revenue the taxes are raised which leads to an exiting of business and actually a reduction in the state's revenue, the opposite of what was intended. The loss of businesses leads to higher unemployment and more demand on government services which requires additional funds. And round and round the cycle goes.
It already appears that more states are heading into this cycle. My home state of New Jersey continues to work with defecits and cannot live within its means. The system is broken and the only way to break the cycle is to have elected politicians who will tell the people the truth that they cannot afford to spend beyond their means. They must drastically reduce their committments and must reduce the size of government. Tough choices need to be made and we must have the stomach for it. Many companies are currently going through these same problems and they must reduce their expenses or else go bankrupt. Similarly, government must do it as well. Trying to raise revenue will only exacerbate the problem.
I am pessimistic that leaders will be elected that will enact these tough choices. Too many people depend on government for welfare, food stamps, health care, and pay checks. Such people will never elect a person that will cut off their benefits. We have tipped over to the point where too many people are government dependents and their votes have been bought. They will only vote for the party and candidate that continues their benefits.
Maybe the quicker California can descend into the abyss, the quicker it can demonstrate to the country how to rebound with proper policy.

religion and longevity

I heard on the radio an interesting study. Those who attend a religious service once per week live on average seven years longer than those that do not. What is it about attending a church, synagogue or mosque that provides this life extension. Well, those with faith believe it is the hands of the divine that provide this benefit. But to a nonbeliever or one trained in the scientific method that answer just doesn't hold up.
Perhaps it is the security of believing that everything which occurs, whether good or bad, has a purpose. This purpose may not be understandable to man but an all knowing being is in control and is working behind the scene. This belief can be very calming and relieve significant stress during difficult periods of ones life and this may translate into longevity.
Perhaps it is the sense of community that often goes along with attendance at a religious service that is the key. The knowledge that their is a group of friends to help you when necessary. To be there for you during times of joy and times of sadness. To give advice when necessary or to help each other with raising children or taking care of an elderly parent. To provide for a divorcee or a widow or someone who has recently lost a job. The community is there financially and socially. It gives people a purpose when perhaps they feel they have no other. An elderly person has a place to go, a place to make friends and converse, a place to be able to contribute. It give people a sense of fulfillment when perhaps nothing else in their life could. It allows people to feel they are not alone.
I am a person who struggles with my faith in the divine. But I do believe that there are benefits to living a life that includes attendance at a religious service. I feel that when I am there, a lot of the daily stresses of life are reduced. It helps to listen to my clergyman discuss the bible and how that can translate into lessons for my own life. It helps me to become a better person to my family, coworkers and clients. If it translates into a longer and healthier life so much the better.
It is a shame that some people avoid or dismiss religion under the assumption that there is no divine entity. There are so many benefits to attending a religious service, an absolute belief should not be a pre-requisite for anyone. If more people attended religious services there would be less mental illness, less criminal activity, less drug use and better health. So join a church a synagogue or a mosque and give it a chance. Who knows? you may get a few years out of it