10 December 2009
Hey, Republicans! Try This One!
Hey all you nay-saying, fumbling opponents to a single-payer health insurance system, you might have come up with your own plan, but I guess when you say you are not "pro-choice", that does mean in everything, eh. Okay, instead of being dead serious, I'll just be serious on this topic and suggest there is at least one other way to reform our national health system. Read on. . . .that means you Democratic senators who cannot commit to an position if it is right in front of your face, blocking your re-election views.
From my perspective of almost 30 years of auditing and management consulting in the patient care institutional settings, I believe that hospitals and clinics should consider a different approach to recording and accounting for patient care revenues, contractual adjustments, accounts receivables and bad debt write-offs.
The first step to change the current, ubiquitous approach for patient receivables would be to stop the Admissions practice of having the patients agree to be financially responsible for all charges related to their care. Especially because 1) most patients do not have the financial resources to pay cash or the debt access [thanks, banks!] to pay the tab, 2) the uncertainties of the upcoming changes in health care insurance from both federal and state governments, and 3) the possible continuing, arcane, cost accounting policies that differ among non-profit, governmental and for-profit insurers, to require the patient to assume an unknown financial burden seems moot, at best, bad business at worst.
The admitting institution should have full financial responsibility because it has to bring in enough revenue to cover at least its direct and indirect costs to remain in business.
Normal purchasing by individuals is a decision made by price, perceived quality of product or service, and, with services, a comprehensive knowledge of what is being bought at point of sale. Price lists would help to choose among providers. I have yet to see human health care priced to allow for the patient to decide between providers, or, once admitted, whether to incur the costs entailed in further pathology interventions available, or to expect to have tiered, treatment decisions that incorporate incremental costs that may be chargeable to the patient as part of the often available consent discussions presented to patients prior to various treatment protocols. [As a side note, I doubt whether patients have the information and knowledge to make an informed, conscious decision whether to agree or not to agree to the content of existing, informed consent forms.]
The other health care system in the US is veterinary practice. I know when I take my dog to his veterinary clinic how much an office visit, a procedure and, if needed, boarding, will cost--barring unforeseen issues. I also have opportunities to decide whether to put my pet through a procedure because of possible quality of life effects as well as because of price. We could argue about the difference in the emotional environment of such a decision, but how many patients are willing to bankrupt their families to live a few months more? *
I believe that hospitals and clinics should bill their costs of treatment and care plus all other charges from physicians, pharmacy, ancillary and others) directly to whatever insurance entity is applicable to a given patient and to whichever research grant or beneficiary fund is appropriate, if appropriate. Further, any billing sent to the patient should be net of any contractual allowances and other write-downs the institution makes. Such a procedure could result in the patient receiving one bill for the entire care and treatment services (including any ED, physician professional fees, ancillary charges and pharmacy) for illustration sake, of $5,000 instead of $190,000. The patient would receive one bill, from the hospital only. The hospital would be responsible for remitting professional fees that now are billed separately to the patient.
The hospital would receive revenue for all costs incurred during the particular patient's care and treatment while in the hospital, net of professional fees for physicians. The patient would be able to compare posted prices to billed prices in a clearer, more understandable manner. The billing institution would have the option of initiating the patient billing concurrent with billing insurers and others, thereby speeding the time between billing and receiving payments--or with establishing a specific accounts receivable amount and payment program with the patient. The billing institution would have to bear the amount of net revenue and could have a more timely balance sheet for operating management.
Such a divergent change from long established pricing and billing procedures could reap additional benefits if hospitals published price lists. A clearer, more transparent competitive market would enable patient and referring physician to make more informed decisions about appropriate providers offering various, more intensive options for treatment and care.
My point is radical, yet if we in the US are serious about offering the best care for the market-bearing prices, it would be easier to have a single biller and still remain a privately financed, national health care system. There will always be a need for a publicly fund for health care, but no one wants to offer a single biller structure for institutional care as aviable alternative to the moral benefits of a single payer structure for our nation's health care system.
* Since our relationship with our pets is custodial or of stewardship, the ethical imperative for me is to minimize my pet's exposure to pain and suffering, if there were no realistic potential for recovery. My dog has not spoken to me in years, but I can tell when he is in pain and that he would want never to have to go out in the rain again, if possible. I do equate human choice about humans with the choice humans make for animals who are dependent on us humans for the quality of their lives. It's in the Bible. ( "God entrusted animals to the stewardship of those whom God created in God's own image." n. 2417, ref. Gn 1:26)
From my perspective of almost 30 years of auditing and management consulting in the patient care institutional settings, I believe that hospitals and clinics should consider a different approach to recording and accounting for patient care revenues, contractual adjustments, accounts receivables and bad debt write-offs.
The first step to change the current, ubiquitous approach for patient receivables would be to stop the Admissions practice of having the patients agree to be financially responsible for all charges related to their care. Especially because 1) most patients do not have the financial resources to pay cash or the debt access [thanks, banks!] to pay the tab, 2) the uncertainties of the upcoming changes in health care insurance from both federal and state governments, and 3) the possible continuing, arcane, cost accounting policies that differ among non-profit, governmental and for-profit insurers, to require the patient to assume an unknown financial burden seems moot, at best, bad business at worst.
The admitting institution should have full financial responsibility because it has to bring in enough revenue to cover at least its direct and indirect costs to remain in business.
Normal purchasing by individuals is a decision made by price, perceived quality of product or service, and, with services, a comprehensive knowledge of what is being bought at point of sale. Price lists would help to choose among providers. I have yet to see human health care priced to allow for the patient to decide between providers, or, once admitted, whether to incur the costs entailed in further pathology interventions available, or to expect to have tiered, treatment decisions that incorporate incremental costs that may be chargeable to the patient as part of the often available consent discussions presented to patients prior to various treatment protocols. [As a side note, I doubt whether patients have the information and knowledge to make an informed, conscious decision whether to agree or not to agree to the content of existing, informed consent forms.]
The other health care system in the US is veterinary practice. I know when I take my dog to his veterinary clinic how much an office visit, a procedure and, if needed, boarding, will cost--barring unforeseen issues. I also have opportunities to decide whether to put my pet through a procedure because of possible quality of life effects as well as because of price. We could argue about the difference in the emotional environment of such a decision, but how many patients are willing to bankrupt their families to live a few months more? *
I believe that hospitals and clinics should bill their costs of treatment and care plus all other charges from physicians, pharmacy, ancillary and others) directly to whatever insurance entity is applicable to a given patient and to whichever research grant or beneficiary fund is appropriate, if appropriate. Further, any billing sent to the patient should be net of any contractual allowances and other write-downs the institution makes. Such a procedure could result in the patient receiving one bill for the entire care and treatment services (including any ED, physician professional fees, ancillary charges and pharmacy) for illustration sake, of $5,000 instead of $190,000. The patient would receive one bill, from the hospital only. The hospital would be responsible for remitting professional fees that now are billed separately to the patient.
The hospital would receive revenue for all costs incurred during the particular patient's care and treatment while in the hospital, net of professional fees for physicians. The patient would be able to compare posted prices to billed prices in a clearer, more understandable manner. The billing institution would have the option of initiating the patient billing concurrent with billing insurers and others, thereby speeding the time between billing and receiving payments--or with establishing a specific accounts receivable amount and payment program with the patient. The billing institution would have to bear the amount of net revenue and could have a more timely balance sheet for operating management.
Such a divergent change from long established pricing and billing procedures could reap additional benefits if hospitals published price lists. A clearer, more transparent competitive market would enable patient and referring physician to make more informed decisions about appropriate providers offering various, more intensive options for treatment and care.
My point is radical, yet if we in the US are serious about offering the best care for the market-bearing prices, it would be easier to have a single biller and still remain a privately financed, national health care system. There will always be a need for a publicly fund for health care, but no one wants to offer a single biller structure for institutional care as aviable alternative to the moral benefits of a single payer structure for our nation's health care system.
* Since our relationship with our pets is custodial or of stewardship, the ethical imperative for me is to minimize my pet's exposure to pain and suffering, if there were no realistic potential for recovery. My dog has not spoken to me in years, but I can tell when he is in pain and that he would want never to have to go out in the rain again, if possible. I do equate human choice about humans with the choice humans make for animals who are dependent on us humans for the quality of their lives. It's in the Bible. ( "God entrusted animals to the stewardship of those whom God created in God's own image." n. 2417, ref. Gn 1:26)
Labels: Democrats, health care financing, hospitals, patients, professional fees, Reid, Republicans. Pelosi
01 November 2009
Bottoms Up!
It is time for some solutions, practical ones that can help the majority of Americans now. First, we need a tax deduction for interest and fees charged by the banks for our credit purchases. Second, we need small business enterprise regions supporting the restoration of local merchants and services to boost local employment. Third, we need to create much smaller, fully funded, family farms to produce the food we eat locally, not as determined by an international agricultural conglomerate.
How do we do it?
- A Tax Cut. As a temporary boost to taxpayers' net income, Congress should approve an additional tax deduction on their tax returns, beginning with 2009 IRS rules, for 45 percent of money spent on credit card interest rates and fees. For me, that would be the minimum level for deduction. This approach would allow consumers to manage their retail debts within the stagnant income levels most have. Further, it would lessen the depletion of personal savings just to pay bills and income taxes. The loss in tax revenues should be funded by unallocated Stimulus Funds or from recovered TARP loans. Such a deduction would benefit the largest number of taxpayers this year. Congress might want to have a defined period for this deduction, but in the meantime there will be help for those not seeing any benefit from the trickle down approach of the Wall Street bailout.
- Small business enterprise regions, rather than zones. In the just recently passed legislation for small business administration, there was no requirement for applicants to provide business plans for assessment by the Administrator. Perhaps individual Administrators would require such documentation, but it should be a universal requirement following FASB accounting principles. The business plan should include all years for which federal funds are borrowed and repaid. Thus, a one-year business proposal will not suffice if the purpose is to rebuild the small business portion of our economy. There also were no provisions for standardized audits of borrowers under this plan. The GAO lacks the resources, just as do most federal audit agencies. Each region should have enough independent, financial and operations auditors to periodically assess the user of borrowed federal funds for the Administrators. Optimal use of SCORE volunteer consultants could help many small businesses to succeed.
- Rebuild the family farm infrastructure for domestic food needs. With the implementation of corporate agricultural combinations and NAFTA, the small family farmer industry has been decimated. Using Stimulus Funds, regional Administrators should establish requirements for lending federal funds to small farm applicants. As with the small business loans, each applicant should have to provide business plan covering the years that include federal funds. For the purpose of this federal action, a small farm cannot exceed two sections in size and with no restrictions on the number of farmers included in that limit. [Note: 1 section = 1 sq. mile = 640 acres] In the US, a township measures 36 sections. The intent for these small farms would be to provide local produce, meat and produce for local retail grocers, especially near major urban centers. The corporate agriculture companies can focus on exports and packaging. The funding process would extend over four years: in Year One, the regional Administrator would grant the applicant the prospective year's capital and operating expenses and family support income to establish a sustainable farm business. In Year Two, the regional Administrator would grant the applicant with two-thirds of the income needs to support the farm and the prior year's operational revenues would provide the remaining third. In Year Three, the regional Administrator would grant the applicant one-third of the income support needs with the farm income providing the rest of the farm and family's income needs. In Year Four, the regional Administrator would no longer offer grants and local credit for crop and livestock because the farm should be self-sustaining in that period of time. The Department of Agriculture would have to establish an audit function to ensure the grantees adherence to good business practices and sustained operations viability.
30 October 2009
Who Should Be Billed for Healthcare Received?
Despite all of the maneuvering and deal makinng going on in the House and Senate, I am still promoting a Medicare for all baseline from which individuals and employers/unions can buy group policy offerings that would be a. in addition to Medicare's services or b. as a competitive option for those who want to opt out of Medicare. So, I'm sending this message to members of Congress:
1) Congress should pass legislation to change the Medicare eligibility to include every US citizen, even those still in the womb, and the non-citizen, legal residents.
2) Congress should pass legislation to remove Medicare Part D's restriction against negotiating prices for prescription medication. The government/tax payers should get the lowest prices simply because it is government procurement.
3) Congress must require providers to identify the insurance company payer and not the patient for all financial responsibility. This change would eliminate the dual accounts receivable for each provider whether for inpatient or outpatient care.
I believe that now is the time to let our representatives and senators what we really want as a health care reform bill. The most important message to send is your opinion on the form of a public plan, such as Medicare for All, an insurance company co-operative pool. or no public option. Deals are being made but they will vanish if we weigh in on the elements we really want.
26 September 2009
Focus, Focus, Focus! Politicians Do Not Want Reform. . .
This is why it is so tough to change health care in America: no one who makes money in the present system will support any change. Ka-ching. It seems some senators wanted to revisit the $86 billion "deal" President Obama made with BigPharma to lower the cost of prescription pharmaceuticals to Medicare or to the public-option plan, I forget which. Such a deal. That's like asking BigPharma to take a 10 percent price cut for selling to the largest market it has. I presume that BigPharma decided that what it lost in pricing, it would make up in the increased volume when everyone would be forced to buy medical care insurance. I would conclude that BigPharma knows its game better than the Administration. The very idea that a government-funded program would negotiate the lowest prices available, why that's absurd! Why should taxpayers cheat private industry out of their profits?
You're right it is absurd! Here is an excerpt from FiercePharma, an industry blog today, Tracy Staton wrote:
You'll recall that Democratic senators backed an amendment to require bigger discounts on drugs for low-income folks on Medicare. Early estimates said it would have cost drugmakers $86 billion. Another provision would have closed the medicare doughnut hole, bringing the cost up to more than $100 billion over 10 years. Proponents, including Sen. Charles Schumer and Sen. Bill Nelson, said they weren't party to the $80 billion industry deal.
Opponents voted the measure down for a variety of reasons: Some Democrats said they wanted to stand by the promise made to PhRMA, saying "a deal's a deal." Republicans such as Sen. Charles Grassley called the mandatory rebates "price controls" and said they'd end up raising drug prices for private patients.
We wonder whether any of them thought about the millions and millions of dollars PhRMA has promised to spend on advertising in support of healthcare reform. They were certainly aware of the fact that drugmakers would be angry. Delaware Sen. Thomas Carper (D) said extracting more money from drugmakers would cause a backlash from the industry: "I know I would walk away" from supporting healthcare reform, he said.
Thomas Carper, the senior senator from Delaware, a close friend of Joe Biden, the Vice President whose pledged to carry out an agenda of health care reform, waffles on his support for the Administration's agenda. Someone else, perhaps Senator Dianne Feinstein, must have voted with the Republicans on defeating the Shumer/Nelson Amendment.
What happened to the Democratic Party on the day it clinched its 60-member majority of the Senate that could allow this to happen. What "backlash" could come from the industry, one wonders. We, the American people, are the biggest customer BigPharma has. It is about time that Democrats acted like they control the Senate. Do it, dammit, and then make it work.
Pass legislation that provides a Medicare for All health care system, discontinue Medicaid, and get on with it. Geesh! Between 65 and 70 percent of the voters--who, by the way, elected you to your jobs, say they want a public option. What could be simpler than providing Medicare for All, negotiated prices that Medicare pays for medications as it has always negotiated prices for professional fees and inpatient care, and let the insurance industry adapt to its changed market mix.
Do it, Congress! Do it, Democrats!
What happened to the Democratic Party on the day it clinched its 60-member majority of the Senate that could allow this to happen. What "backlash" could come from the industry, one wonders. We, the American people, are the biggest customer BigPharma has. It is about time that Democrats acted like they control the Senate. Do it, dammit, and then make it work.
Pass legislation that provides a Medicare for All health care system, discontinue Medicaid, and get on with it. Geesh! Between 65 and 70 percent of the voters--who, by the way, elected you to your jobs, say they want a public option. What could be simpler than providing Medicare for All, negotiated prices that Medicare pays for medications as it has always negotiated prices for professional fees and inpatient care, and let the insurance industry adapt to its changed market mix.
Do it, Congress! Do it, Democrats!
21 September 2009
What's It All About, Barry, Really?
This health care reform thing--what's it all about, Mr. President, Madam Speaker and President of the Senate? Why are people tearing at each other, breaking up friendships, losing any sense of decorum and civility in public meetings, let alone on the Internet?
I always think about health care reform in America in terms of ways to improve the overall health of our citizens. Why are we not looking at ways to improve the survival of new born babies? How can we avoid or eradicate or cure most cancers, human immune virus contagion and influenza? Why do we tolerate hospitals and clinics where we are more at risk for an infection than not?
I always think about health care reform in America in terms of ways to improve the overall health of our citizens. Why are we not looking at ways to improve the survival of new born babies? How can we avoid or eradicate or cure most cancers, human immune virus contagion and influenza? Why do we tolerate hospitals and clinics where we are more at risk for an infection than not?
The current efforts are addressing a system of private insurance company viability as businesses that grew from the 1965 introduction of Medicare and then Medicaid. We now have a health care system dependent upon the goals of private, commercial financial results--which is a sociological, economic and political realm. Please, read Adam Smith's second volume about community and capitalism. Do the proposed reforms address community needs and expectations of living a full life despite disease and trauma? Where is the profit in educating children and adults about how to live a healthy life so as to minimize the care needs provided by these same, commercial entities?
We need to reform the paradigm of societal expectations and norms regarding how we individually and in our community expect for living healthy lives, beginning with considering physicians, hospitals and clinics as working for us.
We need to reform the paradigm of societal expectations and norms regarding how we individually and in our community expect for living healthy lives, beginning with considering physicians, hospitals and clinics as working for us.
We hire them or check-in to a hospital because we believe that this or that is where we find help and answers about living as best we can.
I have had to seek emergency assistance when I sliced deeply into one of my fingers while preparing a meal. I cannot stop it from bleeding. I do not need an admission process that requires my entire life health history. I want my wound treated, not to sign away my financial future or absolve the Emergency Room from liability for any mistakes or accidents.
My priority is to find out what I don't already know, especially when the timing of treatment and period of care are unknown. I like to know what is going to happen in my life when there are other people involved in determining my situation and my future.
I have had to seek emergency assistance when I sliced deeply into one of my fingers while preparing a meal. I cannot stop it from bleeding. I do not need an admission process that requires my entire life health history. I want my wound treated, not to sign away my financial future or absolve the Emergency Room from liability for any mistakes or accidents.
My health care is being diminished for the lack of a single-payer system. I still bleed while my insurance is validated. I need someone to stop the bleeding and to stitch up the wound on my finger. That's all. With the admissions process having to ensure my treatment will be paid for and waiting for a physician to approve treatment so I can wait for someone to treat me, I spent hours for a 15-minute treatment. Then, later came the bills, invoices that are addressed to me, even though my insurance will pay them.
The current efforts by Congress and the White House is to legislate a process that does not have a health care goal or public expectation about health care in America. The goal of the Congress and the Administration focuses on the HOW and BY WHOM actions to attain a political goal that is so broadly stated in three words: Health Care Reform.
Other developed countries think about health and health care and their national programs' primary purpose is to meet the expectations of the people who live there. That purpose comes first and, though different countries have different means to meet those expectations, the health of the populace, individuals drive the means and the resources of the governments, the health care professionals result from the legislative process and public participation.
What do we Americans want? Seventy percent of us, according to published polls, want a single-payer system as an entitlement of citizenship and resident non-citizens. We declared our nation's independence to enable us to pursue unalienable [sic.] rights to Life, Liberty and the Pursuit of Happiness. We should be healthier for this goal. We have failed as a nation to remain true to the attainment of those Rights.
Other developed countries think about health and health care and their national programs' primary purpose is to meet the expectations of the people who live there. That purpose comes first and, though different countries have different means to meet those expectations, the health of the populace, individuals drive the means and the resources of the governments, the health care professionals result from the legislative process and public participation.
What do we Americans want? Seventy percent of us, according to published polls, want a single-payer system as an entitlement of citizenship and resident non-citizens. We declared our nation's independence to enable us to pursue unalienable [sic.] rights to Life, Liberty and the Pursuit of Happiness. We should be healthier for this goal. We have failed as a nation to remain true to the attainment of those Rights.
Labels: Adam Smith, health care financing, health care public plan, single payer
19 September 2009
My Reasons for Wanting a National Health Service for All
I have had to import medication from Canada because it was more affordable a few years back, I have too much money in my remaining IRA investments intended for retirement, accordingly, I have been spending down those IRA savings to afford my living expenses and health care expenses since 1991. I cannot access my veterans benefits nor can I receive coverage under Medicaid because of their means tests. And others have worse challenges than I have. How many parents discover that their child must wait two years for Medicare eligibility if, God forbid, their child develops an immune system disease or has brain damage from meningitis? The parents' private insurance coverage may alter or cancel their family's health insurance and, assuming there is an income-producing person in the household, the parents cannot afford the necessary health care costs until Medicare enrolls the child. The child would be eligible for disability income if they meet the criteria established by Social Security. Someone with lupus, for example, can work, live normally or a little slower and with greater fatigue, yet any physician office visit charges, lab charges and medication charges have to be paid by the afflicted person in addition to housing, food, utilities, cell phones, Internet access costs of daily living. Suddenly the afflicted person, before Medicare coverage, has new claims on the paycheck that may amount to more than the take-home pay for the month.
Often, I should note, the providers will have a sliding scale fee structure so a person without health car coverage should ask the physician or lab or pharmacist about such arrangements. They do not want to charge full rates if they see that they will not be paid anything. So, we ask for financial arrangement that help, but still may overwhelm one's budget.
It seems that every federal program for the good of Americans, including veterans health care, requires the recipient to be impoverished. Find me one that does not- for health care. Try living on the SSDI stipends for shelter, food, transportation and miscellaneous expenses of living. Because I am single, my net $1,700 monthly SSDI income puts be above the poverty level.
I know the health care system very well, because of my executive role for a major university medical center, research laboratories, patient care in two hospitals, administrative process and budgeting, and construction of new laboratories or hospitals or upgrading facilities in place. I led the office that evaluated those operations for 12 years, until I could not handle the stress of my job mentally or physically. Is it not ironic that I cannot make a living from providing guidance and opinion, because my PTSD of institutional politics and my inability to reconcile political and reality perspectives do not allow for full-time employment. You see, my disability prevents me from focusing on a subject or tasks of a job for more than two hours after which I must disengage completely from work type situations and discussions. My former employer, Stanford University, went psychiatrist hunting to avoid paying me any disability income and access to other benefits,even though their first psychiatrist and my psychiatrist validated the nature and effects of my disability. It was several years before I could even think about taking the institutional and legal steps to restore them. I would have difficulty today, psychologically, making the effort to claim disability benefits to which I was entitled as an employee.
I have two more years to go before I will have depleted my IRA that had been created to supplement my pension income from an employer. I was not able to work long enough to generate any pensions, so I will become entirely dependent on government programs for life and pursuit of happiness. There should have been a point after which my IRA did not have to be used for health care related expenses. For me, a national health service with a single payer, would have enabled me to remain in my home and lead a decent, middle class life without having to access any future government programs. My paying out-of-pocket my entire investment portfolio value cash in distributions could have been avoided had we had a national health service for everyone, regardless of income, assets, job, etc. In retrospect, what I should have done is go to France or Italy in 1993, after being enrolled in Medicare A and B, and used my Social Security and Medicare benefits as my contribution to their national health systems. We have bi-lateral treaties with other countries that enable such exchanges, depending on the country where you pay income taxes.
My own health suffered from trying to do too much and the cost of ongoing psychotherapy and associated medications were depleting my IRA at a rate higher than my rent. Another trip to Italy, using the points awarded from charging so much medicine costs, convinced me there was a better way to live, a way without worrying about going broke paying for health care while living on my SSDI for all other living costs. What delayed my obtaining the visas was gathering the required paperwork and submitting my application. What takes most people an hour or two on the phone or filling out forms with accompanying support documents, takes me weeks and months to do. This post has already consumed ten hours today and additional hours of editing just to arrive at this draft.
Now, I may not have sufficient financial resources to move to Italy which still has a much better approach to health care than does the country of my birth and that I defended.
Until a single-payer, like Medicare for all, demonstrates that this country puts the health of its citizens before the profits of private insurance companies and the pharmaceutical manufacturers, I don't see myself as letting go of this issue and my anger.
12 September 2009
Ed
On August 30, 2009, Edward R. Kuhn, DMD, ended his life early in the day, using the semi-automatic rifle he had at home because he had been a lieutenant colonel in the Air Force Active Reserves. I received a call from a mutual friend about four hours later. Neither of could say anything; we were in shock. Marion said he would pick up Ed's daughter at LAX along with his own son and drive them to Palm Springs. Later that afternoon I called Ed's wife and when her cousin answered the phone, I asked her to relay my deepest sympathies to her. I had to go to Palm Springs to be there at their house. I did that, stayed overnight with friends, and went to Ed's home again on Monday. Those are the facts of the beginning of a period of grief, sitting with Ed's in-laws not knowing what to do or how to be helpful. The sudden loss due to suicide does that.
I met Ed and Marion at the Officers Club in Pionier Kaserne, Hanau-am-Main, West Germany in early 1969. Over the next two years, we became friends, good, close friends in the special way that bonds soldiers stationed together. I have never had such close friends before or since. I had other friends from my own unit with whom I kept in touch years after I finished my term of duty. But none was as close as were we, known at the Club as the Mod Squad. Marion was the Provost Marshal in Hanau. Ed, one of Marion's platoon leaders was stationed in Auschaffensburg as provost marshal. Ed, whose hair never made it short enough for US troop standards, and I was the intelligence officer for our combat engineer brigade who, like them, would rather be in the States and were politically and morally against the war on the other side of the planet. We hated the racism that began to infect the troops on base. Marion and I would get into deep discussions about racism in our culture, and what US troops encountered with the Germans. Plus, back home society was having its own war between the mores of The Greatest Generation, hippies, and African-Americans. Martin Luther King and Bobby Kennedy had been assassinated just months before. Anger and frustration characterized the times. Also, the Tet Offensive happened in Viet Nam during this period and the level of fighting ratcheted up another notch. Ed would participate to some extent in our talks, yet was rarely seriously engaged and angry. He was the hippy of our group. His relaxed way of talking was soft and earnest, but I could tell he'd rather be out on his surfboard off Goleta, waiting quietly for a good wave.
Ed knew just the time to break into our significant discussions with his eyes twinkling and a devilish smile. Ed found humor in our daily lives that we were too serious to notice. Ed would quietly ask if we wanted to go to his apartment, one he often shared with his current girlfriend of the season, and get high. For the rest of that evening we would laugh at ourselves, our circumstances and listen to the music of the times. I think we drank German beer from flippies, inexpensive brews in bottles kept closed by a porcelain cap one had to flip open to drink those really good beers of Germany.
Ed and Marion were transfered to Korea for 1971, while I remained in West Germany. Our three-year commitments were over in the Christmas and New Years holidays beginning 1972. Marion and I corresponded a lot while he was in Korea and he kept me current on Ed.
We kept in touch over the next three decades, celebrating marriages and children, professional education that made Ed a dentist and Marion an attorney. I became an administrative executive in higher education and health care institutions. I was in the San Francisco Bay area for most of the intervening time and Marion was studying law at the University of California, Berkeley. Ed bought a practice in Palm Springs. As fate would have it, Marion moved from his job in Detroit to Orange County and was able to enjoy Ed's company on bike marathons, hiking and was Ed's patient even. Time passes and we led our unique lives, always knowing were the other two were.
In May 2008, we had a reunion of the Hanau Mod Squad in Palm Springs, Marion with his wife Amanda, Ed with his wife Patti, and me. The three of us felt the bond of 40 years friendship. I had moved to Southern California, too, so it was especially comforting to me to live close to them. In fact, it Ed who was one of the reasons I was planning to move to Palm Springs, as well as the other attractions and people I liked there. To me, Ed was the linch pin of our group. The three of us truly enjoyed each other as a family. Then I received Marion's call.
During the 1980s and '90s I was living in San Francisco during the worst years of the AIDS epidemic. Friends and partners were dying, I would go to concerts and memorial services at least once a week; a one point, I was overwhelmed with the loss of a generation of San Francisco's most talented, creative and interesting, mostly gay men. I had to choose carefully among which memorials I would attend. It was during that period that I read Antoine de Saint-Exupéry's "Wind, Sand and Stars," written during his French air corps experience early in the 1940s. This one passage captured the survivor's life during the AIDS epidemic; it came to mind after Ed died:
...hidden gardens, gardens inaccessible, but to which the craft leads us
ever back one day or another. Life may scatter us and keep us apart; it
may prevent us from thinking very often of one another; but we know
that our comrades are somewhere 'out there' ---where, one can hardly
say---silent, forgotten, but deeply faithful. And when our path crosses
theirs, they greet us with such manifest joy, shake us so gaily by the
shoulders! Indeed we are accustomed to waiting.
"Bit by bit, nevertheless, it comes over us that we shall never again
hear the laughter of our friend, that this one garden is forever locked
against us. And at that moment begins our true mourning, which,
though it may not be rending, is yet a little bitter. For nothing, in truth,
can replace that companion. Old friends cannot be created out of hand.
Nothing can match the treasure of common memories, of trials endured
together, of quarrels and reconciliations and generous emotions. It is
idle, having planted an acorn in the morning, to expect that afternoon to
sit in the shade of the oak.
"So life goes on. For years we plant the seed, we feel ourselves rich;
and then come other years when time does its work and our plantation is
made sparse and thin. One by one, our comrades slip away, deprive us
of their shade."
¸
Antoine de Saint Éxupéry, Wind, Sand and Stars, 1943
ˇ
Ed, rest in the peace you sought. We miss you a lot.
Labels: Friendship, military life, suicide
11 September 2009
Decorum
When has it become acceptable behavior to shout out "You lie" at the President of the United States giving an address to a joint session of Congress?
How did this individual, an elected member of the House of Representatives, believe that it is proper to act this way, in these circumstances, toward this man? What outcome did he want from vocalizing these words? Why would it even occur to him that doing what he did would be the right thing to do? There seems to have been more media attention to this man's action than to any criticism and subsequent action by his colleagues to show disapproval and sanctions for it. This guy walks among them.
Clearly, the standards of civility and decorum, even appropriate dress codes, have changed significantly in the past forty years, by two generations and condoned by "the Greatest Generation." Through experience, I do believe the social maxim that "you act according to the way you dress." Every so often, young people will discover this and I am somewhat heartened by the life span for this maxim.
As I was leaning to write in grammar school, in the early 1950s, I was taught that one always capitalized the "p" when writing about the President of the United State, but for no other presidents. This spelling maxim applied to any derivative of 'President' as well. Sure that was a time of hyper-patriotism, yet I still consider the maxim appropriate as the proper title's spelling, even when used without the current President's name.
All my life, when the President of the United States gave a nationally broadcast speech, on radio and later television, I was raised to listen closely, attentively and even at home, respectfully. I will admit to ignoring most of GWB's speeches after 2004, yet he was our President and deserved the high respect considered for that office. When I reacted, having read GWB's speeches, by sending him letters by fax, I was courteous and respectful of his office even though I could not respect the man. Until the 1968 election, I heard Presidents Truman, Eisenhower, Kennedy and Johnson being accorded the respect of his office by the press and the audiences. That public respect did not mean there were no dissenters or extremists in opposition to those Presidents; however, people respected the Presidency.
By 1968, however, President Johnson was the target of significant numbers of public demonstrations against the Viet Nam War. Maybe this cause created more disrespect for the Office than respect. Even though most soldiers were draftees, the common reaction to a man in uniform was antagonistic rather than grateful. Television brought that war into our homes so that the realities of war's evil conduct and outcomes became visible to all, not just to the soldiers, adding significant numbers of persons who became antagonistic to any participant in it. Then, the treatment of opposition groups assembled to demonstrate at the Republican Convention in Chicago fortified war opponents and the candidates for the Presidency in 1968.
I was stationed in Europe for most of Nixon's first term of office, after having been relatively isolated to what was happening in the public arena since February of 1968. When I returned to the States in late December 1971, I had missed what I consider to be a social revolution that had changed America. Everyone was using first names at the office, even the executives. President Nixon had implemented most of LBJ's "Great Society" vision with Congress, and Senator McGovern was running for President as an opponent of the Viet Nam War.
So, besides the significant degree of change in society's interpersonal mores, seen in popular music, on television and in the theaters, when Watergate occurred in 1972 and Nixon's unwilling resignation from office in 1974, I believe that most of the nation had lost their traditional respect for a President. There was no longer any distinction between the Office and the man who was President.
This change, for me, has been most unfortunate. Civility in social discourse seems to occur only under power-based circumstances and not automatically. A person's integrity can be challenged and damaged without having any basis in fact. Criminal trial trials seem anachronistic when the public has already found blame in the person on trial. Our courtroom-based television shows do not portray a defendant or a suspect as presumably innocent of any crime, and the prosecutor has to be the hero bringing justice to the victims. The screenwriters actually present the way British juris prudence functions, that the defendant has to prove his or her innocence of the charges. American juris prudence has its stated ethos that a person is innocent until the state's prosecutor proves the person to be guilty of the charge. Just the opposite paradigm from the British system.
Fictional, criminal cases on television and in movies concentrate on the likely person that the police or detective is looking for, rather than on the viewpoint of the district attorney who must find sufficient evidence to arrest and charge the suspect, let alone to have sufficient evidence to convince a jury or judge that the defendant at trial is culpable for crimes against society. The same "bad guy" person will be portrayed in plots that involve the President. Even if innocent of any criminal behavior by someone in his Administration, innocence becomes equivalent to incompetence as President for not knowing about the criminal activity. The last time I checked, incompetence is not a crime in and of itself.
Respect in social settings seems to have fallen victim to an inversion effect, so that most persons worry about the respect they are shown versus any respect they accord as due to others. In the recent town meetings of August 2009, individuals among the constituents in attendance showed no respect for their elected representative, senator or President. The media reported only the most "exciting" reactions to the announcement of President Obama's speech to the nation's children in school. Mothers were accusing the President of interference with parental rights, with dictating school curricula that are the right of local school boards to make.
Several parents said they would not allow their children to see the President of the United States address the nation's children because it would harm them. The media dwelt on these incidents of disrespect without commentaries that such conduct is the wrong attitude to have to judge the anticipated content of the speech without knowing the content. No one criticized these individuals about their behavior and lack of respect for their own elected official. Indeed, there were organized groups shouting opposition to any Presidential address who traveled from location to location. The degree of expressed anger, outrage and righteousness far exceeded civility, let alone respect.
17 August 2009
When Your Staff Slows Down Because Your Focus is Elsewhere
Why White House Spokesman Robert Gibbs is Dead Wrong about Wall Street Pay
Read More: Barack Obama, CEO Pay, Economic Crisis, Financial Crisis, Unemployment, Wall Street,Wall Street Bailout, Wall Street Bonuses, Business News
"A recent report from the New York attorney general's office said nine banks that received government aid paid bonuses of nearly $33 billion last year - including more than $1 million apiece to nearly 5,000 employees." (Wall Street Journal)
"CitiGroup told the U.S. Treasury Department that energy trader Andrew J. Hall, with a pay package of $98 million, and a second unidentified trader who was paid more than $30 million, were exempt from [Pay Czar] review." (Reuters)
"I don't think the American people begrudge that people make big salaries." White House Spokesman Robert Gibbs referring to Wall Street bonuses and salaries. (Wall Street Journal)
Speak for yourself Mr. Gibbs. I got a whole lot of begrudging in me and here's why. We basically own those nine large banks. Without the trillions of dollars of bailouts and loan guarantees we provided, they all would have gone belly-up -- each and every one of them. There would have been no profits, no bonuses, nada.
We saved their butts because at the time it seemed like the only way to stop another Great Depression. Even with the enormous bailouts and stimulus funds, presently over 25 million Americans are unemployed or forced into part time work because of the lack of full-time jobs. I wonder if they are or are not begrudging those "big salaries," which actually are nothing more than welfare checks.
I voted for Obama and hoped he would do the obvious: put a lid on Wall Street's excesses including its sense of entitlement and astronomical salaries. I was hoping against hope that he'd do something sensible like cap all Wall Street salaries at $500,000 at least until the unemployment rate came down to 5 percent. Such an effort would have been a sign of social solidarity. It would have been fair. It would have been just, since it was Wall Street's gluttonous embrace of baseless fantasy finance that set the stage for the recession in the first place. (For a guide to this history and the workings of the casino see The Looting of America .)
Here's what I'll never forget: During the three years leading up to the crash, nine of the largest commercial banks made a whopping $305 billion in profits. Approximately half of that was doled out in bonuses. Since the crash these same institutions lost all of that and more when the world discovered they were raking in profits by selling toxic assets. The bankers and traders, to be sure, didn't pay back any of their gains or make up for the enormous losses. Now that Wall Street is getting on its feet again and we forget that it is doing so because we are bailing it out each and every day. The bonus money they are earning right now is our money. Yes, Mr. Gibbs, I begrudge giving it to those who wrecked the economy. I would rather drop it from an airplane over Detroit.
So why the lack of nerve on the part of such able politicians? First of all, they seem to truly believe that Wall Street profits and high salaries are necessary for our economic survival. Here's how Treasury Secretary Tim Geithner put it: "The fact that the core parts of the U.S. financial system look like they're profitable is overwhelmingly good." It is "a necessary precondition to a stronger economy."
They believe that profitability leads to investor confidence, and the vibrant capital markets needed for a revived economy. But all this assumes that the "core parts of the financial system" don't again turn into a fantasy finance casino.
Second, they worry that the best talent will flee if they don't get the kind of rewards they are accustomed to - which means paying them what they "earned" when they were milking the fantasy finance casino. But the administration has itself to blame for this trap. Had they instituted a wage cap across the board, there would be no place to run to. That would have knocked the living crap out of reckless risk-taking because the rewards would have seemed paltry to our over-privileged bankers and traders.
Finally, the administration seems to believe that its tepid reforms can separate the high salaries earned for necessary banking functions from the high salaries earned for rapacious rip-offs. As Mr. Gibbs says, "The president continues to believe, as he has long before he got here, compensation has to be based ... not on reckless risk-taking , but on value that you're providing and doing so in a way that doesn't jeopardize your firm or taxpayers." That's like believing in the tooth fairy. Please someone tell me how an entire sector that is on taxpayer life-support is creating value that justifies high salaries and bonuses? I'd like Mr. Gibbs to explain to unemployed manufacturing workers how Mr. Allen's $100 million compensation package from Citigroup added value to the U.S. economy.
I too want to believe in the tooth fairy. I want to believe that all of this will work out - that the financial sector will revive, that compensation will be severed from reckless risk-taking, and most importantly, that there will be more than enough decent jobs for the 25 million who are suffering today due to no fault of their own. I want to believe all of this because I worry about a right wing populist revolt catching fire among all those who do begrudge these ridiculously high salaries. I can easily imagine a clever demagogue (or a not-so-clever one like Governor Sarah) going from unemployment office to unemployment office waving a copy of Mr. Allen's $100 million check: "Here's what Obama did for Wall Street. What did he do for you?"
But most of the time, instead of the tooth fairy, I believe in power. And the bankers are strutting their stuff. They're taking our tax dollars and using them to lobbying against all of Obama's reforms. They're selling synthetic derivatives again. They're making the pay Czar look like a wimp. They've even got Mr. Gibbs championing their cause for high salaries.
But Mr. Gibbs, you've got it wrong. The American public does indeed begrudge the bailouts and the lavish salaries going to those who milked the system at our expense. We've got every right to do so. We'd be crazy not to take exception to being ripped off so badly and baldly. It's high time the administration sided with legitimate populist anger rather than with the well-rewarded elites. Unless it does so it a hurry, all of its reforms will crumble at the hands of those with fewer scruples and more determination. We will lose health care reform. We will lose financial reforms. And we will lose the best chance we've had since the Great Depression to make the system work for working people.
Les Leopold is the author of The Looting of America: How Wall Street's Game of Fantasy Finance destroyed our Jobs, Pensions and Prosperity, and What We Can Do About It, Chelsea Green Publishing, June 2009.
Follow Les Leopold on Twitter: www.twitter.com/les_leopold
26 July 2009
What About Workers Compensation?
If there is one topic that raises the blood pressure among business leaders, small and global, is Workers Comp. It adds to the expense burden of every employee with states that require coverage. Insurers to business do not have an incentive to reduce this burden because they make money from the premiums paid.
Why hasn't the Health Reform debate included the potential for reducing the health care costs of persons injured on the job? Some claims result is multi-year payments that contribute to the escalation of insurance premium costs to businesses.
For employer-based insurance, I would think that every local Chamber of Commerce, every state governor or controller, and every state health care insurance provider would be camping on the steps of the Capitol to obtain the lowest possible, yet equivalent to today's, costs for medical care incurred by on-the-job injuries.
Who knows, there may be some Republicans among this heavily affected constituency.
Labels: governors, health care financing, labor entitlements, Republicans Bush Wackovia Pelosi crisis, workers comp
Out Yourselves! about Health Care Reform
I would like each and every stakeholder, at least those so far allowed to participate in the process for reforming health care in this country, to declare:
"What is sufficient for you personally and for those you represent?"
"How will you know when the reform is best for you personally and for those you represent?"
Then, I would like those answers published and read on television. If the President wants this process to foster creativeness, then I believe this last step should be completed by the Administration Departments and the Congress--and made public before Congress adjourns.
Labels: Administration, health care public Obama/Biden competitive markets anti-competitive, health care public plan, lobbyist, McConnell, Reid, single payer
20 July 2009
Federal Fiscal Policy Discounts Greed
Congress failed to help the public, their constituents, to have the means to acquire more control over their debt management and, as a result, to improve their ability to access consumer credit, apartment rental units, jobs, and sense of self-worth. Indeed, the recent legislation has had the effect of making retail credit less attractive to consumers.
Congress failed to address the shrinking of real estate market values for property owners whose property is near to a foreclosure sale, a short sale, or an auction. Reality check: If all homes in a particularly wealthy neighborhood have an average market value of $1.3 million (determined from the prior six months' sales prices), the entire neighborhood's market value can fall several percentage points if a small number of sellers have lost their jobs and can no longer pay their mortgage loans, or if a small number of repossessed homes go on the market at prices over 50% lower than the market value of homes in proximity, the entire real estate market in that area will experience a reduction in home equity value and in sellers' asking prices. Given the lower market value of competing homes in an area, buyers can take advantage of this price cutting, negotiate still lower home prices and the purchase prices negotiated will establish the new average market value for like homes in that neighborhood, perhaps around $675-700,000 or 52% lower.
The banks also have changed their underwritiing standards for mortgage loans. No longer can a mortgagor expect to find a lender using the 20% down/80% loan criterion for taking a new mortgage loan. More emphasis is being placed on the applicant's LTV (loan-to-value) as determined by the appraiser. An equivalent ratio of retail credit-debt-used to available-limits also affects the underwriter's criteria for mortgage loan approval.
There are no steps I can take to increase my credit score, other than to pay down my debts on time and with at least the minimum amount due. I have never had a mark on my payment record, I have owed more than now and I am paying, with exceptions, more each month than the min. amt. due. A year ago, my debt to available credit ratio was 47%. This ratio makes up approximately one-third of my credit score. Another one-third is affected by my debt and payment history. I used to not worry about this latter portion because of my cash available from my home's equity and my IRA. Lenders kept raising my available credit limits because of my access to liquid assets (i.e., to cash). Special rate offers enabled me to transfer a debt at 13.25% to a 0% debt rate for one year, thereafter at an 8.9% rate or to transfer a debt to an account with a 4.99% rate until the entire amount transferred was paid off. I used both, depending on which gave me the better cash flow in the future. Because of my excellent credit score and report, I could refinance my property and pay off all retail credit debt in escrow, and still keep my mortgage payments at almost the same amount as prior to refinancing. Refinancing is no longer an option, because there is no longer any equity in my home's value. TARP and other federal stimulus funding did not directly address the mortgage loan market's dependence on LTV, compounding the error of not addressing the shrinking values or credit card charge limits.
On their own, with nothing other than their ability to do so, all but one of my creditors have lowered my available credit by several thousand dollars. Now, my debt to available credit exceeds 85%. Nothing has changed on my end. How will this 47% to 85+% affect my credit score? I don't know and the credit bureaus are not talking.
In addition, with no constraints or sanctions for the card issuers, and despite the infusion of cash by the Treasury Department and new legislation, creditors still can raise the interest rates on retail credit balances whenever it makes business sense to them. When this has happened to me, I have seen the minimum amount due, as posted for my monthly statement, double my monthly payment.
Because of our "free market" economy, Bank A could care less about Bank B's change of the minimum amount due on Bank A's credit card balances. I put quotation marks around 'free market' because we have never in this country, since the Whiskey Rebellion, had our financial markets unfettered of federal and state regulations and rules for operating. Thus, if Bank B finds out about Bank A's increasing interest rate or minimum amounts due, Bank B can do the same thing. It every bank adopts this method for its revolving credit accounts (credit cards) this action becomes an industry standard way of doing business, not anti-competitive.
This ability to raise or lower interest rates does not stop per se the entry of a new bank into the retail credit market nor does it lead to a monopoly, so our existing anti-trust laws do not offer the consumer any basis for complaint. It seems to me that collusion among bankers or establishing a new industry standard for doing business in the retail credit market should be wrong. After all, the banks' actions have harmed the public at large, especially those persons living on fixed incomes or those persons whose household income is no longer sufficient to pay off existing loans plus provide for day-to-day living expenses.
I wrote in an earlier post about the curious behavior of banks' offering extremely low interest on savings accounts and certificates of deposit (CDs). The cost of cash to a bank, or the federal funds rate, has held constant for the past six months at 0.25 or $ 99.75 per $100 bought. This same bank will lend this $99.75 through a variety of loans and credit card accounts. To attract private capital, a bank today will pay an average interest rate of 1.311 to 1.321% on an average minimum deposit of $10,252, dependent upon the number of days up to 365 days those deposits remain in a money market account or a savings account. Banks will sell CDs of various time periods at an average yield of from a 3-month CD at 0.923 for an average purchase of $8, 547 to a 5-yr. Jumbo CA at 2.728 for an average purchase of $100,000.
In other words, a bank can pay 0.25 % (federal fund rate) up to 2.728% (to depositors) for the bank's operating cash. For an idea of how profitable this capital is, compare the following rates charged for different loans and consumer credit accounts:
- WSJ Prime Rate 3.25%
- Mortgages 5.372 APR for FHA 30-yr. fixed
- Credit Cards:
- Balance Transfer Cards 13.77%
- Cash Back Cards 14.35%
- All Variable 11.14%
- Low interest cards 9.17% [Source: www.bankrate.com, 20 July 2009]
On the other hand, there is nothing to interfere with a new lender coming into the consumer credit market offering completely different, more customer friendly and less costly terms for their customers. Any enterprise can go against an industry practice and such an ability can change the market practices completely.
With an abundance of Stimulus Money available today, perhaps some entrepreneur could have access to the minimum capital required, by regulation, to start a new consumer credit card business as a bank. A strong, perhaps using a different business model, competitor is something that we all need now that the banking industry standard practice for retail credit accounts is stifling small business owners and retail customers from buying and rebuilding our economy with more jobs to handle increased production and sales.
The next Reform stage should start at the local level, incorporate the Enterprise Zone incentives for small business and tax bank revenues from consumer loans and credit card accounts, including all associated fees, for the rate amounts above 10 percent. Residual TARP and Stimulus funds should be used to establish reserve levels before being remitted to the federal government.
Labels: banks, cost of money, credit cards, FICO scores, loans, reform legislation
16 July 2009
Who Should Be The Change Agent?
Many attempt to reform or make changes, whether in an office or in a community, fail because the authority puts the requirement onto managers or supervisors or city department chiefs already in place. I believe that most people want to do their jobs well. If the people given the assignment to redesign a process or function have been in charge of the current way, it is safe to assume that they believe their work is being done in the right way. And they are doing their jobs well. Asking them to design a new way of operating is at once sending them the signal that they are not thought of as doing their jobs well. It also can challenge their self-image or invested ego in an alienating way. Leaders may forget that it is more important to know what is understood rather than what is said.
One reason for charging obscenely high fees for being the consultant hired to design and implement such changes is the knowledge that long after the engagement has ended, every failure or mistake can and will be blamed on the outside consultant.
Labels: change, communications, consultants, fees, organizations
New Light on White House Reform Leader
On June 28, I posted my input to the White House Office for Health Reform and Special Counselor to the President, Nancy-Ann DeParle. See Changes for Health Care Reform. In the July 2 newsletter FierceHealthcare, Ann Zieger posted the following news item:
| By Anne Zieger |  Comment |  Forward |
White House health reform director Nancy-Ann DeParle is in a tight spot. A new investigative report has concluded that DeParle earned more than $6 million serving on the boards of major healthcare corporations, some of which have been accused of fraud, mismanagement and regulatory violations during her service there.
While there's no evidence she was aware of or involved in allegedly illegal activities, she served in three cases on board committees overseeing the companies' legal and regulatory compliance. That certainly doesn't look good, regardless of what actually happened, particularly given her rep as a progressive.
One example of the problem was her involvement as director and compliance committee member at DaVita Inc., which has been subject to investigations into its billing and drug-prescribing practices. She also served in a similar role at medical equipment supplier Guidant, whose execs apparently knew of cases in which its devices failed but never disclosed those failures.
To learn more about these issues:
- read this Kaiser Health News piece
What is the problem? Is Obama thinking that his campaign blog was sufficient for leading the actual reform process? I hope he's not the boss who, after sending out copies of his opinions on a topic, assumes the recipients will faithfully refine and produce a final statement as President. I suppose Joe Biden is doing something, but I'm unclear where is turf responsibilities are. The President and his Chief of Staff move very quickly and may be outpacing their staff. Both are known to be extremely intelligent, fast thinkers.
One of my bosses was like that. In fact, those of us on his senior staff tried to raise his awareness of what his work mode did to us. For one thing, once he had grasped the nature of the issue and had formed his preferences on how to resolve it articulated or not, his mind moved on to other things. Not being mind readers or boss whisperers many of us would have questions about filling in the blanks as he had done in his extraordinary mind. His usual reaction to someone asking for more information would cause a frown and an impatience. Such a boss can be very intimidating and there developed a reluctance to raise issues or to revisit the original item. So, one staff meeting, we turned the tables and had a candid discussion with him about our division's decision-making process, specifically his. Well, he was quite surprised and it took him a while to fully digest our comments. To his credit, he really tried to be more expressive, informative and open to our ideas and concerns.
Is this what is causing simple yet crucial mistakes by the White House staff? A little hero worship? Is the almost messianic awe President Obama evokes inhibiting his staff? Or is the pace of change too ambitious for Washington--and the nation? This current time of change may suggest the need a for a breather.
10 July 2009
I am very disappointed with the shortcomings of the legislation just enacted on credit cards.
Economics can be summed up as the study of the commerce of rents. When I use one of my credit cards, I rent cash from the card's issuer on previously established T&C. For this, the issuer bills me monthly for rent in the amount I paid to the merchant. Using VISA as an example, the merchant will receive about 97% of the amount (including sales tax) shown as the transaction amount charged to my card. The card issuer has an agreement with VISA for VISA to function as the clearing house between me and issuer. For acting as the intermediary or clearing house, the issuer pays VISA to accurately record the transaction total for which I rented cash using the issuer's card and pays VISA the cash transaction total amount. The next paragraph explains two different corporate policies for accounting for revenues.
Not only was the issue of a federal usury limit not open to public discussion, the new law does not restrain the retail credit issuers' ability to make unilateral decisions for changing the terms and conditions for using their cards. Not only have issuers pushed up daily interest rates and shortened the payment due date interval, almost all issuers associated with VISA and MasterCard have reduced the amount of available credit for their customers.
Economics can be summed up as the study of the commerce of rents. When I use one of my credit cards, I rent cash from the card's issuer on previously established T&C. For this, the issuer bills me monthly for rent in the amount I paid to the merchant. Using VISA as an example, the merchant will receive about 97% of the amount (including sales tax) shown as the transaction amount charged to my card. The card issuer has an agreement with VISA for VISA to function as the clearing house between me and issuer. For acting as the intermediary or clearing house, the issuer pays VISA to accurately record the transaction total for which I rented cash using the issuer's card and pays VISA the cash transaction total amount. The next paragraph explains two different corporate policies for accounting for revenues.
It's to the merchant's advantage to have robust sales paid in cash or by credit card. The merchant wants to maximize cash revenues to pay the costs of doing business. The merchant may also purchase inventory using rented cash, viz. credit, to ensure a predictable cash inflow is vital for remaining in business.
What we need for our economy now is Rent Control, plain and simple. Instead of apartment rents, this rent control is about cash.
Banks saw an opportunity to expand their retail banking products to include credit cards for individuals and businesses. Prior to expanding into retail and wholesale credit business, the banking industry's markets were underwriting and mortgages, also known as funding loans and structured repayment loans for real estate and personal, unsecure loans. Bank revenues came from interest charged on mortgages and other loans.
Banks saw an opportunity to expand their retail banking products to include credit cards for individuals and businesses. Prior to expanding into retail and wholesale credit business, the banking industry's markets were underwriting and mortgages, also known as funding loans and structured repayment loans for real estate and personal, unsecure loans. Bank revenues came from interest charged on mortgages and other loans.
Long-term reform of the US banking system will involve parsing out the different kinds of credit instruments in different markets to establish requirements of a new system. Currently, the banks seem focused on cash inflows and minimal cash payments. It seems to me that raising interest rates for savings accounts and CDs would increase the volume of deposits and purchases of CDs even at rates up to half of that charged to its business and individual debtors. The banks, however, seem unwilling to pay out interest on savings and CDs at rates more than 2% of the banks' cost of money or to lower lending rates even when their cost of cash could produce 400-500% profit margins. Instead, absent government regulation, the banks are realizing profit margins for retail credit over 3,000%. When banks can buy money at 0.0-1.23% for their reserve requirements, investments and loans, they charge fees and interest for credit card receivables at unregulated rates of up to 35-40% per dollar owed, the card users provide not only cash related to principal, but also the free cash received from payments for interest and fees.
The Obama Administration did not succeed in reforming a banking system developed in 1934 because the U.S. credit-based economy remains insufficiently regulated to encourage savings, to stabilize the manner in which the banks make their profits from retail credit and mortgage loans. The federal infusion of cash prior to January 20, 2009, gave carte blanche without mandating terms and conditions for using those $ billions offered for the taking. After the Obama Administration set rules on the use of stimulus cash, banks could not pay back those funds quickly enough. Had Congress created a strong, national bank for regulating debt, cash reserves and currency value, then true reform could have been possible.
28 June 2009
Changes For Health Care Reform
I think this is my third or fourth post about changing the absence of a national health care plan in the US. As legislation is beginning to surface in Congress, you may want to send your representative in the House and your senators part or all of the bullet point opinions and recommendations.
I copied these from a letter I just faxed to Nancy-Ann DeParle, Counselor to the President and Director of the White House Office of Health Reform. I wrote to the President some weeks ago. I found Ms. DeParle's resume gave some insight into the several roles she has had that involve health care. She is Obama's advisor on these matters and her corporate, federal agency, private law practice, and investment firm experience and network are extensive. This can all be found by googling her name. The Business Week report of connections and the fact that she once headed HICFA, the predessor of CMS for Medicare. I think I have an inkling about the absence of public lobby organizations "at the table." And, yes, she is another lawyer in the White House.
Here is my input to her today:
HEALTH CARE REFORM
- We desperately need a federal, single-payer health care system, not a federal insurance program among private insurer plans based on employer-based procurement.
- We in this country do not have to reinvent the wheel for a national health service plan.
- The "donut hole" must go, entirely. Pharmacists should play a larger role in matters of policy and practice.
- All federal health care programs should be able to negotiate and receive the lowest prices for all procurement.
VETERANS HEALTH CARE
- Establish the Veterans Health Services (VHS) as a Medicare/Medicaid HMO to enable VHS to receive cost reimbursement and other financial payments the same as Medicare/Medicaid would to private HMOs.
- All veterans receiving Medicare and Medicaid would have the choice, without any means test, to enroll in VHS or in any other qualified HMO like Kaiser Permanente.
ENTITLEMENT PROGRAMS AND POVERTY
- The irony of Congress' requiring means tests, for limiting eligibility for federal programs, is that long-term, future federal entitlement expenditures will increase. We need a new paradigm not based on employment status or a means test.
- Create or require an operational auditing function for health care and entitlement program management of all public and private, public-funded providers.
FUNDING SOURCES
- Look into procurement activities while Cheney and Rumsfeld were in office. A governmental procurement activity deserves the lowest price of all customers. We have to raise taxes plus rearrange some budgets within the Administration.
I hope the current tweaking of the health care system's most visible injustices is only the beginning of full reform. Public health should include the means to keep the public healthy. We deserve better than what we have allowed to accrete into the current, complicated, complex fiefdoms of providers and insurers.
Iranian Political Reality and the US
Finally, on CNN's GPS with Fareed Sakaria today, a former CIA operative really explained the nature of "The Iranian Crisis." Mr. Bauer explained that the military, especially the elite units closest to the president, are trying to wrest control of the country from the rule of mullahs. He also said that this is an internal crisis that the people of Iran must settle for themselves. Paraphrasing him, the US should do nothing to interfere with these internal political matters. He also revealed how little intelligence information the US Government has about Iran. Bauer was last there, as CIA, in 2004. No one speaks or reads Farsi at the CIA anymore. To me, the lack of linguistic intelligence capability seems to coincide with Cheney and Bush's priority on Arabic while planning to invade Iraq. If any translators in training or in operation were identified as "gay" they were drummed out of the military, a stupid action by the Joint Chiefs of Staff, the Secretaries of State and Defense, that eliminated a key element in support of intelligence and of military combat forces. Certainly no one understood the histories of that portion of Asia or their social norms as evidenced by the US military actions and pronouncements in Afghanistan, Pakistan, the Caucacus republics that were part of the Soviet Union, in Iraq and in Iran.
It does not take much effort to read about the several civilizations as they came and went since the time of UR.
In Iran, the cycle of political leadership has been fairly consistent since the Seventh Century of the Common Era, often labeled A.D. Over the past 12 centuries, Persia or Iran has been ruled alternatively by the mullahs or by the secular forces like the military or a shah. Since 1979 CE, the mullahs have had control. Last weekend marked the beginning of secular political leadership. The mullahs will retain their resiliency, as always, because they are Shi'a, and because the Shi'a mullahs run their own public services for health clinics, education, welfare housing and food. [ Hezbollah uses the same methods to retain loyalists within the people of Palestine.] Each faction waits for the other to show weakness or vulnerability as its signal to resume political control of Iran.
Any threats to use military intervention for whatever reason, according to Mr. Bauer, are sabre rattling to appease Congress. In the meantime, by this coming Wednesday, all occupation troops in Iraq will have withdrawn from policing the cities. What might be happening in northern Iraq where the Kurds run things?
Change can happen. The problem with change is that the past tells us very little idea about the future. We overwhelmingly chose 'change' last November at the voting booths. I will wager that every voter had a unique idea about what "Change" would be like and how it would occur. Would continuation of the Bush/Cheney type of federal government, meaning 'better the Devil you know' reaction to fear of change, be better? All we know about the Obama/Biden initiatives comes from press conferences, television addresses and the position papers they have on their campaign web sites.
Labels: Attitude toward Change, control, cycle, history, intelligence sources, Iran, mullahs in charge, political, secular-mullah, translators
24 June 2009
Follow the Money - How?
Within the past month, I have received emails from a group called Organizing for America at "BarackObama.com." A small note at the bottom of the web site informs that this group is a project of the Democratic National Committee. An email on June 18, 2009, said:
Peter --
We've seen a tremendous response to President Obama's email this week and, as of today, an important milestone is within reach -- 100,000 donors to OFA's [Organization for America] health care campaign.
Many are new supporters who did not donate to last year's campaign but know how critical it is to end the broken status quo on health care.
Reaching 100,000* donors will send an unmistakable signal to the opponents of reform: the movement you built is prepared to knock on as many doors, call as many neighbors, and sacrifice as much time and energy as necessary to make health care reform a reality.
Please donate $5 or more today and put us over the top.
Thank you,
David Plouffe
---------Original Message---------
From: President Barack Obama
Subject: This is why
David --
Last year, millions of Americans came together for a great purpose.
Folks like you assembled a grassroots movement that shocked the political establishment and changed the course of our nation. When Washington insiders counted us out, we put it all on the line and changed our democracy from the bottom up. But that's not why we did it.
The pundits told us it was impossible -- that the donations working people could afford and the hours volunteers could give would never loosen the vise grip of big money and powerful special interests. We proved them wrong. But as important as that was, that's not why we did it.
Today, spiraling health care costs are pushing our families and businesses to the brink of ruin, while millions of Americans go without the care they desperately need. Fixing this broken system will be enormously difficult. But we can succeed. The chance to make fundamental change like this in people's daily lives -- that is why we did it.
The campaign to pass real health care reform in 2009 is the biggest test of our movement since the election. Once again, victory is far from certain. Our opposition will be fierce, and they have been down this road before. To prevail, we must once more build a coast-to-coast operation ready to knock on doors, deploy volunteers, get out the facts, and show the world how real change happens in America.
And just like before, I cannot do it without your support.
So I'm asking you to remember all that you gave over the last two years to get us here -- all the time, resources, and faith you invested as a down payment to earn us our place at this crossroads in history. All that you've done has led up to this -- and whether or not our country takes the next crucial step depends on what you do right now.
Please donate whatever you can afford to support the campaign for real health care reform in 2009.
It doesn't matter how much you can give, as long as you give what you can. Millions of families on the brink are counting on us to do just that. I know we can deliver.
Thank you, so much, for getting us this far. And thank you for standing up once again to take us the rest of the way.
Sincerely,
President Barack Obama
*If the figure is true, their goal is to raise at least $500,000 plus the donation is not tax deductible.
I do not appreciate such appeals for monetary support less than six months following a new President's election. I suspect the DNC staff found themselves about to join the ranks of the unemployed unless they could start a new fundraising project. In any event, the appeal assumes that Democrats want the Obama health care plan. This appeal also sends the message that reform will occur on the basis of financial dealings, not on principled policy changes.
I do not like the way the President and his staff have sought input to a plan that the President want to have bi-partisan support. Many of us, a significant number of progressives and liberals within the Party, and a large portion of the public (if polls are accurate) favor a major change and view a single-payer approach positively.
I decided to reply to this appeal without a donation and with my rationale for not answering my party's appeal for money.
David,My position on health care reform, is quite different from President Obama's. Further, it is my understanding that Candidate Obama received $45 million in campaign contributions from the health care and pharmaceuticals industries. My taxes, along with every other taxpayer, are my contribution to the President's reform plans, yet I or other taxpaying members of the public have not had a principal role in the development of the reform package. And we provide $trillions to the President's coffers. Why do we Americans have to reinvent the wheel in this? The Administration is accountable for the quality of the nation's public health, of which the current discussions represent only a means to achieve that public health entitlement implicit in the Declaration of Independence and in the Constitution of 1787.I want a single-payer health care system for all persons on our soil and for US citizens abroad. If private insurers want to offer supplemental products, more power to them, but they, the insurers, should not drive national health policy. As long as clinical standards and practices have to conform to multiple plans' rules, the administrative burden can only become greater due to normal inflationary wage increases. Also, the Medicare codes and its individual negotiations of acceptable payment rates with institutional providers continue to complicate efficient, effective and appropriate care and treatment.Many complain about the USPS and ask if we want out health care à la post office. I think that the USPS would do well, certainly better than our complex and needlessly complicated financing of health care. For $0.47, I can send a letter to the right recipient, even if that person lives in Manhattan or Coral Gables. One price for that service anywhere in the United States.The program being proposed by President Obama does not truly reform our health care system. Where are the price controls for treatment and care? Where are the price controls on pharmaceuticals prescribed by physicians? Where is the limitation on the indirect costs associated with providing health care? Where are the mandated appropriations for internal controls necessary for compliance by all providers and payers? It is in these areas that true reform must occur or else our health care expenditures will exceed the budget of the Department of Defense.Yours truly,
I wonder where these donations will go [to whom] and why are they needed? Other web sites using names that appeal to a targeted demographic, appeal for donations to save different endangered species, to implement or to support alternative energy and green building agendas. Because all of this fundraising occurs on the internet, the cost to ask for donations is minimal, especially if well-designed software keeps track of the addressees and the funds received.
My question still concerns the use of these funds donated over the internet and why an appeal for money is needed at all. The public can telephone, write and fax their views to the President, to the DNC, to our Congressional representatives and to the Secretary of Health and Human Services. If one must send money, find an organization that is already lobbying for your position, such as the California Nurses Association (CNA).
26 May 2009
"The People Have Spoken"
With this perverse rationale, the California Supreme Court upheld Proposition 8. I'm just glad that Lincoln didn't use that logic or that the U.S. Supreme Court did not use that rationale in Brown vs. the Board of Education in eradicating the "separate but equal" definition of acceptable public education in this country. Or, how about continuing to fund a war when over 75 percent of the public disapproves?
The very basis of our form of government articulated in The Constitution of 1787 is that one role of government is to prevent the tyranny of the majority to the detriment of an individual or larger minority. The prople have spoken. Well, this is what we Californians get when we have a state legislature that could not override the governor's veto. We get a misleading, crafty and confusing Proposition 8 on the ballot, in which "yes" meant "no" and "no" meant "yes."
The people have spoken. Narrow-minded, hypocritical, evil, unthinking, bigotted, stupid and religionists have spoken. I think I'll go watch "Superman" on tv.
Labels: discrimination, marriage, Prop 8, same-sex
Let Them See and Let Them Learn - Single Payer/National Health Service
I subscribe to too many RSS feeds and to too many newsletters online. This week I have begun to delete almost all but the few emails from people I know and those newsletters that continually provide provocative, well-written articles. Occasionally, I will subscribe to a web site because I want to voice my opinion or comment on an item I've read there. One instance involved a comment from a person in Texas whose logic and plain ignorance seemed to speak more about her lifestyle than about the article advocating a single payer health care system. I offered my response to her comments:
As the Congress, the Administration, industry groups, media and private citizens try to address the way to change how we obtain medical care in the U.S., some 19th Century Liberals, such as the Comment by Ms. VanArsdall of Dallas articulates, seem unable to comprehend the willingness and ability of our democratic society, our community, to have a birthright or right of citizenship to a healthcare system that seeks to enable us to be healthy enough to enjoy our human entitlements to life, liberty and the pursuit of happiness.
In our Declaration of Independence and in the Universal Declaration on the Rights of Man, entitlement to life infers the right to a condition of health that enables one's life. Contrary to Ms. VanArsdall's assertation, every developed country worldwide, with the exception of the United States of America, provides health care as an entitlement. Debates about health care coverage in those developed countries focus on taxes and costs, not on entitlement. The healthcare debates in the United States, the debate's primary focus is on entitlement and secondarily on taxes and costs. The parties seem to divide between those who consider health care as a benefit of being employed and those who consider health care as a human entitlement per se.
The public instructs our government through our elected representatives, but the public does not instruct private insurance companies, hospital owners, or any of the professional clinical providers of health care. Our government policies frame our health care system by establishing the cost-recovery rules it will fund for professional care and support.
In other words, our government decides how much it will pay for health care provided by any physician, hospital, clinic that agrees to the Medicare rates. The balance of the cost of providing care, at the present time, includes payments from insurance plans, from a charitable grant, and from private sources.
Those interested parties, over whom we have no control--yet--are participating in the debate are 1) the employers/unions who negotiate and pay private insurance companies for group coverage for the employed; 2) the private insurance companies who create and set prices for insurance products sold to qualified groups and individuals; 3) the pharmaceutical manufacturers who provide branded and generic medications; and 4) the hospitals, clinics, medical equipment companies and physicians who contract with Medicare and Medicaid.
Our President has yet to include representatives of the public and Senator Baucus refuses testimony from proponents of a single payer system. So we will have to rely on our elected representatives--excepting President Obama--to look after our best interests. Those groups who are at the table have thrown $millions into the campaign buckets of members of Congress. But, we, the public, have thrown $trillions into the government's till from which our Congressional delegates receive their paychecks, their healthcare group plan, their retirement plans and their costs of running their offices. The campaign dollars might buy an election victory, but none of those elected works on a volunteer basis. (I do not understand the power of a lobbyist as being more influential than the power of the voters who not only voted but also pay taxes to sustain them throughout their terms of office. See prior entry on Corruption.)
If a military veteran qualifies, the Veterans Health Services (VHS) provides comprehensive care, including pharmaceuticals and extended care, for free to veterans with service-connected illness or injury and from co-payments from other veterans. I have had excellent care from the VHS and it offers a proven program for a national health plan, aka a single payer plan. As far as influencing the debate, I doubt the VA will have little if any input considered, which is too bad.
Any person who is not covered by private insurance through an employers or individually--due to the current economic depression the number of people without insurance must be approaching 50 million men, women and children--who is not covered by government insurance through Medicare and Medicaid, has to pay for all costs of any health care he or she might need or forego treatment.
To sum up, our health care system seems based on a framework of having to earn one's healthcare treatments and care as an employee, a retiree or a qualified veteran. If one does not belong in one of these three categories of qualification, then a person must have enough money to pay for individual or family access to professional treatment and care.
I must ask, without order, the following questions for the participants in the current debate about health care reform:
- What is it in the American psyche that prefers government mandates to entitlements as a citizen? Why are we so passively willing to let others decide for us?
- Why do Americans not grow up assuming that institutions for health care are essential to "... life, liberty and the pursuit of happines" unlike those who live in Europe and most of Asia?
- Why don't Americans link their own health with their inalienable rights to lives or living, liberty and their pursuits of happiness?
- Why is this health care reform considered separately or distinct from a reform of the national public health programs? Is not individual health part of national health?
- How can the public, local and federal government (and the judiciary) allow private enterprise, commercial, for-profit insurance companies and pharmaceutical manufacturers control the quality of public health in the United States?
- Why are the costs of medical care always increasing at rates several times higher than the economy's inflation rate?
- Is the health care industry [insurance companies, hospitals and clinics, pharmaceuticals, specialty equipment, specialty technology for diagnosis and treatment] anti-competitive throughout or only in some ways?
- Do the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) contribute to the health care industry's anti-competitive nature by their regulation of research, development and approval for sale of drugs by brand versus generic manufacturing and merchandizing?
- Why do the President and members of Congress state their proposals assuming that participation by private insurance companies' products is a given?
- Why do the California Nurses Association and the SEIU state that their unions will not support any health care reform that includes private insurance companies? Why would the hands-on caregivers take such a definite stance?
- Why are employers allowed to change or to cancel health insurance coverage without sanction? Why are private insurers allowed to discriminate against customers for internally established, arbitrary and unregulated reasons at will, even retroactively?
Over the coming weeks, we will have to tell our Congresspersons and Senators what we want to happen in this radical reform. We should not have to impoverish ourselves before qualifying for public insurance coverage; we should not have to base our national health policies on ability to pay. Time is running out for us to influence Congress better than we did reforming credit cards, banking, or Wall Street.
