On Speaking To Power, Or, When Sanity’s Gone, There’s Always Satire

So everybody’s hearing the news, right?

There is a tentative debt ceiling deal, and this Administration and Congressional Democrats seem to have won everything they wanted: Republicans get to have multiple “we don’t approve” votes before 2012 on raising the debt ceiling, there won’t be any new revenue, there’s going to be another “hostage-taking” event around Christmastime, for many Democrats the issue of the Ryan Budget and the dismantling of Medicare is likely off the table for the 2012 electoral cycle, and the Administration seems to have figured out a way to not involve itself in shaping the way that entitlement reform will work out.

All in all, it’s some pretty slick negotiating, and I’m sure this Administration and Democratic Congressional leaders must be very proud.

Even on bad days, however, you gotta have some fun, and that’s why I’m encouraging everyone to take a minute today to say #thanksalot.

“This is tremendous, Don, just tremendous. The atmosphere heavy, uncertain, overtones of ugliness; a reminder in a way of how it was in March of 1964, at Miami Beach, when Clay met Liston for the first time and nobody was certain how it would turn out.”

--Howard Cosell, from the Woody Allen movie “Bananas”

There are a thousand other people today who will detail exactly where this went wrong, but I’m all about at least sending some kind of message; in order to say “thanks a lot” I’ve been Tweeting satire to the White House, and I’m hoping you’ll take some time today to do the same thing, using the #thanksalot hashtag.

“But I don’t Twibble, or Twister, or whatever they do on twitter”, you might say “and I don’t really get how it works”.

No problem.

If you want to send a message to a twitter user, you just put an “@” in front of their name, as in @whitehouse, usually right at the beginning of your message.

Hashtags are keywords that allow for lots of similar messages to be located, all together; when you put an “#” in front of a “word” it becomes a hashtag, as in #thanksalot or #arentyoutiredof. Popular hashtags become “trending” hashtags, and that’s one way how you make a big public statement on twitter (“Retweeting” someone else’s message is another way it’s done; retweeting and the sending of hastagged messages often occur symbiotically.)

Just to get you in the sarcastic spirit of the thing, here are some of the Tweets I’ve sent so far today:

@whitehouse Obama visits fallen building, a collapsed trench, and Carlsbad Caverns; says he'll "never cave" on debt deal. #thanksalot

@whitehouse republicans propose "logan's run", obama seeks reasonable compromise. #thanksalot

@whitehouse offers 1 Wet-Nap for each American thrown under bus yesterday; Republicans protest new "entitlement" #thanksalot

@whitehouse Prozac pill commits suicide; says in note that White House caving once again is "too depressing" #thanksalot

@whitehouse To avoid uncertainty in December, Obama Administration announces today they're caving on Bush tax cut extension #thanksalot

@whitehouse Dec. 23, 2011-Boehner: "We'll agree to revenue increases when both houses have a clean vote to repeal Obamacare..." #thanksalot

@whitehouse Dec 25, 2011-Administration announces entitlement compromise: cat food now food stamp-eligible #thanksalot

@whitehouse Obama Administration announces they prefer to negotiate with hostage-takers: "It makes us feel less guilty..." #thanksalot

@whitehouse Obama Administration "feels America's pain", announces nationwide program to distribute K-Y after debt deal #thanksalot

@whitehouse is there some sort of political viagra that could make obama "stand firm", just once? #thanksalot

At this point it looks like the only way this stinker goes down is if House Democrats vote against this bill and take the “Debt Ceiling Sword of Damocles” that the President has placed over their heads and put it right back on his, forcing either a 14th Amendment solution or a “clean” debt limit increase; if they do they not only stop this next hostage-taking dead in its tracks, but they create, for this Administration, the same level of fear that the Tea Party has today, and if that happens, then we move into the next stage of debt reduction negotiations from a position of strength.

If they fail to stop this deal, then when Medicare gets whacked in December the Democrats become co-conspirators – and at that point, for a Congressional Democrat up for reelection in ‘12 it’s gonna be either go down with all the other incumbents or run against Obama.

And at that point, the most interesting political question might be: did Obama depress turnout enough to cause Democrats to lose even more seats in Congress, or, when the details are better-known, is there going to be a huge “throw out all the bastards” vote that hammers Republicans just as ferociously as it does Democrats?

And what about Michelle Bachmann?

I don’t know, but it should be quite a soap opera between now and then, so stay tuned, make sure to say #thanksalot…and then do it a few times more…and most importantly of all, try to have as much fun in a bad situation as you can.

After all, as long as it’s happening to everyone else, it’s still comedy; until it finally does hit you…it’s not yet officially tragedy.

On Running Your Own Government, Or, Why Pay The Military?

I have not been talking about the insanity around the debt ceiling and debt and deficit and the efforts of Republicans to drive us all off the cliff, but I am today – and I’m going to do it by allowing you to grab ahold of this problem and see for yourself just how unbelievably bad this manufactured crisis is going to be.

You will hear a lot of conversation about the consequences from others; today, however, you are going to get the chance to be both the President and the Secretary of the Treasury, and you will get to decide for yourself exactly what bills the Federal Government should and should not pay as the cash runs out if a deal is not made by the time borrowing authority runs out.

At that point you’ll be able to see what’s coming for yourself – and once you do, you won’t need me to tell you what ugly is going to look like.

“…no state has the right to secede unless it wishes to…[and] it is the President’s duty to enforce the laws, unless somebody opposes him…”

--William H. Seward, deprecating President James Buchanan’s efforts to preserve the Union, as quoted in the book “Battle Cry of Freedom: The Civil War Era”

So before I go sending you off to take the reins of power, let’s fill you in on a few things that you’ll need to know.

If no one has explained it to you yet, the Great Big Fuss that is going on right now is set around two issues: there are those who feel that the best way to make this economy better is to ensure that the Federal Government is a smaller player in our economy and not running on a deficit; many of these folks feel the way to achieve this is to make immediate, drastic, cuts in Federal spending.

At the same time, the United States has run up against its “debt limit”. That means the US will be unable to borrow money to fund ongoing government operations, and as you’ll soon see, right now we borrow a lot of the money we need to run today’s Government.

So if you are one of those who seeks to immediately cut Federal spending, you could force that to happen by refusing to allow the Federal Government any more borrowing authority; the fear of what could happen after that is presumably going to force the opposition to accept any deal, no matter how draconian, just to obtain that borrowing authority.

Naturally, the bigger a hostage you’re holding, the more draconian of a deal you hope you can make, and holding the “Full Faith and Credit of the United States” hostage is about as big as it gets; that’s why the Republicans are pushing for everything right this very second, from the end of Medicare and Medicaid to the right to mine uranium right next door to the Grand Canyon.

So with all that in mind, let’s talk money.

In the month of August, the Federal Government is expected to take in $172.4 billion.

There will be a mess of bills that are coming due during the month; that amount totals $306.7 billion, and that means about 44% of the bills must go unpaid.

Where’s that money go?

The Big Five are interest on current debt, which must be paid to avoid a default, payments due to defense contractors, Social Security, Medicare, and Medicaid; the five of those, alone, will be just about $160 billion.

And that leaves $12.4 billion to fund everything else the Federal Government has to do.

That would include the remaining cost of supporting our several wars, the entire Federal law enforcement establishment (for example, the FBI, DEA, ATF, Immigration and Customs Enforcement, the TSA, the Border Patrol, the Federal Marshals’ Service and the Bureau of Prisons), the National Parks Service and the Forest Service, the Centers for Disease Control, the Weather Service…well, just about every single thing the Federal Government does, except the Big Five.

So that’s the situation – and now it’s time for you to become the boss and make the choices:

The fine folks at Bloomberg Government have created an interactive tool that allows you to point and click your way to figuring this stuff out.

You will find your spending choices, and you just click on what you want until you run out of money, which the handy bar on the left will manage for you. When the bar turns red…you’re out of money.

“…Each month, I put all my bill collectors’ names in a hat, reach in, and pull out a name. That’s who I pay. If you keep calling here, then your name is not going in the hat next month.”

--Steve Harvey, quoted in October 2003’s “Vibe” magazine

OK folks, so now you know where to go, and you know what to do, so let’s make something happen.

Take this tool and use it to create a conversation about just what really is at stake, and watch the look on your friends’ faces when you point out that the entire Federal Government is about to go out of business if Republicans have their way.

I’d tell you the looks on their faces would be priceless – but that’s not true.

Absent a debt ceiling deal, the price is actually going to be about $134 billion, which is the money we’re just not going to have next month, when we’re not doing things like paying for the salaries of active-duty servicemembers or food inspectors or the guards out there at the Supermax.

It should be a fun time, all the way around – unless, of course, you’re one of the 300 million or so of us who are gonna get screwed over by it all.

On My Last Weekend, Or, Wanna Save A Few Trillion On Health Care?

So I disappeared for a full week, right in the middle of what should have been a busy writing schedule, and I have to claim some “personal days” to cover the time we missed here at the blog – but it won’t be time entirely wasted.

Instead, I’m going to jump into my own personal life for today’s story, and I’m going to do it so that we can stimulate some thinking about where we really need to go to if we ever hope to make some sense out of the crazy way we deliver health care in this country.

Since this appears to be the weekend that a lot of decisions are either going to be made about the future of our “social safety net”…or they wont; we’re entirely unsure…let’s talk about how it actually works for a lot of us – and how it could work a lot better.

But the worst part of the Industrial Revolution – and the part that has never been documented – is what happened to the role of managers. The owners of factories realized they needed a layer of insulation between themselves and the people they were exploiting. They needed the type of people who were incapable of understanding the workers’ pleas for common sense, decency, and safe working conditions. The owners wisely chose managers for these roles.

--Scott Adams, from the book “Dogbert’s Top Secret Management Handbook”

So as most of you know, I am a blogger, and that means, for better or worse, that this is how I’m trying to make a living – and as a result I, along with about 50,000,000 other Americans, find myself on the DGS Health Plan (never heard of DGS? It’s the “Don’t Get Sick” Health Plan).

So what do I do? The same as a lot of you: I don’t get sick.

And up ‘til now, it’s worked out surprisingly well, even though I weigh more than I should and I have a coke addiction that can see me consuming as much as 2 liters in a single day…but by last Friday I had one of those tooth twinges building up that you know is not going to end up well.

By Friday night things were getting bad enough that I had to tell The Girlfriend that we were very likely to be going to an Emergency Room, if not that night, certainly by morning – unless things cleared up on their own, which, if you’re an optimist, could happen.

So much for optimism.

Midday Saturday we’re in downtown Seattle and I’m waiting in line to be seen by an intake clerk, then a triage nurse, and then a financial counselor, because there’s no way I can really take on a big medical bill.

I’m lucky that Washington State has a “Charity Care Law”; that law requires Washington’s hospitals to accept all comers at the Emergency Room, regardless of ability to pay – and there’s been a considerable increase in demand over the past four years.

(The Department of Health reports that $591 million in such care was provided in ’07, and in the last year for which numbers are available, ’09, the same cost had run up to $846 million; that’s a 43% jump in just two years. The odds are pretty good that the ’10 and ’11 numbers will also show an increase that’s well above the rate of inflation.)

Anyway, after that they showed me to a sort of mini-Emergency Room facility, I was examined by a Medical Student and his Instructor, and they decided that maybe a CAT scan would be a good idea, just to determine exactly how badly and how widespread this infection might be.

I rode the ride, an assessment was made, and it time to offer up my various elbows to my Medical Student, which left me with a couple of bruises that are still healing, and him with a couple of experience points.

More assessment followed the return of the lab results; as a result I was given a prescription of a rather unpleasant antibiotic that I’ll be taking for a few more days, but all in all, for me, things worked out pretty well.

That said…imagine if I lived in Canada.

First thing, I waited longer than I should have with this infection, and if I had a General Practitioner with whom I had an ongoing relationship, I would have gone there at least a day sooner.

That delay imposed a few costs: I had that CAT scan, took up ER time and a mini-ER suite; instead I could have made an office visit, and probably walked out with a prescription for the same antibiotic with a quick exam or just a blood test.

There is no financial counselor in Canadian healthcare – instead, you present your Provincial insurance card, and that’s that. For those not aware, Canadian healthcare, for the most part, works like American care, except there’s only one insurance company, and that’s each Province; they also collect taxes to fund the services.

That means providers only deal with one insurer, and all of that cuts a lot of administrative expenses out of the system. It also means patients never have to worry about whether their provider will be “in the network”.

(Fun Fact: bankruptcy is now a big part of the American medical system. In 1981 8% of bankruptcies were related to medical costs, but by 2007 that number appears to have grown to 62%, all this according to the Journal of the American Medical Association. Three-quarters of that 62% had medical insurance.

Canada does not have a medical bankruptcy problem of statistical significance.)

When you add all this together, it begins to explain how it’s possible that Canada can insure all their people for about 11% of their 2009 Gross Domestic Product (GDP) when we pay about 17% of GDP and still leave a huge portion of the population either completely uninsured or unable to pay for care even if they have insurance, due to what won’t be covered when the bill comes in at the end of the month.

(Fun Fact #2: Sweden, Switzerland, France, Germany, Iceland – in fact, any country that you can name on the face of the Earth – pays less than we do for their health care.

By a lot.

When it comes to the cost of health care, the USA is #1.)

So it’s not all skittles and beer, up there in Canada. You might have to wait a while to get some types of care, and it appears that there’s an element of “rationing by waiting period”, which is a constant source of complaints up there. (The counterargument is that rationing of some sort is required in any medical insurance scheme; otherwise, you’ll have folks at the doctor’s for no reason at all, and that’ll quickly drive a system broke.)

There are co-pays, for some services, and no coverage for others, depending on your Province, (nonemergency dental and vision are often not covered) and that can lead to some out-of-pocket, but for the most part taxes cover the bills.

And just as we in the USA are struggling to pay for medical care, so is everyone else: controlling medical costs are hard, for a variety of reasons, including the cost of paying medical professionals to do work in a dangerous environment that can often be hard to automate.

Dangerous, you say?

In healthcare, back injuries, frequently caused by overexertion, occur at a very high rate. Healthcare industry workers sustain 4.5 times more overexertion injuries than any other type of worker…According to national statistics, six of the top 10 professions at greatest risk for back injury are: nurse's aides, licensed practical nurses, registered nurses, health aides, radiology technicians, and physical therapists.

So the other reason I’m having this conversation today is because I was having a talk with a very nice gentleman just about 48 hours ago who is a bit more Conservative politically than I, and he wondered how I felt about “Obamacare” (formally known as the Affordable Health Care Act).

I’m not a big fan of that plan, I’m not, and that’s because I’d much rather do something like expand Medicare to everyone, or “go all Canada”; either choice seems simpler and easier and doable at far lower administrative costs than any plan that relies on private insurers, as the Affordable Health Care Act does.

So there you go: that’s how I spent the weekend, and a couple of days after to boot, and if we were living in Canada I could have had the same problem, but it would have cost the healthcare system a whole lot less money – and when everyone gathered at the White House today, I wish that’s what they had been talking about.

Obama Wants To Attack The Middle Class? Take Congress Hostage!

By now you have heard that President Obama has chosen to throw Social Security and the Medicare and Medicaid Programs over the side of his proverbial fishing boat as bait to see if he can get Republicans to give him another really lousy compromise, much as he did last December when he gave up billions upon billions of deficit reduction in order to help Republicans preserve tax cuts for billionaires.

And it looks like the President doesn’t really lose if you or I get hurt here: in fact, it seems that, in his eyes, it’s to his advantage to fight against his own base as he seeks to be “the adult in the room” in the runup to the ’12 election.

So we’re going to have to find a way to put The Fear on this guy – and I think I’ve got a plan to force this President to listen.

And it works like this: if this President ain’t gonna be moved by our message…we do it by holding the rest of his Party hostage.

"You've got to put the points on the board. Good effort and style aren't enough. Everyone loves the Chicago Cubs, but no one expects them to win. Be more like the New York Yankees."

--Greg Swienton, COO of Ryder Systems, advising Army NCOs at a leadership seminar, July 2009.

First things first: let me tell you how the hustle is potentially going to go down.

Republicans are going to try to force Obama to offer up 100% cuts in spending, with no new money coming in to Government at all, or they’ll let the whole “debt default” thing come crashing down, which looks like The Best Thing To The Tea Party Ever – and based on past history, this is a deal that Obama, around 11:56 PM on August 1st, will be willing to take.

The two most likely ways to cut spending and get results in the trillions of dollars are to change the connection between increases in your future Social Security benefits and the cost of living (which guarantees that you and I will forever be behind the inflation eight-ball), or to cut the payments coming out of Medicare or Medicaid, which is going to stick it, immediately, to medical service providers, the poorest of the poor, your Grandma and Grandpa (or, maybe, you), and the disabled.

It is rumored that both of these approaches have been put out as options by the President. It is also rumored that, in return, he wants some amount of revenue increases – but it’s also rumored that he went from seeking a dollar in cuts for each dollar in new revenue to something that looks more like $6 in cuts for every $1 in new revenues – with lots more time available for Republicans to play chicken and get even more.

So if the President is not going to put a stop to all this, I think we, ourselves, are going to have to step up and get it done.

What I’m going to propose is brutal, unfair to many of our friends, and vindictive to the point of risking an even worse situation than we have now…but these are desperate times, and I suspect it’s now time for desperate measures.

So here’s what I think we have to do:

Now, today, before this gets any farther, we have to call every single Democratic Member of Congress, House and Senate, friend and foe, and deliver this message:

“I don’t care what you ever did for us before, we are not going to let you do this to us now. We cannot stop Barack Obama directly – but we can do this.

We can target Congressional Democrats.

Each and every one of you, as a group.

And with that in mind, you are now on notice: if you allow this President to make a deal that includes any cuts, adjustments, alterations, or anything else, to Medicare, Medicaid, or Social Security, and you don’t get at least a dollar of new revenue for every dollar of cuts…then you are done.

We will immediately stop giving any Democratic incumbent even one dollar of donations, we will not help you win elections by volunteering – and we will vote for any candidate that’s running against you in the next primary.

Even if it’s not your fault.

That’s how serious we are, and that means you better figure out, right now, how to stop Obama from caving…because now, it’s all on you.

If Obama slips on the stairs and his pen accidentally signs the bill…it’s now your fault.

If Obama puts his pen back in the desk set upside down, and there’s an open window in the Oval Office, and an errant breeze drags the bill across the upside-down pen… it’s now your fault.

So what you better do is you better go make sure there aren’t any roller skates on the stairs at the White House, and go close the windows, and do whatever you have to do, because now, you, and every other Congressional Democrat…all of you, together…are going to be held responsible for what happens.”

And then we gotta stick to it – even if it costs us Jim McDermott and Raul Grijalva and Barney Frank, all on the same day.

We have to show that we will bring even more wrath and destruction than the Tea Party – and we have to be ready to support new Democrats who rise up to oppose the current ones.

And consider this: Labor is already making the effort to recruit and train Progressive candidates, and there are lots of opportunities to partner with unions who would presumably love to have some new partners of their own.

The next negotiating session between the President and Congressional leadership is Sunday, and that means we need to move fast if we want this to work – but Sunday is unlikely to be the last day of negotiations, and after that is when we can really crank up the pressure on Democrats.

Is this unfair to our friends?

Yup.

But that’s too bad, because we have been unfairly taking hits from our friends and Republican bullies alike for three years now - and the only thing that’s going to make it stop is if our friends fear us more a whole lot more than they fear Republicans.

And if you don’t think this can work…well, guess what? The LBGT community got “Don’t Ask, Don’t Tell” repeal passed when Republicans said they would never let it get through Congress – and then the LBGT community told Democrats that if repeal didn’t pass…the gAyTM was gonna be forever closed.

And then, mirabile dictu, repeal passed, in a lame-duck Congress, even when virtually all observers had said it had no chance.

That is the power of The Fear, and if we want to win this fight, we need to be the ones putting The Fear on our Democratic friends, not the other way around.

So get up, grab the phone, and start reminding the nearest Democrat that unemployment, in this economy, really, really, sucks – and there’s no reason in the world why they can’t be just as unemployed as anyone else.

It’s time for hardball, folks – and in this fight, we need to be the ones with the hardest balls.

Because if we’re not…the terrorists win.

On Killing Medicare, Or, You Stand Up, They Run Scared

Oh, my, has there been a lot of news since we spoke last about the Potential Impending Death Of Medicare: obviously we’re going to have to talk about the implications of Osama Bin Laden’s death (but we’ll do that another day), President Obama very publicly congratulated Donald Trump for having the leadership skills to know that Gary Busey was the one who needed to be fired after the way he ran the men’s cooking team on “The Apprentice”, and, of course, there was that “extreme ironing incident” on the M1 near London’s Mill Hill.

But what you may not have noticed is that in the past two weeks the Grim Weeper himself, Speaker of the House John Boehner, has gone from saying “I fully support Paul Ryan’s budget, including on Medicare” to saying that the Paul Ryan “Let’s Kill Medicare” plan is “an idea … worthy of consideration”—and when that happens that quickly you know somebody applied what we might politely describe as being at least “an equal and opposite force”.

And what I’m here to suggest today is that the opposite force in question…is you.

When I left for college, I was determined never to be a victim again. I would take my lead from the Hollywood tough guys I had always looked up to: Charles Bronson, Clint Eastwood, Ned Beatty. So on Day One of my freshman year at Dartmouth, I walked into class and punched the first person I saw—my Ethics professor, Dr. Buneta.

--From the book “I Am America (And So Can You!)”, by Stephen Colbert

So as we said, it just a couple of weeks ago that we were talking about the then-underway Congressional Recess and killing Medicare and how you could go make yourself well understood by your local member of Congress; people did exactly that, and all of a sudden the backpedaling was under way.

As we mentioned, back then it was full speed ahead for the Ryan budget plan—but two weeks of facing the voters later, Michelle Bachmann, the Chair of Congress’ Tea Party Caucus and the Woman Who Would Usurp Sarah Palin, says that:

I supported that budget blueprint, though I’ve expressed caution about how we approach the issue of Medicare. We must keep our promises to those who receive Medicare benefits, and those who are nearing the age of Medicare eligibility. Our challenge is to reduce the soaring amounts that government spends on health care, without burdening those who are most vulnerable.

And it’s not just her: virtually no legislation moves through the House unless it first clears the Ways and Means Committee, and Chairman Dave Camp says this about the Ryan plan…

“I am not interested in laying down more markers. I am interested in solutions.”

…and that is his way of saying Ryan’s proposal is toast.

Beyond that, it looks like the Republicans’ most immediate “tactical” effort, tying big cuts in the program to an expansion of the Federal Government’s “debt ceiling”, is also coming apart at the seams; to that end we have the Republican House leadership now suggesting that they understand the urgency of passing the debt ceiling even if the Medicare “reforms” are not in that agreement.

(There is, however, an element of uncertainty still extant: Speaker Weeper spoke to the Economic Club of New York Monday; he told them he’s going to attach lots of conditions to that debt ceiling extension, after which he went off to a private spa to be dipped in whatever orange liquid they use to obtain his peculiar hue.)

Republican Representative Joe Walsh, of Illinois’ 8th, says that he would like to see the Party continue to push the Ryan plan as an issue in the ’12 campaign. That might work well in certain Congressional races, but it would seem to be a problem for any Republican Presidential candidate—and we should note that Walsh himself was elected in ’10 with a very narrow margin of victory.

So that’s all good news, but it’s probably not the end of the story…and if you ask me, the next battle is going to look more like no battle at all.

Here’s what I mean:

A great way to negotiate a deal is to start out with a crazy demand, and then, when that idea falls off the table, come back with something slightly less crazy that looks good enough to the other side to be acceptable.

Another variation on this theme is to start out with an extreme demand, and then you “meet somewhere in the middle”, which ends up moving the entire negotiation farther in your direction than you might have ever achieved by “normal means”.

You would think Democrats would be smart enough to not go along with such a strategy—but with Osama dead, and the “Democrats are soft on defense” argument getting tougher to make all the time, there is going to be a ton of effort going into the ’12 campaign to show that Democrats are “soft on the deficit”, and there is a real possibility that this Administration and certain Democrats in Congress will be susceptible to some of that pressure.

This will begin to play itself out, I suspect, as the effort to reconcile the budget visions offered from the House, Senate, and Administration continues through the summer—and if you want to get a sense of how that battle might look, check out today’s hearing (“Perspectives on Deficit Reduction: Social Security”) before the Senate Finance Committee.

Senate Finance is Max Baucus’ Committee (Orrin Hatch is Ranking Member), so this is a Blue Dog Chairman; he’s also one of those who might be happy to make compromises to “lower the deficit” that we won’t like—including supporting cuts to Social Security or raiding the Social Security Trust Funds.

One way that could be done…very quietly…would be to put a cap on all Federal spending, and then lower that cap by some amount each year, ignoring the fact that Social Security has its own funding source and is in no way connected to the deficit—and they tell me that’s what Nancy Altman, the co-chair of Strengthen Social Security, is going to be saying to the assembled Senators today:

“Social Security lacks the legal authority to deficit-spend, and so, cannot run a deficit. Because it cannot run a deficit, it cannot add to the federal deficit…

Some policymakers are proposing a so-called universal cap as a mechanism to control federal spending. It is important to understand that unlike the general fund, Social Security already has an automatic spending cap. If Social Security were ever to lack sufficient revenue to cover the cost of scheduled benefits, the law provides that those benefits be reduced automatically

To include Social Security in deficit legislation, even with the explanation that the inclusion has nothing to do with deficit reduction, risks reinforcing the widespread belief that Congress is raiding the trust fund…”

(Full Disclosure: I’m associated with the Campaign for America’s Future, and they’re part of Strengthen Social Security.)

It’s a short story this time, so let’s wrap it up here: we’ve had great success this past couple of weeks convincing pretty much every politician in the United States of America that Social Security and Medicare/Medicaid matter to us, and that getting crazy with these programs really is political suicide—but these programs have been under assault since the very day they were born by people with their own agendas and more or less all the money in the world to fund an endless series of fights…and you can kill a popular program in subtle ways that most voters might not even notice until it’s too late; with all that in mind, this one very big victory is not a war finally won.

The shape of the next fight is going to be made more visible today, and I would encourage you to swing by C-SPAN to see how it went

Even more importantly, I want y’all to think about what this past couple of weeks really meant: we went out in force, and we scared the hell out of the politicians who thought they would slam through some major changes that we’d just somehow…accept.

Democrats and Republicans alike need a bit of direction as this electoral season gets underway, and the messages we send out there obviously have the power to turn an entire discussion, so look at what you did, let it give you a bit of confidence that you can have an impact…even in this seemingly impossible year…and then let’s get ready for the next fight, which is going to be just as rough, and just as high-stakes—but this time much of the action will be subtle and deliberately “obfuscated”, and we’ll have to be even more alert if we want to see the scam before it gets set into stone.

And of course, we’ve got to keep showing up for those “Town Halls”, eh?

FULL DISCLOSURE: This post was written with the support of the CAF State Blogger's Network Project.

On Fighting The Madness, Or, Send This To A Deather

We are coming down to the home stretch on healthcare, and we have seen the results of the first couple of rounds of crazy that have been sent forth in an effort to stop the process.

In addition to the Town Halls, opponents are flooding the email inboxes of America’s “low information” voters with no end of lies. Those emails are getting passed around and around and around, and by now some of them have probably appeared in your inbox.

But it’s summer...and who has time to respond to this stuff?

Well, guess what, Gentle Reader: I’ve already done the hard work for you.

Today’s story is an email response that you can send right back to your “inbox friends”. It’s a reminder of some of the frustrations that we all share in this country and some explanations of what’s being proposed...and a few words about socialism, to boot.

So get out there and copy and paste and forward and reply, and let’s see if we can’t fight the madness, one email at a time.

There is a whole lot of talk about health care reform these days, and a lot of it is designed to be confusing, instead of helpful.

To cut through some of that confusion, let me ask you a simple question: is your health insurance stressing you out more than it should?

If you worry about paying for drugs you might not be able to afford, if you don’t go to the doctor as much as you should because you recently pawned your last gold bar to cover a margin call on your AIG stock...or if the odds of getting your insurer to take care of what you thought they’d cover are lower than hitting 13 on a double-zero roulette wheel...we need to talk.

This conversation won’t be about death panels or secret camps or black helicopters or any of that silly stuff. Instead, let’s talk about a few things that we’re probably all worried about, and then let’s talk about some ideas that might make things better.

So first off, why do we even need reform?

How about because we pay about twice what the rest of the word pays for health care—and we don't get good value for the money.

The US spends almost three times as much as the UK, and twice as much as Canada, per person, for health care—and of the top 50 countries in life expectancy...we come in 45th.

Canada, the UK, Cuba...and 40 other countries...also have lower infant mortality rates than the US.

That is not good; and over the long term it's killing businesses and, by extension, the larger economy. Not to mention, as consumers, we deserve better.

We also want to provide for the nearly 50 million Americans that have no coverage at all, for a couple of reasons:

First, it's extraordinarily expensive to have uninsured people showing up at the emergency room. For a good example, consider the cost of treating a relatively simple cholesterol problem with drugs instead of a paramedic response, an ambulance ride, and heart surgery followed by a stay in the hospital.

The average family with health insurance is today paying about $1000 a year in extra premiums that they wouldn't be paying if we could find a way to cover those 50 million people—and if my guess is correct, there are a lot of families that could use the extra $1000.

And for what it's worth, not having insurance is already killing about 18,000 Americans every year.

So that's the uninsured...but what about the insured?

Right off the bat, here's something you should think about: we can expect the cost of the average family's health insurance premium to double by 2020 to roughly $23,000 a year...which is almost $2,000 a month.

If we can't slow that rate of growth, there's going to be a whole lot fewer people getting health care through work—and for several years now employers have been trying to get workers to bear a larger portion of their health care costs.

Plus, insurance companies are increasing profits by looking for more and more ways to cut off policyholders, or by refusing to renew insurance for those clients who do file claims.

And once you get cut off, no one else is likely to allow you to purchase insurance...which means the number of uninsured is growing all the time.

We have also seen the cost of deductibles go up (with $5000 to $10,000 deductibles looking like the wave of the future)—and all of this means that insurance companies are doing great, while the customers are getting the short end of the stick.

Did you know that more than 60% of the Americans who filed for bankruptcy in 2007 did so because of medical bills? That's not all: more than ¾ of those 900,000 or so newly bankrupt families had health insurance when they went broke.

What about this whole "putting bureaucrats between me and my doctor" thing?

How many people have health insurance that requires pre-approval for procedures or pre-approval to see specialists, or drug formularies that charge different prices for generic and brand-name drugs?

All of those things exist because of insurance company bureaucrats that at this very moment sit between you and your doctor.

So those are some of the problems.
Here are some ideas about how to make things better:

—We could tell health insurers that they can't use "preexisting conditions" to deny people coverage, and that they can't just cut people off for the crime of needing care. This allows more people to have access to health care, and it also reduces bankruptcies, since insurers wouldn't be allowed to simply deny coverage when claims come in, leaving families to pay both the health insurance premiums and, later, the medical bills.

This is the least controversial part of the reform plans before Congress today.

—There are proposals to create more competition among insurance providers, the idea being to use market forces to keep private insurance companies from drawing so much money out of the system as profit. This would be in the form of one or more insurance plans, operated by some new entity, for which members of the public would be able to "buy in" and get coverage that they can't get today.

The idea here is to create a large new pool of insured persons, which allows the insured group to negotiate for better prices on drugs and procedures and office visits and medical equipment—and if you allow anyone to sign up it can force private insurers to either match the price of the "public option" or lose customers.

Businesses would be required to either pay for coverage for their workers or a tax if they don't. Small businesses would be exempt, but we are not sure how small exactly "small" would be as of today.

This public option proposal is very controversial, and insurance companies are spending over a million dollars a day to shut the idea down before it gets out of Congress.

—The most controversial reform proposal is to create a "single-payer" system, which is what Canada has today. At the moment, this is not likely to be part of the program that comes out of Congress, if any program does.

In the Canadian system, people keep their own doctors and the Province where you live becomes the insurance company. You go to your doctor, who then bills the Province. Everyone is entitled to an insurance card, which means everyone has coverage. All of this is paid for with tax dollars.

That's also how Medicare works, and there are people who suggest the best way to do healthcare reform would be to simply enroll everyone in Medicare.

The catch would be how to control costs while providing care for all, and that's the last thing we'll talk about here.

Right now it looks like it would cost about $1 trillion, over ten years, to provide coverage for roughly 50 million people.

Remember the conversation we had about how treating high cholesterol problems with drugs is cheaper than treating heart attacks? It turns out it's so much cheaper that about $700 billion of that $1 trillion can be found with that change and other similar changes, like treating people before they have diabetes instead of dealing with the disease later.

That leaves us roughly $250 billion short. In 2003 we gave a substantial tax cut to people with especially high incomes, and Obama has proposed ending that tax cut. This would cause people making more than $1.2 million a year to return to the same tax rates they had from the 1990s until 2003.

If the public option is made widely available, the insurers tell us, private industry could never compete...but that's not as certain as insurers would want you to believe.

Consider the electricity market: in Washington State, Puget Sound Energy, a private company, operates side-by-side, literally, with "public options" like Seattle City Light and Snohomish PUD, and seems to be doing just fine—and they've been doing just fine for roughly a century.

A final point: there is a lot of talk about how government providing health care is "socialism".

Maybe it is.

But you know what? In America we also have socialized police and firefighting and EMS, and socialized streets and roads and libraries and sewers and airports and Post Offices...and socialized National Defense.

And if you really want to talk about the Founding Fathers and socialism, consider this: among the original 13 Colonies were the Commonwealths of Massachusetts, Pennsylvania, and Virginia.

Add in the Commonwealth of Kentucky, and four of the 50 stars on our flag today represent places that are known not as States, but instead as "Commonwealths"...which, oddly enough, is both about as American and as socialist as you can get.

How's that for a lot of stuff to digest?
To finish, let's summarize what we have.

There are a lot of reasons we want to do some sort of reform:

—we pay more than anyone else in the world for health care, but lots of other countries have longer life expectancies and lower infant mortality rates.

—we need to do something about the nearly 50,000,000 Americans who have no access to care outside of the emergency room, both for moral and for economic reasons.

—in 10 years the cost of health insurance will be somewhere around $2,000 a month for the average family. Businesses cannot afford this, so as time goes on more and more people who now have coverage through their jobs...won't.

—if nothing changes those who are able to keep their insurance at work should expect their employers to move to plans with $5,000 to $10,000 deductibles.

—every year, almost 900,000 American bankruptcies are related to health care costs. 3/4 of those people had insurance, but their insurers refused to cover their medical bills, and they went broke.

—if you have a significant claim, or you lose your job, you stand a good chance of losing your insurance, which means you are not very likely to be insurable again.

We talked about some reform ideas, with protections against "preexisting conditions" and cutting people off for having claims being the most likely reforms to be turned into law, a "public option" being less likely, and "single payer" being highly unlikely.

There is money available to pay for this. Roughly 2/3 would come from treating the uninsured in cheaper ways than we do today, and the other 1/3 could be raised by letting a tax cut for very wealthy people expire.

The good news here is that lots of other countries are doing better than we are, and spending half the money we are doing it; which means there are solutions available that do work and do save money.

If we can put some of those solutions to work here, it would probably help us, too.

On The Costs Of Care, Or, You Don’t Want Every Item On This Menu

I don’t know if you’ve been thinking about it, but the costs of long-term care have been on the mind of some friends of mine lately.

For reasons that we won’t go into here, they are in the process of pricing long-term care at care facilities…and yesterday afternoon, we had a chance to have a look at the “menu” of services (the facility's term) that can be purchased at this particular location.

If you are facing this issue in your own family, if you are a taxpayer thinking about how we plan to fund long-term care in the future…or if, one day, you expect to be old yourself…this conversation will surely matter.

To protect the innocent, I won’t be mentioning names today, but here’s what you need to know:

The location in question is an “assisted living facility” located near Seattle, it is somewhat upscale, but by no means ”posh”, and it is a residence of substantial size, with dozens of clients living there. It is not a “mom and pop” business run out of a house, but instead a more corporate operation.

The first thing you are charged for is the “apartment” in which you reside and some basic services to go with it. Those services include “finishing the place” with blinds and appliances, weekly housekeeping and linen, and the power and the water and the cable (“Basic Extended”).

You’re also paying for the 24-hour staff presence, “recreation” services, and scheduled transportation.

Also included: two meals daily, but not breakfast.

Telephone charges are not included.

The cost, for a single person: $1900 per month for a studio, $2300 for a one bedroom, and $2800 for a two-bedroom. There are nicer “views” available, which add about $400 to each price. Adding a second person costs $600 extra every month.

You will note that this price does not include medical and “personal” services…and for that, we will turn to the actual “menu”.

"Old wood to burn! Old wine to drink! Old friends to trust! Old authors to read!"

--Francis Bacon, Apothegms. No. 97.

Start with the basics: a daily wake-up call is $50/month; having a load of personal laundry washed every week or having a staff member make the bed daily adds $70 monthly. Housekeeping is $30/hour…so hopefully the resident can clean their own apartment.

Breakfast is $95 each month.

To determine what additional needs you might have, a nursing assessment is conducted at the time of admission.

If it’s determined that the resident needs bathing assistance, costs work like this:

If the resident can wash themselves, but need to be watched during the shower, that service, once a week, is $165 monthly. If the resident needs a staff member to help them shower, add $60 (If two staff members are required, that’s an extra $140 monthly).

Can the resident dress themselves?

A daily reminder to change clothes costs $100/month. If a staff member needs to spend under 10 minutes a day to help the resident dress, that’s $175/month, if 15 – 20 minutes of assistance is required, that’s $250 monthly.

Can the resident take care of their own personal grooming? If they can’t, that adds $150 to the monthly charges.

There are also “toileting programs”.

Having the staff remind you to go to the bathroom costs $200/month (this also covers the occasional incontinence event), and having a staff member monitor you in the bathroom raises the rate to $275 (this also covers the occasional “bowel accident”).

A “structured toileting program” runs $350…and if you need to be checked for bowel accidents regularly, or need someone to wipe for you, or have regular accidents requiring changes of clothing, that’s $425 a month added to the bill.

Some people have had surgical procedures that require them to use a bag attached to their colon for waste removal. The site where the bag is attached is called a “stoma site”, and the service associated with stoma care is at least $250 monthly at this facility. Supplies (such as colostomy bags) are not included in this price.

Can the resident walk to meals on his or her own?

If yes, but they need a verbal reminder to go to meals, that’s $175/month. If the resident requires assistance to get to the dining room, that’s $225 monthly…and if it takes longer than 5 minutes on average to assist the resident, that adds $275 to the bill each month.

Special diets, prescribed by a physician, add $500 to the monthly bill.

Can the resident take their own medications?

If not, the minimum charge is $230 monthly, which covers up to 5 medications daily, “served” two times a day.

If the client takes more than five meds daily (or takes meds more than twice daily) that cost could potentially increase by another $165/ month.

Oxygen service: add another $150 monthly.

While all that seems expensive…we haven’t come to the big-ticket item yet.

There will be residents who will require “memory support”.

The simplest form of this service provides “redirecting, reassurance, orientation to surroundings, responding to questions/concerns that arise from diminished short term memory” and several checks daily to ensure the resident is on the property. Those who receive this level of service are also physically escorted to meals. The service costs $300 per month.

For $400 the resident is walked back from meals, and a staff member provides verbal cues to get the resident dressed. The resident will also be “convinced” to bathe, if need be.

If the resident requires physical cues to perform the same tasks, the cost jumps to $550 (and at this stage the resident might require two staff members to get them to perform personal hygiene).

The highest level of care also provides someone to check on the resident every two hours, and costs $800 monthly.

This is hardly a complete list: for example, there are charges for making appointments and other “clerical” services, for “concierge” service, and for other incidentals.

However, there’s one other significant charge about which you should be aware, and that’s the cost for nursing services.

Wound care that involves changing a dressing, and takes less than 5 minutes, is $15 for each occurrence. This service must be provided by a licensed nurse…and if you add it up, it works out to $180/hour that the facility is charging you for the services of an LPN/LVN (depends on where you live) who is not likely to be making above $25/hour. (Each dressing change that lasts from 5 – 10 minutes costs $20; meaning at least $120/hour.)

Add it all up, and the chances that you’ll be paying at least $3000 a month are (in the words of Johnny Mathis) awfully good.

"If Mr. Selwyn calls again, shew him up; if I am alive I shall be delighted to see him; and if I am dead he would like to see me."

--Henry Fox, the First Baron Holland

So how is all this relevant to politics, you might ask?

How about this: we are about to enter an age where millions of Americans will require this sort of long-term care…and many of us do not have $3000 per month available to pay for this kind of care.

How many? It is estimated that 70 million Americans will be 65 or over by 2030, and if the numbers from 1999 continue to be valid, roughly 30% of those people will be living in an institutional setting.

20 million people, at $3000 a month, equals $60 billion that will be required to cover the cost of long-term care for this group—each and every month. That’s $720 billion a year.

So how do we deal with the problem when it hits us?

I don’t know…but consider this: it is going to be tough to reduce these costs, if only because these are tasks that are not well suited for automation. These are services, for the most part, that require one-on-one care (or even two-on-one care)…and those who provide the care will want pay raises…which we will want to provide, in order to help keep the quality of care at a high level.

You should also know that there are substantial costs associated with “fixing broken workers”. The fact that workers are often required to assist clients that are physically large or physically awkward puts a lot of these workers out on injury leave…and the unhappy fact is that understaffing is a common way to try to control labor costs in nursing facilities, adding to the injury problem these workers face.

How bad is the healthcare injury problem? Ironically, the Bureau of Labor Statistics tells us health care facilities are the most dangerous work environment in the United States.

“General medical and surgical hospitals (NAICS 6221) reported more injuries and illnesses than any other industry in 2007—more than 253,500 cases.”

To put it another way, there are basically two kinds of healthcare workers: the ones with back injuries…and the ones who don’t yet have back injuries.

As we wrap this thing up, let’s ask that question we ask almost every time: what have we learned today?

If you hadn’t already been thinking about it, it is fantastically expensive to have to receive care at an assisted-living facility, and soon there may be as many as 20 million Americans who will be in that situation…or something even more expensive, such as “skilled nursing facilities” (more commonly referred to as “nursing homes”).

We could be looking at having to find $720 billion (in today’s dollars) to cover the annual cost of that care.

It is going to be very tough to reduce those costs, unless you can develop ways to deliver the same care in a less-expensive environment…or you can find a way to reduce the number of people who will require such care.

Considering the cost of “memory care”, money invested in Alzheimer’s mitigation today might pay huge dividends later.

So that’s the deal: there is a giant bill that’s coming due, we better be thinking about it now…and one way or another, this will become one of the biggest fights in American politics as we move into the middle third of this century—so we can either get ready for it now, or we can all act surprised later.

Of course, if enough of us require “memory care”…then I guess that surprised look on our faces won’t be an act, eh?