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.

On Open-Source Entertainment, Or, Today, Jon Kyl Meets Twitter

So Arizona Senator Jon Kyl went and did a stupid thing the other day by claiming on the floor of the Senate that 90% of what Planned Parenthood does is related to abortions, and that, by God, we need to cut that Federal funding for abortions, and we need to cut all Federal funding for Planned Parenthood—and we need to do it today.

Of course, that 90% claim was total hooey; it turns out that only 3% of Planned Parenthood’s work relates to abortions. (The Federal funding for abortions part is, too; the Hyde Amendment made such funding illegal decades ago.)

When confronted, Kyl’s office released a statement claiming the Senator’s comments were “not intended to be a factual statement”.

Sir Rev. Dr. Stephen T. Colbert, DFA, decided to have a bit of fun with Kyl, and he challenged his audience to Tweet their own “Not Intended To Be A Factual Statement” about Kyl.

I decided to compose a Tweet of my own…and then another…and before I knew it I had an entire story’s worth; that’s why, today, we’ll be taking a taking a short break from the daily grind to have a bit of fun with a man who truly deserves it: Jon Kyl.

...I decided to celebrate Jon Kyl's ground-breaking excystplanation last night by tweeting round-the-clock nonfacts about him:

“For the past ten years Jon Kyl has been two children in a very convincing Jon Kyl suit” and “Jon Kyl calls all Asians ‘Neil’ no matter what their name is”.

Both of which would be libelous if I hadn't added the hashtag notintendedtobeafactualstatement.

Well, Nation, you picked this up and ran with it, using my hashtag to tweet your own nonfacts as an uprece-tweeted rate of 46 per minute!

Which, incidentally, is the rate at which Jon Kyl catapults puppies into the sea.

--Stephen Colbert, speaking on the “Colbert Report”, Wednesday, Apr 13, 2011

So I did a bit of math, and if Colbert is correct about that “46 a minute” thing then about 65,000 tweets went up in the 24 hours following his announcement, and they’re still going up fast; check out #NotIntendedToBeAFactualStatement at Twitter to get a feel for what I’m talking about.

Two Tweets by other writers sort of “bookmark” the types of missives that have been presented; Ben Cobb, writing as @MoltenPanther, Tweeted…

Jon Kyl started a squirrel farm to form a massive squirrel army in preparation for the coming apocalypse.

…and John Q, writing as @PencilName, wrote:

During an emergency, Jon Kyl can be used as a flotation device.

So with that in mind, here’s a few of my #NotIntendedToBeAFactualStatement submissions:

Jon Kyl's head once served as a landing light for Senator James Inhofe at the Eufala, Alabama airport.

Jon Kyl listens to Radio Disney--and doesn't know those are cover songs.

Jon Kyl likes KFC better than Popeye's.

It used to be John Kyl...but he lost the "h" in 1979 after a night of drinking, and now he can't find it.

"The KylBot AZ Mark II v.3.6505 is experiencing software malfunctions. Please try again later..."

Kyl's head brushed against Trump's hair on an airport runway last night. 450 passengers aboard, 0 injured.

On Saturday nights, John Kyl likes to dress up as a giant pretzel and get "stuffed in an M&M"

Why is Kyl so crazy? He gets 5 cents per page view every time he's in The Onion--and he needs the money.

Jon Kyl once caught Larry Craig eating Cheeze Whiz right out of the can.

Jon Kyl once impersonated Flip Wilson so he could appear in the movie "Uptown Saturday Night".

The most popular strain of medicinal marijuana in the United States today is "Jon Kyl".

Jon Kyl can see Russia from his house.

Jon Kyl's Malcolm X poster is covered by a Robert Mapplethorpe poster...so that no one will ever know...

Jon Kyl once snorted coke, but the bubbles really hurt his nose.

215,856 of Jon Kyl's constituents signed a petition asking him to start smoking.

Jon Kyl's iPhone has a dial.

Joe Arpaio is blackmailing Kyl with whatever's on his original birth certificate.

I know where Lemmywinks is tonight--and so does Jon Kyl's colon.

If Jon Kyl was a chicken-fried steak at Denny's he would give you diarrhea the next morning.

Jon Kyl's skull recently committed suicide. It was leading an empty life.

Jon Kyl never got that "Mulva" joke.

Powdered Toast Man once told Jon Kyl to go butter himself.

Jon Kyl once tried phone sex, but he didn't have enough lube, so he had to quit.

Jon Kyl's favorite kink is to dress up like a fence and play "Border Crossing".

From 1977 to 1981, Jon Kyl appeared onstage as Tommy Chong. Cheech Marin was never told of the deception.

Jon Kyl used whiffleball bats for his entire Major League Baseball career.

On his days off, Kyl plays Carl on "Aqua Teen Hunger Force".

Jon Kyl provides sanctuary for up to 800 illegal immigrants at a time in his at-home underground bunkers.

Wendy Williams' wig head Shakeetha has a restraining order out on Jon Kyl.

Jon Kyl once had Hansen's Disease--but then he got his "Mmm Bop" removed.

If Jon Kyl was in "Star Wars" he'd be known as Luke NotIntendedToBeAFactualStatement-Walker.

Jon Kyl's Danny has never met its Dingo.

Jon Kyl once tried to Baskin his Robbins.

Jon Kyl's brain has seen the news reports, and now it doesn't want to come back from vacation.

Every defibrillator in Arizona recently signed a letter refusing to revive Jon Kyl.

If John Boehner's tears ever touch Jon Kyl, he'll dissolve.

So there you go: now that we’ve started the day out with a bit of fun, why not waste a bit of your boss’ time and direct a few Tweets of your own to Kyl?

And don’t forget: be smart, be funny, and be sure to add #NotIntendedToBeAFactualStatement to those Tweets—because after all, you don’t want to be out committing libel now, do you?

On Online Brainstorming, Or, "Hey, Unions...Wanna Grow?"

Sometimes stories happen because of planning; other times serendipity intervenes, which is how we got to the conversation we’ll be having today.

In an exchange of comments on the Blue Hampshire site, I proposed an idea that could be of real value to unions, workers...and surprisingly, employers.

If things worked out correctly, not only would lots of people feel a real desire to have unions represent them, but employers would potentially be coming to unions looking to forge relationships, and, just to make it better, this plan bypasses virtually all of the tools and techniques employers use to shut out union organizers.

Since I just thought this up myself, I’m really not sure exactly how practical the whole thing is, and the last part of the discussion today will be provided by you, as I ask you to sound off on whether this plan could work, and if so, how it could be made better.

It’s a new week...so let’s all put our heads together and rebuild the labor movement, shall we?

Credit Where Credit Is Due Dept.: We’re having this conversation today because of a back and forth between StratfordDem and myself over at Blue Hampshire, as I mentioned above, and the ideas that you’ll hear here are hardly my own—in fact, they’ve been part and parcel of how unions have worked for as long as there have been unions.

My proposal, however, takes an old idea, adds a twist, and tries to develop it to a whole new market, in a place where unions have been disadvantaged for a long time: among small businesses.

Before we move forward with the actual proposal, let’s do a bit of “stage setting”:

We are forever being told that the vast majority of jobs being created in the US economy are jobs created by small businesses. Unfortunately for unions, those small businesses don’t seem to be fertile grounds for organizing.

There are a variety of “structural” barriers that have been put in place over the years to make union organizing harder (and it’s even worse outside the US); one example would be the “right-to-work” laws that exist in more than twenty US states.

On the other side, there are industries that seem to likely targets for organizing, including those nursing facilities providing the kind of “hands-on” care that is often performed by medical assistants...who, quite frankly, would be awfully hard to “outsource”.

In normal economic times, it’s hard to keep these places staffed, particularly when there are either short shifts to be filled or people calling in sick, and that’s why there are “staffing agencies” who provide workers to fill in the gap.

There’s a catch: “agency” help is very expensive—and that often forces facilities to choose between agency help or “mandatory overtime”, which is also an expensive option. Obviously, abusing mandatory overtime isn’t just a budget problem—it will also damage the relationship between management and crew, which has its own costs.

The other players in this environment we’ll be talking about are the “Bryman Colleges” of the world (or Everest College, depending on where you live); you know them for their nonstop ad campaigns hoping to make you anything from a medical assistant to a construction project manager.

According to the General Accountability Office, the tuition for the medical assistant program at one of those schools might run in range of $12,000, which could be triple what it would cost to get the same training at a community college.

Ultra Geeky Fun Fact Of The Month: Those of you who play with Lie Groups and buildings of spherical types probably already knew this, but Belgian mathematician Jacques Tits (so famous, thanks to his “buildings” theory, that the concept of a group with a BN-pair is described as a "Tits System") celebrated his 80th birthday August 12th.

Ironically, Tits and buildings have nothing to do with TITS (the Total Information Transfer System), created by the City University of Hong Kong to to improve the communications process among construction managers developing large building projects.

So now it’s time to put all this together:

Picture, if you will, a union apprenticeship program for medical assistants that is melded with a “hiring hall” for fill-in positions.

Instead of spending $12,000 to go to Bryman, people would join the sponsoring union and start paying union dues.

The union, in turn, would place these workers, at about 125-150% of “normal” wage, in the fill-in slots that become available, allowing workers to “earn while they learn”; at the same time they’re attending the academic classes that would be required of any apprenticeship program.

The union needs to find nursing homes that are willing to place these workers. The way they do that is with a fairly straightforward sales pitch: “I can place workers in your facility, on short notice and with one phone call, for about the same price as overtime...and a lot less than the cost of agency help.”

The union involved will have to accept that they won’t be representing all of the workers at that facility...but they will be placing their workers at higher wages than non-union workers...and as the one group begins to see what the other has, this should help to make the idea of joining a union a lot more interesting to that portion of the staff the union does not yet represent.

It also removes the problem of the facility “pretextually” firing anyone who might look like they’re trying to organize the rest of the workforce.

Since workers would be finding out about the apprenticeship program through advertising and other means of contact, the ability of employers to intimidate workers out of joining a union is diminished; since employers are looking to bring in these union fill-in workers to fix a hole in their very, very, tight budgets, their desire to intimidate is also reduced.

If they do this well, the union should be able to create quite a bit of worker loyalty, and that should help resolve some of the problems associated with “right-to-work” laws.

So there you go: there may be a place for unions to expand apprenticeship by invading the territory of training schools that seem to be sticking it to workers today, and those same unions have a chance to change the relationship between unions and businesses into something that looks a whole lot less threatening to those businesses.

In the process, unions could create new worker loyalty—and they could also create a situation where the other workers start asking themselves: “hey...why don’t we belong to a union?”

And that brings us to the part where you come in:

What obvious things did I miss?
What legal impediments might exist that I’m unaware of?
How can this idea be made better?

Let’s make this a conversation, and let’s see where it ends up.

On Assigning Blame, Or, “So, You Think I’m Retarded?”

LANGUAGE WARNING: Today’s story is uncharacteristically blunt, and from this moment forward we will be using lots of inappropriate language in making our points.

Gentle Reader, you have been officially...warned.

With that in mind, if you take offense when confronted with language strong enough to knock a fuckin’ buzzard off a shitwagon, please stop reading now.

It is by now fairly well known that Rahm Emanuel, President Obama’s White House Chief of Staff, had a bit of a blow-up with liberals who were ready to start running ads against “blue dog” Democrats who were working very hard to shut down the health care reform effort.

Now we’re not gonna get in the middle of that argument today; instead, since we’re finally getting a chance to talk, I figured me and Rahm could get a few other things out of the way that have been on everyone’s mind for the past year or so.

“...What the ancients called a clever fighter is one who not only wins, but excels in winning with ease.

Hence his victories bring him neither reputation for wisdom nor credit for courage.

He wins his battles by making no mistakes. Making no mistakes is what establishes the certainty of victory, for it means conquering an enemy that is already defeated.

Hence the skillful fighter puts himself into a position which makes defeat impossible, and does not miss the moment for defeating the enemy...”

--Sun Tzu, “The Art of War”

So...Rahm, buddy...here’s the thing:

In January of 2009 you came into the White House having just beaten down both the Republicans and Hillary Clinton, and baby, y’all were on a roll.

Reforming health care was the top priority of 59% of the population, you had a 75+ seat majority in the House...and of course, to quote your boss, there was that “largest Senate majority in a generation”.

Y’all were appointing smart people to take over agencies, and the President gave that speech in Cairo—and even though people had their misgivings about the way the bailout and the stimulus came together, we were still right there with you.

And then, in May...remember when y’all promised to get a heath care vote done by August? If I recall correctly (and I do), the President said:

"...We've got to get it done this year. Both in the House and the Senate. We don't have any excuses. The stars are aligned."

And then for some reason, you decided it would be a smart idea to spend a couple of months letting Ben Nelson and Charles Grassley, who were both happy to let you know they were against this thing from the beginning, run the show.

“...When you engage in actual fighting, if victory is long in coming, then men's weapons will grow dull and their ardor will be damped. If you lay siege to a town, you will exhaust your strength.

Again, if the campaign is protracted, the resources of the State will not be equal to the strain.

Now, when your weapons are dulled, your ardor damped, your strength exhausted and your treasure spent, other chieftains will spring up to take advantage of your extremity. Then no man, however wise, will be able to avert the consequences that must ensue.

Thus, though we have heard of stupid haste in war, cleverness has never been seen associated with long delays.

There is no instance of a country having benefited from prolonged warfare...”

--Sun Tzu, “The Art of War”

“...and then the C.H.U.D.S. came at me...”

--Homer Simpson

And then came the Tea Parties. For a solid month we were bombarded with images of uninformed people carrying signs demanding we protect Medicare while at the same time demanding Government stay out of health care, people who see Obama as the new Hitler, and people who apparently think Socialism, Fascism, Communism, and Vegetarianism are all different flavors of the same political junk food.

In other words, fuckin’ retards.

And just to make things perfect, the Republicans couldn’t wait to jump on the retard train: Sarah Palin quit being a Governor so she could turn her interest in “Death Panels” (and her desire to never be a quitter...) into a gig at Fox—and Rick “Goodhair” Perry, the Governor of what might be the most “Rah Rah America!” state in the Nation, suggested that making Texas into its own country might be the smartest way to save these United States.

I loved it.

I knew what was about to happen: the classic “pincer move”, where you let the enemy race into the trap, and then slam the door behind them, locking them in a box from which they cannot escape.

And the best part was, they had made it so easy that a politician with even a moderately high degree of mental acuity could spring the trap. All the President had to do was to go to the States where these politicians live, stand up on a platform, with cameras running, preferably in the early part of the daily news cycle, and do one of these two things:

--Either put his arm around [insert politician’s name here]’s shoulders and tell the giant crowd how the President and [again, insert name] are going to fight the insane Republicans and the evil insurance companies together, “No matter how much they try to stand in our way...”

--Or go to the same podium and give this speech: “I’m going to fight for you, all the way, and I want you to call [insert name here] and demand that they join the fight, too.”

For extra effect, you could have sent him to one of those free clinics the viewers of Keith Olbermann’s “Countdown” were paying for.

Repeat this process a dozen times or so, and the next thing you know you own the news cycle, and the enemy is crushed and disorganized.

This is Politics 101, and it’s just as effective at moving along reluctant Democrats as it is reluctant Republicans.

But that never happened, Rahm, did it?

Instead, as far as I can tell, you let the fuckin’ retards kick your ass for the past eight months.

You didn’t even really try to organize your friends: for example, where was the coalition-building process while all of this was going on? Did it ever occur to you to try to get gay activists and youth activists and healthcare activists together to help move this process along?

Had you been on the ball here you could have organized a “Counter Tea-Party” for every single one of those stupid “patriotfests”...and now, when you need support to move issues that matter to the gay community, you haven’t built up the kind of trust that would have been enormously helpful in keeping the GaYTM open and available, as it was in 2008.

Only in the past ten days or so have y’all finally figured out what Alan Grayson seems to have known all along: an aggressive, in-your-face Democrat will not only survive, but thrive—even in Florida.

And that’s the part I don’t get: you came in here enormously popular, with every advantage, with Republicans who were falling all over themselves to make your life easy, with the facts on your side, and a public who wanted to go along with the program.

And despite that, you let yourself get beaten down by idiots, you failed to spring the obvious trap, you never tried to really engage with your friends at critical times, and now you find yourselves in a tough election environment having to play catch-up, when it’s the Rs who should be running for cover while your guy is pulling a 65% approval rating, or something similar, and Democrats expand that Senate majority to 63 or 64 seats.

And if all that wasn’t enough, now you have to sit here and listen to people like me, the proverbial “overfed, long-haired, leaping gnomes” of politics, tell you something you should have known all along.

Which finally brings me to the part I really don’t understand: how did our situation get so turned upside down that you are viewed as the big-time highly-paid political genius...and somehow, the people who thought you would be easily digest the pre-chewed political snack food that was being served up to you on a silver platter became the fuckin’ retards?

It’s a question I can’t answer, Rahm...but you better figure it out, and fix it—quickly—or the next three years are going to suck a lot more than this one did.

On Health Care, Vegas-Style, Or, Figure It Out In The Ambulance, Chump

I was supposed to begin the long-delayed series of PTSD stories I’ve been planning, but before we begin, I need to tell y’all about something that just happened in my house.

For us it wasn’t a matter of life or death, but it is the kind of story that explains, perfectly, why we need to reform the health care system we have today—and for that matter, it’s also a great explanation of why a single-payer system would be a giant step forward for everyone in this country, whether you’re insured today or not.

It’s also hilarious and sad and frustrating, all at the same time—which makes today’s story a pretty good allegory for the current American way of doing health care.

So follow along, have a good laugh…and at the same time, take a minute to consider what could be, and how much less irritating things should be.

“There was never any thing by the wit of man so well devised, or so sure established, which in continuence of time hath not been corrupted.”

--Charles Pratt, 1st Earl Camden, “Concerning the Service of the Church”

Several things have been happening over the past couple of months to prevent me from writing as much as I would like; among those a series of quite painful medical events that caused The Girlfriend to have to visit the emergency room three times.

Nothing life-threatening, as I mentioned above, but painful nonetheless.

She is a State employee, so she has insurance; the emergency room benefit calls for a $50 co-pay for an ER visit.

The bill has now come in…and much to our surprise, the “patient responsibility” is a bit over $300…for only one of the three visits.

As you can imagine, a phone call to the insurer followed…and this is where the story gets weird.

The customer service rep told us that the emergency room cost is, indeed $50, as we expected—but the services of the ER doctors are not paid at all.

How is this possible, you might wonder?

The customer service rep explained that while the ER itself is “part of the network”…the physicians who work in that ER are not a part of the network.

It takes a minute to make sense of that, so if you want to pause to allow the whole thing to sink in, I’ll understand.

Ready to move on?

The Girlfriend asked the obvious next question: how are you supposed to know, on your way to the emergency room, exactly who might be in the network and who might not?

The customer service rep came back with the obvious answer: there is no way to know…you just wait for the bill, and then you find out.

Our reaction, as you might expect, was something like this:



As of this moment we do not know how this is all going to turn out, but here’s the point:

It doesn’t have to be this way.

Canada manages to get patients in the front door and through the billing process with far fewer administrators, far less hassle, and at far lower cost than the system we have here—and that was the big attraction of a “near single-payer” approach before it was driven out of the reform discussion. (To be technical, a “Medicare for all” system could accomplish the same thing.)

Of course, it’s not just our family that would benefit from reform.

Think about what a hassle keeping track of all of this is for employers.

The State of Washington has an entire corps of workers who do nothing but manage the insurance coverage for State workers…and I suspect your State does as well.

In a time when every State is trying to put as many dollars as possible into maintaining basic services (such as keeping the State Patrol fully operational), wouldn’t it be nice to redeploy some of that money to someplace like the Office of Support Enforcement or Adult Protective Services?

Private employers would obviously benefit as well, as their own no-longer-required health insurance administrators could also convert to jobs that are “bringing revenue in the door”—just as they have done in Canada and the UK and…well, everywhere else in the developed world, more or less.

And that’s today’s story: a moderately serious problem has led to the kind of absurd situation that causes wolves’ eyes to nearly explode; in the process, however, we’ve had a chance to think about how health care reform could make things much better, not just for those who have no insurance, but also for everyone who has insurance, for every one of our employers…and, on a larger scale, for the Nation as a whole.

Unless, of course, you’re lucky enough to have the mythical health insurer whose approach to business truly incorporates the motto “the customer is always right”, in which case you may go ahead and ignore all of this and return to your normal low-altitude recreational hang gliding over the cactus fields.

On Paying For Immoral Things, Or, Is Stupak On To Something?

There has been a great wailing and gnashing of teeth over the past day or so as those who follow the healthcare debate react to the Stupak/Some Creepy Republican Guy Amendment.

The Amendment, which is apparently intended to respond to conservative Democrats’ concerns that too many women were voting for the Party in recent elections, was attached to the House’s version of healthcare reform legislation that was voted out of the House this weekend.

The goal is to limit women’s access to reproductive medicine services, particularly abortions; this based on the concept that citizens of good conscience shouldn’t have their tax dollars used to fund activities they find morally repugnant.

At first blush, I was on the mild end of the wailing and gnashing spectrum myself...but having taken a day to mull the thing over, I’m starting to think that maybe we should take a look at the thinking behind this...and I’m also starting to think that, properly applied, Stupak’s logic deserves a more important place in our own vision of how a progressive government might work.

It’s Political Judo Day today, Gentle Reader, and by the time we’re done here it’s entirely possible that you’ll see Stupak’s logic in a whole new light.

So let’s go back a moment and reconsider what Stupak wants: his religious beliefs are offended by the concept of abortion, and he is taking steps to ensure that the government is not using his taxpayer dollars to pay for the procedure.

This precedent is fascinating—and what I’m inviting you to do today is to consider, for a moment, what our government might look like if we take his logic and...extend it a bit.

“...In the game of life, the house edge is called Time. In whatever we do, Nature charges us for doing it in the currency of time...”

--Bob Stupak, “Yes, You Can Win!”

I always try to find common ground with those I oppose, and the most logical place to start would be to consider the fact that Stupak and I are both morally offended by the idea that we use taxpayer dollars to go around killing people.

So where do we differ?

For starters, I find it morally offensive that my taxpayer dollars are used, on a daily basis, to fund the actual killing of actual, living, people by my Government...so, Congressman Stupak, in the name of finding common ground, how about if the same day your Amendment goes into effect we also stop funding any military activities that might reasonably be expected to, as I hear people say, “stop a beating heart”, so as to prevent offending my religious sensibilities?

John Allen Muhammad, the so-called “Washington Sniper”, is scheduled to be executed today. Are you prepared to support legislation, Congressman Stupak, which will prevent his “post-term abortion” and the potential abortions of all those other human lives on Death Rows around this country if those state-sponsored abortions are as much of an affront to my religious beliefs as they should be to yours?

During the more or less four months worth of slow-walking and stalling that we have seen so far in this process 15,000 Americans have died...or, if you prefer, five 9/11s...simply because they have no health insurance—and unless your religion is a lot more bloodthirsty than mine, the abortions of 15,000 people because of the...what’s the word I’m looking for here...let’s see...could it be...sloth...of your colleagues should be an act as reprehensible as the greatest of blasphemies ever recorded in The Bible.

With that in mind, are you prepared to join me in cutting off the use of my taxpayer dollars to fund the salaries, the “public option” health care, and the office operations of those legislators who are behind these killings?

What else do we do that’s aborting lives on a daily basis that I’m sure Congressman Stupak would be glad to allow me, as a result of the offense to my conscience (and, presumably, his), to “negatively fund with extreme prejudice”?

There’s that Drug War, of course, and whatever we're doing in those secret prisons—and public ones—and subsidies for those who clear mountains and poison lands...not to mention the tax dollars I’ve been providing for a company who did electrical work that’s aborting soldiers.

So whaddaya think, Congressman Stupak?

Since you’re so proud of your pro-life credentials, are you ready to stand up with me and defend the principle that all human lives deserve to be protected, and that we have the right to withhold funding for all those activities that are morally repugnant...or are you just another one of those “enablers” who helped kill 15,000 people this past few months?

Enquiring minds want to know.

On Using Mr. Bullhorn, Or, DC Health Summit Thursday: Come Say Hi...Loudly

It was a long hot August for those who would like to see health care reform, as rabid "Town Hall" protesters proffered visions of public options that would lead to death panels and socialism and government tax collectors with special alien mind control powers that would use sex education and child indoctrination and black helicopters as the means for gay people to impose their dangerous agenda on the innocent, God-fearing citizens of someplace in Mississippi that I'm not likely to ever visit.

Part of the reason that opposition was so rabid was because health care interests were spending millions upon millions of dollars doing...well, doing whatever the opposite of giving a distemper shot to the angry mob might be, anyway.

So wouldn't it be great if all the CEOs of all those health care interests were to gather at one time and place so you could, shall we say, gently express your own thoughts regarding the issues of reform and public options?

By an amazing coincidence, that's exactly what's going to happen Thursday in Washington, DC, as the Patient Centered Primary Care Cooperative (PCPCC) holds its Annual Summit.

Follow along, and I'll tell you everything you need to know.

The Who, The What

There are two important bits of setting up that are required to make this story work; and the first is to explain who the PCPCC is, exactly. To quote their website:

"The Patient Centered Primary Care Collaborative is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians and many others who have joined together to develop and advance the patient centered medical home. The Collaborative has well over 500 members.

The Collaborative believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system. In order to accomplish our goal, employers, consumers, patients, clinicians and payers have agreed that it is essential to support a better model of compensating clinicians."

The "patient centered medical home"?

Is that anything like "precious bodily fluids"?

Actually, the original idea was to create a "home" where a patient's scattered medical records could be gathered. Forty years later, the concept has evolved to a "home doctor" who coordinates all your health and wellness care from all your providers.

This is a huge shift in how care is delivered (and how healthcare dollars would be distributed), which is why the Collaborative has so many members...including seven of the top ten health insurers in the country.

The Why



I've been getting emails that tell me CEOs such as Stephen Helmsley of UnitedHealth and Angela Braly of WellPoint (insert booing and hissing here) will be present--and these are the exact people that you should be giving a "Town Hall-like" welcome of their own when they hit Washington.

Groups such as Democracy for America and TrueMajority will be working together to bring people who have been personally affected by the insurance crisis to the meeting--even though we're not invited inside to support something like, oh, I don't know...maybe a public option?

They want you to attend as well, to make lots of noise, and to send the message that we won't be ignored. It's a critical time in the debate, as there are Democrats yet to be convinced, and if you can be at this meeting it will capture media attention that could help move those Democrats to our positions.

The Where, The When

The event takes place in Washington DC all day Thursday (from 9-4:30) at the Walter E. Washington Convention Center, conveniently located at 801 Mount Vernon Place NW; just six blocks from the Executive Office Building and the White House complex...and, on its south side, just 50 feet from K Street, the "Glitter Gulch" of lobbying.

There's a handy Metro station, and if you walk to the south end of the Convention Center (the Mt. Vernon Square end of the building) you'll find that the American Federation of Labor occupies a building across the street from the Square on the west side--and National Public Radio occupies a building diagonally across the Square on the east side.

So if you're planning to be in Washington Thursday--or you've been looking for an excuse to visit--make a day of it: stroll by the White House, see lobbyists and unions and National Public Radio at work...and most importantly of all, make sure the CEOs of the health insurers in attendance get the same kind of rousing "Town Hall" welcome at the Convention Center that they spent millions of dollars to create in our own home towns.

In other words, bring Mr. Bullhorn--and the extra batteries.

Of course, I don't want to make this too much of a hard sell.

After all, it's not as if your life depends on you attending some--hey, wait a minute...actually, I guess it kind of does.

On Learning To Love Homegrown, Or, Baucus' Fundraising Considered

So we are now finding out the answers to some of our questions about which members of Congress actually represent We, the People...and which ones represent, Them, the Corporate Masters.

We have seen a Democratic Senator propose a policy that would put people in jail for not buying health insurance and a Democratic President who has taken numerous public beatings from those on the left side of the fence for his inability to ram something through a group of people...and yes, folks, the entendre was intentional.

But most of all, we’ve been asking ourselves: “why would Democratic Members of Congress who will eventually want us to vote for them vote against something that nearly all voting Democrats are inclined to vote for?”

Today’s conversation attempts to answer that question by looking at exactly how money and influence flow through a key politician, Montana’s Senator Max Baucus—and in doing so, we examine some ugly political realities that have to be resolved before we can hope to convince certain Members of Congress to vote for what their constituents actually want when it really counts.

“The idea of covering even the early stages of the cynical and increasingly retrograde campaign has already plunged me into a condition bordering on terminal despair, and if I thought I might have to stay with these people all the way to November I would change my name and seek work as a professional alligator poacher in the swamps around Lake Okeechobee.”

--Hunter S. Thompson, “Jimmy Carter and the Great Leap of Faith”

Now any normal person trying to analyze last year’s election would have said something like “the fact that Obama was promoting a new type of politics—and that a large majority of the public liked what they were seeing—should have meant that politicians would finally do what the public wanted”...and if you’re as cynical as I am, you might have thought that the fact that Obama is the most successful fundraiser in the history of politics would have made other candidates figure that supporting Obama, politically, would be the easy way to put more cheddar in their own pockets.

But here’s the thing: Senator Baucus has been in Washington, in the same job, since 1978, which is about three years short of half of his entire life (and he spent those three years in the House), and unless he wakes up dead one morning or Montana secedes from the Union he’s pretty much guaranteed to be there until at least January 2015.

In those three decades he’s been able to create, and then “outsource”, his own independent fundraising operation—and he’s been so good at doing this that he can donate money from his own Political Action Committee (Glacier PAC) to other Democrats, which is the Congressional version of acquiring really cool “Magic: The Gathering” cards now in an effort to both control votes today and become a more powerful player later on.

He did it by cultivating people in his own office who later went on to become lobbyists. At least 24 of ‘em. Since Baucus now runs the Senate Finance Committee and every bill in the Senate that needs money has to pass through his Committee for approval, all those hard working lobbyists now lobby...wait for it...their former boss.

This creates a fundraising “virtuous circle”: “Baucus-affiliated” lobbyists sell access to Baucus...and part of the price of that access is donating to Baucus...which, since “the fix is in”, creates legislative successes that lead to more people wanting more access for bigger favors...which makes the prices all go up, creating more power and influence for Baucus and his orbiting constellation of homegrown lobbyists.

And now that the enterprise has reached the point where the entourage has gone on to have their own entourages, Obama’s vision of “change you can believe in” is sounding more like a promise to screw up a perfectly good hustle than it is a way to run a country.

So how does all this influence the healthcare debate?

At the moment, Baucus could literally coach a basketball team of former staff members who now lobby Baucus on behalf of health care clients:

--David Castagnetti of Mehlman Vogel Castagnetti, Inc. is the vertically integrated busy beaver of the group, representing drug powerhouses Abbot, AstraZeneca, and Biogen, device manufacturers like GE Medical, service providers like Humana and the American Clinical Lab Association, and AHIP, the trade association of health insurers, among others.

--Jeff Forbes, who is currently self-employed, is representing drug maker Roche Group, Manor Care (who provides long-term care services in nursing homes and other environments), and the Advanced Medical Technology Association (AdvaMed), a group which includes many of the big players in the medical business.

--Roger Blauwet (he of DC’s Canfield and Associates), is representing Wyeth and Pfizer (two more major drug manufacturers), the Association of Financial Guaranty Insurers, who are the “reinsurers” who help carry risk for other insurers (in return for a piece of the action), and the Rx Benefits Coalition, which reports that it represents companies that support “market solutions” to make prescription drugs available.

Some clients feel that their needs require more than one “Baucus alumnus” on the payroll, which is why Scott Olsen and Jeff Forbes are working for biotech giant Amgen (along with about 150 other lobbyists), David Castagnetti and Angela Hofmann are slogging it out for Wal-Mart, and Roger Blauwet and Castagnetti are both hoofing it for the Pharmaceutical Research and Manufacturers of America (PhRMA), who is, literally, the “Big PhRMA” that everyone talks about.

Drug manufacturer Merck hired three of the anointed: Forbes, Blauwet and Castagnetti.

All of this effort is working—and working well. According to OpenSecrets.org, somewhere in the range of $4.5 million has been donated to Baucus during his career by insurance and healthcare interests.

It isn’t just health care, either. Because somewhere around two dozen former Baucus staffers turned lobbyists are “home on the Washington range”, no matter what is being debated in Congress, Baucus gets paid (two quick examples of his Committee’s jurisdiction: changes in tax policy and financial industry regulation—or the lack of it).

In truth, “Baucus gets paid” is probably a bit too cynical.

What I really should say is that Baucus has been exceptionally successful in listening to all points of view when considering ways to make the lives of every American all they can be, that the people who get listened to are exceptionally grateful for this attention, that millions and millions of dollars worth of gratitude have been funneled to Baucus over the years because he’s such a good listener, and that, from now until at least 2015, if you need a Senator to support “status quo you can believe in” you might want to try launching a great big brick of cheddar into the Senator’s constellation.

So the next time someone asks you how “change you can believe in” could have possibly morphed into “buy insurance or we’ll put you in jail”...well, now you know—and given the choice, wouldn’t you rather watch someone make sausage?

On Life In The Modern World, Or, What If Jesus Was An HMO?

Those among us who are familiar with the Bible will recall that Jesus Christ himself was an active member of the health care community as he travelled about the Holy Land.

It is reported that he practiced within multiple medical specialties, and his works as both an ophthalmologist and a neurologist are recounted within the verses of the Gospels.

But what if Jesus had been practicing medicine in the therapeutic environment we’re familiar with today?

In today’s conversation we’ll be tagging along with Jesus as he takes a few calls at his HMO’s Customer Care Center—and by the time we get done you should be able to bring a whole new take to those discussions you‘ve been having about why reform matters.

“…a blind man, Bartimaeus…was sitting by the roadside begging. When he heard that it was Jesus of Nazareth, he began to shout, “Jesus, Son of David, have mercy on me!”

…Jesus stopped and said, “Call him.”

So they called to the blind man, “Cheer up! On your feet! He’s calling you.”

Throwing his cloak aside, he jumped to his feet and came to Jesus. “What do you want me to do for you?” Jesus asked him. The blind man said, “Rabbi, I want to see.”

“Go,” said Jesus, “your faith has healed you.” Immediately he received his sight…”

--Mark 10:45-52

“Thank you for calling Customer Care. This is Jesus. How may I help you?”

“Hi, I was recently treated by you in Jericho for blindness—“

“Can I get your account number, sir?”

“J32-21515”

“Oh, yes. Is this Bartimaeus?”

“Yes it is.”

“So what can I do for you today?”

“Well, I went to check my mail, and I found a bill from you for 42,554 shekels for the eye treatment, and I don’t understand why you want me to pay this bill.”

“Well, give me a second while I look that up…ahhh, OK, I understand what happened. You see, I did perform the eye treatment, but your policy requires you to be referred by your Primary Care Physician for any specialist treatment and pre-approved by someone here at Customer Care before we can be liable for any costs of care, and the computer says that you didn’t do any of that first…so, I apologize, but we won’t be able to make any adjustments to this account.

Is there anything else I can do for you today, Bartimaeus?”

“Well, how am I supposed to pay this bill? I don’t have this kind of money. Can’t you perform a miracle or something to help me out here?”

“Well, sir, I can’t do that, but what I can do is transfer you to our Collections Department, who can help you make payment arrangements…”

Needless to say, the call went downhill from there.

“Here a great number of disabled people used to lie—the blind, the lame, the paralyzed…

One who was there had been an invalid for thirty-eight years.

When Jesus saw him lying there and learned that he had been in this condition for a long time, he asked him, "Do you want to get well?"

"Sir," the invalid replied, "I have no one to help me into the pool when the water is stirred. While I am trying to get in, someone else goes down ahead of me."

Then Jesus said to him, "Get up! Pick up your mat and walk." At once the man was cured; he picked up his mat and walked…”

--John 5:3-8

“…so you say you were lame and I made you walk, and now you’re getting calls from a collections agency that wants to garnish your ass?”

“Yes, Jesus, that’s correct.”

“Well, it says here that that back in Tishri of 12 AD you had severe boils and lesions, which is a preexisting condition. Now when I asked you if you wanted to get well you never disclosed any of this, and I don’t see it anywhere in your application packet, either.

Your policy requires you to inform us of any medical treatments you received before you became a policyholder, and because you failed to make a true and complete statement in your application we have to reject this claim.

I really do apologize, but we won’t be able to make any adjustments to this account.”

“To the elders among you, I appeal as a fellow elder, a witness of Christ's sufferings and one who also will share in the glory to be revealed:

Be shepherds of God's flock that is under your care, serving as overseers—not because you must, but because you are willing, as God wants you to be; not greedy for money, but eager to serve; not lording it over those entrusted to you, but being examples to the flock.

And when the Chief Shepherd appears, you will receive the crown of glory that will never fade away.”

--1 Peter 5:1-4

“We didn’t know what to expect when he came here, but in just a few months Jesus has shown us what can happen when the Son of God is a Customer Care Representative.

His average call volumes are more than double those of any other rep, and when you listen to him take calls…well, when you hear him tell someone that they won’t be getting their benefits…it’s almost like he has some divine power over the customers or something, and that’s why today I’ve gathered you together to announce that Jesus is going to be transferred from the call center to the Executive Training Program.

Additionally, because Jesus did not adjust a single claim in favor of a customer for the last three months we’re also giving him the “Employee of the Quarter” award, which means he gets three days off with pay that he can take anytime he wants, a check for $500, and, of course, Jesus gets to use the parking space right by the front door for his Hummer.

We expect really great things from Jesus in the future, and while we will miss Him here at Customer Care I think we can safely say that with Jesus running the show this company is going to remain profitable for decades to come.”

On Understanding Your Market, Or, Mr. Obama, We Need To Talk

So it’s the day of the big speech, Mr. President, and we got trouble with a capital “T” right here in Health Care City.

What are you gonna do? Do we follow the traditional Democratic Party legislative process of passing...something...at any cost, assuming the entire time that the Left and the Netroots will “go along with the program”, or is there a risk that the calculus doesn’t work as well today as it did in 1994 and 1996?

Well, lucky for you, I’m a fake consultant, and I know a few things about your “target market”, so before you answer that question...we need to talk.

So the common sense approach to handling this situation is to make any deal required to get a bill passed, because otherwise your entire Presidency will be tagged as “strong on oratory but unable to govern”. Since the Far Left supports Democrats today and won’t be supporting the Republican Party under any circumstances, they’ll have no choice but to follow the “centrist” (read: “bluedog”) Democratic lead.

What you don’t want to do, common sense tells us, is demand that reform contain elements that simply are too tough to get through Congress. Insisting on a public option is absolutely out of the question, the new “preexisting conditions” requirements would be too onerous on the insurance companies—and requiring everyone to purchase insurance, with no public option competition at all to moderate the prices private insurers charge, and, for that matter, no guarantee of universal coverage, somehow makes perfect sense.

To mollify those who will object, we can hold out “triggers” as a compromise: in other words, Government says “hey, let’s wait a few years, and if the insurance companies still haven’t changed their ways...then we’ll do something.”

If you decide upon this approach, then the speech you want to give is to remind the Far Left and those pesky bloggers that political progress is incremental, you take what you can get, and that we can always come back later and make this whole stew of compromise better than what we propose to cook today.

While that’s a pretty good approach...most of the time...it won’t be this time.

There are two major reasons why, and, ironically, they’re both derived from your success in 2008.

Right off the bat, this strategy assumes the millions of new voters—and even more importantly, donors—that you attracted in 2008 are Democrats, and that, no matter what, they will continue to support Democrats. The problem is, they’re not....and they won’t.

Why? Because the vast majority of those new voters weren’t “redirected” from another Democratic candidate. Instead, they were “political non-participants” who had previously held no political affiliation whatsoever—and other than supporting you personally, the vast majority of those new voters have no long-term political affiliation now, other than, perhaps, “Progressive”.

The only reason they voted for you in the first place was because you were out promoting that whole “change you can believe in” thing. They saw you on TV telling people that universal access to care “...is a moral responsibility and a right for our country...”, and saying you would:

“...set up a government plan that would allow people who otherwise don't have health insurance because of a preexisting condition, like my mother had, or at least what the insurance said was a preexisting condition, let them get health insurance”.

At that same evening’s event (the Democratic Presidential Debate of January 31, 2008), they also saw you say this:

“...because my view is that the reason people don't have health care... [w]hat they're struggling with is they can't afford the health care. And so I emphasize reducing costs. My belief is that if we make it affordable, if we provide subsidies to those who can't afford it, they will buy it.

Senator Clinton...believes that we have to force people who don't have health insurance to buy it. Otherwise, there will be a lot of people who don't get it.

...I think that it is important for us to recognize that if, in fact, you are going to mandate the purchase of insurance and it's not affordable, then there's going to have to be some enforcement mechanism that the government uses. And they may charge people who already don't have health care fines, or have to take it out of their paychecks. And that, I don't think, is helping those without health insurance.”

The fact that you said all those things brings us to problem number two: if you don’t live up to your...exceptionally public...campaign promises, you’re gonna get YouTubed.

Forget about the Republicans. The Netroots will dig these quotes up in about two seconds—in multi-part harmony, I suspect—and all of a sudden, all those “new voters” who helped put you over the top last time, instead of seeing change they can believe in, are going to start seeing you as the “same old same old”...and if that happens, they won’t be voting Democratic again (or for anyone else, for that matter) for years to come.

And if they won’t vote for you...they most assuredly won’t be giving money to Democratic causes and candidates...including you in 2012.

You have to understand, it’s a question of trust. We want to believe that you’ll do the right thing, but we have been lied to for eight years straight...and we now fundamentally mistrust our elected representatives...including you.

Not all the news here, however, is bad news.

There is a way to turn all this to your advantage, and it basically involves “leapfrogging” the opposition.

Here’s what you do:

In the speech tonight, you look America in the eye and you tell us that you said all along that we must have a public option if we hope to control costs, you tell us that insurers can’t continue to “exclude” us out of insurance, and that universal coverage is, indeed, a moral obligation for our Nation—and a smart investment to boot.

Tell America that you will fight for them and against the special interests that are trying to hustle us once again. Most importantly—and this will be The Tough Part—tell us that a bad bill is a bill you won’t sign.

You have to tell America that if we don’t get it this year, we’ll have to come back next year and try again. And if we have to, the year after that, and the next, and the next.

You also get to remind America exactly what kind of methods Republicans were wiling to use to advance their position over this past month, and whose interests they’re representing when they do it.

To put it another way, you gave ‘em enough rope, and now it’s time for some noose-tightenin’.

The best part: not only does this approach lay to waste Republican opposition, it reels in the wavering Democrats—and it allows them to go home and tell their constituents that “Barack Obama and I are fighting for people and businesses and jobs while Republicans fight for fat cat insurance companies”.

If it's done correctly, the 2010 midterms will be y’all’s to lose—but as I said earlier, if you are seen as selling a political product everyone’s seen far too many times before, the cost could be brutal...maybe even “President Palin” brutal.

We all have a busy day today, especially you, Mr. President, so let’s wrap it all up:

You made a lot of campaign promises about public options and universal coverage and ending exclusion abuses, and now it’s come time to make good.

A lot of the people who supported you didn’t do it because you’re a Democrat—and not because they are, either. If you don’t make good, you got a problem, and so do the Democrats, possibly for years to come.

YouTube was a fantastic tool for you and the seed of trouble for many Republicans in ’06 and ’08—but if you’re not careful, the tables will turn, and a lot of the people doing the turning will be to your left.

Do it right and you and the Democrats have a superb opportunity to pivot on the opposition and imprint the Democratic “brand” for a new generation of voters—and donors—and an aggressive approach tonight could be the opening salvo of a message barrage that either forces Republicans to become more moderate, or turns them into a crazier political movement that loses seats and Governors in 2010 and carries even fewer states in the 2012 Presidential than they did in 2008.

Screw it up, and even Tina Fey might not be able to save us from the wrath of “Palin/Gingrich 2012”.

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 Disarmament, Or, How Congressman Larsen Made A "Town Hall" Work

We’ve all been hearing the “Town Hall Meeting” stories the past few days, and the images presented have been of gatherings where you might see some current or former official “death panel” for the benefit of the crowd, where the few people who shout the loudest bully the rest into silence, and where threats of physical intimidation are part of the debate.

I attended one of these meetings, and based on what I saw I’m here to tell you that it is possible to hold an event that features none of the images previously described.

Instead, what I say was an event where people asked their questions, the Congressman answered—and from time to time the angry members of the audience got their shout on, too...but not in a way that was able to ever take control of the venue.

There were helpful lessons that can be applied by others who want to have these meetings, and today’s conversation examines what can be done to make them work for you, too.

Let’s start by meeting the players:

Rick Larsen is the Member of Congress representing Washington State’s Second District. A Democrat, he first won his seat in the 2000 election, and in 2008 he defeated former Snohomish County Sheriff Rick Bart by a 62-38% margin.

The (mostly rural) Second District is bordered by Puget Sound on the west, British Columbia to the north (Vancouver is just a short drive from the I-5 border crossing at Blaine, Washington), the Cascade Mountains to the east, and Seattle’s northern suburbs to the south.

From south to north, major cities include Everett (former fishing, lumber and harbor town), Mount Vernon (the largest town in a region known for tulips and eagles and agriculture and formerly, commercial fishing and lumber), and Bellingham (college town, and, again, former fishing and lumber town). All three towns grew substantially as a result of the Alaska Gold Rush of the 1890s.

There are numerous Indian Tribes within the District, as well as two significant military installations: Naval Air Station Whidbey Island and Naval Station Everett.

Larsen had held a previous Town Hall in Mount Vernon that attracted a crowd that was several times the capacity of the venue, so at the last minute Everett Memorial Stadium was booked for this event.

(Fun Fact: this stadium is the home of the minor-league Everett AquaSox, one of the few sports teams to ever take the field in tie-dye uniforms.)

By my count, roughly 2500 were present—but there was an interesting distribution: it appeared to me that the “Diamond Club” seats right behind home plate, and the two sections on either side, were thickly populated with supporters of reform, with opponents “flanking” them to the left and right. The main entrance is on the third base side, and the seats filled up from that side as well, with the seats out past first base being the most empty.

It was not “high summer”, by any means, and at “game time” (5 PM) we had a cloudy sky and a temperature of roughly 65 degrees.

Larsen stood on the field near home plate, and as soon as he started speaking you could see he had three advantages: the large outdoor venue meant that no single person could shout down the meeting, Larsen’s access to the PA system meant that he could always be heard even if a group tried to “chant out” the meeting, and his use of “runners” to take the microphone to each questioner meant no “in your face” screaming matches were going to take place.

Another smart move: Larsen limited his discussion to one specific bill (HR 3200), which allowed him to avoid having to speculate as to what might or might not be in any other possible proposal.

Beyond that, he made it clear in his opening remarks that he would be willing to spend up to 2 ½ hours to answer questions and that the microphone would be getting to every section, in turn, as much as needed; this seemed to remove much of the concern that people would be shut down and left unable to ask questions.

Additionally, he was more than willing to challenge those with whom he disagreed, as evidenced by his answer to one question from the crowd:

“I’ve got facts on my side and you’ve got Glenn Beck on your side...”

At the same time, he was able to use the PA and personal attention to his advantage during questioning. The “runners with mic” system made sure that all questions, from supporters and opponents, could not be drowned out, and by giving real attention to each questioner and presenting a “non form-letter” response (the PA assuring that his answer also could not be drowned out), Larsen was able to show that this was indeed a conversation and not a shouting match.

The crowd also acted as a moderating influence. A number of the questions came from people who seemed as reasonable as they could be, and when some extremist language was presented, the crowd exerted its own influence.

Here’s an example: a questioner asked the Congressman and the crowd to try to come up with one example of Government ever doing anything right, or words to that effect. The crowd offered some supportive cheers.

A couple of questioners later, a man stood up and told the crowd that he did not appreciate the last 20 years of his life being disrespected. He pointed out that the United States Navy, in which he serves, is the finest military force of its kind on the planet (this, in what is today very much a Navy town)...and all of a sudden, the “Government can’t do anything right” supporters, many of whom appeared to be military retirees (based on their age and choice of hats), found themselves...moderated.

About 90 minutes in Larsen called for a “7th inning stretch”, but much of the crowd took that as an invitation to leave, particularly as it was beginning to get cold, and it was starting to rain. Within a few minutes roughly 1500 of the original 2500 people had left.

The event, all in all, was kept under control, and those who came to disrupt were unsuccessful in creating an environment where that could happen...and a lot of that was because of the efforts of Larsen and his staff.

The goal of this exercise is not to go through all the questions and answers and crowd reactions, but I will tell you that I heard a woman behind us asking out loud about what would happen to senior citizens if the Government ever took over Medicare, which I found both profoundly humorous and profoundly sad.

So what can we make from all of this?

First off, a large venue makes it much tougher for any individual or group to take over the event.

Getting your people into a cohesive group near the center of the action is also quite helpful.

Ensuring that the PA is loud enough to always overpower any “disrupters” is vital.

Making sure the crowd understands that nearly everyone who wants to will get to ask questions matters—and it also matters if you appear to be giving reasonable answers to reasonable questions.

Be a bit of a parent, and call the kids out when they deserve it.

Finally, if a questioner says Government can’t do anything right—ask ‘em why they want to disrespect the brave men and women of our Armed Forces. If you’re in Texas...or North Carolina...or California...or Florida—ask ‘em twice.

If you are going to have to campaign for office every two years (and as a Member of Congress, you do), creating a positive image that transcends electoral cycles can be a great thing. These Town Halls offer that opportunity—and if you do it right, you’ll be able to say that you “listened to the voters” and “stood up for the People” and “made the tough decisions”, despite the efforts of special interests to “hijack the process”, for years to come.

And that, Future Candidates, is not a bad image to take on the campaign trail.

SPECIAL NOTE: We note today the recent passage of Les Paul. Many will remember him as the man who made the electric guitar famous, and still others will remember his work with Mary Ford...but if you have ever stood behind turntables or made a mix or a mashup, you should know that everything you’re doing today also came straight from the mind of Les Paul, who was just about the only person on the planet Earth making 24-track overdub recordings all the way back in 1951.

Obama, Lipton, To Seize World's Teabags

WASHINGTON (FNS) – In a startling development related to the recent disruptions of town hall meetings, FNS is now able to confirm that the Obama Administration, with the assistance of Unilever Group and Queen Beatrix, both of the Netherlands, PepsiCo, Skull And Bones, and the Bilderberg Group, is unleashing a secret plot to dispatch fleets of unmarked aircraft and helicopters to prevent teabag protesters from having access to teabags.

The goal of the plot: to disrupt protesters’ plans to save America from the destruction of our health care system.

FNS reporters have been following a trail of information that includes airport noise abatement records, classified documents, and the testimony of insiders, some of whom are now willing to be publicly identified.

We’ll begin our story by reporting on three events that occurred the evening of Friday, August 8th.

Residents near the Suffolk Plaza complex in Suffolk, Virginia reported seeing unmarked black helicopters landing in the industrial area just to the east of the Suffolk Golf Course. According to our informant, the helicopters settled in behind the truck parking area of the Unilever/Best Foods distribution center. This facility, in addition to distributing Lipton Tea products, is the largest tea processing plant in the United States.

It’s reported that the helicopters spent nearly five hours loading inventory at the location before departing just before sunrise, and that before they left certain records had been erased from the memories of the Markem SmartLase systems used at the plant to encode lot, packdate, and expiration date data onto boxes of teabags before distribution.

A similar sighting was reported the same evening at another Lipton distribution center, the International Food Solutions facility in Wichita, Kansas. In this case, however, after the helicopters landed an unmarked locomotive and three box cars moved to a position just outside the plant gates. Several forklifts carried pallets out the entrance normally reserved for employee parking to the train, which was located roughly 100 feet north of the driveway on South Water Street.

The loading process took almost seven hours, we are told, after which the helicopters and the train left the area. Security guards at the Pepsi plant across the street reportedly kept plant workers away from the west side of the building during the operation.

The third Lipton distribution center to be hit that evening was the Unilever/Best Foods facility in the City of Industry, California. An eyewitness sighted two helicopters, landing at the very end of Otterbein Street. A few minutes later several unmarked tractor-trailers approached the loading docks. Two hours later, the trucks drove away, heading for the Pomona Freeway.

There are rumors that other facilities were being targeted, but we were unable to obtain official comment from representatives of Unilever/Best Foods, nor from Celestial Seasonings, who operate a processing and distribution facility Boulder. Colorado, nor from R.C. Bigelow, Inc, who process both the “Constant Comment” brand and their line of herbal teas from their Boise, Idaho location.

We were able to obtain noise abatement records from the Ontario International Airport and the Wichita Mid-Continent Airport that confirm that aircraft were operating at the times reported by our informants, and that no other air traffic was operating in the area at that time.

Who is organizing all this? That information was recently provided to us by an informant who has only recently agreed to come forward. Harry Paratestes, an Assistant Program Manager who was previously employed by FEMA but now works for the Office of the Assistant Secretary for Administration and Management (ASAM) at the Department of Health and Human Services:

“I was assigned to the ASAM Program Support Center (PSC) in March, after the Tax Day protests. The ASAM PSC is a clandestine office that was charged with coordinating with another clandestine office (the Administrative Services Division of the Department of Commerce’s Bureau of Economic Analysis), the HHS Office of Global Health Affairs, FEMA, and the White House to shut down any efforts by citizens to prevent the Obama Administration from socializing the larger American economy; and we had finalized the plans that were used Friday night in early June.

From the beginning we were aware of the powerful impact of the Tea Party protests, and we knew we would have to block access to those tea bags if we were going to nip this in the bud.”

Who stands to profit from all of this?

There are rumors that Queen Beatrix and members of the Bilderberg Group hold enormous investments in Sanofi-Aventis, AstraZeneca, and Hoffmann-La Roche, three of the world’s largest pharmaceutical companies, and that the Queen influenced Netherlands-based Unilever to cooperate.

In addition, confidential sources have reported to us that during President Obama’s spring visit to Europe he was offered membership in the Bilderberg Group, as well as a multimillion-dollar “recruitment package”, in a late-night meeting at the US Embassy in Paris (along with agreements to allow “rendition” of Tea Party protesters to secret French tropical prisons if necessary) in return for guarantees of future access to the US market on favorable terms.

To summarize: so far we have been able to substantiate that the President has ordered secret seizures of a major portion of the national tea bag supply in just one night, that the plan is part of a larger Federal program to shut down the Tea Party protests, that France has agreed to accept “renditioned” Tea Party protesters, and the this President has agreed to join the Bilderberg Group as part of his plan to “internationalize” American health care.

The best advice we can offer to patriotic Americans is to immediately purchase any remaining tea bags at your local grocery store and to make the purchases in cash, in case Government agents use Federal Reserve Bank records to direct FEMA agents in their future home seizures of the tea bags—and Tea Party protesters.

UPDATE: 8/11/09 3:00AM PST

Guess what, folks...we've already made the USA Today website...and I don't think they know it's a joke.