Frankly Speaking - Too Big to Fail

Frank B. Holding, “the banker,” speaks frankly about financial matters, so when I wrote A Looming Terror, I made an appointment with Mr. Holding to get his outlook. That was almost two years ago that I expressed concerns for perils of a growing national debt and, as I put it then, my “wearily growing qualms about these economic times.”

I first knew of the Holdings in the 1940s. Frank’s father, Mr. R. P. Holding, Cashier at the First Citizens Bank from 1918-1935, became President and Chairman of Board. He was principle leader and stockholder leading First Citizens’ expansion in eastern NC, service primarily to farmers, during the Great Depression era. Founded in 1898, first known as “Bank of Smithfield,” it was the first bank in Johnston County, NC. The first modern physical facility, built in 1913 at Market and Third Streets in Smithfield, was donated by First Citizens in 1996 to The Johnston County Heritage Center.

When I was just a lad, R. P. Holding and C. L. Denning, a local resident running for sheriff, stopped at roadside where I tended the fertilizer bag as my daddy cultivated the crop. It was an era, lethargically growing out of the 1930’s Great Depression, immediately following World War II, eighty-plus years after the American Civil War, when plowing in this Bentonville Battleground soil, sometimes, uncovered “minie balls” (lead bullets). Confederate and Union soldiers fought from opposite sides of Sam Howell branch which ran on the east side of my Bentonville Township community home. Many longleaf pines at field’s edge when sawn for lumber, the smooth cut of the saw blade revealed the shine of a lead bullet, embedded more than eighty years earlier.

As daddy walked behind the horse-drawn plow he might have had an askew eye for a minie ball, to add to his Civil War collection, a bullet that may have been unfurled by the plow. But on this round as he approached row’s end, his eyes would squint on the two stalwart gentlemen-politicians, soon to become successful Democratic officeholders. Mr. R. P. Holding served until death in 1957, at which time his young son, Frank Holding, was appointed to replace his dad as county commissioner. Frank’s reelections gave our county exceedingly capable, admirable service until 1994 when a demographic wave of Republicanism enveloped Johnston County, a bedroom-community expansion in one of the nation’s fastest growing areas, adjacent to the Research Triangle Area of Raleigh, Durham and Chapel Hill, NC.

Frank, his brothers, and family, the majority stockholders, have operated one of the most conservative banking institutions over the past half century. (Some of my friends might say, too conservative.) For most of those years, his brothers held the higher official-officer-titles but no doubt Frank’s influence in First Citizens was, at least, of equal importance to the bank’s success. In addition to his ownership in First Citizens, Frank personally owns fifty-plus banks under the “Southern Bank” name throughout eastern NC. Frank’s unassuming personality, content to be in background, declining commissioner’s chairmanship, his progressive yet fiscally responsible leadership during his thirty-seven years as a commissioner of Johnston County, not only was an invaluable human resource for our county ----- it as well in his responsible, down-to-earth demeanor gave an incomparable impetus for building successful financial institutions.

Time-honored leadership hereof ascribed may be long lost in the management of many colossal financial institutions. Andrew Sorkin, in his current book, Too Big to Fail, chronicles the harried days, 24/7 round-the-clock diligence, leading up to the edge of a national financial apocalypse. He follows the day-to-day role of the big-bank players, including government officials, Hank Paulson, Tim Geithner, and Ben Bernanke. Many people now in retrospect look at these later three as either the “problem” or “the problem solvers.” But as it was in “real time” of a pending financial catastrophe, I believe our world is fortunate to have had these men at the monetary helm. (Even so, a world economic crisis, raising to one billion the number of people going hungry, was not prevented according to the United Nations.) Bernanke, the Federal Reserve Chairman since 2002, an intellectually bright kid raised in Dillon SC, became a scholar of The Great Depression. “He advanced the views of Milton Friedman and Anna J. Schwartz who had argued that the Federal Reserve had caused the Great Depression by not immediately flushing the system with cheap cash to stimulate the economy. And subsequent efforts proved too little, too late. Under Herbert Hoover, the Fed had done exactly the opposite: tightening the money supply and chocking off the economy.” (Too Big to Fail, Location 1836-43) Time Magazine’s naming Ben Bernanke Person of the Year 2009 may be a well deserved recognition for saving the world from a financial abyss. Although, he continues to have critics as in reconfirmation to the Fed: Bernanke Comments on the "Doom Loop." But Does He Get It?

While many of these big-players were extremely intellectually brilliant, probably none could claim a unique-value system such as a Frank B. Holding, whose youth rooted out of economic depression times. Many of Frank’s proudest moments may have been standing with his cotton farmer for a picture, having ginned the first bale of cotton of the season or purchasing an animal at a youth livestock sale. Frank is contented riding his pickup truck, loaded with hand tools, out to the farmhouse for relaxation and exercise. The stories I’ve heard include: Holding as a young boy, to some people’s estimation, at least in some diminutive measure, was a protégé of a local mule and equipment trader by the name of Smooch Heavener. Frank and Ella Ann raised their children, possibly, in an inimitable quality: he walked with them along roadside having them pickup recyclables; the local public schools were good enough for their kids. (Though, some at least, I believe, attended private schools in the higher grades.) I’ve heard their teacher’s comment of their studiousness and very polite manners. When Frank learned of an upper-echelon manager parking his luxurious-model automobile at First Citizens Corporate office in Raleigh, word was conveyed, “That’s not the image of our company.” After many years driving Chevrolets, Frank moved up to Buicks. A former Chevrolet dealer tells of his arrival to purchase a new car, at a time that most autos were pre-equipped with electrical accessories. But he wanted only a vehicle with hand-crank windows. “Well sir, to get hand-crank windows it’ll cost you more.” In SC driving with some friends, he presses the brakes, gets out and walks back to pick up some bottles. Redeemable deposits!

Today, two of Frank and Ella Ann Holding’s children hold chief positions at First Citizens. Frank B. Holding Jr. is its Chairman and CEO. Hope Holding Connell is Executive Vice President at First Citizens & President of Ironstone Bank. On the Nasdaq (FCNCA) as First Citizens BancShares Inc, it is one of the top 100 financial institutions in the country, and it is one of the largest family controlled banks in the U.S. First Citizens’ “Ironstone Bank” operation stretches from Florida and Georgia across the nation to California, Oregon and Washington. This September as reported: “The Raleigh-based bank announced late Friday that it acquired the operations of Venture Bank, which has 18 branches in the Puget Sound region of Washington where Microsoft is headquartered, after it was taken over by the Federal Deposit Insurance Corp. That purchase followed July's acquisition of virtually all the assets of an 11-branch Southern California bank, Temecula Valley Bank.” “First Citizens' conservative banking practices have enabled it to eschew the federal stimulus money that many large regional and national banks have relied on since the recession hit. That conservatism made it one of the select few that can afford to buy troubled banks today.”

Now, almost two years ago when I sat down with Mr. Holding, he briefed me on how some banking functions work. He believed America was a safe haven for China’s investments. He said today’s physical-bank-structure buildings had to be of a modern facade, image, to be successful. He expressed an adverse opinion on CEOs of large banking, and large corporations in general, drawing exorbitant salaries. (American CEO Salaries in the 1980s averaged 40 times that of a regular employee; today it’s 400 times as much, plus large bonuses. European counterparts of the top 20 CEOs make only 1/3 of this amount. [Ref. page 122, Reckless]) In the end, Mr. Holding said he was an “eternal optimist”. No doubt his idealism, in part, comes from his knowledge of the secure-financial base on which his banks are grounded.

In a time past, when toil of hands to the plow, honestly grubbing a living from the soil; when WWII citizens made sacrifices of true patriotism for their country; when the Lee Iacocca type CEOs of Chrysler (in a government subsidized recovery) worked for $1.00 annual salary ---- we have to ask, as Iacocca has: “Where have all the leaders gone?” Where are all the integrity-example setters? Are we a victim to big-money lobbyist? Abuses for personal gain, a disregard for ethics, inside and outside of government, intertwined of government and businesses, ran rampant over recent decades. Time Magazine list 25 people to blame for the financial crisis, including Bill Clinton and George Bush, but at the top of the list is Angelo Mozilo, Countrywide’s co-founder in 1969, who built Countrywide into the largest mortgage lender in the U.S. Countrywide was just one operation to offer exotic mortgages to borrowers with a questionable ability to repay them. As has been reported, many of these institutions crossed ethical lines into predator lending, content to collect their big-package fees, even knowing the deals were spurious. And therein lies a grievous moral decline. Could that be a manifestation of society in general?

A side note: (All too freely Democrats and Republicans, for personal gain in many
cases, aided the Government-sponsored enterprises (GSE) Fannie Mae and Freddie
Mac. Newt Gingrich, Ralph Reed, among others, worked as consultants for Fannie
and Freddie; Raham Emmanuel served on board of Freddie Mac. GSEs cover 40% of
housing investments. Fannie was created in 1938, Roosevelt’s response to the
housing slump of the Great Depression; under Lyndon Johnson a process of
privatizing Fannie began, and in 1970 a political concession [sop] was made to
its critics; thus, Freddie Mac {Federal Home Loan Mortgage Corporation} was
created. {Source: Too Big to Fail})

Holding’s balance of idealism and honest-realistic-pragmatic style of management, where long-term focus is not obscured by a desire for short-term profits, is a lessons to be learned by some of the failed behemoth banks and other corporations that go for big-easy short-term quarterly gains. Frank Holding’s modus operandi is in stark contrast to those CEOs of the super-large banks, too big to fail, who traveled with chauffer driven limousines and private jets. The behemoth-bank players earned the mantra: “Banks that are ‘too big to fail’ are too big not to be regulated.” That’s government’s responsibility. But who will regulate/re-dedicate “We the People” to the better instincts of humanity and a higher moral calling for leadership? Thomas Friedman says: “The standard answer is that we need better leaders. The real answer is that we need better citizens.”

Of our leaders -- one thing is for certain: If the giant financial institutions; predator-loan operators such as Golden West Financial Corporation that mortally wounded Wachovia and Countrywide Financial that significantly injured Bank of America, and their ilk throughout the nation; GSEs Fannie Mae and Freddie Mac; government in its runaway national debt (when it could and should have paid its bills) --- had operated as responsibly as the banks of Frank B. Holding, we would not be in this “Great Recession”. If by chance we had fallen into a mild recession, much easier to correct, the recovery would not be as protracted as inevitably this one is sure to be. However, there may be good reason for brighter economic days ahead: One of the very few who predicted the housing bubble and economic contraction, Nouriel Roubini, said, “The Obama administration’s policy makers—and especially the much-maligned Tim Geithner—have gotten a lot right. Pitfalls may still abound, but he (Roubini) is now projecting an end to the recession, and he sees growth ahead.” On the other hand, some believe we are not out of the woods yet, in part, evidenced by 10% unemployment. In either event, in the highest degree possible, we’ll do well to be an “eternal optimist” of a Frank Holding’s frugal, principled character.

Healing America – Part II / Ideology Rigor Mortis

In continuation of Healing America - Part I, herein is my counterpoint to the Right’s view on health-care reform with respect to the “political aspect” of their comments: “The answer to our problems is not to turn the problem over to politicians but to fix one at the time.” “The politicians can definitely help and we need their help.” “We need broad bipartisan support.” (Read Virgil’s and Staton’s complete text on response to “A Damascus Experience.”)
Procrastination in this response was easy --- because I take no pleasure in critiquing the “Right,” even as I know there are many “classical conservatives” and “moderate conservatives” seeking understanding and resolve to the Republican Party’s predicament. (What I write herein is in no way to excuse any of too many Democrat’s misdeeds or candidates’ indiscretions.) Certainly not a classical or moderate conservative, yet a politician trying to display some sense of decency, SC’s Republican Senator Lindsey Graham mustered courage to refute and admonish those who spew the venomous verbiage of ill-will, hate and fear-mongering falsehoods toward our president. I believe Graham came to the realization that if you don’t reprove this outrageous, degenerative conduct, you are a condoner, complicit in its malevolence. He had the common sense to know it was time to step off the “self-defeating band-wagon” of politics.
It is the inexplicable “political equation/dynamic” of the two-party system of the last several years that I have found somewhat intriguing (trying to understand what’s happening) --- but moreover disturbing. More recently in a crescendo the “extreme Right’s” ideological rigor mortis mounded a pile of inglorious defamation.
Lately, this political inscrutability came to a keen focus when I read Sam Tanenhaus’ “The Death of Conservatism” (TDC) published July 09. Tanenhaus says, what we call conservatism today would have been incomprehensible to the great originator of modern conservatism, Edmund Burke. “The task of statesmen was to maintain equilibrium between ‘the two principles of conservatism and correction.’ To govern was to engage in perpetual compromise – ‘sometimes between good and evil, and sometimes between evil and evil.’ In such a scheme there is no useful place for the either/or of ideological purism.” (TDC 218-26: referenced numbers indicates Kindle Book locations) Tanenhaus quotes Gary Wills who joined Buckley’s National Review in 1957, and in 1961 the 26-year-old promising young conservative thinker wrote The Convenient State: “A consensus as the word’s form indicates is a meeting of several views on common ground; and orthodoxy is a reduction of all views to a single view. Consensus implies compromise, establishing a minimal ground of agreement on which to base political organization. Orthodoxy goes to the roots of metaphysical and religious awareness and demands a ‘right view’ on these things, not merely a modus Vivendi. (The contemporary word for this is ‘ideology.’)” (TDC 264-72)
Thus, the R Party finds itself taken over by an ideological “religious right” and “neoconservatives,” becoming the intractable modus operandi, “Revanchist Party.” Finally, in its defeat after eight years of strict-ideological rule, the authoritarian ideology ratchets up revanchism, meaning to revengefully retaliate, take back lost territory; “block and tackle” almost by any means, to justify some obscure end. It was less than two months after the presidential inaugurations, on the local radio station the host opened an interview with the local sheriff: “We got to take back our country,” with the Republican sheriff emulating exact phrase. But there are elements driving this revanchism beyond the normal prejudicial, political polarizing-forces. Based on some personal experiences I’ve had in support of President Obama, it is apparent there’s an irrepressible prejudicial resentment to his official-capacity. Let me be clear there are many “good and well intentioned people” drawn into this quagmire, including participants at “tea parties,” “town-hall assemblies” or other gatherings, who have genuine concerns for our country. Even so, many, if not most, of these events are organized, lead and/or promulgated by people of special interest with ulterior motives, designed specifically for a revanchist movement.
The Religious Right: In 1916 the Y. K. Rushdoony family from Europe arrived on America’s Atlantic coast and traveled to California. That year a son, R. J. Rushdoony, was born. His brother had been one of the 1.5 million who perished in the Armenian genocide. A descendent of a long line of aristocratic priest reaching back to the year 315, young Rushdoony was raised on stories of slaughter that uprooted his family’s ancient Christian heritage. In California, he studied divinity, plunged into conservative theology, becoming a minister in the ultraconservative Orthodox Presbyterian church, and immediately mapping out a system to restore purity and order to a fallen world that surrounded him. Rushdoony’s radical worldview intensified in 1950 during the peak of anti-communist Senator Joseph McCarthy’s show trials. He befriended a candy manufacture, Robert Welch, who shared his visceral hatred of political subversives. Welch used his fortune to create, in 1958, the right-wing fringe group, the John Birch Society. He had gained notoriety by red-baiting prominent public figures such as President Truman, President Eisenhower, and Allen Dulls, all covert Soviet agents in his mind. (Max Blumenthal’s Republican Gomorrah {RG}, Aug. 2009, 275-82) Welch actually claimed Milton Eisenhower, brother to President Dwight Eisenhower, was the President’s superior and boss within the Communist Party. William Buckley, editor of the National Review, who had been close to the Society in his support, eventually denounced it as an impediment to the legitimacy of the conservative movement. But with the isolation of the society as extremist, Rushdoony’s admiration grew. “In 1973 Rushdoony published his magnum opus, The Institute of Biblical Law, an eight-hundred-page book deliberately invoking Calvin’s Institute of Christian Religion to suggest his traditionalism.” “He labeled his philosophy ‘Christian Reconstructionism’ and painstakingly outlined plans for the church to take over the federal government and ‘reconstruct’ it along biblical lines. According to Frederick Clarkson, a pioneering researcher of the Christian right, Reconstructionism seeks to replace democracy with a theocratic elite that would govern by imposing their (italics added) interpretation of ‘Biblical law.’” (RG 302-9)
Francis Schaeffer (Schaeffer & Rushdoony drew on each other’s beliefs.) was another influence to the right-wing movement. “In 1976, he published a best-selling polemic that inspired the Christian right’s advance guard, How Should We Then live? The Rise and Decline of Western Civilization and Culture. The book concluded by proclaiming legalized abortion – ‘infanticide,’ Schaeffer called it – the final leg in western civilization’s death march. To preserve Judeo-Christian society, Schaeffer implored evangelicals to organize a crusade to stop abortion by any means.” Schaeffer sold Jerry Falwell on the strategic importance of joining “pro-life;” sold the anti-papist Baptist on the concept of “co-belligerency,” or working with conservative Catholics and other non-evangelicals to assail the secular establishment. Under Schaeffer’s guidance, in 1979, Falwell founded the Christian right’s first lobbying front, the Moral Majority. In 1981, Francis Schaeffer, wrote a book, A Christian Manifesto. It called for literally attacking the foundation of liberal democracy. Even though it went unnoticed by mainstream America it sold 250,000 copies in its first year. His son, Frank Schaeffer, commented: What’s amazing about Christian Manifesto “was that my father was calling for the overthrow of the United States government. If his words had come out of the mouth of anyone other than a white American it would have been called sedition.” Dying at the Mayo Clinic in Rochester, Minnesota, Francis Schaeffer agonized about the rise of the Christian right, convinced he had created a monster. And as the outspoken homophobe Anita Bryant appeared at his deathbed for her blessing on the anti-gay crusade, he angrily rebuked her, according to his son. (RG 421-27)
Joseph McCarthy’s true accomplishment, praised by Patrick Buchanan, was convincing the Right there’s an enemy within, “Washington bureaucrats” and “big government.” It became the staple of GOP politics over the next half century, the raid on government itself: practitioners included Richard Nixon (Watergate), Ronald Reagan (Iran-contra), Newt Gingrich (twice: the government shutdown of 1995 and Clinton impeachment), and George W. Bush (his dismissal of nine U.S. attorneys). These three Republican presidents had strong ties to movement conservatism while three others (Eisenhower, Ford and George H. W. Bush) did not. “The first three pursued a revanchist course in which institutional conflict – waged against the other branches of government or against the ‘permanent government’ of the executive – were part of a broader ideological campaign too urgent to be trusted to the traditional channels of governance.” (TDC 173-81)
Howard F. Ahmanson, Jr., an eccentric California millionaire, was another who helped found the extreme, far right. He was left a fortune by his father. On discovering the Rushdoony writings and getting to know Rushdoony, he became a full-fledged Calvinist; he used the fortune to establishment Christian-right organizations and support of their causes. Ahmanson, in 1992, banded four right-wing businessmen to back the campaign’s anti-gay, anti-abortion, pro-big-business candidates for takeover of California’s general assembly. The list of Ahmanson support for religious-right-wing initiated groups goes almost endless.
The Christian-right’s movement is referred to as “The family,” an exclusive sect, or as a whole is called “the pro-family” movement. And movement allies are known as “friends of the family.” The Family (or, in some cases, those who high jacked it for clandestine motives) adopted a Macho Jesus, a Jesus who would find no wrong in their strong-armed-self-serving politics. For those fallen from disgrace, being “born again,” gave a special passage to support “The Family’s” causes. Their “political power position” ensures ongoing, loyal, political backing from ‘The Family.” “Born again,” from a dallying, alcoholic, Texas legislator, Tom Delay’s headstrong march through the U.S. House acclaimed the name, “Hammer.” His Macho Jesus delivered him through many religious-political crusades as House Majority Leader. Association with close friends, the revolutionist, such as Ralph Reed (The Christian Coalition), Grover Norquist (anti-tax guru), and Jack Abramoff, added to his undercover political power. In concert with Abramoff’s circle of banditry, Indian Tribe Casinos and Christians against gambling were duped out of hundreds of thousands of dollars; thus, making a mockery of the legitimate Christian Community, good people who thought “they were doing their part to bring America back to God.” Delay, for the Republicans, was acknowledged the official “K-Street’s lobbyist enforcer.” Where Delay operated at 132 D Street SE, DC, his townhouse was bought by The U. S. Family Network, a nonprofit. The Network mission: “To restore moral fitness to American lives.” On a trip to Saipan of Northern Marianas, a U.S., territory, he defended taking advantage of indentured servants who thought they were coming to America --- but were stuck in sweetshops manufacturing clothing for U. S. companies, legally labeled as “Manufactured in U.S.A.” These captive servants of the labor-camps worked for pittance. (Congress had exempted the island from U. S. labor law.) Again, this was to win lobbyist money from the sweetshop operators (one who had already paid $9 million labor-violation penalty, highest in U.S. history), for political advantage back in the states. In a speech on the island, Lay said, “You are up against the forces of big labor and radical left.” “Stand firm. Resist evil. Remember that all truth and blessing emanate from our Creator.” (I incredulously watch TV and wonder how some people can get air time; many people in this nation never knew or quickly forget recent history.)
The hamstrung Party yields to the James Dobson family, Focus on the Family. “When his Christian army reached critical mass, Dobson set them against the Republican establishment, flexing his grassroots muscle to destroy the ambitions of moderates such as Bob Dole and Colin Powell, and propelling movement figures such as Delay and George W. bush into ascendancy.” (RG 205-12) Dobson has spawned a long list of religious-right faithful, including all those already mentioned. To mention just a few others: Gary Bauer, Bill Bennett, Tony Perkins, Don Wildmond, Jim DeMint, Tom Coburn, John Thune, Ted Haggard, and David Vitter. For those such as Mark Foley or Larry Craig, , it seemed the R Party was a safe haven for egregious, political power while denying (remaining closeted) there true sexual orientation --- adding to the political hypocrisy. Dobson, a licensed child psychiatrist, has no theological credentials, but he is as Alexander Moegerle put it, “a master of clandestine politics.” He has effectively stonewalled every news organization, except Fox News where he is guaranteed deferential treatment from the likes of self-proclaimed “culture warrior” Bill O’Reilly. (RG 810-17)
Pat Robertson, Regent University founder, fired Herb Titus, his founding Law School dean because he refused to stop teaching R. J. Rushdoony alongside constitutional law. Rushdoony teaching, Robertson saw, would have been the key obstacle to Regent’s American Bar Assoc. accreditation.
Mark Sanford, John Ensign, and ‘The Family’ in D.C.: by Becky Garrison: “Presently, the glare of the media spotlight has started to shine on a number of political figures, all of whom coincidentally have a connection to a D.C.-based group called The Family. Stories linking The Family to these politicos have appeared on a number of media outlets including NPR’s Fresh Air, The Rachel Maddow Show, and Salon. Recently, I contacted religion scholar Jeff Sharlet, author of the New York Times bestseller The Family: The Secret Fundamentalism at the Heart of American Power and contributing editor for Rolling Stone and Harper’s, to discuss his research into this group and its connection to this current round of political scandals.” The Family founder, Abraham Vereide, believed, “Christians should work on behalf not of the down and out — the poor, the suffering, the meek — but the “up and out,” the powerful “key men,” as The Family calls them, who will dispense blessings to the rest of us. One evangelical Senate aide describes that as “trickle down religion.” So why haven’t you heard of them before? The Family believes it’s most effective behind the scenes. “The more invisible you can make your organization,” says Family leader Doug Coe, “the more influence it will have.”
Few congressmen/senators and certainly no presidential candidate get nominated and/or staunchly supported for the Republican ticket without the “litmus test,” good graces of James Dobson. Each must endure Dobson’s holier-than-the-other evaluation. John McCain was an outcast; therefore, to get tacit support, Dobson’s in-tow-neoconservatives recruited Sarah Palin, who met his test.
Neoconservatives: The intellectual establishment, conservative writers and TV commentator I once esteemed and admired, such as William F. Buckley, Jr., a moderate-to-right- conservative (Host of TV Firing Line and founder of National Review) has now been inundated with neo-conservatism. William Kristol the founder of American Neo-conservatism leaves a son, Bill Kristol, the standard-bearer of ideological purism. Former VP Dick Cheney and daughter Liz, neoconservatives, hold the banner high for “strict orthodoxy” and “revanchist politics.” Bill Kristol wrote in Washington Post, Oct. 27-09: “The center of gravity, I suspect, will instead lie with individuals such as Palin and Huckabee and Gingrich, media personalities like Glenn Beck and Rush Limbaugh, and activists at town halls and tea parties.” Revanchist! Kristol has openly avowed and admonished all Republicans to oppose health-care reform at every turn since 1994. Since, and even before, our President was inaugurated, by the strict-inside-Party-tow-the-line leaders and the right-wing media, it has been an incessant orchestration of the “regulated-no” - regardless of issue at any given moment.
Selected Representatives/Politicians: The “elected representatives” we have are the politicians we’ve elected to make policy. They may not be the politicians some would prefer; but I’ll take them over the Tom Delay/Bill Frist team (Christian-right’s regiment that got obliterated) that flew back on a Sunday night to Washington for a grandstand in the Theresa Marie "Terri" Schiavo case (known as Palm Sunday Compromise), making a charade of democracy. (The politicians of their type have checked out on “serious negotiation,” policy making, save Olympia Snowe.) These leaders are no longer in power; however, credit Bill Frist, along with Bob Dole, now calling for health-care reform.
Four years ago, when I wrote about Conservative/Liberal Talk Radio, my concern was real. But I never would have believed it came to Limbaugh/Beck’s voluminous, insulting masquerades. It is the hellish, denigration, vilification of personal characters that many, supposedly respectable, people turn to as reliable news sources. Nicholas Kristof writes that “Nicholas Negroponte of M.I.T. has called this emerging news product The Daily Me. And if that’s the trend, God save us from ourselves. That’s because there’s pretty good evidence that we generally don’t truly want good information — but rather information that confirms our prejudices.” It may be politically expedient to appeal to the inferior instincts and prejudices of man; that’s been the Southern political strategy for many years. Although, a candidate truly concerned for America’s wellbeing, healing America, will not succumb to unbecoming, cheap, political gain. One of my favorite conservative Republicans, Chuck Hagel, author of America: Our Next Chapter (2008), said, referring to the political debates, “I refuse to demote it to the lowest common denominator for the use of politics.” (When he announced his run for Senate in Nebraska, he committed to two terms only; in 2nd term re-election, 2002, he garnered 83% of the vote, the highest ever for any statewide race in Nebraska.)
Forward: Our problems in this country will not be solved until we have more Hagel-like true-statesmen. The Republican Party will not recover until there are more courageous Lindsey Graham’s reclaiming Party leadership from Limbaugh, Beck, Hannity, O’Reilly and their ilk. For their rise has correlated almost perfectly with the decline of the G.O.P. Then the healing of America will begin.
Tanenhaus ends: (Whether “left” or “right,” you’ll appreciate his report) “What the times demand today of movement conservatism, if they are to reclaim their place at the center of American politics, is a recognition that the age of orthodoxy – of uncompromising certitude – has ended and will not be reborn anytime soon. At its best, conservatism has served the vital function of clarifying our shared connection to the past and of giving articulate voice to the shared beliefs Americans have striven to maintain under the most trying circumstances. There remains in our politics a place for an authentic conservatism – a conservatism that seeks not to destroy but to conserve.”

Healing America - Part I

This last year, T. R. Reid, author of The Healing of America (July 09), traveled the world to examine how other countries deliver health care, in comparison to USA’s. I’ll, in part, use this book’s information to probe debatable propositions that my friends (Virgil and Staton, my brother-in-law) offered in response to “A Damascus Experience.” Each of their comments is posted on Critical Actions: (click to read) Virgil’s ADE Response and Staton’s ADE Response. Part II, forthcoming, will address the political aspect of their debate. For that, I’ll in part use Sam Tanenhaus’ latest book (July 09) as counterpoint. Tanenhaus puts in historical context, giving reflective, retrospective understanding of movement conservatism (alongside moderate to more liberalist) over the last forty-to-fifty-some years. (Forward, quotation marks will enclose exact quotes from the Reid’s book.)
Reid dedicated The Healing of America to General-President Dwight D. Eisenhower. The Supreme Allied Commander during WWII discovered the German autobahn expressway system built in the 1930s. To great advantage military trucks, tanks, and troop carriers moved much faster than Ike had planned. As a classical-conservative Republican, when elected President of USA in 1952 (1953-1961) and was presented with rather timid plans for a two-lane highway network across America, he trashed the plan for (if you will for a Nazis idea) comparative-German-master-plan USA Interstate system. Today, we have 47,000 miles, 55,500 bridges, 14,500 interchanges, and zero stop-lights. When many hubristic Americans think there is nothing to be learned from other nations, Reid has defined and shown examples of health care that may benefit Americans if we’re only willing to take a look, concede we don’t have all the best answers.
“Contrary to conventional American wisdom, most developed countries manage health care without resorting to ‘socialized medicine.’” “The term was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman’s proposal for a national health care system.” Reid describes four basic health-care models used around the world:
1) Bismarck (named for Prussian Chancellor Otto von Bismarck) is in Germany, France, Belgium, Switzerland, Japan (Japan is the most prodigious consumers of HC; on average a visit to doctor 14.5 times annually, three times as many as an American.), and to a degree in Latin America. France, Germany, Taiwan, and maybe some others use a digital health card, carried in your pocket like a credit card; it knows all your cares, medical records, your doctor visits, pharmacy needs, your payment coverage; it eliminates all the paper work and filing cabinets.
2) Beveridge (named for William Beveridge a social reformer; a plan he viewed as “a program of applied Christianity.”) – countries that use this model or a variation of it, include its birthplace, Great Briton, as well as Italy, Spain, most of Scandinavia, and Hong Kong with its version of Beveridge Style (“The Beveridge Model, with the government holding almost all the cards, is probably what Americans have in mind when they talk about ‘socialized medicine.’” This welfare-state approach, seemingly thoroughly European, is the purest examples of the Beveridge Model or “socialized medicine,” and is in Cuba and the U. S. Department of Veterans Affairs, where health care professionals work for government in government-owned facilities. The patients receive no bills.
3) National Health Insurance has elements of Bismarck and Beveridge. NHI is Canada’s. Some newly industrialized countries, Taiwan and South Korea have adopted variations on the NHI.
4) Out-Of-Pocket is in undeveloped nations. (Only about 40 countries, industrialized-developed nations, have any established health-care payment systems.) If personally wealthy enough to pay, and care is available or can travel outside country, health needs are met. Otherwise, many of the poor stay sick or die; hundreds of millions of people in countries’ rural regions such as Africa, India, and South American never see a physician in their lifetime. Except, maybe a village healer using home-brewed remedies! Luckily some may get help from an international health organization.
America has elements of all of these models in our convoluted national-health-care apparatus. But “The United States is the only developed country that relies on profit-making-health-insurance companies to pay for essential and elective care.” All other developed nations have necessarily, out of fiscal responsibility, decided that basic health insurance must be a nonprofit operation, which may be run by government or by private entities that exist only to pay people’s medical bills. It is not to provide dividends to investors. (When an America’s private health-insurance company pays a bill to doctor, hospital, or pharmacy it is considered a “medical loss.” The “loss ratio,” borrowed from fire and casualty business, is the measure closely watched by health insurers to make sure actual medical payments don’t eat too deeply into administrative cost and profits. Accordingly, ten of the larger health insurers’ combined profits during the past decade has risen 428 %. “U.S. insurance companies deny about 30% of all claims, although some of these are eventually paid through appeal process.”) In today’s N&O, a group of Duke and UNC Hospital doctors say, “Our current system is broken and unsustainable;” they argue for a strong public option. No other developed nation allows there citizens to go bankrupt because of medical bills; a joint study by Harvard Law and Harvard Medical Schools says around 700,000 annually in the USA go bankrupt because of medical bills.
No doubt, America is the most innovative country ever known; it has the best-educated doctors, nurses, medical technicians; best-equipped hospitals, research laboratories; sets global standard in developing miracle drugs and advanced medical technology. The country of Singapore, about as far as you can get from Durham NC, sought out Duke University Medical School to operate its sparkling new state-of-the-art hospital. While most of us think of hands-on medicine as top-notch, there are some defying statistics. “In 2000, when a Harvard Medical School professor working at the World Health Organization (WHO) developed a complicated formula to rate the quality and fairness of national health care systems around the world, the richest nation on earth ranked thirty-seventh.” France ranked 1st. Among nineteen wealthy nations: “A 2008 report by the Commonwealth Fund (CF), ‘Deaths Before Age 75 from Conditions That Are at Least Modifiable with Effective Medical Care,’ concluded the united States ranked nineteenth in curing people who could be cured with decent care.” A study by CF of nine developed nations, e.g., showed Americans with diabetes or asthma die younger; after a kidney transplant Americans have worst survival rate. “Among those nine rich nations, the per-capita rate of ‘Deaths Due to Surgical or medical Mishaps’ was the highest by far in the USA.” Could this a drawback to TORT Reform? Is the high-malpractice insurance that doctors have to pay justified? Is the reported additional 1% extra cost, of all-of-medical-care expense, attributed to malpractice settlements justifiable? A person, or parent of child, whose simple-operation procedure has been botched could better answer this question. There is some evidence that doctor’s excessive testing may not be the direct overriding cause of excessive medical cost. Reference: Medicare spends twice as much on similar patients in some parts of the country as in others. Texas in June 2003 put limits on malpractice payments; malpractice insurance is lower but there is no evidence of consumer savings.
Common of all developed nations that rely on health insurance, except America, is a “personal mandate,” every individual must be signed up for HC. It is considered an element of personal responsibility. What the individual pays is not a tax but a “national insurance premium,” it’s a product: your 100 % inevitable need in a lifetime, “prenatal to grave.” The USA does not allow you to drive your automobile, or other vehicle of your privileged ride, on an American highway without liability insurance; in the USA health liability, 1/6th of national GDP, exceeds automotive liability. In Switzerland, the “right to medical care” is not a political argument by left-wing parties. But President Couchepin, a corporate executive, who became a leading figure in the Christian-Democratic Party (European version of American Republicans) expounded: “A society cannot have complete equality. It is not possible. You can earn more money than your neighbor; that is not society’s business. But a good railway system, a good school system, a good heath system – the basic needs of the people – must be handled with a high degree of equality.” Prior to 1994 Switzerland had been operating with profit-making insurance (same as USA), and their national GDP cost was second to USA (It still is 2nd, at 11% of GDP; improving now with equity in the system.), 5% of their population was uninsured and otherwise an inequitable system. To correct the problem they went with the Bismarck Model, relying on private but nonprofit health insurance plans. (Without getting political, factually speaking, what some call a rush to health care reform: The sixty-year rush? Defeated in 93, revived again after 16 years! As the Swiss equivalent Republican leadership took the initiative as described above, so could have the US Republicans of 2001-2006, six years with full control. But then privatizing social security and a 1.3 trillion tax cut prioritization debarred, apparently, unwanted reform that could have been fashioned to their liking.)
An MRI scan in the U.S. cost $1,000 to $1,400; Japan fixed price is $105. That’s all a fee schedule allows; however, they do a lot of scans, dirt cheap. They got Toshiba to build an MRI scanner for $150,000 without all the bells and whistles, about 1/10 cost of bigger machines used in USA. Japan’s “Dr. Kono emerged from medical school with no student debt; the tuition was only $1,500 per year, and the local government helped pay it.” Most doctors in developed nations have free education, no debt at graduation, and very low malpractice insurance to pay, if any. Many doctors Reid met liked to complain about too low a compensation but very few ever give their profession up for another line of work. Throughout they are dedicated professionals, as we know our American doctors are, who on average don’t match pay (some do) of America’s contemporary --- but have unmatched benefits otherwise.
Regardless of the country, consumers of HC around the world have complaints but the vast majority of citizens in each country like their health care. Margaret Thatcher, the conservative-iron-lady reformer never dared to take on Briton’s NHS. Briton admittedly has some waiting for elective procedures, per NHS, even though in the last 15 years it has improved. Of recent Blair and Brown have poured larger sums of money in the system. America too has copied Briton’s NHS to provide free, no bills, HC to tens of millions of Native American, military personal, dependents, and veterans; all with government doctors in government facilities, dispensing government drugs. (Is this un-American?)
Taiwan undertook a comprehensive study of developed nations’ HC systems and decided to follow the Canadian model. “In 1965 when the U. S. Congress decided to guarantee health care to any American over sixty-five, the Americans adopted both the National Health Insurance model – that is, private providers and public financing – and the name Tommy Douglas gave it, Medicare.” “Douglas came into the ken of J. S. Woodsworth, a Methodist Minister and a fiery populist who preached the ‘social gospel,’ the idea that the church must be concerned not only about the next world but also about injustice and equality in this one.” As Premier (governor) of Saskatchewan, in 1944, Douglas’ successful government-run, single-payer (Technically inaccurate, because Canada really has ten provinces and three territories which operate their own Medicare Plan.) health-care system was adopted by Canada’s federal government in 1961. It covers all medical and psychiatric care, in or out of hospital. It will not pay for Viagra, Botox treatment, or to circumcise your baby. Private insurance may be purchased for these. Reid says Canada’s universal-coverage system is a source of pride, but it’s also a national concern, it’s limping along. The system still records a high level of satisfaction. The “race to south” for care is mainly fictional. Statistically, Canada’s care exceeds USA at a cost of about ½ the per capita of America’s. So far, Canadians have been willing to wait, providing urgent procedures are met and if the rich and poor have to wait about the same amount of time.
My friend’s (Virgil) proposition that American Insurance companies currently have over “1900 mandates” is something I’ve never heard. So far I’ve not been able to confirm or refute, but it sounds like a stretch. Coverage of massage therapy, cosmetic surgery, etc., should be covered if bodily injury/deformity occurs in an accident. But I don’t think my wife’s Blue Cross will cover her face-lift. We know Medicare Supplement Plans, e.g. an election of Plan “F,” must pay same across different companies. But other health-care policies vary to a great extent, in many cases the patient and neither the insurer can readily figure out. It is the mishmash in all these supposedly competitive free-market policies that many buyers find frustratingly complex, which must be rectified if the insurance model continues. Competition across state lines, a familiar mantra, sounds like a good thing; I haven’t heard discussion of its ramification on “states rights.” We do know “state rights” is the political shield for various issues, and it is used when convenient or advantageous. (Some of our health-policy sales representatives, on this list, may have some thoughts on this.) To open competition and give responsibility to all states, on Oct. 1st U.S. Senator Maria Cantwell’s (D-WA) sponsored and the Senate Finance Committee passed an amendment to the America’s Healthy Futures Act of 2009 that will for the first time provide states with the ability to negotiate with health insurers in order to provide high quality health care coverage at a lower cost. Let’s see where this goes!
With insurance, an emphatic exception I take to my friend’s propositions is that Health Insurance companies are encumbered by too many regulations. If it’s going to be for-profit insurance, no improvement in care delivered or cost reduction will result until regulations are applied and enforced. Can we depend on their disciplined morality any more than the behemoth-financial-institutions management’s debacle that cost our nation about a trillion dollars in TARP rescue? Remarkably absent has been the moral, ethical aspect of the health-care debate. In addition, a distraction of flagrant enmities picked from the disparagement-basket has diluted an honest debate: Congressmen’s slackness; excessively paged bill! Surely a congressman’s staff and/or others have assisted in its scrutinizing nitty-gritty. I was satisfied with my congressman’s performance the two times I attended his meetings. How possibly small a bill? It’s to unwind over sixty years of mixed-up complexities unabated? Of course none of the bills are final; yet, much to be hashed out; so let’s lend our civility and call down those who show much disrespect; of course everyone is entitle to free speech and should join a rational discussion.
Regarding “employee coverage” by the employer, tax benefits, etc., I think there may be some problem convincing many people that “individual policies” are cheaper, apple for apple. (The ins-and-outs on this remains open for debate, depending on potential tax-law revision.) Insurance experts say on average a customer stays with company less than six years. Change/lose job; lose or change HC companies! So an insurance executive, with his eye on bottom line, has little financial incentive to pay for long-term preventions. The employers/employee sharing insurance premium is the common practice in countries where HC insurance is the primary payer. Irrespective, in developed nations if a change or loss of job occurs, the individual still has health coverage. Somewhat miss-stated: American auto makers pay HC for employees where as foreign countries do not. “In fact, Japanese companies often build and run hospitals for their workers; Toyota has several of them in Toyota City, just outside Nagoya.” It is a country’s overall-lower-medical cost that gives the foreigner manufacture the advantage (and some would insert USA’s labor cost). But also some profitable American companies such as SAS, a large software company based in Cary, NC finds onsite, convenient, health care good for the company.
It is true “America’s unusually high rate of homicide is one reason we die younger than the Japanese, the Canadians, or the Greeks.” Add to that, auto-accident deaths caused by cells, texting, drugs, and drinking --- gun irresponsibility and smoking --- is not only life-shorting and a health-problem in itself, many times resulting in incarceration, a crippling-national-financial burden. For California it’s a cost of $49,000 per inmate annually. The USA has the highest incarceration rate of any country, 738 per 100,000; next highest is the Russian Federation, 607. The fact that 10s of million Americans don’t have health care and/or have a health-harmful lifestyle, diet, tobacco use; lack preventive medicine; poorest mothers without insurance and prenatal care, all add to a shorter life. No other industrialized democratic country allows people to dies from treatable diseases because they can’t afford the doctors bill. A formula devised by National Academy of Sciences says, people who are uninsured are 25% more likely to die of treatable diseases than people of same age cohort who have insurance. Institute of Medicine says, people without insurance are more likely to die of disease and accidents; 37% greater in US if hit by an automobile; 30 to 50% for various cancers. If these issues were dealt with effectively, perhaps America could be “number one” on the nations’ life expectancy chart.
Health-care economists, and statisticians at WHO, have come up with a range of measures to give a more meaningful rating of countries’ “life expectancy at birth.” The DALE (Disability-adjusted Life Expectancy); sometimes it’s called HALE (Health-Adjusted Life Expectancy). How long can you expect to live a meaningful life without a chronic disease, heart disease, back pain, rheumatoid arthritis, blindness, hearing loss, Alzheimer’s, painful cancer, etc.? A high ranking on this scale means a nation’s population has good health habits and the country provides good health access, for both prevention and cure of disease. Top ranking 1-5: Japan, Australia, France, Sweden, and Spain. To the surprise of Christopher Murray, a doctor and health economist at Harvard, America, the richest country, ranked twenty-fourth. If you want to feel good about America’s health, compare it to China’s: Under Mao’s Cooperative Medical System (Poor man’s version of Briton’s Beveridge Model), spartan but essentially free, from 1952 to 1982, life expectancy increased from thirty-five to sixty-eight and many contagious diseases were controlled. In 1980 the government-run system essentially shut down; China reverted to the Out-of-Pocket Model for most of its 1.3 billion people. Child mortality rates increased, so far life expectancy is same, but epidemical, infectious diseases are occurring, not seen in decades.
Cost control as an imperative before universal coverage? Reid says, “At first blush it might seem logical to go after health-care cost first; once cost are under control, we could more easily afford universal coverage. But everywhere I went on my global quest, I was told that this approach gets things backward. Universal coverage is an essential tool to control cost and maintain the overall quality of a nation’s health.” “All developed nations except the united States have decided that every human has a basic right to health care.” The myths about nations’ health care are: it’s all socialized medicine; they ration care with waiting list and limited choice; they are wasteful systems run by bloated bureaucracies; health insurance companies have to be cruel; those system are too foreign to work in USA; and perhaps the greatest misconception is that all foreign systems are the same.
Is health-care reform politically hopeless? “There are hundreds of companies with a multi-billion-dollar stake in the status quo; those firms and their backers on Wall Street are fiercely resistant to any change that might cut off the gravy train.” I’ve heard there are six or more health lobbyist in DC for every congressman; $1.4 million daily spent on lobbyist. “The USA is the only nation that lets insurance companies extract profits from basic health coverage.” “If you are a senior, a soldier, a veteran, a Native American, a member of congress, or a renal-failure victim, or if you are scratching by on an income below the designated rate of poverty, government will help you obtain health care. (30% of population) It may be possible to provide fair and cost-effective health care for all while maintaining these separate systems, but no country has ever made it work. An essential building block for every wealthy country except the USA is the principle that financing health care must be a nonprofit endeavor. That doesn’t mean people can’t work for a living in a private nonprofit health-insurance industry.
Obviously, to give every citizen the right to the full range of testing, treatment, surgery, and medication afforded by state-of-the-art contemporary medicine would likely lead to bankruptcy. Although, if we are the moralist people some claim and if not, we must work together to gain that rectitude; only then can we answer the basic question other developed, free countries have answered: Should we guarantee medical treatment to everyone who needs it? Or do we continue to default to the secondary question as we have for many years: In a land where all are created equal, which inequalities are we willing to accept? Now we must get serious to answer the first question. And, if the answer is “yes,” then we must do at least what other developed nations have done: provide a floor for basic health care and a ceiling below prudent-commonsense, excessive cost. Citizens with the means to buy expensive-private insurance or have wealth for unlimited treatment are not deterred: state-of-the-art care will be available as long as it doesn’t depress the ‘ceiling’ of those less fortunate.
Can we cure the hubris, be a classical Ike; can America take the first “small step” toward healing America?

Aditional Response to "A Damascus Experience" by Staton Boyette

Additional thoughts on the Damascus Experience and the response from Virgil:

The shotgun approach that our current lawmakers are taking to reformation of health care in the US is overwhelming to everyone including those immersed in the details of the reform proposals. I cannot find a source that tells the current number of pages in the bill, but the last number I heard was over 1100 for the House bill and I also heard an unconfirmed number of over 500 amendments to the Senate bill. If either of these is close to the truth, then I have to conclude that no individual is capable of understanding exactly what is being proposed as the “fix” for health care, much less capable of explaining it to the American taxpayers.

I like Virgil’s approach to defining the problem. He states:

“First, I ask myself: what do we need to fix? What is broke, as we say?

Everyone should be covered. No one should fall between the cracks. It may not be a legal right but we agree that it is a moral necessity. Religious people - Christians and Jews primarily - historically have built the hospitals and provided care to the poor.
Costs must be contained. The current system is unsustainable.
Insurance should be tailored to the needs of each person and it should be portable and non-cancelable.”

I would not state it exactly the same way, but his focus is straight forward and easily understood, so I will leave it as stated and add some further observations and ask a few questions. I will state up front that I agree with Virgil’s conclusion that the answer is not to turn the problem over to the politicians. The politicians can definitely help, and we need their help, but a “Medicare type system” for everyone will wind up as a boondoggle that cannot be untangled.

For those of us in the US that can afford insurance, or are covered by one of our current social programs, Medicare, we are for the most part happy with our coverage and we can generally request health care services and receive them within a reasonable period of time. All of us have had specific issues arise that were unfair or received questionable treatment from our healthcare providers/insurers, but generally have received good health care on a timely basis. Therefore, I will not address the unusual situations.

I believe that in a country as wealthy as ours, we should provide some form of health care to all of our citizens. I do not consider health care to be a “right” as the purchase of a health care policy is a tangible item, and we presently have a choice to spend dollars on a health insurance policy or use these dollars to purchase a new car. If owning a health care policy that provides some level of insurance coverage in the event that one may need the services of a health care provider is a “right”, then it will soon be argued by some politicians, ACLU lawyers, or others that there are a whole host of other tangible wants/needs that should fall into the “right” category. I do not believe any of us want to go there.

Generally, health care for accident, emergency or chronic care is available to everyone in the US today. Most of us, however, do not like the form in which these services are delivered, i.e., overflowing emergency rooms or in perhaps substandard facilities. I am sure that some patients suffer greatly and go through a lot of red tape before they can obtain these services. In some instances they are probably not successful in obtaining care within the required time frame. My assumption is that this is the exception and not the rule, so I am open for argument if statistics are available to prove otherwise. Also, preventive healthcare and the care that most women receive during the months prior to giving birth Is not available to a large group of people. These problems need to be addressed along with the preexisting conditions insurance issues that are a problem for so many.

All of these issues can be clearly defined and listed in a straight forward manner as a subset of points under the question that Virgil asked: “What do we need to fix?” There are specific items related to each point that can be addressed one at a time or in manageable groups. It will take some time to solve the problems, but they are complex and require diligent effort and commitment. With a commitment by the lawmakers to work together (Democrat, Republican and any other ilk that is out there) we can make reasonable progress. This approach is not quick enough or dramatic enough to meet a politician’s need to have something to brag about that will insure reelection or satisfy their view of what their legacy should be, but it could provide steady and measureable progress toward a goal of real health care reform without disrupting and tearing apart the fabric of something that currently works for the majority of US citizens. To quote H. L. Mencken, “For every complex problem there is an answer that is clear, simple, and wrong.” We could add “quick” to this quote. We do not need a quick solution to health care if there is even a chance that it is wrong!!! The problem is just too big and the potential consequences just too severe.

Some of the questions that I have about the current direction being pursued by our lawmakers are:

1. Why are we focused on getting insurance for everybody at such a large cost when a major part of the problem is in the health care delivery system? Insurance will not solve this problem.
2. Why are some things such as tort reform just ignored? A lot of the cost is driven by the unnecessary tests done just to satisfy the malpractice insurance requirements or the unreasonable requirements necessary for a doctor to get paid. I saw this first hand when my own father made his last trip to the hospital.
3. Why are they not dealing with the current laws that prevent the insurance companies from crossing state lines, but allow the company to write a group policy restricted to one state and raise premiums to the point where the more insurable people in the group move to a less costly plan? The insurance company then abandons the group and forces the remaining participants to go elsewhere. Mutual of Omaha did this to us and had the audacity to reserve the right to receive a commission from the company that they recommended to write essentially the same policy with a higher premium.
4. Why are our lawmakers rushing to approve a plan for all Americans that they will not be a part of? Why does this élite group of people believe that they have to enact legislation to govern our lives, but feel that they are different and therefore must have a plan that provides a different level of health care for them and their families?
5. Why the rush to approve a cumbersome, bloated piece of legislation that almost defies comprehension and makes sweeping and dramatic changes to such a large segment of the economy? Why the rush to change a law in Massachusetts to what it was four years ago before it was changed to prevent the governor from appointing a Senator to complete an unexpired term, to allow the governor to appoint a Senator to complete an unexpired term so that this bill can be approved without bipartisan support? Is this politics at its worst? Does this represent the American people and their best interests?
6. Why are our lawmakers passing bills that have such broad application without even reading them? Why are they not allowing the bill to be published and read by the American public before they vote on it? Why are they not listening to the American people?
7. How on earth can we keep things like they are, i.e. keep your present coverage, keep your present doctor, etc., without adding to the deficit or raising taxes? If the answer is by eliminating fraud and waste from the current SS, Medicare, and Medicaid programs, please start now!! Do not wait until this massive legislation adds additional problems to the equation.

As it relates to this last question, I firmly believe that we are going to see major changes if the government option is made available. As I understand it, everyone will be required to have health care insurance or pay a penalty. Is this correct? How will people be able to afford it if they are having a hard time paying a mortgage and putting food on the table? Oh, a government subsidy? Who makes the eligibility determination? Long term, private health insurers will be squeezed out since they will be unable to compete with a “not for profit” insurer like government Medicare. Medicare is facing an enormous unfunded liability. What will happen when everyone, except the legislators, has Medicare or a similar program? Reduced reimbursements to doctors and medical facilities will result in fewer doctors and medical facilities. Reduced revenues and large deficits within the program will result in lowered benefits. With the government run program, I believe this is inevitable.

The “Rule of Unintended Consequences” will rear its ugly head. I do not know where, but possibly through job losses in the private sector. Unquestionably we will have more government jobs created, but after some period of time when more people work for the government and less people work in the private sector, how can we replace the taxes to run the government that are currently generated by corporate profits, small business profits, and private sector payrolls?

Let’s (1) slow down, (2) more clearly define the problems/issues, and eat this elephant one bite at the time. I would like to add with broad bipartisan support, but we may be too far gone for that.

Staton

A response to “A Damascus Experience”

Opinion from the right!

I usually get short, mostly positive, comments from my Critical Actions messages. Although, occasionally I get a comprehensive response, with in-depth thought, such as the one below from my friend who has agreed to share with you. Here's my response to him on Sept. 21st; his response to "A Damascus Experience" on health-care reform follows.
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Sept. 21, 2009: Virgil, thanks for your comments. Actually, we may not be all that far apart. A Damascus Experience was to be "thought provoking" and not to be specific in reform rectification. It was to raise many questions. Of course one could easily deduce that I might call for a more liberal solution. Actually, a 'Damascus conversion," in part at least, might be as simple as a reformed-commercial-private-health-insurance program. That may be the best system for America, contrary to most other developed nations of the world, where many countries have "public-insurance" coverage. Of course, with each of us, exceptions in thoughts would apply. But hopefully, the end goal would be the same.

Saturday afternoon I downloaded the electronic version of T. R. Read's latest book, The Healing of America, just out this July. For the past year he traveled the world to get the nitty-gritty of health-care operations in many countries. Only read 1/3 of it but it's a very interesting comparison to America's health care. I do believe there are some things we can learn from other countries.

Could I print your comments on my blog and share with other's that may chance to read it's announcement? You may want to reference some of the statistics or other quotes. Let me know and I'll share with all. Other than me trying to learn to write, the sharing thoughts in a civil manner is what my blog is about. It is to even question myself, which I often do, introspection, a medication that I believe might be a healer for our country.

Cornell
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Sept. 19th, 2009: Attached are some quick thoughts on health care. I enjoy exchanging ideas and appreciate your including me in the loop. Virgil

Here are some thoughts on how I see the health care reform needs….

First, I ask myself: what do we need to fix? What is broke, as we say?

Everyone should be covered. No one should fall between the cracks. It may not be a legal right but we agree that it is a moral necessity. Religious people – Christians and Jews primarily – historically have built the hospitals and provided care to the poor.
Costs must be contained. The current system is unsustainable.
Insurance should be tailored to the needs of each person and it should be portable and non-cancelable.

My second question is: why are we falling short of those goals? There are many problems among which are….

Private insurance is encumbered with too much regulation. There is no national market for health insurance which would create more competition and thereby lower costs. Each state regulates its own insurance offerings which cannot be purchased across state lines.

There are over 1900 mandates to insurance companies which increase the costs. Such things as covering massage therapy, cosmetic surgery, etc. When mandated, you get it whether you want it or not.

Tax laws. Much of the problem is from tax incentives. Businesses use health insurance as an employee benefit. It is tax deductible to it. When an employee leaves, the employer has no further interest in covering that person. On the other hand, an individual purchases insurance with after-tax dollars. And, contrary to the President, individual insurance is actually cheaper than corporate when all costs are accounted for. The confusion is because the company picks up much of the costs so the cost to the employee is less than private insurance.

Corporate plans are actually designed and paid for by the companies and the insurance companies are just administrators following the rules.

Medicaid is intended to insure those on the bottom of the economic ladder estimated to be 47 million people in the US. Currently Medicaid covers 58 million people plus there are an estimated 12 million eligible who simply have not signed up.
Add those two groups together and there are over 20 million on Medicaid who are not eligible. That is a significant cost. It is fraud and abuse.

Medicare is a favorite of folks my age and for many it is a good deal. But it is not a good program. Its costs are unsustainable by everyone’s assessment. Doctors and hospitals are reimbursed below costs and therefore “cost shift” the balance to private insurance and charity. Its unfunded liabilities are growing exponentially. It is not a success story and its problems lead to the talk of “death panels.”

The Wall Street Journal called Sarah Palin’s term “death panels” inelegant but not without a point. In the UK’s single payer arrangement there is an overall budget for health care. Modern health care technology is very expensive and no country can afford to give everyone everything they want. So there is a budget and allocation decisions (rationing) favor the young over the old and the decisions are made by panels. It is not what anyone wants but it is inevitable.

Litigation costs. America leads the world in litigation causing in the health care business defensive medicine, prohibitive mal- practice premiums, and passed-along costs.

I also think that our health care system is unfairly criticized. While it is true that the life expectancy in the US is less than in many other countries, it is also true that our homicide rate is 5.9 per 100,000 while Canada’s is only 1.95 and .98 in Germany. Also, the US has 14.24 deaths per 100,000 from auto accidents but only 9.25 in Canada and 7.4 Germany. If you don’t die from homicide or auto accident, we out live citizens of every other western nation.

We spend more on health care than other countries but also less than the Sudan. Spending is not meaningful without consideration of value. The US is THE engine for health care technological innovations. We are the destination for those in other countries who have serious or immediate medical problems and who can afford to come here.

The US is THE location for life enhancing and extending drugs. It costs a drug company about $1.4 billion on average to bring a drug to market. US citizens pay more for drugs than others for political reasons rather than market reasons. If we impose price limitations on drugs, the innovation will slow down proportionally as investment moves to more attractive areas.

I could go on but I don’t want to wear you out. Here is my bottom line. I look at the US government, both Democrat and Republican, pushed and shoved by special interests groups and the need to look good for reelection; I look at the current national health services (Medicare, Medicaid, VA, SCHIP) and I see waste and incompetence; I look at congress (GOP or Democratic) and I see self serving partisan bickering, and I conclude that if our government ran health care it would look just like Canada or the UK: routine care for everyone would be accessible and free, but if you really get into trouble, you’ve got a problem.

I think the answer to our problems –which are very real – is not to turn the problems over to politicians, but to fix the deficiencies one at a time: take care of the 12 million or so who really fall between the cracks; free up the private insurance industry from all the rules which make it inefficient; institute tort reform. It could be done if congress would stop the bickering and work on what is best for the people of this country.

A Damascus Experience

On the road to health-care reform

That was Wendell Potter’s experience! If you’ve not heard his story, you’ve missed a persuasive discourse for health-care reform. Potter worked for Cigna Health Insurance Company until he resigned last year because of a personal, moral crisis. As an insurance executive of twenty years he worked to craft a message that a “government takeover” of health care will be a milestone on the road to “socialized medicine.” But now when he hears those terms, Wendell Potter cringes. He’s embarrassed that opponents are using a playbook that he helped devise.
More on Potter’s credentials later, but for now let’s consider the questionable merits of providing health care through commercial private-health insurance. This query is not to suggest pro-anything specific that should come from reform; rather, it is stimulative to consider fundamental questions with regard to serious health-care overhaul.
Begin with this premise: Americans would not make legal the trading and selling of body organs: It is a moral issue and also a life and death matter. Commercialization, Selling and trading, of our health care manipulated by insurance companies, are also life and death matters, thus becoming a moral issue. Then why do it? Some may say this is a bad or unfair analogy, but think about it for a moment. Can you think of anything that from birth to death everyone will need 100%, no odds, for which private-commercial insurance is sold? (I pay for long-term care but odds are, I hope, never to need it.) Significant odds on health-care needs only come into play, for most part, in the event of a catastrophic need. Not everyone will have a catastrophic need --- but everyone will need some health care at some point from cradle to grave. So the important question is how to found a health-care system on moral ground. Does a person who does not have the financial means have an inalienable civil right, e.g. voting and nondiscrimination, to modern-technological heath care? Some might argue that it’s not even a moral right. Every wealthy country other than the United States guarantees essential care to all its citizens.
We can’t altogether blame the insurance companies where virtuous behavior doesn’t seem to be a precept of their corporate instruction. (Corporate managers are responsible to stockholders to make a profit.) And, certainly we can’t blame those who sell the policies. We have a free market system; it’s a capitalist system I believe in. The question becomes, is it possible for a free-market private-health-care-insurance system to be underpinned by moral rectitude so as to ensure ethics in life and death matters? Of course, that’s the question for any system!
“The biggest weakness of private industry is not inefficiency but unfairness. The business model of private insurance has become, in part, to collect premiums from healthy people and reject those likely to get sick — or, if they start out healthy and then get sick, to find a way to cancel their coverage.” That’s how the status quo ensures 12 to 14,000 people daily will continue to lose their private health coverage! “As The Los Angeles Times has reported, insurers encourage this approach through performance evaluations. One Blue Cross employee earned a perfect evaluation score after dropping thousands of policyholders who faced nearly $10 million in medical expenses.” “A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.”
“The health insurance industry, in particular, saw its premiums go from 1.5 percent of G.D.P. in 1970 to 5.5 percent in 2007, so that a once minor player has become a political behemoth, one that is currently spending $1.4 million a day lobbying Congress.” Health-care’s slice of our national GDP is 17% and rising (at status quo, projected in 25 years or so to be 31%) compared European countries of 10%. Juxtapose Core Health Indicators by CodeBlueNow which compares the inefficient and expensive USA health statistics to six other countries: Australia, Canada, France, Germany, Japan, and United Kingdom, all of which have a life expectancy of 2 to 5 five years more than the USA and all of which have a health-care cost of about ½ or less per person.
“According to A. T. Kearney, last year General Motors spent $1,500 per vehicle on health care. By contrast, Toyota spent only $201 per vehicle in North America, and $97 in Japan. In 2007, employer-based health insurance cost, on average, more than $12,000 per family, up 78 percent since 2001.” In Our One Party Democracy, Thomas Friedman writes, “Well, to compete and win in a globalized world, no one needs the burden of health insurance shifted from business to government more than American business.” Toyota, after looking throughout North America for two years, put a new Lexus plant in Cambridge, Ontario. One of the primary reasons was the lower health-care costs that manufacturers enjoy in Canada versus in the U.S., says John Kay, a proponent of single-payer.
Insurance policy-contract mishmash: “Kevin a cancer patient couldn’t figure out why his insurance company had denied his claim for chemotherapy charges. His policy seemed to cover the treatment, but its incomprehensible mishmash of cross-referenced definitions, schedules, exclusions and riders made it hard to tell. When my office pressed company officials to explain the denial, we were told that they were still sorting through the policy; they believed Kevin’s claim was not covered, but they needed more time to figure it out. Even the insurance company had trouble understanding its own contract.”
From above clippings, selected from approximately fifty health-care articles, you quickly begin to recognize the broad economic implications and immense challenges facing our legislative government. Unsettled health-care issues over the last sixty years (Or over 100-years counting President Teddy Roosevelt’s initial proposed health care.) allowed for embedment of private profiteers, an impervious, financial monopolist-lobbyist-stronghold on the health system and legislative process.
The most reflective voice speaking to the insurance malaise is Wendell Potter. From The Washington Post, by Richard Cohen: (Listen and watch video for the full story:) “Bill Moyers interviewed Wendell Potter about health care and such matters. Potter is the former head of corporate communications for Cigna, the nation's fourth-largest health insurer. By his own characterization, he is one of those insurance executives who flew from meeting to meeting in private planes and hardly ever touched ground to meet real people. One day he did. He went to an outdoor health clinic over the Virginia border from his home town in Tennessee. This is what he told Moyers: "What I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents to care for people. . . . And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee -- all over the region." “‘It was a life-changing event to witness that’ he remembered. Increasingly, he found himself despising himself for helping block health reforms. I knew that once I did that (quit Cigna) my life would be different,” he said. “I wouldn’t be getting any more calls from recruiters for the health industry. It was the scariest thing I have done in my life. But it was the right thing to do.” A Damascus experience!
“Mr. Potter argues that much tougher regulation is essential. He also believes that a robust public option is an essential part of any health reform, to compete with for-profit insurers and keep them honest.” But political hopelessness it seems has stagnated rational deliberation, such as when Senator Chuck Grassley of Iowa, who was supposed to be the linchpin of any deal, helped feed the “death panel” lies. Tell it enough times, it becomes a “truth” for many people. As Mark Twain said, "A lie can travel halfway around the world while the truth is still putting on its shoes." Obviously, to acumen-followers of the warped debate of misinformation and fear-schisms, to a great extent, it has been an offensive for profiteers of big industry, insurance and big-pharma. It is those who give political status to elected officials. “Big money” trumps the need of the American people.
My friend Warren recalls a Rotary Club meeting he attended in Chicago during the 70s where former Secretary of Health, Joseph Califano, Jr. spoke. His prophecy was that in coming years there would be a two-tier health system in America: one for basic health services for the common man/non-wealthy and a second-tier for the rich that could afford expensive advanced cutting-edge technological care. We’ve exceeded his prediction of 2-tier, certainly with a sort of multiple-tier complexity. Some single-payer systems have staunchly been defended: Canadian Nationalized Health and Britain's National Health Service created in 1948. Even without a single-payer system, there may be something we can learn from these systems. Paul Krugman, an economist, relates health-care models from different countries, including a Swiss model as the clearest example most likely the U. S. will end with: “everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.”
David Goldhill, a business executive, has written the most comprehensive and thought-provoking, twenty-seven page essay, entitled How American Health Care Killed My Father. (Recommended reading by Fareed Zakaria, Global Public Square.) Interestingly, Goldhill covers the broad scope of health-care business-functions, including hospital billing practices, economy-of-scale savings, and importantly the heavy toll exorbitant medical cost is draining from our country’s economic opportunity and social progression. His reform proposal relies heavily on individual responsibility but yet allows for financing some of our health care through insurance because serious illness or an accident might require urgent, extensive care, an extreme financial burden. (Catastrophic need!) I don’t necessarily agree with him, probably neither will you on much he proposes; however, he make some crucial points. We need more people like Goldhill honestly bringing more of this type serious “critical thinking” to the table. Neither Goldhill nor Potter likely has all the answers but certainly their experiences and Potter’s insider-employment role gives credibility to serious reform considerations.
Measures beyond the obvious criteria for reform must include prevention of moral hazard and stagnation of research and development. The criteria of “Revenue neutrality” is a justifiably concern for many people. What does that mean for each of us? Everyone will have to give something, take less, in some cases. That’s for the insurer, provider, and patient. (Now spread the fear.) We are a long way from a single-payer system, if ever, but John Kay makes a comparison with Canadian’s system whereby they have an average life expectancy of about 3-years more than U. S. and a cost per person of $3,895 to America’s $7,290; comparative savings translated to whole-American coverage is $1.0 trillion dollars annually. If true, we have a double-edge sword cutting our life and pocketbooks. Point is: enormous savings are possible in any system, either insurance based or single-payer. Currently, under a single-payer system, our government pays total-health care for the most sickly and costly group of patients: Medicare, Medicaid, and DVA. In all Medicare cost, 30% comes in last six months of life. In fact the American system may already be more socialist than some others: “The French health system uses a mixture of public and private funding, guaranteeing basic coverage through national insurance funds to which employees and employers make contributions. Most French people supplement these benefits by buying private insurance. The distinctions from the single-payer British system are significant, the results better.” Efficiency in health-care delivery will necessarily become a guiding principle, as illustrated here: 10 Steps to Better Health Care.
My friend David in the care business says his wife refers to the current system as convoluted. Convolution to be sure, in the system and the current reform process, is the unfortunate mudded environment. It is institutionalized inanity, political psychosis/paranoia and red-meat-delirium dealt this administration and all serious attempts at reform. (David Gergen, a bipartisan advisor for Nixon, Ford, Reagan, and Clinton, recently said, you have to wonder if the American people have become so polarized that they’re ungovernable.) Convoluted, for sure when a “U. S. criminal prisoner” can get health care --- but the system is the devastator to “Nikki a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.” And lost her life!
The Peterson Foundation, the entitlement deficit watchdog, reports: The Lewin Group, analyzes America's Affordable Health Choices Act of 2009 (H.R. 3200). Should this Act become law, it would nearly pay for itself over the next ten years. However, further budget projections - taking a look at the following ten years, from 2020-2029 - indicate that the Act could not remain self-funding beyond its initial ten-year run. It’s a criticism and legitimate concern that will have to be addressed ongoing. Evans Thomas in this week’s Newsweek: (an exceptionally good article) “Most of the uncontrolled growth in federal spending and the deficit comes from Medicare; nothing else comes close. Almost a third of the money spent by Medicare—about $66.8 billion a year—goes to chronically ill patients in the last two years of life. This might seem obvious—of course the costs come at the end, when patients are the sickest. But that can't explain what researchers at Dartmouth have discovered: Medicare spends twice as much on similar patients in some parts of the country as in others. The average cost of a Medicare patient in Miami is $16,351; the average in Honolulu is $5,311. In the Bronx, N.Y., it's $12,543. In Fargo, N.D., $5,738. The average Medicare patient undergoing end-of-life treatment spends 21.9 days in a Manhattan hospital. In Mason City, Iowa, he or she spends only 6.1 days.”
An extensive criticism of this administration’s has been nonproposal of a specific health plan. Honestly, the nonspecific approach is the only way it could have progressed this far. Irrespective of a particular specific plan upfront, it would have quickly been shoot full of holes. However, the “hammering away” allowing different-interest groups and ideological viewpoints will not result in everything any group really likes. Although something meaningful, hopefully, will be passed. It won’t be a fix for all time; necessarily, it will require tune-ups ahead.
Incrementally, regardless of the end game, the health reform will eventually move forward. The first “small step” will be key to “One small step for man, (hopefully to become:) one giant leap for mankind.” Major-life-changing legislation only happens on the continuum in the U. S. legislature as when “human rights” legislations took many years to evolve. Coalescence of the best health reform policies is probably some years away, even if meaningful major legislation is enacted now because of complexities of its implementation. That’s the sad reality!
Only when we American people have the “Damascus experience,” as a Wendell Potter, will we cede to a new reality of ethical courage and responsibility; letting go the Saul/Paul blinding scales from our eyes for a new moral vision. A “giant leap” in moral conversion to accomplish decent health-care reform! If that can happen, let’s hope it’s not too late for our country and the needless suffering of its many citizens.