Managing the spill: http://www.wiredbrain.com/
Time for executive
action: (Let no crisis/opportunity go to waste) Can be a Game changer
Strong executive
action putting BP into receivership will change the dynamics of politics
Obama is good at
politics getting elected and good at legislative action building groups
to get things passed but has not shown executive power since he has little
experience at management. Doing a Harry Truman will make most of the people,
most of the time, yield to someone in charge and follow a leader (right or
wrong).
Variations (punctuation not considered): Deepwater horizon rig in the
* When in danger or in doubt, run in circles, scream and shout. Attributed to
Robert A. Heinlein ("The cat who walks through walls" (uttered by
Richard Ames), "The notebooks of Lazarus Long", or "Time enough
for love (p.454)"), and also known as "Mongolian General Prudential
Rule" or "Clint's Cure-All".
Stewart
then became a geyser himself, spewing frustration over the president's use of
the word "complicated" when discussing any of the big issues.
Mentioning the oil disaster, financial regulatory reform, healthcare and
"SO
SIMPLIFY IT!" Stewart yelled at one point. "You're the
president!"
Full
of stress-filled angst, Stewart then made a prediction.
"Mr.
President, let me guess what's your favorite movie?
Don't answer, let me guess."
Perfect set-up.
Meryl Streep's and Alec Baldwin's "It's Complicated" flashed up on the screen.
"I'm
glad that you are looking for an ass to kick," Stewart concluded.
"But in the meantime I gotta tell ya, the
ass has been kicking you." http://latimesblogs.latimes.com/washington/2010/06/gulf-oil-disaster-jon-stewart-rips-obamas-tough-talk.html
Four different
functions;
1.) plug or control the well new engineering
chief
2.) remove or control the oil on the water -
Coast Guard
3.) protect and clean up the shore - EPA FEMA
4.) Pay for loss of income and maintain the
economy SBA FEMA
5.) Return to deep drilling with Liability
Insurance
1.) http://money.cnn.com/2010/06/11/news/companies/Parloff_legal_BP.fortune/
2.) Create and emergency mechanical DOD DOE
taskforce from all companies and countries that have experience in deep water
drilling.
3.) The Coast Guards put in charge of the on and
in water clean up with a billion dollars BP funds and powers of command to
acquisition resources, with compensation.
4.) The EPA
and FEMA (Homeland security) to deal with on shore oil issues and
another billion dollar fund
5.) FEMA and the small business administration to
make grants and loans for loss of income to gulf business.
6.) Require full liability insurance and
re-insurance for all wells which will make a market for risk too risky is too
expensive and the insurance company will likely require and enforce require
http://green.blogs.nytimes.com/oil-spill-resources/
http://www.nytimes.com/interactive/2010/05/25/us/20100525-topkill-diagram.html
http://www.huffingtonpost.com/2010/06/01/gulf-oil-spill-obama-give_n_596227.html
http://www.nytimes.com/2010/06/06/us/06rig.html?hp
· Christoph
Gertler, Bangor University (www.bangor.ac.uk)
· scientific
paper on oil-eating bacteria (www.bangor.ac.uk) · School
of biological sciences University of Wales, Bangor (www.bangor.ac.uk)
Dealing with these
problems required teamwork, a challenge to the throng of different companies
with responsibilities on the rig. Of the 126 people present on the day of the
explosion, only eight were employees of BP. The interests of the workers did
not always align. http://www.nytimes.com/2010/06/06/us/06rig.html?pagewanted=3&hp
Business: The Company File
Job
cuts loom for BP Amoco http://news.bbc.co.uk/2/hi/business/247940.stm
Sir John Browne, chief executive of BP Amoco, is a tough cost-cutter who
is determined to restore profit margins.
The overlap of activities is greatest in the
In the immediate aftermath, the
conventional wisdom was that Wall Street had simply lost its head. It was terrible,
to be sure, but on some level understandable: Dutch tulips, the
In recent months, though, something
more troubling has begun to emerge. In December, Gretchen Morgenson
and Louise Story of The New York Times exposed the role that some firms,
including Goldman Sachs
and Deutsche Bank, played in
putting together investment structures synthetic C.D.O.s,
they were called that were primed to blow up. They did so, reportedly,
because some savvy investors wanted to go short the subprime market. The
section on 'alchemysts' focuses primarily on efforts
to turn base metals into gold. Mackay notes that many of these practitioners
were themselves deluded, convinced that these feats could be performed if they
discovered the correct old recipe or stumbled upon the right combination of
ingredients. http://en.wikipedia.org/wiki/Collateralized_debt_obligation
How
to structure, trap, and control the frame of reference in the message?
http://en.wikipedia.org/wiki/Cognitive_psychology
http://en.wikipedia.org/wiki/Framing_%28social_sciences%29#Frame-alignment
The
basic frame or model of republicans and conservatives are the authoritarian
fathers offering tough love promoting nationalism, independence,
individualism, competition as displayed in the novels of Ayn Rand.
George W. Bush as cowboy is a
good example of the white male image.
The
basic message of democrats and liberals is social democracy and
solidarity. The model is the good
mother who nurtures, guards and protects us from misfortune. Social democrats aim to reform capitalism
democratically through state regulation and the creation of programs to counteract or
remove the social injustice and inefficiencies
they see as inherent in capitalism.
For
the DNC and the candidates (while the President remains on the high ground) the
basic media message is framed by talking points about prosperity politics a
simple way to feel and be better off at little or no cost. The trusted messengers (doctors, military,
and women with authority) offer a cure to the persistent dangers of life. The
face of clear and present danger should be the personal stories of middle class
families destroyed by getting sick or unemployed. The cornier the better, the
more soap opera the better, the more painful the better. We are talking about
deep sub conscience motivation below the rational mind; as is most effective
marketing through advertising.
Bernays
was an outspoken
proponent of propaganda as a tool for democratic and corporate manipulation of
the population. His 1928 bombshell Propaganda lays out his eerily
prescient vision for using propaganda to regiment the collective mind in a
variety of areas, including government, politics, art, science and education.
To read this book today is to frightfully comprehend what our contemporary
institutions of government and business have become in regards to organized
manipulation of the masses.
The American public is not conservative about money.
They are not financially conservative, but motivated by immediate satisfaction.
The traditional middle class put off purchases until there was money in the
bank, (puritan ethic) while lower class people demanded immediate
gratification. Now if they want
something they pay for it on the old never never
credit cards and then put it on their equity loans using their homestead as an
ATM machine. Thus was the cause of the economic crisis. And why Republicans
would say deficits dont matter.
The people vote for politicians who promise benefits
without pain or taxes, the check is in the mail campaign. The conservative movement is more social
than economic and based on prejudices between regional, racial, tribal, moral
family values, religious, WASP vs. foreigners not self interest since people
are voting against their own economic self-interests. Republican get tax cuts
for the rich 1% by their values agenda based on prejudice and
fundamentalism. The rich fear a liberal
popularism of buying vote with an endless stream of entitlements the rich end
up paying for.
SIX
critical advices for the administration:
1.) You
need a Harry Hopkins
who acts as deputy for the President. The chief of staff has too much to do so
the President needs a problem solver with strong powers over the
administration to get things done in the face of bureaucratic resistance. The
Government is an iron triangle a.) Interest groups work with b.) Committee
chairpersons to create 3.) Agencies and programs, often with detailed
administrative requirements and conflicting goals. Agency money and powers do
not come from the executive offices of the president but from congress; they
are all creatures of congress. The power of executive orders needs to counter
this fragmentation and get the job done. This is the true road to less, smaller
and more effective government.
2.) http://www.federalreserve.gov/pubs/frseries/frseri3.htm Regional Government; The USA is more than a
country It is a continent you need to use the federal regional councils to give
the Whitehouse real leverage over the agencies. The ideas that the President is
CEO of the administration are fables. He
sends representatives and ambassadors called secretaries into organizations
that do not respond to commands they or their constituent or committee chairmen
dont want they say yes sir and little or nothing happens. Ten regional
commissioners with deputies for each state report to OMB and have as much
authority as the secretary by executive order. They work with governors,
legislative leadership and interest groups to see the tires hit the road. . As in welfare reform the 10 federal regional
councils were given the job of coordination and making wavers. There was
an attempt to shift power from DC agencies to regional commissioners who were
part of the Whitehouse staff. (Fred
Malek) With welfare reform the councils
were used to manage change. Executive Order 11647: Federal Regional Councils.
Every function that can be regionalized should be mandated to do so and all
activities in the center need specific justification to remain centralized.
http://www.reagan.utexas.edu/archives/speeches/1981/72281c.htm
Boston, New York, Philadelphia, Richmond, Cleveland, Atlanta, Chicago, St
Louis, Dallas, Kansas City, Denver, Minneapolis, San Francisco
http://www.federalreserve.gov/gifjpg/lastmap2.gif
http://www.presidency.ucsb.edu/ws/index.php?pid=6812
The President has designated 10
persons for 1-year terms as Federal Regional Council Chairpersons for the 10
Federal regions.
In letters to the 10 persons chosen,
the President stated that the Federal Regional Council should help implement
his initiative in streamlining and simplifying the Federal grant-in-aid system.
"I am relying on you to identify problems and potential solutions for
management improvement in concert with State and local officials in your
region," the letters state.
The 10 persons are:
Region I (
Region III (Philadelphia)---Thomas
Maloney, Regional Administrator, Housing and Urban Development
Region IV (Atlanta)--Sara Craig, principal regional official, Health, Education,
and Welfare
Region V (Chicago)--Loran Wittner, regional
representative of the Secretary, Department of Commerce
Region VI (Dallas)--William Harris, Regional Administrator, Employment and
Training Administration, Department of Labor
Region VII (Kansas City)--John Kemp, Regional Director, Department of
Transportation
Region VIII (Denver)--Betty J. Miller, Regional Administrator, Housing and
Urban Development
Region IX (San Francisco ) --Bill Arntz, Regional
Administrator, Department of Energy
Region X (Seattle)---Bernard Kelly, principal regional official, Health,
Education, and Welfare
A Federal Regional Council was
established by President Nixon by Executive Order 11647, dated February 10,
1972 as amended. The Councils' primary function is to assist state and local
governments by coordinating federal program grants and operations through the
development of better ways to deliver the benefits of federal programs over the
short term. Councils also encourage joint and complimentary federal grant
applications by local and state governments, resolve conflicts and problems
which may arise between federal agencies, evaluate programs in which two or
more member agencies participate, develop more effective ways of allocating
federal resources to meet long-range needs of state and local communities,
supervise regional interagency program coordination mechanisms, and develop
administrative procedures to improve day-to-day cooperation on an interagency
and intergovernmental basis.
This Bush government should go for real tax
reform - simplification, VAT,
and the budget ..... Real tax reform means a VAT - and payroll deductions that
are ...
www.wiredbrain.net/politicaleconomics.htm
The IRS is replaced by a VAT. (value
added tax no tax on income, investment or savings - tax what you want less of
(debt) and don't tax what you do want ...
www.wiredbrain.net/documents/logos/logos03.txt - Cached
... what's happening and for updates use GlobalVillage
Excite NewsSearch -.
post.htmVAT
initiative.htm ...
www.wiredbrain.net/initiative.htm - Cached
The development of a national sales tax (VAT) and a
income tax based on a graph (inflation protected) based on percentiles on the
scale of all household ...
www.wiredbrain.net/whatwouldyoudo.htm
VAT is necessary because of international trade (
transfer social costs off exports to consumption ) and social stability
to support social welfare. ...
www.wiredbrain.net/doc1g.htm - Cached
on the VAT
( Value added tax ) or national sales tax initiative.htm ...... The
national budget contributions would be come from a VAT or National Sales ...
www.wiredbrain.net/traditions.htm
http://www.nytimes.com/2010/01/11/opinion/11geoghegan.html
ABOUT the
Senate, a college professor of mine used to say, One day, the Supreme Court
will declare it unconstitutional. He was joking, I think.
But the
Senate, as it now operates, really has become unconstitutional: as we saw
during the recent health care debacle, a 60-vote majority is required to
overcome a filibuster and pass any contested bill. The founders, though, were
dead set against supermajorities as a general rule, and the ever-present
filibuster threat has made the Senate a more extreme check on the popular will
than they ever intended.
3.) Span
of control reporting to the President needs to be limited to seven activities:
a) foreign affairs and military affairs, NSC b) treasury and finance OMB c)
justice and law enforcement, d) health includes FDA, research, e) interior and
environmental affairs, f) energy, commerce and agriculture, f) education and
labor. The IT revolution is only in its early stages. The government has a poor
record in IT management because the assistant deputy secretary has limited knowledge
and civil service can not attract really competent people. IT people resent
bosses who dont know what they are doing. The merit system has little merit in
high tech jobs depending on seniority when the half life of knowledge is in
dog years. Contractors are abused and misused and billions are wasted.
a.)
The international community and
security b.) Economy and prosperity c.) Law enforcement and justice d.) Energy,
environment and natural resources e.) Human resources, health education and
welfare f.) communications, IT, regulation independent
agencies.
b.) NRA
National Recovery Administration setting the prices on energy, by setting production
levels on coal, oil imports, natural gas so the CO2 external effects are equal.
This will raise costs of coal and electricity that will be adjusted by supports
to consumers.
4.) One
percent of all government programs can be used for program planning and
improvements in cost effectiveness. The OMB and the regional councils act as
friendly management consultants (not evil inspectors) who work with social
anthropology and systems skills to help make happier and productive workers and
agencies. Outside consultants are used all the time in business and the
government is sure in need of modernization.
5.) Tax reform and entitlement commission to include VAT
the great ship of state will flounder on dysfunctional revenues return to the
1986 process.
6.) There are seven major agencies in security not
coordinated by the 1.)
A
problem is being solved by itself: http://www.nytimes.com/2010/01/25/health/policy/25insure.html?hp
This negotiation is really coming
down to affordability, Mr. Golden said. These are kind of unique
circumstances for all of us involved. Its probably not surprising in this
economic climate. There are tremendous pressures on all of us to make health
care more affordable.
POLITICAL
JUDO: Galbraith
saw the necessity of "countervailing power,"
MODEL
B) MODEL C) HOW A BILL BECOMES A LAW:
Drawing
upon the ideas of the Harvard economist David Cutler,
TWO: What a Texas town can teach us about health
care.
The
Great Laboratory of Democracy:
The Health Insurance Reform (not really
health, not really insurance and not really reform) should be federalized and
regionalized. The principles of coverage (up to 95% of legal residences) the
goal of cost effective delivery of services, and saving the budgets of public
and private organizations is charged to the states. They are asked (not
mandated) to provide plans within a year to submit plans to achieve these
goals. The plans are reviewed by the ten federal regional offices and passed on
with comments to
The
national exchange would move ahead and be opened to large groups with the five
national private plans. States may add public programs including opening
Medicare (at cost) to
individuals and small business.
REALITY:
There
is a scale from fancy and superstition to reality. Tribal society is very collective and the
individual is part of a closed social system such as Islamic extremist or in
Modern
Civilization and civil society requires at least a reconnection of objective
facts and reality. The abstract concept
of law and order, objective public administration, courts and law is not
central to human evolution but requires some education and enlightenment. Scientific analysis and method is relatively
new and a direct threat to subjective community values and traditions such as
evangelicals and the holy Roman Catholic church. Thus the rise of the wing nuts, where the
role of white males with only manual skills has been deeply undermined by modern
developments that attacks their sense of being and their economic status.
Science and objective analysis is only the start of wisdom, which has to
understand being in the world but not part of the common assumptions about the
world. Perceptions are part of reality no matter how false. Information, understanding and analysis, and
then the systems process of going from being to becoming becomes a gateway to
wisdom and judgment.
Written: Written between the autumn of 1901 and
February 1902
Two hundred billion
for four million jobs;
At $50,000 for each job (20 jobs per million)
for pay plus payroll taxes etc. 100 jobs is $5,000,000; 1000 is 50 million,
10,000 = 500 million, 100,000 5 billions,
one million jobs for 50 billion, two million jobs for 100 billion, four
million employed for 200 billion that ends the recession including the housing
crisis once and for now. 200,000,000 /50
(thousands) = 4,000,000. The multiplier effect should be about two, so four
million more jobs will be created to make for full employment without
inflation. Public revenue will recover
20% or 35 billion so the actual cost will be less than the price tag from the
temporary use of the TARP funds.
http://www.wiredbrain.com/reserves.htm
There
has been a trillion spent on recovery with maybe two million jobs created or
saved over two years. It is important to maintain the labor force with work and
work habits, learning new skills, which maintains peoples abilities, pride and
dignity. 10% of our labor force
unemployed is over 8 million. http://en.wikipedia.org/wiki/Labor_force
http://www.amosweb.com/cgi-bin/awb_nav.pl?s=wpd&c=dsp&k=labor+force+participation+rate
The
New Deal employed seven million (20% of 35 million) out of a labor force only a
quarter of the current labor pool.
http://en.wikipedia.org/wiki/Works_Progress_Administration
First
employ thousands of temporary people at the state job offices to handle
applications and supervise work created. Non-profits, NGOs Churches, local
governments, teaching assistants and tutors at pre-schools, daycare and K-12
schools, community colleges, universities including student grants (their job
is to learn) and work study, projects of state and local agencies, environmental
projects, fish and wildlife, conservation and restoration, neighborhood
associations: all can all apply. Small business and construction companies can
apply for weatherization, energy projects and good works. A housing authority may want to buy and
preserve foreclosed housing, renovate property and rent or sell to qualified
low income families. Bridge loans should be available through the SBA and HUD.
The
public or non-profit agencies must offer to contribute to the cost of at least
10% to discourage fake or useless work. Private profit organization and farms
must bid contributions of 25% or more depending on the value of applications
received. Work site contributions cover the overhead and administrative costs
of the program. All federal dollars go directly to working people.
Applications
are awarded by the local offices that need to know what they are doing and send
people out in the field to check. The State audits are checked by the Federal
Regional Office and the federal Departments including IRS. The employees work
for and are paid by, (as is done with unemployment checks) the State Employment
agency. The workers are contract temporary workers and are paid by the jobs
agency based on work vouchers received back from the work site. Jobs pay more
or less depending on the level of skill required and have health
insurance. The jobs end after two years
but new ones are created.
The Works Progress Administration
(renamed during 1939 as the Work Projects Administration; WPA)
was the largest New Deal agency, employing millions to carry out public
works projects, including the construction of public buildings and roads, and operated
large arts, drama, media and literacy projects. It fed children and redistributed food,
clothing and housing. Almost every community in the United
States had a park, bridge or school constructed by the agency, which especially
benefited rural and Western populations. Expenditures from 1936
to 1939 totaled nearly $7 billion.[1]
Created by order of President Franklin Delano Roosevelt, the WPA was
funded by Congress with passage of the Emergency Relief
Appropriation Act of 1935 on April 8, 1935. The legislation had passed in
the House of Representatives by
a margin of 329 to 78, but was delayed by the Senate.[1]
The WPA continued and extended
relief programs similar to the Reconstruction Finance Corporation
(RFC), which was established by Congress in 1932 during the administration of
Until ended by Congress and war
employment during 1943, the WPA was the largest employer in the country. Most
people who needed a job were eligible for at least some of its jobs.[3]
Hourly wages were the prevailing wages in each area; the rules said workers
could not work more than 30 hours a week, but many projects included months in
the field, with workers eating and sleeping on worksites. Before 1940, there
was some training involved to teach new skills and the project's original
legislation had a strong emphasis on training.
Really
hard problems:
http://www.nytimes.com/2009/11/08/magazine/08Healthcare-t.html?pagewanted=1&em
There
are some situations which are so entangled and complex that there are no
solutions. There are actions that will make things better and ways of making
things worse but the interconnections and unpredictable reactions make every
act a high risk and where no action is even worse.
Such
is health care and education in the
The
problem with health care inefficiency is not insurance or drug companies but
the tangle at the delivery of service from medical service centers (called
hospitals) with hundreds of providers not under central control its a
shopping center not Mayo clinic.
http://www.nytimes.com/2009/11/15/opinion/15sun1.html
The New England Journal of
Medicine concluded, Pretty much every proposed innovation found in the health
policy literature these days is encapsulated in these measures.
http://politics.theatlantic.com/2009/11/a_milestone_in_the_health_care_journey.php
Gruber is a leading health economist
at the Massachusetts Institute of Technology who is consulted by politicians in
both parties. He was one of almost two dozen top economists who sent President
Obama a letter earlier this month insisting that reform won't succeed unless it
"bends the curve" in the long-term growth of health care costs. And,
on that front, Gruber likes what he sees in the Reid proposal. Actually he
likes it a lot.
"I'm sort of a known skeptic on this stuff," Gruber told me. "My
summary is it's really hard to figure out how to bend the cost curve, but I
can't think of a thing to try that they didn't try. They really make the best
effort anyone has ever made. Everything is in here....I can't think of anything
I'd do that they are not doing in the bill. You couldn't have done better than
they are doing."
POLITICAL JUDO: Galbraith saw the necessity of
"countervailing power,"
MODEL
B) MODEL C) HOW A BILL BECOMES A LAW:
Drawing
upon the ideas of the Harvard economist David Cutler,
TWO: What a Texas town can teach us about health
care.
THE
INDUSTRIAL REVOLUTIONS: Health
Insurance Costs:
WRONG:
NOT TRUE - FACT CHECK
AND IMPORTANT
Meaning
of "judo" A thought model: FIRST PRINCIPLES: overtreatment.
The
Wrong Diagnosis
THE
REASON DRUG COMPANIES SUPORT REFORM: Expect Congress to seriously
consider a value-added tax
A
THREE prong attack: 1.) Medicare Advisory Payment Commission cost
control Med Pac
2.)
Move from Fee for service to cooperative service agencies 3.)
Competition The exchange or gateways market
A
Message From Warren E. Buffett, CEO of Berkshire Hathaway Inc.
The
Changing Role of the Hospital The way out of the fix:
Investment
vs. consumption:
Page 200 - http://www.wiredbrain.com/documents/ethos/benedict.txt
RE: A.H. Maslow: The Farther Reaches
of Human Nature "Synergy in the Society and Individual"
Ruth Benedict (Patterns of Culture;
Race, Science and Politics) an essay on holism, invented and developed the idea
of synergy at lectures at Bryn Mawr College in 1941.
Maslow had the only copy which was to be published with the assistance of
Margaret Mead in 1970.
Benedict tried to overcome the idea
of cultural equality (not everything is right) and the doctrine of cultural
relativity, what ever works for you is OK by me. Societies she said have a
flavor, character and are not all equally functional. Some societies
(Republican) are "anxious", surly, nasty, aggressive, and hateful,
this come from insecurity and causes low morale. ( such
as the Chuckchee, the Ojibwa, The Dobu,
and the Kwakiutl) Other societies (Democrats) were "nice" people,
affectionate, kind, secure and with high morale. ( Zuni,
Arapesh, The L(d)eKota,
Eskimo ).
The critical element in the concept
of synergy is aggression vs. cooperation. Synergy is where individual benefit
and groups welfare are in sink. Farming,
fishing, hunting can product mutual benefits of cooperation vs. Selfish
self-interest (winner/losers) vs. unselfish, altruism (win/win).
Siphoning vs. funneling of wealth,
use vs. ownership, Comforting vs. Frightening Religion, high energy or low
energy institutions, are characteristics of synergy, where are we ? We have had a out break of
win/lose - me and mine - the hell with the hind most, winner take all,
activity. This discourages the losers, causes aggression, and is socially
dysfunctional. A few institutions maintain high energy but the society is
winding down. Synergy is spirit and systems for successful cooperation,
institutional means of using aggression (learning for conflict), and rewards
for all from social success (tide lifts all boats).
The
American Wars operate in an uncontrolled territory with no one in charge.
Before you can plan and implement change there must be the handles of change
and some sort of system.
On
the wiredbrain front: http://www.wiredbrain.com/public%20service%20academy.htm
http://uspublicserviceacademy.org/
http://en.wikipedia.org/wiki/Demography_of_Afghanistan
There
is and always has been for thousands of years a weak central state, so nation
building is not an option. The realistic choice is a tangle of local authorities
in an alliance or confederation. The outside powers will have bases and make
deals that insure the real security interests of the west. The same strategy
would work for the territories in
http://www.wiredbrain.com/iraq.htm
Iraq
in 1917 and Lt. Gen. Sir Stanley Maude issued a document in Baghdad saying
"we ... The US administrator in Iraq, Paul Bremer, good
luck fellow - it's ...
www.wiredbrain.com/brilliantplan.htm
- Cached
- Similar
Two years later and 23,000 dead the
British withdrew.
For
50 years American policy supported military dictators, starting in the policy
of containment in
In the past, military juntas have justified their rule as a way of bringing political stability for the nation or rescuing it from the threat of "dangerous ideologies". In Latin America the threat of communism was often used, while in the Middle East the desire to oppose Israel and later Islamic fundamentalism proved an important motivating pattern. Military regimes tend to portray themselves as non-partisan, as a "neutral" party that can provide interim leadership in times of turmoil, and also tend to portray civilian politicians as corrupt and ineffective. One of the almost universal characteristics of a military government is the institution of martial law or a permanent state of emergency.
http://en.wikipedia.org/wiki/Military_dictatorship
There was little talk of
democracy the motivation was anti-communist and economic (oil) and a long
tradition in
Kleptocracy, alternatively cleptocracy
or kleptarchy, from Greek klepto (theft) and kratos
(rule), is a term applied to a government that extends the personal wealth and
political power of government officials and the ruling class (collectively, kleptocrats), via the embezzlement
of state funds at the expense of the wider population, sometimes without even
the pretense of honest service. Political corruption is closely tied to the
internal workings of a Kleptocracy. Not an
"official" form of government (cf democracy, republic, monarchy, theocracy) the term is a pejorative used to describe
governments perceived to be highly corrupt.
During
the summer of 1963
Chief
among the proposed changes was the removal of Diem's younger brother Ngo Dinh Nhu. Nhu
controlled the secret police and was seen as the man behind the Buddhist
repression. As Diem's most powerful adviser, Nhu had
become a hated figure in
The
CIA was in contact
with generals planning to remove Diem. They were told that the
Greeting fellow Americans; we must meet the crisis of
our time.
We were elected by a clear majority of the people on the
platform of A change you can believe in. This was not just a convenient
slogan, because the prior administration was unpopular, but a commitment of all
the members of my administration and most of the senators and representative
here today. We always said that elections matter but change needs the active
support of the people to overcome the established interests of great wealth and
power. Our nations Health is not the only cause; we have for decades talked
about our need to be independent of foreign oil and it only has gotten worse.
We have talked about a Nation at Risk but our schools are not world
class. We have talked about a crisis in
our environment, transportation, the nation debt, out of control entitlements,
and many other pressing problems only to be left to the next election and
unfulfilled promises.
Since our nation was fractured by civil rights and the
war in
Three points:
ONE: There is a serious problem and we must show yes we can make government work Not
big or small but effective and efficient. We have done this in the past. The
way to solve the problem requires we
work together with an alliance of the willing and not be stopped by the
forces of reaction. At this time the cause is to renew our faith in
ourselves and renew the faith and trust of the community of nations. This
government must be able to act, must be seen to act to restore the confidence
vital to recovery. We must act not only on Heath Care Insurance reform but over
time restructure the delivery systems.
TWO:
The reliance on the free market. Health Insurance Market is not health, not insurance, and not a market. The best way to fix a
uncompetitive market is to create the framework for competition. There is prima facie evidence of monopoly power. Galbraith saw the necessity of "countervailing
power," It not only includes government regulation and
oversight, but also collective bargaining, and the leverage that large
insurance companies public and private would bring to bear on health care
producers and suppliers.
THREE: The reliance on building from what we already
have as we move over time to what we need. The center of the Health Choices Act
now in congress is the exchange which is the Federal Employees
Health Benefits (FEHB) Program's. The
trigger to include a public option in the exchange comes into effect in
markets under-served, where the state or regions requests it, where the market
is not competitive by Justice anti-trust standards, and is helped by building
upon a program of nationwide private insurance that is working.
LET US TELL THE TRUTH:
NOW THE
PLOT THICKENS: Still, while the Finance Committee is expected to produce a
moderate bill with the best chance of passage in the Senate, it is not clear
whether the White House regards it as a template. Four other committees with
jurisdiction three in the House, one in the Senate approved versions of
health legislation before Congress recessed. The strategy is to go from A the
current mess to B a rational system by way of C the current bill when out of
conference.
POLITICAL JUDO: Galbraith saw the necessity of
"countervailing power,"
MODEL
B) MODEL C) HOW A BILL BECOMES A LAW:
Drawing
upon the ideas of the Harvard economist David Cutler,
TWO: What a Texas town can teach us about health
care.
THE
INDUSTRIAL REVOLUTIONS: Health
Insurance Costs:
WRONG:
NOT TRUE - FACT CHECK
AND IMPORTANT
Meaning
of "judo" A thought model: FIRST PRINCIPLES: overtreatment.
The
Wrong Diagnosis
THE
REASON DRUG COMPANIES SUPORT REFORM: Expect Congress to seriously
consider a value-added tax
A
THREE prong attack: 1.) Medicare Advisory Payment Commission cost
control Med Pac
2.)
Move from Fee for service to cooperative service agencies 3.)
Competition The exchange or gateways market
A
Message From Warren E. Buffett, CEO of Berkshire Hathaway Inc.
The
Changing Role of the Hospital The way out of the fix:
Investment
vs. consumption:
The 21st century will be an American century IF we
can work together to solve communal problems.
Otherwise we will go the way of others and drown in debt and division. -Paul Kennedy, The Rise and Fall of the Great Powers The
capacity to sustain a conflict with a comparable state or coalition of states
ultimately depends on economic strength; but states apparently at the zenith of
their political power are usually already in a condition of comparative
economic decline, and the United States is no exception to this rule. Power can
be maintained only by a prudent balance between the creation of wealth and entitlements, vast military expenditure, and great powers in
decline almost always hasten their demise by shifting expenditure from creation
of wealth to public expenditures.
We have to get beyond what divides us and work
together to reform health care, energy independence, financial stability,
education and ignite the engines of growth with new waves of innovation and
private enterprise.
American
does not have the best health care in the world. No matter how many times the claim is made it is not
true, we have the most expensive but other countries have better care.
The Gordian Knot is a legend
associated with Alexander the Great. It is often used as a metaphor
for an intractable problem, solved by a bold stroke ("cutting the Gordian
knot"):
The nation overcame secession and rebellion and is
slowly conquering the stains of slavery, discrimination and prejudice.
At the turn from the 19th to 20th
century progressives
fought the cartels and trusts, they created the civil service, the 8 hour day,
banned child labor, protected our food supply, created the national parks and
would be shocked by the concentration of power in the health insurance
business, where are our med Muckrakers? The nation reformed the constitutional system
with a can do attitude. Significant changes enacted at the national
levels included the income tax with the Sixteenth
Amendment, direct election of Senators with the Seventeenth
Amendment, Prohibition with the Eighteenth
Amendment, and women's suffrage through the Nineteenth
Amendment to the U.S. Constitution.
We need
anti-trust enforcement where one or a few companies control the market.
FDR
Speech Is a Must-Read, a "Rendezvous with Destiny"
Franklin Roosevelt stood in
1936 with a nation being saved from
falling apart and the world was growing dark as fascist and communist offered despotism
for freedom. "
We cannot afford to accumulate a
deficit in the books of human fortitude. . . . "
"To some generations much is given.
Of others much is expected. This generation of Americans has a rendezvous with
destiny.
"In
this world of ours in other lands, there are some people who, in times past,
have lived and fought for freedom, and seem to have grown too weary to carry on
the fight.
.
They begin to know that here in
"I accept the commission you have
tendered me. . . ."." "I cannot, with candor, tell you
that all is well with the world. Clouds of suspicion, tides of ill-will and
intolerance gather darkly in many places. . . " http://www.time.com/time/magazine/article/0,9171,770245-3,00.html
Thus
social security..unemployment,
disability, but not health care.
Insert
the John F. Kennedy speech and going to the moon a nation with faith in
itself..
Insert
Lyndon B Johnson Civil rights and Medicare how the forces of retreat and
reaction still attack a government run universal health plan (for seniors)
Nixon
tried with mandatory coverage and promoted HMOs
http://www.mixedink.com/Slate/InauguralAddress/
At
this time the cause is to renew our faith in ourselves and renew the faith and
trust of the community of nations. This government must be able to act, must be
seen to act to restore the confidence vital to recovery. We must act not only
on Heath Care Insurance reform but remake the delivery system.
We
then can show ourselves and the world that we can solve our social problems,
conquer our debts and deficits and put the nation on a sound financial footing,
reduce dependence on foreign oil, gain control of green house gases, build a
new green economy, reform and refocus our public schools, increase
opportunities for college or career education, make this nation again with the
song in our hearts and the words on our lips yes we can.
Matthew
5:14 states "You are the light of the world. A city that is set on a hill
cannot be hidden."
This
phrase entered the American lexicon early in its history, with John
Winthrop's sermon
"A Model of Christian Charity," given in 1630.
For
we must consider that we shall be as a city upon a hill. The eyes of all people
are upon us. So that if we shall deal falsely with our God in this work we have
undertaken... we shall be made a story and a by-word throughout the world. We
shall open the mouths of enemies to speak evil of the ways of God... We shall
shame the faces of many of God's worthy servants, and cause their prayers to be
turned into curses upon us til we be consumed out of
the good land whither we are a-going.[1]
COMMON SENSE
Is this nation capable of making hard choices? Do
modern Americans have enough sense of the public interest to rally around the
flag and get the reforms desperately needed?
Now
we are engaged in a great political war, testing whether that nation, or any
nation, so conceived and so dedicated, can long endure.
· "I
offer nothing more than simple facts, plain arguments, and common sense . .
."
· "A long habit of not thinking a thing
wrong, gives it a superficial appearance of being right, and raises at first a
formidable outcry in defense of custom."
Common
Sense[1]
is a pamphlet
written by Thomas Paine. It was first published anonymously on
January 10, 1776, during the American Revolution.
These
are the times that try men's souls: The summer soldier and the sunshine patriot
will, in this crisis, shrink from the service of their country; but he that
stands it now, deserves the love and thanks of man and woman. Tyranny, like
hell, is not easily conquered; yet we have this consolation with us, that the
harder the conflict, the more glorious the triumph. What we obtain too cheap,
we esteem too lightly: it is dearness only that gives every thing its value."
Thomas Paine, The Crisis
LET US TELL THE TRUTH:
The 21st century will be an American century IF we
can work together to solve communal problems.
Otherwise we will go the way of others and drown in debt and division.
We have to get beyond what divides us and work together to reform health care,
energy independence, financial stability, education and ignite the engines of
growth with new waves of innovation and private enterprise.
American
does not have the best health care in the world. No matter how many times the claim is made it is not
true, we have the most expensive but other countries have better care. It is a
national shame and a real crisis. The individual may get good care but may just
as likely die from medical errors in the system. It is a lottery. Some will get
hospital related infections; many will not get the best, most effective care but
poorly coordinated haphazard treatments.
Every American is at risk of medical mistreatments, financial ruin, and
pain and suffering because of a broken system without design or core values.
Our insurance schemes have grown up wilily nilily patch after patch was applied
because the dysfunction political system and insurance market was unable to
deal with a dysfunctional health delivery system.
Article Tools Sponsored By DAVID BROOKS Published:
September 3, 2009
Lincoln was
a great writer, so was FDR who did get some professional help, Brooks maybe the
best Obama can get, since he writes very well himself.
If I were magically given an hour to help Barack Obama
prepare for his health care speech next week, the first thing Id do is ask him
to read David Goldhills essay, How American Health Care Killed My Father, in
the current issue
of The Atlantic. That essay would lift Obama out of the distracting
sideshows about this public plan or that cooperative option. It would remind
him why he got into this issue in the first place.
Goldhills main message is that the American health
care system is dysfunctional at the core. He vividly describes how the system
hides information, muddies choices, encourages more treatment instead of better
care, neglects cheap innovation, inflates costs and unintentionally increases
suffering.
The essay is about the real problem: the insane
incentives. Goldhill is especially good on the way
the voracious health care system soaks up money that would go to education, the
environment, economic development and a thousand other priorities. Health care,
he writes, simply keeps gobbling up national resources, seemingly without
regard to other societal needs.
Then
Id ask Obama to go to the Brookings Institution Web site and read a report
called Bending the Curve: Effective Steps to Address Long-Term Health
Care Spending Growth. This report was written by a bipartisan group of
battle-tested experts, including Mark McClellan, David Cutler, Elizabeth McGlynn, Joseph Antos and John Bertko.
POLICY AND POLITICS:
The design and creation of a complex program is
similar to manufacturing and sales. First comes the engineering of policy which
must take into account costs and consumer preferences. The marketing people
test the product with research and focus groups. Then there is a sales campaign to get the
product sold.
To get a change in the American society takes good
policy, tested at the state and local level, the 50 lavatories of democracy and
good politics. What is the hook or
mass appeal in selling health care reform? The system is out of control and
requires fixing (as has been true over the last 50 years) but effectiveness and
efficiency are hot political buttons.
We hold these truths to be self-evident, that all men
are created equal, that they are endowed by their Creator with certain
unalienable rights, that among these are life, liberty
and the pursuit of happiness. That to
secure these rights, governments are instituted among men, deriving their
just powers from the consent of the governed.
Jefferson
[Ambition must be made to counteract ambition. The
interest of the man must be connected with the constitutional rights of the place.
It may be a reflection on human nature, that such devices should be necessary
to control the abuses of government. But what is government itself, but the
greatest of all reflections on human nature?
If men were angels, no government would be necessary.
If angels were to govern men, neither external nor internal controls on
government would be necessary. In framing a government which is to be
administered by men over men, the great difficulty lies in this: you must first
enable the government to control the governed; and in the next place oblige it
to control itself. A dependence on the people is, no doubt, the primary control
on the government; but experience has taught mankind the necessity of auxiliary
precautions. ([1788] n.d., 337)
BREAVEHEART:
What
types of health insurers qualify for participation in the FEHB Program? The new
exchange or gateways will be the same.
We will consider applications only
from comprehensive, Medicare medical plans. The FEHB Program
contracts only with health benefits carriers that offer a complete line of
medical services, such as doctor's office visits, hospitalization, emergency
care, prescription drug coverage, and treatment of mental conditions and
substance abuse. We do not have the authority to contract with companies that
offer limited services, such as dental and/or vision plans, prescription drug
plans, supplemental insurance and disability insurance. We can not consider applications from fee-for-service carriers. Federal Employees
Health Benefits (FEHB) Program's
We
especially invite qualified applicants from the states that the Department of
Health and Human Services (HHS) has determined to be medically underserved -- Alabama,
Arizona, Idaho, Illinois, Kentucky,
Louisiana, Mississippi, Missouri, Montana,
New Mexico, North Dakota, South Carolina, South
Dakota, and Wyoming.
Federal Employee
Health Plans in your area and how
much they cost. http://www.opm.gov/insure/health/search/plansearch.aspx
We
also encourage applicants that HHS, Centers for Medicare and
Medicaid Services (CMS), determines to be Federally
qualified or that are an approved Competitive Medical Plan (CMP) http://www.opm.gov/insure/health/planinfo/types.asp
A new AMERICARE in the Centers for Medicare and
Medicaid Services (CMS), determines to be federally qualified or that are
an approved Competitive Medical Plan (CMP) http://www.opm.gov/insure/health/planinfo/types.asp
What is needed are new
comprehensive, Medicare medical plans on
a regional and state wide basis. In
short it opens the Medicare system to everyone in the exchange or gateways. At
the same time it moves Medicare and Medicaid to Americare or service
alliances based on per capital costs or bundled, global payments that would
decrease fee for service and cut costs by another 20%. This is a form of
single buyer that has proved itself the best may to reduce costs and improve
quality. The
One persons waste, abuse or fraud is another persons
income, their private plane, and
The reason the public option is critical is that
employers can migrate from over priced private plans to a form of Medicare for
all. When almost everyone is included
there is less cost shifting (where uncollected bill of uninsured are paid by
the insured) and premium would decline. The insurance companies dont want
public competition; and the medical community is not excited by the change that
reduces their incomes.
NOW THE
PLOT THICKENS: Still, while the Finance Committee is expected to produce a
moderate bill with the best chance of passage in the Senate, it is not clear
whether the White House regards it as a template. Four other committees with
jurisdiction three in the House, one in the Senate approved versions of
health legislation before Congress recessed.
POLITICAL JUDO: Galbraith saw the necessity of
"countervailing power,"
MODEL
B) MODEL C) HOW A BILL BECOMES A LAW:
Drawing
upon the ideas of the Harvard economist David Cutler,
TWO: What a Texas town can teach us about health
care.
THE
INDUSTRIAL REVOLUTIONS: Health
Insurance Costs:
WRONG:
NOT TRUE - FACT CHECK
AND IMPORTANT
Meaning
of "judo" A thought model: FIRST PRINCIPLES: overtreatment.
The
Wrong Diagnosis
THE
REASON DRUG COMPANIES SUPORT REFORM: Expect Congress to seriously
consider a value-added tax
A
THREE prong attack: 1.) Medicare Advisory Payment Commission cost
control Med Pac
2.)
Move from Fee for service to cooperative service agencies 3.)
Competition The exchange or gateways market
A
Message From Warren E. Buffett, CEO of Berkshire Hathaway Inc.
The
Changing Role of the Hospital The way out of the fix:
Investment
vs. consumption:
HOW A BILL BECOMES A LAW:
The Edward M. Kennedy Americare Act of 2009
http://www.govtrack.us/congress/bill.xpd?bill=h111-3200&tab=summary
Establishes the Health Choices Administration as an independent agency to be
headed by a Health Choices Commissioner. The bill establishes the Health Insurance Exchange or gateways
within the Health Choices Administration in order to provide individuals and
employers access to health insurance coverage choices, including a public health insurance option. The bill requires the Commissioner to: (1)
contract with entities to offer health benefit plans through the Exchange or
gateways to eligible individuals; and (2) establish a risk-pooling mechanism
for Exchange or gateways-participating
health plans.
The bill provides for an affordability premium credit
and an affordability cost-sharing credit for low-income individuals and
families participating in the Exchange or gateways. The exchange or gateways
will be similar to The Federal Employees Health
Benefits (FEHB) Program can help you and your family meet your health care
needs. Federal employees, retirees and their survivors enjoy the widest
selection of health plans in the country. You can choose from among
Consumer-Driven and High Deductible plans that offer catastrophic risk
protection with higher deductibles, health savings/reimbursable accounts and
lower premiums, or Fee-for-Service (FFS) plans, and their Preferred Provider
Organizations (PPO), or Health Maintenance Organizations (HMO) if you live (or sometimes
if you work) within the area serviced by the plan.
The house committees have reported and the rules
committee would put them together in an omnibus act which goes to the floor.
The house is almost ready to pass its Edward M. Kennedy Health Choices Act
2009. The Senate Finance Committee is holding up the bill for more realistic
finances and co-ops rather than public options which are really public.
Senator Baucus has to report so is being encouraged to do so whatever. Then
the bill is consolidated with the Health committee and goes to the floor. If
there are not 60 votes for the public option the bill passes without it.
Expanding Health Care Coverage: Proposals to Provide
Affordable Coverage to All Americans
Financing Comprehensive Health Care Reform: Proposed
Health System Savings and Revenue Options
But disagreements between lawmakers remained, of
course. Senator Hatch focused on his proposal to leave states considerable
leeway to create 50 different laboratories for health care reform proposals,
rather than dictating a one-size-fits-all approach from
Then it goes to conference committee where all three
house committee chairmen favor public option. The senate members are split
50/50 so the majority rules and the final version contains the public option
(modified with a trigger) and the Senate votes on the conference report that
requires 60 votes. If the Republicans vote against the bills there is no reason
they must be in numbers on the conference committee where final decisions
including ideas not in either bill, are finally made. The vote would be very close to Senate
Vote on Conference Report: H.R. 1: American Recovery and Reinvestment Act of
2009 http://www.govtrack.us/congress/vote.xpd?vote=s2009-64
Legislation is a compromise and final votes have to take
into account the whole 1000 pages and the politics. H.R. 3200: 111th Congress
Edward M. Kennedy
Americare Act of 2009 http://www.govtrack.us/congress/bill.xpd?bill=h111-3200
In a 2004 Health Affairs article,
Professor James C. Robinson examined
The Urban Institute argues that a public insurance option, as
proposed by President Obama, would not drive private insurers out of the
market, but it would break their stranglehold on consumers and would expand
coverage to those without it.
http://www.urban.org/health_policy/
The trigger for the public plan would be the same as
in anti-trust where there has to be four active alternatives (non-cartel) and
the largest has less than 50% of the market. PRE-PAID insurance alternatives
are like cell phones; where for example you get 10 days of in hospital service
up to $50,000 of cost. After that re-insurance kicks in for serious problems.
There is little cost at the point of service after deductibles and co-pays. The
incentives are to do only what is effective.
If the median cost per household for private insurance (or Prepaid
MEDICARE AMERICARE) is $15,000, community alliances PRE-PAID PLANS would COST
half as much (less 10% paper work, 10% best practice and less 20% unnecessary
treatments, and 10% information technology).
The employer would save $4500 and the persons net wages would go up
$7,000 or 15%, a nice raise.
Actual analysis suggests about a 25% savings or 50% of
the possible 50%. This is about 500 billion, split evenly between public and
private programs. The will not be a drastic cut but bending the curve over
years.
The rocky road from A: fee for service to B:
PRE-PAID Americare via C: Accountable Care Organizations "countervailing
power,"
The American political system has lacked a social
democratic base because of the diversity of American civilization. Efforts at
reform have floundered on the shoals of racism, natives v. foreigners,
regionalism divisions, and social class that overwhelmed the collective needs
of the society as a whole. Washington, Jefferson, Lincoln, Teddy and FDR, LBJ
overcame these handicaps as would Obama.
http://www.urban.org/health_policy/
Obama won the Democratic nomination by careful
attention to the details of delegate selection under the rules. He would win in congress by the same baffling
attention to vote counting and leverage.
The plan is working. The opposition has over reacted. The reality is in the details below the radar
of the media. Obscure language with
authorities referenced in other sections, do the real work. What does it take to crystallize
public opinion?
Amazon's
Edward L. Bernays Page
The progressives reforms at the turn of the century
were based on SHAME and GUILT. The shame of the cities and meat packing was direct
threats to citizens welfare and safety. The PR message now should be are we
the only modern society without universal health care? Canadians are taken
care of, French are taken care of, and people are better treated in dozens of
countries at less cost! Stop being so
afraid of the truth and the lie that we have the best in the world we are in
grave danger, there is a crisis, panic .. Health
Insurance Costs: http://www.hlc.org/HRD_Common_Ground_--_FINAL.pdf
Wag
the Dog was produced and directed by Barry
Levinson. The screenplay was credited to Hilary Henkin and David Mamet.
The film is based on the novel American Hero by Larry
Beinhart. The book, however, differs greatly from
the picture. In the book, the president is specifically George
H. W. Bush (in the movie he is unnamed), the fake war operation is
explicitly Desert Storm, and the war actually occurs, instead of
being entirely falsified.[1]
WRONG: NOT TRUE - FACT
CHECK
AND IMPORTANT
The face of clear and present danger should be
personal stories of middle class families destroyed by getting sick. The
cornier the better, more soap opera the better, the more painful the better. We
are talking about deep sub conscience motivation below the rational mind; as is
most effective advertising. Bernays was an outspoken proponent
of propaganda as a tool for democratic and corporate manipulation of the
population. His 1928 bombshell Propaganda lays out his eerily prescient
vision for using propaganda to regiment the collective mind in a variety of
areas, including government, politics, art, science and education. To read this
book today is to frightfully comprehend what our contemporary institutions of
government and business have become in regards to organized manipulation of the
masses.
The American public is not conservative about money.
They are not financially conservative, but motivated by immediate satisfaction.
The traditional middle class put off purchases until there was money in the
bank, (puritan ethic) while lower class people demanded immediate
gratification. Now if they want
something they pay for it on the old never never
credit cards and then put it on their equity loans using their homestead as an
ATM machine. Thus was the cause of the economic crisis. And why Republicans
would say deficits dont matter.
The people vote for politicians who promise benefits
without pain or taxes, the check is in the mail campaign. The conservative movement is more social
than economic and based on prejudices between regional, racial, tribal, moral
family values, religious, WASP vs. foreigners not self interest since people
are voting against their own economic self-interests. Republican get tax cuts
for the rich 1% by their values agenda based on prejudice and
fundamentalism. The rich fear a liberal
popularism of buying vote with an endless stream of entitlements the rich end
up paying for.
Health Insurance Market
is not health, not insurance, and not a market. The fault does not primarily lie
with the insurance industry but a web of tangles in employer based policies.
Two thirds of the premium cost paid by the employer is invisible to the
employee. If the employee pays $300 a month the company pays $600 for a total
of $900 or $10,800 a year. If there is a prepaid plan that is more effective
and efficient and cost less but is not as convenient the small reduction in
employee cost is not motivation. The employer needs to reward the employee with
a share of the employers savings. The employee pays $200 a month and saves
$100 but the employer saves $200 that needs to be paid in wages so the full
$300 or $3600 saving is manifest. The saving should not be taxed but be pretax
as are health benefits.
Edward M. Kennedy Americare Act of 2009 http://wonkroom.thinkprogress.org/2009/06/09/help-bill-release/ (summary) http://help.senate.gov/BAI09A84_xml.pdf
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:
The
so-called gang of six consists of Democratic Sens. Max Baucus (
You catch more flies with honey than vinegar! The offer to the blue dogs is money and
organization get along by going along. The majority is possible by having
conservative democrats in conservative districts. I am in a district which is
at the top of the republican hit list for having a democratic representative in
a very republican district. The way the representative can be saved is with
support not threats. If their vote is needed they would be offered
organization, money, opposition research, and national big time help.
The focus
of Health (insurance) reform should be on free market competition.
We can agree that resources are best allocated by
supply and demand. When beef is high
people buy chicken and the prices adjust.
There has to be regulations to keep the market open and prevent over
concentration. The core idea is that faults in the health system are market
failures and can be repaired by corrections in the market system. Cost control and insurance reform are best
done by changes in bundles, global or per capita payments that increase
effective care and reduce waste, fraud and abuse.
Milton Freeman: If you tax something you get less of
it, if you subsidize something you get more of it.
More money goes into real estate, and health
insurance, because of tax advantages so there is a boom and bust. More is bought than a really free market
would have. Therefore, health benefits big tax advantage distorts the market.
You get more insurance and less of wages, savings, and long term economic
growth but more medical services than useful.
1. People respond to incentives.
2. Demand is elastic, and there are substitutes for everything.
3. If you tax something, you get less of it.
Or to paraphrase Thomas Sowell, this story suggests
that "The first lesson of economics is that people respond to incentives.
The first lesson of politics is to ignore the first lesson of
economics." http://www.hoover.org/publications/digest/3459466.html
It has been
said that the
It can be said that the Health Insurance Market is not health (but sickness management).
And not
insurance as it is normally done (it is not
a plan to pool money to cover rare but major disasters. See Milton Freeman below:
Employer financing of medical care has caused the term insurance to acquire a
rather different meaning in medicine than in most other contexts. We generally
rely on insurance to protect us against events that are highly unlikely to
occur but that involve large losses if they do occurmajor catastrophes, not
minor, regularly recurring expenses. We insure our houses against loss from
fire, not against the cost of having to cut the lawn. We insure our cars
against liability to others or major damage, not against having to pay for
repairs and oil changes)
If you have a PRE-PAID service plan or warranty there
is no incentive for the dealer or repair shop to do more than necessary. If you
had a fee-for-service plan the costs would quickly get out of hand. It is just that simple. All the miles of talk
has missed the point there is a crisis of costs caused by fee-for-service
not by insurance companies, drug companies, or the government but because we
stumbled blind into a quagmire a financial
Health care
is not a market: (prices are not set by supply
and demand which is elastic, and where buyers and sellers set a price in a free
exchange or gateways and there are substitutes for everything. Health coverage
is a scheme where bills are paid by contracts and regulation to the second
persons, the providers, by the third persons, an insurance program, with little
input from the first person, the patient).
POLITICS is the problem and needs to be the answer.
The
Since the
Federal Employee
Health Plans in your area
THE PRESIDENT IS BADLY MISINFORMED ABOUT THE MEDICARE
IN
WRONG: NOT TRUE - FACT
CHECK
AND IMPORTANT
http://en.wikipedia.org/wiki/Prepaid
AMERICARE_%28Canada%29
In a few months all this summers chatter about the
public option would fade into the mist as the Edward M. Kennedy Americare Act of 2009 becomes law.
The way from A: fee for service to B: PRE-PAID via
C: Accountable Care Organizations is by the use of "countervailing
power," POLITICAL JUDO:
The plan A is to preserve private insurance, with a
slow shift from fee for service to bundled, global payments or packaged cost
for treatment groups by private and public insurance. There are lots of incentives for collective
practice and wavers for Medicaid and Medicare to purchase services on a
PRE-PAID basis. They first work on universal coverage and then on cost control.
The Obama Administration and Cost Control
Category I: Improving Medical Practices and Health
Outcomes
Category II: Restructuring the Health Insurance
Marketplace
|
Lessons from Abroad: What Works and What Does Not
Work? |
http://www.annals.org/cgi/content/full/0000605-200904070-00114v1
The Hedgehog and the Fox" is the title of an
essay by Isaiah Berlin,. He
uses this idea of Tolstoy as a basis for an analysis of the theory of history
that Tolstoy presents in his novel War and Peace.
Berlin refer to his "pluralism" and other aspects of our
Western-liberal tradition that Berlin so epitomizes in a way that suggests we
all are better for knowing a lot of things. To begin with, "thing"
tends to become "trick and the "one big thing" that
Why do I know what would happen and you dont?
The talk is all about the fact we are being driven
broke by the cost of health care BUT according to the CBO (Congressional Budget
Office) there is little in the current legislation to bend the curve.
Is not the real crisis is a lack of cost control where
fee-for-service has incentives to encourage excessive treatments, and no
penalties for bad over-priced treatments?
Is not the real answer some form of per capita or
bundled, global payments? OR in other words, Is not the real problem going from
the current crazy fee for service to the use of countervailing power of big
buyers in the current legislation to get somewhere on bending the cost curve
?
We need to be like every other advanced society in
having a form of; if not exactly a single payer, but with a few majority big
payers that have enough leverage to actually solve many of the cost and quality
problems, .i.e. the public option? (The public programs already have 100
million people; Prepaid MEDICARE AMERICARE, Medicaid, VA, military, Indians,
and other smaller programs mostly follow Prepaid MEDICARE guidelines) The Blue
Cross/Blue Shield has another 100 million in their brand. Why is this not
enough to bring buying power that It would rationalize
the system?
A case study:
Our local hospital is a non-profit public agency with
a special district tax to pay for indigent care. Our biggest employer is the
school board and then other public employees. Blue
Cross is a private not for profit, state regulated company. The hospital in
a fit of animal spirits and exuberance and to fight off competitors, over
expanded and needed to pay for its indulgences.
BC objected to the high charges by the hospital and its doctors. For more than a year BC did not have a
contract with the hospital so people covered did not get their bills paid it
was out of the loop. Some of the loss from uncollected bills was shifted to the
other paying insurance companies and Medicare / Medicaid by raising their fees.
After sometime the parties came to an agreement. No one was happy but there was little
competition; the next hospital is 20 miles away, there is no other health
insurance company with contracts for public employees that would take over the
service, and everything would have to be renegotiated. It is a expensive dysfunctional mess.. If you over spend
the way out of the mess is to live within a budget You cant control costs if
you work with a book of blank checks and dont subtract.
In other words we need to go from A the current out of
control system to B a system with real cost control budgets by way of plan C
with a new powerful player and the exchange or gateways that changes the
market enough to make it a really functioning free market.
Galbraith saw the necessity of
"countervailing power,"
It not only includes government regulation and
oversight, but also collective bargaining, and the leverage that large
retailers and distributors would bring to bear on large producers and
suppliers. (For example: Sears and car tires, Wal-Mart and
The Gordian Knot is a legend
associated with Alexander the Great. It is often used as a metaphor
for an intractable problem, solved by a bold stroke ("cutting the Gordian
knot"):
"Turn him to any cause of policy, The Gordian
Knot of it he would unloose,
Familiar as his garter" (Shakespeare, Henry V,
Act 1 Scene 1. 4547)
The majority of families get their health insurance
from a tax advantaged employer based systems, (employer 2/3 employee 1/3) which
was challenged by the
One persons waste, abuse or fraud is another persons
income, their private plane, and
The reason the public option is critical is that
employers can migrate from over priced private plans to a form of Medicare for
all. When almost everyone is included
there is less cost shifting (where uncollected bill of uninsured are paid by
the insured) and premium would decline. The insurance companies dont want
public competition; and the medical community is not excited by the change that
reduces their incomes.
NOW THE PLOT THICKENS:
POLITICAL JUDO: Galbraith saw the necessity of
"countervailing power,"
MODEL B) MODEL
C) HOW A BILL BECOMES A LAW:
Drawing upon the ideas of the
Harvard economist David Cutler,
TWO: What a Texas town can teach us about health
care.
THE INDUSTRIAL REVOLUTIONS: Health Insurance Costs:
WRONG: NOT TRUE - FACT
CHECK
AND IMPORTANT
Meaning of "judo"
A
thought model: FIRST
PRINCIPLES: overtreatment. The Wrong Diagnosis
THE REASON DRUG COMPANIES
SUPORT REFORM: Expect Congress to seriously consider a value-added
tax
A THREE prong attack:
1.)
Medicare Advisory Payment Commission cost control Med Pac
2.) Move from Fee for
service to cooperative service agencies 3.) Competition The exchange
or gateways market
A Message From Warren E.
Buffett, CEO of Berkshire Hathaway Inc.
The Changing Role of the
Hospital The way out of the fix: Investment vs. consumption:
HISTORY
Plan A:
Blue Cross was set up by the AHA (American Hospital
Association) in 1939 and Blue Shield by the AMA (American Medical Association)
to pay medical bills. They all occupied the same neighborhood on the near North
Side of Chicago. Employer based
insurance pay into BC/BS. FICA (wage deductions) paid into Medicare which like
BC/BS paid bills for the elderly. Model A is Fee for service where the more you
do the more you earn. BC/BS was set up
by the providers to pay them not control the cost. Repeal
of Modify the Special Deduction and Special Unearned Premium Rule for Blue
Cross and Blue Shield or Other Qualifying Organizations Page 19
http://www.insuranceusa.com/directorycontent.php?id=Blue_Cross_Blue_Shield
The relationship between insurance as an employment
benefit, subsidized by tax advantages and the fee for service payment system
stems in part from wage controls in WWII where companies competing for scarce
labor would not offer more wages but would provide more benefits. Wages are
taxed and benefits are not. The system is made up of huge numbers of players so
no big payer or big provider can enforce cost controls. Big companies have
employers all over and have to deal with local conditions.
Plan B:
http://en.wikipedia.org/wiki/Kaiser_Permanente
came out of a plan to provide health care to WWII industries where no
facilities were available. It provides the other model of pre-paid (little or
no cost at point of service) system and is MUCH more effective and efficient.
The question has been for the last 50 years how do we go from A to B. MODEL B)
In other industrial countries there is a National
Health Service single payer, or a few big payers by way of state, local and
federal programs and where there is an overall budget. The medical center would
then charge per capita costs to insurance, Medicaid, Medicare and the coop
public program to cover that part of its costs that provided services to the
members of those plans. The critical element is that almost everyone is on salary
plus bonus but still in private practice, with individual organizations,
specialties and services paid by contract budgets. It is not state run care but
private care provided by charity hospitals, city hospitals, collectives, coops,
for-profit hospitals. People and employers pay into
the funds that support the services. The big difference from Model A is they
are paid from a budget not fee for service.
This is the ONLY way to control costs that would
increase due to demographics, and innovation of new treatments where more and
more can be done; the only way to control cost is to move from model A to Model
B.
The current legislation for insurance reform The
Obama plan
Lawmakers also agree on the need to provide federal
subsidies to help make insurance affordable for people with modest incomes. For
poor people, Medicaid eligibility would be expanded. Members of both parties in
both chambers want to create health insurance exchange or gateways, where
people would shop for insurance and compare policies.
Lawmakers also agree on proposals to squeeze hundreds
of billions of dollars out of Medicare by reducing the growth of payments to
hospitals and many other health care providers. They are committed to rewarding
high-quality care, by paying for the value, rather than the volume, of
services.
The most heated points of disagreement concern
employer mandates and the idea of a publicly run health plan. Details of the
major House and Senate bills differ, but most employers would have to provide
insurance or contribute to the cost of coverage for employees, with exceptions
for some small businesses. Democrats also agree that Congress should create
some type of government insurance plan or nonprofit cooperative, which would
compete with private insurers. Mr. Obama says the public plan would keep
insurers honest, but Republicans say it would eventually drive private insurers
from the market, leaving consumers with fewer choices.
A team of researchers recently set out to compare the
quality of VHA care with that of care in a national sample by using a
comprehensive quality-of-care measure.
http://www.hsrd.research.va.gov/publications/citations/abstract.cfm?Identifier=2254
CONCLUSIONS: Patients from the VHA received
higher-quality care according to a broad measure. Differences were greatest in
areas where the VHA has established performance measures and actively monitors
performance.
http://www.nytimes.com/2009/06/14/business/economy/14view.html ?_r=1&ref=health
Its not the profits of the drug companies or the
overhead of the insurance companies that make American health care so
expensive, but the financial incentives for doctors and medical institutions to
recommend more procedures, whether or not they are effective. So far, the
American people have been unwilling to say no.
Drawing upon the ideas of the
Harvard economist David Cutler,
the Obama administration talks of empowering an
independent board of experts to judge the comparative effectiveness of health care
expenditures; the goal is to limit or withdraw Medicare support for ineffective
ones. This idea is long overdue, and the critics who contend that it amounts to
rationing or the government telling you which medical treatments you can
have are missing the point. The motivating idea is the old conservative
chestnut that not every private-sector expenditure
deserves a government subsidy.
Nonetheless, this principle is radical in its
implications and has met with resistance. In particular, Congress has not been
willing to give up its power over what is perhaps the governments single most
important program, nor should we expect such a surrender of power in the
future. There is already a Medicare Advisory Payment Commission, but it isnt
allowed to actually cut costs.
Scholars have been applying comparative-effectiveness
research to Medicare for years, and the verdict is not altogether pretty. It
turns out that some regions spend more on Medicare than others sometimes two
or three times as much, as documented
by the Dartmouth Atlas Project. Yet the higher-spending regions
often fail to produce superior health care results.
Robin Hanson, professor of economics at
If we are willing to take comparative-effectiveness
studies seriously, we would make significant cuts in Medicare costs right now.
We would cut some reimbursement rates, limit coverage for some of the more
speculative treatments, like some forms of knee and back surgery, and place
more limits on end-of-life-care.
Those cuts alone may not solve the fiscal problem, but
if we arent willing to take even limited steps to conserve resources, we
shouldnt be spending any more money elsewhere.
Of course, we have not made such Medicare spending
cuts yet, and there are few signs that we may. A Kaiser Family
Foundation poll found that 67 percent of Americans believe that they
do not receive enough treatment and that only 16 percent believe that they have
received unnecessary care. If the Obama administration covers more people with
government-supplied or government-subsidized insurance, the political support
may broaden for generous benefits, their continuation and, indeed, expansion of
current expenditures.
Suggested ways to lower costs include an emphasis on
preventive care, the use of electronic medical records and increased
competition among insurers. But even if these are likely to improve the quality
of care, they are speculative and uncertain as cost-saving measures. Keep in
mind that while computers were remarkably powerful inventions, it took decades
before they showed up in the statistics as having improved productivity in the
workplace.
One idea embodied in a bill sponsored by Senator Ron Wyden, Democrat of
Oregon, and Senator Robert F. Bennett,
Republican of Utah, is to finance new health care programs by taxing health
insurance benefits. This makes sense in principle: why should
insurance benefits be favored over salary by our tax system? But
employer-supplied insurance is a mainstay of the current health care system,
and there is no adequate replacement immediately in sight.
ITS also hard to convince the American public that
the solution to insufficient health insurance is to tax health insurance. And
such a one-time tax increase would postpone but not eliminate the need to come
to grips with ever-rising Medicare costs.
It sounds harsh to suggest that the Obama
administration cut areas of Medicare spending, but, too often, increased
expenditures and coverage are confused with good health care outcomes. The reality is that our daily environment, our social status and our behavior
including diet
and exercise have more to do with good health than does health care
more narrowly defined.
TWO: What a
by Atul Gawande
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yrail
The explosive trend in American medical costs seems
to have occurred here in an especially intense form. Our countrys health care
is by far the most expensive in the world. In
The question were now frantically grappling with is
how this came to be, and what can be done about it.
The problem is the role of money in medicine in most
countries doctors are on salary or per capita only in
What do we do? Atul doesnt say but implies per
capital payments rather than fee for service which is the CRITICAL issue. It
was in 1965 Medicare when customary and usual was replaced for fair and
reasonable. The public programs (Prepaid MEDICARE AMERICARE, Medicaid, the
public option, of line VA benefits, state and local government employees etc.)
have to offer and ONLY offer per capital fees $3,000, $5,000 per client to a
NETWORK, cooperative, HMO, that provides primary and secondary care. The client
has a choice (in most markets) so there may be competition; client may migrate
to networks that provide good service. Organizations may be motivated to
control costs because it comes out of their pay and profits. 1000 clients at
$5,000 each is 5 million, and networks need 10,000 to be effective and provide
a range of services. (50 million) The network centers on a hospital with a link
to clinics and primary care doctors. The networks may be open to the public and
would be run by insurance companies, for profit hospital, public hospitals,
charities, et al.
Third level care is in another network centered on
research hospitals mostly with medical schools. There would be a pool for
catastrophic care. Doctors in these institutions are professors and on salary
so there is less motivation based on money.
Foreign doctors are shocked by the role of money in
American medicine and the core of the problem. I knew this is the 1950s
as did our family doctor. The joke was Two doctors meet in the hall. I just
had a successful operation what was it for? $5000.00 what did the patient
have? $5000
1750 TO 1870 Steam, coal, Iron and steel, railroads
(industrial barons) foundations of public education industrial one shift
from land to capital as the primary growth model
1870 to 1970 Oil, chemistry (plastics) electrical,
communications, radio, TV automobiles, airplanes, the corporation GM, GE,
DuPont, J.P. Morgan MOST OF CURRENT HEALTH CARE IS INDUSTRIAL TWO as is
education shift to professional management
1970 Information and services IBM, MS, Google,
Oracle, Financial services, smart health care, effective education and welfare
New Age of innovation for the 21st century
LEVELS OF REALITY WELL consciousness..
Page 200 - http://www.wiredbrain.com/documents/ethos/benedict.txt
RE: A.H. Maslow: The Farther Reaches of Human Nature
"Synergy in the Society and Individual"
Ruth Benedict (Patterns of Culture; Race, Science and
Politics) an essay on holism, invented and developed the idea of synergy at
lectures at
Benedict tried to overcome the idea of cultural
equality (not everything is right) and the doctrine of cultural relativity,
what ever works for you is OK by me. Societies she said have a flavor,
character and are not all equally functional.
Some societies are "anxious", surly, nasty, aggressive, and
hateful, this come from insecurity and causes low morale. (
such as the Chuckchee, the Ojibwa, The Dobu, and the Kwakiutl) Other societies were
"nice" people, affectionate, kind, secure and with high morale. ( Zuni, Arapesh, The L(d)eKota, Eskimo ).
The critical element in the concept of synergy is
aggression vs. cooperation. Synergy is where individual benefit and groups welfare are in sink. Farming,
fishing, hunting can product mutual benefits of cooperation vs. Selfish
self-interest (winner/losers) vs. unselfish, altruism (win/win).
Siphoning vs. funneling of wealth, use vs. ownership,
Comforting vs. Frightening Religion, high energy or low energy institutions,
are characteristics of synergy, where are we ? We have
had a out break of win/lose - me and mine - the hell
with the hind most, winner take all, activity. This discourages the losers,
causes aggression, and is socially dysfunctional. A few institutions maintain
high energy but the society is winding down. Synergy is spirit and systems for
successful cooperation, institutional means of using aggression (learning for
conflict), and rewards for all from social success (tide lifts all boats).
PATHOS
HOW DOES IIT MAKE ME FEEL? - TRUE BELIEVERS (dont
bother me with the facts) The southern strategy.. With desegregation anti-bussing Republican
right would mobilize anger to win elections ANTI science (evolution and
climate change) shout out against change because white men are threatened by
uppity blacks, pushy women, the wing-nuts make issues out of prayer in school,
abortion, foreigners, immigrants, gay marriage, socialist, communists, the
daily blast from the past of Rush et al.
Now a shout out from birthers and deathers, anything to
stir up the base. Small government anti-tax people went along for the
ride. False perception is reality seen in a mirror darkly, causing people to
vote against their own interests.
The right has created a nightm
are for itself: He who troubles his own house may inherit wind, and the foolish
may be servant to the wisehearted.
http://bible.cc/proverbs/11-29.htm
The frame is the strict authority figure father..
LOGOS
WHAT IS IN IT FOR ME? A little education is a
dangerous thing when it is dragged a long way from home and simple common
sense the moderates or swing voters see beyond the superstitions and
projections of the wing nuts with normal political/economic self interests
but policy is mostly over their heads because issues are hard and complex
requiring study and work, so who needs it? Trust Obama or say no to your ma-ma.
The frame is the nurturing mother.
ETHOS:
HOW DOES IT MAKE THE
The issue is going from A the current crazy fee for
service to the use of countervailing power of big buyers called Plan C
(current legislation) to get something like every other advanced society has in
a form of Plan B not exactly single payers but majority payers that have
leverage to actually solve many of the problems.
In other words go from A the current out of control
system to B a system with market price controls by way of C changes in the
market to make it a real free market by way of new powerful players.
Galbraith saw the necessity of "countervailing
power," not only including government regulation and oversight, but
also collective bargaining, and the suasion that large retailers and distributors
would bring to bear on large producers and suppliers. (for
example: Sears and car tires, Wal-Mart and
http://en.wikipedia.org/wiki/John_Kenneth_Galbraith#Some_of_Galbraith.27s_Ideas
http://www.nchc.org/facts/cost.shtml
Facts on the Cost of Health Insurance and Health Care
Health care spending continues to rise at a rapid rate
forcing businesses to cut back on health insurance coverage and forcing many
families to cut back on basic necessities such as food and electricity and, in
some cases, shelters and homes.
Experts agree that our health care system is riddled
with inefficiencies, excessive administrative expenses, inflated prices, poor
management and inappropriate care, waste and fraud. These problems increase the cost of medical
care associated with government health programs like Medicare and Medicaid, and
health insurance for employers and workers and affect the security of families.
The reason reform failed under
In Canadian Prepaid AMERICARE, which is single-payer
insurance available to all citizens, doctors may work in private practices or
for public or private hospitals, each of which is in turn paid by government
health insurance. The term single payer
system does not imply a socialized medicine system. President Obama falsely
described the Canadian system in the town hall in
http://en.wikipedia.org/wiki/Single-payer_health_care
The Canada Health Act in terms of regulations. As for
pay being capped, it is not, either here or in the
THE PRESIDENT: Well, let me tell you what happens in
other industrialized countries. First of all, I think it's important for
everybody to understand that Americans spend $5,000 to $6,000 per person more
than any other advanced nation on earth -- $5,000 or $6,000 more than any other
person -- any other country on earth.
Now, if you think that -- how can that be? Well, you
probably don't notice it, because what's happening is if you've got health
insurance through your job, more and more of what would be your salary and
wages is going to health insurance. But you don't notice it; you just notice
that you're not getting a raise. But a bigger and bigger portion of
compensation is going to health care here in the
So clearly we've got a system that isn't as efficient
as it should be because we're not healthier than these people in these other
countries.
WRONG: NOT TRUE - FACT CHECK
AND IMPORTANT In Canada,
the system is known as a "public system" due to its public financing,
but is not a nationalized system such as the UK's NHS; most Medicare services are provided
privately.[5]
Having said that, most other countries
have some form of single-payer system.
There are differences -- Canada and England have more of what's called -- what
people I guess would call a socialized system, in the sense that government
owns the hospitals, directly hires doctors -- but there are a whole bunch of
countries like the Netherlands where what they do is, it's a single-payer
system only in the sense that government pays the bill, but it's all private
folks out there -- private doctors, private facilities. So there are a bunch of different ways of doing it.
Now, what we need to do is come up with a uniquely
American way of providing care. (Applause.) So I'm not
in favor of a Canadian system, I'm not in favor of a British system,
I'm not in a favor of a French system. That's not what Max is working on. Every
one of us, what we've said is, let's find a uniquely American solution because
historically here in the
So all we've said is, in building a better system,
what are the elements? Well, number one, for people like you, you should be
able to get some help going into the private insurance marketplace and buying
health insurance. So we would give you a tax credit, a subsidy of some sort, to
help you obtain insurance.
Now, the problem is, if you're going out there on your
own, then it's much more expensive than if you go in a big group. So we would
allow you to buy into a health care exchange or gateways that would give you
some power to negotiate for a better rate, because you're now part of a big
pool. We would also make sure that if you do have health insurance that you are
protected from some of the policies that we've already talked about that have
not been very good for consumers. So you wouldn't be able to be banned for
preexisting conditions. There would be caps on the amount of out-of-pocket
expenses you would have to spend. So we would reform the insurance market for
people who already have health insurance.
And if we do those things -- making it better for
folks who already have insurance, making it easier for you to buy insurance,
and helping small businesses who want to do the right thing by their employees
but just can't afford it because they're charged very high rates, they can't
get a good deal from the insurance companies -- if we do those things, then we
can preserve the best of what our system offers -- the innovation, the dynamism
-- but also make sure that people aren't as vulnerable. Now, that's essentially
what we're talking about with health care reform.
And so when you start hearing people saying, you know,
we're trying to get socialized medicine and we're trying to have government
bureaucrats meddle in your decision-making between you and your doctor, that's
just not true.
All right? Okay. It's a guy's turn. Gentleman right there in the
back, with the green.
Formalism and strict conduct are typical of
traditional judo.
The word "judo" shares the same root ideogram
as "jujutsu": "jū" (柔?), which may mean "gentleness",
"softness", "suppleness", and even "easy",
depending on its context. Such attempts to translate jū are deceptive, however. The use
of jū in
each of these words is an explicit reference to the martial arts principle of
the "soft method" (柔法, jūhō?). The soft method is
characterized by the indirect application of force to defeat an opponent. More
specifically, it is the principle of using one's opponent's strength against
him and adapting well to changing circumstances. For example, if the attacker
was to push against his opponent he would find his opponent stepping to the
side and allowing his momentum (often with the aid of a foot to trip him up) to throw him forwards (the inverse being true for
pulling.)
In Judo when you made a move and your opponent
responds, instead of being defensive you use your oppositions monument against
them by positive pushing and pulling.
The solution to the crisis in health care cost that is caused by a
dysfunctional delivery system is Medicare for all. Over time the public option becomes the major
if not sole payer. The per family cost would drop by up to 50% from the
Medicare level since the universal pool is much healthier and younger and would
have much better cost controls. The agency, the Centers for Medicare and Medicaid Services,
is the largest buyer of health care in the
The leverage of universal Prepaid MEDICARE AMERICAREs "countervailing power," would change
the system from fee for service to PRE-PAID with little or no cost at the
point of service. Proponents say
bundled, global payments would encourage coordination between physicians,
nurses, hospitals and other providers.
Many proposals for reducing spending focus on chronic
disease because it accounts for 75% of national health spending. Bundled, global payments for chronic diseases is an
important part of potential savings for this reason. In Massachusetts, spending
for people younger than 65 with one of six chronic conditions that are commonly
targeted by disease management programs (asthma, chronic lung disease, heart
disease, heart failure, depression and diabetes) would be 21% of the total in
2010 (Figure 4). Other chronic conditions (such as arthritis) represent a
larger percentage of spending.
The options with the largest estimated savings, such
as payment reform, typically offer a clear and direct mechanism for reducing
spending. Bundled, global payments has been shown to
be effective in prior public and private demonstration projects and would
directly affect the amount paid for health services. Hospital rate setting
would impose statewide controls on the price of hospital services. Other mechanisms for directly controlling health spending, such as
fixed budgets for health care used in other countries, would greatly reduce spending.
Critics, however, say the new model would lead to
unexpected problems. Read more: http://www.quote.com/news/story.action?id=RTT908171608001894
http://www.rttnews.com/Content/TopStories.aspx?Id=1042365&Category=Top%20Stories&SimRec=1&Node=B1
Care would be provided by chains of community health
alliances, co-ops, non-profit and for profit hospitals, modeled after Kaiser
Permanente on a per capital basis based in annual budgets. The cost would be
covered by payroll deductions, taxes and subsidies as it is in all other
developed countries for good reasons. http://www.nytimes.com/2009/08/18/health/policy/18health.html ?scp=9&sq=Centers%20for%20Prepaid
AMERICARE%20and%20Medicaid%20Services&st=cse
The agency, the Centers for
Medicare and Medicaid Services, is the largest buyer of health care
in the
Among those who have been considered for director are Dr. Donald M. Berwick, president of
the Institute for Healthcare Improvement, a nonprofit group in
Cambridge, Mass.; Dr. Glenn D.
Steele Jr., president of the Geisinger Health System, in
Pennsylvania; and Dr. Nicholas J. Wolter,
chief executive of the Billings Clinic in Montana, Three pillars of healthcare
reform.
Employers would offer advantaged plans but everyone
would have the basics. BC/BS (Blue Cross Blue Shield Trade association for the
independent, locally operated mostly for profit Blue Cross and Blue Shield
Plans in the
The door opens for big business MS, Delphi,
SAP, et al; the software to collect and distribute hospital costs by patient,
services, medical group, et al; to bill for treatments in bulk on an annual
budget not fee for service and compare treatments to best practice and fair
and reasonable expenses, cost per year of life saved at what quality of life.
Out patient care and services along with primary care can be included and
advanced care contracted with re-insurance for catastrophic care.
The mom and pop stores were replaced by supermarkets
so 1000s of state insurance companies (mostly affiliated or owned by national
companies) become the major players on the exchange or gateways.
The reason health care in
Model A: There is a large medical shopping center. The
magnet department store is (Hospital) or Obama Memorial Health care Super
Store. All along the mall there are
smaller shops and chains specialty stores general stores, (primary
providers doc in a box in Wal-Mart) other ones dealing in the problems of
individual organs, heart, liver, ears, eyes, nose, digestion, lungs, skin,
bones or specific ailments and disease such as cancer ..
etc.. http://en.wikipedia.org/wiki/Category:Medical_specialties
Over a hundred specialists with many subcategories -
Then there are shops dealing in services tests,
imagines, equipment, pharmacies et al in their hundreds. For example: http://premiermedicalimaging.com/services.cfm
In the super market department store the inventory
(goods on the beds) are patients who receive services; while the customers of
the hospital are the doctors and suppliers not the patients. Since the sick do not pay most of the bills
(after deductibles and co-pays) but are covered by third parties, insurance
industry and individuals both are subject to
exploitation, more C-sections, hysterectomies, and here in lies the core of the
problem. If your car repairs were paid
by third parties, auto shops would find a lot more that needed to be done and
owners wouldnt care because they dont pay directly.
The super health store collects for room and board,
then treatments directed by specialists who are the stores clients. The store acts as billing agent for many of
these services. The patients are billed for pages of individual sales. Most of
the bills are paid by insurance. Of $10000 in bills maybe $7500 is actually
collected, including from the uninsured which by law they have to service. In
order to stay in business the bills are jacked up 25% - 35% so they bill at
125% or $135% of costs to collect something like their actual expenses and
passing much of the money along to the specialists. Private insurance pays full price thereby
paying for those that dont pay, adding billions of cost to the insurance. The
star income producer is surgery and the best paid are surgeons. Many of the small business discussed as
important and not to be taxed by increased rates on incomes above $250 thousand
are doctors and their affiliated business. Much of the luxuries housing over a
million dollars are owned by doctors as are a majority of private small planes.
Medical technology and biomedical research is a vital
engine of growth. However, Europe and
How much does health care cost? $8,000 per capita -
$15,000 pr household - http://www.nytimes.com/2009/07/22/business/economy/22leonhardt.html
The
http://www.harpers.org/archive/2009/06/hbc-90005205
The Crisis in American Medicine. One article notes soaring charges. Another
warns about the volume of utilization of services. And another asks if we can
find a better way [than fee-for-service] for paying for medical care. It
speaks to many of the challenges we face today. The
thing is, this special issue was published by Harpers
Magazine in October of 1960.
Milton Freeman: If you tax something you get less of
it, if you subside something you get more of it. People go into real estate,
condos, because of tax advantages so there is a boom and bust. More is done than a free market would
provide. The same for health benefits where the tax advantage distorts the
market. You get less of wages, savings, and long term economic growth.
1. People respond to incentives.
2. Demand is elastic, and there are substitutes for everything.
3. If you tax something, you get less of it.
Or to paraphrase Thomas Sowell, this story suggests
that "The first lesson of economics is that people respond to incentives.
The first lesson of politics is to ignore the first lesson of
economics." http://www.hoover.org/publications/digest/3459466.html
Employer financing of medical care has caused the term
insurance to acquire a rather different meaning in medicine than in most other
contexts. We generally rely on insurance to protect us against events that are
highly unlikely to occur but that involve large losses if they do occurmajor
catastrophes, not minor, regularly recurring expenses. We insure our houses
against loss from fire, not against the cost of having to cut the lawn. We
insure our cars against liability to others or major damage, not against having
to pay for gasoline. Yet in medicine, it has become common to rely on insurance
to pay for regular medical examinations and often for prescriptions.
The data document a drastic decline in output over the
past half century. From 1946 to 1996, the number of beds per 1,000 populations
fell by more than 60 percent; the fraction of beds occupied, by more than 20
percent. In sharp contrast, input skyrocketed. Hospital personnel per occupied
bed multiplied ninefold, and cost per patient day,
adjusted for inflation, an astounding fortyfold, from $30 in 1946 to $1,200 in
1996. A major engine of these changes was the enactment of Medicare and
Medicaid in 1965. A mild rise in input was turned into a meteoric rise; a mild
fall in output, into a rapid decline. Hospital days per person per year were
cut by two-thirds, from three days in 1946 to an average of less than a day by
1996. end of quote
Something is going to happen, though. That much is
certain. And it probably may be similar to the approach set forth in a white
paper this November by Montana Senator Max Baucus, who is chairman of the
Senate Committee on Finance. The plan borrows ideas from (among many others)
Hillary Clinton, (then thought to be) incoming Secretary of Health and Human
Services Tom Daschle, and Obama himself. The details are vague, but the outline
is clear. It achieves universal coverage by requiring Americans who do not
already receive health benefits to purchase insurance from a private company. has called for the mandate to be universal. In turn, most employers would be required
either to provide benefits to all of their employees or to pay into a fund that
would be used to subsidize the purchase of private insurance by those who would
not afford to pay for it themselves.. http://www.harpers.org/archive/2009/02/0082380
In Overtreated, Shannon Brownlee argues that the major
problem of health care in the
This sounds counterintuitive until you think about the
fact that practically any medical treatment you can name poses some risk. For
instance, doctors regularly test prostate-specific antigen levels in men to see
if they have early signs of prostate cancer. As Maggie Mahar,
the author of Money-Driven Medicine, explained it to me, this sounds like due
diligence, but in fact the National Cancer Institute does not recommend routine
PSA testing, because the majority of older men diagnosed with this slow-growing
cancer may die of something else before they experience any overt symptoms,
whereas if they are treated for prostate cancer, many may experience such side
effects as erectile dysfunction, incontinence, and sometimes even death. When
I was at a conference in
Dr. Andrew Weil Founder and director of the
Posted: August 9, 2009 11:00 PM
But what's missing, tragically, is a diagnosis of the real, far more
fundamental problem, which is that what's even worse than its stratospheric
cost is the fact that American health care doesn't fulfill its prime directive
-- it does not help people become or stay healthy. It's not a health care
system at all; it's a disease management system, and making the current system
cheaper and more accessible may just spread the dysfunction more broadly.
http://www.huffingtonpost.com/andrew-weil-md/the-wrong-diagnosis_b_254227.html
An Artificial
pacemaker costs half as much in Europe than in the
http://www.thaivisa.com/forum/Price-Pacemaker-t77787.html
ACUTE CARE:
there is a curve with acute care where the advantages increase to a
point then they level off and more therapy becomes negative. In the Civil war the wounded mostly died
by World War I Nightingale and Lister give casualties had a 50/50 chance that
required veteran hospital and homes. In WW II the ratio saved increases with
antibiotics and MASH now with air medi-vac and good services 90 % survive. In
decreasing civilian early deaths the big breaks have been vaccinations, clean
water, drugs, better housing and diet. Acute care has not shown much effect on
longevity or disability over the last decades because its on the down slope of
doing too much. Many people are saved by treatments but greater opposite
numbers are harmed, now given
Hospital-acquired infections.
THE REASON DRUG COMPANIES SUPORT
REFORM:
When we move to a benefit/cost analysis drugs do a
much better job than surgery. All the
standard heart operations are no more effective and a lot more expensive than
drugs. Also 40 million more clients from the under insured is attractive and
drug prices are not a force increasing costs but a cost control. The hospitals and doctors are fed up with
paperwork drowning them and look to reform to add to their future.
On health care,
The private market model does not represent
(everything) how the American economy has worked throughout our history. The
following examples of failed markets that have been improved by both private
and public cooperation illustrate this economic history. http://www.sanmarcosmercury.com/archives/9477
How to get from A to B by way of C
http://www.nytimes.com/2005/03/13/magazine/13HEALTH.html
In that video,
the president was quoted as saying, "I don't think we're going to be able
to eliminate employer coverage immediately. There's going to be, potentially,
some transition process: I can envision a decade out, or 15 years out, or 20
years out."
That quote, from a 2007 appearance before the Service
Employees International Union, certainly seemed to indicate that Obama lusted
after the ability to put private insurers out of business. And virtually all
economists agree that the effect of the "public option" would be to
cause private health insurance to eventually lose out in a rigged market.
http://blog.nj.com/njv_paul_mulshine/2009/08/obama_need_to_change_spin_doct.html
The President has laid out a mission impossible. It is
not possible to control costs (the real crisis) and expand coverage to the
uninsured (a social necessity) and reform Prepaid MEDICARE AMERICARE, Medicaid,
and private insurance without going from
A to B America must move to where the Hospital super store has an annual
budget and puts all the specialist on salary and/or bonuses. The other specialty shops in body parts or
services are sub-contractors. The super store buys re-insurance for third level
catastrophic services from research hospitals in medical schools. The money
comes from a FICA like charge on workers, partly paid by their employers or
with subsides from the government which also covers those disabled, unemployed,
seniors etc. that cant pay. People can
select from a few super providers and/or pay for insurance and services outside
the system.
Why do I know what may happen and you dont?
The way from A to B via C
The door opens for big business MS, Delphi,
SAP, et al; the software to collect and distribute hospital costs by patient, services,
medical group, et al; to bill for treatments in bulk on an annual budget not
fee for service and compare treatments to best practice and fair and
reasonable expenses, cost per year of life saved at what quality of life. Out
patient care and services along with primary care can be included and advanced
care contracted with re-insurance for catastrophic care. Accountable Care
Organizations "countervailing power,"
http://www.nytimes.com/2009/08/09/opinion/09sun1.html
What
Now the state seems poised to tackle costs with an
approach that is far more ambitious than anything currently being contemplated
on Capitol Hill.
A special commission has just recommended that the
state try, within five years, to move its entire health care system away from
reliance on fee-for-service medicine, in which doctors are paid more for each
additional test or procedure they provide.
In its place, the commission wants a system in which
groups of doctors and hospitals would receive fixed sums to deliver whatever care
a patient needed over the course of a year. The hope is that doctors would be
motivated to deliver only the most appropriate care, not needless and
excessively costly care, with safeguards to ensure that they do not skimp on
quality.
In
Roger Altman former United States Deputy Treasury
Secretary;
We'll Need to Raise Taxes Soon
Expect
Congress to seriously consider a value-added tax
http://online.wsj.com/article/SB124631646572370703.html
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/26/AR2009052602909.html
Once Considered Unthinkable,
Levy Viewed as Way to Reduce Deficits, Fund Health
Reform
1.) Medicare Advisory Payment Commission cost control Med Pac
http://www.google.com/search?q=accountable+care+organizations.&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a
Creating Accountable Care Organizations: The Extended Hospital
...
2.) Move from Fee for service to cooperative service
agencies
HMO, PPP, per capital budgets, Doc in a Box
for primary care, hospital based secondary plans, catastrophic re-insurance and
research medical schools advanced care.
3.) Competition The exchange or gateways market
they said any
legislation that emerges from the talks is expected to provide for a nonprofit
cooperative to sell insurance in competition with private industry, and/or
giving the federal government a role in the marketplace.
Obama
and numerous Democrats in Congress have called for a government option to
provide competition to private companies and hold down costs, and the House
bill includes one
The
President argued that his proposals would cut hundreds of billions of dollars
in unnecessary spending and change incentives so health providers may give
patients the best care, not just the most expensive care. In fact, a study
last year by an influential health policy research group, the Commonwealth
Fund, found that the
http://www.nytimes.com/2009/06/14/business/economy/14view.html
As we get down into the details of health reform it
becomes clear that there has to be major tax reform at the same time.
There are two primary functions of taxes: first, support of public goods, those
common functions that cant be paid for by individuals but are by nature
collective, defense, quality control of food and drugs, regulation, the money
supply, et al. Some public goods can charge fees such as parks and universities
but there must be arrangements for means testing. These public goods need to be
funded by a VAT, national sales tax so everyone who benefits pays something.
The fair tax is too complex but a national VAT of 10% plus a state and local
tax of 6% gives a 16% VAT well in line with other industrial countries. It may
make exports more competitive since VAT is refunded on exports. It is a big
difference see Sen. Lugers arguments.
http://www.wiredbrain.com/salestax.htm
Google: reform site:www.wiredbrain.com
The second function are entitlements, individual
benefits, the social contract that protects people form personal disasters and
provides retirement, unemployment, disability, which is call the safety
net. At the end of the 19th century Otto Von Bismarck and the social
democrats agreed on the basic social protection, the conservatives to out flank
the socialist and communist, and the democrats to share in power.
These functions need to be paid by individuals to
benefit other individuals or a income transfer to
provide for more equality and social stability. The people who get benefits
support them; middle class support them for human reasons, and part of the
enlightened rich to protect their privileges against populist rabble rousers
demigods has been a basic fault in democracy since ancient
The key element in health care reform is the delivery
system There has to be a switch from fee for practice to per capita base
payments with re-insurance of catastrophic claims. The Nixon plans of regional
planning and HMOs was cut to pieces by everyone wanting everything. As in
welfare reform the 10 federal regional councils were given the job of
coordination and making wavers. There was an attempt to shift power from DC
to regional commissioners who were part of the Whitehouse staff. (Fred Malek http://en.wikipedia.org/wiki/Fred_Malek
) With welfare reform the councils were used to manage change. Executive
Order 11647: Federal Regional Councils
Since this is a big FEDERAL republic the health
delivery system may be hard to change. Thousands of small businesses,
hospitals, clinics, labs, drug companies, et al the regional councils with wide
waver powers over Prepaid MEDICARE AMERICARE, Medicaid, Co-ops, PPP,
HMOs, and the new open public option, may bribe states to act, and force
marginal changes by nagging Nudging the market to promote the
collective practice of medicine such as Kaiser Permanente, Mayo, et al
The Bush administration has shelved a report
commissioned by the Treasury that shows the
The study asserts that sharp tax increases, massive
spending cuts or a painful mix of both are unavoidable if the
The study was being circulated as an independent
working paper among Washington think-tanks as President George W. Bush on
Wednesday signed into law a 10-year, $350bn tax-cut package he welcomed as
a victory for hard-working Americans and the economy.
The analysis was spearheaded by Kent Smetters, then-Treasury deputy assistant secretary for
economic policy, and Jagdessh Gokhale,
then a consultant to the Treasury. Mr. Gokhale, now
an economist for the Cleveland Federal Reserve, said: "When we were
conducting the study, my impression was that it was slated to appear [in the
Budget]. At some point, the momentum builds and you think everything is a go,
and then the decision came down that we weren't part of the prospective budget."
Mr. O'Neill, who was fired last December, refused to
comment.
The study's analysis of future deficits dwarfs
previous estimates of the financial challenge facing
http://www.berkshirehathaway.com/2004ar/2004ar.pdf
A Message From Warren E. Buffett, CEO of Berkshire
Hathaway Inc.
A budget deficit in no way reduces the portion of the
national pie that goes to Americans. As long as other countries and their
citizens have no net ownership of the
As a rich family awash in goods, Americans may argue
through their legislators as to how government should redistribute the national
output that is who pays taxes and who receives governmental benefits. If
entitlement promises from an earlier day have to be reexamined, family
members may angrily debate among themselves as to who feels the pain. Maybe
taxes may go up; maybe promises may be modified; maybe more internal debt may
be issued. But when the fight is finished, all of the familys huge pie remains
available for its members, however it is divided. No slice must be sent abroad.
Large and persisting current account deficits produce
an entirely different result. As time passes, and as claims against us grow, we
own less and less of what we produce. In effect, the rest of the world enjoys
an ever-growing royalty on American output. Here, we are like a family that
consistently overspends its income. As time passes, the family finds that it is
working more and more for the finance company and less for itself.
Should we continue to run current account deficits
comparable to those now prevailing, the net ownership of the
This annual royalty paid the world which would not
disappear unless the
Many prominent
In the article I wrote for Fortune 16 months ago, I
warned that a gently declining dollar would not provide the answer. And so
far it hasnt. Yet policymakers continue to hope for a soft landing,
meanwhile counseling other countries to stimulate (read inflate) their
economies and Americans to save more. In my view these admonitions miss the
mark: There are deep-rooted structural problems that may cause
Proponents of the trade status quo are fond of quoting
Adam Smith: What is prudence in the conduct of every family can scarce be
folly in that of a great kingdom. If a foreign country can supply us with a
commodity cheaper than we ourselves can make it, better buy it of them with
some part of the produce of our own industry, employed in a way in which we
have some advantage.
I agree. Note, however, that Mr. Smiths statement
refers to trade of product for product, not of wealth for product as our
country is doing to the tune of $.6 trillion annually. Moreover, I am sure that
he would never have suggested that prudence consisted of his family selling
off part of its farm every day http://www.berkshirehathaway.com/letters/growing.pdf
Choice about Price and quality in Health care:
A simple principle to rule a complex system:
Consumer choice in a free market works through
competition works a lot better than regulation or publicly provided
services. Current health insurance programs are anything but clear on
consumer choice - doctors select services for patients paid for by third
parties.
A set of choices for insurance, tax advantaged saving,
retirement would be offered to individuals and families such as they are to
federal employees - efficient network services would provide more for less and
be competitive relative to fee-for-practice systems. Low income people
would require subsidies, higher income tax advantages. In order to pay for tax
credits and income subsidies there needs to be tax reform - which is an
economic good it itself.
The total cost of health care would go down while the
quality may go up under free market conditions. Everyone would be covered
for basic services within the 1.4 trillion health budget. There is 25% paperwork
waste and 25% unnecessary over treatment so a
improvement of 50% of 50% is a lot.
The core idea of a free market is a set of accounts
kept for individuals and families by financial institutions. Payroll
deductions, employer contributions and subsidies would be reported in each
account for each person's Social Security, Health Insurance, retirement funds, educational and other tax advantaged or
supported activities. People can spend these funds from these accounts on
the purposes intended with any approved provider. If they want more they
can pay for more. If they just want basic coverage they have choices of
fee-for-service bill paying insurance or provider networks paid on a per capita
basis. They see where the money comes from and where it goes.
GSO (government sponsored organizations such as fanny mae) would help finance some
medical networks but they would be run under contract by professionals. I would
see a few dozen or less national General Health organizations with
economies of scale competing for quality services at a fair price. Each market
should have more than three - not quite an HMO, not quite a Mayo Clinic, but
creative providers of complex care with many sub-contracts and services under a
single management information system. Expensive In-patient care and emergency
room care would become a minor part of the system and hospital space greatly
reduced even with an aging population and increased types of care.
General Health Inc, American Health Corp., National
Health Services, Inc., Continual Health etc. would be formed under the National
Health Services delivery act as an amendment to the Public Health
legislations. States or groups of states would form Health Delivery
Boards with are like public service commissions to promote free markets.
What prevents a open market
in health care?
Providers must negotiate with employers; unions rather
than sell to individuals and get paid from a complex set of funds. If
individuals can select from a handful of National Organizations the whole
playing field would change over time. Big buyers would be a counter force to
big providers.
http://www.healthfutures.net/pdf/w-ushcs.pdf
The Changing Role of the
Hospital
As treatment advances divert large numbers of patients
from the inpatient hospital setting, and as life-support and maintenance
technologies enable patients to carry on their lives away from hospitals and
nursing homes, the hospitalized population may shrink to perhaps half its
current size by the early part of the next century, despite an aging
population. Even though hospital costs have continued to increase, per capita
inpatient hospital use in the
2. Some metropolitan areas such as San Diego and
Portland, Ore (despite large elderly populations), have inpatient use rates
almost a third lower than the 1985 US average, and are continuing to decline in
per capita use
3. These communities present compelling evidence of
further potential for contraction of inpatient use nationally.
The hospital of the future may be transformed into the
critical care hub of a dispersed network
of smaller clinical facilities, physician offices, and
remote care sites that may stretch out as far as 200 miles (320 km) from the
core facility, connected by air and ground critical care transport and
integrated by clinical information and patient monitoring systems.
Health and Taxes:
The political rhetoric and practical programs dont
meet up. The big goals of universal health care must involve tax reform.
The two are connected in ways that cannot be separated and both face a
demographic crisis of retirement income. Neither the health delivery
system nor the social security system can be fixed without fundamental tax
reform based on a VAT.
Be brave it can be done first some simple
principles:
FIRST: Health care has to be a market (not state
provided) and public benefits should not replace private insurance shifting
private programs to public programs. Politicians should not be setting benefits
or fees for reason that is all too obvious.
The issue is the quality of the market. Let the market
get the delivery system right not by regulation but by being more efficient.
The market doesnt work now because people dont know what is paid and what
they get. The consumer is the doctor while the patient is the material to be
worked on but have few or no choices. Disclosure is critical to free markets.
There is up to 40% waste in the system paperwork and over treatment so really
efficient providers should really be able to compete. The market can work the
model used is the public employee benefit plans. Everyone cannot have
everything there is no Santa Claus.
SECOND: The package of benefits insurance, health
care, unemployment, disability, savings, retirement should be provided as a
regular report to the individual or family with the payments from wages,
employers, and public accounts along with expenditures on or into savings
accounts, (IRA, 401K) paying for health insurance, and payments into social
security. The consumer needs to know what is paid and what is received. That
people dont know what they pay, what is an employment
benefit, and how expensive the whole package is makes them poor
consumers. The person needs to select what policy they want (not the government
or the company).
Third the responsibility of the state for low-income
people is limited to basic packages people who have more pay more and get
more. Grow up thats the way it is, has been and always may be. It is the
only way markets work.
OK if we accept market principles and individual
informed choice and differences based on interest and ability to pay.
Now the federal program have
to pay subsidies to low income people and get taxes from high-income people
it is called income transfer but only for basic safety nets. Now how to put
together a package were there are lots more winners and few losers. Here is
where the VAT comes in
With a VAT (about 15% federal plus 5% state) is a hard
sell - but if the top income tax would be 25% or so, corporate taxes 10% low
capital gains, (very good economics is to limit the amount of unnecessary
messing with markets by tax policy or regulation) most people end up not paying
income taxes at all (no loopholes) and the budget in balance. (The idea of real
reserves to use in bad times and add to in good times has made sense since
ancient
Entitlements and tax reform:
For years I have argued that the tax and benefit
system are part of a whole collect money and distribute benefits. There
has to be a fair Tax VAT to support a modern social contract. Each house hold
would be ranked by their position on the income stream. Those above median
income pay in starting at a small percentage which increases (1/2 % each
addition 1% above the median) until the top incomes pay 25% .
All benefits retirement, health, unemployment, are accounts with minimum
benefits and a choice to add more to get more. Those under median income get
support of ½% for each percent they are under until at bottom they pay nothing.
The 45th percentile get a support of 2.5 % ; at 10 % get support of 20% and
those at 55% pay 2.5 % -
Health care may pay a basic per capita fee to a coop,
HMO, collective practice of medicine say $3000 Those at the top pat 100%
and at the bottom 25% $750
http://www.wiredbrain.com/reform.htm
http://www.wiredbrain.com/bigissues.htm
Nixon administration
Malek served in the Nixon administration in several
different roles, including Deputy Under Secretary of Department of Health, Education, and
Welfare under Secretary Robert Finch,
as special assistant from 1970-73 and deputy director of Nixon's re-election
campaign. [2]
As an efficiency expert to Nixon, Malek
helped restructure Nixon's staff and officials and streamline the bureaucracy.[3]
In his memoirs, Nixon described Malek as a
"tough young businessman whose specialty was organization and
management."[4]
Malek was sworn in as Deputy Director of the Office of
Management and Budget on February 2, 1973 and served until 1975 when he
resigned to re-enter the private sector.
Social security and medical insurance reform depend on
the tax and payroll system. This does not make it more difficult but actually easier.
It does require a paradigm shift. The basic issue is to promote savings
and investments, to help and require people buy insurance for life's risk,
health, retirement, disability, unemployment, and big one time expenditures
such as education, home buying or other needs. People should be encouraged to
have reserves and build wealth.
Since there are transfer payments from those with more
to those with less the benefits should compensate those better off through the
tax system. Tax credits and having payments into health and retirement plans be
pre-tax (come off adjusted gross income) is very important for political as
well as economic reasons. There has to be a meaningful income tax rate or 20%
or so. Most of the money to pay benefits to those who contribute less than
their true cost has to come from a VAT or sales tax. Since the less well off
pay a higher rate of sales taxes (higher proportion of their income goes into
consumption) it then becomes fairer that they receive more subsidies to pay for
those benefits.
The paradigm shift is to see payroll deductions as
partly paid by the individual (includes the employer contribution) and partly
subsided for low income or supported by credits for better income people. For
higher incomes there are tax advantages for low incomes direct payments from
entitlement funds. All accounts are private accounts but managed by licensed
providers. For retirement and health funds there is a minimum contribution
(about 15% of total wages) if this is is still less
than required for the basic plans an addition amount is paid in by earned
income tax credits or negative income tax. Those that have more can buy better
plans and pay for it with pre tax income.
There is no large bureaucracy but freedom of choice.
All health, retirement, disability insurance, unemployment, and retirement,
educational, home buying, savings are pre tax and their returns are tax free.
Plan are approved and supervised but private such
as on the federal employees system. People under 40 have their current value in
social security available for transfer to personal accounts at the choice of
the individual. People just entering the labor force only have personal
accounts. Medicaid can't be included but Medicare would with a credit of
several thousand dollars into private plans to be replaced over time by saving
in the health plans of younger workers. Additional benefits require additional
costs. One can hope that real competition can increase efficiency. American
medical delivery system need long term reform to become a healthily systems of
network providers working on a per capita basis rather than the more services
the more fees paid by a third party that can't control the purchases or
prices.
As people and households we know the difference
between investments and consumption. Most business knows the difference but
World Com charges expenses as capital to fudge the books. In the public sector
there are investments that have a return a ROI a return on investments. Infrastructure
(transportation, communications, institution building, education, public
health, science and technology) make the economy more efficient and raise
incomes and welfare. Consumption of military equipment, money used by
beneficiates to consume, subsidies that are likely negative (making distortion
in the effective allocation of resources) tax breaks that encourage less than
optional investment decisions do not add to future welfare but do gather votes
and political money. When we spend billions producing .70 cents cotton, or
peanuts, or sugar when the world market is less than ½ that consumers have less
real income in buying goods at higher prices so able to buy less than
otherwise.
Entitlements are income transfers. Workers pay FICA
taxes (larger than they know because employer contributions are hidden) that
goes into checks for beneficiary recipients. Workers can buy less while people
getting checks can buy more. The economic effects have a small effect in
discoursing work and saving increasing debt and consumption. The fundamentals
of government economic policy should be to encourage work and saving. VAT or
sales taxes encourage investment over consumption if saving are tax advantaged
while consumer prices are higher.
The 19th and 20th century economic problem was
the business cycle. Free market economies suffer from irrational exuberance
based on greed during booms and virtuous cycles, and excessive fear during the
following busts preventing investments and creating an evil cycle of lay off,
disinvestment and hopelessness. We have more to fear than fear itself. So,
first of all, let me assert my firm belief that the only thing we have to fear
is fear itselfnameless, unreasoning, unjustified terror which paralyzes needed
efforts to convert retreat into advance. http://historymatters.gmu.edu/d/5057/
read the whole speech.
Marx called this the surplus product not in the
sense we are too rich but only that the market produces more than can be
consumed by effective demand. By producing income and consumption by paying
people to produce goods that do not enter the market or income transfer sucks
up the surplus. War generates a lot of income but no goods on the market.
Benefits create buyers that dont produce anything. It is not clear that a
global service economy has quite the same level of over production, boom and
bust.
Real reserves would provide pump priming without the
hangover of debt. A revenue and fiscal system based on investment and limiting
the damage done by income transfers (from the productive to the retired and
unproductive) would solve the business cycle issue. The Federal Reserve and
treasury would increase demand in down times (beyond interest rate effects) by
increasing investments (using reserves to build roads, schools, new
technologies, utilities and labor intensive projects in parks, public works,
low interest bonds to rebuild the electric grid, more efficient power plants
etc.) In booms increasing consumption taxes and collecting on construction
bonds, replace reserves and cool over heating.
By making payroll (and other income) taxes go mainly
into transfers which are a form of insurance. Health insurance, retirement is
saving, education saving, house buying, are subsided for the bottom half and
paid for by the top half.
Really powerful "capitalist" understand the
need to "rationalize" the market. From Rockefeller, J.P. Morgan with
GE and US steel, Dupont and Slone with GM, Bill Gates
to OPEC and the seven sisters create a system of cartels to control prices and
supplies so that "cut throat" price competition drive profits down to
a low average return. (in cotton, beer, cigarettes,
peanuts, sugar etc.) Global economics makes this more difficult so capital
formation is slowed unless public managed investments pick up some of the slack
as in
Solving the social security problem:
And the health insurance and taxing issues a set of
simple solutions to complex problems. If the population changes and there are
fewer workers and more people drawing retirement and health benefits the
percentage of GDP going to transfer payments may have to increase there are
fewer paying in and more taking out. Transfer payments have to include some
element of redistribution some pay more than they get out and some get more
out than they contribute. There is no way out of these hard facts. God so
loved the poor he made a lot of them and giving benefits to the rich is a bit
distasteful.
The issue is to increase freedom and choice, to run
the system with efficiency and fairness, and to maintain a large majority
support for social security The Social Security Act, SSA includes retirement,
Prepaid MEDICARE AMERICARE, Medicaid, disability, survivor protection, unemployment,
welfare, with the idea of a social safety net first set up by Bismarck in the
1890s to cut off the growing socialist, in American by the new deal, England
after WWII with the NHS, and now in all modern nations.
There are five elements in a system for the 21st
century.
1.) The payroll deduction system
2.) Choice of extra tax advantaged saving,
insurance, education, health plans
3.) Income and VAT taxes
4.) Redistribution credits
5.) Individual plans and management
systems
The federal pay stub shows all the deductions as do
many state and private pay systems. The FICA shows only the employee
contribution which is just a slide of hand to hide the true cost. The employer
contribution is just as much part of the cost of labor as cash. Health and
retirement plays do not reflect in taxable income or part of the total
employment compensation package and is income in every sense.
Fairness in wages would require (over time) that
everything going in and coming out is regularly reported.
1.) Then the employee or individual can
add to parts of their plan more and better retirement, savings, health,
educational savings, etc. The more they pay the more they get. The choices are
on a menu for the buyer not the employer.
2.) The state and federal government
provide a basic set of benefits retirement and health plans. Beyond these
basics it subsidies add on a diminishing scale. Low income people are
encouraged to have saving with incentives, credits, and subsidies.
The income tax is reduced and made very simple. People
below the 50th percentiles (median) do not pay income taxes but have means
tested earned income benefits to pay part of health care and private retirement
accounts.
3.) If the top rate of Income Tax is 20%
for the 99% percentile (top 1% of all incomes) it is reduced by ½% by each
group until the 50% goes to 0. By setting the tax as percentile it adjusts for
inflation and by setting the top rate and the revenue required the math is
quite simple. It is like setting local property rates to balance revenue
and expenses.
4.) The broad base of needed revenue has
to be raised by a VAT sales tax so the whole system floats for ever.
The tax credits and benefits for health and savings equalizes the issue of low
income people paying more of their income in VAT so the net effect is positive
for low income and does require a fair contribution from those better off.
5.) The management of the individual accounts would be
by contracts in social security the current system becomes a basic plan with
subsidies for the poor especially for health insurance and tax advantages for
the rich who pay more and get more. More can be added into a variety of
retirement options and saving plans.
Financial Times Current projections over future
years is 44.2 trillion debt in current dollars if current benefits are to
be paid to the next generation (unfunded liabilities) - interest costs
alone would be greater than current total budget of 2 trillion -
clearly a banana republic - clearly forces high interest rates - but the scheme
is to "starve the beast" forcing big cuts in benefits - see
http://www.wiredbrain.net/reserves.htm
http://www.wiredbrain.net/politicaleconomics.htm
http://www.wiredbrain.net/reform.htm
An administration official said the study was designed
as a thought-piece for internal discussion - one among many left every year on
the cutting-room floor - and noted the budget's extensive discussion of
projected, 75-year Social Security and Medicare shortfalls.
The study's analysis of future deficits dwarfs
previous estimates of the financial challenge facing
http://news.bbc.co.uk/2/hi/business/2946552.stm
How to get out of this mess?
In a series of telephone interviews yesterday, White
House Office of Management and Budget Director Mitchell E. Daniels Jr. said the
deficits for 2003 and 2004 would approach 3 percent of the economy, or more
than $300 billion a year. That would surpass the 1992 record deficit of $290
billion, even before the cost of a possible war with
http://www.washingtonpost.com/wp-dyn/articles/A57024-2003Jan28.html
The republicans want lower taxes, smaller more
effective government, and more freedom and open markets. So should everyone in
his or her right mind. But the strategy of starving the central government with
debt is plain stupid and harmful. There is another way
decentralization.
The OMB under Nixon developed federal regional
councils and passed program approval powers to local commissioners appointed by
the white house. They bypassed the liberal control of the
In some of the proposed regions they would come up
with lower cost, higher quality health delivery systems without much trouble.
The idea is simple you have to get away from fee for service and toward a per
capital (HMO) system. You can do this my letting the market work not by
politicians or regulators or insurance companies make decisions on who gets
what and who pays what. Everyone should be able to open a page as see his or
her health options just like federal employees and get what they are maying and able to pay for.
The employer, the Prepaid MEDICARE AMERICARE, the
Medicaid, unemployment insurance whatever contributes so many dollars and for
that they can buy plans from the A list at low cost (or in the case of Medicare
or Medicaid no cost). Plans on the B list cost more per person per month
and so up the scale. All plans are paid per person so fee for service plans
may cost a lot more under a really competitive free market (quantity and
quality determined by the market and evidence based IT not by regulation) so
if people want to go to any doctor, not pay for any service, have free (to
them) drugs, glasses, teeth, have any test any doctor wants, undergo any
treatment or service, it may cost a lot more. If they take the free or low cost
plan they have to accept they may go to company doctors, share hospital rooms,
get those services that the doctors believe to be necessary and cost effective,
so be very limited in benefits
Low cost medicine is just as good in outcomes in fact
better than expensive medicine less medicine is good medicine the risk of
over, unnecessary treatments are far greater than the risk of under or no
treatment, is not what people believe or want but true
A strange idea is that (after a mimimum
point) you get less heath when you pay for more medicine.
http://www.washingtonpost.com/wp-dyn/articles/A57024-2003Jan28.html
Let's think of some real governmental reform:
The first federal government:
The American governmental plan that was framed in the
Constitution was a federal idea where there would be a "weak" central
authority limited to maintaining a common market, assure domestic security from
rebellions, and keep independence from Foreign
intervention. We needed a Navy, customs, treasury, foreign affairs (State Dept)
and a framework for interstate arrangements negotiated by the states
represented by the Senate (then appointed by the state legislatures) the
people, more equably represented in the house and a chief executive reflecting
a national interest.
In the written constitutional structure most
public activity was to take place in the states - health, education, welfare,
transportation, law enforcement and public order would be maintained with the
local militia, which has become the National Guard and reserves. This was the
concept but the first Government but has been overwhelmed by the second,
third and fourth governments.
The second government is the standing military
something the founding fathers tried to avoid. The framework broke down
over the issue of slavery. The grand army of the republic was necessary to
preserve the union. Internal taxes are required to pay for a huge
military. The military industrial complex has become a large and powerful
global second government. With bases in most countries around the world,
diplomatic relationships, connections with industry, labor than reach into
every part of the country.
The Third federal government: regulation
The framework was not designed for a continual nation
of fifty states and 300 million people. Modern economics required a railroad
building program, Colleges of Agriculture and Mechanical arts, (A&M land
grant colleges) labor laws, food and drug administration, federal reserve,
Securities and Exchange or gateways Commission and dozens of regulations making
a third government of semi-independent agencies.
The fourth federal government: the money and
lobby power
In World War I and II central planning required a high
level of industrial structure - energy, transportation, material resources,
production that make trade associations the foundation of a
"fourth" government of interest group representatives - 1000's of
trade groups, lobbyists, and political finance. The fourth estates - or media -
are entangled into the special interest politics and campaign management.
The reform agenda must try to reorganize federal
government with the original intent but structured for the 21st century.
Smaller, faster, smarter - doing only what must be done from the center - modern
management ideology is decentralized, task orientated, and held to high quality
and performance standards enforced by active and powerful competition.
How?
Regional governments
Divide the nation into ten regional governments of
about 30 million people. (Something like the existing
federal regional councils) the Regional
They can develop local taxes and become more
independent of the center. The regional plans would still have to pass congress
but there would be an agreement that if the regional councils pass something
the federal congress should go along with the may of the people on the ground.
The budgets would be required to be balanced.
http://www.wiredbrain.net/reserves.htm
Only a national constitutional convention would change
basic structure to create strong intermediate structures between the states and
the federal government. Fifty states are too many and most are too small while
one big central government is not working.
In other modern industrial countries they have universal
health care, (at half the cost) quality education through university, good
public transportation, better land use planning and environmental protections,
in short a more civilized organized society. Most of these services are
provided locally with general rules set at the center or by multilateral
organizations such as the European Union. Our government is a mess because it
is over centralized, and because the second government (military) is so
powerful, the third government (regulation) so influenced by the fourth
government of special interests. Ten regional governments would be more focused
on results and less subject to these forces.
The military needs to be reduced to just a navy (with
Marines and Airpower) which is about ½ of the current structure. The bulk of
Army land forces (not special forces that would be merged with the Marines and
Seals) traditional heavy units should be returned to the reserves and National
Guard in the unlikely case we need a large land army with tanks and cannon. (Repositioned
stocks around the world)
The Navy and marines are closer to being an integrated
strike force under the idea of advanced Warfighting
capacities. (Transformation to IT command and control of smart weapons used by
flexible and smart people on the spot, observe, analyze, and target in one real
time motion, with the right resources, training and structure: being faster,
more mobile, more deadly and more creative than the other side thereby messing
up his mind and plans, just like football) we would
save a bunch of money for tax cuts real tax cuts from real reductions in the
size and real improvements in the performance of government.
While the third government of regulation must remain a
common market function the implementation would be more local and sensitive to
local conditions.
The special interests and money politics would be
weaken by not controlled by decentralization. Democratic reforms of initiative
and even proportional representation might help.
Key word
"infrastructure" http://www.wiredbrain.net/information.htm
What
may happen tomorrow that effects your life
today. News about what's happening and for updates use GlobalVillage
Excite NewsSearch ????
States are suffering from a real "double
whammy" in the current economic slowdown, which has reduced revenues
sharply (especially in the many states that depend mainly on retail-sensitive
sales tax collections), while boosting demands on state programs aimed at
helping people who are unemployed or living in or near poverty -- particularly
the Medicaid program, the top expenditure category in nearly every state.
A majority of states, moreover, have constitutional or statutory prohibitions
on deficit spending, so shortfalls much be closed quickly. The new
responsibilities states are already beginning to face for homeland security and
increased law enforcement generally may not help the fiscal picture at all.
http://www.neweconomyindex.org/states/strategies.html
Since recessions follow booms as winter follows summer
maybe we should expect down turns and make plans. This is called counter cycle
activity - the most natural approach is to have reserves, saving which can be
called into play when needed - such as some states, countries, firms and
individual have a rainy day funds because it may rain. Now it is harder to fix
the roof when it is raining but it still needs to be fixed.
Since states and local government (utilities,
communications and other firms) make the problem
worse by cutting back during recessions - the federal reserves should help hold
up their expenditures up - http://www.wiredbrain.net/salestax.htm
thereby demand, income and
reelection.
Since increasing federal debt raises interests
rates and creates long term problems for social security - a off budget
debt and payback scheme may help better than traditional deficits - the states
and local governments pay back the loans with a federal sales tax on the
internet - states and local governments give up their claims and a flat
national rate is added to interstate sales - In good times the money is used to
build up reserves (actual investments in CD's, state and local bonds, foreign
bonds, index funds, as well as treasuries) in down turns it is used to
prime the old pump. The same would be done with SS trust funds, highway TRUST
funds, water and waste management, airports, utilities, communications,
pipelines, grids, et al) The NRA (National Reserves Administration) would have
trillions ready to pump into a sagging economy without increasing long term
debt and actually would be making money on investments.
If you want more of something you support it, if you
want less you tax it. We tax work, income and investments - we support debt
with equity loan credits. We should support work, savings and investments and
tax consumption and be neutral on debt. Sales taxes are regressive so they
have to include redistribution programs. If everyone over the middle (median)
income paid taxes at .5 of each percentage over the middle 50 % - from 1% to a
high of 25 % - the 75th percentile would pay 12.5 % then each income would be
adjusted for sales taxes with credits. To encourage savings and retirement
those below 50% would get supports those over 50 % get credits - the same for
health insurance, and other payroll protections, unemployment, disability, and
old age insurance.
If the person in the middle (50 percentile) pays 15 %
in payroll taxes - then those over would pay more and those under would pay
less. The benefits for the poor would be supported from sales taxes - the
richer would get credits on their income tax for having more saving, better
retirement, and health care - as they do now with IRA and other tax free saving
and health insurance, the poor would have matching funds - save two dollar we
match it with one - scaled by percentile income group - those at the bottom get
100% benefit - those in the middle none. (benefits
reduce 2 X each percentile) - at 25th percentile
benefits are down 50 % - get it?
This IRA would help the retirement and health care
crisis with private accounts, insurance and savings - Real reserve funds may
keep us out of recessions, promote growth, government revenues and save the
nation. Any questions?
The
Educational Reform Act of 2001:
The several
states and territories are hereby entitled to reimbursement for the same
proportion of the salaries and benefits of qualified classroom teachers for
those professional engaged in basic instruction, the federal government may
contribute that same share of these employment costs as the teachers students
are eligible for the free school lunch program.
The states
and territories may be reimbursed based on approved plans and estimates of the
numbers and costs with the U.S. Secretary of Education, who may approve
definitions of basic instruction, classroom teachers, teacher qualifications,
salary programs, and any incentive pay upon which the secretary may authorize
quarterly advances and adjustments.
The states
may include teachers from charter schools, schools being run by a contractor
and non-public schools within an improved plan only in so far as these serve
the eligible population.About $15,000
for a million teachers - some with a small amount some at 100 % = 15 billion -
not much more than title I and within range - even if twice that - If the feds
pay teachers resources are free for other critical needs.
Then we can
move toward a realistic salary - working conditions - qualifications -
promotion and specialization system - professionals are the critical in
education - then with this base things can really be improved.
The
American Public and both parties say that education is their top priority but
school reform has become so complex that no one understands what is going on -
or is the story reported. Incremental is natural but has a PR problem when
there is the complete lack of focus.
The bills
them-self are endless - there needs to be a clear focus - something beyond
testing because tests do not create solutions only let us know what we already
know - a lot of children are not up to grade level.
The only
meaningful answer is competition - charter schools if not vouchers - the
charter provisions in the current bill are grants and information to state
education agencies - or the fox gets the grants for the chickens or
http://www.wiredbrain.net/public-policy.htm for a
restructured with the feds taking a major responsibility for instruction. ( State and local build building, transportation, overhead
and administration ) All this sound and fury may not do much - but then
something is better than nothing.
http://thomas.loc.gov/cgi-bin/query/z?c107:S.1.PCS
original bill to extend programs and activities under the
Elementary and Secondary Education Act or S.1 H.R.1
No Child Left Behind Act of 2001S.303
Three R's Act Better Education for Students and
Teachers Act
Better Education for Students and Teachers Act
Native Hawaiian Education Act
Access to High Standards Act
Rural Education Achievement Program
Education Flexibility Partnership Act of 2001
Pro-Children Act of 2001
Bilingual Education Act
Teacher Mobility Act
Dropout Prevention Act
21st Century Community Learning Centers Act
Helping Children Succeed by Fully Funding the
Individuals with Disabilities Education Act (IDEA) (Introduced in the Senate)[S.466.IS]
Public School Repair and Renovation Act of 2001
(Introduced in the Senate)[S.471.IS]
Educational
Excellence for All Learners Act of 2001 (Introduced in
the Senate)[S.7.IS]
Under a tentative agreement between Democrats and the
White House, the Senate bill would require mandatory student testing, help
children learn to read by the third grade and give states more leeway in
spending federal education funds -- signature issues for Bush during the
presidential campaign. http://dailynews.yahoo.com/h/nm/20010426/pl/congress_education_dc_11.html
http://www.ssa.gov/OP_Home/ssact/title04/0423.htm
Using language similar to that for social
services in the SS Act.. From the sums appropriated ( or by entitlement as it used to be ) and the allotment
under this subpart, subject to the conditions set forth in this section, the
Secretary ( DOE ) may from time to time pay to each State that has a plan
developed in accordance with regulations an amount equal to 75 per centime of
the total sum expended under the plan in meeting the costs of State, district,
county, or other local basic educational instructional services.
The federal
government may pay 75 % of teachers salaries and benefits (
involved in direct instruction = about 2.5 million teachers @ $
30,000 = 75 billion ) and left to the states and local school boards, all the
other costs - administration, football, transportation, construction,
utilities, then: We would become a modern civilized society with a world class
school system, social justice, economic growth, and political democracy.
There would
be substantial tax relief on property taxes - standards set for teacher
certification - much better salaries for some low paid teachers and salary
grades for high performing teachers tied to the GS federal
scales:http://www.seemyad.com/gov/salary.htm
The big
problems in American Public education are:
There is no
career stream for classroom teachers - pay is only based on seniority and there
is not much difference if you stay in instruction from start to finish.
Basic
Education as a federal responsibility:
The
national interest and general welfare require a large federal role in public
compulsory education. This was not as true in the last centuries but is clearly
one of the most important if not the most important federal function. "A
2000 PricewaterhouseCoopers report found that intellectual assets now account
for 78 percent of the total value of American S&P 500 companies."
"According
to a 2000 OECD [Organization for Economic Cooperation and Development] report,
since 1985, the expansion of knowledge-based industries has outpaced gross
domestic product (GDP) growth in the developed countries. Knowledge-based
industries now account for more than half of OECD-wide GDP." Welcome, to
the Knowledge Age.BUT since we
are a federal system and have a long history of local school boards we can not
just start from scratch.Each state with consultations
with local school system should come up with a plan to provide basic education
- reading ( the nation reads ) writing ( the nation writes ) algebra and other
math ( the nation reasons and calculates ) students knows geography, history,
government, humanities, the sciences and the scientific methods - all standards
and evaluations set by the states.
Then there
is a calculation of what the direct provision of these educational services
cost.
Then the
application for expected expenditures for the next quarter of 75 % of the costs
as a
entitlement - with adjustments for over and under payments from the last
payment.
The states
should report how much would be used for property tax relief - how much for
salaries ( and if there
would be a state wide pay scales with steps - grades like the GS system ).
These costs
should not include support, administration, transportation, athletics,
construction, maintenance, bureaucracy, etc.
Because
these costs remain state and local responsibility and are too much a can of
worms.
The
national estimated cost per student for instruction would be fairly clear at
about $ 2,500 for elementary and $ 4,500 for secondary (
half the total cost ) x 50 million students ( 1 million x
$ 1000 = 1 billion ) so 50 million x $ 3,500 = $ 175 Billion x 75 % = $ 132
billion.
There has
been a vast growth in administrative overhead from 15 % in the 1960's to 50 %
today so increases in resources are absorbed by overhead. In the last decade
there has been a vast underhanded growth in ESE (
special education ) from 5 % of population to 25 % and a
jungle of paperwork without functional outcomes.
The labeling
of students make standards even harder - ESE students are not counted or
counted differently - so if someone doesn't learn they are learning disabled
and labeled - given more resources - and excluded from the testing of school
outcomes.
There has been for decades weak support for standards - support in general but backing off when the tire hits the road and students actually FLUNK and are held back! Standards means that teachers have to teach content - multiplication tables, spelling, parts of speech, geography, algebra - not always fun and often hard - and student have to do their homework.Teachers can be tied to the GS 4 to GS 12 depending on performance - and the DOD ( Military base schools ) teacher pay scales as a base
