Priorities: Afghanistan or Copenhagen?

Today I was thinking about our President, and how he is doing his job.

Let's see: the war in Afghanistan is going badly, and we need more troops, according to our top generals who are prosecuting the war that Mr. Obama said was the war we should be pursuing, as opposed to the Iraq war.
The 2016 Olympics are up for grabs, and several cites are competing for the honor of hosting them. Valerie Jarrett and Michelle Obama have been pursuing it for their hometown of Chicago, and now our President is going over to Copenhagen to lobby for Chicago.

I went back to my trusty Constitution, and reread Article II. It was a quick read, and I found an interesting piece of text. Section 2 says, in part: "The President shall be the Commander in Chief of the Army and Navy of the United States, and the militia of the several states, when called into the actual Service of the United States." I looked around for any mention of the Olympics. Nope, didn't find it.

So what is behind our President winging his way to Copenhagen? Is that where he will meet with General Stanley McChrystal? Maybe General Petreaus will be there to discuss our strategy going forward? No, I see Michelle Obama's fingerprints all over this. She's the one pushing for this, she's going over to Copenhagen, and there is a healthcare strategy all wrapped in one.

They are in full court press and distracting the people from health care by pushing for the Olympics. THey also have other things popping up to distract, like expanding school days and years, illegal immigration, and whatever else they can fit into the kitchen sink. If there is not one issue that distracts you, they didn't do a good job. But while the issues are important, healthcare reform will be the most sweeping, restrictive, costly, and enabling of government piece of legislation they are trying to pass. More later, I have to finish lunch.

A Closer look at the "46 Million Uninsured"

OK boys and girls, today I want to look at one of the main talking point reasons people use to support the President's HC Bill, HR3200. It is widely said by those in power that there are 46million uninsured people, and we must get them covered. It sounds like a crying shame that there are so many uninsured people in our prosperous country. Let's break this group down and see who is in it, shall we?
According to the U.S. Census Bureau, of the 46 million who are uninsured:

• 10.1 million are individuals who have income of $66,000 for a family of four, but who elect to remain uninsured.
• 9.3 million are non-citizens who generally do not pay tax.
• 6.4 million who are enrolled in Medicaid or S-CHIP but reported to the Census taker that they were not. (This phenomenon is known among statisticians as the Medicaid undercount.)
• 4.3 million are eligible for Medicaid or S-CHIP but have not enrolled.
• 5 million are childless adults, mainly healthy, young adults who simply do not wish to pay for insurance.
• 10.9million remain who are truly uninsured, some for short periods of time averaging less than four months.
  

Of those who are uninsured on a continuing basis, this is in most cases due to the working poor earning too much to get Medicaid/SCHIP/Medicare, but too little to afford (less than $50,000) HC insurance (HCI). There are varying estimates of these numbers, but all are roughly the same. It is the chronically uninsured working poor who should be the target of any HC reform.

Why, you may ask, are some not getting into the available coverage? Well, for the young, it is mostly the sense of invincibility and they often don't see any cost benefit. For many, it may just be a lack of initiative, planning, or interest. There may also be some shame at getting into the government handout business, so they just don't sign up. Still others may not realize they are eligible. These factors could be addressed, and in fact, many of the programs allow people to sign up when they enter the ER, so essentially, they are already covered.

Can we all agree that the 46 million number is a myth, and that the real starting point for covering "the uninsured" needs to be those who cannot afford or qualify for HCI? Also, I would be remiss to not direct you to my previous post of 8/7/09 with my analysis of HR3200. This post bumped it off the top of the list, though it is still being updated.

Healthcare Bill H.R. 3200 Analysis

Ok boys and girls, today we will look at the President's Healthcare bill that Congress has written. This is the first installment, as I am certain that I can't possibly fit all of the facts into this one blog, and even more certain that you won't read them even if I did. it has been updated as of 15 Aug 2009, even though the blog spot says the date of its creation, August 7th.

First, let's set the ground rules:

1. I will cite sections by page and line number, so you can go read it for yourself. I have also decided to put in headlines, or titles, so you can search by subject.
   
2. Don't just take my word for it, go check me! I get it wrong, and some things may be subject to interpretation.
3. This is not a witch hunt, it is an analysis, so there will be good as well as bad noted, not just the things that fit my bias. I get so sick of hearing only one side reported, as though the whole bill were either a totally unacceptable piece of trash or the salvational piece of legislation that will do everything for everybody. I don't believe that from either side, and I intend to not treat this bill so trivially. Too much is at stake to play politics, though I do admit my biases.
4. Since I brought up my biases, my bias is against too much government, and toward freedom. It's the American way, and self-determination, with the ability to make "stupid choices" is what I believe we all should have. If you can't choose the stupid, you have no true choice. Once Government decides what you can and cannot choose, in this context of Healthcare especially, We the People will suffer. There is a place for regulation, but excessive regulation is inimical to my way of thinking, so let's just get that out there right from the jump. Knowing that I have this bias, I will try extra hard to cover the other side as well. The reason I use the term "stupid choices" is that Elizabeth Edwards used that term when discussing Healthcare before her husband's affair came out into the news. My choices may seem "stupid" to her, or to others, but my choices make sense for my situation, as your do for yours. If they are uninformed, they may not be the best, but we all deserve the right to make choices that we deem the best for ourselves, no matter how "stupid" they may seem to others. I think many choices made by others are "stupid", like that of ever having an abortion. So you have the right to make your "stupid choices", and I have mine. Let's keep it that way!
5. If you find that I have grossly mischaracterized some passage of the bill, please bring it to my attention, with an explanation of why you think so, and what the bill really means. Lord knows I am no legal scholar, but I am a scholar in general, and a scientific mind who is trained and experienced in debug, analysis, and getting to the root cause of problems.
6. I have read, myself, every line I am pointing out.
   

Now for the actual Analysis:

• Funnel into Public Plan - Page 16, line 10-20: Existing plans may not enroll new individuals, except as family members of the grandfathered-in enrollees. They let you cover your new spouse and children, but nobody else can get in. This means that insurance plans may not grow, and their customers will die off, effectively cutting the insurance companies source of income and customers off. This will cause people to funnel into the only plans that can accept ne enrollees, the government plans.
  
• Minimum benefits set by government panel - Page 17, lines 10-20: All private insurance plans must conform to the same requirements as those for the essential benefit package described by the government plans, within five years. this removes choice of plan benefits, and makes all plans a one-size fits all type, which never fits everyone. It causes some to waste money, and others to not get level of coverage they want and are willing to pay for.
• No new plans on open market - page 19, lines 1 thru 5: All new individual plans must be offered thru the Exchange the government sets up for Health Insurance plans. This means you cannot go buy a plan that is not conforming to the Government standards or benefit packages.
  
• No rejection for preexisting conditions - Page 19, line 18 thru page 20, line 23, there are no limits based on pre-existing conditions to getting into a plan, nor can a person be dropped for another reason than not paying the premiums. this is actually a good reform, and should be so noted, unless it is negated by some other provisions. This is the best thing so far in this bill.
  
• Discouraging company self-insurance - Page 21 line 22 thru Page 23 line 7: The Bill MANDATES a government audit of the books of ALL EMPLOYERS that self-insure in order to “ensure that the law does not provide incentives for small and mid-size employers to self-insure”! This is totally wrong, as it should be up to the employers to find the most cost-effective way to provide for their employees, not the Government's job to disincentive companies from certain choices that are acceptable to their employees. The studies are to be done in 18 months, with reports providing recommendations (on how to change the law to disincentiveize companies from self-insuring).
  
• Limits on profits of insurance plans - Page 25 line 1 thru 11: The Government shall set the amount of profit an insurance plan can have, and the insured (you), will get money back if the plan gets too profitable. How profitable is "too profitable"? The Commissioner will decide.
• Minimum Coverage includes substance abuse Disorder Services - Page 28 lines 10 and 11: This will expand the cost for those who don't have such problems. Not all do!
  
• Minimum coverage includes maternity - Page 28, line 17. This may not seem bad on its face, but for the single guy, it is a waste of money. For the older couple, it is a waste as well. Same for well-baby/child coverage in lines 18 thru 20. Should be optional, to allow cost savings for the buyer.
• Rationing of HC Benefits - Pages 29 line 4 thru Page 30 line 10: The text is somewhat technical, but it says basically that the cost sharing will be "actuarially equivalent to approximately" 70% of the total cost of the individual benefits, and has a maximum of $10,000 per year for a family, and $5,000 for an individual. This seems to indicate taht the benefits woudl cost more a-la-cart, but together there is some cost savings. If someone who has a better understanding of legalese and/or insurance cost structures, I'd love to get a more complete explanation. I'll insert it, if it comes via email, Facebook, or comments.
• A Government Health Benefits Advisory Board will determine covered benefits - page 30 lines 13 thru 18: This board of public and private persons will recommend covered benefits, for the plans. This section introduced the idea of Enhanced and Premium plans, and they decide what goes into them. They are to take into account advances in HC and how they can reduce health disparities. Not HCI disparities, but actual "health disparities". This seems to restrict new medical advances, since the use by doctors often provides incentive to develop new technologies and products. If it can't be used until it is covered, it will slowly strangle our development process (see page 32 lines 18 thru 21).
  
• Standard Definitions of Insurance and Medical Terms - Page 45 lines 11 thru 15: the Government will develop standard terminology for HCI and medical related terms. This is another good thing. This should keep the Commissioner busy for a good while!
  
• HC will be provided to all, even non-US citizens - Page 51 line 21 thru page 52 line 3. This is part of Section 152, "Prohibiting Discrimination in Health Care ", and say "...all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services." No mention of citizenship required, and no limit is placed on non-US citizens either. This is a loophole big enough to fit all undocumented persons through!
• This Tax is not a "Tax" - Page 203, lines 13 thru 18: ‘‘(4) NOT TREATED AS TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES.—The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.’’ This speaks for itself. Not a tax? Note, there is nto even a section 55, so to what are they referring? What did Section 55 say?
  
• Home visits to Parents for child development - Page 837 line 10 thru page 839 line 5: The Government will send trained people to homes of families who are expecting or have young children, to help parents to raise their children properly. Hat tip to Chuck Norris, who pointed this out, though I have verified it myself. The exact wording of their goal is in line 13 on page 837: "to improve the well-being, health, and development of children". Also, on page 839, lines 1-5 indicates that they will "identify and prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families or a high incidence of child maltreatment". Who determines what is "maltreatment"? Is it spanking? Deprivation of cell-phones? Allowing kids to eat "bad" food? This is a nice goal, but it is not the responsibility of the Government to intrude on the raising of our kids. I am certain that we will not be able to influence the content and standards they apply to this program. Amish and Muslims will certainly raise their kids differently from each other, and from those who are Atheists. One size will never fit all.
  
• 
  

More later!

My Family Reunion Song

'Tis the season to be Family,
fah-la-la-la-laa, la-la-la-laa.
Drive we now across the country,
fah-la-la-la-laa, la-la-la-laa.
Love we now our distant cousins,
fah-la-la, la-la-la, la-la-laa;
Spending time with our loved ones,
fah-la-la-la-laa, la-laa-la-laaa!

Eating food and blowing diets,
fah-la-la-la-laa, la-la-la-laa,
Taking pictures, posed and random,
fah-la-la-la-laa, la-la-la-laa,
Holding babes and kissing Grandma,
fah-la-la, la-la-la, la-la-laa;
Getting home to peace and quiet,
fah-la-la-la-laa, la-laaa, la-laaaaaa!!!

Look at what?!

There were two pix from President Obama's recent trip, and one seemed to be really smarmy, with him ogling a young lady's "Stimulus Package". After this brouhaha erupted, suddenly a new picture came out of him when he left the summit. To the right is the first picture. Obviously Nicholas Sarkozy is ogling, but then, he's a Frenchman, so we can understand his behavior. A quick review of the actual footage that this was taken from clears things up nicely, if one cares to get at the truth.

After this turned into an international joke, the person to whom it mattered most seemed to have directed or orchestrated another picture, another photo op, if you will. That person was the First lady, Michelle Obama. When was the last time you saw the first couple enter Air Force One next to each other? Most often, they are in single file, with one going in first, then the other, waves and smiles. But this time, they had to put this incident, shall we say, behind them? They had to let the world know where the President's heart, and hand in this case, was. Look at this next picture, and see for yourself.

This should clear things up. I doubt Obama is a player. This is one area where he gets it right: he is a family man, and seems to be a faithful father and husband. Kudos to him and to his wife, who protected their family image.

Health Care Debate

I watched the President dominate the ABC health care infomercial last night. It was predictable. He took some softball questions, and some that made him struggle to articulate the same answers into the query at hand, but there was no real debate about it. There were also the sob stories, and hypothetical questions that seemed chosen for effect, not to truly debate the issues.

But that is not the point of this post. My point is to ask the questions, and consider things I think real people will be really interested in hearing about. Here they are:

1. What about those who have no health care coverage by choice?
2. What about Tort Reform, in at least two aspects: limiting pain and suffering awards, and "loser pays"?
3. What about illegal aliens and making sure they are not a cost burden?
4. Why does Government intervention have to cost so much?
5. Will the Health care plan work any better than the Stimulus plan, and the natural follow up: why not wait to see how the stimulus plan works first?

That something needs to be done is not really a question. There needs to be some changes, but that does not mean that the program sought by the President and the Democrats is the only way to fix it. We also need to consider our budget as we go. I think that until the budget is balanced, we should not have a government program for health care that costs billions, and certainly not trillions of tax payer dollars. There are some simple things the government can do to dramatically improve the quality of health care, reduce cost, and increase coverage, which would cost relatively little. Before I get into that, however, let me acknowledge the points where the President and I agree. They are few.
1. Portability. We agree that a person's health care plan should be portable, meaning that if an employee leaves their job, they should be able to remain in their health insurance plan. This is something that the Congress can legislate into legality without spending even millions of dollars. With 56% of Americans in employer provided health insurance plans, this would be the single largest step to allowing them to keep their coverage. I have lost mine a few times after leaving an employer, and it was painful.
2. Pre-existing conditions: no exclusions for them. People will in many cases have pre-existing conditions, and that should not be a discriminator against allowing a person who joins a business or other pool to join a health care insurance plan.
3. Health care IT. To stream line storage and retrieval of records would greatly improve health care provided, though I think it would be good for the government to do studies on it, and give tax breaks for the transition to it, rather than for the government to run it. Other countries are using this type of system already, and if the results of their practical experience could be studied with government grant money, an optimal system for our country could be recommended and supported.

Here's what we could probably get passed this year with bi-partisan agreement, and with little cost to the government:
1. Tort reform to limit awards for "pain & suffering", at some reasonable level, such as $1 million. This is not to be confused with allowing suits to recover lost income, medical costs, and other impacts related to medical malpractice. Those types of awards will help keep doctors honest.
2. Tort reform to make the loser pay. In simple terms, this means if a frivolous lawsuit is brought, the loser pays the legal fees of the team that had to fight it (as well as their own). This would reduce lawsuits to those that have basis in fact.
3. Change the law to allow people to keep their health insurance when they leave their job.
4. Change the law to make health care insurance a deductible thing for individuals, and make employers give the total amount of money they would be paying for health care insurance to the employees. That would make the costs obvious, and the choice the consumer's.
5. Start studies on health care IT around the world, and the available technologies.

More later. I have to go earn my health care coverage.

TARP Too: Where do We go from Here?

As I saw the headlines about the banks needing to raise more capital, I started to cross-reference things in my mind.
FACT: many banks want to return TARP money.
FACT: some banks need more money, according to results of the Stress Tests that the government has just reported on.
FACT: The administration does not want banks to return the TARP money right now. Some may be allowed to start soon, but not yet.
FACT: The government arraigned a bankruptcy for Chrysler in which the first bond holders got about 30 cents on the dollar, while the UAW got $55billion worth of equity in the company, and the government got a significant stake in the company as well.
FACT: The First Bondholders who invested in Chrysler offered to take a 50% loss on their investment, but the Administration insisted on them taking a 70% loss.
FACT: the government wants the banks to raise private capital to be capable of passing the stress tests, or else they may need to pump more government money into those banks.

Now why do I mention Chrysler in context of the banks? Simple: the Administration is the entity in ultimate charge of the banks that need more money, and the banks may have a hard time convincing private companies that investing in those banks under control of the Government will not result in their bond contracts being overridden by the Administration in some future move that the Government thinks is best for the "rightful owners of the nation's wealth". Chrysler investors are no different than bank investors. When companies, people, hedge funds or whoever, decide to invest, they trade off return, risk, and other pertinent factors. There is a huge risk when this administration is in control of the banks that they will make some move that will negatively impact the investors who happen to not be the Government. If the banks do not raise all of the capital in six months, the Administration will take a voting stake, and then the investor who stuck their necks out now will be screwed. Never mind that most hedge funds are collections of ordinary citizens trying to provide for their retirement, trying to provide for themselves and their families' livelihood. Businesses try to raise capital to finance their growth, and if they are to be persuaded to invest in banks, they need to know that their rights will be protected. Confidence is the key to investment.

Sure, there are greedy investors who only want to be filthy rich. Who would not want to be rich? I don't begrudge them that, but those are not the majority of the investors the banks are seeking. I mean, if Warren Buffet were to invest his money, with the goal of being filthy rich, would the Administration have a problem with that? Oh, wait, they love him. So why is it bad for others to want to invest and become like Buffet? Oh yes, that's right. Warren Buffet must be one of the "Rightful Owners of the Nations Wealth", at least in President Obama's eyes. I take a simple approach: the "Rightful Owners" in the business world are those who bought the bonds, whose contracts specify that they have rights of ownership or first payment in a bankruptcy proceeding.

So where do we go from here? If a few of the banks (Citi, GMAC) need more capital, we need to approach it from a fiscally responsible perspective, and allow some banks that passed the "Stress Tests" to return TARP money, and the Administration needs to reinvest that money in the other banks that need it. We also need written assurance from the Obama administration that there will be no further interference in the banks which could result in the coveted investors losing their rights or property when they invest in American banks that have received TARP money.

Will this happen? as I sit here up at 2:30 AM on 8 May 2009, I seriously doubt it. But it would work, if done.