Friday, May 22, 2009

Do the Math

A personal story illustrates very clearly why the attraction of a single-payer health care care system is irresistible. When our first child was born my wife and I decided that we would both share the child-care responsibilities. Since I had been freelancing for nearly a decade, it was easy for me to arrange my schedule and still hold up my end of the bargain.

For Maureen the decision was far more complex. She was entitled to child-care leave, but with the associated loss of income and benefits we would have to arrange our life in ways that reflected our new circumstances.

It turned out to be easier than we had anticipated.

Spurred on by the external motivation of having our income halved and the arrival of our second child, my career flourished. And fueled by the internet revolution the ranks of independent contractors and consultants swelled, leading also to an expansion of services and benefit plans aimed at freelancers.

In the area of health care we were faced with a choice. We could cover our family's medical risks with a comprehensive COBRA plan priced at $650 per month or we could design our own plan from the menu of offerings available through the major insurance providers.

We chose the latter option at a price of $196 per month.

Here are the details.

Under the COBRA plan all of our medical expenses would be covered, minus deductibles and co-pays.

Under our plan each family member was subject to a $2,000 deductible with a family deductible of $4,000. After we reached those thresholds all of our medical expenses would be covered.

So let's make a quick cocktail napkin analysis.

Under our plan, the most we could be on the hook for in a worst-case scenario was the $2,352 premium payment plus the $4,000 out of pocket deductible for a grand total of $6,352. In reality, we wrote a check whenever Matt saw the pediatrician and our expenses for that first year topped out at less than $2,800.

Compare this to the best-case scenario under the COBRA. Let's say that none of us got sick or had to go to the doctor. Our premium payments alone would have amounted to $7,800. Add to this the deductibles and co-pays involved had we incurred the hypothetical $4,000 in medical expenses and the total would have topped $9,000.

Our choice was easy and many other New York freelancers made similar choices.

But here in the Empire State CHOICE is a four-letter word, except in a very narrow context. Empire Blue Cross/Blue Shield along with the civil service unions and public policy advocates went in front of our state legislature and LIED, LIED, LIED!

Challenged by an aggressive new group of competitors and facing massive market-share erosion most businesses would seek ways to upgrade their offering, improve their service and reduce their costs.

But no. Empire Blue Cross and other non-profit insurers went crying to the government.

They misrepresented their finances with bogus financial documents.

Civil service unions predicted that New Yorkers would die in emergency rooms if non-profits were forced to compete with the more flexible benefit plans.

Public policy experts described holders of high-deductible plans, like ours, as the growing number of under-insured, forced into inferior plans by dire circumstances or duped by unscrupulous insurance salesmen.

Once again the experts contended that Americans were simply too stupid to make their own decisions.

If given a state-sanctioned monopoly, the non-profits promised to provide better coverage at lower premiums.

So, with no other choice, we were forced into a comprehensive benefits plan. The premium by this time ballooned to more than $700 per month and by the time Maureen went back to work four years later we were paying $980 each month for comprehensive benefits we didn't want and didn't need. So much for promises.

When it became clear that the New York State legislature had formulated their new regulations based on lies, deceit and corruption, I asked our State Senator if there was any possibility that the state would revisit the issue.

"No chance," came his reply.

Graft has momentum and the fruits of graft are so great that individual liberty stands little chance against a stampeding herd of parasites. But there's another dynamic in play. One that's far more insidious: Willful ignorance and the voluntary surrender to constant, relentless propaganda. When describing our chosen medical plan to friends and relatives, they were horrified.

"You mean... you have to pay to go to the doctor?"

"Well, yes, but we only pay $196 per month and if anyone gets seriously ill we don't have to worry about being bankrupted by medical bills."

"Yeah, but, you have to pay to go to the doctor!"

And that's the attraction of a single-payer health care system: Nobody has to pay to go to the doctor.

You can do the math. Run the numbers. Explain the pros and cons, but it's useless because for the vast majority of today's citizens the Canadian model is perfect.

Put simply, in Canada nobody has to go through the humiliation of paying for a doctor's visit, but seriously ill Canadians wait eight months or more for cancer surgery.

So when Hillary Clinton, Howard Dean, Barack Obama or the simpleton who chooses to pay for Starbuck's coffee while waiting for someone else to pick up the tab for health insurance speaks of universal coverage ask this question:

Coverage for what?

The truth is that when health-care bureaucrats and public policy experts refer to cost containment what they really they mean is rationing of the most expensive medical treatments and procedures.

Just as in Canada, the bureaucrats will be happy to provide low-cost services for people who aren't sick, then ration acute care so that by the time the patient's treatment is approved, they're already dead.

That's what I call compassion.

Thursday, May 21, 2009

Health Versus Healthcare

Nearly thirty years ago, as a Fortune 500 employee, I attended a seminar on health care finance. Newly hired and full of enthusiasm I volunteered for every "extra curricular" I could fit into my schedule. This one was very revealing and ominously prescient.

To my great good fortune I arrived in my new position just as the Nixon-Ford-Carter wage and price controls were lapsing so my income increased by about 40% on my starting day.

Other effects of the 1970's economic policies were more pernicious and far reaching. Prohibited from raising salaries beyond the government limit, employers sought alternative ways to attract new employees and retain current ones. As a result, non-salary benefit packages were expanded.

Health care benefits, which were referred to as "Hospitalization" in prior generations now became more comprehensive, adding layer upon additional layer of services that benefit plans would cover.

One member of the panel predicted that the current system of medical insurance was in danger of becoming a bureaucratic third-party payment plan for routine doctor visits.

As with all third-party payment plans, he warned, health-care costs were sure to skyrocket as administrative costs spiked up and consumer choices spiraled down. That was in 1981.

Now, three decades later, we are mired in another self-inflicted catastrophe which the ruling class has termed:The Health Care Crisis!

We can debate the merits of one health policy proposal versus another, but thoughtful discussion of any complex issue requires precise definitions, common lexicon and the agreement among all parties to refrain from personalizing policy disagreements.

In the current climate, thoughtful discussion is impossible.

Those on the left claim that those who oppose national single-payer health care want to see people die in the streets. Those on the right, myself included, brand national health care advocates as communists. Whether they are true believers or merely useful idiots is yet to be determined.

At the heart of the crisis, though, is the mind-set (predicted long ago at that seminar) that reaching into your wallet for routine medical treatment was an ordeal that no American should have to endure.

This is where precise definitions are critical.

Insurance versus third-party payment.

Health care versus medicine.

Most important, the definition of good health and how to achieve it.

This last element has been uniquely damaging. Over the years the term "preventive medicine" has become the Holy Grail of the health industry. While the prevention philosophy is well established, a collective mythology has emerged which equates good health with more trips to the doctor.

Nothing could be further from the truth.

Today, advocates for coercive universal, single-payer health care claim, rightly, that insurance is about spreading the risk. What they fail to accept is that insurance is also about pricing risk. This is the paradox:

How can our national government devise an equitable medical insurance paradigm when the leading causes of disease and premature death are self-inflicted?

The short answer is that they can't.

While very few would advocate for a universal single-payer automobile insurance system that allows a motorist with five drunk driving violations to pay the same premium as another with a clean driving record, this is exactly what the single-payer health care advocates demand.

Moreover, while we all pay auto insurance premiums to protect against large property and liability risks, we don't dip our government-issued insurance cards into the gas pump every time we fill up.

If we did, we should not be surprised when regular unleaded jumps to $8 a gallon.

Once again, as with nearly all social and personal crises, the fault lies not in the stars but in ourselves.

Tuesday, May 19, 2009

Bloated Idiots

In the Dashiell Hammet classic The Maltese Falcon, Casper Gutman discovers that the black bird he has been chasing for nearly two decades is nothing more than a crude fake.

Joel Cairo, unable to contain his disappointment cries:

"You imbecile. You bloated idiot. You and your stupid attempts to buy it!"

Yes. Yes. Crude attempts at gaining what you covet intensely very often result in disappointment. Today, the devotees of Daily Kos and Democratic Underground are consumed by two separate and conflicting desires.

The first is retribution.

George W. Bush trashed our Constitution, lied us into war and authorized an illegal and useless torture program for no other reason than, well, he's bad guy--a stupid guy--who did dumb things and enjoyed inflicting pain.

Today's rabble won't be satisfied until the former president is burned at the stake, paraded to the guillotine in an oxcart or left in a cell with a pistol and a cyanide capsule.

Through all of this, our esteemed Speaker, Lady Robespierre, has been playing a very perilous game, i.e. fanning the flames of wingnut revenge just enough to keep the embers glowing but not so much that they singe her pubic hairs.

It has been a delicate and dangerous dance indeed and she has proven not to be particularly adept at this version of the two-step.

To hear our current national leadership speak, you would think that they had spent the last eight years in a sensory-deprivation chamber.

Silly me, I thought that members of the Intelligence Committee attended briefings on intelligence.

It seems they were as attentive as were members of the Banking Committee and the Financial Services Committee, or so they say.

Funny thing, though, about the goings on in government.

The people who run these fandangos like to keep very detailed records and they keep them for a very long time.

This is a common trait among bureaucrats.

Records of the Nazi Holocaust list names, dates and precise hours of the day for every atrocity they committed in pursuit of a more perfect world. But I digress. Written, contemporaneous accounts of each and every briefing indicate that unless our leaders in Washington were all suffering from somnambulism, they had to have some knowledge of enhanced interrogation methods.

In fact, records indicate that when informed of the details of waterboarding, the Speaker-to-Be asked:

"Are you sure that's enough?"

So now Pelosi, Murtha, are being waterboarded by their own words and they don't like it one little bit.

To add to the irony, Frau Facelift's former patron and mentor, current CIA Director Leon Panetta, issued a scathing memo excoriating those who would cast doubt upon his department and its brave men and women.

Et tu, Leon.

So if Curious George deserves the guillotine, doesn't Nancy at least merit a little nip and tuck with a chain saw?

Which brings us to that other all-consuming craving of the left, i.e. implementing every hare-brained scheme cooked up by Ivy League eggheads and Saul Alinksy acolytes over the last fifty years.

Alas, the distraction of "What Did Nancy Know and When Did She Know It" threatens to divert political energy from more important Democratic Party objectives, such as eroding our freedoms, confiscating our wealth and dismantling free enterprise.

It won't be long now. As their dreams of a Euro-socialist Utopia quickly fade the witless parasites, misfits, and malcontents of the left will soon turn on their own heroes, screaming...

You imbeciles. You bloated idiots!

Migliore fortuna la volta prossima.

Monday, May 18, 2009

Intellectual Misuserisms

During a conversation on politics with an old friend I offered the hope that all his faith in our new president:

"Ain't been in vain fer nuthin'."

With that he reared up and replied to my comment by saying:

"You always ridicule with clever solipsisms."

Far be it from me to be solipsistic, so I pointed out that he probably meant solecism.

Mistake 1: Never quote Lina Lamont at a New York City cocktail party. They won't know what you're talking about.

Mistake 2: Never attempt to correct the tortured misuse of the English language by New York intellectuals who pride themselves on their rhetorical skills. Especially New York intellectuals who took such great glee in equating our former president's acyrologia-laden speech with a simian level of intelligence.

Far be it from me to defend George W. Bush's tortured misuse of English. I confess that I still hold the bigoted view that fuzzy syntax indicates fuzzy thinking.

Then, just last week, during an interview with Wolf Blitzer Senator Dianne Feinstein of San Francisco took a shot at political opponents who would rather keep suicide bombers locked up in Guantanamo instead of halfway houses in Ashtabula.

"And, so, this shibboleth, which is largely used by Republicans, to say, oh, the Democrats want terrorists in your -- in your neighborhood, in your community, that is a lot of baloney. That is not true. And that's the message that is being pushed, because it frightens people."

Far be it from me to to lecture Sen. Feinstein on the Old Testament.

Rather than shibboleth, meaning password in Hebrew, she could have used canard, or misrepresentation, or prevarication or even baloney--which she did use later in her statement. But no, shibboleth has that certain intellectual panache that fuzzy-headed liberals love so dearly.

Never mind that it's incorrect to the point of idiocy.

This week, our Commissar in Chief was asked about his preferences in movies. In addition to calling the White House "my house" he also told of his admiration for the old Star Trek series.

"It turns out we got this nice theater on the ground floor of my house … So Star Trek, we saw this weekend, which I thought was good.

I used to love Star Trek. You know, Star Trek was ahead of its time. There was a whole–the special effects weren’t real good, but the storylines were always evocative, you know, there was a little commentary and a little pop philosophy for a 10-year-old to absorb."

Far be it from me to remind Mr. Obama that he is living in the people's house.

But should I expect the leader of the free world to understand the difference between evocative and provocative? Apparently not. Actually, for a man who had visited all 57 states during his presidential campaign and is now making personnel decisions for the Fortune 500 what's a little misusery now and then.

There I go again. Another clever solipsism.

So now I have had my bigotry reaffirmed. Yes, I do believe that fuzzy usage is an indicator of fuzzy thinking, regardless of how seemingly well-spoken or articulate.

Sunday, May 17, 2009

Before Their Time

In the hierarchy of human misfortune, nothing comes close to the tragedy of mothers and fathers attending the funerals of their children. As a Christian I understand that death is the beginning of eternal life in the presence of God, but as much as I try to reconcile faith and fact I still cannot accept a death that occurs out of sequential order. In the past few months I have listened to homilies delivered by sincere, loving and compassionate ministers of God, but still I ache--my heart has a void at its center.

Many years ago in Peru, we would observe the almost daily ritual of funeral processions with grieving fathers holding the tiny coffins of their infant children. And almost daily we would bow our heads and choke back a tear for babies we did not know and parents who should not have to go through this heart-wrenching ordeal. It's a distant land without modern services and they deserve better.

Almost two decades have past, but rarely does a week go by that I don't visualize those solemn processions.

Then a few weeks ago the word came: a young boy from our community who had been battling leukemia for several years finally lost his long fight.

A few days later, the teen-aged son of close friends was killed while engaging in a bizarre ritual that's become all the rage with kids these days.

And last week, the infant daughter of a friend--born prematurely--could not overcome the stresses of her birth. Forever I will retain the image of a young father holding the ashes of his infant daughter in his trembling hands.

During this period I also got word that my oldest friend had been killed in an accident caused by his own recklessness. He was not an infant or a teenager, but his mother and father still had to attend the funeral for their son and, for them, it was a tragedy.

The circumstances surrounding his death are unimportant. What happened was a reflection of the way he lived his life. He never gave the slightest thought for the consequences of his actions, either on himself or others. In his personal life he ran roughshod over the people who loved him. In his professional life he took advantage of our innate desire for deals that are too good to be true. As result, life savings were wiped out and lives were ruined. The victims were all strangers, of course, but it mattered little.

His death, caused by his own reckless disregard, was a final poke in the eye to the people who cared for him.

Four funerals. Eight grieving parents.

In the first three cases the tragedy involves lives cut short, aspirations unfulfilled and talents left untapped.

In the last instance the tragedy was not in how he died or even that he died. No, in this case the tragedy was in how he lived his life and the trail of wreckage he left in his wake.

Into the Fire

A business colleague once told me that rewriting your life story line by line and chapter by chapter is a futile exercise. "If you want a new life," she said, "you have to throw your old life into the fire."

It's not a new idea.

From the legend of the Phoenix to Götterdämmerung to 2001, A Space Odyssey destruction and renewal have been integral to human mythology.

Frustrated by incremental improvements followed by regression, those who seek perfection look to conflagration as the pathway to a better life and a better world. They're probably correct in their thinking.

Evolution takes time, effort and commitment. Destruction provides instant gratification.

On a macro level, we may be living through the final death scene of American freedom and democracy. In 1787 Scottish historian Alexander Tyler observed:

"A democracy is always temporary in nature; it simply cannot exist as a permanent form of government.

A democracy will continue to exist up until the time that voters discover that they can vote themselves generous gifts from the public treasury.

From that moment on, the majority always votes for the candidates who promise the most benefits, with the result that every democracy will finally collapse due to loose fiscal policy, (which is) always followed by a dictatorship.

The average age of the worlds greatest civilizations from the beginning of history, has been about 200 years. During those 200 years,these nations always progressed through the following sequence:

From bondage to spiritual faith;
From spiritual faith to great courage;
From courage to liberty;
From liberty to abundance;
From abundance to complacency;
From complacency to apathy;
From apathy to dependence;
From dependence back into bondage."

Can anyone doubt that we Americans have learned how to vote ourselves goodies from the public treasury? More alarmingly, the evidence is clear that we are now in the apathy/dependence phase of the American death spiral.

On the personal level, the Émile Coué de Châtaigneraie mantra gives millions of adherents daily inspiration and a faint glimmer of hope that tomorrow may be better than yesterday.

In reality, when looking back at the illusion of getting better and better, few can claim that daily incremental improvements have resulted in dramatic lifetime transformations.

For most, every day and in every way we descend more deeply into conformity, boredom and despair.

Bejeebers, this is depressing, pessimistic even nihilist. No it isn't.

Every crossroad provides the pathway to a better more rewarding life.

As a nation, throwing our old ideas about governance and civic responsibility into the fire may lead to a better society if we choose the right path.

For me, eliminating negative influences, tearing off self-imposed shackles and pursuing a new life story--in effect, throwing my past life into the fire--can and will lead to a happier, more productive and far more rewarding life.

Today, I've resolved to begin the next phase of my of life with a renewed sense of enthusiasm and creative energy.

I'm also very confident that generations to come will create a better world out of the ashes of our collective selfishness and profligacy and that I will see that better world in my lifetime.