Gutless Leadership and Health Care Suicide

One of my close friends is a hospice volunteer. Lately he is supporting a vibrant, full-of-life 80-year-old woman who’s got a bad heart and who’s chosen to die as fast as possible. She’s in an independent care facility that costs a lot so she’s decided to voluntarily starve herself to shut off expenses so she can leave some money to her full-grown children. I know. He’s tried to talk her out of it, but she’s determined. She wants to die because she can’t afford to live. Welcome to America.

Meanwhile our leaders do anything but lead. The Democrats are sissies. The Republicans are bullies. I think most of us are sick of toxic, dysfunctional, ego-bloated politicians pretending to lead our nation.

As I have stated months ago, as well as many great comments from the rest of you, (see Outraged at the Politics of Health Care and Will Marre’s Radical Solution to Health Care) the fundamental problem with a financially unsustainable health care system is that the profit motive is its key driver. This creates a crazy maze of confusion, waste, cost, and suffering. Today’s price of health care is driven by cartels and rich interest groups who compete like Gladiators for a piece of yours and my pie.

1. Thanks to the near elimination of antitrust safeguards, 7 big private insurers control over 80% of health insurance in our nation. These companies are designed to take in as much money as possible from you and pay out as little as possible. They make the insurance claims process confusing and time consuming for patients and doctors, which increases costs and time. This also discourages many people and even physicians from making totally legitimate claims, which increases profits by tens of millions annually. Of course we also know that insurance company claims representations are rewarded for denying claims or finding unethical loopholes to deny payments for treatments to insured persons for trivial reasons causing systematic suffering and in some cases avoidable deaths. Lately insurance companies have been raising premiums in huge chunks to make as much as they can before they are regulated. The obvious conflict between investor interests and our nation’s health care is so great it is breaking our economy.
2. Drug companies have created a closed, unfree market in the U.S., which allows them to charge many times, often 10 times, more for a drug than it costs in other western countries. The idea that Merck drugs in Canada may not be as safe as the same drug in Minnesota is an insult to all of us. The argument that American consumers need to pay higher prices to support U.S. drug companies’ research is simply wrong. U.S. drug companies spend much more on consumer advertising than all of their drug research combined. If business believes in free markets and globalism, then let’s have it. Free trade and a common world price for all drugs.
3. The medical profession has too many incompetent doctors doing procedures they shouldn’t be doing simply because these procedures pay well. It has long been known that the most expensive and difficult procedures are done at the lowest total cost and have the best results when they are done in well-equipped hospitals that specialize in those treatments by doctors who do hundreds of those procedures per year. If you need a heart bypass, go somewhere where they do hundreds of them. These “Centers of Excellence” save money and lives. The medical profession also needs to do a much better job of getting rid of incompetent doctors that cause the majority of malpractice claims. It would also be wise to establish special health courts to curb the abuses of trial-lawyers who game the system to win big awards on the basis of emotion rather than science and responsibility.

I could go on, but who would listen?

The core solution I believe is a universal insurance exchange that is set up as a national non-profit co-op “owned” by all American citizens run by competent executives and properly rewarded employees who have one goal—make sure that the most people have access to the best health care. This can be done with excellence and efficiency. Employees should be rewarded for quality and keeping people healthy not for denying sick people coverage.

We need something more than the best we get from compromising with the huge health care industry that has spent $425 million lobbying against us in the past 4 months. There is a role for private insurance companies, but we must level the playing field by creating a force of citizen power to create realistic and sustainable economics for health care. (The rest of my proposals are in previous blogs.)

Today our health care strategy is a mess because we are trying to turn a rusting ocean liner into a rocket ship. No matter what modifications we make to the rapidly sinking boat, it will never fly.

We must have a whole new system. One that gives people choice and confidence. One that rewards people for healthy lifestyles. One that is uniquely American. Not run by the government but by well-informed citizens who can blend the best of our fierce independence, distrust of bureaucracy and our collective heart for our common good.

I do not claim to have all the answers. But I am disgusted with Democrats who turned what should have been a health care revolution into a poison stew of who-knows compromises. The “brand” of the Democrats is whiny, victim, poor me thinking. They are also ready to compromise because they have no visible backbone and few ideas they are ready to fight for. The Republicans sicken me. Their “brand” is arrogant know-it-alls who only want to lower taxes, fight wars, remove regulations and promote a new aristocracy. Their “I’ve-got-mine and no-one’s-going-to-tell-me-what-to-do” mind set is a cowboy philosophy completely at odds with the higher purpose of society.

As far as health care goes, I am most impressed with Jesus’ advice. When the Samaritan came upon an enemy who was left for dead by the side of the road, he didn’t say, “Well, he probably deserved it.” Instead he took him in and got him medical attention and paid his bills. It seems clear to me that moral maturity demands we seek to reduce all avoidable suffering. If that were our motive and we didn’t compromise with the moneychangers, we just might come up with something simple, practical and affordable.

I, for one, don’t want the status quo. I don’t want some two-bit, best-I-can-get superficial leftovers approved of by the special interests. I am sick of hearing what’s possible.

What I want is a radically new way of looking at this challenge and the leadership courage to make our country a better place to raise our children.

How about you?

–Will Marre

Health Care Dominated by Financial Interests – No Leadership in Politics

Recently, my children and I spoke about our President’s evident failure to lead. One of the first rules of leadership is that leaders need to describe the “what.” If a leader cannot adequately describe the benefits of going to the promised land, no one will follow. Great leaders also allow others to decide “how” or at least to input in, “the how” so that there can be wide agreement that the way we are going to get to the promise land is sustainable. Instead we see our politics as usual…the politics of compromise.

How can compromise work when health care is so dominated by financial interests? Health insurers and drug companies are spending a reported $1.6 million dollars a day. They have hired over 1,000 new lobbyists, most who have been former congressmen or former staff members of congressmen and senators, to work their old colleagues into compromising what should be a moral imperative into an expensive trick. We have a habit of doing this in our country when it’s evident that things need to be done, the forces that make the most money from the status quo push compromise.

We had a real chance to end slavery when our constitution was drafted but we let the economic forces in the south sustain slavery, so our country continued with it for over 100 years. After the Civil War, we could have really installed civil rights laws; making it possible for everyone to vote, but we didn’t. It took another 100 years of civil rights laws to give every citizen in this country the same rights, and still we live with its aftermath. This is not a way to build a society. There are some things that we cannot compromise. In today’s world, we simply cannot be the only developed country in the world that doesn’t provide basic health care to all its citizens. The truth is, it is affordable; it just isn’t affordable in the way that people are presenting it, and that’s on purpose.

When we combine profit and overhead from the top seven biggest health insurance companies in America, it’s $400 billion dollars a year…or $4 trillion that is spent every decade. Only eighty cents of our premium dollars spent with private insurance companies are actually spent on health care. Medicare spends 97% of our tax dollars, but Medicare in its current form isn’t the answer either. It is far to subject to the failings of political bureaucracies. Medicare is loaded with waste and inefficiency.

There are solutions! A national citizen co-op could also work on a very high level of efficiency limiting what is spent to somewhere south of three percent. Also, if every individual agreed to spend up to three percent of their income on health care out of their own pocket we would be much more careful on our purchases of health care, using the Internet to find out what is best, and by following doctor and hospital ratings. This is truly within our grasp, but we are letting it all go because of old style thinking. If people want private health care, they can get it; just like some people send their children to expensive private schools, people could hire private doctors and have private hospitals. There are excellent universities ran by the public. The University of California Berkeley, and UCLA are examples of schools that provide educations that are certainly equal to the Ivy League schools. So the idea that private and public solution can’t exist at the same time is just simply not true.

But, rarely do we hear of this from our President or his leaders. Instead we hear what is absolutely necessary, and what is willing to be given up, and what is likely to be a Frankenstein version of a public and private health care that is full of corruption, just like our defense procurement processes are. Hopefully, my assessment of our new President’s leadership capabilities or intent is premature.  If not, we’re going to be in for a long slog of the same.

FOR MORE ON HEALTH CARE, SEE MY OTHER POSTS:

Outraged at the Politics of Healthcare

Will Marre’s Radical Solution to Health Care

Do Corporations Run Our Government?

Our government has an even bigger problem than granting financial favors to the well connected.  The General Services Agency, GSA, is responsible for managing our massive federal government.  Well, for over 15 years they’ve outsourced the job.  That’s right, beginning under Bill Clinton and expanded by George Bush our leaders have created a 4th branch of government of private contractors that do everything from check our income taxes, run federal purchasing and our governments massive data system.  They run our social services programs, Medicare, social security, make our weapons, serve our soldiers food…just about everything.  Government costs continue to explode not because government employment is growing, but because government contracting is out of control—literally.

Only 48% of government contracts were competitively bid in 2005.  It was nearly 80% five years ago.  Guess who provides contract oversight for you and me?  You guessed it.  A government contractor that’s been investigated for corruption! The same contractor who supplied interrogators to the Abu Ghraid Iraq prison.  No, this is not a joke.  It is our outrageously corrupt system.

Of course, we’re told outsourcing saves us money.  Right.  Audits show that government contracts pay an average of twice the cost of pay of benefits for federal workers doing the same jobs.  Moreover, contractors often don’t have oversight, routinely miss deadlines, and even abandon projects.  So how can a farsighted businessperson get such good work?  Why, pay your dues of course.

The top 20 service contractors have spent nearly $300 million on lobbying and over $20 million on political campaigns in the past 5 years. The most disturbing thing about becoming a “government run by corporations” is that corporate allegiance is to shareholders and executives, not to you and me who pay them with our taxes.  Public servants no longer are serving us.  Rather we’re being had.

Is it any wonder we haven’t been able to provide our soldiers with adequate armor or rebuild hurricane-ravished states?  Our current president is right about one thing–we don’t need more taxes.  Probably 30% of our taxes are just wasted. Yours and my money in someone else’s wallet.

The Congressional elections, which swept up the “bad” Republicans and replaced them with Democrats, had everyone hoping for the best.  We voters sent a message that corrupt politics with special interests writing laws, backroom government contracts, and outright bribery and payoffs was revolting.  So we threw the bastards out.  Or so we thought.  Within a week of conquering Congress, Democrats were crafting high-sounding ethics reforms with loopholes big enough to fly private jets through.  It turns out they are just as dependent on corrupt system of campaign finance as the Republicans. Duh.

We all know there is only one solution.  Sweeping change.  Strict new black and white rules.  Campaigns for national public office cannot be funded except by public money.  Campaign spending limits on money from any source must be mandated.  Congress will never reform itself.  Like alcoholics at a never-ending open bar, they keep making up excuses why one more drink is actually a good thing.  Well, anytime yours and my tax money is spent on ANYTHING that is not openly debated is just not fair.  It’s called taxation without representation.  I believe we already fought a revolution over that one.

Since Congress is too addicted to their votes-for-favors program, there is probably only one way faith in Congress can be restored: campaign finance reform has to happen at the state level.  We must find ways to satisfy the Supreme Courts ideas on free speech by actually protecting it instead of allowing special interests to buy it.  When a candidate has to spend over 500 million smackers on a presidential campaign, democracy is badly broken.

Our states must pass laws prohibiting spending campaign money other than that provided by the taxes you and I pay.  If we don’t make our elected representatives beholden to each one of us, they’ll remain beholden to the deep pockets that already yank their chains.  Before you protest let me remind you this won’t cost us money.  In fact, it will save us hundreds of billions of the unjust tax breaks, subsides, outrageous government contracts, and backroom deals our taxes fund today.  How important is this?  It is essential to save our nation.  Otherwise, our government’s vision of our common good will increasingly degenerate into a parody of democracy.  Don’t write your Congressman.  He’s too busy golfing for dollars.  Write your Governor…?  Is the only way to get change to shame one politician to reform the other.

As Tim pointed out, we need to remove ineffective politicians from office.

What’s the Greatest Thing We Can Do?

Question #16: How do we come up with a solution to remove ineffective politicians from office.  Any ideas?