Government Follies

 

Interesting story in the paper this morning about some spinoffs from the Mueller investigation. Mueller hasn't come up with anything against Trump as far as we know but now they're finding, in addition to Paul Manafort, a bunch of other Washington insiders, from both parties, making big money from secret lobbying deals with various foreign countries.

 

No surprise folks. The place is a money and power magnet, not really a good place in which to put our confidence. It's why our founders were so skittish about the idea of a strong central government, devising a balance of powers, three separate and equal branches, each with designated oversight over the other two. They balanced the States off against the feds, giving each one two senators and setting up the electoral college. And then they topped it off with the Bill of Rights, just to make double sure they got the point of who was boss. They tried their best but, with all that money and influence funneling in to DC it's not at all a sure thing that their strategy worked. It's a constant battle requiring an informed and educated citizenry. Given the present state of our media and education establishment it's hard not to be pessimistic.

 

But, hey, the feds aren't alone. On another page there was another article about New York State considering the funding of badly needed NYC subway repairs by legalizing and taxing pot. It seems inevitable since New Jersey has done it. No doubt some day soon we'll be hearing radio adds to smoke a little dope to keep New Yorkers riding. Sort of like the adds to help the old folks by playing the lottery, otherwise previously known as the numbers racket. No wonder you don't hear much about the mafia anymore.

 

In another part of the article one transportation expert opined that another benefit of legalizing pot would be that it would help keep people more relaxed when the subway was late.

 

Who needs the funny papers?

 

 

 

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Medicare for All

Among the agenda items of the new Socialist wing of the Democrat party is the concept of Medicare for All. Why not! As a standard Medicare beneficiary I can attest to how pleasant it is. At the time of any medical service I present my cards and it's all taken care of. So if it's this easy just extend it to everyone and our health care problems are solved. Seems pretty simple. 

Before we jump into it though there are a few little details that we should think about. 

Medicare Part A, which pays for hospital and home health, is in the red and the trust fund is expected to run out somewhere around 2026. Part B, which pays for the rest, won't go broke because, even though the recipients pay some in premiums, they only cover 25% of the cost and the general tax fund pays for all the rest. The cost is steadily increasing and continues day by day to add to the deficit. The really interesting statistic is that the unfunded liability, that is the amount that is anticipated to be needed for all present citizens when they reach eligibility but would not be funded by the present tax structure is something in the range of $50 trillion. Whoa!

More than that though, Medicare is structured something like a Ponzi scheme. The money that's paid for my medical services comes not from a fund I've saved up, but from taxes paid by present day young 'uns, thank you very much. That's one big problem because every year there are more and more of us, and less and less of them. When you think about it when everyone is on Medicare, who will be the poor suckers paying the bill? I guess all of us, but hey, if it's running us into debt now when the young majority is paying for the old minority, where are we going with that.  

No problema say the Socialistas. We save money on efficiencies and decreased administrative costs. OhKay?? How economical and efficient is the Medicare we've already got. Well for starters it's going broke and continually adding to the debt. This despite the fact that the percent of our incomes we pay to fund it have been gradually increased to anywhere from 10 to 15 times what they were when the program was started. Doesn't seem that economical to me, about what you'd expect from a government run program. What can we say about administrative costs which a single payer system is supposed to reduce. Well when Medicare started, doctors and other service providers just sent in their bills and they were paid. Now the payment systems are so complicated that doctors actually, quite literally, often take courses to learn how to do the coding that must be sent in to get paid. Why's that? Well what do you suppose happens when you're selling a service where you get guaranteed payment whatever you charge. You guessed it! So now the prices are set and documentation is required in detail that would warm the heart of any tax accountant. If you ever wondered why your doctor was typing on his computer so intently instead of listening to you this is what it's about. He's not just catching up on his emails. 

Now think about what I'm describing, folks. In the old days, when I was a young fella, you went into the doctor's office and he was it, or maybe there was a nurse or a secretary hanging around. But all the people around to check your Medicare number and do the billing and coding and reporting and the scribes and all the IT people, why they're all part of the administrative savings. 

Before Medicare poor people were treated gratis by a lot of doctors. I remember that when my mom called him to see me, my pediatrician, Dr Curtin, would always stop by to see the kids of the poor family across the street. When old folks needed the hospital but couldn't pay they went to Scranton State where they were treated by interns supervised by local doctors who went in to make rounds. Lyndon Johnson wanted to change that, and rightly so it appears, since the poor old folks opted for private care in droves. But ol' Lyndon said he wanted things the same for everybody so he arranged to put the government in change of the medical care of everyone over 65 whether they needed it or not. That worked fine for a little while because then there was plenty of money floating around for the politicians to play with. And for us beneficiaries it's still a pretty good deal. Not many restrictions and very heavily subsidized by the rest of the taxpayers and the national debt. The fit's going to hit the shan someday but, Hey, that's the future, and today's today. Personally I think 'ol Lyndon made a big boo-boo. Yes, help those who are unfortunate and can't arrange to take care of themselves, but leave the rest of us alone. 

Medicare for All? Boy does that sound good. But it can't be done without major destruction to our medical care system. I know, I know - they do it in Europe and Australia, etc so there must be some flaw in my reasoning. Our government really can run our medical care economically and with minimal bureaucracy. That's a subject for another day. All I can say is for the seniors who like Medicare the way it is - watch out!

Thoughts on the Caravan

 

 

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The people in "the caravan" are prima facie not asylum seekers although it appears that this is what they propose to claim if they reach our border. If they were fleeing political or social or religious persecution in Guatemala they have now escaped it by reaching Mexico. They are instead headed to the U.S. seeking jobs and available social services, the same as were obtained by those who preceded them. Some few mixed in are coming for more nefarious reasons. They are unskilled but are young and strong, and who does not admire their predecessor's dogged willingness to do hard physical labor. It is just what many of our forebears did, but in a legal fashion.

 

Their intention is to flaunt our sovereignty en masse since for decades this is what has been done on a more individual basis. Our country's immigration policy has been a sorry joke, fairly difficult for those who are inclined to obey the rules, non-existent for those who are contemptuous of them.

 

The timing of this event is fortuitous, some say purposely, coming just before the primaries. The Dems see it as a political opportunity, placing the onus for addressing the incident squarely on the President, even though it is the culmination of decades of mismanagement, hypocrisy and procrastination by previous administrations and especially a dysfunctional congress. They believe Mr. Trump is placed between the Scylla of preventing entry to a large but unarmed band by physical means and the Charybdis of recanting on one of his fundamental issues. He is an expert in getting around tight situations and it will be interesting to see what he comes up with.

 

Here's the issue, and the stakes are high. If this ploy is successful and the caravanners are dispersed throughout our country to do as they will it's essentially the end of any pretense of an immigration policy. They will be hired by the bottom feeders, attend our public schools, use our ER's and their children will blend into the next generation. Money will go back to the mother country and some of them will go back home to enjoy the fruits of their labors. The signal will go out even more strongly to those left behind that the sky's the limit, the boundaries are down.

 

The Dems and Libs are not raising a peep. It's time to make them say what they think. Do they want to go back to 18^th and 19^th century America with unrestricted immigration, but this time with government sponsored social services and Sanctuary Cities? If not what's their proposal for the caravan? This time it can't be "catch and release", because as we've seen, that's the same as doing nothing. Come on you guys, let's hear it!

The Judiciary Committee Hearing. Dr Ford vs Judge Kavanaugh.

I joined the millions of Americans who were riveted by the hearings yesterday.

 

Dr. Ford's testimony was emotional and seemed heartfelt. As it went on, especially in the face of the creampuff interrogation by Ms Mitchell and the interval sympathetic encouragement by the Democrat Senators, the feeling grew in me that Judge Kavanaugh's nomination might be sunk.

 

Then came Judge Kavanaugh, filled with righteous indignation and emotion over what was being done to him, who strenuously and unequivocally, under oath, completely denied all allegations made against him. My impression was that either he was absolutely truthful or a world class liar, on a par with Bill Clinton (couldn't help that one).

 

What is the observer to decide to resolve this stalemate? Well here's what I think.

 

Dr Ford was entirely believable, in that she seemed to believe what she said. But there are some major flaws in her case.

 

She recalled vividly all the details of her traumatic event, including walking past the others to leave the house. I can't fault her for not knowing where she was. She says the party was impromptu. But she doesn't know who took her there or more importantly how she managed to get home since she must have gotten there by car. Such vagaries of memory seem very strange.

 

She was able to name four of her companions at the party, including her close girl friend with whom she says she went to the party. All of these have given written statements under oath that they have no recollection of the event, including her close friend who Dr. Ford says accompanied her and who later apologized to her about having to truthfully undermine her accusation. The Democrats complain that these persons should be questioned in person, but when you read their statements they are all unequivocal. Dr. Ford herself could give no reasonable explanation.

 

It was brought out clearly in the hearing that her statement that she was unable to give testimony in private to the Judiciary committee due to fear of flying was clearly a falsehood. She appeared embarrassed by this. She also seemed not to know that the Committee had offered to interview her in California. It gives the impression that at this point of the situation she had become under the control of her handlers.

 

Judge Kavanaugh's testimony has to be taken somewhat at face value. However he was able to give some corroboration in the form of a calendar which he kept in great detail about his activities. But there is another useful way to judge. By this time numerous of his close high school friends have spoken on national media to testify about his character during the time in question and universally support him. His subsequent conduct since, particularly his behavior toward women, has also been validated by numerous friends, co-workers, students and his public record. The accusations against him are completely inconsistent with this reputation and don't jibe with the normal human experience of consistency of an individual's character.

 

I think those who come out worst in all of this are the Democrat Senators, particularly Senator Feinstein. It seems obvious that when Dr Ford's complaint came to their attention, that they determined to use the situation to their advantage as a political weapon. Probably the most telling fact is that Senator Feinstein had a lengthy private interview with Judge Kavanaugh and made no inquiry about the accusation even though she and her staff had already arranged legal counsel for Dr Ford. It seems clear that the Democrats, despite their call for further investigation at this late date, have no serious interest in fact finding, or as Senator Lindsey pointed out, they would have done it long ago. In fact they actively worked at avoiding fact finding by preventing Dr. Ford from testifying to the Committee in private after the accusations came to light. It seems impossible to avoid the conclusion that Dr Ford was exposed and used as a political tactic.

 

 

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Medicare For All Can't Be Done

As a 15 year Medicare beneficiary I can testify to its appeal. With standard Medicare and a supplemental plan one shows his card and by and large that's it. From then on you get high tech care with no direct cost, extremely wide availability of providers and very timely services. The out of pocket costs for the coverage are heavily subsidized and therefore affordable. I don't think any other national plan I have heard of matches it, and I have friends in various countries around the world whom I have quizzed about their circumstances. Once a month I get documentation from CMS showing me the services I have received, the usually grossly exorbitant prices I was charged and  the markedly lower payments that Medicare has approved, assuring me that I have been protected from the storm. Beneficiaries accept the present level of services as they stand and have little appreciation for the waste and inefficiency built into the system. 

What politician of either party worth his salt wouldn't salivate at the thought of providing this benefit to all his constituents. The reason we don't have Medicare 4 All today is that it can't be done. If it could be we would have had it long ago. But the politicians have a big problem. The Medicare system we have now, with all its gross ignoring of the basic laws of economics, is hurtling toward fiscal destruction. The CMS bureaucrats are flopping around like fish in a net trying to discover some new method of service delivery, risk shifting or management technique which would allow them to realize their vision of central control nirvana. 

There is no possible way that Medicare as presently delivered to the seniors can be extended to everyone and they know it. Any attempt would involve unacceptable increases in taxation, as well as major cuts in the availability and quality of providers and services. This would especially be the case if the thing was done wholesale as its proponents advocate so that people could still recall what they formerly had. 

So I think there is time. And as the foundation of our present overall system continues to crumble I think the best idea is to continue widespread efforts to provide working alternative examples of medical care without third party interference, and to vigorously promote and extend the opportunity for individual saving for future medical expenses through HSA's. I greatly fault the Republican legislature for falling down on this end while they had the opportunity. 

The Argument over President Trump

The election of Donald Trump was a shock, both to his enemies and supporters, in the main because we had been led to believe by the major media and pollsters that Hillary's victory was a foregone conclusion. Immediately after the election, efforts began to reverse the result by recounts, attempts to change the votes of the electoral college and calls for impeachment. Failing that, collusion with "The Russians" became the new battle cry, somewhat ironic in that President Obama was overheard whispering to Vladimir that he would be more flexible after his election and generally placated Russia in multiple policy decisions.

 

Those of us who voted for Trump did not do so because of his moral virtue. We had tried this with Mitt Romney, a squeaky clean goody-goody whom the Democrats and media turned into a haughty aristocrat who mistreated animals and held women in disdain. We wanted Trump because he promised in his many campaign policy pronouncements to end the decades long slide of our federal government into a self-serving oligarchy with the concurrence of both political parties. The ideas and opinions of the east and west coast metropolitan areas were dominant and the concerns of the rest of us deplorables were being held in contempt.

 

In less than 2 years the President has more than fulfilled the expectations of his supporters on many levels. This is partly due to his governing style. He has been skillfully able to use tools that were unavailable to his predecessors, social media and other means, to communicate directly with the public, over the heads of an overtly hostile major media cabal. But his enemies are powerful, wily and relentless.

 

Evidence a special prosecutor investigation, purportedly for the purpose of identifying Russian interference in the 2016 election and now gone far afield to the point where it is unmasked as an effort whose obvious aim is to bring down the President. There seems to be little interest in the strong evidence that leading members of our own government's intelligence community themselves consorted to interfere in the election, exonerating Mrs. Clinton and seeking to undermine the Trump campaign.

 

What's going on now is very reminiscent of the attempt of the Republicans in the 90's to bring down Bill Clinton. That impeachment did not work out well, and Clinton was reelected handily. However Trump's sins pale in comparison with Clinton's. Although not the stated issue of his impeachment Clinton was credibly accused of rape and unwanted genital exposure to an unsuspecting campaign worker, things that landed Harvey Weinstein in prison, as well as using his dominant position to take advantage of a 21 year old intern in the oval office itself. Trump's purported dalliances occurred years ago and involved fully adult and consenting women. He took measures to avoid scandal by monetary inducement whereas Hillary resorted to an all out campaign to threaten, smear and destroy the reputations of the women who were Bill's accusers. Failing to uncover Russia collusion the special council has put incredible pressure on some of the President's aides, obviously more directed at catching up Trump than the accused themselves. Now it's said that his past business dealings are being scrutinized. These have been well documented in many biographies but it's impossible that anyone's activities involving years of complex financial and political maneuvering could avoid something controversial.  

 

Trump's enemies, liberals and many establishment Republicans, despise him in particular because he has been so successful in advancing his policies, and broadcast their animosity at every opportunity. His supporters, on the other hand,  tend to hold back, not being consumed by politics and to some extent disliking the invective they receive if they speak out. That's how I have felt about it personally. I don't like the bitter hostile responses, generally avoid them and when they inevitably arise try to handle them lightheartedly. However I'd like to make one serious point. I voted for Mr Trump wholeheartedly. I did not vote for him because of his moral qualities, although generally I don't find them more offensive than many of his predecessors, just more open, and I think most of the charges against him of ignorance and personal prejudice are obviously false on their face. I didn't vote for him because of his flamboyant style, although I feel that much of it is necessary in today's politics, and I find his forthrightness and openness to be a refreshing change in our politics. I, and millions of others like me,  voted for him because I viewed the situation in our country on many levels to have gone seriously astray, especially in our federal government. He campaigned on an platform of doing something about my concerns and so far he has performed much to my satisfaction and I want him to continue. I understand that many others don't agree with that opinion and wish to change course again. That's their right. But Mr. Trump won the election, fair and square, because those like me voted for him. The accusations that outside interference played a role have so far not amounted to much and in fact much has been revealed about possible election tampering by members of our own government that are seriously concerning. Other elections are coming soon and Trump's opponents should focus on trying to achieve their desires through that mechanism and forget once and for all about trying to remove the President from office by other means. In trying to get around the American system they are forgetting that the rest of us are watching, 

 

Medicare, the American Central Payer System.

There is no need to speculate about what American "central payer" would be like since we already have the bona fide model, Medicare, up and running and refined with the government's best efforts for 50+ years. Just as in the other advanced countries, it's so pleasant to simply present your card and all is taken care of. Who can argue that the same should not be extended to everyone. But there are some problems lurking in this scenario. 

Money will be saved say the proponents. And yet the details of Medicare's financial woes are well known but summarized best by the trustee's estimate that the unfunded liability, viz. the amount promised to present day citizens which is not covered by the present taxing structure, is in the range of $50 trillion. Consider that the benefits to today's elderly recipients are being paid for by present day workers. What will be the result of the Medicare for All system that is being called for so blithely wherein the present day funders would as well become the beneficiaries and we would all be paying for each other. Incalculable! So much for the vaunted cost benefits. 

What about the administrative efficiencies. Since there is no fear of business failure, Medicare is not constrained by the problematic actuarial details faced by private insurance. But a major administrative cost of Medicare is in the form of mandated regulatory compliance. Studies abound detailing the massive waste of time and resources devoted to such effort which has only increased over the years. Are we to believe that this will be lessoned by extending the system?

But the most problematic results of our Medicare system are the severe consequences implied in any centrally controlled system that have been detailed by the liberal economists.

 

Prices in the Medicare world have lost their signaling function. Medical providers do not compete to offer the most efficient economical services, but instead attend to maximizing income through fitting their services to the regulations. Medical records now have documentation for compliance as their primary function. Doctors have limited idea of the cost consequences of their decisions and decide based on other considerations. Their patient consumers act likewise and accept anything that is offered that is not too inconvenient or unpleasant. There is no such thing as shopping for the lowest price. 

Prices are fixed by central committees and are often grossly unrelated to reality. Providers rush to perform overpriced services and ignore underpriced ones. Our medical offices actively resist modern methods of communication with patients since only face to face encounters are paid for. How many millions of hours are wasted as a consequence while committees all over the country go through the farce of debating whether telemedicine should be permitted. 

Drug and device manufacturers focus on efficacy and devote limited R&D attention to innovations in manufacturing so that, unlike the computer industry, new medical products are always more complex and more expensive. Like the rest of the system they are focused on what arrangements they can make with the third party payers. And so we have the spectacle of multiple drugs with the same mode of action from different manufacturers that are heavily advertised but with no discernable open price competition. 

As doctors rush in droves to employment with large medical conglomerates which are tapped into government funding how many articles are written decrying the plight of primary care, the pressure to see more patients in less time, the burgeoning number of medical administrators. Who knows what primary care should be? A free market would sort the problem out far better than any expert committee. 

The U.S. is not Canada or England or France. It is a behemoth of a free wheeling, highly demanding, legalistic and contentious public catered to by a very unwieldy, often self-serving political and bureaucratic class. As a model of central payer the anti-competitive, wasteful, inefficient, fiscally unsound Medicare system is the best we can do. To extend it to all would be a disaster and then where do we go.