Michael Kennedy

Corruption rules our country today.

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I am succumbing to temptation to repeat a post from 4 years ago. The reason is that the problem is now far worse. We do not have just a Principle agent problem, the country is run by corporate renegades and those on foreign payrolls.

The principalagent problem, in political science and economics, (also known as agency dilemma or the agency problem) occurs when one person or entity (the “agent”) is able to make decisions on behalf of, or that impact, another person or entity: the “principal”.[1] This dilemma exists in circumstances where agents are motivated to act in their own best interests, which are contrary to those of their principals, and is an example of moral hazard.

The Founders were well aware of this problem and tried to protect the citizens with certain provisions of the Constitution.

“No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.”

This provision was violated by Barack Obama who spent billions to subsidize insurance companies to support his “Affordable Care Act” which was not successful.

Of course, the Amendments were intended to protect the rights of the people but the one that has been ignored for 100 years is the Tenth.

“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

The Civil War largely ended Federalism.

In recent years, political parties have mislead their voters, the worst offender being the Republican Party. The Democrats posture as the party of the working man but it has become a party with two wings, the rich who want social liberties, and the poor who want to be taken care of. Jay Cost has written a good book about the Democrats Party called, “Spoiled Rotten, which explains the current policies of the party that has adopted “Identity politics” in which race and victim status has become a principal focus. My own review of the book is here.

The Republicans have gradually become the party of small business but the interests of small business are not being considered as paramount as the party seems to be evolving into another party of professional politicians whose personal interest trumps (so to speak) the interests of the voters. The result has been the rebellion of the Tea Party and more recently the election of Dave Brat, an economics professor, to Congress defeating Eric Cantor, a member of the GOP leadership, in 2014.

The election of Donald Trump has presented the GOP Congress with a crisis to which many have responded by retiring. One wonders what the next step of their career will be. Few, I suspect, will return home to the district that elected them. Most will remain in DC as Cantor has done.

Immediately thereafter, Cantor accepted a position as vice chairman of investment bank Moelis & Company. and,

In February 2015, the firm opened its Washington DC office, following the hire of Eric Cantor, former House Majority Leader, in September 2014.

That was bad enough in 2017 but we now have President Ron Klain, elected by no one, with Joe Biden as a prop when he can read his cue cards.

I think Angelo Codevilla’s piece about “The Ruling Class” has the best explanation.

When this majority discovered that virtually no one in a position of power in either party or with a national voice would take their objections seriously, that decisions about their money were being made in bipartisan backroom deals with interested parties, and that the laws on these matters were being voted by people who had not read them, the term “political class” came into use. Then, after those in power changed their plans from buying toxic assets to buying up equity in banks and major industries but refused to explain why, when they reasserted their right to decide ad hoc on these and so many other matters, supposing them to be beyond the general public’s understanding, the American people started referring to those in and around government as the “ruling class.” And in fact Republican and Democratic office holders and their retinues show a similar presumption to dominate and fewer differences in tastes, habits, opinions, and sources of income among one another than between both and the rest of the country. They think, look, and act as a class.

Now, we have a ruling class whose loyalty seems to be to other governments, China, Russia, The EU ? Who are they working for? Biden attacks BREXIT, Supporting the EU over the UK, infuriating the British ruling party. Labour has already ridiculed Biden for his dementia. Who is writing Biden’s speeches ?

Single Payer rears its ugly head again.

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A fellow I’ve known slightly for many years is editor of the Alpha Omega Alpha medical honorary society magazine, The Pharos. He has a lead editorial in The current issue It is titled “Now is the time to enact a US Healthcare System.

Now, don’t get me wrong. Dick has had a more successful career than I have. Many years ago I knew him and he read his acceptance letter to USC medical school in my apartment. He did well in medical school, almost as well as I did, but his wife agreed to go to New York for a high status internship and residency, setting him on a path to great success. He became a Professor of Medicine and eventually President of the University of Colorado. I have not seen him in years and suspect very little of his time has been spent in the delivery of primary health care “in the trenches” so to speak.

My wife refused to leave Los Angeles and I have, as a result, had a less prestigious career but satisfactory as anyone who has read my Memoir will see. I did harbor some resentment and the marriage ended in divorce after 18 years.

Now let us consider what this academic authority proposes. First, we are now ten years after Obamacare and some level of practicality has crept in.

The “federalism” response to the COVID-19 pandemic, medicine, health care, and the profession of medicine is not working well and needs to change. A serious societal and public review and plan of action for change is needed with regard to why and how the U.S. must improve overall health care and create a new health care system for all Americans. The U.S. is the only developed country in the world that has not determined that health care is a fundamental human right. Universal health care should be considered by all as a social good and a national priority.

There is, of course, no such promise in the US Constitution of a “right” to healthcare although we do have an Amendment forbidding involuntary servitude. Section 1

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Shall the federal government have the right to compel doctors and healthcare providers to provide services ? Right now Medicare pays about 13% of billed charges. This produces ridiculous fees on paper but what is the uninsured to do ? Pay 87% higher prices ? At my last understanding, a doctor may not offer a service for less than his/her/xir Medicare price. Anyway, let us see what is proposed.

The long-standing federalism approach to health care is associated with a lack of leadership, the absence of a solid plan, setup, or organization to manage our national health care. Also it is slow to respond to national and international issues. It has not worked well and leaves the country’s health care system disjointed, confusing, and expensive. The federalism approach, in which all 50 states and five territories each have their own rules, regulations, and financing, has been a barrier to providing health care for every U.S. citizen, regardless of where they reside.

I frankly don’t see the Federalism handicap but suspect nationalization appeals to some. Those darned Red States again.

One option that is often discussed is a single payor system in which the government is the only payor through tax and other revenues and manages health care as a public and social good. Currently in the U.S., the Military Health Care System, Indian Health Services, Veterans Health Administration, and Medicare are all government single payor systems. Medicaid and the Child Health Insurance Program (CHIP) are jointly funded by the federal govern-ment and state governments. All totaled, these government funded programs provide health care coverage for nearly 50 percent of the U.S. population.4

The success of the VA and the Indian Health Service is doubted by many. Both have seen repeated scandals.

The other half of the population is covered under their employer-sponsored health plan; is self-insured; or receives coverage through individual market health plans, including ACA-compliant plans; or completely lack any type of health insurance. Through the private health insurance programs, private insurance companies are re-sponsible for paying claims for their members. Hospitals, physicians, pharmacies, and other health care providers each file claims independently. Obamacare is responsible for a significant segment of the uninsured as small group plans were devastated by Obamacare.

According to Jerry Bonenberger of Babb Insurance in Pittsburgh Pennsylvania, “small employer groups with less than 50 full-time employees are experiencing an extraordinary increase in their insurance premiums for 2015. In one case, a professional services firm with 42 full-time employees received an 87% increase in their premiums for next year.”

Through the development of the quasi-independent, apolitical National Health Reserve System (NHRS) pro-posed in the Summer 2020 issue of The Pharos,(1) the U.S. would have a health care system modeled after the Federal Reserve System, allowing for government funded care for half, and private insurance for half. The role of the NHRS would be to govern, integrate, coordinate, and manage a nationwide system of health care, both private and governmental. It would be far more extensive operationally than the Federal Reserve and would be governed and managed by experts, including physicians, health professionals, and others using data, experience, evidence, and planning to operate a national health care system independently with transparency and quasi- independence from politics.

Does anyone really believe that ? At least he wants to get rid of Obamacare although it is too late, as I have repeatedly pointed out. Doctors are no longer small business people but employees with the psychology of employees. Those that are opting out to go to a cash practice are a small minority but that seems the only realistic option. I submitted a rebuttal letter to the journal but doubt it will see the light of day. In it I suggested some reforms on the lines of the French system that I described in multiple blog posts ten years ago. I think the French system would have been a better reform but I doubt that will appeal to the academics who want control. When I was at Dartmouth in 1994-95 I met many of the people who designed Hillarycare, and they were also all academics. Pelosi and Reid who wrote Obamacare (I doubt Obama had anything to do with it) at least learned to include the insurance companies in their plan. In fact, I am sure it was written by insurance lobbyists and 25 year old staff lawyers.

The abysmal implementation of Obamacare suggests that big national scale programming projects are not the federal government’s strong suit. The federalism that my former friend, Dr Byyny, opposes allows for incremental reform and some level of experimentation. A national one-fits-all program failed spectacularly. Another one is likely to fail, as well.

That was 2015.

Medicine and Obama’s Third Term.

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Obamacare changed American Medicine forever. I am becoming convinced that was a major purpose. Since 1978, Medicine and doctors have become the most regulated sector of the American economy.

Five years ago, I predicted one consequence. A doctor shortage. Why ?

A few years ago, it was reported that 10,000 doctors were leaving UK every year. How has the NHS dealt with this shortage?

By importing third world doctors.

The UK’s National Health Service (NHS) will soon begin a major campaign to recruit health workers from other countries to meet growing staff shortages.

Reports suggest a strategy has been drawn up to target a number of countries around the world, including poorer nations outside Europe.

One estimate in March this year said the NHS will need 5,000 extra nurses every year – three times the figure it currently recruits annually.

But what about the countries that it will recruit from – what impact will it have on them?

Where do non-UK staff come from?
The NHS already recruits globally to meet its staffing needs.

More than 12% of the workforce reported their nationality as not British, according to a report published last year.

How are we dealing with our doctor shortage ? By adding “Practitioners” instead of doctors.

How did this begin? In 1978, a new federal program was created called “Professional Standards Review Organizations.”

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The Erector Set

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Here is an old post from my own blog. I thought it deserved another go.

Glenn Reynolds today has a link to Lionel Trains in the anticipation of Christmas. I had Lionel trains and eventually had HO gauge trains, as well. When I had sons old enough to play with trains, I built an elaborate train set in my garage. Then I learned that southern California is not the place for toy trains. The boys were outdoors all the time and the train set gathered dust.

Another toy that kids today will never have the chance to enjoy is the Erector Set. There is still a small source for this toy but the glory days of the Erector Set were long ago. The toy was invented by A.C. Gilbert in 1913. The story is interesting. Gilbert was a Yale Medical School graduate and had also won a gold medal, for the pole vault, in the 1908 Olympic Games. He had a new design bamboo pole that he used in his winning vault and he sold these, as well as other toys.

Like many residents of New Haven, Connecticut, he often took the train to New York City; and on one trip in 1911 he was inspired with what would be the most popular of his dozens of inventions.

Watching out the train window as some workmen positioned and riveted the steel beams of an electrical power-line tower, Gilbert decided to create a children’s construction kit: not just a toy, but an assemblage of metal beams with evenly spaced holes for bolts to pass through, screws, bolts, pulleys, gears and eventually even engines. A British toy company called Meccano Company was then selling a similar kit, but Gilbert’s Erector set was more realistic and had a number of technical advantages — most notably, steel beams that were not flat but bent lengthwise at a 90-degree angle, so that four of them nested side-to-side formed a very sturdy, square, hollow support beam.

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The Destruction of the US Military

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There is an old saying in the military, “Trust No one above O-6” They are all politicians. The Obama years saw more generals retired or relieved than there had been in years. General Carter Ham was one of the notable ones. Wiki sloughs over his relief about Benghazi.

Ham was in overall command of military forces when the September 11, 2012 terrorist attacks were launched on the American consulate and CIA annex in Benghazi, Libya. According to his June 2013 Congressional testimony, Ham chose not to deploy close air support during the attack, based on a lack of situational awareness about the circumstances on the ground. He denied the allegation by some Republicans that President Barack Obama or others in Obama’s administration had ordered him to “stand down” a planned rescue mission that was ready to deploy.

After a 24-month tour of duty[9] as Commander Africa Command, Ham was succeeded by General David M. Rodriguez.[10] General Ham retired in June 2013.[5]

That is one version.

Snopes, of course, insists “All is Well”

The information I heard today was that General Ham as head of Africom received the same e-mails the White House received requesting help/support as the attack was taking place. General Ham immediately had a rapid response unit ready and communicated to the Pentagon that he had a unit ready.

General Ham then received the order to stand down. His response was to screw it, he was going to help anyhow. Within 30 seconds to a minute after making the move to respond, his second in command apprehended General Ham and told him that he was now relieved of his command.

Navy Rear Admiral, former commander of the USS John Stennis Strike Group, Rear Admiral Charles Gaouette was also mysteriously relieved of duty, and all the brass will say is he is “under investigation” for, get this, “inappropriate leadership judgment.”

Just another way of saying that the admiral dared differ with the Administration’s Libya policy and perhaps openly defied Defense Secretary Leon Panetta.

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