Elections

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.

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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The Arizona Recount

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At least Maricopa County has a new county recorder who defeated the Democrat who screwed up the 2018 election.

The preliminary audit aired several unsubstantiated conspiracy theories and baseless allegations of election fraud and partisanship on Fontes’s part, some of which didn’t even cite a source or origin for the claims. Though Richer labeled the claims as unsubstantiated, some Republicans portrayed them as established fact.

Richer also questioned some of Fontes’s other election-related actions in his report, such as the expanded use of emergency voting centers in 2018, his placement of those centers, and his new policy of reaching out to voters with potentially deficient signatures on their early ballots. Richer concluded in the audit that those policies were questionable but not illegal.

Of course a Republican accusation is a “conspiracy theory.”

I’m sure Soros backed Secretary of State would agree. She is convinced an audit of the voting is a waste of time.

“A group of Republicans are continuing to try to appease their base who refuse to accept that … Trump lost Arizona and that he’s not the president anymore,” Hobbs told CNN’s Chris Cuomo on “Cuomo Prime Time.”

This was a few months after she referred to Trump voters as “neo-Nazis.” Certainly no bias there.

First, the Board of Elections denied use of official facilities. Then the Board of Supervisors Tried to prevent access to ballots

The Democrats then sued to try to stop it. The first judge recused himself, then the second judge, a Democrat, Refused to stop the recount.

Why are Democrats so determined to prevent any recount in an election they assert they have won and any questions about fraud are “without evidence?”

Now, the Biden DOJ is trying to intervene.

They really don’t want anyone checking on that election, do they?

Everyone knew this was coming…. The Feds are attempting to get involved in the Maricopa County ballot audit. The DOJ Civil Rights Division has sent a letter [pdf available here] to the Arizona State Senate claiming their review of Lawfare statements and media reports may show evidence of auditing issues that violate federal laws.

Last week a group of Lawfare activists [SEE HERE], including New York University Law School – which leads to Andrew Weissmann, asked the DOJ to get involved.

The ridiculous letter from the Biden DOJ goes on to cite media reports from the Washington Post as evidence to justify their involvement.

Remember, previously the DOJ narrative was that each state makes up its own election rules. Now the DOJ is saying, falsely, that Arizona might be breaking federal laws.

No doubt there will be more to come. You’d think Democrats would be proud of how well the election that Biden won was conducted.

Back Stories and Suicides

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Today, a friend complained of the death of a young man in Portland, of the heart rending interview of his father on Hannity. Some deaths are memorialized, mourned and others disappear from the headlines. Deaths in gang shootings in Chicago of toddlers are given less attention than those of victims of drug overdose in police custody. Not surprisingly, ceremonial ritual respect is given to a police officer killed in defense of the capitol, while the family of a young veteran, a woman whose business was destroyed by the covid lock down, is not. One an “insurrectionist”, the other a defender. Antigone might understand the distinction, if lamenting it. Creon certainly would. Another woman is trampled. Medical emergencies happen. Chaos.

Later, suicides. Of those we speak softly, negation of life hard for strangers and even harder for families. I knew a mother who spent years denying her son was dead – long after she had buried him.

For three suicides following the 6th, we ask, as we always do of these, why? We wonder about a back story? Would it help us understand the fences about the capitol, the vitriol of the impeachment?

One was a rioter, a middle aged man, an officer in a bank, who had been charged by the police. Given the “everyone is an insurrectionist” rhetoric, being charged would make life difficult and being convicted? The proportions of why and what he did – and why and what was said, was charged – were important to him and might well be to us.

Then, the two suicides of defenders, one of a Capitol policeman and the other in the Washington force. They had their reasons – but are they ones we need to understand as citizens or only as sympathizers? Policemen are often of an honor culture who feel keenly their responsibility to protect. A friend posited another reason: resignations and firings are likely (though responsibility for inadequate preparation does not appeared to be the fault of the police but rather of politicians – seldom members of an honor culture). My friend observed that when the airline for whom her husband had piloted for decades went into bankruptcy (along with their pension fund), several pilots committed suicide. Middle aged, they were unlikely to find work of the same kind and pay; they had (according to the financial planner who served the group) chosen to leave their families in a stronger financial place than the coming bankruptcy would. The planner’s responsibility was to ensure those wishes were fulfilled. (She clearly was glad her husband had not chosen that path although 15 years later they have not yet received the appropriate pension.) Protecting family, protecting reputation – those are motives. Most suicides are prompted (if partially) by clinical depression. Back stories can be sad, but need not be, really, our business. But, given the political machinations before and after that day, the back stories might be telling.

This isn’t much of a post – I hope the comments are more substantive than it is.

Some newsy discussions:
For one, such responsibility was inherited – see CNN for what it is worth.
And Politico gives both officer’s names.
NBC gives details.

2/8 – Adding links
Banker
Another on him
The Financial Planner gives more information about Georgia’s employment; apparently he’d spent decades in finance and the order was because he had not “dispersed” when asked to by police. The difference between these arrests and those 4 years ago that protested Trump’s inauguration are telling and are not so much apples and oranges as some contend.

An astonishing article in Time on the 2020 election;

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Time magazine, nearly invisible for years, published an amazing story about how the 2020 election was stolen.

We figured some of this would eventually get out but to see it this soon is just astonishing. The author frames the story as one of “saving the election” from Donald Trump but, of course, that is not what it reveals.

A second odd thing happened amid Trump’s attempts to reverse the result: corporate America turned on him. Hundreds of major business leaders, many of whom had backed Trump’s candidacy and supported his policies, called on him to concede. To the President, something felt amiss. “It was all very, very strange,” Trump said on Dec. 2. “Within days after the election, we witnessed an orchestrated effort to anoint the winner, even while many key states were still being counted.”

In a way, Trump was right.

There was a conspiracy unfolding behind the scenes, one that both curtailed the protests and coordinated the resistance from CEOs. Both surprises were the result of an informal alliance between left-wing activists and business titans. The pact was formalized in a terse, little-noticed joint statement of the U.S. Chamber of Commerce and AFL-CIO published on Election Day. Both sides would come to see it as a sort of implicit bargain–inspired by the summer’s massive, sometimes destructive racial-justice protests–in which the forces of labor came together with the forces of capital to keep the peace and oppose Trump’s assault on democracy.

It is possible to see this from the author’s point of view. That seems to be that it was critical to not have riots and looting like those which occurred over most of the summer. In order to keep the peace, it was necessary to see that Trump did not win. The validity of the election was secondary, if that.

Their work touched every aspect of the election. They got states to change voting systems and laws and helped secure hundreds of millions in public and private funding. They fended off voter-suppression lawsuits, recruited armies of poll workers and got millions of people to vote by mail for the first time. They successfully pressured social media companies to take a harder line against disinformation and used data-driven strategies to fight viral smears.

That is a fairly good example of “newspeak. “Voter Suppression lawsuits” can be translated to voter ID requirements of any type. The “vote by mail” included the absence of voting day requirements or even signature checking. It was wide open for fraud.

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