Health Care Thoughts

As the final federal health care bill is assembled, there should be some consideration given to how this might work, and work well.

No Medicare-for-All option? No Anti-Trust? No Mandate!

Our country was founded on the principle of freedom, and forcing citizens to buy health insurance goes against this principle. If we are to give this up, we should get something in return, namely something that works. 'Keeping Them Honest' can be done with a real Medicare-for-All option, or with regulation. We know Medicare works, and regulation of gas, electric and such utilities works – These are two models we can understand – Let's have both. Mandates for automobile insurance does not apply as a model – Each of us choose whether to drive a car on public roads or not, while living, and thus having health risks, is not a choice. If Obama-care beats nothing at all, they will come – a good plan needs no mandate. If the uncovered must be treated, let them join then – If they can not sign then, let someone sign for them. But more to the point, why should we even settle for either/or, when both would be best?

In Sum, Medicare-for-all Option, No Industry Cartel, Strong Healthcare Police and No Mandate!

Finance Health Care Fairly, and Keep Costs Sane:

Taxing those with big health care plans the most, as opposed to those with big incomes, to pay for care for the poor, is not fair, nor particularly noble, when most of the elaborate plans are held by union members. A third way here is to tax most those who can most afford to pay; those who own the most. A federal property tax would not disproportionately hit poor communities like local property taxes do, and since you own something if and only if the government says you do, owners have the best of incentives to pay property taxes.

'This American Life' reports a third of medical costs are not medically necessary. This is an enormous opportunity that we should all take advantage of, and co-payments can inspire individuals to serve the common good here while they serve their own. But a fixed percentage co-pay can become unaffordable if one really needs healthcare – if you get very ill. One way to balance this conundrum is to let the co-pay rise as the logarithm of the expense. Here if you chose an operation ten times the cost of an alternative, you would pay twice as much – a powerful incentive, without a financially flattening upper range of values for the really unfortunate. So Health care costs should come in from those with the means, and go out with thoughtful oversight.

Why Trap Poor Women in Poverty with Unwanted Children, Just Because a Vocal Few Do Not Like Abortion?

There are plenty of cases in which the desires of a minority of us are sacrificed to the majority, as it should be in a democracy. A fetus is not a child and abortion is not murder under our law. The majority of us need not cave to a vociferous minority and add to this crowded world more children than we, individually or collectively, are ready to raise well. Life can be a blessing, or a curse. To be sure, there are moral issues on both sides of this argument, which we can safely entrust to the parents involved.

Let's fix this health care bill right, and get on to other pressing issues: Green Jobs for All Who Want Them, for fuller employment, a better economy, and a climate we can live well with,

False health care system dicotomy?

Isn't there a third way beside nationalized single payer and the total financial free-for-all we have now?

Aren't the regulated utilities pretty well run and pretty cost effective at providing services or resources?

I do think Medicare for all could work well, but maybe there are other choices here.

There are anti-trust laws on the books already that should 'keep them honest' like single-payer is said to, if we better-regulated the now-free-market health care system to form a fair-market system.

Decades ago, the economist Samuel Bowles eloquently described how health care does not meet the four conditions needed for successful free markets:

1) There isn't ease of entry and exit from the market for buyers and sellers - When you need health care, you often can not wait to shop around. Similarly, becoming a doctor or other healthcare worker is not easy, and hospitals are not quickly opened or shut.

2) Perfect information is not perfectly available - As a patient with even a non-emergency illness, there is no time to learn the intricacies of health care science so as to be prepared to negotiate prices or choose products.

3) We can not assure lack of collusion between buyers and between sellers - Medical science requires extensive co-operation between healthcare providers - collusion is always possible, and organizations like the American Medical Association have seemed to most to be the best way to deal with the complexity of licencing, but necessarily range in behavior into collusion between sellers.

4) We can not practically have large numbers of buyers and sellers in each local health care market - Hospitals are big compared to patients, and necessarily so, I believe.

We will always want police in the streets, umpires on the field and someone looking over the health care system to make it work right and affordably, because this method of designated responsibility excells in large groups of busy equals with unequal power to coerce each other.

Single payer could work, but regulated utilities have also worked well in similar circumstances, and might be a workable solution that also fits the USA's character better.

Brian Cady

Create jobs instantly: Shorten the Work Week

German unemployment is not nearly as bad now as USA's, because Germany shortened their work week from 40 hours of work, so that the burden of recession would be more equitably distributed.

We could do this now, without lessening production, without additional taxes. Perhaps Obama could do this without the bother of Congressional approval - Here a lawyer could provide insight.

If the 32-hour work week came into effect, USA could increase the number of jobs available by one fifth. We could in some ways completely eliminate the real unemployment, rated at 17.5%, as compared to the official distorted rate of 10.2%, and still provide further jobs for those seeking additional work from abroad or with large debts or ambitious goals.

In addition, we USers would have time to both work and pursue additional schooling throughout our careers, and so help make our country more capable, while expanding our individual horizons.

Level of Progress at Copenhagen

The following is in response to President Obama's call for participation in the Community Jobs Forum, which I believe is timely, important and good. First are the questions the Administration asks, beneath each line, then a response.
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From what you have seen, or seen reported about the President’s Jobs Forum on December 3rd, what seems relevant to your community?

My 'community' is one consisting of working scientists. I have not heard anything about the outcome of the Jobs forum at the White House.
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What parts of your local economy are working or thriving? What businesses and sectors are expanding and hiring?

I don't know of any, but I hear rumors of possible research funding coming in phytoremediation research and development.
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What are the opportunities for growth in your community? What businesses and sectors seem poised to rebound?

Bicycling support industries? I don't have much insight here, sorry.
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What do you see as the “jobs of the future”?

As far as 'jobs of the future' I see tremendous opportunity in shifting from research and development of 'labor-eliminating' technology to technologies which eliminate resource use and waste/pollution production. I must acknowledge that this insight is not originally mine, but comes from the brilliant and accomplished Hazel Henderson, the economist who declared conventional economics 'a form of brain damage' in that it it only acknowledges value for the easy-to-price things, unlike air, clean drinking water and other essential but hard to price things.

Please replace Geithner with Henderson, or at least see: http://www.hazelhenderson.com/

Also, if scientific grant-giving foundations like NIH and NAS, etc. were to, in the evaluation for funding of grant proposals, increase the score, to even a slight degree, of proposals creating jobs, and furthermore if the foundations were to increase the score of such proposals in proportion to how many person-years of work they would create, then enormous numbers of positions could be created very rapidly, yet in well-thought-though scientific efforts by leading scientists.

Additionally, devising a sliding scale of the extent of tax-exemption for R & D done by corporations which favored, by exxempting form more taxes, those r & D efforts which would create, or at least not eliminate, jobs could also rapidly both expand employment while also shifting from labor-elminating technologies to the more needed waste-eliminating ( or pollution-eliminating) and resource-use-eliminating technique.
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What are the obstacles to job creation in your community? What could make
local businesses more likely to start hiring?

Basically the inordinate international strength of the dollar. A correction in the valuation of the dollars global purchasing power downward would lead to import replacement, resource efficiency and export industry growth, which would induce USA to lead the world again in the globally-needed cutting edge technologies, now to be energy efficiency, pollution control, appropriate energy generation, etc.

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What other issues and ideas should the President consider?

Al Qaeda is out of Afghanistan, and riven with internal divisions (see: _The New Republic_ June 2008) the USA should declare victory in Afghanistan and return victorious to home, and should wrap up Iraq as either a draw or the previous regime's mistake.

In Copenhagen, the USA should acknowledge First World climate reparation debt, and pay for it with future appropriate technology transfers. Our only acceptable future can include us The current alliance between the pseudo-Christian fanatics in the USA and the pseudo-Zionist fanatics in Isreal serves the needs of neither nation. The USA should now support efforts towards one-nation solutions, via a single election held in both Israeli and Palastinian areas, including Israel, West Bank and Gaza, as well as among Palastinian refugee communities in Jordan, Lebanon and elsewhere. In such elections centrist peace-oriented candidates will win, leaving devisive extremist out of power.

Also, we should follow the thinking of the great USA citizen Henry George in instituting a national property tax akin to local taxes, to better fund government. Sales taxes hit the poor too disproportionately hard, and income taxes discourage employment in comparison to resource and energy use. Ownership is imaginary, but useful because it encourages stewardship. Ownership requires government, and should therefore support government, as stated elsewhere at the blog 'Envision Hope or Perish', which please see.

Brian Cady

It is time to open a Federal Reserve bank:

The Fed is loaning money at 0% interest, while mortgage rates are about 5%.

If the deposit from the Fed was like a checking account, in that the money could be called back at any time, then the Fed requires 10% of the deposited amount held in reserve as cash. Then the bank could earn 5% times 10 = 50% interest on the money held in reserve every year.

But if the deposits from the Fed are like CDs, in which you basically can not readily get your money out at any time, but instead have to wait, then the Fed has a zero requirement for the amount of cash reserves to be held by the bank. Therefore a bank could earn an infinite percentage return on the money it holds in reserve, when loaning money borrowed at 0% and loaned out at 5%.

Our tax dollars hard at work...

Ownership is imaginary, but useful...

Ownership is imaginary, but useful, because it rewards stewardship of resources. Who would oil a bike they did not expect to be able to use later? Who would sow if they could not expect to be the one to reap?

Government enforces ownership. Thus owners are the chief beneficiaries of government. Where government breaks down, as in Somalia, there is no longer any authority to turn to in cases of ownership contention, like theft or piracy. Thus violence becomes the settling factor, and force the arbiter in disputes. There ceases to be an incentive for stewardship of resources, since there is no security of ownership, as government provides.

Now, with the climate crisis looming, is not the time to weaken support for stewardship of natural resources for a number of reasons:

1) if energy resource owners do not expect to have secure access to in-the-ground reserves, they may sell them cheap, leading to an increase in carbon-rich fuel use, and thus carbon release to the atmosphere.

2) if shoreline land owners do not expect to continue to control these lands, they will not be motivated to join together politically to fight the climate crisis.

It follows that it is in the best interests of owners to support government. Hence property taxes make a lot of sense, since the people paying; the owners, stand to gain the most by the continuation of the current order that government maintains.

This is why it makes sense to raise property taxes in a recession/depression - we need to maintain civil order to prevent greater suffering, and owners need this at least as much if not more than others, since it is government that enforces ownership.

In our industrialized world, civil order is the basis for survival, not just a pleasantry we can do without. In this time of economic uncertainty, we all are trying new ways of making money, of surviving as individuals. Some of these ways will be against the general good. We need to stop these methods, and we need to be extra vigilant now in these hard financial conditions, because dire circumstances lead to innovation, both good and bad, and we need to maintain the expectations that the the property concept supports. These are, namely, that taking care of things is the best way to act, and that destroying something of greater public value only for lesser, but personal, gain will not work.

Another powerful concept is that of designated responsibility. For example, each of the rest of us stand to gain by enforcing sensible laws onto the selfish innovator of a new type of crime, and we each have some legal responsibility to enforce some laws in some circumstances, but as a group, we typically designate police officers and the courts with the specific responsibility of enforcing law, and furthermore each group of police officers takes responsibility for a certain area, and divide the work into shifts of time, when each work a given beat. This works
better because responsibility is designated.

The current financial disaster came about because no one was responsible for the enforcement of law onto the new financial entities allowed by neo-cons via revoking the Glass-Steagall act. Yet in response we act as though it makes sense to match declining tax revenues with reduced police forces, and reduced enforcement of law, when the opposite actually makes the most sense. The opposite is increased enforcement during these times of temptation, and increased taxes to pay for it, especially on those who stand to benefit the most by the continuation of our imaginary ownership concepts.

It would be deeply ironic if the financial disaster to which lax regulation led us, led us in turn to lax regulation via government cutbacks, and if this led those most liable to gain by the continuation of the concept of ownership to cut back on just that which best protects the advantage they have worked so hard to create.

We will need more than increased enforcement to get us out of the current financial and environmental bind - we will need to rethink what we do, and take wise counsel. One of the classic ways to take counsel is by reading.

With the invention of the printing press, many can now read what a few have written. Just a few, who have figured out a better way, can lead many along that path. Instead of only having each of us read once a book we bought for ourselves, we have invented libraries, and made them public, so that many can benefit from one book of wisdom. It is a powerful technique that strengthens in the inevitable clash with other different ways of doing things. As we each learn how profoundly changed our individual circumstances are by the financial turmoil of the era, we will each need to rethink our approaches, figure out new ways of doing things, or old ways of doing things that newly make sense, given the new higher cost of energy, and new realization of the great cost of releasing so much carbon from fuel use. There is a great opportunity to take counsel from the learned, via their books, through public libraries, and we can assist each other in doing so by expanding library hours, and by directing acquisition departments to shift emphasis from the purely entertaining to the substantive books.

Libraries also provide access to the powerful tool of the internet for those without the tools at home, It is especially important to provide access to hope, to honest ways of bettering one's life in ways that benefit society, instead of degrading society, to these of us who don't have much, and who are thus more tempted by the struggle for survival to better themselves at the expense of others. Expanded library hours could help here too.

Afghan War Cost: What can we afford?

I read today that the US counterinsurgency field manual recommends a soldier for every 50 residents of an insurgent region:
http://www.tnr.com/article/world/stalemate


Afghan population estimates range from 23-33 million people currently, with most estimates being near 30 million, (from an English language Google search of UN and CIA sources). Let's assume the population is 30 million. So an occupying force of 600,000 would be needed.

With non-US NATO troops at 34,000, the Afghan army currently near 100,000 and the Afghan police at 80,000, there would need to be about 386,000 more troops put up by the US.

How will McCrystal get it done with 40,000 over the 68,000 US troops already there? Won't he be 386k - 108k = 278,000 US troops short?

Then the expected cost of occupying Afghanistan successfully for the US would be 386,000 troops times US$1 million per troop, or about US$ 386 billion per year.
http://www.bloomberg.com/apps/news?pid=20601087&sid=aGvM0165Q9bs

If we can get local control set up in a decade (unlikely, says Rory Stewart, Harvard:)
http://www.hks.harvard.edu/news-events/news/testimonies/rory-stewart-on-afghanistan
then the total US cost would be US$ 3.86 trillion; if it took twenty years, the US cost would be US$ 7.72 trillion.

We have a US population of about 0.3 billion, so that is $26,000 per person, right? Can we get that kind of money? If we could, aren't there better things to do with the money? What will assuming this kind of debt do to the dollar's strength?

Does Goldman-Sachs know something you don't?

Re:
http://www.mcclatchydc.com/227/story/77791.html

For Goldman-Sachs (GS) clients, the question now is not why GS bet against
the housing market. The question is 'Why didn't you tell me?

One might hope that one could hire such brilliant analysts to defend one's
own financial interests (say by putting it into a contract or something).

Recent evidence suggests that even if you find and hire firms that do
understand reality, and can tell a bubble from real value growth, they
will not help YOU.

It is clear that GS did not err in serving their clients out of ignorance,
or incompentence, like the other Wall Street firms - Their record in
serving their own financial interests here proves that.

Can self-interest explain GS perfidy? Wouldn't an investment advising firm
stand to gain when its reputation is enhanced by its clients either
gaining more, or losing less, than other firm's clients?

Here, GS missed the boat, so rational self-interest fails to explain the
firm's behavior, if we assume that clients can learn from reality, and that free markets work, etc.

GS, although perceiving their immediate self-interest in hedging their housing
bets, did not perceive any self-interest in actually serving their clients
similarly.

Perhaps we have only one of three conclusions left:

1) GS is stupid. This is countered by the facts of their success.

2) GS is crazy - crazy like a fox.

3) GS thinks their clients are stupid, too stupid to see GS's perfidy, and
that there is no market-driven need to actually serve their clients
competently, or honestly.

Or is there another, more innocent explanation? Perhaps GS knew that their
clients did not trust GS enough to believe GS when it gave accurate, but
unpopular investing advice. (Cue: violins) GS, knowing that it could do nothing for its insufficiently-trusting clients, was left with no recourse but to survive
alone financially, without its irreparably-doomed clients (Sorry, guys - no time to explain).

While one might be able to discern, with further examination, which of
these best explains our reality, perhaps it is enough to see that any one
of these are true, as one considers investment advisors, or government
management of financial firms.

In sum, the only people wise enough to see the housing bubble were not
honest or sane or trusted enough to tell their clients about it.

And Goldman-Sachs, in its exceptional and now-proven wisdom, knew that the
free market does not work (for you).

Brian Cady