We Interrupt Normal Blogging: How the U.S. Gets Out of Our Current Mess

In meteorology, people employed by the government numerically dominate employment. As a private-sector meteorologist, I have continued to enjoy receiving a paycheck while some of my government colleagues are laid off and not getting paid. They, rightly, feel it is terribly unfair. They feel disrespected. And, they fear for their financial situation because some politicians have stated that, unlike past shutdowns, they will not be retroactively paid. Federal workers, just like everyone else, have bills to pay. 

So, I have been able to read/watch passionate discussion about America and what ails us from a rare, heartfelt political perspective I do not often see (I am a Reagan Conservative). Some of it has been insulting and rude. I've "unfriended" four on Facebook because I have lost what little tolerance I've had for rudeness and baseless charges. But, most of it is heartfelt and sincere. It really helped me internalize their point of view.

So, even though I strongly dislike politics ("the art and science of influencing votes") and am bored by political discussions (as opposed to discussion about how government works), I am interrupting the weather-science-climate-preparedness blog with a discussion of how we get out of our current political mess and restore civil discourse. I'm doing this out of a sense of civic duty. I hope I never feel I have to post about politics again. 

Here we go. Please try to withhold judgment until you have read the entire piece.

Part I

True story. Strolling down a south Kansas City sidewalk with a relative of mine who is over 70.

Relative: “The cost of Lipitor is killing me and my friends.”
Me: “You are kidding, right?”
Relative: (shocked) “What do you mean? Lipitor is very expensive!”
Me: Compared to what? A heart attack might kill you. And, even if it doesn’t, it costs far, far more than Lipitor.”
Relative: “Well, Lipitor is just too expensive!”

Did a little research. Omitting the possibility of death, a major heart attack costs $1,000,000 and a minor heart attack $760,000. Generic Lipitor in the 10mg size, without insurance, has a national average cost of about $425/year when purchased 90 days at a time. Yes, it cost more when it was under patent but even then it was much less than 1% of the cost of a heart attack.

The conversation was what I call “magical thinking*.” While emotions are understandable when comes to health care, we often have things backward. Instead of heralding the invention of statins, their lifesaving properties, and the money they save (compared to heart attacks), we denigrate both the drugs (“too expensive”) and their creators (“greedy!”). We single out medical companies for extra taxes. So, we get layoffs and less innovation when we need more innovation and more jobs. http://www.nytimes.com/2013/10/02/business/merck-plans-to-lay-off-8500-workers.html

Instead of insuring against big hazards (cancer, heart attack, etc.), we want 100% of our fees and prescription medicine covered every time we have an allergy or cold.

This is nonsense -- and we have to stop thinking this way. Yes, healthcare is emotional. But, I fear, without a change in thinking, someone could create a $10 pill that cured all cancer and people would be picketing with signs complaining about “profiting from peoples’ misery.” Even in nations with single-payer (government) insurance, everyone has to pay something. There is no free lunch.

With smartphones, internet, and technology there is a real chance that we can improve healthcare and make it affordable. We need to be encouraging, not taxing, innovation!

So, before I offer any other suggestions about specific policies, I must exhort everyone to stop with the magical thinking. Quality health care is not, and will never be, free. 



Part II.

Think about your apartment or homeowner's insurance: Do you pay to insure a dropped teacup or if your house burns down? Of course, the latter.

The entire theory of "insurance" is for many to pay a (relatively) small amount so that a (relatively) rare catastrophic loss will not bankrupt a person or family. Health insurance works nothing like this, so it is not "insurance." It is very possible my home will never have a fire or tornado. It is impossible I could live a normal lifespan without ever seeing a physician. 

So, why do we think it is a good idea to have "insurance" pay for a visit to a physician or a common cold or allergy for which little can be done anyway (colds and allergies cannot be cured) other than treating symptoms? This is nuts. We have to rethink this. Life has expenses. In my world, getting an annual allergy shot should not be part of "insurance." And, an (relatively) inexpensive physician assistant would handle this to keep costs down. Fixing this would seem relatively simple, at least in concept. But, emotions get in the way. 

Many liberals accurately point out that the U.S. is the only first-world nation without some type of national health program. They see it as unjust because they believe everyone has a right to be cared for when seriously ill. 

Many conservatives and tea party members, after being unfairly and illegally targeted by the IRS (and the perpetrators paying no penalty) look at Obamacare, and the fact the IRS is going to enforce it as completely unacceptable. "Health care enforced by the IRS??!! You have to be kidding!!" Conservatives see Obamacare as tainted and will never accept it (because of the IRS connection) regardless of how medically and economically successful it might or might not be. 

So, let's see if we can agree on some principles for moving forward:

  1. We all want good quality healthcare.
  2. We would like health care to be more affordable (I didn't say fewer dollars in absolute terms, that may be impossible).
  3. All constructive ideas welcome, regardless of origin.
  4. Focus, for now, on healthcare. Stop looking at the Affordable Care Act as a proxy for other political issues.


Part III.


Here are my recommendations for breaking the impasse in a constructive manner. 

Delay the implementation of Obamacare, temporarily.

Conservatives, who have been unfairly and illegally attacked by the IRS, will never accept it as OC enforcer since the Administration has not prosecuted a single one of the wrongdoers. This breach of civic trust makes, for C’s, Obamacare a non-starter. Yesterday's new Christian Science Monitor poll showed 57% against Obamacare, so neither political party would pay a price for the delay. Besides, President Obama has (without authorization of Congress) waived the start of the business mandate, so the precedent exists. 

We should adopt the plan of a Democrat, Bill Bradley, from when he ran for President. Every U.S. citizen and permanent legal resident should be able to purchase either an individual or family policy from the same set of policies available to federal employees and their families. There are something like 20 plans with lots of choice and lots of tailoring options.

For those who are poor, there should be a means-tested voucher (no cash value) that can only be used to purchase a policy. It would be administered by existing state welfare agencies. No new giant bureaucracy. Low cost. The voucher pays for a policy that insures against major illnesses not every time someone has a cold unless someone wants to voluntarily pay more. 

Repeal Obamacare but ONLY when we can simultaneously replace it with a plan of along the lines of the above. It should be named, in the best sense of the term, The Democratic Party Health Plan. It was proposed by a D, they deserve the credit. The R’s have done a lousy job in this area of governance.

The plan will have the same restrictions (i.e., other than in an open enrollment period) as the federal employees' plan: you can’t buy a policy the day after being diagnosed with cancer as the federal employees have. Fraud is a criminal offense. Any connection between the IRS and health care MUST be severed.

This Reagan Conservative acknowledges Medicare delivers good service at reasonable cost. However, it “competes” against private sector plans, which is a good thing. If there is one, and only one, government plan the incentive to innovate and improve will die and it will morph into government at its worst. Yes, other nations have “sole provider” (i.e., government only). And, those nations’ track record at medical innovation is generally (not always) poor.

The tax on medical devices will be repealed. We need more innovation, not less. The U.S. Department of Defense has DARPA, which offers prizes to innovation they deem useful. Perhaps we do the same in healthcare for innovations that improve care for the same or lower cost or provide the same level of care for less cost.

Yes, there is the issue of people refusing to buy a policy. Fine, if they have refused a policy, let them go bankrupt if they have major medical they cannot afford. It is time we get back to a concept of individual responsibility. It is time for "tough love." President Reagan was right: If we subsidize irresponsible (not buying a policy) behavior we will get more of it. 

Yes, there are tort abuses which must be addressed.

"Magical thinking" (see Part 1) needs to stop.

But, liberals are absolutely right that we have to improve the healthcare system. Agree, 100%. But, let's do it right this time!!


Part IV.

At AccuWeather Enterprise Solutions, we have a mantra: “Facts are friendly.” It means that, no matter what “political correctness” might dictate or what we think one of our colleagues might want to hear, facts are facts and good decisions have to be made on facts, not emotions.

Something we must stop in the U.S. is treating people with different political beliefs as somehow illegitimate. One of the things I have learned over the last few days is that liberals are sincerely concerned the U.S. is headed for a society of a few (say, 5%) super rich business-types (poster boy: Charles Koch), 15% middle class, and 80% poor.

Interestingly, conservatives see the U.S. headed toward a nation of choking regulation and taxes. Entrepreneurship dies. Eighty percent are poor, 15% (mostly government employees) are middle class, and 5%, mostly well-connected government types (poster boy: Al Gore) are super rich. Instead of merit (i.e., financial success from inventing an inexpensive cancer cure), success is based on who you know and where you went to school.

Both sides see The American Dream as dying.

And, both sides see the present Obamacare/government shutdown as proxies for these larger fears:
  • Conservatives see the IRS enforcement and new giant bureaucracies as steps down the road to their nightmare scenario. They see some liberals proclaiming the Tea Party “deserved it” and zero prosecutions against these illegal activities. The rule of law, which history shows is vital to prosperity and a civil society, is subverted.
  • Liberals see cruel conservatives not caring that people lose their savings because of an uninsured illness. The subsequent bankruptcy plunges people into the permanent underclass in their nightmare scenario. They believe their side has the moral high ground. 
Any common ground here? I’d say there is quite a lot!

I’ll add more: Both conservatives and liberals see the current crop of national politicians as largely useless when it comes to addressing these bigger, overarching issues but “our guys are better than your guys because we have the moral high ground” seems to be the thinking. 

Regardless of who might or might not have the moral high ground, supporting "our team" are missing a real issue that is driving part of the current unrest, because we tend to rationalize bad behavior by "our" side.

I believe there is a genuine, and growing, rift between the interests of the political class inside the Beltway and the rest of the nation. It is hard to believe, but just a month or so ago, the political class was telling us it was imperative we immediately bomb Syria! Huh? In this case, L’s and C’s bombarded Congress with emails saying “don’t go to war over Syria!” According to several news reports, many members of Congress with shocked at the volume, vehemence, and unanimity of the messages from their constituents. This detachment of the people who are supposed to represent us, to me, represents a great concern. 

So, we have this noisy, angry, giant impasse over Obamacare because, it appears to me, it is a proxy for these larger, and very valid, concerns. The politicians (and media) often focus on the wrong things and seem more interested in their own interests than the hard work of fixing these major systemic problems facing our nation.

While I have thoughts about how to fix these larger issues, I am not a political writer and, as I say, politics simultaneously bores me and frustrates me. I'm writing this because I feel an obligation to put my thoughts into words in hopes of facilitating civil discussion. Personally, I like science where facts are paramount. I would be a terrible politician and, besides, with no real expertise in some of these areas, my solutions might not be correct.

So, my more modest goal has been to demonstrate that there are possible, better solutions to healthcare than the Affordable Care Act and that there is legitimate angst and anger on both sides. 

That said, and I hate to sound like a cliché, there is far more that unites us than separates us. Stop the name-calling and aspersion casting and respectfully LISTEN, then speak. Use the ideas here as a basis for fixing Obamacare in a way of great benefit to everyone. Maybe that will be small step toward restoring civility and credibility and it will spur finding real solutions to these problems.

Thank you for reading my thoughts. I'll resume normal blogging tomorrow. 


*I’m borrowing that phrase, used in a different context, from my friend, Dr. Roger Pielke, Jr.


Glenn Harlan Reynolds has some similar thoughts. He makes the point that no one in D.C. is ever held accountable. 

Comments

  1. FYI - I had a minor heart attack 2 years ago and due to my insurance company's negotiated agreements with health providers the total billed amount for all connected charges (ER, hospital stay, meds, two separate stint emplacements, ambulance to St. Louis ($2300!)) was $104,000. Without the agreements it would have been close to $150,000, but still not close to $750k. My out of pocket for the whole year was $7700. That is why I have health insurance. In case I have a major problem I can survive financially. Exactly the same reason I have car and house insurance.

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  2. Right. A heart attack is exactly what health insurance should be for.

    There should be highly economical pure "insurance" packages without psychiatry, chiropractic, etc, that would handle these huge (bankrupting) events.

    Thank you for the comment.

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  3. One of the issues Mike is that we have insurance in the first place. For the same outcomes we pay 50-75% more than other countries. The secret to this is those countries have a single payer - what this *means* is that instead of 10,000 locations paying whatever markup on each medical device that the manufacturer can get away with - they say "give us a quote and the one we pick gets to have an order for 10,000" - which gets them *much* lower prices.

    If you look at *all* the other costs (labor of doctors, and other staff, prescriptions, lawsuits, rent/real estate) we are less than 5% more than other nations - the reason we pay so much more is almost exclusively the fact that we pay more for medical supplies.

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  4. Mike, you might want to put back on your skeptic's hat when discussing medical practices/sciences.

    The U.S. government has forced the medical community, via published health guidelines, to push statins on everyone showing a certain level of cholesterol , thus enriching the drug companies to the tune of billions of dollars. In the past few years, the U.S. established an even lower cholesterol level that is recommended for statin use.

    The medical advisory panel that made the lower cholesterol recommendation was made up of medical professionals who had received funding/income from...wait for it...the drug companies.

    There is now even a push to get youngsters on statins, which is being recommended by some of the same professionals and groups. Hmmm...I thinks that means even more money for the drug companies.

    Like the connection between CO2 and catastrophic global warming, the empirical evidence supporting the benefits of statins is not exactly overwhelming:

    From this article (http://chriskresser.com/the-truth-about-statin-drugs) we learn that studies have determined: Statins don’t increase survival in healthy people; Statins don’t increase survival in women; Statins don’t increase survival in the elderly; and, Aspirin just as effective as statins (and 20x cheaper!)

    From this article (http://www.drbriffa.com/2013/09/13/doctors-can-help-you-get-back-on-your-statins-but-does-this-help-you) we learn that studies have determined: Statins have many undesirable side effects, including those that can kill.

    Also, the Cleveland Clinic conducted a study on its cardiology patients and found that after 8 years of taking statins death rates were not statistically lower in those taking statins compared to those who were not.

    Despite the preponderance of objective empirical studies identifying statins of having little value for the majority of people, the health care complex is literally pushing statins on everyone because the U.S. government decreed it, without any public scientific debate - kind of like pushing ethanol on everyone despite causing food prices to inflate, with little known positive environmental benefits, and most assuredly, negative eco-impacts.

    How has this happened in our great country?

    Well, people are incredibly gullible and very uninformed about a lot of health science and health care practices, thus the government can literally get away with anything. (Just like they are uninformed and gullible about climate change, CO2, etc.)

    Like the well documented failures in the education and banking realms, the Federal government does not allow a free market in the health care industry - this is true across all aspects. Also, the industry is over regulated and has become a bureaucrats dream, and a crony capitalist's heart throb (a lot of money flows into corporate coffers that support even more regulation).

    Objectively, the Feds will only make health care worse for all - witness the politicos that passed the Obamacare monstrosity for they want nothing to do with it - they want to be exempt from their own creation.

    Btw, here is a video (http://youtu.be/3vr-c8GeT34?t=42m35s) by a doctor talking about his own experience and research on cardiovascular disease - it's is eye-opening and certainly not a ringing endorsement of the government and the "consensus" medical establishment. (At the 42:35 minute mark, watch closely as the evidence of conflict of interest of the medical panel producing cholesterol recommended levels is discussed.)

    So how do we fix all these messes?

    When it involves the government and the industries they regulate, always wear your skeptical hat and educate the uninformed, no matter how long it takes.

    'C3' Editor

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  5. C3, thank you. I was unaware of this.

    However, I need to you that I have been told personally by consultant doctors at Mayo Clinic that statins are effective. Thus, my lack of curiosity (i.e., they are [supposedly] experts).

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  8. (1) By putting off "Obamacare" temporarily, what do you say to the folks -- no, this isn't me , but some I know -- who have diabetes, heart trouble, etc., and have been putting off changing jobs or taking early retirement til 2014 so that they will be able to buy coverage even with a pre-existing condition? If those folks have been doing their planning based on the law of the land and now the law of the land is changed three months before their plans were to cut in, isn't that pretty seriously moving the goal posts?

    (2) Should you say “well let them buy their insurance, but just put off the mandate for all to buy,” how does that keep the insurance companies from being victimized, even bankrupted, when only sick people buy insurance for 2014 and younger, healthier people don't because the mandate is suspended? Doesn't that dramatically change the risk pool and move the goalposts for the companies?

    (3) Don't quite understand the "teacup" analogy on what "Obamacare" compliant policies cover. Take a look at some "Bronze" and "Silver" plans being marketed to Wichitans. I defy anyone looking at the co-pays to say these insure teacups or cases of the sniffles. http://tinyurl.com/pxub8a4 Many of those deductibles are huge, which seems to be what you are suggesting in your post that insurance polices should be.

    (4) Sorry you don't approve of coverage for psychiatric services, but don't understand the objection on chiropractic, which is *not* an essential service under "Obamacare." (Scroll down to "Essential Health Benefits" in this article: http://money.msn.com/saving-money-tips/post--how-to-pick-an-obamacare-insurance-plan )

    (5) My understanding of the $30 billion tax on medical devices, unpopular as it obviously is, is that it was put into the Act as one of several ways to keep the act revenue neutral or positive, so that political complaints that "Obamacare increases the deficit" could not be made. Repeal the tax and keep the Act, and the deficit grows by $30 billion, I suppose.

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  9. Keith, contrary to your assertion, I'm all for psychiatric services as long as they are a choice, not mandatory.

    The "law of land" objection is seems invalid to me. President Obama, unilaterally (i.e., without congressional approval) has waived the business mandate for a year. He has given over 1,000 waivers to unions. None of this was provided for in "the law."

    The system I am proposing is far, far simpler than Obamacare (Proposed by a D!!). In the long run, it will save a fortune in administrative costs.

    We desperately need less taxation and regulation. If we do that, we'll make up the $30 billion very quickly.

    Mike

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  10. Hi Mike,

    As we both know, climate science is a very contentious issue. It turns out, as I discovered, health science is just as contentious, if not more.

    The "experts" represent the science conventional view based on hypothetical science going back decades. If you had the time (ie, you were not running a business and writing books) your inquisitive mind would lead you the incredibly hot debate going on in the cardiology and nutritional science.

    In essence, there is no solid empirical evidence or human clinical studies that prove eating fats/cholesterol cause heart disease. But a huge share of the medical establishment, research and treatment practices are based on that faulty hypothesis, costing us multi-billions each year while enriching corporate interests.

    Like the government involvements in the climate science of blaming CO2, and the subsequent stupid environmental/energy policies that then harm the economy and individuals, the government "experts" have done the same with fat/cholesterol in the health care industry.

    So if a heart specialist ("expert") at the Mayo Clinic, which has built its entire practice around a false hypothesis, which is supported and funded by the federal government, is not about to risk his career and financial security by challenging the lucrative, consensus view.

    Now to add to your misery on this controversial health science subject...the brain is the human body's biggest user of cholesterol; it absolutely has to have cholesterol, and a lot of it; research has discovered that the brain's of Alzheimer patients are dramatically lower in cholesterol content than normal brains; and statins are known to substantially reduce cholesterol.

    So, when you put two and two together, based on the government's approved science and the experts' statin treatments, the result is the the potential unintended consequence of producing more elderly Alzheimer patients - literally, it's already being called an epidemic.

    This epidemic could bankrupt the entire health care system because the care of Alzheimer patients is so freaking costly and growing.

    Because I'm in my sixties with a lot of time on my hands, I have been able to educate myself. I've chosen not to take the "experts'" recommended statins since I really don't want to be sitting in a wheel chair, in front of a TV, drooling into the bedpan I'm holding. If I go out, give me the Tim Russert solution (who by the way was taking statins and had really low cholesterol readings).

    Hmmm, did I mention the expert-recommended statins have not proven to be effective in preventing cardiovascular death events for most of the population?

    To rephrase my earlier comment, how did this great country get to this point regarding the very questionable science backing heart disease policies and the preferred treatment (stains)?

    It was because of politicians (namely George McGovern) and federal government bureaucrats that rubber-stamped a bad scientific hypothesis, which then unleashed bad policies on the American public, wasting hundreds of billions in the meantime on ineffective cures.

    Sounds familiar to the climate science/policy debates, no?

    How to solve the problems of the very dysfunctional and costly health care complex and its reliance on bad science?

    Reduce the government's involvement and regulatory reach. Open the health market to competition, from the insurance side to the innovative non-consensus science that holds so much promise.

    How to solve America's problems in general? Same - reduce the government's involvement, significantly.

    p.s. If your readers are tempted by the "experts" siren song of statins, might I suggest their doing a lot of research prior to making that decision - that homework might save them from a potentially bleak end-game of Alzheimers or severe dementia. Just a thought.

    'C3' Editor

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  11. Very good article, Mike. I would point out that it didn't take the IRS scandal to turn the Tea Party against Obamacare; it was the very passage itself that began the movement. We've got to start electing people who will work with the other side. Otherwise nobody will get any of what they want.

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  12. Mike, I thought this brand new article may be of interest. A peer reviewed study on statins essentially discredits all the "experts" pushing statins on Americans.

    http://articles.mercola.com/sites/articles/archive/2013/10/09/statin-cholesterol-lowering-drugs.aspx

    As a libertarian/conservative, I concur with your suggested approach to fixing the 'mess'. I would add, though, besides each individual taking back more responsibility, each individual also needs to quit accepting at face value the advice/recommendations of "experts", be they in the health care industry and/or the climate science realms.

    'C3' editor

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