Donald Trump on National Healthcare

I missed this one. But as I followed-through on the various claims, I have to say I'm afraid Trump seems to have gotten this one pretty close to right!

Let me get this straight. We're going to be “gifted” with

• a health care plan we are forced to purchase and fined if we don't,
 
• which purportedly covers at least 10 million more people,
 
• without adding a single new doctor, but
 
• >provides for 16,000 new IRS agents,
 
• written by a committee whose chairman says he doesn't understand it,
 
• passed by
  • a Congress that didn't read it, but
   
  • exempted themselves from it, and
 
• signed by a president who smokes [or at least did until very recently--JAH], with
 
• funding administered by a treasury chief who didn't pay his taxes,
 
• for which we'll be taxed for four years before any benefits take effect [well . . . many people would question this idea; there have been several "benefits" (as a result of government mandates, not government funding) that have granted additional coverage to young adults (through age 25) and forced insurers to cover persons they would have previously refused to cover--JAH],
 
• by a government which has already bankrupted Social Security and Medicare,
 
• all to be overseen by a Surgeon General who is obese [Ouch! I can't verify Trump's claim about obesity; though based on what I know of how skinny a person has to be to fall within the "normal" range on the doctors' charts, she is clearly at least "overweight" (again, according to the doctors' charts--JAH], and
 
• financed by a country that's broke.

Hmmmm. And I'm paying my taxes for this?

Unintended consequences of national health care: incentives

I met with a new vitality and longevity doctor last Friday. We had a great time swapping stories and perspectives.

"I'm all for evidence-based medicine," he said. "The only problem is, whose evidence? And how much is required?"

I will give just two examples from my own experience:

• Thyroxine: Kaiser Permanente (at least the doctors I've been dealing with) takes the perspective that a TSH (Thyroid Stimulating Hormone) test is "good enough" to tell whether and how much you need thyroxine supplements. Problem is--and I've seen it in my own body, not to mention read enough stories of others: Your TSH may come back in the "normal" range but the actual thyroxine hormones--T4 or T3 (not to mention Reverse T3)--may be completely wacked out. Or, as many (primarily women) have discovered, their T3 levels may, according to the standards of the laboratory, be within the low "normal" range, but they are feeling sluggish and exhibiting all the signs of significantly low thyroxine. "But the test shows you are normal," says their conventional doctor. "Yeah, but my body says I am low."
  
  Guess who's going to "win" this particular battle?
  
  The only way the woman is going to win is to find a doctor who is willing to consider the broader range of diagnostic symptoms than the TSH test and the supposedly "normal" range.
   
• Testosterone: Yipes!
  
  According to the latest LabCorp standards, "normal" serum levels go all the way from 193ng/dL on the low end up to 740ng/dL on the high. Strangely, up until sometimes late last year, their "normal" range went from 280ng/dL to 800. And while that was LabCorp's standard, my longevity and vitality doctor was recommending a range of 700 to 900 as optimal.
  
  Well, I can tell you from experience that, at least for this guy, at 441, I was definitely below optimal. From the mid-500s up to 900, I was doing very well. When I hit 194 last year (supposedly "normal," right????), I was in major trouble. I had no physical response at all. Without getting graphic, let's say it was as if all the nerves had been cut to a certain portion of my anatomy that, when healthy, would have plenty of neurological receptors.
  
  But there was nothing.
  
  Kinda scary when you think you might have a few years, yet, to live! Or, at least, you'd like to imagine you might have a few more years left.
  
  But "evidence-based medicine" would have told me that my labs were "normal," even if they did come back at the bottom edge of normalcy.

So my doctor and I were discussing things like that.

He brought up the upcoming/expected healthcare program from our federal government.

"The bill is 2,000 pages long," he said. "We are told we can expect that there will be approximately 100 pages of regulations for every page in the bill. In other words, 200,000 pages of regulations.

"Guess what the penalties are if a doctor breaks one of the regulations?"

"I have no idea," I said.

"A $100,000 fine for the first offense," he said, "and it goes up from there."

According to Andrew Breitbart's BigGovernment blog,

The National Coordinator for Health Information Technology “will determine treatment at the time and place of care”. They are charged with deciding the course of treatment for the diagnosis given by the doctor.

Now it becomes obvious why there has been a big push towards the implementation of universal electronic medical record use. It becomes a tool to completely control the physician and the patient. Those physicians and hospitals that choose to practice individualized patient care in consultation with their patients will be punished because they are not “meaningful users of the system over time.”

Beginning January 1, 2013 penalties for doing the right thing for a patient will cost the doctor $100,000 for the first offense and jail for the second offense. This will have a chilling effect and may be the straw that completely breaks the foundation of good medicine – the doctor patient relationship.

And then he said almost exactly the same thing my last pre-Kaiser general practitioner said to me: "I'm going to quit practicing medicine. It's not worth the risk."

My last pre-Kaiser GP, who may be about 60 years old at this point (he would have been in his low 50s back when I dealt with him) said he had made only $75,000 a year in the last three years of his practice; he felt he received no honor anymore as a doctor; all of his decisions were second-guessed and overridden by the insurance companies ("A high school graduate reads down a list and tells me, 'Yes, you can do that,' or, 'No. You may not provide that kind of service to your patient.'). My brother-in-law, who owns a carpet store can win trips to Hawaii, but if I so much as accept a pen from a pharmaceutical salesperson, I am charged with ethics problems. . . ."

He quit.

The doctor with whom I was speaking last Friday made another comment that struck me with respect to my old GP's comment about honor: "We are no longer called 'doctor,' anymore. We are called the same thing as nurse practitioners, chiropractors, and hospital orderlies: We are all 'healthcare providers' or 'healthcare workers.'"

"Why would anyone go through all the pain and agony of a full medical education to wind up hundreds of thousands of dollars in debt . . . and earning $75,000 a year?" asked my old GP.

"Why would anyone want to go through the pain and agony of a full medical education only to become a 'healthcare worker' on the same level as a nurse?" asked my vitality and longevity doctor.

One last comment he made:

"I did my residency in what was, arguably, the very best hospital in the country at the time. But I am paid no more by the government than the person who was trained at ___________" (and he mentioned a fine, but certainly not nationally-recognized facility). "What's the point?"

I'm sure there will still be those who desire to do the best or be the best, no matter what. But one does have to begin questioning the impact of incentives.

Tilting at windmills . . .

After my post Tuesday about Wickard v Filburn, when I began reading my tardy copy of this week's The Week magazine, I realized conservatives are almost assuredly mistaken who took comfort in Judge Henry Hudson's ruling last week about the so-called health-care reform measure.

The Week reported,

A federal judge in Virginia gave new momentum to Republican opposition to President Obama’s health-care reform by ruling this week that it’s unconstitutional to force individuals to buy health insurance. Judge Henry Hudson said the Constitution’s Commerce Clause does not authorize the federal government “to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market.” . . .

This ruling properly frames “Obamacare” as having “historic consequences for American liberty,” said The Wall Street Journal. Obama’s scheme depends on the government punishing citizens who don’t buy health insurance—in effect, a tax on “doing nothing.” Can Big Government get any more intrusive than that? The only flaw in Hudson’s ruling is that it “didn’t go far enough” and kill this monstrosity in its crib, said Investor’s Business Daily. But at least the judge has given “a strong momentum boost” to a repeal movement that once seemed like “wishful thinking.”

Based on what I wrote about Wickard v Filburn, I'm afraid it is still wishful thinking. If the Supreme Court were to overturn this legislation, it would mark an astonishing "new day" in the dismantling of Big Government.

In the same article, The Week said,

The Obama administration compared this ruling to earlier conservative objections to Social Security, Medicare, and civil-rights legislation. “Those challenges ultimately failed,” said Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius, “and so will this one.”

It will be interesting--but, in my opinion, hardly likely to be surprising--whose hopes and/or predictions will come true.

Hey! Let's game the system!

As the rules become clear, the opportunities to push personal responsibility onto the foolish and gullible taxpayers also come to light.

If you don't have a major or chronic illness, forget buying insurance under the new national health care system. Save your money for when you really need it!

Brilliant, easy-to-understand, and mercifully short explanation of how to save thousands of dollars a year in medical expenses now that the government is here to save us all.

What's the word for this?

Oh, yes! "Moral hazard."

The financial future of the United States

Last Saturday evening, Sarita and I went out to dinner with some old friends. He works at a major aerospace company. Whenever we talk with this couple, I know I have to be careful about touching on subjects that could be touchy from a security/secrets perspective.

At some point in the conversation, we got talking about the state of American technology and infrastructure. He mentioned that his group is doing very little truly transformative, new development but is, instead, always having to write code to work around equipment that is breaking down.

????!!!!????

I didn't understand. It didn't make sense to me.

"Wait a second. You're saying the equipment--computer processors--are breaking down? Why wouldn't your clients either get new equipment or fix what they already have? I mean, computing power is getting less and less expensive. . . ."

"But suppose we can't get to the equipment . . . ," he suggested.

????

"Suppose, for example, that we're talking about, say, a communications satellite in geosynchronous orbit. . . ."

"Yes . . . "

"Well, you can't get to it."

"Why not?"

"It's out about 26,000 miles."

"So? . . . I mean, the Earth is only--what?--about 18,000 miles around the equator. So it's not that far. . . ."

So we got talking about the space station and the Hubble Telescope--which are only a couple hundred miles above the Earth's surface--and how difficult and expensive it is for us to get to them to make fixes and adjustments.

Now push that distance out by a factor of 130 times.

The conversation drifted pretty quickly, then, to other subjects, including, for some reason, the interstate highway system: Could the United States possibly do, today, what it did in the mid-50s and through the very early '70s?

We all agreed that such exploits would be virtually impossible.

We could not build another interstate highway system. We could not send a mission to the Moon beginning from scratch (the way the U.S. did back in the '60s). . . .

As Sarita and I were driving home, we drove along a small portion of an interstate highway and the road was pretty broken up.

As we drove across a bumpy section of soaring interstate bridge, I got thinking about the crumbling infrastructure of the United States--how so many hundreds of bridges in the U.S. are in serious need of maintenance, repair, or replacement.

I realized the U.S. can't afford to maintain, repair or replace these roads or bridges, partially because it has never fully paid off the original costs of these bridges . . . since it borrowed money to buy the roads and bridges in teh first place.

But/and now it's 40 or 50 years later, and the U.S. government is like the family that bought a car beyond its means, hoping and praying it would be able not only to pay it off before they figured they would need a new car in five or seven or 10 years, but, perhaps, they would even be able to lay aside some money to have a bit of extra cash on hand to pay for the next vehicle.

Too bad for the family: Having signed up for a $17,000 loan when they first bought the vehicle 17 years ago, they have never really paid it off. Oh, yes, the original debt instrument is no more. But in order to finish their payments, they "simply" bought more of their then-current food, clothing, furniture, toys, etc., etc., on credit (using their credit cards) and used the cash that had thus been "freed up" to pay off the vehicle.

Today, they are still driving the car they bought 17 years ago; it is in truly horrible condition. They have have $35,000 in credit card debt, a $247,000 home mortgage, and . . . well . . . the screws are tightening.

That's the U.S. Most especially at the federal government level.

The U.S. federal government hasn't paid off a lick of debt in 80 years.

And its acknowledged debt obligations amount to almost $13 trillion. Add in all the unfunded Social Security promises it has made (in case you are unaware: the government has saved absolutely nothing for Social Security; it has absolutely no investments set aside to make its promised payments), and the unfunded Medicare and Medicaid promises, and the retirement payment promises it has made to federal employees (who, on average, as wage-earners, earn twice what people in the private sector make), and the . . . well, let's not go into all the details . . . --But if we add in all the unfunded promises the federal government has made--promises to pay that no private company would be permitted to make if it hadn't set aside resources to pay them: the federal government is well over $110 trillion underfunded and/or in debt as we speak.

And who is going to pay these bills?

You and me? People over 40? Not likely!

It's our children, grandchildren, and great grandchildren who will, somehow, have to shoulder the burden. Oh, and some Boomers and X-ers as well, I imagine, as we, who have failed to make preparations for ourselves, will find the government cannot fulfill its promises in any form we might expect based on the government largesse of the '60s, '70s, '80s, and '90s.

A Parable for Our Day

I happened to locate an article yesterday that placed what I had already begun to feel into stark, concrete, historical terms. It's sub-titled Your Future of Blackouts and Shortages as the U.S. Becomes a Third World Country. James Dale Davidson, the author, lives in Buenos Aires, Argentina, and, he says, "There is perhaps no better place on earth to contemplate economic decline than in" Buenos Aires.

In essence, he says, beginning in the late 19th century, and up until 1929, Argentina was a very wealthy country. One of its great advantages: It was in close relationship to Great Britain.

Following WWI, however, with the decline of the British Empire, it didn't fare so well. Still, many analysts believe that, even in 1929, Argentina was one of the wealthiest countries in the world per capita. It was certainly ahead of Germany, France and, of course, Japan (since Japan was still a backward "developing" economy at the time).

In the meantime, however, Argentina has fallen hard. It is now far behind Europe, North America and Japan. The United States ought to look to Argentina as an object lesson for what will happen if we follow the siren song of government salvation.

Human nature being what it is, however, I'm afraid we are going to follow Argentina's path to destruction.

Like the US today, Argentina entered the Great Depression in 1929 heavily dependent on foreign capital, with highly unequal income dispersion, wide political resentments and lots of what would become bad debts in the banking system.

The path Argentina took out of depression led from bank bailouts to runaway budget deficits, hyperinflation and decades of negative compound growth.

An open, free economy was replaced by a closed system, hobbled by intervention and inward-looking strategies after the Great Depression.

Argentine economist Mauricio Rojas writes in his book, The Sorrows of Carmencita (p. 89), “The [Argentine] government couldn’t pay its bills, so it tried to inflate them away. The rise in prices between 1976 and April 1991 was an incomprehensible 2.1 billion times. During approximately the same period, per capita income sank by over 25% and the poverty rate among Argentine households soared from 5% to 27%.”

Argentine pesos worth a billion dollars in 1976 were worth only 47 cents 15 years later. And this was the result of ongoing government deficits averaging only 14% of GDP. Sound familiar?

Of course, it was not merely government borrowing that got Argentina into trouble. It was also government policies.

To illustrate his thesis, Davidson summarizes the sad story of Unión Telefónica del Río de la Plata Ltd., the British-owned Argentine telephone company that operated efficiently and profitably far into the 20th century . . . until the Argentine government under Perón bought it, renamed it Empresa Nacional de Telecomunicaciones (ENTel), and drove it into the ground. (By 1990, Davidson says, ENTel's service was "arguably the worst in the world, even worse than the poorest African countries. Argentines had to wait as long as 15 years to obtain a phone line, and then installation cost as much as $1,500.")

Davidson also describes the Huemul Project--a government program that was supposed to produce nuclear fusion. Energy produced by the process, Perón believed, would be able to be delivered in milk-bottle sized containers for use in airplanes and other vehicles. "Success was proclaimed; but no proof was given. When independent scientists investigated Perón’s Huemul Project to provide nuclear fusion in milk bottles, they revealed the project was a fraud."

[Will the United States endure similar frauds under the ever-louder siren call of research projects "needing" to be funded by the government in order to meet the legislated deadlines of alternative energy? Davidson asks.]

As decision-making power here in the United States becomes ever more centralized, I think Davidson is correct: We can expect greater and greater inefficiency, greater corruption, more and more serious repercussions from every decision that is made.

• The "punitive cap-and-trade carbon taxes" being urged by certain big-government environmentalists, "will make Al Gore richer," Davidson suggests (see this article and this one, too, for some perspective on Gore's expected windfall); but will it make you and me poorer? (Hate to say it, but I think most likely!)
   
• "When Perón took office, Argentina had the world’s second largest gold reserves. But these were soon squandered nationalizing industries and funding politicized investments, like the Huemal Project." (Kind of off-subject, here, but I think it's interesting: I just read that in 1940, when paper dollars were actually redeemable for silver (the face of a silver certificate said, "This certifies that there is on deposit in the Treasury of the United States of America one dollar in silver payable to the bearer on demand."), the United States government held 6 billion ounces of silver--to fulfill its promise. Today, with the "dollar" meaning, really, nothing more than a sheet of paper with printing on it that declares "This note is legal tender for all debts, public and private," the government holds no silver. None. Nada. . . . As for gold, it holds just over a quarter of a billion ounces. . . . A lot of people will say: "Who cares? No one--well, no one who counts--thinks money needs to be tied to precious metals. There are other ways to value currencies" . . . and they will mention land, labor, energy, and other things of value [how about, "a force-backed claim on . . . the productive power and wealth-producing capacity of the sovereign economy on the whole"--i.e., a government's ability to extract wealth from its subjects?] that might be pledged as the foundation for the currency's intrinsic worth. And maybe they are correct. Though it sure feels crazy that an entity like the Federal Reserve can create "money" out of nothing whenever the U.S. government asks. . . .
  
  But while we're on the subject, let me note that, while a quarter billion ounces of gold sounds like a lot, it's really not. At today's prices [just over $1,000 per ounce], that amounts to only slightly more than a quarter of a trillion dollars: "nothing more than pocket change on the Federal balance sheet," the equivalent of little more than "a rounding error . . . and irrelevant to overall governmental finances," according to Bill Zielinski.)
   
• "As the US follows the same policy path as Argentina," Davidson suggests, "it will obtain similar results. Perverse policies will destroy prosperity and inspire thinking people to get out, and/or get their money out." ("This is already happening," says Davidson. "In 2008, more than two million Americans emigrated, marking the first time that net legal and illegal migration . . . reduced the population of the US.")
   
• As more people seek escape, Davidson suggests, the federal government will do what Perón's government did: impose exchange controls. Moreover, "Soon after, the government will demand that people who had the foresight to take their money out bring it back."
   
• "Although the U.S. government will resort to draconian measures to tax the 'rich,' . . . destructive economic policies will diminish tax revenues even as government spending runs amok."
  
  "Diminish tax revenue"? Davidson notes that,
  

  Among other consequences of runaway budget deficits and hyperinflation was the virtual disappearance of the income tax in Argentina. It shrank to just 1% of GDP as the value of the previous year’s income became pocket change by the time taxes were due.

   
• Next consequence? Wage and price controls.
   
• . . . And so on and so forth.

In sum: As the government's true bankruptcy becomes more and more obvious, the U.S. will not be a pleasant place in which to live. And, I might add, it will be especially unpleasant for those of us who grew up here because so few of us have ever lived with any real deprivation. We are not used to the kind of basic living arrangements that so many people around the world experience. We "expect" better. We "demand" better. The government--at least many of us seem to believe--"owes" us better. Y'know, it "owes" us things like free health care.
*******

For more on the subject of the economic future of the United States, I recommend the following articles I discovered in the midst of researching and writing the above:

• What you must know about bankruptcy of the United States--an interesting and, I dare say, informative analogy between the federal government today and General Motors three years ago, before it went bust.
   
• For a brief, crisp summary of Argentina's demise, see Stephen Cox's review of Rojas' The Sorrows of Carmencita: Once a Great Nation.
   
• 20 Reasons Why The U.S. Economy Is Dying And Is Simply Not Going To Recover--a concise, and graphically-rich summary of significant economic data.
   
• Another alarming article by James Dale Davidson, this one from February 2009, subtitled Why the U.S. Banking System is Toast. Davidson offers analogies to and perspectives from the bankruptcy of Iceland in October 2008 . . . and the trillion percent hyperinflation in Brazil during the '80s and '90s . . . to Japan's economic downfall in '89 (from which it has yet to recover) . . . to the Great Depression in the U.S. --To save a bit of time, begin reading from the paragraph that starts "A decade and a half ago there were few subprime mortgages."

I'll stop here. Sorry to have gone on so long.

[NOTE: If you are reading this article on Facebook and can't use links or don't see photos, please realize it originally appeared and is still available on my personal blog.]

Nationalized Health Care

I woke up Christmas morning thinking about this video (0:31):



The people who put the video together obviously believe that a nationalized healthcare system would be/will be a good thing.

Clearly, this family was put into a tremendously difficult circumstance. And then their neighbors came together and bailed them out. Indeed, all the footage and, it seems, all the music, too, is from neighbors' fundraising efforts.

"It took our neighborhood to come together to save us," the narrator says.

But rather than noticing how her family's difficult circumstance were actually overcome through unified community effort. And rather than noticing how truly thrilled participants seem to have been to have helped her, she concludes:
If we can get it in Washington Park [Winston-Salem, NC], then why can't they get it in Washington, DC? Look: "Public Option," "Trigger" . . . --I really don't care what they call it: something's got to change."

And then, finally, a placard: "Isn't it time to put people before politics?"

Ummmm.

My morning wake-up dream/thoughts included these things:

• I would prefer recipients of aid recognize it is a privilege and it is the result of the largesse--the charity, if you will--of those who make it possible for them to enjoy the help they are receiving.
   
• If we are receiving services for which we have not paid, that is a gift; it is not a "right."
   
• Someone is sacrificing in order to make it possible for any or all of us to receive medical help beyond our means. Those of us who receive that aid should recognize the sacrifices of others and express appropriate gratitude. We ought, certainly, not to take the attitude that the receipt of such aid is our "right" and we have the "right" to "demand" such aid.

Upon further reflection, what really bothers me is the notion that some bureaucrats in Washington can cobble together a better, more equitable, more efficient system--in the space of even a few months--than the free market, with all the competing forces of open competition, has been able to create over centuries.

Beyond that, I am deeply disturbed by what I have experienced within and under the drugs regime of our federal government.

I have meant to write on the problems of thyroid/thyroxine over the last couple of months. I expect I will finally get to it sometime in the next week.

I do not regard our government as my friend in the realm of pharmaceuticals. To put them in charge of our entire health care industry is downright scary to me.

*******
And one last set of comments.

I noted the concluding placard in the video: "Isn't it time to put people before politics?"

My question: Are we really dealing with "politics," here? Aren't we dealing with a bankrupt government, already acknowledging it is in debt equivalent to almost 100% of Gross Domestic Product (GDP) ($12.1 trillion of acknowledged debt in a country with a GDP of just under $14.25 trillion) . . . and, if it were to account for its contracted future obligations the way normal businesses are required to account for such things: its total "unfunded future obligations" amount to just a bit over seven times GDP ($106.5 trillion).

Let's put that into perspective.

The ratio of government debt to GDP is really not as important as government debt in comparison to government revenue. After all, the government can't consider total GDP as grounds for spending--either on new obligations or to pay off old ones. It can only spend its actual revenue. And when we look at the debt-v.-revenue numbers, here's what we're really looking at: a government with revenue of not quite $2.2 trillion and an acknowledged debt of $12.1 trillion already on the books.

Put in terms that you and I might be able to digest, that means a family with a net (post-tax) income of $35,000, has a current debt load of (12.1/2.2=5.5; 5.5 x $35,000 =) $192,500. And if we were to include future obligations not funded, the federal government's obligations, for a family with net (post-tax) income of $35,000 is (106.5/2.2 = 48.4; 48.4 x $35,000 =) $1,694,000.

--And this government--this government, that hasn't been able to balance its budget in more than 30 years--through good times and bad--is proposing to take on additional major obligations?

With what money? Whose money?

Do you think the Chinese, who hold close to $800 billion of our government's debt, and the Japanese, who hold about $700 billion, are going to sit idly by as American congresspeople continue to ratchet up their debt with no reasonable idea of how they ever intend to repay it?

I don't. And so, until the American Congress can come up with a plan to pay off its debt, I say: "No new purchases."