Wednesday, June 27, 2018

Universal Health Care

So, health care. What do we need?

The United States is a large, relatively wealthy nation.  Yet in many respects, we act like a poverty stricken region, with little intelligent thought given to our population. It would seem to me that one of the primary responsibilities of a governing system is to see to the overall health and well-being of its population. But what does that mean? That everyone gets free food and free health care? Well, no, not exactly.  But it should be the case that our nation decides that all of its citizens should have access to adequate food and health care, that food and health care should not be denied to any part of the population.

People should not become sick or die of malnutrition because they have no food. People should not die because they cannot gain access to our system of health care. Note, if a ruling party decides that a goal of its system of governance is that its entire population should have access to food and access to quality health care, then that same ruling party must design the systems and programs whereby such a goal(s) can be achieved.

It is a principle of management that, when one develops an overall goal for its population, it is the responsibility of the program managers—the ruling party—to design a complete program that will lead to achievement of the goal(s). To announce a goal, and then leave the program’s design to chance, is to act irresponsibly, and to thereby assure that the goal will not be achieved.

This simple statement appears to describe where we are as a nation at the current moment.
For decades, we have been experimenting with both health care and food assurance to no avail. During the Johnson administration, our nation’s program managers devised a program that would assure access to quality health care for both its senior citizens and its poor. At least for the seniors, the program has worked wonderfully well, although it has begun breaking down as the program’s manager’s delegate increasing responsibility for the program’s finances to for-profit enterprises that actually hold different ultimate goals than the program’s founders and ostensible managers.  

In terms of food, our system of entirely private food production and distribution works well to both produce and to distribute food to all geographic corners. However, access to food is entirely a one element system—money. The government has (no doubt wisely) decided not to interfere in the actual production or distribution systems, but rather to treat access to food as entirely a matter of affordability. If the population has enough money, the entire population will have access to quality food. Therefore, the government’s program to assure access to food is a financial one entirely. The program managers decide how much money individuals need to live reasonably in any given part of our nation (costs vary by geography). The coping system is termed Welfare. When incomes drop below certain predefined levels, the population can apply for and then receive supplements to their income to guarantee access to food (and lodging). Note that the system will break down should the program managers (government) decide that the financial amounts needed by population segments cannot/will not be made available.

But access to health care has always been more complicated.  Our system of health care in its earliest stages was simply on a pay-as-you-go basis, much like food.  But, unlike food, health care services rapidly became expensive to individuals in need of the higher cost services.  And, as more and more people began obtaining health care services requiring care within hospitals, the cost of hospital stays began escalating beyond the ability of individuals to afford.  Thus, enter health insurance.  An entirely new industry, has now emerged as a major element in the ability of the “system” to provide adequate access to the entire population.  Initially, health insurance became an element in employment. That is, if one was employed full time by a responsible company that company entered into relationships with insurance companies that would guarantee access to the employees to full health care. The company and the employees would split the costs of that enterprise, so that health care did not “break the bank” for either party.  It is important to remember that health insurance is affordable so long as the pool of people covered is large enough that the costs are spread such that low users subsidize high users, so as to contain the costs, enabling the entire pool to have access. That is the obvious system design element that is slowly slipping away, and jeopardizing the entire system.

Since the entire system was based on employment, it always contained a fatal flaw. If one segment of the population were unemployed, that entire segment would lose access.  So, two groups were at immediate risk—the unemployed elderly and the underemployed or unemployed younger sets.  With the development of Medicare and Medicaid, the government entered the scene by providing the role of employers in the remaining sectors.  If people were old enough—initially 65—or poor enough (low income levels) they still might have access to health care. And the concept of risk pools still prevailed. That is, the healthy elders subsidized the relatively less healthy elders.  Note the cost sharing depended greatly on government financing. The elders continue to pay into the system, but the government finances a major part of the overall system.

Over time, the private sector system that depended on employment began breaking down, largely because there was no overall system manager whose job it was to assure the program’s success. For example, many companies (e.g., WalMart) decided to reduce their cost envelope by hiring people less than full-time. It had been decided that all employees who were employed more than 30 hours per week were “full-time”. Employees who were employed less than that were “part-time” and, therefore, did not qualify for health insurance coverage.  Thus, cost began to overwhelm access as the ultimate goal of the system. One needed to contain the costs of health care and, therefore, since the system was being managed by the private sector, where cost, not access, was the ultimate goal, cost concerns began eating away at coverage, and segments of the population began dropping out of the system.
Note, there was no alternative system that would take over from the private system that was failing at the basic job of providing access.  In other countries, the government had long since stepped into the role of provider. That is, the governments decided that access to health care was a universal right, and the government, through its taxation system would guarantee that right. America had no such thoughts. We continued on our private sector approach, in which we essentially delegated to the for-profit sector responsibility for health care access. The government continued to intervene for the elderly and the poor, although complaints about the taxation required to sustain that system have never quit.  It is as though our population either does not understand, or simply does not agree that health care is a necessity, not a luxury, and therefore should be guaranteed.

As a result, increasingly large segments of our population have dropped out of the health insurance marketplace, and very large segments of even our covered population (the elderly for example) are now beginning to discover that they cannot continue to afford their health care, as it is currently designed.

So, it would seem that we now require a whole new approach to health care insurance in this country.  We need an entirely new financial approach that would guarantee the entire population with effective access to quality health care. That is, we need to emulate those systems now in use within many/most European nations (including our neighbor next door).

That must be our goal if we are to become once again a full member of the universe of civilized nations. Currently, we have dropped out of that universe.

Tuesday, June 26, 2018

Stay Sober

I am rapidly passing into some magical land of make believe, in which Donald Trump appears wonderful, and accomplished, and perhaps the best president we have ever had. In one article, David Lynch is quoted as saying that Trump could go down in history as one of the greatest presidents we have ever had. Now, to be fair, Lynch did not really say he was in love with our pseudo-human president. He seemed to have favored Bernie Sanders, but he thinks Trump is the great disrupter. According to Lynch, the current system is simply corrupt and inept, and Trump, by blowing it up, could be making way for an actual fixer president, someone who could get things done in a positive way by being thoughtful and by getting the corrupt system to respond favorably to productive policies (he didn’t allude to what such policies might be).

Nonetheless, the system is so hungry for positive words that the entire Republican machine quoted Lynch favorably, including President Stupidhead via his twitter-feed.  But I do keep reading comments from folks who also maintain that Trump is a grand president, some would say the best we have ever had. Mike, The Veep from the local swamp, is touting 500 days, promises made, promises kept.  I guess Mike is a big fan of incarcerating innocent kids in concentration camps, til they either die, or are fostered out to families who need the money. But Mike seems to be a racist like his Big Daddy Donald, so no surprise there.

And Facebook is full of swamp-dwellers who are always alert to Trump critics, whom they rush to call Libtards, and defame them for being less than generous to our Great Leader. And I keep wondering on what planet we now reside.  Trump now is promoting the idea that he should be able to dispose of the families and the children without being fussed by the Courts, or by lawyers and all that legal mumbo-jumbo. He wants no interference from stuff like our Constitution and our system of laws. Heaven forfend the Law should get in his way.

So, how anyone can continue to imagine that he is praiseworthy is beyond my ken.  But perhaps the David Lynch approach to praise is what is now operating within our general public. That is, the system we had/have is essentially broken, whether through corruption or ineptitude matter little. It is broken. So anyone who comes into our universe as a system disrupter is by definition a good person. I gather that Lynch has no idea whether anyone is sitting in the wings ready to assume the mantle of guardian angel.  That Trump could continue beyond his disrupter phase into a power consolidation phase is apparently beyond Lynch’s current caring envelope. He neither knows, nor presumably cares who/what comes next. So, should Trump remain in power because the Reds refuse to move off stage (because the blue folks don’t vote in sufficient numbers), and, heaven forfend, accept a second term as our president, the worst could be at hand, whatever David Lynch thinks.  Lynch apparently doesn’t think too hard or extend his thinking too far, because it is not really a grand leap to imagine the dismantling of our democratic system of government, and its reformation as a Grand Junta such as we see in that North Korea place, or even that Soviet place.  Democratic systems of government are in a state of siege all over the world, including that wonderful European Union.  Right wing authoritarians are in a state of near euphoria at the prospects of taking over in a number of currently democratic states—Germany comes to mind.

So, I find myself thinking maybe I should emulate Steven Colbert’s words (even if he is only joking) that maybe it is time to begin drinking heavily every evening, just so as to stop thinking about the mess we have created.  But no, that would have been my dear Father’s favorite approach, so surely that cannot be the way forward. I know. How about voting? Well, that’s coming up soon, unless the republicans succeed in placing enough barriers to voting that only republicans are allowed to vote.  That’s their plan by the way. Republicans apparently don’t believe in democracy any more than their Glorious Leader.

So, keep your eyes open folks and your brain active. Republicans and The Donald do not want you to vote at all, unless you agree to vote for him and them.  That’s the plan. So, remain alert, whether you want to or not. Try to stay sober at least part of the day.  And then vote if you are still allowed to. That’s our plan.

Tuesday, June 19, 2018

The Destroyer President

I continue to view President Trump as The Great Destroyer. Let’s see, what has he managed?

Well, he has destroyed three marriages. He has destroyed at least six companies—the ones he bankrupted. And then he rode his unparalleled record of business failure into the White House. Apparently close to half of voting Americans love a failure—they remind folks of themselves evidently.

And since his ascension to the throne of America? He has continued to tear apart the fabric of our universe, by backing away or threatening to back away from negotiated treaties or partnerships, such as the Iran Nuclear deal, the Gang of Seven, (formerly eight, and now six), the Trans-Pacific Partnership, NAFTA (just now coming), and we are beginning to learn, even NATO itself.

He has fired or caused to resign dozens of appointees, both in his former campaign and from key positions in the White House or the Cabinet.  Amazing really how many people have left or gotten the royal boot. In observing presidents over many decades, no other president even came close to this dismal record. Turns out he is terrible with people, mainly I assume because he lies all the time. So, unless people don’t mind being lied to, or having to promote obvious lies to the public, they have a grievously difficult time continuing to work for Trump.

But what I am coming to understand is that none of that seems to matter. People either hate him or they will continue to support him (even if they don’t love him).  It seems not to matter what anyone says about him in print.  We have the so-called Faux News Network, Fox, and the other right wing sites, such as Breitbart and InfoWars, who apparently will continue to lie and cheerlead for him, regardless of what he says or does.  He is so close to these “news” sources that he apparently chats routinely with their stars—Hannity comes to mind. I assume that Hannity provides him with Twitterbait, so that he can continue to send out his amazing tweets at odd hours of the early morning.
And then you have all the rest—the New York Times, The Manchester Guardian, the BBC, the CBC, the ABC, NBC, CBS, CNN, and the Public Broadcasting Network.  Apparently, aside from Fox, Breitbart and InfoWars, the rest of the “newsie” outlets at least manage to include both sides of the political spectrum in their coverage.

But, as I noted, none of it seems actually to matter. His supporters will continue to support him, regardless of what he does or says. He asserted, if you recall, that he could shoot someone publically on Fifth Avenue and his support would increase (I maintain that he would have to shoot someone like Comey for that to be actually true). When I note that his Administration has now embarked on a program to tear children from their parents arms and send them to concentration camps far away, and still his supporters continue to like him (adore him??) I have to believe that nothing I or anyone else says or writes, will matter in the slightest to change anyone’s support.  I assume that if he began building and then operating gas chambers for those children, or, more likely their parents, perhaps his supporters would begin to back away—note please, I assume . . . not that I am sure.

His supporters apparently want to blow up our world—they conceive of our world as a place of evil in which they are being destroyed by establishment folks who pay no attention to their grievances.  So, from their perspective, there is no solution, except to blow up this world and then begin to build a new one, in which America is Great Again (circa 1950??).

So, until he succeeds in actually destroying the existing infrastructure of the world order, including all of the extant partnerships, and most/all of the extant political systems and subsystems, they will, a) still be dissatisfied, and b) still continue to support Trump, concentration camps be damned. He doesn’t care, so they don’t care.

And, I observe, there is no serious opposition from within the existing political system, from either Democrats or republicans. Democrats are whining a lot, and sending out e-mails and letters asking for three dollars, while republicans are sucking their collective thumbs, while sticking their second thumbs into their assholes. The collective whining is palpable, but inadequate to dissuade Trump from his mission to destroy everything within his sight.

Because Democrats are incapable of restraining him by dearth of numbers, and republicans will not or cannot stand up to him, there is no public solution, until we all VOTE. If there actually is a sea change in Congress this term, then actions can be taken by Democrats to restrain his worst impulses. If folks don’t vote, or vote to support Republicans, then I see no hope for our American Republic. We would then continue to break apart and move into some form of political bankruptcy, much as he has pushed every business he has created into that same position.

So, in the end, it all comes down to that simple proposition—either Americans vote to take back our country, or our country will begin to break up into uncivil pieces of the former American pie. It’s all up to us.

Wednesday, June 13, 2018

The Art of the Deal

So what do two bullies talk about when they get together? I imagine they first must strut a bit, exchange firm handshakes, look each other in the eyes to see who blinks first, and then compliment each other on their hairdos.  

Then they begin. They first engage in discussions of the last person they cowered into submission. In Kim’s case, it might be the last person he sent off to be murdered. In Trump’s case, it might be the last person he insulted on Twitter, or, more likely, Trump would go on about how he humiliated Justin Trudeau—he didn’t, but he is too stupid to understand that.

Then they might begin their discussions about Mutual Assured Destruction.

Kim: “So, here’s the deal. If you promise not to invade our great nation, we promise not to unleash a hellfire of destruction on California.”

Trump: “Ok, so if you promise to bulldoze into the ocean all of your nuclear weapons, and your stockpile of bombs, we promise not to incinerate your entire teeny nation.”

Kim: “Ok, but you must first promise to refer to me as the Grand, and wise leader of the People’s Republic of Korea (leaving off that North thing).”

Trump: “Ok, but you must then refer to me as that Grand Leader of the entire league of industrialized nations, the greatest leader the world has ever known.”

Kim: “ Sounds good to me, oh Grand Leader.”

Trump: “Yeah, I like that, oh grand and wise leader of Korea.”

Trump: “ So, what do you think, do we have a DEAL?”

Kim: “I think we have a DEAL.”

Trump: “And that, folks, is what I call, The Art of the Deal”.

Monday, June 4, 2018

Actually, He’s Worse

I have been under a misconception for some time now. That is, I have always argued that Donald Trump was well known to all of us, way before the election. We knew he was a pathological liar, a sexual predator, a racist, a misogynist, a con man, a dishonest businessman, and, actually, an incompetent businessman.  What we did not realize is that he is worse than the sum total of those awful characteristics.  

He told us, we thought jokingly, that he could go out on Fifth Avenue with a gun, shoot someone and his support would increase. Apparently, he really believes such a scenario, and might even consider the act.  Because, he now seems to think that he is beyond our Constitution. He is above the law, and his "lawyers" have assured him that is so.  Shades of Absolute Monarchies.  I understand that Ivanka has begun thinking of herself as Princess Ivanka.  I guess, in olden tymes, such creatures as "absolute monarchs" actually existed.  But even they had their problems. In one text, the author argues that even the concept of absolute monarchies was problematic for a simple reason: “Nothing so clearly indicates the limits of royal power as the fact that governments were perennially in financial trouble, unable to tap the wealth of those most able to pay, and likely to stir up a costly revolt whenever they attempted to develop an adequate income.1

So, even if The Donald has begun thinking of himself as a grand monarch, with unlimited powers, his financial supporters will (may?) eventually weigh in whenever he grows “inconvenient”.  In the meantime, however, we the unlucky will need to deal with his powerfully negative and destructive tendencies.  But again, we cannot claim we did not know what he was like. Just that, however awful we thought he was, we did not imagine he was actually this bad.

And I have been thinking all along that at least some of the "powers-that-be" would rein him in, even if just a bit. Turns out there are no actual "powers-that-be",or they are uninterested in doing any reining. See, the problem here is that, if The Donald imagines that he has some absolute power, then it implies that they also have great power, and their limited brain power prevents them from conceiving that their power might eventually clash with his power.  As long as they can roam our country without restraint, why not give him this perception of absolutism? Works for them.  So, the Mitch McConnell’s and Paul Ryan’s of our world seem perfectly ok with this cretin in the White House.  It seems not to matter what he says or does. They have no comment.

And his broadcast network of choice, The Faux News Network, amplifies his message of absolute control, and has been even propagating the stories about “The Deep State”, i.e., the FBI and the Special Council. Sean Hannity has been arguing that they need to be eliminated, as soon as possible, because they pose a threat to His Majesty. With this crew, we have a fairly complete symbiotic relationship, one that benefits The Donald. We have The Donald, his largely ignorant supporters, and The Faux News Network. He says or does something, The Faux News Network amplifies his statements or supports his acts, and his ignorant supporters cheer him on.  It all seems to work wonders.

And now, he has been given almost carte blanche to make judicial appointments, which might well create a more lasting problem for humanity than anything else he has done. His cabinet appointments, Like Pruitt, DeVos, et al, however flawed, are at least limited in time. If we get rid of The Donald, they automatically go away. But his judicial appointments might be getting jobs for life, so they will be around to terrorize us humans for quite a long time.  So, this absolute monarch concept, however much of a teaser, still will manage to plague humanity for quite some time.

But the central question is, what can be done about it?  Again, in normal times, we have three branches of government, intended to hold one another in check.  This system, though still in place in theory, is at best a tattered remnant of its former vigorous self. As noted, Trump has been busily corrupting the judicial branch, and the legislative branch seems corrupt in its own way, and, therefore, disinclined to hold him in check, so long as he does not step directly on their toes.  And he seems not to be doing so, although it is unclear what he would have to do to annoy McConnell, or Ryan, or any of their slavish followers.  Ryan is essentially an anarchist at heart. He wants no government entities to step personally on his toes. Should they step on others’ toes, he seems to care not one whit.  And McConnell just seems a simpleton at heart. So long as folks keep giving him a high-paying job, he is happy.

So, the only remedy appears to be voting them all out of office. Now whether that will work is still anyone’s guess.  We keep hearing rumors that the Dems are poised to turn some formerly red state blue.  But the Dems are, at best, a flawed remedy. Nancy Pelosi is way past her sell-by-date and needs to move off stage. And folks like Bernie also seem a bit long in the tooth.  I still await the arrival of bright, honest, youngish candidates eager to take back the reins of power from the current crop of cretins.  And I wait . . . and I wait . . . the 2018 elections are not all that far off, and I still am waiting for the bright crew to appear.

Maybe they are simply waiting in the wings.

I do worry actually, about the cretinous MAGA supporters, and how they will react, should their King Donald I be hastened out the door, or even impeached. We might actually be facing the Great Second Civil War. Let us hope not.  

And on that Donald I thing, I stumbled across an actual reference to a King Donald in Wikipedia. Turns out:

 Domnall mac Causantín (Modern GaelicDòmhnall mac Chòiseim), anglicised as Donald II (died 900) was King of the Picts or King of Scotland (Alba) in the late 9th century. He was the son of Constantine I (Causantín mac Cináeda). Donald is given the epithet Dásachtach, "the Madman", by The Prophecy of Berchán.

So Donald could now be viewed properly as successor to The Madman. Seems right somehow . . .
Stay tuned . . .

1.     Bouwsma, William J., in Kimmel, Michael S. Absolutism and Its Discontents: State and Society in Seventeenth-Century France and England. New Brunswick, NJ: Transaction Books, 1988