Thursday, July 28, 2011

Watchdogs versus "Government Interference"

Think about this a minute. You maybe have a burglar alarm at your business site, or a watchdog at your home. Military installations routinely post sentries. And most of us are familiar with airport security inspections. None of these guardians are violating Constitutional rights. You may not like the inconvenience, but few would dispute the need. That's because there are occasional people out there, whether citizens or aliens is irrelevant, who do not respect your property or your life.

So why is a watchdog agency such as the Federal Aviation Authority, or the Federal Drug Administration, or the Securities and Exchange Commission, or any of dozens of other government groups considered "interfering" when they blow a whistle on the shenanigans of Wall Street, or lax safety inspection, or executive greed?

Someone does need to blow a whistle when a smelter lets clouds of unfiltered lead dust billow out of the smokestack. Or when a drunk takes the wheel of a car. Or when a bank or insurance company risks its customers' investments by loaning billions of dollars to high risk enterprises.

When an industry persuades Congress that deregulation of pharmaceuticals, or neglecting building codes, or cutting taxes are in the public interest, there is often a thin line between good business practice and corruption.

When a physician, called about a patient, doesn't see the patient but orders some medicine over the phone, and then charges the patient's insurance a fee for doing an exam, "because he is taking the responsibility," he's getting pretty close to fraud. That's a nasty word, but sometimes it has to be said, and it is another large factor in the rising cost of medical care.

There are trade-offs. If the government is to repair highways, it must find funds to pay for the workers, the material, and the equipment. If there is obvious waste in a program, it doesn't make sense to let the money continue to bleed away while the work stands idle. Nor does it make sense to continue to borrow endlessly and let hundreds of billions of dollars go to pay interest on the debt. And it doesn't make sense for a First World nation to leave 15% of its citizens medically uninsured. This makes the taxpayer or those with insurance pay the cost for the visits of the uninsured.

What Government Could Do Better: One of the tasks of Congress is to create laws for public benefit. To leave no doubt of what the law means, Congress adds regulatory clauses, often to the extent of a thousand pages or more. That length creates a lot of doubts of its own. For one thing, I doubt that many lawmakers or their aides have read the whole thousand pages carefully enough to grasp their full meaning.

How about a two or three-page summary stating concisely the purpose and actions required by the act, to which the other 997 pages must conform? And if any don't conform, they must be revised until they do.

The public wants action to produce a medical care act that reduces waste, increases efficiency, and addresses the problems of 45 million uninsured citizens. Instead, both houses of Congress, and many agencies besides, jockey for a political agenda rather than addressing the merits and flaws of the act they are trying to put together. Such delays cost money. Endless catch phrases and frank misstatements of meaning, on TV ads and talk shows, don't get the job done.

Congress can't expect to mandate new standards of care without funding them. It is hypocrisy to say "no new taxes," while cutting federal funding, leaving the states to finance new federal laws through state taxes. And cutting funding for watchdog agencies would be reckless negligence.

This blog post is adapted from my book, "Access to Medical Care, Common Sense for Doctors, Patients, and the Public," © 2009 by Keith Dahlberg, MD; iUniverse, publisher.

Tuesday, July 26, 2011

Road Block Deadlock

All right, it's time to stop fixating on each party blocking the other party and work together to move the nation off the railroad tracks before the train comes along.

Okay, there have to be budget cuts, and yes, they must include parts of the major entitlement programs; I say that as a Democrat and beneficiary of Social Security and Medicare myself. Those who have no other income should not bear the burden, but those of us who do have other resources should not expect full benefits to go on increasing forever. Incremental reductions over several years need not be a disaster.

Republican spokespeople are fond of saying that new taxes destroy jobs. What do they think budget cuts do? I am told (today's Spokane Spokesman-Review editorial) that failure to renew the operating authority of the Federal Aviation Administration last week laid off 4,000 clerical workers, and that in turn halted construction work on the nation's airports and runways, suspending the jobs of the construction workers.

Hospital emergency rooms have been the last resort of the uninsured ill and injured. Now there is a movement afoot, already enacted into law in some states, to limit Medicaid patients to only three paid ER visits per year, with shared computer data bases to detect hospital-hopping. With unpaid ER visits increasing each year, hospitals have no other choice when their funding is cut, but what is the child with chronic severe asthma or any number of other maladies to do?

Yes, small businesses need reassurance that they can plan ahead on tax rates, etc., but the mega-corporations' profits are doing quite well, thank you, and they may have to struggle along, even without the tax loopholes and exclusions and subsidies to which they have been accustomed.

One big difference between President Obama's four trillion dollar debt reduction and the one trillion proposed by Mr. Boehner is the saving in annual interest costs. At six per cent, that extra three trillion cut saves l80 billion dollars per year. So, enough with the smokescreens already. Even the Congressional rookies will have to learn to sacrifice. It comes with the job.

Sunday, July 10, 2011

Solving the Nation's Fourteen Trillion Dollar Debt

I'm glad to see that the President and Congressional leaders appear to be getting closer to reality about lowering the national debt. At least, all sides now acknowledge that defaulting on the debt or endless raises in the debt limit are dead ends. I hope they will also see that cuts in spending and increases in revenue must both begin now, not two years or ten years down the line, if we are to retain our creditors' trust. Some suggestions where to start:

Social Security is one of America's biggest expense programs; I and tens of millions of other senior citizens depend on it for a major part of our old age income. My wife and I contributed to the fund for decades, and now our combined SS benefits are a little over 2,000 a month. We have about an equal amount of other, non-government income, and with our house and our children's college paid for, a modest reduction would not be a hardship for us, as it would be for some who depend on a 500 dollar benefit as their only income. Leave theirs intact, but many of us who are better off could make both Democrats and Republicans happy by accepting a few per cent reduction in our benefit, and a less generous tax break at income tax time. (Because of my low tax bracket, I am only taxed on about 30% of SS income.) You could call that last one either a spending cut or a tax increase, depending on your political view, but there is no doubt that applying it to upper-middle and upper class families translates into billions of dollars off the deficit annually.

Medicare is another big budget expense. My open-heart surgery at age 77 has given me five more years of active life so far, and I am grateful to both the program and to my surgeon, who may have accepted a reduced fee at Medicare rates. But I have a neighbor who also could have benefited from such expensive surgery; he had a heart attack, had to quit his physically active mining engineer job, lost his employer-funded insurance, and ran out of unemployment benefits. There are few new jobs for a fifty-five year old. Emergency rooms have to accept him even if he can't pay, but the ER has to charge over $1,000 per visit to the rest of us to make up for the 45,000,000 Americans like my neighbor whom no insurance company will accept.

Medicare is an even bigger problem than Social Security, because SS beneficiaries eventually die (and that's okay—I sure don't want to be kept alive on machines for months). Patients eventually die too, of course, but medical science keeps on growing, and growing more costly every year. New tests, new machines, new and vastly more expensive medicines come on market, and more training and knowledge is expected of doctors, nurses, technicians and therapists. No matter how rich the nation, there will come a point where there won't be enough funds to pay for all the medical inovations each year.

Some nations' medical systems deal with this problem by having waiting lines. Others have hospitals whose pharmacy shelves are empty before the end of the fiscal year. Still others simply let their people starve or die untreated. Call these methods rationing if you like, but eventually every nation must prioritize. America is to be congratulated on having a good public health system in general, with emphasis on prevention, immunization, and maternal and child health care as priorities

Doctors could share in the burden, too. During my fifty years of medical practice, many doctors would accept some patients that couldn't pay much, or could pay nothing at all. The doctors kept track of how much medicines cost, and prescribed generics when possible. And they listened to the patient first, before firing off orders for routine tests. Today many doctors prescribe with no idea of the cost.

Government could help. Everybody talks about simplifying tax forms, but it hasn't happened yet. I have always been a big fan of charitable gift deductions, but I bet most of us who support charities would continue our support even if only 50% of each gift were deductible instead of the more generous deduction of 50% of adjusted gross income. Hey, are you giving to help the needy or to help yourself?

As to complicated tax forms, consider Singapore, arguably the nation with the largest budget surplus (and one of the smallest populations) in the world. My son has lived there for years, making a well-paid living. He says it takes him only a half hour to fill out his Singapore income tax return, but takes days to do his US form. 'Nuf said.

Military costs are a big budget item too. Sometimes it's necessary to defend our nation, or to stop genocide as part of an international effort. I would like to think failed nations like Somalia and a few others have taught us we cannot police the whole world alone.

National debt interest payments of half a Trillion dollars are one of the biggest expenses we should learn to do without. Every trillion we reduce the debt this year means 60 billion dollars less interest we must pay next year (@ 6%.)

Millionaires and corporations, are you part of this nation or not? You need to contribute to debt reduction too.