You Want More of This…?

As we move closer to election day, we continue to hear more alarming things come out of Trump’s mouth on an almost daily basis. He’s setting the stage for a coup, to enable himself to become the dictator of the Trumpian States of America. Amazingly, there are people who believe this is a fine idea, because why not? These last four years have been a grand ride, why not do this all the time?

Folks, you really aren’t seeing the long view, are you? Once one piece of our Constitution is broken, it all can go. We are guaranteed to have free and fair elections, and a peaceful transfer of power. If Trump removes that and declares himself the winner either by having the senators determine the electoral vote, or simply by not leaving, then what is to stop him from telling us the rest of the Constitution is null and void as well?  You know all the screaming you’ve done about having your 2nd Amendment rights violated, and that a candidate from the Democratic party is infringing on that? Or how awful you think ‘Obamacare’ or the ACA is? Or what about the fact that you’ve been able to speak up at all? If you haven’t thought about that, well, now is the time.

All you need do is look around you at life under other dictators, and it’s pretty easy to see that what you think of as being a pleasure cruise, will become just another nightmare. Gun rights? Gone. That freedom to speak your mind, travel where you want to and stand in front of a government building, throwing fire bombs, smoke bombs or just f-bombs? Gone. (Not that those were good ideas in the first place.) Want to work where you want to, or do what you want to? Gone. Don’t think the rules of the ACA are right, or that it should even exist at all? Then I imagine you’ll love government run Trumpcare, which will determine what benefits you have, and how much money is allocated for those benefits. If they don’t put enough money toward it because this year Trump doesn’t want to, then either you pony up out of pocket, or you just don’t get that medicine because you aren’t allowed to. Don’t make the mistake of thinking that just because you’re on the side of anarchy now, doesn’t mean you get any kind of a pass later. No, you’ll just be Citizen No. 12657390. Just as likely – perhaps more so – to get tossed in jail for activities against the state. Think not? Check these out…

Gun laws in Dictatorships

Russia: According to the Library of Congress, “Individuals are not allowed to carry guns acquired for self-defense; a license only serves as a carrying permit for hunting and sport firearms when these guns need to be transported. Russian citizens may not own guns that shoot in bursts or have magazines with more than a ten-cartridge capacity.”

In North Korea, the right to private gun ownership is not guaranteed by law.

In China, Civilian ownership of firearms is largely restricted to non-individual entities such as sporting organizations, hunting reserves, and wildlife protection, management and research organizations. The chief exception to the general ban for individual gun ownership is for the purpose of hunting.

Cuba: In Cuba, the right to private gun ownership is not guaranteed by law, and civilians are not allowed to possess pen guns, cane rifles, rifles with a calibre greater than 5.6 millimeters, machine and sub-machine guns of any kind, home-made firearms, shortened shotguns, firearms that have been modified with devices to make them more efficient, and certain types of ammunition. Private possession of fully automatic weapons is prohibited, and handguns (pistols and revolvers) are permitted under license. Civilian possession of rifles and shotguns is regulated by law.

Healthcare

Russia does guarantee free health care, 48% of expenditures comes from government sources which primarily come from medical insurance deductions from salaries. While there appears to be private insurance there, the state insurance improved during the 90’s and 2000’s to be very competitive, then it’s quality significantly declined. Due to the Russian financial crisis since 2014, major cuts in health spending have resulted in a decline in the quality of service of the state healthcare system. About 40% of basic medical facilities have fewer staff than they are supposed to have, with others being closed down. Waiting periods for treatment have increased, and patients have been forced to pay for more services that were previously free.

In China, about 95% of the population has at least basic health insurance coverage. Despite this, public health insurance generally only covers about half of medical costs, with the proportion lower for serious or chronic illnesses. In urban areas, insurance isn’t free either. And in rural areas where it is, the quality of care varies widely.

North Korea claims to provide universal health care with a national medical service and health insurance system. North Korea claims that health services are offered for free. However, this claim has been contrasted by North Korean defectors, who claim that patients must in fact pay for health services, that the upper classes have access to a higher standard of healthcare than ordinary ones do, and that “how much money a patient has determines whether they live or die”.

Cuba’s national health system is made up of multiple tiers: 1) the community containing individuals and families, 2) family doctor-and-nurse teams, 3) basic work teams, 4) community polyclinics, 5) hospitals, and 6) medical institutes. The Family Physician and Nurse program is made up of physician and nurse teams that serve individuals, families, and their communities. Polyclinics are community-based clinics that house primary care specialists, and exist in every Cuban community. While preventive medical care, diagnostic tests and medication for hospitalized patients are free, some aspects of healthcare are paid for by the patient

Freedom of Speech

Cuba: The Cuban constitution recognizes the freedom of the press, and prohibits private ownership of the media. “Only 25 percent of Cubans use the internet, while only five percent of homes are connected”, making it one of the Americas’ least-connected countries. The Internet is censored; a number of websites are blocked, and access to information is scarce.North Korea: Human rights groups such as Amnesty International and nations such as the United States have asserted that, in practice, there is no right to free speech, and the only media providers that are deemed legal are those operated by the government.

China: The only people in China who can publish criticisms of, or opinions contrary to those of, the Communist Party, are senior members of the Communist Party. Academics and editors of China’s state-controlled publications are afforded somewhat less leeway than Party officials, but still more than the average person.

Russia: In 2019 Russia introduced new regulation commonly called “fake news law” which criminalizes publications containing “unreliable” information as well as opinions that show “disrespect for society, government, state symbols, the constitution and government institutions”. The law was criticized for vague wording allowing selective application e.g. against political opposition. Since 2009, the practice of the law enforcement agencies (most notably FSB) was to abuse newly introduced anti-extremism laws to suppress freedom of speech, including corruption investigations. On 31 March 2013, The New York Times reported that Russia was beginning ‘Selectively Blocking [the] Internet’.

That’s a glimpse of life under Trump as ‘president’ for life here. So, all those ‘rights’ you keep harping on, well, don’t worry, you won’t have them because we won’t have a Constitution. No Constitution, no rights. And if you think it can’t happen here, think again. He’s already trying to set the stage, with declaring the media “enemies of the government”, and “fake news” (hmm, look familiar?), telling us what he wants us to know around COVID-19, hiding his tax returns, installing his family and flunkies in positions of authority, and making us all question each other. It’s not too late to keep it from happening.

Vote on November 3.

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Crossing the Great Divide

Look around next time you’re running errands, or when you next read the headlines,  pay extra close attention and you’ll probably be surprised to find an overabundance of labels. Oh I don’t mean sticky labels, or post it notes although it might be better if I did, as those could be removed. I’m talking about the kind that are written with the virtual sharpie, and create invisible divisions. Women’s issues…healthcare issues…education issues…human rights issues…gender equality issues…LGBTQ issues…pay gap issues…human trafficking issues…abuse issues. Each of these has the ability to conjure up a picture of someone in distress in our minds, producing a familiar clench in our collective bellies.

Throughout the election cycle and now into the governing cycle we’ve been inundated with stories that cross the partisan divide, educating our nation on how these great groups of electors will solve each of these problems. They’ll fight the war on hunger, on healthcare and health insurance, on education, on trade, on pay, on this, that and the other. It’s the same story told over and over and over again, and nothing really ever changes. The only thing that’s any different now than 50 or even 100 years ago, is that by virtue of the internet and social media, the megaphone has gotten larger and louder. But are the stories really any different? Or are we just more aware of them because they are now able to be placed in front of us constantly? Isn’t it time to ask ourselves, why nothing ever changes? Why is it that when the politicians get to Washington, they spend all their time playing political tug of war? Did we elect them to do that, or is there something else happening?

In theory we’ve elected these individuals that are, in theorysupposedly bright, yet they faithfully embody Enstein’s Theory of Insanity over and over again, year after year, election cycle after election cycle. (Well, not so much a theory, really. He said the definition of insanity was doing the same thing over and over again and expecting different results.) As a child, I learn very quickly if I put my hand on a hot stove, I get burned and I don’t do it again. So why do our politicians insist on fighting the identical fights year after year? Two possibilities exist. One, they aren’t bright enough to figure it out (in which case they should never have been re-elected) and two, they’re all crazy like a fox and know that if they actually solved the issues, they’d have no jobs to come back to. If we go with that first possibility, and we ARE re-electing them repeatedly, well then the problems really are our own damn faults, aren’t they, and we’re the ones living up to Einstein’s definition of insanity.  Which leaves the second option, they’re all crazy like a fox.

There is a central theme in a solution however, for all of the issues that the politicians  – whether they are local or national – are tasked to solve. Remove the labels – all of them. Not just from the issues themselves, but from the individuals trying to solve the problems too. No more making this about a man issue or a woman issue, or a Democrat or Republican. It’s not about you-me-us-them. It needs to start being about doing the right thing for people. Doing unto others as you would have them do unto you. Those last 4 words really are key. It needs to stop being about imposing our beliefs on others, but stopping and thinking about what that really means. How will you feel when someone else forces you to have THEIR beliefs imposed on you against your will? Just because they could? When you begin to think about things with that mindset, suddenly some of the decisions take on new meaning. What might reactions be if someone’s children can’t attend a charter school because a)they already filled their quota for children of minorities  or the poor or b) haven’t filled their quota for children of minorities or the poor so can’t take any more affluent children now even if you CAN donate $1 million to us, so now the Betsy DeVos’s of the world have to send their children to public school whether they like it or not. Or what if our lowest income families that can’t afford healthcare, no longer can get free contraception because of the defunding of planned parenthood, and suddenly we see an increase in birthrates in that demographic? If you’re one of those congressmen or women that have insisted on repeal and replace the ACA, before you continue down this path just stop for a moment and imagine you’re not a congressman/woman but an average hourly wage worker, your spouse can’t work, you live in an apartment and drive a beat up car. Close your eyes and picture it, life is tough, you can’t afford much for new clothes, let alone dining out, and the ACA is the only insurance you can get. Are you still so eager to push thru the plan you propose under those same conditions? What about if you’re a new single mom? Will there be an increase in funding for WIC? For Medicaid? For the stresses imposed on those families? (And to Matt Garza, here’s a newsflash: married couples shouldn’t be forced to practice abstinence just to prevent an unwanted pregnancy.) Don’t misunderstand me, I’m not saying that the ACA doesn’t need fixing, it does. But honestly, ask anyone who has ever worked in a large organization with something like this, is it easier to start over, or incrementally fix, and they’ll probably tell you to incrementally fix it so you don’t make a bigger mess of it.

The issues facing us are people issues. It’s that simple. And until politicians can learn to leave their titles at the door, get off their asses and away from Capitol Hill, really learn how real people live and the real pressures they face, and finally learn to leave the partisan bickering outside the room when they meet, they’ll never figure it out. Or, to paraphrase Donald Ogden Steward and Philip Barry who wrote The Philadelphia Story, “You’ll never be a first class politician until you’ve learned to have some regard for human frailty.”

The Three R’s

Repeal…Replace…Reform…

Not the usual three words we’ve come to think of when we hear the phrase “the three R’s, but new “R” words in the news lately about Obamacare. (Yes, I know I said once I objected to the term ‘Americans’, but if you can’t beat ’em, join ’em.) There is so much information that is hitting the media these days, much of it rather confusing and mystifying so I thought I’d take a stab at peeling back the proverbial curtain so you can see the little man behind it. Full disclosure: While I don’t  bill myself as an expert, I have worked in the healthcare for 40 years, the last 17 of it in insurance, which does make me more informed than the average bear.

What’s the difference between “The Affordable Care Act” and “Obamacare”? The simple answer, none. If you thought there was, you’re mistaken. You can’t repeal Obamacare and have the Affordable Care Act left to fall back on. If you get rid of Obamacare, you’ve gotten rid of the ACA. It really is that simple.

If they repeal Obamacare, what will I have for insurance? Assuming you applied for Obamacare because you didn’t qualify for something through an employer, or for Medicaid, Medicare or some other state based plan, probably nothing. That’s why repealing without something in place and ready to go is a problem. 

But they say that there will be access for everyone, right? So that’s good. Not so fast. There is a big difference between access and coverage. Access isn’t the same as actually having the insurance. I have access to any doctor or hospital I want to, if I can pay for it. What if I can’t pay for it? As Bernie Sanders said, “I have access to buying a $10 million home. But if I don’t have $10 million, then I can’t actually buy that home.”  So don’t be fooled when you hear the word access. It isn’t equal to insured, even though there are those that want you to think it is.

My premiums on Obamacare went up, it’s a failure. What a mess. So here is how that works. Insurance is all about risk. The bigger the risk pool, the more spread out the risk is. But it takes time for the pool to grow and get spread out, and you need to have both healthy AND sick people in the pool so that the risk is spread across everyone. In the first years of Obamacare, the most likely enrollees are the sickest, so there are likely to be more people seeing doctors and going to the hospital. That’s going to make premiums go up at first, then they’ll stabilize as other folks who aren’t as sick sign up. But you need to give it time. And have you checked out the cost of your care WITHOUT insurance? Here are some facts:

Average costs without insurance  

Emergency Room Visit $ 1,200.00
Uncomplicated Delivery $ 3300-37,000
Cesarean Section $ 8300-71,000
Daily inpatient rates in hospitals $ 1700-2300
Daily inpatient ICU rates in hospitals $ 4,000.00

So yep, go ahead and crab about how much it costs. Don’t come crying to me after you get the bill from your stay for that heart attack/car accident/fourth baby/slip on the ice and broke your leg in three places. Shit happens in life. That’s why we have insurance. 

So I heard with this new program, the premiums will be paid for with Health Savings Accounts instead of subsidies. Isn’t letting people set money aside pre-taxes better than giving them an after tax reduction? Well, I guess that depends on how you look at it. Sure the Health Savings Accounts can be a good thing, and a way to help reduce your tax burden, however it assumes a critical point: That you have enough disposable income after you pay your rent, bills, and buy food that you can afford to have your take home pay reduced. Because let’s face it, even though it’s set aside pre-tax, it will still reduce your take home pay. Maybe not in a 1:1 amount, but it will reduce it. So…this new plan takes away the subsidies from the people who needed it the most, and forces them to have a plan that can only be purchased if they have a Health Savings Account. Take the fictional Johnson family from Minneapolis. Tony and Sara make $34,000 a year, and have 2 children. Sara worked but found that all of her income was going to child care, so it wasn’t worth it and she quit to take care of their children. Tony works for a small company that doesn’t offer healthcare. Under Obamacare, they qualify for enough in subsidies that their monthly premium was $98. Now, under the proposed plan with Health Savings Accounts they’ll need to come up with $1102 a month, which is the current cost of the unsubsidized premium for their family. Does anyone seriously think that’s going to happen? Here’s a newsflash, it’s not. After taxes Tony is lucky if he takes home what $800, $900 per paycheck? And out of that has to come rent, utilities, the car payment, and food and we’re expected to believe that shaving $550 off the top of each check before taxes will reduce his tax burden enough that his paychecks will miraculously adjust enough so that he still takes home at least $800 each paycheck? It ain’t ever going to happen. And so we’ll see the number of newly uninsured skyrocket. Immediately. Because there is no flipping way that millions of people will be able to afford their unsubsidized premiums. They’ll go on Medicaid instead, paid for by your tax dollars. Look for an increase in your property taxes, sales taxes, levies and all sort of other taxes to offset those costs.

As a final note, here’s a message for all of our Congressmen/women and Senators on Capitol Hill. Stop fooling yourselves into thinking this is a Democrat or Republican issue. It’s not. It’s a people issue, and the sooner you start treating it like one, the sooner you’ll actually all stop with the craniorectal inversion and move toward real progress toward a solution.  Healthcare is so godawfully complicated it’s not going to be fixed in a single four year cycle. It will take that long to get it started, understand how your risk pools are imbalanced and how you can make positive changes. Those changes need to be incremental, and just a couple at a time, so you can measure, remeasure, perform some analysis and watch trends. As any halfway decent statistician can tell you, if you start reacting to every blip in the graph and don’t understand which part of your process is within statistical control and and what is out of control, pretty soon you’ll make such a mess of the process that everything will be out of control. Like overcorrecting a skidding car on ice. Instead, if everyone put down their swords, shook hands like adults and agreed to leave your party labels at the door when working on a solution, you might actually have a fighting chance of coming together to solve this. Follow quality improvement principles used in businesses such as PDCA and Kaizen. (This ain’t rocket science, it just requires you leave your egos outside the door. Sheesh.) Where I work we are fortunate to have developed a culture built on values that help us to become better and stronger as we work together. Some of those values are integrity, compassion and relationships and I can’t help but think that if applied as part of the process to solve this problem, maybe real change could finally begin.