Brain-Jockey

ACLU and Me: Sometimes We Agree

Written by Audrie Zettick on August 15, 2009

A good friend sent me an email she’d received that contained a flash video by the ACLU.  It’s a fictional account of how we might all be ordering pizza in a year or two, given the Federal government’s propensity for collecting information on us.  Check it out.

They say humor is best when it’s based on reality.  I’d say this presentation is funny, except it’s also scary.  Do I think we as citizens would let our government get to this point?  Probably not. Yet it’s not too far fetched to think of a health insurance plan that knows what we eat and holds us accountable somehow.

The end of the presentation contains a link to a petition asking for repeal of the Real ID Act, passed by Congress in 2005 and requiring that all states share their motor vehicle databases to establish a national ID number for each of us. 

We may have worried over this in the Bush administration.  With the potential advent of a national health database, the concern has upped a few notches.   Given that, the ACLU encourages people to send this message:

Dear Friend,

The ACLU needs our help to protect Americans’ right to privacy today!

New technologies and government policies are eroding our personal privacy and creating a 24-hour total surveillance society.  One example is a dangerous program  ominously called the Matrix - that combines state government records with commercially available data to create a vast database capable of compiling and analyzing a profile of every American. 

Click on the postcard to watch this humorous flash video and tell Congress to protect your privacy now!

A couple years ago, I did a few consulting days for a state contractor who (at the time) was trying to pitch matrix-like technology to state government (I was not hired for this aspect of their operations).  The guy that contracted with me told me about it, asked me if I’d like him to put my name in the system to see what they found. It was an eye-opener for me.

Thus, when I saw this video from the ACLU, for once, I agree.

When I’m Wrong, I’m Right:The Truth About Private Health Insurance and Reforms

Written by Audrie Zettick on August 3, 2009

I chastise my college students for not checking the facts when they cite online articles.  It’s too easy in today’s quick-paced world to promote bad information.  I have them consider the source.

For my recent piece on Health Care Reform, I cited some information provided through Investors Business Daily, a reputable source for finance information.  I did a quick double check of their info, but it wasn’t thorough enough–so I’m in for some self-chastising.

What IBD stated was that provisions on Section 102, page 16 of HR 3200 would make it illegal to provide new individual private insurance.  After looking at that portion of the proposed bill, I used their information as part of a larger article on various provisions that would make us pine for the days when we had choice of private insurers. 

The Facts Mam, Nothin’ But The Facts

Turns out, a deeper look at that section of so-called “America’s Affordable Health Choices Act of 2009″ shows IBD was wrong.  Existing private health care plans won’t be “illegal” but would be “grandfathered” and allowed to continue.  They have up to 5 years to get in line with government-mandated standards on what health care benefits are covered.  However, they can’t enroll new members until they bring their coverage in line.   

So my statement that “private medical insurers are not allowed to enroll ANY new customers as of the first day that the government plan begins” actually should read “ private medical insurers who are not offering all the benefits mandated by the feds are not allowed to enroll ANY new customers as of the first day that the government plan begins.”

But here’s the full picture: H.R. 3200 limits employers’ options to provide a package of benefits that is affordable.  It will mandate what has to be covered.  When the government mandates that all policies have certain benefits the only thing that is certain is that the cost of providing insurance will rise.  HR 3200 and the bill put forward in the Senate both penalize employers who don’t offer health insurance–either 8% of payroll or $750 respectively. 

You don’ t have to be a CPA to figure out that businesses will do what is best for their bottom line.  Although employees are an important asset, business will look to invest their money where they get the biggest bang for the buck–product improvements, technology, etc.  Health benefits probably aren’t high on the list.  Even the most well-meaning companies will quickly figure out that paying penalties is less expensive than offering health insurance.  Employees will be forced to take the only other available option–the government plan.

So I’m still right: “Come 2020, we may be wishing we still had access to private health insurance plans, some choice in what those plans were and less government on our backs.”

Planned Aging, Choice and Pining For The Good Ole Days-ADDENDUM

Written by Audrie Zettick on July 28, 2009

If recent health care reform proposals like ”America’s Affordable Health Choices Act” are passed, where might we be 5 or 10 years from now?  Here’s a link to the proposed bill by House Democrats.  Here’s a brief shot at why we might pine for the good ole days:

Choice–well, not so much. 

Despite the word “choice” in the title, private medical insurers are not allowed to enroll ANY new customers as of the first day that the government plan begins.  As Investor Business Daily notes, Page 16 of the American Health Care Choices Act of 2009 actually makes private health care plans illegal.  Hang on to any current coverage you have, since any new* policies (*ADDENDUM: new policies not in line with government mandates–see new article) written after the effective date of the Act will not be allowed.  But at least you’ll still have your current private coverage, right?

Choice–well, choice of one.

Except that there may no longer BE any private plans.  There are many reasons for this, as outlined by the Heritage Foundation.  But let’s keep this simple: 

Employers will have to offer health care coverage or face penalties.  For large businesses (who are the ones currently offering health insurance benefits), the penalties will likely be 40 to 60% of what they now pay in health insurance premiums.  If I was their CFO, I’d say drop the coverage, let workers take the public option and we’ll pay the penalty.  

But at least they’ll have AFFORDABLE health care, right?

 Affordable? Depends on your definition.

Obama declared that “Health care reform is not going to add to that deficit, it’s designed to lower it.”  Not so much, according to the CBO which estimates that the health care plan offered by the House Democrats will ”add more than $230 billion to the federal budget deficit over the next ten years.”

The doctors may have been bought off (see Pink Elephant Pundit here–but frankly after the Prez’ tonsil-yanking claims, I bet pediatricians are no longer supporting the WH), but ten years down the road, their financial fix morphs into a giant fiscal cancer where the deficit will probably force the only available health plan–the ”public option”– to ration care, lest costs spiral out of control.  

Planned Parenthood Aging:  Then, of course, there’s the provision to MANDATE ( see section 1233) that all seniors have Advanced Care Planning Consultation every 5 years.  While this sounds well-meaning–who can argue with giving seniors information on living wills–the topics REQUIRED every five years include an explanation of end-of-life services.  I can imagine how happy my 91-year old grandfather would be had this already been in effect.  If we start this at 65, he’d already had 6 forced sessions of hearing about planning for the end of his life.  Boy, that would encourage ME to go to the doc’s.

While “rationing” of services is technically not allowed to happen according to the bill, budget pressures combined with the Advanced Care Planning are certain to have a similar result. 

Good Ole Days

Come 2020, we may be wishing we still had: access to private health insurance plans, some choice in what those plans were and less government on our backs, telling us when and what to plan for as we approach our latter years….and wishing we didn’t have to persuade medical and government officials that we still deserve care in our elder years.

A Mad Hatter’s Summer of Events

Written by Audrie Zettick on July 13, 2009

Like Alice at the Mad Hatter’s tea party, taxpayers have recently been assaulted with many wish-it-weren’t-for-real events that make me watch for the white rabbit.  It’s been a Wonderland of events and characters.  Among them:

Queen of Hearts: Nancy Pelosi.  Politico recounts how she “whipped” together the votes for Cap and Trade, replacing “off with their heads” with dogged, in-your-face (and perhaps other body parts) persistence.  Worried more about her reputation than the content of the bill, witnesses recounted that she and her sidekicks even surrounded one holdout–Rep. Joe Baca–who then (surprise!) voted in favor of Cap and Trade.   No wonder Congressman Ciro Rodriguez sprinted like a rabbit out of the House chamber after surprising Pelosi with a “no” vote. 

The Card-Deck Queen’s Men–The eight Republican Congressmen–called jellyfish by Deroy Murdock but who more resemble the cowed cards–who enabled the House to pass Cap and Tax.   They fell flat on their faces when the Queen appeared, but these Congressmen plus others in vulnerable districts will be trying to paint the roses red as they attempt to cover up their mistakes.

Tweedle Dee, Tweedle Dum and Even More Dum: Some of my home state Congressmen who voted for Cap and Trade in spite of the fact that PA gets a majority of its electricity from coal (great editorial here).  It’s been estimated that Pennsylvanians will see over a $3,000 hike in annual electricity fees.  Here’s an estimated impact by Congressional District.

The Caucus Race (click here if you don’t remember this part of the story), represented by the G8 and especially India and China on climate change.  In Alice’s story, the animals, led on by the DoDo, have a nonsensical race ending in everyone getting meaningless prizes, with Alice finding her own prize, which she gives to DoDo who presents it back to her.  Yeah, we may be a high consumption society, but it’s our economy and innovations that have given much of the world the freedoms and standards of living that have grown from development.  Having the U.S. commit to harsher standards while India and China go nearly full speed ahead with development is an absurd gesture. Maybe we should all ride bicycles like they do in China.   

Plus, even though Climate Change Happens, even THINKING that anything we do will make any meaningful impact on Global climate change is the absurdest gesture of all.  The G8 nations committed to limiting global warming (by reducing carbon emissions) to no more than two degrees.  A large volcanic explosion could do just that and more (will they claim success?).  A closer look at Climate Change science and models shows that all the pain caused to our economy by legislation like Cap and Trade is much greater than the impact on the environment.

The Dodo: New York Times columnist Paul Krugman.  He is emphatic that global warming is a bigger threat to America than terrorism.   Enough said.

Cheshire Cat: played by Obama.  I considered casting him as the White Rabbit, since you can argue that the American public followed him down the rabbit hole.  The Cheshire Cat might be more appropriate, as this character appears to be wise, yet Alice never knows if the cat is really steering her wrong.  

Recent White House policy on Iran was every bit as perplexing as anything the Cheshire Cat said to Alice.  In spite of the recent election-sparked violence in Iran, Iranian officials were originally invited to our July 4 celebration–first time they’ve been invited since the Iranian Revolution.  Then they were disinvited.  Of course, this was after it was clear they weren’t intending to show up anyway.  In Wonderland, this all makes perfect sense. 

And proposed health care reform that claims to allow that we keep private insurance while all but ensuring disappearance of private plans is, well, perfectly sensible too.

Czar of Czars: Obama.  Maybe we need a remake of Wonderland, featuring the Czar of Czars instead of the Queen of Hearts.   ”With President Obama, the CZAR business has not only picked up.. It has been put on Steroids, Human Growth Hormones, Protein Shakes, Speed, and Epinephrine Shots.”  Motley Fool

“Drink Me” potion:  Alas, we the American people are at fault, willing to drink whatever comes our way if it looks to benefit us, darn the consequences.  Growth of Big Government is the result. As Robert Samuelson recently noted: “Without anyone much noticing, our national government is on the verge of a permanent expansion that would endure long after the present economic crisis has (presumably) passed and that would exceed anything ever experienced in peacetime.”  

Time to pull ourselves out of the Rabbit hole with a dose of reality.  I wish I’d wake up.

Cap and Tax: Need Truth in Polling

Written by Audrie Zettick on June 25, 2009

Nancy Pelosi is leading the charge to get Democrats in Congress to rush passage of H.R. 2454–The American Clean Energy and Security Act of 2009-before they jet back to their districts. Let not wisdom, deliberate debate and growing public opposition stand in the way of their July vacation (and increase in their carbon footprint).

When asked innocuous questions like “do you support government regulation to reduce greenhouse gases from cars and factories,” three-quarters of Americans purportedly agree.  Heck, I do when worded that way.  Some members of my family have asthma–we’re sensitive to air pollution and stay inside on “ozone action days.”

When polls go on to ask pesky things such as if they’d be willing to pay more for electricity in order to reduce carbon emissions, support for Cap and Trade drops to 52%.

Of course you have to consider that in May, polls showed few people–24% of voters– even knew what cap and trade was.

Imagine if the full truth were asked.  Such as if each poll respondent had to complete this estimate of the personal impact of Cap and Trade.  Or if estimates for outlying years were considered (after 2012).  The bill’s been watered down to minimize impact in the early years, to gain moderate Democrat support.  But when you begin to estimate costs beyond 2012, the financial impact is more pronounced.

American taxpayers better gird their loins for a major change in lifestyle, if Cap and Tax passes.  The Tax Foundation notes that “Lawmakers weighing the costs and benefits of climate policy should be aware that cap and trade would impose a significant and regressive annual burden on U.S. households.” With many households just getting by financially, and with the future tax burden of the bailouts on the horizon, this is ill advised.

My main concern is with the broad impact of vastly higher electricity and gas prices.  President Obama has  himself admitted that “electricity costs will skyrocket” under cap and trade.  See video.

I can envision school taxes rising as districts deal with increased energy costs–for buildings, busing and food.   I know my food bill will rise, impacted by increased energy costs for production.

The Wall Street Journal today refutes the fictional estimates recently released by the CBO.  The Heritage Foundation estimates that cap and trade will cost American families $3,000 per year.

Here’s a better–and more accurate– poll question:

“Would you support an increase in your electricity, gas, school taxes, food items, clothing and general living expenses in order to cap carbon emissions?”

Or perhaps “If your costs go up $3,000 per year, what will you give up first: vacation, braces for your kids, date nights with your spouse, dental work, home renovations, car or electronics purchases.”

Now THAT would make for interesting poll results.

Pardon My French

Written by Audrie Zettick on June 15, 2009

The downside of being a policy and politics blogger is that it’s tough to really take a vacation.  No matter where I’ve been for my family sojourn the past two weeks—travelling through New England, hoofing it up to the Citadelle in French Quebec—I’ve been drawn to things that are writing prompts.  

I was strolling through the upper olde town portion of Quebec (within the walls of the original fortification).  Graffiti is not prominent, but I had just passed “Quebec e Liberte” scrawled on one wall—Quebec Independence.  The Governour Generale of Canada had made a rare appearance at her quarters there, and a supporter of independence took advantage of the event to make his passion known. Hopefully, this was a youthful exuberance by a supporter of Parti Québécois or of Bloc Québécois , not a sign of activity of the almost-but-not-quite-defunct FLQ, a Marxist-leaning and violent organization of previous eras. The PQ and BQ are left-leaning but focused on either independence or protection of the French language, not blowing up coffee shops.  This reminded me of a conversation I had on the previous day with a German couple–sorry, just couldn’t help myself–about countries having official languages (like the U.S. English movement).  I was enjoying using my French but couldn’t help discussing what language differences could do to the unity of a country.  Again, my propensity for political thought trumped all. 

Further down the street, as I was admiring the many street cafes on this sunny afternoon, I spied this graffiti:     

If you can’t read it, it says  

Americans in Deep S@#%  A.i.d.s. 

A decidedly French-Canadian spin on the current American economic and spending situation.  And with the state of the debate on Obama’s budget and the forecasted impact of the ballooning national debt, I’d say I agree.

Brain Food

Written by Audrie Zettick on June 1, 2009

Those of you who follow me on Twitter may already have read these articles.  Consider them brain food on current issues.

• In Pravda, the state news of Russia, an article called “American Capitalism Gone With A Whimper.”  While some things are overstated, it gives an interesting perspective of current events in the U.S. from outside eyes. A bit of a wake-up call.

• In Smart Girl Nation, an article by Dr. Richard G. Fessler debunking the World Health Organization’s ranking of the U.S.’s health care system, showing how their calculations are biased against the U.S.  Numbers aren’t always what they seem at first glance.

Feed your brain.  Think for yourself.  Pass it on.

Duty to Die: Is It Plan B?

Written by Audrie Zettick on May 21, 2009

Some say 70 is the new 50.  I say if we are not careful, 2009 may be the new 1984 and seniors may have much to worry about.  So far this year, we’ve had federal policymakers begin to dictate what we can and cannot drive, seek to inject government into labor contracts via the Employee “Free” Choice Act, and express their desire to explore ways to make “reasonable mandatory service requirements“ for young people.  Can dictates about health care be far away?

You may know our health care system needs some tweaking–you know costs seem out of control–but you’re quite happy with your own employer-provided health care plan.  Maybe–despite being quite intelligent–it just all seems too complicated to pay much notice.

Time to notice. This will affect you in some way.  And it’s likely to come sooner than later, as Congressional Democrats are working under a self-imposed July 31 deadline for passage of any health care reform.

Proposals from Left to Right 

Proposals run the gamut and are under constant development.  On the far left, we have those of the liberal bent (exemplified by Rep. Peter Stark) who, in search of universal health care coverage, carve a large role for a government-provided plan, even automatically enrolling all newborns.  On the center left, we have proposals like the Democrats’ mandated insurance proposal, where a requirement to have health care would apply to individuals and employers would be required to foot more of the bill.  Tax penalties apply to those who don’t comply, and the government takes on an increasing role in setting insurance rules.  Somewhere in the middle are plans like Sen. Wyden’s, which recognize that the private sector must play a large role.  On the center right, we have the Republicans, whose just-released proposal is heavy on consumer choice, with a touch of reality-driven government regulation.  On the far right are proposals that leave total choice up to the consumer, through expanded options like health savings plans–already available to many if they hold a high deductible insurance plan and health .   

Duty To Die

President Obama has laid out 8 principles of health care reform that on their face appear balanced, but his 3 bedrock principles leave much wiggle room, and lead with Cost Containment.  I can’t argue with cost containment in principle, as a former small business owner who watched our health plan premiums skyrocket.  But with Obama’s health care plan estimated to start at $634 billion and rise from there, there is extreme pressure for cost savings.  I’m concerned that any effort to control costs doesn’t digress into a public policy where government makes the choices about significant aspects of our health care.  

The stimulus package already included a favorite of President Obama–Comparative Effectiveness Research–designed to rein in costs to allow expansion of health care coverage for all.  Used correctly, a database of most effective treatments could be a godsend to doctors and consumers alike.  In the hands of a government-run health care program, it could slip into a cost-saving debacle, denying options and coverage to consumers.  Some speculate that the elderly would bear the brunt of this approach. 

It’s a real issue, since Duty to Die is a real philosophy, discussed in many ethics textbooks and proposed by respected academics (see here and here ).  While some scoff that critics are misrepresenting Comparative Effectiveness Research, it’s wise to watch for the slippery slope, since some experts have specifically suggested the following:

•  “there is a moral duty to die inexpensively in healthcare contexts.” J. Angelo Corlett, Professor of Philosophy,  Health Care Analysis, “Is There a Moral Duty to Die,” Nov. 2, 2004.  Corlett based his theory on Paul Menzel’s theory of health care distribution (Menzel is author of “Strong Medicine: The Ethical Rationing of Health Care”)
• “Even very young children can understand that medical costs can quickly absorb money that could otherwise be put aside for college education or a family vacation, for example.”  (Judith Lee Kissell, PhD; professor of bioethics)

To this genre of  philosophers and bioethicists, the duty to die is social policy–based on a view that medicine can be used as a mechanism for a more equal distribution of wealth and resources. 

This is a departure from other physicians who discuss this issue of limited resources.  When discussing medicare funding challenges, doctor Kenneth Prager is more measured, recognizing the challenge of limited resources, but noting that the “proper approach to an aging population that consumes ever more health care dollars is not to cut their access to care arbitrarily but to develop a multifaceted approach that emphasizes patient and physician education about what medical care is helpful and what is not…”

What’s Already In Place

Worry not, you say.  A federal Duty-to-Die policy would never happen.  Perhaps not. The Stimulus Bill created a Federal Coordinating Council for Comparative Effectiveness Research.  Original language was changed to insert words like “clinical” and eliminate any references to cost control because of an outcry regarding these issues.  I agree with Media Matters that the stimulus bill never contained language dictating that knowledge about Comparative Effectiveness be used to prohibit certain treatments.  HHS says that ”The Council will not recommend clinical guidelines for payment, coverage or treatment.” Specifically, the Stimulus Bill says: “Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer.”  Call it semantics, but when we use the term “mandate” we usually mean things the government requires us to DO, not what they don’t allow us to do. 

Semantics aside, it would be entirely possible for another government entity–tasked with cost containment–to take the data compiled as a legitimate part of comparative effectiveness and use it to craft other cost-containing policies that limit coverage.  This is more tempting to invoke the tighter the U.S. gets squeezed by health care coverage costs.

Do the Math

The Council is modeled after Tom Daschle’s references to a U.K board–The National Institute for Health and Clinical Effectiveness  (hat tip Betsy McCaughy at Bloomberg) which “approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.”  This is known as Quality Adjusted Life Year calculations.

Couple this health care framework with statements about saving money,  and we’re closer to the slippery slope.

I have a 91 year-old-grandfather who wielded a table saw last summer to help with a home project and still drove (safely…really) until last month, when a sudden onset of cataracts limited his mobility.  Would a government bureaucracy tell him he couldn’t have his cataract surgery this month, because after all, it makes no sense since he’s near the end of life? If the cataracts had come on at 85 or 89, would a decision have differed?  Health care decisions need to be made on a case-by-case basis.  

I’m not the only one concerned with putting road blocks in place to prevent a slide to Duty to Die.  A group of moderate, business-oriented Democrats just release their own proposal –H.R. 2505–to reshape Obama’s Federal Council, now composed entirely of Federal bureaucrats.  The goal of their Council would be to ensure that “medical decisions remain between physicians and patients.”  Even former Congressman Tony Coelho — chair of the Partnership To Improve Patient Care and certainly not a conservative–voiced his worry that cost containment will become the main goal of the Federal Council in its current form.  While this legislation contains some language regarding examining health expenditures associated with a “health condition or the use of a particular medical treatment, service, or item,” the remaining language makes it clear this new nongovernmental Council would focus on patient health and well-being, and the quality of care.  I view this bill as a guardrail to prevent health care reform (in whatever form) from careening off the cliff and down the slippery slope.

Health care reform is too important to leave the details to Washington without our voices being heard.  Regardless of the ultimate shape of health care reform, we must make certain “Duty to Die” never sees the light of day, setting roadblocks in the way of health care rationing.

Hedge Manager Dares to Speak Out On Obama

Written by Audrie Zettick on May 6, 2009

A departure from my usual longer posts (and something I’ll be doing more of). 

Here’s something worth reading and viewing, given President Obama’s bashing of Hedge Fund managers who supposedly held up the Chrysler bankruptcy because they wanted more than 30 cents on the dollar for their clients.  No matter what your view on Wall Street, hedge funds and big business, it’s worth the listen.

I Want My SUV: More Unintended Consequences On The Horizon

Written by Audrie Zettick on April 27, 2009

Being involved in government policy making is like watching sausage being made: after you’ve seen it done, you want no part of it. 

Guess that’s why I managed to escape my policy stints in some of the world’s largest government bureaucracies with a modicum of increased wisdom based on experience and a healthy dose of skepticism about government.  Among my lessons: 

Always assume your first try at a new policy won’t go as planned.  Triple the probability of it going wrong if you’re hell-bent on rocketing warp speed toward change. 

For good or ill (and usually for ill), there will be unintended consequences. Among many misfires we have had this year:

·         Banks on the dole.  Call it corporate welfare, bailout or stimulus, I was amused to see the supposedly strange (but predictable) behavior of some financial institutions: buying jets, remodeling offices and the like. (Reminder at old Slate article here:  I See Dead Bankers! Wall Street has become The Sixth Sense-filled with corpses who think they’re still alive.)

·         A knee jerk reaction as the U.S. House passed a bill requiring a whopping 90% tax on bonuses at AIG and other institutions that took TARP money–but it turns out many of these folks were working under a retention contract which promised them pay after they stayed a set length of time…and many were with the financially-healthy subsidiaries of AIG. So are we surprised when the talent needed at companies like this flee? Or that other financial institutions, hesitant to face micromanagement by the feds are scurrying to pay back TARP funds rather than stick with the Obama plan?  Oh, then there’s that problem with the bill being unconstitutional.

·         U.S. automakers GM and Chrysler had to be thrown multiple lifelines in the form of $17.4 billion to avoid bankruptcy, but it’s only the threat of that very bankruptcy that has resulted in movement toward hauling in labor and healthcare costs (see Chrysler in Canada here). 

Which leads me to the next unintended outcome of any new “economic stimulus” measures:  The success of car companies like KIA. 

With the U.S. government at the helm of GM and Chrysler, market forces go out the window.  President Obama has made it clear that he will “remake” the U.S. auto industry, ”forcing” consumers into smaller cars that are clean, economical and green.  During his campaign, he scolded auto makers for focusing on popular SUVS and not cars with improved fuel efficiency.     

Yet, KIA is currently building their first U.S. auto plant where their value-priced SUV, the Sorento, will be built.  My neighbors, many of whom had trailers hooked to their big SUVs at the recycling center this past Saturday to pick up free mulch, will be glad to know at least one company will still provide an SUV.