Sunday, August 23, 2009


Did you ever notice that many of the things Republicans have accused Democrats of are things that they are already doing or supporting to a greater degree? For example:

· John Ensign’s righteous indignation over Clinton’s assignations while Ensign was having a full-blown affair with a staff member who was the wife of another staff member. For a while it did seem like the Democrats were linked with sex scandals and Republicans were linked with money and personal privacy scandals, but now the Republicans have pulled ahead in all areas.

· Accusing Democrats of “politicizing national security” just before the release of a book accusing the Bush administration of timing the release of national security-related information for political ends and suggesting they also overstated the danger level for political reasons.

· Accusing Democrats in general and Obama by name of racism (though since Republicans had been openly stirring the racial violence pot before the election, this doesn’t quite fit the preemptive strike scenario)

· Accusing Democrats of hiding in health care legislation “death panels” who will make life or death decisions about who receives treatment and who doesn’t. There are no death panels in the legislation, but there are de facto death panels right now. They work for the Republican-supported insurance companies, and when they deny coverage, benefits, and treatment, they and their shareholders win and sick people lose, maybe even die.

· Accusing Democrats of wasteful spending when Republicans have been spending our national debt into the stratosphere for 30 years. The last big spending Democrat was Lyndon Johnson in the 1960s. Clinton reduced the annual deficit. Why does this myth persist?

· Accusing Democrats of manufacturing public support for health care reform and other issues

· Accusing Democrats of manufacturing scientific evidence supporting climate change and other issues

· Accusing Democrats of trying to turn the country into a fascist state.

Simultaneously, Republicans accused Democrats of trying to turn the country into a socialist state. I have to add here that these two together bug my 16-year-old daughter to no end. She just got an A in history, and she understands that fascism and socialism are drastically different. Under socialism (in theory), production and distribution of goods and services is owned by the public with equal rights for all. Under fascism, the strong eliminate the weak, which is closer to Republican extremism than Democratic.

Then there are accusations of doing what Republicans are already known to have done, like collect an enemies list (Nixon for sure, Bush likely) and take too many vacation days (Bush took many more vacation days at this point in his term than Obama has). Do you remember Republicans accusing candidate Obama of bad taste and poor judgment in asking for campaign contributions last fall as the economy slid into recession?

Why do Republicans accuse Democrats of doing what Republicans are already doing? Is it guilt? Is it lack of imagination? I believe it is tactical: a preemptive strike.

Why is it better to be the first to accuse? First, there is a certain origination value when an accusation is first brought to light whether it’s true or not. People remember it and seem to cede the first accuser the moral high ground. Second, it puts the innocent party on the defensive. Before you can have any credibility accusing the real guilty party, you must clear yourself. Third, the first accusation dilutes all similar accusations that follow. The second to accuse looks like a copycat or worse, spiteful. His or her motivation is immediately suspect. In short, a preemptive strike accusation takes impact away from any later accusation against the original accuser.

In the past, this would have all backfired on the first accuser when the truth came out. Far better to be just guilty than be a guilty, lying hypocrite and false accuser. At least, that’s the way it used to be (though at least Glenn Beck got some pushback for saying Obama hated white people).

Lately, our hypocrisy meter seems to have broken. We’ve moved away from ‘an eye for an eye,’ which is great, but that doesn’t mean we have to turn the other cheek every time, nor do we have to remove every speck from our own eyes to see that giant wooden park bench sticking out of the eye of that lying, smiling, corrupt hypocrite over there. These are Christian metaphors—not ones I’ve heard used by any politician—but you don’t have to have religion to have a good head of righteous indignation steam over this.

I’ve always been a fan of turning bad actions back on the wrongdoer whenever possible—let him shoot himself in the foot, so to speak. So here’s what I propose. We have learned that when Republicans accuse Democrats of something, it’s often a tactic to protect themselves while doing or supporting the same thing. Republicans will always know what they’re up to before anyone else, so they have the advantage in first strike capability. But let’s use that. Consider that first accusation a clue telling investigators where to start turning over rocks on the Republican side.

Sunday, August 16, 2009

Health Care and the Incentive System

Fair warning: If you're sick of hearing about the health care debate, skip this post.

So like most everyone else, I want health care reform and I'm not seeing the public discussion covering the issues I think need to be aired. I have been a business consultant among other things, and I believe that the origin of our health care problem is that we don't have a system that rewards the right results.

HEALTH CARE INCENTIVES, PART 1 Health Insurance Companies 8/16/09

We are watching the PGA golf tournament, and I just saw a commercial in IBM's "Let's Build a Smarter Planet" campaign about their work to link up medical data. This would allow a person’s entire medical history to be accessed by an emergency medical provider. It would reduce the cost of lawsuits involving medical records, which is a ton of lawsuits. (It would also eliminate suits by plaintiffs who currently try to hide aspects of their medical history).

At a higher level, it would allow people who study public health to draw conclusions about large and small populations by slicing and dicing health profiles based on any measured variable. Certainly some cause-and-effect relationships are known, but some are just conjectures. This kind of deep study could replace supposition with real facts about who is at risk for what long before symptoms manifest.

How can this information be used? Under the current system, insurance companies are rewarded for using diagnostic tools to deny coverage to people for the things they are most likely to get. And I’m not the only one who realizes this. Cancer runs strong in the women in my husband’s family. Young relatives in his family are afraid to get tested for cancer susceptibility not because they are afraid to find out they have the gene but because they are afraid they will become uninsurable.

Earlier this morning, on Meet the Press, Sen. Tom Coburn MD (R-OK) said we don’t need a public option, we need to open up competition among insurance companies. The above is just one reason why that would not work. I’m not sure that profit incentive is even appropriate in a health care environment, but I am sure that it’s not working in its current form.

In addition to denying coverage, insurance companies also make money by dragging out disability benefit payments hoping that claimants will recover, give up, or miss a deadline and forfeit benefits. You don’t have to go far to find stories of people who waited two and three years (people I know) to start collecting benefits.

And why shouldn’t insurance companies delay? Once payments begin, companies pay back benefits with no interest, which means they earn interest on payments for as long as they can keep from paying. They do not risk punitive damages for denying benefits. There is no downside to the company for delaying; it would practically amount to corporate irresponsibility not to delay.

It's not too much to ask that everyone in the health care chain of care have the same incentive: to improve our health, now and in the future.


The most rational of the people who object to a public health care option agree that the current health care system is broken but argue that the government can’t afford to pay for an alternative. Under the private insurance option, the parties are the doctor, patient, and insurance company. The fundamental flaw in the cost argument is assuming that the government’s overhead will be as much as the insurance company’s. The government can operate with far less overhead, plus it is not looking to make profits. The health insurance industry makes over 30 cents profit on every dollar of premium. That’s a huge cost that the government doesn’t have. How could it not do more for less?

Doctors: People perceive that doctors make too much money and that reducing reimbursements is the way to cut costs. I am not a doctor, but I research statistics about doctors’ finances and post to a doctor chat board. Here’s what I learned:

· Doctors today come out of school with over $200,000 in debt –more if they specialize. Before they see one patient or get a roof over their heads, they have the equivalent of a mortgage to pay off.

· They graduate at a later age, so they have fewer years to build a nest egg.

· If they buy into a private practice, they add around $400,000 to $500,000 in debt—again, some more, some less.

· Even among dentists, who don’t have the reimbursement problems physicians do, more than 90% see their lifestyle drop in retirement. This suggests that they didn’t save enough and invest well before retirement. In fairness, they’re not poor. However, the corollary is that they spent too much before retirement. So yes, you may see doctors living the good life, but many of them can’t afford it.

· The doctors I know that are doing very well have active practices during the week plus they are giving continuing education seminars on weekends. They work hard.

Personally, I want doctors to earn a lot of money. I want clinical medicine to attract the best practitioners available, and I want public health care that is competitive with the private sector. Do you think if we take some of that 30+ cents on the dollar and use it to boost paltry public reimbursements that we can achieve that? I think we can.