While I will confess to be a very partisan person, I chose never to engage in partisanship on this blog during the election. There was already way too much partisan hatred and bickering. There was already a cacophony of voices screaming insults and abuse at each other. This is no way to run an election, or a country for that matter. But now we need to sort things out and begin our journey forward. To do this we must take a painful and honest look at our nation’s troubles, and figure out how we can best come together to solve them.
We need to find a way to come together as a nation and discuss our various issues and their best solutions. In the present political climate any civil discourse seems impossible.
The Republican leader in the Senate said early on that the party’s primary goal was to prevent Barack Obama from being elected to a second term. Such a stance can only be described as destructive defiance. It seems that the Republicans, and especially those of the Tea Party persuasion, tried to sink the ship of state because they were unable to set its course. That is partisanship gone rancid. Every proposal that Obama offered up, including his quest to find acceptable compromises, were shot down by intransigent Republicans. And then, to add insult to injury, the Republicans viciously accused Obama of having a failed presidency. A failed Tea Party mutiny is a more apt description of the last two years.
In the kinder, gentler times in Washington, Speaker of the House Tip O’Neill declared that, “We are all friends here after 5:00 pm and on weekends.” If only we could recapture such civility in today’s political life.
Our country is still in a mess. There is no dispute about that. We have rampant unemployment, soaring debts, a shaky, unfunded entitlement system, a collapse of the middle class, a large and accelerating gap between the haves and the have-nots. The middle class is hurting and the poor are becoming ever more destitute.
We need tax reform, immigration reform, and regulatory reform. We need to create jobs, rebuild our infrastructure, rebuild our economy, and rebuild our crumbling education system that was once the pride of the planet and the source of our great economic well-being as a nation that once allowed even our working classes to participate in the American Dream.
On the global front we are in the midst of the largest mass extinction in seventy-five million years. We need to develop a sustainable economy that does not plunder the earth’s resources or endanger its future to power our economy today. So, before we build pipelines to move shale oil down from Canada we need to stop and assess the environmental impact. Sustainability must now be a key component of every decision.
If Mitt Romney ever had a plan to govern this country he refused to communicate it to the general public. Every question directed to him was answered either by reciting his talking points or by attacking the president.
He spoke repeatedly about tax breaks for the millionaires and billionaires on the grounds that these are the job creators. But this was also George W. Bush’s line. It was a failure then and it would be a renewed failure again. It might be a good idea to give tax breaks that spawn actual job creation. But without such a linkage many of the rich would simply park their excess cash in their Swiss bank accounts helping no one.
There is already too much idle cash on the sidelines awaiting productive investment opportunities. What is lacking is not excess cash, but rather consumer demand. If you want to stimulate the economy and create jobs then put some extra cash in the pockets of the middle class so that they can go out and buy tires and refrigerators, thus creating demand and driving production.
Romney wanted to see financial regulations abandoned to free up business from government interference. But we have had three major financial crises in recent history that were directly caused by the lack of effective government regulation:
- The Savings and Loan Crisis in the Reagan era caused by deregulation of the thrift industry.
- The stock market collapse of 2000-2002 caused by the complete failure of the Securities and Exchange Commission to regulate our financial markets. Elliot Richardson, then the Attorney General of the New York was the only person even trying at that time to regulate the financial markets. During this time of regulatory abdication, the predators, thieves and con-artists had their field day. The rogues list includes such names as Enron, WorldCom, Arthur Andersen, and a host of others. The financial losses from this event totaled over $5 trillion.
- Finally, we had the global collapse of our financial markets due to the “liar loans” in 2008. Mortgage companies would give loans to anyone who could fog a mirror. These trash loans were then securitized with “AAA” ratings and sold throughout the global financial markets. When this house of cards, built on corruption and regulatory abdication, finally collapsed, it created a global recession from which we have yet to extricate ourselves.
Does any of this sound like we need LESS regulation?
Romney never did explain how he could give tax breaks to the rich, increase military spending by two trillion dollars and balance the budget. Such nonsense is what George H.W. Bush called “Voodoo Economics.” He did speak of doing away with almost all federal programs that actually benefit the middle class and working poor. In a frenzy of social Darwinism he would cut funding for Head Start, unemployment insurance, Pell grants and student loans. The millionaires and billionaires would prosper mightily under a Romney administration, while the rest of us would be floundering in debt and despair, and left with no rope to climb. Even Big Bird had his head on the chopping block. Excuse me, but is not Big Bird about preschool education? While government subsidies for public television do not pay for the production of Big Bird, they do go to sustain broadcasts of Big Bird to smaller, mostly rural communities where the need for such preschool education is critical.
And then there is the strange case of Obamacare that was at the center of Romney’s attacks. Obamacare began as Romneycare in Massachusett. So, how could Romney attack what was essentially his own plan raised to the federal level?
The American health care system before Obamacare was a disgrace. The U.S. spends 17% of its GDP on healthcare, while no other country spends more than 12%. And still our health care outcomes trail most of the world. The leading cause of personal bankruptcy in this country is from medical bills. It would be hard for anyone to argue that our system did not need a major redesign.
Romney claimed that he would repeal Obamacare his first day in office. But he never told us what he would do to replace it.
Health Care Issues
The Unites States spends 17% of GDP on healthcare, or over $8,400 per capita, more than any other nation. No other developed country spends more than 12% of GDP on medical care. And yet our people have some of the poorest healthcare outcomes in the developed world. Some 46 million Americans are uninsured. We rank 30th in infant mortality. Our life expectancy is 50th in the world, behind all developed nations. Medical expensed is a major factor in 62% of personal bankruptcies.
CLICK ON GRAPH TO ENLARGE
Truly we are not getting the maximum value for our health care expenditures.
We need to have universal access to healthcare. This does not need to be accomplished through a government bureaucracy, but it does need to be done.
Universal healthcare will provide for early diagnosis and intervention, saving billions of dollars in the long run. As it is now, people without access to health care normally wait until their condition requires emergency room treatment at high cost. They are forced to wait until their minor medical issues become crises before their conditions can be treated.
Under the current health care system medical care is delayed for those who can least afford it. Imagine a small child with an earache. The parent is forced to delay medicalcare due to the high cost of treatment, let’s say $200 for a doctor visit, lab tests, and prescriptions. Without access to healthcare the child’s condition worsens until the child is taken to the emergency room with a high fever and unbearable pain. Because of the delay a relatively minor malady that could be treated for a few hundred dollars may now cost thousands or even tens of thousands of dollars. And on top of this, the child may have become deaf or suffered other permanent impairment requiring a lifetime of special care.
Single payer health care will end the costly paperwork and delays caused by our current multiple-payer system. Health care professionals would be able to concentrate on providing health care as opposed to figuring out who is going to pay and how to prepare and submit the paperwork for reimbursement.
Pre-existing conditions will no longer be an issue as all will have insurance regardless of their condition. Everyone can be covered if everyone pays.
Universal healthcare will focus on prevention and early intervention. Vaccines, blood pressure monitoring, diabetes testing, cancer screening, health education, weight control, nutrition and exercise, stop smoking campaigns, and perinatal care will become essential programs for maintaining health and wellness, and for reducing healthcare costs in the long run. Under universal healthcare the focus will shift from disease care to wellness care.
We need a fundamental shift in priorities for healthcare. Under our current system, approximately 75% of a person’s health care expense comes in the final year of life. Instead of paying for heroic measures to extend life of the critically ill, we need to shift our resources and our focus towards maintaining health and wellness for all. In the most extreme cases, our heroic measures do not extend life, but only prolong death at a horrific cost. Those are healthcare dollars that could better be invested elsewhere.
Healthcare rationing will be required under any conceivable healthcare system. The old indemnity insurance system failed because plan members could demand essentially unlimited medical coverage. If the first doctor refused to do a requested procedure, the patient could seek out ten additional doctors, and undergo ten more sets of tests. Eventually, a doctor would agree to do the procedure, even if it had limited or no justifiable medical value. And the result was that the insurance company was expected to pay the full cost of the search for treatment as well as the actual treatment.
It is not financially possible to perform all of the medical procedures that we know how to do. Nor is that always the wisest course of action. The cost of heroic medical care is paid not only in scarce healthcare dollars, but in pain, incapacity and suffering of the patient as well. The cost of intensive care is approximately $3,000 per day.
If the patient in such circumstances has a chance of recovery, then the expense as well as the pain and suffering may well be worth it. But if the patient has no chance of recovery, then what is gained by the expense, pain and suffering? And in gauging the capacity for recovery we must use sober reasoning and not wishful thinking.
But we must also look at the negative quality of life for the patient. If a patient has no chance of recovery, how long should they be maintained by such heroic means? And furthermore, what is the quality of life for that patient? This situation demonstrates the difference between extending life and merely delaying clinical death. The irony is that under such extreme circumstances we treat our pets more humanely than we treat our parents.
Before making any major medical decisions we must also consider other factors such as the patient’s age, health, his or her capacity to endure the procedure, and the potential for improvement in quality of life that the procedure offers. For example, an eighty-six year old with congestive heart failure ought not to be considered for a liver transplant.