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The One About Book Club: The 48 Laws Of Power: Laws 9 and 10

POSTED: 5:59 pm, February 28, 2010 View Comments

Hello again. Well yesterday we took a look at laws seven and eight, of The 48 Laws Of Power. Today we look at the next two laws, one of which is incredibly important for Progressives to start following.

LAW NINE: Win through your Actions, Never through Argument

Any momentary triumph you think gained through argument is really a Pyrrhic victory: The resentment and ill will you stir up is stronger and lasts longer than any momentary change of opinion. It is much more powerful to get others to agree with you through your actions, without saying a word. Demonstrate, do not explicate.

Wow. This one is huge. And it’s one that Progressives often have a hard time with.

We often have a tendency to think that if we can just keep talking we will get people to see the sense of our ideas. Generally speaking all that does is make people tired of listening to you. While there is nothing wrong with talking, we must also make certain we are acting. Now the ideal action would be to get Progressive legislation passed and have people see how successful it is. But that is problematic since we are usually out of power more often than we are in. Fortunately that does not mean that we have no other options.

One of our best options is the formation and usage of Non Governmental Organizations or NGO’s. Now this is tricky since central to the Progressive message is that reasonable responsible government is a good thing. However if our message is one of reluctant warriors we have the potential to go far. If we are constantly reminding people that if government were doing what it’s supposed to do in protecting the people and ensuring their well being their would be lessened need for NGO’s. The main thing is that any extra-governmental steps we take must be presented as not a refutation of government but rather as a criticism of governments failure to act.

Another problem we have regards those who oppose us and our seeming disability to disengage with them. So often I see Liberals and Progressives who will debate with a Conservative until they are blue in the face. This is always a losing proposition. I’m not saying we should not engage. But we should do so in the manner or, and to the degree of our choosing. It is easier to do that if you keep a couple of key facts in mind.

1: YOU ARE NOT COMMUNICATING TO ATTEMPT TO EDUCATE A CONSERVATIVE PARTISAN.

Here’s the thing, broadly speaking Conservatives are our enemy, ideologically speaking. They may be good people, love their kids, hug puppies etc. But never forget that their entire world view is based on the idea that people should stand on their own unless they have absolutely no other recourse, and then dependence on private charity is preferable to government intervention. They reject the notion that government ever helps. They believe it always and only hurts. They believe that businesses if left unregulated will generally do the “right” thing and that government regulation again only makes things worse never better, etc. etc. They are fanatically devoted to this mindset and message. So strictly speaking on such matters there really is no point in even talking to a Conservative is there? But you are not talking with them for their sake. Rather the point is to get the Progressive message out there to those who have not made up their minds yet. This is why it is important for Progressives to comment on Conservative blogs, call conservative talks shows, write letters to the editors of Conservative newspaper and magazines etc. But it is important to put forth our message or talking point, and then to disengage. Now you may sometimes feel like follow up debate, and that’s fine, but be selective where and how you engage. Most of the time you will only be expending time and energy that is better spent elsewhere. Also keep in mind that the window of open mindedness can be rather small. So a reader of a Conservative blog reads the comments section and sees your point and they think about it. But if you keep coming back to defend yourself they will see you as weak, and defensive. Now they disregard your original point, hell they don’t even remember it. The window is gone and instead of lodging a Progressive point in their heads they now are even more filled with Right Wing ideology.

2: PICK YOUR MAIN POINT AND THEN HIT AND RUN.

Progressives often want to refute every point that a Conservative makes, but most people find that tedious, especially from a responder. If you want to make a point by point refutation save it for your venue that YOU control, be it blog, TV show, what have you. When you are in the realm of someone else’s control, the briefer and more to the point your message is, the harder a time they are going to have distorting it.

REVERSAL OF THE LAW:

It’s not precisely a reversal, but the fact is that in this day and age, there is not getting away from talking. Ours is not an age where it is generally possible to have one’s enemies killed, or exiled etc. without running into a large number of problems, and you can’t do it publicly. So we talk, which is why they call it a war of words. And while there is strength in silence we must be careful about what message the silence communicates. It must be a dignified silence that says, “I’ve said all that needs to be said and I trust the people to understand what I’m saying.” rather than the fretful fearful silence that conveys a message of weakness and fear. Often times once you have disengaged on a particular point with a particular opponent the worst thing you can do is reengage. It will make you look weak. I understand that no one likes it when your words are twisted around but the truth is that is something Conservatives excel at. So you break your silence to explain yourself, to clarify, and they twist that, so you break silence again. Quickly it becomes clear to everyone who is really in control, and it’s not you.

LAW TEN: INFECTION; AVOID THE UNHAPPY AND UNLUCKY!

You can die from someone else’s misery – emotional states are as infectious as disease. You may feel you are helping the drowning man but you are only precipitating your own disaster. The unfortunate sometimes draw misfortune on themselves; they will also draw it on you. Associate with the happy and fortunate instead.

This is one of the ugly realities of politics and it is one that as much as we might wish were otherwise no one, not even Progressives can escape. It is the reason why even though we know the circumstances beyond his control that led to Jimmy Carter’s presidency being perceived as a failure, we also know how he is perceived and generally hold him at arms length. It is why no Progressive gets too close to Ralph Nader. It’s the reason why Howard Dean after getting his message across about his fundamental problems with the current Health Care Reform bills, stepped back from saying that it would be best to start over. He wanted to make certain he was no identified with Jane Hamsher of FireDogLake who in the eyes of the general public, and a great many Progressives has destroyed her credibility. Now obviously we don’t want to cut people loose the first time they have a defeat or suffer a reversal. But ultimately there comes a point, like it or not that we have to be ruthlessly pragmatic, and when the very mention of someones name taints the Progressive Movement, we’ve got no choice but to distance ourselves from that person. If we do not, then it hampers our ability to do anything worthwhile.

REVERSAL OF THE LAW:

As The 48 Laws Of Power, says there simply is no reversal of this law. However I think for both our image, and for our spiritual well being, we should be careful in how we apply this law. We must not become a group that cuts someone out the first time they run afoul of circumstances (generally speaking obviously there could be a situation that a person has done or said something so horrible that to be seen supporting them for even one instant more would be destructive to our goals) and we should usually try not to be seen demonizing former allies and leaders who have fallen from glory. Again Carter and Nader are great examples. We are more than happy to allow with Carter on things like Habitat For Humanity etc, but we are careful to make certain that he is not seen as influencing either the directions our policies take, nor the reactions we have to current events. Nader is a popular columnist, and a very intelligent person but any time the subject of his making another Presidential run comes up most smart Progressives find a way to say something nice that amounts to either “Well it would be nice if he could win, but in the current climate I don’t think it’s a good idea.” Or even better, a nice sounding statement that amounts to “No comment.”

Alright everyone, that’s it for this installment of The One About Book Club and for this weekend. Check back next weekend when we’ll be diving into laws 11 and 12, and 13/14. Plus remember to check in every day for the weekly edition of The One About…. This week I’ll be looking at topics ranging from the problem with religious exemptions, to the Conservative double standard around Obama engaging with “Religious Extremists”, and I’ll even have tips on how to use martial arts to stop a Republican dead in their tracks. Until next time….

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One About…)

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The One About Book Club: The 48 Laws Of Power: Laws 7 and 8

POSTED: 1:05 am, View Comments

Hi all. Welcome back to The One About….’s special weekend feature, The One About Book Club. For those of you who are new readers to The One About…., let me recap for you. On the weekends I write in depth about a book that I feel is of significance to Progressives, looking at one or more chapters per post. For the complete introduction to the project you can go here. My pick to inaugurate this project is The 48 Laws Of Power. So far I’ve offered an introduction and overview of the book, and written about Chapters(or in keeping with the tone of the book Laws) 1 and 2, 3 and 4, and 5 and 6. So I bet you can guess what comes next.

LAW SEVEN: Get others to do the Work for you, but Always Take the Credit

Use the wisdom, knowledge, and legwork of other people to further your own cause. Not only will such assistance save you valuable time and energy, it will give you a godlike aura of efficiency and speed. In the end your helpers will be forgotten and you will be remembered. Never do yourself what others can do for you.

Now so far I, taking a fairly pragmatic view have made suggestions for ways that Progressives could, one might even say should, be using the prior laws of power. This law however is one that I must strongly caution we must avoid being seen using at All Costs!

Progressivism should be, and more importantly must be seen to be, a populist movement, and a largely egalitarian one. While no one expects every single person who might play a minor role to receive some huge acknowledgment, there is a general expectation that credit will be given where it is due. It is by eschewing and being seen to eschew this law and it’s adherents that we can better establish our core identity and values. Hogging the spotlight, hoarding the power, that’s what “They” do. Sharing the glory, empowering everyone, that’s what “We” do.

REVERSAL OF THE LAW:

For Progressives the thing we have to watch out for are Fame Whores. People who wish to be famous, and have no real investment in our cause. Such people when they are found out should be kept as much out of the limelight, and as far away from power as possible and they should quickly move on to the next venue to fame.

LAW EIGHT: Make other People come to you – use Bait if Necessary

When you force the other person to act, you are the one in control. It is always better to make your opponent come to you, abandoning his own plans in the process. Lure him with fabulous gains – then attack. You hold the cards.

This law is a hard one, practically speaking for Progressives to follow right now. We have precious little real power so it is difficult to be attractive enough to have others come to us. However we would be well advised to get to work on changing that. One very simple step is to stop whining about not being included. I heard this repeated over the last couple of days with some Progressives complaining about there not being any advocates for Single Payer speaking at the recent Health Care Summit. Such whining makes us look weak and is not attractive. Rather the official Progressive position should be one disdaining the Summit as just another example of the Right and Left arms of The Corporatocracy getting together to foul the atmosphere with hot air in hopes of fooling the people that they are actually doing something. It should be the same for anything we are not allowed to take part in. In the meantime we absolutely must continue to get organized, and we should be forming PAC’s that are large enough and strong enough to suggest that we could deliver a sizable block of votes. Then the first time that Democrat leaders or the President call upon us to meet with them, we should politely decline. Then on the second invite we should graciously but grudgingly accept.

Now of course the above is merely an example. Politics is a dynamic situation and we need to always be on the look out for how best to act and react in any given situation. The important thing is that we must be seen Not running to the beck and call of non Progressives in power simply because they’ve snapped their fingers.

REVERSAL OF THE LAW:

Basically we must be sensitive to the situation and our position at any given moment. Once we have managed to get some unity and some effective PAC’s formed we will be in a better position to make people come to us. Until then we should be careful not to over play things. Again the recent summit is a great example. Since we were not invited we should be seen to disdain the event, but had we been invited, we should have gone.

Alright gadies and lentlemen, that’s it for today’s installment. Check back tomorrow when I’ll be looking at Laws 9 and 10. Until then….

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One About…)

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The One About Tom Coburn’s “Under Cover Patients”.

POSTED: 11:21 pm, February 26, 2010 View Comments

One of the few Republican ideas brought up at Thursday’s Health Care Reform summit that seemed to be really popular with both parties was suggested by Senator Tom Coburn. The idea basically is to have people go and visit doctors, and try to get them to break Medicare rules. I presume that if they created such a program for Medicare they would try to see to it that it was applied to Medicaid as well. It has been compared to the practice that many fast food restaurants and retail clothing stores have been employing for a while now, commonly known as “Mystery Shopping“. This is a horrible idea for several reasons, and the comparison to the Mystery Shopper, is frankly weak and ultimately inaccurate. More importantly I have a suggestion that contains none of the yuck factor of Under Cover Patients, and could potentially play a significant role in changing the way that doctors and patients relate to one another.

WHY UNDERCOVER PATIENTS ARE A HORRIBLE IDEA….

The primary reason is that the practice will create a climate of fear in doctors. They will be looking at every new patient wondering, “Is this person sincere or are they here with a hidden agenda?” Further more it runs the risk of warping the doctors focus. Instead of focusing on how well they are treating the patient, they will instead be more likely to focus on whether or not they are following all the rules so as to not risk getting in trouble. In short order doctors will come to resent their patients and it will increase the likelihood that more doctors will be unwilling to go through the hassle of seeing Medicare or Medicaid patients. The idea is also a terrible one, because it is highly unlikely to be all that effective. Good doctors will either try to continue to focus on doing what is best for their patients, and so might be caught because of not having an encyclopedic knowledge of Medicare rules. Bad doctors, will be in a state of heightened alert and will most likely mind their P’s and Q’s around new patients until they feel they have weeded out the undercover agents. It is also massively disrespectful to doctors. It says that essentially they are not to be trusted and that their time is not valuable, since every time they have to see one of these undercover patients is time they will not be spending with someone who truly needs to be seen. And finally on the list of reasons why this is a piss poor idea, is the fact that it seems like ultimately it would expend money on hiring, training, and employing these agents, some of whom would just about have to be sent on long term missions to have even the slightest hope of effectiveness, without there being much hope of the expense really being justified by what ever slight “savings” there might be from the relatively low number of doctors that you might catch. And even if you did catch some it would not surprise me if a high proportion of cases were thrown out of court for breaking laws against entrapment.

UNDER COVER PATIENTS AND MYSTERY SHOPPERS ARE VERY DIFFERENT THINGS….

One of the things that is being used to sell the undercover patient idea, is comparing to the practice of employing “Mystery Shoppers” engaged in by many in the retail and service industry. The mystery shopper idea in brief is to take an ordinary person, give them a check list to fill out, and then send them to a store or restaurant to act as a customer, fill out the form and report their impressions. It can be an effective tool to help a business discover areas in which they could be performing better. But the undercover patient idea is similar in only the most minimal of ways, and there is one very important difference. Mystery shoppers are not attempting to get anyone to break the law. Whereas the undercover patients would be.

MAYBE I’M PARANOID BUT….

I honestly have to wonder how sincere the Republicans even are with this suggestion. Frankly it sounds like something that they came up with figuring that it would so outrage the Democrats that they would reject it immediately and so they could continue to push their, “The Democrats won’t listen to any of our ideas.” meme. Further more, what better way if such an idea was put into practice, to continue their campaign of destroying people’s confidence in government as the legitimate organ of managing the people’s well being. How much do you want to bet that if the undercover patient program came to be, that the Republicans would quickly denounce it and demonize it as “Your government spying on you!”, making certain of course to distance themselves from being the ones to originally suggest it. Obfuscating the fact that they are part of that very same government.

THERE IS HOWEVER A BETTER POSSIBLE WAY….

I am not unaware of the need to not only ferret out actual fraud, and other misdeeds, but also to make it easier for patients voices to be heard. So instead of doing it in a way that breeds fear and suspicion, let’s do it in a way that is honest and open, while still protecting patient privacy.

We can use websites designed for customer reviews as a model. The idea behind such sites is that people go and rate on a scale (usually one to ten) how the service they received, and they leave messages discussing what was good or bad. A similar site attached to the main White House site could be created. Furthermore doctors and hospitals who take Medicare patients could be required to distribute surveys that could be sent postage paid to a department tasked with collecting, reading them and tabulating the results. There could also be an 800 number available. Then if a pattern was noticed there could be a follow up investigation. But why just use it to weed out the bad? It could also be used to reward the good. Doctors who were consistently getting excellent ratings could be rewarded some way.

This would be totally above board since doctors would know that all patients were empowered to utilize the PERN (Patient Experience Reporting Network) they would strive to give excellent service to all patients, but would not have to live in perpetual fear that new patients were in reality undercover government stoolies. Any wrong doing on the part of doctors that was discovered would be a great deal more likely to stand up in a court of law since there would not be the taint of entrapment. The cost to benefit ratio would be considerably higher I suspect than if one attempted to maintain a network of what are to put it bluntly spies. Plus it would help patients feel like they truly had a channel for sharing their experiences both good and bad, and that their voice was being heard. I myself would call that a win for doctors, a win for patients, and a win for the bottom line.

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One About…)

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The One About Health Care, Doctors, And Misplaced Priorities.

POSTED: 8:12 pm, February 25, 2010 View Comments

Allow me to make a confession. I was being naive thinking that I had any hope in hell of managing to come up with a coherent analysis of today’s Health Care Reform summit in time to have it up any time today. In fact I’m not sure if it will be ready before next week. But never let it be said that I don’t come through with at least a little something for my loyal readers.

Today’s article comes from a comment that one of my readers at Daily Kos made in the comment section of my look at Obama’s suggestions for Health Care Reform. He opined that he felt it was inappropriate for Doctors to ever have an investor interest in providing extra services. I said something to him in my reply, that the more I thought about it today seems more and more true.

I said, “What’s more I’d like to see us return to a very old fashioned notion that there are simply some jobs you take expecting to not get rich. Medicine used to be one of those.”

And I kept thinking of that, over and over again, especially every time today during the Health Care Reform summit that one of the Republicans would carry on about doctors getting paid through Medicare and Medicaid a lower percentage than what they get paid via insurance companies.

The more I think it over the more I think that I’m right, and that I’ve hit upon a problem that is an important part of why Health care in this country is so horribly broken.

ONCE UPON A TIME…

Here’s the thing, once upon a time, generally speaking the talent for being a medical practitioner, doctor, nurse, what have you, was considered a gift. People generally were aware that the ability to take in and retain such complex knowledge and be able to act on it, under incredible pressure was not something everyone had. Most people felt that while in a way it set them apart, it also gave them a duty to their fellow human beings. Kind of a, “Of those to whom much is given, much will be demanded,” mentality. Generally speaking the ideal was that a doctor would often have well off clients who could afford to pay in full, and they subsidized the doctor spending some time treating those patients who could not afford to pay much if anything.

This worked well enough although imperfectly to be certain. There were always those doctors who didn’t give half a shit for anything other than making money, and thanks to The Great Depression the number of people who needed medical help but could not pay was enormous.

It was in part because of the Depression that ideas like Medicare and Medicaid came into being. The idea at least in conception was that rather than leave people dependent on charities, which are not immune from the ups and downs of the economy, and during lean times might have to cut back on the help they give, or on individual doctors who could easily get overwhelmed and simply decide to stop seeing hardship cases, better to create a program that would guarantee that doctors, nurses, technicians, etc would get paid something. It might not be much, but it would still be more than nothing, and might serve as in incentive for more doctors to see impoverished patients.

I like to think that this suited most, if not all doctors (and by the way from here on out I’m going to be using “doctor” as a generic term since it’s quicker and easier to use than Health Care Professional over and over again) and that the majority were happy to be able to treat people in need and not have to worry quite so much about being able to make a living.

 THINGS CHANGE AND NOT FOR THE BETTER…

But then something insidious in this country happened. We had a steady and persistent decay in our core values. Like most things it did not happen in a day, or a week, not even a year or a decade. But bit by bit, we lost sight of the idea of service to our fellow human beings, being one of the highest callings one could have. Slowly it started to seem that making money and serving oneself became the highest calling. The ideas behind that ethos seemed to coalesce and become codified during the ’80’s. Everything about that decade seemed to be people trying to justify greed and selfishness. That’s what Gordon Gecko’s speech in wall Street is about, and that at it’s core is what “Trickle Down” Economics is about. It’s not actually an economic theory. What it is, is an attempt by people to rationalize and justify greed. “Well it’s okay that we have all this and keep getting more, because just by doing what serves us, just by doing what feels good, it’s benefiting those below us, so we’re actually helping them.”

The next factor in this moral warping involved envy. People in parts of society that were not usually easy paths to riches saw how much comfort and what nice things those with lots of money had, and they wanted it too. You know what? I can empathize. I really can. This is something I don’t talk about much but when it’s relevant and important to understanding the story I do not withhold the truth about my life and experiences from my readers. When I was young my father worked in the timber industry in the Pacific Northwest, and during the late seventies early eighties it was still a boom time. We were working class, but he was involved in both production and management, roughly the equivalent of middle management, and he was paid very very well. My mother did not have to work outside the home. There was nothing we did not have. Doctor visits? Not a problem. Nice cars? No difficulty. A nice house, good food, clothing. The only time I didn’t get something was because my parents didn’t want me to have it. Whether or not we could afford it was not an issue. And then over night the bottom dropped out of the timber industry. If my father had savings they were not much, why save when things were going to go on forever like they always had. Suddenly we were just one bad moment away from being not merely poor, but destitute. We lost our house, we moved back to the town where he had grown up and moved in with his parents. Suddenly every purchase had to be carefully monitored, food, clothing, doctor visits, all had to be viewed with an eye towards money and if we would be able to pay for it.

And do you know something? I hate it. You see I was just old enough to understand the ease that having money brought to our lives, and to understand how difficult things became because of not having it.

So I do not demonize people who looked at those who lead lives of ease and comfort and wanted to have a piece of it. To just not have to work quite so hard to have a decent life.

 WHICH BRINGS US TO TODAY…

And so a little at a time over many years, the Health Care landscape changed. More and more doctors specialized, the general practitioners became fewer and fewer, because specialization was seen and not wrongly so as where the big money was. Meanwhile the general practitioners that were left wanted more, so they started to change the way they did things, many of them. They started to see more and more patients, and often rather than really handling cases themselves simply determined what relevant specialist they could refer them too, often a specialist that they had made a deal with to receive a gratuity for every patient referred to them. Often times it was a flat fee per patient, sometimes it would be a percentage of what the specialist received from the patient. Ultimately though health care, increasingly became a volume business.

The acquisition of a large number of hospitals by large corporations did not help matters, more and more the focus went from changing to changed. It became about almost nothing but the bottom line. This has led us to today. Giant insurance companies boast record profits. Profits which they in part achieved by raising rates astronomically, and then by canceling policies out from under those who dare to actually make use of the service they’ve been paying for. And when called to account for such practices they shuck and jive and say, “oh well, it only looks like we’re making money, in truth we’re almost poor ourselves. Why we’re practically down to our last million.”

And in the midst of all this we hear about how doctors are refusing to see Medicare and Medicaid patients, because essentially they don’t get paid as well billing the government as when they see patients who have private insurance.

To put it very simply if we are going to have any hope at all, of fixing this incredibly broken health care system and the country it sits within, we are all of us going to have to make some changes.

 IT’S TIME FOR A CHANGE FOR THE BETTER…

It is time for doctors who enter the medical profession because they want to help people, not because they want to get rich, to go back to being the standard, instead of being an exception. It is time for us as a society to make the well being of our citizens and those who care for them more important than the well being of multinational corporations and the CEO’s that run them. It is time for us to begin the move back towards the idea that some professions you choose, not for the money, but for the chance to do something good for your fellow man. We need to return to a mindset where doctors look at the money they make from those who have public insurance and feel grateful that it’s presence means they are able to treat those who most desperately need their help, without having to be wholly dependent on their own resources for the wherewithal to do so. Basically to look at Medicare and Medicaid as a gift that helps make it possible for them to serve their community, not as a burden preventing them from making the big money.

To be certain this change alone will not fix what is broken within Health Care, nor within our nation as a whole. But I think that it would be an important first step, and would help to make all the myriad of subsequent steps that must be taken possible.

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One About…)

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The One About I Calls Em Like I Sees Em On Healthcare(Obama Edition)

POSTED: 7:56 pm, February 24, 2010 View Comments

And we are back. Yesterday I took a look at some of the Republican ideas for Health Care Reform, and while some of them aren’t bad, some of the ideas I have learned are already essentially being done, and others are pretty much pure bullshit. But surely the ideas that President Obama has presented are all wonderful right? Right? Uh, well, not exactly.

Now of course what has some people pissed off right off the bat is not mention of a Public Option, and continuing to push the insurance exchanges and allowing companies to sell across state lines. Something that I do not believe is impossible to manage in a way that is better than how it was managed when credit card companies were allowed to do business across state lines, but it is surely nowhere near as good as Medicare for all or a strong public option. And to be certain we should not stop for even a moment pushing for those things. But at the same time I think there is some potential good ideas in Obama’s suggestions that deserve to be looked at and judged for what they are, not for what they are not.

There are ten “titles” with multiple sub sections. I am going to go in order but I will not be excerpting every section, just those that I have something to comment on.

Before I start let me offer a universal caveat so I do not get too repetitive. Any idea that I opine sounds good, must always be taken with a grain of salt, because even the best idea can become a massive Mongolian Cluster Fuck if it is implemented poorly.

And now let’s dive right into….

Title I. Quality, Affordable Health Care for All Americans

“Nothing in this act or anywhere in the bill forces anyone to change the insurance they have, period.”

Hmm. My question, is it still accurate that if you have insurance already say through your work that you would not be able to leave it for one of the exchanges? Or will that be changed?

“Americans without insurance coverage will be able to choose the insurance coverage that works best for them in a new open, competitive insurance market – the same insurance market that every member of Congress will be required to use for their insurance.”

I have to admit that I really rather like this sauce for the goose is sauce for the gander provision. I’m not holding my breath that it will make it through, but I can always hope.

“It keeps insurance companies honest by setting clear rules that rein in the worst insurance industry abuses. And it bans all insurance companies from denying insurance coverage because of a person’s pre-existing medical conditions while giving consumers new power to appeal insurance company decisions that deny doctor ordered treatments covered by insurance.

Make it illegal for insurance companies to deny coverage for children because of a pre-existing medical condition;

Provide rebates to consumers from insurance companies when they spend a large percentage of consumers’ premiums on advertising, bonuses and other administrative expenses instead of patient care;

Review of unreasonable insurance premium increases and rebates if unjustified; health insurers with a pattern of excessive rate increases can be blocked from selling through new insurance exchanges;

Remove arbitrary lifetime or yearly limits on coverage so people know that all of the care they need will be paid for;

Prevent insurance companies from dropping insurance coverage when a person gets sick and needs it most.”

Frankly there is part of me that thinks that even if they manage to get this passed and give it some real teeth then something substantial will have been accomplished. It would still have us a long, long, way from being where we need to be, but it would definitely be a huge step in the right direction.

“Americans with pre-existing conditions will finally have the choice of quality, affordable insurance through a new insurance pool;

Small business owners will be eligible for billions in tax credits to help offer insurance coverage to employees;

Paperwork reduction and simplified forms will begin to reduce costs for doctors, employers and consumers;

New plans will have to offer preventive care and immunizations at no cost;

New plans will have to cover an enrollee’s dependent children until age 26;

A re-insurance program for employers that offer health insurance to their early retirees will save as much as $1,200 for every family enrolled.

A new website to help consumers compare different insurance coverage options along with state-by-state health care consumer assistance and ombudsman for any of their health insurance questions;

Public disclosure by insurance companies of the amounts they spend on administrative expenses including advertising, profits and salaries compared to what they spend for care.

Clear and easy-to-understand insurance documents to help Americans make decisions when shopping for health insurance;”

Again some really good ideas, and one that is very very good, and that some people will malign and deride as not that important. The simplifying of paper work. Now I no it’s no Public Option (Only The Public Option is The Public Option! Accept no substitutes) but it would save time, it would save money, and it would save people incredible amounts of stress. I recently was involved in a health care situation and the number of times that I had to recite medication list, patient history etc was pretty much ridiculous. The worst was having to repeat all this information at the general hospital that we had just given to the specialty clinic that was associated with the hospital and located just a few hundred yards away. The amount of stress this puts on people during a health crisis in incalculable.

Another great idea is to have new plans provide immunization and preventative care (I’m assuming they are meaning things like annual check ups, screenings etc.) and I’d love to see it even go so far as to make it free or low cost to do what Bill Clinton did which is to see your doctor when you first suspect a problem, instead of waiting and trying to ignore it.

“The Act asks everyone to take responsibility for improving America’s health care. In order to lower costs for all Americans and extend coverage to people with pre-existing conditions, all Americans who can afford to purchase insurance will be asked to.

Those who are uninsured add over one thousand dollars to the average premium of families with insurance. This added cost covers emergency room care for Americans without insurance. To help bring costs under control for all Americans and cover all Americans with pre-existing conditions, all Americans who can afford insurance will have the responsibility to purchase it.”

Now this part I don’t like one, bit. Personally I think it’s absolute bullshit, but if you are going to insist on it, I would say that it should be attached to a trigger. Then if in ten years there aren’t enough people buying insurance, AND the insurance companies are keeping their end of things up, then and only then would the individual mandate kick in. Frankly I think that most people are willing to buy insurance from companies even if they would prefer a public option, single payer, or medicare for all, so long as the coverage is affordable and provides real value, not just vaporcare.

“Individuals and families are eligible for a waiver from the requirement to purchase health insurance if coverage is unaffordable – if premiums exceed 8 percent of income.

In addition, exceptions are made for religious objectors, taxpayers with incomes below the tax-filing threshold ($9,350 for a single or $18,700 for a married couple in 2009), and Indian tribe members.

Americans under the age of 30 and other Americans who are exempt from the requirement to purchase insurance are eligible for a low-cost catastrophic plan that covers serious illness and injury.”

Most of these ideas are decent. Although I’m not a fan of the religious out, but I accept it. I also like the idea of the catastrophic plan option for those who are exempt, although more information would be nice about what exactly it would cover etc.

“Larger companies that offer coverage must automatically enroll any new eligible employees. Any company with 50 or more employees that does not offer coverage and whose employees access taxpayer supported health programs will be required to help offset the costs to the American taxpayer.

No small business owner will be required to enroll an employee or to offset health costs to taxpayers. As mentioned earlier, small business owners will receive incentives to cover employees through tax credits and enjoy greater buying power and insurance choices in the exchanges.”

Most of that is alright, although I have to admit that personally I’m not a fan of automatic enrollment. I’d rather see the law made so that companies that provide insurance have to keep in a state of open enrollment. This would allow employees to switch to the employee plan if they already have insurance, or would give them time to comparison shop and then choose.

Title II. The Role of Public Programs

“Beginning in April of this year, States will be allowed to expand Medicaid eligibility to more individuals. Starting on January 1, 2014, all low-income, non-elderly and non-disabled individuals will be eligible for Medicaid. This includes unemployed adults and working families – all people with income below $29,000 for a family of four (133% of poverty).

The Federal Government will support States by providing 100% of the cost of newly eligible people between 2014 and 2017, 95% of the costs between 2018 and 2019, and 90 percent matching for subsequent years.

All states will be treated equally and will not receive any special matching rates under this provision.

“Hmm. Okay, so instead of Medicare for all Medicaid for more? I’m sure the last bit about no special rates for some states will piss of a lot the GOP.

“Individuals will be able to apply for and enroll in Medicaid or CHIP through streamlined, easy to use, State-by-State websites. These programs will coordinate procedures to provide seamless enrollment, save time and lower administrative costs.”

Again, this might be a small thing, but I would say that anything that can make dealing with this stuff less confusing for people is a good thing.

“Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, nursing facility, or intermediate care facility will have a new option offered by States for community-based attendant services and supports. The Federal government will offer increased assistance for States who offer these community-based services.

States will be allowed to provide home and community-based services and full Medicaid benefits to people with long-term care needs. They’ll be allowed to extend the “Money Follows the Person” rebalancing demonstration, protect recipients of home- and community-based services against spousal impoverishment and increase funding for State Aging and Disability Resource Centers.”

I think these are some wonderful ideas. While I understand that there will always be people who’s needs are so intense and vast that caring for them in their own homes and communities is not realistic, the more people who can be kept out of institutions often hundreds of miles from their friends and families, the better. It is not to disparage such institutions, but people want to be where they know and are known, not in the company of strangers.

“The government will save money with increased rebates on prescription drugs furnished under Medicaid. The rebates will increase from 15.1 to 23.1 to more accurately reflect market prices and discounts typically provided by drug manufacturers to large volume purchasers. Drug manufacturers will also be required to extend these same rebates to new drug formulations and Medicaid managed care organizations.”

Well it sounds like this is meant to redress the bullshit corporatist nonsense from several years ago that crippled Medicare’s ability to negotiate lower drug prices. At least I’m hoping that’s what it will mean.

Title III. Improving the Quality and Efficiency of Health Care

“In 2010 seniors who reach the “donut hole” will receive $250 to reduce the cost of their drug purchases. Over 8 million seniors hit this gap in Medicare coverage, and for those who do not have other coverage, average drug costs are $340 per month, or $4,080 per year. Seniors who hit the gap in drug coverage are often chronically ill and many are forced to go without the prescription drugs they need.”

Um, okay, spiffy, just one question. Is that $250 per year or per month? I know it may seem like a dumb question, but given the disconnect from reality that some government plans can sometimes have, I don’t think it’s a completely unrealistic one.

“Insurance companies will be required to offer Medicare Advantage plans at reasonable rates so that seniors are guaranteed the best benefits at the best price for all Medicare beneficiaries. They will be rewarded if enrollee satisfaction and quality of care are high. And MA plans will also be prohibited from charging seniors more than they would pay for services delivered under the traditional Medicare program.”

Sounds reasonable.

Title IV. Prevention of Chronic Disease and Improving Public Health

This section honestly if fairly light on ideas. Some bits about making the Center For Disease control more efficient etc, and then this chunk of well frankly crap,

“The Act will help to put American families in control of their own health decisions with nutrition and prevention information based on the best science, including a requirement that certain restaurants and vending machines post calorie information.”

Because the problem is just that there isn’t enough nutrition information. No the problem is that crap food in the immediacy is perceived as cheaper and it’s easier to acquire. I’ve got a better idea. How about offering rebates for buying food ingredients instead of ready to heat foods? How about rebates for planting a garden? Offering incentives and ways for people to eat healthier, instead of providing them more detailed information that frankly they either know and don’t care, or know and don’t feel like they have viable alternatives.

Title V. Health Care Workforce

“By funding scholarships and loan repayment programs, the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists will increase in the areas of the country that need them most. With a comprehensive approach focusing on retention and enhanced educational opportunities, the Act combats the critical nursing shortage. And through new incentives and recruitment, the Act increases the supply of public health professionals so that the United States is prepared for health emergencies.

The Act invests in grant programs that support the training of primary care providers, including family medicine, pediatrics, general internal medicine, and physician assistantship. It also provides payment bonuses to primary care physicians.

The Act will increase the number of primary care providers, including doctors, physician assistants, nurse practitioners, and dentists in the areas of the country that need them most. Through the National Health Service Corps, the Act provides significant funding for scholarships and loan repayment for doctors, nurses and other providers who provide medical, dental, and mental health care in urban and rural areas that have a shortage of health professionals. It also increases the loan repayment amount and enables additional flexibility for providers to meet their service requirements.

It creates a loan repayment program for pediatric, mental and behavioral health specialists who provide services to children and adolescents in underserved areas or with underserved populations.

The Act also supports scholarships and loan repayments for disadvantaged students who commit to work in medically underserved areas and who serve as faculty in participating institutions.”

There are similar provisions for increasing the pool of nurses as well. I think this is a great idea. For far too long there has been no attempt to offer incentives to make being a general practitioner as attractive as being a specialist has become, and it is way past time that something was done to redress the imbalance.

Title VI. Transparency and Program Integrity

“To give patients greater choices, doctors with financial interests in imaging services, like MRI services, must inform the patients in writing that they can obtain the recommended imaging service from a person other than the referring physician, and provide a contact list.”

Nope. Totally wrong. This provision is wholly unrealistic. Instead of giving people who are either sick and worried about their problem, or their family something else to have to deal with, why not simply make it illegal either for a physician to have an interest in such a service, within a certain mile radius, or illegal for him to refer patients to any service that they have an interest in. Why give people one more thing to have to think about.

“To prevent conflicts of interests and insure full transparency and information for patients, the Act requires all drug companies, device, and medical supply manufacturers to fully disclose and report any gifts they make or financial arrangements they have with doctors, a physician practice or group.

All pharmacy benefit managers (PBM) that manage the prescription drug portion of health plans under Medicare or the Exchange must report information regarding any rebates, discounts, or price concessions they negotiate for prescription drugs. They’ll also have to report often they use generic drugs rather than more expensive brand name drugs, to ensure more accurate payments for their services and keep health care costs down.”

Great idea, and let’s make sure that there is one single website to go to for this information so that way people don’t have to try and hunt for it.

Then there are some commonsense ideas about better training for nursing home staff, requiring background checks etc. Also some more of the reforming medicare to cut down on fraud, which while I’m sure is important frankly seems vastly over hyped compared to the need for oh say a public option, or keep insurance rates down to reasonable levels etc.

Title VII. Improving Access to Innovative Medical Therapies

“The Act promotes innovation and saves consumers money. It ends anti-competitive behavior by drug companies that keep effective and affordable generic drugs off the market. It extends drug discounts to hospitals and communities that serve low-income patients. And it creates a pathway for the creation of generic versions of biological drugs so that doctors and patients have access to effective and lower cost alternatives.

Ending Pay-for-Delay

Saves money for consumers and taxpayers by ending the collusion between pharmaceutical companies where companies with brand name drugs pay companies who make generic drugs to keep the generic drug off the market.

Extending the Discount Drug Program

The Act extends discounts on drugs to hospitals and communities that serve low-income patients.

Promoting Biologics Price Competition and Innovation

The Act creates a new pathway to create generic versions of biological products so that Americans have access to effective, lower-cost alternatives.”

Hmm. Some good ideas, maybe some day drug reimportation will be part of these cost cutting innovations.

Title VIII. Community Living Assistance Services and Supports Act (CLASS Act)

“Establishing a Voluntary, Self-Funding Long-Term Insurance Choice for American Families

The Act provides Americans with a new option to finance long-term services and care in the event of a disability.

It is a self-funded and voluntary long-term care insurance choice. Workers will pay in premiums in order to receive a daily cash benefit if they develop a disability. Need will be based on difficulty in performing basic activities such as bathing or dressing. The benefit is flexible: it could be used for a range of community support services, from respite care to home care.

No taxpayer funds will be used to pay benefits under this provision. The program will actually reduce Medicaid spending, as people are able to continue working and living in their homes and not enter nursing homes. Safeguards will be put in place to ensure its premiums are enough to cover its costs.”

An interesting idea, although it really sounds like a glorified no interest savings account. I would think that offering to pay a fairly high interest rate so long as the money was left untouched until needed, or the offer of a certain amount of matching funds might go over better with most people.

Title IX. Revenue Provisions

Frankly most of this part made no sense to me, and I’m a fairly bright person, so I have to wonder how a lot of working class people would fair trying to wade through it. There was one part that stood out though, and not in a good way,

“Under current law, workers who earn a salary pay a flat tax of 1.45 percent of their wages to support the Medicare Hospital Insurance (HI) trust fund, but those who have substantial unearned income do not, raising issues of fairness. The Act will include an additional 0.9 percentage point Hospital Insurance tax for households with incomes exceeding $200,000 for singles and $250,000 for married couples filing jointly. In addition, it would add a 2.9 percent tax for such high-income households to unearned income including interest, dividends, annuities, royalties and rents (excluding income from active participation in S corporations).”

Well the idea in embryo doesn’t sound so bad, but 200K for singles and 250K for marrieds seems a touch low. And why the odd figure for marrieds. Most things seem to be based on X rate for single and X(2) for marrieds.

There is also a proposed excise tax on medical devices. My question is what is to keep insurance companies from passing that on to the consumer?

Finally Title X, is very short and is just about reauthorization of the Indian Health Care Improvement Act, which is great for them and I don’t begrudge it to them.

Well there you have it, the highlights. There are some good ideas, and I certainly hope that they make it into law. But I sure hope Obama doesn’t think that this is going to placate us. If we should not let the perfect be the enemy of the good, neither should we let the good enough for now be the enemy of the even better in the future. Whatever is passed is going to be imperfect, so we must keep pressure on to improve it as quickly as possible.

Tomorrow I will hopefully be wrapping up with a look at the Healthcare Summit. Until then….

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One About…)

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The One About I Calls Em Like I Sees Em On Healthcare(Republican Edition)

POSTED: 3:10 pm, February 23, 2010 View Comments

Well it looks like it’s mid afternoon in Health Care Reform land. You remember Health Care Reform don’t you? That thing that some of the talking heads were carrying on was a dead thing? Yeah well about that, not so much. People might not completely agree on details, but the one thing that pretty much everyone who’s not a politician or a CEO Can agree on is that we are sick and tired of having to go through our days living in terror of getting sick. The system is broken and we want something done about it. NOW!

But sadly of course it’s never quite that easy. There is still a process to deal with. The current part of that process is a “bipartisan” meeting between President Obama, and Democratic and Republican legislators. An event which I do find fairly shrug worthy. Although I do have to give the Republicans credit for holding Obama’s feet to the fire over the original plan to do it behind closed doors. But then I take that credit right back because once he agreed to have CSPAN cover the talks they started whining about it.

Basically at this point there are two significant pieces of writing regarding Health Care Reform. One comes from an Op-Ed piece in The New York Times. It is co-written by a small handful of Republicans including Newt Gingrich. The other one is presented on the Whitehouse website, and is essentially President Obama’s ideas on what should be added to a finalized bill.

Today I will be taking a look at the Republican Op-Ed, excerpting portions of it and providing my thoughts, and also excerpting some of the ideas from the Whitehouse Health Care section detailing what Republican ideas have already been included in either the House/Senate bills or in Obama’s suggestions.

Our first contributor to the Op Ed is surgeon and former United States senator from Tennessee Bill Frist,

“President Obama, Harry Reid and Nancy Pelosi have failed at health care reform. They have failed because they fundamentally don’t believe in markets, incentives and the power of hundreds of millions of people to make smart choices about their health. It’s just not in the Democratic leaders’ DNA.”

Wow. Way to set that Bi Partisan tone we hear is so important to you Republicants Dr. Frist. I’ll tell you the gods honest truth, if I was not reading this for the blog, I’d have stopped right there.

“The most powerful way to reduce costs (and make room to expand coverage) is to shift away from “volume-based” reimbursement (the more you do, the more money you make) to “value-based” reimbursement.”

This sounds great on the surface. In fact it almost qualifies as an “All Babies Need Milk” kind of statement. But what has me concerned is that word, “value”. What exactly are they wanting it to mean. After all while I don’t imagine there are many who would disagree that needless testing is a bad thing, sometimes it can be a very, very fine line. The simple truth is that sometimes in the absence of a clear line of inquiry to follow testing may be all a doctor has to fall back on. Now common sense tells us that Doctors should reasonably start with the simplest and least expensive tests in such situations. And anything that encourages the use of common sense by medical practitioners is surely a good thing. However I would hate to see a climate created where doctors are not ordering tests that might ultimately help them to discover what is wrong with a patient, because they are constantly second guessing themselves as to whether or not that test will be seen as “Adding Value”.

“Medicare and private insurance companies should reimburse providers not for each discrete service they provide but for managing a patient’s condition over an entire episode of care.

The disbursement of that payment would then be made at the local level, where value can be most accurately determined, and waste most likely eliminated.”

Now I have to admit that in my laysentients view this doesn’t seem like such a bad idea. It might also help to nip some of the interdepartmental and disciplinary rivalries that can sometimes take place, and help keep the focus on helping people get and stay healthy.

Next we hear from director of the Engelberg Center for Health Care Reform at the Brookings Institution and former Medicare administrator in the George W. Bush administration, Mark McClellan,

“Republicans should also build on proposals to enable health care providers to get higher Medicare payments when they deliver better care at less cost. For example, the Democratic bills would let providers share in Medicare savings if they can show that the way they prevent and manage illnesses reduces complications and costs Medicare less. Republicans should further propose that Medicare strengthen its capacity to provide data and measure patient outcomes—to help providers and to evaluate changes in care quickly.

This is desperately needed to help make Medicare sustainable while improving the quality of care. Currently, doctors lose money when they work with nurse practitioners, pharmacists or wellness programs to help patients avoid costly complications—because Medicare doesn’t pay for this, and it results in fewer billings for the visits, tests and procedures Medicare does pay for.

“Here is another not terrible idea. Basically rewarding care providers for having healthy patients. Now obviously there’d have to be some pretty strong protections in place to make sure that people weren’t getting claimed treated successfully when in truth they weren’t. I also like the part about reworking the system to encourage physicians to work with nurse practitioner, pharmacists, etc. Because right now there is not only no real incentive to do so, but rather a huge disincentive, Nurse Practitioners, especially in rural areas can often be your first best line of defense as I learned during my mother in-laws recent illness.

“All these steps can add up to a health care system that does much more to support patients and health professionals in improving our health and saving money. That’s a bipartisan opportunity we can’t afford to miss—either because Democrats are unwilling to change or because Republicans insist on starting over.”

Now this part surprised me considerably. Personally I don’t think it’s the Democrats that have been “Unwilling To Change”, but it is nice to see a Republican acknowledging the folly of the “Scrap The Bill And Start Over” meme that some Republicants have been trying to foist off on the American people.

Next we have a very special Angry Hour(TM) section thanks to fellow at the New America Foundation and former domestic policy aide for Presidents Ronald Reagan and George H. W. Bush, James P. Pinkerton.

I would like to start off by warning you that Mr. Pinkerton doesn’t have any ideas to present. I mean that quite literally. His entire portion of the Op Ed amounts to “Obama and Dumocrats Ebil, Republicans good”. Then he breaks into a few rounds of “Free Markets! AHHHH! Savior of the Universe. Free Markets! AHHHH! They’ll save every one of us!”(To the tune of the Flash Gordon theme by Queen). Frankly I was on the fence about even wasting my time excerpting any of his nonsense, but I decided that his opening salvo is so odious it cries out for a response.

“When Americans think about health care, they think first of health, not finance. They go to the doctor to get well, not to show off their government-issued insurance card. So President Obama’s health care reform plan was doomed from the moment the American people figured out that his goal was to spend less on health care.”

Allow me to misquote Dan Akroyd from his SNL days. James you ignorant slut. First of all I can pretty much guarantee that finance is indeed the first thing most of us think of these days. We have been forced to by this incredibly broken system we suffer under. We think of finance first because if we don’t we run the risk of quickly winding up bankrupted. As for Obama’s health care reform plan being “doomed from the moment the American people figured out that his goal was to spend less on health care.”? Well allow me to quite simply say. Fuck you, you brain damaged Right Wing Republicant asshole. I’m curious as to why one, note I said ONE of Obama’s goals is to spend less on health care? Do you know? I bet you do, but I bet you won’t say. It’s because of Republicant assholes like you having a major hissy fit and flapping their hands and carrying on about how they would kill any bill that added so much as one penny to the deficit. Frankly to insinuate that Obama is in the wrong for seeking to reduce costs after you lot all but insisted on it, is a bit like demonizing as a slut, the girl that you talked into sleeping with you.

“While the president’s idea of “bending the curve” on health care means cuts in Medicare, to the American people bending the curve means living better and longer. To the folks on Main Street, it means not appointing Kafkaesque committees to measure “quality-adjusted life years” but fostering a vibrant climate of scientific research and opening a wider pipeline for new medicines.”

Wow. I’m impressed. I don’t think I’ve ever seen someone take so many words to say “Death Panels” in my life. You know death panels like the ones that work for insurance companies and decide that ten year old boys should be refused treatment. And as for the “Wider Pipeline For New Medicines” well sure that’s a great idea, because the FDA’s approve it and then see if it kills someone methodology has been entirely too stringent.

Personally I have to wonder how Mr. Pinkerton ended up in this group, how did that phone call go, “Hi James, listen we need someone to be a massive asshole, that way it will make Newt Gingrich seem almost cuddly by comparison. Do you think you can do it?” Given the final result I’d say the answer is that he most definitely can.

Alright, now we hear from former domestic policy adviser to President George H. W. Bush and president of the nonpartisan Committee for Economic Development, Charles Kolb,

“Health care reform should have two critical goals: reducing costs and covering more people. To meet them, Democrats and Republicans must abandon simplistic, ideologically driven proposals that animate each party’s base. Liberals cannot insist on Medicare for all, and conservatives cannot insist on markets for all, plus tort reform. Neither approach will work.”

Wow. Now as before with Mr. McClellan, I don’t agree entirely with Mr. Kolb’s take on the unworkability of Medicare For All. In fact personally I would think MFA would make the most sense, since there is already infrastructure in place. While surely it would need tweaking, I would tend to think that much like renovating a house is usually less expensive than building from scratch the same would be true here. However I have to tip my hat to anyone who is willing to acknowledge that the market “solution” and tort reform is not going to solve these problems. Certainly not all of them, and frankly I doubt many if any of them.

“Our existing employer-sponsored system offers most Americans little, if any, real choice among competing insurance plans.”

I can’t really disagree with this. Personally I think that a little competition would be a good thing instead of an insurer knowing that they have a monopoly on say Goodburger (Home of the Goodburger) employees, so they could charge pretty much whatever they felt like, they would know that they had competition and so their prices and offerings would have to be competitive so as to be as attractive to employees as possible.

“Congress should not micromanage people’s health care decisions by imposing price controls or setting up more bureaucracy. Rather, it should introduce competition to the insurance market by creating a system of regional exchanges, similar to the one now operated by the federal government for its employees[.]“

Well I don’t entirely agree with the first part of the above statement. Here’s the way I look at it, set a reasonable ceiling that rates are absolutely not allowed to go above. Then if all of these other innovations work, well that’s great and no one will have to worry because no one will get anywhere near the ceiling. But if there is gap in the system and somehow an insurer manages to find a market in which they have no competition and think that means they can charge whatever they like well then the ceiling will already be in place to stop them. It’s kind of like shutting the barn door before the horse gets out instead of after.

“Appropriate risk adjustment—a mechanism by which insurers who cover more sick people are compensated by insurers who cover fewer of them—could reduce the incentive of some insurance companies to sign up only the healthy.”

Now this I like. I don’t think it should be suggested in place of legislation making denial of coverage based on pre-existing conditions illegal, but I think it would be a wonderful supplement.

“Congress should also end the current tax exemption for employer-sponsored insurance coverage. This change would encourage people to pay more attention to the price of their health insurance. And it would provide the money that will be needed to help underwrite coverage for the uninsured.”

Aw hell. And here we were doing so well, and suddenly you have to veer the car into RWNJ wargarbleville.

Trust me most people are paying plenty of attention to the price of their health insurance. You see the reality is that there are very few in the working class who have their insurance truly “provided” by their employer. Generally the employer kicks in X amount towards insurance and the employee has to pay the rest. So I can pretty much guarendamntee you that those who are liable to pay attention already are. And those who don’t? Well I doubt if much of anything will motivate them to.

“Finally, no backroom deals—for pharmaceutical companies, individual members of Congress or anyone else.”

Yep. And remember No means No. So none of this Republicant bullshit of “Well it’s okay (somehow) when we do it, but wrong and horrible and immoral and the terrorists win, when Democrats do it.”

And finally we have a man that needs no introduction, The lover of Lieberty, The defender of Marriage(s), the author of The Contract On America, Newt (The Hoot) Gingrich!

“If President Obama and Congress are serious about reducing health care costs, then the more than $600 billion a year in unnecessary care should be at the top of the list. Congress must give states the incentive to reform their civil justice systems so that lawyers will think twice before suing doctors for frivolous cases. There is a place for health courts that address only medical malpractice cases, and a need for caps on damages for “pain and suffering” that have nothing to do with lost wages or actual damages. Doctors who incorporate best medical practices should be protected from lawsuits altogether.”

Ah it’s time for the tort reform song. Okay first of all I would wholeheartedly support pain and suffering award caps so long as the care provider if found guilty could prove to the courts satisfaction the following,

1: That the error was not the result of gross or willful neglect. If you showed up drunk and performed surgery? Well then I hope they bankrupt your ass. Seriously.

2: That you made an admission of wrong doing to the patient and/or the patients family and that said admission came from you, and was made prior to the wronged party having been contacted by your or the hospitals lawyers. In other words did you have the common decency to admit you made a mistake and apologize (something which many studies have shown is more important in most cases to patients and their families, than receiving a huge payday)?

3: That you and the hospital have taken all possible steps to correct the error as quickly as possible, assuming that it is correctable.

If you have done those three things then I do believe that there should be a reasonable ceiling on pain and suffering awards.

Now as to the last sentence in the excerpt from Newt’s portion? Well I pretty much call bullshit on that one. No one, at anytime should be “protected” from lawsuits. What they should instead be protected from is ridiculous malpractice insurance premiums, so long as they are able to demonstrate that they are using “best practices.” Frankly if you are doing that, if you are a careful and conscientious practitioner then you are not likely to get sued in the first place, and with common sense reforms there would be strong penalties for true nuisance suits. So instead of creating obstacles for those cases where a doctor well and truly screws up, to be rightfully sued, instead reign in the profiteering insurance companies that charge rates that are astronomical even to doctors who have never had so much as a suit threatened against them.

And now for our wrap up I take a quick look at some of the Republican ideas either already in the House/Senate Health Care Reform bills, or in the suggestions made by President Obama.

Frankly after giving that part another looking over there’s honestly not much there. Largely there are several ideas that all stem from the same basic idea which has to do with cutting down on Medicare fraud. It’s not that, that’s not important or valuable, but how many times do you essentially have to say the same thing?

Well ultimately this has been a perfect example of why a Republican bill would be a disaster. Democrats are willing to at least consider Republican ideas. Republicans on the other hand are largely unwilling to do so. I personally found it interesting that the most open minded and flexible of the ideas presented belonged to people who had never held an elected office before. Perhaps the kind of mindset needed to do well in politics, makes it harder for one to truly think for oneself outside of the partisan box.

Check back tomorrow for an in depth look at President Obama’s proposals. And until then….

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One about…)

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The One About Better Protecting The Welfare Of Animals Is An Important Step In Improving Our Humanity!

POSTED: 3:34 pm, February 22, 2010 View Comments

(Stay tuned immediately after today’s article for a special announcement)

Every once in a while I get to read and share with you my loyal readers some genuinely happy news. This article in the New York Times, is a perfect example.

“California may soon place animal abusers on the same level as sex offenders by listing them in an online registry, complete with their home addresses and places of employment.

The proposal, made in a bill introduced Friday by the State Senate’s majority leader, Dean Florez, would be the first of its kind in the
country[….]

Under Mr. Florez’s bill, any person convicted of a felony involving animal cruelty would have to register with the police and provide a range of personal information and a current photograph. That information would be posted online, along with information on the person’s offense.

The bill was drafted with help from the Animal Legal Defense Fund, an animal-protection group based in Cotati, Calif., north of San Francisco. The group has promoted the registry not only as a way to notify the public but also as a possible early warning system for other crimes.

‘We know there’s a link between those who abuse animals and those who perform other forms of violence,’ said Stephan Otto, the group’s director of legislative affairs. ‘Presumably if we’re able to track animal abusers and be able to know where they live, there will be less opportunity where those vulnerable to them would be near them.’”

This news has me terribly excited and hoping that the measure in some form or another would be adopted in multiple states, perhaps even nationally. Further more I think it represents an important step in the history of animal welfare.

I have stated in the past and am more than willing to state here again for the record, that while I do not consider animals to be the same as people, at the same time I am saddened and disgusted by laws that attempt to view them as nothing more than mere property. If someone kills one of my babies, and the judge starts talking about depreciation schedules just watch me flip out.

Even live stock which I like many do not have an emotional attachment to, surely deserve more consideration than they are currently given.

This is why I advocate for a new distinct class of laws that are uniquely tailored to animals. I think that this proposed law in California may help to make that a reality.

Also as the article states, it may be an important tool in helping to forestall, or more easily solve crimes involving humans since there has been a more than anecdotal link between people who routinely abuse animals, and who then go on to commit crimes against people.

My hope is that my readers will join me in contacting their elected officials at all levels and encourage them to create similar legislation (or in the case of Californians, to pass it). Together we can help enhance our own humanity be ensuring that their are strong protections for the furred, finned, feathered, and scaled with whom we share the planet.

Keep The Faith My Brothers And Sisters!

And now for a special announcement:

Tomorrow and Wednesday I will be talking about Health Care Reform. Tuesday I will be looking at a joint Op Ed that appeared in the New York Times by a number of Conservative leaders, and then on Wednesday I will be delving into President Obama’s suggestions regarding Health Care Reform. I have a special offer to make to the readers of The One About…. If you’ve gone to the official Whitehouse web site, you’ve no doubt seen that there are several items regarding Health Care Reform. Most of them are easy to read quickly, such as the overview of the plan which is available in both HTML and PDF formats. Likewise the information about Conservative ideas contained in both the House/Senate bills, and in President Obama’s suggestions. What is a bit more of a hassle though is the offerings of President Obama’s plan in greater detail. Titles I thru X offer much more detail, but there is no easy way to access the information all at once and just print it out. Instead it is broken down into sub sections. So for my own convenience I copied and pasted so I could print it out. And now I’d like to offer it to you my readers. It is a simple text file, so should be compatible with pretty much any word processing program. It’s not fancy I’ll be honest, but if you’d like I’d be happy to email a copy to anyone who’s interested. Simply send an email to toriach@gmail and I will email you a copy. I can send you all ten parts or just a particular segment whichever you prefer.

Alright, special announcement over. See you tomorrow, and until then….

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One About…)

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The One About Book Club: The 48 Laws Of Power: Laws 5 and 6

POSTED: 5:15 pm, February 21, 2010 View Comments

Well here we are again. I wasn’t sure at first if there was going to be an installment as for most of the morning my ‘Net access was down. But here we are. Yesterday I talked about Laws 3 and 4, and now without further Apu….

Law Five: So Much Depends on Reputation – Guard it with your Life

“Reputation is the cornerstone of power. Through reputation alone you can intimidate and win; once you slip, however, you are vulnerable, and will be attacked on all sides. Make your reputation unassailable. Always be alert to potential attacks and thwart them before they happen. Meanwhile, learn to destroy your enemies by opening holes in their own reputations. Then stand aside and let public opinion hang them.”

This law is so very important to Liberal Progressives, and it is one that I have been harping on for a while now. What it boils down to, is that perception shapes reality. It may not be fair. It may not be nice. But It is TRUE! It is an unassailable truth and if we do not learn how to deal with it then we are never going to get anywhere.

There was a time when Progressivism was seen as a populist movement. It belonged to the coal miner, as much as it belonged to the University Professor. And then slowly that started to change. Some of that change happened in the sixties. Many young people did not realize, and I suspect still don’t realize the damage that many of them did to the health of Progressivism with their radicalism. When people started to protest for the sake of protest and to use violent rhetoric and action they created an image that most working class people did not want to be a part of. As a result the Right swooped in and started to say all the right things, making the working classes believe that the Right understood them and agreed with them. Suddenly a party that was increasingly about making sure the haves had more, and the have nots had only enough to keep them quiescent was viewed as the party of ordinary people. And it has only gotten worse since then. While there are still some Working Class Progressives out there, they are far fewer in number than they were during the thirties and forties. If we are to have any hope of keeping Progressivism alive, this must change and now. We must craft an image that says that you don’t have to have a degree, or be from a certain kind of background. All that you have to have is a burning desire to see everyone in this country given a fair chance and a level playing field. All else is details.

Reversal Of The Law:

None. Allow me to quote from The 48 Laws Of Power regarding this question,

“There is no possible Reversal. Reputation is critical; there are no exceptions to this law. Since we must live in society and must depend on the opinions of others, there is nothing to be gained by neglecting your reputation. By not caring how you are perceived, you let others decide this for you. Be the master of your fate, and also of your reputation.”

Law Six: Court Attention at all Cost

“Everything is judged by its appearance; what is unseen counts for nothing. Never let yourself get lost in the crowd, then, or buried in oblivion. Stand out. Be conspicuous, at all cost. Make yourself a magnet of attention by appearing larger, more colorful, more mysterious, than the bland and timid masses.”

Here again we have something that we could learn from our enemies. The Conservatives are the absolute masters of getting people to pay attention to them. The recent Conservative Political Action Conference is one of the best examples of that. Every year for a solid week they are in the news. Sure they look more than a bit silly. But here’s another hard truth. Progressives are going to have to not just get comfortable with looking silly, we are going to have to learn to love it. To embrace it. We need to create our own version of CPAC, we need to be willing to be seen shouting our message at the top of our lungs. And every time someone tries to shame us for looking “silly” we can smile inside knowing that it means they are paying attention. Some of the best examples of Liberal Progressives getting this law right include, John Stewart, Keith Olbermann, and Rachel Maddow.

Reversal Of The Law:

While some attention is good, and more is usually better, there is indeed such a thing as too much. We need to be on the look out for when the moment comes that we should sit down and shut up. For a little bit at least. This will give people a respite, and make them look forward to hearing from us. Again CPAC is a great example. Conservatives know that if they hold such an event once a year people will pay attention. But if they held it every month quickly people would cease to give it any mind.

Well that wraps up for this week. Check back next week when I’ll cover Laws 7 and 8 on Saturday, and Laws 9 and 10 on Sunday. Until then I’ll look forward to reading your thoughts on this weeks entries.

Keep The Faith My Brothers And Sisters!

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The One About Book Club: The 48 Laws Of Power: Laws 3 and 4

POSTED: 2:26 pm, February 20, 2010 View Comments

Welcome back to the special weekend edition of The One About…., known as The One About Book Club. Currently at The Book Club I’m taking an in depth look at The 48 Laws Of Power. Last week I offered an over view of the book, and delved into the first two chapters, or Laws. Today I’ll be looking at Laws 3 and 4, and tomorrow Laws 5 and 6.

Law Three: Conceal your Intentions

“Keep people off-balance and in the dark by never revealing the purpose behind your actions. If they have no clue what you are up to, they cannot prepare a defense. Guide them far enough down the wrong path, envelope them in enough smoke, and by the time they realize your intentions, it will be too late.”

Well now here’s something the Republicans excel at doing. And they don’t do it through silence but rather through noise. They talk incessantly about their goals, but usually the goals they are talking about are not their true goals. The invasion of Iraq is perhaps the best most recent example. Frankly I’m not sure besides access to oil what Bushco.’s long term goals, but you can be certain it had nothing to do with the spread of democracy.

The same is true of Obama, but his problem is that he tends to say too little, which allows people to come up with their own stories about what his intentions are, which is dangerous. No action, no statement should be left open to interpretation.

Meanwhile for Progressives while we must figure out our agenda, we must also figure out how best to present our actions. Simply revealing our goals is not wise. Sometimes it is in our best interest only to focus on the simplest, easiest to accept parts of our agenda and build from there. Also it is high time that we start making use of sleeper agents. People within both the Conservative and Liberal wings of both parties who are in fact Progressives. They will have the freedom to do things in the short term that may be counter to our larger agenda, but are meant to set us up to be in a stronger position to advance our goals. Sometimes I wonder if that’s not part of what’s been going on with things like the bank bailout etc. Decisions that are so clearly anti citizen that it will serve to stir up the electorate. If that is the case though the question is what’s the next move? Are there Progressive agents involved in the tea parties waiting to push them in an anti corporate directions? Are Progressives going to launch their own populist movement?

Reversal Of The Law:

This is honestly where Progressives as a group have the greatest strength and the Conservatives the greatest weakness. Generally speaking while we might be too quick to compromise at the first sign of resistance, Progressives generally are acting guided by their principles. Most Conservatives at the higher levels are quite frankly not. That is what has most thinking people upset with them. They see through the charade of Republican “principles” for the naked ambition it is. So when they reject something like Health Care Reform, many people know that they are not doing it on principle at all.

Law Four: Always Say Less than Necessary

“When you are trying to impress people with words, the more you say, the more common you appear, and the less in control. Even if you are saying something banal, it will seem original if you make it vague, open-ended, and sphinx-like. Powerful people impress and intimidate by saying less. The more you say, the more likely you are to say something foolish.”

Ooooh. This is perhaps one of the hardest ones for Progressives and Liberals, and a big part of why we have such a bad image with average Working Class Americans. We love to talk. At great length. And the more resistance we feel we are getting to our message the more we talk. Now there’s nothing wrong in the least with talking. But we need to be careful that what we are saying has value, and that we are not wasting our words and our time. Frankly over engaging with those who will not yield in the least little way only distracts and depowers. I see it all the time online, especially on Twitter. Liberal Progressives, who are constantly debating Right Wing Twit Jobs, as if they think they’ll win some special prize for being the most patient, the most open minded etc. There comes quite simply a point where you are well advised to having said your piece, to stop talking. Perhaps to even withdraw from the field for a little bit.

Reversal Of The Law:

*sigh* Sometimes I honestly wonder if Liberal Progressives don’t have our heads wired backwards. We seem to be prone to talk when we should be quiet and to be quiet when we should be not just talking, but shouting from the roof tops. The most famous example of this I would have to say is when Gore chose to sit back and act “Presidential” instead of pressing his case in the press as well as the courts. The result was that to most people he came across as detached and disinterested. In our 24 our info culture, too much silence pretty much equals political death.

The challenge is to find the right balance to strike. Not an easy one, but not one that is beyond us.

Alright gang, that’s it for today. Check back tomorrow for the next two laws, 5 and 6. Until then.

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One About…)

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The One About Have People Confused Anonymity With Privacy?

POSTED: 12:38 pm, February 19, 2010 View Comments

I am an amateur semanticist. I have a great love and respect for words and their power. I do my very best to always choose my words with great care, to pick exactly the right word to express my thoughts. Therefore it is more than a bit jarring when I come across someone using words in a way that are objectively or subjectively incorrect. In some cases it’s obvious and objective, like when someone in a recent comment on an earlier article about Obama’s Business Week interview said, they didn’t like his “polices” when clearly they meant to say “policies”. But other times it can be much more subtle and subjective. I recently came upon such a situation in regards to the Internet.

Over the last few months it has seemed that the two most consistently recurring articles about the ‘Net and the ‘Web has been either proclaiming that we are in the post privacy era, or opining that we are all turning into a giant E-lynch mob. Both opinions of course have those that agree with them and those that vehemently disagree. But as I was thinking it over the other morning it occurred to me that the two situations could not easily exist simultaneously. Suddenly it occurred to me that the problem might very well be that people are not using the correct words.

Let’s start by defining our terms.

Privacy: The quality or condition of being secluded from the presence or view of others.

Anonymity: The quality or state of being unknown or unacknowledged.

Okay, that right there gives us some idea right off the bat why people tend to use the two terms interchangeably. They are very similar in some ways, but at their essence they are really quite different.

Privacy, at it’s essence is about only sharing yourself with those whom you choose. Like many things there is not one singular PRIVACY, but rather many degrees based on choice. For example you might be fine with anyone being able to see pictures you’ve taken of antique cars, but not with just anyone being able to see pictures of your kids. You might not mind people knowing that you are married and have children, but you don’t want the whole world to know their names. Well as regards the online universe, it is still more than possible to set such distinctions. I can assure you that we are not even close to the “Post Privacy Era”. Now we are to be sure past the point where privacy is automatically ensured. Many default settings for things like Facebook, etc. are slanted more towards the openness side of things, but I can assure you that with just a little effort it is still more than possible to set one’s preferences to achieve just the level of privacy you desire.

Anonymity on the other hand is quite another thing all together. Anonymity is at it’s core the belief that one can act with impunity and never have to suffer the consequences of those actions. Now of course if it’s something good, an act of charity say, then no one in their right mind would have even the least little problem with anonymity. But when it is something like a group of people getting together to hurt others by their actions, well precious few people would speak up and say that anonymity is a good thing under such circumstances. In the physical world it is harder and harder for people to do harmful things and remain anonymous thanks to ever increasingly sophisticated methods of detection. First finger print detection, now DNA. Online it is similar. Thanks to various means of determining a persons location, their ISP, computer browser etc, it is increasingly difficult for someone to engage in harmful action without running the risk of being found out and being made to suffer the consequences of their actions.

In addition to the technological aspect there is also the social to consider. People who speak anonymously are increasingly suspect, especially if what they have to say is hurtful and hate filled. While there are still some who prefer to protect their privacy by using a “Net Handle” in place of their offline name, most of them use that handle as if it were their own personal brand. They use it online consistently, and they do not hide behind some alter persona crafted only for them to spew bile and then run away.

Ultimately neither sets of extremists are even remotely close to articulating the truth of the times in which we find ourselves with regards to the World Wide Web. We are not even close to the “Post Privacy Era”, but thanks to our entering or being close to entering the “Post Anonymity Era” it is growing increasingly difficult for people to be able to attack others online without being made to suffer some kind of consequence. If I was an optimist I might even suggest we are entering into the best of all possible scenarios as regards interpersonal interaction online.

Keep The Faith My Brothers And Sisters!

(This article originally appeared at The One About…)

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