Healthcare: Half-Empty, Half-Full

Tonight will be one of those nights where you peak in on your emotional investment only to wish you had buried it in the sand for another long while.  And if, and when it matures you now know you will soon be either satisfied or unsatisfied, but not based on the results, but based on your glass half full, glass half empty persona.

This health care “reform” process has taken liberty with our abilities to proceed on principle.  Everyone involved has sacrificed their moral stance and the results will reflect this.  This battle was honestly waged by some for the greater good.  Nevertheless, with it they have used what ethical fundamentals were left as collateral.  This is not a new feeling.  A crucible of short-term and long-term necessities where used to sacrifice other long-term and short-term necessities.  Just look at our averted total fiscal collapse and how we feel now about it.  It still stinks.  I believe in the buck stopping at the president’s desk.  However, it is hard to blame him for the economic and cultural mess we are in.  No mater which direction he turns he will be blamed.  Therefore, he has done what we do as a nation, thrown it right down the middle and gambled that more people will see the world as half full in the aftermath.

This is a decent bet.  As I have written before we are stable, because of our natural affinity to being middle class in the middle type people.  This cultural and economic reality have played the most significant role in our stability and longevity.  Nevertheless, it has also made us complicit in the manipulations we are subject to and the resulting controlled chaos we are amerced in today.  As “Muse’s” song Uprising has captured our attitude our actions remain far removed from those that birthed this great nation.  In the end, this may prove to be a good thing.  As Joe Scarborough inferred the other day, most of us will wake up when this healthcare bill is passed and still be alive.  However, this attitude may also prove to be our world’s demise, keeping us moderately tuned to our commitments to resolving our issues. 

In the history of the world, we have not been faced with a more dire forecast of our environments future.  The truth is as individuals we can do things to change the environment, but we are either conditioned or in reality we cannot do enough to hold back the tide.  We know that it would require governments big business, and religious leaders to work coordinately with sincerity to accomplish saving us from global warming.  As a consumer and voting mass, we maintain some power in effecting that change.  But the truth is it has been these large entities that have been orchestrating our manipulations.  Apparently for so long that they are unaware of this fact, it has become an instinctual action in the institutions to manipulate our communities away from coordinated efforts to solve world problems in order to further institutional growth.  Communitarians and Individualism will for foreseeable future be at odds, maintaining a moderate existence serving the manipulating unconscious efforts of our institutions hubris, until we adapt or it is to late.  A dire proclamation, considering I am glass half full type.

In Michael Lewis’s “The Big Short” we find high drama in individual stories, but the biggest revelation to me was the reality that the institutions were unaware they were orchestrating their own downfall.  In addition, well all know the government stepped in deeming them to big to fail.  Perhaps saving us, but in such a way that corrupted our ethics and ignited our rhetoric.  A rhetoric that has been easily carried over to healthcare, an issue that if done correctly in the most significant way contribute to lessoning the negative impact of the economic collapse.

Since we are all winning and loosing in this healthcare bill on a most basic level what are the gains and sacrifices?  I am not sure all is know yet.  Much of this is a gamble. 

I would be remiss in stating first that the vast majority of this bill’s ideas on policies original sources are Republican.  Yes over time, Democrats have found it politically exspediant to adopt these ideas as much as Republicans have found it politically beneficial to stonewall policies they came up with.  The process on both sides of the isle have been so toxic, that we may find that subsequent congresses continue to manipulate their rules and the constitution in order to “win.”  Democrats who have been weak and naive in enacting meaningful policy change, have taken this time to adapt ethical standards that mirror their advisories.  The crumbling highroad has been demolished.  This was a congress that set out to bring ethically reform to the institution, but the extreme circumstances, and their own human ethical fallacy proved to strong. Republican’s like the wolf they are found opportunity in obstruction and false characterizations that serve to undermine their own agenda while obstructing “actual” will of the people.  If this year has not been an argument for term limits and actual transparency, what has?  Democrats now get to sate they are as strong (corrupt) as Republicans (at least in carrying our Republican agendas) and Republicans can say they believe in doing nothing.  Not exactly, the deficit reducing small government we all wish was a reality these days.

More people will have healthcare, so at least that goal will be met.  Most of the discriminating polices that contribute to cost cutting or higher profits for Insurance companies, but ultimately contributed to the higher overall healthcare budget.  This increase of coverage will result in less emergency visits for PCP care and increase preventative and conservative treatment of our populace which should result in lowering cost while increasing quality of care.

There is an exchange and some price regulation by the government, so that may prove to provide competition that results in some cost cutting.  Insurance companies gained a lot with the Mandate, but I wonder if they will be forced to lower cost also by the lower of the penalty for not having insurance.

The CBO has projected a substantial deduction of our national debt while only increasing taxes for the wealthy.  Something that is morally appropriate, but still an issue of conflict based on some very principled arguments.  If we can enact a budget that is deficit neutral and a pay-go plan then we may be able to retain sustainability.  One step I would take would be to end our wars and reduce military spending while marinating a strong deterrent and improving our intelligence efficacy in the guidelines set out by the freedoms garneted by the constitution.  This militarily isolationist approach (another truly conservative approach…not a perversion that we see in the Republicans now) could prove to be more effective on the war on terrorism then current policy.  Don’t get me started on the urgency of this threat. I digress.

Medicaid expansion and Medicare fixes are important, but not even close to as effective as had been suggested through the process.  It is watered-down.  Seniors and the needy will see modest but important improvements.

Small and Moderate business employers will see modest improvements, but nothing as good as originally advertised.  It may fall short of improving their ability to survive the current economic conditions.  If the exchanges are effective, it may save the small business however.

The issue of Abortion, I feel as someone who is pro-choice, but concerned about the number of abortions and a practical person, I am concerned about the debate of abortion in this legislation.  What is most alarming is the diverse interpretations of the language and hope this is not representative of the opacity of the overall language in the bill.

Most of what is in the bill will not take effect for 4 years, well after political shift occur.  So who knows what will occur.  This is a purely political reality.  The good news is the discrimination against kids will be immediate.

This patchwork, that the political climate has barely been able to withstand, particularly with the self serving pool of elected officials we have, and the lack of honorable, intelligent and valiant leaders, may still prove to be just enough to accomplish most of what it set out to do in helping reduce cost, and expand coverage and fix ethical issues in our medical system.  However, three huge issues were not addressed.  We did not make coverage universal in quality (perhaps not even in affordability or coverage).  We did not reduce the deficit all the way.  Moreover, the one that drives me crazy the most, because it was hardly addressed and could be the most significant elephant in the room.  We did nothing to change the way in which doctors are paid.  The reason the quality is good in some places and horrid in others.  The reason we have a shortage of medical providers in some fields.  The reason costs are so bloated.  The reason this entire thing is a mess, is because we pay doctors to do procedures, not so solve efficiently and effectively patient problems, while considering the realities of chronic illness and the need for focus on quality of life and patient productivity in these cases.  Until we deal with that, we are just putting a band-aid on it.

Blabber: Pop Consumerist Middle Class...to SAVE WORLD.

Vali Nasr and John Stewart were discussing on the Daily Show the rise of the Middle East’s Middle Class. In doing so they focused on the role the middle classes have on stability and sustainability of communities. Nasr alluded to the formation of a middle class being the foundational element in creation of the United States. Stewart questioned that if we had helped bolster the middle class and then introduce democracy would we have had better results . This idea of the stabilizing powers of the middle class are not new or elite. An issue finds it legs when it is agreed upon by the middle class. Plans are broadly implemented once it is affordable to the middle class. Social contracts are enacted into law when the middle class embraces it.

It has always been difficult for me to embrace extremes. I have had an uneasy feeling about some of the rhetoric I grew up with in a liberal culture. I realized I had taken for granite much in my upbringing when I moved to a more conservative community and certain sentiments made me bristle. Clearly, efforts on the fringe can pull a culture in alignment. As an growing minority (Atheist) I am pulling for liberal extremes. As fiscal conservatives, I hart blue dogs. But in truth I live in an increasingly middle class reality and I hope to keep it that way.

The further the American middle classes embraces the ideals of a greener social and economic model and the more we expect affordable, efficient, caring healthcare, the more our chances of destroying our planet or suffer while trying will diminish. As China has cultivated a middle class, they have been confronted with facing their human rights and environmental responsibilities. The USSR’s fabricated equality fell like a house of cards and without a stable middle class the vacuum was filled with corruption, but perhaps over time a stable middle class will emerge. India’s class system is the only thing standing in the way of progress lead by their middle class. Pakistan’s stability relies in the expectations of its middle class. We will never be successful in Afghanistan until their poverty is changed to a middle class upbringing. Hope in Iraq and Iran lies in the hands of its growing middle class. Egypt, Saudi Arabia, Jordan, UAE all struggle with understanding how to transition to a middle class, but know it must be done. With the voices and success of the middle class in Palestine and Israel so goes the region. In Africa, stability only exists in nations that have a middle class. As the middle class grows in many East Asian nations, the tragedies will diminish. In Europe the middle class has created new levels of stability in just decades, despite the issues in the Baltic States and the social intolerance in Italy. The failure in Iceland after the financial collapse has had an upswing in social issues in the small Island nation. World wide and through history we know success exists in the hands of the Middle Class.

Our modern success was built on pre WWII plans, WWII actions and post WWII transitions centered on the growth of the middle class. Despite the efforts of McCarthyism to embed extremist perspective into our middle class envisions established, success was driven by less ideological realities. McCarthyism only bread extremes embedded in the anti-was and social justice movements. The practical elements of both measures, patriotism and equality have held on, but are there less colorful elements that helped keep the middle class going through daunting times and still help us today?

While my family has a long tradition of secular Jewish culture, I do not believe the Jewish rise in the middle class would have been so rapid without the role my people played in American pop culture. I also come from a Christian family and I do not believe their shedding of Christian traditions would have come without the rise of the middle class and the consumptions that were driven by the rise of the golden era of American advertisements and McCarthy Era iconic imagery of a middle class life and home.

Could our guilt of pop culture and consumerism be misguided? Could it be that not just public education, freedom of speech, a judicial/legislative/execu

tive system, patriotism, the pioneer spirit, civil rights, the separation of church and state, walking softly and carrying a big stick have lead to our middle class and our stability (as fragile as it seems at this moment, that seems far to similar the end of the Roman Empire and speaks to accurately to the prognostications of the end of days)? What is it that seems to accompany modern developments of middle class? Could it be that addictive consumerism and delusions of traditions enabled by appetite for media arts have helped sustain and develop the middle class?

As a graduate from a Media Arts School, I do wonder if my interests are not misguided after all. Now if only we could get our businesses and politicians to take a more moderate perspective and our environment, health, and bank accounts into serious consideration, perhaps we could be Regan’s shining city on a hill and inspire stability and not just jealousy and sometimes-righteous mistrust.

The Bill

Paul Krugmen has said there is simply not enough in the Economic stimulus plan to solve the issues. Republican’s are instinctively resistant to the size of the bill…I have this instinct as well…But I can see Obama’s position that we have to stop the spiral before we balance the budget. These are extraordinary time and if you are not into revisionist history you know that FDR’s approach was effective. I think there should be some separation of issues here (putting healthcare in a comprehensive health care bill). Also there is the Tarp bill which should be tweaked and can help with much of the same issues. My bottom line is that we should be using the necessity of changing our energy policy as an opportunity to get out of the broader economic issue. I am not alone in this thinking and Obama is attempting to do this. This imperfect bill may do it, but I am worried it is not enough. And then I am also worried it is to much. If we focus on info structure and renewable energy we will create the next great economic opportunity, we will reduce our dependence on foreign oil (an important part of our security needs), we will improve our environment slowdown in global warming, we will revitalize the American Auto industry…on and on…this is a no brainer.
Breakdown of House and Senate bill commentary:
It is scary that the numbers in both the house and senate plans seem so low to provide aid to poor and unemployed. Particularly the only 1 Billion for heating.
The direct cash payments seem much better in the senate bill, but again provide roughly a week to two weeks worth of relief. This maybe significant for those who live check to check and can be disciplined enough to save the amount they are given…this is an unlikely reality. When I was living in this category it would have been gone immediately.

The amount to be spent on Infrastructure is a big chunk at 46-47 billion, but is not significant enough. I know the reality of needs in Vermont is significant. I also realize that there are likely unfunded plans in the Midwest and Gulf Coast that have not finished and are great health and safety concerns. Don’t get me started on Earth Quake engineering needs.

Health care is an integral part of everyone’s economic reality and significant pointing of fingers, corruption and pushing the ball down the road has lead to an even bigger issue. Also I know of potential growth economically in this sector (we have shortage of nurses, dentist and TMJ specialist in our state). But I do wonder if this is not just throwing money out. I would prefer that it was part of a more comprehensive, well debated, thought out bill that was a permanent solution to this growing issue…I have much more to say on this issue.

Education is the foundation of our economic system and never been fully treated as such. There are calls for more efficient, effective and pervasive investment in education of all areas for all students; these calls are coming from rural communities, inner cities as well as the top executives in the silicon valley and energy companies in Texas. This is because they are all concerned about the future…not just for everyone else…but for themselves. Both bills provide some relief, but there have been finance promises dating back to the 70’s that still need to be paid for. This like healthcare is huge issue to tackle and one that cannot wait. It should be comprehensive and extensive. With lively debate. My top concern as an art teacher is the cutting of funding for arts education…which I argue is just as important as science, math and English.

Energy is just as important to invest in this bill as Infrastructure. In fact I think the two have the best option to build for the future while effecting positively the jobs market and individuals income. The senate number at 40 billion sounds better…but I still think it is way low. Every home should have the option to have energy provided by solar power. Every community should benefit from wind and hydro. Every car should have one of the options for alternatives to gas. The car industry should be working on all fronts not just one solution. All the energy providers should be investing in renewable energy. The days of coal, gas and oil should be ending.


Why is Homeland security in this bill. Other then in the context of eliminating foreign oil there should be no security components to this bill. (There I just saved us 4.7 billion). We have spent enough on this military crap…time for them to tighten their belts. Is this not pork.

Law enforcement I think the military budget should take some of their extensive funds and donate it to Law Enforcement so we don’t need it in a stimulus bill…there I saved another 3.5 billion. Is this not pork.

Housing has virtually no difference in the two bills…I side with John Stewart show has been suggesting we take these funds and the Wall Street bailout money and use it to pay down individual debt based on individual needs. This way the banks would get their money the right way and people who are hurting will be helped directly not accidentally if at all.
Tax credits are nice and all, and the plans to move closer to the reasonable tax plan Obama campaigned on. But again comedian John Stewart made a great point…what about a payroll tax…it would benefit workers and employers. From what I know about this bill it does not address it.
Expanded college credit is a nice idea, but again helping reduce student loans would benefit more people. I do think increasing the pell grant is vital.

The Home energy credit is a nice start, but is it enough…see above.

The senate’s Unemployment leaves me conflicted.

Bonus depreciation is out of my league…can someone explain this.

Money losing companies plan sounds good…is it?

Government contractors seem to be getting a brake…do they really need it?

Energy production tax credits are essential, I am wondering if the number is high enough at $13 billion.

Repealing bank credit is a great provision.

Bond subsidies is unfortunately needed, if you are aware of local bond issues nation wide this is a huge issue that needs to be addressed as part of the infrastructure and education needs. The senate version is better, because is includes infrastructure.

I am curious about the benefits of $11 billion to make interest payments on most auto loans and sales tax on cars deductible in the Senate bill.

Any thoughts?