Detroit Review 8/29/13

This morning MSNBC provided a three and a half hour telecast from Detroit, specifically a Ford manufacturing plant. On the whole MSNBC presented a positive picture of the future for the city. They did not address the rape of the city by democrat politicians and the democrat party. There were oblique references to bad management and mismanagement of the city. There were several references to the fact that creditors are not willing to take a haircut in the bankruptcy proceedings suggesting that “the other guy” should take the losses. It was pretty clear from the bankruptcy manager that the heart of the city is doing well but the outlining neighborhoods are a disaster. Interestingly the point was made that three hundred million dollars of the operating budget comes from federal programs and grants. That means almost one third of the annual Detroit operating budget of one billion dollars comes from the federal government.

Congratulations to MSNBC for doing an excellent “selling” job for Detroit’s future. However anyone involved in the actual process of saving Detroit should remember that a political party, the democrats ruled the city for fifty years and raped it, period. If the same corrupt political control emerges with the rebirth of the city it will be doomed to disaster whether it is a republican or democrat administration

Al and Jessie

This weekend the network news shows all contained considerable coverage of the MLK 50th anniversary walk on Washington D.C. for jobs and civil rights.

I don’t know if you noticed but not one of those shows used Al Sharpton or Jessie Jackson on their panels. In fact Comcast that owns NBC and MSNBC and has Al scheduled each weekday at 5 p.m. didn’t use him on “Meet the Press.” Do you think it is possible the management of these news organizations recognize that Al and Jessie have done a disservice to the civil rights movement by pushing the Martin/Zimmerman issue as a racist motivated killing?

I would also point out that neither Al or Jessie made mention of the black teen who actually pulled the trigger in Oklahoma on a young white Australian college athlete and was shown to have posted a message on the Internet that said; “I hate 90% of all whites.” I wonder if they don’t consider that a racist statement. They also failed to address the tragic death of an 88 year-old World War 11 army veteran beaten to death by two young black teenagers a few days ago. Are you wondering why there no comment from these two civil rights leaders?

I would suggest that there is no way for Al and Jessie to get donations to their “charities” or activist organizations to fight racism in this country. In other words there is no money for them. They remain silent on these killings just as they have not contributed to problem solving on the south side of Chicago in the unending black on black killings of your men, usually related to drugs or gang memberships.

Piling on

Today’s announcement by the Washington Post using documents supplied by Edward Snowden that the NSA has been gathering much more personal information than what has been claimed by the NSA and the administration. Once again it proves we can’t trust the government and in particular having the administration tell the truth about what should be confidential information. Mind you it doesn’t matter who the administration is the trust by the American people is not there and this latest incident just proves they are justified in their collective distrust of the government.

So if you want to say I’m piling on please do because the government deserves the criticism. The public needs the truth about how the NSA is managed, monitored and admonished for mistakes it makes in revealing private information about U.S. citizens.

No it does not!

The Patient Protection and Affordable Care Act does not contain a “death panel’ it does establish an unelected board of bureaucrats who will be tasked with cutting Medicare spending. According to a description of the Independent Payments Advisory Board (IPAB) in the New England Journal of Medicine, the board will consist of 18 appointed members (including three from the Department of Health and Human Services) and will be required to submit proposals to reduce per capita Medicare spending in years in which spending is projected to exceed target rates.

The NEJM notes that the IPAB is prohibited from rationing care, increasing co-payments, restricting benefits or modifying eligibility criteria. One of its few options is the ability to cut payments to doctors and, after 2020, specific providers such as hospitals and hospices. Overriding the IPAB’s recommended payment cuts would require a three-fifths vote of the senate. This means that stopping the IPAB’s cuts would be very difficult and most likely require a bipartisan effort.

The NEJM also points out that currently the IPAB’s recommendations for payment cuts for transactions through private health insurance are not binding. These price controls on private medical transactions would have to be approved by Congress, which, the NEJM says, “may not be able to cap Medicare expenditures without addressing private expenditures as well.” This points to price controls for private medical costs as a means of controlling Medicare’s runaway costs.

A consequence of price controls is fewer available doctors. If providers cannot charge a market price, the supply of providers will decrease. This is already happening in Medicaid. The Wall Street Journal reports that 31 percent of doctors already do not accept new Medicaid patients because the entitlement pays them at a lower rate than private health insurance companies.

Price controls are effectively a form of health care rationing. As price controls cause shortages, allotting the available care will fall increasingly fall upon government bureaucrats.

Rationing is the inevitable outcome of price controls and shortages. Donald Berwick, the administrator of the Centers for Medicare and Medicaid Services, said in an Associated Press interview, “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open. And right now, we are doing it blindly.” President Obama appointed Berwick during a senate recess to avoid confirmation hearings.

Other countries with government-administered health care have followed the price control and rationing model. Canada’s universal health care system has led to long wait times “for practically any procedure or diagnostic test or specialist consultation in the public system” according to the Wall Street Journal. In Canada, only half of ER patients are treated “in a timely manner by national and international standards.” Perhaps this is why the premier of the Canadian province of Newfoundland came to the United States in 2010 when he had to have heart surgery instead of going to a Canadian hospital. In fact, many emergency patients in border areas are sent to U.S. hospitals for treatment.

In England, the Daily Mail reported in 2008 that a government edict to treat patients within four hours of check-in had led hospitals to keep patients in ambulances for up to five hours before being allowed access to the emergency room. The four-hour wait as measured by the government did not begin until the patients left the ambulance and entered the hospital. Over 45,000 patients waited more than one hour for access to the emergency room. Leaving patients in ambulances also means that the ambulances are not available for new calls.

In 2011, the Independent reported that budget cuts were forcing the British National Health Service to overtly ration health care. Two-thirds of the national health trusts in the U.K. are rationing treatments for “non-urgent” procedures. Examples of rationing include only allowing hip and knee replacements for patients in severe pain, delaying cataract surgery until the patient’s sight is substantially affected, requiring seven cases of tonsillitis within a year before allowing children to have a tonsillectomy, and mandating “exceptional circumstances” and six months of monitoring before inserting “grommets” in a child’s ears to improve hearing.

These economic laws hold true even in the United States. In Massachusetts, which has been cited as the prototype for Obamacare, the Boston Globe reported in November 2011 that tiered health plans with limited networks that force consumers to endure long wait times or pay more out-of-pocket to be treated sooner are becoming more common in the state. An analysis by the Cato Institute found that since Massachusetts enacted health care reform wait times have increased. Wait times for a doctor’s appointment in Boston, already longer than other metropolitan areas before the reform, have increased while they have improved in other cities. Health care costs in Massachusetts have increased faster than the national average and adverse selection, the sickest people choosing the best insurance plans, has led some insurers and employers to stop offering the most comprehensive plans.

Massachusetts Governor Deval Patrick signed a health care price control bill into law. The New York Times reports that the new law will cap both public and private health care spending “so that it will grow no faster than the state economy.” The law sets up a commission to monitor increases in spending. The commission can demand an explanation from providers or insurers whose costs exceed the target rate. It can also fine organizations up to $500,000 if it finds that they did not make a good faith effort to reduce costs.

A 2009 Rasmussen poll indicated that only 32 percent believed that Massachusetts’s health care reform was a success. A more recent WBUR poll found that 78 percent still consider health care costs a significant problem for Massachusetts. Sixty-three percent say that costs have gotten worse over the past five years since the reform was enacted.

The discussion of quality adjusted life years brings the discussion of rationing full circle back to Palin’s original quote. Quality adjusted life years (QALYs) is a calculation that measures “the benefits gained from a variety of medical procedures in terms of quality and life and survival for the patient” according to Oxford University’s Bandolier Journal.

While the ACA currently forbids the use of QALYs “to determine coverage, reimbursement, or incentive programs,” an article in the New England Journal of Medicine is openly critical about the law’s prohibition, saying that the “notion that the country can avoid the difficult trade-offs that cost-utility analysis helps to illuminate” is “magical thinking.” If the law were amended to allow the use of QALYs, it might mean that older patients would be unable to receive certain surgeries because the procedure offered more benefit to younger people.

As the demand for health care increases due to more people being covered with health insurance, there are certain to be shortages since the supply of doctors and hospitals is not increasing. Rationing and shortages in such situations commonly take the form of long wait times for treatment and price controls. This has occurred in a multitude of other countries where government-controlled health care has been tried. Given the shoddy, backroom manner in which the ACA was written, it is unlikely to contain any new and different approaches that will work where previous government health care bureaucracies failed.

President Obama and the Democrats may have been able to pass the Affordable Care Act and get it past the Supreme Court. As yet, they have been unable to repeal the laws of economics.

In a July 7, 2010 recess appointment, President Obama named Dr. Donald Berwick to head the Centers for Medicare and Medicaid. Berwick’s past statements have led to extreme controversy. Among them was one in a 2008 article in which he wrote: rational common interests and rational individual interests are in conflict….The stakes are high. Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs.”

Dr. Berwick’s telling statement is “rational collective action aver riding some individual self-interest, can reduce per capita costs.” It seems clear Dr Berwick’s mission is to work the system to the “logical conclusion” that universal heath service will be the only option. Since citizens 65 plus represent 13 percent of the population but use two and a half times their “share” of health care services based on per cent of population it is reasonable to assume that older citizens will be the first category to receive cuts and delays in services. So is this a death panel, no. However it is clear discrimination for the older citizens in out country, discrimination that will lead to less medical services and longer delays in getting those services.

Washington Post

The sale of this historic paper is making headlines and well it should. No one knows what will be the final outcome of the purchase by the owner of Amazon is fraught with questions. It seems reasonable that the liberal bent of the paper will stay in place given the donations of Amazon ownership to the democrat party but nothing is for certain.

I met Mrs. Graham about forty years ago in my role in the broadcast world and I was immediately impressed with her willingness to take on the internal workings of her husbands business and do it well. From the start of her reign I sensed she was special and even though I didn’t agree with her left wing support I knew she would do what she wanted to do in an even handed manner. The reality of business has over taken the historic publication. Interestingly Mrs. Graham’s son with all of his resources could not save the paper from a financial spiral down resulting in large accumulated losses.

One of the contentions coming from the current management of the Post is that they will continue to direct the editorial content and they have reassured [mostly democrats] that there will be no changes. If this proves to be true they won’t survive even with the new ownership. I don’t mean that if the paper suddenly became conservative they would do better. Whatever form the Post takes they will have to drop the current editorial control whether it is via new technology or some other innovation that might promise to save this part of the media royal family.

One final thought, I draw parallels to the U.S. government and the Washington Post. The government believes it should be able to pursue “do good” programs but not have to pay for it, paying for the present programs with money from our children and grandchildren’s future. Much like the Graham family the government will need to come to grips with reality. Unlike the Post we don’t have a wealthy individual to bail our country out rather we have the average man paying exceptional taxes and fees to bail out the liberal administrations academic efforts at creating a life of financial equality for all Americans in country driven by creative ideas with commensurate rewards.

A yearly contract

For as long as I can remember in my adult life I have been an advocate of marriage contracts for one year. It would require each partner in the marriage to resign an agreement of marriage at the end of one year for another year on the exact date [before midnight] they were originally married. If either partner refuses to sign then the union is broken. The sole exception would be for the birth of a child in which case the financial support of said child would be based on the income of the two members of the marriage. If one partner is unemployed then they pay nothing. My arbitrary decision is that the child would reside with the mother [probably a reflection of my age] unless there was a separate agreement signed at the time of the signing of the yearly marriage contract. This arrangement seemed reasonable to me. It would require each partner to reevaluate the relationship each year giving each partner a chance to take another road if they desire. I believe that romance will stay in most marriages for many more years with this arrangement than the traditional marriage agreement provides. Well apparently someone else agrees with me although they provide a more practical explanation of why this arrangement would work based on logic. I will let Paul Rampell explain in his article for the Washington Post titled “WedLease could be the alternative to a divorce rate that’s too high.” At the close of his article he suggest “ Why doesn’t society make the legal structure of marriage more congruent to our behavior?”

Just a feeling

For some time I’ve looked at the patterns of violence in our society and noted that as the economy dives the number of unexplained acts of violence go up. I mean things like the recent act of a man in California who ran over eleven people killing one, or the man who stood outside a town hall meeting shooting randomly and killing indiscriminately. The reasons given for these kinds of killings, shootings, fire settings, explosions are on the surface some what understandable but hardly a reason to run over eleven people or shoot up a meeting with the potential for multiple deaths. There is something deeper here and I don’t mean new gun laws but rather a deep-seated unhappiness with ones life in the United States. In a word the economy dictates so many other factors in our life, getting married, having children, buying a home, elective surgery, saving plans, school selection, military service considerations, religious beliefs, ability to move within our country and job/career opportunities to name a few.

We have been told since 2009 the recession is over and we are in a recovery, a very slow recovery but nonetheless a recovery. Yet when I look around at my friends the problems that they have persisted with home mortgages, real jobs, cost of living, medical services and costs, health insurance costs, utilities and power prices continue to rise and there is absolutely no confidence in retirement plans. The economy chips away at whatever reserves a family has and eventually leaves many people with no hope. If you haven’t been forced into foreclosure on your house you may have had to take tremendous losses on the home you keep, still pay very high taxes without any back up equity. If you are laid off you must take another job or two that covers part, usually two thirds of what used to be your monthly cost of living. These problems penetrate the whole family. They weigh on the individual and the family and as hope fades violence seems to be an inevitable result.

I believe the net results is more and more people become unhinged by these pressures which are not going away no matter what the administration tells us. Some time people just explode and do irrational things.

My prediction is that the random violence will become less random and more frequent until and if we can once again have real jobs. A government administion seeking to develop business opportunities, new inventions, reinvesting in the space program and a leadership of hope based on what is best for the United States of America.