Healthcare From the Trenches

I recently talked with a physician from south New Jersey.  He thoughtfully enlightened me on a couple of healthcare talking points.



The 30 million uninsured

A while back, says my friend, a woman physician in south Jersey got a grant to start a clinic that would exclusively serve the uninsured.  He helped her getting started with office space in his own clinic.  The clinic for the uninsured closed after a couple of years due to lack of business.  The truth is that when an uninsured person gets sick they can probably sign up for Medicaid on the spot.  So why bother getting insured?  An elderly acquaintance from Peru, wife of a retired Lima physician, reports that when she gets health care in the US she never has to pay.  Now why would that be?



Those Medicaid reimbursement rates

How, I have wondered, given that Medicaid reimbursement rates are notoriously low and Medicaid patients have trouble getting physicians to see them, do Medicaid patients get their health care?  My friend told me.  In south Jersey they have recently set up a federal funded chain of clinics to serve the Medicaid folks.  How do the clinics get paid, I wondered?  They get paid through the usual reimbursement schedules, just like the private docs.  But, of course, they also get federal funding.  Nice gig if you can get it.



Entitlement mentality

The wife of a friend of mine here in Seattle works in University Hospital and complains that Medicaid patients tend to move in, and often only get discharged after a couple of weeks when the Medicaid coordinator puts an end to their shenanigans.  Regular patients with private insurance are whisked in and out in a couple of days.  My south Jersey friend has similar experiences.  He gets Medicaid recipients that come in and say: Give me the works, doc: MRIs, CAT scans, the whole enchilada!  Whatever happened to the grateful poor?



Maybe we should all be outraged by this corruption of the entitlement state.  But I am not.  It is perfectly obvious to me that any entitlement program or indeed any government program of any kind is bound to be riddled with waste, fraud, and abuse.  Government programs are not responding to human need; we have a market economy for that.  Government programs are projections of political power:  We are doing this because we have the power to do it.  In the end all government programs regress into a simple scramble for loot.  But at least when Boss Tweed looted the City of New York the city gotuilt a magnificent marble City Hall for their trouble.  The monument to our corrupt liberal welfare state will just be the broken lives and gigantic debt it left behind.

Democrats Losing It

Back in the 2000s leadership Democrats encouraged their rank and file in a lot of smash mouth partisanship. It worked, up to a point, in delegitimizing President Bush and setting up their 2006 capture of Congress and 2008 capture of the presidency.



But the smash-mouth tactics doesn't work so good when your guy is in the White House. That's because while vigorous opposition is a necessary safety valve for the loyal opposition, vigorous attacks on the opposition are another matter. It makes you look like fascist thugs.



Thus, for Cenk Uygur to complain about the president's treatment by Speaker Boehner over his upcoming address to a joint session of Congress is foolish and ignorant.

President Obama has now changed the day of his address to Congress to accommodate the Republicans. They were having a GOP presidential debate on the original date he picked. So, Boehner told him to move his speech. He is the president for Christ's sake. Of course, they should have accommodated him, not the other way around. But as usual, President Obama bowed.

Er, well, no. The president doesn't have the power to order up a joint session of Congress. Congress gets to decide that. That's the whole point of a divided government and a separation of powers.



Then there are the cute "theocracy" attacks on the Republicans. This is a recurring tactic of Democrats; they must think it works a treat. They take the statements of Republican politicians that their religious beliefs inform their politics and inflate them into a secret plan to legislate morality. This is actually part of the whole "Democrats are pro-science" and "Republicans are anti-science" meme. It shows an astonishing ignorance in Democrats for not realizing that their progressive beliefs are in fact religious and not scientific. Everybody brings their religious beliefs to politics; it's just that Democrats bring their secular religious beliefs in socialism and progressivism and statism to the table.



Here is the Washington Post's liberal Chris Cillizza acting dumb about the whole issue.



But here is my prediction. All the smash-mouth tactics being ginned up by the Obama guys are going to fail. The American people don't care about church-state issues this year. They don't care about Speaker Boehner playing footsie with the president. They just want someone to fix this lousy economy. And because President Obama is the president they figure that he's to blame.

"Too Many Takers -- Not Enough Givers"

That's the considered response from an Irish cab-driver. Larry Elder asked him what the No.1 economic problem was for welfare-state Northern Ireland.

The problem with the welfare state is that it rewards takers and penalizes givers. Why should that be?

The reason is not that difficult to figure out. It is that government is force, politics is power. Politics is the rule of the powerful, the guys with the guns. Of course, they may not actually display their guns, not all the time. The most effective government is the one that never has to show its guns. But the political sphere is the sphere in which things are decided by force. It may be the force that is legitimated by the "mandate" conferred to an electoral majority by winning an election. Or it may the mandate conferred by winning a civil war or conquering another country.

The power conferred by force is the power to set the rules and the power to take away.

But humans are social animals. The great trick of any species of social animal is that the advantages of social organization are, for the most part, not based on force. In the best social systems people sacrifice for the good of the community not because they are forced to do so but because they want to give, to contribute to society.

In the basic unit of society, the family, the parents give and the children take; it must be so. The parents give so that their children may grow up to adulthood and then give in their turn. In the market economy, people only get to receive if they are willing to give. Workers must develop skills to make themselves useful to employers. Business people must make and sell a product that other people want before they can take anyone's money. In religion people are socialized into becoming givers: people who want to give to others, and people who are reluctant to resort to conflict within a community.

The welfare state is different. It is the opposite of a social system. It is an anti-social system. It is based on the idea that people have basic economic rights, enforceable by the state, and that anything short of an adequate transfer of economic goods to the less fortunate is unjust. Thus it rewards takers, people that demand assistance, and it penalizes givers, people that think up ways to serve their fellows. There is nothing new in this. Robber bands have operated according to this principle since the dawn of time.

Our modern problem is that the welfare state, beginning with the modest transfers of a century ago, has followed its internal logic to the point that, we can now see, it leads to national bankruptcy. Also, it encourages a host of social vices. It encourages people to work less; it encourages people not to have children. It encourages children to abandon their ageing parents to the state. It encourages ageing parents to sicc the state on their children.

The welfare state. It's simple really. "Too Many Takers -- Not Enough Givers."

Obama's Wet Jobs Noodle

According to ABC's Geroge Stephanonpoulos, the president's new economic plan for jobs will include three major components.

1. Tax Relief "for companies that create jobs and hire new workers."
2. Infrastructure Investment in "clean energy and new construction projects to build schools and transportation."
3. Assistance for Long Term Unemployed that will feature a program like Georgia's to give "unemployed Americans eight weeks of training at a local company while allowing them to still collect their unemployment benefits."

Stephanopoulos also adds that the president's will speech will include "a proposal for how the government will pay for these initiatives without adding to our debt."

All this shows how deep in a hole the president is, and yeet he's still digging. The president's problem is that to revive the economy he really needs to undo everything he has done. To get the economy going again, as Tony Blankley writes, he really needs to choose the "nuclear option" and steal all the Republican ideas.

He could decide to embrace all the major Republican, Tea Party free-market ideas - marginal business and personal tax-rate cuts (leading to a net tax cut); big discretionary spending cuts to be implemented before the 2012 election; genuine long-term reductions in Medicare, Medicaid and Social Security costs written into law now; major deregulation, including Environmental Protection Agency rules, Dodd-Frank financial burdens and nanny-state consumer regulations; unlimited oil- and gas-drilling and shale-fracking authorization; permanent extension of the George W. Bush tax cuts; repeal of the double tax on American corporations’ foreign profits; limits on unemployment insurance extensions; and withdrawal of his big union initiatives, such as the National Labor Relations Board’s opposition to the Boeing Co. building a factory in South Carolina.

Imagine that! Then he would have stolen the Republicans' clothes.

Republicans, of course, would vote for all of them, as they are Republican positions. The Republican candidate for president as well as GOP congressional candidates would be left with almost nothing (except opposition to Obamacare) on the economic front to oppose in the president’s policies.

You might ask: well why not? The answer is that if the president did all that stuff he would lose his Democratic base. All those policy ideas are poison to the average New York Times reader and NPR listener. And as for the average MSNBC watcher and "progressive:" To them such a program would be a "sellout." What's the point of being a liberal if you give it all away just to create jobs for the American people and profits for the American entrepreneur?

Race Mob Violence and Obama

Now that it has happened, the wonder is that it didn't happen sooner. I am talking about the race-mob violence in cities like Denver. It started in 2009, according to John T. Bennett.

In 2009, a four month wave of mayhem broke out in Denver. There were at least 26 violent robberies committed by two black gangs. The victims were -- without exception -- whites and Hispanics. When the dust settled from that initial spate of violence, victims were left with injuries ranging from a skull fracture to broken noses and shattered eye sockets.

Of course the Denver police and the media did not alert people to the fact that these incidents were caused by black gangs were operating out of their neighborhoods. They didn't alert the public to the racial nature of the events at all until the local TV news finally broke ranks at the end of 2009.

Of course the rest of the mainstream media are soft-pedaling the race angle of this, as they have soft-pedaled black violence for half a century.

This wave of racist flash mob violence presents our national leadership with an astonishing opportunity to end the race madness of the last 50 years, the post-civil rights era.

Here we are in 2011 with a black president and a black attorney general. They can make history by initiating a national conversation on race and race violence. Race violence is unacceptable when it is white guys in sheets and it is unacceptable when it is black guys in baggy pants and reversed baseball caps.

But I don't think that President Obama and Attorney General Holder will do that. They are race-based politicians and, give them credit, they actually believe the poisonous race doctrines of the race industry and the identity left.

But they are standing in the way of history. America desperately wants to get beyond the corruption and the hate of race cards and race hustlers.

Think of it: here we are with a black president and a black attorney general. It is the ideal moment to close down the evil of liberal race politics. But Obama and Holder won't do it. They wouldn't know where to start.

Unfortunately, the people that will suffer for their ignorance and their bigotry are the African Americans. They desperately need a politician to lead them out of the land of racial Egypt and into the Promised Land of race harmony. But don't look for Obama to be that leader. Because he just doesn't get it.

The Liberal Establishment of Secular Religion

When we search for the central injustice pressed down upon the brow of the American people, we always end up at the central conceit of the liberal ruling class. The big liberal idea is the separation of church and state, that no one religion or sect gets into a special relationship, an establishment, with the state.

Liberals are very pleased with themselves about this. That is why it is their central conceit. Liberals are not as other men are, theocrats and moralizers trying to legislate morality. They insist that morality should be a private thing, not forced into the bedrooms of America by would-be theocrats.

But the idea that liberals are not in the moralizing business and not trying to legislate morality is a delusion. For if we expand the notion of religion from a particular religious sect or church to a more general definition, where we define "religion" as a belief system that organizes the meaning of life and establishes a definition of the good from which a system of ethics can be developed, then it is easy to conclude that our liberal masters, in violation of the spirit of the First Amendment, do in fact operate an establishment of religion, whereby liberals advance the belief system of the upper-middle class educated elite to a privileged status vis-a-vis the state. And what liberals do from the moment they get up in the morning is try to legislate liberal morality.

Have they ever succeeded! Liberal ideas are taught in government schools, in government universities; they are broadcast by government radio (NPR) and government TV (PBS). And of course the organs of the welfare state constantly broadcast and teach the essential humanity and compassion of the authoritarian welfare state. And liberals have the cultural power to run a kind of Holy Office of the Inquisition where dissidents and heretics to generally established liberal shibboleths may be shown the instruments of torture.

Oh, we are not talking about the instruments of physical torture, nothing so crude, darling. But liberals have their way of making you see the light.

There is the accusation of racism. Most Americans will do anything to escape an indictment of racism. And now liberals, with the help of the gay activist community, is making like very difficult for anyone that questions the moral status of gay marriage.

Indeed, if you disagree with any liberal notion you are risking some sort of social shaming. Create a political movement like the Tea Party, and pretty soon you will be fending off accusations of incivility, racism, extremism, and crypto-violence.

Some day, Americans will birth and grow a moral movement to end the reign of the liberal establishment of secular religion. Perhaps it is already born. It cannot come too soon. For if America is to rebuild itself out the social and economic wreckage of Hurricane Obama it must find a new moral ground, as Americans once created the moral foundation to build a movement to end plantation slavery.

It cannot come too soon. Life is good for the liberal upper-middle class in America. Liberalism has successfully built a nation and a culture well adapted to its needs and values. There is preferment and there are sinecures for those who serve the established church of liberalism. But other Americans must struggle in moral subjection and daily deal with the cultural humiliation dealt out to those that dare to question the Articles of liberal faith.

America needs a reformation, a cry of protest against liberal orthodoxy and hegemony. Only then can it become what it was prophesied to be, the shining city on a hill, still a beacon for all who must have freedom.

Warren Buffett, Crony Capitalist?

Remember the letter that President Perry (or was it Romney) sent to the Danbury Tea Party in 2015? Here is an excerpt:

I contemplate with sovereign reverence that act of the whole American people which declared that their legislature should "make no law respecting an establishment of business, or prohibiting the free exercise thereof," thus building a wall of separation between Economy & State.

Yeah. It's a pity that they left that bit out of the Bill of Rights. Because what we have, in Hurricane Obama, where politics and business are all mixed up, is an "establishment" or virtual nationalization of business. And just as you can't trust divines to get mixed up in politics or politicians to get mixed up in religion, surely we can all agree now that it is death to let politicians meddle with business. Just as nobody would think of letting businessmen run the government.

Exhibit A in all this is Warren Buffett, Sage of Omaha. He's just ponied up $5 billion for some preferred shares in Bank of America, currently fingered as the weakest bank. That comes a couple of weeks after Buffett penned an Obama-friendly op-ed in the New York Times and just before Buffett hosts an Obama fundraiser at the end of September.

Perfectly harmless you say? OK, let's put Republicans in all the speaking roles. Remember when old Sam Walton penned a Bush-friendly op-ed in the Wall Street Journal, then invested a few billion to rescue bankrupt Enron, then hosted a Bush fundraiser, all the time getting calls from the president on economic policy? You don't remember that? Of course not. Neither Sam Walton or the Bushies would dare to mount such an obvious staging of crony capitalism.

If I were Warren Buffett in the US in 2011, I would be hedging my political bets. Look here. Berkshire Hathaway is valued today, August 26, 2011, at $172 billion. At any moment some political aide at the White House could sicc the SEC or the Justice Department or the new Consumer Financial Protection Bureau on one of Buffett's businesses, just as the SEC and the EPA are currently hounding the horizontal "fracking" business. Right now the jackals, from New York State Attorney General Eric Schneiderman to Elizabeth Warren of the Consumer Financial Protection Bureau, are hounding Bank of America, trying to get BofA to pull the nation's mortgage chestnuts out of the fire.

How do you get the jackals to go away? Call in Warren Buffett!

Let's go back 100 years, to the aftermath of the great Crash of 1907. Back then J.P. Morgan got the richest men in America, locked them in a room, and wouldn't let them out until they had triaged the US economy. They let the insolvent firms go to the wall, the healthy ones survive on their own, and lent money to the firms they thought would survive with a bit of help. They did all this with their own money.

Fast forward a couple of years and the politicians had their progressive knickers in a twist over the "money trust." Just a few men, you see, seemed to own most of American business. Yeah. No doubt. And those were the men who, with Morgan stiffening their backs, kept their heads in the market meltdown when everyone else was losing theirs.

I'm sure that Warren Buffett is an honorable man, not a crony capitalist. But in times like these, when Hurricane Obama could rip the roof off your business just in order to narrow the odds on a marginal state next year, what businessman in his right mind would not be paying protection money to the politicians? After all, that's a nice business you got there, Mr. Billionaire. It sure would be a pity if something happened to it.