Dean: Obama Care is a Bailout That Makes AIG Look Cheap

Bureaucracy is the collective organizational structure, procedures, protocols, and set of regulations in place to manage activity, usually in large organizations and government.it is represented by standardized procedure (rule-following) that guides the execution of most or all processes within the body;. A bureaucracy traditionally does not create policy but, rather, enacts it. Law, policy, and regulation normally originates from a leadership, which creates the bureaucracy to put them into practice. In reality, the interpretation and execution of policy, etc. can lead to informal influence. A bureaucracy is directly responsible to the leadership that creates it, such as a government executive or board of directors.As a matter of practicality, the bureaucracy is where the individual will interface with an organization such as a government etc., rather than directly with its leadership.

Midwest Voices: I suddenly realized how easy it might be to get “the bureaucracy” working for you. If there existed a “consensus” on what the greater good should be- and maybe even the means to get there (ends justifying the means) by the various ruling elites in this country (and/or world), then the few people willing to take a personal hit for justice might never get his or her message out due to the machinery of the bureaucracy working against them.

The bureaucracy doesn’t question orders or take the initiative to question assumptions. The bureaucracy obeys. And once the government bureaucracy gets moving in a certain direction it isn’t that easy to get it derailed- no matter how idiotic what they are doing seems. It is a self-licking ice cream cone, as some call it. Paradigms are not questioned nor directions changed- until maybe there’s a lot of embarrassing press and Congressional inquiries.

ClimateGate, challenging the “bureaucracy” and “the consensus” that the Global Warming Religionists have built up. And how the media is on board with the “consensus” and unwilling to question it.

Just like Health Care Reform.

Just Like ACORN.

Just Like Cap & Trade.

Just Like “terrorism”, a word a Liberal can’t even think let alone discuss.

The wheels of bureaucracy grind very slowly.

And when the media is in on it. It’s positively Orwellian.

IBD:  Here’s a dirty little secret about the New York Times: It likes to leak things. Important things. Things that change the course of the public conversation. From the Pentagon Papers to the ruined terrorist-surveillance programs of the Bush era, the Times has routinely found that secrecy is a danger and sunlight is a disinfectant.

Until now. A troublesome hacker recently released e-mails going to and from the Climate Research Unit at the University of East Anglia in Britain, e-mails that exposed how the “scientific experts” cited so often by the media on global warming are guilty of crude political talk, attempts at censoring opponents and twisting scientific data to support their policy agenda.

The e-mails prove just how dishonest this left-wing global warming agenda truly is.

And now suddenly, the New York Times has found religion and won’t publish these private e-mails. Environmental reporter Andrew Revkin, who’s more global warming lobbyist than reporter, quoted — sparsely — from the e-mails, but declared that he would not post these texts on his “Dot Earth” blog on the Times Web site: “The documents appear to have been acquired illegally and contain all manner of private information and statements that were never intended for the public eye, so they won’t be posted here.”

That rule didn’t apply to things like the disclosure of the Swift global bank monitoring program against terrorists.

Unlike our secret terror-fighting efforts, there is no grave matter of national security to protect here. There is only a danger of shredding the undeserved reputation of some global-warming alarmists as nonpartisan, nonideological, just-the-facts scientists with no preconceived environmentalist or statist agenda.

The networks also have ignored this emerging scandal with all the ignorance they could muster.

But in the seven days after the New York Times revealed the existence of an NSA program to monitor communications to terrorist cells abroad, the three networks ran a combined 23 stories about the program, more than one story, per network, per night.

How many have run stories on ClimateGate?

Virtually none, and the few, like CNN’s micro-mini blow-off is about what you get.

It doesn’t fit THEIR agenda.

Their bureaucracy.

Their “perceived wisdom”

Their “consensus”.

So it’s no big deal.

Charles Krauthammer:  The United States has the best health care in the world but, because of its inefficiencies, also the most expensive.

The fundamental problem with the 2,074-page Senate health care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

Worse, they’re packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency.

Each must be able to garner just enough votes to pass. There isn’t even a pretense of a unifying vision or conceptual harmony.

The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:

• You’ll find mandates with financial penalties — the amounts picked out of a hat.

• You’ll find insurance companies (who live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates that the young shall now pay at minimum one-half; the Senate bill, one-third — numbers picked out of a hat.

• Y ou’ll find sliding scales for health-insurance subsidies — randomly picked — that will radically raise marginal income-tax rates for middle-class recipients, among other crazy unintended consequences.

The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool.

But the Bureaucracy demands to be fed. And the Democrats want to gorge it on 1/6 of GDP of this country.

They believe it benefits them.

The Frankenstein’s Monster of Bureaucracy will be created by them and they will be Frankenstein.

They will still have the illusion of being in control of it.

Even after the creature breaks out and terrorize everyone it won’t be their fault.

And considering they were off by on Medicare cost projections. They  were 1/9 of the reality and it’s getting worse every day. Can you imagine what this going to look like in your kid’s life time??

God help us all.

(oh, sorry left wingers that was a right-wing extremist evil Christian moment)

Allah Akbar.

Feel better now

Try Nate Silver, a statistician and liberal-media favorite, recently named one of Time’s 100 Most Influential People. He says scientists in this exchange were unethical:

“Dr. Jones, talking candidly about sexing up a graph to make his conclusions more persuasive. This is not a good thing to do — I’d go so far as to call it unethical — and Jones deserves some of the loss of face that he will suffer.”

But then he adds the typical liberal disclaimer: “Unfortunately, this is the sort of thing that happens all the time in both academia and the private sector — have you ever looked at the graphs in the annual report of a company which had a bad year? And it seems to happen all too often on both sides of the global warming debate.”

When conservatives are wrong, conservatives are wrong. When liberals are wrong, everyone does it, don’t you know?

It’s no big deal.

Nothing to see here.

Hey, did you remember Mark Foley? , wasn’t he just awful…

In another e-mail from Jones to Mann, the Washington Post reported, there’s talk of cutting skeptical scientists out of the official U.N. report: “I can’t see either of these papers being in the next IPCC report,” Jones writes. “Kevin and I will keep them out somehow — even if we have to redefine what the peer-review literature is!”

But you can’t take that literally, it was “out of context”. That’s not really what he said…

But Tea Bag Protests are all shills for Insurance Companies.

And anyone who denies the “consensus” on Global Warming must be a shill for the fossil fuels industry…

Fascinating, isn’t it folks.

This kind of censor-your-opponents activity ought to disgust a journalist who values openness and rigorous debate above all.

Every day the networks avoid this story, they’re saying they don’t really care about either of those values. In fact, they become willing accomplices in a cover-up of global proportions.

So what else aren’t they willing to tell you? Hmmmm….

That is, after they get over their obsession with the couple who crashed the State Dinner, that is.

After all, that is really big news.

And ClimateGate is not.

And the formation of massive new bureaucracies is not either.

Nor is massive tax increases in a recession.

And we all know that bureaucrats are vastly more tolerant, kind, flexible, efficient, and more willing to help you out in a real crisis.

Don’t worry, be happy.

“Hope and Change” is on it’s way.

If you are one of the many seniors who followed the plan and put away your money in your company’s retirement program over the last twenty-five years on a regular schedule and pick what you thought were sound investments, you thought you would have a nice nest egg to live off the rest of your years. In theory it should have worked out well for you, but the problem is that while you were saving for the rainy day retirement fund the one thing that you never new was brewing throughout the world was what I like to the Big G. So I guess you are wondering what the Big G is well it is something that just got so big that it hate itself.

The Big G is Greed the single biggest factor and in fact in my opinion is the number one reason for the financial mess that the world is in today. The Greed Factor is wide spread it has hot every segment of the economy and each and every hard working person in the country. The one thing that continually going on was that if they can get one then they could ten and then twenty and fifty and so on until the bottom had no choice but to drop out and the ride was over. The ride was good for so many people the biggest problem was that all of the people who trust the money keepers that they could continue on forever and the script was so well written they everybody believe it. It does not matter what investment it was from real estate to stocks, there had to be a hole in the donut somewhere and it had to come to and end sometime.

The seniors put all of their faith in the system and the system let them down in a big way, many have seen all of their hard work go right down the drain and the ones that are responsible for handling the investments had shown no remorse. In fact they turned around and held the country and the world at gun point and forced a bail-out of their mistakes. The problem is that the bailout should have gone to fix the peoples losses and not the ones who made the most profits from the losses.

I read an email a while back and it made more sense then anything I had read that either came out of the government or anywhere else and it went something like this, so think about this real hard. If you take the entire amount of the two stimulus packages which was around 1.5 trillion dollars to date and you took all of the money and took every person in the country who pays taxes and this to me was the key Pays Taxes and you divided the money up equally between each person and sent them a check tax free. The check would equal somewhere in the area of $250,000 tax free this would correct the economy. People who received this check would have been able to pay off or pay large amount of the credit issues off they would be able to purchase goods and services and much more then just giving it to the same people who cause the problem in the first place. Think about this; what could you have done if you were sent a tax free check in the amount of $250,000 do you think that this would change your life financially. Would it not have reduced people bad debt and banks and creditors would have the money that was loaned out back in their pockets in many cases. Even if the person who received it went out and just blew the money it would have been put into the economy one way or another that money would be in circulation today.

They would buying cars, houses, goods and services and even paying off debt, if this would have taken place there would be more capital going around the country and the world and even the people who lost their jobs would have been able to survive or start a business and not be wards of the government. The biggest problem is that this is to simple and not complex enough to keep the average person confused for life. With all of the money that has been loaned or given away to all of the banks and companies has it changes your retirement income for the future in anyway shape or form. The answer to that is no and it will not simply because if you are at the age of 70 when you can receive the most from Social Security you just don’t have enough time left in your life to get it all back in your lifetime.

Now the fact is this will never happen the government or anyone else is going to hand you $250,000 tax free and not have to pay it back right! Well that is not completely accurate because there is a program that is complete for seniors who are over the age of 62 and have work hard to keep their homes. These same people are the ones who built this country and they deserve to have a program that will give them back some of the money they given up because of what the greedy investment and company owners have taken away. This exclusive program has over the years receive good and bad press and the real truth is that the people who say negative statements are most likely the same people that took you r money in the first place. The program is the Reverse Mortgage, this program gives the availability to take a portion of the equity you have in your home and use it tax free and you never have to pay it back in your lifetime. In many cases people are able to take care of the mortgage that they currently have and pay if off completely and eliminate payments, which in turn increase their income dramatically.

In other case where people who do not have a mortgage they can have a large sum of money to use anyway the see fit to use it or they can choose to have a month check for the rest of their lives no matter how long they live. They can also have a combination of choices as to how they want to receive the money over years or they can just have if something comes along in the future. Yes there are people that say that the cost of a Reverse Mortgage is very expensive; but the fact is very simple the cost of doing nothing and just stressing your life over things that you cannot control it more expensive then the cost of receiving a lifetime of piece of mind. Not to mention the cost of a Reverse Mortgage is not and upfront cost it is spread out over the life of the loan even though it comes out up front from the total proceeds.

Now here is the simple way to determined how much money will be available to you gross! If you are currently at the age of 65 and you have your home that you owe nothing on take your age and minus 5 years and this would be the estimated gross amount you would receive percentage wise about 60% of your homes value and from that the cost of the loan closing cost and insurance is deducted which on the average is around 10% in the first two years. Remember this; the longer you stay in your home the less it will coast over years, meaning added to the loan balance. Since you are going to be able to stay in your home for the rest of your lives without have to make any payments ever again other then taxes and insurance you will not only have more money but you will have less stress in your life and live longer and have a better quality of life in the year that you should. So think Reverse Mortgage and don’t let the negative people sway you from enjoying what you worked so hard to achieve they have already taken away the other parts that you work hard for over your life.

Tim Robbins, Sr. is a senior Reverse Mortgage Specialist. My main goal is to provide the best education resources available and to always place the seniors interest first and foremost. My website is designed to give you all the available information which you can review either in print or video by visiting http://bestmortgageplans.com for all your senior resources to help you enjoy a good life. Also contact me Toll free at 800-610-3599 for a Free Report All About Reverse Mortgages you can call my 24/7 recorded HOT LINE at 1-800-610-3599 Serving all of Florida and New Jersey.

Article Source: http://EzineArticles.com/?expert=Tim_G_Robbins

First let’s look at where we have been in the past and then we will look into the future and get some strategies that you can implement to protect your assets for the future. If you are over the age of 80 you are one of the few people that know what happen in detail when the great depression hit even though you would have been a baby at the time, you must have heard stories from your mom and dad or relatives.

The depression hit in 1929 when the entire US economy clasped, which cause many wealthy people and some not so wealthy people to end their lives because they did not have protection in place. The key to surviving is having a fail safe program in place that will protect from total failure. The difference from 1929 and today is that every aspect of today’s economic melt down is it is worldwide. The issues; there are hundreds of millions of more people in the world then there was then. Most people today do not realize nor do they think that most of their wealth is in the single largest investment that they ever made and that is their home.

Yes the home is and was for most people the single largest investment of their life! The home in the US and the equity that is just sitting around untapped is estimate at well over 2 Trillion dollars; just for people over the age of 62 and growing faster than any other segment in the country today. This is true even though the values of homes around the country have been declining over the last 5 or so years.

You see most people do not understand that fact that equity in your home does not mean you are wealthy unless it is working for you to solve a problem for you. If you have $200,000 or more equity in your home or even a lot less you are what is called House Rich and Cash Poor! Understand that having a home that is yours and owning out right just means you have no payments it does not mean that your equity can do anything for you unless you have cash to make things happen to will either grow your cash flow or maintain your life for many years without stress. Here lies the problem, you have what is called a net worth of $200,000 or what ever, but if a situation in your life appears if you don’t have the cash to fix the problem you still have a net worth but you cannot spend it to fix your problem or invest it to increase your wealth.

So now let’s look at some strategies!

Strategy # 1

Increasing your Income Tax Free

To maintain a standard of living, some older homeowners are starting to convert home equity to monthly income. This approach is a relatively new concept that has gained momentum with the development of reverse mortgages. Financial professionals are also beginning to explore different options for using home equity to increase and annuitized income. The foundation for retirement security has traditionally likened to a three-legged stool consisting of savings, pensions, and Social Security.

Recent financial trends suggest that this conventional approach is becoming less effective. The savings rate among Americans has declined significantly since the 1980s-reaching its lowest level in 2004 since the Great Depression-although it recently turned upward. Compounding these cash shortfalls is the decline of defined benefit plans, which leaves many Americans facing a future with less guaranteed retirement income.

As the cost of living continues to rise, many older Americans find it hard to make ends meet. Researchers estimate that nearly 78% of all older adult households do not have sufficient resources to sustain them through their retirement years. Baby Boomers are also concerned about being able to maintain their standard of living as they grow older. Older workers who expect inadequate retirement income, or a less reliable source of income, such as a defined benefit plan, are more likely to plan to use home equity to pay for retirement expenses.

Option One

To increase monthly annuitized retirement income is to defer Social Security payments. Retirees receive a reduced monthly benefit at age 62 and progressively larger benefits for each month they postpone benefits up to age 70. Elderly widows could see the greatest benefit, since deferral would increase the expected value of their monthly survivor benefits. To maximize their monthly payments, as well as that of their spouses and other dependents, people near retirement could continue working. However, this option may be difficult for workers in physically demanding occupations, and those who are limited by health problems. To help workers who anticipate a long life, and who must retire before age 70, some financial professionals are recommending a term home-equity loan or reverse mortgage to help pay for everyday expenses for a few years until they are eligible for maximum Social Security benefits.

Option Two

Another option for older homeowners to ensure retirement income would be to buy a “longevity” annuity with their savings, and tap small amounts of home equity to fill financial gaps until they start to receive their annuity payments. Longevity annuities require a smaller investment than an immediate annuity because they usually do not begin payouts until after age 80 or 85. This approach could be attractive to older americans who worry that purchasing an immediate annuity will leave them little cash to pay for unexpected expenses or to leave a bequest. Consumers should carefully examine the fees associated with longevity annuities, since they can be expensive.

Option Three

This option is one that reduces stress and also is the safest option of the three, it requires very little on your part and is the easiest to accomplish. By utilizing the equity in your home and not using available saving or other instrument you can have the best of all worlds. Let’s look back a few decades and see what became available that had never been available before for many people especially seniors over the age of 62. As they age, people face a growing possibility that a costly health problem could disrupt their family budgets. When they cannot make their monthly loan payments, they may lose their houses.

A recent study found that by the end of 2007, more than 684,000 homeowners age 50 and older were delinquent in mortgage payments or in foreclosure. A reverse mortgage allows older homeowners to defer monthly mortgage payments on a conventional home loan. Borrowers (or their heirs) do not have to repay the loan until the last borrower dies, permanently moves out, or vacates for a period of 12 months. About 46% of reverse mortgage borrowers surveyed by orgainizations have paid off their regular mortgage in this way. Some are transferring their existing housing debt to meet the requirement that a reverse mortgage be in primary lien position. Anecdotal evidence suggests that growing numbers of older homeowners are taking out this type of loan specifically to avoid the need to make monthly mortgage payments.

Using home equity to manage debt became popular after the Tax Reform Act of 1986 phased out the deduction for interest on credit cards, auto loans, and most other types of consumer debt while preserving tax deductions for certain home loans. Since then, borrowers have shifted from installment plans to tax-advantaged mortgages and home-equity loans to pay for major purchases such as cars and appliances. Easy access to credit also provided lower-income households with greater liquidity to purchase the goods and services that they need to continue to live at home.

Using housing wealth to manage consumer debt can enhance a person’s standard of living. But if this resource is not used wisely, it can also be a source of financial insecurity. Older homeowners often take on sizable debt without considering the potential impact of these loans on their long-term retirement security. Using a reverse mortgage to defer debt payments can also be risky. Borrowers who use loan funds early in their retirement may have little home equity later in life. Borrowers continue to accumulate interest payments on the loan balance as long as they stay in their homes. Those who continue to live in their homes for many years may find that they have little or no home equity left after they repay the loan.

This could be problematic for older adults who need to move to an assisted living facility or other supportive setting as they become frail and in need of care. Without sufficient funds, some may need to turn to Medicaid to pay for long-term care.

Having Reverse Mortgage in place and setting it up I a way that takes into consideration of things that may or may not take place in the future is what a Reverse Mortgage is all about. The flexibility within the mortgage affords you the option unlike anything else anywhere. You control the amounts and timing and you can change it as situation change. In addition; it gives you the freedom to decide what, when and how you can receive income or payments and unlike most of programs depending on how you choose to receive you can never out live the money no matter what happens in the future. You will also never in your lifetime have to pay anything back it all happens when you are gone and no longer live in your home as your primary residence.

The Reverse Mortgage is so versatile in everyway from choosing how interest charges accumulate over time meaning a fixed rate verses adjustable. You can also choose how you will receive the money either all at one time or over a specific time period or for life. Not to mention you can also have the amount that is set aside for the future grows over time. This option is the built in Equity Credit Line! This part is only available when using the adjustable rate program, but it is the one that really gives you the most flexibility for a real edge against inflation.

Any financial expert who is worth a grain of salt has to agree that in our latter years we need the maximum amount of security coupled with the maximum amount of flexibility and that is what the Reverse Mortgage can and does for millions of seniors. So don’t look at the Reverse Mortgage as just another mortgage, look at it has the ultimate program that can do more things to protect your future and provide for today at the same time all it needs is to be setup properly from the on set and then adjusted as your own personal situation changes and there is one the thing that you can count on it that your financial situation will change the is no doubt about this. It is not IF it is when.

Tim Robbins,Sr I am a senior Reverse Mortgage Specialist. My main goal is to provide the best education resources available and to always place the seniors interest first and foremost. My website is designed to give you all the available information which you can review either in print or video by visiting http://bestmortgageplans.com for all your senior resources you may need for a good life. Also contact me Toll free at 800-610-3599 for a Free Report All About Reverse Mortgages receive it via email

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It has become an epidemic in the world of senior citizens who are sitting in their home, worrying about how they will survive the many financial issues that may and will surface in their retirement years. Most seniors and their families just go through doing without the simple things like medicines, personal care items and other things that make their lives more comfortable. This does not have to happen since the majority of seniors whom own their homes are sitting on their largest portion of the estate right under their feet.

Here’s the problem; most of them do not even realize that they have a wealth of financial resources just sitting collecting dust in their home that they spent a lifetime of paying for and budgeting to make sure they paid off their home. It would able to take care of them in the Golden Years. When they purchase their home years ago when they were going to raise a family, no one told them about the real purpose of buying home really was going to be to them. The belief that the home was a place to raise their children and provide warmth and comfort was the only thing they could even think about at that time.

In the era of the seniors productive earning years they provided for their families, worked hard to keep a roof over their heads provide and care for their children, save and budget so they would be good parents. Now fast forward to today; they are now doing without and in many cases they are doing without too leave their kids something of value. The main issue is that they are still denying themselves of the things that they really need to live a life at the time in their lives that they should be enjoying their life. No one knows how the rumor got started, that parents are supposed to die and leave everything that they worked a lifetime to build to their children. As in many cases the children actually believe that they are entitle to inherit the fruits of their parent labors

Where has all this come from, can it be that the children really believe they should get anything, since they were raised, put through school and got three meals and day and in many cases even more! In today’s environment the children of seniors should only be concerned that their parents are able to provide for themselves and not be a burden on their children who in these trouble times are struggling financially themselves. With unemployment at and all time high and projected to go even higher over the next twelve months or so, many children across the country are having to move back home. In these cases it will place another hardship on their parents meaning additional expenses within the home.

Children of seniors should stop and think about the facts that their parents worked all of their lives, they did everything right from saving, pay off their mortgage and trying to provide for their retirement years. They listen to all of the financial gurus and the government who made provisions to save tax free and grow tax deferred and then from all of the greed throughout the world they got screwed in the end. Now at this unprecedented time in history with most pension, IRA’s and investment portfolios in ruin or at an all time low they need to look to other source of money to use to provide for their future. The future is now and in this ever changing environment and government changes they should seriosly think about the Reverse Mortgage before the Government Changes or does away with the most stable and most satisfying to seniors ever created.

The one place that they did make the safest and securest investment which did not start out that way was in their homes. It is stated that there is an estimate Two Trillon dollars in equity sitting around that many seniors could be using to provide for themselves and living a life that is safe and secure and not sitting up all night worrying.

The Reverse Mortgage is not for every person who is over the age of 62 but in addition to providing a safe and secure venue to access money which is tied up in homes, it will also provide a great financial planning tool for the estate of many seniors when it comes time for their children when the time comes to take care of the final estate issues. So if you are wondering about if and how a Reverse Mortgage can help you and your parents get relief take the test and see if it will work for you.

Tim Robbins,Sr I am a senior Reverse Mortgage Specialist. My main goal is to provide the best education resources available and to always place the seniors interest first and foremost. My website is designed to give you all the available information which you can review either in print or video by visiting http://seniorconsumerreport.com and take the Reverse Mortgage Test with no obligation just education which is the first step that every senior must take. And for all your senior resources you may need for a good life. Also contact me Toll free at 800-610-3599 for a Free Report All About Reverse Mortgages and to receive a Free DVD in the mail Click Here
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Scott Meeker’s well-composed article in Thursday’s Joplin Globe was about a courageous 26-year-old, Curtis Almeter, from Anderson, who is preparing for a double lung transplant to counter the ravages of cystic fibrosis, a genetic disease he shares with his 18-year-old brother, Tim.

The article focused on Mr. Almeter’s ability to maintain his love for photography while struggling with his disease, but I want to focus on this:

Last week, Almeter went active on the transplant list. He and his mother are staying at Barnes Lodge [at Barnes Jewish Hospital in St. Louis] and will soon move to a duplex near the hospi­tal. The call informing him that a donor has been found could come at any time. Today, perhaps, or maybe a year from now.

On a TV near where the mother and son sit, U.S. Sen. Pat Roberts of Kansas is talking about his thoughts on the health care reform bill.

Almeter qualifies for Medicare and Medicaid, which will cover much of the transplant cost.

“We didn’t know that initially,” says Karen Almeter [Curtis' mother]. “It was good news…one less thing to stress over.”

God only knows what this family would do, were it not for those magic words, Medicare and Medicaid, which will cover most of the estimated $600,000 cost of the lung transplant.

Those “magic” words, which, of course, are really just the product of our collective agreement that folks like the Almeters shouldn’t have to choose between treatment and bankruptcy on the one hand and suffering and death on the other.

But these days, in the minds of some, those words, Medicare and Medicaid, stand for bloated, wasteful, “socialist,” government programs, and are used as props for intense criticism of Democratic efforts to reform our health care system.

At least part of those Democratic reform efforts are directed at people who don’t qualify for Medicare and Medicaid—people who fall between the cracks of our system—who have jobs but no or inadequate insurance, and who have to worry about bankruptcy when faced with their own $600,000 bill for medical treatment or who simply have to waive treatment and suffer through until the end.

And, of course, many do suffer through until the end, as studies show.  Thousands of Americans die each year for lack of health insurance, and we need to fix the system that tolerates such outcomes, instead of carrying swastika-emblazoned placards to tea parties and singing the word ”socialist,” as part of the Pale Face Choir.

Since Scott Meeker’s article referenced Republican Sen. Pat Roberts, our Kansas neighbor, who not only opposes the Democratic plan, but who happened to enjoy more than $500,000 in contributions from “medical interests,” in his last campaign, I thought it would be nice to watch Stephen Colbert adeptly skewer the senator, a few months ago: 

[Globe Photo: Roger Nomer]

Demonstration outside the sit-in for single-payer at Pelosi's office

About a dozen single payer activists, including three Gray Panthers, sat in at Rep. Nancy Pelosi’s SF office on November 3rd, demanding she honor her promises on single payer. Pelosi had promised that the House health reform bill, HR 3962, would include the Kucinich Amendment, allowing states the option for single payer and the Weiner Amendment, allowing a full House debate on substituting HR 676 (Conyers national single payer bill) for the entire House bill being proposed.

Our immediate demand was that staff reach Pelosi or her chief aide in Washington by phone, and that we talk with her. We said we would stay until this happened. Some three hours later, we were arrested for failing to follow directions to leave. The arrests were ordered by Pelosi aide Dan Bernal, whom we remember for calling the GP office several years ago demanding apology for our newsletter article attacking her votes for war funding.  Bernal was too chicken to make the formal complaint from Pelosi’s office, so he went scurrying around trying to find someone else to make a complaint. All this time, we and the crowd outside were dialing Pelosi’s Washington office, so the switchboard was jammed and calls were rolling over onto a fax line.

Pelosi’s position as House Speaker is largely based on her ability to raise huge sums for Democratic electoral campaigns, so she stands at the intersection between political power and big money including big money from insurers, drug companies, and hospital chains. It is particularly galling that she uses that power to stall implementation of single payer in California, which twice passed the legislature of the state she is supposed to represent.  This is what dictatorship looks like.

]]> http://mlyon01.wordpress.com/2009/11/25/flawed-health-reform-could-hurt-dems-in-2010%e2%80%94part-i/ Thu, 26 Nov 2009 05:38:19 +0000 mlyon01 http://mlyon01.wordpress.com/2009/11/25/flawed-health-reform-could-hurt-dems-in-2010%e2%80%94part-i/

Flawed Health Reform Could Hurt Dems in 2010—Part I – Working In These Times

Congressional Longevity Record Falls

Thursday, November 26, 2009. The white noise coming from Capitol Hill lately is so red hot that it was easy to miss a significant milestone last week.  Senator Robert Byrd of West Virginia became the longest-serving member of Congress in history, passing the previous record of former Sen. Carl Hayden of Arizona.

Fifty-six years, 326 days and counting for those of you keeping score at home. That’s more than a half century, sneaking up on six decades. One more election and the good senator’s term of service could qualify for Social Security. Byrd has been roaming the halls of Congress longer than ten of his current colleagues and President Barack Obama have been walking this earth.

An amazing set of circumstances must come together to allow this kind of achievement. Personal health, energy and desire to keep serving play into it. Hayden actually retired four years prior to his death in 1972 or he might still hold the record.

The ability to keep winning elections is certainly a large factor. Former Senator Frank Church of Idaho was fond of saying “Your friends come and go, but your enemies accumulate.” Church served four terms in the Senate before the accumulated enemies resulted in his defeat. His 24 years of service fall substantially less than half of Byrd’s, Hayden’s and quite a few others’.

A member has to be very right for his state or district to start with, and then be able to change and adapt with a changing society.

Byrd’s adaptation is perhaps his most interesting characteristic. He was, after all, boys and girls, a young man and former redundant member of the Ku Klux Klan as a young man. His record is strewn with apologies, but it also contains a filibuster against the Civil Rights Act of 1964 and a vote against the Voting Rights Act of 1965. He did vote for the Civil Rights Act of 1968 and has called his earlier segregationist actions — based on a commitment to states’ rights, or not — among his biggest regrets. Ok. I’ll take him at his word.

For my purposes today, the more salient point is that he was present for these votes. In 2005, Roll Call newspaper brought together a panel of liberal and conservative congressional scholars to determine the most important legislation of the previous 50 years. Beginning with the National Defense Education Act of 1958 at number six, and reaching to the Patriot Act of 2001 with an honorable mention, only Byrd and Representative John Dingle of Michigan were members of Congress for all the votes on the list.

Number three, according to the Roll Call panel, are the Medicare and Medicaid Acts of 1965. Compared with Social Security in their impact on American life, these programs have enjoyed broad bi-partisan support from their inception, as did all of the top bills on Roll Call’s list.

House Speaker Nancy Pelosi recently compared the House’s passage of health care reform legislation with passage of the Medicare and Medicaid Acts. I love her passion and understand her excitement, but this assessment is, at best, premature. Medicare and Medicaid passed both bodies and were signed into law. Health care reform has not.

Then there’s that pesky bi-partisan thing, which will continue to elude  health care reform if Republicans stick to their current strategy. Medicare passed with a majority of both parties in the house and 40 percent of Republicans in the senate. The history of significant legislation suggests such bi-partisan support may be needed to produce a law that the nation will embrace.

This country is a different place than it was in the mid-sixties. So is Congress. The entire political system is so much more polarized that achieving bi-partisan support for significant change may not be possible. If this is so, and if the Democrats succeed in passing health care reform over the dug-in heels of the Republicans, we’ll get a chance to see if a one-party bill can be the kind of game changer that Medicare and Medicaid have been.

One thing is for sure — it is risky money to bet against Robert Byrd being around for whatever happens next.

Congratulations, Senator, and thank you for your service.

A Milestone in the Health Care Journey

by Ronald Brownstein

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. “The bottom line,” Nichols says, “is the legislation is sending a signal that business as usual [in the medical system] is going to end.”

Both the Senate bill’s priority on controlling long-term health care costs, and its strategy for doing so, represents a validation for Senate Finance Committee chairman Max Baucus (D-MT). When Baucus released his health reform proposal last September, after finally terminating months of fruitless negotiations with committee Republicans, Democratic liberals excoriated his plan as a dead end. And on several important fronts–such as subsidies for the uninsured, the role of a public competitor to private insurance companies, and the contribution required from employers who don’t insure their workers–Reid moved his product away from Baucus toward approaches preferred by liberals.

But the Reid bill’s fiscal strategy, and its vision of how to “bend the curve,” almost completely follows Baucus’ path from September. Baucus’ bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that’s the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas’ for shifting the medical payment system away from today’s fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus’ most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that’s just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.) Most of the other big ideas for controlling costs (such as medical malpractice reform) tend to draw support primarily among Republicans. And since virtually, if not literally, none of them plan to support the final health care bill under any circumstances, the package isn’t likely to reflect much of their thinking.

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end “Cadillac” insurance plans; to pursue “aggressive” tests of payment reforms that will “provide incentives for physicians and hospitals to focus on quality” and provide “care that is better coordinated”; and establish an independent Medicare commission that can continuously develop and implement “new efforts to improve quality and contain costs.” Finally, they said the Congressional Budget Office “must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter.”

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests. The CBO projected that the bill would reduce the federal deficit by $130 billion over its first decade and by as much as $650 billion in its second. (Conservatives, of course, consider those projections unrealistic, but CBO is the only umpire in the game, and Republicans have been happy to trumpet its analyses critical of the Democratic plans.)  “Let’s use the metric of that letter,” said Orszag, who helped shape the health reform debate for years from his earlier posts at CBO and the Brookings Institution. “Deficit neutral; got that. Deficit-reducing second decade, got that. Excise tax: That was retained. Third is the Medicare commission: has that. Fourth is delivery system reforms, bundling payments, hospital acquired infections, readmission rates. It has that. If you go down the checklist of what they said was necessary for a fiscally responsible bill that will move us towards the health care system of the future, this passes the bar.”

McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag’s assessment of it. “It has got all four of those elements in it,” McClellan said in an interview. “They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go.”

Reid gave ground on one Baucus proposal that the economists identified as a priority-taxing high-end insurance plans. Like many health reformers, the economists who wrote Obama argue that such a tax “will help curtail the growth of private health insurance premiums by creating incentives to limit the costs of plans to a tax-free amount.” Amid intense opposition from unions, Reid raised the thresholds at which family plans would face that excise tax from $21,000 to $23,000. But given all the pressure from labor, the more striking thing may have been that Reid didn’t increase the thresholds even more; the CBO calculated the proposal, which the House excluded from its bill, would still raise $35 billion annually by 2019. “They held pretty strong,” said one administration health care expert. “It’s not like unions haven’t been making the case that it shouldn’t have been a much higher number.”

On delivery reform, Reid stayed even closer to the Baucus blueprint. The Finance bill laid out a series of measures to change the way providers are paid for delivering care to Medicare recipients; the hope was that once Medicare instituted these reforms, private insurers would also adopt many of them. “The goal here is that the things we do in Medicare will translate over into the private sector, and there is quite a bit of historical precedence for that,” said one Democratic aide involved in drafting the package.

The Baucus delivery reform ideas revolved around two central aims. One was to reward Medicare providers who deliver care more efficiently and penalize those that don’t. The Reid bill upholds the major proposals Baucus offered to advance that goal. For instance, hospitals under current law must report on their performance in treating patients for common conditions like heart problems and pneumonia; under the bill, their Medicare payments, for the first time, would be affected by their ranking on those reports. Hospitals would also be penalized if they readmit too many patients after surgery or allow too many to acquire infections while in the hospital itself. Another provision would begin the process of applying such “value-based purchasing” toward other providers like hospice providers and inpatient rehabilitation facilities.

With physicians, the Reid plan takes a step back from the Finance Committee bill but still a long step beyond current law. The Finance Bill proposed automatic reimbursement reductions for doctors who order up the most care for Medicare recipients with similar medical and demographic characteristics. That was meant to respond to the research showing big disparities in spending on medical services for similarly-situated patients in different communities. But, Democratic sources say, that proposal ran into charges that it would promote rationing-and even function as “a death panel by proxy”-by compelling doctors to arbitrarily reduce care. So the final bill takes a less direct route toward a similar end. It requires Medicare to begin studying the utilization patterns of doctors participating in the program. And then it establishes a “values based payment modifier” that would, in a budget-neutral manner, increase reimbursements for physicians found to deliver high-quality care at lower cost, and reduce them for physicians at the other end of that spectrum. “It will, we believe, have the same net effect [as the original proposal],” said the Democratic aide. “It should change behavior around that threshold.”

The other set of Baucus proposals were intended to promote more coordination among providers. These have survived almost verbatim into the final bill. The bill encourages groups of providers to establish doctor-led “accountable care organizations” to more comprehensively manage patients’ care by allowing them to share in any savings for Medicare they produce. It also establishes a voluntary national pilot of “bundled” payments that would encourage hospitals, doctors and other providers to work more closely together. Another pilot program would test coordinated home-based care for chronically ill seniors.

Finally, the Reid bill maintains the two powerful institutions the Finance legislation proposed to promote these reforms and develop new ones. The one that’s attracted the most attention is an independent “Medicare Advisory Board.” Under the Senate bill, that board would be required to offer cost-saving proposals when Medicare spending rises too fast; Congress could not reject its proposals without substituting equivalent savings. Since the board would be prohibited from offering changes that raise taxes or “ration care,” and since the legislation initially exempts hospitals from its recommendations, it could choose to promote the sort of payment reforms the bill establishes. (More prosaically it might also clear away some of the expensive coverage mandates that Congress imposes on Medicare under pressure from different elements of the medical industry). Given the limitations imposed on the commission, an equally important means to expand these reforms might be a second institution the legislation creates: a Center for Medicare and Medicaid Innovation in the Health and Human Services Department. Though this center has received much less attention than the Medicare Commission, it could have a comparable effect. It would receive $1 billion annually to test payment reforms; in a little known provision, the bill authorizes the HHS Secretary to implement nationwide, without any congressional action, any reform that department actuaries certify will reduce long-term spending. While the House bill omitted the Medicare Commission (a top priority for Obama) it included the innovation center.

No one can say for certain that these initiatives will improve efficiency enough to slow the growth in health care spending. Some are only pilots; others would affect only a small portion of providers’ revenue from Medicare. CBO typically evaluates them skeptically: it generally scores little or no savings from most of them. Former CBO director Robert Reischauer, who signed the November 17 letter, says that’s not surprising. “CBO is there to score savings for which we have a high degree of confidence that they will materialize,” says Reischauer, now president of the Urban Institute. “There are many promising approaches [in these reform ideas] but you…can’t deposit them in the bank.” In the long run, Reischauer says, it’s likely “that maybe half of them, or a third of them, will prove to be successful. But that would be very important.”

While generally supportive of Reid’s approach, McClellan, the former Medicare administrator under Bush, offered several specific ideas for strengthening it. He says the Senate should improve the capacity of HHS to more quickly evaluate whether the payment reforms are working, and also to provide data and technical assistance to new physician groups like the accountable care organizations that will be attempting to better coordinate care. “Ideally you’d both be able to tell the organizations involved and Congress what is working or not, and give the organizations the feedback and data they need to know whether they are doing a good job,” he says. McClellan also believes that the plan needs sharper sticks-tougher penalties on providers who don’t provide efficient and effective care. “There are a lot of carrots and not so many sticks,” he maintains. Of course, tougher penalties might provoke more opposition from provider groups like hospitals and physicians now tenuously supporting the legislation.
[[McClellan stands at the forefront of centrist Republican thinking on health. Even the more ideologically conservative health care thinkers to his right generally don’t oppose long-term reform ideas like bundling payments (John McCain promoted that during his presidential campaign). But they tend to view them as insufficient or tangential to the real problem. Their view highlights a fundamental difference between the parties’ on health care. To save costs, Democrats mostly want to change the incentives for providers. Republicans mostly want to change the incentives for patients by shifting toward a model where insurance covers only catastrophic expenses and people pay for more routine care from tax-favored health savings accounts. In essence, the Republican view is that the best way to hold down long-term costs is to directly expose patients to more of them. Few Democrats accept that logic though and it has little influence on either chamber’s legislation.

Another Republican cost-containment priority missing from the bill is meaningful medical malpractice reform. (The bill only encourages states to think about it.) Nichols, of the centrist New America Foundation, would like to see that included as well. Its omission is one reason he says he gives the plan a “b” rather than an “a”; the other is he’d like to see mechanisms to more quickly diffuse into the private insurance system reforms that show promise in Medicare. Democratic sources say a group of centrist Democrats led by Virginia Senator Mark Warner is trying to devise a package designed to do just that, perhaps by expanding the role of the independent Medicare advisory commission.

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn’t able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. “One never knows whether we’re turning the corner or if this is just playing the same old game for another inning,” he says. “But I sense there’s something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve.” If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.

From the makers of bankrupt Social Security, indebted Postal Service, broke Fannie Mae, deteriorating Medicare and Medicaid, and broke Freddie Mac, comes health care.

When it comes to Healthcare, I’ve a little experiment to suggest. You can take the combined brain mass of the intellectuals around the world, and defy them to come up with a mess. I’ll bet the feather on my hat that they could not come up with a solution that matches the large scale bungling that capitalism has produced.

There are certain things that Doctors have to do to survive, and there are certain things that Insurance companies have to do to survive. What’s the wrong with that? Nothing *shrugs shoulders* Everyone could sing and admire sunrises, but for the minor blemish on the horizon: The things that Insurance companies and Doctors have to do to be healthy financially don’t always intersect with the fact that the patient has to healthy.

Let’s consider a chest congestion. If the same ailment were to befall me in my hometown in India a few years ago, I would walk up to the clinic across the street. Not in the mood for a clinic? No problem, I’ll settle for the pharmacy and refer lovingly to the “brother” who runs the store as “Anna”, and say I have a cough. If I could cough for him grossly, with the ringing sound of phlegm, he would prescribe me an anti-biotic in a jiffy. Two days later, I can breeze along the streets of Broadway and perform as the lead singer at the Italian Opera without anybody being any the wiser.

Not so here – uh uh! Nope! I have to get a minimum for 3 appointments before the anti-biotic, charging my insurance company I know not how much, and charging me my “co-pay” each time. Let’s say, the co-pay is $20. $60 and 10 days later, I am still no closer to getting a cure than a baboon coughing up phelgm without any access to health care in the Congo basin.(I don’t know whether baboons cough, but let’s assume they do) Then, it is prudent to have a meltdown in the Doctor office, at which point a nurse would stir in your direction, and touch you with her sympathy. By the time, the anti-biotics come along, the lung that’s been wheezing along fine thus far looks pneumonic, and a chest x-ray is in order, the bronchial tract that was hitherto clear has constricted making you whistle everytime you breathe. In short, you can forget the opera, and the coughing baboon in Congo is better off, because it did not lose $60.

I am not saying that walking to a pharmacy and having an anti-biotic prescribed has merits. But you must accept, it has ease and works for 80% of the minor ailments that befall a middle aged person.

Now, we come to Pricing. You can get the medications from an approved pharmacy for $160, whereas the same thing in Walmart costs something the common man can afford(like $10). It has happened to me, I got something for $4 in Walmart, while the same medication cost $100 in Walgreens after the co-pay of $20!

What is frightening is, where does this rip off stop?

Does it make older people feign health as long as they can possibly help it rather than get entangled in the quagmire of health care?

As if, the medical healthcare industry has not caused enough heart-ache, they are now becoming creative. Case in point: this lady’s depression treatment was denied because she put up photographs of herself in a bar on her birthday on Facebook!

http://tech.yahoo.com/news/ap/20091123/ap_on_hi_te/cn_canada_facebook_insurance

(which incidentally lends credence to my previous post on Facebook)

Where does this long road lead?

The health reform legislation before Congress contains a little noticed provision that allows an increase in health insurance premiums for those under 65.The idea is that as we age we cost the health care system more, but as  the National Committee to Preserve Social Security and Medicare notes “age is far from an entirely reliable predictor of health care costs, accounting for less than 20% of the variation in costs across age groups. A healthy 55-year-old may well consume fewer health care dollars than a 35-year-old who is obese or has diabetes. ‘’ As the Committee goes on to note:

The current House bill would allow someone 55 or older to pay premiums that are twice as high as a young enrollee (a 2:1 age rating). The Senate agreed to a 3:1 age rating, which would allow premiums to be three times higher for older people. In a recent briefing, Karen Ignagni, head of the American Health Insurance Plans that represents private health insurers, called for a 5:1 age rating. 

  All this raises a new question for the Congress: Will this age based rating system  coupled with a lack of serious public option, end up forcing older Americans to forego expensive insurance altogether.

 This is not just a numbers game. There is both a human and financial toll to be paid. A recent Harvard study published in the American Journal of Public Health found that American adults under 65 who lack health insurance have a 40 percent higher risk of death than those who have coverage. Ailing and uninsured people in their 50s and 60s will likely add to the strain on Medicare’s budget as they seek care for neglected health problems as soon as they become eligible for this entitlement. 

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Rob & MiMi on tour! On the bus!®

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