My ONE (AND ONLY?) Political Post…

If you aren’t in the mood for an old-fashioned political discussion, please stop now – we want you NOT to be mad at us and hope you will keep following our adventure.  I have avoided doing this for over 2 years. But the last 30 days have been particularly ugly and partisan and my tongue is bloody and red from biting it. And Liz has been unsuccessful at talking me off the publishing-ledge. I hope at least some of you will still speak to Liz, even if you write me off. 

I am NOT trying to change anyone’s mind, or accuse anyone who does not agree with me of being a cretin. I think we need to HAVE the discussions that need to take place to find our way out of the problems we face. We have friends and colleagues whom we respect across all of the political spectrum, and somehow we (and by that I mean the broadest possible “we”) have lost the ability to have a thoughtful and solution-oriented discussion while respecting differences in opinion.

And, when did it become “OK” to LIE about – not distort, or bend or exaggerate or simply misstate but actively LIE ABOUT – the facts to SHOUT one’s opinion and to ”Prove” the “other side” are idiots? And, to be clear, I am not taking sides — the lying is performed on both ends of the VERY POLARIZED political spectrum. And repeating others’ lies is still lying…even if we (yep, WE as in YOU AND ME) are doing it unknowingly…We ALL have a duty to fact-check before furthering the misinformation.

Speaking of facts, Can we not AGREE on these as a basis for our discussion: A set of facts (facts are without political orientation) and that there is no “other side.” Let’s talk about “sides” for a moment? There is only OUR SIDE – the USA (and after the USA, the world for which we DO bear some but not total responsibility)! Can we not again engage in calm and thoughtful discussions about the issues that affect us all?

Here is a SCARY Fact: If all the reasonable and thoughtful people bite their tongues and stay away from political discourse, we are left with only the radical non-thinkers discussing AND SETTING policy for us!!

Tell you what, I will START! If you have a thoughtful, respectful, differing opinion, feel free to comment. Or call me. Or invite us to dinner for a face-to-face discussion. I can commit to travelling 1,000 miles (and staying in your driveway) for such a discussion. I MISS THE DISCOURSE, and I like to eat!

So what are the issues (Today, at least) that NEED but somehow CANNOT HAVE rational discussion about solutions? There are many, but we have to start somewhere. How about starting with IMMIGRATION and HEALTHCARE? We can leave others for later, after we have establish we can have constructive, not divisive discourse. Tune me out, if you want, but let’s no longer give audience or weight to strident Twitter and Facebook Posts and Reports that quote “facts” that ostensibly support one side or the other’s righteousness while impugning the other’s.

Meanwhile, real people are being hurt by the lack of action/resolution. We (and I mean again the broadest possible “WE”) need to solve these problems, and we cannot do so if we cannot even discuss them.

So, let me lay out MY VIEWPOINT on these issues. LIBERAL ALERT!!! I am. Generally. But not completely. And I hope those of you who know me will consider that I am NOT a COMPLETE IDIOT (or socialist, which is the same thing to many) and will at least listen to my opinions FOR DISCUSSION PURPOSES. Because ONLY through discussion can we reach consensus. Something we need to model, since our elected representatives have lost their way on this.

And can we for a moment discuss the difference between “Consensus” and “Compromise?” The former means two parties reach a conclusion that both support going forward through full execution. Including tweaks and updates along the way to improve progress towards the consensual goal. The latter means that one party “wins” and the other “loses” (or both lose and hate the result) and will try to undo at their next opportunity. COMPROMISE is not helpful; consensus is the only way forward without lurching backward (or at least in another, contradictory direction) every 4 years.

On Immigration…

I believe STRONGLY the following: We should have VERY LIBERAL Immigration (almost “open”) QUOTAS and efficient administration of them, so that many MANY people LEGALLY come to the USA to be productive members of society. Please don’t misinterpret what I said. I did NOT say “Open Borders.” I do NOT believe in OPEN BORDERS.

I believe that EVERY MEXICAN or HONDURAN or GUATEMALAN or ETHIOPIAN or SYRIAN (or Norwegian…I don’t want to appear bigoted in any way) who wants to escape poverty and violence in their country should be able to follow an easy, legal and fast path to citizenship in the USA. EASY, LEGAL and FAST.

Why are such folks today any different or worse than ALL OF OUR ANCESTORS who came to the USA for the exact same reasons 50 or 100 or 200 years ago? NOTE: I DO realize that a very substantial number of people came here unwillingly. Can we set that discussion aside for a moment? Instead of (or in addition to?) building a wall, we should DEMAND that our politicians increase quotas, while also reforming immigration policies and funding immigration courts and processing administration and vetting to eliminate the years-long backlogs for LEGAL immigration.

I believe EQUALLY STRONGLY that we MUST eliminate ILLEGAL immigration. Listen carefully; this is important to my belief: Not to stop criminals or drugs or social welfare recipients, but so we can WELCOME new citizens and help them gain a foothold as productive members of society.

MANY are refugees fleeing terrible conditions. NONE are familiar with daily life in the USA. THEY NEED HELP. Track them thru the border so we can guide them to jobs and communities in need of new resources. That is what an enlightened society would do! But we can only do this when we have streamlined our LEGAL processes so that people escaping humanitarian disasters in their home country (and poverty and violence are nothing less than that) can move here for a better life. Not waiting for YEARS to be permitted to come.

What would YOU DO if your children were starving and in danger? You would come ILLEGALLY if you could not come legally.  Make it easier to do the latter, so no one feels the need to do the former.

And, let’s be honest – a “WALL” is not the best way to stop illegal immigration – most of which comes from people over-staying legitimate visas. Yep…most illegal immigrants “became” illegal after they were already here! A wall will temporarily stop desperate women and children, but the criminals (all 1% of them…facts on that, below) will still find a way. Career Border Patrol folks can tell us where we need barriers (and what they should look like) and where we need Drones or patrols or ??? Career Immigration Judges can help us create an efficient and FAST processing strategy so that the caravans of “Illegals” can become a stream of new immigrants to enrich our society.

Can we not LISTEN to them (and then fund these) instead of the bloviating Politicians on the best way to do this? Discussing a wall is a distraction from solving the real problem, together, for the benefit of the country and for us all! The Wall discussion is not the solution; some border barriers MAY BE a part of Comprehensive Immigration Reform. LET’S GET ON WITH THAT!!!

What I really DO NOT understand is how anyone in the USA can be opposed to High-volume, LEGAL Immigration. We all came here as immigrants, escaping from the exact same conditions as most of the Caravans of refugees are running from today. Our parents came here to give their children a better life. Worked low-skilled jobs (sometimes more than one) so we could go to school and so on. This is what today’s immigrants also want. Why are we so stingy to offer this gladly?

Note: I refuse to believe it is because the majority of immigrants today are darker-skinned and/or of different religious persuasion than “us.” Call me an optimist in addition to a Liberal (and an idiot).

A few FACTS that inform my opinions, as facts should do. When “facts” (true or not) become arrows flung at one’s opponents, we are in trouble…

— IMMIGRANTS do not commit crimes in excess of the rates for US Citizens (quite the opposite, actually). Immigrants are PEOPLE, and they are good and bad in some proportion as all other people.

2018 Study by Cato Institute (Libertarian orientation…NOT the Liberal Media…) In Texas (a state with some experience with immigrants both legal AND illegal): Per 100,000 people in each category, ALL CRIMES: US Citizens: 1,700 LEGAL Immigrants: 750 ILLEGAL Immigrants: 32. Similar disparity on Murders and on Larceny. 

If you are curious or skeptical, here is a brief abstract on the Cato Institute: “The Cato Institute is a public policy research organization — a think tank — dedicated to the principles of individual liberty, limited government, free markets, and peace. Its scholars and analysts conduct independent, nonpartisan research on a wide range of policy issues.”

From the Journal of Criminology: “Increases in the undocumented immigrant population within states are associated with significant decreases in the prevalence of violence. This set of findings runs contrary to the marginalization and disorganization perspectives.” 

OPINION based on these facts (important to differentiate opinion and not represent it as fact): The key is to efficiently vette potential immigrants—in days not years – to identify as much as possible the bad apples. We will NEVER identify ALL the bad apples because the places these refugees come from don’t have proper record-keeping in many cases. Recognizing that some will slip thru is part of the deal…these will be dealt with by law enforcement just as if they were always here in the USA. We should not be locking the doors, blocking entry for mostly solid and productive potential-citizens in the hope of keeping out a few bad guys. Any more than we should forbid driving cars because there are accidents. Or flying in airplanes because there are crashes. We overlook inevitable negatives – weigh risks and benefits — in all aspects of our lives to embrace the positives.

— IMMIGRANTS do not come here for public assistance. The unemployment rate and welfare rates for immigrants are, with some nuances, LOWER than for US Citizens. Many, if not most, immigrants work 2 or three jobs to feed their family and put a roof over their heads and so their children can have a better life. AS DID OUR IMMIGRANT PARENTS.

Again from the Cato Institute: “Overall, immigrants are less likely to consume welfare benefits and, when they do, they generally consume a lower dollar value of benefits than native-born Americans”

Some end up on welfare – but no more so than US citizens. Remember…it is awfully hard to feed and house a family on minimum wage…MANY working poor (not just immigrants) use some forms of public assistance such as food stamps and Medicaid. Does not mean these folks are burdens on society…it means you cannot make a living wage at low-skill jobs. CAN WE DISCUSS THAT? Some folks on Facebook seem to be concerned about the numbers coming to live on the dole….the facts do not support this, but IF it is a problem or becomes a problem, address this as you would with US citizens on welfare. Welfare reform is another ANOTHER issue that needs to be discussed without histrionics but so far cannot be. Shall we tackle that next, in a reasonable, thoughtful, LOW VOLUME way? I am here; let’s do it!

Furthermore, note that qualified immigrants that are new to the United States are “generally banned” from receiving welfare benefits in their first five years. University of California, Davis Law School Dean and immigration expert Kevin Johnson said immigrants cannot be over consuming public benefits because they are not eligible to receive the benefits in the first place. Here is a link that discussed this eligibility:

— IMMIGRANTS do not “Steal” US Jobs.   Here is an interesting article:   Our economy is strong and employment is NEARLY COMPLETE. Unskilled, and in some cases low-level, minimum wage jobs are begging for workers across many industries. Restaurants can’t find cooks – we actually tried to go to a local Diner/breakfast place on our travels, only to find it was CLOSED FOR BREAKFAST because they could not get a cook for that shift. Agricultural workers are scarce. Truck Drivers are so difficult to find that freight costs are becoming a significant challenge across many industries. I just saw a TV News Report in Phoenix about how schools are severely impacted by a shortage of bus drivers. Immigrants have always filled these positions, requiring limited education and experience as they are getting established.

Our economy needs MORE such workers; indeed is negatively impacted by lack of them. Immigrants represent a pipeline of people who will fill these critical positions.

— We NEED a shot of young, working-age people to help SAVE SOCIAL SECURITY. Or at least prolong its demise until politicians can tackle THAT issue in the peaceful, consensual process that needs to happen before we tear ourselves apart.

Here is an interesting article: 

There is no escaping the demographic changes that imperil this critical (to many CURRENT US CITIZENS) entitlement. No amount of political rhetoric about spending or deficits or entitlement reform can change this demographic imperative. As the numbers of Social Security RECEIVERS grow and CONTRIBUTORS shrink, the trouble is obvious. And let’s put Medicare into that same Demographic Peril. Too many old folks needing services and fewer and fewer young ones paying for it.

A shot of new workers, with 40-year careers (tax-paying careers!!) ahead of them is EXACTLY (part of) what we need.

And, the final facts: The Democrats previously supported strong borders including many barrier improvements, but now cannot do so because the other guy wants it. The Other guy, despite the fact that his many properties employ illegal immigrants in significant quantities because American Citizens will not do those jobs, sez we need a wall to prevent the significant numbers, who are ALL rapists and murderers (which they are NOT), from pouring across our southern border.

Which just demonstrates that there are no facts at all involved in the divisiveness of this issue.

On Healthcare…

I believe that Healthcare must be available for all. It seems that everyone believes this – at least few dare to say some do not deserve healthcare. The question, if we all agree that everyone deserves it, is: How to deliver it efficiently and cost-effectively, in a way that everyone gets it and can afford it?

Our current insurance system is badly broken. The political discussions around what to do are more about hating on what the other party wants to do. No one is discussing the specifics of how to cover EVERYONE so they can see a doctor regularly when they are well, and get what care they need when they are sick.

That we NEED to do this can be illustrated by discussing how DIABETES is managed in our society today. This disease has huge quality of life and COST OF CARE implications in its end stages. It can be managed in “pre-diabetes” stages in inexpensive, life-improving ways. If one does not have insurance in today’s world, one goes to the emergency room (which MUST treat you) to EXPENSIVELY address chronic and medically catastrophic symptoms. If one does not have insurance, one never sees a Family Doctor or Medical Paraprofessional for dietary management and other proactive diabetes management strategies.

Let’s be clear and restate this: We as a society are ALREADY PAYING at HUGE COST in Emergency Rooms for medically uninsured folks (many of whom look just like Dan and Liz) to get end-of-life treatment. And for Group Health Insurance through Small and Large Businesses. And through Obamacare for everyone else. Can we better apply those dollars already being spent? THAT is the discussion we should be having.

I personally believe (an OPINION in search of a discussion!) that the only logical solution is a single-payer solution where everyone is “covered.” PLEASE DON’T STOP READING YET….I am not a socialist or a pervert (which is redundant to some, I know).

Some would call this “Medicare for all” but to others that sounds like government overreach approaching socialism. I am going to say “Medicare for all” or MFA because it will make this post shorter. I simply struggle to find alternatives, but would LOVE a discussion about options. Why would a private insurer cover pre-existing conditions? Why would a healthy 26-year old buy hugely expensive insurance? How can small businesses continue to provide increasingly cost-prohibitive health insurance for their employees? Why should we wait in line to get a non-critical procedure done? Why do people go to the emergency room for their basic health care?

In our divisive world, If the discussion turns to “Medicare for all” or “single-payer” solutions, the cries of socialism, and WHO WILL PAY get even louder. So, how to unpack the issues and separate them from the misrepresentations and divisiveness that enters this discussion.  AND, at the same time, how to separate resistance to universal healthcare from the proprietary commercial interest of health insurance companies.

Without discussion, no improvement will ever be made, and healthcare costs will increase in raw terms and as a percentage of GDP until we are spending 50% or more of every dollar on it. Especially since we are aging as a society – requiring MORE healthcare.

In discussing “Who will pay” for a mandated, single payer solution (i.e. Medicare For All — MFA), we all need to rachet-down the rhetoric and do the work on analysis. No one is proposing ADDING MFA ON TOP OF all existing government and private healthcare expenditures.

A single-payer system could ELIMINATE group policies paid by business (at the costs of many hundreds or thousands per employee/family) and replace these premiums already weighing on businesses with an employment tax. I know as a former small business owner that PRIVATE health care insurance was my single largest payroll expense after salaries. Would I exchange this premium for a new payroll tax? Dollar for Dollar? More? Less? How can I know? I am not sure if this is a net-zero exchange – and no one is doing that calculation or even discussing it.

There is just a hue and cry about 32 TRILLION dollars of cost to MFA. NO discussion about the costs this would replace. It is the NET COST that I want to know!

I suspect MFA could SAVE MONEY net-net, because there are no PROFITS baked into the MEDICARE insurance market. I know all the arguments about the inefficiency of government programs – but efficiency can be audited and improved. And, it may surprise many people to learn that, objectively measured, Medicare has a FAR LOWER administrative overhead than Private Insurers.

You can look it up (I did…see below).

A system based on scraping profits off the top so Private Insurance Companies can produce Shareholder value automatically diverts money FROM healthcare TO shareholders. And private insurers are incentivized to maximize profit and shareholder value…NOT to improve healthcare outcomes. So, it seems to me that MFA is the answer because it sends most dollars to healthcare, and is incentivized to optimize medical care for its constituents – the citizen-voters. WE are the shareholders for whom value would be produced.

But OF COURSE we need to be EVER VIGILENT about government waste and largesse. PLEASE, let’s discuss!!!

People want “choice” in their healthcare, and offer this as opposition to MFA. But we DON’T HAVE IT NOW. If you (or your employer) can pay, you have SOME choice. BTW, if you are already ON Medicare, you actually have a LOT MORE CHOICE. But most choices are already made by the insurance companies. Who is in your PPO? What Drugs will be covered? Which Specialist can you see? And costs are “controlled” by them. (NOT – see below).

All single-payer systems in the world are reputed to have queues and “death committees” who decide who gets healthcare and when. Stories are common about people who wait for years for Cardiac Bypass and other life-saving treatment. Does anyone really think that our system does not have people waiting, too, for the same procedures? In our case, it is because people do not have insurance, or their insurance will not cover these “pre-existing” issues. Or their chosen specialist is busy…when I had my hips replaced, I had to wait 6 months for an appointment with my chosen specialist.

The facts are that allocation of a valuable resource MUST include prioritization. Sickest get taken care of first. Less critical get in line. Everyone gets to see a doctor regularly — to STAY HEALTHY.  You can ask our friends in Canada and Australia how this works (and it DOES work). I have asked. At length. MANY MANY discussions with rational, conservative AND liberal friends in places with different sorts of healthcare systems.

No one in these places claim their healthcare systems are perfect, but I also hear that the baseline coverage “for everyone” is important for a modern society to offer. The single-payer systems in those and other countries “put back” choice for the consumer in the form of additional “private” or “supplemental” insurance options. Or simply pay-as-you-go with private clinics. If you can pay, you can jump the queue. My personal opinion: that is how it SHOULD WORK. Get in line based on critical-ness for base coverage that is a human right; if you can afford more, that is your choice in a free and capitalist society.

One thing I do not understand: Many people I have met (not an objective sample, I know) who seem to oppose the “Single Payer” system are older and retired. Maybe that is because RVers in general are older? Anyway, many are already on Medicare. Or they are veterans in the VA system. Liz and I are an RV community minority trying to manage our healthcare pre-Medicare. RVers seem to like their situation (for the most part) even as many lambast Obamacare and MFA. The cynic in me would say these folks belong to a nice club, and they don’t want the rest of us to be allowed in!

To me, It is simple, really. Medicare Works. Not without issues, so make it available to everyone and WORK THE ISSUES. SHOUTING at each other while we in the meantime have nothing is just idiotic.

As a household, if you hope to economize and live within your means, you focus HEAVILY on efficiency of your largest costs. Let’s DEMAND that our selected representatives do this for us in a thoughtful way. No more catch phrases or 30 second sound bites about how bad the other guy’s proposals are.

To the Politicians: Liz and I NEED HEALTHCARE OPTIONS. Make it so…it is what we pay You to to!!!

PLEASE. Let’s discuss!

The facts (from credible, non-partisan sources) that inform my beliefs are as follows:

–US Health Care Spending is already the single largest portion of the GDP. That is, we spend more on Healthcare than on Cars, food, energy, the military…the Wall…whatever! It is more than ANY OTHER COUNTRY, including many with single payer systems AND better Health care Outcomes, objectively measured.

The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. … U.S. health care spending grew 3.9 percent in 2017, reaching $3.5 trillion or $10,739 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 17.9 percent. As a reference point, the U.K. spends 9.9% of THEIR GDP in a Single-Payer System. US Healthcare Spending is growing at 10% per annum. Defense spending in 2017 was $590M or 3.1%. Foreign Aid (the elimination of which is often proposed as a way to fund Healthcare or Social Security or ???) is 0.18% of the GDP so IN NO WAY could be used to pay for healthcare.

We are NOT getting our Money’s worth. In comparison to other western economies, US Citizens pay the MOST BY FAR (in raw dollars, of course, but more important as a % of GDP) for their health care, and achieve outcomes (objectively measured) that are squarely middle of the pack. So, competitively speaking, even if you can afford insurance you are NOT getting our money’s worth.

There are lot’s of sources for volumes of data on this. Here is an interesting summary:  Here are some of the conclusions presented:

• The U.S. has the highest rate of deaths amenable to health care among comparable countries, “Amenable to health care” refers to diagnoses like Diabetes, High Blood Pressure, obesity, etc.
• Potential Years of Life Lost have fallen steadily in the U.S. and in comparable countries
• Disease burden is higher in the U.S. than in comparable countries. (Total years lost to disability or premature death)
• Hospital admissions for preventable diseases are more frequent in the U.S. than in comparable countriesAnd MANY MANY MORE metrics.

The Insurance Industry, consisting of multiple Fortune 100 Companies, is immensely profitable, despite providing no health care services or products to the insured. Please RE-READ that last statement. They are middle-men, scraping their administrative overhead, salaries and profit off the premiums paid by consumers, before compensation to providers. Here are Health Insurance Companies whose gross revenue puts them in the upper tier of the Fortune 100:  

In 2017, United Healthcare was #5 in the Fortune 100 ($157B in revenue); Anthem #33 ($79B); Aetna #46 ($60B); Humana #52 ($54B). United Healthcare forecast earnings per share in 2019 of at least $14.40/share for 2019. 968M shares outstanding, so AT LEAST $13.9B PROFIT.

What % of this revenue actually pays for healthcare vs. Salaries and shareholder value/profit? Asking that question does not make me a socialist.  Someone with an accounting degree could go through their SEC filings to learn about administrative overhead (i.e. salaries and expenses) associated with receiving premiums and paying providers. Let’s ASSUME it is equal to Profit (and I am SURE that is low). This would mean AT LEAST $28B of UHC Revenue (insurance premiums) is not paying for healthcare. That is just ONE COMPANY – I listed several in the Fortune 100! An interesting note: MEDICARE’s Administrative costs are estimated to be 2%. PRIVATE Insurance Administrative Costs are estimated to be 17%. Here is a GREAT summary of this: . (Data from Congressional OMB and other objective sources).

The cost of EVERYTHING related to healthcare is high and increasing at rates that are many times inflation. This is despite the “competition” that private insurance is supposed to bake into the costs paid for things. Note that costs negotiated by Medicare are WAY LOWER than for Privately Insured. That bears restating: MEDICARE does a MUCH BETTER JOB of negotiating prices for medical care and products than private insurance.

Do I need data for this? Cost of Pharmaceuticals leads this list, but if you have ever examined a hospital bill, you know EXACTLY what this is. Still, looking at Pharmaceuticals may be instructive if one gets past the well-publicized stupidly-expensive products and obvious cases of consumer price gouging. Here is a super-interesting article from the American Hospital Association: 

Until “Obamacare,” Health Insurers were allowed to exclude “pre-existing Conditions” from individual policies. Those covered on group policies through their employers were often not restricted in this way, but many people do not obtain health insurance through their employers. I know this – Liz and I both fell into (and fall into) the “Pre-existing Conditions” bucket. Before Obamacare, we both had nerve-wracking gaps in our coverage because of these carve-outs, despite having VERY EXPENSIVE individual coverage. Obamacare required insurers to eliminate pre-existing exclusion, in exchange for which, Obamacare MANDATED that everyone have insurance.

For sick people to get coverage, healthy people have to also pay premiums. Because that is, in a large part, how insurance works! Similarly, men pay for maternity benefits and women pay for prostate health. The marketplace breaks down if healthy people are allowed to “opt out” until they are sick or if people are allowed to opt out of specialized coverages that they may not specifically need (until they need them).

Insurance is simply NOT a pay-as-you-go proposition; You cannot buy car insurance AFTER you wreck your car or Homeowner’s Insurance after a fire!!

PLEASE NOTE: I am not defending Obamacare as “The Answer.” It was a start. It is at present a car-wreck. This is due in large part to continuous undermining from all sides. But it DOES cover Liz and me, despite our pre-existing conditions, and at a rate lower than our previous individual policies. We are grateful for the imperfect Obamacare scenario. THOSE ARE FACTS.

Please remember, it was from the beginning a political compromise (not consensus) based on an important premise: That everyone should have and be able to afford health care. UNIVERSALLY. This premise, BTW, was long ago proposed by the Republicans. UNDER NIXON. It has since become a political football, set upon from all sides like a Rugby Scrum…to the detriment of the REAL PEOPLE WHO RELY UPON IT! Trust me, I know this – I am one of them!

I will restate my belief, which is neither liberal or conservative: a Civilized Society (are we?) needs to take care of ALL of its members. That includes a base-level of health care…it is not an “entitlement,” it is a basic HUMAN RIGHT. For a very large segment of our society, we are not providing this; just shouting political buzz-words and epithets at each other. What is the matter with us?