DOT: Taxpayers pay into a highly necessary component of any state or federal government- the Department of Transportation. No one would deny that we need roads, construction workers, signage, highways, bridges, paths, drainage, grading, traffic control lights and other infrastructure requirements I couldn't even identify related to streets and highways, but we are unable to determine a method for overturning the nature of this little known black hole:
PREVAILING WAGE:
Prevailing wage: I had never heard of this issue until a local television station included a special report in its 10 o’clock news program one night. (See Part II-Prevailing Wage In Need of Fix?” by Rick Kupchella, May 5, 2008- http://www.kare11.com/news/investigative/extras/extras_article.aspx?storyid=509683.) Apparently Part 1 of the prevailing wage story is about as popular as Gary Glitter’s “Rock and Roll Part 1” because I can find no indication on the internet that the prevailing wage story part 1 exists. This is not true of Glitter’s forerunner (part 1) to his hockey anthem masterpiece (part 2) that’s only lyric is the word “hey”. Thankfully, Kupchella’s on camera reporting artistry is much more substantial. Briefly (who am I kidding) . . . basically- the prevailing wage is a wage that construction workers are paid for their labor based on a set of licensing predictors that not even those managing the industry understand. If issues such as immigration, campaign finance, taxation, and the health care and insurance industries, etc. weren’t so Dickensian in terms of dysfunction, the issues comprising the prevailing wage mess would be the Jarndyce and Jarndyce of issues. I’ll explain Jarndyce v. Jarndyce eventually. For now, consider the information that Kupchella presented:
1) Chris Duininck is a road builder whose company bid $10.8 million to complete a 12-mile stretch of road. The bid “was loaded with extra pay for workers that was mandated by the state.” In other words, the bid would have been substantially lower than $10.8 million had the state not escalated the price.
2) The workers Duininck used were the same as used in other Midwestern states.
3) The amount of labor charged to the MN taxpayer for just that one road construction job amounted to $810,167. Imagine that amount dramatically increased by the construction of office complexes, strip malls, government works buildings, libraries, post offices, houses, public streets and a series of road jobs dozens of times larger. Imagine how much tax money is lost to the issue of misunderstood prevailing wage laws. When you think of it, $810k+ doesn't actually sound that bad a price on labor. It costs a person $90 for a service call from a air conditioning installation company that installed the unit not two years previous. The technician had no knowledge of the customer having a warranty. I know because the technician from Metro Air had that amount indicated on the invoice before I came up with the warranty information which enabled me to avoid the charges. Necessary costs see. A 2-year-old air conditioning unit, that I paid over $1,800 for breaking down and the company responsible for installing it wanted to absolve themselves of all responsibility. But I digress . . .
4) Throughout the Minnesota metropolitan area a man holding a “stop and go” sign is paid $37.49/hour but the market rate is $23.06/hour.
5) Many people in the business told Kupchella that the “labor unions have been particularly effective in helping keep these wages artificially high.” Unions receive abundant compensation for these services, because union members pay dues which fund this brand of underhandedness. Unions act nearly like the Federal Reserve in their capacity to conflict the public in terms of the benevolence v. complicit intent to defraud Americans. I paid union dues for nine years as a member of the United Food & Commercial Workers Union. I don’t know how much I ended up paying in over the course of my tenure in dues. What I do know is that I saw people steal from the company and continually abuse time-off policies and through the union they continually retained their jobs. On the other hand, I have seen my wife’s wages as a registered nurse remain high, whether that is attributable to the duties of a union is a matter of debate. I am told that the nurse's union in Minnesota is pretty good. So, just like everthing else, there is some good and some bad. Overall, if a union were to flip a coin representing your dependence on them the result may be communicated by them thusly, by the shop steward of course- “Heads I win, tails you lose.”
6) “The prevailing wage sets a ‘floor’- a minimum wage”- so the cost to the taxpayer for each construction job, whatever the type, becomes much more expensive if one considers the number of experienced workers tasked with the job of laying tar or installing a metal door and is different depending on the county or state in which the construction is taking place.
7) Misclassification of workers. “Those who are trained for and work in one job classification . . . are, for the purposes of the state prevailing wage program, put in a completely different, sometimes more expensive, job class.” The state sometimes “orders contractors to pay the ‘carpenters’ as if they were ‘ironworkers,’ effectively giving them another, very large raise.”
8) The state (MN) “sets pay rates for some 4,500 different job grades- [but] does not have a definition for any of them.” I know this is trite and overused, but if we put a man on the moon almost forty years ago, perhaps it is time to classify the tasks of some 4,500 jobs in order to pay workers for their contributions and not cost taxpayers more than is necessary by an amount of money that could probably colonize the moon today. Seriously, some defenses in all-star games participate with less apathy than those responsible for the continued fleecing of the Minnesota taxpayer on the issue of prevailing wage.
9) A third generation builder is quoted in the story as saying- “A new person hired as a general laborer, with no prior construction experience” was “described as something of a glorified gopher. One of his duties was to pick up and deliver rebar to ironworkers on the same job site. Because the man wrote ‘rebar’ on a timecard, the state ordered that the man be classified as an ironworker . . . The state currently lists the rate to be paid to ironworkers in Detroit Lakes [MN] at $52.22/hour” perhaps double what a new worker might receive. My wife works in the obstetrics (baby delivery) unit of a hospital. More often than not, she monitors the vital signs and attends to mothers who are fighting against delivering their children pre-term due to various complications. One woman was in the hospital more than two months and began to develop pain local to one of her teeth, which was recommended for removal while she was still on bed rest in the hospital. My wife attended to the needs of the patient, given a certain rapport she had established with the patient throughout her pre-term stay. If my wife’s attentions paid during the removal of the tooth could somehow be considered in line with a rebar delivery person receiving the pay of an ironworker, perhaps she could receive compensation along the lines of a dental assistant.
We are in a fairly modern age where we need to track how our natural resources are maintained, how our income is measured against our debt and how the various government agencies or state governments contracting with businesses building our infrastructures spend our money. If we never make those in power accountable for the decisions they make, the actions they take or the inaction they can continue to justify in lieu of action, from deciding not to extend the Bush tax cuts to negotiating suitable compensation for services rendered on road construction or bridge replacement jobs, we will always be wondering where our tax money goes. Again, who guards the guards? “Increasing the carpenter’s pay from the state-mandated wage of $33.75/hour to an ironworkers pay of $52.22/hour—can really add up.” I would think so.
10) Employment lawyer Doug Seaton says, “there’s no way to measure the exact cost to taxpayers. But in a deposition on this case, a MNDOT [Minnesota Department of Transportation] compliance officer said they had found problems—one on side or another [sic] in 90% of prevailing wage jobs.” If we wanted to “measure the exact cost to taxpayers,” we could. We could employ and impanel an independent governing body. They would likely make up their salary with their findings of exorbitantly paid state infrastructure workers a hundred times over and though this would increase the size of government, it would reduce the probability of misallocated taxes and in turn reduce the amount of justifiable taxes period. Such an agency, like those I have already recommended to be put in place on the state and federal government levels to investigate the enumerated and total government waste born by taxpayers is more necessary than a partner in the synchronized swimming event at the Olympics. With that, they would pay for their salaries no fewer than twenty times over in a given year because we would not need twenty judges to rule on the wastefulness of a project given that they are adequately versed in the principles of reasonable needs of the city, county, state and country. There is no need to qualify the demerits of a government made larger as long as the services they provide equate to a monetary savings to all taxpayers.
11) Former “legislator and speaker of the Minnesota House of Representatives for decades” Steve Sviggum “fought the prevailing wage laws in Minnesota.” Now he works on the other side trying to maintain the ambiguous and vague nature of the prevailing wage laws because it benefits the labor unions. He is now commissioner of the Department of Labor and Industry and agreed, “that the issue of defining job classifications is something that sits squarely within the Department of Labor.” A labor union spokesman refused to believe that the labor unions benefit from vagueness. My good sir, most government agencies do and benefit quite a bit when Mr. and Mrs. Taxpayer go about their lives without asking gatekeepers who is watching them. Again, quis custodiet ipsos custodes (who guards the guards- see part 31).
I am not attempting to remove earned money from the wallets of any skilled infrastructure craftsman who may work harder at their job than I do at mine. I know a few guys that perform very valuable services to customers and work quite well with their hands, but what is fair is fair. However, I hope there is a special hell-annex for contractors and state and federal infrastructure workers who abuse the system, that must in turn be delayed in the purgatory of afterlife, which they have all of their employed lives, subjected their clients to. St. Peter, it is to be hoped, has a sense of irony.
The below notes and information can be found at:
http://www.auditor.leg.state.mn.us/ped/2007/prevailingwagessum.htm
Although the Department of Labor and Industry calculates most prevailing wage rates in accordance with state laws and rules, the department has incorrectly set some rates due to computer programming and other errors.
Minnesota has an acceptable program for enforcing the state’s prevailing wage law on state-funded highway projects, but there is confusion over the responsibility for enforcing the law on other projects. (For a set of people who speak the same language, at least up until the present time- meaning P.A.- pre-amnesty, this is no excuse.)
Research does not provide a clear answer about how prevailing wage laws affect public construction costs or construction quality. (Ah, if you are paying a worker twice as much as the national average and employing 20 workers to perform those duties, couldn’t you use a calculator, an abacus, do some math in the miles of roads that can remain unpaved for any number of days that are littered with dirt, dust and sand and on which your workers tread on a daily basis? Here, let me get you a stick. My 22-month old girl is more capable of fixing herself a meal than those who seem apathetic toward the regulation of prevailing wage laws and she cannot reach the microwave, open the refrigerator or work the security latch on the pantry.)
Except for state highway projects, Minnesota lacks a prevailing wage enforcement program. Here is how you can fix that . . . get one!
Jarndyce v. Jarndyce:
Jarndyce and Jarndyce: This was a fictional chancery court case which was used as a major plot element concerning the central characters in Charles Dickens' novel “Bleak House”. From the Wikipedia entry (http://en.wikipedia.org/wiki/Jarndyce_and_Jarndyce):
“The case concerns the fate of a large inheritance, but has dragged on for many generations prior to the action of the novel, so that, by the time it is resolved late in the narrative, legal costs have devoured nearly the entire estate. The case is thus a byword for an interminable legal proceeding. Dickens used it to attack the chancery court system as being near totally worthless, as any "honourable man among its [Chancery's] practitioners" says, ‘Suffer any wrong that can be done you rather than come here!’ ” The same might be said to an American citizen with certain expectations of their government.
The same could pretty much be said for any attempt at issue resolution in this country- the negotiations, consensus-building, attempts at compromise, ego-massaging, decision-making and waste of taxpayer money, etc. is interminable. This interminable nature of issue debate, which still takes a back seat to TMZ-related factoids and candidate personality conflicts during election time in terms of wasted opportunities, builds for America an incessantly strife-ridden, over-budgeted, divided, Bleak House. I would concede that the interminableness of something else could also be metaphorically compared to the case of Jarndyce and Jarndyce . . . the overall length of this blog topic. Touche, if you considered that before having read the previous sentence.
HEALTH CARE:
Health Care: I will have to take up much less space revealing this issue than if I hadn’t read both Nader’s- “The Good Fight” who addresses some health care concerns on (pgs 205-213) and Dobbs’ chapter on health care, to be found in “War on the Middle Class” (pgs. 157-172). I could spend multiple posts commenting on medical malpractice and immigration’s affect on health care costs (see part 26 for the immigration component), the push and potential cost to taxpayers, for digital medical record keeping across the country, the uninsured’s and under insured’s affect on the average cost of health care, and how Welfare affects the sub-topic, among a host of other related pieces of information. But I think I can communicate enough on the sub-topic by simply using the rest of this post . . . go figure.
“Parents” magazine: See the August 2008 article written by Janna Oberdorf (pgs. 44 and 46). “There has been a 78% increase in the cost of health-insurance premiums since 2001.”
- “The amount that insurance companies reimburse the average family physician has gone down . . . so to make a decent living, a family doctor has to cram more patients into his schedule.” Oberdorf writes here about the insurance companies not being willing to pay for the time a doctor might spend discussing smoking, diet or exercise with a patient. Largely, unless someone has just had a heart attack or cannot breathe because of the smoke in their lungs- a patient is not going to listen to a doctor about trimming back their caloric intake or curbing their smoking. So, I can’t blame the insurance company there. One city in California (see “L.A. Oks Moratorium on Fast-Food Restaurants” Associated Press, July 29, 2008- http://www.msnbc.msn.com/id/25896233/) believes it can influence the eating habits of its citizens. I imagine that the people will just continue to eat at the unhealthy and more moderately-priced fast food restaurants in their own city or travel to a neighboring city which features a new Fat-Asses-‘R-Us type option.
- “Kids get sick: They get the flu and strep throat and other contagious illnesses. If a child isn’t treated, he’s not the only one at risk—so are healthy kids who share the classroom or ride the bus with him . . . When uninsured kids need to see a doctor, they often have no other option than to go to the E.R., where they receive very expensive care—more expensive than a regular office visit. That cost is passed on to insured families through premium increases and taxes. We spend more than $35 billion every year to cover these costs. And if our emergency rooms are treating kids who have less-critical illnesses, they have less time and fewer resources to handle true emergencies.” (Health insurance companies are aware of a recently discovered phenomenon called germs- yes/no? Have politicians been made aware of this hazard? See, because then other children would then presumably be on the hook to be scheduled for an appointment to the doctor’s office- which then would necessitate a co-pay, perhaps the acquiring of a prescription for medicine that the afflicted would not need to pay for if the communicable illness were treated in the few uninsured. I don’t want to get all conspiracy-theoried out, but this "lack of insurance deal" would then benefit the doctors, the insurance companies and the drug companies- not a bad hi-jinx, but of course- completely out of the realm of possibility.)
“Ultimately, Who’s Going to Get Stuck with the Bill”: (See the Minneapolis Star Tribune Opinion Exchange section OP pg. 1 and 5, by Jill Burcum, May 18, 2008 a Q&A exchange with Bruce J. Rueben, the president of the Minnesota Hospital Association. The article’s main focus concerns the fact that hospitals struggle to make up for lost revenue due to medical debt and how serious the problem is perceived to be in Minnesota. Rueben identifies MN as a state with not as many uninsured citizens as many other states.) The three Minnesota health care supplement options- Medicare, Medicaid and Minnesota Care (the equivalent of CalWorks- see part 32, “pay hospitals less than the cost of providing care. So, there is a lot of pressure on private insurance to cover the costs of under funded care. As a result premiums grow . . . you’ve got companies not necessarily dropping their coverage, but dropping the amount of services they will cover or adding costs for employees.”
Rueben also contributed these health care cost related nuggets: 1) “a bigger and bigger share of bad debt is from people with insurance, but who are unable to pay the out-of-pocket expenses.” 2) “the rising cost of health care is contributing to the rising amount of bad debt.” 3) “every time the state and federal government decide they’re going to pay hospitals less for delivering services to public-program recipients, [those receiving Medicare, Medicaid or Minnesota Care benefits] those costs don’t disappear [it] ends up in the bill.” 4) “Minnesota hospitals lost $1.3 billion due to underpayment by Medicare and Medicaid.” (No one can assume that the hospitals or the insurance companies are willing to incur all of those costs. It would be interesting to know how those overage costs are shared by the hospitals, the insurance companies and those with health insurance plans. As one Minneapolis Star Tribune letter-to-the-editor writer queries- will we soon need to tap into our retirement accounts or take out a home equity loan in order to afford health care coverage?
Compensation reform policies: This editorial “A Healthy Focus on Compensation Reform” can be found in the Opinion Exchange pages of the paper (from December 30, 2007). This is exactly what I am looking for from an accountability standpoint from all of the industries responsible for providing us with the economic issues for which we most need resolutions so that the middle class can stop what is a continual financial blood-letting. Here are the facts as represented:
1) former UnitedHealth Group CEO William McGuire initially obtained a $1.3 billion stock option and retirement pay settlement upon his departure from UnitedHealth (I am adding the $420 million in stock-option gains and retirement pay he forfeited to the $874 million the courts have frozen);
2) McGuire had backdated stock options (I have no idea what that means but would probably feel less disgusted about finding out than attempting to figure on the diet of an Amur tiger based on its scat using only broken used popsicle sticks and pleated sandwich bags. Note- this use of the word “scat” should not be confused with a British or German card game (Skat) or said tiger’s ability to vocally shadow, or riff, alongside Jazz music. Look up scatological . . . bleck- the short form of which, in the zoological groupie world is scat);
3) UnitedHealth hired an independent counsel “to look into the company’s stock option practices” (good idea). “The company has taken several steps to improve transparency and strengthen accountability”;
4) “The company has set up a representative committee which includes institutional investors and member of the medical community to provide advice on nominations for new board members. “The company also has changed its approach to executive compensation” (good) as the employment contract of McGuire’s successor is without target bonuses and stock option guarantees, “although the board may decide to reward him with them later” (not as good);
5) Risk Metrics Group “assesses the policies companies have in place to protect shareholders and keep executives accountable” and gives ratings on corporate governance policies.” (As Frank [Peter Boyle], from “Everybody Loves Raymond” would say- “Holy Crap!” This is news and perhaps too good to be true. While it is a start- it won’t be nearly enough from an accountability standpoint until meaningful fines are assessed and paid by corporations that violate lawful committee declarations of a corporation’s exorbitant financial excesses that continue to put the average middle class citizens net pay in jeopardy. Can we see some progress there?) Keep in mind- “workers are paying more in premiums, co-payments and deductibles, and public programs such as Medicaid are among the fastest growing items in the state budgets. ‘All of these combined create an increase in the number of uninsured,’ ” said Ron Pollack, executive director of Families USA. And those concerns are for people that do not have to buy their own health insurance. Anyone looked into having to do that lately? My wife and I switched to her insurance because of the lovely co-insurance option that was positively introduced into my company’s “benefit” plan three years ago.
Health insurance premiums: “Michigan health insurance premiums increased 66.4 percent between 2000 and 2006, while median incomes grew 7.7 percent, making Michigan second worst in the nation.” See The Detroit News, April 5, 2007 article by Kim Kozlowski (key in the title- “Health Care Costs Hitting Middle Class.” (See- premiums would be tied to out of pocket expenses, which would equate to the average middle class taxpayer needing to devote more money to the necessary cost of health care and as you’ve just read, the cost of living increases are not matching that cost alone. Perhaps there is some merit to a lame-brain’s contention that the middle class will be in some form of economic despair in the next generation; convincing Mr. republican of that would be more difficult than telling a Burmese python it suffers from scurvy, or at least from a prolapsed mitral valve, and that it might want to eat that next rat with a lime chaser).
National Coalition on Health Care:
“In 2007, total national health expenditures were expected to rise 6.9 percent –two times the rate of inflation.”
Total spending, in 2007, was 2.3 trillion; about half of what it is estimated to be just 8 years from now.
“In 2007, employer health insurance premiums increased by 6.1 percent—two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,100.”
“Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud.” The good news though, is that the factors, which have been identified in the previous sentence, as being the causes for the annual increases, are not necessarily in order. I took the liberty of severely increasing the size of the word "experts" above because my republican Echo Narcissistic counterpart, who interviews economists that maintain that all is well, claims they are experts. I guess I get a touche for that one.
Alan Shore wannabes/democrats- those of you who would like to redirect the attention of how much we spend on health care should know that we spend four times less on national defense. “The United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens.” Hold on, the quality of that health care is debatable. That is the good news, because as you know, we have to start thinning the American herd some way. (Psst- I am only setting up a bigger “good” news joke later on- be patient . . . admittedly, a strange thing to write to no one in a column about health care. Note: Alan Shore is played by James Spader on Boston Legal, a noted, though cooky, liberal- believe it or not, those two terms are not as synonymous as experience has led you to believe.)
Arnie Becker wannabes/Republicans- who think that the limits placed on personal bankruptcy filings was a good thing, who considered that only those who overextended their credit cards and/or were parties to the accepting of dangerous sub-prime mortgage interest rates were to blame for their own financial condition, should be made aware that Harvard University researchers “noted that 68 percent of those who filed for bankruptcy [in 2007] had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.” (Note: Arnie Becker was played by Corbin Bernsen in the 1980s television drama “L.A. Law.” Becker was a noted, though fiendish conservative fictional attorney that bears no resemblance to at least 50% of practicing conservative attorneys in terms of dress, diction, antics, attitude, and/or god-complex derivation.)
I could go on: There are facts, figures, percentages, decimals, and fractions galore at these two locations. If you want this version of the very striking truth- please see: http://www.nchc.org/facts/cost.html which falls under the heading- “Health Insurance Costs”. I will use just two pieces of information from the companion article from the same entity (National Coalition on Health Care) - which fall under the broad heading “Health Insurance Coverage” please see: http://www.nchc.org/facts/coverage.html. These two pieces would be- “Nearly 47 million Americans, or 16 percent of the population, were without health insurance in 2005” and “The large majority of the uninsured (80 percent) are native or naturalized citizens.” If my math is correct, and this is the good news, that leaves only 20 percent of uninsured citizens who are illegal immigrants or legal immigrants who have not yet become naturalized. 20 friggin percent! That . . . is great news! I opted to leave out important pieces of information for the sake of saving space- things like “The percentage of people . . . with employment-based health insurance has dropped from 70 percent in 1987 to 59 percent in 2006” and things like “Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more. A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.”* Yes, I won’t even reveal things like that. Some employers may have long ago decided to continue to offer coverage but someone, in their largesse, has also decided to spend a lot of money on foliage to make a work campus pretty, excessively pretty. I am speculating, but it seems as if some suits, or on-staff horticulturists with a large budget, considers plants- the way high school fashionistas treat wardrobes. While a highschooler could no longer subject themselves to the wearing of a certain pair of jeans, apparently a certain breed of shrubbery is considered passé if it has been left in the ground for more than a year. This necessitates its removal and replacement. Just innocently wondering how much has been spent on these types of landscaping decisions, which monies might be better directed toward health insurance coverage for employees. A clouded leopard diagnosed with a learning disability would have a better chance of squeezing lemonade from a turnip than a rational member of the human race could justify why a company would waste so much money on Salvia. What is the plural of Salvia anyway?
Digital age: “Getting Doctors to go Digital” Minneapolis Star Tribune editorial, Opinion Exchange section (AA4), September 30, 2007. “A 2005 study by RAND Corp. suggests that Americans waste at least $100 billion per year in duplicated medical tests, bad prescriptions and other waste—not to mention errors and missed diagnoses—because most doctors and nurses lack quick access to accurate medical records.” My good republican friends- all is well? Perhaps a member of the medical industry could key into the computer the fact that I am allergic to aspirin and penicillin and that when I was a child I broke out in hives when thus exposed- (they usually ask what the effect of my having been in contact of those two rather major elixirs used to be). I am asked the same questions every time I visit the doctor, which is about once every year or two. Imagine the time that could be saved, if these people actually keyed in and saved the answers into a computer. Apparently, before the advent of electronic medical records, the pens they have been employing for the past twenty-five years have been writing in invisible ink. Allina hospitals have gone digital and “expect[s] to recoup its $250 million investment within four or five years by practicing better, more efficient medicine . . . an ER physician was about to order a battery of tests for a young woman admitted with abdominal pain, when he noticed she had just had the same tests at another Allina facility.” Nice- and there is a desire “in setting a common technology standard so that Allina’s computers . . . can talk to Medica’s.” (Now, that is just making too much sense- something America’s industries have only been inconsistently good at since their respective inceptions- since the first wooden leg attachment [medical field] or the first loan for Cletis to buy a cow [banking industry], etc.)
Like I mentioned: Three years ago, a certain person's employer made a deal with the devil and somehow agreed that having its employees pay co-insurance as a way to distribute costs among the masses more evenly was a good way to go. I cannot fault the employer, as they are just responding to the health care market, but the presentation of this change was despicable. We were told in the annual presentation of the rollout for slaughter of our cost-of-living increases that we had choices.** We could make the best choice for ourselves and family on the health care plan option which could best meet our needs. A sentence on a page headed “Building Your Own Medical Plan for 2005” reads: “Each year when you enroll, you’ll decide how much coverage you’ll need for the upcoming year.” Oh goody, so not only do I need to pay more overall given the hike in co-pays and the introduction of co-insurance, but I get to pretend to be a super-hero with the very enviable make-believe talent of attempting to see into the future. I have always wanted to guess as to when or if I would need surgery on my face, when I might be breaking my leg, whether my wife will suffer from pneumonia or if my kids will come down with a protracted illness. That sounds like fun. Since most people don't know what kind of blizzard they are going to order when they are in the drive-thru at Dairy Queen, I don't imagine a lot of collective excitement surrounded this ordeal/opportunity. I can’t remember having so much fun- not even when my dad gave me a buck to play Q-Bert at the campground arcade and he supposed that 100 cents should last me all day. Did they really expect someone with an IQ of at least 13 ½ to buy this crap? The Wholly Mammoth’s choices were better when it could decided between getting speared to death by the caveman or have rocks dropped on its skull from the women and children who stood on the top of a cliff.
Still mentioning: I do not remember saying anything during the presentation about our individual opportunity to make illness or injury prognostications for the coming year, because I say a lot of things. I cannot possibly remember everything. I know that I did not mention this- “your approach of attempting to put a positive spin on this news of asking an employee to acquire some prescient ability to determine our future health care needs is akin to telling an innocent man that he is to be put to death in as subtle, seductive and placating a manner as possible, while in the same breath telling him that the other good news is that he is able to choose from the many options of death available to him- hanging, drug overdose, drowning, being burned or buried alive, shot, stabbed, lethally injected, annoyed to death by a republican who thinks that all is well or a democrat who defends an illegal by using silence, supposing you are the one who is being extreme . . . quite a choice. To borrow Home Depot’s current advertising slogan- “You can do it . . . we can help.” I can choose the mode of death among the options you allow. Thanks.
Standard health screenings: Read this story about a young girl who was administered a series of health screenings, which saved her from the unenviable position of living with cystic fibrosis- see http://www.startribune.com/1244/story/1541400.html. When people talk about the escalating health care costs and the subsequent diminishing coverage, consider that in the future, a health insurance company may not cover the battery of tests which innocent little babies may go through, as they do now, to ensure their health, because, they could justify, just 1 in 10,500 babies are born with a certain disease. Yes, a baby's health may not be insured. Granted, the story itself pits DNA genetics and pre-screenings against the perceived lack of privacy one might be subject to given that DNA information obtained from the screenings might be retained. I am using the vignettes contained in the articles to illustrate that certain types of coverage can be dropped*** by health insurance companies without anyone being able to object. If any of a wide variety of covered procedures, tests, medications, etc. were to be dropped, because of how much they were costing the insurance companies, there is every reason to believe those types of decisions would ultimately cost those who are insured much more in totality than if they had kept certain procedures in place to begin with. There is something to be said for pre-emptive care- I discovered this when I neglected spraying the weeds that took over my patio last year. (Also see http://www.startribune.com/1244/story/1541400-p2.html. Perhaps a person with all of the fortune in the world, both economically and in a familial sense will forgive someone looking out for people who had to routinely pound on their little girl’s breast and ribs in order to loosen the mucus inside her chest which kept her from suffering from cystic fibrosis. At least they knew they had to.)
RX for Change: In yet another Minneapolis Star Tribune Opinion Exchange article (OP1 and OP5) “RX for Change” March 30, 2008, the Mayo Clinic leader said that the health care system is not broken; “there is no system” . . . We’re going to go bankrupt. Medicare is order of magnitude more of a significant financial problem for this country than Social Security is, and it’s coming in the next four, five years.” (See- http://healthpolicyblog.mayoclinic.org/2008/04/01/star-tribune-interview-with-dr-cortese/)
Cortese also mentions, during the course of the article: “We have a public and private insurance system in this country . . . When you’re under 65, you’re in the private system. When you’re over 65, you’re now in the public system . . . That means the insurance companies don’t have a real incentive to keep you as healthy as you could be.” Cortese's example- if you “get diabetes when you’re 50- Insurance companies and your employers right now will give you as much care or as little care as they can get away with. There’s no incentive for them to invest more in keeping you really, really healthy because when you get all your complications from diabetes, you’ll get them when you’re 70, 75. Complications occur 20 years later. Then it’s all Medicare’s problem. We need to have insurance companies get their reward for keeping you healthy.”
Moving in the right direction: In theory, Cortese likes the proposals of each of the presidential candidates and says they are moving in the right direction. At least until they probably have flip-flopped on a number of methods or approaches to health care delivery. Hell, keep in mind, that Cortese was interviewed in March (2008). We can’t expect consistency when we have been told to embrace change. Further, Cortese says- “Nobody I have heard of is talking about system-engineering in health care to redesign the way we provide care. Nobody’s talking about the vision.”
Why both sides are wrong: The left/democrats want government run health insurance (i.e. universal) for all and the right/republicans want as little government interference in health care as possible. The solution lies somewhere between. We, as individual members of the middle class, cannot afford to pay someone else's medical bills- whether they are natives, naturalized citizens or illegal immigrants. We also cannot afford to let everyone sink or swim and allow the insurance companies to control everything. I use Milton Friedman and his economic philosophy to be found in “Capitalism and Freedom” as a model of conservatism to balance against a more liberal approach like mine. I agree with much of what Friedman wrote about public assisted housing and social aid generally and tend to object to his private market business philosophy, which unfortunately is how I would expect he would have handled the health care problem- which he did not address in the aforementioned book on the overall sub-topic of social aid. I have not read any of Friedman's other material, but the contents of pages 177-189 should give a reader a fairly vague conservative mindset toward how he would have handled the issue of health care. Intellectually, the man was brilliant, but unfortunately there is no way to measure the brilliance of a man's heart.
Remedy: 1) Involve insurance companies, independent panelists, doctors, and informed patients of all educational levels in a managed care system. Involve insurance companies, do not completely empower them. 2) Stop lobbyist efforts to get doctors to prescribe their brands of medications. 3) Mandate that all of those who can afford health insurance are paying for it; requiring this would necessitate the involvement of an objective person to make a logical decision. 4) provide incentives to doctors, hospitals and clinics who deliver high quality health care consistently without a duplication of effort, utilizing a universal digital medical record system which is linked across the country. 5) discourage doctors from requesting unneeded tests or from prescribing medications simply for the benefit of medical apparatus or drug companies.**** 6) Any and all panelists on medical boards and those deciding upon compensation packages for any medical company’s directors should serve a term no longer than a member of the House of Representatives, which would help minimize the amount of continual damage they could do to the bank accounts of the average stockholder, which in turn affects insured patients. 7) in line with the second portion of #4, mandate that all clinics and hospitals make the transition to digital record keeping and stop asking me what I am allergic to. (If this endeavor runs into the billions of dollars, then again remove the taxes which are already being paid and wasted by our federal and state governments in any number of other areas, and redirect them toward this end);
8?: I read a story where the Federal Trade Commission has been encouraging the entertainment industry (from television and movies) to utilize characters as spokes . . . things to promote more healthy foods and drinks to America’s youth. Surely we should do this, because if Sponge Bob promotes an e-choli spinach salad or the Backyardigans push whole grain bread upon the inexperienced taste-buds of the young, the latter will of course clamor after the healthy food and whine down aisle 7 in the grocery store that they want King Vitamin cereal instead of the Lucky Charms that is rotting their teeth while making their mornings more enjoyable. Getting this proposal to work would be more difficult than trying to mate a carpenter ant with a hippopotamus; the former won’t move out of the shed and the latter won’t stop bragging that it was just made a research fellow, studying philology, at a community college. The hippo has long preached togetherness and community, too often in Greek by the carpenter ant’s estimations, but brags about his political tolerance. Now that semi-aquatic, river-inhabiting sea-cow/horse is one giant hippo-crite.
I am aware: that technically speaking, we already have private payment and universal health care-like aspects to our current system, such as it is. We pay co-pays, co-insurance and our household’s policy mandates that we pay $11 for most prescription medicines. The health insurance company that works with our employer then pays for many of the remaining in-network services and for referrals to affiliated physicians. The question then might be asked is- if we are already, in part, sharing the burden of paying for health care among those who are provided health care (the patient/insured) and the employer- what is the next step. Easy to answer if the answer to a follow-up question is answered- is there complete justification in the amount of money we are charged for medical services?***** I don’t have the answer to that question; good people who are far more enlightened and experienced, while having the requisite objectivity would be best equipped to provide the answer to that. Are we to the point yet that this problem of the type of health care system to be adopted cannot only rely on all consumers of health care services fending for themselves or having the insurance companies, and thus, the insured to their detriment, continuing to pay for the uninsured? Surely only a Sudanese-American binturong that keeps forgetting to take its statins****** and that would renounce its dual citizenship (the renunciation of the American component of the duality) would choose to adopt the all or nothing (either conservative or liberal) method to any of a number of the issues I have addressed to this point- and would continue to be oblivious to the mean resolution which exists between the two.
Well-enough: There is that old adage- “leave well-enough alone” that’s two framing words propose inaction should the middle portion, applicable to any type of issue, is objectively judged as not broken, or is otherwise not deficient in some way. The adage itself, when the topic is health care, is particularly interesting. On the subtopic of health care, we are most assuredly not well and neither the democratic, nor the republican antidote will provide us with the cure. Neither side is maintaining that the issue of health care is well, but their continued inaction and inability to compromise on behalf of the people rather than a compromise for its own sake should leave us all feeling sick. Solutions are not easy; sometimes finding the fly swatter is the most difficult part of killing a fly- especially if you do not have a magazine to sacrifice. My wife mentioned that a fly may have been pre-conditioned to recognize the sound of a whooshing swatter stored in its genetic memory- given to it by generations of flies perhaps trained to escape a well-aimed thrust. She didn’t put it like that of course, I extrapolated- she just said- “it probably knows.” I don’t know that a single fly’s likelihood of being killed decreases with repeated failures. I think something similar to that was a story component in the movie “The Incredibles.” If only we could attribute that much prescience to our elected officials . . . comparing them to insects and cartoon characters will have to do for now.
Next time: Education.
* It is likely that a number of people not choosing to be insured by their employer perhaps have extended cable television packages, cell phones, video gaming systems, plasma televisions, and overall live beyond their means. It is just as likely that a great number of these people are parenting children in single family homes.
** Silly me, I had planned on using my cost-of-living increase on gasoline.
*** Not necessarily these types of well-baby screenings, or pre-screenings, but items that were formerly covered. This is a much more serious problem than a cable company deciding not to include ESPN Classic in its basic cable television package.
**** I am not going to comb through internet results on this sub-sub-subtopic of this overall issue, but I think it is highly likely that doctors would necessitate some tests attempting to utilize expensive machinery more often if there is a chance they will be compensated. Referrals to imaging centers, or to specialists who use such equipment are bound to increase and I don’t know that it could always be because a doctor is innocently ruling out other potential diagnoses. But I recognize the fine line between a physician genuinely attempting to determine all avenues available for discovering a problem and being afraid to because of accusations that they are feeding the pig/giant medical apparatus development and distribution company or the prescription drug company. On the prescription drug front- I have no doubt that certain doctors can have the tendency to prescribe/push the drugs of certain drug companies. I’ve read this a number of times from a number of different sources, during quite different stages of my research on this topic.
***** I have heard horror stories of how much patients are charged for a box of tissues. I equated this to being charged $12.79 for shop supplies as a portion of my $200+ bill for a car repair a couple decades ago. When I asked the mechanic what that meant- he mentioned that it was for towels, use of tools, etc. I was dumbfounded. I had not yet become well-versed in the benefit of the Better Business Bureau. I don't know that anyone anywhere should ever be able to draw a parallel comparison between the goings-on in an automobile repair shack and a hospital room. I could make many more comparisons between the two, but I need to get to bed.
****** Statins are cholesterol-lowering drugs that have been proven to assist in the fight against heart disease and have been found to benefit the brain, “dramatically reduc[ing] the risk of developing dementia and Alzheimer’s disease.” See- http://www.newsweek.com/id/149270. Just ignore all that false positive, the exact opposite may also be true stuff; that kind of back and forth only plays out between combatants involved in political discussions . . . or something.
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