Monthly Archives: August 2017

Politics is a Game; You and I are Minor Players

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Paul Krugman: “Politics determine who has the power, not who has the truth.”

Will Rogers: “A fool and his money are soon elected”

Politics is a game. That has probably been the case throughout history, but it is more true now than ever before. It seems that at every level of government, even in “democratic” societies, attaining power is all that matters.  The benefit of the citizens is secondary or tertiary, and we the voters seem to condone this attitude even though government often benefits a small group in society to the detriment of the larger group.

We expect this in autocratic societies such as North Korea or Russia, but we want to believe that in free societies with open elections those whom we choose will actually, you know, represent us.

Evidence is to the contrary. Government is a seemingly endless series of deals that in the end favor those holding power. Most of my professional life I rejected this notion, trying to believe that the democratic experiment was working. It isn’t. In a previous post I discussed how legislation rarely favors regular citizens, and that includes the recent healthcare proposals that  worked their way  through Congress.  The truth is that citizens have very little power and society is controlled by a fairly small group of people.

Back in 1956 sociologist C. Wright Mills concluded that there is a “power elite” controlling all major American institutions such as banking, major industry, and political offices. Mills didn’t believe there was a grand conspiracy to attain and control power by the elites, but rather that their wealth and power simply gave them control. He argued that the group was relatively small and that earning our way into that group is determined by the schools we attend, the areas in which we live, the churches we attend, and social clubs to which we belong.

Pretty depressing stuff for those of us not belonging to the power elite.

And Mills is not alone in reaching these conclusions. In 1913 political scientist Charles Beard concluded that even the U.S. Constitution was constructed by elites belonging to the same groups. He argued that the Founders wrote the Constitution out of a desire to protect their own financial interests. If you are familiar with the Constitution’s provisions it is fairly easy to agree with him. In later works Beard concluded that almost all governmental decisions are intended to financially favor the elites.

Countless other observers have reached the same conclusion but, like I said, I tried to disagree.

I was naïve.

So, the argument is that the elite class is relatively small, it is at least partially determined by the schools one attends (and other factors), and wealth and political influence define the group.

Here are some things to consider:

  • As always, there are nine member of the U.S. Supreme Court. Guess where they attended law school? Four went to Harvard, three to Yale, two to Columbia. Other law schools equally prepare future judges but only judges from these schools (plus Stanford, Northwestern, etc.) are ever appointed.
  • The median net worth of members of Congress is more than $1,000,000, and that is 18 times the average net worth of Americans. Since 2007 Americans’ net worth fell 43% while that of members of Congress increased by 28%. Representative Darrel Issa from California is worth about $450 million.
  • Every president since Ronald Reagan attended Harvard or Yale (Reagan attended Eureka College in California). And no, attending an Ivy League school does not necessarily mean entrance was earned or deserved or that one graduated as an enlightened citizen. These are obviously great schools but there are lots of great American schools.
  • In the 2016 election cycle one organization (Fahr LLC) donated more than $90 million to Democratic candidates and causes, Renaissance Technologies donated almost $56 million (half to Democrats and half to Republicans), Las Vegas Sands donated more than $44 million to Republicans, and fifty companies donated at least $8 million to candidates. Can Americans in the lower income brackets compete with that type of influence?
  • The “Trumpcare” healthcare bill passed the House of Representatives this year in spite of the fact that only 17% of Americans favored and 56% opposed it. According to the non partisan Congressional Budget Office the bill would have cost 23 million Americans their healthcare coverage. The bill would have allowed insurance companies to deny coverage for pre-existing conditions and it would allow states to permit insurers to deny coverage for specific conditions such as cancer. The bill also cut $880 billion from Medicaid over ten years thus significantly reducing coverage for the poor and elderly. The bill favored the elites and was opposed by almost everyone else.
  • I have mixed feelings about labor unions, but they have historically been a major player in the fight for common workers. Many of them fought against segregation, fought for Social Security, helped get minimum wage and maximum work day policies implemented, and promoted the creation of OSHA, a government agency working to ensure safe working conditions. I do know all of the labor movement’s warts and failings, but they have absolutely improved conditions for workers. Today more than half the states have implemented “right to work” laws that purposefully weaken unions and favor company owners (elites).
  • And then there is the “revolving door”. If I had a magic wand this is one of the three or four things I would change. Essentially what happens is that certain well-placed individuals alternately hold positions in government and powerful corporations that benefit from government’s policies. For example, Dina Powell is President Trump’s Deputy National Security Adviser.  Prior to that appointment Ms. Powell worked for Goldman-Sachs, a multi-national corporation, for fifteen years. And, by the way, she is only one of five Goldman-Sachs appointees in the current administration. Congressional staffers also take advantage of the revolving door. So, for example, to date about 190 individuals have served for a time on the Senate Finance Committee Staff then taken a job lobbying for companies benefitting from that committee’s work. These folks are part of Mills’ “Power Elite”.

Political Scientist Thomas Dye and his students have been studying American leadership for more than 45 years. They are well-informed and their research is very thorough. They conclude that a small number of “top positions” in America “run programs and activities of major political, economic, legal, educational, cultural, scientific, and civic institutions.” They found that about half of industry, transportation, and banking positions are held by this small group. The group controls about 2/3 of insurance assets. They also found that “less than 250 people hold the most influential posts in the executive, legislative, and judicial branches of the federal government, while approximately 200 men and women run the three major television networks and most of the national newspaper chains”.

OK. Sorry. That’s a lot of information. The bottom line? A relatively small group of citizens controls a lion’s share of the power. These folks make all the major political, economic, and social decisions.

Even former Trump adviser Steve Bannon (who attended Harvard and worked for Goldman-Sachs) concluded that “elites have taken all the upside for themselves and pushed the downside to the working- and middle-class Americans”.

Is this cynical view of society accurate? I’ll let you reach your own conclusions.  All I know is that, if accurate, it is dangerous. It assumes that some people are more intelligent and are uniquely qualified to make major decisions and that those outside the elite are incapable of contributing very much. That is both dangerous and just plain dumb. The most unique and original ideas I’ve heard in my 63 years came from folks who were certainly not part of the “elite” class, and a cursory glance at the ideas currently generated by those in power makes it clear that those who happen to be in the elite class are often clueless.

 

Capital Punishment

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In 2001 Marcellus Williams was convicted of first degree murder. The 42 year old female victim had been stabbed 43 times in her St. Louis home. No DNA evidence was available at that time and Williams was convicted based primarily on the testimony of two convicted felons. Now DNA from the murder weapon and  hair samples found at the scene are available, and it appears that DNA does not match Williams but is a match for someone else. The State of Missouri still planned to execute Williams last night.

Yesterday, Republican Governor Eric Greitens issued a stay of execution until the case can be examined by an independent body. In issuing the stay Greitens said: “To carry out the death penalty, the people of Missouri must have confidence in the judgment of guilt”.  Well…yeah. But there is often a problem with that whole “confidence in the judgement of guilt” thing.

In 2016 149 people were exonerated and freed from American prisons after being incarcerated an average of fifteen years for crimes they did not commit. Some of these were for drug offenses and other felonies, but 54 were convicted murderers, five of whom were on death row awaiting execution. Many of those 149 were young or were mentally handicapped at the time of their conviction.

There is no way to know exactly how many people currently sitting in jail or prison are actually innocent. If you ask the prisoners I’d bet you would learn that almost all are, but I’d have trouble trusting their honesty! However, mathematical modeling by the National Academy of Sciences concludes that based on the percentage of prisoners exonerated over time we could anticipate that at least 4.1% of people currently in prison convicted of murder are innocent.

Those convicted of crimes other than murder are also a concern. The University of Michigan’s Exoneration Registry reported that 891 people convicted and serving time in prison were set free in a 13-year period beginning in 1989. And these are only the cases that were proven by The Innocence Project and other non-profit groups; one must assume other innocents were not exonerated.

So let’s just go with that 4.1% estimate and assume it applies to people convicted in American courts. Approximately 2.3 million Americans were incarcerated in 2013, the last year federal data were  available, and about 6.9 million adults were under the supervision of a corrections system, either actually incarcerated or under control of  probation or parole. Yep. That’s a lot of people convicted of crimes. So even if 1% of those found guilty are innocent that would be 69,000 wrongful convictions. If the 4.1% figure is accurate there are more than 282,000 innocent Americans currently under the control of local, state, or federal corrections systems.

Again, these are just estimates. I’m just making up numbers. It is impossible to know whether they are accurate. But what if they are? What if the number is even higher? Does it matter if the number is much lower if we know we have innocent people spending time in prison or being executed? What if it is only a dozen? If I’m one of that dozen it sure matters to me.

So why am I confident at least a portion of Americans convicted in court are innocent? Well, I’ve been studying courts and teaching classes on court structure and procedure for more than three decades, but I’m sure you want more evidence. You can watch this episode of Adam Ruins Everything for a sort of lighthearted approach to the subject. Adam will probably be more interesting than what I have to say, but if you insist…

In 2009 the Florida Supreme Court created the 23 member Florida Innocence Commission to determine why the state had a high rate of wrongful convictions. The Commission released its report in 2012 and listed several reasons innocent people are convicted, and the Commission’s conclusions are relevant to all American courts.

Here are the major problems identified:

  • Unreliable jailhouse snitches. Remember Marcellus Williams? He was convicted based on the testimony of two jailhouse snitches. This is a problem in about 15% of wrongful criminal convictions.
  • Eyewitness misidentification. It is estimated that eyewitnesses misidentify criminals in about 75% of the cases that are later overturned using DNA evidence. This piece in Scientific American explains why memory is not accurate. In fact, eyewitnesses often create false memories. Unfortunately juries really rely on eyewitness evidence.
  • False Confessions. A large number of innocent people have spent a lot of time behind bars because of false confessions. This often is the case when young people or those with limited intellectual abilities are subject to aggressive interrogation. They may be intimidated by authority or have other immature reasoning abilities.
  • Invalidated or Improper Scientific Evidence. Science is awesome, but it is often incomplete or overstated. In other words scientific methods used in criminal convictions often lack complete validity or are exaggerated by prosecutors. Examples of less reliable forensic evidence are bite marks (very unreliable), tire treads, fiber evidence, and hair matching. Or to be clearer, these have not been subject to thorough scientific validation, so we cannot be certain they are valid. DNA evidence is highly reliable but is often unavailable.
  • Professional Responsibility and Accountability of Both Prosecuting and Defense Attorneys. Attorneys are bound by state ethics codes but they also work in a system that expects them to do everything they can to win their case. Need I say more?

The Commission also found that an overarching problem was that the entire criminal justice system was underfunded. Prosecutors and public defenders often deal with unmanageable caseloads, crime labs are underfunded, court-appointed attorneys are paid less than they should be, police are under paid, and more.

So the bottom line? It is almost certain that an indeterminate number of people currently sitting in a prison cell or under the watchful eyes of the pardon and parole system are innocent. At least some of those folks are either serving life sentences or are awaiting execution in one of the 32 states still using the death penalty. Being wrongfully incarcerated is unacceptable. Being executed for a murder one did not commit is, in itself, criminal.

I oppose capital punishment for personal/spiritual/philosophical reasons, but not everyone shares my personal views. However, we should at least be able to agree that executing people who are innocent is unacceptable, and I believe we almost certainly have done so in the past and will do so again as long as we rely on a fallible human institution to convict people accused of crimes.

I’m glad Governor Greitens appointed a panel to review evidence used to convict Marcellus Williams, but even after that review we will not know for certain whether he is guilty or innocent. That group of five people will have an opinion. Is that enough to justify taking someone’s life?

 

 

 

Confederate Monuments and Symbols

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“I think it wiser not to keep open the sores of war but to follow the examples of those nations who endeavored to obliterate the marks of civil strife, to commit to oblivion the feelings engendered.”  Robert E. Lee (1869)

 

I bought my first car when I was sixteen years old. It was a used 1964 Chevrolet Impala, red, two-door, four speed (stick shift), dream car. I paid $600 for it. I blew it up drag racing on a Mississippi country road after only a few months (I still won the race).

On the front of that car when I bought it was a Confederate battle flag plate with “The South’s Gonna Rise Again” emblazoned in gold letters. I wasn’t very studious at that point in my life (remember I said I was 16 and drag racing on a country road?) and the significance of that license plate never really crossed my mind back then.  I now know the meaning and significance of that flag and that phrase.

Most (but not all) informed Americans understand that The Civil War and its causes have been thoroughly researched and debated by scholars and others since the war ended. Some writers argue that the War was fought over states’ rights, economic differences, or because of the election of Abraham Lincoln. These arguments are generally offered by those wanting to justify the secession of the Southern states or by those wanting to hold on to the Southern “culture” and heritage represented by heroes and symbols from the war.  I believe they are misguided.

Yes, I know the Southern states were fighting over their states’ sovereignty. Yes, I know that most Confederate soldiers didn’t own slaves (because they were too poor to own that much property). Yes, I know there were stark differences between the industrial North and the agrarian South. I’ve heard all the arguments.

But the war was about slavery. It was about those Southern states wanting to continue enslaving and often mistreating men, women, and children because of the color of their skin. That is the states’ rights issue for which they fought. So the bottom line is that the Southern military heroes who were great tacticians, great leaders, great men in other areas of their lives, were fighting to retain an immoral and inhumane institution. And the symbols such as the Confederate flag that still find their way in to our public discourse were a part of that horrific chapter of American history. It was all about slavery.

The events, economic factors, and anti-slavery literature leading to Southern secession would fill countless pages. Essentially, the Southern states that  declared themselves independent of the United States Constitution  were angry that the national government was limiting the expansion of slavery to the new territories. Abraham Lincoln, the Republican presidential candidate in 1860, ran on a promise to oppose the expansion of slavery, so within a few months of his inauguration the Southern states claimed secession and the Confederacy was formed. So at its heart that secession was about slavery.

Here are a few facts about American slavery:

  • Virginia laws as far back as 1669 stated that if a slave disobeyed his or her master and the punishment resulted in the death of the slave, the master could not be charged with a felony.
  • The infant mortality rate for slave children was twice that of white children.
  • The slave ships bringing captured Africans to the New World via the Middle Passage were cramped, to say the least. Slaves were forced to lie on wooden beds, male slaves were shackled, they were exposed to disease, and female slaves were subject to rape, and both male and female were subject to brutal treatment and beatings while aboard ship.
  • During the plantation era about 1/3 of Southerners were slaves.
  • Only about 25% of all Southerners owned slaves. However, slave owners controlled a very large number of the governmental positions and a whopping share of Southern wealth. In Texas, for example, only 27% owned slaves in 1860 but the slave owners controlled 68% of governmental positions and 73% of the state’s wealth.
  • At least some slaves were subject to daily torture and beatings because their masters were cruel.
  • In most cases female slaves had no legal protection from rape and sexual assault from their masters.
  • When they were placed on the auction block black women were often forced to strip off their clothing so potential buyers could prod and poke on their bodies.
  • By 1850 there were more than 3.2 million slaves in the United States.

So yes, The Civil War was about states’ rights; it was over the rights of states to continue treating other human beings as less than human. And yes, the war was over economic differences but the South’s plantation society was built on slavery.

And of course I know that slavery was not something unique to our country, but that does not excuse it. And I know slavery was introduced thousands of years ago, but again that is no excuse. The first declared truth in Jefferson’s Declaration of Independence was that “all men are created equal”, yet slavery violated that very first precept.  That violation meant that the majority (white folks) had to somehow morally justify the notion that slaves were not real “men” since they were not considered equal.

I also know that we often say that such things must be considered in historical context, and that is certainly true. The times were different. Human sensibilities were at least somewhat different. But even if we do accept the argument that slavery must be considered in historical context that does not excuse glorifying those men and symbols that represented slavery.

As I said earlier, the Confederate war heroes were often good men in other respects, but they and the other symbols of the Confederacy should be allowed to die because they represented slavery. The fact that those heroes and symbols have now been adopted by the KKK and other racist groups should be sufficient evidence. These symbols do represent our heritage, but it is the part of our heritage represented by bigotry and malevolence rather than the kindness and generosity found in most Southerners these days. I’m more than happy to release forever the bigoted part of my Southern heritage.

And the quotation by Robert E. Lee above was his objection to establishing a proposed monument in Gettysburg following the war. Lee thought building monuments commemorating Confederates should be avoided.

The Democratic Party’s Irrational Exuberance

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Democrats are all giddy because President Trump’s approval ratings are at historic lows. Further, only  about 25% approve and an overwhelming 70% disapprove of the job Congressional Republicans are doing. Democrats are certain this will translate into great success in the 2018 Congressional elections and that they will gain control of Congress. Not so fast. The districts from which we choose our representatives favor Republicans.

A little background is necessary.

At every level of American government we use single-member districts to choose representatives. The notion is simple; we have districts that are equal in size (based on population) and each district has one representative. We use districts for members of the U.S. House of Representatives, state legislatures, city council seats, school boards, county commissioners, and more.  It is a nice idea because at least in theory we know who our representative is and he/she is responsible for representing us as citizens. Like I said…nice idea. Except like most aspects of American government, the reality isn’t as nice as the idea. Politicians have a history of playing nasty.

There are numerous problems with single-member districts. For example, they make it very difficult for minorities or even a minor party candidate to win because they must go head-to-head with candidates from the majority and candidates who represent the two major parties.

Another problem with districts is referred to as “Fenno’s Paradox” based on conclusions reached by Political Scientist Richard Fenno. After conducting exhaustive research Fenno discovered that representatives do everything possible to be liked by the people in their district, often to the point of absurdity. He said members of Congress develop a “home style” in which they sell themselves as “one of us”.  So the paradox is that people think Congress as a whole is pretty bad (Congress currently has an approval rating of about 15%), but they like the member of Congress from their district. Consequently, incumbents, those holding the office, are almost always reelected even though people pretty much hate Congress. It is a paradox.

The greater problem, the one favoring Republicans, is gerrymandering, a term going back to the early 1800’s which means drawing districts to favor a group or party. I don’t want to get bogged down in the mechanics of gerrymandering, but be assured it is fairly easy to do and most American districts are gerrymandered. All national and state legislative districts must be redrawn every ten years after we take the national census (required by the Constitution). Since we take a new census in years ending in zero, the last was in 2010.

Here is what matters: The party in control of the state government at the time of redistricting (following the census) has a great deal of control over drawing those districts and, consequently, every district can be gerrymandered by that party.

After the 2010 election the Republican Party had “control” of 24 state legislatures and Democrats controlled 15 (others were divided, with one chamber being Republican and the other controlled by Democrats). Twenty nine governors were Republicans and only eleven were Democrats. You get the picture.

The Associated Press (AP) recently examined current legislative districts and found that four times as many state legislative districts are skewed toward the Republican Party than those favoring Democrats. About three times as many U.S. House districts favor Republicans. For Democrats the news gets worse because states in which they historically had a good chance of winning (Michigan, North Carolina, Pennsylvania, Wisconsin, Florida, Virginia, etc.) now had districts favoring Republicans. All these states had Republican control after the 2010 census, so the districts were drawn by Republicans.

A number of additional factors favor the Republicans, and that led to much better results for their party in 2016 than would have been expected.  But gerrymandering played the major role in Republican success. Remember that in 2016 about an even number of Americans identified with each party, so we could expect almost even success in districts. That was not the case.

There are solutions to the gerrymandering problem. They could be drawn by non-partisan groups (Iowa does this), for example, or they could even be drawn by computer software. But the Democrats and Republicans like being able to gerrymander when they are in control, so nothing changes.

The bottom line is that unless support for Congressional Republicans really goes in the tank (people of all demographic groups begin turning against the party) and support for President Trump continues to decline among all groups (a real possibility), the Republican Party will retain control of Congress in 2018.

The Healthcare Mess: Part II

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At the end of my first post on America’s healthcare system I concluded that the acceptable solutions to the healthcare mess depend on one’s ideological leanings. Let’s begin by examining how those on the ideological extremes, Libertarians and Socialists, feel about healthcare:

  • Libertarians (ultra conservative): Let everyone die because it is nobody’s business whether people have healthcare or not. Survival of the fittest! Healthcare Darwinism!
  • Socialists (ultra liberal): Government should provide healthcare for everyone and their pets, and patients should be given a snuggly bunny and a box of Twinkies when discharged from the hospital.

OK. Let me start again.

  • Libertarians: The Libertarian Party’s website states that “Libertarians believe that healthcare prices would decrease and quality and availability of healthcare would increase if providers were freed from government meddling and control. ” In other words, the government should not be involved in healthcare at all. Individuals, insurance companies, and healthcare providers should be responsible for healthcare decisions and healthcare should be like any other commodity. I choose which automobile to purchase without government involvement and I can decide based on price, quality, fuel efficiency, and color. They believe we should be able to do the same with doctors and hospitals (well…except for the fuel efficiency thing).

I don’t want to get bogged down in free-market theory, but I do know that applying it to healthcare is difficult. Under the free market I get to choose what good or service to purchase, but if I’m unconscious in an accident I lose that choice because someone will make it for me. If I live in an area with only one hospital or doctor, my free-market options are limited. And, to safeguard against bankruptcy resulting from illness, the free market pretty much forces me to purchase insurance and when I do so I surrender much of my decision making to the insurance company that, quite honestly, has profit rather than my best interests in mind. And unless there is a government regulating that insurance company I cannot be guaranteed that it will actually pay for my care. There goes the free market.

For a more in-depth explanation of why the free market will not work in healthcare, read this.

  • Socialists: The Socialist Party’s website states: “The Socialist Party stands for a socialized health care system based on universal coverage, salaried doctors & health care workers, and revenues derived from a steeply graduated income tax”.  The Party also supports eliminating private health insurance companies, supports government take over and control of the pharmaceutical industry, and supports public funding of all medical care including vision, dental, mental health, and alternative medicine practices.

This view considers healthcare a basic right (like speech, religion, and voting) that should be guaranteed by the government. Consequently, everyone would receive care regardless of their income or economic status. To provide such care taxes must obviously be increased.

The major arguments against fully socializing medicine are that it takes away personal responsibility for our health, government is in essence inefficient and delivers services poorly, and during times when the economy is waning the government must reduce all spending, so healthcare availability would depend on the health of the economy.

This is a pretty good summary of concerns over socialized medicine.

Are These Options Viable?

The truth is that we are not likely to adopt healthcare plans supported by either Libertarians or Socialists.  Instead we will continue seeking something in between. Again, the acceptable “in between” solution depends on whether one is liberal or conservative, whether one believes healthcare is a “right” to be protected and guaranteed by government, and at least to some extent on one’s personal socioeconomic status.

WHAT CAN WE DO?

Continue with Obamacare

The Affordable Care Act (Obamacare) reduced the number of uninsured Americans significantly, mostly because of Medicaid expansion adopted by 31 states, and it ensured that insurance companies could not reject applicants for pre-existing conditions and that young people must be covered by their parents’ insurance through age 26. Obamacare also required insurance companies to cover several healthcare costs such as lab tests and infant care.

A good summary of Obamacare’s provisions may be found here.

Americans are evenly split on Obamacare, about half supporting and half opposing it’s policies. Americans generally believe Obamacare should not be eliminated, instead favoring a line-by-line review and reform by Congress (which would be unique since most members didn’t read it initially). As is to be expected, Democrats tend to think favorably of Obamacare and Republicans tend to think poorly of it (but remember that almost half of Americans are not Democrats or Republicans). Americans overwhelmingly agree that reducing individual healthcare costs should be a priority; today Americans spend an average of 35% of their income on healthcare, and according to some reports our average individual costs have increased under Obamacare.

There are other problems with Obamacare, some of which may be found in this summary by The Heritage Foundation, a conservative think tank.

The bottom line is that a large number of Americans are still uninsured and healthcare costs continue to climb.

SO?

 I will assume that our goal is to find solutions that cover all or almost all Americans rather than accepting the Libertarian argument (favored by only about 5% of the public).  About 60% of Americans agree that government has a responsibility to ensure health coverage, and even the 35% who say they disagree with government involvement support Medicare and Medicaid, two government-sponsored healthcare programs. The higher one’s income the LESS likely one is to support government-ensured healthcare, so it can be assumed that those who have it or can afford it are less likely to want much government involvement. Interestingly, even lower and middle-income Republicans increasingly favor a government solution.

No rankings or indexes are perfect, but they do provide some guidance. Two healthcare rankings, one by The Commonwealth Fund and the other by The World Health Organization place the USA’s healthcare system far below those of other countries. And even if we do not accept rankings by these and other organizations, we do know that Americans live shorter lives, we have a higher infant mortality rate, and some Americans die each year because they lack healthcare.

SO?

No single solution will likely solve our healthcare problems, but there are a number of things we should at least consider trying, some of which have been successful in other countries and some of which might address our unique circumstances.

  • Tort Reform: This will honestly not help a great deal but it could address frivolous litigation against healthcare providers. As I stated in Part I, doctors admit that they often over prescribe medication and procedures to protect themselves from potential litigation. The problem with tort reform is that it is written by legislators, most of whom are attorneys, so it is rarely done right because attorneys make money off litigation. To be clear, I absolutely believe that healthcare providers should be subject to litigation when they act irresponsibly, but they should not be liable for circumstances beyond their control.
  • Have the national government cover preventative care (mammograms, prostate exams, immunizations against disease, etc.) as well as catastrophic care for illnesses that could be financially devastating. We could then choose to purchase personal insurance (subsidized for the poor) for stuff like the flu and minor injuries. This has been successful in Singapore and promotes personal responsibility for healthcare (which conservatives support) but also gives the government responsibility for preventative and catastrophic care (favored by liberals). And yes, I do know Singapore is unlike the USA, but that doesn’t mean we cannot consider their very successful healthcare system as a model.
  • Regulate Prices. In all healthcare systems used by our peer countries, regardless of their approach to healthcare, the government either sets or negotiates prices for medicine and other healthcare services. This is the reason prescription drugs are Canada’s top illegal export to the US; Americans can buy the same drugs illegally from Canada for a fraction of the cost paid here at home. Setting prices is a radical notion but the free market only works when competition is present, and that is often not the case with pharmaceuticals or medical devices. There may be only one or two drugs or devices available for less common illnesses or injuries, so the drug companies can charge as much as they want thus creating a monopoly. And as I mentioned earlier, in some areas only one healthcare provider is available and that can also create a healthcare monopoly. Just so you know, the pharmaceutical and medical device industries have among the highest profitability margin of all American companies.

The government has been regulating monopolies since the 1870’s when railroads were targeted, so regulating medical industries would only be a next step.

  • Single-Payer System: Since millions of Americans are still uninsured by Obamacare, just torch the entire system and start anew. Believe it or not, a good many doctors actually support this idea, arguing that the government should pay for healthcare (as the single payer) for all Americans. They argue that the profit-driven system has led to high healthcare costs and that the increased initial costs of moving to such a system would be offset by savings in premiums and “out-of-pocket” costs.

OK. I’ve run on too long again and I have not even scratched the surface. If you are interested in reading more about single-payer systems I suggest this piece from The Washington Post and this from The Heritage Foundation. For suggested alterations to Obamacare I found that this offered valuable insights. And this smartly written and nicely researched essay offers several ideas for reform.

I do not favor an immediate jump to a single-payer system, and most countries that have created advanced socialized medicine systems have not followed that path. A successful healthcare system must be fashioned to meet the needs of each country, and The United States is unique in numerous ways. I do believe the government must be more involved in regulating the prices of healthcare for the reasons mentioned above, and I believe the government should provide basic preventative and catastrophic healthcare for everyone. A citizen’s health should not depend on his or her socioeconomic status. People should not die simply because they cannot afford health insurance.

Oh yes. One final point. People often point to the healthcare provided by the Veteran’s Administration (VA) as an example of poor care provided by the government.  The truth is that veteran care has consistently outperformed care in the private sector and has been at the forefront of advances in record-keeping and accountability. And remember that the VA’s success depends almost entirely on politicians providing adequate funding.

I could honestly spend weeks on this topic, but I’m ready to get back to other (EASIER!) political and social topics. I hope you will offer comments or suggestions for addressing the healthcare crisis as well.

Thanks for reading!