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Thursday, December 17, 2009

Howard Dean's Recommendation for the Current Senate Reform Bill

This comes from today's Washington Post Editorial by Dean. Oddly I couldn't find any share links on the article or I would have just posted it to Facebook. So I am putting it up on Greeleyville instead. The commentary I read initially covering Dean's role was a bit snippy. The impression I got was that the writer held that President Obama had stiffed Dean and left him out of the cherry roles in the administration. Therefore Dean is now playing the role of rogue liberal and can rally people to not back the bill rather than towing the party line.

I am not sure I buy into this analysis. It may be an odd concept but perhaps Dean is just stating the reality of how many people feel. I don't see it as a particular political strategy but it could certainly have those connotations to the inside circle. That is the problem with politics. It doesn't really matter whether the intent is there for Dean. If those "in-the-know" game players think the intent is there then they manifest it on the rest of us and the painting of a controversial relationship between Obama and Dean becomes our perception as well. A new reality so to speak. The real strategy, in my mind, is the need to create tension or increase tension when it already exists because that is what sells the news.

Here is my favorite paragraph from Dean's editorial. The whole thing is rather short and sweet but I thought this paragraph poignant. I hadn't realized that the preexisting conditions segment had been used for gain as well. Here is the link to the entire piece.

"Real health-care reform is supposed to eliminate discrimination based on preexisting conditions. But the legislation allows insurance companies to charge older Americans up to three times as much as younger Americans, pricing them out of coverage. The bill was supposed to give Americans choices about what kind of system they wanted to enroll in. Instead, it fines Americans if they do not sign up with an insurance company, which may take up to 30 percent of your premium dollars and spend it on CEO salaries -- in the range of $20 million a year -- and on return on equity for the company's shareholders. Few Americans will see any benefit until 2014, by which time premiums are likely to have doubled. In short, the winners in this bill are insurance companies; the American taxpayer is about to be fleeced with a bailout in a situation that dwarfs even what happened at AIG."

Wednesday, December 16, 2009

Health Reform: Senator Joe Lieberman Skewered by Ann Telnaes

Thus far, the best indication of Senator Joe, Let-the-Poor-Die, Lieberman's take on what he would like the health care bill to look like comes from a searing Washington Post Cartoon done by Ann Telnaes. She disembowels the Senator using his own words and a few well placed pen lines dancing to modern technology's tune. I've posted the link to the cartoon below along with Ann's Bio on the Washington Post.

Senator Joe Lieberman skewered by Ann Telnaes

Ann Telnaes, who was awarded the Pulitzer Prize for editorial cartooning in 2001, has published her work in newspapers and magazines around the world. Her cartoons have been exhibited at the Library of Congress, in Paris and in Jerusalem and have been collected in two books, "Humor's Edge" and "Dick.

On the Huffington Post--the best quote I've seen in print yet although I heard something very similar expressed by our own Ed Craig.

If I wanted Joe Lieberman to write health care reform, I would have voted for John McCain.

Later in the post, this tidbit of information

The Trojan Horse at the center of the Senate's health care package is the mandate that people without health insurance be forced to purchase it from private health insurance companies or pay a fine. And the dirty secret of the package is that the price they will be paying is quite high - like up to 10% of income. So the way that we move along the path towards greater coverage is that the taxpayers and poor and working class people pay more to the insurance companies. What part of this is the "good"?

I haven't seen the 10% data in a first source document anywhere but if that is true just imagine Santa Claus coming down the chimney for the insurance industry with 10% of all working class American paychecks in his sack for all the good little greedy toads and toadies in Insurance Land. I'd quit and take my blanket and lie on the steps of the Senate before I'll be shackled to an insurance company, private or nonprofit.

Good grief, both France and Britain have dared to work together to fine and limit their banking industry and America can't even find the spine to tell the Insurance Companies they have to compete to survive? I think the American Senate has been paying Lucy van Pelt for advice.

In the meantime Howard Dean is calling in an Op-Ed piece on the Washington Post for a No-Vote on the now worthless reform bill and for the Senate to start over again. On a Dr. Dean site there is a form for submitting a supportive statement to the tune of

Give America a choice. We support healthcare reform that allows individual Americans to choose either a universally available public healthcare option like Medicare or for-profit private insurance. A public option is the only way to guarantee healthcare for all Americans and its inclusion is non- negotiable.

From Susie Madrak on the CrooksandLiar's website

WASHINGTON -- Howard Dean said a public health insurance option is more important than bipartisanship, and that Democrats should pass health-care legislation that includes the option with 51 votes if necessary.

Dean added that Democrats should have "no intention" of working with Republicans if it's not the strongest possible legislation that could be passed with a simple majority.

"If Republicans want to shill for insurance companies, then we should do it with 51 votes," Dean said during a news conference at the first day of the liberal America's Future Now! conference here.

Dean, though, also praised what he called President Obama's "realist" approach to trying to pass health care reform.

If you want or need a quick lesson on how the "media" can get their own private agenda across without a word just take a look at this site and the picture of Dean the site has chosen to put up discussing his views on health reform.

Speaking of the media, here is a nice clip from the White House (Obama) on the House bill passed this summer. Note the words "...all Americans..." not "SOME" Americans. What happened to your Senate President Obama?

"I thank Chairmen Rangel, Waxman, and Miller for their hard work on this bill that fundamentally reforms the health care system. As this process moves forward, I look forward to continuing to work with all House members in ensuring this legislation helps all Americans and plays an essential role in reducing deficits and bringing fiscal sustainability to our nation."

Searching on Thomas, Library of Congress, I came across the text for December 15, 2009 that I have posted at the end of the blog. But before I post this blog-o-information clips, I thought I'd share my own poignant morning discovery. I went into Fort Collins to visit the Harmony Campus Lab to get a routine blood test ($150) done for my doctor's appointment tomorrow. I was told at the receptionist's desk I'd have to show a photo ID to the nurse. The people in front of me were told the same thing.

Excuse me? This is not a plane. I haven't read any terrorist threats lately to blow up Poudre Valley anything. It is a place of healthcare where people go to be cared for and to gain comfort. It is a place where people who take the Hippocratic oath work. It is not your friendly, give me your data, your ID, your social security number, your health care history, your fingerprints--so I can give it to the authorities to make sure you are going to put in your 10% to the Christmas Fund for the Insurance Elites type of place. Doctors do not swear to treat people only if they pass the photo identification test. If don't have an ID do you not pass go? Do you not get medical treatment? Maybe they can just do a skin test to see if you are brown and legal. If the medical center is really nice they can lay down a doormat in the foyer and allow the really sick and undocumented to die on a nice comfortable mat. Or the homeless, take your pick.

Really, while my rhetoric may be a bit extreme, the privacy invasion is getting out of hand. Do we surrender our individual identities in the name of efficiency? We didn't surrender it in the face of Redcoats, the Confederacy, or the Nazis. Are we going to do it under the guise of healthcare reform? I sure hope not. Electronic records may be a step towards efficiency but there are some things that are just not for sale in America. And never should be.

Here is the text page of amendments. I am not sure why I am posting this here. Maybe I am imagining that there is some one out there who can decipher and make sense of this process. From my read through it looks like the Senate is making a mountain of regulations designed to control the initial development of what the press have referred to as the "nonprofit option". This option was batted about to negate the need for a true public option. I wrote on this topic a couple of months ago suggesting it was a really bad way to produce quality care but a great way to ensure that private insurance"and medical care organizations would face little competition or reform. Here it looks like they are trying to develop the structure for a model to then be used nationwide. I could be wrong.

I repeat... I could be wrong. So if there is anyone reading with a clearer understanding of the process of amending Senate bills and you want to take a shot at it--please feel free to correct my interpretation.

TEXT OF AMENDMENTS -- (Senate - December 15, 2009)

``(2) EXCEPTIONS.--The following rules shall apply to a proposal transmitted pursuant to paragraph (1):

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``(A) RECOMMENDATIONS FOR ACHIEVING TARGET.--The requirement under subsection (c)(2)(A)(i) shall not apply.

``(B) REQUIRED INFORMATION.--The proposal shall not include--

``(i) recommendations described in subsection (c)(2)(A)(i), pursuant to subsection (c)(3)(B)(i); or

``(ii) an actuarial opinion by the Chief Actuary of the Centers for Medicare & Medicaid Services certifying that the proposal meets the requirements of subsection (c)(2)(A)(i), pursuant to subsection (c)(3)(B)(iii);

``(C) CONTINGENT SECRETARIAL PROPOSAL.--The Secretary shall not submit a proposal if the Board fails to submit a proposal pursuant to subsection (c)(5).

``(D) CONGRESSIONAL CONSIDERATION.--

``(i) Subparagraphs (A) and (B) of subsection (d)(3) shall be applied by substituting `subsection (c)(2)(C)' for `subparagraphs (A)(i) and (C) of subsection (c)(2)'.

``(ii) Subparagraphs (D) and (E) of subsection (d)(3) and subsection (d)(4)(B)(v) shall be applied by requiring a simple majority rather than three-fifths of the Members duly chosen and sworn.

``(iii) Subsection (d)(4)(B)(iv) shall not apply.

``(iv) Subsection (d)(4)(C)(v)(II) shall be applied by substituting `subsection (c)(2)(C)' for `subparagraphs (A)(i) and (C) of subsection (c)(2)'.

``(v) Subsection (d)(4)(E)(iv)(II) shall be applied by substituting `subsection (c)(2)(C)' for `subparagraphs (A)(i) and (C) of subsection (c)(2)'.

``(E) SECRETARIAL IMPLEMENTATION.--Subsection (e) shall not apply and the Secretary shall not implement the recommendations contained in the proposal unless the Secretary otherwise has the authority to implement such recommendations.

``(h) Annual Report With Recommendations With Respect to the Private Sector.--

``(1) IN GENERAL.--Not later than July 1, 2014, and January 15, 2015, and annually thereafter, the Board shall submit to Congress, the Secretary, and the Medicaid and CHIP Payment and Access Commission a report that includes recommendations on--

``(A) requirements under the program under this title (or requirements included in the proposal submitted under this section in the year); and

``(B) in the case of any report submitted in a year after a determination year (beginning with determination year 2017) in which the Chief Actuary of the Centers for Medicare & Medicaid Services has made a determination described in subclause (I) or (II) of subsection (c)(3)(A)(ii), other requirements determined appropriate by the Board;

that should be included in the requirements established under section 1311(c) of the Patient Protection and Affordable Care Act for a health plan to be certified as a qualified health plan, such as requirements that improve the health care delivery system and health outcomes (including by promoting integrated care, care coordination, prevention and wellness, and quality and efficiency), decrease health care spending, and other appropriate improvements

``(2) INCORPORATION INTO CERTIFICATION REQUIREMENTS.--

``(A) IN GENERAL.--The Secretary shall review the recommendations contained in the report submitted to the Secretary by the Board under paragraph (1). The Secretary may, if determined appropriate, incorporate such recommendations into the requirements for certification under such section 1311(c).

``(B) REPORT TO CONGRESS.--Not later than December 31, 2014, and June 15, 2015, and annually thereafter, the Secretary shall submit to Congress a report on the application of subparagraph (A). Such report shall include, with respect to each recommendation contained in a report submitted by the Board in that year, a description of whether or not the Secretary incorporated the recommendation into the requirements for certification under such section 1311(c), and if not, the reasons why.

``(3) MACPAC.--The Medicaid and CHIP Payment and Access Commission shall--

``(A) review whether or not recommendations contained in a report submitted to the Commission by the Board under paragraph (1) would improve the Medicaid program under title XIX and the Children's Health Insurance Program under title XXI if implemented under such programs; and

``(B) include in the Commission's annual report to Congress the results of such review.''.

SA 3241. Mr. CARPER (for himself, Mr. Conrad, and Mrs. Shaheen) submitted an amendment intended to be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes; which was ordered to lie on the table; as follows:

On page 722, after line 20, insert the following:

SEC. 3016. INTEGRATED HEALTH CARE SYSTEM COLLABORATION INITIATIVE.

(a) In General.--In order to improve health care quality and reduce costs, the Secretary of Health and Human Services (in this section referred to as the ``Secretary'') shall develop, in consultation with major integrated health systems that have consistently demonstrated high quality and low cost (as determined by the Secretary and verified by a third party) a collaboration initiative (referred to in this section as ``the Collaborative''). The Collaborative shall develop an exportable model of optimal health care delivery to apply value-based measurement, integrated information technology infrastructure, standard care pathways, and population-based payment models, to measurably improve health care quality, outcomes, and patient satisfaction and achieve cost savings.

(b) Participation.--Prior to January 1, 2010, the Secretary shall determine 5 initial participants who will form the Collaborative and at least 6 additional participants who will join the Collaborative beginning in the fourth year that the Collaborative is in effect.

(1) INITIAL PARTICIPANTS.--Initial participants selected by the Secretary shall meet the following criteria:

(A) Be integrated health systems organized for the purpose of providing health care services.

(B) Have demonstrated a record of providing high value health care for at least the 5 previous years, as determined by the Secretary in consultation with the Medicare Payment Advisory Commission.

(C) Agree to participate in the Medicare shared savings program under section 1899 of the Social Security Act, as added by section 3022, the National pilot program on payment bundling under section 1866D of such Act, as added by section 3023, or a program under the Center for Medicare and Medicaid Innovation under section 1115A of such Act, as added by section 3021.

(D) Any additional criteria specified by the Secretary.

(2) ADDITIONAL PARTICIPANTS.--Beginning January 1, 2013, the Secretary shall select 6 or more additional participants who represent diverse geographic areas and are situated in areas of differing population densities who agree to comply with the guidelines, processes, and requirements set forth for the Collaborative. Such additional participants shall meet the following additional criteria:

(A) Be organized for the provision of patient medical care.

(B) Be capable of implementing infrastructure and health care delivery modifications necessary to enhance health care quality and efficiency, as determined by the Secretary in consultation with the Medicare Payment Advisory Commission.

(C) The participant's cost and intensity of care do not meet the definition of high value health care.

(D) Agree to participate in the Medicare shared savings program under section 1899 of the Social Security Act, as added by section 3022, the National pilot program on payment bundling under section 1866D of such Act, as added by section 3023, or a program under the Center for Medicare and Medicaid Innovation under section 1115A of such Act, as added by section 3021.

(E) The participant would benefit from such participation (as determined by the Secretary, based on the likelihood that the participant would improve its performance under section 1886(p) of the Social Security Act, as added by section 3008, section 1886(q) of such Act, as added by section 3025, or any similar program under title XVIII of the Social Security Act).

(3) ADDITIONAL CRITERIA.--In addition to the criteria described in paragraphs (1) and (2), the participants in the Collaborative shall meet the following criteria:

(A) Agree to report on quality, cost, and efficiency in such form, manner, and frequency as specified by the Secretary.

(B) Provide care to patients enrolled in the Medicare program.

(C) Agree to contribute to a best practices network and website, that is maintained by the Collaborative for sharing strategies on quality improvement, care coordination, efficiency, and effectiveness.

(D) Use patient-centered processes of care, including those that emphasize patient and caregiver involvement in shared decision-making for treatment decisions.

(E) Meet other criteria determined to be appropriate by the Secretary.

(c) Collaborative Initiative.--

(1) IN GENERAL.--Beginning January 1, 2010, the Collaborative shall begin a 2 year development phase in which initial participants share the quantitative and qualitative methods through which they have developed high value health care followed by a dissemination of that learning model to additional participants of the Collaborative.

(2) COORDINATING MEMBER.--In consultation with the Secretary, the Collaborative shall select a coordinating member organization (hereafter identified as the Coordinating Organization) of the Collaborative.

(3) QUALIFICATIONS.--The Coordinating Organization will have in place a comprehensive Medicare database and possess experience using and analyzing Medicare data to measure health care utilization, cost, and variation. The Coordinating Organization shall be responsible for reporting to the Secretary as required and for any other requirements deemed necessary by the Secretary.

(4) RESPONSIBILITIES.--The Coordinating Member shall--

(A) lead efforts to develop each aspect of the learning model;

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(B) organize efforts to disseminate the learning model for high value health care, including educating participant institutions; and

(C) provide administrative, technical, accounting, reporting, organizational and infrastructure support needed to carry out the goals of the Collaborative.

(5) DEVELOPMENT OF LEARNING MODEL.--

(A) IN GENERAL.--Initial participants in the Collaborative shall work together to develop a learning model based on their experience that includes a reliance on evidence based care that emphasizes quality and practice techniques that emphasize efficiency, joint development and implementation of health information technology, introduction of clinical microsystems of care, shared decision-making, outcomes and measurement, and the establishment of an e-learning distributive network, which have been put into practice at their respective institutions.

(B) RESPONSIBILITIES.--The Coordinating Member shall do the following:

(i) Partner with initial participants to comprehensively understand each institution's contribution to providing value-based health care.

(ii) Provide and measure value-based health care in a manner that ensures that measures are aligned with current measures approved by a consensus-based organization, such as the National Quality Forum, or other measures as determined appropriate by the Secretary, while also incorporating patient self-reported status and outcomes.

(iii) Create a replicable and scalable infrastructure for common measurement of value-based care that can be broadly disseminated across the Collaborative and other institutions.

(iv) Implement care pathways for common conditions using standard measures for assessment across institutions, targeting high variation and high cost conditions, including but not limited to--

(I) acute myocardial infarction (AMI) and angioplasty;

(II) coronary artery bypass graft surgery and percutaneous coronary intervention;

(III) hip or knee replacement;

(IV) spinal surgery; and

(V) care for chronic diseases including, but not limited to, diabetes, heart disease, and high blood pressure.

(v) Deploy and disseminate the comprehensive learning model across initial participant institutions, achieving improvements in care delivery and lowering costs, and demonstrating the portability and viability of the processes.

(6) ADDITIONAL BEST PRACTICES.--As additional methods of improving health care quality and efficiency are identified by members of the Collaborative or by other institutions, Initial Participants in the Collaborative shall incorporate those practices into the learning model.

(d) Implementation of Learning Model.--Beginning January 1, 2013, as additional participants are selected by the Secretary, Initial Participants in the Collaborative shall actively engage in the deployment of the learning model to educate each additional participant in the common conditions that have been identified.

(1) DISSEMINATION OF LEARNING MODEL.--Dissemination methods shall include but not be limited to the following methods:

(A) Specialized teams deployed by the Initial Participants to teach and facilitate implementation on site.

(B) Distance-learning, taking advantage of latest interactive technologies.

(C) On-line, fully accessible repositories of shared learning and information related to best practices.

(D) Advanced population health information technology models.

(2) EVALUATION OF PARTICIPANTS.--

(A) IN GENERAL.--Evaluation of initial participants shall be based on documented success in meeting quality and efficiency measurements. Specific statistically valid measures of evaluation shall be determined by the Secretary.

(B) PERFORMANCE TARGETS.--The Secretary shall develop performance targets for participants. Performance targets developed under the preceding sentence shall be based on whether participants have improved their performance under section 1886(p) of the Social Security Act, as added by section 3008, section 1886(q) of such Act, as added by section 3025, or any similar program under title XVIII of the Social Security Act (as determined by the Secretary).

(e) Measurement of Learning Model.--Participants shall implement techniques under the comprehensive learning model. The Secretary shall determine whether such implementation improves quality and efficiency, including cost savings relative to baseline spending for the common conditions specified under subsection (c)(5)(B)(iv) and quality measures endorsed by a consensus-based organization or otherwise chosen by the Secretary. The Collaborative shall prepare a report annually on each participant's performance with respect to the efficiency and quality measurements established by the Secretary. Such report shall be submitted to the Secretary and Congress and shall be made publicly available.

(f) Administrative Payment.--For purposes of carrying out this section, there are authorized to be appropriated $228,000,000, to remain available until expended. Amounts appropriated under the preceding sentence shall be distributed in the following manner:

(1) The Coordinating Organization shall receive $10,000,000 per year for program development related to the Collaborative, including for health information technology and other infrastructure, project evaluations, analysis, and measurement, compliance, auditings and other reporting. Not less than $5,000,000 of such funds shall be provided for education and training, including for support for the establishment of training teams for the Collaborative, to assist in the integration of new health information technology, best practices of care delivery, microsystems of care delivery, and a distributive e-learning network for the Collaborative.

(2) Each Initial Participant shall receive $4,000,000 per year for internal program development for health information technology and other infrastructure, education and training, project evaluations, analysis, and measurement, and compliance, auditing, and other reporting.

(3) Beginning in 2013, the Secretary may provide funding to additional participants in the Collaborative in an amount not to exceed $4,000,000 per participant per year under the same use guidelines as apply to the Initial Participants.

(g) Continuation or Expansion.--

(1) TERMINATION.--Subject to paragraph (2), the Collaborative shall terminate on the date that is 6 years after the date on which the Collaborative is established.

(2) EXPANSION.--The Secretary may continue or expand the Collaborative if the Collaborative is consistently exceeding quality standards and is not increasing spending under the program.

(h) Termination.--The Secretary may terminate an agreement with a participating organization under the Collaborative if such organization consistently failed to meet quality standards in the fourth year or any subsequent year of the Collaborative

(i) Reports.--

(1) PERFORMANCE RESULTS REPORTS.--The Secretary shall provide such data as is necessary for the Collaborative to measure the efficacy of the Collaborative and facilitate regular reporting on spending and cost savings results relative to a value-based program initiative.

(2) REPORTS TO CONGRESS.--Not later than 2 years after the date the first agreement is entered into under this section, and annually thereafter, the Secretary shall submit to Congress and make publicly available a report on the authority granted to the Secretary to carry out the Collaborative under this section. Each report shall address the impact of the use of such authority on expenditures for, access to, and quality of,







Tuesday, December 15, 2009

Senator Lieberman Takes Reform Out of Health Care Bill

Gee thanks Joe. What a swell guy.

All things I am hearing and reading point to the fact that Senator Joe Lieberman has gutted the "reform" from the health care bill in the Senate. Senator Harry Reid turned into a puddle at Lieberman's feet. I'm digging for more information and will post it as soon as I come up with something substantial to post.

If I were in the other Democratic Senators shoes I'd vote against the bill. It is gutless. Worthless from its original intent.

Sunday, December 13, 2009

A Mood is Rising in America's Underclasses

Sixth grade gave me one of the loves of my life, history. I had a superb teacher in a small rural school. He traded his history book for a coach's cap during part of each day. But he certainly didn't mind mingling the two. He'd round us up, all eighteen students, and send us out on a sunny day to the green playground field for a game of "History Baseball". It could just as easily been known as the "Geek's Revenge". The kids normally chosen last during recess to be on a team we often clamored over and fought over when it came down to the fact that the only way to score a home run would be if one could name all of Britain's King Henry's eight wives and their religious and genetic heritage. I found simply amazing how fast political alliances could change in the twelve year-old's world.

I am reminded of this sensation of change by the political climate emerging in America these days.

Years after my sixth grade love affair began I found myself sitting in college absorbing every history course I could cram into my loaded schedule. I found a good history course to be a wonderful stress reliever for the pressure of college. But I was forever trying to fathom how the America I was growing up in had been the same America which bred McCarthyism, school segregation, and the likes of the Big Five oilmen and the banking crisis in the early part of the century.

It didn't seem like that much time had passed yet the society I lived in had passed through all these troubled times. I didn't see any scars. Where were the scars? Did people just forget? Did time heal all? Was it real or did the victors in history just have their way with the retelling? How could it be possible that my parents, grandparents, and people I passed every day on the street had carried such hatred in their hearts to have allowed these things to occur? What happened to those democratic ideals? Didn't the government work for the people? After all I had been raised to the standard that all human beings in America had this gift of equality bestowed upon them at birth. I was told that over and over and over again in school. I not only took that literally I took it to heart.

Yet, here, was evidence of time in which the world seemingly turned upside down and it wasn't so long ago.

Thirty years later I am finally resolving how societal norms and expectations can shift so rapidly. How a period of time can be defined by a beginning crisis and the ending result of the remedy of the crisis. This is how you title a chapter in a history book.

Suddenly I find myself looking backwards over my shoulder and realizing why, in each society, there is a certain period of time known as the "Golden Age". I thought it was just my art history professor's conjuring up his favorite artworks and tagging them as superior. So what if Rome declined thereafter--it still made great art for many years.

For the greater part of my life, by random chance of birth it would seem, I have lived through a time of great stability in America and, comparatively, one of peace. That time has ended. The "Golden Age" has peaked and what comes next appears to be in the hands of fate and in the simmering consciousness of the American underclasses.

Now that this particular era has ended, I see some signs that America appears to be going down that not-so-gilded path towards the giant salad bowl looking to toss it up into the air. The salad, so it would appear, has taken those years of relative stability, and decided to settle itself into fixed strata. The lettuce leaves are all stacked at the bottom with the tomatoes and cucumbers being squished in the middle whilst the chevre crumbles, bacon bits, and salad dressing are heaped on the top. A distinctively medieval European recipe. Not exactly what many people in this country expected to find on its table of feast.

I read an interesting article describing the mood in universities around the country. The basic suggestion was that students were full of jubilee about the idea of change coming to this country when Obama had been elected. They were one with many of us who felt that the system had expunged the clog in the lines and eliminated the need to detour around the corruption and the ruination of the concept of the rule of law. Sure a lot of work had to be done but surely the tools were at hand. The voters had spoken.

However the special interests, the elite, the corporate were not interested in the commentary the common man and woman had laid at their feet.

Fantastic I thought to myself after hearing of the student interest! After my second stint in college for an advanced degree a few years ago I had become dismayed at the passive, commercialized, attitudes of my fellow students in class. All much younger than I, whizzes with the electronic gadgets calculating in their hands, they tended to ask less questions, never raise an eyebrow, whined and complained when too much complexity and history was brought into a subject being discussed, and just mechanically went about having professor's zip open their heads and stuff data inside and zip it closed. They smiled. They picked up their paper at the end of their incarceration and went on to claim their birthright--a job. Not just any job but one that paid money and required minimal physical labor.

Comparatively to my earlier stint in college fifteen years ago this was rather like watching a a Twilight episode called the Stepford Students. One I wouldn't care to see again.

It was business school. The Stepford approach to capitalistic indoctrination. Maximum efficiency. ROI the school mascot.

When I first made the decision to go after my MBA I had called up my Alma Mater and spoke with the Commandant in charge of the Business School. "Could I write my own program with a dual major? Business and Ethics." A stern "No" came the reply. I sucked up the wounds of naivete and entered the program regardless. But I digress into the reality of the dark spaces behind the stage curtain.

The article I read went on about how the financial crisis we are facing invokes the need for reworking and remaking content for the university classroom. Ultimately a professor disclosed his opinion about how his students had grown cynical over the past year upon realizing that the institutions in America are not interested in changing.

Corporations have studied and prepared for this battle.

I read a great book in the 1990's recommended to me by an early-entry triple-scoop kind of technology whiz geek. Who, come to think of it, worked for a Texas based insurance company. One of the big five. The book "The Sun, the Genome, and the Internet" frequently gets panned still in reviews by reviewers with less geek on their lapels than my friend's. But these reviews miss the big picture of the book.

The book outlines how the infrastructure of western civilization, long reliant on coal, oil, and the auto industry to sustain their economy was about to undergo a radical transformation from these outdated sources of infrastructure and technology to, you guessed it, using the sun, the genome, and the Internet.

The student of history will easily point out that these cycles replay themselves over and over again throughout all civilizations and human population centers.

The importance of this shift, grossly understated in this book when taken into political terms, can only be described, less than adequately, as enormous. Our grandchildren and their children for years will be reading about this period of time where America attempted to shift power gears and ended up blowing out the clutch. The powers in charge of these aging technologies were not quite ready to be put to bed yet and wanted to take out one last hurrah of final profiteering before the economy shifted. Hence, I'll argue, one of the reasons for backing the Bush Cheney Iraq war. Also the fight over health care.

The shift, for the American economy, got delayed for ten years--thank you to all the greedy profiteering self-interested executives and investors living in their castles on the hill and watching the peasants toil in the fields everyday looking up longingly for their opportunity to climb the ivory steps to their own gilded apartments in the high towers above those with "less".

Now here we are, the lower classes in America, left with the proverbial mess after the big party and taped to our besotted foreheads is the taxpayers' bill for cleaning it up. The gum crushed into the pavement, the litter strewn about here and there, people maimed and laying on the curb, the panties wrapped around streetlights, and all those little annoying party favors. Obama crushed and weighted down with the responsibility for coming up with a plan to clean it all up. The nobility of course demanding, and receiving, payment for showing the lower-classes how to party.

"Thanks for the good time. Don't call home when the baby arrives."

Isn't it funny how sometimes that one crucial, beautifully snapped, public tableau, like the party scene, can implant itself into the brains of an entirely unsuspecting generation... and fester. College is a special place for the incubating "Festers". Hence underfunding college for the less-than-elite-legacy players is a great idea for those specially interested in staying in power.

Fester like a wound improperly cleaned. Fester like a canker sore on a tongue so it hurts every time flicked. Fester to irritation like the pimple rubbed into a boil. Until suddenly the thought of the wound takes over everything and explodes into the consciousness so ripe and ugly that nothing else matters until it is cured.

Now I am beginning to understand, you see, how those periods of strife appeared within my naive ideal of America. Now I am beginning to see how an idea can exist in the unspoken consciousness of people but never emerge until the moment is ripe. Now I understand how political dynamics can change just as rapidly as they did in the minor experiment of sixth grade politics. Seemingly overnight when placed against the scale of human history.

The working class is restless in its slumber. The real question is whether or not it will awake. The students are becoming disquieted. The wind blowing across America's underclasses is not as temperate as it was yesterday. Now there is an air blowing that we have all been used. Duped. Taken advantage of. Our country seized by the powerful and wealthy and used to advance the big national corporate plunder. We, the common and average citizen, have been the mules to curry large amounts of wealth into the hands of the "handlers". The shadow thought of equality and democracy just a hand puppet figurine drawn on the wall to elicit cooperation.

How long will this brew take to boil? Or will it just allow a lid to be put on the wicked pot of thievery and placed back on the stove to simmer? It has happened before. The robber barons have been clocked. The peasants have taken back their country and reignited the idea of democratic equality. History has repeated itself more than once.

The only question is how to right the wrongs in a way which also upholds the integrity of the American ideal. This to me is what the real underlying fight for the public option in health care reform is all about. It isn't about the budget. It isn't about the Democrats versus the Republicans. It is about who owns this country.

The people or the corporate elite.

Time will tell. History will be written. Someday some teacher will ask his students the home run question. "What is the defining moment of American Democracy?"

The entire American public is about to learn if the investment being made into the public education system pays off and how that question will be answered now and in the future. The power of the vote is mightier than the sword. I learned that in sixth grade. Hopefully other students did too.

Saturday, December 12, 2009

Healthcare Reform: Greeley's Thunderhead on Frog-Walking Conservative Democrats

A guest posting, written over the course of the last few months as the nations law makers bicker over health care, by the Greeley blogger Thunderhead. Thunderhead describes the legislative fallout of first giving the insurance industry the power to ignore antitrust legislation after WWII, for valid reasons, and now, three-quarters of a decade later, removing from the current House bill on healthcare reform the language which would have terminated such an advantage for the insurance industry.

Article 1 by Thunderhead

For health care reform in the congress, a hidebound Republican Party is frog-walking conservative democrats away from the establishment of single-payer policies. As unemployment numbers stretch into the multi-millions, as the dollar undergoes devaluation, as more American work is outsourced by chasing cheap labor-gradients around the world, we’re just going to have to take Bush’s advice and buy that health insurance savings account after all. You remember…the republican solution to health care?

Instead of repealing insurance mandates and anticompetitive legislation, the Senate Finance Committee’s reform of health insurance does nothing to lower health care costs. In fact, competition is inhibited to support existing monopolistic and cartel formation. The Finance Committee’s policy-making elite relies upon the continued abandonment of federal antitrust enforcement to further the erosion of competition; it also ensures that the industry’s captive customer base undergoes additional harm from systematic denial of vital medical services in support of corporate/investor profits.

Let us ask our health insurance agents: “What percentage of my spouse’s health and of my children’s health should be subject to profit-taking?”

But why must we now advocate for competition? While competition is the health of our economic system most businesses, large or small, given the chance, will seek to eliminate it; competition protects the life of the economy and requires constant vigilance by congress. It is not true that free markets self-regulate; unrestrained, undisciplined markets are deregulated markets that hinder rivalry and rush toward monopolization—toward anti-business and the brute-force application of corporate economic might alone--wiping out competition and consumer choice along a trail of fraud and deceit. Government, the necessary evil, provides the proper restraint, discipline, regulation and enforcement which makes an economy work for everyone, the poor, the middle-class, and the wealthy.

The Transition Report on Competition Policy compiled by the American Antitrust Institute states: that “…competition is the preferred regulator of business behavior.” The conclusion is undeniable--competition lowers costs. Competition is the market’s equivalent of natural selection. Bailouts are indicators that congress, over several administrations, failed to maintain competition in our markets. The aggregate of coincidence, folks, points to intent. Look to congressional PAC funding to see theirs.

By refusing to invest the health insurance industry with competition the Senate Finance Committee publicly demonstrates that it has no interest in improving health care by controlling costs. Instead, the Finance Committee is perpetuating a monopolized health insurance market.

Competition, essential to economists from Adam Smith to Milton Friedman, is now portrayed, through blustering media repetition, as a radicalized Bolshevik notion since it comes to a monopolized insurance market by means of “infused” competition via public option, that is, by government—the only entity large enough to compete with monopolization. Thus the Finance Committee will not place competition at the feet of an insurance industry which begs, by policies harmful to its customers, for regulation.

The 60 member democratic majority is, in part, complicit with the shrinking ranks of the republicans in forging a bill unpalatable to the public. All things considered, much of the Senate simply cares more about the relationships they’ve forged with large corporations. Their word, commitment and pride, is vested in those who pay to get them elected and re-elected.

Yet you have to wonder why they are not upfront about the wretched truth of their policies. The exertion of extraordinary corporate influence on congress is the most fundamentally obvious example of conflict of interest, anywhere. It is what happens when congress understands the natural human weakness to accept bribery then sanctifies it with legality. How do we think it will turn out?

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Let's talk about what is, what has been, and what can be. What is a town made of? What is the meaning of quality of life? Where does the future lie? And where have all the flowers gone?

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