Circumcision

See: http://www.webmd.com/parenting/news/20120827/new-policy-supports-choice-male-circumcision.  Excerpt:

“Studies from Africa and Europe show that circumcision cuts the rate of transmission of sexually transmitted diseases, including HIV, herpes simplex, and human papillomavirus (HPV). Evidence also shows that circumcision reduces the rate of urinary tract infections, especially in the first year of life; reduces the risk of penile cancer; and reduces the risk of cervical cancer in sexual partners.

What’s more, a study published last week in the Archives of Pediatrics & Adolescent Medicine estimated that if circumcisions continue to decline to levels seen in Europe, the U.S. could see:

·         A 12% increase in men infected with HIV

·         A 29% increase in men infected with HPV

·         A 19% increase in men infected with herpes simplex

·         A 211% increase in urinary tract infections in infants”

It really makes me wonder what is going on here.  In 1989, the American Academy of Pediatrics saw benefits.  Then in 1999, they said there were no benefits.  Now they find significant benefits.  There don’t seem to be any advances in the relevant issues to study or in the possible techniques.  So why would they be changing their mind so much?  It may be attributable to studies performed by other organizations.  But this does not create confidence that the AAP is critically reviewing the studies before publishing conclusions.

51-year-old attorney returns to work paralyzed

Follow this link to a story of a tremendously bright and successful attorney who has returned to work after being paralyzed by a skiing accident at the age of 50.

http://professional.wsj.com/article/SB10000872396390444233104577595571430731982.html?mod=WSJPRO_hpp_LEFTTopStories#printMode

The Future of Health Care in the USA

This article from the following link may sound scary, but it exposes a true risk and a major problem in President Obama's vision.  Not surprisingly, I don't entirely agree with the article.  It ignores, for example, the value of electronic medical records.  And I see value in studying best practices; although I'm not sure the government should control the research, we need to be sure we get objective analyses.

As a population ages and new technology is created, health care costs inevitably rise.  Our population wants everything without having to pay for it.  So politicians make us crazy promises they know they can't achieve.  If we want to reduce the cost of health care, we need to take personal accountability.  To encourage personal accountability, we need to:
* encourage programs such as HSAs that reward people for taking action to improve their health
* create more incentives in health insurance to encourage such behavior.

The radical wing of the Democratic party seeks equal results for everyone instead of equal opportunity for everyone.  They believe that people with drug, drinking, smoking or eating problems should not be held responsible for their behavior.  Of course, these people are responsible for an inordinate amount of our health care costs.  Many comparisons between USA costs and foreign costs make no adjustment for relative obesity and sedentary behavior, either because it is easier not to make the adjustments or because making the adjustments would interfere with their political goal.  Health care reform forbade charging more for health insurance for obese people, drug addicts, and alcoholics and allowed only partial reflection of the impact of tobacco use.  Ironically, in an effort to lower costs, health care reform allowed such people to pay less than people with healthy habits, if they engaged in cessation programs.  Yup, they could pay less than people with healthy habits but not more.

Just one other distinction between the USA and other countries is "end of life" care.  We spend a huge percentage of our health care dollars on "end-of-life" care.  Other countries are amazed at what we do, but the same studies do not reflect or separate out "end-of-life" care.

President Obama's policies would discourage private development of new drugs, technology, etc.  The result will be inferior health care, but we won't know what we are missing.

Radical Republicans would remove all safety nets, but I don't think either extreme is necessary.  In fairness to the Republicans, I should note that they would encourage charitable contributions, relying on individuals rather then the government to decide where our money should go.  In their vision, people would choose to support a health care safety net charitably, if they felt it was important.  If they chose to give more money to education or the arts, that would be their choice.

Ironically, the health care industry has been supportive of President Obama's efforts (so far thwarted) to nationalize the health insurance industry, being oblivious to his desire to nationalize health care as well.  He also essentially wants to nationalize non-profits, having such decisions controlled by the Executive Branch.

I have always cringed at and opposed "Robber Barons" and unreasonable bonuses.  I want to see flatter net income levels and generally support higher taxes.  I favor estate taxes and strongly-graduated income taxes.  But I also strongly support fiscal prudence and checks and balances.  President Obama sacrifices fiscal prudence in favor of unsustainable politically-attractive proposals and he actively is undermining the checks and balances as partly described in the following article.  I've commented on these issues elsewhere.

In some respects, the best short-term government might be a benevolent dictatorship.  But history has proven that benevolent dictators often become non-benevolent dictators and that their successors are less likely to be benevolent. Because of the foibles of all mankind, we need checks and balances.  I ask supporters of President Obama: "How would you feel if the Tea Party won a future election and inherited the control that the President is creating for the Executive Branch?"


http://online.wsj.com/article/SB10000872396390444358404577605233123916096.html

Cheesecake Factory Medicine

Paul Ryan's critics and the architects of ObamaCare reveal their real vision for health care: coercion.

The liberal assault on Paul Ryan's Medicare reform has often been ugly, but that's not to say it hasn't been instructive. While ripping Mr. Ryan, ObamaCare's intellectual architects have been laying out in more detail their own vision for the future of American health care. It's a vision that all Americans should know about before they go to the polls in November.

***

No one did more to sell the Affordable Care Act than Peter Orszag, the former White House budget director who claimed during 2009-2010 that as much as a third of health spending is "waste" that doesn't improve outcomes. But now that he's repaired to Wall Street and writes an online column, he's deriding the idea that better incentives can reduce costs and sneering at the "health-care competition tooth fairy."

So get a load of Mr. Orszag's Tinker Bell alternative, which he called the "most important institutional change" after ObamaCare passed in 2010: the Independent Payment Advisory Board composed of 15 philosopher kings who will rule over U.S. health care.

Who are these Orszag 15? Well, nobody knows. The board was supposed to be up and running by the end of September, but the White House is avoiding naming names for Senate confirmation until after the election. No one knows, either, what this group of geniuses will propose, but that too is part of the grand Orszag plan.

ObamaCare included dozens of speculative pilot programs that are supposed to make health-care delivery and business models less wasteful. Mr. Orszag's payment board is then supposed to apply the programs that "work" to all of U.S. medicine through regulation, without Congressional consent or legal appeal. Seriously.

It doesn't take a mythical childhood metaphor to mock this theory. Mr. Orszag's style of central planning—in what was already the heaviest regulated U.S. industry before ObamaCare—has failed over and over again in Medicare since the creation of the fiat pricing fee schedule in the 1980s.

***

Meanwhile, another ObamaCare godfather, the surgeon and influential New Yorker magazine writer Atul Gawande, has further instructions for the medical masses, this time from—believe it or not—the Cheesecake Factory, the chain restaurant.

Dr. Gawande's point is that medicine would function better if care were delivered by huge health systems that can achieve economies of scale, like commercial kitchens. Care ought to be standardized like preparing a side of beef, with a "single default way" to perform each treatment supposedly based on evidence, with little room for personalization.

No doubt health care could learn a lot about efficiency from a lot of industries, but to understand the core problem with assembly-line medicine, recall that ObamaCare actively promotes medical corporatism. The reason isn't to encourage business efficiency but for political control. Liberals believe in health-care consolidation because fewer giant corporations are easier for Mr. Orszag's central committee to control, and more amenable to its orders.

Thanks to ObamaCare, Cheesecake Factory medicine is already becoming a reality. Irving Levin Associates, a research firm that tracks health-care mergers and acquisitions, reports that M&A hit $61.2 billion in the second quarter and the highest annual levels since the 1990s. Three of five hospitals now belong to a parent company's network, while more than half of physicians are employed by hospitals or systems, not independent practitioners.

On the insurer side, too, incumbents are demolishing their smaller rivals. Aetna is buying Coventry Health Care, a company that administers Medicare and Medicaid benefits, for $5.6 billion. WellPoint made the same play in acquiring Amerigroup for $5 billion in July, while last October Cigna laid out $3.8 billion for HealthSpring.

This bureaucratization will amplify everything patients and businesses despise about the current system: the unintelligible $103,234.61 bill for a turned ankle, the doctor who can't take a phone call because of how the hospital schedules shift.

Why aren't mom's eight specialists aware of each other's existence? Why is health care mostly conducted via a pad and pen, and beepers and fax machines, in the iPhone era? Why are there so few geriatricians when the first wave of Baby Boomers is already turning 65? Why is it still so hard to find usable information about quality and prices?

The reason isn't a lack of hospital administrators or technocratic experts. More often than not it's that patients aren't the true consumers. The government is, and medical providers inevitably serve the paymaster.

Mr. Ryan's insight is that health care would work better if patients were controlling their own dollars. His reform accepts the fact that health, disease and treatment are usually complex, individual and unpredictable, not commodities that can and should be reduced to protocols, metrics, algorithms.

***

The immediate danger of the Orszag-Gawande-Obama vision is that layer on layer of new regulation will lock in less-than-best practices. This makes the status quo worse, because too-big-to-fail oligopolists have less incentive to innovate to reduce costs and improve quality.

The longer-run danger is that Mr. Orszag's cost board starts to decide what types of care "work" for society at large and thus what individual patients are allowed to receive. One way or another, health costs must come down. And if Mr. Ryan's market proposal is rejected, then government a la Orszag will do it by brute political force.

A murderer's row of liberal health-care gurus—Zeke Emanuel, Neera Tanden, Don Berwick, David Cutler, Uwe Reinhardt, Steve Shortell, Mr. Orszag, many others—recently acknowledged as much in the New England Journal of Medicine. They conceded that "health costs remain a major challenge" despite ObamaCare. That would have been nice to know in, oh, 2009 or 2010.

Anyhow, their big idea is the very old idea of price controls that are "binding on all payers and providers," much as post-RomneyCare Massachusetts is already doing. When that strategy fails as it always has, and the public denies further tax increases, the Orszag payment board will then start to ration or prohibit access to medical resources that it decides aren't worth the expense.

These political choices will be unpopular and even deadly, which is why Mr. Orszag worked so hard to insulate his payment board from oversight or accountability. Congress can only reject the board's decisions if it substitutes something else that reduces costs by as much. More amazing still, only a minority of the board can be "directly involved" in the provision of health care.

This latter provision is supposed to prevent the alleged conflicts of interest that come from knowing something about how health care is provided in the real world. What it reveals instead is that this board isn't about medical quality at all. It is purely a balance-sheet exercise to make sure that the Orszag-Obama agenda of top-down health care can't be undone by something as crude as democratic consent.

And they claim that Paul Ryan's proposal is "radical"?

***

What the debate over Mr. Ryan's reform is revealing is that the real health-care choice, and the real choice this November, is about the role of government. The Orszags of the world ultimately have what President Obama would call an "ideological" preference for coercion over individual choice. They want to impose the unilateral decisions of the state over those of millions of Americans.

The larger irony is that ObamaCare's architects claim that all of this will lead to more equity in the delivery of medical services, but in practice it will have the opposite effect. Americans of even middle-class means will not tolerate being told they cannot spend their own money to improve their own health or save the lives of their loved ones, so under price-controlled ObamaCare we will quickly see the emergence of a two- or even three-tier system outside the reach of government.

The affluent will get their own special level of service. Certainly Mr. Orszag, a vice chairman of corporate and investment banking at Citigroup, won't be getting treatment at some municipal hospital. The Cheesecake Factory is a great place to eat but you probably wouldn't want to be operated on there—especially if it's run by the government

Tidbits

A review of the Nurses' Health Study and the Health Professionals Follow-up Study showed that the likelihood of coronary heart disease was significantly higher among people with blood types A, B and AB compared with those with type O. Rh factor was not associated with any difference in cardiovascular risk
(http://www.smartbrief.com/news/ahip/storyDetails.jsp?issueid=6B380F66-F6EC-427D-A5D4-E9F694EDB434&copyid=B81BBF98-5F7F-4C55-8E30-02209B42FB59&sid=ef128aed%2dbf15%2d4049%2d85c5%2de984f6aeb71c&brief=ahip)

Since the vaccine against chickenpox became available in the United States, the country is seeing a lot less of the disease.  Between 2000 and 2010, the incidence of chickenpox declined nearly 80 percent, from 43 cases per 100,000 people, to nine cases per 100,000 people, according to a new report from the Centers for Disease Control and Prevention (CDC).

(http://www.myhealthnewsdaily.com/2970-chickenpox-cases-drop-80-in-last-decade.html)

Only 31% of TX doctors now accept Medicaid patients because the reimbursements are too low. ("'You lose money' - small clinics leaving Medicaid System", Mark Haslett, Amarillo Globe-News, August 12, 2012)

Supreme Court Ruling on Health Care Reform

I have not previously commented on the SCOTUS ruling on health care reform because I wanted to read more about it.  I’ve now done that.

Although I do not like PPACA (the health care reform bill), I initially opposed the effort to contest its constitutionality.  Whether or not I liked the bill, the unusual tactics used to pass it or the fraudulent accounting used to justify it, it had passed legally.  I also thought it was strange, at best, to attack PPACA with an argument that would lead to the conclusion that the government could create a mandatory government-run program but not require that people acquire similar services if they are available only in a private market.

As the debate continued, my position modified somewhat.  I recognized that there was a legitimate argument against the constitutionality of PPACA.

As explained below, the four parts of the Supreme Court ruling make sense to me. I can’t say that I would have voted with Chief Justice Roberts because I have not done the background reading and thinking that a Supreme Court justice needs to do to rule on such issues.

1)     As a result of this debate, I’ve learned about the unreasonable interpretations that have been made regarding the Commerce Clause of the US Constitution, starting in 1942 with the Wickard v. Filburn decision.  In its decision on PPACA, SCOTUS rejected the Commerce Clause argument made by the administration.  That is encouraging, but I am concerned that the SCOTUS ruling on PPACA might not preclude continued abuse of that clause, because the SCOTUS decision might be interpreted narrowly, might be ignored or might be reversed in a future case.  I’m confident that I would have voted with this part of the decision.

2)     Secondly, the administration attempted to blackmail states into adopting PPACA’s major expansion of Medicaid, by pulling unrelated Federal funding away from the states that did not adopt the expansion.  SCOTUS ruled such blackmail to be unconstitutional.  Unfortunately, it appears that the wording said that the government could not withhold other Medicaid funding if a state chose not to adopt the expansion.  I would have preferred wording that rejected such blackmail in general.  Although I like this part of the decision, I don’t know if I would have voted for it.  Although I think such blackmail is unquestionably wrong, it is not clear to me that it is unconstitutional.  As noted above, I have not done the requisite reading and analysis to reach such a conclusion.

3)     The Anti-Injunction Act (AIA) prohibits lawsuits from challenging a tax that has not yet been assessed.  The least publicized aspect of the PPACA decision is that SCOTUS ruled that, in the case of PPACA, such a lawsuit could be filed because PPACA included specific wording that it was not to be treated as a tax.  I think I would have supported this interpretation, but I am concerned that the Anti-Injunction Act may have unintended detrimental consequences.  It did not anticipate taxes interwoven with ancillary, costly and difficult-to-reverse implementation requirements.  AIA seems somewhat similar to disallowing anti-worm computer protections (you couldn’t take corrective action until the worm has activated in your computer).  I hope Congress modifies AIA so it cannot be used to protect a major controversial program.  But I don’t think that is going to happen.

4)     Lastly, of course, SCOTUS ruled that PPACA is not an “individual mandate” but rather imposes a tax burden on anyone who does not participate.  I think that is a logical position.  It then begs the question “What is a constitutional tax?”  I don’t know what restrictions might exist.  But there seem to be relevant precedents.  For example, the high sales tax (N.B., this is not a Federal tax) on the purchase of cigarettes is presumably justified because people who purchase cigarettes, as a group, add to our health costs, at the expense of other citizens.  A similar argument could be made that people who don’t buy health insurance could add to our health costs, at the expense of other citizens.

Why I Voted For President Obama

The primary reasons I voted for President Obama were:

1.     I felt that we needed a President who would bring us together as a country to solve our problems.

2.     I thought he would be the “education” President.  With his background as a community activist, he seemed particularly well-positioned to encourage our inner-city youth to pursue the education which is critical to them.

3.     President Obama promised to tackle our national debt, which is a huge threat to future generations.

4.     President Obama, like many politicians, promised to take a new ethical approach, changing Washington for the better.

President Obama has done some things well.  For example, in general, he seems to have handled Guantanamo and Libya well, caught Bin Laden, uncovered Medicare fraud and had much success with drones (a tactic worthy of significant discussion that probably would have aroused heated opposition if done by President Bush).  I also am sympathetic to many of his values, but he has fallen dramatically short relative to the four key reasons I voted for him and his actions could be disastrous to the future of our country.

Bringing our country together politically

During his primary campaign, President Obama’s theme was that we could solve our problems by working together.  During the election campaign, that theme disappeared, but I hoped he would follow that course when he became President. 

Most politicians gravitate toward the center when they become President.  However, President Obama did not do so.  Whether that was his plan or whether he was persuaded by Nancy Pelosi to bulldoze the Republicans (Ms. Pelosi says that she worked hard to push President Obama in that direction), he is responsible for dividing our country tremendously.

President Obama and his extremist allies (such as Nancy Pelosi, Barney Franks, Harry Reid and Henry Waxman) concluded that they did not need any Republican votes, so they would ramrod their programs through Congress.  Many of my friends listen to President Obama’s glib statements and believe that he reached out to Republicans in an effort to be bi-partisan.

Had he done so, the Republicans as a group may not have responded favorably.  Unfortunately, he did not test them.  Because of my strong feeling in this regard, I watched closely for such actions and gave President Obama the benefit of the doubt until it became undeniable that he had no intent to work with the Republicans.

Instead he focused entirely on bringing the Democratic vote together.  He and the above-mentioned Congress people cajoled the Blue Dog Democrats, lied to them (and the public) about the provisions and impact of proposed legislation (his health care reform was laden with fraudulent economics), then tried to bribe them (outrageous bribes for Nebraska, Florida, etc.), and then resorted to hard pressure politics to bully the Blue Dog Democrats into abandoning their principles.  The result: President Obama destroyed the Blue Dog wing of the Democratic Party, causing them to be pushed out of Congress by Tea Party Republicans who were elected with the support of moderate Democrats such as me who felt betrayed by our elected officials.

In the past, although we had only two parties, both parties were dominated by their moderates.  President Obama changed that.  If you don’t like the Tea Party (I don’t support most of their key positions), you should vote against President Obama because he created the Tea Party success by destroying the Blue Dog wing of the Democratic Party.

I held out hope until two developments made it impossible to pretend that President Obama had any intention of bringing the parties together.

The first was the election of Scott Brown.  President Obama campaigned in Massachusetts against Scott Brown, taking the position that he could never get any Republican to vote for his programs.  That was mind-boggling to me.  He couldn’t get a single Republican to vote for his programs?  Ironically, Scott Brown himself sided with the President on some votes soon after being elected.  Olympia Snowe was one of the Republicans who voted for President Obama’s stimulus program and was willing to vote for his health care reform with reasonable modifications.  Even Congressman Paul Ryan has sided with President Obama on some issues. 

Then when Scott Brown was elected, I was hopeful that President Obama would take advantage of that election result to tell his Congressional constituency that they had to find a way to work with at least the most moderate Republicans.  Instead, he resorted to shenanigans to push legislation through.  There was precedence for those techniques, but they were abominable and inappropriate for a President who had vowed to cleanse the political culture in Washington.

Shortly thereafter, there was a heavily publicized day to discuss all the issues regarding health care legislation to see if compromises could be found.  As was obvious to anyone who watched the event and as was documented by printed exchanges among Democrats, the event was staged not to work together to find solutions (as advertised), but rather specifically to embarrass the Republicans.  I’m sure some of my friends are saying “the Republicans would have done the same thing in President Obama’s place”.  That might be right, but my conclusion is that we need to discipline our politicians who act in such fashion.  “Would have” is speculative; President Obama led the effort to act in this fashion.

The only ray of hope was ironically on a tax bill on which President Obama compromised.  I actually was opposed to his compromising on the bill, but I took it as a possible sign that he might be changing his approach.  Unfortunately, it was a singular aberration.

I understand that many of my friends will reject the above commentary.  Many appear to be guided by what they want to believe.  I’m sure there are people in our country who are biased against President Obama because he is black, but, in my circles, I’ve seen a common resistance among whites to question President Obama’s actions.  It seems important to them to support President Obama blindly to demonstrate to themselves and others that they are not racist.

Bringing the citizens of our country together

Well before the press sounded the alarm, I observed to friends and family that I was shocked that President Obama was encouraging class warfare.  I’d never see a President do anything like this.

President Obama has been setting up scapegoats whom he illogically and shamelessly blames for everything.  Although I have consistently supported higher taxes and believe that the affluent should probably shoulder a bigger share, President Obama’s diatribes remind me of the approaches of demagogues.  He blames everything on the wealthy and business and gets away with this approach because frustrated people love to have scapegoats.  It is foolish to support such behavior.

If despite his war on business, business makes some progress, he of course takes the credit (as would other politicians).  I have more staff now than when Mr. Obama became President, but counter to what he would have you believe, that has occurred because of my intentions and efforts despite the obstacles he has created.

I have never seen a President drive our country apart as much as President Obama has with either his undermining of the moderate wings of both parties or his class warfare.  Either one of those positions would cause me to be upset about his behavior.  The combination of the two is calamitous.

I thought President Obama would be the “Education” President

I admit that President Obama did not say he would be the “education” president.  I reached that conclusion on my own, recognizing that his community activist experience in the inner city, his race, the benefits that he had gotten from his education and the importance of education to both our less affluent population and the country at large all would likely cause him to make education a big issue and allow him to have a major impact.

He picked Arne Duncan to be the Secretary of Education, which seemed promising.  But they have done little.  I was not a big fan of “No Child Left Behind”, because I think there is more to education than just test scores, and I have experienced that, human frailty being what it is, teachers will “teach to the test” if encouraged to do so.  However, it put a spotlight on improving results and increased accountability.

However, I have not seen much progress along the educational front under President Obama.  Education has clearly not been a key priority, other than student loans (which seem to have become a priority because of the opportunity for appealing sound bites).

I may have missed some good that has been done, but impressions are important in influencing behavior.  Lots of people say “perception is reality”.  I object strongly to such a sloppy thought.  Perception is not reality, but perception does influence reality.

I believe that President Obama’s influence on education has been negative.  It is not disastrous except to the degree that he has failed to take advantage of his golden opportunity in this regard.

The overwhelming impression left by the Obama administration is anti-education.

·         He lavished praise on the “Occupy America” movement, at no time suggesting that the students involved would do well to attend to their studies.  Personally, I applaud activist involvement, but it should be coupled with a strong emphasis on education.

·         He has continually been messaging to the less-educated parts of our population that their difficulties are not the result of their poor education, but are rather because the “1%” is taking advantage of them.

Even his health care reform was short on education. 

President Obama promised to tackle our national debt

President Obama promised repeatedly, during the campaign, that he would address our national debt and reform our entitlement programs to be sustainable.

When he came into office, he created the Simpson-Bowles Commission to propose solutions.  They did an absolutely fantastic and admirable job!   There were several aspects of their proposal that I loved and several that I felt sick about, but we needed to reform our approach.  If nothing else, the Simpson-Bowles plan would have sparked important national debate about how to get our finances under control.

So what did President Obama do?  He shelved it.

Later on, our silver-tongued President actually persuaded many of our voters that it was the Republicans who were “kicking the can” down the road.  When the debate raged about extending the debt ceiling, President Obama was single-focused on pushing the issue beyond the 2012 election.  Remember Animal Farm’s shift from “Four legs good, two legs bad” to “Four legs good, two legs better”?  President Obama has used similar catchy phrases to misrepresent his positions.  For example, his “Don’t kick the can” statements really meant “Don’t kick the can a shorter distance than after the next election”.

Whether you like Congressman Ryan’s budget ideas or not, he has bravely touched the third rail of US politics, as did Simpson-Bowles.  When he was in Congress, President Obama said that Congressman Ryan’s ideas deserved consideration. Since then he has cowardly backed away from trying to solve our financial debt issues, while increasing the debt in unprecedented fashion, resorting to gimmicks to hide the real situation, and jumping at the opportunity to criticize Congressman Ryan for his courage.

Upon being named as Mr. Romney’s intended running mate, Congressman Ryan stated that politicians should be “worried about the next generation instead of the next election”.  The Democrats who I’ve seen quoted about Congressman Ryan’s selection have underscored the relevance of his comment.  Although I’m sure there are Democrats (such as Erskine Bowles) who want to address our debt problems, all of the Democrats who I’ve seen quoted about Mr. Romney’s selection have been gleeful that they can bury Mr. Ryan for having bravely touched the third rail. They’ve gone even further, misrepresenting Ryan’s Medicare proposal. 

Just as with the case with Simpson-Bowles, everyone will disagree with parts of the solutions we need to take to solve our debt problems.  Neither Simpson-Bowles’ suggestions, nor Ryan’s, are likely to be adopted as presented.  But those with the courage to make such suggestions deserve appreciation, not dirty campaign tricks.

In considering the debt, in addition to the above commentary, these are some sub-topics that might be considered:

·         A big part of our problem is that major expenditures are off-ledger.  That is, we spend huge amounts of money on things that are NOT counted in the reported deficit.  Items that are off-ledger include Social Security, Medicare and prior to President Obama, our war efforts.  When the deficit and debt are reported, these costs are often ignored.  Even some of the alarm-sounding hawks on the budget substantially under-report the problem because they rely on projections of entitlement programs that presume that in 75 years the programs will be abandoned, leaving those who would then be eligible in the lurch.

·         I was excited when President Obama brought the wars on-ledger, thinking that Social Security and Medicare might follow.  My hopes were dashed.  President Obama did not bring the wars on-ledger to have more realistic accounting.  Rather he brought the wars on-ledger because he was expecting war costs to reduce.  He could then unrealistically use reduced war costs to mask large increases in deficit spending.  War costs are actually much more logical to be off-ledger than the entitlement programs because wars require temporary deficit spending.  Rather than bringing the wars on to the ledger, it would be more appropriate to create a sinking fund to set aside funding for a future war.  On the other hand, with our entitlement programs, we inexorably go deeper into debt each year.  It would be appropriate for the entitlement programs to be in the budget, which would make it harder for politicians to ignore their funding problems.

·         Regardless of whether you support President Obama’s health care reform or not, no one can reasonably defend the accounting* that was used to convince legislators and the public that PPACA would not increase our national debt.  I’ve commented on this in the past, so see my earlier writings if you are interested in this topic. 

*People who defend PPACA accounting tell me it would be fraudulent for private enterprise to do such accounting, but that the government can do whatever it wants!

·         President Obama bought votes by creating a payroll tax holiday for workers.  What a devilishly clever idea!  He gave high-visibility money to lots of voters, while reporting deficits that ignored this revenue loss.  Because social security is off-ledger, he dug its hole significantly deeper without having to acknowledge the impact.  This is parallel to the tactic he took in health care reform in which he dug a much deeper hole for Medicare in order to support acute health care.  In both cases he pushed us further under water by hundreds of billions of dollars without changing our reported deficit at all.  The payroll tax holiday also dramatically shifted away from the 50/50 employee/employer cost split that had always been followed.  It is scary that “solving” a problem by digging the hole deeper is a common President Obama strategy.  (He also tends to treat symptoms, rather than underlying causes.)

·         I supported President Obama’s stimulus program in largely lukewarm fashion.  I actually strongly supported (check my earlier messages if you question me) the infrastructure spending and electronic health care records.  We had ignored our infrastructure too long and an economic crisis is a great time to put people to work upgrading our infrastructure.  Unfortunately that was only a small part of the stimulus.  While more spending scared me, I felt it was important to support our new president and give him the benefit of the doubt. Furthermore, you can’t be sure of what will be the best solution and there are circumstances under which it makes sense to dig a deeper hole first.  For example, if a house is badly burned, it makes sense to tear down the remaining structure before rebuilding.  In retrospect, the stimulus failed to accomplish the goals President Obama predicted for it, but we don’t know what would have happened without the stimulus.  To me, the stimulus is not a major election issue even though I have a nagging feeling that unlike FDR’s programs during the depression (which created a lot of wonderful libraries, college buildings and park improvements), we won’t see much long-term benefit from the stimulus.  And I am definitely concerned that President Obama’s response to most issues seems to be to spend lots of money.

·         President Obama takes credit for the bail-out, even though it did not occur under his watch.  Most politicians would take such credit.  I also supported the bail-out in lukewarm fashion.  I look at things long-term.  Relative to the stimulus, I was concerned about increasing long-term debt.  Relative to the bail-out, I was concerned about bad precedent that could lead to poor future risk-taking. However, there was little doubt in my mind that the government would benefit financially from its “bail-out” investments.  Precedents suggested strongly that such would be the case.  As I predicted (a relatively easy prediction, albeit counter to a lot of people’s thoughts at the time), the government is reaping a profit.  President Obama should not be credited with that profit, but this is not a big deal to me.

·         As noted earlier, I have never strayed from being a relatively “high tax” voter.  I am not a fan of deficit spending, although there can be times (such as wars) when deficit spending makes sense.  Deficit spending could also make sense during a recession.  But if you’re going to engage in deficit spending during a recession, you have to build surpluses in good times.  We have not done so.  While I favor higher taxes, I want those taxes to be put to work to reduce our debt.  The left wing of the Democratic Party tends to spend more than every dollar they get, in good times and bad.  We could have higher taxes and at the same time plunge deeper into debt.  (Note: some readers will point out that Bill Clinton “balanced” the budget.  I agree that President Clinton did a good job in that respect, but our finances were not even close to being balanced when you consider the entitlement under-funding.)

·         Tax issues are very murky and our politicians obfuscate them.  The issue is less about who pays what share of taxes, but rather the relative net costs comparing taxes to benefits.  If you increase everyone’s income tax by $1, but then give $1.50 to the people in the lowest third of income, statistics will show that the less affluent are paying a higher percentage of the income tax, but the affluent will be subsidizing them more than before. 

Furthermore lots of hidden taxes (which politicians love) make the income tax slope much steeper than publicized.  Some of those hidden taxes include government revenue items such as uncapped Medicare tax, a higher Medicare tax on higher levels of income, proposed removal of the Social Security cap, higher Medicare premiums for more affluent people and taxing social security payments. 

Although not directly related to income, it is interesting to consider the hidden taxes of health care reform, which intentionally under-charges obese people and drug addicts (can’t pay any more than people who are not obese or drug addicts), smokers (can’t pay more than 50% extra, which understates the added cost, especially for long-time smokers), and old people (the oldest age price can’t be more than three times the youngest age price; might HHS restrict that further?).  PPACA expanded the reduction in health insurance premiums that can be provided to someone in a weight-loss, drug addiction, or other wellness program from the 20% limit in HIPAA to 30%.  (I don’t know why the government has wanted to restrict the incentives for such programs, but am glad that they raised the cap.)  The discount hopefully will reduce obesity in our population.  But it seems strange that someone who is obese could pay 30% less than someone who is thin.) 

Other hidden taxes extend beyond government revenue such as artificially high private pay rates for college and long-term care, which result from scholarships and under-funded Medicare and Medicaid services.  One of the potential benefits of PPACA is reduction of cost-shifting due to uninsured emergency room visits.  (Note: I strongly support scholarships; that’s not the point.  The point is that there is a lot of unrecognized cost-shifting.  We should be thankful that our more-affluent people are bearing these costs.)

On the other hand, arguments that low capital gains taxes bring in more revenue do not impress me; they are short-term studies which draw their conclusions based on people’s behavior of cashing in when tax rates are low.  I believe that in a steady-state environment, lower capital gains rates will reduce tax revenue.

Tax strategy deserves more honest and comprehensive analysis.

·         I believe that trickle-down economics has not matched expectations.  Too many of our business leaders have leveraged economic opportunities for their own benefit rather than showing adequate concern for their staff.  This has contributed to a lack of hope and lower expectations among the less affluent, which has increased the percentage of people who respond to class warfare rhetoric.  I believe government has a role to play in terms of checks and balances.  An economist from Yale (Robert Schiller) has an intriguing idea.  He suggests that the income tax rate schedule automatically get steeper when there is more income disparity and less steep when there is less income disparity.  I’m not sure that is a good idea, but it would be interesting to discuss.

·         President Obama expanded federal spending tremendously, then reduced it somewhat.  Of course, he takes credit for reducing the spending without recognizing that it is much greater now than when he took office.

Although I believe the affluent should pay higher taxes, I think we should recognize and appreciate the contributions they make to our society.  They have contributed a lot, but we need them to contribute more.  Declaring war on them is a cynical tactic for securing political power.

Has President Obama Delivered a More Ethical, Transparent, Effective Government?

I believe the magic of the United States has been a government based on checks and balances.  I think this entails checks and balances among arms of the government (judiciary, executive and legislative) and among powerful institutions (government, business, religion, education, the press, etc.). 

History has confirmed that power corrupts and absolute power corrupts absolutely.  Even if a miraculous leader avoids the temptation to abuse power, that leader’s successors will succumb to the temptation.

The Tea Party wants to shift power too far to business and the affluent. I don’t support their goals in that regard.

On the other hand, President Obama is a huge proponent of big government.  I think he believes that he supports capitalism, but it is clear that he does not.  He, like many other politicians with limited business experience, believes that government can figure out how best business should run.  They do not trust the market, nor people with experience.  Instead they think they if they sit down and study something for a short period of time, they can become better experts than people who have specialized in that area for a long time.  Their hubris is huge!

I don’t harp on Solyndra; investments can go sour.  The issue is not that President Obama has wrong environmental ideas, the issue is that, as is typically the case, he approached the problem inappropriately.  He presumed that he and his staff could pick the winners and losers.  Having government pick winners and losers is detrimental even if it works.  It gives them vested interest in influencing results when government should be independent.  If we want to encourage investment in environmental industries, we should do so with the tax code or other measures, allowing investors to pick the winners and losers.

If those are your goals, it is critical to encourage people to take control to lower their health costs.  Wellness must be encouraged.  However:

·         The Democrats insisted on overcharging non-smokers, the young and other people with healthy habits.

·         They chose to under-utilized wellness concepts.

·         They minimized the More importantly, he approached health care

When I was young, I was enamored with the potential for centralized government to create fairness and efficiency.  Like many people, I’ve learned as I’ve aged that huge government creates fundamental problems:

1.     The farther spending decisions get from the public, the more waste occurs.  State politicians are elected partly based on their ability to secure federal funds.  Local politicians are partly elected based on their ability to get state funds.  Everyone wants to get their “fair share” of the government spending.  Everyone feels that they are spending someone else’s money.

2.     It becomes an increasing burden on the economy.  When business gets smaller and government gets larger, it becomes harder and harder for business to generate the economics to cover the expense of government.

3.     More government leads to more rules.  The cost of doing business is unnecessarily large.  Government creates lots of ‘tax breaks’ to encourage various actions.  The cost of reviewing, understanding and applying those tax breaks may well exceed the benefits.

4.     It thwarts democracy.  Government workers are less likely to vote against the government.

5.     As noted above, power corrupts and absolute power corrupts absolutely.  Central governments grab and exercise power in coercive ways.  Consider recent actions of many Federal departments, such as the National Labor Relations Board.  When I confronted two Department of Health and Human Services’ employees (who I greatly respect) about their efforts to change the CLASS Act* in ways that were unequivocally contrary to the wording of the law and the expressed goals of the law’s proponents, they did not deny my characterization of their action.  Instead, one responded that he thought it was okay to do so because “they were making the law better”.  The other acknowledged that the administration’s efforts might get blocked.

*The CLASS Act was a long-term care insurance part of PPACA which was included in health care reform so that proponents could use all of its premiums over the next 10 years to fund health care reform while ignoring the need to set up reserves to pay future long-term care claims.   When industry experts pointed out that the CLASS Act was mortally flawed, the administration continually denied that fact, until PPACA was passed, at which time they suddenly changed their stance.

Those of you are comfortable with the increased powers granted to and/or assumed by President Obama should consider how you would feel if, in the future, a Tea Party president had such powers.

Many politicians, non-profit professionals and academics see themselves as “white hats” and perceive business people to be “black hats”.  We’re all human and vulnerable to the vagaries of human emotions.  That’s why we need checks and balances.

The irony of this “black hat” vs. “white hat” world view is that I find that business people often question the ethics of their behavior more than politicians, non-profits or academics.  I’m not suggesting that business people are more intrinsically ethical.  Even if they are less intrinsically ethical, the nature of our world causes them to question their decisions from an ethical position more than academics, non-profits and politicians in general. (There are, of course, many counter-examples.)

Some business people question the ethical nature of their decisions because of strong personal ethics.  Others do so because they know that they are subject to significant checks and balances with the government, media and social media.

On the other hand, many politicians, non-profits and academics are so convinced that they are “white hats” that it never occurs to them to question their motives.  Many of them are strong adherents of the belief that the “ends justify the means”.  Following an “ends justify the means” philosophy is degrading to the ethics of our society.  Think about all the distortions, lies and chicanery in our political elections.  We need to discipline our politicians.

A prime example of “the end justifies the means” was President Obama’s campaign against insurers.  He and his allies in Congress have repeatedly talked about forcing insurers to cover pre-existing conditions.  However, they concluded that the insurers were right that no insurance system can survive if pre-existing conditions are covered without mandating insurance.

The insurance industry, of course, can’t mandate insurance.  When the Federal government created a tax on people who did not purchase insurance, it did not force insurers to cover pre-existing conditions, it enabled them to do so.  But describing the situation fairly and rationally would not be as politically expedient as the divisive approach of mis-educating the public so that they could scapegoat the industry.

In one small but even more illuminating aspect of that campaign, candidate Obama repeatedly complained that the insurance industry had denied paying his mother’s health care bills.  He suggested that she died prematurely because insurers would not pay for her treatment.

After the election, it turned out that her health insurer covered her costs and paid her providers directly.  She had no complaints about her health insurance.  However, she had filed disability income claims that had been denied.  President Obama had been her attorney in her challenges of the disability claim denials.

He brazenly distorted the situation.  When the White House was confronted with the evidence, they did not deny that his repeated statements were inaccurate.  Instead, they said that he had reported his recollections.  If you don’t find that outrageous, please give it careful thought.

1)     These were not off-the-cuff reminisces.  This was an orchestrated repeat campaign.  When you’re going to highlight such a situation, it is inexcusable not to check your facts.

2)     President Obama was his mother’s attorney on the case.  Is it credible to believe that he did not remember the case he managed for her?

If my friends have read this far, I know that many of them are trying hard to rationalize this abhorrent behavior on the part of President Obama.  They’ll “buy into” the “how he remembered it” argument or that it “doesn’t matter whether it was disability insurance or health insurance” or that “others lie like that too”.  I’d simply ask them to fairly evaluate what they would say if an opponent of President Obama were to be exposed as having told such a lie.

Candidate Obama severely criticized Hillary Clinton for her statement that she had encountered enemy fire getting off an airplane.  Her lie paled compared to President Obama’s repeated malicious statements.

I like to vote for candidates who have integrity.  Even if I disagree with them, at least I can trust them.  Of the four people running for President and Vice President this year, there is one who seems to have unquestionable integrity.  That is Paul Ryan. 

President Obama’s clear lack of integrity makes it imperative that I vote against him.  His lack of integrity is unquestionable when you consider:

1)     His continuous scapegoating of industry and the “1%”, pretending that he can balance the budget by soaking the rich.

2)     His repeated fraudulent accounting.  As I’ve told people, if I’d ever done accounting like President Obama, I’d be in jail.

3)     His stubborn and cowardly refusal to deal with debt issues, while pretending a willingness to do so.

4)     His blatant lie about his mother’s insurance.

I also think we need a centrist.  Mitt Romney is the only centrist candidate.  The best evidence: the Democrats indicate that he is the father of health care reform*, yet also criticize him as an extremist.  Obviously those are contradictory arguments.  Clearly, Mr. Romney worked with the Democrats in Massachusetts to try to improve health care, at the same time turning a $3 billion dollar deficit into a $1 billion surplus.  That is the sound financial and centrist, across-the-aisle behavior we need. 

*For what it is worth, there is a difference between a state-run program and a federal program.

In Massachusetts, his platform for education helped Massachusetts develop top results. 

Earlier he agreed to be responsible for the Winter Olympics in Utah.  It had been riddled with ethical problems and a $379 million shortfall.  He produced a wonderful event, with class, integrity and a $56 million surplus. 

He has served in a variety of roles and has succeeded in all of them, while gaining varied, valuable experience. 

He has shown courage in addressing issues.  You can read his platform at http://www.mittromney.com/issues.  I don’t agree with all of it, of course.  In particular, I disagree with him on taxes and abortion.  But I agree with him more than I agree with President Obama and, as noted above, Mitt Romney is a proven across-the-aisle worker, diametrically opposed to President Obama’s record. 

He will listen to both sides and find what appears to be the best solution.  I think he will be the first president since Bill Clinton to perform in such fashion. President Clinton was the most recent president to have a positive impact on the budget, even though the claims about his presidency greatly overstate his results in that regard.  Mitt Romney’s style is closer than President Obama’s style to President Clinton’s style.   I certainly did not agree with everything that President Clinton did and his inability to control his sexual urges was a significant problem.  But he did work well with the Republicans and he did make progress on the budget and welfare.  His foreign policy was strong.

President Obama eschewed orderly transition in Egypt, being overly anxious to demonstrate his absolute rejection of a US ally.  Contrast that with his comparative long tolerance of Assad’s terror in Syria.  Admittedly, some other presidents have taken similar steps.  But it is an amazing policy to encourage developing leaders in other countries to align with our opponents because they can rely on the support of our opponents and rely upon the US not being willing to oppose them.  If they choose to side with us, they know they’ll get resistance from our enemies and a likely stab-in-the-back from us.

President Obama did well in Libya, but he really has screwed up in Palestine.  His solidly pro-Palestinian messages encouraged the Palestinians in their UN efforts, at which point President Obama reversed his stance, surprising everyone.  He was right to reverse his stance, but what a screw-up it was to signal the Palestinians to proceed in the first place.

One of President Obama’s least heralded actions was to oppose democracy in Honduras in order to prop up a Marxist regime that was flouting Honduran law.  Our media did a terrible job in reporting that action.

Mr. Romney is a good man, not egotistical, who not only has donated a lot of money to charity, but also has behaved in a sympathetic and altruistic fashion well beyond any reasonable expectations in a number of circumstances. 

He is also waging a much cleaner campaign than is President Obama.  Note that I am NOT endorsing the approaches of many of the Republican state and local candidates.  They are waging some misleading campaigns.  We should strongly oppose the candidates who engage in the dirtiest campaign practices.  How else will we reform politics if we are unwilling to hold our politicians accountable?