We have to admit, we didn’t really follow all this photographers and bakers and gay wedding controversies as closely as we maybe should’ve. Silly us, we thought this was a personal service case or by extension personal servitude problem, but this somehow is bound up in religion and gay rights. When you get into an argument it may go off the rails if the wrong principles in invoked. A photographer refuses to render his personal photography service to a Gay wedding on religious grounds and loses under a state anti discrimination law. Take Gay and religious freedom out of the case entirely. A asks B to provide a good or service which requires a future meeting of the minds. B refuses by saying they are not a good fit. End of story. Professionals have done this forever. For whatever reason your heart isn’t in it and you can’t provide your best product or service you bow out. That protects both A & B from shoddy or worse outcome. Professionals have always had the right to not take on a client without providing any reason. “Just not a good fit” suffices. Judges most of whom were in private practice know this and should extend this logical choice to everyone.
Policy
THE SIMPLICITY OF DAVE’S PLAN
A common reaction we’ve received to Dave’s Plan to reform the Affordable Care Act (ACA) is that it’s just too complicated. Why mix retirement and other savings plans in with medical care reform? Actually the point was to simplify both by reestablishing the link between savings and expenditures. In the U.S. as with many other countries we don’t save as much as we should. This leads to problems as populations age. In the not too distant future entitlements for the retirees will crowd out most other Government spending. That of course will prove to be impossible. For instance, we just might need a national defense. Australia looking at a similar future has already opted for a mandatory 10% savings plan. It isn’t that we don’t have people participating in retirement plans. According to the American Benefits Council, defined contribution plans such as 401ks had 74 million active participants and that was in 2010. In that year total employment was 138,641,000. Employer health plans cover the majority of Americans. Obviously, we have a good base. All we are proposing is the accounts be held by Individuals with employers and the self-employed making the payments directly into Personal Benefits Accounts (PBA). Add a Catastrophic Health Policy to the PBA and everybody having one and we have the basics. We kept the ACA’s popular features of making the policies non-cancel able and children being able to stay on their family policy till 26. The ACA Subsidies and Medicaid payments based on age group experience would be deposited directly into qualifying PBAs by the IRS when their tax forms are processed, just as we do the Earned Income Tax Credit. With the PBA’s constant inflow of funds and growth, adding a Medical Credit Card completes the package. Continue reading
SSSHHH! MORE MIDDLE EAST POLICY ON THE QT
For the first time in more than half of century, we have a chance to have a Middle East Policy based on the actual realities on the ground and our own interests and values. The cold war and the West’s dependence on Mideast Oil forced us to overlook the fact that underneath a thin veneer of modernity, the area was actually moving backwards towards an imagined Muslim World that never existed. To curry favor with the various states we made alliances with leaders such as Sadat and Mubarak in Egypt who were less than democratic. Monarchs from Morocco to Iran were supported. As we did elsewhere in the world, we adopted alliances based on the enemy of my enemy is my friend policy. Just like our World War II alliance with Stalin’s Russia, we chose what was perceived to be the lesser of evils. Unfortunately, this forced us to overlook things that were abhorrent to Americans and/or policies that would be dangerous to the world. Beyond the basic lack of freedoms, two areas we went along with, much to our future distress, were the endless life of the Palestinian Refugee Camps and the continuing march of Muslims towards extreme forms of their religion.
At the end the 1948 Arab-Israeli Conflict, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was established to provide relief for 652,000 Arabs that fled the Israeli areas. Today UNRWA provides education, health care and social services to the 5 million Arab refugees in 58 registered camps. Over the same period approx. 850,000 Jews left Arab countries, the vast majority going to Israel. None of these people or their descendents live in refugee camps, even though there were cultural differences between the Jews from the middle east and Africa and other Israelis, they were welcomed and integrated in Israel. Why didn’t the Arab Nations also welcome and integrate their fellow Arabs? Only Jordan granted citizenship to the Arab refugees living there. While Palestinian refugees have worked in other Arab lands such as Kuwait and Saudi Arabia, Arab League instructions bar Arab States from granting citizenship. Without citizenship, the refugees have been at the mercy of a change of winds in host countries. For instance, Kuwait expelled Palestinian Refugees after the Gulf War. Why wasn’t the fate of these poor trapped people handled differently? Where was the U.S? Instead of helping these people find new homes throughout the Arab World, we were paying the biggest share for UNRWA to maintain these camps. We never put real pressure on the Arabs to do right by their brothers and sisters. And they are their brothers and sisters. Palestine was never a separate Arab Country. It was always a part of a bigger entity. Surely, Palestinian Arabs are closer culturally to others in the Arab League, than the Jewish Middle East and African Refugees that went to Israel. The Arabs other than Jordan shunned their humanitarian responsibilities and we felt it was in our interest to actually support this financially.
STILL MORE DAVE’S PLAN Q & A
Q. You say that your plan will cost even more than the ACA. How do you propose to pay for it?
A. Funding for the ACA is supposed to pay for coverage of most of the currently uninsured. For the moment we would leave funding as it is, knowing that it is probably inadequate. The reason is we really don’t know what our plan would cost. Instead of presenting some computer printouts and pretending we have real figures, we took a different tack. We already had a form of universal coverage before the ACA. It’s just that by comparison with the rest of the world it was very high cost inefficient system. Further it favored large companies over individuals and smaller entities, impeding labor mobility. Instead we designed a system to achieve the lowest cost to our economy. As a bonus we wanted the flexibility that would actually enhance economic growth. Catastrophic policies without any bells and whistles sold nationwide without having to cover preexisting conditions. Medical credit cards with little or no credit risk for providers. Huge reduction in third-party pay and the attendant costly paperwork. Every individual will have a financial incentive to find the best service and cost solution. People no longer locked in jobs for fear of losing their health insurance. This should give leverage to employees to get wage increases based on employers benefit savings and increase their mobility. If all these market incentives don’t reduce health care costs as a percentage of GDP, probably nothing would.
MORE Q & A ON DAVE’S PLAN
Q. How does this differ from Health Savings Accounts and very high deductible plans on the ACA exchanges?
A. We think our plan would be much better at lowering costs. The Catastrophic Policies would be cheaper because they could be bought Nationally with no payment defaults and stripped of any mandatory additions such as birth control or prostate tests. You tailor you account to your individual needs. Everything else in healthcare should be cheaper. If a huge market with no credit risk or no third parties to add costs and paper work doesn’t lower costs than nothing will. One caveat, however, is in the beginning with so many newly covered even 2 1/2 years might not give providers time to gear up. That might result in some bottlenecks that might result in some temporarily higher prices or waiting times. We don’t think the market will let that go on very long. In any case providers are dropping Medicaid patients now at an alarming rate and that would never get better. Because surgeries are a big part of the Catastrophic Policies, one other thing we would like to see is a policy option that would cover accredited foreign providers to lower the premiums. According to the Oct./Nov issue of AARP magazine a heart bypass in the U.S. costs $88,000, In Costa Rica $31,500 and in India $14,400. We saw a brand new hospital in India and when we asked about the surgeons we were told that every one of them had served on the staff of a major U.S. hospital. Additionally this would put price pressure on our hospitals. In any case each dollar in your PSA would buy more health care than if it was put in a Health Savings Account or an ACA very high deductible plan does now. We believe that the differences could be substantial. As people’s accounts grow and innovation kicks in over time the problem as a percentage of GDP would shrink. You can’t say that about any other plan we’ve seen. Continue reading
Detour on the Road 