Now, just wait a minute.

You knew it had to happen. Obama has steamrolled many other items in his first few months, now, according to his latest plea, it's now or never for health care. He reminds me of a little boy that has to urinate, jumping up and down and holding his genitals. But let's think about this for a minute before we start "reforming",about 20% or so of the entire US economy.



There are multiple facets to the question of health care costs, many stake holders, many many different functions. Most points of view, payers, providers, hospitals, technology firms, medical equipment suppliers, and on and on. As an opinionated jerk, I know little about all of these points of view..........but, I spent thirty-three years of my life making a living selling, underwriting, servicing and paying claims for benefits of health insurance. I've met with provider groups, been in on the creation of two aspects of cost-containment benefits, built networks and been the President of CNA Ins Federal Markets Division. I took a book of business of 145 million dollars of premium to over 2 billion dollars when I left in 1997. I should point out that 10 years in the health care industry is a lifetime of changes so many things are different then and now. Therefore I'm going to keep my comments simple and focused on the basics, the "truths" about funding health insurance that are timeless.




As I understand it, the President's goal is to reduce health care costs while insuring everyone. Right off the bat that goal shows the naivety of rhetoric written to supposedly allow the masses to understand the policy and political goals of the administration. The old sound bite approach. How can overall health care costs decrease if we're adding approximately 46 million new people? Just for kicks let's assume there are 200 million people in the USA if we subtract the 46 million without insurance we come up with a total of 154 million insured. The costs of that 154 million would have to reduce by (46/154=29.8%) almost 30 percent to add the 46 million uninsured and just stay even. Let me put that number in perspective. An insurance company in the health care field rarely is allowed to keep more than ten percent of the premium for expenses and profit. There is one glaring exception HMOs, but I"ll get to those bastards later(remember...opinionated). Let's assume there we're no expenses and profit........impossible I know, but I want to keep the math simple. That reduces all costs by ten percent. Boy are we on our way or what! However, there is that pesky 20% of the costs of 154 million people we still have to deal with. The first thing that we have to do is see how much that is, as a percentage of all costs, when spread over all insureds. I won't bore you with the math but 20% of the costs of 77% (154/200 the total population) is 15%. So every persons health care costs, once everyone is insured, and we've eliminated expenses and profit, has to decrease 15% to stay even for adding the costs of 46 million uninsured.



To reduce all costs by 15% is a Herculean task, but nothing is impossible for Obama. OK, lets start, first we get rid of all fraud, that's worth about 3%. Then comes the prices of drugs, overall a 5% reduction is doable without gutting R&D. Tort reform, capping liability claims , is probably worth at least another 2 % and that reduces the 15% to a 5% reduction in all health care costs. Hell, man, we are there. You can't tell me that we can't find 5%, fewer unnecessary procedures, more stringent cost controls, reduce elective procedures, there's lot's of places to look. Remember this 5% just gets us back to where we were before we added 46 million uninsured. We still haven't really addressed reducing costs....... we're just getting rid of the cost increase from adding the uninsured.



Only thing is it's all assumptions. Real cost reductions would not only take further assumptions............assumptions of the assumptions............but a bunch of wishful thinking while we're at it. Further, much of the data to quantify these assumptions doesn't exist, the assumptions are all inter-related, change one and all the others probably have to move, in other words it's a big house of cards on over 20% of the nations GDP. If it's wrong on the low side the architects are genuises, if its wrong on the high side, there is no going back, the commitment has been made, it will bring a whole new definition of deficit spending.



But, hurry, hurry, hurry, it's gotta go, hurry fast. I don't know man, maybe we ought to stand back and take it a little slower. Make sure we got one part right before we take on another segment. Huh?



Just for the hell of it I'd like to discuss two other complications of all of this. Why health care costs increase annually and will forever, and, preventative care.



There are five separate areas that contribute to normal annual increases in health care costs.

1. Inflation. This one is pretty much self explanatory, if every other part of the economy is raising their costs to make up for increased costs or decreased dollar value, so will every one in this sector of the economy. Health Care isn't immune.


2. Increased frequency of loss. As the population gets older they use more services, seeing the doctor more often is an example.


3. Increase in claim severity......as we get older not only do we use more services we use more expensive services. Inpatient surgery rather than outpatient, heart bypass rather than stints, etc.


4. Technology progresses every year and it is generally more expensive than the technology that it replaced. This cost has to be paid and it increases overall costs.


5. Advances in technology tend to generate new treatments for diseases that were untreatable before adding to the overall cost of health care.

There are many more things that add to costs but, usually, they'll fit into one of the categories above. I should make another point here, as health care gets better and better it will solve more and more problems. This, of course, will result in a better quality of life and, probably, longer life. Both of these will increase the cost of health care. A bunch.

Another twist, as supply (number of Docs, etc) costs increase rather than decrease. This is caused by two phenomenons, the first is that even if the demand doesn't increase the community of doc's will raise their fees so that the current Doc's keep their income and the new guy's make a living as well. If the demand increase, it usually does as supply increases, then just overall cost increases occur due to the added services delivered by the new guys. It's sort of circular, but the point is that supply and demand don't work the same way in health care as they do in other area's of the economy. It revolves around a necessary increase in supply in order to generate new providers to take over from retiring providers and, apparently, a bottomless pit of demand.

One of my pet peeves is the unabashed claim, the true mantra, the unquestioned statement that increased preventative care equals lower health care costs. This is total bullshit on so many levels that I'm a sputtering blob of humanity seeping into the keys of my computer whenever I try to address it. But, I'm going to give it one more go.

Even if you buy that preventative measures (notice I didn't say health care, you'll see the difference in a while) increase the health of an individual it's pretty damned hard to add up the costs of forty or fifty years of preventative expenses (I didn't say health care care expenses) and come up with a cost reduction based on lower than expected health care costs associated with the last several years of an extended life . Firstly what is a preventative expense, exercise over your life makes you more healthy, let's assume that is true although no one has ever proven it in a controlled sample using a statistically valid approach, so are health club expenses "preventative". Running is healthy, does the plan pay for the shorts and the shoes? "Lean Cuisine low fat dinners are good for you, does the plan reimburse you for food? When you think about it any reasonably intelligent adult could easily charge off 10% or so of his normal monthly expenses, especially if he's physically active. How are you going to show savings by avoiding a bottle of beta blockers and an avoided bypass surgery (my last one cost the insurance company, thanks to network discounts, $12,000).

See my point, I think a more valid and truthful approach to preventative expenses would be to disallow them in all health insurance plans. The human body is a machine, like all machines it requires maintenance, that's preventative care. Nobody but the owner is in charge of maintenance, and the owner is responsible for it's cost as well.

I don't buy for a minute that Obama or any other politician can significantly effect the cost of health care in the USA short of destroying it with rationing, mandated payments per procedure, in other words cost and frequency controls as law.......then they'll be no care, no costs, no jobs, no company cars, no hotel stays, airline trips, on and on...............hell ofa plan Obama, hell ofa plan Reid and Pelosi. Man are you guy's on it or what?

Real reform, creating a totally redesigned system capable of handling today's market rather than carrying the costly historical baggage of addressing the evolution of health care in the US over the last two centuries, will take an interdisciplinary approach, carefully monitoring the installation of each phase of reform probably over three decades. No politician ever born can think beyond the time of his hopeful re-election at the end of his current term. It takes a non political body comprised of all stake holders acting without lobbying or political interference to have any chance at really making a difference.

So, if it were up to me, I am afraid Obama would just have to wet his pants.

Good vs. Bad

Both Obama and Cheney gave speeches this week on National Security. Both said they were right, Cheney in the real world of foreign poor people that hate us and will take every opportunity to get us..........basically the old argument that man is inherently evil and will practice it every chance he gets. In that world lost wallets are never returned, lost children never found safe, etc. In this world we watch the haters and try to catch them before they act. And then we bomb them.



Obama, on the other hand basically argued that we should take the moral high ground and act as though man is inherently good...........then when they do inherently evil things we bomb them. It's mostly a difference that only progressive nations get. The rest of the world wonder why we waited so long. We have the power everybody knows we're going to use it if we're attacked or threatened credibly. So why not get on with it.



Way I see it both guys are wrong, man is neither good or bad. It's who wants it the most at that particular time and who thinks they can get away with evil acts. Man acts in his own best interest 99% of the time. Osama didn't care about a bunch of ideologues on plane that were going to kill themselves and he knew that the mountains of Afghanistan would hide him until the USA lost interest. He's just about made it, a couple more years of quagmire in Afganistan at 90 billion dollars a year and Obama will cut and run.


The thing that was most puzzling to me was that Obama said the past eight years were a mess that he had to clean up, but he has reserved to himself every tactic Bush used and an overwhelming majority of the policies of the last eight years he has kept in effect. Some of them are public some aren't. His solution for Gitmo is basically the Bush solution. So what, whatever works in a pinch. He's acting in his own best political interests and the best security interests of the country, which also happens to be in his best political interests.



His speech was more about busting Congress' balls than anything else. They actually stood up to him and said he can't have the money! How dare they, everybody knows he's just trying to fix the world, it's a hard job but he's taken it on, the people think he's the messiah (at least the starry eyed left). Who the hell is 90 senators to tell him, our fearless leader and a minority at that, what he can and can't do. How much money he get. Honky Muthafuckers.


I spent 17 years of my life going to 37 union local annual meetings, banquets, picnics, etc. As well as all the national meetings of the National office. Every officer and about eighty percent of the union were black and worked in the lowest wage grade of the the USPS. Minority Union politics was a wonder to watch and exciting to learn. Most meetings, eventually, dissolved into an argument between factions as to "who be da muthafucker".

However, there was a definite pattern to their elections and subsequent governance. First the candidate firmly establish a problem that was partially real. It's real aspect, or it's economic aspect, was soon after expanded to contain a significant social aspect.............which existed mostly because they were a disadvantaged underclass, or in street talk, black. The plan of action was established in broad general terms, political action, grievance filing, membership drives, etc. were blended into the candidate's version of an unique solution to what upon research were found to be historically complex problems requiring all three branches of government, acting against their own interests, to fix. In other words unsolvable problems that only the senior people in the three branches of government understood. Of course, only lawyers and interested vendors did the research, the union was too busy arguing the basic premise explained in the last paragraph.. Upon election the new President of the union and his entourage traveled, flying first class, staying in four star hotels and eating at only four star restaurants, collecting input for the issue at hand, they even changed the union constitution to handle some problems, i.e. they could deem, by a vote of the executive board their girl friends to be their spouses for a certain trip, they were required to visit all 37 locals once per year, especially the 19 members in Hawaii, and 15 in San Juan Puerto Rico, and, of course they were required by the constitution to travel by first class air to maximize the status of the union. When the money ran out and enemies started to swarm, mostly white, i.e. the Dept. of Justice, Dept. of Labor, the parent body, a large broad based national union known for some very tough national liaisons between the unions, these gentlemen were, to a person Italian and either from New York or Chicago, the president concluded and spoke extensively at every meeting that he was making progress and that his enemies were on him only because he's black.

Just watch, if they congress continues to be a rational check and balance as the are supposed to be under the constitution Obama will return to the street where he came up in Chicago politics, race politics and hard, bad ass tactics. It's who he is after all. There is an old saying in race politics......you can take the boy out of the ghetto, you can't take the ghetto outta the boy. If I'm remotely right this could get to be fun. He's already admitted we're out of money. God I hope I never hear Obama claim that anything happened "only because he's black".


Of course along the way the reason for the fight, remember Cheney vs. Obama, will get lost. We're going to close Gitmo and send the poor bastards to the wild of the Montana plains, no town within fifty miles and then anybody there from the middle east is rifle practice. In the summer there is no breeze, it's over 100 every day and rain is scarce, just like home , but in the winter they're going to freeze their Yemeni asses off, as much as fifty below, not above twenty from early November until late March when it turns to one big mud puddle until May when it starts to bake. Welcome to the USA, see what the liberals wrought, nice guys huh, from the tropics and Caribbean ocean to hell.

Even that is neither good or bad, it's possible, it'll be done with Congressional approval, the press will find something else to satiate their desire for dirty laundry and everything will go along as normal...............all screwed up.

Heeee's back

For some unknown reason I have had political correctness on my mind lately. Notice how you never seem to hear about it in the TV news or main stream press anymore? It is just part of everyday life now, no longer news.



I retired in 1997 and I know the workplace has changed a great deal since then, but in the 1997 workplace, a female employee complaint was met with a question about the local court's attitude rather than any question about the facts of the case. In most jurisdictions you were going to lose in a jury trial...........so if the complainant became the plaintiff, well just give them the company.



I hope it's gone back to more fact based now, but I doubt it. It. the whole political correctness thing, is a creation of a collaboration between the feminist movement of the 80's and the ACLU wing of the far left. The starting premise exists only in the more paranoid minds of the left. They theorize and move on to God;sown truth, the idea that all corporations are bad and that fact is self evident. A corporation seeks labor at the lowest rate it can get in the community and (this is the part the left can never stand) guarantee the quality and turn over rates they need to adequately serve their customers. They leave out the last part and conclude, every time, that the management of such enterprises are there to violate employees rights and subjugate the employees to managements whim.

Obvious horseshit, no business enterprise could exist in today's market of cost, quality and service requirements with a business model and human resources outlook such as this.

Of course the left doesn't agree. Their "truth" is that their world view is not only "right" but morally superior to any other. Attempts at rational discussion, negotiated compromise and reconciliation of divergent views are met with claims of moral superiority, demonetization of the company involved and political demagoguery. That's our moral darlings on the left......always the first to use dirty political tricks. Doesn't anyone else see this as inconsistent and contrary to moral superiority? I submit that it is proof that the left is morally bankrupt. The left is better characterized as a toy of George Soros culminating in organizations such as Acorn Corporation. Morally superior my ass.

But these guys brought us political correctness as proof of their moral superiority. They've constructed a world where any female or minority that cries foul is automatically a downtrodden unfortunate who white managers are abusing, they are, if they make it to court, to be buried in money and lauded as standing firmly on the moral high ground even if his or her complaint is utter bullshit and has been labelled as such by everyone, save the jury, that has rationally examined it.

Remember I'm an opinionated jerk..................and I fucking hate these guys, they are rapists at heart, superficially attached to a perverse world view that has more to do with emotion than logic and observation. You've heard "first we hang the lawyers", whoever said it got the order wrong, liberals and unionists should take the first walk up those gallows stairs. I, for one, hope they are steep and high and they arrive at the drop out of breath and legs burning from the effort, then unceremoniously hung , gently, no drop, so it takes a long while for them to strangle to death, providing the crowd plenty of time to buy popcorn and cokes............whata you want to bet that those serving same are minimum wage long-haired, earth shoe wearing, Volkswagen van with a peace sign on the front and Jerry sticker on the back window, driving, Whirled Peas and Obama 08 bumper sticker, certified morally superior buddies of the unfortunates dangling at the end of the rope.

It'll be their turn soon enough.

Time for the second excursion into the dark world of the mind

It occurred to me while listening to President Obama the other day on the subject of the economy that he had to have been born in the early 60s. A lot of the new generation of our leaders were. It further occurred to me that their year of birth perhaps explains their odd sense of belief that science, hard such as physics or soft such as psychiatry, can solve almost all problems, leaving us no worries and then we can all live happily together.

It is a formula that you hear again and again in their speeches. First we'll fix, through science that the car companies will invent, the emissions that cars spout incessantly, and then we'll reduce the amount of gas they need to run and we'll have more cheap gas than we need and everything will be wonderful. Science and then happiness, over and over.

My epiphany..... they grew up in the 60's and seventies, parked in front of the TV as most kids were then. The two most popular shows for kids....................Star-Trek and Sesame Street...........science and happiness...........think about it.

Starting off with a bang...........

One needs to go no further in proof of life's unfairness than to learn that Farah Fawcett, a woman over whose image nearly every man over age thirty has masturbated at least once, is dieing of asshole cancer.

Nancy Pelosi, on the other hand is a cancerous asshole over which no one has ever masturbated. Go figure.

I actually kinda like Obama even though he's a dyed in the wool, 100%, Commie Cocksucker that has spent us into the poor house. However I offer the following as food for thought:

A dear friend of mine, now deceased for two years, once said to me in his best South Philly Italian rasp, " first thing you do when you get married, you take the first paycheck and blow it on something extravagant, Italian hand made shoes, silk shirts, really expensive ties, something just for you that you can take home on that first payday.", " Scares the shit outta them, they think you're gonna blow the food and rent money, hell you'll have 'em squirrelling money away everywhere, saving to feed the kids, you'll have more money than you ever had".

So, you don't think Obama is running some kind of similar scam?

I spent my working life in the Health Insurance field. It pisses me off when people tell me how complex it is, how difficult to understand......horseshit. You want something that's truly complex........impossible to understand, try shopping for cell phone service. My advice, tell 'em to roam up your asshole and make calls from home.

Lastly, the fuckin Cards are in first place in the central division, a catastrophe of the first order. I don't know where the Mets doesn't matter much until the play offs. I'm planning on seeing the CUBS in September..........AT&T Park, San Francisco. I'm thinking of taking a run at the bride about driving my decrepit ass to Denver to take in a few games. Fucking foreigners, except the Japanese, don't get baseball. The beauty of the game is lost on them.That, of course, should tell you something.

It's a weird world where you have more appreciation for guys that eat raw polliwogs for lunch than guys that have a couple a pints a bitter, a chunk of cheddar cheese and white bread with some pickles on the side. I mean one side has cheerleaders for their baseball teams, the other call soccer football and look at cricket as the predecessor of baseball.

I like the bitter, ploughman's lunches, and my fish cooked, but lets face it.............the Brits are fucked when it comes to sport. Any people that doesn't appreciate baseball are (to come about full circle) assholes.