A Comment on Health Care

Every Monday morning J H Kunstler publishes an essay in his blog called Clusterfuck Nation. I recommend it as, whether or not he hits the mark, his writing is always provocative and entertaining. This week he took on health care reform, surprisingly from a very anti-Republican angle. He isn't usually so decisive, even though one would never accuse Kunstler of being Pro-Democrat! Kunstler's world view could be summed up as expecting a decisive economic slide into poverty and limited technological resources for the US and anyone riding on the Empire's coattails. From this week's blog I read this rather cogent comment from someone called Jeff, who offered a personal insight into the US's health insurance mess that resonated with me. This is not a comment by the author of the blog (a link to that is at the end of the page):

I found the summit very useful, not just for exposing transparently obstructionist Republican tactics of the "let's just start over" (repeated ad nauseam) sort but also for laying out some honest-to-goodness policy differences. The mainstream media seemed to willfully ignore those, in favor flogging some personality driven sniping, of which there was actually comparatively little, the better to convey the meeting as some kind of demeaning, reality TV show.

Of the substantive differences, perhaps one of the most telling: Republicans object to the Obama plan in part on grounds of defending Medicare. When you hear a Republican defending Medicare, your bullshit antenna should go up, you should cover your nuts and grab your wallet (not necessarily in that order.) It became apparent that what they really meant is they want to protect Medicare C (aka "Medicare Advantage" plans.) I learned what these things are the hard way recently, by doing bureaucratic battle to get my geriatric father's Medicare advantage coverage accepted by a prominent national cancer center. In a nutshell, these things are private insurance market policies which "replace" the insured's Medicare, plus (in theory) provide a little additional coverage like preventative services, gym memberships, etc., of the sort which are extremely cheap and very infrequently used by senior citizens. For this, the private insurers can charge policy holders additional premium over and above what Medicare would charge, they also get paid an incentive from the government of about 15%, and are permitted to allow doctors and hospitals to whack insured's for an additional chunk of the total bill.

The kicker? Doctors and hospitals are free to accept or reject the coverage on a visit by visit basis. Meaning the policy holder cannot know in advance (as they can with other types of policies which have networks of hospitals and doctors)where they'll be eligible to be treated.

This is what Republicans mean by "market based solutions." The whole experiment has been an unmitigated disaster - - except for the agents and insurers who've reaped huge profits from a previously untapped market. And for Republicans who found a back door way to undercut Medicare, and provide themselves with another example of how "big government" programs don't work. Think Grover Norquist's wet dream of shrinking government down to the size where it can be drowned in the bathtub.

http://www.kunstler.com/blog/

Petronia On The Hill

Some people think it amusing that Key West's highest contour is but 16 feet (4.5 meters) above the sea. Solares Hill makes for a nice spot to take a bicycle if you'd like a stretch of downhill for a change. And though the hill itself is actually located on Angela Street one block over, it's upper slopes reach out to Petronia Street forcing a cyclist to put in some effort to get over the rise:.You can cycle uphill to this spot from over by the Schooner Wharf Bar if you feel like it. Elizabeth starts (or ends) in front of Conch Republic Seafood. Elizabeth Street runs by on a lovely downhill glide all the way to Truman Avenue where cars and motorbikes are all backed up waiting for the light to change so they can spill onto Duval Street. Of course you would be cycling the wrong way on a one way street which could get you pulled over...perhaps you might plead your case for a stern verbal warning. I'd give it a try for the pleasure of the long free wheel down hill.Petronia Street is full of classic Conch touches.And here we have a church that puts me in mind of another island I have long wanted to visit. My wife and I considered a cruise ship ride to Bermuda from Charleston with a two night stopover (and rented scooters of course) on the island. But those were happier economic times and now I content myself with armchair travel. This church, one of the trillion in Key West has the square bell tower of a solid Church of England export built in a bright sunny land, the sort of thing I'd expect to see in Bermuda. Except it's on Petronia street.

I can't keep the names of all these churches straight so from the horse's mouth as it were...A dude next door was frozen in one single posture saying hi to passers by. I returned the salute with a picture.
His home was as trim and neat as he was himself:
As you look through these pictures of various aspects of the historic little homes at the top of the hill you might be struck, as am I by the deep blue sky overhead.

These are the homes that have survived storms and wars and depressions and population growth and bankruptcy.The sun shines, the banana trees grow and give us a splash of green between the white and the blue.

Whitmarsh Lane is open to car traffic believe it or not. You could drive here from Angela Street and the "real" Solares Hill. Notice the downhill slope toward the camera.The unnecessarily tall pillbox on the skyline isn't a defensive measure, it's just a commercial building struggling for a view in a community that is so flat the best you can normally do is see a sea of roof lines.

And palm trees of course.The homes have endured here for decades, some of them, for much longer some others.

And the sun still shines on them on Petronia Street. Banksters be damned.

Tort Reform

Earlier this week I got an anonymous comment asking why Democrats don't support tort reform in the current debate about health insurance reform. In the best of times I wouldn't be able to answer such a question "for democrats" and these days, pissed as I am at the Democrat leadership I certainly don't feel qualified, even though President Obama has recently endorsed this idea for inclusion in the new plan. When George Bush was Governor of Texas he pushed for medical tort reform and it was passed into law around 2003. The result has been a massive change in the structure of law firms and a huge reduction in lawsuits. Amusingly enough with the complex requirements to attain proof of damages, the pursuit of tort lawsuits has now become the realm of the wealthy victims only. A mother on welfare has a dismal economic future anyway therefore seeking a settlement will yield very small results. You might argue this was an unintended consequence of tort reform. I'd argue it's another way the Republican myth making machine has convinced working people to argue against their own benefit. Tort reform makes it impossible for working people to get justice against...corproations! Brilliant! And furthermore I dug up this commentary from an attorney opposed (obviously) to tort reform in which Mike Ferrara points out another consequence of Texas tort reform:

Texas Tort Reform is NOT a Model for Nationwide Health Care Reform
Mike Ferrara Attorney
September 07, 2009 8:24 PM

Tort reformers like to talk a lot about how the threat of malpractice suits raises health care costs by forcing doctors to practice “defensive medicine”—the ordering of unnecessary tests, procedures, and prescriptions in an attempt to protect themselves against a possible negligence lawsuit.


In a 2008 AMA survey, they remind us, a majority of the doctors who responded admitted to practicing defensive medicine—a number that translates, the AMA calculated, to $1.4 billion more spent annually on health care. If our doctors weren’t threatened into doing this, we’d all save loads of money and our national health crisis would be over.


Are the tort reformers right? Well, let’s look at Texas. Several years ago, the state passed a stringent medical malpractice law that capped awards for pain and suffering at $250,000, and brought the number of malpractice lawsuits down dramatically.


So the cost of health care in Texas must also be down, you suppose, since doctors don’t face the same malpractice threats as the rest of the country. Eh, No. In fact, Texas is home to three of the top ten most expensive cities in the country to receive health care: McAllen, Harlingen and Corpus Christi. In each of these cities, every Medicare patient is costing the country more than $10,000 a year (a couple thousand more than the national average).


So if defensive medicine against the threat of malpractice suits isn’t driving up costs, what is?


Harvard Medical School surgeon Atul Gawande got a candid answer to this question from a general surgeon in McAllen, Texas:


“Come on,” the general surgeon finally said. “We all know these arguments are [BS]. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.


The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ” –Atul Gawande, The NewYorker



While tort reform like Texas' won't improve the cost of our health care, changing our charge-per-service structure just might.

So, is the high cost of health care the doctors' fault or the lawyers? I'd argue neither: it's the insurance companies. Take your pick.

700 William

William Street does a weird jog around Charlie's Groceries, one among a gadzillion inconvenience stores in Key West though this one has been around a while.

The white concrete block building marks one of the more tortured intersections in a city that struggles with right angles in streets and in construction generally. The 19th century cemetery was designed to sit on the edge of town when it was built in the middle of the island. It seemed like a good idea at the time owing to a hurricane that blew open the beach side cemetery scattering corpses and coffins. In those far off days this area was on the very limits of the urban development of Florida's wealthiest city. So they put the dead people out here and then, over time, the living caught up to them and now the dead are surrounded by a maze of awkwardly shunted streets. The seven hundred block of William is marked by this magnificent structure, the add-on to the original shown by the completely different roof line.:
Vehicles clutter the street as they always do in Key West especially in winter.

Though some few lucky souls enjoy the benefit of Off Street Parking. On an island 2 miles by four (3km x 6km Canadian) a structure this size could easily be rented for living space. I doubt the owners need to violate zoning laws to pay the mortgage.

Once you get behind the palisade of parked cars you can frequently find some lovely homes: Did I say parked cars? I should have included parked boats. This one is technically off the street but it makes for a nice botany experiment to amuse passers by. Who needs a daggerboard on dry land anyway? "We seceded where others failed" is the theme of the well worn mutiny against the Border Patrol in 1982. Conch Republic Days will be upon us soon to mark the end of snowbird season when all the unoccupied homes will be rolled up for the summer and some sort of somnolence will sink over the city until schools get out and the next wave of visitors shows up to save our city budget by spending money.

Yes indeed we could use blue skies this winter. There has been far too much rain and cold temperatures. A friend was looking wistfully out at the storm clouds mumbling about how in winter we used to be able to sit with the doors and windows open enjoying sunshine and a cooling breeze. Oh happy, lost, days!

This next picture reminds me of a saying they used to have in Marin County north of San Francisco, the county where Mercedes are as common as dirt and half the price. Conch cruisers will rule the streets again soon. Summer has to be coming.
The 700 block ends at Bill Butler Park, the open space with no benches to prevent vagrants hanging out in it. A Kermit chair would do nicely here as Cheyenne roots around in the shade.

Several months ago I noted in an essay that a stray pair of women's knickers were dangling mysteriously from a bush. Well. I am glad to report they are still there, a little sun bleached but hanging defiantly. Rubber gloves anyone?

One last view up William Street from the park.

It's Greek To Americans

The Greeks are among a select few people who use an alphabet created for them by a Christian saint and such is the oddness of the alphabet compared to our "proper Roman" letters, it has been customary to describe any problem too complex to unravel as being "greek." St Cyril's transliteration of sounds made by Greeks, Bulgars and Russians isn't that hard to understand if you are forced to study it for a little while, and when, many years ago I took a very long train ride across the Soviet Union, a place that exists no more, I devoted some time in my carriage to trying to learn the spelling.I shocked my wife when I was able to translate place names on our road trip through the Balkans, driving in the Republica Srpska, a bastard pseudo-state in Bosnia-Herzegovina whose fascist leaders yearn to be part of the Cyrillic world of Serbia and Russia. Of course languages are alive and to be remembered they have to be used and nowadays I find my ability to remember the difference between a D and an L, or a YI and an N to be fading away...

The language of bankers is, unhappily international and a crisis of epic proportions is brewing in Europe, thanks in part to the meddling of Goldman Sachs- the Slobodan Milosevic of the current conflagration. In the same way the last President of Yugoslavia tore apart that confederation it seems US bankers are standing by to tear apart the Euro world of the civilized, industrialized nations of the European Union. The story, as it becomes public is complex enough to be defined as "greek" yet in some ways is as simple as a second mortgage on a US home. In order to join the European Monetary Union, abolish the drachma and replace it with the common currency called the Euro, participating nations had to keep public debt levels within 3% of their budgets. Germany met this arbitrary goal easily France managed it and Britain decided to opt out of the whole mess (which was a decision I found annoying at the time, though perhaps I was wrong as we shall see). In some manner not specified the weaker members of the European "snake" which then became the European Monetary Union, managed to meet these goals too prior to economic unification. Greece Italy and Portugal got in under the wire and abolished their currencies in favor of the European Central Bank (ECB) gaining total control over their money supply. Now they all use the Euro, with scudos, lire, pesetas, schillings, marks, and francs all gone into the rubbish bin of history, poor things.

Unhappily for all concerned there was no mechanism written into the new currency to allow for countries that essentially over borrowed and went belly up, which is what has happened in all but name in Greece. That was because the framers of the Union didn't think about secret deals that might be made between governments and bankers and Goldman Sach's deal with Greece, it turns out, was a doozie. After much reading I think I have figured out in plain terms what they did. Goldman Sachs lent enough money to Greece to allow the country to write off sufficient debt to allow it to meet the threshold for entry into the Euro-zone. The loan was masked as a currency trade and the Greek government used future income (!!) as collateral for the loan. Does this sound like a crazy mortgage as sold to "home owners" in the US? What makes this even worse is that it seems Goldman Sachs bought and sold Credit Default Swaps on this loan giving the bank an incentive to drive Greece into bankruptcy.

There has been much discussion in the US about the moral legitimacy of walking away from "underwater" home loans and in the ordinary course of things one can understand a certain moral repugnance at people who abandon loans that cover properties that have simply lost value. However it is really important to understand that the institutions that underwrote those loans weighed the odds against them. Not only did they happily make loans to people clearly not able to handle them, they then bet the loans would fail, by using Credit Default Swaps. They then cut up the loan packages, mixed them in with solid performing loans and sold them around the world as Grade A US loans backed by the burgeoning real estate market. In this way they made it extremely complex for people to renegotiate their loan terms as the paper was held by thousands of people and institutions around the world (literally!) and besides that they had no interest in getting these loans to conform or pay off! They wanted these fragmented investment papers to fail because their insurance- the Credit Default Swaps- then paid off and paid off big time. And even then the banks caught in the trap pleaded with the US government that promptly shoveled some twelve trillion dollars of YOUR DEBT to them to cover their losses. This is exactly what is happening with Greece. It profits Goldman Sachs if Greece implodes! Are you scared yet? It gets worse.

Strikes and protests are building in Greece with workers demanding to know (unlike American sheeple) why the bail out has to come on their backs, and their indignation is spreading across Europe as the realisation sinks in that bankers have duped their governments. The Greek Government has no answer to this fundamental question of human justice, the Germans don't want to know about Greece's problems and the European Central Bank has no mechanism to bail Greece out except to pay off it's debts. It's as though the US Federal Government were to pay off Illinois and California's debts knowing full well both states will go back down the path of overspending and racking up more debts. Besides there isn't any money left! From here on out the Fed has to print dollars because foreigners, seeing the coming crisis, have figured they better not buy any more American debt. China and Japan principally have cut back hugely on US sales of Treasuries.

To close out this excessively long and unpleasant essay let me say that I believe we are in the equivalent of 1931 of our own 21st century Great Depression. I have no idea what to do to prepare for whatever comes next, except to keep on keeping on. I don't believe there is any recovery coming soon and we are starting to hear publicly expressed doubts by people who usually are in the cheerleading section of mainstream news. There is no jobs program and health care reform will run up against God knows what economic crisis. Even if what happens in Greece looks Greek and alien to us, it might be worth while paying attention because the next phase of economic collapse may take the same shape here in the US and it would be nice if it didn't come as a surprise.

Our bankers have already baked the first layer of our cake with the housing collapse, unemployment was the next layer, and to top that we will soon see public employment attacked as parasitic and then the icing will be the failure of our currency. Just like them Greeks are seeing right now.

Beach Walk

There are still people who think long sandy beaches are one of the draws of the Florida Keys. Poor deluded fools, even Cheyenne knows better.Low tide produces exposed limestone rock and dead seaweed:
It can be quite scenic if you keep your eyes on the horizon:

From the south shore of Big Pine Key we see the old Bahia Honda Bridge shimmering in the haze: Only if we are looking for it, of course.
Classic red mangrove in water.
Equally classic washed up beer can:
There is more sand around here at the top of the low ridge that backs the beach itself.
And the views can, paradoxically, be more scenic if you clip the beach itself out of the picture:

A discarded fishing trap and a rocky foreshore.

Visitors can get awfully fussy about seaweed on the beach. Mainland Florida is made of sand, but the Keys are definitely not.

Why would anyone bother to go for a walk here on a sunny February afternoon? Much better to stay indoors in the bars and make friends. Have at it, I like my solitude.