I am concerned for the security of our great Nation

OK, lets get the whole quote in here:

"I am concerned for the security of our great Nation; not so much because of any threat from without, but because of the insidious forces working from within."

Now, who would have said something like this? Given the fully polarize environment that exists in this country today, I'm sure each side will point the finger at the other and say either it is a right wing agitator or some loony left wing liberal. Anyone have a clue, how about a picture???

Recognize this man, General Douglass MacArthur. I didn't realize what insight he had into the day-day political arena until I started seeing some of his quotes. A new fan to be sure. So, what is he, a right wing agitator, or a left wing loony? How about just what he thought he was, a patriot who wanted nothing more than the best for his country and wasn't afraid to say what he thought regarding what it took to achieve that end. No matter the consequence, no matter who he bucked, no matter the outcome.

Now, as my first personal post, I have a lot of medical history and have learned from the school of hard knocks about how well our health care "system" works and doesn't work. I'm lucky, I'm still here, and like the proverbial bad penny, still showing up and getting more involved, and now speaking up. I know I won't get everything in here, but every journey starts with a first step and this one is mine. As a way to see where I come from, in this 1 hour round-table produced by TPT in Minneapolis, you can see various thoughts, and my 30 minute interview was trimmed down to about 90 seconds, actually, not to bad.

http://www.mnchannel.org/video_archive.php?video_id=22

I now speak up on health care from the patient side of the house and what I see going on from the distribution of funds and where the money is going. I can't stand what I now see going on during the recess regarding the poisoning and statements being made. People standing up on the floor of congress perpetuating nothing but pure lies, and as history as shown, if you say these things long enough, they begin to stick.

Unfortunately, Health Care Reform doesn't fit into our tidy world of immediate news and 30 second sound bites. People actually have to take some time to read, think, and understand the aspects here. Just like Medicine is not a one sided view of the world either, this debate should be framed from a holistic view, but, alas it is not. There are several aspects that must come together, that in balance will achieve a truly American solution that can give the best of all worlds.

Therefore, here is Ken's Health Care Manifesto:

• Payment Reform
  First off, stop the MADNESS of pay for service and not results!! This is crazy, pure insanity and there are people making a lot of money for just doing one service item after another. And, if they refer something like an MRI scan to a service provider they have an alliance with, they get a finders fee to boot. Great work if you can get it. Read this article:
  
  http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
  
  From this you can see the disparity of paying for value/quality and paying for service. This is key, without the teeth of this type of change in any bill that comes forth, IMHO, DOA! Don't bother, we won't get anything from a cost perspective. This is true reform, this is true change, and there are people making a lot of money spending a lot of money trying to stop it. Don't let them, stand up and yell for the right stuff, this is where we must draw the line in the sand and not retreat.
  
  
• True Competition, not Coo-petition
  I'm a capitalist, don't ever challenge that. I have 30 years in the software industry and even though I was dumped on the street in the most unethical of circumstances, my stance hasn't changed. I understand what real competition does to improve a business, I also understand what happens when those rules are circumvented and unfair advantage is given. I believe Health Care is a right, not a privilege. As a right, it is very difficult to provide service when one is beholden to the stockholder, and not the patient. The correct result is not achieved overall for society. By sub-pooling, rescinding, and other activities, the Health Care Insurance companies are making a tidy sum. Are there record profits right now, no, remember we are in a recession. But, don't see many of them going Chapter 11 either. As Rush, says, look it up. Get the facts.
  
  They aren't hurting, but the general populace is because they can't afford COBRA. The company I was with merged with another, we had 200 people and those who where let go at the time of the merger had COBRA payments of $1800/month. Really, I should say no one had payments, who could afford that? I was let go four months later, I was on disability and recovering from Leukemia, my payments were $1200/month, I had no choice. The only reason it was less is because now the pool was 500. Do the math, if the pool was 1000, it keeps going down and becomes more reasonable. Imagine if you where going for individual insurance? Don't even ask what the number would be. Now, look at the 6 million unemployed right now. Imagine if there were in one pool. Why did the stimulus plan just pay 60% of COBRA when we could have put them all on Fed Insurance until they found another job? They could have afforded paying the premiums out of unemployment insurance. The government would have saved millions, billions? The insurance would of had to compete on a different forum, now we're talking reform and change? Why wasn't this done instead of rolling over and just paying into the insurance funds?
  
  So, now everyone gets hung up on the public option. Well, look at Fannie Mae and Freddie Mac. Here we have public options for mortgages with FHA loans. Much easier to get into a house if you qualify, doesn't appear to have hurt the rest of the industry for conventional loans. Can you imagine what the terms of those loans would be if the FHA option wasn't there. I'll give you a hint, look at my previous paragraph. Reign it in, and we will get our Health Care costs relative to a competitive % of GDP, allow more money to go to salaries instead of expenses that go to insurance companies, and allow the upcoming recovery to really boom.
  
  
• Tort Reform
  Very simple concept, loser pays. We are the only Western country that doesn't have that. If the Bar Association wants to fight it tooth and nail, then at least give the proviso that this rule applies on malpractice suits. I am a volunteer chair of a Sub Committee for the State of MN and have seen members of my committee, prestigious, knowledgeable, MD's argue that their studies backing their positions aren't relevant. It's easy to see how any lawyer can bring some expert in to back a claim. Therefore, many Doctors practice defensive medicine to protect themselves. It drives up costs. Does malpractice occur, yes. When it does, claimants have the right for restitution. However, the numbers are not consistent with the degree of malpractice.
  
  Lawyers contend that if this policy were put in place, then many people wouldn't have a chance of having their claim. Two words, pro bono. If one feels that strong, then make their case. If also means that the delaying tactics and unnecessary delays that drive up costs under a siege mentality must also be contained to level the field.
  
  
• Personal Responsibility
  Now comes the real hard part, each of us has to step up to the plate. No one is invincible, you are going to have something happen to you at some time, count on it. Therefore, each of us has to participate. Whether you like Social Security or not, when you turn 65 and you start getting checks in the mail and your health care is taken care of , you don't complain as much. So, time to deal with it for when you are younger than 65 as well. You can't just be a ward of the state and suddenly show up in the ER and have a problem with no insurance and the file Ch. 11 and the hospital gets the bill. Remember, the larger the pool, the more the cost is spread out and the cheaper for all of us.
  
  If you don't get this, how many of you on your car insurance have to pay for uninsured motorists? Same concept, paying for those who don't. No one should have a free ride, America first, we're all int this together.
  
  However, that is the easy part, the hard part is life style. If you lead a risky lifestyle, then guess what, you need to pay more. Why should others pay for you? Now it's a little like auto insurance, if you have a DWI, guess what, your rates go up. Guess what, if you smoke, if your BMI is way out of whack, nothing like a little financial incentive to help correct the problem. Imagine on your health care premiums you saw a line item for high risk individual compensation even thou you weren't high risk? How happy would that make you?
  
  Lets understand the financial s of smoking in the workplace. It wasn't because corporate America wanted to do the right thing, it was because the insurance companies realized costs could go down if this one item was removed from the work place. The fewer smokers, the less lung cancer and other related diseases. This has spurred huge anti-smoking campaigns and at least in this one area, seen improvement.

OK, these are my initial thoughts and hopefully, they won't be the tree falling in the woods that no one hears. I just couldn't be quiet anymore, I had to put this somewhere. It is time for us to stop yelling at each other, understand the facts, and have the appropriate civil discourse as patriots for a better country to move into the 21st century. Remember, America first !!!! If we all together give in, we can really make this work. But, it can't be lopsided, all areas need a balance or no reform will take place. Come on people, we can do this ...

Ken Zaiken


8/11/2009
P.S. Here is an article someone sent me after reading my initial tirade. Obviously a much better writer than I am.

http://www.newsweek.com/id/209817/output/print

8/15/2009
Additional input and comments

Bipartisan Plan from the Senate:
At last, rationale thought, now, how come this article has not received the kind of media coverage that the shout downs have. I don't have confirmation yet, but a statistic I saw was that 17/23 town hall meetings were orderly, but our hyped up 24/7 news hilited the 7. Here is some great news that should have been all over everything? What happened ???
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/04/AR2009080402523.html

Charles Krauthammer: A Better Plan
This isn't all that bad actually. He has two points, one on benefits and one on tort reform. I am in favor or driving out the lay people who are swayed by legal rhetoric. I am concerned about the makeup of the group that would decide and a binary view of just losing your license does not yield enough options. But, this does give another aspect to tort reform other than putting a ceiling on how much malpractice rewards can be given out, that doesn't solve the problem.

I agree it makes no sense that corporations can fully deduct their medical benefits payments as expenses but an individual buying private insurance cannot. Now, it itemizing, there is that 7% threshold at which time expenses can begin to be deducted. But, this does appear to be unfair and some equity should be brought between the two.
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080602933.html

Lastly, get the facts, please!! There is so much dis-information out there. I tend to like PolitiFact. The pants on fire does send a strong message, and as said, this isn't easy stuff, so easy to get caught up on a hot button. Take the time, do your homework, please.
http://www.politifact.com/truth-o-meter/rulings/pants-fire/

Other comments:
On Tort Reform, when I say loser pays, I mean the loser pays the expenses for the winner. One other item I had forgot to mention, mandate. Everyone has to be in. Lots of people when they are younger than 65 complain about Social Security taxes, that they are 65. Then all of a sudden they get highly subsidized medical and a monthly check from the government. The complaints do go down. The same should occur with Health Care, pay to play. It is like when we buy car insurance and there is this line item for uninsured motorist. Doesn't that get you mad knowing that you are paying because someone else isn't? In reality, we pay now. The cost for medical services does have a cost shift in it to help the providers cover the costs of treating uninsured patients. Of course this needs to be progressive based on need, but whether it's employer based, personal, public option, exchange, whatever, everyone has to play.

8/20/2009
Case in point, here is a story from Tuesday's USA Today that talks about how unemployed people are jumping on the COBRA bandwagon as part of the stimulus package. I think it is great that this is an affordable option, I just disagree that is was a government giveaway to the insurance companies to make it happen.
http://www.usatoday.com/money/perfi/columnist/block/2009-03-02-stimulus-cobra-health-premiums_N.htm

On the same day, USA Today also had an article on a topic that is not getting the attention it deserves, the unbalance of skilled General and Geriactric MD that are needed given the demographic shift over the next 10 years. If we don't start dealing with this now, we will just have another crisis on our hands that will take dire measures to fix. It takes 10-12 years to train someone for this role.
http://www.usatoday.com/news/health/2009-08-17-doctor-gp-shortage_N.htm

9/16/2009

OK, I admit this is from Rolling Stone Magazine, and some of the writeup here is rather blunt, but it is a real in your face view of what is going on and very sobering. Especially seeing this was written on 9/3 and today Baucus came out with his first draft. Rather foretelling, and sad. We need change and I fear it may be slipping away.

http://www.linkedin.com/news?viewArticle=&articleID=68331589&gid=1866463&articleURL=http%3A%2F%2Fwww.rollingstone.com%2Fpolitics%2Fstory%2F29988909%2Fsick_and_wrong%2F1&urlhash=dgGU&trk=news_discuss

Understand, Then Be Understood ....

Habit 5 of Stephen Covey's Seven Habits of Effective People. All I can say from my observations regarding the ruckus around Health Care Reform right now, this isn't happening a lot. Lots of people are talking at others, with ears and minds closed. Beset with misleading truths and non-factional information, we don't have the right dialogue going on right now. Here is an example of what happens when people don't open their minds and ears and listen. This has to do with the perception that we in the US have of the French, and the perceptions they have of us.

This is the reality regarding what the two cultures have in common. While one can see that we are not 100% the same, there is a significant level of overlap. A degree of overlap that given the high level of rhetoric on the French, one might not expect.

The next chart shows the emotional impression of what we in the US and the French think of each other. As you can see, the normal stereotypes. Especially given all the hype that has occurred since 9/11 and the French unwillingness to enter into the war. Remember Freedom Fries vs French fries?

So, I now look at some events I attended last week. One was a MN Democratic-Farm Labor Party event in support of Health Care Reform. The other was sponsored by the local Tea Party Patriots group. While both sides had their extremists, both sides also had their representatives who wanted to talk and learn. I can't help but go to these charts above and just change the labels to see how much there is in common under the covers, yet, when you don't listen and understand, you get the extreme views shown in the second chart.

The reality that I see is that for all the TV spots showing shouting and high emotions, there ia level of violent agreement that people are just not seeing. I believe this is more in the majority.

There are those who are stirring the pot and either have a political agenda and continue to foster misleading information, or just don't have the facts. Remember the words of the late Sen. Patrick Moynihan,

Everyone is entitled to their own opinion, but not their own facts.

I am reading HR 3200 and going right to the pages that some groups cite for death panels, government edits, abortion, illegal immigrant support, what have you. I guess I don't get it, but then again, I'm a laymen, not a lawyer or legislator. I saw a video clip this morning of a town hall in La. where the Senator cited an example of a pregnant women who was turned away from the hospital for lack of insurance and said that was a government issue and that is what we get if we go forward. The government had nothing to do with that case, it was all insurance, why do people stand up and say these things?

So, please, lets act like we are the greatest nation on the planet and have discussions based on fact, not fear. The worst thing we can do right now is nothing. Three years ago the Dow was at 11,500 and if someone told you if we don't do something in three years we would be on the brink of a complete financial meltdown. GM would be bankrupt, major banks wold be failing and only a massive government bailout would save the banking system. Would you have believed them? Yet, many were out there saying just that but no one was listening. No one was listening at the SEC about Bernie Madoff even when years of evidence was placed on their front door.

Well, history is repeating itself, only now its worse because we are trying to climb out of the financial hole we dug for ourselves. So, now is the time to get the facts, stop and listen before you talk, find the common groud, and lets as a nation move forward from there. I see opportunity and a great future ahead, if we first understand, then be understood.

Walk a Mile In My Shoes ...

Now that the heat regarding the nomination and confirmation of Judge Sonamayor is over, time for a little retrospect and understanding from all sorts of different sides of the fence. Lets start simply, not to generalize, but I have seen radical transformations from people who used to be smokers and really didn't care less that their smoke ended up in my lungs. However, once they saw the light and stopped smoking, they became much more acute to the smoke around them and many have become rather aggressive in letting their feelings be know to their ex fellow smokers. Suddenly, they had their minds opened to something that hadn't realize before, the proverbial epiphany.

I am a 3 time cancer survivor, and the most disturbing item people say to me is oh I know how you feel. My response, what Cancer did you have? Well, I haven't, I just know I understand. Wrong, sorry, you don't. This is why I am so fond of the Relay for Life (http://www.relayforlife.org/relay/ ) movement, survivors are together, we get it, we know, we can look each other in the eye and understand. It can't be explained, it is a shared experience thing. Not to be a hypocrite, I am guessing, not knowing, but guessing, it is similar to Veterans of real combat. They can talk among themselves, but very hard for them to talk to non-veterans. It is a shared experience.

So, I believe I get it. I identified iinstantly with what Judge Sonamayor said about a wise Latina. I'm not Latina, but I understood what she was saying. Call it deja-vu all over again, but been there, done that, and still doing it. I have been to many round-tables and town meetings on Health Care and hear the experts up on the panel pontificating on what needs to be done. There are good ideas coming from the podium, but, no one up there really understands it from the patients standpoint. I stand up with questions and tell them you are lecturing it, I live it. Of course, they got even with me by putting me on Advisory and Steering Committee's, but that's OK at the least now a voice is at the table. Be careful what you ask for, or said another way, no good deed goes unpunished.

Supreme court nominees are nominated at the will of the president. Unless the Senate finds something totally failing about the candidate, then all due course of fairness should take place. It would have been a very interesting Judiciary Committee meeting if Harriett Myers had made it that far. Luckily cooler heads prevailed and that mistake was understood before it went too far.

So, to that, I am very discouraged to find that this is the first Supreme Court nominee that Senators McCain and Hatch voted against. Given that they both voted for Judge Thomas, who really should not have made it out of committee, and they voted nea here. Come on, we need more rationale debate, our problems are too big to get into this kind of thing. We all have to get bigger and more mature, please ...