Monday, November 30, 2009

Healthcare Reform-Now With 100 New Opinions!

Here we go again with healthcare reform. Recently the House of Representatives muscled through a healthcare reform bill by a narrow margin using the advantage of a Democratic majority presence. Now the Senate has also used a Democratic majority to narrowly vote to entertain a healthcare bill in coming Senate sessions. Let us be very clear about this. The Senate needed to vote on whether or not to debate the healthcare reform bill. After they debate it they can vote on it. I suppose we should be glad they did not need to vote on whether to vote to debate the bill. We are already a year into the Democrats rule and are still stalled on healthcare reform, though it’s not hard to see why.

First, the Senate only narrowly voted to allow the bill to be debated. Even with a majority of Democrats, they could barely get all the Democrats to agree that healthcare reform was needed. And as with the House, there are some Democrats that behave more like Republicans. Heck, they call themselves the Blue Dogs in the House! Why not just call yourselves Republicans? This tells you that everyone’s vision of healthcare reform is different. This also means that healthcare in its current state was no one’s vision. It should then follow that whatever form healthcare policy takes will also match no one’s vision. It makes sense that it should not be one person’s vision, but it would be tantamount to trying to create a lion and ending up with a chimera. It should be expected that the Senate will modify the bill to a mindboggling degree, so that everyone’s personal vision can also be inserted. So why waste a week of Senate sessions to only decide to debate the bill? Obviously because not everyone actually wants healthcare reform. That tells you a lot right there.

Second, the Senate healthcare reform bill is different from the House healthcare reform bill that passed a few weeks ago. Why is it different? If the Senate actually passes a bill it will have to go to House to be debated on as well. Which makes you wonder why the House even bothered to develop a healthcare bill in the first place. And all this time the Obama administration has its own plan for healthcare reform but must wait for the Legislative branch to finish its job first. It is quite a wonder that anything is actually accomplished in government.

Third, the House just passed a bill removing the twenty percent Medicare physician reimbursement cuts that were proposed this year. Will the new healthcare policy reinstate it? Has it been compensated for in the new budget? Granted, Medicare is only a part of the overall healthcare bill, but it can be a deal breaking part. Just as the public health insurance option seems to be a deal breaker for many Congressmen. The thing that the government is failing to recognize is that while it can force people to get health insurance and set its own reimbursement rates however it pleases, it cannot ever force people to provide medical care and products. Nor can it force companies to stay in business to provide health insurance. It is a dangerous bluff that will likely be called. If you pass a bill for healthcare reform that saves over a trillion dollars in the next decade you should be happy that it will likely save even more than that because healthcare providers will opt out of government insurances like Medicare, hospitals will close down from poorly reimbursed services, and insurers will close their doors rather than be told how to run their businesses. That means the government will be paying less to fewer healthcare providers, fewer hospitals, and will be the insurer for most Americans. That will save a ton of money. Too bad the actual healthcare will become nonexistent.

The problem with trying to insure everyone is that in order to reduce costs you will need to cut services—office visit time, testing, drugs, and procedures. And no one likes being told what they can or cannot do for their health, especially if it is so important that we need a law for it. In fact, the reverse may actually work better—making people purchase their own insurance and literally letting that drive the market. That means no money, no healthcare. Is that fair you say? Is it any fairer than the disparity in access to food or shelter? We have federal subsidies for that. There could be healthcare stamps. Just as you would not buy filet mignon with food stamps, you would not get a full body CT because you wanted it. But you could still get antibiotics for that pneumonia. Is health insurance that important? Most people care more about their cars than their health. And healthcare is not in the rule of twos—two hours without shelter, two days without water, and two weeks without food. What would it be—two decades without health insurance?

Monday, November 23, 2009

Strike Out!

Hooray! The SEPTA strike is over. For those of you not in the Philadelphia area, SEPTA is the Southeastern Pennsylvania Transportation Authority. It is a primary transportation service for most of the Philadelphia and Philadelphia environs population. In the beginning of this month the workers of SEPTA, whom are unionized as Transport Workers Union Local 234, went on strike at 3 am. Of course, they wanted to strike at 12:01am on Halloween, but did not knowing the wrath of the public if they shut down public transportation during the Phillies World Series attempt. So they waited a few days and then shut down the public transportation to and from Philadelphia, causing widespread inconvenience. This was of course, the whole idea, and it worked, as six days later, a deal was reached to end the strike.

Was it really a deal? For the union, it certainly was a great deal. Let us take a look at what they won. First, they not only retain their pensions, but they get an additional $5000 a year for a $30,000 a year pension payment. Not too bad for a pension plan that is already horribly underfunded. Historically it has been funded by workers contributing a grand total of 2% of their paycheck. Now the workers have to contribute a whopping 3%. What financial hardships they must endure. On top of that, there is no disclosure for the management of the pension fund. They could be investing in alchemy or a Madoff fund for all we know. And the union also won the ability to prevent auditing of the pension fund. That is a gigantic coup. Not only is the public on the hook for the union’s pension payments if it becomes underfunded in the future (which it most certainly will), it is forbidden from looking at the books to see if the money is being handled correctly. Don’t you just love public servant pension plans? They might as well all be invested in the latest fad stock. If it makes money, it makes it big and the fund managers make out like bandits. If it fails, who cares, because Joe Q. Public will pay for it then.

How about healthcare? Are we worried about Obamacare affecting insurance premium rates and having that cost trickle down from the company to us? Do we worry if our businesses will be able to afford to offer healthcare policies? No if we are in TWU Local 234! Not only will they continue to contribute a measly 1% of their paycheck, they will retain all their current benefits and prescription coverage’s and dental. That’s right. They have dental. And they have a PPO, not some gatekeeper HMO tee ball plan. So what does that mean? It means that not only will you have to pay more for health insurance to keep the same coverage or lose coverage to maintain costs, you will have to pay more taxes to pay for the increase in healthcare costs for the union, since they sure are not going to pay for it. And since the money has to come from somewhere, it will come from the public. And do not forget—the contract was signed with SEPTA/Philadelphia/Pennsylvania, so if there is a union healthcare fund deficit, you know from where the money to make up for it will come.

How about salary? With the economy still in somewhat of a slump, many businesses are freezing pay raises. Not SEPTA. They have to pay out an 11.5% pay raise over the next five years. Are these people professional athletes? How many people have five-year contracts with the volatility of the economy these days? Also, there is a $1250 signing bonus for each union worker. Just for renewing their contract. Why even bother with this? Why not just given them free healthcare and reduce the contract by twelve pages of legal parlance? Mayor Nutter of Philadelphia had to go to Harrisburg and plead with the Pennsylvania Capitol for more money so that he could pay past wages earned of city workers and not have to layoff more workers in the near future. But we somehow have $7 million stuffed in the Pennsylvania mattress to payout signing bonuses for striking workers? Of course we do not. It’s coming out of our mattresses through our taxes.

There are many other facets that also show how the TWU Local 234 spanked SEPTA and the public, but are not available to the public. For instance, the layoff clause has been retained, which considering the current contract negotiations, likely covers income for laid off workers for at least six months but probably an entire year. The UAW had clauses of that ridiculous magnitude and look where it is now. It would certainly seem that TWU Local 234 has won the battle, but has it really? And at what cost?

Since the ending of the strike, Pennsylvania legislators have been up in arms about TWU Local 234. And it has spilled over to essentially all public service sector unions. A representative made a specific comment about how the sudden strike left many night shift nurses stranded and unable to get home. The TWU Local will argue that the strike was not sudden, but planned for several months and was even advertised. But really, who puts that sort of information into their daily planner so they can arrange alternative transportation for that day? Really? One might also argue that this particular representative obviously knows a nurse that works night shift—a family member, a friend, or someone close to a powerful campaign contributor. Otherwise, they would likely have used another example based on easy personal acquaintances rather than sit and consider the ramifications of the strike. After all, they are busy politicians. But I digress. The legislators are looking to prohibit the striking of public sector unions, and particularly those of essential services. This is similar to Ronald Reagan’s problem with the air traffic controllers. There is no doubt that it will snowball to include any trade, whether public or private, that the majority of politicians believe is essential on that particular day. And that would be a shame, since nothing would be more karmic than to have a TWU Local 234 member or someone close to a member die after his or her nurses decided to strike because they wanted more money and believed their greedy needs superseded any consequences of their actions. Is that so bad? I wonder how many people did not make it to the hospital to see a loved one in time during the ever important strike.

Sunday, November 15, 2009

How To Strike

There is nothing that brings more smiles to people more than seeing public servants go on strike. It seems that at least twice a year public servants in some sector decide to go on strike. And it is always with the same demands. Money. They want more money. They want higher pay, they want more benefits, they want more paid vacation, and they want more pensions. And for several reasons, they usually get more money. In the past this was not so unusual, especially given that we as a country have only decided to finally raise the minimum wage rate after a few decades. But in this economy? It takes some very large brass ones to do that. And we will see why they feel so secure in going on strike. (Hint: it is not that they have nothing to lose.)

When was the last time you heard of private sector workers going on strike? Difficult to remember, isn’t it? The last time I heard of a private sector strike was four years ago, when hospital support staff went on strike because they wanted—wait for it—more money. And they did get more money. Not as much as they demanded, but then you never ever demand what you want. You always, always demand for much more. That is Rule #1. There will always be a compromise. There has to be. That way both parties keep up the appearance that they have conceded something. It makes their own concession more palatable. But because you always ask for more than you want, your concession is really nothing, and your win is deliciously more enjoyable. And when you demand more money, there is little the other side can do to counter that other than to compromise. After all, they can’t demand more than they want because what they want is to not change anything. Demanding more for them would be to ask you to give past monies back. What a PR nightmare that would become.

And when was the last time you heard of a nonunionized group of workers going on strike? I have never heard of such a thing. That does not mean it has never happened, but certainly it suggests that it has never happened successfully. And that is Rule #2. You must strike only with a union. A union has power because there is power in numbers. This is, in fact, the major power of the union—to be able to have a large number if not a majority of current workers suddenly stop working and halt productive activity on a moment’s notice. That would cripple any large company. It is no wonder then, that Walmart and McDonald’s try so hard to prevent workers from unionizing. Also, a union has an obvious hierarchy and a clear leader and spokesperson. This protects the union because it prevents the possibly of workers getting turned against one another by the other side. Everyone accepts the majority sentiment of the union and a small compromise in their wants for the power of the collective union. There is another strength of the union, and that is securitization of wages during a strike. That means that though you are on strike, you will still get paid through the magical feedbag into which you put your union dues allowing the union to strong arm the company into agreeing to that clause in your contract. If you did not have that security, the war of financial attrition will always favor the company rather than the individual worker, and companies would simply draw out negotiations until the workers could no longer pay their mortgages.

Thinking of all the strikes you have heard about, how many have somehow affected you or someone you know? Probably even odds on that one. The purpose of any strike is to cause chaos and disrupt as much normal flow as possible anywhere. That is Rule #3. You must create chaos and involve as many bystanders as possible. In an imaginary Walmart strike, the stores operations would cease. Revenue would be loss. Management would be sad. But more importantly, customers would not be able to shop at Walmart because it would be chaos in the store—no one to stock or restock merchandise, no one to ring you up, and so on. That would make you mad, and as much as you would like to believe you could be objective about the issues with the strike, you will always blame Walmart at least a little. (Or a lot, since we are talking about Walmart) But what if it is a teacher’s strike? Teachers stop teaching, and children stop learning. But even worse, children now have to be somewhere else, and parents now need to watch them or get babysitters. This then disrupts the parents’ work schedules and income flow for families. This makes the parents mad and they get mad at both the teachers and administration and pressure for a compromise to be made. So the administration is villainized when the teachers intitiate the strike. This is the same with the SEPTA strike. Buses, trains, and other public transportation stop running. Commuters everywhere must scramble to find other ways to get to school, work, and leisure activities. This pisses everyone off. And then the public demand that the city find a way to fix the strike problem because, after all, the city government works for us, the public.

That leads us to Rule #4. Strike only against bosses who have no clear leadership. Now I did oversimplify the power of unions earlier. A union, once created, gains certain rights that protect the workers in the union. One such protection is that against wholesale termination of the workers in a union. This is why Walmart and McDonald’s have been rumored to fire all the employees and shutter stores where employees have attempted to unionize. This makes it doubly easy for civil servants to strike. Not only are they afforded the protection of the union, but the bosses against whom they strike are the most poorly organized, bureaucratically riddled system out there. If you went on strike against a stiffly hierarchal company, you likely would not have a union, so they would more than likely fire you on the spot and have your replacement hired and working before your butt hit the pavement.

But how can you increase your chances of having a successful strike? You must gather public sentiment. That is Rule #5. Fake a nobler cause or pretend you really love your job despite the obvious notion that striking means you are unsatisfied with your job. This means that when the local news crews come to interview you on the picket line, you should say, “ We want to be working and doing a great public service, but those ogres are running the equivalent of a Thai sweatshop in there.” Do not under any circumstance say, “Well, we clearly deserve far more money for the job we do but are too lazy and ignorant to find a better way utilize our talents, so we thought we would just extort the public taxpayer and the game the system to get what we want.”

While these rules have worked well in the past for the majority of strikes, we must not forget the times that it has backfired. The most notable would the air traffic controller strike in 1981. Reagan order the controllers back to work on the premise of national safety and security. The majority of the controllers refused and were subsequently fired by the President. It was a humbling time for unions. If you incorrectly assess your public circumstance, the strike may backfire. Let us take the current the recent teacher’s strike in Pennsylvania. This strike came around the time school started this year. The teachers were asking for—more money. They wanted higher salaries, better pensions, and better health insurance. What they failed to recognize (and especially the social studies and economics teachers) was that the public was still in financial jeopardy. Most people were still down 25% or more on their retirement nest eggs, taking pay cuts or were laid off, and paying higher insurance premiums. And now here come teachers, asking Joe Public to pay more taxes so that their pensions and retirements are secured while his circles their gym toilet. More taxes so that they can pay less for prescription medicines while he has to go to Canada or Mexico for generics. More taxes so they can get a pay raise while he takes a pay cut and works longer hours. Then the teachers have the gall to say to the news cameras, “We really want to be in the classroom teaching, not out here on the picket line.”? Let’s say that while the strike did end, and the teachers got more money, they more than likely did not get what the wanted. More importantly, they will not be able to strike for a while without severe public backlash. At least not until the next financial bubble is growing steadily. The same can be said of the SEPTA strike with the addition that the strike was even more poorly planned because it is heavily dependent on Rule #3. They lost all public sentiment by disrupting already somewhat disrupted work/life balances more. And on top of that, their jobs are not specialized enough to offer them protection. In 1981 the FAA managed to train enough new air traffic controllers to get half the flights back in the air. Think how easy it will be to get new bus drivers.

Monday, November 9, 2009

Can the House Always Win?

The House has passed a health care bill! Let’s celebrate! It only took over a year and won by a very slim margin in a Democrat dominated House, but it passed, so healthcare reform must be around the corner. Right? I said, right? Wrong. It will still be stalled and the system will still be flawed and we will still bitch and moan about it. Why? Because we are flawed at every level from the people utilizing healthcare to the people providing health care to the people moving money for healthcare to the people legislating healthcare. That’s four groups of people debating. If the government and its three groups (White House, Senate, and the House, really, but executive, legislative, and judicial for you hopelessly optimistic in the system) cannot pass most bills easily, imagine how much harder it is with four groups. Let’s look at the four groups.

People utilizing healthcare. Or as some call them, the patients. Nearly everyone falls into this category at one time or another, and so the disharmony among this group is by far the worst. This group will only agree on one thing and one thing only. That the healthcare system is flawed. That’s it. Not even everyone believes that the healthcare system needs a complete overhaul. Those people exist, and Katie Couric or Michael Moore have already found and hounded them. Because not everyone even agrees on what parts of the healthcare system are flawed, there is no agreement on how to fix the system or structure a new one. And not only that, this group of people, while the largest of the four groups, has the least amount of influence over healthcare changes anyways. They have no say as to what goes into a healthcare bill, or how costs are contained, or who will be covered. Sure, they elected the President, and sure, they elected their politicians. But that is where it all ends because they did not elect their politicians’ friends in the healthcare industry. They also did not elect the lobbyists wining and dining their politicians. So what is this group left to do? The only thing they can do is what they already do best. Complain to anyone that will listen, and elect a Democrat when a Republican has failed them and vice versa.

People providing healthcare. This is still a large group of people, including not only doctors, but nurses, techs, secretaries, drug company personnel, biomedical manufacturing personnel, and all people working for medical facilities. Though the peripheral people in this group, such as secretaries and hospital valet services may not feel like they are in this group, they are because their financial livelihood is tied to their employer’s financial livelihood. This group is also divided, though not quite as severely as the first. Healthcare has morphed significantly over the decades. The days of prestige and personal fulfillment from practicing medicine are gone. Ninety nine percent of people going into the medical field do not enter the field because they “enjoy helping people”, but because they see the financial stability in a vocation in which they are or could be proficient. And changes to the system will invariably attack that financial stability. But of course, the disharmony comes from many aspects. First, many simply do not understand how they could be affected. There are many nurses and techs, for instance, that do not think their pay could be cut, or benefits stripped, or even jobs laid off. It is an unfortunate ignorance that will be their rude awakening one day. Others are not dependent on their healthcare jobs for financial stability, and so default to their “people utilizing healthcare” stance. Other opposed groups are those between the private practice doctors and the academic doctors, and the old school and the new school. The AMA (American Medical Association) and the Sermo are example of this, as they have differing views on healthcare reform. One thing is certain—half of this group will be very unhappy if healthcare reform hangs the providers out to dry. The question is if they will be unhappy enough to leave and make the question of healthcare reform moot and the question of who will provide healthcare very real.

People moving money for healthcare. I almost called these people the ones who pay for healthcare, and that would have been a gigantic faux pas. This group includes all the insurers as well as the government. While the government is motivated by its need to stem the Medicare and even Medicaid bleed, all other insurers are motivated by their need to make money, and for some, make money for their stockholders. This means that both need to make a profit—the government to stop losing money and keep Medicare viable, and the private insurers to stay in business. The strategies are somewhat different for each one. Medicare will essentially cover anyone with enough work credits in their lifetime and meet certain age or medical condition criteria. It is difficult to be excluded from Medicare. That means that the way to change loss into profit will be to increase revenue with more taxes, or reduce costs by cutting reimbursements, denying some drug coverage and diagnostic testing, and denying more procedures. For private insurers, much of their edge was derived from their ability to deny coverage based on preexisting conditions. This, however, is being targeted by healthcare reform. That means that the private insurers will also need to resort to the same cost cutting techniques the government will use. No longer will they be able to offer more brand name drugs or allow more testing than Medicare because they spend less money on healthier patients. In the insurance world, it is split down the line. Private insurers benefit and profit from the current system. The government and Medicare are bleeding and losing money from the current system. But only one of the two has lobbyists.

The people who legislate on healthcare. These are your politicians. The shifty, unreliable, tunnel visioned egoists you thought were idealists when you elected them. This group has battled over a public option healthcare with a devastatingly enormous amount of wasted time. This group has the most power over healthcare reform but is also the most internally conflicted. They have to listen to the other three groups to determine what to do. And when you are listening to a lot of noise, you end up producing rubbish. The other thing you do when you listen to a lot of noise is daydream and think about what you what to think about, much as a weed smoking teen does in history class. This is how we end up with six thousand little pet projects attached to the healthcare bill. This is also how we end up with a President that has to make the statement, “Now it falls on the United States Senate to take the baton and bring this effort to the finish line on behalf of the American people.” Congratulations to the legislative branch. You’ve forced the President to be your schoolmarm. Apparently, no one has considered passing healthcare reform the same way that Medicare ended up where it is today—by piecemeal. Sure, Medicare started with a band in the 1960s, but there have been many small changes over time. And this way you know exactly with what each shifty politician is taking issue. But then, where is the glory is writing a bill that makes only one change in Medicare? You can’t run for your fifteenth reelection on that feather in your cap.

So what do we have when you add it all up? You have a public made up mostly of people who care only about themselves and not the future or public good. You have healthcare providers that depend on the system they love to hate (frenemies). You have insurers profiting off the public’s medical testing obsession. You have politicians who certainly do not understand the healthcare system any more than most people trying to get their cut of the cash cow that is the healthcare reform process. What does that equal? A perfect example of bureaucracy minus understanding and direction. At this point we would be just as better off if we put the healthcare bill to a national vote and literally let it be decided on the majority of individual votes. That or flip a coin. But I’m sure the politicians would have something to say about which coin is used and who would flip it and where it is flipped and how many times it is flipped…