Psssst....It's Too Big!

There is much furor among left wing Democrats and the far left over Independent Senator Joe Lieberman standing in the way of the Senate passing the 2,000 page health care bill from Harry Reid. From the beginning Lieberman has said he will oppose any bill that expands MediCare or has a government insurance option. Evidently when Reid sent his minions to write his bill he either did not listen to Lieberman, figured Lieberman would not be able to discern the provisions in 2000 pages of legal gobbly-gook, or did not believe he would stand firm on his position. Playing political poker Reid included the provisions for both expanding MediCare and a public option; calculating Lieberman would not want to tick off Democrats and be the lone vote in the way for passing historic legislation.

Desperately needing Lieberman's vote to reach the magic number of 60 needed to end debate and get a floor vote on his bill, Reid publicly has made no statements regarding Lieberman and his position. Instead Reid has focused his ire on Republicans for blocking the legislation--comparing the Republican position to that held by Democrats in the 1800's who blocked anti-slavery legislation and 1950's Democrats who blocked Civil Rights legislation.

Reid has shown he is not the brightest person in the Senate. Lieberman owes nothing to him nor the Democrats. Reid forgets that in 2006 Democrats ran a candidate against Lieberman in the primary election for his Senate seat and defeated Lieberman. Immediately following the election Lieberman announced he would run as an Independent. Reid quickly announced that the Democratic Senatorial Campaign Committee supported and endorsed Lieberman's opponent, Ned Lamont. The campaign was quite heated and vitriolic with Lamont and the Democrats tying Lieberman to President Bush in every speech, every campaign piece, every interview. For the DSCC and Lamont's campaign it was as if the Evil Axis crafting war on the American people was Bush-Cheney-Rove-Lieberman.

Lieberman won quite handily, beating Lamont and the GOP candidate combined. The people of Connecticut spoke, "We like Joe more than we like Harry." Back on Capitol Hill Lieberman received a chilly reception and many Democrats wanted Reid to yank his seniority on committees and any leadership positions he held. When 2008 came around and Democrats held 59 seats in the Senate plus Lieberman who has continued to caucus with Democrats everyone quickly realized that unless a Republican or two jump the aisle, Lieberman is critical to all Senate votes. He therefore needs to be listened to, everyone understands this but the Majority Leader, Harry Reid.

Hence where we find ourselves this morning. In order to get Lieberman's vote Reid needs to scrap, at minimum, the government insurance option and expansion of MediCare. In doing so he upsets the far left Senators and can lose more votes. While that fight goes on the next ones to rear their heads are the abortion provisions and costs. Some Democrats will not support a bill that provides any federal funds to pay for abortions or loosens regulations on abortions, other Democrats say they will not support any bill that does not include abortion assistance nor tightens regulations. Some Democrats actually care what the cost of this legislation is to Americans today and tomorrow, and the day after tomorrow, and the day after that.

And on and on the battles within the party continue on this massive legislation. All the while trying to cobble together the 60 votes he needs from within his own caucus, Reid is blaming Republicans for blocking the legislation--such a bold false statement as to be comical. Members of Reid's caucus are balking at the cost, balking at specific provisions and balking at the lack of information, but because the Republican members of the Senate have stayed united thus far in opposition to such a massive bill and its costs it is their fault Reid cannot deliver a bill to President Obama.

This bill is a disaster as written and a disaster if passed. Politically it is guaranteed to cost many Democrats their seats in the 2010 elections, and again in 2012 and more in 2014 when the laws begin to take effect. Because it aims not to reform the health care system in our country but rather to build a brand new one at enormous costs it is destined to end many political careers. Ignoring that almost 60% of Americans oppose the bill, and the more than 45% who strongly oppose it, Reid and the majority of Senate Democrats continue blindly down the path of trying to pass a bill that has not yet been fully released and disclosed and not yet had a full and accurate Congressional Budget Office cost analysis.

From the beginning I have said this bill and effort by Democrats is too big to succeed. Politically the Democrats and the Obama Administration would be better off taking smaller steps in reforming health care. Put forth a legislative time line that goes beyond 2010 that would entice voters to re-elect their Senators and Representatives so they can maintain their majorities. Instead of a legislative mantra and mandate from the White House of "just pass something" it should be "one-step at a time."

Tackle first the biggest external cost to health care delivery: tort reform. Instead of going against the people who voted for you, go against the trial lawyers who contribute to your campaigns. Simple tort reform eliminates billions of dollars in defensive diagnosis, defensive tests and defensive procedures.

Then tackle insurance costs. Allow insurers to compete nationally. Democrats love to tout how the marketplace needs competition but they will not allow insurance companies to compete. The competition is restricted by federal and state laws.

Once these two low hanging fruit have been knocked down then tackle fraud and abuse in MediCare and MediCaid/Cal. Obama has admitted it costs Americans billions and billions of dollars (most estimates are 10% of the total program budgets). So do something about it separate from massive legislation. Instead of paying for the fraud and abuse by lowering payments to health care providers, save the money being wasted and stolen by cracking down on it.

If Obama were to lead a concerted, continuing and successful effort to pass health care reform piece, by piece, by piece, he would fulfill the promise so many put in him in November 2008. He would show leadership, foresight, vision and success. Re-election in 2012 almost guaranteed and poll numbers slipping into the low 40's turning into high 50's or low 60's. Instead he sits on the sidelines until the last minute when it appears his pre-written legacy may need some editing and admonishes, scolds and tries to frighten Legislators to quickly pass a bill. Time being more important than substance or consequence.

Joe Lieberman is taking considerable heat from Democrats and liberals for maintaining his stand, on the other side he is being applauded for sticking by his word--that he gave Reid very early on in this debate. Hopefully his stance and the resulting altering of Reid's bill will derail this current health care reform effort and we can start again. But smaller and in targeted detail that does not obfuscate the provisions nor costs from the American people.

In the meantime why all the heat on Joe for standing by his position and no heat on the other 59 Senators who caved into his position and abandoned theirs?

Back To Health Care

As Summer gets further away and Fall ensconces much of the country the town hall debates, the protests, the marches, the nasty statements, have settled back into committee rooms and back offices of Washington D.C. and the halls of Congress. Yesterday the Senate Finance Committee finally passed its version of health care reform and it appears headed to the Senate floor. Where it will probably get shot down.

Meanwhile across the building Speaker Nancy Pelosi is said to have gathered her strongest allies in the Democratic Party and is hammering out her own version of health care reform to put through the House of Representatives. Where it will probably get shot down.

In July it was critical, in the eyes of the President and senior Democratic leadership, that health care reform be passed by August, September, now the date has been moved to the November recess. But we are no closer today than we were when Obama took the Oath of Office.

So what to do about health care reform? There are many who feel governments should learn more from the private sector on how to run their business of governing. Health care reform is an area where the practices of private business could lead to health care reform that will be long lasting and positive for America.

First let's take a basic look at the problem. We have a huge amount of press and anxiety in some corners of the country because approximately 30 million Americans do not have health insurance coverage (I am aware that the White House and others have tossed out up to 45 million uninsured "in" America, but this includes illegal aliens). This amounts to approximately 10% of the population. So when it comes to costs of covering these 30 million people consider many of them have the opportunity for insurance but elect not to purchase it, while others are without and truly want insurance. So 10% uninsured that we want insured. Of the 90% with insurance polls suggest that upwards of 85% are satisfied with the insurance coverage they have. So 77% of the population happy with insurance, 13% unhappy with insurance and 10% without insurance but want it. Approximately 90% of those with insurance wish their premiums were lower and quit rising every year at renewal.

From the provider side, doctors and hospitals are getting squeezed by the government for Medicare and Medicaid reimbursements (currently about 18% of charges, due to drop in January) and insurance companies are looking to cut better and better contracts which means less reimbursements. The way the game is played reimbursements are based on a percentage of actual charges, charges must be in-line with other health care providers in a region, so every provider inches up their costs whenever possible to get the inches up in reimbursement. As this goes along government regulations increase the costs of personnel, equipment installation, oversight and other operating factors. Approximately 50% of hospitals in the country operate at a loss, were it not for private insurance reimbursements, which significantly outpace government reimbursements, many of those in the red ink category would close. So providers are getting less and treating more and the hospitals with less private contracts are in danger of closing.

Politics of course come into play on resolving this issue, a factor that is not an issue with the private sector--it is but not to the same extent dealing with shareholders or partners versus an electorate. Politically the President has been hemorrhaging political capital all summer and into the fall. His party has a large contingent that is aligned philosophically with the Republicans on health care reform and there are elections approaching in thirteen months that could cost Democrats the majority in the House, their filibuster proof 60 seats in the Senate or deep dents in those majorities. Passing health care legislation now will give Republicans thirteen months to pick out every issue within the legislation and make a case for how it is bad for the people of Greensboro, Columbia, Lexington or Talladega. It is easy for those on the coasts to say "big deal what they think," but those people vote and elect members of the House, and many of them did not see big margins in 2008.

Boiling this very complex problem into a few items: the overwhelming majority of Americans are satisfied or pleased with their health insurance, a small percentage of Americans are uncovered; health care providers are getting less and less for the same procedures under government contracts that could put them out of business; politically the party in power has an increasingly tenuous grasp on their majority heading into mid-term elections.

So what to do about health care reform? My advice to President Obama is this: take a long term approach and layout a plan for this and future Congresses to follow in a step by step manner, just as a private company would do when overhauling a process that is instrumental to their business but needs to be brought into the current era and technologies.

Were Obama to lay out a plan with time frames that are not days and weeks but rather months and years he would create a vision for Americans to follow to health care reform. Rather than tearing down the existing system that three-quarters of Americans are satisfied with in order to insure 10%, show a path of reform to existing processes and practices that will take several terms of Congress and will probably need to continue into the next Administration--be it his or someone else's. If the plan is working in 2012 he can pretty much guarantee his re-election based on his courage and vision to create a long term plan of reform that is methodical in its process rather than a short term plan that no one has read that is crammed with special interests and payouts that harm the entire system.

Step 1: Having admitted that Medicare/Medicaid is rife with fraud, abuse and waste, Obama creates as new department that only exists for two years, no permanent bureaucracy, that is composed of officials from Justice and Health and Human Services that is charged specifically with auditing the entire Medicare/Medicaid structure and correcting the waste, prosecuting the fraud and eliminating the abuse. With the savings from this audit and investigation contracts to health care providers are raised back to levels that would if not encourage at least not discourage their seeing patients. The remainder of the savings goes back into the general fund to cut deficits.

Step 2: Overhaul private insurance laws nationwide. While I am very much in favor of states rights over federal rights, in this instance the American public benefits if there are not 50 different regulatory bodies overseeing health insurance coverage. Allow insurance companies in Iowa to offer medical insurance in California and vice-versa--watch what happens to premiums when this type of competition is allowed into the marketplace. Next disconnect the insured from their employers and their insurance pools. Small and medium size companies, who employ the majority of Americans, are disproportionately impacted by a severe illness to one of its employees or beneficiaries, have a couple huge medical cases in a few years and watch premiums for everyone skyrocket. Further, too many employees are trapped in their employment situations because of the health benefits, having their own health insurance premiums and health savings accounts allows individuals to pursue better employment opportunities and will increase the efficiency, satisfaction and productivity across the nation. Just as employers make direct deposit into their workers checking accounts for salary and 401(k) accounts for retirement, so too can they make direct deposits into Health Savings Accounts that can be used for insurance premiums and co-pays. Make the individual responsible for seeking and obtaining their own medical coverage with a company, plan, deductible and payment that meets their family's ability and needs.

Step 3: The uninsured in our country already have access to health care, go into the emergency room of any hospital and you will see them sitting there waiting to be seen for routine medical care. Hospitals are not allowed to ration care based upon ability to pay, and the ethical and moral obligations of the health care providers prevent them from doing so as well. Beyond the moral aspect the legal aspect is one that is subject to legislation and enforcement. Allow a national database on uninsured patients, providing personal data such as name, date of birth and social security number, and reimburse health care providers for some of the cost of treatment. Not all of it but some of it. With the tracking the government can issue communications to those who appear to be abusing the system with liens and other fines to reimburse the costs through withholding, tax refunds, etc. Find a method that does not penalize the providers, does not unduly punish the tax payers and makes the individuals responsible for their health.

Sounds simple doesn't it? Present a plan with a realistic time line and reform the existing system within its current framework. It works for business and it would work for government if any of the elected officials had the courage to present a long term plan where implementation goes beyond their term of office. Voters would reward this type of vision and leadership if only given the chance.

Health Care Reform Questions That Linger

Questions continue in the health care debate across the country. While every weekend I ask "Just Some Questions" for readers, here are some questions on unresolved issues that face Congress when it reconvenes in September.

The 111th Congress reconvenes in a few weeks, gathering its members from across the country as they return to Washington from visiting their Districts and their constituents. This summer has been different than any summer in recent memory as traditional summer townhall meetings and meet and greets staged by members of both the House and Senate have been the focal point of the health care reform debate. At the center is HR 3200, a proposed bill that runs 1,017 pages as currently offered by the government printing office. Typical summer vacation meet and greets and townhall meetings with members of Congress attract thirty or forty people at most, this summer's meetings have seen overflow crowds and Americans speaking directly to their elected representatives for the first time in generations. With almost 24/7 coverage of the health care reform debate, okay argument, in this country, there are many questions and issues that I feel Congress must address when its summer hiatus is over.

Former Alaskan Governor Sarah Palin created a mini-storm within the storm when she wrote on her Facebook page about "death panels" staffed by government officials who would determine which citizens would be approved to receive which treatments. Mocked, scorned and scoffed at by many, Palin stood her ground and wrote a follow up post on her Facebook page that provided more details and connecting of the dots from HR 3200 that outlined coverage by government insurance of family doctors having end of life consultations with patients, and ability to introduce no extreme measures authorizations among other issues that could be discussed. President Obama reacted by saying, "we won't be pulling the plug on Grandma." Palin and others countered that the intent and attitude of HR 3200 is to use cost-benefit analysis in determining what care can be administered; between cost-benefit analysis of keeping Grandma alive and her consultation with her doctor whom she trusts she may pull the plug on herself. When looked at rationally the argument makes sense. So much sense that members of the Senate Finance Committee have already stated they are pulling any end-of-life consultations out of any bill before them, "it's too confusing" said one member.

Against this background with the House change, modify or delete the end-of-life language in its current version?

With its new name, or new to me, Pharma, Pharmaceutical companies have long been the bad guy in any health care discussion. The number one argument made about Pharma is the huge profits they make and the incredibly expensive costs of their products--particularly products that are mostly consumed by senior citizens on fixed retirement incomes. Not presented in any of those arguments are how Research and Development costs impact those profits. As outlined in a Congressional Budget Office report Pharma's R&D costs and the number of drugs approved for market have a big impact on their profit numbers. "Adjusted for the value of its R&D assets, the drug industry's actual profitability still appears to be somewhat higher than the average for all U.S. industries, but not two to three times higher, as standard measures of profitability indicate." Pharma pays taxes on its profits and then puts money into the approximately $800 million per drug in R&D for new products. Obviously drug companies make money, otherwise they would not be in business. As obviously the profits they make that allow them to stay in business is beneficial not only for the American public but is a global benefit as Pharma has developed drugs that cure cancer, prevent pregnancies, prevent major illnesses like polio, cure our hangovers and allow better performance in certain parts of our lives. With the long and protracted process of getting a drug from laboratory to pharmacy shelf the overall cost of drug development climbs every year. For many years Pharma has been one of the go to whipping dogs of the Democrats when they jumped on the health care soap box. A few weeks ago it was leaked that the White House made a deal with Pharma without bringing in any members of Congress--yes a secret, backroom deal from the Obama Administration with the Pharma lobbyists. In exchange for $150 million in support for advertising and public relations for the Democrats health care reform, the reform would include caps on drug costs that Pharma could accept to maintain their profitability.

How will the majority in Congress deal with the deal made between the President and Pharma? Will they compromise their desire to cap drug costs at a higher level and respect the President's deal and $150 million cost for the deal to Pharma?

Currently hospitals must treat all who enter their facilities for service. The financial problems often begin after treatment has started or ended. In California if a patient comes into a hospital that is not contracted with MediCal, once the patient is stable for transport the hospital must contact hospitals in the region to see if any have beds available to accept the patient. For both MediCal/Medicaid and Medicare, once a patient leaves a hospital a bill is presented to the appropriate government bureaucracy for payment. The bureaucracy then replies back, often at a much reduced payment and multiple denials of coverage for days in the hospital, treatment, etc. After the patient has been stabilized and sent home or to another hospital, in other words once the sick patient is cured, the government entity responsible for payment denies payment to the hospital for some of the treatment provided. This post-treatment denial of coverage, decisions made by government employees without medical degrees or training, costs hospitals, doctors, laboratories, technicians, billions of dollars every year.

In HR 3200 is a lot of language about cost-benefit decisions on care. Currently those decisions are being made by government health insurance programs after care has been provided and costing our health care system billions of dollars. Expanding this process to even more patients across the country will lead to even more treatment of patients with even less payment. How will you balance the cost-benefit treatment analysis with keeping hospitals open?

HR 3200 is over 1,000 pages in length. It is incredibly detailed and complicated. This has been one of the biggest arguments against HR 3200, because of its length and complexity almost no one who reads it can understand all of it. Of all I have read and seen, the public's questions of their Representatives, the one most often repeated is, "How can you vote for something you do not understand?"

Will members of the House and Senate work to simplify HR 3200 so that most Americans, let's even say most Americans with a college degree, can read and understand the bill? Will members of Congress read the final bill before voting to pass it?

One of the biggest arguments in favor of health care reform is health insurance companies denying coverage because of pre-existing conditions. This pre-existing condition denial happens most often when an individual or family moves from one insurance company to another, which happens most often when the primary beneficiary changes employment. With the average American being much more mobile in employment between companies over his/her career than in the past, with the growing number of self-employed or independent contractors in American, more and more Americans every year are in a position where they do not qualify for a company based insurance program, or must go through the expensive COBRA option. Our health care system has evolved, through government encouragement and directive, so that employers have become responsible for the health insurance of their workers and their families. This costs employers, including public entities, billions of dollars every year in costs and at the same time limits the insurance choices now and in the future of its workers--many Americans stay in jobs they hate because of the insurance coverage for their family, especially if they have a child with a specific condition that would prevent them from getting insured from a new company should they change employers.

Will Congress create a plan that would make it more beneficial for Americans to purchase and maintain their health insurance coverage as individuals instead of their having to purchase their insurance through their employers--or the government? Will Congress changes the rules so that insurance companies can offer coverage across state lines without being subject to multiple state rules and allow a family to stay with the same carrier through many jobs, many moves and changes in their conditions?

Many have used the argument for the end of July push to get HR 3200 passed in a couple of weeks that, "we have had over 40 years to fix this, hasn't it been enough time." Or, "the Republicans had eight years to fix the health care system and didn't do it." Well yes, the Republicans had the White House for 8 years under George W. Bush and there was no health care reform, and before that the Democrats had the White House under Bill Clinton with no health care reform, and before that the Republicans had the White House for 12 years between George H.W. Bush and Ronald Reagan, and....during this time the Congress was at various times controlled by one party or the other. Just because several Administrations and Congresses have not addressed health care reform seems to be a reason for pushing through lengthy and complex legislation that has been read nor understood by almost no members of Congress, unless you just want reform of any kind without concern as to the consequences of the reform.

Will Congress take a measured approach to health care reform and divide the reform into manageable segments with the agreement of both parties? Will Congress enable thoughtful discussion and debate on a piece by piece basis addressing the current private and public insurance options, reimbursement of health care providers giving care to uninsured, ability to continue insurance with the same carrier and doctors throughout ones career/life, simplifying billing an reimbursement processes, government involvement in health care delivery and approvals?

Finally, can members of Congress, particularly those in leadership positions, quit with the divisive politics and name calling? Can members of Congress accept that most Americans consider government involvement in their health care to be somewhat scary, very unknown as to what it will mean to their future and the future of their families and very personal and as such they do not want political rhetoric, name calling and dismissive remarks and behavior? Can members of Congress do what they have been selected by the American people to do, which is to lead with the consent of their constituents?

Most Americans want our current health care system to undergo some changes and reform, our disagreements are over how those come about and what the total reform needs to be. Can members of Congress understand they can achieve national unity with a clear stated final objectives and then work together for common ground on how to achieve those objectives?

In about fifteen months every member of the House of Representatives and about one-third of the members of the Senate are facing re-election. How these members of Congress perform in the coming months on the health care reform issue will matter greatly in November 2010, for there has not been an issue in the past few decades that has gained the attention of so many Americans with disparate views. Not wars, not economies, not political scandal. Not since the Civil Rights movement of the 1960s have so many Americans who are usually silent raised their voices on an issue. Do members of Congress hear those voices? Are they all listening?

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Who Controls Your Health?

President Obama has said that he wants a comprehensive health care bill through Congress by October. "Comprehensive health care bill" covers a lot ground and when most people hear it they think of universal health care in the form of a Federal health insurance program to cover those currently without insurance. To many this is one of the single biggest issues in our country--the millions of Americans without health insurance--and it is there goal to ensure every American is insured. But "comprehensive health care" can, and will, go far beyond insurance, count on any such bill to include regualtions on the food and restaurant industries, health care providers, labs and any sector of the country that in somehow impacts personal health. It will offer another opportunity for Obama's growth of the Executive Branch and Federal Government into our daily lives--this time under the guise of health.

The focus by the media, and those in government who craft the bill, will be on the health insurance component. Count on Obama's media machine, and his allies in the Mainstream Media, to touts the benefits of a universal insurance plan and that every American will have health care. Count on them to ignore the details, as they did for the stimulus package and his budget. Having seen first hand and upclose the financial intricacies of health care delivery in our state I am very certain the current system is seriously flawed. But with this knowledge I am even more skeptical of any program that comes out of Washington to "fix" our health care system, and any program that provides universal health care run by Washington. No amount of positive spin from the policy makers or the media will allay this skepticism.

Obama is saying that any national health insurance will be paid for by the "wealthiest Americans," his favorite source of cash. The group of Americans that already pay in the neighborhood of 80% of taxes will be asked to shoulder a bill that is now priced at $1.2 trillion. To further pay for the package will be employers, large and small, either through health care providing mandates or penalties--I'm sorry, contributions--to a health care pool. On top of this is a proposal to stip away the tax deduction for health care insurance premiums, so those employers who are now paying all or part of their employees medical insurance premiums will no longer be able to deduct those premiums from their income tax, or if they are allowed to do so the recipients--the workers--will have to pay taxes on the benefits. On the one hand Obama is throwing trillions of dollars in "stimulus" funding into the economy to create jobs, on the other he is proposing increasing taxes on everyone who works, and/or their employer, which will result in job losses due to higher operating costs.

When it comes to taxing working Americans to pay for the health care insurance of others, I ask: Do we not already pay a tax to provide health care to those without insurance? Look at your paycheck, do you see deductions for MediCal? For MediCare? What is the purpose of these deductions? To fund health care for uninsured Californians and Americans.

Further our hospital and health care system is also self-funding health care for illegal aliens who are treated the same as those who are benignly clasified as "self-pay." The law, and morality, mandates that hospitals treat anyone who walks, or is transported, in the door, whether they have the ability to pay or not. To stay in business hospitals raise their charges to try to cover the amount of free care they are providing from those who are paying through their insurance coverage. This increases the costs to the insurance companies, who in turn charge higher premiums. In the end, through a very flawed system that is costing the health care system the most, everyone who needs treatment gets it. Realizing this is very broad stroked and there are Americans with serious medical situations without coverage that are struggling, overall the vast majority of those within our borders have their most basic health care needs met--whether insured or not.

So that brings us to what will change? If there is a national insurance program what will change in our health care delivery? Besides even more government beauracracy than there is today. Besides even more resources having to be spent by hospitals and doctors to hire employees just to bill the government and follow up when they do not pay--as happens today. Besides have someone at a government desk with no medical training making a decision as to whether a medical procedure is necessary or not. Besides increasing the taxes on every American with a job--not just the "wealthiest among us." Besides that what will change? A base level of health care insurance for all Americans currently without insurance? That we already have but is being funded by the hospitals?

A major reason our health care system is screwed up today is government intervention. In California the state is so involved in health care that it mandates how many nurses have to be on shift for every patient that is in the facility--whether it be two in the morning or two in the afternoon--thanks to union influences on health care legislation. Government is involved in micromaging what equipment can be used in hospitals, where it can be placed and how health care programs can be run. Regulations mandated by elected politicians with only the advice of the lobbiests with the most money, not the most experience. Patient health is not nearly a primary consideration. Need proof: Martin Luther King Hospital.

Ask yourself how will the overwhelming majority of Americans be better off by more control of our health care system taken out of the local hospital, out of your doctor's office and out of your own control and put into the hands of politicians who are already making decisions based on campaign contributions and not what is best for the rest of us. Ask how a new level of spending in excess of $1 trillion, on top of the $2+ trillion already dedicated in five months, will be paid for if not by you and your taxes. Ask how our economy can absorb yet more debt, force yet more taxes on employers, and expect to add jobs? Ask how a system that currently has a fraud rate of about 10% will not maintain that same rate of fraud when the spending increases to $1 trillion (that would equate to $100 billion in fraud)?

My solution to the health care crisis is somewhat simplistic. First, any hospital that is licensed in the state is eligible to receive MediCal/MediCaid/MediCare funding. Second, all payments are the same to all hospitals for the same procedures and treatments, no more contracting with specific hospitals. If all hospitals have to take all patients when they come in, then all hospitals should be reimbursed the same for the same treatments. This includes private insurance--no more separate contracts for every group and hospital. Third, no more system where the more patients a facility or state has under MediCal/MediCaid the more funding they get from MediCare; fund based on need not on what is already being billed. Fourth, use Oregon as a model with promoting treatment and payment of preventative medicine first, encourage well-checks and screenings on a regular basis. Fifth, for those uninsured with employment when they file their taxes they are billed for a health care account; for those without a job their other public benefits are adjusted for the medical coverage provided.

There will always be a small minority of our populace that will not work, that will not pay for insurance, that will not take care of themselves. Our most fundamental question must be: to what extent must we burden the responsible to care for the unresponsible? I know this opens a big can of worms, especially among the most liberal among us, but that is the most basic question. How much must you pay to care for the drug addict, the habitual alcoholic, the woman who sees no problem in multiple children with multiple fathers, what is your personal responsibility through your hard work and success to support those among us that are least responsible? Obama and his allies think it is all your responsibility and the health care bill going through Congress will show that philosophy.

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