Our future is our children. We have heard that a million times. I’m here to tell you that our future is still in jeopardy.  It may even be in grave danger.

On Tuesday, September 8^th, 2009 President Barak Obama is scheduled to telecast a message to all elementary students in public schools in the U.S.  Many conservative republicans have labeled the speech subversive – aimed at indoctrinating the fragile youth of America.

This telecast has been in the works for some time.  The U.S. Department of Education and the White House have been discussing the key factors involved in school drop outs, low test scores, drug use, etc.  Obama, a social worker in the streets of Chicago, knows all too well the challenges facing parents and teachers in today’s violent and polarized world.

Politically, I have issues with some (not all) of Obama’s views. But I am secure in the knowledge that the President does not make laws, the congress does. He does not levee or remove taxes, the congress does.  Even the Education Secretary had to be approved by congress.  So if I have an issue – I know who to talk to: The people who actually write the laws and build social reforms, enact legislation, levee taxes.. You know – the ones who are always complaining about Obama… Humm.. I think I see a pattern here.

But I digress… Back to this subversive speech…

The speech will have an impact. Two impacts to be precise.

The first will be on black youth in America.  They will listen because Obama is an icon of the equality they so desperately seek.  They will listen and many may very well be saved from a life of ignorance, crime and poverty because of it.

The second impact will be on children of racist white parents.  Those parents that have unleashed their poison racial hatred under the guise of political opposition. They call themselves “conservative republicans” that fear “socialist brainwashing” of their children.  When in reality, they are the brainwashers of children. Their own. They teach them hate with a constant bombardment – daily – of anti-government sentiment and anti-black rhetoric.  I hear it all the time. If they are strangers I usually say something. I’m not one to back down from a fight. But when they are family… I stay quiet.  Too much rests on keeping my mouth shut.

Our children are in danger; not from a one hour long speech from a historic president – but from years of indoctrination, political dogma and racial hatred of the “right wing Christians” with such inane remarks as: “I don’t want our school turned over to some socialist movement.” [Brett Curtis, Pearland Texas]; or “I wouldn’t let my next-door neighbor talk to my kid alone; I’m sure as hell not letting Barack Obama talk to him alone.” [Chris Stigall, Kansas City]; “Indoctrination” say pundits on FoxNews; “Brainwashing” is the word of the day on Rush Limbaugh… and it goes on and on.

I have this to say to these idiots.  First.. Mr. Curtis, most ‘movements’ take longer than an hour; second; Mr. Stigall, where I grew up all the neighbors looked out for each other.  Everyone’s kids were at everyone’s homes ALL THE TIME. We ate with our childhood friends and neighbors, we slept over, went to the drive in – with whichever family was going… it was a “neighborhood”.  Because of people like Mr. Stigall and Mr. Curtis, we have a much less rich and much more ‘brainwashed’ set of children today. Parents control their kid’s thoughts and their aspirations like nothing I can remember in my life.  And I grew up during the Cold War when we had nuclear bomb “hide under your desk” drills every month. Tell me that didn’t freak out a 12 year old.

Yes “conservative republicans” – or whatever you un-American racists are calling yourselves these days – your children are in danger – from the person in the mirror.

JB

Sources & References

McKinley, J. (2009). Some Parents Oppose Obama School Speech, New York Times, retrieved September 5, 2009, from:  http://www.nytimes.com/2009/09/04/us/04school.html?em

ED.gov. (2009). President Barack Obama to Make Historic Speech to America’s Students, U.S. Department of Education, retrieved September 5, 2009, from http://www.ed.gov/admins/lead/academic/bts.html

CNN (2009). White House set to release text of controversial Obama school speech, CNN Wire,retrieved September 7, 2009, from: http://cnnwire.blogs.cnn.com/2009/09/07/white-house-set-to-release-text-of-controversial-obama-school-speech-2/

Downloadable video of the speech will be made available at http://www.whitehouse.gov/mediaresources/ as well as on www.ed.gov . C-SPAN.org  will provide archived and “on-demand” viewing options

First of all, it’s important to understand that this Act, as written today, is as much a framework as it is a specific set of laws and edicts.

Four yet-to-be-assembled organizations will control the administration, coverage, limits, costs and applicability to individual plans – both public and private.  They will have two years to get established, become operational, and provide specific details on administration and operation before the “Act” kicks in.  These four organizations are:

1. The Health Choices Administration headed by the Health Choices Commissioner (Commissioner).  An independent organization (operating much like the Social Security Administration) the Commissioner is appointed by the President and ratified by the Senate.  The Commissioner establishes the rules governing access to, and the provisions of, personal medical insurance coverage in the U.S..  Overall, the Commissioners power to control insurance providers (including Medicare & Medicaid) is exceptional.
2. The Health Insurance Exchange (Exchange) – it is essentially the government’s public insurance portal. The competition to private single carrier insurance, if you will. State based exchanges are encouraged – but not mandated.  The Exchange is established by, and reports through, the Health Choices Administration.
3. The Office of the Special Inspector General for the Health Insurance Exchange.  At this juncture, there is no way to insure that the Act will deliver on the promises to lower costs and improve coverage. Thus, an independent oversight office was established to annually audit the Exchange and report findings to the Commissioner and Congress.  I thought it was interesting that the Special Inspector General office was established for only the first five years of the Act.
4. The Health Benefits Advisory Committee (HBAC). Chaired by the Surgeon General, the HBAC has up to 26 members. It is an independent panel that is appointed by the president (up to 17) and the Comptroller General (9).  Three year terms for each member.

The HBAC can only advise The Dept of Health & Human Services (HHS) and the Commissioner on the definition of benefit standards and the level of cost sharing for premium and enhanced plans.  But I expect that advice will carry the power of an edict.  Low is the political career of any HHS Secretary or Commissioner that does not heed the advice of the HBAC

The Commissioner is a Kingpin of sorts and appoints several others; such as the Qualified Health Benefits Plan (QHBP) Ombudsman – a central complaints department for any individual or business that has a problem with a QHBP provider.

Before I get too far along here, we need to understand the QHPB.  It appears that all insurance plans (covering more than one person or one business) in the U.S. will need to be “QHPB” certified – but they do not need to be part of the Insurance Exchange.  “QHPB” certified means only that the plan meets the minimum coverage outlined in the Act.

The QHPB “Minimum Standard Plan” (Sec 122 (b)) includes hospitalization, emergency treatment, outpatient and preventive care, as well as a basic prescription plan.  This minimum coverage includes wellness care, vision & dental for those under the age of 21. So the “Minimum Plan” is pretty comprehensive from a content point of view. However, actual coverage, costs, co-pays, etc. – will be determined by the Commissioner (see what I mean about a framework? – A lot of detail TBD).

An insurance plan must be a “QHBP Offering” to be offered by the Exchange as a public plan.  By default, it appears, Medicare and Medicaid will be QHBP Offerings.  Any insurance company that wants to participate in the insurance Exchange program must submit their proposed “QHBP Offering” to the Exchange for approval – much like a Request for Proposal (RFP) is submitted for contract consideration.

It is obviously the hope of the authors of the Act that all national health insurers, and most state and local insurers, will place QHBP offerings with the Exchange – thus diluting their risk and improving their premium base – throughout the U.S..

The exchange will set up a ‘Trust Fund” that gets filled by tax credits, premium payments and tax collections. The Exchange pays the QHPB providers from this fund for policyholders that qualify for premium assistance.

There are provisions for State or regional Exchanges that will preempt the national exchange program. It is not clear how the Commissioner with administer and regulate these exchanges.

The Secretary of HHS also has a lot of preparation. This includes working with the Commissioner and the Labor Department on a major study on how to keep small and medium business from self-insuring to avoid taxes or payments to the exchange.  This could be a big deal. A topic for another day.

Here’s an eye catcher: Insurance Company profit from QHPB premiums are to be controlled! (Section 116).  A substantial portion (“substantial” to be defined by the Commissioner) of the premiums paid must go to patient care. If an insurer exceeds the profit margin on any plan in a given year, they will have to return the difference to policy holders.  This section is trying to address the issue of insurance companies routinely denying claims and limiting payments to improve profits.

However, the minimum actuarial value for standard minimum QHPB with no cost-sharing is 70% (Section 122).  This might be seen by insurers as a baseline for a 30% ROR (rate of return) on premiums applicable to Sec 116.  That’s higher than the industry reports today!  Enhanced and Premium plans will have cost-sharing limited to 85% and 95% respectively.  So it’s really all over the board as to what the profit margin should be.  The problem is that the actual margin will be dictated by the Exchange Commissioner – sometime over the next 18 months. The reason for the Special Inspector General becomes clearer.

From an industry point of view, I could find no provisions for the establishment of arbitration or appeal processes to Commissioner “rulings’ on profit restriction.  That is sure to get attention by the Republicans in the Senate.

CONCLUSIONS

Well, there’s the “quick and dirty” on the “Healthcare Reform” Act.  It has 243 subtitles spanning three sections. So there’s a lot of detail I did not think was critical – yet. It’s pretty compact by government standards. It won’t stay that way.  The Senate is sure to pump it up by an unnecessary 50%.  If they didn’t they would not be necessary.

My take is that it is an expensive gamble.  We will not know for three years if it is likely to pan out.  More like a NASA project than Health Reform in that regard.

However, I am hopeful, because we need to be hopeful.  The Act is banking on one thing: Greed.  And as long as the Senate does not dilute that, it may just work.  The Act is betting that insurance companies would rather have volume than margin.  It’s the McDonald’s economic approach wherein you would rather make .50cents each on a million hamburgers than $10 each on 1000 hamburgers. ($500,000 vs. $10,000).

You see, that’s the real solution in a capitalist society.  More is less and less is more. The over-quoted “win-win” scenario.  In this scenario a greater portion of individual premiums go to care providers; nearly everyone gets insurance; individuals get more coverage for their money; insurance company stockholders get more return for theirs; the government gets a net-zero trust fund and American business is no longer holding the bag.

Looks good on paper.

But if insurance companies would rather have the status quo – or individuals don’t want government insurance – the whole cost will go to the taxpayer and the deficit. Disaster and success share a common bed.  It also assumes that individuals and businesses will comply by joining the Exchange. You know what they say about assumptions.

A lot of ‘ifs’.  If you have a better idea… let me know.

JB

References and Sources

HR3200. (2009). The Library of Congress, Thomas Bills & Resolutions, Retrieved August 1, 2009, from: http://thomas.loc.gov/cgi-bin/query/z?c111:h3200:

Every time you go to the ATM machine, you are cutting the cost for banks to provide services to you by a whopping 65%. That’s the difference in administrative & processing costs between a teller transaction and one handled by the customer at an ATM. Not to mention the amount of time you are saving you.

It is estimated, that like the banking industry in the 1960s, healthcare providers today spend over 50% of their human resources on patient record keeping and record management. Patients, in turn, spend 75% of their time sitting in waiting rooms and doing paperwork – and/or waiting while the care provider does theirs.

In addition to the obvious need to keep exemplary records of patient treatment, allergies, drug prescriptions, and the like; today’s healthcare providers must address governmental regulatory constraints such as HIPAA and OSHA; health insurance reporting, filing and coding; Medicare & Medicaid compliance; the demands of legal protections around malpractice and liability; and much more.

In an effort to reengineer the cost per patient ratio in American healthcare, the Obama administration (and admittedly, several prior administrations – of both parties) has targeted the cost of patient record keeping and record management as a key success factor in healthcare reform. While this is the right target, not much of the work to date (nor much of that proposed) has resulted in cost reductions for either the healthcare provider or the patient.

The answer may lie in the lessons learned from the ATM.

Giving the patient responsibility for the accuracy and availability of their health records is not much different than expecting a person to be responsible for their financial records. What’s truly exciting about this approach is that it can improve the privacy profile well beyond what HIPAA requires.

By using the internet and a set of well designed secure web “Patient Registry” applications an individual patient could:

• Develop a single heath history and personal health profile – like the history profile everyone fills out time and time again when applying for healthcare or admittance to a health facility;
• Define emergency contacts, successor information, power of attorney and life support instructions;
• Disclose which providers or healthcare interests can have access to their records, and what topics might be restricted and to whom they are restricted.
• Ask to be notified when anyone accesses or attempts access to records – or certain topics (mental heath, for example);
• Remove much of the legal burden from providers with regard to record accuracy between unrelated healthcare events;
• Perform periodic review (or assign a reviewer) to insure continuity of information, treatment, charts and records.

For the care providers, this approach has some immediate benefits. Any person that utilizes this Patient Registry has a fast path through applications, admissions, referrals and appointments. By entering the individual’s SSN and a PIN number – assigned by the patient to the provider – the entire patient history and the history of all relevant treatment, diagnosis or medical advice is available electronically and instantly.

This is only the beginning. As electronic records and digital diagnostic data (such as MRI, CAT Scans, X rays, etc.) become available, they can be linked to the Patient Registry data and automatically reviewed by patient and provider alike. The patient’s insurance company or employer may be given access to certain information to speed payment or reimbursement. Medicare, Medicaid and Social Security access could be granted to reduce, if not eliminate the paperwork and delays involved in treatment assessment and reimbursement.

Reality Check

You may ask “Well, if it’s this simple why hasn’t anyone tried to do it?”. The answer is – they have. Personal healthcare records (PHC) web sites such as Zweena [http://www.zweenahealth.com] or MyPHR from Allima [http://www.myphr.com/] are just getting started. But once again, these attempts are based on self-interest or self-promoting programs. They are competitive ventures that seek to be different from one another rather than be a standard around which all patients, care providers, insurance companies – and federal, state & local government regulators – can frame a record management solution.

Until the patient is directly in charge of their medical records and history – securely and free of charge – none of the extensive and expensive electronics records initiatives will result in major savings. As long as PHR sites, providers, record keepers, laboratories, governments and insurance companies attempt to create holistic solutions – based on their business interests – without first addressing root standardization and the basic needs and rights of the patient – we will fall sort of true reform; Not to mention true cost containment.

Of all hype around what role the federal government should play in healthcare reform, the establishment of a standardized patient registry organization (PRO) would have the most impact on reform and the least impact on the federal budget of any proposal. As an independent, non-profit organization – with record standards developed by the medical industry, the National Institutes of Health (NIH), the U.S. Department of Health and Human Services (HHS) and the insurance industry – the PRO could remain autonomous and independent of industry and government influence. Its sole purpose would be the establishment, standardization, accuracy and protection of personal healthcare records – managed by the individual patient; a healthcare “ATM”, if you will.

Been there..

In 2006 I developed the architecture and design of such a system. Repeated attempts to get it in front of responsible interests in Washington have met with futility.

But I keep trying…

JB

References and Sources

Beaudoin, J. l (2006). Article: HHS to fund trial NHINs in 2007; Healthcare IT News;http://www.healthcareitnews.com/story.cms?id=6036

Bogatin, D. (2007). Blog: Google scary now? Personal Health Records, sponsored by Google, next; ZDNet.com; Retrieved August 22, 2007 from: http://blogs.zdnet.com/micro-markets/?p=1261

Broder, C. (2005). Article: Feds seek national health information system prototype; Healthcare IT News, http://www.healthcareitnews.com/story.cms?id=2978

HIPAA, (2006). Health Insurance Portability and Accountability Act, as referenced at,http://aspe.hhs.gov/admnsimp/pl104191.htm

HIMSS News (2006). Seeking Stakeholder Representation for HIMSS/NEMA MDS2 Joint Standards Writing Committee, http://www.himss.org/ASP/ContentRedirector.asp?ContentID=66391&type=HIMSSNewsItem

Rehm, S., Kraft, S. (2001), Electronic Medical Record Systems, American Academy of Family Physicians (AAFP), Retrieved January 8, 2005 from:http://www.aafp.org/fpm/20010100/45elec.html

Weinert, K. (n.d.). A Brief History of ATMs, retrieved May 16, 2009, from:http://www.stopatmfees.com/newpage3.htm

Other Reading:

American Health Information Management Association (AHIMA), Coding Policy and Strategy Committee, Payer’s Guide to Healthcare Diagnostic and Procedural Data Quality, [2001] http://www.ahima.org/infocenter/payersguide/payersguideprt1.pdf

Electronic Health Records Workgroup, U.S. Department of Health and Human Services, Washington, D.C. http://www.hhs.gov/healthit/ahic/ehr_main.html

HIPAA Compliance, Financial Payment Clearinghouses,http://www.hipaabanking.org/healthcare.html , January, 2005

Medical Privacy – National Standards to Protect the Privacy of Personal Health Information, http://www.hhs.gov/ocr/hipaa/ , January, 2005.

National Guideline Clearinghouse, a public resource for evidence-based clinical practice guidelines at http://www.guideline.gov/ , January, 2005

Can someone own you? Can they own your biological parts – such as your genes?

Yes they can. And you might be surprised to learn that the biggest owners of human genetic info are not corporations, but universities.

The ACLU is trying to upend a practice that goes back to 1980 when the U.S. Supreme Court found in favor of an inventor that used human bacteria to engineer a microbe that dissolves oil. The “bacteria” was a genetic “discovery” of an existing organism and the bacterial genes were patented as a component in the microbe invention.

U.S. Patent Law is developed to protect the genesis of invention. In doing so, the law defines the term “invention” to mean invention or discovery [35 U.S.C. 100 Definitions. Para (a) ]. That “or discovery” part is what all prior genetic patents relied upon. So the fact that one discovers a gene – is set apart from actually doing anything with it; like creating an invention. So while it can be argued that the precedence set by the Supreme Court in 1980 was to effectively protect the components of an invention, subsequent patents have not had to pass this test, apparently. And the Court’s ruling did not elaborate on the aspect of invention as a precursor to patenting a genetic discovery.

So what’s wrong with gene patenting anyway? Well, the case in which the ACLU is involved is a prime example. A Utah university and a private drug company jointly hold patents on genes named “BRCA1” and “BRCA2”. These genes have been proven responsible for many cases of hereditary breast and ovarian cancers in women.

By owning the genes, they also own the test for them. So if a woman wants to be tested to see if she has genetic markers for breast or ovarian cancer, she will have to pay the patent holding drug company $3000. Clearly this is not the intent of patent law, especially when federally supported universities are involved.

“It is the policy and objective of the Congress to use the patent system to promote the utilization of inventions arising from federally supported research or development…to ensure that the Government obtains sufficient rights in federally supported inventions to meet the needs of the Government and protect the public against nonuse or unreasonable use of inventions,…” [35 U.S.C. 200 Policy and objective.]

Since “Inventions” is also defined as “discovery”, this policy applies amply to the ACLU “unreasonable use” assertion.

You will be happy to know, however, that the practice of patenting your genetic code is, for all practical purposes, stopped completely. The Human Genome Project (HGP), which has successfully mapped the entire human genome, has made all our genes a matter of “public record”… so patents on solely the ‘discovery’ of a human gene are no longer valid. You can still patent an invention made from them… but not the genes themselves.

But the issue of patenting discovery still has ominous connotation. And while much of our genetic code is now protected from this practice – (and the patents that came before the HGP have a life span of only 20 years so they are expiring quickly) – there is a precedent here that may cause future discovery to be held hostage thorough misused patent law. In the approximately 80 pages of current patent law, the team “discovery” is used only three times. Therefore it should not be a significant effort to amend this law with more precise language that supports the scope of invention – rather than greed.

JB

References and Sources:

ACLU (2009), Article: ACLU sues over patents on breast cancer genes, CNN, Retrieved May 16, 2009, from: http://www.cnn.com/2009/HEALTH/05/12/us.genes.lawsuit/index.html

Burger, Chief Justice. (1980). Diamond, Commissioner of Patents and Trademarks v. Chakrabarty, United States Supreme Court, June 16, 1980, 447 U.S. 303, 206 USPQ 193; Retrieved May 16, 2009, from: http://digital-law-online.info/cases/206PQ193.htm

Human Genome Project (2009). Human Genome Project Information, Oakridge National Laboratory, Retrieved May 16, 2009, from: http://www.ornl.gov/sci/techresources/Human_Genome/home.shtml

Landau, E. (2009). How human genes become patented, CNN, Retrieved May 16, 2009, from: http://www.cnn.com/2009/HEALTH/05/13/genes.patent.myriad/index.html

US Patent and Trademark Office (2009). United States Code Title 35 – Patents, Appendix L Patent Laws, Retrieved May 16, 2009, from: http://www.uspto.gov/web/offices/pac/mpep/consolidated_laws.pdf

With an obvious left slant to the political landscape in the U.S., 2009 has seen more discussion about decriminalizing drug use, specifically cannabis, that at anytime in recent memory.

The U.S. “War on Drugs” is all about morality, and has little to do with reality. After billions of dollars spent, and tens of thousands incarcerated, the U.S. has the highest drug related per capita arrest, conviction and incarceration rate in the world. And of course, drug use in the U.S. continues to be three to four times that of the next closest country.

A recent study by Glenn Greenwald, attorney and best-selling author, under consignment to the CATO Institute (listed as a “Right Wing” think tank), shows that the complete decriminalization of drugs in Portugal, has been a resounding success. Much to the amazement of the conventional wisdom of the right, drug use did not increase, it decreased. After a couple years, violent crime and criminal activity surrounding drug trafficking has fallen drastically.

This will not be the only such decriminalization. Many other countries are eyeing Portugal’s achievements. Portugal did not have an easy road either. There had to be adjustments made to policy and approach as time went on. But it is the consensus that they will never again return to criminalizing drugs in Portugal. In countries that decriminalized only cannabis, the results are good, but not as stark as the complete decriminalization of all drugs, as in Portugal.

I, for one, am a right-of-center Independent. My politics generally follow the most achievable and sensible policy. But, I have been one of those misguided hypocrites that used drugs in my youth, but supported heavy legal penalties later in life after my house was robbed by people trying to get valuables to sell for drug money. As I grew older; as my own children went through young adulthood, I grew more fearful for their safety from “the drug dealers” lurking in every school cafeteria.

But then, slowly, I saw the disparities in the law around drugs vs. other offenses. Mandatory sentencing laws affected several friends and their families. Then a friend’s son faced a life ruining arrest, but his attorney prevailed. If convicted, the ¼ ounce of cocaine found in his apartment could have made him a life-long felon at the age of 19.

Today we face overcrowding of prisons and jails where over 25% are incarcerated on mandatory sentences for trivial offenses. Our tax dollars provide billions in training, arms and materials to dozens of foreign countries that export drugs. We fight an endless war along our boarders with dozens now dying daily in Mexico… all on account of illegal drugs. Thousands die. Millions are spent on law enforcement and interdiction. And the drug use, drug killings and drug crime continue unabated.

I also look at the moral impact of drugs on our society. Young women are especially vulnerable to drug related abuse and crime. From prostitution to neglect and physical abuse, women, especially those with children, fear to avail themselves of help or social programs for fear of loosing their children or going to jail… so they simply endure the addictions, abuse and heartache.

I remember when I was young; one of the lures of drug experimentation was simply the fact that it was illegal. It had little real ‘value’ outside of claiming my independence from the status quo. Now, older and wiser, I see more clearly the fallacy of the “War on Drugs”.

“There is clearly a growing recognition around the world and even in the U.S. that, strictly on empirical grounds, criminalization approaches to drug usage and, especially, the “War on Drugs,” are abject failures, because they worsen the exact problems they are ostensibly intended to address. “Strictly on empirical grounds” means excluding from the assessment: (a) ideological questions regarding the legitimacy of imprisoning adults for consuming drugs they choose to consume; (b) the evisceration of Constitutional and civil liberties wrought by drug criminalization; and (c) the extraordinary sums of money devoted to the War on Drugs both domestically and internationally.” - Glenn Greenwald

It is time for a non-ideological, scientific, realistic debate on the causes and effects of drug use, and the complete cessation of the war on symptoms. A war on the problem has been missing in this debate. We need to now address the “Law on Drugs” and remove the fulcrum on which organized crime and personal addiction balance.

JB

Sources and References:

CATO. (2009). Drug Decriminalization in Portugal, POLICY FORUM, Friday, April 3, 2009; CATO Institute; retrieved March 15, 2009, from: http://cato.org/event.php?eventid=5887

Chin, B. (2008). Mass. voters OK decriminalization of marijuana, The Boston Globe, retrieved March 15, 2009, from: http://www.boston.com/news/local/breaking_news/2008/11/question_2_setu.html

Degenhardt, L. et al (2008). Toward a Global View of Alcohol, Tobacco, Cannabis, and Cocaine Use: Findings from the WHO World Mental Health Surveys, PLoS Medicine Vol. 5, No. 7, e141 doi:10.1371/journal.pmed.0050141, Summary retrieved March 15, 2009, from: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050141

Economist (2009). How to stop the drug wars, from The Economist print edition; retrieved March 15, 2009, from: http://www.economist.com/opinion/displayStory.cfm?story_id=13237193&source=hptextfeature

Greenwald, G. (2009). The success of drug decriminalization in Portugal, Salon.com; retrieved March 15, 2009, from: http://www.salon.com/opinion/greenwald/2009/03/14/portugal/index.html

Grudgings, S. (2009). Latin America ex-leaders urge reform of US drug war; Thomson Reuters; retrieved March 15, 2009, from: http://www.reuters.com/article/latestCrisis/idUSN11358345

Olszewski, D., et al. (2009), Women’s Voices – Experiences and perceptions of women who face drug-related problems in Europe; EMCDDA; retrieved March 15, 2009, from: http://www.emcdda.europa.eu/publications/thematic-papers/womens-voices

Peters, J. (2009). Albany Takes Step to Repeal ’70s-Era Drug Laws; The New York Times, retrieved March 15, 2009, from: http://www.nytimes.com/2009/03/05/nyregion/05rockefeller.html?_r=1

Reuter, R. (2009). Professional Bio Brief, Professor, School of Public Policy and Department of Criminology, University of Maryland, retrieved March 15, 2009, from: http://www.publicpolicy.umd.edu/facstaff/faculty/Reuter.html

RightWingWatch.org. (2009). Right Wing Organization Profiles: Index; People For the American Way; retrieved March 15, 2009, from: http://www.rightwingwatch.org/content/right-wing-organization-profiles-index

Wickham, D. (2009). Bill Clinton admits ‘regret’ on crack cocaine sentencing, USA today, retrieved March 15, 2009, from: http://blogs.usatoday.com/oped/2008/03/bill-clinton-ad.html

Recently president-elect Obama’s transition team sent email to the party faithful asking that they go to their www.change.gov website and postulate on their “Vision” of what American can be. Now, I don’t know if this is just good political theater, or if each and every response will actually be given due consideration. Probably somewhere in between. Nevertheless, I am always up for a challenge so I thought I’d give this a try.

Definition of a “Vision”

So what is a “Vision” anyway? Among the definitions of “Vision” put forth by Princeton University’s web dictionary are:

• A vivid mental image; “he had a vision of his own death“;
• sight: the ability to see; the visual faculty, “His vision is 20/20”;
• the perceptual experience of seeing; “the runners emerged from the trees into his clear vision“; “he had a visual sensation of intense light“;
• imagination: the formation of a mental image of something that is not perceived as real and is not present to the senses; “popular imagination created a world of demons“; “imagination reveals what the world could be“;
• a religious or mystical experience of a supernatural appearance; “he had a vision of the Virgin Mary“.

So a vision can range from fantasy to science to observation and back. Give a writer that much ground and you could end up with almost anything. However, I will try to keep my “visions” in the context of the political – categorized using the Obama team “Agenda”.

• Revitalizing the Economy
• Ending the War in Iraq
• Providing Health Care for All
• Protecting America
• Renewing American Global Leadership

The Economy

It seems as though every major economic FUBAR in the last 200 years was perpetuated by government. Not by government regulation – but government deregulation and meddling in business operations. Recessionary influence comes from debt/deflation reactions. When government influences poor business decisions (push sub-prime ARM mortgages – then follow with higher prime rates) and encourage over speculation (remove regulations on credit default swaps, etc.) they establish the environment of crisis.

It does not stop with Wall Street or financial institutions. Such poor political decisions as allowing corn ethanol subsidies and disallowing zero emission electric vehicle subsidies (Calif – 2000)– shows that government is still engaged in the practice of trying to generate wealth rather than competition. A very bad idea in a free market economy. Government is the biggest factor in ‘un-leveling’ the free economy playing field and it must stop soon. A global free market economy will not stand for long if governments get in the way of the process. Just as with a professional baseball game, the umpires and referees are there to see that the game is played by the rules – but they should not influence the outcome of the contest. Government is here to establish and enforce the rules – from there on out the players of the game need to stand or fall on their own merit. Bailouts only perpetuate the bad play of the contestants.

Economic recovery is embodied in many of the initiatives about which the president elect has opined. Energy solutions, infrastructure repair and improvement, ecology requirements and re-creating jobs are paramount. But when the government becomes the key de facto job producer and employer, there comes a threat to – once again – create an imbalance in the free market opportunities of business.

And lastly, let’s stop the political B.S. about energy. We are not stupid. Corn ethanol is a BAD idea; there is no such thing as Clean Coal; Hydrogen is not a panacea for energy solutions; and even if we had an abundance of energy creation – our national delivery grid is ancient and technically obsolete.  Petroleum will run out in 30 years (or at least it will be too expensive to ‘burn’ as fuel).  Scientists say CO2 will be at dangerous levels within 80 years. Do the math. Spend our national resources where it makes sense.

Actions: Suggested actions to restore a free market vision for America: Repeal the Commodity Futures Modernization Act; phase out Freddie & Fannie completely; flatten out the tax code; allow free enterprise to determine the best next energy solution; get “shovel ready” infrastructure projects underway immediately; stop funding ‘operations’ like corn ethanol production and start funding ‘research and development’ – like better battery technology, lower cost nuclear energy solutions and natural gas storage methods; to name only a few.

War in Iraq – and Elsewhere

While the war in Iraq is thankfully winding down – as it should not have been started in the first place – Afghanistan looms as our next great FUBAR. More troops may not be the answer. More economic and educational aid may prove – pound for pound – more influential than ammunition.

Pushing Al Qaeda and Taliban fighters into Iran and Pakistan has its own set of potentials that may be worse than the disease. It appears that Islamic fundamentalists throughout the region out number democratic moderates. At least they are more prone to action, so it seems that they number more. If only we could mobilize the moderates….

Back in Iraq, our draw-down there is seen as inevitable. But the pressures on the fledgling democracy of Iraqi President Jalal Talabani and Prime Minister Nuri al-Maliki are such that – without the powerful military of the U.S. to quell unrest – a power struggle will ensue and Obama may be forced to redeploy combat troops if he is not careful. I’m not sure that a coup or civil war in Iraq can be ignored by the U.S. due to the destabilizing influence of Iran in the region.

This bed was made by Bush – but Obama will have to sleep in it.

Actions: Suggested actions to restore a ‘world peace’ vision for America: Engage in dialog and technology exchange with fundamentalist political groups. Education and knowledge will trump cultural dogma every time – given enough time. Infrastructure, schools and free trade improvements will bolster democratic governance. Use force only where life and liberty are in eminent danger. This goes hand in hand with the Global Leadership role the U.S. needs to reassert. When in Vietnam we Marines often complained about the “do not fire until fired upon” rule of engagement. However, in our own way we were somewhat proud that we where held to a different standard than our foe. It is not a weakness to hold humanity in high regard, even while others do not. Especially when others do not.

National Health Care Reform

I have been on the front “side line” of this for some time. I wanted to be on the front line, but my proposals never gained much momentum. My proposal was to establish a non-profit organization that was funded by government grants as a start-up, and then self funding over time. Investors are not all that excited about non-profit funding and the government seemed disinterested since I did not have any academic sponsorship.

First a little background. My wife is a nurse; her father a retired surgeon; her mother an RN. I have heard all the stories. On the other hand, I am an information technology (IT) professional by trade  (www.jwbennett.info). I’m one of those misguided individuals that think IT can help address any problem.

After hearing all the family war stories of how medical practitioners are forced in ever increasing numbers to abandon insurance networks and controls in favor of cash-services – and looking at the staggering number of people without health insurance, the long lines at emergency rooms, and so on – I had a thought. Let’s do a typical IT “Business Analyst” review of the average heath provider. Where do they spend their money; where do they spend their time; where do they make their money, and lastly, how do we measure success of the product or service offering?

My analysis led me to several conclusions. First, by far the most time and money is spent on record keeping. Patient records, insurance records and regulatory record keeping took 60% of the effort of a heath provider. None of which are particularly beneficial to the financial success of the enterprise. In typical IT Analyst fashion, I deduced that automating – or removing – much of this record keeping burden was essential to lowering cost and improving productivity of health providers.

The problem, of course is HIPPA. Not the Act, per se, but the processing and management of patient records by a 3^rd party is problematic. Answer – do HIPPA one better. Put the patient in charge of the record keeping (with considerable help from a secure internet based application that does the heavy lifting).

Next problem – who owns, controls and administers the internet application and database? An insurance company? The government? Hummm.. Any for-profit enterprise or government entity could have conflicts of interest that would strain the intent of HIPPA. So, the only answer I saw was a Non-Profit corporation that had considerable oversight by the government, the healthcare industry and the insurance companies. The internet program application must have considerable benefit for all – including, and foremost, for the patient. Tall order.

Beyond just electronic record keeping, this “Medical Registry Organization” (MRO) would provide ANSI-type standards for record interchange and security. The patient or his/her designate would determine which records were public, which were private, which were available in emergency, which providers has access to what, and so on.

Actions: Suggested actions to provide a ‘universal healthcare’ vision for America: The answer lies in offloading the recordkeeping burden to the record owner. Until the records burden is addressed costs will not moderate – for the taxpayer or the government. Just as banks used ATM’s to offload teller workloads to the account owners (decreasing cost and increasing productivity & profit dramatically, I might add); health care record management can be also offloaded to the patient. Every insurance or for-profit industry “electronic records” initiative will fail in the end due to competitive and regulatory pressures. An independent non-profit organization or “institute” is the only reasonable answer. Health care reform should also look at the many agencies and departments of government that are charged with health and welfare oversight (some 20 agencies in HHS plus EPA, OSHA, USDA,…) and try to rationalize and/or consolidate data, technology, personnel and facilities into a more robust and functional public health organization.

Protecting America

Homeland security has most of its resources focused on the prevention of terrorism. But the fact is most of the death and destruction the average citizen will face comes not from terrorists, but from nature and human error. Considering the money spent to date on homeland security, we have little to show for it. Katrina showed us what real homeland security should be – but was not. Beyond prevention, security means good threat assessment and effective first response.

As most intelligent travelers will tell you, the security show TSA puts on at the nation’s airports is nothing short of pageantry. It is there to instill a sense of security in the public – nothing else. Actually, the single reason 9/11 could not be repeated today is that airlines are now required to secure the cockpit door. It has little, if anything, to do with the TSA’s elaborate security threat detection methods. I could make a belt out of C4 explosive and walk on any plane in all but 4 or 5 airports in the U.S.. No problem. Any nonmetallic weapon can be taken on board almost any aircraft by almost anyone. And if you think this is news to any would-be terrorist, forget it. They already know. But since they cannot use the aircraft as a weapon any longer (and since the average American passenger is more attentive now days), they will move to softer targets.

By far the most effective anti-terrorism activities have been those we hear only rumors about. Communications monitoring & analysis, elaborate pattern matching, decryption methods and other technologies used by the NSA have done more to spoil would-be threats than all the long TSA lines put together. Add to that the efforts to remove the terrorist network money supply, and I think we could have decommissioned every metal detector in the US and been just fine. Ok, maybe that is a little irrational, but not by much.

Actions: Suggested actions for a “secure” vision for America: The DHS is a great idea, but its focus is upside-down. The TSA is at the top of the heap with regard to funding and influence, when it should be FEMA. Keep up the good work at NSA and CIA. Keep the DOD out of DHS programs. I’ve heard rumors of bills floating around congress to deploy federal troops to “assist” local law enforcement in the event of ”emergency”. Hummm. If the National Guard or state and local police are not properly trained or equipped, then fix it. Leave federal troops out of homeland security contingencies.

Renewing American Global Leadership

Without a doubt we have already made progress in this area. Just by electing president-elect Obama, Americans have reached across the cultural and economic gulf of world opinion. But we cannot rest on that laurel.

When we think of global leadership we think of the Middle East, Russia, Africa, Asia… but we also need to consider Mexico, Latin America and Canada. Of all our international dealings, our dealings with American states and border states should be improved first.

Under the Bush doctrine we have seen a major shift to the left in Latin America and an increase in organized drug crime in Mexico. While I too fear a nuclear Iran, I fear more a destabilized government in Mexico. If push came to shove, the Israelis are more than capable of handling a threat from Iran. Mexico however has many infrastructure, education and economic issues – exacerbated by U.S. immigration policy – that have a greater potential to affect the U.S.. You want to restore the U.S. leadership? Start by addressing the Mexican immigration issue.

Outside the Americas, a global economy – enriched by a global information technology network – is moving at breakneck pace. The welfare of everyone is starting to be influenced by everyone else. This will require – in time – a new look at not only national policy – but global policy and global governance. The U.N. is a political football and pretty much as effective as any organization run my committee. But, it is all we really have right now, so let’s see what we can do over the next four years to give it some balls (excuse the vernacular). Darfur, Guinea, Burma, Zimbabwe, et al – little action to deter genocide and massive rights violations. I think there is a place for an “international police force” but they must have the mandate, the training and the equipment to do the job.

Actions: Suggested actions to restore a “global leadership” vision for America: Start with immigration reforms and boarder state relations. Want to stop the march of leftist ideology in Latin America? Lift the Cuban embargo. Engage in open and frequent dialog with other states. Encourage political dissent and policy arguments. Often, if you get the other party talking enough, they reveal the REAL reason for their conduct. And it is usually power related. Give them ‘perceived power’ and they will be your friend for life. And sanctions rarely work either. Not in Cuba, not in Iran, not in Palestine. They only tend to push our adversaries closer together. Let’s try something different. How about open trade, domestic technology transfer, cultural influence, free and open dialog,… What a novel idea!

Lastly, I believe the U.N. is a fine place to voice opinion and do some political wrestling, but no where near a venue for pursuing global peace or justice. At least give it the mandate to do good independent international intelligence gathering so the true cause and affects of actions can be understood by all.  In my fantasy vision of a new world order I have a list of “what ifs”: What if Interpol became an agency of the U.N.? What if the G10 shared threat assessments with them? What if we established a full volunteer U.N. Police & Peacekeeping force?  What if we sponsored a movement to establish an international language?  A language not spoken by any permanent member of the Security Counsel; like Spanish?  What if, indeed. Too far out maybe?  Mark my words, the day may come when the U.N, yes the U.N., is our last best hope.  Woodrow Wilson’s League of Nations vision was far ahead of its time.  But – with the advent of the internet, international free trade and economic symbiosis among nations – it’s time may have come.  Indeed,  the time to make it work may be moving right past us….

For what it’s worth.

JB

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I received a letter from my Doctor about a week ago. His name is Dr. Gary Brewton and he is no longer accepting medical insurance (including Medicare) in his practice. He is not alone. Each year thousands of U.S. doctors are abandoning a broken medical insurance system; and Dr. Brewton tells us why.

An original copy of Dr. Brewton’s letter can be seen here.

While insurance companies constantly raise premiums to policyholders, they simultaneously reduce what they reimburse doctors, labs and care facilities. Health insurance companies are among the largest ‘institutional investors’ on Wall Street. They are using our premiums to make risky investments in Wall Street – not health care. Then our tax dollars are used to bail-out the companies and institutions that get into trouble.

But is it their fault? Not entirely, no. It’s the US Government that promotes credit and investment policies that cause these corporations to abandon sane business practices in an effort to increase shareholder value through ‘insured’ speculation – insured by US taxpayer dollars.

I say it is not entirely their fault because no Fortune 500 company will engage in credit polices that loan money on insufficient collateral or to those unable to pay. No Fortune 500 company will reduce customer satisfaction and lower product quality if their competition does not also do so. Only some kind of unseen force could make these large corporations make such risky and un-businesslike decisions. That ‘force’ is the dark side of government monetary and regulatory policy.

Education, health Insurance, mortgages and global trading policies are all influenced by US Government tax breaks, loopholes, pork, subsidies and insurance schemes. It is a not-so-well-hidden set of under-the-table hand-offs where money changes hands between the major political parties, special interest lobbies and major investors. This has overflowed into global markets and now threatens the stability of the US dollar – and the very security of the United States.

Only when these polices, strategies and tactics trickle down to the Dr. Brewton’s of this world do we see the far reaching affects on the victims – the U.S. Taxpayer and those that invest in the U.S. Treasury.

By then, it is often too late.

JB