Stimulating the economy.

KA-CHING.
It’s not complicated, but that doesn’t make it easy. There is no secret why people aren’t spending money, which is why the economy has tanked. First it was dropping home values and stocks coupled with rising gas prices that made people leery of spending money they might need for essentials, while watching their nest eggs and equity (traditional sources of backup) dwindle. Then the expected rise in unemployment made even those with money insecure about spending it lest they find themselves in dire need in the near future. To turn the economy around quickest, we need job creation, which will remove the fears of unemployment that get exacerbated when jobs reports show growth in unemployed instead of employment. Then we need the stock market to start rising. When people feel secure, and that their safety nets are okay, they will start gobbling up deals—whether in stocks or housing, and prop those up as well. However, for them to feel that way, not only do jobs need to be growing, but stocks and homes need to show a bit of a rebound on their own. Enter the government. Obama’s job creation plan seems like a sound beginning. We also need to bailout the states with ballooning deficits or we could lose as many jobs as Obama’s stimulus creates. I keep mentioning this, but I am not hearing much about it from anywhere else. This is one of the cheapest things we can do (less than $100 Billion for part of 2008 and all of 2009) that would give greta returns in saving jobs and building consumer confidence. We need to continue to help the car companies weather the storm while they retool. We need some of the financial bailout to be sued to ease credit and also refinance mortgages and give extended terms to those unemployed by the recent downturn so we can stop the foreclosure morass. If we bailout the state governments, they will be able to stop their own layoffs, stop layoffs from their contractors and suppliers, and continue to invest their pension system assets into the stock market, helping to push that up. It will be expensive, but this multi-prong approach will help the economy get in the black before the end of 2009. When America's economy is humming, the world will follow close behind. Then we can focus on the savings and improvements that HealthCare reform will bring!

Happy 2009! and … My Year End Dinner with Satan. (part 1)

I was sitting here contemplating how far behind I’d fallen in my blog. Among other things, there was no election night coverage with Satan, because election night had gone much quicker and smoother than I had anticipated. Luckily, at least for the possibility of getting something interesting up on the blog, my cell phone rang and the display said Hell.
“What’s going on?” Satan asked. “I noticed you didn’t post our election night coverage.”
“Post what? How we sat there and watched the returns as they came in, smooth and steady to the conclusion projected by the polls? That would’ve been particularly boring, even for this blog.”
“We enjoyed that nice Chianti and some fine cigars.” Satan retorted
“Yeah, but that’s more interesting in person than it is for people to read about.” I responded.
”You think?”
“Duh!” I responded. “Not a lot has gone on lately. The economy is still having a rocky time, we’re in that after election lull--- politically. There’s just not much to do.” I said, disappointed.
“Are you burning out, man? Because if you are, you came to the right guy.” Satan laughed.
“No. I would just like some material for a post. Election night didn’t give it to me.”
“There’s more to this world than the election.” Satan said.
“Which reminds me, I’ve been meaning to ask you, are republicans dumber than dirt? Or is it that they just think everyone else is? And what do you have to do with it?”
“Moi? And, whatever do you mean?” Satan asked innocently.
“Well, let’s look at this whole automobile companies bail-out. The Republicans blocked it, because they said the greedy unions, and thereby, greedy union workers, would not make enough concessions. Now, while admittedly, the unions are going to have to continue to give concessions on benefits, current, and especially in the future, where do the Republicans get off stopping the bailout and calling these workers greedy? Even with the limitations on executive compensation in the $700 billion financial services bail out; an executive can make as much as a score of auto workers, or more. Also, we can blame a chunk of our current financial woes directly on the financial sector---that we had to bail out. While the auto companies certainly could have done a better job of remaking themselves for the future, if the economy hadn’t tanked so suddenly and credit tightened up so, completely, the auto companies would have continued getting by, while they continued their own attempts at turnarounds. So, again, are Republicans dumber than dirt, or do they just think the rest of the American public is? Clearly, they have no sympathy for hundreds of thousands of union workers who----tend to vote Democrat. But for them to do all of this so blatantly and arrogantly, it makes me wonder if there are outside forces contributing to this nonsense?” I paused at this point, waiting for Satan to fess up.
"I take it you are pausing, waiting for me to confess?” Satan asked.
“Sure.” I said.
“I had nothing to do with it. It was a plan conceived and implemented by conservative Republicans, to appear fiscally responsible, if you can believe it. In reality though, it was also a move to force President Bush to act, so that they could embarrass and blame him if it went awry, for handing them the loss in the presidential election, which of course they blame entirely on him, because it is more palatable than them ever having to take any responsibility themselves.”
“I see.” I said “It reminds me of a song, but not, of course, Obama the magic negro.”
“A lot of people were upset with Obama the Magic Negro. I understand upset, but surprised? If I have had anything to do with any of this, it is helping many politicians open up and face the light. I help them to let everyone get to see the real person inside, instead of just let them hide in the shadows and do things behind the scenes. From singing about Obama to, can you say Blagojevich?, I like to see people be themselves. It's very entertaining." Satan laughed. "Besides, I understand you have been working on a tune of your own, which I assume was the song you were eluding to.”
“How did you know?” I asked.
“Demonware on your computer. Better than spyware and hey, at least, I helped you finish it! You did not seem able to find a suitable ending, so I gave it one only I could!”
“You mean, I should have entitled this post “Satan is my co-author?!”
“Yep! Here we go….”
(To the tune of Rudolph the Red Nosed Reindeer, sort of, loosely)

Republicans, the Red Necked Failures

Republicans, the Red Necked Failures
Had an 8 year collapse
First they brought down the nation
Then helped the world fall on its ass.

They spend us into oblivion
Then blame it on Democrats past
Ignored all the warnings
Blame everyone else until the last

Invade Iraq for no real reason
Attack the unions but bailout your friends
Republicans with your lies so bright
Wonder how you sleep at night?

Now all the failures love Palin
I guess in 2012 we’ll see
If she’s better than a potted plant?
Evil-doing Republicans. you’ll go down in HELL…with ME.

“Nice twist at the end.” I said.

“Please note that I specified 'evil-doing Republicans' at the end, to preserve your open mindedness and not imply that you lump all Republicans together."

"Thank you. It is true. I have some good friends and relatives that have more conservative viewpoints. I find them often wrong, but not evil in any way." I said.
"Listen," Satan began, "why don’t you come meet me at the bar of our favorite New York night spot, and let’s see if we can brainstorm a good sendoff for your blog in 2009.”

“Okay, but by sendoff…you really mean like 'kickoff', sort of a new beginning, not like a farewell to blogging or anything, right? You’re not getting blogger to kick me off, or something?”

“Get my favorite blog canceled? Now that would be a helluva thing to do, wouldn’t it?”

“Yeah, real funny. I’m on my way….”

(To be continued…..)

Tax Credits to Help Society Balance the Physician Supply.

Here's to your health America. Tax credits were used to help spur Hybrid Car sales, but were limited to a specific amount per car model, so as not to just be a giveaway once that model's market was established. What does this have to do with health care? Or is this just another post about the bailout? I'll tell you, and no. We need more General Practicing Physicians and we need to slow the growth in specialists. So, once again, enter the tax credit. Every year, for 15 years from when a new physician would enter medicine, and of course they would have to verify they have remained a general practitioner, they would get a tax credit equal to 3.5% of what they paid for medical school. After 15 years they would have saved over half of what they paid. Practice generally for less than 5 years and owe back whatever credits they received. 5-10 years they owe back half of what they received. 10-15 years, they owe back a quarter of the benefit they received. Within a decade we should have corrected the imbalance. If after 2-3 years of the start of this program, we are finding the credits do not outweigh the perceived benefits of being a specialist, we can increase and accelerate the credits. Once we have the proper balance, we can use credits to address whatever new areas need to be adjusted, or to keep people continuing in those practice areas most beneficial to society. The risk of physicians who practiced 10-15 years wanting to then change course to pursue a specialty would be small.

Don't let MotorCity Stall.

Surprise, the Republicans are opposing bailing out the car companies. Unlike financial jobs and companies, they don't seem to worry about the ramifications and human costs of losing union jobs and manufacturing, especially when they reside in a state that just voted democrat in the presidential election. As Satan said about this Republican opposition: "That's my boys!" Sure, dating back to the days when there was little competition and the car companies were flush with cash, the unions won contracts loaded with high costs for health care, retirement and hourly wages that during the more recent times of intense competition, have helped to derail the car companies. Of course, it was also the manufacturers own lack of foresight in the areas of quality and hybrid technologies, that also cost them dearly in the competitive marketplace. True, also, the public continued to ask for, and buy, gas guzzling SUV's, which did little to encourage the manufacturers to make the changes to better fuel economy that manufacturers in other countries already had to contend with because of the high price of oil in their local markets. Now, of course, the public changed its tastes very quickly in the face of high gas prices, and the manufacturers have to play catch up. It is important to note, that the situation was not ignored, and the manufacturers did not remain stagnant. In recent years they were winning concessions from the unions, improving quality and updating their green technologies. Because of all of this, the car companies were in the midst of a promising turn around when this terrible economic slump derailed them. It is the combination of the sagging economy and tight credit that has halted car sales in their tracks, and all the manufacturers are suffering. These conditions were brought on as much by bad government policies and poor stewardship of the economy by the financial services sector that has now received its own bailout, as any missteps by the car companies. Don't let this temporary economic upheaval, exacerbated by factors outside the control of the automobile manufacturers, permanently impair manufacturing in America. We would lose hundreds of thousands of jobs, both automakers and the companies that support them, erode the tax base of the middle of this country, reduce our exports to other countries, completely cede our personal transportation choices to foreign manufacturers and give up the ability to innovate and recapture global sales in entire sectors of the economy. There is more at stake here than 3 irrelevant companies and a few over compensated line workers, whatever some conservatives would have you believe. I know I am asking you to write a lot of letters to politicians lately, and, well, write another one!!

Don't Let the Bailout Leave These Behind!

Whether Bush does it (unlikely) or Obama has to do it (likely?), it is imperative that one group not be left out of the financial assistance. Failing to assist them will lead to rising unemployment, a rising number of uninsured, escalation of the recession and further financial pain and instability for most Americans. It would cost less than $170 billion to provide complete aid to them for two years! I am speaking, of course, about the States. Many states are looking at budget deficits, cuts to necessary services, often health care and education, and will be forced to cut drastically, lay off, or at least cause layoffs in the industries effected by the cuts. Compared to the bailout of finance and business, whose real cost, especially if you factor in the coming assistance to the automobile manufacturers, is already fast approaching $1 Trillion dollars, this would be economical and wide ranging. The effects of ignoring the states would be a dire progression of the recession. The effects of helping the states would be an instant upsurge of consumer confidence and easing of recessionary pressures. Write to your government officials. Even Satan gives this plan '2 horns up', because, as you know from reading this blog, unlike President W. Bush, Satan hates to see more uninsured kids roaming the streets of out great nation. Just another difference he likes to point out because during this election season he has continuously heard a comparison that causes him a great amount of personal distress: "George W. Bush is the devil!" So please, let your politicians know you support bailing out the states. And if you hear anyone calling W. Bush the devil, please, let them know that Satan finds that very offensive.
Thank you.

Tomorrow: Triumph and Regrets.

If Obama loses, though polling would tell us the Bradley effect is as bad as ever it was, I think he can regret his ultimate mistake of not asking Hillary to be his running mate. She attracted just about as many people as he did, they were different people, which together made a formidable base, and she beat him in most of the states he needs to win the election. If John McCain loses, then he can regret taking Palin as his running mate. Picking a right wing W. Bush apostle may have helped with his base. Picking an unqualified, lying (can you say bridge to nowhere), unintelligent (is pollution really caused by people?, she does not think so!)person was an obvious pander; believing that choosing a woman was more important to the women of America than picking someone qualified. Tomorrow night we shall see who regrets what.

Barack Obama for President

I have been working on this endorsement for a while, and scrapped it several times. I have made the case here for months and did not think I needed to say much more here and now. Nevertheless, I hear a lot of things that don't seem so optimistic in a Presidential election for the greatest nation ever on the face of the earth. Also, I do not think everything I hear is accurate. I do not think that in this election it is about choosing the lesser of 2 evils or the devil you know over the devil you don't know. First, these are 2 basically good men. One has a longer history of time in politics, but if you visit his own website, that of John McCain, you will find little about his record. It is not nearly the extensive history we used to see at Hillary Clinton's website. This is because, except for campaign finance reform, you cannot find much John McCain has accomplished. He has reached across the aisle and usually aggravated Democrats as much as Republicans. He is a maverick in the sense that as a politician you usually need to get along with someone, even if it is just your base, but he actually gets along with very few, or at least agrees with them, and gets them to agree with him, equally little. This is not really the mark of someone who can bridge gaps and get things done. I have been told by conservatives, that McCain only agreed with Bush for expediency, and would be his own man if elected. They seem comfortable with this postulated dichotomy, but not with the idea that Obama is not an unknown but actually says what he means (as opposed to what Republicans say Obama "really meant"). I'll try out his ideals and new ideas, as opposed to what John McCain has done lately (agreed with George W. Bush a lot) or what John McCain used to be like (nice guy who did not get along well with others or get much accomplished). When he was so much one way, and then sold himself to another direction to try to get a nomination, how can anyone know what a President McCain would really be like? What would a President Obama be like? I don't know. Obama has not had as many years in office to prove he won't get much done, that is true. He says a lot of good things, and when McCain supporters ask me how I can trust that he means those things, I can only assume they are mistrustful from personal experience with their candidate. That's why I endorse Barack Obama for President. There's no reason to think he is the lesser of 2 evils. He might actually be good. Next up. My election night with Satan---2008! (Then maybe we can get back to all that health care stuff on the back burner, and catch up wih some of the other promised posts that I have fallen behind on, as well as those promised from guest satanic bloggers.) Until tomorrow night then!

A knowledgeable and eloquent man from the Conservative side.

Although I am sure Republicans just see a turncoat for racial reasons.
http://www.msnbc.msn.com/id/21134540/vp/27265490#27265490

Am I Harder on John McCain?

Sure. Here's why. He's not a bad guy and I don't think he's a racist, but he has borrowed advisers and plays from the book of George W. But that is only part of it. It is the way he misleads us, as all conservatives do, when they talk of domestic policy. You see, I have talked a little about Obama's health plan, and it has merits and short comings. His energy policy will be expensive, but he does not deny it and he does not hide it or lie about it. Let's look at a couple of McCain's major policy claims as an illustration. Energy and health care. For energy he says he will build 45 nuclear plants. Now, I am not a big fan of nuclear, clean in some ways, nasty dirty in others and could be dangerous. But we didn't invest all these years in new technologies and because of that fusion, among other technologies, is as elusive as it was 20 years ago. So we may have no short term choice. But here's the thing, McCain talks about cutting spending and shrinking government. Each of those plants will cost $10 billion dollars. Cut spending and shrink government, or start a half trillion dollar energy program, and that is just one piece of the energy puzzle! So which will it be? As for his health plan, I have already talked about how his tax ideas won't work, but I like his community health centers idea. If you have read this blog about health care reform you see I want hospital run medical clinics. But with Medicare rates and insurance reimbursement what they are, the hospitals can't afford to build these clinics. Billions more for that and I won't put an exact price because John won't put out an exact number of clinics. Is he going to cut spending and shrink government or enact these initiatives? If history of conservative administrations from 1980 to the present is any guide--- he will do neither. He will tell us what great plans they are, but we need to "wait, my friends, until times are better and we can afford to do this. Let us first spur on the economy with a tax cut for business and the wealthy". This is why I am so hard on John McCain. Because even if you like what he says...he won't be doing it. As for some other things, as I have previously said, John McCain thought the economy was good before he thought it was bad and he thought the bailout was bad before he thought it was good. He might help in Afghanistan, but hasn't a clue about Iraq. A McCain presidency will be 4 more years of inaction on important issues, and mistakes on others. That is why I am harder on him. Not a bad guy, just mired in an ideology that will not let him succeed.

How I believe the election will unfold.

Here is my take on the electoral college map. I believe Obama will win the popular vote by about 3-5%. Here is my electoral college map, as provided by Yahoo. I will update that and my popular vote totals as information comes in right up to the election. I hear talk of an Obama rout, but I do not see justification in the statistics to call for that yet. Check back as conditions change. I will put it in my link section, and leave it up until the election. If I am turn out to be pretty accurate on election day, then I will leave it up until Yahoo stops the link!!
http://news.yahoo.com/election/2008/dashboard?mapid=42919
By the way, I have only given Ohio and Florida to McCain because I do not think the voting will be fair in either state. If there does turn out to be irregularities, I will renew my call to remove Florida from the electoral college, and start looking at Ohio next. See how quick they get their acts together if that were to happen!!

Debates are done! Where do we stand?

They're done. I think this was John McCain's best debate, but I don't think he did very well. That is because he could not. His policies and stands are not what are right for America now. He tried to frame this debate about what was wrong with Obama because he knows there is not enough substance behind his policies. He wants health care insurance to be able to be shopped across state lines, which take it from someone who sold the stuff, will raise the premiums and screw up the plans in all those states where health care and thus health insurance, are cheaper. He would rip apart the state system, which might have merit, but not for the reasons he gave. Then on abortion he explained that he would leave it to the states to go against Roe Vs. Wade because he's a Federalist. He said there would be no litmus test for judges, except he ended by saying, and I bet he wishes he'd ended a few seconds earlier, "no litmus test except a strict adherence to the constitution, but any judge that supports Roe in my opinion isn't adhering to the constitution" (I did paraphrase a little, but that was pretty close) Which is it John? Break apart state governance or a Federalist? No litmus test, but no judges who find Roe acceptable? He mis-characterizes Obama's plans but that is okay. If Joe the Plumber is rich now congratulations, many in America are not. Which leads me to my biggest gripe about Obama's performance. Enough with letting John McCain talk about redistribution of wealth and class warfare. What Obama is proposing for the richest Americans, is making the tax code fair again, by repairing the inequities that have favored them in the tax policies under George W. Bush. That is all. Fairness. Not redistribution and not class warfare, and I am disappointed that Obama has failed to clarify that. Nevertheless, as McCain still comes across as dismissive (although less so tonight), seething and petulant, Obama continues to make the case that he is the steady and Presidential figure this country wants and needs. SO where do we stand? The polls indicate it is going for Obama and I do not see that anything changed that tonight. We shall see what the polls continue to say. Some have questioned, with some statistical merit, that in some ways the race and in particular the electoral race is closer than it appears. Maybe, but the momentum for change seems t be with the candidate the people are embracing as the agent of change. I have said it before, and I say it again, there is nothing so scary about the unknowns of Obama compared to all the mistakes and poor policies John McCain has made and proposed, much less all his poor choices in support of much of the W. Bush agenda. Tonight, he could have tried to turn the tide by really speaking to the people about how his policies could benefit them. Instead, as he has done, he gave short answers about how he was going to take care of everything (because, you know, this stuff is all so easy) and then made this about why Obama was not a good choice. It did not work for George H.W. Bush against Clinton, and it is not going to work against Obama now. I look forward to all of us trying to take a President Obama's good starting plan for health care reform, and moving it into a true agenda for reform needed for the 21st century and beyond. WHat is best about this situation though, is Obama has shown he has a command and plausible agenda for most of the aspects of the Presidency. He is not a one issue candidate, which is fortunate because this is not a one issue nation. God bless this great country of ours, the men and women out there risking their lives to defend it, and all of us, as we move forward and show the entire world that the best times for the greatest nation ever on the face of this earth---are ahead of us!

I had to laugh....

I found this online: If Obama Were White, He'd Be Hit Twice as Hard.
If you are interested, it is short and can be found here: http://www.newser.com/story/39904/if-obama-were-white-hed-be-hit-twice-as-hard.html. (So can my comment, but I have copied and expanded it here.)

While it is true that generally, I would say it was Sarah Palin and not John McCain that has been stoking hatred, it is John McCain that is paying for it. The reality is that the Dems have been going equally soft on McCain because he is a war hero, something the Republicans didn't do for Kerry. Where conservatives took a war hero and tried to lie about his accomplishments, no one has pointed out that what McCain gave for his country was a great sacrifice, but getting shot down and imprisoned for years is not a qualifying event for President. And NO ONE is taking any shots against Palin, presumably because she is a woman---except to point out the numerous things she says that do not make sense. The democrats have treated John McCain better than George W. Bush did in the 2000 primaries. Conservatives just cannot accept that they were in charge of the WhiteHouse for 8 years, the congress and senate for 6, and have made such a disaster of things that the country is leaning left. Rather than take responsibility, which conservatives never do, they will now blame their losses on fears of being labeled racists if they said "the truth". My friends, you have pointed out about Ayers, and the democrats pointed out about Wright long ago. But those aren't the issues. They are the economy, Iraq, the environment and the future of America, and on those fronts are why Obama is leading.
It is not pretty watching conservatives panic. Amusing, but not pretty. Would that they had spent years worrying about our soldiers dying in Iraq, our 45 million uninsured Americans, business getting rich while ordinary Americans were falling behind and the looming energy crisis, they would not have to panic now as America might even agree that Obama was too inexperienced. But now, thanks to the mess the W. Bush Administration and Republican Congress created, people are craving that change, even if there is an element of unknown. Better the unknown that seems in the right direction, than the known which clearly isn't.

McCain scrambles to remake candidacy with 'comeback' speech. Decides to start discussing issues instead of anti-Obama rhetoric. Palin speechless.

Really. Sarah Palin has nothing to say, because she doesn't know anything about the issues. She threw a tantrum when she heard about this new campaign style, because she was told this was always going to be all about hate, and she knew she could handle that. It is rumored that she was overheard telling her taxidermist: "...crazy old man! How does he expect me to learn about the issues now, it takes all my time trying to spin my ethics violation, which by the way was neither improper nor a violation, nor unethical even, no matter what that bipartisan commission found. C'mon, who you gonna believe, a bunch of politicians and lawyers or a wolf shooting, moose eating, soccer/hockey mom that does a wicked Tina Fey doing herself, impression?"
Oh yeah, and McCain says he is going to talk issues---as soon as he gets some. No, no he has some, he just likes to change them often. It's like a hermit crab trying on different shells, he just wants to see which one is best, and by best, he means which one does not get ripped apart by the pundits and the public, so he can move on to the next issue. Remember, John thought the economy was good before he thought it was bad. He thought the bailout was bad before he thought it was good. And he thought Sarah Palin was a good choice and now he tries not to think of her at all.

New York Times Columnist and Princeton Professor Paul Krugman wins Nobel economics prize

Smart and perceptive. A man who's research spawned new ways of thinking about global production and trade and who is right on the money, often, on the home political scene. Congratulations!
Here is a link to his blog:
http://krugman.blogs.nytimes.com/

McCain Locks In the White Supremacist Vote. (and what vote is Sarah Palin going for?)

With John's latest verbal assault "in the next debate I will whip his you-know-what" referring to Obama, are we to presume he was throwing out a little code to remind the southern states that might for the first time in decades be leaning towards a democrat, of the good old days when blacks knew their place---and if it wasn't picking cotton it was tied up and at the end of their owner's whip? Or are we to believe that this usually well spoken and learned man is just becoming unglued? He probably resents the implications that he is unstable. Will he really prefer becoming the KKK poster boy, instead? He seemed to be trying to avoid that recently by trying to paint Obama as a decent man at some of his more vehement rallies, and saw the ugly side of some of his supporters when they booed their candidate. Has he decided, like he did years ago with George W. Bush, that if he cannot beat them he should join them?? Now, I am quite sure conservatives will say over-sensitive liberals are just nit-picking. Possibly, but in a year long primary battle with a full field of candidates, the democrats all managed to avoid such verbal blunders (even if their spouses did not always do as well). Or perhaps John was just trying to show that he can put his foot in his mouth as easily and often as his running mate Sarah Palin. I haven't bothered with her much because...well, why bother. But did you know she feels she was exonerated of ethics violations even though the bipartisan commission in Alaska found she violated ethics rules. Foot in mouth or just plain liar? She must be going for the 'liars who can't even get their lies straight' constituency, but I think she already had a lock on that one.

What Republicans are afraid of. (Part 1)

You know, I know a lot of conservatives, and speak with them on a fairly regular basis. They're actually family and friends and I care a great deal about them; not because they're conservatives of course, but because their family and friends. So when the issue of the election comes up, which is probably a stupid thing to be talking about in the 1st place with family and friends, I often get the same response, "I'm afraid of Obama." Now on the face of this, I can understand. They say they don't understand exactly what he would do or stands for because he's an unknown. You don’t have to argue that point with me, because here on these very blog pages I have not been so friendly to Obama during the primaries and had endorsed his rival Hillary Clinton. But since, politics affects health care reform and this blog is actually about both, I feel it's time I weigh in on this election although I have been uncharacteristically silent compared to previous elections. So, in part 1 I am going to state my thoughts on what conservatives are afraid of, and then in part 2 we are going to hear from our favorite pollster from Hell; he's lean and mean and a soul searing machine… he puts the Satan in satanic and the devil in the details… he's no stranger to you and he’s a friend of this blog… Satan. But first, I look at the country and the world today. I think back to eight years ago, when we ignored the warnings about Al Qaeda using our own airplanes a month before 9/11. I think about the fact that the military we used to clobber the Taliban in Afghanistan and defeat Saddam Hussein's armies in Iraq was the military that Bill Clinton maintained and armed. Certainly, we know this to be true, because George Bush didn't have time to alter the military. Now, every conservative likes to say that Democrats will decimate the military if given the chance. They say this for two reasons. First , because they need to find something to say, because they used to say it was the tax-and-spend Democrats. A funny thing about that. While it's true that you can't say the Republicans like to tax people, although I like to call them the unfairly taxing Republicans, because they have no problem with an unfair tax code that more burdens the middle and lower classes. You can however call them the free-spending Republicans. How can they any longer attack the Democrats for big government and high spending, when in the last 28 years, the only time we did not have hundreds of billions of dollars being added national debt every year , was under Bill Clinton --- a Democrat. I've actually heard a couple of conservatives have the nerve to claim that the credit for that goes to the Republican-led Congress and Senate that Bill Clinton had to deal with during much of his presidency. They fail to note that under Ronald Reagan, the Democrat led Congress and Senate gave into most everything he wanted because the public support was behind Reagan, and also that under George W. Bush he mostly had a Republican-led Congress and Senate that led to the biggest deficits of all time. This despite all the spending in Iraq and Afghanistan only totaling a little more than one year's deficit under George W. Bush, is pushing through tax policies that he said was going to increased tax revenues because they would expand American business, the fact that his wars have expanded America business by war spending on materials, the fact that we have had growth in stock market and housing price values for much of his terms and decent employment figures. If we had these raging deficits during reasonably good times under most of the W. Bush administration at least economically (which was certainly a hold over from the wonderful Bill Clinton years) and in what circumstances could Bush and the Republican Congress and Senate have imagined America would have to have had to start to reduce deficits during their terms? Conservatives also like to say that the Democrats will cut spending and ruin the military because they like to scare people. After all it worked so well in 2004 when it reelected George W. Bush. Now, go back to 9/11; we can blame 9/11 on a combination of factors, but none of them relate to Bill Clinton. Bill Clinton built up a fine military, a good reputation for the US around the world and had Richard Clarke in there fighting terrorism. George W. respected Richard Clarke so much he kept him around for a while. And after all, George W. Bush was being George W. Bush. Why would we expect him to take anything seriously, and not be playing golf, which is just the way he's always been as all his successive business ventures collapsed. It wasn't a surprise to me that Mitt Romney wasn't the Republican candidate for this election, because clearly conservatives like to choose business failures not business success stories. So you take a lazy failure and you make him president, you have no right to expect he's going to do any better than he did. Now jump ahead eight years, our initial success in Afghanistan and Iraq was destroyed not by a bad military, but by a bad commander-in-chief and the poor people he put under him to manage the warfare. Did the surge work? Of course, sending in thousands more troops to kill more Iraqis worked just like Bill Clinton sending in 100,000 new police officers across the country to curb crime. Eventually, if we send in enough troops and kill enough Iraqis, when their leases many troops as there are Iraqis left, we will have created a real and lasting peace. At least from our viewpoint, apparently. Besides Iraq and Afghanistan, we have the economy, which we drove so into the ground thanks to George W. Bush and six years of conservative Congress and Senate that voted along with him all the time, that we have driven the rest of the world's economies into the toilet as well. I actually have seen conservatives blame the current state of the economy on the Clinton administration's deregulation. When I stopped laughing, I point out that whether deregulated or regulated, a situation is only as good as the current oversight. Nobody has been minding the store during the entire Bush administration. Plus they have continued to deregulate, and pass rulings that encouraged less oversight. The lone exception is the Sarbanes-Oxley act, passed under George W. Bush out of panic for the last corporate greed mess stimulated by the attitude and lax oversight of this administration, that has onerously burdened smaller businesses, while clearly not handling those areas of business practices that were going to cause us these problems. Then of course, we have the rest of the Middle East, where we have accomplished nothing of note in the last eight years, but of course not much of note had been accomplished before that. We have the environment which has gone a bit downhill in the last eight years. We have North Korea and Iran which have basically been mishandled in the last eight years. The world is a much worse off place than it was eight years ago. Some conservatives point to the fact that we haven't been attacked on American soil since 9/11 as proof that their policies, at least in some ways, work. But as I point out, the attacks on our soil were the two on the World Trade Center eight years apart. We weren't necessarily due yet. We have certainly seen terrorism across the world, terrorist recruitment up thanks to some of our policies, and Al Qaeda enter Iraq where it never was before we invaded. You will notice that 9/11 happened in 911 2001 not during the Clinton years. You can blame the conservative supreme court and the poor voting procedures of a Bush run Florida for 9/11 as much as anything else. You see, if the actual elected person, Al Gore, had taken office, we would have every reason to believe based on past experience that he would've read the reports and taken them seriously and acted a month before 9/11. It may never have happened. Of course, we'll never know, but it should keep you awake at night thinking about it, because no one has ever accused Al Gore of being uninformed or not on top of what's going on. So after all this, what is my point? What are conservatives afraid of? I've tried to point out, that what I truly believe they are afraid of, is that things will get better under Barack Obama. They like to say they're afraid of the unknown and the terrible things that might happen, but could the consequences be much worse than what's happened under George W. Bush, which is why I stated everything or I should say, restated everything, here now. No, what conservatives don't even have the ability to admit to themselves, which is why they just have this blanket statement "Obama scares me", is because what they're really afraid of is that things will get better and they won't have a shot at the White House again for a very long time. You see that's what happened last time, after things are great on the Clinton, Al Gore won the election. However, because of shenanigans in Florida and a conservative supreme court they were able to steal the election for George W. Bush. They know that won't fly with the American people again. The American people don't forget and they will remember for a very long time what happened when they allowed the Supreme Court to steal an election and how bad everything has been since.
I have weighed in here on the negatives of Obama in the past. I have weighed in on some of the positive aspects of John McCain from the distant past. Haven't bothered to weigh in on some John McCain's weaknesses when he was a Republican that I liked. Why bother? And all his time in the Senate so, actually hasn't accomplished much. It's true, what he said in the debate about his record, that he is reached across the aisle, but also that he hasn't always been like by people in his party or the other party. It's true. He doesn't get along with enough Republicans or Democrats to accomplish very much. He never has. More recently, for several years, he has tried to get along with the most conservative Republicans by kissing up to George Bush and showing that he can be the kind a guy that they can get behind. Pathetically, they still haven't really gotten behind him, but that's okay because let's be real, they’re not going to vote for Barack Obama. I guess McCain is most worried that they won't come out and vote at all. Now in the last debate, John McCain explained in just a couple of sentences, that he's going to fix the economy and catch Osama bin Laden because those things are really not that hard. Not that hard?! John McCain is either a liar or is sadly confused and deluded. These have been two of the greatest hallmarks of the George W. Bush administration. In just a couple of sentences John McCain has proven what he's been trying to stop the Democrats from doing for quite some time. He proved he is just like George W. Bush. And as I have stated here, anything we could possibly fear about the unknown of Barack Obama, has sadly already been realized by George W. Bush and company. This is why I can wholeheartedly endorse Barack Obama for president and why I dearly hope his deeds will match his words and the feeling and compassion behind them, and that he will do his best to fulfill the promises and expectations his belt among the people who were going to vote for him. His words and deeds and what actions we have seen, have all been of a man who cares about this country and all the people in it. There is no history or uncovered documents and letters that would lead us to believe there is anything more to fear from Barack Obama than fear itself.
Next up: we'll hear from Satan.

Paying Healthcare Providers for Performance.

It is interesting that in today there is an article in the New York Times Science Times about paying healthcare providers for performance, because I happened to have just been working on this same topic. The article clearly, and concisely pointed out the pitfalls of paying for performance. I think there is merit and reason to such a promise, but I advocate a much different system. There is the idea of paying for results, which is different than paying for performance, and is also being tested by Medicare. But as usual, insurance companies and Medicare, just don’t get it. Their solutions fall somewhere in the middle, rather than developing proper methods, they like to use the most basic and limited thinking to reach their goals. In my pay-for-results plan, there is your base pay plus two bonuses for lowering mortality rates and improving treatment rates based on certain criteria. There are no payments for treatment guidelines as in the current system, because it contributes to the risks and abuses pointed out the article, such as avoiding surgery for patients at higher risk or even treating patients who are very high risks, as well as starting antibiotics and other treatments before you are clearly sure of the diagnosis. You earn your bonuses for lowering mortality or treating in the most efficient manner, meaning earliest and easiest intervention. Only if you don’t get a good result while not following the guidelines the government has established, would you be penalized. In this way, you can show that you are able to achieve excellent results without blindly following generalized guidelines. The problem with these guidelines developed by the government is not that they’re bad, because they’re not. Statistically, they are driven as the generalized best practice. However, if people were machines, especially mass-produced well maintained machines like computers, this generalization would work a lot better. The problem is, human bodies don’t all work perfectly alike, and medical science is art as well as science as there is so much still to be learned. Therefore, providers for innovative and maintains strict controls to be on top of the situation can probably do a better job than generalized guidelines. However, if you’re not good at what you do, and you are flouting guidelines without showing a corresponding better practice, you’ll not only get worse results but the system will now be in place to penalize you for it. Patients will need to be set up in the two tiers, with the most sick patients being put in the final tier, and will be judged statistically on a separate basis, so as not to skew your results and lower your bonus. This will help to remove the encouragement, not to take on the sickest and most high risk cases.
Since generalization is built on statistical evidence I am quite sure it saves lives in institutions where the creativity is lacking, or the attention is not quite there, where they are understaffed and overworked, so it is not a good idea to abandon them completely. Rather, they should be used as a measurement tool to compare what treatment is being done at organizations that are doing below acceptable limits. For the best institutions they should be used to figure out what they are doing right and how to ultimately make those generalizations even better.
It is important to create a tier structure that takes into account the kinds of cases, the hospitals are taking on. We don’t want to encourage hospitals to shy away from the toughest cases, or those institutions that currently do, and should handle the toughest cases, to worry about how they may skew their results in a negative manner.
Clearly, we need to hold providers accountable. Just as we want people who repair all our homes or cars. We need to understand that unlike homes, cars and computers, fixing people is not an exact science, and everything we need to know is not known. Having said that however, we have a right to expect that our providers are not only well trained and licensed, but are knowledgeable and prepared to practice using established, statistically beneficial guidelines, unless they have a good and experienced rationale to divert from these guidelines.
We should not allow insurance companies and Medicare to start dictating treatment. When the only way for a provider to get paid is by following the guideline of treatment, even when they strongly have reason to believe they can do better than those guidelines, then they won’t, and medical science will not march forward. Insurance companies and the government are always looking for a way to pay out less, and this is reasonable if they can find ways to more efficiently offer the same or more effective care. However, what’s necessary here is the creation of a more comprehensive and multi-tiered evaluation system and check and balance system, to allow providers to do what they do best, yet help them to avoid some of the pitfalls and errors to which many of them are prone.
We can do better. We must not allow insurance companies, nor government, to choose what is easy and expedient. Simple cost-cutting and financial constraints are not going to fix our health care system, nor halt health care inflation in the future, unless we accept the realities that major change must be affected. At the same time, we must preserve what is best about our system, and that is our well-educated provider system, our top-notch research and development system and our cutting edge development of technology in healthcare and related fields. We can do better and we will do better.

The Fighting Terrorism Scorecard.

Some Presidents have terror trust upon them, like Bill Clinton in 1993 when, without warning the World Trade Center was attacked. Others are prepared and forewarned with their great understanding of the world around us, like George W. Bush who ran during the 2000 debates as the "anti-terrorism President". After 9/11 George W. Bush said he would have "moved heaven and earth to have stopped those attacks". Since it has long been established that he had warning that Al-Qaeda and Osama bin Laden were planning to use our own airplanes against us in a terror attack, we can presume that rather than figurative, W. Bush was being literal. Apparently he might move heaven and earth, which I am pretty sure he actually cannot do, but he would not order the airlines to lock their cockpit doors; something that has been done since the attacks, and has long been credited with helping Israel's airline, EL AL, avoid hijackings. Because he was warned but failed to act in any way, shape or form, George W. and his administration get a big NEGATIVE on their first brush with terrorism. George W. then invaded Afghanistan, the hideout of Osama bin Laden, after establishing that he and Al-Qaeda were the culprits. That goes down as a big POSITIVE. We then invade Iraq, even though intelligence tells us they are not related to the attacks, do not harbor Al-Qaeda, in fact Saddam Hussein was afraid of Al-Qaeda. That's okay. We don't claim they had anything to do with 9/11. We claim they are dangerous on their own right, preparing weapons of mass destruction and all. When this turns out to be false, and we start to learn that the administration knew these were lies, we suddenly start to claim they were part of 9/11 all along. By 'WE' of course, I mean our Government. Then the bipartisan commission finds, as we knew all along, that Iraq had nothing to do with Al-Qaeda or 9/11. George W. Bush, Dick Cheney, John McCain and Joe Lieberman have apparently not read any of this intelligence or been briefed on any of these reports. Many citizens of our country and people around the word have been getting the message however. That would go down as another big NEGATIVE. Our destroying the Iraqi military and having not a clue how to fill the void allowed Al-Qaeda to, for the first time, get a foothold in Iraq and start killing our troops with roadside bombs and Iran supplied anti-tank and helicopter weaponry. Incidentally, also empowering Iran. Our use of torture and indefinite imprisonment during the conflict has helped to turn Arab sentiment against us that had been won over back by the Gulf War. Our hypocrisy has tainted us not only in the MidEast, but on the entire world stage, emboldening Russia. We'll call that another real big NEGATIVE. Our taking the eye off the ball by going into Iraq leaves the job undone in Afghanistan, allows the Taliban to regroup and lets Osama gets away. NEGATIVE. That's five events with one positive and four negative for, or a 20% positive percentage. If you took math anywhere but President Bush's classes at Yale, you know that is a failing grade. If there is any place where John McCain most agrees with George W. Bush, it is in the fight on terror. Do the math. What is really sad is that because the Republicans talk tough, people actually believe them, even with their abysmal record. These are smart people, some of them anyway. If a stockbroker told them he'd make them a lot of money but had a terrible track record of losing people's money, these people would never listen to them. If they were shopping for a car and the salesman said this is the best car in the world, they would still look up Consumer Reports to objectively verify this. But let a Republican talk tough on terror, and it doesn't matter that they have done absolutely nothing, well, almost nothing, and certainly done almost nothing right. Like I said, DO THE MATH, and if you don't want to vote for Obama, then write in a vote for a house plant, or a sponge, or anything or anyone not McCain/Palin, because this country and its citizens cannot afford 4 more years of fighting terrorism the Republican way. We need to start fighting the real threats and we need to focus on that fight until we beat them! But when you do cast your vote, before you write in that house plant, remember that Bill Clinton, a democrat--shudder---caught the 1993 attackers of the World Trade Center, and when Al-Qaeda attacked us in other countries, Bill Clinton sent in cruise missiles, and when Saddam Hussein would break the no-fly zone, Clinton would bomb his bases and other military targets. By that count, Bill gets a passing grade. You can vote Obama, or vote for a sponge (Spongebob for President, anyone?), but I think we'll all probably be better off with Obama.

Country First

Country First. That's the sign that the Republicans wave around at their convention. I guess they are trying a change of pace, since they tried putting their country last and the richest people first from 2000-2006. They still put their country last from 2006-2008 but it was less comprehensively because they lost the congress, because the country woke up and realized they were being put last. Just about their entire convention has been about veterans. Veterans are heroes and patriots, but that does not mean they are qualified to be President. If you only had to be a brave war hero, then John Kerry would have been our President the last 4 years, and America might have already been on the road back to the greatness it deserves. We can't change the past, but we can fix the future. The Republicans had their chance...and they messed things up. True, we don't need Obama to get us out of Iraq because despite what the Republicans want; Bush wanting the war to continue and McCain saying we will stay there 100 years, the Iraqis are throwing us out! Still, we need a change to right so many other things. Vote Obama. Or go ahead and write in your vote for a sponge, a Buick, a house plant, what-have-you, just not John McCain or any other Republicans.
By the way, did you notice those young Republicans cheering Rudy Giuliani saying John McCain would keep the fight against terrorism on the offensive? Why are they at the convention? Why haven't they enlisted to fight the good fight in Iraq (or even better---the real fight in Afghanistan)? The old Republicans love to cry for war because they aint going, and they aint sending their kids either, make no mistake. Seem a bit hypocritical? Alright, it's true, not just a bit. Of course, not all Republicans are hypocrites. John McCain's kid is in Iraq (as will soon be Joe Biden's), and Palin has family going as well, but sadly, that is pathetic, not patriotic. The only terrorists they will get to shoot at in Iraq were ushered in by George W. Bush, as has been pointed out in this blog before. If Republicans are so easily fooled, and fail to learn when the truth is pointed out to them; that Iraq had nothing to do with 911, and a bipartisan commission pointed that out, and that the Bush Administration lied, and covered up these issues, how can you trust such easily fooled people to run your country? The answer of course, is you can't, and when you try, you get the last 8 years. And Bush was the guy doing the fooling! He's the clever one! The rest are just still believing the lies he sowed! At this point it should just be NUFF SAID. Time will tell.

More on Health Care Reform. Changes to come.

I just want you to know that I have happily worked for insurance companies selling both life and health insurance as well as managing entire units and regions for those companies. Nevertheless, I must call this section, "how the evil insurance companies screwed up everything".
You see, in the 70s and 80s, when insurance companies are able to make ordinals of money on safe interest-bearing investments, they took their eye off the ball and simply reimburse whatever charges doctors and hospitals submitted. This allowed for out of control costs growth and waste. There was no fiscal discipline for decades in healthcare. This is by far not the only cause of the situation, but because the insurance companies acted as insulation between the public and providers, there was never the need to deal with the spiraling costs. Of course, due to the complexity of healthcare, it’s never going to be cheap, and there is no developed nation where health care is quality where it is cheap, although in many places it's less costly and more efficient than it is in the United States.
Now, I don't blame the insurance companies for everything or necessarily even the majority of the current problems. I also wouldn't blame them almost at all if they made a reasonable rational attempt to fix the problems that they did create. But they did not they, like the government, tried Band-Aid fixes that not only do not address the problems that are unfair in their attempts at what meager solutions they offer.
Their cost containment solutions are always aimed at the end providers, ignoring what those providers cost of doing business really is. Now, I have stated myself but I believe we spend enough on healthcare already, but I know that to fix the system to make it operate on these budgets requires major policy retooling. To go to the last end of the providers and say you've got to charge less, we are not paying you any more next year than we did this year, we are only paying for this many days of hospitalization and we won't take into account that people aren't machines and we can't always know exactly what's going on inside them and what the outcome is going to be, are all punitive measures with no rational basis for expecting them to work , or work efficiently. Neither government nor insurance companies get it. There is no simple fix here. Insurance companies place in this business is going to need to change drastically. Insurance companies and HMOs aren't doing a good job, aren't doing the right job and aren't set up correctly for what our healthcare system needs. On a much more superficial basis I am going to begin to lay out here what I do much more comprehensively in my book; and that is how we are going to need to remake the interplay of insurance companies, government funding and healthcare providers into something that works now and will continue to work into the very far foreseeable future.