Friday, October 8, 2010

Obamacare Looming: Perpetual Motion Machines of Repetitive Failure

Today I went with my wife to her neurologist appointment.  She has epilepsy, so finding a neurologist in Lubbock was something we'd been quite concerned with.   We found a half dozen or so who were in network providers on our insurance, so we called around and found out that we had to have a referral first.  Off we went to the general practitioner, who gave us a referral to a local neurologist.  All was well, until we went to the appointment today and the neurologist informed us that he was shutting down his practice in anticipation of Obamacare.  

It seems as though the switch to electronic records alone would have cost him some $30,000 initially, with an update every two years.  Call me crazy, but I don't think the major problem with our healthcare system is the way we keep medical records.  Amazingly, despite my nomadic lifestyle during my own Lost Decade, my doctors always seemed to be able to keep track of my health history.  A copier and a few stamps were all that was needed to send my medical records in their entirety from one city to the next.  

"At this stage in my career," the neurologist said in a somber voice, "I'm not going to spend $30,000 on switching to electronic record keeping."  I didn't much blame him.  I asked whether or not he knew of any other neurologists who had shut down, and that's when the news came: of the half-dozen or so neurologists who accept our insurance, two have already retired and our new neurologist will be the third.  A specialist practices out of UMC, so it looks like we'll at least have one long-term neurologist with a specialization in epilepsy providing care in Lubbock.  

This neurologist didn't seem to be a man who wore $500 tassel loafers. He had displays of old pistols on the wall, and the interior decor consisted of stuccoed walls with cow horns and various types of spurs mounted on display.  It was a neurology practice, Texas-style.  His dress shirt was nothing fancy, and his demeanor was professional yet down to earth.  He pointedly referred to the people who composed Wal-Mart's FMLA forms as idiots for asking him to estimate how long my wife's episodes with seizures might last.  

The great issue in our country is that individuals with minimal qualifications to run anything control how things run for the rest of us.  The track record in Washington over the past 40 years has not been impressive. We've had forty consecutive years of deficits.  The conventional wisdom says that we had four years of surpluses under the Clinton Administration, but those surpluses depended on pilfering Social Security surpluses in order to mask an actual operating deficit.  

Inflation over the past 30 years has been a complete disaster. Instead of tripling the GDP, Washington managed to grow it around $680 billion in inflation-adjusted dollars.  In essence, the myth of American dominance is just that: a myth.  Our economic mirage depends largely on inflated, devalued dollars.  It's comforting to know that much of the Chinese success story depends on the same kind of currency tricks we've pulled.  

We have individuals who would be in jail right now for breaching their fiduciary duty if they were in charge of a private retirement fund running this country.  Because Social Security is a public program, and because Washington made a law in the mid-1980s which requires every Social Security surplus to be automatically loaned to Congress, everything these crooks have done to rob the retirements of Americans is entirely legal.  

These same individuals deign to tell doctors how to run their practices.  There's a part of me that doesn't sympathize with the medical industry at all. It's riddled with corruption and conflicts of interest, as any pharmaceutical rep who's had to buy doctors sports tickets and expensive gifts will tell you.  Don't even get me started on the insurance industry.  However, doctors are, by and large, good people.  When I first started college, and I developed my yearly sinus infection one November, I remember an English professor calling up a physician who saw me for minimal charge.  I paid for a Z-pack and some Lortabs.  That was it.  He knew that I couldn't afford to see him on my own without insurance, so he made an exception because I had a clear need.  

Doctors do these sorts of things as a matter of routine.  I have a friend in Utah named Pamela who alerted me to a clinic which sees the uninsured for a recommended donation of $10.  It's staffed by volunteer doctors, nurse practitioners, and nurses, who donate their time and expertise free of charge.  The equipment and medications are donated by the pharmaceutical and medical equipment industry.  The local hospital donates an annual stipend because this clinic saves its emergency room an average of $150,000 a month just by seeing psychiatric patients.  That's over $1.8 million a year.  

You see, solutions emerge because ordinary people, some of whom happen to be doctors, go outside the system to ensure that the least of us receive the care we need.  That clinic didn't arise because a bureaucrat in D.C. wrote a law requiring it to emerge.  It arose as a response to the need created by decades of ill-advised government regulation, regulation which has resulted in some 40 million Americans going without health insurance.  

Government regulation created the incentive for a paradigm shift to HMOs under the Nixon Administration.  Today, we have a system that doesn't work, and rather than recognizing that decades of either socialized medicine or for-profit incentivizing regulation hasn't worked, our government wants us to believe that the answer is more of their medicine. They broke it in the first place, but they want us to really believe that this time, they'll fix it for good.  

It strains credulity to believe that Washington can fix anything.  They've broken our economy, our fiscal foundation, and shattered our image in the world with a ruinous foreign policy.  The problem isn't confined to one party or the other: it's bipartisan.  In politics, the most ignorant people rise to the most eminent positions of power.  They couldn't have careers without Washington bureaucracy, because their asses would be fired in the private sector.  

No matter how you look at it, these people aren't that smart.  They either get their private wealth through marriage, primogeniture, or outright nepotism born out of political patronage.  Sometimes they receive it through some combination of the three afore-listed factors.  

We've got Hank Johnson of Georgia, who actually queried an officer of our armed forces as to whether or not additional Marines might cause Guam to tip over and capsize.  We've got Alcee Hastings, one of a select group of judges to be impeached and removed from his courtroom. We've got John McCain, a man who crashed more planes than he ever flew, and whose entry into politics had its origins in an extramarital affair with an heiress whose family has financed his campaigns ever since.  His wife's fortune comes from a distributorship, which itself is the sole creation of government regulation dating from Prohibition. What is the economic purpose of a distributorship?  As nearly as I can tell, the purpose is to add 20% to the cost of liquor and beer, 20% which goes to those families who were fortunate enough to be politically connected when the distributorships were being doled out.  So much for John McCain the free market champion.  We've got George W. Bush, whose business record consisted of three failed companies that never made any money, and a ball club that financed its stadium on a sales tax increase and seizures of private land at below market values through the city of Arlington's use of eminent domain.  If that's capitalism, I'm Karl Marx.  

These are the sorts of people who tell the rest of us to defer to their considerable expertise and long documented track record of achievement.  There are very few signs of intelligence in Washington, and a good many glaring indicators that we are a nation of idiots run by the biggest idiots from our ranks.  This is the price of tolerating nepotism and primogeniture as a means of selecting leaders.  Nancy Pelosi is daughter of a political figure.  Rand Paul is the son of Ron Paul. The fact that these individuals are the offspring of formerly famous political figures does not in and of itself disqualify them from the ranks of the competent.  However, given our recent history, it ought to give you pause.  

We can't afford this.  We can't afford a Ben Quayle, or a Rory Reid, or a Rand Paul.  It's time for this country to wake up and decide to chart a fundamentally different course, to break once and for all with the past.  America needs a revolution.  It's time to recognize that our government no longer works.  

Years ago a political figure asked a very simple question: are you better off today than you were four years ago?  I'd ask it again, except the answer is so glaringly obvious.  If you were already rich four years ago, you're likely richer.  If you weren't, well...your opportunities have been diminished by the legacy of decades of government mismanagement and incompetence. It falls to us to fix the mess that our leaders have made of the world's greatest nation.  

The war isn't in Afghanistan or Iraq.  The war is here at home.  It's a battle to restore some form of common sense to government.  It's a war where we have to re-establish the obvious: you don't spend more than you take in, and deficits really do matter when they're financed with interest.  Turbaned fanatics didn't do us in on 9/11.  We were done in by men who wore suits and ties and matriculated at institutions like Andover and Phillips-Exeter, men who went on to graduate from Yale and Harvard.  Let's just be honest for one moment: those institutions are part and parcel of what's wrong with this country: George W. Bush has a Harvard MBA, for Christ's sake, and an undergraduate degree from Yale.  

Al Gore, that pseudo-intellectual charlatan with a fondness for run-on sentences and Ponty, is also a product of the Ivy League.  So is Larry Summers, a man who trashed our financial regulation and Harvard's endowment before getting called back to duty as Obama's economic advisor.  Really?!  After a track record as destructive as that, you get rewarded with a position as the highest ranking economic advisor in the entire Executive Branch?  

I'm sorry, but an Ivy League degree is losing its luster, given the relative performance of Yale and Harvard alums in public service.  Actually, I'm not sorry.  I'm irritated.  Yale, Harvard, and Columbia are a lot like those designer jeans that cost hundreds of dollars yet are made from the same material as jeans you can buy in any Wal-Mart.  They're a brand, a name that has a certain cachet to it, and any increased merit is solely a matter of perception.  

No one cares to admit that the reason Yale and Harvard alumni succeed in business has more to do with the network they gain access to as graduates than it does with their actual ingenuity.  That network is the reason they have access to start-up capital.  It's also the reason this country is drowning right now.  That network is the same network that used public money to underwrite private losses in the financial sector.  

These people create our crises with their earlier answers to earlier crises, and then they propose new answers that only multiply our problems.  They are not the best and the brightest.  They are simply the best connected.  The problem with America is systemic.  When the people you know are more important than what you know or how well you can apply it, the results are not going to be good.  

In the future, if there is to be any sort of future for this country and its people, the solutions will not emerge out of intellectually stagnant networks.  The solutions will emerge in spite of those networks.  If we are to survive and thrive in the new world, we must evolve beyond the old.  What this naturally means is that the old order has to be extinguished.  We can't have Jamie Dimon sitting on the board of the New York Fed and the ex-CEO of Goldman Sachs sitting at the Treasury Department handing his former company an indirect bailout through their insurer AIG.  

This is anti-competitive.  In China, a CEO who fails usually kills himself.  In the United States, they collect millions of dollars in golden parachutes and exhibit a defiant, entitled attitude on the way out.  The CEO who bears responsibility for food contamination in China doesn't receive entry into a government job.  He's disgraced to the point where he chooses to commit suicide.  He certainly doesn't get to live and advise his country's leaders on how to perform their jobs.  

These networks are fantastic for those who occupy their ranks, the select few among us who parlay their privileged upbringings and connections into a perpetual motion machine of repetitive failure and cyclical booms and busts.  But for the nation as a whole, these networks are fatal.  For America to survive, they have to be utterly smashed.  We can't tolerate this, because it undermines our competitive standing in the world to constantly be rescuing people whose narcissistic outlook enables them to believe that they really are too big to fail. No one is too big to fail, and if this country doesn't start recognizing that fact, it will find out the hard way that even the United States can fail.  If you mortgage the entire country to save 5% of the population from the mess of their own making, you can and will fail.  

Obamacare is not the problem. It's merely a symptom of the deeper pathogen infecting our country.  That pathogen enables the connected to avoid the reprisals and consequences for their bad decisions, and it spreads those consequences to the rest of us with publicly financed bailouts.  These people preach individual responsibility until it's time to absorb said consequences, at which time they start ominously droning on about how their failure will collapse the entire world.  Their inflated sense of self is consistent with the arrogance that has driven their myopic worldview for decades past, and it's a direct contributing factor to the loss of American competitiveness.  It's why we now lead the world in derivatives and follow in everything else.  

You can't expect these people to do anything to replace the broken system that sustains them and protects their station in life.  Why would they do that?  It's a damn good deal for them. They aren't interested in reforming the system or replacing it. They're interested only in prolonging the system, in developing a solution that enables the system to survive just a little while longer.  That's why we received the healthcare reform bill we received, because at the end of the day it wasn't about actually reforming or fixing healthcare: it was about enabling the current system to survive, warts and all.  

It's absurd and it has to stop.  

Posted via email from momus1978's posterous