jims musings

So, it seems that the Amer­i­can pub­lic is slowly becom­ing dis­grun­tled with lob­by­ists in Wash­ing­ton. Fur­ther, the notion that lob­by­ists rep­re­sent the root of what is wrong with our gov­ern­ment seems wide­spread.
I step for­ward now to say: Baloney. It’s pop­py­cock, I tell you. Flim­flam.
I’m not say­ing that lob­by­ing is not a prob­lem; I also believe most red-blooded Amer­i­cans would vomit if we knew all the back-room under-the-table wheel­ing and deal­ing that takes place as leg­is­la­tion is writ­ten and polit­i­cal back-scratching… scratches.
The prob­lem is the amount of influ­ence Wash­ing­ton has in the daily life of Amer­ica. The found­ing fathers had fan­tas­tic exam­ples of this when the coun­try was founded. They were inti­mately famil­iar with Eng­land and France. They had read their Plato, Addi­son, Cicero and Aris­to­tle (not to men­tion Mills, Smith, Thucy­dides, Hobbes, Mon­tesquieu and Kant). The knew very well that the Fed­eral Gov­ern­ment ought not be involved in the daily life of its cit­i­zens. That respon­si­bil­ity was reserved to the States.
We destroyed that notion with the Civil War, the 17th Amend­ment and the New Deal. The Fed­eral Gov­ern­ment is now involved in the daily life of its cit­i­zens through taxes (income, social secu­rity and medicare), health (HIPAA, Medicare/Medicaid, NIH), real estate (Fan­nie Mae/Freddie Mac), schools (Depart­ment of Edu­ca­tion, No Child Gets Ahead), energy (EPA, DOE), base­ball (Fed­eral Base­ball Club of Bal­ti­more, Inc. v. National Base­ball Clubs (Supreme Court,1922),Federally Con­trolled Sub­stances Act)… the list goes on. And on.
So, with all those fin­gers and ten­ta­cles reach­ing across the coun­try, there is lit­tle won­der why so many peo­ple and busi­nesses have an inter­est in what the leg­is­la­ture is doing. Thus, we have lob­by­ists, lots of lob­by­ists.
In 2008, there were over 14,000 pro­fes­sional lob­by­ists who spent $3.2 Bil­lion try­ing to influ­ence con­gress. I would like to point out that these num­bers are the known amounts. I imag­ine there is more under the table. They say a bil­lion dol­lars doesn’t buy what it used to, though.
Per­son­ally, though I find these devel­op­ments dis­heart­en­ing– the rise and impor­tance of lob­by­ists– it is all pre­dictable and ulti­mately change­able.
My pre­ferred change would be for con­gress to devolve its influ­ence and power back to the states. This is very doable and I think would be for the greater good, but for rea­sons of pol­i­tics, power and per­sonal ambi­tion will never hap­pen.
The more likely course is for things to sim­ply con­tinue until a cat­a­strophic event forces change– like 9/11. Iner­tia is a pow­er­ful force; P=mv, my friends. There­fore, the only rea­son­able thing to do is lobby con­gress your­self. This isn’t as hard as it sounds.
Here’s how:

• Write a let­ter.
  Keep it short and to the point. Short hand­writ­ten let­ters are best, and remem­ber to be spe­cific about the action you want your Con­gress­crit­ter to take. Make sure to include your full address so that they know you live in their dis­trict. Some have even been known to respond to email sent through their web sites. (House of Rep­re­sen­ta­tives, Sen­ate)
• Make a Phone Call.
  You can call a U.S. sen­a­tor or rep­re­sen­ta­tive by con­tact­ing the Capi­tol Hill switch­board at 1–202-224‑3121. Once you are con­nected to the right office, ask to speak to the staff mem­ber who han­dles the issue you are con­cerned with. Clearly have in mind a spe­cific request of your representative.
• Meet with your Con­gress­crit­ter.
  Hard when con­gress is in ses­sion, but leg­is­la­tors spend a good deal of time in their home dis­trict office. Make appoint­ments with sec­re­taries and keep your mes­sage focused. You can also attend pre-scheduled town hall meet­ings; call their office for schedules.

The fol­low­ing is from an email I sent to a friend today, and it was cogent enough that I thought I’d post it here.

First of all, health care is expen­sive and gov­ern­ment is not likely to be any bet­ter. By all accounts (and lots of real-world exam­ples) social­ized health care is worse than what we have now. So, fol­low­ing the Hip­po­cratic oath, any changes must first Do No Harm.

Sec­ond, because of the costs, it seems appro­pri­ate that any social­ized health care sys­tem be meant for cit­i­zens. One of the major bud­get prob­lems in Cal­i­for­nia and Ari­zona are ille­gal aliens’ use of the hos­pi­tals and emer­gency rooms– the most expen­sive and valu­able health care resource there is. This is not a good use of resources and serves as one of many induce­ments to come here illegally.

Third, roughly 30 mil­lion peo­ple in the United States do have no or inad­e­quate health care. Another 30 mil­lion are strug­gling to with their pay­ments. So, while 60 mil­lion peo­ple ‘need’ help, another 240 mil­lion are okay. In other words, 80 per­cent of the pop­u­la­tion is okay– though I sup­pose every­one would like things to be cheaper. Who wouldn’t? (Dis­claimer: These are the best num­bers I have at the moment; they may have changed recently with the increase in unem­ploy­ment.)
To put things into fur­ther relief, there is an unknown num­ber of ille­gals included in the ‘lacks cov­er­age’ seg­ment above. (Wikipedia says there are cur­rently 12 mil­lion undoc­u­mented work­ers in the coun­try.) Add into the ‘lacks cov­er­age’ group all the college-age kids who are young enough that health care is not a big con­cern for them, or even unwanted. Per­son­ally, my fam­ily is healthy enough that I loose lots of money on health insur­ance premiums.

Fourth, we don’t want the new sys­tem to sup­press research and devel­op­ment of new treat­ments, tech­niques and drugs. We, and the rest of the world, rely on these improve­ments… and the United States has been a key dri­ver of health care improve­ments for decades.

There­fore, the prob­lem to solve is: 1) We desire that all Amer­i­cans have access to qual­ity health care. (The Pres­i­dent called this a ‘Right’.) 2) We don’t want to decrease the qual­ity of cov­er­age that most Amer­i­cans enjoy, and it would be a bonus to improve it; and 3) We would like to pro­vide this cov­er­age with­out dam­age to the bud­get or by rais­ing taxes to oner­ous levels.

How is this to be done?

First and fore­most, if health care is a ‘Right’ as our pres­i­dent has said, than it must be restricted to cit­i­zens. (Egal­i­tar­ian democ­racy, open bor­ders, and social­ized health care is a recipe for dis­as­ter.)
Sec­ond, it should not be free. Some con­trol should be placed on access to med­ical care– sim­ple eco­nom­ics says that valu­able goods pro­vided for free will soon be con­sumed. Cur­rent con­trols are co-pays and wait­ing rooms, which aren’t so bad when alter­na­tives are con­sid­ered.
Third, pay­ment for goods and ser­vices should be swift. Remov­ing the delay in pay­ment would do won­ders for the respon­sive­ness and costs of the sys­tem. Part of the delay cur­rently comes from efforts to reduce fraud.

So, if I was given a magic wand and told to fix health care along the lines out­lined above, I would:

1) Pro­vide gov­ern­ment spon­sored health clin­ics, mod­eled along the lines of Urgent Care cen­ters. These clin­ics would be a place any­one can go and get basic health care. Each hos­pi­tal com­plex would have one of these on cam­pus or nearby, where emer­gency room staff could route the non-emergencies and non-citizens. These clin­ics would pro­vide free inoc­u­la­tions and treat­ments for com­mu­ni­ca­ble dis­eases. They are capa­ble of han­dling cases of hypo/hyperthermia, heart attack, drug over­dose and other sim­i­lar non-surgical items– in other words, things that trained nurses can man­age. Every­one pays a co-pay (with the excep­tion of inoc­u­la­tions and treat­ments for com­mu­ni­ca­ble dis­ease, which are in the pub­lic inter­est that every­one receive), for which they are given a voucher which later serves as a tax deduction.

2) For cit­i­zens with­out health care, the gov­ern­ment serves as the insurer. A spe­cial ID card is issued to peo­ple in this group. Qual­i­fi­ca­tion for this group is reviewed once a year, some­thing sim­i­lar to a dri­vers license.

3) For cit­i­zens with health care, the gov­ern­ment can serve as the ini­tial insurer; the gov­ern­ment will pay quickly and review costs for fraud (thus cen­tral­iz­ing a ser­vice prob­a­bly bet­ter per­formed by gov­ern­ment, rather than each insur­ance com­pany doing this on their own), and finally will bill the person’s insur­ance com­pany for the cost of care. Pri­vate insur­ance com­pa­nies can con­tinue to com­pete with the gov­ern­ment– there is still money to be made after all. Health Sav­ings Accounts will prob­a­bly be the most com­mon vec­tor of pri­vate com­pe­ti­tion here, and will be a pop­u­lar option for the young and healthy. This is a key fea­ture, that com­pe­ti­tion is main­tained, because this is the pri­mary cost-control mech­a­nism over the long term.

4) Some cit­i­zens and health care insur­ance com­pa­nies will opt to stay com­pletely out of the gov­ern­ment sys­tem. Law may man­date that costs to the group may be no higher than the cost of care for every­body else, but the insur­ance com­pany may charge higher pre­mi­ums for the addi­tional pri­vacy, advanced or exper­i­men­tal care or other spe­cial ser­vices. These com­pa­nies would con­tinue to oper­ate sim­i­larly to the way they do today.

5) I would change leg­is­la­tion gov­ern­ing phar­ma­ceu­ti­cals. The cur­rent stan­dards for safety are set too high… I would allow drugs with more side effects into the mar­ket­place, and allow doc­tors and patients the option of using less-safe-but-very-effective drugs. At some point, the doctor-patient rela­tion­ship needs to be trusted. Much more debate about this idea needs to take place.

A final thought: if the gov­ern­ment con­trols our health care, what is to pre­vent it from, say, plac­ing addi­tional taxes on alchohol, choco­late and big macs because those items con­tribute to poor health? What if health care is denied you because you have a his­tory of smok­ing, or of not exer­cis­ing? Some­thing impor­tant to con­sider.

Gen­er­ally speak­ing, the planet has moved into a post-industrial world. This does not mean that indus­try is no longer impor­tant; rather, indus­try is no longer the pri­mary finan­cial dri­ver for most economies.
Indus­try, by the way, is the energy-intensive act of cre­at­ing a fin­ished prod­uct from raw mate­ri­als. Thus the cre­ation of planes, cars, houses, shoes and dish­wash­ers can be con­sid­ered indus­try.
On the other hand, infor­ma­tion is rapidly becom­ing a pri­mary prod­uct. Soft­ware is what man­ages infor­ma­tion. And soft­ware is being included in increas­ingly many things. In fact, it is the com­put­er­i­za­tion of so many pre­vi­ously ‘dumb’ items that has increased their util­ity and value.
Take cars. With the addi­tion of some sim­ple sen­sors and a com­puter, their effi­ciency vastly improves. Add some motion sen­sors, explo­sives, a kevlar bag and a com­puter and you have airbags which save lives. It is the com­puter that keeps the sys­tem from killing peo­ple.
Smart wash­ing machines now exam­ine the out­go­ing water to deter­mine when clothes are clean, improv­ing clean­li­ness and sav­ing water.
Installing a $100 pro­gram­ma­ble ther­mo­stat in a home can save hun­dreds of dol­lars a year in energy.
Our post-industrial age offers many improve­ments on pre­vi­ous items… new twists on the old to make daily life bet­ter. Look at mobile phones! Impos­si­ble with­out com­put­ers.
At some point, we’re going to start improv­ing the human body. We already have, in a way: arti­fi­cial joints. Breast implants. Pace­mak­ers, defib­ril­la­tors and cochlear implants. Soon we’ll have arti­fi­cial hearts and syn­thetic blood. Not very far off are replace­ments for the pan­creas, kid­neys and per­haps the liver.
Are these devices going to be acces­si­ble on-line? I can imag­ine some­body hack­ing into some busi­ness leader’s med­ical implant and doing nefar­i­ous deeds. (Inter­est­ing idea for a book, by the way…)
Where is the line? Is there a line, demar­cat­ing ‘okay’ and ‘to far’? Would it be good to have arti­fi­cial eyes, to rid the world of blind­ness? They’re com­ing! How about if that bionic eye allowed the user to see ultra­vi­o­let and infrared? How about radio waves or x-rays? How about a zoom capa­bil­ity? Heck, why don’t we throw in a video cam­era!
Tak­ing it fur­ther, why don’t we equip the police with these things? They get great vision, and the pub­lic gets a video record of every­thing the offi­cer does– just like the car-mounted cam­eras, but bet­ter!
How about an implanted mobile phone? You just think about talk­ing to some­one, and it’s done! It would be like telepa­thy. (Wow, talk about voices in your head, though.)
Arthur C. Clarke wrote about a future world in which every­one had a skull­cap– really a computer/brain inter­face. One side effect was that any­one with crim­i­nal intent was eas­ily detectable. Oth­ers with psy­cho­log­i­cal prob­lems were quickly removed from the pri­mary pop­u­la­tion and ‘fixed’ if pos­si­ble.
So, again… how far is to far?