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State Of The Onion, Jan. 2006, Part 2
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Social programs and the economy
Where is the government going with social programs? Social programs include Social Security, Medicare, Medicaid, health care (which has limited availability), and income security. That government is not going to fulfill much of a role in supplying social programs, is becoming painfully obvious. Social workers used to be able to find a program to help people in crisis. Today they are turning people away without aid - there is no help. Program after program at Federal and State levels are being cut drastically. Congress recently cut $11 billion from social programs, finding it enormously difficult to do, and Bush has requested another $50 billion in cuts. We are witnessing the dismantling of social programs funded through government.
What is particularly repugnant is to see huge favors paid at the same time to industries that don't need favors, such as pharmaceuticals and petroleum. Most pathetic is to see the attitude reflected in government leaders that social programs should be operated by faith based organizations, especially for crises like Hurricane Katrina. Such an attitude is totally unrealistic - even the largest of faith-based organizations have no way to address such problems. But it is an easy answer for government leaders who don't want the government to take responsibility.
Funding of social programs is difficult. Such programs, if not carefully controlled, have the ability to absorb most of the taxes that we send to Washington. They are already 43% of government expenditures, most of which is mandated, although this amount is offset by Social Security receipts, so the figure is misleading. Remove Social Security and the actual spending on social programs is 10% of government spending. Our ability to fund programs depends on wise choices, the ability to administer programs, and on the economy - more specifically on our income (jobs).
How are jobs and the economy? US Wage growth has been on a steady decline since 1982. Since 1999 (to 2004), it has dropped from 4% to 2.4%, the lowest on record. Thankfully in most years it has stayed a percentage above inflation (3%). The weak job market is mostly to blame, with energy costs running a distant second. (See: Economic Policy Institute reports.)
According to government reports, economic growth is doing well, and so is growth in employment. Business is doing well: productivity has continued to improve. So, if everything is doing well, does this mean that people are making more money? No. While productivity rose 11.7% from 2001 to 2004, wages rose only 1.6%. Economic growth has been going straight into profits.
Whether we fund social programs out of our own pockets, or through the taxes we pay, the source is the same - you and I pay. You and I are also the recipients of social benefits, maybe not today, but someday for almost all of us. So to fund social programs, there has to be jobs that support realistic wages.
There are four trends working against realistic wages. The first trend is, since the 1980s, employers have become more competitive by doing three things: 1) reducing the number of middle management (higher paying) jobs, 2) avoiding unions, which tend to reduce efficiency (productivity) while raising wages, and 3) asking skilled personnel to take on more responsibility and be more productive.
The second trend is that markets have broadened to global scope, which drives down prices. As a result, we purchase many tools and furnishings at supermarts for less than we paid in 1980. We like this. Foreign suppliers like this. We all benefit. But to compensate and compete, US productivity had to increase even more, if it could, or go out of business. Both happened. Productivity sometimes comes by getting rid of one high paid worker to hire two less experienced workers for the same wages.
During the last five years, another trend landed on us: people who earned good wages were laid off due to the economic downturn, and if they managed to find jobs at all, they found lower paying jobs. Government jobless figures have a nasty habit of dropping people off the chart when they fail to find jobs - it makes the picture look so much brighter. And for those who found lower paying jobs - McJobs doesn't cut it for family finance and retirement.
What seems to be happening now is another relatively predictable fourth trend. There are few (in my opinion) jobs in industry and business that can't be done by someone with an 8th. to 12th. grade education (if they were serious learners). What we seem to be seeing is a continuation of the two for one trend of replacing one high paid worker with two lower paid workers with less education and experience. Wages are increasing slightly for those with high school diplomas, while falling sharply for those with college or technical degrees and other skilled workers. To stay competitive, demand and pay is falling for those who would typically command higher pay. (In 2006, the market is a bit brighter for those graduates with degrees in some fields, like math.)
Unrestrained competition is going to continue to spoil the pie, making the pie smaller so that everyone gets less. That's the nature of unrestrained competition. (See: Competing Against Ourselves.) The world is going to have to find a way to be competitive, but pay reasonable wages, or find a better way to make social services available: Social Security, Medicare, Medicaid, health care, and income security.
The following image shows how our economy basically works, and shows that to afford things we want, we have to apportion our money, putting less in some areas and more in others.
Spending by federal, state, and local governments accounts for about 20 to 28% percent of our GDP. About 12% goes back to the States. Defense: 20%; Social programs: 42% (offset by social security contributions of 33%); Interest: 9%; Foreign aid: 1%; Other: 12%; Discretionary spending 18%. The spending on the Iraq war is outside of the budget, and not reflected in these figures, but it is reflected in our rapidly growing national debt of 9 trillion. (See: A Citizens Guide to the Federal Budget.)
Wage increases, higher paying jobs, technological increases in productivity, and price decreases (compared to inflation), are the main drivers of individual prosperity. But higher wages and lower prices have to be linked to increased productivity, or all they do is create inflation. Experience, education, and technology commonly create higher productivity.
It isn't necessary to redistribute wealth. Everyone can get their fair share of the pie, without diminishing anyone's share, if they can just get employment with pay that supports living. When people are employed, they contribute to the economy as much as they take away. It is basically a zero-sum system, and the most important thing is just to keep the money moving. Hiding money under a mattress is the only thing that truly stops the economy.
Where we apportion our money is important. Everything is in competition for our money - energy costs (petroleum, electricity, natural gas) are the things currently waiting in line to eat our lunch if we don't find ways to control them.
Every penny that people spend on interest on loans is put in another person's pocket. Some of it is good - it finances housing and retirement and contributes to the economy. But too much debt harmfully reduces the money that people have to spend on daily living, and reduces the amount that each of us can save.
Most family budgets are tight - people badly need the cash for other things. Too many families earn close to minimum wage ($5.15 to 7.40 per hour, depending on the State). The following table shows what it actually takes to live in low (rural), medium (metropolitan) and high cost (NYC, LA, Chicago) areas:
Government defines things, such as "Poverty Level" and Minimum Wage, more for political reasons than reality, reflecting what legislators think the economy can afford to address. Reality is much different, as shown in the cost of living (preceding) and the effects of debt (following).
The effects of debt. Life is difficult for families earning even $36,000.00 per year, especially if they are paying on loans. For example, if a family has $200.00 a month discretionary money in their budget (many don't have nearly this much, or turn that 200 around immediately on credit cards), and they want to finance a $2000.00 item (at 15% interest for 36 months, $69.33/mo.), this means that at on an average salary of $36,000.00 a year, the person has to work 144 hours to pay back $2,495.88. If they instead saved for the purchase, they could get it by working 118 hours.
A $13,000.00 loan will devour all of a family's $200.00 discretionary money in just interest - when paying interest only, the loan payments never end. A $26,000.00 loan will mean cutting out at least $200.00 of other necessary things from the family budget, just to pay interest, and will mean that no more purchases can even be afforded. Reality: many credit cards have doubled their payback rate, so a $200.00 payment is now $400.00. For many families, reality means living with less.
On a national basis, the war in Iraq and the national debt are good examples of what loans and interest payments are doing to our economy - to us as individuals, who each have $30,000.00 loans through the national debt. Each man, woman, and child owes at least $150.00 a month (at 6% interest) in just interest on the national debt.
The Iraq war is getting billions and billions of dollars. Most of the American people do not think this is where our money and lives should be going. This money is borrowed, raising the national debt - mortgaging the future of every person in the US to the tune of 9 Trillion dollars - that is $30,000.00 of debt (at 6% interest) for every living person in the US. That's a college education for every person in the US. That could be 20 years of health insurance for every person in the US. That same money could be spent on education and health care, either directly or through the government. Instead, we're paying debt, and adding enormously to debt through the Iraq war (up to $1 trillion).
Is this a place where we can reapportion money? We argue publicly about the war, as we should about important issues, but the arguments seem more oriented to good politics, good TV, good for Al Qaida and the insurgents.... Plain talk: The Iraqis have been given the opportunity to liberate themselves from Sadam Hussein, and other types of tyranny, such as religious dictatorship. We did what they could not do: removed Hussein and disrupted the political and military grid of tyranny that kept him in power. Those tyrannical influences aren't gone, just dispersed - as shown by what can happen through religious fanaticism in the legal system in Afghanistan, and by radicals in Iraq and Iran. It is now up to the Iraqis to complete the job, and they are a strong, resourceful, intelligent people who want to live in peace, and we can be confident that they will complete the job.
We can't impose a solution on the Iraqis; that is, we can't make the decision for them to be free and work out their differences. This absolutely must come from within them, just as it always has for other nations - they have to make and own their decisions or they will have no commitment to those decisions. We can help with guidance and assist with some level of protection to prevent them from becoming another Serbia/Kosovo type conflict. What we are currently seeing is people living in a society that has only partially made its own decisions and not become fully committed to them. They haven't built the system that will keep order and follow the rule of law. But they do have a large number of lawless people (extremists, insurgents, Al Qaida) who are going to try to get their revenge or try to impose their will on others. What else is new? The US has as many extremists who would use violent means if in the same situation as Iraq.
As the Iraqis solidify around their constitution and their nation, they will take care of security problems, just as other nations of people have. It won't be perfect or pretty some times, but they will get the job done. Recent actions have indicated that they are at that point (I agree with the Bush assessment regarding civil war) - the attack on the religious mosque was answered with calls for restraint from religious and political leaders with wide ideological differences, and there was restraint. Coddling the Iraqis while pounding on their problems for them only prolongs the problems, while it drains us financially. If you pound on something long enough with a hammer, you destroy everything around it.
Few people are saying, "quit - abandon Iraq." Most are saying, make a wise decision and strategically wind down US support. Let the Iraqis defend themselves and rebuild their own infrastructure so that they are paying each other to do it - they invest, it's their commitment - so it means something to them instead of being a free gift that is less appreciated and used as pawns by insurgents. Freedom and infrastructure aren't free gifts - they are a triumph over tyranny and chaos and a dedication to an ideal. It requires a continuing investment in hard work and vigilance to retain. It is time for the Iraqis to make it theirs. Could we make significant cuts in the Iraq war budget that will benefit each of us? Yes. There is a tally at the end of this report that indicates how much difference.
Health and healthcare funding
Healthcare funding is in crisis. Costs are rising much more rapidly than inflation. Hospitals can't afford to pay nurses salaries that are competitive enough to attract them. Insurance company rate increases drive people off insurance, and make it impossible for others to get it. The cost of prescription medications is rising at double-digit rates, while pharmaceutical profits soar beyond any other industry, making people choose between healthcare and other necessities. Catastrophic and chronic illnesses ruin people financially. For those without health insurance, there is no access to the medical system - for all practical purposes, medical treatment just doesn't exist for a high percentage of them.
New technology and new pharmaceuticals are expensive. This is where the main problem lies. This is the primary culprit in driving up the cost of insurance and medical costs. If a treatment is effective, insurance companies will likely approve its use, and then have to share the cost with all members. Medical treatment would be more available and less financially damaging to individuals if new technology and pharmaceuticals would just stop. And sometimes the new treatments are not found to be cost effective - for example, aspirin is almost as good a blood thinner and life saver for heart attack and stroke patients as other very expensive medications. Many of the new expensive blood pressure drugs aren't as effective as a simple inexpensive diuretic. (Please don't take this as medical advice - consult your physician.) On the other hand, the newer medications often have health prolonging advantages that diuretics don't have.
Oddly, a lot of health improvement depends on our attitudes. Right now scientists are trying to eradicate the disease Polio from the earth, just as they did Small Pox. What is standing in their way is patient paranoia. Just as some major political leaders in Africa believed that AIDS was not caused by HIV, many in Africa believe that Polio vaccinations are a Western plot to sterilize children. Parents hide their children from medical personnel. From this geographical area spreads outbreak after outbreak, defeating the efforts to eradicate the disease. Scientists may have to revaccinate for outbreaks in surrounding areas for may years, to control the disease.
People in the US thought that scientists were kidding about tobacco causing lung cancer. It was more convenient to disregard health risk warnings. Attitude. People with lung cancer feel they have been given a death sentence that they deserved. Doctors and other people around them often feel the same. Smokers brought the disease on themselves. As a result, many either aren't treated as aggressively as they might be, or stop treatment. Attitude.
People who are obese think that overeating won't hurt them. Overeating is a major cause of major diseases: diabetes and heart disease. Attitude. Teaching kids is very difficult. Yet in some school systems where children have been given more healthy food, they like it. Healthy eating requires a sea change in attitude and lifestyles that begins with parents, and has to be guided and supported by society, government, and industry.
A lot of people have back surgery and believe that it's a magical cure and they don't have to correct the conditions that helped cause the back condition, such as overweight and lack of exercise. The surgery fails to help. Attitude.
Many people believe that medications are a bad thing, treating their disease won't help much, they don't have to take their medication regularly when their symptoms aren't present... attitude. It is more convenient to believe something else. Attitude and lifestyles are as difficult to change as defeating diseases. Our attitudes are colliding with the health care system. Our crisis in attitudes is going to have as much impact on our ability to afford healthcare as any other factor.
Some attitudes have to change. One attitude is that we can live irresponsibly and not become a burden to society. If we aren't willing to take care of ourselves, is it right to expect others to pay for the consequences? We are responsible for our actions and their consequences. The other attitude is the belief that the US has the best health system when a large percentage of people cannot get health care at all - we create an unequal system and then believe that no one is responsible. Self-aggrandizement creates blindness to other's situations. Somehow this "best" nation has to start acting like the best.
Changing life expectancy. We can blame a lot on the baby-boom generation that is flooding into retirement age. But it carries with it the benefits of longevity borne of medical science. In 1900, the average life expectancy was 47 years. Today it is 77 years. It may peak at ~85 years. Social Security retirement was enacted in 1935. At that time, on average, people didn't live to 50. Today 50 is middle age, and medical science continues to improve the quality of life for most people age 40 to 90.
The expense of medical care is a drain on our social programs and private pockets. People nearing retirement age (65) are finding that they have to continue earning an income to survive. A large percentage of people have no plan for retiring, have no savings, don't own their own homes, and realize that their income is not likely to continue at rates that will support them. Only a few can live entirely on Social Security. At least they do have Medicare and Medicaid.
We have known about this since at least the 1970s. It is all very statistically predictable. But what is anyone doing for effective planning? I'm not talking about sweeping social experiments, funded by the government, that would impose some expensive and ineffective solution on people. I am talking about people in their 40s and 50s, sitting down with people from 60 to 90, talking about the real needs, and coming up with plans for semi-retirement living that meet a variety of needs, coming to grips with what people themselves must do to afford semi-retirement living, and asking the government for some support in making the plans a reality. Solutions to tough problems should be what an intelligent and wealthy nation does best.
Medical wealth/health study - as income goes down, so does longevity. The main factor in quality of life and longevity may simply be money. It's long been known by the insurance industry that health and longevity belong to corporate executives who take care of themselves, in spite of the high stress associated with their jobs. As a group, they are great insurance risks. Being able to afford to pay attention to your health makes a dramatic difference.
Various studies have shown a correlation between socio-economic status and health. One study shows that there is no correlation with short-term changes in wealth. If you lose your fortune tomorrow, you probably won't die from it this year. No one is quite sure exactly what the causal factors are. Perhaps it is self-discipline. Perhaps it is access to medical care. Perhaps long-term stress is the cause. Perhaps it is the fact that hard work is hard on people - they die younger. But the correlation exists, and it doesn't seem likely that poor health causes lower socio-economic status, since poor health comes later, not at the beginning.
In a Cleveland Clinic study, the following was demonstrated over six and a half years:
"There were 2,174 deaths during the period, and patients in the lowest quarter of socioeconomic status score were twice as likely to have died as those in the highest quarter, even though the two groups did not differ in age, sex, race or current smoking habits."
The fact is, if we as a society make one's financial status the key to accessing healthcare, we are killing off the poor.
Having money is not necessarily a guarantee of good health. Physicians miss the correct diagnosis around 20% of the time. If the sue-happy lawyers could find and prove these, they would bankrupt the system with lawsuits. No wonder physicians worry. Yet most physicians try to do an excellent job for their patients. Medicine is a very tough field, and getting it right, in spite of all the hindrances presented by the patient and environment, is very difficult. The House medical series is a lot closer to reality, when it comes to patient lies and physician dedication, than people think.
We may have very sophisticated tests for disease, but doctors don't use them. The reasons are because by the time you grow a culture or get a test result, the disease has already run its course. Insurance companies balk at paying for these expensive tests. Many tests are very expensive and take a lot of time from the patients' lives. Evidence based medicine teaches doctors to treat on what is the most likely cause (from experience) and see what works. This actually works. If they get it wrong the first time, they just try a different medication. I'm not going to say that Evidence Based Medicine is a good thing or a bad thing - it has its faults and strengths. But keep in mind that ~80% of conditions will get better without treatment. And physicians get it wrong ~20% of the time.
"As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930's. "No improvement!" was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation."
A personal note: I worked in the healthcare field for 13 years, with cutting edge equipment in research and diagnostics, including DNA sequencers and synthesizers, testing reagents, bio-lab test equipment, in the environment of hospitals, research university labs, and pharmaceutical labs. My background helped put me in tune with the way the medical system works. Plus, I have had plenty of experience with family and others who have had life long treatment experience in the medical system, from birth through geriatric care. I regularly hear physicians speak about treatments. So I research this area for trends knowledgeably. Of course, I'm not a physician, and nothing in this article should be taken as medical advice - it is an overview.
Medical - obesity
The biggest problem facing the US is obesity. Obesity is not just being over weight, it is a severe level of overweight to the point that it affects health. Obesity reflects a larger problem - that our world has changed, and we have not adapted. Food is very available. Self-discipline is not. The question is, how will we respond to this new challenge.
From 1991 to 1998, obesity in the US grew ~50%, from 12 of every adult to 15. Europe faced a similar increase.
What to do, what to do?
One way to work with obesity is to say that everyone will learn the hard way - either learn how to control your weight - that is the amount you eat compared to the amount of exercise you get - or suffer the consequences: fatigue, lethargy, worn out joints, blindness, multiple organ failure, congestive heart disease, heart attack, stroke, diabetes, and rotting and amputated limbs. It isn't a pretty picture. Learning the hard way is a difficult path.
While obesity is an individual problem, its impact on society is also horrendous. It places a very large load on the medical system (100 billion) to treat all of the maladies that happen because of eating too much. If obesity remains unchecked, it will demolish the availability of medical care for all of us.
At some point in their lives, people become willing to do something about their weight, even if they lack the knowledge and self-discipline to actually accomplish the task. This is where government and industry can help. We need to be on the preventive side of the obesity problem, not the repair side.
The government's role should be educational: in our schools, in ad campaigns on television and other media, including monitoring what works and adjusting until it does work. My first rule in marketing is to put your message where people are looking (usually looking for a solution). The government needs to find out where people are looking, and be there. Saturate people with information that is understandable so that they get and apply the message. Saturation works. Effective preventive education, compared to medical repair, is the most effective stewardship of our money.
In general, it has to be recognized that applying uniform diet restrictions across the general population is not a strategy that works. The ingredients of a diet have not been shown, in major studies, to significantly impact the health risks of the general population. From experience I can say that the individual's response to different types of food is critically important. Each of us have to know our own bodies, and develop the eating habits that work for just us... and appeal to us enough that we can stay on our diets. Recent studies have pressed the reset button on most of the nonsense propaganda about any particular diet, or medical treatment, being good for all of us. Hopefully the days of making blanket statements about health are gone - health is different for every individual. What is most important in any way of eating is portion control (controlling calories) - this is the critical place to start.
What I am outlining below is a plan, but it isn't just an educational plan, it is also a business plan (I have developed several business plans) - probably a very lucrative one - for businesses who wants to try it.
((())) Business plan to address obesity (click to expand and see)
It helps to understand the problems:
Three or more times a day, most people have to think about food. We don't really want to do that - it is just a necessity. For those who are "dieting," it wears them down and demoralizes them. Most of us take the easiest path forward. We grab whatever is available.
A personal note - I struggle with weight control, just like everyone, and I have experienced friends and family dieting seriously for most of their lives. Personally, I think that it helps to have the attitude that "I am a person at his correct weight, and I don't overeat - I feel satisfied." But then, I had the metabolism of a blast furnace, and at 26 could eat six heaping meals a day and not gain weight, while every woman around me was furious with my male metabolism. Today I struggle to maintain my weight, and have high blood pressure, if that gives them any satisfaction. I do think attitude helps.
Even if we were willing, few of us have time, or the facilities, to do much about food except grab it. The briefcase and purse are today's lunch box. We don't even have the time to leave the office, or our cars, for food. If we don't bring it with us, then the fast food joints are the next most convenient thing.
We also get bored easily. New restaurants are lucky to last two years before the public becomes fickle and stops all visitation. The sandwich in the lunch bucket soon becomes just another slice of bread. We don't like manna.
We learn very bad habits. I was raised in farming country, and learned to eat large meals three times a day. That's a farmer's way of eating - he works it off. Once you learn that way of eating, it is difficult to look at a speck of nouveaux cuisine and think, "Satisfying." Other people develop other bad habits. We eat because we are bored, nervous, depressed, social, hungry, happy, celebrating, don't know when to stop, and we have a habit that is difficult to break, of sticking stuff in our mouth. Food is a comfort - it has sedative qualities.
Just as bad is the fact that we mostly have no idea what is healthy, we don't carry calculators and gram weight scales with us to solve complex nutrient needs problems involving fat, protein, carbohydrates, fiber, age, sex, exercise, and weight; and restaurant portions - especially fast food - are very very large. Somebody help us!
If people aren't scared off by the mere threat of using calculators three times a day, there is the plague of having to do all of that planning about what you are going to eat and then there is the image of diet... yech!... food, if you can call it that.
People want, and need, certain things:
Problems are opportunities. Solve these problems - make sales.
Here is the business plan.
1. Make sure you have the passion and the stamina to work on this for years. This is much too big to do on your own.
2. Get together a group of investors and business partners. This is much too big to do in your kitchen.
3. Learn from those who eat. Many businesses do things the other way. They get together a dietician, some cooks, and some product managers, and try to come up with what they think the public should want. It's a disaster for both the company and the public. If you don't think so, just put a leaky frozen meal in your briefcase, heat it up, choke down the tasteless, textureless, steamed cardboard, and taste the preservatives for three hours after you eat.
4. Go out and see what people like to eat, how they prepare their food, what works for them and what doesn't. Add some talented chefs. Bring it into the lab and make magic.
5. Name your food selections, "Control." People want control over what they eat. Losing weight - the traditional diet - isn't nearly as important as maintaining weight. This isn't a diet, it is a plan to control nutrition and eating - don't associate it with health food or dieting unless you want people to avoid it.
6. Don't be deceptive. I once was very pleased with a great tasting chicken fettuccini meal that I ate regularly for lunch. It was only 340 calories. And then someone pointed out that the serving information stated it was two servings - 680 calories. Are people going to cut the package in half? Share it with another at the table? Get real.
7. Make four portion sizes: small(~230 calories), medium(~350 calories), large(~500 calories), and generous(~600 calories). They will get deployed in the following way in which people can make quick selections (example - not researched):
Children will lose weight just by eating a standard diet.
8. Twenty to thirty percent of your offerings should rotate regularly so that people get variety and the product line always seems fresh (people are fickle - just note how a new restaurant goes from dazzling success to total failure in about a year if they don't continue coming up with new appealing menu items).
9. Expand. Make a fast-food style restaurant where people can stop and eat the food, or take it home. Offer delivery, and offer a monthly plan of daily delivery that can become an efficient (inexpensive route).
This is an opportunity to do something vital and meaningful, and make an impact in the lives of millions of people... and probably make a lot of money.
Many physicians are now no longer prescribing many drugs that have any safety issues of any kind, for fear of litigation. Almost every prescription drug, and many over the counter drugs, have side effects. In populations of millions of people, a few react to a drug in totally unexpected ways, and a few will react to known issues. So millions are left suffering because a few people and their lawyers are wild about filing law suits.
Physicians do make mistakes, but most take very seriously their oath of "Do no harm." For example, the majority of physicians simply will not give a medication that has life threatening side effects, for a condition that is not life threatening. In reviewing and using a new drug, doctors typically screen the side effects as a priority, and then wait to see how the drug works for others before prescribing it themselves. Doctors are more cautious than most people believe. But once a drug is prescribed, they may not see the patient for months to over a year - they have very little control over how well people comply in taking the drug, judging efficacy, or monitoring side effects, and many side effects don't show up until months into taking the drug. The system and people leave doctors very little time for monitoring.
Probably the only way to resolve the litigation issue is to leave the decision to take the drug in the hands of an informed public. Expect to see more "black box warnings" and safety warnings on drugs. Expect more software in physician's offices that alert them to drug interactions and possible side effects. What may happen is you will sign a form at your doctor's office and pharmacy stating that you are fully informed of the safety issues and are taking the drug at your own risk. Expect fewer people to take medicines that may have a small risk of major side effects. Many people are so risk averse that they will accept the risk of an untreated disease over the remotely possible side effects.
Medical researchers are finding that for many medications - those countering, treating, or preventing arterial sclerosis and heart disease, cancer, diabetes - that the earlier these are prescribed, the more effective they are. Long term health and longevity is dramatically improved by early intervention. Many of these drugs have preventive actions which actually inhibit the development of the disease as well as alleviating the symptoms.
For example, using ACE inhibitors to treat hypertension (symptom: high blood pressure) actually inhibits (but doesn't stop) the progression of the disease. Angiotensin suppression is believed to prevent the scarring of renal tissue, preventing kidney failure. Additionally when some agents are used in combination with other drugs, efficacy exceeds expectations, since body chemistry finds ways to get around the suppression of angiotensin when controlled by only one drug, and treatment by two prevents the response. Similar mechanisms operate in various diseases. (This is not intended as medical advice - just observations.)
So investment up front saves considerable long term expense to the health system and the individual. Investing more up front on new medications pays big bonuses. However, this isn't an absolute. In some cases new medications do little for the disease, and in some disease states at advanced ages (prostate cancer), treating the disease can be more detrimental than allowing it to follow its slow progression - the person will die of other causes first. But in general, new medications are proving their value in preventing the progression of diseases, extending quality life, and treating disease - they typically should be given early.
The single most important thing that the government could have done in health care is provide the prescription drug plan. It will have the most long-term benefit of any medical program except possibly other forms of prevention. Despite sour-grapes feelings by some Congressmen, Congress and the President did something right. The prescription drug plan is a win-win for everyone: government funding, the people, the pharmaceutical industry, and the medical community.
This report is not about government, but about us. We have control, unless we default our responsibilities to others. Sometimes we work outside of government to solve our problems, and sometimes we work through government. So here are a few thoughts about the government's role. There are many great politicians in Congress with noble purpose who work very hard at doing their best for the people. No doubt President Bush and his administration also try very hard.
Having said that, this also must be said. The response to Hurricane Katrina is symbolic of the major flaws in our government. In March of 2006, several months after Katrina burst the levies and destroyed thousands of homes, several events stand out. One, horribly slow response by FEMA and local government. Two, incredible ineptness by Federal, State, and City government. Three, thousands of mobile homes sitting empty while taxpayers pay for hotel rooms for thousands of displaced people. Four, just this month (March) the resumption of the search for dead bodies. Words hardly suffice, and I prefer never to use disparaging words, but bungling, irresponsibility, ineptness and incompetence, and unconscionable inattention seem to fit. Keystone Cops fits even better. In comparison, I wonder if the earthquake displaced people in Iran and Pakistan fared as badly?
The response to Hurricane Katrina seems representative of the current US ability to prepare, plan, and respond to anything.
I submit that based on 50 years of watching the government, what the government does best is political wrangling. Typically the party in power rams through legislation without bipartisan consensus. The party out of power does its best to undermine those in power, while jockeying rhetoric to persuade its way back into power.
Legislation (spending bills) get passed and no one even knows what is in them. No one is interested in addressing long-term problems or making difficult decisions that may prove unpopular with 10% of the people - election margins are so slim that upsetting 10% can get a politician out of office. Preparedness is something the government does after we've been hit. Special interest groups have the power and finances to sway political opinion (legally or illegally) in ways that do not represent the best interests of the public. Government is effective at a very shallow level.
The democratic political and capitalist economic systems should be shining stars. The current state of affairs is dismal. We need to do much better.
Social programs - particularly the 10% of government spending outside of Social Security contributions - need to be divorced from the whims, political infighting, misplaced priorities, and ineffectual control of the politicians. Just as the Federal Reserve is an independent agency that sets its own policies, so should be social programs. Once again I submit that the public needs to directly control these safety net programs. An independent, non-profit organization should be established, given the power to assess needs, set policy, establish funding methods, give citizens and special interest groups equal power to be heard, and make sure that social programs are available to all.
Short of creating another bureaucracy, are there other simple mechanisms that could finance social programs without destroying us financially? Yes. For example, healthcare funding, by way of health insurance, could be done through simple tax breaks. The tax break would be a major incentive to people to purchase health insurance. But by requiring an investment by them, it would not be taken lightly, and would not go to those who have no need.
Potential solutions to health care funding:
The Ratings -
Why ratings? Maybe President Reagan (or his predecessor?) started it with his, "Are we better off today than..." We create a lot of talk about things like the economy, and the government has statistics to assess various aspects of the economy. We use superlatives, like "the economy is good, strong..." they sound good, but what do these really tell us?
In these ratings, I suggest that there are qualitative and quantitative things that we really need to look at to determine how things are doing? If you say something is doing well, but only two thirds of the people are actually being served, there is a real problem with perspective. My hope is that these ratings encourage others to look at our economy, and other things, objectively and raise the profile on the areas where we need to improve. I would expect a rating of at least +3 in a "good" system.
What are our values? Possibly the noble ideas are that we live in peace and harmony; that we create an economy in which all of us prosper, and have safety nets for when we fail - together we share our risks; that we have opportunity to pursue our careers and interests; that we have good health throughout our lives and into our golden years; that we have a government that represents our interests, protects us, and makes sound decisions, and through which we collectively enable our endeavors; and that no one is repressed. These are values. In the US, these might be called the pursuit of happiness. How are we doing?
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