The old phrase, thou dost protest too much expresses the truism that the strongest moralizers are often the biggest sinners.

Liberals have been roundly condemned by conservatives for moral looseness. It is a strongly held conservative belief that liberal values led to a “decline of the West” – an abandonment of family and traditional values in favor of a soft hearted and soft headed rainbow world where people can run amok.

But it turns out that conservatives like Mark Sandford or John Ensign were every bit a likely to screw around on their spouses as were liberals like Bill Clinton. And when it came to how conservatives wanted to raise their kids – they hate public schools and sex education. Yet given the chance, and they were over the last 8 years, so they launched abstinence only sex education programs – well it turns out that their teen are fucking around anyway, but without the benefit of birth control, their girls become pregnant (as we saw with Sarah Palin’s witless teen, Bristol).

And no, I don’t really believe that conservatives are less moral than liberals, but their certainty only looks foolish.

Remember the fear about what America would be like if Obama won, that if we were presented with an african american president who admitted to drug use, and a first lady who admitted her skepticism about america – that we would have something entirely unpalatable to America? After a few months in office, the first couple looks like the most wholesome american first family since Teddy Roosevelt.

So maybe the only lesson is that we have been thinking way to long and too hard – so what we need now is an era of realism, pragmatism, and contingency.

To every issue, let’s vow to go in with openness, let’s look at the facts (and facts only) and let solutions flow from the problem.

Although our blog is wide ranging, there are a few themes that repeat themselves. One is that the best things in life are often simple and inexpensive. A book of poetry, a fresh home grown tomato, a visit to a museum to look at fine paintings. Good music can be had for a pittance.

I thought of this on Thursday night, as the news of Michael Jackson’s death sank in. Thursday night was an otherwise ordinary evening. I rarely get eight hours of sleep, so as the week goes on, I become more and more tired. Still, my son was expected to come over, not for anything special, just to pick up some fishing gear. Although he moved out about a year ago, he left his rods and tackle boxes at our house. We still have boxes of his baseball cards in our basement.

Although not a formal visit, it takes him an hour to get from his condo to our house, so we always like to spend some time together when he does come over. He grabbed some Taco Bell on the way. I arrived home from work after he got to our house, but we spent about an hour visiting with each other. We talked while the TV stayed on in the background. We were tuned in to the either the History Channel or the Military Channel, and something was on about WW2. Didn’t really pay much attention, but every so often the strutting figure of Adolf Hitler would appear, and in hindsight, its hard not to wonder why he didn’t come off as a joke when he first appeared on the scene some 80 years ago. We are told that he was a compelling orator, but I don’t understand enough German to be able to tell. My son, my wife and I had a quiet, mellowed evening. It grew late, and my son had to go home.

Nothing earth shattering in any of this. Most of us know the private joys of family life. When your kids are young, you sometimes forget that you love them, with the stress of telling them what to do, and the shock of hearing their backtalk. But my son in 30 now, has his own place, a steady income and so when he visits his home, which is often, all we have to concern ourselves with is the pleasure of shared company.

Among the many things that Michael Jackson lacked was normal private life. He had (no doubt) hangers on, so had many who stood ready to tell him how wonderful he still was. But he had no one to sit down with him to bask in the warm glow of family affection.

As Brian said, Michael Jackson’s death was a blessing. It was the life that was the tragedy.

I know that Brian is at the end of a financial rope that has stretched way too thin. Still, I know he has friends, and the love of a daughter, so in the scheme of things, he and I are far richer than Mr. Jackson ever was.

By the way – here is the view from my son’s condo.
The first from his balcony. The second view is from the pool area. I love visiting my son’s condo. If I were young like him, it would be just the sort of place to crash in after work. And a good view, like this one, is a priceless pleasure.

The situation in Iran is an easy one for Republicans to exploit. A Senator can deliver a strong speech about how our president needs to take a hard line against the current regime, and no one can prove him wrong. Since he (or she) is not the president, he risks nothing. But the real president can’t risk a mistake. The truth about American influence is that we have much less influence than we think we do. Before the president speaks about Iran, he has to remember that the Iranian regime can’t wait to identify the protesters as influenced by us. If anything, the president needs to apply just the lightest touch.

Before we kid ourselves about the value of our getting “tough” with Iran, we ought to remember how little we are able to accomplish among our friends and trading partners.

Among the folks we trade with:

We can’t get China to ease up on the Uyghur people, nor have our human right speeches encouraged China to grant free speech or freedom of religion even to the Han Chinese.

We guarantee security for the Saudis, but we are unable to make them do something as simple as let their women drive.

We were a generous occupier to Germany after WW2, but now that we need them to cooperate on a world stimulus plan, we can’t get the Germans to stimulate their economy – thus increasing their consumption of imports.

Our free trade policies have allowed Brazil to have a place in the economic sun, yet on a simple matter of child custody (American father, mother is deceased) we can’t get Brazil to let David Goldman bring his son back home.

When it comes to our enemies, we pretend that we can and should so “something.”

But 50 years of boycotts and rhetoric haven’t transformed Cuba.

And we are completely impotent with benighted states like Myanmar or Zimbabwe.

So now, while we would all like to see the Iranian protester succeed, right now is the time for us to be humble and silent.

While Brian has reviewed our rainy weekend, I thought I would show a different side of the same time and weather.

Yes, it’s been raining a lot, so much so that I can’t complete my chores.  I have a hedge that takes a month to trim, working section by section.  Well, I’m into my sixth week, and so far, I have a one 60 foot patch left to work on.  Oh well!

But our month of rain and drizzle have been a boon to my plants.  Here is a short tour of one portion of my back yard.

Lists are arbitrary, but we use them anyway.  They are a good way to begin a review of an issue.  This week, my issue of choice is health care/health insurance.  There are many things wrong with our health care “system” – the first is that it is not a system at all.  We don’t have any single gatekeeper, nor a set of standards.  Doctors are regulated by the states, as are hospitals, but drugs are regulated nationally.  And surgery is not regulated at all.  Procedures are invented and then years later, the medical community is still debating whether they work.  If this surprises you, then please Google heart stents and  arthroscopic knee surgery – you’ll be amazed to find out that these procedures may not improve outcomes much at all.  

My short list of our two biggest health care problems is the following: 1) many people cannot afford to see a doctor on a regular basis, and 2) for decades now, the cost of health care and health insurance has increased at a rate far in excess of inflation.  The first one is a problem because when someone does not receive regular care, he or she loses an opportunity to find out about chronic conditions in their early stages – for  example, adult onset diabetes and hypertension.  When a person has a “regular doctor” he or she will typically ask about the person’s lifestyle, and the patient benefits from the doctor’s advice.  Using myself as an example, I am a middle aged man, a few pounds overweight, with hypertension.  A few years ago, my blood sugar was slightly elevated, nothing alarming, random glucose about 105 on successive tests.  In my regular visits, my doctor and I spoke about my diet and other habit.  I decided to cut back on snacking, and to eat a healthier breakfast.  Over 24 months, I lost a few pounds, and now my tests have come back improved.  Those who don’t see a doctor regularly, miss the chance to stop something before it becomes serious.  

The second issue (increasing costs) is a problem because, as health costs increase, health insurance becomes unaffordable.  Since many of us use insurance to reimburse some of our health care costs, as insurance becomes unaffordable, more and more folks join the ranks of those who can’t afford to see a doctor.  

Health insurance was once a bedrock employee benefit, but now, employers are dropping plans where they have had them, and new businesses are electing not to offer health insurance at all, when they design a compensation package.  

Barack Obama has decided that it is time to embark on health care reform.  

You remember all the fuss when the president proposed his stimulus package; now that health care is on the table, it is happening again.  Republicans and their right wing echo chamber are pouncing.  Much of what they say is nonsense, but members of the press can’t tell the difference.

This You Tube video exaggerates only slightly! 

As an insurance professional, I thought I would add my perspective – today on my top two health care issues.  Then over the next weeks add some thoughts about the rest.  

Let’s start with those who can’t afford to see a doctor.

Although the focus has been on those without insurance, this focus makes us believe that insurance is the solution, but it is not.  A focus on insurance will get us more policies, not more health care.  Watch this example!  If a working family no longer had group health insurance but instead had to pay, lets say $600 per month for a “policy” and then needed to see a doctor, they would still need to fork over $100-$150 for an office visit.  So (and remember, working people wages) what do you think happens after a family pays for mortgage (or rent), car payments, groceries, gasoline, and new clothes for their growing kids?  They don’t go!  

Yes, young adults can go for years without care, but pregnant woman, babies, children, and folks over 50 all need to see a doctor regularly.  Many should see a doctor regularly at younger ages. If all we get out of “reform” is to help the uninsured “buy a policy” they would be little better off than the uninsured who first learns of his hypertension when he wakes up in a hospital after a medical emergency.  The only advantage the policy gives is that the emergency room visit would be paid for.*   

So why do we care?  Well, the cost of uncompensated care is shared by all of us, factored into the hospital’s prices, and partially reimbursed through federal aid.  And some hospitals are publicly funded, so a share of local taxes also goes to health care.  

If we are going to be stuck with the bill anyway, we ought to get more for our money.  

What working people need is something like what SCHIP provides. SCHIP provides coverage that costs less than $150 per month (for poor families) and covers doctor’s visits for a minimal co-pay (using NJ figures).   Working folks might be able to pay a bit more, maybe as much $300 per month for insurance, and $50 for doctor visits, but individual health policies will never provide anything like this, though some group plans do – and the real cost to the employer is often over $1000 per month per family.  

Health care costs are another issue entirely.  Some of what has gone is inevitable, as medicine has gone high tech.  Some is demographic.  As a population ages, it needs more medical care.  But some is based on doctors mining the system for fees.  There is an excellent article in the New Yorker (written by Dr. Atul Gawande).  He compares health care costs in different regions and finds that excellent care is often cheaper than mediocre care.  And he had the specifics.  So read his article.  

After you finish, you’ll agree that we must institute some form of medical gatekeeping.  We also need to move reimbursement away from fee for service to fee for outcome (or something like that).  If that means that we have some “overseer” ok.  What we have now is not working.

Then we have the prices that doctors and hospitals charge.  The list price can be monumental.  I had a colonoscopy last year.  The list price was $3308.  My insurance company paid $890.  I paid $10.  I have no reason to believe that the $900 that the doctor received was not enough to pay him a fair salary and maintain his attractive and well equipped suburban office.  Yet the list price was $2400 above my negotiated one.   The difference benefits me, but it is a system that gives the most benefit to those with income and a powerful insurance company to work for them.  Those without power are SCREWED!  So we may need price controls of some sort.  And price parity.

Finally we have drug costs.  Big Pharma has bought our congress.  But the production of drugs, where slight tweakings of formulas are patentable, and where the FDA does not test for effectiveness of new medication compared to existing ones, well, that’s crazy!  

That’s enough for now.  I hope to follow up with more words about other “buzz words” and buzz phrases:

• Competition
• America has the best health care in the world
• Consumers need to pay for their health care so that are forced to make more prudent choices
• Lawsuits

*Health Insurance Policy.  For most of us, we get our health insurance from an employer plan, others get it through the government, Medicare of Medicaid.  Only 7% of adults (figures vary) have health insurance through an individual policy.