A Healthcare System for California That Could Work



This is doable. To get there, here are what I believe to be the primary considerations for making an affordable healthcare system a reality - in California, or anywhere else in the U.S. for that matter:

1. Controlling runaway administrative overhead.

2. Mandating the negotiation of uniform fees for all medical products, services and procedures.

3. Incentivizing positive health outcomes and preventative care, instead of perpetuating a fee-for-service model that maximizes profit instead.

4. Providing a secondary insurance market for boutique or elective medical products and services.

5. Ending direct advertising of healthcare products and services to consumers, and providing better vetted and participatory data for patients to make decisions about their own care.

6. Identifying a reliable source of revenue to pay for the new system.


What we are aiming for here is a way to maintain quality and choice for everyone who needs healthcare and wants to preserve options that are important to them, while containing costs and disrupting perverse incentives. Right now the opposite is increasingly true: choices can be limited, costs excessive, and both care providers and medical product suppliers are incentivized primarily by profit. Here is how we might address these core considerations, one at a time....


1) Controlling Runaway Administrative Overhead

Right now the administrative overhead of private, for-profit health insurers runs upwards of 20%, whereas, in contrast, Medicare administration costs are under 2%. Insurers currently have no incentive to lower these costs - which is likely why they have continued to rise, which has contributed to escalating premiums. Containing such runaway administrative costs does not, however, require us to create a single-payer system. In Switzerland, private (but non-profit) health insurers compete with each other for customers, under government regulations that - among other things - guarantee certain levels of coverage and cap administrative overhead. The focus, of course, is to shift healthcare itself from a for-profit enterprise to a non-profit enterprise. Why? Because illness and poor health actually increase profits in the current U.S. healthcare system, thus creating self-perpetuating perverse incentives.


2) Mandating Negotiation of Uniform Fees

To contain costs, there is no reason that healthcare providers and medical manufacturers should not submit to fixed price negotiations in order to participate in the California healthcare market. Fees can be indexed using a number of factors, such as the necessity for everyone's basic care, production costs plus a fixed profit margin, cost-saving innovations, and so forth. In other words, products and services that lower overall costs while healing chronic conditions and improving long-term health outcomes could be rewarded with higher profit margins, while the more specialized and expensive products and services that simply mitigate chronic symptoms in the short term, and are less curative overall, would be provided much smaller profit margins. The goal here would be to incentivize actual healing and wellness rather than a gravy train of ever-increasing profits. As just one example, pharmaceuticals are subject to price controls in every other developed country, so that U.S. consumer pay between 30% and 300% higher drug prices than everyone else.


3) Incentivizing Positive Health Outcomes

Along the same lines, why could healthcare providers and medical manufacturers be rewarded for improving patient health outcomes (say, above an established baseline)? For example, a primary care doctor who sees more patients and keeps all of them more healthy than his fellow practitioners with a similar patient demographic should receive a nice fat bonus, don't you think? Why should doctors be rewarded for seeing patients more often, or ordering more tests, or prescribing more drugs, if their approaches do not improve the health and well-being of their patients? Again, the system we have now is upside down in terms of incentives. In fact, there should probably also be mechanisms for disciplining doctors, service providers and medical product manufacturers who are either contributing to poor health outcomes, are ignoring proven curative but low-cost approaches, or are otherwise operating in a profit-centric, rather than wellness-centric, orientation.


4) Secondary Boutique Insurance

There will be folks who want special advanced treatments, alternative treatments with as-yet-unproven efficacy, more expensive pharmaceuticals, elective surgeries and so forth - so why should they not have access to those options? This is where the traditional model of health insurance could operate similarly to how it always has - except of course that the insurance would be targeted to inherently more expensive products and procedures. There will be a market for this - even if it is expensive and its related costs continue to rise - so it might be worth the experiment. At the same time, any patient should also be able to obtain a desired form of treatment as an out-of-pocket expense.


5) Ending Direct-to-Consumer (DTC) Advertising, & Providing Better Data

The U.S. is the only developed country on the planet that permits pharmaceuticals to advertise directly to consumers. This is, frankly, a ridiculous practice, and has led to countless problems in treating all manner of conditions - both real and imagined. Shouldn't a patient be made aware of all of the options available, including which are most effective, which are most costly, which have been in use the longest, etc.? Of course - but this is not what for-profit advertising offers consumers. Instead, a web-based information clearinghouse that is overseen by doctors and other medical professionals can provide educational information on the efficacy of all manner of treatments and technologies. In addition, patients could also weigh-in with their own experiences, ask questions, etc. It would then be incumbent upon California regulatory mechanisms to make sure the data was accurate, and that contributors are real and not just medical industry advertising bots.


6) A Reliable Revenue Stream for the New Healthcare System

Prop 13 Reform

I think a main component of the solution is obvious and straightforward - because we can fix a gaping hole in California's tax landscape at the same time. Article XIII of the California Constitution needs to be amended to eliminate Prop 13 benefits for corporations, commercial property owners and developers, while retaining Prop 13 tax increase limits for residential homeowners. Since this initiative was intentionally deceptive when first proposed and passed - being sold as protection for retired homeowners with a fixed income, when really it was a huge windfall for corporations - it's long overdue to be amended. And of course the fact that commercial property ownership changes hands more slowly (or more deceptively, thanks to some sly legal maneuvering) than residential property just adds insult to injury - making those same vulnerable homeowners liable for a larger and larger share of the tax burden. The solution? A split-roll tax initiative (or legislative amendment) that keeps the protections for residential homeowners, but returns commercial property taxes to current values. One estimate (see http://www.makeitfairca.com/) puts the annual revenue increase from such reform at $9 Billion.


Closing Other CA Corporate Tax Loopholes


According to a recent review performed by State Auditor Elanie Howle
of California's six largest corporate tax incentives, there is approximately $2.6 Billion in tax breaks that have either never been reviewed to determine whether they are actually fulfilling their intended purpose. One of them, for "research and development," is $1.5 Billion all on its own. And, unlike most other states, California has no regular review process for these tax breaks!

And...well...the rest is math. Let's start with the estimated $400 Billion for the current single-payer proposal (SB-562). If $200 Billion can be reallocated from existing Federal, State and local healthcare funds, that leaves $200 Billion. And if administrative overhead can be reduced by 90% (as proposed above in item #1), then the rest of the funding required could be generated by some combination of: closing California's gaping corporate tax loopholes (#6); proposed pricing controls (#2); the transfer of high-cost or ineffective treatments and technologies to boutique supplemental insurance (#4); a reduction in advertising-generated demand (#5); and incentivizing lower-cost, more highly effective healthcare overall (#3). Whatever costs can't be met by these efforts could conceivably be covered through a variable, progressively tiered tax on all Californians. Also, the proposals I've offered here do not require a single-payer system - though that is certainly one framework that could integrate all of these variables.


Conclusion


There are a number of different scenarios that can successfully provide higher quality, lower-cost healthcare to Californians. The major barrier to such solutions has traditionally been the lobbying of medical service providers, insurers and product manufacturers who profit most when patients either a) don't get well, or b) otherwise require expensive specialties, drugs, medical devices or procedures in an ongoing way. But the current, corporate-controlled environment turns the priorities of healthcare upside down. Lobbyists should not be able to override a common sense approach to fixing these problems in California and other places in the U.S. To date, even well-meaning initiatives and State assembly bills have fallen woefully short of addressing some of these longstanding. If elected politicians cannot be swayed to do what's right for Californians, perhaps we need to approach this issue via the initiative process.


References

This approach to CA healthcare was inspired by the Level 7 philosophy and approaches: see http://www.level-7.org

Also, here is a thoughtful overview of how the current single-payer proposal could work, with some caveats: https://rantt.com/honest-thoughts-on-californias-single-payer-healthcare-proposal-c82c2d0b5d39

http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-first-fiscal-analysis-of-single-payer-1495475434-htmlstory.html

https://www.bloomberg.com/graphics/2015-drug-prices/

http://www.californiaprogressreport.com/site/proposition-13-tax-breaks-big-boys

https://www.thenation.com/article/have-california-voters-finally-had-enough-of-prop-13/

https://www.laprogressive.com/make-it-fair/

https://www.couragecampaign.org/press-releases/courage-campaign-slams-passage-ab-2372-smokescreen-fails-address-major-problem

http://www.sacbee.com/news/politics-government/politics-columns-blogs/dan-walters/article148716959.html

http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2010/Jun/1417_Squires_Intl_Profiles_622.pdf






Why are people like Noam Chomsky (considered the greatest philosopher today) never interviewed on major media stations?

Chomsky’s views were not considered all that radical or non-mainstream in the 1960s, when institutions, government, corporations and the societal status quo were being challenged and questioned en masse. He was part of the populist wave of salient criticism and intellectualism of that era.

However, since the concerted neoliberal efforts to recapture media, cultural institutions and government since the early 1970s (see Lewis Powell’s Memorandum: Attack On American Free Enterprise System), Chomsky has been pushed farther and farther out of the mainstream - and certainly the mainstream media.

Just consider how successful the neoliberal agenda has been on several fronts in its expenditure of billions to increase its cultural and institutional controls over civil society - and most particularly with respect to the media - while lining the pockets of the wealthy along the way:

1. Election of **Idiot #1** (Ronald Reagan) as puppeteered by the Kitchen Cabinet, resulting (among many other neoliberal priorities) in the end of the Fairness Doctrine and a generally persisting “anti-government” populism, regressive taxation and militarism

2. Complete takeover of the IMF/World Bank to facilitate self-enriching globalization

3. Creation and lavish funding of conservative/far right media

4. Further globalization under Clinton, as well as a more aggressive onset of regulatory capture

5. Installation of **Idiot #2 **(George W. Bush) under the careful handling of Cheney, Wolfowitz and Rumsfeld, with a handsome war profiteering success and decimation of government institutions, and near complete regulatory capture

6. Inventing then corrupting the Tea Party movement

7. At long last capturing the election process itself (dark money protected under corporate personhood “free speech” via Citizens United)

8. Election of **Idiot #3 **(Donald Trump) as a direct consequence of the economic impact of neoliberal policies on the folks who so angrily blamed everyone BUT the neoliberals!

Now how could the media, who are so carefully directed by these wealthy elite, ever interview someone who pulls back the curtain to reveal the aging rich white dude pulling all the levers…? We’re much more likely to witness Milton Friedman’s artful propaganda being replayed instead…because that feeds the false narrative rather than contradicting it. And, as a final nail in the coffin of Chomsky’s media viability, he of course says and writes stuff like this: What Makes Mainstream Media Mainstream, which basically explains that mass media - even public and academic media - is a parasite feeding off corporate wealth and, unwittingly or complicity, fulfilling their agendas.

My 2 cents.

Post-Postmodernity's Problem with Knowledge

Sell Sell Sell


This may actually be a pretty straightforward problem, with a challenging but nevertheless obvious solution. Here's my take....

I would propose there are nine primary forces at work in present-day knowledge generation, dissemination, evaluation and integration, which I would sketch out as the following inverted values hierarchy:

A. Titillation to entertain or make money.
B. Arrogant ideological agendas.
C. Tribalism and groupthink.
D. Extreme, self-protective specialization of informational domains and language.
E. Democratization and diffusion of knowledge.
F. Appreciation of an ever-increasing complexity and interdependence of all human understanding.
G. An understandable fluidity of exact knowledge.
H. Critical self-awareness.
I. The humbly inquisitive ongoing search for truth.


What seems immediately evident when looking these over is that personal and collective values have tremendous influence on the efficacy of a given approach to knowledge - and, perhaps most importantly, this influence can and does defy any institutions created to sustain a more diverse or fruitful values system. For example:

1. If the profit motive reigns supreme, then titillation to entertain or make money will trump all other variables. This has clearly had a role in news media, where entertainment and sensationalism have far outpaced accuracy or depth. More subtly, this has also had an impact on scientific research, where competition for grant money has distorted methodology and data in order to attract sufficient funding.

2. If a particular belief system is venerated above everything else, then arrogant ideological agendas destroy truth in favor of persuasive propaganda - especially when combined with tribalism and groupthink. We see this with religious indoctrination and exclusionary bias (i.e. denial of empirical evidence), with conservative news media that promote neoliberal political and economic agendas, and with the refusal of institutions of higher learning to allow truly diverse or controversial perspectives among their events and curricula.

3. When democratization and diffusion of knowledge is prioritized above every other value, then we end up with the armchair Dunning-Kruger effect, where folks believe they have mastered a complex discipline after reading a few Internet articles, and are then able to confidently refute (in their own estimation) the assessments of more educated and experienced practitioners in that field. Social media seems to provide considerable reinforcement of such knowledge-distorting self-importance - as do participatory systems and institutional dialogues that refuse to qualify or evaluate sources of information or their veracity, and give all input equal weight.

4. With extreme self-protective specialization, we end up with isolated islands of understanding that do not fully comprehend or appreciate each other - and in fact often can't function harmoniously together in society. One consequence of this are graduates of universities who are preoccupied with scholastic performance at the expense of actual learning, or who cannot understand their field in a way that actually adds value to its execution in the real world. In other words, an education system that rewards one narrow flavor of performance, while devaluing creative productivity in order to generate compliant specialists.

There are also some nasty values combinations in the post-postmodern era that seem increasingly pernicious in the destruction of knowledge, mainly because they deliberately exclude F, G, H & I - that is, the humbly inquisitive ongoing search for truth, fluidity of exact knowledge, critical self-awareness, and appreciation of ever-increasing complexity and interdependence. Really, whenever these four characteristics are deprioritized or absent, insight and understanding tends to be thoroughly crippled. But let's briefly take a closer look at each of these fundamentals....

What is "critical self-awareness?" I think it could be summarized many ways, such as taking one's own opinion with a grain of salt, or having a healthy sense of humor about one's own understanding, or being able to effectively argue against one's own position and appreciate its flaws - i.e. some of the central themes of postmodern thought. The "humbly inquisitive ongoing search" is certainly a kindred spirit here, but also implies that our journey towards the truth is never-ending; it's not just humility about conclusions, but about the process of seeking itself. Appreciating the "fluidity of exact knowledge" is an additional variable to balance out other, less rigorous impulses. It means there will be few black-and-white conclusions that are accurate; that ambiguity and imprecision are inevitable; that assertions should be tested in small arenas for limited periods, rather than as sweeping revisions; and so on. This fluidity does not, however, insist on a nihilistic or dismissive orientation to qualitative truth; on the contrary, it can recognize and integrate absolutes while remaining keenly aware of context. And, finally, "complexity and interdependence" means that we will of necessity be synthesizing a collective understanding together - there isn't much opportunity for elitist leadership or vanguardism, except perhaps in a few highly abstracted or technical areas. In other words, functional truth is perpetually intersubjective. At the same time - again as a balancing factor to the diffusion and democratization of knowledge - we will also need to appropriately weight the insights of experiential "experts" to help us navigate complexity.

These four characteristics can be viewed as attitudes, character traits, virtues, priorities, beliefs, operating assumptions, etc. The point is that if we prioritize these four above all considerations - subordinating our other beliefs, reflexes and desires to them - we can begin to formulate a healthy, fruitful relationship with knowledge, both culturally and interpersonally. If we don't prioritize these characteristics...well, then I suspect we'll keep making the same kinds of errors that have led us into our current state of apoplectic befuddledom. We simply can't afford to constrain the four essential qualities of truth-navigation in a straight jacket of what really should be extraneous and subordinated values and habits. And thus we arrive at a proposed values hierarchy that maximizes the utility of any approach to true and useful knowledge:

A. The humbly inquisitive ongoing search for truth.
B. Critical self-awareness.
C. An understandable fluidity of exact knowledge.
D. Appreciation of an ever-increasing complexity and interdependence of all human understanding.

E. Democratization and diffusion of knowledge.
F. Extreme, self-protective specialization of informational domains and language.
G. Tribalism and groupthink.
H. Arrogant ideological agendas.
I. Titillation to entertain or make money.

As you can see, this is simply an inverted version of the current status quo. Okay...if we can entertain this thesis, how do we get from here to there? Well I think education about this issue will help, but really we need to evaluate what is generating the memetic force of competing values hierarchies, and disable or de-energize that force wherever possible. How is it that titillation to entertain or make money has gained such prominence? Or that arrogant ideological agendas or tribalism and groupthink have usurped both the scientific method and common sense? Why has extreme, self-protective specialization so often shattered collaborative, interdisciplinary exchanges and synthesis? And how has the democratization and diffusion of knowledge rallied itself into such a farcical exaggeration...? Is there a common denominator for all of these trends...?

Well I think the answer is pretty straightforward, and I along with many others have been writing about it for a long time - it was Aristotle, I believe, who most clearly identified the same core issues we face today. The central problem is our highly corrosive form of capitalism. But perhaps I should forsake my own confidence for a moment and - applying the very virtues I've exalted here - humbly offer that a culture of acquisitiveness, infantilizing consumerism, competitive egotism and blindly irrational faith will likely not facilitate the four essential qualities humanity requires for thriving and productive knowledge. And I do believe this is a cultural decision - one in which we have all become complicit, and have all reinforced through tacit acceptance of the status quo. To break free of our shackles, we will need to let go of some of the habits and appetites we most covet and adore. But I could be wrong. Perhaps we can achieve equilibrium through our continued bluff and bluster, through ever-greater fabrications, self-deceptions and carelessly conspicuous consumption. That seems a risky bet to me...but again, I might be mistaken.

End The Madness - How To Resist The Propaganda Machines

As an attempt to pry well-meaning folks free of the orchestrated spectacle that is keeping us all at odds with each other, I've created a meme to share:

End The Madness

Why haven't Russians awakened to the fact that Putin is leading Russia to economic destruction, or can Putin prevent it from becoming publicly known?


Historically, “strongman” governments like Putin’s routinely make temporary economic improvements that bolster popularity and offer an illusion of ongoing wealth production (while skimming as much off the top as possible, of course). Putin seems to have done the same. Further, his tight control over politics, media, other elected officials, major industries, the judiciary, banking and so forth make it fairly easy to perpetuate that illusion for the Russian people. It’s kind of like when dictators win “elections” for decades by 99%. Eventually, however, the “get rich quick” schemes that inherently avoid developing a robust, sustainable and competitive economy, and instead focus on raping, pillaging and hoarding of local resources (or neoliberal exploitation and monopolization by another name), will eventually hit a wall. In developing countries this is called “the resource curse.” What Putin seems to be banking on is expanding his economic and political footprint by military force, which is a very old method of sustaining economic expansion - and in a strongman’s case, prestige as well. Study any megalomaniacal dictator in history, and you’ll find they all did pretty much the same thing that Putin is doing. Until someone stood up to them, or their resources were ultimately depleted. It’s unclear what will arrive first to end Putin’s popularity, but once the Russian economy begins to stutter (and I do believe it eventually will) - perhaps as a result of increased sanctions and containment strategies, or because of a countering military action that frustrates expansion - it will become harder and harder for Putin to sustain the illusion of prosperity and maintain popular support. Perhaps that is why he has worked so hard to get a friendlier…asset into the White House?

My 2 cents.

From Quora post: https://www.quora.com/Why-havent-Russians-awakened-to-the-fact-that-Putin-is-leading-Russia-to-economic-destruction-or-can-Putin-prevent-it-from-becoming-publicly-known/answer/T-Collins-Logan

Muhammad Ali




I've been confronted with what seems like a fair amount of grief lately - about some small stuff, and about some bigger stuff - and Ali's death came as a shock. Arriving so unexpectedly, it invoked a bizarre dissociation before the tears came. I didn't understand why at first, and then it hit me: Ali wasn't just my childhood idol, he was the tip of the spear for everything I believed defined masculinity for most of my life. Indefatigable courage. Poetry of heart. Eloquence in adversity. Standing on principle. Belief in self. Integrity. Physical prowess and grace. Willingness to speak one's mind, regardless of the personal cost. Intelligence. Persistence. Thinking deeply about one's beliefs, then being willing to abandon cherished plans in order to live by those beliefs. Being multidimensional...and good at it. All of these things and more have remained with me for years, and Muhammad Ali was the anchor that held them in place without my fully realizing it. Even in death, he is still there, grounding the value of these qualities in my psyche; but the living force that so beautifully animated them has shed its mortal coil. That will take some time to integrate.

Now that I have thought about this, I also now know why I have allowed Ali's symbolic presence to languish in my subconscious: It was because he also offered less than positive lessons that have been very difficult for me to learn. That sticktoitiveness can become stubbornness, and stubbornness, in turn, can have tragic costs. That truth can become mean and arrogant, and that this can both undermine its effectiveness and demean the person who speaks it. That idols can have flaws. That physical violence against another human being - no matter how refined and artful in its form - is really just horrific animalism at its core. These lessons do not diminish Ali in my eyes...I don't think the young boy within my heart will ever allow that. That boy will still cheer and prance with delight at every jab and punch that Ali made with his fists and words. But those lessons temper the qualities I so worshipped in Ali back then, and rearrange the priorities of what it means to be a man - even as I am still learning them myself.