Category Archives: Healthcare

A Healthcare Story: A Health Insurance Victim

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A young woman in Indiana, twenty-eight years of age, seemed poised for a good life. She liked her job in a small professional office where she was respected for her consistent performance. She enjoyed the people with whom she worked and she was engaged to be married, in only a few months, to a young man with whom she was thoroughly in love. Life was happy, busy, and could hardly have been better so she paid little attention when she experienced occasional dizziness and a slight numbness in her left arm and leg. These symptoms were followed by blurred vision and headaches and, at the urging of her family and her fiancée, she went to her doctor.

Although she had no health insurance—her employer was a small business and offered no employee benefits—her physician was able to arrange for a stream of increasingly more sophisticated and more expensive diagnostic procedures and, a referral to a neurologist. The diagnosis was Multiple Sclerosis. By this time the young woman’s symptoms had progressed and her physician pronounced her disabled and unable to work. Reluctantly she quit her job—at that time she truly was unable to perform her duties–and applied to Social Security for a disability.

After a lengthy process, during which her symptoms began to abate, the application for disability was rejected by Social Security. Although she felt much better, and was able to return to work, she was told that the MS symptoms might recur and could be even more debilitating. She was now a twenty-nine year old woman whose life was not so promising. She was unemployed, thousands of dollars in debt, and lived with the fear her health could deteriorate at any time. Her fiancée had stuck by her during the ordeal but the couple was advised to postpone their wedding, as a husband would become liable for her indebtedness. Heartbroken, frightened, discouraged and deeply in debt, she filed for bankruptcy.

Eventually she found a new job – her previous one no longer available – and although she didn’t care for the work or co-workers nearly as well as her prior job, a group health plan was offered. Unfortunately her MS was ruled as a pre-existing condition that would not be covered, at least during the first year. The monthly payroll deduction for the health insurance premium reduced her take home pay by twenty percent.

This young woman had become a victim, not only of her illness, but also of the system. The healthcare providers who took the financial risk to provide care for this patient were left with little choice but to write off a portion of the charges for their service. Although not visible to the public, costs such as these must be born by the system and they fuel the fires of medical inflation. There is no such thing as a free service, and someone, somewhere must pay.

Are Free Market Forces Good for Healthcare?

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Contrary to popular belief, the problems with the American Health Care System are not the result of market forces run amok. In fact, just the opposite is true. The American health care system languishes because the forces of the free market are unable to exert their influence. Imagine, if you will, how our free market system would look if it functioned like our health care system.

Imagine that you are sitting at home, watching television, and something feels out of sync. You can’t put your finger on what it is you are feeling but it is nagging at you and keeping you out of sorts. After a few days, the problem seems to be worsening and you are really beginning to worry. Finally, you pick up the phone and place a call to your local retail professional and make an appointment.

On the appointed day you arrive at your local mall or shopping center and you describe your symptoms to your retail professional. Your retail professional listens intently, asks a few questions, and then diagnoses your problem and offers a treatment protocol to make you feel better. Your retail professional tells you that the problem is that your home entertainment system is not meeting your minimum daily requirements. As a solution, your retail professional tells you that what you need is a new home entertainment system with state-of-the-art technology.

Now, it just so happens that you retail professional has the perfect home entertainment system to sell to you and guess what? It’s covered by your retail insurance policy. In checking your benefits it turns out that you’ve already satisfied your deductible so your insurance is going to cover eighty percent of the total cost of your new system.

What your retail professional may not explain to you is that your home entertainment system exceeds the usual and customary charges for such items so the insurance is not going cover your retail professional’s full cost. She’s not worried, however, because there are a number of accessories she can sell to you that are covered and these will more than make up for the difference.

I know this sounds a little silly, but think about how our free market economy would work if the merchants with whom we do business would decide for us what we need and how much we are going to pay, and that we would be happy to accept their decisions without question because our insurance is going to pay for the merchandise, anyway. This is exactly how the healthcare system works today and we wonder why costs continue to rise at or above the rate of the Consumer Price Index.
The problem with the American health care system is not that doctors make too much money, the problem is that the incentives in healtcare reward the wrong behavior. The problem is not that health insurance companies, managed care, Medicare or Medicaid absorb huge chunks of our health care dollar, the problem is that these entities exist at all.

Think about it for a moment. If we really want to provide universal health care what value do health insurance, managed care, Medicare and Medicaid contribute? Don’t these entities exist to restrict access to care to only those who are eligible for coverage? Don’t these entities exist to limit care to only those services that are covered by our schedule of benefits and for which we have paid?

If we want to provide comprehensive health care to all Americans we have to change the way we think about our health care system. There is a solution but it resides outside the boundaries of conventional thinking.

Visit my website atwww.melhawkinsandassociates.com and check out my book, Radical Surgery: Reconstructing the American Health Care System. In fact, tell all of your friends about it.

Obamacare aka the Affordable Care Act Mis-Named!

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The Affordable Care Act, affectionately or not so affectionately called Obamacare has been misnamed. It should have been called the Affordable Health Insurance Act because it addresses the issues of healthcare, only indirectly.

What Obamacare does is allow people to purchase health insurance coverage for themselves and their families. “Allow” is not the right word, however, as the law is set up with penalties for families who do not enroll in a health insurance plan within a designated time frame.

The types of health insurance coverage that will be available to people will vary as each individual or family will be shopping for coverage that seems to best fit their unique requirements.

The ACA also asks health insurance providers to incur more risk by eliminating provisions like pre-existing conditions. Apparently, it is a trade off for being assured of getting more business.

We admire the sentiment of the act, which was intended to reduce the number of Americans who are uninsured and, therefor, not able to get the medical or hospital care that they need.The logic is somewhat confounding, however.

Rather than make health care available to all Americans as a right of citizenship, as so many other nations have done, it was decided to require everyone to have health insurance. How they arrived at the next logical conclusion, which was to penalize people who are unwilling or who think themselves unable to pay for the now more readily available coverage, is somewhat of a mystery.

The problem with Obamacare is that it will commit our nation to a future in which we are tied to the health insurance industry. Almost certainly, the people of other developed nations must be shaking their heads in bewilderment at those crazy Americans. I’m sure they must be asking themselves why we think it a good idea to do business with a middle man who only adds cost and complexity to the process of delivering needed healthcare to people.

It is hard to come up with a comparison that illustrates the absurdity of the concept but here’s an example that at least comes close.

Earlier I used the example of fire protection for citizens and asked the reader to imagine a scenario where the fire department pulls up to your burning home and asks to see your fire insurance card before they will turn on their hoses.

In most communities in the U.S., people have determined that everyone deserves fire protection and that the community will pay for that protection with tax dollars.

I have heard of a few communities where citizens are asked to pay a direct fee for fire protection. Now imagine that, in these latter communities, a problem has developed because not everyone is willing to or can afford to pay the fee for their fire protection. This theoretical community could decide to solve the problem the way most American communities have, by paying for fire protection with local tax dollars even if this initially requires an increase in property tax rates, the adoption of some type of local option income tax, or even some type of earmarked sales tax. Whatever the method of taxation, these communities have made fire protection a right of citizenship.

Now, lets consider that there is another community that still requires individual property owners to pay a separate fee for fire protection and that this community is also concerned that not everyone seems willing to pay for fire protection. The leaders of this community are not willing, however, to make fire protection a right of citizenship in their community.

Instead, someone comes up with the idea that requires insurance companies to provide at least a minimal level of fire protection coverage, no matter what the condition of individual properties, and also requires all citizens to purchase fire protection insurance coverage or pay a penalty.

Now, it is difficult to imagine that any community would choose such an approach because common sense would dictate that it will almost certainly cost more to pay a middle man for fire protection insurance than it would be to pay for it directly, through tax revenue. After all, the middle man has to cover their operating costs and, because we live in a free market society, make a profit.

Why is it that so many Americans seem so wrapped up in their daily activities and challenges that they are unable to step back and think about what they are doing and why?

The Acts of a Faction of Elected Officials Places Democratic Principles at Risk!

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Forget, for a moment, how you feel about the Affordable Care Act (we should call it the Affordable Health Insurance Act but that is a discussion for another time). Forget about what you think about the national debt, government spending, entitlements for the disadvantaged, national defense, public education, or protecting the environment. All of these issues are important, to be sure, but not one is anywhere near as important as what you think about the principles of democracy in a world where powerful men and women can force a government shutdown to get what they want.
The principles of democracy are based upon the premise that our government is a government of the people, for the people, and by the people. It is based on the principle that the American people exercise their precious right to vote and that the majority vote prevails. And let us not get distracted, here, by the fact that because so many Americans fail to exercise the right to vote that very often it is the will of a plurality rather than of a majority that prevails. The point is that important decisions are supposed be made by American citizens, in a ballot booth, or by our elected representatives in a roll call vote in their respective houses of Congress.
The underlying premise of the Constitution of the United States, which may be the most important political document written in the history of mankind, was to prevent the powerful from usurping the will of the people just because they have the power to do so. The Constitution was meant to protect the American people from despotism under any guise, even in the disguise of elected officials who strive to exert their will when they disagree with a decision that was lawfully and constitutionally determined. Make no mistake; forcing a government shutdown is an act of despotism.
The acts of a single faction of one of our two main political parties in shutting down the federal government, leaving millions of American citizens injured in their wake, is no more appropriate than it would be if our military decided that they do not like how the elected government went about its business. It is just as wrong as it would be if our generals and admirals would use the incredible power of Armed Services of the United States to coerce our elected representatives into giving them the decision that they want.
The issue, today, is not how we feel about the budget, the ACA, or the federal deficit; it is about how we feel about our elected representatives forcing a government shutdown with total disregard for democratic principles.
Imagine a future in which the tactics displayed, today, by a political minority became the accepted way of conducting the business of the people. How long will our right to vote matter in a world in which powerful men and women can disregard the voice of the people and use coercion to get what they want?

Consequences of our Action: No One to Blame but Ourselves

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Imagine that you are an employer and economic conditions have required you to cut back wherever possible. Some of you reading this won’t have to try very hard to imagine such a scenario.

Imagine how your employees would feel if your response to the need for belt-tightening was to freeze wage rates or possibly even cut wages and benefits. On the benefit side, imagine that you dropped health insurance coverage for your employees and their families and that you suspended all travel and training programs, much of which had been offered to help your employees qualify for opportunities for advancement within you company.

It is reasonable to expect that your employees would be disappointed, at the very least, and we can be certain that some would be angry and resentful. During hard times, however, people understand that sacrifices must be made and the majority of your people would not lose their trust and respect for their employer or for you and your leadership.

Now, let us add a new variable to the equation. Let us assume that the members of the management team have not been asked to make corresponding sacrifices, even in this difficult economy. Imagine, in fact, that your management team is still eligible for the same salary increases and bonuses that were common when times were good. Imagine also, that the management team got to keep their executive health package and that they routinely attend training programs, seminars, and conferences in many locations around the U.S. and the world.
How would these factors affect the morale of your employees not to mention their loyalty to their company and its leadership team? Would they still be willing to endure the sacrifices they have been asked to make? Would they still be committed to the long-term best interests of your organization?

We all know, at least at an intellectual level, that such decisions on the part of management would have huge consequences with respect to their ongoing relationship with their people. No doubt many would begin looking for new opportunities.

Now, let us take a step back and think about the current reality about the way the federal government, particularly Congress and the executive branch, treat the American people at the low end of the economic continuum.

Whether these Americans are minimally employed, unemployed, on welfare or disability, depend on Medicaid or Medicare, or are on a fixed retirement income that depends almost totally on Social Security; every time the government feels the need to reduce spending it is the people in this group that are asked to take the hit. How do you think these people feel when Congress refuses to even consider asking the wealthy to pay a little more in taxes.

These Americans cannot get decent healthcare for their families, ObamaCare not with-standing, while they read about the extravagant health plan that Congress creates for themselves and their families. They also read that virtually every other developed nation on the planet considers healthcare to be a right of citizenship and provides comprehensive healthcare and prescription drugs for their people.
In the interim the poor, the unemployed, and the underemployed citizens of what is considered to be the richest and most powerful nation in the history of the world are asked to believe in an American dream that is little more than illusion to them.

These people are told to take advantage of the opportunities of this great nation and that an education is the ticket to the American dream. What these American know to be true is that getting a good education is a myth when they are asked to send their kids off to public schools that have embarrassing failure rates and that seem to chew their children up and spit them out.

As a result, these Americans no longer believe in the American dream and they no longer teach their children that the dream exists. Neither do they teach their children that getting an education is important and something for which they should work hard and make sacrifices. Not surprisingly, the children of these Americans arrive at their first day of school with precious little motivation to learn and are poorly prepared to succeed. Rather than accept responsibility as a partner with their children’s teachers and principals for the educational success of their children, these mothers and fathers look at school as a form of free day care that keeps the kids out of the house for eight hours a day, five days a week.

They see an educational process that is focused on failure. When their children struggle to understand their lessons, rather than take extra time to make sure their kids understand, they see their children pushed prematurely from one lesson to the next by teachers who do not seem to care. The result is that their children fall further and further behind until they are so hopelessly lost that they give up on themselves. They begin to lose all hope that they can catch up with their classmates and they learn quickly that the surest way not to suffer the humiliation of failure is to avoid participation. The rest of us sit back in indignation, clueless to the dynamics of this reality.

The parents of these children understand what their children are feeling because it is the very same thing they felt when they were still in school. As a result they refuse to cooperate with their children’s teachers because they view those teachers as adversaries and as tellers of lies; as so-called professionals who simply cannot be trusted to do what is best for their children.

As this cycle of failure repeats itself semester after semester and year after year, why do we seem surprised that these children grow up and give birth to a whole new generation of children who are reared in an atmosphere of hopelessness and powerlessness.

Other Americans become frustrated with these people because they rarely exercise their right to vote and seem unwilling to accept the responsibilities of citizenship. We cannot quite comprehend that these Americans feel this way because they have absolutely no faith that their voices make a difference. As a result these men and women are effectively disenfranchised. They feel hopeless and powerless to control the outcomes in their own lives and in the lives of their children.

The rest of us point the finger at these Americans, never fully comprehending that the reality in which these Americans live and endure is one that exists solely as a consequence of our own actions; of the decisions and policies of people who view themselves as leaders of the free world.

As we have pointed out in earlier posts, we are fast approaching a tipping point in which mainstream Americans can no longer bear the weight of the poor, the uneducated, the hopeless, the powerless, and the disenfranchised. As we sit by in our blissful ignorance and self-righteousness, that tipping point is rushing at us at the speed of desperation.

The Kids Are at their Games Again!

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Yes, we all know we need to get people off of Food Stamps!

Yes, even though it is the law of the land we know the Affordable Care Act, affectionately or not so affectionately known as ObamaCare, is a bad solution that will only make the system worse and drive up costs because of its reliance on the health insurance industry.

But, why do we continue to play the same games. Rather than put our heads together in recognition that our country is in trouble and because we need to find some new solutions that will actually work, we play like two kids on the beach who cannot get along. Rather than build something beautiful, together, we devote all of our energy to tearing down the other guy or gal’s sand castle.

On the beach, the only consequence of such child’s play is that parents have a source of frustrated amusement that Bob and Sally can’t play together.

In the real world, at the seats of power of the United States of America, such games hurt people who can least afford to be hurt and bring us no closer to meaningful solutions.

When we use ObamaCare as leverage to try to win budget concessions in an attempt to reduce federal spending, we create a stalemate that will eventually lead to a government shut down or sequester that will take money out of the pockets of hard-working Americans and benefits away from the unfortunate who have no way to make up the difference.
Of greater long-term consequence is the fact that such stalemates and painful cuts only deepen the resentment of the disenfranchised who have already become embittered; they are citizens who no longer believe in the American dream and who have become hopeless, and feel powerless to change the outcomes in their lives.

As long as this population of the disenfranchised continues to grow, the burden that must be carried by the rest of us will only grow with no end in sight. Somehow, rather than push them further away from mainstream America we need, desperately, to find a way to pull these people back in as productive citizens who can help us face the challenges of an uncertain and rather frightening future.

When are we going to find positive leaders who can find a way to set aside their differences and work together to find solutions to the enormously difficult challenges confronting us? When will someone say “enough!” and begin working to pull people to the table to do the important work of our government?

Our elected officials in both the executive and legislative branches of our government have become trapped in their daily work that they have forgotten to step back and look at the panorama. The only thing they know is attack and destroy what their opponents want to accomplish and to remain committed to fruitless process of incremental change in dealing with monumental challenges; challenges that cannot be overcome incrementally.

For those of you who are reading these words, you are not powerless. Provide some positive leadership and begin expressing you concerns directly to your elected officials. Tell them what you think. Just as importantly, encourage the people you know to roll up their sleeves and share in the work.

The clock is ticking and when the tipping point is reached there will be no second chances.

America: A Leadership Crisis of Great Urgency!

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During the recent crisis with Syria, the Russian government as stepped up to offer a solution. What was most interesting was that Vladimir Putin, the Russian President, chided the U.S., in response to a statement by President Obama, noting that “It is extremely dangerous to encourage people to see themselves as exceptional, whatever the motivation.”

However much we might resent Putin’s audacity to say such a thing, maybe we need to stop and think about the possibility that he could be correct.

Any illusions we might have had regarding the invulnerability of the United States as the richest and most powerful nation in the world were surely shattered in the wake of Standard and Poor’s decision to downgrade our nation’s credit rating in 2011. Our inability to dictate our political and military will in the Middle East and the blatant hatred demonstrated by the people who have attacked our Embassies are examples of a recurring theme that challenges our nation’s belief in itself as somehow special.

Maybe it is time for the American people to step back and take stock of who we are and how rate when compared to other developed and developing nations in the world.

The U.S. national debt is measured in trillions of dollars, with China, the single greatest challenge to our economic supremacy, our largest creditor. Our ability to compete in the world marketplace over the next half-century is dependent on the quality of the American workforce, which, itself, is powered by the American educational system. According to The Programme for International Student Assessment (PISA), the U.S. ranks 25th in math, 17th in science, and 14th in reading out of the 34 Organization for Economic Cooperation and Development (OECD) countries.[1] That China ranks first in all three areas should strike fear, if not outright panic, in every American heart.

We are in the midst of a crisis of historic proportions in which our way of life as a people is in jeopardy. It is a crisis that cries out for positive leadership and yet our elected leaders in Washington stomp around like spoiled and stubborn children who have yet to learn how to work and play with others.

The challenges facing our nation and its people are immense. Whether our burdensome debt; an economy that is only a shadow of its former self; a natural environment that seems to be stumbling under the weight of a burgeoning population that fouls the very air that we breathe and the water we drink; a system of public education that is laden with failure; a health care system that fails to meet the needs of nearly a full third of its citizens, we place our future in jeopardy unless we meet these challenges.

We use oil, a diminishing natural resource, to fuel our demand for energy even though the future will belong to the first nation to develop reliable, alternate sources of energy whether solar, hydrogen, or nuclear fusion. Worse, we are dependent on foreign suppliers of oil that are friendly to us only as long as we are able to pay.

We are a people who have forgotten that the historical strength of our democracy has always been our rich diversity as a people living together, in harmony, under the rule of law. Today we govern ourselves with a two-party system in which loyal opposition has given way to enmity and distrust to such an extent that each side feels the other is out to destroy America.

We must understand that the problems of the Twenty-first Century are of such magnitude that the politics of the past are no longer adequate to meet our needs. We must find fresh solutions that satisfy the needs of the masses on the one hand and that foster a strong economy on the other. We need the kind of leadership that will demand that its people replace a rampant entitlement mentality with an abundance mentality centered on the belief that there is enough for everyone as long as each citizen is willing to give one hundred percent of themselves through hard work and participatory citizenship.

We need leadership that understands that we cannot preserve our nation’s status as the richest and most powerful nation in the world just because we think it is our right and privilege.

We are like a baseball or football team that has been in first place for so long we have forgotten what it took to rise to the top and we have become complacent. Right now, people of other nations, with China and Russia leading the way, are working hard to challenge our nation’s status. Just as importantly, the children of China and other nations are working hard to gain what they believe is an educational advantage that will seal the deal for their people and economy in the Twenty-first Century and beyond. That they are outperforming American children by a wide margin is simply unacceptable and we must answer the bell.

It is unreasonable to think that one nation will be able to dominate the future the way America has dominated the past but if we want a place at the head table, we have to elevate our game. To do so, we must reunite as a people and demand the best from ourselves, from our fellow Americans, from our children, and from our political leadership. We can ill afford to waste a minute let alone a generation.

Stand up, toe the mark, and get moving while we can still see the coat tails of our competitors. We need positive leadership and it must start with each and every one of us. That means me and it means you!

ObamaCare Approval Rating Continues to Fall

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Over the last few months there have seen and heard numerous reports that the public’s approval rating for ObamaCare, more appropriately referred to as the Affordable Care Act, has been falling steadily and now rests well below forty percent.

This should come as no surprise. Attempting to fix the American healthcare system by relying on the health insurance industry is like trying to fix Congress by making it easier for people to get re-elected.

The best we can say about the Affordable Care Act is that it was a nice try but one that was doomed to fail because its design was driven more by political considerations than by an understanding of how the healthcare system actually works. All ObamaCare really accomplished was to add another layer of complexity to a system that was already unimaginably complicated.

Until we are ready to acknowledge that health insurance is one of the biggest reasons why our healthcare system fails and, of course, that human beings actually deserve medical care when they are ill or injured, our tinkering with the healthcare system will only make it worse.
Focus on health insurance, if you will. Imagine for just a moment that we all could agree that there ought to be a way to see that all men, women, and children have access to health care when they need it.

Now, think about what health insurance actually does. The health insurance industry restricts access to care to only those people who are covered by a health insurance policy and it limits care to only those services that are specifically covered by that policy.
Assuming, again, that we want everyone to have access to healthcare, why would we be willing to pay the health insurance industry hundreds of billions of dollars to restrict care to a special few individuals and to limit care to only services that have been specifically identified?

And, yes, I’ve heard the argument that we over-estimate the amount of money siphoned off by the health insurance industry. Just the opposite is true. We grossly underestimate the degree to which the health insurance industry contributes to the rising cost of healthcare. The cost of health insurance is not just the result of that portion of our premium dollars that are retained by the health insurance industry after payment of claims to providers.

The cost of health insurance also includes every dollar that is spent by doctors, hospitals, nursing homes, out-patient surgery centers, rehab facilities, lab and imaging centers, home health care providers, and hospice providers to manage the process of filing insurance claims and fighting to get the paid what they are rightly owed.

We could also add the expenditures by employers as they manage the process of selecting health insurance or managed care providers, managing the enrollment process, and mediating grievances when their employees are unfairly reimbursed for care.

And, we could factor in how much the health insurance industry pays to influence legislators. And then, of course, there is Medicare and Medicaid.

If we could recoup every healthcare dollar expended by people like you and me, and also by our employers, that does not end up in the hands of actual providers of care we could afford to provide comprehensive healthcare and prescription drugs to every American man, woman, and child.

And, if you want “to hear the rest of the story,” as Paul Harvey used to say, take a look at my book, Radical Surgery: Reconstructing the American Health Care System Continue reading →

Act Now and Save $15 Trillion ($15,000,000,000,000)

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Let us forget, for just a moment, the debate about the Affordable Care Act or, as most of us would call it, the Obamacare Act, and focus, instead, on the issue of providing universal healthcare (translated to mean comprehensive healthcare for all American citizens and legal aliens).
No matter how we feel about Obamacare, we certainly would agree that the Affordable Care Act will not provide access to healthcare for every single American. The absolute most the Affordable Care Act will do is to make it easier for more Americans to purchase health insurance coverage. There also seem to be few illusions that Obamacare is going to cost less than what healthcare in America cost before implementation of the Affordable Care Act. Many will suggest that it will, in fact, cost more than what we have spent in years past.
The real question we should be asking, however, is “why are we unable to provide comprehensive healthcare and prescription drugs to every single American Citizen and legal alien?” In other words, why are we unable to provide universal healthcare?
For the moment, I want to forget about all of the altruistic reasons as to why the richest and most powerful nation in the world should have a healthcare system that meets the needs of all Americans, like virtually every other developed nation? I want to forget about these things because no one really seems to care.
We seem more concerned with rejecting the concept of socialized medicine than we care about all of the men, women, and children in the United States who are unable to gain access to and afford the medical care they require.
The fact is that the vast majority of Americans are unable to distinguish between the concepts of universal healthcare and socialized medicine. These to concepts are, in the minds of these people, synonymous. I suggest to you that it is this inability to differentiate the concept of universal healthcare and socialized medicine that is at the root of the entire problems with the American healthcare system.
Since no one seems to care about the suffering that so many Americans are made to endure, let us focus on the one issue about which everyone seems to care and that is the cost of health care in America.
From 2001 through 2011, the total annual healthcare expenditures of the U.S. grew from $1.2 Trillion to $2.8 Trillion. This represents an average increase of 8.8 percent per year. If that trend continues from 2012 to 2022, our annual healthcare expenditures will increase from $2.8 Trillion in 2011 to just under $7.1 Trillion in 2022. For the eleven calendar-year period from the end of 2011 until the end of 2022, we will have spent just under $56 Trillion on healthcare. Mind boggling, is it not?
In 2001, I wrote a book entitled, Radical Surgery: Reconstructing the American Health Care System, in which I proposed a healthcare solution that would provide universal healthcare without socialized medicine. In other words, I wrote that we could provide comprehensive healthcare and prescription drugs to all Americans and legal aliens without relying on government. Let me say it differently in order to alleviate any confusion. I proposed a way in which we could give every American access to whatever healthcare they required but that would involve neither federal nor state government in the healthcare delivery or decision-making process.
One of the features of this new system was a mechanism that would allow us to control the increases in the cost of care so that costs would rise no faster than increases in the Consumer Price Index (CPI). At that time I projected that the CPI would grow at a rate of 5 percent per year. At that rate, I suggested that healthcare expenditures would have risen to $1.86 Trillion by 2010. Had we been able to hold the increase in annual healthcare costs to 5 percent per year we would have saved an aggregate amount of $3 Trillion over the ten year period. Pretty significant savings, wouldn’t you say?
In fact, the actuall CPI growth during that same period was an average of 2.7 percent per year. Had we been able to control the rise in healthcare expenditures to actual inflation rates, costs would have grown only to $1.55 Trillion resulting in an aggregate savings over the decade of just under $4.5 Trillion. Even more impressive, don’t you think.
Now, let us assume that the actual rate of increase in healthcare costs between now and 2022 would remain the same as the previous ten year period (8.8 percent). In that case healthcare costs will rise to a staggering $7.086 Trillion by the end of 2022.
If, however, we were to implement the healthcare proposal presented in Radical Surgery: Reconstructing the American Health Care System, and inflation would continue to increase at the rate of 2.7 percent per year as it did over the last decade, our annual healthcare expenditures would rise to only $3.9 Trillion. Under this scenario, the aggregate saving in healthcare costs over the ten year period from 2013 to 2022, compared with the projected 8.8 percent per year increase, would be $14.9 Trillion dollars.
Forget altruism, just give me the money!
The question for the reader is a simple one. Can the American people afford to spend an extra $15 Trillion over the next decade for a healthcare system that will continue to leave a significant percentage of the American population with inadequate access to healthcare?

Disenfranchisement and Hopelessness

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What does it mean to be disenfranchised? What does disenfranchisement have to do with Hopelessness?

The most common use of the term disenfranchised has been associated with the right to vote. People who are disenfranchised are not permitted to participate in their own governance. More generally, it could refer to the loss or denial of any of the civil liberties to which a free people are entitled, under the law. Typically, when we say that someone is disenfranchised we are talking about people from whom something has been taken away.

We have chosen to expand the term to include people who have essentially disenfranchised themselves. These are individuals who no longer believe that what they do, think, or say matters to their community, their nation, or society. In this case, disenfranchisement is a voluntary abdication of one’s responsibility to participate in one’s own governance. This type of disenfranchisement flows from hopelessness.

Human beings experience hopelessness when they no longer believe they have control over their own destiny or over the outcomes in their lives. Literally tens of millions of people, in this great nation of ours, have lost hope. They no longer believe that the American people, as a whole, care about them. They no longer believe that anyone is interested in listening to their complaints of woe let alone take action to address those complaints. They no longer believe in the “American Dream.”

It is easy for the rest of us to shout out in pious righteousness that these people need to do something for themselves but, literally, these people do not see anything they can do. That’s what it means to be powerless. Hopelessness and powerlessness are so closely intertwined that it is almost impossible to distinguish one from the other.

We tell them to get a job, but there are no jobs for them that will enable them to support their families. They can work somewhere for minimum wage but no employer is going to give them a sufficient number of hours per week that would obligate the employer to offer benefits. They can make a better living on Welfare. The argument that Welfare offers no advancement opportunities is meaningless to people who cannot envision something better. We must be able to envision if we are to believe.

When faced with serious injury or illness of a family member, the disenfranchised know that the American people are prepared to let them suffer. They know that every other developed nation in the world, apart from “the land of the free and the brave,” has addressed this issue of access to healthcare. Americans, however, steadfastly refuse to provide healthcare to all Americans. Even when the President of the United States has pushed through healthcare reform legislation in the form of the Patient Protection and Affordable Care Act (PPACA), however imperfect, the opposition attacks it relentlessly. The message that the disenfranchised hear, loudly and clearly, is that the majority of Americans “do not want us to have quality medical care for our families nor are they willing to pay for that care.”

Mainstream Americans are frustrated that so many people have become dependent on the government for welfare, food stamps, and Medicaid. We cry out, “What more do you want?” We do not understand why these people express resentment rather than gratitude.

When, in the face of our staggering national debt, all the disenfranchised hear from those in power are proposals to cut food stamps, welfare benefits, or other entitlement programs; why would they feel anything other than resentment?

What Americans need to wake up to is the idea that this reality with which we are confronted is a consequence of decisions we have made over the last seventy years. We created this monster called welfare. It was intended to make sure that poor mothers could care for their children but the reality is that it succeeded only in trapping huge populations of Americans in a reality that is little more than second-class citizenship.

It used to be that even the poorest of the poor would see an education as a ticket out of poverty and as a stepping stone to the American Dream. In most urban communities, the disenfranchised no longer believe in education as a ticket to anywhere other than free day care. What they know is that huge percentages of their children are failing in a school system that is also second class. When we offer voucher programs to help families put their children in better schools we are sending a subtle but powerful message that America has given up on urban public schools.

The fact is that the only parents that take advantage of vouchers are people who still cling to hope and some vestige of the American Dream. The other significant fact is that unless the parents who opt to take advantage of vouchers are also willing to accept responsibility as partners in the education of their children and ferociously encourage their sons and daughters to work hard at school these kids will be no more successful in their new schools than they were in their old ones. Many “charter schools” and other schools that admit “voucher children” to their classrooms are finding this out as they see their school’s declining scores on state competency exams.

So, let’s think about this for a moment. We have an expanding population of poor Americans who:
• Are third- or fourth-generation beneficiaries of welfare
• Cannot gain access to anything more than the minimal level of healthcare for their children and little or no healthcare for themselves,
• Who cannot find jobs that pay better than minimum wage and that offers enough hours to qualify for benefits,
• Who see their children fall so far behind in school that “failure” seems inevitable, and
• Who hear elected officials and policy makers demand that we cut entitlement programs rather than increase taxes paid by the wealthy and the middle class.

Why in the world would we expect these men and women to believe in an American Dream that is nothing more than an illusion for them and an empty promise for their children?

Welfare and other programs that teach people to be dependent rather than independent and interdependent are a cancer that is eating away the heart and soul of our nation.

We must acknowledge, as we move further into the Twenty-first Century, that the policies that got us into this mess are incapable of getting us out. We desperately need new ideas and new solutions. We need to think exponentially and challenge all of our assumptions about the way our society provides for the poor, takes care of the sick, and educates our children.

How much longer can we expect working men and women of our nation to continue to carry the burden of a burgeoning population of poor and disenfranchised people on one end of the productivity continuum, and population of retirees that is growing at an unprecedented rate on the other? What happens to our status as the leader of the free world when our economy buckles under the oppressive weight of the retired and the dispossessed?

In a few weeks, I will be introducing my latest book entitled, Re-inventing Education, Hope, and the American Dream: The Challenge of the Twenty-First Century. It is a book that offers a strategic action plan to address major components of the dilemma in which we find ourselves. In this book, I suggest that our systems of education, both public and private, offer the best hope for attacking the problems we face as a society and for bringing the disenfranchised back into a game in which their contributions are desperately needed.

My book Radical Surgery: Reconstructing the American Health Care System, published in 2002, already offers a solution for providing universal healthcare and prescription drugs at a price that we can afford; and, in a way that relies on free market forces, not government, to drive quality, cost, and accountability.

Many people have branded Radical Surgery, sight unseen, as just another proposal for socialized medicine. If they would set aside their prejudices and open the book they would learn that Radical Surgery rejects socialized medicine and offers another alternative. It is an alternative, however, that requires that we open our minds to a whole new way of thinking about healthcare.

Implementation of the very specific strategies offered in these two books, Re-Inventing Education, Hope, and the American Dream and Radical Surgery, will provide a realistic opportunity to re-engage the disengaged members of our community. The consequence of seeing this population continue to grow will be nothing short of apocalyptic, which is what my novel, Light and Transient Causes, has been written to illustrate.