Today's news reports are just full of things that I could not make up. No matter how snarky I'm feeling.
First, we have the Moldovan Orthodox Church, one of whose priests led a mob chanting anti-Semitic slogans in tearing down a public Menorah erected by the Jewish community in the Moldovan capital, Chisinau (no, this is not an old Mission Impossible rerun). Obviously inspired by the spirit of Christmas, the Church leaders said that the "cult" should have erected its Menorah at a Holocaust memorial and not in a public square of historical importance to Moldovans.
Next, it seems that the US Congress, the SEC and now the New York Times is shocked, shocked to discover that there is gambling going on on Wall Street. The Times has finally picked up the story, which I think began either in Rolling Stone or one of the blogs, that Goldman Sachs and other banks, but Goldman in particular, had created and sold collateral debt obligations to customers which securities could only increase in value if the real estate market continued to rise in value. At the same time it seems that Goldman, among others, had concluded that the real estate bubble was about to burst and began shorting the very same CDOs they were selling to their customers. Goldman et al made fortunes, the customers lost big time, the credit markets collapsed and you know the rest.
Third, as one Jewish observer has put it, we may have gotten Jimmy Carter back but lost Garrison Keillor. I'm not so sure. Carter issued the sort of apology that you get from someone who knows he's in trouble but is not quite ready to confess to his misdeeds. But, hey, it was a start. Today we learn that Carter's grandson (are Amy and I really that old?) is running for the Georgia State Senate in a district loaded with a significant Jewish presence. What a coincidence.
Garrison Keillor, meanwhile, is being raked over the coals for an otherwise innocuous rant about how Christmas in America is being secularized (and he figured this out when?), in which he goes off on cheesy Christmas music written by Jews. This, to some, makes Keillor the anti-Semite of the week. Personally, I think that pumping Irving Berlin tunes into malls is the Jews' revenge on the Christians for anti-Semitism. Given that we were inflicted with pogroms, cheesy Christmas music is a wimpy form of retaliation but, like Carter's apology, it's a start. Keillor's problem is he figured it out and wrote about it without first turning into a snarky Jewish blogger.
Of course, we could state the obvious, which is that anyone seeking a spiritual Christmas will find it at home and in church and should simply stay the hell out of the malls. Even better, let Keillor and the rest of the "War Against Christmas" crowd come to Israel for the holiday.
And, finally, there is the report, based on recently released Israeli government documents, that Maale Adumim, a West Bank settlement located about half way between Jerusalem and Jericho, and the area between Maale Adumim and Jerusalem (known as E-1) were intended to be annexed as part of Jerusalem back in 1975, when the community was first being planned. Yes, you fans of Labor, that's two years before a Likud-led coalition gets a majority in the Knesset. Oh gee, what a surprise.
Read more!
Thursday, December 24, 2009
Wednesday, December 23, 2009
2010 - A Good Year To Die - Unless You're Gilad Shalit
Tel Aviv
23 December 2009
2010 is a good year to die. At least it is if you are subject to the US Internal Revenue Code and have a taxable estate. Why? In 2010, the estate tax and its evil spawn, the generation skipping tax, completely disappear for one year. (Trust me, if you don't have an estate worth more than $3.5 million and grandchildren to whom you want to give very large gifts you don't want me to explain the GST. If you do then you've already hired good tax counsel and don't need me to tell you about the GST but you are definitely picking up the check when we next have lunch.) In 2011, the estate tax and GST rise again, as from the dead, like a movie's bad guy who just won't die in the last reel. And, like the bad guy who comes back but short a limb, the two taxes come back with a much lower exempted amount. In sum, unless Congress changes the law, if you die and/or make gifts to grandchildren in 2009 you can exempt up to $3.5 million from the two taxes, in 2010 you get a free ride and in 2011 the exemption drops to a mere $1.5 million or so. As they say in the trade, this leaves us with numerous planning opportunities, especially if you can time someone's death.
And so, as I write this, good tax attorneys are faced with the somewhat ghoulish but necessary task of telling people who hold the health care proxy of a parent or grandparent on life support that, to best effect their loved one's wishes regarding the estate (which is lawyer talk for keeping the money out of the hands of the government), they might want to consider spending one last New Year's Eve with mom or grandpa, before pulling the plug. Absent a change in the law, which Congress keeps promising but failing to do, the conversation during the last week of 2010 will be even more ghoulish as pulling dad's or grandma's plug before the new year begins leaves more money for the grieving loved ones.
This sounds pretty cold but death is something that can't be avoided. The only questions are who and when and what are the consequences. Which brings us to Gilad Shalit.
The current debate raging in Israel makes the estate tax and GST conundrum look like fun and games. The Israelis are not talking about money, they're talking about lives. Their lives and the lives of their children. Lives already lost and those that may be lost in the future. As of this writing, the Israeli Prime Minister has allowed his negotiators to send, through a German mediator, Israel's response to what Hamas has described as its last demands (they may say "offer" but these are not people interested in bargaining or who really give a damn about human life). The media reports that Israel is ready to agree to release about 1000 Palestinian prisoners in return for the safe return of Shalit. This includes about 100 convicted murderers who have no regrets or remorse and are (if past experience holds true) very likely to just go back to terrorism once they are set free. Israel is asking that the worst of the worst be exiled, either to Gaza from the West Bank or out of the territories to other countries. Hamas has said it will take a few days to consider a reply. And so we wait.
The arguments for and against the deal are all correct. In arguing against this deal many have pointed out that freed terrorists go back to terrorism, and Jews die. Hamas is demanding freedom for men who are not just good soldiers but leaders of Hamas and similar groups. If denied the opportunity to go back to blowing people up in Israel or the West Bank, they'll blow people up wherever they can. While everyone fears for the safety of Gilad Shalit (what happens to him if no deal is made?) those opposed to a deal see it as merely substituting one victim for other victims.
Furthermore, every terrorist group will have further proof that Israel will pay a huge price for the return of an Israeli. What other conclusion could they draw if Bibi Netanyahu, a man who made a political career out of being tough on terrorism, gives in to Hamas' demands? Doing the Shalit deal will inspire further attempts at kidnapping Israeli soldiers and civilians and, sooner or later, one or more will succeed.
Finally, doing the deal will give Hamas a significant political victory. Palestinians will dance in the streets, cheering the group who drove Israel to its knees, honoring their returning heroes and calling for the next wave of "resistance." The deal will set in concrete Hamas' rule in Gaza and give them a good chance of taking over in the West Bank should Abu Mazen ever be so foolish as to allow free elections.
And on the other side of the debate, we have an entire country run by for and about Jews, who value human life above all. Jews who do not raise their children to be martyrs. A majority of the Israeli public seems willing to pay any price to bring Shalit home. For his Mother's sake. And because those being asked are Jewish parents who want to know that their children would also be ransomed if taken captive. The bottom line is that every life is precious and, even if the price is terrible and risks more deaths, that life has got to be saved. Israel does not leave soldiers behind on the field and should not do so now.
Those who want Shalit home by doing the deal will tell you that Hamas, Hezbullah and their ilk will try to kill or kidnap Jews, whether or not Gilad comes home. So we may as well bring Gilad home. The weight of the survival of Israel should not be put on his narrow shoulders.
As for Hamas' political victory from the deal, Israelis arguing for the deal will tell you that Hamas will have its moment in the sun but then, a few months from now, with no end of the Israeli blockade of Gaza in sight and no reconciliation with the PLO, it will be a matter of "what has Hamas done for us lately."
Israel does not handle this sort of crisis like other nations. (Of course, most other nations don't have their citizens routinely subject to acts of terrorism.) Before responding to Hamas, Bibi and his closest aides met with all the military, intelligence and political leaders you'd expect a Prime Minister to consult with. But they also met with Shalit's parents. (An easy meeting to arrange since the Shalits and their supporters have been camped out in front of the Prime Minister's residence in Jerusalem for close to a year now.) They also met with the survivors of the victims of those who might now be freed and with the leaders of a group representing the parents, spouses and children of Israelis murdered by terrorists set free in earlier deals. The press reports that the Prime Minister spent most of the meetings just listening to the real people who will be affected in very real ways by whatever he decides to do.
Will the deal get done? No one knows for sure. Hamas is run by at least four different factions (the political and military wings in Gaza, the political wing in Damascus and the prisoners who are the very subject of the negotiations). One of the reasons that a deal has not yet been made is that every time the parties get close, one or more of the Hamas factions finds an excuse to back away. My own theory is that some of the Hamas leadership is reluctant to make the deal because giving up Shalit means giving up power. (Yeah, I know this sounds like the behavior of a 4 year old but remember, we are dealing here with politicians and religious zealots, so what's the difference?) Maybe they've figured out that any victory will be fleeting (see above). For it's part, the Israeli government is very badly divided on the deal and there's no guarantee that a "Yes but" reply from Hamas would generate a positive Israeli response.
Whatever happens, the "resistance" will continue. And, either angered by the lack of a deal or encouraged by the making of a deal, someone is going to go out and express his inner terrorist by killing a Jew. And then Bibi is going to have to deal with the consequences which will likely include explaining to the victim's Mother why he made the deal, or didn't make the deal, that led to the death of her child. Which is why I think Bibi will find a way to bring Gilad home. Given his low opinion of the Palestinian leadership, he's going to conclude (if he hasn't already) that no matter what he does a Jew will die, so he'll at least take the opportunity and save Gilad Shalit.
And so Bibi, like our tax attorney, is faced with the prospect of timing someone's death. The big difference is that the tax attorney knows who is going to die, knows that that death is unavoidable and has helped the soon-to-be-deceased plan for the consequences. Bibi gets to decide without knowing the ultimate outcome and has to deal with the consequences as they arise. Personally, I'd rather be the tax attorney.
Read more!
23 December 2009
2010 is a good year to die. At least it is if you are subject to the US Internal Revenue Code and have a taxable estate. Why? In 2010, the estate tax and its evil spawn, the generation skipping tax, completely disappear for one year. (Trust me, if you don't have an estate worth more than $3.5 million and grandchildren to whom you want to give very large gifts you don't want me to explain the GST. If you do then you've already hired good tax counsel and don't need me to tell you about the GST but you are definitely picking up the check when we next have lunch.) In 2011, the estate tax and GST rise again, as from the dead, like a movie's bad guy who just won't die in the last reel. And, like the bad guy who comes back but short a limb, the two taxes come back with a much lower exempted amount. In sum, unless Congress changes the law, if you die and/or make gifts to grandchildren in 2009 you can exempt up to $3.5 million from the two taxes, in 2010 you get a free ride and in 2011 the exemption drops to a mere $1.5 million or so. As they say in the trade, this leaves us with numerous planning opportunities, especially if you can time someone's death.
And so, as I write this, good tax attorneys are faced with the somewhat ghoulish but necessary task of telling people who hold the health care proxy of a parent or grandparent on life support that, to best effect their loved one's wishes regarding the estate (which is lawyer talk for keeping the money out of the hands of the government), they might want to consider spending one last New Year's Eve with mom or grandpa, before pulling the plug. Absent a change in the law, which Congress keeps promising but failing to do, the conversation during the last week of 2010 will be even more ghoulish as pulling dad's or grandma's plug before the new year begins leaves more money for the grieving loved ones.
This sounds pretty cold but death is something that can't be avoided. The only questions are who and when and what are the consequences. Which brings us to Gilad Shalit.
The current debate raging in Israel makes the estate tax and GST conundrum look like fun and games. The Israelis are not talking about money, they're talking about lives. Their lives and the lives of their children. Lives already lost and those that may be lost in the future. As of this writing, the Israeli Prime Minister has allowed his negotiators to send, through a German mediator, Israel's response to what Hamas has described as its last demands (they may say "offer" but these are not people interested in bargaining or who really give a damn about human life). The media reports that Israel is ready to agree to release about 1000 Palestinian prisoners in return for the safe return of Shalit. This includes about 100 convicted murderers who have no regrets or remorse and are (if past experience holds true) very likely to just go back to terrorism once they are set free. Israel is asking that the worst of the worst be exiled, either to Gaza from the West Bank or out of the territories to other countries. Hamas has said it will take a few days to consider a reply. And so we wait.
The arguments for and against the deal are all correct. In arguing against this deal many have pointed out that freed terrorists go back to terrorism, and Jews die. Hamas is demanding freedom for men who are not just good soldiers but leaders of Hamas and similar groups. If denied the opportunity to go back to blowing people up in Israel or the West Bank, they'll blow people up wherever they can. While everyone fears for the safety of Gilad Shalit (what happens to him if no deal is made?) those opposed to a deal see it as merely substituting one victim for other victims.
Furthermore, every terrorist group will have further proof that Israel will pay a huge price for the return of an Israeli. What other conclusion could they draw if Bibi Netanyahu, a man who made a political career out of being tough on terrorism, gives in to Hamas' demands? Doing the Shalit deal will inspire further attempts at kidnapping Israeli soldiers and civilians and, sooner or later, one or more will succeed.
Finally, doing the deal will give Hamas a significant political victory. Palestinians will dance in the streets, cheering the group who drove Israel to its knees, honoring their returning heroes and calling for the next wave of "resistance." The deal will set in concrete Hamas' rule in Gaza and give them a good chance of taking over in the West Bank should Abu Mazen ever be so foolish as to allow free elections.
And on the other side of the debate, we have an entire country run by for and about Jews, who value human life above all. Jews who do not raise their children to be martyrs. A majority of the Israeli public seems willing to pay any price to bring Shalit home. For his Mother's sake. And because those being asked are Jewish parents who want to know that their children would also be ransomed if taken captive. The bottom line is that every life is precious and, even if the price is terrible and risks more deaths, that life has got to be saved. Israel does not leave soldiers behind on the field and should not do so now.
Those who want Shalit home by doing the deal will tell you that Hamas, Hezbullah and their ilk will try to kill or kidnap Jews, whether or not Gilad comes home. So we may as well bring Gilad home. The weight of the survival of Israel should not be put on his narrow shoulders.
As for Hamas' political victory from the deal, Israelis arguing for the deal will tell you that Hamas will have its moment in the sun but then, a few months from now, with no end of the Israeli blockade of Gaza in sight and no reconciliation with the PLO, it will be a matter of "what has Hamas done for us lately."
Israel does not handle this sort of crisis like other nations. (Of course, most other nations don't have their citizens routinely subject to acts of terrorism.) Before responding to Hamas, Bibi and his closest aides met with all the military, intelligence and political leaders you'd expect a Prime Minister to consult with. But they also met with Shalit's parents. (An easy meeting to arrange since the Shalits and their supporters have been camped out in front of the Prime Minister's residence in Jerusalem for close to a year now.) They also met with the survivors of the victims of those who might now be freed and with the leaders of a group representing the parents, spouses and children of Israelis murdered by terrorists set free in earlier deals. The press reports that the Prime Minister spent most of the meetings just listening to the real people who will be affected in very real ways by whatever he decides to do.
Will the deal get done? No one knows for sure. Hamas is run by at least four different factions (the political and military wings in Gaza, the political wing in Damascus and the prisoners who are the very subject of the negotiations). One of the reasons that a deal has not yet been made is that every time the parties get close, one or more of the Hamas factions finds an excuse to back away. My own theory is that some of the Hamas leadership is reluctant to make the deal because giving up Shalit means giving up power. (Yeah, I know this sounds like the behavior of a 4 year old but remember, we are dealing here with politicians and religious zealots, so what's the difference?) Maybe they've figured out that any victory will be fleeting (see above). For it's part, the Israeli government is very badly divided on the deal and there's no guarantee that a "Yes but" reply from Hamas would generate a positive Israeli response.
Whatever happens, the "resistance" will continue. And, either angered by the lack of a deal or encouraged by the making of a deal, someone is going to go out and express his inner terrorist by killing a Jew. And then Bibi is going to have to deal with the consequences which will likely include explaining to the victim's Mother why he made the deal, or didn't make the deal, that led to the death of her child. Which is why I think Bibi will find a way to bring Gilad home. Given his low opinion of the Palestinian leadership, he's going to conclude (if he hasn't already) that no matter what he does a Jew will die, so he'll at least take the opportunity and save Gilad Shalit.
And so Bibi, like our tax attorney, is faced with the prospect of timing someone's death. The big difference is that the tax attorney knows who is going to die, knows that that death is unavoidable and has helped the soon-to-be-deceased plan for the consequences. Bibi gets to decide without knowing the ultimate outcome and has to deal with the consequences as they arise. Personally, I'd rather be the tax attorney.
Read more!
Friday, December 11, 2009
On The Road In Appalachis - Part 3 - Getting There Is Half The Fun
It's one thing to say you'll be at the elementary school in McRoberts, Kentucky at 8am on Monday, November 9, 2009. Its quite another to actually get there. My first instinct was to just get in the car on November 8 and drive. But I was told that it would be better for us to fly and rent a car. Just this once, I turned out to be right (and I will be the first to admit how rare an event that is).
McRoberts is one of those places to which you cannot get from here. We had to fly on US Airways, which us northeasterners know as the successor to such stellar enterprises as Mohawk and Allegheny. The nearest serious airport to McRoberts is in Charleston, West Virginia, to which one flies from Newark by changing planes in Charlotte, North Carolina (where Naomi, Liz and I were to meet up with Ranya). From Charleston we planned to drive a rented car two hours to Whitesburg, Kentucky, the Letcher County seat, leaving us about 30 minutes southwest of McRoberts.
Why bypass McRoberts to go on to Whitesburg? Whitesburg has the only motels close to McRoberts. The crown jewel of these is the Super 8 next to the truck stop. In addition to checking into our home away from home we would be joined by Vinny Green and Debby Singer, Jewish educators from California who, in all their spare time, work on Ranya's distributions. At least, that was the plan.
There's a reason US Airways is more remembered for emergency landings in the Hudson River than on-time performance. Our flight from Newark to Charlotte went well enough given the rough weather. We even met up with Ranya as planned. But when we got to the gate for the Charleston flight we were told that it had been canceled. No reason. No warning. Just canceled. But, not to worry, US Airways has programmed its computer to automatically find alternative flights for passengers they have just stranded. I guess they got tired of doing this by hand. Our new boarding passes were printed and ready when we arrived at the gate. One small problem. We were booked on a flight the next day.
Now, while I'm sure that Charlotte is a real happening place on a Sunday night, we could not fail to reach McRoberts as scheduled. Naomi explained to a Customer Service Representative that we were on a humanitarian mission. The CSR offered us a late flight the same day that would, with only one stop, get us to Charleston around 10 pm (after the car rental counter closes). Even if we could get a car we'd get to Whitesburg after midnight. This would leave us with enough time to get four hours' sleep before driving the last leg into McRoberts. No thanks. When we were 19 or 20 road trips could be done with little to no sleep. But that was 40 years ago. Today, my traveling companions and I need things like sleep and showers to function. So, Naomi decided to rent a car and drive to Whitesburg, cutting our travel time down from over 12 hours to about 4.
Appalachia is among the poorest parts of the country but it is also among the most beautiful. Our drive from Charlotte skirted the southwestern end of the Blue Ridge Mountains and took us into the Cumberland Mountains with their closely spaced ridge lines. The narrow, wooded valleys between the mountain tops are known as hollows, pronounced "hahllers", which is a really accurate description of the topography. There are those who think that replacing coal with tourism would both preserve Appalachia's natural beauty and provide a serious number of long-term jobs for the locals (something coal long-ago ceased doing).
If you've never driven through this area, do yourself a favor and get it on your itinerary. You'll need to lower your expectations about cuisine and hotels, for now, but the scenery alone is worth the trip. Except for the strip mines opened by blowing off mountain tops, which we'll get to in Part 4. You can drive into the hahllers but be careful. Our hosts warned us that we might be met by a resident with a shotgun. Moonshine and meth labs are material to the local economy and the proprietors do not take kindly to strangers. And there are some folks who just don't care for tourists gawking at them. If they liked crowds, they'd move down out of the hahller into the valley.
After a pleasant ride in good company (I'm leaving out the gossip, to protect the guilty), we finally arrived at the Super 8 where we were joined by Vinnie and Debby. The next morning we would make our way to McRoberts.
[To Be Continued]
Read more!
McRoberts is one of those places to which you cannot get from here. We had to fly on US Airways, which us northeasterners know as the successor to such stellar enterprises as Mohawk and Allegheny. The nearest serious airport to McRoberts is in Charleston, West Virginia, to which one flies from Newark by changing planes in Charlotte, North Carolina (where Naomi, Liz and I were to meet up with Ranya). From Charleston we planned to drive a rented car two hours to Whitesburg, Kentucky, the Letcher County seat, leaving us about 30 minutes southwest of McRoberts.
Why bypass McRoberts to go on to Whitesburg? Whitesburg has the only motels close to McRoberts. The crown jewel of these is the Super 8 next to the truck stop. In addition to checking into our home away from home we would be joined by Vinny Green and Debby Singer, Jewish educators from California who, in all their spare time, work on Ranya's distributions. At least, that was the plan.
There's a reason US Airways is more remembered for emergency landings in the Hudson River than on-time performance. Our flight from Newark to Charlotte went well enough given the rough weather. We even met up with Ranya as planned. But when we got to the gate for the Charleston flight we were told that it had been canceled. No reason. No warning. Just canceled. But, not to worry, US Airways has programmed its computer to automatically find alternative flights for passengers they have just stranded. I guess they got tired of doing this by hand. Our new boarding passes were printed and ready when we arrived at the gate. One small problem. We were booked on a flight the next day.
Now, while I'm sure that Charlotte is a real happening place on a Sunday night, we could not fail to reach McRoberts as scheduled. Naomi explained to a Customer Service Representative that we were on a humanitarian mission. The CSR offered us a late flight the same day that would, with only one stop, get us to Charleston around 10 pm (after the car rental counter closes). Even if we could get a car we'd get to Whitesburg after midnight. This would leave us with enough time to get four hours' sleep before driving the last leg into McRoberts. No thanks. When we were 19 or 20 road trips could be done with little to no sleep. But that was 40 years ago. Today, my traveling companions and I need things like sleep and showers to function. So, Naomi decided to rent a car and drive to Whitesburg, cutting our travel time down from over 12 hours to about 4.
Appalachia is among the poorest parts of the country but it is also among the most beautiful. Our drive from Charlotte skirted the southwestern end of the Blue Ridge Mountains and took us into the Cumberland Mountains with their closely spaced ridge lines. The narrow, wooded valleys between the mountain tops are known as hollows, pronounced "hahllers", which is a really accurate description of the topography. There are those who think that replacing coal with tourism would both preserve Appalachia's natural beauty and provide a serious number of long-term jobs for the locals (something coal long-ago ceased doing).
If you've never driven through this area, do yourself a favor and get it on your itinerary. You'll need to lower your expectations about cuisine and hotels, for now, but the scenery alone is worth the trip. Except for the strip mines opened by blowing off mountain tops, which we'll get to in Part 4. You can drive into the hahllers but be careful. Our hosts warned us that we might be met by a resident with a shotgun. Moonshine and meth labs are material to the local economy and the proprietors do not take kindly to strangers. And there are some folks who just don't care for tourists gawking at them. If they liked crowds, they'd move down out of the hahller into the valley.
After a pleasant ride in good company (I'm leaving out the gossip, to protect the guilty), we finally arrived at the Super 8 where we were joined by Vinnie and Debby. The next morning we would make our way to McRoberts.
[To Be Continued]
Read more!
Wednesday, December 9, 2009
On The Road In Appalachia - Part 2 - Ranya the Shoe Lady
Uncle Bernie would have loved Ranya Kelly. Ranya once described herself to me as an ordinary suburban housewife, leading an ordinary life and not making much of a contribution to the world around her when, in 1991, she went to a mall and had what I can only describe as an epiphany. Ranya noticed a dumpster filled to overflowing with hundreds of shoe boxes. The next thing she remembers is dumpster-diving for boxes of what turned out to be new shoes. Ranya asked the shoe store about the shoes and was told that, at the end of a season, the shoe store simply threw out unsold inventory. And, no, they didn't mind at all if Ranya wanted to take their overstock and give it away to poor people. And so, Ranya Kelly, suburban housewife, became Ranya the Shoe Lady.
Ranya began working to develope networks of shoe stores and organizations serving shoeless people. She also discovered that it wasn't just shoes that were being thrown out. As word of her new-found life work spread, Ranya, receiving requests for help from all over, went national. Today, the Redistribution Center, Inc., Ranya Kelly, Founder and President, gathers and distributes millions of dollars worth of food, clothing, building supplies, toys, furniture, household goods, school and office supplies and, of course, shoes (Ranya long ago abandoned all hope of ever going out of the shoe business.)
Somewhere along the line Ranya met the Jews. One of the stereotypes of the Jewish world is that we all know each other and, working through various formal and informal organizations, networks and extended families, provide for the needs of our less-fortunate brethren (while, of course, doing business without much regard for things like borders). While most sterotypes arise from mindless prejudice, this one does have some truth to it. After a couple of centuries of living in ghettoes, exiled from our homeland, we learned to provide for ourselves. The Jews have gotten pretty good at moving money, goods and services around to help one another. But it's more than that. Central to the Jewish tradition are three things - study of Torah, prayer and acts of loving kindness. The latter is ingrained in us from an early age. Everyone, no matter how rich or poor, is obligated to do tzedakah (roughly translated as, "charity"). If you've got nothing yourself, you give a penny or you provide volunteer labor. If you've got a million bucks to spare you may as well ante up now because the Federation will find you. The obligation to do good works goes beyond fellow Jews. We have obligations not just to our brethren but also to to "the stranger within our gates", which is to say anyone in need. In the United States, this tradition has led an affluent community to direct its efforts toward any number of community-based organizations, without regard to religious affiliation.
For Ranya and the Jews, it was love at first sight. She found numerous kindred spirits, to say nothing of more sources of donations and targets for distributions. She also became a sought-after speaker at conferences and synagogue programs, delivering her message that what she does can be replicated in other communities. All you need to do is ask around and be ready for some creative dumpster-diving. Having been adopted by the Jews, Ranya met Naomi Eisenberger
Naomi is the Executive Director of the Good People Fund (having held the same position with a predecessor organization). The Good People Fund raises money for small groups and people in the US and Israel who work, usually on shoe-string budgets using volunteer labor, to do some good in this world. The Fund, which is small by US charitable organization standards, works mostly with community-based organizations for whom a $10,000 grant is a major gift. Naomi's Fund also makes donor-advised gifts to organizations approved by its Board. Naomi runs the Fund out of her New Jersey home with the occasional road trip to vet potential grant recipients or get involved in projects. Naomi has known Ranya for years and both directs cash donations to the Distribution Center and connects Ranya with local groups who could use her help.
Liz recently began to volunteer to help Naomi, handling some administrative tasks and helping to edit communications. The two are kindred spirits in that they have the talent to bring together people who, working together, can make a real difference in the lives of people who could use a break. Yes, dear reader, this is going to be one more tale of my wife doing good while I show up in time to eat.
Naomi has been working with an Appalachia-based organization called Family-to-Family and, through them, was introduced to people from a community center in McRoberts, Kentucky. McRoberts was a coal company town until the 1950s when the industry began to wind down and switch from deep tunnel mining to strip mining. Today any mining in the area involves blowing off the tops of mountains, spewing debris into local streams and creating lakes of sludge from the water and solid waste left over from refining coal. This leaves places like McRoberts with few jobs but lots of polluted drinking water and the occasional flood from a sludge lake. The coal companies and the politicians they own will tell you that all of this is safe. I'm not sure than someone whose land has been covered by a sludge flood would agree.
Economically-speaking, McRoberts is poor. The per capita income is about half that of the state average. Drug abuse is rampant (this is oxycontin country). Lots of people need clothing and basic household goods. These needs only increase in the winter as kerosene heaters burn down the houses they were supposed to just heat. But McRoberts is rich in its sense of community. Rich in people willing to help each other as best they can. People in McRoberts may. like Israelis, know that things can always get worse but, like Israelis, that doesn't stop them from getting on with their lives. And that's what got them onto Naomi's radar screen.
Naomi suggested to community representatives a distribution of needed items trucked in by Ranya the Shoe Lady. Naomi knew this could be done. But Naomi's audience consisted of people who have heard lots of promises from lots of outsiders that were never fulfilled. So when this Jewish lady from New Jersey (and, trust me, this is not a common sight in McRoberts) promised that someone known as Ranya the Shoe Lady from Denver would deliver enough clothing, shoes and hosehold goods to help dozens of families, the locals were understandably skeptical. Nevertheless, they agreed to the distribution, setting a date, lining up a location and identifying volunteers to do the heavy lifting. Naomi called in some of her own regular helpers and asked Liz if we would like to help out. And that's what got me on the road to McRoberts.
[TO BE CONTINUED]
Read more!
Ranya began working to develope networks of shoe stores and organizations serving shoeless people. She also discovered that it wasn't just shoes that were being thrown out. As word of her new-found life work spread, Ranya, receiving requests for help from all over, went national. Today, the Redistribution Center, Inc., Ranya Kelly, Founder and President, gathers and distributes millions of dollars worth of food, clothing, building supplies, toys, furniture, household goods, school and office supplies and, of course, shoes (Ranya long ago abandoned all hope of ever going out of the shoe business.)
Somewhere along the line Ranya met the Jews. One of the stereotypes of the Jewish world is that we all know each other and, working through various formal and informal organizations, networks and extended families, provide for the needs of our less-fortunate brethren (while, of course, doing business without much regard for things like borders). While most sterotypes arise from mindless prejudice, this one does have some truth to it. After a couple of centuries of living in ghettoes, exiled from our homeland, we learned to provide for ourselves. The Jews have gotten pretty good at moving money, goods and services around to help one another. But it's more than that. Central to the Jewish tradition are three things - study of Torah, prayer and acts of loving kindness. The latter is ingrained in us from an early age. Everyone, no matter how rich or poor, is obligated to do tzedakah (roughly translated as, "charity"). If you've got nothing yourself, you give a penny or you provide volunteer labor. If you've got a million bucks to spare you may as well ante up now because the Federation will find you. The obligation to do good works goes beyond fellow Jews. We have obligations not just to our brethren but also to to "the stranger within our gates", which is to say anyone in need. In the United States, this tradition has led an affluent community to direct its efforts toward any number of community-based organizations, without regard to religious affiliation.
For Ranya and the Jews, it was love at first sight. She found numerous kindred spirits, to say nothing of more sources of donations and targets for distributions. She also became a sought-after speaker at conferences and synagogue programs, delivering her message that what she does can be replicated in other communities. All you need to do is ask around and be ready for some creative dumpster-diving. Having been adopted by the Jews, Ranya met Naomi Eisenberger
Naomi is the Executive Director of the Good People Fund (having held the same position with a predecessor organization). The Good People Fund raises money for small groups and people in the US and Israel who work, usually on shoe-string budgets using volunteer labor, to do some good in this world. The Fund, which is small by US charitable organization standards, works mostly with community-based organizations for whom a $10,000 grant is a major gift. Naomi's Fund also makes donor-advised gifts to organizations approved by its Board. Naomi runs the Fund out of her New Jersey home with the occasional road trip to vet potential grant recipients or get involved in projects. Naomi has known Ranya for years and both directs cash donations to the Distribution Center and connects Ranya with local groups who could use her help.
Liz recently began to volunteer to help Naomi, handling some administrative tasks and helping to edit communications. The two are kindred spirits in that they have the talent to bring together people who, working together, can make a real difference in the lives of people who could use a break. Yes, dear reader, this is going to be one more tale of my wife doing good while I show up in time to eat.
Naomi has been working with an Appalachia-based organization called Family-to-Family and, through them, was introduced to people from a community center in McRoberts, Kentucky. McRoberts was a coal company town until the 1950s when the industry began to wind down and switch from deep tunnel mining to strip mining. Today any mining in the area involves blowing off the tops of mountains, spewing debris into local streams and creating lakes of sludge from the water and solid waste left over from refining coal. This leaves places like McRoberts with few jobs but lots of polluted drinking water and the occasional flood from a sludge lake. The coal companies and the politicians they own will tell you that all of this is safe. I'm not sure than someone whose land has been covered by a sludge flood would agree.
Economically-speaking, McRoberts is poor. The per capita income is about half that of the state average. Drug abuse is rampant (this is oxycontin country). Lots of people need clothing and basic household goods. These needs only increase in the winter as kerosene heaters burn down the houses they were supposed to just heat. But McRoberts is rich in its sense of community. Rich in people willing to help each other as best they can. People in McRoberts may. like Israelis, know that things can always get worse but, like Israelis, that doesn't stop them from getting on with their lives. And that's what got them onto Naomi's radar screen.
Naomi suggested to community representatives a distribution of needed items trucked in by Ranya the Shoe Lady. Naomi knew this could be done. But Naomi's audience consisted of people who have heard lots of promises from lots of outsiders that were never fulfilled. So when this Jewish lady from New Jersey (and, trust me, this is not a common sight in McRoberts) promised that someone known as Ranya the Shoe Lady from Denver would deliver enough clothing, shoes and hosehold goods to help dozens of families, the locals were understandably skeptical. Nevertheless, they agreed to the distribution, setting a date, lining up a location and identifying volunteers to do the heavy lifting. Naomi called in some of her own regular helpers and asked Liz if we would like to help out. And that's what got me on the road to McRoberts.
[TO BE CONTINUED]
Read more!
Wednesday, December 2, 2009
On The Road in Appalachia - Part 1 - Remembering Uncle Bernie
Uncle Bernie died on Thanksgiving Day. Uncle Bernie was a great uncle. He was funny, compassionate, committed to human rights and the mass consumption of good food, booze and, of course, the best cigars that could be found around the globe. Bernie was a photographer both for love and for making a living. Every photograph, slide and home movie had the same artist's touch that could be found in his professional work. If you ever see a news reel from WWII of a tank rolling over the cameraman, that was probably Uncle Bernie, lying in a ditch somewhere in Italy. Or the stills from Quo Vadis, shot while Bernie was back in Italy on a Fullbright Fellowship. Once, when walking through the wooden corridors of the Larchmont Beach Club lockers, Bernie stopped and pointed out a certain corner under a certain skylight. "I always liked the light at this spot," he said. "I used to take pictures of Amy [his younger daughter] right here."
To the rest of the world, Uncle Bernie was Bernard Birnbaum, a legendary producer for CBS News. He was compassionate and cared deeply for and about not only his family and the people he worked with but also many of the people whose lives he covered. At the age of 89 his big heart finally gave up. With my cousin Debbie's permission, I missed the funeral in order not to miss my flight to Tel Aviv. This is not so unusual in our family. Uncle Bernie would sometimes miss family gatherings because he would be in Italy, India, Vietnam or a few dozen other places.
Bernie went to work for CBS in 1951 and stayed for over 40 years. He didn't just produce TV news, he was one of the people who invented it. If you're old enough to remember shows like Omnibus and Camera Three or when the CBS Evening News with Walter Cronkite went from 15 to 30 minutes, then you remember what I knew as Uncle Bernie's shows. You young folks may have noticed his credits on Sunday Morning. During his career he covered serious topics like political conventions, the civil rights movement, the Eichmann trial, Vatican II, the Kennedy and Oswald assassinations, the Vietnam War and most of the rest of the history of the second half of the last century. But he also produced shows in a lighter vein, like the report on the Bossa Nova craze sweeping up from Brazil to the USA. Or stories about ordinary people living their lives which came to full fruition with the series "On The Road with Charles Kuralt." Bernie was famous for thinking of what would make a story hit home and then getting it on film. Like the mother of a Boston auto rental clerk who lived in fear of the Boston Strangler or a live interview with Marina Oswald just days after the assassination. The latter made Dan Rather into a national star (and a life-long friend).
Bernie never admitted how he got Mrs. Oswald on camera but his usual technique involved a lot of charm and winning someone's trust. Or sometimes it was just reverting back to his Brooklyn roots. Like that time he set up his film crew on a Jerusalem street across the street from the courthouse where the trial of Adolph Eichmann was about to begin. A man who objected to CBS News cluttering up his sidewalk leaned out from a balcony and started yelling at Bernie, first in Hebrew and then in Yiddush. That did it. Bernie says he told the guy a few things, also in Yiddush, using some expletives that we will delete here. Not 15 minutes later, Bernie, now lighter by two cigars and $50US had rented the balcony for his camera crew. Bernie thought the shot would be better from one story up.
One of the stories Uncle Bernie told me starts with Bernie having breakfast in a bar (a number of his stories start this way). This particular breakfast took place in late November, 1963 in Dallas. Bernie was having breakfast with Fred Friendly, then head of CBS News. They were discussing how best to cover the ongoing story of JFK's assassination. The networks' national news crews were packing up to follow the story from Dallas to Washington for the funeral and the start of the Johnson Administration. But Fred and Bernie concluded that the arrest and trial of JFK's alleged assassin was also major news worthy of leaving a national crew in Dallas with the resources to broadcast live. When word got out that CBS was staying, ABC and NBC also decided to stay. And so, Lee Harvey Oswald became the first person to be assassinated on live television. And, thanks to the then-high tech device of kinescope, his was also the first assassination to be shown on instant replay.
Uncle Bernie also had some of the character traits of an absent-minded professor (this amused the children while exasperating my Aunt Ronnie). For example, there was the time Uncle Bernie sat with Liz and I in his Larchmont living room and told us that he once had the opportunity to get a real insider's take on what had really gone on in Vietnem. Bernie having breakfast in a bar in Bangkok with a four-star general. The general said to Bernie, "You know, most people don't understand that Vietnam........" I never heard the rest of the story. Uncle Bernie suddenly remembered something that needed his attention, stood up, walked up the stairs and never came back to the story.
Bernie produced numerous documentaries over the years. But the one that gets referred to most often is "Christmas in Appalachia." With Charles Kuralt in front of the camera, Bernie brought into millions of homes the horrors of crushing poverty and environmental ruin wreaked upon people living in the wake of the coal industry. Christmas in Appalachia didn't just win Bernie his first Emmy award, it also helped stir a public debate that lead to the Johnson Administration declaring a War on Poverty.
Unfortunately, that war and much of its good intentions got lost in the jungles of Vietnam. Today, over 40 years after Uncle Bernie's show was broadcast, not all that much has changed. I got a lesson in poverty and compassion in early November when I went On the Road in Appalchia with Ranya the Shoe Lady.
[To be continued.] Read more!
To the rest of the world, Uncle Bernie was Bernard Birnbaum, a legendary producer for CBS News. He was compassionate and cared deeply for and about not only his family and the people he worked with but also many of the people whose lives he covered. At the age of 89 his big heart finally gave up. With my cousin Debbie's permission, I missed the funeral in order not to miss my flight to Tel Aviv. This is not so unusual in our family. Uncle Bernie would sometimes miss family gatherings because he would be in Italy, India, Vietnam or a few dozen other places.
Bernie went to work for CBS in 1951 and stayed for over 40 years. He didn't just produce TV news, he was one of the people who invented it. If you're old enough to remember shows like Omnibus and Camera Three or when the CBS Evening News with Walter Cronkite went from 15 to 30 minutes, then you remember what I knew as Uncle Bernie's shows. You young folks may have noticed his credits on Sunday Morning. During his career he covered serious topics like political conventions, the civil rights movement, the Eichmann trial, Vatican II, the Kennedy and Oswald assassinations, the Vietnam War and most of the rest of the history of the second half of the last century. But he also produced shows in a lighter vein, like the report on the Bossa Nova craze sweeping up from Brazil to the USA. Or stories about ordinary people living their lives which came to full fruition with the series "On The Road with Charles Kuralt." Bernie was famous for thinking of what would make a story hit home and then getting it on film. Like the mother of a Boston auto rental clerk who lived in fear of the Boston Strangler or a live interview with Marina Oswald just days after the assassination. The latter made Dan Rather into a national star (and a life-long friend).
Bernie never admitted how he got Mrs. Oswald on camera but his usual technique involved a lot of charm and winning someone's trust. Or sometimes it was just reverting back to his Brooklyn roots. Like that time he set up his film crew on a Jerusalem street across the street from the courthouse where the trial of Adolph Eichmann was about to begin. A man who objected to CBS News cluttering up his sidewalk leaned out from a balcony and started yelling at Bernie, first in Hebrew and then in Yiddush. That did it. Bernie says he told the guy a few things, also in Yiddush, using some expletives that we will delete here. Not 15 minutes later, Bernie, now lighter by two cigars and $50US had rented the balcony for his camera crew. Bernie thought the shot would be better from one story up.
One of the stories Uncle Bernie told me starts with Bernie having breakfast in a bar (a number of his stories start this way). This particular breakfast took place in late November, 1963 in Dallas. Bernie was having breakfast with Fred Friendly, then head of CBS News. They were discussing how best to cover the ongoing story of JFK's assassination. The networks' national news crews were packing up to follow the story from Dallas to Washington for the funeral and the start of the Johnson Administration. But Fred and Bernie concluded that the arrest and trial of JFK's alleged assassin was also major news worthy of leaving a national crew in Dallas with the resources to broadcast live. When word got out that CBS was staying, ABC and NBC also decided to stay. And so, Lee Harvey Oswald became the first person to be assassinated on live television. And, thanks to the then-high tech device of kinescope, his was also the first assassination to be shown on instant replay.
Uncle Bernie also had some of the character traits of an absent-minded professor (this amused the children while exasperating my Aunt Ronnie). For example, there was the time Uncle Bernie sat with Liz and I in his Larchmont living room and told us that he once had the opportunity to get a real insider's take on what had really gone on in Vietnem. Bernie having breakfast in a bar in Bangkok with a four-star general. The general said to Bernie, "You know, most people don't understand that Vietnam........" I never heard the rest of the story. Uncle Bernie suddenly remembered something that needed his attention, stood up, walked up the stairs and never came back to the story.
Bernie produced numerous documentaries over the years. But the one that gets referred to most often is "Christmas in Appalachia." With Charles Kuralt in front of the camera, Bernie brought into millions of homes the horrors of crushing poverty and environmental ruin wreaked upon people living in the wake of the coal industry. Christmas in Appalachia didn't just win Bernie his first Emmy award, it also helped stir a public debate that lead to the Johnson Administration declaring a War on Poverty.
Unfortunately, that war and much of its good intentions got lost in the jungles of Vietnam. Today, over 40 years after Uncle Bernie's show was broadcast, not all that much has changed. I got a lesson in poverty and compassion in early November when I went On the Road in Appalchia with Ranya the Shoe Lady.
[To be continued.] Read more!
Friday, November 20, 2009
"Health Care Reform" - A Bad Bill Is Not Better Than No Bill
Getting ready for my winter sojourn in the Holy Land, I spent a couple of days counting pills and refilling prescriptions. US law doesn't just forbid me to import identical but cheaper drugs from abroad. It also forbids my mail-order pharmacy from mailing my pills to me in Tel Aviv. So, once a year, I become a traveling pharmacy. If this sounds lame to you, you're right.
Any day now, the e-mails and the robo calls from Obama's Organizing for America (the ongoing campaign to maintain the grassroots support that got him elected in the first place) and the AARP (American Association of Retired Persons), America's largest lobbying group for senior citizens (which they define as anyone over 50) will start flooding in. They're going to ask me, yet again, to support whatever mess Congress finally gags up as "health care reform" because a bad bill that sort of seems to do some of the things we need to get done is better than no bill at all. Sorry, this time I'm not on board for the fantasy express. A bad bill that leaves us at the mercy of insurance companies and Big Pharma will not assure universal coverage at a reasonable cost. I'd rather have no bill and work for a single payer system.
In 2010, my medical insurance will cost more for less coverage. Rather than the 15% or so rate increase that is now metastasizing its way through US medical insurance, I'm getting a 3% bump but my deductibles and co-pays will increase, raising my total cost by some as yet undetermined amount. What can I say. Don't get old and don't get sick. It seems I'm not alone, however, as most small businesses are looking at 15% rate increases. Just before Congress acts on a Bill which the insurance industry fears might actually put a lid on what they can charge. What a coincidence.
Want another coincidence? Big Pharma and the President made a big deal out of how Big Pharma would reduce consumers' costs by $80 billion and support (or at least not oppose) a health care reform bill. At the time, the bills kicking around Congress would have saved about $160 billion in drug costs. Since then drug prices have been going up at a rate of 9% a year for brand name drugs under patent protection (this while the rest of the economy has been deflating). So, by the time Congress passes something, Big Pharma will have taken in more than the $80 billion that they'll then make a big show of giving back by discounting their prices. As a famous business writer likes to say, pretty slick.
In addition to counting pills, I've been trying to get vaccinated against Swine Flu. No luck. None of my doctors has the vaccine and the town I live in may get some but children, teachers, health care workers and first responders are all in line ahead of me. I don't mind having the lower priority but I do mind being told I need to vaccinate myself against the worst pandemic since the 1919 flu plague and then told that private industry just could not produce and distribute enough vaccine before the season began. But I do have an alternative. I wrote to my cousin in Jerusalem. She is both a Family Doctor and our family's doctor. She can get us the shots when we're in Israel but expressed surprise that I could not get vaccinated in the US. I explained that this is because Israel has a serious national health care system that responds on a national level to things like flu pandemics while the US system is f****d up beyond all recognition.
When Congress came up with the Medicare drug bill, a $450 billion giveaway to Big Pharma, AARP argued that a bad bill was better than no bill. US taxpayers buy some drugs for some seniors but we're not allowed to negotiate the price because that would somehow be unfair to the pharmaceutical companies. We were told by the Bush Administration that drug prices would be controlled by free market competition. Wanna bet? Within 6 months of the drug companies' initially enrolling retirees at low ball rates, the price of prescription drugs began to spike upward and have never looked back. What we got, all dressed up as reform, was the biggest giveaway to private industry since the Feds gave the railroad barons the rights of way west of the Mississippi.
Americans will probably continue to spend more money on health care than any other country but actually be less healthy than citizens of comparable, first world countries. The problem with health care in the US arises mainly from the lousy method of allocation of resources and the uneven methods of payment. Its all driven by profits and all maintained in the name of free market capitalism using the canard of patient "choice" as the "on" button. We are all programmed by constant, mass advertising to demand the latest, most expensive forms of treatment and will sue if we don't get them (or sue if we do get them and they don't work). As anyone willing to really look around them knows, unfettered free market capitalism doesn't really work if your concern is the general welfare of the entire citizenry. Its great for a handful of investment bankers and hedge fund managers but not so wonderful for factory workers or retail store employees. The cure is a single payer system.
First let's get over ourselves and talk about what single payer is not. Its not socialism. Why not? A truly socialist medical system would involved public ownership and control over not just the funding but also the providers of health care and the manufacturers of the drugs and equipment they use. Single payer would leave the actual practice of medicine and all its related goods and services in private hands (except of course for public services like the VA hospitals). Single payer would involve the representatives of the US taxpayers negotiating prices and working on quality assurance.
A doctor friend of mine once said he opposed government-run health care because he did not want medical care rationed based on economics. To which I replied, "What the hell do you think goes on now?" And, if you're out there screaming in terror about "death panels," let me be the first to tell you the truth. We've had death panels for years under euphemisms like "managed care" and "peer review" and "bankruptcy court."
What single payer would be is a way to reduce costs and open the health care field to improvements in quality (like a national computer data base of medical records and drug prescriptions which would cut down on medical errors which would cut down on tort awards and save us all billions) and best practices based on patient care and not on how large a bonus the CEO of the insurance company will get this year. It's no accident that the best health care at the most affordable prices is available from not-for-profit, community-based health care systems.
What would single payer cost compared to what we're spending now? The cost of single payer would involve a tax higher than the current Medicare tax but less than the total employers and employees now spend on Medicare taxes plus the cost of private health care insurance. Do you own a business? If you could get health care coverage for yourself and your employees for less than the current cost of such insurance plus your Medicare taxes, would you take the deal? Damn right you would. You can add. Congress can't.
You see, Congress and the Administration, having taken billions in political contributions from insurers, drug companies and other health care players, did not have the political nerve to dare interfere with our relationship with our health care insurer. They won't do what's right because they are afraid we will be upset over having the government disrupt our wonderful, fulfilling relationship with our health insurers. Ask me if I care about my deep, sensitive relationship with my health care insurer. Funny you should ask, but no. What I do care about is my relationship with my cardiologist and the other doctors who have spent considerable time and effort keeping me alive. And single payer, just like my Medicare, leaves me free to keep the doctors I have and choose new ones and that's what matters. Not how they get paid.
By the way, when you add Medicare taxes, plus state taxes for Medicaid plus the Federal tax advantages given to medical expenses plus the cost of Federal health care programs for the military (both active and veterans), the US income taxpayer currently foots the bill for about 60% of the total cost of health care in the US. That's before our own expenses for private coverage. Bottom line, we're paying most of the cost of health care now and, in return, we live in a country where the infant mortality rate is comparable to that of Bangladesh.
How do we go to single payer? The financing side is easy enough. Start with the Medicare law and take out the age and disability limitations. Just cover everyone. Then we can go to work on improving quality, on negotiating fair reimbursement rates for providers and all the rest. Every individual and employer has to pay into the system or can opt out for private coverage but still pay a tax. This way private insurers can't cherry-pick the young and healthy out of a system meant to insure everyone. Anyone who wants to buy private insurance is always free to do so.
So where do we find enough money to pay for expanding Medicare to cover everyone? Well, let me count the ways for you. First, Medicare delivers a dollar of benefits for about 4 cents in overhead. Private insurers spend up to 30 cents per dollar. Administrative costs alone would represent a saving of about $500 billion dollars over ten years. Make a serious dent in unnecessary procedures by insisting on best practices and setting reimbursement rates to favor keeping patients well and you save another $850 billion. (These are AARP estimates.) Let's see, we need a trillion and single payer saves us at least 1.35 trillion. And there's the cost reduction described above. You do the math. Congress doesn't seem to be up to the task.
Single payer would also take Medicaid and similar programs off the books of state governments. Yes, your Federal taxes will go up but, just this once, your state income and maybe your property taxes will go down. Go find a Governor who wouldn't love to shove Medicaid expenses back up to the Federal level.
But no one, except maybe Bernie Sanders, the only socialist in Congress, is advocating for single payer. Why not? You'd think AARP would follow the logic of its own research. But they seem to be too busy trying to sell me health insurance to get to work on real health care reform. The rest of Congress is too busy accepting campaign contributions and after-office jobs from insurers and Big Pharma to get too worked up over your health.
Finally, I don't know why the CEOs and CFOs of every S&P 500 company (other than the health care insurers) are not raving socialists when it comes to health care expenses. To use an oft-cited example, it costs about $2000 less to build a car in Japan or Canada because those countries have national health insurance. Its the same for most other industries. Its a mystery to me why otherwise cold, calculating business people don't jump at the chance to get this albatross off their bottom lines.
And just what are we getting instead of single payer? We seem to be on the verge of getting some modest rule changes so some people can't lose coverage just because they lose their health or their jobs. Plus some, but not all, of the uninsured (most of whom have jobs and pay taxes) get coverage through a "health care exchange." That's why AARP and Obama will tell me soon that a bad bill is better than no bill. But given that the exchange, which may or may not have a public option along with 5 or 6 private options, may not be allowed to seriously negotiate prices, its not clear how "reform" will control costs or improve the quality of care.What we do know is that the exchange, which may or may not be open to a wide group of employers and individuals, is based on some flow charts which, in turn, are based on work done by Jacob Hacker, a Yale University professor of political science. They look like this:
That's right. These flow charts were given to 535 US legislators and they were asked to come up with major health care legislation. When I first saw these charts I had one of those moments of clarity in which it become clear that the world has really gone insane this time around. I believe I can sum up my take on the pending legislation in two words, "We're f****d." (And that's not even taking into account the Stupak Amendment which will send women's health care back into the middle ages.)
But don't take my word for it. Here's a message from a Canadian health care consultant using a form of communication that Americans are sure to understand -- a beer advertisement:
Read more!
Any day now, the e-mails and the robo calls from Obama's Organizing for America (the ongoing campaign to maintain the grassroots support that got him elected in the first place) and the AARP (American Association of Retired Persons), America's largest lobbying group for senior citizens (which they define as anyone over 50) will start flooding in. They're going to ask me, yet again, to support whatever mess Congress finally gags up as "health care reform" because a bad bill that sort of seems to do some of the things we need to get done is better than no bill at all. Sorry, this time I'm not on board for the fantasy express. A bad bill that leaves us at the mercy of insurance companies and Big Pharma will not assure universal coverage at a reasonable cost. I'd rather have no bill and work for a single payer system.
In 2010, my medical insurance will cost more for less coverage. Rather than the 15% or so rate increase that is now metastasizing its way through US medical insurance, I'm getting a 3% bump but my deductibles and co-pays will increase, raising my total cost by some as yet undetermined amount. What can I say. Don't get old and don't get sick. It seems I'm not alone, however, as most small businesses are looking at 15% rate increases. Just before Congress acts on a Bill which the insurance industry fears might actually put a lid on what they can charge. What a coincidence.
Want another coincidence? Big Pharma and the President made a big deal out of how Big Pharma would reduce consumers' costs by $80 billion and support (or at least not oppose) a health care reform bill. At the time, the bills kicking around Congress would have saved about $160 billion in drug costs. Since then drug prices have been going up at a rate of 9% a year for brand name drugs under patent protection (this while the rest of the economy has been deflating). So, by the time Congress passes something, Big Pharma will have taken in more than the $80 billion that they'll then make a big show of giving back by discounting their prices. As a famous business writer likes to say, pretty slick.
In addition to counting pills, I've been trying to get vaccinated against Swine Flu. No luck. None of my doctors has the vaccine and the town I live in may get some but children, teachers, health care workers and first responders are all in line ahead of me. I don't mind having the lower priority but I do mind being told I need to vaccinate myself against the worst pandemic since the 1919 flu plague and then told that private industry just could not produce and distribute enough vaccine before the season began. But I do have an alternative. I wrote to my cousin in Jerusalem. She is both a Family Doctor and our family's doctor. She can get us the shots when we're in Israel but expressed surprise that I could not get vaccinated in the US. I explained that this is because Israel has a serious national health care system that responds on a national level to things like flu pandemics while the US system is f****d up beyond all recognition.
When Congress came up with the Medicare drug bill, a $450 billion giveaway to Big Pharma, AARP argued that a bad bill was better than no bill. US taxpayers buy some drugs for some seniors but we're not allowed to negotiate the price because that would somehow be unfair to the pharmaceutical companies. We were told by the Bush Administration that drug prices would be controlled by free market competition. Wanna bet? Within 6 months of the drug companies' initially enrolling retirees at low ball rates, the price of prescription drugs began to spike upward and have never looked back. What we got, all dressed up as reform, was the biggest giveaway to private industry since the Feds gave the railroad barons the rights of way west of the Mississippi.
Americans will probably continue to spend more money on health care than any other country but actually be less healthy than citizens of comparable, first world countries. The problem with health care in the US arises mainly from the lousy method of allocation of resources and the uneven methods of payment. Its all driven by profits and all maintained in the name of free market capitalism using the canard of patient "choice" as the "on" button. We are all programmed by constant, mass advertising to demand the latest, most expensive forms of treatment and will sue if we don't get them (or sue if we do get them and they don't work). As anyone willing to really look around them knows, unfettered free market capitalism doesn't really work if your concern is the general welfare of the entire citizenry. Its great for a handful of investment bankers and hedge fund managers but not so wonderful for factory workers or retail store employees. The cure is a single payer system.
First let's get over ourselves and talk about what single payer is not. Its not socialism. Why not? A truly socialist medical system would involved public ownership and control over not just the funding but also the providers of health care and the manufacturers of the drugs and equipment they use. Single payer would leave the actual practice of medicine and all its related goods and services in private hands (except of course for public services like the VA hospitals). Single payer would involve the representatives of the US taxpayers negotiating prices and working on quality assurance.
A doctor friend of mine once said he opposed government-run health care because he did not want medical care rationed based on economics. To which I replied, "What the hell do you think goes on now?" And, if you're out there screaming in terror about "death panels," let me be the first to tell you the truth. We've had death panels for years under euphemisms like "managed care" and "peer review" and "bankruptcy court."
What single payer would be is a way to reduce costs and open the health care field to improvements in quality (like a national computer data base of medical records and drug prescriptions which would cut down on medical errors which would cut down on tort awards and save us all billions) and best practices based on patient care and not on how large a bonus the CEO of the insurance company will get this year. It's no accident that the best health care at the most affordable prices is available from not-for-profit, community-based health care systems.
What would single payer cost compared to what we're spending now? The cost of single payer would involve a tax higher than the current Medicare tax but less than the total employers and employees now spend on Medicare taxes plus the cost of private health care insurance. Do you own a business? If you could get health care coverage for yourself and your employees for less than the current cost of such insurance plus your Medicare taxes, would you take the deal? Damn right you would. You can add. Congress can't.
You see, Congress and the Administration, having taken billions in political contributions from insurers, drug companies and other health care players, did not have the political nerve to dare interfere with our relationship with our health care insurer. They won't do what's right because they are afraid we will be upset over having the government disrupt our wonderful, fulfilling relationship with our health insurers. Ask me if I care about my deep, sensitive relationship with my health care insurer. Funny you should ask, but no. What I do care about is my relationship with my cardiologist and the other doctors who have spent considerable time and effort keeping me alive. And single payer, just like my Medicare, leaves me free to keep the doctors I have and choose new ones and that's what matters. Not how they get paid.
By the way, when you add Medicare taxes, plus state taxes for Medicaid plus the Federal tax advantages given to medical expenses plus the cost of Federal health care programs for the military (both active and veterans), the US income taxpayer currently foots the bill for about 60% of the total cost of health care in the US. That's before our own expenses for private coverage. Bottom line, we're paying most of the cost of health care now and, in return, we live in a country where the infant mortality rate is comparable to that of Bangladesh.
How do we go to single payer? The financing side is easy enough. Start with the Medicare law and take out the age and disability limitations. Just cover everyone. Then we can go to work on improving quality, on negotiating fair reimbursement rates for providers and all the rest. Every individual and employer has to pay into the system or can opt out for private coverage but still pay a tax. This way private insurers can't cherry-pick the young and healthy out of a system meant to insure everyone. Anyone who wants to buy private insurance is always free to do so.
So where do we find enough money to pay for expanding Medicare to cover everyone? Well, let me count the ways for you. First, Medicare delivers a dollar of benefits for about 4 cents in overhead. Private insurers spend up to 30 cents per dollar. Administrative costs alone would represent a saving of about $500 billion dollars over ten years. Make a serious dent in unnecessary procedures by insisting on best practices and setting reimbursement rates to favor keeping patients well and you save another $850 billion. (These are AARP estimates.) Let's see, we need a trillion and single payer saves us at least 1.35 trillion. And there's the cost reduction described above. You do the math. Congress doesn't seem to be up to the task.
Single payer would also take Medicaid and similar programs off the books of state governments. Yes, your Federal taxes will go up but, just this once, your state income and maybe your property taxes will go down. Go find a Governor who wouldn't love to shove Medicaid expenses back up to the Federal level.
But no one, except maybe Bernie Sanders, the only socialist in Congress, is advocating for single payer. Why not? You'd think AARP would follow the logic of its own research. But they seem to be too busy trying to sell me health insurance to get to work on real health care reform. The rest of Congress is too busy accepting campaign contributions and after-office jobs from insurers and Big Pharma to get too worked up over your health.
Finally, I don't know why the CEOs and CFOs of every S&P 500 company (other than the health care insurers) are not raving socialists when it comes to health care expenses. To use an oft-cited example, it costs about $2000 less to build a car in Japan or Canada because those countries have national health insurance. Its the same for most other industries. Its a mystery to me why otherwise cold, calculating business people don't jump at the chance to get this albatross off their bottom lines.
And just what are we getting instead of single payer? We seem to be on the verge of getting some modest rule changes so some people can't lose coverage just because they lose their health or their jobs. Plus some, but not all, of the uninsured (most of whom have jobs and pay taxes) get coverage through a "health care exchange." That's why AARP and Obama will tell me soon that a bad bill is better than no bill. But given that the exchange, which may or may not have a public option along with 5 or 6 private options, may not be allowed to seriously negotiate prices, its not clear how "reform" will control costs or improve the quality of care.What we do know is that the exchange, which may or may not be open to a wide group of employers and individuals, is based on some flow charts which, in turn, are based on work done by Jacob Hacker, a Yale University professor of political science. They look like this:
That's right. These flow charts were given to 535 US legislators and they were asked to come up with major health care legislation. When I first saw these charts I had one of those moments of clarity in which it become clear that the world has really gone insane this time around. I believe I can sum up my take on the pending legislation in two words, "We're f****d." (And that's not even taking into account the Stupak Amendment which will send women's health care back into the middle ages.)But don't take my word for it. Here's a message from a Canadian health care consultant using a form of communication that Americans are sure to understand -- a beer advertisement:
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