A Crucial Balancing Act: DACA and Enhanced Border Security

President Trump has invited an explosion in Congress with his recession of the 2012 Obama Executive Order that protected undocumented aliens who were brought to the United States by their parents when they were still children and before 2007.

There is majority public support for legislation to protect the “DACAs” (Deferred Action [for] Childhood Arrivals). https://today.yougov.com/news/2017/09/05/most-americans-supports-daca-trumps-base-opposes/

Three bills have been entered into Congressional hopper – the bi-partisan Senate Dream Act 2017, the House Recognizing America’s Children Act and the House Dream Act.

Nancy Pelosi, embolden by her meeting with President Trump, insists House Democrats will settle for nothing less than their Dream Act – which broadens the categories of eligibility beyond President Obama’s Executive Order and offers Dreamers a direct path to American citizenship. http://www.huffingtonpost.com/entry/democrats-trump-dream-act_us_59bad3aee4b0edff971a6735

The two other bills take a more measured approach — offering at first provisional legal status to work, travel, go to school, etc. Only after serving several years of provisional status would “Dreamers” earn a right to apply for permanent residency and eventually citizenship — hardly a “get out of jail free” card. http://nypost.com/2017/08/31/dont-end-daca-the-immigration-program-trump-must-save/

Initial reaction on Capitol Hill suggests that there is broad support, in Congress, for DACA-fix legislation – limited in scope and purpose.

After sixteen years of bi-partisan failure to pass such a bill what is different this time?

Passing a small, targeted immigration bill will benefit both political parties going into the 2018 mid-term elections.

Politics Makes Strange Bedfellows

Does President Trump think he can trade a DACA law for his often promised southern “border wall”? It’s possible but not realistic.

More realistically — the Republican majority in Congress knows it cannot afford to lose this opportunity to partially rebuild its relationship with Hispanic voters. But the GOP must also be responsive to its own base – which has used its votes repeatedly to demand enhanced border security first and granting legal status second.

Democrats will seek political advantage in the mid-term elections by supporting a “clean DACA law” (effectively an amnesty) that would attract more Hispanic support from the US citizen brothers and sisters of the Dreamers — even at the expense of further erosion of their traditional organized union, blue collar base in the mid-west.

Representatives and senators in the center of both parties have a clear common interest. The majority want a bill they can pass, the President will sign, and that they can defend to their constituents during the 2018 primary and general elections.

Senators as philosophically opposed as Lindsey Graham (R-South Carolina) and Diane Feinstein (D-California) have both acknowledged that only a DACA Fix that includes steps to strengthen our border security meets all three conditions.

Effective Border Security Doesn’t Mean Walls

A wall on our southern border — even if Mexico or Congress was willing to pay for it – will not secure our borders.

Fact is every year since 2007 more than half of the illegal immigrants to the USA have been airport arrival “visa overstays”. https://www.nbcnews.com/news/latino/visa-overstays-outnumber-illegal-border-crossings-trend-expected-continue-n730216

Technology, not concrete, is the solution to our 360 degree land, air, and sea border security problem. https://www.wsj.com/articles/white-house-wont-insist-on-wall-funding-in-dreamer-bill-1505240723?mod=itp&mod=djemITP_h

  1. Strengthen E-Verify

The 1986 Immigration Reform Act (aka Simpson Mazzoli) attempted to balance compassion for some two million illegal aliens who had been in the country for many years with stronger border security and enforcement measures. https://en.wikipedia.org/wiki/Immigration_Reform_and_Control_Act_of_1986

The 1986 legislation defined as a crime any USA employer hiring/employing a person who could not prove they had the legal right to work (and live) in the United States.

To help employers stay “on the right side of the law”, Congress mandated the development of an electronic verification system – E Verify — every employer would need to use to verify every new employee’s “work authorization status”.

The bureaucracy took a different approach than the law required while subsequent Congresses just looked the other way.

Participation in the E-Verify System is voluntary unless the employer is a federal contractor – or in some states a state contractor. There is only limited enforcement even for federal contractors. http://www.latimes.com/local/california/la-na-immigration-e-verify-20170911-story.html

Any other employer can enroll to use the system on a voluntary basis with little risk of being subjected to enforcement action by Homeland Security.

Under current Homeland Security policy, even if a new hire is “non-compliant” – determined not to have work authorization – termination is not required only strongly suggested. https://www.uscis.gov/e-verify/publications/manuals-and-guides/e-verify-user-manual

Congress should give Homeland Security twelve months from date of passage of new Border Security legislation to deliver an E-Verify System that is tested, proven and works.

Once tested and proven, the system must be made mandatory for all newly hired workers – every employer, everywhere – with significant civil and criminal penalties for employers that violate it.

Restricting the E-Verify mandate to new hires will protect those working without papers in the USA today – i.e. DACA’s parents – from termination because of status.

No DACAs could move from provisional status to permanent resident status until E-Verify is successively implemented, rolled out nationally and demonstrated to work – including employer enforcement.

  1. Discourage Illegal Entry with Improved Tracking Technology at Every Border

Simultaneously, Customs and Border Security must
improve its ability to electronically track arrivals and departures of tourists and other foreign nationals with temporary (time fenced) visas.

Currently, a photo is taken of every airport arrival and stored with passport information collected prior to and upon arrival.

  • Sharing photos with a modernized E-Verify System — capable of rapid facial recognition — would prevent the presentation of counterfeit identification documents to potential employers. https://www.nytimes.com/2015/02/08/education/edlife/fake-ids-or-why-would-a-student-order-a-tea-set.html

Today, Homeland Security has no way to track where a “visitor” goes once they cross the border or walk out of the airport. It’s just too easy to blend in and stay – get a job, rent an apartment, or buy a car.

  • Congress should authorize the Attorney General to determine the Constitutionality of attaching a GPS tracking device to all foreign passports in the United States to ensure timely departures.
  1. Eyes in Sky

High tech surveillance is part of 21st century life – at the mall, the airport, the stop light, on the freeway – rendering walls historic artifacts.

Congress needs to increase funding for technology already used by Border Patrol including satellites, in the ground sensors, and drones to patrol remote stretches of both the southern and northern borders.

  • More drone operators, for example, to spot irregular arrivals faster and guide border patrol agents to apprehend them.
  • Ground level sensor technology can be more effective than walls.
    • Tunneling under the sensor will “set-it-off” while the wall just stands there. http://www.foxnews.com/world/2016/04/28/us-looking-to-israel-for-technology-to-undercover-drug-tunnels.html
  1. A Tamper-proof Internal Identification System

Homeland Security must be given a deadline to negotiate a plan with the states to issue technically sophisticated drivers’ licenses and other internal identification documents.

  • Congress first mandated a tamper-proof “National ID” following 9/11 but it has never been implemented.
  • Adding technical sophistication to our (state issued) internal identity documents will prevent the possibility of unauthorized immigrants using our air travel system – reducing the terrorist threat as well.
    • Some states currently issue Driver’s Licenses to undocumented aliens but those licenses must meet federal guidelines that insure TSA can quickly identify them as not authorized for air travel.

Tamper-proof national identification documents are, also, a defense against the growing national threat from counterfeiting and identity theft. https://www.usatoday.com/story/money/2017/09/15/equifax-data-breach-what-you-need-know-hacking-crisis/670166001/

None of these four steps would deny sanctuary to anyone currently in the United States.

Build Public Confidence for Immigration Reform

If the public saw each step implemented, tracked and succeeding — public confidence in the government’s ability to secure our borders would grow.

Simultaneously, Congress could use the two or three years required to implement and assess the effectiveness of these first border security steps to develop a thoughtful set of next steps to fairly resolve the status of DACA’s parents and other undocumented immigrants.

Securing the border along with resolving the legal status of those who have been living in the shadows of America for many years would
build public confidence in the government’s ability to manage our immigration system.

Public confidence is the necessary pre-requisite to a comprehensive 21st century immigration reform plan.

Graphic courtesy of iconfinder.com

 

The Real Truth Behind the Health Care Battle

I was in Washington DC for meetings last week.

Washington is not America!

Nowhere in America could a restaurant catering to the business traveler charge $23.00 for a first course Caesar salad and stay in business.

But in central Washington that’s the common price at every day restaurants – not white table cloths, tuxedoed waiters and elegant French cuisine — but the type of place a business traveler goes for a quick bite and a glass of wine at the end of a long day.

And those restaurants are packed – not by the tourist families who crowd the Capital Mall — but by government workers and lobbyists.

The average government worker in Washington earns $112,000 a year before benefits.

Contrast the national median income for a family of four — $55,775 — against the average bureaucrat or congressional or presidential staffer, who earns twice what the average American family does (members of Congress earn 3.2 times their average constituent), and the picture becomes clear.

They can’t possibly understand the daily life of the average American.

In this context, the GOP proposal to “repeal and replace Obamacare” makes perfect sense. From their cushy perch — $16000 a year for health insurance is not such a big number.

This difference in earnings and benefits, also, explains why they see Medicaid spending as just numbers on the ledger rather than the human lives protected. Debit the rate of Medicaid spending and credit income tax rate reduction by the same amount and federal budget deficit remains the same.

Medicaid is Largest Health Care Insurer in America

In the roaring US economy of the 1960s, Medicaid was an afterthought – an amendment to the original Medicare hospital insurance (Part A) proposal – a few dollars to protect “poor women and children”.

Today, Medicaid is the largest health insurance program in the United States – 40 percent larger than Medicare.

Medicaid enrollment grew from 4 million (of 196 million) in 1966 to 73.5 million (of 326 million) in 2017 as a series of economic shocks took a toll on the American middle class.

  1. The wide-spread loss of employer based pensions and cuts to union sponsored pension programs beginning in the 1980s.
  2. The erosion of semi-skilled mining and assembly-line manufacturing jobs through automation and outsourcing to lower wage countries
  3. A reduction in family savings
  4. Reduced capital investment in innovation and technology by both private investors and the government.

Over the last quarter century quality jobs have declined — resulting not just in fewer jobs but lower wages, shorter hours, and fewer employee benefits. Fully 25 percent of US jobs, today, are in the retail sector.

The Kaiser Foundation reports in 30 of the 50 states the median income for a family of four has fallen below the national average of $55,000.

The twenty states at or above the national average tend to be the large coastal states where concentrated pockets of wealth mask the overall condition of their populations (California, New York and Virginia – buoyed by technology, global banking and an overpaid federal work force).

Lower wages, fewer employee benefits, less job security and lower savings add up to more families who need government help paying for necessary health care.

Medicaid is the primary health insurance for forty (40) percent of US children. These are the children of the shrinking middle class plus the “birthright citizen” children born in the United States to undocumented/illegal aliens.

For too many Americans whose jobs and job prospects deteriorated or vanished in mid-life (along with guaranteed pensions, good wages and employee based health insurance), Medicaid has become the necessary bridge to Medicare.

Medicaid is Just a Symptom of the Real Problem

Since the 1990s, Congress, and both Republican and Democratic administrations, papered over the drip, drip, drip of declining job prospects for millions of Americans with “temporary help” government programs – tax cuts, college loan programs, 60 separate federal job retraining programs, extended unemployment insurance and – most recently – subsidized health care – leading to an explosion of the national debt.

The solution to the mushrooming Medicaid program cost is not to punish the vulnerable dependent upon it. Medicaid pays 2/3 of all old age and dementia patient nursing home bills.

The challenge to Congress is to reform Medicaid — bend the cost curve without cutting access or benefits to the growing number of Americans who need the help.

Three Potential Reform Ideas:

1) Ban All Political Contributions: Shift Congress’s focus from the stake holders to the shareholders and customers by banning all political contributions from health care providers, drug and device manufacturers and other profit centers in the health care eco-system.

Once freed from deference – their first question to their former donors should be “why does health care cost so much”? Why does health insurance, health care devices, drugs, surgery, laboratory tests, even a visit to a primary care physician cost Americans 50% more than any other developed nation’s citizens?

The next question should be – what are you going to do about it?

2) Federalize the Program: Allow states to design delivery systems that are specific to their environment and patient population.

The states are laboratories of innovation. States have stronger incentives to use Medicaid dollars efficiently. They pay as much as forty (40) percent of their Medicaid costs and must balance their budgets.

Plus, if the program were federalized, the number of Center for Medicare and Medicaid Services bureaucrat rule writers in Washington would decline – saving $112,000 plus benefits times several hundred individuals.

3) Hold the Bureaucrats Accountable: Medicaid fraud rises every year. In 2016 it amounted to $33 billion. Congress must hold federal and state bureaucrats collectively and individually accountable to reduce the rate of Medicaid fraud to zero over the next 10 years.

Eliminating Medicaid fraud over the next 10 years would save at least $333 billion — more than the $319 billion savings the Congressional Budget Office projected from the first Senate healthcare reform.

Added together these simple reforms would save as much as half a trillion dollars over the next decade without cutting one penny from beneficiaries.

After all, aren’t the beneficiaries the purpose of Medicaid?

 

Thanks to 101Clipart.com for the graphics

Biggest Hurdle Standing in the Way of Obamacare Reform

During the two recent Congressional Recesses, we’ve seen countless pictures of angry town hall meetings where people with so-called “pre-existing” health “conditions” have expressed their fear that the Republican Congress is working to take away health coverage they gained under Obamacare.

Some of the shouting and finger-pointing are manufactured by the Democrats’ “Resistance Movement” but some of it is genuine fear from people who suffer from debilitating diseases with no possible “cure” but – potentially — years of expensive control.

These are exactly the people Congress wanted to help when they created Obamacare.

The people who are coming to town halls have a point. Their justifiable anxiety (some of it sparked by politicians and the news media) stands in the way of a down-payment on reforming Obamacare in short run and reforming our health care delivery system in the medium to long term.

Their small numbers are magnified because it is an axiom of American democracy that we have a collective responsibility to care for those who cannot care for themselves

Obamacare Redefined “Pre-existing Condition”

These vocal town hall participants are part of the 1 percent of the USA population that incur 23 percent of the cost of health care in the United States.

Numerous studies have demonstrated that 5 percent of the population incurs 50% of the cost of health care in the United States.

Prior to Obamacare many states set up “high risk insurance pools” to help these people who were considered “uninsurable” in the private, non-(employer) group health insurance market because they had a serious and significant “pre-existing condition”.

The pools were narrow in coverage, exorbitantly expensive, limited to a pre-determined number of people regardless of the number who needed this assistance and capped maximum payments.

Other patients with – for example “seasonal allergies” were not considered to be “high risk” but were “rated” by private insurers.

“Rating” meant that the insurance company charged an additional premium for every “rated” condition that specific insured person might ever had symptoms of – even without a diagnosis – or sought treatment for.

The result was that the many of the most seriously ill Americans could not afford health insurance or, as a result, adequate health care.

How “Community Rating” Increases Risk to All

Obamacare changed this by imposed “community rating” regulations which limit insurance companies to considering only age and continuous coverage before application (no gap in insurance greater than 63 days) when determining the premium for that patient or family.

Now, any person between the age of 26 and 64 is charged the same premium – regardless of their individual health or claims experience.

Employer-based health insurance uses “community rating”. Every employee pays the same insurance premium per individual or family covered regardless of age or health. “Pre-existing conditions” can be excluded only if the insured has a 60 day “gap” in coverage.

Medicare uses a similar eligibility formula but their “community rating” is dependent on insured’s income during the previous calendar year – everyone with the same income in that calendar year pays the same Medicare premium.

Generally, employer-based insurance and Medicare “forgive” such a “pre-existing condition” after 12 months of continuous insurance coverage.

Theoretically, if the “community rated” pool is large enough and diverse enough the insurance company can absorb the cost of any single large claim because there are relatively few large claims as a percentage of the total claims paid.

Why Obamacare Insurance Mandate?

This theory is behind the “insurance mandate” in Obamacare. Everyone in the United States must obtain health insurance or pay a fine to enlarge the size of the insurance pool.

But this theory has not played out in practice.

Average estimates are that 5.2 million Americans with incomes over 138% of the Federal Poverty Line (included those turning 26 and no longer covered under their parents) bought Obamacare approved private health insurance policies in 2016.

That is fewer than the 8 million who decided it is cheaper to pay the IRS fine than buy insurance under Obamacare.

Those Americans are “betting” they won’t need health care.

The result is a smaller pool of people who know they are going to file health care claims; older people, people with more health issues – i.e. people with “pre-existing conditions” or “chronic” diseases (for example Type II Diabetes).

Smaller pools and proportionately higher utilization of increasing costly care left insurance companies with little choice but to increase “community rated” premiums for everyone or to exit the Obamacare market entirely.

The result is a pool of beneficiaries in a state of uncertainty exasperated by the uncertainties created by a Republican Congressional effort to “replace” Obamacare with something more “affordable” for more Americans in the private and employer insurance market places.

To Lower Insurance Premiums, Share the Risk

Instead of creating hysteria and fear among those who most need help to pay their health care bills and, in-so-doing, delay relief for 95% of Americans, let’s take a cue from Medicare and create a program tailored to these special cases.

Presently, the poorest older Americans are assured of care through a joint Medicare/Medicaid program.

Why can’t Congress similarly “guarantee” coverage to people under 65 with “pre-existing conditions”?

Instead of paying the Obamacare subsidies to private insurance companies, Congress should create a special category under Medicaid to manage care for at least the 1 percent – if not the 5 percent – of “high risk” patients.

Enrollees in the special group would contribute to the cost of their care according to their ability to pay, just as they do under current Obamacare, in exchange for a guarantee of access to quality care. The government would pay their claims (at Medicare rates) through the Centers for Medicare and Medicaid services.

The risk of a disproportionate number of catastrophic claims would be dramatically reduced for private insurers.

The reduction in risk should lower the cost of insurance premiums by as 25% for the average American.

The less expensive the cost of “peace of mind” health insurance brings the more premiums the insurance companies could sell further sharing the risk.

Equally important, politically, this approach – which addresses the heart of the problem Obamacare set out to “fix” — should be able to attract at least some moderate Democratic support in the United States Senate.

Bi-partisan support for any Obamacare repeal or repair is a pre-requisite to attacking the real problem — the unsustainable cost of health care in America.

Public Option is Part of Fix for America’s Broken Health Care System

In the aftermath of the latest Republican House of Representatives’ attempt to “repeal and replace Obamacare” two things are certain.

  1. Health care is an entitlement due to all American citizens and a smaller group of legal non-citizens.
  2. Health care costs too much for too many people.

Quinnipiaq polling found only 17 percent of people approved of the Republican health care bill after hearing Congressional Budget Office projections that 14 to 24 million Americans might lose their health care coverage if the American Health Care Act became law.

Only eight percent of respondents supported just repealing Obamacare without replacing it.

But more than 50 percent want significant changes to the program.  Changes that will reduce cost – the cost of insurance and the underlying cost of health care.

Americans Reject Government-Run Health Insurance

It is an axiom of American politics that Americans reject a public health care option.

I don’t know whether to be worried or amused that members of Congress do not recognize the USA has a defacto public option?

Rhetoric to the contrary: 49.6 percent of the American people get their health care paid for by a government-run insurance program. The dictionary definition of a public option!

Consider the facts.

There are 47.2 million Americans on Medicare.

More than 70 million Americans are covered by Medicaid through a variety of programs that have been added over the last half century.

  • Medicaid covers about 40% of all children in the United States
  • Medicaid pays for about 50% of maternity expenses in the United States
  • Medicaid pays for 2/3 of nursing home expenses in the United States

The Veterans Administration claims 8.9 million health care plan participants.

The Bureau of Indian Affairs provides health care for approximately 2.2 million American Indians and Eskimos who live on traditional native lands.

The United States military insures +/- 14 million uniformed active duty and retired service members and their families.

The Obamacare private health insurance exchanges subsidizes premiums for 11 million Americans without employer based health insurance who are not eligible for either Medicare or Medicaid.

Approximately 4.8 million federal employees including civil service, executive and legislative branches and the courts participate in the federal government (employer) health insurance program

Add it all up — 154.8 million Americans get their health insurance from the federal government at a cost of +/- $2 trillion (about 64% of all health spending in the United States).

Embrace Reality with Public Option

What if Congress seized on the opportunity instead of railing against “government intrusion into health care”? They could turn the USA public option into a benefit instead of a financial sink hole with a bad reputation – an excuse for the escalating cost of care in America.

Let’s start with a new piece of legislation that all Americans without a law degree can understand:

A public option health insurance program open to everyone from age 0 to 64 years not covered by private employer health insurance. The plan would cover all currently mandated Essential Health Care Benefits.

To succeed Congress must remove the “Medicaid stigma”— the broad public perception that Medicaid is health care for only the poorest people delivered by less skilled personnel in substandard facilities. The insured cannot be embarrassed to “show their card”!

The new product must appeal to the 11 million who are currently insured under Obamacare exchanges and to some portion of the remaining 23 million Americans in the private insurance market. People must be willing to pay out-of-their-pocket to belong to the program.

This alternative begins with assuring prompt access to current-in-industry standard treatment in first class facilities – for example, Kaiser, Humana, Cleveland Clinics, and Sutter Hospitals – probably operating only as health maintenance organizations.

Congress should “guarantee” the plan offers best-in-class care options by enrolling themselves, their families and their staffs in the new public option.

The public option must be a good enough product to compete as one of the choices for Federal employees and their families.

Access to a public option health insurance card could bring the nation’s 8.9 million veterans improved care in their home communities.

How to Create a Realistic Funding Source: Follow the Money

A new and realistic funding source must be a cornerstone of the new legislation — fair to all, affordable and paid for now and into the future (not adding to the national debt).

There’d be some savings to be recouped into the public option funding pool from existing government activities:

  • Collapsing the five or six government insurance bureaucracies into a single department.
  • Eliminating the Obamacare guaranteed profits to private insurers.
  • Claims processing through Centers for Medicare and Medicaid Services (CMS) at .84 cents a claim

There would be new funds earned from premiums paid by insured – based on income.

But these savings and premium payments would not come close to paying for the subsidized care of close to one-third of Americans = +/- $1 trillion/year

Every American has to know where the $1 trillion is coming from, how it will be collected, and how it will be spent.

Since the 1980s there has been a shift in our economy from production (30%) to consumption (70%).

Fewer good paying manufacturing and other semi-skilled jobs have swelled the rolls of Medicaid and reduced the role of employer-paid insurance.

Logically, then, the new source of revenue to pay for public option health care (even to continue to pay for Obamacare and Medicaid) must come from the consumption side of the ledger – taxes paid by the ultimate consumer.

Take a Small Step First

Congressional Republicans should acknowledge reality — pass legislation authorizing the development of a public option health insurance program effective January 1,2019.

Force Democrats – who have long argued for a public option — to “come to the table” leading to lasting, bi-partisan legislation.

Establish a budget line item and allow tax reform legislation to move forward.

Provide certainty to the current health insurance market and warn against unjustified 2018 insurance premium increases.

Encourage the health care industry, fearing further regulation, to come to the table with alternatives to ever escalating health care costs.

Isn’t that the bottom-line for all Americans?

Health Insurance Drives Sky-Rocketing Health Care Costs

Health Insurance Drives Sky-Rocketing Health Care Costs

My girlfriend, Sandy, and I had our first springtime “spa-day” last week.

Being “girls” we talked about our travels, our families, and fashion while enjoying a pedicure.

Sandy worked in the health care industry before her recent retirement, and I have consulted extensively to large health care organizations over the years.

Not surprisingly the conversation quickly turned to health care – the Republican proposal to repeal and replace “Obamacare” and the just published Congressional Budget Office analysis of that proposal.

Beyond our professional experience, we are consumers. We are experiencing the increasing cost of health care insurance, co-payments, drugs and other expenses.

Spending Other People’s Money

Over our sun-drenched lunch, Sandy and I talked about the growing role of government into our health care system and about some of the unintended consequences.

During his very wonky Power Point press conference, Paul Ryan accurately pointed to the spending of “other people’s money” as a powerful driver in the alarming rise in the cost of health care. http://www.cnn.com/videos/politics/2017/03/09/paul-ryan-full-health-care-bill-powerpoint-presenation.cnn

Let’s break this down.

  1. Obamacare requires that every American citizen must be covered by health insurance. Americans are required by force of law buy to insurance from a private insurer if they are not covered by an employer plan and have an income above the Federal Poverty Line.   That insurance must include benefits you or I might or might not want.
  2. Your individual premium is calculated on age, number of insured in the family, and the average cost of all the mandated benefits – whether you may use them or not – because someone else insured by the same company may – indeed – use those benefits. That is called sharing all the risks.
  3. If you do not buy insurance, the Internal Revenue Service will impose a penalty (i.e. a tax on you) that is used – in theory – to help pay for health insurance or Medicaid for your neighbor whose income and family size qualify them for help paying their legally required insurance premiums.
  4. All insurance payment premium payments for health insurance are paid into the insurance companies’ premium account(s). Premium accounts  are a pool of money in which your individual contributions can no longer be identified or separated out for your specific use.

Once our dollars are pooled with every other tax payers’, we have no control over how they are invested or spent.  They become someone else’s to spend on any person or any benefit – at any price the insurer agrees to.

The more services the government mandates insurers to cover from first dollar or after a minimum co-payment, the less sensitive the consumer is to how much that service costs.

For example, last Tuesday my allergy doctor suggested a vapor treatment for my pollen-driven chest. I said okay. It never occurred to me to ask how much does the treatment cost because I won’t get a bill. The charge will merely be an object of curiosity when the insurance company sends me an explanation of benefits they paid.

If I had to pay the bill for that treatment, I would have asked more questions about the cost and efficacy.

Are government bureaucrats creating an almost irresistible temptation for the health care providers? In a word, YES!

If the insurer is required to pay – no questions asked – for tests and treatments, the profit-making health care eco-system is going to prescribe more tests and charge more for them.

The Affordable Care Act (Obamacare) mandates for first dollar coverage of preventive and diagnostic testing exaggerate these consequences.

The more services are mandated without adequate cost controls, the more the insurers must charge in premiums and co-pays.

Faced with exploding insurance costs for all of us, is it time to change the assumptions about personal responsibility for your own health care and government’s power to mandate that responsibility be underwritten by the taxpayer?

The Purpose of Health Insurance

“Sandy, I think I remember paying bills from the pediatrician when Craig was a kid – like his well-baby care? What do you remember from your children?”

“Yes”, she replied “I remember paying the pediatrician”. Sandy was living in the mid-west at that time and remembers she took her children to community childhood immunization clinics that were “much less expensive” than the pediatrician.

When Craig was born, insurance paid for hospital costs for both of us – but I paid a contracted amount – directly – for my obstetrical care – spread over the pregnancy.

I was in graduate school and working for the University of California’s Statewide Office of Administration at the time. That meant I had really good (state employee good) health insurance.

What I experienced was normal practice in the 1970s.

I don’t remember when the practice changed and I stopped paying doctors’ bills and started paying only a co-payment – and it doesn’t matter. The point is health insurance started out as hospitalization or serious illness insurance – not the primary vehicle for obtaining routine care.

Health care coverage, today, is not only protection against major illness, major accident or hospitalization. It is, also, really pre-payment of anticipated routine services – an indeterminate number of services each at an indeterminate cost. Indeterminate is driving rising premiums and deductibles.

Necessity is Driving Innovation

While Congress is debating how to insulate more people from a price and service model no longer affordable for either the American tax payer or the individual middle class consumer, a few health care practitioners are developing real solutions in real time for real people.

Here are two examples I found – without even trying – that are working in local practices today.

As of January of this year, my dentist is offering patients an annual contract for care. For a monthly fee paid automatically via credit card, the dentist will provide all preventive care and fillings. Other services are paid by the patient at a discounted price – determined before service.

The monthly expense is two-thirds of what my previous dental insurance company charged for a smaller benefit. If I were to need a crown, I would still pay less, out of pocket, than the previous premium plus co-pays.

Not only is this a good deal for the patient, it is a good deal for the dentist. If a majority of his patients subscribe to his plan, it smoothes out the cash flow peaks and valleys of a traditional small business and it allows him to schedule his employees – hygienists, dental assistants and office staff –efficiently.

This efficiency removes time consuming disputes with insurance companies.

Taken as a whole, the dentist can grow his practice while, at the same time, controlling his payroll costs. In other words, he can make a larger profit on same or lower revenue.

While we were talking, Sandy remembered a friend whose family practitioner has a similar program for healthy patients not yet eligible for Medicare. That doctor charges a flat fee of $2000 a year for all routine and sub-acute office visits plus annual preventive care – including blood draws and other routine laboratory testing.

That patient must still purchase major medical (i.e. hospitalization and catastrophic illness) coverage. But, according to my quick Google search, those policies start at about $600 a year. https://healthplans.com

This approach is definitely a money saver. It’s less than the cost of Medicare plus a Medicare Supplemental Plan for someone who meets the health criteria implied in the contract.

Here, too, the regular payments help to smooth the doctor’s cash flow and simplify insurance claims processing – benefitting the bottom-line.

Both of these patient/provider contracts are treated equally with employer-based health care premiums for tax purposes through the use of Health Savings Accounts – an objective of the GOP sponsored plan. http://www.hsacenter.com

Could these be early signs of return to a health care model more typical in the 1970s? A model middle class Americans and their health providers can afford.

When routine health care was something consumers paid out-of-pocket, we paid attention to how much it cost. We shopped around for the best deal.

Old fashioned competition is the elixir of innovation – a tonic the American health care system urgently needs.

Graphic — screen shot by author.  With all thanks to MSNBC and my Samsung Smart TV

CBO Waves Yellow Flag at GOP Healthcare Bill

CBO Waves Yellow Flag at GOP Healthcare Bill

By the time I had printed out a copy of the just released Congressional Budget Office (CBO) cost estimate of the GOP proposal to “repeal and replace Obamacare” my inbox had filled up with draconian headlines and alerts:

A complete reading of the 27 page report paints a more complicated picture but does urge caution as the House of Representatives moves to debate, amend and attempt to pass the American Health Care Act (AHCA).

Assumptions

To reach the cost estimate, the CBO had to begin by making a set of assumptions.

1. Health care is an entitlement – just like Social Security and Medicare.

2. The nation’s health care eco-system is a permanent fixture that cannot be evolved and made more cost-effective.

3.  Health insurance is and should be the future primary source of payment for an individual’s health care.

4.  The non-group insurance market place will see a smaller portion of premiums returned as benefits to insured individuals – resulting in higher out-of-pocket expenses for the insured.

5.  Higher out-of-pocket expenses are, by definition, bad for the insured individual.

      6.  Absent a government mandate and associated tax penalty, about 14 million Americans will choose to go without health insurance.

7.  Absent a government mandate, many employers will stop offering health insurance to their employees.

Everyone in business knows step one in making a go/no go decision on any proposed project or product rollout is to validate the underlying assumptions. If even one of the assumptions is proven to be invalid, then the rest of the analysis is immediately called into question.

The project cannot be green lighted until all of the assumptions are deemed valid – either by addressing the flaw in the proposed project that invalidated an assumption or by proving the assumption, itself assumed the wrong input or outcome.

Below I’ve made a quick pass at whether the American Health Care Act should be “green or yellow lighted” – based on CBO assumptions.

Health Care Is an Entitlement

Let’s give the Democrats their due. Regardless of its flaws, the Affordable Care Act of 2009 firmly established health care as an entitlement due every American.

Other entitlement programs – i.e. veterans’ benefits, government pensions, Social Security and Medicare all require some prior contribution by the individual beneficiary. The beneficiary is said to have “paid into the system”– before receiving a specific and defined benefit.

For example, in Social Security there is a legally defined, published maximum benefit paid monthly regardless of how many additional dollars the recipient may have (or is) paying in Social Security taxes.

Payroll taxes (Medicare, Social Security etc.) deducted from your wages are deposited into a trust fund to be used to pay your benefits in retirement. Congress considers these benefits to be “earned”.

Contrast the new health care entitlement. It is paid for entirely by current income tax payers, in addition to taxes paid for their own future Social Security and Medicare benefit (or taxes on these benefits), and by future tax payers (borrowing). Borrowing that is moving the nation ever closer to the “fiscal cliff”.

There is no dedicated new funding source to pay for this new entitlement.

The taxes – now suggested for repeal by the GOP bill – are a mirage. They “move the chairs around on the deck of the Titanic”. The tax paid in column A is credited back in column B or passed on in higher health insurance premiums. There’s no new money except borrowed money!

Show Us the Entitlement Money

Republicans in the House of Representatives need to affirm healthcare is an entitlement and then develop a new funding source to pay for it. They are, after all, the “party of fiscal responsibility. Or, they’d like to have us believe they are?

The GOP (Study Group) should recognize that voters’ theoretical – i.e. gut reaction – to the idea of “government controlled health care” (2010) and their opposite reaction to getting a new health care “benefit”(2012) are both rational.

Voters are afraid of government mandates but will punish anyone who tries to take away a benefit bestow by those mandates once they’ve experienced it.

In 2016 voters supported “repealing” the higher cost of Obamacare era insurance premiums, co-pays and deductibles. They did not vote to give back the additional benefits received from Obamacare!

Accepting that a new entitlement exists does not mean the entitlement cannot be changed. The fact is that there are too many mandates, rules, and required benefits under the current law.

But any change made must demonstrate that is a fairer, better deal for a majority of Americans. Most Americans must be able to see and feel – experience – that the change is a better deal and be willing to pay for it, directly, or it is not going to work in practice.

Health Care Eco-System is Static

The CBO analysis completely misses the most compelling problem. Their analysis assumes the current structure is here to stay and that all reforms will be made through and not to the existing health care delivery model.

That assumption is incorrect.

The cost of health care services, drugs, appliances and anything else associated with the delivery of health care in America today must be changed – lest it bankrupt the nation.

The government is consumed by the question: How to pay for insurance premiums covering the unaffordable existing health care model?

At the same time, the American private sector (the consumer) is already experimenting with new models – more efficient and less costly.

Twenty of the nation’s biggest employers are banding together to create the Health Transformation Alliance aimed at using modern technology to control the rising cost of employee health care benefits. These employers, including American Express, Verizon and IBM (Watson) all understand the power of information to spearhead innovation.

These major employers are making an investment in reform because they remain committed to maintaining health insurance as a necessary employee benefit – calling into question, as well, the CBO’s 7th assumption.

These two CBO assumptions are incorrect. That means the 10 year projected cost estimate is reduced to pure conjecture.

14 Million More Uninsured in 2020

Not even the CBO “believes” this assumption.

Instead, they argue that an expanded range of choices in insurance products available to younger Americans – after the expiration of government mandates – will actually attract more young and healthy Americans to the non-group insurance market after 2020. This will positively impact the ratio of younger/to older Americans involved in the market place.

CBO projects a 10 percent reduction in overall insurance premiums as a result.

But – and here I agree with the CBO – the American Health Care Act – needs to be improved for older Americans still too young to qualify for Medicare.

These are people whose income exceeds the ridiculously low federal poverty guidelines – making them ineligible for Medicaid – who cannot afford health insurance premiums of $12,000/yr or more – that are only slightly reduced through $4000 “tax credits”.

Some of these people are, also, sicker and more expensive to care for.

A Roadmap for Dialogue

To their credit, the CBO has done an extraordinary job of laying out the challenges not just to the current House AHCA proposal but to the underlying problem of health care delivery costs, as well.

How much better off would the nation be if Congress – both Republicans and Democrats – were to embrace the cost estimate as a starting point?

“What-if” the ACHA were viewed as a bi-partisan starting point from which our health care eco-system is encouraged to evolve?

  • “What-if” Medicaid could be reformed and modernized into an attractive, affordable option for some middle-aged, middle income Americans as well as those too poor to pay health care?
  • “What-if” members of Congress were to work with all the stakeholders (from the President to the smallest tomato grower) to examine, question and rethink each CBO assumption?
  • “What-if” Congress started a discussion that engages provider, payer and patient in a singular effort to achieve better quality and lower cost health care for all – i.e. those who must rely on the health care entitlement and those who must pay for it?

But, as the CBO report cautions, it’s not possible to put such far-reaching improvements into place by 2020 as the AHCA requires.

Congress must learn from its past mistakes. Reforming the healthcare entitlement must be both bi-partisan and implemented over a 10 year time horizon that allows for intermittent adjustments as circumstances require.

Photo at US Capitol by Author — March 2,2017

Here’s What GOP American Care Act is not -- Affordable

Here’s What GOP American Care Act is not — Affordable

“If you want your legislation to last, it has to be bi-partisan,” — Ron Johnson, Republican Senator from Wisconsin, told the No Labels Problem Solvers Conference in Arlington, Virginia, on March 1.

He illustrated his observation, echoed the next day by my own Congress member, Anna Eshoo (Democrat – California), by pointing to Obamacare and Dodd-Frank. Both were rammed through Congress without a single Republican vote and are now targets of a Republican majority in Congress. Sadly, it appears the House Republicans have not learned the lesson.

Every comment made by House GOP leadership, the White House, and Republican members of the Senate point to a decision to ram the Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable Care Act through Congress on a party-line vote.

Once again, the victory will be pyloric and short-lived.

Healthcare is 20 percent of the United States economy. It impacts each and every American. It’s a huge problem and it can only be solved through a bi-partisan debate in full view of the American people.

Obamacare Impacts 330 Million Americans

Right after the conference, I shared a lunch table in the Longworth Congressional Office Building cafeteria with a couple from Mississippi.

Just as it does in almost every conversation in the Capitol, healthcare costs came up as we were just sharing our experiences from meeting with our representatives.

Owners of a small business, the Smiths described the difficulty they have in providing health insurance to their employees. The individual monthly premium is $400 a month – split 50/50 between the employee and the employer. “It’s the most we can do to pay half the cost.”

The median income in Mississippi is about $37,000/year – meaning a family of four participating in employer-based health insurance is paying 17 percent of their pre-tax income for health insurance. The policy has very high deductibles. In a word it’s “unaffordable”!

An average family of four in Mississippi is only a few dollars above the federal poverty line. But if their employer offers health insurance, they are not eligible to enroll in Obamacare – where the same monthly premium would be heavily subsidized.

Friday, standing, jet-lagged at my regular grocery store I was chatting with the man standing behind me in line. I said I’d been in Washington and the conversation, inevitably, turned to healthcare. He said he pays $1000 a month to cover his healthy family of four on an employer-based plan.

Before the Obamacare mandated changes in his coverage, he complained, he always had an annual preventive physical. Now, he has to pay $40 for the initial visit, $40 dollars for each of the routine tests and $40 for the follow-up visit. He concluded his prevent care is too expensive when prioritize against co-pays for his children. He figures he will go to the doctor when he gets “really” sick.

Nothing in the newly released GOP plan addresses either of the problems which these accidental meetings illustrate.

  • It does nothing to reduce the cost of health insurance because it does nothing to change the underlying healthcare cost crisis.
  • It does nothing to reduce the employer-based premium increases triggered by Centers of Medicare and Medicaid (CMS) Obamacare mandates.

Healthcare is an Entitlement

The Republicans’ most conservative members are still resisting reality. They claim that they must repeal Obamacare because the country cannot “afford another entitlement”.

Get over it.

  • Supreme Court ruled there is a universal right to care for all people at the emergency room door.
  • Once the government provides a benefit to some portion of the people – it cannot be taken away – only expanded in the name of equity.

But the conservative wing of the Republican caucus is partially right: The USA cannot afford another entitlement that is not paid for before and after it is granted.

Rather than repeating the mistake the Democrats made when they enacted Obamacare on a party-line vote the Republicans should take the time necessary to craft a bill that clearly addresses the coverage issues and is paid for.

A Down Payment on Reform

Paul Ryan must have been joking when he said “every American should read the bill”. Take a look here.

I read it but I didn’t understand all of it – just like most members of Congress!

Speaker Ryan surely recognizes the importance of slowing down the process of moving the proposed legislation to give his team a chance to garner at least some bi-partisan support for the plan.

That begins with the Congressional Budget Office (CBO) “scoring the bill”. How many people will get coverage under the American Health Care Act (AHCA) at what cost to the tax payer, and what’s the indirect impact be on employer-based insurance health insurance premiums?

CBO scores are notoriously inaccurate – over-estimating the benefits of legislation and under-estimating the costs. But they offer a starting point for a negotiation.

The current 120 page bill is nothing more than a “strawman” that will be modified by the long process of moving legislation into law.

In business the “strawman” plan is assumed to be a “starting point” — something that every member of the team can “take shots at” (debate and amend) in an effort to improve the proposal and, through participation, to encourage skeptics to “buy-in”.

For example, what-if Republicans (based on CBO estimates) offered to improve out-year Medicaid funding in exchange for Democrats supporting equal tax treatment for Americans with employer-based and private purchased health insurance?

No Democrats may come around to voting for the plan but, at least, the American people will see Ryan and his team willing to compromise to improve the bill.

Because of the limitations of the Congressional Budget Reconciliation process, the AHCA cannot address the underlying problem: the cost of health care. The reality is that no health insurance plan Congress generates can be affordable and effective without addressing the underlying problem.

To insure that Congress takes on the larger problem with urgency, the current bill must be amended to include concrete triggers guaranteeing healthcare cost containment legislation is written, investigated, debated and passed prior to the effective dates of AHCA.

For example Democrats get stronger drug pricing controls and the Republicans get malpractice reform.

Only by incorporating these guarantees in this first bill can we, the people, be assured the subsequent legislation will ever be introduced – let alone passed.

The battle ahead will be fierce — fiery.

Reimagineamerica will continue to observe, educate, clarify (if possible) and prepare each of you to be an active advocate in the battles to come.

Photo Credit: the author’s iPhone with thanks to MSNBC live broadcast

What Americans Don’t Want to Hear About Healthcare

What Americans Don’t Want to Hear About Healthcare

I decided against going to a Healthcare Town Hall Meeting with a local Congressman because I knew the outcome before the gavel went down.

There will be a lot of speculative hysteria surrounding potential changes to Obamacare benefits or changes to Medicare.

Let’s relax. Entitlements once granted never go away – they take on a life of their own.

What attendees won’t be told is that Obamacare is collapsing under its own weight – insurers are fleeing in droves unable to sustain the coverage losses they’ve experienced over the last few years.

Nor will they hear the Congressional Budget Office prediction; Medicare Hospital Trust Fund will be bankrupt in 2020 and the larger Medicare Provider Trust Fund will be exhausted in 2028.

But Obamacare and Medicare are not the problem – they are just a symptom.

Medical Bills Are Killing Us

In a seminal piece written for Time Magazine in the summer of 2013 Steven Brill laid out the problem in detail.

Medicine in 21st century America is big business. It’s very profitable for employees and stockholders.

The United States of America spends more on healthcare than the next 10 biggest spenders combined! Based on exhaustive comparative studies of Adult Welling Being the additional $650 billion a year does not result in better outcomes for Americans.

McKinsey Consulting studies have shown that the average private healthcare employer has a net operating margin (profit) of 16.2 percent compared to ExxonMobil’s 8.2 percent.

Spending for healthcare services, drugs, devices and facilities equals 20 percent of total USA Gross Domestic Product (GDP) or about $4 TRILLION a year – every year.

By comparison, the American Association of Civil Engineers estimates the total national backlog of needed infrastructure (airports, trains, highways, energy grids, etc.) will equal only $3 trillion by 2020.

Healthcare Spending is Out of Control

We see the headlines – EPIPEN price increases from $57 to $600 per prescription in a decade.

New York is the financial capital of the world – right? Wrong, of the 18 largest employers in New York four are banks and eight are hospitals.

We have heard for years that employer based (and private) insurer payments to doctors, laboratories and hospitals needed to be increased to cover the losses health care providers experience in serving Medicare patients, Medicaid patients and the uninsured.

If Medicare is “unprofitable” why does every major for-profit healthcare system aggressively pursue those patients? It’s simple. The Medicare payment formula includes a guaranteed percentage of profit!

It stands to reason, then, that if there are 23 million more insured patients the providers’ need to recover “uncompensated care” costs has decreased but medical spending continues to increase dramatically.

While healthcare is something we all need; we’ve come to expect someone else to pay for. On average, the patient pays only about 12 percent of the total bill.

That’s made us insensitive to prices and providers greedier. The escalating greed is reflected in the skyrocketing price of health insurance.

Medicare Cost Data for All

If we want good healthcare coverage with reasonable insurance premiums, Americans must become active consumers. We must advocate for a system without hidden costs.

If we want the impending debate in Congress to conclude with a better outcome than just “Obamacare2.0”, we, the people, are going to have to hold our representatives’ feet to the fire!

We must insist they begin with a comprehensive investigation of the underlying costs of healthcare.

Rather than focusing on perpetuating yet another “entitlement”, Congress’s objective must be to reduce the cost of care for all Americans – not just those who receive government subsidized care.

Brill argues that Medicare can compute the real (true) cost of delivering each health care benefit they cover. They reimburse providers based on cost of service delivery in the provider’s region in the country – i.e. cost of a day in hospital costs more in California than in Idaho.

Then Medicare applies a percentage of profit authorized by Congress to the provider. Cost plus profit is the contracted price Medicare pays to providers – no negotiation.

But Medicare is prohibited by Congress from sharing that cost data.

As consumers we have to start to shop for the best deal even if someone else is going to pay the bill!

As voters we must insist Congress allow Medicare to share their cost data — putting other insurers in a stronger negotiating posture with healthcare providers. The result would be a better deal for both patient and insurance carriers.

Manage Costs or Ration Care

As a nation, we cannot continue to fund a healthcare system that has no self-discipline. To do so would pass an immoral debt onto several generations of Americans not yet born.

If we are going to make the promise universal health care (not single payer health care) an affordable reality for all we must be willing to make changes in the ways we consume and pay for healthcare – that includes Medicare patients.

  • A redefinition of what health insurance is and what it pays for.
  • A reorganization of how we deliver healthcare to increase efficiency and reduce costs.
  • Rapid adoption of technology to both better determine diagnosis and treatment and to manage chronic disease
  • Greater transparency so that patients can make smarter decisions about where and how they will receive necessary care.
  • Greater transparency around the relationship of drug development costs and drug prices
  • Medical malpractice tort reform.
  • Identification of realistic funding sources for health insurance subsidies, Medicaid, Medicare and veterans’ health care.

The good news is there is a great marketplace of ideas about how to tackle all of these issues.

The bad news is that all of the good ideas are being drowned out by the political rancor on both sides of the aisles of Congress and the army of special interest lobbyists who feed that rancor.

Over the next few weeks, I’ll explore each of these opportunities with you – so that we can help our fellow citizens understand both their possibilities and possible perils.

It is up to us to engage our elected representatives in “fixing healthcare for all”, not fighting to score political points for the 2018 mid-terms.

Pink

Born After 1950? Counting on Social Security OR IRA Retirement Savings? Think Again!

I had never heard of “Pink Day” until Alyssa, my 13 year old granddaughter, said we had to absolutely go on Friday for back to school shopping.

After I paid the bill for her “loot”, I looked her in the eye and said “my credit card is now in DEEP FREEZE!

That didn’t keep her from trying, again, on Saturday to see if she could get me to use it, again.

No dice, sweetie. Unlike our government I need to live within my budget.

Once a month, I have to gather all the bills, including that credit card, check my bank balance, pay all the bills, subtract the payments, and put some of the remainder into savings. What is left is so-called “discretionary revenue”.

National Debt will Reach 110 Percent of GDP by 2036

If we impose that kind of prudent thinking on the American economy — that means no more “pink days” for Congress and the American people.

We can’t pay the bill!

The Congressional Budget Office (CBO) projects, based on current law, the National Debt will rise to 86 percent of Gross Domestic Product (GDP) by 2026 and will exceed 110 percent of GDP by 2036. (The 2016 LONG-TERM BUDGET OUTLOOK Table 1.1)

That’s the rosy scenario.

As debt grows, interest on the debt grows, squeezing out private investment and with it economic growth. As the economy shrinks, the ratio of debt to GDP accelerates.

Before the United States reaches the 100 percent Debt to GDP threshold, no investor, foreign or domestic, will be willing or able to purchase our debt at any interest rate.

The largest economy in the world — the collapse of the USA’s economic system would lead to a worldwide cataclysm.

The military superiority the world has depended on to bring order and stability since the 1940s would disappear – in fact, we wouldn’t be able to maintain an army or navy to defend the homeland.

Prepare to Lose Your IRA Savings!

Not planning on Social Security — believe your retirement savings will secure your old age? Think again.

On our current course, you are likely to live to see the United States unable to meet its financial obligations either domestically (Social Security, Medicare, Education) or internationally.

The combination of political and social instability and the collapse of our financial system will swallow everything – including your savings.

For a preview of what could happen during your lifetime or your children’s look to history the rise of Nazism in Germany  or to Greece or Venezuela today

President Obama Couldn’t Defuse Debt Bomb

During his 2008 Presidential campaign Barack Obama excoriated President George W. Bush and the GOP Congress for increasing the National Debt (credit card) from 33 percent of GDP in 2001 to 35 percent of GDP in 2007.

Three big, unexpected events drove the Bush-era increase in the National Debt:

  • Cost of tax rate reductions following the 2001 recession
  • Unprecedented spending for Homeland Security after 9/11
  • Wars in Afghanistan and Iraq.

When President Obama came into office in January 2009, “Job 1” was stabilizing the economy – that meant spending more money to get the country moving forward, again. The only way to do that was to borrow still more money – the National Debt quickly rose to 62 percent of GDP.

During his tenure in the White House the first of the Baby Boomer Generation would retire – putting more pressure on an already stressed Social Security System.

The President faced a steep challenge — balancing the budget would require shared sacrifice across the American population and the American economy.

Every special interest served by the Federal Budget would resist. He needed a Bi-Partisan PLAN.

His answer: A National Commission on Fiscal Responsibility and Reform.

To lead the effort he invited former Republican Senator Alan Simpson and former Clinton Chief of Staff Erskine Bowles. Both of these men have strong reputations as citizens before they are partisans.

Among others, he appointed Alice Rivlin, who had served as Clinton-era Director of the CBO. She warned about debt in general and the need to reform Social Security in particular.

The Commission membership included Republican and Democratic House and Senate leaders and others from the Administration and outside government.

Their findings were published in December 2010 — to significant fanfare — subtitled The Moment of Truth:

But the Moment of Truth never reached Congress for an up or down vote.

Instead the National Debt rose from 62 percent of GDP in 2009 to 75 percent of GDP in 2016.

The striking rise in debt is the result of unrestrained government spending, Congressional reluctance to raise or reform taxes, natural disasters, and continued military operations.

Next President Has Last Chance to Defuse the Bomb

And yet, unlike Barack Obama, neither Hillary Clinton nor Donald Trump have focused on the rising ratio of Debt to GDP or the risk it presents to every aspect of our national life and government.

Libertarian Gary Johnson (former Governor of New Mexico), has made debt reduction and balancing the budget a priority in his campaign but the limited press exposure he receives has allowed Ms. Clinton and Mr. Trump to “skate” on the issue.

In fact, both promise more discretionary spending, expanded Social Security and lower taxes.

They are either lying or they can’t do basic math?? I’ll let you decide.

Every American Must Make the Hard Choices

One thing is certain, as citizens, taxpayers, parents, and grandparents it is our solemn duty to elect a President and a Congress willing to confront debt, deficit, and balancing the national budget honestly and courageously.

No one wants to pay more in taxes, but the fairly small sacrifices required of each of us in this decade pale in comparison to the consequences that could face our children in the next decade.

  • It is up to YOU

    Get Involved

    In the coming weeks, Reimagineamerica.org will do what our Presidential Candidates and other politicians are not - throw out some positive and plausible ideas to "right the ship of state".

    Ideas you can ask candidates about during the Fall Campaign.

Photo by author

Firearms Transaction Record

Honor Orlando with One Small Step toward Unity of Purpose

After I turn off the lights each night, I repeat the basic prayer of my faith followed by a brief, extemporaneous chat with God. It was just after 1 AM Sunday morning when I asked God to do what he can to achieve peace on earth.

At that very moment the largest mass shooting in the history of the United States was taking place across the country.

How can it be that 49 people were murdered in an Orlando, Florida, night club? How can it be that 53 people who went out for a good time on Saturday night – ended up fighting for their lives in Orlando hospitals on Sunday?

Then the “other shoe dropped”. The killer who pledged allegiance to ISIS — was known to the FBI but still was able to buy a military-style assault rifle from a legitimate gun dealer.

Massacres Have One Common Denominator

Watching the breaking news, I was struck by the sounds recorded by law enforcement. The rat-a-tat-tat – the speed and the volume or shots fired.

It sounded like a Hollywood war movie!

It’s the same sound we heard in the videos of Fort Hood, Sandy Hook, Tucson, San Bernardino, Charleston, Aurora and a dozen other instances in the last 8 years.

There is a common denominator: A semi-automatic, military-style assault rifle (AR-15). We learned after Aurora that you can buy this type of weapon at Wal-Mart!

To the best of my knowledge there are no wars going on in Aurora!

Democrats could not resist the urge to politicize the tragedy. They took to the Floor of the House of Representatives shouting “Shame” at the Republican Majority. They ignored the fact they failed to pass any meaningful gun control legislation when they were in the majority in both the House and the Senate. This is an Election Year and gun control is a perpetual issue to rouse voters.

Not a Time for Typical Politics

When I work on a new strategic direction with a corporate client I start with the facts. Focusing on facts avoids inter-personal tensions and political agendas from side-tracking the discussion.

All the participants are focused externally – listening more than talking — until they all come to a consensus about what to do with those facts. It is a first step in building the trust necessary to take more significant, risky actions.

People are scared.

What they want are solutions not posturing.

Our leaders must avoid political finger pointing and focus instead on quiet conversation that allows the evidence to lead us to constructive consensus, which would build a new multi-pronged strategy to combat all forms of domestic terrorism.

It is a fact – based on ample evidence – federal gun purchase background checks do not work to make us safer. 80 percent of Americans agree they must be strengthened.

Background Checks Are Not Gun Control

Congress passing legislation to expand and strengthen background checks could be a confidence building step toward a new homeland security strategy.

They have the facts:

  • The Charleston massacre last year demonstrated that an arbitrary three day maximum waiting period is not long enough for a thorough FBI background check.
  • The Orlando killer had been under FBI surveillance for nearly a year (2013-14) as a suspected terrorist but was able to walk into a gun store and walk out with a military assault rifle – no questions asked.
  • The Department of Homeland Security maintains a “no-fly list” of potential terrorists to prevent the use of an airplane as a weapon of mass destruction but Congress has refused – so far –to make it illegal for these people to buy a gun.
  • This policy is in fact: Crazy in its contradiction!

Congress has had more than a dozen opportunities to debate this subject over the last seven years. It’s time to stop talking and listen to the American people!

Amend the background check legislation this week with a simple amendment to the law that honors the memory of those who died in Orlando – while they were just out living their lives.

  • Remove the 72 hour restriction from the background process. The FBI completes the background check when they have all the data required – no matter how long it takes.
  • Integrate FBI interview records and the “no-fly list” with FBI gun background check system.
  • If someone who has been interviewed or surveilled as a potential terrorist attempts to purchase a gun they should be flagged for an FBI interview before any action is taken on the gun purchase application.
  • Similarly, anyone on the “no-fly list” who applies to purchase a gun must be subject to FBI interview and further investigation before any action is taken on the gun purchase application.

This legislation would be a small, politically safe step for Congress. It would be a huge step forward toward building a national consensus on steps that can make our homeland and our homes more secure by following the evidence the FBI and the ATF are developing in Orlando and across the country.

To do less dishonors the lives lost!