Where is the Elon Musk or Steve Jobs of healthcare?

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What a mess.

President Trump made statements about healthcare reform while running for office that promised better healthcare that would be much more affordable, and he specifically said that we must also take care of the poor and those that cannot afford healthcare.

The type of healthcare reform he described would have been a wonderful opportunity for a deal between moderate Republicans and moderate Democrats.  What the President wanted was achievable as a true bipartisan effort, marginalizing the extreme right and extreme left.

Instead, the bill that moved forward in the house was largely a return to the dysfunctional healthcare system we had before Obamacare, while it added the expense of covering pre-existing conditions and some of the subsidies provided by Obamacare.  It did little to improve the quality of healthcare or reduce costs.  It did not even tackle prescription drug cost reductions or enable insurance to be sold across state lines.

How was this bill going to improve the quality of healthcare, and how would it drive down the costs?

And even this proved controversial, splitting the Republican party into those that thought it went too far in subsidizing healthcare for the elderly and poor and those that thought it didn’t go far enough in eliminating subsidies.

What a mess.

The fact is that the House bill lacked any imagination or innovation.  What happened to actually reinventing healthcare for the 21st century?

No one is talking about the need to fundamentally reinvent the delivery of healthcare, embracing new technologies, earlier detections of problems, less costly interventions, incentivizing wellness, producing much better and lower cost outcomes. What ever happened to the use of telemedicine, or to developing innovative programs to drive Americans to live healthier lives, promoting wellness as a way to substantially drive down healthcare costs?

We can deliver more responsive and available healthcare services at much lower costs but only if we reinvent how we deliver those services. New automated techniques can handle many functions of the healthcare system more often, more accurately, less intrusively, more conveniently and much more cost effectively, while maintaining a personalized connection between patient and doctor.  New powerful uses of ‘big data’ can identify best practices and provide a clear path to better outcomes.  As a result, doctors will be able to return to delivering care, relieved from the burden and crushing load of bookkeeping and other activities that can be automated or done by others.

Companies like Google, Facebook, Amazon, and Uber have reinvented the world by fundamentally changing the way people find what they want, form communities and connect together, shop, or travel.  Visionary leaders like Elon Musk are reinventing multiple industries by completely rejecting old methods and constraints in favor of profound new approaches that slash costs yet deliver better products and services.

Where is the Elon Musk or Steve Jobs of healthcare?

Healthcare is due for reinvention.  If we want to bring down the cost of healthcare 50% or more, we have to change the way healthcare works.  Elon’s SpaceX today launches satellites at less than 25% of the cost NASA incurred, and expects this cost to drop to around 10%.  Imagine the impact on our economy if a new improved healthcare system emerged at half the cost of the current system.

Ross Perot used to say “You have to start with a clean sheet of paper”, and it would be great if we could simply throw out the old healthcare system and replace it with a revolutionary new healthcare system. Unfortunately, our healthcare system represents 20% of the economy and there are too many industries, services and jobs dependent on the current system.  We can’t instantly create a new replacement healthcare system and transition to it.

What then should we do?

Let’s start by defining the new healthcare system, as if we had a clean sheet of paper, and then define a transitionary strategy to move us to it on a constantly improving basis.  The full transition might take 5 or 10 years, or perhaps the time window for complete transition is 25 years.  And as we’re implementing the transition, we can’t be afraid to make changes to it, embracing even better options that emerge, correcting approaches that proved to be wrong.

In the meantime, the legislation we pass now should be viewed as positive incremental improvements and corrections to the existing system; band-aids that are important and helpful, but not the end-game.

Let’s make Healthcare great again!

Buying Elections

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What’s wrong with Billionaires spending unlimited amounts to influence elections?

Do we seriously need to answer this question?

The fact that some think its ok is shocking, and scary.

Remember the images from decades ago — of back-room ‘power-brokers’, rich white guys, smoking cigars, making the decisions, controlling the media, manipulating the political process.  No women, minorities, no unions, few work-place safety rules, few environmental regulations, put business first.

How some long for the good old days…

We as a nation rejected back-room politics, not because every idea was bad but because hijacking a fair process was corrupt.  Yet here we are again – now with a new twist.  The manipulation today is so effective that the Billionaires are no longer afraid to come out of the closet and show themselves and announce their willingness to spend hundreds of millions of dollars to further their agendas. They’ve convinced us that those who are against their freedom to exercise their rights are socialists, are against the First Amendment, are un-American.

Wealthy Americans are absolutely entitled to voice their opinions, as are all Americans.  But when their wealth permits them to so overpower and dictate the conversation and when they’ve apparently lost the awareness that unbridled domination of ideas is bad for America, we’re in trouble.

Worst of all, their money is largely not used to build support for their ideas or vision.  They are not trying to show us a better plan, a better strategy for success.  Instead, they are largely focused on vilifying and destroying those they disagree with.  They are spending their money trying to scare the American people.

Remember – they’re not the candidates.  Their Americans who supposedly have a vision that they believe is best for America – yet they don’t spend their money trying to convince the voters of this wonderful vision; they instead work to destroy the other choices.

That’s what’s wrong.

When parents are splitting up and divorcing, the saying goes that you have to love your kids more than you hate each other.  Translation – for the sake of the kids, don’t destroy each other, because you end up deeply harming the kids.

Well, the political elite in this country hate the prevailing majority view, and their really scaring the kids.

President Obama and Governor Romney both have many ideas about the way government should work for the people – about the role of government – about where we may need more government and where we need less.  Thankfully, their views are quite different.  And we as Americans desire to hear from and understand what each side wants and sees for America, what they believe in, and how they see the country operating if they should be elected in November.

Citizens United handed Billionaires the ability to manipulate our elections.  They should now show the intelligence and love of America to not do it just because they can.

Nero Fiddles While Rome Burns

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We’re in a fiscal crisis.  We all know it.

Federal government revenues and expenditures are out of balance and as a result we’re running enormous and unsustainable deficits.  If the rest of the world should decide one day that lending to the United States is a risky bet, interest rates will sky rocket, businesses will cut back or close unable to afford to borrow or pay off existing loans, unemployment will rise rapidly, and deficits will soar as tax revenues plummet and expenditures for debt service and for social services rise dramatically – leading to even higher interest rates, and worse unemployment, and even larger annual deficits – and a spiral downward that will be next to impossible to break.

We’re in a very precarious situation because our financial house is not ‘in order’, yet fortunately the rest of the world is lending us money at record low rates.

So with this scary but very lucky ‘low interest rate’ reality, what do our politicians do?

Republicans actually spook the rest of the world intentionally by playing chicken with the debt ceiling.  Imagine, they actually drive the United States towards default of its debt obligations to our lenders.

And Democrats act irresponsibly by appearing to be in denial about the seriousness of our fiscal situation, failing to put forward and embrace a thoughtful, substantive fiscal plan that includes significant expense reductions in entitlement spending.

But worst of all, because it is an election year both parties have abandoned all serious attempts to accomplish anything substantive this year.  Republicans pass bills in the House knowing they will never pass the Senate, while Senate Democrats try to move legislation forward that they know will be killed by Senate Republicans.  Both sides posture in order to have campaign slogans and have the ability to point and blame the other side, and in the meantime the Republic is failing. They don’t even have the courtesy to pretend to lock themselves in round the clock, all night sessions, for a solid month, trying to hammer out a ‘grand bargain’ in order to begin to responsibly address this crisis.

Nero Fiddles While Rome Burns.

President Obama, John Boehner, Nancy Pelosi, Harry Reed, Mitch McConnell, together with Mitt Romney to avoid political advantage – all need to put country first and come together as a group and solve this problem.  Serious expense reductions need to be on the table in social programs, in military spending, in all aspects of government operations.  Tax rates need to be on the table, as well as tax policy and the closing of tax loopholes. Investments in infrastructure that make us more competitive over the next 100 years need to be on the table, as do investments in new technologies that will spawn new industries and provide the jobs of the future.

A combination of serious expense reductions, targeted tax increases, closing tax loopholes, strategic investments is the way forward.

And as soon as they come to a deal, our markets will explode as confidence in our fiscal future rises.

Americans know it, and it’s time our political leaders stopped fiddling.

Voter Fraud Fraud

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Do we want dead people, non-citizens, and others ineligible to vote voting in our elections?

NO!  Nobody wants voter fraud.  We should make sure that voter fraud is stopped.

By the way, how big a problem is this?

Well in Florida with more than ten million voters, since 2000 the Florida Department of Law Enforcement has had 178 cases of alleged voter fraud referred to them (and only a handful resulted in convictions); around 1 in every 5,000,000 votes cast over the past 10 years.

OK, so it’s actually a very small problem – but what’s wrong with toughening the laws that prevent fraudulent voting, in order to improve the quality of our elections?

Nothing unless the way we reduce voter fraud also stops legal voters from having the right to vote, and therefore greatly harms the quality of our elections by preventing legal voters from voting.

Florida officials announced they were purging the voter rolls of 2,600 “non-citizens” with plans to remove tens of thousands of additional names.  But in the process and as reported in the Sun-Sentinel and Orlando Sentinel newspapers, they’ve swept up a war hero born in Brooklyn, plus hundreds of immigrants who have long been U.S. citizens.  Of 1,594 names sent to Miami-Dade, 447 have thus far proved they were citizens, while 13 said they were non-citizens.

Imagine it was you – suddenly your right to vote was taken away.  And you wouldn’t be able to vote again unless you took the time to prove you were a citizen – no doubt to a nightmare bureaucracy that is even worse than dealing with Motor Vehicles to register a car.

Among these identified as non-qualifying registered voters, 64% identified themselves as Hispanic (roughly 5 times the normal percentage of voters), while only 9% identified themselves as whites (normally making up 68% of all registered voters).  Only 21% reported being Republican – half the normal level.

In other words, we know that there is virtually no actual voter fraud in Florida, and we know that the new method of detecting non-qualifying registered voters is inaccurate and imprecise, and we see that the method of selecting supposedly non-qualifying registered voters ‘appears to be’ prejudicial and political, and yet this strategy continues to be overwhelmingly supported by Republican lawmakers in Florida.

These facts should be of great concern to all citizens. 

The desire to reduce voter fraud makes sense when there is voter fraud.  But a process that has been shown to be flawed and that forces many legal voters to prove that they are legal in order to regain their right to vote is obviously wrong and should not be supported by anyone.

Republicans and Democrats should debate and fight about the issues, and then let all the voters decide, and may the best ideas win.