Supporting Wall Street Reform

Today I had a letter to the editor published in both the Las Vegas Sun and the Las Vegas Review Journal. The letter had to do with record earnings on Wall Street and my support for Senate Majority Leader Harry Reid and Wall Street reform. Here is the letter:

"On Monday, Citigroup announced it raked in $4.4 billion in the first quarter of this year and its stock went up. Last week, JP Morgan and Bank of America reported it earned $3.3 billion and $3.2 billion, respectively, during the same time.

They’re back in the black after Americans bailed them out (of the worst national economic debacle we’ve seen in decades), but Nevadans aren’t so fortunate. While Wall Street rejoices, thousands of Nevadans like myself are still making hard choices between food or medicine, shelter or education.

I’m proud of Senate Majority Leader Harry Reid of Nevada for having the courage to hold Wall Street accountable for the mess it created and insisting on financial reform. If folks don’t get behind Reid and get this done, Wall Street will still be posting record profits next year and Nevada will still be in the dumps."

Oops. I forgot to include the part about Goldman Sachs, currently under federal investigation and being sued for fraud, also posting earnings of $3.3 billion in the first quarter of 2010.

And let's not forget the bonuses.

Earlier this month, Goldman Sachs paid $5 billion in bonuses to staff for just three months of work. THREE MONTHS.

Eric Daniels, CEO of Lloyds, is up for 9.5 million in salary and bonuses this year.

And that's just a sample.

I think it's reasonable to assume that it's not too difficult for a bank to make money. Think about this: they get to borrow from the Federal Reserve a rate of zero and then lend that same money back to the Treasury at an interest rate of 3% through (bond purchases). But if they're not totally profitable, they can fool their customers into thinking they are because we don't require transparent accounting. And while the Obama administration set up programs to help Americans from losing their homes, the banks are not being very compliant and they're getting away with it because there is little if any oversight or enforcement.

Republicans like to tell us that lower taxes and less regulation on business is the key to national economic health and stability.They call it "Supply-side Economics". Others call it "Reaganomics," a term coined in the '80s to describe President Reagan's economic policies while he was in office. Still others call it the "Trickle-Down Effect", claiming that businesses able to put all its resources into their product without impediment will ultimately reward the consumer with lower prices and greater availability.

The problem with the trickle-down effect is twofold: 1) - It requires the poorest of the nation to carry the greatest burden while business and corporations (the richest among us) get all the breaks; and 2) - It doesn't work. Business rarely passes down the benefits, choosing to keep them for their own instead. This is one of the reasons why banks have such record profits.

Although Republicans promote this idea that if business is successful, they will share that success with the consumer, it's simply not true. They do not share the wealth.

Bring in the Tea Party. Patriots are outraged over any suggestion that would ask them to share the wealth. What's theirs is theirs, they worked hard for it, and they're not going to share it with you or me or anyone. A great many Republicans also subscribe to this philosophy, telling us that we've created a nation of people dependent upon government for their very survival. They want government to stop giving handouts to the weak, the lazy, and the illegals. Kick the bums out and make everyone else pay their own way. That's the American way - or so they say.

So it came as some surprise to me today when I saw that the Review Journal changed the title of my letter from "Why We Need Financial Reform" to "Share The Wealth." What a bunch of hooey. I never asked the banks to share anything. Instead, I'm asking them NOT to rip off their customers and NOT to give bonuses to the very same people who nearly bankrupted this country. Call me crazy but I think it's wrong to reward the people who brought us to our knees, who required us to go to China to get loans, and whose greed and fraud forced the very people they screwed to have to rescue them in the largest bank bailout in American history.

While it looks like the recession is turning around for the banks, you'll forgive me if I don't wait around for the infamous trickle-down effect to feel the benefit. I've never seen it work nor have I ever seen a bank willing to share it's good fortune with the common folk. Instead, what we need is meaningful financial reform, the kind the banks are opposed to, the kind that will keep them from screwing over their customers again and again. Without it, it's just business as usual, at the peril of the people.

How To Help The Tea Party

Yes, it's been quite the Tea Party season. We watched history made as humans sunk to new lows with rising amounts of violence, hatred, racism, and modestly clever adaptations of well-known political sayings. But the effort of useless repartee is beginning to take a toll and patriots are showing signs of fatigue. Even Rupert Murdoch and FOX has started going critical of the Tea Party. Could defection be on the horizon?No need to wait to find out. I've created a few new tools to use for deprogramming if (and when) the situation presents itself. Here's a few bumper stickers:

• Tea: Not Just For Classy People Anymore

• The Tea Party - Where Imaginary Friends Come to Life

If you sense doubt on their part about the truth of what they're saying, use these:

• Hey Tea Party - How's that whole Truth-ey Honest-y thing working out for ya?
  

• I'll take the Party of Know for $1,000, Alex

You can take the coy route.....

• Teabag Party: Want To Know What It REALLY Means?
  

• I Can See The Moon From Where I Stand. Please Don't Bend Over Again.

or go elitist....

• Silly Tea Party - Tax Cuts Are For the Middle Class

• For The First TIme in My Adult Life, I Am Ashamed of my Countrymen

but these last two can be used for just about anything. Put 'em on signs, bumper stickers, hats, or just tape 'em up on front of the outhouse:

• Tea Just Makes Me Need to Pee Really, REALLY Bad

and

• TP - No Matter How You Spin It, It's Still Just For Wiping Asses

Going Forward with Health Care Reform

Today, we were witness to history as H.R. 3590 became law with the stroke of a pen. Well, okay, with the stroke of 20 pens. Health care reform is something that most of us feel passionately about and have been working on for a long time. Typical of liberals, we had split camps among us about the best way to approach reform. Some said it was single payer. Others said it was revoking the anti-trust exemptions. Still others said it was public option. It was impossible to come together as one cohesive unit and work toward one common goal. But today, one version of HCR was signed into law.

Regardless of where you stood in the debate, I want to take this moment to say thank you. Thank you for standing up for what you believe and taking an active role in the process. Thank you for deciding to do something about a national disgrace, for developing a platform and organizing to make yourselves heard. Thank you for doing it an honest and ethical fashion. The majority of Americans are not willing to do what you did, which was to step away from the kitchen table or armchair dialogue and translate an opinion into action. Whether I agreed or disagreed with your position, you have my respect and appreciation for taking action.

I know that some of you are unhappy about the passage of this bill. We heard you say that it's an insurance company windfall, it's a snow job on the American public, it costs too much, it penalizes the poor, it doesn't go far enough, it won't really help small businesses, it won't do what it promises, etc. I sincerely hope that those predictions do not come to pass. But one way it could happen is for us to fall apart now.

Which is why I ask those who are unhappy with the way things turned out to get on board and help refine the bill over time. No one believes this is over. We've still got much work ahead of us. The best possible way for us to do that is to unite, to deal with the reality of what is, and then find a way to make that reality look more like the vision of how we want it to be.

We need you. We need us. It is my fervent hope that every one of you are still up to the challenge. Thank you for all that you did. Thank you for all that you do. Please stay with us; we need you now more than ever.

Why the HCR bill is Not Health CARE Reform

There are many in our own camp who declare the HCR bill to be a victory for corporate America. Many believe that single payer is the only way to truly reform our health care system. Others say the current HCR bill is meaningless without a public option. As someone who devoted my life to a career in health care, I think it's really, really important to distinguish health care from health insurance. What we just accomplished was a modicum of health insurance reform. If we want to reform health care, I suggest focusing on the following instead.

1. Nursing Shortage
According to a report conducted two years ago by the Health Resources and Services Administration, The nursing shortage is considered critical in more than half of the U.S. Unable to fill positions, 90% of long term care facilities do not have sufficient staffing to provide even the most basic care and home health agencies are being forced to refuse new admissions. The nurses who remain are overworked, underpaid, and undervalued. The number of unfilled nursing positions across the country is expected to reach 1.1 million by 2012. If you want to improve health care, we need to examine why nurses are leaving the field, strengthen the infrastructure, develop retention programs, and give them the respect, salary, and voice they deserve.

2. Local Budget Cuts to Higher Education
Seems like one solution to the nursing shortage would be to promote the heck out of nursing schools. But nursing programs across the country have had their budgets slashed repeatedly over the last 10 years, so much so that many junior colleges no longer even offer accredited nursing programs and state universities have long waiting lists for classes. Waiting times have been reported to be as long as two years.

3. Fewer Physicians to Choose From
In today's world of litigation, tort reform, and skyrocketing malpractice insurance rates, many physicians are being forced to amend their services, take early retirement, or shut down their solo practices altogether. Ob/GYN has the highest number of casualties with 25% of physicians no longer offering obstetrics care as part of their practice. With malpractice insurance rates quadrupling in many states, physicians are being asked to pay more per year than they actually make.

4. Access to Facilities
In the '80s we saw the rush of private investors taking over a large chunk of facilities across the nation. The Rick Scott's of the world got together with their buddies and decided that health care was a great financial investment. So they began buying up hospital after hospital, merging some with others, and permanently leaving doors closed on others. Which ones? Mostly the charity ones. Health care became a high stakes investment managed by a bunch of lawyers and few medical experts (except the token ones who also served in Congress). With companies like Humana, Galen, Columbia, Hospital Corporation of America all coming together to form a conglomerate that included 166 hospitals and 112 outpatient centers across half the U.S. (and England, too) they were prime to do whatever they wanted, marginalizing standards of care for ROI all the way. With strategic facilities kept closed, people really were at the mercy of getting health care only if they could afford it.

Interestingly enough, in 2006, HCA underwent another merger that allowed it to become a private company once again. Who were the investors? Affiliates of Bain Capital, Kohlberg Kravis Roberts & Co. and Merrill Lynch Global Private Equity, and HCA founder Dr. Thomas F. Frist, Jr. Isn't that interesting.

With fewer facilities to choose from, fewer practicing physicians, a critical nursing shortage, and fewer people entering the field, my question is this: Who is going to care for all the millions of people now able to enter the health care system? Answering these questions is how we're going to fix health CARE.

So, You Think You Can Get Health Care If You Need It?

In the raging discussion about the need (or lack thereof) for health care reform, one of the arguments that comes up frequently is that there are already laws in place guaranteeing medical treatment for those who are sick, irrespective of their ability to pay.

Not true.

The majority of indigent care is provided by charity hospitals. They may be funded by their local government or have various private benefactors. In order to be designated a 501(c)3 non-profit facility eligible for federal tax-exempt status, the IRS requires that they provide a "community benefit" (as stated in the Internal Revenue Code). As such, charitable hospitals are judged on whether they provide sufficient health benefits to the community.

The key word here is "sufficient".

Much of what is considered sufficient is dictated just as much by local governments and benefactors as the regulating agencies. The facility doles out care as described in its charter and as required to keep its non-profit status. That generally involves treating those at or below the poverty line. So if you're super poor, you'll most likely be able to get the treatment you need. It may take awhile to get, and it may not be as good as the care your neighbor got when he had the same thing, but you'll get treated.

But who is treating the guy making $70,000 per year, providing for a family of four, who doesn't have health insurance? He won't meet the charter of the community hospital. What if he gets sick? At the end of the day, real world practice is much different than any ideal penned in a lofty mission statement.

The Emergency Medical Treatment and Active Labor Act (EMTALA) was created in 1986 to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to "charity or county hospitals" because of inability to pay or Medicare or Medicaid coverage. EMTALA makes sure you or I get care no matter what if it's a life or death situation. It provides for women in active labor or those requiring emergency treatment to avoid long-term consequences (i.e. broken bone, etc.). But the reality is that many private facilities consider EMTALA a bad word and do everything they can to minimally stablize patients and boot them out the door as fast as possible.

When I worked in the emergency room of a large, for-profit hospital, I can't tell you how many times we had to turn patients away because they didn't have insurance. Or how many times the E.R. docs claimed it wasn't safe to let a patient leave but the hospital administrator refused to allow them to be admitted. The rule of thumb was do to as little as possible in the least expensive way to be able to transfer them somewhere else.

During my time there I saw three patients die after E.R. docs were forced by hospital administrators to discharge them. One of them died not 10 feet away from the E.R. doors, another died in the hospital lobby, and another died in the car as her husband was taking her to the county hospital. And at the end of the day, what did the hospital gain? They had to pay huge legal fees to represent them in court.

The only ones who have the "right" to care now are those with insurance who show up at the right provider's door (the one in their network), the independently wealthy, and the super poor. It's the middle class that's having the problem - and they represent the largest group of citizens in America.

Sources:
1. EMTALA: http://www.emtala.com/faq.htm
2. IRS Regulations for Non-Profit Facilities: http://www.irs.gov/publications/p557/ch03.html
3. Portrait of the Middle Class:http://www.commerce.gov/s/groups/public/@doc/@os/@opa/documents/content/prod01_008833.pdf
4. How the Middle Class Struggles: http://www.usatoday.com/money/perfi/general/2003-09-14-middle-cover_x.htm

Progressives Working Against Progress

I'm running out of heart and patience for angry Progressives doing their best to defeat the health care reform bill. I expect Republicans to try to thwart this legislation, that's pretty much a given. But when those who call themselves Democrats or Progressives or Liberals, etc. do it I feel frustrated. While each side's reasons (and values) are different they have one thing solidly in common, and that is the insistence on total purity and the complete unwillingness to consider anything but the everything they want.

Listen, I know that all of us are trying to do what we believe is right. I know that no one is undertaking this cause out of any malevolence. But I'm here to say that unless you're someone whose very life depends upon whatever action Congress takes, there is no way you can fully understand or appreciate what health care reform means to me or thousands of other Americans like me in similar shoes. And unless you've been practicing mainstream medicine of late, you can't really know what takes place in the medical setting, who is doing what, and what the mentality is.

I worked for nearly 30 years in a variety of clinic and hospital settings: the emergency rooms, acute care, oncology, hospice, quality improvement, administration, outpatient doctor's office, and the clinical research settings. I've been on the floor unit, hospital administrator, and clinic director. I've worked in hospitals and doctor offices in half of the U.S. states. And I spent nearly 20 years serving on board after board, committee after committee as a volunteer in the non-profit sector, successfully developing and implementing medical care plans for those in under-served, under-represented, and poor areas that most people don't care about. I think I know a little something about nearly every medical perspective on this issue and learned about community and legislative resistance the hard way. And after being a patient with chronic illness for nearly 10 years, I know a little about the system and how it treats people like me.

Something has to be done.

Now.

I agree with much of the progressive argument against this bill. Yes, it's been watered down. Not enough is being offered. It leaves too many people out. Corporations will find ways to get around certain provisions. But I'm not going to overlook the good this bill will do simply because it has problems. I won't ask that several thousand lives be sacrificed now in order to hopefully save more lives in a few years. To me, that makes no sense. And I'm not willing to take a chance that we won't HAVE another chance if reform fails this time around.

The irony here is that while progressives claim Washington is not listening to them, they're not listening to me - or anyone else who has a differing opinion either. And they fail to see that their efforts not only hurt people like me but fracture our ability to get anything done. In their unwillingness to compromise anywhere on this issue they've become just as dogmatic and self-righteous as the right wing.

So if you're one of those Progressives reading this now, I pose the following directly to you:

I know you think I'm a deluded, kool-aid drinking, spineless Democratic Obamabot wandering aimlessly in my drunken crush-on-Obama stupor. I know I hold no credibility with you. Still, I want you to know that if you get your wish and the current health care reform bill dies, so will I. A successful defeat of this bill will eliminate my chance of getting the transplant I need. If the bill succeeds, I will be able to purchase the secondary insurance required to be accepted at a transplant center. That option will become available almost immediately, it's not one of the things that will be phased in over several years. Short of a new miracle drug or other cure, without that option, I have no options.

So, if you still want to continue this fight and your efforts to defeat the bill are successful, I have one final question for you. Will you give the eulogy at my funeral and explain why it really is a victory to my grieving family?

Happy New Year 2010

As we head into the final days of 2009 I wish everyone eternal optimism and the hope that the coming year is the one in which we see love, peace and understanding in the eyes of all our brothers and sisters.

Happy New Year with all my best to you and yours!

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English: Happy New Year

Afrikaans: Voorspoedige Nuwe Jaar

Albanian: Gëzuar Vitin e Ri

Arabic: سنة جديدة سعيدة

Bulgarian: Честита Нова Година

Chinese: 新年快樂

Croatian: Sretna Nova godina!

Filipino: Manigong Bagong Taon

Finnish: Onnellista uutta vuotta!

French: Bonne année!

German: Glückliches neues Jahr!

Greek: ευτυχές το νέο έτος!

Hebrew: שנה טובה

Hindi: नया साल मुबारक हो

Irish: Athbhliain faoi Bliain

Italian: Buon anno!

Japanese: 新年あけましておめでとうございます

Korean: 새해 복 많이 받으세요

Macedonian: Среќна Нова Година

Persian: سال نو مبارک

Portugese: Feliz Ano Novo

Romanian: La mulţi ani!

Russian: С Новым Годом

Serbian: Срећна Нова Година

Spanish: ¡Feliz Año Nuevo

Swedish: GOTT NYTT ÅR!

Thai: สวัสดี ปี ใหม่

Ukranian: 3 Новим Роком

Vietnamese: Chúc mừng năm mới

Welsh: Blwyddyn Newydd Dda

Yiddish: גליקלעכן נייעם יאָר