Open Source Politics

If you have not done so, I encourage you to mosey over to the National Journal and read Jonathan Rauch’s in-depth analysis of the Tea Party movement: How Tea Party Organizes Without Leaders.

The Tea Party movement which has arisen over the past two years has proved an enigma to politicos and pundits alike. Unable to grasp its essential nature, caricatures and character assassinations have abounded, and the straw man thus erected — angry, racist, extremist white men, secretly funded by corporate America and puppets of the Republican Party — bears no resemblance to the reality on the ground. In reality, the Tea Party represents open source politics — individuals empowered by connectivity and the internet, functioning in many ways like a living organism.

If you have been reading John Robb’s Global Guerrillas blog (and you should, if you want some deep insight on how society and the nation-state are evolving to something radically different than that to which we have known over the past half-millennium) you will recognize well its form: the empowerment of individuals and small groups by technology and connectivity, undermining and hollowing out centralized command-and-control structures, whether they be military, governmental, or political in nature, utilizing their very size, ossification, and inertia against these institutions in sociopolitical jujitsu.

The Tea Party movement has grown out of the widespread frustration with aristocratic, corrupt government and politicians, of both parties, indifferent and contemptuous of their so-called constituents, running a nation reeling toward bankruptcy as their “experts” increase their control over society with increasingly reckless and destructive policies and plans.

The goals and concerns of the Tea Party movement are laudable and widely held: reign in out-of-control spending and massive expansion of government; address our disastrous spiraling national debt; increase the accountability of politicians and civil servants to the public; foster transparency and rational governance among the elected. The Tea Party has the potential to bring about enormous changes in our political system — which is why those entrenched in power fear it so, while understanding it hardly at all.

But we would be foolish if we were to ignore the downside potential of this 21st century phenomenon. The potency of connectivity and instantaneous communication, unbounded by geography and national borders, resides in the leveraging of the Lilliputians: a small terrorist faction with a few thousand dollars can destroy an oil pipeline carrying billions of dollars of crude; an unknown pastor with a match and a Koran can trigger a global crisis in Islam. A miscreant with a web site can expose tens of thousands of secret military documents, endangering the lives of thousands of informants and forcing changes in strategy in billion-dollar military campaigns. A broker with an incorrect trading order can spark a flash crash in global stock markets, potentially triggering a financial crisis costing trillions.

Our current government has become profoundly dysfunctional. Its massive size creates an enormous inertia rendering it incapable of responding appropriately to even the most straightforward problems; it is a paraparetic pachyderm crushing everything it stumbles toward. Its politicians and civil servants have created an impenetrable fortress, gerrymandering their way to eternal election, indenturing the the taxpayer to support lavish and corrupt lifestyles and unsustainable public salaries and benefits. The Tea Party is a response to the widespread frustration and helplessness engendered by a preening, ignorant, arrogant aristocracy which treats its citizens with utter contempt as it squanders their grandchildren’s future to further entrench themselves in power. Party no longer matters; all are spoiled royal heirs whining and squabbling over who wears the king’s robes.

The Tea Party movement — loosely organized, decentralized, superempowered by modern technology and connectivity — may represent our best, and perhaps last, hope of reversing the disastrous and destructive bent toward an economically bankrupt aristocratic dystopia. It is by no means assured of success; our fate may already be preordained, and we do not know how well those elected by them might govern. But the genius of our young republic resides in the checks and balances of tripartite, representative government. It is not a populist democracy, as was ancient Greece — indeed the Founders saw the dangers of purely populist government, where charismatic despots or a fickle and easily-swayed populace could make drastic changes in governance ultimately destructive to the health and integrity of the nation.

The empowerment of a populist revolt is not without risks: an enraged and empowered populace could sweep into power those supportive of despotism, or religious persecution, or reckless policy-makers who could trigger financial or social meltdown.

But one thing is clear: the rules of the political game have changed, forever. Let us hope and pray they have changed for the better.

The Coming Cataclysm

It is late in the day, and few are prepared for the darkness coming. The signs, it seems, are everywhere:

U.S. Treasury 2009 Financial Report Shows Dire Course

The Treasury Department recently issued the 2009 financial report of the United States government. … the annual report is untainted by creative accounting but also because its message is too important to ignore.

That message is that the sky is indeed falling…

…simple addition indicates that the total net position of the government is a whopping negative $57.4 trillion… if current policies are left unchecked U.S. government debt held by the public will increase from approximately 80 percent of GDP today to 700 percent in 2080.

The Fiscal Nightmare of the Welfare State

Bloggers post what they claim to be the scariest economic chart or the chart of the century. Indeed, many data sets are frightening, but none more so than the tables found here. This data shows incontrovertibly that modern government has failed. These countries are all insolvent and will eventually default.

All Western democracies are on death row. The unlimited welfare state is the cause. Some governments are delusional, believing they can continue on their present paths. Others cling irrationally to hopes of some miraculous reprieve. All are dead men walking.

Is Greece Just the Tip of the Iceberg?

Virtually every country in the EU spends more than it takes in and has made long-term fiscal promises to an aging work force that it can’t keep … Europe would have to have the equivalent of roughly $60 trillion in the bank today to fund its very general welfare benefits in the future. Of course, it doesn’t.

Today, Greece is only the tip of a very large iceberg.

America in the Red

America is digging itself into a deep fiscal hole. In 2009, the federal government spent $3.5 trillion, but took in only $2.1 trillion in revenue — thus spending $1.67 for every dollar it collected. The resulting $1.4 trillion deficit was equivalent to 10% of the nation’s economic output, the highest percentage since the end of World War II. America’s publicly held debt now totals $7.5 trillion, about 53% of gross domestic product — the highest it has been in more than 50 years.

These figures are alarming, but they pale in comparison to budget projections for the years ahead… By 2020, the United States would owe more than $20 trillion, the equivalent of about 85% of GDP. At that point, interest payments alone would consume about $900 billion a year — almost five times as much as they did in 2009.

The outlook grows even more bleak when we account for the ongoing retirement of the Baby Boomers and further increases in public spending on health care… The twin pressures of increased entitlement spending and slowing revenue growth mean that the debt will skyrocket — to roughly 200% of GDP in 2035, under one CBO scenario — unless there are dramatic cutbacks in all other government activities or an equally dramatic increase in taxes.

The euro crisis is a judgment on the great lie of ‘Europe’

We have still scarcely begun to wake up to the gravity of the crisis now upon us, not just for the eurozone but also for us here in Britain and for the entire global economy. The measures so far taken to prop up the collapsing euro, such as that famous “$1 trillion package”, are no more than gestures.

Greece was just the antipasto: Italy, Spain, Portugal and others are now hanging over an abyss of debt which scarcely all the money in Europe could fill – created by countries living way beyond their means, thanks not least to the euro’s low interest rates. The only possible consequence of the collapse of one of the world’s leading currencies, leaving Europe with no money to trade in, would be utter chaos…

…If the euro does disintegrate … the consequences would be incalculable … Without a currency, trade would collapse – leaving Britain, dependent on Europe for 50 per cent of its trade, just as seriously affected as everyone else. A system failure on this scale would make the 1930s pale into insignificance…

Dow Theorist Richard Russell: Sell Everything, You Won’t Recognize America By The End Of The Year

Do your friends a favor. Tell them to “batten down the hatches” because there’s a HARD RAIN coming. Tell them to get out of debt and sell anything they can sell (and don’t need) in order to get liquid. Tell them that Richard Russell says that by the end of this year they won’t recognize the country. They’ll retort, “How the dickens does Russell know — who told him?” Tell them the stock market told him…

… If the two Averages violate their May 7 lows, I see a major crash as the outcome. Pul – leeze, get out of stocks now, and I don’t give a damn whether you have paper losses or paper profits!

Is Europe heading for a meltdown?

The Bank of England Governor summed it up best: “Dealing with a banking crisis was difficult enough,” he said the other week, “but at least there were public-sector balance sheets on to which the problems could be moved. Once you move into sovereign debt, there is no answer; there’s no backstop.” … Politicians temporarily “solved” the sub-prime crisis of 2007 and 2008 by nationalizing billions of pounds’ worth of bank debt. While this helped reinject a little confidence into markets, the real upshot was merely to transfer that debt on to public-sector balance sheets. This kind of card-shuffle trick … is not so different to the Ponzi scheme carried out by Bernard Madoff, except that unlike his hedge fund fraud, this one is being carried out in full public view.

No worries, mate — sleep well.

Of course, this is merely the opinion of the pessimists, who, if they predict calamity long enough will eventually prove right. The optimists say: no worry, the economy’s getting stronger, and once that bipartisan commission on deficit reduction reaches its conclusions we’ll just spend our way out of this crisis, just like we always have in the past…

Meanwhile, the U.S. Treasury is buying its own T-bills to artificially suppress interest rates; states are going bankrupt, issuing IOUs instead of tax refunds or civil service salaries; and are funding their public pension plans … by borrowing the money from their public pension plans. Sweet! Let’s pay off our credit card debt by putting it on our credit card!

I’m no economist, but it seems blindingly obvious that the current global economic climate is extraordinarily fragile, and seems poised for an cataclysmic meltdown. Even without a black swan — a hot war in the Middle East or Korea; a mass casualty terrorism attack here or abroad; a huge natural disaster or another financial meltdown like September 2008 — the whole house of cards is poised to collapse, catastrophically. The timing is unknown, but the inevitability clear. The players are hard-wired: the Ponzi scheme of being paid today with tomorrows dollars is a powerful drug, intoxicating to both those who deal and those strung out on its increasingly delusional indulgence. And the addicts will not lie down meekly when the dealer runs dry.

Beyond the obviousness of this impending crisis lies our stunning unpreparedness to face the chaos which most surely ensue. As David Warren writes,

Europeans, outside the Nazi-Fascist Axis, and North Americans were as utterly unprepared for the horsemen of the apocalypse riding their way in the 1930s, as we are today. In fact, they were materially less well-prepared, though spiritually perhaps rather sounder. Nevertheless, the spirit of denial, which includes the desire to focus on problems that aren’t real, to avoid staring at the real ones, was so alive in our predecessors that their naiveté has become our cliché.

But I think the tests we face from abroad may, this time around, be matched by the tests we face domestically. And for those I think we are even less prepared… we are living out lives in which the focus of our attention is constantly displaced from the here and now, towards any number of fidgeting external distractions, in a “virtual reality” that disappears in the first moment of a power failure. So that, when something happens in the here and now, transcending the technological order, and muting all sources of external entertainment, we are at a loss.

How or when this cataclysm will play out is pure speculation — a speculation in which I may indulge, time and grace permitting, in coming days. Our leaders have arrogantly boasted: “Never let a crisis go to waste.” While theirs is the opportunism of self-destructive power, we too should not waste the opportunity afforded us by this impending implosion to make the most of that which soon threatens to burst upon us in ways most frightening and unpredictable.

Now is the time to become grounded, to set aside frivolous things and focus on that which is permanent, unshakable, and sure. The time to do so surely is short.

Meditations on Good Friday

Today is Good Friday. It has been my custom, on this extraordinary day, to post an old meditation on the meaning of the cross, called Three Men on a Friday. Today, however, I feel led to meditate on something rather different, though not unrelated.

Good Friday, of course, is the Church’s remembrance of its most central truths: that God became man, was crucified to pay the price which we could not pay, and was raised victorious on the third day. Good Friday is a somber day, a day to remember that we individually are responsible for the torture and agony which befell Christ — that he hangs on the Cross in our stead.

Yet, in the deep sorrow and humility which we bring to mind on this profound day, there is also an extraordinary hope: that in our greatest disasters, in our biggest failures, in our most agonizing and painful moments, there is a purpose, a plan, a hope which is both utterly irrational, yet absolute and sure.

Good Friday teaches me that failure is not to be avoided at all costs, but instead embraced as a great opportunity. Good Friday teaches me that my lifelong struggle for perfection is doomed to failure, and is chasing after the wind. Good Friday teaches me that I have no idea what is best for me, that pain and suffering have a purpose which I need not, and often should not, understand. Good Friday teaches me that God can make sparkling diamonds out of filthy coal, that my worst attributes, my most painful failures, the most disastrous events which have befallen me beyond my control, are but the building blocks of a new and far better life in hands of God.

I have recently shared some of the struggles in my life, especially my professional trials, and these have indeed taken no small toll on my spirit. Beyond that, like many, I have watched as a country which I love, whose institutions and traditions have blessed and prospered millions, is undermined and corroded by greedy men lusting for power who serve only themselves. Like many, this has been most painful to watch, engendering much anger, frustration, dismay, and discouragement.

Yet I must not forget that I too am greedy, that I too seek to control others and manipulate my world for my own benefit and betterment. We hate most in others what we see in ourselves, and our instincts scream to return evil for evil. Yet by so doing, I enslave myself to those who would enslave and destroy me.

The Cross teaches me another way. It teaches me, quite simply, that God is in control of all things, and that His ways are not my ways. It teaches me that the darkest hour comes before dawn, that God can use evil for good, and that only by bending my will and my knee before Him, no matter what the cost, can my own victory and deliverance, and that of others, be purchased.

We are at war. This is a war, not merely of bombs and guns, nor of words and arguments, nor of politics and power. It is an ancient war, from the very beginning of time: a war between the will of man and the will of God. One way is the way of hatred, anger, revenge, and destruction, whose outcome, no matter how fleeting its seeming victories, will inevitably and invariably lead to defeat and destruction. The other way is that of submission, of self-crucifixion, of “not my will but Thine.” Every fiber of my being strains against this way; every inclination of my will and spirit runs contrary to such surrender. Yet on the Cross, surrender, humiliation, agony, and defeat became the very instruments used of God to reconcile man — stubborn, rebellious, hateful man — to Himself, and to bring new life, and new power, and new hope to those who would follow in the irrational ways of God. And this war must be fought and won, first and foremost, within me.

Yet in this way of submission, brokenness, and humility, we are not called to passivity nor defeat. We are called — each in our own way, using our own gifts — to do battle. For some this will be a way of persuasive words, or prophetic proclamation of the evil which surrounds us. For some it will be writing letters, contributing money, volunteering time and effort, running for office, becoming involved.

But for all, first and foremost, it must begin with prayer, with self-examination, with the submission of every aspect of our lives to the will and wisdom of God, for judgment begins with the house of God. It is time, quite literally, to be on our knees; it is time to fast, to repent, to make amends, and take hold of that joy and purpose which can only come by aligning our wills with that of Him who paid the ultimate price to make us whole.

We do not know — we cannot know — what the outcome will be; the ways of God are vastly higher than our capacity to understanding, and our efforts will come to naught if we try to bend the plans of God to the will of man. We must submit to crucifixion if we are to see the Resurrection.

There are many paths, the broad leading to destruction, the narrow to life. May God give us the will and the wisdom to follow that narrow path.

Addendum: The code at the top of my home page pulls up random quotes, each time the page is refreshed. Upon posting this, the above quote from Whittaker Chambers came up:

To those for whom the intellect alone has force, such a witness has little or no force. It bewilders and exasperates them. It challenges them to suppose that there is something greater about man than his ability to add and subtract. It submits that that something is the soul. Plain men understood the witness easily. It speaks directly to their condition. For it is peculiarly the Christian witness. They still hear it, whenever it truly reaches their ears, the ring of those glad tidings that once stirred mankind with an immense hope. For it frees them from the trap of irreversible Fate at the point at which it whispers to them that each soul is individually responsible to God, that it has only to assert that responsibility, and out of man’s weakness will come strength, out of his corruption incorruption, out of his evil good, and out of what is false invulnerable truth.

Wow.

The Future in Health Care

From the New England Journal of Medicine, a recent physician survey on the effects of the pending health care reform legislation on physician supply:

Key Findings

Physician Support of Health Reform in General

• 62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.
• 28.7% of physicians are in favor of a public option.
• 3.6% of physicians prefer the “status quo” and feel that the U.S. health care system is best “as is.

Health Reform and Primary Care Physicians
• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

Health Reform, Public Option, and Practice Revenue/Physician Income
• 41% of physicians feel that income and practice revenue will “decline or worsen dramatically” with a public option.
• 30% feel income will “decline or worsen somewhat” with a public option.
• 9% feel income will “improve somewhat” with a public option, and 0.8% feel income will “improve dramatically” with a public option.

Health Reform, Public Option, and Physician Supply
• 72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.
• 24% of physicians think they will try to retire early if a public option is implemented.
• 21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.

Health Reform and Recommending Medicine to Others as a Career
• 36% of physicians would not recommend medicine as a career, regardless of health reform.
• 27% would recommend medicine as a career but not if health reform passes.
• 25% of physicians would recommend medicine as a career regardless of health reform.
• 12% would not recommend medicine as a career now but feel that they would recommend it as a career if health reform passes

And this from the New York Times today:

With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise [hedge alert!] if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.

In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

What the Times neglects to mention is that physicians’ overhead expenses substantially exceed these reimbursements — every Medicaid patient seen will cost the physician more than they will be reimbursed, often substantially more. Malpractice premiums annually for obstetricians? Generally well over $100,000. It takes a lot of $29 office visits to pay for that — and that’s just one part of overhead.

So, for those who believe we have to do “something” to fix health care, so let’s just pass this monstrosity and fix it later, this is what you’re looking at: fewer doctors, already in significant shortage; health “insurance” that pays so poorly no physician will be financially able to see you.

My suggestions, if this health care bill passes? 1) stay healthy, very healthy; 2) start saving a lot of money, since your only access to health care will likely be a shadow system where physicians will see you for cash only.

Welcome to the new millennium in health care.

What’s the alternative? Well, I hope to lay some out in the near future, time permitting.

Taking the Blue Pill, Rather than the Hip Replacement

As the Democrats in Congress press forward in blind determination to pass their health care reform legislation come hell or high water, the pernicious effects of the legislation are increasingly becoming evident to anyone who takes the time to dig into its details. Though our Congressional representatives cannot seem to find the time to read these gargantuan, 2000-page bills, busy as they are padding their pockets with filthy lucre from lobbyists and interest groups, those at the state level who are will be responsible for picking up the credit card bills from this monomaniacal spending spree are starting to sweat. Even the Blue states — no strangers to fantasy spending budgets, punitive taxes, and political giveaways — can see the handwriting on the wall.

Out here in scenic Washington — where Patty Murray is considered an astute statesman and Jim McDermott is considered sane — the details of Obamacare are becoming frighteningly clear:

Washington has a 13.2% uninsured rate and one half of these people are in the age range of 18-34. Because of the bill \'s individual mandate that would require every adult to buy health insurance, 432,000 young healthy people in the state would be forced to make this purchase … The bill also requires a community rating price control on all policies which would cause these young Washingtonians to pay a higher price for coverage, while older, sicker individuals would pay less for their insurance.

There is something of a sweet irony here: those who voted overwhelmingly for Obama and who much prefer spending money on grunge music, Hempfests, and gas masks are about to wake up and find themselves paying hefty premiums to greedy insurance corporations, or facing big fines or jail time for refusing to do so — proving there truly is Karma in the world.

The Avatar-blue seasoned citizens will likewise find themselves unpleasantly surprised:

On the other end of the age spectrum, 890,000 seniors have Medicare coverage in Washington. Congress plans to finance the Senate bill in part by cutting Medicare by $471 billion. Physician reimbursement would be reduced by 21%, while Medicare Advantage would essentially be eliminated, forcing 205,000 Washington seniors out of the program and back into traditional Medicare. Access to doctors is already a problem for Washington seniors because of low Medicare payments compared to private insurance. Further cuts in how much Medicare pays doctors will only make this access problem worse for seniors.

In fairness here, the 21% cut in physician reimbursements is by no means certain: Congress has consistently blocked these “budget neutrality” cuts in the past (to prevent a mass exodus of physicians willing to see Medicare patients), even though they use the imaginary $250 billion “savings” as part of the budgetary chicanery to make Obamacare look affordable.

But Medicare Advantage plans are squarely in the sights of the Congressional cost-cutting guns. These plans provide benefits to Medicare patients using private health insurance, typically providing much better benefits than Medicare alone while costing less than expensive supplemental plans which merely cover Medicare’s substantial co-pays and deductibles. MAs are very popular — 30-40% of Medicare-eligible patients use Advantage plans, and the percentage has been growing rapidly. The drastic slash in funding for MA plans will result in benefit cuts and stiff premium hikes, driving many patients back to traditional Medicare, drastically ratcheting up out-of-pocket expenses for the elderly and cutting many of their benefits.

And it should be stressed that physician access problems in Medicare patients (it is extremely difficult in Washington to find primary care physicians who accept new Medicare patients, and the specialists are fast bringing up the rear given Medicare’s drastic cuts in fees to specialists) are not simply about low payments, and greedy doctors wanting more money; it is about reimbursing physicians to provide care at levels substantially lower than their overhead costs.

Quite simply, when you see a Medicare patient, you lose money.

Of course, you don’t have to be young or on Medicare to reap the benefits of health care reform:

Almost 130,000 Washington residents have health savings accounts (HSAs) and high deductible insurance plans. The Senate bill reduces the HSA contribution amount by one half and doubles the penalty for non-medical withdrawals. New government limitations will probably eliminate high deductible policies and consequently eliminate HSAs. All HSA holders would lose their personal coverage and be forced to buy traditional insurance.

The Seattle area has growing industries in biotech and medical device manufacturing. The Senate bill would add a 10% to 20% tax on these businesses. The cost would either be passed on to consumers or, more likely, would cause a reduction in medical research and development.

Almost 2.7 million workers and their family members in Washington receive health insurance through their employers’ self-insured programs. These people would be allowed to keep their insurance for five years. The plans must then comply with strict government benefit plans which would cause many employers to drop their coverage and force many workers to join a government plan. In addition, generous employer-sponsored insurance will be subject to a new 40% tax. In three years, 20% of all workers will be paying this tax and in six years, 20% of all households making more than $50,000 a year will have to pay this tax.

And then there’s Medicaid — coverage for the poor co-funded by federal and state governments. Obamacare extends health insurance to the uninsured poor by greatly expanding Medicaid, which is already well on its way to bankrupting the states:

Under the Senate-passed bill the number of Medicaid recipients in Washington would immediately increase by over 280,000 people. The federal taxpayers would initially pay for these new enrollees, but within five years state taxpayers would be forced to pay at least $6.8 billion more over the following ten years. The total cost of Medicaid to Washington taxpayers would then be nearly $36 billion for that ten year period. Access to doctors for Medicaid patients is even worse than for Medicare patients because of lower doctor reimbursement rates. Adding hundreds of thousands of people to Medicaid, when these patients are already being turned away by doctors, makes no sense for either patients or taxpayers.

This is fiscal insanity, akin to buying a ticket for passage on the Titanic after it has hit the iceberg.

Washington State is hardly alone in its terror about the coming health care regime. California, whose credit rating is shakier than a welfare queen on crack, is looking at financial and medical Armageddon as well. From the New York Times:

The [California Medicaid] program, known as Medi-Cal, currently serves roughly 6.5 million poor Californians. And that number could increase by 2 million under the pending legislation. Congress wants to use the Medicaid program as a way to cover more of the uninsured poor, reasoning that it’s a relatively cheap way to go by relying on existing programs.

But doctors say only a third of the state’s 60,000 practicing physicians are participating in the program because of low reimbursement rates, and they fear that more physicians will opt out.

“Increasing eligibility for Medi-Cal without increasing reimbursement rates would be catastrophic,” said Brennan Cassidy, president of the 35,000-member California Medical Association. “There’s no place for those patients to go for primary care because doctors aren’t accepting them.”

Again, the problem is not merely “low reimbursements” — it is Medicaid payment rates which cover less than half a physician’s costs to see the patient.

It is difficult to overstate how disastrous the pending Congressional legislation will be for health care and our nation’s financial stability. Are we really getting ready to jump off this precipice?

Sadly, it appears so.

Our Gnostic Masters

The madman is not the man who has lost his reason. The madman is the man who has lost everything but his reason.
 
       — G.K. Chesterton —

We have become a nation of experts.

They are everywhere: on TV, advising us about raising our children or improving our sex life; in magazines and newspapers, lending a measure of weight to opinion pieces disguised as news; in business, promising to improve productivity and bolster profits through higher productivity, or slicker marketing, or yet another reorganization or “team-building” project. They are ubiquitous in government and politics, lending credence to the implausible and certainty to the unpredictable. Armed with statistics, and studies, and the ethereal proclamations of other unnamed experts like unto themselves, they saturate our psyche with innumerable “facts” and figures, that we may live perfect lives in an imperfect world. The chaos which swirls around us need not engender fear and hopelessness — there will always be an expert to hold your hand, lest you become lost and wander from life’s perfect path.

Intimidated by their credentials and self-assured certainty, we slowly relinquish the uneasy feeling that their advice and conclusions invariably run counter to our experience, and common sense, and the simple wisdom of life acquired through parents and parish, logic and lore. Theirs is a relentless battering of our natural defenses, made ever more potent by lives lived without margin, frantically running to and fro, pursuing the very goals our experts have set forth, while quietly dying to the insight gained by simplicity and satisfaction with life’s precious but fragile treasures. Their strident advocacy drowns out the the quiet wisdom whispered to the soul in contemplation and prayer, found only in reflection and the fertile soil of rich relationships.

The fecklessness of our experts is often utterly dispensable, if annoying, as our guilded guides waffle from truth to contradictory truth: “Take estrogen!” “Don’t take estrogen!” “All fats are bad!” “These fats are good!” “Sun causes cancer!” “Sun prevents cancer!” What is true today will be foolishness tomorrow — and nary a hint of humility will be heard from those who hustled us mere months before.

As our increasingly secular and superficial culture abandons the transcendent truths of faith and the tested wisdom of tradition, we search desperately for a lodestone upon which to ground our lives, and so trade trust and belief in transcendent and transformational absolutes for fear and the desperate desire to control the world which has become our enemy. We frantically cling to every proffered proof, no matter how foolish or feckless, seeking something upon which to ground and anchor our lives. As these sands shift dangerously beneath our feet, we lurch and stumble from fragile branch to broken rail, as we stagger along a path which leads ever downward.

Yet the allure of the experts can prove far more destructive than mere personal angst in a turbulent, fast-moving world: how many listened to the professionals who told us we could not lose in real estate? Leverage to the max, it can only go up! The consequences across the economy have been devastating — except for those who sold us this sage advice. These “experts” understood the game far better than the market, and walked away unscathed and wealthy, leaving only our wreckage in their wake.

Our dependence on the guidance of scientists, economists, educators, and technocrats proves especially toxic when their expertise becomes wedded to money and political influence. Under the guise of shielding us from the complexity of their disciplines, they evolve into closed guilds, guardians of a secret knowledge which we, in our harrowed and hectic lives, have no time and little interest in understanding. As our educational system — itself run by a closed guild — produces generations of students tutored in woman’s studies, postmodern deconstructionism, and the evils of the West, yet ignorant of logic, philosophy, and the rigors of the hard sciences, the problem is compounded. We increasingly are left with little recourse but to trust those who guard and disperse the hidden knowledge we no longer comprehend. Our gnostic masters dispense their wisdom; ours is but to nod, and obey.

Nowhere can this process better be seen than the unfolding drama surrounding the East Anglia email scandal. Centered on one of the three major centers for climate research and data in the world, the hacked emails and software code have ripped open the veil to show us the inner sanctum of science utterly corrupted and politicized. At issue is anthropogenic global warming (AGW) — the theory that recent warming trends in global temperatures are caused by rising levels of carbon dioxide from human activity, fostered by industrialization. It has long been a theory which struggled to pass the sniff test, placing undo weight on a trivial component of so-called greenhouse gases, while ignoring the enormous (and obvious) impact of solar activity, water vapor, and cloud cover. Yet for years we have been told — in increasing shrill and strident tones — that this theory is “settled science,” and there is an imminent crisis at hand.

It has been fascinating to watch this ball of yarn unravel. In what may prove to be the greatest hoax mankind has ever witnessed — most certainly the one with almost unimaginable financial impact globally — we are watching the “settled science” of AGW disintegrate. We read how data was manipulated to hide declining global temperatures and make them appear to be rising sharply (“Mikes nature trick“). The peer review process made sure no contrary or skeptical opinions were published, and efforts were made to delegitimize journals which published such articles. Proxy data such as tree-rings were cherry-picked to ensure that the data conformed to the AGW philosophy. FOIA requests for data were met with stonewalling and destruction of raw data. The homogenization of temperature station data — making adjustments to the temperatures to reflect changes in the surrounding environment, such as urbanization — showed shows striking and arbitrary adjustments to demonstrate a sharp rise in temperatures when no such changes existed in the raw data. Other major climate research centers are similarly stonewalling raw data requests. The data problems just scratch the surface; the software used to generate reports and alarmist graphs was incompetently written by amateur programmers — and could not even reproduce the graphs from the original data without massive software hacks and fudge factors — by the programmer’s own admission.

The response of climate scientists to these devastating revelations? Denial and attack. The response of the UN Climate gurus and American and Western policy makers? Denial and attack. The response of the media to this massive global meltdown of AGW “settled science? Silence.

Amazing.

Whatever the role of human activity in global warning, one thing is abundantly evident: the current “science” of AGW is not really science at all, but more closely resembles a pernicious, cultic religion. Its priesthood holds the secret knowledge about “climate change,” and we the fools who question or challenge them engender naught but condemnation, ridicule, hatred and disdain. For the priesthood and the true believers who bow to them, the payoff for guarding their secrets are huge: for our scientist priests, millions in research grants, often at taxpayer expense; for the evangelists (Al Gore comes to mind), the ability to engender hysteria with wild, apocalyptic climate claims while raking in millions on carbon trading and investments in “green” technology; for the politicians, the opportunity to further extend the control and power of government into every aspect of its citizens lives while pocketing huge political contributions from environmental groups and green industries.

We have been lectured endlessly by our postmodern mentors that religion is naught but ignorance and superstition, while scientific “facts” are Truth. But “knowledge is power,” as the saying goes — especially when the knowledge can be hidden behind a veil of secrecy, manipulated at will to conform to unchallengeable presuppositions and philosophies, then relentlessly drilled into our collective consciences through compliant and complicit channels of media, education, and politics.

The climate scientists are hardly alone in such gnostic gambits; evolutionary biology — whose “scientists” seem to spend most of their efforts proving that God doesn’t exist rather than demonstrating that their tattered and threadbare theories of evolution have an actual basis in reproducible science and genetics, and a demonstrable and reliable predictive value (which all solid science must have) beyond the the pure speculation and projection that comprises most evolutionary science. Think I’m being a crazy fundamentalist creationist? Try, as a scientist, to demand that evolutionists satisfactorily answer any host of devastating challenges to their theories: the irreducible complexity of biological subsystems such as the eye, the cellular mitochondria and intracellular protein factories; the entropy problem (complex systems tend naturally to disorder and chaos, not more complexity); the Cambrian explosion; the impossibly long odds that all physical constants stood at precisely the correct values at the instant of the Big Bang; the enormous problem of free will, higher intellect, and purpose in the human animal which has no precursors in lesser beasts. Challenge these — even with understated, respectful, and serious questions — and watch how quickly the ad hominem attacks begin, how quickly you will be excluded from “peer reviewed” literature, ridiculed and ostracized, and labeled as an ignorant creationist fundamentalist, an enemy of science — or worse.

In our repudiation of a world based on absolutes and transcendency, our free fall into secularization has ironically left us clinging to science as our sole absolute, our foundation in a world which no longer makes sense, in which there are no true absolutes. Yet science cannot bear such weight alone, detached as it has become from notions of absolute truth and the true nature of the creation that is man and his universe. It has become instead a tool of power, and manipulation, and deception. The ship of knowledge no longer has an anchor, and drifts aimlessly toward the rocks of self-righteous deception and the shoals of arrogance.

G.K. Chesterton, writing nearly a century ago, mused that “this is the age in which thin and theoretic minorities can cover and conquer unconscious and untheoretic majorities.” What was true then is ever more true today, as we relinquish our own convictions and the truths which come by faith and tradition for the perilous tyranny of rule by experts. True freedom requires absolute truth, with its liberating transparency and the humility of knowing we are not gods. Science detached from absolutes will not bring progress but peril, not truth but tyranny. In our quest for the Utopia which technology enticingly promises, to forget our foundational truths is to invite disaster and slavery.

Sadly, we are already well on our way.

The Non-Reform Health Care Bill

In the dark of night, appropriately, the Senate last night voted to end debate on its health care reform bill, bringing it to a floor vote. From Commentary magazine comes the following assessment of what will be voted on:

The non-reform health-care bill does, to the disgust of liberals, make insurance companies very happy. The government is coercing customers to buy the companies’ products under penalty of prosecution and fine. The non-reform health-care bill does, to the horror of seniors, slash $500B out of Medicare with no conceivable alternative other than rationing to meet its new budget. The non-reform health-care bill does, to the delight of trial lawyers, do nothing to reform the tort system or the problem of defensive medicine. And the non-reform health-care bill does, to the chagrin of deficit hawks, do nothing to bend the cost-curve or cut the deficit. (James Capretta explains: “For starters, as CBO notes, the bill presumes that Medicare fees for physician services will get cut by more than 20 percent in 2011, and then stay at the reduced level indefinitely. There is strong bipartisan opposition to such cuts. Fixing that problem alone will cost more than $200 billion over a decade, pushing the Reid plan from the black and into a deep red.”) Finally, the non-reform health-care bill will, to the embarrassment of good-government types, in all likelihood get passed through a combination of bribery and secrecy, with virtually no time for thoughtful consideration.

On every level it \'s a policy train wreck.

Not to mention that it pushes many of the uninsured into Medicaid, in a massive expansion of a program which is bankrupting the states, and which very few physicians can afford to take due to abysmal reimbursement rates which do not come close to covering expenses. The 22% Medicare fee cuts to physicians — one of the many accounting gimmicks thrown in to make this bill appear to be financially viable — will, if enacted, lead to a mass exodus of physicians from Medicare as well. Universal insurance coverage (which this bill does not even achieve) does not equal universal access, as we are about to discover to our horror and dismay.

I am doing my best to be sanguine about things over which I have no control, but it is difficult to watch the death of a profession and a superb health care system, to advance the partisan agenda of the power-hungry crooks and cronies who make up our current government. Revulsion is not too strong a word.

We will live to rue the day this disaster passes into law.

UPDATE: From the WSJ:

The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that “reform” has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state. An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it, as Finance Chairman Max Baucus admitted on the floor last week. The only goal is to ram it into law while the political window is still open, and clean up the mess later.

***

• Health costs. From the outset, the White House’s core claim was that reform would reduce health costs for individuals and businesses, and they’re sticking to that story. “Anyone who says otherwise simply hasn’t read the bills,” Mr. Obama said over the weekend. This is so utterly disingenuous that we doubt the President really believes it.

The best and most rigorous cost analysis was recently released by the insurer WellPoint, which mined its actuarial data in various regional markets to model the Senate bill. WellPoint found that a healthy 25-year-old in Milwaukee buying coverage on the individual market will see his costs rise by 178%. A small business based in Richmond with eight employees in average health will see a 23% increase. Insurance costs for a 40-year-old family with two kids living in Indianapolis will pay 106% more. And on and on.

These increases are solely the result of ObamaCare --above and far beyond the status quo --because its strict restrictions on underwriting and risk-pooling would distort insurance markets. All but a handful of states have rejected regulations like “community rating” because they encourage younger and healthier buyers to wait until they need expensive care, increasing costs for everyone. Benefits and pricing will now be determined by politics.

As for the White House’s line about cutting costs by eliminating supposed “waste,” even Victor Fuchs, an eminent economist generally supportive of ObamaCare, warned last week that these political theories are overly simplistic. “The oft-heard promise ‘we will find out what works and what does not’ scarcely does justice to the complexity of medical practice,” the Stanford professor wrote.

• Steep declines in choice and quality. This is all of a piece with the hubris of an Administration that thinks it can substitute government planning for market forces in determining where the $33 trillion the U.S. will spend on medicine over the next decade should go.

This centralized system means above all fewer choices; what works for the political class must work for everyone. With formerly private insurers converted into public utilities, for instance, they’ll inevitably be banned from selling products like health savings accounts that encourage more cost-conscious decisions.

Unnoticed by the press corps, the Congressional Budget Office argued recently that the Senate bill would so “substantially reduce flexibility in terms of the types, prices, and number of private sellers of health insurance” that companies like WellPoint might need to “be considered part of the federal budget.”

With so large a chunk of the economy and medical practice itself in Washington’s hands, quality will decline. Ultimately, “our capacity to innovate and develop new therapies would suffer most of all,” as Harvard Medical School Dean Jeffrey Flier recently wrote in our pages. Take the $2 billion annual tax --rising to $3 billion in 2018 --that will be leveled against medical device makers, among the most innovative U.S. industries. Democrats believe that more advanced health technologies like MRI machines and drug-coated stents are driving costs too high, though patients and their physicians might disagree.

“The Senate isn’t hearing those of us who are closest to the patient and work in the system every day,” Brent Eastman, the chairman of the American College of Surgeons, said in a statement for his organization and 18 other speciality societies opposing ObamaCare. For no other reason than ideological animus, doctor-owned hospitals will face harsh new limits on their growth and who they’re allowed to treat. Physician Hospitals of America says that ObamaCare will “destroy over 200 of America’s best and safest hospitals.”

• Blowing up the federal fisc. Even though Medicare’s unfunded liabilities are already about 2.6 times larger than the entire U.S. economy in 2008, Democrats are crowing that ObamaCare will cost “only” $871 billion over the next decade while fantastically reducing the deficit by $132 billion, according to CBO.

Yet some 98% of the total cost comes after 2014 --remind us why there must absolutely be a vote this week --and most of the taxes start in 2010. That includes the payroll tax increase for individuals earning more than $200,000 that rose to 0.9 from 0.5 percentage points in Mr. Reid’s final machinations. Job creation, here we come.

Other deceptions include a new entitlement for long-term care that starts collecting premiums tomorrow but doesn’t start paying benefits until late in the decade. But the worst is not accounting for a formula that automatically slashes Medicare payments to doctors by 21.5% next year and deeper after that. Everyone knows the payment cuts won’t happen but they remain in the bill to make the cost look lower. The American Medical Association’s priority was eliminating this “sustainable growth rate” but all they got in return for their year of ObamaCare cheerleading was a two-month patch snuck into the defense bill that passed over the weekend.

The truth is that no one really knows how much ObamaCare will cost because its assumptions on paper are so unrealistic. To hide the cost increases created by other parts of the bill and transfer them onto the federal balance sheet, the Senate sets up government-run “exchanges” that will subsidize insurance for those earning up to 400% of the poverty level, or $96,000 for a family of four in 2016. Supposedly they would only be offered to those whose employers don’t provide insurance or work for small businesses.

As Eugene Steuerle of the left-leaning Urban Institute points out, this system would treat two workers with the same total compensation --whatever the mix of cash wages and benefits --very differently. Under the Senate bill, someone who earned $42,000 would get $5,749 from the current tax exclusion for employer-sponsored coverage but $12,750 in the exchange. A worker making $60,000 would get $8,310 in the exchanges but only $3,758 in the current system.

For this reason Mr. Steuerle concludes that the Senate bill is not just a new health system but also “a new welfare and tax system” that will warp the labor market. Given the incentives of these two-tier subsidies, employers with large numbers of lower-wage workers like Wal-Mart may well convert them into “contractors” or do more outsourcing. As more and more people flood into “free” health care, taxpayer costs will explode.

• Political intimidation. The experts who have pointed out such complications have been ignored or dismissed as “ideologues” by the White House. Those parts of the health-care industry that couldn’t be bribed outright, like Big Pharma, were coerced into acceding to this agenda. The White House was able to, er, persuade the likes of the AMA and the hospital lobbies because the federal government will control 55% of total U.S. health spending under ObamaCare, according to the Administration’s own Medicare actuaries.

Others got hush money, namely Nebraska’s Ben Nelson. Even liberal Governors have been howling for months about ObamaCare’s unfunded spending mandates: Other budget priorities like education will be crowded out when about 21% of the U.S. population is on Medicaid, the joint state-federal program intended for the poor. Nebraska Governor Dave Heineman calculates that ObamaCare will result in $2.5 billion in new costs for his state that “will be passed on to citizens through direct or indirect taxes and fees,” as he put it in a letter to his state’s junior Senator.

So in addition to abortion restrictions, Mr. Nelson won the concession that Congress will pay for 100% of Nebraska Medicaid expansions into perpetuity. His capitulation ought to cost him his political career, but more to the point, what about the other states that don’t have a Senator who’s the 60th vote for ObamaCare?

UPDATE 2: from Robert Samuelson, WaPo:

These fears are well-grounded. The various health-care proposals represent atrocious legislation. … So Obama’s plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation’s passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.

Samuelson argues that the uninsured will receive better care because more of them are covered. Of course, that is only true if they can actually get to see a physician who accepts their Medicaid coverage, which is already an enormous problem, and will certainly grow worse. I suspect they may actually receive better care now, uninsured, than they will covered under Medicaid.

No Death Panels Needed

Over at Big Government, we get a glimpse of where ObamaCare will take us: Health Care \'s Coming Heart Attack – A Pre-Obama Care Death Panel?

I am writing of the Obama Administration \'s – regulatory decision – to go ahead with a massive cut in Medicare payments to cardiologists. I emphasize that this is a regulatory decision because it was not made by the Congress legislatively (not that that would be ok) but, instead, it was made by the massive Health and Human Services Department of the US Government. Given the limited resources of the Medicare budget, in order to increase payments to general practitioners (in an effort to attract more such doctors – a good idea), bureaucrats needed to gore somebody \'s ox and cardiologists were chosen (a horrible idea).

The decision to do so is astonishing.

Keep in mind that the very purpose of health care is to improve the health and therefore the lives of Americans. The cardiologist community has been wildly successful in that endeavor. Although heart disease remains the #1 killer of Americans, the mortality rate for heart attacks has plummeted. For instance, the post-heart attack, 30-day mortality rate decreased from 18.9 percent in 1995 to 16.1 percent in 2006 and the in-hospital mortality rate decreased from 14.6 percent to 10.1 percent.

Further, between 1994 and 2006, the mortality rate among women 55 and under who suffered a heart attack dropped an incredible 52.9%. For men in that same age group the drop was 33.3%. According to the author of the mortality study that determined those latter figures: “It appears that risk factors, which may be controlled through prevention efforts, are very important in driving these mortality reductions.”

Given those figures, it is hard to argue with the success of cardiologists who sit on the forefront of heart care and heart disease prevention – unless, of course, you are a government bureaucrat.

Rather than pouring more dollars into an obviously successful branch of medicine that is saving lives (the ultimate purpose of health care?), the Obama Administration is going ahead with a plan to cut nearly $1.5 billion from Medicare payment to cardiologists. Obama is doing so by such devices as literally eliminating reimbursement for certain services and/or reducing the amount they will pay for others. Case in point, cardiologists have been able to bill for an extended first visit with Medicare patients to get their history and to recommend a course of treatment. As of January 1, 2009 [2010 – ed.] – no longer.

What is being referred to here is Medicare’s decision to eliminate consultation service codes as of Jan 1 2010. These codes are almost exclusively used by specialists, and pay substantially better than standard visit codes, reflecting the higher complexity of care typically involved in specialty care. It is not just the cardiologists who are affected by this administrative change in Medicare payment — it is all specialists: oncology (cancer treatment), infectious disease, pulmonary, surgical specialties such as orthopedics, urology, ENT, neurosurgery, cardiac surgery, etc. etc. They are betting on a premise already proven false: that preventive medicine through primary care will reduce costs.

Specialty care is more expensive because specialists care for the sickest and most complex patients. When you are having your acute MI, you need a cardiologist, not a family practice physician. Specialty care is where the vast number of advances in American medicine have taken place — the advances which give us the best results in the world in cancer treatment, heart disease, and surgical advances such as laparoscopy and other minimally invasive procedures.

The inevitable outcome of these changes are that Medicare patients will have reduced access to specialists, as specialists increasingly are unable to afford taking a loss on every Medicare patient they see due to reimbursements which fall below their costs of providing care. They will by necessity reduce the number of Medicare patients specialists see, or force them to stop seeing Medicare patients altogether, resulting in longer waits to see a specialist and regional shortages of care in these areas. One does not need “death panels” to make policy changes which restrict care to the elderly and disabled; quiet bureaucracy works every bit as well, with the added advantage of plausible deniability.

Welcome to the new millennium in health care. Hope you enjoy your government-run universal health care.