Conservatives and the moral high ground

I had read the column by J. Pepper Bryars earlier in the week with my AL.com application on my smart phone and could barely restrain myself from writing before it was published in the Huntsville Times.

What follows is my letter to the editor on the matter.

On the one hand, I agree with his observation of the apparent hypocrisy in the conservative "acceptance" of Donald Trump's moral turpitude with respect to his three marriages.

I disagree, on the other hand, with his premise that seems to say that conservatives have traditionally held the high ground when it comes to moral decisions, that we live in a world of black and white choices where there generally are no shades of gray.

Let's review some history and see where conservatives have found themselves.

Slavery -- conservatives argued for the peculiar institution.

Emancipation -- conservatives opposed freeing of the slaves.

13th amendment -- conservatives opposed granting citizenship to the freed slaves.

Women's rights -- conservatives opposed "giving" women the right to vote.

Labor law -- conservatives have always sided with management with regard to worker rights.  They generally have opposed unions and that whole "collective bargaining" thing.

Child labor -- where were the conservatives advocating for the elimination of children working in sweatshops (and worse)?

Civil rights -- guess who opposed the Civil Rights Act and the Voting Rights Act of the 1960s.

Vietnam War -- now here's one where neither party has a corner on the right side of history.  Eisenhower started with military advisers, Kennedy ramped up, Johnson took us all the way in, Nixon slowly and painfully removed us (but not until he'd won a second term).  Still, there were few "conservatives" to be found in the anti war movement.

Equal Rights Amendment -- conservatives claim unnecessary, but women still don't earn as much as men in the same job.  Passed the senate in 1972, but failed to carry three fourths of the states in the ratification process.

As for living in a world where there are few shades of gray:

1. Consider how we all recognize national sovereignty (especially our own) but are wrestling with certain countries (Syria, North Korea, Iran) that could really stand a change in regime.  A word of caution:  we've tried regime change in other countries before and that has worked so well for us, hasn't it?
2. Health care -- a right?  a privilege?  Oh, Mr. Byars, don't think I've forgotten your previous column where you claimed the system in Europe is in tatters but we have the greatest healthcare system on earth.  Both claims should be reviewed with the actual data.
3. Russia -- friend or foe?
4. China -- our administration wants its help in dealing with North Korea, but has everyone forgotten about what China is doing in the South China Sea?
5. Israel -- ally, worthy recipient of our aid, but serial abuser of Palestinian rights.

I hope I've made my points.  Conservatives cannot claim the moral high ground.  The world is full of shades of gray.  Moral dilemmas abound.

What do you think?

Something some politicians obviously don't understand about healthcare

We (the media, the politicians, regular people who care) are all agog about the most recent development in the discussion about the nation's health care:  the GOP proposal to repeal (partially) the Affordable Care Act.

I've heard a quote from a Congressman that uninsured people can always use the emergency room for their health care.

No!  That is wrong on so many levels, so let me hit the high points.

The emergency room is the most expensive environment to receive routine care.  The reason, primarily, is that the fixed costs associated with an ER are high because the ER has to be prepared to treat the most critically injured or ill patient.

Next high point:  An ER, by law, cannot turn a patient away regardless of the patient's ability to pay.  When an ER sees an uninsured patient (at an average cost in excess of $1200, that patient must pay out of pocket.  Since few of us are prepared to fork over that much money, the care falls into the category of "uncompensated".  But a hospital has to stay in business, so how does it cover the cost of that care?

A public hospital, underwritten by a city or county government, turns to the taxpayer to make up for the loss.  In addition, it may, like the private hospital, attempt to shift costs to insured patients, by raising prices to recover the costs, hopefully, from those patients' insurance companies.

One of the motivations behind the Affordable Care Act  was to provide insurance coverage to more people so that they could go to their doctor for their routine care and not strain the health system's emergency rooms' resources.

Twenty odd years ago, when Tennessee conducted the great Tenncare experiment, converting Medicaid to a managed care model and expanding Medicaid coverage, the hospitals were primary supporters of the effort, for precisely this reason.

So reducing the number of insured lives will eventually hit everyone's pocket, either through taxes or through higher insurance costs.

So, please, get it out of your head that the ER is the best safety net for uninsured people.  It doesn't provide appropriate level care and it is too expensive (especially when you multiply one visit by 24 million lives).

What do you think?

The Military

Let me say from the outset that I'm going to try to avoid getting myself into a lot of trouble, but am likely to fail.

This issue most recently made it into my thought processes during the Republican presidential primary season.  Everyone, it seemed, felt that the military needed to be rebuilt and that more money needed to be spent on the military.

That led me to investigate just how much money we appropriated for the military.  The first thing I learned was that the spending is divided into two categories, discretionary and mandatory.

The latter is formula driven and consists of Social Security, Medicare and Health (including Medicaid), Veterans' Benefits, Transportation, Food and Agriculture, and some other areas.  It is the larger portion of the budget (about $2.45 trillion for FY 2015).  However, it should be noted that some of the largest portion of these expenses are offset by the Social Security and Medicare Trust funds, into which payroll taxes have been paid over the course of the working lives of citizens.  

The smaller portion, discretionary spending, (about $1.11 trillion for FY 2015) is determined by Congress.  Congress decides how much is going to be spent and on what.  For FY 2015, the appropriation for all things military was $598.49 billion or about 53% of the total for discretionary spending.  So, defense spending is clearly the highest priority when it comes to discretionary spending.  Lower priority categories include government (to fund the executive, legislative, and justice departments), education, additional Medicare and Veterans' Benefits spending, housing, etc.)    See Federal spending for additional details and an informative description of the budget process.  

Do we ever think about the details of that spending?

We pay the salaries and benefits for military personnel, we pay for equipping those personnel and for the development of weaponry.  We pay for the upkeep of some 800 military bases throughout the world.

I'd like to raise a couple of questions for pondering.  First, does anyone else wonder about our having military bases all over the world?  Does this trace back to the "manifest destiny" philosophy of the 1800s?  For an excellent summary, read US bases in foreign countries.
Most of the growth took place during World War II and the Cold War.  Has anyone noticed that WWII is over as is the Cold War?  Why do we still have all these bases?  Does anyone wonder why we even have a military base on Cuba of all places?

Now, the Trump Administration wants to increase defense spending by 50+ billion dollars, alleging that our military has fallen into disrepair.  Really?  Does anyone really believe that?  If so, what has the Congress been doing with the incredible amounts of money we've already spent on defense?  How could they let it fall into such a tattered condition?

Why do we spend more on our defense than the next 10 countries combined, at least 8 of whom are considered allies?

What do you think the reaction would be if, say, Russia built a base in Canada?  Or France built a base in New York state?  Wouldn't we complain of imperialist intentions?

We do not have an emperor, yet, but with the number of bases we have girdling the globe, it looks as though we have an empire.

Let's assume that we really don't need that extra $50 billion to be spent on the military.  Let's also assume we really don't even need the $600 billion we're spending now, that we could "live" on spending $400 billion.  Imagine what could be done with that extra $200 billion dollars.  How much infrastructure could we address?  How much healthcare and research into cancer, ALS, diabetes, and other debilitating diseases could we support?  How could education benefit?

I think we should rethink our priorities.  What do you think?

Let's not repeat 2009

Seeing some of the "town hall" meetings disrupted by protesters opposing  Donald Trump's actions as well as the actions of the Republican Congress took me back to 2009 when the nascent Tea Party was using similar tactics to voice opposition to the government bail outs of the financial system as well as to voice opposition to a newly elected President.

It seems to me that belligerence generates more heat than light.  Shouting down your representative falls into the same uncivil trap as 8 years before.  To paraphrase Michelle Obama, "They went low, we go high!".  It also gives people like Alabama Representative Mo Brooks the opportunity to avoid such meetings with constituents, claiming the need for additional security against "anarchists".

The point is, progress will not be made when you start with a shouting match.  I am a firm believe in civil dialogue as the best way forward.

What do you think?

Healthcare -- Who pays for what?

Obamacare, Medicare, Medicaid, Private Insurance.  Who pays for what?

The answer, unless you have absolutely zero assets, is you.

First, if you are employed and your employer offers health insurance as a benefit, you pay premiums to an insurance company so that you will have health coverage.  These premiums are usually deducted from each paycheck.  (Your employer typically also pays a portion of your premium, but we'll get to that later.)

But you're not finished paying yet.  Your policy, in order that you can "share" the cost of healthcare with your insurance company, requires that you pay a deductible.  For hospital related charges, that means you must pay everything up to a certain level.  That's what the deductible is.  If I have a $1,000 deductible, I must pay hospital (and lab, x-ray, CT, MRI) charges up to $1,000 before the insurance company starts to pay.

Wait, there's more.  If you go to a doctor, there is  something called a "copay".  If I have a $30 copay, that means I pay $30 every time I go to the doctor, and the insurance company pays the rest of the charge.

Finished?  No.  Now we have to talk about co-insurance.  The easiest way to understand this is to consider an example.  Let's suppose you have an appendectomy.  Further, let's suppose your doctor charges $1,000 for the procedure.  Your insurance company has decided that they will only "allow" $800 for the procedure.  So your doctor has a fee schedule, but the one that counts is your insurance company's.  Your doctor, by agreeing to be part of the insurance company's "network", also agrees to the discounted rate on the company's fee schedule.  Now, your policy usually has language like "the company will pay the doctor 80% of the allowed amount".  That means the company will pay $640 for the appendectomy and you foot the bill for the remaining $160, the co-insurance.  If you have a second insurance policy (e.g., both you and your spouse are covered through work), then the secondary coverage steps in to pay the "co-insurance".

Let's summarize so far.  You pay insurance premiums, deductibles, copay, and coinsurance.  Got it so far?

That's all, right?  No, next you pay for health coverage for when your retire.  That's called Medicare.  Every time you are paid, 1.45% of your pay is deducted from your check and sent to the Federal Government for deposit into something called the Medicare Trust Fund.  Your employer contributes an equal amount to the Trust Fund.  So, in a way, you are paying premiums for your healthcare now and for when you retire.

Whew, thank God that's over, right?  Not by a long shot.

Let's talk about Medicaid, government provided health insurance for the poor.  It is a collaborative program provided by both the Federal and state governments.  Taxes fund Medicaid.  Who pays taxes?  You do.

Now, to the uninsured.  People lack insurance for one of two reasons:  they can't afford it or they refuse to have it, preferring, they think, to pay for all their healthcare out of their own pocket.

The problem with the latter approach is the cost of healthcare.  If you don't have insurance, then you don't get to take advantage of the discounted rates that come into play when you do have insurance.  So that appendectomy?  You pay $1,000 unless you personally negotiate with the doctor for the discount.  If you have appendicitis, you are not in a good bargaining position.  You are in just as poor a position with regard to the hospital bill that is sure to come and is likely to be even higher.

In the United States, the average costs of a day in the hospital are $1,878 (for state/local government hospitals), $2,289 (non profit hospitals), and $1,791 (for profit hospitals).Average Cost of Inpatient Care  That's just paying for the privilege of being in a hospital bed and receiving nursing care.  That doesn't include charges for operating room services, emergency services, and forget about intensive care services.

It's easy to see how a 10 day stay in the hospital can reach five figures.

Getting back to those uninsured people.  The ones who couldn't afford to pay insurance premiums sure can't afford to pay for this kind of care.  The ones who think they will pay for their care out of pocket are headed for bankruptcy.

This is the situation that the Affordable Care Act (Obamacare) attempted to address, to have more people covered either by commercial insurance or by expanding Medicaid to cover more poor people.  For people who can't afford their entire premium, subsidies were offered.  Where do the subsidies and the additional expenses related to the Medicaid expansion come from?  Two guesses.

Believe it or not, there is one more leg to this stool.  Remember how, if you are employed and covered by insurance, your employer usually pays a portion of your premium.  Also, your employer pays half of your Medicare premium.  Your employer pays taxes.  Where does your employer get that money?  From you or people like you who buy their goods or services.

That should close the loop.   Thanks for staying with it.  It's actually more complicated than I've outlined hear.  More about healthcare in days to come.

I'd love to hear feedback from readers.

The Loyal Opposition

A term has come to mind that I haven't heard in a while and it seems to apply to our current political climate:  loyal opposition.

As I understand it, the notion comes from parliamentary forms of government, such as in England.  Simply put, it describes the collection of people and parties not in power.   For a more complete definition see Loyal opposition.  

I wonder why we can't use the term and, to a certain extent, the concept to describe those of us, both post- and pre-Donald Trump, who remain loyal to our country, but who disagree with the party in power.  The term seems to carry more respect than we use now to vilify whoever opposes us.

And that's my point, to return to a civil discourse.  So, yes, I'm loyal, but I am definitely the opposition.

Why did it happen?

Yes, I'm disappointed with the results of the election.

I have my own thoughts as to why things turned out the way they did.

One of the main reasons, I believe, has to do with the economy.  Pundits say that Donald Trump tapped into the deep seated conviction, primarily of white blue collar workers, that they have been treated unfairly.  Their jobs went overseas.  They were not able to obtain jobs that allowed them to keep their middle class lifestyle.  Someone must be to blame:  immigrants, documented, undocumented, and CITIZENS, make easy targets.

I agree with them.  Someone is to blame.

There are the politicians who lacked the vision to support educational efforts that would enable those who have lost their jobs to compete in a new economy.  There are the politicians who lacked the vision to see the opportunity in an economy no longer based on fossil fuels but on renewable resources.  There are the politicians who hold to the old economy because they are afraid to tell the truth to their constituents.  There are the politicians who, simply put, are afraid to lead.

There are the education systems that devolved into teaching for the test and not for competence. There are education systems that forgot how to instill values without resorting to one brand of religion or another.

There are the major corporations, lacking any sense of civic responsibility to their employees and the communities left reeling in the aftermath.

There is a culture that no longer valued education the way it did in the post World War II years that sent millions of veterans to school and created a generation of businessmen, lawyers, doctors, and other professionals, that values the superstar basketball player over the high school physics teacher, that does not insist that an educated electorate is to be prized.

Finally, there are the citizens themselves.  Those who refused to admit that they no longer had the skills to make it in a new economy and refused to take responsibility improving their lot by means of education.

What's the big deal about education?  A well rounded education, easily obtained or not, gives the individual the tools, not only to earn a decent living, but also to learn to think critically, to have a sense of curiosity about the world, to learn to discern truth.

So we ended up with two candidates, but with flaws.  We decided with our emotions on which was the more flawed.

One had a career in public service.  She had made some mistakes, was not the most likable or approachable, but was clearly competent to take on the job.  You don't have to like your President.  But that doesn't mean you can't go the extra mile and decide for yourself whether her flaws were so significant and verifiable that she didn't deserve the office.  There's that critical thinking thing again.

The other had no background in public service.  By one measure, he lied once every three minutes he was on the campaign trail.  He kept the fact checkers busier than they've ever been.  He scapegoated immigrants, insulted women, threatened to put his opponent in jail.

Over fifty newspapers endorsed one of the candidates.  Only two endorsed the other.  But newspapers are languishing.  Readership is down.

One candidate had her party solidly behind her.  The other found his party seeking to distance themselves from him.

So I'm disappointed.  I'm disappointed that it was even close, so close that the electoral college is being challenged.  How was it close?  Did we think change was so important that we were willing to allow a campaign that resembled a demolition derby more than civil discourse?  Were we more willing to accept the easy lies rather than the difficult truths?

I've done my best to keep an open mind.  It's been easy for me.  Either way, I don't really have a dog in the hunt.  I'm white, male, and sixty-seven years old with retirement savings for which I am more grateful than I can express.

I also know that we live in a world that disputes facts, truth.  I remind people that you can have your opinion, but you can't have your own facts.  But that's what happened.  People chose their own "facts".  They listened to the big lie.  They went for the outsider in the White House, but re-elected the same Congress.

I've tried to speak truth here.  I hope I've given you something to think about.

Until next time.