What About Health Care Costs?

If someone magically came up with a way to run a health insurance company for free (no employee costs, no building rent, no supplies, no software licensing fees) everyone with health insurance under that company would see something like a 15% discount (13% if you believe health insurers' numbers, 25% if you believe the U.S. Senate Commerce Committee numbers) for the first year. That would be the extent of the reduction.

Health care costs, on the other hand, rise 4% each year. So somewhere between three and six years, whatever gains had been got by running the health plan for free would be eliminated. And yet the medical inflation trend would continue unabated. Health care consumers would be right back to unsustainable costs, with no help in sight and another 4% price hike on the horizon each successive year.

That is why Obama called health care costs the biggest threat to our nation's balance sheet. Eliminating health insurers entirely makes for nice theatrics but in reality accomplishes little to benefit health care consumers.

In an article in the Salt Lake Tribune, two researchers from the Heritage Foundation point out that:

Today's health-care system is fraught with perverse incentives that generate artificially increased spending. But nothing in the House- and Senate-passed health bills, or in the president's plan, would reduce these incentives. And some provisions would make them worse.

In most fields, such as computers and cell phones, new technology usually increases quality and reduces prices. Health care prices, though, often go the opposite way. Not always; drug prices drop when generics replace brand-name drugs, and expensive drugs sometimes replace even-more-expensive surgical interventions. But often, new health technologies increase prices. Why? Health-care prices are determined by a bureaucratic process that prevents competition from driving prices down.

They conclude that the current proposals would bend the health care cost curve, but in the wrong direction.

Advocates of the current reform proposals say that free markets are what got us into the current health care crisis. I say phooey. Our current state is nothing of a free market.

A successful "up" vote on health reform would be a pyhrric victory for Americans who actually work and pay for their health care. They will feel momentarily better for having struck a blow against "evil" health insurers. They will soon find the gains erased and subsumed in the inexorable rise of health care costs. More importantly, lawmakers will have squandered the opportunity to address health reform in a meaningful way while the attention and will to do so were in place.

Macy Foundation Recommendations on Primary Care Reform

Recently the Macy Foundation held a conference on issues concerning the delivery and payment of primary care services. The conference was co-chaired by two professors at Duke University and included 49 participants representing a broad range of views on primary care.

The conference report makes some astute observations, including the following:

We are facing an economic situation in which the current rate of rise of medical cost is unsustainable, and this situation is exacerbated by an aging population with higher care needs and expectations. These events have created a climate in which it is necessary and appropriate to question the models of care and health professions education on which we have relied.

I agree with this wholeheartedly. Among other recommendations submitted by the panel, this one makes the most sense:

. . . state and national legal, regulatory, and reimbursement policies should be changed to remove barriers that make it difficult for nurse practitioners and physician assistants to serve as primary care providers and leaders of patient-centered medical homes or other models of primary care delivery.

This is a simple and straightforward example of how mundane - - some might say pedestrian even - - changes in existing laws could support profound changes in health delivery and reimbursement. Sure, changing licensing laws is not as flashy as a hatching a "national plan." But in effect, rolling back laws instead of creating new ones would provide room for primary care providers to come up with different delivery models to meet patient needs without sacrificing quality. I don't know exactly what that model would look like, and neither does anyone in Congress. Which is why the model itself should not be legislated, but need only be given space to grow.

The health care market is suggesting that there are better and cheaper ways to delivery primary care. Laws and regulations stand in the way. Those laws should be changed.

THAT is health *care* reform. THAT is what will provide downward pressure on health *care* costs. THAT is what will actually address the "biggest threat to our nation's balance sheet." THAT is something that should get done.

I'm Not the Only One That Thinks The President's Bill Won't Cut Health Care Costs

People far smarter than I am don't think so either:

CBO expects the cost of the new entitlement spending aimed at coverage expansion in the Senate bill – the premium subsidies in the exchanges and the expansion of Medicaid -- to reach about $200 billion by 2019 and then grow at a rate of 8 percent every year thereafter. In other words, this new health entitlement spending is expected to escalate just as rapidly as Medicare and Medicaid have in the past. CBO does not expect the “delivery system reforms” in the Senate bill, which are mainly small initiatives and pilot programs, to amount to much of anything in terms of cost control.

Read the rest of the bad news at KaiserHealthNews.

And if I didn't say it enough yesterday, I'll say it again: President Obama thinks health care costs are the single greatest threat to our nation's balance sheet.

But nevermind that. Now the mantra is: "let's get it done."

Dissecting DeParle's Propaganda Letter on Health Reform

A letter from Nancy-Ann DeParle, Director of the White House Office of Health Reform, arrived in my in-box today. I've watched the health care reform debate (so called, even though the debate has had next to nothing to do with health "care" and everything to do with health "coverage") go on for the better part of a year and have largely kept my thoughts to myself. But as my childhood hero Popeye liked to say, "I've had all I can stands, and I can't stands no more!" Or to rephrase: "I'm mad as hell, and I'm not going to take this anymore."

So here is a reprint of Ms. DeParle's letter, interlineated with my responses.

Good morning,

It was, until now.

Democrats and Republicans agree -- the health care status quo isn't working for the American people.

Some would argue that Democrats and Republicans are not working for the American people either. But we're off on a tangent already, aren't we?

Health insurance is growing more and more expensive by the day. Too many of us can't afford it -- not middle class families, not businesses, not the Federal Government.

Well, let's slow down a minute there. Health insurance premiums are typically adjusted annually, so to say they're growing more expensive "by the day" is kind of a misstatement. I'll give you some leeway here to speak figuratively for the purpose of lending a sense of urgency to your message. But I'll have to think about whether that sense of urgency is justified, or whether it's intended to create a false sense or emergency so that people will be more comfortable with acting unwisely. After all, who is more vilified in pop movies: the person who makes a bad decision during an emergency or the person who can't make any decision at all?

Onward then: "Too many of us can't afford health insurance," you say. And my question in response is, who says how much is "too many?" Figures issued recently by the United Hospital Fund suggest that 41% of New York's uninsured are actually eligible for public coverage, but aren't enrolled. So it's not that they can't get health insurance, it's that they don't get health insurance. Perhaps they want other things instead. Are American citizens not permitted to forego health insurance? I venture to say here that you firmly believe no person who could get health insurance would forego it. And I say you are arrogantly supplanting your value system on someone else who may or may not hold to your point of view.

Also, I see here another propaganda technique you've deployed: "too many of *us*," you say. Really, you --- the Director of the White House Office of Health Reform --- can't afford health insurance? Please. I suppose you need more leeway to write figuratively here again. You don't really mean "us" because you yourself are not included in the group, so you must mean "you" or "them" but you write "us" to create a false sense of similarity. As if you were in "our" group. As if you were "just like us." I say go to hell.

And another thing, didn't this debate start out as health *care* reform? Your boss, the President, once said "By a wide margin, the biggest threat to our nation's balance sheet is the skyrocketing cost of health CARE." Now, reasonable minds might disagree with that statement, but it's what he said so I'll take it as a given that he actually believes it. So, Ms. Director of Health Reform, when are we going to start talking about the skyrocketing *costs* of health care? You know, how much it costs to go to the doctor, or have your tonsils out, or get an MRI? After all, I'm pretty sure the costs of health care are, in fact, "growing more and more expensive by the day."

Insurance companies have too much control over health care decisions that should be left between a patient and their doctor.

Still on insurance, eh? So the strategy has become to pick the least sympathetic character in the health reform arena and pick on them? It would appear that way.

Out of curiousity, I have to ask - - when Medicare Advantage managed care plans conduct utilization review on behalf of the U.S. government are they exercising too much control over health care decisions that should be left betwen a patient and their doctor? When Medicaid managed care plans conduct utilization review on behalf of state governments are they exercising too much control over health care decisions that should be left between a patient and their doctor? Where is the federal plan to disengage from managed care, thereby restoring health care decisions to their "proper" place - - between the patient and the doctor? There aren't any? Well it *used to* be that way - - it was called Medicare fee-for-service and in the private sector was called a traditional "indemnity plan" and those models broke the banks of the government and employers, respectively, who paid for them and now both models are both virtually nonexistent. Is that what we're going back to?

They [health insurers] freely ration care based on who's sick and who's healthy; who can pay and who can't.

Oh, the dreaded "R" word - - rationing. Nice turnabout here, using the word that Republicans first threw at the Democrat's plan. I actually spent a long time trying to figure out what you are trying to get at in that sentence and I can't even venture a guess. Health insurers collect dollars ("premium") and then pay out expenses ("loss"); since the number of premium dollars is finite (i.e. limited) then in a way health insurers do "ration" payment. And I suppose that have to ration it based on who's sick and who's healthy, after all you want sick people to be able to get care and should worry less about health people. And I suppose they ration based on who can and who can't pay the premium; you can't pay out in loss dollars that you never received in premium. But maybe I'm misunderstanding your point, which really was just to throw out the word "ration" in the same sentence as "health insurers" and hope it sticks.

By the way, when do we start talking about what your boss called "the biggest threat to our nation's balance sheet - - skyrocketing costs of health care?" Not yet, it would seem.

On both sides of the aisle, we all agree that if we do nothing, the problem will just get worse. Now, after a long and wrenching debate, it's time to make a decision. Yesterday, President Obama called on the United States Congress to cast a final up or down vote on health insurance reform in the coming weeks and pledged to fight for it every day until that happens.

Well damn, let's boil some water so we can get on with delivering this baby, shall we? Let's not stop to ask - - *why* will the problem get worse if we do nothing? The White House message is the classic message of those who use their position for the purpose of abuse: YOU ARE IN TROUBLE AND YOU ARE POWERLESS, AND I'M THE ONLY ONE WHO CAN HELP YOU. Really, Ms. DeParle, do you think I haven't read "The Gingerbread Man"? But now the urgency begins to make more sense, doesn't it? Yes or no! Now! It's urgent! Decide! Don't think, ACT!

No, thanks. Health care transactions are 16% of all economic activity that occurs in our country, and is projected only to grow and grow. When you open the want ads, the first three pages are health care positions, and then there's half a page of tech jobs, and then a few service jobs. (I'm sure Ms. DeParle doesn't open the want ads, though, even though she's one of "us".) I don't want to monkey with that much of our economy in one chunk unless I'm certain that I've got the right answer. Are you certain, Ms. DeParle, that the President's proposal is the correct course? If so, you must be the smartest person in the universe.

To believe that there is a sense of urgency about health insurance reform (let's just call it that from now on, since it's clear we're not going to talk about costs) when so much is at stake is to buy into the Democrat theory that something - - anything - - is better than nothing. Yes, the current health model is a disaster in progress, but it's a long slow trainwreck of a disaster. There is time to make the correct decisions, be assured.

The President's final plan for health insurance reform puts control of health care where it belongs -- in the hands of American families and small businesses, not health insurance companies or government.

My goodness, but this line almost made me fall out of my chair. How on Earth does the current proposal even begin to accomplish this? What exactly is "control of health care" anyway? Are we not going to have health plans anymore to tell us what's covered and what's not? Actually, we'll have MORE people enrolled in such models.

This is a propaganda technique borrowed straight from George Orwell: call it whatever it's not. Make the censorship bureau a "Ministry of Truth." Hitler put "Work Makes One Free" over the gates to his concentration camps. This line about "putting control in the hands of American families" is the line that got me. It is the line that tells me the President is selling the American people a crock of shit, with a label on it that says "Honey." The current reform proposals will concentrate power in the federal government, will undermine the autonomy of the states, and will restrict the liberty of the citizens that make up the "American families" referenced here. And not just for today, but for generations at least. Honey indeed. How sweet.

So let's turn back for a second to my earlier question - - why should we believe that we are powerless to solve the problem on our own? Why hasn't the market solved the current crisis?

I venture an answer here: it can't. And it can't because the third party payor system has essentially been cemented into place by a complex series of laws and regulations, coupled with intertia and a generous dollop of fear. You can only escape it by not buying insurance at all, and the Democrats would even take that option away.

It's somewhere between difficult and impossible for payors to develop new reimbursement models that would damp off the incredible upward price pressure that a third party payor fee-for-service system creates. The fundamental mechanics of human decision-making make it easier to spend other people's money; this isn't just a mental state, it's the result of the physiological process of making a decision. A third party payor model *inherently* encourages overutilization by patients and overtreatment by providers. It inherently sets up the patient to be disastisfied with the level of coverage and inherently sets up providers to be disatisfied with the level of reimbursement. In both cases, it's always other people's money so it's too easy to want more.

The current proposals do nothing to return health care transactions to the two people who are actually involved in the transaction: the patient and the provider. In fact, the current proposals merely expand the current model and make it far less likely that we will ever get to the point where patients and providers alone truly make health care decisions together.

Remember - - and these aren't my words - - the biggest threat to our nation's balance sheet is the skyrocketing cost of health care. The current proposals do nothing to reduce health care costs. As soon as the Obama administration perceived that health plans could become the scapegoat of all that's wrong in the current health care crisis, "health care costs" fell right out of the dialog. Instead, it became all about "coverage."

"Greedy insurance executives" and "excessive insurer profits" at their worst take up a few pennies out of the health insurance dollar. "Health care costs," in contrast, are 75%-80% and as high as 90% of the health insurance dollar. Which might be more effective to focus on in making some meaningful progress in health reform? Imagine a salesman that walked up to your house, looked at your missing front door, and said, "You know, if you bought some new windows you could really snug up this place." If you buy the Obama proposal you are paying for new windows while ignoring your missing front door.

His proposal takes the best Republican and Democratic ideas and changes three main things about the current health care system:

• It ends the worst insurance company practices and outlaws discrimination against Americans with pre-existing conditions.


• It reduces costs for people with insurance and makes coverage more affordable for people without it today.


• It sets up a new competitive insurance marketplace where small business owners and families can shop for the insurance plan that works best for them, giving them the same buying power and insurance choices as all members of Congress.

Ms. DeParle: did you notice that New York required guaranteed issue, guaranteed renewable policies fifteen years ago? Did you further notice that government plans are available for families making multiples of the federal poverty limit? And did you further notice that New York's uninsured problem, while slightly less than the national average, persists?

Or perhaps you regard the problems you intend to address with your reforms as having been solved in New York, in which case, where is New York's exemption from the price tag for this so-called "reform"?

Health insurance exchanges, your third bullet point, could be neat. But having a fancy mart in which to look at policies you can't afford anyway isn't altogether helpful. At least not in my book.

I skipped over your second bullet point which is just flat out not true. Not even the budget director that your boss appointed thinks so.

The single greatest weapon that could be deployed against skyrocketing health care costs (in Obama's words, the "biggest threat to our nation's balance sheet") is the measured consideration of the American health care patient. But that's exactly who is carved out of all of the decisions under the present system. And that's exactly who is carved out of the more burdensome variation of the present system that Mr. Obama proposes.

What kinds of policies are actually available in the marketplace? State regulators will tell you. How much will they cost? State regulators will tell you, and if not them then federal regulators. Which policies will be offered to you? Your employer will tell you. Which doctor can you go to? The health plan will tell you. What services can you get? The health plan will tell you. How much does it cost? The health plan and your physician decide, and then keep the price secret from you. Can you opt out of this morass and just pay for the care you want? No, sir, no. That freedom is not yours.

Imagine a going to a place where you can review available options, weigh prices, ask questions, and decide not to buy if it's not what you need. You can do that if you want to buy a big-screen TV, but not if you want to make very important life-impacting decisions about your health care. I can find out more information about the service quality provided by a person selling antiques on eBay than I can about my family physician, or the surgeon that wants to cut open my back. I can see how many transactions that antique-seller has completed, his or her satisfaction rating, average time to ship, and I know what the price is going to be ahead of time. Not so in health care. In some cases no one knows these things; in other cases the numbers are known but they are confidential. But go ahead, ask that surgeon how many cases he's done and what his error rate is and how many complaints he's had, and see what kind of frosty response you get. Are antiques really more important than back surgeries?

The free market brought us eBay user ratings, Amazon book reviews, and built-to-order computers by Dell. In New York, you can't buy the coverage you want, you can only buy the coverage the State Insurance Department wants to allow payors to sell you, and the State Legislature has mandated that all policies must cover things like prostate cancer screening even if you are female and Pap smears even if you are male. By the way, the American Cancer Society just released a policy urging doctors to stop performing digital rectal exams as a cancer screening tool because they don't work. Think those New York docs are going to stop doing them? Nope, because when they do them they get paid - - the policy has to cover it. And because it's a law, insurers can't take it out of the policy even when the procedure has been discredited. That's what laws do - - they cement things in place.

And so in my libertarian mind I believe that laws should be reserved for areas that one does not perceive as having to change in any forseeable future.

Our health care delivery system? You bet I want it to change. I want it to change faster than any Congress can pass laws. I want my family physician to retool his practice so that it pays attention to me, not my insurer. I want going to the medical doctor to be more like going to my dentist, who relies primarily on direct payments, whose waiting room is empty, who uses hi-tech radiological images so I don't have to wait for x-rays, whose staff is friendly. Or like the plastic surgeon I went to once for a scar excision, whose website told me everything I need to know in advance, who saw me on time, who spent an unrushed half hour with me, who gave me free coffee for the 12 minutes I sat in the waiting room watching HD TV, and who quoted me a price on the first visit. All because they know that they need to deliver service that justifies the price they are asking me to pay. My family physician? Not so much - - I have no idea what it costs to visit him. In his mind and in my mind it's "free" (and no degree of Democratic propaganda can change that physiological truth) and so if the service is poor there's not much to complain about.

Incidentally, the price for the surgery dropped my jaw, in a favorable way. Does that ever happen when you are on the "medical" side?

We've debated the issue of health insurance reform thoroughly, not just over the past year, but over decades.

And so the "urgency" of health reform is here proved to be utterly manufactured. To paraphrase: "the debate . . . which has gone on for decades . . . MUST END RIGHT NOW!!" Must it really? Kathleen Sebelius' digging in to health insurer rate increases in a state in which she has no jurisdiction and can literally do nothing about it amounts to a desperate grab for traction in an otherwise untractionable position. It is intended merely to provide a backdrop for Ms. DeParle's dramatic intonation that "health insurance costs are going up every day."

It's time to make a decision about how to finally reform health care so that it works for America's families and businesses -- not just for insurance companies.

Whip away, Ms. DeParle, whip away. I have to look askance at anyone that believes there is a moral highground in the health reform debate or that - - conversely - - points to any one party as The Problem.

Let's get it done.

Let's get it done indeed.

In the current health care market, Medicare is about a third of spending and the remainder of the market tracks Medicare. Do we really want the price for services in a sector that will soon make up 20% of all economic activity in the United State to be determined by the government? There are examples of societies that have tried on centralized price control. You can find them in the history books.

Let's not forget what effect this will have on costs. Just a few days ago Congress decided to hold off on a price cut for Medicare services. Do we need prices of medical services to come down? Yes, we do. Do prices under Congressional control ever come down? No, they do not.

Free markets are not perfect. But they are the best model anyone's yet come up with. And they do not guarantee that things will always stay the same. In fact, what you observe in the market place today is the free market coming to bear on the inefficient third party payor model. It is the agonal lurching of a system that should die and should be allowed to die. It has priced itself out of viability.

So let's see some "reform" proposals that actually give life to health care in the United States! Let's see some proposals that look towards the future, not ones that take a broken system and put it on life support and then sign a contract binding five future generations to the expensive prospect of keeping it alive. Just so a president can say he got something done.

Yes this is a crisis, friends, but not the one that it seems. This is a crisis far greater than whether grandma gets her CT scan. This is a question of whether the federal government GETS OUT OF THE WAY and lets the innovation of 280 million minds find out what health care is going to look like tomorrow. It is arrogance beyond measure to think that a few hundred people sitting in Washington can figure out the "one best way." America has never worked that way.

Find me an example where true market innovations have sprung lively from the enactment of federal statutes, and I'll be happy to change my mind. Microsoft wasn't legislated. Google wasn't legislated. Dell wasn't legislated. Apple wasn't legislated. eBay wasn't legislated. Twitter wasn't legislated. Amazon wasn't legislated. Nor did they operate in an environment where their product designs were regulated, their marketing plans preapproved by regulators, their pricing regulated, and their internal processes and procedures regulated, their relationships with vendors regulated, their ownership and governance structures regulated. They were given room to dream, and what they dreamed has brought untold value to Americans. When providers dream of different reimbursement models, lawyers tell them, "the law won't let you do it that way." When payors dream of innovative policies that better meet consumer demands, lawyers tell them, "the law won't let you do it that way." When patients dream of different ways of interacting with medical service providers, they find that no one is paying attention to them.

The government is not "causing" the current health care crisis - - it is the natural and predictable course of the existing model. But the laws and regulations that were intended to bring that system to heel have now ironically become its perpetuator - - by prohibiting the natural development of models that would take its place.

And so what to do?

"Climb on to my back, Gingerbread man, and I'll take you to the other side of the river."

"Thank you just the same," I say.

We have a choice - - the option of getting off the fox's back. If we let the fox carry us to deeper water, we'll have no other choice but to jump in to the maw. That is the real urgency with which the health insurance reform question should be viewed.

Let's take Scott Brown's advice and go back to the drawing board. Let's not go to the stakeholders like the American Association of Health Insurance Plans or the American Medical Association or the American Hospital Association or union groups or the AARP and ask them how we can improve things for THEM. Let's instead ask those players a simple question, "what is preventing you from responding to patient demands?" When the answer is laws or regulations, roll them back. When the answer is inertia, provide incentive. When the answer is momentum, provide a brake. The proposal for health care reform should create an open space for the inevitable innovation that will follow when given the chance. The current proposal is not so much open space as it is a careful script of How Things Will Be For The Next Fifty Years, and it will have to be that way, and it will have to proceed that way, until the bank is broken and our grandkids move to China because there's nothing left of the US economy.

So know this: my evaluation of health reform proposals moves from these principles: free markets; room for innovation; primacy of the patient. These things are utterly lacking from today's model. Anything that moves towards those principles, I like. Anything that moves away from them or that attempts to cement today's model in place, I dislike. And any representative of mine that votes for it will get a resounding NO from me the next time I see their name in a voting booth, and forever after that until they are gone.

It is time indeed to end the national health insurance debate. It is time to begin the debate that never happened, which is the national health care debate. And it is time to make room for a new system that will give patients the same benefits of technologies and knowledges that are ubiquitous in our society but that have failed to penetrate the health care sector because of its arcane reimbursement models.

It is time indeed.

Thank you for bearing through this diatribe til the end. Please share freely.

Statesmanship or . ..

Listening to the news the other night I heard one of the New York Democratic legislators claim that the current standoff between the Democrats and Republicans was "statesmanship versus gamesmanship." Presumably that meant that the Democrats were engaging in "statesmanship," which is the exercise of wisdom in the matter of public affairs, and the Republicans were engaging in "gamesmanship," a sort of taking-advantage-of-technical-rules-in-a-mean-spirited-sort-of-way kind of thing. Today I looked for the quote, and it turns out it actually came from Senator John Sampson, who is the Democractic Conference Leader. He said it in response to a question why Democrats had failed to show at a meeting to which Republicans had shown up because the Democrats had been running around publicly demanding a meeting. Apparently they wanted to meet on a different day.

So Senator Espada, at the center of the supposed coup staged June 8th, claims that he has a video tape of the proceeding that clearly shows the validity of the vote that accomplished the coup.

No back to Sampson's quote, here in full: "There needs to be public negotiations, but not negotiations where you have video tapes of what happened on June 8th," Sampson said. "This is about statesmanship, versus gamesmanship".

So, essentially, Sampson is saying that he is interested in negotiating, but only when the truth is not invited to the meeting.

What could Senator Sampson fear from a videotape? Either it shows, or does not show, the validity of the Republican-led vote. If it shows the vote is not valid, then his party gets to keep the gavel. But - - as is more likely - - if it shows the vote is valid, then the reality becomes that Sampson wishes to retain power where he validly has none. Put different, he wishes to subvert a legitimate vote in the exercise of state authority for the sole purpose of keeping "his party" in power over "their party."

That sounds more like "gamesmanship" to me than anything.

Remember, they are all getting paid for this. And yes I know the State Comptroller has decided to hold the vouchers. He doesn't say he won't pay them, however, he just says he won't pay them right now. So rest assured that if the Senate ever does come back to work, all those vouchers will move through pretty quickly. (Incidentally, the State Comptroller is a former legislator himself. And he was put in the State Comptroller's position by . . . the legislature. The gesture of holding the vouchers is meaningless and meant only to coax his former colleagues out of a position of embarrassment.)

Now the interesting thing is that at this moment various powers in government are discussing whether it should be considered "fraud" for a doctor to submit a bill to Medicare for a surgery if the surgery fails to meet certain quality standards. So if you go in for surgery and the surgeon does kind of a poor job, then submits the bill, the Medicare overlords get to say that's "fraud." There's a parallel in goods law also, that goes much further back, called the "lemon law." If you buy what looks like a car, but it turns out to be a lemon, it's a fraud and you get your money back plus a little something for your lawyer.

So if you send a person to Albany who is supposed to be a legislator, but then it turns out that the closest they come to legislating is engaging in some sort of sophomoric football game designed to figure out who has the better "team," well, then you've bought a lemon. It's a fraud and you should get your money back.

I want my money back.

A Look at Constitutional Relevancy

Well the New York State Senate decided to take the day off again today while I went to work, and the money I earned will still be taxed to pay their salaries. One of life's sweet little ironies, I suppose. I wish I had a job where I could just not show up and still get paid, don't you?

So this evening I figured I would waste some time by reading the state constitution. I say wasting time because the state constitution apparently has nothing to say about the present lack of anything productive being done in Albany. So --just for fun, as it has no bearing on the present crisis --here is one of the sections on constitutional amendments:

Any amendment or amendments to this constitution may be proposed in the senate and assembly whereupon such amendment or amendments shall be referred to the attorney-general whose duty it shall be within twenty days thereafter to render an opinion in writing to the senate and assembly as to the effect of such amendment or amendments upon other provisions of the constitution. Upon receiving such opinion, if the amendment or amendments as proposed or as amended shall be agreed to by a majority of the members elected to each of the two houses, such proposed amendment or amendments shall be entered on their journals, and the ayes and noes taken thereon, and referred to the next regular legislative session convening after the succeeding general election of members of the assembly, and shall be published for three months previous to the time of making such choice; and if in such legislative session, such proposed amendment or amendments shall be agreed to by a majority of all the members elected to each house, then it shall be the duty of the legislature to submit each proposed amendment or amendments to the people for approval in such manner and at such times as the legislature shall prescribe; and if the people shall approve and ratify such amendment or amendments by a majority of the electors voting thereon, such amendment or amendments shall become a part of the constitution on the first day of January next after such approval. Neither the failure of the attorney-general to render an opinion concerning such a proposed amendment nor his or her failure to do so timely shall affect the validity of such proposed amendment or legislative action thereon.

So let's say you are a citizen and you have a good idea for amending the constitution, first you have to find a legislator to put the bill in, then the Attorney General needs to offer an opinion on the bill, then it has to be voted on by . . . yes, the legislators, not once but twice, in two consecutive sessions . . . and then it gets put to a vote by the people, and then if the measure is approved it takes effect the first day of "January next." When you add this all up it's at least two years, more likely more, and you might have better luck betting on Michael Jordan's famous shot to keep his Big Mac away from Larry Bird: "over the second rafter, off the floor, nothing but net."

Clearly there is a need to protect the foundational documents of state government from arbitrary change. At the same time, a document that is so diffcult to change and is protected by such onerous ballot access laws risk becoming ossified at first, and later irrelevant. And when control of government is taken out of the hands of the people, that is the death of democracy.

Did I mention that currently our state legislature is utterly non-functional, and that the state constitution has nothing to say about it? Is our constitution merely ossified, or has it already become irrelevant?

I Can't Stand It Anymore

There's got to be a revolution in New York State. Not a bloody coup, mind you, so anarchist gun nuts and Koresh compound holdouts need not apply. I am talking about a purely peaceful, purely democratic, purely radical revolution.


Our state government is corrupt and defunct. At its best, it takes a third of your income and puts three men in a room behind closed doors to decided how to spend it. The biggest chunk goes to the worst social welfare system in the nation - - we spend the most per Medicaid enrollee of any other state in the Union by far and yet our outcomes are less than so-so.


The state Senate is not working. Viscious party politics have hamstrung the legislative branch. While the two dominant parties devote most of their effort to trying to figure out how to screw the other party the people's work remains unaddressed - - this is a year forecasting massive budget deficits and an economic crisis gripping the state and the nation in ways that have not been seen in an age.


Our economy lags behind the nation, which in turns lags behind the world, which makes New York, the Empire State, into the world's laggard. But instead of leading us towards tomorrow, our political leaders squabble and squawk about what happened yesterday.


The icing on the cake is that any serious effort to reform the state government requires the approval - - yes, the state government. The same government that hasn't been able to decide whether it's even open or closed for business in over three weeks. By the way, any reform under the current rules would take at least three years and would not be approved directly by the voters at the end of the day. So good luck with that.


I can't stand it anymore.


I can't stand giving my money to a government that quite simply fails of its intended purpose. I want my money back. Or, I want a real government - - one that puts its responsibilities to the people above individual responsibilities to "the party." I don't really give a rat's ass whether Democrats "win" or Republicans "win" or the Green Party "wins," as long as they are doing things that make New York nicer to live in. And generally speaking, making New York nicer to live in means getting out of my shorts.


So what is needed, as far as I can tell, is a brand new government. It will begin with a convention of delegates from each of the counties, and end with a state government that is genuinely by the people, and for the people.


The process must be democratic beyond fault, and utterly peaceful. And it must be driven forward with a will of iron and an unerring eye for truth, liberty, and justice.


It has to happen. It has to happen now.