An Inconvenient Bruce

Baby Boom Delusions and Solutions (Chap.3, Part 2)

2010-04-14T15:31:00.003-04:00

Today's post was delayed as I researched the most current trends in using reverse mortgages as a strategy for aging at home, instead of in an institution. The housing catastrophe of the past 30 months changed much of what I had originally written in the early drafts of the book. I am still waiting on Medicaid to provide some updates but decided to post this entry now, even if the final version of the book is somewhat different, based on those updates. Medicaid is currently overwhelmed with adopting changes related to the new healthcare legislation and my request for interviews and information are likely a low priority.

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Chapter 3 (Part 2)
A PLACE CALLED HOME

The Reverse Mortgage

In 2030 the youngest boomers will be 67, the oldest 84. The homeowners in this group--eight of every ten boomers are homeowners--will be perched atop a home equity money mountain worth $8.1 trillion. Unfortunately, unless current efforts and policies are improved, many of these house-rich and cash-poor seniors will struggle to find the money they need to pay for the help that would allow them to remain at home. Failing that, they will be forced to sell the house in order to pay for alternate living arrangements.

A reverse mortgage—and there is currently only one type available—can unlock much of a home’s equity value, putting cash in the homeowner’s pocket immediately, without putting the house at risk. The cash can be used to make staying at home possible.

A reverse mortgage is a relatively new, creative and promising financial service. Those seniors who need help at home but find themselves house-rich and cash poor deserve a reverse mortgage option that is affordable, well-designed, carefully monitored and delivered by trustworthy professionals. The roadblocks for making this happen on a large scale are apparent: (1) $8.1 trillion piled up in one place will attract a lot of additional flies and as seniors lose their mental acuity, advantage can be taken; (2) the lending industry has proven that it cannot effectively police its own; (3) policy-makers do not understand the service and its potential positive impact on lowering Medicaid costs; (4) seniors do not understand the service benefits and believe many negative myths and (5) the product could get expensive again.

First, let’s understand the service. Below are the basics of the one service currently available, the Home Equity Conversion Mortgage (HECM, “heck’um”). This service was co-designed by AARP and The Federal Home Administration (FHA) and is underwritten by The Department of Housing and Urban Development (HUD):

1.    Every HECM applicant receives mandatory professional information counseling to insure that they understand the service.
2.    Available to those 62 or older, the homeowner gets the equity advance (loan) but maintains title to the home.
3.    There is no time limit on how long the homeowner can then stay in the home.
4.    The loan is not due until the home is sold by the homeowner or his or her heirs.
5.    The homeowner’s heirs will never be responsible for paying any part of the loan. Any negative gap in home sale price to loan value is insured by HUD. A positive gap goes to the estate.
6.    The loan proceeds can be used for any purpose.
7.    Loan proceeds are not income and therefore, not taxed.
8.    The homeowner must keep the home maintained, pay the real estate taxes and keep the    home insured.
9.    A homeowner’s other assets, income or credit score play no role in qualifying for the loan.
10.    The amount of the loan is based on a formula that includes the appraised value of the home, the homeowner’s age and current interest rates.
11.    Currently, there is a cap of $625,500 on the appraised value of the home, an amount that includes the vast majority of American homeowners.
12.    Interest on the loan is a tax deduction expense in the year the loan is repaid.
13.    The older the borrower, the greater the percentage of equity value he or she can free up.

Here are three simplified examples:

Borrower A
Age: 65
Home Value: $200,000
Mortgage Owed: $0
Cash to homeowner: $101,600
Interest Rate (2010): 5.7%

Borrower B
Age: 75
Home Value: $200,000
Mortgage Owed: $0
Cash to homeowner: $117,000
Interest Rate (2010): 5.7%

Borrower C
Age: 85
Home Value: $200,000
Mortgager Owed: $0
Cash to homeowner: $134,000
Interest Rate (2010): 5.7%

In the past, based on the $200,000 appraised value, each borrower would have paid $4,000 in mortgage insurance, $4,000 in origination fees plus title, closing and appraisal costs; likely about $10,000 in all. However, due to recent changes in the value of HECM-backed securities, the prices from some lenders have dropped dramatically, by as much as 70%. The actual out-of-pocket costs are relatively small because most of the fees are incorporated into the loan. The borrower could choose to take the loan proceeds in one of several ways: a lump sum, as a set monthly distribution, set up as a line of credit or some combination of those three.

So, in a country where several million retirees could benefit from this service, why are there only about half a million of these loans in force? More importantly for baby boomers, how can the percentage of users increase dramatically over the next 20 years?

In 2005, the National Council On Aging (NCOA), with the support of the Robert Wood Johnson Foundation and the Centers for Medicare and Medicaid Services, published a study entitled “Use Your Home to Stay at Home: Expanding the Use of Reverse Mortgages for Long-Term Care: A Blueprint for Action”. The study pointed out that one of the ironies of our current situation is that at a time when millions of impaired older Americans are financially struggling to maintain their independence at home, their homes could be the source of the money needed to stay in their homes.

Currently, there are four major barriers to a more robust and successful use of home equity to help seniors remain at home and pay for appropriate support services: (1) The uncertainty of reverse mortgage costs and features, (2) consumers’ negative attitudes, (3) government policy and (4) the fraud potential.

Historically, compared to other home mortgage products, the HECM has not been cost efficient. Interest rates, servicing and origination fees and mortgage insurance were markedly higher than conventional mortgages. Recently, however, these cost differentials have begun to moderate, making the costs of a HECM much more attractive. There is a role for federal government regulations to play in encouraging the mortgage industry to keep these costs competitive. Doing so would encourage millions of retirees to include reverse mortgages in their long-term financial planning.

Even among seniors who are familiar with reverse mortgages (and most are not) many are reluctant to consider one because they think that they are putting their home at risk; in fact, they are not. Many believe that this type of loan is only appropriate for the financially desperate.

One of the biggest negative perceptions is caused by semantics. The term “reverse mortgage” immediately brings to mind the 30-year mortgage debt of which most homeowners could not wait to be rid. The notion of taking on substantial debt late in life, using the home as collateral, seems an anathema. But--and this is key--as long as the borrower is alive and able to live in the home (and this provision extends to the borrower’s spouse and certain other qualified dependents while they remain alive), they can remain in their home. This financial product should probably have been initially labeled something like “cash leverage service” or “liquidity generator account” so that consumers would perceive it in a more positive light. Maybe it’s not too late to re-think the label that providers put on this service.

Yet another perception problem is tied to the desire to “leave something to the kids”. This often means the home. Nearly 80% of home owning seniors view their home as a primary asset for bequest. Many children, however, have a decidedly different view. Fewer than 15% express any interest in retaining their parent’s home, either as a residence for themselves or as a rental asset. Adult children are much more amenable to seeing the equity value of their parents’ home used for their parents’ long term care needs, especially when the money helps the parents stay in their home.

Currently, some state Medicaid policies work at odds against the broader use of reverse mortgages. For instance, because reverse mortgages are required to be first mortgages, if the state has placed a lien against a home when one of the residents goes on Medicaid, and this is often the case, the spouse who is not on Medicaid is not qualified to get a reverse mortgage to help pay for any at-home care as long as the state lien is in the primary position. This policy increases the likelihood of one or both of the elders being forced into a nursing home where Medicaid picks up the entire cost of their care.

There is also a problem when states define reverse mortgage proceeds as “income or assets” in their calculations for Medicaid eligibility for poorer citizens. Reverse mortgage proceeds are loan proceeds, not income and should have no impact on determining eligibility just as the value of the home plays no role in eligibility. Unfortunately, many states have failed to see that this policy is working against the best interests of the state’s taxpayers. It discourages poorer homeowners from obtaining a HECM for fear of losing their Medicaid eligibility. Thus, cash strapped for private pay help at home, they end up, at state expense, in the local nursing home.

For elders who qualify for Medicaid nursing home services, several states have developed waiver programs that pay for some in-home services; that’s good. However, the current limitations of these programs still make it difficult for many elders to remain at home. One such benefit exclusion is “room and board” or the cost of maintaining a home, groceries and utilities. In addition to excluding these day-to-day expenses, there is a limited set of authorized in-home medical and support services for which Medicaid will pay. This limited set does not include home modifications, companion care, house keeping, shopping services, meal preparation or most transportation. By requiring that homeowners pay out-of-pocket for these in-home services, while not encouraging the use of reverse mortgages—indeed, even discouraging their use by threatening the loss of Medicaid eligibility—Medicaid prematurely funnels millions of elders into the more costly nursing home alternative. Sometimes the government’s left hand needs to have a conversation with the government’s right hand.

The increased use of reverse mortgages is not a cure-all for what ails the Medicaid funding crisis but it can be an important part of the overall fix. Reverse mortgages hold the realistic potential to increase private sector (homeowner) funding for in-home support services which could save Medicaid about $4 billion each year, or roughly 10% of its annual budget for long-term care for the elderly. As the baby boom closes in on its dependence years, the comparable illiquid housing wealth will escalate because we have been better educated and more financially successful than our parent’s generation and much of our wealth has been poured into housing stock.

Medicaid policy change will also have to address the issue of reverse mortgage proceeds use, which currently has no restriction. For those who would otherwise be destined for a nursing home at Medicaid’s expense, reverse mortgage money must be dedicated to in-home care expenses meant to replace the nursing home alternative. This requirement likely means that a specific HECM product be developed for those homeowners who are already—or soon to be--Medicaid qualified, to insure that HECM proceeds don’t end up paying for things unrelated to in-home care.

Finally, and also related to the current issue of “no restrictions on HECM proceeds use”, is the specter of fraud. The immense liquidity value of baby boomers' home equity coupled with rules that put no restraint on what the HECM money can be used for and the mental deterioration that will be visited on too many as they age, is a recipe for fraud on a massive scale. The flies aren’t just circling; they are already feeding on the exposed cash. The current fraud activity associated with reverse mortgages is, in a major way, tarring the HECM service with the brush meant solely for the unscrupulous and outright dishonest. Once again, government policy and oversight are required to address this issue.

If, as a nation, we truly intend to resolve the cost challenges associated with the long-term-care of the country’s largest ever generation, then creatively using the generation’s own wealth as a foundation is a necessary (but not sufficient) prerequisite.

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Bruce

Observoid of the Day: Bikers who wear a helmet look silly. Bikers without a helmet look like organ donors.

Baby Boom Delusions and Solution (Chap.3, Part 1)

2010-03-10T14:39:00.003-05:00

Today's post begins an in-depth look at the five overarching issues confronting the nation as a result of the Baby Boom's march towards old age. This chapter addresses the alternatives of how and where best to live dependently.

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Chapter 3 (Part 1)

A PLACE CALLED HOME

“Can a man put on his socks? If not, he will soon
need someone to dress and bathe him.”

Frederick T. Sherman, M.D., Instructor

Mount Sinai Hospital Cont. Ed. Seminar.

Here is a common Baby Boomer Delusion: growing old and needing help with things that are now taken for granted will never happen to me.

For about 20% of boomers, this belief will be true because they will die before becoming significantly infirm. Deborah Chase’s husband will be in this category; healthy enough to go on a golfing holiday but beset with the high blood pressure that will do its damage in a massive and immediate way. The rest of the generation will benefit from improved medical care, survive into advanced old age and eventually suffer the indignities of various physical and mental impairments.

To determine whether or not a patient is “at risk” when living without help, clinicians observe a patient’s ability to accomplish five Activities of Daily Living (ADLs). When these activities become problematic, living without assistance is dangerous, unhealthy or both. Here are the things that an independent person must be able to do for themselves: (1) get dressed and undressed (Dressing), (2) transfer food to one’s mouth, chew and swallow (Eating), (3) walk around (Ambulating), (4) get to the bathroom in time, take care of business and clean oneself afterward (Toileting) and (5) keep oneself clean and relatively sanitary (Hygiene).

There you have it, Dressing, Eating, Ambulating, Toileting and Hygiene or, as the clinicians mnemonically and ironically remember them, DEATH. If you lose the ability to do one of these activities, you need a little help. Lose several and you need a lot of help. Either way, a person with one or more of these deficits has entered the realm of dependent living.

Currently in the U.S. there are four basic dependent living alternatives, not counting the dangerous, but oft chosen, alternative of toughing it out alone.

(1)   Stay at home. This is almost everyone’s preferred alternative and there is much to recommend it. First, some relatives are likely nearby. Also, you know and are known in you community and deep social roots are important. Staying put is less stressful than moving. And, there is compelling medical evidence that, done right, staying at home will add to the length and quality of your life. When you are dependent at home, you will rely on your mate, other family members, friends or someone responsible and trustworthy to come in and provide the required help. Unless the caregiver is a family member or close friend, you will pay for the cost of these care giving services privately. If the ADL challenges are in their earliest stages, the amount of necessary paid help could be just a few hundred dollars a quarter. If you are eventually so impaired that you need 24/7 skilled care, privately paid assistance at home currently costs about $15,000 per month. It is a safe bet that costs will be a good bit more in 2031. As Deborah Chase’s family learned, this “at home” alternative is often complicated, aggravating and expensive. Medicare will not help, unless the in-home care is associated with a short-term medical problem. With a few pilot program exceptions, Medicaid will not pay for these types of in-home care services; not at all if you have assets. Long-term care insurance may pay, if you had the foresight to be one of the very few who bought such a policy when it was affordable. Even then, the home care benefit is likely to be only a portion of what private insurers pay should you move into a nursing home.

(2)   Move in with family or friends. To a lesser degree than staying at home, living with those who truly care about you has many positive aspects. However, there is no substantive monetary relief for the care giving household in the current tax code. Neither is there much, if any, monetary assistance from Medicare, Medicaid or the private insurance sector. There may be some tax relief for the hosting household if you can be qualified as a penniless dependent and, in that case, Medicaid may help a little. Clearly, this alternative poses some challenges to the established routine and budget of the hosting household. It also requires that you adjust to living in someone else’s home and the reality of being a minor or major burden. There is a nascent but very small movement called senior co-housing (sharing a modified residence with friends or colleagues), a variation of home-based living which will be discussed later in the chapter. However, the financial and social cooperation requirements for this approach will restrict its availability to a very small slice of the aging population.

(3)   Buy or lease an apartment in an Assisted Living Facility (ALF) or Group Home. These institutions are designed for those whose ADL deficits are mild to moderate and who do not require all of the clinical skills available in a nursing home. Here, communal meal service, laundry and private apartment or room maintenance are usually part of the paid package. Assistance with ADL deficits is available for additional fees. The expenses at an ALF are private-pay. The average monthly cost, not including routine assistance with daily activities, is currently $3,200. Prices vary widely across the country, however, from $1,900 per month to $5,600. Help with ADLs usually costs $15 to $30 per hour depending on the level of clinical skill required to provide the assistance. If we assume that you move to the ALF because you need some daily assistance, say two hours per day at $20 per hour, it would add another $1,120 per month in out-of-pocket expenses for a monthly total of $4,320 in 2007 dollars. If inflation averages just 2% per year, the yearly out-of-pocket expense will be almost $72,000 in 2031. And, this calculation assumes that the amount of paid care remains constant at two hours a day, a risky and likely unrealistic assumption. The downscale version of the ALF is the Residential Care Home or Group Home, a version of dependent living that has been around for generations. Small, independent, for-profit and often run by families, these are basically rooming houses for the elderly. It is estimated that half of them are not licensed and therefore fly under any regulatory radar. Very little national data is available about the overall quality of these small operators. The conventional wisdom suggests that some of them are pleasant and responsible and others far less so. Take your chances.

(4)   Move into a Nursing Home. A Skilled Nursing Facility (SNF) is an institution for many who need constant hands-on care. (However, many U.S. nursing home residents are there only because it is the only alternative in their market, even though their ADL deficits are mild to moderate.) Unless you are verifiably destitute, you or your family will pay the SNF out-of-pocket. The current average monthly tab for a semi-private room is a staggering $6,025. If you want privacy, the rate escalates to $6,782. Adjusted for a theoretical 2% inflation rate, the monthly cost in 2031 will be north of $11,000. Should you go broke paying these costs, Medicaid is the social safety net that will pick up the tab. However, many SNFs accept only a limited number of Medicaid patients because of lower benefit payments (compared to private pay). So, you may eventually be moved to another SNF where there is room for lower-revenue generating Medicaid patients. For many reasons beyond just the financial, the SNF is almost everyone’s option of last resort. If you reach 85, however, the data indicate that you have an 80% chance of spending some time--recuperating from an illness or injury, or living permanently--in such an institution.

Each dependent living alternative presents unique emotional, financial, physical and psychological implications for the frail elderly and their family. When one of these alternatives become unavoidable, families often experience confusion, frustration, heartache, anger, despair, guilt, denial, remorse or even trauma. With few exceptions, transitioning from living independently -- after having done so for six or seven decades -- to any one of these four alternatives is difficult and, a blunt reminder of our mortality.

I’d Rather Stay at Home, Thank You

Nearly everyone (93%) wants to age-in-place and then die at home; at least that’s what the data indicate. However, it may not always be the best alternative and certainly not always the most affordable. Our current long-term care policies, funding mechanisms and support systems don’t often encourage this option when help is needed. Changes will have to be made to make the “at home” alternative easier, more financially sensible and less traumatic for all involved.

For those experiencing the steady erosion of their ability to be independent, a much-loved home eventually becomes an unsafe environment. Throw rugs and loose carpet menace the less than sure-footed. Hot water heaters direct scalding water to skin that no longer always senses heat and cold as it once did. Medicine cabinets and counters are filled with powerful prescription drugs for multiple ailments and often there’s the cognitive challenge of remembering which drugs to take, how many and when. Just to round out the potentially dangerous chemical cocktail are all those over-the-counter supplements, vitamins, minerals and remedies that the doctors and pharmacists rarely know about.

Getting into and out of the bathtub or shower provides an adventure of slick surfaces and missing handholds. Burned out light bulbs darken the hallways and stairs because replacing them is problematic. Repairs and maintenance to loose steps, railings or floor tiles are postponed until someone else can get to them. Meals become a succession of microwave or TV dinners because the spouse who once cooked is no longer around or because preparation of fresh food is simply too difficult. There’s also the problem of remembering to turn off the stove or oven when meal is finally prepared. And, even if the oven timer goes off, there’s the problem of hearing deficits. Adding to these lesser indignities is the embarrassment and hygiene issues resulting from the occasional or constant problem of incontinence, one of the primary reasons that the elderly end up in an institution.

And, there are those mailings and phone calls from friendly strangers announcing that you are a winner in that rich Canadian or Nigerian sweepstakes. These elder-targeted offers become more and more attractive as the senior becomes lonelier and less skeptical of such scams. Ah, home.

Clearly, not every person attaining their 85th birthday and living in their own home suffers from even one of these problems, let alone all of them. Those hail and hardy few with no deficits at 85 are a very small minority however and, unless they then die suddenly after being the picture of health into their ninth decade, they too will experience the frustrations of decline for some period of their life prior to death. When this occurs, staying at home without assistance becomes a personal safety and health gamble.

Prior to WWII, 65% of adult children lived within five miles of the place where they were raised and where their parents yet lived. When mom and/or dad became infirm, there was family nearby with whom they could live or from whom they could get assistance. Particularly in rural America, this generational family care giving still occurs, but it is far less common than it was 60 years ago. This cultural sea change is attributable to an American society and workforce that became mobile and restless in the latter half of the 20th century. There were two driving factors: (1) adult children began moving away from hometowns to further their careers and (2) many retirees migrated to warmer climates across the Sunbelt, leaving family and friends behind. Today the percentage of adult children who remain in the same general location as their parents has flip-flopped and now only 35% live within an hour’s drive.

When we look at this particular issue in the retirement destination geographies, what we see is a 65+ population, 85% of whom have no local family support.

The problems associated with the “at home” alternative have several sources. First, there is the denial factor. Frail elders are rarely the first to volunteer that they need assistance. The weekly phone conversation wherein the senior responds that he or she is “doing fine” is often a pale imitation of reality. Second is parent/child role reversal. Many adult children are uncomfortable taking the lead and many aging parents refuse to relinquish their leadership. Third is the reluctance of the elderly to pay the going price for assistance. Fourth is the confusing and fragmented nature of the local community-based care providers. Fifth is most family’s lack of clinical expertise to determine the elder’s actual assistance needs. This lack of expertise leads to reactive solutions instead of planning. Frustration ensues.

In spite of all of these potential negatives, about 2.7 million of America’s 4.7 million 85+ population continue to live in their own homes (1.7 million alone and 1 million with spouses). Over 80% of these elders are struggling with one or more of the quality of life or safety challenges mentioned earlier. By 2031 the number of frail elderly trying to live independently in their home will balloon to over 6 million. And, because the trend of adult children not living close to their parents is not likely to reverse, the “at home” alternative has the potential to become one of the nation’s leading social and health care problems.

There is nothing to suggest that we Baby Boomers will be any less stubborn about aging at home than our parents have been. If anything, given our reputation for independence and disdain for authority, the trend is likely to intensify. Therefore, America’s policy-makers must look at long-term care funding issues with a keen sense that aging safely at home is at least as big a concern as fixing the institutional problems of nursing homes or ALFs.

To be sure, aging at home is not the best alternative for some elders. Those who have ADL deficits and/or dementia issues that require 24/7 nursing care or monitoring are faced with enormously expensive paid care giving options or overwhelmingly difficult family burdens. However, millions can live very safely and contentedly at home with the appropriate support. But what is appropriate and who should decide? Most family caregivers are not clinicians or care giving professionals, nor are their elders. As a result, the care giving tends to be based on reactive and defensive perceived need, some real, some not.

Family caregivers face one or many of a myriad of tasks in support of the elder: scheduled and emergency trips to doctors, health care benefits management, insurance and payment questions, financial management, fraud prevention, home safety challenges, nutritional issues, medication management, grocery and other personal shopping, meal preparation, housekeeping, home maintenance, toileting, bathing, dressing, grooming, companionship and socialization.

The fragmented nature of the community-based services that could support a family caregiver makes it very difficult to organize and execute an effective plan for aging-at-home. This is especially true for those elders who don’t live in the same community as their family. As discussed before, this long-distance care giving scenario is the rule in American today, not the exception. As a result, support and service opportunities are missed, money is ill-spent and frustration grows as solutions are created after problems develop.

Where there is a need there is a market opportunity and, indeed, a small industry has emerged in the U.S. to address this need. The service is known as Geriatric Care Management, although it might better be described and understood as Assisted Living at Home. Consisting primarily of clinicians (nurses and social workers) the role of this small industry is to provide families with a knowledgeable representative in the community where the elder lives. The care manager’s job is to evaluate the real assistance needs of the senior, create a care plan, arrange for appropriate help, using community-based providers, monitor the quality and effectiveness of that help and generally be a quality-of-life ombudsman for the elder and the family. There are only a few thousand of these independent practitioners in the U.S. and they tend to be concentrated in the destination retirement communities of the Sunbelt where there are many frail elderly who have aged-in-place but not near their families.

For their services these practitioners charge a fee, which varies widely across the geographic markets of the U.S. The industry has a professional organization headquartered in Tucson, Arizona, The National Association of Professional Geriatric Care Managers. The association provides a certification process for practitioners but, to date, there are no state or federal licensing requirements, which means that care manager knowledge and quality can differ dramatically from one practitioner to another.

Nonetheless, with appropriate funding support, stricter competency requirements and wider consumer awareness, this Assisted Living at Home industry is destined to grow, especially if it links itself to the ALF industry where 92% of the prospective clients visit the ALF and then return home to try and “tough it out” on their own. As a better and safer at-home living option and/or an interim step to institutional living (if that becomes necessary), having a geriatric care manager who can help assure safer aging-at-home, which is more satisfying and affordable for all concerned, should be on our national policy agenda now not later. (To find a care manager in your particular area of the country, go to www.caremanager.org. and click on “Find a care manager”.)

Aging-at-home is what most Americans prefer. This alternative could be improved dramatically with common-sense policy decisions that encourage tax benefits that are beneficial to dependent elders and their informal unpaid caregivers and Medicare and Medicaid rules that encourage care at home and not in an institution. We don’t need further national debate, we need policy change.

Baby Boom Delusions and Solutions (Chapter 2, Part 3, Final)

2010-03-02T12:34:00.002-05:00

With today's post, Chapter 2 is complete. Chapters 1 and 2 have set the stage for the remainder of the book; a close look at the five challenges and their potential solutions. While some of my solutions may prove controversial, their debate, final form and transition into policy and law cannot wait another generation.

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Chapter 2 (Part 3, Final)
A GREATER GENERATION?

4. Demand Knowledgeable and Sufficient Care

Here’s a fact that many in the medical community would rather you not know: they don’t know much about treating the elderly. Unless a medical student or resident is planning on being a geriatrician, the American system of training doctors almost completely ignores the unique needs of the elderly. If your reaction to this fact is “So what, I’ll just get a geriatrician when the time comes,” you are in for an unpleasant surprise. Geriatricians are a rare and shrinking breed in America. You are unlikely to find one. This situation is a result of relatively low pay for geriatricians, ageism and the issue of professional status.

Compared to their specialist peers, who routinely earn $500,000+ per year, the geriatrician, similar to the family doctor or pediatrician, can expect to earn only about 1/3 as much. When many young MDs emerge from med school owing hundreds of thousands in student loans, there is little monetary incentive in becoming a geriatrician. And, our medical students and residents are not immune to the issue of ageism; old people with multiple complaints are just going to get older and develop other complaints. Then, there is the issue of professional status, where the pecking order surely does not begin with doctors whose specialty is geriatrics; it doesn’t sound glamorous and, relatively speaking, it doesn’t pay that well. Deborah Chase’s internist was not sufficiently schooled in geriatric depression and his ignorance ruined at least a year of her life.

The demographic realities of America indicate that all physicians should be schooled in the basic aspects of health care for the elderly. Geriatric medicine is different in the same way that pediatric medicine is different. The training issues and pay disparities must be addressed through policy solutions.

Broadening geriatric medicine expertise will reduce health care costs by reducing the current mistakes in diagnosis or treatments that occur because a clinician doesn’t know that the aged often present symptoms and react to treatments quite differently than younger patients. At the very least, all 131 American medical schools should include an expanded, recurring and required geriatrics curriculum, regardless of the student’s declared specialty. For most of them, treating elderly patients will be a given not an option. Such schooling would also have a moderating effect on the issue of professional status as clinicians come to appreciate the complexities of dealing with the health issues of aging.

America already has a nurse and nurse’s aide shortage, especially for those serving the dependent elderly. The trend of producing qualified new ones is down and we’re only 22 years away from the first of the Boomers turning 85. Without a measurable reversal in this situation, there won’t be enough qualified caregivers (RNs, LPNs and nurses aides) available to provide the help many Boomers will need to live dignified lives when they are dependent on help. This shortage will mean rationing of assistance and/or care provided by the inept and ill-trained.

Although better than the geriatric educational in America’s med schools, the amount of geriatric training in America’s nursing colleges falls short on two fronts: (1) the shortage of classroom space and instructors to train nurses of all types, including geriatric nurses and (2) the same issues of ageism and professional status that plagues the med schools. Creating classroom space for the 92,000 qualified nursing school candidates who are turned away every year will be easier than training the trainers to teach them. The latter will require changes in policy and the creation of financial incentives for some nurses to teach rather than to nurse, a decision that is often driven by pay differentials.

While there are enough candidates for nurse’s aide jobs now--as there will be in the future--the poor working conditions in which aides are often asked to build a career, for meager pay and low professional status, attract only the most altruistic or desperate. If this were not so, the average annual turnover rate for nurses aide workers in geriatric settings would not be 85%, a number that does not reflect career satisfaction. The solutions for this particular problem involve issues of more and better candidate screening, working environment improvements, training, job status, career path and pay, and immigration policy.

5. Eliminate Lingering, Lonely and Painful Dying

The irony of the incredible advances in medicine in the past century is that these advances have turned death into a medical failure, even for the very old and very sick. With one or two arguable exceptions, for every recorded human birth in history, there has been a related human death. Up until about 1950, old age was but one of many causes of death, e.g. child birth, heart attack, pneumonia, cancer, stroke, the flu, the plague, polio, accident, ruptured appendix, infection, et al. Today, old age and its related vicissitudes—which, individually, get the credit on the death certificate--dominates the “cause of death” paradigm in America. Sure, the other causes of death still remain but the bulk of Americans now die because their systems simply wear out with age.

The human body can now -- with mechanical and chemical aids -- continue the processes controlled by the lower brain stem; respiration, circulation, digestion and elimination, long after the higher brain functions of communications, memory, emotion, muscle control, senses, etc. have disappeared, never to return. The fact that 80% of Americans now die at an advanced age, in small undignified steps, in institutions surrounded by well-meaning strangers (instead of at home, where over 93% of Americans claim that they want to die) illustrates the problem. What we want and what we get at life’s final milepost are completely different.

Today, once the old and terminally ill enter the health care system, the choice about the nature of their care is usually out of their hands. The end-of-life health care choices are complicated by the following: confusion about who is to make decisions on behalf of the incompetent dying patient, newly available medical alternatives, ethical dilemmas, religious beliefs, cultural taboos, legal precedent and, most importantly, ignorance of the patient’s wishes.

Perhaps the biggest reason that the very old have such a low chance of experiencing the dying process they might want is the distancing between physicians and their patients. This disconnection means that many physicians, particularly specialists, don’t know the patients under their care very well. If a family doctor is involved but hasn’t had a specific “end-of-life” discussion with the patient, their end-of-life care input is trumped by the specialists. Deborah Chase’s internist is a case in point. This situation has been created by the emergence of specialized and more complex medical alternatives, Medicare’s cure versus care bias and woeful confusion or ignorance regarding the nature and intent of living wills, health care surrogates, Do Not Resuscitate orders and Advanced Medical Directives

If Boomers want better options for their own end-of-life care, whether it is “Do everything possible to keep me breathing regardless of the consequences” or “Let me be comfortable, unafraid and at peace with the outcome,” then Boomers need to help create and support sensible end-of-life health care policy, greatly expand and refine the use of advance care directives, demand better end-of-life health care training for clinicians and promote insurance reimbursement for care expenses not just cure expenses. These changes should come from a recognition by the public and the health care system that dying is eventually a natural process for the very old, not an enemy to be vanquished. The real villain is a dying process that needlessly prolongs suffering and/or robs people of the dignity each deserves.

Having a national policy that encourages citizens to consider these issues and talk with their physician about their end-of-life care wishes is the antithesis of the notion of “death panels”, a patently ludicrous fiction promoted by the hopelessly paranoid.

Becoming a Great Generation

The five challenges outlined are daunting. It will take wisdom, courage and strength to take them on. There will be sacred cows to herd. Large and moneyed lobbies will rear up to oppose the process. Some influential but cowardly politicians will regard power as more important than the common good. There will be well-meaning but wrong-headed opponents and proponents clouding the issues with their own religious, spiritual or personal objections. There will certainly be defeats, self doubts, contentious viewpoints, heated debates and strange bedfellows along the way. What, you thought this would be easy? Well, it’s easier than wading ashore under withering fire at Omaha Beach on the morning of June 6, 1944.

And, should the Baby Boom take up the call and succeed, it would not be classy to seek accolades. We should take on these challenges simply because they desperately need to be done; right now. Someone has to take the lead and it is our turn.

In the following chapters I will elaborate on the nature of the challenges and suggest solutions, but mine aren’t the only ones. My goal is to give you ideas about how you can help move the agenda for change along. We must act now or the necessary changes will not happen. Unless you and I and Deborah Anne Chase individually decide now to put our support and influence into improving the systems, institutions and attitudes related to dependent living alternatives, entitlement programs, unnecessary costs, geriatric health care and end-of-life care in America, the same dysfunctional system is awaiting our arrival. Considering how much of our lives has already been lived, that future is very close.

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Bruce

Observoid of the Day: Freud said, "We cannot imagine our own death." Nevertheless, Freud is dead.

Baby Boom Delusions and Solutions (Chap. 2, Part 2)

2010-02-25T11:42:00.001-05:00

Today's post highlights the first three of five policy issues confronting and/or caused by the Baby Boom. These issues will significantly impact all 77 million Boomers, their children their grand children and the fiscal viability of the American Republic.

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Chapter 2

A GREATER GENERATION?

(Part 2) See previous posts for background

In brief, here are the challenges:

1. Completely Re-Think Long-Term Care

Putting mom or dad in a “home” after they have lived a lifetime at home is a decision that usually causes immense family heartache, anger, guilt and division. Do you want to live in a nursing home? Deborah Chase certainly didn’t. Statistics indicate that you and Deborah probably will spend some time there at the end of your life—unless we begin changing policy and nursing homes now.

There is a reason that nursing homes are so universally feared; it’s because they are rarely good places to finish out a meaningful life. Nursing home owners and managers will likely take exception to this viewpoint. Many of these professionals are devoting their careers to making their nursing home(s) the exception to the rule. However, you know what is said about pigs and lipstick. You can gussy up an institution with flowers, homey furniture, sun rooms or allow pets and it’s still an institution. It is not and will not feel like home.

America’s institutional nursing homes develop rapidly in the mid-20th century in response to the fact that Americans were beginning, in large numbers, to live beyond their ability to live independently. Not only was advanced old age a new norm for America, it was new to mankind, thanks to better health care and new medicines. American politicians did their best to resolve this challenge and passed appropriate legislation to encourage (through financial incentives) the creation of beds to serve this growing infirm population. In the 1950’s this new industry borrowed the clinical hospital model as the template for building. There was no other model that seemed to fit.

Today there are better alternatives (many involving staying at home or moving into a truly home-like setting) and, here’s the promising part, these alternatives are budding just as the old institutional nursing home infrastructure is aging and crying out to be replaced. However, without the right incentives and public demand, the private sector will likely just tear down the old nursing home and put up a new, bigger institution. If so, one of those oxymoronically named “semi-private” rooms will be waiting for you and Deborah Chase, whether you want to live there or not.

Creating ways for people to age in-place--in their homes, or in a home-like setting--requires that we (1) provide more substantive support and tax relief for family caregivers, (2) re-direct public funds from institutional care to in-home care, (3) be creative and sensible in using the equity value of home mortgages so that the costs of in-home care do not translate into a higher tax burden for subsequent generations, (4) provide incentives for long term care facility providers to expand on a building model that mirrors a home environment and (5) insist that long term care insurance (including Medicaid) not be skewed toward institutionalization, as it is today.

2. Re-Design Social Security, Medicare and Medicaid

Any talk of trimming the big three entitlement programs makes politicians grow pale and wet themselves. They react thus because, once a benefit is established, it’s political suicide to suggest taking any of it away, even if the original benefit no longer makes any sense in a dramatically changed demographic and financial environment. As a result, we now have a Social Security system designed to serve the conditions of a 1935 America when there were 16 wage earners supporting one pensioner. Today, the ratio is about 3 to 1 and about to get worse.

Politics has generated a popular Medicare system that focuses on cure but shifts the cost of long-term care to the family. It is a program that is an unwilling and unhappy passenger on a run-a-way health care cost inflation bus. And, although it is arguably the nation's most efficient and fastest payer of claims, it is rife with fraud primarily because of this efficiency. No good deed goes unpunished.

Politics has also given us a Medicaid system that steers elders to nursing homes in many states (once beneficiaries can prove themselves penurious) and too often discourages care solutions that favor aging at home. Medicaid is another unhappy passenger on the health care cost inflation bus.

The conventional wisdom is that if law-makers tinker with the nature and intent of these entitlement programs, voters will relieve them of their power. Touch the entitlement “third rail” and you will be political toast. George W. Bush tried to tweak Social Security during his second term and was resoundingly booed off the stage. Although, he did manage to add an unfunded drug benefit to Medicare while big pharma cheered and waved pom-poms on the sidelines. Adding stuff is way more popular than subtracting stuff.

The consequences of maintaining the status quo of these programs makes for a grim financial picture. In fact, the status quo is unsustainable; period. No kidding. If the Baby Boom wants to make a reasoned and reasonable sacrifice for the common good of the country, amending these entitlement programs is the opportunity. If, however, the entire Baby Boom demands these entitlements in full, as currently constructed, the Boomers will eventually be hoist by their own petard. If Boomers fail to help adjust these programs now, their children and grandchildren will have less reason to remember “Grammie” fondly.

The fixes for these entitlement programs require political will, an attribute currently in short supply in Washington and State Houses around the country. Boomers must provide the backbone and leadership on these issues because the politicians have proven themselves unable to lead, time after inglorious time. We must insist that lawmakers grab the “third rail” and make sure that the entitlement train is headed in the right direction, not just in our direction. The fiscal viability of America depends on it.

3. Expose and Eliminate the Hidden Costs of Growing Old

Fraud.   Unless you have had first-hand experience or have made it your business to explore the ways in which the unscrupulous relieve the elderly of their money, you probably have but a cursory idea of the problem. The scamming of the elderly has become--thanks to sophisticated data base mining, improvements in telephone technology and the Internet--an international industry. The perpetrators are often beyond the reach of local law enforcement, highly mobile and relentless. Deborah Chase meant well, “Dr. Someone” did not.

Even more frequently than strangers, known caregivers financially abuse the elderly. These caregivers are often relatives but also include hired help such as aides or professional advisers. These financial losses often go undetected and/or unreported. It is a difficult problem because of privacy and autonomy issues. This hidden cost will significantly balloon with the aging of the Baby Boom, a generation that has more assets than any before it.

America needs to put a much higher priority on catching and meting out deterring punishment to those who take financial advantage of the vulnerable elderly.

Medication Mismanagement.   Another cause of unnecessary spending can be found in the medicine cabinets of the elderly: rows of medications, some current, many out of date and most of them potent. Without a reliable means of assessing the possible interactions or a foolproof way to manage their proper use, the aged too often end up in the emergency room because of over dose, under dose or drug interaction.

Beyond the problem of medication mismanagement, medication overload becomes problematic as the elderly expand their coterie of medical specialists, many of whom have neither the time nor inclination to conduct a thorough inventory of their patient’s medication regimen. In addition, few of these medical providers have even basic training in geriatrics. Boomers should take the lead in demanding that the health care industry find a workable solution to medication management, a problem that silently leeches away billions in private and public funds every year.

Corporate Inefficiency and Family Costs.   According to a 2006 MetLife study, the annual inefficiency cost to American businesses for the “under the radar” elder care responsibilities shouldered by employees was $33 billion. These corporate costs come from (a) unexpected turnover, (b) absenteeism, (c) workday interruptions and (d) diverted attention on the job because of the employee’s need to provide care for an elderly relative. It’s conservative to estimate that this inefficiency cost now exceeds $40 billion every year.

These figures do not include the out-of-pocket expenses incurred by employees, which, especially for the long distance caregiver, can easily be thousands of dollars per year. Deborah Chase’s children spent thousands for travel alone. Layered on to these dollar costs are the emotional and physical tolls that elder care can extract from family caregivers, most of whom have jobs and many with children still at home. American business leaders and government policy makers need to bring elder care out of the shadows, relieve it of its stigma in the workplace and help caregivers find affordable solutions. Not only is it the right thing to do, it is the economically sensible thing to do.

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Bruce

Observoid of the Day: 43.7% of all statistics are made up on the spot.

Baby Boom Delusions and Solutions (Chap. 2, Part 1)

2010-02-22T15:30:00.004-05:00

With this post begins Chapter 2 of Baby Boom Delusions and Solutions. This chapter focuses on five demands that the Baby Boom must make on our policy and law-makers. If these demands are not realized, the negative experiences visited upon Deborah Anne Chase and her family--as recounted in Chapter 1--will be visited upon millions of Boomers and their families.

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Chapter 2

A GREATER GENERATION?

Tom Brokaw’s 1998 book, The Greatest Generation, tributes his parent’s cohort, the one that mobilized, fought and helped the Allies win the Second World War. Millions of relevant examples can be recounted that illustrate the effort and sacrifice of the American generation born between 1910 and 1924. They rose to the challenge of a world threatened by the ideologies of fascism and militarism. Many did it enthusiastically. Others grumbled and groused but did it anyway. The overarching reality was a national effort and sacrifice in blood, money and deprivation. The Greatest Generation’s contribution from 1941 to 1945 was primarily as the military muscle. When blood was spilled, it was mostly theirs. They didn’t choose to play this role but they did it when history brought it to them.

Here are a few examples of that effort. Deborah Chase’s father piloted an Army Air Corps C-47 Skytrain and ferried airborne troops to North Africa, Sicily, Italy and France. He was wounded by flak fire on D-Day just after he had dropped paratroopers behind German lines. Deb’s grandparents, her mother and the others on the American home front endured shortages of critical raw materials, lived with rationed gasoline and foodstuffs, tended “victory gardens”, gathered scrap metal and bought War Bonds. It was a brief time of effort and sacrifice for the common good. Brokaw has a case.

When the war was over, the Greatest Generation then produced Deborah’s generation, the Baby Boom. Using Brokaw’s yardstick to compare the Baby Boom to the Greatest Generation, how do we Boomers measure up?

In terms of sheer numbers there is no doubt that the Baby Boom can claim the title of America’s biggest generation. Those of us born between January 1, 1946 and December 31, 1963 make up the largest generational cohort in American history: 77,000,000. Raised and educated in a prosperous post war society, the Baby Boom is the bull in America’s demographic China shop. Being big, however, doesn’t mean being respected and it certainly doesn’t mean general popularity.

Even a cursory review of things written and said about the Baby Boom will often include such descriptions as: “selfish, self-absorbed, entitlement mentality, navel gazing, irresponsible, immature, self-important, smug, frivolous….”, you get the drift and may agree. As a Baby Boomer, I squirm a bit considering that these descriptors could be more right than wrong. But are we as bad as our general reputation?

Very few voices have risen to defend us. One of those voices is sociologist Leonard Steinhorn whose 2006 book The Greater Generation, In Defense of the Baby Boom Legacy, suggests that the Baby Boom is generally getting an unfair evaluation. Steinhorn says that Boomers “created, reinvented, invigorated or sustained the great citizen movements that have advanced American values and freedoms” since the mid 20th century. Among these movements he includes environmentalism, consumerism, women’s rights, civil rights, gay and lesbian rights and openness in government. Well, maybe.

To be sure, Boomers took up many of these causes and provided the ground troops and some ballot muscle to change America for the better. However, in virtually all cases, the visionaries who first stepped out of line to challenge society on these seminal issues were from the generations that preceded the Baby Boom; Martin Luther King, Jr. (civil rights), Gloria Steinem and Betty Friedan (womens’ rights), Aldo Leopold, Rachel Carson, Bob Hunter (environmental awareness), Franklin Kameny and Barbara Gittings (gay rights) were all born before 1946. To claim that that the Boomers created these movements just doesn’t match the calendar.

The Baby Boom’s contribution to these social sea changes has more to do with lucky timing than with pioneering vision. The social movements of the 60’s and 70’s occurred when Boomers were very young adults, teens or adolescents, the perfect rebellious age for latching onto causes that parents and society were resisting. Unlike China’s Cultural Revolution, which harnessed the same age-related energy for destructive social upheaval, America’s turbulent 60’s and 70’s were fueled by the participation of Baby Boomers for the common good. But the leaders and visionaries behind these movements came from the ranks of the Boomers’ parents or older brothers and sisters.

Steinhorn also asserts that Boomers had an important influence on remaking the American workplace as soon as they began to enter the job market. “In the seventies,” he says, “at the precise moment that a critical mass of Boomers was entering the workforce, it became painfully clear to them that the economy was collapsing under the weight of shortsighted management decisions that protected the status quo at the expense of investments needed to keep our economy a step ahead. As Boomers saw it, the dinosaur organizations their parents embraced stifled not only creativity but fulfillment on the job.” (Italics, mine)

I was one of those early Boomers entering the workforce in 1972 and I can assure you that I was not thinking about any of those things and I doubt that very many of my contemporaries were either. We barely knew what an organizational chart was. We were just happy to have jobs. Granted, as our careers and business savvy matured and as younger Boomers entered the workplace behind us, we changed the American workplace, but then each new generation does, whatever its sensibilities. I don’t think that this makes the Baby Boom special, except for the sheer number of plum jobs that we now occupy. Deborah Chase attained one of those good jobs.

While Baby Boomers might want to take credit for most of the cultural good that has emerged in America since the 60’s, I think it's a stretch for Steinhorn to label it the “Greater Generation” in pointed comparison to the Greatest Generation. To quote Brokaw’s book, “In the World War II generation, ordinary people found common cause, made extraordinary sacrifices and never whined or whimpered.” To date, we Baby Boomers may have found several good common causes to rally around but the quantity of self-sacrifice has been measurably less than experienced by the Greatest Generation and we have not developed a comparable reputation for stoic acceptance of whatever burdens we have assumed. We tend to be a bit whiny.

Whether you agree or disagree that the Baby Boom has earned the appellation of “greater generation” based on its vision and sacrifice for the common good, I believe that there is one final chance for the cohort to truly earn (or burnish) such a reputation. This chance comes with the aging, decline and eventual death of the Baby Boom itself. It is an eventuality that is only now dawning on Boomers; a process and finality that most Boomers would rather not ponder. Many boomers are under the delusion that they will be spared.

The Baby Boom has prospered and the great majority of us will live long. History, therefore, has presented our generation with a monumental challenge based on our newly experienced longevity. Living long has some down sides.

America’s current social service policies, entitlement programs, health care systems, end-of-life care standards and support structures are ill-prepared for the onslaught of Boomers as they age beyond good health and independence. These shortcomings are plaguing the very old in America today, but the dependent elderly are, as they have been for many decades, not a powerful voice for change. Even now, millions of Baby Boomers are observing the challenges discussed in this book because they are grappling with the frustrations of care for their own parents. It’s amazing that this experience hasn’t already created a loud and long outcry for change.

If the Baby Boom wants better and more effective policies dealing with their own care, decline and death than are currently in place, the changes must begin now, not in 22 years when the oldest Boomers will be 85. Boomers should want to tackle these challenges for three reasons: (1) for their own good, (2) to save their children and grandchildren from a support system that, if not broken, is certainly dysfunctional, and (3) to allow America to regain budget sanity.

These systemic changes will impact how Americans are cared for as they decline and die for generations to come, not just the Baby Boom. And, some of the needed changes will ask for real but reasonable sacrifice from many Baby Boomers, lest the burden fall on their children and grandchildren. So, the changes are for the common good, many of them will require measurable self-sacrifice from Boomers and they need to be done with stoic awareness that they are necessary. Given these elements, it can be argued that if the Boomers take up the challenge and succeed, then the claim to be a great generation has traction.

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Bruce

Observoid of the Day: Anywhere is within walking distance if you have the time.

Baby Boom Delusions and Solutions (Chap. 1, Final)

2010-02-17T10:15:00.009-05:00

Final Installment of Chapter 1, "A Baby Boomer's Life and Death". See previous posts for Parts 1 and 2.

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One morning the other bed in Deborah’s room was empty and neatly made. She haltingly asked an aide where the other woman was; the aide said that Deborah “needn’t worry about it” and quickly left the room. Death was not spoken of in this place, although it occurred regularly. Two days later, another woman moved into the room with Deborah. The new roommate was ambulatory, talked incessantly about the same topics over and over and pawed through Deborah’s chest of drawers when she thought that no one was looking. She took clothing and small items. The aides recovered most of Deb’s stuff but it was a constant activity. Deb had never suffered fools gladly but here, she was forced to endure them; and, to endure this place along with them. They were all inmates.

Because Deb’s step-daughter made regular and unannounced visits, Deb was kept relatively clean and dry. When the daughter considered her mother’s care unacceptable, she made a fuss. The aides soon learned that Deb’s daughter could be a problem if they didn’t attend to her mother’s needs. Since there were too few aides for this 120 bed facility, taking good care of residents-- especially those who had regular visitors--meant that those residents with no one routinely stopping in for visits received less care. Often, when being wheeled past particular rooms along the long linoleum corridor, Deborah could smell the residents who were left to marinate in their own filth until the aides could find time to clean them up, sometimes hours later; too much work, too few workers.

In mid-September of 2035, Deborah developed an infection in an ankle wound suffered when an aide accidentally banged into her with the footrest of a wheelchair. The infection spread up her leg and proved resistant to the regime of antibiotics. After years of taking antibiotics for various infections, Deborah’s bacteria were well armed to resist eradication. The infection turned ugly and her leg gangrenous. Deborah was sent to the ICU at a large Atlanta teaching hospital. Her leg was amputated at the knee. The surgery site contracted another and different infection, a bug from within the hospital. The new infection spread to her lungs and they quickly declined in function. The medical team, none of whom her family had known prior to this hospitalization, recommended that Deborah be placed on a ventilator to “ease her breathing”. What they did not tell the family was that it was very unlikely that Deborah would ever breathe on her own again, ever.

Deborah’s kidneys began to fail. A young resident arranged for her to be gurneyed to the dialysis three times a week. Her daughter agreed.

The amputation site was painful and Deborah often teared silently and furrowed her brow when the doctors or nurses asked her how she was feeling. Pain medication was administered but never enough to do the job.

The wounded stump required another surgery to clean up additional gangrene. Deborah’s eyes were now sunken hollows, seeing little but still registering pain and misery. Her med-student grandson argued with one of the residents about failing to provide sufficient pain medication. The resident insisted that to give Deborah more drugs would make her dependent on the morphine; he said that she would become addicted. The grandson also argued with his own mother about her decision to allow Deborah to have dialysis. His argument was based on the medically obvious; Deborah was dying; doing anything to prolong that process was simply extending her suffering.

The daughter called Deborah’s doctor for his advice. He deferred to the hospital’s medical staff. It was clear, he felt that his role as a healer was over because Deb couldn’t be healed. Cure trumped care.

Deborah had never filled out an advance medical directive, although such forms were readily available. She had not discussed her end-of-life wishes with anyone, including her doctor. She had given her daughter a medical power of attorney but she never talked with her daughter about her wishes for care when her condition became terminal. Perhaps Deborah wanted every treatment available regardless of the expense, discomfort or likely outcome. Or, perhaps, she wanted the dying process to be comfortable, without intrusive and futile medical interventions. Her family was left to guess, because Deborah was no longer able to communicate.

As it was, Deborah experienced the first kind of dying; lingering, painful, undignified, fearful and lonely, in spite of the best intentions of the medical staff and family.

Dozens of friends, former employees, business associates and family members attended her memorial service. She was fondly remembered by these people. Most, except for the immediate family, were unaware of the details of Deborah’s life during those final few years.

No one from the hospital team attended nor did her family receive notes from any who had served her in the medical or care community.

Deborah’s rich and meaningful life spiraled into ignominy during her final four years. When she lost independence, she was swept into an elder care, health care and dependent living systems that were fragmented and awash in state and federal policies that frustrated proper and affordable care for the dependent elderly. In general, it was a dysfunctional, multi-layered system, ill-prepared for the tsunami of dependent elderly still known in 2035, ironically, as the Baby Boom.

Health care professionals, politicians, federal and state bureaucrats plus the voting public had seen the elderly tidal wave coming years before but, for various and not always altruistic reasons, had chosen to avoid big fixes. Instead, there was patching here and there hoping that it would somehow all work out. It didn’t. It was a delusion to think that it would work itself out.

The biggest delusion was that of the Baby Boom. They allowed themselves to believe that they would never grow old and dependent.

By 2064 there were but a mere handful of centenarian Baby Boomers left. The majority of the cohort had already experienced much the same kind of physical decline, sub-optimal care and poor dying process that Deborah had experienced. Their education, money and reputation didn’t alter the nature of the outcome. The Baby Boom failed to take control of its own inevitable future back when it still had political and financial clout. The generation’s lack of political will and action sealed its fate. It should have been different. It could have been different.

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Coming next: Chapter 2 "A Greater Generation?"

Bruce

Observoid of the Day: Growing old is an accumulation of small indignities.

Baby Boom Delusions and Solutions (Chap.1, Part 2)

2010-02-15T13:48:00.002-05:00

See previous posts for background.
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Deb’s daughter and stepdaughter arranged for a series of private duty in-home helpers. The first woman was good for the first few months and then began to skip days, show up late or leave early; but, she was always sweet to “Miz Chase” and Deborah liked her. The woman asked Deborah for a loan of $10,000, claiming that her husband “needed emergency surgery”. Deborah wrote her a check. The woman cashed the check but never returned.

The second woman lasted one week. The third, referred by an employment agency, turned out to be in the country illegally, had a drug habit--which she partially funded by fencing Deborah’s jewelry--and left the country before she could be arrested. Frustrated, the family hired bonded help through an in- home companion service agency. As Deborah’s confusion mounted and her memory slipped, the tag-team of companions had to be with her nearly 24/7 and the monthly bill exceeded $15,000. Because Deborah’s care needs were not directly related to medical treatment, Medicare paid not a penny. While well-to-do by most standards, Deborah’s nest egg could not stand a nearly $200,000 per year tab for trustworthy in-home assistance.

Her children might have pooled resources to keep her at home but they were already paying over 22% of their incomes to fund Social Security, Medicare and Medicaid. Their generation was financially struggling to fulfill the government’s entitlement program promises now that the entire living Baby Boom was over 65. It was rumored that FICA would increase another 2% in 2030.

After much rancorous family discussion, Deborah moved to an Atlanta assisted living facility. She left behind her spacious home with its beloved art collection, her craft studio, beautiful kitchen and peaceful screened deck. She gave her cat to her granddaughter because pets were not allowed at Heritage Gardens. She moved into her new small apartment an unhappy camper.

She hated the community dining room with its cliques of “ins” and “outs”, social butterflies and overly attentive gentlemen. She despised the cafeteria-style food. She wanted nothing to do with the group outings to local attractions, all of which she had seen before and several for which she had served on the boards or fund-raising committees. She only admitted it to herself, but the thought of returning to those local attractions as just another senior citizen shuffling off of the van was humiliating.

She made one or two friends, was attended to by the facility’s health and daily care staff and life for her scattered family returned to nearly normal. It wasn’t normal for Deborah and she developed clinical depression, a condition that went undiagnosed for over a year. Her doctor had no training in geriatrics. He mistook her symptoms as the natural state of the elderly. The woman that her children, grandchildren and friends visited and phoned during this time was a heart- breaking shadow of the vibrant woman Deb had been for nearly eight decades.

In March of 2030, Deborah’s daughter, by then living in Santa Fe, received a call from Deborah’s tax attorney. The attorney, a long-time friend was in the process of preparing Deborah’s 2029 return and had come across some banking transactions that were problematic and of no small consequence, nearly $80,000. She suggested that the daughter come to Atlanta right away.

Within the week it came to light that Deborah had been contacted via untraceable wireless phone by “Dr. Someone” (she just couldn’t remember his name) in Nigeria. He claimed to have gotten her name from the director of Deborah’s favorite charity, one that indeed did good work in Nigeria. The ”Dr.” indicated that there was a very large pool of money—Deborah thought it was $4 or $5 million, or maybe he said $45 million--available there, left over from an unfulfilled Nigerian government contract. If Deborah would just help free up this money he promised to give one quarter of the millions to the favorite charity.

Over the course of the next four months, Deborah wired $5,000, then $12,000, followed by $8,000, $35,000 and finally, $19,000. Each transfer was preceded by a call from the friendly “Dr. Someone” who assured Deborah that these additional payments were needed to take care of unforeseen bribes, a bureaucratic snafu or tax payment and that soon the charity would have its grand gift, thanks to her. He also assured her that she would soon get all of her money back with interest. Deb told her trust officer that these large checks were cash gifts for her grandchildren and children. Deborah had once been one of the most respected financial executives in Atlanta.

The money was never recovered; Deborah continued to insist that “Dr. Someone” was “such a nice man” and would never cheat her and she was livid when her daughter had Deborah’s phone number changed. For security reasons, the tax attorney was added to her checking account and did a daily on-line review of transactions. This trusted professional charged a pro-rated $250 hourly fee for this service. None of the government entitlement programs paid for this type of oversight or could provide someone who could do it cheaper.

The brain aneurysm did its damage late in 2030, just before the holidays. By this time, only one of her children remained in Atlanta. After the initial hospitalization, Deborah’s daughter and stepdaughter searched for a skilled nursing facility (nursing home). Deborah was now almost totally dependent. She could no longer communicate clearly, dress herself, go to the toilet on her own or transfer from wheelchair to bed. She was once a woman who ran 10Ks in support of local charities.

After a sobering tour of several facilities, the daughters selected the one that didn’t smell of disinfectant and urine. This “home” had the fewest residents aimlessly parked in front of common area TVs. The institution was pleasant looking from the street with well-maintained grounds and walking paths. Inside there were live plants in the sun rooms and common areas and the semi-private rooms had floor to ceiling windows that looked out onto small patios and gardens. Deborah’s roommate was bedridden and talked to unseen visitors while awake and even during her dreams. She had no idea who Deborah was day-to-day.

A nurse’s aide awakened Deborah each morning at 6:30. With nearly 100% of the nursing home’s aide staff turning over every year, the person who woke Deborah was often a new face with a new accent. Some aides were more patient with Deb’s physical deficits than others. All of them called her “Debbie” or “Darlin’” or “Honey” or “Suga”. None of them called her Ms. Chase and they spoke to her as if talking to a child. When they were angry, like when she soiled herself after they had just changed her into something clean, they spoke harshly. On these occasions, Deborah was frightened and cried. Some of the aides called her a “big baby”. During her career, Deborah had a reputation for speaking truth to power, it was one of the attributes that made her successful, but none of the aides knew of her personal history and they had all the power now.

In her one-piece shift with Velcro fasteners and her skid-grip socks, Deborah was wheeled to the dining room every morning at 7:00 a.m. She sat beside another woman in a wheelchair and both were fed oatmeal, always oatmeal, by one aide who spooned first to one and then the other. There were not enough aides to feed the residents who needed eating assistance one-on-one. Deborah hated the oatmeal. It was tasteless, always nearly cold and nothing like the delicious oatmeal that she used to make with a touch of brown sugar, wheat germ, fresh berries and a splash of half and half.

The aide who fed them talked to the aide at the next table and Deborah ate very little. Most of the gruel slid out the side of her mouth that drooped. Nevertheless, the aide was instructed to feed [them] “all of the oatmeal” and so the feeding charade continued until the bowl was empty. Much of the food slipped down the neck of Deborah’s shapeless dress. She had once been a superb cook and she still knew what good food was. What was shoveled at her three times a day in this fluorescent-lit, loud and confusing place was certainly not it.

On Tuesdays, Fridays and Sundays, Deb was wheeled to the shower room where someone would remove her skid grip socks, help her stand, strip off her dress and underwear and ease her onto a wet plastic bench where she steadied herself as the aide shampooed her snow white hair and washed her down. There was no dignity in this routine but it was efficient. Once, many years ago, Deb had redone her master bath with a large walk-in shower. She could still recall the pleasure of the slate tiles under her feet and the hot water coursing from two shower heads. In those years, showering efficiency was not a goal.

******************************************************

To be continued.

Bruce

Observoid of the day: A nursing home bears little resemblance to your home.

Baby Boom Delusions and Solutions (Chap.1, Part 1)

2010-02-09T18:11:00.000-05:00

With this post, I am making good on an earlier threat to use this blog to pre-publish the book that I have toiled over for more than three years: Baby Boom Delusions and Solutions. Given its length, this will be accomplished via serialization. The end result will either be a ticker-tape parade in downtown Peoria--with me riding in the convertible--or a blog readership that shrinks to nada, as if it were the wet witch in the "Wizard of Oz". Either outcome could be good, depending on your vantage point. No guts, no ticker-tape.

Please take note: The person of "Deborah Anne Chase", featured in Chapter 1, is referenced throughout the remainder of the book. This is a literary device that allows me to provide examples of the topics covered in the subsequent chapters. Therefore, a reader who begins reading at some point after Chapter 1 would be confused by any "Ms. Chase" references. Therefore, in this blog version, I will parenthetically remind the reader to ("see Chapter 1") when these references occur. For those of you who start at the beginning it will be but a minor annoyance. Mea culpa.

Also, the subject matter is serious. Therefore, I try to respect the content appropriately

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Chapter 1

A BABY BOOMER'S LIFE AND DEATH

This is a story for those Americans born between January 1, 1946 and December 31, 1963, the Great American Baby Boom. The narrative will be true with some details altered to avoid unnecessary angst for Deborah Anne Chase and her family in the future. The details of the story are based on the facts of a real life and the realities of growing old, dependent and dying in America in the 21st century. Barring significant changes to current policies, programs, health care systems, institutions, ethics and attitudes, this story mirrors how the great bulk of the Baby Boom Generation will decline and die when their independence wanes. While this happens, America will financially struggle to keep its promises to a generation who thought mostly of itself. Only the Baby Boom has the financial and political power to demand the necessary changes so that this story is not their fated future or that of the country. Only a truly great generation would have the will and capacity to demand and institute these changes.

May 4, 1950, Greensboro, North Carolina, 8:52 a.m.
Deborah Anne Chase gulped in her first air and cried.

December 14, 2035, Atlanta, Georgia, 3:35 p.m.
Deborah’s final breaths were raspy and labored on this cool late fall afternoon. A tear pooled in the corner of the one eye that remained open as she slowly grew still. This was as close to crying that her body would allow. Her eyes hadn’t seen much in that sterile hospital room, the final 90 days of her 85-year life. A respirator had softly and inexorably shuffled air in and out of her useless lungs. Nutrition, one recoils from calling the milky liquid “food”, had dripped directly into her small intestine through a surgically inserted abdominal tube. It had been nearly four years since she had eaten a pleasant meal, cooked in her own nicely appointed kitchen. She had once, and for a long time, been a creative cook. Now, in her desperate silence, her clouded mind conjured long forgotten favorite recipes in great detail. Strange how the failing mind can manage to recall the specifics of small things loved.

Her daughter had finally insisted on the removal of the respirator and nutrition support. She left the room in tears a few minutes before her mother’s labored breathing finally stopped. She was simply not prepared to observe her mother struggle to breathe. Remaining in the room were Deborah’s youngest grandson who was a third-year med student, the shift nurse who had removed the feeding tube, a hospital administrator and a young resident who had agreed to turn off the respirator. None of them thought to hold her hand in those final minutes.

Deborah’s pulmonary specialist had refused to assume the “withdrawing of treatment” task, citing ethical and legal concerns. This particular specialist had been assigned to her case several weeks ago but he had never really communicated with Deborah because, in her condition, only eye contact communication was possible. He avoided the family. Too many questions and he had no good answers.

This doctor had noted to one of his colleagues that Deborah often had tears in her eyes when his morning rounds included her room. Those visits became less and less frequent in the final days. The doctor had concluded that Deborah was aware of her environment even though she was unable to communicate. He was thinking of writing a paper about the issue of the “incomplete communications loop” and its impact on treatment decisions. Interesting article topic, he thought, when he had time to get to it. In the meantime, he had patients who might actually recover most of their functions. He didn’t know that Deborah had been a world-class communicator most of her years.

Until the 2030 brain aneurysm that, in a matter if minutes, permanently took away much of Deborah’s left-side muscle function, further clouded her memory and sentenced her to over four years in a nursing home and finally this hospital room, she had lived the American dream. Born to educated middle class parents, Deborah earned a degree in French from Tulane University and then a Masters Degree in Business Administration from Georgia State University. Deb then did a two-year stint in the Peace Corps, an adventure that took her to Ecuador and fulfilled a self-made promise, following JFK’s assassination. Kennedy had been killed later the same autumn that Deb had screamed her thirteen-year-old-self hoarse at a concert in Jacksonville, Florida: The Beatles.

She married her college sweetheart in 1978 and they had a daughter in the spring of 1980. In spite of their subsequent divorce, the couple remained committed to raising the daughter as partners, remained on good terms and succeeded in raising a young woman who became a successful business owner and mother to two of Deborah’s grandchildren. Deborah’s remarriage in 1990 brought two stepchildren into her life and eventually three additional grandchildren. Over the 37 years that she was married to her second husband, she and his children grew very close and all the grandchildren simply adored “Dee”.

By 1981 Deb had begun what was to become a successful 30-year corporate career in financial services. A true believer but not a shrill voice in the pursuit of women’s rights, Deborah did not change her maiden name through the course of two marriages. She advanced in the corporate world with the Chase family name. An admired manager, skilled at recognizing and rewarding talent, she became a valued senior executive and was well known in the Atlanta business community because of her board participation with several large non-profit organizations. By the time she retired in December of 2011, Deb had earned a comfortable retirement nest egg. When her Social Security checks began arriving she diverted the money to her grandchildren’s education funds because her pension and investment income was more than sufficient for her needs.

She and her second husband used the freedom of their retirement to launch second careers, he as a free-lance copywriter and she as an American craft artist, turning a long time hobby into a small business. They also enjoyed hosting their children and grandchildren on trips to Europe, the American Southwest, South America and Africa to visit the places that they had come to cherish in their earlier travels together. Deb had a talent for languages and always charmed the locals by using their language with passing skill.

In the spring of 2027, Deborah’s husband died suddenly of a massive stroke while on an Arizona golf vacation with his son, sons-in-law and grandsons. Some would say that he was the lucky one.

Returning to Atlanta after scattering her husband’s ashes in a national park on the western slope of the Rockies, Deborah resumed creating art, reconnected with friends, hosted the children and grandchildren for holidays and adapted to life as it now confronted her. However, during the next two years it became evident to friends and family that her short-term memory was failing. This memory loss led to a series of prescription medication mistakes, three times sending her to the emergency room in 2029. With each crisis her level of confusion grew. The children suggested that she sell the house and move to an assisted living facility. Deborah was having none of that.

(To be continued)

******************************

Bruce

Observoid of the Day: You can take the bumpkin out of the country but you can't always take the bumpkin out of the bumpkin.

Uh, About That Raise You Want...

2010-02-01T13:17:00.009-05:00

I stumbled across the following post while doing my morning blog reviews. It's written in a style that leans toward the condescending, which, given the topic (health care reform) and the current mood in many quarters (populist anger), seems highly appropriate. I wanted to share it for three reasons: (1) I mostly agree, (2) I love well-deserved condescension and (3) the writer saved me a lot of work.

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(posted on Craigslist, Chicago, January 28, 2010 by anonymous)

WHY you keep getting screwed--MR. (Tea Party Patriot):

Hey you. You there in the Glenn Beck T-shirt headed off to the Tea Party Patriot rally.

Stop shouting for a moment, please, I want to explain to you why you're so very angry.

You should be angry. You're getting screwed.

I think you know that. But you don't seem to know that it doesn't have to be that way. You can stop it. You can stop it easily because the system that's screwing you over can only keep screwing you over if you keep demanding that it do so.

So stop demanding that. Stop helping the system screw you over.

Look, you can go back to yelling at me in a minute, but just read this first.

1. Get out your pay stub.

Or, if you have direct deposit -- you really should get direct deposit, it saves a lot of time and money (I point this out because, honestly, I'm trying to help you here, even though you don't make that easy Mr. Angry Screamy Guy) -- then take out that little paper receipt they give you when your pay gets directly deposited.

2. Notice that your net pay is lower than your gross pay. This is because some of your wages are withheld every pay period.

3. Notice that only some of this money that was withheld went to pay taxes. (I know, I know -- yeearrrgh! me hates taxes! -- but just try to stick with me for just a second here.)

4. Notice that some of the money that was withheld didn't go to taxes, but to your health insurance company.

5. Now go get a pay stub from last year around this time, from January of 2009.

6. Notice that the amount of your pay withheld for taxes in your current paycheck is less than the amount that was withheld a year ago.

That's because of President Barack Obama's economic stimulus plan, which included more than $200 billion in tax cuts, including the one you're holding right there in your hand, the tax cut that's now staring you in the face. Republicans all voted against that tax cut. And then they told you to get angry about the stimulus plan. They didn't explain, however, why you were supposed to get angry about getting a tax cut. Why would you be? Wouldn't it make more sense to get angry at the people who voted against that Obama tax cut?

But taxes aren't the really important thing here. The really important thing starts with the next point.

7. Notice that the amount of your pay withheld to pay for your health insurance is more than it was last year.

8. Notice that the amount of your pay withheld to pay for your health insurance is a lot more than it was last year.

I won't ask you to dig up old paychecks from 2008 and 2007, but this has been going on for a long time. Every year, the amount of your paycheck withheld to pay for your health insurance goes up. A lot.

9. Notice the one figure there on your two pay stubs that hasn't changed: Your wage. The raise you didn't get this year went to pay for that big increase in the cost of your health insurance.

10. Here's where I need you to start doing a better job of putting two and two together. If you didn't get a raise last year because the cost of your health insurance went up by a lot, and the cost of your health insurance is going to go up by a lot again this year, what do you think that means for any chance you might have of getting a raise this year?

11. Did you figure it out? That's right. The increasing cost of health insurance means you won't get a raise this year. Or next year. Or the year after that. The increasing cost of health insurance means you will never get a raise again.

That's what I meant when I said you really should be angry. That's what I meant when I said you're getting screwed.

OK, we're almost done. Just a few more points, I promise.

12. The only hope you have of ever seeing another pay raise is if Congress passes health care reform. Without health care reform, the increasing cost of your health insurance will swallow this year's raise. And next year's raise. And pretty soon it won't stop with just your raise. Without health care reform, the increasing cost of your health insurance will start making your pay go down.

13. I wish I could tell you that this was just a worst-case scenario, that this was only something that might, maybe happen, but that wouldn't be true. Without health care reform, this is what will happen. We know this because this is what is happening now. It has been happening for the past 10 years. In 2008, employers spent on average 25 percent more per employee than they did in 2001, but wages on average did not increase during those years. The price of milk went up. The price of gas went up. But wages did not. All of the money that would have gone to higher wages went to pay the higher and higher and higher cost of health insurance. And unless Congress passes health care reform, that will not change.

Well, it will change in the sense that it will keep getting worse, but it won't get better. Unless the problem gets fixed, the problem won't be fixed. That's kind of what "problem" and "fixed" mean.

14. Sadly for any chance you have of ever seeing a raise again, it looks like Congress may not pass health care reform. It looks like they won't do that because they're scared of angry voters who are demanding that they oppose health care reform, angry voters who demand that Congress not do anything that would keep the cost of health insurance from going up and up and up. Angry voters like you.

15. Do you see the point here? You are angrily, loudly demanding that Congress make sure that you never, ever get another pay raise as long as you live. Because of you and because of your angry demands, you and your family and your kids are going to have to get by with less this year than last year. And next year you're going to have to get by with even less. And if you keep angrily demanding that no one must ever fix this problem, then, you're going to have to figure out how to get by on less and less every year for the rest of your life.

16. So please, for your own sake, for your family's sake and the sake of your children, stop. Stop demanding that problems not get fixed. Stop demanding that you keep getting screwed. Stay angry -- you should be angry -- but start directing that anger toward the system that's screwing you over and taking money out of your pocket. Start directing that anger toward fixing problems instead of toward making sure they never get fixed. Instead of demanding that Congress oppose health care reform so that you never, ever, get another pay raise, start demanding that they pass health care reform, as soon as possible. Because, until they do, you're just going to keep on getting screwed.

And it's going to be that much worse knowing that you brought this on yourself -- that you demanded it.

Thanks for your time.

P.S. -- I didn't mention this because I'm trying here to be as patient with you as I can, but you might also want to keep in mind that in addition to screwing over yourself and screwing over your family and screwing over your own children by demanding that Congress oppose health care reform so that you will never, ever see another pay raise, by doing that you're also demanding that I never, ever see another pay raise, which means that you're also screwing over me, and my family, and my children. Not to mention the millions of poor and uninsured and uninsureable (sic) people I didn't even mention above because they don't seem to matter at all to you. And for that, let me just say the only appropriate thing that can be said to someone so determined to do direct, tangible harm to the welfare of my family: F*ck you, you f*cking moron.

********************************

Well now; clearly, there is a bit of anger on both sides of this issue as the final sentence indicates. However, the writer did patiently walk the reader through some basic financial facts about a very complex issue, facts that won't ledgibly fit on a T-shirt or homemade poster. And, as many wags have recently noted, while we are entitled to our own opinions, we are not entitled to our own facts.

Here's a fact: If you are upset about America's current and projected deficits--and we all should be greatly concerned--you will be apoplectic when you see the results of the Baby Boom aging into the waiting arms of Medicare, a system held captive by the mushrooming Leviathan known as health care cost inflation. Changing the insurance rules, as the current legislation attempts, is but a small step. America needs a lot more selfless thinking and a large dollop of intellectual courage.

Bruce (a.k.a. "Mr. Full of Elitist Crap")

Observoid of the Day: Every new administration has to clean up after the previous party's party.

We Has Met the Special Interests and They Is , Etc.

2010-01-27T10:30:00.003-05:00

Angry Populism has burst forth across America, and high time. We haven't had any good quality Populism since Huey Long, unless you count the 1994 Gingrich-led hoo-hah. Let's do. So, take 2010, subtract 1994...let's see, borrow from the "tens", repeat from the "hundreds" column and...krimanee, it's been 16 years!

That's almost a generation of aimlessly bobbing around without the common folk steering a sensible course for our wallowing ship of state. I would never have thought that the elites could have insinuated themselves back into control so soon after Gingrich reached the "Contract With America". Guess the conservatives have a few elites of their own who think that they know how to steer, maybe even navigate. Bush/Cheney, now those boys could navigate and steer; in their time they reminded me of Columbus, the Italian who thought that he had reached the outskirts of China when he was actually in the Bahamas (and, he used Spain's money; attaboy Chris, a typical gummit project).

Anyway, it's "us" versus "them" now, the Real Americans (RAs) against those Elite Special Interest Bastards (ESIBs). The ESIBs don't care what is good for the Republic; they just care about what's good for them. And, the ESIBs have the ear of the lawmakers. But, methinks the tide is turning. Thanks to a recent split-decision by the conservative Roberts' Supreme Court, the RA Populists seem delighted that those ESIBs will now have even more money to wield in their....hmmm, wait, something's amiss here. Aren't most RAs fed up with big money influencing politics? So then...why are they cheering...oh, well, consistency of ideology was never that important to a staunch Populist. Anger, that's the ticket, consistency is for sissies.

I'm sure that Sarah Palin, RA in Extremis, will explain it in her charming, convoluted and somewhat tortured way on FOX. The other RAs will, no doubt, understand.

Just who are these ESIBs anyway? Let's review.

1. Anyone in the financial services business is an ESIB. They got bailed out by the RAs. As a result, they still have their fancy-schmancy 9 to 5 cushy jobs. CEOs, CFOs, loan officers, trust officers, check verifiers, tellers, branch managers, custodians and on-and-on. Schmucks. The RAs have seen through their game and insist that the government squash them like the bugs they are. I hope this doesn't mean that we can't still be friends when I need a loan.

2. Auto industry employees are ESIBs. Yo, fat cats, the RAs saved your behinds and your jobs; starting with the suits right down through the union guys bolting the axles onto the GMC Sierras. Morons, you couldn't build vehicles that RAs wanted and so you came whining to the RAs for money. Have you no shame?

3. Education Employees are ESIBs. Sure, educators claim to want better education for our little tykes. So, how come RAs can't fire a teacher's incompetent butt when it becomes clear that he or she couldn't teach a chimp to peel a banana? I'll tell you why, it's because they are part of a large and powerful ESIB group (a.k.a. a union).

4. Health Care Workers are ESIBs. This is a powerful group because of its size, 17% of our GDP: doctors, RNs, LPNs, lab technicians, hospital administrators, home health workers, makers of durable medical equipment, drug makers, ambulance companies, EMTs, etc. etc. Greedy Gus's the lot of them. A chicken pox on all of their houses. RAs are tired of the 8% health care price inflation every year and have risen up to kill any legislation that might slow it down even a littl.....wait, this inconsistency seems to need a Sarah Palin explanation.

5. Health Insurance Employees are ESIBs. As the premier category of ESIBs, this group causes slime to appear on my keyboard when I write about them too much. Ergo, I'll stop.

6. Agri-businesses (farmers) are ESIBs. Thought that you could hide from the wrath of the RAs you subsidy-taking slackers? Our good tax money is going into your pocket so that you WON'T PLANT STUFF! Puuuhlease. You've got those Congresspeople scared witless and you only account for about 3% of the nation's GDP. Please don't let this little rant keep you from putting some pork chops on my table this evening, plus a few artichoke hearts; I really, really love those artichoke hearts.

7. Business owners, large and small, are ESIBs. This category is so obvious that I hesitate to even write it out loud. Big businesses have the individual financial clout to buy all the "free political speech" that they need to get special favors and access, while the small businesses of America have the pooled resources of the National Chamber of Commerce, one of Washington's most feared and powerful arm twisters. Smack down those minimum hourly wage bills. Kick and scream about mandatory health insurance for your RA employees. RAs haven't been able to compete in this uneven policy marketplace but now they're fighting back. That Roberts Court decision is just a minor speed bump.

8. Churches are ESIBs. Reverend "Bucks-Up" in his Mercedes, Chrystal Cathedrals, Cable Network Clubs; they all rake it in on Sunday (as well as the rest of the week) and nary a tax dollar do they want to pay. And, they have all the best real estate, sans property tax of course. All this, while the RAs dutifully pay their fair share with no tax breaks in sight. Woe be to the politician who takes on this pious crowd.

9. Federal, State and Local Government Employees are ESIBs. Yet another category that almost goes without saying; too obvious. If there is any group of ESIBs that RAs really, truly despise, it's this one. The only exceptions are the enlisted military folk plus a few junior officers. Once a military man or woman reaches the Pentagon, however, they have clearly earned ESIB status. Bureaucrats are bureaucrats, uniform or no. I'm confident that this criticism of government employees won't impact my routine trash pick-up days (Tuesdays and Fridays with recyclables on Fridays) or my protection from enemies, foreign or domestic.

10. Non-Profit Enterprises are ESIBs. Tree-hugging, endangered-species-saving, soup-kitchen-operating, social-services-providing, bleeding-heart leeches. Do they want special favors? Yes. Do they want to pay taxes? No. (I sound like Donald Rumsfeld). These wimps appear before Congress and get all teary-eyed about this or that "special cause", contribute some campaign money--even more in the future thanks to the Roberts Court decision--and viola, get special deals; favors that simple, God-fearing RAs could never get. It's a damn shame is what it is.

11. Unions are ESIBs. Previously singled out in several of the categories above, the likes of the AFL-CIO, et al, are re-emerging as one of America's most influential ESIB groups. They don't want a tax on Cadillac health insurance plans, they condone--nearly outright encourage, in my experience--"featherbedding" and "closed shops" and favor anonymous union sign-up for employees. Tricksters. RAs are proud of the groups to which they belong and needn't hide behind some union rule in shame for their socialist beliefs.

12. Lawyers and Law Firms are ESIBs. This is another slime-producing category. As is their wont, these chameleons work both sides of the ideological street, often at the same time. They are either carrying the water for other ESIB groups who oppose RAs interests or are fighting proposed tort reform that would keep them from continuing to make a bundle off of the misfortunes of RAs (think John "Two Americas, One Illegitimate Baby" Edwards and his ten thousand square foot house).

13. Retirees are ESIBs. Need I say any more than "AARP"?

These thirteen categories do not constitute the entire list of ESIB groups. They do, however, cover those ESIB groups that provide the bulk of the special interest roadblocks that vex Real Americans at every turn.

This leaves me to identify the brave army of Real Americans, the Populists, who stand united against the special interests crowd; untainted in their desire for policies, procedures, taxes and services that benefit all equally and fairly, without favor and for the greater good of the Republic. By definition, an RA cannot be a part of an aforementioned ESIB group (or be dependent on anyone who is).

O.K., let's see, there's a guy in Omaha named Chuck; another fellow in Sacramento by the unlikely name of Carroll; two women in Tempe, Janet and Shirley (they don't know each other); a man and his adult son who live in an AirStream just outside of Joshua Tree National Park, Bill and Bill, Jr. and an unemployed husband and wife team in New Orleans whose last name is either DeCarbonnet or DeCarbonee, depending on which issue of the White Pages you are consulting. I continue to search for other qualified RAs and will find a few, no doubt. Right now, however, that's it. Eight Real Americans vs. a vast sea of ESIBs.

I'll give them credit, for such a small group, they have kicked up quite a fuss.

Bruce

Observoid of the Day: A successful rain dance has a lot to do with timing.

Wait, Wait, Where Are All the Angels?

2010-01-11T11:51:00.006-05:00

Come with me now, thrill-seekers, to that land where even angels are affeared. It's the land where the talk is of racism, religion, political correctness and women's studies.

Senator Harry Reid, the mild-mannered Mormon from Nevada has come under withering political fire from conservatives. For the better part of a year the criticism has focused on the Senator's role in shepherding health care reform legislation through the sausage grinder known as the U.S. Senate. Just recently, however, it has come to light that not only is Harry a Mormon, a bit of a sad looking sack, a legislative "water-carrier" for the Obama administration on health care but also a racist pig.

From no less an authority than Liz Cheney, a Washington pundit who proves that the "mean gene" can indeed be passed from generation-to-generation, we learn that, unlike the morally superior Republicans, not a single one of whom has ever harbored a racist thought, Harry Reid isn't fit to serve as Senate Majority Leader. His crime, in case you have been in the Gobi Desert until just today, was to utter the perfectly benign truth that Barack Obama is a "light-skinned African American"--for which he can blame his Kansas hippie white mother--and who "speaks without a Negro dialect unless he chooses to". The latter observation is also something for which Obama can blame his mother plus his grandmother and grandfather, none of who be talkin' a Negra dialeh 'round de howz when Barack was a tad. Further, none of them likely spoke as iffin he'us raised up in the holler a fur peas back 'round yonder. Ergo, Barack does not talk like Reba McEntire either.

(An aside: Had Barack been raised by his father, he would likely speak with a Kenyan accent and, to our American untrained ears, sound like Nelson Mandela.)

In any case, he wasn't. So, for many Americans, who would otherwise be uneasy with a presidential candidate who looked like Robert Mugabe and/or sounded like Ludacris, Barack Obama was a politician who looked and sounded like a reasoned and reasonable candidate. It's the same thinking that led Colin Powell to be considered a promising Republican presidential candidate. Liz Cheney will, no doubt, deny that this Powell observation ever arose around the Cheney family dinner table, given that the Cheney's are, apparently, completely free of any racial prejudices (except as relates to Middle Eastern and South Asian Muslims, all of whom should be legally tortured to extract "ticking time bomb" information in order to "Keep America Safe.com").

The conservative gas bags claim that Reid's "racist statement" is equivalent to that of Trent Lott who was forced to relinquish his Senate leadership position after suggesting that the country would have been better off if Strom Thurmond--that paragon of racial harmony--had ascended to the presidency in 1948, thus maintaining racial segregation as the national standard.

So, let's review: Reid's statement, "because Obama is a light-skinned and well-spoken Negro, it was possible that he could get elected president" is equated, by the likes of Liz Cheney, to Lott's statement suggesting that America would be a better place if blacks kept to their own restaurants, rest rooms, schools, movie balconies, rear bus seats and water fountains. For my racial entertainment dollar, the comparison would be laughably priceless if it weren't so hypocritical and ludicrous; Ludacris would likely agree.

I believe that Mark Twain said, "If you want to make people angry, lie to them. If you want to make them purple with rage, tell them the truth.''

Here's my truth. All of us are racists; we only differ in degree. At the most harmless end are people who are probably much like Harry Reid and, hopefully, you, my dear reader. At the other end is the neo-Nazi skin-head. To claim that being positioned anywhere along this continuum is equally odious is to be completely out of touch with reality and human nature. Or, if you are Liz Cheney, to be looking to score political points, in spite of the fact that you really know better. Liz isn't dumb, just shameless.

Bulletin: Blacks (and other ethnic groups) harbor racists attitudes toward whites. Here again, however, the poles are widely separated. For instance, Obama might look at me and in a benign (and mostly correct) way, figure that I can't jump, don't dance very well, love New England pot roast with potatoes, listen to NPR and sleep in striped pj's to keep my small package warm. Louis Farrakhan, however, might see me as an evil manipulator who despises ethnic "others" and who would con them out of their money and, if it weren't for federal law, own slaves and insist on being called "massa" and who walks around with big money in my pocket (next to my small package) just begging to be mugged.

But, back to the neo-con wing nuts. Even George Will, a man never once accused of being a liberal of any sort, found Ms. Cheney's pronouncement too too, when they appeared together on this past Sunday's edition of "This Week with George Stephanopoulos", (a host who could sell several of his vowels to "Wheel of Fortune" and still have a long name). Save for Robert Reich, the world's shortest economist and a flagrant academic liberal, who briefly gnawed around Ms. Cheney's ankles, the other panelists failed to help George and Robert gang tackle Ms. Liz on this topic. They should have.

Bruce

Observoid of the Day: Judge a man by the content of his character, not the color of his skin unless, of course, you are holding tryouts for an outside linebacker.

"The doctor will see you now......bwahahahahahah"

2010-01-04T14:49:00.010-05:00

Perhaps you've noticed. When you visit your PCP (primary care physician), your time schedule and the doctor's time schedule are not in sync. This is the reason that you have ample time to fill out your entire medical history, beginning with your polio shots from third grade and then additional time to read and review a Sports Illustrated or Better Homes & Gardens issue from 1994.

Then, just as you are fully engrossed in learning about the Nancy Kerrigan/Tonya Harding dust-up, a nurse flings open an unmarked door, bellows your name and briskly leads you to a very public hallway scale where you are weighed, despite the fact that you still have your clothes on, are carrying a coat and toting a briefcase with a laptop inside; nurse clucking and scowling ensue. Then, you are taken to a small, chilly room, your blood pressure taken (more clucking and scowling) asked to disrobe, don a paper gown, not to be confused with anything Halston would design, and told, "The doctor will be right in". This is the medical equivalent of the phrase, "Of course I will respect you in the morning."

You spend enough time alone in this chilly room, in your non-insulated paper gown to discover and read more not-too-recently issued magazines--usually vintage 2003 to 2006 -- and to have various parts of your body react to the chill; depending on your gender, either enlargement or shrinkage.

Then, just as you are absorbed in an investigative Newsweek report about Dick Cheney having accidentally shot a fellow quail hunter in the face, in comes the doctor, looking confident but somewhat harried. There is brief small talk, a question or two, a quick look down your throat and into your ears and tah-dah, you're done. "What, what, wait; I forgot to ask about that burning sensation when I pee." Too late. You peek out the door one way, then the other, clutching the paper gown so as to keep your dignity, but the doctor is gone and, in that gown, there never was any dignity.

The nurse tells you that the burning sensation is "very common in people your age" and to try "cutting out spicy food." Total time at the doctor's office, two hours and twenty minutes; portion of that time with the doctor, twelve minutes.

However, if you have an appointment with a specialist, particularly some arcane medical specialty such as "Reproductive Organ Cosmetic Surgery" (I'm not making this up), you barely have time to hang your coat, grab a complimentary cup of Irish Mist Mocha Java and begin searching for reading material before you are graciously escorted into the inner sanctum. There, you are asked to disrobe so that the body part of interest is available for convenient inspection. You are provided a warm terry robe and the doctor and his or her assistant whisk efficiently into the room almost the moment you loosely knot the sash.

The specialist listens attentively, types notes in a laptop, clicks from screen to screen checking your medical history and the net present value of your previous procedures. Then, only after you have completely covered the reason for your visit and your vision for the eventual outcome, the doc carefully examines your present condition, followed by providing a thorough explanation of the procedure alternatives, likely outcomes and risks. There is a tasteful discussion of price ranges for the procedure and some clever banter about "lifestyle improvements". The doctor suggests that you call later if you have questions. He or she will take the call personally. You get dressed and you are done. Total time at the doctor's office, 45 minutes; portion of that with the doctor, 35 minutes. Who needs magazines?

Your primary care physician likely sees 30 or more patients every day and earns about $170,000 a year, less if he or she has a lot of Medicare patients.

The specialist may see six to 12 patients a day, three days a week and do procedures one or two days a week. The specialist will earn $400,000 a year at the low end and $1,000,000 (or significantly more) at the premier end of the income scale.

Let's see, the math indicates....divide the bigger by the smaller.... carry the 15.... add a decimal....hmmm......Wowzer! If you want to be a rich doctor and quickly pay off that pesky $200,000 student loan, then a specialty is for you. (By way of full disclosure, my oldest is a general surgery resident M.D. hoping that when he finishes his specialty training that there will be sufficient diseased gall bladders, inflamed appendixes, etc. to put him in the higher end of the income bracket).

Much as I appreciate financial success, especially among my own, there is a way big problem for America in the financial disincentive to become a PCP, family doctor, internist or geriatrician, each a category that falls well below the highly-compensated specialty clique. For those of you haven't been paying rapt attention and haven't already seen the hitch in this ointment (or maybe it's the fly in this git-a-long), here's the deal: the accepted wisdom is that America needs lots more PCP's, geriatricians, family practitioners and internists and fewer specialists but the current free market system works directly against that goal. Oh-oh.

If you are a Baby Boomer, you should be particularly uneasy. Should you reach the age of 65--and that begins to occur in 2011 for the oldest Boomers--you have an 80% chance of then living to 85+. Somewhere around 65, your body's biology begins to change measurably, much the same way that your biology changed markedly during junior high school, morphing you from child to a nearly-grown slightly crazed sex addict with acne and additional hair. Growing old reverses some of those changes. Providing appropriate medical care to geriatric patients is similar to providing appropriate pediatric care to children. The skill set for either is different than it is for treating young and middle-aged adults. For most readers, your doctor has very little, if any, training in geriatrics because our medical schools do not require it.

The number of geriatric patients in America is currently growing. In 2011 it will begin an 18-year slow motion explosion as the Baby Boom turns into 77 million cranky old sex addicts with multiple medical complaints, worn out body parts but less hair. There won't be nearly enough trained geriatricians--and I'm talking about a huge gap because the number of geriatricians is shrinking--to provide appropriate care. The end result will be millions of misdiagnoses, over-medication (already a troubling problem), unnecessary and expensive procedures (likewise) and a reduced quality of life for millions of Boomers who would otherwise do quite nicely with correct care.

The free market does many things very well. For instance, flat-screen, high definition TVs are becoming more affordable, in a classic case of free market creative destruction, foreign auto companies have run Detroit into the ditch (where the gummit should have left it) and department stores have something "On Sale until Midnight Tomorrow" 24/7, etc. However, in the realm of health care, the free market does a lousy job in a number of areas, including the one that determines how many of what kind of physicians we have, in spite of what we need.

The current proposed health care legislation takes some teeny weeny steps in the direction of addressing this problem. The loyal opposition (also known as Republicans) decry these modest proposals as "a gummit takeover of the health care system" and innocently look the other way while some of their nuttier supporters liken it to the policies of the Third Reich.

Should we fail to modestly change our current health care system, thanks to the loyal opposition, the irony will be that eventually, Mitch McConnell, Jim DeMint or some other loyal opponent will be misdiagnosed by a well-meaning but inadequately trained physician. The aging legislator's "advanced dementia" will actually be symptoms of clinical depression, poorly trimmed toenails and a urinary tract infection, none of which Aricept will improve. As a current example I give you Senator Robert Byrd who has been repeatedly misdiagnosed as "not quite dead yet". A geriatrician would have spotted the reality several months ago.

Bruce

Observoid of the Day: It's not really winter until all of the kudzu has turned brown.

Putting the Hype into Hypocrisy

2009-12-16T21:45:00.009-05:00

Immediately after signing the Declaration of Independence in 1776, the Founding Fathers began to rancorously bitch at each other and disagree on many a political issue. For instance, Jefferson was a champion of "states rights" while Madison and Hamilton were leading "federalists". Here's the primary difference: State's Rights = the states get to boss the fed around; Federalism = Washington gets to boss the states around. Even today, this argument isn't totally settled but the Feds have had the upper hand ever since that pesky Civil War back in the mid-19th century. The current Supreme Court is trying to re-balance the scales.

From the outset, one of the primary "state's rights" issues was slavery. Jefferson argued that the states should each decide for themselves. At the time, Jefferson was busy making babies with his slave, Sally Hemmings, and probably didn't want the federal government legally messing with a really sweet arrangement. (I'm nearly certain that Miss Hemmings was given a binding "yes-no" vote regarding sleeping with Massah Thomas, but it's just my intuition.)

Well, this slavery argument festered for the better part of 80 years until it was finally settled by force of arms in 1865 (politics at an extreme level). The Federalists won this particular skirmish. If they hadn't--and if you currently live in one of the original Confederate states and you are white--you could own your very own darkie today. Given current demographic realities, however, contemporary slaves would likely be Guatemalans. On second thought, were slavery still legal in the south, there would likely be far fewer Central and South Americans blithely scurrying across the border. I'm sure that some conservative or libertarian talk-show host has already proposed "the slavery solution" as an effective curb on illegal immigration (I'll check Lou Dobb's Twitter posts as he is the most likely candidate).

All of this is to illustrate that early in our Republic, politicians argued, scuffled, occasionally dueled and voted based primarily on contrary beliefs and differences of ideology. Today's politics, although they are often elaborately cloaked in ideology, are really, truly, actually, no kidding about money. I give you, as example number one, the junior Senator from Connecticut, Joseph I. Lieberman. As a observant Jew, Joe would like you to think of him as Joseph I. Liebermensch, a "man" yes, but one who stands out as particularly reliable, stalwart, brave, true and independent in a robust and very self-reliant independent way; sort of an Adult Jewish Eagle Scout.

Joe, having had no chance of being re-elected as the Democratic candidate from Connecticut in 2006 by losing the primary, peeled himself away from the Democratic Mother Ship and ran as a faux independent (actually he called his campaign the "Connecticut for Lieberman" party). It worked and Joe returned to Washington as Senator. His actions chapped off a number of really important Democrats and Joe repaid their bad attitudes by endorsing and campaigning for John McCain and Sarah Barracuda in the 2008 election. Joe can torch a bridge, push come to shove.

Now we come to Joe's most visible, if not shiny, hour since 2000 when he actually made Dick Cheney look good during the V.P. debate.

Health care legislation has returned Joe to center stage. In Joe's hands rests the outcome of the entire nation's dysfunctional health care contraption.

Joe has recently risen up, done an airborne 180 that would make Nureyev proud, and, mid-leap, tossed a wrench directly into the cogs of the Congressional sausage-making apparatus.

Let's keep Joe's stated and actual reasons for his behavior simple.

Joe "Remember, I am an independent and self-reliant mensch in a very independent way" Lieberman's stated reason: The current Senate health care legislation is fiscally irresponsible.

Joe objects to two very specific provisions. First, he opposes the "public option" insurance proposal. Second, he also opposes the "Medicare Buy-In" alternative, an idea that he championed as late as September (not September 2008, this year's September which was, what, less than 90 days ago?). He claims not to recall his recent position. If true, that fact alone should give the citizens of Connecticut a queasy feeling about old Joe's mental faculties.

Both of these insurance alternatives would give people a choice between private insurance coverage and a government version. This, loyal readers, is a key distinction.

Independent Joe represents Connecticut. Hartford is in Connecticut. Hartford is the Valhalla of big insurance. In fact, five times a day, across this great land, insurance agents are required to repair to their prayer mats, face Hartford, kneel and pay homage. This is the reason that your insurance agent is so often "away from (his or her) phone" when you call.

One of the downsides of leaving the Democratic Party was the loss of financial support for campaigning. So, more than ever, Joe really, really needs the $427,894 that the Hartford insurers gave him just this last reporting period. Over his Senate career, big insurance has provided Joe with way north of $1 million. Now, big insurance absolutely, positively wants no provisions in the current health care legislation that would create bona fide competition. The public option or the Medicare Buy-In alternative would certainly do that. Someone probably recently reminded Joe of that, given his memory problems of late.

So, wrapping himself in the tasteful pashmina of "fiscal responsibility", Joe has doubled back on Reid and the rest of those loathsome Democrat/nanny state wimps and stood up for the "58% of Americans who currently oppose the current health care legislation", even though this opposition cannot be based solely on federal deficit concerns.

Besides, as a recovering consumer behavior researcher, I am leery of statistics that claim to represent the feelings of the American people regarding complex issues. The answers to many such questions can be easily manipulated by the way the question is asked or by carefully selecting the group of whom you ask it, or both. This, plus, at least 25% of adult Americans couldn't tell you the difference between a "public option" or a "public restroom" and they get their current and ever-changing political viewpoint from either Old Blevins down at the Neon Angel Lounge or some talk-show entertainer. Subtract that 25% out of the data and the percent of Americans who have some knowledge of the issues yet still oppose modestly modifying health care--for the eventual good of most Americans--is probably 33% which is, coincidentally, about the number of Americans who are insurance agents.

Senator Lieberman (and now we come to the actual reason) has insured that the financial spigot in Hartford will continue to gush lucre his direction. And, even should Joe fail in his 2012 bid to remain a Senator from Connecticut--and it seems highly likely that he will fail--Joe has insured (ahem) that a lucrative lobbying job for the insurance industry awaits. Therefore, supporting the legislation would indeed be fiscally irresponsible, primarily for Saint Joseph his-own-self. So much for ideology. Perhaps Chris Dodd should challenge Joe to a duel related to insurance industry fund-raising since the slavery issue has been settled already.

Bruce

Observoid of the Day: Can't wait for the Rose Bowl Parade featuring Tiger Wood's All-Ex-Mistresses Marching Band.

Outing the Coca Cola Santa

2009-12-04T15:29:00.011-05:00

It's always about this time of December that my thoughts turn to Saint Nicholas. I can't explain it. You would think that his being such a culturally important figure, Santa would also enter my thoughts in, oh say, July or May, in much the same way that thoughts of the Pope, Augusto Pinochet or Tiger Woods occasionally pop into my head unbidden throughout the year. But, as far as I can recall, that doesn't happen. Nope, on the Santa front, it is just one of those December things.

And, unlike many, I don't conjure up the the Coca Cola version of Santa, the morbidly obese one, a condition caused partly by his habit of chugging sugar-laden Cokes from breakfast until the cocktail hour. This St. Nick would likely have such a caffeine buzz going that Mrs. Saint Nicholas, nee Earlene Goldberg--a long suffering saint in her own right--couldn't get the old boy to calm down and make anything before 2 or 3 every morning. Of course, at the North Pole, it's hard to keep to a regular circadian schedule what with 24 hours of daylight half the year and 24 of dark the other half. Seems to me that Santa ought to relocate to improve the efficiency of his operation. I'd suggest somewhere near the equator in southern Asia, closer to lead paint suppliers and where most of the toys are jobbed out to third-party providers anyway. It would way shorten his supply chain.

No, the St. Nick of whom I think is the one from the Clement Clarke Moore poem, the one that I read to my children so many times that I can still recall it from memory. I sometimes intentionally made mistakes when I read it to my son as a way to determine if he was asleep or just listening with his eyes closed. If it were the latter, he would stop me mid-poem, insist on a correction by reminding me of the right words. He would do this without opening his eyes..."Dad, it's not, Vomit, Stupid, Dagwood and Nixon, it's Comet, Cupid, Donner and Blitzen."....or, "Dad, it's not a 'bowel, foul and smelly' it's a 'bowlful of jelly'". Tykes demand accuracy.

Moore's poem describes Saint Nicholas as a "little old driver so lively and quick", a description that runs quite contrary to the dressed-in-red slab of humanity that I saw today at the Mall, posing stoically with screaming toddlers and greedy pre-teens with lists of "demands" in hand. In fact, later, as I left the mall by my usual side door route, there was "Santa", next to a dumpster, beard hanging from one ear, sucking on a Marlboro Light and looking haggard. I strongly doubt that this was the real Santa. He seemed neither lively nor quick and he was at least 250 lbs. past "little". If this Santa tried to come down our chimney, there would be a prolonged interruption of his intended delivery schedule.

The poem also describes the flying reindeer as "tiny" and the sleigh as "miniature", additional clues that if one were to plop the Mall Santa or the Coca Cola version onto the sleigh, there would likely be some serious issues with The International Brotherhood of Flying Reindeer, Local 001.

Moore was the scion of a prominent New York family. His father, Bishop Benjamin Moore, officiated at the inauguration of George Washington, invented lead paint and was personally responsible for the creation of the accent wall color "Tangy Tangerine" in 1808. But, as so often happens, I digress.

The magical St. Nick in Moore's poem is dressed "all in fur, from his head to his foot", a sartorial decision that has just caught the attention of PETA, an unusually irritating organization that plans to station members with buckets of fake blood on rooftops across the globe this year in hopes of creating a media event. My bet is that they just freeze their butts and get coal in their stockings. I suppose St . Nick could pick out some cold weather gear from REI but then he could easily be mistaken for any number of small, round southerners who pile on the down when the temperature plunges into the 50s.

Clement Moore's Saint Nicholas is my kind of Santa: smokes a pipe (not Marlboro Lights), is a jolly elf, lively, quick, magical, wouldn't think of letting relatively enormous and greedy children sit on his lap, wears leather, knows where all the "bad" girls live, has a license to fly, is droll, has twinkling eyes, merry dimples, rosy cheeks and a red nose. In brief, a very small W.C. Fields. Now we're talking.

Bruce

Observoid of the Day: A journey of a thousand miles begins with a stop at the ATM.

The Bob of Rights

2009-11-30T11:53:00.009-05:00

In 1789 the U.S. Congress wrote the first 10 amendments to the Constitution. These amendments, for those of you who were out with the Chicken pox during this 5th grade class, are known as the Bill of Rights and were adopted in 1791. I don't know exactly who "Bill" was but there were a number of "Williams" who were involved in the Revolution. I assume that someone (probably that jokester, Franklin) slapped some poor William's nickname on the legislation and it just slipped through.

These 10 Rights were added to the Constitution to satisfy those members of Congress who were concerned that without them that the Federal Government could become tyrannical, much like the central governments of Europe at the time and similar to today's DMV offices. These amendments were vaguely written in one or two areas, e.g. armed militias, gun ownership rights, privacy issues, the government's relationship to religion, liberty and such. Many folks these days believe that they know exactly what each of these amendments means because they can divine the writers' specific intent, i.e. "I can own a rocket propelled grenade launcher if I want to, the Second Amendment guarantees it."

I'm a bit more guarded in my interpretation given that the 1789 framers were unfamiliar with grenade launchers. "To bear arms" does suggest that the writers had in mind personal firearms and not more advanced weapons of war. Citizens, for instance, were not guaranteed the right to "bear howitzers" or "naval gunboats". I'm sure that there are some out there in reader land who disagree and plan to build their own naval gunboat for back yard defense, local ordinances and lack of water be damned. Go right ahead. The construction and maintenance activity will likely preclude you from positioning yourself for a Supreme Court slot or starting your own talk show.

In any case, the Bill of Rights has been and will likely continue to be, at the heart of contentious issues. People of intellect on both sides of the divide will disagree and the pendulum of legal interpretation will swing left and then right as the makeup of the Supreme Court evolves. Currently, Antonin "Batman" Scalia and Clarence "The Quiet Robin" Thomas bat from the right side along with Roberts and Alito with Kennedy as the switch hitter whose stats are a little weaker from the left side, if you get my drift.

But I take keyboard in hand today to talk about the "Bob of Rights" not the Bill of Rights. The Bob of Rights, named after fellow Georgian Billy Bob (he asked that his last name not be revealed) are founded on his observations of fellow Americans as they go about their daily routines. These Rights are based on many citizens' sense of entitlement regarding a number of issues and activities and they exercise these Rights with abandon.

And so, with no further to do, here they are.

**************************************************************************************************

The Bob of Rights (2009)

Be it knowneth hencefortheth and forevermoreth, not including Federal and State holidays, weekends and regular work days, by all who are in the literate to non-literate continuum and who are bona fide legal residents of the United States of America plus Puerto Rico, American Samoa, the American Virgin Islands and Canada (just a joke, you overly-sensitive Canadian readers) that the following are apparently guaranteed Rights of Individuals in spite of the fact that they do not appear anywhere in the U.S. Constitution but have been observed time and again by Billy Bob (and others). To whit: An Individual, because he or she is very special, has the Right to:

1. Ignore the line of cars patiently waiting in the exit lane and speed down the adjoining lane and force someone to let you into the front of the line because you drive a (BMW, Escalade, Mercedes, Lexus, etc. etc.).

2. Forward unsubstantiated, unattributed and scurrilous e-mail postings to everyone on your distribution list and insist that they do the same "for the good of the country".

3. Bang your over sized carry-on luggage against the heads and shoulders of fellow passengers unlucky enough to have an aisle seat.

4. Hoodwink the hosts and authorities, crash an important state event, get your picture taken with all the pooh-bahs and then demand $500,000 to tell your story to some faux news outlet.

5. Take a multi-million dollar bonus based on profits that were either (1) not profits after all or (2) profits made because the rest of the American public provided money to keep your business afloat for another year and because that's the way it has always been done on the south end of Manhattan Island.

6. Drive 80 MPH on the bumper of the schmuck ahead of you, another very special person who is already going 25 MPH over the posted limit and who has cars on either side, thus precluding a lane change.

7. Bring your five-year-old poorly parented child onto public transportation and let said five-year-old run the show for the duration because "that's the way (he or she) acts at home" (apologetic smile).

8. Loudly share your cell phone conversation with all around you, those who understand that you are very special and so therefore just can't wait to hear the details of when you got on, how long you will be on or when you will be getting off the friggin (train, plane, elevator, escalator, bus, what have you).

9. Ignore the "Don't Walk" light and enter the crosswalk while the "Left Turn" arrow is illuminated thus freezing left turn traffic and glare menacingly at anyone who dares blow their horn at your-own-special-self.

10. Strongly and loudly state your opinions on topics about which you have very little factual knowledge and no expertise.

Thus sweareth, stateth, avereth, orateth, sayeth and proclaimeth Billy Bob (Anon) this December 1, 2009.

****************************************************************************

My thanks to Billy Bob for sharing this vital information. For the good of the Republic, please forward this to all of the people on your e-mail distribution list. If you don't, someday you will have bad luck and/or die.

Bruce

Observoid of the Day: If you have a bunch of clowns, you're going to have a circus.

New Light Through Old Windows

2009-11-10T11:58:00.005-05:00

In the late eighteenth century, America's Founding Fathers (salute) came together in Philly, declared the colony's independence from England, established a constitution and very possibly invented the cheese steak sandwich. The first two accomplishments are irrefutable facts.

We remember many of these Founding Fathers (there were no Founding Mothers, and this is an important fact as you will see directly) as literate men of property, education and creativity. Most of them were Christians--with the exception of a handful of the most influential--all of them were Caucasian and all of them wore silly pants, which were the rage at the time. Many wore wigs, a style that has pretty much faded away, except in some sectors of the entertainment business. These men clearly saw themselves as qualified to lead the country and to be selected and re-selected by voters who were similar to them: literate, educated, land-owning white men.

I suspect, that if the Founding Fathers were to learn that in today's America we encourage to vote anyone who is at least 18, can prove legal citizenship and can fog up a mirror, they would be horrified. Women voting? Nonsense. Negroes? You surely jest. Illiterate workers? Outrageous. Indians? Now you are just being silly.

The "All men are created equal" thing was limited to the aforementioned "men" and to a certain class of capable men, in other words, the Founding Father archetype.

Eschewing current political correctness, let me opine that our Founding Dads had a point. Wait, put down that rock and hear me out.

I strongly believe that citizens of the female persuasion, Blacks, Indians, non-property owners, laborers, et al, who were originally left out of the voting equality equation should be included, just as they are now. However, if any of these folks is a certifiable moron, I don't want them helping me select representatives or to run for office themselves. Moron inclusion is the standard now and it is a major contributor to the fact that we get a fair share of morons in state and federal legislative seats. The fact that we don't have effective moron screening as part of the voter or candidate registration process is unconscionable.

Let me be clear, I don't mean to denigrate morons and for those of you who are morons, "denigrate" means to "put down" or "to make fun of".

Seriously, we don't let people drive cars who can't pass the driver's test but we let people vote--no, we encourage people to vote--who know virtually nothing of the policies, implications and nuances of the issues at hand or the machinery and purposes of the three branches of government. Many of these voters likely don't have the capacity to be informed voters, much like some people can't safely merge onto a freeway. Both are dangerous types in their own special way.

There is a faint but growing wail building in the distance as the liberals amongst my readers began to understand my rather conservative take on voter's rights. My take is simple: an adult U.S. citizen has a right and duty to vote but only as long as there is some evidence that he or she has the mental capacity to think clearly and independently.

Along with the right to vote comes the obligation to be informed instead of merely influenced by those who would twist and spin the facts. If one is unable to think rationally for themselves, someone else will always be available to think for them, rationally or not. Based on much of what I see and read on the Internet, it's clear that some citizens, many of whom would probably make good next door neighbors and/or drinking companions, should be kept away from the polling station through threat of force because they are political and policy morons. Ergo, we get the government that we deserve.

Some may argue that I just don't want people voting or serving in office who do not agree with my personal political views. Au contraire. There is always room for disagreement and ideological differences between people of informed goodwill. For instance, I believe that the current proposed health care legislation is better than doing nothing, although it is far from being adequate to solve the problems of the system long term. Others, on the other hand, may think that an entirely different approach is the better way to go; I'm glad to hear them out, maybe even give their ideas a try. However, if you carry a sign showing corpses at Buchenwald and equate that horror to "Obama's health care solution", your right to vote or hold office should be immediately revoked because you are a moron.

I haven't solved the moron screening conundrum and so I can't provide a simple solution today. Perhaps science could invent a machine similar to a metal detector that emits a silent alarm when a moron passes through. It would be silent so that the moron not be unduly embarrassed. Surely they suffer enough embarrassment by routinely saying and doing moronic things, i.e., former Congressman and soon to be convicted scofflaw Tom DeLay appearing on Dancing with the Stars. A moron screening machine could have caught him before he even ran for Congress.

I will be interested in your thoughts and comments regarding voter and candidate registration moron screening. Be advised, if what you write is moronic, names and embedded cookie identifiers will be archived for possible future use.

Bruce

Observoid of the Day: Willie Nelson is the son that Ozzie and Harriet never mentioned.

Full Disclosure

2009-10-08T15:57:00.005-04:00

Some readers likely missed the announcement on October 6 that the FTC has set new product and service endorsement rules for blogs. We bloggers, however, straightened up and took notice.

Many bloggers, my-own-self included, were shocked, shocked I tell you, to learn that some of our less ethical peers were using their world-wide communication platforms to earn money and receive free stuff from the marketing departments of various for-profit, capitalistic firms.

See, when these devious bloggers have the chance, they sing the praises of a particular product or service, without mentioning that they are actually on the touted provider's payroll. Scurrilous, just scurrilous.

When I first learned of this practice I was so upset that I had to take a break from reading the WSJ online and kick back with an ice cold and amazingly refreshing bottle of caffeine-free Coke Zero, the only sweetener-based drink that really does provide a pick-me-up without causing caloric intake guilt. I recommend Coke Zero without reservation. I've tried the Pepsi version and it just doesn't have it going on, you know what I mean; it's kinda flat.

Where was I? Oh yeah. Anyway, marketing sharpies are constantly trying to find ways to make people buy stuff that they don't really need; worming their slimy way into the social networking arena is just the latest trickery.

Speaking of worms, my dog is now completely worm-free thanks to Interceptor Flavor Tabs, a palatable monthly tablet that has kept my dog completely free from heartworms, adult hookworms, adult roundworms and whipworm infections. I mean, this stuff is amazing. If you have a dog that you treasure and you can't stand to see him or her dragging a wormy butt across your $4,000 imported Persian, Interceptor Flavor Tabs are the answer. Of course, that's just my opinion; I'm not a veterinarian or anything, just a simple blogger.

The FTC is "...taking this nefarious endorsement practice quite seriously," according to Rick Calvert, chief executive of the blogger conference, Blog World & New Media Expo. Fines of up to $11,000 per violation can be imposed on bloggers who fail to reveal to readers that their endorsements are compensated, either through direct payment or the receipt of free goods and services.

Speaking of services, I recently experienced some of the best that I have ever had on a Carnival Cruise ship adventure to the Caribbean. Just a sensational trip, start to finish. Not a want went unattended. I've tried all the other cruise lines and, what with all of the vacationing sales managers, dentists, insurance agents, blue hairs and Midwestern families with their strange Fargo accents who usually end up at my table, they couldn't deliver the faux royalty experience that I was looking for in a four-day, three-night romantic get-a-way for under $1,000 per. But, Carnival came through with colors flying. I've even coined a slogan based on the experience: "Carnival, the cruise line for the particularly picky."

Of course, the practice of product placement in television and movies is an established and hoary marketing deceit. History suggests that product placement in movies began with the release of "Gone With The Wind" in the late 1930's. Apparently, in the scene where Rhett tells Scarlett that he "...(doesn't) give a damn", in the background, sitting on a foyer table behind Scarlett, is her Blackberry. One has to look very quickly to see it but the power of subliminal advertising is well-known among marketing gurus.

Speaking of "quickly", I want to share with you my high regard for Levitra, the erectile dysfunction drug. Those folks at GlaxoSmithKline Corporation put the "A" team to work creating this product. I mean, it's "pop the puppy and bingo", if you get my drift. I tried Viagra and found the "warm-up" time to be a real problem, often resulting in one of the necessary actors in this interpersonal drama being deeply asleep when the desired result was finally achieved. As you might imagine, this was frustrating for all concerned and sometimes necessitated single partner activity just to keep the relationship from deteriorating into late-night squabbles and finger-pointing. Eli Lilly's Cialis is O.K. but requires that the partners recline in adjoining claw-foot bathtubs of warm water while staring into the sunset for some period prior to coitus. What I found was that the soak created significant "pruning" (wrinkling, if you will) of all body parts. This "prune" look tends to work at odds with the intended result of the drug, lessening the hubba-hubba quotient of the act. No, for my ED dollar, Levitra is the one. But, that is just my opinion; I'm not a doctor or anything, just a humble shagger, I meant blogger.

Clearly, these endorsement practices by some unethical and widely-read bloggers have put me in a high dudgeon. This state-o-mind is prompted by the fact that these bloggers are both widely-read and highly compensated and I'm not. In such a state, I could just rant on-and-on-and-on. However, seeing as how Mad Men will air in a few minutes on HBO, one of the finest cable operations on the entire planet and well worth whatever your local cable provider is charging extra for the privilege of having it in your home*, and Mad Men is far and away the best thing on the telly since Bonanza, I will demur.

Bruce

*Comcast provides my HBO service at no additional charge in return for certain promotional considerations. (FUFTC)

Observoid of the Day: If "The carrot and the stick" is good motivation, wouldn't "The chocolate eclair and the two-by-four" be even better?

Like Summer Camp Without the Chiggers

2009-09-16T10:43:00.004-04:00

Wow! What a weekend!!!!

I just returned from the Anti-Obama March on Washington. They called it a "march" but we actually took a bus. From the looks of some of the other "marchers" it's probably a good thing too, because many of them didn't appear to be prepared to march any further than from the La-Z-Boy to the fridge and back (ha-ha).

We staunch true Americans came from all over this great country to wave placards, shout slogans and basically de-rail Obama's plan to convert our great country to socialism, communism, Marxism, fascism, Moslemism, Muslimism, tyrannyism, feminism, Bolshevism and all the other evil "isms". The good "isms", the ones that we support are: Americanism, capitalism, individualism and freedomism.

According to FOX News and Michele Malkin, our protest group was 2,000,000 strong. Of course, the D.C. police department claimed that there were about 70,000 demonstrators but then what would you expect from a department that has to kiss up to the new and illegitimate president and whose Chief of Police is probably some uppity nig...man with a hidden agenda. Oh, my bad, the D.C. police chief is a white woman by the name of Lanier. Makes you wonder if she can do the job AND take care of her family. She'd have to be a regular Sarah Palin and that's unlikely.

Anyhoo, in a country of 300 million people, the difference between 2 million and 70 thousand is a rounding error isn't it?

I was amazed at the diversity of our group (whatever its actual size). We were a veritable cross-section of true Americans. There were young white women, middle-aged white women, elderly white women, young white men, middle-aged white men, elderly white men, short white people, tall white people, thin white people and husky white people. There was even one women who looked sort of Oriental or Asian or whatever it is that slopes prefer to be called these days. I didn't actually see her in person but I saw a YouTube clip where she was praying in front of the camera. I couldn't tell from the video prayer exactly what she was praying for but it had to be something good because it was a prayer, right? She kept opening her eyes to see if the camera was still running and as long as it was, she would close her eyes again and continued praying. What a trooper!!!!

I'll bet that if Jesus were alive today and on earth, instead of being alive today but in heaven at the right hand of God, taking names, he would certainly have joined our crusade. Like us, Jesus was a rebel and he loved poking fun at people like that illegitimate president, Obama, who is just an uppity nig...a man with an evil agenda and certainly not one of us.

The creativity of our group was just too much fun. I was impressed by many of the signs and slogans. They just made me proud. Some of my favorites include:

The placard that read "The Zoo has an African (picture of a lion) and the White House has a Lyin' African" (ha-ha).

There was a great sign that read "Bury Obama with Kennedy" (ha-ha). What a clever way to say that a dead Obama would be good for the country without actually, you know, threatening the president which, apparently, is against some law. If you ask me, free speech regarding presidents has taken a real beating ever since the Kennedy shooting (John or Bobby, take your pick).

One large man had created a t-shirt with this message across the front: "We're mad but we came unarmed. This time." (ha-ha) It's subtle, I'll admit, and I had to think about what it meant for a few minutes. Here's my take; his message makes the point that unless things change (or not change) the way we true Americans want them to change (or not change), gun play is an option. That's how potentially dangerous we are.

One guy had created a large, long poster with pictures of Mussolini, Castro (Fidel not his weenie brother, Raul), Stalin, Obama (altered to look like Heath Ledger as the Joker in "Dark Knight" ha-ha), Marx (Karl not Groucho, silly), Chavez (Hugo not Cesar, the grape-picking communist, although that would have been good too) and Hitler. Some wiseacre reporter tried to point out that communism and fascism are very different "isms" and that Hitler and Stalin were mortal enemies because of their "ism" differences. But, that's not the point is it? If I have to explain to you what the point is, you are likely not one of us.

Another really clever placard read, "Politicians are Like Dipers. They need to be changed often and for the same reason." Poor guy had left out the "a" in "Diapers" and had to pencil a tiny one in between the "i" and the "p" but you couldn't really see the "a" from a few feet away. His idea was great though and besides, what's a little illiteracy among true American friends?

I'm pretty sure that our messages got through to the powers that be. According to Glenn Beck, Michael Savage, Rush, Sean Hannity and the rest of the brave and unbiased journalists, the administration and their lackeys in the Congress are now running scared. With the 2010 mid-term elections looming, they are afraid that they could be changed like dirty dipers (ha-ha).

Bruce

Observoid of the Day: The Black Hole Theory of the Human Condition = some people are so dense that nothing illuminating ever escapes from them.

Dear Children: I Apologize

2009-09-08T10:21:00.005-04:00

I should have done this long ago but I kept hoping that things would work out; praying that I wouldn't have to humble myself with an apology. However, it has reached a point where the inevitable is, well, inevitable.

So, (deep breath), here goes.

I am deeply sorry about the Baby Boom; no really, very deeply, remorseful even.

Being one of the very oldest Boomers my-own-self, I take great responsibility for our unusually irritating generation, much as an oldest child often takes responsibility for his or her siblings. We had good intentions. At least the road to hell is well paved.

There are a number if specific failings that deserve full disclosure. However, before I go down that inglorious list, let me acknowledge that we actually did pretty well in the music department.

The Baby Boom rescued the 1950's music scene from, among others, Gogi Grant, Kay Starr, Frankie Lane, Jo Stafford and Mario Lanza. And, although there was a brief 1956 "Hit Parade" uprising by the "old schoolers" when Hugo Winterhalter released "Canadian Sunset", rock-n-roll beat back the challenge easily.

Launched in 1955 by Bill Haley and his Comets, rock-n-roll never much looked back. Almost immediately it gave us Elvis (pre-Army, authentic,"I ain't fat yet", bad boy), The Platters, The Champs, The Coasters and Domenico Mudugno. The magic fuel in the R&R tank was the introduction of the Les Paul solid-body electric guitar. In all of its various designs, the electric guitar was, and is, the bedrock requirement. It gave rise to such Baby Boomer rockers as Dion and the Belmonts, The Beatles, Jimi Hendrix, Chuck Berry, Bruce Springsteen, Robert Palmer, The Eagles, Bon Jovi and scores of others, some of them wimmin', like Martha and the Vandellas and Bonnie Raitt.

There were the occasional lapses, I'll admit, like the unfortunate Sheb Wooley "Purple People Eater" release, but in the main, the music created and supported by the Boomers is still classic, hummable and endlessly covered by contemporary pretenders. I think that even the most ardent Boomer haters will have to admit that our music is far superior to rap, krunk, ska, grunge, punk, bitpop, filk or skronk.

I'm also sure, however, that even with the music, the Baby Boom's multiple sins outweigh this singular contribution. And so, let us commence the secular confession and apologia.

I'm ashamed that you have to endure Viet Nam War stories. The Boomers weren't responsible for this particular dust up but we contributed most of the blood in the "blood and treasure" part of the equation. Now, at any gathering that includes Boomer men, someone will launch into a primarily fabricated account of their heroics during the Tet offensive or some such. In my experience, having been on active duty with the U.S. Army (salute) from 1969-1972, those who actually had "in country" combat experience rarely want to re-visit the experience and those who tell the tales were probably somewhere safe and warm, like Toronto.

We lied about Woodstock, sorry. It was a lot more fun if you weren't actually there. Crawling in the mud, sleeping in the rain, worrying about tainted drugs and arguing with some dipwad from New Jersey about the meaning of Joe Cocker's version of "A Little Help From My Friends" is only fun in hindsight. Personally, I was doing most of these same things when Woodstock occurred, except that I was in basic training at Fort Leonard Wood. I can assure you that "fun" was not how we thought of it then, or even in hindsight.

We ask forgiveness for our George McGovern support. Not that George isn't a fine fellow, he is, and not because we, in our "let's change the world" young idealism were wrong about Richard Nixon, we weren't, but we should have backed a candidate who actually had a chance of winning. George amassed a whopping 17 electoral votes by taking one state, Massachusetts. The man couldn't even carry his own state of South Dakota, the political equivalent of not being able to get laid while at the Chicken Ranch. We Boomers must take our lumps for our part in the public re-emergence of Tricky Dick from his lair in San Clemente.

We regret Bill Clinton and deeply regret W. We may end up regretting Obama, a very young Boomer, he, a fact that may grant him a bye, depending on how things go. As for Bill and Hillary (co-presidents), while the country was actually in reasonably good shape economically, we pretty much dismantled the financial regulatory system during their tenure and this came back to haunt America big time. It isn't so much Bill's lack of foresight and leadership that deserves a mea culpa from Boomers, it's our support for a recovering nerd and policy wonk with little or no class and no self control whatsoever. He was the first Boomer president and yet his historic legacy will usually begin with the words, "Using a cigar...". Ouch. Apparently, not learning a major lesson regarding Boomers, the country turned to yet another, this one poised to lead thanks only to having won the Lucky Sperm Contest. As the second presidential representative of our cohort, W was a genuine embarrassment. While he would likely make a great next door neighbor, you know, genial, willing to lend tools and a hand, share a cold one, etc. etc., I already have good neighbors and none of them strike me as Leader of the Free World material either. Obama is probably the Boomers' last shot. I just wish that he had actually been born here, wasn't a closet Muslim and didn't have that whole Antichrist cloud hanging over his head.

We are mortified by our sheer numbers; forgive us. True, it was our randy parents who, caught in the titillating afterglow of saving the world from fascism, resumed a normal home life and bred like mink. By January 1,1946, the first of 77 million Boomers emerged from wombs across the country, screaming for attention and succor, activities that we habituated. The harvest of our parent's libidinous loins didn't slow to a more puritanical pace until the year 1963 finally closed up shop. By then, the demographic charts contained this humongous lump of humanity that has since been working its way through the American digestive tract like an entire pig in a python. When you walk down the street today, one of every four passersby is a Boomer. They are the ones who have that smug look of the entitled.

We're ashamed that you are an only child. That's right, we could have followed our parent's example and practiced unprotected sex and the "rhythm method" through our fecund years and provided you with many brothers and sisters just like we had; the kind of family with, at the very least, a middle child who would go on to either win a Nobel or become a stalker; the kind of family that makes family reunions interesting, large and sometimes dangerous. Instead, believing every word of Paul Ehrlich's book, we reined ourselves in to just 2.1 children per couple, often foregoing rug rats altogether. We were discovering ourselves through navel contemplation. Producing a big family would have been a tremendous distraction.

Forgive us our trespasses as we forgive those who....oops, wait, no one actually trespassed against us. In fact, we pretty much got the long end of the stick. We would really, really like to return the favor, kids. However, we do actually want everything that has been promised us. So, the next best thing is for us to keep on taking, piling on the debt (you can pay it later) and plead for your understanding as your standard of living falls, your payroll taxes steadily mount, your children face their limited educational and career choices while we Boomers sail on through our very special, meaningful, creative and blessed lives. We want every red cent of our Social Security, even the The Donalds and the Bills and Melindas among us. We want it, even though the amount we paid in is far short of what we'll extract, now that we are living 30 years past our retirement. Fair's fair. And, those artificial joints, we want those too, at your expense of course, and I know that I speak for The Donalds, the Bills and Melindas, the corporate pooh-bahs, the investment bankers and the Hollywood icons on this issue. We're all sorry, damned sorry, sincerely sorry. But the fact is, and we don't know on whom to blame this, Boomers just weren't wired for sacrificing for the common good. Apparently, our parents and their parents used up all the genetic altruism fighting the Axis of Evil (the first one, not W's pretend one). We don't know where your altruism came from; certainly not from us.

I'm sure that there is much more that you expected to see in a blanket apology from a Baby Boomer but whatever it could possibly be is easily countered with slippery, lawyer talk, e.g. "...that depends on what the meaning of 'is' is."

We are sorry, though, in a way in which only Boomers can be sorry (not being one, you wouldn't understand). It is deeply, truly, in-the-marrow painful, a pain that can only be managed with Medicare Part D prescription anti-psychotics.

Kids, please find it in your collective hearts to forgive and forget, and quickly. Bear in mind, without the Baby Boom it is unlikely that "Saturday Night Fever", "Grease" and "Urban Cowboy" would be classics. You're welcome.

Bruce

Observoid of the Day: There is no known collection of Hugo Winterhalter's Greatest Hits.

Slip Sliddin' Away

2009-09-01T10:56:00.008-04:00

The American Public says, "We're mad as hell and simply won't take it anymore. Kick the rascals out. Give us a new and promising administration; we'll even vote for a nearly black guy."

"What do we want? A growing economy! When do we want it? Now!"

"What do we want? Victory in Iraq! When do we want it? Now!"

"What do we want? Higher employment! When do we want it? Now!"

"What do we want? Affordable health care! When do we want it? ....hummmm, well, sometime soon would probably be good but let's not rush into anything that might possibly impact us personally because, you know, we don't really like our insurance companies all that much but, then again. And, we can't actually afford the brand-named drugs that keep us from having a massive health problem, like dying, but if we don't eat on Thursdays we can squeeze the pills into the budget, so there is a work-around. Plus, we can see 'ol Doc Wilson for a physical if we don't mind waiting until after the holidays and he is, after all, one of the last family docs in our area. Yes, yes, the uninsured are in a tight bind but, as W reminded us back in the day, they can always go the emergency room. So, on reflection, and with plenty of very helpful information from the insurance industry, drug companies, the AMA and bona fide experts like Glenn Beck and Senator DeMint, it seems prudent to kick this particular can, you know, down the road, again, I think."

President Obama campaigned, in part, on the promise to fix the American health care system. In other words, to stick his ungloved hand into the beehive, bless his heart.

Obama and his budget sidekick Peter Orszag made a strategic decision to put "health care cost inflation" at the very tip of the reform spear and then aimed that spear at the for-profit health insurance industry. However, the other health care players (docs, hospitals, drug companies, durable medical equipment manufacturers, et al) know that their time is coming. So, they have circled the wagons, even though they don't much care for the guys in the insurance wagon with its big bull's-eye on the canvas.

In the meantime, big chunks of the American public have gone all wobbly on health care reform. It sounded good until the details started to emerge and then the opposition had something to spin. We Americans do love our spin cycle.

New York Times conservative columnist, David Brooks has noted: "Voters often have only a fuzzy sense of what each individual proposal actually does,....(but,) it must involve big spending, big government and a fundamental departure from the traditional American approach."

So, support is flagging. Americans are anxious about the unknown and this is perfectly reasonable. The unease is primarily a "big spending, big government, big deficit and self-interest" defensive response.

Here's Obama and Orszag's strategic mistake: they have not effectively communicated that to do nothing assures an even bigger spending government that, in the very near future, gets pulled into a nearly bottomless financial abyss by health care costs. Medicare will be leading the group over the edge, leaving its heel marks right up to and over the precipice.

I find that reviewing facts often helps to steady a wobbly thinking process. The following facts have nothing to do with what health care reform should look like. They are simply facts that focus one's thinking, sort of like a firing squad with you as the guest of honor. Final cigarette?

1. In 1993, nearly all health insurance providers in America were not-for-profit. Back then, for every $100 of premiums collected, $95 was paid out in health care reimbursements. Today, for-profit health insurers dominate the market. For every $100 of premium revenue, Wall Street pressure demands that they pay out no more than $80 in reimbursements.

2. About 47 million Americans do not have health insurance because they (1) don't want to spend the money, (2) don't have the money to spend or (3) have a pre-existing condition that precludes them from buying coverage. Still, when their health gets desperate (or even not so) they seek and get some medical care and that cost is shifted to the rest of the insured or affluent population. If you are well-insured, rich or both, you get great health care in America, but you also get the burden of paying for relatively modest health care for the rest of the country.

3. Today, an M.D. with a specialty, can routinely earn $500,000 (taxable) income, many exceeding $1 million. A family doctor can expect an average of $171,000 (taxable). It is the latter physician of which America needs more, particularly geriatricians, but isn't producing because of the income disparity.

4. Americans pay for medical procedures not outcomes. As a cause and effect result, those U.S. cities and towns with more physicians, diagnostic equipment and medical facilities have the highest per capita spending on health care but do not have better outcomes than markets that spend less per patient.

5. Thanks to market forces, Americans pay far more for patented drugs--moderated by paying less for generics--than their first-world brethren. Even so, on a per person basis, America is the prescription drug spending champeen by nearly a two to one margin and the largest share is for patented drugs. And, thanks to market forces, patented drug prices in the U.S. are escalating annually at double digit rates. (The scramble to raise prices on newer drugs is thought to be the industry's defense against any health care reform. "When the government is talking about more aggressive discounts, your start price is going to determine your end price," according to Catherine Arnold of Credit Suisse. "I don't think I have ever seen anything quite like this.")

6. One half of America's hospitals lost money in the final quarter of 2008. Through the first quarter of 2009 that dismal statistic had moderated to about 30%. The median profit margins across the entire hospital industry were just 3%, compared to an average of 17% for the drug industry.

7. About 100,000 Americans die each year because of preventable mistakes made in hospitals primarily due to under staffing and flawed communications, often caused by cost-cutting measures.

8. Using the American Enterprise Institute's estimate, so that my conservative readers won't jump down my throat for using Harvard's much higher and more oft-quoted estimate (I don't happen to believe it either), at least 108,200 American families declared bankruptcy due primarily to medical debt in 2008. It's likely to run a bit higher this year. By comparison, added together, the number of personal bankruptcies due to medical bills in France, Germany, Belgium, Spain, Canada, England, Iceland, Switzerland, Australia, New Zealand, yadda, yadda, are nearly non-existent.

9. Using tax levels consistent with the past half century in America, then subtracting entitlement payments as currently promised for Social Security, Medicare and Medicaid, The Heritage Foundation (another conservative think tank) estimates that sometime just before 2020, there won't be enough money in the federal treasury for anything but the entitlement programs. The Medicare portion of the problem--and it is the largest problem--is the direct result of two variables: (1) health care cost inflation and (2) 77 million Baby Boomers lurking at Medicare's door.

10. Inflation adjusted wages in America have remained stagnant since about 2000. Virtually all of the potential increase in our standard of living has been re-directed to pay for health care cost inflation.

11. Leaving the health care situation "as is" insures that there will never be another opportunity for a tax cut. In fact, just the reverse in inevitable.

Seems to me, as a nation with many pragmatists, that we ought to try and improve something, even if it's just a little bit. The chance to do something is slipping away on wobbly gurney wheels.

Bruce

Observoid of the Day: Things aren't as bad as they seem, they're worse.

Bumper Sticker Solutions Needn't Apply

2009-08-26T12:14:00.004-04:00

If I were a much smarter and more analytical writer, I might have written the article to which I now direct you. Alas, David Goldhill gets the credit and all I can do is to say, "Attaboy" and pass it along. I thank my son-in-law, Travis Thomas, and my friend Pat Morgan (knuckle dragging conservatives, both) for bringing this article to my attention.

If your tolerance for reading about health care solutions is limited to Twitter-length messages, this piece is likely wasted on you. If, however, you could benefit from some well-researched straight talk about the real (but politically unrealistic in the short-term) changes needed to heal a dysfunctional "system" and introduce true free-market cost discipline into American health care, then your time and reflection will be well-spent.

Copy and paste this URL into your browser:

http://www.theatlantic.com/doc/200909/health-care

Bruce

Observoid of the Day: Dude ranch horses and lemmings have much in common.

Just Shoot the Old Geezer

2009-08-21T10:28:00.005-04:00

Regarding proposed health care reform legislation, pundit Charles Krauthammer ("Kraut" in certain salons) wants to "be honest about death counseling" according to his syndicated column in the Atlanta Journal Constitution, August 21, 2009. In this op-ed, Kraut quickly distances himself from Sarah "death squad" Palin. Her comments on this aspect of the House's proposed legislation clearly proves that Ms. Deathacuda is a cup, saucer, salad plate, butter knife, dinner fork, spoon and water glass short of an entire place setting. This fact makes her the darling of voters who live in a parallel universe called the Paranoid Dimension, aheeeeeeeooooo.

Some of these voters have shown up at the recent and infamous town hall meetings waving posters of Prez BHO altered to make him resemble Hitler. Apparently, Kraut (not unlike my-own-wizened-self), doesn't believe that these voters will be dissuaded from the "death squad" belief so he attacks the end-of-life-counseling provision from a different angle to widen the dissenting audience to include the less creepy elements. While not a fascist plot to euthanize the infirm and helpless, he says, the counseling and attendant outcome (the creation of a Living Will) "mean nothing" at the end-of-days and is, in a strange and illogical flip-flop, a subtle government push toward a less expensive end for the elderly.

In Section 1233 of H.B. 3200, there is a provision allowing for the payment to doctors for their time to meet with Medicare patients and discuss the patient's end-of-life health care wishes. Doctors can do such counseling now but it's a freebie. Kraut asserts that introducing payment into the equation is bad thing. Doctors, he claims, would bring the subject up "whether the patient asked for it or not," because there would be a financial incentive to do so. Such discussion may then lead to the creation of a Living Will and we know what Kraut thinks about those.

Kraut, no doubt, is glad that Terri Schiavo avoided that conversation with her family doctor and let Congress decide about her end-of-life care. Oops, isn't that government involvement in health care decisions? Damn those ideological hard places and contra-logical rocks.

Further, Kraut argues, "Living Wills" are literary, not legal, documents. Here's Kraut's take on his personal Living Will (note that Kraut has one in spite of his professed belief about them): "I've had some good innings, thank you. If I have anything so much as a hangnail, pull the plug." From a literary perspective, and one does write their own wishes in the document, his is but one long cliche. From a pain and suffering perspective, Kraut is apparently deathly afraid of hangnails. Specificity in a Living Will is good but hangnails seem a pretty low bar. Well, we all have our quirks. I am, for instance, morbidly afraid of the "erection lasting longer than four hours" that I hear so much about on the telly. If this condition arises on my deathbed, UNHOOK THE VENTILATOR!

For those of you who think that Charles Krauthammer is the epitome of measured and objective observation, stop reading now, call your real estate agent and ask about buying a lot in a Paranoid Dimension subdivision, aheeeeeeooooo.

The way that most elderly Americans die in 2009 bears little resemblance to the way it occurred even as recently as 1950, thanks to giant advances in medical care. This fact is a double edged blade. American medicine has been successful in lengthening life but lousy at recognizing when life lengthening efforts become negative for the patient, who, at this late stage, often cannot speak on his or her own behalf. American medicine attacks a 1950 paradigm with 2009 technology, it treats people to death. The result is often quite heartbreaking for the family; painful and scary for the dying.

The expense of such care, while high in absolute dollar terms, adds only about 1.1% to the country's total health care spending. Therefore, the issue of counseling with a doctor and creating an Advanced Directive isn't about significantly putting the brakes on costs as Kraut would have us surmise. It is about going through the dying process on one's own terms.

A well-written Advance Directive, updated as frequently as wished and as circumstances change, is the best defense against three things: (1) a dying process that you don't want, (2) unfair pressure on family members to reach consensus about what you would want and (3) pressure from the medical team to take additional action or pull the plug, as they may advise.

An Advance Directive can instruct the medical team to be aggressive and keep a patient breathing for as long as possible, damn the consequences, or it can stipulate that when the hangnails appear, stop treatment. Kraut may want to revisit this particular stipulation as he ages. It is the specificity of the document (current condition, prognosis, quality of future existence, pain tolerance, both physical and mental, etc.) that puts the patient in control. Advance Directives (an umbrella term under which exist both Living Wills and Durable Powers of Attorney for Health Care) are legal documents. The medical team (and the family) would ignore them at their peril.

When surveyed, 90+% of Americans say that when their time comes, they want to "die at home, emotionally and physically pain-free, with dignity and autonomy, unafraid of caregivers and surrounded by loved ones." Currently, 80% of deaths among the elderly occur in an institutional setting, e.g. hospital ICU or nursing home, with the patient often tethered to one or more machines, surrounded by well-meaning and competent technicians (strangers) and suffering one form of pain or another. This is how 4,000 elderly Americans die every day, almost none of them with an Advance Directive.

There are plenty of things in the proposed health care legislation that deserve criticism and revision before we jump off of the unintended consequences bridge. Opposing end-of-life-counseling, however, is a cheap side show (particularly the Ms. Deathacuda version) that should be euthanized.

Bruce

Observoid of the Day: Money won't buy happiness but it makes being melancholy more bearable.

Is it Nuts in Here or is it Just Me?

2009-07-30T14:47:00.002-04:00

American political dialog (for public consumption) and reality are conveniently shielded from one another by a wall of fear. That fear is composed of the politician's fear of election (power) loss and the voter's fear of hearing about entitlement loss. What follows is an example of what is said and heard versus what is real but not heard.

I will paraphrase the Obama health care dialog: "We need to reform the system so that everyone can be covered by affordable insurance and can receive affordable care and no one will have to sacrifice if we do it right."

Here is a shortened version of reality: "The health care cost crocodile is eating the American way of life, currently it has swallowed an entire leg and is going for the other, so we must cut the first leg off at the hip to save our entitled ass."

Here's another example: Senator Lamar Alexander of Tennessee said on The News Hour last week that "the entire country should look to the examples of the Mayo and Cleveland Clinics where costs are relatively low and the outcomes good and replicate those models as a way to moderate health care cost inflation."

Here's the reality that he didn't mention: Both of those facilities pay their doctors--not for procedures--a salary. It's the primary reason that the care in those facilities is less invasive and less expensive. The day that Senator Alexander introduces Republican-sponsored legislation that puts all American doctors on salary is the day that Nancy Pelosi and Jim DeMint are caught in a compromising embrace in the Senate cloakroom.

You want more examples? No? Well too bad.

Here's a paraphrased version of the conservative push-back on reforming anything about American health care: "We have the greatest health care system in the world and if we change it there will be.....wait for it......wait for it, rationing!"

Here's the reality: America has great health care if you can afford it, otherwise it's mediocre at best and non-existent at worst. We already ration health care in America; we do it through cost and it's rapidly slipping out of the reach of even those with basic health insurance.

Speaking of rationing, let's do a little exercise inspired by a recent op-ed column by Peter Singer, professor of bioethics at Princeton, a small university in New Jersey (not that there is anything wrong with that).

Suppose that there is patient in your insurance pool who has aggressive liver cancer that will kill him in 12 to 24 months. There is a drug called Sutent that slows the spread of the cancer and could give this patient an extra six months of life if he starts taking it now. Whatever the insurance pool pays for this patient and others like him in the pool will impact future premiums for all pool members. Please answer "yes" or "no" to the following questions.

1. The Sutent costs $50 per month, should your insurance pool pay?
2. The Sutent costs $1,000 per month, should your insurance pool pay?
3. The Sutent costs $10,000 per month, should your insurance pool pay?
4. The Sutent costs $100,000 per month, should your insurance pool pay?
5. The Sutent costs $1 million per month, should your insurance pool pay?

If you answered "no" at any point in this continuum, you believe in rationing; you must be a realist and therefore, according to the conservative right, a leftist "socialized medicine" pinko. Otherwise, you are a strict non-rationer; you can march with Glen and Rush, gasbags who never take the "no rationing" argument to a thoughtful conclusion. You can beat the drum and argue that all life, regardless of circumstances and cost, must be paid for with everyone's last dollar. Frankly, I'm not willing to go down, along with my children and grandchildren, on that flawed fiscal ship.

The political will to do the things that would truly moderate health care cost inflation in America is not to be found in D.C. because the message contains news of change and sacrifice for most Americans and the entire health care industry. Try getting elected or re-elected on that platform.

Here's another reality,the necessary sacrifices, if designed and distributed fairly, would not ruin our lives nor wreck the balance sheets of the health care industry. However, the legislative sausage that is currently being packaged in Washington does little or nothing to curb health care cost inflation and a whole lot to place the economic sacrifice on future generations, in spite of Obama's message to the contrary. If the Republicans had a better solution than, "do nuttin' honey", we could turn to them.

Where's Ross Perot when you really need a short Texas nut case to lead a third party?

Bruce

Observoid of the Day: A martini may quench many things but one of them is not thirst.

The AntiChrist Wears FootJoys

2009-07-23T14:33:00.000-04:00

I snuck out to the golf course earlier this week. As is so often the case, I was alone because none of my friends are dumb enough to play golf, which spelled in reverse is "flog". The friendly first tee starter matched me up with a pair of brothers, I'll call them Daryl the Younger and Daryl the Older.

The Younger was an investment manager for a national brokerage firm, married, the father of two teens and, in outward appearance, a pretty standard suburban fellow. Daryl the Older had been in sales for a telephone equipment manufacturer but was "between opportunities", married and the father of a 20-something who was soon to go to college. He too was a typical-looking once-a-month golfer: Bermuda shorts, Polo shirt, anklet socks and a baseball cap with a University of Georgia logo.

We were an agreeable threesome and exchanged pleasantries, golf cliches--"never up, never in", "You da man", etc.--and bits and pieces of personal information.

It came to light that I was a writer of sorts and they asked about the nature of my latest efforts. They were hoping, I imagine, that I was a famous author of crime fiction or, given that I have a rainbow hued umbrella on my golf bag, romance bodice rippers. They tried to hide their disappointment when I explained that I wrote policy-wonkish non-fiction with nary a sex scene, except for occasional comments about various politicos and their penchant for having sex with those other than their spouses.

After grabbing a cold one at the turn, we arrived at the 10th tee. The Younger asked what I thought of the proposed health care reform currently being turned into sausage by the congress. My response indicated (1) that I thought that both political parties were avoiding the core problem of America's health care crisis (provider cost inflation) and (2) although Obama was addressing insurance coverage for all, he was not providing cost inflation solutions, a combination that would prove too expensive.

Apparently, my answer indicated that I was not an Obama worshipper because Daryl the Younger followed on with this question, asked without the slightest hint of irony, jest or sarcasm and apropos to nothing that we had been discussing, "What do you think about Obama being the AntiChrist?"

I am, if I do say so my-own-self, pretty quick on my 9.5 B width feet but to this question I could only manage a weak, "I beg your pardon?"

Given a few hours I did come up with one or two clever rejoinders such as, "I thought that Cheney had a lock on that", or "Barack's new dog is going to be very disappointed." However, as with all bon mots, better never than late.

The Younger continued, "He matches up on many of the signs of being the AntiChrist. You should check it out."

I did a quick take over each shoulder to make sure that Allen Funt and his camera crew were not lurking in the bushes. No, I was quite alone with Daryl and Daryl. I turned to my companions, took a deep breath and said in a clear, if somewhat tremulous, voice, "So, how 'bout those Braves?"

This being Georgia, I could have used "Dawgs" instead of "Braves" and the result would have been the same. We immediately launched into a sports conversation unrelated to politics or religion and thus it remained for the last nine holes.

The incident, brief as it was, is unsettling on a number of levels. One would think that for a person who believed that a sitting U.S. president was the Biblically prophesied AntiChrist, drastic action would be warranted. Daryl the Younger is not a wild-eyed, wild-haired crazy in the mold of Rasputin but faced with worldwide Armageddon shouldn't he be out plotting heroic measures to save mankind? But no, he's out playing golf.

The opposing, yet still unsettling, possibility is that the Younger, being a Christian, which is a necessary ingredient in the AntiChrist scenario, is comfortable in the eventual triumph of good over evil wherein the Christians are olly-olly-in-free. The Younger may be looking forward to the big day with great anticipation. Shoot, he may have voted for Barack just to help kick-start the program. It depends on when the Obama/AntiChrist news hit the Internet and talk shows, before or after the November elections.

Also, curiosity being what it is among writers, I visited the Internet and found several unsettling sites devoted to the specific topic of Obama the AntiChrist. These sites have one common denominator, all of them are spooky in their sincerity. I also found that Obama is not the only living person currently in the running as the AntiChrist. The Pope is also a contender, given his position as head of the Catholic Church (which for some is enough said) and his brief stint in the Nazi Youth Corps.

But, back to Obama the AntiChrist. Perhaps most unsettling of all is the fact that Obama is a golfer, one of the fraternity of self-loathing masochists in soft spikes and hideous slacks. I think that the Biblical prophets, being all-seeing and all-knowing, would have mentioned something about that in the 27 signs of the AntiChrist. However, I have carefully read all 27 signs and there is no mention of anything that would seem related to golf. There is, however, the "666" sign (Barack=6 letters, Hussein=6 letters and Obama=5 lett....never mind).

It is in the following bit of presidential golf information that I found proof that Obama is not the AntiChrist. By all reliable accounts, Barack is a hacker, just like the rest of us delusional clowns who buy $400 drivers. We who load up on Titleist Pro V 1 balls at $4 each only to launch them directly into the first water hazard that confronts us. This group who own range finders that give accurate distances to the pin, a very thin object 183 yards away which we couldn't hit unless it was a mistake; middle aged men in Nike golf clothing (just like Tiger's) who attack the course like a better dressed version of a Texas chain gang hacking weeds in a bar ditch. He's one of us.

If Obama were the AntiChrist, with immense power and total control, he'd have game. Perhaps the Pope plays to scratch. Yikes!

Bruce

Observoid of the Day: Silence is golden; duct tape is silver.

Miss Elainy

2009-07-13T11:56:00.000-04:00

There has been much in the news recently that deserves comment. Reams have already been written about certain people and issues. You may think that all pertinent information on the following topics has made it into the public domain and that any additional perspective would be redundant. Of course, you would be wrong. In my review of available information on these stories, there is a glaring gap and that gap is the perspective of an aging white guy transplant from the mid-west who is currently living in the deep south. This is a gross oversight that must be addressed.

So, without further ado--and there has been a gracious plenty of that--I present said perspectives.

Michael Jackson. From all indications, Mr. Jackson is still dead. As a business model strategy, one that closely parallels that adopted by The King his-own-self, Elvis Presley, when your act is popular primarily because you have become a parody of your own-earlier-self, death is an excellent career move. Reportedly, there is a large cache of unreleased MJ recordings which will now be packaged and relentlessly marketed via Infomercials. These new recordings, along with collections of MJ's "Greatest Hits", MJ's "Mediocre Hits" and MJ's "B Sides" will continue to create millions of dollars of revenue. The most interesting aspect of this looming marketing juggernaut is the question of who, exactly, will benefit. My prediction, given the early indications based on recent child custody discussions, family comments to the media and such, is that the scramble for a place at the MJ lucre trough will make the family squabbles over Dr. MLK's money-producing legacy look like a pillow fight at a Brownie Scout pajama party.

Sarah Palin. For my personal entertainment dollar, Ms. Palin is still the most interesting nut job in the Republican party, and recall, this is the party of Governor Mark "I love your tan lines" Sanford, Newt "Hey, here's yet another new idea" Gingrich and Nevada's Senator John "The wife and I joined the Promise Keepers (wink, wink)" Ensign. These are tough acts with whom to compete but the Thrilla from Wasilla is more than up to it. It helps, of course, to have an entire family, a daughter's former main squeeze and a hairdresser at the Beehive Beauty Salon who are attracted to media mics like liberals to Birkenstocks. Some say that Ms. Palin is "crazy like a fox" and, in part, I agree. If you want to sharply focus your mind, imagine that Ms. Palin, given the right set of circumstances, could eventually have access to the U.S. nuclear arsenal codes; David Letterman should watch his tasteless remarks.

Swine Flu. This illness is now officially called the H1N1 virus after a well-orchestrated outcry from the U.S. pork industry claiming that the handle "Swine Flu" was a pejorative, reflecting poorly on pigs and, more to the real problem, ruining bacon sales. The moderately serious influenza has spread worldwide, according to the World Health Organization. It is thought to have incubated and first spread from porker to human in rural Mexico. Apparently, pigs are no longer needed to spread the bug and neither are Mexicans. One could assume that if the bug can jump from pigs to humans that it can also jump back, a possibility that the Chinese government is suppressing lest its population of 2 billion pigs becomes restive and takes to the streets like unhappy Uyghurs. Ironically, a report out of Michigan this week indicates that out of 10 cases of H1N1 in one hospital's ICU, 9 of the patients were obese. This medical observation is another PR body blow to pigs in general and swine in particular.

Global Warming. Al Gore missed the fact, probably because he was born several million years too late (a fact about which Tipper is somewhat conflicted), that Earth has had significant warming(s) in the past. Thanks to these earlier warming cycles, Hollywood has been able to create blockbuster releases bases on the flora and particularly the fauna of those epochs. (I am still working on the difference between "epoch", "eon", "age" and "era". I mean, why do we say, "The Jazz Age" instead of the "The Jazz Epoch"? Huh? Huh?) Anyway, without those warmer days of yore, we could not have enjoyed such classics as "1 Million Years, B.C." with Raquel Welch in that really, really fashion-forward one-piece animal skin (PETA approved) or "Jurassic Park" in which Laura Dern proves that the acting gene isn't necessarily passed from father to daughter. It seems to me that the most important reason for reducing greenhouse gases isn't the warming impact, it's that we're all breathing this crappola into our lungs!

Health Care Reform. According to the pundits and experts (rarely the same people) there are "billions here" and "trillions there" to be spent, saved, squandered, applied, acquired and/or taxed, all associated with U.S. health care. The Democrats push for this or that reform, the Republicans push back. For all of the pushing and pushing back, it seems inevitable that some legislation is going to pass, but it isn't likely to help much. Here's why: unless a majority of Americans and their representatives are willing to admit (1) that it is not an appropriate use of the innovative free market to let that market set the agenda for national health care (as the providers do now) (2) that paying providers for procedures, regardless of the potential and actual outcomes, is a poor way to run the rodeo and (3) that it is a fallacy to assume that the payers--government, private insurers or patients--are going to rein in the cost associated with items (1) and (2), which are now ordained by the providers plus flawed policy. If we don't address the primary reasons why health care costs in America are unsupportable and climbing, those rising costs will continue to eat America's corporate budgets, America's family budgets and America's federal budget. Both parties are dodging these realities. If you were looking for a chuckle in this final item, sorry. I'm as serious as a colonoscopy prep about this one.

Bruce

Observoid of the Day: Cats are needy; they just refuse to let on.

Free Market Convert

2009-07-01T16:33:00.000-04:00

I confess, I have been desperately wrong about runaway health care costs and the solution. I'm deeply, deeply ashamed of my stubborn insistence that the free market is precariously tipped in favor of the providers and therefore lacks the essential mechanism for encouraging innovation, efficiency and competitive pricing. How silly of me, as has been pointed out by a number of concerned readers. The real solution is not less free market activity plus more gummit planning (intervention) but quite the opposite.

I am now bathing in the soothing light of the free market solution. Either that or there is a large locomotive bearing down on my position. If I squint, maybe I can tell which.

Clearly, as my betters point out, the gummit can't do anything right. Nothing. Zilch. Nada. The Post Office clearly doesn't work. The IRS is an embarrassment. Our Federal highway system is the laughing stock of the free world. The FBI, CIA, Secret Service and NSA are out of control and routinely trample the rights of up-standing, often gun-totin', citizens (especially those patriotic Minutemen protecting our southern border). NASA hasn't put a man on the Moon for 40 years (and maybe not even then). The CDC can't protect us from flu caused by Mexican pigs. The list of failed or anemic government programs just swells.

The free market is the answer. Given the right incentives and the freedom to innovate and compete, private enterprise could replace all of these inefficient, fraud riddled, wasteful and lumbering bureaucratic gummit sloths. I am now so convinced of this orthodoxy (think: enthusiastic reformed smoker) that I believe America should immediately adopt free market policy across the board, starting with national defense, the largest, most unwieldy, wasteful and inefficient of our federal budget gobblers.

Just think of the possibilities.

Each patriotic defense contractor, currently saddled with top-down planning coming from those yokels in the Pentagon (and we could certainly use that building and land for something more productive), would be free to approach each individual, consumer group or state to sell their wares: naval vessels and munitions to those with oceanfront properties to defend and land based military hardware to the land-locked. Everyone would be free to choose from whatever the defense industry decided to present to them, unless, of course, they couldn't afford it.

And, since places like Florida and Maine have no real beef with any Middle Eastern, Far Eastern or former Soviet entities, there would be no wasteful spending for additional vessels or munitions to patrol those parts of the world. Certainly, residents of places such as Kansas, Missouri and Nebraska are morally concerned with possible dust-ups and genocide in faraway lands but sending their artillery, tanks, bullets, armored personnel carriers and such to wield a big military stick would be seen for what it is, wasteful use of dollars.

The military equipment manufacturers would decide who needed what, based on their superior judgment and profit potential. Then they would make their case to citizens and state legislators (and here in Georgia we hold our state Representatives in particularly high esteem, at least the ones who aren't currently serving time) and then build and deliver the hardware. There would be a real scramble in the competitive bidding process to drive the costs down. Just think, acres of inexpensive Bradley Fighting Vehicles in Wisconsin, a tarmac chock-a-block full of bargain-basement F22s in Ft. Worth, etc. Then, as contractors came up with new and innovative weapons systems, regardless of the real or imaginary threats to the population, market them directly to the voters and encourage the politicians to buy (sort of like big pharma's, "Ask your doctor if you are healthy enough for sexual activity" pitch).

The current system of planning national defense and then directing private enterprise to produce the required equipment (admittedly, at a profit) is for socialist sissies. It is the Nanny State run amok. Look at the military messes it has gotten America into. We don't need no stinking planning; the providers know what's best; certainly better than those pesky four stars and gummit bureaucrats. (I don't know about you, but when I hear "bureaucrat" I think of short-sleeve, drip-dry dress shirts and clip-on neck wear.) The providers, however, are free market innovators and they would never produce and sell military equipment that wasn't desperately needed somewhere by somebody, would they?

Of course, there would still be some gummit involvement (sorry Libertarians), but just at the state level. That would be where a Congressional sub-committee, headed in Georgia by a guy whose real job is in industrial pest control in Macon, can decide how many mortar tubes the state really needs next year. Oh, and shoulder-fired missiles, don't forget them, they are really, really cool. You could buy one for home use.

Naturally, the funding would have to be arranged through the individual voters in each state to insure that it is a totally free market defense system. Deciding whether or not to take part would be up to each citizen, akin to deciding whether or not to have health insurance. The gummit shouldn't force anyone to pay for military equipment if they have better things to spend their money on--and it is their money, you tax-and-spend liberal bastards.

I'm sorry, but I feel strongly about this.

I am planning to evaluate the improvements that a totally free market orthodoxy will have on the other gummit agencies. I get goose flesh just imagining how much different and cheaper, not to mention innovative, our national highway system will be after a couple of decades of free market direction sans gummit oversight.

Rest assured, BHO is on my distribution list for this post. He has got to come to his senses and soon.

Bruce

Observoid of the Day: You cannot out-think a person who isn't thinking.

Ayatollahs, Imams, Mullahs and God

2009-06-24T14:13:00.000-04:00

I charged up the old cell phone, cozied up next to the land line on my desk and dialed God's unlisted number (see earlier post for the technical explanation). There were a number of clicks, some static, a faint whirring and finally a gender-neutral voice that sounded like Joan London channeling James Earl Jones.

"Hello, Boots." It was God. "I've been expecting a call from you.

"What happened to your receptionist," I inquired?

"Oh, that job is handled by a revolving crew. Answering my line for eternity is very boring so we try to rotate every billion years or so with the harpists. We're smack dab in the middle of a crew change so I'm doing my part to make things go smoothly. Besides, I knew it was you. Your antique Nokia phone creates a distinctive ring."

"So, what's on your mind." God likes to cut to the chase, none of that "How's your mom an' em" small talk. Besides, God already knows how your mom an' em are.

I told God that I had been following the Iranian Election dust-up pretty closely and was wondering about Heaven's take on the situation.

"Well, first of all, there are quite a few of those Iranian clerics who are in for some really, really unpleasant surprises when their numbers come up. I've got my nether world emissary arranging for some unique treatment. Satan takes great delight when we send down special requests. It gets the old boy's creative punishment juices boiling. I hear that there will be some virgins involved but certainly not in the way that those clerics day-dream about, heh, heh." God can generate a wicked little chuckle.

I noted that much of what the clerical leaders throughout the Middle East say and do, they say and do in the name of God; "Allah Akbar" and all that.

"And, that," said God, "is where they get their collective beards in the wringer. I defy anyone, cleric, theologian, Jew, Muslim, Christian or Oral Roberts to point to a place where I purportedly say it's O.K. to kill innocent people in the street. Ridiculous."

"The underlying problem,' God continued, "is that throughout the history of the earth, at least since humans have been around, some of them have tried to put words in my mouth. They do O.K. for awhile but eventually they botch it up big time. For instance, I never sent Saul and his army to slaughter all of the men, women and children of Amalek. How stupid is that? That was some man's agenda. I'm not about the wanton slaughter of innocent people."

"Muhammad didn't do any better in keeping some silly stuff out of the Koran," God continued. "Of course, if one hangs out in the Arabian desert for years and years all by your lonesome, one is likely to write some weird stuff. He was no exception."

I told God that I was confused by many of the Muslim titles and names that get bandied about in the press. I wondered what the differences were between an ayatollah, an imam and a mullah.

"Beats me," said God. "That just more of that man-made foolishness. One is either truly trying to be holy or not. As far as I'm concerned, it's far better not trying to be over-the-top holy and admit it than it is to slap a title onto your name indicating that you are particularly holy and then do a bunch of unholy things."

So, I observed, the differences are no greater than, say, than those between a preacher, a pastor and a priest.

"Pretty much," said God, "except, of course for the celibacy part, which, I'm pretty sure, the pastors and preachers want no confusion about whatsoever."

And, so, I continued, the differences between Sunni Muslims and Shi'ite Muslims are similar to the differences between Methodists and Episcopalians.

"Well, not exactly," said God. "Shi'ites try to kill Sunnis and vice versa because of some minor differences. Episcopalians and Methodists have minor differences, for instance, Episcopalians have nicer cars, but that rarely leads to gun play or beheadings."

"Look," said God, "it's not just the Muslims who let religious titles get out of hand. The Catholics are particularly culpable. They have padres, priests, deacons, monsignors, bishops, cardinals and a pope. Geesh. And, the more august the title, the sillier the hat. How would you like to sit behind the Pope on movie night at the Vatican Cinema 6?"

God seemed pretty steamed up so I tried to change the subject with a question about Joseph and Mary and the quality of their relationship once they had successfully dealt with the virgin birth deal.

"Hold on," said God, "I've got an urgent call from one of the parallel universes. We'll have to talk another time, Boots. Take good care."

The line went silent and I was alone with my thoughts. The "parallel universe" comment was intriguing and I intend to follow up on that subject.

Bruce

Observoid of the Day: Although they both start with "A", the Appalachian Trail and Argentina are not the same thing but some folks apparently missed that day of geography class.

Tree Bleeding, Volvo Hugging, Chardonnay Jerking, Pansy

2009-06-15T16:58:00.000-04:00

It's come to my attention that some of my readers and not a small number of friends, acquaintances and enemies have labeled me (shudder) a Liberal. Most have done so with the thin lips and squinty eyes associated with suspicious--some would say, "paranoid"--Conservatives. Without protesting overly much, let me adjust the lens and set the record slightly less ajar.

I have never once hugged a tree. Yes, yes, there was that time, tangled in snow ski bindings, poles and deep powder, that I used a tree to haul myself to a standing position. However, I never saw that particular tree again and we did not subsequently exchange Hallmark cards and breathy phone calls. Don't get me wrong, I certainly like a good tree, and there are many just outside my window, but I have no desire to hug one. In fact, in just the past month, I have directed that several of the really ugly, scrawny ones be taken down in favor of a more pleasing assemblage of ferns and such. The other, more elegant, surrounding trees seem pleased with the extra room and sunlight.

It's also true that in years gone by I owned a Volvo. This was back during the days when my children were car-seat bound and safety was a paramount concern. However, once Ford came along with their gas-guzzling Explorer, I went through a series of three of them, looking down with disdain from my high perch on the more lowly sedans, including the Volvo. I currently drive a Chevy SUV called the Equinox, a name that has celestial meanings unrelated to ground transportation. This is one of the reasons that GM has been nationalized--poor model naming. I must also confess that there is a 11-year old Saab in the garage. I tried to sell it several times but it is a hatchback 5-speed. Older drivers want four doors and younger ones can't drive a stick. I'm stuck.

I have been known to suck down the occasional chardonnay but I also enjoy Bordeaux, Italian reds, pinot grigio, mojitos (Hemingway's fav) and the ice cold Bud out of a long neck. I used to think that scotch was where it was at until it dawned on me that I really didn't want to be where it was at, or at least where too much scotch took me.

It should be clear by now that putting me into the Liberal pigeon hole is not entirely accurate. The question is, where do folks like me fit into the political bell curve, bracketed by Sean Penn on the wacko left and Sean Hannity on the nut-job right (I call this the Sean to Sean continuum).

As luck would have it, I recently came across a book review of Alan Wolfe's latest, The Future of Liberalism, and it struck me that his description of a true liberal was eerily like me. This serendipitous discovery has allowed me to created a political label for myself that is neither too Sean nor too Sean; I am a Wolfesian.

Here, in brief, is what being a Wolfesian means:

1. I have a "sympathy for equality". This does not mean that I believe that the outcomes of people's lives will be equal or should be made to be equal. It does mean that, for those who want to try for better outcomes, artificial barriers should be eliminated so that they can have a go at it.

2. I have "an inclination to deliberate." Black and white solutions to social, political, religious and policy issues are exceeding rare. "You are either for us or you are against us" statements usually lead to poor outcomes instead of solutions. Most bumper stickers are evidence of narrow thinking and lack of deliberative thought. Real solutions printed on bumper stickers would lead to tailgating because the print would be so small.

3. I aspire to have "a commitment to tolerance" although I struggle with this one on occasion. There will many readers who will roll their eyes and think, perhaps aloud, "No joke, Sherlock." Go on, have your fun, I can handle it. I'm working through the 12-step tolerance program. However, in the end, I still won't be able to tolerate either Sean.

4. I "appreciate openness." This tendency toward candor, of course, has gotten me into much deep doo-doo over the years and is one of the reasons that I could never be elected to political office. Having lived in the South since 1972, however, I have learned the technique of being open with folks and then immediately soothing the sting so that they know that I have their very best interest at heart. An example: "No, those stretch pants don't make your butt look big, it's just that you have a big butt, bless your heart." See, honest but sympathetic.

5. I have "a disposition to grow." This is a reference to intellectual or knowledge growth. I have long since come to terms with the fact that I am never going to be taller. This ability to grow really means the ability to change my mind as I garner additional information. If I didn't do that, I would be stuck in some past ideological rut. Many of our elected officials seem tethered to ideologies from the past, ideologies that have been refuted with the illumination of additional information. This is true at both ends of the political bell curve, i.e. we didn't eliminate poverty by giving people money and the unmonitored financial free-market wasn't the holy grail of perpetual prosperity.

6. I have "a preference for realism." Here are some examples of conservative and liberal ideas that are not grounded in reality and so, either haven't worked or won't work. (a) Promoting sexual abstinence will lower teen pregnancies and the spread of STDs. Posters in the classroom have no chance against raging hormones in the backseat. Bristol and Levi please step forward as Exhibit A. (b) Banning all privately-owned firearms will dramatically reduce gun violence in America. This Pollyanna dream will not be possible in a democratic society borne of a violent revolution. The independence and self-protection implications of owning lethal weapons are woven into the fabric of American culture. Neither is it realistic to allow the private ownership of shoulder-fired missiles, anti-tank weapons, Claymore mines, rocket-propelled grenades, fully automatic assault rifles with military-grade ammo and such. The realists among us must draw the line and the NRA has proven itself unable to play that role. (c) Universal health care insurance is socialism. No, universal and socialism are not synonyms. Universal health care insurance means only that. Our employment-based health insurance system has given rise to a whopping 47 million uninsured Americans, some employed, some not. Those Americans eventually receive health services and the rest of us pay for their care through cost shifting by the providers. Finding a way to get everyone some insurance coverage lessens the under-the-table cost burden on those of us who are insured. "Socialism" suggests that not only is everyone covered but that all of the providers are government controlled. What's up with that unrealistic conclusion?

7. I have "a taste for governance." Let me amend that slightly. I have a taste for "good" governance. Unlike Ronald Reagan and Libertarians, I do not think "that government is the problem". The problems come from "bad" government. In a government responsible for 300 million independent-minded citizens, there will always be pockets of bad governance...always. Generalizing that to mean that the problem is the entire government is simply too simple. The apostle Paul was a firm believer in having no ruling church hierarchy, an early Libertarian he, but his letter to the Corinthians indicates that things in Corinth got way out of hand in the absence of some governance. Anarchy is a lousy substitute for a governance structure that allows personal freedoms but sets realistic limits on same. (For the official record, neither do I believe that government is the solution for every social, financial or health care challenge that crops up.)

So there you have it, the labeling of moi and other like-minded citizens as "Wolfesians", a label that rests nicely on my psyche. Perhaps I'll get several million t-shirts printed up and sell them on-line. The slogan could be: Wolfesians Give Good Government.

Bruce

Observoid of the Day: Unless one is a catcher, a baseball hat worn backward is the international symbol for "immature, vapid, knucklehead."

Da Leg Bone Connected to Da Very Pricey Hip Bone

2009-06-08T12:44:00.001-04:00

Based on recent experience, let me share with you three basic observations regarding total hip replacement therapy: EECHA! OOCHA! OUCHA!

I recently entered and emerged from the great maw of the U.S. health care system, or as Senator Richard Shelby (R: Alabama) so glowingly called it in a brief TV appearance last week, "The greatest health care system ever created in the history of the world."

We should all remember that Senator Shelby represents Alabama, the birthplace of the toothbrush (else it would be the "teethbrush") and where, it has been reported, family reunions first rose to popularity as efficient hookup events for singles. (Hey, I'm only kidding here. As we all know, it was really Mississippi.) These facts, coupled with the Senator's apparent inability to slowly back away from an unattended microphone, prompted him to make a statement so at odds with virtually every objective evaluation of the U.S. health care system as to defy categorization. Senator Shelby is either (1) ignorant, (2) a liar or (3) deeply dependent on campaign contributions from Alabama's sophisticated health care community. Being a Republican has nothing to do with it, although, in the current political environment, it may help.

I actually like Dick Shelby, and on many issues, particularly defense and financial services reform, I think that he contributes knowledge-based conservative value to the debate. His take on American health care , however, drips with hyperbole and reeks of special-interest snake oil.

Given my recent experience with our health care system, I can defend the notion that if one is to replace a major body part, an American hospital such as the Emory Orthopaedic Hospital in Atlanta, is a confidence-enhancing choice. My doctor, Doogie Howser, M.D., is well-trained in the latest joint replacement techniques. The staff is devoted to ensuring that the patient's experience is as good as can be, given the realities of slicing, dislocating, sawing through bone, pounding prosthetic devices into femurs, stitching muscle back together, et al. The equipment appeared first rate, the drugs were very magical indeed and the food was better than the airline version.There was an in-room TV problem but that was a minor annoyance.

Lest you think that what follows is the musing of an unhappy or unappreciative patient, let me be very clear: I am grateful for the expertise, advanced technology and caring that contributed to what appears to be a successful medical intervention. I am a lucky guy.

I'm also a lucky guy in that the eventual price tag for the procedure, headed north of $40,000, will largely be borne by private health insurance via my wife's employer. This price tag does not compare favorably to the cost of having the same procedure done in say, Singapore or Mumbai, in a first class medical facility, staffed largely with surgeons who trained in U.S. hospitals (currently $5,000 to $15,000). Going offshore to obtain quality but far cheaper medical treatment is known as Medical Tourism. (Safety tip for those considering such a tourist adventure: I wouldn't plan time for sightseeing after the procedure because of the "eecha, oocha, oucha" factor.)

The savings and successful outcomes associated with going offshore for expensive surgeries are substantial enough that some U.S. insurers are now encouraging the practice and providing travel reimbursement as part of the coverage. Compared to what they would shell out for a U.S. procedure, they still save money.

My rejoinder to Senator Shelby is this, "No, but we do have the most expensive health care system ever created in the history of the world."

If it were the greatest then (1) any American (not just the fortunate ones like me) who needed a total hip replacement in order to live comfortably could get one without fear of financial ruin, (2) the health care outcomes in the U.S. would be far superior to those of the rest of the developed world (they are not) and (3) the costs would be competitive (reasonable) instead of eating up 17% of our Gross Domestic Product and climbing.

The changes required to actually achieve Senator Shelby's vision are daunting but claiming, as he does, that we are already there doesn't move us forward. The various U.S. health care players have substantial skin in the current fragmented game and they will defend the status quo vigorously, likely with Dick Shelby's help.

So, as a convenience to you alert readers, I am developing a guide to parsing the health care debate as it slowly builds toward aircraft engine decibels. To start, here is a list of words and phrases which indicate that you are listening to someone who either has a financial interest in keeping our health care expensive instead of making it great or hasn't actually done much homework on a complex issue.

1. access to health care insurance for everyone is socialism
2. nanny state
3. bureaucrats, not doctors, will decide
4. health care rationing
5. Canadian wait times
6. British wait times
7. innovation will disappear
8. the free market works better
9. government run health care will be like the post office, the IRS, (name of your least favorite federal bureaucracy)
10. Illegal immigration is the root of the problem
11. It's all the _________________fault (insert one choice only: doctors', hospitals', drug companies', insurance companies', government's, technology's, Democrat's, or Republican's)

More of these fear-inducing catch phrases will emerge as the defenders of the current system dig in. As they do, I will keep you updated.

Bruce

Observoid of the Day: When it hurts like the dickens to bend at the hip, the toilet seat is very, very far away.

Parts Is Parts

2009-05-28T10:49:00.000-04:00

Over Memorial Day weekend, my brothers and I hosted a big hoopla for our father's 90th. He lives in south-central Kansas where the air is pure, the water clean and the politics slightly right of Kubla Khan but just left of Genghis. We grew up in the same small town where Pop still lives. We are three sons of the high plains, a phrase that sounds like a B-western singing group.

Our father is still a very active camper. He is an insurance consultant (part time), a church choir baritone, an independent resident of a retirement community and a daily golfer (unless there is snow on the ground, tornados touching down nearby or steady rainfall greater than one inch per hour). As much as he ever had them, he retains all of his marbles. Part of his longevity success has been the replacement of critical body parts: knees (both), hip (left), arterial stents (couple), urinary tract mechanical sphincter (original plus replacement) and so forth. Since he has been older than 65 for the past 25 years, Medicare has picked up the great bulk of the expense associated with his renewal projects.

Proving that the fruit doesn't fall far from the tree, I am having a brand new titanium and stainless-steel left hip inserted into my-own-fruity-self on June 1. The surgeon appears to be no older than 17 but he assures me that he is fully qualified, certified and insured. The good news for you readers who still pay taxes is that I am not yet old enough for Medicare to pick up the tab.

As some of you already know, if all of the Baby Boomers were asked to line up based on birthday and year, with the oldest at the head of the line, I would be right up at the front with the other January 1946 (year one of the 18-year generation) geezers while Barack would be way, way back in the 77,000,000 person queue. This line of Americans will begin to depend on Medicare for replacement parts starting year after next. I could have waited until then but my intake of Advil during that time would likely pickle my liver, yet another medical expense to present to the taxpayers. That, plus I am a sensitive, altruistic guy who wants to get back to pole vaulting soon, my exercise of choice.

New body parts are expensive. Multiply "expensive" by 77 million and you get a truly impressive number. How impressive, you ask? Let's see now, multiply the 7, carry the 2....hmmmm. Yowzer!

Medicare money, which comes out of the government's general operating budget, has a projected shortfall of $80 trillion. How big is $80 trillion you ask, your eyes glazing over like they always do when very large numbers are presented? Here's a nifty comparison: all of the personal property in the U.S., houses, land, office buildings, cars, mink muffs, Rolex's, lawn tractors, art, iPods, Wii's, etc. is valued at $50 trillion. Everyone in the country could sell everything that they own (to foreign buyers because we can't sell it to each other else we would still own it) to pay for Baby Boomer Medicare expenses and we would still be $30 trillion short. Sorry Barack, your new hip is on hold because the guys at the head of line used up the money.

The entitlement shortfall is not a problem that can be tweaked to a solution. Trimming around the edges, paring a few hundred million here and there, extracting a $2 trillion pledge that "we promise (but don't guarantee) to do better over the next 10 years" from the hospitals, doctors, big pharma, medical equipment manufacturers and insurance companies amounts to chump change. It's akin to asking the 800 pound gorilla to trim down to 768 pounds knowing that we don't have room for a gorilla of any size.

Here's one solution, immediately increase payroll deductions for Medicare by 134%. Don't care for that one? O.K., hows about we immediately decrease Medicare benefits by 53%? Not to your taste either? We could ask every other Baby Boomer to off themselves prior to their 65 birthday ("Ask not what your country can do for you..."). I'm sorry, but you and your elected representatives (those unique mammals that mysteriously lose their spines upon arrival in Washington) will have to make a selection from this list or come up with some combination of the three that equates to the same outcome.

Oh, wait, I forgot the fourth choice, reigning in medical cost inflation from its current rate of about 7% annually; perhaps, you know, keeping it in line with actual cost-of- living increases which are currently 1.3% per year. Heck, we should probably allow for 3% annual health care cost inflation just to keep the industry happy. What, you don't think that the health care players would be happy with revenue inflation of more than twice the rate of the actual cost-of-living increase? Why not? Greed? Wall Street demands? Stupidity? The public demand for Rolls Royce health care for the price of a Kia and leave the grand kids to pay the difference? These are, as some of you have likely noted, rhetorical questions, each of them containing a kernel of truth. This begs the question, why do we pronounce "kernel" and "colonel" exactly the same? Very odd, that.

Dealing with health care cost inflation is the biggest piece of the Medicare liability puzzle; not all of it but the largest by far. The solution(s) for what is best for the health care of all U.S. citizens at prices that reflect sustainable reality will be at odds with the financial interests of many in the health care industry and likely at odds with some of your self-interests. We can either (1) all dig our heels in and slowly be pulled into the abyss in this financial tug-o-war with the gorilla or (2) educate ourselves about the actual alternatives and support the ones that will work, even if we have to hold our noses, or better, make some shared sacrifice.

Bruce

Observoid of the Day: Health care cost reform is not an ideological problem, it's a math problem.

God and Me

2009-05-05T11:30:00.000-04:00

I had not intended to bring this topic up because of all the possible attendant media hoopla, but circumstances prevailed. So here's the revelation, I talk with God. It is not your standard, on your knees or at the dinner table, one-way communication either. In fact, it's a Jerry Falwellian type of connection. There is routine repartee. I didn't always have this communications channel; it presented itself when I changed cell phone carriers recently.

Somehow, the combination of AT&T on my office line, mixed with Sprint on the cell phone created this phenomenon. It only works when I use my cell phone within three feet of my office phone. I'm not sure whose network is responsible.

A few weeks back I misdialed my urologist's number (I can't say what that number is for obvious reasons). A pleasant and gender-neutral voice answered but it was not the receptionist at the doctor's office because she is definitely not gender-neutral, if you get my drift.

"Thank you for your call, it is very important to us. God is either away from the phone or on the line with another entity, please hold. Your expected wait time is less than 3 minutes." This was followed by music that sounded suspiciously like Jim Morrison and the Doors as covered by the Mormon Tabernacle Choir. Well, the "God" reference got my attention, so I hung on instead of up.

As you might expect, the actual wait time was less than three minutes but only by a hair. God apparently follows the dictum of, "If you can't be on time, be early." I like that.

"God speaking," came another pleasant and gender-neutral voice, except that this voice had a slight reverb, but less reverb than a Julio Eglesias recording.
"How can I help you, Bruce, or do you prefer 'Boots'?"

I was taken aback that the speaker knew who I was without introduction (probably caller I.D.) but the voice also knew that some in my family call me 'Boots' (caller I.D., not!). It was the first of several clues that eventually convinced me that I was really, actually, sure 'nuff, talking with God.

I explained that I hadn't been trying to call God and that it was an accident.

"That's often the way it works," said God. "In any case, you've reached me, so perhaps we can talk a bit and maybe learn some things. There are a number of things, for instance, that I would like to know about you."

Well, if there's something that I always spark to it's talking about myself, so I agreed.

"Why do you shave your head?" God asked. "After all, I arranged for you to have a full head of hair with only modest male pattern baldness occurring after you reached 40, but you razor it off every day or two."

I explained that the growth pattern--thin on top and back, thick on the sides--plus the aggressive graying, made me look a lot like Slobodan Milosevic, the unpopular Serb. I added that Slobodan wasn't with us anymore.

"He's not with me either." said God.

Well, anyway, I continued, now I look a lot like Ben Kingsley.

"Oh, he's the one who starred in "Gandhi", said God. " Great actor; loved him in 'Sexy Beast'. Speaking of Gandhi, now there's an interesting guy. He followed the Hindu path during his temporal years. I see him often. He tells great jokes; a real ham."

So, I observed, it is the Hindus who have the secret to eternal life.

"Well, they get lots of it right," said God, "but miss a few elements here and there. I can't fault them. They make a legit effort. And they certainly treat their cows better than most of the other earthly sects."

I asked God if this meant that there were other religions represented in heaven, or wherever God was.

"Oh sure,' God said. "We're an equal opportunity destination."

That begs the question, I continued, if it's not the specific religion that gets one there, what is the secret?

"That, I'm sure you will understand, is classified information," said God. "While this is our "Help Line" we don't offer that much help. You will have to determine the answer on your own. If we just gave out THE ANSWER willy-nilly, all of the heavy lifting of spirituality would be eliminated. After all, mental heavy lifting is the journey and the journey is the point."

This line of thought was getting a bit too circular for me so I changed the subject. I asked God if "God" was a real name or just something created by the King James translators.

"My real handle is a series of energy bursts, interspersed with dollops of space-time continuum but that doesn't translate well into any existing language. The Greeks tried but gave up and went back to nature worship," said God. "I've always been fond of 'Yahweh', 'Shaphat' and 'Jehovah' but don't care much for 'Elohim', 'El Shaddai' or 'Hupsistos'. Some of those early Jewish writers went a little overboard. 'God' works fine; I use it for autographs."

"Look," said God, "This has been instructive, Bruce, but I've got some other calls to take so let's have one more question each and pick it up another time."

I agreed and let God ask the next question.

"Why is it," asked God, "That your are so good at lag putts but miserable at anything between two and five feet?"

I said that if I knew the answer to that one that I would be a slightly wealthier man. I opined that it probably had to do with some repressed childhood trauma.

"Yeah, right," said God.

It was my turn. I asked God if the earth was really created in six days.

"I get this one all the time," said God. "Time is a relative notion. Look how far that simple concept took Einstein; Austria to Harvard with a visit to Oslo thrown in. By the way, he and Gandhi have become pals here but I, as I so often do, digress."

"Anyhow," God continued, "you have to bear in mind that eternity is really quite a long haul. Most humans have trouble with the concept. Some perspective helps. Imagine yourself sitting through an entire beginners' piano recital at Madame Eloise's School of Music. Eternity is longer than that."

For me, this was a "Wow" moment.

"Earth days," God continued, "Are merely a construct determined by the earth's rotation speed. While I was creating earth, you may recall, I was also putting the rest of universe together. Some of my other trillions of orbs rotate much faster and some much slower than earth, so the definition of 'day' gets all cockeyed once you venture out past your little patch of the Milky Way. Let's just say that the Old Testament writers did the best they could with the information that they had at the time."

"They aimed for the perfect metaphor but sometimes missed," God said. "That can be a problem, especially when interpreted too literally. For instance, I really need to spend some time resolving this snake handling business. The snakes are on my case big time."

"Well," God was obviously wrapping up the call, "It's been real, Boots. I hope you don't mind that I use the family nickname. I feel we've connected at a familial level, especially regarding the hair issue, which I fully understand. I think that you should re-evaluate the cause of the putting woes. Give my best to Mimi and the pets. Let's do this again."

Click.

I've decided not to take advantage of this communications coup by calling God weekly, although I do have many more questions. I don't want to be a pest. Even so, from time-to-time, I plan to ring God and schmooze a few minutes. When I do, I'll post a de-briefing on the blog and share it with my little corner of earth man and womankind.

Bruce

Observoid of the Day: You can watch yourself wink but you cannot watch yourself blink.

Cruel but Not Unusual

2009-04-20T12:36:00.000-04:00

The CIA and all Federal Law Enforcement agencies have been directed by the BHO administration to stop using Enhanced Interrogation Techniques (EIT) on detainees of all persuasions. O.K., but what is law enforcement to do when the "ticking time bomb" scenario eventually happens? Surely it will happen, won't it? It happens every week on "24" and life imitates art. If it didn't we would have no rational explanation for Paris Hilton.

I have some suggestions for Innovative Interrogation Techniques (IIT) to replace the discredited EITs. While none of my ideas have been vetted regarding legality, I have e-mailed these ideas to David Addington, John Yoo, Jay Bybee and Perry Mason for their expert legal opinions. Given their enthusiasm regarding EIT--with the possible exception of Mason, who I understand may be fictitious or possibly dead--I expect full approval for these new techniques.

INHUMANE CONFINEMENT. A suspected terrorist will be assigned to ride around in a four-year old Lexus 400 with a 45+ year-old real estate pro who frequently pops Tic-Tacs to ward off nicotine cravings, sports reading glasses (dangling handily from a beaded chain) and who applies great splashes of cologne each morning. The sole purpose of the activity will be to tour every foreclosed property taken back in the sub-prime mortgage meltdown. The real estate pro will refer to all foreclosed houses as either a "golden opportunity' or a "diamond in the rough" and remark that each would be "just marvelous for the suspect and all his wives". The constant search through the tiny MLS listings and treks through vacant McMansions will have no foreseeable end point nor goal; it will just be the shopping process including the relentlessly chirpy sales patter used to break down resistance. The confinement ends when valuable terrorist information is forthcoming or he agrees to buy one or more of the properties for cash, in which case the feds can then follow the money back to the terrorist's sleeper cell.

WAGNER BOARDING. The suspect will be placed, head down, on an incline board, wearing an After Six tuxedo--one size too small--with a terry towel placed comfortably across his eyes and mouth. Then, at reasonable decibels, the entire Richard "Dyck" Wagner catalog of operas will be played, from "Die Feen" through "Parsifal".The suspect will be allowed bathroom breaks but only between entire performances, the completions of which are signaled with an aria from a fat lady. As stated, the entire list of Wagner operas--most of which start with the words "Der", "Das" or "Die" as in "Die Hard", which, I'm advised, is not a Wagner product--will be presented and then repeated ad infinitum until sufficient information is forthcoming. There will be special emphasis on performances of "Das Liebesverbot" and "Die Valkure" as performed by the all volunteer Des Moines Civic Opera Company. Food will be provided by a Jewish deli but the suspect will have no choices from the menu and will dine on a constant parade of liverwurst, tongue and scrambled brain on rye sandwiches. This technique could prove to be the fastest method of information extraction as many suspects will likely break during the tux fitting.

FEAR OF FLYING. This particularly diabolic technique is also ironic, given terrorists' use of aircraft in their most deadly tactic. This technique requires (1) Three rows of five-across tourist class airline seats, all occupied. (2) The middle seat of the middle row is reserved for the suspect. (3) Two morbidly obese agents will occupy the seats on either side of the suspect and both will constantly nosh on highly seasoned sandwiches bought from airport vendors (the suspect will get airline food at odd times of the day and night, just as in actual air travel). (4) A 6'5" agent with chronic dandruff will occupy the seat directly in front of the suspect and the agent will keep his or her seat back fully reclined at all times. (5) In the seat directly behind the suspect, an agent will hold a squirmy three-year old on his or her lap; a child raised by the theory that any discipline will permanently scar the child's self esteem. The child will be allowed to scream incessantly, especially when the snippy flight attendants (once again, disguised agents) drop by to pacify the child with a nearly worthless plastic "Captain's Wings" pin. Repeated kicking of the back of the suspect's seat by the child will be discouraged, as suggested in the Geneva Conventions, but not prohibited. (6) Bathroom breaks will be allowed as needed but only when the "Fasten Seat Belt" sign is not illuminated and even then, there will always be a line. In keeping with routine airline policy, the "coach" suspect will not have access to the vacant Business Class lavatory. Estimates are that solid information will be obtained during the equivalent time it takes to fly from JFK to Heathrow.

These are three techniques that I have fully developed and should provide a solid platform for for effective interrogations. I am working on several others, still in their formative stages. These include: THE SENSELESS COMMUNICATION LOOP, involving customer service operators in Lahore and Mumbai, HOPE ABANDONMENT, simulating wait-times and staff interactions at the Department of Motor Vehicles and SOUL EROSION, a technique that creatively uses C-SPAN broadcasts.

Should you have a favorite Innovative Interrogation Technique, please send it and, if considered potentially effective, I will share it with my following of innocent readers and the appropriate authorities.

Bruce

Observoid of the Day: Never do it just for the money unless, of course, you really need the money.

On Being Brown Shoes

2009-04-15T13:05:00.000-04:00

"Did ya ever feel like the world was a tuxedo and you were a pair of brown shoes?"
Lonesome George Goebel

I'm feeling very brown. And scuffed too. My heels are worn and my soles have worrisome thin spots.

The world of technology is dressed for the gala but I'm still searching for some new laces, not those flat, fat cloth ones, but the ones that are sleek, waxed and round. Even if I find them, however, I'm still brown shoes.

My Internet marketing advisor has almost given up on me. He keeps trying to pull me through the magic looking glass into the world of the future, a world, he insists, that is already here. I've looked into that mirror but all I can see is my own rapidly deteriorating face and strange words such as "monetize", "hyperlink", "twitter", "intranetworked corporate conversations" and "de-cloaking". Do you want that "HTML, ASCII or PDF?" Actually, I wanted fries.

Monday, a storm took down a nearby tree and I was without power for seven hours. My dependence on technology was abundantly clear. Can you blame me for being cautious about digging further into this hole? Lucky for you eager readers, the power is restored but my confidence that I can tame the technology beast and ride it to riches is not.

In 2007 I wrote and recorded a professionally produced music CD. Friends and family did the honorable thing and bought some. Some went so far as to say, "Hey, this is pretty good." Bless you. All the same, I have a storage room with 700 more. I started with 1,000. Now, when service technicians, repairmen, delivery goons, etc. show up at the house to do their thing, I give them a CD instead of a cash tip. They are polite but they aren't effusive.

I tried selling the music on the Internet, using all of the hyped "this is the future of music industry" methods but to no avail. I had imagined that honky-tonky/folky/rock-a-billy songs by a Type-A, aging, white guy from the Midwest would sell like Preparation H at Daytona Bike Week. After all, if Jimmy Dale Gilmore can make a living writing and singing this low-rent stuff, I figured that there was room for at least one more nasally troubadour. Boy howdy-doody, was I mistaken.

(If you are thinking, "Hey, I should own some nasally and original Americana music by a guy who blogs," simply go to www.brucebrittain.com and carefully following the instructions on the "OnLine Store" page.) This has been a non-paid commercial announcement.

But wait, there's more.

In 2006 I wrote a book, Marriage Roulette, thinking that the American public was ready to hear--from a Type-A, aging, white guy from the Midwest--how to avoid marriages that end poorly, either in divorce, silent desperation or gun play. My only apparent credentials were to have experienced both types of marriages, one failed and one successful. I am not a psychologist, psychiatrist, marriage counselor, social worker, minister or self-ordained relationship expert from Marin County, California. Apparently, those are the only professionals who are suppose to write such books.

Instead, I was a concerned father and an experienced researcher who delved into the subject, I was also susceptible to the siren song of "You should write a book about it". The book has no psycho-babble because I'm not licensed to use it. It basically says, "Here are seven things that will make or break a relationship, try not to let the sex blind you to the other six." It's a very short book. Some of the handful of readers who bought the book have commented on its "common sense insights".

Word around the Internet was that publishing houses were so 20th century and that self-publishing was the new, new best way to go. Google word-search advertising would put my book in front of "millions of eyeballs" (that's a gruesome image, truth be told) and then several thousand of those eyeballs, apparently with heads, bodies and VISA cards attached, would flock to my title. What the flock? How come it didn't work? I can't 'splain it. Wish I could.

(If you are saying to yourself, "Hey now, I could use a primer on how to avoid another dirt bag," just visit www.marriageroulette.com and carefully follow the "Buy It Now" instructions to Amazon and throw one in the shopping cart.) This has been another non-paid commercial announcement.

With that experience in the rear-view mirror, I did what any slightly crazed person would do, I wrote another book. There's probably some medication that I should have been taking but the symptoms of madness are often confused with those of gastro-esophageal reflux.

This time, however, I was firm in my conviction to get an agent, who would find a publisher, who would secure Oprah and Dr. Phil appearances, which would secure my retirement and my place in the pantheon of successful writers. To date, I'm having problems with step one, finding an agent. The self-publishing promise is now playing faintly in the background as my Internet marketing advisor croons softly a tune of temptation. "No, no, I dassn't," I implore, but the flesh is weak, particularly that which is trapped inside my cranium.

The decision to self publish rests on the promise of technology, the same technology that has whopped me upside the head twice before; technology that is spiffy in its After Six tuxedo, chumming around with the likes of Mashable, Guy Kawasaki, LinkedIn, Facebook, Twitter, BookSurge and Kindle. Here I am, a pair of brown shoes who actually uses words like "spiffy". I could hope that technology smiles on me, asks me to dance and turns me into patent leather opera slippers, but hope is not a strategy.

Bruce

Observoid of the Day: That which hits the fan will not be evenly distributed.

Making a "Comment" Tip-o-the-Day

There is only one "Comment Box" and it is at the end of the first page of posts. Instead of scrolling through all of them to get to it, click on the icon at the end of any post (on which you wish to comment) that shows how many comments have been made about that post, even if it is "zero". The comment box should magically appear. If it doesn't, simply call our "We Care About You So Much That We Could Just Pinch Your Cheeks Helpline" and a friendly foreigner with a bizarre and manufactured Nebraska accent will be happy to confuse you further. Our helpline number is unlisted.

Seasonal Sports Dyslexia

2009-04-06T14:13:00.000-04:00

Finally, the NBA basketball season is over. No wait, that was college basketball ending on April 6. March Madness morphed into April Anxiety! The NBA will continue to play into June. After that, the league takes a month off so that the players can get additional tattoos and make their brief but required appearances at paternity hearings. Then, it's back to the hardwoods, an apt name, given this particularly fertile and randy group.

Baseball season officially launched April 5, although they were playing in snow flurries in Cincinnati and Chicago. Shouldn't basketball season be over if baseball has started? Or maybe baseball starts too early. The boys of summer begin in the snow and often end in the snow when the World Series is decided in late October. In the middle of the regular baseball season, late July, the NFL starts playing pre-season football games, shorty after the NBA finals are final and long before the World Series begins.

Hockey; when, exactly, does that season begin? Is it almost over, just getting underway or is it time for the Stanley Cup and who came up with the name "puck" anyway? Probably the same dofus who decided to call it "hockey" instead of "ice boxing".

Then, thanks to college football, side by side with news stories of the Sweet 16, tight NBA play-off races (which will decide the four NBA teams that WON"T be in the play-offs) and baseball opening day festivities, the media are also reporting on collegiate spring intra-squad football practices. In the south, one would suppose that these events were as important as NASCAR.

Of course there is year-round golf coverage because the PGA tour follows the weather; January in Hawaii, February in Arizona, March in Florida, April at the Masters, etc. However, the stories are short and don't require much reporting skill. "There was a tournament, Tiger won." Next story.

Soccer, don't get me started. School kids have summer soccer, fall soccer and then spring soccer. Who, except for recent immigrants, really knows when the pro season begins and ends. And another thing, either you are hurt or you are not hurt, which is it, Miguel?

Bowling is limited to winter coverage in the media but for all I know there's professional kegling year round. Certainly one can kegle for the sheer joy of it year round, although there's not as much joy now that bowling alleys are smoke-free. There were few satisfactions like that of picking up a 5-10 baby split and smugly walking back to the scoring table for a long pull on an unfiltered Pall Mall followed by a deep, phlegmy cough. Pure pleasure; but I, as I so often do, digress.

Of all of the major professional sports, I regularly follow only baseball and golf, although Tiger has taken some of the suspense out of golf by eliminating competitive tension. One of the reasons that I prefer baseball over basketball, football or soccer is baseball's absence of "stylin". You don't see baseball players doing their favorite disco moves after a home run or a spectacular defensive play. They act as if they have done it before, which they have.

In the NFL, NBA and MLS, fans are regularly subjected to physically robust but emotionally stunted men doing boogie-woogie dances, pulling jerseys over their heads, leaping chest-to-chest and strutting like a barnyard rooster over a fallen opponent. These antics occur after a participant does whatever it is that he is paid to do. Baseball players do not showboat for a simple reason: in the next inning or three, each player will have to stand in the batters box and face a pitcher who throws a very hard object 96 m.p.h. It's far better if the pitcher is not irritated with you. This fact breeds better manners and sportsmanship among baseball players.

As a registered fogey, I grew up playing sports where any show of "stylin" would get one yanked from the playing field or court by the coach for being an idiot and poor sport. In this same vein, baseball pitchers have always been the unofficial regulators of self-aggrandizing show offs. Even Neon Deon left his boogie in the clubhouse when he made his brief appearance in the major leagues. Neon was fast but he wasn't 96 m.p.h. fast.

While there are occasional fights in baseball (poor sportsmanship) there are far fewer than in hockey and far less damage is inflicted. Pay close attention to the rare baseball dust-up and you will notice that few punches land and that the scuffle involves more wrestling and dodging and no one brings a bat. If this were not the case, baseball players would look like splay-noses, gaped-toothed hockey players. The primary reason for the lack of sucker punches and cheap shots in baseball, once again, is the presence of and the players' ultimate appearance in, the batters box.

Professional baseball players play a game that children play and generally play it with the same patina of good sportsmanship, even if it is enforced by the unspoken rule of the high, tight fastball.

Perhaps a batters box should be on the football and soccer sidelines and court side at basketball games. If a player is called for "stylin", the penalty would be to stand in the box against Brad Lidge for four pitches. 'Tis a sweet thought.

Bruce

Observoid of the Day: Having a "Bad Hair Day" is a dream come true for a bald guy.

Babies That Go "BOOM"

2009-03-30T10:11:00.000-04:00

I'm only now beginning to understand why all Americans aren't running around with their hair on fire and screaming, "The baby boom is coming, the baby boom is coming, hide your money." Most simply don't accurately know what and who the baby boom is. Even the national press corps is somewhat cloudy on the issue. For instance, with the election of BHO, many in the media talked of the "new generation" taking the helm. Sorry press boys and girls but BHO is also (gasp!) a boomer.

BHO was born in 1961, making him three years older than the youngest of the baby boomers, those born in 1964. I am, my-own-wizened-self, very nearly the oldest of boomers, having been born in January of 1946, the first year of the post WW II birth boom (nothing like a defeat of fascism to get the old libido pumped up, eh?). Therefore, starting with "When in doubt, whip it out, Clinton", through "Don't misunderestimate me, Bush" and through "Hope is a strategy, BHO", whatever his tenure turns out to be, the country will experience 20 to 24 years of baby boomer administrative leadership.

When Sarah Palin becomes president in January of 2017 (visible shudder), THEN we will have passed the torch to the next generation. Of course, if the Terminator has successfully changed the Constitutional restrictions by then and becomes president, the baby boom, with a little help from hot Austrian loins, will continue its strangle-hold on the reins of power.

Suffice to say, the baby boom covers more chronological territory than most Americans understand, except demographers (a fun, fun group). A generation covers about 18 years, the time it takes for an infant to become old enough to start producing babies of his or her own. There are some fecund and formerly precocious older boomers who have children who are also boomers. Now that is profoundly weird.

When the concept of the baby boom is discussed today, many people think only of 60's Flower Children, Vietnam vets and Woodstock mud. True, but that is far too narrow a slice of the generation to get a real sense of dread for what the "aging of the baby boom" means to our country and its treasury. You may have noticed that our treasury is already under a bit of stress; it's been in all the papers (for those of you who read papers). As serious as it is, we ain't seen nothin' yet.

In exactly 20 years, the youngest boomers will celebrate their 65th and the oldest boomers will be 83. Even considering that some will have gone to their own Strawberry Fields Forever by then, the actuarial crowd (another fun party group) estimates that America will look like Florida does today, with every fourth person a qualified geezer at the public trough. If I take care, I'll be slopping there my-own-shrunken-self. Currently, it is only every eighth American who is old enough to slop.

The promises made by our elected officials since 1935 (Social Security) and 1965 (Medicare), to all those who have the foresight to reach the age of 65, are far beyond what the national pocketbook can afford, once the tsunami of boomers begins to muscle their way to the trough. The elected officials have known this for a long, long, long time but making more and bigger promises keeps them in office, the future be damned. (W gave us unfunded Medicare prescription drug coverage but McCain lost anyway, so sometimes the strategy fails.)

These entitlement chickens are coming home to roost and they are in a foul mood (I apologize for that one. No really, I do.)

Here's my reality. Only those of us in the baby boom can save America from the baby boom. We can do it through modest shared sacrifice by say, agreeing that some affluent portion of us could get by nicely on 95% of the Social Security that the fiscally irresponsible blowhards in Congress said that we were going to get. Bill Gates, Donald Trump and others of us don't need 100 cents on every dollar promised in order to live a comfortable retirement. If Bill, Don and I all kick and scream and demand our 100 cents on the dollar, then our children and grandchildren will see us for the navel gazing, greedy generation that we promised not to be back in our idealistic days.

Harder will be the changes necessary to shield America from the rampaging financial bull that Medicare/Medicaid are becoming. Make no mistake, these programs have many systemic problems that desperately need correction, fraud and financial abuse being prime examples. However, the programs actually work pretty well as a (sorta) single-payer health system for retirees and the destitute. The poisonous ingredient in the Medicare (and Medicaid) soup is health care cost inflation of 7% each year. If America doesn't finally address and solve our market-driven health care cost inflation challenge, Medicare and Medicaid will sink the ship of state. The solution that Washington has adopted to date is, "Quick, have the orchestra play something perky".

Solving the Medicare/Medicaid challenge means changing, and dramatically so, our health care system. That is what makes it difficult and a problem that all Americans, not just boomers, will have to approach while trying to ignore the screeching coming from the extreme ends of the political bell curve and those of the special interests groups. This is also why, in spite of doubters, BHO is keeping health care reform as part of the agenda in the midst of this financial crisis.

As a voting block of 77 million, baby boomers hold the key. United, we can prove ourselves a great generation, not just a great big generation. Divided, however, our ability to secure the fiscal future of the country vanishes in opposing ideologies. We've already tried it that way and it has brought us to a perilous place.

Have two epiphanies and call me in the morning.

Bruce

Observoid of the Day: Always keep your fork, there may be pie.

Torches and Pitchforks

2009-03-20T10:20:00.000-04:00

It's getting ugly out here. The very mention of A.I.G. or Timothy Geithner can cause normally mellow folk to begin frothing. In fact, some folks remain in a constant state of froth, e.g. Barney Frank and other lesser known bulbs in the House of Representatives. (You would think, Barney being openly gay and all, that he would be a snappier dresser but the constant frothing does go well with the rumpled appearance.)

I recently read an "outraged, outraged, I tell you," essay by no less a financial maven than the ever-popular and ever-present Jesse Jackson. Try this yourself: stand on your front lawn and whisper "social injustice" into the wind and chances are that within 24 hours, Jesse will be at your home with an entire cadre of indignant, placard-bearing and out-of-work protesters eager to shout slogans for your cause. Now, what was your cause, exactly? Can we create a brief chant with hackneyed rhymes?

Anyway, Jesse was predictably railing about the way A.I.G. shoveled taxpayer money out the door to such scumbags as Goldman Sachs, Citibank, Deutsche Bank of Germany, (Germany for chrissakes!) et al. He referred to this process as "injury" to which A.I.G. then added "insult" by paying $165 million in bonuses to its own employees.

The populists and their mob of followers have swooped in and are pulling the guillotine out of storage. Similar to the French experience of the eighteenth century, when heads begin to roll, the crowd gets less and less discriminating about whose heads, as long as the show goes on. If he wasn't currently dead and headless, you could ask Robespierre about the way that these mobs eventually eat their own.

Excuse me while I clean the spittle from my keyboard. All this talk of railing, raging and indignation has created quite a lather. There, I've calmed a bit.

I wasn't sure who Jesse thought that A.I.G. should pay the bailout money to if it wasn't to the firms to whom it owed the money. I soon learned.

Believe me, I am not defending A.I.G.'s business model, wherein they created unfunded insurance products and called them "Credit Default Swaps" so that they could avoid the established rules of insurance regulation. Anyway, they did, sold barrels of them to Goldman Sachs, Citi, Deutsche Bank, et al, all while the regulators shuffled papers for several years. Well, when the credits "defaulted", A.I.G. owed these bank customers barrels of settlement money. Because they hadn't established a fund to pay off claims (as legit insurers are required to do), A.I.G. was in deep doo-doo (a technical financial term, that). And, because the banks had bought these swaps to protect themselves from the eventuality of credits defaulting, they were getting no money from defaulting borrowers nor money from A.I.G. to cover the losses. Deeper doo-doo.

Timothy Geithner to the rescue with $170 billion for A.I.G. Now, A.I.G. may well be run and overrun with avaricious, scheming, soulless jerks but, by law--you remember the law--they were required to use the money to pay their obligations. I hope that they negotiated some cents-on-the-dollar deal but I know nothing about the terms. Their obligations were owed to the banks that bought the credit default swaps.

Jesse apparently thinks that A.I.G. should have taken the $170 billion, ignored the law and used the funds to pay off student loans. Actually, he says, the government should never have given A.I.G. money in the first place and instead, just wipe student loan debt off of the books as an "investment in our future". No doubt, the Rainbow/PUSH Coalition will print up bumper stickers, "Students Don't Pay and Save the Day."

Addressing student loan issues is a worthy endeavor; I know because my oldest is a struggling surgery resident with a whopping student loan debt clouding his future. However, Jesse's solution is the same as pouring money into more firefighter training when the house is ablaze.

Here's a handy tip: If a solution to the current international financial crisis can be put on a bumper sticker it is not the solution. The populist mob may think so, may give a "thumbs up" as they pass by on their way to the next beheading, but they'll be wrong. In this instance, solving the current banking crisis has nothing to do with solving student loan issues.

As for the $165 million in A.I.G. bonus money, which is .001 percent rounding error of the $170 billion in taxpayer money that A.I.G. has sucked up, it's a public relations disaster but it has also created a populists legislative reaction that is way over the stupid line.

There are thousands of bank employees in the tub of TARP bathwater, a very tiny percent of whom had any hand in creating sub-prime loans, derivatives based on securitized debt, credit default swaps, and all the other creative products that built the house of sticks that is now burning brightly. Even so, blustery Barney and a whole posse of do-righters wants legislation to impose a 90% tax on bonuses of employees of any institution that was asked by the government to take TARP money. The populist solution is this: the greedy bastards are in there somewhere, throw out the entire tub.

There will be some game-changing unintended consequences if this legislation passes and unfairly punishes thousands of hard working financial executives whose primary reward for their long hours and honest effort is a lump of coal. These folks vote and so do their families and friends. I have first-hand knowledge of this issue, up close and very personal (by way of full disclosure).

For those readers who have already decided that the only good banking executive is a headless banking executive, I challenge you to a spit-wad duel at ten paces--make that eight paces--and bring your own drinking straw and spit-wads. The first one to lose temporary vision in one eye, loses.

Bruce

Observoid of the Day: It's really strange that flammable and inflammable mean the same thing.

Health Insurance Paradox

2009-03-18T11:26:00.000-04:00

After I posted "Free Market Viagra" in early March, a concerned reader commented publicly that I had my "free market" definition wrong. She noted that between government regulation, federal and state spending for Medicare, Medicaid and other discretionary health care outlays that we (Americans) "...in no way whatsoever, have a free market health care system". We can't both be right.

My understanding is this: who the payers are is immaterial to defining a free market. Neither does regulation necessarily indicate that a market is not operating as a "free" market. Case in point; the government pays for all military hardware, is very specific about what it wants, regulates the process and then spends billions in the free market. This is why Boeing and Northrop Grumman have sales guys who treat generals to golf outings.

In our free market health care system we have providers who decide what to offer, where to offer it, how much to charge and to whom to offer it. This explains why the big drug companies spend more on marketing of erectile dysfunction drugs than they do on Alzheimer Syndrome research. From the drug manufacturers' standpoint, it's better for the stockholders if the manufacturers insure that Grampy can get a woodie than it is to insure that he can remember with whom he is sleeping. Some would argue that this is an odd decision. Not really; it is a free market decision, the gummit doesn't mandate it.

I'll save the rest of my big pharma comments for a subsequent posting. Let's turn our collective attention to the 800 pound turd in the punchbowl, which has cleverly disguised itself as a gorilla, the great American, for profit, private health insurance industry.

Lest you think that I am an unreconstructed insurance scold, let me set the record straight; some of my friends are in the insurance game and they are--with one or two exceptions--reliable, upstanding people. My very own father is still plugging away at making sure that people have the life and property coverage that they need. At nearly 90 years old, we thought that he would have left this challenge to others by now, but, noooooo. Do not let him corner you at a cocktail party.

However, there's insurance and then, there's insurance.

Life insurance is pretty straight forward, either you are or are not dead, except for Jimmy Hoffa, Keith Richards or Senator Robert Byrd. They are considered outliers. Property and casualty insurance is somewhat more subjective, to whit: the water damage was caused by flooding and not a burst pipe so there is (or isn't) coverage.

Health insurance, however, is just chock-full of subjective, market-driven decisions before payment is made.

The first free market decision is whether or not to insure at all. Pre-existing medical conditions usually doom an applicant. After all, insurers want healthy health insurance customers. In a free market system this makes sense. Of course this system creates a pool of uninsured citizens, many of whom could afford the premiums and who are, via poor decisions or bad luck, the most likely to need health care. When these citizens finally show up at the emergency room, society pays for their care one way or another. The insurance companies have no skin in this payment game because providing sick folks with coverage is bad business.

If one has health insurance, the free market subjectivity issue does not go away, however. The insurance company will subjectively decide one or all of the following: which physician(s) can be visited, which treatments are covered, which drugs can be used, how long the treatment will last and what are the "normal and customary charges" on which they will base their eventual payment. You can be sure that each decision is carefully vetted on how it will impact the company's profits.

Unlike death and property damage, the range of subjectivity surrounding health care insurance coverage is the main ingredient in the industry's business model. The less they pay, the more they profit. Therein is the consumer's paradox. The insurance companies have legions of employees whose job it is to review claims and find ways to deny them. They also negotiate with the providers to secure cheaper rates, yet our national health care costs escalate about 7% each year. So much for that cost control strategy.

Besides, the insurance industry simply raises its premiums to match the health care cost increases and concentrates on keeping its percentage of the total payment low. The patients or the taxpayers pick up the rest.

The George W. Bush administration introduced private health care insurance into the Medicare system in order that "...competition among private insurance providers would drive costs down", you know, the free market promise. The Medicare Advantage program, which Prez BHO is now trying to dismantle, costs Medicare 13% MORE than what it pays for retirees who chose to stay with straight Medicare. There are no differences in medical outcomes between those who opted for Medicare Advantage and those who didn't. There was one "advantage", alright; the private health insurers made more money. The downside is that we, via the gummit, spent more for Medicare. Oops, and a tip-o-the-hat to W from the health insurance poobahs.

To conclude today's post--but leaving many threads still dangling to be discussed and trimmed later--it's instructive to note the following: in the entire developed world, it is only in America that the loss of a job often means the loss of medical insurance coverage and only in America does a major medical event, insured or not, often lead to personal bankruptcy.

Neither of these facts is acceptable unless you believe that access to health care is a privilege not a right. If you are in that camp--populated primarily by healthy people who have subsidized health care coverage, are independently wealthy through their own efforts or who won the "lucky sperm contest"--please refrain from trying to convert me.

Bruce

Observoid of the day: No one ever talks about Custer's next to last stand.

The American Wet Dream

2009-03-05T18:27:00.001-05:00

By the time I bought my first house in 1973, I was a college grad, had just spent three years as an Army officer, had a full-time job, had a growing family and was attending graduate school. Even so, some would say that what I knew about buying a house and getting a mortgage was "diddly". Others might say that I didn't know "squat". So, in an effort to please all, let's just say that I didn't know diddly-squat. The process was quite scary and the real estate agent and mortgage broker led me around, had me sign things, patted me reassuringly and told me that everything was "going to be all right". Three years later I sold house number one and bought house number two. I wasn't much sharper on the mortgage issues the second time around. Terms like "equity", "bridge loan", "mortgage insurance" and "title deed" would bring a slightly dazed look into my incredibly limpid blue eyes.

By the time I moved to the deep south and bought house number three I should have been a real pro. Need I say, "not so", or was the set-up too transparent? The house I bought was brand new. The builder had been sitting on the house for so long that he was preparing to move into it. In spite of that, the real estate agent convinced me that on "new construction it was inappropriate to make an offer lower than the asking price". And so it went.

When it came to buying the American dream, I remained as ignorant as a bag of hammers for quite some time. The real estate professionals and mortgage brokers were the "experts", they had the knowledge and experience. I took their advice because it seemed like the right thing to do. I've since learned somewhat better, regarding mortgages. However, I'd bet that some shark could still talk me into something unwise, unless, of course, my wife was there, in which case she would gut 'em like a carp and throw the chum to the other sharks.

In recent days I have seen the video of the CNBC meat puppet, Rick Santelli, do his outraged riff on "responsible taxpayers forced to subsidize losers' mortgages" and asking, theatrically, a room of Chicago stock traders whether they wanted to "pay their neighbors mortgage" (the answer was a mob-rule, "NO"). I have also received a number of e-mail jokes and comments indicating that the sub-prime mortgage debacle and subsequent world-wide financial meltdown can be blamed almost entirely on the overreaching, conniving, greedy and scheming homeowners, Santelli's "losers".

This viewpoint implies that nearly everyone who received a sub-prime mortgage--and subsequently found themselves underwater on their American dream--completely understood what they were doing. In fact, these messages and jokes imply that these borrowers were at least mildly larcenous or just incredibly stupid and stupid doesn't deserve a break.

With several million homeowners already booted out of homes for non-payment and millions more now facing foreclosure, there's little doubt that some of them were and are larcenous. The great majority, however, were simply ignorant as a box of dirt and, just as I did (three times), took the word of the real estate agent and mortgage broker (probably a former pizza delivery guy who bought two cheap suits at The Men's WearHouse and presto). Those "experts" told the buyers that everything "will be all right; sign here".

Assured by these experts that the American dream was now within their reach because of "new mortgage products", never mind the niggling details of equity, balloon payments, the LIBOR rate tied to adjustable interest rates, flapperschnapple, quirkenblanks, prasquattle, blah, blah, blah and then, "the house can be yours, sign here." Where's my pen?

Before you sit down with venom in your heart and fire in your fingers to write me, let me assure you that I do not hold these homeowners blameless. Most of these homeowners were ignorant and that is a fault that can be cured. I was ignorant about the mysteries of mortgages some time ago, but, and you will have to trust me on this, I wasn' t larcenous. Those of you without faults of ignorance about something in life please report to the Vatican.

Millions of potential homeowners were manipulated; O.K., O.K., let themselves be manipulated. Their desire for owning their home was stronger than their ability to overcome ignorance. My perspective is this: the manipulators shoulder far more of the blame than the manipulated. The manipulators weren't ignorant, they knew what was what.

Frankly--and I'm sure you all remember Frank--the mortgage brokers, the real estate agents, the mortgage companies and most of the the banks with mortgage divisions were themselves ignorant of the risks associated with sub-prime lending. Most of these people did not really understand the complex new derivatives that gave rise to sub-prime mortgage lending. Their collective fault was in not raising a hand, at the risk of embarrassment, and saying, "Wait a second, I don't understand this, please 'splain it to me." There was money to be made, Wall Street's quarterly expectations to be met, the risk was being passed on and the gravy train was leaving the station. All aboard.

There is much blame to parcel out. To conclude, however, that the bulk of it should be given to those least able to sort through the tangle of terms, promises and nuances is a very cheap shot, especially when it was the carrot of the American dream that was dangled before the wide eyes at the bottom end of the mortgage food chain. It's like blaming over-fishing on the fish.

So, who, you ask, should shoulder the bulk of the blame? Wall Street; a place where the moral compass is unusually wobbly thanks to the pull of money being stronger than magnetic north.

Some whiz with a math degree, a computer model and no experience in mortgage lending came up with a way to "securitize" (combine) mortgage debt and, mathematically, "take the risk out of it". Ha! That's like saying that you can mix a bit of fecal matter with a larger amount of clean water and it all magically becomes clean water. Also, the model only worked when housing values climbed INDEFINITELY or at least until the January bonuses were paid, whichever came first. The math whiz's boss knew that the model was shaky, but what the hey, bonus time was just around the corner. With the "no risk" mentality driving the industry, lots of folks who couldn't really afford the American dream were convinced that they could. After all, there was money to be made and the gravy train was constantly leaving the station. So, fog up a mirror, here's your loan. Everything will be "all right"; pat, pat.

Then, to cover their bonus larded butts, the Wall Street bosses sent out linguistically double jointed sales folks and they sold these "safe, mortgage backed, AAA rated securities" to town councils, retirement funds and other entities around the world. The rating agencies were in on the deal. The gravy train had room for them too. "Stringent regulation," said the bright bulbs in Washington, would strangle the economy and besides, everyone is entitled to own their own home. And so, lax regulation was the order of the decade leading up to the bubble pop.

When you assign blame for the current sorry state of the economy, I suggest that you parcel it out with some semblance of fairness. In my opinion, the great bulk of the homeowners who are in trouble and now need help are the least at fault, not blameless, but not the drivers. They had no idea that the American dream was (supposedly) within their reach until somebody, only marginally less ignorant, came along and convinced them so. The town councils also made their investment decisions based on trust. If you can't trust anyone, life is nearly unliveable.

If you have hard data that proves that a majority (or even a plurality; heck, I'd settle for anything above 10%) of the defaulted and defaulting homeowners in America are larcenous and cunningly taking advantage of those civic-minded paragons on the southern tip of Manhattan, please forward it to me. If the data are convincing I'll write a corrective blog. It's the least I could do.

Bruce

Observoid of the day: A bag of hammers and a box of dirt are equally ignorant. Neither, however, is as ignorant as a carton of sludge.

Free Market Viagra

2009-03-03T14:39:00.001-05:00

The healthcare reform debate is officially enjoined, now that Prez BHO has unveiled the new budget. Actually, the term "debate" is probably inaccurate because "debate" indicates patiently listening to the opposition and then calmly re-butting those points that seem most vulnerable. In debate, the exchange of facts is mixed with thoughtful opinion in order to reach, if not consensus, at least compromise. Our current cultural and media propensity is to ignore the rules of debate and simply yell at each other in what I call the Jerry Springer model of communication. We're due for a whole boatload of this competitive yelling over healthcare reform.

Already, we are hearing from such experts as Rush Limbaugh that BHO wants our healthcare turned over to "nanny state" bureaucrats and that the relationship between physicians and patients will soon be controlled by the government. Rush is on record as wanting Obama to fail. Oh, Momma! The gasbags on FOX relentlessly talk of "socialized medicine", as if they really knew what that meant, and that if BHO gets his way that we will get healthcare from the same slugs who inhabit the postal service and the IRS. Unless one parses and shines a light on all of this scary rhetoric, the warnings from the extreme right--you know, the kooks who insist that Governor Bobby Jindal's "Republican Reply" speech was a lollapalooza, whizbang homerun instead of an eighth-grade level presentation on "Why I Want to be a Politician" that it was--you could get the wrong impression of where the country is likely headed regarding healthcare. I encourage you not to swallow the extreme left's version either. They may believe it perfectible, but a healthcare system serving over 300 million people and run by humans will never be perfect and there will still be plenty to bitch about at the water cooler.

Speaking of Bobby Jindal, one would think, given his south Asian lineage, that when he changed his name to Bobby, which he did some years ago, that he would have opted for the "Bobbi" version with a tip-o-the-political-hat to Ghandi. But I, as I often do, digress.

America has, by very far, the most expensive healthcare system in the world. If you think that it is also the best and most efficient, you have dipped into the magic kool-aide. Our totally free-market system has brought America to a point where, for every man, woman, boy and girl we spend about $7,200 every year for healthcare. When I say "we" I include, patient out-of-pocket, insurance payments, government payments and borrowed payments. Given that the insurance money, government money and borrowed money originally came out of or will come out of the consumer's pocket, the annual $2.4 trillion bill for healthcare is consumer money.

With all of this spending, however, the World Health Organization (WHO) ranks the U.S. well down the list of countries whose healthcare systems provide the best outcomes. America ranks 37th out of 191 countries measured. Our infant mortality rate is the same as Slovakia and Poland and lags behind Cuba. As for "unneccessary deaths", a category for which the WHO (the organization, not the band) measured 19 countries, the U.S. is, pardon the pun, dead last.

Instead of being outraged by these facts, the Republican base insists that the solution is to let the free markets work without government intervention. There is one glaring error to this logic: America has reached our sorry state of expensive and inefficient healthcare solely through the magic of the free-market system. Why in the world, if the free market caused the problem, would the free market fix it, Bruce asks, rhetorically?

Here's the long answer: it won't.

In the book that I have just written, The Baby Boom Delusion, a book that still needs a literary agent and a publisher lest it become a 251 page doorstop, I have a section that deals with this very problem. I posit the following: healthcare is a right, not a privilege, in much the same way that our national defense is a right or the use of the national highway system is a right and not based on privilege. If you don't agree with my position then you probably have health insurance and haven't experienced too much friction with the various systems that make up the industry.

Imagine, if you can, what our national highway system--roads, bridges, tunnels, et al--would look like if we let it be planned, delivered and maintained solely by the free-market profit motive. The "empty quandrant" of the great plains and mountain west would have very few highways and the ones that were there would be very expensive to use because a for-profit road system would be pay-as-you-go. On the plus side, no federal gasoline tax. Roads between small towns or far-flung tourist destinations would also be quite pricey. On the other hand, along the northeast corridor, the population centers of California, the industrial north and the Sunbelt, the number of roads, bridges and tunnels would spread, toll plazas would increase to capture revenue every few miles. Price competition and poor planning would mean that some infrastructure would fall into disrepair and be abandoned. "I get my kicks on Route 66....oops, big chunks of that are gone. Never mind." Those without much money couldn't use the road system unless those with money stooped to subsidize the poor, unfortunate traveler, all the while grumbling, "They should have made better choices". Finally, the impact on the nation's economy of a road system organized, run and maintained in a strictly for-profit environment would likely be a disaster.

Of course the national highway system still makes many companies bunches of money in a free-market way. The road designers get paid, the road builders get paid, the asphalt, rock and sand suppliers get paid, the equipment manufacturers get paid, etc. etc. There is plenty of free-market competition. The one area where we eliminate the free-market is in the pooling of taxpayer money to pay for and plan where the roads ought to go for the benefit of all. It ain't perfect but it works pretty well.

Back to healthcare. If the biggest things we do to re-design healthcare are to (1) make sure that everyone takes part and (2) to centralize the planning and payment, there is still a ton of free-market activity remaining in the system. It would certainly be a long-long way from the British model of "socialized medicine" where the whole shebang is owned by the government (even so, the Brits are ahead of us in the WHO rating). U.S. docs would still be for-profit, as would the clinics and hospitals, medical equipment would still be produced in the private sector, big pharma would still be for-profit and so on. The nanny state would then be "running" healthcare in much the same way that it passively "runs" the highway system day-to-day. The government does not decide where you go on the highway system, nor when; you do. I contend that this would be a good thing in healthcare as well and for much the same reasons.

I have much more to cover on this topic but you will have to wait with bated breath until subsequent blogs. Until then, suck on a breath mint.

Bruce

Observoid of the day: The "young and ignorant" have a shot at becoming the "old and wise". The "young and stupid" merely become the "old and stupid".

The Political Bell Curve

2009-02-25T14:43:00.001-05:00

Our new prez is reaching "across the aisle", as the pundits say, and trying to close the breach that has plagued American politics since Jefferson and Adams hired PR hacks to lie about one another in an effort to become President Number Two. Adams, apparently, was the more successful smearer, although Jefferson returned the favor the next election cycle to become Three. Political snarling has a lengthy pedigree and there really weren't many (if any) good old days when the two parties put their collective shoulders to the ground and noses to the wheel, an activity that makes for some really hideous noses, and created legislation that was supported by all involved.

Obama seems intent--and I wish him success--but, as a long-time realist and recovering cynic, I doubt that there will be any dramatic shift in the comity quotient inside the D.C. echo chamber.

I have a pet theory or three about why the current snarling seems so widespread and constant. Would you like to know what they are? No? Too bad because I'm going to trot them out for inspection anyway.

First, in the past 30 years or so, the size of political staffs in Washington has exploded. These folks write the legislation, deal with the lobbyists who help write the legislation, write position papers and speeches that the lawmakers present as their very own. Often, a legislator doesn't know what his or her position is until the staff decides. In the case of Robert Byrd of West Virginia, he doesn't know what year it is or if he is still breathing without staff confirmation.

Once was, lawmakers actually took a significant role in the law creation and policy development processes but now they are consumed with raising money for the next election and don't have the time. Young staffers (and they are mostly young, energetic and ideological) do not have to stand for election and therefore can carve out, with impunity, some radical positions for the boss to take. Given that the boss doesn't really have time to think deeply and often about anything but fund-raisers and donors, the ideological lines in the sand, from left to right, get further and further apart.

The second theory deals with just the House of Representatives. Both Republicans and Democrats are in on this one and it's called "redistricting". You may recall in 2003 when all the Democrats in the Texas Legislature hid out in New Mexico and Oklahoma trying to avoid a legislative quorum that would have led (which it eventually did) to a vote to redistrict Texas in such a manner that there would be a majority of Congressional districts that were solidly Republican. See, the district lines get re-drawn based on polling place and census data to make the district a "safe" one for whichever party is re-drawing the lines. This is also known as the gerrymander, after the fictional critter of indeterminate shape that describes the new, often odd-looking district. How, you may ask, does this contribute to politicians in Washington who barely speak to one another? Well, thanks for asking.

In a safe district the general election is a foregone conclusion, that's what makes it "safe". Therefore, the real drama takes place in the primary election, among the candidates from the party that created the district. If you are a Democratic primary candidate in a liberal safe district, you had best be REALLY liberal otherwise the "base" of your party will look on your more liberal opponent with favor. When pundits talk about the "base" of either party, you can substitute the word "kook" and find that they are synonymous.

In a :safe district" primary, the only voters who count are the ones from the party that owns the district. A voter from the minority party is just voting so that he or she can get one of those little "I voted" sticky thingies. Their candidate has no chance in the general election but the voter will get yet another little sticky thingy. Therefore the majority candidate who makes it to the general election has had to appeal to his or her "base", make some odious promises to same and sell their soul to these devils, if they weren't already a kook themselves. This is how people like Cynthia McKinney and Tom DeLay end up in Washington talking past each other. With great relief I can report that both of these politicians are gone from D.C. now (interestingly, McKinney rose up from ignominy to run for president this last election on the Green Party ticket and was trounced rather soundly by a young, semi-black man from Chicago). However, Cynthia and Tom's replacements in the House are products of the same rigged system.

Finally, there is the wonder of talk radio, the perfect media outlet for bloviators from either kooky end of the political Bell curve. The conservatives have really co-opted this forum because the kookiest of the liberals aren't much good at it. Besides, as almost everyone seems to believe, without any reliable imperical evidence to prove it, the main-stream media are all the lap dogs for the liberals and the scales weren't fairly balanced until Sean Hannity, et al, came along.

Well, apparently, even some conservatives are now questioning conservative talk radio's real contribution to the party's appeal beyond the kooks...I'm sorry, base. In fact, one of my favorites, John Derbyshire, posits in the American Conservative Magazine that conservative talk radio is counter-productive to growing the Republican Party back to a position of relevance.

I suggest that you give it a glance: http://www.amconmag.com/article/2009/feb/23/00006/

Bruce

Observoid of the Day:
You can point something out to a dog but the dog will just stare at your finger.

Pennies From Heaven

2009-02-19T12:44:00.000-05:00

In honor of Abe Lincoln's 200th birthday, the U.S. Treasury has created four new designs, seen here, for our most beloved but perhaps most useless coin, the penny. I recently received a forwarded e-mail narrative (misspellings, poor grammar and all) from a friend about these new designs. My friend did not write the narrative below but forwarded it to me.

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THIS IS WHAT OUR NEW PENNIES WILL LOOK LIKE.
THANKS TO THE ACLU AND OTHER SIMILAR GROUPS THE WORDS "IN GOD WE TRUST" HAVE BEEN REMOVED.
WHEN ARE WE AS AMERICANS, GOING TO SAY ENOUGH IS ENOUGH AND STOP BOWING DOWN TO THOSE THAT TAKE OUR BELIEFS AND RIGHTS AWAY FROM US?
IF WE DON'T ACT SOON THEY WILL HAVE THE WORD "GOD" COMPLETELY ELIMINATED FROM OUR LANGUGE.
THEY'VE ALREADY STOPPED SCHOOL PRAYER, PRAYER AT SPORTING EVENTS AND NOW FROM OUR CURRENCY.
WHAT'S NEXT? WILL THEY OUTLAW PRAYER IN CHURCH?
WILL THEY OUTLAW THE SELL OF BIBLES?
TIME TO SPEAK UP BEFORE THE THE BELIEFS OF A FEW BECOME THE LAW.

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Indeed! I too am outraged, albeit for a completely different reason than that of the creator of this particular bit of paranoid bile.

But first, the fact. Yes, the penny is being re-designed but only the "tails side" not the "heads" side. "Heads" will still have the "In God We Trust" motto arching above Abe's profile, gigantic mole and all. This was not difficult to verify. Simply search "new penny" on the search engine of choice and there it is. Even FOX News got it right.

So, how does such a piece of misinformation, with its overt claim that the ACLU and "other similar groups" have secretly hatched an evil plot to erase God from the public domain, one penny at a time--with the apparent cooperation of the U.S. Treasury to boot--make it to my in-box and to tens of thousands of other in-boxes around the net?

Initially, someone had to write the crappola, although they could have made better use of their spell check software. The author could be (1) supremely ignorant and paranoid, (2) having a bit of fun at the expense of the supremely ignorant and paranoid or (3) intent on spreading divisive misinformation in an attempt to rally the supremely ignorant and paranoid to some cause, apparently which is to "speak up". Of course, speaking up on the penny issue would simply open one up to embarrassment sort of like Rosanne Roseannadanna. I'd advise against it.

Here's the issue that has my dander up--which begs the question, what the heck is a "dander" and why do we prefer to have it "down" instead of "up"?--I digress; someone who I know, someone who has made it onto my distribution list of e-mail contacts and friends, forwarded this bit of blather to me in an apparent and earnest attempt to recruit me to the speak up against the new penny design. Me!

No, I'm not an offended member of the ACLU, although that organization does some very worthwhile things while at the same time doing and saying some really silly things. Go figure. Neither do I object to the motto "In God We Trust" on our lucre, although, historically speaking, it is a rather recent addition to which Teddy Roosevelt objected strenuously but to no avail.

The reason that I received it was because the sender likely sent it to his or her entire contact list--10 others, 20 others, 50 others, more? Who knows? Certainly not all of the recipients of this one forward did likewise (I, for instance, forwarded it to no one) but there's a good chance that more than one recipient did and so on and so on. This stuff grows like mold in a bachelor's refrigerator.

The internet has put the power of communication in the hands of nearly all. This is a good thing with a dark side. The paranoid, the ignorant, the stupid, the crazed, the mean-spirited, the radical left, the unbending right and the merely careless now have much the same megaphone power as that formerly reserved for people who bought ink by the barrel or had access to the airways. We have more communication now--often better communication--but also mounds of bullshit.

I have no illusions that the B.S. will ever go away. My hope, however, is that the "merely careless" among us will begin to realize that forwarding unattributed, unverified and scurrilous information is an activity--and all too easy at that--that does not advance the common good and often retards it. If we are all to be "journalists" with the click of the "Send" key, then we have an obligation to our friends and contacts to send them information, not misinformation. For you readers who are paranoid, ignorant, stupid, crazed, mean-spirited, radically left or unbending right, and you know who you are you little dickenses (is that a word?) this admonition from Mother Brittain will likely go unheeded.

This rant does not condemn the forwarding of satire, The Onion headlines and newscasts, jokes (although some of my contacts are good taste challenged), videos of interest, family gossip that we all knew was true long before we heard it officially from a reliable cousin, interesting pictures (preferably undoctored but who can tell anymore?), irritating editorials from Paul Krugman or John Krauthammer or official notification that the sky is falling.

Bruce

www.brucebrittain.com

Trillions and Trillions Adds Up

2009-02-11T10:16:00.000-05:00

There is real freedom in creating one's own blog. Foremost is the absence of those pesky "fact checkers", the busybodies employed by most magazines and newspapers to verify, well, facts. In a blog, one has the option of verifying the facts ones-own-self or--and this is much, much faster--simply making stuff up. What you are about to read has been personally fact-checked by the author. This practice is known in the publishing field as "on the author" which indicates that the writer takes responsibility. If there is to be legal action, his or her buns are on the line.

Yesterday, our newest Secretary of the Treasury, Timothy Geithner (his mother calls him Snooky) came before the Senate Finance Committee, an assemblage of Senators who pretend to fully understand "finance" (and in the case of their re-election campaign war chests, they do) to explain the administration's bailout plan for the nation's ailing financial industry. Apparently, the whole show didn't go that well and the Dow Jones indicator took a nearly 400 point beating, especially the bank stocks. My bet is that Snooky found this outcome problematic and called his mother for advice. "Old Lady Geithner" (albeit she was only in her 30's at the time) was the long-time treasurer of P.S. 419 PTA during much of 70's and the books always balanced under her watch.

In any case, much of the discussion in the Senate hearing involved how many "trillions of dollars" would be involved in righting our listing financial ship. Over the past several months the media have been tossing around the term "trillion" with, dare I say, abandon, without providing the average Joe the Plumber (who now has a national speaking tour contract, a fact that I find extremely disturbing) with context or perspective. I'm here to help.

A trillion: a 1 followed by 12 zeros plus four commas. 1,000,000,000,000. If you really want to get a banker's attention, place a dollar sign before the 1. Still, even in this stark numeric presentation, a trillion is an abstraction. What you need is a concrete illustration. Okey dokey.

The average pubic hair is 60 microns in diameter. Not all pubic hairs are created equal, with fine blond hair being somewhat smaller and coarse dark hair larger. For reasons that I will explain directly, I shall use the worldwide average. Picturing exactly how science developed this average gives me a slight case of the shudders. Now, were we to lay 1 trillion pubic hairs cheek by jowl, that is to say side-by-side not end-to-end, and assuming that they have cheeks and jowls (at this small size it's very hard to tell) this collection would extend from the earth to the moon and then nearly half way back. This thin mat of pubic hair could act as a route map for future moon exploration although they will not want to get too close because the hairs would likely scatter quite easily, even in the vacuum of space.

Collecting 1 trillion pubic hairs might prove more interesting than actually figuring out how to arrange them side-by-side and extending them into space. Both endeavors, however, would require a very large workforce, a fact with implications for the "creating jobs" part of the Stimulus Package, yet another trillion dollar government project. Given the total population of the earth, factoring out those who have no pubic hair, the very young (not yet) and the very old (not anymore), the trillion hair collection would certainly have a wide range of hair type, from extremely fine (think Gwyneth Paltrow) to quite coarse (think Whoopie Goldberg) which leaves me comfortable with my calculation's 60 micron average.

If one didn't want to bother with the difficulties of space placement, 1 trillion pubic hairs could be laid (lain?) side-by-side in 150 rows between Atlanta, Georgia and Birmingham, Alabama. Then again, what with earth's atmosphere, air currents and tens of thousand of all terrain vehicle enthusiasts between the two cities, maintaining an accurate count could prove difficult. Better, I think, to simply imagine the illustration, although that would have no impact on the jobs front (for those of you considering a "public pubic hair collector's" spot on the government payroll).

Nearly suffice to say that most of us have a tenuous grasp on the true magnitude of 1 trillion. I say "nearly" because there is one additional example that really brings it home. In the vein of several illustrations that I have read recently regarding time equivalents of a mere 1 billion, e.g., "1 billion seconds ago, Jimmy Carter became president in 1977", let me use a time yardstick to capture 1 trillion, which is one thousand billion or 32,000 years before anyone had heard of the peanut farmer from Georgia. Here we go.

One trillion nanoseconds ago it was 16.6 MINUTES AGO. Your lukewarm coffee was piping hot back then. Just over a quarter of an hour ago you were doing something productive instead of reading this and then "Wham", a trillion nanoseconds whizzed by. Did you put them to good use? Hardly. You were thinking about collecting pubic hairs off of bars of soap or perhaps plucking them a few at a time from Gwyneth Paltrow, an activity that some critics would say was appropriate payback considering some of her work. Some of you were likely thinking of other fantasy celebrity donors, although very few probably recalled poor Whoopie, while still others got the urge to dust off the old ATV and go out for a little environmental destruction. No, none of this has been productive and I consider this my calling.

Bruce

www.brucebrittain.com

More Internet Drivel from a Reliable Source

2009-02-09T14:20:00.000-05:00

It is my understanding that if I create a web log, at least one trillion people will eventually visit and collectively embrace me to their digital bosoms. That's a lot of bosoms; more, actually, than there are dollars in the fiscal stimulus package. Therefore, with visions of digital bosoms dancing in my very modest brain, I am launching "An Inconvenient Bruce", my very own soapblog. I make no apologies to Al Gore.

As I am a recovering businessman, musician, writer and mediocre raconteur, my hope is that I may eventually produce some information and/or insight about something that will benefit mankind or womankind (especially the ones with the bosoms who will embrace me; digitally speaking).

My plan is to also use this space to publish, in serialized fashion, my latest literary effort, The Baby Boom Delusion, a book that is currently being reviewed and summarily rejected by every single literary agent in New York for being "too depressing". Well, I say, if one can't be depressed about the current state of affairs and the Baby Boom's contribution to same, then that person has not been paying attention. New Yorkers, I find, often do not pay attention unless it happens in New York.

Naturally, I will treasure the feedback that comes pouring in from my trillion or so bosom buddies, though I may not respond to all.

If you are reading this initial missive, you are currently on my e-mail distribution list. If you have e-mail contacts who might be interested in some of my various postings, please forward this to them so that they too, can join in the fun by visiting "An Inconvenient Bruce" to be entertained, offended, outraged, illuminated, titillated (which sounds like it has to do with bosoms and sometimes does) and/or updated.

As for now, I will leave you with an Observoid of the Day:

Barack Obama has been president for three entire weeks and, except for large chunks of the Kansas population, the sky has not fallen and socialism has only a tenuous hold on the financial system.