Veterans. What Are They Entitled To?

Congress should stop treating veterans like they're asking for a hand out when it comes to the benefits they were promised, and they should realize that, were it not for these veterans, there would be nothing to hand out.

 Congressman Nick Lampson (R-TX)


This is what arrived in my Inbox a few days ago:

Case # 7658: SM (that’s Service Member, in case you didn’t know) filed a VA claim for service connected PTSD ( that’s Post Traumatic Stress Disorder) on November 17, 2010 just beyond the 24 months per SOP (Standard Operating Procedure) policy for consideration…. SM became homeless (emphasis added) in October 2010 and was forced to live out of her car while her 12 year old daughter resided with friends that lived close to her school…. once all the required documentation is submitted to HUD, it may take up to two (2) months to process the case completely…. landlord requires SM pay, security deposit, first and last month’s rent immediately.

SM requested just over $5900 for first and last month rent, food and other expenses. What would you do?

On July 28, 1932, U.S. Army troops commanded by General Douglas MacArthur attacked WW I veterans marching on the U.S. Capitol demanding payment of veterans benefits promised to them by the World War Adjusted Compensation Act of 1924. Believing they were communists and criminals, the General ordered infantry and the Third Cavalry Regiment (led by Major George S. Patton) to attack the marchers. Fifty-five veterans were injured and 135 arrested.

Well, I guess things aren’t that bad for veterans. Are they? Here’s another one:

Case # 9051: SM participated in the OIF (Operation Iraqi Freedom) campaign from May 1, 2003 to April 23, 2004. SM was discharged as an Army National Guard reservist on August 26, 2010 and was subsequently admitted to a Rehabilitation Program at the Miami VA Hospital [for PTSD]….. SM states he did not want to admit that he had this and this is why he waited 3+ years to seek treatment.

I am not making this up. These are real cases of SM’s who have submitted claims to Operation Homefront, a non-profit that provides assistance to wounded warriors, combat veterans and their families. In a strange twist on Joseph Heller’s novel of WW II, Catch-22, one can get help from the VA for PTSD but is discouraged by a culture of denial to apply.

SM has applied to VA to increase his PTSD rating. He requests assistance to avoid eviction….

The Serviceman’s Readjustment Act, or GI Bill, was passed in 1944 to provide veterans with educational opportunities after the war. Most soldiers and sailors who served went straight from high school to boot camp and received little or no vocational training. As such they were trained to be soldiers but had few skills required in a manufacturing or service-oriented workforce.

President Barack Obama appointed retired General Eric Shinseki to head the Veterans’ Administration at the beginning of his term. In August of 2009, he liberalized rules used by the VA to diagnose and treat PTSD saying, “The hidden wounds of war are being addressed vigorously and comprehensively by this administration as we move VA forward in its transformation to the 21st century”.

SM returned from deployment with a mild case of TBI (Traumatic Brain Injury) has been unemployed for eight months……

Unlike previous wars, including the war in Vietnam, our soldiers in Iraq and Afghanistan are exposed to danger constantly with little opportunity for rest. Operation Homefront provided assistance to over 160,000 veterans and their families in each of the last two years. The cases ranged from dysfunction related to PTSD to debilitating wounds that prevented veterans from finding work to veterans and their families becoming homeless.

SM is E4 Army veteran, infantry who served 7 years with Army with 2 tours with OIF. SM was honorably discharged April 6, 2007 ….. SM displayed PTSD symptoms after return from second tour in Iraq, and these symptoms increased after his discharge.…. SM was incarcerated in November 2008 when he fired “warning shots” at an aggressive driver from his gun in his car.

I am delighted that Secretary Shinseki has embarked on a program to increase the numbers of service members who would be eligible for treatment for PTSD. However, in my role on Op Homefront’s Florida board, I am exposed to the extent to which the VA and the services themselves are guilty of not helping discharged veterans to successfully transition back to civilian life.

This is not an attack on the Armed Services or the Veterans’ Administration. There are laws governing what they can and can’t do. The laws are converted to regulations and the people who deal with these cases are legally bound to follow the rules. Any set of rules will create exceptional cases and many of them will be egregious.

I think the larger question is: are we, as a society, ready to deal with the aftermath of our dual combat missions? The amputees? The psychologically impaired? The family problems?

There are ancillary questions as well. How do we evaluate these cases to ensure people are getting the help they need? What is the responsibility of government to help them? How will we expand the existing entitlement programs to encompass this new population?

Or to say it differently, WHO WILL LEAD?

Rules? What Rules?

"My, we seem to be a little short on brotherly love round here." 

-- Butch Cassidy, as played by Paul Newman in Butch Cassidy and the Sundance Kid

I got into a Facebook Fight last week. Have you ever been in one? It's kind of like that scene from Butch Cassidy and the Sundance Kid. You know the one where Butch has to get into a knife fight with a really big, scary guy. He asks him, "What are the rules?" Big Scary Guy replies: "Rules? In a knife fight? No rules!"  He no sooner gets the words out of his mouth than Butch kicks him in the groin. Well, there are no rules in a Facebook Fight either.

I use different internet tools for different purposes. LinkedIn for business; Facebook for personal stuff, pictures and messages to friends and family, etc. So, when I woke up at my usual 5 AM to a posting on my Facebook wall supporting the Wisconsin 14, I went off the deep end. Last year, I had de-friended members of my own family for posting their support of the Arizona immigration law. So, why am I waking up to some commie crap on my damn wall? By a so-called friend no less.

Now, 5 AM is not my best time of day. I could have deleted it. I could have blocked the friend from posting on my wall. I could have de-friended him. But, no-o-o-o! I responded aggressively.

My opponent was a very well read Ph.D. And worse, he was abetted by an old high school chum of mine with whom I haven’t spoken since graduation day. In fact, I am not sure I even spoke to him then. Two against one. That’s not fair! Oh yeah, there are no rules in a Facebook Fight. My H.S. buddy is a school psychologist according to his Facebook page. So, he is right there with the Ph.D.

Ph.D. hits me with Robert Reich. I parry with Freidrich Hayek. He’s never heard of him. Hah! Take that, Ph.D.

I am a fan of NY Times columnist, David Brooks. I never miss a column. He mostly writes about political and policy issues and represents a moderate voice that does not adhere to any political dogma. I guess that’s why I like him. His new book is called The Social Animal. I understand from the reviews and summaries that it is a fictional representation of the ways in which we form relationships and connect ourselves to ideas and social norms. Though not an expert on brain science, Brooks has written of our new understanding of it and how it has affected us. Think of all those bright business school grads on Wall Street and how they self destructed during the financial crisis of 2008/09.

So, here I am parrying the thrusts and jabs of my formidable opposition and it occurs to me that Brooks is right about all this. I am fairly well read myself and yet could not convince either of these guys of the wisdom of my thinking any more than they could convince me of theirs. It’s not that their thinking was irrational. Indeed, their thoughts might be considered to be a rationalization of their beliefs.

All their reading and learning had been directed to support their values and biases. So, were mine. There was no winning this Facebook Fight for any of us. No way, no how.

Isn’t that what’s happening across the nation? Don’t you get emails from your friends and colleagues that either reinforce your views or infuriate you? So, how can we solve the big national problems when we are all so enamored of what’s going on in our own heads that we can’t compromise?

A recent speech by Republican Governor Mitch Daniels of Indiana to the Conservative Political Action Committee provides some insight on how we might answer that question. He counsels his right wing followers to put everything on the table including tax increases and defense spending to resolve the problem of our deficits and debt.

He reminds his followers that “big change requires big majorities” and that we will “need people who never listen to Rush or Glenn or Laura or Sean”. He also reminds us that the founders “made compacts and concessions and, yes, compromises” in the cause of creating one union from the 13 colonies who won their freedom from the British crown.

NPR called it a Grown Up brand of GOP politics. We need that from both sides of the aisle. A recent report from economist John Mauldin found that a “majority of voters incorrectly believes the federal government spends more on defense/foreign aid than it does on Medicare and Social Security (63%). Also, a similar majority (60%) incorrectly believes problems with the federal budget can be fixed by just eliminating waste, fraud and abuse.”

The President created his own version of Grown Up politics with the Simpson Bowles Commission aimed at resolving our national debt. Their controversial proposal is dying a slow death like those of most Presidential commissions.

Our debt problem is serious and addressing it will be painful. What is called for is the equivalent of Ronald Reagan’s dollar bill speech in 1981. He held up a dollar bill and opened with “This is a dollar bill…..”

We guffawed about it the following day on the trading floor at Goldman Sachs. But, that’s the kind of communication that is called for now. Reagan explained to voters how every dollar they earn is divided up. The equivalent of a PowerPoint pie chart.

The pie chart needs to be updated. If nothing changes, every dollar of tax revenue will go to paying interest on the national debt within 10 years. Nothing left for national defense. Nothing left for social programs. Nothing.

The only question is: WHO WILL LEAD?

The Disunion of 'Dis Union

The dogmas of the quiet past, are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise -- with the occasion. As our case is new, so we must think anew, and act anew. We must disentrall ourselves, and then we shall save our country.

                                                               ---  Abraham Lincoln


It’s hard to imagine that President Grover Cleveland ordered the US Marshalls and the National Guard to put down an insurrection in this country. The year was 1894 and the insurrectionists were members of the American Railway Union. The troops killed 34 union members and wounded 57. The leader of the ARU, Eugene Debs, was arrested, convicted of violating a federal court order and was imprisoned for six months.

Trade unions have been around for a long time but it was the labor movement of the 1930’s that forged the cultural institutions that survive today vexing corporate executives and state governors alike. Laws signed by Presidents Hoover and Roosevelt gave impetus to larger unions banding together to bargain with employers. It was a period in which attacks against striking workers by US troops and hired thugs gradually came to an end. But, the unions were poorly run and infused with Communists. During the depression, with unemployment at 25% and workers unable to pay dues, they were not very effective.

After WWII, Walter Reuther became head of the UAW, purged Communists from their management to become well administered and powerful negotiators. He set an example for his peers to follow. The booming economy of the time coupled with higher wages and benefits created a middle class economy throughout the Midwest and northeastern US underpinned by union workers.

By the 1970’s, the impact of a new, more global economy called for a paradigm shift. The impetus for that shift was provided by Ronald Reagan who famously disemboweled PATCO, the air traffic controllers union. I think he did it to set a precedent and prove to industrial leaders that they could too.

But, ultimately, it was the market not politics that undid the union. Union wages and benefits added costs to the manufacture of finished goods that made US industry uncompetitive on a global scale. Foreign auto manufacturers seeking to neutralize the impact of volatility of the dollar built their US auto plants in the South where they were less likely to unionize.

I won't go through the history of unions for the past thirty years.  Nor will I reiterate the issues that are well covered in the news of late.  If you have read this far, you probably already know and have an opinion.  Instead, I would like to pose a business question. 

Union membership has declined precipitously. In 1950, 25% of American workers belonged to a union. Today, the percentage is half that. And, tellingly the percentage among employees of private companies is 7.5% while over 36% of public employees are union members.

Now, if a business had seen such a precipitously decline in its fortunes, it would have to transform itself or face liquidation.  Instead, unions have resisted change.  The unions won’t win this war. They might win a battle or two but I am here to tell you that their day is done. The model doesn’t work anymore.

What should they do? Give up? Close up shop? NO! They should transform themselves into 21st Century institutions. Why would anyone think that the 19th Century model honed to perfection 60 years ago will work now?

Unions should be transformed into Centers for Human Capital Development. Instead of an entrenched interest that fights progress; they should be training people for 21st century jobs. Manufacturing has become more high tech. Math and science skills are lacking.  Last year, the NY Times reported that a factory in Cleveland had over 3600 applicants for jobs to run a high tech machine used in fabrication.  Each applicant was tested to see if their math skills were at the ninth grade level.  The company was unable to fill the 100 job openings in a city that has lost over a million manufacturing jobs in the last decade.

If a manufacturing company could come to the union to find workers trained to work in this new environment, they would see a union contract as beneficial to their business rather than an obstacle to be overcome. This new model would work for public employees as well – including teachers.

If unions offered benefits – healthcare, 401K’s – to their members in addition to training matched to employers’ needs, they would find membership an attractive value proposition.  It would take the burden off the employers who contracted with them. 

If unions were to follow this model, everyone would be a winner: the employers, the employees and the unions.

But, entrenched interests have over a century of momentum. Quoting Lincoln again, “As our case is new, so we must think anew, and act anew. We must disentrall ourselves, and then we shall save our country.”

The only question is WHO WILL LEAD?

The Bulworth Solution: Try It Now!

All we need is a voluntary, free-spirited, open-ended program of racial deconstruction…. Everybody gotta start f***in’ everybody till we’re all the same color.

           Senator Jay Bulworth, as played by writer-director Warren Beatty in the movie, Bulworth (1998).  (Listen to the whole speech HERE)

Last October, German Chancellor Angela Merkel denounced multi-culturalism at a meeting of young Christian Democrats (her political party).  She cited a study that found that 13 percent of Germans would welcome a “Führer” to run the country “with a firm hand.” Some 60 percent of Germans would “restrict the practice of Islam,” and 17 percent think Jews have “too much influence,” according to the study.

This past week, British Prime Minister David Cameron echoed her words, pointing to the failure of “multi-culturalism” in the UK as a factor in national security. He noted that home grown terrorism in the UK was not always the product of poverty. Terrorists, such as those who perpetrated the London bombings in 2005, were middle class. The failure, in Mr. Cameron’s view, is that “we have encouraged different cultures to live separate lives, apart from each other and apart from the mainstream.” He believes that the UK should strongly defend its values and culture and let it be known that those who don’t believe as does the mainstream should find someplace else to live.

Open borders and an influx of immigrants from the Middle East have challenged Western Europe in ways that we can only imagine. However, America has an extraordinary history of absorbing and integrating foreigners. Perhaps the so-called LEADERS of these great European democracies should study our success before giving up.

The Irish, Germans and Scandinavians who came here in the 19th Century were followed by Japanese and Italians in the 20th. All faced resistance from the establishment at first. However, they brought up their children here. By the second or third generation, the children and grandchildren of these immigrants had become as American as the Britons and Scots who revolted against the British crown at the birth of this nation. As a resident of South Florida, I can tell you that the children of the Cuban, Puerto Rican and South and Central American immigrants who predominate here want to act like their American peers by age 6, have unlimited texting on their cell phone by 12 and to be driving and dating by age 18.

One of the challenges of last year’s census was how to “classify” its respondents. The NY Times, this week, published the story of Michelle Lopez-Mullins who is of Peruvian, Chinese, Irish, Shawnee and Cherokee descent. How did the government classify her? It depends on which cabinet department you ask. The Department of Education classifies her as “Hispanic” so they can measure the educational progress of that “class”. Meanwhile, the National Center for Health Statistics classified her as Asian and Hispanic. But, if she had no “Hispanic” in her background, she will be classified in the “two or more races” category along with the children of black and white couples or Asian and American Indian parents.

While many here have been concerned that Latinos do not want to be integrated into our society, the College Board reported this week 14.6% (an increase of 2.6%) of US high school seniors who passed an Advanced Placement exam in 2010 were Latino. This, despite the fact that 41% of Latino’s over the age of 20 have no high school diploma.

One can only wonder how Mr. Cameron and Ms. Merkel would respond to that. Perhaps they should consider how the provincialism of European societies dooms multi-culturalism. Perhaps they should consider that their LEADERSHIP role requires them to address the challenge rather than to denounce its failure.

As for the US? Well, maybe it’s time to stop “classifying” people.

The forbears of Ms. Lopez-Mullins didn’t really care about their classification. Their multi-racial, multi-cultural multi-copulations were the product of sexual attraction, pheromones, whatever! Indeed, the Times story reported that one in seven births is the result of a multi-racial relationship.

So, it seems that we are taking Senator Bulworth’s advice. Maybe we’ll all be the same color someday.

From Zell to Fiscal Hell

“A college education should be more than an item of currency to be traded on the job market. To view it solely as an economic asset is to devalue it.” – Zell Miller, former Governor and US Senator representing the state of Georgia

I would like to welcome a guest blogger this week, my brother Christopher.  Chris has been actively involved in matters pertaining to public education for several years and has served as Chair of the Georgia House District 103 Education Advisory Board to Rep. David Casas.  A few weeks ago, the NY Times published an article titled, Georgia Facing a Hard Choice on Free Tuition.  I asked Chris for his view and here is what he wrote:


I have lived in Georgia since 1981. While the state has many things to boast about, public education is not one of them. For the past 30 years, student achievement has ranked at the bottom or near the bottom of state rankings. Every Governor comes into office vowing to make measurable improvements in education and most fall short. One significant exception was when Gov. Zell Miller fulfilled a campaign promise to institute a State Lottery and use the proceeds solely for public education.

The controversial Georgia Lottery law was written so that the funds could only be used for three specific purposes: Pre-K programs available to every family at no cost, technology for primary and secondary school systems, and the HOPE scholarship.

HOPE stands for Helping Outstanding Pupils Educationally. The program provides that any student who maintains at least a B average will not pay any tuition when attending a post-secondary program in a Georgia public college. The HOPE Scholarship is based on merit, not means.

A recent NY Times article talked about students at The University of Georgia driving “HOPEmobiles” which are cars given to students from families with means. The parents don’t have to pay tuition, so they reward their kids with cars. But, to talk about HOPE as giving money to families who don’t need it misses the point. The principle of HOPE is that it rewards hard work. You give something; you get something.

The HOPE Scholarship program has had many consequences for Georgia; both intended and unintended. Over the past two decades, many of our top high school students have stayed in-state for college when they may have otherwise gone out-of-state. This has swelled the rolls of many of Georgia’s colleges, created a demand for new colleges to be built, and increased competition for admission to the top schools. The University of Georgia, for instance, once was accessible to average students. Now, it’s the hardest public school in the state to get into.

The demand for HOPE money has increased as attendance in Georgia’s post-secondary schools increased. Then, as the economy declined and the state cut the education budget, colleges have had to raise tuition and fees. The result is that HOPE’s liabilities now far outstrip its funding mechanism. The newly elected Governor, Nathan Deal, has had to propose some tough and unpopular choices. Do we increase the GPA requirement, reduce the percent of tuition covered, or institute means testing?

Attempts to duplicate the success of HOPE at the national level have fallen short. Tax credits for education involve complex IRS rules and only rebate you after the money is spent. A federal education loan is good but it has to be paid back. A recently released government report indicates that the total outstanding education debt held by Americans is greater than that owed on credit cards. Has the ease of getting these loans created another economic “bubble” waiting to burst?

Few would disagree that a well-educated work force is key to our future success in this global economy. While we used to view a high school education as the door to opportunity, increasingly that is not enough. Persons without a college degree, on average, have seen lower pay and higher unemployment. Few parents would discourage their children from seeking a college degree, but more are having trouble paying for it.

America has the finest post-secondary educational institutions in the world. That’s one reason why colleges are bulging with enrollment of foreign students. Should the best and brightest Americans be excluded because it’s too expensive? For once, the politicians in Georgia got it right. While HOPE will certainly change with the current economic realities, it’s not going away. Good students in Georgia will continue to have opportunity regardless of their means. The question is why other states haven’t followed Georgia’s lead.

Since 1993, the Georgia Lottery has generated $5 billion for education. So, go out and buy a lottery ticket and feel good about it. We shouldn’t be “HOPE-less”, we need to invest in the next generation.

- Chris Calia

Christopher Calia graduated cum laude from the University of Virginia and received his Masters in Mechanical Engineering from M.I.T.  He was a national Fellow in Nuclear Engineering and now runs a small, private software company.  He clearly values the education he was fortunate enough to receive, and is a frequent activist on legislative issues related to education.


In my last posting, I repeated the oft spouted phrase that governing is about choosing.  Clearly, we are all facing some tough choices which will create controversy and disillusion many Americans.  The only question is:

WHO WILL LEAD? 

Adam Smith: Communitarian

It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own self-interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages.



 Adam Smith, Scottish philosopher, economist and author



A colleague of mine – a college professor – describes herself as a Communitarian. She quickly quips that her husband says that’s the same as a Communist. But, while some Communists might be Communitarians and some Communitarians might be Communists, they are not the same. Wikipedia defines the term this way: “Communitarianism emphasizes the need to balance individual rights and interests with that of the community as a whole, and argues that individual people (or citizens) are shaped by the cultures and values of their communities”. Sounds pretty far from the common perception of Adam Smith. However, I think it’s fair to say that Smith might buy into that philosophy.

Conservative politicians have promoted the “invisible hand” of the markets quoting Adam Smith from his treatise, the Wealth of Nations. I doubt that many of them have actually read the 1000 page tome. If they had, they would know that Smith believed that efficient markets and general welfare resulted from local business owners bearing the cost of their enterprise and sharing the values of their communities.

Smith strongly disliked both governments and corporations. He viewed government primarily as an instrument for extracting taxes to subsidize elites and for intervening in the market to protect corporate monopolies. In his words, "Civil government, so far as it is instituted for the security of property, is in reality instituted for the defense of the rich against the poor, or of those who have some property against those who have none at all.” Certainly, that was an accurate description of 18th Century colonial America ruled by the British throne.

But, Adam Smith was a Scottish philosopher whose theories were not supported by data. A century and a half later, Friedrich Hayek developed the data to take Adam Smith’s philosophy to a new level. He advanced what would later be called Austrian Economics, a theory of monetarism that was embraced by his colleagues (including Milton Friedman) while he was part of the faculty at the University of Chicago in the 1950’s. Hayek believed that manipulation of interest rates distorted the price of capital leading to the boom and bust cycles we have seen throughout our history. In other words, the way to prevent the bust is to avoid the boom.

Like most students of economics of my generation, I lean toward the supply side theories that have been espoused by conservative economists, Hayek and Friedman. Their progeny like Arthur Laffer influenced Ronald Reagan whose response to an economic crisis was to return control of capital to those that earned the money. Lower taxes meant more money in your pockets, lower capital costs (without monetary distortions) and through the “multiplier effect” an expansion of the economy. He also coined the term “trickle-down economics” to describe the benefit to lower income families.

The expansion of our economy these last 30 years has been extraordinary. However, the promised trickle-down effect isn’t trickling. Over the last decade we have seen global corporations earning more money while the average real income for families has remained flat. Adam Smith would be appalled. Not only is the central government co-opting a significant share of our personal incomes but also it is reallocating our income to corporate interests in the form of subsidies and tax breaks. And, it has done so to the ill effect of the people who have elected that government.

Indeed, I know of no economic theory called trickle-down economics nor of any data to support its promise. It’s a political phrase. That’s all.

So, what would Smith and Hayek have to say about that?

Rarely do we hear of the other views expressed in The Wealth of Nations captured here: “It is not very unreasonable that the rich should contribute to the public expense, not only in proportion to their revenue, but something more than in that proportion.” Nor, do we hear much from his seminal work, The Theory of Moral Sentiments, where he explored the nature of mankind in civil society. How’s this for an Adam Smith quote: “This disposition to admire, and almost to worship, the rich and the powerful, and to despise, or, at least, to neglect persons of poor and mean condition, though necessary both to establish and to maintain the distinction of ranks and the order of society, is, at the same time, the great and most universal cause of the corruption of our moral sentiments.”

Hayek, who had the advantage of observing governments in action in the 20th Century (Smith lived his entire life in the 18th), also espoused the creation of a “safety net”. In his most read work, The Road to Serfdom, he said: "There is no reason why, in a society which has reached the general level of wealth ours has, the first kind of security should not be guaranteed to all without endangering general freedom; that is: some minimum of food, shelter and clothing, sufficient to preserve health. Nor is there any reason why the state should not help to organize a comprehensive system of social insurance in providing for those common hazards of life against which few can make adequate provision."

So, where do we go from here? The threat posed by our national debt and its evil twin, the budget deficit, are real. If current trends continue, 100% of our tax revenue will go to paying interest on the debt within 10 years. That can’t happen. And, when something can’t happen, it won’t.

It is often said that governing is about choosing. We have rarely faced choices as difficult as those we face today.

Tuesday’s State of the Union Address will be interesting on many levels, political and otherwise. The President’s public pronouncements have recently focused on helping business in the name of lowering unemployment. He even took the extraordinary step of authoring an Op Ed piece in the Wall Street Journal. Will he announce that he will introduce the recommendations of his Fiscal Commission to Congress and ask that they make them law? Will he acknowledge the work of Rep. Paul Ryan who is carrying the Republican flag, toward a compromise that will balance our budget within a decade?

Will the next two years be marked by more partisan bickering? Or, to paraphrase my usual closing question, WILL HE LEAD?

How's This for a Healthcare Problem?

"Hundreds of residents had been seized by the disease within a few hours of one another, in many cases entire families, left to tend for themselves in dark, suffocating rooms."

Steven Johnson, from his book “The Ghost Map: The Story of London's Most Terrifying Epidemic - and How It Changed Science, Cities, and the Modern World”



Not much was understood about disease and how it spread in the early part of the nineteenth century. In London -- perhaps the most civilized of cities at that time -- the medical profession theorized that the black plague and cholera were spread through miasma, the foul smelling stench that emanated from factories and sewers. London’s population had more than quadrupled in the first half of the century and the city was unprepared for the impact of more than 2.4 million people.

A cholera epidemic in the 1840’s had killed thousands and led to the creation of the General Board of Health. Despite the Board’s efforts, an outbreak of Cholera threatened London again in 1854. Inside of a week, over 100 people died and many more were sick. Seventy-five percent of the residents of Soho fled the city leaving factories with a dearth of workers. There were calls to shut down the factories as they were thought to be the primary cause of the miasma.

Dr. John Snow did not believe in the miasma theory and he set about to prove that contaminated water was the cause. The science of epidemiology was in its infancy and it wasn’t as simple as peering at water samples under a microscope. Rather, Snow acted more detective than physician. He famously mapped the cases and triangulated on a public well – the Broad Street Well -- that had been contaminated by sewage.

The city government shut down the well. How? By removing the pump handle. Wouldn’t it be great if all such problems could be solved so easily?

The following year, the General Board of Health drafted a bill for consideration by Parliament. The Nuisances Removal and Diseases Prevention Act threatened to curtail or shut down factories by regulating the foul odors that emanated through the city. Its proponents continued to promote the theory that miasma caused disease. Businesses objected vehemently. In their view, the bill jeopardized their ability to continue to do business.

In other words, the bill was a “job killing” healthcare law. Dr. Snow testified on behalf of industry, reasoning that since factory workers were no more likely to die of the disease than other residents of the city the smell could not be its cause. The bill was defeated.

I guess some things never change.

Today, congressional Democrats, who believe that the government should engage in economic intervention, argue that we are the only industrialized country that does not provide universal healthcare to its citizens. As though that is a good reason to do anything!

Meanwhile the Republicans have labeled Obamacare as “government controlled healthcare” and have promised to “repeal and replace” it. Huh? Replace it with what? If you think that government controlled healthcare is bad, then just repeal it! They point to the US Constitution as the proper construct and who can argue with that. It’s an extraordinary document and no other country has been able to improve upon it in the last 230 years.

In my view, all of the political rhetoric is a distraction.

The Brits don’t even have a constitution. And, whether the foul stench of 1850’s London was causing disease or not, it was probably a good idea to get rid of it. It’s not there today so something must have happened in the last century and a half.

There’s no question healthcare needs reform. The rising costs threaten our economic security.

Fifty years ago, the AMA feared Medicare and decried it as “socialized medicine”. Over the last two generations the program, which is a bottomless pit of taxpayer money, has made many a doctor filthy rich. Meanwhile, roughly 40 million Americans have no coverage. Many, who can afford it, can’t get it because of pre-existing conditions or some other nonsense. (I’ve been there, personally.)

The problem with Obamacare is that it doesn’t address the core problem – cost. So, what should we do? Like most of you, I have opinions but lack expertise. However, I have read a number of studies including one by McKinsey and Co. which compares the embedded costs of our system to others in the industrialized world. McKinsey lays it down to three simple matters that need to be addressed: (1) the rapid growth of outpatient costs due to higher utilization, (2) higher pharmacy costs and (3) higher administrative costs (including malpractice claims). I won’t go into details. If you’re interested, you can read the study by clicking HERE.

Those who would argue for no change (let the market decide) are not coming to grips with reality. The current system is not free enterprise. And, anyone who doesn’t think it needs reform is simply nuts. The reason that government needs to be involved is that the industry is too fragmented. Unlike for example the auto industry, there is no dominant player who can drive standards and automation into the supply chain like GM did in the 80’s.

That said, the country simply cannot afford another entitlement program when the national debt threatens our financial security.

We will undoubtedly be treated to lots of posturing by politicians and blathering by pundits. Ignore it. It’s a distraction.

It really comes down to one question: WHO WILL LEAD?