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Thursday, April 30, 2009
Paul Greenberg :: Townhall.com Columnist
The Last Optimist
by Paul Greenberg
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It makes a fellow lonely, not to see the disaster everybody tells me is upon us. It's not easy, being the Last Optimist of the Western World. I do my best, honest I do, to share the pervasive pessimism about the American economy and where it's headed in a handbasket. I feel it's expected of anyone who wants to retain his credentials as a Serious Thinker.

But every time I peer around, sincerely in search of the economic apocalypse that's upon us, all I can discern is just a classic 19th-century financial panic.

Yes, this 21st-century panic will strut and fret its hour (or even year or two) upon the stage, but then it will subside. Like the bust that follows every boom. Though the whole, familiar process would go a lot faster if we had a Federal Reserve System as competent as J. P. Morgan's one-man equivalent thereof in 1907.

What I'm starting to worry about isn't the great worldwide deflation that's supposed to be the big threat on the horizon, but the great inflation sure to come if government keeps spending money it doesn't have, and using the printing press to finance its mounting debt. Or maybe we'll get the worst of both worlds: another Carter Era stagflation, which brought us a two-fer: both stagnant growth and a depreciating currency.

The American economy may have seized up, but the engine is still there. It's not dead, just cooling off. What it may need most just now is a good leaving alone.

This isn't the Great Depression all over again, in large part because of the New Deal reforms that were adopted to deal with it, like federal deposit insurance, Social Security, unemployment insurance and one safeguard after another. If only we had stuck to that wall the New Dealers erected between commercial and investment banking! That way, some banks' speculative investments wouldn't have infected the whole system.

If the New Deal had its failures (see the late and unconstitutional NRA with its price controls and other economic diktats), it also had its successes, which still protect us from the results of our own excesses.

A little more perspective, please, and a little less panic. America isn't done for yet. And neither is capitalism. Though some of the remedies being proposed may only make the patient sicker. Like nationalizing Detroit's Big Three, perhaps as a prelude to making every bank a wholly owned subsidiary of the U.S. government. What a brilliant idea: That way, the economy could be run as efficiently as the U.S. Postal Service. And with all the clarity and simplicity of the Internal Revenue Code, heaven help us.

Here's this week's worst idea/trial balloon from the Obama administration: Convert the government's bailout loans to banks into common stock, making Uncle Sam not just the regulator of banks but their owner. So that the country's largest banks could become public-private corporations, like Fannie Mae and Freddie Mac, and just as capable of creating the next big boom. Which would soon enough trigger the next and even bigger bust. Will we never learn?

The New Deal never made that mistake. FDR saved the banking system by insuring and reconstructing it; he didn't seize it. No wonder our new president has already noticed a "confidence gap" in his administration.

Some enterprises have earned failure. Let them have it. That's what we have Chapter 11 and bankruptcy courts for: to save the assets, pay off the creditors, reorganize those parts of the enterprise worth reorganizing, and get on with business.

I myself hear from a bankruptcy court regularly, the one supervising the Tribune Company's crack-up. I'm a bona fide creditor now, if on a tiny scale, because its syndicate handles my column. But I notice its checks still cash. It's only bankruptcy, not the end of the world.

I've known some cock-eyed optimists who can see nothing but the bright side of things. But at times like these, it occurs that some folks can become intoxicated with pessimism, too. And it makes them advocate precisely the wrong policies.

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Realism Will Get You the Farthest
Some of your comments I can agree with. The business that failed, should have failed. No bailouts! But, this is going to have very long road to recovery, supposing that there even will be. We don't know what's going to happen down the road. There's no point in being either optimistic or pessimistic right now. But no sane person is going to say that things are looking up right now...

Obama agrees
As I posted on Huff Po, I think Obama not only agrees, he's counting on this. He plans to take credit for the recovery before the stagflation he's causing begins. I belive he may have outsmarted himself.

I'm optimistic as well but many people are going to be hurt. Even if I end up on the short end, which is both possible and probable, there are worse things than being poor.

I'm Optimistic too......
I do not know WHAT tomorrow holds, but I do know WHO holds tomorrow....

This will NOT be the game "Let's Make a Deal".....it will be...."This IS the Deal".....

They are Commandments, NOT suggestions.....


Is this all they've got?...

Silver Lion
I knew that was one of the main reasons I like you so much! The best is yet to come!..just maybe not in this lifetime! Have you heard about some of the cataclysmic predictions for changes the earth is possibly going to go through in 2012? I hope it means what I hope it means!(Yes,that's what I mean!) At the rate we're going,I wouldn't be surprised,would you?

Mr. Greenberg
Mr. Greenberg,

I enjoyed your very good article and largely agree with you. One big problem area that needs to undergo transformational change is our "Healthcare System".
(see below).

Real Healthcare Reform: Changing the Incentives and the Rules of the Game; Creating an Electronic Health Record for Every Citizen Who Wants One.

If you have the financial resources of Bill Gates or Warren Buffett you needn’t pay money to a health plan each month, since if you get sick or injured – even very seriously - you have more than enough money to pay all your medical bills yourself.

But those of us with significantly less financial resources must find some other means of dealing with the thousands or even hundreds of thousands of dollars or more of medical expenses that we might incur should a serious illness or injury be our fate.

Enter the concept of “health insurance”.

Large numbers of individuals and/or their employers pay some money each month into one or another big pot called a “health plan”. Those individuals who remain essentially very healthy for many years and then suddenly die or perhaps leave a particular health plan for some other reason – if they have put more money into the pot than was taken out to pay all their medical expenses - wind up helping to pay the medical bills of those members of the health plan who become seriously ill or injured and incur a lot of medical expenses.

Healthcare Reform 2
Many members of health plans don’t seem to fully understand - or perhaps choose to forget - that if they become seriously ill or injured, for the most part their medical bills will be paid by the members of their health plan who have remained healthy. Some Americans believe that healthcare should become a “right” of every American citizen. If a nationalized single payer health plan were enacted, every American citizen - who for whatever reason became ill or injured and incurred significant medical expenses - would for the most part have his or her medical bills paid by all U.S. taxpayers.

For any health plan to work which has a large number of people pooling their money to essentially pay the medical bills of whichever members of the plan become seriously ill or injured, rules must be established as to when and how much money may be taken out of the pot e.g. “legitimate” doctor bills and hospital bills. Equally important is keeping track of the amount of money that is being put into the pot each month in premiums paid by health plan members or their employers. If too much is being paid out in expenses as compared with the amount being received in premiums, the pot will soon become empty and the health plan will go broke.

Healthcare Reform 3
As previously mentioned, the monthly premiums paid by individuals or their employers go into a health plan’s big pot from which “covered” healthcare expenses are paid. But also from this pot are paid all the health plan’s administrative expenses including what may be big salaries and golden parachutes for CEO’s and other “healthcare executives” – individuals who may be paid to find technicalities of one sort or another in the health plan’s agreements so the health plan can deny or reduce payments, raise premiums, cancel insurance, or in one way or another minimize or exclude “bad risks” from the health plan. All such questionable business practices are done to enable the health plan to make a profit and remain in business.

Currently we are experiencing continual increases in healthcare costs that are unsustainable and which, if unchecked, will soon seriously threaten the future of the entire American economy. Healthcare costs must be controlled, but how? If a healthcare system made up of health plans is going to have a chance of meeting the needs of its health plan members and simultaneously be able to keep costs under control, something very critically important must first occur.

It turns out that a lot of illnesses and many injuries are actually preventable.

Healthcare Reform 4
Although health promotion and disease and injury prevention receive fashionable and socially acceptable lip service, the fact is that most of the participants in what should be more appropriately called our “sickness and injury care system” actually have no significant financial incentive whatsoever to spend significant time and energy in genuinely promoting health and helping to prevent disease and injury.

Much to the contrary. Other than the actual members of a health plan – patients and potential patients - and their employers and perhaps the employees of some health plans, most participants in our sickness and injury care system - because of the way they are paid - have an enormous (if unspoken) financial incentive for massive amounts of disease and injury – much of which is preventable – to continue to occur in America. Strictly from a financial point of view, for those whose income comes solely from the treatment – not the prevention - of illness and injury, the more illness and injury, the better. And if the illness or injury is serious and requires perhaps many expensive tests, multiple surgical procedures, and other very complicated prolonged treatment in intensive care, so much the better; just as long as those unfortunate individuals who happen to be ill or injured are “covered” by “good insurance”, i.e. health plans that are reliable bill payers.

Healthcare Reform 5
This is not to say that there are not some excellent very dedicated and hardworking doctors and other health professionals - although they are paid on a fee for service basis to care for illness and injury – who nevertheless attempt to essentially work themselves out of a job by making health promotion and disease and injury prevention a top priority with their patients.
It should also be recognized that some existing health plans – e.g. Kaiser and Group Health - combine insurance, doctors, and hospitals into a single entity in such a way that provides everyone - including all the health plan’s doctors - a real incentive to spend time and effort with patients on health promotion and disease and injury prevention as well as on early diagnosis and treatment.
But unfortunately the above examples represent only a small part of the current sickness and injury care system throughout America.

For the most part - because of the way they are compensated – the majority of doctors and other professional providers, acute care hospitals and long term care facilities, pharmaceutical manufactures and pharmacists, medical and surgical equipment manufacturers and personal injury and malpractice attorneys - among others - depend mightily on massive amounts of disease and injury occuring in America; and these participants in our sickness and injury care system would be significantly negatively impacted if a lot of the preventable illnesses and injuries were actually prevented. This must be changed.

Healthcare Reform 6
Unless the incentives and rules are changed to give as many participants as possible a real financial stake in health promotion and disease and injury prevention, in early diagnosis and treatment, and in maximizing health and minimizing disease and injury, healthcare costs in America will never be brought under control. Making appropriate changes in the incentives and the rules of the game in this direction is the real task and challenge of “healthcare reform”.

What about financial incentives for individual health plan members? Should individuals receive a financial incentive to be healthy? It is well recognized that engaging in regular exercise, abstaining from tobacco, and eating moderately so as to maintain a reasonably normal body weight are all significant factors in helping to promote an individual’s health and wellness. These healthy behaviors can all be confirmed by simple tests in a doctor’s office. Why shouldn’t those individuals who practice these health promoting behaviors and comply with recommended immunization schedules and appropriate preventive screening examinations such as for colon cancer and breast cancer pay significantly less to their health plan each month than those who don’t?

To really reform healthcare we must find ways – through changes in incentives and the rules of the game - to actually prevent what is preventable, to maximize early diagnosis and treatment, and minimize disease and injury with all its cost. We must find ways for participants to be part of our “healthcare system” and not just a part of our “sickness and injury care system”.

Healthcare Reform 7
Significant changes in the rules of the game for our legal system – tort reform – is also critically important so that the gaming of the system now being done by personal injury and malpractice attorneys and their clients can be ended and so that the exorbitant costs to physicians and other professionals for malpractice insurance can be dramatically reduced.

Truly transforming our “sickness and injury care system” into a “healthcare system” by making significant changes in the incentives and the rules of the game may seem to be a formidable task and one that probably has never really been done before on a large scale anywhere in the world. But it is a worthy task and a critically important task for the future of America and its people.

One important part of this process is developing the capability of creating an electronic health record for every American citizen who wants one. We need a standardized framework that will allow every American citizen to have an individual electronic health record – a computerized medical record - that can be accessed by all the doctors who care for a particular individual, regardless of wherever on the planet the doctors or the patients happen to be. It would be like having your own personal online banking account that only you have the password to, but which you can share with the doctors who are caring for you, wherever you or they may be.


Healthcare Reform 8
I strongly applaud those who are using their energy and expertise to upgrade our deplorable current paper medical records system and bring medical records in America into the 21st century. Developing a standardized framework for an electronic health record - for every citizen who wants one – created by your doctor with your assistance, which has proper security and safeguards is something that our national government can and should do as a part of healthcare reform.

If done well, electronic health records will be transformational in helping doctors efficiently and effectively care for patients – whenever and wherever they may be - and will save an enormous amount of time, effort, and money which is currently wasted on needless and frequently inaccurate duplication. Also, electronic health records will make it easier for an individual and his or her doctors to thoroughly evaluate each patient with regard to appropriate health promotion and disease and injury prevention. Like the telephone and the computer, someday we will all wonder how we ever got along without them.

But we need action, not just words. Now is the time for Americans and their leaders and doctors to step up to the plate and begin the process of transforming our “American Sickness and Injury Care System” into an “American Healthcare System” that is worthy of our great country.


Robert Westafer M.D.

Thank You Dr. Westafer
Do you have any suggestions on how to erase the material profit motive that debases the entire system?

non-federal ngo federal reserve monopoly
"spending money the gov't doesn't have" is so very on point ! congress borrows money from the nga fed that we income taxpayers are obligated to repay ..plus interest ! ALL OUR INCOME TAXES GO TO PAY JUST THE INTEREST ON THE NATIONAL DEBT ! !! ! ! ! ! ! !

the "fed" [no more federal than fedex is unconstitutional; lincoln, jackson , garfield, mckinley,wilson and jfk despised the private central banks and their franchises to print money adding to the national debts of their day ! lincoln and jackson succeeded for a while ; the parasite is back , the fed ;
NATIONALIZE THE FED ! ! ! !

Mary 8:30 AM
That is an interesting question. I happen to think that the Kaiser and Group Health type of health plans that combine insurance, doctors, and hospitals into a single entity and allow doctors and hospitals off the fee for service treadmill by having a genuine incentive for prevention– although they are not perfect(what is?) – make a lot of sense.

Mary's comment reminds us all
how "profit " has become a dirty word under the Obama administration. Moral preening at its worst. Imagine, as she says, profit debasing the system!!!!!!!!!!

Refatsew
That sounds like a good start.



Loco...my apologies. What I meant to ask the Dr. is "How do we erase the corruption?"
Thank you for pointing out my error. I understand why you're sensitive on that point.

I think the main point of this article
is correct and we should let the market straighten out this mess. It was government with its everyone regardless of income should have any home they desired that started it all. But if the government continues it manipulation of the market place it will turn from bad to a real nightmare. The buy outs and spending has to stop.

Greenberg & refatsew
.
One of Greenbergs best recent articles.Congrats.
.
.
The good doctor makes a lot of interesting and I would say accurate points although rarely suggesting real solutions. That's the hard part, right doc.??.

Yes, profits or excuse me, corruption is the villan of the moment but comes from too many lawyers involved and too many big money investments made and viciously defended by segments of the "illness and/or injury industry". We are not even told the real story about our most serious illnesses, ie., cancer's cause and cure, heart and arterial problems, so called sugar diabetes, etc. The truth about cause and cure would free us of many, many cases and certainly lower the costs to reduce and or cure them. But, alas, the truth would reduce profits, not of insurance but of treatment and whether or not it was ever needed.

No, our real problem is not how but when we will ever get the truth from medicine about that which should be popular and public knowledge but instead is a hodge podge of half truths and lies.
.

Misplaced optimism
You are wrong, Mr. Greenberg, and your error lies in your looking at one tree, rather than the forest.

Consider that in just three or four years the Social Security system will become insolvent, whipsawed between the Baby Boomers retiring and their drawing benefits. This will necessitate a significant tax increase.

Consider also the Medicare program, which will be in much more trouble than Social Security, as Boomers sign up and receive benefits. This will require an even greater tax increase, added to the above.

And then there is the trillion-dollar stimulus burden, payment for which will involve an enormous tax increase, added to both the above.

And the Administration is pushing a 3-trillion dollar budget for next year, which, of course, will require yet another huge tax increase, added to the three above.

Nor should we neglect the cap-and-trade scheme wending its way through the legislature, since this would be an immense tax (although mislabelled) added to the four above. It would have the further effect of slowing the economy, so that all tax revenues would be less than anticipated.

Since tax increases, even at confiscatory levels, cannot meet these gargantuan obligations, government will resort to printing money, rendering savings and investments worthless. This is a replay of Weimar Germany, and spells the end of America as we know it.

Do you now see, Mr. Greenberg, why optimism here is utterly misplaced?

A

refatsew-CA
Dr. I,m Not Sufficiently knowlegable in the Medical Services to say anything other than BRAVO!! I have relatives who are HealthCare providers of various persuations and I know they agree with you..One of these people has been engagd in the Consolidation/Automation end of Medical Records with the DOD in DC for Years.. Much progress is being made but the "Privacy" thing seems to be a major obstacle..I guess I'm the only Retired GI in the world who thinks the VA is an even *Mediocre* Service, but for 25+ years the Local VA has done an excellent Job in my case and the Automation of MedRecs is Fantastic..I hope for the best from the CONGRESS but don't expect much..A GOOD DAY TO U, SIR!!
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