Letter to Progressives

November 2, 2010

Fellow Progressives:                                                                                                   

I cannot begin to tell you how frustrated I am over the multiple issues I feel that we progressives have mishandled.  In these confusing times, I guess that I would be called an “atypical” progressive.  I believe my goals are exactly the same as most liberal Americans. We need   adequate health care for all citizens at affordable costs with coverage for those unable to afford it.  I agree that a socialized medical system, without hundreds of billions of dollars in over payments and graft would represent the best and obvious solution.   Redundant and useless military spending and manufacturing needs to be redirected to mass transportation, engineering and restoration of the infrastructure.  I realize that the only real product this country currently produces is weaponry.  The rest of the industrialized world seems to outproduce us in every other area.

I realize that economically and morally, the idea of deporting millions of hard working, but “illegal” Mexican-Americans is based, mostly, on emotional rather than socioeconomic concerns. It is obvious that only Mexico can guard its borders.  We cannot afford to spend tens of billions of dollars and thousands of innocent lives, nor imprison scores of innocent American border guards, while depending upon the success of another “Berlin Wall!”  To guard the border, we must invest a few billion dollars in the Mexican economy and work out an agreement with our southern neighbors.

We need to understand, just as President Clinton explained a few years ago, that President Reagan, in his second (absentee) term permitted his administration to deregulate everything possible, destroying the savings and loans and raising the national debt to higher levels, proportionately, than did Junior Bush.  We need to remember that with guidance from James Baker, Bush’s father reluctantly raised taxes and convinced Democrats to cut spending and used the extra funds to begin paying down the debt.  He sacrificed a second term “to do the right thing,” thereby avoiding the huge economic catastrophe unforeseen by most recent Republicans and Democrats alike.  Clinton reminds us that he promised Senior Bush that he would continue his “mentor’s” economic policies which proved to be so successful.

We stood by and watched an incompetent and greedy administration start two useless wars, financed by the looting of over a trillion and a half dollars from the Social Security Fund while stupidly cutting taxes.  We did almost nothing to stop them and then, to add insult to injury, we supported the same incompetent morons who voted for those wars and who so willingly vandalized the most vulnerable segment of our society. We even tried to elevate two of the most incompetent and foolish senators in the history of the institution into the White House!  One, a decorated war hero didn’t have the brains to call draft dodger Cheney a coward and the other a “teenybopper” may have been the only living person who could lose a debate to the psychotic Dick Cheney.  Meanwhile, we know that the government cannot be sustained with our present tax cuts, even with cuts in spending.  We realize that raising taxes only on the rich is a token gesture, of little value in itself.  The middle class taxes must be restored as well because that is where the government’s real tax base lies. 

With the figures staring us in the face, we stand in abject denial.  Medicare wastes between one hundred and two hundred billion dollars per year in over payments!  Next to the Defense Department, it is the most wasteful and corrupt agency in the government!  Drugs are overpriced by an average of 100-150% more than the V.A. or military costs.  Durable goods like wheelchairs and braces are usually four times average retail prices and oxygen costs the agency three times the retail cost.  Medical laboratory prices are up to four times what they would be if competitive bidding were employed.  There is almost no competent oversight of hospital charges.  One hospital may find ways of charging three or four times the amount that its neighboring hospital charges for the exact same procedure without a peep out of the pathologically inept Medicare bureaucracy. I sometimes wonder why the government can’t own its own HMO and pay a hearty 15-20% to the competent private insurance bureaucracy to run it for them?

Believe it or not, Medicare spends more than 12,000 dollars per patient per year!   Medicare HMO’s, may take as much as 37 and a half percent off the top in profit and management fees.  Other management fees can raise the total to 40%.  Physicians, even those like myself and my associates, providing the same and often superior care to that afforded to private patients, can earn far more than “Medicare Allowable” fees.  What I am saying is that without any loss of quality, Medicare could easily spend seven thousand dollars per year per patient.  In short, it is the worst run agency in the entire government!  Before the collapse of the banks, I would have said “in the world!”  Respectfully, most progressives have no idea, at all, just how much political graft there is in Medicare.  Worse yet, until the massive Republican Part D scam, we Democrats, through the bogus efforts of people like Stark, Dingell, and others, were 100% responsible for the over payments.

Let’s see how proficient we are in arithmetic.  If I can buy my health insurance in Vermont for 20% less than I can in Florida, how much will I save, buying it in Vermont?  Yes-20%, not 3-6% as reported by the CBO.  Now, why would the CBO, certainly more proficient than you or I in arithmetic, provide bogus figures?  More importantly, how much did Insurance lobbies pay Democrats to keep portability out of our health care bill?  How much did lawyers pay certain progressives to keep even token tort reform out of the bill?

I’ll take a wild guess that we all detest the insurance companies’ practice of gouging the public and making illicit profits.  The question is: can they survive, even with collusion on rates and owning the soul of almost every state insurance commissioner, if there are no preexisting condition clauses or caps on expenditures?  More importantly, can a public option survive without some sort of control of these two factors?  For me to say that progressives may be naive about health care reform is actually an understatement!  Forcing people to buy really over priced and woefully inadequate private medical coverage (the only kind available at this time) merely because they fear punishment by the government... (why don’t we try substituting “punishment by the mob” and see how naturally it fits) is far too much like a protection racket to suit me!  Don’t our progressive leaders get it?  Tell them what you and I already know: we can’t mandate purchase of health care except through taxes!  No matter how hard we wish it, mandatory health coverage comes with national health care, not before it!  Put the freaking horse before the cart!

I am in no way trying to trash Anthony Weiner, Bernie Sanders, Dennis Kucinich or any of the passionate few who have laid their careers on the line for health care and other important social issues.  I know, arguing with them is like arguing with family and one takes liberties one would not take with an adversary.  I am only trying to help them attain common goals without taking two steps back for every one step forward.  Sometimes there are better ways to attain our goals, if they are more carefully planned and, yes, if we can calm our emotions and substitute long term strategies.

When Rahm Emanuel, someone I have roundly criticized in the past, and his good friend, Lindsay Graham approached President Obama, asking him to study the Republican health care proposal, apparently he did not.  The plan actually seemed to represent an excellent start to health care reform, one that if passed, would have been amenable to almost all voters.  Of course, they realized that the Republicans had no intention of passing their own bill and it was lacking in adequate coverage for the uninsured and a public option.  If passed, however, with reluctant easing of preexisting illness and cap clauses, with the inclusion of Medicare reform, portability and token tort reform, Democrats could show fiscal responsibility and they could win resounding victories in the midterm election.  Then they could bring back more progressive ideas, step by step.  That was Emanuel’s “wise” advice to the President, who, unfortunately, did not study the bill until his meeting with the Republican caucus.  By then Mr. Obama could see the merits of passing much of their bill, but was told that he was stuck with passing the fiscally irresponsible House bill by reconciliation in the Senate. 

Please realize that I feel that through naivete and over-zealousness, in their eagerness to rush through health care reform, progressive leaders may have actually made reform more difficult.  That is the only real disagreement that I have. 

I have spent almost thirty years fighting for health care reform and for socialized medicine.  I am a dedicated physician and health care provider who has managed to persuade even conservative physicians that if the public asks for a public option and even socialized medicine, that noone has the right to turn them down. Like many others, I have sent many letters and articles to progressive leaders, including Mr. Weiner and Mr. Sanders.  I am not surprised that they and their staff have not read them.  It will not affect my quality of life, but the less input they accept from health care experts and the less attention they pay to fiscal responsibility, the less they will accomplish in their efforts to bring affordable health care to all Americans

Yours truly,

Allen Finkelstein, D.O.