Saturday, March 15, 2014

More Observations on the Affordable Care Act

The worthy and inspiring promises of the Patient Protection and Affordable Care Act, "Obamacare,"  were reductions in health care spending to either reduce the national debt, of great interest to fiscal conservatives, or to free resources for other things, of great interest to fiscal liberals, even while increasing life expectancy, increasing personal well being of the citizens, and making sure nobody dies prematurely for lack of access to good health care, all benefits of great interest to most everybody. That is a nice package of promises, or at least of expectations, something for every constituency.

It seems to me that the judgments of and opinions about the ACA, now that it has been law for several years, are all about "me." My premiums went up so the ACA is BAD. My policy was cancelled so the ACA is BAD. My new insurance doesn't cover my old doctor so the ACA is BAD. Or, I have insurance now so the ACA is GOOD. My premiums went down so the ACA is GOOD. I'm getting "free" stuff now so the ACA is GOOD.  And both sides, proponents and opponents alike, play up this appeal to unpatriotic selfishness, barraging us with stories of people with such testimonies. 

And, I am not seeing any interest in or discussion of health care funds being freed up for other uses or in increased life expectancy, nor am I seeing any headlines about how many fewer than the disconcerting uninsured 30 million or so of 2008 are now uninsured.  I have heard of about 7 million signing up on the exchanges, but it is unclear how many have actually paid premiums, and I can't help wondering how many of the 7 million signing up are the same people who lost their insurance due to ACA requirements. After all, those are the people who have already demonstrated an intent to be insured and would be expected to waste no time replacing the lost insurance.

And, in all the discussion about there ACA, there seems to be little if any recognition that there is not necessarily any connection between health care insurance and the availability and quality of actual health care, a service than can be provided only by qualified providers, trained and educated doctors and nurses for the most part.



Given all that, my prediction is that health care spending will continue to increase, the debt will continue to increase, life expectancy will stay about the same, about as many people will be happier as will be unhappier, and about the same number of citizens will remain uninsured at any given time as before the ACA.  And the government will control a larger percent of the GDP through their new agencies, the health insurance companies, and through our new taxes disguised as health insurance premiums and penalties.  

I posted earlier on the same subject here.




Friday, March 7, 2014

Tax Return Woes, South Carolina Version

I always find absurdities in the tax forms conquerable only with the help of TurboTax or a qualified and expensive tax accountant.  And, It is not just the federal tax code that is ridiculously complex and unfair. Here is the list of tax credits available to South Carolina Income Tax payers. Don't feel lonely if you live in South Carolina and don't find anything here that applies to you. I didn't qualify for any of them either, but these are the reasons tax rates have to be as high as they are. Venison for charity credit? SC Quality Forum Credit? Mercury Switch Disposal Credit? Give us a break!

Lawmakers, tear down this tax code,  lower the rates, and give up your unjustified power to reward and punish and manipulate and buy votes via the tax code! Then you can get to work on things that matter.



Thursday, February 27, 2014

A Million Dollars! Not What it Used to Be

My financial objectives during thirty four working years at Eastman Chemical and Eastman Kodak were to meet family and personal obligations, stay out of debt, avoid credit card interest, and save and invest enough to be able eventually to “retire” and live comfortably on the income from same.  Age 60 seemed a long way off and a reasonable target.  I understood that there were two essentials for meeting those objectives, reasonable income and limited spending, and I was a pretty strong believer in avoiding unnecessary spending, a serious practitioner of so called “delayed gratification.”

I well remember during my early days at Eastman cashing a $20 check each week and expecting that to cover all my miscellaneous expenses, lunches, gas, fried pies, etc., for the week.  First apartment was $95 a month.  First house was less than $16,000. There was no color TV or new car or component stereo, a big thing in those days, until well into my mid thirties.  I hope my sons and my wife don’t think they suffered too much from my frugality.  I’m not sure what I thought about the concepts of retirement and not working, but was certain that I wanted more flexibility than would be possible as long as I had to follow somebody else’s schedule of work hours.  I wanted discretionary time.


Above is an artifact that might help make my point about frugality.  It is my very first payroll deposit slip from Eastman Chemical in September, 1965.  Rate of pay was $770 a month, and that $100 to the Credit Union was my first deposit in a brand new savings account. How about that twenty five cent Credit Union Entrance Fee?

Having been raised Southern Baptist, I was somewhat legalistic about tithing, and clearly remember the $77 check I wrote. It seemed like a lot of money.  Most months in those early years, I wrote my church check first thing and then sat on it till the next deposit to make sure the combination of that and the savings didn't cause me to default. That approach to budgeting may seem strange in 2014, but I had lots of frugal company in those days.  

Now, back to the issue of “retirement” and the funding of same.  I was in Rochester, NY, working at Kodak at age 50 and with 25 years of service, during Kodak’s declining years and was shocked, at a time much earlier than I had expected, to find they were willing to pay me and thousands of others quite a bit of money to just leave.  What an insult!

Kodak’s defined benefit retirement program provided full retirement benefits once age plus length of service totaled 85, and a person could retire with 50% of the defined benefit amount once that total was 75.  The year was 1991, and as of September, I had 75 “points.”  The early retirement incentive being offered stipulated that anybody with as many as 75 points would receive benefits calculated on the basis of 85 points.  I would qualify for a lump sum approaching a million dollars.

That was sobering.  I was pretty sure it didn't make sense for me, even though both our sons were already through college and we were debt free, but just to confirm that, I made an appointment with a local financial adviser familiar with Kodak benefit programs and listened carefully to his explanation of the benefits and the impact of taxes on them and how I was still fifteen years away from Social Security and Medicare, and various other complications and considerations.  If I was planning to take the offer, he suggested, I had better have another job in my hip pocket.  It just wasn't going to be enough, and finding a well-paying job at my age was not going to be a simple matter, at least in Rochester.

That was twenty three years ago.  A million dollars wasn't worth nearly as much as it had been in the days of my youth when a popular TV series featured wealthy benefactor John Beresford Tipton  giving a million dollars to a selected beneficiary each week, thereby enabling them to live in luxury forever after.  And since 1991, the value of a dollar has diminished such that in 2014 it would take $1.7M to buy as much as could be bought with $1M in 1991.  Adding insult to injury, with interest rates as they are today, the idea of safe income from savings and investments is only a dream…or a nightmare. A safe and guaranteed investment of a million dollars will generate income of about $15,000 a year, roughly matching a full time job at minimum wage.

I turned down the offer, worked another eight years, continuing in relative frugality, and retired at the turn of the century.  I fiddled around with golf and fishing for two or three years and then decided work was better.  I got a degree at a Lutheran Seminary which was a LOT of work, and since then have become increasingly involved in volunteer effort of various kinds, very fulfilling and somewhat demanding, but not clock controlled, and made possible only by those years of frugal saving and investing. And I enjoy contributing money along with the volunteer efforts.  I am thankful.

In light of my own philosophy and experience, it is sobering to read of the financial irresponsibility of so many Americans today.  About half have little or no savings and no retirement plan.  Another big group is saving far too little to maintain their accustomed standard of living in retirement. Tens of millions are living on the edge, beyond their means, enjoying the latest technologies and expensive coffees and “foodie” restaurant meals, paying big interest bills on credit cards or payday loans, and will be heavily dependent on Social Security and Medicare or whatever government programs are in place when they retire.

That may be OK if a person has simple tastes and little responsibility for family or anybody else, but it will be a saddening shock to many.  To top it off, even generously salaried working folks are at the mercy of their employers, and the paternalism I enjoyed at Kodak and Eastman Chemical, with pension and health care promises plus company sponsored savings and investment plans is dead.  It’s a jungle out there.  Shape up, America!

A penny saved is a penny earned.” – Not from Benjamin Franklin, but true nevertheless.

"He who does not economize will have to agonize." --Confucius

"The thrift that does not make a man charitable sours into avarice." - M. W. Harrison


I found some quotes condemning, but none promoting extravagance.

I never needed Dave Ramsey’s course.  I could have written it.  But for anybody needing an intervention, that is a good place to start.  


Wednesday, February 19, 2014

Plugged Ears, Downcast Eyes, Don't Know

I never think of myself as an environmentalist or nature lover, but maybe I qualify.  When I am out walking or biking, I am always looking and listening and paying attention to what is around me.  Sometimes it is traffic which is a danger to life and demands careful attention, but, on the Columbia Canal Trail, for example, it is flowing water, sometimes low and sometimes high, sometimes clear and sometimes muddy, rustling and falling and blowing leaves, plants and creatures of various kinds, all providing interesting sights and sounds, differing through the seasons and even from day to day.  And other humans are interesting to observe as well, all shapes and colors and sizes, moving at different speeds and in various manners, some gracefully and some clumsily. Contrary to popular thought, humans also are part of nature.

A disturbing thing to me is the number of those humans who are completely tuned out of their surroundings, ears plugged and eyes downcast, all attention focused on some little hand-held device, sometimes moving slowly and exercising their thumbs more than their legs.  On the Canal Trail, they often occupy the middle, probably reducing their chance of stumbling into the river or canal, but making it very difficult for cyclists to get around them.  And they have trouble hearing my bicycle bell or even my final desperate shout before a last minute decision about whether to try passing on one side or the other or just grind to a halt.  I have a problem with my recumbent bike:  when it grinds to a halt, my feet locked in the pedals, it tends to tip over and macerate my elbows and hips.  Maybe I should switch to a recumbent trike.

Those tuned out folks seem completely oblivious to their surroundings, and, unless they are reading news and commentary on their hand-held devices, I suspect they may be oblivious also to much of what is going on beyond their immediate presence, in the city, state, nation, and world.  Sometimes I see such folks on TV being interrupted by "man in the street" interviewers and being asked and failing to correctly answer such questions as, "Who is the Vice President of the United States?"  I fear some may be continuously connected via. Facebook or other social media to people who share and reinforce their own opinions, and that their habit extends to times when they are not out walking.   I love the joke (which I read on Facebook) about trying to explain, to someone who died in the 1950's, the most amazing thing about the technology of the early 2000's.  The proposed explanation consists of holding up a smart phone and saying, "I have in my hand a device that gives me quick and easy access to much of the knowledge in the world, and I use it to argue with strangers and look at pictures of cats."

I was a big fan of the TV series, Friday Night Lights, and in particular of Coach Eric Taylor of the Dillon Panthers football team.  Before games, Coach Taylor always reminded the team of their motto: "Clear Eyes, Full Heart, Can't Lose."  Now there seems to be a growing cult, the motto of which might be: "Plugged Ears, Downcast Eyes, Don't Know."

Maybe this fad will end up being as short lived as the driver distracting CB Radio fad (in which I participated) of the 1970's.  At least the illegality of texting while driving, if not while walking, is expanding rapidly.


Tuesday, February 18, 2014

Mileposts on the Way to Drowning in Debt

President Obama has been saying positive things lately about our declining federal deficit, pointing out, for example, in the State of the Union Address, that the deficit has been cut by more than half during his administration.  Well, that is true since it was highest since WWII at about 10% of GDP in 2009 and is now about 5% of GDP. It is also true that it remains unsustainably high by any reasonable historical or fiscal standards and that we are warned that it will increase again as costs of Social Security and Medicare continue to rise, and as the Affordable Care Act takes effect.

Why is the most prosperous nation on earth persisting in an intentional decline into destructive debt in the futile and self defeating pursuit of increasing prosperity?  Why can we not develop a responsible sense of priority about spending and taxing?  Why can we not resist demanding more and more from the federal government even while insisting on paying less and less?  And why does an irresponsible congress keep granting our wishes in the pursuit of votes?

I like thinking of 1960, my high school graduation year, as a sort of baseline for the modern economy. We had largely recovered from the debt incurred during WWII, the economy was strong, Social Security had been in effect for 25 years but there were still lots of workers for every retiree, and we had not suffered the fiscal or psychological effects of the Vietnam War or President Johnson's War on Poverty. Oil was still $3 a barrel. We were happy and confident. We could graduate from high school, move to Atlanta, and take a job earning enough to get married and start a family.  And nobody had been assassinated in recent memory.

In 1960, very few were receiving a check from the federal government, and the total government paid social benefits were $20B, about 4% of GDP.  Now, almost half the population receives some check from the government, and total social benefits are $1.86T or about 11% of GDP.  Of course that is just part of the spending problem but one that threatens to get much worse as the population ages, work force participation declines, and the practice of family units working together as economic units becomes increasingly uncommon.

Below is a chart I constructed of the annual federal deficits defined as total federal government spending minus total federal government revenues as a percent of GDP.  Major mile posts and turning points are indicated.  It has been a 54 year slippery slide, with occasional relief. Chances are some readers will disagree with my mileposts, but the data are irrefutable, taken directly from the BEA NIPA tables. Final numbers for 2013 are not in, but the point plotted is for the first three quarters.  Click on the chart to see the whole thing.


How soon and how deep will the next hole be after the next burst bubble which could be bond prices or education prices or health care prices?  Or the government  might even pump enough into real estate to generate another bubble there.   

Thursday, February 13, 2014

TQM, Health Care, and the Federal Government

TQM, Total Quality Management, was a buzzword of the 1980’s and 1990’s that, as all buzzwords eventually do, has pretty much vanished from the language of management.  But the validity of the organizational principles on which it was based is clear.  Those basic principles, as I remember them are:
  1. Top leadership must establish clear objectives and goals for the organization and communicate those throughout the organization.
  2. All activities of all individuals, teams, and units must be based on an understanding of and be closely linked to the goals of the total organization.
  3. Standards and status quo maintenance are forbidden; the objective is always continuous improvement.
  4. The goal is prevention of, rather than detection and sorting of, defects, including bad decisions, leading ultimately to error-free operation.
  5. Improved control of processes, including management processes, leading to less variability, greater reproducibility, and fewer defects, errors, problems, and waste is always the primary route to continuous improvement and the primary responsibility of leaders and managers and employees at all levels of the organization.
  6. About 80% of defects, errors, problems, and waste are caused by about 20% of the sources of such.  Data based measures must be established in order to determine these sources, and the highest priority must always be given to the 20%.
  7. Complete fact- and data-based diagnostic journeys must be completed and validated before leaping to solutions.
  8. Solutions must be preventive rather than compensating or correcting, must be permanent in nature, and must become institutionalized.
·     The fundamental basis for all the above is a belief that improved quality, properly understood, and reduced cost (waste) are opposite sides of the same coin and together determine the success of any enterprise, private, public, or government, non-profit or for profit, manufacturing or service.

There are various lists of these principles, with various slants, developed by various consultants who offered their services to companies and organizations anxious for improvement.  At one point, the buzzword became Customer Satisfaction.  Of course that is generally true, but I always liked the Steve Jobs quote: “Customers don’t know what they want until you show them.”  One list of principles in Wikipedia is attributed to the US Navy, an early adopter of TQM.  

A problem in TQM implementation was that it often tended to start at the bottom with "Quality Circles" and other low level teams, management seeing it as a way to get the employees to get busy and do what management wanted them to do.  The unfortunate result of that often was organizations and groups running off in various directions, sometimes doing quite well in achieving objectives that had nothing to do with success of the total enterprise.  That is why Dr. W. Edwards Deming, one of the two or three most prominent gurus, normally refused to talk to management groups unless the CEO was present.  Use of TQM principles at the top of any effort, including careful identification of issues and disciplined diagnostic journeys will almost always result in organizational and staffing improvements and will always result in clearer direction for the separate teams and organizations.

So, a reasonable question might be about whether and how to apply TQM principles to the issue of health care from the viewpoint of the federal government?  There is a single clear purpose of our federal government: preservation of life, liberty, and freedom to pursue happiness.  While it is true that the founding fathers built in a certain level of chaos with the essential “balance of powers" concept, no CEO with the power to unilaterally dictate objectives and goals, I think it is clear that they intended the branches of government to work together to provide leadership in the accomplishment of that single clear purpose. 

With respect to the health care law, had I been president and wanted to apply TQM principles, I might have identified lack of accessibility to health care by 20% of the population as a serious and significant problem defeating our purpose stated in the previous paragraph.  If so, I would have worked with both parties, from a position of neutrality, and away from the eyes of the media, to get buy in on the seriousness of that problem and agreement that it deserved our attention.  Then I would have appointed a cross functional bipartisan team to analyze the data and tell us what the major causes of lack of access to health care are.  I would want to know how much is due to poverty, how much due to poor choices, how much due to insurance company policies on pre-existing conditions, etc.  I would have kept my mouth shut, except for asking questions perhaps, as they worked.   I would have resisted the temptation, always my biggest problem in using this technique, to jump right to a solution.  

I am very comfortable that such a process would not have led to anything remotely resembling the ACA.  I can imagine it might have led to gradual reduction in the age at which Medicare becomes available and, for fiscal sustainability, a restriction of Medicare availability to people below certain income or wealth levels.  It might also have led to a loosening of restrictions on access to Medicaid.  It might have led to a mandatory insurance pool, with participation by all insurers with government contracts, for people with pre-existing conditions.  It might have led to establishment of free medical clinics in counties nationwide.  It would not have led to a takeover and expansion of the insurance industry and a requirement that everybody do business with that industry or be penalized by the IRS. 

So, now we have a bulky, clunky, burdensome new system, with various new taxes and restrictions on freedom, overlaid on everything that was already there, passed by one party only, establishing a new entitlement that will grow as long as our debt can stand it and then shrink along with other entitlements such that health care on average will suffer, with implementation of key provisions being continuously delayed because of unforeseen difficulties and, maybe, looming elections.  

And it is obvious that, even for the simple task of designing the website to support the ACA, no principles of TQM were successfully employed, even at that low level of the organization.  The fatally flawed approach to the health care access issue was obvious when the CEO assembled and led the Feb 27, 2010, "bipartisan" meeting of congressional leaders on health care and publicly admonished Senator John McCain: “Let me just make this point, John, because we are not campaigning anymore. The election is over.”  I did a blog post on it here

TQM principles are valid, but have to be applied at the top to be successful.


Monday, February 10, 2014

Labor Supply vs. Labor Demand

Here is a key point to keep in mind: Labor supply and labor demand are separate and independent variables. When the demand exceeds the supply, wages will tend to rise, and when the supply exceeds the demand, wages will tend to fall.  The large number of women entering the workforce beginning in the 1970’s increased the supply and put downward pressure on wages.  Starting about that same time, automation and globalization decreased the demand and put downward pressure on wages. I believe these are the reasons pay has not kept up with inflation and economic growth in recent decades. 

While it was standard in the 1950’s and 1960’s to have one wage earner per family of five, it has now become standard to need two wage earners even in a family of three.  Here’s an idea.  If all the men were to decide now to leave the workforce, there would be a tremendous shortage of labor, upward pressure on wages, much higher pay for working women, and the need for two wage earners per household would disappear, at least for those households in which there is a woman.  Equal pay for equal work might still be an issue but with no sexual component.  And the interiors of houses would get dirtier and dirtier even as landscaping improved dramatically, cars glistened, and garages became perfectly organized.  I'm not sure how the children would fare.        

One factor that could be easily overlooked is the change in family composition over fifty years.  The standard, admittedly for a very short time in the history of the universe, was wife, husband, and three kids with one breadwinner heading out to work five days a week, eight hours a day, and one homemaker doing the really hard full-time work of housekeeping, child rearing, shopping, meal preparation, etc. Now there is no standard.  Single parents and unmarried folks living alone abound and usually must work both at home and away.

Homelessness is an issue exacerbated by the breakdown of the family and could be greatly reduced by formation of a new family structure, two heterosexual, down on their luck, homeless guys in a civil union.  Lots of homeless guys have some income such as disability and food stamps but not enough to rent an apartment and pay utility bills.  Two such persons together could swing it and leave the ranks of the homeless. They would just need a two bedroom unit.  The union would have to be civil though…no fighting allowed.

What made me think of this mess is recent news on the number of people expected to leave the workforce because of the Affordable Care Act.  Here is what the CBO office reported: "CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 to 2 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor—given the new taxes and other incentives they will face and the financial benefits some will receive," said the report. 

It almost seems like the strategy of our leaders is to get us to just relax and smell the roses.  Don’t worry about working, they seem to be saying.  They will take care of us. 

ACA supporters are saying that this is a great thing because people who were in jobs they didn't really like just for the sake of health insurance can now stay home.  With the ACA, extended unemployment, expanded food stamp rolls, and early retirements, more and more are making that choice.  There will be a tipping point at which wages will soar as labor supply dries up.  Eventually, wages will be astronomical, but nobody will be working. 

It’s a complicated world, mostly because we make it so. Go back and read the first paragraph again.  It is probably the only thing in this post that makes any sense.


More Social Security? Yes, for a few.

In the last six years, as a volunteer with Home Works of America, I have visited the homes of, and met and had discussions with, 244 low income elderly retired or younger disabled persons looking for assistance with repairs to their homes.  We are able to assist about eighty percent of homeowners whose homes are previewed, and I have had the privilege of helping with forty eight projects over the last eight years.  Home Works, founded in 1996, repairs about 150 homes per year.

Typical income for homeowners we assist consists only of Social Security of around a thousand dollars a month.  All are on Medicare or Medicaid, so, including that, a very little help from family, and occasional trips to the food bank or visits from Meals on Wheels, they can just barely make it in a house with no mortgage and no maintenance expense. Unfortunately, houses require maintenance.

I say this just to provide some credibility for comments I make and opinions I hold about the problem of poverty in the United States. I am not making this information up.

We have a sad situation, but it provides no support or justification for the arguments some are making  for a general increase in social security benefits and taxes.  The solution to our Social Security funding problems is cuts in both benefits and taxes and careful targeting of the benefits.  

That may seem heartless, but the elderly income data provided in economist Paul Samuelson’s February 7th column provide a sound basis for it.   Samuelson’s information comes from a Congressional Budget Office study based on Internal Revenue Service data and reports average pretax incomes of the poorest to the richest fifth of older Americans in 2010.  Here are the data:

               Poorest fifth: $19,900
               Second fifth: $34,400
               Middle fifth: $55,100
               Fourth fifth: $82,100
               Richest fifth: $219,500

So, at one end of the Social Security spectrum, we have elderly widows in crumbling housing getting along on $1000 a month and seriously needing help.  At the other end, we have retired professionals and executives, people like me, getting probably $3000 a month from SS and hardly being aware of it because of other retirement income.  Many retired people may enjoy but do not depend on Social Security, unless you want to argue that they depend on it for golf and restaurant and vacation expenses or maybe to fund a second home in a low tax state claimed as primary residence.

That would be fine if our Social Security taxes paid over our working years had been invested for our benefit rather than "borrowed" and spent and if our working population were willing and able to continue to fund the program adequately to cover all those benefits.  But the current situation is that the excess funds we paid in are gone, Social Security is on a borrow and pay as we go basis, and young working families are contributing 12.4% to 15% (if self employed) of their pay to Social Security, presumably for their own future benefit, but actually to support the often comfortable retirements of their parents and grandparents.  It isn't fair.  Somebody should go to jail for raiding the fund.  Maybe one of the huge fenced retirement communities could be converted to a prison because the raiders are dead or retired or still members of congress about to be retired due to low approval ratings.

Of course we retired folks are justified in demanding the benefits we were promised.  We paid those taxes all those years, and it's our money.  I still have my very first pay slip from Eastman Chemical in September 1965, and it shows that I paid $27.91 in Social Security (F.I.C.A) taxes on a monthly rate of $770!  I suppose Eastman paid the same amount for me. We want that money back with interest!  We are entitled to it, and we are going to get it even if it does come from our children who are raising our grandchildren on tight budgets, or as loans from China, and even if it ruins the credit rating of The United States of America!

A certain segment of the US population has little or no sympathy for the poor widow on $1000 a month. They argue that her problems are of her own making, but she was probably born into poverty, got a substandard education, spent her life working  in a series of part time jobs at low wages with no benefits, and, without Social Security and Medicare, would be destitute.  You may be asking, “Where are her children?”  Well, they too were raised in poverty, got substandard educations, and are spending their lives working in a series of part time jobs at low wages with no benefits.  And, a hundred years ago, families took care of families, but, for various reasons, family structure and responsibility are not what they used to be due to deterioration aided and abetted by some of our government benefit programs (example). 

So, changes will have to be gradual because we have to keep promises to taxpayers retired and near retirement, but, for the long term we need to shrink Social Security by eliminating promises to future retirees that push total income above $60,000 or so in 2014 dollars while still providing a safety net for us all but luxury and comfort for none.  That will mean lower taxes, lower or no total benefits for most, more benefits for the truly needy, and less money being channeled through Washington DC for redistribution.  

I have read arguments that Social Security must be expanded and benefits increased and that the solution to the financial problems is to remove the cap on Social Security taxes, currently at 12.4% of the first $117,000. I did some analysis on income and tax data that Warren Buffett provided here.   Mr. Buffett and his employer(s) apparently paid the maximum $14,508 in Social Security taxes in 2010.  With the cap removed, he would have paid $7.8M.  I can see why some people might think that is cool, but it would simply result in a much bigger unnecessary flow of money through Washington, DC, much of it going to people who don’t need it and much coming from families who, unlike Buffett, do need it.  It would be much wiser and more fiscally sound to shrink and target the program so that it becomes a true safety net rather than golf money for prosperous retirees.

Those of us campaigning for increases in Social Security in the name of "social justice" while receiving non-essential Social Security may want to carefully review, and probably increase, our charitable giving in support of the helpless elderly and disabled.  Just don’t give it back to the government where it would disappear into a black hole.

As I have argued several times on this blog, we have plenty of money to help the truly poor if we would stop trying to help everybody in an unholy pursuit of votes. 



Tuesday, February 4, 2014

Equal Pay for Equal Work

In my early days at Eastman Chemical, in the late 1960’s, I learned a lot of practical stuff about chemical plant construction, and a little common sense, from a pipe-fitting foreman, Mr. Hugh Wilkerson, a man with probably 35 years seniority over me.  Hugh’s superintendent was Mr. Bill Kappa.  One hard and fast rule at Eastman, a very conservative and paternalistic company, was that our salaries and our raises were to be considered confidential information between us and the company and not revealed to other employees under any circumstances.  Hugh and I were discussing that policy one day and he said, “I’ll tell you how Mr. Kappa explained it to me.  He said that if two people swap salary information, one of them is going to be unhappy, and he doesn’t want anybody unhappy.”  I should say that the policy on pay secrecy didn't have anything to do with keeping women and minorities in their places because there were few if any.

Let me digress a moment and share another bit of wisdom from Hugh.  He told me once not to work myself to death for “The Eastman” as it was called in the local community.  He told me I could work myself to death, die on the job, and be carried out the gate on a stretcher and everybody would say, “There goes ole Darryl.  He was a good man.”  And that would be the last time I would be thought of in the work place.  My absence would be like the absence created by removing ones finger from a bucket of water.  I didn't die on the job, but I would say that pretty much describes the impact of my retirement at the end of 1999.  

But back to the subject at hand.  Unequal pay is a fact of life in most situations, maybe at least partly because, during a 34 year career in industry, I rarely observed instances of equal work being done by two persons.  That was true even in situations where compensation was exactly the same, hourly chemical operators at the same pay grade and same length of service, office assistants at the same pay grade and same length of service, janitorial workers at the same pay grade and same length of service, etc.  In anything other than routine production line work with little or no human interaction, and strict adherence to standards and procedures with little room for creativity, every individual brings unique contributions to his or her job and, as a result, contributes at a different level from others with the same assignment.  And over time, rates of compensation diverge and opportunities for advancement fall unequally based on management perceptions of those contributions and the abilities of individuals to take on additional responsibility.

Of course management is sometimes wrong, and sometimes those management perceptions are colored by personal or institutional biases based on race or gender.  I would say such biases were fairly common and sometimes openly expressed when I started my career in the 1960’s but completely suppressed by the time I retired at the turn of the century. Any expressed biases in the 1980’s and 1990’s were completely opposite those of the 1960’s as the company endeavored to get more women and minorities in well-paying positions of responsibility.

This is not to say that I had or have a great deal of confidence in the ability of management to accurately assess the values, in the short term, of the contributions of individual employees.  I came to agree with Dr. Deming that many of the perceived differences in performances of individual employees are due to pure chance or uncontrollable circumstances or to assignments, some easy winners and some doomed to failure.  Still, there is validity in consistent high ratings over time by a variety of supervisors, in a variety of jobs, and that is what was normally required at Eastman for steady advancement.

So, since the idea of “equal work” is pure fiction, at least for professionals, we might as well forget any idea of “equal pay for equal work.”  Even “work” itself, except for manual labor, piecework, and other easily observable and measurable effort is difficult to define.  During my career, I normally “went to work” at 8am and “got off work” at 5pm.  But, many of my best ideas and most productive efforts came during the drive to and from work or during a good long run before supper or perhaps in bed just before drifting off to sleep.  (No cell phones or email or home computer during most of that time.) I might have stood around the coffee pot eating donuts most of the day, looking totally non- productive, and then had a real breakthrough idea during my run.  As a matter of fact, I recall one of my managers once telling me in a performance review session that, though I seemed to be getting good results, I never seemed to be doing anything. (That was before computers.  Once we got computers, I was always busy.) 

Maybe we need to strive for equal pay for equal experience, wisdom, knowledge, skills, effort, responsibility, and results.  I suppose that would be fair, even if impossible and maybe even unimportant.  If we fail, we can at least be thankful for this:   "...life does not consist in an abundance of possessions.” – Luke 12:15b (Revised to omit 15a on greed).  

Hmmm.  That is a similar theme to that of the advice I got from Hugh Wilkerson.  If I hadn't followed it, I could be richer and deader now.

Monday, February 3, 2014

One Little Health Care Conspiracy

I've written about this before, and the issue was documented in Time Magazine's February 20, 2013 article on US health care, Bitter Pill, but nothing has been done, so I think I will bring it up again. Once a year or so shouldn't be too often, considering the seriousness of the problem.

The issue I am talking about is the lack of price transparency and competition on hospital charges and the unfairness that results.  Bitter Pill described the "chargemasters" hospitals use and the ridiculously inflated faux bills based on them.  According to Bitter Pill, "hospitals end up being paid a lot less overall than what is itemized on the original bills. Stamford ends up receiving about 35% of what it bills, which is the yield for most hospitals."  Can any enterprise survive receiving only 35% of what it bills, if the bills are reasonable and fair?

But what do we care if the hospitals are having trouble collecting their accounts receivable?  The problem is that, while insurance companies, Medicare, and Medicaid have negotiated, or dictated, much lower reimbursements and simply ignore the hospital bills, individuals without insurance receive the faux bills, followed closely by bill collectors, and are expected to pay the full amount.  To be fair, it is my understanding that an uninsured person can usually complain and jump through some hoops and get some reduction in the bill, but that is not guaranteed, may vary from patient to patient, is humiliating and time consuming, and is unfair.

I have on my desk a hospital bill for a three or four hour visit for a check up and CT Scan following a fall that resulted in a bloody nose.  Here is what the hospital billed:

   CT Scan General                        $1,635.98
   Drugs Req Detailed Coding            217.70
   Emergency Room General              457.70
   IV Therapy General                          69.00
        Total Charges                        $2,380.38

Now that is a scary bill, enough to drive a person to the health care exchanges even if the exchanges  aren't working.
(Let me just mention parenthetically a big driver on health care spending increases, the simple fact that 25 years ago nobody would have gone to the hospital for a CT scan after such a simple accident and injury. Now there are all these scanners, rumored to increase the risk of cancer, installed, and reimbursements for their use, though low, are guaranteed and well above the variable cost, and there is that liability concern if a patient is not scanned and later turns out to have a cracked skull, and so the doctors keep prescribing and the scanners keep scanning and generating revenue.)
The patient, in the case above, had a Medicare Advantage Plan with one of the four or five largest US health insurance companies, and the "Account Summary" says that the insurance payments to the hospital totaled $235.74. The patient was asked to pay the hospital $65.00. That means the hospital actually collected $300.74, only 13% of the faux bill total, which left an unpaid total of $2,079.64, shown as an "adjustment" to the bill.

So, the hospital misled the patient, winking at the insurance company, claiming that $2,380 is a reasonable and normal charge for the services rendered. The insurance company, which had already negotiated what it would pay, misled the patient, winking at the hospital, implying that their superb negotiating skills and bulk purchasing power enabled them to buy this package of services, worth almost $2,400, for less than $300. How lucky can a patient be to have such a great insurance company?  My interpretation would be that they are involved in a price-fixing conspiracy to the detriment of uninsured individuals.

I suppose this deception and game playing would matter little except that when an uninsured person comes in for exactly the same treatment, that person will be presented the bill for $2,380 or some similar total and will be expected to actually pay it. Is it any wonder that we hear all that meaningless chatter about expensive emergency room visits, "expensive" only because of arbitrary cost allocation systems, and have become convinced that health insurance is essential to life and maybe even more important than health care itself?  If a person is paying $5,000 per year for an insurance policy and it provides a benefit of $2,300 in a simple case such as this, the person is probably going to believe strongly in the value of that insurance. Finding out the insurance company only paid $235 greatly diminishes the perceived value of that policy.

We have a grossly unfair system, based on deception, with no price transparency and no competition, and it should be changed now.  An easy way to do it would be to implement a health care provider regulation that says individuals without insurance cannot be charged more for any particular treatment or service than the average paid by the insurance companies.  An easier way would be for the hospitals and other providers to just come clean with fair and competitive prices, publish them for all to see, charge everybody the same, similar to the way grocery stores and furniture stores do it, and quit cutting special deals with the insurance companies, Medicare included.  Maybe an occasional BOGO offer on knee replacements would show up in the newspaper supplemental ads.

Don't look for either of those things to happen because both would make people less scared about health care bills and therefore less likely to sign up for the prepaid health care plans being offered by the new ACA health care exchanges.  Our relationships with our insurance companies, or with the government insurance programs, now required to provide everything from birth control pills and Viagra to abortions, heart transplants, and chemotherapy, are examples of the Stockholm Syndrome.  We are their prisoners, and our lives depend on them.  I've heard people brag on their excellent coverage by describing some humongous medical bill they received which was "handled" by their insurance company.  I usually ask how much the insurance company actually paid.  I rarely get an answer to that.  We'd be much better off paying for our own routine care at competitive prices and buying major medical insurance, at competitive prices, to take care of the big stuff.  And spending on health care would be much lower because we would not have to bear the cost of insurance company and medical provider overhead required to code and document and process every tiny procedure.

I'm wondering if a good strategy for the Catholic hospitals, under such pressure to provide insurance for abortion and birth control against the teachings of the church, might be to stop accepting third party insurance and simply establish and advertise fair and reasonable prices that most people could afford to pay at the time of the service, no red tape or paperwork required. The hospitals could offer their own catastrophic health care insurance by selling memberships, total concierge health care for the middle class.  I'm guessing a premium of around $1,000 a year per person would cover the catastrophic expenses for cancer, heart disease, etc., and would leave a lot of money available for charity medical services for those overlooked or underserved by Medicaid.
________________________________________________

The American Hospital Association was not happy with Bitter Pill and published its responses, including a weak defense of "chargemasters," here.

And Forbes Magazine pointed out some business related errors here.


Thursday, January 9, 2014

List of Previous Posts to This Blog

1/4/2013
1/7/2013
1/18/2013
1/23/2013
1/31/2013
2/2/2013
2/3/2013
2/10/2013
2/12/2013
2/13/2013
2/17/2013
2/19/2013
2/21/2013
3/2/2013
3/7/2013
3/10/2013
3/14/2013
3/18/2013
3/21/2013
3/26/2013
3/28/2013
4/8/2013
4/12/2013
4/13/2013
4/22/2013
4/23/2013
4/24/2013
4/27/2013
5/7/2013
5/9/2013
5/20/2013
5/22/2013
6/6/2013
6/12/2013
6/30/2013
8/23/2013
8/27/2013
9/20/2013
10/1/2013
10/3/2013
10/4/2013
10/18/2013
10/20/2013
10/27/2013
10/28/2013
11/7/2013
11/9/2013
11/13/2013
11/16/2013
11/23/2013
11/30/2013
12/15/2013
12/30/2013

1/8/12-I Liked and Like Ike
1/9/12-REALLY Boosting Buffett's Tax Bill
1/19/12-Pay Me Later - Mitt Romney
1/22/12-Self Esteem, Sackcloth, and Ashes
1/27/12-Catholic Hospitals, From a Child's Viewpoint, Then...
1/28/12-Post WWII Economic History in a Nutshell
2/3/12-Komen - Planned Parenthood Publicity Stunt?
2/14/12-I Know the USA, and the USA is no Finland
2/16/12-What Are Your Assumptions?
2/23/12-Election Outlook
2/25/12-Free Pills, Pricks, and Probes for All?
3/7/12-Doolittle Raider Memorial Update
3/26/12-No Individual Mandate in Spanish Health Care Syste...
3/28/12-Spain’s History of Tyranny, Tolerance, Tribute, an...
4/3/12-Lest We Forget (As Elections Approach)
4/6/12-Inflation: Why Not?
4/17/12-Washington Fiddles While Government Burns
4/20/12-States' Rights and Wrongs
4/22/12-Don't Make Me Mad!
4/29/12-Erik Larson’s In The Garden of Beasts - A Cautiona...
5/4/12-Predicting Markets Is Easy; Being Right Is a Matte...
5/10/12-Obesity in America, Personal and Federal
5/20/12-Prosperity is Back...in Washington, DC
5/22/12-Private Equity: Could It Have Saved Kodak?
5/23/12-Texting While Driving Warning App Needed
6/5/12-Lying Awake, Getting Up
6/11/12-The Money Hypothesis
6/15/12-Harvey Golub, Simple Minded Genius and Dreamer
6/16/12-Paying for College
6/20/12-Harry Truman, Humble Public Servant
6/27/12-Political Operatives "Like" Survey Writers
6/29/12-Conservative Justice Roberts - The Day After
7/2/12-Federal Social Insurance Tax and Benefits Update
7/3/12-Looking for a Goldilocks Government...Just the Rig...
7/4/12-History of Federal Debt in the USA - An Issue for ...
7/6/12-New Governing System In Place?
7/10/12-Volunteers Robbing People of Jobs
7/17/12-Home Works of America Needs Your Vote - Today
7/18/12-Personal Responsibility, Humility, and Making Thin...
7/20/12-Golf: What's the Point?
7/30/12-Defining and Preserving the Middle Class
7/31/12-Postal Woes Continue
8/8/12-Democrats 0, Republicans 0, USA 0
8/10/12-Romney's and My Real Estate Investments
8/14/12-Battle of Budget Gurus, Stockman and Ryan: Food fo...
8/25/12-Quality, System Dynamics, and Mr. Romney
8/27/12-Norquist Plan Failed - Time to Regroup
9/6/12-Skeptical Observer With Dirty Hands?
9/9/12-Employment and Job Woes
9/11/12-Going, Living, and Dying Broke
9/14/12-Fed Stimulus a Politician's Game
9/17/12-Sequester Panic
9/19/12-Romney No "Silver Tongued Devil"
9/22/12-Tax Rate Increases Signify Trouble...Or Poor Manag...
9/23/12-Dreamy Future for USA Health Care
9/25/12-Oh Canada, Will You Loan Us Some Liberals?
9/27/12-Stinginess Not The Only Alternative (To Philanthro...
10/6/12-Debate Reflections
10/7/12-Private Investment, Big GDP Driver, Lagging
10/12/12-Exit Blocked, No Way Out
10/15/12-Stephen Colbert Cheap Joke Opens Way for Daily Kos...
10/22/12-Creationism (As it Relates to Jobs)
10/28/12-Drug War Option
10/31/12-Why the Class Warfare?
11/7/12-Election Reflections
11/9/12-Fooling Around With Mother Nature
11/12/12-Taking the Leap, Hitting Bottom
11/19/12-Taxes and Consequences
11/24/12-Recent Economic History...Since the Good Ole Days
11/27/12-US Gov. Social Insurance an Unbelievably Good Deal...
11/30/12-Troops or Teachers?
12/2/12-Following Thelma and Louise
12/6/12-Jack's Cafe Executive Chef
12/7/12-Red State Blue State, Demographics, Economics, and...
12/11/12-Man Alone
12/18/12-Looking Up?
12/21/12-None of Their Business
12/30/12-Asking the Wrong Question About SS and Medicare
1/4/13-No Satisfaction?
1/7/13-Tax Rates, Breaks, and Relief
1/18/13-Rosy Outlook?
1/23/13-In The Long Run We Are All...What?
1/31/13-All Federal Spending Discretionary
2/2/13-Crime, Guns, and Lead
2/3/13-Debt Woes Not So Dire?
2/10/13-The Stock Market Forest (Over My Adult Life)
2/12/13-State of the Union Address Ideas
2/13/13-Deficits are Flows, Debt is a Stock
2/17/13-Two Sets of Books?
2/19/13-Creating A Crisis
2/21/13-Confluence of Aging, Health Care, and the USPS
3/2/13-Getting Serious About Health Care Reform

Postings From 2009, 2010, 2011

Business
9/23/2009 Where Have All the Profits Gone?
10/9/2009 Executive Pay - A Corrupt System
1/22/2010 Separation of Business and State
3/1/2010 To Profit or Not To Profit
4/28/2010 Bonuses, Variable Pay, and Unintended Consequences...
8/21/2010 Shrunken Kodak and Its Southern Offspring
2/8/2011 Teachable Moment Flubbed
4/27/2011 Getting to the Bottom of Things: Universal Toilet ...
7/21/2011 Apple and Peter Lynch Big Winners, But Not I
Climate Change
9/16/2009 Global Warming Considerations
12/6/2009 Climate Change Questions and Concerns
12/10/2009 NBC Joins Time Magazine in Global Warming Battle
12/11/2009 Fishy Global Warming Story
12/13/2009 US Warmer Than 110 Years Ago
12/14/2009 350 PPM, A Goal Snatched From the Air
1/7/2010 Geoengineering and the Coming Ice Age – Word from ...
1/20/2010 Balmy Breezes in January!
2/16/2011 Where Can I Apply for Carbon Credits?
11/5/2011 What's the Weather Going to Do?
Culture
12/8/2009 Values, Morals, Virtues, Jesus, Paul, Tiger Woods,...
1/6/2010 Population Age Distributions Interesting
8/5/2010 Sheltering Women - Making New Ways
8/16/2010 Language, Culture, and Mosque Difficulties
8/23/2010 (Not) Growing Up In America
8/28/2010 The Residual Burdens of Slavery, Civil War, and Op...
9/2/2010 Moderate Muslims and Religious Tolerance
9/19/2010 Feeling Crowded and Frustrated?
9/26/2010 Looking For a Few "Diverse People"
Education
1/29/2010 Education Reform?
4/25/2010 Rating the Teachers
5/10/2010 Education Report Cards and the New High Schools
5/12/2010 Education in America (Well, Tennessee Anyway) - 100 Yrs Ago
5/14/2010 Personal Experience, Logic, Data, and Ideas
5/17/2010 Multiple Choice Tests and Education Spending
5/26/2010 MHS - Secondary Education Success Story
6/5/2010 False Hopes and Student Loan Sharks
10/30/2010 Lady Gaga Course Offered at USC
12/6/2010 Public Schools, Private Schools, and the Voucher Q...
12/26/2010 Poverty And (Or of) Education
6/14/2011 Higher Education Higher and Higher
10/11/2011 When Averages Matter; When They Don't
11/1/2011 Education Essentials (For Getting A Job)
11/6/2011 Future of Education - Khan Academy
Government
11/2/2009 Socialism Not All or Always Bad
11/10/2009 Please, Please Don't Privitize Social Security (ch...
11/23/2009 Postal Service Woes and the Public Option
1/4/2010 Unionization of Government Employees
1/14/2010 All Eyes on Washington!
2/6/2010 Shatterproof Pub Glasses – A Permanent Fix?
3/15/2010 Supersize That Combo!
3/19/2010 Peggy Noonan and Chris Matthews on Baier-Obama Int...
4/19/2010 Legislate or Regulate, What Shall We Do?
4/26/2010 To The Parents of Darryl Williams
4/30/2010 Enough?
5/5/2010 My Obesity Challenge to Congress
5/13/2010 (CDCEACMB) Confusion and Depression Caused By Expensive Acronyms Created by Massive Bureaucracies
5/25/2010 Gulf War Complex, Many Combatants, Fuzzy Organizat...
6/14/2010 Voters, Pay Attention!
6/24/2010 Getting Early Morning Stimulation From The News
6/25/2010 Theological and Financial Reformation Issues
7/7/2010 Giving Up on Fox News?
7/9/2010 Forgive Me. I Used To Be a Chemical Engineer
8/18/2010 Social Security Projections Mysterious and Controversial
10/1/2010 That Regrettable Ruling Mentality: CNN Lets Cat Ou...
11/30/2010 Secrets
2/4/2011 Government Barriers, Government Bridges
2/22/2011 Japan, Saudi Arabia, and the USA
2/27/2011 Social Security "Privatization"
3/5/2011 Noonan to the Point
5/3/2011 Tweaking the Social Security Wage Cap
6/8/2011 Theology of Wealth Spreading
6/12/2011 Feral Cats, Hardwood Floors, Guns, or Butter
9/7/2011 Postal Problems Persist
9/25/2011 Congressional Suggestions and Executive Actions
Government Spending
8/18/2009 A River Runs Through It
9/30/2009 Government Policy Driving Up Prices
10/22/2009 Long Term Trends in Government Spending and Transfer Payments
10/23/2009 Government Income and Spending Diverging
10/29/2009 Changing Demographics/An Aging Population
11/4/2009 War on Poverty in America
11/12/2009 False Choices
11/13/2009 Kristof Column Followup - Analysis of Comments
11/24/2009 Now I Get It! (Why Some Prefer Government Insurance
11/29/2009 Pistol Creek Days
12/1/2009 Grant Writer Extraordinaire
1/19/2010 War at Stalemate, Costs Rising! Now What?
1/20/2010 US Subprime Debt Set To Explode
1/21/2010 Foreign Aid - How We Have Helped (Let Us Count the...
1/26/2010 Preliminary 2009 Federal Spending and Income Figur...
2/1/2010 Every Tub on It’s Own Bottom – Except for Earmarks…
2/2/2010 Now We Are All on Welfare, Even if Not on "Welfare...
2/3/2010 Deficits Not Always Bad
2/4/2010 The Money Is in the Budget, But Is It in the Bank?...
3/25/2010 Taking Care of the Poor and Everybody Else
3/29/2010 Total Government Spending and Debt As Percent of G...
3/30/2010 Used Appliances For Sale (Not)!
4/9/2010 Update on Federal Spending, Transfer Payments, Rec...
4/13/2010 What? No Income?
4/15/2010 Culture Shifts?
5/3/2010 Don't Worry. Clean-Up Funds Available...Maybe
6/23/2010 Oh, What a Debt We Owe...
7/28/2010 Prices of Electric Cars to Soar, Stoked by Governm...
8/15/2010 Social Security and Medicare Distrust Funds
8/30/2010 Defense Spending Trends
9/24/2010 Response to Republican Pledge: Forget Cutting Taxe...
10/5/2010 Inflation's Not the Problem (For Education and Hea...
10/21/2010 Inheritances and What to Do With Them
10/30/2010 Democrat Congressman Retires, Sees the Light
11/7/2010 Government Dairy Products, Inc.
12/11/2010 Federal Spending as Percent of GDP
12/11/2010 Beltway Back Scratching
1/27/2011 Our Great National Sickness
1/31/2011 Trimming the Federal Budget
2/2/2011 High-Speed Rail - Coming to America!
2/15/2011 National Debt a Moral Issue
2/28/2011 If Only...
3/9/2011 Drinking or Thinking?
4/30/2011 Federal Income Tax, Government Spending, and the National Economy
5/21/2011 Living In an Imperfect World
6/21/2011 Federal Lottery Announced
7/5/2011 Reduced Deficit = Increased Debt
8/2/2011 Following the Rules; Changing the Rules
8/6/2011 Anniversary Post - Cash For Clunkers
8/25/2011 Deficit Watch - Just the Facts
8/27/2011 It'll Be a Brighter Day Tomorrow...Maybe
9/5/2011 The 38% Problem
Health Care
8/20/2009 Aetna's River of Money
8/21/2009 Articles and Blurbs Available Online - Good and Ba...
8/24/2009 Medicare - Evolving to Silliness
8/28/2009 Health Care Olympics - Norway vs. USA
8/31/2009 South Carolina No. 3 In The Nation
8/31/2009 Health Care Reform and Government Fiscal Responsibility
9/2/2009 Free The Doctors!
9/3/2009 Flu Shots and Tooth Maintenance
9/4/2009 Looks like everybody is in bed together but the patient
9/28/2009 It's The (Lack of) Competition, Stupid!!!
10/2/2009 Universal Food Stamps: Next Big Thing
10/12/2009 OK, But What Happens in Year Eleven?
10/12/2009 What Do You Mean, “Quality Health Care”
10/14/2009 Spending Too Much On Health Care?
10/15/2009 Medicare Annual Mail Deluge and Related Retiree Musings
10/28/2009 "Public Option" to Drive Out Profits? Give Me a Break
10/30/2009 We The Customers...
10/31/2009 Medicare Chart Book and the Henry J
11/1/2009 Really SERIOUS Health Care Problems We CAN Solve O...
11/3/2009 Doctors vs. Lawyers (Fixed Game on Capitol Hill?)
11/5/2009 Medical Care Costs, Prices, and Accounting Systems...
11/7/2009 Not In Good Hands
11/8/2009 Medicare Troublemaker
11/15/2009 Death Panel Op-Ed in Today’s New York Times
11/16/2009 Urinary Tract Infections and Medicare Waste
11/18/2009 PSA Tests, Mammograms, and Universal Health Care
11/21/2009 Senator Al Franken in Senate Health Care Debate To...
11/25/2009 Antitrust Problem With Private Health Insurers
12/7/2009 Medicare Premiums, Homeland Security, and the Righ...
1/27/2010 Oh Death!
2/5/2010 "Elegant Solution" for Health Care Mess - No Duct Tape Allowed
2/8/2010 Health Care System Analysis – A Good Read
2/19/2010 Don't Just Do Something. Stand There!
2/22/2010 Those Obscene Profits of Health Care Insurers
2/23/2010 WSJ vs. NYT
3/4/2010 "Real" Insurance for Irresponsible Americans: The Health Care Summit
3/9/2010 The Innovator’s Prescription by Clayton Christense...
3/11/2010 Doctor Raises Rates; Patient Refuses to Pay
3/13/2010 Low Life Expectancy
3/13/2010 Please Recommend a Book for Me
3/17/2010 Can't Afford Health Insurance? Let me see.
3/19/2010 Panic over the Donut Hole – Bad News for America -...
3/21/2010 Things I Like and Don't Like, As If It Mattered
3/22/2010 New Game In Town – Who Wants to Play?
3/24/2010 Good Health and Improved Quality Are Their Own Rew...
3/26/2010 Whatever Happened to Fair Play and Good Sportsmanship
4/3/2010 Constitutionality of the IRS Rules and Regulations...
4/8/2010 Now We Can Know What's In The Bill (But It Doesn't...
4/9/2010 Abortion Insurance?
4/14/2010 Grant Writers and Job Seekers, On Your Marks!
4/23/2010 Just In Case You Are Happy (With the Health Care L...
5/4/2010 Physical Activity and Physician Reimbursements
5/30/2010 A Message from Kathleen Sebelius
6/8/2010 Government Sponsored Corruption
6/17/2010 "Doc Fixes" and Economy Fixes
7/11/2010 Health Care Improvement Through TQM - Seattle Chil...
7/19/2010 The Berwick/Godfrey Book – Curing Health Care
7/20/2010 Repeal Health Care Reform? Not a Chance!
7/29/2010 Skipping a Visit to Your Doctor?
8/11/2010 More On Evil Profits (And the Jobs They Make Possi...
11/1/2010 WSJ Reveals Some Secrets About Medicare RVU Determ...
11/18/2010 Health Care Free Market Non-Existent (And that is ...
12/8/2010 Medicare Treatment Options for Prostate Cancer
12/16/2010 Just Thinking Out Loud…About Healthcare Legislatio...
12/17/2010 Imagining a Better Healthcare System
12/29/2010 End of Life Counseling - The Last Word?
1/5/2011 Irrational Exuberance (About Health Care)
1/24/2011 The 80 - 20 Rule and Why It Doesn't Apply to Healt...
2/4/2011 OK, I Was Wrong, Partly (About Health Insurance)
5/6/2011 Supplementing My Medicare Supplement
5/31/2011 Senator Schumer Offers to End Medicare As We Know ...
6/3/2011 Social Benefits for the Elderly In Trouble
6/27/2011 Medicare Medicaid Overlap - A Simple Permanent Fix...
7/16/2011 Suicide by Living
7/18/2011 Congressional Beliefs and Prerogatives
10/19/2011 Oh, What a Tangled Health Care Web...
11/15/2011 What About the Doctors?
Investing
9/21/2009 Buying Gold?
5/1/2010 Real Estate Investors Caught With Their Values Down
5/2/2010 Suck It Up!
7/30/2010 A Sobering Look at the Nikkei Average
8/14/2010 Investing or Speculating?
9/6/2010 Silly Sales Slogans - GOLD!
10/7/2010 Gold Price Update
11/5/2010 Stock Market Excitement
7/17/2011 Reality Check on Gold
7/19/2011 Boost Retirement Income with Kodak Bonds? (A Lesso...
8/7/2011 Conquering Greed?
9/1/2011 Real Estate Recovery Complete
Management
1/4/2010 Six Sigma Theory and Airline Terrorism
1/5/2010 Airline Safety and Health Care - A Link!
5/29/2010 Organizing vs. Community Organizing
6/16/2010 Good Management Not Easy
Marriage
8/16/2009 Church and State in Avoidable Slow Motion Collision
9/25/2009 Paying for Marriage – A “Welfare” Idea
10/3/2009 Follow Up on Civil/Religious Marriage (Plus Nuclear Energy)
6/26/2011 Marriage: "Ticket for Entitlement"
8/14/2011 Margin Matters and Motivates, Even in Marriage
Media
10/13/2009 Quick Highlights of Morning Newspaper
11/20/2009 Flash: Wealthy and Famous Guys Argue on Television...
12/6/2009 Time Magazine Opinion Piece (Disguised as a News Story)
4/25/2010 Interesting Op-Ed on The Boy Scouts and Lazy Minds...
5/16/2010 Looking for Editorials in All the Wrong Places
7/13/2010 Media Bias?
8/25/2010 In a "More Perfect Union"
10/22/2010 On the Other Hand… “News” Reporting
1/22/2011 Time Magazine Gets It Right - On Loughner
9/13/2011 Leonard Pitts Jr. Draws SRO Crowd in Columbia SC
10/2/2011 Leonard Pitts Striving for Fair and Balanced?
National Debt
10/25/2009 Making Bad Choices
11/19/2009 Continued Reckless Driving Not a Good Idea
2/16/2010 Our National Debt, and the Lenders We Owe
2/16/2010 Here's an Idea...and an Offer – A Personal Note
3/7/2010 OK, Maybe I'm Wrong Again (About the National Debt…)
3/27/2010 "Figures Don't Lie, But Liars Figure"
Personal
8/16/2009 Introduction to www.permanentfixes.com Blog
8/23/2009 Weekend Edition - Black Pepper Headache Fix
9/14/2009 Irish Vacation Report - Photos at Link Below
9/18/2009 Ireland Health Care - Personal Experience
10/20/2009 Signs Of Sobriety in The Big Apple
11/10/2009 Why Blog?
11/11/2009 Government Stimulus Program Works - Creates Lastin...
11/15/2009 New Blog - Last of All or Last to Fall
11/30/2009 Making a Difference - The Personal Touch
12/2/2009 Last Of All Posting
12/9/2009 Update on Black Pepper Headache Fix
12/16/2009 Christmas Celebration, Home Repairs, and Vacation
3/5/2010 Home Works of America: A Big Winner
3/22/2010 John Bull, Poet
3/30/2010 Dillard L. Williams And The Confederate Flag
5/8/2010 Safer Drilling - Back of Envelope Design
5/18/2010 Prisoners of Our Cars?
5/24/2010 Shared Experiences and Common Ground - Lessons Fro...
6/3/2010 Restoring Hope to Elderly Homeowners - Home Works ...
6/26/2010 Church Shopping?
6/28/2010 Columbia Remembers the Doolittle Tokyo Raiders - E...
7/8/2010 Ace Hardware!
8/1/2010 My Daddy Drove Fords
8/3/2010 Outrageous Statements from this Blog and Links to ...
8/9/2010 Second Thoughts on the Electric Car
9/14/2010 Sevier County, Tennessee, "Taliban"
9/22/2010 Bedbug Stimulus!
9/29/2010 Carrying the Mail
10/11/2010 I Like Dick Cheney; We Have Some Things in Common
10/19/2010 Pushy Atheists and Weak Christians
10/27/2010 "Repairing Homes/Restoring Hope"
12/20/2010 Home Works of America 2010 Columbia Christmas Brea...
12/21/2010 Any Old Excuse (Secession or Reformation) For a Pa...
1/22/2011 "Giving Back" vs. "Paying Forward"
3/9/2011 Giving Something Up
5/11/2011 Errors of First Kind Not Necessarily Worst Kind
5/19/2011 Bleeding For Each Other…And Ourselves
8/22/2011 Little Red Shack Out Back
9/16/2011 Granddaddy Williams and the National Economy
10/2/2011 The Irreversible Penalty
10/24/2011 Dying to Get In to Avoid Being Left Behind - Cemet...
11/16/2011 Free Camping on Public Property
11/25/2011 I'm Part of the 99%, and These Are My Demands
12/5/2011 Reading the Comics
12/11/2011 William Starrett's Columbia City Ballet
Politics
10/7/2009 Embarrassed Again by the Republican National Committee
10/9/2009 A Gift For the President
12/3/2009 Strategy Revelation Is No Virtue
12/14/2009 Good Quotes from President Obama
12/23/2009 Statesmen or Elitists, Givers or Takers
2/27/2010 John McCain, United States Senator, 123-45-6789
8/24/2010 A Promotion for the President?
10/4/2010 Thoughts on the Upcoming Elections
10/29/2010 Brooks' Recovery Plan for the President
11/3/2010 Election Reflections
11/14/2010 I'm Not Excited (But I am Hopeful)
11/27/2010 Partisanship Out of Control?
11/28/2010 Compromise or Corruption?
12/1/2010 Toxicity Reduction Plan for Entitlement Cuts
1/11/2011 Congressional Reform Through Constitutional Amendm...
1/13/2011 Notes from The Simpleminded
1/15/2011 Partial Realization of Hope
5/23/2011 The Power of Pronouns (and Banners)
7/29/2011 Staying Out of the Ditches
8/3/2011 Territory Protection
11/4/2011 Football and National Politics - The Big Pictures
Poverty
10/18/2009 Disrespecting The Homeless
12/15/2009 To Bank Or Not To Bank
4/1/2010 Letter to Mayoral Candidates, City of Columbia
9/2/2011 Methobapterians in Union, SC?
9/10/2011 Adding Value, Making a Difference, Even if Homeles...
9/21/2011 Paying, and Receiving, a Fair Share – Conquering Poverty
Taxation
12/9/2009 Nonpayers
1/11/2010 High Earning Folks and the Taxes They Pay
2/25/2010 Complexities of the Tax Code and Why Congress Loves It
3/17/2010 Only Use for Fair Tax Movement is to Scare Congres...
7/3/2010 Tax Talk for Independence Day
8/10/2010 They Just Can’t Help It (Tax Code Tinkering)
8/13/2010 Doing Away With the Mortgage Interest Deduction?
8/27/2010 Federal Income Tax Fading In Significance - Replac...
11/1/2010 Proposed Richland Sales Tax Increase
12/8/2010 Government Speak on Taxes
12/10/2010 Estate Tax Considerations and Maybe a New Idea
12/14/2010 Class Warfare and Why A Million Dollars Is Not Wha...
1/2/2011 More Careless Tax Language
3/3/2011 Tacks Time Again
4/24/2011 Three Simple Truths
5/6/2011 Letter to The State Newspaper on Amazon Sales Tax ...
5/13/2011 More On Careless Tax Talk
5/15/2011 A Big Whine From The New York Times
5/18/2011 Amazing Amazon - High Tech Company
8/5/2011 Lessons From a Real Estate Investment Gone Bad (Wh...
8/17/2011 Zero Marginal Tax Rate in China?
8/19/2011 Buffett Highlights Payroll Tax Problem
8/21/2011 Even Warren Buffett Can Think Fuzzily; Maybe Keyne...
8/29/2011 Lack of Interest
8/31/2011 Boosting Buffett's Bill
9/21/2011 TaxVille!
10/6/2011 Tax Reform Now, Seinfeld Inspired
10/7/2011 What Do You Mean, "Long Term?"
11/2/2011 What In the World is Senator Reid Talking About?
12/1/2011 SC Sales Tax Reform Needed Badly; Courts Can Help
12/18/2011 The Sacred Tax Deduction
US Economy
9/5/2009 Something to Share
10/5/2009 Why So Many More People Than Jobs?
10/27/2009 How's the Economy Doing?
10/28/2009 Cash for Clunkers Update: Needy Cars; Also Bob Her...
11/17/2009 US Trade With China - A Sore Thumb
1/24/2010 Manufacturing Jobs
2/13/2010 Creation or Intelligent Design
5/6/2010 Color TV's, Inflation, and Government Spending
5/19/2010 Easy Money and Easy Living...For a Time
5/27/2010 How About a Two-Armed Economist?
6/8/2010 Economics: Science Skewed by Selfish Self Interest...
6/10/2010 Unemployment Is Not a Problem! It's a Symptom.
7/7/2010 Trade Talk
7/14/2010 New Biography of Cornelius Vanderbilt – History Le...
7/27/2010 Consumer Spending...on Imports!
8/12/2010 Free Them Up - Let Them Work
8/19/2010 Long Term Trend for US GDP Growth
10/7/2010 Mourning Manufacturing in America
1/10/2011 Texas 25, New York 19
1/26/2011 Take This Job and Do It
3/5/2011 Fundamental Problem with the US Economy
5/9/2011 Neither Employed Nor Unemployed
5/17/2011 Industrialization of America - A Refreshing Story
6/5/2011 Bubbles Never Have Soft Landings
6/17/2011 Fathers' Day Shopping and Consumer Spending
7/9/2011 Good GDP, Bad GDP
9/12/2011 Assessing the President's Plan
9/14/2011 Samuel Clemens’s Job Getting Strategy for the Unemployed
11/7/2011 Life Lessons from Yogi Berra and Jesus
11/30/2011 Hard Times
12/3/2011 Jobs, Prosperity, and Psychological Profiles