Monday, May 18, 2015

Sanders - Is An Earthquake Coming?

Sanders Campaign: The Media "Responds"
Corporate Instructions: "Ignore"

Commonly prevailing logic dispatches this "new face" in the Democratic Party primary to the status of a  political "curiosity." Visitors to this blog have heard every corporate "opinion" pundit obediently parrot the inane collection of think tank talking points about the Senator's announcement, each one attempting to plunge the Sanders' campaign further down the "rabbit hole" which has been so painfully excavated by the comic desperadoes from the perennially failing Republican clown car of Presidential "dreamers."

[MeanMesa makes a distinction between even the comparably fuzzy designation of "Presidential hopeful" and the cold, tedious realism of "Presidential dreamer." The corporate media is, apparently, under orders to continue the use of the designation of "hopeful" until the last possible moment when -- frantically jumping from a flaming, private jet over Iowa -- the inauthentic "star" of one of these billionaire-driven fiascoes officially becomes a "dreamer."]

The established bastions of "free speech," that is, the corporate American media industry, at first, no doubt, considered pitching a "broadcast tantrum" over the stark, anarchic "unfairness" presented by the possibility of a candidate such as the only narrowly known Sanders whom has not been defined by their relentless, commercial bias. [Don't kid yourself. The media moguls get paid plenty to create "name recognition -- and, of course quite selectively, "even more" about the candidates they have also been paid to publicize.]The heavily soiled US media has long considered "candidate definition" to be an exclusive privilege for which only the sold out networks are "uniquely qualified" to handle "for the democracy."

"If voters want to know something about a candidate, they should just go along with the information and opinions that we've broadcast for them."

Of course the corporate media's interest in "candidate preparation" is not driven solely by back room phone calls from the billionaires who own them. Once the amusing "dust up" of the primaries is completed, huge advertising buys to promote the survivors will be waiting just around the "electoral corner."

So, where does this leave Senator Bernie Sanders amid the chaos of all this monetized, manipulated, corporate media PR muck and maelstrom?

Sanders himself is a remarkable candidate, but what if we are seeing the faint first glimmer of something destined to become orders of magnitude greater than his candidacy?

All the "Important" Reasons
 Why Sanders Isn't REALLY Important
Pay attention..."Believe..."
this message is from your media.

Literally moments after the Senator announced his candidacy, the far right, "wing nut" pundits were already receiving "important management editorial guidelines" upon which they were ordered to base their commentary -- or "non-commentary" -- concerning the "news." Not surprisingly, the folks who own the US corporate media and control its broadcasting content already absolutely detested exactly everything that has absolutely anything to do with Bernie Sanders' platform.

Even the tediously relentless litany that "Hillary couldn't be trusted" was interrupted briefly -- just long enough to insert a few dozen repetitions of the urgent new talking points. A veritable legion of right wing "scandal hunters" were immediately unleashed from the corporate skyscrapers. The old bird had to hiding something somewhere -- something that could gain traction with the trailer park crowd of the GOP base.

The talk show prep gangs were frantically struggling to locate the most intimidating portrait of Joseph Stalin they could find in the FOX research archives. Meanwhile, the "psych-handlers" responsible for anchoring sarcastic one liners in the nearly brain dead, Pavlovian, FOX blond "hostesses" scrambled with their "now, repeat this back to me" demands while fumbling threateningly with their cattle prods.
Right wing pundits talking points dismissing Sanders campaign
The Wing Nuts Spring Into Action! [image MeanMesa]

Interestingly, the right wing "mouth junk" experts completely skipped over any of Sanders' policies in their instantaneous derision of his candidacy, instead focusing very strictly on politics and dogmatic ideological talking points -- many of them only narrowly removed from the glacial anti-Soviet US propaganda of the 50's and 60's.

The "detail free" nature of all of the GOP campaign points to date is an interesting one. The Republicans have been consistently weak on policy proposals for decades, turning, as an alternative, to constantly repeated strings of "political rhetoric" to replace the more normal approach of describing "policy proposals."

Listen carefully to what the GOP's candidates are saying as they campaign. 

Much of the GOP's jingoistic, Christian "heartland narrative" is derived directly from fundamental features of that same old anti-Soviet propaganda. The government's investment in promoting that material so effectively during the Cold War was astronomical, and the oligarchs have plainly come to consider its continuing durability in their information challenged GOP base to be a cost savings opportunity, replacing the expense of generating any hazardous, newer propaganda narratives to replace it.

What is so blankly missing in the right wing political narrative is any direct counter or contradiction to Sanders' policy propositions. This is what a block of hastily organized, "corporate, ideological, ad hominems" looks like when the script's authors have been shoved beyond the established boundaries of their field. Still, very obviously, "the show must go on..."

Network pundits' talking points dismissing Sanders candidacy
Insightful Observations from the Alphabet Networks. [image MeanMesa]
The "non-FOX" -- albeit more and more "FOX-like" -- corporate media networks are having their own embarrassing crisis with the Sanders announcement. The networks' corporate business plan for "reporting" election campaigns is easily discerned.

Their "idea of a good time" is to sell hundreds of millions of dollars worth of time to sterile opposing candidates primarily arguing with each other over either raw, half-baked ideology or fabricated scandals and gaffs.

To some extent this under-cutting propaganda flood is working. Even those who whole-heartedly agree that Sanders' platform is exactly what the country needs, preface statements describing their enthusiasm with "Of course he can't win..."

Sanders doesn't fit into that scenario at all, and should his populist campaign platform trigger the response from voters that MeanMesa is anticipating, the network "cookie cutter" approach to monetizing the 2016 election -- just as they have monetized previous elections for decades -- may be unraveling at the seams as we speak.

The billionaires hate -- and fear -- "real politics."

What the Earthquake Will Look Like
It may not be quite the earthquake we first imagined.

While it may be quite socially amenable to speak of politics' capacity to be "full surprising," it would be a mistake to proclaim that politics is "full of surprises." In this case, although "the dog has been waiting under the dinner table since before the meal began," there is no reason to proclaim "surprise" when, given the opportunity, the dog treats himself to the untended chicken thigh resting at the edge of the table cloth.

The point? The missing chicken thigh is not really a surprise...or an "earthquake."

We will have to look beyond the candidate to get a glimpse of the "earthquake" to which we refer, here. In fact, we will also need to look beyond that candidate's political platform in our search for the "earthquake." Granted, Bernie Sanders has already established himself as a candidate quite removed from the contemporary "norm" -- representing an entirely new phylum and species of primate so far as the clown car is concerned, but even with respect to the already announced Democratic candidate, Sanders may be literally light years distant.

When we come around to Sanders' campaign, we are already -- unavoidably -- noticing an important new "political direction." He is speaking in a almost brash, undeniable way about his plans and about his policy proposals. While this rather bold trait of his may be a shocking departure from politics as we are accustomed to it, a clear view of the actual "earthquake" to which MeanMesa is referring may still remain elusive if not out rightly mysterious.

So, it's clearly time to move ahead --  that would be to move on to the "earthquake."

As Americans we have been very patiently, very tediously, fed a very carefully fabricated myth regarding the vast bulk of the American electorate. Further, the fabric of that myth was not a mere coincidence any more than the "weaving" of that myth was simply an understandable accident or innocent over sight.

The myth?

This was the myth that a strong, stable majority of American voters were driven exclusively by right wing ideology. The myth repeatedly painted a grisly picture of a violently reactionary, maniacally religious, raging, screaming, tea bagger majority. At least millions, but more likely billions, of dollars were pumped into obedient, wholly owned media corporations to "install" the  myth -- as a sort of "default reality" -- in as many minds as possible, including those far afield politically from the right's information challenged base.

As a result this toxic myth's credibility has inched toward a flimsy, undefined, yet unilateral materiality to the extent that far too many American voters have passively grown to accept it without actually examining its "inauthentic credibility."

Now, the oligarchs who have been calling the tune for so long see the very real possibility of a very expensive -- at least for them -- federal government "lurking in the shadows" just beyond the 2016 election which may be slipping out of their monetary grip. They have invested heavily in the "care and maintenance" of that myth, and they have also become equally heavily reliant on its continued domination of the US "political mind."

Unfortunately, for those with ambitions to even further reduce the struggling electorates' already flickering hope for some sort of "recovery" from the most recent Republican looting spree, the environment for frustration and distrust is ripe with opportunity. These are the "years of pain," economically -- the perpetually lingering "toothache stage." Wall Street has recovered beautifully, but everyone without a lobbyist remains stuck at the bus stop.

The oligarchs, having already ordered their obedient media to strip away any inconvenient facts, intended to simply "fuel the fires" of malcontent while cleverly directing "the blame" for this economic mess at any political adversary they chose. Obama, himself, foolishly uttered a prescient note to this effect years ago:

"You go into some of these small towns in Pennsylvania, and like a lot of small towns in the Midwest, the jobs have been gone now for 25 years and nothing's replaced them," Obama said. "And they fell through the Clinton Administration, and the Bush Administration, and each successive administration has said that somehow these communities are gonna regenerate and they have not. And it's not surprising then they get bitter, they cling to guns or religion or antipathy to people who aren't like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations."   [Read more  here - HUFFINGTON]

Notably, however, for the oligarchs to actually use this sentiment effectively for their take-over scheme, it must be re-framed into an ideological and abstract media package which can gain traction among the otherwise disinterested, grumbling GOP base.

Concerning that base, what has looked increasingly like an insurmountable wall of distrust and discontent in the past years represents the tectonic fault. If, indeed, there is to be an "earthquake," it is precisely the fracturing of this tenuous PR thread which will finally trigger it.

Those billionaires still actually able to perceive the events around them have suddenly become quite nervous. However, although the large remainder of billionaires not in this first set are still relying on Rupert Murdoch to tell them "everything they need to know" about modern reality, they may look back at these times to realize too late that they were simply continuing to pour big cash into buggy whip futures.

To the distress of apparently both parties in the coming election, the "earthquake" will not be another political "love affair" with a smooth talking "alternate" candidate. Instead. its foundation will lie deep below the current "fist fight in the parking lot's" visible asphalt surface, and its "action of motion" will be occurring directly beneath the heretofore remarkably stable enmity the billionaires have worked so hard to create.

  The "Obama hating," "government hating," "don't trust anyone," "everything is hopeless" crowd is getting ready to change its collective mind in a big way.

THAT will be the "earthquake."

The actual cause will not be anything as startling as, for instance, the prosecution of the last administration for war crimes or the banksters for the damages they inflicted during the 2008 "correction." Rather than such dramatic "water shed" events, this shift in the minds of the GOP's base demographic will resemble the proverbial "pork chop pared by a dozen knives."

It's going to "drift" into the consciousness of those erstwhile outraged, unsettled, intentionally suspicious, perpetually incited Republican voters like the fog at an autumn dawn in Maine. Although Bernie Sanders -- as a man, a Senator and a candidate -- may very well prove to be the "mechanism" which instigates this shift, it will be his message which actually moves the political soil under our feet.

Sanders has no intention of proffering up an alternate ideology, one which might compete with the road weary, heavily armed "death march" on the right or the whimsical yet "less than reassuringly pragmatic" idealism of the loudest voices currently claiming to represent the "left." [MeanMesa considers this element of the "leftist" demographic as little more than stoic eschatologists, bravely marching forward to certain doom but offering very little by way of plans or proposals which might actually "exist" in this universe much less mitigate our difficulties.]

Ironically, we've seen an excellent example of the "collapsing side" of this prognosis this week. The cataclysmic train wreck on the Washington - New York route makes this point. 

Just as the news was being reported, the Republicans controlling the House of Representatives cut the additional funding from the AMTRAK budget which might have paid for the necessary safety equipment. [Boehner snapped at the reporter who attempted to get him to concede this connection.

First, this isn't ideology, at least not pure ideology. But second, this is exactly the kind of "news" which can reach through the craftily induced fog protecting the oligarchs' position with the right wing base. It deals with them.

It turns out that this troublesome Republican base understands train wrecks much better than the ALEC authored, fantastical liturgy about drowning "small government" in a bath tub.

Political Fracking - Sanders Style
Oooops. The earth is moving under our feet!

Think of examples such as this train wreck as "fractures." It is typical of the precise type of weak points where Sanders' down to Earth, populist policy proposals can enter the political discussion -- even on the right. To the chagrin of the billionaires and their networks, Sanders is "full to the gunwales" with an almost limitless supply of such points -- every one of them focused on a "fracture" fastidiously constructed by those same worried billionaires.

Heh, heh. Importantly, a reminder -- because it's been such a long time since we've heard such things, these "points" are called "populist points." And, at least for the time being, those "populist points" are planted in a garden very, very distant from the ideological "weeds" being juiced up to counter them. The usually eager and obedient network "news" rooms are beginning to spin out of control. They have no idea what to do with this.

Added to the "unpleasant chowder" already boiling in these networks' "head offices," all this attention to "POPULIST POINTS" is introducing the serious threat of a "bottom line" problem with the profit centers in their "election season business plan!" It turns out that the networks' dream of peddling the usual truck load of meaningless election campaign "got cha'" doesn't really work when a bunch of nasty "populist points" have penetrated the normal "foot ball game" reporting.

In the eyes of the networks this is probably even far more threatening than being drenched with a tub of ice cold Gatorade that's "turned" from the hot sun.

The Republicans have now developed a long, embarrassing history of elevating politics far above policy. The advantage of this approach is that it eliminates any need for proposing any actual "risky policies." Instead, GOP politicians and pundits focus on rhetoric about ideology as the highest possible priority when measuring the effectiveness of their attempts at communication.

It would be nice to say that Democrats do exactly the opposite, but that would clearly be stretching the facts. MeanMesa will go as far as saying that Democrats are inclined to do this less. This means that the Democrats have, actually, proposed new policy on a frequent basis even though in some cases that policy really did turn out to be quite risky politically.

Sanders is introducing a new campaign "business model." Whatever the outcome of his efforts, he will not be beholding to a "pocket billionaire," he won't be funneling hundreds of millions into media buys and he won't have to pay additional millions to put "paid for" campaigners and canvassers on the street.

He is already counting 100,000's of "ready to go" volunteers and a few million dollars in his war chest from campaign contributions averaging $43 each mere days after his candidacy announcement.

Keep track of the voices who hate him the most. That should be more than ample evidence to convert you if you're still undecided.

Friday, May 15, 2015

The State of Health Care - Pay the Nice Doctor

Getting the Maximum Media Value from
"The High Cost Of Health Care"
The hopelessness of the PR "cloud" versus actual "billing rates"

Even before the first "shot was fired" in the Senate Health Care "debate," a single thread had already woven its way through every discussion on the topic. [MeanMesa uses the term, "debate," rather loosely. The "debate" amounted to very little more than a negotiation with the insurance corporations to settle "how far things could go" before a politician was going to be facing one of their Super PACs in a primary election.] Unhappily, that same thread is still, today, becoming even more "threadbare" daily although the ACA is rapidly becoming "settled history."

Even before speaking a single word, absolutely anyone standing before a microphone knew that he had one "freebie" regardless of what else he intended to say. That "freebie" would be a glancing reference to "high health care costs," and it could be seamlessly inserted into his rhetoric whether he was preparing to say that the ACA was going to be the "Stalinist death of America" or "the best thing since sliced bread."

This commenting pundit could be quite confident that every member of the citizen class without a lobbyist, hedge fund or an off shore account had, at some point, faced a health care bill massive enough to knock him to his knees. In far too many cases that bill was also "unexpected," and that "unexpected" part might be the result of mistakenly presuming that a cost was going to covered by insurance or merely face flushing shock at the "unexpectedly" high amount being charged for something he "expected" to be far less.

After the Senatorial fog and feathers of the "debate" had subsided, the "high cost of health care" phrase remained not only very useful as a "thought provoking issue," it became impressively chic politically. In no time a political speech concerning the ACA, the economy, the deficit, the cost of living or practically anything else was simply incomplete without a passing reference to the "high cost of health care."

Predictably, there were a few "news" reports about very small, somewhat innovative changes being made to the industrial health care leviathan in efforts to do something about the "high cost of health care," but we can be certain that these "innovative changes" were:

a. not going to particularly impact the industry's bottom line, and 
b. not particularly change the "out of pocket" drain on Americans attempting to use their insurance coverage.

In fact, both "a." and "b." [above] were exactly what the ACA was designed to do, and in a measure commensurate with how much the ACA is actually doing these things, we understand why the health and insurance industry loathe the whole program.

As a result of this cleverly orchestrated scheme, the "high cost of health care" gradually became quite accepted as "just one of those things ... you know ... like death and taxes," something immutable, unchangeable and inevitable. Even as the ACA's remedial provisions began to "bend the curve" of the constantly rising expense of the "high cost of health care," just a tantalizingly little, tiny bit, the explanation of the success grew too complex for the majority to comprehend it, much less pay it much attention.

The issue really did remain as amorphous as, say, "death and taxes." The "high cost of health care" had become enshrined in a permanent marble sarcophagus guaranteed to preserve its corpse for eternity. We always saw a few irritating details such as the ten dollar aspirin, but the real "nuts and bolts" which were responsible for the "high cost" of the "high cost of health care" remained shrouded in the details of industrial complexity protecting the corporate hospitals-doctors-medicine-insurance investment groups' business plans.

After all, this was the bunch who had "negotiated" the plan with the Senate. And, this was the same bunch who had been "struggling along" and "making ends meet" on their cut of the $6 Tn [$6,000,000,000,000] Americans spend annually on trying to stay well. Speaking of this bunch, their cut amounted to very tasty part of the $6 Tn. And, of course, this was also the same bunch which has been spending $1 Mn per week since the day the Senate "debate" began for propaganda efforts to totally discredit the ACA in public opinion.

 "Lifting the skirt..."  [image]
So, if we were to quite simply -- and passively -- accepting the idea that "the high cost of health care" really is just as ever present and inexorable as "death and taxes," we can begin to "lift the skirt" in search of some serious, concrete facts which might help explain "the high cost of health care." So long as we "subconsciously accept" the idea that "the high cost of health care" is so complex and driven ["justified..."] by so many factors that it simply cannot ever be comprehensible to Americans paying insurance premiums -- and taxes -- we will remain "stuck" with more of what we already have now.

The rest of this post shares a little of what MeanMesa has found under that "skirt."

It shouldn't really surprise anyone that it turns out that although the "girl" who's wearing this "skirt" is neither very pretty nor particularly friendly, she is incredibly rich.

One Thing At A Time
Let's take a closer look at those "billing rates."

The total expenditure for health care in the US runs roughly $6 Tn per year. As was mentioned before, this astronomical total can "disappear" in a tangled jungle of "details" -- at least it can obscure itself in a complex cloud of shadows effectively enough that US voters, each one with plenty of other things needing to be done. won't possibly have the time and information to sift through the monster's "chart of accounts" to size up just exactly what was purchased with those trillions of dollars.

Relax. This little post has no recklessly dreamy aspiration of resolving all the thing's monumental quagmire of conditions and other details.

In fact, the information which is "at the root" of this post was actually revealed almost by accident, and if not entirely "by accident," at least by an interesting coincidence -- in this case a billing coincidence.

The "interesting" part of this "billing coincidence" arose from some sort of error crediting MeanMesa's HMO account with a co-payment made just prior to a doctor's visit. That error subsequently precipitated an "invoice" which described this error, and it was precisely this otherwise rather innocuous "invoice" which contained the heretofore "hidden," interesting information.

So, instead of wasting any time blathering generalities around about how irritating the entire health care and insurance industries have become, let's focus on one single issue.

Among other things, the "invoice" noted the "billing rates" for three of MeanMesa's HMO doctors.

Dr. E
Primary care physician, [DO], billing for one visit = $161,
Medicare co-pay = $5
Dr. E is a young man [30's], and rather than the more or less normal "MD" credentials, he has a "DO." [Doctor of Osteopathy] MeanMesa assumes that one of the reasons his hourly billing rate is somewhat lower can be explained by his "lack of seniority" among other HMO doctors. The HMO probably likes him because 1. general practitioners are apparently hard to find when so many doctors have chosen to become specialists, and 2. his billing rate and his lack of seniority make him a cost effective staffing statistic.

Dr. E has stepped in to treat one of MeanMesa's medical conditions [diabetes insipidus] which had previously been treated exclusively by the endocrinologist. This has been good.

Dr. K.
Psychiatrist-MD, billing for one visit = $268, 
Medicare co-pay = $50
The main function of Dr. K is prescribing medication. MeanMesa has taken this same medication for years, but it of a class which requires a written prescription. Very recently, an additional regulation has been added which requires an office visit with this doctor every three months. Dr. K is 74 years old and has just retired. Although he has been a very competent doctor, the frequent office visits have always seemed to be a serious under use of his expertise, He was the senior doctor in his department.

Dr. R,
Endocrinologist-MD, billing for one visit = $166, 
Medicare co-pay = $50
Dr. R has been treating MeanMesa's diabetes for a decade. Several years ago she absolutely saved MeanMesa's life when kidney failure had reached a critical stage. However, in recent years conditions have continued to deteriorate. This is what prompted Dr. E to "try his hand at the problem."

As a specialist endocrinologist, an appointment with Dr. R can often only be scheduled months in advance, a factor which may have complicated the decline of the kidneys. There is a tremendous number of HMO patients seeking her treatment, and the HMO has a very limited number of specialists in this field. On the other hand, the much more accessible Dr. E, the primary care doctor, has made some progress.

Industry Costs, Billing Rates and Medicare
Is the health care industry simply working
the health insurance industry [including Medicare]?

All of this is laid out here for a reason. The "billing rate" noted in the case of each of these doctors is the rate at which that doctor's treatment is billed to Medicare [...or other insurance -- in this case it is Medicare]. We can bring this into a clearer view by calculating an approximate annual amount of Medicare billings being generated by each of these three doctors. We'll need to begin with a few assumptions.

Traditionally, US workers work 40 hour weeks which means around 2080 hours per year [including sick leave, vacations and time off -- not nearly all American workers get all of these benefits]. Doctors probably don't work this much, so let's assume that they work around 1900 hours per year.

A typical patient visit to any of these doctors usually runs 10 to 15 minutes. This means that in one hour of working time each of these HMO doctors can see three patients. Of course we have no way of knowing the rate of pay for these doctors, but we can estimate the annual billing generated by their practices which would be sent either to Medicare or any other insurance policy held by their patients.

Dr. E
1900 hours per year seeing patients  X 3 patient visits per hour X $161 for each visit
= $917,700 per year
Dr. K
1900 hours per year seeing patients  X 3 patient visits per hour X $268 for each visit
= $1,527,600 per year
Dr. R
1900 hours per year seeing patients  X 3 patient visits per hour X $166 for each visit
= $946, 200 per year

Right away the "cloud" of "unknowable" billing complexities enters our calculation. For one thing Medicare rates for a doctor visit may have been "negotiated" downward from the "full price" rate being charged to other insurers. Additionally "cloudy" is the aggregate of additional expenses required to support each of these practices. There is insurance, nurses and attendants, buildings to both build and maintain and physician "services" such as electronic medical records, administration, reception and so forth.

Yet, even at reduced Medicare rates these three HMO doctors are generating more than $3 Mn dollars worth of billing per year. MeanMesa's HMO has dozens of clinics and hospitals, hundreds if not thousands of doctors and tens of thousands of other employees. The "billing rate" for each of these doctors represents what is called a "burdened rate" because it also bears the "burden" of all these necessary additional costs.

Interestingly, MeanMesa's HMO, Presbyterian Senior Care, is a  "not for profit" Medicare "supplier." This means that it can charge Medicare around 15% more for Medicare provided services. The HMO "justifies" this extra cost by offering free exercise facilities [The nearest one would be an hour's bus ride for MeanMesa.], useless annual "membership" conferences and a few other things which are also, essentially, equally useless. This "justification" was one of many contentious issues in the debates about ACA provisions.

In any event the "shroud" provided by both Medicare and the insurance companies which pay these "burdened rates" for doctors is suspiciously effective. Most recipients of care -- care provided by compensation from either Medicare or other insurance -- have no idea about the "billing rates" and, hence, the actual cost [price] of their insured medical care.

This is one of the places where the "true face" of the $6 Tn annual price tag successfully avoids the "light of day." Predictably, political discussions of the matter very clearly prefer discussing, debating and lamenting the various, amorphous threads of the "cloud" much more than specifics.

Even the heretofore "happily insured" might take pause if they were aware of "billing rates" as high as these.

Is It A "Single Payer" Issue?
This beast has "two horns."

Not really. The "universal coverage/single payer" arguments focus on one of the two primary horns of the beast -- the cost and difficulties of getting for-profit, private insurance to actually pay for health care. This post is about the "other horn" -- the astronomically high cost of health care buried beneath the "cloud" of myriad reasons we've heard plenty about already.

The ACA took the first steps in resolving the "first horn" problems, but the bizarre complexity of the industry's $6 Tn "business model" has made making any real progress on the "raw cost" issue significantly more challenging.

The "first horn's question" is all about who will pay for this doctor's visit, but the "second horn's question" is a little tougher. "Why does it cost $150 to see a doctor for fifteen minutes?"

Another entire post could be written about this last question. Naturally, more questions rush in to join the list right away.

"Why are other developed countries apparently able to price a similar doctor's visit at a substantially lower cost?"

"Why are health outcomes better in those places even though operating their nationalized medical industry is less expensive?"

"Did we get so involved with the 'first horn' -- paying for medical care -- that we, more or less, have thrown up our hands at the prospect of really addressing the 'second horn' -- the incredible cost?"

If we wish to make further progress with this, we will probably need to approach the "two horned beast" more patiently than we might wish. It will take years for the ACA's provisions to finally reign in the insurance industry, but it will take even longer for any kind of a rational re-organization of the industry costs. While the pain from trying to make the unquestionably clunky insurance scam actually work has served to instigate these "reform questions," it is the outrageous cost which has been quietly "driving the effort."

As this work continues, "kissing the girl friend" will amount to finally addressing the cost problem. Considering the amount of perfidy, bribery, greed and episodes of the "maudlin drama of the wounded" we have observed in our dealings with the beast's "first horn," we should steel ourselves for an even bigger scrap as we deal with the "second."

A Final Note
"Bringing it home..."

MeanMesa has taken some "serious hits" inflicted by the present system, although -- in stark comparison -- not nearly as serious as some of the "hits" taken by thousands or millions of others. Beyond the examples already presented in this post, a great majority of US "Medicare seniors" have faced the budget wrecking necessities of eye glasses and dental work on their own. The policy provides basically no coverage for these types of expenses.

Hmmm. Perhaps it was simply an oversight. Why in the world would any Congressional policy makers ever consider that old people might need glasses or dental work? MeanMesa scrounged up enough money to purchase a wonderful crown a couple of months back.

The price was higher than a month's rent. However, that crown makes all the difference in the world! Chewing such challenging things as a stalk of celery or a slice of a fresh apple has become a divine experience!

Likewise, last month's cataract surgery -- MeanMesa can actually see better without the old trifocals than with them! The cost controlled "Medicare package" at the local eye clinic required a $300 co-payment. There was a carefully scripted conversation with the "insurance lady" emphasizing the difference between the insurance coverage for eye glasses -- none -- and the insurance coverage for cataract surgery -- Medicare, Part B.

Including the co-payment MeanMesa's surgery cost $5,000. The new eye glasses will be paid for from next month's Social Security check, a check which has already had MeanMesa's monthly Medicare premium deducted.

Interestingly, the wife of one of MeanMesa's acquaintances here in Albuquerque had similar cataract surgery at the same facility a month previously. Because she was covered with Medicaid instead of Medicare, she was not required to make a co-payment. Her rather expensive post surgery eye drops were also fully covered. Filling MeanMesa's prescription cost around $50, and the refill [fewer prescriptions] was still around $30.

It is curiously ironic that the famously opportunistic ophthalmologist and "free marketeer," Rand Paul [Rand got his "eye doctoring" education from something akin to a "Mechanics Illustrated" learn by mail courses before he received his remarkably high "National Board of Ophthalmology" ranking. Of course Rand founded the NBO and is currently one of its few members. Read more here.], hasn't concocted a means to legislatively extract eye care from Medicare. Rand has long been obsessed with the prospect of privatizing the entire Medicare program but especially "privatizing" the $2.5 Tn Social Security Trust which finances it.

There is also a "lost story" which might be added here. During the Senate's "debate" on the ACA, Senator Bernie Sanders [I-Vt -- Yes, the same one who just announced his bid for the Democratic Party Presidential nomination.] proposed an $11 Bn addition designed to create Federally subsidized Community Health Clinics. This would have been enough to build such clinics in most of the US states where they were needed, [Read more  here.]

This hasn't always been a mysterious "lost story," but it rapidly became one when the Republicans and their corporate health insurance masters were through with it. Happily, this common sense guy is now campaigning for President.

Monday, May 11, 2015

Carly Fiorina's Pink Slip

The GOP's "token female" Presidential candidate gets out sourced [image]
Where Do You Go
 When You've Gone Too Far?
Thinning the Clown Car's "herd"

One might think that anyone with "hopeful" ambitions for landing the famously elusive Republican nomination for President might avoid at least a few of the more notorious "hash tags" which have brought previous "hopefuls" into the GOP's "ash can of political history." Astonishingly, this turns out to not be the case with "Carly the Brave." 

Dispatching all fear of public opinion backlash, she has assembled every scrap of the scant remaining debris possible of the "previously discarded planks" for the haphazard construction of her "political image." Granted, the already impressively ponderous "junk yard" of GOP road weary talking points has begun to "turn" in the summer heat as we approach the Republican "clown car debates," but Carly still stumbles ahead, unshaken, through one heavily scripted "soft ball" interview after another.

She hasn't so much as broken a sweat while wasting no time at all disregarding any opinion poll not originating the bowels of FOX News. Still, there are more than a few embarrassingly "tufts of reality" unavoidably landing on the hood of her Bentley like pigeon droppings. For example, lots of the folks comprising the zombie-like GOP base really have very little appetite for massive layoffs and massive outsourcing of American jobs [estimated at around 30,000] to eager, low labor rate spots scattered around the Third World.

Naturally, MeanMesa's enduring fixation with "interpretive fiction" is drawn to this situation like moths to the patio candle. While there is little possibility of ever penetrating the layers of obfuscation protecting the inner workings of the GOP billionaires' K Street think tankers, we can still fall back to the prospect of tastefully indulging ourselves in a bit of "quietly imagining" a brief glimpse of Ms. Fiorina's actual dealings with her lobbyist handlers.

What could possibly be more well deserved recompense -- gerechte strafe -- for Ms. Fiorina than to see her shockingly inauthentic candidacy being brutally outsourced to save a few dollars?

Let's take a look at what her termination letter might possibly contain.

A MeanMesa Fiction
The Letter

From: Mr. Jimmy "the rat" Handler, Esq.
           Koch Industries Communications Div.
           GOP Candidate Management Group
           Republican National Committee
           6969 K Street, Suite JO
           Washington, D.C.

To:     Headquarters Offices
           Wash Out Gulch Executive Plaza
           Suite 291
           13,477 East 398th Street
           Nowhere, CA.

Subject:                    Termination of Contract
Attn.:                        Ms. Carly Fiorina

Ms. Fiorina:

I regret to inform you that effective immediately please consider our contract terminated. This office received additional direction from several of our major RNC contributors expressing a growing uneasiness with cost to benefit calculations concerning your Presidential Campaign.

In response to these contributor concerns the K Street RNC offices will issue no further cash advances for payment of your campaign expenses. You will also be expected to establish alternate arrangements for making the lease payments for your campaign headquarters.

I want to personally thank you in behalf of the RNC sponsors most responsible for financing your entry into the Presidential nomination contests. The Candidate Management Group had concluded early in the process that both a token female and a token black candidate were necessary additions to our Party's new "big tent" campaign and candidate imaging strategy.

Although both of these marketing "landmarks" remain as priorities for our Party, it has been decided that your individual candidacy carried with it certain significant costs which could not be reconciled with your extremely low approval ratings among Republican voters and the very low probability of your campaign's success should you be nominated. We suspect that a good deal of your negative press is originating from disgruntled previous employees at Hewlitt Packard which you fired during corporate out sourcing.

However, be assured that we at Candidate Management Group have not abandoned the value of the fundamental concept of including both a woman and a black in our primary field.

In fact the Candidate Management Group's HR representative has identified a number of attractive candidates to fill your position now that you will be withdrawing from the race. One candidate in particular is especially impressive. Ironically, HR located her in a Vietnam brothel near the very factory compound where outsourced Hewlitt Packard products are being manufactured right now!

Of course, thanks to both advantages in the international exchange rate and additional cost savings available in local prevailing labor rates, this new candidate offers very substantial reductions in cost compared to estimates of your own campaign's projections. We find the additional benefit deriving from leveraging this nominee candidate's very uncertain immigration status to also be quite appealing, and expect her, if she is selected, to be both quite eager and also very successfully manipulable in conducting Candidate Management Groups' "operational priorities" during the election.

We would like very much for you to consider training this replacement in some of the campaign fundamentals you have employed during your own candidacy. Again, eliminating the costs associated with retraining her here at Candidate Management Group's facility offers an attractive additional savings to our sponsoring contributors.

Thank you again for your work with the Republican Party, and I hope to hear from you soon regarding your decision to provide training for your replacement candidate. I will take this opportunity to caution you to strictly adhere to the provisions in all aspects of our non-disclosure agreement which remains in full effect even though our campaign association has been terminated.


J. Handler, Esq.

Friday, May 1, 2015

Laying the Blame - A Drone and Death Primer

April in North Waziristan [image - WP]

"Death From Above"
7,000 Miles East of the Potomac
Speculating about the foggy military details
The history is now longer than the missile.

The mission was, after more than a decade of similar missions, intended to vaporize four al Qaeda "commanders" in a little hut located in the Shawal Valley in West Central Pakistan. In the planning stages this mission looked disconcertingly similar to many previous missions targeting "combatants" in the North Waziristan Province. Everywhere inside the dotted line on the map [left] is considered to be under the control of either the Taliban, al Qaeda or one of the equally hostile factions.

[MeanMesa uses the term "combatants" for lack of an any more objective choice. Apparently the initial targets of the drone strike were two individuals performing in command positions within the local groups.]

Nothing has been revealed about whether or not these specific targeted people had actually been observed doing acts of "jihadist violence" or if the evidence of them being in this command role may have been somewhat circumstantial. In any event, it is most likely the case that through aerial observation it had been determined that there was sufficient evidence that they were "commanders" and, hence, targets for the drone program.

Further, the official report of the incident -- including the carefully worded Presidential apology -- doesn't reveal much more, either. A tantalizing bit of the corporate media coverage briefly emphasized the absence of the use of the precise term, "drone" in both the news reports and the President's explanation. 

MeanMesa interprets the careful adoption of this "contextural anomaly" as a suggestion that the drone was under the control of the CIA rather than the Defense Department.  [The DoD usually makes drone strikes public. The CIA hardly ever does.]

Regardless of the departmental loyalties of the drone's command and control officers, it was at this point when the "law of accidents" entered the little ship's mission direction. In the best of worlds a cautious probability that the hostages were sequestered in the shack might have been calculated, but even that caution would have relied on parameters simply not accessible to those giving the orders for the drone's path.

Equally likely, the hostages could be sequestered out of sight in one of other two dozen targets being considered that day. They could have been in the next shack, ten feet away from the one targeted, or they could have been hundreds of miles away -- or already dead. Both the nature of the drone program and the nature of hostage holding come into play. Each has inherent strengths and weaknesses, advantages and disadvantages.

It is these complexities which were apparently too taxing for a corporate media reporter to bother presenting to the public in a form which could be reasonably comprehensible to a print or broadcast audience. It is also precisely these complexities which the public has predictably "mashed" into an unruly collection of conversationally convenient new narratives quickly "woven from whole cloth" which have essentially nothing at all to do with the facts of a situation there in Western Waziristan.

Lo Porto and Weinstein [image - TheGuardian]
Perhaps the most important part of this sad tale rests squarely with this last fact. The American public was already burdened with an overly simplistic model of the combat "arena." More than a few of these Pentagon supporting tax payers still presume that the action in Pakistan is somehow similar to World War II, replete with dough boys, battleships and tanks. 

Unhappily, such disconnected "visions" have been further embellished with every type of mischievous emotional addition and intentionally manipulated by a steady stream of additional, politically biased "information."

The Public Responds
The tone is even more shockingly
immature and unrealistic than usual.

Nanoseconds after the news of the drone killings was released for public consumption, a tediously road weary narrative dutifully marched out to accompany it. In fact, watching this play out in a litany of "reportably relevant," thought provoking questions -- each one bearing more "insinuated baggage" of implied mistrust, outrage, Obamaphobia and spirit crushing hopelessness that the one before -- amounted to little more than the "third helping" rerun of a not particularly memorable, black and white soap opera episode from four decades ago.

There were, unhappily, a "few facts" missing from the public's response, and -- also unhappily -- these "facts" could have served to place the tragedy into perspective, at least with respect to scale. MeanMesa recalls an equally exaggerated public response when a US citizen, after becoming an active participant in al Qaeda, was killed by a drone strike in Yemen. There was, at the time, a murmuring of  complaints regarding "due process." [Read more  here - WIKI]

In addition to the two hostages and the 3,000 dead on 9/11, there have been 6,000 American dead resulting from the invasion of Iraq and another 2,000 from the invasion of Afghanistan. [Read more Iraq Casualties WIKI and  Afghanistan Casualties WIKI] Recent estimates of Iraqi nationals dead have now officially reached one million. [Read more  here - REUTERS] Deaths of Afghan nationals are estimated at around 20,000. [Read more  here - Afghan casualties WIKI]

For anyone presuming that the "Bush-Cheney Church of Death" label is somewhat overly dramatic or exagerrated, this is what MeanMesa means when using it. Some of these deaths were those of "combatants;" the remainder may as well be classed as "sacrifices." The point is that these two additional deaths, while not being in any way less tragic than any of the others, must now become simply what they are -- two more added to this mountainous pile of corpses. In every one of these cases someone bled, and someone cried. Many of the orphans created are now reaching "fighting age."

Is there some way we can convince ourselves that any sentiment held about Lo Porto and Weinstein should not also apply to these other grisly numbers?

The Bush-Cheney "Church of Death" military campaigns cannot be conveniently set aside as we lament the loss of these two hostages. Those disasters were huge and bloody, and they were done in our name.

There were plenty of these carefully crafted, utterly predictable, unspoken insinuations embedded in this story's otherwise banal reportage. [Is there a term for the cheaply disguised editorial equivalent of "reportage?" The "policy issues" have been the "burning question of the day" for weeks.] However, "debating policy issues" becomes rather dull when one no longer enjoys the option of making any of the choices being debated. Dead hostages or not, thanks to the effeminate Commander in Chief before this one the prospect of making "policy choices" concerning the drone program is a null set.

Nationally, we are "on the train" and we're going "where the tracks go." As Americans we've been on this dead end rail route for more than a decade. There are now, officially, more than a million corpses strewn on the rails behind our car.

Nonetheless, a "suspiciously thought provoking" media continued to obediently march forward, trudging directly into the fray, spewing one "thought provoking question" after another like a meth addict with a box of Roman Candles until the "mouth junk" network pundits were nearly collapsing from exhaustion. It was fascinating to watch them labor to keep a straight face while the cameras were running.

Not a single hour passed without the following proposition being once again breathlessly and relentlessly repeated as if it were a fresh faced, new born colt venturing beyond the barn doors into the sun light for the first time.

We need to debate the drone program.

The "publicity appeal" of this proposition is understandable. However, the drones are but a "tip of the ice burg" with the remainder of the ice burg being another military colonial adventure in the Middle East. The cowardly Republican controlled Congress has, so far, been so frightened by the political ramifications of either authorizing or not authorizing another Iraq War that they won't touch the question with a stick. Meanwhile, the President's "authorization to use force" is wearing thinner by the day.

There is a nice collection of "thought provoking" policy "adjustments" being bandied about. MeanMesa has provided selected links to sites offering further discussion of these examples.

The drone program should be transferred from the CIA to the Pentagon for increased oversight and accountability.

We should simply stop the drone strikes altogether. They are only creating more jihadists.

Why can't the drone strikes be 
managed more effectively?

Why are we killing people when 
we're not even sure who they are?

What about the civilian casualties?

Is the drone program effective in anti-terrorism?

Of course the "elephant in the living room" suddenly becomes "interested in your dinner" every time this insightful discussion careens toward the blood drenched "boots on the ground option." The Congressional politicians most "indebted" to Pentagon procurement contractors' lobbyists can be identified immediately by simply watching which ones seemed permanently stuck in the "unfortunate necessity" of reintroducing American ground forces into the fray. [Most of the Congressional Democrats holding this same point of view are currently under indictment for something else.]

The point here is clear. This discussion has been going around in circles for more than a decade. Drone technology has, predictably, improved by orders of magnitude, but drone policy has turned out to be frozen in time. Perhaps history will view the effort as something akin to an "airborne Maginot Line." The refinement of asymmetric terrorist tactics has kept up with the work of the drone engineers. [Read more  here -MeanMesa - Understanding Asymmetry]

Even the "actual picture" of someone like Barack Obama -- compelled by present and unchangeable history -- "signing off" of something like a drone war is bizarre. The man is a law professor. The fact that he is currently standing ankle deep in this blood and gore accurately indicates just how grotesque his predecessor really was. On one side he faces the public horror and disgust resulting from having been so duped, and on the other he faces to next, inevitable wave of terrorists eagerly beheading any unfortunate they can find.

Philosophy: Death, Righteousness
 and the American Religious Culture
And, of course, Politics
Gee whiz. This hardly looks like a perfect deal.

The prevailing American religion has everything to do with death. This situation is roughly also quite similar to the religion prevailing in the region where these hostages were killed. It is the designed intention of such modern manifestations of prehistoric mythology to "comfort" the dying -- and certainly to "comfort" the living. Perhaps the original idea was to offer an alternative -- although it turns out, a rather flimsy alternative -- to the inevitability of a devout individual's "end of the future."

In the unmatched luxury of the West the more or less normal traditional appetite for religious fervor has been replaced with a much less potent addiction to religious ecstasy. MeanMesa has always had difficulty explaining the Middle East's cordial hatred of the US as enmity justified exclusively by religious dictates. Although mythology's presence in western culture may have become embarrassingly hollow, it remains hard to imagine that its Islamic equivalent has inertia sufficient to explain the languishing hatred for that reason alone.

Given all of this, when military violence is added to the conceptual mix, death gains the added dimension of becoming "just," "unfair," "unfortunate." "untimely" or even "avoidable" and so on. If any part of the concept starts to emerge as paradoxical, the difficulty can be completely attributed to the reality that it "emerged" in the eyes of the living. The sanguine natures of both death and military violence are absolute, implacable and very dependably, always define themselves.

Even the logic of our own language deceives us. We think that some humans "deserved" to die while others did not "deserve" it, when the fact is that every human both "deserves" and does not "deserve" to die -- continually and simultaneously. Imagine a sentencing verdict which would deny a miscreant the death that he "deserved" for the duration of his "punishment" -- say, a duration of a hundred years or a thousand years. If that proposition seems similar to the religious mythology all around us, so be it.

The living consider the dead and decide if that death had "meaning," but with cooler minds we discern that every death has both "meaning" and, paradoxically, "no meaning." It is far more cruel to make a similar judgement as to whether lives had "meaning" or no "meaning." MeanMesa has come to consider such judgements to be "no more than the idle folly of the breathing."

The indigenous residents of New Mexico's high desert, themselves enjoying a peaceful, insightful, cultural maturity, call death "the dark wind."

So now, having accomplished all this "preparatory discussion," we should progress to the topic of this post: the deaths of the hostages in the drone attack. We should probably begin with one of MeanMesa's frequently repeated, iconic axioms.

"There is nothing which can be done with the reality of military combat which will make it palatable to civilians."

[Visitors can read a February, 2013,  MeanMesa post concerning drones here: So. You Have A Problem With The Drones]