Forest and the trees.  Reflecting on the OJ Simpson trial in which microscopic analysis of a topic obscured the obvious macroscopic truth, I thought it might be an illuminating exercise to rise above the trees and get a more global view of Obamacare and where we could be headed.

 As a starting point, let’s examine the primary issue.  The third party payer system is a broken model that incentivizes overutilization of services and poor patient outcomes.  It has created a culture where people feel entitled to healthcare for free, insurance companies generate outsized profits by exploiting their control of the system, and providers own businesses that are driven by subsidies.  It is self-evident that Medicare, the nation’s largest insurer, has been operating at a deficit since its inception in 19651, and is an unsustainable model, sadly resembling a Ponzi Scheme.  The projected date for Medicare insolvency is 20262. These are indisputable facts.

 Fast forward to the Obama administration in 2008, who made it their priority to fix this seemingly intractable problem.  As we all know, the U.S. healthcare problem is vastly complex, emotionally charged, and driven by both a moral imperative and powerful plutocratic interests.  There are thousands of moving pieces flying in every direction.  So, what is the best way to get the system under control?

 If one views the situation purely from a business perspective (given the fact  that healthcare has evolved into a big business), the most logical approach to correcting the overall problem is to adopt a single payer system.  Kaiser is a good example of such a system, and I believe that the Obama administration took notice of their success and aspired to emulate their model.  Kaiser is both an insurer (they take risk) and a provider.  No middleman.  They own the hospitals, the doctors (salaried), the labs, pharmacies, imaging centers and dialysis centers.  They are not subject to capricious charges from any of these providers.  If a Kaiser hospital is underperforming, the administration has the ability to fire the staff and hire better people.  In contrast, what could Aetna or United do about one of their underperforming hospitals, especially when they absolutely must have the institution in their network?  In addition, the control inherent in a single payer system enables the administration to drive rapid adoption of more efficient processes and better patient care.  Among these are disease management programs, population management, clinical decision support, cost controls, and better patient support services.  That’s how you run a business.  Control.

 But here’s the problem.  A single payer system has the aroma (perhaps rightfully so) of socialized medicine, which is a show-stopper for the American public.  It is an unsellable concept.  Yet, common sense dictates that it is the only practical solution to the healthcare meltdown.  So, what to do?

 Perhaps a history lesson might provide an answer.  Back in the ‘80s, when HMOs began to gain momentum in the employer-based healthcare market, most Americans considered the option to be repulsive.  But as a result of the confluence of rising healthcare costs and a contracting economy, these plans gained significant market share through a slow, but steady recruitment of providers and employers looking to reduce expenses.  In the end, the folks who initially turned-up their noses at these plans were faced with a new environment of limited, and often no choices for healthcare coverage.  Health benefits, once an afterthought and perceived entitlement, now became a priority when it came to employment.  Many people took a second job at Starbucks or Home Depot just for the benefits.  Notably, it took an assault on the consumers’ pocketbooks to achieve this wholesale attitudinal change.  It was a two-stage process.

 Whether by design or evolution of economic market forces, there is a strong possibility that this lesson will be applied to the current healthcare reform movement.  As we know, in general, Obamacare requires every U.S. citizen to buy health insurance to amortize the underlying financial risk profile of the system.  In order to facilitate this requirement, the now infamous federal and state healthcare insurance shopping exchanges were created, all in an ostensible effort to lower costs to the consumer through even-playing-field competition.  Ironically, the unintended (or intended) consequence of this setup has been sticker shock.  As most people get their benefits through work, they are now being given a monetary stipend to purchase their own health insurance, and are largely finding that this amount is grossly inadequate to purchase the type of healthcare coverage they feel they need.  And for those who heretofore had no insurance, the premiums are indeed more affordable than before, but their out-of-pocket expenses will be significant thanks to high deductibles.  Bottom line:  if you are above the poverty line, you are being forced to buy insurance that you may not be able to afford.  It is my contention that this situation may very well eventually lead to a public outcry for emergent corrective action and create a climate in which a single payer system will be viewed as an acceptable alternative.  HMO redux.  A two-stage process.

 Should this be the ultimate outcome, then what will be heralded as the precipitating factor: Natural market evolution or a pre-conceived strategic two-stage plan?  I suspect most people would argue that the current administration could not have had the insight nor the capacity to engineer such a complex vehicle of social change.  But irrespective of the majority view that Obamacare was ill-conceived and improperly thought out, it is difficult to dismiss the amount of collective brain power gleaned from an army of recruited academic and healthcare industry experts that went into creating thousands of pages of healthcare reform legislation.  This exercise obviously represented more than just throwing something against the wall to see if it would stick.

 Clearly, the overall picture is much more complex than outlined above, given recent developments such as the emergence of Accountable Care Organizations, hospital systems becoming insurers, Medicare flat-rate reimbursement, concierge medicine, etc., but is it possible that the end game is actually being driven by the old “Potomic Two-Step” presented to Harrison Ford in Patriot Games?  It’s sure beginning to look that way.

1  With the exception of 1966 & 1974; National Review Online, April 25, 2012, “Medicare’s Dirty Little Secret”, Holtz-Eakin, D. and Nussle, J.

2  2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds (Medicare Trustees Report), pg. 6


Societal Myopia

Why is it that we’re always focusing on the wrong things?  There is a clear human tendency to only see that which is directly in front of us, as opposed to envisioning the bigger HD picture.  We love easy answers.  I’ll take “Copernicus Was a Moron” for $500, Alex.

This myopia is universally pervasive.  In algebra we were often told to find “X.”  Perhaps it’s time to leverage those skills to find “why” (or in shorthand, “Y”).  Let’s look at a couple of sample problems:

1) We accept religious dogma blindly – Find Y (the 72 virgins qualifies as one of the answers)

2) You caught a cold – Find Y (I’ve always felt that, when you catch a cold, it is more important to identify who gave it to you than it is to concentrate on getting better)

3) The Romans thought-up crucifixion – Find Y (wasn’t it one particular individual who raised his/her hand in the back of the room and articulated this idea?  Who exactly was that?)

It’s all about cause and effect.  But, the cause is usually a couple of generations removed from the effect, and therefore obfuscated by the most recent and/or easily visible precipitating factor(s).  Example: It was an earthquake that caused an electrical outage and subsequent nuclear meltdown in Japan.  Really?  How about the cerebrally-challenged original plan to build a nuclear plant on a major tectonic fault?   You get the idea.  So let’s apply this more insightful analytical approach a little closer to home.

Times have been getting tough for Americans. The price of oil/gas is way up again, consumer staples are painfully more expensive and we have 9% unemployment (arguably closer to 17% in most major cities, especially if you consider the number of underemployed and those who gave up looking for jobs).  Most recently, the insolvent local and national government authorities have been instituting enormous global spending cuts.  Prisoners are being released, government workers and teachers are getting laid-off, Social Security and Medicare are being eviscerated, taxes and healthcare costs are inexorably rising and employee benefits are being thrown in the food processor.  And the debt!  Doesn’t anyone out there understand the meaning of the word trillion?

O.K., so why is all of this happening?  Clearly because the economy is bad.  But, why (Y) is that?  Because of poor Presidential leadership?  Because of OPEC?  Because of global political unrest or a Japanese tsunami?

Hello McFly!  Maybe it’s . . . I don’t know . . . Wall Street. Remember those guys? The banks, the hedge funds (still unregulated), the broker dealers, the mutual funds, the day traders.  You know . . . the “unfairly criticized and demonized” folks still making a killing while the rest of us are bleeding in the streets.  My deepest apologies to my very many close friends who toil daily in the volatile finance field, but have we all become infected with amnesia?  Is 2008 that far away that we can no longer recognize the original cause of the problems that have only just recently erupted?  It was never about the stock market declining.  It was and is about the destruction of the American economy – and that happened 2 years ago.  Your money, your benefits, your jobs have been stolen by the very people who bankrupted you for their own benefit. And what has their punishment been for putting us all on the unemployment line?  Record bonuses.  The average Goldman Sachs employee made $430,000 in 2010.

It’s usually not healthy to engage the process of assigning blame.  But in this case, the exercise might yield three positive results:

1) Removing the obscene leverage, guaranteed by the taxpayer, that caused this problem in the first place (the gasoline for the fire)

2) Hyper-taxing the throngs of people who gamble with our money and who have reaped inconceivable fortunes while taking no risk (except possibly losing their job), thereby supporting the society that made it all possible in direct proportion to the level of their lottery win

3) Requiring that 80% of the zero-interest government loans to the banks be lent to businesses and individuals

Just a thought.  We could continue to be intoxicated by the flowery prose and intellectual spin of those in control of our plutocracy, or we could finally make the effort to elevate ourselves above the trees and start repairing the fire-ravaged forest.  I would argue that the emerging crumbs of sporadic new (and arguably less substantive) job creation and decrease in the VIX are largely inconsequential to the big picture.  Can someone please get us a pair of those progressive glasses!

Selling Vapor

Thought experiment. Let’s say Simon Properties launched a new program that rewarded you with a free iPad for every $10,000 you spent in their stores.  So you go out of your way to buy most of your family’s needs at a Simon mall, bypassing many of your favorite shopping destinations like Costco, the factory outlets, and the internet.  After 18 long months, you reach your goal and receive a coupon that can be exchanged for an iPad at any of the Simon Mall Apple stores.  Off you go to collect your bounty, but when you arrive, the Apple “specialist” tells you that the item is out of stock.  You curiously scan the surrounding bustling retail landscape and see salespeople handing out hundreds of iPads to customers.

“What gives?” you ask.  The specialist responds that only a certain amount of iPads can be dispensed to coupon owners each day, and today’s allotment has been filled. “But I paid for this coupon with thousands of dollars of my hard earned salary,” you say.  “Why isn’t my money as good as the money those customers have?”  The specialist just shrugs. So you ask if you should come back tomorrow, and the specialist tells you that tomorrow’s allotment has been exhausted as well.  In fact, the entire allotment for the next 11 months has been consumed by way of a very long waiting list.

Frustrated, you ask about your options.  You are told that you should come back every day because occasionally a scheduled coupon holder doesn’t show, and their reserved iPad will then be made available to the first coupon holder in line at the store.  Alternately, however, you can receive an iPad today in exchange for 2 coupons.  “But that’s bait and switch,” you say.  “You just doubled the price.”  The specialist refutes the allegation saying that it’s merely an optional customer convenience premium.

Reflecting further on this issue, you demand to know exactly how many iPads are made available on a daily basis for coupon holders.  That particular piece of information, you are told, is unavailable. Really? Could it be just 1 or 2 out of the 200+ product inventory per store?  Or maybe zero on certain high traffic days?  Isn’t this like Nathan Lane and Mathew Broderick selling 300% of their company’s stock to disparate qualified investors?  Another shrug.  “I wouldn’t know, sir.”

I used Apple as an example here because they have legendary customer service and sell killer products that are coveted by most people.  I would argue that the above scenario, irrespective of the specific company or service promoting it, is not an ethical practice, and would further question its legality.  And I would be most interested to hear a counter argument from anyone except those folks representing the businesses profiting from such a program.  My guess is, it would be a one-sided debate.

If you agree, perhaps it’s time to examine your frequent flyer program and then call your state senator.  Unfortunately, the “miles” scheme is only the tip of the iceberg.  One could easily argue that the airlines have earned the collective wrath of multiple government agencies, including the FAA, FTC and Congress for abusing their oligopoly power and exploiting a worldwide recession and energy emergency. They have quickly manipulated their market with the polished skill of Wall Street bankers and OPEC Ministers by strategically limiting supply (canceling flights), devaluing loyalty miles currency, and adding insidious charges for everything from fuel tax and carry-on luggage to seat selection, blankets and peanuts.  Most of us believe in free markets, but air travel has become as much of a necessity as are utilities; hence the airlines’ status as a regulated industry.  One would think it’s high time to evaluate the regulators. And beyond the necessity, wouldn’t it be nice to be able to use your frequent flyer miles to book a flight at the advertised reward level that departs before 2 am and has less than 3 connections, one of which is through Guam?  They say you get what you pay for.  Unfortunately, we all paid for the promise, but were sold vapor.

So . . . it’s a brave new world — again.  Back in the 60s, the term “generation gap” was introduced to describe the cultural disconnect between parents of the WWII generation and their children.  And the divide was palpable given the contrast between a responsible population raised on depression-era, community-oriented values, and their generally self-indulgent, sex, drugs & rock ‘n roll Boomer progeny.  Although there was a clear hierarchical respect for one’s elders, on the subject of world view, parental thoughts were universally marginalized, if not completely dismissed.

Hello new millennium.  The Boomers are now the parents.  Beneficiaries of the greatest wealth-accumulation era of all time, they have spawned a couple of generations of hyper-indulged offspring.  Every kid’s special.  Everyone gets a trophy for playing.  iPhones, X-boxes, karate, semesters abroad, cars, exotic travel, Mark Jacobs bags and boob jobs.  And every one of them is headed for Wall Street, preferably by way of Harvard.

Interestingly, the chasm between Boomer parents and their kids didn’t seem to be very wide until recently.  Both generations essentially listen to similar music, watch the same TV shows, play video games and participate in similar sports.  Out-of-the-nest daughters call or text their mothers 50 times a day (I believe I only spoke with my mother once a week after I graduated from high school).  The parental line has now been skewed toward the category of “friends.”  Nice . . . at least on the surface.  But if you dig a little deeper, you’ll find a significant divide.

A tectonic cultural shift has emerged that has amplified and transferred the self-absorption of the “me generation” to the progenitor “bubble” generations, ultimately completing the feedback loop to the makers.  And with that shift has come a pervasive rudeness and emotional indifference that is not only ubiquitous in its delivery, but considered socially acceptable in its reception.  Give and ye shall receive.

Technology is probably the greatest catalyst of this anti-social transformation, which is most concentrated in the bubble generations.  The obvious symptoms include screening calls, not responding to messages, talking on cell phones when you should be paying attention to someone or something else, not looking at the person you’re speaking with, Blackberry obsession, indiscriminately using “reply to all”, not thanking someone for holding the door open (or anything else for that matter), a general lack of empathy and compassion, avoiding the “not interested” conversation with the opposite sex or a job applicant, and on and on.  Perhaps the most emblematic sign of this non-civil movement is texting.  By definition, it is telling someone that they are not worthy of the time investment required for a conversation or for spelling words out in their entirety (although its use has mercifully cut down on the number of obnoxiously loud cell phone conversations in restaurants and on commuter trains).  Of course, there are many wonderful dividends that technology has given us.  And yes, the pace of societal advancement has been absolutely breathtaking.  But guess what, Neo . . . no one is really HERE.  They’re all somewhere else.  Their attention is directed everywhere except toward the folks that surround them.

Well, how about the social networks, you say?  After all, they are “social” aren’t they?  Yes, they are.  On the most superficial of levels.  I like to think of Facebook, Twitter, Foursquare, etc. as “look at me” platforms.  They’re not so much about staying connected as they are about giving ordinary folks a microphone and feeding their A.D.D.  It’s the high school popularity syndrome where we all want to be the center of attention.  Look how many “friends” I have!  But interacting through the veil of technology allows us to hide — to “dis” people without the discomfort of direct confrontation.  That way, in our minds, we can all remain nice guys.  Of course we know that’s a fallacy, but we’re just not willing to admit it to ourselves.

O.K. — back to the real face-to-face world.  How do you feel about the attitude you get from the cashier at the deli or the comatose workers at the post office or the guy that speeds-up to block your lane change?  And how about the staff at the doctor’s office who, without apology, make you wait 2 hours to be seen or put your call on hold until your next birthday.  Is all of this now considered acceptable behavior?  Moreover, does anyone even notice it anymore?  If not, I think we should.  Perhaps that would fuel a civility revolution.

So next time you voicemail or text your daughter/friend and don’t hear back for 24 hours, pay attention to where you lie on her priority list.  She got the message and is passively dissing you.  But the good news is, she’s a nice guy.

So . . . it’s been a year and a half since all of us were scrambling to protect our savings accounts from a possible collapse of the banking system.  In our panic we first redistributed everything over $100k to separate institutions, then we considered stuffing the mattresses when we heard the FDIC might not have the reserves to cover our insured assets.  Geithner, Paulson and company stepped-in and took extraordinary measures to fight the raging inferno, as new viral emergencies of increasing magnitude relentlessly surfaced on a daily basis.  The fire was mostly extinguished with TARP, and then the government went on a spending spree to begin to repair the extensive damage which had gone airborne and spread to the rest of the world.  And so here we are 18 months later, unemployed, economy beginning to recover, with the luxury of playing Monday morning quarterback to the firefighting team.  And our collective conclusion?  Our government did a crappy job.  What a great country.  It took us a while, but we’re now a serious threat to France’s dominance in the short-term memory competition.

Let’s review the corrective actions taken so far.  We bailed out the “too big to fail” institutions with TARP money ($700 billion).  Some of these loans made us money (Goldman, Bank of America), some made us road pizza (AIG, most likely GM, Citi and Chrysler), but none led to consumer lending by the banks or any new jobs (so far).  And just one year after the nuclear ashes settled, Wall Street gave out all-time record bonuses in the middle of the worst economic collapse since the Great Depression (glad to see things have changed).  Next, there’s the Public-Private Investment Program ($500+ billion) to buy, and ostensibly overpay for, toxic assets from banks.  But the centerpiece is the American Recovery and Reinvestment Act ($780+ billion) which funds everything from college tax credits, energy and unemployment benefits to healthcare, education and construction projects.  Remember when a billion dollars was a lot of money?

Apparently this plan has not released any endorphins for the American public.  Maybe that’s because of the lack of jobs.  Perhaps it’s because the Republicans pollute everything that comes out of the White House in order to position themselves for the next election (self-serving politicians and their demonization of the opposing party is a subject for another day).  So I ask you, what would YOU have done to address the financial Armageddon?  Give out cash?  Give big tax credits to corporations so that they can hire and manufacture in the U.S. for the same cost as outsourcing to China?  Sell more of our worst NBA teams to Russian billionaires?  I know what I would have done.

I would have declared a new Manhattan Project to develop alternative energy.  And I would have put a trillion dollars into it.  That’s right — A TRILLION.  Why?  Because it is a time-honored fact that when there’s a lot of money at stake, technological developments miraculously occur in record time. It’s the Gordon Gecko “greed is good” phenomenon.  Suddenly, corporations pour huge money and resources into developing solutions in order to capture the big prize.  In 1961 when when Jack Kennedy announced we were going to the moon, 400,000 jobs were created in one year, and the resulting technology explosion led to everything from computers and MRI machines to satellite systems and smoke detectors.  It would be impossible to calculate the incredible value of the benefits gained from that initiative.  Next to Viagra and Google stock, it may have been the greatest investment of all time.

Why energy?  Because it would generate a ton of jobs, facilitate worker retraining, make the U.S. the sole supplier of an essential commodity to every country ($$$$), and improve the environment.  But most importantly (and this alone should be sufficient reason to pursue this course), we would be energy independent.  The value of oil would go to zero, and every Arab country would be marginalized.  They would be abandoned by China, Russia, and us, and would no longer enjoy the longstanding tacit sovereign support for their terrorist activities.  Problem solved.  Party over.  Without a world war.

There is no question that this is achievable.  My brother is fond of saying, “if the world ran out of oil tomorrow, how long do you think we’d be sitting in the dark?”  When you create that level of urgency, things happen very quickly.  Seems like a better investment to me than giving billions to car manufacturers who have proven, over and over, they can’t (or won’t) compete with other countries.  How nice would it be to turn-on CNBC in the morning and not care about the fluctuating price of oil and how it will affect us?  That would be something to celebrate.  And this time, the party would be ours.

So . . . what’s at the core of our healthcare mess?  The doctors and hospitals overcharging?  Insurance companies stealing from everyone?  Pharmaceutical companies paying-off Senators to allow the continuance of obscene pricing?  Medical device manufacturers creating margins of a million percent?  The government’s ineptitude at administering the Medicare program?  Well, yes.  And no.  These are all contributors (and there are many, many more), but as Curly said to Billy Crystal in City Slickers, it comes down to “One Thing.”

Now, it took Billy 1:45 of cinema run time to figure out what that One Thing is.  But for the rest of us 300+ million Americans, this healthcare movie is like watching “Lost” — there’s no real answer and there’s no end in sight.  So I’m here to give you the answers to the SATs.

The “One Thing” is entitlement.  Every American feels entitled to receive healthcare services for free.  It’s why we constantly complain about $20 copayments and deductibles.  We think that’s unfair.  The doctors and hospitals make enough money.  Why should we have to shell out hard-earned cash because we were unlucky enough to get sick or hurt?  I mean, how much did it really cost the doctor to look in my kid’s ear for 5 seconds and write a stupid prescription?  Is the cost of the ink that much?

Most people deny this is the way they feel. They’ll tell you that doctors should get paid well.  But the truth is, that is EXACTLY how we all feel.  We just don’t want to pay for this stuff.  So where does this feeling of entitlement come from?

Well, it starts with the insurance companies.  There is always going to be a problem when you have a third party paying the bills.  Think of it this way . . . if your father is filthy rich and he happily pays all of your bills, how much attention are you going to pay to prices or the amount of stuff that you buy?  Well guess what . . . when it comes to healthcare, most of us have that rich father.  Let me ‘splain.

A couple of generations ago, insurance companies recognized a new way to make money by wedging their way in between the doctors and the patients.  The result of this was, and is, a system where patients see their doctors, and their insurance company mails their doctor a check.  Free healthcare.  In point of fact, the original “indemnity” plans paid 80% of the doctor’s charges, but the doctors never bothered to collect the other 20% from the patient because the reimbursement was so good, and because they didn’t want to upset their “customer”.  But then came the ’80s Wall Street boom.  The doctors saw how much money their investment banker friends were making, and wanted to even the playing field.  So they started charging more for their services, unbundling their bills and performing more money-generating services and tests.  The same greed entered the hospital, pharmaceutical, medical device, and other healthcare sectors resulting in an explosive increase in costs to the insurers.  The insurers (never ones to lose money) responded by developing managed care plans (HMOs & PPOs) to control costs, cutting back on benefits, instituting lifetime caps and exemptions for pre-existing conditions, requiring referrals and preauthorizations, establishing co-pay requirements, increasing deductibles and raising premiums. Doctors got paid less and responded by billing more aggressively and performing extra tests to protect themselves from the rapacious malpractice attorneys.  Ultimately, the result is less service for a higher cost.

Now, most Americans get health insurance through their employers (or the government), who pick up most, if not all of the premium payments.  In recent years, as the cost of insurance has escalated, the employers have passed more of the costs on to the employees.  So an employee might be paying $50, for example, out of each bi-weekly paycheck for health insurance ($1,200/year) plus a $20 co-pay when they see their doctor.  But their employer is likely paying $20,000/year to their insurance company (or self-insured administrator) on their behalf.  A nice perk, but very few employees recognize or appreciate this. They see the health benefit as a “given right” instead of viewing it as additional compensation.  I have a friend who just lost his senior-level Wall Street job, and his primary complaint is that, in addition to not earning income, he now has to pay $25,000/yr for health insurance for his family.  In the words of Bruce Willis, “welcome to the party, pal.”  He has been incessantly whining because this is a new expense for him that is unfair.  Of course, the fact that he earned a million dollars a year for umpteen years and got health coverage for free didn’t seem to soften the blow for him.  Entitlement!

And then there’s the “pass the bill” attitude. Since insurance is paying the majority of our healthcare bills, we want to get the most for our money.  It’s like going out to a fine restaurant with a large group.  Everyone subscribes to the Nash Equilibrium concept and orders the most expensive dish and multiple drinks, figuring that when the bill is split equally among the throng, they’ll pay less than their fair share because those that have consumed less will make-up the difference.  The only problem is, in healthcare everyone is gaming the system.

So we all go to the doctor and allow him/her to take unnecessary x-rays, perform extra blood tests, do unnecessary vascular doppler studies, hearing tests, physical therapy — whatever — because the insurance company is paying.  What do we care??

Well, here’s what happens.  The bills get passed to the insurance company and they respond by raising the price of coverage, which you and I pay directly, or indirectly in the form of a smaller paycheck from our employer.  And we thought we were getting away with something — that someone else would pick-up the tab.  In reality, when you litter in healthcare, you will, at some point, have to clean-up your own mess.  The penalty is guaranteed . . . it’s just delayed.

Now, in the case where Medicare (the government) is the insurer, eventually the system runs out of money.  And they can’t pass the loss on to employers, so they pass it on to the tax payer — YOU and ME!  So along comes Obama who says we have to fix this.  Well . . . there are 3 components of healthcare delivery, and to fix the system, all 3 have to lose money.  And we all know, nobody likes to lose money.  Those 3 components are 1) Providers [i.e. doctors and hospitals]; 2) Insurance companies; and 3) Businesses that feed off healthcare like pharma companies, blood labs, imaging centers, medical device manufacturers, etc.  And all three lobby heavily to both sides of the aisle to block this new legislation that will blow-up the runaway, money-generating healthcare gravy train.

The Republicans argue that reform will be bad for business, generate unrecoverable debt, and result in poorer healthcare services because of government mismanagement.  The Democrats argue that everyone is entitled to healthcare access at any cost.  But there is one thing we all agree on — SOMETHING has to be done.  We just don’t want to pay for it.  A complicated issue, to be sure.  Let’s just hope we’re moving in the right direction.  That we’re entitled to.