Joey’s Take: A New Contract

You may remember 1994’s Contract With America with its sweeping reforms to shrink government, cut taxes and revive entrepreneurship. Well, it’s time to put out a new contract – a Contract on Congress that goes after the representatives and senators who are holding our nation’s prosperity hostage to their own political agenda.

This contract would:

1. Require a balanced budget constitutional amendment that would be strictly enforced. No more “pay it forward a few generations” or “pay as you go when you feel like it.”

2. Limit ALL bills to one item and 5,000 words. If it can’t be expressed in 20 pages, it’s not ready for a vote. Bills must be written in plain English, and they can’t be amended or stuffed with unrelated business.

We all heard Nancy bragging yesterday about the new inclusion of student loans in the deformed health care bill. How many more trees are the greenies going to cut down just to print this massive abortion of legislation?!

The sad thing is that some parts of the health care bill would have easily passed a year ago had they not been bundled into this colossal mess, and many Americans would have already benefited from the changes.

3. Practice zero tolerance on congressional misconduct and ethical breaches. No more cover-ups, slaps on the wrist, looking the other way, or saying “but he did it too.” Violators, and their offices, would be subject to the same laws as the rest of us, and the cases against them should be heard in a court of law – not a select committee of partisans and cronies.

4. Limit Congress to two 60-day sessions a year, and adjust congressional pay accordingly. Think of the money we would save.

5. Ban all taxpayer-funded political travel – for the president, his staff and Congress.

6. Make Congress live by the rules it imposes on others. For instance, if other government employees can’t fly first class or by private plane on the taxpayer’s note, then a senator or representative can’t either. (Reps and senators need to be reminded that they are government employees.)

7. Enforce the constitutional separation of powers.

I may be a dog, but even I know it’s way past time for us to make Congress an offer it can't refuse.

I’m Joey. And I endorse this Contract on Congress.

Joey's Take: Putting limits on Congress

Campaigning has been fun these past few days – what with all the snow and ice. Watching the folks slipping and falling has made me appreciate being four-footed. I’ve had no problem getting around. And watching Congress slipping and falling all over the place to try to get “meaningful” legislation passed has made me realize even more how much we need a sure-footed dog on Capitol Hill.

When I’m elected, one of the things I’ll push for is a limit on how long Congress can meet each year. It seems to me they are wasting all too much time and money passing bills we didn’t even know we needed. If we’ve managed to survive 220 years as a nation without a law on how loud commercials can be, we probably don’t need the law. (Yes, loud commercials are annoying. But even I know that’s what the mute button on the remote is for.) Instead of being distracted by the noise on TV, Congress needs to focus on setting a budget that doesn’t break the bank.

Then there’s the healthcare joke that’s making its way around Capitol Hill. I’ve got to admit, I’m still waiting for the punch line. Perhaps that's the joke.

What gets me is how oblivious these “leaders” are to the obvious. One reason so many people don’t have insurance these days is that they don’t have jobs. Arff! Get the economy rolling (I don’t mean adding more government jobs) and a lot of these healthcare issues will take care of themselves.

You know, had Congress taken a commonsense approach to healthcare, the legislation would have passed ages ago, the president would be relaxing in Hawaii, all the senators could be home with their families or mistresses and we would have the peace of mind that comes with knowing we – and our hard-earned money – are safe from congressional shenanigans for at least a few weeks.

Next year I know what I'm putting on my Christmas wish list -- relief from too much government.

Merry Christmas!

The Good, The Bad and The Ugly

Here's my take on the good, the bad and the ugly when it comes to national news this week.

The Good: President Obama announced yesterday that he will nominate geneticist Francis Collins to be the next director of the National Institutes of Health. Collins led the government's Human Genome Project while serving as director of the NIH's National Human Genome Research Institute and is well-respected for his work -- in most circles.

But as I wrote in a previous blog, there are some scientists who take issue with Collins because he is an evangelical Christian. These people don't think anyone who believes in God is fit to run a government agency that deals with science.

The Bad: Our economy is still spiraling downward. Despite the billions of dollars we have borrowed and spent on "stimulus" projects, the national unemployment rate is now expected to hit 10 percent. The latest employment figures show 467,000 jobs were lost in June, and the jobless rate hit a 26-year high of 9.5 percent, according to the Associated Press.

To sell the stimulus package, the administration and Congress talked a lot about all the new jobs it would create across the country. Those promises have changed. Now all the talk is about the jobs the stimulus is "saving."

The Ugly: When it comes to efforts to change the nation's healthcare, things are getting pretty ugly. At first, it was just the Democrats fighting the Republicans. But now the Dems are fighting each other, according to an AP report. A group of Blue Dog Democrats are threatening the due date the president and congressional leaders had set for a "reform" package, making the case that more time is needed to craft legislation that tackles the real problems.

One of the concerns is paying for the massive changes many Dems have proposed. A solution bandied about this week is a "surtax on the wealthy." The suggestion is to levy a new tax on individuals who make $200,000 or more and couples who make $250,000 or more. But that would create a $150,000 "marriage penalty" that could throw the whole thing to the courts. (That reminds me of a "sale" I once saw in a clothing store. The item cost $2.50, but the sale let you buy three for $10.)

Where's the Savings?

When Candidate Obama hit the campaign trail, he promised to reform the nation's healthcare system. One of his promises was to cut through the costs.

President Obama is trying to deliver on those campaign promises -- sort of. He is trying to bring change to our healthcare system. But if you've been following all the reports on his efforts, you know his proposals are adding to the bill -- not reducing it.

For starters, the president and the Democrat-controlled Congress devoted $1.1 billion for comparative-effectiveness research -- basically comparing one treatment against another to see which works best for the least amount of money for the most people. However, several Democratic leaders, including Sen. Max Baucus, are stipulating that this research cannot be used to cut healthcare costs. Hunh?

Meanwhile, the president is touting a $2 trillion savings in healthcare costs over 10 years -- based on a conversation he had with industry. He uses that savings to balance the $1 trillion he's planning on spending on healthcare coverage and other "reforms." Since that meeting, the healthcare industry has outlined some vague steps that might save some money but nowhere near $2 trillion.

Yesterday, the Congressional Budget Office (CBO) released a document acknowledging that many of the industry proposals will not affect government healthcare spending and the ones that do will fall far short of the president's promise. Responding to the CBO report, Sen. Chuck Grassley (R-Iowa) says in a statement, “As predicted, the $2 trillion savings pledge didn’t materialize from CBO’s perspective. The headlines generated by the White House event a month ago don’t get us much closer to affording health care reform today.”

At the Doctor's Office -- Take 2

When the president and Congress are talking trillions of dollars for universal insurance coverage and comparative-effectiveness research -- all the big-dollar items of healthcare reform -- they tend to ignore the small practical steps that really could add up to make a huge dent in our national healthcare dollar.

Take the doctor's office, for instance. If doctors and other healthcare providers followed the lead of veterinarians in offering evening and weekend hours and took other steps to prevent lengthy office waits, we could see some real savings. For example, let's say Sally, an expectant mother, makes $15/hour (the median average wage for women in 2004, according to the U.S. Census Bureau). Over the course of her pregnancy, she will make at least 10 prenatal visits to the doctor. While her HMO will cover most of the cost, she will have to miss an average of three hours of work for each doctor's visit (including the commute), so she will miss a total of 30 hours of work because the doctor's office won't work around her schedule. If she doesn't get sick leave, she will lose $450 in pay. And even if she is covered, her office will lose 30 hours' worth of productivity.

According to the Centers for Disease Control and Prevention, 4,265,555 babies were born in the U.S. last year. For the sake of our example, let's just say that 3 million of the women giving birth to those babies worked and made an average of $15/hr. That would mean that in one year, the nation would lose $1.350 billion in productivity for this prenatal care. Over 10 years, that would total $13.5 billion. If you add to this the cost of time off work for all employees to go to the doctor or take their families to the doctor, the amount would be staggering.

Now, no one is suggesting that people shouldn't go to the doctor. But when people can't afford to take off from work for routine doctor visits, they end up going to the emergency room or waiting until their condition gets critical, both of which addseven more to the national healthcare bill. All of these problems could be addressed if we simply change the hours doctors, physical therapists, etc., practice -- or at least cut the amount of time people waste while waiting in the doctor's office.

But since this is a solution that could save billions of dollars while costing us nothing, it probably won't find its way into any national agenda for healthcare reform any time soon.

Joey's Take -- At the Doctor's

Call me crazy, but I like going to the vet's. I enjoy being the center of all that attention.

Even though I'm not covered by their health insurance, Mom and Dad make sure I get all my preventive care. It's always been affordable. The veterinarians are upfront about how much each shot or treatment will cost. And they've never prescribed unnecessary tests.

What amazes me is that we've never had to wait months to get an appointment for me. And Mom and Dad have never had to take off from work to get me to the vet's. All the vets we've gone to offer evening and weekend hours to accommodate working parents.

Except for the one time that I had an emergency visit on a Sunday, I've never had to wait more than a few minutes to get in to see the vet. And on the emergency visit, Mom walked me around outside while we waited so I wouldn't give the other dogs my cooties and I wouldn't get theirs.

Another thing I've noticed is that the results of my lab work generally are back within minutes. The longest they've ever taken is a day or two. And then the vet's office always called Mom and Dad to let them know that everything was OK.

If people doctors operated the way animal doctors do, healthcare costs could be cut drastically. For instance, just consider what their waiting rooms cost in terms of lost productivity and wasted time. Those rooms also are germ incubators. If you're not sick before you go to the doctor, give it a few days. Think about it. How often have you seen anyone truly disinfect the waiting room?

And when's the last time a doctor discussed treatment costs with you -- that is, before you complained about the bill? The last time Mom went to a doctor, he wanted to send her to a different specialist for every ache and pain she mentioned. He figured she had insurance, so it would be no dollar out of her wallet. Had she followed his advice, she would have been out of work for weeks just making the rounds and her insurance company would have shelled out thousands of dollars so all these specialists could tell her, "Hey, you're not so young anymore. Your body is going to ache occasionally."

When it comes to healthcare, people are a lot like Pavlov's dog. They've become too conditioned to the way things are. Healthcare reform shouldn't be about coverage; it should be about the way medicine is practiced in this country. It should be about patients becoming impatient with the status quo.

People doctors could learn a lot from the vet's office.

Healthcare Reform -- In the Workplace

In what is becoming his trademark style, President Obama sent a letter Wednesday to two Democrat congressmen, informing them that he expects them to have healthcare reform legislation passed by October. And in keeping with how he handled the stimulus, he's leaving the details up to Congress. He does signal that his idea of healthcare reform is basically public insurance.

Worrying about universal health insurance before seriously addressing healthcare itself is like treating a patient before diagnosing the problem. If we rethink how we handle healthcare and cut costs instead of merely slowing the growth (see yesterday's post below), insurance reform will naturally follow.

To truly cut healthcare costs, we must put everything on the table -- sick leave, doctor's office hours, hospital practices, treatment costs, malpractice lawsuits, drug patents, even the training of healthcare providers.

Let's start with the workplace, which is generally overlooked in healthcare discussions. Through sick leave policies -- or lack thereof -- the workplace can be a breeding ground for contagious illnesses and a huge obstacle to preventive care. Think about the problems with common sick leave policies:

--No or limited sick leave. Employees come to work sick, making others sick and reducing productivity. They also may not take the time for preventive appointments and may forgo necessary treatment that is only available during the workday. When they do seek help, their condition is pretty bad -- and costs a lot more to treat.

--Sick leave restricted to the employee only. Workers may not take children, spouses or elderly parents to necessary medical appointments -- until an emergency crops up. Again, the costs skyrocket.

--Family leave restricted to extended periods of time and only after all other leave is used. If workers could take family leave for a week or so without jeopardizing vacation time or their own sick leave, they would be free to care for family members while they're in the hospital or recuperating at home. This could cut down on in-home care and speed recovery time for their loved ones.

Changes in sick leave could be written into labor laws. And employers should be encouraged to promote telecommuting when their workers may be contagious but not too sick to work.

Sanitation is another obvious issue in the workplace. How many employers change their air filters regularly or clean the HVAC system? How many warn sensitive workers of pending pesticide spraying? How many workers do not properly wash their hands? These are simple things, but they all add up.

Feel free to contribute your ideas for changes that can be made in the workplace that would help with our healthcare crisis.

Next, we'll tackle the doctor's office.

Healthcare at a Crossroads – The Problem

The growing cost of healthcare was a national problem back in 1992 when Hillary Clinton failed to come up with a workable solution. It’s an even bigger problem today, costing us 18 percent of the national GDP – a figure that’s expected to nearly double over the next 30 years, according to a report released this week by the president’s Council of Economic Advisers. That means more and more of our paycheck – and a greater share of our tax dollar – will go for healthcare.

President Obama made healthcare reform a centerpiece of his campaign. And he’s told Congress it has to get it done this year or else. Although the president is spotlighting any vague promise of future savings as proof that his campaign speeches were more than rhetoric, a lot of Beltway insiders are admitting that the likelihood we’ll see any true reform is getting slimmer and slimmer.

The president can’t blame this one on the Republicans not playing nicely with the Democrats. The truth is that the Democrats aren’t playing nicely with each other. Some congressional Democrats are holding out for all or nothing – meaning they will settle for nothing but a universal, socialized coverage plan. Others insist on a more moderate approach.

Meanwhile, the president and his economic advisers are touting as real progress a broad promise extracted at a closed “summit” last month from a coalition of healthcare providers and pharmaceutical and medical device industry groups. After the afternoon summit, the president proudly announced, without giving any details, that the coalition had promised to slow the growth of healthcare costs by 1.5 percentage points a year over the next decade for a total savings of $2 trillion.

If that savings were to occur, the typical family of four would have $2,600 more in its pocket in 2020, according to the council’s report.

But since that summit, the members of the coalition have had a chance to crunch some numbers. They released a joint letter this week listing some general steps they could take to slow the growth of healthcare costs. (Note that we aren’t talking about actually cutting costs.) And in that letter, they say they might be able to save as little as half of the $2 trillion Obama is counting on.

Yes, we need healthcare reform. But if we want true reform, we’re going to have to come up with the solution ourselves – and then sell it to Congress and the various stakeholders.

I’ll start the ball rolling tomorrow night with some ideas that could realistically – and almost painlessly – change healthcare as we know it.

No Driver on a Rough Road

Tomorrow (March 5), the president is revving up the engine on his much talked-about healthcare reform summit. Has anyone noticed that we don't have any drivers yet?

Obama's second nomination for HHS secretary has yet to be confirmed. (The first one ran out of gas before he got started because of a tax issue.) We also don't have anyone nominated to head up the FDA, NIH, CMS, CDC -- all that alphabet soup that regulates and dictates our national health issues. Hmmmm, I wonder who's going to do the driving on this one.

We definitely need healthcare reform. Mom spoke to that a bit yesterday in her blog. But we don't need any more excuses for Congress to jump into the driver's seat. And we don't need another reform that's an accident waiting to happen. Remember the Clinton healthcare plan that never got off the starting line?

We do need to keep our leaders in prayer. They're bumping along on some rough roads without a reliable GPS system and not much in the way of emergency equipment.

How Much Is Your Health Worth?

One of the many earmarks in the stimulus package that isn't getting much play outside the healthcare industry is $1.1 billion for comparative effectiveness research. What the government is saying this money will be used for is to compare various medical treatments to determine which ones are the most effective for most people with a specific ailment. To get the medical community onboard, several senators have promised that this will ignore cost. But will it? Can it?

The UK uses a comparative-effectiveness approach that basically comes down to cost effectiveness. Essentially, this means the UK-sponsored health system will cover whichever drug, biologic or medical device or procedure has been "proven" to be the most effective for a particular problem. There is a catch. It's known as "QALY." The British system has determined that the Quality Adjusted Life Year is $55,000. In plain English, the British healthcare system is basically saying a year of life is worth $55,000. If your healthcare costs more than your QALY, you're out of luck.

This one-size-fits-all approach doesn't mesh with the advances being made in medical research that show what works for one person may kill or seriously injure another person. But, if we are to have equal access to healthcare, which seems to be the goal of most reformers, we will have to do away with personalized medicine and accept government-imposed caps on the value of our life.

Is this really what we want?