If Health Care Was More Like Flat-Screen TV's

We'd apparently all be getting treated in France:

Now don't get me wrong, I am just as much for the profit motive as the next guy, but the question I keep coming back to is simply why is the United States health care system so expensive?

I mean $116,796k for a bypass operation here vs. $11,916 in France? Really? Are we 10x's better at it than the Frogs?

If so, great!

Well I certainly don't know the answer, but if you're interested in finding out more, here's the CEO of Kaiser Permanente attempt at answering this very question in a recent interview with the Washington Post.

Part I

(Highlights include, "Why do we need private insurance companies?" "Do we have a competitive market in the US?" "Why is the US system the most expensive?")

Part II

(Highlights include, "Do you believe that the problem is 'fee-for-service'?" "How will electronic medical records affect the delivery system?")


Favorite exchange:

A number of the organizations that are considered the best and most cost-efficient in the United States – Kaiser, Mayo, the Veteran’s Health Administration – are integrated at a level that’s really quite rare. Normally, you’d expect that to give them a competitive advantage, and they’d eventually take over the market. But that doesn’t seem to happen. Why?

Well, the VA has its own population. When you look at the Mayos of the world, they’re doing well. They have a good business model that’s working for them. But everyone else has a good business model that’s working for them, too. There are $2.5 trillion in this market. There’s no reason, if you have a comfortable cash flow, why would you do hard things and heavy lifting to get to a different model? That’s one reason I’ve been such a strong proponent of exchanges. I believe we need a truly competitive market for insurance.

Great stuff!

The Texas State Government is Inefficient

Before heading out the door to start our Thanksgiving holiday, my plan was to spend a few seconds filing my annual vehicle registration renewal for the state of Texas. As I was about to pay the fee however, I stumbled across something that was too good NOT to pass along.

Keep in mind this is the cost to register ONLINE:

(A 38% tax rate on vehicle registration? Reflectorization? A mail-in fee for online
registration? Rick Perry has some splaining to do.)

You should immediately notice that all of these fees add up to a ridiculously high tax rate of 38%. Now take a second to reread line #3 and #6.

Go ahead I'll wait...

That's right the Texas Government found the time to pass a budget resolution that tacked on $0.30 per vehicle for "Reflectorization." Not only does this seem like a complete waste of tax payer money, but as I finished typing the word reflectorization, my spell-check informed me that it is in fact NOT A REAL WORD!

If you're telling me that it costs $0.30 to add the reflective skin onto a window decal, shouldn't that be included in the cost of the decal? What am I missing here? Also, $1.00 "MAIL IN FEE" for an on-line payment? How is this legal?

And I feel as though I should inform you that the cost to file this IN-PERSON is $52.80, while the cost to MAIL-IN the form is $53.80. In other words, according the state of Texas, it is cheaper in the aggregate to staff a window full of people forced to interact with irritable (at the moment anyways) vehicle owners such as myself than it is for the US Postal Service or the Internet to consolidate each of these transactions.

It's as if the technological achievements of the past 20 years have only served to INcrease INefficiencies in delivering information to end users. Unbelievable!

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Thanks for listening, now back to your regularly scheduled Thanksgiving holiday.

Where Should I Eat Fast Food?

The holidays are quickly approaching, with Thanksgiving now only a few days away, which depending on who you are can mean a lot of time on the road.

Andrea and I for example will spend the first half of the week here in DFW and then head up to Tulsa, OK to see our new nephew for the first time as well as the rest of my family.

That's the good news.

The bad news is that we both love to eat. A lot.

Thankfully Andrea hates fast food due to the high calorie count and overall negative nutritional effects. I however love fast food due to its high levels of deliciousness. So naturally an argument or two is inevitable.

If you have similar conflicts arise during your holiday roadtrips, I thought I'd do my friendly blogger duty and pass along this helpful decision tree for you to take on your next roadtrip.

Enjoy!

Congress: S-A-T-U-R-D-A-Y NIGHT!

Today marks a "major" milestone in the Senate. Now I'm not sure why Congress is all about Saturdays lately, but to help explain the "" around major, here's Ezra Klein:

Little will illustrate the absurdity of the filibuster as neatly as tomorrow's vote. This is not the vote to pass the bill. It's the vote to begin considering the bill. Changing the bill. Amending the bill. Recall that the purpose of the filibuster is to protect debate and ensure that members can make their opinions heard and ensure they have an opportunity to add their ideas to the legislation. Tomorrow, however, 40 Republicans are expected to use the filibuster to close off debate and ensure that no more opinions are heard nor changes considered. The right to unlimited debate has become a tool for cutting it off.

Just in case you don't find that as noteworthy as I do, you might enjoy the fact that the Senate bill is described as a proposal “To amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes.”

Wording that seemed odd until the interwebs informed me that it is is a Constitutional requirement that these types of bills originate in the House of Representatives.

You're welcome.

(Title Inspriation: The Bay City Rollers)

The Worst Commerical of 2009

Undoubtedly goes to the GAP's GO HO HO:



I'm still trying to figure out whether it's the Joaquin Phoenix-esque rhyme scheme, the inclusion of "solstice" with the 3 other December holidays, or the guy doing the jump-shimi thing at the 0:17 mark that really gets under my skin, but feel free to leave your thoughts in the comments in the meantime.

How We Hurt By Helping

Have you ever heard of the Poverty Trap? Me neither.

Thankfully Greg Mankiw is here to help:

He goes on to conclude, "The Bottom Line: If you are poor, the government is inadvertently ensuring that you have little incentive to try to improve your condition." Of course one could also conclude that "The Bottom Line: If you are poor, the government will ensure that your family will not starve" but that retort only leads us into a means vs. ends conversation that I find extremely boring.

Not to mention the fact that I tend to agree with both assertions.

So instead I'll turn to a new book from the Brookings Institute entitled Creating an Opportunity Society, co-written by a former Bush adviser, that reveals one very sobering fact:

42% of American men with fathers in the bottom income quintile remain there as compared to: Denmark, 25%; Sweden, 26%; Finland, 28%; Norway, 28%; and the United Kingdom, 30%. They present a wealth of new and old research evidence to support the conclusion that if you're born poor in America, you're likely to remain poor.

The book ignores the traditional left-right divide to arrive at a set of policy recommendations that are novel only in the comprehensive and non-partisan way in which they are presented (via Pete Davis):

• We start out life with advantages and disadvantages which are hard to alter.
• We underinvest in the disadvantaged.
• Personal responsibility it very important.
• Promoting education, work, and family is very important. Convince disadvantaged kids at an early age that they need to go to college, develop a strong work ethic, and get married. Policy incentives aren't enough. Publicity campaigns are needed to change attitudes.
• Government should do more, but it can't do it all.
• Slow the growth of benefits for the elderly to fund a $20 billion per year program of specific policy changes, including some spending cuts.

But don't take my word for it, click here for the full summary. My intention here is simply to raise awareness to the fact that there are no easy answers, and that oftentimes it is the unintended consequences that can have the greatest impact. However with half of American kids set to live in households that receive food stamps by the age of 20 , this is a problem we cannot afford to ignore.

Let's hope the administration is paying attention.

Travel and Leisure Inspires New Dallas Slogan

"Dallas, where white people go to buy designer shoes."

(via: Travel and Leisure Magazine)

FAS: Andrew Greer

Continuing my "Best of Affiliates" series, which is featuring a few of the amazing musicians I have had the pleasure to play with that have recently released albums, including MK & The Gentlemen, Amy Stroup, Katie Warren, Manic Bloom, Andrew Greer, and Paul Banks & The Carousels, we hit upon the Nashville super-one-man-group Andrew Greer.

ANDREW GREER

Nashville artist Andrew Greer will make you think. Nashville artist Andrew Greer will also make you forget.

With his most recent release, Open Book, this Azle, TX native brings in a feeling of nostalgic wonder and has really come into a great sound all his own. Andrew finds the perfect balance with hints of country, pop, contemporary and indie stylings that keeps you on your toes and provides a thoroughly enjoyable music listening experience.

Teaming with such heralded artists as Ginny Owens and a plethora of successful Nashville musicians backing him, Andrew's natural composing talents really shine. He seems to always find the common thread that ties all people together, be it through his writing, composing, producing, or interviewing. No matter what the medium, Andrew's true talent is making people feel comfortable and at peace. He comes from a place of selflessness, servitude, creativity and confidence, all of which are shown throughout the album.

I first crossed paths with Andrew after my sophomore year of college when a good friend (and former band-mate) (and crazy talented person), Julee Duwe - who produced Andrew's GREAT music video, which you can see below - called me up asking if I wanted to do a small summer tour playing bass with some classmates of hers from Nashville. I jumped at the opportunity and soon found myself cramped in a silver Durango pulling a U-Haul across 5 states, practicing every morning and playing most nights. It was a great time in my life and one that I am very thankful for having. It was the only time that I have been what would be considered a "full-time musician" on the road.

The next summer I landed an internship up in Nashville at EMI records and Andrew and I shared an apartment. He almost killed me one time. And I introduced him to tequilla shots. We were bosom buddies.

He frequents Texas and Nashville concert halls and if you have a chance definitely look him up.

• Buy "Open Book" on iTunes


• Visit his official website


• Follow Andrew on Twitter

"Learning To Live" by Andrew Greer


"Emmylou" by Andrew Greer


"Gone Are The Days" by Andrew Greer - Music video produced by Julee Duwe



GONE ARE THE DAYS Official Music Video from Andrew Greer on Vimeo.

Cheers,

What Will It Take for Senator Cornyn to Support Reform?

Image via Wikipedi)((a

Here is the Senator in a recent Op-Ed in the Dallas Morning News explaining why he voted against the Baucus Bill:

The nonpartisan Congressional_Budget_Office said the bill will cost $829 billion, but when it's fully implemented, the Senate Budget Committee estimates the real cost to be $1.8 trillion. Either way, it would still leave 25 million Americans uninsured, impose billions of dollars in new taxes and mandates, and cut more than $400 billion from Medicare. It would take away Medicare Advantage benefits from seniors, and make Medicaid the only option for 14 million Americans.

Or in other words, he's against the whole thing. You should really read the whole thing before jumping to any conclusions (click here for the full article), but let's take these one at a time shall we?

(Feel free to disagree with me in the comments)

1. "The bill will cost $829 billion, but when it's fully implemented, the Senate Budget Committee estimates the real cost to be $1.8 trillion."

That sounds like a lot of money doesn't it? The problem with this figure is that it is highly misleading:

The bill received an important boost last week when the Congressional Budget Office estimated that it would cost $829 billion over the next 10 years — well under the $900 billion President Obama had suggested — and would reduce the deficit by $81 billion over that period.

Senator Cornyn and I have similar concerns in that many of the cost saving mechanisms seem like pipe-dreams, but there are some actual revenue generators (see below).


2. "Either way, it would still leave 25 million Americans uninsured..."

One conclusion I'm completely confident making here is that Republicans do not believe that 46 million people are currently uninsured because they are too poor. Senator Cornyn admittedly might, but here's the standard talking point from Philip Klein in the American Spectator who claims, "the ubiquitous figure is highly misleading":

When all of these factors are put together, the 2003 BlueCross BlueShield study determined that 8.2 million Americans are actually without coverage for the long haul, because they are too poor to purchase health care but earn too much to qualify for government assistance.

Some are arguing that the Baucus bill doesn't go far enough to expand coverage, but that is primarily the result of lowering subsides to low income Americans in order to reduce the price tag. Here's a helpful breakdown of the two bill's in Congress:

Under the HELP Committee bill, 27 million people would buy insurance through an exchange, using subsidies that would cost the government $723 billion over 10 years. The Finance Committee bill would spend $461 billion for the 23 million people who would enroll in insurance through an exchange.

3. "...impose billions of dollars in new taxes and mandates"

One of the aforementioned revenue generators is the "excise tax" on Cadillac plans which would begin in 2013. Republicans oppose this measure, yet it is judged by some to be one of the best cost containment measures in the bill.

As for the mandates, it seem like a logical component when you consider the bill will also bar insurers from cherry-picking only the healthiest customers. Wouldn't a sensible compromise then be to require everyone to buy into the pool thereby lowering the overall risk, and provide subsidies to poor people to follow suit? Yes:

The HELP Committee bill includes an individual mandate that requires nearly everyone to obtain some form of health coverage or pay a $750 penalty, with a maximum of $3,000 for a family. The principles behind this policy are simple: Only by getting everyone covered can the cost of healthcare be spread more equitably and the health of Americans improved.

The Finance Committee started out with a very similar proposal, but it was watered down because of worries that people would be punished if they simply could not afford insurance. More people were exempted and penalties scaled back.

[UPDATE]
Or no, as Tyler Cowen explains in today's NY Times, "Why an insurance mandate could leave many worse off".


4. "and cut more than $400 billion from Medicare."

Looks like he's right on this one:

The Finance Committee, which has jurisdiction over Medicare and other health programs, identified $404 billion in spending cuts. Republicans have attacked those cuts as harmful to seniors, which could make them tough to keep.

I'll only add that the recent news that Democrats lost the fight to raise Medicare reimbursement rates I think proves our government's bipartisan appreciation for budget gimmickry. Passing temporary fixes to the Medicare growth rate formula (which is what this was) began some time ago and is now a time honored tradition that serves one purpose; the deficit looks smaller by implicitly assuming that Congress will one day cut Medicare by ~30%. They won't.

I don't know who has less credibility here, Dems claiming the bill is paid for with magical cuts or Republicans obstructing the bill over the proposed magical cuts. It does beg the question though, what's the deal with Medicare reimbursement rates?

5. "It would take away Medicare Advantage benefits from seniors..."

I don't know about you but when I read reports indicating that for every dollar spent on the program, $.14 cents is returned in value while the remaining $.86 goes straight to the bottom line of an insurance company, I get suspicious.


6. "...and make Medicaid the only option for 14 million Americans."

Senator Cornyn is perhaps correct here, but that's because the bill will expand the Medicaid to include households up to 133% of the poverty line. Which is great news for the working poor who previously couldn't afford insurance. This will impose a larger burden on the states however, but that might be a reason to nationalize Medicaid rather than to deny poor people access to insurance.

Then again I'm not running for office in Texas.

The full 1500 page bill is here.
------------------------------------------------

Bonus:

Kevin Drum passes along a helpful chart which explains why we spend $650 Billion more per year on health care than expected:

FAS: MK & The Gentlemen

After a few week hiatus, the Friday Afternoon Song is back in full force.

In the past few weeks there has been an onslaught of great music coming out from some incredible musicians. And while they are all very different in style, they have one very important thread tying them together - me.

It was the plan to have a "Best of Affiliations" post, due to the massive amount of previous bandmates that are putting out records right now. MK & The Gentlemen, Amy Stroup, Katie Warren, Manic Bloom, Andrew Greer, and Paul Banks & The Carousels are all stellar, STELLAR, S-T-E-L-L-A-R musicians whom I have been lucky enough to play with at one time or another. But unfortunately all their albums aren't out yet for purchase, so instead I will push one a week.

This week's FAS comes from good friend, former band mate of Mick Kelleher and The Ray Smiff Project...


MK & The Gentlemen

That funky beard touting bard, Mick Kelleher, has done it again as he puts out his second EP, Mixed Tape EP.

Changing the moniker to "MK & The Gentlemen" (first coined on this poster), Mick's sophomore EP is a fantastic listen. The sound and writing have matured while still keeping the irreverant, tongue-in-cheek tales of bars, strippers and travels that promises a party where ever Mick plays. And the addition of horns and keys perfectly compliment the funky grooves and are reminiscent of Bob Schneider's early SCABS work (who he gives a subtle shout out to during "Kiss Kiss Bang Bang").

Mostly made of new work, he also brings back a remastered "Baby Come Back," a superbly remixed "Hollywood Hello," and redoes a WAAAAY early crowd favorite, "Go On." Those that have followed Mick from his beginnings opening up for College Station super-group Bobbing For Tucker will not be disappointed, while this album carries the momentum to pick up plenty of brand new listeners.

Also of important note, MK&G recently sold their souls to reality tv (we would all do the exact same thing if given the opportunity... but Kristi already shot down my goal of being of Real World/Road Rules Challenge). Be sure to catch Style Network's Dallas Divas and Daughters this week where the girls hit up a MK&G concert at the Dallas House of Blues. The song featured Mick and the song "Highland Park."

I had the pleasure to play with Mick during his start in College Station and travel back and forth to Los Angeles to record his first EP. I also got to work with him at Winter X Games, US Open of Surfing, and a few Dallas shows when he was still writing all the songs on the new release and he was just testing them out live.

There are too many to choose, and am tempted to put the whole album up, but I had to limit it. Take your pick below but be sure to pick up your own copy on iTunes.

"Tonight" by MK & The Gentlemen (explicit)

"Kiss Kiss Bang Bang" by MK & The Gentlemen

"Highland Park" by MK & The Gentlemen (featured this week on Dallas Divas & Daughters)

"Baby Come Back (Remastered)" by MK & The Gentlemen (featuring the bass stylings of yours truly)


** UPDATE - I just found out that AMY STROUP's song "Hold Onto Hope Love" will be featured this Sunday as well on ABC's "Brothers & Sisters" at 9PM CST. Man, two former band mates both on shows this Sunday... Be sure to check them both out.

Cheers,