A National Disgrace

A recent front page story re: "High Drug Costs..." fails, as expected, to mention a host of relevant facts, bulleted here to save words:

·       Medicare part D (2003 Bush era Law) bans Medicare from negotiating drug costs and 3 of 5 Part D insurers specifically ban some generics, in favor of more expensive specific brand names

·       Medicare pays 706% more than the VA for same Cholesterol drug! Zoloft costs Medicare more than twice what the VA pays.

·       Rep Billy Tauzin (R-La), who sponsored part D, retired just after its passage , is now  president of Largest Pharma lobbying group at $2 million annually.

·        Pharmaceuticals  average just about 3 times the national average for corporate net profits. In 2016, Pfizer hit 42% NET profit.

·       Many, "new"  drugs are now developed with Federal grant money. Harvoni for Hepatitis  C, by a professor at Emory with an NIH grant. Allowed to patent it, he did, than sold the patent to Gilead for $400 million! Gilead charges Medicare around $90,000 for the 12 week course of treatment. The same drug and course costs $197 in India and under $12,000 in the UK!  

·       Big Pharma lobbying heavily favors Republicans, but heavily lines pockets of both. 2016 numbers show that of the top 7 contributors by industry, 4 were medically related. The total spent by just Pharma was over $312 million. For some perspective that's more than  $500,000 for every single member of Congress!

·       Have you heard Paul Ryan or Donald Trump, or anyone, for that matter,   even mention this sweetheart deal for Big Pharma while they're speaking of cutting medical services to the poor? Me neither. And by the way, Jonas Salk developed the polio vaccine with a government grant and gave it to the world for free.

Health Care Redux

        In the course of numerous  rounds of golf or the mandatory post golf debriefing over lunch, I have heard some truly ludicrous misstatements regarding healthcare.  Because of where I live and the political persuasion of many of my friends (some of whom, in fairness are in the throes of serious buyers' remorse) I generally am silent or non-committal in these discussions; I know, I find it hard to believe myself.

        My favorite bullshit statements are usually in the area of "Obamacare is socialized medicine" or, should one to  dare mention or endorse the concept of a single payer plan, the response is to lambaste the cost and taxes that the speaker believes must attend  such a measure. I say "believes" because, as so many of the Reflexive Right do, the speaker frequently is orating based on what they believe to be factual without ever having done the homework.

         So....although they'll never read it, here are some stats related to the issue. It must also be mentioned that all of these chaps are retired and on Medicare, which, being a single payer system, IS "socialized" medicine.  So far this has not caused any of them to refuse it. I pointed this out to one such soul who immediately responded that "I paid into it!" My response that the Brits do too, through taxes, elicited a harrumph.  

       First: The Affordable Care Act is not socialized medicine since it mandates the purchasing of private healthcare insurance. Note the word "private" as in "not government" insurance. It is a poor compromise forced on the President at the time, because of the intransigence of the opposition party in Congress, who refused to even sit down and talk about it. The extension of Medicaid  by the states to persons above, but close to, the federal poverty limit would be "socialized" to a degree, if most states did it. Many didn't for the wrong reasons, preeminent among which was. "They're poor, screw 'em."

       Second: There is almost a unanimous belief among these persons that the British national health service costs the nation more than whatever the US has in place. When one considers the amount of salary which goes to the National Health Service (NHS) it might seem that way, but it isn't in fact. Consider the example of a middle  class wage earner (or any one for that matter): The percentage of income which goes to the NHS is 5.7% of income. So what do you get for that? Zero co-pays for Doctor visits, hospitalization or medical procedures, which now are frequently faster than in the US. There are modest, especially by US standards, co-pays for dental, (Far less than almost any US dental plan), Optical, and prescription drugs. A note here, the co-pay for prescription drugs in the UK is typically far less than the same drugs in the US. In the UK, if over 60, under 16,  pregnant, or with any other of a long list of issues or financial  circumstances, they are free. This includes if you walk in to a hospital off the street in need of medication. Cancer drugs are free. Period!    

        Wow, 5.7% seems like a lot, huh? Consider that the average American spends about $1300 annually on drugs, but those with insurance spend more like $200, since insurance pays much of the cost. But wait: How much does the "average" American  family spend on the actual out of pocket cost of health care? In 2017, it looks like the one earner family of four will contribute (pay - call it what it is!)  about $6717 to the cost of an employer sponsored group plan and an additional $4316 in additional out of pocket costs. This amounts to right at $11,000 per year in health insurance costs! Compared to the UK percentage, as a percentage of gross income this is about twice as much paid  for much less health care. Note that this is for persons with employer facilitated plans, those who are self employed, just lube up and bend over.  

        So, for a real world comparison of what this means, I did the following comparison using an imaginary UK single earner family and the same family working for my former Employer, Orange County (Florida) Public Schools. In each case it assumes a spouse and children (number is irrelevant for this case.) I also assumed that the teacher was a high earner in the 17 year plus bracket with a master's degree. I will assume the teacher is me, I  taught 20 years, I had  yearly evaluations of "Highly Effective" (I did/was) and a Master's degree add on of $3000. Today this would put me at a lofty $68,766 annual salary!

        As an aside, this is about $4,000 per year less than my basic military pay would be at 20 years and an E-9 (I was). Adding in allowances, an E-9 on recruiting duty today in Leesburg Florida would earn, before FICA, just under $104,000 annually and have essentially ZERO health care costs!

       But, back to the teacher:  Depending which employer offered Health Care Insurance plan I choose for myself and spouse,  I could expect to see (from cheapest to most costly for employee, spouse and kids) another annual cost of from $3600 to $11,760! This is exclusive of co-pays (extensive in the "cheap" plan) and, in the lower tier two plans limits on choice of providers. In fact, in the lower tier plan, add $3000 for initial copays alone before Insurance pays a dime!

        Now for the big reveal, as they say on "Fixer Upper."  A person living in the UK earning the same as the teacher (£54,576. or $68,766)  pays exactly (I used the online UK tax calculator but assumed zero deductions, so it's the absolute max tax load) $13,236 adjusted from Pounds, annually in taxes. This is before personal savings deductions or pension contributions or other reasons to pay less which many Britons use.  By comparison, an "average US taxpayer would pay an 13% effective tax rate with all available deductions (unless, of course they're a "one percenter" like Donald Trump). This amounts to about $ 8939 in taxes paid, and you say, "But Mike that's less than the Brit."  Yes, but, and this is a big but, the US taxpayer actually got less in the paycheck due to employer deductions for health insurance and spent much more out of pocket for health care to boot. Add this average annual expense back in and the equation changes radically.

The US teacher actually only got paid (assuming the "best" employer plan) $68766 - $6717 (health care contribution) for a total before taxes  of $62,049. deduct 13% X $62,049 (witholding, it would actually be more) for a take home of $53983 (this is actually too high, since I'm using the effective tax rate, not the witholding one, which also includes Medicare, which the taxpayer will pay before using it as well as after.

        Add to this the after tax cost of (again an average) $4316 in out of pocket costs, and the comparable take home is   $49,667. This is equivalent today to £39,418. This within a couple of hundred dollars of a precise break even, but wait! For his money, the Brit will also have Dental (Root canal $67.00!) and Vision care (with some co-pay for glasses;  cataract surgery is free, but if you don't want to wait 18 weeks, then have it done privately, cost is about $1200, compared to US average of $3700!).

        Additionally, this assumption for the US employee assumes zero hospitalization or even urgent care or Emergency room visits and no catastrophic health care issues, because that shifts the whole equation, since for the Brit, there is essentially zero additional expense. It must be noted that I used the UK as an example here, but every European nation has National Health Care and, with the exception of Norway, all do it cheaper on a per capita  basis than the US. So yeah, The ACA is a poor substitute for National Health Care, but as long as Big Pharma and the Insurance Industry have legislators, and now POTUS , in their pockets, we'll be better off muddling along than with the giant bucket of horseshit proffered by Ryan and company.  Bless the hearts of those few Republican legislators who listened to their constituents and said "Hell no!" May they continue to use their consciences.
   

Just an opinion

        In response to a FB discussion re: the Orange County Fl State's Attorney's refusal to seek the death penalty in a controversial deputy murder by a man who had already killed his girlfriend and daughter. In the meantime, the state legislature has bent over backward to pass a couple of death penalty laws since the USSC shot down the first one which was basically, "fuck it, kill him."

        The second iteration, rapidly passed, was rapidly rejected by the Florida state Supremes who thought "we're pretty sure" still wasn't good enough, so to preserve Rick Scott's status as the all time leading Florida Governor in the death warrant derby, they pushed through a law requiring that 12 of 12 jurors must agree prior to a death penalty verdict.   

        Ok, I've waited a bit since I first read this to weigh in, but there are several things which come to mind . First, who ever said the death penalty was about deterrence? Do we really think anyone who has made the decision to take another's life has that issue at the top of their list of yes/no? Did Jeffrey Daumer eat those guys because he knew he'd only get jail time? Do we think Omar Mateen seriously considered the issue?

        Secondarily, for too many death penalty supporters, there seems to be this idea that we'll feel better about the death of our loved one if we execute their killer. Wanna bet? Closure is largely just a word those who are in the counseling business use to mollify those dealing with grief. If a child is lost, closure means finding out what happened. The disposition of the person responsible is unrelated to that sense of loss.

         Third, for many and especially the far right (you know, those who espouse that muscular Old Testament, "Jesus was a pussy," eye for an eye,  pseudo-Christianity?) the death penalty is about revenge. I get that, in the heat of the moment, many humans will feel that way; it's almost an automatic. But any sense that we'll feel better about the death of loved ones because their killer is killed is specious at best.

        Fourth, consider the following: As of March 2016, 340 people previously convicted of serious crimes in the United States had been exonerated by DNA testing since 1989, 20 of whom had been sentenced to death. Almost all (99%) of the convictions proven to be false were of males, with minority groups also disproportionately represented (approximately 70%). The National Registry of Exonerations lists 1,579 convicted defendants who were exonerated through DNA and non-DNA evidence from January 1, 1989 through April 12, 2015. According to a study published in 2014, more than 4% of persons sentenced to death from 1973 to 2004 are probably innocent. Here is just one cases' summary: In 2014, Glenn Ford was exonerated in the murder of Isadore Newman. Ford, an African American, had been convicted by an all-white jury without any physical evidence linking him to the crime, and with testimony withheld. He served 30 years on death row in Angola Prison before his release.

        Having said all that, I agree  that in very narrowly defined instances, the death penalty is probably warranted. The case of Dylan Roof is one such. We're not talking about one tainted witness here, and regardless of the lunatic ravings of ex Marine white supremist wingnut, Richard Steele, this wasn't a false flag ploy to push for gun control. This was the uncontroverted case of a young man who sat in a Bible study group,  contemplated his actions and then began killing people. He made absolutely no attempt to deny these actions, which would have been a hard sell in any case since there were multiple surviving witnesses. Timothy McVeigh is another such self confessed calculating mass murderer. So is Markeith Loyd,  the shooter of Deputy Clayton in Orlando. None is of diminished mental capacity, and in none of these cases is there the slightest shred of doubt or is there any factor in mitigation. In fact, Roof's was the classic example of a hate crime.

        In cases such as these where there is absolutely zero chance that an innocent person might be executed, and as just a personal opinion, if an individual has demonstrated behavior that is so outside the bounds of the rules by which our society has agreed to live that they cannot be allowed to exist within that society, then execution is probably merciful. Not revenge, not for "closure," not for deterrence, but simply because by their voluntary actions and  beyond any conceivable doubt, the person in question has decided to unilaterally "void their warranty" as a member of the human race. A voluntary, considered  choice to  act in such an inhumane manner would seem to me be a self declared abrogation of all rights to consideration. Not interested in any response citing cost, etc, because it isn't about that. If a beloved dog becomes rabid, we put them down. Period. And before you give me any of that "But, people aren't dogs" bullshit, yeah, I know. I love my dog far more than several people I know. 

        Finally, while Ms. Ayala, the State's attorney in question, has the right to dislike the death penalty, there are other ways, and far better cases in which to express that opinion. Her job, as an elected official would seem to me to be to carry out the existing law in such a manner as the majority of her constituency believes it should be done. I really doubt that she is meeting that job requirement in this instance. In fact, I am reasonably sure she is not.        

Where to begin?

       I haven't blogged recently for several reason. The first and satisfying one is that I'm in the throes of co-authoring a book. It's a modern "Clancy" type of military/political thriller set in current events in the Middle East. It's in final draft form now and we're looking forward to publishing.

       The far less satisfying reason is that I have been so saturated with outrageous actions by the current "administration" (in quotes because they're really not administering anything except Twitter") that I really don't know where to start. I pick up the paper most mornings and simply say "ah, shit," because once again the frequent flyer has done something which demonstrates his sheer stupidity, cultural illiteracy, lack of reasoned judgement and even worse, the malleability of his almost non-existent moral code. I just can't sift through all the possible topics and find just one on which to focus. 

      So forgive me if I focus for a bit longer on writing fiction rather than commenting on fiction masquerading as press briefings.   

Trumpists Lie Again

        In what must be one of either the most blind or simply most venal "e-mails"  I've ever received, the hard right has run completely over the edge into lunacy. I say "e-mails" because I sometimes get sent these thing by  well meaning people who are simply forwarding political screeds with absolutely no filter along the lines of "does this make sense?" or "is this possibly slanted?" or  specifically in the case of the most recent bloviation, "So friggin' what?"    

        The supposed  "concern" (actually political sniping masked in a microscopically thin veneer of semi objectivity)  of the originator of the document is that the Obamas are apparently going to stay in DC for the moment. I know, I know, the kids, school, and all that. The complainant moans about the Obamas spending on   a vacation home in Hawaii as well as a house in Washington, even sniping at the DC home purchase as "environmentally irresponsible," although they know essentially nothing about it except that it's air conditioned. Who knew having a climate controlled house was a bad as a pipeline spill? This disconnect was, of course, completely ignored by the writer and the forwarder.

        Along the way, the writer refers to Barack Obama as the "golfer in chief." Really? have you noticed the ruts in the sky between Andrews AFB and Mar a Lago in Jupiter, Fl? Obama took a car to the course, Trump has logged $11 million in air fees alone in under two months! This is just $1 million less than the yearly average for the Obama's travel. To this, one might add the $19.5 million and counting that we are spending for Melania Trump's separate maintenance in NYC, an estimated $500,000 daily!

       This is, of course, simply a continuation of the bashing that began with Obama's election with absolutely zero provocation from  the man himself. These are the same folks minimizing the train wreck that has been the initial weeks of the Bannon administration's front man, the Cheetoh in Chief.

       Remember facts? Well, here are some. Trump was worth, according to Forbes, $3.7 billion when elected, and yet, over the past 25 years, the most generous estimate of his actual charitable donations is between $5 and 6 million.  That works out to a measly average of about $225,000 annually, and that doesn't account for the fact that the vast bulk of the Trump foundation's giving is actually other peoples' money. Along the way, he was paid over a million dollars each for speeches at "seminars" etc.

        On the other hand, the Obamas came to the White House relatively well off and definitely upper middle class, but far, far from the Trump realm of wealth. However, the Obamas' book deals have earned about $12 million. So why the furor over a house, paid for with legitimate earned income?  Oh, and  yeah, the Obamas donated $1.6 million of those earnings to charity - 8% of their income annually,  I said their money, not donations by others to a fake trust and paid from that trust.    

       Missing from all this, of course,  is any mention of any Republican of note. No mention of the $22 million "W" is worth, even though his book was essentially entirely ghost written (you know, like Bill O'Reilly's are?) This also excludes any mention of the $15 million he was paid over four years for speeches. Yes, someone paid the semi-literate schmoe to speak.        

       There is likewise no mention of the upscale neighborhood  home of the Reagans.  A group of friends bought the house for the Reagans in 1986 for $2.5 million;  it was worth $5 mil at move in three years later. No mention of the over a million dollars worth of  designer size 4 dresses Nancy Reagan  "borrowed" forever. Six years after the IRS first told the Reagans they were taxable if she kept them, she had neither  returned them or declared them. But it 's OK, they're not Democrats. In one last broad swipe, the originator of this verbal vomit blasts all former high level persons who make speeches and get paid well for it. Again, a disclaimer, not really all of them, just mainly the Democrats.

        Some day, somehow, I hope a light will shine in the recesses of the minds of those who perpetuate such scurrilous and defamatory garbage. I would like to be there when the light goes on and suddenly one figures: , "Hey, if it sounds like bullshit and it looks like bullshit, it's almost certainly bullshit." and then simply pushes  the "delete" button. Not holding my breath, sadly because, with the great and powerful Cheetoh in place, supporters  will continue desperately slandering those undeserving of such treatment in an effort  to deflect attention from his nudity by maligning  those who don't deserve it.