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Johnsoncare and Obamacare and Trumpcare, Oh My!

Johnsoncare. That would be the popular term for Medicare if Congress had created it now instead of back in 1965 when Lyndon Johnson was president. Imagine listening to your dad talk about how, in just a few short months, he will be able to retire and sign up for Johnsoncare. He might even opt for the Johnsoncare Part D prescription coverage and get him some Cialis, proving in pure cosmic Baby Boomer fashion that the party never ends.

Johnsoncare, Obamacare, Trumpcare – these terms are all attempts to associate bad policy with the president who signed the policy into law. Newspapers and political opponents have been trying to tag presidents with them since the days of Mr. Jefferson’s Folly (The Louisiana Purchase) and Mr. Lincoln’s War (pick a name, any name that captures your version of the complexity of the late unpleasantness). The grammatical term for these rhetorical creations is eponym. An eponym most commonly occurs when a proper name of a product becomes the generic or popular name for all similar products.

People use eponyms all of the time. We ask for a Band-Aid or a Kleenex instead of an adhesive bandage or tissue paper. Some folks ask for a Coke when they mean any flavored soda water. I don’t because I was raised in a Pepsi drinking household and was taught the proper names of soft drinks. Common eponyms are harmless unless you really believe that buying the world a Coke would make a difference.

Political eponyms are almost always negative. Stalinism and Maoism are not fondly remembered forms of communism unless you enjoy political reeducation camping in Siberia or tank spotting in Tiananmen Square.

Thatcherism wasn’t used by Great Britain’s Labour Party to celebrate the shrinking of their welfare state. Obamacare isn’t used by conservatives to show respect for Barak Obama’s Affordable Care Act. To some of us chronically ill patients who depend on the healthcare system, Obamacare really means palliative care for all involved – patient’s lives, physician’s careers and our entire healthcare system. The only winners are the hospital administrators and the insurance companies, but they are merely the walking dead at this point.

Which seems fine for the Republicans up in DC. When it comes to repealing Obamacare, there are more than a few cowardly lions, scarecrows and tin men in the GOP leadership. These reform wannabes say they can’t repeal Obamacare outright so they want to just take out the bad parts to make healthcare cheaper. To borrow from P.G. Wodehouse, that’s just piffle.

Their bright idea is to exclude poor people who might be unhealthy and give tax breaks to rich people who don’t need them. These are the same old political trade-offs the two parties have been making since 1965. Use the poor people and tinker with the tax code. Make no mistake. Both parties are committed to government intervention in our healthcare.

Due to the mental atrophy that comes from socialistic thinking, they refuse to think really hard and come up with a superior healthcare system based on the patient/physician relationship rather than on the hospital administration/insurance company axis of evil. Maybe they just can’t think outside of the political donation box.

Here’s a big thought the DC Republicans should consider. Medical treatments for a host of illnesses are advancing rapidly and continue to accelerate. Just as our political understanding of natural law and the individual rights of man came from the Age of Reason, our medical understanding of the right to individual healthcare access should be formed from the coming Age of Health. The future of healthcare lies not with covering the group but with treating the individual.

Obamacare and all other current universal healthcare schemes become unaffordable because hospital administrators and insurance companies commoditize treatment. That means they commoditize patients. Insurance companies and hospital administrators want desperately for illnesses to present the same in all people because they believe that physicians are as interchangeable as light bulbs. The problem for them is that good physicians cost more than light bulbs and patients can see the difference between a 40 watt and a 100 watt.

Patients who are trapped in hospital-dominated healthcare systems see their experienced physicians replaced by temps to keep physician salaries suppressed. Patients then receive treatments based not on their highly individualized symptoms and the latest research but on what the insurance companies and their indecipherable minimum standard of care treatment codes will allow. This strategy leads to sicker patients and higher healthcare costs. No wonder our healthcare system staggers towards collapse.

At this fleeting moment, when Republicans control Congress and the White House, they should forget any system that smacks of Trumpcare and offer a new approach to healthcare based on the relationship between patient and physician. Allow physicians to determine the best course of treatment for their patients, put hospital administrators back to ordering supplies and stop the insurance companies from practicing medicine without a license.

I know. It’s a broad idea with no detail but just consider it for a moment. A physician directed healthcare system leads to better health for the individual. Healthy individuals have greater opportunity to lead productive lives and give back to the community. Greater opportunity creates new wealth. New wealth balances the cost of previously provided healthcare. Physician directed healthcare becomes an investment, not an expense. Sounds sort of Republican, doesn’t it?

Illinois Pending Junk Bond Rating: A Case Study for South Carolina

During a recent Lions Club dinner I was asked, “What happens if a state cannot pay its bills? Can a state be dissolved?” The questions were prompted by my comments about Detroit’s bond rating downgrade, their ensuing bankruptcy, the bailout of Detroit’s city employee pension plan and South Carolina’s problems with our state retirement system.

Being a lawmaker rather than a lawyer – only a slight difference on the credibility scale – I assured them that I was not issuing a legal opinion. I answered that it was my belief that no other governmental entity can dissolve an individual state whose citizens have voted to join the United States.

States are our first governmental principle – they formed our federal government and they form the local governmental entities within their borders. States retain the original creative power.

No state has ceased to exist in our national history. Through wars, economic disasters and civil unrest, these United States have remained intact with each member state retaining its individual constitution

The same cannot be said for counties and cities – the two primary local governmental entities formed by states. Municipalities are regularly dissolved after their populations decrease to the point that their tax base cannot pay for basic municipal services. Driven by economic downturns or poor governance, counties and cities declare bankruptcy more than most people realize and at great cost to their creditors and taxpayers.

To get an idea of the cost, Forbes reports that the five largest city and county bankruptcies since 1990 are Detroit (2013, $18 billion), Stockton (2012, $1 billion), San Bernardino County, CA (2012, $500 million), Jefferson County, AL (2011, $4 billion), and Orange County, CA (1994, $2 billion).

Being the most recent, Detroit offers a fresh example. The city was poorly managed for decades. By 2013, large numbers of residents had fled, leaving the streets to resemble a ravaged city abandoned after a siege. City government was $18 billion in the hole. The city employee pension fund siphoned off 40% of Detroit’s general fund every year just to stay solvent. After their bond rating was downgraded to “junk” status, the city filed for bankruptcy. Their creditors were shook down for $7 billion during the bankruptcy negotiations and Motown was saved for the time being.

Now here’s where the two paths diverge in a red ink stained wood. Cities and counties may declare bankruptcy if their state constitutions allow it; states cannot declare bankruptcy.

Sometime this month, Standard & Poor’s will determine if Illinois bond rating should drop to “junk” status. If dropped, a driving factor in their decision will be the state’s unfunded pension obligation of $251 billion to the Illinois state retirement system.

The Illinois legislature tried to dodge this massive liability by passing a pension reform bill in 1995. That bill required the retirement system to be 90% funded in 50 years. Instead of improving the funding status of the plan, it codified the underfunded status indefinitely.

The bill’s reform measures might have worked if the Illinois legislature had created a sustainable revenue flow into the pension system that ensured its viability. To do so would have required a cut to the state budget or a tax increase combined with a large dose of political courage. That didn’t happen.

In addition to the $251 billion pension debt, Illinois has $15 billion in unpaid bills, their lottery commission does not have enough funds to pay the winners and their legislature has not passed a budget in three years.

Illinois has limited options. The state can default on their bonds but will be sued by the bondholders. They cannot default on their state pension obligation. The Illinois constitution bars their legislature from reducing pension payments. The likelihood of a federal bailout of a state pension system is nonexistent even if it were constitutional. If Illinois bond rating falls to “junk” status, the interest cost that they pay on each bond it issues will increase. That increase is a direct hit against the Illinois taxpayer.

South Carolina should check a mirror to make sure Illinois isn’t staring back at us. Both states made the top ten list for most underfunded state pension plans. Both states passed pension reform bills with targeted debt reductions. Illinois failed to fund a dedicated revenue stream to decrease their pension debt.

The South Carolina legislature has a joint committee studying on the recipe for a sustainable revenue stream for our pension system. We shouldn’t forget that a dash of political courage will be the most necessary ingredient.

Otto Warmbier and the Rule of Fear

The man in constant fear is every day condemned – Publilius Syrus c. 50BC

In March 2016, Otto Warmbier was tried and sentenced for allegedly stealing a North Korean political poster from his hotel in Pyongyang, a hostile act purportedly planned by the CIA. North Korean authorities arrested Warmbier at the airport just as he was leaving the country with his tour group. His trial lasted one hour and Warmbier was sentenced to 15 years hard labor.

Bill Richardson, diplomat and former governor of New Mexico met with North Korean officials in New York on behalf of Warmbier. Upon learning about Warmbier’s 15 year prison sentence, Richardson commented in an email to The New York Times that the prison sentence was, “An unfortunate development but a familiar pattern with American detainees . . . hopefully a prelude to negotiations that might lead to a release on humanitarian grounds.” After all, Warmbier was nothing more than a college student on holiday.

Richardson along with the Obama administration, American news media, international human rights organizations and most everybody else never guessed that Warmbier would soon be tortured into a coma, a condition not known to the public until Warmbier’s return to the United States last month.

Warmbier died this week. He died never waking from a coma, never seeing his family again, never returning to the University of Virginia, never completing his economics degree and never having an opportunity to develop his talents for the greater good. Instead, North Korean dictator Kim Jong-un and his communist thugs reduced Warmbier to an unlikely biological weapon that would eventually inflict fear upon the civilized world.

In the bad old days of the Cold War, an arrest like Warmbier’s was used as political propaganda against the West. Everyone would have understood that the crime was fabricated, the trial a sham and the sentencing designed to exert leverage in some classified spy game – a game played with the finesse found in an Ian Fleming or John le Carre’ story. Everyone also understood that a student like Warmbier would eventually be returned unharmed – an assumption made in 2016 by Richardson.

The Cold War was a battle of ideologies. The Soviet Union tried to win the hearts and minds of the West over to a nonexistent communist utopia. Kim Jong-un has no ideology other than fear and no purpose other than to destroy hearts and minds. He understands what Publilius Syrus meant about fear and the condemned person. He rules North Korea as the warden of a prison state.

To divert attention away from his brutalization of his own people, he shoots his prematurely exploding missiles at the civilized world while we mock his technological incompetence. We should not be so amused. Kim Jong-un may be unable to destroy America with his missiles but he managed to destroy Otto Warmbier, a single American citizen, in what has become a very public execution. Kim Jong-un adeptly projects fear where his missiles could not come.