The headline on Sunday (8/23/09) reads, “Miami-Dade mayor hands out big raises to top advisors.” In this report we learn that “12 employees of the mayor have received raises of more than 10 percent” while “Miami-Dade County government confronts a $427 million budget gap” and is “laying off 1,700 county workers.”

And these are just the financial issues associated with the mayor’s friends, but what if we were to include his County Administrator Mr Burgess.  Alberto Milan writes that this administrator has 18 assistants whose salary reaches $4 million.  One may differ on the merits of the salaries but that is not where the truly abusive behavior lies; no, to identify the problem requires that we compare the number of assistants now employed with previous administrators that only  maintained half that many assistants.

Add to these wasteful and fraudulent finances the inexcusable pension benefits offered by the City of Miami. During the same period of economic distress, as reported on August 4 by Charles Rabin, these retirement benefits “skyrocketed 400 percent” increasing pensions obligations by $166 million.  In addition the city executive salaries have also risen leaving the city of Miami staring at a $60 million hole.

To me this is convincing evidence that government is simply unable to respond to financial realities.  Where there is no competition, as you see in any monopoly such as government, you can expect that services and financial responsibility are merely public relations banners.  Their answer to these financial debacles is taxes.

Unquestionably private executives are capable of similar disingenuous financial behavior but, and here is a big difference, these executives cannot just simply tax to make up for their deceitful practices.  This is exactly what they are planning at city hall where a careful plan is set for action, as I’ll explain.

I’ll be willing to bet that the mayoral office is counting on some other headlines soon replacing them as a topic of discussion. Maybe an international or national event, or more likely, and more beneficial to these local officials, some celebrity event which, aided by the media, will overshadow this squandering of civic trust.  At the end, with the attention of the electorate distracted, the citizen can expect the same old answer from City Hall: Taxes

Jose A. Hernandez, MD
Invisible-Hand@invisible-hand.net 

If the government were to run the health-care system
can “We the people” expect satisfaction?

Recently a Facebook friend posted an excellent video depicting the travails that patients encounter trying to navigate through the Canadian health system (such difficulties are depicted on A Short Course in Brain Surgery). A challenge to his post argued that “We the people,” since we are the government, should be able to solve whatever problems a public health system, not driven by the greed of private companies, encounters during its implementation.  This prompted my response that follows.

Government, when it comes to providing services, reminds me of Will Rogers’s aphorism that states: ”I don’t make jokes. I just watch government and report the facts.”  One could well ask why is government such a joke.  There are many reasons for our propensity to ridicule government, but in my mind the most relevant characteristic is the inefficiency innate to government projects.

This begs the question: why it is so inefficient?  An answer to this, I believe, can be found in what is the main driving force of elected officials, which is to get re-elected.  In their quest for reelection most elected officials, if it were legal, would simply hand out cash to buy your vote.  Because this process, direct hand out of cash, is too crass and unseemly, they have perfected other mechanisms to lure your vote.  One of these is to legislate programs that are basically give aways.  Their aim is to keep the voter in a state of euphoria, “drugged” with governmental offers and elaborate rhetoric, with minimal concern for efficiency. 

In the first paragraph I mentioned that an individual had challenged my Facebook friend’s view that a public health system would not be advantageous for our country.  He argued that our Constitution states that “We the people” established our government then, he logically concludes, “We the people” should be able to fix the problems of any governmental program.  The fallacy in his reasoning is that the daily running of government is supervised by elected officials, not ‘We the people”, and these legislators are driven by an insatiable impulse for re-election.  They will do anything legal, sometimes questionable, to get our vote. They are well trained, and most are quite talented, in the ways of enticing us with promises of free services (another expression for hand outs) and elaborate speeches to make you pull that lever (now may be the push of a button) that gets them elected.  But they know that the efficiency of a proposed governmental program is one factor that will not lure the voters, simply because voters don’t believe they can deliver, even the ones that vote for them.  In addition efficiency usually entails unpopular measures that don’t make you popular; so don’t expect the legislators to be too concerned about efficiency.

In the health-care system you can expect many wonderful governmental promises.  These will simply be too expensive creating a mammoth health-care budget which,  given the expected 20% fraud rate now endured by Medicare, will be a bonanza for thieves. The promises for more medical services and the Madoff-sized larceny expected will ravage even more the country’s finances.  At some point the legislators will attempt to control these staggering expenses which, were they inclined to efficiency, could be accomplished by strict accounting and detailed oversight. But how often have you seen a governmental programs implement these steps?  And, ask yourself, how often do they simply limit services?  Guess what you can expect in the health-care system.

Limiting health access will create many nightmares which can be gleamed from the experience of our Canadian neighbors as depicted on this video of a patient in the Canadian system (A Short Course in Brain Surgery). It is clear that once the government takes over the health-care system, in order to cover expenses, it will not implement efficiency but will simply limit services. 

Although “We the people” have little power over the daily execution of governmental programs, the Constitution does provide for “We the people” to vote them out of office.  This requires that we are cognizant of the doping effect their “free” programs and luring speeches may exert on the citizenry. But what if ‘We the people” prefer the euphoria of empathetic speeches enshrined within inspiring rhetoric of master orators? Then we are in trouble.

 Jose A Hernandez, MD
elcubano@aol.com

By Jose A Hernandez, MD

Posted in Facebook - 8/09/09

Harvard University’s Malcolm Sparrow, specialist in health-care fraud, estimates that as much “20 percent of the federal health-care budget is consumed by fraud, which would be $85 billion a year for Medicare.” While on the Medicaid side the GAO calculates Medicaid fraud at $33 billion, and this does not include Medicaid’s nursing-home “benefits.” (1) Fraud is only one part contributing to the inability of government health-care system to control its cost, which now outpaces private insurance by approximately 1/3. (2)
In contrast Safeway, implementing market-forces which rewards personal responsibility through financial incentives, was able to keep per capita health-care costs flat while most American companies’ costs have increased 38% over the same four years. This grocery-chain calculates that if the nation had adopted their approach in 2005, the nation’s direct health-care bill would be $550 billion less than it is today. (3)

Based on this snapshot into health-care cost, what would you predict is the most effective mechanism to control the skyrocketing health-care cost, market-forces or government control?

1) Government health care is a target for massive fraud.

2) Costs of Medicare/Medicaid Have Outpaced Other Health Costs by 1/3 Since 1970

3) How Safeway Is Cutting Health-Care Costs