Globalism can kill us! An April 2023 on-line Supply Management article makes some startling remarks about drug shortages in the US. Nine in 10 (90-95%) of generic sterile injectable drugs for critical acute care in the US rely on key starting materials from China and India. India possessed 62% of the global manufacturing capacity of active pharmaceutical ingredients, API, in 2021, while China stood at 23%, and the US just 4%, and doctors were rationing lifesaving treatments. The article concludes with this dire warning, Drug shortages are increasing, lasting longer, and having a greater impact on patient care.
A May 2023 on-line article reviewed a Senate report that cited an overreliance on foreign sources as a concern. Factories in China and India supply most of the raw materials used in American medicines. Early in the COVID-19 pandemic, India restricted exports of API’s and finished drugs made from those chemicals to protect its domestic drug supply. BIG PHARMA further complicates supply shortages because medications like Adderall and amoxicillin generate thin profits so companies don’t have an incentive to make and store large amounts in case a shortage develops, University of Utah Health researcher Erin Fox observed. In addition, when demand spikes. Federal regulators limit supplies of Adderall each year because it is a controlled substance. Once shortages develop, they can last for years; and it can be tough for patients to get reliable information. Fox said there is no legal requirement for drugmakers to update the public. Companies have said they aren’t getting enough raw materials to make the drugs, and the federal government says companies aren’t using what they have. Fox said, There’s been a lot of finger pointing back and forth.
The finger pointing is amplified by a February 2023 CNN on-line article, McKinney, the FDA spokesman, clarified that although the FDA is working with manufacturers, the agency does not make drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug. The lack of transparency about these production issues “ how big the shortage is and how much drug each company is making “ is hindering solutions. Additionally, pharmaceutical manufacturers are not required to disclose the reason for disrupted supply. Knowing the exact reason for a given shortage is needed to anticipate shortages and find solutions. Without solutions, globalism can kill us.
The Administration for Strategic Preparedness and Response told the committee staff that 90 to 95% of injectable drugs used for critical acute care rely on key substances from China and India. In other words, a severe breakdown in the supply chain could leave emergency rooms scrambling. The report also found that the federal government and industry regulators lack visibility into the supply chain for such drugs, making it harder to predict shortages. The Food and Drug Administration doesn’t know, for example, the amount of starting material a manufacturer has available, or, in some instances, how many manufacturers are involved in producing the final drug.
Nikkei Asia headlines and summaries note that China’s pharmaceutical market is already the second biggest in the world, after the U.S., thanks in large part to domestic demand from hospitals. Now Beijing wants to take the final step and surpass the U.S. Many pharmaceutical companies faced supply chain disruptions, especially since Covid-19. Often, chemicals used to produce the key ingredients in drugs were sourced from only a few suppliers in China — or sometimes just one. The pandemic has brought to light just how much the global pharmaceutical supply chain depends on China, even for the most basic ingredients. Consequently, globalism can kill us.
According to an August 2021 Harvard Business Review on-line article, most finished pharmaceuticals, whether made abroad or in U.S. factories, depend almost entirely on the availability of API’s, the primary functional components of the drugs we take. These ingredients include everything from the active substances in over-the-counter pain medications to life-saving IV solutions. Without APIs, pharmaceutical manufacturing grinds to a halt and shortages quickly follow. There is a very limited domestic capacity to make these essential medicine ingredients. The U.S. manufacturing base to make APIs has drastically eroded over the last several decades. Most of the supply now comes from abroad. For many materials, there is a single, foreign source of supply. The global over-reliance on China and India for APIs required to produce them, and essential medicines is especially worrisome. An estimated 80% of the world’s APIs come from China, India, and a handful of other foreign countries.
For several decades globalists in our national government, pharmaceutical industry, and many of our other domestic manufacturing conglomerates have moved manufacturing overseas. The result is a progressive globalism contradiction. They do this to save money on land, labor, facility construction due to lower environmental protection laws, and fewer occupational safety regulations. Consequently, the United States no longer controls our supply chains for many products needed to maintain our dominance in several global markets, including pharmaceuticals. Where the pharmaceutical industry is concerned, globalism can kill us.
The fact that the US only produces 4% of the globes API needed to manufacture critical pharmaceuticals must be solved. This is a national security problem and a national health problem. The fact that most of our pharmaceutical companies are now international conglomerates run by globalists makes solutions to this problem difficult. The multinational corporations must first answer the question of allegiance. Do they owe their allegiance to their shareholders; or to the nation and people where they gained their stature and competitive position on the world market? This is the most critical and contradictory question that progressive corporate globalists must answer. If corporate leaders and boards of directors cannot convince pharmaceutical shareholders that they should put the United States and We the People ahead of profits, then globalism can kill us. If the majority of the pharmaceutical supply chains, API sourcing and production, and final product manufacturing cannot be either greatly diversified or moved to US facilities, globalism can kill us.
Solving these critical issues will require cooperation between our local, state, and national governments and the entire pharmaceutical industry. At the national level, many of the more restrictive environmental assessment requirements could be waived to facilitate timely plant construction. State and local zoning regulations could be reduced and programs to train the workforce for these plants could be implemented and timed to meet plant openings. Government and the pharmaceutical industry must work together to ensure that We the People have the medications to live healthy, productive lives without the danger of medication shortages. If this cannot be done, shame on you in government and the pharmaceutical industry, globalism can kill us; it has and it will.
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The healthcare plan issue is the difference between socialistic government dictated plans and capitalistic individual based plans.
The healthcare plan issue is the difference between the socialistic approach to healthcare and the capitalistic approach to healthcare. Consequently, the Democrat socialistic healthcare plan must articulate every aspect of their plan for coverage. With a Democrat plan, everyone is covered at no cost to individuals or families, pre-existing conditions are covered for all; costs are paid by the government through taxation, and the price, type and availability of treatment or medication is determined by healthcare bureaucrats. A Democrat healthcare plan requires thousands of pages of regulations to implement and rarely fully understood by the citizenry. A Democrat plan is a government controlled one size fits all plan so every aspect can be articulated.
In contrast, a Republican capitalistic healthcare plan is based on individual choice. Capitalistic plans reduce taxes and allow the individual to choose their personal plan based on their personal health profile and risk tolerance. Consequently, a Republican plan lacks detail and specificity because there is no monolithic one size fits all plan. In reality, there cannot be a Republican Healthcare Plan because Republicans will allow We the People to develop our own personal healthcare plans that fit our personal or family requirements.
As a result, a Republican capitalistic healthcare plan or law must define the parameters that all private healthcare plans must include. At a minimum, the plan or healthcare law must require coverage for all pre-existing conditions, define the maximum age for covered dependents, define coverage limits for, hospitalization, specialist, physician, support staff, and medication related treatment of all diseases and chronic conditions. The healthcare law should also require complete cost transparency related to physicians, facilities, diagnostic procedures and equipment, supplies, medication both prescription and over the counter, and coverage related to eye, dental, and hearing health. The Republican healthcare law should allow home delivered meals, transportation for physician visits, and remote physician care for those who wish to pay for this coverage in their personal plan. This law should also allow individuals and families to form healthcare insurance cooperatives to compete with employers for insurance coverage prices in their area. Healthcare providers must be allowed to provide fully transportable healthcare insurance to customers in all 50 states, Washington DC, and all US Territories creating competition and lowering healthcare insurance costs for individuals and families. Unlimited Healthcare savings plans must be allowed in the Republican healthcare law. The Republican plan must also allow a range of low-cost plans allowing people to have a combination of healthcare savings plans with a range of catastrophic healthcare insurance plans that fit their health profile, risk tolerance, and ability to pay.
The Republican capitalistic healthcare law should also require complete healthcare provider transparency related to quality of care. The professional evaluations and disciplinary citations against all healthcare practitioners at every level and citations against healthcare facilities and their staffs should be publicly accessible to all. This is the only way the public can be sure that their care is the best available in their area. Such transparency would eliminate poor healthcare providers and reduce the overall cast of healthcare because medical liability insurance would go down. No one would go to a poorly rated practitioner or medical facility. Capitalism would eliminate the bad actors. Of course, medical practitioner groups and institution groups would oppose this level of transparency.
Meaningful tort reform is also necessary to control healthcare costs and must be included in Republican capitalistic healthcare laws. I am a good example of the added medical costs of our current tort laws. I was a truck driver with a heart condition. DOT regulations required me to have a tread mill stress annually. This test costs about $700; but my cardiologist would not approve my physical without a myocardial stress test which costs about $3,500. He required this test as a means of litigation mitigation in case I was involved in a heart related traffic accident while driving my truck; and he would be blamed for allowing me to drive with a defective heart. Physicians prescribe innumerable diagnostic tests as litigation mitigation measures. Meaningful tort reform would reduce such testing and reduce healthcare costs with little reduction in the quality of healthcare.
Healthcare and healthcare insurance comprise at least 17% of the US economy. Previously, several expansive and radical capitalistic healthcare and healthcare insurance proposals were discussed at America’s Crossroad. These proposals include A FORGOTTEN AMERICAN’S ALTERNATIVE HEALTHCARE PLAN which discusses employer provided plans, Obama Care, Medicare, Medicaid, VA Healthcare, and a unique proposal for dedicated Wounded Warrior Healthcare, TRUE FREE MARKET HEALTHCARE INSURANCE, IT IS TIME FOR THE HEALTHCARE RESPONSIBILITY ACT, and THE INDIVIDUAL HEALTHCARE TAX CREDIT. This discussion illustrates the fact that it is impossible to formulate a single comprehensive Republican capitalistic healthcare plan which gives individuals, families, and their practitioners complete control over their healthcare. For Democrats, a healthcare plan regulates every aspect of the healthcare system from costs to treatments and treatment accessibility requiring thousands of pages of regulations which are indecipherable to laymen. Accordingly, a Plan giving individuals and families control over the type and cost of their personal healthcare Plan ds not qualify as a healthcare Plan in Democrat circles. Therefore, healthcare based on free market capitalism can never qualify as a healthcare plan to Democrat socialists; and the healthcare plan issue cannot be resolved politically simply because Democrats and Republicans will never agree o the definition the word Plan as it pertains to healthcare.
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Americans need an alternative healthcare plan. As a “forgotten American,” allow me to propose a radical healthcare plan for consideration. Neither Obamacare nor any current GOP Healthcare Plan is either patient centered or free market. Since they barely cover 20% of the total healthcare insurance market, the current alternatives will fail; and we will be left with socialized single payer, VA style healthcare. Maybe it is time to consider at least one other healthcare plan. None of the current plans even offer free market healthcare insurance. Everything either existing or contemplated will leave us with varying degrees of government controlled healthcare insurance. The vaunted strong patient doctor relationship will be non-existent. In my opinion, a true free market healthcare plan is no longer possible due to the high cost of modern healthcare. However, a true free market healthcare insurance system that also provides for strong patient control and patient doctor relationships could be accomplished if several changes to the current or contemplated healthcare plan were adopted.
Before suggesting an alternative healthcare plan, a discussion of the United States government role in healthcare is appropriate. Nothing in the Constitution of the United States specifies that either the United States or State government is responsible for any individual’s healthcare, well-being, welfare, or education. Specifically, Article I, Section 1 states, All legislative Powers herein granted shall be vested in a Congress of the United States. Accordingly, only those powers specified, herein granted, in Article I, can or should, be enacted by the Congress of the United States. Individual healthcare, well-being, welfare, or education is not among the legislative Powers granted in Article I, Section 8 of the Constitution. The first paragraph of this section,
The Congress shall have Power To lay and collect Taxes to pay the Debts and provide for the common Defence and general Welfare of the United States,
refers to revenue collection necessary to pay for or maintain the general welfare of the United States government, as defined in the remainder of the section. This section ds not say, provide for… the general welfare of the”people or citizens,” the section says, “provide for the… general welfare of the United States.” Furthermore, Amendment X states,
The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
Consequently, the words and original Intent of the Constitution dictate that individual healthcare, well-being, welfare, and education are not the responsibility of the United States government; but they are the responsibility of the States respectively, or the people. Article I through Amendment XXVII of the Constitution provide the Constitutional details for the United States government to protect We the People and implement the general guidelines and objectives described in the Preamble, or introduction, to the Constitution.
However, Marxist, socialists, progressives, liberals, and the Democrat Party on left generally consider the Preamble to the Constitution as part of the implementation instructions rather than an introduction providing the general guidelines and objectives of the Constitution. The Preamble states that the United States should promote the general Welfare, and secure the Blessings of Liberty to ourselves and our posterity. The Merriam Webster On-Line Dictionary defines promote as follows: to contribute to the growth or prosperity of or to help bring into being. Neither the word contribute nor help connotes the concept that the United States government is required through legislation or responsibility to provide Welfare of any type. The archaic Merriam Webster On-Line Dictionary definition of secure follows: overconfident, easy in mind, confident, assured in opinion or expectation, having no doubt. Again, nothing in the definition of secure implies that the United States has the responsibility to provide, through legislation, welfare of any type. We the People are confident and assured that our Constitution will allow each individual to work to secure the Blessings of liberty. This phrase in the Preamble indicates that the United States Constitution provides a legal, political, social, and economic environment that contributes to and helps We the People secure (or have confidence regarding) the Blessings of Liberty. The emphasis of the Preamble is that the Constitution provides a framework by which We the People can secure the Blessings of Liberty for and by ourselves and our posterity. We the People individually determine how we are blessed by the liberty to pursue all that life offers to each of us. Nothing in the Constitution indicates that the United States government must or should provide anything but general, not any specific type of Welfare.
EMPLOYER HEALTHCARE PLANS
Since both Obamacare and any GOP plan are doomed to failure because only around 20% of the population will be covered, discussion of the current state of the healthcare plan in the United States seems appropriate. No segment of our healthcare insurance industry bears any resemblance to a free market, including employer provided healthcare insurance. No category of healthcare insurance is free of some form United States government control or subsidies. Over 50% of the people in our country benefit from a subsidized employer provided healthcare insurance. In each employer based healthcare plan, the value of the insurance is not considered as taxable income for employees, a government entitlement or subsidy; and businesses are allowed to deduct their employee insurance costs as a business expense, another government entitlement or subsidy. Thus, each employer provided healthcare plan is subsidized by the United States government and is an entitlement.
Additionally, each employer based healthcare plan is not a free market system for the employee and ds not guarantee meaningful, long term patient doctor relationships. Normally, employees must choose from at most three healthcare plan insurance providers that have contracts with their employer. Often employees must settle for the insurance offered by their employer for only one healthcare plan. Additionally, employees are usually limited to the HMO or PPO practitioners participating in their employer contracted healthcare plan. If the employer finds a better healthcare plan provider, the employee must change to the new plan and associated medical practitioners.
An individual or family healthcare plan has many advantages over employer provided healthcare plan insurance. Neither Obamacare nor any GOP plan provides any employee/patient control over their patient doctor relationship or other service providers for those participating in an employer provided healthcare plan.
OBAMACARE
In 2017, 12.2 million new individual consumers enrolled in Obamacare exchanges; but only slightly more than 20 million people were enrolled in all Obamacare programs including the Marketplace, Medicaid expansion, and young adults staying on their parents plan in 2016. This represents only 10-15% of the US population. Approximately 8.5% of our population has no healthcare plan. Consequently, Obamacare and any GOP individual healthcare insurance plan is attempting the build financially solvent individual healthcare insurance exchanges or markets serving about 20% of the total population of the nation, any State, or locale. In addition, a large proportion of the people served by both plans fall in the lower 30-40% of income earners. Some self-employed people in this group have higher incomes. With these small exchanges, markets, or patient pools, both of these plans are doomed to fail. Consequently, it is not surprising to me that Obamacare is failing!
THE “FORGOTTEN AMERICAN” PLAN
In my opinion, the only way to create a true, free market healthcare plan and insurance system that maximizes individual patient control and strong patient doctor relationships is a radical, comprehensive restructuring of the entire healthcare insurance industry in the United States. Accomplishment of this restructuring would require elimination of all vestiges of United States and State government as well as employer control over the types and cost of individual and family healthcare plan coverage offered by private insurance carriers. Employer paid healthcare insurance plans would be eliminated and converted to individual and family plans. Non-subsidized Obamacare plans would also be eliminated and converted to individual and family plans. Individuals and families receiving Obamacare subsidies and those receiving Obamacare coverage through Medicaid could continue these benefits until they are phased out by the respective states as new markets provide effective and economical individual and family healthcare insurance plans.
Government involvement should be limited to ensuring that healthcare plan providers treat people fairly and ethically, cover preexisting conditions for those changing healthcare insurance providers, and cover children under age 26 who are students or have incomes below the individual poverty level. Although it could be a leap too far, no PPO or HMO type restrictions should be placed on individuals and families in the proposed healthcare plan system. Each healthcare plan should allow people to select the practitioners and care facilities of their choice in every state where their insurance provider participates in the markets. This would insure high quality patient doctor relationships. All taxes, mandates, including the linkage between Medicare costs and private healthcare costs, penalties, and other regulations of Obamacare, unrelated to fair and ethical healthcare plan practices must also be eliminated.
Elimination of employer paid plans, in combination with those in Obamacare and the uninsured, would create a potential individual and family healthcare plan free market involving at least 70-75% of the US population. With exchanges or insurance pools this large, insurers would be able to eliminate life time coverage limits. Since coverage would be for individuals and families, preexisting conditions would not be an issue because lapses in coverage would not normally occur. Changes in employment or location would not affect individual and family insurance coverage. When individuals or families change insurance carriers, the old insurance carrier would provide a letter of continuing insurance as required now, and the new carrier would be required to cover all preexisting conditions.
Several steps would be necessary to accomplish this change. First, healthcare plan carriers must be allowed to offer insurance coverage in all 50 states like property casualty and life insurance carriers. Healthcare insurance carriers would be regulated in accordance with the laws of each state to account for differing state to state populations and economic situations. This would ensure total nationwide healthcare insurance portability, the largest possible insurance pools, competition among carriers, and the lowest possible free market costs to individuals and families. Second, states may require a reasonable amount of time to adjust their regulations to accommodate these changes. This could be done concurrently and in consultation with healthcare plan insurance carriers planning to compete in their state. Carriers must also have adequate time to develop a variety of plans to meet the needs of the people of our county in each of the states they plan to serve. The time allowed must be set in the legislation eliminating employer healthcare plan insurance and Obamacare. Third, employers must be required to provide a net wage or salary increase equal the amount they pay for employee healthcare plan insurance coverage at the time of the conversion. The new total labor cost, including the healthcare plan adjustment, would remain a deductible cost of business. Once state regulators and carriers have approved the healthcare plan insurance available in each state, employee pay raises could be increased by a reasonable amount if individual and family plans are more expensive than the cost of previous employer plans.
Medicare, Medicaid, and VA healthcare are United States government provided entitlement healthcare programs covering about 30% of the US population. These programs can require participant premiums, copays, and deductibles. A significant proportion of the population currently receiving healthcare through these government programs should be transferred into the proposed individual and family healthcare plan insurance market place.
Many individuals currently enrolled in Medicare are already enrolled in Medicare Advantage Plans or Medicare Supplemental Insurance Plans involving private carriers. Healthy retirees usually participate in Medicare Parts A & B incurring no premium costs. Privatization of Medicare would eliminate the entire Medicare bureaucracy. After the Social Security Administration certifies individual qualification and level of coverage for eligible private healthcare plans insurance and the individual enrolls, the plan would be funded. State regulations would govern administration of these Medicare funded plans. Privatization of Medicare would further expand the national individual healthcare plan insurance free market, increase coverage options, increase competition, and reduce costs. Privatization of Medicare along with other changes currently under discussion should increase the probability that Medicare would remain solvent for future generations.
VA HEALTHCARE
Although, a significant number of veterans have individual or employer provided healthcare insurance and do not utilize Veterans Health Administration services, most veterans and all military retirees qualify for VA a healthcare plan. Some must pay modest co-pays for VA healthcare or prescriptions. To provide services, the system depends on annual discretionary congressional funding resulting in potential yearly changes in enrollment category requirements and top income enrollment thresholds. VA healthcare has eight eligibility and priority categories that determine access to the system. Preference is given to military retirees and veterans with service-connected disabilities, categories 1-3. Statutes require that Veterans Health Administration facilities treating privately insured veterans with no service-connected conditions are reimbursed for the services by the private carriers. Low income veterans and those experiencing financial setbacks can request hardship waivers for out of pocket VA costs. The lowest priority is given to wealthier veterans with no service-connected conditions or disabilities, category 8. The wealthiest veterans with incomes above a threshold level and no service-connected conditions or disabilities are not eligible for VA healthcare services. Therefore, each VA healthcare plan is means tested.
For military retirees, their spouses, eligible children, and eligible surviving family members, a variety of retiree healthcare benefits are available. Although military retirees can receive VA medical benefits and use VA facilities as space allows, retirees are advised that VA medical care has many limitations and eligibility requirements. VA medical care should not be their only source of healthcare. The most common source for military retiree medical benefits is TRICARE, a provider that covers retirees from all uniformed services. TRICARE and TRICARE for Life, for those over 65, allow use of a civilian healthcare plan. Retirees are also encouraged to obtain supplemental healthcare plan insurance for copays, deductibles, and dental needs which can be costly. Retirees are also encouraged to sign up for Medicare when they become eligible.
In my opinion, veterans receiving VA healthcare and military retirees with TRICARE lacking service-connected conditions or disabilities could be transferred into the proposed free market individual and family healthcare plan insurance system. To be fair to this unique group of citizens, the United States should ensure that their out of pocket costs would not increase. These costs could be offset by permanent insurance premium, copay, and deductible supplements or tax credits. Veterans and military retirees, who enlisted under the current system, should be able to choose between VA healthcare, TRICARE for retirees, and private healthcare insurance. Transfers should not be done without a guarantee that all commitments to veterans and military retirees would be fulfilled. These veterans and military retirees must also be eligible to return to the VA healthcare system or TRICARE when a newly manifested condition or disability is attributed to their military service.
Because of our Nation’s unique commitment to our veterans and military retirees, this proposed change in their healthcare should not occur until the proposed private individual and family healthcare insurance market is operating effectively and a full range of private coverage healthcare plan insurance is available. However, if this proposal were to be adopted, subsequent military enlistees must be advised that the new private individual and family healthcare plan insurance system would provide medical coverage for veterans and military retirees not incurring service-connected conditions or disabilities at the successful completion of their military service. Veterans and military retirees in this group incurring service-connected conditions or disabilities would receive medical care through the Veterans Health Administration. This change would further expand the national individual healthcare plan insurance free market, increase coverage options, increase competition, and reduce costs of both the individual market and veteran and military retiree medical costs.
WOUNDED WARRIOR HEALTHCARE
A “Forgotten American’s” wounded warrior healthcare plan.
Perhaps the most important advantage of this change would be to allow the Veterans Health Administration to concentrate on military retirees and veterans with service-connected conditions and disabilities, our wounded warriors. The savings from this change would be available for research, construction of more rehabilitation facilities, specialized therapists, and expanded post-traumatic stress syndrome and other mental illness diagnosis and treatment. The proposed change in veteran and military retiree medical care would result in significant reduction in patients served as well as the size and cost of the entire VA bureaucracy. Another advantages of the change would be related to applicant classification which would be reduced from eight eligibility and priority categories to three at most. This current, cumbersome and complex, classification system undoubtedly contributes to the long and often dangerous delays in processing veterans and retired military personnel into the VA medical system. Most of the current categories are not related to service connected medical issues which would be the primary mission of the newly organized Veterans Health Administration. The proposed changes in VA Healthcare might go a long way to finally provide our military retirees, veterans, and wounded warriors the medical care promised to them by We the People of the United States of America.
“FORGOTTEN AMERICAN” PLAN REQUIREMENTS
To complete the radical, comprehensive restructuring of the entire healthcare plan industry in the United States, three additional components of the system require change. First, the young and the healthy must contribute to the financial stability of the proposed individual and family healthcare insurance system without imposing a mandate. My suggestion is a “Healthcare Responsibility Act.” The idea is that every individual or family must be legally responsible for all of their healthcare plan costs either with their personal assets, appropriate healthcare insurance, or a combination of the two. This law would make every individual, family, or their estate legally liable for payment of their entire healthcare costs without litigation or bankruptcy relief requiring major asset liquidation and/or a lifetime payment plan to cover all of their healthcare costs. With such severe consequences, people would be far less likely to avoid securing adequate healthcare plan financing or insurance.
Secondly, providers must be legally required to publish the costs of prescriptions and their services for patients to compare with other providers. In addition, information regarding the quality of prescriptions, the care provided by each practitioner, hospital, and clinic must be easily available to the general public. This would also work to eliminate or reduce poor quality care, corrective procedures, and related litigation. This concept would result in open competition for healthcare services creating true free market competition among providers by allowing each individual or family to shop for providers based on the price and quality of healthcare services. This requirement would result in real provider patient based care and an overall reduction in the costs of healthcare plan insurance.
Thirdly, tort reform is essential to control healthcare costs. One of the most important reforms would be reasonable limitations for loss and punitive damages to control the costs of healthcare plan insurance. The sheer size of most of these settlements fuels the tort industry which often results in frivolous law suits and unnecessary legal fees that further increase all healthcare costs. Tort reform should also require the loser to pay all court costs. My experience as a former trucker is a perfect example of both these issues. After a heart attack, safety laws required an annual rather than biannual physical. At that time, laws specified that the physical include a $700 stress test, treadmill, but my cardiologist would not release me for work without a $3500 myocardial stress test. The difference, charged to my healthcare plan insurance, was necessary for my cardiologist to mitigate potential litigation if I was subsequently involved in a heart related traffic accident. Tort reform is essential to further decrease the cost of healthcare insurance.
Technology has drastically improved prescription efficacy, diagnostics, and available treatments. It has also caused costs to rise to the point that healthcare plan insurance is essential for patients to afford the benefits of these advancements. Government interference in healthcare as a protagonistic regulator, price fixer, and provider has virtually eliminated any vestige of free market healthcare insurance. The result is nearly uncontrolled increases the healthcare costs and resultant healthcare plan costs. The attempt to control costs without radical, comprehensive changes to the entire system will fail. In my opinion, the alternative being proposed would create what everyone claims to want, a free market, patient doctor oriented, healthcare plan insurance system where We the People control our healthcare.
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Capitalism’s globalism contradiction centers on cost savings in emerging markets.
Capitalism’s globalism contradiction centers on Executive’s and Board of Director’s obligation to maximize profits and their obligation to their employees, their communities, and the nations of their origin. Failure to consider the implications of this contradiction provides the left with a powerful criticism against capitalism. In the United States, this contradiction is exacerbated by our high labor costs and benefits, safety regulations, environmental regulations including environmental impact assessments that increase both the costs and time required to open a facility or project, financial system regulations, land use and zoning regulations, and past high corporate taxes. The relationship between profit and societal obligation is only one component of capitalism’s globalism contradiction.
Another aspect of capitalism’s globalism contradiction is the incredible economic success of western civilization, especially in the United States, since the start of the industrial revolution. Until the 1960’s or 1970’s, globalization was not a significant issue in relation to competition and market share for corporations in the western world. Consequently, costs associated with land, labor, and capital were comparatively inconsequential strategic considerations compared to today’s markets. Costs of doing business were evaluated only in relation to competition in the United States and other western industrial powers. For example, the big three US auto makers competed among themselves for US market share and labor. Labor union contracts for wages, benefits, and working conditions that often precluded effective discipline and quality control were virtually identical throughout the US auto industry. The result was high industry wide wages, benefits, and job security. As countries like China, South Korea, India, other Eastern Pacific rim countries, and parts of the old Soviet Union emerged as competing centers of industry, the cost of land, labor, and capital became a competitive liability for western industry.
Finally, North American and European capitalists are harnessed to strongly unionized labor forces unwilling to negotiate lower, more globally competitive wage, benefit, and work condition packages which could have slowed reductions in US manufacturing and plant closures. This issue is complicated by the success of western capitalism causing high costs of living and the expectation of high disposable income to finance the good life. These two factors make efforts to make our labor costs more competitive in the global market difficult. Western capitalism’s success also amplifies capitalism’s globalism contradiction when faced with emerging markets for our products and competition with our products throughout the world.
Capitalism’s globalism contradiction is profit versus support of the labor force that makes their products or provides their services and loyalty to the communities and countries of their origin. Interestingly, it is also the left’s globalism contradiction, maintaining wealth for our workers while redistributing wealth to developing country industries and workers.
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One reason that Republicans snatched defeat from the jaws of victory was that they chose the wrong slogan for elimination of Obamacare. The idea of replacement is framed by Democrats as replacing a failed monstrosity with a new replacement monstrosity. As with everything else, Democrats demand a single comprehensive healthcare plan. The Republican failure to have a united front on a clearly articulated Obamacare replacement plan provided fuel for Democrats and the media on both the left and right to oppose Obamacare repeal and replacement. Consequently, doubt and speculation rather than clarity prevailed. Going forward the question remains, “Will Republicans ‘snatch defeat from the jaws of victory?'” Can Republicans solve the nation’s healthcare issues?
We the People need Real Healthcare Solutions Now not Obamacare lite.
In my opinion, the Republican slogan concerning Obamacare should be Real Healthcare Solutions Now. This would place the important issues at the forefront. The slogan, “Real Healthcare Solutions Now, would provide emphasis for a campaign to verbalize exactly how healthcare should be improved and perfected both in relation to the pre-Obamacare healthcare environment and the healthcare failures caused by Obamacare. A monster bill or law covering all the ills of healthcare would be counterproductive and ineffective in solving all the pre-Obamacare and Obamacare caused issues.
Two critical issues that plagued healthcare before Obamacare are transparency within the medical profession in relation to quality and cost of healthcare and tort reform. Providing the people of the United States with high quality, economical healthcare would require that each of these issues be effectively addressed. First, the medical profession should be totally transparent or patients will never have control of their own healthcare. Patients should be able to easily determine and compare the quality and cost of care that they would get from every doctor, analytical procedures, and clinics and hospitals where they will receive care. CBS News reported that clinics, hospitals, and their emergency rooms utilize some specialists and practitioners, like anesthesiologists, that are out of network and not covered by the same insurance plan. The report noted that the patients were not informed about the situation and were billed for the entire cost. Such a situation should be illegal. If a hospital or clinic is covered by your insurance, all of the practitioners at the facility should be part of each plan. The cost and quality of prescription drugs should also be easily comparable for the general public. Unfortunately the medical profession has succeeded in getting state and federal laws that make this type of information difficult for the public to access so that they can ensure the quality and cost-effectiveness of care they receive.
Secondly, tort reform is essential to control healthcare costs. As a former big truck driver, I am a perfect example of this issue. After a fairly severe heart episode, safety laws required a physical annually rather than biannually. At that time, laws specified that the annual physical include a $700 stress test, treadmill. However, my cardiologist would not approve my physical without a $3,500 myocardial stress test where the law simply specifies a treadmill. The difference, charged to insurance, was necessary, from my cardiologist perspective, to mitigate potential litigation if I was subsequently involved in a heart related traffic accident. I also have two all metal artificial hips which, in a small minority of patients, can cause surrounding tissue damage and prosthetic replacement. The daily barrage of attorney advertisements seeking clients for litigation regarding medication side effects and in my case the artificial hip side effects demonstrate the great potential increase in costs associated with litigation. It is not difficult to imagine how much this tort environment increases the cost of healthcare. Healthcare laws should address these issues.
In my opinion, every individual and family in the United States of America should be legally responsible for payment of their healthcare costs. This could be accomplished by my proposal for “The Healthcare Responsibility Act.” Admittedly, it is a wild and crazy idea to think that everybody should be legally responsible for their healthcare and the healthcare of their family. Under this concept, there would be no healthcare insurance mandate; but individuals and families would secure healthcare insurance if they knew that they would be legally responsible for all their healthcare costs whether or not they were responsible enough to secure healthcare insurance and/or fund a healthcare savings account. To ensure their financial future, the young and healthy would secure state or federally defined legal minimum health insurance coverage. This concept would help insure that the insurance provider pools had adequate funding to cover those with pre-existing conditions and children under 26 years of age with their parents insurance.
As a young, 70 year old geezer, my pre-Obamacare healthcare experience was extensive. Before we lost her, my wife and I were never without family healthcare insurance which covered ACL replacements on each of our son’s knees, surgeries on both of my knees and two fingers, my initial heart care, and her cancer care which exceeded $250,000. Subsequently, in New Mexico, while attempting to start a ministry/business, my heart condition precluded private individual healthcare insurance. My premium through the New Mexico Health Insurance Alliance (NMHIA), a state run program for uninsurable entrepreneurs, was nearly $700 a month. Premiums were high because the pool was limited to uninsurable entrepreneurs with businesses in New Mexico, a rather small group. Monthly copays for three branded prescriptions totaled $120, and practitioner copays ranged from $10 to $40 per visit. In my opinion as a citizen, healthcare insurance was my responsibility. Both of my hip replacements, abdominal hernia repair, and prostate cancer surgery were covered under this Insurance totaling less than $1250 in copays. Without this insurance these procedures would have cost between $250,000-$500,000. NMHIA is an example of a state licensed healthcare insurance co-op or pool limited to an individual state resulting in very high premium costs unlike the suggestion for insurance co-operatives discussed below.
The best way to ensure high quality cost effective healthcare is an open, transparent, free market healthcare system. Establishment of the rules and regulations, as well as cost administration, should be a state by state responsibility because the population health status, cost of living, and business costs vary in each state. Suggestions abound to achieve this goal. In the individual and single family healthcare market, allowing healthcare insurance policy coverage without state by state restrictions and allowing every provider to sell policies in all 50 states, is one suggestion. To accomplish this option, the national government would need to mandate uniform regulations among all 50 states. In a mobile society like ours, this idea would also allow complete transportability between states. In addition, allowing individuals and single families to form interstate insurance co-operatives would allow these groups to compete more effectively in the insurance market place. The same rules should also apply to employer provided health insurance which would probably reduce employer costs for large multi-state corporations with high interstate employee transfer rates.
In my opinion, the solutions for our healthcare issues being proposed will never create a truly patient doctor centered free market healthcare system. Currently, each component of healthcare has different rules and regulations. Only a small portion of the total healthcare market was covered by Obamacare. The total healthcare segment of our economy includes employer based healthcare which is over 50% of the market, Veterans Administration healthcare, Medicare and Medicaid, and the uninsured. Each has it problems and patients do not control their care in any. Until problems of the whole system are addressed by a true free market solution , problems will continue.
A healthcare plan that includes the requirement for healthcare cost and quality transparency, tort reform, creation of interstate insurance purchasing power, insurance co-operatives, and legal requirement for individual and family responsibility for all the costs of their healthcare would provide significant steps toward providing healthcare that is patient based rather than more costly, ineffective government mandated healthcare plans. Passage of legislation covering each component of healthcare should result in a more perfect healthcare system than a single healthcare omnibus bill, an Obamacare like disaster. Republicans in Congress and the Trump Administration must quickly settle on a unified, patient centered healthcare plan, or they will snatch defeat from the jaws of victory.
We the People need
Real Healthcare Solutions Now.
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The progressive globalism contradiction is global wealth redistribution from US laborers to foreign laborers.
The goal of global wealth redistribution, globalism, is contradictory to the progressive goal of wealth redistribution within industrialized capitalistic countries. From the beginning of the Industrial Revolution, progressives struggled to increase the wages of the lower and middle classes, the primary work force. Activists on the left called themselves communists, socialists, progressives, and liberals depending on which term was more acceptable to society at large at the time and location involved in the world. These activists were essential to the success of the labor movement in Western Europe and North America. As a result, the wages and benefits of Western workers became the envy of the rest of the world. The contradiction, for progressives, is the fact that Western wages and benefits have resulted in comparatively high disposable income and standard of living in the industrialized Western world. For globalism, global wealth redistribution, to succeed, workers in industrialized countries must expect wage and benefit stagnation at best or decreases in their standard of living through reduced disposable income. In other words, the left gives and the left takes away, the left’s globalism contradiction.
As industrialization expanded to other regions of the world, specifically the Asian-Pacific rim countries and China, global competition also increased. Initially, lower wages and benefits in these regions allowed Asian automakers, consumer product producers, as well as Chinese steel and other consumer good producers to compete effectively in Western European and North American markets. Additionally, the fall of the old Soviet Union brought capitalistic enterprise and increased industrialization to Russia and Eastern Europe which allowed additional low-cost consumer goods to enter Western markets. The result was that Western manufacturers faced competition from newly industrialized areas where wages and benefits were lower than those in the United States and other Western countries. In the United States, our manufacturing plants, steel and special metal mills, textile mills, and consumer product manufacturing plants were old and outdated. The cost of updating these facilities as well as the time required for licensing and construction and the high cost of construction labor made new manufacturing plants even more time consuming and costly to bring on line. The time and expense of environmental impact and economic assessments adds significantly to the time required and the expense of constructing new modern manufacturing facilities.
Faced with low cost competition and the rapidly expanding global market, the globalism contradiction forced corporations to make decisions regarding manufacturing plant locations. The result was plant closures in the industrialized parts of the United States and new plant construction around the world to replace facilities closed in the US. These decisions have adversely affected the number of manufacturing jobs available, wages, and benefits in western countries like the United States. As a result, middle and lower working class wages and benefits have been at best stagnant or declining for at least two decades.
The final globalism contradiction is related to free trade agreements like NAFTA and TPP. When these agreements result in excessive trade deficits for the United States, they are effectively global wealth redistribution. This fact is contradictory to conservative ideology. Although US consumers purchase goods at a lower price, the value of the good paying jobs we lose in the exchange is roughly equivalent to the value of the trade deficit. The free trade competition results in lower cost consumer goods, but we lose good paying manufacturing jobs due to the high costs associated with US manufacturing. From the perspective of the left, opening factories in developing countries is great. Capital is redistributed from developed industrialized countries to underdeveloped Third World countries creating good paying jobs, more disposable income, and increased standard of living, global wealth redistribution. Of course, leaders and planners on the left do not discuss the sacrifices this global wealth redistribution inflicts on the middle and lower class workers of the more advanced industrialized countries. They stress that the top 1% are not paying their fair share of the costs they inflict on our workers. The question is, are workers in the United States satisfied with the answers provided by the Left?
On his last overseas trip, President Obama indicated that globalism has not leveled the world playing field as quickly as he had hoped. The 2016 election demonstrated that workers in the United States are not interested in sacrificing their standard of living to advance global income redistribution. It was the progressive globalism contradiction, stagnant or declining wages and employment in the United States, that cost progressives the Presidency in the 2016 election. This debate will be critical for the future of our country. This issue among others at this point in time and our history places us at America’s Crossroad.
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To understand progressive domestic policy it is necessary to understand that globalism is wealth redistribution. The critical concept of globalism is the statement by Marx, From each according to his ability to each according to his need wealth redistribution will occur on a global scale. To prepare people in successful, industrialized, capitalistic countries like the United States for a totally globalized economy, several precursors are necessary. Changing the minds of the citizenry to accept global wealth redistribution is probably the most difficult, but essential, step. To accomplish this goal, an educational dictatorship has been established by progressives. The second step is the left’s domestic policy. The third step is the lefts foreign and immigration policy. These three prerequisites are discussed in detail at the links provided. A great deal of progress must be made in these three areas before the final stages of global wealth redistribution can be accomplished. The left plans and thinks in evolutionary time frames. They have worked toward their goal of complete globalism, wealth redistribution, since at least the early 1800’s.
For progressive domestic policy and globalism to succeed, it is necessary to understand that both require wealth redistribution.
Some of the tactics of the left in this process are virtually invisible especially in the developed countries. From the perspective of individuals and families, the greatest difference between the people of advanced countries and Third World countries is disposable income. In my opinion, disposable income is income available beyond basic survival needs. Basic survival is simply food to maintain population vigor and vitality or a strong, healthy, and reproductive society. Safe water to drink and the ability to survive extreme heat or cold which requires adequate shelter are also basic survival necessities. The ability to stave off severe epidemics and diseases is also a basic necessity for life. Virtually everything beyond these survival necessities constitutes disposable income. Meeting these needs constitutes the fixed costs of life at the survival level. The more income a population has to secure amenities above these survival needs, the greater their disposable income.
The left has numerous resources and tools available for their closure of the disposable income gap between advanced capitalistic countries and Third World countries. Incremental increases affecting regulatory policies that increase production costs and higher taxes on fixed cost products and services like food, shelter, water, and healthcare are stealthy methods of reducing disposable income in advanced countries. In addition, taxes and regulations that increase costs of unnecessary necessities, such as advanced transportation systems, entertainment, recreation, and technology related to the basics of the good life decrease disposable income available for these necessities in industrialized Western cultures.
Similarly, excessively high business income and property taxes as well as business and financial institution regulations reduce available capital for business expansion. One of the most detrimental regulations has been Obamacare which mandates employee health insurance coverage for all businesses with 50 or more employees. This regulation stifles business growth and profitability. Small businesses either restrict growth to less than 50 employees or increase their prices to cover increased costs. Banking and financial regulations such as increased cash reserve requirements for banks reduce the supply of capital for business improvements or expansion. Financial regulations also cause a reduction in the number of local banks further reducing the supply of capital available to many small businesses. These actions result in lower product and service supplies resulting in increased costs. Until the current administration reduced regulations and taxes, these costs caused corporations to move their headquarters or factories overseas to reduce overhead costs. Loss of productive capacity also increased costs. When taxes and regulations increase, the resulting cost increases are added to fixed costs related to the real or perceived necessities for life, thus reducing disposable income in developed countries.
Possibly the most powerful tool in the progressive stealth toolbox is global environmentalism. In the United States, the environmental movement has been supported by both Democrat and Republican administrations. Republican support shows that they support reasonable efforts to maintain safe water, clean air, and stable ecosystems. Republicans, however, do not support regulations that have adverse effects on the quality of life of our citizens by increasing fixed costs of living. One of the strongest proponents of environmentalism has been the United States federal court system. Our federal courts usually side with environmentalists. Often, these court decisions have the effect of decreasing supplies of lumber products, agricultural production, other renewable natural resources, and nonrenewable natural resources, both petroleum and mineral extraction. Environmentalists also work actively to reduce planned, and in the not too distant future, eliminate existing hydroelectric and irrigation dam projects. Many existing Hydro projects are facing their fifty-year environmental impact reviews in the near future. In all these critical areas of our fixed consumer economy, the result is a decrease in disposable income as fixed costs of the basic necessities of life increase. Environmental regulations associated with global warming have the same impact. They increase the fixed costs of both real and perceived necessities for life. Costs of heating, cooling, energy production, manufacturing, and transportation and sales of consumer goods, constitute increases in fixed costs in industrialized societies.
From the left’s perspective, the stealthy beauty of the entire environmental toolbox is the fact that saving minnows, spotted owls, or rare lizards, sounds so progressively wonderful and feels so good to a large portion of the populace, the urban dwellers. The impact on their disposable income and quality of life is irrelevant to them. After all, they already have enough, until they start losing too much of what they currently have.
In the United States, middle class voters in the northeastern industrialized states who experienced stagnant wages and rising fixed costs for a decade voted for change. They voted against the status quo and declining disposable income because they started experiencing the reality of global wealth redistribution on their quality of life.
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Globalism can kill us! An April 2023 on-line Supply Management article makes some startling remarks about drug shortages in the US. Nine in 10 (90-95%) of generic sterile injectable drugs for critical acute care in the US rely on key starting materials from China and India. India possessed 62% of the global manufacturing capacity of active pharmaceutical ingredients, API, in 2021, while China stood at 23%, and the US just 4%, and doctors were rationing lifesaving treatments. The article concludes with this dire warning, Drug shortages are increasing, lasting longer, and having a greater impact on patient care.
