THE U.S. CONSTITUTION NEEDS AMENDING – AND FAST
On 8/9/09 Alec MacGillis in the Washington Post outlined one of the largest problems today in our Constitution that distorts the legislative process and often thwarts the will of a large majority of Americans. The composition of the U.S. Senate permits several small state Senators to essentially wield excessive power. MacGillis wrote:
“The Senate Finance Committee’s “Gang of Six” that is drafting health-care legislation that may shape the final deal..…represents six states that are among the least populous in the country: Montana, Wyoming, North Dakota, Maine, New Mexico and Iowa.
Between them, those six states hold 8.4 million people — less than New Jersey — and represent 3 percent of the U.S. population…..In the House, those six states have 13 seats out of 435, 3 percent of the whole. In the Senate, those six members are crafting what may well be the blueprint for [health] reform.
Climate change legislation, which passed in the House, also faces daunting odds. Why? Because agriculture, coal and oil interests hold far more sway in the Senate. In the House, the big coal state of Wyoming has a single vote to New York’s 29 and California’s 53. In the Senate, each state has two. The two Dakotas (total population: 1.4 million) together have twice as much say in the Senate as does Florida (18.3 million) or Texas (24.3 million) or Illinois (12.9 million).”
We unfortunately need 4 new Constitutional Amendments to fix this and other affronts to our system of one-man-one-vote representative democracy and to address three other serious long-term Constitutional problems.
A 28th Amendment would change the composition of the Senate to better reflect the relative populations of the 50 states. All states with at least 1 million people but less than 10 million inhabitants would have 2 Senators. States with less than 1 million inhabitants would be allocated only 1 Senator. States will 10 to 20 million people would get 3 Senators, those with 20 to 30 million would get 4 Senators, and so forth.
Reviewing the Census numbers from 2008 and extrapolating the 2010 Census results, this new Senate allocation would still result in about 100 total U.S. Senators. 34 States (68%) would have 2 Senators each since they have between 1 and 10 million inhabitants each. Only 7 states would have 1 Senator each (Alaska, Delaware, Montana, North Dakota, South Dakota, Vermont and Wyoming) because they all have less than 1 million people each. 5 states would have 3 Senators each: Florida, New York, Illinois, Pennsylvania and Ohio as they have between 10 and 20 million inhabitants. Texas with about 25 million people would have 4 Senators and California with around 38 million people would have 5 U.S. Senators.
There are 2 states that might change places after the 2010 Census. Michigan has been steadily losing population and is just over 10 million inhabitants. North Carolina which has been steadily gaining population is just under 10 million in habitants. This proposed U.S. Senate allocation would ensure better national representation of all Americans in this very powerful national legislative body.
An additional change to the U.S. Senate would involve the filling of vacancies. To fill a vacant seat, a new election would have to be scheduled by the State’s Governor within 3 to 6 months from the date of any vacancy. The winner would take office within a week from the certification of the election results. No more political appointments would be allowed as was proven to be a real political fiasco in several states after the 2008 elections.
Finally, all laws passed by the Senate would only require the consent of a majority, or 1 vote more than half of the total Senators elected, provided a quorum were established. The filibuster should be prohibited. This would not change the two-thirds majority votes required for judicial appointments, treaty ratifications, or other specific matters listed in the Constitution. The President of the Senate (The Vice-President) would be able to cast a vote at any time on any vote, not just when the Senate is equally divided as it stands under current law.
In addition, we should admit Puerto Rico with about 4 million U.S. Citizens as a state and merge the 2 Dakotas (with just under 1.5 million total people) so we can still retain the magic number of 50 states. If the 2 Dakotas merged simultaneously with Puerto Rico Statehood, it would be a political wash in the Senate as the new State of Dakota would have 2 Senators (1.5 million people total) and Puerto Rico with 4 million people would also get 2 Senators. Alternatively, the residents of the U.S. Commonwealth of Puerto Rico could vote for complete independence.
Washington DC should revert back to Maryland, as did part of the Federal District to Virginia during and after the Civil War. Only a small geographic area surrounding the National Mall and including most Prominent Federal Government Buildings (including the Capitol, the White House, Supreme Court, Library of Congress, the Smithsonian, and most Federal Department headquarters) would be part of the Federal District for Congressional Administration. It is an affront to representational democracy that over 600,000 residents of the District of Columbia have no Congressional representation.
A 29th Amendment would increase the U.S. House of Representatives from 435 to a total of 777 members who would all serve 4-year terms, with one-half (½) of the House up for election every 2 years. It would become a continuous legislative body as is the Senate where only a third of Senators are up for election every 2 years. Each state would still have at least one Representative as provided by the Constitution. Actually any number between 500 and 1,000 would work so long as it becomes too expensive to bribe enough Members of Congress to influence important legislation.
Of all modern democracies, the U.S. has the most people allocated per federal legislative district (between 525,000 and 700,000 each) compared to most other countries which have less than 250,000 people per national assembly seat. These changes would significantly reduce the perpetual campaigning and fundraising that consumes more than half the time of our U.S. Representatives who must stand for election every other year. They may also increase direct voter access to their Congressional representatives and limit the power of a few well-moneyed campaign contributors.
Another change for the U.S. House would require that all Congressional Districts be determined by a bi-partisan commission appointed by Congress after the results of each Census are announced and certified. Districts would be based upon contiguous geographic entities without regards to the demographics, politics, economics, races, creeds, colors, religions or national origins of the inhabitants. This would actually return Congressional districts to the geographic basis of the original Constitution rather than the strange-shaped gerrymandered districts we have seen for the past 30 years. There should be no safe Democratic or Republican seats that reflect extreme gerrymandered partisan groupings of voters.
A 30th Amendment would eliminate the Electoral College and have the President and Vice-President elected by direct popular vote. In this manner, all candidates would have to campaign in every state and not just “battleground” ones, because one could never tell where the winning votes might come from. No state or large groups of the electorate would be disregarded as being safely in the Blue or Red camps as occurred for all of the Presidential contests since 1996.
A 31st Amendment would define and limit “person” for all Constitutional and legal purposes to natural born human beings. It would not attempt to define the beginning or end of human life, as that would be left to each state, or to future generations through legislative enactments. This is not a proposal to address abortion, euthanasia, or marriage, which could properly be the subjects of other Amendments. Most importantly the definition of “Person” would exclude all business, social, labor, or other organizations, including corporations, partnerships, companies, LLCs, foundations, Unions and all government-created “legal fictions.” This clear definition is particularly important for defining whose speech and civil liberties are to be legally protected and who may give money to political organizations and individual campaigns. Business entities, trade organizations and other legal fictions should be protected under the 5th Amendment and other specifically enumerated and reasonably related Constitutional protections but they should not be equated with living individuals. This was a serious interpretive mistake from several past U.S. Supreme Court decisions that must be rectified to reassert the authority of people over corporations.
With the requirement that Constitutional Amendments be approved by three-quarters (75%) of the states, the chances of passage may be decent for most of these 4 proposed Amendments. 82 percent of the states would retain 2 Senators or actually gain a few Senators. All states would likely see an increase in the number of Congressional districts instead of about a third losing seats if the House remains fixed at 435 members and the 2010 Census requires reapportionment. Finally, every state would probably like to be an equal focus of future Presidential elections instead of limiting the battlegrounds to fewer than 10 states.
Alternatively we could instead just add a fourth branch of government to reflect political and economic reality. This branch would have absolute veto power over the other three (Legislative, Executive and Judiciary). It would consist of permanent appointed representatives of all major U.S. corporations (including multinationals) that have at least $1 billion in total annual revenues as per their most recently filed federal tax returns. The make-up of this group would change a bit from year to year but essentially it is a pretty solid club. That way the rest of the government would not depend upon campaign contributions from this group of wealthy corporations, but they would face the normal reality of being wholly subservient to them. Full transparency and honesty would finally be achieved – even if the reality would not be so pleasant. The proposed 4 Amendment discussed above would go a long way towards reversing the ongoing surreptitious takeover of our country by large business interests.
As always, I welcome reader comments. – 8/11/09 by Marc Pascal in Phoenix, AZ.
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76 Responses to “THE U.S. CONSTITUTION NEEDS AMENDING – AND FAST”
Thank you, by the way, Hemm. This is the most interesting discussion I've been in since I started hanging out here.
My categories weren't supposed to be political, more ideological. Political mechanics are a topic of their own, and both parties are a mess.
I'm trying to digest your comments about the elites. It suggests this haves-versus-have-nots tension that I just don't perceive. We're the richest country on the planet, and many groups wield political influence through money or votes or both. Which are the elites? I can't tell.
What I can tell is all these groups keep the government pinned down like Gulliver, and any movements it manages to make will be dictated more by opportunity than deliberation. Which is precisely why I have little faith in government to solve people's problems.
What is the conclusion you hate? I don't think I caught it.
Dr J
I couldn't agree more, conversations like this are why I come here. I also want to apologize upfront for the harshness of my earlier comments. Bomb throwing can be fun in these comment sections, but they really are a huge distraction to everybody's clear thoughts.
Anyway, so you can't tell the elites without a scorecard? Exactly, me too at lot of the time. They obviously go to great lengths to keep their actions behind the scenes. The political parties are no help in exposing these manipulations, and MSM media is all about the sound byte.
I'd like to mention something about your groups:
“My categories weren't supposed to be political, more ideological. Political mechanics are a topic of their own, and both parties are a mess.”
I would submit the conservative/liberal ideological divide is equally an illusion. To start, consider a real world personal problem you and your family faces. What important decision have you had that only had two possible solutions? Life's problems tend to be more complex than black/white, good/bad, or liberal/conservative. Yet all our country's problems are immediately divided in just that way.
I'm certainly not asking you to defend your conservative leanings, but I ask you if you have analyzed how you came to believe them. Is there no single question that was better answered through a different philosophy? Has there been a single legislative action taken by conservatives that made you go WTF? Maybe not. I ask you this because I ask myself the same things on a regular basis.
Ideology tends to come to people as a complete ready to eat meal, some book you've read or some person you've heard. Tell me, what person have you met that you completely agree with all the time? I've read philosophies from the Bible through Marx, Budah through Adam Smith. I agree with parts of all of them and disagree with the totality in all of them. The bigger the group you wish to join, the smaller the common ideology you can share in common.
I require of myself Dave's philosophy, an understanding not based on what some group believes, but what I've personally hammered out over time.
The effect of such a search is that one find's themselves intellectually alone. For many, that's a real uncomfortable position to be in. It's so much easier to adhere to a group, and if at some point that group demonstrates an action or idea you don't quite agree with, you find your “friends” will turn on you for your blaspheme. I'd prefer not to be required to defend my group. I am only compelled to defend myself, to others, but just as importantly, to myself.
Your turn (I hope)
” What is the conclusion you hate? I don't think I caught it.”
Oh yeah, you asked me a question.
The conclusion I hate is that the political stuff we spend all our time arguing about is a complete waste of our time as the real agenda being carried on is beyond our reach. We are acted upon and clutch at the illusion that we are somehow participating in how the country is being run.
I agree the liberal/conservative dualism doesn't do justice to real world complexity, and I'm not really meaning to suggest everything is that tidy. But I have been in many conversations where different people who agree on one issue give the same answers on another issue. The correlation in their positions suggests they're reflecting deeper fundamental principles. That Jonathan Haidt talk on Ted suggested fairness was one of the liberals' more characteristic principles, accountability one of the conservatives'.
I can relate to your intellectual aloneness. There have been a bunch of influences on my thinking, from working for the government to studying issues and people's thinking on them, to reading the local paper. Primarily my beliefs are driven by which models better explain the data I've seen. From what I've seen, God-is-superstition fits the data better than God-is-alive-and-well-and-disapproves-of-your-sex-life. Markets-drive-growth fits the data better than markets-drive-oppression. Government-as-bumbler fits the data better than government-as-savior. When it comes to how power is wielded in our system, I don't see the cabal you're worried about, I see something closer to a circus, with lively participation from all over and somewhat random output.
All of which leaves me without a party. I'm fiscally conservative, socially liberal, and I agree with Camile Paglia that neither party stands for anything at this point. I'm registered libertarian, which got me a knock on my door last election from some guy named Starchild. They are a difficult group to take seriously.
Dr J
So now we finally understand each other enough to talk about my proposed amendment. $100 cap on donations. My reason is straight forward, congress is a house of prostitution, and lobbyists are their best customers. Being good prostitutes, they will say or do anything for the money. Their ideological positions shift with each John willing to pay. The circus you see is a merely commerce, and people like you and me end up paying for the trade. I don't see this as the “General Welfare” our founding fathers had in mind.
Blue Dogs – fiscal conservatives, required that health care costs could not be set, but must be negotiated. If they want to save money, why allow year over year increases? And of course costs will increase under that system, not because things cost more, because last year I got this and so this year I need a little more.
These same fiscal conservatives have no problem fighting an increase to the minimum wage, however. They're happy to cite their ideology then. Remember that historically, the minimum wage came about because businesses had so overpowered employment that kids were working instead of going to school. Mandeville had thought that was the way it should work.
The general welfare should not mean select groups benefit at the cost of others. The current lobbyist industry does exactly that. The $100 limit doesn't remove one's right to support who he wishes, it just takes concentrated wealth out of the equation. If you have a better way to accomplish this leveling, let me know. I'll back it in a heartbeat.
At the very least, you and I going forward may better understand each other's comments. I have enjoyed this
$100 cap on donations. My reason is straight forward, congress is a house of prostitution, and lobbyists are their best customers.
So we've established what the politicians are but now you're haggling over the price, Hemm.
I say that tongue in cheek, but it gets to your earlier discussion with Dr. J about how we come by our ideological predispositions. If you and I agree that politicans are basically whores, then why do you trust them more than conservatives like Dr. J and myself do?
Where did you ever get the idea that I trusted politicians? I may be able to appreciate their skills without necessarily wanting to take them home to Mom.
Seriously, it goes back to the minor dissertation I gave above about the two basic ways that “the General Welfare” clause has been interpreted. Despite the rigged game I see in Washington, I believe many there really are interested in the welfare of the populace. They are just fighting an uphill battle.
My Senator claire mccaskill is a case in point. She served here in Missouri as State auditor for quite some time before going to Washington. I still watch her like a hawk, but she seems dedicated to the general welfare as I see its definition. Yet, I had reason to disagree with some things she's done.
I don't ask that these people be saints, just accountable.
I know you distrust Obama, and again, there have been things with which I disagree. But all in all, he's seemed to me to follow that same desire to help those in our society who have the least control over their existence.
The past two terms of Bush has pretty much put me off of the “conservative movement” as it was manifest under his reign. The elitism that I oppose above has never in my lifetime been more obvious that in his times. Conversely, William F Buckley was magnificent, even if I didn't always agree with his points.
Both Buckley and Obama are wicked smart. Maybe that's the common attraction for me.
I think a $100 cap on donations merely shifts groups' support for politicians to a more cumbersome currency, not unlike requiring donations be made in rubles. Rather than a check for $1M, lobby groups will produce 10,000 people each bearing $100. Far from changing the nature of the system, such a change might even tilt the field toward the largest PACs with the means to build big campaigning machines to mobilize armies.
And honestly, I don't see what's necessarily wrong with how things work today. Money talks, but only indirectly, in the sense that it allows politicians to buy the votes that will keep them in office. It's ultimately us voters who are for sale. And it's not like there's only one set of lobbyists. As that list of groups trying to influence health care legislation shows, there are many different voices at the table representing the diversity of the so-called public interest. I dunno, it looks kind of like democracy to me. I'm not sure what else democracy *could* look like at national scale.
To Dr. J's point about the unintended consequences of capping campaign contributions, I think there's already plenty of evidence that these things happen. We have caps now, and bundling has become a common practice. Maybe lowering the limit all the way down to $100 would make that endeavor more difficult, less lucrative, and less common- or maybe it would increase fraud in the system as bundlers can more easily come up with fake donors of $100 than fake donors of $2300.
I do feel, moreso than Dr.J, apparently, that money is a problem in our system. But like him, I don't think that you solve it by trying to regulate the money. I think the only real solution is an informed electorate and transparent donation policies so that smart voters can hold the politicians accountable.
Remember, I'm writing this amendment, so bundling is not allowed. No one person or organization may make a donation over a hundred bucks. If 10,000 people send in a hundred each, that's 10,000 separate envelopes.
For purposes of this pipe dream consider every possible way to avoid the amendment's intent and put in a safe guard against that abuse.
My intent is simply, I want the legislators to figure out how best to govern by thought, not money.
” And honestly, I don't see what's necessarily wrong with how things work today”
Really. I find that the whole idea of health care reform being driven solely by those who stand to make a profit is very wrong. The general welfare drives my concern.
“I find that the whole idea of health care reform being driven solely by those who stand to make a profit is very wrong.”
I agree it's wrong, in the sense that I don't see it happening in the sense you mean. Insurers and pharma companies are trying to shape reform, for sure. But so are unions, and practitioners, and the AARP.
And I disagree that profit is a dirty word, because health care reform is mostly about money. The problem of the uninsured is much more financial than medical–if they get sick, they will generally get treated but risk being wiped out in the process. Everyone from corporations to unionized nurses to retirees to taxpayers is weighing in on the reform process, and they're all looking after their bottom lines. Nothing wrong with that, and again, it's hard to imagine the system could work differently.
I'd like to see legislators be more thought-driven than money-driven too. But I think the fundamental barrier is voters' limited attention span. Voters can't keep track of hundreds of complex issues, understand the tradoffs involved, and evaluate their representatives fairly on their own. So representatives (both incumbent and aspiring) are forced to market themselves and try to win voters over to their positions, and they need money to do so. If you successfully restricted most of their funding, it's not at all clear to me that voters or legislators would do their jobs any better.
For purposes of this pipe dream consider every possible way to avoid the amendment's intent and put in a safe guard against that abuse.
Fine as long as you know that it's just a pipe dream and that any attempt in the real world to implement it would fail to meet those criteria and in fact could make problems worse instead of better as people find ways to game the new system.
And the way to get the legislators to figure out how best to govern by thought, not money, is to have voters who won't reelect them if they govern according to who lines their pockets the most. If the lobbyists and special interest groups want to give tons of money, and the politicians reward them with policies that aren't in the public's interest in order to keep the gravy train going, then the voters shouldn't reward that behavior.
A big part of the problem is that a lot of voters don't believe that THEIR party is guilty of this.
Dr J
Big Pharma et al are the only ones who stand to ake a profit here. You may believe that unions are involved (I've seen nothing along thos line but could have missed them) – but unions only stand to save money, not make it.
The current process ignores the whole idea of reform. Could things be done cheaper, more efficiently, made more universal? of course. is there any great effort to do so? nope. Efficiency is bad for profit as I stated before. Which debate is taking place, saving profits or creating efficiency?
Efficiency helps those of us who pay.
Inefficiency helps those who are paid.
Like one of my entries the other day, I'm ready for the current effort to fail as the plan so composed will only guarantee costs to continue to skyrocket. That's not good enough for the general welfare.
CS
I would honestly ask if you really think ANY of our discussions are more than pipe dreams. The fruits of our logic and intellectual rigor used to analyze and debate could possibly find real solutions to these problems. But even if we did, it would never be heard in Washington. We don't have the price of admittance without the big bucks to hire a lobbyist.
A Constitutional amendment changes the legal foundations of laws that follow. If the lobbyist system is to be broken, it will have to go through a change in the constitution, not through prostitute legislators
Unions are the main opponents of the number one reform I want to see–shifting the health insurance tax deduction from companies to individuals. They don't like it because their members enjoy quite nice health benefits, which would come under threat if companies lost their tax deduction. Call that making a profit or avoiding a loss, it's much the same thing. And as unions are heavy contributors to democrats, we're unlikely to see that change made.
Dr J
” They don't like it because their members enjoy quite nice health benefits, which would come under threat if companies lost their tax deduction.”
If companies pay for health insurance coverage, it's a business expense just like payroll./ I'm not following your logic here. Is somebody trying to take away a business expense?
Companies have to pay a tax on payroll and other benefits. But health insurance benefits are deductible from it. So it's cheaper for your employer to buy your health insurance than to pay you the cash and you buy it on your own. As a result, most people with insurance have it bought for them.
This is the single most broken aspect of our health care system. It means you don't have much choice of insurers and will lose your insurance when you lose your job. COBRA laws give you 18 months grace before finding a new job (and a new insurer you didn't choose), but if you miss that you'll have to buy insurance on your own and face the pre-existing condition hurdle doing so. The arrangement saves you money, but you pay for it in risk and lack of choice.
Worse still are the systemic effects of this single tax policy, because they create a situation where no one really cares about value for money. You don't care how much your insurance costs, because your employer pays for it. You and your employer don't care how much your doctor costs, because the insurance company pays for it. They care how much the doctor costs but don't care whether you felt better after seeing him. Even if they did they'd have no way to tell, because your specific case gets lost in the averages when they renegotiate their contracts.
This is the weirdest industry we have. It's entirely about delivering value to to individual consumers, yet consumers can't make any real decisions, and providers care so little about them that large numbers are simply priced out of the market. The solution is very clear: take the power out of the hands of HR departments and give it back to the consumers. This is the single most meaningful health care reform we could enact.
I agree that choice is fundamental for reform to take place. So I take it that coops would be your advocated solution?
You mean coops of doctors? I like a lot of aspects of that model. A coop can be accountable for how healthy you are rather than how many treatments you get, which is crucial. Having a long-term relationship with a local co-op (which you picked based on its cost and track record) might work much better for a lot of people than having a short-term relationship with an insurance company.
I wouldn't advocate imposing coops as the reform, though. They won't be the right answer for everyone. I'd rather reform focused on flexibility–fixing the market so it was easier for coops to catch on if and where they made sense, and easier for them to evolve into something even better some day.
I guess my question was meant to be more open ended. What things do you advocate to increase efficiency, reduce customer cost, and help ensure everyone is guaranteed health care.
That last one obviously doesn't mean walk-ins to the emergency room is acceptable.
I just haven't heard your list of improvements. This certainly isn't some kind of challenge.
There are some obvious improvements waiting to happen, like paying for results rather than treatments, and not doing tests that don't tell anything. We should streamline the FDA's approval process and rely more on existing product liability laws (which we ultimately do anyway, because the FDA's process doesn't work that well). We should streamline malpractice settlements to make common classes of issues like honest mistakes cheaper to resolve, with no lawyers involved. We should stop discouraging integration of medical records through HIPAA–indeed, we should require them to be integrated, so we can tell what works and what doesn't. We should take a hard look at certification requirements for nurses and other practitioners, which unions have successfully inflated to discourage competition and create shortages. If we simply encouraged a more direct payment model–you pay a co-op a flat rate, for example–a ton of billing overhead, coverage disputes and fraud controls would simply evaporate. For crying out loud, there are *entire college degrees* devoted to medical billing.
But I'm not in the medical field (and even the healthcare-reform-harridan field is just a hobby), so my visibility is limited. Those are some inefficiencies I notice, which means they're large enough to be seen from outer space. There are literally a million more where they came from, and they're below the radar of what any central authority will notice or be able to fix. That's precisely the power of the market. Once you get millions of brains engaged on the task of looking for incremental improvements, they find them, and those add up. Computers have gotten a million times more powerful over the past few decades, not because of one sweeping reform, but because of many incremental improvements. We could use some of that magic in health care.
Oh, and you asked about ensuring coverage. We probably solve half the problem by simply reconnecting supply and demand. Suppliers will figure out they can make a buck by offering cheaper options to consumers, coverage at a wider range of price points will emerge, and many people currently priced out of the market will be able to buy back into it.
But that's only half the problem. To solve the other half, for people who still can't afford even basic coverage, the government needs to get involved. It should do so by writing these people a check, not picking up a stethoscope.
Dr J
I've read your two responses a few times to make sure I understand what improvements you are suggesting. I admit, I don't understand some of them. I'll include the pertinent quotes from you and my response. If I have somehow trimmed your quotes to the detriment of your meaning, please let me know as that is decidedly not my intention.
“like paying for results rather than treatments, and not doing tests that don't tell anything.”
Three issues with this, how do you pay for results and not treatment? Are you saying that if a treatment is not effective, we don't pay? If so, I suggest you don't understand medicine; a treatment that works for one does not necessarily work for another. Second, what kind of test tells you nothing? More importantly, who decides that a test is unneeded? The insurance company?, the doctor?, the lawyer of the doctor who is trying to save him from malpractice?
You see, I agree with your point about malpractice as long as truly egregious practices are still nailed for all their worth. I believe the only thing worse than lawyers making a killing through questionable lawsuits are doctors that damage a patient through true negligence. Operating on the wrong leg is a good example.
“We should stop discouraging integration of medical records through HIPAA–indeed, we should require them to be integrated”
I agree 100%. Medical computerized records accessible by any medical person will reduce cost, improve treatment, and virtually eliminate medical errors treatment errors.
“certification requirements for nurses and other practitioners, which unions have successfully inflated to discourage competition and create shortages.”
I would suggest you don't know the facts here. There are 2.5 million nurses in the US, and only a very small portion are unionized. You favorite union, the Service Employees International Union, is the nation's largest health care worker union, only has 110,000 nurses as members out of 900,000 total members. The vast majority of nurses are on the own employment wise.
The constant cost cutting that goes on at hospitals always lessens the number of RNs as a way to save money. One of the reasons my wife, and RN for 30+ years, quit floor nurse work was due to the fact that fewer and fewer nurses were asked to be responsible for more and more patients. It wasn't the work load she shied away from, it was the safety issue for the patients. You can't be in two places at once.
You may not know that an interesting effect of unionized nurses is that union hospitals have a lower mortality rate among patients than non-union shops.
“we simply encouraged a more direct payment model–you pay a co-op a flat rate” Do you mean no deductible or do you mean that people get insurance outside of work?
” they can make a buck by offering cheaper options to consumers, coverage at a wider range of price points will emerge,”
Where do the cutback of services occur in the cheaper plans? The definition of what's a catastrophic illness is defined in medical or financial terms? Is reconstructive plastic surgery a luxury? How about a kid's hair lip at birth? I think I know where the lines are drawn if the insurance company makes the call.
Thanks for your clarification.
Dr J
I've read your two responses a few times to make sure I understand what improvements you are suggesting. I admit, I don't understand some of them. I'll include the pertinent quotes from you and my response. If I have somehow trimmed your quotes to the detriment of your meaning, please let me know as that is decidedly not my intention.
“like paying for results rather than treatments, and not doing tests that don't tell anything.”
Three issues with this, how do you pay for results and not treatment? Are you saying that if a treatment is not effective, we don't pay? If so, I suggest you don't understand medicine; a treatment that works for one does not necessarily work for another. Second, what kind of test tells you nothing? More importantly, who decides that a test is unneeded? The insurance company?, the doctor?, the lawyer of the doctor who is trying to save him from malpractice?
You see, I agree with your point about malpractice as long as truly egregious practices are still nailed for all their worth. I believe the only thing worse than lawyers making a killing through questionable lawsuits are doctors that damage a patient through true negligence. Operating on the wrong leg is a good example.
“We should stop discouraging integration of medical records through HIPAA–indeed, we should require them to be integrated”
I agree 100%. Medical computerized records accessible by any medical person will reduce cost, improve treatment, and virtually eliminate medical errors treatment errors.
“certification requirements for nurses and other practitioners, which unions have successfully inflated to discourage competition and create shortages.”
I would suggest you don't know the facts here. There are 2.5 million nurses in the US, and only a very small portion are unionized. You favorite union, the Service Employees International Union, is the nation's largest health care worker union, only has 110,000 nurses as members out of 900,000 total members. The vast majority of nurses are on the own employment wise.
The constant cost cutting that goes on at hospitals always lessens the number of RNs as a way to save money. One of the reasons my wife, and RN for 30+ years, quit floor nurse work was due to the fact that fewer and fewer nurses were asked to be responsible for more and more patients. It wasn't the work load she shied away from, it was the safety issue for the patients. You can't be in two places at once.
You may not know that an interesting effect of unionized nurses is that union hospitals have a lower mortality rate among patients than non-union shops.
“we simply encouraged a more direct payment model–you pay a co-op a flat rate” Do you mean no deductible or do you mean that people get insurance outside of work?
” they can make a buck by offering cheaper options to consumers, coverage at a wider range of price points will emerge,”
Where do the cutback of services occur in the cheaper plans? The definition of what's a catastrophic illness is defined in medical or financial terms? Is reconstructive plastic surgery a luxury? How about a kid's hair lip at birth? I think I know where the lines are drawn if the insurance company makes the call.
Thanks for your clarification.
[...] few weeks ago, Marc Pascal wrote a post over at The Moderate Voice listing a number of Constitutional Amendments he believes need to be adopted as soon as possible: On 8/9/09 Alec MacGillis in the Washington Post outlined one of the largest problems today in our [...]
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