CONTINUED: HEALTH CARE AN EVER ESCALATING CRISIS

HELLO, ONCE AGAIN EVERYONE ...

Below, is a previous posting, for which there were some cogent comments. Understandably, it has taken a bit of time - to find the time – to do their work - to have some medical–legal friend(s), and authorities consider your comments and answer towards them.

They and I respected and appreciated your questions, please respect their answers. This is, and must remain a dialogue between caring people.

Now, from previous blog postings, I know that these answers may not satisfy you the readers, nor answer your heartfelt concerns and questions. Causing you then, to ask more questions. I must say that this is such a complex area, and takes much time, and great knowledge to answer any question, if not to your satisfaction, at least as thoroughly as feasible, from the Respondents' position.

My point is, I hope you appreciate the time the Respondent(s) put into these answers, and with out “streaming”, I ask that you consider them, and reply respectfully, in a constructive dialectic open minded, learning manner.

We all have acutely personal vested interest(s) in the issues of healthcare facing all of us, and some, actually get to work diligently and directly on the solutions and/or the practice of it daily.

Your insights, and questions also can and are more often than not, most helpful, in effecting a positive change. The Respondent(s) I know appreciate hearing your concerns, and time permitting will endeavor to answer your questions.

Remember, we (The Reader(s) and the Respondent(s)) here on this blog, and within this issue are all on the same team.

Thank You for your constructive, non tendentious interactions, and interest.

don
:)

ORIGINAL POSTING: Friday, September 02, 2005
By Don Regan at: 7:50 PM


Health care is in an escalating crisis of historic proportions with the costs of healthcare distribution and insurance skyrocketing to over 1.6 trillion dollars, with no end in sight.

The medical malpractice crisis, although not insignificant, pales in the face of over 45 million uninsured Americans, many who are gainfully employed, and employers unable to meet the healthcare cost demands of their employees.

The time to stop issuing blame is over, and palliative measures must be recognized as only putting a band-aid over a bleeding aorta.

It is a time for real, long-term, solutions and difficult decisions: Centralized specialty care; patient assisted medical care payments; economy of scale treatments; greater attention to end of healthcare decisions; recognition of the human errors associated with medical care with a transition from litigation to remediation; improving communication openness and patient safety.

It is a time that healthcare providers and patients take responsibility for their tasks and situations, and remember that it is disease, not ourselves who we are fighting as a team. Attribution

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Lompoc Lamb said...
Disposing of all of those lawyers would be a healthy start.A doctor can't afford to open a simple family practice without a fear of being litigated out of town by a lawyer in a cheap suit.Remember the character of the doctor on "Northern Exposure"? We need more of those in real life, but those times are long gone.
8:12 PM

- Lompoc lamb … Please keep in mind that although med mal is a major concern, it is less than 1% of the total health care expenditures (2002 - 110 billion for med mal out of 1.6 trillion for overall healthcare costs). It is true, however, that this impacts a small number of individuals, ~500,000 docs, and leads to expensive defensive medicine, but it is still not the lion's share of costs.

- In addition, lawyers do not, for the most part, chase after pt plaintiffs. In fact, only 1 out of 10 potential cases are accepted and there is an over 75% attrition rate of those taken by plaintiff attorneys. The literature and the IOM report point toward the fact that, because of legal defense costs and our anachronistic legal system, that many individuals who have suffered malpractice damage do not have cases that can support the costs of legal defense.

- Finally, the literature is clear that over 95% of all mal practice suits are based on communication and relational failures, not outcome! It becomes evident that we need to address physician communication (unrealistic expectations, misinformation, failure to apologize and take responsibility, etc) and dispute management skills, if we truly wish to reduce the malpractice suit frequency.

- Although it is internally satisfying, we must stop blaming attorneys, who simply represent clients who have contracted them for such services, for the ills of the healthcare world. Keep in mind that early conflict intervention programs and apology programs have reduced suits and increased patient safety overwhelmingly, but are rarely implemented, and do not exist in our county.

- One last thing, patients must understand that being ill creates a risk, and the more ill one is, and the higher the need for complicated care, the more likely they will experience medical error - this is a fact. Patient safety programs are being introduced to help reduce the error rates and improve outcome, but it is a team effort, an effort that directly involves the patient's input.

There are docs like in northern exposure, they are just buried in paper and beaurocracy. It is unfortunate that docs wear their frustrations on their sleeves, but make no mistake, they remain dedicated to their patients and steadfast to their oath to heal the sick.

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NewsstandGreg said...
Doc,Great topic...but a two questions:What are the numbers in SLO county for medical malpractice suits? Somebody has the info for you as close as a phone call.How many people in SLO county are estimated to have no health insurance? Likewise, someone in the County government offices has that number for you also.If we keep some focus on the "local," we'll be more informative to our readers.
9:22 PM

- Newstandgreg … As for the stats, it is true that local figures are available, however, the impact of the uninsured and malpractice costs are not, in my mind, locally driven costs. As such I deal with healthcare distribution and conflict at the national level, but will gather that information for you, if you wish, or you could retrieve it and share it with us all.

- My reality is that even if our local uninsured rate is lower than the national average, we are still impacted by the costs expended nationally. The bottom line is this, we have spiraling premium rates with progressively larger numbers of uninsured, including the working uninsured. I know of no local action that will materially modify this trend nationally, and if available would only slow the tide of change for us in the central coast.

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Spectator said...
I was listening to a speach by Newt the other day. He estimates that the amount of medicare fraud in New York, if stopped, would cut the cost to the population there by 50%. Have you looked at the statistics?

He also feels that a national database of patients and their medications would do a great deal to reduce expenses and death from perscription error. It would also wipe out multiple billing from fraudulent doctors. I agree with him on the database.

For replacement of medications, consider the refugees from New Orleans.

The time has come to hold the AMA accountable for policing the members of their own union. How do you feel about this union? Is it like the teachers union?It is time that unions went back to the time of guilds, where excellence was rewarded, and poor work was rewarded with expulsion.It is the socialistic nature of unions that is killing them.

I hear that one has a far better chance of being killed by a doctor or nurse mistake in a hospital than by gunshot or stabbing.

Blame is good! It contributes to discourse. Team? When you go to most doctors, you are in the hands of the Phillistines. Doctors through the AMA limit the amount of students going to medical schools to produce a shortage, and thus insure higher rewards because of lack of competition.

The government allows foreign trained Doctors to come to the US to counter this shortage. It is hard in many cases to communicate with them in English. Not to say that they are not good doctors.

Doctor is a respected word, but any PHD is a doctor. A lot of ignorant people do not know the difference between a PHD and a MD. And that is why we have people in turbans waving hands over people taking money for cures.Not that I do not believe in witch doctors. If they make you feel better, you are on the way towards recovery.

And then there is the question of the bloodsucking lawyers. Put a cap on their percentages above costs, and stop them from grossly inflating their office costs. 75 cents a copy? And boy, do they like to send copies!

It gives me great joy to see that lawyers have to buy malpractice insurance also.

But how do you find a lawyer to sue another lawyer when the judges are lawyers bound to protect lawyers and the whole "good old boy" legal system?
11:23 PM

- Spectator… Wow, lots of thoughts.

- I did not hear Newt's rendition of Medicare fraud, but I sense that he is a bit overstated. in addition, there is a huge difference between the allegation of Medicare fraud and that which is proven to be fraud. However, no doubt it exists and should not.

I am also not certain how another data base would be helpful in reducing rx costs and adverse outcomes, but I do support 100% the institution of computerized prescription software that checks for errors, creates a common data base for patients so that their medical information could be acquired by hospitals and healthcare providers. Such a system will markedly improve patient care and safety and is a major focus nationally, especially after the 1999 IOM (Inst of Medicine) study, To Err Is Human.

- I am unclear about your reference to the New Orleans crisis?

- The AMA is simply a trade and lobbying organization and has no authority over the practice of clinical medicine. However, the boards of specialties do set standards and guidelines and certainly the state medical board closely follows patient safety and quality management concerns. The AMA, like the state med societies, acts to lobby for physician rights and needs, along with being very proactive for patient treatment advances and safety protection. I have worked closely with the Calif Med Assoc, and can tell you without hesitation that these folks are true patient advocates, as well as physician advocates.

- The members are highly motivated and are dedicated to the improvement of not only physician interests, but the protection of patient care availability and quality. The problem is not the "union" in this case, but the falling membership that leads to less influence on the state and federal legislature. Docs see that things are getting worse, and attribute that partially to inaction of the medical societies. However, if if were not for the tireless work of these individuals the system that provides patients care, would be imploding at an even greater rate. Unfortunately, damage control is the best that they can do, at the present time.

-As for being "killed" by a doctor, I suggest that you read the IOM report and the Chaudry study of medical error. Docs are not murderers, nor are they the enemy. It is true that mistakes occur and, institutionally, at a level greater than we should experience. However, it must be understood that many of these errors are termed organizational errors, and are the product of patients with multi-system failures, undergoing complex treatment, with multiple healthcare providers (nurses, docs, resp. therapists, pharmacist, technicians, etc). Even at average care standards, the variables in such cases are so varied that mistakes are common.

Blame is not the answer, but acceptance of responsibility certainly is part of the solution. hence, there is a national movement to improve patient safety which includes computerized patient data bases and prescription programs, team based medical care, confidential reporting of errors and remedial care programs. I am very optimistic that

Blame is non-productive. I do not know any doc that purposely goes out to hurt his/her patient, but know many whose hearts have holes burnt into them when preventable harm does occur.

The culture of medicine is a complex study of behavior and exists as a zero tolerance for error community - tough gig!!! Punishment is not a good mechanism to broaden another's scope of practice, instead it intimidates one from admissions and corrections and creates an unhealthy attitude about facing responsibility. There is no question that the public must be protected from incompetent physicians, but there are not as many of them as there are good docs afraid to admit a mistake based on the impact on their career through the existing punitive systems, if they so acknowledge their shortfalls.

If you feel that you are in the hands of the philistines, then change hands - you are in charge of who cares for you, don't be a victim of your own indecision.

The AMA has no power to limit medical school numbers or admissions. There is no covert or insidious scheme to harm patients by setting up a false shortage of medical professionals.

In fact, medical such applications are falling because being a doc is becoming less and less appealing to young people and the "rewards" are certainly not $$$.

I will tell you factually, that my son elected to become a doc (after living with both my wife and myself, both docs, I am uncertain what was so attractive). He is now a 3rd resident out of a 6 yr program, is $250,000 in educational debt and although federal guidelines limit his work week to 85 hrs, is working well in excess of this. Yeh!, great life and lots of rewards - make no mistake on this either - it is dedication to people, and desire to be an aid to others that drive us, not the $$ which is, for the hours spent, quite modest in comparison.

- Yes, it is difficult to communicate with some FMG (Foreign Medical Graduates), and cultural differences occasionally become a barrier - and - yes they are often very good docs, but it is not a scheme to limit docs that bring them to the U.S., and the government does not actively recruit them. FMG's are more common in areas of lower reimbursement (rural), like our county, believe it or not (didn't think of us a rural, huh??) Want more docs here, no problem, convince your legislators to pay them like they get paid in Santa Barbara, and they will come. Like the movie "Field Of Dreams" - If you build it they will come - well here it is "if you pay them, they will come!"

I am a bit befuddled over the PhD, turban, hand waving commentary, but if it is in reference to alternative medicine, I have two things to say:

- 1. There are many methods to healing and although Alipathic methods are most favored and successful, you should not discount reputable alternative treatments that have been with us for centuries.

- 2. There are charlatans out there for sure, so, be smart and be aware - choose wisely.

As to the "blood-sucking" lawyers, please refer to my comments about med mal to lompoc lamb, above. Caps, although helpful and appropriate in reducing malpractice awards and subsequent insurance premiums, etc do not reduce the frequency of law suits.

People sue because they are unhappy or angry, not, in general, to make money - it is retribution not restitution that most often drives people to sue and an inability to get satisfaction outside of the litigated arena for their sensed injustice (some docs just don't do all that well at dealing with conflict). If you want to put the blood-sucking lawyers out of business? Remove the source of the suits: communication and personality dissatisfaction with medical care providers.

Most lawyers do have E&O insurance for professional negligence claims. There is a fundamental difference in medical and legal malpractice suits - in the latter, you must prove not only duty, breach, causation, and damage, but that the damage would not have otherwise occurred.

In other words … That but for the negligent action of the attorney … You would have won your case. And yes - it is unfair - you bet - so don't complain about it - help to change it.

Lawyers are not only, not bound to protect each other, but are serious competitors, and if contracted to sue another attorney for negligence will do so with full effort under the law. Judges, I can tell you, are not a part of any lawyer "good old boy" club. In fact, judges may no longer belong to the Bar Association as practicing attorneys. I may not always agree with their decisions, but they are not protectionists of their "own kind."

STREAMING – OR VERBAL STALKING IN THE AGE OF MILLENIUM MODERNISM


The above title might suggest that all this is new in the history of communication, art, business and or politics. But, we know sadly, that it is not, and as it perniciously persists into our current day, it seemed a not so inappropriate title, to me.

I’ve been attempting to understand its style and usage for many a moon now. I am (like, I believe so many of you) available to and victimized by Streaming, and have been for many years as a child; a student in training; a working professional, and now more recently in a larger public forum.

I have become more recently impressed with it’s increasing frequent commonality, on all fronts – on television; on the radio; in hallowed halls of governance, and between all sorts of people, their agencies, as a seeming preferred method of non-communicative communication.

Mercifully, I have not personally experienced it in the day to day vernacular of the rancher or farmer, or those vocations of the hand. But it is truly pathological in the vocations of the trite mind and parroting mouth, drawn ever more confuscatingly to the forefront by volitional defensive over thinking and paranoia.

The most obvious example being that of the media’s newest witless permutation of this mental flogging and sheer drivel, as promoted by their continuous cable news coverage’s ever increasing magnified thirst for what passes as their effluent river of “news”.

It not only seems sadly more common, but paralytically endemic to our way of life, as divisive polarization, rather than unifying symbiosis seems to be the encroaching idealized desirable mass communicative hallmark of our day.

A day in which background noise and clatter overcomes dialogue, dialectic, and common sense solutions. It now seems the rule, rather than the exception. The very thing to do? It is the verbal analogy to doing nothing – saying nothing – helping nothing. Our modern day equivalent of politically correct Nietzsche-esk infantile nihilsms (Aren’t they all?).

I even think I remember, that as far back as 1968, when I was living in San Antonio Texas, the halting personal realization, that local and national news was just then beginning to use percussive classical music to highlight and emphasize the ugliness of any particular car accident, and that ever more similar negative information, and close up “in your face” bloody visuals were increasingly being presented and defined as … “The News”.

Streaming may have been around before, but I find myself today, escaping back to more austere linguistically simpler days, as memorialized in the silent and then classical noir movies of the 20’s, 30’s and 40’s for more encouraging examples of direct and realistic interpersonal relationships, problem solving, and just good ole dialogue between open minded considerate people.

Now, before I get criticized roundly for this comment, let me just say, ok, not all, but many, and regardless, I find such movies enlightening and enheartening, rather than stupefying, as so many of today’s movies seem to me personally.

And, yes … you are correct this posting is not intended as a critique of movies now or then, but just as personal reflections offered as back ground on today’s increasing use of Streaming, as an excuse and inferior destructive substitute for the more laudable and constructively hopeful communication between and among folks.

What is Streaming:

Repetitive restatements, banal, childish, unsupportive, non sequitur re-questioning, and positioning, regardless of any facts for, or to the contrary. Substantiative arguments are always conveniently and carefully avoided. Bromidic self indulgent sermons guided by clinically and clearly culturally conditioned passive aggressive behavior.

When:

Any time, by anyone seeking to ignore one or another’s vision, words, or actions directly. The design apparently to state and restate the insinuated obvious, while avoiding any rationale or logical argument to the contrary. The point being the intentional belittlement through the lessening of authority, dignity, or reputation of one’s peers, competitors, or colleagues.

Why:

Not sure why, exactly, perhaps it embarrassingly boils down to it simply and sadly being the only tool available in the questionably cognitive toolbox of the noncreative thinker, and their need for what has now become the ever ageless and hapless indiscriminant flogging of the proverbial and now perpetually well dead horse?

Streaming is seemingly often used for any purpose instead of stating a simple Yes, or No, or defining a position, which might otherwise by indefensible, or at best subject to rationale criticism or challenge by the self professed loyal and unyielding opposition.

Those who do Streaming, emphatically denying it (sometimes unconsciously), while simultaneously accusing the other of yielding to its illogic illusory and cowardice like strategies.

Results:

Unanswerable unfounded aspersions, assertions, and accusations, which defiantly challenge the very nature, humanity, and personal motivations of the respondent, while intentionally diverting from any authentic answer to the actual question(s) posed, or offering any mutually constructive solutions.

This destructive and serpentine tactic resulting in mutual distrust, and fear, while further exacerbating the problem confronting both, or all parties, as well as jeopardizing all parties by the increased time necessary to move through this highly charged emotional mind field toward a mutually desirable constructive outcome.

Lord Tennyson, in his “… The Charge of the Light Brigade”, perhaps said it best:

"Theirs not to make reply,

Theirs not to reason why,

Theirs but to do & die"


AND I COULDN’T RESIST: From our once very own, briefly local, Nobel Laureate:

… Every man, wherever he goes, is encompassed by a cloud of comforting convictions, which move with him like flies on a summer day. …
Bertrand Russell
Skeptical Essays - 1938


All Put More Simply:

Streaming is what we do -- on our falsely self constructed indefensible and shallow cognitive islands, habitated by only one other person, when we offer no solutions to the survival challenges confronting us, and instead of solving the problems constructively together, one finds irrational differences -- attacks and kills the otherwise willing collaborator, leaving the one to die slowly, and inconsolably alone.

APRECIATIVELY TO DAWN, ALL PUNS AND AFFECTION INTENDED

9-10-05
6:57PM

First, I want to say again, thank you Dawn, for your non-tendentious, gracious, encouraging and motivating reply to my Reply, regarding your initial article in the Pac Biz Times, and your resultant excellent observations.

I have had the great enjoyment of checking out the websites you have discussed in your reply to me on 9-8-05.

Let me begin by saying, that I too am a big fan of George Lakoff, and found his book, “Moral Politics” to be quite insightful, albeit equally quite long and cumbersome, and transparently partisan, despite his personal denials of that, throughout his book.

I was given his book, by a dear and respected friend.

Never-the-less, even though one could not say he was without his biases (like all of us), I thought it was a most informative and enlightening book, and that his philosphical stands, helped me understand his political points, and did not get in my way of understanding. In great part I agree with most of what he wrote there.

I only hope that CalPoly and other educational institutions of higher learning provide equally informative books either with a different political bent, or no personal political conclusions needed to be drawn. But, if not, “Moral Politics” is indeed a landmark book.

As to his article on Katrina, I also found it to be wonderfully worded, informative and emotionally powerful. I wish I could write like that. (As you have see from my critics, I am long from that.)

One cannot arguably disagree with Lakoff’s Katrina-esk observations, nor his words, as to the apparent causative factors. Yes, I too believe, along with seemingly most others, that at this point a case could be well made for fault being laid unquestionably at the feet of almost everyone, who made no effective plans or preparations prior to the event, and those responsible for the abysmal ineffective, humanely inexplicable response during and after the hurricane.

Be cause of what we saw, which sadly fulfills what we expected, we all now live in fear, that we are all equally vulnerable, and that the old saw … “Hi, I am from government and here to help”, is indeed sadly no joke, but a telling bell, which rings warning truth for all of u s.

And One would hope that indeed its reverberation does change the political messaging, and social imperative throughout our country, and even the world from that/this day forth.

I too had hopes for the same effect after 9-11, sadly we did not see it as definitively, nor as permanently as we would want and deserve. Katrina, is a deadly testament to that, as well as to the devastating institutional poverty on whose heads we daily tread.

What greater and more lasting memorial would there be (rather than always and only granite), than if we as a society became more actively responsible to/for all of us, especially the weak, the unrepresentative and the vulnerable among us. We all deserve to feel secure and necessary, in a caring national family.

The real problem, to me seems to be, that otherwise, there is a indeed a huge quaking price to be paid for this type of social disregard, and it is always and inevitably paid more permanently and destructively by our Nation, our society and our culture.

I agree also with your conclusive implications, that we as a nation, and as a democratically caring society seem to have our expenditure priorities fully screwed up.

I do believe you are correct that it is because of bad decisions made by questionably scrupulous, morally bereft, and seeming solely self-interest oriented people, whom we call our elected representatives, not to be confused with the totality of our government.

By this I mean, we have an Executive Branch, a Legislative Branch and a Judicial Branch. But this government is not intended as a Triangle with the President’s executive branch at the top, or wherever you might put it, but rather it is to me, a square formed by 4 equally important foci, to include most importantly and prominently “We the People”. The fourth foci in any government that would hope to call itself democratically representative.

So, when we complain of the three branches, so common in all political communication, we must realize that they conveniently leave us out, as it is to their everlasting benefit to do so. We can not and must not let them do that, nor let that happen. Otherwise we get the kind of government we deserve. We deserve much more.

So much of our lives are handed off as pablum, and our rights as citizens can not be, and is in fact not pablum , but the core responsibility we have, and must daily act on, if we are to maintain ourselves, as the great representational nation we want to be,

It is the US in U.S. that we must not leave out, and in fact can not in truth ever be really left out, otherwise the words anarchist and anarchy would not be so readily on the mouths of so many frustrated souls. A no better solution, by the way, than any other injurious and destructive forms of governmental experimentation so inhuman to the human condition, such as socialism, nazism, fascism, etc..

But when representational government and the moral imperatives of we the people are not acted on, in an efficient and effective manner reflective of we the people’s mass moral imperatives, then inevitably strife results, and sadly the pendulum swings badly, and we begin spiraling uncontrollably in the slow and desperate process of humanitarian re-enlightenment, all over again. It is pain we should/must avoid, at all costs, but can not, if we do not respect our preeminent rights as citizens to be heard, not just to have a titular voice.

So for me, my answer to you, does not lie in eloquent (or in my case not so eloquent) expressions of support or denials of the efficacy of tax cut economics, or no tax cut, because the problem you address, seems to me bigger than that, and outside of a general malaise regarding government as a whole.

The problem you address isn’t only how we get the money, but importantly what we do with it? Again not speaking at this moment in economic terms, but in moral and civil representational terms.

So, putting aside, for the moment, how government’s money is gotten (…And as you can see from the comments, many have many ideas and suggestions …), I think the bigger issue is: Who decides what we spend it on, and how. That to me is of equally great concern, and perhaps greater, within the context of my understanding of your, and others’ observations.

I suggest we as a nation have a new additional TAX Day entitled: National Personal Tax Disbursement Day, where simply phrased, we go on-line, and determine where and who gets our individually taxed money. Yes, we each would get to determine who gets what, and whoever gets it has to be accountable to us, each individually specifically, as to how our individual money sent, is spent.

The technology is available, and whatever tweaks it might need are certainly achievable to make it equitable and accountable. Then with a process including secure social, environmental and defense “Safety Nets”, we have then re-included we the people in a permanent and undeniable way. Now we are fully represented in the representational square, of Legislative, Executive, Judicial and Citizen.

Then our elected representatives indeed become the permanent bureaucratic set, that they so ardently and seemingly strive to become.

With that having been done, or at least proposed, we can then actively control spending by government, and as a nation we the people can then, by being included directly, be talked with, respected, and included in the discussion of what direction this country must take, to remain morally viable, and the type of moral and economically viable leader in the world, which we wan it to be.

Now, having done that we can then look at how we take our money from us, and what is right or wrong and equitable for the workers/laborers and businesses, in this country that create the capital power that drives this country.

Because we citizens would then be sitting at the table, we now indeed would have a voice, the most powerful voice, our economic voice, individually expressed, and nationally manifested.

The implications are potentially staggering, and I believe until we do something in this manner, we will continue to see the frustration, and pain of our fellow neighbors and citizens, and wonder about the true viability of our representational government, as we move forward in this still newest millennium.

I agree with you, Dawn, it is indeed time for the dawning of a more representational process, that assures that “we the voters”, are not excluded from the process of representational democratic self government.

Then we will be secure an independent. We need to fear ourselves more than those from outside, because until we unify and fix ourselves we can not prevent, nor effectively defend ourselves from any threat internally, or externally.

It is never to late to begin. I certainly think we have seen enough tragedy and war, to finally begin asking the tough and real questions, and insisting on leadership that will get us there. The time is ripely now.

Another More Reasoned View

The following is a reply I felt compelled to construct afer reading a reader's views in a recent edition of the much respected Pacific Coast Business Times, read throughout our Central Coast.

I read in its August 19th edition, a readers reply, entitled: … “A Reader’s view of Federal Tax Cuts” … with bemused confounded curiosity.

Other than as another Pollyanna manifesto of destructive partisanship, I could find no other way of understanding such incongruous incredulity.

The point of it appearing to be, once again, the ill conceived retro ratcheting up of the now vacuous and most wearisome endless partisan blame game, so often insipidly offered up as nurturing pablum for the masses.

Followed then, by the usual inexplicable old baseless justifications of making that old saw of: soak the rich - again, ever inanely more palatable to that very same and otherwise very discriminating and savvy audience, who are the very ones burdened with paying those taxes.

How tired are we of seeing this, and hearing this? Few discriminating citizens, any longer are fooled, by such foolhardy ill advised strident partisan commentary.

The old maxim, credited to the late Louisiana Senator Russell Long so many years ago, that so many Americans seem still to favor when considering taxation, particularly their own, seems a fitting summary reply to such innocuous commentary.
"Don't tax you, don't tax me. Tax that fellow behind the tree."

If those rich trees tank, the governments’ coffers dry up as well. People, who don’t like to be taxed (many, if not most of us.) have figured out that the more undesirable alternative to taxing the rich, is to tax everybody else, i.e. themselves.

To be clear, there is a complete absence of any credible evidence or research to back up laying out a damning scenario where tax breaks to the “rich”, are not justified, and resultantly economically productive.

Moreover … If to, how much to, and how to … tax the “rich” also manifestly depends on how they will respond to attempts to being taxed further. All things being equal, it seems prudent to me to limit the extent to which any taxpayer may be induced to pursue less socially productive pursuits, in order to avoid those very taxes, upon which we all so depend.

If half or more of all American families pay little or no income taxes, who does pay income taxes? Why the "rich," of course. Nationally, they pay on average about 96% of the total taxes levied. Here in California, that lopsided statistic is not much better.

I would dare say, that very few of us would consider ourselves “rich”, by any stretch. Hard working, Yes. … Rich, No.

Consequently, if I hear that intentionally misdirecting and guilt damning term of “rich” applied to we over burdened taxpayers again, in order to obscure and distort the truths of our tax system, in some absurd attempt to falsely redistribute hard earned dollars from very deserving citizens, I may just hyperventilate, and pass out. A result, even if minuscule, can only serve to yet further reduce the tax coffers.

Most, are not “rich”, but rather small business owners, who by their own fortitude, sweat and perseverance put the larger majority of people to work, statewide and nationally, who then also pay taxes.

All the Bush legislation did was to provide obvious productive economic tax incentives from historically and well hewn proven economic principles, in order to provide: real tax breaks for people, who actually pay Federal and State income taxes, and also, then provided an additional further tax break for people, who do not pay income taxes.

Did it work, Yes. Is it perfect? No, but it beats mind boggling bashing and whining.

Is it correct then to tie California’s abysmal record on business and economic incentives and growth to the Federal government, or Bush in particular? No.

That is a stretch of illogical disconnect, that only a truly committed Bush Basher could attempt to make. And like swimming the Bering Sea in a Speedo, it doesn’t work.

So, please … “Don’t Keep Getting Stuck on Stupid.”

Having said all that, is there a need for practical changes in our debilitating progressive Federal and State tax codes (supplanted by preferred rationale protocols of economic incentives and applied pragmatic earned distribution); economic fairness; moral dictums, and effective, consistent operationally efficient management?

A system where we as citizens can elect, determine, and not unimportantly account for: who gets what, why, and where our tax dollars go?

ABSOLUTELY, without any question!

Is it realistically going to happen? Sadly, absolutely no … in the near term, at least. Certainly not tomorrow. But that doesn’t mean we can not, nor should not, push for such much needed change. Hope springs eternal.

After all without someone taking the reins to truly bring leadership and common sense to the business and economic environment here in California, we will soon become yet another third world nation, but one with a current estimated annual output of about $1.3 trillion. Sadly, quite an economic potential, to be so disabled, and threatened by poor legislative management.

The problem is not, nor ever has been, any desperate need for increasing income brought in by over burdensome taxes, nor how to squeeze more out of some partisan fallacy, of distorted Nimbyism.

But, rather, it is how to stop our elected representatives (local, state, and/or federal) from spending money they don’t have, on schemes for which they have no citizen mandate, nor personal responsibility for, seemingly beyond their egos, presumptuous legacies, and re-election schemes.

In the meantime, we citizens and taxpayers can only be actively vigilante to be sure, that we as a Nation and as a State, do not tie our horses solely to the vagaries of the rich, as was done here in California, and its recent Ponzi schemes of dot com wealth, nor then to contrastively bite the very hands that feed us.

We must also not succumb to mindless Bush bashing schemes of dalliers and dilettantes, no less unproductive than old Mr. Ponzi’s shell games. Games of personal convenience, which serve only to otherwise distract us from more practical solutions of inducing our now oft felt tyrannical tax system (as it distressfully continues to be irresponsibly propelled by unrestrained government spending), to become more responsive to we citizens, and our most necessary economic incentives. Our wallets, our hearts and our lives.

We must have an economic engine which unhesitantly employs productive economically symbiotic tax codes; constrained and responsibly reduced regulatory environments; and mandated unqualified rules of restrained spending, in order to maintain and sustain a well forged and economically independent and secure Nation, and State.

Overwhelmed Yet Spiritually Uplifted--It Ain't Easy

I continue holding my breath, over the last days and nights, as I remain completely overwhelmed with a persistent deep sense, and mix of compassion, sadness, dread and hopeful promise for the people of the Gulf Coast, and New Orleans in particular.

I wanted to write on local issues and ideas of concern, and talk to solutions for so many challenges facing us locally, here on our Central Coast.

As everyday, there are so many, so many to consider, not the least of which is Los Osos, and it’s current deeply divisive, persistent and painful battle -- emotionally, physically, personally and politically, to do what is right for all the people in that otherwise wonderful local neighboring Community.

But daily, so blatant and deeply personally painful and overwhelming are the sights and sounds coming across our television screens and radios, from our Gulf, that I am profoundly, genuinely, mentally, and spiritually immobilized, from commenting today on anything else.

I thought today I would say something on Labor, but the very embodiment of Labor I see, is the grateful self sacrificing Labor of so many volunteers, and our incredible spiritually and literally uplifting military personnel.

I am even surprisingly proud of many in the media, for their persistent and consistent self sacrificing respectful representation to us of the deeply moving conditions there on the ground, and their obvious passionate commitment to making it better for all the people, so unfortunately now laid out in front of them.

There are certainly no words, and have been no words for the abject destruction and justifiable disgust seen throughout these last few days from the inexplicable confusion, and lack of leadership, further exacerbating the incremental added suffering of so many people in so many communities and neighborhoods, as well as, all our friends, family, and fellow citizens left so utterly and mind boggling devastated in Katrina’s annihilating wake, throughout the entire Gulf coast region.

For many days and months to come, there will be much said about what was worse, the worst Hurricane and natural disaster in our Nation’s history, or the indefensible, vacuous absence of any apparent or effective life giving leadership in those first few and most critical days?

It is good not to forget this. Never forget. Nor point fingers and join in the blame game. As the one gratefully emergent leader, General Honore said: “Don’t Get Stuck on Stupid” .

But, please do remember … “But for the grace of God go I.” We must be sure that this man’s inhumanity to man does not happen here, on our exquisite Central Coast. That will not happen here, if we are about good planning, and security. Planning and First Responders will indeed save your life, and that of your dear families, as well as importantly your very human dignity.

There seems to me no greater priority or justifiable lesson from this vast wasteland of personal devastation, unfolding on our television screens, and so deeply and pervasively felt within our very hearts and souls.

We must assure our public safety personnel, First Responders, and ourselves, that they/we have unequivocally the fullest financial support necessary to assure the best proper planning; training; recovery, and care to the citizens we so depend upon and entrust to their care. This must happen here, so that the Gulf Fiasco, does not happen here. We must not take them, or us for granted.

Most certainly of comparable importance, and for which equally there are no words of praise or gratitude sufficient to embrace the wondrous, god gifting work of our Military in particular; volunteer organizations such as: Salvation Army; American Red Cross; Neighboring States and Cities; individual volunteers, and First and Always Responders -- our Doctors, Nurses, drivers, police, fire, all too many to itemize here.

Literally thousands of giving people doing what is right and necessary to save lives; rebuild lives and lifes; a sense of nurturing community, and human dignity again -- in one of the pre-eminent spiritual hearts, and life giving industrial and agricultural arteries of our Southern neighbors, and that of our Nation.

So, for today, it is that Labor I want to acknowledge, and hold up as our goal, as their Labors indeed represents the best of what we are about as: humans, citizens, and as the great united Nation we are, and must always be. A Nation admired, envied, and looked up to and emulated around and throughout the world.

And in a coincidently timely manner to my words here, is today’s announcement, just moments ago by Secretary Elaine Chao of $62 million dollars in Grants to provide assistance through the immediate establishment of temporary jobs, Business Disaster Unemployment Assistance, and other time honored unemployment insurance programs. Temporary jobs now to create regular income in a most irregular time, getting us through and to our well deserved dreams of tomorrow.

Jobs to rebuild personal and regional economies, so that the South like the winged Pegasus, or ancient Egyptian mythical Phoenix, as historically it has always been, shall indeed rise again, ever more beautiful, and more prepared for its promised future, and destiny, as a leader and cornerstone of our great Nation.

I leave you with these hallmarking words … Faith, Hope, Compassion and Dignity, as people return to their lives of healthful and mutually helpful living. I am, and shall remain, in awe of their faith, and their incomprehensible epic making resilience.

HEALTH CARE AN EVER ESCALATING CRISIS

Health care is in an escalating crisis of historic proportions with the costs of healthcare distribution and insurance skyrocketing to over 1.6 trillion dollars, with no end in sight.

The medical malpractice crisis, although not insignificant, pales in the face of over 45 million uninsured Americans, many who are gainfully employed, and employers unable to meet the healthcare cost demands of their employees.

The time to stop issuing blame is over, and palliative measures must be recognized as only putting a band-aid over a bleeding aorta.

It is a time for real, long-term, solutions and difficult decisions: Centralized specialty care; patient assisted medical care payments; economy of scale treatments; greater attention to end of healthcare decisions; recognition of the human errors associated with medical care with a transition from litigation to remediation; improving communication openness and patient safety.

It is a time that healthcare providers and patients take responsibility for their tasks and situations, and remember that it is disease, not ourselves who we are fighting as a team. Attribution