Tales from the Stoj Mahal

Letter to Congress, re: NPR defunding

2011-03-18T16:04:00.000-07:00

Folks,

I don't seem to blog all that often - although I always mean to, there never seems to be enough time, or subject matter. So, why the decision to get off the bench? In this case, the complete partisan foolishness that is the recent House vote to defund NPR.

Seriously? This is how the U.S. House of Representatives is choosing to spend its valuable time? We're still involved in two overseas wars (and looking to start a third), the fiscal crisis and recession continues with little abatement, health care "reform" was and is a complete failure, and federal government budget deficits stretch as far as the predictive eye can see. Yet our illustrious House of Representatives is spending precious time trying to "save" $5 million by defunding NPR. $5 million. The 2011 federal government budget is approximately $3.82 trillion. In other words, the House is stirring the pot over 0.00013% of the budget. Well done.

If you think this is a waste of the government's time, in addition to defunding what I believe has become a national resource, please feel free to copy the letter below and send it to your local representatives.

Congressman,

I recently learned of your vote in favor of H.R 1076, also known as "To prohibit Federal funding of National Public Radio and the use of Federal funds to acquire radio content." With all the challenges facing our nation today, I find it difficult to believe that you could possibly think this a good use of your valuable time. Not only that, but I value the programming NPR presents, whether I agree with some of their political leanings or not. NPR often provides the only classical music in many markets, and it's programming is very much apolitical. It disappoints me that you would vote in favor of such a clear partisan bill, which provides no real assistance in deficit reduction, and wastes time which would be better spent solving the very real problems we face.

Sincerely,

John Stoj

Atlanta, GA

Here is a link to the vote:

http://politics.nytimes.com/congress/votes/112/house/1/192?ref=politics

You can likely post a copy of the letter above to your Representatives' website. Please do.

New (Old?) car review - 2004 Cadillac Escalade ESV

2011-01-14T16:03:00.000-08:00

Ok, so I'm only seven years late in writing this review. I know many better known auto writers have beaten me to it, but after this crazy week in the ATL, I really feel like writing an ode to the vehicle that saved Cadillac, and maybe GM.

A little background - the second week in January, 2011, in Atlanta had to be the worst driving conditions for years. From Monday morning through Friday night, many of Atlanta's roads were covered with a thick sheet of ice. The city was paralyzed for the first half of the week, and the second may have been worse, because people started venturing out on the roads. Now, my wife id a doctor who needs to get to the hospital every day, no matter what. Needless to say, I enlisted the Escalade to truck her back and forth to St. Joe's. Here's where the review really starts:

I can say unequivocally that there are many genuine reasons why this truck deserved to save Cadillac. The Escalade performed flawlessly over icy hill and snowy dale. The throttle was extremely easy to modulate on poor road surfaces, and the transmission "tow mode" worked wonders when I had to pull a neighbor's Mercedes up the hill in our neighborhood. Through it all, the seat warmers kept our buns warm, the defroster never let the visibility diminish, and the lighting gave confidence in the wee hours.

I was concerned about the all wheel drive system, after having sold my old Iron Maiden Land Rover to buy the Slade. Thankfully, I had no reason to worry. The computers did their magic, and I never really experienced wheel slippage - even while I watched 4Runners and the like slip and slide.

The upshot is that I have no problem heartily recommending the last generation Escalade to anyone who wants or needs an extremely useful truck, as well as a comfortable travel vehicle.

The Taking - a health care commentary

2010-10-09T09:55:00.001-07:00

I hope the author of this article does not mind my reprint - anyone can sign up and log in to read the commentary for free anyway, so I don't think I'm overstepping. The problem is that when I link to Facebook, etc., it only links to the login page.

Please take a read. This is one of the most thoughtful commentaries I've read about the dangers of the new health care bill yet.

COMMENTARY

ISSUE: 10/2010 | VOLUME: 36

The Taking

David V. Cossman, MD

taking (n.) An act by government depriving a person of private real or imagined personal property without payment of just compensation.

The Taking. No, it’s not the sequel to “The Shining.” It’s worse. It’s what I thought of after I read nearly all of the Patient Protection and Affordable Care Act. Reading it was only slightly more painful than the “Aeneid,” in Latin. Nancy Pelosi was right. We needed to wait until health care reform passed so we could find out what was in the bill. Doing so did not make me happy. Not as a taxpayer. Not as a patient. Not as an employer. But especially, not as a physician. The doctors get “redrum”-ed just like in “The Shining.” By the time I got to page 2,407, I was convinced that the bill had been designed intentionally for failure because the architects were sore they had to remove the public option and wanted to throw health care into chaos to expedite a second run at a federal takeover.

I should have just watched “True Blood” with TSVBMC (The Still Very Beautiful Mrs. Cossman).

It should be clear to physicians by now that the power in Washington does not believe doctors should be the stewards of their own profession. When the Patient Protection and Affordable Care Act was being debated, the president made it abundantly clear that he believed physicians in general, and surgeons in particular, were more motivated by self-enrichment than science or concern for the welfare of their patients. He never apologized for comments he made about “pediatricians” preferring tonsillectomy rather than antibiotics to collect a fee or surgeons ignoring preventive care to get $50,000 for an amputation, because even though the names and numbers were inaccurate, the sentiments weren’t. I don’t know whom he likes less, the Supreme Court or us.

So it’s no surprise that there is no tort reform in the bill and that the $50 million for a pilot project to study the issue is a sham because large states like California and Texas already have proven tort reforms that have stabilized malpractice premiums, increased physician retention in their states, reduced overall health care costs and decreased filings of frivolous lawsuits. Pilot projects are pacifiers, and we don’t need them.

It’s also not surprising that there are no specific provisions to address the problems associated with the sudden influx of 32 million new patients, like training new doctors and funding new medical schools. Imagine what would happen if the teachers’ union was told there would be 32 million new students in September but not a dime for more teachers, classrooms or books. The academic calendar would be trimmed to about a month. To add insult to injury, the cost of care to treat these new patients is being partially funded by draconian physician pay cuts with off-balance sheet “fixes” to make the bill appear revenue-neutral. If I remember correctly, those shenanigans got Enron and its executives into a lot of trouble. Who knew that the Office of Management and Budget would use those same accounting principles to certify that the health care bill is revenue-neutral?

Ironically, only the insurance industry is happy with the bill because it is the only one powerful enough to have killed it, so the industry got what it wanted—32 million mandated new customers with no acquisition or advertising costs. Their premiums will be paid for by your brand-new Medicare tax increase on investment income (3.8%). Sure, there are some cosmetic insurance reforms like keeping your kids on your policy until age 26 and no termination for preexisting conditions, but these are a small price to pay for padding their enrollees. Most of the cosmetic insurance reforms come with the same expectation for success as “border security” had when amnesty was granted to illegal aliens in 1986. The reforms will be as porous as our borders while premiums skyrocket and doctors’ offices are clogged with millions of new patients.

Remember, the designers of the bill wanted the public option and the extinction of the insurance companies to clear the path toward one-size-fits-all federalized care. They were thwarted this time around by a grassroots revolt and were forced to retreat and remove the public option, but they did not remove the expensive apparatus designed to support the public option. They hurriedly cobbled together a bill guaranteed to fail and increase the public demand for a federal takeover. The insurance companies will get their final feeding frenzy for now, but when 150 million Americans with employer-sponsored health care find themselves in insurance exchanges on Medicaid-lite because their employers elected to pay a nominal penalty instead of renewing their policies, the public’s rage will boil over.

The president pledged if you liked your insurance you could keep it, but he didn’t say for how long. There will be widespread demand for the final solution, which won’t be a market-based delivery system controlled by physicians like we had in the 1960s and 1970s, because we won’t get another chance to control our own turf. And it won’t be the HMOs of the 1980s and 1990s that failed miserably, pleasing no one except the doctors who felt vindicated because corporate greed made them look like pikers. This current hybrid public–private phase orchestrated by the Patient Protection and Affordability Act also will fail due to the mendacity of the insurance companies, long lines at doctors’ offices, physician shortages and unimaginable cost overruns, leaving a vacuum that only the government can fill. That is the plan.

Although the public option was aborted in the current bill, the infrastructure to service it was not. Although the public debate over the bill focused on abortion, death panels, care for illegal aliens and tort reform, no one seemed to notice that the massive federal bureaucracy to service government-run health care remained in the bill. The trillion-dollar bill that is sure to break the bank provides for about 250,000 new federal employees to staff at least 150 new agencies, councils, committees, advisory boards, bureaus and departments to cover everything from lactation training to geriatric medicine. Prior to the establishment of this behemoth, the federal government ran a fairly lean machine in providing Medicare and Medicaid services. Almost everything was outsourced. This time, all functions and services will be brought in-house. When people asked me why I didn’t drop Medicare when I dropped private insurance, my answer was simply that, at a 4% operating budget, I never felt like Medicare was stealing my money like the insurance companies that used 50% of premium dollars to excessively reward themselves instead of paying my bill. This bill changes all that. You’ll never be able to trace the flow of funds in the government like you can in a public corporation because government programs are sinkholes with accountability to no one. God strike me down for saying this, but I’d rather deal with the insurance companies as an intermediary than the U.S. government.

The plan for physicians is clear. The bill could have rewarded doctors for the imposition of 32 million lives in a number of ways. Tort reform would have been a nice touch. Debt relief for the average young physician who enters practice with nearly $250,000 of debt and then has to go back to the bank to get a loan to start a practice would have helped (especially because a rider to the bill provided for a federal takeover of the student loan program from the banks). The bill could have eradicated the sustainable growth rate calculation for physician payments that causes high anxiety over steep pay cuts every year. The bill could have subsidized physician assistants and nurse practitioners for physicians burdened with so many new patients. Instead, the bill is financed with $130 billion in new physician pay cuts, some of which will go for increased funding to the IRS, presumably to be used to train agents to remove gallbladders. The bill prohibits the expansion or establishment of physician-owned hospitals (Title VI, Section 6001) to close one of the few remaining opportunities for doctors to make money. The bill establishes a mechanism for the federal government to play doctor by mandating treatment pathways for virtually any disease or condition. In short, the bill skewers doctors, financially, spiritually and professionally.

The bill falls short of commandeering the medical profession to provide services to patients for little compensation. Doctors see the writing on the wall, however, and polls show that more than two-thirds of them oppose the bill, and are planning to work less, open concierge practices, drop insurance, or refuse to see patients from the insurance exchanges. I believe that a manpower shortage, induced by the new law, will force the government to enact EMTALA II [Emergency Medical Treatment and Active Labor Act] to ensure access to physicians. EMTALA II will force physicians to see any patient who shows up in their office. Thus, “The Taking” of our profession.

You will remember EMTALA I requires hospitals to care for anyone who shows up in the emergency department. EMTALA I is the best-kept secret in America. You never saw it referenced in the debate over health care because its existence is off message for those claiming millions of Americans have absolutely no access to care. This simply is not true. Although millions have no access to routine outpatient preventive care, anyone in America can show up at my hospital and leave with a heart transplant if needed. EMTALA I makes it illegal to transfer or deny services to any patient who shows up, except for transfer to a higher level of care.

Now, don’t write me letters and tell me I’m the hard-hearted incestuous product of an illicit relationship between Glenn Beck and Marie Antoinette. I support universal care. I also support my profession and want to see it remain independent and viable. An EMTALA for doctors will be an insufferable attack on our profession, but something like it simply must be enacted to prevent chaos once the provisions of the bill are up and running in 2014. The Massachusetts experience mandating everyone to buy insurance seemed like a good idea at the time, but has become a fiscal and logistical nightmare. In other states like Maine, “universal coverage” broke the state coffers even before the financial crash of 2008. The lack of funding has caused doctors to opt out of the state-run system, causing rationing and long lines waiting for care. The states do not have the legal authority to force physicians to participate. Neither does the federal government, in my opinion, but it thinks it does, and will.

A private workforce and a public distribution and finance system are incompatible, so something like EMTALA II that enjoins physicians not to opt out will be required. Ultimately, the huge new federal bureaucracy put into place by the current law will take over health care and force physicians to participate. If you believe that this apparatus with a workforce of 250,000 new federal employees has been put in place for peaceful purposes and not to take over health care, you probably believe Ahmadinejad is firing up his new nuclear plant so the oil-rich Iranians can keep their lights on.

EMTALA II, for all practical purposes, will be an illegal seizure, or “taking,” of the health care profession. Physicians have long believed, perhaps anachronistically, that they have an equity interest in health care because it wasn’t the government or corporate America that developed health care in this country during the past century, it was doctors who independently and privately nurtured the finest health care system in the world, the World Health Organization’s wacky assessment notwithstanding. We started medical schools. We established first-class training programs in medicine and surgery. We formed societies for sharing information and establishing professional standards. We discovered new drugs and surgical techniques. We partnered with industry to develop incredible new technologies that have revolutionized surgical care. And, most of all, we took care of patients one at a time in the old-fashioned “doctor–patient relationship” that yielded spectacular results and remains the backbone of our system. Although our profitability has been eroded by large corporations that have picked our pockets for the past 30 years, many of us still believe that our health care system belongs to us, paid for by our education, training, experience and long years of service.

The government disagrees. Using the well-worn shibboleth of “providing for the public welfare,” Washington believes it can turn us into civil servants.

No one has less love for the insurance companies than I, but the insurance companies can only steal my money, not my practice or my independence. The government can take both, and will.

“Takings” are supposed to be illegal. The Fifth Amendment prohibits them. The federal government has the right of eminent domain to seize real property for public use for roads and military bases, but it has no right to seize intellectual property, such as one’s training, skill and experience. The seizure is especially galling because there will be absolutely no consideration for it, as is constitutionally required for the seizure of real property. At least in the social democracies where physicians work for the state, the government underwrites the cost of education and maintaining a practice, and medical negligence cases are virtually nonexistent. Our government wants it all, for free.

When I write my check to the American College of Surgeons-Political Action Committee (ACS-PAC), I daydream that the money will be used to finance a constitutional challenge to this de facto “taking” of our profession, which will come about through some mechanism similar to EMTALA. The ACS is justifiably concerned that any concerted action by physicians to protect their economic interests will be met with criminal charges of collusion and free-market manipulation as was recently demonstrated in Idaho when the states’ orthopods refused to see patients on workers’ compensation because fees were too low. The Department of Justice brought suit, accusing the physicians of anticompetitive practices and collusion, and prevailed. Ironic, isn’t it, that the government that wants one-size-fits-all medicine brings a suit alleging anticompetitive practices and free-market destruction? Hopefully, the Idaho decision will be challenged and work its way to the Supreme Court that might remember getting trashed by the newly minted president during his first State of the Union speech in front of Congress and the American people.

A legal challenge to the constitutionality of this taking is worth a try, because otherwise, the medical profession as we know it is on the final pathway to ruin. In a decade or so, when it’s obvious to all that the Patient Protection and Affordable Care Act of 2009 was neither affordable nor in the best interests of patients, I’m afraid frustrated patients and doctors will capitulate and support state-run health care. This will fulfill the long-term strategy of those who were forced to remove the public option from the current bill and gave us a lump of coal instead, with no real prospects of lowering costs, solving the medical malpractice crisis or rationalizing physician payments.

As a taxpayer, I’m concerned.

As a patient, I’m frightened.

As a physician, I’m angry.

But as a taxpayer, I can eat the loss. I’ll miss the extra money for my family and for my employees, most of whom had a different interpretation of “redistribution.”

As a patient, I am less concerned about how long the line is going to be than who’s at the end of it to treat me when it’s finally my turn. I think you’re going to see a sudden interest in “expedited pathways” for marginal doctors from other countries to meet the surge in demand.

As a physician, I’m angry that my profession is being taken, perhaps unconstitutionally, by forces that clearly have very low regard for or understanding of what we do. They are gravely miscalculating the competency of socialized health care systems that have been subsidized with drugs and equipment developed in our for-profit market-based health care industry. If this source gets turned off because there is no market for innovation, the stark deficiencies of government-sponsored health care will be laid bare for all to see.

It will be too late.

Dr. Cossman is a vascular surgeon in Los Angeles.

Responses to the "GOP Pledge to America"

2010-09-23T08:51:00.000-07:00

I just couldn't resist. I'll just give a few of my thoughts regarding the GOP's Pledge to America. Read on if you'd like, and let me know what you think. The full draft text appears below, with my comments interspersed in italics.

Pledge to America

America is an idea, an idea that free people can govern themselves, that government's powers are derived from the consent of the governed, that each of us is endowed by their Creator with the unalienable rights to life, liberty, and the pursuit of happiness. America is the belief that any man or woman can‚ given economic, political, and religious liberty‚ advance themselves, their families, and the common good. America is an inspiration to those who yearn to be free and have the ability and the dignity to determine their own destiny. These first principles were proclaimed in the Declaration of Independence, enshrined in the Constitution, and have endured through hard sacrifice and commitment by generations of Americans. Whenever the agenda of government becomes destructive of these ends, it is the right of the people to institute a new governing agenda and set a different course. In a self-governing society, the only bulwark against the power of the state is the consent of the governed, and regarding the policies of the current government, the governed do not consent.

America is more than a country.

Seems reasonable so far (though the right to "life" clashes somewhat with the right's desire to withhold health care in many instances).

A PLEDGE TO AMERICA

An unchecked executive, a compliant legislature, and an overreaching judiciary have combined to thwart the will of the people and overturn their votes and their values, striking down long-standing laws and institutions and scorning the deepest beliefs of the American people. Rising joblessness, crushing debt, and a polarizing political environment are fraying the bonds among our people and blurring our sense of national purpose.

Hasn't our executive been repeatedly checked by filibustering Republicans? Tabling the repeal of DADT, the DREAM Act, a better health care reform bill, etc.

Shouldn't unfair and anachronistic laws sometime be struck down, no matter how "long-standing"?

An arrogant and out-of-touch government of self-appointed elites makes decisions, issues mandates, and enacts laws without accepting or requesting the input of the many.

I don't believe anyone can "self appoint" themselves to a position of power within the Federal government. I would also argue that the input of "the many" was taken in November, 2007, and will be again in a few months.

With this document, we pledge to dedicate ourselves to the task of reconnecting our highest aspirations to the permanent truths of our founding by keeping faith with the values our nation was founded on, the principles we stand for, and the priorities of our people. This is our Pledge to America. We pledge to honor the Constitution as constructed by its framers and honor the original intent of those precepts that have been consistently ignored, particularly the Tenth Amendment, which grants that all 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. We pledge to honor families, traditional marriage, life, and the private and faith-based organizations that form the core of our American values.

My guess is that they aren't including Muslim "faith-based organizations" in this group.

The need for urgent action to repair our economy and reclaim our government for the people cannot be overstated.

Like free peoples of the past, our citizens refuse to accommodate a government that believes it can replace the will of the people with its own. The American people are speaking out, demanding that we realign our country‚ compass with its founding principles and apply those principles to solve our common problems for the common good.

Compass (transitive verb) - to devise or contrive, often with craft or skill. Hey, you learn something new every day.

We pledge to advance policies that promote greater liberty, wider opportunity, a robust defense, and national economic prosperity.

1

We pledge to make government more transparent in its actions, careful in its stewardship, and honest in its dealings.

File under: I'll believe it when I see it.

We pledge to uphold the purpose and promise of a better America, knowing that to whom much is given, much is expected and that the blessings of our liberty buoy the hopes of mankind. We make this pledge bearing true faith and allegiance to the people we represent, and we invite fellow citizens and patriots to join us in forming a new governing agenda for America.

2

CONTENTS

3

It's time to do away with the old politics: that much is clear. It's not enough, however, to swap out one set of leaders for another. Structure dictates behavior, so we have drafted this blueprint on a process of listening to the American people and fielding their concerns and ideas for turning things around. Our plan offers a clear and clearly different approach, one in which the people have the most say and the best ideas trump the most entrenched interests. Our plan stands on the principles of smaller, more accountable government; economic freedom; lower taxes; fiscal responsibility; protecting life, American values, and the Constitution; and providing for a robust national defense. These are focused concrete examples of the policies through which we will promote greater liberty, wider opportunity, and national economic recovery, and they can be implemented today. ***

Cool.

Politicians in Washington have imposed an agenda that doesn't reflect the priorities of the people. What's worse, the most important decisions are made behind closed doors, where a flurry of backroom deals has supplanted the will of the people.

Though these petitions come from different walks, their message is uniform: Washington has not been listening.

Yes, I don't disagree with this, but also understand that as many backroom deals were made by Republicans as Democrats.

The American people do not accept these counsels of timidity, failure, and despair. In town halls and on public squares, in every corner of this country, people have gathered and spoken out‚ in small groups and larger crowds, through phone calls and in letters, through websites and new technologies.

Americans need no reminder that the challenges we face are enormous. Our economy has declined and our debt has mushroomed with the loss of millions of jobs. The social fabric that binds us as citizens, families, and communities is unraveling. Voices in and out of government whisper that our standing as the world leader of democracy and economic growth is ending.

FOREWORD

Our plan puts forth a new governing agenda that reflects the priorities of the American people‚ priorities that have been ignored, even mocked by the powers-that-be in Washington.

I would imagine that the GOP would like their incumbents (aka, the powers-that-be) to be reelected, despite their past record of ignorance and mockery.

By permanently stopping job-killing tax hikes, families will be able to keep more of their hard-earned money and small businesses will have the stability they need to invest in our economy and help grow our workforce. We will further encourage small businesses to create jobs by allowing them to take a tax deduction equal to 20 percent of their income. We will rein in the red tape factory in Washington, DC by requiring congressional approval of any new federal regulation that may add to our deficit and make it harder to create jobs. In addition, we will repeal the costly small business mandates contained in the new health care law.

OK, as a small business owner, I might be inclined to take this one. My only question is whether they can accurately determine which tax hikes are job-killing vs. necessary.

A plan to create jobs, end economic uncertainty, and make America more competitive must be the first and most urgent domestic priority of our government. So first, we offer a plan to get people working again. We will end the attack on free enterprise by repealing job-killing policies and taking steps to assure current businesses and future entrepreneurs that the government will not stifle their ability to compete in the global marketplace.

Nice. I can't say I like job-killing policies either.

4

With common-sense exceptions for seniors, veterans, and our troops, we will roll back government spending to pre-stimulus, pre-bailout levels, saving us at least $100 billion in the first year alone and putting us on a path to balance the budget and pay down the debt. We will also establish strict budget caps to limit federal spending from this point forward. We will launch a sustained effort to stem the relentless growth in government that has occurred over the past decade. By cutting Congress's budget, imposing a net hiring freeze on non-security federal employees, and reviewing every current government program to eliminate wasteful and duplicative programs, we can curb Washington's irresponsible spending habits and reduce the size of government, while still fulfilling our necessary obligations.

I like the sound of this, but again, given the fact that the majority of the relentless growth in government occurred under the GOP's watch...

If we've learned anything over the last two years, it's that we cannot spend our way to prosperity. We offer a plan to stop out-of-control spending and reduce the size of government.

I'd say we should have learned this after 9/11.

Instead of pushing off our long-term fiscal challenges, we will reform the budget process to ensure that Congress begins making the decisions that are necessary to protect our entitlement programs for today's seniors and future generations.

We will also prevent Washington from forcing responsible taxpayers to subsidize irresponsible behavior by ending bailouts permanently, canceling the Troubled Asset Relief Program (TARP), and reforming Fannie Mae and Freddie Mac.

TARP's basically done anyway - the damage & the good it did is water under the bridge. I would like to see Fannie and Freddie reformed.

Above all else, the primary obligation of the federal government remains providing for the common defense against all threats foreign and domestic. We offer a plan to keep our nation secure at home and abroad that will provide the resources, authority, and support our deployed military requires, fully fund missile defense, and enforce sanctions against Iran. We will keep terrorist combatants in Guantanamo Bay not in our local jails and courtrooms. Our borders are a vital part of our security, so we will act decisively to ensure that the federal government fulfills its constitutional duty to protect our citizens and our Nation, working closely with our state and local governments.

We recognize that these solutions are ambitious, and that we are proposing them at a time of intense public distrust in politicians and the political system. That's why we are offering a plan to reform Congress and restore trust so that we can put power back where it belongs: in the hands of the people. We will govern differently than past Congresses of both parties. We will require that every bill contain a citation of Constitutional authority. We will give all Representatives and citizens at least three days to read the bill before a vote. We will make sure that the floor schedule and operations reflect the priority of revitalizing the economy, and ensure there is an open process that makes it easier‚ not harder‚ to eliminate unnecessary spending on any legislation that spends the people's money.

Great. Only they haven't proposed and solutions yet, only goals - which is fine, just don't call them "solutions."

Of course, Americans remember that President Obama argued his government takeover of health care was the single most important thing we could do to address our growing debt crisis. This notion has since been thoroughly discredited: we now know the new health care law will mean more financial pain for seniors, families, employers and the federal government. We offer a plan to repeal and replace the government takeover of health care with common-sense solutions focused on lowering costs and protecting American jobs. We will enact real medical liability reform; allow Americans to purchase health coverage across state lines; empower small businesses with greater purchasing power; and create new incentives to save for future health needs. We will protect the doctor-patient relationship, and ensure that those with pre-existing conditions gain access to the coverage they need. We will permanently end taxpayer funding of abortion and codify the Hyde Amendment.

Just to clarify, whatever its flaws - and they are many - the PPACA is not a government takeover of health care. I also think the reference to abortion and the Hyde Amendment flies in the face of the earlier pledge to let the states decide issues which aren't Constitutionally allocated to the Federal government.

5

Joblessness is the single most important challenge facing America today. Jobs are the lifeblood of our economy, and for our workforce, there is no substitute for the pride and dignity that comes with an honest day's work and a steady paycheck. Washington's heavy-handed approach is not working. Private sector unemployment remains at or near 10 percent, jobless claims continue to soar, and the only parts of the economy expanding are government and our national debt. It is time to end this liberal Keynesian experiment and stop the attacks on our employers that prevent them from investing in our economy. We need private sector jobs, not more government. We have a plan that will help create jobs, end economic uncertainty, and make America more competitive.

A Plan to Create Jobs, End Economic Uncertainty, and Make America More Competitive

The trillion-dollar stimulus spending bill has made‚where are the jobs? a national rallying cry after failing to live up to the specific promises made by its architects. Instead of remaining below eight percent, unemployment has been above nine percent for 16 consecutive months. This is a far cry from the recovery the American people were promised. Undeterred by dismal results, Washington Democrats continue to double-down on their job-killing policies. President Obama is proposing spending billions more on government stimulus projects. He also wants to raise taxes on roughly half of small business income in America. Raising taxes on anyone in a struggling economy, especially small businesses, is precisely the wrong thing to do. Economists agree, as do the American people. Top-down one-size-fits-all decision making should not replace the personal choices of free people in a free market, nor undermine the proper role of state and local governments in our system of federalism. Gov. Bob McDonnell (VA)

So they're willing to keep the non-job-killing policies?

Washington-focused economic policies have failed to put people back to work and have pushed our nation to the brink of a fiscal crisis. The American people know that to boost the economy, spending must be slashed, tax increases must be prevented, and small businesses must have certainty that the rules won't change every few months so they can get back on their feet. The constant threat of new taxes and new regulations prevents investors and entrepreneurs from putting capital at risk. These private sector employers must be given the certainty that if they take a risk to expand their company or hire a new employee, Washington won't yank the rug from under their feet.

In addition to punishing businesses, these looming tax hikes will hurt every family in America. During the 1990s, a Republican Congress enacted pro-family policies such as marriage penalty relief and the child tax credit. Unless action is taken, a $3.8 trillion tax hike will go into effect on January 1, 2011 that will unravel the pro-family policies. A family of four with a household income of $50,000 a year will have to pay $2,900 more in taxes in 2011, according to a new analysis by Deloitte Tax LLP, a tax consulting firm. The same family making $100,000 a year will see its taxes rise by $4,500. In addition, the marriage penalty will return, the child tax credit will be cut in half, and the Alternative Minimum Tax will ensnare more than 25 million taxpayers.

The tax code needs to be revised and simplified, but extending the fiscally irresponsible tax cuts of the past just sweeps the main problem under the rug.

An economy constrained by high tax rates will never produce enough revenue to balance the budget, just as it will never create enough jobs. John F. Kennedy

6

SIDE BAR TEXT:

Permanent bailouts, government takeovers, threats of tax increases and ‚Äústimulus‚Äù spending sprees have combined to create uncertainty for private investment in our economy and keep employers on the sidelines. The longer our government refuses to wake up and abandon its job-killing agenda, the longer it will take to turn things around and get people working again.

‚ÄúWhere Are the Jobs?‚Äù Since the trillion-dollar ‚Äòstimulus‚Äô was signed into law in February 2009, the unemployment rate has climbed and is stuck at near 10 percent. Despite the ‚Äòstimulus‚Äô and Democrats‚Äô promises the unemployment rate would remain below eight percent, the unemployment rate climbed from 7.7 percent in January 2009 to 9.5 percent in August 2010.

So far, Washington Democrats have passed, and the president has signed into law, at least 14 violations of his pledge that ‚Äúno family making less than $250,000 a year will see any form of tax increase.‚Äù o The White House‚Äôs own internal departments have identified 191 planned rules that will have an economic cost of at least $100 million, including mandates related to the government takeover of health care and the financial regulation bill. o

Since January 2009, President Obama and Congressional Democrats have enacted $680 billion in gross tax increases, $316 billion of which are tax hikes that hurt the middle class families President Obama said would not see a tax increase.

Source: January 2009 Romer/Bernstein Report and U.S. Department of Labor data.

7

‚ÄúA wise and frugal government, which shall leave men free to regulate their own pursuits of industry and improvement, and shall not take from the mouth of labor the bread it has earned this is the sum of good government.‚Äù ‚Äì Thomas Jefferson If we‚Äôve learned anything during the recession, it‚Äôs that we cannot tax and spend our way to prosperity. The best way to get people working again is to rein in the growth of government and end the uncertainty facing small businesses. By addressing both issues, our plan revives free enterprise and moves America away from a debt-driven economy. ‚Ä¢ Our Plan to End The Uncertainty and Create Incentives for Job Growth

‚Ä¢

Permanently Stop All Job-Killing Tax Hikes: We will help the economy by permanently stopping all tax increases, currently scheduled to take effect January 1, 2011. That means protecting middle-class families, seniors worried about their retirement, and the entrepreneurs and family-owned small businesses on which we depend to create jobs in America. Give Small Businesses a Tax Deduction: We will allow small business owners to take a tax deduction equal to 20 percent of their business income. This will provide entrepreneurs with a much-needed infusion of capital for investment and new hiring.

‚Ä¢

‚Ä¢

Rein In the Red Tape Factory in Washington, DC: Excessive federal regulation is a de facto tax on employers and consumers that stifles job creation, hampers innovation and postpones investment in the economy. When the game is always changing, small businesses cannot properly plan for the future. To provide stability, we will require congressional approval of any new federal regulation that has an annual cost to our economy of $100 million or more. This is the threshold at which the government deems a regulation ‚Äúeconomically significant.‚Äù If a regulation is so ‚Äúsignificant‚Äù and costly that it may harm job creation, Congress should vote on it first.

MORE SIDE BAR TEXT: ‚Ä¢

Repeal Job-Killing Small Business Mandates: One of the most controversial mandates of the Democrats‚Äô government takeover of health care requires small businesses to report to the Internal Revenue Service any purchases that run more than $600. This 1099 reporting mandate is so overbearing that the IRS ombudsman has determined that the agency is ill-equipped to handle all the resulting paperwork.. We will repeal this job-killing small business mandate. At the current pace of job growth, it will take longer to recover now than it did to recover from the Great Depression. At this rate, the pre-recession level of jobs will not be achieved until September 2017, more than 80 months from now. That would be nearly 10 years after the recession started, or almost two years longer than it took the U.S. to recover from job losses during the Great Depression. A single mom earning $36,000 per year could pay more than $1,100 more in taxes.

‚Ä¢

‚Ä¢ ‚Ä¢ ‚Ä¢

According to congressional analysts, these are the consequences of the tax hikes that are set to take effect on January 1, 2011: 31 million families will pay an average of $1,033 in higher taxes next year due to a reduction in the child tax credit from $1,000 to $500. 8 Married senior citizens earning $40,000 per year could pay more than $1,400 in higher taxes.

‚Ä¢

‚Ä¢

88 million taxpayers will pay an average of $503 in higher taxes next year due to the elimination of the 10 percent tax bracket.

35 million married couples will pay an average of $595 in higher taxes next year due to a reinstatement of the marriage penalty.

9

It isn‚Äôt just that we need to stop spending so much ‚Äì we need to stop spending so irrationally. The spending process in Washington is designed to make it easy to increase spending and raise taxes and difficult to cut spending and lower taxes. The deck is stacked against limited government and fiscal responsibility. This must stop. We have a plan to impose fiscal discipline and cut government down to size. WHAT WE‚ÄôRE UP AGAINST

Washington‚Äôs out-of-control spending spree needs no introduction. Our debt is now on track to exceed the size of our economy in the next two years. The lack of a credible plan to pay this debt back causes anxiety among consumers and uncertainty for investors and employers.

A Plan to Stop Out-of-Control Spending and Reduce the Size of Government

Economists have warned that all this borrowing runs the risk of causing a damaging spike in interest rates, which would cripple job creation. If our economy remains debt-driven, it will not be in a position to support a lasting economic recovery.

Within three years, our government will spend more than $1 billion a day just to pay the interest on our debt. That money won‚Äôt build roads, fight terrorism, secure our border, or support Medicare for seniors. It is simply the cost of Congress‚Äô failure to control spending. ‚ÄúGovernment‚Äôs view of the economy could be summed up in a few short phrases: if it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it.‚Äù -- Ronald Reagan

Over the past three years, non-security discretionary spending (the spending that is approved each year by Congress outside of the Department of Defense, Department of Homeland Security, and Department of Veterans Affairs) has increased a staggering 88 percent. As a result, we now borrow 41 cents of every dollar we spend, much of it from foreign countries, including China, and leave the bill to our kids and grandkids.

Instead of putting the brakes on Washington‚Äôs spending habits as they promised, President Obama and Democratic Leaders have stepped on the accelerator and demonstrated unparalleled recklessness with taxpayer dollars.

Unfortunately, Washington Democrats refuse to listen to the American people and eliminate, restrain, or even budget for their out-of-control spending spree. Indeed, Democrats simply walked away from writing next year‚Äôs budget altogether ‚Äì a first in the modern era. Without a budget, Washington will try to get away with continuing to spend at current ‚Äústimulus‚Äù levels. We cannot allow that to happen. We will have a responsible, fact-based conversation with the American people about the scale of the fiscal challenges we face, and the urgent action that is required to deal with them. We will curb Washington‚Äôs spending habits and promote job creation, bring down the deficit, and build long-term fiscal stability. ‚Ä¢ Our Plan to Put Government on a Path to a Balanced Budget

Act Immediately to Reduce Spending: There is no reason to wait to reduce wasteful and unnecessary spending. Congress should move immediately to cancel unspent ‚Äústimulus‚Äù funds, and block any attempts to extend the timeline for spending ‚Äústimulus‚Äù funds. Throwing more money at a stimulus plan that is not working only wastes taxpayer money and puts us further in debt. 10

‚Ä¢

‚Ä¢

Cut Government Spending to Pre-Stimulus, Pre-Bailout Levels: With common-sense exceptions for seniors, veterans, and our troops, we will roll back government spending to pre-stimulus, pre-bailout levels, saving us at least $100 billion in the first year alone and putting us on a path to begin paying down the debt, balancing the budget, and ending the spending spree in Washington that threatens our children‚Äôs future.

‚Ä¢

Establish a Hard Cap on New Discretionary Spending: We must put common-sense limits on the growth of government and stop the endless increases. Only in Washington is there an expectation that whatever your budget was last year, it will be more this year and even more the next. We will set strict budget caps to limit federal spending on an annual basis. Budget caps were used in the 1990s, when a Republican Congress was able to bring the budget into balance and eventual surplus. By cutting discretionary spending from current levels and imposing a hard cap on future growth, we will save taxpayers hundreds of billions of dollars. Cut Congress‚Äô Budget: This year, Congress increased its own budget by 5.8 percent at a time when families and small businesses across the country are cutting back. We will make Congress do more with less by significantly reducing its budget. Hold Weekly Votes on Spending Cuts: Earlier this year, House Republicans launched the YouCut initiative to combat the permissive culture of runaway spending in Congress. Over the course of nine weeks, YouCut produced proposals to save taxpayers more than $120 billion. We will continue to hold weekly votes on spending cuts. End TARP Once And For All: Americans are rightly outraged at the bailouts of businesses and entities that force responsible taxpayers to subsidize irresponsible behavior. We will cancel the Troubled Asset Relief Program (TARP), a move that would save taxpayers roughly $16 billion.

‚Ä¢

‚Ä¢

‚Ä¢

‚Ä¢

End Government Control of Fannie Mae and Freddie Mac: Since taking over Fannie Mae and Freddie Mac, the mortgage companies that triggered the financial meltdown by giving too many high risk loans to people who couldn‚Äôt afford them, taxpayers were billed more than $145 billion to save the two companies. We will reform Fannie Mae and Freddie Mac by ending their government takeover, shrinking their portfolios, and establishing minimum capital standards. This will save taxpayers as much as $30 billion. Impose a Net Federal Hiring Freeze of Non-Security Employees: Small businesses and entrepreneurs are the engine of our economy and should not be crowded out by unchecked government growth. We will impose a net hiring freeze on non-security federal employees and ensure that the public sector no longer grows at the expense of the private sector.

‚Ä¢

‚Ä¢

Root Out Government Waste and Duplication: Once created, federal programs almost never go away, even if the problem they were created to address is no longer relevant. More than 20 states have addressed this problem by requiring that programs end ‚Äì or ‚Äúsunset‚Äù ‚Äì by a date certain. We will adopt this requirement at the federal level to force Congress to determine if a program is worthy of continued taxpayer support. Reform the Budget Process to Focus on Long-Term Challenges: We will make the decisions that are necessary to protect our entitlement programs for today‚Äôs seniors and future generations. That means requiring a full accounting of Social Security, Medicare, and Medicaid, setting benchmarks for these programs and reviewing them regularly, and preventing the expansion of unfunded liabilities.

DID YOU KNOW? ‚Ä¢

Today, Washington spends $7 million every minute of every hour of every day. That is twice as much as was spent per minute in 1980.

11

‚Ä¢

‚Ä¢

There is literally no aspect of our economy or our society that the federal government doesn‚Äôt tax, regulate or subsidize, and often it does all three at the same time. The most recent edition of the Catalogue of Federal Domestic Assistance listed 2,050 different assistance programs available to states, local governments, for-profit and non-profit organizations, groups, and individuals. Taxpayers are literally funding programs from cradle to grave:

Our cumulative national debt now exceeds $13,000,000,000,000 which is more than $42,000 for every man, woman, and child in America. Under the most recent budget projections, it will continue to grow, doubling by 2020.

Federal Assistance Programs
16 12 41 35 34 24 12 132 413 59 64 83 95 95 107 111 125 172 184 236

Dept of Health and Human Services Dept of Agriculture Dept of the Interior Dept of Education Dept of Justice Dept of Housing and Urban Development Environmental Protection Agency Dept of Commerce Dept of Homeland Security Dept of Transportation Dept of Defense Deptof Labor Dept of Veterans Affairs Dept of Energy Dept of State

Federal spending consumes nearly one-quarter of our entire economy and is crowding out the private economy. Indeed, today more Americans work for one level of government or another than work in all the goodsproducing industries, such as manufacturing, combined. According to the Obama Administration‚Äôs most recent budget forecast, government spending as a percentage of the economy will be, on average, several percentage points higher over the next ten years than it was during either the Clinton or Bush presidencies.

SIDE BAR TEXT/GRAPH

12

Federal Spending as a Share of the Economy

24.00% 23.00% 22.00% 21.00% 20.00% 19.00% 18.00% 17.00% Average During the Clinton Presidency Average During the Bush Presidency Average Under the Democrat Budget Blueprint 2009-2020

13

The American people wanted one thing out of health care reform: lower costs, which President Obama and Democrats in Washington promised, but did not deliver. Instead of expanding the size and scope of government with more debt, higher taxes, and burdensome mandates, Americans are calling for reforms that lower costs for families and small businesses, increase access to affordable, high-quality care and strengthen the doctor-patient relationship. We have a plan to do just that. WHAT WE‚ÄôRE UP AGAINST The core promises Washington Democrats made to force the health care law through Congress have already been broken: ‚Ä¢ Jobs. Employers large and small coast-to-coast have announced that they are considering laying off employees or dropping their health care coverage in response to the new law, despite President Obama‚Äôs boast that it is also a jobs plan.

A Plan to Repeal and Replace the Government Takeover of Health Care

‚Ä¢

‚Ä¢

Costs. Both the nonpartisan Congressional Budget Office (CBO) and the chief actuary at the Obama Administration‚Äôs Centers for Medicare & Medicaid Services (CMS) have confirmed that the new law fails to lower health care costs as promised.

‚Ä¢

‚Ä¢

‚Ä¢

Seniors. The chief actuary at the Obama Administration‚Äôs Centers for Medicare & Medicaid Services has confirmed that the new law‚Äôs massive Medicare cuts will fall squarely on the backs of seniors, millions of whom will be forced off their current Medicare coverage. If You Like It‚Ä¶ You Can‚Äôt Keep It. The Obama Administration has been forced to acknowledge that the new law will force some 87 million Americans to drop their current coverage despite President Obama‚Äôs promise that Americans would be able to keep the coverage that they have. Abortion. Americans are overwhelmingly opposed to using tax dollars to pay for abortion, and the executive order issued by President Obama in conjunction with congressional passage of the health care law is inadequate to ensure taxpayer funds are not used in this manner.

Taxes. The new health care law includes at least a dozen violations of President Obama‚Äôs pledge not to raise taxes on middle-class families. The Obama administration has conceded that the ‚Äòindividual mandate‚Äô at the heart of the new law is indeed a tax, a notion the president ‚Äúabsolutely‚Äù rejected last fall.

Deficits and Debt. The Obama Administration‚Äôs Social Security and Medicare Trustees report confirms that the new law does little to address the nation‚Äôs growing fiscal crisis despite President Obama‚Äôs pledge that passing his plan constituted the ‚Äúmost important thing we can do‚Äù for the nation‚Äôs financial future.

‚Ä¢

Instead of bringing the full weight of the government to bear in enforcing this job-killing health care law, Washington Democrats should listen to the American people and stand down. Our Plan to Repeal the Job Killing Health Care Law and Put in Place Real Reform o

o

Repeal the Costly Health Care Takeover of 2010: Because the new health care law kills jobs, raises taxes, and increases the cost of health care, we will immediately take action to repeal this law.

Enact Medical Liability Reform: Skyrocketing medical liability insurance rates have distorted the practice of medicine, routinely forcing doctors to order costly and often unnecessary tests to protect

14

o

themselves from lawsuits, often referred to as ‚Äúdefensive medicine.‚Äù We will enact common-sense medical liability reforms to lower costs, rein in junk lawsuits and curb defensive medicine.

o

Purchase Health Insurance Across State Lines: Americans residing in a state with expensive health insurance plans are locked into those plans and do not currently have an opportunity to choose a lower cost option that best meets their needs. We will allow individuals to buy health care coverage outside of the state in which they live. Expand Health Savings Accounts: Health Savings Accounts (HSAs) are popular savings accounts that provide cost-effective health insurance to those who might otherwise go uninsured. We will improve HSAs by making it easier for patients withhigh-deductible health plans to use them to obtain access to quality care. We will repeal the new health care law, which prevents the use of these savings accounts to purchase over-the-counter medicine. Strengthen the Doctor-Patient Relationship: We will repeal President Obama‚Äôs government takeover of health care and replace it with common-sense reforms focused on strengthening the doctor-patient relationship.

o

o

o

Permanently Prohibit Taxpayer Funding of Abortion: We will establish a government-wide prohibition on taxpayer funding of abortion and subsidies for insurance coverage that includes abortion, this includes enacting into law what is known as the Hyde Amendment. We will also enact into law conscience protections for health care providers, including doctors, nurses, and hospitals.

Ensure Access For Patients With Pre-Existing Conditions: Health care should be accessible for all, regardless of pre-existing conditions or past illnesses. We will expand state high-risk pools, reinsurance programs and reduce the cost of coverage. We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition, eliminate annual and lifetime spending caps, and prevent insurers from dropping your coverage just because you get sick. We will incentivize states to develop innovative programs that lower premiums and reduce the number of uninsured Americans.

DID YOU KNOW? ‚Ä¢ ‚Ä¢ ‚Ä¢

‚Ä¢

The new health care law includes $569.2 billion in tax increases ‚Äì including taxes that will directly increase the cost of health care goods and services ‚Äì and $528.5 billion in Medicare cuts, which will be used to create new programs not related to seniors.

Roughly 16,500 IRS auditors, agents, and other employees may be needed to collect the hundreds of billions of dollars in new taxes levied on the American people by the new health care law.

Through July 31, 2010, 3,833 pages of federal regulations have been issued regarding the new law.

The new health care law provides for the creation of more than 160 boards, bureaus, and commissions. Republicans on the Joint Economic Committee have released a chart detailing this maze of busybodies and bureaucracies:

15

16

We now propose changing the way Congress works once and for all, so that the will of the people can be heard and the best ideas can trump the most vested interests. WHAT WE‚ÄôRE UP AGAINST

Americans have lost trust with their government, which has too often ignored the will of the people in favor of party loyalty and a desire to pass partisan bills at any cost. Backroom deals, phantom amendments, and bills that go unread before being forced through Congress have become business as usual. Never before has the need for a new approach to governing been more apparent than under Speaker Nancy Pelosi and her leadership. Americans are demanding change in the way Congress works, and we are fighting to bring much-needed sunlight to the process and give the American people a greater voice in their Congress.

A Plan to Reform Congress and Restore Trust

The House of Representatives continues to move further away from its roots as a deliberative body, toward a centralized power structure where the majority does whatever it needs to win at all costs. Over the course of her tenure, Speaker Pelosi has consolidated authority, abusing the letter and spirit of the House rules to get the outcome desired, while ignoring the voices of the American people, the minority and even dissenters within her own party. ‚Ä¢ ‚Ä¢ Despite having the largest Democratic majority since 1993, the current Congress marked the first time in the history that not a single spending bill was considered under an ‚Äúopen‚Äù amendment process.

Democratic Leaders continue moving in the wrong direction by limiting openness and debate, and using various backhanded tactics to ignore the will of the people: During final consideration of President Obama‚Äôs government takeover of health care, Speaker Pelosi and Rules Committee Chairwoman Louise Slaughter publicly discussed a plan to allow the House to pass the bill without a vote by the House. Referred to as the ‚ÄúSlaughter Solution,‚Äù House Democrats eventually abandoned the scheme under the weight of a sustained public outcry. When the House was poised to consider legislation to impose a ‚Äúcap-and-trade‚Äù national energy tax, a 300page ‚Äúmanager‚Äôs amendment‚Äù rewriting key provisions of the bill without a separate vote was dropped in the laps of lawmakers at 3:00 am. The House began debate on the bill just a few hours later. For the first time in modern history, the House failed to pass or even debate a budget, allowing spending to continue to grow at a breathtaking rate without any blueprint for making fiscal decisions.

‚Ä¢

‚Ä¢

The top-down way of governing is outdated and just plain backwards. We will launch a prolonged campaign to transfer power back to the people and ensure they have a say in what goes on in the Congress. This year House Republicans launched a first-of-its-kind web platform called America Speaking Out to engage directly with the American people and allow them to establish a dialogue with their members of Congress. We will continue this groundbreaking transformative effort to give people a voice in real time with their government. We recognize that if we are truly committed to addressing the American people‚Äôs highest priorities, the House of Representatives must operate differently ‚Äì differently from the way the Democrats do now, and differently from the way Republicans did in the past. Change begins at home. Our Plan to Restore Trust 17

It‚Äôs no wonder that a national survey released earlier this year showed that just two in 10 Americans believe our government operates with the consent of the governed. We cannot continue to operate like this.

‚Ä¢

‚Ä¢

‚Ä¢

‚Ä¢

DID YOU KNOW? ‚Ä¢

Advance Legislative Issues One at a Time: We will end the practice of packaging unpopular bills with ‚Äúmust-pass‚Äù legislation to circumvent the will of the American people. Instead, we will advance major legislation one issue at a time.

Make It Easier to Cut Spending: By forbidding amendments on spending bills, Democrats have denied lawmakers the opportunity to tighten Washington‚Äôs belt and slash wasteful and duplicative programs. Structure dictates behavior, so we will let any lawmaker ‚Äî Democrat or Republican ‚Äî offer amendments to reduce spending.

Adhere To The Constitution: For too long, Congress has ignored the proper limits imposed by the Constitution on the federal government. Further, it has too often drafted unclear and muddled laws, leaving to an unelected judiciary the power to interpret what the law means and by what authority the law stands. This lack of respect for the clear Constitutional limits and authorities has allowed Congress to create ineffective and costly programs that add to the massive deficit year after year. We will require each bill moving through Congress to include a clause citing the specific constitutional authority upon which the bill is justified.

Read The Bill: We will ensure that bills are debated and discussed in the public square by publishing the text online for at least three days before coming up for a vote in the House of Representatives. No more hiding legislative language from the minority party, opponents, and the public. Legislation should be understood by all interested parties before it is voted on.

‚Ä¢ ‚Ä¢

The number of House legislative days devoted to action on noncontroversial and often insignificant ‚Äúsuspension‚Äù bills is up significantly in this Congress by comparison with the past several Congresses, wasting time and taxpayer resources. Of the bills considered under the suspension procedure ‚Äì requiring 2/3 vote for passage ‚Äì so far during this Congress, more than half were bills naming federal buildings, recognizing individuals or groups (like sports teams) for achievements, or supporting the designation of particular days, months, or weeks. This year, for the first time in the modern era, the House did not pass a budget, and of the twelve regular spending bills, only two have passed. House Democrats have relied heavily on what are known as ‚Äúmartial law‚Äù procedures during the current Congress, particularly provisions that allow them to bring any bill to the floor with little or no notice and deny Republican members of Congress or even factions of their own party their right to debate and offer amendments or substitutes for consideration or vote.

18

We are a nation at war. We must confront the worldwide threat of terrorism and to deal with the world as it is, not as we wish it to be. We will do all that is needed to protect our homeland, support our troops and the veterans who have so honorably served us, and ensure our government has a coherent strategy to confront and defeat the terrorist threat. And we will never apologize for advancing the cause of freedom and democracy around the world, nor will we abandon our historic role in lifting up those who struggle to receive the blessings of liberty. Over the last year, we have seen clear and immediate evidence that terrorists continue to plot devastating attacks against our homeland, including a plot to bomb the New York City subway system, and continuing with the attacks at Fort Hood, Times Square, and on board Northwest Flight 253. Each of these attacks represented new strands of terrorism, new signs of an enemy ready and willing to adapt. ‚ÄúHistory does not long entrust the care of freedom to the weak or the timid.‚Äù ‚Äì Dwight D. Eisenhower

A Plan to Keep Our Nation Secure at Home & Abroad

We have a plan to keep our nation secure at home and abroad and hold the current government accountable for fulfilling its responsibility to provide for a robust defense. Our Plan for National and Border Security Providing for the common defense is a not just a priority or political imperative ‚Äì it is a Constitutional duty. National security is more than just war fighting: it is protecting our citizens, bringing certainty to an uncertain world, supporting those who volunteer in the service of their country and defend our way of life, using every tool to protect Americans from threats at our borders. ‚Ä¢

‚Ä¢

‚Ä¢

‚Ä¢

Demand an Overarching Detention Policy: Foreign terrorists do not have the same rights as American citizens, nor do they have more rights than U.S. military personnel. We will work to ensure foreign terrorists, such as the 9/11 conspirators, are tried in military, not civilian, court. We will oppose all efforts to force our military, intelligence, and law enforcement personnel operating overseas to extend ‚ÄúMiranda Rights‚Äù to foreign terrorists.

Keep Terrorists Out of America: We will prevent the government from importing terrorists onto American soil. We will hold President Obama and his administration responsible for any Guantanamo Bay detainees they release who return to fight against our troops or who have become involved in any terrorist plots or activities.

Pass Clean Troop Funding Bills: When asked to provide our troops with the resources they need, we will do so without delay. That means no more troop funding bills held up by unrelated policy changes, or extraneous domestic spending and pork-barrel projects.

‚Ä¢

Fully Fund Missile Defense: There is real concern that while the threat from Iranian intercontinental ballistic missiles could materialize as early as 2015, the government‚Äôs missile defense policy is not projected to cover the U.S. homeland until 2020. We will work to ensure critical funding is restored to protect the U.S. homeland and our allies from missile threats from rogue states such as Iran and North Korea.

Require Tough Enforcement of Sanctions Against Iran: The Iranian regime is a state-sponsor of terrorism, has actively worked to harm our deployed troops in Iraq and Afghanistan, and violates the rights and will of its own people. It has declared its determination to acquire a nuclear capability, which threatens its neighbors and the security of the United States. We will work to ensure the government aggressively and effectively implements the sanctions tools Congress has provided.

19

‚Ä¢

‚Ä¢

Establish Operational Control of the Border: We must take action to secure our borders, and that action starts with enforcing our laws. We will ensure that the Border Patrol has the tools and authorities to establish operational control at the border and prohibit the Secretaries of the Interior and Agriculture from interfering with Border Patrol enforcement activities on federal lands.

‚Ä¢

Work with State and Local Officials to Enforce Our Immigration Laws: The problem of illegal immigration and Mexican drug cartels engaged in an increasingly violent conflict means we need all hands on deck to address this challenge. We will reaffirm the authority of state and local law enforcement to assist in the enforcement of all federal immigration laws. Strengthen Visa Security: To stop terrorists like Omar Farouk Abdulmutallab, the Christmas Day bomber, we will require the Department of Homeland Security to review all visa applications at high-risk consular posts and prevent aliens from attempting to avoid deportation after having their visas revoked.

20

Unfortunately, the metrics used to hold Congress accountable are often flawed. Rather than using the scale of how well elected representatives represent the views of the people, the scale is often currently measured in bills passed, dollars spent, and programs created. This must change.

Our founders built a system of checks and balances to slow the growth of government and prevent the tyranny of the majority. The ultimate power in this system of government is held by the people, who were given the tools by our Founders to hold those they elect as their representatives accountable for their actions. Government exists to be the servant of the people, not their master.

Checks and Balances

We will stand committed to our principles and fight to renew the drive for a smaller, less costly, and more accountable government. We will promote and advance solutions that get people working again, stop out-ofcontrol spending, repeal and replace the government takeover of health care, make Congress more open and transparent, and keep our nation secure at home and abroad. At the same time, we will serve as a check and a balance against any schemes that are inconsistent with the priorities and rights of the American people: ‚Ä¢ ‚Ä¢ ‚Ä¢ ‚Ä¢ ‚Ä¢ ‚Ä¢ We will fight to ensure transparency and accountability in Congress and throughout government. We will fight efforts to fund the costly new health care law.

Every American must ask: what has Congress done to ensure opportunity and to safeguard my liberty and the freedoms guaranteed to me in the Constitution? We stand ready to be judged by that standard.

"But the whole history of America is quite different from Europe. People went there to get away from the intolerance and constraints of life in Europe. They sought liberty and opportunity; and their strong sense of purpose has over two centuries, helped create a new unity and pride in being American.‚Äù ‚Äì Margaret Thatcher

We will continue to fight the growth of government and oppose new stimulus spending that only puts our nation further in debt.

We will fight to increase access to domestic energy sources and oppose attempts to impose a national ‚Äúcap and trade‚Äù energy tax. We will fight for the rights of workers and oppose ‚Äúcard check‚Äù schemes that put union bosses before individuals‚Äô right to a secret ballot. We will fight efforts to use a national crisis for political gain.

Built through a process of listening to the people, this is our Pledge to America. To begin the process of implementing a new governing agenda that honors our Constitution and reflects the will of the people, we call on the leadership of the 111th Congress to bring these reforms and policies to an immediate vote, and ask all citizens of our Nation ‚Äì men and women of good will and good heart ‚Äì who share in our beliefs, to join with us today.

Call to Action

21

Michael Lewis, "The Big Short"

2010-08-18T04:21:00.000-07:00

Well, I know this is semi old news, since the book was published in March of this year, but I just finished reading it, and I just feel I need to comment.

First of all, for anyone reading this who doesn't know, up until fairly recently my career was also intimately tied up with the structured finance markets. I spent time on a mortgage trading desk in the early 1990's, then audited structured finance transactions - mainly subprime mortgage deals - before becoming a deal structurer (or "quant") and banker. I left the sell side to manage subprime mortgage bond portfolios for a large institution, and then finally actually became a CDO manager myself. I experienced everything in the book first hand (with the exception of making millions of dollars), and even knew many of the people mentioned in the book. This made for a crazy read, as if someone had written about my life after secretly observing me for years. Very strange.

In fact, reading the book, after many passages I had to look up and take a quick reality check. I really couldn't believe how well Lewis captured the era, and the unbelievable (to this day) shortsightedness which so many of us were afflicted with.

Our little CDO manager went under in late 2007 as a result of the financial crisis - among other things, so it's been a while. Happily, I've moved on to join a company which I believe actually contributes something to society. Still, on some nights when I can't fall asleep, I'll find myself thinking about the whole subprime mortgage/structured finance/CDO business, and it makes me a little sick to my stomach. The worst part is that I'm even conflicted over why I'm sick over it. Part of me can't believe that I was party to a business which so clearly took advantage of so many people; both unsophisticated borrowers, and (what should have been more) sophisticated investors. I can't believe that the business I was generally associated with and that paid the bills for me since 1992 almost brought down the entire financial system, and that we (the American taxpayer) will be paying for its transgressions for decades. The other part of me just can't believe how I managed to live through that period of time and 1) not see the clear writing on the walls how bad things could get, and 2) not find some way of making tons and tons of cash from it. All I ended up getting out of it was a ringside seat to the crisis and the opportunity to collect unemployment.

There's a lot more I can say about the book and my personal experiences: I can tell you about how I thought I was one of the smart ones up until that point. I can assure you that my IQ really is high enough so that I should have seen the proverbial forest, but I guess the trees were just too big. I can tell you how even though I was reading alone or on an airplane, I wanted to look up from the page and tell someone I knew exactly what they were talking about. But in the end, I think it's just extremely important for people of all trades to read "The Big Short" so they get a better idea of who is managing (or not) their money, and who we sent all our government's money to.

On top of it all, it's sickening to think that so little has changed. Sure, tens of thousands of finance professionals, like myself, lost their jobs and will probably never have the same type of job or income again, but... Thousands more kept their jobs, and are continuing to be overpaid to do jobs whose value to society I can not help but to question. Wall Street bonuses were paid, and are still continuing to be paid because the government (read: us) is subsidizing them. We kept the big banks in business, which I do think was a good and necessary thing, but we failed to demand anything in return, which was and is a travesty of justice.

I also kept asking myself, what are the people who I know who are still employed in the business actually doing every day? So much of what we did was proven unequivocally to be unsound financial practice, yet to the extent possible in the current stagnant finance markets, it's still being done. Why? I'm not sure I know.

Of course, if the best way to finance growth for Bumblefish is to issue some structured finance securities...

Just kidding.

http://www.amazon.com/Big-Short-Inside-Doomsday-Machine/dp/0393072231

It's been a long time

2010-08-14T15:29:00.000-07:00

Well, it's true, it has been a long time since my last post. While I've been busy on Facebook and LinkedIn to some extent, this blog has taken a backseat to actual work.

What's stirred me? Just a fantastic quote I came across while reading a review of the conspiracy theory, "Family of Secrets." The LA Times book reviewer Timothy Rutten writes in his review,

"Here it's necessary to declare a personal bias. I regard the belief that Lee Harvey Oswald acted alone as an important indicium of mental health. In fact, I think there are three things that every serious American needs to believe about our recent history: Kennedy was killed by a lone lunatic, Americans really did land on the moon and the Twin Towers were destroyed when they were struck by two fully fueled airliners that had been hijacked by Islamic extremists organized by Al Qaeda. People who do not believe in these things are, within reasonable limits, entitled to sympathy. They are not entitled to a seat at the table where serious discussions occur."

How perfect is that?

What WOULD my suggestions be for health care reform? (Part 1)

2009-11-11T03:53:00.001-08:00

I have been treating this blog as a brain dump for not only my ideas on health care reform, but also just my opinions on others' arguments against reform. It has been pointed out to me that although that could be entertaining (to some), it is not the most efficient way for me to convince anyone that I am "right" or have any better ideas than the ones people brought with them before reading my blog. As a result, I am going to spend the next few blog entries by asking one simple question, and then outlining a high level health care reform plan - which admittedly is absolutely nothing like the one before Congress.

First, the question: Should the United States provide basic health care for its inhabitants?

This is a thorny question, as we have seen. It also involves two very different arguments for or against: the moral argument, and the financial argument. Some may believe so strongly in the moral argument that they would be willing to pay a significant amount to provide that care for all. Others may believe so strongly that there is no moral imperative to provide health care for all that even a possible financial benefit of universal health care would not be enough to encourage them to support it. Yet another group may even agree that the provision of health care for all is an admirable goal, but that the government does not have the right to "impose" that health care on everyone, that it would impinge on individual freedoms by forcing everyone to go to the doctor, and forcing some people to (necessarily) pay for the care of others.

My thought is that by attacking the issue in series, rather than in parallel, as it is currently being addressed, we should be able to come to a better conclusion. Let us see.

(to be continued)

What kind of country do you want to live in?

2009-11-10T03:33:00.001-08:00

The health care debate in the U.S. this year has brought out a deluge of emotional responses from all sides of the argument. I believe many of the problems have arisen because of the poor manner in which the Obama administration has approached the issue, both in terms of "salesmanship" and the basic questions behind the need for health care "reform." In the process, people have become more partisan and have gotten lost in political ideological debates instead of the root health care debate, and as a result even many otherwise rational people seem to have lost the ability to clearly assess the issues.

I do not disagree that health care reform could and should be accomplished in a fundamentally different manner than the way its being addressed by Congress right now, but I also can not imagine who would not agree that it is necessary. The Obama administration has forgotten the KISS principle (and I'm not referring to Gene Simmons' band here). Only two questions need to be asked when attempting to determine whether the U.S. should provide basic healthcare to all its citizens (and perhaps, simply, inhabitants - including legal aliens):

1) Do you agree that the United States has a moral responsibility, as one of the wealthiest countries in the world, to provide basic healthcare for all?
2) Even if you do not agree with the question above, we ARE currently providing health care for anyone in the U.S. - only in the most inefficient and costly manner. The economic health of the country depends on reducing health care costs, and creating a health care system (which the U.S. has never had) which expressly provides basic health care to all, and requires everyone with the means to pay for it, should lower overall health care payments for those who currently contribute to the system simply by requiring the current "free riders" to pay their own way.

In fact, there is no credible argument against universal healthcare in the U.S. unless you really and truly wish to forbid hospitals and doctors from treating the uninsured and those without means, thereby leaving them to die. The law currently forbids hospitals from turning away those in need - any argument against a universal health care system with the reason given as the lowering of health care costs would require overturning that law. Is that a country you wish to live in?

The Healthcare Debate: Two for the Price of One

2009-10-30T15:39:00.000-07:00

It strikes me that one of the problems we have here in the U.S. regarding the current healthcare "reform" debate is that things get all mucked up because in general we're combining two important questions:

1) Should there be universal healthcare in the United States, and if so, what form should it take?

2) How can we improve health CARE in the United States to both improve patient outcomes AND help control rising costs?

As I have observed recently, many people get caught up in #1 and ignore #2. The government, on the other hand, is mostly trying to focus on the latter part of #2 while attempting to provide a limited #1 (which is an oxymoron anyway - how can you have limited universal healthcare?).

I agree with those that are saying that Obama and the Congress are trying to do too much. Unfortunately, most of those opposing voices are coming from the Republican side of the aisle and do not appear to be genuine criticisms, but simply anti-Obama politics. This has tainted any voice opposing the current attempt at health care reform as obstructionist, even if genuine. As a result, this has become a one sided "debate" where those who support reform have almost no reason to listen to any ideas from the opposition. Where we as a country NEED genuine debate, we are getting nothing of the sort.

What car we do about this? Anything?

Why don't the good aspects of debates get to the government?

2009-10-11T03:58:00.000-07:00

Over the past several months I've been following two national (and international) debates rather closely: the health care debate in the U.S. and the debate surrounding the war in Afghanistan. While there have been any number of reactionary opinions put forward by the extremists on both sides of the socio-political spectrum, there have also been a heck of a lot of good ideas put forward by both "intellectuals" and the "man on the street." I've enjoyed reading well thought out opinions in places from the New York Times to Facebook. What continues to amaze me, however, is the almost complete lack of translation from the good ideas brought up all over the country (again, by people from all walks of life) to the debate within the U.S. government.

Why is this? Sure, we all know about lobbyists and their ilk, but why is it that so few of our elected officials can be bothered to attack the incredibly important problems facing our country today with anything other than partisan pandering?

Health "Insurance" for Everyone?

2009-09-19T08:59:00.000-07:00

With the recent focus of health care reform being placed on utilizing (for the most part) the existing insurance based system, the question becomes whether you can create an insurance based system that would work for everyone.

I suggested the following idea on another discussion site:

I am not an insurance expert, but I'm willing to bet that if you ask for your coverage to include all care - including regular check-ups, examinations, care for possible sickness, and coverage for bad or life threatening issues as well, then the coverage is going to cost a lot (perhaps not much less than it currently costs the average family - currently around $13,000 per year).

If, however, you ask for coverage only for catastrophic risk, then I'm also willing to be the annual premiums will be significantly cheaper (the numbers I could find indicate catastrophic family coverage would cost around $4,300 per year).

You could devise a system which would take some of that "savings" and create forced savings for people to pay for any "normal" health care - similar to a 401k. Some people would use up the money, some wouldn't.

People who were in need of extensive/expensive care would use up their health savings and then fall back on their catastrophic coverage. The health savings account balance could be used to pay the deductible on the catastrophic coverage.

The money in the health account would accumulate, perhaps providing savings for eldercare. There are anynumber of ways you could go with it. Either way, the money would be "yours" - which would encourage people to shop around for healthcare, thereby encouraging health care providers to compete for business (and profit as well BTW), lowering overall costs.

It seems as if I got some of numbers wrong (thanks a lot Google), since I received the following reply:

Well, as someone who's had to deal with corporate benefits, here's what's currently available, and it's not far off from what you describe:

You can get a "high deductible" health plan for a family for about $14000 a year. That would mean that the first $5-6K of expenses are incurred by you. Everything over that for the year is covered 100% by the insurance.

You can contribute about $6K a year into a health savings account (pretax). This money can then be used to cover the deductible. If you don't use it, the money can roll over an be invested like a 401K.

So, the two main issues I have with this status quo is: 1) cost - at $14-20K a year for a family, it's way too much. 2) We've got to close the loopholes that let the insurance companies weasel out of paying for what they owe.

So my main thrust would be to figure out how to make a system like this what everybody uses, and determine how to reduce the premium cost to maybe 50% of what it currently is now, and I would keep the government's role to making sure that the insurance companies provide what we're paying for, and close those loopholes so that you don't hear about the horror stories that insured Americans go through.

Clearly I had the wrong numbers. But if I had the wrong numbers, from sources such as:

http://www.nchc.org/facts/cost.shtml

then what else are we getting wrong?

I think part of the problem is that we are still confusing health insurance - in other words, what should be insurance against a health issue placing you or a family into bankruptcy - with health care provision. If using insurance to provide health care were an efficient system, then wouldn't we be using automobile insurance to provide car care (brakes, tires, etc. in addition to accident insurance)?

Thoughts?

Open question #1 on the healthcare crisis

2009-08-20T06:43:00.000-07:00

Since healthcare is currently (rightly or wrongly - war in Afghanistan anyone?) issue #1 in the press and Congress these days, I thought I'd ask a few questions. Obviously, I have my own opinions, but mostly I'd like to see what other people think. So, without further adieu...

Question #1: Why are doctors considered to be so much different than other professionals?

The obvious answer to me is because their profession deals with life, death, and healing. Until the advent of modern medicine, these were strictly the purview of the gods. That doctors could seemingly alter the course of life understandably could lead to an outsized level of respect for the profession, of course, but as humanity has advanced in all areas of knowledge, shouldn't it be that we could recognize that medicine is simply a profession like any other? A profession which requires an incredible amount of skill and knowledge (and also sacrifice to gain that skill and knowledge) to be sure, but a chosen profession like any other.

If we can agree that the medical profession is a profession like any other, then many other questions arise when we look at how they are currently and potentially to be treated under different healthcare "reform" proposals, as well as Medicare/Medicaid.

For instance, current government health programs such as Medicare and Medicaid set strict limits not only on reimbursements to doctors for their work, but also set ceilings on the amounts doctors/hospitals can charge for certain work. For some reason, this doesn't seem to strike most people as inherently wrong. What if the government, either arbitrarily or in an effort to reduce costs, were to declare a ceiling on what airlines could pay a pilot for transcontinental flights? Or that no teacher could be paid more than a certain amount for teaching high school math? That might lower plane ticket prices or school tuitions (whether paid directly or indirectly through taxes), but I don't believe that we, as Americans, would stand for such drastic government involvement in compensation. Why isn't government's involvement to that extent a problem when it comes to healthcare? What's different about doctors that makes it OK for us to allow the government to meddle directly with their ability to practice their trade?

Where have I gotten it wrong?

My Page - BankInnovation.net

2009-07-22T13:57:00.001-07:00

My Page - BankInnovation.net

Shared via AddThis

(Semi) First Blog Post

2009-06-23T08:05:00.000-07:00

Well, I'm joining the 21st century, or at least the geeky part of it. I imagine this blog to be a place for me to collect my thoughts. If anyone else wants to read them, I supposed they're welcome to.