Good Journalist Hunting, Part 2: Drugs, Sex, and American Healthcare

Background

In Part 1, I conveyed my experience in Target Corporation's stockroom to explain Amazon and Costco's success and said I'd discuss insurance companies and opioids in a subsequent post. 

The War on Drugs Results from Government's Desire to Monopolize Revenue Streams

Fewer than 0.06% of Americans between 15 and 64 years died from any kind of drug overdose in 2017. Why, then, are U.S. politicians so enamored with the drug war and opioids in particular? 

If you're a Chris Rock fan, you already know the answer. 

We got a horrible drug policy... The government always says drugs are illegal because they're bad for you and they're trying to protect society... [but] the government doesn't [care] about your safety... They don't want you to use your drugs, they want you to use their drugs... So every night, you see a drug commercial... trying to get you hooked on legal [stuff]... 

The reason cocaine and weed are illegal in America [has nothing] to do with your safety. The reason cocaine and weed are illegal in America is because the best cocaine and weed aren't made in America. If they made the good [stuff] here, there'd be a "Cocaine and Weed" restaurant on every corner [like Starbucks]... The government will never legalize drugs in America... because the government makes way too much money putting [black people] in jail. [Never Scared (2004)]

What you may not realize, however, is why the government is so keen to protect its own pharma revenue stream. 

Simply put, it costs a lot of money to develop new drugs. According to Bill Bryson in The Body (2019), on average, a billion dollars invested will get you one-third of a new drug, not even a complete one. 

Innovation within such a front-loaded system generally means only "Big Pharma" can participate, and research focuses on chronic illnesses like cancer and mental health issues--not life-saving new antibiotics, which work too quickly to generate recurring revenue. [Andrew Lo's Adaptive Markets (2017) proposes better ways of funding pharma R&D, but his ideas haven't caught on.]

America's funding paradigm incentivizes unnecessary diagnoses of mental health issues, autism, and other long-term conditions; worse yet, attaching the imprimatur of science to greed reduces the credibility of experts as well as academics.

Let's talk about how I found myself in a psychiatrist's office playing word association games at a rate of 300 to 400 dollars per hour. I've had weak ankles since a teenager, and after another swollen twist, I mentioned my despondence. My doctor, hearing Pavlovian bells of negligence, asked if I wanted to be referred to a psychiatrist. Having more free time due to an inability to play basketball, I agreed. Under the ACA, each state may create its own "competitive" marketplace, and mine is called "Covered California." Members can choose from platinum, gold, silver, or bronze plans, but the older you are, the more prohibitive the costs of anything above bare-bones bronze. In the beginning, insurers tried excluding mental health coverage to offer better cost-benefit propositions or more than de facto catastrophic coverage.   

Unfortunately, California's state legislature nixed the mental health and substance abuse opt-out, which it could do because once again, states dictate the terms and conditions of insurance coverage on state exchanges, not the federal government. (Incredibly, inclusive mental health coverage is more common than useful dental coverage, a distortion caused by pharma R&D costs being subsidized through insurance reimbursements, plus government's intent to delegate mental health and addiction issues to Big Pharma and religious entities rather than asylums, prisons, or clinics.)

Had insurance companies capped physical rehabilitation treatments to twice per month or not covered epidurals during childbirth, governmental intervention would be welcomed, but almost all medical coverage categories are general, figuring doctors should determine treatment, not legislators. Here, national legislators devised a healthcare program covering all Americans at reasonable prices, only to see courts and state legislators whack insurer flexibility and federal enforcement, thus reducing cost-effective options and oversight. 

A dysfunctional dynamic within government increases complexity and the likelihood of divided realities, especially when few Americans understand the law; conveniently, such ignorance leads voters to blame faraway Congress instead of nearby state and local politicians.

I believe that today, the average person is overwhelmed by the complexity of life because it got more complicated... I barely know an adult who isn’t on some kind of drug, either prescribed or otherwise, to deal with anxiety. -- Scott Adams, on "digital disease" (2018)

The general population doesn't know what's happening, and it doesn't even know that it doesn't know. One result is a kind of alienation from institutions. People feel that nothing works for them. -- Noam Chomsky (1993)

Yet, both sides, even their extremists, reflect one of three crystal-clear images: 

1) frustration with well-intentioned government programs no longer resembling their original conception as they trickle down to local levels and multiple special interests; and 

2) a sincere belief that more centralized (aka national) governance will reduce multi-layered bureaucracy as well as local resistance to implementation and change; or

3) a sincere belief less government and a more direct relationship between buyer and recipient will improve accountability.

All three choices are correct and also equally wrong. Whether a program works depends on the individuals administering it and incentives for questioning orthodoxy, not whether the program is corporate or governmental. It may be true some governments are inept at hiring, but so are many corporations (e.g., Enron, WeWork, Theranos, and Wirecard). If multi-national corporations have an advantage, it is mainly because they can hire non-citizens, meaning their talent pool is not only global, but able to gauge workers' skills at lower wages before bringing them onshore. (Government unions, especially teachers and police, don't help, but that's another matter.) 

Additionally, the lines demarcating private and public healthcare are often so blurry, they cannot be found. Take the Covered California website. It's possible the state created the website itself or the contractor who won the RFP (by bidding the lowest) hired only American citizens or onshore workers, but once up, de-bugging and security likely went offshore. Either way, I had to visit a private benefits office in person to show identification, because the state's website refused to accept my license or passport uploads. (Side note: economic data is easily manipulated; for instance, if the government's deficiencies create private sector "clean up" jobs, such jobs are given the same weight as meaningful jobs in the unemployment numbers.) 

Once registered and referred by my primary care physician to a psychiatrist, I drove to a private office complex, walked upstairs to a private office, waited about 10 minutes, and was shown into a lightly furnished room. The psychiatrist asked me a few questions, then began a modified version of the Rorschach test, where he displayed words on index cards and prompted for associations. If he showed you the word, "police," you could say "blue" or "Black Lives Matter" or "law" and so forth. After about 30 minutes of this ridiculous game, he decided I was bipolar and prescribed lithium and follow-up sessions. If I remember correctly, I attended two more sessions, which were similar, then stopped. The sessions, which my insurance paid, cost about 1,000 dollars. No solo practitioner in the legal field could ever get away with such lucrative billing for similar levels of work, but most independent lawyers do not have an insurance company paying their bills. The lesson? Insurance coverage raises prices with no guarantee of competent service, regardless of whether governmental or private actors are involved. Furthermore, inserting a third party between buyers and sellers increases risks of corruption, especially if the category of reimbursable services is ambiguous. 

Governments Must Be Allowed to Successfully Compete against Mafia Influence

Besides insurance, why are legal drugs and the process for obtaining them so expensive? First, you have to understand why governments exist. Government's primary function is to create, whether directly or indirectly, better alternatives to the informal economy while allowing reasonable inflation. Without inflation, debt becomes exquisitely burdensome for borrowers; and without debt, most legitimate businesses could not have been created or could not have survived economic cycles. (Amazon and Walmart are turning economic theories on their head, but both are inherently multi-faceted and trans-national, meaning they can accept lower profit margins and pass along cost savings by targeting billions of global buyers and sellers.) When considering the billions of dollars of banking loans to major pharma corporations, every illegal drug deal harms the flywheel of pharma R&D by reducing insurance reimbursements as well as healthcare premiums, making it harder for operators to pay back debt or to set up new labs at hospitals, university research facilities, or Merck and Co. headquarters. 

Now imagine an empty lot fifty miles from your house. 

From Sabrina (1954): 

Linus Larrabee: What’s money got to do with it? If making money were all there were to business, it'd hardly be worthwhile going to the office. Money is a by-product. 

David: What’s the main objective? Power? 

Linus: Agh! That’s become a dirty word. 

David: Well then, what’s the urge? You’re going into plastics now. What will that prove? 

Linus: Prove? Nothing much. A new product has been found, something of use to the world. So, a new industry moves into an undeveloped area. Factories go up, machines are brought in, a harbor is dug and you’re in business. It’s purely coincidental of course that people who've never seen a dime before suddenly have a dollar. And barefooted kids wear shoes and have their teeth fixed and their faces washed. What’s wrong with a kind of an urge that gives people libraries, hospitals, baseball diamonds and movies on a Saturday night?

If the mafia buys the lot instead of a mall, office, or factory developer, the city will not only receive less tax revenue, but will likely see its police force outgunned and outwitted, making neighborhoods less attractive to families and PhDs. More importantly, a mafia-influenced city--where violence exacts efficient payment and coercion--attracts different kinds of businesses and thus unreliable accounting as well as diminished transparency. Whereas most businesses seek to grow through superior service or products, the mafia grows as a way to evade taxation and to launder money.

In the EU, where the "Las Vegas" development model is being used to incentivize legitimacy, several blocks in Eastern Europe (aka former Soviet Union) have more dim-lighted casinos, wagering rooms, and upscale bars than Starbucks and McDonald's. In the United States, after "obscenity" charges became passé, content-neutral "time, manner, and place" restrictions required strip clubs, night clubs, hookah lounges, and other drug dealer hangouts to be away from schools, suburban moms, and anyone else with an 11 o'clock bedtime. 

Despite attempts at reasonable regulation, our ever-increasing levels of police funding and mafia growth--both of which reduce fertile ground otherwise able to foster economic diversity--indicate the balance of regulation has failed. 

Lawyers, Judges, Police, Politicians, and Teachers Have Used Governmental Influence to Create Jobs but not Meaningful Economic Alternatives, Allowing Mafias and Nepotism to Prosper 

Somehow, laws designed to give politicians and police greater ability to shape communities have caused the mafia and informal economic actors to become more respected. Such a result is only possible if government has misused its powers to create an antiseptic or equivalent existence, rendering the mafia the more interesting one. This anti-hero script explains the tragedy of Western governments, which have delegated social services to religious institutions, especially the Catholic Church; divided themselves by litmus tests of abortion and death penalty rights; and promoted separate and unequal compensation and disciplinary terms favoring existing employees and fellow churchgoers, with the occasional minority highlighted to mislead taxpayers, results be damned. 

In 2008-09 California’s [government] teachers were predominantly white (70.1%) and female (72.4%), quite a different look from the student population that was 51.4% male and had major ethnic categories of 49.0% Hispanic, 27.9% white, 8.4% Asian, and 7.3% African-American.

Setting aside global tax reform, you'd think a decent education would be the antidote, and it's not as if American K-12 education lacks money--the California teachers' pension fund alone has 242 billion dollars--so the absence of an informed public must be attributed to journalistic abdication and institutional corruption. 

In fact, American education is so terrible at producing competent voters, few adults realize state constitutions exist or that only governmental activity falls under the 1st Amendment. 

The Free Speech Clause prohibits only governmental abridgment of speech. The Free Speech Clause does not prohibit private abridgment of speech. - Supreme Court Justice Gorsuch, Manhattan Community Access Corp. v. Halleck (2019)

(I count myself as one of America's neglected--when I graduated law school, I didn't know about state constitutions, which typically extend rights beyond the federal Constitution, or even the location of the local courthouse.) 

In Western countries where governments haven't ceded education and social welfare to the Catholic Church and other "nonprofits," they, too, have failed to create the appropriate balance between regulation and opportunity. For example, according to journalist Stig Abell, Britain's NHS is the "fifth largest employer in the world." Mr. Abell's pride in his country's subsidized healthcare system excludes important details: when the NHS was created, research assumed shorter lifespans for most citizens, as well as higher birthrates to support tax transfers into a national healthcare system. If America has a military-industrial complex, then Britain has a healthcare-and-pension complex, and both require so much debt to occupy their economic spaces, efficiency and accountability by any means necessary look increasingly attractive to voters. (Meanwhile, if one enters a mafia-owned strip club or massage parlour and pays cash, one can usually get service without queuing or being assigned to a waiting list.) 

And so, however one looks at Western healthcare and secondary education, failure looms, and exceedingly complex failures are exactly why most Western politicians can focus on opioids and other outliers without fearing logical retort or upsetting the status quo. Worst of all, the honest politician who tries to re-enact Mr. Smith Goes to Washington (1939) on the local level must contend with other cities and states of lesser moral fiber capturing lobbying and other dollars on the sound principle that if they do not accept inertia's largess, someone of even lesser moral fiber will. Given such circumstances, one can be forgiven for elevating a mafia don or high-level confidential informant above a politician or lawyer who makes promises s/he cannot keep without becoming a banker's whore. 

The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which. -- George Orwell, Animal Farm (1945) 

The Path of Least Resistance

Now that you better understand the miasmatic cauldron of corruption and general depravity through the lessons of Western drugs, healthcare, and education, you can vote more responsibly. Will your heightened civics knowledge make a difference when the only consistently good Western politicians are Scotland's retired Gordon Brown, Australia's retired Paul Keating, and Czechia's dead Vaclav Havel? Probably not, but democratic governments were never meant to be better than the citizens within them. In fact, though democracies tend be more transparent, transparency combined with complexity spanning multiple levels of governance is no guarantee of clarity. Thus, despite much progress, we have returned to where we were centuries ago, mucking about, unclear which direction to go, side-eying our neighbors, and praying a pandemic doesn't wipe us out. If this be progress, I'll take the whore, and you can keep the teachers, priests, politicians, lawyers, and made men. 

© Matthew Mehdi Rafat (2020) 

"Men will never be free until the last king is strangled with the entrails of the last Catholic priest." - attributed to Denis Diderot

Bonus: as Adam Gopnik, New Yorker (2017) explains, John F. Pfaff makes reasonable counterarguments regarding Chris Rock's statements above: 

"During the great wave of incarceration—generally thought to have begun around 1980, and cresting about three decades later—state prisons added something like a million inmates, with about “half that growth coming from locking up more people convicted of violence,” Pfaff calculates. Nonviolent drug offenses accounted for only around a fifth of the new incarcerations... [Emphasis mine.] 

So what makes for the madness of American incarceration? If it isn’t crazy drug laws or outrageous sentences or profit-seeking prison keepers, what is it? Pfaff has a simple explanation: it’s prosecutors. They are political creatures, who get political rewards for locking people up and almost unlimited power to do it." 

Bonus: Good Journalist Hunting, Part 1 is HERE. Part 3 is HERE. 

Technology Isn't the Problem

I'm tired of people blaming technology for America's problems.  Apple, Amazon, and Facebook have grown rapidly, lessening America's dependence on oil prices and oil discoveries for economic growth.  Without technology, we wouldn't be talking about driverless cars, disease eradication, or personalized medical advances.  Just when we are close to implementing the Jetsons lifestyle (sans jetpacks), we screw it up by turning on each other.

I'm particularly troubled by pundits and regular people picking on "millennials," branding the latest college grads as lazy or self-entitled. If you spend close to 100K on a piece of paper, it's perfectly reasonable to think it should lead to a decent-paying job in the absence of a recession.  Let's try to agree on at least a few principles so we're not always speaking past each other:

1.  An economy based on consumer spending--especially on unnecessary items--needs more and more consumers, so if population isn't growing steadily, especially among middle and upper classes, then you have two choices: 1) increase legal immigration; or 2) make it easier for your businesses to sell abroad, especially to countries with growing populations (i.e., the probable rationale behind President Obama's "pivot to Asia").

None of the above means you have to support illegal immigration.  It just means if you want a wall, you have to ask yourself whether you'd rather spend x billion on the massive number of police and federal employees required to maintain and patrol it rather than spending x billion on more healthcare subsidies, lower college tuition, stronger Social Security, etc.

I suppose such a choice depends on whether you believe illegal immigrants bring crime with them, which is contingent on what you see.  Do you live in a city where they work in restaurants keeping your discretionary food prices low, or do you see them loitering outside, up to no good or engaging in what you believe to be drug sales?

In any case, you cannot possibly be against legal immigration because it is undisputed America has a low population density outside its fifteen to twenty largest cities, which is why its highway and public transportation systems are such a mess. (Too much space begets sprawl.)  All this means we either have to figure out a way for native-born women to have at least two kids, especially higher-earning college educated women, or we need to attract law-abiding immigrants into mid-sized and smaller cities.  As an American, you cannot be against the aforementioned statement if you have both logic and facts--and that's without even discussing how entitlement programs like Social Security and Medicare work.

2.  Why aren't more American women having at least two kids, especially college-educated women?  About 65% of American women have at least two kids, but only 30% have at least two kids by the time they're 29 years old. (Fertility issues also exist in Europe.) 

In addition, about 20% of native-born American women never have kids, and about 30% to 42% of women with at least a bachelor's degree never have kids. Interestingly, 80% of women without a bachelor's degree have at least one child in their lifetimes.  Basically, less education in developed countries means more kids, and more education means fewer kids.

The reason college-educated women are having fewer kids than lesser educated women is obvious--college takes a long time, is expensive, saddles many women (and their partners or spouses with debt) and doesn't guarantee a middle-class job.  Why would anyone favor a system where more ambitious women have fewer opportunities to raise the next generation of citizens?  And yet, here we are.  It's not just lawyers who need grad degrees now--even social workers in many large cities need master's degrees to be competitive. (By the way, what logical relationship does sitting in a classroom and studying macro-social issues have with working in a hospital and dealing with people one-on-one every day?)

Evidence shows college now helps student loan creditors--which include the federal government--more than graduates in terms of practical or job-related skills.  Yet, we keep demanding more of our taxes go to K-12 and university systems without any incentives linked to increased employment or some system of checks and balances imposing discipline on admissions counselors (such as partial refunds of tuition if a grad is unemployed 6 months after graduation).  Americans now owe $1.19 trillion as a result of student loans.  Don't voters know that "insanity is doing the same thing over and over again and expecting different results"?

(Bonus: “I've been making a list of the things they don't teach you at school. They don't teach you how to love somebody. They don't teach you how to be famous. They don't teach you how to be rich or how to be poor. They don't teach you how to walk away from someone you don't love any longer. They don't teach you how to know what's going on in someone else's mind. They don't teach you what to say to someone who's dying. They don't teach you anything worth knowing.” -- Neil Gaiman, The Sandman, Vol. 9: The Kindly Ones.)

[Update on November 2017: a counterargument is here, but notice that the data used concerns families making over 500,000 USD annually and/or women with graduate degrees, i.e., outliers.) 

3.  When your profit and investment structure incentivize short-term goals, why would you expect long-term success?  Having about 25% of innovation, especially in tech and biomedical sectors, backed by venture capital guarantees anti-trust problems because profit, not competition or lasting change, is the primary goal.  (VCs back "more than a quarter of the total government, academic, and private U.S. R&D spending of $454 billion.")

Throw in quarterly rather than annual earnings or semi-annual reporting requirements, and you have a recipe for disaster.  Need more sales?  No problem--increase the discount, cannibalizing future sales, or borrow money to hire commission-based workers you'll let go the second they're not profitable.  When debt is so readily accessible and a significant percentage of creditors or founders focused on short-term gains, then the private sector becomes a feast-or-famine circuit for large companies to pounce upon.  There's no one left except for military R&D--which lacks fiscal checks and balances--to take a long term view.  The lessons are simple: public companies must be incentivized to reduce, not increase non-R&D-allocated debt; accounting rules must become stricter and globally consistent (I rue the day "pro forma" earnings gained any sort of credibility); and reporting earnings must be reduced from quarterly to at least mid-annually. 

4. Promoting long-term romantic relationships requires job stability, but not in ways that promote factions.  Most Americans don't understand the following principle: the more groups able to negotiate terms separate from everyone else means some costs must fall on persons not able to access the group rate and therefore disadvantaged. Such a dynamic harms the individual and incentivizes factions and a fractured society as some people care more about their "in-group" than the public trust or the individual.

Such faction-building--which inevitably facilitates corruption by reducing accountability and then trust--is particularly problematic within America's government unions.  Such unions have used their insider knowledge of complex hiring and political procedures to negotiate separate and unequal compensatory and disciplinary terms exclusively for their members, but without any direct benefit to the taxpaying public.  In doing so, they--and other fiefdom operators--have made America into a complex web of laws favoring only certain connected groups, causing dissension and the mainstream media's suppression of politically unfavorable facts.  Such suppression--rather than honest, thoughtful dialogue--inspires rebellion in any free person, leading to oppositional forces--such as Fox News's political pundits (excepting the wise Judge Andrew Napolitano) and Breitbart--that increase rather than heal growing divisions. Viewers forgive the divisive bombast because pablum and condescension are not features, and the material taps into a visceral belief that honesty and integrity no longer lead to success.  The outrage is really because fiefdoms promote system-gaming, but the complexity of how this occurs is difficult to get across in any kind of 30-minute dialogue, so we are left attacking factions receiving different benefits from the general public rather than the system itself.

Let me try to explain how this dynamic can work against the individual.  Group A has lots of members and, through a broker, approaches a health care provider or insurance company and negotiates a discount or shops around for better deals.  The ability to get an excellent insurance broker is somewhat dependent on the fees paid to the broker, and broker fees can be more easily spread out over groups if paid directly, or indirectly if commissioned based on overall value.  [My friend says, "Brokers make a first year bonus form the actual insurance based on number of lives insured. If they maintain the account, they get a yearly retention bonus based on the number of lives insured. If new employees are added, they get a bonus for each new addition.] Therefore, the group rather than the individual is able to better attract the finite time of the better negotiator because the fee system tilts in the group's favor--even if the services requested are essential on an individual level.  The better the broker, the better the discount or research, but without an in-depth medical examination of every single plan member, no one really knows whether the larger size of the group helps insulate the plan or provider from excessive costs in the future.  [According to my friend, an employee census of the business is obtained by the broker and given to the rate-runner or insurance fiduciary.] The future, as always, is unpredictable, especially when individual assessments aren't done, but the group generally ends up with a better or more cost effective plan if the age ranges are comparable.  (Imperfect metrics like age and zip codes are used in the absence of individual assessments.)

In contrast, an individual who wants to buy a health insurance plan must generally choose a more costly plan because he or she is an individual and cannot demand an individual health checkup and negotiate a discount based on good health.  [My friend adds, "True, but it's like picking a single stock vs. a mutual fund with 100 stocks--more people insured spreads risk, lowering premiums by a group on a per capita basis.]  Insurance is tricky--it needs both healthy and unhealthy people to be possible.  If insurance companies were able to identify and sign up only healthy people, insurance wouldn't work--no one would insure the more costly unhealthy people, or they'd put in so many exemptions as to make coverage inadequate.  [My friend adds, "ACA depended on 'young invincibles' signing up to pay for the sicker patients but this didn't happen, which led to dramatically increased premiums.] The reason insurance works is because a healthy person today may be unhealthy tomorrow, and an unhealthy person today may be healthy in a year, and no one can predict with any certainty the future.  Key takeaway: the system is not designed to evaluate the individual, whether alone or in a group. ["The system is designed as a risk pool with ratios of healthy to sick people being the factor for solvency."]

In any case, if the projections for a group's negotiated costs turn out not to be true and more than expected, the provider can try to pass on those costs in the future, but chances are, because of their greater numbers and therefore greater revenue potential, the health care provider or insurance company will generally pass on unexpected costs to them and dispersed individuals, eventually raising premiums for everyone.  The minute you allow separate groups within systems that provide either essential services or that serve all persons, you must be an oracle when it comes to costs or try to pass those costs into the future. [My friend adds, "Not necessarily.  You use predictive analytics and population-based health models."]  The same dynamic applies to private vs. public schools, but such factions are tolerated because education, while essential, isn't geared towards the best performing students, and no one wants to argue that such students should be short-changed if they can pay voluntary and additional fees.  In the case of health care, the argument for allowing fiefdoms is much less clear because insurance requires healthy people to be part of the system, and segregating them would cause the collapse of the insurance plan.

Let's dive into another example of a fiefdom in America: local government unions.  In most major American cities, 50% to 70% of all local tax revenue is spent on "public safety" aka cops and firefighters. Many of these taxes go to pension obligations, i.e., paying gov employees who no longer work and who haven't paid into the retirement fund in sufficient amounts to sustain it without higher taxes or cutting other local programs.  As a result, not only do police officers lack full-time partners riding with them in patrol vehicles due to the increased expense in paying a six-figure pension while also generating sufficient, sustainable tax revenue to pay for an active-duty officer, but working hours are extended, leading to higher stress, which creates greater likelihood of mistakes and impatience.

What's the upshot?  America's military spending is not subject to any real audits due to the federal government's ability to borrow almost unlimited debt, and even local entities are forced to divert their taxes into strengthening a police state because by law, pension interests--at a guaranteed 7.5% ROI, regardless of GDP growth--are vested and therefore untouchable.  Instead of discussing these issues--which require nuanced, fact-based dialogue--American mainstream media leads the public into the morass of useless, emotion-based dialogue about Black Lives Matter or All Lives Matter, which will do nothing to resolve any substantive issue.  It's like Laurence Fishburne's line in Boyz in Da Hood--"They want us to kill ourselves," except in this case, they want us to be confused so we don't rock the (political) boat.

When your educational system lacks any real connection with the job market, despite receiving the lion's share of taxpayer dollars in most states; your government employees are insulated from accountability through laws and procedures they themselves helped pass; and your private sector, which drives most employment, is subject to a completely different set of employment rules from your public sector, what could possibly go wrong?

My proposed solutions?  For companies of at least 100 people and over a certain revenue threshold (adjusted for inflation), I like the idea of IBM's peer review panel. It used to be that IBM would not generally terminate a post-probationary-period employee until a peer review panel of three managers and worker representatives evaluated the facts and heard testimony from the manager and the employee. (The difficulty would be determining which "side" held the majority vote, even under a rotating power setup, or how to guarantee a cost-effective way of bringing in a truly independent third person with enough knowledge about the company.  Highly respected ex-employees who left voluntarily might be the best bets.)

Witnesses would be restricted to co-workers with personal knowledge of the employee's work and managers participating in any performance review or termination.  Testimony would be confidential--but an opinion must be published with a chance for dissents--and the number of days of the hearing could be set at a minimum of one and then increased (up to a cap) based on the number of years of the employee's tenure. The written opinion would be inadmissible in court.  The overall number of employee and company "wins-losses" must be publicly available for each location in a simple two-number chart (e.g., Due Process Outcomes: Termination Upheld = 20 in 2014, 10 in 2015; Reversed = 10 in 2014, 5 in 2015; link to opinions here, etc.).

Ideally, the turnover rate within every employer above a certain size--both governmental and private--should be publicly available for each division.  A simple chart would suffice: one row for the division (sales and marketing, engineering, etc.); one column for the number of years of employee tenure (less than one year; more than one year; more than two years, etc.).  To promote full transparency, companies relying on contractors (rather than W-2 employees) must publish the same chart but with a twist--they must show how many contractors became employees, and after how many years.  (Of all my employment-related ideas, I'm most optimistic of the ones directly above.)

What's the incentive for a business to allow such meddling in its employment processes, especially in a rapidly changing competitive landscape?  In exchange for due process, employees would agree that if they lost at the peer review stage and sued in court for any claims relating to their termination, they would be liable for the employer's attorneys' fees, capped at some reasonable amount--perhaps a percentage of the employee's annual salary at the time of termination.  Such a process would provide a way for companies to save on litigation costs as well as give their lawyers insights into the employee's credibility, while capping the downside for the employee if s/he lost in court.

One problem would be if a company wanted to do a mass layoff (say, at least 50 people at one time), indicating it wasn't intending to terminate a specific employee for performance-based reasons.  Perhaps it wanted to dedicate more resources to software rather than hardware or do something else that would increase its competitiveness and protect jobs in the rest of the company.  In such a case, each employee should receive 6 months' worth of salary or at least double the minimum wage multiplied by six months.

Current laws in California try to protect employees above 40 years old from being included in mass layoffs as pretext for removing older workers, but once again, an American law has managed to accomplish very little in preventing age discrimination while increasing the power of lawyers and the public's reliance on them.  It is far better policy to accept that if discrimination occurs, then the idea should be to provide some automatic and substantial benefit to mitigate the effects of pretext.

Government agencies could still investigate and bring claims against companies but an employee who filed such a claim--say, for termination based on racial discrimination--would waive his/her right to collect monetary damages. (European companies have a similar set-up where they appoint a management and worker representatives to a panel that hears issues of importance, but I'm unsure if such panels also hear employment disputes.)  Note that claims not related to termination would still be viable, such as sexual harassment, civil assault, invasions of privacy, etc.

Basically, post-probationary employees in businesses with 100 employees or more should have some form of due process before losing their livelihoods, which would incentivize relationship-building, and the process should be the same in the private as well as public sector to prevent faction-building.  In other words, for any entity with 100 or more employees, any legal change to the due process system would apply to both the private and public sectors.

Combine a due process system with an ESOP that cannot be leveraged or borrow against its assets (retirement assets would increase based on governmental bond rates with additional returns, if any, from some capped percentage of annual profits)--and you would create a private sector employment and retirement system not overly dependent on Wall Street. After a certain size, a credit union for your employees could continue to keep the money "in house" and revitalize Main Streets everywhere.

Another idea includes recruiters going to major city hubs and having one-on-one interviews with persons terminated 150 days or less.  Think of it as "speed dating" for job applicants.  Such interviews would be much more useful than post-termination resume building workshops, which are sometimes included in severance packages for employees.

We've covered the employment side of the "stability" equation, but we're still bound by other factors, such as marriage and child support laws.  From my own perspective, marriage under American laws becomes riskier over time, as both men and women gain more assets than can be used by a random judge to give to a less ambitious or unjustifiably greedy former spouse.  One problem is that the judge--who is paid out of the public purse--has incentives to prevent any spouse from going on welfare, thereby minimizing the government's own obligations.

No logical person with assets would get married under these circumstances, where there is no upside and extensive downside.  Such a system discriminates against lower-earning and middle class persons by making marriage the resort of the ultra-rich--who can afford lawyers who draft airtight prenups and update them as laws change every year--or the cult of sameness, where people from similar backgrounds are incentivized to marry or couple together, increasing class and educational segregation rather than encouraging people to focus on personal qualities like integrity, patience, and resilience.  When the laws of a nation expressly discourage an emphasis on personal honor and render a life's savings contingent on the discretion of random government employees, contempt for such a society cannot be far behind. It is no wonder that in such a system, even the elites believe that government should be a mere referee rather than a more active participant in enforcing predictability and financial stability.

5.  If we cannot agree on the general principles above, there is no point in discussing anything of substance.  European and other countries may have issues with immigration and escalating social welfare costs, too, but they continue to make their political structure work for them by using the majority of their tax dollars to implement essential programs for all residents. Thus far, European countries, for the most part, are not set up structurally to encourage specific factions for purposes of siphoning substantial tax dollars from the public purse for benefits that apply only to a small number of politically-connected residents.

Like Americans, Europeans have ample and complex laws, and they, too, have problems with segregation and upward mobility, but continue to show ample common sense, such as Sweden's linkage of old age pension benefits to annual GDP.  In Sweden, public retiree benefits are adjusted annually according to changes in prices--which means benefits can be reduced if overall GDP declines. Other retiree benefits are based on an annual index of trends in average wages (including social insurance benefits); an annuity factor depending on average life expectancy at the time of retirement for the appropriate age cohort (based on the most recent 5-year average of unisex life expectancy projections); and the expected increase of average wages in future years.  Under such a system, sustainability is the goal, which minimizes the need for emotion-based drivel.  To have a discussion means knowing your metrics and data, and because everyone is on the same system, "good data" becomes incentivized.

Meanwhile, in America, retiree benefits are assigned an arbitrary increase--never a reduction--every year called COLA, which is manipulated by political parties depending on the need to fund other programs.  Over time, politicians exhaust arbitrary means of manipulating existing metrics, which forces them to start excluding persons from the programs or to make it more difficult to apply for the same level of benefits.

Welcome to America in the year 2017: factions galore, and a political system designed to either become a police state or to collapse eventually because of demographic headwinds or through laws that increase segregation and lead to less accountability. In just ten or fifteen years, my optimism has gone missing, much like America's institutional integrity.  Why?  It's becoming apparent America's current laws and debt restrict the primary engine that made it so successful--the ability to absorb immigrants, even uneducated ones, and assimilate their children in ways that benefit everyone. At least I can say, at the age of 39, I've already lived through the highest of the high--a national budget surplus and the dot com boom in Silicon Valley--and the lowest of the low--9/11, the 2008-2009 financial crisis, and the aftermath.  Since it appears I've lived in exactly the right place at the right times to see the highs and lows, I wonder what my future holds.  To paraphrase W.H. Auden,

When the future comes, will it come without warning
Just as I'm picking my nose?
Will it knock on my door in the morning,
Or tread in the bus on my toes?
Will it come like a change in the weather?
Will its greeting be courteous or rough?
Will it alter my life altogether?
O tell me the truth about my future. 

© Matthew Mehdi Rafat (2017) 

Debate on Health and Healthcare

Status Update from Lawyer/Solo Practitioner: Eff you, Kaiser. I'm not paying $352 a month for health insurance in 2011. I don't smoke, I exercise, I'm not involved in any risky activities, and I avoid liquor. You people saw me about five times in 2010 and don't even provide me with my hearing aids or dental work. Does anyone have any advice for other health insurance options?

P.S. The biggest long-term medical expenditures will be on Medicare. Do you see what I mean when I say that current American society is financially stealing from the young to benefit the old? Do you really expect us to continue to be the world's superpower when we spend ever-increasing resources--already about 50% of federal tax revenues--on senior citizens? Money is finite. One dollar spent on senior citizens--who've had their chance to save money, have families, and buy homes--is a dollar not spent on the young, who have yet to have families, buy homes, and utilize compound interest.

Rob: Do you drive a car?

Lawyer: Yes, and I have the med pay option on my car insurance.

Older people drive, too. Why not let them pay a higher share of overall insurance costs, given that they've had an additional 30 years to save up for it and have also benefited from the real estate boom--unlike most people under 35 years old? Americans don't understand that the real threat against our way of life isn't Al Qaeda, Iran, or Iraq--it's older people and government workers voting in benefits for themselves at the expense of the young and unborn.

Trent: I have great insurance. Don't use it..have a DR/Hospital phobia. Only go if injured.

Laura: I feel ur pain. I was looking to switch from Anthem BC to Kaiser but rates at Kaiser were slightly higher..

Roger: Start smoking and drinking and engaging in risky activities.

Mary: I've got to point out that I'm certain there are plenty of elderly Republicans reaping the healthcare benefits for which you hold all Democrats responsible.

Lawyer: yes, but the GOP is trying to cut universal healthcare coverage while the Dems passed it, which has caused my premiums to increase drastically over the past three years. I will now have to get a reduced benefit health insurance plan b/c of the Dems. You want me to give them a medal for passing lame, watered-down, insurance-company-friendly legislation? I'd rather cut programs Tea-Party-style if it means I save money.

BTW, isn't it lovely being in a union, where taxpayers like me pay for fed, state, and local gov employees' benefits even as our own costs increase? Ah, those Dems--looking out for their unions. You want me to support a party that doesn't care about small businesses, young people, families, or inflation? I'll take the war-loving whack-jobs over the alternative, b/c the GOP has promised to cut spending and government programs. And Obama's pay freeze on federal gov workers doesn't go far enough--he should have cut salaries by 15% for anyone making more than 75K/year, including himself.

Mary: Oh, and we opened up 3 [police] dispatcher positions today. Check out the CalOpps link on my page, I encourage you to apply.

Lawyer: Re: dispatcher positions, so the government is expanding while the private sector and consumer spending is declining? This will totally work...as long as the laws of economics and math don't apply.

Mary: we aren't expanding. We are perpetually shortstaffed. As a matter of fact, I'm finishing up day 2 of 6, with a 68 hour workweek. For lack of a more appropriate term, I am dog arsed tired... So please, apply, and encourage others to also. I'd love to have my weekends...in all seriousness. I'm thankful for job security, but this still is no cakewalk. :-(

Lawyer: no well-paying job's a cakewalk. If we keep inflation under control, have a balanced budget, and stop relying on accounting gimmicks and constant bond issues, we can hire more gov workers. The private sector is getting more squeezed than the public sector--I've never seen so many hi-tech working so hard b/c of job cuts. Many engineers I know are working 19 hour days...with no job security, pensions, or lifetime medical benefits. The real problem is that so much of our taxes are going into the pockets of retired gov workers, which leaves your department with less money to hire workers now. Why can't more people see this simple fact? Public pensions cost current jobs and are unaffordable during a recession.

Also, if the private sector economy improves, the issue of gov benefits will not be at the forefront of budget discussions. Thus, the best thing gov workers can do is help the private sector get back on its feet.

Until just recently, the Dems controlled Congress for the last four years. All I see is my costs going up and my income getting more and more unstable. In fact, I've begun representing more gov and union employees now than ever before. It's scary to think that I am getting fewer calls from private sector workers because they just aren't enough of them working anymore, and the ones who have jobs are probably not willing to rock the boat under any circumstances. Sigh.

Mary: I credit divorce :-)

Lawyer: It's all a big mess, isn't it?

Mary: So in a way we are paying your salary too then?....

Lawyer: yes, except it's completely voluntary, and if I don't perform well or provide a service better than my competition, I don't get paid. Also, my services create no long term, unpredictable costs to taxpayers, and my fees are negotiable. Oh, and I have no job security or guaranteed income stream from taxpayers. So yes, to an uninformed person, it's exactly the same thing :-)

In the gov world, if you're incompetent or if they don't like you, they tend to reduce your duties and stick you in a corner somewhere until you retire. In the real world, if you don't perform, you get fired, and I might be able to get you a severance package, perhaps between three and twelve months. (It's usually easier to get a severance if you see a lawyer before you get fired, BTW.) Unlike the gov, the effects of a bad employee in the private sector are finite and definite.

Mary: I will absolutely agree with you in that sense. It is infuriating and a slap in the face to all of us that DO come to work and give our jobs and the public our all when we see substandard employees retained and given the same pay.

FWIW, the union really doesn't do everything in the best interest of even its members. I'm fighting what seems an uphill battle on right vs wrong, negligent retention and nepotism...not to mention favoritism and inappropriate relations among ranks. The union's stance is, "well let's see how it pans out." Um, for the $1,000 I pay you each year in membership fees alone, that answer isn't gonna fly! So I applied for the job in question when it opened...my interview was yesterday.

Lawyer: Some unions do a great job protecting their workers, but some are terrible when it comes to protecting the rank and file, especially in some California county hospitals. That's why some union members come to me for advice, even though their union should be the one assisting them. (Hey union reps, you might want to return a phone call once in a while and keep your members appraised of deadlines, including the deadlines to file grievances. I'm just sayin'.)

British Citizen: I love the NHS [national healthcare system in the U.K., which is free for British citizens.]

Rick: I cannot believe I'm attempting to defend Obama, but blaming Obama and fed govt employees for the high cost of your crappy health insurance is just silly and childish. Let me get this right; G.W. Bush and the Republican policies (dragging our troops into Iraq costing us billions of dollars a year, deregulating banks and insurance companies allowing multi billion dollar profits for those companies and their CEOs at the peril of poor and middle class Americans, and more...) took this country into the worst recession in our history since the Great Depression. Now, Obama has been trying to get the country out of recession, stabilize our economy, and yet help millions of Americans who lack any type of health insurance (a very sad condition for any civilized country) and regulate those greedy bank executives. There are many wealthy corporate executives, including the ones at insurance cos, that see their corrupt money-making ways endangered, hence are raising the cost of your less than adequate health insurance to compensate for it. If there are blames to go around, it should be directed to greedy and corrupt corporate executives and their lobbyists and Republican policies, not federal govt employees and the new Health Care law.

Lawyer: it's perfectly consistent to criticize Bush II and also increased healthcare costs. My comments were directed at Congress, which has been in Democratic hands for the last four years. Bush II was a moron, but like any American president, he doesn't have much control over domestic spending. Outside of of a war situation, an American president is just the mouthpiece for his party, especially if his or her party controls Congress.

I don't think the Dems realized that insurance companies would jack up policy premiums so quickly. And I still don't see any plan on their side to deal with the increased premiums.

[Speaking of unfinished business, we also need better financial regulation--we still have not solved the "too big to fail" problem, which is actually worse than before (all the big banks got even bigger).]

With respect to health care, I remember our president saying that the expanded coverage would be paid for by cutting the fat from programs internally, especially Medicare. I supported that and continue to support anything that will cut long term, unpredictable fiscal obligations. I never heard our president say anything about me paying 10 to 15% increased premiums each year for the past three years.

I recently got a pain in a tooth. I have no dental coverage, b/c individual dental coverage plans are generally worthless. (There aren't enough individuals buying dental insurance to make the plans beneficial or worthy of consideration.) I am going to India soon. I am not sure if I should wait to go to India and get dental care there on my vacation, or just pay up here. I am going to take Advil and see what happens in the meantime. It's a bit astounding to me how our country talks so much about small businesses and entrepreneurs and yet does nothing to assist us except when it comes to retirement plans (like individual 401ks, SEPs, etc).

Rick: I completely share your sentiment re rising cost and lower quality of health and dental insurance. Our president and the Congress need to address the outrageous cost of living, including dental and health insurance costs. It's incredible that US corporations are making record breaking profits while unemployment rate and cost of living continue to rise, and the average American is hurting. And then, there are elected politicians who argue less govt and more tax breaks for the wealthy. Meanwhile our country stands in a mountain full of debt which if not properly addressed will break our back. But hey let's give the wealthy more tax breaks so they can enjoy their yachts, luxury cars, and Tiffany & Co jewels, because the rich can stimulate the economy better than average Americans. And let's deregulate big banks, insurance companies and other large corporations and let them make more profits for their executives while they treat their employees like slaves...advantages of smaller government and less regulations.

Lawyer: this post was never about "smaller government," which is a different discussion. My post was about a poorly conceived healthcare law that has caused my premiums to increase 10 to 15% annually over the last three years, when the Democrats controlled Congress. The Dems passed a healthcare law that was supposed to be paid by cutting spending, not increasing premiums. They apparently did not anticipate insurance companies increasing premiums quickly or did not pass a healthcare law properly drafted to protect the young and middle class.

Insurance companies are a necessary evil that keep healthcare costs in check. Without them, our long-term healthcare costs would be even higher. We ought to have better procedures for contesting denials of care and reimbursement, but we shouldn't lose sight of the fact that insurance companies prevent healthcare costs from spiraling out of control.

Democrats like to joke that Republicans want older people to die quickly, and the GOP talks about rationing and death panels, but no one is questioning the wisdom of paying billions of dollars annually to give grandma and grandpa an additional 6 months of life and all the morphine they want. How did healthcare costs increase so much in 30 years? Is it b/c we used to let older people and people with terminal illnesses die comfortably instead of doing everything we could to prolong their last six months of life? How did Americans survive 30 years ago without Xanax, Prozac, etc.? Are we a more healthy society than we were 30 years ago?

The medical doctor who helped draft the original healthcare bill knew that healthcare expenses during the last six months of a patient's life were outrageous and needed to be reduced. In other words, the Democrats did in fact try to pass a law rationing medical care, which would have been a significant achievement. But insurance and drug companies quickly realized that the original bill would cut their profits and watered down the legislation using GOP scare tactics of "death panels." Now, instead of paying for universal coverage via spending cuts, people like me, you, your children, and the middle class will be paying for it. And it's b/c Americans were too naive to understand that rationing over the last six months of a patient's life is necessary to control healthcare costs.

Rick: I agree with end result of your proposal, but the way to get there should be better articulated than to cut govt employee salaries or reduce the size of govt agencies. Now, if studies prove wasteful spending in certain areas of govt, then yes they should be cut off. Govt should be here to protect the citizens not to waste their tax money.