Common Sense Gun Control

It is so disturbing to continuously watch these horrible mass shootings and reflect on how our broken political system is unable to take simple steps to blunt the impact. Here is what I think would be very beneficial and would not impact gun lovers who want to kill animals or shoot for sport.

1) Ban all high velocity guns when simply pulling the trigger can spray out multiply shots per second. There is no need for military type weapons.

2) Inforce background checks on ALL purchases.

3) Require parent approval for anyone under age 21.

4) Require a 14 day waiting period before one can take possession of their gun purchase.

Now the NRA types will say it's impossible to control private party gun sales or sales at gun shows. I completely disagree. To make this work....

a) Make it a felony to sell a gun directly to anybody without going through the proper procedure.

b) The transaction process would work like this.

1) Seller and Buyer would fill out a sales form that has all the information for the background check and the seller and buyer information.

2) Seller and Buyer would agree on a gun retail shop for the gun to be deposited. Seller would take the gun to the retail gun shop. At gun shows there are probably gun dealers on site who could take immediate possession.

3) For a small fee the gun shop would run the background check and hold the gun waiting for the check to be completed and approved and the 14 day wait to expire.

4) Once the sale has been approved and the 14 day wait has passed the buyer can stop buy and pick up the gun. 

Simple deal that the gun shops would probably love since they will get more traffic into their stores from sellers and buyers.

5) And finally we should offer a generous buy back program for those in possession of banned guns who would like to be reimbursed for their costs.  

 

 

MEDICARE FOR ALL

The Medicare for All (MFA) proposals from Warren, Sanders and some of the others who have fallen off the campaign trail are all dead on arrival proposals and if we democrats are naive enough to elect a candidate who goes all in on this we will lose badly to Trump. The sad thing is that MFA would actually be a very beneficial change and would dramatically improve health (and cost) for most Americans.

So why is it viewed as such a radical proposal? All the candidates are afraid to fully explain the economics of how it would work and how it would actually reduce health costs for most Americans, especially lower income. We hear these ridiculous statements about how it would cost $44 trillion over 10 years, something Biden knows is pure fantasy but repeats it because he is smart enough to know that vast majority of uninformed voters will believe it. Sanders is the only one who occasionally says the right things about the cost but has not done an adequate job of fully explaining it. So here are facts...

1) As any current Medicare recipient will tell you the government DOES NOT PICK YOUR DOCTORS. You have many options for coverage.

• You can just take medicare without any other insurance and be reimbursed 80% of your medical costs that are allowed by Medicare. You can pick any doctor or hospital that takes medicare.
• You can buy a supplement that pays the 20% not covered by medicare and pick any doctor that accepts medicare.
• You can join an advantage program like Kaiser and pay nothing extra but you are locked into their system and their doctors.

          

Why the advocates for MFA don't run ads interviewing current medicare recipients letting them tell people how much they like the system and what freedom of choice they have is a mystery to me.

2) Medicare is not free. Each recipient pays a monthly fee based on income. Base cost for 2020 is $144 but can be higher if your income is much higher.

3) Today, all people who have employer based health insurance are paying on average $462per month per person covered and the employer is paying about $1,172 per month for their part of the insurance premium.  So employees pay about $5,547 per year and employers pay about $14,069 per year for a total of $19,616.  With 132 million working Americans that multiplies out to a 10 year cost of $26 trillion.  The total average total cost of health is about $28,125 per year per household which equates to $36 trillion in year 1 and with 4.8% inflation would equal $44 trillion. This extra cost is what's paid out of pocket.

4) People without employer insurance and not eligible for medicare are paying on average $18,000 per year for a decent coverage plan.

So today when you add up all the costs for medical care it does come up to about $44 trillion over 10 years.

5) Administrative costs are estimated to be 14% of all costs for insurance companies and all the people in companies and health care who are employed to handle insurance claims, etc. This amounts to $5.0 trillion over 10 years. 

So if you could cut admin expenses by 90%, saving $4.5 trillion over 10 years, the total cost of healthcare would be about $38 trillion over 10 years.

Now the idea that we would offer totally free healthcare to everyone with neither employers or employees paying anything would indeed require a tax increase of $38 trillion. But that is an absurd assumption. So the obvious solution is to levy a health care tax just like social security. In 2019 a health tax rate of 15% for both employee and employer (30% total) would generate $38 trillion over 10 years.

The table below shows how much employees would have taken out of their earnings. For 77% of the population the annual cost would be less than what they are paying today. And those making over $200K per year the cost would go up.

And the employer part of the cost would represent a big savings to the employers because it's less than what they pay now and they don't have to have administrative people to manage the programs.

Now if you assume that voters would go along with this, which is highly unlikely, then the next big question is how to actually implement this. A sudden shift would be a colossal disaster because the system could not possible cope with any sort or overnight change. So it would have to be phased in over many years. The only thing I think might work would be to lower the medicare eligibility age to gradually convert,  something like this:

 But even this type of gradual change would probably be very disruptive over many years as unexpected things come out of the woodwork. And doing it over a long period of time would enable endless attempts by those most affected to lobby for change or killing it outright.

And two other big things would have to be adjusted:

One is the loss of revenue for hospitals and doctors if 100% of their income was based on medicare reimbursement rates. This would have to be dealt with and the only option is to up the rates to an acceptable level. This would be a true cost to the government.

The other is cost of drugs.  The only way that other countries have much lower drug cost is that Americans are subsidizing the rest of the world. If the price of a given drug was the same in every country then our costs would go way down and the rest of the world would go up. But our percentage decrease would be significantly greater and the rest of the world would go up much less. Any new program would have to demand that prices are the same world wide.

All of this is way to much change for our partisan political system so my thinking is that the only solution is to adopt the Biden plan.... Revive the Affordable Care Act and offer a public option which would be run by medicare. Then the system could evolve at a more organic rate. Many good things could be done within that framework, especially on prescription drug costs. 

How to reduce Police Brutality

We are all grateful for the many ways police officers risk their lives keeping the peace but the small percentage of bad apples are tarnishing the entire organization.

In about 2004 there was a publication by the "October 22nd" group that publicized the details of victims of police brutality. It was compelling to read and quite disgusting. At the time I felt that perhaps we should pass out video cameras to people in high brutality areas so they could film the police in action. Well fast forward to 2018 and now everybody has a camera on their phone and we are now getting first hand documentation of the police crimes committed. Surely with all this factual evidence the prosecution of rogue cops would go up and the unjustified use of police force would go down. And yet it hasn't because time after time we see the cops getting off. Why is this happening?

1) Let's assume that 95% of the cops are great public servants who would never be brutal or murderers. There are 1.1 Million cops in the U.S. so that leaves us with 55,000 rouge cops on the beat. I think the upper levels of police management know who these hot heads are but they are powerless to get rid of them until they do something bad. Why, because the police union protects the bad apples and their cohorts are afraid to speak out.  

And we have these ridiculous rules in some areas where the cop cannot even be questioned for 24 or 48 hours which leaves them plenty of time to cook up their story with cohorts. Plus they get Qualified Immunity which in many cases shields them from prosecution. In normal police investigations you interview all the potential witnesses quickly so people can’t try and coordinate their stories. In normal businesses you can get rid of poor performers quickly. The police unions should recognize that protecting bad apples is not in their best interest.

2) The second major problem is that the decision to prosecute and judge police brutality is in the hands of local district attorneys and judges and they are somewhat "in bed" with the police. A DA who is aggressive in prosecuting police will suffer the consequences of the police not cooperating with the DA for other activities. They can fail to show up to testify. They can in many ways make the DA's life miserable. DA's and Judges are elected in most states so getting reelected is one of their primary objectives and if the police are against them they will have a very difficult time with reelection.  So the DA's are reluctant to aggressively go after the rouge cops. And the judges are in the same position. They don't want to piss off the police chiefs and the cops.

So the most important thing we could do is move all investigation and prosecution of police to independent state prosecutors and judges who are appointed by the Governor for a limited 5 or 10 year term. All police killings would automatically go the the state prosecutor for investigation. Other less dramatic events would be referred to the state prosecutor by local DA's. The obvious advantage is that the state prosecutors and judges would not care one wit about what the local police think. They would be totally independent. And I suspect the local DA's and judges would secretly love this change so they are don't have to deal with this tricky problem.

California list of criminal cops

The 28th Amendment (2050)

If the founding fathers could see how our government has evolved they would be horrified and would go back  and make many changes. This is my idea of what we should change.

It should be obvious to everyone that our governmental process is broken. We have evolved into a system whereby the elected officials running our country really only care about one key thing and that is to GET REELECTED. This results in terrible decisions or non decisions being made that are dramatically effected by big money donations. Citizens United was the final act that pushed things over the edge to our current situation.

When a Senator or Congressman first gets elected they of course will have had to fight through a nasty primary and general election. This process alone is a cause of concern as only a certain type of ego driven person will subject themselves to this torturous process. But once they are in the desire to stay is overwhelming and their primary goal. Why? Because once in the club you are treated like royalty, especially if you're a Senator. People fawn over you. Your jokes are really funny. You get access to the best table in restaurants. You get to go on TV. All kinds of people want to talk to you and they listen to what you say as if you have great incite into almost any subject.  You get a great retirement package and health care. In short, you start believing that you are a really special person and want that to continue.

So what happens.... if a congressman you  have to start your reelection campaign about 6 months after just getting elected. Senators can put it off a couple of years. And since today's campaigns cost an enormous about of money you have to start dialing for dollars and you have to take meetings with lobbyists and beg for their money even if you don't agree with there cause.

The end result is that decisions are made with "how it will effect my reelection" as the primary factor. Just look at how Mitch McConnell supports criminal Trump because he is afraid of not being reelected. How sad.

Some examples of the terrible congressional actions....

GUNS

Our fascination with guns is a huge problem that should and could be reined in with simple steps that 70% of Americans support. 100% background checks, no assault riffles, limits for people who are mentally ill. Limits on ammunition, etc. None of these restrictions would impact the normal gun owner who likes to shoot animals and compete in target practice. But as we all know the NRA support and contributions completely blocks any sensible changes. Doesn't matter how many people get killed everyday because voting for change would impact my ability to get reelected.

CLIMATE CHANGE

Oh how different the world would have been if Al Gore had been elected in 2000 and the country had embarked on an all out assault on carbon. The solution was trivially simple: Slowly raise taxes on carbon and subsidize clean energy which would let the market fix the problem. Had we taken the lead it would have pulled along the rest of the world and our economy would have thrived. But of course the fossil fuel industry contributes massive amounts of money and so today we have this bone headed outlook that defies logic. Pretend that there is not a problem and just push the problem into the future. Thank Republicans for the agony that mankind will experience 50 years from now. The obvious conclusion is that they don't care about their grandchildren. Period. They only care about getting reelected. And of course the stupid actions of Trump just confirm that we will not do enough to fix this problem.

DRUGS

The opioid crisis is real and as 60 Minutes revealed the primary cause was congress passing laws that PROHIBIT the DEA from going after companies that are pushing the pills. We blindly let a pill pharmacy distribute millions of pills in a community that has only 2,000 people. How stupid. The whole problem could have been controlled by limiting how many pills a given doctor could prescribe in a year. How did this happen? The pharmaceutical industry spent millions making sure they could do whatever they wanted. And of course there are the stupid drug laws affecting  marijuana where we lock up people in one state and give them free access in others.


Well, one could keep going on this list as it is very long but let's focus on other structural problems in our system that contribute in wrong headed direction.


GERRYMANDERING

This is one of the more disgusting things that we have let happen. Republicans are great at using the system to favor their side. Democrats are probably equally to blame.  We have now created a system where a logical cohort of citizens do not have a representative who aligns with their interest and needs. 

JUMBO BILLS

I am not sure what other name to give for the process whereby a given bill in congress can get loaded up with numerous things unrelated to the supposed main topic of the bill.  Want to limit abortion, tack it onto the highway bill. Want a new airport in your district, try to get a line item on the health bill. The fact that a given bill can have just about anything it means we don't know what laws are being passed because nobody, probably not even the congressman, know what's in the bill. We need to fix this.

VOTER LIMITATIONS.

A favorite tactic of the Republicans is to essentially cheat the system by trying to limit who can vote and create gerrymandered districts. This is a cancerous assault on our system.


THE ONLY SOLUTION TO CHANGE DIRECTION IS A 28TH AMENDMENT.

Now when one thinks about an amendment you quickly realize that nothing in the amendment would pass because current Senators, Congressman, State Governments, and lobbyist would fight it to it's death.

So the most important part of this amendment is the effective date of Jan 1, 2050. This is 23 years into the future. Most of the current politicians will be dead or retired along with the lobbyists and state governors.  The hope then is that they will not be concerned with how it affects them TODAY and just might vote their true conscience for a better future.

OK, here are all my changes to put into the amendment.


1) Effective date of Jan 1, 2050

2) Term limits on all politicians.

• Two 4 year  terms for president (already done)
• Three 6 year terms for a Senator
• Five 2 year terms for a Congressman
• Three 4 year terms for a governor

And to sweeten the deal for existing politicians the term limits would not apply to those who are already in office on Jan 1, 2050.

The objective here is obvious. If people know that they cannot make politics a life long career they just might do the right thing because they know they don't have to fight for reelection every term. 33% of senators would be on their last term with no need to placate special interest groups. 20% of congress would be terming out. 

Now a major argument I hear from people opposed to this is that there will be no institutional memory and novice short term politicians will not know how things work and will be greatly impacted by lobbyists. I think this is totally unfounded. In my career I joined several new companies and had to learn quickly about the company process, politics and historical events. It takes about one year to be fully operational. Now think about becoming a senator or congressman. It's the identical job that hundreds have held before and they all need the same knowledge of how things work. It would be easy, and probably already exists, to publish "Senators for Dummy's" that gives a new senator a blueprint of how things work.

The advantages of term limits far outweigh the potential disadvantages.

3) Non Partisan establishment of congressional and state voting districts. 

• Within 1 year after the 10 year census all districts will be modified as necessary to reflect the current population.
• All districts must have geographical and ethnic coherence.
• No district can have non adjacent boundaries.
• The establishment of districts will be done by a bi partisan group of citizens selected by the state supreme court.
• Gerrymandering is forbidden.

4) Congressional Bills must be for one cohesive subject.

No congressional bill can contain sections or amendments that are unrelated to the primary definitions of the bill. Provisions of the bill will be monitored by an independent bipartisan commission and enforced by the supreme court as necessary.

The obvious advantage to this amendment is we stop ear marks and all the other stuff that happens when a bill is moving through congress.  You want a large infrastructure bill that provides funds for road improvements, sewer and water upgrades, and airport expansion, then you won't be able to tack on a birth control amendment or a new border wall, etc. You could add an amendment to increase the budget of air traffic controllers because it is related to the bill definition.

5) Right to Vote.

All citizens have the right to vote. No one can be denied the opportunity to vote. Each voter must register to vote and that process can be via mail and must be available at all times. The penalty for illegally voting is $10,000 and/or one year in prison.

6) Voting process.

• All elections will be held on Saturday and Sunday with polling areas open from 7:00 am to 7:00 pm each day.
• No election results can be revealed until after voting ends on Sunday at 7:00 am.
• All citizens will have the right to vote by mail with mail ballots being available at least 30 days prior to election weekend.

7) Appointment of judges and cabinet members.

All nominations put forth by the president for judges and cabinet members must be approved or disapproved by the senate within 90 days of nomination. Failure of the senate to act within the 90 days results in an automatic approval of the appointment. 

8) Eliminate the Electoral College

This ancient process might have made sense it 1787 but today it clearly denies the majority their right to pick the candidate of their choice. Trump is a fraud who clearly was not wanted by the majority of citizens.

Well that's it for now.  If would be great if we could get a "28 in 2050" movement going and test the water to see if it's at all feasible.

Education and Trump

PTC (Positive Train Control) Another broken system?

I have no idea how PTC works but when you listen to all the excuses for why it has not been rolled out everywhere and the general technical specs you get the sense that it is another outdated approach that should be scrapped.

We now have self driving cars and we can't control a train that is moving on a fixed track??

Seems to me that the solution should be pretty simple. Outfit each train engine with a system that constantly uses GPS to know it's exact location. Then, based on the location, use the control application to know what the maximum speed limit is for that location and force the train to slow down to that level if necessary and report the over speed condition to train management on a real time basis so they can decide it it's necessary to contact the engineer. (Being 2 miles over not so big a deal, 25 over, red flag)

Mapping all the train routes with the max speed would seem to be a trivial task by having a Google type train that travels each route and establishes the maximum speed. In fact I suspect you could define that simply by monitoring radius of a turn and pitch of the tracks.

Think about it... you can buy a Garmon GPS for under $100 that shows you the speed limit for almost every road you travel on. Mapping that for train tracks should be easy.

Congress could fix this by simply mandating the solution by 2020 but of course our dysfunctional government will not do anything because they want the big contributions (bribes) from the railroad industry.

Medicare Fraud

Medicare fraud is estimated to be from $60 to $100 BILLION a year which is an astounding amount of fraud. And in today's NYT we learn...

Last week, when the Department of Justice charged three people in Miami with fraud and other crimes in a $1 billion scheme to bilk Medicare, it was the single largest criminal case in the nine-year history of the Medicare Fraud Strike Force, a coalition of federal, state and local law enforcement agencies. A month earlier, a crackdown by the strike force led to civil and criminal charges against 301 people in dozens of schemes totaling $900 million in allegedly false billings."

To me the most frustrating thing about this is the inept way fraud is investigated. Everything is done way after the fact probably using ridicules outdated tools.  How could we let someone run one billion of false charges before being stopped?  I think there is a much better approach to fix this once and for all. The key is early detection and utilization of current technology.


PART ONE  (Early Detection)

1) Require all providers to submit their claims within 14 days of the service or have a 20% penalty assessed for late submission. 7 days would even be better.

2) On a very timely basis enter the data into the system the day it is received.

3) Immediately after data entry send an email to the patient asking them to confirm that they in fact did received the service. Send snail mail for those who don't have email.

Today I get documents in the mail from Medicare showing the doctor visits and procedures that have been billed and paid by medicare. They typically come months after the event, so it's hard to remember what happened 3 months ago,  and there is nothing indicating that I should review these and report fraud.  I once discovered obvious fraud from a supplier of my INR test strips. They were billing for twice the amount that I actually received. I attempted to alert medicare but as I remember the process was cumbersome and after filling my report I never heard a thing about what, if anything, happened.

If the patients could simple click a box saying yes or no you can quickly start to see a pattern on a given provider AND someone could immediately call the patient to clarify what has or has not happened in cases where they clicked on the NO option.

4) Using very simple statistical analysis we should constantly compare a given doctors submissions against normal and average charges for similar procedures so you can quickly discover anomalies.

This is a no brainer approach.  How can one Doctor submit 15 claims a day for motorized scooters. The minute you see a statistical anomaly you flag the doctor for investigation and hold up payment.

PART TWO ( Investigation)

Investigation of potential fraud must be very timely so it can be nipped in the bud. 

Here is how it should work....

1) All payments that are flagged for investigation because of statistical anomalies, patient feedback and other causes, (like first submission from a new clinic or doctor) , are added to the investigation queue with step one actions.

2)  iPads or other tablets are used to direct field investigators on what they are to do. This would be a rich and very intelligent application that manages the investigators day. Here is how it would work.

a) Investigator opens the app at his home for the start of the day. Obviously the app captures his start time, etc.

b) App gives him or her their  first assignment. Assignment would typically start with a map showing them to go to a doctor/clinic address and the app would give clear directions and act as a GPS for the agent. 

c) Once they have arrived at the address they click on ARRIVED. and then the app gives them the next instruction. Things like...

-Verify that the office actually exists.  (Does the office exist, yes or no)
  If yes, show next step. If No ask agent to describe what they see at the address if it even exists.
-If yes then various types of instructions could be given such as:
  
Go in and attempt to make an appointment. Observe what you see and answer these questions:
      Did the office look official and normal for the type of service.
      Was there a receptionist who could allow you to make an appointment
      Were you asked about the current provider and insurance.
      Etc.
or

Wait for n hours and observe patient activity.
     How many patent's came and left
     And perhaps other questions that relate to the type of service, etc.

- Once done with this office, present the investigator with the next address, etc.

Now the obvious advantage of this relatively simple process is that you are getting timely feedback about a given provider that is very actionable. If the office does not exist you shut them down, hold payment and refer to next step potential criminal processes. If it exists but there was no lobby or receptionist you go to the next steps, etc.  If no patients came and went in the normal business hours when the office was supposedly open then it's probably a scam requiring further investigation. You could loop back the next day and have the agent observe things again, etc.

There are all kinds of thing one could do with this approach. 

The cost to develop this app is literally floor sweepings compared to level of fraud. The tasks for the agent are pretty low level so the cost per agent, including salary, travel and and I.T. support should not exceed $85k per year. At that rate you could hire 20,000 agents for about $1.7 billion a year.  I doubt you would need more than 2,000 to have a significant impact. I guarantee that fraud would drop by 75% with this approach. Will medicare do anything like this? Sadly I suspect nothing will change.