Dear Mr. President

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Thu, Dec 31, 2009, 7:15 pm  //  Tip Johnson

Dear Mr. President,

Down here on Main Street, Wall Street seems far away. Is Pennsylvania Avenue even farther?

Welcome to the United States of America, land of opportunity. Here, unlike any other developed country in the world, we have the opportunity to get sick, lose everything and die. Here, also unlike any other developed nation, private, for-profit death panels with actuarial tables decide who is eligible for insurance and who will be denied care. However, affordable comprehensive health care insurance is available nearby. Those willing to get it can find it for $300 per year. Yes, that's right...per year, not month. More and more Americans are taking advantage of this affordable option. How? By moving to Mexico! (Go ahead, Google it. It's actually decent care.)

Our northern neighbors in Canada have a similar, slightly more expensive system so moving there is an option, too. Most health care in Canada is paid through taxes, but a few provinces charge premiums. If I lived 25 miles farther north, in White Rock, British Columbia, my premiums would be about $50 per month. Co-pays are extremely low or nil and there are no deductibles on essential health care, no exclusions for preexisting conditions and no lifetime limits. Have you tried shopping for a health insurance plan in the U.S. recently? Individual plans are simply not available. Nothing is affordable. How can these relatively less productive economies provide affordable health care for their citizens? Perhaps because they cannot afford the alternative. Uncompensated care adds billions a year to the cost of our system. Other incalculable costs mount as a result of deferred or denied care and the lack of incentives for prevention. How can the value of even one unnecessary death be reasonably defined in terms of shareholder dividends?

Dear Mr. President, we'd sure like decent health care without having to move! Living between the borders of Mexico and Canada should not constitute a threat to our health, safety and welfare. Congress has proved they will not put the vital interests of their constituencies ahead of campaign contributions from the medical/industrial complex. They are actually willing to let citizens die, destroying families and their estates, to keep a few bucks in their campaign coffers. They are willing to protect a health care system that costs two to twenty times as much as any other, and neglect one of the most basic needs of the populations they supposedly represent. Shame on them!

Among the tenets of our country's inception was objection to government that neglects provisions "most wholesome and necessary for the public good." Our Declaration of Independence also asserts the people have "unalienable rights" to "life, liberty and the pursuit of happiness," the right "to alter or to abolish" government "destructive of these ends," and a duty "to throw off such Government" and "institute new government...most likely to effect their safety and happiness." Our founding fathers had experience with government that was useless, irrelevant and harmful to the public good. They did therefore "ordain and establish" a Constitution empowering "We the People" to, among other things, "promote the general Welfare, and secure the blessings of liberty." Wouldn't affordable health care greatly advance the public good and general welfare, promoting life, safety, happiness and the blessings of liberty?

Dear Mr. President, upon what principles do we authorize a trillion dollars in military and black budgets, wreaking death, destruction and havoc around the world, while ignoring the basic needs of the people here at home? How can we afford to bail out big banks and automakers, but let the sick sink unsung into oblivion, one by one? Good health care would achieve more of our most principled aims at much lower cost. Could Congress possibly ignore this wholesome approach to our general welfare? They just did!

Anticipating such Congressional neglect, Article V of our Constitution provides for amendment upon "the Application of the Legislatures of two thirds of the several States" when "ratified by the Legislatures of...or by Conventions in...three fourths of the several States." The legislatures of all states can place measures on the ballot. Many specifically provide for some form of citizen initiative and referendum. Except for Delaware, every state requires a popular vote to approve Constitutional Amendments.

Dear Mr. President, you are our Commander in Chief, our chief executive officer and a constitutional scholar! The dereliction of Congress on this issue must have amazed you. Or were you joshing all along? If not, I think you know what you could do on our behalf and I think you know We the People would happily do our part. Congress had their chance. Please help us have ours.

I propose a national referendum on health care and the plan Congress has fashioned. Let's find out if people are satisfied. Exert your authority to invite applications from the several states for a Constitutional Convention: Should government guarantee universal, single-payer health care with a not-for-profit public option? Period. I listened to your campaign speeches. I know you know the system could easily be twice as good at half the cost. But that's not where we are headed under the incompetent direction of Congress. Ask states to help the people judge whether Congress has done its job.

In states where legislatures fail to apply but which provide for an initiative process, invite and assist citizens to qualify their applications for the ballot. Provide a timetable and uniform model application with solid language forbidding additions or deletions in convention and stipulating ratification by popular vote in the states. If a majority of voters in 38 states ratify the amendment, you would be well on your way toward accomplishing your earlier stated goals - at a minuscule fraction of what has already been spent.

Dear Mr. President, in conversation with a local homeless man earlier this year, he scoffed at the notion that Americans might receive, as you suggested, the same health care coverage Congress enjoys. He opined it would be far more effective to start by giving Congress the same health care he has - none! How right he was! After 43 years of far too much of the type of volunteer community service and public interest advocacy you strongly encourage, I really need to fix my teeth and put a new roof on the house. If we really scrimp, my family might be able to afford one or the other (though probably not after the self-employment taxes in our "new" economy) - and we still need decent health insurance! Credit is still very tight. The economy is still uncertain. Could you please help me out? Health coverage that serves We the People instead of the medical/industrial complex would be a great start.

Please, let's just see if We the People vote this issue differently than Congress. Take this issue away from Fox News, out of Congress' dirty hands and the influence of industry lobbyists. Put it on the ballot. Ask the people. This would be very simple for you to promote, but extremely difficult for citizens in fifty different states to coordinate. Will you help us? Be our leader. Stand up for us and see us stand with you! Give us a chance. Use your savvy grassroots tactics to show you still put the people's interests first. That's why we elected you. Offer a clear political plan, consistent with your campaign promises, and give the people something to rally around. If We the People reject such an amendment, we have no one to blame but ourselves. You will have done your very best. Then those who want affordable health insurance can, adiós, move to Mexico - or, au revoir, to Canada, eh?

Thanks, Kind Regards and God Bless America,

Tip Johnson

Craig Mayberry  //  Fri, Jan 01, 2010, 3:36 pm

I think there may be a disconnect in many people between the right to have health care and the single payer system.  I believe that if you asked citizens whether they think health care is a right that a high majority would say yes.  By the way, in my business ethics class that I teach we have a conversation on rights.  We list all of the potential rights that we have and then I do a vote on how many think it is really a right, and health care usually is in the 70%+ range.  The problem is that health care currently is a right, if you are having an emergency and go to the hospital they have to treat you irrespective of whether you have the ability to pay.  Clearly that is not perfect, but every right gets violated occasionally. 

The two fundamental question are really how do you pay for health care and who makes the decision as to treatments.  The single payer system would mean that health care is paid for by everyone’s taxes and ultimately government officials decide who gets what treatment based on how much is budgeted.  That thought scares a lot of people, and rightfully so.  I think if you did a survey on single pay payer system the number of people wanting it would be well below 50% (which is why it is not getting any traction in Congress). 

There are certainly inequalities in our current health care payment system, but if we want to fix them then we have to have an honest discussion on the possible solutions and ramifications of those solutions.  Many Congressmen/women came in with preconceived solutions and were not willing to discuss alternatives and it seems like all of them are not willing to have an open and honest debate about the ramifications of their solutions (on both sides of the political aisle). 

Unfortunately, Pres. Obama only exacerbated this situation by laying down a few high level goals which were very reasonable and then ignored them in an attempt to get anything passed.  The lack of leadership has been telling and may very well hurt any chances of getting anything more of substance done, even if a watered down bill that accomplishes nothing does get passed.

Tip Johnson  //  Fri, Jan 01, 2010, 7:00 pm

“Single payer” does not equal “socialized”.  I am not necessarily opposed to socialized medicine. Probably anything would be better than the current system.  But I acknowledge that many privately based systems work very well - when adequately regulated. Somehow, we fail to recognize the parallel between health care and other essential services, like utilities.  We happily regulate utilities to protect the rate base, but health care seems to get a predatory pass.

Single payer simply means that the administration of payments and reimbursements is centralized.  This is how successful and affordable systems cut administrative overhead by 20% or more compared with our dysfunctional system. Decisions about care are still made between you and your doctor.  Yes, the system will often treat elective, non-essential and essential care differently.  That’s where the stories about long waits in Canada originate.  If you break your hip, you get in and get fixed.  If you want a hip replacement, you might have to queue up for the specialist and wait.

The fact remains that we spend two to twenty times as much as any other system but get lower quality care with more exclusions, limitations, higher deductibles and co-pays.  Probably the biggest problem with our system is that there is absolutely no incentive for prevention, and that is where the greatest savings result in the long term.

Tip Johnson  //  Fri, Jan 01, 2010, 7:06 pm

Reprinted from my comment on Craig’s article of Nov. 28, 2009, “Real Health Care Reform”

“I strongly recommend folks listen to T.R. Reid?s Town Hall Speaker?s Forum. Reid authored ?The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care? after studying heath care in various nations of the world. The talk he gave did the best job I have heard of outlining the different systems and targeting why ours works so badly.”

Craig Mayberry  //  Fri, Jan 01, 2010, 7:43 pm


I agree with your comments, but that is where we keep running into problems.  We continue to not thoroughly define the terms.  A non-governmental single payer system would be more effective then we have now, the question then becomes single payer at what level, federal, state, local.  I believe a government run system would be a disaster given the state of our 2 political parties.  My suggestion is at the local level, I am less confident that a national system would work effectively with 300 million people.  Most single payer systems (whether public or private) are done on a much smaller scale, so how scalable is it? 

The other issue that needs to be address is the role of competition.  Competition is a great mechanism to get feedback on how you are doing.  If you provide poor service you will see customers decline, if you provide better service than your competition then you see your customer base increase.  Competition provides a critical check and balance in the system.  Maybe it is not needed in health care (just like you mention for utilities), but you have to be able to explain why it is important or not.  I can see how competition does not help much from a utility standpoint, electricity is electricity so what service would an additional company provide.  In health care I can probably argue both sides, but I do not think you can completely discount the checks and balances that comes through the role of competition.

Doug Karlberg  //  Sat, Jan 02, 2010, 12:58 pm

You two doctors are treating the symptoms, rather than the disease.

Virtually every role the government plays in our lives, is broken; Health care being just one.

One of the original debates when developing a government system for our country was how to effect the Declaration’s promise of a government “of the people, for the people, and by the people”.

Should we develop a “direct democracy”, where all issues are voted upon directly by the citizens, or should we have a democratic republic where we elect representatives to manage the daily affairs of government while we went on with out lives.

Obviously, we selected the second.

Implicit in a “Representative Democracy” is the guarantee that our representatives will actually represent our interests. The loyalty of a Representative is to its citizens.

This implicit guarantee of loyalty and duty to the citizens, and not special interests or their own selfish pocketbook, is what is broken.

This breakdown shows up in far more than the healthcare debate.

Even when a single party is handed the levers of power. Even with a majority in both the House of Representatives and an important 60 votes in the Senate. Even with one of the most popular Presidents’ in history, fresh from the campaign trail which had health care as a centerpiece; we get this abomination of healthcare legislation, which fails on all three of Obama’s promises.

The taxes started yesterday, and the benefits start in 6 years, after Obama is re-elected.

It seems like we don’t have many choices. There is a battle waging across the nation with citizen’s Initiatives sprouting up in every State, with legislatures fighting over their turf daily. Watering down the people’s wishes constantly.

It seems like Craig is correct, as elected leaders and their party’s gorge on our earnings, with no real consequences the feedback loop of “crime pays” gets tighter, and our government gets less responsive.

By all polling, frustration with government is rampant across our country, and is not limited to party lines. The Tea Party is a symptom of unresponsive government, and represents this frustration.

We don’t have many choices. We can continue to endure it. (this is decidedly against the American cultural grain)

We can continue to resist with citizen’s Initiative.(this is not producing the results we need and legislatures are circumventing the people’s wishes)

These are the conditions that revolutions are made of. Could we have a revolution? Not likely, but certainly not impossible either.

Civil disobedience is another avenue, which is possible.

Probably our best bet is a call for a Constitutional Convention. Rare events, but they are our guaranteed right, and a better alternative than the violent overthrow of the government.

The trick would be for the people to control the agenda and outcome, so that our needs are met.

May be time for a binding Contract for America.

Term limits, getting the money out of getting elected, ending the primary system of voting, and the elimination of designing congressional districts so that the incumbent virtually always wins.

Changing parties, hasn’t worked, as both parties are beholden to the special interests which feed them.

Oddly in this goal, the Tea Party folks could be the deciding factor. They are new and a little unorganized, but their votes could swing the direction of the nation, like no other organization that exists in American politics today.

The right has had its chance to lead, and now the left is having its chance.

As a Nation; We are happy with neither.

Our Founding Fathers would not recognize America today, but they had studied various governments and empires, their successes and failures extensively, and designed our system of government with this history in mind. They were wise beyond their years, and this Republic endured and prospered, leading the world in a predominantly good direction for centuries now.

We know what is wrong, the only question is will Americans stand up and fix our fundamental problem, which is to insist on the “promise of representation” being returned to its rightful role into the concept ...

... of a Democratic Representative Republic.

Tip Johnson  //  Sat, Jan 02, 2010, 10:46 pm

Sue the Bastards: Why are only Republican AGs Threatening Court Action against Health ‘Reform’ Legislation? By Dave Lindorff

“...expanding Medicare both to cover everyone in the US, and to cover each person in full, instead of only in part, would result in a net savings to Americans of $1.2 trillion to $1.3 trillion a year!

How can this be, you might ask? Well first of all, remember that programs like Medicaid ($400 billion a year), veterans care ($100 billion a year), and charity care delivered by hospitals to the indigent ($400 billion a year) would be eliminated as redundant. So would premiums for mandated workers’ compensation insurance paid by employers, and the hundreds of billions paid in premiums by workers and employers for private insurance coverage. Also, costs would be hammered as government set the rates for doctors, hospitals, and drugs.

Polls have consistently shown that half or more of Americans want Medicare extended to all.”

Craig Mayberry  //  Mon, Jan 04, 2010, 4:00 pm


Medicare reimbursements for doctors are anywhere from 60%-80% of private insurance, for some procedures even lower.  If we expanded medicare to all at the same rates, what impact do you think there would be on the doctors, nurses, hospitals and others in the medical system?

Tip Johnson  //  Mon, Jan 04, 2010, 4:48 pm


I guess they would need to learn to be more competitive in a global context.  That means learning to do it more efficiently. Medicare reimbursing at 20-40% less doesn’t concern me a great deal when every other health system already does it for half or less. If it was anything else, we’d have outsourced it by now. Being held hostage to a rapacious, self-regulating industry wouldn’t bother as much if they actually provided the service.

Dear Mr. President

Tip writes a letter to President Obama about Health Care and about his concerns that Obama has sold us short.

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