Time Magazine on Health Care

My family has always had a subscription to TIME Magazine, and because of that I've always had a weak spot for the magazine.  Even though there are other, better written news magazines out there, and even though there are times that I want to slap the editors, I still come back to TIME.  ("Time after time" is now stuck in my head...)  So, when I saw TIME's newest issue on health care reform I had to pick it up and read. 

As usual, the main article was 95% fluff with about 5% decent commentary/opinion, but it's the opinion articles that come after the cover piece that I'm always interested in.  True to form, four pages later, an article written by Joe Klein, titled "Democracy's Discontent," takes on the issues and makes an elegant argument.  Klein believes that the problems facing Obama are many, but two obstacles provide most of the resistance. 

Klein writes: 

"One of the most difficult things to do in a democracy is react to a problem that is real, but not immediately threatening. Obama is trying to do this in two monster areas, health care and climate change."

Anybody that has studied American history knows that we're extremely practiced at ignoring problems until they are staring us right in the face.  It's human nature.  Why deal with something that we can deal with later?

The second problem Klein discusses is, in my opinion, a far more serious concern.  Special interest groups are dominating and directing the conversation.  That's not to say that special interest groups are a demonic hegemon in American politics.  Such groups are vitally important, and provide outlets for individuals interested in solidarity and effecting change.  What's at issue here is that these special interest groups aren't interested in the health of American citizens, but in the health of their own pocketbooks. 

It's disingenuous to say that the current system isn't broken.  One of the biggest reasons to keep the current system in place is to ensure that the individuals profiting off of current insurance policies continue to profit.  Coupled with the fear and uncertainty that change always brings, we are looking at a political stalemate that will have far reaching ramifications, even beyond what we can currently envision.


'Gatesgate' and Race

When Barack Obama was elected President, there was immediately talk of how racial tensions in the United States had gone by the wayside now that we had a "man of color" in the Oval Office.  If the recent hullabaloo over Harvard 'scholar' (side note:  I wish that I was a 'scholar' somewhere.... are there applications to be a scholar at Ivy League universities?) Henry Louis Gates Jr.'s arrest in his home is indicative of anything, it's that as a country we are far from moving past race as an issue.  And that's not a bad thing at all; from several different perspectives.

First off, for anyone that was naive enough to think that racism was a thing of the past, this serves as a wake up call.  While I'm the first to admit that this situation has become an over-hyped victim of the 24-hour news cycle, it has also been an excellent reminder that race and racism is still a hot topic in America.  During President Obama's hour-long news conference on health care reform two weeks ago, two minutes were dedicated to this topic. What was the news the next morning? 'Gatesgate' (second side note: If this entire situation has taught us anything, it's that the media really needs to stop adding 'gate' to every scandal).  As a country, we are still hyper-sensitive about racism, and, as I said at the beginning, that's not a bad thing.  Racism is still a problem in this country, and should be focused on as such.  The only problem I saw with the story was how it was covered.  This type of coverage, without a serious and sincere discussion on the problems of racism in a forum not driven by ratings, cheapens the topic. 

Secondly, American is the quintessential 'melting-pot.'  As such, it's difficult to identify with any sort of 'American' culture, because (aside from patriotism, NASCAR, and country music) there really isn't a dominant American culture.  In the United States, we take from different cultures and add them to the mainstream as they grow in popularity.  This type of cultural environment means that many individuals and communities hold tightly to their race and unique culture because it is central to their identity.  That is what America is all about:  The freedom to choose how you express yourself insofar as it does not infringe on another person's ability to live and express themselves.  

Race should always be a topic in America, it just shouldn't define how we interact with each other.  We should all be able to sit down and have a beer with one another. 

Wisdom Teeth Removal and Insurance

It's been an incredibly busy past couple weeks, so blogging has not been at the forefront of my concerns, but now that things are getting back to normal I can return to the blogosphere with some fresh ideas.  On Tuesday my wisdom teeth were removed, and while I don't really remember anything about the actual operation, I can certainly remember what the bill looked like: 

  • Tooth #1: Simple - $133
  • Tooth #2: Simple - $133
  • Tooth #3: Complete - $327
  • Tooth #4: Complete - $327
  • IV Sedation $278
  • Total Fee - $1328
  • Anticipated Insurance (if any) - 80% coverage
  • Payment Due - $265.60

Even a simple procedure like getting your wisdom teeth removed is a costly procedure, and without insurance I would be in a world of hurt financially.  The benefits of health care reform in America can't be underestimated when even simple, necessary procedures such as this are bleeding Americans dry.

Campaigning for Health Care Reform

Earlier this week, President Barack Obama went to Annandale, Virginia to continue his push for health care reform.  I haven't been in a house with a television for nearly a year, so watching the President on CNN instead of YouTube was definitely a change (I loved how there were three tickers simultaneously giving us unnecessary news.... can anyone say 'information overload'?).  As I was watching President Obama, I was struck, once again, by his unrivaled oratory skills and ability to work a crowd.  He was cracking jokes (mostly at his own expense) and consoling people in the crowd, all while peddling his vision for the future of health care.

The speech itself was fairly straightforward.  Obama hit all of the same points he's made countless times now:

  • There are 46 million uninsured individuals in the United States
  • Entitlement costs will soon be the federal government's greatest expense
  • Insurance companies are already adding to premiums to cover the costs of accidents involving uninsured parties
  • The solution must be deficit neutral and it must happen in the next year

The solution President Obama proposes (a public option provided by the federal government to compete with the insurance companies) was also laid out: 

  • Hospitals should digitize medical records to reduce medical errors and confusion
  • Preventative medicine must be a focus
  • There must be a change of incentives for the medical community.  Expensive tests are not always necessary to ensure the best care.
  • A public option would force insurance companies to offer competitive prices while keeping a majority of our current insurance/medical system in place

A large part of the President's focus was on the most important part of health care reform, at least in many American citizens' eyes: $$$$$.  How does the administration propose to afford this sweeping reform?  President Obama's response? Two-thirds of the costs will covered by reallocating money that will become unnecessary as our health care system evolves.  Already, $950 billion over the next 10 years has been found using this method.  The other one-third?  President Obama proposed to cap the itemized deductions available to individuals making more than $250,000/year.  That sound you hear?  Wealthy Americans everywhere calling their congressmen.

There was so much more in this speech that I want to cover and discuss, but it's drawing close to the Fourth of July weekend, and my ability to provide a concise analysis of all these topics while popping off pithy comments is about nil at the moment.  Next week, however, I'll be focusing on this topic in depth, and what it means for the future of medicine. 


Cyberspace: The (New) Final Frontier

For decades, the United States' defense budget was spent on defending our borders from conventional military threats.  Even though projects such as the 'Star Wars' debacle drew attention (and a large chunk of change), most of the Department of Defense's $500 billion budget has been directed towards military personnel and traditional equipment (although some of our 'traditional' equipment is far from the norm).  However, it seems this trend is set to change.

The new administration is pushing for a greater focus on defending national interests in cyberspace, and defense contractors are directing spending towards hiring hackers instead of engineers.  Bloomberg estimates that this new sector in the defense industry could grow to $11 billion by 2013, and Lockheed and Boeing (among others) are quickly pouring time and money into expanding their cybersecurity units.   Hackers (Worst/Best. Movie. Ever.) have historically been on the opposite side of the law, but as cyberspace becomes the new battlefield, individuals who used to be criminals are now our first line of defense from foreign attacks on the Pentagon's data centers.  And if this sounds like the plot to a bad summer movie, it gets better: the Russians are involved. 

President Barack Obama has made no secret of his desire to shore up the Pentagon's cyberdefense, and has gone so far as to announce the creation of a 'cyber command' in the Pentagon.  Over this past weekend, as the NY Times reported, President Obama is making it clear that he plans to take this program a step further.  This next week Obama will visit Russia, and one of the top talking points on the agenda will undoubtedly be the differences of opinion regarding international cooperation in this new frontier.  Russia is pushing for a treaty like the kind used in constricting the use of chemical weapons, while the United States is looking for international cooperation between law enforcement agencies.  I put the odds of this turning into a complete mess at about 2:1.

The potential for legal conflict, confusion and censorship (among a litany of other possible problems) when discussing national 'cybersecurity' is astronomical, and there will certainly be issues as this agenda becomes more defined.  The fact that this requires international cooperation to be effective only complicates matters.  However, one thing is certain; it's a cool feeling to use terminology like 'cybersecurity' and 'cyber command unit' and not get laughed out of the room.

Obama the Rock Star

I went to Transformers 2 at midnight last night (I know, I'm a nerd, let's just get over that and move on), and lo and behold, two-thirds of the way through the movie, whose name comes up? President Barack Obama.  Granted, it was hidden amidst a series of explosions, GM cars (if they could come out with a model that actually transforms it would probably save their brand) and horrible acting, but his name was there nonetheless. 

There was something hilarious about hearing a name like that in a Michael Bay film, and it was indicative of Obama's rock star-like draw.  Most of the crowd was in the 12-16 year-old age range, but the recognition of his name was clear.  Combine that with Bay's inability  to mention anything that isn't insanely popular or embedded in pop culture, and it's easy to see Barack Obama's iconic status.  The most revealing part of the experience for me was the fact that his name was mentioned without a chorus of boos or catcalls from the audience.  I had become so used to the negative reception that President Bush would receive in movies that it was surreal to hear a few chuckles and claps when Obama was mentioned.  We truly have a rock star President in the Oval Office. 

Health Care Reform: Coming Soon to a Hospital Near You?


It seems that nearly every day for the past few weeks I've heard some news about President Barack Obama's plan for the future of health care in the United States.  You would be hard pressed to find many people who are ecstatic about the current state of affairs, but while there is unity in our discontent, all parties remain far from agreement on a solution.

Obama’s comments in front of a panel of AMA members on  are emblematic of how our new president will handle such concerns. Confident in his oratory skills (and why shouldn’t he be; if you can rally a few thousand Germans then you can do anything in front of a crowd), Obama will seek to change the minds of the medical community, insurance companies and hard line Republicans one speech at a time. However, he should be wary of being overconfident of his powers of persuasion. Even though he is taking a far different approach, we can certainly all remember how well Bill and Hillary Clinton fared in their attempts to woo people over, and ignored the tough political facts. 

Insurance companies, for better or worse (I side with ‘worse’), are a part of our economic and political system. Republicans and Democrats alike have lined their coffers with money from such companies, and eliminating them from the picture will take more than a pat on the back and some kind words. There are also a number of political detractors who will have to be won over in the backrooms of Congress. Deals will certainly be cut, and Obama’s health care plan will undergo a vast transformation from its inception, through the committee process, and by the time it makes it to the Senate floor it may nearly be unrecognizable. 

Regardless, the most important players (as I see it) are the doctors (and the medical community at large) and the patients. These are the people that need to be convinced that health care must be fixed. When speaking in front of the AMA panel, President Obama mentioned that the current number of malpractice lawsuits should be reduced. In my opinion, he should stray from making such statements. While I agree with him, by making such a bold declaration he is dangerously  close to missing the point (malpractice lawsuits are a problem, but they’re only a symptom of a larger disease) and creating new enemies. Judging by campaign contributions over the years it's obvious that attorneys are among the most influential contributors to the Democratic Party.  Alienating such important contributors will inevitably become a major problem come 2012, and like any elected official President Obama must be concerned with possible backlash resulting from policy decisions.  These landmines are placed after every turn and are exactly what Obama has to avoid. The problem, obviously, is noticing these landmines before you step on them.

The White House is in for a rocky road if they remain unable to convince the medical world of the benefits a government run insurance system can bring. One way or another, we will see the federal government play a large part in the future of health care services. Whether or not the federal government is suited to such a task (and can be more efficient than the current quagmire), is another, larger question. The only question Obama should be asking right now is whether or not he can even get a bill passed. 


The Compensation Czar Cometh

Earlier this week, the Obama administration appointed Kenneth R. Feinberg to the exulted new position of 'Compensation Czar' (Feinberg had previously been mentioned as a candidate for a "car czar" position).  Feinberg, whose expertise lies primarily in alternative dispute resolution and mediation, appears to be a good fit for such a controversial position.  During the aftermath of the September 11th attacks on the World Trade Center, Feinberg was tapped by the Bush administration to determine adequate compensation for the families of the deceased.  Given the difficult nature of that task, and how Feinberg weathered the controversy, he seems to be just as qualified as any other man or woman for this job.  But what exactly is his job going to be?

Feinber's job as compensation czar (Doesn't anyone remember that the last czar of Russia, Nicholas II, was killed by the Bolsheviks? Isn't that a good enough reason to stop using this title? No? Okay then.) will be to oversee the compensation given to top executives at institutions that have been beneficiaries of the government's recent bailouts.  That the Obama administration would create such a position is no surprise considering the public outrage over the news of some top executives getting bonuses after receiving government aid.   

While I may personally agree that this position makes sense, I wonder how effective Feinberg will be, and what help he will have in determining compensation levels.  Remember, we're dealing with 175 executives whose companies received billions of dollars.  These executives are still powerful men, and the culture that allowed those excessive bonuses seems entrenched in the American spirit.  How long will it be before these companies are out from under the federal government's thumb?  How long before these top CEO's return to the same risky practices that got them there in the first place? 

Creating this new position for Feinberg seems to be equivalent to putting a band-aid on gaping wound.  In my mind, the larger problem is the fact that these kind of bonuses are possible at all, not that these execs are using taxpayer money to give themselves huge bonuses.  Although, let's admit it, that's definitely a good reason to be livid.  But if we were to actually hold these CEO's accountable then we may have to take a big step and start holding our politicians accountable as well.  I'm not sure we're ready for that quite yet.

An Brief Introduction to the Executive Office of the President

No one will argue that the federal system of government has its flaws, and the American style of federalism is no exception. Our winner-take-all elections can sometimes leave a large percentage of the public feeling disenfranchised. The legal system (with the tiers of courts, overworked public defenders and frivolous lawsuits) leaves much to be desired in certain situations. The bureaucracy that impedes swift change can be infuriating. However, the three branches created by the Founding Fathers still operate in concert after all these decades of political infighting, public upheaval and overall turmoil that any nation encounters.

I've grown to appreciate the scale of the political games that each branch of government plays, and one branch, and in particular one office, has always held my attention. The Executive Office of the President represents a window into the psyches of the most powerful people in the country. The President of the United States, and the people that advise the President, shape policies that affect a nation.

Created in 1939 by President Franklin D. Roosevelt, the Executive Office of the President (EOP) was designed primarily to coordinate the growing staff of the President, and to give advice on the President's annual budget proposal.  The Office of Management and Budget (OMB) is now responsible for that monumental task, and even has a blog where various policy issues are discussed.  Over the years the EOP has changed drastically, and I would doubt that the first Presidents would recognize the new tools available to the 'modern' President.

Far from the staff of two or three that early Presidents had, the EOP has grown to include a staff of over 1,800 that operates with a budget of over $300 million. From the Council of Economic Advisers (particularly important in our current economic situation) to the National Security Council, the EOP plays a vital role in depicting the policy goals of the President, and helping him or her reach that conclusion. 

Still, why should anyone pay so much attention to this particular facet of our government? Because unlike other areas of government, it is far more difficult to hold this Office accountable for its actions. If a Senator is accused of corruption, he or she can be ousted and replaced in a fair election. Should a judge be ensnared in a scandal, there are impeachment procedures that can be followed and a new judge can be elected or appointed and confirmed.

The staff of the EOP is not elected. With the exception of a few high ranking positions, the people that give advice to the President are rarely confirmed by the Senate. In short, the people that have the ear of one of the most powerful men in the world do not answer to the public. For that reason, they deserve special attention. Behind President Obama stands a team of men and women that can offer up years of political and professional experience.  Think X-Men, but without the ridiculous latex suits. But who are these individuals that stand in the shadows of mystery, giving advice to our fearless Commander in Chief? (A comic book author I am not.....) People like Rahm Emanuel, the White House Chief of Staff, and Larry Summers, Director of the National Economic Council, have direct contact with the President on a daily basis, but to some all that is recognizable is their names.  We'll surely get to know these gentleman a great deal more as this administration continues to show the direction their policies will take. 

Welcome to the Blog

Welcome to the Executive Office Policy Blog. My name is Jared Sulzdorf, and I will be the primary author on this site. It is my hope that this blog will serve as a source of information and insight for anyone who is even remotely interested in the policy that emanates from the executive branch of our government, with a focus on the news coming from the Executive Office of the President (EOP). Over the next few weeks I'll be writing about the nature of the executive office, its importance, and my interest in this fascinating area of our federal system.  This blog will endeavor to give substance and character to the men and women that advise the President, as opposed to the names and faces we are usually limited to in press releases.  As an erstwhile student of political science, and political junkie, I hope that I'll provide a unique (and overly sarcastic) take on policies and current events.  If you want to see other ramblings of mine you can follow me on Twitter (@j_sulz), and I'm also on Facebook. The beauty of the Internet is that communication is always open, and in that spirit I hope to get to know anyone that has enough time and interest to read this blog.