Clark Newhall MD JD

As Casey Stengel famously said, “it’s déjà vu all over again.”  Last week I wrote on how this bailout was a manufactured crisis, precipitated by greedy administration fatcats leading George “Dummy” Bush into a panic and then into a stupid decision.  I likened this “crisis” to the panic that led us into Iraq.  I suggested that just as Cheney’s old company, Halliburton, profited mightily from Iraq, so too would Paulson’s former cronies at Goldman Sachs profit from this panic.

All that was missing was the smoking gun.  Today the smoking gun turned up on the pages of the New York Times.

It turns out that at the meeting in New York where Paulson and Bernanke were discussing the bailout of AIG, “the only Wall Street chief executive participating in the meeting was Lloyd C. Blankfein of Goldman Sachs, Mr. Paulson’s former firm.”  The article goes on to detail the reason for Goldman Sachs’ interest: it was on the hook for $20 billion as counterparty in trades with AIG.  No bailout for AIG and presto—Goldman loses 20 billion and Blankfein loses this year’s bonus.

Well, all’s well that ends well.  AIG got its bailout and Goldman remains standing—for now.

Oh, by the way, the article also reports the details of how AIG collapsed, mostly due to trades of “handpicked” credit swap guarantees, supposedly risk-free insurance policies on debt paper.  These “insurance policies” written by AIG produced billions in profits, almost of half of which was paid out in employee compensation.  And guess what—the collapse of this market was no surprise.  It could have been easily foreseen as early as a year ago, when AIG first showed a loss on these transactions.

It might have been foreseen earlier had anyone cared to look into the characters behind AIG and this particular bright financial scheme.

It turns out that the guy who ran the AIG subsidiary, Joseph Cassano, was a former colleague of convicted felon Michael Milken, the jailed junk bond king of Drexel Burnham Lambert.  The apple didn’t fall very far from the tree.

One could also look at AIG’s own black history under Maurice Greenberg, the former AIG chief executive who was kicked out because of an accounting “scandal” (closely akin to fraud and theft.)

It seems reasonable to point out that doing business with thieves often results in losing your money to theft.  And so now we, the taxpayers, are going into business with the thieves of Wall Street and—it appears from the smoking gun news—the thieves have completely hoodwinked George “Dummy” Bush and the Congress once again.

I understand John McCain—he wants to be the bad boy who becomes the hero.  He is a Peter Pan, a boyish old guy with adult responsibilities who wants to chuck them all for NeverNeverLand.  That is how I explain his otherwise inexplicable (or at least irrational) choices.  Sarah Palin (forGodSake) as Veep.  “Suspending” his campaign to ride off to rescue the nation from Henry Paulsen.  Joe Lieberman as keynote speaker.

This is also a good explanation for his radical lurches into insulting and misogynistic riffs on his wife and his (female) campaign aides.  To his wife—“At least I don't plaster on the makeup like a trollop, you c**t.” To his aide, Brooke Buchanan—“bipolar”, “a drunk”, “someone with a lot of boyfriends.”  Peggy Noonan and even less reactionary mediaheads write this off as the “fun-loving” McCain, the “boys on the bus” goodtime Charlie, the “maverick.”

Truth be told, I understand and so do a lot of guys.  Off-handedly insulting, then profusely apologetic or enragedly self-righteous because my insult was “just in fun.”  It’s comforting to be able to claim the moral high ground of being misunderstood.  I am sure Peter Pan would cop the same attitude.

This even shows up in McCain’s political stands over the years.  He has the reputation of a “maverick” but he is only a “maverick” when ca cause excites him, when he sees some way he can throw a bomb and come out without a scratch.  McCain is less a maverick than a bomb-thrower.  He takes a contrary position, sometimes just for the hell of it, sometimes because he is mad, sometimes on the strength of personalities, but never on well thought out principle.  He throws bombs at other people’s ideas or comes up with his own bombastic ideas mainly in order to portray John McCain as “his own man”, “nobody’s stooge.”

Even in the Senate, this is fairly innocuous.  After all, an occasional bomb thrown into the crowd does not mean that you can’t vote 90% of the time with the rest of your party.  They will forgive the occasional bomb as long as it’s mainly a stinkbomb that you are throwing.

But that gets to the point.  A bombthrower in the Presidency is dangerous on a nuclear scale.  Throwing an occasional bomb, even if it is only a stinkbomb, has far more serious consequences in the Presidency than for a Senator from a western state known mainly for cactus and unrelenting sunshine.  And that brings me to my second point, which surprised me but makes sense.

I think McCain wants to lose the Presidential election.  Maybe he won’t admit it to himself and certainly not to others, but I think he knows that the job of President is hard and demands steadiness and forethought. It demands that you put your mind in gear before your mouth is in motion.  McCain is good at talking but not at thinking and not at sticking to a position.  He is chimerical and he does not like to be told what to do.  He really didn’t want to win the Republican nomination, at least not if it meant compromising whatever few principled positions he has taken.  Unfortunately for him, his Republican opponents were so weak and lacking in principle themselves that not even the “base” could stomach them.  So the “base” stayed away in droves and McCain was nominated despite himself.

Now he has what he wants—top Republican dog.  Now he has shown the Bushes, the Roves, the Falwells that he is a “maverick” who can win, a bad boy turned hero.

Again unfortunately for him, nomination is just the first step and this is where he falters.  After nomination, he has to swallow a Republican platform written by the most conservative members of the “base”, a platform that trashes McCain’s own views on immigration and abortion, that makes no pretense to be “maverick.”  And as the nominee, but not yet the “boss”, McCain has to swallow.  It’s as if Peter Pan came to London with Wendy and shed his green tights for a suit and tie.  A disappointment to himself and to his lifelong image of himself as someone who can thumb his nose at authority (his father the Admiral, the Naval Academy, the Vietnamese, the Arizona Republican Party, the President) and get away with it.

That is how I explain the otherwise inexplicable.  McCain doesn’t really want to be President.  Peter Pan doesn’t want to grow up.

Oh and by the way, even Peggy Noonan agrees: “He doesn’t need the presidency. He got what he wanted. So now he can coast.”

So here I am in McCarran Airport in Las Vegas, returning late in the day after a deposition in Dallas.  McCarran must be the best airport in the world for wireless users--I need a name for that concept.  Free wireless everywhere, no ads, no hassle.

I had a taco salad in the Jose Cuervo and overhead two youngish women talking about the mother of one of them.  her mother has recurrent metastatic breast cancer with mets inthelung.  "Can't she have a lung transplant?"  "I thought whenit went to thelung it was lung cancer."  She is going to run for the cure.  I will pledge to support her.  But she talked about getting her mother in to see a doctor in Dallas where she lives.  "We have to have a referral first.  The we will call y ou seven buseines days later."  She had connections, she worked for an insurance company.  She got her mother in to see the doctor faster.  "Oh" said the phone person at the doctor's office, "I'm so sorry.  I didnt know you worked for  [insert your favorite health insurance megopoly here].  the doctor can see her tomorrow."

We are back in the Middle Ages, where who you know or how much you have means more than justice or equity.

The New York Times figured it out on the front page this past Sunday—health insurance premiums are too high for people to afford to be insured. Wow. What a revelation for New Yorkers and the nation.

It came home to me this past month when I got a letter from my friendly health insurer, Blue Cross. I am self-insured and belong to one of the health insurance ‘nonprofit” plans gobbled up in the past couple of years by the big Blue Cross consolidator, Regence. Regence is also a ‘nonprofit.’ Why the quotation marks around ‘nonprofit?’ You will have to remain in suspense until a future posting. Maybe you can guess. If you think you know the answer, email me and win my everlasting silent praise.

No, sorry. This blog is not about ‘nonprofit’ healthcare organizations. It is about why I can’t afford health insurance and neither can you. And what is going to happen to us as a result. You might be surprised.

Anyway, my Blue Cross insurer kindly informed me that my copay percentage went up from 20% to 30%, my deductible increased from $2500 to $3500 and my premiums went up about 10% also. This is all for my own good of course. I need to make these ‘changes’ so that my ‘nonprofit’ Regence Blue Cross of Utah can 'continue to serve’ me.

Well, I guess I am lucky and I am certainly right in the place where John McCain and Shrub want me—I am an entrepreneur, I have my own small business, and I buy my own health insurance with a high-deductible Health Savings Account.
I just wish I felt like I was saving something. Instead it feels like I am pouring it down a rat hole called “the medical industrial complex.”

OK. I know that is a rip-off of Ike Eisenhower and the military-industrial complex. As a matter of fact, the rip-off was not mine (in print anyway.) The discredit belongs to Arnold Relman MD, former editor of the New England Journal of Medicine, who altered the phrase to mean the uneasy alliance of doctors, hospitals, insurers and drugmakers who are gorging themselves on the $2.3 trillion spent on healthcare last year and have been snorting and fighting at the trough since the mid-60’s.

The reason we pay so much (and get so little, but that’s another story) was masterfully stated in the title of two articles from Health Affairs; It’s the Prices, Stupid and It’s the Premiums, Stupid. They made the point that we pay high insurance premiums and that’s why there are so many people uninsured and under-insured.

The articles made the further point that the reason we pay high premiums is because the prices we pay to doctors and hospitals are also highly inflated. No surprise to anyone who ever looked at a hospital bill, I suppose. But apparently a big surprise to the apparatchiks who run the medical industrial complex and the minions who genuflect around them.

Anyway, to get to the point: What is going to happen? Well, there are only two courses. Either the medical industrial complex dies and is replaced by a system where money bears some relationship to delivered value OR the medical Industrial complex finds a new source of revenue. Clearly, the current revenue sources (you and me through direct payment and through failure of salaries/wages to keep up with inflation) are withering.

Given the power of the medical industrial complex (read $$$$) and the fact that it benefits from $2.3 trillion revenue last year, I predict that the new revenue source will be: NATIONAL HEALTH CARE.

TaDaHHH. Sure enough, just in time for elections, both Democrats propose essentially identical plans for bailing out the insurers-doctors-hospitals-drugmakers. Shrub was a piker when it comes to largess. He only managed to give a massive profit boost to drugmakers. He didn’t do anything for his other constituents in the medical industrial complex.

President Hillarack Obamton promises to step into the breach with a plan to make national health insurance an entitlement to perpetual profits for the insurers. This is NOT national healthcare, as everyone else in the universe understands it. It is a bailout of a failed system of Balkanized fiefdoms in medicine. The Balkanization will continue, courtesy of our taxes, disguised as NATIONAL HEALTH INSURANCE. The insurers and hospital and doctors and drugmakers will spend more and more on trying to out-advertise each other to get their slice of the pie. And our medical care, which never was the ‘best in the world’ that doctors like to lie about, will get worse and worse.

The other course, the unthinkable for the medical industrial complex, is a SINGLE PAYER UNIVERSAL HEALTH PLAN (no insurers need apply). In other words, adequate health care becomes a right, not a commodity.

That dream requires that the insurance companies, who drive the whole system by their false ‘nonprofit’ status, by their secrecy, by their immunity from antitrust laws---the insurers are driven away from the table. They do not deserve a place at the table. They do not do anything to add value to the discussion. They must not be allowed a voice in the discussion.

In the end, what we need is simple: Medicare For All. If Medicare, provided through a single payer that collects taxes and pays the providers, is good enough for you and me when we are 65, why isn’t it good enough at 55 or 45 or 35 or 25 or 15 or 5 or (dare I say it) a fetus?
So learn about HR676, the bill in Congress that allows the insurance dinosaurs a decent senescence period of fifteen years to die off and replaces them with an immediate MEDICARE FOR ALL. Sure, you won’t get liposuction on the national health plan. Sorry. You might have to buy insurance for that and great, go for it. But if you can’t always get what you want, you can get what you need. Support HR676 and tell your Congressperson to sign up as a sponsor or risk your wrath.

Dear Sirs,

I am responding to the letter from John Henkels about medical malpractice to applaud him for exposing the magnitude of the problem and to chide him for seeking a solution that disregards the victim.

Mr. Henkels is correct in stating that "There are enough true instances of actual malpractice on the part of doctors and hospitals for trial lawyers to make a good living." In fact, the Institute of Medicine has estimated, based partly on data collected in Utah, that there are as many as 100,000 deaths annually from medical mistakes. That is more than double the 45,000 annual deaths from auto accidents.

Unfortunately, physicians, hospitals and their malpractice insurers are not willing to admit even the simplest and most obvious mistake without forcing the medical malpractice victim to resort to costly and time-consuming litigation. As a result, many victims of medical negligence never receive compensation for their injuries. For many, the injury they sustain is worth too little in dollar terms to justify the huge cost of hiring medical experts and preparing to fight the well-heeled insurer in court. Malpractice insurers, doctors and hospitals know this fact and count on the inability of the injured person to afford the cost of obtaining fair compensation.

Doctors, hospitals and insurers work very hard to keep the public in the dark about the reality of medical malpractice. Most lawsuits are settled with strict confidentiality provisions that prohibit the injured person from exposing the healthcare provider who injured him or her. This is true even if the doctor or hospital has been the culprit in many previous instances of malpractice. We are periodically horrified to discover a killer in the medical profession. We shouldn’t be. In Utah, as in many states, laws passed at the urging of the healthcare industry prevent disclosure of hospital records that describe why and how someone was injured and what actions the hospital took (or didn't take.)

Shielded from public scrutiny by these laws, negligent or dangerous doctors, nurses and hospitals can continue to operate with minimal oversight. We may be horrified at the killer doctor, but we should be even more worried to learn that the organization that hired him or her knew about dangerous activities long before anyone died, yet took no effective action to prevent a dangerous situation from becoming deadly.

So yes, Mr. Henkels, you are correct; there is plenty of medical malpractice to keep my legal colleagues and me busy far into the future. But you are wrong in assuming that restricting the injured person's ability to obtain compensation for his injuries is the right answer. The solution to the problem of continuing malpractice should not come at the expense of the victim. Thank you,

Clark Newhall MD JD
Physician & Attorney

1. Encourage practice guidelines. “Practice guidelines” are what less competent doctors call “cookbook medicine.” Hundreds of practice guidelines have been tested and verified over many years and well-trained physicians know them and heed them.

Unfortunately, getting most doctors to follow guidelines is like herding cats. Therefore, the report recommends enshrining practice guidelines in law, making practice guidelines an absolute defense to a malpractice claim. This turns a good idea into a colossal mistake. Making practice guidelines an absolute legal standard will not protect negligent doctors from liability; but it will force competent doctors to practice by guideline even when it is not appropriate. Guidelines are just that—guidelines, not firm and fast rules. As medical knowledge changes, so do the guidelines. They change much faster than the law could ever track. Making these guidelines a legal standard guarantees bad medical care in the future.