The Need for a Positive Approach to the Medical System in the United States

The First Thing that needs to be said here is that the Medical System in the United States does need to be drastically reformed.  It is the most expensive Medical System in the World and No. 2 does not even come close.  To make Things worse, someone who lives in the United States has about the same Life Expectancy as one does in Cuba, Way behind Places like Japan, Italy, France, Switzerland, Germany or, say, even behind Singapore or Cyprus.

 

Chart showing the astronomical Rise of Health Care Costs in the United States

The Health Care Reform Act (so called „Obamacare”) is an Attempt at doing precisely that.  However, what started as a well intentioned and even noble Effort was deteriorated by Compromise after Compromise and became filled with Loopholes which, not unexpectedly, Health Insurance Providers are eagerly trying to exploit.

Just to set something in Perspective:  the United States has the highest paid Doctors in the World.  Many Doctors who graduate from Medical School in Foreign Countries, where the Cost of getting this Education is Zero or near Zero, trek over as soon as they can to the United States where they can earn 100 Times or 1.000 Times more than they can in the Country where they went to School, leaving their Governments angry at having invested in their Education but not being able to retain Doctors in their own Country, where they are so desperately needed.

Doctors are just one additional Problem.  Hospitals have in place Elaborate Systems to extract the Maximum possible Revenue not only from Insurers but from the Government as well, when providing Medicare or Medicaid covered Services.  Both the Government and Insurance Companies fight back.  Some think, Hospitals know how to outsmart not only the Insurance Companies but, more importantly, the Government.

If you are an Individual who would pay out of your own Pocket for Medical Care without having any Insurance, forget it.  The so called „List Prices” for Facilities and Services could be (and generally are) several Times higher than what the contracted Prices which the Insurance Companies or the Government pays are.

One Example that has been used alegorically over and over is the Cost of an MRI, which is the modern Version of a simple X-Ray.  Sometimes, just an X-Ray might suffice but, not surprisingly, Hospitals almost exclusively do MRI's which can be/are far more profitable.  Just how profitable?  The List Price for an MRI can vary, are you ready for this, anywhere from $ 800,00 up to $ 17.000,00 at some Hospitals.  And that, according to a recent investigative Report, for the same exact Procedure.

Ever wondered what an MRI costs in Germany?  We can end your Suspense:  $ 160,00.  France:  $ 160,00.  Italy?  $ 140,00.  Japan, which has one of the highest Cost of Living Indexes in the World?  $ 60,00.  All, using the same Equipment.  Now, an MRI is no indication of how long you are going to live but it can be more than a Coincidence that People in Japan live the longest followed by those in Italy.

There have been well publicized Problems with the Federal Government's Health Insurance Marketplace Website; These were not to be unexpected and certainly will be resolved, probably sooner rather than later.  The Problem, however, lies deeper than that.

Most People are clearly dissatisfied with the Situation as it currently stands and is developing.

http://firstread.nbcnews.com/_news/2013/10/30/21252291-poll-majority-think-health-law-needs-overhaul-or-elimination?lite

The Question, we believe, is just what Kind of a Path is necessary to go forward, whether Congress, the Health Insurance Industry, Hospitals, Doctors and Health Workers want to hear it or not.  Health Care in the United States consumes, if one includes the Cost of Litigation (such as Malpractice) associated with Health Care to more than 18% of the GNP, a staggering Amount.  Even without the Cost of Litigation, it is in Excess of 16%.  Some sort of National or quasi National Reform which would include Coverage ensuring reasonably unform Health Care for all Americans is not only necessary, but also overdue, way, way, way overdue.  Bismark figured this out way back in the 1890's.  Every other industrialized Nation and many others in the lower Tier have some System to deal with Health Care for its Population in some Form or another.  There are Similarities as well as Differences between the Systems that various Countries use.  That is not only understandable but to be expected.

And, as President Obama stated (and conceded, although others did not), one must start from building by drawing on the System that is already in Place.

Looking at the American Precedents already in Place, why not keep everybody's Insurance where it is (which is what was originally envisioned), take all the uninsured under the Threat of a Penalty (as the Legislation does now) and throw them into a Medicare/Medicaid/quasi Medicare/Medicaid Program and then, based upon Verification of Employment or Self Employment, charged them a Premium based on Income/Ability for Coverage.  Then take the Insurance Premium which would be actuarially appropriate for that Individual and throw it on an Insurance Company based on a statistical Pool.  Insurance Companies which throw Individuals out of their Plans hoping to cash in on the Bonanza, would be discouraged in doing that because all that would happen to those Cases is, the Government would turn around and throw the Policies back at them through this Assigned Risk Pool and charge the Premiums which should prevail; they would be the same or lower as what the Individuals would have had under their previous Plan, since the Insurance Companies would try to change the Insurance Plan only for those who they thought they could get more Money from.

Bottom Line, except for General Rate Revisions (which is not what one should be talking about right now), all Insurance Health Insurance Policies which are already in Place, should not be changed based on „Technicalities” (Change in Provisions, number of Insured Covered and so on).  This, however is not what is happening right now and, some say, 14-18 Million Americans could be either left without Health Coverage or be forced to pay significantly higher or exorbitant Rates or, worse, be thrown out of the Insurance Pool altogether.  This is the very opposite of what the Law is trying to accomplish.

http://investigations.nbcnews.com/_news/2013/10/29/21222195-obama-administration-knew-millions-could-not-keep-their-health-insurance?lite

Another Thing that would resolve the Mess (this, based on Systems used in other Countries); if you are unemployed (with insufficient Assets), then the Government picks up the Insurance Premium until you are re-employed; if you are married, then the whole Family is covered under the Premium, even if Wife (oops! Or Husband)/Children are unemployed/not working and if your Wife/Child/ren seek/obtain Employment, they do have to pay their Premium and so do you.  Translation:  everybody working pays a Premium and everybody not working has Insurance based on working Family Member(s) or the Government.  Retirees would continue to get Medicare as they currently do.  Medicare Part B is already based on Ability to pay, since the Cost incurred by the Government per Beneficiary is $ 400,00 or so.  Most pay $ 100,00 or so but, even if on Medicare and having Part B, if someone has or is making abover certain Thresholds, they have to pay more, up to the entire $ 400,00 or so.  Finally, for Retirees, the Concept that Medicare Part A is paid 100% by the Government for all, then Medicare Part B is paid partially by the Government for most and that, regardless, on Top of that, one needs still additional Insurance in Order to reach a Deductible Level which they can afford...well...that sounds, no it doesn't sound, it is a Can of Worms in which Doctors, Hospitals, Clinics and Insurance Companies only see Billions and Billions of Dollar Signs.

 

Finally, someone woke up and removed the Cap on the Medicare Tax.  That is a good Thing.  Currently, however the Medicare Tax Rate is 0,9%.  Why the Medicare Tax Rate (which is supposed to cover  Medicare Costs on a current Basis...those working today pay for the Health Care of Retirees) does not even come Close to covering what it costs the Government to provide Medical Care to Retirees defies Credulity.  Keep in Mind, this is just to draw a Parallel on Priorities, The Fed(eral Reserve Bank), (Mr. Bernanke), is spending $ 82 Billion a Month (a Figure not included in the Federal Deficit), simply for his Quantitative Easement Theory (he would call it a Policy), the only tangible Result of which has been to propel the Stock Market (Dow Jones) to over 15.000 Points.

 

 

Armed Guards...Everywhere?

Recently, we wanted to mention something when several People got shot somewhere...where was it?  It is easy to begin losing Track.  Then, 13 People, including the Killer, got shot and killed at the Washington D. C. Navy Yard.

The Situation in some distant Places is also dire.  60-70 People died over the Weekend at a Shooting in a Mall in Nairobi, Kenya and it is not over yet.

Schoolchildren got killed.  Innocent People got shot at in Public Parks or, in some Cases, worse yet, killed, in Chicago and elsewhere.  An Arizona Congresswoman got horribly injured and several innocent People around her got killed in a Shooting.  People got killed while matching (albeit a violent) Movie in Colorado.  Students shot Students in Schools.  Some got caught in Time but others didn't and they wound up killing their fellow Students.  We could go on and on but it is not necessary, we don't think.

In the Middle of all this this comes Wayne la Pierre; he is the Leader of the National Rifle Association; with a Suggestion:  place more Guards, more „Armed Personnel” as he put it under the Scenario, „Arm more good Guys to Keep the bad Guys at Bay (or simply shoot them, we surmise)”

http://presspass.nbcnews.com/_news/2013/09/22/20636650-nras-lapierre-calls-for-more-armed-personnel-after-navy-yard-shooting?lite

Aside from what we think are the obvious Problems with that Line of Thinking, we see another Problem; we are wondering if Mr. la Pierre and others see the Problem too.  There used to be a Time when everything, well, almost everything, was easily accessible; Government Offices, Courts, Schools, Hospitals, Airports and more.  All this has changed now, of course.  What makes it particularly worrysome is not necessarily those who live and work in these armed Fortresses, but those who have been left outside.

Ordinary Citizens.  Be it in an Automobile, on the Street, in a Shopping Mall, even in a Home or an Apartment.  Clearly, there simply isn't enough Money, either in the United States or elsewhere to have Guards everywhere.  The logical Conclusion of such an Argument, ad Absurdum, would be to have almost as many Guards as People who Need to be guarded, Police and quasi Police everywhere.

All Firearms are by Definition deadly.  Having a Pistol for Self Defense or a Rifle for Hunting are Rights protected by the Constitution.

However, allowing the Citizenry to posess sophisticated automated or semi automated Weapons which have clearly been designed for Warfare, for Conflicts between States, in the Hands of everyone is simply bringing Warfare into our Cities, Communities, Places of Work, Places of Worship, Places of Entertainment, on Streets and Parks, everywhere.

And while Mr. la Pierre (and others) may think it is a swell Idea for a whole Bunch of „Good Guys” to posess such Kinds of Weapons, meanwhile, countless Individuals who are simply going about their ordinary every Day Business, who do not own such Weapons, who may not want to own them, who may not have the Money to own them, who may be too old or too young to own them, are simply unwitting Targets for an incredible Carnage which is taking place in Front of our very Eyes.

Syria -- a difficult Choice

So, now, Syria has come to the Front Burner.  A Friend who wondered what would be the correct Choice on Syria also expressed the Inclination that to strike might be the preferred and logical Alternative.

It is a difficult Choice.  However, it does not appear that all of the necessary Variables of the Equation are available in order to make a correct Decision.  It might be appropriate to list just what the available Information is, at this Point in Time.  It also needs to be emphasized that the Information which is available, classified or not, is subject to re-Evaluation, literally, at a Moment's Notice as more Information becomes available.

Here is what we see so far:

The United Nations

It is clear that an International Intervention against Syria, limited or otherwise, is not possible within the Framework of the United Nations.  Russia and China are against a Security Council Resolution authorizing such Action and both have Veto Power.

This makes problematic any Action outside of the Scope of the United Nations, because such Action would be taken precisely because Approval cannot be obtained in the Security Council.  Simply put, one cannot easily make the Argument that the United States would go to the United Nations seeking Approval of such Action and, absent such Approval, it would act outside of the Scope of the United Nations or within another Framework or Coalition.

United States Domestic Policy Considerations

President Obama has set a courageous and correct Precedent by going to Congress to ask for Approval of a contemplated Military Strike.  We discussed the Implications of the Policy in an earlier Article.

Approval in Congress may be difficult but, it may prevail.  Straws in the Wind seem to indicate, however, that there might be some tough Sailing ahead.  Senator McCain, an outspoken Hawk in favor of Intervention, confronted some tough Questions at a Couple of „Town Meetings” which he has just held.  Polls seem to indicate that the Population as a whole is opposed to Intervention, limited as the President said it would be, by something around 48 to 28%.  There is a strange Coalition, composed of Liberal Democrats and Conservative Republicans which oppose Intervention of any Kind, leaving those who are in the „Mainstream” to carry the Weight and Responsibility for giving such Approval to the President.

The Situation in Syria

No one, including the Syrian Government disputes that they posess Chemical Weapons.

Less clear it is who used these Chemical Weapons in the latest Incident in which, according to credible Reports, approximately 1.400 People were killed, many of them, Children.  Truly a horrendous Act.  Some have suggested that the Rebels may have captured some of these Chemical Weapons and used them deliberately in order to entrap the Assad Government.

The United Nations Inspectors' Report will be available shortly and will become an important Factor if it corroborates the Intelligence Reports obtained by the United States establishing that the Assad Government used these Chemical Weapons against Civilians.

Even if the Rebels are aided as a Result of these contemplated Military Strikes, it is by no means a foregone Conclusion that Rebels associated with al-Qaeda or other Fundamentalist Movements would not inordinately benefit from them.  Interesting is the Position taken by a Veteran French Diplomat in an Open Letter to the French Parliament:

31 août 2013

Non aux frappes symboliques et de bonne conscience. Oui aux frappes utiles en Syrie.

31 August 2013

No to Symbolic Strikes (and for Conscience's Sake).  Yes to useful Strikes in Syria.

(Le Monde)

http://syrie.blog.lemonde.fr/2013/08/31/non-aux-frappes-symboliques-et-de-bonne-conscience-oui-aux-frappes-utiles-en-syrie/


(in French)

The Allies

Crucially important are the Allies who would be participating and/or supporting such Strikes.

So far, they are Canada, Turkey, Saudi Arabia and France.  After Canada, however, Things get murky when analyzing these Allies.  Saudi Arabia, which has Regional Political Considerations, that is one Thing.  Turkey which has been an arch-Enemy of Syria and would like nothing more than to have Syria destroyed, is another.  France; France has just announced that they will wait for the United Nations Report which seems to be an eminently sensible Thing to do.

Notably not joining in such a Coalition are Countries which normally can be counted upon:  Germany, Japan, Italy and, most importantly, the United Kingdom, where Prime Minister Cameron's Motion to join in such a Coalition was voted down by Parliament, putting his Government on a rather shaky Footing.

The Damage in Syria has been done.  There may be more Damage done if there are no Strikes.  However, the Likelihood appears to be that there will be more Damage done even if there are such Strikes and that Prudence and Patience are the best Choices as the Order of the Day.




 

Shifting from the Snowden Affair to the Real Debate

To briefly recapitulate the Events concerning the Snowden Affair:  After Days and Weeks of Salami Tactic News Developments, Edward Snowden left Hong Kong for Moscow on Sunday, 23 June 2013, his Final Destination still unclear.  Hong Kong jumped on a Technicality to rid itself of Snowden and thusly, together with and likely in Consultation with Mainland China (Hong Kong is under the ultimate Jurisdiction of The Mainland) passed on the hot Potato (or kicked the Can, one might say) into the Hands of Russia and President Putin.  President Putin and consequently Russia have been ambivalent on the Issue; they have refused to hand Snowden over to the United States, yet, at the same Time, they have not been particularly eager, if indeed, eager at all, to offer Asylum to Snowden.  Indeed, President Putin has come down, to a Degree, on the Side of the United States, stating that as a Condition for Snowden to be offered Asylum in Russia, Snowden would have to agree not to further „damage” the United States.  As recently as today, however, President Putin indicated that Snowden should ultimately leave Russia.  Russia's Motives are unclear and perhaps intentionally murky but it is difficult to imagine that it has not had at least partial Access to the Information which Snowden has; nobody knows what Kind of Information this is, perhaps not even The (Manchester) Guardian, which broke the Story and has been continuing to develop it but all Indications are that it is considerable.

Snowden had originally wanted to go to Iceland but he appears to have changed his Mind and now wants to go to South America.  He seems to have been influenced in this Decision by Julian Assange, of Wiki Leaks.  Julian Assange himself has received Asylum in Ecuador but cannot get there; he is confined to the Ecuadorian Embassy in London.  Venezuela, Bolivia and Nicaragua (the Latter in Central America), seem to have offered him Asylum of one Sort or another but it is not easy for him to get there because any Commercial Flight might either have to fly through United States Air Space or be within reach of United States Jets which may force the Aircraft to land on United States Territory, thus effectively foiling Snowden's Escape.  There has been much made of the Fact that Snowden cannot fly because his U. S. Passport has been revoked; this Point is of questionable Validity because any Country which offers Asylum to Snowden can also issue a Laissez Passer (a simple Travel Document, literally meaning, let this Person pass).  People have and still do travel without a Passport (willingly and sometimes unwillingly) when extraordinary Conditions exist.

However, ultimately, we believe, the Fate of Mr. Snowden is not central to the Crux of this Issue.

So, moving on to the Second Aspect, it has been revealed that considerable Eavesdropping has taken place against Friends and Foe alike; Russia, Western European and South American Countries.  Many of these Countries are furious over the Revelations and demanding Explanations, which may be slow in coming.  This Issue, we believe, is not central to the Crux of the Issue, either.  Espionage has taken place since Time immemorial, both against Friend and Foe alike.  It is often a messy Business but everyone does it and everyone uses any and all Means at its Disposal to do it as best as possible.  Nearly all Countries, if indeed, not all Countries, conduct Espionage at some Level or another and, whoever is best at it comes up with the best Scoops.  Greeks did it, Persians did it, Romans did it, the French did it, moving along to more recent History, the Germans did it, the Allies did it and most certainly, the Chinese have done it all the Time and keep on doing it in the grandest of Styles.  So, while it may sound like a dirty Business and it is, everybody does it and, thusly, nobody should be surprised by it.  In the old Days, when caught, Spies were hanged or, as Things became more modern, shot; these Days, they are usually sent to Jail or traded for other Spies.  At Times, Spy Trade become a flourishing Business, actually (Take, for Example, the Case of former Russian Spy Anna Chapman-yes, she is Russian, who supposedly even offered to marry Snowden).

 

Former Russian Spy Anna Chapman who was „traded”

To the Question, what is the central Crux of this Issue, we believe, the Answer is simple:  based on Snowden's Revelations and other Information, one Needs to ask, what are the Powers and, indeed, the Boundaries of a Country (in this Case, the United States) to gather indiscriminate Information on most if not all of its Citizens.

http://nbcpolitics.nbcnews.com/_news/2013/06/09/18863448-lawmakers-americans-dont-know-how-carefully-the-government-is-watching?lite

It is also interesting to note the evolving Role not only of the NSA but also of at least one Private Corporation, Booz Allen Hamilton, which was (perhaps it still is) a noted Accounting Firm (in plain English, Bookkeepers, Beancounters), which has gotten into a Business which does not have much (if anything at all) to do with Accounting.  Sorta like Lawyers getting into Brain Surgery, one might say.

http://usnews.nbcnews.com/_news/2013/06/15/18940842-growth-of-intel-outsourcing-no-secret-but-now-congress-taking-notice?lite

http://usnews.nbcnews.com/_news/2013/06/11/18901089-leaked-secrets-pose-a-risk-for-booz-allen-where-secrecy-means-billions?lite

President Obama correctly pointed out that one has to strike a Balance between Security and Privacy; the Question is, if this vast amount of Information which is being collected from the American Public markedly increases the Security of ordinary Americans and if so, by how much.

Recent Experiences, those in Communist Countries and other Dictatorships indicate that ultimately, total (or nearly total) gathering of Information from the Populace can be a suffocating Experience.  According to the Explanations offered by James Clapper, the Information Gathering Activites of the NSA are not only legal but have been authorized by Congress.

Many disagree.  A Reading of Section 702 of the Foreign Intelligence Act,

http://uscode.house.gov/download/pls/50C36.txt

does not, we don't think, lead all of us to reach the same Conclusion which Mr. Clapper (and others), seem to have reached.  Many Congressmen were not familiar, if familiar at all, with everything that the NSA has been doing, even though Mr. Clapper assures us that every Member of Congress was debriefed on the Activites of the National Security Agency.

http://usnews.nbcnews.com/_news/2013/06/07/18827047-who-is-behind-the-snooping-and-how-long-has-it-been-going-on?lite

Of Concern are also the Activities of the FISA Court, the secret Federal Court to which the NSA goes for Approval, although, we assume that they did not even have to go to the FISA Court for the broad intercepting Activities which appear to involve a huge Amount (if not most) of all Telephone Conversations and eMails.

http://www.nytimes.com/2013/07/07/us/in-secret-court-vastly-broadens-powers-of-nsa.html?nl=todaysheadlines&emc=edit_th_20130707

Constitutional Concerns have been raised on the Issue of the FISA Court (which most People did not even know existed, until recently), having non adversarial Proceedings and what Appeals, if any, can be made.

Of further Concern is the broad trawling of Data (which the Government calls Meta Data) which, as the Word Trawling suggest, is essentially nothing more than a Fishing Expedition.  The Concern has been expressed that if one can use the Constitution to justify that Type of Activity (the Process has not been subject to Constitutional Review), then a Lot of other Things could conceivably be justified which otherwise, one might have been reluctant to justify.

It should further be noted, in this Context, that, according to recent Polls, most American People oppose this Kind of Wholesale Data Gathering, Meta Data, Trawling, Fishing Expedition, whatever one ultimately calls it.

The Constitution of the United States is a wonderful Document; it was written more than 200 Years ago by some brilliant People who could not have possibly imagined what the Country they were founding will some Day look like.

Many have argued that the Constitution should be treated as a dynamic Document, which is to say, a Document which should be interpreted in accordance with the changing and evolving Conditions which prevail today.  That may be true; it may also be appropriate in many Instances; however, at the End of the Day, we are still left with that relatively simple Document; the Constitution of the United States and one should be careful, we believe, not to equate Dynamism with Evisceration.

Why don't they tell us?

There has been a steady Stream of Bad News from Washington lately, having to do with Surveillance, Privacy and related Issues.

There was the Associated Press Reporters Story.

Then there were the IRS Stories, involving, of all People, some Tea Party Groups seeking Tax Exempt Status.

Overnight, last Night, the Story regarding the Gathering of Telephone Call Logs by the National Security Agency from Verizon broke out.  Quickly rumours spread that other Carriers, notably A T & T are involved also.

http://usnews.nbcnews.com/_news/2013/06/06/18796204-nsa-snooping-has-foiled-multiple-terror-plots-feinstein?lite

Now it further appears that an enormous Amount of Internet Traffic, eMails, Web Site Visits, we don't know exactly the Extent of it, is under Surveillance also.

http://www.nytimes.com/2013/06/07/us/nsa-verizon-calls.html?nl=todaysheadlines&emc=edit_th_20130607&_r=0

http://openchannel.nbcnews.com/_news/2013/06/06/18809021-sources-us-intelligence-agencies-tap-servers-of-top-internet-companies?lite

There is Legal Precedent, for those of us who have studied Law for having serious Concerns regarding something called „Overreach.”  The Reason the Government has given for obtaining Secret Court Orders for such extraordinary Surveillance, unprecedented in American History is Terrorism.  And, Terrorism is a serious Issue, witness the recent Events in Boston, not to mention 9/11 and everything else that has happened in between.  Nonetheless, many are beginning to look at whether the War against Terrorism can be achieved without resorting to Secrecy when undertaking such extraordinary Measures which many also view, correctly, as Invasions of Privacy; something which the American Constitution and American Tradition have fiercely guarded for over Two Centuries and something which has become a Model, an Ideal, a Beacon for the Rest of the World.  In other Words, the War against Terrorism can be used to justify many Government Actions but not all of them in this Context.

To be sure, the Roots of these Kinds of Actions go back to the (George W.) Bush Administration.  But President's Obama's Administration has to shoulder the Responsibility and, right now, it appears more and more likely that Attorney General Eric Holder will be asked to fall on his own Sword.  But that may only be a Stop Gap Measure unless President Obama confronts the Issue and also establishes a Model, a Policy for successive Administrations to follow.

The simple Question is this:  why don't they tell us beforehand?

Senator Lindsey Graham (R., North Carolina) stated today that he is himself a Verizon Customer and if the Government was keeping track on his Calls to Waziristan, we think he said Waziristan, he would not have a Problem with it.  Neither would we or anyone else, we don't think, but would it not be appropriate to tell Senator Graham and everyone else that the National Security Agency would be doing this?  Then everybody knows and understands that Telephone Calls, Internet Traffic, whatever, is being subjected to some Sort of Surveillance and that can be the End of that, rather than the Facts coming out Slice by Slice in what one might refer to as a „Salami Tactic.”

Likewise, it may all be well and good that Senator Dianne Feinstein (D., California) states that all this was cleared and approved in Advance Years ago but, the Issue seems to be of sufficient Magnitude to where one has the Right to ask, why were the American People not informed this was going on?  It is difficult, we believe, to formulate an Argument that Secrecy adds Value to the Program; Carrier Pigeons and other antiquated Methods are not alternatives which Terrorists and Enemies of the United States could use with much Success.

 

Fiscal Cliff

Recent Reports suggest that soon, a Family of Four will be paying $ 25.000,00 for Health Insurance annually and that, with less Coverage and higher Deductibles.

While the Affordable Care Act (so called Obamacare) is a Step in the Right Direction, it is, some suggest, not nearly enough to bring under Control Medical Costs.

Various Statistics reveal the following:

§ Medical Costs in the United States are the highest in the World.  The Second Runner Up is at less than half.

§ Doctors in the United States earn the highest Incomes of any Doctors anywhere, so much so that Doctors from less affluent Countries who have a Medical Education in English (it is considerably more difficult to pass the Boards with a non English Medical Education) are clamoring to get a Foothold in the United States and practice, yes, practice Medicine, of course.

§ Despite all this, Life Expectancy in the United States is just about Neck in Neck with Life Expectancy in, of all Places, some place like Cuba.  There are a Multitude of Reasons for this, of course, including Dietary Factors but, still, one would expect more, given the Costs of Health Insurance and Health Care.

§ A Common Medical Procedure, known as an MRI costs, on Average, according to some Statistics, $ 2.500,00 in the United States.  It can be performed at some Outpatient Clinics for as low as $ 600,00 and one Reporter recently found a Hospital in Boston which charges in Excess of $ 7.000,00 for this exact same Procedure.  Health Insurance Companies have Contracts under which they pay less (why should people who pay for Medical Care out of their own Pocket have to pay more is a Question which deserves being raised and be examined on its own Merits).  The more interesting Thing, though, is that the same exact Procedure, an MRI costs approximately $ 160,00 in Germany, France and Italy.  In Japan, a Country not exactly known for low Costs, it costs $ 60,00.  They all use the same exact Equipment, manufactured by either Siemens or GE and, at least two of the four Countries above, Germany and Japan, are not exactly known for low Wages.

What is going to be compromised between Mr. Obama and Mr. Boehner with regard to the ,,Fiscal Cliff,'' whatever that means, is yet to be revealed and it is probably not known by either of them at this Moment.

However, one Item which has come up is the new Medicare Taxes which will be going into Effect 1 January 2013, as a Result of Legislation passed by Congress and signed by Mr. Obama.  This Legislation provides, no, it does not provide for new Taxes, it establishes the Provision that Medicare Taxes should continue on Wages in Excess of $200.000,00 (for Single Taxpayers) and $ 250.000,00 (for Married Taxpayers).

http://nbcpolitics.nbcnews.com/_news/2012/12/11/15846903-democrats-seek-delay-in-one-obamacare-tax-increase?lite

Suddenly, this Provision has now come under Scrutiny and may be sacrificed as part of the Negotiations to avoid the so called ,,Fiscal Cliff.''  We do not understand this Point.

The Congress and the President of the United States can decide what the Obligations (including the financial Obligations) of the Federal Government will be on a Year to Year Basis.  Some of these Obligations are inescapable, they are either dictated by Law or by Contracts (such as Debt Interest, for Example).  How are Wage Earners who make more than $ 200.000,00 or $ 250.000,00 ,,hurting'' the Economy by paying 1,45% of their Wages for Medicare Tax on Income above that Amount?

Paranthetically, another Tax which is equally regressive is the Social Security Tax, currently at 4,2% for Employees, but only on the First $110.000,00 of their Wages.  Translated, that means, of course, that People who get huge Salaries, sometimes $ 500.000,00, sometimes $ 5.000.000,00 or even more, simply pay that $ 4.000,00 or so in Social Security Tax and then are 4,2% ahead for every Dollar they earn from $110.000,00 forward.

One Thing is apparent.  With this Kind of Manœvering, if it comes into Play, very little is going to get accomplished.  And the Can will be kicked forward.