Healthcare focus should be on cost reduction.

 SUBSIDIES AND THIRD PARTY PAYERS 

NO INCENTIVE FOR COST REDUCTION

It seems there may be some sort of short term agreement on the budget. The big obstacle has been the elimination of subsides for policies based on income for those who purchase a plan on the Obama exchange. Extending subsides and other ideas that help to pay for plans do not address the outrageous cost of so called, "healthcare" in the United States.

The Cost of healthcare in this country is not balanced in relation to peoples ability to pay. It has exploded way over what it should be as a proportion of peoples income. The cost is now 18% of the GDP, near double of the cost in other countries, the cost in 1960 in the U.S. was 5%. Many of these countries have government provided healthcare and it seems it inevitably lead to a decline in service. The per person cost in this country is now near $14,000 a year. 

In is no secret that the cost of healthcare rise is directly associated with the introduction of Medicare and Medicaid. When Medicare was first started, it paid the prevailing rate for service, but as the use of Medicare quickly increased, due to the fact that the cost was paid for by someone else, it quickly led to efforts of the government to cut costs by reducing payments for service. This instigated the practice of cost shifting, where insurance and self payers costs were increased to offset the cutting of payments for Medicare. This practice by government and the reaction by providers has been incrementally continued and increased  for many yeas. This created another problem with increased insurance costs that made many unable to afford insurance at all. Of course the answer is again, more government intervention and the pressure to go to government funded healthcare which will not fix this problem.

Most people get insurance coverage through their employer, the rise in cost has contributed to the non competitiveness of U.S. based companies. It has also raised the cost of education and government through very generous benefits. The co-pays have also increased dramatically. When people have third party payers they will show up for service for the most minor issues,. if they had to pay, they would do a cost analysis for many of these issues. 

The focus of government needs to be shifted from attempting to find ways to pay more to finding ways to cut costs. Only real market forces can do that. It is interesting that non insured elective surgeries have remained much more reasonable were individuals have to pay for the procedure, breast implants and laser eye surgeries are good examples.

There needs to be some new thinking, like employers giving employees a lump sum to purchase insurance. Really create market incentives in the market. Require up front estimates for surgeries and other services, patients could then make some choice based on the charges. It is the only thing we do with no up front revelation, just a massive bill at the end and negotiations either by self payers or insurance companies. Realize, that insurance companies often do not pay the bill that you see, it is often negotiated.

So, the best idea would to gather representatives of all interested parties and look for ways to cut the costs. Providers are saddled with massive amounts of red tape and efforts to get paid. I suspect there is much we don't understand about why these cost have exploded, find solutions to cut costs.

I think Kennedy is correct about focusing on prevention, starting at an early age through diet and exercise. I suspect we will reanalyze the heavy incentives for drug therapy that is costly and often leads to other problems created by the drugs. We need far more education about the dangers of the use of prescription drugs. With 20% of GDP spent on healthcare, we must be the most unhealthy people on the planet, not only physically but economically.

 

Election volatility, voters searching for real representation.

 ELECTIONS ARE SYMPTOM OF CHANGING WORLD

WORLDWIDE PHENOMENON

The election in New York city has many bewildered, how can a openly socialist candidate win this election? Of course, many have still not understood why Donald Trump has been able to win 2 elections for president. Much of this is not so much the allure of the candidate, but the rejection of the existing power structure that is now the being questioned, no only here but around the world. 

In fact, Obama was the pictured by many as a outsider candidate, but soon proved to have the same policies, especially in foreign policy, as the rest. Trump immediately went to the front against a bunch of traditional candidates because he was an outsider, then the outrage and universal opposition of the power structure, media, politicians and experts, just added to that outsider image. The reality is many people, and with 75% of the people under 30 voting for Mamdani, are rejecting the traditional candidates. They are being rejected because most believe they will not change course from the existing policy. A policy that in this country has resulted in a $38 Trillion in debt, and growing, a foreign policy of death and destruction that has not positively effective their lives and the perceived reality that none of them represent them once elected. 

In Europe the leaders of the the UK, France and Germany are under 25% approval  and they are openly attempting to disqualify any opposition candidate or party. There will be huge changes coming to the Eurozone one way or another. 

We see the same thing in central Africa, were traditional candidates are being replaced by those that are shedding themselves of the last remnants of colonialism and are being threatened from outside powers.

There is a strong desire for a change of direction and it is always dangerous because that direction may also not be exactly what people desire. It is obvious that the world order that existed since WW2 is coming to an end. The leading nations of that order are weighed down with massive debts and a loss of direction, other than attempting to keep the whole thing going a little longer. This debt and failure to address issues at home are now becoming evident everywhere. It will require new policies and new thinking, something that has not as yet become solidified into real policy.

Is Venezuela preparing for a serious conflict?

 CAN RUSSIA MAKE THIS INTO A HEMISPHERIC PROXY WAR?

IT APPEARS IT MAY BECOME MORE THAN A FEW DAYS CONFLICT

Reports are increasing of Russia, China and Iran supplying Venezuela with sophisticated drones and other equipment to at least give the United States some sort of damage if it attempts to attack Venezuela. Or will it actually put the cost high enough for the U.S. to rethink any attack at all?

No one believes that Venezuela can prevail against the U.S. if a serious effort is made to win a war. Many wonder if this whole thing was not a bluff to force Maduro to exit the country, if so, it now appears that is not going to happen. This will put Trump in a difficult position, if no attack is made he will appear weak and if he does and suffers casualties and even ships damaged it will not be a positive. It appears Venezuela is making preparations to seriously defend and the introduction of foreign assistance is another escalation, now in the western hemisphere.

The Russians and Iranians may consider this a payback for the support that the U.S. has been providing against them for years. The U.S. has assisted in the death and destruction of their countrymen in their part of the world.

Will this become another Cuban crisis in the effort to challenge the U.S. at home for leverage in what many believe is a system being proposed to concede spheres of influence in an effort to minimize nuclear armed conflict?

We will soon find out, as every day Venezuela becomes more prepared and the cost to the U.S. of maintaining this force is increasing every day. One might expect some sort of negotiated victory for Trump, to avoid actually risking some sort of prostrated conflict with losses for the U.S. military. 

Anticipating war, now the new normal.

 MAYBE LOTS OF POSTRUING, BUT NO ACTION

IS THIS TRUMP'S STRATEGY?

For months, there have been reports of war being imminent, Israel/Iran, long range missiles to Ukraine and now Venezuela. Lots of logistics, lots of assets moving into position, but so far, no action. Is the hope that threats of military action, will cause surrender by Iran, Russia or now Venezuela. If that was the plan it is obviously not working.

In Iran, since the last action in June, Iran has reinforced and strengthened is defenses, its offensive capacity has also been reinforced. Israel is in a far less positive political. economic and military position and the devastation from the last encounter with Iran is now finally being revealed.  The window to attack Iran may be closing, is this Triumphs strategy in these conflicts, procrastinate until the possibility of an attack is far more risky.

While we still hear reports from Ukraine and the U.S. media how Russia is losing and Ukraine is winning, it is clear that Ukraine is about to lose its last pivotal defense hub in Pokrovsk and is losing ground everywhere. While Ukraine still makes valiant attempts to resist they are usually resulting in more loses. While EU continues to talk of escalating, it is clear they do not have the political, economic or military to actually enter this conflict. I suspect Trump and Putin have agreed that they will not risk going to war over Ukraine.

The latest imminent conflict is Venezuela, where the U.S. has moved large numbers of assets into the region, indicating that war with Venezuela is in the works. Trash talk, encouraging Maduro to leave while he can and other threats have resulted in Venezuela taking action, including new defensive weapons from Russia and China to prepare. While the air power and naval power is massive, it would require at least 50,000 troops to invade. I do not expect that Trump wants to get mired in a ground war in South America, it would be magnet for all kinds of anti-American factions to get involved. What would an air campaign accomplish, except alienate most of South America from the U.S..

One must wonder if Trump, really is reluctant to get involved in any wars, but is stalling the neocons in Washington, who seem willing to go to war everywhere, Netanyahu who has been desiring destruction of Iran for decades and the same neocons in the EU who would love to rope the U.S. into war with Russia.

If this Trump's strategy, it will soon become clear, then those in favor of war will either escalate the pressure with false flag attacks or direct pressure on Trump. It is a high stakes game that is costing money, but not as much as war.

The tragedy of the Ukraine project.

 DOES UKRIANE HAVE A FUTURE?

SAD RESULTS OF FOREIGN INTERVENTION

It is estimated that Ukraine had a population of over 50 million in 1991 when they gained independence from the Soviet Union. The country has had a tumultuous political environment ever since that time. Todays population is now estimated at 26 million. Some of this decline is attributed to the population that is now in those areas controlled by Russia. 

Much of the discord has emanated from the fact that the eastern part of the country is primarily a Russian population, which has had close economic and cultural ties to Russia, the western parts have aspired to join the EU. In previous elections, the eastern population voted overwhelmingly for Viktor Yanukovych. In 2004 the election was close and Yanukovych edged out Yushchenko by a slight margin. The election was disputed and unrest followed with eastern oblasts threatening to secede if the election was overturned. A new election took place in 2005 with Yushchenko winning in a close race. 

In 2010 Yanukovych won 48.9 to 45.4 with overwhelming support in the eastern oblasts. After both these elections there was big increase in lawfare attempting to neutralize opposition leaders. Ukraine extended the lease with Russia for the Sevastopol navel base in Crimea until 2042 in exchange for low priced natural gas.

In 2013 a vote to begin integration into the EU was postponed and led to increased political demonstrations. Russia did not necessarily oppose Ukraine joining the EU, but a stipulation of the EU was that Ukraine would no longer be allowed commerce with the Russian federation. This was not acceptable to the eastern oblasts of the country. There was also speeches by western leaders claiming Ukraine would also be a new NATO member, this was clearly opposed by Russia.

In 2014 the crisis grew, with US. politicians like John McCain and Lindsey Graham speaking to the crowds encouraging them to change their government. Victoria Nuland admitted funneling $5 billion to opposition groups.  Eventually Yanukovych fled the country. This led to the secession of Donbas and Luhansk oblasts and the occupation of Crimea and a referendum that voted 95% to join the Russian federation. It also brought about attempts of the Ukraine government to outlaw all things Russian, from former monuments, to even speaking or teaching in Russian.

This began the conflict between Ukraine and the 2 oblasts that resulted in over 14,000 deaths over the next 8 years. There were several attempts at mediation that really were just window-dressing for preparing Ukraine for war with Russia. This came to a head when Zelensky, who won his election by promising to make peace with Russia, voiced and began moving troops to the east to exert dominion over the 2 breakaway oblasts and Crimea. This was countered by the Russian invasion into Ukraine in February 2022.

It is now almost 2026 and the war continues, It is reported that Ukraine has near 2 mullion soldiers killed. This would also translate to 2 million disabled due to this conflict. There are at least 7 million who have left the country, 1.3 million to Russia, 1.2 million to Germany and over 1 million to Poland, the rest dispersed around the world, mostly women and children. Men between 23 and 60 are forbidden to legally leave. Many younger men have also sought to leave the country.

Civilian casualties are estimated at 49,000 with 13,800 killed. It is most likely most of these are in the eastern part of the country. Many of the eastern cities have been leveled, although far eastern cities like Mariupol are being quickly rebuilt. 

Life goes on pretty much unaffected in the western part as primarily military resources are targeted, but daily life is interrupted by air raid sirens.

The east is the industrial and resource area of Ukraine, much of it part of the defense apparatus of the former Soviet Union and also the Russian federation. The loss of this region will have lasting economic consequences and every day Ukraine becomes a little smaller. 

It is likely that many of the educated and skilled who have found jobs and a new life elsewhere will not return. The country is now dependent on the west for financial support to keep the government going and estimated $5 billion a month. It may take many years for the country to recover economically. The eastern part will be rebuilt by Russia, but the infrastructure in the west will be a drain on the west to assist in rebuilding.

So far, Russia has avoided taking out the bridge infrastructure and the historic cities in Ukraine. The sooner the end comes to this conflict, the sooner Ukraine can attempt to be a viable country in the future. It may never be able to reach the potential that it had before the interference from outside in what was a internal political dispute.

The demonization dog and pony show.

 JUSTIFYING ACTION ON VENEZUELA

THREAT, PLUNDER OR JUST NEEDING A WIN

We are now witnessing the parade of talking heads, demonizing everything Venezuela and it leader Maduro. It is reminiscent of the same tactics we have witnessed many time over the last few decades. From Cuba, Iran, Iraq, Syria, Russia, Libya and now Venezuela. All the reasons to justify a military attack and a hoped for regime change operation. In every instance that this has been perpetuated, it has ended in disaster for the people of those countries, even while claiming victory.  

Are the people better off in Iraq, Syria and Libya? Has the U.S. national security actually been preserved and enhanced? Is Ukraine now in better place than before the U.S. funded and aided revolution in 2014? Is Russia now weaker and less of a challenger to the U.S. since our decades of demonization? We have witnessed similar tactics concerning Iran, the supposed major funder of international terrorism, which is a lie. Every President since George Bush 11 has been coaxed and chided into attacking Iran, so far, all have decided to pass. Is Iran an actual threat to U.S. national security? Is Venezuela? 

The U.S. citizens and the world have all seen this theatrical escalation to justify wars and death and destruction without any redeeming result, at least not in the national interest, but likely in the interest of some special interest. Whether it was for the plunder of the oil reserves in Libya and Iraq or the wish list of a middle east ally. These all have ended with disaster for the people of those countries and may continue for several more generations.  In fact, this pattern has eroded U.S. standing in the world, contributed to an escalating debt and imperiled the economic future of our people. 

Donald Trump's instincts wanted to stop this pattern of forever war, so far he has avoided plunging the U.S. into another participation in a major war. We can all see the immense pressure from within and without for the U.S. to take part in military action in many places. Can he say no to Venezuela?

Of course there are those who seek to plunder the resources of Venezuela, all which could readily be bought on the open market to the benefit of all. Then there are those who understand that protracted conflict in Venezuela and South America will be very damaging to Trump's hope of reform at home and his standing in the world.

Then, maybe it is just a hope for some sort of win, similar to Panama and Granada, rather than the risk associated with war in Iran. Trump still has some time to get out of this possible fiasco, but the clock is ticking, the cash register is ringing with costs associated with these forces standing by and the pressure is likely extreme by many factions to pull the trigger. It may be another defining moment in Trump's legacy.

Exodus out of Ukraine underway.

 YOUNG MEN ATTEMPT TO ESCAPE THE INEVITABLE

100,000 MIGRATE IN LAST 60 DAYS

In August, Ukraine softened its rules on cross border migration, it was hoped that it would increase repatriation of citizens now living outside the country. In September and October an estimated 100,000 exited the country. Ukraine also lowered its draft age to 23, it has been incrementally lowering the age from 27 over the last few years. One can assume that it may be set to go even lower, with increased pressure from U.S. supporters, like Lindsey Graham, to lower the age to 18. 

At present, voluntary enlistments are rare with most of new recruits abducted by teams that routinely watch for men between 23 and 60 that are forcibly sent to the front, many assume it is to their certain death.  

It is also reported that infantrymen in most brigades are hopelessly undermanned with officers and commanders often far outnumbering foot soldiers. The life expectancy of commanders, some who have been fighting for 3 years, is far higher than new recruits.

With the prospect of lowering the draft age to 18, one might expect anyone even close to that age, to be a prospective migrant.

In that same time period 50 eligible draftees have died attempting to cross the river into Romania. One can only speculate how many may have been able to successfully escape.

At present the military prospects for Ukraine are growing dimmer with numerous battles in the process of being concluded. It is clear that Ukraine, without direct intervention by NATO personnel, will be continuously retreating over the blood and bodies of its young men.