Dusk Jacket Hardcover (6x9) Price: $23.98 
What is our duty as We the People when over 80% of us feel that the country has gone off track and is moving in the wrong direction? Washington seems incapable of bringing it back. Well meaning politicians with good intentions are not able to fix the problems because they have become part of the axis of SIGLAP (special – interest – groups – lobbyists – and – politicians). Corporations are engaged in the practice of “capitalism without conscience”. One percent seems to be amassing inordinate wealth and power at the expense of 99%.
Obviously our duty as We the People is to help Washington and corporate America to restore their sense of direction.
When my book “Sense of Direction It Needs to be Restored” first came out in 2008, the national debt was a little less than 10 trillion dollars. Now nearly six years later it is over 17 trillion and climbing. Per capita healthcare expense was around $7,000. Now it is around $9,000 and climbing. With the implementation of Affordable Care Act (it should have been named Unaffordable Care Act), it will climb further and faster. Median household income has come down 5% and unemployment has gone up considerably.
The financial and economic crises of 2008 have been treated with Troubled Asset Relief Program, Economic Stimulus and Quantitative Easing, pumping trillions of dollars into the system, while saving the miscreants and their loots for them to enjoy. The rich are getting richer and poor are getting poorer and increasing in numbers. The middle class which is the bedrock of society and democracy is contracting in numbers as well as in earnings.
President Nixon went to China with the intention of opening a huge market for American goods. America has become the largest market for Chinese goods, and China has become the manufacturing factory for the rest of the world. With its surplus holdings of 1.3 trillion US dollars, government of China or its Communist Party can easily influence and manipulate the economy and politics of this country. The “Citizens United” verdict by the US Supreme Court in 2010 has extended this right to non citizen entities in the name of the freedom of speech.
To rebuild and boost the middle class we need to bring the manufacturing back to the United States of America. Cost of labor is the biggest expense in manufacturing. If we can reduce this cost, many American companies and multinationals will happily bring their manufacturing business back to this country because American culture is very conducive for achievement and innovation, and American workers are the most productive.
Healthcare expenditure has become the 800 pound gorilla in the room. The cost of healthcare for an American worker is twice as much as for a Japanese worker and more than 10 times that of a Chinese worker. We spend 18% of gross domestic product for healthcare in this country. In Japan they spend only 9% and their healthcare outcomes are better and longevity the highest. If we bring down our healthcare expense to 15% of GDP (gross domestic product) we will save about 500 billion dollars per year. This will work as an economic stimulus year after year after year and the US government will not have to borrow more money to provide stimulus to the economy. It will also save our children and grand children from the burden of an ever increasing national debt. With per capita healthcare expenditure coming down, the cost of labor will come down and manufacturing will go up and provide new job opportunities. Unemployment will go down and middle class, once again, will begin to expand and prosper.
So how can we bring the healthcare expenditure down irrespective of the source of funding, and make healthcare affordable and accessible to everyone? Obamacare which took nearly thirteen months of full time work on the part of the President and the Congress and produced 2300 pages of unread materialhas failed in this respect. Moreover it was passed by Democrats only without a single Republican vote. The Social Security Act of 1935 and the Medicare Amendment to the Social Security Act which established Medicare and Medicaid in 1965 enjoyed bipartisan support. The congressional voting record shows that. These two programs enjoyed a much larger support and reflected the will of the people a lot more than Obamacare, which is now losing support even among many Democrat congresspersons and senators.
Three bad laws need to be repealed : (1) “Citizens United” because in the name of the freedom of speech, it allows corporations, associations and labor unions to make contributions of unlimited sums of money to super PACS which can greatly influence political campaigns and elections, (2) “Obamacare” because it will increase the overall cost of healthcare and even after its full implementation, it will leave twenty to thirty million people without health insurance and (3) Medicare Modernization Act of 2003 that went into effect in 2006 because it has increased the cost of healthcare by $ 40 to $ 75 billion a year for prescription drugs for seniors, inflating further the coffers of already super rich pharmaceutical and insurance companies at the expense of US taxpayers.
The influence of corporate America on Washington has been increasing over the years. The enactment of Medicare Modernization Act or Medicare part-D is a perfect example. In 1965 when Medicare was enacted it agreed to reimburse hospitals at “cost plus” basis which meant a reasonable cost plus a reasonable profit. Both kept going up and became very unreasonable. In 1983 Medicare used its innovation to develop Diagnosis Related Group / Perspective Payment System (DRG/PPS) to control the hospital costs. Similarly Medicare started reimbursing the physicians for their services in 1965 at their prevailing customary charges and these charges kept creeping up over the years. In 1992 Medicare came up with another innovation and introduced Resource Based Relative Value Scale (RBRVS) system to control physicians’ fees. In 2003 when Medicare part-D was being developed, a similar innovation should have been used to control the cost of prescription drugs. An easy and simple method would have been to mandate drug makers to charge Medicare beneficiaries no more than the average market price of any drug in G-7 countries other than the United States. These countries are Germany, France, England, Italy, Japan and Canada. They are rich and fully developed. Pharmaceutical companies have no justification whatsoever to charge US consumers more than what they charge in these countries. If they want to be fair, they should actually charge less because US taxpayers provide nearly 45% of funding for research and development of new drugs. Their stronghold on Washington helps the drug companies to maintain the status of sacred cow and keep on charging US consumer two to three times as much as they charge in other G-7 countries.
Other examples are the insurance companies and HMOs. They joined hands with the pharmaceuticals and all worked together to extract maximum benefits from Medicare part-D. They used 952 individual lobbyists to do their bidding in Washington in 2003 and spent nearly $141 million on this effort. Aboutone-half of these lobbyists had easy access to the Congress or the White House because of their prior job related connections. The Medicare Modernization Act of 2003, although dubbed the Medicare Drug Benefit Act to help seniors, was essentially a giveaway to special interest groups comprising drug companies, HMOs and insurance companies. Their army of lobbyists made sure that Medicare Part-D would be administered by private companies and that Medicare would not be allowed to negotiate or bargain the prices, nor would it be allowed to import drugs for seniors from Canada or other countries where medicines are just as safe as here but much less expensive.
After the passage of Medicare Modernization Act (MMA) or Medicare part-D in 2003 the drug prices in the US started rising even faster than before. The drug manufacturers knew that the MMA was going into effect in 2006 and their bills for the largest segment of prescription drug users – the Medicare beneficiaries – would be guaranteed by American taxpayers.
In a similar fashion health insurance rates started going up rather dramatically after the passage of Patient Protection and Affordable Care Act (ACA) in 2010. Some rate increases, say 5% to 7%, were justified in order to cover the cost of some extra benefits required by the new law. But an increase of 20% or 30% as many big companies did was totally unfair. I think these companies knew that a very large segment of population was going to receive government subsidies to buy insurance through the health insurance exchanges. In other words they could see the guarantee of being paid by Uncle Sam through these subsidies. Obamacare, without a doubt, will increase the total healthcare cost and help the health insurance companies get richer at the expense of US taxpayers, just as MMA did. And in my opinion the overall increase in healthcare expenditure as a result of Obamacare will be far greater than that by MMA.
No serious effort has been made over the last eight years to bring down the overall cost of healthcare. During this period the healthcare expenditure has gone up from 15 per cent of the gross domestic product (GDP) to 18 per cent. During the next eight years it is likely to go up to 21 per cent. With Obamacare it will get there sooner and faster. Even at 18 per cent it is much too high and poses an undue burden on economy.
Fixing the medical liability system can bring the heath expenditure down by 10%. Another 10% of savings can be achieved by curtailing excessive utilization and excessive profits along with a rational approach to the care of terminally sick and elderly. Four to five per cent of savings can easily come from replacing the Medicare Modernization Act with Medicare Fair Drug Pricing Act. All these have been described in a comprehensive manner in my book “Sense of Direction IT Needs to be Restored”, along with the ways and means to reform and boost Medicaid, Medicare and Social Security and make these programs sustainable for the long haul. A twenty to twenty five percent saving in healthcare expenditure would mean a reduction from 18% of GDP to 15% or even lower, and will represent per capita savings of $2000 to $2500. That should be our goal and we must achieve it sooner than later, so that it may bring the cost of labor down, and at the same time, provide economic stimulus year after year without borrowing any money from future generations.
Now the final step – how to convince Washington and corporate America to cooperate. Both seem to have become immune to old methods like writing letters, signing petitions or even demonstrations in the streets. Even mass media seem to have become ineffective. Michael Moore’s movie, Sicko, in 2007 brought to the attention of millions how sick and expensive our healthcare system is, and how insurance companies keep on getting richer at the expense of their insured members. But it failed to bring about any useful changes. His movie “Capitalism: A Love Story” in 2009 exposed the extremes of capitalism harming the society along with the lack of will or inability of the political class to do anything about it. It also failed to bring about any changes in Washington or corporate America. Then came the Occupy Wall Street movement of 2011 – 2012 with protests, sit-ins, sleep-ins, and speeches by the Occupiers, to highlight the disparity in the income and power of 1% versus 99%, all around the country. With the help of ruling class, 1% seems to have won, reinforcing the fact that they are happy with their power and money and want to maintain status quo and keep on denying economic justice to 99%.
This brings me to the final and most important point that We the People must find a new method to influence Washington and corporate America. In order to restore their sense of direction we need to change their mindset so that they give up their allegiance to the axis of SIGLAP and reaffirm their dedication to serving the people. It may look like a formidable task, but it is a challenge, we must take. The question is how we should proceed. Here is the answer:
We should write a comprehensive document on behalf of the people detailing the problems and their solutions, and bombard Washington with at least one million copies – A Million Book March – if you will. The book “Sense of Direction It Needs to be Restored” is that document and it has been written on behalf of, and dedicated to all people living in the United States of America. A blank page has been left in the beginning for a personal note in individual handwriting to the President, Congresspersons and Senators.
This note, in my opinion, should go like this: Dear Mr. President........ / Dear Senator........ / Dear Congressperson.........,
We / I want you to repeal “Citizens United”, “Obamacare” and “MMA” and enact “MFDPA” (Medicare Fair Drug Pricing Act) as outlined in this book. We/I also want you to make new laws and policies based on the recommendations given in this book.
Thanking you,
Respectfully,
Signed (All family members if possible)
(Home address)
Sending all these books via US Mail will have a greater impact and help the United States Post Office also, creating awareness all around the country at the same time. The President’s address is: The White House, 1600 Pennsylvania Avenue NW, Washington, DC 20500. The names and addresses of senators and congresspersons can be easily obtained from the government websites. All books should be sent to Washington and not the local offices.
Books with dust jacket hardcover will look nicer in the hallways of the White House and the Capitol than the paperbacks. Four copies per family (one for the president, one each for the two senators and one for the congressperson of your district) bought from the website www.sodhealthcare.com will cost less than $ 100 – a very worthwhile investment for this cause. The bulk of profit from the sale of this book will go to charity, research and education. That is my pledge.
The voice of the people from the pages of a million copies of “Sense of Direction It Needs to be Restored” lining the hallways of the White House and the Capitol will reverberate 24/7 and help Washington to restore its sense of direction. Corporate - America, and its lawyers and lobbyists will take notice and study in depth the contents of this document. To their dismay they will find that they have been engaged in the practice of “capitalism without conscience” for a long time, denying economic justice to so many people. They will also learn how to practice “capitalism with conscience”. This will help them to restore their sense of direction. With Washington’s and corporate - America’s sense of direction restored, the country will start moving in the right direction.
Abraham Lincoln, before he became the presidential candidate, gave a very long speech at Cooper Union in New York City in February 1860 and closed with these words: Let us have faith that right makes might, and in that faith, let us, to the end, dare to do our duty as we understand it.
As I understand it, our duty, at this juncture in the state of the Union, is to try to bring the country back on the right track. For my part, I am trying. But I need at least a million more to join and make this movement successful. The youth of America should take the lead and all of us should help and support them whole heartedly. With a mounting national debt of over 17 trillion dollars that they are inheriting without their consent or even knowledge, it is their future which is at stake. And they are the future of this nation. It behooves us, each one of us, to make this movement successful.
We the People must do it. There-in lies our duty, and redemption too.
Raj K. Gandhi, MD
05/14/2014