However, the same distrust and disgust are just as true with the state government of Illinois. We have a governor under multiple federal investigations, a General Assembly that can never seem to pass a budget, and political patronage happening out in the open with no regard for citizens. The gridlock in Springfield is universally despised and all other attempts to reform Illinois have failed. Change is sorely needed for Illinois.

That is why it is disappointing to see the same firm that crafted the candidate for change was just given a  two to three million dollar contract to oppose a constitutional convention. Among the arguments they will make is that convening a constitutional convention will give power to all the special interests, that the constitution will be made worse, and that there is no way to elect good people to a convention. They have already gone so far as to tell seniors that a constitutional convention will take their pensions away even though federal law is clear that it can't. In short, the ads can be reduced to a sound bite: "No… you can't."

In November, voters will be able to vote to convene a constitutional convention to amend the state charter. This would allow for the ending of gerrymandering, the practice of politicians picking their voters and not vice versa (see Illinois Congressional District 4's map for an illustration of how absurd the maps have gotten). An additional change could be adding the ability of citizens to recall elected officials, a right many states currently already enjoy.

Many of the problems that Illinois faces are a direct result of a constitution written in 1970 to create a "strong government." This allowed politicians to amass incredible power and to engage in rampant and overt corruption. For instance, the Cook County presidency was almost literally bequeathed from father (John Stroger) to son (Todd Stroger) reminiscent of a title of nobility in the Middle Ages. The constitution guarantees state pensions but it was also explicitly written to not require funding of the pensions. This has resulted in the worst funded pension system in the nation. We aren't even close to 49th place.

The governor can treat budgets as advisory and move money around at will. The leader of a legislative chamber can unilaterally kill a bill with no recourse by other members of the chamber (see House Bill 1 which was sponsored by over 80% of the Illinois Senate, yet still killed by Senator Debbie Halvorson).

In all this, the citizens are disempowered. Illinois election law is the most restrictive (and unconstitutional) in the Union. Third party and independent candidates are required to get over 10 times more signatures and are subject to capricious ballot challenges that keep them from being listed on the ballot. Ballot initiatives are not binding and routinely ignored by politicians.

Even the balanced budget requirement in the Constitution is considered a "moral imperative" when crafting the state budget. This requirement is unenforceable which is how the state gets away with trying to pass a budget $2 billion out of balance. Try considering paying your next property tax bill with a "moral imperative" and see how that works out.

Citizens are disempowered and government is dysfunctional. The result has been a grassroots movement comprised of Republicans, Democrats, Libertarians, Greens, and those who normally would not associate with a political party. The citizens are demanding that Springfield change. The question is why the same people running Obama's campaign are saying, "Change you must fear."

The pension problem is chiefly a creation of the current Illinois constitution. The constitution regards pensions as an “enforceable contractual relationship” which cannot be diminished. Come hard times the pension checks must still go out. However, the constitution does not require the funding of the pension system. This was a very intentional choice by the convention delegates in 1970 who wrote the text.

It made sense to the delegates to give the General Assembly discretion in how they funded the pension system. The General Assembly has used this discretion to shortchange the pensions every single year since ratification. Some years they even took money out. This discretion has been grossly abused and shows the General Assembly as a poor steward of the pension system. The chief problem facing the pensions is not “generosity”, it is a chronic and perpetual failure of the state to contribute the amount they promise.

There are those that argue the solution to this problem is to simply let the state out of its promise to workers. The problem is that such a solution would be ruled unconstitutional under the federal constitution. Article I, Section 10 of the U.S. Constitution lists several things states cannot do. States cannot enter into treaties, coin money or impair the obligation of contracts. By calling pensions an “enforceable contract”, the U.S. Constitution forbids them of taking them out from under people, even via constitutional amendment.

Those who are vested in the pension system could not have their pensions confiscated, period. Federal case law is clear on this point in cases such as McGrath v Rhode Island Retirement Board. Anyone who says the pensions will be taken is using fear-mongering in an attempt to scare citizens from demanding the reforms they are entitled to.

On the other hand, adopting a “wait and see” approach will only result in an exponentially growing pension debt that eventually leads the state into bankruptcy. There is an exception to the federal contract clause, namely if the diminishment of a contract serves an important public purpose. While it is impossible to know for sure, avoiding bankruptcy of a major state certainly is an important public purpose to which a court may decide a benefits reduction is necessary.

In short, there is no risk to the pensions by trying to address them in a convention, however, waiting for bankruptcy does entail significant risk to those in the pension system and potentially even those already retired.

So what could be done to fix the pension problem in a convention? The only proposal in the state (that isn’t a promise to fix the problem) is one that I created. Namely, the General Assembly has proven they cannot be trusted to fund the pensions and keep their promises. Instead, the constitution should be amended to require the employing agency to pay the pension contributions directly out of their own budget.

The benefits of this are several. One, a state agency can be sued to force them to pay the promised pension contributions, the General Assembly cannot be so sued. Two, employing agencies pay the full cost of abusive pension games to benefit top administrators. Three, employing agencies will bear full cost for employment of people and will make more efficient hiring decisions. This will not fix the debt already incurred, but it stops the massive bleeding from a General Assembly failing year after year to keep their promises.

If you want to save your pension in November, vote yes for a constitutional convention. If you want to roll your dice and gamble with your retirement, vote no. Either way, we deserve a state that keeps its promises.

Two lessons learned:
1) Always have a sport coat with me
2) When my hair gets long, it looks like crap (I have since gotten a haircut)

Two weeks ago, I testified at the Senate Executive Committee hearing on HJCRA28 and spoke specifically about the ability to recall judges. There is understandably some concern with this (and rightfully so) that unpopular but legally sound decisions could cause a judge to be recalled from office. I had proposed that as a prerequisite to recalling a judge, the judicial discipline process in Article VI, Section 15 of the current state constitution be used. At the time, Senator Hendon expressed that he liked the idea and he has incorporated my suggestion into his current amendment.

The big problem with the bill that no one has caught so far (and admittedly, I missed it when I testified two weeks ago) is that an officeholder subject to a recall can also run to succeed himself should the recall succeed. To illustrate, let’s say Blagojevich/Quinn get a successful recall petition that’s on the ballot. Both can, in turn, can submit the right paperwork to run in the succession election that occurs during the same election. It is important to note because of the condensed time frame, there are no primaries. This means, like what occurred in California in 2003, you would have a crowded field running to replace a recalled official. It is entirely plausible that an official who is successfully recalled will be able to get “re-reelected” with a plurality of the vote in a crowded field. That is why most recall provisions prohibit the recalled official running from running as a successor candidate. There is no prohibition in this amendment.

An interesting idea surfaced two weeks ago during the recall debate then, that because the Governor and Lt. Governor run together as a ticket that they must be recalled together. I find this idea rather unconvincing considering that there is no requirement that they must be impeached together. I think it is a ploy to accomplish two things: put Lt. Governor Quinn in the hot seat for pushing this issue and make it harder to accomplish recalling a governor successfully. Voters who may want to recall a Governor may vote no simply because they don’t want to “take it out” on the Lt. Governor. I am not sure how much of an effect it has, but it’s there.

Lastly, the big change and big win is the inclusion of local officials in the recall amendment itself. The amendment, however, restricts recall to only “salaried” elected officials. This immunizes school boards, for one. In smaller towns or counties, elected officials there may not draw a salary. Officials who are paid per-meeting “stipends” may also not be subject to recall. It’s a limitation that I can live with, but I prefer that anyone elected can be recalled. It’s philosophically sound that way. I’m not sure the reason for shielding unpaid officials.

I certainly do think that SJCRA70 is an improvement on HJCRA28 with the adding in of judges and most local officials. I think the threshold for signatures could be lowered to 10% for all the offices and would like to raise the number of counties needed for statewide recalls, but by and large I think most of it is good. The show-stopper here is that a recalled official can run to be their own successor which all but nullifies the intent of recalling them in the first place.

Largely, the preparation for a constitutional convention has been done by the same two individuals (with the valued assistance of many other individuals) who are pushing for a yes vote on the con-con question: myself and Bruno Behrend. We’ve been talking about this for years, identifying the flaws in the current constitution, the reforms that are sorely needed in Illinois to stem corruption and ways to truly empower the voters to make their voices heard. Admittedly, this is a less than ideal situation.

In addition to a book we’ve written that will be coming out in May called “Illinois Deserves Better: The Ironclad Case for an Illinois Constitutional Convention”, we’ve written a draft constitution which we think covers the deficiencies in the current constitution, reforms those aspects of the constitution that assist corruption and truly empowers the voters.

You can view our work at http://www.myillinoisconstitution.org and comment on each section of our draft constitution individually. It is time to open up the political process to the public so that we can truly participate in the governing process and that should start with the drafting of our new constitution (or the amendment thereof). Feel free to leave comments and feedback, we want to know what you think.

There are two arguments that a constitutional convention is inadvisable: the necessary changes can be made through other means (i.e. electing better politicians) and that there is no way to ensure that reform-minded delegates get elected. Skipping past the individual merits of these arguments for a moment, the arguments perfectly illustrate the problem. On one hand, we need to elect better politicians (I agree); on the other hand, we can’t enough elect good politicians to make a difference (I also agree). The opposition to a convention presents no solutions, just another intractable problem.

Fixing the balanced budget loophole that allows the state to count debt as “income”, ending gerrymandering, allowing binding citizen referenda, creating recall elections, enabling open ballot access and term limits all have to be done in a constitution. There exist only three ways to amend the constitution. The legislature can do it, citizens can have a referendum to amend the legislature article only, or a constitutional convention must be convened.

Currently the General Assembly is required to pass only one bill per year, the state budget. They could not even do that without being months late and still engaging in chicanery. HB 1, one of the many state ethics reforms bills in the General Assembly was passed 116-0 in the House and has 47 Senate Cosponsors. You would think that a bill that is not only supported by 80% of the Illinois Senate, but actually sponsored by 80%, would be law. One Senator, Emil Jones, has killed the bill and that is that.

The General Assembly cannot pass simple reforms right now, much less the constitutional changes that are required to fix our broken government. There are amendments in the General Assembly that contain many of the reforms that Illinois citizens want, they’ve been declared dead on arrival.

Citizens could initiate referendum, but only on the legislative article of the constitution and then only the “structural and procedural” items it contains. Some good reforms could be made this way, but it would not fix the deep-seated structural problems (like counting “debt” as “income”) in the Constitution because those referenda would not be allowed.

That leaves the only option to fix the structural problems with our government and the current constitution is a constitutional convention. This is the precise reason why such a provision was put into the current constitution; to allow the people to take control and reform the government when all other avenues have failed.

The state is in dire shape with over $106 billion in debt, a failing pension, government officials on every level being investigated or indicted on federal corruption charges, and the needs and interests of citizens routinely being ignored. Illinois deserves better.

Electing good politicians would help, but there are structural problems in our constitution and laws that close the political process to “outsiders”. Third party and independent candidates, for instance, have to get 10-15 times the number of signatures as “established” parties, for instance. More importantly, constitutions are written to restrict the harm bad politicians can do. That’s why there are “Bills of Rights” and “checks and balances” with a mind of keeping the level of harm as small as possible.

If a convention happens, it will take work to identify and elect reform-minded delegates and it won’t be easy. However, sitting by and hoping things get better means the state gets driven to bankruptcy, more politicians get indicted and the needs of the citizens continue to be ignored. This November, citizens have the power to take back their government and effect the changes that are needed before it’s too late. The General Assembly has failed; now it falls to us.

For most of my life I have been a staunch conservative, not sure really when that started, I just always was. It was the way of things. However, after 7 years of a conservative presidency, a quagmire of a war, an economy in tatters and on the way down, it is clear that conservative policies are simply wrong.

If the “free market” big business policies of Republicans worked, why are millions of us losing our homes and millions more on the edge? If tax cuts for the rich were to herald in an era of unpresidented prosperity, why are there records of numbers of people on food stamps? We’ve seen tort reform, where is the health care for the 50+ million people who don’t have insurance?

It’s clear that the ideas have simply failed, which is largely why I (and conservatives and right-wingers) were so vicious. When you don’t have anything else to stand on, you attack and claw away. But eventually (hopefully) you realize that you are fighting for a failed idea. And that’s why I’ve jettisoned conservatism, the Republican party and I’m going for Obama.

The Obama campaign, more than anything, is a voice to the disenchanted that things have to change. Republicans, despite the rhetoric, have sold us out to the rich. Values voters are all about the “right” thing, as long as its “their” rights. Yet, not even a few weeks can go by without a Bush cabinet member being implicated in corruption, more Republican congressmen found on the take, and the biggest proponents of “social values” being exposed as notorious perverts. Enough is enough; we need change. I cannot associate with the Republican party anymore. I’m not leaving them, they have left me and millions others poorer in their wake.

The childish partisanship (which I had once ashmadely participated in) that has been fostered by Bush has brought about bitter divisions that have left America weaker within than we ever have been. A senseless war has left us weaker abroad. A “go-it-alone” foreign policy has left us isolated with no friends. No that we need foreign investment to prop up our economy, we are left with no one willing to help us except George Bush’s Saudi oil buddies.

Limited government has been shown for what it really is, allow big corporations to run roughshod over workers, the environment and our legal system. When banks are on the verge of falling over now, it is the shareholders not the average consumer that gets a bailout. It’s no wonder the gap between the rich and poor is accelerating so rapidly… at every chance this government simply takes more from us and gives it to them.

I plan to vote for Obama in November (as soon as Hillary’s slash-and-burn campaign of self destruction ends) so we have the chance to turn America around and make the American Dream possible again

The interesting thing about the debate on this issue as a travel across the state is two-fold. First, honest grassroots people of all political stripes generally agree that both Illinois is in serious constitutional trouble and generally agree about the package of reforms needed. Second, those opposed to a convention do not debate the reforms that are needed, they simply argue that a convention would "make things worse" or that it simply would not be successful.

It is important to point out, my push for a convention is not meant to enshrine conservatism in the Illinois Constitution. While every reform I am pushing is amenable to conservatives, progressives and moderates agree also. A constitution isn’t a place for policy debates, it’s a place to deal with fundamental rights and governmental structure in which amazingly everyone more or less agrees. For instance, recalling elected officials, open ballot access, binding citizen referenda, open government and ending gerrymandering all enjoy majority support in both parties among the grassroots.

If such a push for a convention were meant to establish conservatism as the supreme law of the land, it would fail. Let’s be honest, conservatism isn’t particularly welcome in the Illinois GOP. The push for a convention would allow for people of all political stripes (including conservatives) to freely advocate for their ideas in a meaningful way. An as an aside, I firmly believe that the future of the ILGOP depends on convincing voters of their reform credentials and supporting this convention is about the only way they can assume any real power in this state again.

The push for a convention is meant to open up the political process so people besides entrenched interests can influence the debate on issues. The corruption in the governor’s office is enhanced and incentivized by a constitution that gives him a great deal of power he ought not to have. The governor should not be able to create legislative benefits that no one asked for, no one wants but no one can do anything about. We should not have a chief executive who can establish laws by fiat.

The corruption in the General Assembly is a factor of a legislative structure that insulates the ILGA from public influence. Districts are gerrymandered to make races uncompetitive. Elections push out third parties and independents. The primary system reflects a political reality that hasn’t been true for many decades. Lastly, the legislative leaders (the four tops) have complete control over the legislative process. We do not elect and pay the salaries of 118 representatives and 59 senators just so Sen. Jones and Rep. Madigan can make all the big decisions. Those two can and have unilaterally killed bills, just take a look at HB1 to see how a unanimous bill in the House with 47 Senate cosponsors can be stopped because of one man. We vest too much power in this individuals and we see the logical result… rampant corruption.

Normal Illinois voters see this and are disgusted. They see their friends, families and themselves taxed out of their homes for "pay-to-play" politics. They see government at every level in Illinois under federal investigation. They see other states thrive while Illinois is left behind. Most importantly, the issues important to Illinois voters are left by the wayside.

Not every problem facing Illinois needs to be addressed in a constitution, but many elements of the 1970s constitution (for instance, creating a strong governor) have directly lead to the constitutional crisis we are in now. There exists no other avenue with which to effect these reforms and waiting 20 years ensures that the crisis will grow to the breaking point. This is the last, best hope for normal Illinois voters of all political persuasions to enact the reforms we so desperately need. Illinois deserves better. Join me in making it happen.

In what was considered a bizarre response, Chavez ordered several battalions to the border with Colombia and has threatened all-out war with the country. Ecuador is understandably upset, but many attribute Chavez's latest media-grabbing stunt as more saber-waving from a dictator who craves international attention for "standing up to U.S. imperialism." There are important reasons to take Chavez's threats at face value, but first some background.

United States Military Doctrine

Since the 1990s, the United States Armed Forces have held various iterations of a win-win doctrine. The current version of the doctrine (the 4-2-1 strategy) states that the United States will maintain the capability to "conduct two, overlapping 'swift defeat' campaigns… [and] the force must be able to 'win decisively' in one of the two campaigns". In layman's terms, this means the United States has set up its military to win two medium-sized wars simultaneously.

It is also important to note that the United States military debates its over-reaching strategy out in the open for the world to see. Not a single spy is needed to determine how we structure our military and with what aims in mind. A foreign agent can pick up any number of academic journals, surf the various public military and government websites, or read the many books written on the subject. No security clearance is needed. Other countries know full well what we design our military to do and conversely know what limitations we build into our system.

One can look at the current situation of the U.S. military and see how this strategy has worked (albeit not without bumps). The military is engaged in operations in both Afghanistan and Iraq and achieving successes in both countries. The only area where improvement has not been substantial is in the area of nation-building, particularly, getting the native populations to take responsibility for their own political destiny. The lack of will for U.S. imperialism has come at a price.

The current situation shows that the strategy can work and is working. Al Qaeda in Iraq is essentially no more. However, it has also shown that it engages a large proportion of the resources available to the United States military that can be used for war-fighting. The preventative operations still continue, sure, but it is less than clear that the United States could, without significant difficulty, engage in a third conflict; much less a fourth conflict.

The Foreign Policy Objectives of China and Russia

In the sense of power distribution, international relations is similar to a zero-sum game. When one nation loses power, some other nation or nations gain power. The inverse is also true; when a nation gains power, it comes at the expense of another. When the USSR collapsed, the United States largely gained the power that was left on the table. This has been a point of consternation for some time for the former world power.

On the other hand, China, which has never been a superpower, does overtly crave such a status. In order to achieve such a status, the United States would have to relinquish or lose some of its current power. This leaves China and Russia as partners in a similar quest, to gain international power at the expense of the United States, the only country which that power must come from.

As an additional sideshow, there are a variety of powers across the globe that would cheer at the prospect of an American military embarrassment (no small number are European). Many lay commentators cheer on Russia and China, who criticize America's foreign policy, including commentators in the United States. One ought not to be naïve to think that these nations which murder journalists and dissidents, repress speech, and shun the rule of law inside their own borders are suddenly acting with the purity of wind-driven snow once on the international stage.

Currently, both Russia and China have ties with Venezuela (that include Russia shipping military goods to Venezuela). Russia also has historical ties with Serbia and has been a vocal supporter of Serbia against the independence of Kosovo. Currently, both areas are now volatile with Chavez's threats on one side and antagonistic behavior by Serbia on the other. Kosovo and Colombia, on the other hand, are US foreign policy commitments to continue to support those countries.

As an important counterpoint, there are elements in China and Russia that do not see eye-to-eye with the hostile-to-the-US foreign policy. They are minorities but they are the ones with money. Many of the largest businesses in both countries are beneficiaries of the American economy and thus have a vested interest in the status quo.

Could Chavez Be Serious?

Currently, the United States economy is in trouble; there is broad consensus on that at this point. Bad lending is never a good thing for an economy. Full-on economic collapses are usually combinations of multiple factors, bad lending often being one. So if Chavez isn't serious, he, along with Russia and China, is quite stupid. That is a presumption we ought not to make.

The United States military is structured to win two conflicts simultaneously. If both Kosovo and Colombia-Venezuela go hot, even militarily we would be stretched thin, if not to the breaking point. Odds are we would face the choice of sacrificing one or the other to avoid "losing" a war. With forces already on the ground in Kosovo under the auspices of NATO, we would likely have no choice but to fight in that conflict. Colombia, on the other hand, would be very easy to leave out to dry.

If forced to fight in both additional conflicts, it would provide an enormous additional strain on an already troubled economy. Drastic funding choices would have to be made to support the resources required to fight in all four conflicts simultaneously independent of the number of troops consideration. It is entirely possible that it could push an economy on the brink of recession into a full-on recession. Or for that matter, push an economy in a recession into a far worse economic position.

If China and Russia want to take definitive action to ensure American power is decreased, all they have to do is stoke the flames of conflict in Kosovo and Colombia. American political debate is focused on the superficials; no real political movement would support retaliatory action for subtle actions by Russia and China to provoke other nations to pick fights. In short, there would be little political cost to Russia and China in provoking these fights while there is everything to gain.

The only counterbalancing effect is whether those nations would prefer to ride on America's economic coattails or if they'd rather see American foreign power decline to their advantage. With the economic troubles America is facing, it becomes increasingly tempting to think those economic coattails aren't as long as they once seemed. Time will tell which trains of thought will win out.

The structure of HMOs was also largely different than traditional indemnity plans. HMOs require primary care physicians to act as gatekeepers of advanced care and it empowered insurance companies to challenge the medical judgment of doctors. It restricted choice to those doctors and providers “in the network” and any care provided by outside providers, care that didn’t follow the right regulations or didn’t have the right referrals was simply not paid.

It is indisputable that we are currently in a health care crisis with skyrocketing costs and extreme customer dissatisfaction. It is never a good sign when medical providers have to market themselves on customer service. No other industry has to try to convince consumers that “we won’t abuse you” and that “you matter to us”. The current argument is that health care needs to be socialized because the free market hasn’t worked.

First, the central principle of the free market is that the individual parties of a transaction are able to negotiate the terms of that transaction themselves. For instance, if I want to buy a car, I can negotiate with the dealer the terms of the transaction and the dealer can do likewise. If neither of us wishes to proceed, we can move on. Without free choice on both the provider and consumer in deciding terms of the transaction, there is no free market. There is no free market without choice.

The health care system in this country, developed by Democrat Ted Kennedy who now campaigns against his own creation, all but eliminates choice in both doctors and patients.

Limiting the Choice of Patients

Let’s say you, Joe Consumer, want health insurance. Because of the structure of the tax system that enforces what is basically an historical accident, you will probably get this through your employer. Your employer is limited by tax law to only let you make decisions about your health insurance provider at certain times, basically when you are hired and once a year thereafter. You will likely get a few choices, an HMO with higher deductibles and lower premiums, an HMO with lower deductibles and higher premiums (from the same company), and a traditional indemnity plan. If your employer chooses Blue Cross Blue Shield, you’re only going to be able to choose Blue Cross Blue Shield.

Employers decided which insurance company to work with. Their motivation is clear, to save money. As a secondary objective, they want happy employees. However, the insurance company is selling insurance to your employer, not you. So they craft policies that are lucrative to your employer. Maybe 60% of employees are happy with what they get, but the other 40% are pretty much hosed. If they want a different insurance company they need to pay full price and the employer is not allowed to compensate the employee on what their portion might have been. End result: consumers do not choose their insurance company, their employer does. If they want to change their insurance, they can’t until the next benefit choice period dictated by the IRS.

Now you, Joe Consumer, want to go to the doctor. You take your handy dandy provider directory (or go online) and you select from the list of doctors your HMO allows you to go see. You may know you need an orthopedic doctor to deal with your knee problems but that’s too bad, you need to go to a primary care physician first (and pay for that useless appointment that you don’t need). This primary care physician’s job is to limit the amount of advanced care patients receive. In fact, in some cases, primary care physicians get a bonus based on how few referrals they give.

Let’s say you do get a referral. Then you go to where the HMO tells you to go to with even more limited choices in the provider directory. Let’s change the scenario, let’s say instead of knee problems you have cancer. You hear good things about the Mayo Clinic and you want to get care there. Too bad, you need to go where your HMO tells you to go to. You may have a better shot at survival at Mayo, it doesn’t matter.

You may wish to explore alternative treatments, however, your doctor who knows what your insurance company will and will not pay for better than you ever will, simply will limit you to those choices which your insurance company has already decided you will have. He knows that they won’t pay (and he probably won’t get paid) if his plan of care deviates from the dictates of the insurance company’s accountants. These people have never seen you, have no information about you but have near complete control over your health care decisions based on some sparse paperwork sent back and forth. The patient will never get the opportunity to talk to much less negotiate with these people.

Lastly, you want to choose a doctor among the choices that are provided to you in your provider directory. If you want to “price shop”, well, you aren’t provided pricing before hand. This may be difficult in some cases, but patients simply have no pricing information with which to judge before they’ve already committed themselves to care (some exceptions, not many).

The net balance of all of this is that in every single step of the health care system, the consumer is removed from the decision-making loop. The only health care decision the consumer gets to make is whether to have the insurance company pay or to do what they think is right and pay full price out-of-pocket and risk bankruptcy, even if it is the right decision.

Limiting the Choice of Doctors

On the other side of the transaction we have doctors that also have their choices restricted and taken out of the equation. Before a doctor sees his first patient, before he gets an office or buys any equipment, he needs liability insurance. The premium he is charged will be identical to other providers with similar practices no matter what training, experience, qualifications or differences exist between them. A Saturday-night hack artist pays the same as a doctor who has won the Nobel Prize. In Illinois, the premium for an OB-GYN before they see their first patients is about $240,000. In surrounding states it is about one-fourth as much which is why Illinois in particular has a health care crisis. Providers are fleeing the state. Take a look near any state border and you will see a thriving health care practice just on the other side of the Illinois border with that state.

The terms of this insurance policy (in addition to the price) are non-negotiable and designed to do one thing, prevent lawsuits or make them easier to win. For OB-GYN’s the terms are the most notorious. For instance, a woman who has had 2 children already without complications, is having a third low-risk pregnancy needs to go through the same regimen of care as a first pregnancy. If you’ve had children you know how this works. Started second trimester or so, you go for bi-weekly checkups (that become weekly as you get closer to birth). You pee on a stick, you get weighed and they ask you if you have any questions. There’s an ultrasound in there and a couple of blood tests.

With my first child, after a few of these appointments, I began to wonder what was the point. We didn’t have questions. In, out, 15 minutes: that’s $50 (the copay in this case). Why do I bring up this story? Because if you, the patient, decide that these visits are superfluous, your provider is required to drop you as a patient. You may have no complications, you may have no questions and there may be absolutely no reason for these visits, but your provider is required to mandate that you go, regardless of medical need or you can’t be their patient anymore. By the way, you, the patient, pay for this decision made not by your doctor, but by some lawyers at a liability insurance company. The United States has the highest C-section rate in the developed world because liability insurance companies insist that if anything is “abnormal” a C-section must be performed. Not because of medical need, but because of “limiting liability”.

In addition to liability insurance companies dictating the terms of care, doctors then have to deal with health insurance companies (or even worse, Medicaid). About 30% of medical bills sent to private individuals (not insurance companies) are paid. Doctors know that they are being paid by the insurance companies, not the patient. They know that if the insurance company isn’t going to pay them, they probably won’t be paid. The only exception to this is patients who walk into an emergency room or doctor’s office with a Platinum American Express card. Providers know these people are paying cash and they get treated with far more respect than insurance carrying patients do.

Before the question of the “bonus checks” for limiting referrals even comes in to play, doctors know that the insurance company is calling the shots. They know they won’t get patients without joining a “network” of some providers in a given insurance company. The insurance company will then dictate what rates they can charge, what services they can provide, what drugs they can prescribe and in some cases how many patients they can see.

A doctor that practices without taking a major insurance policy will have a hard if not impossible time earning a living. A doctor that practices without a liability insurance policy (even in places where that’s legal to do and that isn’t many) can be considered certifiably insane.

Conclusion

Both doctors and patients have their choices and ability to negotiate their health care severely limited. There is some competition in a very limited sense where employers can choose from a small selection of HMO companies. Doctors can choose too and there is a small subset of liability insurance companies they can choose from as well. One of the major plans for “health care reform” is to simply have the government serve as the HMO instead of private companies. It is unfathomable to believe that taking away the trivial amount of choice in the health care system that is left will result in a better system that is more responsive to patients.

The solution to the health care system is to let those who are part of the transaction, doctors and patients, have the freedom and latitude to decide their own plan of care. Removing the patient from the decision-making loop has only created a health care system that thinks of the patient last. Let’s give the free-market and freedom of choice a chance.