In 2012, America Must Elect a Turn-Around Specialist

America must conquer real threats if we are to reverse the inevitable slide into the annals of ancient empires following the downward slope from England to Rome. If we fail to overcome our formidable obstacles, historians will dissect America’s recent political machinations and federal budgets to interpret why we failed to reverse course as we battled our decline. My guess is that our descendents will wonder how America ever became so transfixed on military and healthcare.

Fear has driven America to the brink. To escape the jaws of death, we have become obsessed with healthcare, spending twice what the rest of the industrialized world spends and more than the incomes of most people in the world. Half of our health care budget is desperately spent in the last six months of our lives. America’s combined federal medical expenses of Medicare and Medicaid exceed $740 billion dollars annually.

To ensure that no 20th century military will ever rise up against us, America’s military budget has grown larger than all other countries on the planet combined. we expend $1.4 trillion dollars (shocking) annually including the DoD budget ($653 billion), military budgets of other departments such as NASA ($153 billion), the war on terror ($162 billion), current wars in Iraq, Afghanistan, and Libya ($200 billion) plus $484 billion of carrying costs from past military spending. Ironically, our obsessively growing military budget may prove the old saying that pigs get fat and hogs get slaughtered.

Since our civil war, no battles have been fought in America and 2,977 American lives were lost to foreign terrorists. 9/11 exposed our vulnerability to terrorism, but we lose more Americans to deadly American-on-American violence in two months than we have lost to terrorism and foreign invasion in 150 years. The odds that you will be murdered are about 1 in 200 in your lifetime, and considerably worse if you live in a city. 16,000 Americans are murdered and 1.5 million are victims of violent crimes every year. Our real threat of internal violence has grown to overwhelm our potential threat of external violence, yet America continues to spend $1.4 trillion dollars annually against potential foreign invaders and only $150 billion dollars on police, federal enforcement and prisons combined.

So we spend a combined $2.2 trillion dollars to protect ourselves from the perceived threats of foreign invasion and from dying 180 days before our time. $2.2 trillion dollars is 100 % (ONE HUNDRED PERCENT!) of federal revenues collected in taxes from the American people. To pay for our obsessions, all other services and interest on the debt are paid for with borrowed money. How have we let our fears overtake reason and push America to the binge spending brink of what may be coined by historians as America’s Greatest Depression?

Rather than crowd out our budget with perceived threats, America must assess our greatest threats and opportunities going forward and they must then be supported by our budget. Our debt has unfortunately been allowed to bubble into a historic crisis that could threaten to pull the world’s reserve currency into hyperinflation, so it has become our most urgent threat. Yet as our political leadership chooses to gamble with the debt ceiling, they have placed military and healthcare costs that consume 100 percent of our federal taxes in protected fortresses of untouchable expenditures. With this display of political bravado, they have boxed the impossible solutions of either eliminating the rest of government or raising taxes to a level that would plunge America into an austerity led depression.

The fable being spun inside Washington’s beltway is that minimal cuts can be made from military and healthcare as Congress and the President fight hand-to-hand combat to eliminate their political opponents’ favored programs. Are we to believe that America can turn around its deadly retreat with the table scraps given to us by our military and healthcare industry? Our political leadership continues to misread their vital mission of the people’s work. America knows it is not elimination of political opponents’ pet projects that will right our course but it is the charting of the true north of America’s best opportunities that must be protected by our budget.

In business, companies that present such insolvent balance and P&L sheets as exist in America’s federal budget, are subjected to the rigors of the turn-around specialist. All budget items no matter how large or small are prioritized as to their future value for the company and those below the expected revenue line are slashed. We must now subject our country to this difficult rigor that can best be accomplished with consensus of the American people.

The secret of the turn-around specialist’s success is that they know their employees will have been subjected to the harsh realities of drastic budget alignments and will end up hating the turn-around specialist as much as they love what he did for the company. The specialist knows when their vital work is done that they must leave the company to find the next financial disaster to correct.

The turn-around specialist work that America must endure is not for the weak of heart and will be distasteful to politicians that wish to be elected next term. But it must be done. The men or women, including those running for President, that stand up before the American people stating they will do the hard work, pledging only one term, are perhaps the only ones capable of getting the job done.

Top Ten Reasons That Hospitals are Not Prepared to Evacuate in a Large Emergency

When natural emergencies disable a hospital, inhibiting its ability to provide care to its patients such as recently occurred when a tornado devastated the St. Johns Regional Medical Center in Joplin, Missouri, the emergency community rushes to its aid. Acting on years of training and planning, they quickly evacuate its patients and victims to safety. However, in large scale disasters affecting multiple hospitals within a region, the overwhelming emergency resources required to evacuate a single facility may not be available for days.

During regional emergencies, hospitals are much more dependent on their own emergency and evacuation plans and resources to save lives. Having reviewed several hundred hospital evacuation plans, I can attest that while the hospital industry has made major strides in emergency preparation during the past decade, a majority of hospitals in America are unprepared to evacuate in a large scale emergency. As a brief summary, I have listed ten reasons:

1. Insufficient transportation resources – During a large emergency, local, state and federal resources place hospitals at a lower priority of evacuation. Most hospitals do not have alternate sources of transportation nor have they considered the number and type of resources that would be required to adequately respond to their emergency.

2. Undeveloped receiving facility resources – While most hospitals have mutual aid agreements and MOUs with other hospitals in their region, many have not developed detailed procedures for emergency acceptance and admittance. Most do not have agreements that go beyond their region in the event that their MOU receiving facilities are affected by the emergency.

3. Limited tracking – A large scale evacuation of several hundred patients in the span of 24 hours entails the potential use of dozens of ambulances, helicopters, and aircraft as well as the coordination of hundreds of personnel. In addition, internal and external tracking of patients, medicines, charts and personal belongings must be managed and tracked to mitigate the effect on patients and their families. Most hospitals do not have systems to accomplish this feat.

4. Lack of Coordination with Emergency Community – A majority of hospitals have reviewed their emergency and evacuation plans with their emergency management, EMS, police and fire departments. However, many have not relayed the weaknesses of their facility, nor have they clearly delineated the expectations they have of their local emergency providers. In the event that local providers are unable to assist, most hospitals have not detailed what is required to bring in outside providers. In addition, most have not detailed the communication plans that must be in place between the facility, their providers, and the emergency community.

5. Unclear triggering strategy and methodology – JCAHO standards outline minimum rationale for evacuating a hospital, yet realistic criteria are more complicated. Because of conflicting management issues, most decision criteria are not well delineated, creating confusion amongst the implementers of evacuation policies.

6. Undefined communication system – While most hospitals have acquired adequate communication hardware, including multiple backup methods, most have not defined the detailed communication processes that must be in place to implement a realistic evacuation. Rapid mass coordination of admission to receiving hospitals is one example.

7. Limited triage plan – Most hospitals have basic triage methodology to fit specific vulnerability analyses. However, many hospitals’ triage procedures have not considered realistic timing limitations of known transport resources and receiving facilities as well as a realistic rate of patient and personnel evacuation.

8. Undeveloped patient preparation plan – While much work has been done by most hospitals to develop detailed vertical and horizontal evacuation plans that correspond to required fire safety protocols, many hospitals inadequately rely on this planning to fulfill emergency internal evacuation processes. As an example, in most cases, vertical evacuation should be coordinated with the arrival patterns of transportation vehicles.

9. Lack of cost tracking – To be reimbursed by the Federal Government after incurring emergency expenses during a federal emergency, the hospital must provide detailed time and cost records for all personnel, materials, and vehicles used in the emergency. Most hospitals do not have adequate procedures or capacity to account real time for costs, potentially forfeiting millions of recovery dollars as a result.

10. Inadequate funding – The United States has access to 70,000 ambulances, enough to overwhelm even most large disasters. However, many hospitals rely on the Stafford Act to fund their rescue, limiting access to available resources. Most have not planned for alternate funding mechanisms to draw upon during an ongoing emergency.

For the Sake of America’s Health and Jobs, Congress Must Debate Healthcare Again

As the courts decide the fate of Obamacare, the hard work of congress regarding a comprehensive healthcare policy must begin again.  America cannot afford for Congress to wait when America’s health is at stake.  And waiting also has the foreboding consequence of continuiing our downward economic spiral and loss of jobs.

As a result, Congress must first decide how much of our budget can support healthcare. No more than 10% of GDP is needed for government to support America’s economic growth. Today, we tax America 28% of GDP and borrow an additional 13% of GDP. The additional 31% goes to military, interest, and the redistribution of America’s wealth to improve the lives of Americans.

A consequence of spending more than 10% of GDP is that supplying today’s needs reduces the economic output and social spending of future generations. Our budget now demonstrates both the overwhelming desire of Americans to care for our own, and our inability to pay for our altruism. For every dollar our government spends, we borrow 40 cents from future Americans that will also want to meet the social needs of their citizens. Before we resolve healthcare, we must agree on a sustainable social care budget, the priority of our causes, and the amount available for healthcare. This amount combined with private contributions must meet our healthcare needs.

Then we must set about reducing costs to meet revenues. For instance, government has placed restrictions on revenue aggregation that are unnecessary burdens. Both political parties have advanced methods to reduce these costs. Compromise should float best ideas to the top.

Prevention must be on the legislative table. America’s habits promote peculiarly western major disease processes. Sugar, corn syrup, and processed fats industries promote an epidemic of obesity, diabetes, heart and vascular disease and strokes. Cigarettes help a quarter of our country to die extended, painful COPD deaths. Our dependence on pharmaceuticals precipitates growth of resistant bacteria.

Cultural decisions should not necessarily be a burden to all Americans and need prioritizing in the healthcare budget. Our disconnection with our elderly has escalated institutional costs. Our striving to extend lifespan has led us to spend a majority of healthcare costs on the last few years of life.

Competition must be allowed to drive costs down. Americans are rightly skeptical that capitalism will lead to corporate profits at the expense of our health. We have too many examples such as insurers culling unhealthy persons from the pool of insured, leaving the very people who need insurance without the ability to pay for their care. Much more competition balanced with thoughtful regulations is required. The alternative is a healthcare system marred by cost controls, leading to shortages of quality care.

American healthcare is dominated by a medical cartel that limits supply of doctors, limits procedures that can be performed by lesser educated personnel, and limits information needed for the average American to make good financial decisions regarding their health. To truly have competition, doctors must loosen their grip on access to medical schools, and permit more procedures to be performed by others. In the process, our medical professionals must be protected from our litigious society’s need to blame inaccurate medical science for the natural course of life.

Information must become transparent. We need knowledge of physicians’ capability to manage the health of their constituents just as we need knowledge of school teachers’ ability to teach. Our fractured healthcare industry also needs to aggregate information to increase up front spending that will decrease long term costs and to reward industry participants for achieving this outcome. 

These problems are certainly looming but not insurmountable. However, both parties must subordinate the interrelated goals of their special interests to America’s goal of providing all Americans access to a healthy life, and must work together to put the best ideas of both sides of the aisle to work on behalf of all of us.