A year after the Health Care Reform Act code named “Obamacare” was written into law, its incendiary effects continue to rage on. Much of the right-wing gripe over the law has focused on the unconstitutionality of government mandates to buy health insurance. But the more important issue, from my perspective, is the system’s failure to support and create incentives for the most crucial components in the delivery of health care: doctors.

Doctors face a slew of financial and administrative obstacles today that prevent them from providing the best possible treatment for their patients. Because the incentives provided for doctors under the health care reform law are drastically misaligned, unless more focus is placed on the issue we will be facing a shortage of 62,000 doctors by 2015, according to the Association of American Medical Colleges. This massive projected shortage is only four years away. As Medicaid programs expand under the recent health care reform, only a finite number of doctors will be able to treat everyone, and this will lead to lower quality of care.

According to the U.S. Department of Health and Human Services, there is currently a shortage of 16,000 primary doctors.¹ One of the driving factors of this shortage is the high cost of medical school, ranging from $120,000 to $150,000 on average.² In order to pay off their scholastic debts, doctors have an incentive to go into high-paying specialties, instead of primary care. Although Obamacare allegedly recognizes the need for more primary care physicians and includes funding for scholarships and loan forgiveness, it ignores a key part of the problem. Crucially, med students who hope to become practicing physicians must undergo a “residency” period. Residency is a stage of graduate medical training in which students or “residents” practice under fully licensed doctors in hospitals and clinics in order to get in-depth training in a specific branch of medicine. Currently, there is cap on residency funding, which means that the law’s efforts to increase the number of medical students via subsidy is useless, since there is a bottleneck in another part of the process to becoming a practicing physician.

Another way the current government strategy is punishing doctors is through Medicare payment cuts. Medicare is a federal program that provides health insurance to 45 million Americans ages 65 and older. Medicare, along with Medicaid, which provides health insurance to people with low-income and resources, are both inefficient and unwieldy programs. Both programs have very low reimbursement rates to physicians, and in January of next year, an additional 30 percent physician payment cut will be instituted. Counterproductively, this gives physicians further incentives to stop accepting Medicare patients or to drop existing ones.

One of the main goals of the health care reform law was to target rising health care costs. Physicians today face the threat of multi-million dollar malpractice lawsuits. There has been no cap on the amount of damages that can be paid out to plaintiffs, and, as a result, physicians practice “defensive medicine:” they order more expensive tests and procedures because they must operate based on liability rather than need. According to industry experts, defensive medicine counts for about 10 percent of health care costs or $100 billion annually. Not only does the law do nothing to reduce this financial burden on physicians, it very often ties their hands in seeking the best treatment for their patients.

While Medicare and other government programs have failed, private health plans continue to innovate new payment systems. Private plans have incentives to compete for better doctors for their networks, and thus they have provide financial incentives in order to achieve better health outcomes. In a report by PriceWaterhouse Cooper, 8 out of the 10 largest community health plans in the country had implemented performance-based pay for doctors.³ In Pennsylvania, the Geisinger Health System has created a “warranty” program for heart surgery; they charge a flat fee for the heart surgery and an additional 90 days of follow-up treatment.⁴ If there is anything that goes wrong after the surgery, the responsibility is on them. Currently, the incentives for quality elsewhere are misaligned. If a physician makes a mistake the first time, they get paid more for the services incurred by a repeat visit. Conversely, these private plans are innovating strategies to cut down on costs while improving the quality of medical treatment.

It is important to acknowledge that not all of the issues of the health care system can be solved by moving it into the private market. A very large segment of our population is uninsured, which both the right and left should acknowledge as a large problem. However, redistributing the incomes of physicians to increase bureaucracies and the already inefficient and unwieldy government health programs is not the answer. There needs to be a realignment of incentives in order to increase the number of primary care doctors in our country, adequately reimburse current doctors for quality care, and untie doctors’ hands so that they can do their jobs.

References
1 Kirch, Darrell G. “How to Fix the Doctor Shortage.” Wall Street Journal. Jan. 4, 2010.
2 Kavilanz, Parija. “Doctors: 5 gripes about the health law.” CNNmoney.com. April 21, 2010.
3 Gottlieb, Scott. “How Obamacare Will Affect Your doctor.” Wall Street Journal. May 12, 2009.
4 Abelson, Reed. “In a Bid for Better Care, Surgery with a Warranty.” The New York Times. May 17, 2007.

Despite international sanctions, North Korea continues down the same threatening path regarding its nuclear program. Last November, American nuclear scientist and Stanford professor Siefried S. Hecker visited North Korea where officials showed him a large new facility they had secretly built to enrich uranium.i

The facility, which did not exist when inspectors visited the country in April 2009, is indicative of North Korea’s increasing military aggression. The country is in the midst of a leadership transition from Kim Jong-il to his son Kim Jong-un, who is the grandson of the founder of the country. The new leadership is trying to become more militaristic and to establish itself as one of the world’s nuclear powers.

Last month, Secretary of Defense Robert Gates said that “North Korea is becoming a direct threat to the U.S.” due to the fact that it will develop an intercontinental ballistic missile (ICBM) within five years.ii North Korea tested its first nuclear devices in 2006, in violation of previous U.N. Security Council sanctions established to punish the country for its continuing enlargement of its nuclear program. They have continually proven unwilling to cooperate with the international community. In April 2009, for example, North Korea ousted U.S. and international inspectors from the country. The country’s 2009 Taepodong 2 test flight fell short of its expected range, but still traveled far enough to hit Hawaii.

In other words, North Korea has maintained a consistently belligerent stance and seems unwilling to back down in the near future. In March 2010, the South Korean government blamed a North Korean torpedo for the explosion and subsequent sinking of a South Korean warship. The explosion claimed the lives of 46 sailors. The United Nations Security Council voted to condemn the sinking of the warship but elected not to place the blame on North Korea, due to resistance from China. Later, in November 2010, North Korea shelled a South Korean island after it claimed that South Korea had fired first. The South claimed that they had engaged in an artillery test, but that it had not been directed toward the North.i

As this credible threat looms larger, the Obama administration continues to cower in the corner. According to the 2010 U.S. Ballistic Missile Defense Review, U.S. missile defense capabilities “exist in numbers that are only modest in view of the expanding regional missile threat.”iii Thus, the government has allowed North Korea to gain the upper hand. In the March 2010 warship attack and November 2010 shelling, the U.S. and South Korea could not respond with adequate force because they feared the possibility of the escalation of conflict.

The Obama administration needs to take concrete measures to secure our country and invest in technology. Allegedly, new talks on North Korea will be initiated when Chinese President Hu Jintao makes a state visit to the U.S. from Jan. 18-21.iv Hopefully these talks will be more successful than the stalled six-nation which in 2005 produced an agreement for North Korea to dismantle its nuclear programs in exchange for economic aid and diplomatic concessions. South Korea has shown resistance to engaging in more talks with North Korea, saying that the neighboring country has repeatedly shown aggression followed by a request for talks and economic aid. Obama hopes to convince China, North Korea’s largest political and economic supporter, to take a harder line against the rogue country. China in turn claims that its influence over North Korea is limited and it fears that withdrawal of aid from the nation will result in a collapse that will destabilize the entire region.iv

Against this bleak landscape, it is crucial that the U.S. enlists help from the international community in order to ensure that North Korea’s threat is contained. Japan has made many technological advances in missile defense strategies and the Obama administration should be utilizing these further. Additionally, the administration should push South Korea to join in a comprehensive regional missile defense network along with Japan and the U.S. Limited sanctions and negotiations have not worked with North Korea in the past, and therefore, the U.S. needs to change its strategy in dealing with the unpredictable country. The U.S. should refuse to accept China’s hollow excuses for backing North Korea politically and financially. And if China refuses to take a harder line and withdraw all financial support to the rogue country, the U.S. must be willing to send its own troops to the region to ensure our country’s security.

i The New York Times. countriesandterritories/northkorea/index.html>
ii Wall Street Journal.
iii Ballistic Missile Defense Review. < http://www.defense.gov/bmdr/ >
iv Washington Post.

Obama’s policy in the Middle East has been based more heavily upon the perseverance of his political image than on pragmatism.

On Aug. 2, 2010, Obama said that he is on the way to fulfilling his campaign promise of ending the war in Iraq. Under his plan, the United States will have removed all combat troops by Aug. 31, 2010 and 50,000 troops will remain to train Iraqi security forces, conduct counterterrorism operations and provide security for ongoing U.S. civilian efforts. Obama, however, seems more intent on being precisely on schedule to withdraw than to actually assess the situation and to make decisions based on that assessment. According to Obama’s website, “the responsible pace of redeployment called for by the Obama-Biden plan offers more than enough time for Iraqi leaders to get their own house in order….” However, on August 1, 2010, the Washington Post reported that “nearly five months after disputed parliamentary elections, leading Iraqi politicians say they have all but abandoned hope of resolving an impasse over forming a new government before fall.”

The latest government figures show that July has been the most violent month for Iraq in more than two years. These figures cause critics of the withdrawal to question the readiness of Iraqi security forces to take over.

Although Obama is adhering to his withdrawal timetable, he is doing so at the expense of stability in Iraq and the welfare of Iraqi civilians.

As Obama draws down forces in Iraq, he has also ordered a surge of 30,000 additional troops in Afghanistan. He has emphasized that al-Qaeda was responsible for the 9/11 attacks and that the goal of the war in Afghanistan is to ultimately defeat al-Qaeda. However, the goals of the withdrawal in Iraq and the defeat of al-Qaeda are at odds with each other. General Michael Hayden, the Director of the CIA, says that a quick U.S. withdrawal would result in a political vacuum that the al-Qaeda network could quickly fill, thus establishing a major safe haven from which to expand its jihad in the region and plan attacks against the West. A National Intelligence Estimate released on July 17, 2007 states that “al-Qaeda will continue to enhance its capabilities to attack the Homeland… and will probably seek to leverage the contacts and capabilities of al-Qaeda in Iraq, its most visible and capable affiliate.”

The continuing violence in Iraq and the Iraqis’ inability to form a new government reveals the region’s instability. The political vacuum created by US withdrawal would open the floodgates for sectarian and terrorist violence, and the inevitable spillover effects could destabilize the entire Middle East, including tipping the balance of power in favor of Iran. A State Department-issued report on global terrorism declared that Iran “remained the most active state sponsor of terrorism” in the world in 2009. On August 3, 2010, John Bolton, former U.S. ambassador to the United Nations said that “this is exactly the wrong moment to complete the withdrawal of combat forces, given the uncertainty in Iraq and Iran’s increased involvement in trying to cause trouble in Iraq.” And yet, Obama not only ignores the threat of Iran, he wants to open up the possibility for talks in Afghanistan. According to an article in the Washington Post on August 5, 2010, Obama said he favored a “separate track” for discussion of the issue, in which the two countries have a “mutual interest” in fighting the Taliban. However, a February 7, 2005 threat report, which was released as part of the Wikileaks Papers, showed that U.S. commanders received regular reports of collusion between the Iranians, al Qaeda, the Taliban, and other extremists groups. The report states that Iranians arm, train, shelter, and fund the jihadists.

The president told reporters that Iran “could be a constructive partner” with the U.S. in fighting the Taliban and stabilizing Afghanistan.

Obama was criticized in the 2008 presidential campaign for having an appeasement policy toward Iran. He has since made concerted efforts to assert his “hard-line” stance on Iran. On June 9, 2010, the U.N. Security Council imposed a fourth round of sanctions on Iran’s military establishment to pressure Iran to negotiate with the U.S. and its allies. However, the legitimacy of his stance on Iran begins to fall apart when he states that he wants to partner with a country who is at war with us. Former CIA Director Michael Hayden said in 2008 that “it is the policy of the Iranian government, approved to the highest levels of that government, to facilitate the killing of Americans….”

If there was any confusion on Iran’s sentiments and the likelihood that it would partner with us in Afghanistan, Iranian president Mahmoud Ahmadinejad made the situation quite clear on the day after Obama’s new peace offering. According to the Weekly Standard, Ahmadinejad hosted Afghan president Hamid Karzai, and declared that their two nations, together with Tajikistan, could form an alliance that would serve as a bulwark against Western influence in the region.

Obama cannot continue to ignore the threat that Iran poses to both U.S. domestic security and to regional security in the Middle East.

The popular rhetoric of campaign speeches is a poor substitute for informed foreign policy decisions. Obama needs to adapt to changing situations in the Middle East, and make decisions that will protect the American people.

You know there is a problem with the tax system when the U.S. Secretary of the Treasury fails to file his taxes correctly.

Whether or not Timothy Geithner knowingly evaded his taxes, the discrepancy shows how complex our current tax system really is.

If you’ve ever filed taxes, images of inscrutable tax policies and forms are probably ingrained in your recent memory – studies agree.  A Tax Foundation survey in April 2007 found that 83 percent of people surveyed said the federal income tax is “very complex” or somewhat “complex.” The Brookings Institution reports that a recent study estimated that taxpayers spent 3.2 billion hours and $18.8 billion preparing and paying taxes in 2000. On average, each taxpayer spent an average of 25.5 hours and $149.

The tax system is difficult to navigate because over the years, Congress has made rules and exceptions to incentivize taxpayers to use their money in certain ways. However, taxpayers often cannot easily take advantage of incentives, because they are hidden amid the mounds of instructions.

In addition to being complex, the current tax system discourages savings, according to a testimony to the President’s Advisory Board on Tax Reform. The government taxes hard-earned income each step of the way. With payroll taxes and income taxes, state taxes, local taxes, property taxes, sales tax – even taxes on money made from investments, the government seems to have developed a never-ending stream of innovative methods that serve the sole purpose of taking money from the Americans that earn it.

To fix this system that fails to reward the middle class for working hard and being economically productive, the tax system needs to be completely overhauled. We need a simpler, flatter tax.  It seems that most Americans would agree, as

78 percent of people surveyed by the Tax Foundation believed the federal tax system  needed “major changes” or “a complete overhaul.”

One alternative tax proposal is the “FairTax.” The FairTax would eliminate all federal income and payroll-based taxes and institute a flat 23 percent national sales tax in its place. The tax is levied at the point of purchase on all goods and services for personal consumption.

According to the Americans for Fair Tax, the FairTax is more progressive than the individual income tax, payroll tax, and the corporate income tax. Only those with the ability to pay actually pay. It eliminates both the payroll tax and hidden tax costs passed along to consumers in the price of goods and services.

By proposing federal government issue monthly “prebates” that would ensure no American pays federal taxes on spending up to the poverty level, this tax method would continue to protect lower-income families. For example, under the U.S. Department of Health and Human Services poverty guidelines for 2005, a family of four could consume $25,660 worth of new goods tax-free (under this system, used products would not be taxed at all). Above the poverty line, taxes increase according to how much a family consumes. The tax, unlike the current tax system, gives workers their full paycheck so they have the choice to spend, save, or invest.

One primary point of concern is the viability of such a flat tax, even though this model has already improved financial stability in a number of European countries. In a February 2010 article, the Financial Times compared 27 European countries’ gross government debt to their gross domestic product in 2010. The overall European Union nation has a gross government debt that represents 79.3 percent of their gross domestic product. European nations with flat tax systems tend to have more financially efficient government systems: six of the eight lowest indebted countries have a flat tax system, with an average gross public debt of 29.2 percent.

Tax policy is complicated and controversial, and ideas for tax reform are often met with cautious silence from political leaders and misrepresentation from media outlets.  According to research by the Business and Media Institute, the media has largely ignored the FairTax and has mischaracterized many of its measures when the FairTax has been covered. It is time that the American people set the facts straight and advocate for a better system.

So when the dreaded April 15 rolls around again, just remember that the Secretary of the Treasury could not even get his taxes right. Hopefully that will offer some consolation. When it doesn’t, consider supporting a better method of taxing.

Bribery, corruption, cronyism, you name it. Obama’s new appointees have participated in them all.

These policy “czars,” as they are often called by the media and the Obama administration, are high level White House officials appointed sans Senate confirmation. Historically, presidential administrations have used czars to rise above the usual Washington fray and help various bureaucracies work together. However, the Obama administration has run amok with the appointments.

According to the White House Report to Congress on White House Staff, the czars are among the highest paid staffers in the White House, and they have a free rein with federal funds and policy-making . There is not enough scrutiny of their actions, and many Americans are not even aware of their existence. If we look closely at some of the backgrounds of these czars, we find histories riddled with corruption, and they bring their expertise to the current administration.

On the campaign trail, Obama pledged to transform Washington’s lobbyist culture. Soon after taking office, he signed an executive order saying that White House appointees should not participate “in any particular matter involving specific parties that is directly and substantially related to any former employer or former clients.” Certainly a noble goal to bring change to Washington.

Ladies and gentlemen: meet Obama-appointed health czar, Washington professional Nancy DeParle, formally known as the director of the White House Office of Health Reform. DeParle ran the Medicare and Medicaid programs during the Clinton administration. Following her tenure, she proceeded to make over $6 million in the health care private sector, according to the Investigative Reporting Workshop, a project of the school of communication at American University. DeParle served on the boards of nine other prominent medical companies companies, many of which have undergone federal investigations and whistleblower lawsuits. An example is while DeParle was a board member of the Guidant Corporation, government regulators found that the company was hiding patient deaths from the FDA.

While serving on the boards of these companies (2002-2008), DeParle was also a member of the government-sponsored Medical Payment Advisory Committee (MedPAC). MedPAC advises Congress on the services Medicare should cover and its reimbursement rates. According to The Commonwealth Fund, a private organization that supports the improvement of the health care system, DeParle is quoted as saying that Obama was “open to making the recommendations of MedPAC mandatory.”

The Obama administration casually overlooks DeParle’s industry ties, despite its rhetoric. The Investigative Reporting Workshop found that as the health czar, she controls $19 billion of federal stimulus money that has been earmarked for health information technology.  DeParle served on the Board of Directors for the company Cerner Corp., which, shockingly, specializes in health information technology.

For another spectacle of cronyism within the Obama administration, look to Adolfo Carrión. He heads the White House Office of Urban Affairs, whose role according to a July 2009 Washington Post article, is to be “part of the Obama administration’s new kind of urban policy to address cities and also their suburbs, which urban advocates hoped would be the focus of the administration’s development approach.” In March of 2009, the New York Times reported that Carrion had accepted thousands of dollars in campaign contributions from developers and real estate firms while their projects were being reviewed by Carrion’s office. As a result, these companies landed lucrative deals.

Carrion also has been known to spend an excessive amount of taxpayer dollars on items such as a $1,700 for the purchase and installation of blue fabric to cover a podium, $690 on gold-sealed business cards, and $50,000 on a going-away party on himself, according to a February 2009 NY Daily News article. A classic example of hard-working Americans’ tax dollars being flushed down the toilet.

On December 15, 2008, the Obama administration added yet another ethics-compromised Washington professional to the White House staff. Carol Browner was named the Director of the White House Office of Energy and and Climate Change Policy, or better known as the “energy czar.” Browner headed the Environmental Protection Agency from 1993-2000, and many controversies abounded during her reign. In her first term as the head of the EPA, a Congressional subcommittee found her to be using taxpayer funds to send out illegal lobbying materials to around 100 environmental lobbying organizations around the country. Browner used her government position to mobilize left-wing groups and forward her own liberal agenda.

In addition, according to the testimony in a freedom of information lawsuit filed against the EPA by the Landmark Legal Foundation, Browner ordered the destruction of agency computer files on her last day as the head of the EPA. A federal court order for the EPA to preserve records had already been put into place. When the case was brought to court by the Landmark Legal Foundation, the judge held the EPA in contempt of court.

Members of Congress from both sides of the aisle have voiced their concerns about Obama’s czars. Democrat Sen. Robert C. Byrd of West Virginia voiced his concerns in a cautionary letter to Obama in early 2009. In reference to past czars and White House staffers, Byrd writes that “they rarely testify before congressional committees and often shield the information and decision-making process behind the assertion of executive privilege.” He adds that, “the rapid and easy accumulation of power by White House staff can threaten the constitutional system of checks and balances.” Ironic, since this is the same party that denounced the Bush administration’s use of executive power.

For his part, Rep. Jack Kingston (R-GA) is sponsoring a Czar Accountability and Reform Act of 2009 that would “would bar the use of appropriated funds to pay either expenses or salaries of members of task forces, councils, or similar offices established by the president and headed by a person appointed inappropriately to such a post without Senate advice and consent.”

Obama promised to bring change to Washington, but he continues down the path riddled with corruption and cronyism. The facts are clear: despite touting its dedication to government transparency, the Obama administration has reneged on its promises and continues to cater to the Washington elite, amassing enough czars to make the Romanovs turn in their graves.

On Feb. 1, Obama presented his $3.8 trillion budget proposal for the next decade. The deficit will hit a post-WWII record high this fiscal year at $1.6 trillion. The budget is supposed to save $1.2 trillion over the next decade, but this savings becomes nearly meaningless when compared to the $6 trillion debt that is supposed to accrue in the next 10 years.

Obama’s big effort to to reduce spending is to freeze some domestic spending for three years. Sounds great on the surface until you read the fine print. The freeze exempts spending on the wars in Afghanistan and Iraq, spending by the Pentagon, the budgets of the Veterans Administration and Department of Homeland Security. Also, this spending freeze would not impact the mandatory spending on Social Security, Medicare and Medicaid. These three programs account for 59 percent of all federal spending.

So in essence, the three-year spending freeze is completely irrelevant.

To make the spending freeze even more insignificant, according to the Office of Management and Budget’s numbers, the baseline discretionary domestic spending has been increased by $115 billion since Obama’s inauguration. Great place to freeze spending, if you ask me.

Even with all this, you would think that the administration would actually attempt to decrease spending in the non-security, discretionary domestic arena. However, in the budget, education, civilian research, food and drug safety and biomedical research would all get more money. NASA would be granted $18 billion to spend on new technologies that could take humans farther into space. The Department of Health and Human Services would see an increase in their budget of $1.7 billion to $81.3 billion. The National Institute of Health’s budget would see an increase of $1 billion, to $32 billion. Cutbacks, you say?

The focus of the administration should be on fiscal responsibility. Social Security will be bankrupt by the year 2017 and Medicare will be bankrupt by 2037 if nothing is done to reform these programs. There cannot be a significant reduction in the federal deficit without attention to these huge entitlement programs.

Pork-barrel spending pervades the federal budget. Currently, the Senate and House Appropriations Committee members are so protective of their own interests that there is no chance for cutting excess pork. We need to grant the president the power of the line-item veto so that waste can be cut from the budget.

We are borrowing heavily from China and other countries, and by 2020, our debt will be 77 percent of the gross domestic product. Frightening.