July 31, 2012

Health, Water and the Environment

Warning this water is unfit for human consumption

By Melvin J. Howard

I knew a woman that would not and could not drink from her tap. She carried a water bottle with her everywhere she went. I would tease her constantly she had water jugs placed in strategic locations in her car, her gym bag, brief case etc. I thought if Armageddon happens today I know where I am getting my drinking water. Most people take their drinking water for granted just go to the tap presto a nice cool drink of water. But do you know what you are really drinking you might be surprised and disgusted at the same time. People all over the world are getting sick because of their drinking water. So it begs the question are market solutions as efficient as Mother Nature's way of managing and distributing water? I think not because there is obvious waste in these market solutions. For example in order to clean water that has been polluted by human activities some electricity is needed, and this is extra energy that is simply not needed in the natural process. Not only is extra energy needed but there are waste products produced by the human processes, such as extra water treatment chemicals, that cannot be readily absorbed by natural processes and so create waste. Add to this the fact that human alteration of land has increased flood risk and drought risk that then gets adjusted for by all these human constructions - holding ponds, gutters and so forth - adding more and more energy input into the water cycle, that is in turn further disturbing the water cycle through channelling flows, which causes stream bank erosion and the list goes on and on. Surely it would be hard to argue that markets can run the water cycle - that cycle responsible for the stuff of every life we so depend on - more efficiently than Mother Nature can. Nature has had the opportunity to develop a most energy efficient water cycle millions more years than the humans have, and we are after all, creatures of nature ourselves.

Especially since land alteration pressures lie right at the heart and foundation of our mainstream monetary system. Unfortunately this approach only sees everything through profit and money tinted glasses. Industrial global concerns think of environmental problems in terms of dollar cost and often think of solutions in terms of getting more profits in monetary terms. Thus, much work in the field of sustainable economics often gets reduced to converting all natural processes into monetary equivalents. Continuation of this practice could very well lead to a situation where economic sustainability looks great on paper in terms of long term sustainable profits but completely misses the prediction of, say, catastrophic alteration to the water-cycle - increasing flood, drought and contamination risks of human and industrial waste which as already happening worldwide. As a country we must move from contemporary economics, which has historically ignored natural destruction, and to a more ecologically sensitive "Ecological Economics" we must move away from the practice of converting anything and everything to dollars terms in order to analyze them.

The necessity for this can be seen in the observation that money is an abstract human invention that doesn't obey natural laws, but Nature does! For example, when it comes to water, the primary measure for analysis should be water indicators - say probability of flood, drought, and contamination - NOT money. We can also use energy itself as an indicator, since distribution of energy is so much of what our markets are about.

After such analysis, and given that nature is the most efficient user of energy shouldn't we use natural solutions (preservation, conservation) to complement and mitigate the effects of human development, rather than energy intensive human mitigation efforts. Having established the right balance between human development and natural land features based on purely ENVIRONMENTAL indicators we can then bring money into the picture based on ENVIRONMENTAL CONSTRAINTS and not the other way around, as it happens today. This approach finally would constrain the monetary system to recognizing the Laws of Nature, which it has never done before. Finally money would begin to respect the Entropy Law, the Second Law of Thermodynamics!

In summary, this would result in fundamental changes to the monetary system itself right at the point of money origination - a much more radical approach than proposed by any of the finance industry dominated groups such as the UNEP Finance Initiatives group. But it is an approach that seems necessary. For years manufacturing plants and gas exploration companies dumped its waste products into several landfills and waterways of the world. Often times leaving PCBs (polychlorinated biphenyls), dioxins (the killer chemical in Agent Orange) and many other chemical cocktails behind that I can’t even pronounce these reminders are a cause for concern. Because not only is clean drinking water become a problem in North America it is become a worldwide epidemic.

Written by the Sierra Club:

Toxic Tar Sands Oil

An Assault on American Water, Air, Health and Jobs

On July 26, 2010 an Enbridge tar sands pipeline ruptured in Michigan, spilling one million gallons of toxic crude into the Kalamazoo River, a major tributary of Lake Michigan. The crude oil contaminated more than 30 miles of river and forced evacuations for dozens of families. The lasting damage to the Kalamazoo River and Lake Michigan watershed may take years to resolve. This spill, the worst in Midwest history, is only the latest in a string of ongoing environmental disasters stemming from the production and distribution of the world's dirtiest oil from the Alberta tar sands.

Tar sands oil is an environmental and health nightmare. Stripmined in the boreal forests of northern Alberta, it is the most toxic form of oil on Earth. Tar sands oil is laden with sulfur, arsenic and heavy metals, and contaminates vast amounts of fresh water in processing. Mining and refining tar sands crude produces up to three times as much greenhouse gas per barrel as conventional crude oil. America currently consumes 1.35 million barrels of tar sands oil each day. Planned expansions will nearly triple our reliance on this toxic fuel.[1]

The safe life span of the average oil pipeline is only fifteen years, and most pipelines in the U.S. are much older. The Enbridge pipeline that burst in Michigan is 41 years old, and has no plans for retirement. Unfortunately pipelines are not always reliable even within the first fifteen years, and even the newest pipelines have already reported leaks.
A planned expansion of tar sands pipelines and refineries in the United States poses a grave threat to our farmland, water, and communities--not just from massive spills like the one in Michigan, but from toxic pollution known to lead to health problems like cancer and emphysema.

Tar Sands Oil Poisons Our Air

Processing tar sands oil releases pollutants directly linked to asthma, emphysema and birth defects into American communities. Because tar sands oil is a heavy, low-quality form of crude, it requires extensive 'upgrading' to be transformed into fuel. Refining tar sands crude creates far more air pollution in American communities that are already burdened with cancer and poor air quality as a result of oil industry activities. Tar sands oil contains, among other toxic metals, 11 times more sulfur and nickel, six times more nitrogen, and five times more lead than conventional crude oil.

Heavy metals and polycyclic aromatic hydrocarbons released in tar sands refining have been linked to pre-natal brain damage. Nitrogen oxides, along with volatile organic compounds released in tar sands refining are the principle causes of smog and ground-level ozone. Exposure to nitrogen oxides is a direct cause of asthma, emphysema and other lung diseases.

With plans to triple refining and transportation of tar sands by 2015, there is no question that air pollution--and health problems--in communities from the Great Lakes to the Gulf Coast will increase.

Tar Sands Oil Contaminates Our Clean Water

Tar sands production wa stes and contaminates tremendous amounts of water. Every barrel of oil produced requires four barrels of water. In this process, water is pumped into toxic waste reservoirs large enough to be seen from space. The mercury, lead and arsenic in tar sands waste threaten human health, even at small levels of exposure. Already, communities downstream from tar sands mines in Canada report 500 times more incidents of rare bile duct cancer than those who do not live near the tar sands. Expanded reliance on this dirty oil would put important American water sources at risk. Canadian pipeline companies currently operate 1,900 miles of oil pipelines in and around the Great Lakes watershed, which supplies 25 million people with drinking water.

Tar sands oil contains elevated levels of many known carcinogens and toxins. In a recent study, tar sands wastewater 'tailings' from extracting oil were found to contain ammonia, benzene, cyanide, phenols, toluene, polycyclic aromatic hydrocarbons, arsenic, copper, sulphate, and chloride[6]. Many of these chemicals are highly toxic and known to cause cancer, and regularly leach into groundwater from the massive lakes used to store tailings. These chemicals are present in tar sands oil before and after processing, and will end up in American groundwater when pipelines leak.

From Montana to Texas: American Communities at Risk

The Keystone XL Pipeline: A Threat to America's Heartland

The largest proposed tar sands pipeline expansion, the Keystone XL, will slice through six states, including Montana, North Dakota, South Dakota, Nebraska, Oklahoma and Texas.

This massive pipeline is nearly 2,000 miles long. It threatens hundreds of acres of wetlands and 91 streams that support large recreational and commercial fisheries, in addition to thousands of smaller streams and waterways. Worse, the pipeline jeopardizes one of the most important agricultural aquifers in the nation, the Ogallala aquifer. Equal in volume to Lake Huron, the Ogallala aquifer supplies the breadbasket of America with fresh water. Onethird of all irrigated American farmland relies on water from this single aquifer, supporting one-fifth of all cattle, wheat, and corn grown in the United States.

To make matters worse, TransCanada, the company behind the Keystone XL pipeline, has proposed using cheaper steel for the pipeline, needlessly exposing American communities along much of its route to risk of spills.


In addition to the Ogallala aquifer, the Keystone XL pipeline will traverse some of Nebraska's most important rivers and fisheries, including the Niobrara River, the Elkhorn River, Cedar River, Loup River, and the West Fork of the Big Blue River. Even the oil industry admits it can't prevent pipeline spills. Despite their continued assurances of safety, pipeline companies know their products are inherently unsafe. A spill in this area of Nebraska would be disastrous for the Ogallala and major Nebraska Rivers. The Niobrara River area is of particular concern, since it flows above shale deposits that are highly prone to fracturing and sinking, making underground pipes especially risky.

These important rivers are home to a vast array of birds and aquatic life, as well as large recreational fisheries, which are particularly vulnerable to oil contamination.


In Oklahoma, the Keystone XL pipeline will cut through the Okmulgee State Park and Deep Fork Wildlife Management Area. The Deep Fork Wildlife area is one of the only public hunting areas in Oklahoma. The Canadian River, Red River, and six other sensitive and protected waterways in Oklahoma will be exposed to threats from tar sands contamination in construction and operation of the Keystone XL pipeline.

In addition to thousands of Oklahoma farmers who rely on fresh water from the Ogallala aquifer, anglers and residents living near these waterways will be hit hard by a pipeline spill.


In Montana, the Keystone XL pipeline will cut through historic sites near the confluence of the Milk and Missouri Rivers--sites so important that they are under consideration for Montana State Park designation. The pipeline will also cross some of the state's largest and most vital rivers, including the Missouri and the Yellowstone.

The Missouri is the second-largest tributary of the Mississippi River, and the longest river in the country. The Yellowstone River is the longest undammed river in the lower 48 states. These massive rivers serve as major sources of fresh water to Montana's arid regions. Spills in these rivers would prove disastrous for the state.

The Keystone XL pipeline will also cross nearby tributaries of Lake Fort Peck. This lake is among the largest in eastern Montana, supporting a large fishing and boating community and tourism industry. The Keystone XL pipeline would threaten Montana residents and visitors who count on clean water and fresh fish from Lake Fort Peck.


In Texas, the Keystone XL pipeline will traverse sixteen large rivers. It will crisscross several rivers that are listed as sensitive and protected, including Big Sandy Creek, Angelina River, Neches River, and the Pine Island Bayou.

These rivers and drainages feed 21 lakes and municipal reservoirs, including the Pat Mayse Lake, Lake Tyler, and Lake Cypress Springs,[10] supporting robust fishing and tourism industries. As the BP disaster in the Gulf showed, oil spills can be devastating to tourism. It's not worth putting these major Texas lakes at risk from a toxic pipeline disaster.

Water contamination isn't the only concern, however. Ninety percent of the increased refining capacity accompanying the proposed Keystone XL pipeline will likely occur in Port Arthur and Houston, an area already plagued with poor air quality. In fact, a Rice University study found that levels of cancer-causing chemicals produced in oil refining are already much higher in Houston than in any other city--in some cases, twenty times higher.[12] If the Keystone XL expansion is built, Houston residents can expect to see an increase in the kind of air pollution that leads to these serious health problems.

Tar Sands Expansion: Putting the Great Lakes Region at Risk

The Great Lakes region is already home to the largest overland pipeline network on the planet, Enbridge's Lakehead system, and one of the highest concentrations of pipeline leaks and breakages in North America.

Up to seventeen major tar sands refinery expansions are in the works or already developed in and around the Great Lakes, threatening to bring air pollution and health problems to residents in the region.


In Whiting, Indiana, a refinery owned by BP is expanding to handle thick tar sands crude oil. Because it lies in a densely populated area just outside Chicago, at the corner of Lake Michigan, this expansion will impact air quality for millions of residents across three states. Studies estimate emissions of particulate matter may increase 21 percent with the expansion.[15]The BP Whiting refinery already discharges forty five toxic compounds into Lake Michigan, including benzene, toluene, mercury, lead, nickel and vanadium.[16] The refinery is the top industrial source of lead, nickel and ammonia, and one of only two industrial polluters that still dumps mercury directly into Lake Michigan.

In Fact, the BP Whiting refinery is also the number one source of mercury in Lake Michigan.[18] A permit loophole has allowed the refinery to release an average of 671.5 pounds of mercury into Lake Michigan every year.


We've already seen the impacts of a pipeline spill in Michigan. Now, tar sands refinery expansions threaten the state's air. The Marathon refinery in Detroit recently approved plans for a massive expansion to process tar sands crude, in the heart of Michigan's Oakwood Heights neighborhood. The neighborhood, which sits adjacent to the Marathon tar sands refinery, has the highest rate of pollution in Michigan, according to the University of Michigan and Karmanos Cancer Center. Thirteen of Detroit's twenty-seven polluting industries operate in the Oakwood Heights area. Bringing toxic tar sands to this area would increase health threats in a community that is already unfairly burdened by pollution.

Tar Sands Oil:
A Barrier to America's Clean Energy Future

Tar sands oil has no place in America's clean energy future. America's addiction to oil has created a growing threat to our national security, and importing toxic tar sands oil will make it worse. Canadian oil companies stand to make windfall profits from our addiction, and industry front groups for major tar sands developers are waging a massive lobbying and legal campaign against policies to reduce our dependence on oil, like California's low carbon fuel standard.

While measures to reduce global warming pollution and oil dependence--like a national Low Carbon Fuel Standard--would spur development of cleaner fuels and American jobs, tar sands companies are spending millions lobbying Congress to block them.

We already send over one billion dollars a day to foreign countries in exchange for oil, bolstering their economies instead of making clean energy at home. In 2010 tar sands became the number one oil import in the United States, and we are projected to spend $47.4 billion on Canadian crude this year. Instead of exporting billions of dollars and putting American farmland and water at risk with foreign crude pipelines, we could be investing in self-sufficiency and clean, homegrown American energy. Every dollar we spend importing oil is a dollar taken away from growing green, clean jobs at home.

Clean energy is already a thriving business in the United States. The number of clean energy jobs in the United States grew 9.1 percent between 1997 and 2008, while jobs overall only grew by 3.7 percent.

In just one example, Michigan, the site of the massive Enbridge pipeline disaster, has seen sixteen new electric vehicle technology plants open in the past year alone, creating new jobs in the wake of a crashing auto market. These plants are projected to create 62,000 new jobs over the next decade. What's more, American wind energy continued its pattern of growth in 2009, despite the recession.

Efficiency measures alone can save more oil than the tar sands can provide, and will save billions in American dollars--money that could be invested in domestic clean energy jobs.

Expansion of tar sands pipelines and refineries will only bring health problems, air pollution, water contamination, and a constant risk of oil spills. The only way to make our nation more secure, healthy and prosperous is to reduce our dependence on oil by building a 21st century transportation system and investing in clean energy like wind and solar power.

The Keystone XL pipeline will deepen our reliance on foreign, dirty fuels and undermine American clean energy jobs. A massive tar sands expansion stands in the way of our clean energy future, threatens our most precious agricultural and water resources, and puts American health at risk.

NAFTA behind the hidden door:

Trade ie NAFTA, Private Contracted Health Care Services i.e.Medical Services Plan and PharmaCare  And Third Party Contracted Family Maintenance Enforcement Program In The Province Of  British Columbia FMEP. How are they all connected once you hear how you will be outraged and all under the guise of public trust and accountability. Corruption left unchecked destroys societies this is corruption that is gone unnoticed and rampant for far far to long. Usually a clause like only the names have been changed to protect the innocent. But in this true life event there are no innocent people everybody new exactly what they were doing. My philosophy about life is if you make a life changing decision that affects the life of people you should stand accountable for your decisions so in that spirit names will be named hold on this is going to be a good one. Better then any dime store novel or reality TV show this is real life.

July 23, 2012

Social Security And Medicare How Is It Funded

And Will It Still Be Around For The Next Generation?

By Melvin J. Howard

If you look at your pay-stub you will see two deductions for FICA taxes. Ever wondered what it means? Well FICA stands for Federal Insurance Contributions Act and covers two basic benefits for retirees and disabled persons:
Social Security:

Labeled as FICA-OASDI or Old Age and Survivors Insurance and Disability Insurance. This provides pension benefits to retirees, survivors and disabled persons.

Labeled as FICA-HI or Health Insurance. This provides medical insurance for retirees, survivors and disabled persons.

Some of you may be aware that the amount of money the government collects from employees and employers as the FICA taxes has exceeded the government's obligations in Social Security and Medicare payments for the past three decades. This has been true since FICA taxes were increased under the Reagan administration in 1983, at a time when other Federal Income Taxes were reduced. Then the question is "What has the government done with that excess money?" Its all been spent on other things. About $2.2 Trillion of Social Security and Medicare Surpluses - all spent elsewhere by the US Treasury. Lets see why this is. Many people are upset because they think the government should have "saved the money" for the future and often they are misled to believe this through the existence of what are called the Social Security and Medicare Trusts, or sometimes know as the Lock Boxes. In what form could the government save the money?

* Keep it as US dollars or deposit it in a bank,
* Invest in the private sector, or
* Buy government bonds. I.e. write IOUs to oneself.

Let's look at the first possibility. If the government keeps the money as US dollars this is tantamount to the Treasury intervening in monetary policy, which is the job of the Federal Reserve. The Treasury would be essentially holding large sums of money out of the economy for many years, which would not make sense at all. The Treasury could instead decide to deposit the savings in a bank thereby making the funds available for use in the economy and draw on its deposits later as benefits fall due. But the banking system is backed up by the government itself, so the promises of the bank to make good on depositors funds is ultimately the promise of the government to itself. So why bother with all the banking fees?

It makes more sense for the government just to write a note to itself - "I owe to my self $x trillions of dollars", which is essentially what happens. A similar argument applies to investing the funds in the non-government guaranteed private sector. The private sector depends for its success on the stability and financial security of the State. If the State collapses so does the private enterprise defined by the rules of the State. If certain private enterprises collapse it shouldn't affect the State, except if there is massive widespread collapse like the recent banking crisis and then the State would step in to provide as many guarantees as possible. 

So some ultimate risks are still born by the State. The main point is that investing in the private sector carries with it higher risks than holding a government obligation. And the main point of Social Security is to pass risk from those that can least bear it over to those that can. Private investing without government guarantees completely removes this risk transfer feature of Social Security and places private sector investment risks onto those who can least afford it.

Therefore, as nonsensical as it sounds, so long as there is a surplus collection, the most sensible thing to do is for the Social Security and Medicare funds to pass over the excess funds they collect each year to the Treasury for it to spend back into the economy. The Treasury then writes an IOU to the trust fund to pay back the amount it just spent on something else. Basically the Government is writing an IOU to itself. Then they put the IOU in a box, lock it up and call it a safe "lock box" or trust fund. 

Whether intentional or not, what effectively happened to the Social Security and Medicare surpluses generated by the Reagan Era FICA tax increases and reductions in benefits, helped fund Reagan's big military build-up of the eighties. With a Federal Income Tax Cut, but an increase in FICA taxes, the tax burden was less progressive, and the loss in tax revenues in the general Treasury account was somewhat offset by Social Security Surpluses. 

This shifting of funds also enabled the government to replace borrowing from the private sector (the markets), which it cannot default on without dire consequences to the economy, with a promise to "pay back" the funds to Social Security and Medicare many years in the future when needed. This is a much less serious promise than issuing debt to the private sector because future governments may very well get away with reducing publicly funded social security benefits if they argue it effectively enough.

However the government cannot default on debt issued to the private sector else it will send the markets into a tailspin (since it is the most risk-free asset) and thus send the world's economy crashing. 

The Bush tax cuts and the recent extension of those cuts has compounded this trend of borrowing from Social Security and Medicare to make up for lower general revenues and thereby fund other government expenditures, and substitute borrowing from the markets with borrowing from 

Social Security/Medicare. Only time will tell if this was the right move or will promises be broken.

July 15, 2012

Credit Enhancers

Credit Enhancers for Hospitals and Major Clinics
By Melvin J. Howard
Credit enhancement refers to the use of bond insurance, letters of credit, guaranties and other devices by which a third-party (the credit enhancer) guarantees the payment of principal and interest on the bonds, providing additional assurances of payment to the bondholders and therefore lowering the interest rate demanded by investors.
Providers. The most common forms of credit enhancers for hospitals and major clinics are:
1. Bond insurers, which provide bond insurance over the life of long-term bond issues in return for a payment of an up--front fee.
2. National and international banks, which provide letters of credit, for a period of 5 to10 years, with annual fees.
3. Local banks, which provide letters of credit, usually in smaller amounts. Local banks are sometimes more flexible than national and international banks in their terms.
Making the selection process. In theory, choosing if and how you use credit enhancement is quite simple: If the interest rate savings exceed the costs of the credit enhancement, the credit enhancement is worth buying. For a letter of credit, the market rates for the unenhanced credit are compared to the gross interest costs of the enhanced transaction, i.e., actual interest rates plus the annual fees for a letter of credit and remarketing if variable rates are used. For bond insurance, since the premium is paid in advance, the comparison is between the present value of debt service on an unenhanced issue with that for an insured issue. This calculation should reflect the fact that the insurance premium is usually paid out of the bond proceeds and therefore increases the principal amount of the bonds. In actuality, the cost benefit analysis is more complicated because of:
Transaction costs. Transaction costs both in terms of delays and increases of such matters as counsel fees.
Timing. If credit enhancement is selected before the marketing of the bonds, it may be impossible to measure accurately whether credit enhancement is cost effective. On the advice of underwriters, hospitals frequently "go into the market" without credit enhancement, obtaining a ruling and circulating the preliminary official statement and then deciding during the actual marketing of the bonds whether to use credit enhancement. This process, however, complicates the role of hospital counsel in negotiating reasonable covenants with the credit enhancer.
Managing the Selection Process. If the hospital has sound credit, it may have the option, particularly in bond insurance, of having proposals from several bond insurers. Bond insurers are increasingly competitive. The hospital should look to the financial advisers and/or underwriters to give it a general analysis of then various bond insurers. All AAA rated credits are not alike in pricing, and all bond insurers are not rated AAA. The hospital and its counsel can also learn from financial advisers and underwriters generally how flexible particular bond insurers are on particular points.
Responding to Proposals. When a hospital receives multiple proposals of insurance, perhaps the only easy comparison between them is in price. The hospital then runs the risk that the low bidder will ultimately prove to be unsatisfactory because of the insurer's insistence on financing and operating covenants that the hospital finds burdensome. While the hospital cannot string along multiple insurers indefinitely, it may wish to keep the second lowest bid "in reserve" until it has a handle on the operating covenants the low bidder will require.
Negotiating With the Low Bidder. Once the hospital has the low bid and believes it has selected an insurer, it should press ahead quickly to negotiate the actual terms and conditions of the commitment, i.e., identify precisely what financing and operating covenants the insurer will require. The insurer sets these conditions out in a commitment letter, but there is frequently room for negotiation. Once the hospital has gone so far down the road with bond insurance that it cannot easily retreat (such as mailing of a preliminary official  statement that names the bond insurer), the hospital essentially has no leverage to negotiate operating covenants with the insurer.
Operating Covenants. While commitment letters generally list required operating covenants, they are frequently subject to negotiations. Upon the recommendation of underwriters and financial advisers, hospitals frequently have their bond counsel produce financing documents that have the "loosest" possible financial and operating covenants. There then follows a negotiation process in which the insurer requests changes in those basic documents and may or may not insist on all of the operating covenants in precisely the form set forth in the commitment letter. The hospital and its counsel should press ahead with this process as quickly as possible after the initial decision on insurers is made. Otherwise its ability to go to another insurer is lessened.
Utilizing Financial Advisers and Underwriters. A financial adviser is frequently important as a mediator between the hospital and a credit enhancer. Hospital and its counsel should look to the financial adviser to provide a realistic understanding of what changes the bond insurer will or will not accept. Similarly, the existence of credit enhancement frequently changes the relationship between the hospital and the underwriter. In a normal transaction, the underwriter will frequently insist on operating covenants that it believes appropriate. With credit enhancement, the underwriter generally become an ally of the hospital in negotiating with the credit enhancers, since the underwriter generally doesn't care what operating covenants exist in a credit enhanced transaction (even though the Securities and Exchange Commission thinks it should).
Particular Types of Covenants. Credit enhancers have a variety of views on the operating and financial covenants that they require. The most common ones include:
Rate Tests. These are standard. It is important to have a flexible "out" that provides the hospital with the ability to avoid "default" if it drops below a required coverage so long as the hospital hires a consultant and follows all of the consultant's advice as to operations. Nonprofit hospitals should also have provisions that recognize that their ability to comply with rate covenants may be affected by tax code requirements for continuation of tax-exempt status.
Restrictions on Debt. These are frequently the most significant restrictions for hospitals in credit-enhanced transactions. In recent years, greater flexibility has become common, and the insurer's willingness to be flexible likely will reflect both the creditworthiness of the particular hospital and the insurer's current appetite for business. The chief financial officer of the hospital should undertake actual calculations as to the amount of debt that the hospital would be able to incur under the debt restrictions proposed by the credit enhancer.
Transfer of Assets. As hospitals engage in increasingly complicated corporate structures and affiliation agreements, insurers (as well as other lenders) are increasingly concerned on restrictions on the amount of asset transfers that hospitals can transfer to other entities. Again, it is prudent for a hospital and its counsel to consider particular expansion and other plans that the hospital may want in the future in light of such tests.
Credit Enhancer Consents. Credit enhancers frequently require that they consent to particular actions by the hospital. The hospital sometimes find that such consents cannot be obtained or obtainable only at some kind of cost. Hospital should insist on a standard of reasonableness in such consents.
Counsel Fees. Hospital and its counsel will want to be specific on whether there will be a separate payment for counsel to the insurer and whether there is a cap on such amount.

July 11, 2012

National Security And Global Public Health

By Melvin J. Howard

Global public health security covers a wide range of complex issues, including the health consequences of human behavior, climate change, weather-related events and infectious diseases, as well as natural catastrophes and man-made disasters. Many people don’t think of national security when it comes to health care. But lets go back in history Europeans brought the first diseases against which the Native Americans had no immunity. Chicken pox and measles, though common and rarely fatal among Europeans, often proved fatal to Native Americans, and more dangerous diseases such as smallpox were especially deadly to Native American populations. It is difficult to estimate the total percentage of the Native American population killed by these diseases. Epidemics often immediately followed European exploration, sometimes destroying entire villages. Some historians estimate that up to 80% of some Native populations may have died due to European diseases. In addition to the diseases brought over by the first wave of immigrants to Hawaii, leprosy, whose origin is not known and for which there has never been a cure, had a profound effect on the public health of native Hawaiians. Because of the social stigma attached to the diseases (it was mistakenly thought to be a venereal disease) as well as its extreme contagiousness, lepers were isolated on the island of Molokai beginning in 1886. For 16 years, a Belgian priest named Demian Joseph de Veuster provided medical care for these patients, whom the medical community refused to treat, before succumbing to the illness himself in 1889.

Compared to Hawaiians of European and Asian ancestry, native Hawaiians have continued to bear the brunt of the archipelago's health problems. Whereas Hawaii as a whole boasts the longest average life span of any state (males live an average 75.37 years, females, 80.92 years), the death rates of native Hawaiians at all ages are above average. The infant mortality rate for native Hawaiians is 6.5 per 1,000 live births. In addition, native Hawaiians experience high rates of diabetes and hypertension. Health workers consider poor diet a major factor, and economic problems undoubtedly contribute to this situation.

Then there was the dreaded Black Plague or Black Death, the most severe epidemic in human history, ravaged Europe from 1347-1351. It is thought that as many as 25 million people (one third of Europe's population at the time) were killed during this short period,. Thousands of people died each week. This plague killed entire families at a time and destroyed at least 1,000 villages. Once a family member had contracted the disease, the entire household was doomed to die. Parents abandoned their children, and parent-less children roamed the streets in search for food. If the people weren't dead they ran away in vain attempts to save themselves. Victims, delirious with pain, often lost their sanity. Life was in total chaos. The Black Death struck the European people with very little warning. They did not understand the causes of infectious disease, or how they spread. They did not have the ability to understand where this sudden cruel death had come from. And they did not know whether it would ever go away. The Plague was a disaster without a parallel, causing dramatic changes in medieval Europe, contributing to what is called the Crisis of the Fourteenth Century.

National Security 

The Obama's administration National Security Strategy, is a 52 page document intended to guide U.S. military and diplomatic policy for years, is to eliminate the need for the U.S. to strike first or take unilateral military action," the policy puts "heavy emphasis on the value of global cooperation, developing wider security partnerships and helping other nations defend themselves." The strategy also outlined the importance of improving the U.S. economy for national security "through better education, national debt reduction, a stronger U.S. clean energy industry, greater scientific research and a revamped health care system. In the strategy President Obama writes that the U.S. Armed Forces "will always be a cornerstone of our security, but they must be complemented." Obama adds, "Our security depends on diplomats who can act in every corner of the world ... development experts who can strengthen governance and support human dignity. Part of the document focuses on promoting national security through global health and related efforts. "The freedom that America stands for includes freedom from want. Basic human rights cannot thrive in places where human beings do not have access to enough food, or clean water, or the medicine they need to survive," the document states, noting the U.S. role in assisting with efforts to achieve the U.N. Millennium Development Goals.

The strategy cites examples of how the U.S. aims to "promote dignity ... through development efforts." They include, the Global Health Initiative (GHI), U.S. food security programs and leadership in humanitarian crises. The U.S. "has a moral and strategic interest in promoting global health. When a child dies of a preventable disease, it offends our conscience; when a disease goes unchecked, it can endanger our own health; when children are sick, development is stalled," according to a section of the document that focuses on the GHI. On food security, the document states that instead of simply providing aid for developing countries, we are focusing on new methods and technologies for agricultural development. This is consistent with an approach in which aid is not an end in itself – the purpose of our foreign assistance will be to create the conditions where it is no longer needed. We are promoting child and maternal health. We are combating human trafficking, especially in women and girls, through domestic and international law enforcement. And we are supporting education, employment, and micro-finance to empower women globally. Global public health security depends on actions to prevent and respond to threats that endanger the collective health of the global population. Those threats have an impact on economic or political stability, trade, tourism, access to goods and services and, if they occur repeatedly, on demographic stability.

Environmental threats to global health security

Non-occupational human exposure to arsenic in the environment is primarily through the ingestion of food and water. Of these, food is generally the principal contributor to the daily intake of total arsenic. In some areas arsenic in drinking water is a significant source of exposure to inorganic arsenic. In these cases, arsenic in drinking water often constitutes the principal contributor to the daily arsenic intake. Contaminated soils such as mine tailings are also a potential source of arsenic exposure. Inorganic arsenic levels in fish and shellfish are low. Foodstuffs such as meat, poultry, dairy products and cereals have higher levels of inorganic arsenic. Pulmonary exposure contributes to smokers and non-smoker alike, and more in polluted areas. The concentration of metabolites of inorganic arsenic in urine (inorganic arsenic, MMA and DMA) reflects the absorbed dose of inorganic arsenic on an individual level. Exposure of the general population to arsenic occurs mainly through food and water and in most areas, food is the main source. Arsenic in food is mainly in the form of organic arsenic, which is generally thought to pose less health problems than inorganic arsenic. About one-quarter of the arsenic present in the diet is inorganic arsenic, mainly from foods such as meat, poultry, dairy products and cereals. Fish and shellfish contain the highest concentrations of arsenic, but the proportion of inorganic arsenic in fish is very low, below 1%. In some areas, where levels of arsenic in groundwater are high, drinking water may be the main source of intake. In drinking water, arsenic is present in the more toxic, inorganic form. Contaminated soils such as mine tailings are also a potential source of arsenic exposure.

Urbanization, increasing international trade and travel has contributed to the rapid spread of viruses and insects that carry them. For instance, dengue caused an unprecedented pandemic in 1998, with 1.2 million cases reported to the WHO World Health Organization in 56 countries. Since then, dengue epidemics have continued and have affected millions of people from Latin America to South-East Asia. Globally, the average annual number of cases reported to WHO has nearly doubled in each of the last four decades. Surveillance is crucial for public health security and without it, it is impossible to detect and respond to emerging health threats. For instance, HIV and AIDS had perhaps been occurring for many years in Africa and Haiti but had not been detected due to inadequate surveillance and health systems in these developing countries. This new disease was only brought to international attention when the first few cases appeared in the United States. Even then, the disease was not detected by surveillance systems but by chance, when epidemiologists noticed an unusual number of orders for drugs to treat a rare infection that is common in AIDS cases.

The behavior of individuals at all levels – political leaders, policy-makers, military commanders, public health specialists and the general population – can have major health consequences, both negative and positive. Threats to public health security such as natural disasters, epidemics of infectious diseases, chemical and radioactive emergencies or other health events, can have one or more causes. The causes may be natural or man-made, environmental or industrial, accidental or deliberate, and in many cases related to human behaviour. Public health is undermined not only by human action but also by the lack thereof. Complacency and a false sense of security can tempt governments to reduce spending on public health and to scale down prevention programmes with potentially disastrous consequences for collective global health.

July 01, 2012


By Melvin J. Howard

For the people by the people

You would think that the State and Federal Government would work together for the common good of its citizens. I would think health care reform would rank high on that scale. But you would be wrong the issue has become polarized and political and for this reason I worry that health care in this great nation of America with its run away costs and the non coverage of some of its most vulnerable citizens will continue to be a long dragged out debate with never ending challenges to the constitutionality of the law. At the heart of health reform is a legal debate surrounding THE COMMERCE CLAUSE. Basically, it is the scope of the federal government's power to regulate interstate commerce. The new healthcare reform bill places a requirement mandating all Americans must obtain some form of health insurance or risk being fined or penalized. Some GOP states argue "The Act represents an unprecedented encroachment on the liberty of individuals living in the Plaintiffs' respective states, by mandating that all citizens and legal residents of the United States have qualifying healthcare coverage or pay a tax penalty. The brief goes on to say that the Constitution nowhere authorizes the United States to mandate, either directly or under threat of perjury, that all citizens and legal residents have qualifying healthcare coverage. But it also states under the Constitution, Congress shall have the Power to Coin Money and Regulate the Value Thereof but we all know that is not the case today.

The GOP wants to argue that the federal government's power to regulate interstate commerce doesn't entail the power to create an individual mandate to buy health insurance, since the act of not buying health insurance shouldn't be seen as engaging in interstate commerce. But yet the GOP's counter-proposal for health-insurance reform is to "let families and businesses buy health insurance across state lines," which would clearly place health insurance in the category of "interstate commerce". That ought to give the federal government all the regulatory powers the states currently have to regulate health insurance and lets not leave out Massachussetts' health care system, with an individual mandate whose constitutionality has never been challenged in court. Also lets not forget Medicaid, which already is heavily subsidized by the federal government. National or multinational firms have increasingly dominated the industry, agriculture, services and finance, the government has the power to regulate national and international commerce and it has had increasing sway over economic regulation since the beginning.

Lets just take a look at what would happen without some key important mandates from congress in the form of the forgotten man: When A takes from B to give to C, the world is well aware of the benevolence of A and of the plight of C; but B is the forgotten man.

The relevant point for us is not that B is being treated unfairly; the point is that B isn't going to stand still for this. He'll look for ways to prevent A from stealing from him. He may begin avoiding or evading taxes; he may earn less so that less will be taken from him; he may move out of A's jurisdiction; or he may start pretending to be C.

The end result is a society in which everyone wants to be C (or A), and no one wants to be B. But B was the person who originally financed A's generosity; and without him, there will be little to redistribute. In addition, if C doesn’t have to pay for his own needs, it's inevitable that his need will grow larger. Society develops that it has boundless needs and no one to pay for them. We can see how this happens if, we look at one sample of the A-B-C process in the health care reform debate.

Health care advocates believe, for example, that people have a "right" to free medical care. Since no "rights" can be asserted against nature, the advocate must not be thinking of a right to live without disease. They are, in fact, thinking that no citizen should have to pay for medical treatment that it should be free.

But since nature doesn't provide medical care, it must come from other human beings. So one person's right to medical care is a claim upon some other person's time, energy, money, or knowledge. The man on whom this claim will be made is B, the forgotten man. Now the politician offers free medical care, but he never says, "You will have free medical care because we are going to force B to pay for it."

The plan becomes unrealistic from the start in that it assumes that B will submissively pay the bill without looking for loopholes. It's unrealistic, also, to believe that the costs of the program won't change when the economics of it change.

The politician sees that people presently spend $100 billion per year on medical care. So he plans to collect $100 billion on new taxes or ( medical insurance "contributions"), and use the money to pay for doctors, nurses, medicine, X ray etc. He believes that this will make medical care free.

But once the program is underway, the economics change drastically the 100 billion was what people had spent yearly when the money came from their own resources. Now that medical care is free their medical needs suddenly in­crease. Why forgo that operation, checkup, or treatment that might have some value.

Or if your lonely, why not go talk to your doctor? Or if you need a place to stay check into the hospital; they'll find something wrong with you many people will see that this is wasteful-for the nation. But for each individual, the con­sideration is always that it costs zero dollars to obtain something that might prove to be valuable so free medical care turns out to cost far more than $100 billion per year.

And after a while B decides that he’s tired of paying for what he deems these loafers and he checks into the hospital, too from stress.

Or at least he stops working so hard. His income is taxed to pay for free medical care and for all the other government programs. And so leisure (unpaid and therefore untaxed) seems more attractive to him. He earns less; and he saves less, too, because he'd just have to pay tax on the interest his savings earn. And because he and all the other Bs are earning less taxable income, the politicians have to raise tax rates even higher than they planned—to collect the money they need for free medical care.

Because even the government's resources are limited (it can't tax what doesn't exist), it is forced eventually to do something to limit the costs of the program. Naturally it won't end the program that’s political Armageddon; it will declare that a crisis exists and impose rationing.

So when the cost of free medical care has reached double or triple or quadruple the original estimate of $100 billion, the government announces that it will decide who gets to see the doctor first. You will have to go without—unless you have the right disease or fill out the right form or know the right people.

And most people will have no choice but to wait in line for free medical care. The billions spent on the program will have bid up the price of medical services; only the very wealthy (of whom there are fewer) will be able to afford to hire a doctor on their own.

Just as promised, medical care is free; it just isn't available. We would be sobered by the medical situation in Canada and some European countries. Government medical and "Social Security" pro­grams are far advanced there, compared to the U.S. The shortage of medical care is chronic because doctors emigrate to the U.S. and other countries where there are greater op­portunities to earn more money. Waiting lists sometimes are years long. Mr. B. has long since disappeared.

I've used this as an example of the way the health crises develops. The crisis is always a conflict between the government's goals and the actions of individuals. Many in­dividuals will sympathize with the government's position, but none will sacrifice his personal interest.

It isn't a matter of selfishness vs. unselfishness. Every indi­vidual acts in his own self-interest; that's a principle of hu­man action. The conflict is between the individual who selfishly pursues what he believes is best for himself and the politician who selfishly wants the individual to act under his direction. There is no right or wrong answer to this dilemma but in order to have true dialogue about how to cover the uninsured and to bring down health care costs in America. We must first acknowledge good ideas and implement them no matter what the source political or otherwise. So no one becomes the FORGGOTEN Man, Woman or Child!