06 Sep

An Economic Review of Calaveras County

An Economic Review of Calaveras County

 By Susan Ashby for CCDCC

This paper reviews current economic factors in the County plus the State’s forecast for the next several years.  It will also discuss potential impact of certain events on the County.

United States’ Economy

Before looking at Calaveras information, let’s look at the state of the economy for the U.S.  The current economic expansion is the third-longest in U.S. history but it is the weakest economic recovery since World War II.

“Only two expansions have matched the lifespan of the one that began June 2009 and has endured for 96 months:  a 106-month expansion that ran from February, 1961 to December, 1969 when President Lyndon Johnson stoked growth with spending on domestic programs and the Vietnam war.  And a 120-month streak that began in March, 1991 and ended in March 2001, after the dotcom bubble burst.”

Employers have been hiring steadily since 2010 – “81 straight months – easily the longest streak on record.  And the number of Americans applying for first-time unemployment benefits has stayed below 300,000 for 125 straight weeks.  That’s the longest such streak since 1970, when the population and workforce were much smaller.”

However, compared with the other two long-lasting expansions, the current one looks weak.  A big reason is just how bleak the job picture was eight years ago.  The Great Recession wiped out 7.4 million jobs and the job market didn’t actually hit bottom until February 2010.”  “…over the last couple of years, we have definitely moved to a slower pace of job growth” says Robin Anderson, senior economist at Principal Global Investors.
AP Economics Writer Paul Wiseman

Nationally, the unemployment rate was 4.4% as of June, 2017. For California, 17600 new jobs were added in May, dropping the State’s unemployment rate to 4.7%.

Current Economy in Calaveras County


With a population just under 46,000 and a civilian force of a little over 21,000, the current unemployment rate is 5% –down from 6.1 in January, 2017, and 5.6 a year ago in June, 2016.  By comparison, for 2016, Amador County was 6.0 and Tuolumne 5.7.   Mariposa, Merced, Madera counties all have higher unemployment rates than Calaveras.


“Calaveras …draws tourists from all over the globe to its cultural events and to treasure the small town ambiance. Because of its attraction to visitors, the tourism business is thriving, and it is one of the major growth industries in the County.”

Lisa Boulton, Executive Director, Calaveras County Visitors Bureau.

2016 preliminary data from the State shows $180 Million in total travel-related spending and 2340 jobs in Calaveras County.

There has been steady growth in visitor spending and travel-related employment since 1994.  The average annual change in visitor spending since 1994 is 3.3%; between 2015 and 2016, an increase of 3.0%.   With regard to employment, the average annual change in travel-generated employment from 1994 to 2016 is 1.0% and between 2015 and 2016 there was an increase of 2.0%.


In February, the University of the Pacific Business and Policy Research, Eberhardt School of Business, Stockton, and McGeorge School of Law, Sacramento, wrote “An Economic Impact Assessment of the Cannabis Cultivation Industry in Calaveras County.”  Key findings of direct impacts of 2016 Calaveras cannabis cultivation include:

  • Sales value: $251.5 million
  • Direct employment: 2605
  • Direct labor income: $148.4 million.

Cannabis cultivation equates to about 15% of the county’s Gross Regional Product (GRP) and when indirect and induced impacts are included, the total impacts are about 19% of GRP and 21 percent of the county’s jobs.

Other Farm Commodities in 2016

Cattle and calves – $9.3 million; Poultry $52M; Wine Grapes $2.7M; Walnuts $2.2M; Timber $1.7M; Sheep, Vegetables, Apiary, Nursery, and Misc. Livestock $886,000.

Forecast 2016-2021

Per the State’s forecast:

  • Population growth will be flat, with the county neither gaining nor losing a substantial number of residents.
  • Job growth will average 0.3 percent per year.
  • The largest job gains will be observed in wholesale and retail trade, as well as leisure and hospitality. Combined, these industries will account for 77% of net job creation in the county.

The above forecast would change drastically and in a positive direction if cannabis cultivation were to be approved in this County.

2017-2018 County Budget

The county really doesn’t generate enough revenue to pay for its basic needs including some things that are important to a healthy, thriving community. The preliminary budget, recently passed by the Board of Supervisors, reflects a deficit of $3.3 million.  This amount will have to be resolved, by finding revenue and/or cutting costs, by September, 2017.

Events that could impact our economy in the near future

  • Cannabis:  Legalizing cannabis cultivation would clearly impact the County positively.  If cannabis is banned, the GRP and job figures will suffer significantly.  If 19% of the GRP for 2016 was due to cannabis and the 2017-2018 preliminary budget is negative $3million, what is going to happen if cannabis is banned?
  • Tourism:  This past winter brought a lot of snow and water for winter and summer recreation.  But it also brought road closures that were not opened until late June which may show up as a negative impact on the 2017 tourism figures.  Future winters, ones with damaging storms or of drought will always impact the tourism industry here.  If the biggest industry, other than cannabis, is tourism, than we should take all the necessary steps to support it.
  • High-tech:  Another item that might have a positive impact on the economy of the County, but for which there is no economic estimate, is bringing a high-tech venture into the county.  However, that is difficult because what companies look for in a community are the very things we lack:  hi-tech labor force, hi-speed broadband,  parks, recreation, culture.

If the county had more money, what could we do with it?

It depends on who you ask.  Here are a couple of examples:

  • Law & Safety:  The DA might like a victim’s advocate.  The Sheriff’s department might want increased salaries and/or more staff, although these would mean bigger retirement liability.  Plus they might want a fully-staffed jail.
  • Health & Social Services:  Calaveras has no substance abuse treatment, no narcotic detox, no family planning services, no emergency domestic violence shelter, no 24- hour care for mentally ill, no parks and recreation department.  Also, things like an education program about drugs and alcohol could be initiated.
  • Infrastructure: Investment in clearing the soil of arsenic from old mining operations.
  • Tourism:  Improve the trail system and public roads improvements; make improvements and advertise for more mountain bikers, campers, and water rapids riders.   Beautification of the Highway 4 corridor.   Regional parks.

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07 Aug

McClintock’s Monthly Staff Meetings

McClintock’s Monthly Staff Meetings

By Susan Ashby

Do you want to let Tom McClintock know what you think of his views and actions?

I’d like to encourage you to attend the monthly staff meeting. This is a great opportunity to let McClintock know what you think about his actions.

Every month, Tom McClintock sends a staffer to represent him at the different counties in CA04 (10 counties in all). For Calaveras County, these meetings are held on the fourth Tuesday of the month, 12:30 pm, in the Cheesebrough Room at the San Andreas Central Library. Matt Reed is the staffer who conducts the meetings for Calaveras County. He’s a very good listener, is extremely nice and polite, and seems to take thorough notes on comments, complaints, and questions. During the meetings, he often states McClintock’s views and defends them very well.

Attendance varies in size and usually consists of both McClintock supporters and non-supporters. One thing that you can count on is everyone’s willingness to state their opinions. Matt is just there to document attendee concerns, answer questions, occasionally commit to get back to the attendee, and make sure that everyone gets a chance to finish speaking their piece. Sometimes, however, Matt states incorrect information. Recently, I’ve called him on this on a couple of subjects.

One nice side-effect of the meetings is that it can be a great way to meet others in the county who you might not have met before.


At the July meeting, there was a small group of like-minded non-McClintock supporters. All were in agreement as we discussed the following:

  • Climate Change: At both the May and June meetings, Matt stated that McClintock relies on two studies (Purdue and Cook) to support his position that there is no human-cause climate change. This month, I provided Matt with documentation from both those studies indicating contrary findings — they do NOT support his position and in fact both clearly state that 97% of climate scientists, worldwide, accept human-caused climate change. Hopefully he’ll stop citing them.
  • Matt had said in June that, per the EPA, fracking does not harm ground water. This month, I gave him information from the EPS’s final report (issued last December) that states the findings confirm that fracking does indeed seep into and pollute ground water. Hopefully he’ll stop citing this.
  • There was a long discussion on Trump — how disrespectful and rude he is and that he lacks moral character; how it was such a sad day for America when the President of the United States, while on foreign soil, criticized and denigrated our intelligence agencies and our free press. All agreed that if Trump finds a way to fire Mueller and stop the Russian investigation, that it should be a wake-up call to the Republicans to stand up for the country and not allow that action.
  • Support for other items was also discussed: Planned Parenthood, Net Neutrality, and maintaining the Johnson Amendment.

We must let McClintock know what we believe in, what we do and do not want from our government, and what we want him to do for us. Let’s have a show of strength from the citizens in this County.

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Lying Politician
30 Jul

Does the Truth Matter?

Does the Truth Matter?

Linda Abbott Trapp, PhD

July 28, 2017

From Eve onward, people have lied -“the snake gave me the apple…”.

From Plato forward, the lies of politicians have been excused as necessary to shield the masses from even greater harm. For example, many believe it’s OK for the government to announce, falsely, the capture of a terrorist, since that probably will cause other potential terrorists to hesitate. Whether there is, generally, more lying among candidates and politicians than in the past is open to discussion.  Before telegraphs, telephones, and radios, candidates sent out others to speak for them and their words may or may not have been faithfully repeated.  All over the contemporary world, leaders of governments and companies need to maneuver among competing interests and may find themselves telling each group what it wants to hear.  So, lying is and has been widespread.  We may be entering an era, however, where disrespect for truth is so widespread that the basis of trust  among the people in our democracy has been irreparably damaged. The question is, “Does it matter?”

If someone near to you lies, how does that make you feel? For example, If your mother  says you can’t borrow the car because it’s low on gas and you see that the tank is full, do you wonder what else she might not be telling you or how she might be misleading you on other matters?  If your spouse says the meeting he/she is going to should be out be 8:30 and at 11:00 you are still home alone, do you worry?  Get angry?  We think we know the people we love and our knowledge of their character is the strongest reason to believe what they say.

In today’s political world, demonstrations of character seem to be rare. In fact, some claim that self-interest has entirely taken over our judgment. If a candidate takes a position we support or seems to favor the needs of our group, we tend to believe anything he or she says, although the facts may support a contrary view.  Even if the evidence clearly points to a different, more painful, truth, we don’t want to hear it.

Manipulative politicians have learned that lesson quickly — their “base” will accept almost any outrageous claim from them and the echo chamber of sources the base consults will only reinforce that message and as the lie is retold, it becomes more “true”. The narcissistic politician, aware of this dynamic, has figured out the cost/benefit analysis of lies vs. truth and fully believes that dishonesty is the shortest road to success. The growth of politics as entertainment, performance and posturing supports this trend – real, substantial searches for truth on an issue don’t provide the wanted clicks and sound bites. Ugly attacks, however unfounded, draw the numbers, reasoned analysis doesn’t.

So, we have to ask why we accept, even enjoy, the show.  Is it worth losing our position of world leadership, the respect of other nations, and the moral high ground our former national ideals supported?  Could we just try to place analysis over amusement in making decisions that affect thousands, even millions, of our countrymen and women. I, for one, would like to replace coarseness with consideration, argument with analysis, and Twitter rants with truth. Ask yourself if you are easily swayed by personality, vulgarity, simplification of complex issues, and pandering to the lowest common denominator. Democracy is hard. We need to soften the rhetoric and sharpen the analysis.  You know, among friends and family, how to judge character. Please apply that knowledge to the political realm. We all need to step up our citizen game.

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25 Jul

McClintock is not concerned that his actions could result in another Great Recession and your financial security would be at risk!

McClintock is not concerned that his actions could result in another Great Recession and your financial security would be at risk!

by Susan Ashby

The Republican-dominated House recently passed HR10, the Financial Choice Act.  The vote was 233 Yea (all Republicans) and 185 Nay (all Democrats).  McClintock co-sponsored this bill and voted yea for passage on June 8.

If the bill becomes law, “it will represent a huge defeat for the American public and increase the possibility of another financial crisis” said Rep. Jim Himes, D-4th District.  “The Financial Choice Act attempts to undo all of the protections we have instituted… It strips power away from the (Securities and Exchange Commission) and the Consumer Financial Protection Bureau; makes it easier for banks to gamble with taxpayer money …”

“This is a dangerous piece of legislation…”   This bill would repeat recent history and put Americans at risk of losing millions by taking “referees off the field.”  Said Steny Hoyer, the House minority whip said on the House floor on Thursday.


The financial crisis happened because: 

  1. Banks created too much money too quickly. Every time a bank makes a loan, new money is created. In the run up to the financial crisis, banks created huge sums of new money by making loans. In just 7 years, they doubled the amount of money and debt in the economy.
  2. They used this money to push up house prices and speculate on financial markets. Just 8% of all the money (billions) that banks created from 2000-2007 went to businesses outside the financial sector.
  3. Eventually the debts became unpayable.  Lending large sums of money into the property market pushes up the price of houses along with the level of personal debt. Interest has to be paid on all the loans that banks make, and with the debt rising quicker than incomes, eventually some people become unable to keep up with repayments. At this point, they stop repaying their loans, and banks find themselves in danger of going bankrupt.
  4. This process caused the financial crisis. Straight after the crisis, banks limited their new lending to businesses and households. The slowdown in lending caused prices in these markets to drop, and this means those that have borrowed too much to speculate on rising prices had to sell their assets in order to repay their loans. House prices dropped and the bubble burst. As a result, banks panicked and cut lending even further. A downward spiral thus begins and the economy tips into recession.


In response to the financial crisis of 2007-2008, the Dodd-Frank Wall Street Reform and Consumer Protection Act was passed in 2010.

  • The Act’s numerous provisions are being implemented over a period of several years and are intended to decrease various risks in the U.S. financial system. The Act established a number of new government agencies tasked with overseeing various components of the Act and by extension various aspects of the banking system.
  • A key component of Dodd-Frank, the Volcker Rule(Title VI of the Act), restricts the ways banks can invest, limiting speculative trading and eliminating proprietary trading. Effectively separating the investment and commercial functions of a bank, the Volcker Rule strongly curtails an institution’s ability to employ risk-on trading techniques and strategies when also servicing clients as a depository. Banks are not allowed to be involved with hedge funds or private equity firms, as these kinds of businesses are considered too risky.


What does HR 10 do to the Dodd-Frank Act provisions?

  • Repeals the “Volcker Rule.”
  • Repeals a the provision requiring the Board of Governors to prescribe capital adequacy and other risk management standards for supervised securities holding companies
  • Repeals the Consumer Law Enforcement Agency’s authority to monitor for risks to consumers in the offering or provision of consumer financial products or services, including developments in markets for such products or services.
  • Repeals the Consumer Law Enforcement Agency’s supervisory authority over financial institutions and limits the agency’s authority to take action against entities for abusive practices.
  • Repeals the Department of Labor fiduciary rule which gives SEC the authority to impose a fiduciary duty on brokers who give investment advice –the advice must be in the best interest of their customers.
  • Repeals the section of Dodd-Frank that provides limitations on fees that may be charged to retailers for debit card processing

“It’s a bill that’s so harmful to vast swaths of the American public if it became law… It would make it easier for predatory lenders to rip people off. It would make it easier for Wall Street to keep taking $17 billion out of retirees’ pockets by repealing the fiduciary rule. It would make it easier for big Wall Street banks to take the kind of risks in pursuit of short-term gains that go directly to the pockets of the tiny handful of people at the top that led to the financial crisis.” said Lisa Donner, executive director of Americans for Financial Reform.

 “It’s shameful that Republicans have voted to do the bidding of Wall Street at the expense of Main Street and our economy,” said Maxine Waters, currently the top Democrat on the House Financial Services Committee.

“The Wrong Choice Act is … an invitation for another Great Recession, or worse,” said California Rep. Maxine Waters.


Remember,   your representative in the House, Tom McClintock voted for this bill.  We need to replace him with someone who cares about our financial security!

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Highway 26
20 Jun

McClintock is a climate change denier!

McClintock is a climate change denier!

By Susan Ashby.

McClintock believes global warming is not a threat.  April 7, 2014, McClintock online at

“… the planet has been warming–on and off–since the last ice age….   Until the earth begins moving into its next ice age, we can reasonably expect it will continue to warm gently….  Droughts are nature’s fault and beyond our control.”

And so are the majority of the Republicans:

Climate change is happening, humans are the cause, and a shocking number of congressional Republicansover 56 percentdeny or question the science. ….170 elected representatives in the 114th Congress have taken over $63.8 million from the fossil fuel industry that’s driving the carbon emissions which cause climate change. They deny what over 97 percent of scientists say is happening — current human activity creates the greenhouse gas emissions that trap heat within the atmosphere and cause climate change. And their constituents are paying the price, with Americans across the nation suffering 500 climate-related national disaster declarations since 2011.

Make no mistake, climate change is real and attributable to human activity.  The majority of scientists from around the world agree:

Purdue study: Climate change consensus extends beyond climate scientists:

“Our survey indicates that an overwhelming majority of scientists across disciplines believe in anthropogenic climate change, are highly certain of these beliefs and find climate science to be credible.   … scientists who are climate change skeptics are well in the minority.”

Previous studies have shown that about 97 percent of actively-publishing climate scientists believe in human-caused climate change, and a review of scientific literature on the existence of climate change indicated that about 97 percent of studies affirm climate change is happening.


The science says that humans are causing global warming is the position of the Academies of Science from 80 countries plus many scientific organizations that study climate science.  More specifically, around 95% of active climate researchers actively publishing climate papers endorse the consensus position… The greater the climate expertise among those surveyed, the higher the consensus on human-caused global warming.

The Paris Accord was not a “deal”

There was no requirement to meet specific measurements and no penalties for anything.  It was a volunteer agreement to do the best each country could do.   To find out more go to:


Concerned people voiced their disapproval of Trump’s announced withdrawal from the accord:  

“Donald Trump is making a shameful and historic mistake. Our grandchildren will look back on with stunned dismay at how a world leader could be so divorced from reality and morality. He is abandoning millions of Americans who will bear the brunt of climate disruption — from record floods to droughts and hurricanes that destroy people’s homes and livelihoods.

Leaving the agreement is also an outrageous abandonment of American leadership. The move puts the Trump alongside Syria’s Bashar Al Assad as one of only three world leaders keeping their countries out of the climate accord. With almost 70% of Americans supporting the Paris Agreement — including majorities in every state — it’s clear that Donald Trump’s reckless action is completely out of step with the wishes of most Americans.”   — From the Sierra Club

Gov. Jerry Brown called President Trump’s decision to withdraw the U.S. from the Paris climate accord an “insane move” and said “California will resist because his effort is misguided.”… “He’s wrong on the facts. California’s economy and America’s economy are boosted by following the Paris agreement,” Brown said in a call to reporters with U.S. and global experts on climate change. “Trump is wrong when he says this is bad for jobs. It’s good for jobs — the jobs of the future.”

McClintock was wrong again!  He praised Trump for leaving the Paris Climate Accord.

What does climate change mean to our community and California?

“If global warming continues unchecked, rising temperatures and potential changes in precipitation patterns will pose serious challenges for California’s agriculture and forestry industries…. global climate change may enhance ozone pollution, which harms plant growth and makes them more susceptible to disease and pests.”  See more detail impacts on fruit trees, timber, dairies, wine grapes in this article by the Union of Concerned Scientists:

Cherries, almonds, pistachios, walnuts and other fruit trees need a certain number of “chill hours” in the winter in order to produce a crop.  Chill hours have been steadily going down year after year as has the crop yield.

“In 2015, California’s pistachio industry was hit hard by a lack of chill hours. As a result, the crop was nearly split in half. The UC system and the pistachio industry have invested about a million dollars to figure out how to cope with warming temperatures.”

A slow-moving emergency is lapping at California’s shores – climate-driven sea-level rise that experts now predict could elevate the water in coastal areas up to 10 feet in just 70 years, gobbling up beach front and overwhelming low-lying cities. …. . Roads, bridges and railways along the coast from Mendocino to San Diego will be abandoned and relocated inland….. San Francisco’s Embarcadero and low-lying cities such as Huntington Beach will flood more frequently and more severely.  Read more at:

If McClintock continues to deny the science, then how can he help our community and our state?


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14 Jun

Does Tom McClintock hate women or does he just not care?

Does Tom McClintock hate women or does he just not care?

By Roy Mapps

Congressman McClintock has a long history of voting in opposition to issues vital to women. A five minute search of the internet reveals that in his entire history McClintock has voted against the rights of women in every case!

Beginning in 2006, as an Assemblyman from Southern California, he voted against a bill (California AB 2555 Wage discrimination Penalties Act) which would impose penalties on employers who practiced gender-based wage discrimination. This bill passed the California Legislature by a three to two margin, but McClintock was opposed.

In 2009 McClintock voted against amendments to a bill (HR 12) in the U.S. House which would allow victims of wage discrimination to sue for damages and require employers to prove that any wage discrimination was job related. This bill passed the US House by a three to two margin, but McClintock was opposed.

McClintock has consistently voted against the Equal Pay for Equal Work bills. In 2009 he voted against the Lillie Ledbetter Fair Pay Act of 2009 (S 181). What could you possibly have against paying women the same as a man for doing the same job? This bill passed the US House by a three to two margin, but McClintock was opposed.

In 2013 McClintock voted against the Violence Against Women Reauthorization Act (S 47). This bill passed the Republican-controlled House by a vote of 414 to 9 !!! Imagine, only nine congressmen out of 423 thought it was not necessary for the Federal government to oppose violence against women. McClintock was one of the nine!

McClintock has consistently sponsored bills to defund Planned Parenthood. His reason for this position is that Planned Parenthood performs abortions and the funds could be redirected to community health centers to provide the same care. This is simply not true. Many community facilities are not equipped, not staffed with the appropriately qualified personnel, e.g. OB/GYN trained doctors, or are out of capacity. The CBO has estimated that defunding of Planned Parenthood would result in 650,000 women losing their healthcare. In McClintock’s district many of the 8,000 of his constituents who depend on Planned Parenthood will be without health care.

Apparently McClintock just doesn’t care!!!

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07 Jun

Sickness Unto Death: An American Dilemma Parts I-8

Sickness Unto Death: An American Dilemma

Part I

By John MacWillie, Ph.D.

Murphys, CA…Introduction: The United States is alone among industrialized nations in using wealth as a gatekeeper for access to health care. The wealthier you are, the more and better health care you get. The national debate that is now taking place focuses on whether every individual, irrespective of their income, should have access to great health care.

This is a series of eight articles on a single theme to be released once a week. Copyright license granted under ©Creative Commons.

The United States is alone among industrialized nations in using wealth as a gatekeeper for access to health care. The wealthier you are, the more and better health care you get. The issue isn’t about efficiency (keeping costs down) or efficacy (performance), it is about whether you have the financial wherewithal to be able to see a doctor, have surgery, visit a mental health professional, or afford prescriptions. The national debate that is now taking place focuses on whether every individual, irrespective of their income, should have access to great health care.

From Medicare to Obamacare

Before 1965 and the creation of Medicare and Medicaid, if you were elderly or very poor, the answer was definitively no. In 2003, President George W Bush signed legislation to expand coverage to include prescription drugs. But the working poor, those working for small companies, individuals with pre-existing conditions, students, and those seeking employment — a population in the tens of millions — were still not covered by these programs. The Affordable Care Act (ACA) of 2010, more popularly known as Obamacare, sought to address these concerns by mandating increased coverage for those with pre-existing coverage and a host of other changes.


The House of Representatives recently voted by the narrowest of margins (217-213) to radically alter Obamacare. While the primary associations of doctors, nurses, hospitals, and mental health professionals have been quick to criticize what is becoming known as Trumpcare, most Americans are confused by the bewildering debate and changes in insurance plans. Over the next several months, while the Senate and the Congressional Budget Office weigh in on what House Republicans have adopted, it is time to consider why coming up with a good health care system is so contentious.

The Republican plan, known as the American Health Care Act (AHCA), would provide tax credits in lieu of subsidies for insurance premiums, eliminate Federal mandates for insurance coverage, establish high risk insurance pools for those with pre-existing conditions, provide limited underwriting of these pools for a short period of time, and authorize health care savings plans. In its original form, the AHCA flamed out when the non-partisan Congressional Budget Office (CBO) forecasted that 24 million people would lose health coverage by 2024. (CBO March 13, 2017). That does not include the 28 million citizens without insurance today. Even with this projection, the most conservative wing of the Republican party known as the Freedom Caucus rebelled against any protection for citizens with pre-existing conditions. Because the House rushed the adoption of the latest version of the AHCA, we will have to wait for a revised CBO analysis. But, even an early reading of the bill reveals that the numbers of those who will lose their health insurance will be substantially higher. The AHCA is opposed by the American Medical Association, The American Hospital Association, and the Catholic Health Association. Republican Senate leaders have already indicated they will ignore the House bill and write their own.

California’s Single Payer Proposal

In California, legislators are moving forward with an alternative to all of these programs with a proposal to create a single payer health care system for all residents of California. (CA Senate Bill 562).

The Great Question

The difference in these programs and proposals mirror the divisive debate in America on how (and whether) everyone in our society can (or should) have the opportunity to live longer, healthier, and satisfying lives without creating a burdensome regulatory environment and bureaucracy to administer this opportunity.

What We Need to Know

The challenge of health care governance for policy-makers and politicians, as well as the general public, arises from: a.) a lack of knowledge about how the health care system works; b.) the lack of consensus over goals and objectives for health care; and c.) fundamental differences in what role the government should play in health care delivery. For something so vital to all Americans, these are big problems.

How Little We Know

First of all, most of us do not appreciate just how complicated health care is and how little we know about its cost and performance. Consider the fact that the United States spends $600 billion for defense (armed forces, civilians, equipment, operations), while, at the same time, we spend nearly 8x more — $4.6 trillion — for health care services (doctors, hospitals, drugs, long-term care). Ironically, there is more publicly available information about the fire and flight control problems of the Pentagon’s F-35 Joint Strike Force Fighter than about the effectiveness of cancer treatments.

Healthcare is a Question of Ethics

Second, the goals and objectives of health care services are not only economic (how much) and political (who controls) questions, but emotional and ethical ones as well. Consider the decision process about a patient with catastrophic anoxic brain injury (i.e., persistent vegetative state). Whether the doctor (for reasons of viability), the patient’s family (for hope), the government (for policy), or the insurance company (for cost containment) makes the decision to terminate life support, it is still an ethical choice. This decision matrix complicates many, if not most, health care related decisions.

Who Makes the Decisions

Third, this leads to the question of who makes this kind of decision. Most people, if asked, would assert it should be the patient or his or her family. But in many cases, the final decision is made by those paying for the care: the hospital, insurance company, or the government. From its inception until the end of 2016, half of the country opposed Obamacare largely around concerns about the insertion of the Federal government into healthcare decision-making. By the beginning of 2017, twenty-five million Americans had been given access to health insurance through Medicaid expansion, insurance subsidies, or direct purchase and the latest Gallup poll now shows that 55% of Americans support Obamacare, while 41% oppose it. (Gallup April 4, 2017). Opinions shift relative to perceived value.

In the Coming Weeks

In this series of columns over the next month, I will examine why health care, as policy and as practice is so complicated, why we as Americans are sicker and die earlier than residents of other countries, why our health care is so expensive, why the answers to these questions have a particularly grave importance for rural America, why the system that Obamacare tried to fix was so broken, and finally, the political question of whether health care is a right or responsibility.

Part II: Who Knew It Could Be So Complicated?

Murphys, CA…Ever been to a hospital? Apparently, not President Trump. How else to explain his apology for not initially getting a “repeal and replace” bill through Congress, by incredulously asking of healthcare, “who knew it was so complicated?” 

Ever been to a hospital? Apparently, not President Trump. How else to explain his apology for not initially getting a “repeal and replace” bill through Congress, by incredulously asking of healthcare, “who knew it was so complicated?” Nevertheless, I want to give the President credit for illustrating what most professional health care workers know, and is largely unobserved by the general public — health care is complicated.

What Do Americans Want?

Take the commonly accepted primary goal of health care — to help people live healthier and longer lives — which turns out to be an enormously complicated objective. Do we, for example, take all measures to sustain someone’s life even if they have no cognition of what is going on around them? Do we provide expensive chemotherapy treatments to someone with lung cancer who insists on smoking cigarettes? Do we emphasize preventative care to reduce pathologies? When do providers intervene when they observe someone hurting themselves? When does the government get involved when there is a determination that a workplace environment is hazardous to workers? Every question provokes a surplus of contradictory responses. How do we sort this out without asking our Congress to prescribe our health care. Health care is not trivial — and being a Democrat or a Republican does not simplify any decision we make about it. It’s a fundamental human problem.

At the risk of losing my readers, let’s consider some numbers.

Poor Use of Resources

In 2012, 130 million patients visited emergency rooms for a variety of reasons, only ten percent of which required admission to the hospital for inpatient care. (CDC 2016). Most of the reported problems included headache, fever, bad cough, etc. In 2013, private practitioners recorded 70 million scheduled patients. (Physician Foundation 2017). Thus, there were twice as many visits to an emergency room than to a doctor — the emergency room was the family doctor. Given that emergency room visits cost nearly twenty times a comparable visit to a private physician and thirty times the cost of a family clinic, something is clearly wrong with how we provide health care in this country.

Size of Healthcare Industry with Other National Priorities 

The U.S. health care system has over 900,000 professionally active physicians and surgeons and more than 4 million professional nurses. In addition, there are lab technicians, pharmacists, physical therapists, nursing aides, nutritionists, psychotherapists and a host of other direct service professionals, as well as all employees of the broader health care eco-system like the information technologists, insurance representatives, administrators, pharmaceutical representatives, researchers, community health educators, for a total of 12 million health care workers (Kaiser Family Foundation 2017). By contrast, the U.S. Defense Department has 2.9 million employees (active forces, civilians, and National Guard). The health care industry is four times the size of the Pentagon and that doesn’t count research and development in the pharmaceutical and medical device industry.

In the U.S., there are 5,500 hospitals with nearly 900,000 attended beds in the U.S. for those patients with more serious conditions or for inpatient surgery. (American Hospital Association 2017). The U.S. Department of Defense maintains some 800 bases around the world — including training, active combat, command, storage, and intelligence bases.

Thousands of Bad Guys

Let’s not forget, however, why we even need a health care system to begin with — diseases and injuries. Our bodies are susceptible to all sorts of dysfunction — pathogens (viruses, bacteria), genetic malformations, bio-chemical imbalances, developmental disorders, and environmental (ecological as well as social). According to the World Health Organization, there are 30,000 categories of diseases in the world (of which 7,000 are considered rare). Having once inadvertently ingested a rare parasite while travelling overseas, I can attest to just how many laboratory tests were required to identity the pathogen. As the little critter had not been seen in the U.S. before, it took substantial experimentation to find an effective antibiotic.

Fortunately, the number of serious diseases in the United States is much smaller. In 2014, for example, the most prevalent causes of death in the U.S. were forty-two different forms of heart disease (23% of all deaths) and ninety-seven types of malignant neoplasms (cancer) which caused another 23% of deaths. Emphysema, accidents, Alzheimer’s disease, strokes, suicides, and diabetes account in toto for 27% of all deaths. Even this subset of common ailments requires a large number of technicians, techniques, physicians, nurses, and resources to identify and treat the cause and symptoms.

Can You Afford to Get Sick?

Planning for and providing health care is complicated and the President is right to call it out. The elephant in the room, when speaking of the complexities of health care in America, is not just who gets covered, or why they get covered, or even how they get covered. It is if they get covered and the gatekeepers for that complex topic are the insurance companies, to which I will return in Part VI.

Part III: Why Katsu is Healthier Than Carl? ~ By John MacWillie, Ph.D.

Murphys, CA…Americans like to think of themselves as the wealthiest, healthiest, and luckiest country in the world. I won’t debate the first and last points here, but, the United States is decidedly not the healthiest. How do we know that?

How Long Will You Live?

One answer is measuring lifespan — how long is the average person likely to live? In the United States, that probability is 79.8 years (longer for white women, less for black men). But when compared to the rest of the world, the United States ranks 42nd. Really? The U.S. lags behind Japan (3), Israel (11), Italy (14), Sweden (16), Canada (19), United Kingdom (33), Germany (34), and even bankrupt Greece (35). (CIA 2017). If you are young enough and you want to live longer, move to Canada.

It is not that simple, though, as this difference is partially explained by three important variables: diet, lifestyle, and access to health care itself. Compare the health status of residents of Japan who live longer than Americans.


Americans eat substantially more calories than residents of other countries. Americans consume, on average, 3,754 calories. The Japanese consume 2,768 calories. But when you look at the components of what is eaten, it is more striking. Americans eat 126 grams of sugar everyday; in Japan it is 56 grams. Americans consume 65 grams of fat every day, while the Japanese, with a diet more reliant on fish, only consume 45 grams. (Euromonitor 2017). The difference in obesity rates couldn’t be starker — 36% of Americans over the age of 15 are considered obese, while only 3.5% of Japanese are similarly categorized. (OECD 2017).

“Obesity raises the risk of morbidity from hypertension, dyslipidemia, type 2 diabetes mellitus (diabetes), coronary heart disease, stroke, gall bladder disease, osteoarthritis, sleep apnea and respiratory problems, and some cancers.” (Jensen, et. al., American Heart Association 2013). Comparing data from the United States and Japan for deaths due to cardiovascular disease finds that Americans die at a rate more than 70% higher than Japanese. The data may not establish causality, but if you are betting person, those are not great odds for Americans.

It Helps to be Rich

Second, this data suggests that health is related to lifestyle and one of the principle drivers for lifestyle is income. In a study just published by the American Medical Association, the data shows the wealthier lived much longer than those who are poor — males with the top 1% in income in the U.S. live fifteen years longer than males in the lowest 1%. (JAMA 2017). Lifespan is directly related to lifestyle and the economically poor are much more likely to have poorer nutrition, at much higher risk of being the victims of homicides, and be more susceptible to environmental risks.

This raises the question of the relationship between lifespan and income inequality. Here the numbers are particularly striking. The World Bank calculates the difference between a theoretically equal society (in terms of income) and the actual distribution of income in a nation (what economists call a Lorenz curve). The United States ranks 63rd among 167 nations such as El Salvador, Russia, Uruguay, Gabon, Turkmenistan, and Madagascar — in other words, the U.S. is very unequal in income distribution. Japan ranks 122nd, where the higher ranking represents less income inequality along with the United Kingdom, Ireland, Switzerland, and South Korea. (World Bank 2013, 2008). This raises a political (and ethical) question, which I will address in Part VII of this series.

I am Sorry, the Doctor is Unavailable

Third, lifestyle may account for a large part of a healthy life, but access to health care providers is important too. In the United States, the average adult visits a doctor four times a year. In Japan, the average number of visits is thirteen — or three times more often. (Commonwealth Fund 2010). The health care system in Japan is a mix of public and private control. The government mandates universal health care insurance with fees set by the government, while hospitals and clinics are controlled by doctors in not-for-profit corporations. Policy consistently demonstrates an effect on behavior — and given longer life spans in Japan, it suggests that that just might entail a positive effect.

Of course, there are limits to comparing Japan with the United States. Among other things, Japan is a nearly homogeneous society that has less than half the population of the U.S., yet lives in a territory the size of California. These are very important differences that should caution any argument that America should adopt the Japanese approach to lifestyle and health care.

Healthcare as an eco-system

But, health care is part of an eco-system — biological, social, economic, and technical. Eco-systems are, by definition, complex. Some complex systems maintain self-governing stability. Other complex systems exhibit a high degree of indeterminateness — the so-called butterfly effect. And yet other complex systems are inherently unstable, bordering on catastrophic decay. Before you start radically altering a complex system, we ought to know its current state — a two week debate in Congress would not seem to qualify for the kind of deliberation we should expect for something so important to our collective lives.

Part IV: Dollars and Sense – In Sickness and Health

Murphys, CA…We pay more for our health care — in some cases, twice as much as countries like France. Is it worth it? There can be no argument, however you want to analyze health care delivery and the value of outcomes, the American health care system is significantly more expensive than any other comparable system in the world. The US spends $9451 per person on health care. That is 121% more than citizens of Japan spend on health care. (OECD 2015). The next nearest country to the United States, in terms of health care spending, is Norway which spends $6567 per capita. In other words, the U.S. spends far, far more than other nations — and on a few very important measures is performing nowhere as well.

A Mixed Bag

Having said this, the United States is doing very well in some specific disease treatments. A massive study of 26 million patient records in 67 countries from 1995 to 2009 which was published in the highly regarded medical journal, The Lancet, showed that the United States, France, and Sweden had scored the highest remission rates among women with breast cancer. But for other types of cancer, the United States did not do as well. In the case of cervical cancer for the period 2005-2009, U.S. remission rates were below more than half of all European countries, as well as Nigeria, Cuba, and many Asian countries. (Allemani, et. al. The Lancet 2015).

A World Leader in Medical Research

There is no doubt that the United States is formidable in its pursuit of research of diseases and the basic sciences, but the execution of these competencies appears to fail when we apply them to those actually in need. An in-depth study by the Commonwealth Fund in 2010 concluded, “the U.S. fails to achieve better health outcomes than [six] other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity. ” (Davis, et. al., Commonwealth Fund 2010).

But at What Price?

Is it for lack of effort? In 2006, Americans spent $2.1 trillion on health care products and services — a value equal to 16% of our national Gross Domestic Product. In 2017, we are expected to spend $4.6 trillion or 19.5% of GDP. (Kaiser Family Foundation). Even in constant dollars, that is a stunning number. But what is perhaps more shocking is that fully 50% of that increase is not due to more patients, better procedures, or even improved delivery — it is due from the rapid investment in and adoption of advanced technology — from proton beam radiation to future-edge genetic surgery.

Technology for Life

Americans love technology.”After all, that innovation has given us vaccines, antibiotics, advanced heart disease care, splendid surgical advances, and fine cancer treatments. And many diseases and crippling medical conditions remain that call for yet more innovation. The opposition to imposing controls on costs is politically more intransigent than the opposition to providing universal coverage.” (Daniel Callahan, Hastings Center Briefing, 2008).

We have more MRI machines per person than any other country except Japan — and we do far more (expensive) MRI exams and computed tomography scans than any other country at substantially higher prices per exam. And more revealing is that Americans take nearly 50% more prescription drugs than the French, at a cost double that of the U.K., Canada, and Australia. Poignantly, following the United States, Germany and Switzerland have the next highest cost per person for drug costs. These three countries account for having the headquarters of the pharmaceutical companies with the largest market share of drug sales in the world. (Commonweath Fund 2015).

Part V: Why Rural America is So Sick

Murphys, CA…The health of rural Americans is worse than those who live in cities, in part because rural health care systems are collapsing. This is a problem that has been long in the making. America shifted from a predominantly rural population to one that was more urban in 1920. This pattern continues today. In 1990, 25% of Americans still lived in rural counties. Today that proportion is closer to 17%. A more important characteristic is the difference between urban and rural areas in terms of income, poverty rates, and unemployment. According to research from the US Department of Agriculture, urban residents make nearly 30% more per year than do rural residents and the difference between these regions is growing. (USDA 2015). The rate of urban employment is 112% above what it was in 2000, while rural employment is at 97%. (USDA 2017). Consequently young people in rural areas are migrating to cities for employment and other opportunities, leaving the social fabric of rural areas older, fragmented, and less resilient. At the same time, the proportion of rural residents that are older or are veterans has substantially increased — populations that need more not less health care.

Cities are Where the Opportunities Are

The reasons for this economic transition arise from the advantages of cities over rural areas in the new economy. Cities offer economies of scale (greater density makes it easier to communicate and interact), larger pools of well-educated potential employees (the new economy requires technical training not available in rural areas), requisite infrastructure (very high speed Internet broadband, mass transit, and airports are generally not available), and access to capital. Venture capital firms are more likely to only invest in local economies — where “local” means urban areas. Some rural areas, particularly those offering recreational amenities are attracting new residents — mostly retired.

Disappearing Rural Healthcare

With a declining economic base and a health care model which presumes community hospitals will deliver care, rural areas of this country are in trouble. Since 2010, more than 80 rural hospitals have closed and literally hundreds are on the verge of bankruptcy. In California alone, nearly a hundred hospitals, mostly small and rural, have closed since 1996. (California Health Line 2014). Losing a hospital not only creates a loss for health care, it costs the community economically. Rural areas that lose a hospital see a fall in income and an increase in unemployment. (National Institute of Health 2006).

But the Need is Increasing

Males living in rural areas are 38% more likely to have chronic arthritis than their urban counterparts; 20% more likely to have diabetes; and are diagnosed with asthma 50% more frequently than city dwellers. (Georgetown University Health Policy Institute 2003). And the rural population is older — much older.

But it isn’t just the loss of health care that makes this problem so critical. There is a social crisis in rural America — unemployment, mental illness, drugs, and alcoholism are plaguing rural America. For example, opioid use is increasing at a faster rate in rural areas than in cities, particularly among white working-class people. (Keyes, et. al., National Institute of Health 2014). Suicide rates among rural youth is now double that of the urban young, with far less access to mental health care than in cities. (Fontanella, JAMA Pediatrics, 2015). As researchers put it, “Our research validates the hypothesis that rural healthcare providers serve populations which are not only socioeconomically disadvantaged but also suffer from numerous health disparities and poorer outcomes than non-rural communities.” (Chartis 2017).

Numerous studies have shown that Obamacare strengthened the financial health of rural hospitals by stabilizing payments, particularly for populations without health insurance. This is a conundrum that Republicans seeking to repeal Obamacare must confront. In fact, the highest proportion of rural hospitals most likely to close are in those states (Georgia, Texas, Louisiana, Mississippi) that chose not to expand Medicaid under Obamacare.

Part VI: Free Market Health Care that Isn’t Free

Murphys, CA…If you draw a graph of the American health care system, it looks like a home-stitched quilt made by someone that cannot see. Nothing fits together — not the colors, the design, or the function. There are a lot of reasons for this picture, but how we fund health care is the single biggest problem.

By almost any measure, the American version of health care is bizarre: one health care system for seniors (Medicare); another for veterans (Veterans Health Administration); yet another for the poor (Medicaid); and for a majority of Americans employed by medium and large companies, there is a network of possibilities offered by a mix of not-for-profit and profit-making insurance firms; finally, there is a stop-gap measure for employees that lose their jobs (COBRA). That leaves a large percentage of Americans with no insurance coverage at all — perhaps of because of pre-existing conditions, lack of financial resources to purchase private health insurance, or works for a small business doesn’t offer any health insurance.

As one moves from one plan to another, those lucky enough to be insured may have to change doctors, dentists, clinics, laboratories, and therapists. And along with clinicians, the quality of insurance coverage changes, as do patients’ payments for premiums and deductibles.

How It All Began

How did we get such a patchwork quilt of services and insurance? Surprisingly, the adoption of health insurance in the United States is relatively new. Before World II, health insurance programs were spotty at best and were primarily run by hospitals — the first one was in Dallas — to help fill empty beds. This concept became what we know today as Blue Cross. During the war, U.S. employers, desperate to find workers, began to offer health insurance as a benefit of employment. In 1943, the Internal Revenue Service ruled that employer-sponsored health care benefits would be tax deductible as an expense of doing business. By the early 1950’s, more than two-thirds of adults were covered by health plans.

Research and development, as well as research on the battlefield, led to major innovations in health care technology (medicines, procedures, training, and facilities). Not only did this R&D lead to much better health outcomes, it was also more expensive. In 1900, the average household spent $100 a year (in dollars equivalent to 2009) mostly on quack remedies like “snake oil”. By 1950, Americans were spending $407 per person for health care services. By 1980, that per person rate jumped to $2050 per year and by 2009, the cost increased to $6807 per year (all dollars in current 2009 dollars). Today, the cost is $7847 in 2009 dollars (or, for those keeping track with earlier columns $9451 in today’s dollars).

Somebody is Paying More

What is most striking in this data is the proportion of this cost paid out of pocket by consumers and how much is paid by insurance companies and government agencies. In 1900, all costs were borne by the consumer. In 1950, fifty-six percent of health care costs were paid out of pocket. But by 2009, only fourteen percent of costs were paid by consumers and eighty-six percent of costs were paid by third parties. (All data except 2015 from Fuchs, New England Journal of Medicine, 2013. Data for 2015 is from OECD 2017).


The principle reasons for this increased cost are complicated, but there is no doubt that there are three very significant reasons.

First, as mentioned in an earlier column, Americans love technology. Technology promises better health care and better health care promises a longer life. The problem with this syllogism is that it isn’t working for Americans — we invest more in technology than any other country and we live substantially shorter lives than those living in comparable systems.

Second, attempts to contain these costs by eliminating duplicative purchases and redundant capital investments have never made it out of Congress. At least twice in the past fifteen years, legislators responding to the pleas of pharmaceutical and medical device manufacturers have buried these reforms.

The third major reason for cost increases is the rise of the for-profit insurance companies in the market, collusion, and market consolidation (acquisitions). In 1981, 12% of the health insurance market was supplied by for-profit insurance. By 1997, that proportion increased to 65%. (Jonathan Cohn 2007). Today that percentage is estimated at more than 70%. It is estimated that the cost to consumers for for-profit insurance companies as intermediaries is between 7-15% of their annual premiums.

Insurance Monopolies

In 2015, Aetna (2016 revenue = $60 billion) and Humana (2016 revenue = $54 billion) announced their intention to merge. If permitted, the two firms would control 25% of the Medicare market. It isn’t as though Obamacare hasn’t been good for business. Aetna shares were trading at $42.09 per share and Humana’s at $79.52 on Jan 1, 2008 before President Obama took office. On October 1, 2016 (when most forecasters thought Hillary Clinton was going to win the Presidency and there was no expectation of “repeal and replace”), Aetna’s shares traded at $124.01 (+194%) and Humana’s were traded at $171.53 (+115%). A Federal judge blocked the proposed merger in 2017 citing the consequences of monopolization. Another merger by Anthem and CIGNA has also been blocked for the same reasons.

Many Congressmen refer to the importance of a free and open health care market. But the data strongly suggests that what we have isn’t a market, but a monopoly of insurance interests in which sicker citizens are abandoned while Aetna’s CEO pockets $17 million in annual compensation.

Part VII: Health Care — Right or Responsibility? 

Murphys, CA…The United States Declaration of Independence declares “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” Without good health, where is the possibility for the pursuit of happiness? As the Declaration’s primary author, Thomas Jefferson, would later write, “The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government.” (Jefferson 1809). 

For the past six weeks, we have examined the issue of health care in terms of its delivery, effectiveness, and cost. This week we turn to a much more contentious question — the political status of health care. Is health care a fundamental right, or is it simply a privilege granted to some in society? Under what basis could health care be considered a right?

There are two categories of rights: legal rights and natural rights.

We are all familiar with legal rights. They are rights established by law. Laws passed by Congress and business contracts set forth certain kinds of rights. These kinds of rights are presumed to be valid as long as the statutory provisions remain valid or until a contract expires. For example, under the Affordable Care Act (Obamacare), the right to health care is assured by statute that simultaneously enables these rights through the provision of insurance contracts between insurance companies and their customers. A customer with a pre-existing condition is guaranteed by legal rights that he or she will not be treated differently than any other customer of that insurance provider. It does not establish a rightful guarantee that insurance rates among customers in California and Alabama will be the same.

By contrast, there are natural rights. Originally, natural rights were assumed to be those rights guaranteed by a divine power, as it was assumed that everything in nature is derived from God. For example, the U.S. Declaration of Independence refers to self-evident truths that human beings are “endowed by their Creator with certain unalienable Rights”. In this secular age, natural rights are more likely to be referred to as “universal rights” and are asserted by consensus in a common compact and in an appeal to common interest. The right of free speech is an example of a claim to a universal right. Universal rights, by their very name, are asserted to apply to all that are a member of a common compact and, without exception, unlimited in scope or time. Thus, the claim that there exists a right to universal health care is much stronger assertion than a contractual or statutory right and one that all persons have a right to exercise.

Is there any basis for saying that American citizens have a universal right to health care?

Consider the following interpretation.

Thomas Jefferson stated in the United States Declaration of Independence that “all men….[have natural rights including] the pursuit of happiness.” Curious word, “happiness”. Whatever did he mean? Surely not that everyone has the right to “feel” happy or “giddy”? Hardly.

Jefferson was a child of the Enlightenment — the age of Reason — when philosophers such as Locke, Rousseau, Diderot, and Montesquieu took their inspiration from the ancient world and relied on Reason as the best guide to a better, freer life. In their turn to the ancients, Jefferson, like Madison, Adams, and Hamilton observed that happiness was interpreted as the highest satisfaction one could derive from the highest goal — virtue. For the ancients, happiness referred to the Greek word “eudaimonia” (u-dy-moh-nee-ah) which means “living well” or “flourishing”.

Any examination of this nation’s founding documents, including the Federalist Papers, as well as Jefferson’s phrasing of the Declaration of Independence, will highlight the degree to which the founding fathers saw the kind of happiness the ancients called “flourishing” as the ultimate goal of a new nation. As George Mason, the author of Virginia’s Declaration of Rights wrote, stated “All men are created equally free and independent and have certain inherent and natural rights . . . among which are the enjoyment of life and liberty, with the means of acquiring and possessing property, and pursuing and obtaining happiness and safety.”

But if happiness was so important to the early leaders of this country, why is there no mention of health, doctors, or medicine? First of all, health care in the eighteenth century was not much more than superstition and experimentation. To be treated by a “doctor”

The first vaccine was not discovered until 1796 by Edward Jenner; a general anesthetic (ether) was not developed until 1837; Joseph Lister didn’t demonstrate antiseptics to reduce infections until the 1860’s; while it wasn’t until the 1870’s that Louis Pasteur and Robert Koch identified bacteria as a major source of pathogens; a decade later a number of biologists isolated and grew viruses. It was not until 1928 that Alexander Fleming developed the antibiotic, penicillin. Only in the second half of the twentieth century, did biologists, pathologists, geneticists, and molecular scientists begin to unravel the enigma we call biological life. In other words, for most of this nation’s history there wasn’t a health care practice about which anyone would care to claim a right. It is only in this century that we have the knowledge, the capacity, and the will to offer health care for all.

So the question has to be asked: if something didn’t even exist as a conceptual possibility in the eighteenth century are we limited to those concepts as the basis for asserting political rights or do we re-evaluate what the founders meant when they said the foundations of our social compact included social flourishing? Given the capacities of modern medicine to give everyone a more flourishing life, can we not begin to consider the possibilities of what happiness means in the twenty-first century?

There is a very strong argument that equal access to flourishing (which does not mean everyone will flourish) justifies the claim that healthcare is a universal right. And if it is a universal right, it is something far more exhaustive and extensive than the legal right to health care which is the standard of Obamacare.

What such an assertion that implies is taken up in next week’s final article.

Part VIII: No One Dies From the Lack of Health Care?

Murphys, CA…On May 7, 2017, Congressman Raul Labrador (R-ID) spoke at a town hall meeting with his constituents. He exemplifies the chutzpah of many in Congress: “No one dies because they don’t have access to health care”. Then there is the case of Chris Collins (R-NY). Just after the House of Representatives voted to “repeal” Obamacare and potentially cause tens of millions of Americans to lose their healthcare coverage, Collins was interviewed by CNN’s Wolf Blitzer. Collins, who voted to “repeal”, acknowledged he never read the bill upon which he voted. It brings to mind Aldous Huxley’s dictum, “Facts do not cease to exist because they are ignored.” (1926). 

Over the past seven weeks, this series has offered an overview of the state of healthcare in America. In this last article, I summarize some of the key observations from this series and a few of the more important implications:

  • We all want good healthcare.
    • We are all fragile organisms that are going to die, but we are self-conscious organisms that want to live.
    • There are thousands upon thousands of pathogens that can kill us, millions of possible genetic mutations that can do us grave harm, and even more accidents that could do either.
    • Good healthcare gives us the substantial possibility of improving our odds of living longer.
  • Access to quality healthcare is critical.
    • Emergency rooms and doctor’s offices have more than 200 million visits a year.
    • There are 900,000 beds in hospitals for individuals that need more than an emergency room.
    • More than 38 percent of Americans will be diagnosed with cancer sometime in their lifetime. (National Cancer Institute).
    • Cardiovascular disease kills 800,000 persons a year and another 92 million are at risk or are recovering from a stroke. (American Heart Association).
  • Healthcare is crucial to our economy.
    • Healthcare is the largest sector of our economy and accounts for 19% of our Gross Domestic Product.
    • It generates nearly twice as much revenue ($4.6 trillion) as all manufacturing ($2.4 trillion).
    • More than 12 million Americans are employed in healthcare, or 10% of the entire U.S. workforce.
  • Healthcare delivery is complicated.
    • There are 900,000 doctors and surgeons organized into nearly 230,000 practices. Increasingly doctors are joining hospital (e.g., Stanford) or not-for-profit practices (e.g., Sutter). The complexities of multiple insurance and payment systems, regulatory reporting, and increasing specialization and technology, doctors are finding it advantageous to “go corporate”.
    • There are 5,500 hospitals in the U.S. and over half belong to a health system network. For example, Dignity Health runs 39 hospitals, while Adventist Health operates 20 hospitals. Moreover, the number of independent hospitals is declining dramatically as the result of merger, acquisitions, and bankruptcies.
    • With increasing specialization, laboratories, clinics, pharmacies, diagnosticians, medical equipment, anesthesia services, etc. are provided by different providers who have different billing systems, insurance coverage, and liability coverage.
  • Healthcare funding is fractured.
    • One of the most unique features of the American model of healthcare is the reliance on market-based funding. Healthcare services are priced by the originating provider (doctor, hospital, etc.), but what fee that provider actually receives is set either by an agreed-upon contract amount the provider makes with an insurance company covering a specific patient or by a fee established by the government for covered classes of patients (seniors, the poor, disabled, etc.). A patient with no insurance will be billed for the original (and usually much higher) amount set by the provider. A patient covered by insurance plan A may pay a different amount from a patient covered by insurance plan B, which in turn is likely to be quite different from the price charged to a government covered patient.
    • Some patients discover that being covered for services in one part of a hospital network (e.g., an emergency room visit) may not be covered in another part of the same network (e.g., outpatient laboratory tests).
    • A majority of individuals over 18 and less than 65 years of age are traditionally covered through their place of employment, but this proportion has fallen from 65% in 2000 to 52% in 2015.
    • If you change from one job to another, it is highly likely the insurance coverage will also change, and along with it, the providers which you can use.
    • If you are unemployed, self-employed, or a low-wage employee and do not receive health insurance, you can show up at a hospital emergency room and get “charity care”, which is reimbursed from public funds.
    • If you become unemployed, you may stay on your former employer’s insurance plan for a set period of time (COBRA) by paying the full cost of insurance. But if you do not find employment with coverage at the end of the COBRA period, you lose all health insurance coverage.
  • American healthcare is outrageously expensive.
    • Americans spend more for healthcare than any other country — $9,451 per person. The second highest expenditure per person is Norway with $6,567. Japan, with one of the best health systems in the world, spends $4,951 per person.
    • Perhaps even more shocking is that the U.S. uses 19% of its Gross Domestic Product (total national income) for healthcare, while Norway only invests 9% and Japan 10%.
  • People do die from poor healthcare.
    • What we get from that steep investment in healthcare is surprisingly not all that much. Our expected lifespan ranks only 42nd in the world. While some Americans love to criticize the Canadian healthcare system, Canadians live longer than us.
    • Because we have traditionally run our medical system as a factory that responds to symptoms rather than a value-based service emphasizing prevention, many of our performance numbers have been getting worse rather than better.
    • Healthcare performance is also related to economic health. “A large segment of white middle-aged Americans has suffered a startling rise in its death rate since 1999, according to a review of statistics…that shows a sharp reversal in decades of progress toward longer lives. The mortality rate for white men and women ages 45-54 with less than a college education increased markedly between 1999 and 2013, most likely because of problems with legal and illegal drugs, alcohol and suicide, the researchers concluded. Before then, death rates for that group dropped steadily, and at a faster pace. An increase in the mortality rate for any large demographic group in an advanced nation has been virtually unheard of in recent decades, with the exception of Russian men after the collapse of the Soviet Union.” (Washington Post Nov. 2 2015).
    • Before Obamacare, it is estimated that 45-50 million Americans did not have health insurance. According to the non-partisan Congressional Budget Office, the so-called Trumpcare plane would result in 24 million losing health insurance. Does it make a difference? According to the American Journal of Public Health, those without insurance have a 40% higher chance of dying from health-related issues in any given year than those with health insurance. So yes, Congressman Labrador, the lack of health insurance can kill you.
    • Healthcare in rural communities is not keeping up with the demand. Rural hospitals are failing and closing at an alarming rate.
  • Healthcare policy is brain dead.
    • As this is being written, a small group of Senators have been closeted away trying to draft legislation that would shape the entire healthcare system in the United States. Donald Trump once asked, “who knew it was so complicated?” The American Medical Association and the American Hospital Association have both pleaded with Congress to fix, not replace, Obamacare. Yet, a small group of Senators think they know better.
    • Perhaps more important is the difference between market-based healthcare, universal healthcare, and single-payer health care:
      • Market-based funding — the model of healthcare since World War II — presumes that the employer is the best source of coverage through private insurance. By 1965, it became clear that seniors who no longer work and those who are unemployed do not have access to this form of healthcare financing. As a result Medicare and Medicaid were created to fill the gaps.
      • Universal healthcare — Obamacare — is premised on the fact that additional gaps have been generated in the economy because increasingly the emerging job market does not offer health insurance — retailers, fast food chains — or the large number of self-employed. Fewer than 50% of those employed no receive employer-based health insurance. But universal healthcare is like sticking your fingers in an ever failing dyke. More and more gaps or leaks appear and failure is inevitable.
      • Single-payer healthcare guarantees that if you meet basic, non-discriminatory conditions, you are guaranteed access to healthcare. There are no insurance companies and no middlemen siphoning off life-giving resources. In many countries, even prescription drugs are included in these programs.
  • How can we fix it?
    • Our fractured healthcare system is in the state it is primarily for one reason — it meets the business needs of the health insurance industry. Professional medical groups agree that we need major reform that moves towards a more holistic healthcare system. The major source of disequilibrium in this market is largely attributable to the ever larger and dominant, for-profit health insurance companies. They are the primary opponents of healthcare funding reform.
    • The numbers on a single-payer universal healthcare system are still out, but the momentum for such a system is alive and well in California. The State Senate passed SB 562 and moved it on to the Assembly.
    • There are many questions that need to be asked about the implementation of a system — for example, will the Federal government waive the use of the Federal funds for this system? Is the funding model predictably solvent? There is a question as to whether such an entity should be a not-for-profit corporation created by the State or another state agency.
    • We need to reform the healthcare system in this country — a system that makes the value of service as important as its cost.
    • Granted, there is a nearly insatiable demand for healthcare. The question isn’t whether everyone has a right to all the healthcare that is possible, but rather it should be possible everyone has access to healthcare. Perhaps there should be conditions for this access — no cigarette smoking, for example. But people who become ill from exposure to toxic chemicals, like farm workers or miners, or gardeners and lifeguards who get melanoma from increasing exposure to the sun should have ready access to appropriate treatments. Many do not.
    • Rural areas, which are losing their hospitals and doctors, should receive financial support to get quality healthcare.
    • Healthcare is a universal right derived from the promise of our Declaration of Independence — the universal right to pursue happiness. Not a privilege, but a right!

Author: John MacWillie is a native of Calaveras County, California. He graduated from UC Berkeley where he studied European history and bio-engineering. His graduate studies include economics and urban planning at New York University and philosophy at San Francisco State. He received his Ph.D. from the University of Leeds in the U.K. He worked for ten years in law enforcement policy and administration in New York City, spent nearly thirty years as a senior executive in the software industry, primarily in information security, and for the past twelve years has been teaching in undergraduate and graduate programs at California State University — East Bay in multimedia, art history, and criminal justice. He resides with his wife, an attorney, in Murphys CA.

The copyright for this series of articles is held by John MacWillie and is licensed for distribution without royalties for non-commercial use under a Creative Commons License with the restriction that the content is copied in-whole and sole attribution for authorship is prominently displayed consistent with the title of individual article(s) or the entire series.

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05 Jun

McClintock is not the person to protect our public lands!

McClintock is not the person to protect our public lands!

By Susan Ashby

A number of organizations have recognized Tom McClintock (R-CA04) as being an enemy of public lands and the environment.  His voting record confirms their assessment.  Below are excerpts from a couple of environmental groups and several House Bills he voted for, and more, all exemplifying his anti-environmental stand.

  • McClintock is among a group of 15 congressmen designated as “Public Land Enemies” by the Center for Biological Diversity.
    The Center for Biological Diversity released a report today identifying the top 15 members of Congress trying to seize, destroy, dismantle and privatize America’s public lands. These “Public Lands Enemies” are part of a growing movement to industrialize public lands for profit, including increased exploitation for oil and gas drilling, fracking, logging, mining and development.

    “For everyone who cares about our national forests, wildlife refuges, national parks and monuments, these elected officials need to be watched very closely and opposed at every step.”


  • McClintock scores 0% on the National Environmental Scoreboard issued by the League of Conservation Voters for 2016.
    Examples of his votes in 2017:

    • On February 7, the House approved H.J. Res 44. This is an anti-environment bill.  This legislation would repeal efforts to improve the management of public lands by increasing the participation of local stakeholders and engaging them earlier in the process. McClintock voted for yes – the pro-environmental vote would have been NO. Our adjacent districts, CA-03, CA-06, CA-07, CA-09, all held by Democrats, voted no.
    • On March 30, the House approved H.R. 1431. This legislation would undermine the ability of the Science Advisory Board to provide independent, objective, and credible scientific advice to the EPA. This legislation would allow industry to significantly prolong the scientific review process which would delay key public health and environmental protections.  McClintock voted for yes – the pro-environmental vote would have been NO. Our adjacent districts, CA-03, CA-06, CA-07, CA-09, all held by Democrats, voted no.
    • On March 29, the House approved H.R. 1430. This legislation would endanger public health by making it extremely difficult for the EPA to use the best available science. This legislation would result in less effective public health protections. McClintock voted for yes – the pro-environmental vote would have been NO. Our adjacent districts, CA-03, CA-06, CA-07, CA-09, all held by Democrats, voted no.


  • McClintock co-sponsors H.R.622 Local Enforcement for Local Lands Act.
    This bill declares that, by September 30, 2017, the Department of Agriculture (USDA) shall terminate the Forest Service Law Enforcement and Investigations unit and cease using Forest Service employees to perform law enforcement functions on federal lands. It basically removes the power to enforce laws from the Forest Service and the Bureau of Land Management on any land they manage throughout the entire country. If this bill passes, law enforcement will instead be the responsibility of local agencies, which will receive a stipend from the government for their services.  Many of these smaller community and county sheriff departments are ill-equipped to enforce laws over vast new areas of rough, inaccessible terrain, or that the Forest Service and BLM rangers currently enforcing the laws there know the land better than they would.Picture this: Your car is being broken into at a Forest Service trailhead. A ranger is nearby but they have to radio down to a city sheriff department to get someone to come up to apprehend the suspect because they are no longer allowed to enforce laws on Forest Service land.


  • McClintock co-sponsors bill that would be devastating to the forests he says he wants to protect. R. 2647 The Resilient Federal Forests Act.
    This bill is pro-industry and anti-environment, and seeks to eliminate public participation in federal decisions about forest management that could negatively impact local communities, ecological health and wildlife.  From The Wilderness Society: this bill

    “would undermine important environmental laws and increase unsustainable logging in our national forests.”

    The National Parks Conservation Association provides an excellent summary including:

    “Rather than promoting healthy forests, the bill encourages management actions that would threaten communities, wildlife, and clean water.”

    The bill ignores the best available science on the restoration of forests, undermines bedrock environmental laws designed to provide for substantial public involvement and accountability in land management decisions, and poses a threat to ongoing and effective collaborative forest restoration efforts….

    “This bill does not address the fundamental issues needed to protect communities from severe wildfires, fails to address wildfire funding at the U.S. Forest Service, and does not protect America’s forests or make them more resilient.”

    The bill passed the House in 2015 by a vote of 262-167, with all dissenting votes coming from Democrats.  It is currently on the Senate Calendar.


  • McClintock signs on to nullify a BLM rule which improves how the BLM conducts its large-scale resource management plans. In December, 2016, the BLM finalized its Planning 2.0 initiative which opened up a whole new level of public participation, creating a more transparent process that gives lots of opportunities for the people who love public lands to shape how those lands are managed. It also does a much better job of recognizing the importance of recreation, including for local economies, and greatly improves the agency’s ability to handle data.  The new House passed a bill that would nullify this rule.  It passed the Senate and came back to the House as H.J. Res 44.  The Outdoor Alliance (outdoor recreation advocates, including back country skiers, paddlers, climbers, and mountain bikers) and the National Parks Conservation Association among others opposed the bill.  In February, 2017, the House, including McClintock passed HJ Res 44 (see the National Environmental Scoreboard above) which nullifies the BLM Planning 2.0 initiative.

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07 May

Algiers Street Walking Bridge

FROM: Ryan Heryford

RE: Algiers Street Walking Bridge Sponsorship

TO: Murphys Community Supporter

I am writing you this letter to tell you of a community concern of mine. The Algiers Street road bridge near Murphys Park has been a safety hazard for local pedestrians for a long time. Tourists and locals find the Black Bart Theater parking lot a great place to park, but they must cross the dangerous one-lane road bridge to walk to the park, Veterans Memorial and Main Street. On popular weekends, the bridge becomes a bottleneck and can get jammed up with both pedestrians and vehicles. I have been working on a solution to fix this unsafe situation.

My project consists of the installation of a 60’ walking bridge, parallel to the existing Algiers Street road bridge (See attached image). This bridge has been my Eagle Scout and Senior Project for the past year. The walking bridge area has been surveyed, engineered, had a wetlands study done and is now ready for construction. I have already received approval from Calaveras County Public Works, Union Public Utility District, the Calaveras Board of Supervisors and the Department of Fish and Wildlife for this project. Although this is my personal goal and project, this bridge has been and is to me a community effort, and without your help, we will not be able to complete it. The estimated remaining budget for the entire project is approximately $45,000 (See attached cost breakdown). Construction materials and labor, including the bridge, will be sourced locally. If all the necessary funds are allocated, we can begin construction as early as April!

If you would like to be a part of this project, your donation check can be made payable to the Calaveras Community Foundation (CCF) with a note that it should be deposited for the use of the Algiers Street Walking Bridge Sponsorship. Their address is Post Office Box 1436, Angels Camp, CA 95222. As a 501(c)(3) non-profit corporation, the IRS recognizes the Foundation as a recipient for tax deductible donations. You can also go to their website and donate through PayPal. After your donation, CCF will send you a letter recognizing your contribution. Funding needed by March 31st.

If you would like more information about this project, please feel free to contact me at my email address:, or my cell phone 209-768-9882.

Together, we can make our community a safer place!!!

Thank you,

Ryan Heryford
ALGIERS STREET WALKING BRIDGE Support a part or portion of the Bridge!!

Site Surveying: (PAID by Donor) $ 500.00

Permits: (PAID by Donor) 260.00

Engineering/Plans (PAID by Donor) 5,100.00

Erosion Control 300.00

Equipment 1,200.00

Form Materials 600.00

Rebar 1,415.00

Concrete Pump Truck 1,200.00

Concrete 3,063.00

Crane 1,015.00

Bridge 17,500.00

Special Inspections 800.00

Miscellaneous Materials/Incidentals 750.00

Labor Costs 16,800.00

Any amount of a donation will be appreciated and welcomed.
Send to: CCF at PO Box 1436, Angels Camp, CA 95222 With Notation: “Algiers Walking Bridge”

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