Friday, February 26, 2010

Why do health costs go up? -- Research

I have previously pointed out that economic regulation will ineffective in holding down health costs. Before addressing how to contain costs, discourse should begin by exploring why costs are so high. I do not pretend to have all the answers. Nevertheless there are several obvious sources of high health costs that I will explore in this and other blogs. We will start with the impact of medical research.

Much is made of the shortfalls in our investment in science and technology. That cannot be said about medical research. I doubt the world has ever seen an explosion of medical advances like those which have occurred in my lifetime. I hear it said that the quality of care in this country is not superior to other countries. That may be true, but I find it hard to believe. Every day I see myself and others who have escaped the grim reaper because of leading edge medicine.

When I was young, my father suffered from a thyroid condition that the doctors could not diagnose for two years. He almost died because of the delay. Today standard blood tests routinely identify thyroid abnormalities. My mother died of breast cancer that would be picked up in a regularly scheduled mammogram today. My brother in law died of heart attack that would have been corrected by open heart surgery today. Two aunts were institutionalized for conditions that would now be controlled by drugs. On the other hand, my prostate operation came in time to spare me of the ravages of cancer because of the PSA test which is regularly administered on a yearly basis to middle aged males. My gall bladder operation that required a three and a half hour stay in the hospital and about a twelve hour recuperation was once a dreaded massive operation that could send the patient to bed for months with a scar that stretched across the torso..

These stories are not unique. Our life expectancies are expanded because of massive investments, public and private, into medical research over the previous decades. Nevertheless, inventions carry their costs. When a new medicine is developed, its inventor receives a legal monopoly for a specified period of time. The FDA must allow the pharmaceutical company to recover its research costs of developing that drug. These companies must also recoup the costs attributable to exploratory research that did not result in producing a marketable drug. Otherwise the enterprise cannot sustain itself.

Moreover when a drug, device or procedure is invented, the costs must often be recovered out sales in a relatively small market. An MRI machine for instance can only be sold to a handful of hospitals and other diagnostic centers. You cannot sell MRI machines like automobiles that fill up two car garages.

Some demagogues argue that those costs can be avoided by letting the government control all medical research thereby eliminating “excess profits.” Don’t believe it. The costs described above exist regardless of who may bear them. If the government does not receive enough return for its investment to cover the successful and unsuccessful research as well as the cost of raising the necessary capital, then it must absorb the costs and charge us to make up the loss costs either by taxing us or borrowing the money from somebody, probably the Chinese. We are getting a full dose nowadays of the dangers of that tactic.

The costs of research are vividly revealed when our favorite medicine becomes generic and the research costs are no longer a factor. Our insurance companies have educated us to the fact that generic drugs are the same medicine at drastically reduced prices, simply because the influence of research costs on the price of medicine has ended.

Under any circumstances, I doubt that our appetite for medical innovation is waning. I do not believe that we, the consumers, will tolerate a reduction in medical research, particularly with respect to the ailment that affects us or our families. Moreover, I would not be surprised if the recoverable costs actually increase as the drugs and devices brought onto the market become more specialized treating fewer patients a thereby creating ever smaller markets for the products.

In my next blog, I will discuss American medical education and how it contributes to higher costs.

Tuesday, February 23, 2010

Obama's Price Controls- Is he disingenuous or brain dead?

Obama is in a hole. He needs to get out of it as soon as possible. He needs a bill with the title “Health Care Reform” on top of it. He needs to put this mess to bed as fast as possible and go on to other matters. I was encouraged last week that he had seen the light. This week I am not so sure.

He is now pulling out his new panacea. He is pushing for a general federal jurisdiction over price controls on health care insurance, effectively controlling all prices for hospital and medical services as well as pharmaceuticals. If he seriously pushes for this jurisdiction, he will drag the country back through the dismal swamp of partisanship. I cannot believe that a reprise of this sort will enure to the benefit of his party. It is bad politics, but it is worse economics.

It has been pretty well established since the New Deal experience that government regulation could can be quite effective in matters other than prices. such safety and environmental regulations. Business interests predicted the sky would fall in when OSCHA and automobile mileage standards were enacted, but by and large these laws have worked.

On the other hand studies have shown that efforts to control pricing have not effectively reduced costs. Price control has been tried in industries classified as so called natural monopolies such as transportation, communication, natural gas and electrification It is pretty well established that these control have resulted in no significant savings to the consumer.

Instead regulated industries have often become inefficient and unncompetitive as a result of regulation. For instance, when the airline industry was deregulated, prices were reduced drastically because of competitive forces in the industry. Regulation was actually holding prices up rather than down.

Nixon’s attempt to resurrect price controls during the spiraling stagflation was ineffective. Market forces are simply too strong to be controlled by a bureaucracy.

So, when Obama suggests that health costs can be controlled by the government for any length of time, he is either disingenuous or brain dead.

Sen. Judd Gregg of New Hampshire claimed on the PBS Newshour last night that this attempt to regulate health care insurance is a predicate for going to a single payer system, which is a euphemism for extending Medicare to all persons. Democratic Senator Sherrod Brown did not deny the allegation.

If Gregg’s assertions are correct, we are really facing a debacle. It is generally agreed that the federal budget problems are caused primarily by the rigid entitlements found in Social Security, Medicare, and Medicaid.. Our president voices concern about that deficit and at the same time seems to be working toward quadrupling Medicare, which is our biggest fiscal problem. He reminds me of a lawyer person I once knew whose nkickname was Gator. That is, he smiled at you and ate you up.

Monday, February 22, 2010

Gambling In Alabama

Recent newspaper reports show that Milton McGregor has donated in excess of a million and half dollars to the campaign to legalize bingo gambling. This current effort is a part of the ongoing fight to bring the gambling industry to the state.

I am opposed to the whole idea. My objection is not based simply the issue of morality of gambling. Like most of us, I find a small wager to be entertaining and do not feel that I have committed some mortal sin in doing so.

I do not feel the same way about the gambling industry. It is a fact that the leading employers in a community have a direct effect on the quality of life. Our governor has successfully brought industries into Alabama that employ many of our citizens who were previously unemployed or under employed. These companies are good citizens and serve to bring about a better community life. Does the gambling industry offer the same? I do not think so.

Several weeks ago it was reported that a prominent politician who had been friendly to gambling interests visited a casino in Mississippi and encountered unbelievable good luck hitting jackpot after jackpot until he won over a million dollars. Welcome to the real world of gambling.

What does the gambling industry offer to the state? It can provide a handful of low paying jobs and a little entertainment for their patrons. From time to time some patrons lose their pay check, or their car, or their house, and receive nothing in exchange. The casinos flood the highways with billboards containing false advertising puffing all the winnings, when we know that losing is ultimately inevitable. Consider the millions that Toyota is expending because of the public outcry over perhaps a hundred incidents worldwide. Yet the gambling industry wipes out its customers regularly and not a peep is heard.

And now they gambling interests are using what appears to be phenomenal profits to push for more and more of the same. What kind of leaders will we have when they, too, “enjoy phenomenal good luck” in the slots or at the crap table? Next time it will be casino gambling. What next? Nevada has pushed the envelope now to cover legalized prostitution. Before we aspire to be the next gambling Mecca, I suggest that we consider whether we want Las Vegas and Atlantic City to be our future.

Tuesday, February 16, 2010

Books of the Bible- Answers to the test

1. Which of the following books does not begin with the words “In the beginning”?

C. Matthew

Genesis opens with “In the beginning God created the heavens and the earth”. John begins with “In the beginning was the word...”


2. Which of the following books is found in the New Testament?

C. Philemon.

Philemon is a short letter from Paul to a friend recommending to him the services of Onesimus. Though short in length, this letter is considered an authentic example of the fellowship of the early Christian believers.

Ezra is the story about the priestly rule of Israel when Israelites returned from captivity. Nahum is a minor prophet.


3. Which of the following books takes place totally outside the land now known as Israel?

D. All the above.

Daniel took place in Babylonia under the rule of Nebuchadnezzar and Daniel lived during the time after the Persians conquered Babylonia. Numbers chronicles the wandering of the Israelites in the wilderness after leaving Egypt but before they reached the promised land.



4. Which two books did Martin Luther say should have been excluded from the bible?

B. James and Revelations.



5. Which of the following letters was not written by Paul?

A. Jude



6. Which of the following books (Genesis, Matthew, and Romans) does not mention Moses by name?

A. Genesis

The events in Genesis took place before Moses was born. Matthew stated that Jesus directed the leper he had healed to present the offering that Moses commanded (8:4) he also reported that Moses appeared to Jesus at the time of the transfiguration (17:3) and Jesus later discusses his stricter attitude toward divorce as compared with Moses (19:7-9). Paul argues that the law did not exist up until the time of Moses and thus “Death reigned “ but for grace. (5:14).


7. Which of the following books (Genesis, Matthew, and Romans) does not mention Abraham by name?

D. None of the above.

The narrative of Abraham’s life appears in Genesis. Matthew leads off the genealogy in the first chapter with Abraham (1:2) Jesus chastised the Pharisees for claiming that they had Abraham as their father (3:9) In chapter 8 Jesus states that many will recline at the table of Abraham in heaven (8:11). He reminded those who said that God is the God of Abraham that the Father is the God of the living (22:32). In Romans Paul

7. Which of the following books does not contain words spoken by Jesus?

A. Mark
B. John
C. Acts
D. None of the above.

8. Which of the following books were written to a person known as “Theophilus”?

A. Luke and Acts.



9. What is the last book in the Old Testament?

B. Malachi


10. In which book did the Jews finally arrive in the promised land?

B. Joshua.

Monday, February 15, 2010

Books of the Bible

The following is a test of your knowledge of the Books of the Bible. The answers will appear in tomorrow’s blog:

1. Which of the following books does not begin with the words “In the beginning”?

A. Genesis.
B. John.
C. Matthew
D. None of the above.


2. Which of the following books is found in the New Testament?

A. Ezra.
B. Nahum.
C. Philemon.
D. None of the above.


3. Which of the following books takes place totally outside the land now known as Israel?

A. Daniel
B. Esther
C. Numbers
D. All the above.


4. Which two books did Martin Luther say should have been excluded from the bible?

A. Ezra and Nehemiah.
B. James and Revelations.
C. Song of Solomon and Ecclesiastes.
D. None of the above.


5. Which of the following letters was not written by Paul?

A. Jude
B. Philippians.
C. Titus.
D. All of the above.


6. Which of the following books does not mention Moses by name?

A. Genesis
B. Matthew
C. Romans.
D. None of the above.


7. Which of the following books does not mention Abraham by name?

A. Genesis
B. Matthew
C. Romans.
D. None of the above.


7. Which of the following books does not contain words spoken by Jesus?

A. Mark
B. John
C. Acts
D. None of the above.

8. Which of the following books were written to a person known as “Theophilus”?

A. Luke and Acts.
B. Corinthians I and Corinthians II.
C. Chronicles I and Chronicles II.
D. None of the above.


9. What is the last book in the Old Testament?

A. Haggai.
B. Malachi
C. Revelation.
D. None of the above.


10. In which book did the Jews finally arrive in the promised land?

A. Deuteronomy.
B. Joshua.
C. Kings I
D. None of the above.

Thursday, February 11, 2010

Travel - The legacy of the Khmer Empire

Angkor Wat Archeological Park is located near Siam Reap, Cambodia. The park contains a series of the millennium-old temple ruins of the Khmer Empire dating back to 1000 A.D. If it were located in this hemisphere or near Europe, it would be as famous and as popular with travelers as the pyramids and Machu Picchu. It has been designated by UNESCO as a World Class Heritage Site.

Angkor Wat, is a massive 'temple-mountain' dedicated to the Hindu god, Vishnu. It is surrounded by a moat and an exterior wall measuring 1300 meters x 1500 meters. The entire temple is covered with murals and art images .but the most memorable are the bas reliefs on the exterior walls depicting stories and characters from Hindu mythology and the historical wars of the rule at that time. These pictures are an unparalleled display of the life and times of the Khmer Empire.

There is much more to see at Angkor Wat with countless numbers of other temples. The entire area was abandoned for many centuries. As a result many of the structures were invaded by enormous trees that cannot be fully extricated from the ruins. Thus, it is a fascinating study of the power of unabated jungle growth

It is not necessary to live in a hut in Cambodia either. Like most Southeast Asia destinations Siam Reap has a world class hotel called the Angkor Wat very close to the ruins. The rates are quite reasonable, too.

Wednesday, February 10, 2010

Travel: An Overlooked Gem in Alabama

Travel: A Gem in Alabama


I have previously suggested trips to distant lands in Asia and Africa in this series. You may recoil at the time, effort, and expense needed to reach those places. You have no such excuse with respect to today’s posting. It surprises me that so few of my acquaintances have ever been to what I regard as the second best travel destination in Alabama, Tuskegee University.

Booker T. Washington was an amazing man. He was employed in the late Nineteenth Century to run an impoverished school for Negroes in an unlikely locale in Southeast Alabama. When he completed his work, Tuskegee Institute was one of the finest educational institutions for African American in the United States and remains so today. He had a remarkable ability to raise funds from rich Yankees and Southern white politicians. He also became the primary spokesman for African Americans during the first two decades of the Twentieth Century.

Tuskegee University campus remains a reflection of the man, Booker T. Washington. He believed that true liberation to the black man would come from education, particularly education that qualified his graduates to have the skills necessary to be gainfully employed. His students constructed the early buildings on the campus out of materials that they had manufactured themselves. These buildings remain today. They are simply designed but an eloquent statement of the history of the school

Monty and I visited Tuskegee primarily to see the “Singing Windows,” portraying various Negro Spirituals. It is probably the best known window in the state. The window was nice enough, but I was stunned by the chapel itself. The old chapel had burned down and the new one was designed by the famous architect and Auburn graduate, Paul Rudulph. It is the most impressive contemporary building I have seen in Alabama, and there are few that can match it anywhere.

Other sites well worth the trip are the Booker T. Washington-George Washington Carver museum. We saw the movie on Booker T. Washington, and it is well worth the twenty minutes or so. Washington’s home is now on display on the campus. The airport where the Tuskegee Airmen were trained during World War is a few miles out of town. One of those flyers, Chappie Hayes, a Tuskegee graduate, became the first African American General in the Air Force. I had the privilege of hearing him speak at the Birmingham Rotary Club in the early seventies, where he received a rarely bestowed standing ovation.

Spend a day at Tuskegee and you will not regret it.

Tuesday, February 9, 2010

Breaking News - President Obama’s News Conference

I have just heard Obama’s news conference concerning his meeting with Congressional leaders from both parties. It was, in my judgment, a watershed event

Obama seems to be doing all the things he should done a year ago. He stated that the country cannot endure another year of wrangling over health care. He called on the leaders to find those parts on which they can reach agreement.. In addition he indicated a willingness to horse trade on the issues which are the sacred cows of both parties.

He must have been persuasive because the Republican leaders hinted that they are willing to participate in the process.

He also took a middle position on the energy policy. He said that both sides must recognize that there is a need for expanding our use of carbon fuels to satisfy the needs for the short run and for research and development of “clean” sources of energy, particularly for the long run. I believe that his position will resonate well in Congress and in the country.

I view that this new position towards compromise and accommodation may reverse the downward trent of hyper-partisanship and that the country will benefit from it.

What has happened to bring about a change of heart? We certainly can thank the people of Massachusetts who sent a welcome wake up call to Washington. Another possibility has not been mentioned anywhere to my knowledge. Obviously President Obama read, studied and understood the message contained in Mainlineexpress.blogpot.com last week!

Monday, February 8, 2010

Travel - A Charming Saharan Land

If you are squeamish about visiting Arab countries, then consider Morocco. The U.S. enjoys its oldest non-broken friendship treaty with this country. It has a peaceful history and is very hospitable to foreigners.(Morocco is not to be confused with the neighboring Algeria, which has a much more speckled history.) It is also a delightful country worthy of a trip.

Geographically, Morocco is divided by the Atlas Mountains which run parallel to the Mediterranean coast. Most of the economic and governmental centers are north of the mountains. The Saharan desert is located to the south.

We flew into Marrakech, which lies on the northern edge of the Atlas Mountains. Marrakech is a popular spot for Europeans but does not get its due from USA. It has great hotels, top restaurants and other accoutements of a modern tourist town and also has authentic old town where story tellers and snake charmers can be found.

We stayed in a small residential hotel that ranks with the best we have seen. Our luxurious room was accompanied by a private rooftop patio. Having breakfast on the roof was an unforgettable experience.

From Marrakesh we hired a driver for the rest of the trip. Using a driver is probably the best means of travel and not prohibitively expensive, although driving a rented car is a perfectly acceptable alternative. We crossed the Atlas Mountains into Ouarzazate, where the best known Kasbahs have been preserved. Kasbahs are adobe buildings associated with Saharan Morocco.

From Ouarzazate we drove to Erfoud on the eastern corner of the desert. The drive was very interesting. We were able to observe life in the desert where camels remain the staple transportation of people and property.

Erfoud has one main attraction, that is a chance to see the desert sun at dawn. I sometimes wondered why we were going so far to see a sunrise, but Erfoud was one of our favorite stops.

The concierge at our hotel informed us that we would be picked up at four o’clock the next morning and taken to a special place to see the sunrise. The next morning we were met by one of the fiercest and most dangerous looking human beings imaginable. Monty was afraid that this man was an imposter who would kidnap us once we left the hotel. No one was awake in the hotel to confirm that he was indeed our guide for the morning. I kept my thoughts to myself, because I was not sure Monty was wrong.

Our fears were not allayed when our driver stopped the car in the loneliest place on the planet, so it seemed. It was a perfect scene for a mugging. He directed us to get out of the car, which we did with apprehensively. Then he pointed up to the sky. What we saw was as beautiful as any sight I can remember. There was the milky way in its full splendor and virtually every star in the heaven. He then broke into a big smile extremely proud of what he was showing us.

He next took us to an area where dunes dotted the landscape. We then embarked on a camel ride in the dark running through the dunes in the darkness. At the conclusion of the ride we were deposited on one of the dunes to wait for the sunrise. The whole event was so thrilling that the sunrise itself was almost an afterthought.

I have ridden on several camels and have not particularly enjoyed it, but the Erfoud ride was something special.

From Erfoud we drove to Fés, supposedly the sight of the beginning of Moroccan history. Its Medina is supposed to be the nearest the modern visitor can get to a medieval town. It is the sight of the palace of the modern day king and one of the great mosques.

I have noted three principal reasons why people who like to travel tend skip Morocco. First, most of us are apprehensive about going to countries where we do not like their politics. I have long since learned that most people are not the same as their politicians, and that concern is often overrated. Moreover, Morocco is much more closely tied to the West than many of its Middle Eastern neighbors. I believe that there is more danger attached to traveling in New York or the District of Columbia than in Morocco.

The second obstacle is that people fear that their accommodations will be inferior in what they believe to be underdeveloped countries. My experience is that the facilities in many places such as Morocco are superior to what we find in this country.

Last, but not least. Many people, often choose to take a cruise and drop off for a day trip Unfortunately, the real Morocco is not found on the Mediterranean beach. You must explore, and the rewards will be great.

Thursday, February 4, 2010

The Failing Health Care Reform Bill IV - The Belligerent Left

The far left seemed to insist on strict conformity with their own agenda and regularly threatened to bolt if anything less was adopted. They ignored the fundamental fact that they can only pass what the sixtieth senator will support.

For instance Senator Baucus warned them early in the fall that the public option was dead. Yet the far left threatened to revolt, if it did not stay in. Keeping that issue alive prevented the Senate leadership from reaching the magic number of 60 before the Massachusetts election..

Obama also reneged on his promise that he would seek a bipartisan solution largely because the far left forced him into a more strident posture.. Both sides accuse the other of abandoning bipartisanship. I come down squarely on the side of the Republicans on this issue. Not because they were enthusiastic participants in a bipartisan strategy, but because the Democrats gave them no other viable alternative.

The Democrats have been in charge and must take the initiative. It appears to me that the Democratic idea of bipartisanship is to adopt their own plan and ask the Republican to rubber stamp it..

I do not believe that the Democrats ever really wanted to reach an accommodation with the Republican leadership. Instead they were simply trying to pick off a handful of backbenchers so that they would have a comfortable margin to pass the Democratic plan. That is not a bipartisan strategy in my book. Those tactics made the job of the Minority Whip to keep the Republicans in line very easy.

If the bill does not pass it will be the left who killed it.

Wednesday, February 3, 2010

The Failing Health Care Reform Bill III - Transparency

Obama vowed to bring transparency to government. Ironically, he is now identified with a massive, secretive and sometimes confusing campaign to pass health care reform.

We hear about backroom deals with blue dog senators that do not pass the smell test. In most instances the bill was drafted behind closed doors without significant dialogue in public hearings explaining how it works. It was initially presented to Congress and the Senate without any explanation as to how the costs would be covered. The public was simply supposed to trust them.

When details on financing came out, the vast bulk of the costs were to be underwritten by savings which the plan was supposed to generate. The proponents skipped over the details about how these costs would be wrenched out of the system. Obviously they were placing a lot of the burden on new regulations that they were also proposing.

I for one am cynical about cost reduction. History has proved that regulations coming out of the New Deal era were totally ineffective in reducing costs in the long run. Moreover, our government has proved that it has a rapacious appetite for spending saved moneys rather than paying off debt. I have watched the Department of Defense save costs decade after decade, but somehow the actual totals go up. We have already seen the Obama Administration’s propensity to spend. Last year the administration was downplaying the long term cost of TARP loans, because the banks would pay it back. Now that some of the banks are repaying the loans, Obama seems to be looking for ways to put the money into other give away programs.

Moreover, there are a myriad of taxes, including medicare premium increases, being proposed. Virtually every one of these taxes have been met by a maelstrom of criticism.

The sheer size of the bill also prevented thoughtful and thorough discussion of the ramifications of the plan. Most of the public, including me, does not understand all that the it entails.

Democrats charge the tea party types with distortion when they claim that the Federal government is planning to kill grandmother in order to save costs. The claim is easy to make, however, when no one can give an adequate explanation as to why that will not be the case. The cost savings are largely dependent on removing “unnecessary” expenses incurred in the final months of life. Admittedly a large portion of the costs are related to the final illness. Moreover, the present tends to enable incurring excessive expense for heroic but futile efforts to extend life. Who is going to make the decision as to which costs are unnecessary? Some bureaucrat?

The sprouting Tea Party movement has probably benefitted most from the non-transparency. They smell a conspiracy and have found that many others do, too. It is only human nature to believe that anyone who is hiding something does not want us to know the truth. I do not believe that the Democrats ever took them seriously enough until after they showed their muscle in Massachusetts. And then it was too late.

Tuesday, February 2, 2010

The Failing Health Care Reform Bill II- Overreaching Legislation.

The Democrats should have learned from Clinton’s experience that it is extremely difficult to adopt an comprehensive plan covering various subjects, all at the same time. One constituency may be concerned about by an isolated portion of the plan, but their best strategy is to oppose the entire package. Another segment may have entirely different concerns but they join in opposition in order to prevent their own interests from being adversely affected. Thus two groups with different interests combine to constitute a more formidable opposition.

That phenomenon is apparent in the case of health reform. Obama expressed shock that the insurance companies invested so much in their lobbying activities. Why not? Proposals such as the public option and single payer government insurance threatened their existence. I already mentioned the unions who suddenly became disaffected with the new taxes being assessed on the health plans they have proudly negotiated over the years.. The Medicare generation, which was betrayed by the NAARP, does not believe that their benefits will be secure. Even those who are approaching 65 have been hearing that they will not receive all the benefits now included in Medicare. Even the issue of the deficits is tied to self interest. Three quarters of the population are happy with the insurance they now have. Most likely they see the plan as a trillion dollar boondoggle for the benefit of some one other than themselves.

Clinton made the same mistake as Obama in attempting to take too big a bite at the apple, but he quickly retreated. If the Clintons had successfully sponsored a less ambitious plan, Obama could have built on what had been done and the Democrats might have had a significant trophy in their cabinet.

Sometimes overlooked is the fact that the most significant health care reform actually enacted was proposed by George W. Bush, who procured prescription drug benefits for the elderly. It certainly was not comprehensive, but it survived the scrutiny of a contentious congress.

Instead all the Democrats have done is generate a lot of hot air and, so far, have nothing to show for their work.

Monday, February 1, 2010

The Failing Health Care Reform Bill I - Who is to blame?

Obama and his party have a debacle on their hands.. They have fiddled with health care reform for an entire year, while more important issues remained unresolved. The Democrats have managed their razor thin majority in the Senate with the sophistication and finesse of a mafia hit man. Now that they have been caught making all the wrong choices, it is time to look for scapegoats.

The media has tended to look for parallels with the first years of the Reagan and Clinton. Both presidents escaped largely unharmed from their early failures. I believe that the Jimmy Carter years may be more apt. Carter had a strong mandate with a convincing victory over Gerald Ford and control of both houses. It appeared that the way was clear for the Democratic juggernaut to restore the New Deal. In fact they squabbled so much that very little was accomplished. The economy went south, and Carter ended up with a one term presidency.

The stunning defeat in Massachusetts now leaves the Democrats in limbo with a few choices that are all distasteful to them.

Abandoning the health care effort will make them look like the gang that cannot shoot straight.

Starting over again, as the Republicans smugly suggest, would take at least another six months. Neither the Congress, which is facing an uncomfortable election, nor the country will tolerate more of the endless bickering and stalemate.

The only viable choice would be for the House of Representative to adopt what the Senate already passed without changes. In that case, they would avoid the necessity of coming back to the Senate where the Republicans are armed with their forty first vote. The problem is that the Senate bill includes terms that the left wing Democrats deem to be abominable, such as restrictions on funding abortions and taxing the so-called Cadillac plans which are largely established through union collective bargaining agreements.

How did they get into the mess? I have three major suggestions, which will be discussed separately over the next three days. I hope you will join me.