Is Healthcare a Right?” Are we asking the wrong question?
A couple months ago I had the pleasure to be a member of a post gubernatorial debate question and answer panel discussion at Kentucky State University. The panel provided equal representation with two members for each of the three Kentucky Governor candidates -Independent Drew Curtis, Republican Matt Bevin, and Democrat Jack Conway.
Early in the panel discussion the moderator asked “Is Healthcare a right?” The partisan responses were predictable and therefore offered no new insights, but rather rehashed the stock partisan responses that anyone with any political intuition would have known were coming. The Democratic State Senators on the panel instinctively argued yes, and the Republican state senators instinctively argued no.
My Answer? I said that the question fed into the partisanship that divides us and it was the wrong question to be asking. Rather than ask “is healthcare a right” (Which I believe while morally right, is difficult to argue is a right in a constitutional perspective) the question should be, “Is providing universal access to affordable healthcare for all the right thing to do” from an economic and national self-interest standpoint? I do not discount the moral argument in favor of universal healthcare, I am however trying to transcend the ideological divide that only hardens positions and makes reasonable debate less likely. I approach my answer from three angles. One: Support for a healthy ready work force with fewer folks dependent on our thinly stretched social safety net; two: Increase American competiveness; and three: Our National Security.
A Healthy Ready Work Force. I am an Occupational Health Physician Assistant. I regularly see patients for “fit for duty” physical exams. Too often I see patients with treatable medical issues – hypertension, obesity, diabetes, obstructive sleep apnea, old poorly treated injuries or other medical or physical issues that preclude them from passing a fit for duty physical or physical demand screen. For many, the underlying treatable condition has had minimal to no routine medical care and management for years because they either have no insurance, cannot afford the copays and annual deductibles, or cannot find a provider who is willing to provide care through their Medicaid or other base level insurance. The result is either they are already unfit to work safely and productively without risk to self and others, or will eventually be in such a condition. The cost to them and to our society as a whole is tremendous. The long term eventual medical costs are compounded by their continued deteriorating health and the comorbid conditions that will develop into costly emergency medical interventions or greatly shortened productive lives. You want fewer folks dependent on our state and federal social safety net and a higher labor participation rate? Then invest in a healthier America that will be “fit for duty”.
Increased American competiveness and reduced burden on US businesses – This goes hand in hand with argument number one in that a healthier work force is more reliable, will have fewer sick days or family leave days and be more productive. But let’s take this further. Why is our US Health Care system traditionally employer based? It is because of the legacy of a World War II loophole in wage and price controls. With most able-bodied men and many women off at war, and our nation’s great industrial capacity geared up to supply the ships, aircraft, vehicles, weapons, ammunition and all other needs to support the fight, labor markets were stretched thin. President Roosevelt implemented wage and price controls to stop the spiraling inflation of both labor and production. One avenue used to recruit and retain workers which was not constrained by wage controls was employer provided health insurance. Thus the employer based US Healthcare system was created. Now, rather than a single payer universal healthcare system as is found in most other 1st world industrial nations, Americans are insured through a convoluted network of insurers and our US businesses are entangled in the endless complications, administrative hurdles, and expense of providing health insurance. Prior to the restructuring of General Motors and Chrysler (and I am sure the same is true for Ford Motor Company), before an ounce of material or a second of time was invested in a vehicle on the assembly line, there already existed a legacy medical cost of between $2000 and $2500 per vehicle – a cost NOT borne by foreign assembled vehicles from nations with universal healthcare and manufacturers free of these obligations. While the ACA represents a step forward in several areas reference broadening access to care for many millions of Americans (9 million fewer Americans are without some degree of health insurance), it has also created further burdens of administration and compliance for US employers which erodes our competiveness. Universal single payer health care could lessen this administrative and compliance burden and associated expense. And if the examples of most of our competition is any indication, universal single payer healthcare can deliver equal or better healthcare outcomes at a significantly reduced cost – approximately 10% of GDP to provide healthcare for all versus approximately 18% of GDP we currently spend while we are still leaving approximately 32 million Americans uncovered and 10s of millions of other Americans with marginal coverage with exorbitant co-pays and debilitating annual deductible along with very limited access of care depending on their insurance carrier. A good analysis of the American competiveness deficit secondary to our current healthcare model is found in the following article from Council on Foreign Relations: http://www.cfr.org/competitiveness/healthcare-costs-us-competitiveness/p13325. Additionally I will argue that access to Universal Healthcare would be a boon to entrepreneurship. More Americans would be more likely to take that leap and pursue their own inventive business dreams if the risk of losing healthcare were removed from the calculations when considering striking out on their own.
National Security. What does the current state of our healthcare system have to do with national security? Well, approximately three years ago the US Department of Defense sounded the alarm stating that less than 1 in 4 (24% to be exact) of our prime recruiting age Americans met the threshold medical standards to enter our Armed Forces. Let’s look at this a bit deeper. I believe that the 24% estimate was across all socioeconomic strata. Reality is that our Armed Forces – in which I was a proud member for nearly three decades – recruits disproportionately from lower middle class and poorer Americans in which the health statistics are significantly more worrisome and whose percentage deemed “able bodied” by US Military medical standards is likely even lower than the 1 in 4 aged 17 to 23 population as a whole. Lack of routine medical care, poor or sporadic disease and injury management, and a lack of prevention for many of our fellow Americans is a significant contributor to this current dismal state, exacerbated by 32.2 percent of American children living in poverty (the U.S. ranks 36th out of the 41 wealthy countries included in the UNICEF report - https://www.washingtonpost.com/news/wonk/wp/2014/10/29/child-poverty-in-the-u-s-is-among-the-worst-in-the-developed-world/ ) . With our current force drawdown (which I do not support – for more on my thoughts of military strength and the value of national service see - https://dl.dropboxusercontent.com/u/49082861/Thoughts%20on%20a%20National%20Service%20Requirement.pdf ), our dwindling number of able-bodied potential recruits may not be an imminent insurmountable obstacle to meeting force strength targets, but we cannot stand up a truly able-bodied force of significantly greater numbers if and when the need arises. Many factors contribute to the poor physical and medical conditions of too many of our young Americans. Lack of consistent quality care, preventive health service, and continuity of care is one factor we can address as a nation through universal single payer health care.
The strict partisans and ideologues will continue to argue whether or not healthcare in America is a right guaranteed to all. But again, that is not the question we should be asking. I will continue to argue that universally accessible quality health care is the right thing to do morally, as well as for our economic competiveness, to maximize our workforce participation potential and productivity, and for our Nation’s security. Regardless of where you stand on the healthcare as a right debate, universal healthcare is the pragmatic sensible right thing to do for our nation’s best interest.
Ronald Leach, Major (US Army Retired)
Posted on 01 Jan 2016, 22:39 - Category: Health Care
A Rude Unhinging – a Political Body in Shock
A medical provider’s examination and prognosis of the multiple comorbidities afflicting our democracy
Checking the Vital Signs of American Democracy
My medical colleagues will recognize the title - A Rude Unhinging - derived from Dr. Samuel Gross’ 1862 description of a rapidly deteriorating physiological state of the human body now known as shock; “the rude unhinging of the machinery of life.” They will also recognize the term homeostasis; the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes, necessary for health and long-term survival of the biologic organism. Just as the biologic body – human or other living organism, and the interconnected ecosystem - requires a state of equilibrium within narrow metabolic norms, our “body politic” requires homeostasis, or a balance within certain ranges of normal if the essential core functions of that body shall persist and serve us appropriately.
Just as our bodies have normal criterion ranges on exam resulting in optimal outcomes, our body politic operates most effectively and for the good of the body as a whole – i.e. all of us - within a narrow range of healthy norms. The current political vital signs and behaviors point to trouble. On exam I see an abnormal temperature in our political temperament - ideological extremes. I see multiple Behavior Health concerns such as paranoia, schizophrenia, and depression. I see a substance abuse disorder manifested in the ever growing influence of money used more frequently even once the damage is readily apparent - (yet I am sure every politician will insist that they don’t have a problem, and can quit any time).
In human medicine, seriously concerning values or significant behaviors abnormalities require immediate attention. Measurable quantifiable lab values, when significantly outside of normal, are referred to as “critical values” and require immediate reporting to and acknowledgement by the treating provider. I am reporting the critical values and out of range behaviors I am seeing in our democracy or Body Politic. We – all of us – as the care takers of our own democracy must acknowledge these critical values and formulate a treatment plan.
A Febrile Body Politic - Ideological extremes and hyperpolarization: Whereas the human body has a vital sign of temperature, our politics has a measurable vital sign in temperament. The current polarization within our politics exceeding normal values on both the left and right, has stricken our democracy and wrought a paralysis rendering our body politic unable to appropriately address the most significant and growing challenges of our nation. What is a “normal” range/value for political vital signs? Biologic normal values are often derived from a reference range defined as the set of values for which 95 percent of the normal population falls within. So, what would be a normal range for political polarization and what would indicate a body politic with a polarization and partisanship that exceeds a “normal” healthy range and potentially a critical value? By what measure can I definitively state that our politics is no longer in homeostasis and is in a life threatening state of imbalance? First, I will point to the quantifiable and measurably growing polarization within the walls of our US Congress. From post WWII through the early nineties, 40 percent of US Congressional members where rated as moderates based on their votes and positions. These moderates carried, nearly equally, the label of Democrats or Republicans. Within the ranks of Democrats and Republicans there existed a degree of common ground on many issues and room for mutual respect and compromise. Now the number of moderates has dropped to 10 percent, with a growing absence of bridge builders and coalition builders on both sides of the isle. Another way to examine this shifting vital sign of our democracy would be to look at the shrinking number of US House and Senate members who fall between the most liberal Republican member and the most conservative Democratic members within their respective legislative bodies as discussed in Chris Cillizza’s The Ideological Middle is Dead in Congress - Really Dead, 10 April 2014, Washington Post. A few graphics from that article to make the point:
It is no coincidence that this trend has coincided with more frequent ideological showdowns while our US Government is frequently taken to the brink of shutdown or default, sequestration in lieu of responsible budgets, and CR (continuing resolution) after CR; no actual budget passed from 2009 until just recently while on the brink of a fiscal cliff once again.
Polarized Congress Only Getting More Split– Now Proven by Math by Seth Augenstein, Digital Reporter 04/22/2015 reaches the same conclusion: http://www.laboratoryequipment.com/news/2015/04/polarized-congress-only-getting-more-split%E2%80%93-now-proven-math
The US Legislature is temporarily playing nice. In October 2015 a budget was finally passed and the US House passed a deal to finally fund the Highway Trust Fund for more than a few months at a time (although riddled with financing gimmicks/ smoke and mirrors rather than a clean straightforward adjustment in the federal gas tax that has remained unchanged for about two decades now – has lost inflation adjusted value of 63% since last raised and is further diminished measured by revenue per mile driven due to successes in increased fuel efficiency – a double whammy that has repeatedly depleted the fund). As we get into the swing of another election year the perceived ability to actually govern is becoming a key issue in voter’s minds. Legislators are attempting to imitate actual governing. But the near insurmountable ideological divide remains and is growing, and the failure to make pragmatic and realistic deals is the result. This mounting and ongoing failure is reflected in the electorate’s declining congressional job approval ratings:
Signs of Depression within our Body Politics: Anhedonia– “the loss of interest or pleasure in activities one normally engaged in”, is a key indicator of depression for which we strive to screen for at each patient encounter. Anhedonia, while a subjective measure when evaluating our human patients, is a measurable and objective vital sign of our politics. A key normal activity in a democracy is voting. Yet, in the US, generally the rate for Presidential elections is around 50% participation, around 40% or less in midterm elections, and as witnessed in Kentucky’s Governor’s race last Tuesday, can be as low as 1 in 3 eligible voter or lower. Just like our individual patient dealing with depression, our body politic expresses feelings of hopelessness and futility. In addition to a voluntary lack of participation, we must add the millions in America who are disenfranchised by law – prior convictions of non-violent crimes for which they have paid their debt, or discouraged often intentionally by politicians seeking to choose the electorate, rather than trusting the electorate to choose them.
Schizophrenia – “a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.” –Or more simply - (in general use) “a mentality or approach characterized by inconsistent or contradictory elements.”  Is the electorate - the global cognitive functioning of our body politic - exhibiting signs of schizophrenia? YES, absolutely! Let’s look at Boyle County KY exit polling from the now only 10 days past Kentucky Governor’s race. While not a perfect picture of the state as a whole, it is close. (According to the Secretary of State’s website, 54.7% of Boyle County voters voted for Bevin, 40.1%, Conway, and 4.6% for Curtis, while Kentucky as a whole went 52.5% Bevin, 43.8% Conway, and 3.7% Curtis). According to exit polling, 64.3 percent AGREE on raising the minimum wage to $10.10/hour – a position aligned with the Democrat that they rejected. The electorate agree on EPA regulation of the coal industry at 56.2% - Yet Bevin has been quoted as saying he will ignore the EPA and that the EPA can “go pound sand”. The electorate agrees with outgoing Democratic Gov. Beshear’s Medicaid expansion decision at 61.9% and support, Gov. Beshear’s implementation of KYNECT insurance exchange (Kentucky’s successful state run insurance exchange) 55.2%. Yet Governor elect Matt Bevin - while waffling from immediate repeal to “scale back” and shift current insured onto the federal exchange (so much for that libertarian “the states can do it better” mantra) is opposed to this position. On the issue of support for Rowen County Clerk Kim Davis’ refusal to issue marriage licenses, only 32.6% support her and Governor Bevin’s position. Yet these same voters gave Matt Bevin 54.7% of their vote (a 14.6% margin of victory over Democrat Jack Conway). Of the six exit polled questions, the only exit question in which the electorate sided with the candidate for which the majority gave their vote was on the issue of random drug testing for recipients of public benefits. So, yes, the electorate reflects a degree of inconsistency, i.e. “a mentality or approach characterized by inconsistent or contradictory elements.”
Substance abuse disorder- Substance use/abuse disorder, also known as drug use disorder, “is a condition in which the use of one or more substances leads to a clinically significant impairment or distress.” The abused substance/ the substance for which our body politic has developed a disabling and unhealthy dependence is money. “Money is not the root of all evil in politics, In fact, money is the lifeblood of politics” former House Majority Leader Tom DeLay once said. Majority Leader DeLay was later indicted for election law violations asserting undue corporate money influence (later acquitted – because that same corporate money can buy whatever “justice” is sought). How do we decide when there is a substance abuse disorder vs a harmless and responsible use? For alcohol the long used screening “CAGE” questionnaire asks the following:
• Have you ever felt you should Cut down on your drinking?
For our Body Politics we could ask equivalently “have you ever felt you should cut down on the amount of time you spend fund raising and spend more time actually governing?
• Have people annoyed you by criticizing your drinking?
For our legislators clearly under the influence, we could ask “have your constituents, those you are elected to represent, ever suggested that you fund raise too much and have no time for them or their concerns?”
• Have you ever felt bad or Guilty about your drinking?
We could ask “have you ever felt guilty with the company you keep to supply your insatiable need for money? Have you ever done things/made votes you are ashamed of because you needed another fundraising fix?”
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?
Have you ever missed a vote or a constituent meeting for a fund raiser? How soon after the previous election (how many hours later) do you feel the need to do just a little more fund raising?”
Item responses on the CAGE are scored 0 or 1, with a higher score indicating alcohol problems. A total score of 2 or greater is considered clinically significant. I feel we can safely assume that the vast majority of our elected “representatives” would, if honest, produce a max score of 4 indicating a significant dependency impairment. Relentless as any opiate or nicotine dependency, finance addiction is just as difficult to eliminate. A prolonged and increasing public tolerance for our out of control campaign financing suggests that more and more of the substance “money” is needed to achieve the same "high state", more extremes are necessary to arouse public scrutiny, and every candidate must find ever larger doses in order to remain competitive.
Oppositional Defiant Disorder  is a condition in which a
child (substitute US Representative) displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority (the electorate/ E Pluribus Unum –the idea that we are all in this together and stronger as one). The child's (insert the US House “Freedom Caucus”) behavior often disrupts the child's (Legislators) normal daily activities, including activities within the family and at school (insert US Congress). Are there any questions on the validity of this pathology exhibited by approximately 40 of our 435 US House members and a smaller handful of US Senators that have hijacked and rendered our US Congress dysfunctional? ODD is a disorder of childhood, suggesting that we have "regressed" or gone backwards. This is not what would be expected of a mature democracy.
Are we now witnessing our body politic spiraling rapidly to the rude unhinging, towards a point of no return? A traumatized or ill body has compensatory mechanisms that can for a short duration stave off shock – an increased heart rate, peripheral vascular constriction to restore blood pressure and direct blood and oxygen to core functions of the heart, brain, and other vital organs; but at the expense of other less immediate needs. We are witnessing this compensatory state within our body politics. Core functions, while maintained in a clunky inefficient, and short term myopic fashion, are continuing. But the non-standard - outside of “regular order” methods – of Continuing Resolutions in the absence of responsible and deliberate budgeting, sequestration that fails to distinguish between vital and non-vital investments, discharge petitions to force votes on popular bills with wide spread bipartisan support, etc., employed to sustain minimal core functions are not without costs. The less immediately vital, but in the long-term essential, functions required to maintain our nation’s growth and health are starved and will deplete and weaken our nation over time. A healthy Body Politic has the mental and cognitive strength to constrain excesses, plan for the next generation rather than pander for the next election, and give due diligence to all that ails us, not just blunder forward aimlessly.
Just as the human body’s ability to compensate eventually fails and is followed rapidly by the rude unhinging of the machinery of life, with rapidly diminishing likelihood of recovery in the absence of timely and aggressive interventions, our body politic is approaching the point of decompensating and a precipitous decline towards a point of no return. In the early stages of shock, as core immediate body functions are prioritized and less immediate needs are neglected, the damage begins almost immediately as areas deprived of normal oxygenation and blood supply begin anaerobic metabolism resulting in acidosis, lactic acid production, and an accumulation of metabolic toxins that even if full reperfusion is restored, will wreak havoc and harm to the body as a whole. We see this same toxic buildup in our body politics today – an acidic political environment, atrophy of our public institutions and the public’s confidence in these institutions, a steady spiral towards the point of no return, towards a rude unhinging that is eventually irreversible.
What interventions would I prescribe?
Regular Exercise – Exercise our Vote! And as with all healthy exercise programs, we need voters to “exercise smartly”, and able to make informed and healthy exercise routines.
(1) Automatic voter registration for every citizen at age 18.
(2) A National Election Holiday on our traditional Tuesday federal election day as well as open polls the Saturday and Monday prior.
(3) Mandatory public debates that will force incumbents to face and engage opponents and defend their record and ensure a more informed electorate able to exercise their vote more effectively. Debates are a vital part of democracy often dodged by incumbents calculating that they have everything to lose and nothing to gain – as my opponent demonstrated in Kentucky’s 2nd US Congressional District race in 2014. P.S. –Debates should be over public airwaves and accessible to all, not only for those with the right cable package!
Substance Dependency Treatment
(1) End Citizens United, END ALL Corporate political funding and Super PACS, make public all money spent to achieve political outcomes – i.e. buying legislation. Enforce moderation with enforceable caps on contributions for any perceivable purpose of influencing the electorate.
(2) Consider lengthening and staggering US House terms to mitigate the polar swings election cycle to election cycle and the member’s perceived need for endless fundraising due to the always near term next election.
(3) Voice of the Represented Only - Ban contributions from outside the district for which the candidate seeks election – only allow contributions from the State for which a US Senator seeks election or re-election, the multiple counties of the district for which a US Representative seeks election, the few counties that a state representative or state Senator seeks to represent. In doing so, election results will be determined by those represented, not by millions of dollars in outside contribution. This would greatly level the playing field upon which incumbents currently have a near insurmountable advantage. Elections would less likely be won through saturating the airwaves with biased and carefully crafted TV ads (financed from out of state Super Pacs), but rather be won by good old fashion shoe leather, local organizing, public debates and engaging with the electorate directly.
Antipyretics – Fever reduction. Address the temperament –hyperpartisanship - that is destroying our body politic.
(1) End Gerrymandering. All state and federal legislative districts should be created by an independent non-partisan means. Several computer algorithms have been suggested, and demonstrated, that would accomplish this without any possibility of manipulation.
(2) End “straight ticket voting” here in Kentucky and the remaining other nine US Sates that allow it. Straight Ticket voting only exacerbates polarization. Parties are NOT candidates. Voting straight ticket without making individual choices from top to bottom of the ballot is not actually voting for actual candidates on their merits at each level/race, and unless the voter can actually name each and every candidate on the ballot for which he or she is indicating a vote (for or effectively against) by choosing straight ticket, the basis of an informed vote is not truly exercised and they have not actually cast a vote for or against any actual candidate. Independents are disenfranchised/ disadvantaged – there is no Independent slate “straight ticket” choice, therefore they are not equally represented in the process. In the case of severely polarized electorate (most electoral districts in Kentucky) the down ticket major party candidates on the wrong side of the polarized divide are also disadvantaged having their fate severely skewed by the electorate’s response to the “top of the ticket” exacerbated by “straight ticket” voting option.
(3) Eliminate the (D), (R), (I) and other party designations next to the names on the ballot. This overlaps with the aforementioned elimination of straight ticket voting, but takes it one step farther in seeking to ensure voters are selecting people rather than parties.
(4) Runoff elections: Consider voting that allows the electorate to rank candidates when three or more candidates seek the same elective office. Might also consider adding “none of the above” as a standard choice. If no one candidate reaches a greater than 50 percent threshold as the electorate’s “1st Choice”, then there would be a runoff election for the top two finishers two weeks following the first round elections. In the case where the Independent or third party candidates rank high as the second choice for a majority of Democrats and Republicans, they would be more likely to move forward in the runoff rather than be eliminated because of the “spoiler effect” and “least of two evils” fear during a one off election. This technique may very well have resulted in a Bevin vs Curtis runoff election here in Kentucky and the possibility of a non-partisan and pragmatic outcome for our Great Commonwealth of Kentucky which would have better served us all. (See data confirming Independent Drew Curtis support less partisan/more moderate)
You may note that I did not include term limits. Why? Because without many of the above and other measures, I fear that term limits could inadvertently bring about greater polarization. How? Consider a “wave” election year (landslide left or right) in which a relatively centrist legislator who would otherwise likely be reelected cannot seek reelection due to term limits. His or her potential moderating influence would be lost and likely replaced by a more ideological newcomer. Additionally, unless you cutoff the immense influence of PACs, Super PACs and other special interest monetary advantage, these entities will simply swoop into every race now an open race (no incumbent) due to term limits and install the candidate of their choice – i.e. he or she most compliant or willfully sponsored by them. I do not completely reject the idea of term limits and am sympathetic to the argument, but fear the result may not be as intended if not implemented in conjunction with other systemic reforms.
This is not an all-inclusive list of the measures I would suggest to restore the health and functionality of our American democracy, and I do not suggest that I have all the answers. I welcome your thoughts and suggestions – second opinions or the assessment of specialists so to speak. The bottom line is our Body Politic is severely ill, and further delay of our intervention will only result in a continuing deteriorating state with diminishing chances of recovery. Some of what I have suggested may have untoward side effects and may not be the right answer. In medicine every intervention if followed by a reevaluation and adjustment of the treatment plan as indicated. The same will need to be the case as we attempt an aggressive resuscitation of our democracy. But doing nothing would equate to malpractice. We are the care takers of our own democracy. We must acknowledge the current deteriorating status and actively and aggressively intervene now.
Posted on 08 Dec 2015, 23:10 - Category: Partisan Extremes
Thoughts on a National Service Requirement:
Less than one-half of one percent of US population is in active military service today, and only about 7.5 percent of the US population has ever served in our active military forces.
What portion of our US Congress that we entrusted with life and death votes for our men and women in uniform have any military service experience? Answer: It is the lowest it has been since prior to World War II, currently only about 1 in 5 of our current US House or Senate have ever served.
How many of their children and grandchildren deployed in support of the war in Iraq or Afghanistan?
How would the deliberation prior to sending our soldiers to war differ if more Americans, and particularly our leadership, had a direct connection with our military either through prior service themselves or the current service of a spouse, son, daughter?
Thousands of American Servicemen and Women, who had honorably completed their service obligation during OIF and OEF were compelled to continue service under military “stop loss” which denied them the ability to exit the military upon their ETS (End of Term of Service). They were forced to put plans of education, careers, families and other life plans due to our limitations as a nation to grow our force to meet the extraordinary demand, while the vast majority of America felt no real connection to the ongoing wars and were asked no real sacrifice.
I would suggest that in a time of “Global War on Terrorism” – or whatever the current vernacular - that it should not be un-thinkable to institute some form of National Service. Likewise In times of peace, the concept of National Service – giving to one’s nation – is valuable for development of a sense of citizenship and a common national experience. In the current polarized and divisive environment, the common bonds and experience established through National Service may be vital to our national survival – or at least a step towards greater cooperation.
Proposed National Service Options:
1. Active Duty Military – 2-year commitment
2. National Guard or Reserve – 6-year commitment (Obligation adjusted for any Federalized/activated time served beyond initial entry training)
3. Teacher’s Aid– 2 year Commitment in over populated elementary and middle schools with pupil to teacher ratios of greater than 20:1 for elementary and 25:1 in middle school or schools identified as failing schools. These individuals should be chosen based on aptitude, demonstrated desire to pursue a career in education, and undergo appropriate interview and screening processes with the local school administration and board making final approval.
4. Border Patrol – 2 year commitment. These individuals would bring much needed manpower to our over stretched border enforcement.
5. Port Security – 2 year Commitment. Port security remains a significant vulnerability in our homeland security.
6. Transportation Security Administration (TSA) – 2 year obligation.
Benefits of a National Service Program:
1. Starting place for those graduating High School to break the cycle of our current “Lost Generation”. Giving real world experience and benefits to start with – College benefits, Job Skills, and a sense of duty and service.
2. A trained ready reserve force to fill force requirements as they arise. This would have reduced the strain on our Active and Reserve Forces during the peak of post 911 deployments. The current situation in Iraq, Afghanistan, and Syria and throughout the world remains fragile. Peak deployment rotation schedules wear our forces thin with cumulative medical, emotional and family strains. To reestablish credibility in our Nation’s ability to execute and sustain actions in two major theaters simultaneously (if dictated by clearly defined threats to our nation with clear achievable objectives) will require a greater standing force and or a greater ready reserve that can quickly and effectively augment or active forces. The end to the cold war did not result in the much anticipated peace dividend. The emergence of non-nation terrorist organizations and rogue states as the aftermath of the superpower standoff has in many ways left our world more volatile and unpredictable. Currently the United States is demonstratively ill prepared for the multiple contingencies of emerging threats abroad, the demonstrated terror threat to our homeland and the need for effective/timely response to natural disasters.
3. Take pressure off Guard and Reserve Forces, which during the height of our post 911 deployments faced back-to-back deployments. Allow our Guard and Reserve to be available for Home Land Defense and response to terror attack and natural disasters. Pre-911 planning called for the Guard and Reserve Forces to face the possibility of one major deployment (generally of 6 months duration) per six years. During the peak of operational tempo during the simultaneous wars in Iraq and Afghanistan and with forces deployed elsewhere in support of the “War on Terror” our Guardsmen and Reservist faced deployment rotation schedules and deployment durations equal to their Active Duty counterparts. While they performed admirably, it was not sustainable, had a substantial detrimental effects on the soldier’s families, careers, education plans, small businesses, force retention and our rural communities as a whole. These soldiers are often members of local police departments and EMS services. This, in turn, has greatly undermined many communities ability to respond to major emergencies or a potentially new terrorist attack on our homeland.
4. Reduce the increasingly expensive reliance on Non-Military contractors. With our uniformed forces in Iraq, Afghanistan and elsewhere are a historically unprecedented number of Civilian Contractors. These contractors are not held to the same standards enforceable by the Uniform Code of Military Justice (UCMJ), are compensated with outrageous sums of money that undermines the motivation and morale of our soldiers who face greater danger for far less financial security. During my second Iraq deployment in 2005, a civilian contractor assigned to train our troops on close quarters combat and help units conduct convoy live fire exercises prior to unit movement north, insisted on pointing out to our Soldiers that he was being paid in excess of $10,000 dollars per month (tax free for the first $90,000) from the relative safety of Kuwait. Meanwhile a PFC who may be tasked with daily convoy duties in Iraq or Afghanistan and in constant threat of catastrophic injury and death received about $1,600 dollars monthly in base pay. A cadre of uniformed US soldiers – any competent Noncommissioned Officers - could have conducted this training. Additionally, Non-military contractors regularly place an undue burden on theater medical and evacuation assets – they are often poorly screened for chronic medical conditions that are exacerbated by service in theater.
5. Return a commonality of experience as Americans that has been a bond between generations and social classes of Americans in past generations. All Americans would have a connection and understanding of what service entails. A sense of National Service and Duty to Nation and a shared destiny would be re-instilled in our Youth- What Senator John McCain refers to as service beyond one’s self.
6. Trained ready reserve population. We would have a trained population in those who had completed their National Service from which to draw from in times of national emergency. During WWII the United States stood up a 16 Million Man Military Force from a national population of only 160 million. We are currently unable to sustain a deployed force of 1.25% of our WWII standing Armed Force despite a doubled national population.
7. Heightened level of Understanding across ethnic social and economic experiences. There would be a natural mixing of people and society from all regions of our nation. This represents a valuable exposure and in some cases enlightenment to many. The United States has a rapidly increasing underclass of citizens locked into environments of economic insecurity and violence. We are at risk of the eruptions of violence and radicalization that grow in the shadows of hopelessness, cultural isolation, and disenfranchisement.
8. Maintain the World’s most competent, capable and professional fighting force. National Service would enable us to maintain the quality of our volunteer force because the NCOs, Senior Enlisted and Officers would be those identified with requisite qualities, skills, and commitment that volunteered for continued service beyond their National Service obligation. Our current force is experiencing the loss of our most talented service members at unprecedented rate secondary to an operational tempo which is exhausting our under-sized force and straining families to the breaking point.
9. NO More “Stop Loss”. Soldiers in our “Volunteer Army” would not be caught in “STOP LOSS” status that has involuntarily held many thousands in service beyond their contracted end of service unless a national emergency is declared which requires a general draft/call up of all available forces.
10. An experienced future national leadership. A greater number of our future leaders would have practical military experience upon which to draw when making decisions that commit our men and women to harm’s way. For far too long, many in Washington have treated our men and women in uniform as their personal easy button. For any problem, they hit the easy button with no thought of the repercussions. Well, real respect and support for our military, real respect and support for our military families, real respect and support for our communities which often rely on our guardsmen and reservists as their first responders, fire and polices forces; real respect and support requires that the mightiest and most professional military the world has ever known be used appropriately, with forethought, restraint and with clear concise achievable objectives and a plan, and never be used for political advantage. The limits of power and appropriate employment of our military must be understood and respected. I believe that, over time, National Service would help achieve a more informed and deliberate debate prior to committing US forces.
11. Retention of skilled talented military professionals. Millions of dollars spent on enlistment bonuses to attract non-skilled entry-level soldiers into the service could be refocused on retaining our experienced Non-Commissioned Officers and Junior Officers.
12. Enhance homeland security. Port and Border Security duty would greatly enhance homeland security. I am not anti-immigrant – we are a nation of immigrants. However, no nation can consider itself secure with open borders in an environment of non-nation terrorist elements demonstrated willing to indiscriminately murder thousands of our citizens.
13. Truly leave no child left behind. Teacher’s Aid service would enhance the quality of education in our underserved schools – and truly leave no child left behind while provide valuable experience to future educators. This program could also be used to help provide personnel needed for expanded or universal high quality pre-K programs.
Additionally, a National Service commitment could be incorporated as a tool to assist in closing the education gap in America. All who successfully and honorably complete National Service should be eligible for assistance for post-secondary school – a new GI bill. Many of our high school graduates are deficient in many areas requisite for successful transition to the college environment. Through service entrance exams, these shortcomings could be identified and targeted assistance given through the Military Education Assistance offices and similar organizations established for those serving in non-military duties could help reduce identified weaknesses and better prepare these young Americans for college or other post-secondary training success post National Service.
Few HS graduates are fully aware of what they intend to do, have been exposed to few options, and may lack the self-discipline for success at the college level. Two years of National service will serve to bring focus and discipline and greater success to our future college freshmen.
Coupled with this National Service plan we must also address the health trends in America. I would suggest a greater emphasis be placed on cardio fitness and weight control in our primary and secondary schools as a matter of national necessity. Thirty Six Billion dollars are spent on obesity related illness in US annually. Physical Education should not be an elective. The US Department of Defense sounded the alarm a few years ago reporting that less than 1 in 4 Americans in the primary recruiting age group of 17 to 23 met initial entry medical fitness standards. And the picture is actually worse when you consider that this rate is even worse among the population from which our armed forces primarily recruit, our lower middle class down to those in poverty. A single payer universal healthcare system would also serve to mitigate the current trends, but will save that argument for future articles.
Who should be required to serve?
All Graduated Seniors who are found fit physically and mentally for one of the Service options (Military (Active, Guard or Reserve), Teacher’s Aid, Border Security, Port Security, or TSA) should be obligated to service to their country. Honorable completion of National Service would be earn preferential hiring for federal jobs, free education at any public trade school, community college or university.
As always, I welcome your thoughts, critique, and suggestions.
Ron Leach, MAJ (US Army Retired)
Posted on 21 Jan 2015, 22:49 - Category: National Service
“If we are the richest country in the world, how come so many people can't afford to live here?”
This was the bottom line question from a fictional letter from “Henderson Kentucky” at the end of the 2009 movie The Swing Vote. Yet it is a variant of what I hear throughout Kentucky from real men and women finding it increasingly difficult to keep their and their family’s heads above water despite often working multiple jobs.
“How come so many people can't afford to live here?” Good question isn't it? Isn't it time that voters start electing representatives who seek answers to that question, instead of ones that keep regurgitating the same tired rhetoric we have heard now for greater than thirty years? With the income gap now at record levels it is time to recognize the simple fact that wealth piled at the top isn't trickling down. It is time to recognize that government is going to be “the problem” as long as we keep electing representatives who are dedicated to ensuring that government cannot function. It is time to recognize the fact that a consumer driven economy works only as long as folks have jobs that pay sufficient wages – a tide that lifts all boats rather than only the largest yachts.
We are now witnessing the first American generation facing general downward economic mobility, a generation less likely to rise above the economic level of their parents as had previously been the achievable norm for past generations. We now have a generation of young Americans called the “lost generation”.
This is no accident. This is not the result of an evil plot from beyond our borders. The current state of our economy, an economy that simply no longer works for the majority of Americans – i.e. the demise of the American dream - has been thrust upon us from Washington, by our own elected “representatives”. It required Washington to willfully shift the tax burden from the affluent - who could afford it, to the middle class that would have to borrow to maintain their standard of living or lower it. It required destroying the public's faith in government in order to allow the undoing of the new deal programs that provided safety nets and protection for the public (repeal of Glass-Steagall and the relentless destruction of organized labor, for example). It required trade agreements that opened the doors to globalization while discarding the hard fought achievements of American Labor. It also required politicians – consistent with Senator McConnell’s ideology of “money equals free speech” – to willfully become dependent on big money backing to remain in office. All this led to the disintegration of the middle class, the inability to maintain the infrastructure and public investments that progressive taxation built, and levels of inequity that simply will not allow an economy to grow and serve most Americans.
It is time we stop listening to the rhetoric that has got us in the fix we are in and time to honestly answer the question of why so many people can't afford to live in the richest country in the world. It is time to elect representatives who believe that everyone who works hard should be able to afford to live a decent life in America, instead of representatives who primarily seek to prove that government is the problem, while enabling a few to buy America. It is time to elect representatives who want to ensure that government has everyone's back, instead of representatives who only believe in getting government off the backs of the very few who have reaped the benefits of a thirty-year con-job on America.
We need Leaders, not looters in Washington!
We need a Kentucky and an America that works for ALL of US!
We need functional government that represents ALL of US!
Democratic Candidate for US Senate
Website - www.ronleach4ky.com
Contact Us - RonLeach4ky@gmail.com
Posted on 4 Apr 2016, 20:54 - Category: Economy