Monday, September 27, 2010

Jake Towne: Who IS This Guy?

Jake Towne is an Independent candidate running in the 15th 
Congressional District: In other words, he wants to be YOUR representative.

Posted by: Noel Jones

I have been not only very curious about the views of this Jake Towne since the forum held at Lafayette a few weeks ago, but have also been very impressed that he has taken the time to interact with readers of this blog to answer their questions directly. A 31 comment blog post (please post new comments here) resulted with more information posted than I can possibly hope to digest between now and the election, but it's nice to see a candidate engage on this level with residents and it's great that the info is all there to draw from if I and readers need to.

In my mind, one of the key issues for candidates to debate (which didn't really get debated at all during the candidates forum, unfortunately) is Health Care Reform. Not just because access to health care is important, but because encapsulated in that one issue are several tenets of the classic Democrats vs. Republicans debate: Big Government vs. Free Market, Taxation vs. Noblesse Oblige,  and whether health care is an Entitlement vs. Personal Responsibility.

YouTube video of Jake Towne explaining his stance on Health Care Reform (Part I)

YouTube video of Jake Towne explaining his stance on Health Care Reform (Part II)

I am still not completely clear on Towne's philosophy on health care with regard to how it would help the poor and the uninsured, but I'm still listening. I will be posting soon on the topic of health care as it stands for the uninsured in the Lehigh Valley, but for now, I'm interested in opening this discussion with the public, to see where readers thoughts are--even if those thoughts are simply confusion--and to hear about readers' experiences with health care premiums and care. I'm also interested to hear your views on Jake Towne's position as he explains it in the video above.

Believe me--if you post a question to him, he will respond. Whether you agree with him or not, you've got to admit that it's refreshing to be able to interact with someone who wants to represent you in Congress, who will answer questions directly and let you know where he stands. You may not like where he stands, but you'll at least know where he stands.


noel jones said...

On the topic of Taxation vs. Noblesse Oblige, I am having difficulty understanding this:

I know that Jake is running as an Independent, but his views seem to lean Libertarian, and my question for all Republicans and Libertarians (and I ask this earnestly) is--in a system where government does not provide health care to the poor at all, what is it within the Free Market idea that ensure that the poor have access to health care? Are people in those camps asserting that 1. enough people with money would care enough about the poor to donate to nonprofit hospitals sufficiently to ensure that every American can get care if they are sick or injured? (noblesse oblige), or 2. that they shouldn't have to care about the poor and that they don't care if they suffer and die without being able to afford care?

#1 would seem to suggest that wealthy people will not be selfish and just keep their money to themselves--which seems like an awful lot of trust to extend our wealthiest class when they had no problem running our economy into the ground for the sake of greed over mortgaged-backs securities.

#2 I just can't get with this, but props for honesty. If this is how some people running for office actually feel, then let them admit it, and go for the votes of all who feel the same.

Let's be clear here--lower premiums does not mean health care would be accessible to the poor, if in fact they could not afford even cheap premiums--I really want to know what the Republican/Libertarian rationale is behind privatizing health care completely. I'm starting to understand how the beaurocracy of subsidized care drives up costs, but am not yet clear on how the poor would be helped when sick and injured if health care were entirely private.

Jake Towne said...

Dear Noel -
Let me try to quickly address the very good points you have here. Let me also reassure you that we have the same ultimate goal - I am not so sure most of the Republocrats share it.

"in a system where government does not provide health care, what is it within the Free Market idea that ensure that the poor have access to health care?"

Simply because higher quality care will be more cheaply provided. A state or local plan will offer a lot more diversity and success than a federal one.

Please also note that under the EMTALA Act of 1986 the poor can get care - though sometimes this law is ignored/subverted.

My health care plank goes into a lot of detail here

The overall scheme+content of the GOP plans are very similar to the Democrats'.

Jake Towne said...

I had a longer follow-up on helping the poor, but lost it while posting somehow, have to get somewhere this evening, but wanted also to share my post on the solutions.

Destroying the cartel is what's most important, and what the Republocrats (overall) will always do is protect the cartel.

noel jones said...

Thanks for posting, Jake. OK, I looked up the EMTALA Act and am posting it here for readers--this definition is from Wikipedia:

"The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.

EMTALA applies to "participating hospitals", i.e., those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. However, in practical terms, EMTALA applies to virtually all hospitals in the U.S., with the exception of the Shriners Hospitals for Children, Indian Health Service hospitals, and Veterans Affairs hospitals[citation needed]. The combined payments of Medicare and Medicaid, $602 billion in 2004,[2] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, and not just to Medicare patients.[3][4]

The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[5] Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is "overburdened, underfunded and highly fragmented."[6] More than half of all emergency room care in the U.S. now goes uncompensated. Hospitals write off such care as charity or bad debt for tax purposes. Increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care.[7] There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S."

I will go check out your plank on this...

noel jones said...

p.s. Jake--it still looks, from the Wikipedia definition that Medicare is necessary to pay for this Act...

i'm going to check out the other links now...

Anonymous said...

let's face it, this guy doesn't have a prayer of a chance of winning. Fortunately or unfortunately I don't know but a vote for him is a wasted vote to an extent. In looking at the two candidates of the major parties and not at their opponents ads I must say that a vote for Callahan is a vote I think I am ready to cast. I like the positions, I like what he has done for Bethlehem and not just the richie rich areas. Look at all he has done for Souht Bethlehem, once the armpit of the world. It is transformed. My vote goes to John. Chrlie had his chance and all he did was vote no om anything in the last 20 months.

noel jones said...

Anon 4:06--You are expressing a sentiment that a lot of people share on both sides, who at times would like to vote for Independent candidates. One fear is throwing one's vote away, and another, in an election that is close between a Rep and Dem, is that they might vote for a "spoiler"--as in voting for Nader in the Presidential election of Bush vs. Gore.

When it starts to get interesting, is when one party is ahead in the polls by double digits. When there is a clear favorite in the race, and that favorite is the candidate you least want to win, then voting for an Independent does not effect the result for your candidate--but it does send a message, if a lot of other people feel the same.

And then there are those who vote for Independents simply because those are the candidates that resonate most with them.

If the Rep or Dem you want to win is likely to lose anyway, then you can afford to vote for an Independent, guilt-free. And any Independent that gets more than 8% in an election sends a strong message of dissatisfaction in the two-party system and support for ideas on that candidate's platform, and that has an effect on the campaigns of future elections. Last I heard, Independents were the fastest-growing "party" in the U.S.

I do not know the latest polling percentages for Dent and Callahan--does anyone know?

noel jones said...

Jake--I checked out your Health Care Plank, and I have to take issue with the candy store analogy (by the way, the image of the stacks of chocolate is at least partially responsible for my breaking down and buying some today, but that's quite alright)--here's why:

When, in depicting our admittedly overly-litigious society in the analogy, you say:

"Imagine for a moment you own a candy store. You work hard to find all the best suppliers and employees and to make your prices competitive so you can increase the size of your business and profit.

However, several people eat way too much chocolate and start getting health problems. After several lawsuits, your candy store is faced with two choices: either increase your prices, or go out of business. You choose to increase the cost of your chocolate.

The government decides that you are overcharging people for chocolate. They decide that the best thing to do, is to open a new candy store which will guarantee cheaper prices. They lower their prices to an amount that is well under what you are now able to charge since you got hit with all those lawsuits."
My problem with this analogy is that you are comparing people who sue for malpractice with irresponsible people who make themselves sick by consuming too much product--this seems like comparing apples and oranges to me, because when people sue for malpractice, it is not because they have consumed too much health care, but because either the doctors or hospital staff have done something wrong (or failed to do something right) that has worsened a patients health, rather than making it better.

noel jones said...

(cont.) Now, there are all kinds of phony or unwarranted suits happening in all arenas, not just health care--and I agree that to a certain extent, the threat of lawsuits from those trying to take advantage of the system do contribute to rising costs of health care. Here's a personal example of how:

I have had conversations both with my GP, and with technicians at Easton Hospital, asking them what they thought about Health Care Reform. The general feedback was that it might help a little here and there but that things would pretty much be the same for them before and after. I asked my GP what aspect of health care in her experience she thought was driving up premiums. She said that some doctors are incredibly anxious about potential lawsuits and will order all kinds of tests, not because they feel, in their medical opinion, that the tests are necessary, but because they want to cover themselves in case anyone hits them will a lawsuit later--that way, no patient can claim that a doctor should have done this or that test and try to sue them. She said the number of tests that you might get sent for (and therefore the amount of co-insurance you might have to pay on each test or procedure) entirely depends on how much of a nervous nellie your doctor is.

noel jones said...


When I went to get my first mammogram, the technician was very forthcoming, and urged me not to be nervous if I got a call to come back to get my breast smashed in a giant robot clamp again (somehow I have a hard time imagining a device like this invented to scan for testicular cancer, but that's another rant for another day). I asked her what it meant if I got called back. She said absolutely nothing, that 1 in 10 women are called back for a second mammogram, but that over 90% of those end up finding nothing. Why then, I asked her, are these women getting called back? She said it just depended on the doctor that ended up reading the scan. She said there were many doctors on staff who might end up reading and interpreting the image, and that one doctor sends back 3% of the images she sees, while another sends back 50% because he's nervous about lawsuits. I asked her to please do what she could to make sure that mine went to Ms. 3%. She smiled and said that she couldn't do that, but I think she did. I did not get called back.

So I agree that our overly litigious society is creating a nervousness among doctors that adds to health care expenses because they are pre-emptively ordering unnecessary test and procedures to protect themselves, but at the same time, when I hear about people that want to cap malpractice settlements at $250K, I can't help but think that would be too severe and simplistic an answer. If someone, like my cousin, for instance, gets appendicitis and goes to the emergency room and gets sent home with aspirin and told that she just has cramps, and then her appendix bursts and she almost dies--and then the hospital destroys the files documenting the mistreatment, and the botched surgery leaves her so scarred internally that she has chronic pain for the rest of her life, I think they owe her. Unfortunately, she did not have the money for a lawyer, and was afraid to go through the stress of the law suit, so she decided not to pursue it, and instead she moved to Europe where she can get free health care.

The other claim I take issue with is:

"With government-run health care, the best health care available in the world (ours!!) will be reduced to the level of a third-world country’s medical care. "

I hear this idea tossed out often--that America has the best health care system in the world, and it simply isn't true--we are ranked 37th in the world out of 190 countries. We do have the best specialty surgeons for the wealthy, but one cannot assess the health care of a nation by specialty surgeons alone. The idea that America has the world's best health care is sadly, a myth.

I am strongly in favor of torte reform, but not in the way it is usually presented--it will take a very creative problem solving process to devise laws that protect doctors from frivolous suits, while protecting citizens from having their lives devastated physically and financially due to malpractice.

Any ideas as to how we could achieve both?

noel jones said...

Jake--did I miss your take on Big Pharma's part in driving costs up--I saw the Rx image, but didn't see anything that discussed the drug companies role in driving the costs of their drugs (and therefore, the costs of our insurance premiums) higher...I feel strongly that Big Pharma is a big part of the equation.

Sadly, we hear barely a peep even out of the most liberal news stations on the role of pharmaceutical companies, and it's no wonder, considering every other commercial from their sponsors is a pharma ad...

Jake Towne said...

Dear Noel -
Thanks for writing back and very insightful comments, sometimes writing on blogs isn't the best way to have a conversation.

On the chocolate analogy (apologize for any unwanted calories), you have a good point - it is not a perfect analogy, and the key difference is we are dealing with people's lives.

I haven't been able to find - probably because it is hard to quantify - the true costs of defensive medicine due to fear of lawsuits, but one thing everyone seems to agree on is that it's significant.

In the case of tort reform, the best solutions is for state legislatures to work on the issue both due to its constitutionality and also so acts that don't work can be removed/not used by other states. It's an issue that contains a lot of detail and requires customization in order to work.

Big Pharm and the insurance companies is what I collectively refer to as a government-sponsored cartel. If you ever wonder why a German will buy a big bottle of aspirin over here, it's due to the trade monopoly in Europe - we have the same issue vice versa, depending on the drug.

I will not claim to be extremely knowledgeable on this subject (Big Pharm ripoffs) - or things like GMO foods - but again, this is why informed citizens like yourself and my Open Office idea are so critical.

"We do have the best specialty surgeons for the wealthy, but one cannot assess the health care of a nation by specialty surgeons alone."
I agree, and it's part of what I meant - but I am also of the opinion that several other areas - trauma emergencies, for instance - are also cutting-edge, and this care is far more available.

Jake Towne said...

Back to the health care for the poor, I should perhaps write an article on this, but in short

1) with a more prosperous society, yes we would have more charity. (and yes, this won't completely solve the problem!!)

Check out some of the world's best charity organizations, none of which came from gov't

2) cheaper costs goes the farthest towards alleviating the problem, and I am not opposed to local or even state plans to either provide the care or insurance -- check out Health Care Sharing Ministries which a supporter wrote about last year

noel jones said...

A new tidbit to toss on the fire:

I was in New York last week, staying a couple of nights with a friend in the hospital who was recovering from a C-section, so I had the opportunity to chat with one of the nurses. She said a few things that were interesting...

She mentioned that this particular hospital (Maimonides in Brooklyn) delivers 8,000-9,000 babies a year--almost twice the number of other hospitals in NYC. She said that the numbers were only getting higher, because so many other hospitals were closing. I asked her why other hospitals were closing, and she said, she didn't know really, but that they were just saying that they couldn't make ends meet. I said that seemed so strange since items on hospital bills are so expensive, and health insurance companies are reimbursing them. She said that what she was hearing was that it was because so many patients were on Medicare, and that the hospitals couldn't make enough money off those patients to sustain the hospital. Then she told me something that really surprised me--she said that the majority of patients at Maimonides are Medicare patients. The majority.

Now this brings two questions to my mind:

1. HOW did we get to a place where MORE patients are on Medicare than buying insurance?

2. How is Maimonides managing to survive and thrive if the majority of their patients are on Medicare, and other hospitals claim that they are closing because they can't afford to sustain the hospital on Medicare payments?

I asked her if she liked her job, and she said yes, but that it was incredibly busy. She said that she had worked in private practice before, and the pace was much better, but the pay was terrible.

So this makes me wonder a couple of things too:

1. If private practice is superior to subsidized practice, then why would it pay less?

2. Is Maimonides just an incredibly efficient hospital that cuts waste to survive on subsidized health care and yet understands the importance of paying their nurses well?

I would have asked her, but she was very busy, and had to run.

Anonymous said...

The answer is in the profit motive. Health care is not widgets. The capitalist profit-driven model does not benefit the patient.
@Jake, really? Our society hasn't been "profitable" enough to solve the problems of our health care delivery system in all these decades? Corporate profits, including the health care industry, at record levels...why aren't all of our problems solved by now? If your "profitable society" theory was at all accurate, we would be living in utopia.

noel jones said...

Anon 4:17--good point, but then what IS the answer? A single-payer system paid for by taxpayers? Do you think that we as a nation could sustain that? If so, I'd like to hear it because with profit-driven businesses out of the equation, the prices for services would come down, and cost the taxpayers less? I am really trying to get to the bottom of this. And what of all the worry that it would result in lower-quality care for all? What is the rationale behind that fear? My cousins live in Ireland and Germany and seem to get fine health care over there...

The idea that the rich becoming richer will also make them more generous--so generous that enough hospitals and clinics would be funded to take care of our nation's poor, seems an almost romantic idea. While Jake is willing to give up 2/3 of his congressional salary and donate it to a nonprofit hospital, I happen to think that he operates at an unusual (and admirable) level of integrity that is not likely to be met by most. Certainly his opponents have not risen to the challenge and offered to do the same. I am not confident that most people in this "me-me-me" era will live up to it. It seems like a bit of a trickle-down rationale, only rather than corporate wealth trickling down into new jobs, it's positing the corporate wealth will also trickle down into more charities, so many charities all poor people would get health care.

But then again, I guess that point is that with The Emergency Medical Treatment and Active Labor Act (EMTALA)[1], the poor can all already get care anyway...

However, I can't help but assume that those who would like to get rid of Medicaid, would eventually seek to repeal EMTALA (not Jake, necessarily, but other passionate free-market proponents).

I am all for the free market when it comes to most businesses in America, but as Anon 4:17 pointed out, allowing health care to be a for-profit industry seems problematic, as the ultimate goal is to make money, not to save lives or limit suffering.

However, the system is what it is at the moment, and it seems like certain free-market measures, i.e., allowing insurance to be sold across state lines, or allowing pharmaceuticals to be bought from Canada, could help bring costs down for the average American...

Anonymous said...

Where are you Jake?