Americans are being screwed - royally

I am passionately in agreement with some Republicans who warn us that the health care reform package recently passed by Congress does not go to the roots of the problems and will therefore not solve the health care crisis in America.

The Democrats' health care reform legislation is a very promising start, but the country's efforts to rein in the cost of its health care will not be successful if the root causes are not addressed.

We know that doctors are a major cause. The practice of medicine in this country is an exercise in capitalism. It is no longer considered as a public service, which it is in many countries ranging from the highly industrialized countries such as Canada, Australia, Great Britain, France and Germany all the way to third-world countries such as the Philippines and Cuba.

We know that lawyers drive up costs by going for doctor's jugulars every time doctors make mistakes. If there is no tort reform, costs will remain high.

We also know that drug companies' primary mission is to maximize returns for their stockholders. As public corporations, their ultimate responsibility is to their stockholders. Providing cures or alleviating symptoms is only a secondary mission. Once upon a time, drug companies started out with a mission to find cures for diseases. Not anymore, now Big Pharma's mission is to maximize returns for stockholders.

We know that the same drugs that are sold in the U.S. cost at least twice as much as those sold in Canada. If those drugs were invented by Americans and developed by Americans, how come American consumers pay much more for them than their Canadian counterparts?

There is only one way to explain this. U.S. drug manufacturers made the determination early on that the way to recoup their research and development expenses was to charge American consumers outrageous prices.

The American system is perfect for this. The insurance companies are the ones paying for the drugs, and as everyone knows the huge for-profit insurance companies can afford to pay. They can absorb the costs since they can merely pass them on to their insured by periodically raising insurance premiums. There is no limit to the number of times insurance companies can raise premiums.

The high-cost drugs are absorbed into the health care system in the U.S. because we have a pipeline mentality here. Whatever costs are incurred by the members of the system are merely passed on ultimately to consumers. The drugs go smoothly through the pipeline and as long as the howls and protests are few, drug prices just keep on flowing at prices that have no relation to production costs.

Only the sick notice, but sick people do not have the energy to demonstrate in Congress. They will pay any amount to get well or to keep the symptoms of their ailments under control.

The insurance companies profit from the atrociously high drug prices. Assuming that insurance companies are allowed an 8 percent return on their costs, the higher the cost of the medicines, the bigger the profits for the insurance companies.

We keep reading in the papers that American consumers subsidize the cost of drugs in other countries. To what extent? Below is a comparison of the prices of some life-sustaining and life-saving medicines sold in the U.S., Canada and Mexico.

Prescription Drug-----Dosage------Price in Maryland----Canadian Price--Mexican Price

Zocor--------------5 mg., 60 tab.-----$113.97-------------$46.17----------$67.65

Prilosec-----------20 mg., 30 cap.-----122.62--------------55.10-----------32.10

Procardia XL-------30 mg., 100 tab.----144.89--------------74.25-----------76.60

Zoloft-------------50 mg., 100 tab.----238.44-------------129.05----------219.35

Norvasc-------------5 mg., 90 tab.-----127.17--------------89.91-----------99.32

The average price differential, based on the above drug cocktail, is 98% for Maryland versus Canada and 95% for Maryland vs. Mexico. (Source: Minority Staff Report prepared for U.S. Congressman Elijah E. Cummings of the Committee on Government Reform and Oversight, U.S. House of Representatives - August 10, 1999.)

The prices charged for drugs in Australia are even lower than the prices in Canada, according to one source.

The drug industry apologists do not deny that American consumers are being raked by the drug companies for even their spare change. Every single apologist for the drug industry will tell you that drug companies must be allowed to recoup their huge investments in research and development through atrociously high prices charged American consumers.

Yes, folks, the drug companies have determined that U.S. consumers must underwrite the cost of R & D, ahead of everybody else. We Americans must pay through the nose so that others - Canadians, Mexicans, Australians, Europeans - can have the same drugs at a fraction of the prices charged Americans.

Is this right? Why must it be a disadvantage to be an American compared to being a Candaian, or an Australian? Shouldn't it be the other way around? Shouldn't we Americans pay less for prescription drugs since it is our American drug companies who are constantly coming up with these newer and better drugs with less and less side effects?

Is it because our higher standard of living allows us to afford more? Maybe so. But as we Americans know, and as the whole world now knows, the American standard of living is under attack. We Americans are becoming more and more like the Europeans. The Chinese are fast catching up with us. The Japanese have exceeded us. The Australians and Canadians are right on the trail of the Japanese.

So why do we Americans continue to subsidize the cost of medicines in other countries? Because we allow the drug manufacturers to price discriminate against us. That's the only explanation.

If we Americans stand on rooftops and scream enough is enough, we will no longer be forced to subsidize the world's consumption of life-saving and life-preserving drugs things will begin to change. And this is change that we can believe in.

The situation is urgent. Without a reform of the way drug companies price their products in the U.S., health care reform in America will remain just a dream.

We made a great start with the health care reform package passed by Congress and signed by President Obama. But, we must not stop there. Drug companies must charge consumers in other industrialized countries the same or nearly the same prices for their products as they charge American consumers.

It is not only fair, it is one essential way to reduce the cost of health care in America.

(Next week: the hospitals.)

Thank your lucky stars for Lawyers

FLASH! Sunday, March 21, 2010, 6:00 p.m. Las Vegas time:

PELOSI, REID AND OBAMA AND THE NATION TRIUMPH!

In 1936, Franklin Delano Roosevelt offered a new bill of rights that would supplement the list of rights embedded in the U.S. Constitution. Among the new rights that Roosevelt advocated was the right to health care. The U.S. Legislature did not pick up on Roosevelt's idea, and the new American "rights" died with Roosevelt in 1945. Not a single right on Roosevelt's list became law.

This historic weekend, the country enacted a law that makes health care a right (and a duty) in America. While still work in progress, the new health care reform act that creates the right to health care for every American national took a dramatic turn for the finish line when President Obama refused to be intimidated by the recent Democratic defeats in New Jersey, Virginia and Massachusetts.

Grown men and women openly wept when the first black President was elected on November 4, 2008. This time, everybody was all smiles. It was a giddy moment for the Democrats and the country. Everybody in this country will remember what they were doing the night health reform passed.

All of us, you and me, are witness to history. Never before in this country has health care been considered a right of every American. It has taken a black President to get it done. It has taken all of conscience-stricken America to prod him on, telling him he was on the second yard line, all he needed to do was to punch it into the end zone.

Yes, like "all" that was needed was to soften the muscles of the huge defensive linemen, the Republican misinformation machine. In one gigantic muscle coordination move and rocket-like leap, the President, Speaker Pelosi and Senate Majority Leader Harry Reid - all blocking for each other - punched the ball into the end zone.
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I may have made enemies last week, or at the very least I may have tried and tested some friendships, when I openly questioned the present system that rewards U.S. doctors as capitalists rather than reward them as public servants, which most of them are, and which is the way most doctors are treated in other countries - advanced, developing or underdeveloped.

A doctor in Las Vegas has surrendered his license because of the huge scandal
that resulted from the terrifying news that his clinic had reused needles and
that thousands of patients at the clinic had contracted hepatitis B. No HIV
cases had been found, or more appropriately been broadcast to the public, but
suspicions are rampant that there may have been such cases.

The doctor operated on the principle that he was a capitalist and that his first
obligation was to himself and his employees. His first obligation, in his mind,
was to maximize the profitability of his enterprise.

Doctors in most countries are franchised by governments to serve the public good and the systems in those countries afford doctors a comfortable lifestyle but not ordinarily an opportunity to create huge personal fortunes. The U.S. is one of a very few countries that consider the practice of medicine as a capitalist franchise.

Because of the magic of capitalism, huge fortunes are being made by doctors in the U.S. That is why lawyers and the public are holding doctors to heightened scrutiny and unusually high standards.

The nature of work, especially delicate and demanding professions such as doctoring, is that mistakes are inevitable. It is estimated in one study that 80,000 medical malpractices occur every year in the U.S. Of those 80,000, only 10,000 actually result in lawsuits. And out of those 10,000, 96% are settled out of court. Only 4% of the 10,000 - or 400 - actually go to trial by jury.

Insurance companies that issue malpractice insurance to doctors are therefore "saved" by the system. The 96% of the cases that are settled out of court cost the insurance companies an average of $125,000 while those that go to the jury average $235,000 in awards. My statistics do not reveal if the cost figures include the cost of insurance company lawyers. I apologize for not knowing.

The message is clear. Insurance companies are highly motivated to settle malpractice suits out of court because no matter how good their lawyers are, plaintiffs will nearly double their awards if the cases go to trial.

The lawyers know this, and short of encouraging frivolous lawsuits, lawyers tend to advice their clients to sue on the slightest provocation. They know they will collect regardless of merits, what more if there are compelling reasons to sue.

Assuming in all this, of course, is that it is not a frivolous lawsuit.

Chances are, it is not a frivolous lawsuit. People make mistakes, especially when they are on a steep learning curve. Doctors especially, when they are under stress and are making life-or-death decisions.

It is therefore unrealistic for the public to expect that doctors will not make mistakes. They will and they do. Every day. And they will continue to make mistakes. And they will continue to cover up those mistakes.

The public's defense is to know as much about their doctor as they possibly can. They must research their surgeon's credentials before they agree to lie on the operating table.

They look into the horse's mouth, don't they, before they buy the horse?

When I was starting out in college in the traditional world of business, there was the caveat emptor rule (Let the buyer beware). It was only recently that the world has been evened out for consumers through consumer protection laws.

For patients, however, it is always wise to assume that caveat emptor rules. Pretend that there are no consumer protection laws. Besides, the government cannot prevent, no matter how tough the laws, doctors from making mistakes. While the law will grant redress, doctor's major mistakes cannot be undone.

The patient is never the same, even after being showered with malpractice money awards.

And, though malpractice awards and settlements are for the most part modest, some awards have been huge, enough to slam the knees of insurance company executives:

Failure to timely diagnose, $10,200,000 settlement (Feb. 11, 2010).
Breast Cancer lawsuit, $17,500,000 settlement (Oct. 30, 2009).
DeKalb County birthing malpractice lawsuit, $15,350,000 settlement (May 23, 2008).
Medical malpractice lawsuit awarded by jury, $60,000,000 (February 18, 2010).

The Disability Insurance Resource Center website lists hundreds of awards and settlements, each one potentially if not actually ruining a doctor's career.

Do you see anything wrong with this picture? I do. We know that doctors will make mistakes. Experience tells us that these mistakes are often unavoidable, which is why malpractice insurance is a major source of revenue for insurance companies that offer them.

If you combine the universality of malpractice insurance policies with the certainty of mistakes occurring in the practice of medicine, you are looking at a gold mine for lawyers. Lawyers will get their 30% - after expenses - whether the plaintiffs settle or the case goes to the jury.

While awards are generally modest and reasonable, there have been very expensive cases to settle or litigate. Insurance companies must set their premium rates according to the possibility that any malpractice case will result in huge settlements or jury awards, tempered only by actuaries' estimates of what the likely breakdown will be between major news-making awards and usual and customary awards.

A recent study demonstrates that in the long-run, as the size of awards have gone up, the premiums charged by insurance companies have also gone up. In insurance underwriting, premiums are set on the basis of potential maximum losses, not on best-case scenarios. This is why malpractice insurance premiums have gone through the roof in this country.

The cost of malpractice insurance, especially in some professions such as obstetrics, gynecology, oncology and all kinds of surgery, has become so prohibitive that doctors have been known to take the early retirement route or branch out to other fields.

Doctors are being squeezed by insurance companies that are on a drive to tamp down the fees charged by doctors, and from below, by the cost of malpractice insurance.

This is the cruel present, but the promise of the future is worse. The doctors who bail out further exacerbate the shortage of doctors in many areas of the U.S..

Something must be done. The country cannot continue on this road to higher and higher malpractice insurance premiums because of higher and higher settlement and jury awards in malpractice cases.

Obama, Pelosi, Reid and others in the Democratic Party have done the heavy lifting in the struggle to provide health care to most Americans. They must now even the playing field for doctors and insurance companies.

The jury awards in malpractice cases must be capped. The Bush administration proposed capping jury awards to $250,000, with exceptions for egregious cases. Obama seems to be open to the suggestion, though the $250,000 figure is arbitrary and likely to change.

I advocate this change because I know that doctors do make mistakes, and it is the responsibility of everyone to select doctors that are least likely to make mistakes. How does one do this? By researching the doctor's qualifications. The Internet has so much information that one can use. Patients should beware of doctors about whom there is little information on the Internet.

Patients must also gather information by word of mouth, from other doctors, nurses or hospital administrators.

We do a thorough research before we buy a new car, it is only fitting that we ask a lot of questions before we agree to being treated by a doctor, or God forbid, being opened up by them.

When we make the final decision on the choice of our doctors, implicit in that decision is that we are partly responsible for what results from that choice. If our doctor makes a mistake we are partly to blame because we chose that doctor.

While this does not absolve the doctor of responsibility for loss of income or loss of job (economic losses), the more lucrative type of settlement or award (pain and suffering and punitive) would be removed from the equation. Should that happen, settlements and jury awards would tend to drop dramatically.

This makes a lot of sense. Let me restate my case in plainer terms. Assuming that we choose our doctors intelligently, what the doctors do to us is partly our fault. If we suffer pain and suffering, it is ultimately because we made the wrong choice. Punitive damages would be unavailable to us because we were a part of the decision making in the choice of our doctor.

Insurance companies are granted by states a certain profit margin based on their expenses. If their expenses are high, their margins are bigger and the total cost of malpractice insurance is high. If their expenses are low, their margins are smaller, resulting in the cost of malpractice insurance going down.

If the cost of malpractice insurance goes down, doctors' fees assuming a rational world would also tend to go down. As more doctors return to the practice of medicine because they are no longer intimidated by the cost of malpractice insurance, the doctor shortages occurring in many parts of the U.S. will be alleviated.

The increase in doctors practicing in their fields will tend to keep doctors' fees from spiraling ever upward, and in fact may result on doctors' fees going down. But don't hold your breath for that one.

Of course, we could short-circuit this whole process by eventually going to a single-payer health care system, a Medicare for all system where the Federal government covers all Americans and most doctors no longer make the huge fortunes that they build over their lifetimes. Doctors would be just like every body else in this country. They have to be truly outstanding in their professions in order to earn huge fortunes over their lifetimes.

The lawyers would just have to find others to sue for big bucks.


(Nest week: The pharmaceutical industry.)

What does society owe its doctors?

Shortly after we moved to New Jersey in 1977 from Portland, Oregon, my first wife and I bought a house in South Orange, New Jersey not knowing that my life was about to change in a very dramatic way. I was swimming in the town's community pool when I noticed someone who was trying to figure out if he knew me. After a brief period, he exclaimed, "Chay?" Chay is what all my friends call me. How I got that name is a long story.

My friend, whom I grew up with in school - from grade one through high school - had become an oncologist, a pillar of the community, someone people from all over the country consulted with when they discovered they had cancer.

We quickly renewed our friendship and his wife quickly became one of the closest friends of my wife. I said that my life, unbeknownst to me, was going to take a dramatic turn. It did. My friend introduced me to his circle of doctor friends and suddenly I was moving around in a circle of highly accomplished doctors.

I maxxed out my credit cards, went to the best parties, tried to keep up with the Filipino Joneses. It was very different in Portland, Oregon and before that in Seattle. In both cities where I had been, most of my friends were working-class people and Filipino old-timers. Now my wife and I were in the giddy company of doctors who were destined to become some of the best doctors in their fields in the New York metropolitan area.

I was having career midlife crises at the time and it was inevitable that I would eventually start feeling sorry for myself. I felt, at times, that my new friends were asking, in the back of their heads, why I did not become a doctor. Doctoring, after all, was for them the zenith of anyone's professional aspirations, so why did I not go into medicine when I had the chance? Assuming that I had the chance.

I was convinced that the world was tailor-made for doctors. All they had to do was put in the work and the long hours, and bingo, after a few years they would live in these houses that ordinary people could only dream about. Not to mention the sports cars.

I went through much of my life not being in awe of anyone, but I must admit I looked at doctors with awe. Except my life-long friend. He was my friend, after all, and I would never allow myself to be in awe of him.

I lucked out when later in life my net worth increased to a level I had never imagined I was capable of accumulating. Not in the league of doctors' fortunes, but still more than enough for me to live on for the rest of my life.

It was only then that I felt I was equal to the doctors. I started to ask the questions that I would never have asked if I had not known financial success later in life. I would never question doctors' incomes if by doing so I would expose myself to suspicion of committing the cardinal sin of Envy.

But now that the whole country is discussing health care reform, I feel that it is time to analyze the level of income of doctors and that one of those who will do this analysis is me.

I will also try to analyze the impact of lawyers on the health care costs in this country in a future blog post.

For starters, let us look at the macro picture. Australian doctors earn 70,000 to 98,000 Australian dollars (U.S. 63-90,000 dollars) per year, compared to U.S. general practitioners and internists at $125,000 (according to the McKinsey report). This is a fair comparison because in the latest World Health Organization rankings of health care systems, Australia came in at number 32 while the U.S. came in at number 37. We're comparing similar health care effectiveness, though Australia is ahead of the U.S. in that category for half to 80% of the cost of internists and general practitioners.

The WHO rankings' number one health care system is the French. There general practitioners earn 71,000 to 72,000 Euros (about $100,000 U.S.). Again, compare this to $125,000 Internists and General Practitioners in the U.S. Not much difference in earnings.

It is estimated that the U.S. pays its doctors $58 billion a year more than they deserve to be paid for comparable care in other countries (McKinsey report). If the difference in earnings is not in Internists and General Practitioners between U.S. doctors and doctors in foreign countries, whose earnings account for the excess $58 billion a year that U.S. doctors are paid?

You guessed it. It's in the specialists. While specialists in Australia typically earn $200,000 a year, U.S. specialists' earnings are in the millions.

There is a special category of doctors in the U.S. who have opted out of the health maintenance organizations and the Medicare/Medicaid systems. They don't need the insurance companies because they are in such highly-specialized fields that people mortgage their houses to be treated by them.

Why do U.S. specialists earn as much as they do? Most people will tell you that it is because of two factors. One, U.S. doctors - especially those who have specialized in extremely complicated surgeries - went through highly intensive and rigorous study not only in medical school but also in hospitals as interns and residents before they began their independent practice. They therefore deserve whatever rewards society will grant them. U.S. doctors go through 16 to 18 years of intensive study, according to some reports, before they establish their practice.

Two, doctors are in the business of saving lives and making lives more productive by curing diseases.

Let's analyze reason number one. If doctors are compensated highly for the number of years they spent in intensive study, then we should also compensate the PhD's in philosophy, in science, in psychology nearly as much as if not as much as the doctors.

Aha, you might say, those PhD's do not do a lot of overtime work and save lives. I will grant this, though in the case of the PhD's in Psychology, they do save lives by preventing suicides. I will not go there, will instead grant that doctors save lives and PhD's don't.

But what about the firemen and the policemen? Don't they save lives? And don't they put in long hours? Don't they patrol the dangerous streets where in an instant they could be dead? Firemen and policemen save more lives than doctors, so why do they not make anywhere near as much as doctors?

Let's redirect our inquiry to doctors all over the world - not just in the U.S. Why is it that doctors in Australia, in many European countries and in developing countries like the Philippines are not automatically some of the richest people in those countries?

What is unique about doctors in the U.S.? I have wrestled with this subject lately because I am one of those who are glued to the TV watching talking heads spew their wisdoms about the health care crisis in America.

Doctors in underdeveloped countries are operating in lean mines. The economies simply cannot support the lavish lifestyles of doctors that are typical in America. Some doctors in third-world countries like the Philippines are in fact paid, not with currency, but with livestock (chicken, pigs, etc.)

In Europe, Canada and Australia the practice of medicine is restricted because doctors for the most part work for a single payer, the government. Government, as we all know, is stingy. It's built that way. Have you ever heard of anyone working for the government - except the successfully corrupt - getting rich from that employment?

The conditions in the U.S. are tailor-made for the fortunes being amassed by doctors. This, after all, is the richest country in the world, and in this richest country, there is no mechanism for keeping doctors' incomes down. The sky is the limit for doctors' incomes, and that is the way it should be, if one embraces the pure capitalistic system of charging patients what the market will bear.

And here is where we go back to Adam Smith. Is there perfect competition in the practice of medicine? Adam Smith always assumed that perfect competition was possible. When we look at the fees charged by doctors to rich or uninsured patients or to insurance companies, etc. are these fees what a willing market must pay?

Why are there shortages of doctors in the U.S., which should have a bumper crop of doctors since the practice of medicine is very profitable here? Has our legal system in fact created conditions that led to a chronic shortage of doctors thereby insuring that those who practice medicine here are rewarded with lavish lifestyles?

I must be careful not to overstate this case since there are many doctors who are barely getting by. The insurance companies have over the years cut back on doctors' compensations and doctors no longer make as much as they did.

You want to know why health care is so expensive in the U.S. that now 17% of the country's GDP is spent on health care? It is because many doctors, including most specialists here, are automatic multi-millionaires. Radiology companies, independent staffers of nursing, collection agents for doctors, ambulance companies, MRI and kidney dialysis companies - all businesses connected to the field of medicine - are raking in. If no drastic changes occur, the field of medicine and satellite industries will bankrupt the Medicare and Medicaid systems in as little as one generation.

More and more Americans are just one major sickness away from bankruptcy - even if they have insurance.

How do we get out of this loop? The obvious solution is through a single-payer system. Let there be universal health care, with the government setting limits on what doctors and peripheral medical service providers charge for their services.

If Americans do not want a single-payer system, then they must lobby their government to step in and address the problem of too few specialists and too many general practitioners in the field of medicine.

For far too long, the actual numbers of specialists have been kept down artificially by all the silly requirements imposed by the states' medical boards and by the AMA. A doctor who performs complicated surgeries in India, Thailand or the Philippines, for example, will not be allowed to practice in the U.S. unless those doctors are willing to take the medical board exams, go through an internship program, etc. which will set these eminent foreign doctors back a few years from which the doctors could never recover. So these accomplished doctors don't come here.

The doctors who are recent graduates of medical schools in foreign countries are being shunted into general practice and internal medicine and psychiatry, which are not as lucrative as the glamour specialties.

This assures that the glamour specialties - the various surgery specialties, oncology, cardiology, etc. - always have a shortage of practitioners. The system has institutionalized those shortages. That is why we as a country pay so much for surgical procedures and other highly specialized doctors' services.

We pay to the tune of $58 billion a year more than what we should pay each year, according to the McKinsey report.

The solution, therefore, is to open up the practice of medicine in this country, with the specific mission of recruiting more specialists who have made a name for themselves in their home countries. Actual work experience in foreign countries must be considered equivalent to work experience in the U.S. Only U.S. arrogance denies that fact.

The government must provide incentives by underwriting the cost of medical school for aspiring high school graduates. The government can start by canceling student loans for those medical school graduates who choose to specialize in fields where there are shortages that cause huge fees being charged by doctors.

Recently, two new medical schools have opened up. More are on the pipeline. That will help.

We are on the cusp of insuring 30 million Americans who have not had health insurance through the health care reform movement in Congress, graduating more doctors will tend to keep costs where they currently are. Or bring costs down. "Down" is ironic because in the U.S. that still means high up there in the deep blue sky.

Either we do this, or we as a country will be forced at some future date to revisit the idea of a single-payer system similar to Australia's, and Canada's, and many European countries.

We will have to ask ourselves: What does American society owe its doctors?

(Next week: How do lawyers contribute to the high cost of health care in this country? After lawyers, we will examine the drug companies, then the hospitals.)

Is health care a right?

Is health care a right or a privilege? If you ask the Europeans, the Canadians and Australians, health care is a right. If you ask Americans, nearly half will tell you that it's a privilege, though nobody disputes that emergency treatment at the nation's hospitals is a right.

We in America are deeply divided on the issue of health care. And we are conflicted, very conflicted. We want Medicare to be a right for our parents, and ourselves if we are age-qualified. We want children to have health insurance. We want the poor, through Medicaid, to have health insurance. We want our criminals to have access to health care - at our expense.

But we don't think that our taxes should pay for the health care of the unfortunate Americans who can't afford to pay the high premiums charged by insurance companies.

One could argue that old people have earned the right to Medicare because - generally - they have worked for many, many years and have contributed to the Medicare fund all those years.

People who are 65 and older are presumed to have contributed to the Medicare fund and therefore deserve Medicare in their old age. But how accurate is this, really? Americans who turn 65 - whether or not they have worked most of their lives - automatically are enrolled in Medicare.

Housewives who never worked a day in their lives, old retirees who lived most of their working years in a foreign country and worked in the U.S. for only a few years, are all eligible.

No matter how one cuts it, ultimately Medicare is a right - for old people.

Now, let's look at health care as a right. Why do old people have that right, while young people don't? Because young people are presumably working and their employers are providing them with health care? True, in the 1970s, in the 80s, in the 90s. But is this true today? More and more companies are dropping their health insurance because they can no longer pay for it. More and more companies are classifying their employees as independent contractors to avoid giving them benefits.

What happens to such people - the backbone of American industry - people who are not old enough to be on Medicare, not poor enough to be on Medicaid, not young enough to be on CHIP, the children's version of Medicare?

Small businesses cannot afford to provide health insurance to their employees, so employees who go through life working for small businesses live their lives without health insurance. Many of the older folks wait for their 65th birthday, hoping they do not get seriously ill, so they can finally have health insurance.

Artists, entertainers, musicians, writers, editors and other self-employed people go through their whole lives without health insurance. Because health insurance is so expensive, these Americans treat health insurance as a luxury that they cannot and probably would not be able to afford.

They buy auto insurance, renters insurance, credit insurance. They buy life insurance because it's so much cheaper, and they want their children to have something if they pass on prematurely because they don't have health insurance.

How many Americans are we talking about? The high estimate is up to a staggering 50 million Americans. The low estimate is 40 million.

Do those 40 or 50 million Americans have a right to health care? Not if you ask about half of Americans. This is Darwinian politics at their worst. This is the movie 2012, where only the lucky and wealthy - they have to be both lucky and wealthy - can be saved. The rest are left fending for themselves.

Whatever the actual number, the Democratic-sponsored legislation approved in both Houses of Congress will insure 33 million of them. And the Congressional Budget Office has certified that the legislation will not cost the country a dime. In fact, the savings to the U.S. government will be 100 billion dollars over the first ten years and more than a trillion dollars in years 11 to 20.

So why are the Republicans - to a man - opposed to health care reform now working its way to the reconciliation process and eventually to President Obama's desk? You have to ask the Republicans that, but don't expect a credible or cogent response.

There is none. What they want the country to do is to shelve the two health care reform bills approved by the House of Representatives and the U.S. Senate and start over. Yes, start over!

They want us to go back more than one hundred years, when Teddy Roosevelt was President and when health care reform was first proposed by a sitting President.

After the U.S. government has spent countless hours and billions on salaries and research and development costs, the Republicans want the Democrats to throw away all of that work and start with a blank sheet of paper.

They are not arguing the truly debatable question, such as, do Americans have the right to health care, or is it a privilege? The Republicans don't want to go there. They have conceded that health care is a right. They just don't think that the country can afford to act on this right. It's been 100 years since this question came up. Each time, Republicans tell us that the country cannot afford to act on the right of Americans to have health insurance.

Out of the goodness of their heart, the Republicans, through their House leader John Boehner, are proposing that 3 million out of the 40 to 50 million uninsured Americans should be helped. The rest, wait around a little bit, they will get their turn.

When there's a blizzard in hell. That's what the Republicans are asking the rest of the uninsured Americans to watch out for, because that very likely phenomenon - snow in hell - is not too far down the road.

Meanwhile, about 14,000 Americans lose their health insurance every day in this country, according to some studies. And, of the many bankruptcy filings in the U.S., two-thirds are filed by people who got sick and could not afford to pay their hospital and doctor's bills.

Also, a Harvard study demonstrates that those without health insurance are much more likely to die from sickness than those with insurance.

We have in this country decided that old people have a right to health insurance, so do children and so do the very poor. So do criminals. But for the great percentage of Americans - those who are neither young enough or old enough or poor enough, or criminals - they're on their own.

Who benefits from this system? The insurance companies, the drug companies, doctors, nurses and hospitals, the old, the poor and the young. The rest of Americans are getting squeezed and if you ask them, being screwed.

The country is in a state of vigil. We have lighted our imaginary candles. We have waited long enough, a few more days or weeks is no big deal. We are waiting for our legislators to get the damn bill passed. We expect President Obama to keep on top of these Democratic legislators and whip them into action. We think the President has it in him to muster enough courage and energy to get that ball across the goal line.

Next week: What are fair earnings levels for doctors? What should the top oncologists and surgeons make? Does society owe surgeons and other specialists their lavish lifestyles? If doctors are being compensated for saving lives, should they not charge millions for each life saved? Isn't human life, after all, worth millions?

Governments on Ice

The earthquake that hit Chile a little more than 24 hours ago is nothing compared to the earthquakes that have been collapsing governments all over the world.

I am talking about the social, political and economic earthquakes brought about by the clash of tectonic plates of confrontational ideologies in cyberspace, cellular waves and cable TV. It started, innocently, with the creation of cable TV and the Internet two generations ago, followed briskly by the invention of technologies that filled the expanded needs of people who suddenly found themselves armed with the most potent force in the universe.

Yahoo, notebooks, texting, google, YouTube, I-pods, Blackberry and I-phone all followed in quick succession, and not necessarily in that order.

The world's new literates - those who see the computer and the cellphone as their friends and constant companions - have erected a new international society that can topple many of the world's governments.

Every wild gallop and swaying of a government structure in recent years has been the result of people texting and communicating on the Internet through mammoth e-groups and YouTube.

Police brutality cases, captured on cellphones and video cameras. In inner cities of the U.S. In Iran. In China.

Abu Ghraib and torture of prisoners. Dissident students in China's Tiananmen square.

"Obamacare" massacred on the Internet and on cable news shows by allies of the health insurance industry in the U.S. Obama's birth certificate issued by the state of Hawaii determined to be a fake by bloggers and Internet phantoms.

A deluge of text messages quickly formed the Filipino people's resolve to topple Philippine President Estrada and his government. A few years later they turned around and almost toppled the Gloria Arroyo government.

England's former Prime Minister Tony Blair, Italy's Premier Silvio Berlusconi, New York's Eliot Spitzer, Tiger Woods and many others swiftly falling from grace as Internet savvy folks and opinion-making bloggers weaponized the new technologies and fired away.

Everything happens instantaneously. Reputations are lost, frauds are exposed in cyber-speed. To compete, the traditional media such as newspapers and magazines must jump in the mud pool quickly and match the Internet and cable TV speed for speed.

The fallen cannot recover, because speed breeds finality. Senator Ensign in Nevada and Governors Mark Sanford of South Carolina and Paterson of New York are still in office, despite their much-publicized human frailties, but in reality all is lost for them.

This is our world now. We have created arguably the best inventions in the history of man - the Internet, the cell phone and texting, the Personal Computer and Notebook - which are also fast becoming an arsenal for assassins.

Without our having intended it, or being aware of it, we have transformed ourselves into piranhas in cyberspace and cellular waves. Governments are no match against us. Duly elected governments - even those overwhelmingly voted in by the electorate - can be neutered into inactivity by people like you and me.

All we need are people who think like us - and there are plenty of us on the Internet universe - and what we have created, overnight, is an invincible army of radioactive activists. We may be the loneliest creatures on earth, abrasive fools with no friends in the real world, yet if we can find a handful of people who believe as we do, we can suddenly be leaders of an army that has the potential of toppling governments.

The illusion of the Internet and cellular waves is that people who are drawn to the same causes and who share the same biases and pet peeves are friends. The reality is that such people do not even know each other. They have each other's email addresses and cell phone numbers and through the magic of the communication channels, act overnight as friends and allies.

Complete strangers who are allies and protagonists in cyberspace have already determined that whoever wins the presidential election in the Philippines in May cannot govern effectively. The candidates' reputations are shot.

Today's technology does not just wreck and topple governments, groups and individuals; it also builds reputations and careers where none should exist. The emergence of Sarah Palin, who in a sane world would be laughed out of politics in an instant, is proof of this. The Iranian opposition leader, Mir Mousavi, is most certainly a creation of the YouTube technology - a leader who overnight went from being an ally of the religious dictatorship in Iran to the symbol of the democratic ideals and yearnings of the Iranian people.

The shadowy forces that make up the Tea Party movement, can anyone really put a finger on them? Yet the Tea Party thrives, fueled by the libertarian front, aided by today's talking heads on cable.

Ever wonder why the world is so divided? Ever wonder why people's ideologies have hardened? Right-wingers will not talk to liberals and progressives. Libertarians condemn both liberals and progressives. Religious zealots are in a permanent war with the religious moderates and liberals.

People with opposing views do not need to talk to each other anymore. Every ideology, every major sliver of philosophy attracts almost an unlimited number of allies and adherents. You can find on the Internet millions of people who believe that Obama was born in Kenya. If you believe that the Ten Commandments should be in all the government buildings in the U.S., there are millions of Americans and non-Americans who will chorus "Hear, Hear" at cyber-speed.

If you are a racist, you have millions of friends on the Internet and in the world of texting. If you are a bleeding-heart liberal, you belong in a huge community of bleeding hearts. No need to link up with people who do not believe as you do - you don't need them. Why risk injury to your heart?

You can debate people you do not agree with all you want and there is no possibility of defeat. You could be illogical, obtuse and dumb in your thinking - not to worry, there are others on the Internet who will be your cheering squad. In our world not too long ago, your arguments could be demolished by people who were more informed than you. Not now, not while people create their own realities and truths on the Internet and are supported by huge peanut galleries.

We used to call these peanut galleries "Chu-chu-wa" in the Philippines and that is probably an appropriate label. For that is what they do: they sing "Chu-chu-wa" in the background while their leaders make one outlandish claim after another. Their existence assures that you never have to admit your mistakes on the Internet. Even and maybe especially when you are very, very wrong.

While our world has most certainly been enriched beyond the wildest expectations of our grandfathers because of the new technologies, we also have awakened to a world where half of us cannot have a meaningful conversation with the other half.

Governments cannot communicate with those that oppose them.

Everywhere we turn, we see evidence of governments being on the brink, as a great portion of the citizenry refuses to pay lip service. In fact, nearly everyone in the world, it seems, is angry with their government. Those who support their governments are angry that their leaders appear to be flummoxed by the challenges they face. Those who oppose the governments are indignant because those same leaders are unable to see the world as they see it.

Governing has become nearly impossible. If you are an elected official, how can you in conscience pursue a course of action that half of your constituents oppose? Yet this is the challenge that confronts elected public officials in every corner of the world.

Some, mainly leaders in Africa, find it easier to simply resort to genocide. Leaders of tribes that oppose them are hacked to death in front of their families. The wives and daughters of those tribal leaders and their followers are raped before being hacked to death.

Such leaders may eventually end up in the World Court, if the Interpol can get its hands on the slippery characters. It's a risk that the brutal African dictators can take because those dictators know that the probability of capture and extradition is low.

Absent large-scale eradication of opponents and intransigent citizens, the world's political leaders really have no solution to the problem that confronts them. Their country's citizenry has become ungovernable. It is as though a strange new virus has infected the system and mechanism for communication between the government and the governed. And this new virus threatens to kill the government.

The solution is for the world to step back and survey the open fields, the Elysian fields of victims of wars and intransigence, the sacrificed offerings to the gods of communication and technology and to exclaim with one voice: My God, what have we done to our world? Why can't we together find solutions? Why can't we march together anymore?

What can we do to manage our future - not as Blue Staters and Red Staters in America, or Muslims and Infidels in Europe, or pro-Gloria and anti-Gloria in the Philippines - not as soldiers of competing armies but as common citizens of a world that must pick up the pieces?

We must be forewarned that if the monster of the Internet becomes bigger, it will consume all of us, just as those who ride the tiger invariably end up in its belly. The Chinese may be on the right track. They seek to tame the Internet.

We in America must do the same. In addition, we must tame hate radio and hate cable TV.

But how do we do that without infringing on the right of free speech?

And we haven't even talked about the mountains of debt being created by some of the advanced nations, such as the United States, Greece, Spain and Ireland.

La Sallites and Lasallians

It was an innocent, run-of-the-mill event in our lives as La Sallites, back in 1960. An announcement came out on campus, on bulletin boards, dubbed as "Name Your Campus Paper Contest." The faculty moderator of the school newspaper, Aurelio Calderon, wanted a new name for the campus paper to further distance itself from the old paper called "The La Sallite."

"The La Sallite" had been published by, for and of the students at De La Salle College in Manila for as long as anyone could remember. The quality of the paper had been under attack by some members of the faculty, including and especially Mr. Aurelio Calderon - later Dr. Calderon after he earned his PhD.

As one of those who organized the new campus paper, I was aware of the entries that were coming in. Some appeared to be good, others were particularly witty, while others just plain stunk.

Then one day, Mr. Calderon opened his mail and found an entry: The La Sallian. "This is it," he exclaimed. "This is what we will call the new newspaper. The La Sallite, after all, is a strange name. People are not called 'ites' anymore, they are 'ians' or 'ans.' Theresians, Paulinians, Ateneans, Bedans, Rizalians, Mapuans, Upians. La Salle students are the only ones who are called 'ites,' La Sallites."

We did not know it then, but Calderon apparently had planned to send us La Sallites prematurely to extinction.

When the first issue of the new campus paper came out in 1960 and it hit the homes of many La Sallite families, a huge throng of mothers visited the campus. They protested the name change. "My sons are not La Sallians," they screamed. "They're La Sallites. They will always be La Sallites."

Our mothers apparently knew what was really going on, while we La Sallites had no idea we were sauntering in, like Agamemnons, to our slaughter.

Over the years, the students at De La Salle College, later De La Salle University, became known as La Sallians. It was, however, an issue that wouldn't quit. It made its way all the way to the world's number one Christian Brother in Rome, and the scholars of the Christian Brothers felt obliged to rule on the question. The students of De La Salle College in Manila would henceforth be known as Lasallians, they ruled, following the tradition of calling students of nearly all schools run by the Christian Brothers worldwide Lasallians.

That ruling effectively made us La Sallites obsolete.

What's in a name? Is a rose a rose by any other name?

To a lot of people in the Philippines, the term "La Sallite" carried a certain cachet. There were very few La Sallites in the Philippines. The La Salle system consisted of De La Salle College in Manila and the La Salle College in Bacolod City in Central Philippines.

The Manila campus consisted of grade school, high school and college, later also Masters. Most people who went to La Salle grew up on that one campus. That was our home away from home, from kindergarten all the way through college.

We knew everyone, and everyone knew us. We were family. We fought like brothers. We had no sisters, not unless you count the obviously homosexual among us, who walked and looked like girls. There were very, very few of those and most of us went to school with torn pockets (from roughhousing) and didn't care if our socks had holes.

We played marbles on the soft muddy grounds, so we walked around with dirt caked in our fingernails. Nobody cared.

We were born into large families, and in every family there was a designated potential public servant, a designated potential priest, Brother or nun, a designated potential doctor, businessman, artist, musician. We were born in an age of heroes, minor and larger-than-life heroes. We assumed that no matter what role we played in nation-building it would be an important role.

Our mothers drilled into us the notion that we were special, that we would grow up to be leaders of the nascent democracy that was truly the Pearl of the Orient Sea.

Our role models were Rizal, Mabini, Bonifacio, Quezon, Magsaysay, Recto, Manglapus and Diokno. We would live our lives in the Philippines and breathe our last breaths there. We would go abroad just to hone our skills - skills that we could then apply to solving the problems in the Philippines - and not live permanently elsewhere, losing the nationality we were born with.

The movies that we saw were all violent - there were no boards yet that rated movies as PG, PG-13, R, etc. We saw all the violent movies of Errol Flynn, Humphrey Bogart, John Wayne. We saw the movie "All the Brothers were Valiant" and when we were in school we looked for fights. We also watched actors and actresses kiss in the mouth and as they un-clinched, we could see a string of saliva connecting the two mouths. That was the trademark of sexually suggested movies in those days - the string of saliva connecting two mouths.

There were four of us Lumbas in school all at once. The bravest among us was the youngest, Oscar, who was known on campus as "Bulldog." Oscar feared no one. The other guy could be a foot taller with a reach at least a foot longer, but Oscar would be unfazed. He was a bleeder - in the tradition of the boxer known as the Bayonne Bleeder. Every time Oscar got into a fight his nose bled.

One memorable fight he had was with the late Jaime Jose. The guy was just a regular La Sallite, decent-looking like everybody else on campus, and none of us had any idea that he would someday gain the ultimate notoriety of being sent to the electric chair - by Judge Lourdes San Diego for the rape and sexual mutilation of Maggie de la Riva, a beautiful actress in the 60s whose angelic face made her desirable to all Filipino men and pimpled teenagers.

One of my brothers, Amado, saw that Oscar was suffering a beating at the hands of Jaime Jose, so Amado wrapped his arms around Jaime Jose's arms and body and told Oscar to just keep punching. Oscar obliged and by the time he was done, Jaime Jose had tasted a horrible Lumba beating.

The oldest Lumba, Jose, was lean and easy to underestimate. So he got into a lot of fights. I never knew anyone with quicker fists than my brother and every time I saw him fight, the other kid got bloodied. And that brother of mine had a temper - he still does.

I was always big boned and, being a basketball player, I was muscular. Not too many wanted a part of me, and as a consequence I did not get into many fights. I did get into a lot of fights in my neighborhood in Santa Ana, Manila, however, and those were nasty.

Fighting at La Salle was part of growing up. We were all boys and we settled our differences as boys - with our fists. After we fought, we took our lumps, made up and acted like nothing had happened. We were all La Sallites, we were brothers who settled our differences bravely and without rancor. No one kept a grudge for longer than a week.

UNIFORMS. Our grade school uniform was a white short-sleeved shirt with one pocket on the left breast. On that pocket was sewed in a green "Religio-Mores-Cultura" insignia, the patch that identified a grade schooler at La Salle. Our pants were short khakis or long khakis. Most wore short khakis because it was hot in the Philippines and there was no air-conditioning in the classrooms. The short pants were cheaper; plus, we couldn't tear our short pants at the knees.

In high school, we wore grey military uniforms. La Salle High School was a quasi-military school and students were disciplined to the core. We respected our teachers - generally - and treated them like they were military officers.

One distinguishing trait of La Salle High School students was that we stood out in parties. We were well-behaved - generally - and gallant towards the girls. We were military officers and gentlemen. We were also dancers, as opposed to the standers - the Ateneans who preferred to stand in corners and philosophized, in Latin - among themselves while the La Sallites got to dance with all the girls.

In college, we wore white shirts and ties to school.

Everyone who went to college at La Salle had a younger brother or cousin in high school and/or grade school on the same campus. We all knew each other. We didn't know each other's names, but we saw each other on campus and we could recognize each other everywhere.

La Sallite was not just a brand, it was a way of life.

TEACHERS. Growing up in La Salle, nearly half of our teachers were Christian Brothers, all of them coming from the U.S. We grew up under the tutelage of Americans who taught us English, Religion, Math, Science and Sports - lots of sports.

In grade school we were not allowed to speak Tagalog; we had to use English. We were fined if we were caught speaking in Tagalog. The rationale was simple: we spoke Tagalog at home and everywhere, we had to speak English in school because the only way to learn a language is by using it.

The Christian Brothers education that we got at La Salle - in the minds of our parents - was one of the best that could be had in the Philippines at the time. The American Brothers had Masters amd PhD's in Education and were some of the best-qualified teachers that the Christian Brothers organization in California could send abroad.

My mother told me that when she was going to public schools in the early 20th century, they also had excellent teachers, some of them from the U.S. I never bothered to ask my mother if the American teachers she had were the Thomasites. We all know about the Thomasites from our history books, those American teachers who went to the Philippines to staff the public schools that were modeled after the public school system in the U.S.

The students of La Salle these days (now known as Lasallians, not La Sallites) are not growing up under the American Christian Brothers. They are not growing up under the Filipino Christian Brothers either because the Filipino Brothers rarely teach nowadays. They are busy with administrative concerns. There are 18 La Salle campuses now and a few years ago I was told there were not enough Brothers to staff all the schools.

The ideal set-up is three Brothers on each campus, so there is always a tie-breaker. A few of the campuses have less than three Brothers.

The Christian Gentleman. I may have given you the impression that La Sallites all came out of the cookie cutter. Of course there were many variations, many gradations of Christian Gentlemanliness.

Every time the Ateneo basketball teams played the La Salle teams on the La Salle campus on Taft Avenue in Manila, many Ateneans went home with shiners and bloodied noses. And every time La Salle visited Ateneo at Loyola Heights, La Sallites went home like they had been through a meat grinder.

It was a part of the culture, part of the fun. I personally did not join in the melees but I knew the kids who were regulars in those NCAA fights and I enjoyed vicariously all the stark details of those fights.

We had goons on campus, just like everywhere else in the Philippines. But we never strayed too far from the norm. Many of the campus goons became doctors, bank presidents and businessmen and are now some of the wealthiest Filipinos.

The La Sallite brand was, deservedly, elitist. For that reason alone, it was understandable that people would want to change it. This, however, should have been done through attrition, not by fiat.

La Sallites are unavoidably on their way to extinction. The De La Salle University campus in Manila is just a college campus now. Grade school is either La Salle-Zobel in Alabang or in any of the other campuses on the island of Luzon.

High School is primarily on the Green Hills campus and other campuses all over the islands.

Today's Lasallians grew up on different campuses and do not have the benefit of being classmates and schoolmates for fifteen to sixteen straight years on the same campus. And, since DLSU is now co-educational, the camaraderie is different. It's no longer a "boys will be boys" culture but rather a "Is she looking at me because she finds me attractive, or do I have food stuck on my cheek?"

Every time you throw girls in the mix, you change the culture. Girls are always welcome, of course, and very desirable. But you change the culture. The guys become more aware of their appearance because they are dressing up for their schoolmates now. We La Sallites could care less what we looked like, as long as we had a tie on when we were on campus.

Today's Lasallian is into appearance and being cool. The girls like being ogled at as they saunter past the Bench Boys who regularly sit on the benches lining up the walkways. Girl-watching is the rage, since many of Metro Manila's pretty lasses choose to go to La Salle.

La Salle is also trimestral now and a lot of students go through college in three years. It's like Lasallians are being mass-produced by a long factory line.

I visited the La Salle campus last year and the year before that and each time I saw a sea of faces. La Salle has so many college students now the campus looks like what FEU (Far Eastern University) looked like in the old days.

With so many students on campus, it's impossible to know everybody. Cliques are inevitable. Clique identities are far more important, with the Lasallian brand now a much watered down version of the old La Sallite.

Like most young people all over the world, Lasallians practically live on the Internet. It's where they learn, lecture, debate and sometimes fight. It is virtual fighting now, not the traditional mano a mano that La Sallites used to engage in.

And because it is all happening in cyberspace where people are in no danger of getting their noses bloodied, except figuratively, the protagonists can be very vicious or brave, depending on one's point of view. The Lasallian community is becoming divided, just as divided as the Philippine society at large.

Ideologies are hardening, just as they are hardening in the country and the world. The great philosopher, Plato, introduced the dialectical method of advancing knowledge, which is thesis, antithesis and synthesis. In between the first two steps - thesis and antithesis - there usually is conflict.

In Philippine society at large, and in Lasallian society as well, debates and discussions get stuck in the conflict stage. Rarely do national as well as private conversations progress to the synthesis stage: consensus or compromise.

I think that is why it is very difficult for the Philippines to make transformational changes. That is also why it is difficult for Lasallians to form a consensus on anything. National politicians simply stop talking meaningfully, they instead posture and play political games. Lasallians avoid talking about serious issues altogether.

We La Sallites did not grow up under a culture of permanent impasse and conflict. Many of us were born in the age of heroes and nationalists, people who could get things done.

We believe that it is possible to arrive at consensus and so we do not always avoid serious issues. We also get along well with each other because we settle our differences and move on. None of us carry grudges long term, with a few exceptions of course. Certainly not like some Lasallians who carry grudges that persist for decades.

My high school class (La Salle High School Class of 1959) held a Golden Jubilee reunion last year and it was a blast. It was like we were time travelers reliving our past.

For one brief moment, a fleeting moment it seemed though it lasted two weeks, we were all La Sallites. We seemingly had no idea we were going the way of the dinosaur.

A Hornet's Nest

Politicians in the U.S. stink. They posture and hide, posture and hide. They tell you and the whole world that they are for health care reform, but once hidden from the public eye, they do what's best for the industries that reportedly bankroll their political campaigns. The biggest contributors to political campaigns are health insurance companies and big pharmaceutical industries, so it is only natural that those industries would command the passionate loyalty of love-struck suitors.

So many of the Democratic and Republican legislators are in the pockets of the health care industry and the behavior of many legislators reflects this Mephistophelian influence.

Fed up over the impasse on health care, I decided to write an "I'm fed up" letter - a reverse psychology, a devil's advocate kind of letter - to the liberal-leaning Las Vegas Sun last Monday. The Sun published it on Wednesday and unleashed a torrent of befuddled, annoyed, defensive reactions from other readers. Even the Sun editorial writers chimed in - twice.

Here was my letter that elicited the cascade of other readers' reactions:

"... President Obama and the Democrats promised the country health care reform legislation during the 2006 and 2008 elections and the country responded by giving the Democrats overwhelming majorities in Congress, not to mention the Presidency itself.

"If the Democrats fail to reform health care this year, the resultant carnage in the 2010 elections will make the 1994 Democratic debacle look like a 4th of July picnic. Democrats and Independents are fed up with the Democratic legislators they elected in Congress.

"I am a dyed-in-the-wool Democrat - have been since JFK - yet I have become convinced that for the sake of the country the Republicans must control both Houses of Congress. Many of my friends also feel this way. (This is known as the take-away close: if you don't shape up, we will take away your Democratic majority in Congress, hold up our noses, and give it to the other side.)

"The reason is simple. The Republicans act as one, think as one. They proved during the George W Bush years that they could pass major legislation with narrow majorities in Congress. The Democrats, working with absolute majorities last year, could not pass health care reform. They passed a stimulus bill, true, but it was an anemic bill. They rescued the banks but did not insist on restraint on bonuses and a promise that the banks would start lending.

"Many of the Democratic legislators are compromised in that they take money from lobbyists for industries they are trying to regulate. The Republicans are also in the pocket of the same industries, but at least the Republicans are not being hypocritical. We know what we are getting when we elect Republicans. They're the devils we know."

The Sun published Las Vegan Bart Atwell's letter which read in part:

"Regarding Cesar Lumba's Wednesday letter to the editor...Republicans offered little but obstructionism, publicly stating that they were going to use the health care issue to undermine the president... It strikes me that the real solution is to increase the Senate's Democratic majority so that legislation doesn't require unanimous Democratic support to pass. Increasing the number of Republicans would only further stymie the legislative process."

The Las Vegas Sun editorial writers joined in the fray - twice - by claiming that the Republicans offer nothing but obstructionism. It's lead editorial "Blocking Progress - Republicans should quit slash-and-burn tactics, help push country forward" argues that "Republicans have mounted an incredible effort to try to derail the president, and in doing so, have further inflamed the nation's angst. Republicans have spread their dire prophecies of doom and gloom about health care, the economy and just about anything else the president has supported. They have consistently derided Obama's plans and refused to work with him - and then they blame him."

I checked out the Las Vegas Sun website and to my amazement, there was an ongoing debate raging in the "Letters" section featuring Democratic and Republican partisans' reactions to my letter.

I am a Democrat first and an American second. In the end, I will always vote for the Democratic candidates. But I wanted to stir up a hornet's nest, hoping that some good might come out of going public with my frustration over the failure - so far - of the Democratic majority in Congress to pass health care reform.

Because health care has not been reformed, the issue hangs over the head of Obama and he cannot give 110% to his efforts to create jobs. Because health care reform has not passed, the country calls into question whether Obama and Congress shall be able to come up with a jobs-creation bill that is pure job-creation and not a sausage made up of Republican and Democratic pork.

Because health care has not passed, other major legislations that will transform the country are now called into question. Will the country pass cap-and-trade, which will limit the volume of noxious and global-warming gases released by industry into the atmosphere? Will the country finally make the huge effort to convert to renewable sources of power - solar, wind, steam - creating jobs and rendering the Middle East sheiks irrelevant in our major foreign policy decisions?

Will the President be able to pass another stimulus bill that will provide a much needed push to the earlier stimulus bill that is currently stalled in the extremely complicated maze of government and private industry bureaucracies?

There is so much work to do to make sure the country - the world - does not slip into a double-dip recession and push the world economy into another Great Depression.

Will President Obama and the Democrats be able to pursue the agenda that got them elected in the first place?

My disappointment was not over the Republicans' obstructionism. Republicans have always been obstructionist in recent memory. But they are not to blame for the failure of health care reform last year.

The Democrats had a huge majority in both Houses of Congress in 2009. They still do, the only change being that in the Senate they have one vote short of a filibuster-proof majority. Last year, the Democrats could pass any legislation they wanted to pass because they had a super majority in the Senate and the House, but they failed to pass health care reform.

The Republicans did not succeed in obstructing health care reform. It was the Democrats themselves who torpedoed the legislation. Joe Lieberman, the Senator from Tel Aviv, held the legislation hostage by threatening to join the Republicans in their filibuster if the public option was not dropped from the Senate version of health care reform.

Sen Ben Nelson of Nebraska said he would not vote for health care reform if he did not get a huge concession for Nebraska. Harry Reid agreed to an exemption for Nebraska from picking up additional Medicaid costs arising out of the health reform package.

Senator Mary Landrieu, Senator Blanche Lincoln, Senator Evan Bayh all threatened to join the Republican filibuster if the bill was not watered down and emasculated. The bill that came out of the Senate was something that nobody wanted. The majority of Democratic senators felt no passion for the bill because it would not control costs. It does not include a public option - a mechanism for the government to compete with the Pac-Man health insurance companies and keep costs down.

Senator Max Baucus of Montana put the manacles on his fellow Democrats when he made haste slowly in the Finance committee to make sure that Obama's before-the-2009-Thanksgiving-recess deadline would not be met. Max Baucus - but of course - is one of the biggest recipients of political contributions from health insurance companies.

These are all Democrats, except for Joe Lieberman, who is an Independent but who caucuses regularly with Democrats. He would have shown his true colors earlier if he did not caucus with the Democrats, He was, after all, the Vice-Presidential running mate of Al Gore in the 2000 elections. Until he turned traitor, it was generally assumed that he was a Democratic Party statesman in the Senate.

In other words, it was not Republican obstructionism that stalled health care reform, but Democratic obstructionism.

We as a country elected President Obama and a huge Democratic majority in Congress because we wanted transformative changes. We demanded action - bold action. Instead what we got was a limp-wristed approach to governance where Democrats simply laid over and played dead.

They went to the airwaves and denounced Republican obstructionism - which was truly abominable. But Republicans were powerless to stop the Democratic train. Whatever the Democrats wanted they could have gotten, because there were not enough Republican votes to stop them.

What stopped President Obama and the Democratic initiatives in Congress were fellow Democrats.

I wrote that piece in the Las Vegas Sun because I wanted to let my fellow Democrats know that the time for blaming Republicans was long past. We Democrats must figure out a way to pass major legislation by bypassing, by pole-vaulting past Republican obstructionism. We must convince the country that we are capable of "change that we can believe in."

If our Democratic legislators cannot do this, it will be time to turn over Congress to the Republicans because the Republicans proved in the Clinton years and in the George W. Bush years that they know how to pass major legislation with narrow majorities in both Houses of Congress.