Stanley Feld M.D.,FACP,MACE

It seems as if it is very hard for the people’s voice to be heard in Texas. Contacting the Governor is harder than paying the water bill in Franz Kafka’s book “The Castle”. Even if we were listened to, we would not be heard by our governor. He still believes building the Dirty Coal Plants and polluting the state and cities in Texas is good for the growth of Texas even if the majority of the people disagree. Presently, Texas is in the top six for pollution. I bet these coal plants will propel us to “Number 1”. Governor Perry’s office called the opposition of the Dirty Coal Power Plants a liberal Democratic plot. I call it a refusal to understand the issue on the part of the governor.

The following quotes appeared in the Herald Democrat December 8, 2006

“Dozens of David’s lined up here (Bonham,Texas) Thursday (December 7,2006) to see if State Administrative Law Judge Kerry Sullivan would give them a rock to use in the battle against Goliath TXU.”

“Ranchers and those who have built wetlands and wildlife sanctuaries fear devastation of their land, ponds and trees from acid rain caused by sulfur dioxide (emission from the Dirty Coal Plant proposed in Savoy Texas.)”

In addition to sulfur, people in Fannin and Grayson County are going to be exposed to 72,480,000,000 billion micrograms of Mercury a year (160 lbs). All of this Mercury is additive each year. Mercury affects fetal and infant brain development with resultant increase in Autism, attention deficit syndrome and loss of memory in adults. Maybe the increase in Alzheimer’s disease is secondary to the increase in pollution in the country.

“TXU said the plant will emit 3,787 tons(7,574,000 lbs.) of sulfur dioxide each year, less than current coal-fired plants and within the U.S. Environmental Protection Agency’s limits.”

The lowering of these toxic levels of Sulfur and the resulting conversion to sulfuric acid when reacting to the air have be stalled by the Bush Administration. The administration does not believe in the existence of acid rain or the global warming resulting from excess production of carbon dioxide. This belief is held in spite of the abundance evidence for it effect. Nitrogen effluent will produce 1894 tons per year (3,788,000 lbs.) resulting in increased production of ozone. The particulate matter from the Savoy Texas Dirty Coal Plants will be 1515 tons( 3,030,000 lbs) per year. How many of us think this is healthy for the kids of North Central Texans in general and Grayson and Fannin County residents in particular.

However we, the people of Texas, will be stuck with the high levels for the next 50 years long after this administration is gone. I thought people were wrong when they said these groups of government officials were not compassionate. They are not compassionate and they do not listen to the will of the people.

“When the judge found there were more than 40 people who live within 10 miles of the plant at the hearing asking for status as individuals, he said, “I am required by law to hold this hearing in a way to have an organized process for the development of the evidence that will focus on issues and that can be cross examined effectively. And there is simply no way we can have this many active participants prepare for this hearing and then formally participate in it.”

“With all due respect to everyone, you are working within the parameters you have to work in,” Feld said. “I can see that clearly. What has happened is there is something wrong with the system of parameters when local people didn’t know anything about it (the proposed coal plants) and haven’t been able to express their opinion. With the rules that have been set up, Texas Electric (the former name of part of TXU) has said ‘OK, let’s batch everyone together and make it quicker.’”

This was a very good move on TXU’s part. TXU would love to shut as many people up as they can. What is magical about 10 miles? What is so wrong with educating your neighbor about the risk we will permit in our neighborhood? Presently we get 70% of our electricity from Dirty Coal burning plants and right now we are the most polluted in the country with mercury.

Large area lakes in East Texas are already shut down already to fishing because of contamination with Mercury. We do not want Lake Texoma to be contaminated. TXU’s response is “Who said the contamination came from the Mercury produced by the Coal Plant.” Where does the Mercury come from?

“Sullivan reversed strategy and reconvened the hearing. He let all those interested in joining as individuals plead their cases.”

Maybe someone will get the point that the people want to be heard and we want the coal plant project stopped! Governor Perry seems not to be able to visualize that if we live in a polluted state no one will want to live here. TXU will not have a problem because they will sell the excess electricity on the national grid.

We the residents of Texas will suffer and the government will say it made a mistake. We have heard that before, haven’t we?

Stanley Feld M.D.,FACP,MACE

Thank you, Brad Feld for encouraging me to start this blog a year ago. I had no idea RSS was so powerful.

While at Columbia College C’59, we were required to take a course called Contemporary Civilizations. A big take home point was that we as citizens have an obligation to contemporary society and future generations.

We have an obligation to our health and the health of future generations. This is the reason it is so important everyone of us step up and protest TXU’s 18 Proposed Dirty Coal Plants for us presently, our children, and our children’s children.

About a week ago, Harry Jaeger, editor of Gas Turbine World, posted a comment on my blog.

Two days ago, I heard the TXU representative present to the People and the City Council of Savoy, Texas (ground zero for the Dirty Coal Plant) the same, as well as additional half truths, about how clean the Proposed Plant will be. He reported on how experimental and impractical IGCC plants are. I researched the half truths recited at the Bells City Council meeting and reported only on the Mercury issue at 160 lbs per year in a previous posting.

I wrote to Harry Jaeger asking about TXU’s assertions about gasification plants. Harry Jaeger’s answer is specific and is published below.

Harry Jaeger’s comment should help the Texas Cities Coalition for Clean Air get standing at the permit hearings on Thursday December 14. Twenty eight cities throughout Texas have banned together to slow the process down and get clean air for all Texans. They have been denied standing in the hearing to this point on a questionable technicality brought up by TXU.

His comments might help some of the city and county officials near ground zero understand the issue of IGCC plants a little better. Hopefully it will encourage them join the Coalition to get a seat at the table to protect their citizens health and healthcare cost. They also have an obligation to protect our recreation areas and Lake Texoma.

Dallas Business leaders just formed their own coalition against the permit process and the Dirty Coal Plants.

The Dallas Morning News asked for a moratorium on the permit process yesterday.

All that is required is Governor Rick Perry call off the fast track. He should learn about the issue of Dirty Coal Plants and their implications to the health of Texans. He should see how it contradicts his promise to the people of Texas.

I know he would be opposed to these Dirty Coal Plants and their threat to the health of Texans’ if he really understood the implications to health and the cost to the healthcare system.

Harry Jaegers comment is published in the preceeding post. “What is IGCC? Are They Practical?” Thank you Harry!

Comment:

Dr. Feld,

TXU is using the same arguments against considering the cleaner IGCC technology that have been used by all utilities who are hell-bent on getting their conventional coal plants built before they have to face up to tightening air quality regulations that may include limits on CO2 emissions.

The main claims are that IGCC is not reliable and that it costs much more than coventional coal.

We find that the boiler manufacturers, who are enjoying a heyday these days, are providing a lot of the fodder that feeds such arguments. This is quite understandable, as IGCC would cut into their market just when the world is turning back to coal, and large coal-fired steam power plants to meet the growing need for energy.

Regarding the reliability issue, I find it a travesty that those who reject IGCC as unproven and unreliable still refuse to look beyond the US borders for their data. There are several commercial IGCC projects operating in Europe that are exhibiting plant availability levels well above the US national average for conventional coal plants.

Granted, some of these plants are using refinery wastes, such as asphalt, but the difference between using coal and these feedstocks is not that significant from a reliability standpoint. After all, proponents of PC plants will tell you that coal preparation systems are very reliable.

Also, if one looks into the data, including that from the US plants, one will see that most of the past problems with IGCC plants were due to the turbine equipment and not with the gasification system.

Both US plants (Tampa and Wabash) used early versions of the same model gas turbine that had many reliabiiity issues all over the world – not just in the two IGCC plants.

In Europe, an IGCC plant in Spain used another advanced-design gas turbine that also was the cause of most of the plant outage time.

Meanwhile, there are three or four plants in Italy, and one in the Netherlands, that used a more proven gas turbine design and were able to reach very acceptable availability levels within two or three years of operation.

A new IGCC plant in Japan has apparently gotten over its initial “teething problems” in only one year, and is operating quite satisfactorily.

With this experience behind them, there are European and Japanese suppliers, as well as ones in the US, who would supply an IGCC plant, and who would apply lessons learned from these earlier plants to make new ones even better.

In addition, the construction schedule for an IGCC plant should not be any longer than that for a modern PC plant. So it is not clear that IGCC technolgy would have a problem with meeting the real rate of load growth being experienced on the TXU system.

If an IGCC plant can enjoy the same “fast track” permiting process as being allowed for the proposed PC plants, there is no reason why the first plant couldn’t be online in 2011.

As for the other principal argument used against IGCC, that is, its higher cost, the issue today is that costs of large construction projects are escalating so steeply that it seems to be anyone’s guess what these plants will really cost. In other words, if someone claims that IGCC will cost, say, 20% more than PC plants, that is well within the uncertainty seen in current construction estimating.

Besides, we have been seeing some estimates for new PC plants coming in higher than most IGCC plant cost estimates, and they continue to climb.

In this regards, there was a study completed recently by the Electric Power Research Institute (EPRI) that was sponsored by CPS of San Antonio. That study did find IGCC plants to result in higher cost of electricity, but when one looks into its details, we found some questionable underlying design assumptions, as specified by CPS, that were the cause of most of the cost difference.

If EPRI were to do the same study over again, restating these assumptions to put IGCC on a more level playing field, we think that the results would be quite different.

Unfortunately, in the case of TXU, there was no parallel plant cost study performed in order to obtain a fair comparison of the two technologies. In the case of CPS, the study was done post facto, so quite naturally it could be expected to support the decision that was already made to go with conventional coal burning technology.

I’d fear that any similar study done by TXU, perhaps as might be ordered by the courts now looking into their plans for a new fleet of PC plants, would suffer from the same problem.

Apparently there is a third problem with IGCC that is raised by TXU, that being the claim that there are no suppliers who would guarantee an IGCC plant using low rank coals.

I’ve attended several conferences where the gasifier suppliers all say that they have the ability to use such coals in their gasification process – perhaps at some loss of efficiency and economy – as is the case of a PC plant as well. Granted that the case for IGCC is hurt somewhat with the use of poorer coals, but it is not so much for technical reasons as for economic ones.

TXU should be reminded that the demonstration plant that operated for a number of years during the late ’80s and early ’90s at the Dow Chemical facility in Plaqumemine LA operated on a wide range of coals, and mostly on sub-bituminous. The same gasification process is now operating commercially at the Wabash plant in Indiana and is being offered by ConocoPhillips (Houston) who purchased the technology a few years ago.

At the Wabash plant, the gasifier is co-firing coal with petroleum coke, which enhances the performance of the process and greatly improves the economics.

I hope that this information is helpful to you and to those who are urging the use of IGCC instead of perpetuating the use of PC technology which, as you have shown, promises to leave a long legacy of much higher impact on the air quality of central Texas, and on the health of your citizens.

Harry Jaeger
Gasification Editor
Gas Turbine World Magazine

Stanley Feld M.D.,FACP,MACE

It has been an interesting week for me. The week has been an exercise of an understanding of the legal process in American democracy. It has demonstrated, in my opinion, a flawed process of issuing permits for Dirty Coal Burning Power Plants in Texas. The result is the state government does not seem to protect the interests of the people who elected them. State officials are supposed to be representatives of the people. In this case they are not representing us well. We were unaware of the dangers of the proposed power plants to our health. As individuals the process makes it difficult to defend ourselves and easy for TXU to defeat the people of Texas. I feel like we are the stooges for their profit producing Dirty Coal Burning Plants.

I have also discovered that it starts at the top. Therefore one should never believe any of the campaign promises of any candidate. Governor Rick Perry promised us one thing and then fast tracked another. It seems to me he has no regard for the health of our North Central Texas community. He seems to have a high regard for the vested interest of TXU because “we need energy for Texas to grow”. We are not going to grow if we are the most polluted state in the country. It is possible that he does not understand the issues. However 15,000 of us have sent him letters about the danger to the citizens of our state. He has not responded. Probably the system did not get our pleas to him because he is a busy man. If he cares for the state as he says on his web site he would do what he promises to do. He should intervene immediately and stop the TXU fast track (railroading) Dirty Coal Burning Plants throughout the State of Texas.

On December 5 the Bells City Council joined the Coalition of Texas Cities to protest and stop the proposed Coal Power Plant 4 miles from Bells in Savoy Texas. TXU slipped its application on the proposed plant past most of the cities adjacent to the Coal Burning Power Plant without the proper information. Cites within 100 miles will be adversely affected. When you put all 11 plants together the state will be covered with soot and polluted with everything that is bad for ones health.

Somehow, the flawed hearing process is preventing a Coalition of 25 Texas Cities (with more coming on board daily) from having standing in the permit proceeding. The elected officials in these cities represent the people of these cities. They are acting responsibly as surrogates for the will of the people in their cities. Is it democratic to restrict the will of the people from being expressed? My answer is, it is wrong! What is yours?

This week I heard TXU’s public policy director argue the case for the coal plants at the Bells City council meeting. TXU’s published argument is lame. The presentation is worse. It is filled with sound bites that are half truths. The argument is crafted to have people think it is good for the growth of the area. In fact, it is bad for the growth of the area. Who wants to live in a polluted city?

The Savoy Valley Dirty Coal Plant is going to produce 160 pounds of Mercury per year. What does that mean? Let us do a little arithmetic. 2.2 lbs of anything is equal to 1000 grams. One ounce of anything is 30 cm3. It takes two ounces of mercury to contaminate a 20 acre lake. Each ounce of water weighs 30 grams. The density of water is 1 gram per cm3. The density of Mercury is 13.54 gram per cm3.

160 lbs of Mercury per year is equal to 72,727 grams. One ounce is 30 cm 3. Each cm3 of Mercury weighs 13.54 grams. Therefore, there are 405.2 grams of Mercury in one ounce of Mercury. One ounce of Mercury contaminates 10 acres of water. Therefore one years worth of Mercury from the Dirty Coal Power Plant contaminate the fish in 1,795.29 acres of lakes in North Central Texas. Mercury does not disappear so each year of Mercury contamination is additive.

The TXU representative Mr. Ross told us this is a clean plant because it has decreased the Mercury emission 80% from 800 lbs per year in older plants to 160 lbs per year. The 80% figure reduction is correct. However the Dirty Coal Power Plant is contaminating 1795.29 acres of our fish and soil each and every year. The TXU representative said we are trading in your 1974 truck for a 2006 truck. I told to him the 2006 truck is still a lousy truck.

Mercury does bad things to people as well as fish and plants. It has been found that the incidence of autism was 61% higher in contaminated environments as opposed to uncontaminated environments. School in the contaminated environment had a 43% higher need for special education classes. The result was a higher cost to the community. We know that Mercury inhibits brain growth. May be the increasing incidence of attention deficit syndrome in America is due to the increasing exposure to Mercury in contaminated areas. Maybe as people get older and are exposed to high mercury levels they lose brain tissue faster than people living in clean non polluted environments.

Dallas has been out of EPA attainment for 10 years. EPA compliance levels are too high according to the EPA literature and must be lowered. Yet our federal government has not lowered the levels to levels that will protect us. Dallas can not figure out how to lower the levels. After the new Dirty Coal Power Plant goes on line Dallas will never get into the artificially elevated attainment level. Some one is going to have to be responsible. Governor Perry has not responded the request for action from more than 15,000 letters voters have sent him throughout the state. .

How come? How come the same thing is going on all over the country? We are exposed to toxic compounds and get sick. Healthcare cost increase by 34 billion dollars. Insurance premiums are increased. The result is more people are uninsured. The $34 billion can be saved by our elected officials exercising a little civic responsibility.

TXU knows how to work the legal system to their advantage. They have spun the story to their advantage. We in Bells Texas are just ordinary folk who have little experience working the system. We have few funds to pay for expensive lawyers to defeat TXU. Our state and several local governments have not stepped up to help us out. Our Federal representatives have not stepped forward to help us and to date have supported the TXU application because of TXU’s promise of jobs and growth to the area. Who in the world wants to live in a polluted area where their kids could get asthma and autism?

Organic food farms, cattle farms and fish farms are going to be ruined in the North Texas area with this Dirty Coal Plants. It looks like our elected officials know what is right but do what is wrong for the people who elected them.

I believe part of the reason is because they are so “busy” in committee meetings that they make decisions on sound bites also and do not study the facts. We have to demand they study the facts. If they do not we have to kick them out of office. The ordinary citizen’s health is also going to be ruined. Some families in Bells have owned their farms for 150 years.

Below is the difference in emission between a Clean Coal Power Plant and a Dirty Coal Power Plant. TXU said at the Bells meeting there is no one applying for clean IGCC gasification power plants in Texas. I think that could be true. They also said they are too experimental. However I discovered there are 117 gasification plants in the world and 10 real North American Gasification Units. Three of the ten are in Texas. One of the three has been in operation since 1977. Please study the emission comparison from the chart below. The real issue is not the experimental nature of the plants. The issue is building the cheapest plant you can build to generate the most profit if you can get away with it because the people in the area are not paying attention. Where is TXU’s corporate civic responsibility?

Hooray for the Bells City Council and their standing up to TXU!
Sherman, Denison and Bonham have not seen fit to do the same yet. Few leaders in those cities have studied the issues deeply. I know their citizens will moan and groan after the plant is completed. We will all suffer the effects of the plant. These cities have to act now. We need to hold our elected officials responsible for there inaction.

Stanley Feld M.D.,FACP,MACE

Dirty Coal Power Plants are bad for the health of the nation. A major electric company (TXU) and our state government are fast tracking permits to construct 11 such power plants past unsuspecting citizens without regard for the health consequences. The issue of health care costs is a big issue. The healthcare costs are out of control. The incidence of illness is also increasing.

Governor Rick Perry of Texas has made his position clear on his web site. In his healthcare platform he “strives to make healthcare an efficient expenditure of taxpayer dollars, by focusing on health education and disease prevention.” This is an empty promise when he has encouraged the development of Dirty Coal Power Plants all over Texas. These plants will affect the health of all Texans’. The Clean Air Act proposed by Jefford’s will avoid 300 deaths per year in Dallas and 1176 deaths per year in Texas by 2020.

I have choosen a few paragraphs from Rick Perry’s current web site. It is clear he promises us one thing and does the opposite. The take home point is Governor Rick Perry knows what is right and tells us he is going to do the right thing for us. He then does just the opposite. He has it in his power to immediately stop these Dirty Coal Burning Plants that he opposes online.

Below are some of his pronouncements to the citizens of Texas.

Health Care

Governor Perry signed legislation providing expedited permitting and financial incentives to attract the U.S. Department of Energy’s (futureGen) zero-emission coal power plant. In addition to generating clean power, the futureGen project is expected to create over 11,000 jobs, and result in over $1.2 billion in total economic benefit if Texas is chosen.

How about that? In light of the eleven proposed TXU power plants this represents quite a contradiction doesn’t it? These plants will make us sicker, cost the state and federal government more medical care dollars and do nothing to clean up our air.
Today I received the following comment for yesterdays post “Our Sound Bite Society”:

You hit the nail on the head here, Stan. Well done.

Richard

Richard

I am optimistic. I believe we the people are going to have to take charge and change the system with the very technology that is solving other problems. The moochers are anachronisms in the new society.

Look at what Compact Disks did to Vinyl Records and Steve Jobs did to the CD industry. Innovation has the power to turn legacy system on its ear. Politicians and Lobbyist are going to have to watch out. Someone is going to come along and leave them in the dust. It is going to take a prepared mind with innovative spirit. The people will be there to cheer them on.

Stanley Feld M.D.,FACP,MACE

We have highly developed short attention span. I believe it is a result of our sound bite society. Our information is fed to us in sound bites and grabbers. Little information is in depth. On the five minute “News Summary” all the news is bad news sound bites. It is time we shake this somnolence and act on the facts and not on the sound bites!!

“There is perhaps no greater State of Denial in modern life than sticking a plug into an electric outlet. No thinking person can eat a hamburger without knowing it was once a cow, or drink water from the tap without recognizing, at least dimly, that its journey began in some distant reservoir. Electricity is different. Fully sanitized of any hint of its origins, it pours out of the socket almost like magic.”

Where does electricity come from? It turns out 50% of the electricity in America is produced from burning coal.

Coal is a dirty fuel emitting carbon dioxide, nitrogen oxides and sulfur dioxide along with Particulate Matter and Mercury. The combinations of substances cause chronic diseases and the complications of these diseases. Coal is an abundant energy resource in America. Today, we have the technology to clean up the coal emissions and make it a safe source of energy for electricity generation. However, electric companies are doing their best to avoid the use of this new technology and use old cheaper technology in their new Coal Power Plants.

Why is this important to Repairing the Healthcare System? If our government did not permit industry to pollute our environment, there would be fewer people with chronic diseases and the complications of the chronic diseases generated by coal burning power plants throughout the country.

President Bush’s Clean Air Act for coal is the least stringent of the bills on the table. The estimate is his modest restrictions will cost the healthcare system $34 billion a year and save the power plant companies 4.7 billion dollars.

The $34 billion dollars per year is a recurring cost. It is a waste of money on diseases that are totally preventable by newer coal plant technology. The new technology reduces coal emissions 90%.

With new technology we could prevent at least 21,850 hospital admissions per year nationally. There were 26,000 Emergency room visits for asthma alone last year. Asthma is the No. 1 cause of kids ending up in the Emergency Room. Dirty Coal Burning Power Plants cause 554,000 asthmatic attacks, 16,200 attacks of chronic bronchitis, 38,200 heart attacks and 23,600 deaths per year. One can only guess at the staggering increases the 11 proposed plants will have in Texas.

I have emphasized that preventing chronic disease and its complications is the key to reducing our healthcare costs. Eighty percent of our healthcare dollar is spent on the complications of chronic disease. Ninety percent of the Medicare dollars are spent on the complication of chronic disease. The emissions from Dirty Coal Power Plants cause chronic disease and the complications of chronic disease. The diseases can be prevented by decreasing emissions with the new technology available.

Texas Governor Rich Perry acted irresponsibly when he issued an executive order to fast track new power generation plants that use “Texas Natural Resources” for “energy diversity”.

Rather than protecting the people from environmental pollution, he has acted to expose as many of us as he can to pollution. The Governor and state legislature could finally start helping us utilize solar power and wind power. We have plenty of these “natural resources” in Texas. These clean, renewable natural resources will not hurt anyone.

At the same time, TXU “our electric company” applied for permits for 11 new, giant, “dirty” coal plants in Texas. Where is the coal coming from? It is coming from Wyoming via very long noisy freight trains riding through our beautiful North Texas countryside.

One of the coal plants proposed is on the border of Fannin and Grayson County in North Central Texas. One Dirty Coal Burning Plant is within 10 miles of my farm in Bells, Texas. The proposed plant is within one and one half miles from the new public elementary school, middle school and high school in Bells, Texas. The forty story smokestack will be belching soot, mercury, sulfur dioxide and nitrogen oxides and ozone at children all day long contributing to the early onset of chronic lung illness in these children. These compounds do not stay in the local area. They spread for miles. Dallas, Texas presently has a large air quality problem. This proposed plant will add to Dallas’ air quality problem.

TXU defense has been lame at best and arrogant at worst. They say they are going to reduce emissions by 20% over present operating coal power plant emissions. The pollutants can be reduced by 90% with new technology. TXU says the pollution is exaggerated. Carbon dioxide is not a regulated pollutant. The Federal Environment Protection Agency (EPA) disputes this statement with many good scientific studies. TXU also says it is good for the local economy. However it is obvious that a polluted environment will drive people away from the area and drag down the local economy. We need to immediately stop tolerating sound bites.

The people who should be worked up by the proposal are the local people but they seem to be believing TXU’s sound bites. Laura Miller, the Mayor of Dallas, and the Mayor of Houston are forming a coalition to fight TXU’s application. I hope it works. I hope Governor Rick Perry wakes up and stops his irresponsible action.

Everyone throughout the United States should be on alert. The use of Dirty Coal Power Plants represents 50 year blight on the health of our nation.

What do these pollutants do to our health?

Sulfur Dioxide: Sulfur Dioxide is formed when coal on burning releases sulfur that reacts in air to form sulfuric acid. Sulfuric acid causes wheezing, coughing, nasal congestion, and cardiac irregularities. It also causes low birth weight and increases the risk of sudden infant death syndrome (SIDS). The most vulnerable people are children and adults with asthma or other respiratory diseases.

Dioxins: Dioxin is an endocrine disruptor that can cause hypogonadism in both males and females. It is also a precancerous irritant.

You do not need further explanation to realize our public health is at stake. Corporations have to be required to exercise reasonable social responsibility. Government has a responsibility to set the rules. When something is obvious the government must act for the good of the people and not the good of industry.

This is a case for Erin Brockovitch. Whoever is going to issue the permit should be notified of their liability before all these people get sick, and not after they get sick. The officials’ should also be liable for the 34 billion dollars the result of the pollution is going to cost the healthcare system. Maybe this will get TXU to think twice before completing their application process?

The devil is in the details. Let us start thinking about the details and not fall for the sound bites of irresponsible corporations and sound bites of our irresponsible elected officials.

Stanley Feld M.D.,FACP,MACE

We have experienced an increased number of uninsured patients for the past 16 years as insurance premiums have escalated and employers have been reducing and eliminating medical insurance benefits as part of the employment package. In 1990, 34.4 million Americans were uninsured. At that time, 85% of the uninsured patients were members of a family with a working adult.

Today, that number is 46.6 million, according to a new Census Bureau report. This represents 15.9% of our population up from 15.6% of our population in 2004 representing an increase of 1.3 million in the last 2 years. The number of workers with no health insurance rose from 26.5 million to 27.3 million. Nearly all the increase in uninsured was among working adults.

Do you think we need a creative innovative solution to ensure that all Americans have affordable and comprehensive health insurance coverage? You bet!

Congress has so far failed to reach a consensus on how to even approach the problem.
Our difficulty is we have an elected Congress that professes to support the publics’ vested interest but in reality is swayed by vested interests’ political contributions. This is the reason they are in a State of Denial about everything including medical care of our population. America does great when the crisis is overwhelming. When the crisis subsides we resort to our highly developed short attention span and ignore our problems. We leave ourselves vulnerable to be taken advantage of by stakeholders who are protecting their vested interests.

What should we be focusing on?

1. As the price of insurance has increased and out of pocket payment for the employed has increased, the price of coverage has exceeded the price the employers can afford.

2. People working and not covered by employer provided health insurance have to pay for health care premiums with after tax dollar, while their employers pay for employee health insurance with pre tax dollars.

3. Evolving tax laws and employee benefit laws are causing employers to act in ways that cause the employer to provide fewer benefits to the employee. The biggest impact is felt by moderate to low income families. They are priced out of the market. If they get sick, they figure they can get medical care paid for by their community. The result is an increase in economic pressure on the individual and the community.

In light of this the facilitator stakeholders try to protect their envisioned vested interests at the expense of the patients and society. Policy makers have proposed to force everyone to buy insurance. The goal is to force the employer to buy insurance for the employee, or force the uninsured to buy insurance or go on Medicaid. The State of Massachusetts just passed a law mandating insurance and guarantying insurance for all.

It seems to me all of these proposals ignore real reason people do not buy insurance on their own in the first place.

They cannot buy reasonably priced insurance on a before tax basis. The patient is disadvantaged by an expensive and defective third party payer insurance system that does not permit them to control their healthcare dollar.

A Medical Saving Account system in a Price Transparent environment cures all these defects. Real insurance would be sold to individuals using after tax dollars in a freely competitive environment. The competitive environment would not be price manipulated by the insurance industry as the Medicare Part D benefit is. People would have an economic motivation to purchase insurance and keep themselves healthy. If someone had a chronic illness and if they avoided the complications of disease they could be rewarded economically.

Families on Medicaid could be motivated in the same way with the government providing the same or similar subsidies. The cost of care to State governments would be less than it is today. However, we would be empowering to the Medicaid family to make independent decisions rather than demoralizing these families in the present system of care rationing.

Americans yearn to be free and make free choices. We are not a dumb people even though our education system is crumbling. We need enlightened leadership not imprisoned by our hierarchical bureaucracy. I believe it is going to be up to the population of 40-50 year olds to step forward and say “we are sick and tired of this and we do not want to take it anymore.”

Stanley Feld M.D.,FACP,MACE

I have just finished Bob Woodward’s new book “State of Denial” and feel devastated. State of Denial of describes the facts and information denied by our government about Iraq. I am convinced neither the people running the executive branch or legislative branches of our government are stupid. The dumb part is how information is gathered, reported, scrubbed and then presented to leaders to make decisions. The problem seems to me to be independent free standing information systems that do not communicate with each other. Additionally, everyone presenting the information wants to look good or hide for their mistakes. The longer the mistakes are covered the worse situation gets. The mistakes are the result of the hierarchical structure of a bureaucratic government. Clearly the government needs to be tightly networked.

Bob Woodward has had the ability to survive the Washington bubble for some 40 years without being destroyed by the political machinery. I believe his book may have helped the Democrats win both houses of Congress last week. It may help change the course of the war in Iraq as well as the geopolitics in the Middle East forever. He accomplished his goal, to unseat the Republicans. However, he did not fix anything that is wrong with our government’s decision making process, the defense department, nor the relationship of the administration to congress.

We continually hear criticism of what is wrong. Somehow it seems the government hardly ever does it is right. However, I believe that the intention of all branches of government is to do what is right. The government’s problem is similar to the problem many industries in our country have.

The automotive industry is in almost in a melt down. Why can’t GM or Ford build a better car than Toyota or Honda? I do not think it is because GM and Ford spend $1500 a car for healthcare. I think the smart people running GM and Ford are ossified by the same bureaucratic structure that has ossified our military, intelligence organizations, our energy department, social security administration, the medical care administration, and department of education. The structure of organizations has evolved to inhibit innovation and marginalize creativity.

Michael Mandelbaum, the author of “The Case for Goliath.’ remarked “We’re not just in a ‘state of denial’ about Iraq,” We’re also in a state of denial about the budget deficit, health care, energy and Social Security.”

Thomas Friedman wrote in his column of November 4 “If I had one wish” that he hoped each house of congress was won by the Democrats by one vote. Then the Republicans and Democrats would have to work together in order to get anything done.

The administration is not the only one in a state of denial. Both the House and Senate are in a state of denial. They are all impotent to do anything constructive about the war, the budget, health care, energy and Social Security. It seems pretty to me that if the government really wanted to do something for the people (you and me) it takes more than begging for our vote the last week before elections. They should do sensible, logical and innovative things to fix our problems without protecting the vested interests of those who can afford the best lobbyists. It looks like a football game to me. If one lobbyist is better than the next, the better lobbyist will win. The government ends up doing the wrong thing rather than the right thing for the majority of the people.

Thomas Friedman also said, “The reason that Mr. Bush’s call a year ago to end our oil addiction has been a total flop has to do with a struggle in his administration between foolish market worshipers led by Dick Cheney—who insist markets will take care of everything—and wiser, nuanced policy makers who understand that government’s job is to set broad goals and standards, and then let the market reach them.”

We, the people, are also in a state of denial. About twenty years ago, I had a patient to whom I complained about the state of the world. He had done consultation work for many Presidents. He said to me that we get what we deserve. We have been programmed to have a short attention span, and have been manipulated by the media. The details of our problems and real issues are not compelling enough to command our attention.

I have also recently been impressed by the book Fooled by Randomness. We are information junkies that buy not the best information but the smoothest sounding information. The best Public Relations firms craft the messages that win in our society. We should demand accurate information from our government.

With medical care we should demand free choice to buy the best insurance product on a level playing field under government set broad goals and standards. Then let the consumer driven marketplace decide the winner. We would be surprised how powerful this would be.

Nancy Pelosi’s call for government negotiation of drug prices is another complicated mistake. We need to understand the cost of production of drugs, eliminated waste in the drug companies and let the drug companies compete for our business. Price controls never work.

I spent a lot of time on the DRG fiasco. The final rules have just been published by the government. The point is the hospitals won. The physicians lost. There is no movement to fix the DRG system. Hospital payment was neutral. Physician reimbursement was decreased by 6%. There are no incentives to decrease the complications of chronic diseases. Remember, the complications of chronic disease cost the government 90% of the healthcare dollar. The beneficiary of that money is the hospitals. Guess who has the best lobbyists. Who is in a State of Denial? The government!

Remember the real role of government is to set broad goals and standards for the patient, and let the market reach them. Saying it another way is to set the rules for true price transparency and give patients an opportunity to buy real insurance in the form of the ideal Medical Savings Account. With the incentive to shop for savings and quality, the consumer will force reduced profits. Then we can see if the market place will determine the winner. From past experiences it will work.