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Friday, September 25, 2009


JC Leahy

If you want a little getaway from the city without having to cross the Maryland Bay Bridge or drive all the way to Pennsylvania, you might want to consider the St. Mary's County Fair this weekend. Sunday looks like the best driving day, with rain clearing early. St. Mary's County is Amish country, so watch out for horse-drawn buggies as you drive the rural roads, especially Route 5. A county fair in a rural setting with Amish presence AND a farming community AND a commercial fishing community should be very interesting. For example where else could you witness a major oyster shucking contest!! :)

Besides the fair, there are lots of other things to see in St. Mary's County. You might want to start with the county tourist information center, which is not far from the fairgrounds, located at 37575 Charlotte Hall School Road, Charlotte Hall, MD 20622. From there you can find details on other interesting things like Historic St. Mary's City (first capitol of Maryland), Patuxent River Naval Air Museum, Sotterley Plantation, Smith Island cruises, restaruants, fishing opportunities, and on and on. You could easily make a drive to St. Mary's County an enjoyable weekend getaway with lots to do and places to relax.

For information about the St. Mary's County Fair, see this link:

Tuesday, September 15, 2009


JC Leahy, Accountant on the Scene, Washington, DC

Based on on-the-scene evaluatioin lasting until 1:30 pm on 9/12, the Journal of American Ideas Today originally estimated a 9/12 March on Washington total attendance of a million to 1.2 million. This compared with other estimates ranging as high as 2 million. However, our best current information is that Pennsylvania Avenue is 180 feet wide including sidewalks. We know from having walked the entire walk that folks were not marching on the sidewalks. Allowing for 40 feet of sidewalks, the march's pathway would be 140 feet wide. If Pennsylvania Avenue is only 140 feet wide, then 70 marchers passing over an imaginary intersecting line at any given moment might be too high a figure because that would be one person every 2 feet. We therefore reduce the figure of 70 to 50 marchers passing at any given moment at a speed of approximately 2 miles per hour. It would take only a second for each set of 50 to pass over the imaginary line, making the rate of passage 3,000 per minute. This rate happens to agree with the rate estimated by a videographer whom JC Leahy interviewed at the scene. We know from actual observation that the march ended at 1pm but that the density of marchers was much less by that time. Our best on-the-scene information is that the march went at "full volume" for 2.5 to 3 hours and tapered off after that. If we say, 2.5 hours at full volume at 1.5 hours tapering off to zero at a linear rate, at a "full" rate of 3,000 per minute or 180,000 per hour, that give us: 180,000 x 2.5 plus 90,000 x 1.5 = 585,000 marchers arriving via Pennsylvania Avenue. Some marchers arrived by other routes. If we allow 10%, or 58,500, from other routes, this gives us 643,500 attendees. Round it to 640,000 -- that is the Journal of American Ideas Today's revised attendance estimate for the 9/12 March on Washington. I would add that there is a zero percent chance that fewer than 100,000 attended, as reported my many in newspapers and broadcast.

Monday, September 14, 2009


"I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretence of taking care of them." Thomas Jefferson

Submitted by James Louloudes, Silver Spring, MD

Sunday, September 13, 2009


by JC Leahy, Washington, DC

If you want an exciting day-trip with friends, white water rafting is definitely something to consider. From the Washington-Baltimore area, it makes an easy day trip. I tried white water rafting for the first time recently and it was breathtaking!

(Nurses, with yellow helmets, left to right in above photo: JC Leahy, Janice Zarrabi, Carole Daley, Peggy Cannon, and Nell)

Unless you're really experienced, your best bet is to sign on with any number of guide companies. Some of these are better than others. For example, my daughter and her husband have rafted with several guide companies. One of them sent the raft full of inexperienced rafters out into the rapids and the guide shouted instructions from the shore. That's not a real confidence builder, and not really that helpful. My son in law said that one of the rafting guide companies did a very safe and professional job. When Peggy, my nurse co-worker, got the itch to go rafting, I phoned my son-in-law and got the name of the rafting company he liked. It was Laurel Highlands River Tours, in Ohiopyle, PA.

Five of us left early on a Saturday morning. Laurel Highlands had told us we would spend 6 hours on the river, including a company-provided lunch. My GPS said that Ohiopyle, PA, was 3 hours driving time away. I allowed a half hour to get lost or delayed. With a 10am rafting start time, that meant departure from my house at 6:30am. We departed on time.

It was an interesting ride. Janice and Nell sat in the back seat of my Explorer with Carole between them. All the way to Pennsylvania (and back) they debated something...politics, marriage, sexual issues, and on and on and on. I wish I could talk without any gaps of silence like that. Carol sat between them and as each spoke, Carole looked very interested and earnest, turning her head from one to the other as each spoke. I thought her neck would get sore. Peggy and I sat in the front chatting.

When we arrived, we were given lifejackets, paddles, and an introductory speech that led us to believe that death awaited us on the river. We were offered a chance to back out without shame. As a matter of fact, it's probably safer to fly a commercial airliner; the speech is mostly just a part of the excitement package. At least, that's what I assured the 4 nurses in my party.

We paid a few buck extra to have a guide in the boat with us. Good move. Really good move!! Unless you're experienced, don't go without a guide inside your boat, please. Nell sat in the back of the boat a bit sour that the rapids weren't bigger. She expected more and she wanted to let us all know. Wouldn't you know --- it was Nell who fell out of the boat into the raging rapids. Our guide grabbed her and dragged her back into the boat before the rest of us noticed she was missing.

Lunch was nothing fancy -- sandwiches and juice. I was rafting with 4 women, and I felt a little put-off when the head guide announced that ladies would go first to the food. "Ladies first!! Ladies first, please!! I'm sorry, ladies first --- PLEASE!!! Ladies, kindly fall in line here, make a sandwich and bring it to your man. Then make one for yourself!" LOL! That's river humor. Let me know if they use the same joke when you go.

When we finished, I tipped our guide $20. Nell paid extra.

This company is Laurel Highlands River Tours. The river is the Youghiogheny River.

(At left: JC Leahy and Peggy Cannon on the Youghiogheny River.)

Saturday, September 12, 2009


JC Leahy, 9/12/09, Washington, DC

I made my way downtown early this morning with low expectations. I thought the "March on Washington" would be small. What I encountered was the experience of a lifetime!!!!

I got up early and put on my best lab coat. The sky threatened rain. I phoned the Army and Navy Club to find out whether I could drive or needed to take the Metro subway. The roads were reported clear. That reinforced my expectation of a small turnout of demonstrators. I down 16th Street to the Club two blocks from the White House, left my car with the valet, and strolled off in the direction of Freedom Plaza. As I passed the White House, I encountered the first of the demonstrators. They were in small groups, ranging from 3 or 4 to 20. Some were posing for photos in front of the White House. I mistook them for the main gathering, and thought that this would be a small demonstration, indeed. My hands were full with my camera, a shoulder bag, and 500 flyers about health care and JITODAY.COM. I began passing out flyers and talking to folks. Everyone was friendly. Everyone was polite. Most of them were actually engaging. Woah! Friendly? Polite? Engaging? I began to wonder where they were from.

I continued on towards the "advertised" gathering point at Freedom Plaza, a couple of blocks east. The crowd at Freedon Plaza was huge. I commenced to chat with various people and pass out flyers I asked them where they came from. They came from Florida,Texas, Massachusetts, New Jersey, San Fransisco, Georgia, Arizona, the Carolinas, Ohio. Panama City Panama., and many other places. There were mothers with babies in strollers (even some double strollers!!), parents and children strolling along together, friends chatting as they walked, and a wheelchair-bound folks of different ages, all moving along together. My 500 flyers were gone as fast as I could separate the pages and hand them out. I talked with an easy 600 people. There was no one there from Washington, DC.


(Photo at right: The crowd encircled the massive reflecting pool and stretched all the way to the steps of the Capitol and around to the sides!!! )

As I walked along Pennsylvania Avenue towards the Capitol, the throng of people was so thick that I had difficulty positioning myself to take pictures. I began to marvel at how many people there were! One woman with a video on a tripod at the roadside said at 11:20AM that she had been video taping the crowd for an hour and 23 mintues straight and still couldn't see the end of the line. Wow! That's going to make a really interesting home video! But -- I had the impression I was near the front of the parade. I had no idea that there were at least and hour and 23 minutes of crowd in front of me. That meant this was a really big crowd. I walked along and found another guy with a video on a tripod. He had been taping the parade for an hour and a half. He told me that at least 3,000 people per minute were passing. Wow! Another great home video! Three thousand a minute?? I thought that must be wrong, so I stopped and watched. I imagined a straight line drawn across the street. I estimated that at any point in time, there must be at least 70 people stepping over the line -- maybe more. It didn't take them more than a second to pass over the line. 70 people times 60 seconds was...4,200 people a minute. Wow! If he had been video taping for 1.5 hours and there were 4,200 people a minute passing....there were at least 378,000 people in front of me!! And at 4,200 people per minute, that's 252,000 people per hour marching down Pennsylvania Avenue for hours. Woah! This was getting interesting! Later I would learn that the Daily Mail newspaper had each estimated a total crowd of 2 million!!! (But I'm the accountant, right? My estimate is that around 951,000 people arrived by Pennsylvania Avenue and some arrived by other routes. I say, a million to 1.1 million people attended. That's the official Journal of American Ideas Today estimate.)

As I said, the crowd was strikingly well behaved. I talked with hundreds and hundreds of people, and encountered 30-40 health care professionals, mostly doctors and nurses but there were a significant number of occupational therapists and EMT's. I joked with them that we ALL should have worn our lab coats to show that many health professionals are opposed to President Obama's scheme. They all laughed and agreed. I didn't see any other lab coats in the crowd but mine. As a result, a number of people wanted to take my picture or have their picture taken with me, What fun!

When I reached the Capitol's reflecting pool, I was dumbstruck by the vastness of the crowd. How spectacular!! The crowd encircled the entire pool and extended all the way to the steps of the Capitol and around its sides. It was awesome! I worked my way around the pool, trying to capture the vastness of the crowd on film. I'm not sure that I succeeded.

Eventually, I decided to leave early before the rest of the crowd and before any rain might fall. It was 1pm. I was shocked to discover that the throng of marchers was still arriving down Pennsylvania Avenue!! I took another street back to the Club, past Freedom Plaza where it had all started. The crowd was gone from Freedom Plaza -- gone to the Capitol. I made a mental note that someone must have cleaned the Plaza already because except for some overflowing trash cans, it was remarkably litter-free.

What an amazing and uplifting time!

PS - In case you have an interest, I took the above photos with a Canon Elan IIE camera with a 28-135mm zoom f3.5-5.6 lens and Kodak print film.

Friday, September 11, 2009

Now, A Word About Health Care :)


As a registered nurse and masters-educated accountant, and simply as an interested citizen, I have been reading about health care reform for years. I have noticed something pretty important: Some of the words used by reformers, including President Obama, do not mean what you might think they mean. For example, if I told you that bread cost too much and I wanted to reduce the cost of bread, you would probably think I wanted to lower the price-per-loaf of bread. That might be a good thing. However, in the realm of health care financing, they don't talk about price; they talk about COST. It's not the same thing at all!!! In the health-care-system analogy, the principal way of reducing the cost of bread is to either give you less bread or to make sure the supermarket only collects a dime for each loaf of bread it delivers to you. Either way, you get less bread. Key point: price and cost mean different things. Health care reformers talk about costs, not prices. Theoretically, the health care reformer could reduce the cost of your bread to zero by simply not giving you any bread! The problem is that when they reduce the cost, you eventually pay the price. Having learned from Marie Antoinette's misfortune, however, the wise health care regulator would never say, "Let them eat cake!" but rather would provide just enough bread to avoid revolution -- which is not a pleasant prospect for folks needing health care!! Americans can do better than that!!

I want to talk to you about health care reform. We can learn from each other. Please join me at my blog site, and or e-mail me at



The March on Washington tomorrow (9/12) looks interesting -- lots of speakers & entertainment - plus a chance to march down Pennsylvania Avenue from the White House to the Capitol. I think I'll wear my lab coat, bring my camera & go downtown to check it out.

Here's the link to the event website if you're interested.

PS - If you're interested in going downtown together, shoot me an email. :)

Nurse JC Leahy
2009 "100 Most Outstanding Nurses" Award, Wash, DC

Thursday, September 10, 2009


September 9, 2009

Madam Speaker, Vice President Biden, members of Congress, and the American people:

When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month. Credit was frozen. And our financial system was on the verge of collapse.

As any American who is still looking for work or a way to pay their bills will tell you, we are by no means out of the woods. A full and vibrant recovery is many months away. And I will not let up until those Americans who seek jobs can find them; until those businesses that seek capital and credit can thrive; until all responsible homeowners can stay in their homes. That is our ultimate goal. But thanks to the bold and decisive action we have taken since January, I can stand here with confidence and say that we have pulled this economy back from the brink.

I want to thank the members of this body for your efforts and your support in these last several months, and especially those who have taken the difficult votes that have put us on a path to recovery. I also want to thank the American people for their patience and resolve during this trying time for our nation.

But we did not come here just to clean up crises. We came to build a future. So tonight, I return to speak to all of you about an issue that is central to that future — and that is the issue of health care.

I am not the first president to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every president and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge — year after year, decade after decade — has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can't get insurance on the job. Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.

We are the only advanced democracy on Earth — the only wealthy nation — that allows such hardships for millions of its people. There are now more than 30 million American citizens who cannot get coverage. In just a two year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.

But the problem that plagues the health care system is not just a problem of the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day.

One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer more than doubled in size. That is heartbreaking, it is wrong, and no one should be treated that way in the United States of America.

Then there's the problem of rising costs. We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It's why so many employers — especially small businesses — are forcing their employees to pay more for insurance, or are dropping their coverage entirely. It's why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally — like our automakers — are at a huge disadvantage. And it's why those of us with health insurance are also paying a hidden and growing tax for those without it — about $1000 per year that pays for somebody else's emergency room and charitable care.

Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close.

These are the facts. Nobody disputes them. We know we must reform this system. The question is how.

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

I have to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months.

During that time, we have seen Washington at its best and its worst.

We have seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before.

Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups and even drug companies — many of whom opposed reform in the past. And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and countercharges, confusion has reigned.

Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.

The plan I'm announcing tonight would meet three basic goals:

It will provide more security and stability to those who have health insurance. It will provide insurance to those who don't. And it will slow the growth of health care costs for our families, our businesses, and our government. It's a plan that asks everyone to take responsibility for meeting this challenge — not just government and insurance companies, but employers and individuals. And it's a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans — and yes, from some of my opponents in both the primary and general election.

Here are the details that every American needs to know about this plan:

First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies — because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

That's what Americans who have health insurance can expect from this plan — more security and stability.

Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange — a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It's how everyone in this Congress gets affordable insurance. And it's time to give every American the same opportunity that we've given ourselves.

For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.

Now, even if we provide these affordable options, there may be those — particularly the young and healthy — who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for those people's expensive emergency room visits. If some businesses don't provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek — especially requiring insurance companies to cover pre-existing conditions — just can't be achieved.

That's why under my plan, individuals will be required to carry basic health insurance — just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.

While there remain some significant details to be ironed out, I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole. Still, given all the misinformation that's been spread over the past few months, I realize that many Americans have grown nervous about reform. So tonight I'd like to address some of the key controversies that are still out there.

Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple.

There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false — the reforms I'm proposing would not apply to those who are here illegally.

And one more misunderstanding I want to clear up — under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

My health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly sponsored insurance option, administered by the government just like Medicaid or Medicare.

So let me set the record straight. My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down. And it makes it easier for insurance companies to treat their customers badly — by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates.

Insurance executives don't do this because they are bad people. They do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill; they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations."

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. The insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear — it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

Despite all this, the insurance companies and their allies don't like this idea. They argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

It's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated — by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end — and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another nonprofit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

Finally, let me discuss an issue that is a great concern to me, to members of this chamber, and to the public — and that is how we pay for this plan.

Here's what you need to know. First, I will not sign a plan that adds one dime to our deficits — either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize. Part of the reason I faced a trillion dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for — from the Iraq War to tax breaks for the wealthy. I will not make that same mistake with health care.

Second, we've estimated that most of this plan can be paid for by finding savings within the existing health care system — a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment — it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid.

In fact, I want to speak directly to America's seniors for a moment, because Medicare is another issue that's been subjected to demagoguery and distortion during the course of this debate.

More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. That is why not a dollar of the Medicare trust fund will be used to pay for this plan.

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies — subsidies that do everything to pad their profits and nothing to improve your care. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

These steps will ensure that you — America's seniors — get the benefits you've been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pocket for prescription drugs. That's what this plan will do for you. So don't pay attention to those scary stories about how your benefits will be cut — especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past, and just this year supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch. I will protect Medicare.

Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average. The commission can help encourage the adoption of these common sense best practices by doctors and medical professionals throughout the system — everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money — an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.

Finally, many in this chamber — particularly on the Republican side of the aisle — have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.

Add it all up, and the plan I'm proposing will cost around $900 billion over ten years — less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration. Most of these costs will be paid for with money already being spent — but spent badly — in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. And if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.

This is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight — Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.

But know this: I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.

That is why we cannot fail. Because there are too many Americans counting on us to succeed — the ones who suffer silently, and the ones who shared their stories with us at town hall meetings, in e-mails, and in letters.

I received one of those letters a few days ago. It was from our beloved friend and colleague, Ted Kennedy. He had written it back in May, shortly after he was told that his illness was terminal. He asked that it be delivered upon his death.

In it, he spoke about what a happy time his last months were, thanks to the love and support of family and friends, his wife, Vicki, and his children, who are here tonight . And he expressed confidence that this would be the year that health care reform — "that great unfinished business of our society," he called it — would finally pass. He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that "it concerns more than material things." "What we face," he wrote, "is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."

I've thought about that phrase quite a bit in recent days — the character of our country. One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and sometimes angry debate.

For some of Ted Kennedy's critics, his brand of liberalism represented an affront to American liberty. In their mind, his passion for universal health care was nothing more than a passion for big government.

But those of us who knew Teddy and worked with him here — people of both parties — know that what drove him was something more. His friend, Orrin Hatch, knows that. They worked together to provide children with health insurance. His friend John McCain knows that. They worked together on a Patient's Bill of Rights. His friend Chuck Grassley knows that. They worked together to provide health care to children with disabilities.

On issues like these, Ted Kennedy's passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick; and he was able to imagine what it must be like for those without insurance; what it would be like to have to say to a wife or a child or an aging parent — there is something that could make you better, but I just can't afford it.

That large-heartedness — that concern and regard for the plight of others — is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people's shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.

This has always been the history of our progress. In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism. But the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress, Democrats and Republicans, did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom; and we can no longer even engage in a civil conversation with each other over the things that truly matter — that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves.

What was true then remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road — to defer reform one more year, or one more election, or one more term.

But that's not what the moment calls for. That's not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test.

Because that is who we are. That is our calling. That is our character. Thank you, God bless you, and may God bless the United States of America.

Sunday, September 6, 2009



See "Older Posts," below for full details.



Dear JC,

You are a very good writer! Would like to know more about this issue
and look forward to talking. Like most liberals, I just feel universal
care should be easy to do for the world's remaining superpower (at least for a couple more decades, I hope). I understand every other industrialized, modern nation is able to do it. Also, I hear our health
care statistics put us somewhere below Slovakia in most India. But I
don't know much about it, so would welcome a talk. Good luck with your
fine work.


(Background: I had written to this educator because I knew she supported the Canadian Health Care System. Canada's single-payer health care system is important because it is cited by many as the shining model for the United States. I told this educator that I needed someone to argue with me. I was surprised by her response. -- JC Leahy)

Hi JC,
I am a bit jealous (in a good way) for soon-to-be grandparents. Your aging process will be enriched by it. I can just imagine the mixed feeling of Adalia! Congratulation and best wishes.
Could you kindly mail Theresa's address? I thank God for all His goodness but above all He never give up on me. Yes, reaching this age is not too bad.

I could not disagree with you about Canadian health care program.I have taught about our Canadian Health care history as part of nurses professionalism. In the beginning the social medicine in Canada serves the purpose for that era. However,after many years it evolves into something that becomes a challenge even more so now. When immigration opened the door for millions of immigrants including refugees, there was not much protection for its abuse and misuse. Visitors and others entered Canada for surgeries and other medical interventions using the health insurance card of their relatives here who are legal residents or citizens of this country. Now, that we spend billions of dollars in health care even after we almost went bankrupt with Health Care,we are nowhere near a healthy solution. I don't have particular complaint for me and my family because I was working as crown employee as a college teacher. But the majority of those with only basic coverage and the way health professionals are being used even with minimum personnels including doctors, the patients care is marginalized. So you see,I am not diagreeing with you on this matter. It is the way it is written in the constitution that I don't know if we can just amend or change any of this. Whereas, the U.S. Health Care Program is totally different from ours. Keep your fire burning! It only takes a spark, it only takes one's passion to get it going. May you use that spark to make a difference.

Be well!


Attacking Dr. Jain's premise hardly changes the truth about healthcare in America. American Insurance do far more to 'ration care' or deny care as it is, than worrying about long wait times. I had nurses not give my dying grandfather pain medicine to keep him comfortable. So my mom and her sisters, and my grandma had to watch him die in pain over several days. I had to take care of a patient who was brain dead for days, but the family was stupid, uniformed, and wanted everything done, (didn't want him to be a tissue or organ donor either).

Comparing Canadian healthcare with American is a mistake for several reasons. The most obvious is the huge difference in population between the countries. over 300,000,000 to 35,000,000. Why would you even expect their resources to rival ours? I know plenty of Canadians who are satisfied with their healthcare. To say something like that about getting an MRI being harder for a person than a dog is patently false. Canadian's don't have nearly the high rate of heart disease that fat sedentary Americans do, so why would they need the same amount of access? Access to a cath lab means you need close access to open heart surgeons, if they aren't at the same hospital. These statistics don't impress me, and I find them to be misleading to the uninformed. I have seen and taken care of plenty of open heart patients who shouldn't of had the surgery, but did because someone paid for it. They had poor outcomes because of their co morbidities, and lifestyle choices, but as long as the surgeon gets paid, he'll operate on any bedridden stroke victim with dementia, and tell the family or the legal P.O.A, whatever the case may be, the operation will improve the patient's quality of life. Same goes for interventional cardiologists, putting stents into people, stents that hardly work. I had an old saint with 15 stents!!! If he fell and started bleeding he would die, since he is on 3 anticoagulants. Don't pat yourself on the back because you think we have better technology than Canada. Canada will catch up with us soon enough. We will almost never catch up with Dubai's technology. I am thinking of going overseas to be a nurse actually. A billion dollars? Not much actually, since we are spending over 18% of our GDP on healthcare.

The UK's population is much denser than ours, so again a direct comparison is not that relevant. And I know English people and nurses who worked in the UK. Most people are still satisfied with the level of care given. But I have nurses from India, not believing the level of care they see here. (It's very poor) They give better care in India.

So great, you got your letter published, but America seriously needs healthcare reform. And I am so sick of Republicans, saying no to everything and not even wanting to reform health care. Only 2 or 3 Republicans in Congress (representatives not Senators) have shown any unction for introducing legislation on healthcare reform. Members of Congress have received millions from the healthcare lobby to not reform anything. If a public option does not come out of the healthcare bills being debated in Congress, it will only get worse. Republican senators and pundits are quoting their facts and figures from an insurance think tank group. It disgusts me.

You seem to be focusing on the wrong issue here. I don't care what comparisons Dr. Jain makes if it makes a difference.

Jeremy B., RN, BSN


Woah! Jeremy! Take a deep breath! I feel your passion! I admire you for that! I'm really sorry about your grandfather's death.

I'm sensing that you're pretty down on the health care in America. I respectfully disagree with a lot of what you've said. You made a number of different points, though, so let me attempt to summarize:

Point 1:
American health care sucks big-time compared to Dubai and India.

Point 2:
Plenty of Canadians and Britons are happy with their health care; therefore, you imply, health care in Canada and Britain must be okay.

Point 3:
It is actually easier for Canadians to get MRI's for themselves than for their dogs.

Point 4:
Although you are quick to compare American health care with Dubai and India, I must not compare Canadian or British health care with American because Canada is smaller and Britian is denser.

Point 5:
Republicans just say "no" to everything and don't have any proposals for reform. They get their facts from an insurance think tank. They're disgusting.

Point 6:
Whether a newspaper article is true or untrue does not matter so long as it facilitates "change."

I'm double-checking your e-mail, Jeremy. I believe those are your major points. So let me take them one at a time. Here goes!


You didn't sign your last name to your e-mail, Jeremy -- but aren't you the Jeremy who worked with me in Cardiac Critical Care at Washington Hospital Center? When folks came to our hospital with chest pain plus either EKG changes or cardiac enzyme elevations, how long did it take them to get a cardiac cath and any needed angioplasty and stents? Same day? Next morning at the latest if they presented in the afternoon? How does it get any better than that? Even when folks came to outlying, rural hospitals, how long did it take those hospitals to perform diagnostic caths and helicopter the patient to us for treatment as needed? Same day? Same day, Jeremy!! How in the world does it get any better than that?!! Have you ever worked on Dr. Sugarbaker's gastrointestinal cancer surgical unit? Have you seen the miracles they perform there? How does it get any better than that?!!! Do you know what on the 5th floor of WHC, Jeremy? It's the extra-high-class hospital rooms for all the rich folks who fly in from all over the world to cured by the American health care system!! Honestly, Jeremy! Give me a break!!! American health care is the final resort of the sick people of the whole world!!!


I have a good story to tell about this, but in the interest of brevity, I'll save it for another day. Here's the basic deal. Only about 2% of people are acutely sick. 98% aren't. No, I didn't make those numbers up. Based on the US experience, that 2% of the population consumes 41% of all health care expenditures, and 10% consumes 72% of health care expenditures. The point is that sick folks are really expensive to cure. I know this firsthand because 3 years ago I had an 80% chance of dying and it cost about $80,000 for me to pull back from the drain hole.. Sick folks are very expensive to cure. Your average healthy person, on the other hand, can be satisfied with relatively little -- perhaps an annual checkup and a free pair of eyeglasses, for example. Relatively speaking, healthy people are just a whole lot cheaper to satisfy. So --- forgive me, I'm going to be cynically frank here --- faced with a need to "buy" votes, the prudent politician will allocate resources towards pleasing the healthy 98% of the population at the expense of curing the sick. ( I didn't just make that up by the way. There's a whole school of study called "public choice theory" aimed at predicting how politicians will act. To read a good summary of public choice theory, see chapter 21 of Lives at Risk, Goodman, Musgrave, et al.) When you place health care expenditures in the hands of politicians, they become political just as sure as the night is dark. I'm sure you must understand that, Jeremy. That is why Britons have no difficulty visiting their personal physician, or getting a free health club memberships -- but can't get renal dialysis to save their lives, literally. It's sad, but most Britons are happy with this. Canadians likewise. For cultural reasons and because of familiarity with the Internet, I think American consumers are a little more sophisticated than that, and less docile. Hence, the current uproar over President Obama's health care proposals.


No, Jeremy, I didn't just make up the part about MRI's in Canada being easier to get for pets than for people. Goodman, Musgrave & Herrick point out that, "While Canadian pet owners can purchase an MRI scan for their cat or dog, purchasing a scan for themselves is illegal." ( Lives at Risk, page 16.) We also know that in Canada there are only 2.5 MRI units per million people -- which is pretty darn few even compared to Britain. Here are some links to Canadian newspaper articles about pet care in Canada that you might want to read.

Canadians can simply buy an MRI scan for their dog. For themselves, however, it's pretty darn hard to get one -- except by driving into the US where they can purchase a full body scan in some shopping malls and many outpatient centers for around $1,000.


Well, we really need to evaluate and compare findings to be able to draw conclusions and learn. We must learn!! If there are differences between countries, we must seek a way to adjust for those differences to make comparisons more valid. For example, when we say that Canada ranks dead-last in availability of medical technology among developed nations, we take the different population sizes into account by counting the number of MRI units per million Canadians and per million Americans. The number of lithotripsy units per million Canadians (0.2) and per million Americans (1.5). Or the number of CT scanners per million Canadians (6.5) and per million Americans (13.6). Really, though, those comparisons don't tell the whole picture. We should also note that a great proportion of medical equipment in Canada is severely outdated. This includes 63% of general x-ray equipment and half of all diagnostic imaging equipment.

Point 5:

Let's do try to not rant on about "Republicans" or "Democrats", shall we? Health care financing is way, way too important for that. It's important because, obviously, our health is at stake. Some of our lives are at stake, too. Additionally, it's important for a less obvious reason: We may very well be traveling on what Hayek, in his seminal tome, called "the road to serfdom." I personally believe we are, in fact, speeding along on that road, and if we are, we had better discover it pronto. Otherwise, we shall find ourselves to be plantation workers in a big system designed to benefit drug companies, insurance companies, big labor unions, doctors, hospital operators, bureaucrats, and career politicians -- at the expense of us little people, who will slave away to pay for it all. So let's you and I be allies in a quest for change, Jeremy. Okay?

By the way, one little correction of fact: Republicans do have proposals for change. Here are links to 3 bills introduced during 2009. You don't hear much about them in the press.

Putting Patients First Act:

Patients Choice Act of 2009:
Full Text:

The Health Care Freedom Plan

Point 6:

This sounds like the old "ends justifies the means" argument. I thought we put that argument to rest at Nuremberg. The problem here is that the wrong kind of "change" would be catastrophic. Continuing along the road towards a Canadian/British-style single-payer system looks like the wrong kind of change.. And so, President Obama's health care plan looks like a really bad idea that needs to be just scrapped, now. NOW, NOW, NOW!!!

If all you want is an annual checkup and a free pair of eyeglasses, I'm sorry, I don't want to be part of that system. You and I and all of us need to get interested and get together at a grassroots level to find a better way without the advice of our Republican or Democrat politicians. Then we can tell them what we want. They will only listen if WE tell THEM what we want, loud and clear!!!!

So let's talk. Sign up to "follow" this web site. And/or leave a "comment" on the here on the site. And/or e-mail me at

JC Leahy
"100 Most Extraordinary Nurses" Award, Washington, DC

Thursday, September 3, 2009



If you are a nurse (or know a nurse) interested in being a part time university-level Nursing clinical instructor, here's your chance!!!! Washington Adventist University (formerly Columbia Union College) is looking for a medical-surgical clinical instructor for 4th year BSN nursing students. Requirements are: (1) a BSN degree, and (2) medical-surgical nursing experience withing the past 3 years. The University is located in Takoma Park, Maryland, and the clinical site will be Shady Grove Hospital on a stroke unit. If you're interested, act fast!!!! Clinical sessions for this particular class will be Tuesdays and Wednesdays. There is some flexibility about time-of-day, but 6:45am to 2:45pm would be optimal for CUC. Call the nursing department at 301-891-4544 and say you want to talk to Valerie Swan, about the med-surg clinical instructor position. If you get voicemail, Mrs. Swan says LEAVE A MESSAGE and she'll call you back!!!

Good Luck!!!

JC Leahy

PS: Here's another job opportunity that has come up, if you are a nurse wishing to work for an insurance company. I believe this one is in PA:

Job title: Appeals Nurse Analyst-Highmark Medicare Services
Job Opening #: 1
Posting Dates:
Internal: 9/3/09-9/11/09
External: 9/3/09-9/11/09
Salary Grade/Salary Range: SO3:48720/60900/73080
Locations: Camp Hill
Job Opening ID: 58386

This position is responsible for the following: Conducting a review of medical documentation to provide a clinical determination on a Part A and/or Part B case file by applying Medicare coding and policies and rendering a first level appeal decision. This position is located in our Camp Hill department and supports work being conducted in Pittsburgh, Camp Hill and Williamsport units. The position is responsible for rendering a clinical decision based on the Center for Medicare and Medicaid Services (CMS) national requirements, Highmark Medicare Services local policies, Social Security Act and the accepted medical standards of practice. The incumbent will use his/her clinical knowledge along with the Medicare guidelines to render a clinical decision. This is accomplished through working within several computer systems, Standard Medicare Systems (FISS or MCS), an Oracle database (Part A), On-line forms and Lotus Notes; as well as through utilization of advanced computer skills for Internet research and Windows applications. The incumbent is responsible to meet workload expectations as established by management.

A high school diploma or GED. One to three years of experience in clinical decision making. A current LPN or RN license designation.

A Bachelors degree in Nursing (BSN) or Business Administration. Certification in Certified Professional Coder, Certified Professional Utilization.

Maureen Fairbanks
Affirmative Action & Diversity Consultant
Highmark Inc.