Some Concerns

1) ISSUE: Health Care - Both Hillary and Obama have run on the platform of universal health care. The first Clinton administration failed in this endeavor. What is the likelihood of this becoming in a reality in our lifetime, and who among the 3 candidates has the ability to "get 'er done?"

COMMENT: I think the big issue is to modernize the system, and NEITHER the market NOR the government is doing much to 'get 'er done.'

That young actor, Health Ledger's, death points to something obvious: the best choice for a "gatekeeper" in a managed care environment and a medical environment that is more and more dependent on use of prescription
drugs is a pharmacist NOT a PCP. You can't do that, however, because of State (50 of them, which vary widely) licensure and corporate practice laws AND because physicians (without whom you can't practice Medicine) would
baulk and Managed Care Organizations ("MCOs"), despite occasional bullying, dare not alienate physicians so existentially.

Electronic Medical Records are a great idea and the Bush Administration has been effectively facilitating this idea, among other ways, with the HIPAA data set requirements (which confuse everyone), however, NOBODY in the Private Sector seems to want to share the data. As a result the electronic medical record is going the way of the Physician Practice Management Company and the Integrated Delivery System, other "new, innovative solutions" that did not work.

The current US Healthcare System (which isn't a system, but that's the
heart of the problem) ties Medical Benefits to employment ... and the global trend in employment is towards more contingent employment using contractors, project work,etc. Other ways to bring consumers together to buy insurance at a favorable rate are really ham strung, by ERISA and DoL regulations on Multiple Employer Welfare Arrangements (quot;MEWAs").

A big part of the solution is probably to realize that a certain level of health services should be available to everyone, regardless of means and that insurance should be purchased through entities other than employers (e.g., Chambers of Commerce, Trade Groups like the ABA, Churches, etc.) Perhaps the way to sell this sweeping change is to use the threat of bio-terrorism from AQ as a rationale, just as the Cold War give Ike a justification to build the interstate highway system in the 1950s. (Or how WWII brought in employer sponsored health insurance, in the first place.) The savings would come from rationalizing the system by creating more uniform licensure and corporate practice regulations, allowing PAs and NPs to do more, using Pharmacists more as gatekeepers and doing whatever was needed to make the healthcare market more of a national market, Weinberg's small area variation studies that tend to prove that medicine is practiced very differently across the Country be damned ... or cured.

2) ISSUE: Economy - Do you see any of the 3 candidates with the ability to turn this downward slide around?

COMMENT: I disagree with the conventional wisdom here, as I think a lot of the problem we have was created by the Government and the Central Bank and
needs to be cured by the Government and the Central Bank.

We need to raise taxes, cut spending and convince the rest of the world we are a good investment risk, especially our private sector. I am terrified about the prospect that our public debt might be downgraded, it would be a shame to finally squander "Hamilton's Gift."

We also desperately need to do things to encourage domestic savings and investment. For example, money from investment in stocks provides only a small amount of funds to businesses, however, we favor this with a low tax rate on Capital Gains. Most corporations are financed mostly by retained earnings and bank debt. Why don't we institute a reasonable increase in the Capital Gains tax while eliminating taxation of 1099 interest income? This would also tend to make interest rates given by banks for savings accounts and CDs functionally higher, encouraging savings.

3) ISSUE: The War in Iraq - Let's face it, we are dealing with a partisan war, which by many learned projections, estimates a minimum of 10 years to win such a partisan war. (Example of a partisan war - Northern Ireland, which took over 30 years.) I frankly don't believe any candidate who wins the election will be able to quot;end" this war easily or cleanly. To me, it's almost a
non-issue, as any succeeding president will have to deal with a mess,
as this country will likely be dealing with it 4, 8, and 12 years from
now. I don't believe candidates should waste their time on "let's get
out now" rhetoric, rather, they should be focused on making better
choices for this country. More honestly, none of them know HOW to get out now.

COMMENT: There are people far smarter on Iraq than I (I haven't been there since 1991) and I defer to them. It appears to be going much better in Iraq. However, we need to figure out how to export this improved process to Afghanistan, the Horn and other places.

The big threat in any of these places, and any new fronts in the Global War on Terrorism ("GWOT"), is not the insurgency. It is not even the failed state that may follow an insurgency. The existential threat to the US is from those who potentially will rebuild order after a failed state occurs, neighborhood by neighborhood, village by village, and what they stand for. For this reason, we need to remain involved in Iraq, Afghanistan and the Horn if and when our military involvement ends.

4) ISSUE: Big Business - Oil - I firmly believe George Bush Jr. was a president for oil, by oil, and of oil, and other big business. I think the Democrats are more insulated from big business interests, but what are the chances of McCain following in Bush's footsteps? (As an aside, take a look at the complete and utter lack of funding for the National Institutes of Health under the Bush administration.)

COMMENT: As a lawyer in private practice, I have become convinced that most of the vibrant, forward looking, innovative approaches generally are coming from .... smaller entities. I think that these smaller entities usually get short shrift from the Federal and, at least, NYS Government.

If the economy is to grow, we can't favor the large companies of the past over the small, nimble innovative companies of the future. I believe we have done this for the last 8 years, and not only at the Federal level.

You ABSOLUTELY need regulation. I believe this because, generally, no successful business leader seems to want effective markets. The natural tendency when you make your nut is to want to lock in your windfall. Because of this natural human tendency, you need an outside entity to police the game and insure no one is doing a blanket roll or loading the dice. In the end, no one really wants to play in a rigged game and that's why you need to put Pecora's "cop on the corner of Wall Street." People who say that there have been fewer IPOs done in the US since Sarbanes Oxley ("SOX") came in, miss the point that ENRON, WORLDCOM, Global Crossing, Tycho, etc. probably did more to cool investor's (particularly overseas investor's) ardor for our markets than SOX.

However, Regulations need to make sense and, for example, the predictable (and, in my opinion, stupid) tendency to apply SOX rules to close corporations and LLCs is, I think, a prima facie case of gutless lawyering and imbecilic regulation. Additionally, it might make sense to work with Companies that make administrative errors but crush people ripping off the public ... and to know the difference.

I had problems with former Gov. Spitzer because he seemingly leaned on a client of mine that made a stupid administrative error when he was AG and because he hindered the lawyer from his office I was working with to resolve the issue, because that lawyer made what I thought was a fair deal to resolve the matter. It seems to me what that lawyer tried to do is what you are looking for from regulators, not something you are trying to discourage.

5)ISSUE: Single Women voters - National Public Radio today reported today that single women voters will have the biggest influence on this year's presidential election. I think the bottom line is that the average American is sitting home, poor, ill, wondering where next month's heating bill money will come from, how they're going to pay their mortgage, pissed off and waiting for a candidate who will address their concerns.

COMMENT: On single women, as everyone reading this will attest, I can't claim any expertise whatsoever on that topic.

I do think that there is a lot of trepidation generally about the economy
and I see this in everyone I meet. I think people have a sense we have
been eating the seed corn and the harvest is far off.