Trump has explained the free market part of his healthcare plan in detail. It is heavily influenced by the free market part of Singapore’s tremendously successful free market healthcare system. I have no doubt that if implemented as described, it is going to work and work well.
Trumps plan for the free market healthcare system is great.
But what about Singapore’s socialist healthcare system for the poor and unfortunate?
Trump gets vague. Hospitals, he tells us, are going to get paid to take care of people “who really cannot take care of themselves”.
The trouble with this is that as I said earlier if bums, vagrants, and drug addicts go through the same intake, queue in the same line, and get the same treatment as you and me, there are going to be so many drug addicts looking for free drugs, and so many vagrants looking for free room and board, in line ahead of you and me that you and I are not going to get treated.
The way Obamacare deals with this problem is that you and I cannot afford to get treated because we are paying so much to look after drug addicts and vagrants.
Obamacare has provided insurance for everyone, by making everyone equally uninsured, provided equal access to everyone by equally denying everyone access. Obamacare has, predictably, collapsed. Ann Coulter cannot get insurance that covers broken bones and cancer. If you cannot get insurance that covers broken bones and cancer, not much point in having insurance at all. (Ah, but she is guaranteed free abortions, which get priority above broken legs.) If she suffers anything expensive, she will wind up with the same treatment options as the homeless bum who heads to hospital for free room and board. Which is to say, really crappy room and board, which is what you got in place of treatment in Cuban hospitals. Universal healthcare for the poor has become universal lack of healthcare for the well off.
The healthcare system has, predictably, collapsed, because it is being swarmed by bums, vagrants, and drug addicts.
When you fly, there is business class and cattle class. For Trump’s plan to work, hospitals are going to have to have separate intakes for those who are insured and paying deductible, and those who are getting free handouts. And those who are getting free handouts have to be made to really wish they were getting the kind of treatment that those who are insured and paying deductible get.
The big, big, problem, the problem he is being very quiet about, is preventing his plan for “Insurance for everyone” from devouring free market insurance the way Obamacare did. To prevent it from devouring the free market, you have to be mighty harsh on people who are getting medical care free.
You cannot adequately take care of bums, because bums will always demand more care than can be supplied. Thus a genuine universal scheme always winds up not providing care for anyone. If Ann Coulter breaks a leg or gets cancer, probably will wind up flying to Singapore, Thailand, or India.
For Trump’s scheme for “those who cannot take care of themselves” to work without destroying healthcare for paying customers, hospitals are going to have to have a separate door for “those who cannot take care of themselves”. And behind that door there needs to be someone with a taser, a stun gun, and a baton, plus doctors with a very simple and effective treatment for drug addition and obesity. They give the druggie no drugs till he completes withdrawal, and the obese person with no food at all till he is slim. Doctors have a hundred too clever by half rationales for not giving unpopular treatments. For non paying customers, however, need to give the most unpopular effective treatment possible.
Set up maquiladora hospitals in mexico for the indigent.
The meta-problem of US healthcare is the inability to say “no”. Can any president actually reduce coverage for anyone? I am not sure. If not, there is no answer to this problem. A good solution to US healthcare would see spending as a proportion of national income halve. Possible?
I agree it would be easier to say no if the public and private were totally separate, this would make the private system much cheaper so more available and the public system could abandon all the paperwork and build the entire system designed to serve non paying as cheaply but humanly as possible.A well designed free system could provide much better care and much cheaper
Possible. Singapore spends 4% which is probably around what the US would spend if it was fully free market in health care (obese NAMs canceling out that advantage).
So how DOES Singapore handle this problem?
Forced savings, so that most people can pay when something bad happens to them, and Death panels and all that for those that cannot.
Singapore’s Medisave, a medical savings account system, is large part of Singapore’s health care funding, but don’t forget the government subsidies. No use dodging reality. Straight from the Singapore Ministry of Health:
“Medifund is an endowment fund set up by the Government to help needy Singaporeans. Medifund is a safety net for patients who face financial difficulties with their remaining bills after receiving Government subsidies and drawing on other means of payments including MediShield Life/Integrated Plans, Medisave and cash.”
http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies.html
Looking at the financial statistics, the Singapore government subsidizes 35% of health care spending.
I disagree heath saving plans are stupid no one but wonks like the idea. we want insurance, the only problem with insurance the public heathcare is full of stupid niggers and spics and fraudulent smart immigrants and the government interference bogs down the private insurance model they need to be completely separated.
People want hands to be held and bruisers to be kissed better.
If you get cancer and it costs $1m to treat with 5% success rate, you don’t want to be told that, sorry, you only have $250k in your health savings account. You want to be lied to that the condition is untreatable so that you can die in peace, as you will be in the UK.
HSAs are also inefficient in the sense that people with big HSAs are old. People who see large returns to healthcare spending are young.
Rather than stuffing $250k into a HSA to be drawn down extending barely livable life by six months, we should be passing that money to our children.
Yes. The biggest problem we have, it manifests everywhere, is this perception that all lives matter.
High IQ youth should have the top priority for medical intervention, but are often the ones skipping health care because it costs too much for their student loans.
The amount that will be spent on medical intervention should be determined by an estimate of how much money the person will make in the future and how many cute White children they will raise, which is by definition how valuable they are economically and to the nation, with hospital-underwritten medical loans that aren’t dischargeable in bankruptcy and community or governmental assistance to the mothers and fathers of those cute-looking White children.
its more than that, as someone whos good with math and money they really dont appeal even to me.
I want to save for things other than healthcare, but since I can never predict what my healthcare needs might be if i am self funding out of pocket all of my savings is at risk and seems pointless since even that may not be enough I might as well be a spendthrift.
On the other hand I know the odds are not bad, and I know no one else can know for sure if they will be the unlucky one so it will be possible to get them to pay a bit more than the odds would indicate for insurance but no where near as much as what they would feel safe saving. Its game theory.
My insurance covers me and my family for a couple million I think, it costs 25K a year.I know that some serious medical conditions can rack up 200-300 in no time it can even be much worse or more than one family member could get hit, if that happened my life is wiped out even if I get well again, Insurance works because everyone is paying a bit more than the math requires but they cant know what their personal future will require. I would buy divorce insurance if I could.
Good point about old people having large accounts, young people small. However, when HSAs are done Amish style, at the group level (100 or so families per group, who all know each other and have strong ties) then it becomes very effective. Learn from the Amish.
Wonkish? Trump’s plan includes Health Savings Accounts. I bet Trump has looked closely at Singapore’s Medisave program.
DONALD TRUMP’S VISION
• Repeal and replace Obamacare with Health Savings Accounts (HSAs).
http://www.donaldjtrump.com/policies/health-care/
Insurance just opens you up to abuse and fraud. In Canada, insurance cost for health and automobiles would drop in half if we kicked the East Indians out and sent them all back home.
The Amish method of insurance works well. Each community, where everyone knows each other and is accountable, pay into a common fund, that is used for emergencies. It is a form of insurance with strong safeguards against bad actors. Of course, Canada tries to forbid that, because, you know, everyone knows who the bad actors are, and the insurance groups would try to exclude them.
Jim,
Any thoughts on Karl Denninger’s take, at https://market-ticker.org/akcs-www?post=231780 ?
That plan would be the disaster he says it is.
It pretends to be the Singapore plan (prices and free markets) but it is not.
The hospitals rather like socialism, and therefore do not like prices, and if you want free market health care for the better off, going to have to drag hospitals and doctors into the free market kicking and screaming.
Starting 100 years ago, the doctors feathered their nests very nicely. Now they’re through the flesh, and chomping into the sinew and bone of our people.
O dear God, fear the “patient advocates,” even worse than sociak workers. They’ll need to be liquidated 1st
Anne does not get cancer and bones because Anne does not pay what health care costs, My insurance that cover cancer and bones costs $26,000 year. It did not have to add much post obamacare because being a union plan it was already comprehensive and expensive and of course exempt at least temporarilly to get the unions to sign on the were exempted.So we already covered 26 year old children in college, and if you were laid off long enough to lose coverage [over a year] and then returned to work you were again covered regardless off medical condition. So the increase in cost of the plan post obamacare is the result of inflation generally and the ant costs obamacare has managed to shift to the system that the obamacare insurance does not cover.The combined increase is about 33%.
But this is a NYC plan and as anyone here knows the poor here are treated free and so show up at emergency rooms for the stupidest reasons, I have niggers and spics work for me some times that bring their kids to a hospital as often as twice a month, they are simply too stupid to know what common ailments and remedies are or use web MD.Inm my other home state Idaho if the poor show up with a broken leg they are treated since the poor work in Idaho they usually cant qualify for medicaid so are sent a bill, yes the hospital has the temerity to actually send the bill and sue if it is not paid and so the poor have ruined credit, which tends to make it more difficult to get out of poverty.It can get pretty grim for poor whites in areas like that but they get by on poaching venison and such, in the end they maintain their character at least.
Having built a dozen or so NYC hospitals I can tell you The cost of anything medical related is 10x normal even a chair.We all know the paperwork is insane, and the systems used to prevent fraud cost as much as the fraud.Probably a lot of the drugs are worthless snake oil but everyone has a basic human right to the latest snake oil.And it seems everyone has a basic human right to the same treatment as the wealthiest person in the world can afford because we all know the only reason that poor person is not the wealthiest person is oppression by evil white system.
The entire system need to be overhauled from the ground up. Clinics should be set up in poor areas for the stuff a hospital is not needed, it should be run more like costa rica no unnecessary expensive shit.every med student should have to do some time in these places and their poor hospitals, they should pay new drs enough to make it a reasonable place to work a few years as a new dr.This should probably be entirely free for citizens who have qualified for medicaid, so as to take the fraud incentive and anti fraud cost out of the equation as well as the cost of billing paperwork.They should invest in technology to teach the poor to ise their obama phones and free internet to use a virtual practitioner before coming to clinic, for instance they could be routed to a poor system pharmacy for supplies or meds with simple instruction or told to call back in 24 hrs if things dont improve.the poor should be given basic healthcare in a dignified way that in a pinch none of us would object to. Big cities do have a problem with bums drug addicts alcoholics crazies. The poor med facilities should have the ability to not let these destroy the dignity of the poor hospitals so, treat any immediate med emergency and then institutionalize, many countries can institutionalize the addicts and crazies.These should be like work farms where they dry out and are introduced to treatment recovery programs, their stay should increase every time they are re institutionalized, obviously these have a penal element and light law enforcement will be needed and they will have work therapy that cover their costs.Crazies will be similar some may be released to see if they can manage their meds etc some will be deemed too dangerous.
Private care will vary it will be a private system offering various levels of service and cost. However it too must be completely reworked, any laws that prevent innovation must be abolished, if insurers want to sell across state lines or open their own hospitals its a free country. Medical paperwork should be totally standardized simplified and one system all private providers use, and like the public system a built in ability to track costs for analysis.Portability between employers, COBRA type options,adult children and retirement plans will be available because private insurance will be much cheaper as a stand alone. It will be able to offer options like unemployment extensions Having separate systems it will soon become apparent the poor are not being given less resources but rather using much more resources and not paying for it.
We have to get rid of no good people who besiege hospitals for free health care. If health care is free for certain people, they will abuse the system.
So, go to hospital for drug addiction, get locked up in prison to dry out. Go to hospital for free treatment of obesity related ailments, get no food, and go into a locked ward where you cannot sneak out to get food.
well I pretty much explained a work camp as treatment, however being 27 years recovering alcoholic I know a bit about what actually works and regular prison wouldn’t help but a theraputic work camp would be dirt cheap, moderately penal to encourage self reflection once released, and have an introduction to recovery program while inside. A lot of mental patients could also use work camps better than insane asylums.
The poor who I would like to phase out by paying them to sterilize or carry genetically modified elites. In any case ought to have dignified care because its what we will tolerate and because we may at times need to use that system. If its a free sytem it needs no paperwork fraud prevention or expensive extras for the paying customers.
Well i think the heeb thread was a rousing success jim.
Yes it was, but some people just kept saying that Jews were such a bad thing it is necessary to get rid of every single one – including, I presume, Moldbug.
Now I don’t mind people saying that once. Or saying it twice. Saying it three times was excessive, and saying it a lot more than three times is time to turn off the thread.
The Jewish problem is that Jews, like nonwhites, don’t feel themselves at home, and are hostile. And they get into power, and are still hostile, and exercise political power to do bad things to the majority. Having a home solves the one, and keeping them out of power solves the other. Genocide is excessive.
I think another factor driving up medical prices is… excess doctors. Yep. Too many doctors. Mainly from third world countries. All wanting their piece of the pie. You would think the competition would drive prices down, but in this case competition is driving prices up, because of the way the system is structured.
Price competition is suppressed. Hence the Trump plan to force people to advertise prices, and to adhere to advertised prices. Then oversupply of doctors will drive prices down rather than up.
How many people would pay double to be treated by a white doctor, rather than Rajeesh from India?
Anywah, what do you think about the high-profile detentions of visitors, is the Cathedral trying malicious compliance now?
More likely stupidity.
Your proposed solution sounds a lot like the Australian solution — cattle class healthcare can provide for basic needs and can even do so reasonably well for someone whose needs aren’t excessive. But there’s also the business-class, pricey-but-manageable option available to those willing to shell out a few thousand extra dollars for something like extra embryonic screening and more comprehensive prenatal care instead of just showing up on delivery day.