Instead of having a plan developed behind closed doors and then you have to vote for it to find out what is in it, you legislate the old fashioned way, congressional vote by vote. “A return to regular order“.
The great advantage of this is its great disadvantage. Congress cannot centrally plan the economy, or any significant part of the economy. No one central plan can receive a majority vote, or even a large plurality. Your are only going to get two or three percent to vote for one central plan, and four or five percent for another, and three or four percent for yet another, because there is a near infinity of possible central plans, any one of which is going to step on lots of people’s toes, each plan stepping on a different set of toes. You can never socialize medicine, or anything else, by congressional vote, except they vote for a closed box and discover to their big surprise what is in it when it gets implemented.
Before Obamacare, American medicine was unreasonably expensive by a factor of about ten or twenty.
After Obamacare, American medicine was unreasonably expensive by a factor of about ten or twenty, but bums, drug addicts, and vagrants were getting a lot more of this very expensive medicine, paid for mostly by white middle class males, and very shortly thereafter, white middle class males were getting a whole lot less of this very expensive medicine. Obamacare wanted more care for the poor, but it sought to prevent the total consumption of care from rising, for fear that would accelerate the already excessive price pressures, so a reduction in access to care by white middle class males was planned and intended from the beginning, though I don’t think anyone wanted to admit just how drastic and radical a reduction they had in mind.
The way to substantially reduce the cost of medical care is to have a free market in medical care with well known, well defined, and advertised prices, as in Singapore. At present, no one knows how much care is going to cost, and prices are frequently absurd by world standards. There is no good reason why a treatment in America should cost ten or twenty times what unsubsidized, for-profit, care, paid for out of pocket, costs in Taiwan and Singapore.
Genuine advances in medical care make medicine more expensive, as things can now be (expensively) treated that formerly could not be treated. But this fails to explain the enormous discrepancy in healthcare prices between America, and prices charged by private enterprise, for profit, healthcare businesses in Taiwan, Thailand, Singapore, and India.
They have to tax healthcare benefits. A straight repeal of Obamacare, allow the purchase of insurance across state lines (at least one state will figure out abolishing regulations will bring every health insurance company in the nation to their state), plus taxing benefits, will go a long way to improving the system. They have tax reform on the table so they can make it a mostly tax neutral plan. Healthcare spending will plummet immediately.
We indeed have a two-tier health care system — Medicaid and everything else. OK, maybe Medicaid, the VA and everything else.
The interesting thing is Medicare (i.e. the Single Payer Plan for old persons in contrast with Medicaid, the Single Payer Plan for indigent old persons who have exhausted their money and require long-term care, keeping in mind that the biggest payout from Medicaid is said to be to nursing homes).
I am told that Medicaid is not something you aspire to be benefiting from, if you can help it. As I said on an earlier thread, every health care plan these days apart from being Mohammad Reza Pahlavi and going and seeing whatever doctor he wanted regardless of the consequences to the International Order, every health plan has some restriction of having a “network”, that is, its own set of “doors you are allowed to enter.” Medicaid can have a fairly restrictive set of doors.
I also get the vibe that the reason the Medicare Single-Payer System remains reasonably door-number-one is that old people have a very strong lobby as they vote in large numbers and have nothing else to do with their time. Poor people don’t vote or are as well self-organized.
Maybe the different doors are not as blatant as two separate entrances to an Australian clinic, but in the U.S., we still “do segregation” for the social purposes that we want segregation for but cannot admit publically that this is going on, and it is done in the uniquely Anglo-Orwell style of going ahead and doing it but not calling it what it is. Maybe it is segregation done badly, maybe it is segregation done at great expense, but we still have it when we require it.
How many bums, drug addicts, and vagrants are purchasing subsidized health care plans on the Exchanges? The bums and drug addicts and vagrants are still getting Medicaid, or more likely, they are just walk-ins (or drag-ins by the cops as our first tier health-care practitioners), and maybe that is the story behind the yelling homeless drunk person in the next curtain over while a person with “good” health insurance is in the ER being treated for symptoms of venomous snake bite after a freshly minted doctor, responding to an edict that no blood pressure reading slightly above norms should be left un-medicated, had prescribed a widely used no-fuss-to-adjust-the-dose medicine that depresses blood pressure according to the action of snake venom?
Two things about the discrepancy in cost. I visited my hospitalized uncle in Bavaria. The hospital was without air conditioning, which I guess is a Spartan ethic in a German kind of way and their summers are rather moderate in temperature anyway, but the place was just oppressively damp indoors. The I.V. bottles (yes bottles, not bags) were glass! Were they reusing those things? Yeah, that is what Germans do.
The second is that much if not most of the medical advances, in treatment, medical devices, medical imaging, and drugs are developed here. When Canada drives a hard bargain with the U.S. pharma companies, they are being cross-subsidized by USians?
OK, OK, Paul Ryan is moving the chairs around. Instead of a subsidy paid through the Exchanges, you get a tax credit? Maybe you “see” more of the big number of on the bill and this is more free-enterprise-y? Instead of paying the John Roberts “tax” for not having a prepaid health plan, you pay an “enrollment charge” for picking up a plan if you let your’s lapse? I don’t know, can we give Mr. Ryan, Dr. Price, and Mr. Trump a chance before we “pile on”?
》 can we give Mr. Ryan, Dr. Price, and Mr. Trump a chance before we “pile on�
No. We had to give them the chance to present something so they would be accused of being all talk no action. Now we have to make sure Democrats, not Republicans, are blamed when the system collapses under the weight of its’ promises and something more radical can be done.
Blame is what you do when you lack the Power to do anything about anything.
what about cases where an unconscious man is picked up by the privatized ambulance, and taken to the privatized hospital, to pay very expensive prices, when he would be better off with the county ambulance and socialized prices or even death for that matter?
In Australia, the ambulance asks people which hospital he should go to (code for “does he have health insurance”, and if they cannot figure it out, take him to a public hospital. Which gives him emergency treatment, then figures out whether to enroll him as a public or private patient. (Code for “does he go with the paying patients, or the non paying patients”)
I know of a motorcyclist who went bankrupt due to a helicopter ride that he tried to refuse. My Uncle chose to die rather than receive treatment for a common heart condition because the doctors refused to give him any kind of cost estimate. Our system completely lacks the transparency needed for a market to function. This is the great blindness of the neocons who clam that privatizing everything will solve all the problems. A market bazaar in Pakistan is private enterprise, but you have to haggle for everything, and you really don’t know what you are buying.
Handle on healthcare (down on ASKblog):
“What I am saying is that, for a variety of reasons, the ‘market’ for health care in the US is especially broken in terms of the ability to “shop around for prices.â€
One of those reasons is that medical providers themselves, perhaps incentivized by contracts with the insurance industry and the regulatory and legal climate, are extremely resistant to playing it straight with ordinary consumers, in a way which makes used car dealers look like models of integrity and transparency.
This is simply an essential and indispensable feature of any functioning market, and without which it is totally naive to hope for better results simply because of introducing some inadequate pastiche of ordinary purchasing dynamics.
I had an HSA for a few years and I tried to make it work, and believe me, it was a nightmare. Shopping around was something even a sophisticated consumer coldnâ€t do well, and I’m confident that it was utterly beyond the capacity of at least half the population.
The problem is that the existing US ‘marketplace’ is in a regulatory and commercial equilibrium that is simply too many steps removed from an environment in which these sorts of mechanisms and “Kayak For Healthcare†could actually work.
As bad as it may presently be, the whole domain between the current equilibrium and a more genuinely market-like equilibrium is a vast no-man’s-land of even more dysfunctional instability. This type of circumstance is usually a big factor when bad systems are surprisingly stable.
Again, anyone that proposes a reform that relies on nudging the system towards the market-equilibrium from where we are now by taking one little step is being very naive. One has to accept the possibility that we might have to pair pro-market moves with non-Libertarian coercive regulatory actions, at least in the short-term.
The state may have wrecked this market, but in order for reform to work, the state would also have to fix it along multiple dimensions and intervene to ensure that, at the very least, medical providers had to behave like ordinary retail enterprises with regard to publishing prices and the ease by which consumers could access and compare those prices.
“
One thing Paul Ryan the ayn randitarian could have but didn’t propose was legalizing medicine without a license meaning there would be multiple competing ratings boards. That’s the #1 cost cutting measure no one wants to talk about and won’t until the collapse of healthcare.
OT but rather important:
http://www.vdare.com/articles/scotus-leftists-rule-child-molestation-less-important-than-the-depravity-of-whiteness
The Supreme Court has either totally lost their minds or is trying to deliberately destroy the American court system. No, I’m not exaggerating.
Why aren’t you instead surprised when modern jurisprudence ISN’T decided by partisan considerations?
In any case, crimes against infidels are obviously no reason to punish the worshipful ingroup. They’re only infidels, after all.
I’m not surprised by that. I’m surprised by them doing something that would destroy the court system by flooding it with appeals. This is the sort of thing that blows up immediately- you’d think they have a little more self control then that.
Yes, I know, never overestimate the ability to put feelings before reason or sanity.
Nah, it’s typical unprincipled exception decision making.
Kennedy signs on saying that “this doesn’t apply to every case, just special exceptions” – of course without defining what those exceptional circumstances are.
That way things can limp along for a while until everyone suddenly notices that every single criminal trial of a NAM is tainted and needs to be appealed. Of course the resources don’t exist to appeal all of the cases so there’ll just have to be massive agreements between prosecutors and some kind of legal defense slush fund which result in a reversal of the unfortunate mass incarceration that has caused all that minority crime (along with a huge payout to the slush fund).
The same script as always.
American medicine is expensive because of a cascade of the AMA guild cartel.
http://freenation.org/a/f12l3.html
AMA has a monopoly on who can practice medicine, so every guild member gets to charge monopoly prices. Presumably in exchange for kickbacks to the AMA. Though maybe they do it purely for the power/’impact’ hit.
Health ‘insurance’ companies are a way for the AMA to charge healthy folk as well, effectively increasing what doctors can charge, presumably in exchange for kickbacks. Instead of merely charging the patient, the doctors charge everyone who buys that insurance. Since this allows prices to be so high, almost everyone must have insurance.
Romney/Obama decided ‘almost’ everyone wasn’t everyone enough. The whole point of it is to allow the AMA guild to charge yet higher prices.
You can advertize prices all you like, but without busting the AMA guild, it’s fairly pointless. Since toes must be stepped on, the minimum toe set is the AMA and the ‘insurance’ companies. However, what did we learn in basic economics about special interest groups in a democracy?
Trump is ignoring short-term incentives by force of will. Perhaps also trying to change the long-term incentives by same. Does he have the necessary will to oppose the basic mechanics of democracy and make medicine legal again?
—
Note also the AMA has no incentive to make sure there’s enough doctors. Each new doctor lowers the prestige of existing doctors, for no personal benefit, so there is an incentive to restrict supply.
Of course even if Trump was successful, it would be necessary to elect someone else with the same drive and will, or the medicine guild will simply reform sooner or later.
just change Congresses rules to allow for ranked preference voting
Ranked preference voting would require congressmen to accurately evaluate each of one hundred central plans.
Congressmen circa 2017 wouldn’t know what to do with that power if it fell into their lap.
“That would require congress to do actual work. Like they had a job or something truly mad like that.”
My blog marshals further facts and figures re Obamacare’s repeal and replacement.
http://americanpaleocon.blogspot.com/2017/03/obamacare-repealed-and-replaced.html
It also briefly glosses the relevant history of the issue, back to the Truman administration.
I attended a healthcare town hall meeting recently. It was awful, like a communist party meeting. The 99% white, 95+% retiree audience, most of whom are proud Medicare recipients, selfishly obsess over this issue, to no good effect. They do not even imagine having up-front prices, did not learn from OPEC in the 70’s that cartels are dangerous, did not save up for higher medical costs in old age, do not care to have advance directives in place in case they might be resuscitated, and perversely enjoy feeling valiant in resisting big bad Drumpf. They are emotionally primitive, and mentally lacking, not to mention spirituality. They don’t care about the current drug epidemic, suicide rates going up, or any other health-related stuff, because it’s not healthcare *for them*.
They do, however, like that Medicaid is available to illegal aliens in CA, and really think younger rich people can pay for all this entitlement. They
don’t expect anyone to say, “sorry, your human right to medicine is unaffordable and exaggerated.” But that’s how I feel, though they are nominally my neighbors, when they clap like idiots at the congressman telling bad jokes and tricking them like the fools they are.
They went from booing a congressman they don’t really know well, from another region, as soon as they heard that he opposes RyanCare. They are one-issue voters, at most.
The best part was when the congressman admitted he can’t effectively oppose the American Healthcare Act, except by calling it Obamacare Lite, or, he added to stay PC, TrumpCare. A smart Republican apparently told him this pisses off Republicans, as if non-Democrats care about names, like Obama and Trump, so much. His point is that the “new” plan is mostly the same, but comes from a Bad Guy, so whether it will leave ~20 million people uninsured like the CBO says or not is not a sincere concern. He even called the new proposed entitlements “emasculated,” as if manly ones insure everyone for free. Odd word choice of his… maybe he should go back to his home state and stop being a cuck.
If there were sincere concern about the uninsured suffering and dying, we would already have a VA-style public health system for the needy, and maybe also forced labor to pay off the debt and earn some money for a Health Savings Account for those who can work but can’t get jobs
(debtor’s communal capitalism, basically, a hybrid model which might be unfeasible despite my idealism). Everyone agrees honesty about payment, not calling everything insurance even when it’s free, must be step 1. Step 0 is clarifying who is entitled to what. We might never get past step 0 at this rate, but this rate of economic freefall is very unsustainable.
A doctor I asked said we could have a national non-profit org. provide everyone monopoly healthcare, and it would somehow work because, I guess, he doesn’t actually care if it works. The idea is to guarantee his paycheck, and cut out the corporate profiters, as if insurance profit is sin, unlike treating patients more directly.
He’s smart on the job, but too slick in his rhetoric. I don’t believe these intermediate, “arguing over who’ll pay for it” costs are so high. But it’s true that insurance companies have lowered their % of premiums spent on paying for patient’s needs, a lot in recent decades. This was revealed by an insurance co. marketing executive gone rogue, Wendell Potter, in his book,
Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans.
Here are brief quotes:
The average employee contribution to company-provided health insurance increased by more than 143% between 2000 and 2005, while
average out-of-pocket costs increased by 115%
“From 2007 to mid-2009, insurance and HMO political contributions and lobbying expenses totaled a jaw-dropping $586 million, according to Public Campaign. At the height of the battle, the industries were spending nearly $700,000 a day to influence the political process” (p. 193).
Wall Street judges insurance companies harshly by their MLR, or Medical Loss Rate; the amount of money they pay out on medical claims. Since
1993, the average MLR in the US has dropped from 95% to 80%.
Maybe it’s gone up again since the book was published in 2010, but the interesting thing is that MLR went down while average costs went up,
more than doubling. The insurance co.s claim, when asked by customers, that their profit margin is legally regulated, implying we already have price controls. I think that’s exaggerated.
–
There has been preening/ trolling about insurance for decades:
http://prospect.org/article/aids-and-moral-economy-insurance
but I found out there was officially a healthcare crisis in the early 80’s, when it cost less than half of what it costs now. When you look at a graph of how costs rose over the 20th century and since then, the main jump is Medicare and Medicaid in the 60’s.
Jim, In places like India, the government provides free care for the poor via government hospitals which anyone can walk into the door for any problem. All paid by the government, all run by the government.
Wonder of wonders, even the most desperate poor go there only as a last resort. And why is that? Well, it is because you might well walk in with a Migraine, But you might walk out without a kidney. The poor gets his free care worth Rs 10000 ($160) on the open market, but he walks out without a kidney worth Rs 975,000 (USD 15000) on the black market.
See, the lefties are right! “Free health care” works. Why can’t you reactionaries get that? Probably what they say about lefties having higher IQs is true. You see, they get it!
Don’t believe me? Look, even the “venerable” New York Times agrees with me!
http://www.nytimes.com/2008/01/30/world/asia/30kidney.html
You can tell doctors really care about healing by the way they aggressively lobby for the government to let them work for free on the poor…
Evidently you are the sort of person who is surprised when humans attribute altruism to their self-interests.
Used to be, yeah.
Now I’m spreading the bad news.
Score another one for jim in predicting that the housecleaning would begin in March.
https://www.whitehouse.gov/the-press-office/2017/03/13/presidential-executive-order-comprehensive-plan-reorganizing-executive
Does this qualify as a Coup that Jim was talking about? Where are the Howls from the Lefties?
Not yet, but it is a step in that direction.
They are not howling yet because they think it will come to nothing. Maybe they are right, but I think they are wrong. Howls will start in due course, around December or January.
(OT but potentially crucial story we should be screaming from the rooftops)
Everyone, including me, thought that President Trump had jumped the shark with his tweet claiming that President Obama wiretapped him during the latter stages of the 2016 campaign. But it looks like Trump may be vindicated after all.
You may recall that Robert Hannigan, the former head of Britain’s NSA–the GCHQ–abruptly resigned on January 23, 2016–three days after Trump’s inauguration. There was widespread speculation in the British press that this was no coincidence, but the exact connection was difficult to discern. Former CIA officer Philip Giraldi speculated in The American Conservative (http://www.theamericanconservative.com/articles/is-there-more-to-the-flynn-story/comment-page-1/) that perhaps the Obama administration reached out to British intelligence for information that would justify initiating an otherwise transparently partisan FBI investigation into Michael Flynn–if this came back to haunt them, they could simply disclaim responsibility by noting that the British had no stake in U.S. domestic politics. But there was no evidence to support that guess.
Now, according to Judge Andrew Napolitano (http://insider.foxnews.com/2017/03/14/judge-napolitano-why-there-may-never-be-proof-even-if-obama-spied-trump), “‘Three intelligence sources have informed Fox News that President Obama went outside the chain of command […] He didn’t use the NSA, he didn’t use the CIA, he didn’t use the FBI, and he didn’t use the Department of Justice.’ Instead, Napolitano said, Obama used GCHQ, a British intelligence and security organization that has 24-7 access to the NSA database. ‘There’s no American fingerprints on this,’ Napolitano said. ‘What happened to the guy who ordered this? Resigned three days after Donald Trump was inaugurated.'” I’m sure the media will suddenly discover a newfound skepticism for unverifiable claims from anonymous sources to avoid reporting on this, but this is as good an explanation as any for why Hannigan had to go. I’m almost kicking myself for not piecing it together. It may never be proven, but it makes perfect sense, and my crystal ball says: More likely than not.
That should be January 23, 2017.
One is always skeptical of conspiracy theories, but yours is admittedly more interesting than most. When your crystal ball says more, let us know.
“Everyone, including me, thought that President Trump had jumped the shark with his tweet claiming that President Obama wiretapped him during the latter stages of the 2016 campaign.”
Not I. Never bet against Trump. When his tweets don’t make sense it’s usually because he has information we lack. His knowledge is imperfect but he’s right more often than not.
Turns out there wasn’t an actual wiretap, but nor is this the non-story the media has made it out to be. According to Larry Johnson, a former intelligence officer that says he unwittingly served as one of Napolitano’s sources (http://thehill.com/homenews/324707-ex-intelligence-official-napolitanos-british-wire-tapping-claim-didnt-get-it-right): “Now, I had known about the fact that the British through GHCQ were passing information back-channel. This was not done at the direction of Barack Obama. Let’s be clear about that. It was being done with the full knowledge of people like John Brennan and Jim Clapper. […] I’m not saying the British GHCQ was wiretapping Trump’s Tower. […] [Napolitano] shouldn’t have used the word wiretap. I call it an ‘information operation’ that’s been directed against President Trump [by] people like John Brennan.” That’s more than enough to explain why Hannigan had to go, but hardly sufficient to render Trump’s apparently Fox-inspired tweets true by sheer coincidence.
Trump did err by grossly embellishing on a grain of truth, and it hasn’t helped him politically.
If anyone in a Republican administration had gotten the Brits to spy, the legacy media would say that the Republican president had ordered a wiretap through foreign intelligence, it’s worse than Watergate, impeach.
Instead, this equivocation.
No.
Fuck that.
Obama’s administration ordered GCHQ spying.
Plus there’s this (http://www.politico.com/story/2017/03/devin-nunes-donald-trump-surveillance-obama-236366): “House Intelligence Chairman Devin Nunes declared Wednesday that members of Donald Trump’s transition team, possibly including Trump himself, were under inadvertent surveillance following November’s presidential election. […] Nunes, himself a Trump transition member, said a ‘source’ had shown him evidence that members of the Trump transition team had been unmasked — and that their identities had been revealed in U.S. intelligence reports. Nunes had previously raised questions about the unmasking of former National Security Adviser Michael Flynn, whose communications with Russia’s ambassador were intercepted by the U.S. government and whose identity was leaked to the news media.
Nunes suggested this unmasking might have been done for political reasons, saying the evidence he had seen had been widely disseminated across the intelligence community and had ‘little or no apparent intelligence value.’ He added that he was trying to get more information by Friday from the FBI, CIA and NSA.
‘I have seen intelligence reports that clearly show that the president-elect and his team were, I guess, at least monitored,’ the California Republican told reporters. ‘It looks to me like it was all legally collected, but it was essentially a lot of information on the president-elect and his transition team and what they were doing.’ He said the information he had seen was not related to the FBI’s Russia investigation. […] During his press briefing, Nunes said he did not know yet whether the Trump transition officials who were ‘unmasked’ were communicating from Trump Tower. Earlier this month, Trump claimed in a series of Tweets that former President Barack Obama ordered a wiretap of the phones at Trump Tower — something Nunes reiterated on Wednesday he had no evidence of.”
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