Wednesday, March 15, 2017

Response to The Expected Perfect Storm

(See: Just Above Sunset: The Expected Perfect Storm)

Here’s the issue that’s at the bottom of the question of what to do about Obamacare:

Do you believe in our national government being involved in the nation’s healthcare, or don’t you?

If you do, you’re probably a Democrat (and/or a liberal), and if you don’t, you’re probably a Republican (and/or conservative, and/or a Libertarian). And for all practical purposes, there is no in-between. 

Which is to say, if you’re a believer, you should be all-in, and if you’re not, you should be all-out, because anything in between is just a tangled miss-mosh, with compromises left in there for the sole purpose of pleasing the other side, which ends up costing us way too much money, and not doing the job any of us want done anyway.

And just to be crystal clear, I myself am a "true believer" — which is to say, I’m a liberal and/or Democrat, the implication of which is this:

If I had to choose between the somewhat-flawed Obamacare and the absolutely brain-dead and duplicitous Trumpcare, please give me Obamacare any day. 

Obamacare may be way too complicated and twisted to be of as much good to anybody as it is intended to be, but it was working pretty well, in spite of the ubiquitous Republican noise machine chanting that it was a total disaster.

But more to the point, Trumpcare is an out-and-out lie, put forth as a stalking horse, with the ultimate purpose of doing away with any and all public healthcare systems altogether.

Republicans actually believe in “Bupkis-care”. That is, they don’t believe in any healthcare program at all, but lack the courage to admit this out loud.

In their soul of souls, they think everyone should take care of their own doctor and hospital bills, without digging into everyone else’s pocket. But they’re afraid to admit this, given the country's having warmed up to the idea of government involvement in healthcare, and so when Republicans seriously brought up “repeal”, and found themselves having to answer questions about what they would do with all the sick-and-dying left out in the streets, they gave into pressure to change their mantra to “repeal and replace” — but with a much better plan.

That was the crack in the dyke.

Before long, they were crawling deeper and deeper into the trap, claiming their plan would keep the good parts of Obamacare — such as coverage of pre-existing conditions, and letting kids stay on their parents’ plans until age 26, and no annual or lifetime caps — but they’d just replace the parts they didn’t like — such as, well, how to pay for the parts they did like — the particulars of which, of course, they would have to get back to us about, since it was going to take some real noodling to figure that out.

But now the time has finally come to place their bets!

Had they kept their noses clean, we wouldn’t see a painfully joyous Paul Ryan yesterday, clumsily trying to explain how the CBO scoring that shows 14 million fewer Americans with healthcare next year, and 24 million fewer ten years from now, actually supports his proposal:
"Our plan is not about forcing people to buy expensive, one-size-fits-all coverage. It is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down. That’s what this report shows. And, as we have long said, there will be a stable transition so that no one has the rug pulled out from under them."
“Rug"? What “rug"? There will be a “rug”? (More on that in a minute.)

Some problems with his arguments, in order:

1. It seems that his plan is about “forcing people to buy expensive, one-size-fits-all coverage”. Go look at Steven Ratner’s recent New York Times column that has a chart (see “Fact #1”) showing the comparative size of tax credits in 2020 under “Obamacare”, which varies according to level of income, and the “New GOP plan”, which varies according to age, but stays constant across all incomes. In other words, one size fits all.

2. The magical thinking — that “when people have more choices, costs go down” — may actually be true, but it also seems to be that when costs go down, insurers start dropping out of the program, as evidenced by what happened last year.

3. And maintaining a “stable transition”, as described here, seems to suggest that, when the time comes to "pull the rug", everyone will hopefully have enough advance warning to get off it before it gets pulled. And where is this “stable transition” supposed to be transiting to? Sounds like the plan is to leave everyone with “Bupkis-care”, which is pretty much what we had before Obamacare came along.

It’s like you hire an advisor to come into your house to figure out how you can spend less money on food, and they come up with a plan that involves slowly cutting down on buying food, until eventually you find yourself not buying any food, and your family starves to death. But on the bright side, you did save a lot of money.

But last Friday, Paul Ryan explained to radio host Hugh Hewitt what he thought would be the reaction to the upcoming CBO estimates on the reduction of the insured, and how he’d handle it:
"If the government says 'thou shall buy our health insurance', the government estimates are going to say people will comply and it will happen. And when you replace that with, 'we’re going to have a free market, and you buy what you want to buy', they’re going to say not nearly as many people are going to do that. That’s just going to happen. And so you’ll have those coverage estimates. We assume that’s going to happen."
And he was right! Sure enough, the CBO scoring ended up predicting millions more will be uninsured, quite possibly because Obamacare coerced people into buying health insurance, while Ryan’s plan did not.

Ryan seemed to have no problem with there being fewer insured, since, for Republicans, healthcare reform is all about exercising one’s freedom to pick one’s own plan from a whole big list of plans, all of which promotes competition and brings down costs and blah-blah-blah — instead of being about getting more healthcare to more Americans!

I don’t don’t mean to be flip, but if you can’t get a big list of companies willing to compete under a system where citizens are penalized if they don’t buy insurance, then why would insurance companies want to compete among the much smaller group of customers willing to do it without the penalty?

And to that suggestion that there is something wrong with penalties:

What if there were no penalty for not paying income taxes? Couldn't we assume the number of people paying their income taxes would do down? And if so, would that be a good thing?

If there were no truancy laws, do you think maybe there would be fewer parents sending their kids to schools, with the result being that we would become a nation of nitwits? And if so, would that be a good thing?

And then there’s the big problem with Obamacare that you don’t get with Trumpcare, which is that Obamacare taxes the rich to fund Medicaid, which is what many call “class warfare”.

You’ve heard the expression, “it’s his world; the rest of us are just living in it”? Those rich people who don’t like the idea of progressive taxation think they own the economy, and the rest of us are just living in it. But in fact, everyone from high-income through middle-income to no-income, we all own the economy, because we created it, even the poor, by buying and selling goods and services within it, and anyone who tries to claim they deserve most of it, because they earned it, has to get over themselves.

And the “class warriors” are not the people who claim the economy belongs to all of us; it’s those who think it belongs to only the rich who are the real "class warriors".

But then there’s also that question of “socialized medicine”:

Back in the early middle ages, the government didn’t have its own military; rich guys did. We don’t do that anymore. We let our country have a monopoly on owning armed forces. You could call it “socialized military”. I believe in that.

A long time ago, governments weren’t the only ones who printed money; banks printed “bank notes”, which in many cases were worth even more than the so-called national currency. Nowadays, the federal government has a monopoly on printing money. We don’t think of this as socialism, but it really is.

But maybe the big problem with Obamacare has been, because it doesn’t do away with the insurance middlemen, nor own all the hospitals and employ all the doctors, it isn't really socialized medicine. It would be better if it were, in that (1) it would probably have better healthcare outcomes than what we’ve ever had, and (2) it would also be cheaper.

Come to think of it, maybe that’s the answer for both the Democrats, who’s main concern is to get everybody covered, and for the Republicans, who are mostly interested in seeing costs come down, with both of them interested in best possible health outcomes!

Maybe we should just forget Obamacare! Forget Trumpcare! We can even forget about so-called “Single Payer”! Where in the world can we find a system like that?

Would you believe the Jolly Old United Kingdom?

We are so used to hearing some overly-enthusiastic jamoke, usually of the Republican persuasion, off-handedly boast that our country has “the best healthcare in the world”, but luckily for him, nobody ever asks him to back up the claim:
For this [2014] survey on overall health care, The Commonwealth Fund ranked the U.S. dead last. 
1. United Kingdom 
2. Switzerland 
3. Sweden 
4. Australia 
5. Germany & Netherlands (tied) 
7. New Zealand & Norway (tied) 
9. France 
10. Canada 
11. United States 
It's fairly well accepted that the U.S. is the most expensive healthcare system in the world, but many continue to falsely assume that we pay more for healthcare because we get better health (or better health outcomes). The evidence, however, clearly doesn't support that view.
Notice who’s number one? Yep. The UK!

And sure enough, according to a link sent to me by a friend up in Canada (who seems to share my admiration for Britain’s National Health Service), the U.S. topped a chart listing the costliest healthcare systems in the world for that same year, 2014, the most recent available:
The chart is titled, "Healthcare Costs Per Capita (Dollars)”, and runs from left to right, cheapest country to most expensive on the list: 
1. Italy ($3,207) 
2. U.K. ($3,971) 
3. Japan ($4,152) 
4. Australia ($4,177) 
5. France ($4,367) 
6. Canada ($4,506) 
7. Sweden ($5,003) 
8. Germany ($5,119) 
9. Switzerland ($6,787) 
10. United States ($9,024) 
(Source: Organization for Economic Cooperation and Development, OECD Health Statistics 2016. Compiled by PGPF.)
So maybe not coincidentally, the UK, with their out-and-out socialized medicine, has about the cheapest and the best healthcare system in the world. If we copied them, we’d be up there, too.

What’s that you say? Good luck getting that past the Republicans?

My answer to that is, just give the Trump gang a few years of trying to jibber-jabber their way out of the “Repealing and Replacing” mess they’ve made for themselves, and there’s just a chance Americans will become fed up, and will come to their senses.

After all, that ACA stuff was just Barrack Obama trying to solve our healthcare problem in a way he thought Republicans might buy into — which was an admirable attempt, but look where it got him.

So maybe it’s time to stop working so hard for the other side to come to our side. Maybe we should just do what we should have done from the start, and make the same healthcare choice that that crusty old conservative, Winston Churchill, did. In fact, he was apparently one of the movers behind getting the NHS up and going.

And while I realize Democrats may not be feeling all that bold lately, this may be exactly the time to get started talking about it, just when there might be a constituency primed for trying something brand new.

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