Tag Archives: healthcare

When The Emperor Has No Clothes…

Yesterday, the Republicans’ much-hyped replacement of the Affordable Care Act went down in flames.

There are multiple lessons to be drawn from the legislative fiasco we’ve just witnessed, although I am doubtful the people who most need to learn those lessons are capable of doing so.

The first–and most obvious–is that Donald Trump presides (in the words of David Gergen, who has served both Republican and Democratic Presidents) over an incompetent and delusional Administration. “I actually think this may be the worst hundred days we’ve ever seen in a president.”

As one wag commented, William Henry Harrison had a better second month.

Political commentators have repeatedly catalogued the myriad ways in which Trump is unsuited for the Presidency–including but not limited to his emotional and mental instability, lack of intellectual curiosity and ignorance of the structures and operations of government. Those deficits translate into an inability to understand that Presidents–unlike CEOs of closely-held corporations–cannot simply issue orders to Congress, a co-equal branch of government, and expect compliance.

The art of a legislative “deal” is distinctly different than the art of developing a parcel of real estate. A successful Presidency requires skills that Trump neither possesses nor understands.

Then there is Paul Ryan, who has long been lauded as the Republicans’ policy wonk. The lesson here is that in a group of midgets, even a short guy looks tall. Ryan has had seven years to craft a replacement for Obamacare; clearly, he spent none of that time considering what such a replacement should look like. Ryan has been “defrocked”–shown to be all political posturing and no policy chops. The bill he tried to peddle to his fractious caucus was an abysmal piece of legislation–a “steaming pile of excrement” in the words of one Republican lawmaker.

Even if Ryan had possessed the skills credulous pundits have attributed to him, however, it probably would not have been possible to bridge the deep divides within the GOP. The aptly-named “lunatic caucus” wants nothing less than a government retreat from any participation in healthcare, including Medicaid and Medicare. The moderates–mostly elected from more competitive districts– understand that such a retreat is neither possible nor desirable, and wanted legislation that they could have described as improving upon the ACA.

The only thing the two factions agreed upon was that they were being asked by a President with a 37% approval rating to vote for a measure supported by 17% of voters.

Congressional Republicans are hopelessly divided between the radical ideologues produced by 2011’s extreme gerrymandering (who don’t give a rat’s patootie what their party’s leadership wants) and the GOPs (somewhat) more traditional representatives.

The third lesson, then, is that It will only get worse.

The Party of No is no longer capable of getting to yes.

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Now For The Numbers….

So–the nonpartisan Congressional Budget Office has released its analysis of “TrumpCare.”

Here are their numbers:

14 million Americans will lose their insurance by 2018
21 million Americans will lose their insurance by 2020
24 million Americans will lose their insurance by 2026
There will be 52 million Americans with no health insurance by 2026 (for comparison, there were 46 million uninsured before Obamacare became law)
The bill will cut $880 billion from Medicaid by 2026
15 percent of Planned Parenthood patients will lose access to care
A 64-year-old making $26,500 would have to pay $14,600 for insurance in 2026 (for comparison, that 64-year-old pays $1,700 under Obamacare), and

After transferring $275 billion from public-health spending to the richest 1 or 2 percent via tax cuts,  it will reduce budget deficits by $336 billion between 2018 and 2026.

AHCA–aka “Trumpcare” or perhaps “Ryancare”– would reduce deficits by $336 billion but would cut government spending on healthcare programs by $1.2 trillion.

When you think about it, this is a brilliant approach to deficit reduction that we could apply across the board.

We can cut billions out of the budget if we stop paving Interstate highways and inspecting and fixing bridges. We can reduce the deficit significantly if we stop hiring those high-priced CPAs to monitor bank compliance with financial regulations and enforce the SEC’s oversight of corporate securities offerings. We can save another bundle if we no longer enforce rules against air and water pollution (actually, Scott Pruitt, the new EPA Chief, has already begun that effort.) Betsy DeVos assures us that schools don’t need oversight, so we don’t need the Department of Education. We probably don’t need those bean-counters at the CBO or the Bureau of Labor Statistics, either.

And of course, we could stop paying Social Security to all those useless old people. Think of what that would save us!

It’s true that if we did all these things, government would no longer function, and we’d be thrown into a Hobbesian, dog-eat-dog world, but that’s actually the result many Republican Congress-critters have been working toward. The President wouldn’t mind, because he really has no idea what most of government does anyway.

Of course, if we wanted to make a real dent in the national debt, we could dramatically reduce the bloated amounts we spend on the military. But something tells me that might be a bridge too far…..

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Telling It Like It Is

John Green explains American healthcare .

The most mind-blowing statistic is one I didn’t previously know: The American government already spends more on healthcare per capita than the U.K., Australia and other countries with “free” systems. Think about that.

Then watch this!!

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Health and the Market

Well, I see that the Congressional GOP is threatening to shut down the government in October if the Democrats block repeal of the Affordable Care Act, aka Obamacare, and the partisan rhetoric is predictably flying.

A Democratic friend sent me an email listing the multiple sins of the Bush Administration, from wars of choice to decimation of the economy to the massive increase in the national debt; the message was something like “You didn’t get mad about any of these things, but now a black guy wants to provide healthcare to Americans who don’t have it, and that makes you mad!?” A Republican friend sent me a similarly incendiary message insisting that Obama is a “socialist” who hates capitalism and wants to destroy the market “that made American health care the best in the world.”

Let’s stipulate that not everyone who opposes Obamacare is a racist, and that American healthcare before the ACA was not only not the best in the world, but actually ranks around 37th. Other than that, my purpose is not to engage these arguments, but to point to a perfect example of the way “the market” works in areas like healthcare, where buyers and sellers are not on equal footing, and do not possess the sort of equivalent information that is necessary for markets to work.

I have previously referred to a book written my cousin, Morton Tavel, in which he takes on the “snake oil” aspects of the healthcare industry. He has now created a blog devoted to the subject, and his first post is a perfect example of “the market” in medicine–a discussion of all the ads about “low T”–testosterone deficiency. I encourage you to click through and read the whole post, but the bottom line is that  “low T” is extremely rare. The numbers the manufacturers are hyping are misleading at best and fraudulent at worst, and the “remedy” they are promoting is expensive, unnecessary and unlikely to restore the virility of the aging men who miss their morning erections.

Markets are wonderful where they work. And they work more often than they don’t. But in those areas where they don’t work, they enable the snake oil salesmen who prey on the unwary and drive up costs for everyone.

As with so many policy debates, this isn’t an “either-or” debate between all market all the time and socializing every aspect of the economy. We “socialize” functions that markets cannot efficiently provide–police and fire protection, infrastructure provision, national defense, public education. We leave to the market those economic areas where markets have proven their effectiveness.

The decision whether to leave an activity to the market or provide it through government should be based on evidence, not ideology. And as every other western industrialized country has long recognized, the evidence for government’s role in healthcare is overwhelming, just as the evidence for the market in consumer goods and manufacturing is overwhelming.

The evidence also tells us a lot about elected representatives who–having lost the argument–are willing to shut down the American government in order to protect the profits of health insurers and drug companies.

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