The Health Care Debate We Should Be Having-Part One

By Mike Appleton, Weekend Contributor

“We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us. . . . It will be in a much simplified form. Much less expensive and much better.”

-President-elect Donald Trump, Washington Post (January 15, 2017)

Even if one supports the Affordable Care Act, there was nothing satisfying about watching the legislative circus over repeal and replacement unfold in the Senate over the past few weeks. To an outsider the entire process appeared disjointed and at times almost incoherent. It became increasingly impossible to fathom what Senate Republicans were trying to accomplish. So when the final effort, an eight-page bill apparently drafted over lunch, was rejected in a 51-49 vote, the most appropriate emotional response was neither elation nor disappointment, merely exhaustion.

Efforts to lay blame for the debacle have already begun, of course. Reince Preibus has been summarily booted from the White House and the three Republicans who defied Mitch McConnell by voting against the so-called “skinny” repeal bill have been castigated by the right. But it would be wrong to think that there isn’t a way forward. That first requires that we dispel several misconceptions.The first attempt to fully repeal the ACA was the “Repealing The Job-Killing Health Care Law Act,” introduced by then House Majority Leader Eric Cantor and passed by the House on January 19, 2011. According to a recent report by the Congressional Research Service, while there were several additional pure repeal bills over the following years, the vast majority of the proposed bills concerned modifications to the ACA, either by eliminating or postponing the effective date of certain provisions, withholding funding approval or otherwise hindering implementation of portions of the Act. Several proposed revisions to the ACA actually passed both houses of Congress and were signed into law by President Obama. Therefore, the Democratic charge that Republicans have had eight years to draft a replacement for the ACA, while technically accurate, is somewhat misleading. A true replacement bill has never been drafted because replacement of the ACA following repeal was not a Republican goal. The “repeal and replace” slogan only came into prominence when Donald Trump was nominated with his promise to give the nation better and cheaper health insurance coverage as soon as he took office. His surprise election victory left Republicans scrambling to come up with something in a hurry. The fact that they were unable to do so does not mean that a good faith effort to develop a comprehensive bipartisan solution to the acknowledged deficiencies in the ACA is impossible.

A second misconception is that Congress can expect meaningful leadership from the White House on healthcare reform. In the same interview with the Washington Post quoted above, Mr. Trump said that his proposed plan was “very formulated down to the final strokes. We haven’t put it in quite yet, but we’re going to be doing it soon.” Either his plan was not submitted to Congress in the ensuing six months or I missed it. But if I missed it, so did Congress, because neither the measure passed in the House nor any of the Senate’s failed efforts bore any resemblance to what the President has repeatedly described: lower premiums, lower deductibles, more coverage and cheaper prescription drug costs. He celebrated the passage of the House version in May, only to criticize it in June as “mean, mean, mean.” Since the most recent Senate vote, the President has almost simultaneously vowed to let the ACA die on its own and encouraged the Senate not to give up on passage of “Repeal & Replace.” One is left with the impression that were Congress to pass a statute simply stating, “We love healthcare,” Mr. Trump would sign it with a flourish before a battery of cameras and send out multiple tweets proclaiming his great legislative victory for the American people. If any bill it adopted under guidance from the White House, it ought to at least mandate whiplash coverage.

Perhaps the biggest misconception, however, is the assumption by the President and congressional Republicans that their views on healthcare policy represent prevailing public attitudes. The unpopularity of the House and Senate bills has been widely reported. Moreover, recent polling suggests that a slight majority now prefers that the ACA be retained and improved upon. Most importantly, a January report by Pew Research reveals that fully 60% of the public believes that “government should be responsible for ensuring health care coverage for all Americans . . .  .” That number includes 52% of Republicans with annual incomes below $30,000.00. What this means is that it is time for political leaders to abandon partisan rhetoric and seriously engage voters in debating questions which are routinely relegated to academics. What kind of animal is healthcare? Is it a public good or a commodity like any other? Where do personal and collective responsibility intersect? What is the role of the free market in the provision of healthcare? What are the proper limits of government involvement? Is universal healthcare a moral imperative or merely a desirable goal? How should the burdens of the cost of healthcare be allocated? These are issues that go to the heart of how we view ourselves, our relations with others and the limits of constitutional government. Until we eschew the slogans and the convenient labels we use to categorize political views and thoroughly review first principles, no consensus is possible. Part Two will address some of these questions.

Sources: “Trump Urges Republican Senators Not To Give Up On Healthcare,” Huffington Post (July 30, 2017); David A. Graham, ” ‘As I Have Always Said’: Trump’s Ever-Changing Position on Health Care,” The Atlantic (July 28, 2017); Kaiser Health Tracking Poll: The Public’s Views on the ACA (July 15, 2017); Astead W. Herndon, “What’s more popular than the Senate health care bill?,” Boston Globe (June 29, 2017); Jessica Estepa, “Poll: Majority of Americans want to keep Obamacare,” USA Today (March 7, 2017); C. Stephen Redhead and Janet Kinzer, “Legislative Actions in the 112th, 113th and 114th Congresses to Repeal, Defund or Delay the Affordable Care Act,” Congressional Research Service (February 7, 2017); Robert Costa and Amy Goldstein, “Trump vows ‘insurance for everybody’ in Obamacare replacement plan,” Washington Post (January 15, 2017); Kristen Bialik, “More Americans say government should ensure health care coverage,” Pew Research Center (January 13, 2017); Byron York, “No, House Republicans haven’t voted 50 times to repeal Obamacare,” Washington Examiner (March 25, 2014); Ed O’Keefe, “The House has voted 54 times in four years to repeal Obamacare. Here’s the full list,” Washington Post (March 21, 2014).

The views expressed in this posting are the author’s alone and not those of the blog, the host or other weekend contributors. As an open forum weekend contributors post independently without pre-approval or review. Content and displays of art are solely their decision and responsibility.







183 thoughts on “The Health Care Debate We Should Be Having-Part One”

  1. The good news is that government cannot nationalize healthcare because Single-Payer will throw America into insolvency and Single-Payer will destroy the superior American health-care system.

    The bad news is that proponents of Single-Payer are criminals engaging in subversive and treasonous acts with the full knowledge that Single-Payer is unconstitutional.

    It is unconstitutional for the government to compel Americans to purchase a product.

    Article 1, Section 8

    “To regulate Commerce with foreign Nations, and among the several states, and with the Indian Tribes;…”

    Reference Obamacare:

    The Commerce Clause

    “The administration has relied most heavily on the Commerce Clause, which was the basis of all three decisions upholding the mandate. The Clause gives Congress authority to regulate “Commerce . . . among the several states.” But the individual mandate regulates that which is neither commercial nor interstate. Virtually all purchases of health insurance are intrastate because a combination of state and federal law makes it illegal to purchase health insurance across state lines. Moreover, the object of the mandate is not even commerce at all. Instead of regulating preexisting commerce, the bill forces people to engage in commercial transactions they would have otherwise avoided.”


    Government may ONLY tax for General Welfare. Government man NOT tax for Individual Welfare. General Welfare means ALL as in all people make similar use of water, currency, roads, sewers, post office, airports, etc. People make “individual” and vastly different use of food, clothes, automobiles, entertainment, insurance, houses, healthcare, etc.

    Article 1, Section 8

    “The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defense and general Welfare of the United States;”

    “From each according to his ability, to each according to his need” is pure unconstitutional communism.

    1. For the last, I recommend a close reading of the Book of Matthew.

    1. Uh, Medicare is a fiscal disaster – it actually doesn’t really work for anyone.

  2. With copays and deductibles and premiums going way up, for many people – where is all this extra money going?

    1. to people that consume insurance and health care but don’t pay the full load, or anything at all. ACA is simply a massive redistribution of wealth … much like pretty much everything the Dems do.

      1. The “people” don’t get the money. The medical establishment and insurance establishment does.

      2. ACA is simply a massive redistribution of wealth …

        No, it’s a redistribution of costs, which implicate people’s incomes, not their wealth. (And that’s what risk-pooling does, socially and temporally).

        You can treat medical care as if it were a mundane commodity, to be paid for out of available income in real time. You can, if you’re ready to go full Ayn Rand. See Whittaker Chambers’ critique of Ayn Rand’s social philosophy, inspired by the WInston Tunnel Disaster in Atlas Shrugged Full Ayn Rand is not salable…for good reason.

  3. I found Mike Applegate’s essay to be refreshingly free from ideology and name-calling, and focused in on the actual issues at stake, and a discussion of “what are we actually trying to achieve.”

  4. If there is one take away from Mike’s enlightening article that is a bit unconventional it is that waiting for politicians to correct something to benefit one’s life is folly. Years of impasse and intrigue has not benefited the citizenry.

    For this reason it is paramount for individuals to take personal charge of their lives and make themselves strong, flexible and independent enough to live a fruitful and enjoyable life without looking up with puppy dog eyes hoping for a morsel of congressmen’s table scraps.

    We all know that a government strong enough to give you everything you want is powerful enough to take everything you have.

    1. The American Founders gave Americans the one and only thing they could:


      Ben Franklin, we gave you “a republic, if you can keep it.”

      Franklin’s was a restricted-vote republic, not a one man, one vote democracy.


      America is in the end stage of Tytler’s dictatorship.

      “A democracy cannot exist as a permanent form of government. It can only exist until the people discover they can vote themselves largess out of the public treasury. From that moment on, the majority always votes for the candidate promising the most benefits from the public treasury, with the result that democracy always collapses over a loose fiscal policy–to be followed by a dictatorship.”

      ― Alexander Fraser Tytler

      Charity is industry conducted in the free markets of the private sector.

  5. As being the attorney-in-fact representing a disabled relative of mine it is not long before someone in this role realizes how impoverishing it can be to be forced through circumstances into accepting Medicaid benefits. The system is designed to, and promotes actively citizens having everything taken away by the government.

    This is something that simply does not happen with private health insurance.

    Take this for example. Over the past few months, and a great amount of red tape, I enquired to the feasibility of enrolling my principal in Medicaid for the sole purpose of receiving in-home care services. In order for her to receive any amount of state provided in-home benefits she would essentially have to spend 45% of her gross income first as a form of co-pay (named Participation). She would only be allowed a personal allowance of $1005.00 which roughly equals her housing costs. If other expenses she pays are added together she would go several hundred dollars into debt each month just to receive her first $1.00 in payment for her in-home care. There were no factors as to how much her housing, utility, or other expenses cost when calculating her portion.

    She must choose between leaving her home to live in subsidized low income housing, or receiving full in-home care services to the amount she was permitted by her assessment.

    Moreover, under Medicaid, she can have a lien placed on her house or any other real assets she owns.

    Having a fiduciary responsibility to protect her financially, I decided not to enroll her in this Medicaid program because she would be financially ruined. Sadly, from a cost perspective she would not go into debt if she moved to a nursing facility the government could only take all but $60.00 of her income. Yes that’s right folks. Take everything she has to get medical care for her.

    Having private insurance means freedom from government financial tyranny. Private insurance requires only payment of premiums, and indemnifies for the medical costs after any deductible or copay is met. Unless there is fraud committed by an insured the only recourse I know of is that if an insured receives a judgment for medical costs as the result of a lawsuit or damage claim some policies have a subrogation clause that could compel the insured to cover the insurer’s payouts for these costs.

    It is for this reason and a few others that I don’t trust the government to have full control of medical care. At least private insurance doesn’t take your house after you die or potentially everything you earn.

    1. Thank you for bringing up this aspect of Medicaid.

      Medicaid is essentially a “loan.” Any income or property over the amounts allowed is taken to repay the “loan.” At death, anything left is used to recoup, to the extent allowed by law, the cost of care. For the permanently disabled and their families it is a guarantee of permanent poverty, because the restrictions also affect property and income of a spouse. Once they are in the system, is it virtually impossible to get out. For those disabled early in life, it also affects the future prospects of their children. There are no assets for the children to inherit, and probably no money at any time to fund their higher education.

      I wish I had a suggestion for a better system, because although Medicaid does help people who have no other option for health care, it also contributes to the perpetuation of the very poverty it is supposed to alleviate. I’m not a health policy guy or an economist, but when a family is limited to (a) one car of small value and has to be able to transport a disabled person in that car, (b) a house, and (c)limited personal property (no significant financial assets), and when a spouse has no incentive to get a higher paying job, because the government confiscates excess earnings and savings, it seems to me that there is little chance that such a family will ever get out of poverty.

    2. Thank you for bringing this up, Darren. I went through this with some of my relatives and had the same experience.

      On top of that, Medicaid would only approve a pill form of a medication instead of the more expensive liquid version. The only problem was my niece had brain tumors and was on a feeding tube. Her doctor explained that crushing and dissolving the pills would constantly clog her feeding tube and require surgery constantly to fix it. Our benevolent government said no although most private insurance covered it. So her mother had to spend out of pocket. In fact, there was so much it didn’t cover that her mother had to declare bankruptcy shortly after her daughter died. She went broke trying to cover all the gaps in her care.

      Anyone selling you better life through big government is just trying to get your vote. They don’t actually believe it, or politicians would all live in Section 8 on Medicaid or at least an Obamacare individual policy.

    3. I am intimately familiar with the medical care and medical insurance systems of Canada, France, Great Britain and the US. The US is the only country of these four where this would happen. With a single payer system, with premiums based on income, personal funds are not touched. My aunt had ALS and was cared for over many long years with visits, electric wheel chair, electric adjustable bed, all prescriptions, and in house visits by nurses and aids; all paid for by BC Med. A dear friend was first incapacitated and then later died from early onset Alzheimers, over a period of twelve years. He never wanted for care and his family’s home and equity were not touched.

      The ideological perspective of the US is the law of the jungle. This is a survivalist mentality that is proving to be contrary to the social evolution of humans. America is that one soldier out of step with a mother proud that her son is the only one in step. In the end, we all pay for the inequality of wages and fleecing of family fortunes. Our country is the worse for this perverse perspective, in many other ways. Of course coming from a Canadian/American that carries no weight, to the small minded.

      1. Do any of the countries you mentioned have the size of the US along with the population numbers? We have 330,000,000 people. Probably more than the countries you mention put together. Such a large undertaking should be done at the State level. I would prefer sending a portion of my Federal tax to the State government for use in providing care of the State’s population. Why send $$ to D.C. and then returning the $$$ to the State, after a portion are siphoned off by D.C. for their review cost?

  6. We wait years for MikeA to help out JT w/ a weekend post and this is what we get? Damn shame.

  7. For those who choose to comment about healthcare coverage for members of congress and their staff members, please educate yourselves before you post false claims. No one posting here, so far, got it right. It’s okay for you to be wrong, and it’s okay for you to post comments that are wrong. Just know that by doing so, you contribute to the lack of accuracy on the internet. The details are in this link:

  8. The administrative costs of the private system of health care insurance are conservatively three times greater than Medicare, Medicaid, and the thirty-six better systems around the world that are organized under one system. There are over 1,300 health insurance companies in the US, most of which are re-insured by a half dozen global companies such as AIG, Lloyds, German Re, Swiss Re, etc. There is no benefit of competition only the misery and confusion of unnecessary choice. The demise of the US auto industry was partially due to the ‘misery of choice’, too many models and none of which was reliable. The US ranks 37th in the world for per capita quality of health care and next to last for efficiency of dollar cost-just ahead of Algeria. We need to hear this constantly and understand why.

    The US is the only country that advertises pharmaceuticals. This accounts for over 20% of the cost of drugs. R & D accounts for less than 17%. Yet Big Pharma argues that the high cost of drugs is due to R & D. And the politicians parrot this from down in the pockets of Big Pharma.

    The US government is, for some perverse reason, not allowed to negotiate as a block for drugs as are all the other countries. Canada buys pharmaceuticals from US corporations cheaper than the US government can.

    There is no one way to bring down health care costs but the overall cost of health care could easily be reduced by a third if the above issues were addressed. The private sector will always cost more than the public sector regarding health care. If someone wants something yesterday they will pay more and doctors will charge more to do it immediately.

    The single payer or government system that allows a second tier of private insurance and private clinics in almost all the other countries that have better systems are constantly being tweaked and adjusted to the economies of their nations. Province by province in Canada health care changes with the economy and the governments. Lately in Victoria, BC people have been experiencing longer waits as the population has been growing without the system adapting. With the new more socialist government just elected, as before, more funding will be allocated to health care. If one wants an elective procedure done immediately they can visit a private clinic. The provincial medical system will pay ‘their’ cost for the procedure and the individual can deduct the difference. In the end it is cheaper and no one pays more than a few hundred dollars a month, most much less.

    The main reasons why single payer is resisted by politicians on both sides in the US are partially ideological but totally hypocritical. The argument of not having to pay for health care for others is a falsehood. In the end we all pay all costs as no one ends up going without. Some pay cash. Some pay premiums. Some get it for free. But we all end up paying in the end. Another reason is the corporate lobbying by the oligarchs that can make or break a political career. Another reason is that if the insurance system was to be organized as it is in other countries, several hundred thousand jobs would be made redundant. We, the people subsidize almost a half million unnecessary jobs to support the private parasitic system, not to mention the CEOs and their lifestyles. Visit any doctor’s office and there will be three to four clerks administering to each practitioner, sorting out the ridiculous system that only exists in this country. We pay for that directly. Another benefit is fraud and negligence would be reduced. The Governor of Florida, Rick Scott, defrauded the American people out of a quarter billion dollars and then became Governor, twice. Somehow Americans regard these crooks like Scott and Trump as heroes because they get away with crimes the rest of us can only imagine.

    So, first step is to ban private funding of elections, like the more advanced nations. This will release the politicians from the clutches of the oligarchs. Then, perhaps, some sanity will seep into our government, more parties, better quality of representatives, more accountability, etc. Imagine a politician forced to express their opinions over a regulated national media, instead of the circus we just experienced. A democracy is only as good as its voters grasp of the issues. In the US the voters never get past the garbage coming out of the mouths of the candidates. How can a voter make a well informed decision with this stupidity going on?

    1. “The US government is, for some perverse reason, not allowed to negotiate as a block for drugs as are all the other countries. Canada buys pharmaceuticals from US corporations cheaper than the US government can.”

      This has similarities to the Medicare system. Doctors can afford to accept the lower reimbursement of Medicare because they can spread out their practice among patients with regular insurance.

      Pharmaceutical companies can afford to accept lower reimbursement from some countries because they have a diverse portfolio of clients, and they can make up the cost elsewhere. I’m not talking about the reprehensible gougers, like the EpiPen or that toxoplasmosis drug, but the reputable companies.

      What you may find interesting is that Canada actually has the second highest prescription costs in the entire world. That’s not a result you would expect from national bargaining power. Generics actually cost more in Canada than they often do in the US. That’s because although they have a regulatory board that protects against spikes like the EpiPen, they just pay a percentage of the brand name for a generic. Since companies can charge whatever they like, generics in Canada can cost up to 30% more. Many Canadians cannot afford their prescriptions.

      I do agree that we should improve cost efficiency. And I consider the increase in the EpiPen to be in the same class as Natural Disaster Profiteering. Both should be addressed in the US.

      1. As I pointed out, there is no one solution but many facets to a larger problem. Drug costs, as well as other issues, in Canada ebb and flow. With provincially administered programs there are always areas where the system(s) are not working as well as they should from time to time. Governments come and go, problems are addressed and new problems take their place. The higher cost of drugs in Canada is not something that has always been the case and will probably be addressed when its profile threatens political careers. At one time Canada was pegged at one of the higher rates of drug consumption due to lax oversight of physicians and cheap drugs. That condition has changed as it rose to the attention of more and more of those who make the policies. The short response is that any system will always have weaknesses. However, no system has as many weaknesses and costs as much as the one in the US. Only New Zealand allows advertising pharmaceuticals in the media. Think for a moment; how stupid is the person who responds to an ad for drugs on TV with animated characters going from glum to glee after popping a pill? That is simply over the edge. Think for a moment; over 1300 insurance companies all controlled by a half dozen re-insurers. That is a monopoly, not lower costs through competition. Think for a moment; subsidizing half a million jobs, just to support an industry that profits from health care. Doctors are sick of it. Consumers are sick of it. Why isn’t it changed? Because we live in an oligarchy. Control is by a few corporations, not the will of the people. There does not exist one politician that is free from the purse strings of the oligarchs. The first politician who supports single payer will find him or her self losing to a better funded opponent in their next election. This is the primary reason we are number 37th in quality of health care and 99th in efficiency regarding care received for dollar spent-per capita in this world.

        1. To Isaac,

          If only the Supreme Court had decided that voting, too, is speech, then we might still have a Voting Rights Act. [That is not a proposal for plebiscite.]

      2. Karen

        Your response to my post illustrates more clearly than I ever could, the problem with the US health care and health care insurance system. You find one problem out of the hundreds of issues and then use this as the basis of your position. The Canadian, British, French, German, etc systems can all be found to have problems. The difference between them and the US system is that they work them out in the best interests of the people. In the US the oligarchs maintain a system that only serves redundant workers, shareholders, and CEOs, at the expense of the people. When you finally come to realize this, you might have a point. Until then your post is nothing more than a ‘yeah but’….. Your supporters are those who defend dysfunction because it is American dysfunction rather than evolve.

        1. They’re very good at seeing dots, Isaac. Bu not so good at seeing the picture the dots form.

    2. Isaac is such a pathetic DNC partisan loon that it’s difficult to take anything he types seriously.

      It’s not just the pure unadulterated crap he types about Trump (God knows there’s plenty of honest criticism, such as this column), but what he does not type. Such as the fact that the DNC is wholly owned by the trial lawyers association, who positively prevented tort reform under the ACA. Which reform could save up to 1/4 of the medical procedures, per a medical doctor who practiced and also has a law degree, Charles Krauthammer. Search yourself his Tucker Carlson interview 7-10 days ago.

      Charles said up to about 1/4 of the medical procedures prescribed by MDs exist for one reason: to avoid lawsuit.

      Admittedly, I’ve not heard a peep from the party in power Re. tort reform.

      Younger healthy Americans, if charged appropriately, would pay about 1/6th the average for medical insurance. Instead of charging them 1/6th, the ACA charges them either 1/3rd the average (double what it should otherwise be) of a few hundred dollars per year fee to not have insurance.

      Apparently, Isaac’s demigod Jesus Obama fails 3rd grade math. Shock of shocks, young healthy Americans opt in overwhelming ratio to simply pay the annual fee rather than be pay twice what they should pay for insurance.

      The notion of allowing people to buy insurance after they become ill is so effing stupid and ignorant it can not even be calculated with math and/or words. Why is this not the case with all insurance, car, home, life, etc, etc.

      At this point, I admit it appears like the best answer is simply single payer. I’ll go for it, as long as every American now on disability or welfare who is physically able must report for government service full time work, and submit at any moment to drug and alcohol abuse testing. Maine started such program. Low and behold, about 90% of the welfare queens dropped their benefits rather than appear for government service. I can count at least a half dozen disgusting, putrid Americans collecting welfare who don’t deserve it. One gets cash, food stamps, and free rent, paid by taxpayers. She’s a god forsaken drunk, buying alcohol with taxpayer funds. It’s positively criminal. Another one suffered some mental trauma in her younger age, and refuses to work. Another one just refuses to play be the rules. He does have a physical limitation, but none that would keep him from working.

      1. Great comment, Karen. Year in and year out you have been the most informed and passionate on this topic.

    3. Imagine getting caught on a transatlantic flight w/ the pompous, insufferable, Canadian Rain Man.

      1. If Trump had $1,000 for every one of the insults you and others have hurled Issac’s way on this blog, Trump might be worth some real money. You may get your jollies hurling these insults, but I doubt that most of the readers of this blog get their jollies reading them.

        1. Well stupid is as stupid does. Don’t Read Them. DuuuUUUHHHH. It isn’t ad hominem if it isn’t human.

          1. Oliver is not stupid for defending Isaac. And you know it. And you don’t care. However, Isaac is overly fond of accusing Americans of being stupid. And Isaac knows he’s overly fond of it. And he does not care. At least Paul Krugman qualifies his accusation of stupidity against Trump’s red-state working-class supporters. FTR, I disagree with Krugman on that count. To be stupid is to be stunned, as in struck in one’s head by a stone. That has not yet happened to the Trumpa-lumpas. Perhaps it won’t.

            1. Using Paul Krugman, who is consistently wrong on just about everything, is not a good leverage tool for your argument. Or the rest of the MSM that he is party to. As you point out, Issac is frequently rude and condescending on this blog, and his arguments are very narrow and he frequently sound as if he is rationalizing some internal strife.

              1. Oh? Krugman wrong? So do you believe that trickle-down economics actually works? If so, how do you explain Kansas?

                1. There is no such thing as ‘trickle down economics’ its a rhetorical thrust by partisan Democrats, not an actual school of macroeconomics or a basket of distinct policies.

                  Not sure what you fancy is wrong with Kansas. Personal income per capita in Kansas is about average, violent crime rates a bit below average, property crime rates a tad above average, the labor market robust (employment-to-population ratios above average), ample tertiary schooling in terms of enrollments and institutional variety &c. The one problem you have seen is long term demographic decline in population centers with fewer than 15,000 people (and long term decline in adjacent countryside as well). This is a longstanding phenomenon and has persisted since about 1930 through a variety of macroeconomic regimes.

                  1. “There is no such thing as ‘trickle down economics’ its a rhetorical thrust by partisan Democrats, not an actual school of macroeconomics or a basket of distinct policies.”

                    This is an evasion. ‘Trickle down’ refers to supply side economics, the claim (dare we call it a theory??) that tax cuts lead to increased economic activity sufficient to generate tax revenue sufficient to make up for the tax cuts.

                    Governor Brownback in Kansas managed to lead the legislature to implement large tax cuts (and corresponding austerity measures )that he claimed would lead to massive economic growth. It did not happen. Kansas economic performance was less than its neighbors, less than the nation, and notably less than more liberal states such as California.

                    As a result of tax cuts, state deficits soared. Some conservative apologist have claimed deficits soared because state expenditures were not reduced sufficiently, despite the fact that education was cut so much the state supreme court ruled Kansas underfunded state schools by hundreds of millions of dollars.

                    General fund revenues in 2016 were nearly $600 million below 2013 levels leading to reduction in the general fund from over $700 million in 2013 to just $40 million in 2016 – this despite significant increases in sales and cigarette taxes enacted to partially offset the income tax losses.

                    Kansas’s bond rating was downgraded twice, in 2014 and again in 2016, aggravating the states precarious financial position due to likely higher interest rates on future borrowings.

                    However one stands on deficits in Kansas, the stubborn fact remains that business activity, investments and revenues did not greatly increase, refuting the central claim of supply side economics.

                    More specifically, since 2013 when Brownbacks cuts took effect through third quarter 2016 total private employment in Kansas rose 3.5% compared with 7.6% nationally. In the period ending February, 2016, Kansas actually lost more than 5,000 jobs, despite Brownback’s claim that his economic program would generate 25,000 new jobs every year. State GDP grew 4.8% from end of 2012 through first quarter 2016, compared with national GDP increase of 11.9% – less than half the national average.

                    In Kansas, despite the fact that Governor Brownback implemented exactly the tax program he asked for, business activity did not greatly increase, and business activity was not sufficient to generate taxes revenues sufficient to replace the tax revenues lost due the the tax rate decreases.

                    The example of Kansas is a complete shutout for the claims of supply side economics, which is also referred to as trickle down economics.

                    1. This is an evasion. ‘Trickle down’ refers to supply side economics, the claim (dare we call it a theory??) that tax cuts lead to increased economic activity sufficient to generate tax revenue sufficient to make up for the tax cuts.

                      “Supply side economics’ is a shorthand used for a theoretical model promoted by Arthur Laffer, an economist at USC and then at Pepperdine. The essence of it was that as you raise marginal income tax rates, you reach a point where revenue collections begin to decline because you’ve hit a point where the marginal benefit of work effort no longer exceeds the marginal benefit of leisure consumption. I don’t think you’re going to find many economists who would dispute that such an inflection point exists. Bradford deLong, for one, does not. He’s a vicious partisan Democrat, just less deceitful than Krugman. The dispute there is not whether such an inflection point exists, but at what tax rate it lies. DeLong has said that marginal income tax rates above 70% are self-defeating. Other economists put it higher. Laffer thought it was somewhere below 70%.

                      “Trickle down economics’ is a term favored by partisan Democrats and in circulation before anyone had ever heard of Laffer. My junior high school history teacher used it to describe the policies of the late Hoover Administration. That particular teacher graduated from college around about 1953. It was a dopey bit of terminology and he really was not all that familiar with the economic history of the period running from 1929 to 1941.

                      Governor Brownback in Kansas managed to lead the legislature to implement large tax cuts (and corresponding austerity measures )that he claimed would lead to massive economic growth.

                      Find me a quotation where he ever claimed any such thing. State income tax collections average about 2.4% of GDP nationally. A 20% cut in state income tax collections means you reallocate the finance of state spending between income tax collections and consumption tax collections to the tune of about 0.5% of the state’s domestic product. There may be some efficiency improvements in such a maneuver, but they’re not going to be massive. You might also see efficiency improvements by reducing transfer payments or reducing state purchases of goods and services. Critics of public expenditure (e.g. Jeremy Greenwood) have maintained that (at current rates of public expenditure) that for every dollar you increase public expenditure, you’ll have 25c worth of deadweight loss in domestic product. We’re talking marginal improvements in efficiency, not ‘massive growth’. Gov. Brownback certainly understands this even if you don’t.

                    2. There is no doubt that Brownback, using Arthur Laffer and Steven Moore as consultants, promised the sky to justify his massive tax cuts in a program of supply side economics.

                      Here is a quote from an op-ed by Gov Brownback that appeared in the Wichita Eagle:

                      “Our new pro-growth tax policy will be like a shot of adrenaline into the heart of the Kansas economy. It will pave the way to the creation of tens of thousands of new jobs, bring tens of thousands of people to Kansas, and help make our state the best place in America to start and grow a small business. It will leave more than a billion dollars in the hands of Kansans. An expanding economy and growing population will directly benefit our schools and local governments.”

                    3. That’s a sales pitch, bigfatmike. Advetisers hawking detergent tell you it’s ‘new and improved’. That’s static.

                      Brownback has the same problem any other committed Republican executive has: there’s usually a corps of careerists in the Republican caucus who can and do frustrate any serious reforms by teaming up with the Democratic caucus. Consider what’s up on the House Appropriations committee: a greaseball named Ken Calvert led 1/4 of the Republican caucus on the committee in teaming up with the Democrats to maintain funding for a collection of professors’ pork barrel programs. They aren’t large programs, but they’re about the first thing you’d elect to kill if you were a serious advocate of decentralization and circumscribed federal function. By all accounts, these goons in the Pennsylvania legislature made Gov. Corbett’s world worse and with scant doubt you find them in Topeka, too. Cut taxes, rah! rah!, but do not cut any spending. The deadweight loss is to be found in the architecture of taxation (not rates) and in the overall dimensions of spending. However, tax breaks and spending programs have their constituencies, and that’s who careerists listen to.

                    4. “Brownback has the same problem any other committed Republican executive has: there’s usually a corps of careerists in the Republican caucus who can and do frustrate any serious reforms by teaming up with the Democratic caucus.”

                      That may be the case in other states. But in the case of Gov Brownback and Kansas, Brownback convinced the legislature to pass the cuts to taxes in the areas he wanted (as advised by Laffer and Moore to unleash the economy), and the cuts in expenditures that he wanted.

                      The cuts in expenditures were so massive that in the case of education the state supreme court ruled the cuts were unconstitutional. And regarding economic development, Brownback promised the sky the moon and the stars all due to the tax cuts.

                      It was about as pure a test of supply side economics as there could possibly be.

                      But it did not work. In a previous remark I have mentioned some of the execrable, unsustainable economic results. Various measures of economic activity were significantly less, sometimes a half to a third the rates experienced by similarly situated states. The result were an unmitigated disaster.

                  2. The cuts in expenditures were so massive

                    State expenditures were as follows (per Ballotpedia), for the fiscal year ending in the year named:

                    2010: $14.044 bn
                    2011: $14.685 bn
                    2012: $14.396 bn
                    2013: $14.405 bn
                    2014: $14.669 bn
                    2015: $15.043 bn
                    2016: $15.528 bn

                    Over the six year period in question, the population of Kansas increased by 1.9%. The GDP deflator increased by almost precisely 10%. Your real expenditure per capita declined by…1.3%. Massive.

            2. I’m not “defending” Issac. I’m just trying to raise the level of debate above the level of throwing verbal rotten tomatoes back and forth.

              Issac has his own issues with civility, as you note, even though he makes some valid points along the way. His repeated use of the word “dupes” is grating. I know quite a few Trump supporters, and I would never call them “dupes” or “stupid.” Mistaken, yes. Poor judgment, yes. But even intelligent people make poor decisions, often for reasons involving emotions. Also, as Roger Ailes figured out years ago, propaganda works. (That’s why advertisers pay big bucks for Super Bowl Ads.)

              Throwing pies at your neighbors because you believe they are mistaken does not lead to much of anything productive.

          2. How pathetic that you get your jollies by writing responses like this.

    4. issacbasonkavich, Well said. As long as our politicians are allowed to be bribed by the insurance and pharmaceutical companies, the people be damned.

    5. ” There is no benefit of competition only the misery and confusion of unnecessary choice. The demise of the US auto industry was partially due to the ‘misery of choice’, too many models and none of which was reliable. ”

      This is just too stupid. Gee I wonder why Henry Ford started offering colors other than black.

      The biggest issue with subsidized insurance is once you go down that road, the people who’s property is stolen feel (and rightfully so) that they should have a say in the lazy ones lives. This is all about power, control and dumbing us down.

      1. This is just too stupid. Gee I wonder why Henry Ford started offering colors other than black.

        Aye, which is why his critics here call him Canadian Rain Man. You’re not getting paid to listen to him free-associate or write his prescriptions.

      2. Jim22: “. . . the people whose property is stolen . . .?” That is existential, Jim. Congress shall have the power to levy taxes. Meanwhile, a fair bit of the property that people have was conquered by The British during The Seven Years War, a.k.a. The French and Indian War, or, as Isaac’s former neighbors from Quebec might say, The War of Conquest. FTR, while the taxes The British levied on Colonial Americans were exhibit A in The Declaration of Independence, the founding fathers quickly levied remarkably similar taxes to pay for said independence. They also raised revenue by selling the land East of The Mississippi and West of The Appalachians to as many people other than Native Americans as could afford the hefty price for it.

        No taxes; no Army. No Army; no country. No country; no property other than labor, tools and the fruits of labor. Are you a disciple of Nestor Mahkno, Jim?

    6. “The private sector will always cost more than the public sector regarding health care. ”

      A remarkable statement that defies history.

  9. I don’t know much about history. I don’/t know much about biology. All I know is that one and one is two. And its a wonderful world. Outside the U.S. if you need healthcare.

    1. If that was true the Canadians and so many other foreign nationals wouldn’t come here for real healthcare.

      1. Your comment is misleading. Foreigners only come here if they are wealthy, and they are looking for Rolls-Royce level treatment. For most any ordinary ailment, foreign health care systems provide better care for less money, than we “enjoy” here.

        1. Beg to differ I spent two years selling insurance on the side and my best and largest customers were catastrophic policy customers from Canada. They would drive across the border even do a physical at a local clinic never late with their premiums. Most of them were in the $10,000 plus deductible class some as high as $100,000 deductible. Guess what the next step will be if ACA is not round filed. But that’ s only one part of the problem can’t attack it piece meal, tort lawyers, ultra multiplied hospital expenses, mondo costs for medicine and tons of unwanted features all contribute. along with the permanently unemployed employables. Can’t fix it without fixing everything Or the rest of the manure pile will cover the fence.

    2. That much is true. I solved Obamacare by not caring about Obeyme.

  10. Why do Senators and Congressmen and Congresswomen get free health care? Is it because they helped themselves? Yes.
    So. The first solution to the healthcare crisis is to have some Congressman or woman introduce a Bill to end CongressCare. If they are going to repeal ObamaCare then repeal McConnellCare.

    1. That’s a good point, P Runna Gade.

      I think that Congress should not exempt itself from the ACA or any other health care bill. Whatever health care bill they pass for others they should be forced to use themselves.

      That’s also why I think we should only have individual policies. Everyone should be buying in the same market. Employees with benefits have absolutely no idea what individual policy holders have been paying. If they paid the same, the ACA would never have limped along as long as it did. They would have clamored for change, and gotten a better bill, right at the start.

      By having everything an individual policy in the future, we’ll know right away if it’s working or not. I never again want a bill passed that’s too big to fail. We shouldn’t be stuck with junk just because it was written to be onerous. Too ponderous to unwind is not an endorsement of policy.

      1. That’s also why I think we should only have individual policies.

        Won’t work.

    2. The Congress will get rid of their special healthcare when they rip up the underground Senate Subway and put in bike lanes. [ = never ]

    3. It’s not free and it is obamacare although a special offering but it is heavily subsidized but sounds like the employer is about ready to dump the subsidy. See how long they will take to get the job done when they have to pay full price.

    4. I beg to differ, I would recommend that we give all the congresscritters a raise and full year’s vacation to stay away from DC. World would improve quickly.

      1. Well, that would leave the entire US government unfunded, with no way to pay Social Security, military salaries, or anything else.

  11. Medical services and l/t care services are not ‘public goods’ as economists’ use of the term. They are private goods which present some distributional problems.

    The Republican congressional caucus has no excuse for not having a plan. They can commission work according to spec from Heritage or AEI or Hoover or the RAND Corporation. Their real problem is their own mediocrity. It’s all been an exercise in striking attitudes. As we speak, Obamacare has been in a death spiral in some states, with the individual market disappearing on the exchanges and off.

    It’s not all that challenging to come up with a sketch of a plan, it’s just that you have to accept that you can have anything you want, but you cannot have everything you want. You can have comprehensive coverage and sustainability manifest in a fixed portion of discoverable personal income being devoted to publicly-finance medical care and long-term care. What you cannot have at the same time is first-dollar coverage. The deductibles have to be large and adjusted every year.

    I don’t think the Republican caucus has the stones to tell people that first-dollar coverage is not sustainable or desirable.

    1. Did The G.I. Bill and The Interstate Highway Acts provide public goods in the sense that economists use? Or do guaranteed low-interest government loans for houses or college educations and excise taxes on gasoline and automotive tires to build roads ostensibly for civil defense [don’t snicker] provide only private goods–so many more mere commodities to be bought and sold in the free market?

      1. Roads, military services, police services, and sewerage and drainage are public goods. The coasts, parklands, the air, rivers, game, and migratory species are common property resources. Medical care, long-term care, schooling, and legal services are private goods with some distributional challenges.

        1. If everyone is healthier or sicker, is the entire country better off or worse off?

          1. It’s a service which appears on the open market, ergo, not a public good.

            Its provision improves people’s utility (though not reliably). So do groceries. Groceries are not a public good.

            1. Is military defense a public or a private good? Are the vital national security interests of The United States so many more mere commodities to be bought and sold in the captive marketplace? How much did it cost The Russian Federation to buy Snowden’s stolen goods.

                1. Because national defense is a captive market. Ditto for health care. Medical services should be moved into the public good column. Stop seeing dots. Start seeing the picture. Look at the expenditure for national defense in The U. S. then tell your readers we can’t afford national health care.

                  1. Because national defense is a captive market. Ditto for health care.

                    This is a nonsense statement.

                    Medical services should be moved into the public good column.

                    Again, Diane, the term ‘public good’ is an economists term of art for a service for which producers cannot exclude free-riders from the beneficiary pool, ergo provision by private enterprise is not optimal or even possible. Medical care is not such a service. It doesn’t turn into such a service just because you feel like it.

                    1. Is the market for illegal narcotics a free market rather than a captive one because drug dealers can and do exclude free-riders [drug addicts] from the beneficiary pool? FTR, some of your readers, here, believe that illegal immigrants are free-riders whom the federal government has failed to exclude from the beneficiary pool for national defense but whose labor services have often been recruited by private enterprise primarily because those labor services are “captive” in about the same way that drug addicts are held “captive.” Does that read nonsensical to you?

                    2. The term ‘captive market’ makes sense only when you’re referring to natural monopolies.

        2. The Land Acts of 1784 and 1785 set aside one section per township for education and another for government use to be named at a later date. If public education is a private good, then how do classical laissez faire economists explain those Land Acts?

          1. The legislators who made the enactments wished to provide an avenue for subsidized education of the young.

            Again, education is a private good which emerges readily on the open market. It has some eccentric features for a private good, but those features do not make it a public good. You’re persistently failing to understand just what is meant by ‘public good’. ‘Public good’ is not ‘something I like’.

            1. You are wrong. I understand perfectly well what economists mean by their use of the term ‘public good.’ It just so happens to be the case that I disagree with that exceedingly narrow usage. Meanwhile, you’re persistently failing to reach beyond the confines of classical laissez faire economics. For instance, to say that natural monopolies–such as military defense–are the only ‘captive markets’ is studiously to ignore any and all illegal, underground markets made possible by law. For military defense is also made possible by law and taxes. Perhaps you see no difference between disagreement versus understanding.

              1. Meanwhile, you’re persistently failing to reach beyond the confines of classical laissez faire economics

                I studied perfectly mainstream neo-classical / Keynesian synthesis, Diane. You might find some fringe economists or some union shill to take exception to what I’ve said, but what I’ve said is pretty much what they’d all tell you.

                And, again, if you wish to subsidize private goods, that’s what you’re doing. They don’t transmogrify into public goods just because you like them.

                1. Do economists have a registered trademark on the term ‘public good?’ Can The Congress still decide what is or is not a public good without being sued for trademark infringement by a consortium of economists? Can we get nuclear-powered aircraft-carrier battle groups from The People’s Republic of China without risking jail or worse for violating The Espionage Act of 1917 or The National Security Act of 1947?

                  If not, then we are in a captive market for military goods, despite the comparative advantage of outsourcing national defense to China. Surely there are patients who have no alternative but to get sicker and sicker until they die from treatable illnesses years before they otherwise would have died had their illness been treated. Fewer years of life leads to fewer business transactions which leads to economic contraction. Look at how much we’re spending on national defense. Look at the tax burden for those expenditures. See the picture.

                  1. Diane, the term ‘public good’ is a shorthand for services which are necessarily provided by the state financed with taxes. They don’t arise (or they arise, but only in suboptimal quantities) from voluntary private transactions. Medical services are not that. It doesn’t matter how long you bleat and chew over it, they are still going to be not that. The question at hand, re medical services, is distributional in character.

                    You keep whining about ‘captive markets’. You find them with regard to natural monopolies (which have been subject to regulatory supervision for a century) and intellectual property.

                    1. DSS: I am not constrained by your didactic diction. Capish?

                      You can define the term captive market out of existence only in your own mind–not anyone else’s. Otherwise your defined terms would possess magical powers to cause, change and control the nature and extent of reality whatever it is or might be. And, were that the case, you might more properly define both death and taxes out of existence. I’ll wait for so long as I can.

  12. The health care debate is related to but different than the insurance debate. Health care is about many things, including both pro-active care and reactive care. Pro-active care involves minimizing use of unhealthy foods, maintaining a degree of physical fitness, and being educated about all of the things you can do that will lower reactive costs for yourself (and the population as a whole). Pro-active health care, done properly, can lower reactive health care costs significantly.

    Overall, the traditional medical care system in the US sucks when it comes to pro-active health care. Many “Non-traditional” health care practitioners, including eastern (Chinese) medical practitioners, are far more pro-active than western medical practitioners. And eastern medical practitioners recognize problems that are not even on the radar screens of western medical practitioners. Eastern medical practitioners have helped save my life more than once.

    1. Proactivity was one of the heralded benefits of HMO insurance at first and while that differs from what that form of insurance has become I agree that prevention is best in all measures.

      But unfortunately we live in a poisoned environment having far more mutagens and pathogens present in our surroundings than we did two centuries ago. Our lifestyle is not optimally conducive toward health, and there is some credible evidence to suggest that if it was not for medical gains in technology and otherwise our health might actually might be worse than it was in the past.

      1. I don’t think the average person is exposed to more mutagens/pathogens than someone who lived 200 or 2000 years ago, particularly since we’ve engineered natural plant toxins out of much of our food, and most people never venture outside of their climate-controlled bubbles. You can certainly make the argument that modern medicine is keeping weaker examples of humankind alive that would have normally died out at an early age, but the horse is already out of the barn. Picomolar concentrations of pesticides/hormones in drinking water/surface water aren’t the most significant issues informing bad health outcomes for the majority of Americans. Suicide rates and deaths by drug overdose are rising and Alzheimers’ is taking more of the elderly, but I still think outside of those cohorts and the cancers related to smoking/drinking, a primary driver of mortality is obesity-related diseases.

        And as for me, Obamacare sucks.

        1. Congratulations ! I think you are the only person to ever have used “picomolar” on this blog. And to the less-well-educated: No, it isn’t a very small tooth.

    2. Many “Non-traditional” health care practitioners, including eastern (Chinese) medical practitioners, are far more pro-active than western medical practitioners.

      More iatrogenic ailments! Great! Great!

      1. On the bright side, dentists are once again making a killing treating the unfortunate kids of woo-loving parents who think fluoride is a government mind-control agent.

        1. “We must protect our precious bodily fluids.” Brig. General Jack D Ripper

          1. LOL.
            “our precious bodily fluids”. Protect them until we need to dilute them a million-fold in H2O, then drink them
            as a therapeutic agent!!

  13. I experienced an Obamacare individual policy. Most consumers have no idea what their health insurance actually costs. Either their employer pays part of it, or the government subsidizes it. What they think health insurance costs is actually nowhere near the ballpark.

    I used to have a very affordable Blue Cross PPO. Every doctor I wanted accepted it, the deductibles were low, and the premiums were affordable. I had affordable health care. This affected me on a visceral level when I found out that Obama not only was wrong when he said that if you liked your doctor and/or your insurance, you could keep them, but that he deliberately lied. He, and the architects of Obamacare, knew it was not true at the time they said it. The designers have also admitted that saving money for the unsubsidized was never one of their goals, or predicted outcome.

    And believe me, we did NOT save any money. My deductible went from $500 to $6,000. Families now have deductibles of over $12,000. The middle class cannot pay this. Period. End stop. It has nothing to do with their level of concern for health care access for the poor. They cannot pay this. Those of us in the unsubsidized middle class individual policy holder market look at what the Democrats have done to the cost of health insurance, and feel ill. We cannot pay this.

    The Democrats fought to make us keep paying this. They have fought tooth and nail to label anyone opposed to the ACA as horrid. Are we supposed to eat cake so they can have some platform to run on?

    To add insult to injury, the standard of care was sub par. Obamacare cuts reimbursements to doctors and hospitals, around 30% in some areas. Would you like to earn 1/3 less pay? Doctors don’t. So the best ones don’t accept it. I used to take pictures of signs in all of my doctors’ offices stating they would not accept ACA individual policies and send them to my doubting friends. Many top hospitals and cancer treatment centers do not accept it. That is a death sentence to someone diagnosed with cancer who does not live near an in network cancer treatment center.

    I’ve gone over this before so I’ll just sum up: drug formularies tightened and off formulary benefits disappeared, so such costs no longer count towards your max caps. The only doctors who accept the ACA have to use a high throughput model, to see as many patients as possible, which is the opposite of quality health care. My two friends who were subsidized were so excited to get this new ACA insurance. Only…they got county style health care. The standard of care was so bad by the few doctors they could find to take it that they end up paying out of pocket to see a quality physician. The end result is that they pay more now than they ever did before, because now on top of having to pay to see a good doctor, they are still forced to pay this partially subsidized premium. Insurers are leaving the market as they hemorrhage money, and there are increasing areas where there are one, or even no provider at all.

    On the other hand, the Republicans apparently never thought they would take the White House again. Was repealing Obamacare just a catchy slogan? Because they had never built a coalition to agree on how to approach healthcare. They had 100 different ways they wanted to do it, and this skinny replacement wasn’t the best they could have produced.

    One option is to just do nothing and let this behemoth sink into the tar and die. It is failing. If the government signals no bailouts and no replacement, then the few remaining insurers are just going to bail. That would be cruel for everyone impacted. But that’s what’s going to happen if the Dems succeed in obstruction and the Republicans can’t get their act together.

    As far as other models that I like, the difficulty is that we have far higher immigration and poverty than many other nations, so they don’t have the drain on resources that we do. Shine it up with PC all you want, but this is a numbers game, not an emotional one.

    One of the systems that I find interesting is Switzerland. They take a combined approach. Everyone is required to buy a basic insurance policy, which is a very simple standard that does NOT stack up to 6 feet tall like our monstrosity. Those on lower incomes get some discounts. The basic policy is sold by private insurance companies, which are required to be nonprofit for the basic plans. They make their profits by selling supplemental policies. In order to keep costs down, all citizens pay premiums, copays, franchise fees (deductibles). There are over a 100 providers in that tiny country, so competition is brisk for those supplemental policies. ALL policies are individually purchased, so there are no relatively healthy employee pools and relatively unhealthy uninsured or individual policy holders. The employers are not in the insurance business. Just imagine, where employers won’t be forced to provide coverage for medical procedures they morally oppose! It would actually not involve them at all. Novel idea.

    And individual policy premium for an adult 26 and older would be $243, and only $56.14 for a kid.

    There is a valid argument against forcing people to buy anything. Opposition reduces, however, if the cost is relatively low. One of the main point of contention against forcing people to buy Obamacare is that middle class families cannot afford to pay a $12,000 deductible each and every year stupid! I’m talking to you Nancy Pelosi! Do you think female heads of households can pay this?)

    Unfortunately, Switzerland takes great pains to ensure that there is relatively low drag on benefits. In order to immigrate to Switzerland, you have to live in the country for something like 12 years without committing any crime under their residence visa, and you have to prove that you have a job and can support yourself. I actually prefer our own invitation to the poor. We are supposed to have a robust economy where anyone can realize the American Dream, from even the most humble beginnings. My own grandfather left home at 16 because there were too many mouths to feed during the Great Depression, hopped a train, and worked across America before landing a solid middle class career. However, with our open borders and uncontrolled migration, we have too great a strain on our resources. We need balance. I never want to get to the point where our population grows so much that everyone has to live in a city, there is no more open space, and we have to import all our food and water. I always try to think of trends in large chunks of time. What will the US look like if our population grows at this rate for 100 years? 500 years? I don’t like the scenarios. At some point we have to slow down our growth or the environment and our resources will collapse. And one of those tipping points is our public resources.

    Another system that has some good points is Romneycare. I like that he got universal,100% consensus between Republicans and Democrats, it had a very focused goal (get rid of the free ride for those who could afford health insurance, choose not to, and then show up to get treatment). I like that the bill was concise. I like that it didn’t try to remake the entire health insurance industry, require certain coverage, or force little old lady nuns to pay for contraception or abortion coverage. It was just a tidy little concept. There are aspects that I don’t like, and it won’t work in every state.

    But those are the two directions that I’d like to explore and learn from.

    Look, I accomplished more in this one long post than Congress has in 7 months. I keep waiting for my phone to ring with Congress on the line asking me how to fix this, but it never rings…

    And that’s part of the problem. The politicians who cobbled Obamacare together didn’t actually understand what the poor and middle class really want and need. (They gave a false promise of quality healthcare to the poor when it really amounted to the same bad care anyone could get at a county hospital for free.) How many years have Dems claimed that people like me were lying when we complained about unaffordable costs and limited access to doctors? That is, until the studies and reports started coming out that they couldn’t ignore. And even THEN it wasn’t until Trump actually won that all of a sudden Dems cared about the high cost of Obamacare. If Hillary had won, there would be none of this talk about the middle class not being able to keep the lights on because of Obamacare. And Republicans don’t seem to really have a grasp on what the poor and middle class really want and need. They know Obamacare is failing, but that’s about it.

    Congress is letting down the American people. I am so disappointed, and worried.

    1. Let me add one point.

      A common solution proposed is Universal Healthcare/Single Payor.

      Single payor or universal healthcare is not a type of healthcare or a standard of quality. You could have a single payor Christian Science insurance system. Or a witch doctor system. All this means is that the government would collect taxes and turn around and pay all of the costs of health care.

      Here are the problems. It is almost universally understood, to anyone besides Nancy Pelosi, that premiums, deductibles, and copays help keep healthcare costs down. If all health care was free, all the time, then people would go to the doctor every day every time they sneezed or got a splinter. There would be no incentive to gauge if you could take care of it yourself or if you really needed to be seen. So then the benefits system runs out of money and there are long wait times.

      Those countries who choose universal healthcare discourage overuse by rationing access. There are long wait times, many months long often, and some procedures are just not covered. The government takes complete control of healthcare. Case in point was that poor baby in England who suffered a terminal genetic illness. Their parents wanted to take their baby out of hospital and fly him to the US for an experimental treatment. The US doctors felt his condition would improve. The NHS said no. The parents had no say. They fought the NHS in court, but the judge said no. The NHS got to decide what was best for their baby. They were just the sperm and egg donors, I suppose. So then they wanted their baby to come home to die. The NHS said no. He would “die with dignity” in hospice. What the heck is dignified about dying in an NHS hospice rather than trying to get therapy in the US, or at home with his Mum and Dad? Why did the government of the UK get to define what “dignity” meant for an infant in a coma? When you turn over control of your life to your government, you may not like the choices it makes.

      Switzerland is not single payor. It uses entirely private health insurance but with a hybrid non profit/for profit framework.

      1. With single payor, there is no premium, deductible, or copay. The government imposes a tax to cover everything.

        Historically, health insurance plans that had no deductible or copay were extremely expensive. Why would single payor be any different? Only, instead of calling a cost a “premium”, “deductible”, or a “copay”, it’s called a tax. And there is nothing you can do to reduce your health care costs. Working out, eating healthy, meditating, doing yoga, and quitting smoking will not reduce your costs if you pay the same tax. There is no longer saying on your deductible by being healthier. No chance for savings. And we’d all be stuck with the Cadillac plan of the most jacked up premium possible (called a “tax”) because we just had to go with the one that didn’t have any cost reducers such as copays or deductibles.

        Universal health care is not free. You pay for it. You just do so in another area, where you pay a tax.

        Who cares what they call the cost of healthcare – tax, premium, or whatever? What matters is the total cost, and if you could afford it. Venezuela has “free” healthcare, but they are only allowed to keep about $20/month of their income. The government takes all the rest. I’d call that health care pretty expensive.

      2. Karen S says: When you turn over control of your life to your government, you may not like the choices it makes.

        I must agree with this. Governments do not give their citizens their lives. Their mothers do. Consequently, governments cannot deprive their citizens of life. Governments do, however, have a great deal to do with giving their citizens both liberty and property. For instance, most of my family lives in what used to be called New France, then The Northwest Ordinance and currently Illinois. Consequently, governments can, with due process of law, deprive their citizens of liberty or property–with just compensation for the latter. In fact, governments may also forcibly conscript their citizens into military service–which puts their lives in jeopardy–and even if their mothers say no. These are but a few samples of the “first principles” to which the original poster alluded.

        The trouble comes when one perceives health care as a free market. It is not–elective procedures excepted. The only alternative for many patients is to get sicker and sicker until they die from treatable illnesses many years before they otherwise would have had they had access to medical treatment. That makes health care a captive market of very nearly the same type as military defense. Not even Adam Smith himself would apply the principles of classical laissez faire economics to the vital national security interests of any nation–wealthy or otherwise. The founding fathers themselves formed a Continental Congress to fund The Continental Army. They went deep into debt for the sake of our national independence. For when The Redcoats are coming one is in a captive market.

      3. I have to respectfully disagree with some of Karen S’s points.

        Those countries who choose universal healthcare discourage overuse by rationing access. There are long wait times, many months long often, and some procedures are just not covered.

        Not generally true. England has been under austerity assault since Margaret Thatcher and this austerity has recently been applied double dose to health care. It’s called starving the beast. So care rationing is now becoming a major issue but that is by choice of the Tories and is not intrinsic to the country. Nations of Englands economic size can afford health care if they choose to.

        These particular issues sounds more like complaints about the Canadian system which have occurred over a longer period because the federal government has been very inconsistent with financial assistance to the provinces.

        England’s wait times were not always an issue. France has never had significant wait times. Oh yes, and the vast majority of people do not like going to the doctor so that is not a real problem, but one that is being sold to the public.

        Switzerland, btw, requires by law that all insurance companies provide generous policies that MUST BE run without profit before they are allowed to offer additional “for profit” policies. Health care is highly regulated.

        It should be noted that almost all Western countries are attempting in one way or another to privatize their health care systems by the pressure of and for the benefit of modern day international robber barons, that is, banks, private insurance companies, private hospitals, drug companies, and doctors and doctor “factories” as well as financial institutions that “bet” on these markets The use of austerity has so far been the major tool to “break” the public systems and yet even with massive spare no expense propaganda efforts (usually paid for by taxes), still, most of the public responses to these privatization attempts have been highly negative. The duplicitous ways of trying to foist these systems on the public alone should be proof enough that private systems gravitate toward maximizing profit and minimizing service.

        I loath Obamacare, but I guarantee it is Wall St.and not the public preventing our politicians from making a move to touch it without putting something equally mind numbingly profitable to put in its place.

        1. England has been under austerity assault since Margaret Thatcher and this austerity has recently been applied double dose to health care.

          From 1972 to the present, the ratio of public expenditure to GDP in the UK has varied between 35% and 52% and currently stands at 42%. The median figure during Mrs. Thatcher’s 11 years in office was about 45%. The notion that this constitutes an ‘austerity assault’ will be amusing to many.

          (While we’re at it, that figure does not include the value added in state enterprises, which amounted to 10% of gdp at the time Mrs. Thatcher took office).

    2. Karen. I knew a woman who ran a temp agency. She said any resume she received longer than one page was round-filed immediately. (“It’s not worth my time to read even the first page”). She said long resumes were appropriate only for professional people, i.e. about 15% of the workforce.

      You’ve provided 1,500 words of text. Is there 1,500 words worth of worthwhile content therein, or are you squirting verbiage like a cow squirts milk?

      1. A cow doesn’t actually squirt milk any more than a woman does. But I’m so happy to have inspired such a strong visual.

        I have a lot to say about Obamacare which would never fit into a Twitter character length restriction. I suppose I could try posting 27 snippets if that would help. This is a blog post, not an oeuvre.

        1. Karen, Desperate is just a curmudgeon who has a good vocabulary but is dumber than a bag o’ hammers. She’s got a huge chip on her/his shoulder.

        2. ” I suppose I could try posting 27 snippets if that would help. ”

          Thanks for your interesting comments.

          If you are really committed to getting through to the ones with short attention span, you might try bright, colorful pictures.

    3. KS-Your right in many ways especially disappointed and worry. I often think about the stress a young married American couple are under having a baby and the bills after. Then you have an illegal sitting in some safe house waiting to go into labor, she’s dropped off at some hospital get the greatest care free and now we own them and family members.

    4. Spectacular contribution, Karen S. You and Isaac have really illuminated the relevant issues, problems, and potential starting points for a real solution. I actually am more optimistic after learning of the functioning systems which you two have described. Thank you. I have finally found something serious and coherent on this website.

      1. That”s amazing all three robo clones with the same programmer this week.

    5. As an employer, for most of the time I was in business I provided healthcare to all my employees. The individual group premiums were manageable for the employee but astronomical for dependent medical. There is no way I could afford this as a business. But I saw so many increases in premiums due to political costs it frequently tested my ability to provide this benefit.

      Health care and pension obligations are strangling many businesses and are one of the reasons for outsourcing. (because one particular task can be hired out to a company that does not provide employees these benefits and the main company doesn’t fall into violation with tax law in providing benefits)

      If health care costs were borne by the employee through a plan as you suggested in Switzerland the outsourcing would minimize and employers could actually pay better wages for lower cost. Defined contribution retirement also allows pension costs to be better managed through known contribution costs rather than open ended retirement payouts.

    6. One of my sons had an affordable Blue Cross policy the benefits of which were less than the ACA required. The premiums doubled along with the increased coverage. He’s enrolled in Medicaid now. If only he were unemployed, the ACA tax penalty would be no goad to Medicaid enrollment. Isaac is right about one thing: The system is crazy.

  14. This healthcare thing is too complex for me to offer a solution. What I can say is the Dums went gangbusters passing a system they knew would implode and the Republicans claimed for 8 years they would repeal and replace. Now the Dums who put us here are blaming the Republicans who really don’t have an answer after all. The whole crew in DC made sure that they were insulated from Obamacare with a Cadillac plan which we pay for. One thing for sure government does not belong in the business of healthcare.

    1. Every single problem that we face in either Obama failing or the changes from replacing it can be laid squarely at the feet of Democrats.

      They forced through a plan, passed on lies, that is failing. It’s down to a single provider or no provider at all in too many areas. It’s going to die whether Democrats or Republicans do a single thing about it.

      And the reason that it’s failing is in its architecture. It cannot be “fixed.” It’s foundation is flawed. You do not take a condemned house and start nailing on additions hoping it will work.

      It was deliberately written in “tortuous language” to “take advantage of the stupidity of the American people,” to quote one of its architects. It was never designed to save the middle class any money. It was passed based on deliberate lies. It is so long and impenetrable that no one congressperson could ever hope to read and understand every page. And when you pass a bill, you should read and understand every page. These are facts not opinions. You do not start tacking on amendments to a bill with that kind of un-permitted, not level, bad pour foundation. You rip it up and compost the shredding, to be environmentally responsible, and then you make a fresh new bill with all of the things that you want and none that you don’t. Otherwise, we’ll be fiddling around with this mess for a hundred years and it will still be a mess.

      Let Obamacare go, Democrats. It failed. It’s a mess. Post it on Stop trying to make political hay out of trying to save the name “ACA” when it’s hurt so many people. Face it. You just want to say that you made the enduring law of the land. But you should care more about the people than you do about politics, leverage, or platforms. It would be so much better if we could get consensus from both sides of the aisle on a whole new bill, that’s short enough that everyone actually reads it before they vote.

      1. One must wonder why so many segments of the health-care insurance industry remain keen on keeping the ACA from being repealed without a replacement? Don’t they know that ACA is just a name?

      2. Well, Obamacare was based on the “Romneycare” plan that has been in place in Massachusetts since 2006. And the Massachusetts plan was based on ideas developed by the Heritage Foundation, hardly a liberal group. Since then, Massachusetts has had the lowest rate of uninsured citizens. The details of Romneycare were tweaked to align them with Obamacare, but these were small changes. Insurers have not fled the market there, and the state has not gone bankrupt.
        Among other reasons, this is because Massachusetts wants it to work. Elsewhere, Obamacare is doing worst where state officials are doing everything they can to undercut and sabotage it. Obamacare has “failed” and is a “mess” because Republican state officials want it to be so.

        1. Well, Obamacare was based on the “Romneycare” plan that has been in place in Massachusetts since 2006. And the Massachusetts plan was based on ideas developed by the Heritage Foundation, hardly a liberal group.

          No, a Heritage fellow named Robert Rector floated a plan which included a coverage mandate. That’s it. As for Romneycare, he had to negotiate with a legislature controlled by the opposition and the task at hand was the revival of the ruined market for individual plans. That market had be ruined by previous exercises in officiousness by the Massachusetts state government.

          1. Persnickety sticklerisms. The ACA hasn’t failed until it has failed. The identification of flaws in The ACA, or in Romneycare, do not constitute failure. But here’s what would: Do nothing–nothing at all. That’s the greatest failure.

            1. Diane, he’s recycling a partisan Democratic talking point that Obamacare was a ‘Republican’ plan. It wasn’t and it’s structural flaws reflect the Democratic Party’s way of doing business.

              The problem the Republicans have manifested is a failure to produce a counter-plan.that would actually be sustainable.

              1. Could any Republican counter-plan be sustainable without taxes? If not, then could that be the real “structural flaw” you perceive in the ACA?

                1. We already collect FICA, income taxes, and state sales taxes to finance Medicaid and Medicare. It would be a question of redeploying those collections and adjusting the mode of collection.

                  With scant doubt, some of the Republican legislators haven’t a clue as to what they’re doing and the rest want to keep playing the shell-games the political class has been playing since 1965. If you want to fix this problem, you have discontinue first-dollar coverage. The only person I’ve seen advocate that is Milton Friedman, and that was 18 years ago. I think Megan McArdle has written on those lines as well. Neither is an elected official.

                  1. Suppose we take one dollar of defense spending out of The Pentagon’s pocket for every dollar of health-care spending we put into the health-care industry’s pocket. Would we then be defenseless? Would we have to increase our taxes to defend our nation? Why not increase our taxes to pay for health care while cutting defense spending by only so much as would achieve both goals?

  15. What do social security and Medicare and the affordable care act have in common? The congressmen and senators aren’t on them. They convieniently made themselves exempt from these laws. Also if you are a staffer for a congressman or a senator you are eligible for up to $12,000.00 a year assistance to help you off set the cost of the affordable care act. Now that’s thinking of the people!

  16. Michael A. That was quit a post and very well put. There are well over 25,000 Americans receiving their social security checks in Central America, because they can afford to live there(cost of living and health care).

  17. As a Republican I am angry and ashamed. One Senator asked why Trump didn’t bring a plan. Congress makes law, talk to Trey Gowdy,. Why no one started framing a law on last November Ninth was stupid. Where was Price? McCain could have had seven months of protocol.

    1. I might go a step further and say that congressmen and state legislators do not write law either. They simply sign papers.

      I had an awakening to this in a conversation I had with a lobbyist in our state. He said to me that it is rare for individual legislators to craft original bills, that most of the time the text is written by special interests and handed to them by the lobbyists. The legislators provide only small updates and sign bills. I suspect strongly this is the case at the federal level.

      It would be a curious demonstration to put a test to each of these politicians. Put them before a typewriter or computer and have them craft a bill from scratch on a simple topic, say mandating that dogs be vaccinated prior to an pet day care accepting a client’s pet. I’ll bet two thirds could not craft such a law in the standard law format and cover all the nuances of such legislation.,

  18. So far the best and most coherent writing offered on this particular situation. As an aside I could see this coming about about eight year plus off and long ago took care of the pending problem. Early on I wanted a career that offered some kind of health care after retirement. That turned out to be Tricare/Medicare not much and it still costs but better than nothing. I also knew how to go into any medical clinic regardless of funds and coverage and get stablization treatment. They could go after Medicare or Tricare I didn’t care which and when in the unions go after them first. I wouldn’t give them one thin dime. That was up to their billing clerks and the cost of those clerks was also billable.

    In retirement I have no union insurance and VA ….Well since 1988 I have yet to get a card needed to go use it which may be a blessing. BUT I have $70 a year DAN air medevac from anywhere in the world an anywhere is a place where medicine and treatment is 40% of the cost of the USA for quality service.

    So my wallet is my third payer. You absolutely cannot afford to be without it unless you are a moocher or you are filthy rich. and as we’ve seen if you ask for unreasonable forms of coverage (hey I got this medical problem going back 37 years and it needs treating, and stupid requirements like masectomy for men and cosmetic belly tucks instead of a diet. well to end I now have medicare $105 a month, TriCare an annual fee as part of retirement package, DAN evac, and my wallet. but I stay out of the USA as much as possible as a result. Priced itself out of the market and I am with a few dollars of exact median income.

    Foir those who are younger rethink your retirement the COLA adjustments are insufficent and there is no adjustment from the cycle of inflation, devaluation and debt repudiation. What ever you thought you needed in retirement double it and double it again. Can’t do that when you are 70 except by winning powerball.

    And the f’n politicians of any description absoutely do not care but truthfully it was ok until this last batch got in and for that and LBJ I will never vote for anything that smacks of socialism. The Republicans are no great shakes but the others can’t even spell Constitution but can quote Marx all day long. .

    1. Point is start young plan well then multiply by four as a minimum. Or have rich parents. OR go on welfare on purpose and use your skills to, as cream of the crop always does, milk the system. They been ripping us off long enough time for some paybacks.

      1. Is welfare still available? Oh! That’s right. Toxic Asset Relief Program. Silly me. I keep forgetting. Maybe Isaac is right about the oligarchs as well.

        1. The banks who received bridge loans under TARP paid the loans back in a couple of years and serviced those loans while they were outstanding.

          The agencies which proved to be money pits were not banks. The money pits were Fannie Mae, Freddie Mac, the auto industry components, and AIG. AIG was the cheapest date among them (and the only one not an established Democratic Party client).

          1. Still waiting on that free car that GM owes all of us… since they ducked out on that last $10+ billion in loans. Why weren’t those guys hauled out in shackles? Because of the system Darren describes above. Whatever healthcare becomes, you can bet in the current circumstances it will not improve the life for the average citizenry.

            1. I’m not persuaded that putting GM out of business would have helped the country.

          2. Were the “bridge loans” under TARP public goods or private goods in the sense that economists use? Where did the toxic assets themselves go? How did the banks repay the loans? With whose money did they “service” those loans? Can a free market privatize a nation’s treasury?

            1. The bridge loans are not, AFAIK on the public-private good spectrum.

              Some of the toxic assets were written down and left on the banks’ books, some were sold to funds which speculate in distressed assets.

              The banks serviced and repaid the loans with their revenue streams. How did you expect them to do this?

              The Treasury was not ‘privatized’ and the ‘free market’ is not an agent.

              1. Whatever in the world might the alternative rationale for TARP have been, if the provision of said bridge loans to private enterprise was neither a public nor a private good?

                The statement, ‘some of the toxic assets were written down’ means that the debt was forgiven; doesn’t it?

                The banks revenue streams are new debts; aren’t they?

                The thing itself is going to happen again; isn’t it?

                1. Bank revenue streams are not debts. “Written down” means the value of the asset on the balance sheet was cut or expunged because it was deemed to be an uncollectible receivable. No, you cannot abolish financial crises. They happen from time to time.

                  1. More persnickety sticklerism. Bank revenue streams are not debts because they are collectible receivables from agents indebted to banks. Devaluing or expunging an asset is not debt forgiveness because that asset was an uncollectible receivable, instead. Transferring uncollectible receivables from the banks’ books to FannieMae and FreddyMacs’ books is neither corporate welfare nor the privatization of our nation’s Treasury, because Three Card Monte is not a term of art employed by economists. Cazart! You really, really, truly, truly do believe in the magical power of words; don’t you?

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