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Thursday, November 3, 2016

President Clinton (II), or President Trump®, and health care policy

What hue will national health policy take after November 8th?

Margalit Gur-Arie has not posted since September 1st -- "The Dog Whistles of Health Care." Until today. The new one, on THCB, is equally a doozy.
"If Mrs. Clinton becomes the next President of the United States, Obamacare will survive largely unharmed with a few minor tweaks to address a few minor initial oversights..."

"If Mr. Trump becomes the next President of the United States, Obamacare will come under vicious attack. Mr. Trump, who is running as a Republican, adopted the GOP “repeal and replace” Obamacare battle cry pretty much verbatim..."
Well worth your time. Read all of it.
...[P]erhaps you should consider that the health care Inferno is nine circles deep, and what you see at first blush is just a hint of the horrors that lay beneath.
  • Health care is too expensive in America because America has become too poor. Health care is too expensive because American workers didn’t get a meaningful pay raise in decades. Health care is too expensive because poor people tend to be sicker and so are their children.  Health care is too expensive because there are too many middlemen and regulators between doctors and patients taking profits for busywork that adds no value. And most of all, health care is too expensive because politicians must pay back for their last campaign, and raise money for the next.
  • Health care is not a “consumer” product or service, and as Bill Clinton said, health insurance is not like auto insurance or home insurance. People don’t want to “shop” for medical care like they shop for hotels or shoes. It is frightening and humiliating to shop for your life or the life of your child. Imagine if you had to do that in a dire situation and understand that all people feel the same way (even the deplorable ones). Price transparency is just a load of crap. It’s one of those empty phrases politicians use to hoodwink voters. You are not a politician, so don’t do it. Just say no.
  • Free market for health care will work as well as free trade is working for the economy as whole. There is no such thing as free trade or free markets. There never has been and never will be. Trade and markets are manipulated and defined by the shrewdest and strongest participants. Sick people of limited means are no match for global corporations that managed to bring our entire government to its knees. Free market health care will leave most Americans with no doctors, no medicine and no care, just like free trade left us with no factories, no jobs and no income. You offered to be our voice, to fight for us and drain that swamp. There is no bigger swamp than health care in America.
  • Just take a look at the disgrace called Medicaid. No, seriously, look at it. Tossing block grants over the wall to states that are even more corrupt than the federal government, and washing your hands of the whole mess, will just make things worse. Remember that the vast majority of people on Medicaid are employed. They are employed in those new and improved crappy jobs that replaced manufacturing. Medicaid is now a penny-vacuuming machine that treats both doctors and patients like trash (with all due respect to your VP). Here is a litmus test for health care plans: would your less wealthy buddies be okay with getting care through Medicaid? Are any doctors you know okay with working for Medicaid? No? Neither is anybody else. You can’t fix health care without fixing Medicaid.
I don’t know how to fix health care. No matter how loudly they scream, how certain they are that theirs is the absolute truth, and how vigorously they wave their illustrious credentials, nobody knows how to fix health care...
A comment I left beneath her post:
“There is no such thing as free trade or free markets.”

Glad I’m not the only one saying this. Moreover, to the extent markets are “free,” the most venally adroit and asymmetrically powerful Gresham’s Dynamic actors among us are “free” to obfuscate, collude, and capture the markets for their own benefit. This is not exactly news.

Human socioeconomic affairs get regulated one way or another.

Oh, and by the way, “libertarian” Peter Thiel (Trump SCOTUS nominee?) is on record advocating Monopoly power — i.e., that “competition” and “capitalism” are mutually antithetical. See his book “Zero to One.”

“Monopolies drive progress because the promise of years or even decades of monopoly profits provides a powerful incentive to innovate. Then monopolies can keep innovating because profits enable them to make the long-term plans and to finance the ambitious research projects that firms locked in competition can’t dream of.

So why are economists obsessed with competition as an ideal state? It’s a relic of history.”

Thiel, Peter; Masters, Blake (2014-09-16). Zero to One: Notes on Startups, or How to Build the Future (p. 33). Crown Publishing Group. Kindle Edition.

“CREATIVE MONOPOLY means new products that benefit everybody and sustainable profits for the creator. Competition means no profits for anybody, no meaningful differentiation, and a struggle for survival. So why do people believe that competition is healthy? The answer is that competition is not just an economic concept or a simple inconvenience that individuals and companies must deal with in the marketplace. More than anything else, competition is an ideology— the ideology— that pervades our society and distorts our thinking. We preach competition, internalize its necessity, and enact its commandments; and as a result, we trap ourselves within it— even though the more we compete, the less we gain.” (ibid, p. 35)
See also my prior post "Election Day 2016 can't come soon enough."

To me, should Donald Trump win the election, health care federal policy reform may well be far down our list of rational concerns.

More to come...

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