Joe Doakes from Como Park emails:

Republicans in Congress are doing their usual job of chickening out from taking effective action, preferring half-assed deck-chair-arranging and cost-can-kicking instead of risking the chance someone might call them names.  Fixing this mess requires understanding how we got into it. 

Before the Great Depression, doctors charged what the patient could afford, overcharging some to give free care to others.  Hospitals charged the patient directly.  In the Roaring 20’s, people could afford good medical care.

 During the Great Depression, people couldn’t afford doctors so they substituted nurses and midwives or went without care.  Private hospitals ran short of money.  FDR spent federal money on medical care as a stop-gap measure.  Hospitals associated with charities or religions provided reduced-fee medical care.

 When World War II loomed, FDR worried that federal contractors would gouge the government so the Office of Price Administration set wage and price controls.  When men rushed to enlist after Pearl Harbor, employers scrambled to fill positions on the now-booming assembly line but were unable to offer higher wages to entice employees.  Employers offered free health insurance to pad the offer and deducted the cost as a business expense.

 After the war, employers couldn’t drop insurance because it would be seen as a pay cut.  But as Baby Boomers aged and needed more expensive care and the economy slumped reducing profits, employers were forced to drop coverage.  The clamor for free health insurance turned to government, resulting in Obamacare. 

 The health insurance problem is just like rent control in New York – it was a temporary war-time something-for-nothing measure that was continued too long and now the addicts are screaming because they won’t get their special war-time subsidies.  They shouldn’t.  The war is over.

 The first step is to end the deduction for employer-paid health care so that more employers drop coverage, and prohibit units of government and unions from paying for health insurance, which will level the playing field as everybody becomes a health insurance consumer, same way everybody is a car insurance consumer.

 The second step is to let states decide what insurance policies are allowed to be sold.  Minnesota coverage will cost a bundle because the legislature will require every policy to cover everything.  That decision will cost us jobs as employees leave to get lower premiums elsewhere.  The laboratory of democracy eventually will find its balance.

 The third step is to means-test Social Security and Medicare.  Seniors who can afford to pay, must pay, or the system goes broke.

 The fourth step is to limit the use of welfare medical care.  People who buy health insurance have deductibles and caps so they don’t run to the doctor for every sniffle.  People who don’t buy insurance should have similar incentives to conserve resources.  Yes, this means some children will suffer and die.  If the entire system collapses, all the children will suffer and die.  We’re trying prevent that.

 The fifth step is to deregulate medicine.  Allow more drugs to be sold without prescription.  Allow non-doctors to prescribe medicine.  Allow medical providers flexibility in meeting standards.  The country doctor who had his office in the front room of his house could handle most of what came in the door, he didn’t need admitting privileges at a Level 1 trauma hospital.  That policy might also mean recruiting more health care professionals from other countries – we’d rather have them than have unskilled laborers climbing The Wall.

 The sixth step is to limit medical malpractice lawsuits to reduce malpractice insurance premiums so doctors can afford to charge patients less.  Doctors make diagnoses by using statistics to play the odds, there always will be mistakes, not every mistake is a lottery ticket.

 I know: Democrats will howl.  The media will howl.  College kids will howl.  Seniors will howl.  Everybody who wants Free Stuff will howl that they’re not getting enough Free Stuff, fast enough.  Doesn’t matter, clean up the mess anyway because (a) it’s the right thing to do and (b) if we don’t, the system will collapse and the howling will be even worse.  Time for Republicans to man up and do the right thing, for a change.

 No, I’m not holding my breath.

 Joe Doakes

Nor should you.  The cult of the government savior is ascendant.

16 thoughts on “Howl

  1. What the socialists promise you isn’t health care, but access to health care, which is not the same thing at all.

  2. I don’t agree with every single fix, but I wish like hell the GOP would have taken a year and laid it all out like that, plus how the ACA is both imploding and was very clearly built to force single payer.

    Joe Doakes for Dictator Of Everything.

  3. Taxation is theft because when the government generates so many non-public goods the value generated is negative. 100 years of this crap. This is why we are in this mess and the GDP is chronically low by ***33%***.

    How can you pay for this stuff without more GDP?

    Question: is means testing wealth taxation? How did it come to this? Where does it stop? The Left loves wealth taxation now, but the only one that helps anything is Medicare.

  4. IMO, the way out of this is an Americanized Swiss system that simply stuffs cash into Large HSA based on what you need to socialize. The baseline would be the amount for a catastrophic plan with a majorly fat deductible. The reason Guber, Obama et. all. didn’t do this is because it’s too transparent, and they can’t central plan the destruction of the health insurance system much with it. On the other hand they could hijack it later with some bad elections.

  5. First of all, politicians have become accustomed to bribing voters by ever–greater spending. So we don’t even pretend to run a balanced budget.
    Secondly, there are too many stakeholders involved with too many varied interests to successfully reform healthcare. And yes, the Swiss system would cure what ails our current system.

  6. And why is it we can overspend? Fed discretion. Rob, rob, rob the future with money printing and the debt it generates. Voting just makes it worse. I’d be for socialism if it worked. We are proving it doesn’t.

  7. Eminently sensible suggestions, which, of course, won’t come to pass. My accountant has told me how much I can collect from Social Security if I delay benefits until age 70, and it’s like winning the lottery. Yes, I could live easily on my retirement account. But why leave all that money lying on the table? Nobody else is. I’d settle for getting back what I paid into the Social Security Ponzi Scheme, plus interest, and call it square.

  8. “I’d settle for getting back what I paid into the Social Security Ponzi Scheme, plus interest, and call it square.”

    When I was 30, I said the feds could keep everything they had forcibly taken from me to that point, if i could opt out right then. 20 years later I can’t logically make that deal, but in reality, I’ll get back even less than I’d have lost at 30.

    The fed needs to start winding SS down. Set a limit for new workers; anyone that has put in less than, say $30k loses it, but is out. Those of us that have been ripped off for a lifetime will have to settle for pennies on the dollar, but those of us who saw that coming years ago never counted on anything better anyway.

    Those that didn’t will be reminded, in the harshest terms, that trusting the government was always a suckers bet. Hopefully, at a minimum, they have raised their kids to recognize a fiduciary responsibility to their parents. Sorry, but there it is.

  9. How in the hell could they not put automatic actuarial stabilizers into Medicare and Social Security? Theft and graft.

  10. Covering more people is the easy part. Just make buying a certain amount of health insurance mandatory. People act like it’s a frikkin’ miracle, and a testament to the genius of Obamacare, that more people are covered.
    The real trick was supposed to be bending the cost curve. That didn’t work. Covering 10 or 20 million more people is meaningless if you can’t bend the cost curve. Soon they will be paying $20k/year in premiums for a plan with a $20k/year deductable and a max lifetime payout of $100k.

  11. Any resemblance between AHCA and a health insurance bill is purely coincidental.

  12. If we did the whole Twila Braise thing the deflation in health care and health insurance would spin your head.

  13. JD, you’re on the right track but to effectively deal a deathblow to obamacare congress needs to address, and I suggest repeal, most of ERISA, specifically ERISA Section 514.
    Obamacare was built to service and support the demands of ERISA’s most adamant defenders and cannot be effectively undone without a direct assault on ERISA itself. The deep entanglement with ERISA is the reason Ryan is having so much trouble envisaging an adequate replacement for Obamacare

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