Categories
society

Block Grant It All

Instead of sending money for particular things to the states, the federal government should send a single check, along with letters to every citizen of what they have calculated the statewide improvements should be if the money is responsibly allocated and what the results were over the previous period. If the people do not see the predicted results, they can know their state government is to blame and fire them.


1 October 2016

Dear Citizen of the State of Freedonia,  

We have sent your state $30 billion for 2017-18
as part of the Great America First Transfer Act
(GAFTA).

By our projections, Freedonia should provide
the following improvements:

1. 10% increase in total healthcare enrollment.  
    1. 10% decrease in obesity rates.  
    2. 3% decrease in heart attack fatalities.  
2. Infrastructure improvements:  
    1. State roads improved from D- to C-.  
    2. State bridges improved from C to C+.  
3. Poverty down from 15% to 13%.  
    1. Reduced unwanted pregnancy 10%.  
    2. Improved access to education 50%.  

If these improvements are not realized, the
agency recommends you vote for different people.
Note that failure to see improvements will
result in reduced funding, and if failure
continues, Freedonia will be placed in
receivership.

1 October 2018

Dear Citizen of the State of Freedonia,

We sent your state $30 billion over the past two
years 2017-18 as part of the Great America First
Transfer Act (GAFTA).

They have performed as follows:

1. 2% increase in healthcare (expected: 10%).  
    1. 12% decrease in obesity (10%).  
    2. 4% decrease in heart attacks fatalities (3%).  
2. Infrastructure improvements:  
    1. No change in state roads (D-; expected C-).  
    2. State bridges worsened (C-; expected C+).  
3. Poverty remained unchanged at 15%.  
    1. Unwanted pregnancies up 5%.  
    2. Diminished access to education.  

Due to the overall failure to meet the benchmarks,
the 2019-20 GAFTA grant will be for $24 billion. A
subsequent failure to improve will result in the
state losing control over GAFTA funds and a
takeover by the federal government.

By our projections, Freedonia should provide the
following improvements:

...

We urge you to vote next month. Freedonia may
benefit from new leadership that can deliver the
needed improvements to Freedonia.

Conservatives want smaller government, but they seem reluctant to put their mouth where their money is. Make the government tell people when they’re being screwed by lousy governance. Given that a majority of state governments are Republican-controlled, they should be eager to make such a change.

Under a block-grant-plus-reporting system, the people would know if their government was not effective. They would be able to compare such a report to the other 49 states and see where things stand. It would increase transparency while returning much control to the states, where conservatives say it belongs.

We have good measures of what healthy governance looks like. We just have a complicated system that often thwarts its delivery. And we have endless fighting over whether we should have good governance or more tax cuts. A block-grant system cuts through all of that. It says to conservatives, either you can deliver on your promises, or the public can vote you out.

A copy of the information would be affixed to the top of all ballots, and incumbents would be clearly marked.

Categories
society

An Even More Better Way

Nobody likes the Republican plan. The nerds said it will screw everything up except for rich people. The übercons said it doesn’t harm enough poor people. The bleeding-heart moderates said it harms too many poor people. The liberals agreed with the bleeding-heart moderates, and they added that Jesus also would agree with them.

There’s been talk of some rework before it gets to the House, but with so much division it seems like any fixes will surely tip it too far for two-plus GOP senators. There’s no way they can swing single-payer. What to do?

  1. How to Pay for It
  2. Medicaid
  3. Marketplace
  4. Employer Coverage

How to Pay for It

Republicans hate taxes. That limits the options to some combination of:

  1. Raise the deficit.
  2. National lottery.
  3. Subsidized Time (see Infinite Jest by David Foster Wallace).
  4. Price controls.
  5. Competition.
  6. Carbon Tax.

Or some other things.

But healthcare costs. If you do what the current bill does, the cost of care still goes up when uncovered people need care and everybody else pays for it. We pay when people file for bankruptcy. We pay when people are sicker than they should be and call in sick.

Medicaid

Some people don’t make enough money to buy insurance. Either they can:

  1. Be sicker and raise the costs for everybody else
  2. Be subsidized
  3. Be given a raise such that they can afford insurance

Now, the current plan likes the first option. The ACA does the second. Maybe we should seriously consider the third, though. We could raise the minimum wage enough to ensure that everybody who works full-time can afford coverage. Something tells me the GOP won’t want to do that.

Marketplace (and Private Insurance)

For people who make enough money, healthcare is still very expensive, particularly if they become sick enough to run through their deductible. That’s at least $10,000 on average, per year of being sick. For upper-middle-class folks and above, it’s doable. For anybody lower down, more than a couple years of that will start to wear them down and make bankruptcy inevitable.

Ideally, for anybody who isn’t earning above maybe a couple times the poverty line, there would be a much lower cost guarantee, linked to income. Some sort of stability.

But none of this is entertained by the Republicans.

Employer Coverage

Employer coverage is a hardship for businesses and employees. It keeps people from changing jobs, and it makes it more difficult to start some businesses or grow them. It should be phased out.


The basic choice here ends up being between paying more, covering less, or cutting costs. All three are unpopular, but the current proposal sees kicking people off healthcare as the best choice of the three. It puts budgets and the wealthy before the people. So much for populism.

Categories
society

This Healthcare Mess is All Your Fault

Look. God knows you can’t pick a cellphone plan or a cable plan without paying through the nose. But you have to get smarter, America. Stop getting sick, and when you do get sick, spend less on getting better (never mind that, like with cellphones and cable, there is major price obfuscation at play; never mind that, like cellphones and cable, you are shopping for an inclusive product and can’t duck out of one hospital for a blood test at another). If you weren’t so stupid, the very smart Republicans wouldn’t have to take all this time and effort to fix the mess you made.

That, in a nutshell, is the message put forth by the GOP. You should be squirreling your money away in a health-savings account, doing reverse auctions for your care when you get the flu. Set up a proper bidding process, for Christ’s sake! And if amputation is the cheaper option, you didn’t really need that arm anyway! Sigh. I’m ashamed, frankly, to call you an American. The CBO estimate may say it’s not your fault, but the CBO is just a bastard machine full of bleeding heart liberals coddling your snowflake ass.

Fun fact: the Democratic Party is the real anti-abortion party. The Republicans may be pro-life, but the Democrats are anti-abortion. Their support for contraception and for organizations like Planned Parenthood have prevented thousands of abortions. The Republicans haven’t prevented a one.

Fun fact: insurance is when the healthy pay for the sick.

But somehow, abortion is still Planned Parenthood’s fault. They need defunding. Those heathens, how dare they prevent abortions! Their fault! Shame, shame, shame.

But somehow, the sick are the source of the problem. They’re cutting into profits.

We have to fix healthcare, it’s dragging the economy down. The same economy that keeps posting positive, healthy signs from jobs numbers to construction. That economy is in shambles thanks to your wastefulness on healthcare. So we have to fix healthcare by giving the wealthy thousands of dollars a year for every schlub we kick off the insurance rolls. To the tune of hundreds of billions of dollars and ten million newly uninsured.

Because, it’s your fault, God damn it. What are you trying to do to America! Asshole!

——-

I don’t see a good way around the above conclusion. It’s all our faults. We thought we had a society, when in fact we’ve got a business venture that we’re all just screwing up so badly on. The Republicans have tried to get it through our heads, but somehow we just can’t seem to avoid getting sick. And they don’t want to reward our selfishness by actually paying for the care we need.

Fuck them. It’s idiotic, and their bill is a pile of shit. Anybody who has bothered to look at the whole picture of healthcare knows it. Anybody who has looked at the economy knows that the rich aren’t suffering and don’t need these tax cuts.

The goals for the American Healthcare Act (Aha!, AKA Trumpcare, AKA Republicare):

1. Technically count as “Repeal and Replace”
2. Not wander too far from the status quo as to fuck everything up

The actual bill? Fails on both counts. On Medicaid they will gut the expansion through a sort of sideways rescission. They withdraw it in 2020, but in the meantime bleed it out by making it harder for individuals to remain covered. On the individual market, the subsidies get contorted so that most people pay more for less. Coverage gaps means 30% more, being old means 5× the cost.

And, on top of all of that, it’s not even a real repeal. It leaves the mandate, just zeroes out the tax. It leaves the regulation of insurance. It leaves in place (though delays) the Cadillac tax.

But, to hear the Republicans tell it, this is all your fault. Pathetic.

In a few years when all the Republicans finally admit the existence of global warming, they’ll blame you for that, too. Sad.