An Even More Better Way

Nobody likes the Republican plan. The nerds said it will screw everything up except for rich people. The ├╝bercons 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.

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├Ś 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.

Immigration and Trade: Trump’s Iraq

President Donald Trump, our Markov-chain in Chief, had been an ill-weather critic of the Iraq war, and over time his criticism developed to the point where, in the face of intelligence that the Russian Federation acted to unlawfully tamper in the 2016 election, he claimed we cannot trust the intelligence community.

But Trump himself is cooking the books on immigration and trade. With respect to undocumented immigration and with respect to documented immigration from Muslim-majority nations, he is over-blowing the threats while ignoring the benefits. He pretends that the reality warrants his response, when it does not. And again on trade, where he sees an economic world very different from the one that exists. Taken together, this is Trump’s (first?) Iraq.

It will not be as bloody, and it may only be a fraction as expensive in direct costs, but it is still a major blunder supported only by faulty intelligence and an administration hell-bent on pursuing a policy while ignoring all the red flags.

Donald Trump would have (is having) the USA invade itself. In the wake of this invasion, there will be economic calamity. There will be huge disruption to the lives of many innocent people. It is an asinine vision from a cross-eyed administration that cannot seem to admit when it has made a mistake.

All the while, he is treating the budgeting process as a piggy bank ripe for the hammer. He is proposing a number of major spending initiatives and his only hope of paying for them is that the economy would grow so fast that the interstate highway system would develop stretch marks.

But that’s not going to happen. Worse, the opposite is sure to pass if we see the expected downturns in tourism, agriculture, construction, and other sectors that will be mauled by his anti-immigrant lunacy. The projections that this administration would have us believe excuse not paying for spending up-front will look like cruel jokes.

All the while, the debt grows, the politicians become more reluctant to spend correctly in the face of their past mistakes that were all caused by incorrect spending… This is not the path to a great America. They tried the austere path in Europe, and they’re still trying to figure out what’s what.

All the while, the likelihood of another recession grows. The inability to regulate industry properly makes recession worse. It makes the global threats of war worse. It increases the inevitable flow of economic refugees and helps guarantee a future of climate refugees.

We cannot afford to have an Iraq happen with every other president. Mistakes are one thing, but easily recognizable blunders need to stop. Trump’s immigration policy and trade policy are just that.

Pause 2.0

This is going to take some time. Please continue to be patient.

Post images will continue to be missing for now. Theme will be abnormal. “All is calm, all is bright…”

Economic Problems

We see it on education. On healthcare. On climate. On recreational drugs. On abortion. On practically every issue our nations face.

Our debate isn’t really about any issue, per se. It’s all come down to the economic structures we use to do work.

Take education. We know how to teach people things, more or less. While there are challenges, the fundamental question of education is one of funding. The conservatives want to have McSchools pop up across the land, where you go in and order a number six with cheese and you learn how to do algebra (with cheese). The liberals want to continue to have school lunch: you go to school and the meal is the meal.

In both scenarios, the mechanism of learning is basically the same: read, hear, watch, then practice. The idea that we need to undercut the fabric of education, that this has to be a debate rather than an experiment, is silly, but for scarcity of time and money.

The same is true on healthcare. There’s nobody saying we need to trepan patients’ skulls to let the demons out. The medical science is advancing as it is, more or less on schedule. The argument is over how much money should be made, and how should it be allocated. The courts are currently blocking the march to private-single-payer with their rulings on anti-trust actions by the DOJ.

And climate, where the oil companies aren’t arguing that global warming isn’t real (not really), that the disasters aren’t coming, but that we should pay for it by enduring its effects, rather than mitigating it. Or, as some Republicans now push for a carbon tax over regulation, maybe there can be a market structure.

Reduced to this high-level view, our problems are fundamentally about who profits and how much, a frank discussion that is sorely needed but that is continually obfuscated by pretending it’s about healthcare or abortion.

We should not be fanatical about which side of the imaginary public-private line a service like education or healthcare resides on. But, more importantly, the people should demand high-quality and low-cost with protections and rights retained wherever the service lives. That includes representation, due process, fiduciary duties, and the like.

The politicians need to stop having fake arguments about issues and start having the real argument about the monetary structures of society.


In unrelated news, 1.5% of the current presidential term is already over. Just remember, every fortnight is 1% more of the term gone.