Universal care here would be run by Blackrock and Pfizer (absorbed into full government agencies instead of just being the beneficiaries of them) and push pills, not health. We need to fundamentally fix the system first.
Enough hand wringing and complaining about Obama Care, how about showing everyone the republican health care plan. It never existed, and probably never will! All I hear is get rid of the ACA and the Republicans will replace it with something great and wonderful! Well where is it? I've been hearing this forever, with nothing produced in writing. The Republicans all talk about "concepts, plans and ideas,” but concepts, plans and ideas, don't help people who are sick now or can't afford to purchase medications.
Your 15,000 community health clinics number is BS. I followed the link you supplied, and looked up my zip code, and found all kinds of centers that had nothing to do with actual health care.
It's easy to complain about the existing situation, but way more difficult to find and implement an actual workable solution, because that takes real work, not words.
Well so far all my interactions with the VA health system here in the San Francisco Bay Area have been stellar, and I have zero complaints. They have been more than helpful.
When they say “thank you for your service,” I counter with "I appreciate your service, and I really do.
Taken to its logical conclusion, this sounds like a National Health Service. But it’s also incomplete. It doesn’t account for critical care, trauma centers, teaching hospitals, major medical issues, and specialty care. It covers the basics, and only the basics. We have two problems, the cost of providing care, and the coverage of that care. The government should focus on what it can do: cover the care. In the meantime, we need to work on bringing down the cost of delivering that care. Interestingly, this proposal, non-profit community health centers, is a good start. Removing private equity and for-profit ownership (and insurance) will go a long way towards solving the remainder.
Let's remember Obamacare was written by professor of health economics Nancy Pelosi. In her hateful worldview, the problem she sought to solve was greedy private insurance executives, which contributes marginally if at all to ills in our system. She didn't understand risk pools and admission to risk pools. She didn't understand adverse selection. She uses the term moral hazard without an inkling to its definition. But she certainly knew which special interests demanded to be reimbursable under her bloated definition of "adequate" insurance. 10 kindergartners couldn't have gotten this more wrong.
This will help more with the politics than with health care. Not that it is a bad idea for health care but it is based on a faulty idea of where the problem is. The sickness is not in the insurance industry but in the medical system itself. Private Equity is taking over hospitals, medical practices, nursing homes, labs and even veterinary practices. We are still in the pump phase of their business strategy but dump is coming. Supply restrictions by the professional cartels enhance this effect. IBeyond that is the 30M illegal aliens who are free riders. The unhealthy habits of Americans are a big problem too. Even if MAHA reaches is potential, it is a long term strategy. And nothing is going to reverse the aging of the population other than a fertility increase. MAFA? People blame insurance because that is who they interact with but the problem is much,much deeper.
"We are still in the pump phase of their business strategy but dump is coming."
The question in my mind, Richard, is why so few seem to understand the fundamentals. Oh, the obscurantism and motivated reasoning is clear enough as a contributing factor, but there is a disconnect, a sort of willfully-embraced cognitive dissonance.
Your conclusion regarding the depth of the problem is a poignant observation. It's a set of interlocking "wicked problems" where every proposed "solution" introduces even more intractable obstacles.
There are no solutions, absent a clear and honest assessment of the problems. Most folks don't seem to grasp that regardless of their disinterest in economics, economics is interested in them.
Excellent post, Chris. Not a complete answer, but a big step in the right direction. Meanwhile, President Trump has been promising to unveil a fantastic health care policy for America for…checks notes…ten years. We still don’t even have from the president the sketch of an outline for the concept of the possibility of a plan. You’d think the greatest tribune of the people ever to walk the earth and the advocate for the forgotten America would have had a crack team working night and day on this absolutely fundamental heartland, pocketbook, common good issue. You’d think that your own idea would have occurred to said crack team. What could possibly explain the fact that all we’ve heard for ten years running now is crickets?
I read this article the last time it was here, and I liked it. Since then I've mentioned the idea a few places. Health centers are a great idea, Health Savings Accounts a horrible one.
College graduates can't fathom how to handle money, like compounding interest on loans is a concept beyond their ken. How is someone barely literate supposed to make informed decisions about co pays, deductibles, premiums, max out of pocket, various coverages, etc. I can't and I think I'm bright. Most people can't save anything.
Health centers should be open 24/7 and serve the function that primary care now does. Open to all, with insurance or without. The staff at the centers can assign coverage and referrals if needed. Much of our cost come from being needlessly complicated. Around the world when I need medical care I go to the closest hospital, and they take it from there, why can't we have as good a care as the third world for regular issues?
Obamacare is affordable. It is based on income. The choices in coverage are wide and they offer the same coverage that people can get through their workplaces.
It's horrible, so are the plans at workplaces. Impossible to understand, all that money out of pocket means no health care. Below a certain level you are on Medicaid, which is free, but administered by states and very hard to stay in compliance if your income varies, also very hard to get care as many in health care dislike medicaid patients.
Its amazing how the author snarkily dismisses just another "23 billion" to keep the Medicaid subsidies for the ACA afloat while glibly describing the $50B to bail out hospitals in rural areas as a step in the right direction. Back here in the real world, that $50B is nothing more than an admission that republicans have no plan - indeed, have never had a plan - for healthcare at all, other than cutting services for the poor. That is, the poor that live outside the areas that vote for Trump.
Sending money directly to HSA accounts is a bad idea - it would actually make things worse for anyone who can't afford insurance.
Sending money directly to HSA accounts would help people who need routine healthcare. But what about the catastrophic coverage that Obamacare provides? Major hospitalizations would eat up the additional HSA money as well as any money saved by not enrolling in Obamacare, leaving people vulnerable to medical bankruptcies - an almost unique feature of our healthcare system.
The core issue with our system is its cost - 40-50% more than other countries pay for similar (or better) outcomes. President Trump has talked about attacking prescription drug prices - allowing Medicare/Medicaid/insurance companies to negotiate prices would be an obvious first step. Elimination of employer tax deduction for health benefits is another.
But a move to a real market solution - where health care 'insurance' is really insurance - meaning covers catastrophic events, and people paid for most of their other costs out of pocket (along with real price transparency and support for low income people via tax breaks or subsidies) would be a effort that could provide better care for our citizens at less cost than even our competitor countries pay. We could lead the world in our solution. But I doubt either party has the ability to even suggest such changes. Give that, I'm afraid we'll be stuck in the world of "subsidized insurance for all" that we're in now...
Right now HSAs are tied to HDHP, what would be great reform is creating HSAs tied to Direct Care with no insurance requirement. Focus on health centers is fine but that affects few people.
Great post, but pls reply to Mr. Cuttler's comment below re: health centers being BS. Do these wonderful community centers exist or not? And there was no mention in your writing re: the massively organized insurance (now vertical-integration) lobby that pressures lawmakers in both parties to do things their way every time. They will fight to the death to keep their bloated, useless industry profitable and happy, and I've never seen a legislature yet who will stand up to them. Even Obamacare came about only because "all stakeholders" were "at the table," and we need solutions to healthcare that do NOT include the "coverage" lobby. Thank you again for this great discussion!
Emper’s ideas are nothing more than minor tactics to score political points rather than make Americans healthier, and most importantly, keep them alive if they are not. I’d prefer to see any party address the real problem in health care: the financial customer in almost all aspects is never the patient.
This is a “just okay” solution. Senate Republicans led by US Senator Don Nickles (R-OK) devised and introduced the Consumer Choice and Health Security Act 32 years ago, which allows consumers to buy and own their own guaranteed-issue, universal, tax-credit-funded health insurance plan that allows them to buy only what they need, just like auto insurance. https://kellyjohnston.substack.com/p/go-ahead-gop-take-on-the-health-care
Until we provide universal health care (like every other developed nation!!!) this is our best plan.
Universal care here would be run by Blackrock and Pfizer (absorbed into full government agencies instead of just being the beneficiaries of them) and push pills, not health. We need to fundamentally fix the system first.
I agree with you. I recently read an article by Bobbie Anne Cox. I like her idea of getting the government out of insurance. Make insurance part of the free market and give out health vouchers for those who cannot afford insurance. It is time that people have a choice in their insurance and force some competition. Maybe that will bring down the prices, and the consumer will be treated better. Here is the article: https://open.substack.com/pub/attorneycox/p/pawns-in-a-political-game-of-chess?r=2c9g6j&utm_campaign=post&utm_medium=web&showWelcomeOnShare=false
Enough hand wringing and complaining about Obama Care, how about showing everyone the republican health care plan. It never existed, and probably never will! All I hear is get rid of the ACA and the Republicans will replace it with something great and wonderful! Well where is it? I've been hearing this forever, with nothing produced in writing. The Republicans all talk about "concepts, plans and ideas,” but concepts, plans and ideas, don't help people who are sick now or can't afford to purchase medications.
Your 15,000 community health clinics number is BS. I followed the link you supplied, and looked up my zip code, and found all kinds of centers that had nothing to do with actual health care.
It's easy to complain about the existing situation, but way more difficult to find and implement an actual workable solution, because that takes real work, not words.
Turn the VA into community health centers. Give vets choice of providers.
Well so far all my interactions with the VA health system here in the San Francisco Bay Area have been stellar, and I have zero complaints. They have been more than helpful.
When they say “thank you for your service,” I counter with "I appreciate your service, and I really do.
Taken to its logical conclusion, this sounds like a National Health Service. But it’s also incomplete. It doesn’t account for critical care, trauma centers, teaching hospitals, major medical issues, and specialty care. It covers the basics, and only the basics. We have two problems, the cost of providing care, and the coverage of that care. The government should focus on what it can do: cover the care. In the meantime, we need to work on bringing down the cost of delivering that care. Interestingly, this proposal, non-profit community health centers, is a good start. Removing private equity and for-profit ownership (and insurance) will go a long way towards solving the remainder.
Let's remember Obamacare was written by professor of health economics Nancy Pelosi. In her hateful worldview, the problem she sought to solve was greedy private insurance executives, which contributes marginally if at all to ills in our system. She didn't understand risk pools and admission to risk pools. She didn't understand adverse selection. She uses the term moral hazard without an inkling to its definition. But she certainly knew which special interests demanded to be reimbursable under her bloated definition of "adequate" insurance. 10 kindergartners couldn't have gotten this more wrong.
This will help more with the politics than with health care. Not that it is a bad idea for health care but it is based on a faulty idea of where the problem is. The sickness is not in the insurance industry but in the medical system itself. Private Equity is taking over hospitals, medical practices, nursing homes, labs and even veterinary practices. We are still in the pump phase of their business strategy but dump is coming. Supply restrictions by the professional cartels enhance this effect. IBeyond that is the 30M illegal aliens who are free riders. The unhealthy habits of Americans are a big problem too. Even if MAHA reaches is potential, it is a long term strategy. And nothing is going to reverse the aging of the population other than a fertility increase. MAFA? People blame insurance because that is who they interact with but the problem is much,much deeper.
"We are still in the pump phase of their business strategy but dump is coming."
The question in my mind, Richard, is why so few seem to understand the fundamentals. Oh, the obscurantism and motivated reasoning is clear enough as a contributing factor, but there is a disconnect, a sort of willfully-embraced cognitive dissonance.
Your conclusion regarding the depth of the problem is a poignant observation. It's a set of interlocking "wicked problems" where every proposed "solution" introduces even more intractable obstacles.
There are no solutions, absent a clear and honest assessment of the problems. Most folks don't seem to grasp that regardless of their disinterest in economics, economics is interested in them.
Excellent post, Chris. Not a complete answer, but a big step in the right direction. Meanwhile, President Trump has been promising to unveil a fantastic health care policy for America for…checks notes…ten years. We still don’t even have from the president the sketch of an outline for the concept of the possibility of a plan. You’d think the greatest tribune of the people ever to walk the earth and the advocate for the forgotten America would have had a crack team working night and day on this absolutely fundamental heartland, pocketbook, common good issue. You’d think that your own idea would have occurred to said crack team. What could possibly explain the fact that all we’ve heard for ten years running now is crickets?
I read this article the last time it was here, and I liked it. Since then I've mentioned the idea a few places. Health centers are a great idea, Health Savings Accounts a horrible one.
College graduates can't fathom how to handle money, like compounding interest on loans is a concept beyond their ken. How is someone barely literate supposed to make informed decisions about co pays, deductibles, premiums, max out of pocket, various coverages, etc. I can't and I think I'm bright. Most people can't save anything.
Health centers should be open 24/7 and serve the function that primary care now does. Open to all, with insurance or without. The staff at the centers can assign coverage and referrals if needed. Much of our cost come from being needlessly complicated. Around the world when I need medical care I go to the closest hospital, and they take it from there, why can't we have as good a care as the third world for regular issues?
Obamacare is affordable. It is based on income. The choices in coverage are wide and they offer the same coverage that people can get through their workplaces.
It's horrible, so are the plans at workplaces. Impossible to understand, all that money out of pocket means no health care. Below a certain level you are on Medicaid, which is free, but administered by states and very hard to stay in compliance if your income varies, also very hard to get care as many in health care dislike medicaid patients.
Its amazing how the author snarkily dismisses just another "23 billion" to keep the Medicaid subsidies for the ACA afloat while glibly describing the $50B to bail out hospitals in rural areas as a step in the right direction. Back here in the real world, that $50B is nothing more than an admission that republicans have no plan - indeed, have never had a plan - for healthcare at all, other than cutting services for the poor. That is, the poor that live outside the areas that vote for Trump.
Sending money directly to HSA accounts is a bad idea - it would actually make things worse for anyone who can't afford insurance.
Sending money directly to HSA accounts would help people who need routine healthcare. But what about the catastrophic coverage that Obamacare provides? Major hospitalizations would eat up the additional HSA money as well as any money saved by not enrolling in Obamacare, leaving people vulnerable to medical bankruptcies - an almost unique feature of our healthcare system.
The core issue with our system is its cost - 40-50% more than other countries pay for similar (or better) outcomes. President Trump has talked about attacking prescription drug prices - allowing Medicare/Medicaid/insurance companies to negotiate prices would be an obvious first step. Elimination of employer tax deduction for health benefits is another.
But a move to a real market solution - where health care 'insurance' is really insurance - meaning covers catastrophic events, and people paid for most of their other costs out of pocket (along with real price transparency and support for low income people via tax breaks or subsidies) would be a effort that could provide better care for our citizens at less cost than even our competitor countries pay. We could lead the world in our solution. But I doubt either party has the ability to even suggest such changes. Give that, I'm afraid we'll be stuck in the world of "subsidized insurance for all" that we're in now...
Do it.
Right now HSAs are tied to HDHP, what would be great reform is creating HSAs tied to Direct Care with no insurance requirement. Focus on health centers is fine but that affects few people.
Great post, but pls reply to Mr. Cuttler's comment below re: health centers being BS. Do these wonderful community centers exist or not? And there was no mention in your writing re: the massively organized insurance (now vertical-integration) lobby that pressures lawmakers in both parties to do things their way every time. They will fight to the death to keep their bloated, useless industry profitable and happy, and I've never seen a legislature yet who will stand up to them. Even Obamacare came about only because "all stakeholders" were "at the table," and we need solutions to healthcare that do NOT include the "coverage" lobby. Thank you again for this great discussion!
Emper’s ideas are nothing more than minor tactics to score political points rather than make Americans healthier, and most importantly, keep them alive if they are not. I’d prefer to see any party address the real problem in health care: the financial customer in almost all aspects is never the patient.
This is a “just okay” solution. Senate Republicans led by US Senator Don Nickles (R-OK) devised and introduced the Consumer Choice and Health Security Act 32 years ago, which allows consumers to buy and own their own guaranteed-issue, universal, tax-credit-funded health insurance plan that allows them to buy only what they need, just like auto insurance. https://kellyjohnston.substack.com/p/go-ahead-gop-take-on-the-health-care