Category: Paul Murphy

An Integrated Healthcare Strategy


What’s missing from the healthcare efforts undertaken by the Trump administration is a political strategy aimed at defeating leftist efforts to implement a national socialized healthcare scheme like those in England and Canada. Absent such a strategy, present efforts to repeal and replace ObamaCare simply play into the left’s long-term plan to force national healthcare by discrediting all alternatives.

There is a strategy that has a good chance of working — but there’s a risk: adopting only the parts the GOPe will easily accept hands the ballgame to the democrats.

The strategy has five elements:

  1. Take legislative action in the house to completely defund all actions authorized under both ObamaCare and Dodds-Frank. Pass single paragraph, full repeal legislation on both in the House and force the Democrats to campaign for 25 senate seats on 2018 on their opposition to doing what the public wants.
  2. Put a full court press on legislation, much of which Congress is currently working on, covering ancillary issues including tort reform; deregulating interstate commerce; and, equalizing tax treatment for group and private health benefits plans.
  3. Fully privatize the VA by shifting service responsibilities to privately run, for profit benefit plans. Ensure that beneficiaries have financial incentives to minimize usage and can annually choose both carriers and benefit packages.
  4. Have the secretary of Health and Human services develop for congressional review and approval a plan to place Medicaid and Medicare entirely under state control, dissolve the Centers for Medicare and Medicaid Services, and eliminate to the maximum extent possible federal legislation and/or regulation impeding state operation of these programs.
  5. Pass a new national healthcare reinsurance act limiting losses incurred by privately owned reinsurance providers on health catastrophe coverage provided by nongovernment health insurers.

Congress would decide, both as part of the initial legislation and periodically thereafter, what constitutes qualifying coverage, what the limits are, how risks are shared between government and the reinsurance industry, and what steps, if any, may be necessary to deal with states seeking to reduce their Medicaid/Medicare costs by means such as enrolling people with private health care insurance providers operating under the reinsurance umbrella.

The three most important effects this strategy will have are:

1. Politically, this strategy has Republicans doing something that seems even more unlikely than Trump’s election: honoring their commitments to the voter as the voters understand them.

If this were to happen, the Democrats and their media colleagues would be expected to gnash teeth, wail loudly, glorify victims, increase their commitment to violence, riots, and the invocation of various isms; file multiple lawsuits with their colleagues in the judiciary; mislead the public about their own positions, and be utterly wiped out in the 2018 midterms.

2. Politics would also dominate what happens to state and federal budgets. It seems reasonable to hope that the transfer of most Medicare and Medicaid monies and decision-making to the states would trigger significant experimentation with service delivery and management — and, if so, you’d expect to see some states driving toward fully socialized health care; others following the VA privatization model; most just muddling along with no clear direction; and an eventual resolution after the 2024 elections decide the political issues surrounding the leading options.

That differentiation among the states is critical because those states choosing to manage Medicare and Medicaid monies down the Democrat route to health care can be expected to reclaim VA and similar facilities while implementing increasingly bureaucratic rules for all of healthcare. That, as Canada, the U.K. and every other country from Cuba to Holland adopting nationalized healthcare have shown, will be followed by institutionalized mediocrity, the development of long waiting lists, huge annual deficits, removal of quality indicators from public review, and wildly enthusiastic claims that all will be well if only a politician promising to root out fraud and waste in the system is elected.

In contrast, those states opting for the capitalist approach along the lines of the VA privatization will thereby create incentives for medical investment, medical training, and the in-migration of patients and health care professionals from other states. As a result, these states will develop lively markets in which health care quality improves as costs go down.

Trigger this process in 2017, and by 2020 people in those states that are essentially just muddling along waiting for the politics to settle will start to see both significant contrasts between the cost and care available in states representing the two extremes and the effect of socialist state attempts to cut costs by freezing out people who aren’t legal, permanent, state residents. More importantly, those differences will become both more obvious and more dramatic as long as democrats in interventionist states stick to their policies – by 2024, therefore, most Americans will understand the differences well enough to more or less permanently reject leftist dreams of bringing Canadian or British style nationalized health care to the United States.

3. A federal reinsurance program budgeted in the $140 billion range should drop the cost of a basic individual policy for a 30-something with no known health problems and a $500 annual deductible to perhaps $35 a month — and this will require very little in federal administrative effort because there simply aren’t many reinsurers in the business.

The expected result, as long as Congress prevents the reinsurance carriers from laying off all their risks on the federal government, is that retailers will move rapidly down market and then start to compete by strategies like sliding downslope to benefits management for smaller groups or building consumer value through policy linkage to financial products like permanent life.

Note in this, that insurance companies dealing with people with pre-existing conditions have their risks limited by the reinsurance carrier which, in turn, passes costs in excess of the limit set by congress to the federal government. This program therefore greatly reduces the retail cost of coverage for people with no pre-existing conditions, and caps the cost essentially at the reinsurance limit for those facing known or imminent catastrophic health care costs.

Thus the net on this strategy is that it provides exactly what Trump promised and most conservatives want: essentially universal health care coverage in a free health care services market, while practically forcing the Democrats to destroy themselves in states where their majorities give them the ability to grow Medicare/Medicaid into fully socialized systems. 

What’s missing from the healthcare efforts undertaken by the Trump administration is a political strategy aimed at defeating leftist efforts to implement a national socialized healthcare scheme like those in England and Canada. Absent such a strategy, present efforts to repeal and replace ObamaCare simply play into the left’s long-term plan to force national healthcare by discrediting all alternatives.

There is a strategy that has a good chance of working — but there’s a risk: adopting only the parts the GOPe will easily accept hands the ballgame to the democrats.

The strategy has five elements:

  1. Take legislative action in the house to completely defund all actions authorized under both ObamaCare and Dodds-Frank. Pass single paragraph, full repeal legislation on both in the House and force the Democrats to campaign for 25 senate seats on 2018 on their opposition to doing what the public wants.
  2. Put a full court press on legislation, much of which Congress is currently working on, covering ancillary issues including tort reform; deregulating interstate commerce; and, equalizing tax treatment for group and private health benefits plans.
  3. Fully privatize the VA by shifting service responsibilities to privately run, for profit benefit plans. Ensure that beneficiaries have financial incentives to minimize usage and can annually choose both carriers and benefit packages.
  4. Have the secretary of Health and Human services develop for congressional review and approval a plan to place Medicaid and Medicare entirely under state control, dissolve the Centers for Medicare and Medicaid Services, and eliminate to the maximum extent possible federal legislation and/or regulation impeding state operation of these programs.
  5. Pass a new national healthcare reinsurance act limiting losses incurred by privately owned reinsurance providers on health catastrophe coverage provided by nongovernment health insurers.

Congress would decide, both as part of the initial legislation and periodically thereafter, what constitutes qualifying coverage, what the limits are, how risks are shared between government and the reinsurance industry, and what steps, if any, may be necessary to deal with states seeking to reduce their Medicaid/Medicare costs by means such as enrolling people with private health care insurance providers operating under the reinsurance umbrella.

The three most important effects this strategy will have are:

1. Politically, this strategy has Republicans doing something that seems even more unlikely than Trump’s election: honoring their commitments to the voter as the voters understand them.

If this were to happen, the Democrats and their media colleagues would be expected to gnash teeth, wail loudly, glorify victims, increase their commitment to violence, riots, and the invocation of various isms; file multiple lawsuits with their colleagues in the judiciary; mislead the public about their own positions, and be utterly wiped out in the 2018 midterms.

2. Politics would also dominate what happens to state and federal budgets. It seems reasonable to hope that the transfer of most Medicare and Medicaid monies and decision-making to the states would trigger significant experimentation with service delivery and management — and, if so, you’d expect to see some states driving toward fully socialized health care; others following the VA privatization model; most just muddling along with no clear direction; and an eventual resolution after the 2024 elections decide the political issues surrounding the leading options.

That differentiation among the states is critical because those states choosing to manage Medicare and Medicaid monies down the Democrat route to health care can be expected to reclaim VA and similar facilities while implementing increasingly bureaucratic rules for all of healthcare. That, as Canada, the U.K. and every other country from Cuba to Holland adopting nationalized healthcare have shown, will be followed by institutionalized mediocrity, the development of long waiting lists, huge annual deficits, removal of quality indicators from public review, and wildly enthusiastic claims that all will be well if only a politician promising to root out fraud and waste in the system is elected.

In contrast, those states opting for the capitalist approach along the lines of the VA privatization will thereby create incentives for medical investment, medical training, and the in-migration of patients and health care professionals from other states. As a result, these states will develop lively markets in which health care quality improves as costs go down.

Trigger this process in 2017, and by 2020 people in those states that are essentially just muddling along waiting for the politics to settle will start to see both significant contrasts between the cost and care available in states representing the two extremes and the effect of socialist state attempts to cut costs by freezing out people who aren’t legal, permanent, state residents. More importantly, those differences will become both more obvious and more dramatic as long as democrats in interventionist states stick to their policies – by 2024, therefore, most Americans will understand the differences well enough to more or less permanently reject leftist dreams of bringing Canadian or British style nationalized health care to the United States.

3. A federal reinsurance program budgeted in the $140 billion range should drop the cost of a basic individual policy for a 30-something with no known health problems and a $500 annual deductible to perhaps $35 a month — and this will require very little in federal administrative effort because there simply aren’t many reinsurers in the business.

The expected result, as long as Congress prevents the reinsurance carriers from laying off all their risks on the federal government, is that retailers will move rapidly down market and then start to compete by strategies like sliding downslope to benefits management for smaller groups or building consumer value through policy linkage to financial products like permanent life.

Note in this, that insurance companies dealing with people with pre-existing conditions have their risks limited by the reinsurance carrier which, in turn, passes costs in excess of the limit set by congress to the federal government. This program therefore greatly reduces the retail cost of coverage for people with no pre-existing conditions, and caps the cost essentially at the reinsurance limit for those facing known or imminent catastrophic health care costs.

Thus the net on this strategy is that it provides exactly what Trump promised and most conservatives want: essentially universal health care coverage in a free health care services market, while practically forcing the Democrats to destroy themselves in states where their majorities give them the ability to grow Medicare/Medicaid into fully socialized systems. 



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Democrats in the Cesspits of Despair


This behavior stands in stark contrast to what Republicans do when they lose elections: no serious conservative, for example, advocated that Obama be shot; tea party gatherings never turned into riots; and even fringe right wing sites generally talk more about issues than personalities.

So why are Democrats such hypocrites? Remember, they’re the party of liberal progressivism: the party that inveighs endlessly against racism but embraces eugenics, spawned the KKK, and rewards people like Al Sharpton; the party that accuses its enemies of Nazism but embraces the Moslem Brotherhood and accepts both funding and direction from the only self confessed and unrepentant Nazi in American politics; the party that sees working Americans as deplorable embarrassments to their own enlightened community for their imagined illiteracy, homophobia and misogyny but reflexively defends Islam’s right to enslave a billion women and stone deviants in the public square; and the party that fervently believes all forms of socialism morally better than the Christian ethos built into the American Constitution despite socialism’s unbroken record of devolution to mass murder, social stagnation, and the effective enslavement of more than 99% of the people by less than 1%.

When Leon Festinger and his associates undertook the work leading to their widely misunderstood and maligned theory of cognitive dissonance, their ultimate goal was to understand how forty million decent Germans and tens of millions in the rest of Europe could so enthusiastically support Nazi methods — and it’s their research on how cult members react to the unequivocal disproof of some central belief that’s important today — because the increasing calls among Democrats for violence shows that same process at work here as in Germany of the 1930s.

In brief, what happens when events disprove a cult’s major belief is that some adherents drop out; a majority first reshape their vision of reality to accommodate both their belief and an edited version of reality and then either gradually fade out of the cult or double down on their efforts to find confirmatory opinion by compromising others; and, a few set out to force others to act as if the belief stands unchallenged.

Among the last group, the nature and duration of the disproof process matters: the more abrupt and final the disproof, the more violent the reaction — leading, in the extreme, to Jonestown events in which mothers murder their own children rather than face reality. Where that disproof is gradual and cumulative, however, the extreme group both grows as some majority members find social support by edging into the extremist camp, and loses its inhibitions against the organizational use of dishonesty, crime, and violence at roughly the rate at which the belief loses market share in the society they either belong or aspire to — a classic slippery slope political and media players are particularly susceptible to because the pre-existing professional community amplifies their ability to provide their own social support while shutting out contrary voices.

The key elements that have to be in place for the true believers to slide toward dishonesty and violence are personal commitment to the belief, undeniable disproof, and enough rationality for the person to know that the belief has been disproven.

That two of these are in place with the Trump victory deniers is obvious: most of the journalists and others now attacking Trump in particular and Republicans in general have overwhelming and long term commitments to the progressive cause. This despite the fact that every major attempt to act on those beliefs, whether by Uncle Joe, Chairman Mao, the Kim Dynasty in North Korea, or that great hero and champion of the poor, Hugo Chavez, has turned into a murderous regime corrupting everyone and everything it touched.

Whether most of these people are rational enough to comprehend the truth that they can’t acknowledge is a much more difficult question, in part of course because they can’t be rational on the subject.  But the fact that they generally don’t apply their beliefs to themselves suggests that most have at least some grasp of their falsity. So far, for example, the number of dedicated leftists in politics and the media who have voluntarily gone to Cuba, Canada, or a V.A. hospital for superior health care remains, like the number voluntarily paying higher total taxes or offering lands and beaches they own for windfarm development, as close to zero as it is possible to get.

Thus the behavioral explanation for the fact that conservatives will generally accept electoral defeat gracefully whereas Democrats eagerly embrace hypocrisy, corruption, dishonesty and even violence to continue the fight by any means necessary is simply this: reality supports conservative belief, but pushes leftists down the slippery slope to the insanity of Trump derangement syndrome.  Reality forces them to continually choose between recognizing the emptiness and historical absurdity of their core beliefs or holding themselves hostage to those beliefs by escalating their commitment, no matter what foul means may be required to make reality conform to their fantasy.

I have an answer for the Instapundit’s favorite question: “Why is the Democratic Party such a cesspit of hypocrisy?” in two words: “disconfirmatory reality,” meaning the failure of reality to conform to their beliefs. This leads to all sorts of mischief and worse.

Last week, revered left wing thinker Noam Chomsky said that President Trump and the Republican Party represent a worse threat to humanity than ISIS; NBC news reader Lester Holt interrupted the President of the United States nine times in three minutes; some art professor announced that Republicans in Congress should be lined up and shot; and exactly none of the mainstream media players, from the New York Times to CBS and the Huffington Post, all of which had spent weeks enthusiastically berating Sarah Palin for suggesting the Republicans target a few House districts for election purposes protested repeated calls for Trump’s assassination or saw anything wrong with any of the rest of it.

This behavior stands in stark contrast to what Republicans do when they lose elections: no serious conservative, for example, advocated that Obama be shot; tea party gatherings never turned into riots; and even fringe right wing sites generally talk more about issues than personalities.

So why are Democrats such hypocrites? Remember, they’re the party of liberal progressivism: the party that inveighs endlessly against racism but embraces eugenics, spawned the KKK, and rewards people like Al Sharpton; the party that accuses its enemies of Nazism but embraces the Moslem Brotherhood and accepts both funding and direction from the only self confessed and unrepentant Nazi in American politics; the party that sees working Americans as deplorable embarrassments to their own enlightened community for their imagined illiteracy, homophobia and misogyny but reflexively defends Islam’s right to enslave a billion women and stone deviants in the public square; and the party that fervently believes all forms of socialism morally better than the Christian ethos built into the American Constitution despite socialism’s unbroken record of devolution to mass murder, social stagnation, and the effective enslavement of more than 99% of the people by less than 1%.

When Leon Festinger and his associates undertook the work leading to their widely misunderstood and maligned theory of cognitive dissonance, their ultimate goal was to understand how forty million decent Germans and tens of millions in the rest of Europe could so enthusiastically support Nazi methods — and it’s their research on how cult members react to the unequivocal disproof of some central belief that’s important today — because the increasing calls among Democrats for violence shows that same process at work here as in Germany of the 1930s.

In brief, what happens when events disprove a cult’s major belief is that some adherents drop out; a majority first reshape their vision of reality to accommodate both their belief and an edited version of reality and then either gradually fade out of the cult or double down on their efforts to find confirmatory opinion by compromising others; and, a few set out to force others to act as if the belief stands unchallenged.

Among the last group, the nature and duration of the disproof process matters: the more abrupt and final the disproof, the more violent the reaction — leading, in the extreme, to Jonestown events in which mothers murder their own children rather than face reality. Where that disproof is gradual and cumulative, however, the extreme group both grows as some majority members find social support by edging into the extremist camp, and loses its inhibitions against the organizational use of dishonesty, crime, and violence at roughly the rate at which the belief loses market share in the society they either belong or aspire to — a classic slippery slope political and media players are particularly susceptible to because the pre-existing professional community amplifies their ability to provide their own social support while shutting out contrary voices.

The key elements that have to be in place for the true believers to slide toward dishonesty and violence are personal commitment to the belief, undeniable disproof, and enough rationality for the person to know that the belief has been disproven.

That two of these are in place with the Trump victory deniers is obvious: most of the journalists and others now attacking Trump in particular and Republicans in general have overwhelming and long term commitments to the progressive cause. This despite the fact that every major attempt to act on those beliefs, whether by Uncle Joe, Chairman Mao, the Kim Dynasty in North Korea, or that great hero and champion of the poor, Hugo Chavez, has turned into a murderous regime corrupting everyone and everything it touched.

Whether most of these people are rational enough to comprehend the truth that they can’t acknowledge is a much more difficult question, in part of course because they can’t be rational on the subject.  But the fact that they generally don’t apply their beliefs to themselves suggests that most have at least some grasp of their falsity. So far, for example, the number of dedicated leftists in politics and the media who have voluntarily gone to Cuba, Canada, or a V.A. hospital for superior health care remains, like the number voluntarily paying higher total taxes or offering lands and beaches they own for windfarm development, as close to zero as it is possible to get.

Thus the behavioral explanation for the fact that conservatives will generally accept electoral defeat gracefully whereas Democrats eagerly embrace hypocrisy, corruption, dishonesty and even violence to continue the fight by any means necessary is simply this: reality supports conservative belief, but pushes leftists down the slippery slope to the insanity of Trump derangement syndrome.  Reality forces them to continually choose between recognizing the emptiness and historical absurdity of their core beliefs or holding themselves hostage to those beliefs by escalating their commitment, no matter what foul means may be required to make reality conform to their fantasy.



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Understanding the Ryancare Play


When it comes to health care reform, there most certainly is a right thing to do.  But those guys in Washington are clearly launched in a very direction.  So what’s that about?

Ryancare was fundamentally flawed because it accepted the basic leftist premise that government should be responsible for individual health care.  This is wrong, both morally and practically – morally because nationalized health care corrupts everyone it touches, and practically because it’s ridiculously expensive.

The Canadian situation is typical in its illustration of the moral issue.  Canadians are under enormous and unrelenting media and government pressure to praise the national health care emperor’s shining halo and glorious clothes when, in reality, the system is terribly expensive and often ineffective; disenfranchises millions; and can, at best, be said to work most of the time for most of the people.

  1. Services are rationed, with the average waiting time between initial diagnosis and non-emergency treatment now in excess of 140 days, with almost a million Canadians on waiting lists.

Since paying for services directly is, except in relatively limited circumstances, illegal, someone who needs a service is, by law, unable to buy that service in Canada until the system gets around to providing it.  Since many of the rationed services are tests or specialist judgments based on tests, and the system won’t take action on issues that can be seen as related to those tests or judgments pending their outcome, placing those affected on waiting lists effectively suspends their access to the services they need just when they need those services most.

  1. The system works well for routine, easily scheduled, and widely understood services but essentially abandons those with ambiguous (or under-funded) problems until they recover naturally.  The problem morphs into something easily recognizable and funded within the system, or these people die.

Bureaucracy can neither tolerate nor accommodate TV’s Dr. House: quality of care is de facto determined by the extent to which the problem is familiar to the first gatekeeper (usually an emergency or family physician) the patient encounters.  Thus, a friend who, forty-plus years ago, spent six years jumping out of airplanes is now feeling the consequences in his neck and upper back, but his MRI, ordered by a family physician in October of last year, isn’t scheduled until August of this year – and, because I’m fairly sure the microfractures and membrane tears that are now starting to bother him won’t be obvious to a bored tech babysitting a one-tesla unit, he’s very likely to find himself expeditiously, efficiently, and very compassionately abandoned to over-the-counter painkillers.

  1. People who are neither rich nor politically visible but think they are the victims of malpractice have no practical access to either legal recourse or the information they need to determine whether the system served them properly or not.
  2. Health care costs are largely hidden within the general tax system.  Thus, free health care for roughly thirty-six million Canadians costs each of them about $4,700 (USD) per year – mostly collected through taxes and increases in the public debt.  Thus, gasoline produced in Alberta costs people working at the refineries in Fort Saskatchewan more than twice what it does after it’s shipped to Montana.  This year’s increase in Alberta’s public debt is budgeted at around $1,850 (USD).  And most Canadians pay a 15% retail sales tax on just about everything.

Basically, “free” health care for a Canadian family of five costs that family an average of about $23,600 per year.

Trump and his advisers may not know how misleading advocacy claims (and the OECD numbers) on nationalized health care quality and cost really are, but they have been dealing with the VA example and its problems since the campaign began, including uncontrolled cost escalation, lengthening waiting lists, increasingly inadequate care, depersonalized treatment, and the suppression or distortion of both cost and quality information.  These are typical of nationalized health care everywhere.  As a result, it’s difficult to believe that Trump’s people would want to go along with the policy ideas and key assumptions built into the Ryancare proposal.

Less rationally, Ryan is the GOPe leader

And yet an administration that both has to know better and has personal reasons to oppose anything Ryan seems to have pulled out all the stops in support of Ryan’s plans.  Why?

My theory is that what Trump did made Trump look like an apolitical team player willing to work with his political enemies for the public good, left Ryan walking roadkill run over by the bus he aimed at conservatives, and is the first major step, something akin to firing a flare over a swamp at night, in a plan to rebuild the Democratic Party by making its hypocrisies obvious to everyone.

In this view, the long-term effect of the Ryancare debacle will turn out to be the light it shines on the Washington elite, because the GOPe has just shown itself to represent the values most Democrat voters think their party stands for, the Freedom Caucus and their colleagues have shown themselves to be mostly genuine republicans, and the cabal in control of the Democratic Party has shown itself to be little more than a gathering of convenience for America haters-ranging from simple crazies like Maxine Waters to the man who would be Kalif and various servants to the über-rich – like Schumer and the Clintons.

It will take further increases in acrimony, leftist violence, judicial abuse, and the operation of uninformed rhetoric for Trump and his political operatives to fully separate those in control of the Democratic Party and its media from their audience, but we’re already seeing unease among the grassroots and a market pullback as the über-rich start to understand that Trump is for real – and once the traditional balance between the elites and the middle-American Democrat voter reasserts itself, nothing will stop them until people like John Brennan are in jail, Obama is discredited, the Democratic Party once again welcomes people like Joe Liebermann, and America can safely be American again.

When it comes to health care reform, there most certainly is a right thing to do.  But those guys in Washington are clearly launched in a very direction.  So what’s that about?

Ryancare was fundamentally flawed because it accepted the basic leftist premise that government should be responsible for individual health care.  This is wrong, both morally and practically – morally because nationalized health care corrupts everyone it touches, and practically because it’s ridiculously expensive.

The Canadian situation is typical in its illustration of the moral issue.  Canadians are under enormous and unrelenting media and government pressure to praise the national health care emperor’s shining halo and glorious clothes when, in reality, the system is terribly expensive and often ineffective; disenfranchises millions; and can, at best, be said to work most of the time for most of the people.

  1. Services are rationed, with the average waiting time between initial diagnosis and non-emergency treatment now in excess of 140 days, with almost a million Canadians on waiting lists.

Since paying for services directly is, except in relatively limited circumstances, illegal, someone who needs a service is, by law, unable to buy that service in Canada until the system gets around to providing it.  Since many of the rationed services are tests or specialist judgments based on tests, and the system won’t take action on issues that can be seen as related to those tests or judgments pending their outcome, placing those affected on waiting lists effectively suspends their access to the services they need just when they need those services most.

  1. The system works well for routine, easily scheduled, and widely understood services but essentially abandons those with ambiguous (or under-funded) problems until they recover naturally.  The problem morphs into something easily recognizable and funded within the system, or these people die.

Bureaucracy can neither tolerate nor accommodate TV’s Dr. House: quality of care is de facto determined by the extent to which the problem is familiar to the first gatekeeper (usually an emergency or family physician) the patient encounters.  Thus, a friend who, forty-plus years ago, spent six years jumping out of airplanes is now feeling the consequences in his neck and upper back, but his MRI, ordered by a family physician in October of last year, isn’t scheduled until August of this year – and, because I’m fairly sure the microfractures and membrane tears that are now starting to bother him won’t be obvious to a bored tech babysitting a one-tesla unit, he’s very likely to find himself expeditiously, efficiently, and very compassionately abandoned to over-the-counter painkillers.

  1. People who are neither rich nor politically visible but think they are the victims of malpractice have no practical access to either legal recourse or the information they need to determine whether the system served them properly or not.
  2. Health care costs are largely hidden within the general tax system.  Thus, free health care for roughly thirty-six million Canadians costs each of them about $4,700 (USD) per year – mostly collected through taxes and increases in the public debt.  Thus, gasoline produced in Alberta costs people working at the refineries in Fort Saskatchewan more than twice what it does after it’s shipped to Montana.  This year’s increase in Alberta’s public debt is budgeted at around $1,850 (USD).  And most Canadians pay a 15% retail sales tax on just about everything.

Basically, “free” health care for a Canadian family of five costs that family an average of about $23,600 per year.

Trump and his advisers may not know how misleading advocacy claims (and the OECD numbers) on nationalized health care quality and cost really are, but they have been dealing with the VA example and its problems since the campaign began, including uncontrolled cost escalation, lengthening waiting lists, increasingly inadequate care, depersonalized treatment, and the suppression or distortion of both cost and quality information.  These are typical of nationalized health care everywhere.  As a result, it’s difficult to believe that Trump’s people would want to go along with the policy ideas and key assumptions built into the Ryancare proposal.

Less rationally, Ryan is the GOPe leader

And yet an administration that both has to know better and has personal reasons to oppose anything Ryan seems to have pulled out all the stops in support of Ryan’s plans.  Why?

My theory is that what Trump did made Trump look like an apolitical team player willing to work with his political enemies for the public good, left Ryan walking roadkill run over by the bus he aimed at conservatives, and is the first major step, something akin to firing a flare over a swamp at night, in a plan to rebuild the Democratic Party by making its hypocrisies obvious to everyone.

In this view, the long-term effect of the Ryancare debacle will turn out to be the light it shines on the Washington elite, because the GOPe has just shown itself to represent the values most Democrat voters think their party stands for, the Freedom Caucus and their colleagues have shown themselves to be mostly genuine republicans, and the cabal in control of the Democratic Party has shown itself to be little more than a gathering of convenience for America haters-ranging from simple crazies like Maxine Waters to the man who would be Kalif and various servants to the über-rich – like Schumer and the Clintons.

It will take further increases in acrimony, leftist violence, judicial abuse, and the operation of uninformed rhetoric for Trump and his political operatives to fully separate those in control of the Democratic Party and its media from their audience, but we’re already seeing unease among the grassroots and a market pullback as the über-rich start to understand that Trump is for real – and once the traditional balance between the elites and the middle-American Democrat voter reasserts itself, nothing will stop them until people like John Brennan are in jail, Obama is discredited, the Democratic Party once again welcomes people like Joe Liebermann, and America can safely be American again.



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Cutting the Obamacare Knots


Conservatives in Congress are not buying Paul Ryan’s proposed ObamaCare revisions mainly because Ryan seems have accepted, as Trump implicitly did when he promised nearly universal coverage, the idea that health care services should be provided federally. In effect, Ryan’s plan is unacceptable because it accepts the unacceptable: the replacement of individual responsibility for health care by collective responsibility and so drags the nationally socialized health care camel’s nose further into the tent.

Last year, the same Paul Ryan said this about a full repeal bill vetoed by Obama:

Speaker Paul Ryan (R-Wis.) on Friday pledged that Congress would vote to override Obama’s veto. The party lacks the two-thirds majority necessary to achieve that, however.


“It’s no surprise that someone named Obama vetoed a bill repealing Obamacare. But we will hold a vote to override this veto, taking this process all the way to the end under the Constitution,” Ryan said in a statement.


Ryan said the vote showed there is a “clear path” for Republicans to repeal the law.


“The idea that Obamacare is the law of the land for good is a myth. This law will collapse under its own weight, or it will be repealed,” he said. “We have now shown that there is a clear path to repealing Obamacare without 60 votes in the Senate. So, next year, if we’re sending this bill to a Republican president, it will get signed into law.”

It’s now “next year” so why not send Trump the same bill? Remember the “Romney killed my wife” ad from 2012? That’s why: the story turned out to be a lie (the wife had health insurance, died in 2006, and Romney hadn’t been involved with the company since before the layoffs) but the ad was devastatingly effective in hardening opposition to Romney among committed Democrats, including the media and the social circles the GOPe reacts to. It’s rocks and hard places for Republicans elected on a promise to repeal Obamacare: they now control the House, the Senate, and the presidency but are desperately afraid to act because the media’s emotional message will be uniformly negative and delivered by helpless minorities, weeping widows, and brave but uncomprehending children whose lives have been ruined by those terrible Republicans and the Nazi in the White House.

So what to do? how do we beat the unbeatable? Here’s a four-step program that will work:

1) Send a full repeal bill — 100% status quo ante as of some date like January 1st, 2018 – to the Senate and force the Democrats to block it.

At the same time, quietly pass the 2016 partial repeal (much of which is replicated in Ryan’s current proposal) to the president for signature.

2) Have every GOP representative and senator use weeping widows and uncomprehending children to repeatedly expose VA abuses and failures (waiting lists, inadequate treatment, excessive paperwork, improper use of resources) in his or her district or state. The VA is much better than nationalized medicine in England or Canada, but is well on its way to developing many of the same problems — and a concerted media campaign to show people what’s going on will force Democrats in every district and every state to defend the indefensible while weakening their ability to deploy the same tactics against Republicans.

At the same time, develop and pass a VA privatization bill clearly distinguishing services for active duty personnel serving outside the United States (which would remain under DOD control) from services for personnel, dependents, and others in the United States — with the latter served through ordinary employer group coverage. Ensure that members have cash incentives to minimize utilization and the power to direct DOD healthcare dollars to the providers of their choice.

3) Develop and pass a new health care act including hot button issues like tort reform, interstate access, and tax equalization through deductibility from income (but not through grants or credits) for private and employer plans, but largely focussed on the creation of a federally funded reinsurance program.

Under this program, the secretary of Health and Human Services would choose, every three years, at least two reinsurance carriers each represented in at least 40 states, to administer programs, open to all healthcare insurance providers operating in the country, designed to limit carrier exposure to catastrophic risks affecting their customers. Buy down limits, thresholds, and the carrier share of the cost, would be set in the initial legislation and amended (or automatically continued if not amended) by Congress prior to carrier selection every third year.

The point of this is that it uses limited federal funding to move health catastrophe insurance significantly down market and thus opens new markets to the industry without creating an entirely new set of perverse incentives driving costs up and performance down, without creating a new federal administrative bureaucracy, and without creating a highly visible public entitlement.

Note that this approach meets President Trump’s commitment to making coverage available to almost everyone while supporting the conservative view that people should take responsibility for meeting their own needs.

4) Have Tom Price work with all fifty governors to develop a general framework for the administration and development of both Medicaid and Medicare in light of the other changes taking place in the federal role in health care funding. Divide this effort into two: in one of which every governor regardless of party (and every state representative or senator the governor involves) gets significant local air-time; and one in which state level experts get the work done.

Basically, it’s obvious that Medicaid and Medicare have to evolve into a single program with Democrats trying to push toward nationalized healthcare, Republicans generally sitting with their thumbs in uncomfortable places, states rights advocates foaming, and no one either ready or willing to bell the cat — so lets take a couple of years, hang it all out in public as elections 2018 fodder, and let the combination of VA privatization and partially federally funded reinsurance for carriers selling cheap catastrophic health insurance show people what the right answer might really be. 

Conservatives in Congress are not buying Paul Ryan’s proposed ObamaCare revisions mainly because Ryan seems have accepted, as Trump implicitly did when he promised nearly universal coverage, the idea that health care services should be provided federally. In effect, Ryan’s plan is unacceptable because it accepts the unacceptable: the replacement of individual responsibility for health care by collective responsibility and so drags the nationally socialized health care camel’s nose further into the tent.

Last year, the same Paul Ryan said this about a full repeal bill vetoed by Obama:

Speaker Paul Ryan (R-Wis.) on Friday pledged that Congress would vote to override Obama’s veto. The party lacks the two-thirds majority necessary to achieve that, however.


“It’s no surprise that someone named Obama vetoed a bill repealing Obamacare. But we will hold a vote to override this veto, taking this process all the way to the end under the Constitution,” Ryan said in a statement.


Ryan said the vote showed there is a “clear path” for Republicans to repeal the law.


“The idea that Obamacare is the law of the land for good is a myth. This law will collapse under its own weight, or it will be repealed,” he said. “We have now shown that there is a clear path to repealing Obamacare without 60 votes in the Senate. So, next year, if we’re sending this bill to a Republican president, it will get signed into law.”

It’s now “next year” so why not send Trump the same bill? Remember the “Romney killed my wife” ad from 2012? That’s why: the story turned out to be a lie (the wife had health insurance, died in 2006, and Romney hadn’t been involved with the company since before the layoffs) but the ad was devastatingly effective in hardening opposition to Romney among committed Democrats, including the media and the social circles the GOPe reacts to. It’s rocks and hard places for Republicans elected on a promise to repeal Obamacare: they now control the House, the Senate, and the presidency but are desperately afraid to act because the media’s emotional message will be uniformly negative and delivered by helpless minorities, weeping widows, and brave but uncomprehending children whose lives have been ruined by those terrible Republicans and the Nazi in the White House.

So what to do? how do we beat the unbeatable? Here’s a four-step program that will work:

1) Send a full repeal bill — 100% status quo ante as of some date like January 1st, 2018 – to the Senate and force the Democrats to block it.

At the same time, quietly pass the 2016 partial repeal (much of which is replicated in Ryan’s current proposal) to the president for signature.

2) Have every GOP representative and senator use weeping widows and uncomprehending children to repeatedly expose VA abuses and failures (waiting lists, inadequate treatment, excessive paperwork, improper use of resources) in his or her district or state. The VA is much better than nationalized medicine in England or Canada, but is well on its way to developing many of the same problems — and a concerted media campaign to show people what’s going on will force Democrats in every district and every state to defend the indefensible while weakening their ability to deploy the same tactics against Republicans.

At the same time, develop and pass a VA privatization bill clearly distinguishing services for active duty personnel serving outside the United States (which would remain under DOD control) from services for personnel, dependents, and others in the United States — with the latter served through ordinary employer group coverage. Ensure that members have cash incentives to minimize utilization and the power to direct DOD healthcare dollars to the providers of their choice.

3) Develop and pass a new health care act including hot button issues like tort reform, interstate access, and tax equalization through deductibility from income (but not through grants or credits) for private and employer plans, but largely focussed on the creation of a federally funded reinsurance program.

Under this program, the secretary of Health and Human Services would choose, every three years, at least two reinsurance carriers each represented in at least 40 states, to administer programs, open to all healthcare insurance providers operating in the country, designed to limit carrier exposure to catastrophic risks affecting their customers. Buy down limits, thresholds, and the carrier share of the cost, would be set in the initial legislation and amended (or automatically continued if not amended) by Congress prior to carrier selection every third year.

The point of this is that it uses limited federal funding to move health catastrophe insurance significantly down market and thus opens new markets to the industry without creating an entirely new set of perverse incentives driving costs up and performance down, without creating a new federal administrative bureaucracy, and without creating a highly visible public entitlement.

Note that this approach meets President Trump’s commitment to making coverage available to almost everyone while supporting the conservative view that people should take responsibility for meeting their own needs.

4) Have Tom Price work with all fifty governors to develop a general framework for the administration and development of both Medicaid and Medicare in light of the other changes taking place in the federal role in health care funding. Divide this effort into two: in one of which every governor regardless of party (and every state representative or senator the governor involves) gets significant local air-time; and one in which state level experts get the work done.

Basically, it’s obvious that Medicaid and Medicare have to evolve into a single program with Democrats trying to push toward nationalized healthcare, Republicans generally sitting with their thumbs in uncomfortable places, states rights advocates foaming, and no one either ready or willing to bell the cat — so lets take a couple of years, hang it all out in public as elections 2018 fodder, and let the combination of VA privatization and partially federally funded reinsurance for carriers selling cheap catastrophic health insurance show people what the right answer might really be. 



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