Why can’t we get from here to there?  Today we have access to GPS to guide us anywhere we wish to go.  Just walking around dodging people glued to their smartphones is indicative there is hardly anyone without GPS.  All you need to do is tell your phone where you want to go and it gives you turn by turn directions.  There’s just one rub, you must have a destination. Even something as wonderful as GPS is useless without a clear end point. This the failure of our present health care plans, whether it’s the ACA or the new Republican  AHCA.  Where exactly do you want to go? Is it universal coverage? We have that already.  The Emergency Medical Treatment and Active Labor Act in 1986 established anyone showing up at an emergency room needing medical care must receive it whether or not they could pay. From that point on we’ve had universal care, just the most expensive and least effective system possible.  Treating a cold at an emergency room is incredibly expensive, but waiting for something to become an emergency situation can be far worse. Without government total reimbursement, we have providers shifting costs to those who actually have insurance.  Up goes everyone’s premiums. This unfunded mandate has resulted in cost distortions without improving the overall access to health care. The first thing then, we have agree we have universal care but we have to make it effective care on a cost-effective basis. Emergency rooms just aren’t going to turn people away and someone will pay.

So how do we do we get to the right  Universal Coverage ? Some favor the Government solution. We’ll call it the Washington resolution.  Government either is the provider of all health care or  the sole payer for services. In the first instance think of the VA. Providers all work for the Government in buildings owned and equipped by government. In the second providers are paid for services by the government at prices it determines. Think medicare. Both are top down operations ,with Elites getting together to decide what’s offered at what price. History has taught us, no matter how smart the people running things are they rarely get it right. If this wasn’t true the Soviet Union would’ve won the cold war. Instead it crashed. Without market pricing to regulate supply, we can’t obtain market clearing prices. Too little capacity and we have shortages leading to long waits. Too much and we empty spaces and under utilized  resources. We in Phoenix are well aware of just how deadly long waiting times can be with the VA horrors.  The right to health care is meaningless unless it is given in a timely, professional and up to date fashion. The people who died waiting at the VA had “affordable”coverage.”  Didn’t do them much good.  Venezuelans have “coverage” but no medicine. Equal suffering doesn’t equate with actual care and we shouldn’t confuse the terms. Medicare and Medicaid offer “coverage” to an ever-increasing number of people, at the same time an ever decreasing number of people are offering to service them. Now we want to add more people? What could possibly go wrong?  Yet, those advocating the top down Government solution such as Bernie Sanders roar, “Medicare for all.” Never mind Medicare will exhaust its reserves in 2028 or sooner if we have a solid recession or two in the meantime. However, with all its problems the Government solution is popular the world over. Most of our NATO allies have gone this route. Europeans since World War II have really taken to entitlements no matter how uneconomic.  Maybe that’s why they can’t spend even 2% of their GDP for their own defense. It isn’t only other countries, our current President, a longtime single payer admirer, just lauded Australia’s Government centered system. It’s easy to see why. Initially it’s  simple to understand and use. You need medical care, just give them your medicare card. You paid something in and you’re entitled to care. Well maybe you didn’t and aren’t. According to Politifact in 2014:

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Politics:

It’s been really hard to comment on the Trump administration. Whatever you thought Trump stood for yesterday is the opposite today.  Put a thought on paper about a Trump policy, turn on the TV and  find he’s now 180 degrees from where he was when you started writing. Not that we find this surprising. We warned everyone last November in our Election Recap post, if Trump adopted  the Republican establishment program he ran the risk of losing his clout.  His first act, the Travel Ban, was a disaster but at least kept faith with his most ardent followers.  However, health care was another thing entirely. Trump had promised “Repeal & Replace” Obama’s Affordable Care Act (ACA) and then outsourced the legislation to Paul Ryan and the Republican House leadership.  Six years in the making and their bill was so poorly conceived it garnered only 17% approval. Trump not only wasn’t aware of  the legislation’s multitude of failings but ordered his chief strategist, Steve Bannon, to demand the most conservative members of Congress, the Freedom Caucus, to fall in line and support the bill or else.  The Caucus at least realized the bill as written was unacceptable to everybody.  In fact, the Bill’s only saving grace for Republicans was it cut Medicaid enough to facilitate their Tax Cut Bill.  The Trump pressure expressed through Bannon,was horribly misplaced.  The only special power Trump has over some Republicans is the threat to primary opponents. This can only be done by running candidate further to the right against the offending incumbent. How do you get to the right of the freedom caucus?  With no running room on the right, the Administration could only belatedly give ground to the Freedom Caucus, but this lost moderate votes.  By not knowing where his power emanated from and how to use it, Trump saw the bill pulled with egg on everyone’s face. Bannon was blamed and now the Troika of Ivanka Trump, Jared Kushner and Gary Cohn appear to giving direction to the administration. All three are Democrats.

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