Trump Concedes Health Law Overhaul Is ‘Unbelievably Complex’
nytimes.com
nytimes.com
1) eliminates unnecessary middlemen, the private insurance companies, saving beaucoup dollars [we all love our insurance companies, don't we?]
2) solves the biggest problem the VA system currently has, namely, determining who has VA coverage.
"The VA: Another reason for single payer":
http://www.pnhp.org/the-va-another-reason-for-single-payer
Furthermore, he could bring in Bernie Sanders to implement it (second article below) since Sanders is fully up-to-speed on this topic.
"VA: Do we awfulize, or do we fix it? Chairman Sanders Lays Out Legislative Action Plan for Veterans":
http://www.pnhp.org/news/2014/june/va-do-we-awfulize-or-do-w...
Sure, I'd like to see that plan regardless of who proposed it, but aside from speculation about Trump's own actual preferences and goals (which obviously play a role in what he would support), I'm not sure embracing the epitome of what Republicans have attacked as socialism would do anything but lose him support (and not just on this issue) within his own party, without buying him any support (except maybe on that one issue) from the opposing party.
It would probably be a good way to Republicans in Congress on board with investigating the Russia issue, with an eye toward President Pence.
1) eliminates unnecessary middlemen, the private insurance
companies, saving beaucoup dollars [we all love our
insurance companies, don't we?]
The fact that people still believe that both the VA and the USPS are prime examples of government gone _wrong_ should tell you everything about how well a national single-payer system would work out. Even if it was a success by the numbers, it would never be a political success. The political costs would be tremendous and perpetual.
Look at Social Security. Most conservative voters think it's a broken system, even though by the numbers it's one of the most successful and well-run programs anywhere in the world, public or private.
The baby boomer gap is easily fixed by adjusting the age of retirement, which was precisely how the system was designed to operate from the very beginning. But in the present political climate politicians 1) avoid proper maintenance while 2) simultaneously blaming "government" for the prospective short fall purely of their own creation.
The only politically viable single-payer system would be state based. There's no European Union-wide single-payer system, either.
Funding it, though, raises all sorts of problems. It's difficult for states to fund such a system independently because the Federal government soaks up so many tax dollars to spend on the military and pre-existing health programs. It's extremely difficult as a political matter to both devolve powers _and_ the requisite tax dollars back to the states. At the same time, improving the function and efficiency of federal programs is difficult given a ruling party which actively tries to sabotage those programs, even though they're politically _unable_ even among themselves to make the hard decisions that make the alternative--devolution--feasible.
(This is why there was a bus with "£350 million per week" written on the side in the referendum: the NHS is really popular, and it's easy to blame outsiders).
In principle, the NHS covers me when I'm anywhere in the EU, by paying for local treatment. In practice, it's not identical quality treatment, and there are edge cases.
I suspect that the NHS will disintegrate under the pressure of Brexit, but on e other hand I'm extremely pessimistic about the whole thing and half the country thinks it will be great.
While technically true, in the US, when people say "single payer" they usually mean the system Canada has, which is quite different from the UK.
In Canada, doctors are still private. They merely get compensated by the government (by billing them).
In the UK, doctors are public employees. Doctors don't bill the government for a procedure. They just get paid a salary.
I honestly don't know how the finances of different parts of the NHS are run (Hospitals, Primary Care Trusts, it's just jargon to me), has it ever been closer to the Canadian system than it is now?
I think that's purely for historical reasons, though. There's no EU-wide military either.
Government usually tries to limit its spending (because it already is indebted beyond reason) thus using its effective monopoly to force lower and lower prices of all drugs and medical procedures. At the same time the voters pressure (every government wants to be re-elected) forces it to provide reasonable quality of service in healthcare. At least that's how it works in most of EU.
Private insurers want to maximize profits, so they charge a lot of money for their policies, while lowering overall quality of healthcare (by denying insurance to low income, high risk clients - and healthcare quality for not insured is tragic).
P.S. Social Security is a flawed analogy, inner workings of Social Security and Healthcare are totaly different.
At least that's how it works in most of EU.
The US has _always_ been strongly deferential to corporate interests. It's the thing that stood out to me the most when I read the excellent book, "There is Power in a Union", a history of the American labor movement from the early 19th century to the mid 20th century. Even at the apex of the union movement--and thus the apex of a national collectivist mentality--the U.S. government and population both heavily favored corporate interests. That's not a value judgment or criticism, it's just the cold historic reality.
I don't think Social Security is a flawed analogy at all. The core issue of viability isn't about the technical machinations of health care vs retirement income; it's about the politics of not only creating a national program, but _maintaining_ that program in earnest over the long-haul. And specifically the politics in the United States.
Something like Social Security is the best we can hope for in terms of pervasiveness and stability. Social Security has survived precisely because it falls far short of the kind of a strong collectivist, redistributive commitment the country would need to make to enact and _sustain_ a single-payer program. In objective terms both Canada's and Japan's healthcare systems strike a decent balance between public and corporate interests, and Obamacare is tantalizingly close to them on the public/private spectrum.
But I think American progressives don't appreciate how deep, strong, pervasive and _persistent_ are the conservative currents in American political culture. When progressives complain about the poor and working class voting against their own self-interest, they don't appreciate how consistent this behavior has been over the centuries. Without appreciating that, they are miscalculating the viability of their preferred options.
If you examine American political history both over the long term (centuries) and short-term (decades), Obamacare was the best we could ever hope for, and even that was probably too much. And any progressive who thinks Obamacare is hopelessly flawed--because of unnecessary costs sustaining the superfluous private layers--should realize that the _only_ viable alternative is to refocus on state-based solutions.
Let's imagine that Bernie Sanders won the presidency. No way in heck would he be able to champion a single-payer system. The nation didn't just elect President Trump, they gave conservatives a huge majority in _both_ Houses. So, again, the best progressives could have hoped for was tweaking Obamacare and keeping it fiscally viable. The rise of conservatism isn't going anyway any time soon; it's actually a regression to the mean for American politics. People need to keep that in mind, and stop with the wishful thinking.
If only that would happen. Colorado had a ballot measure last year that was soundly defeated (nearly 80% NO votes). This is in a state that went for Hillary, voted to increase minimum wage and also legalized pot a few years ago.
Healthcare and health insurance have become so politicized and toxic that most people's immediate reaction is NO! to any changes or even suggestions.
hmm, but wha-
> Furthermore, he could bring in Bernie Sanders to implement it
uh... yeah, the Republicans aren't going to go for that. The President doesn't get to adopt the role of dictator for four years (as much as many would wish they do), and there is zero chance Republicans would go for this.
Right now many Republicans are tolerating Trump's antics because they see him as a means to implement the legislation they've wanted for the last eight years. If that turns out to not be true they'll kick him to the curb.
You don't want to be treated under a system like the VA. It is not a model.
It's just such a strange thing to say.
a) don't have to worry about costs
b) have someone arrange it for them
Primarily it shows that for all the bluster about Trump standing up for the "common man", he has absolutely no idea how the common man lives.
The issue at hand is that Trump is either willfully or unknowingly ignoring that he and his people are the ones who actively prevented us from having a better system. And the only reason why they're only now acknowledging it's a hard problem, is that now they're the ones who have to fix it.
In my experience, especially in complicated situations people really crave for simple solutions.
The essence of the success of populist politicians is to say there are simple solutions for all problems. No hard choices are needed.
We can have it all.
It's worse than even that.
We all knew it was complex. He said it wasn't. But had no clue.
It's like he left them a 6th grade level puzzle, knowing the bucket of 3rd grade idiots won't be able to solve it, and hopefully they'll be stuck banging it against their heads until they get voted out of office..