Republicans could win in November if they gave Americans universal health insurance?

In September 2009, I wrote “Health Care Reform”. Essentially the government would take the $trillions being spent on Medicare and Medicaid and put it into buying every American a reasonably good HMO policy.

  • each resident will be given a voucher good for signing up at the clinic or HMO of his or her choice; the amount of the voucher will depend on the resident’s age and sex (the weighted average of all vouchers will equal $2,000 or whatever we’ve decided we want to spend)
  • a clinic or HMO that wishes to get any revenue from the federal government will be required to take any person who submits a voucher, regardless of preexisting conditions
  • a resident of the U.S. can switch clinics annually, let’s say on May 1.
  • the clinic is responsible to pay for the resident’s emergency medical care at another facility

A note:

One likely side effect of this reform is the return to centrality of the primary care physician. Joe Medicare Patient often does not have any doctor who understands much less coordinates his care. If Joe has seen six specialists, he may be on drugs that are working at cross purposes. If Joe is in the ICU at a typical hospital, the multiple doctors treating him may never talk to each other. Each one knows what tests and procedures he or she has ordered, but, except by looking at the patient’s chart, has no idea what the other doctors are investigating. One primary care doctor who reviewed this proposal said “The first item I address with new patients in my office is to try to get them off as many drugs as possible; when a 70-year-old is on 11 meds you better believe there are many unintended interactions.”

How has this aged and what would be different during coronaplague?

Americans want, most of all, for the Great Father in Washington to love them. “Trump, like Herbert Hoover, is ‘the man who doesn’t care.’ Biden can make that stick.” (USA Today, June 28):

Most of all, Trump is the man who doesn’t care. He doesn’t feel your pain. He doesn’t mourn the dead, comfort the grieving, or support the struggling. He doesn’t consider his words or worry that they could have consequences. He doesn’t listen to experts or ponder his options.

Congress is almost finished with its “work” for this session. If the Republicans want to win in November, why not make Americans feel that the they are loved and cared for? We don’t care about money anymore, right? We are happy to spend 100 percent of our accumulated wealth hiding from coronaplague if that is what it takes to cut the death toll slightly. We are happy to print and borrow trillions. A universal HMO policy for every resident of the U.S. wouldn’t have to cost any more than the current bleeding for Medicaid and Medicare plus whatever employers pay for mid-range coverage.

Will anyone, other than folks in the industry, miss the current system? A couple of recent news items:

At least to judge by my Facebook feed, Americans are convinced that, despite the lack of any effective therapy for Covid-19 and despite the fact that the Feds pick up the tab when the uninsured are treated for Covid-19, universal health insurance would hugely cut the number of Covid-19 deaths.

Readers: What do you think? Could Trump and the Republicans take most of the wind out of the Democrats’ sails with one big health care hand-out? (of course, all of the money for this would just come from taxpayers themselves, but somehow Americans never seem to consider that they will ultimately have to work for whatever the government “gives’ them)

Bonus pictures of the house that Medicaid and Medicare built, in Nome, Alaska, from September 2019. This single building is likely worth more than all of the rest of the houses and commercial real estate in the city.


16 thoughts on “Republicans could win in November if they gave Americans universal health insurance?

    • Toucan: My righteous friends might be incorrect that “universal health insurance would hugely cut the number of Covid-19 deaths”, but it doesn’t matter if they’re right or wrong factually, does it? They aren’t going to change their beliefs and their beliefs could influence whether they vote (not “how they vote” since they’ve already said that Biden could be a convicted rapist and they would still vote Democrat, but maybe they would be less likely to turn out if Trump were actually giving them what they are demanding!).

  1. Nome Alaska barely has 4000 people – does Nome Alaska really need such a huge hospital? Are there even enough doctors and nurses to staff the Hospital? Seems bananas.

  2. What you should do is take the original Health Care Reform post, update it for 2020 section by section, and then enlist a small army of friends to email it and also send a snail mail copy to every Republican legislator in Washington and at the State level. You should also set up a new website – not a blog! – devoted exclusively to that single article.

    Set up a nonprofit devoted to maintaining the website and establish a presence on Facebook, Twitter, Instagram, etc., and issue press releases and bulletins.

    Most of your ideas were great in 2009, but they need to be refreshed and you need to amplify the urgency and get a lot more people talking about them. The biggest problem isn’t the quality of your ideas, either in this post or the 2009 article: it’s that you’re going to have a lot of enemies, based on the other content on this weblog, unfortunately.

    The domain is available. You need to generate interest and buzz, and get people talking about it. I wonder if you would consider it worth your time and effort to really take your own ideas seriously enough to spend a full year seeing if you can make a dent in the monstrosity we’re currently bankrupting our country with.

    • I’d like to note something here: sure, if you pick it apart, some of the ideas and analysis from the 2009 post will turn out to be wrong in 2020, some will need to be updated. But I can’t think of anyone “big and important” i.e., Bill Gates echelon, who put as much thought into it as you have. It’s like your post on the economy from all those years ago.

      It’s clear that your blog by itself is an inadequate vehicle to turn your ideas into action.

    • Alex: Agree about the the blog. I would suggest PhilG needs to consider a run for (initially) a Maskachusett’s State Senator Seat, and then US Senator.

    • @PaulB: I’ve suggested it before as have others, but he’d have tremendous opposition. It’s a sad measure of the times we live in that people who challenge orthodox thinking are canceled, have their names dragged through the mud, with their livelihoods and families threatened by mob rule, particularly in a one-party state like Massachusetts. He’s probably the most defriended Ph.D. on Facebook, and if he ran, the political establishment here would make him look like a monster.

      To show you the totality of one-party rule in MA, just a few days ago, Helen Brady finally prevailed in her case to remain on the ballot against a five-term (D) Rep. incumbent, after fighting all the way to the Supreme Judicial Court. William Galvin, the Secretary of State (who has held that position for more than 25 years himself) threw her electronically-collected ballot eligibility signatures out. The Court reinstated them. She was the only candidate who received that treatment.

      This is just to get a name on the ballot so that a five-term incumbent wouldn’t be running completely unopposed! He’s still greatly favored to win, but now at least he’ll have to put up some kind of token campaign effort for the privilege.

      “Her attorney, Christopher Kenney, had argued that blocking her from the ballot on the technical point would have violated her equal protection constitutional rights, noting that 39 other candidates — including several who qualified for the ballot — used the same company to collect signatures but did not face any consequences because their eligibility was not challenged.”

      Read the rest of the article to scratch the surface of the totalitarianism here.

      Back in April, this woman tried began her effort to get on the ballot in Ayanna Pressley’s district. She would probably have been a big underdog in the general election, but that wasn’t enough. She lost her case before the SJC. They ruled that although COVID-19 probably did hinder her efforts to collect signatures in her district, this time that hardship wasn’t severe enough for her Black Life to Matter and she lost the case.

    • I colloquially refer to one-party rule in MA as the “Fire Suppression System.” Any time an “unapproved” candidate challenges a Democrat in this state, the tiny spark of support triggers the machine’s extensive firefighting apparatus, which swings into action with a five-alarm call and the HALON. Even though the EPA banned Halon in 1994, Massachusetts made sure it was grandfathered into their candidate suppression system. Put that spark out before it has the chance to start a grassroots fire.

      That was true well before cancel culture really got rolling in the past few years. Nowadays, the Cancel Witch Burning system has been added to “preburn” candidates before the FPS gets called. First the unapproved candidate has to stand in a tank out in the middle of a big field, up to their waist in gasoline, and light a match. After the fire burns out — and if they survive — they are charged with arson and attempted suicide. *Then* the fire suppression apparatus descends on their candidacy to extinguish any remaining sparks.

      The results are clear. Massachusetts is a very safe state, based on the composition of the Massachusetts legislature:

      MA Senate: 36 (D), 4 (R)
      MA House: 126 (D), 31 (R), 2 (I)

    • Alex,

      The MA legislature composition may be skewed a bit by various shenanigans, but just a little bit.

      My subjective sense, based on numerous acquaintances and colleagues mood and convictions, school experience in MA as a parent, etc., is that the MA legislature composition reflects correctly electorate wishes.

      Republicans simply cannot offer any compelling and exciting alternative to the progressive vision, they are the boring and racist past, the progressives are the present and the bright diverse future, let’s admit it. The progressive future may very well be of the Venezuela or Bolshevik variety, or worse, but that’s what people want without realizing what the path they are on can lead to. Vox populi, vox Dei.

    • @Ivan: I know, I hear people talk about it all the time, and we have lit the fuse on the bomb that nobody has ever seen explode in their midst before here, so they are not aware of the dangers.

      I think the United States is in for a big, big crash in the next six months, to be followed by a largely socialist government that is going to preside over a broken nation, with tens of millions of displaced people, ruined lives, and deaths of despair.

      I think the banks are going to collapse, the stock market is going to tank, we’re going to see defaults across the board in every kind of credit market, and 2021 is going to be the worst year in American history. What comes out the other side of that is going to be unrecognizable to anyone who lived in the past 60 years.

      Here in Massachusetts, something like 60 economists (including Jonathan Gruber at MIT, the Obamacare architect) signed a letter to the Governor expressing the preference that MA raise taxes on businesses rather than consider any cuts to government funding in any area. That was something like a month ago, when MA’s coronavirus cases were dropping, and it looked like the rest to US was opening up and we might actually make it through the year without a total economic disaster unfolding. It looks now that the situation in Q3 and Q4 of this year are going to be much, much worse than was expected. We are going to crash the economy into the wall again, and probably a third time. There isn’t going to be anything left to tax before it’s over. We’re going to see things that were simply unthinkable in this country.

    • Here’s the economists’ letter from May 26th. Their advice was to raise the personal income and business taxes!

      “Both the personal income tax and the corporate tax are fair ways to do this, since they fall only on persons with incomes and businesses with profits.”

      Good luck in the coming year to anyone who expects to have an income or a business that makes a profit….A one percentage point increase in the income tax could raise $2.5 billion per year while a one percentage point increase in the corporate tax rate could raise $180 million per year, even if the income tax base falls by 25% and the corporate tax base falls by 50% during this recession. These tax rates could be phased back as the economy
      returns to its pre-recession level.

      Look at what they’re really forecasting: a 50% drop in the corporate tax base. They’re talking about half the businesses in the state going belly-up, but raise taxes anyway! Government jobs must be preserved! I don’t know what that is except Venezuela.

  3. The Answer is to return to the “Hippocratic Oath”.
    Doctors and facilities first treat, all.
    Then route them by the cash register for payment determination.
    Dirt simple. All doctors are required to perform charity work. Folks with insurance or money can visit a ’boutique private facility’.
    ALL Doctors are require to put in minimally 20 hours per week
    on charity needs.

    Big tax breaks and other financial incentives for Doctors; this puts DOCTORs BACK IN CHARGE of Medicine, like it was for thousands of years. All Drugs are public patents, after just 7 years. Patented drugs must be (100%) manufactured in the USA to keep their patents enforceable.

    Shoot those that profit, excessively, from drug patents, just like illegal drug dealers.

    • That is way too totalitarian. What is that – forced labor? Shootings of those who have “excessive” profit? Soviet Union, take 2.

      Now, there are much simpler things to do:

      1. Remove all patent protection for anything medical. (Better yet, disband USPTO completely and recognize no patents or copyrights whatsoever). This will have an effect of shifting research from pharmas (which will be rightfully relegated to manufacturing and distribution of drugs and medical devices) to the parties which are actually interested in curing illness and prolonging healthy life: the insurance companies. Oh, and because no one will be able to lock in the research discoveries the actual research will become a lot more cooperative and open (and thus reliable).

      2. Remove all restrictions on international drug / medical device shipment and importation. Here’s that notorious 10x price difference between exactly same drugs in Mexico and US goes away. Oh, and disband FTC which enforces this atrocity to save money for taxpayers.

      3. Remove requirement for prescription for most (or, better, all) drugs. Here’s 2x price reduction, right here. Physicians will be unhappy, but will end up spending more time on people who are actually ill enough to require a doctor.

      4. Remove right of medical guilds (such as AMA) to “certify” doctors and thus artificially restrict the supply of medical professionals. Most common illnesses do not require years and years of hard training to diagnose and treat. The first-line medical personnel only need to be trained enough to recognize when the patient should be sent to the fully qualified MD (or emergency room, for that matter).

      5. Expand tax breaks for medical insurance from employer-based to individual plans. Remove the requirement that employers must provide insurance. Allow a lot more flexibility in plans (i.e. catastrophic-only for young and healthy, more comprehensive for older and sicker).

      6. Make medical insurance more like real insurance (rather than socialist wealth redistribution programs): namely, require that ALL loss (i.e. medical consequences) of an illness or trauma being diagnosed or incurred during covered period are fully covered for the entire lifetime by the insurer (so that subsequent insurers could properly exclude pre-existing conditions). The total amount of pay-offs and thus premiums won’t change because of that, but incentives are radically different: insurers will be a lot more interested in prevention, and won’t be interested in dumping people who got ill. Allow lifestyle-based price discrimination. Make INFORMED consent the requirement for any insurance plan offering: most people have no knowledge or time to go through voluminous small print, so their “consent” to insurance terms is not informed at all.

      7. Prohibit bait-and-switch pricing (which is a species of fraud): you should know up-front exactly how much this or that costs, so you and your doctor can make informed price/expected benefit decisions.

      8. Make following industry’s best practices the affirmative defense against medical malpractice claims – and make losers to bear all the legal costs. No more ambulance chasers preying off decent people. No more doctors practicing self-defensive (against lawyers) medicine. The only criterion doctors should have in choice of treatment is patient well-being.

      9. Disband the pharma cartel enforcing agency (aka FDA): it doesn’t actually protect patients (if anyone has illusions about that, read about Vioxx) but is VERY effective in killing off competition. Instead, make executives in pharmaceutical manufacturers criminally liable to damages (up to murder charges) for misrepresenting benefits and dangers or knowingly selling dangerous or ineffective drugs and devices. It should be up to the doctors to choose which drugs and treatments to use based on the public information from manufacturers and guidelines from industry associations and insurers (and their professional education and experience, too!)

      In short: the answer to health care crisis is not more totalitarianism, but less government meddling (for the benefit of politically connected corporate “elite”, as it always goes) and more free market coupled with strong enforcement of laws against fraud and malpractice (instead of prescriptive and very costly regulations).

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