Guest Post by Scott Adams
People accuse me of imagining that everything President Trump does is brilliant (persuasion-wise) no matter what he does. But I expect the next version of the Republican healthcare bill to be a complete failure. That’s because Republicans seem deeply committed to a losing path, thanks to what might be called the Contrast Problem.
Contrast is the driving principle behind all decisions. You have to know how your options differ, and by how much, or else you have no basis for a decision. President Obama solved for the contrast problem by designing Obamacare to cover more people than before. The rest of the details – especially the costs – were hard to predict, so our brains flushed that noise and focused on the greater number of people covered.
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Everyone knew Obamacare would need future tuning to get it right. That gave us mental permission to focus on the good parts we understood – the greater coverage – and hope the other details would get worked out later. President Obama nailed the Contrast Problem like the Master Persuader he is.
That was then.
Now, President Trump and the Republicans have the “going second” problem. The public will compare their proposed bill with Obamacare and conclude that the one metric they understand – the number of people covered – does not compare favorably with Obamacare. The contrast is fatal.
We know Paul Ryan will do his wonkish best to tell us about all the amazing advantages of this new bill. And we know the public won’t understand any of it. But they sure will know it doesn’t cover as many people. Done. Bury it.
During the campaign, candidate Trump made some references to taking care of everyone. It sounded like universal coverage, but no one thought he meant it.
He did mean it.
He meant it because he understands the contrast problem. Any Obamacare replacement needs to cover more people than Obamacare, or else it is dead on arrival. Any skilled persuader would see that.
Paul Ryan doesn’t see the Contrast Problem as important, evidently.
I think most trained persuaders would agree that the one-and-only path to a successful replacement of Obamacare should include AT A MINIMUM a plan to reach greater coverage. And the only way to get there is by goosing innovation in the healthcare field. We can’t tax our way to full healthcare coverage. We need to lower the costs. And President Trump also needs to solve the Contrast Problem.
To that end, I suggest creating a special low-cost (or free) plan for low income people who are willing to accept a bit more risk. If the plan is robust enough, it could provide a path to greater patient coverage compared to Obamacare and solve the contrast problem. As a mental exercise only, the plan might have the following elements:
1. Online doctors for 90% of routine cases.
2. Require big pharma to provide free meds for people in this plan as a condition of selling in the United States. The low-income people covered would be the ones who would not otherwise buy these drugs, so the companies would only lose the cost of the materials themselves, which is trivial.
3. Recruit and approve special doctors for this plan who are by law exempt from any malpractice suits so long as they provide reasons for their decisions. This would allow them to avoid some red tape and also use new and inexpensive medical technology before full FDA approval – but only for the new stuff that common sense tells the doctors would not be especially dangerous. I’m not talking about pills and internal medicine. I’m talking about medical devices, mostly. It would be up to the doctor to decide when it was safe to risk using the new methods.
4. Patients agree to wear health monitors – the newest prototypes – and to share their medical information (anonymously) for the greater benefit of society. This would allow early detection and treatment. Perhaps the low-cost insurance could be free to those who walk 10,000 steps a day, or something of that nature.
5. Shine a government light on any medical technology or systems improvements that would lower cost, to guarantee that the good ones are known to doctors and investors. (Then stay out of the way.)
This is just a starter concept for what a special low-cost plan (with slightly higher risks) might look like. The main point is that you could cobble together a low-cost plan if you had some government muscle behind it to clear out the useless regulations and to focus energy in the right places.
If President Trump presents us with a healthcare plan that doesn’t cover as many people as Obamacare, but will cover more people eventually, that’s a winning contrast.
Otherwise, the bill will die on the Contrast hill. And that’s the direction we’re heading.
As I’ve said before, America can’t make a strong claim to greatness if we can’t do healthcare right. So let’s do it right. Or at least have a plan to get there.
Adams is right in that a GOP/Trump plan should try to cover more people than are currently covered. More accurately, their plan should allow for more people to purchase insurance at a reasonable cost. I doubt Adams’ solution – online doctors, etc. That’s not ready and may not work. In the meantime, allow catastrophic-only policies and policies with a (high) lifetime cap. McDonald’s got an Obamacare waiver with insurance policies far less generous than those mandated under Obamacare – including a cap ($1 mil?) on payouts. Obamacare went to extremes to protect all people from “bankruptcy”. Hell, half of Americans are de facto bankrupt already, and the other half can afford insurance (which would be a lot cheaper without the hidden taxes and stupid mandates of Obamacare).
Get government out of “healthcare” altogether. They screw up everything they try to administer like this. Open insurance companies to compete across state lines. Allow low-risk people (i.e. healthy/healthy young adults) to forgo full coverage and opt for catastrophic coverage, because that’s pretty much all they will need for a long time, and make people RESPONSIBLE FOR THEIR OWN HEALTH. If you smoke, you pay more. If you’re fat, you pay more. If you drink too much, you pay more. This is not rocket science people.
Another way would be to allow medical practices to allow their patients to participate in a very small, localized type of health insurance. In other words, pay into that medical practice’s “group plan” with a very defined cost accounting and benefit package and a catastrophic national plan to cover the big stuff, cancer, accidents, etc. I would GLADLY pay $300-400 per month to a small group plan than thousands for something I will never use.
And for crying out loud, get the medical community to POST WHAT SHIT COSTS. Everyone else has to do it. It would create competition which of course drives down costs. No one would walk into a grocery store, fill up their cart, and then go to the check out and not have some kind of clue what their bill will be until they get their, and only after some lady behind the check out runs a card seeing what your co pay is for the groceries, it’s ludicrous, leaves way too much room for price gouging and fraud/overbilling, and takes all the power away from the consumer.
I’ll shoot one more time.
Eliminate Medicare, Medicaid, VA (except for injured vets) and all employer based insurances. Government sponsored catastrophic health insurance based on income, for all MEDICALLY NECESSARY services. Routine vision, hearing, dental not covered. Premiums based on AGI minus FPL (Federal Poverty Level deduction). 5% for individual, 6% for couple, 7% for three, 8% for 4, 9% for five, and 10% for 6 or more. Maximum premium $24,000. Out of Pocket maximum 3% of AGI, after which government pays the bill. Government provides no health care. Mandatory physical and lab work annually or loss of coverage. Transparent pricing for physical and lab work, as well as any other routine services. 10% surcharge on premium for destructive behaviors such as drug and alcohol abuse, smoking, obesity(food induced)etc. All employers contribute 2% of payroll toward premiums.
Example: Couple with AGI of $60K would get a $16K deduction for FPL and have a premium income of $44K. Their cost for insurance would be 6% of that or $2640 for year. Their OOP maximum would be $1800($60K at 3%) after which government pays bills for year.
Example: Individual earning $12K per year gets an FPL deduction of $12K so no premium. Individual would have an OOP of $360.
Example: Family of three with AGI of $300K would have a premium charge of 7% on an income of $278K for a cost of $19460. Maximum OOP would be $9000. No reason why employers can’t offer premium coverage as part of compensation if they want.
There would be no more pre-existings, no caps, etc. Government gets to negotiate its costs for services and medicine.
None of it matters. None of the ‘plans’ matter.
Health care costs too much – by at least a factor of 2. Why would going to the ER for a cut finger (my only trip to the ER ever) cost $1200. Christ – I didn’t even get a blow job from the nurse. Should be able to get something for your money. How can a 1/2 hr of a Doc’s time be worth $1200 – that $2400 an hour – $2400 / 60 = $40 a minute! Yeah we have to pay the overhead for a hospital that’s built like a palace. How can you lower the price, when there’s all these fixed costs?
I’ve never seen the price of anything go down – except for 8 Track Tapes and old DVD’s.
Prices have gone down tremendously for many things. Just not healthcare, education, housing, taxes or cars(?).
yeah, prices have come down for many things… all of them from china
Why would you go to the ER for a simple cut finger?
If you must have medical treatment -a wimp that can’t just sew himself up or something- why not go to an Urgent Care or walk in clinic instead of the emergency room?
A cut finger, assuming it is still attached, is not what I would consider an emergency if it happened to me and I’ve had more than a few serious cuts I either sewed up or super glued myself without visiting one.
Innovation is probably dead in medicine, because the entire field’s probably already covered.
Suppose you invent a new medicine to treat XXX. In the 1880’s, you could bottle and sell it yourself, locally at first and nationwide if your stuff was good (and sometimes if it wasn’t, buyer beware).
Nowadays the FDA would lock you in jail for trying, no doctor would prescribe it for fear of AMA retaliation, and anyone who made something to treat the same disease would sue you for “patent infringement”, which a small concern cannot defend effectively against (the lawyers, they are not cheap). So unless you have a “sponsor” (who is already in the business) you have no chance to penetrate the market.
Unfortunately, Scott (for all he is a Mensa member) does not know everything about everything. Nice try, though.
Let me shorten this down some: “Why the New Healthcare Bill Will Be a Loser”? Because government has no authority to meddle with the healthcare system. nuff said.
Brian-Oh, but they did/are and the IRS jackboots are the enforcers. Too late to say .gov should not be in the business. Now, how do we get them out of healthcare and convict the cabal that is the Medical Industrial Complex?
Scorecard so far:
Goy/sheep – 0
Trump- 0
CONgress- 0
Medical Cabal/ Insurance Co’s- “WINNING”
BL, When you see the government overstepping their “traditional” authorities and the IRS is involved, this means the federal reserve is the root of their “authority”.
It is assumed you are dealing in bank credit as your income sources and therefore they now have authority to manage your personal money supply to ZERO.
Central planning can never work as well as the free market. All attempts to “fix” government management of health care are doomed. Of course the one true fix is the one thing they won’t do – exit entirely and let the free market take over.
“People accuse me of imagining that everything President Trump does is brilliant”
Not me, Scott. I accuse you of being a mongoloid libtard cocksucker who created one of the dumbest cartoon series in history. Defend yourself against that accusation before you go any further.
So, I’m guessing there is a strong possibility that you are a pointy-haired boss. But, how do you really feel about Dilbert. Don’t hold back.
It will be a failure because NEITHER major political party knows the first things about economics, human action, or free markets, and more importantly, NEITHER supports or cares about FREEDOM or LIBERTY or FREE MARKETS anymore (if they ever did). GOVERNMENT destroyed the medical system in this country both through meddling and direct collusion with the AMA, the insurance industry, and bigPharm. MORE GOVERNMENT most certainly isn’t going to fix what ONLY market forces and FREEDOM can fix.
The point of the Federal Government being involved in healthcare has nothing to do with fixing anything. That’s just an excuse. It’s all about skimming money. The second that a third party payer is involved, especially a government, the opportunity to skim money or direct revenue to a connected group exists.
The primary point is the real winner in this article – the Obamacare replacement has to cover more people than Obamacare. This time I think Adams is dead on. It appears that most of the commenters here missed that point. Summing up, if Congress doesn’t replace Obamacare, they will double down on Obamacare. Everything that is hated about Obamacare will be made at least twice as bad. So the Repubs need to suck it up and at least start the process by getting some part of Obamacare undone. Do something that can be built upon later (in a good way).
You are conceding ground to the enemy without a battle!
WHY should healthcare be a “basic human right”? Didn’t we outlaw slavery some time back? If so, why are you making me a slave to some unemployed immigrant by making me pay for his healthcare?
We need a whole Congress who has been beaten with a stick to the mantra “It’s not YOUR MONEY. It’s TAX money, and every cent must be spent wisely, without taking any more than the minimum necessary to fund the mandatory roles of government!” Keep beating until they agree.
Oh well, it was good while it lasted – time to prepare some more.